Utility version: 2.2 Run started: 11/17/2020 9:26 AM Location: ST. ELIZABETH EDGEWOOD Payer: HUMANA Ref Date: 11/17/2020 Procedure|Code Type|Code|NDC|Rev Code|Procedure Description|Quantity|Payer|Contract|Plan(s)|IP Price|IP Pricing Detail|IP Expected Reimbursement|IP XR Detail|OP Price|OP Pricing Detail|OP Expected Reimbursement|OP XR Detail 95188422|EAP|Custom 95188422||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Hemostasis Repositionable Duraclip (for Colonoscope)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Meridian #4/14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,976.50|FSC: 13; Default||Not reimbursed separately|9,976.50|FSC: 13; Default||External grouping not supported 95185388|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 5 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95180421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Biocomposite 8mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95115105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Vit Taper 28mm 5-40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95192178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Cannulated Ti 11mm /125 Deg 320mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95180423|EAP|Custom 95180423||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Oral Swab Q4 Petite W Biotene 24 Cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115110|EAP|Custom 95115110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone Artisan Small|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95180424|EAP|Custom 95180424||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Oral Swab Q4 Petite 24 Cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115112|EAP|Custom 95115112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Slighty-curved 9.3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180428|EAP|Custom 95180428||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stay Elastic 20 Mm X 20 Mm 3 Finger 4 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115114|EAP|Custom 95115114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 200gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115115|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115116|EAP|Custom 95115116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill 1.3mm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180430|EAP|Custom 95180430||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Otsc System 12 6gc 165cm|1|HUMANA [1294]||HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95115118|EAP|Custom 95115118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill 1.4mm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180431|EAP|Custom 95180431||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Otsc 165cm|1|HUMANA [1294]||HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95115119|EAP|Custom 95115119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill 1.5mm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180432|EAP|Custom 95180432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115120|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Cv Patch 10.0cmx1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,873.00|FSC: 13; Default||Not reimbursed separately|3,873.00|FSC: 13; Default||External grouping not supported 95180433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 14mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95115121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 2.7x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95180434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 10mm X 130 Degree X 400mm Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95115122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 2.7x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95180435|EAP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Neuromend 12mmidx2.5cm|1|HUMANA [1294]||HUMANA [11839]|5,493.00|FSC: 13; Default||Not reimbursed separately|5,493.00|FSC: 13; Default||External grouping not supported 95115123|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95180436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 26 Mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95115126|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95180437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 Mm X 55 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95115127|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95180438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 Mm X 30 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95115128|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95180439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Bone With Cancellous Chips 300 Express 2.5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95115130|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95180440|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 5.0mm X 3cm|1|HUMANA [1294]||HUMANA [11839]|6,549.00|FSC: 13; Default||Not reimbursed separately|6,549.00|FSC: 13; Default||External grouping not supported 95115131|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95185400|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Power Tl 30cm St Acute Dial Kit 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95115132|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95115137|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter 2s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95115138|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95188417|EAP|Custom 95188417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter Ii Short 10.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115139|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95180441|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7 Fr 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95115140|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95180442|EAP|Custom 95180442||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Retracta Detach Embolization 7fr 14|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95115141|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95180443|EAP|Custom 95180443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Retracta Detach Embolization 7fr 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115143|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 3.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180444|EAP|Custom 95180444||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Retracta Detach Embolization 7fr 10|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95115144|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95115145|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 36.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95115150|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 3.2mm X 300mm Calibra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115151|EAP|Custom 95115151||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Drill Schanz 5.0|1|HUMANA [1294]||HUMANA [11839]|616.05|FSC: 13; Default||Not reimbursed separately|616.05|FSC: 13; Default||External grouping not supported 95185399|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Power Tl 24cm St Acute Dial Kit 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95115152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 5.0mm X 175mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.05|FSC: 13; Default||Not reimbursed separately|616.05|FSC: 13; Default||External grouping not supported 95115153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 5.0mm X 200mm 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.05|FSC: 13; Default||Not reimbursed separately|616.05|FSC: 13; Default||External grouping not supported 95185407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.3 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|FSC: 13; Default||Not reimbursed separately|165.75|FSC: 13; Default||External grouping not supported 95115156|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ball-tip 3.0mm 950mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Connecting Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|788.31|FSC: 13; Default||Not reimbursed separately|788.31|FSC: 13; Default||External grouping not supported 95188418|EAP|Custom 95188418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Clip Otsc Ovesco 220cm 12/6t|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180445|EAP|Custom 95180445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acid Renal Pure 2 Potassium 2.5cal Gallon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115160|EAP|Custom 95115160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 5.0mm Three-fluted Cal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180446|EAP|Custom 95180446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acid Renal Pure 3 Potassium 2.5cal Gallon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115161|EAP|Custom 95115161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 3/4-diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 Stryker 22.2mm Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95115162|EAP|Custom 95115162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 205mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180448|EAP|Custom 95180448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Aspira Drainage Pleural 1000ml 5 Ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115163|EAP|Custom 95115163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Adjustable 4.0mm X 4.0mm T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180449|EAP|Custom 95180449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Aspira|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95180450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Arthrodesis Hindfoot Ti Ex 10 Mmx240mm Lt St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,813.83|FSC: 13; Default||Not reimbursed separately|4,813.83|FSC: 13; Default||External grouping not supported 95115166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95180451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Nail Arthrodesis Hindfoot Spiral Bld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.40|FSC: 13; Default||Not reimbursed separately|680.40|FSC: 13; Default||External grouping not supported 95115167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 11mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95180452|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Unify Assura Bi V Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|FSC: 13; Default||Not reimbursed separately|60,912.00|FSC: 13; Default||External grouping not supported 95115168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95180453|EAP|Custom 95180453||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr Wide 10x22x55mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95115169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 13mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.55|FSC: 13; Default||Not reimbursed separately|224.55|FSC: 13; Default||External grouping not supported 95185382|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 4 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95115171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|FSC: 13; Default||Not reimbursed separately|242.91|FSC: 13; Default||External grouping not supported 95192181|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 8.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|235.83|FSC: 13; Default||Not reimbursed separately|235.83|FSC: 13; Default||External grouping not supported 95115173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95185390|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 6 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95115175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|FSC: 13; Default||Not reimbursed separately|242.91|FSC: 13; Default||External grouping not supported 95188420|EAP|Custom 95188420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Endoscopic Amplif Eye Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 11mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|FSC: 13; Default||Not reimbursed separately|242.91|FSC: 13; Default||External grouping not supported 95115177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95185387|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 5 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 13mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95115179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95115180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95115181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95185412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Pin Tracker System 2mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95115182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95115183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 62064551|EAP|CPT® 84182||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Protein, Wb, Probe Band Id, Csf -ref Lab|1|HUMANA [1294]||HUMANA [11839]|87.63|FSC: 13; Default||Not reimbursed separately|87.63|FSC: 13; Default||External grouping not supported 95115184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 13mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95115185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95185392|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 6 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95192182|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 9.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95185396|EAP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Optisure Defibrillation 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95115190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 13mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.4mm14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95188423|EAP|Custom 95188423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tratner 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.4mm18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95185395|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 7 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95115197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|FSC: 13; Default||Not reimbursed separately|207.90|FSC: 13; Default||External grouping not supported 95185413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Pin Tracker System 2mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95115198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|FSC: 13; Default||Not reimbursed separately|166.38|FSC: 13; Default||External grouping not supported 95115199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95192183|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 9.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95115201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95185401|EAP|Custom 95185401||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Plus Allograft 10cc|1|HUMANA [1294]||HUMANA [11839]|6,103.50|FSC: 13; Default||Not reimbursed separately|6,103.50|FSC: 13; Default||External grouping not supported 95115202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 11mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95115203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95115204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 13mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95115205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95185397|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Power Tl 15cm St Acute Dial Kit 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95115206|EAP|Custom 95115206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 12mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115207|EAP|Custom 95115207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 14mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115209|EAP|Custom 95115209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 20mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115210|EAP|Custom 95115210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 22mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185391|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 6 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115211|EAP|Custom 95115211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 24mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115212|EAP|Custom 95115212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 26mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192184|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 10.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115213|EAP|Custom 95115213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 28mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115214|EAP|Custom 95115214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 30mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185383|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 4 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95115216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.3mm X 23mm 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95188430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95115217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.3mm X 47mm 12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 95115218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Extended H 1.3mm 19mm 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95185381|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 4 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Extended H 1.3mm 19mm 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95115220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.3mm X 35mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.75|FSC: 13; Default||Not reimbursed separately|738.75|FSC: 13; Default||External grouping not supported 95115221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.3mm X 35mm 4 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95185408|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Octrode Trial Kit 60cm Length|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95115222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 1.3mm X 37mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.75|FSC: 13; Default||Not reimbursed separately|738.75|FSC: 13; Default||External grouping not supported 95188432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95115225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Condylar 2.0mm Pin Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.98|FSC: 13; Default||Not reimbursed separately|673.98|FSC: 13; Default||External grouping not supported 95185406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.3 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|FSC: 13; Default||Not reimbursed separately|165.75|FSC: 13; Default||External grouping not supported 95115226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Condylar 2.0mm Pin Ri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|FSC: 13; Default||Not reimbursed separately|516.00|FSC: 13; Default||External grouping not supported 95192185|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 10.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.5mm X 29mm 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|FSC: 13; Default||Not reimbursed separately|583.20|FSC: 13; Default||External grouping not supported 95115228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Ti 1.5mm 59mm 12-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|775.17|FSC: 13; Default||Not reimbursed separately|775.17|FSC: 13; Default||External grouping not supported 95180454|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Forte 14f 16f 35cm 6 Bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.5mm X 44mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.75|FSC: 13; Default||Not reimbursed separately|738.75|FSC: 13; Default||External grouping not supported 95180455|EAP|Custom 95180455||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Loop T Lif 6 X 32.5mm X 6 Degrees|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95115230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.5mm X 44mm 4 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95185403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mm X L46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95115231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Extended H 1.5mm 22mm 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95115232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Extended H 1.5mm 22mm 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95115233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 1.5mm X 46mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.75|FSC: 13; Default||Not reimbursed separately|738.75|FSC: 13; Default||External grouping not supported 95115234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 2.0mm X 35mm 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|701.04|FSC: 13; Default||Not reimbursed separately|701.04|FSC: 13; Default||External grouping not supported 95115235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 2.0mm X 71mm 12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.93|FSC: 13; Default||Not reimbursed separately|837.93|FSC: 13; Default||External grouping not supported 95115236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm X 53mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.93|FSC: 13; Default||Not reimbursed separately|837.93|FSC: 13; Default||External grouping not supported 95115237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 2.4mm X 36mm 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95188434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 44 16mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95115238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 2.4mm X 72mm 12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.33|FSC: 13; Default||Not reimbursed separately|906.33|FSC: 13; Default||External grouping not supported 95185389|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 6 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.4mm X 54mm 2 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.48|FSC: 13; Default||Not reimbursed separately|861.48|FSC: 13; Default||External grouping not supported 95115240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.4mm X 54mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|920.52|FSC: 13; Default||Not reimbursed separately|920.52|FSC: 13; Default||External grouping not supported 95115241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 2.4mm X 56mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|889.83|FSC: 13; Default||Not reimbursed separately|889.83|FSC: 13; Default||External grouping not supported 95185393|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 7 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 2.4mm X 57mm 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.48|FSC: 13; Default||Not reimbursed separately|1,005.48|FSC: 13; Default||External grouping not supported 95188429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 10mm/130 Left 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95115243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 2.4mm X 57mm 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.48|FSC: 13; Default||Not reimbursed separately|1,005.48|FSC: 13; Default||External grouping not supported 95115244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.4mm 31mm 4 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.57|FSC: 13; Default||Not reimbursed separately|1,071.57|FSC: 13; Default||External grouping not supported 95192186|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 11.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.4mm 47mm 6 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.78|FSC: 13; Default||Not reimbursed separately|1,203.78|FSC: 13; Default||External grouping not supported 95115246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.4mm 63mm 8 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,300.53|FSC: 13; Default||Not reimbursed separately|1,300.53|FSC: 13; Default||External grouping not supported 95188431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95115247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.0mm 24mm 4 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95185415|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 7mm Diameter X 37mm Length X 135mm Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95115248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.0mm 36mm 6 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.57|FSC: 13; Default||Not reimbursed separately|1,008.57|FSC: 13; Default||External grouping not supported 95115249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.0mm 48mm 8 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.09|FSC: 13; Default||Not reimbursed separately|1,029.09|FSC: 13; Default||External grouping not supported 95185416|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Rosen Inquire .35 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 55mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95192187|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 11.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 65mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|FSC: 13; Default||Not reimbursed separately|544.26|FSC: 13; Default||External grouping not supported 95185418|EAP|HCPCS Q4195||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply 2x4 (8 Sq Cm)|1|HUMANA [1294]||HUMANA [11839]|243.75|FSC: 13; Default||Not reimbursed separately|243.75|FSC: 13; Default||External grouping not supported 95115252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 70mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.66|FSC: 13; Default||Not reimbursed separately|459.66|FSC: 13; Default||External grouping not supported 95180456|EAP|Custom 95180456||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 10 Mm X 9 Mm X 30 Mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95115253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Ti-end (for Distal Femoralna|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|268.50|FSC: 13; Default||Not reimbursed separately|268.50|FSC: 13; Default||External grouping not supported 95180457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Fixed Bearing Ultracongruemt Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115254|EAP|Custom 95115254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 70mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188433|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Attrax 10cc Synthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95115255|EAP|Custom 95115255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 75mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115256|EAP|Custom 95115256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 95mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180459|EAP|Custom 95180459||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Segment Fibular Greater Than 10 Cm Frozen Cryo|1|HUMANA [1294]||HUMANA [11839]|2,340.00|FSC: 13; Default||Not reimbursed separately|2,340.00|FSC: 13; Default||External grouping not supported 95115257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 15mm 10mm Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.50|FSC: 13; Default||Not reimbursed separately|265.50|FSC: 13; Default||External grouping not supported 95180461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii Sz #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95115258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti For-solid-tibial-nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.50|FSC: 13; Default||Not reimbursed separately|175.50|FSC: 13; Default||External grouping not supported 95180462|EAP|Custom 95180462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pinnacle Access 4fr Box/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 15mm-ext.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95180463|EAP|Custom 95180463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pinnacle Access 5fr Box/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Ti-end(for Ti-cannualted Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95180464|EAP|Custom 95180464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pinnacle Access 6fr Box/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95185417|EAP|HCPCS Q4195||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply 5x5 (25 Sq Cm)|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95115262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 32mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95115263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 34 Mm Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180465|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 2.250x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95115264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180466|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 2.250x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95115265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 38mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95180467|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 2.250x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95115266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.00|FSC: 13; Default||Not reimbursed separately|234.00|FSC: 13; Default||External grouping not supported 95180468|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 2.250x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95115267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 13mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95115268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 44mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95115269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95180471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95115270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180472|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Cuff Aortic Proximal 34mm X 34mm Covered 100 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,497.00|FSC: 13; Default||Not reimbursed separately|16,497.00|FSC: 13; Default||External grouping not supported 95115271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180473|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Endologix 260 Cm X .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180474|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Percutaneous Mri Surescan Vectris 1x8 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95115273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.19|FSC: 13; Default||Not reimbursed separately|533.19|FSC: 13; Default||External grouping not supported 95180475|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Ability 78cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95115274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|701.22|FSC: 13; Default||Not reimbursed separately|701.22|FSC: 13; Default||External grouping not supported 95115275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95180476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Bio Composite 2.4mm Double Loop|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95115276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180477|EAP|Custom 95180477||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Avs Anchor L 12degree 14x25x35|1|HUMANA [1294]||HUMANA [11839]|19,500.00|FSC: 13; Default||Not reimbursed separately|19,500.00|FSC: 13; Default||External grouping not supported 95115277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Avs Anchor L 5.0x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95115278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 4.9mm X 30 Mm Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Avs Anchor L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95115279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Short Es2 6.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95115281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Rad Es2 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95115282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Rad Es2 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95115283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 4hole L121mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,067.00|FSC: 13; Default||Not reimbursed separately|8,067.00|FSC: 13; Default||External grouping not supported 95115284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95115285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95115286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95115287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95115288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95115294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Taper 12/14 Revision Uncemented Wagner Sl Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,934.50|FSC: 13; Default||Not reimbursed separately|18,934.50|FSC: 13; Default||External grouping not supported 95115295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulation Cr Persona Fixed Bearing Left 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95180491|EAP|Custom 95180491||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Passport Button 10x30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95188443|EAP|Custom 95188443||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervial Stealth 14x16x7 0degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95115298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Solid 9mm X 380mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185427|EAP|Custom 95185427||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14x16x8 6degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95115299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid Ti 8mm 300mmst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180500|EAP|Custom 95180500||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Gracilis Tendon|1|HUMANA [1294]||HUMANA [11839]|3,619.74|FSC: 13; Default||Not reimbursed separately|3,619.74|FSC: 13; Default||External grouping not supported 95115300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 10mm X 330mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7 3.5mm Va Lcp 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,468.77|FSC: 13; Default||Not reimbursed separately|4,468.77|FSC: 13; Default||External grouping not supported 95115301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mm X 360mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 22mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95115302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 285mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Locking 2.7mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95115303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 330mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X3 Sz 7 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95115304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 345mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180505|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Amplatz Right With Sideholes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95115306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|FSC: 13; Default||Not reimbursed separately|2,262.00|FSC: 13; Default||External grouping not supported 95115307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95115308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 12mm X 360mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95115309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,831.28|FSC: 13; Default||Not reimbursed separately|2,831.28|FSC: 13; Default||External grouping not supported 95115310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|FSC: 13; Default||Not reimbursed separately|2,312.64|FSC: 13; Default||External grouping not supported 95115313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 45mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95192188|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 12.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 90mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95185424|EAP|Custom 95185424||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 8mm X 11mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95115315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 100mm For|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95123675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Tibal A P Lipped Mgii Yellow 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,156.50|FSC: 13; Default||Not reimbursed separately|7,156.50|FSC: 13; Default||External grouping not supported 95115317|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 6fen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180508|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Roadrunner Uniglide 0.18x 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115318|EAP|Custom 95115318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Multipin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180509|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada .35 80cm 40 Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Attachment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.64|FSC: 13; Default||Not reimbursed separately|872.64|FSC: 13; Default||External grouping not supported 95180510|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada .35 80cm 60 Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 5.0mm X 125mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.05|FSC: 13; Default||Not reimbursed separately|616.05|FSC: 13; Default||External grouping not supported 95180511|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 6fr Jr 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115322|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 10cfn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180512|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 7fr Ar1 W Sideholes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115326|EAP|Custom 95115326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blanket Hot/ice Knee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180513|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Whisper Ms J 5 Bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180514|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wireprowater J 180cm 5 Bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180515|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 80cm 20 Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115350|EAP|HCPCS A5073||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Urostomy 2-1/4 Natura|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115351|EAP|Custom 95115351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trocar 32fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115352|EAP|Custom 95115352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trocar 28fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115353|EAP|Custom 95115353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trocar 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 12mm Ect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95115378|EAP|Custom 95115378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kidney Artificial F8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115379|EAP|Custom C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cancellous Chips|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95115385|EAP|Custom 95115385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Angiocath 10ga X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115388|EAP|Custom 95115388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Derma Sterile 1/2 Arc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180516|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 5mm 20mm 80cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180517|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 5mm 20 135cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115405|EAP|Custom 95115405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Curved Harmonic Scalpel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180518|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 5mm 40mm 80cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115408|EAP|Custom 95115408||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Needle Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160699|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Excimer 14fr 50cm 10.2 .134 3.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160700|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Excimer 16fr 50cm 12.5 .164 4.17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180543|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 8 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115416|EAP|Custom 95115416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Easy Mate 4 Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180544|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180545|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 8 X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115419|EAP|Custom 95115419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Cricothyrotomy Ed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180546|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 9 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115424|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Sro 8fr Swartz 63cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180547|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 9 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115437|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bmw 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180549|EAP|Custom 95180549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chuck Hoffmann3 For Pins Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115468|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rigidloop Cortical Fixation Implant 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,083.00|FSC: 13; Default||Not reimbursed separately|1,083.00|FSC: 13; Default||External grouping not supported 95115470|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180551|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Battery Restore Ultra Mri Compatiable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42,000.00|FSC: 13; Default||Not reimbursed separately|42,000.00|FSC: 13; Default||External grouping not supported 95115471|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,837.56|FSC: 13; Default||Not reimbursed separately|4,837.56|FSC: 13; Default||External grouping not supported 95115472|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180553|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 10 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115477|EAP|Custom 95115477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Ear|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180555|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 12 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115478|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180556|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 12 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115483|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180557|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 12 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115486|EAP|Custom 95115486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous 22 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180558|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada Workhorse 12 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188436|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape 585cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95115494|EAP|Custom 95115494||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Ventricular Left|1|HUMANA [1294]||HUMANA [11839]|108.48|FSC: 13; Default||Not reimbursed separately|108.48|FSC: 13; Default||External grouping not supported 95180560|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Ao Diopter Crystalens Posterior Chambe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115501|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Hnbr5.0 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185420|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 5x5 (25 Sq Cm)|1|HUMANA [1294]||HUMANA [11839]|384.00|FSC: 13; Default||Not reimbursed separately|384.00|FSC: 13; Default||External grouping not supported 95115503|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-limb 11.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,275.00|FSC: 13; Default||Not reimbursed separately|7,275.00|FSC: 13; Default||External grouping not supported 95180561|EAP|Custom 95180561||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Semitendinosus|1|HUMANA [1294]||HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95180562|EAP|Custom 95180562||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft H2 Extensure Ii 14mm|1|HUMANA [1294]||HUMANA [11839]|6,960.00|FSC: 13; Default||Not reimbursed separately|6,960.00|FSC: 13; Default||External grouping not supported 95115505|EAP|Custom 95115505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Splint Nasal Reuter Bivalve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115507|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Hemoset 14fr.x12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.9 Osteoraptor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,031.76|FSC: 13; Default||Not reimbursed separately|1,031.76|FSC: 13; Default||External grouping not supported 95115508|EAP|Custom 95115508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Graduated Sizing N5.0-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biocomposite 5.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95115509|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Bifurcated 13.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,300.00|FSC: 13; Default||Not reimbursed separately|24,300.00|FSC: 13; Default||External grouping not supported 95180565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Twinfix Ultra 4.5 With 2 Sutures Blue & Black|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|FSC: 13; Default||Not reimbursed separately|870.00|FSC: 13; Default||External grouping not supported 95115510|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-limb 8.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|FSC: 13; Default||Not reimbursed separately|6,675.00|FSC: 13; Default||External grouping not supported 95180566|EAP|Custom 95180566||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Tendon Tissue Bovine Fetal Tissue 6cm X 10cm|1|HUMANA [1294]||HUMANA [11839]|10,013.85|FSC: 13; Default||Not reimbursed separately|10,013.85|FSC: 13; Default||External grouping not supported 95115511|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Magic Torque .035 Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biocomposite 4.75mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95115514|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intraventional 7 French X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180568|EAP|Custom 95180568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Nipple Contact Sterile Standard-16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115518|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Contralateral 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture Calcaneal Perimeter Xs Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95115519|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Flexor Introducer Kcfw7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180570|EAP|Custom 95180570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115521|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm X 50mm Partial Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95115525|EAP|Custom 95115525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180572|EAP|Custom 95180572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .078 X 8 With Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115526|EAP|Custom 95115526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Tapered|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115530|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 7 X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95115531|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 7 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95180574|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Zinger Light Ls 180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115535|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Judkins Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Lateral Proximal 8 Hole 173mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,577.00|FSC: 13; Default||Not reimbursed separately|8,577.00|FSC: 13; Default||External grouping not supported 95115538|EAP|Custom 95115538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115542|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotablator Coronary Rotalink Ada|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180576|EAP|Custom 95180576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Gastrostomy Profile Low Mic Key 20fr 4.0 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115543|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Rotowire Extra Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Y Knot Rc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,042.50|FSC: 13; Default||Not reimbursed separately|1,042.50|FSC: 13; Default||External grouping not supported 95115544|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115545|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115546|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115547|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115553|EAP|Custom 95115553||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Introducer 18gax7cm Muhur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115556|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180620|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 10 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115558|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Symmetry 4 Fren|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180621|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 9 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115559|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 80166853|EAP|HCPCS A9606||0344 - NUCLEAR MEDICINE - THERAPEUTIC RADIOPHARMACEUTICALS|Hb Xofigo Radium Ra 223 Dichloride Per Micocurie|1|HUMANA [1294]||HUMANA [11839]|403.47|FSC: 13; Default||Not reimbursed separately|403.47|FSC: 13; Default||External grouping not supported 95115563|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intraventional 6 French X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185423|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 6x9 (54 Sq Cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.23|FSC: 13; Default||Not reimbursed separately|372.23|FSC: 13; Default||External grouping not supported 95115564|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 7frx90cm 2/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180622|EAP|Custom 95180622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Monopolar Nitinol 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115566|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Steerable Wire Control|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 10 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95115567|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Curved 0.35 Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 1level 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95115568|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 4cfn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95115569|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Stiff Shaft .035 Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180626|EAP|Custom 95180626||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation|1|HUMANA [1294]||HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95115570|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Tapered Tad .035-.018x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180627|EAP|Custom 95180627||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Allograft Puros S2 7x11x14mm 7degree|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95115574|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial Intracoil 5mm Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95180628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii Sz 2 35mm Ne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95115576|EAP|Custom 95115576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Umbilical Dual-lumen 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180629|EAP|Custom 95180629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Biom Optic Set With Hd Lens Disposable 12 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Short Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95180630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Medium Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95180631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Versys Crc 13/15 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|FSC: 13; Default||Not reimbursed separately|1,317.90|FSC: 13; Default||External grouping not supported 95180632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Versys Crc 13/15 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|FSC: 13; Default||Not reimbursed separately|1,317.90|FSC: 13; Default||External grouping not supported 95180633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Versys Crc 17/19 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|FSC: 13; Default||Not reimbursed separately|1,317.90|FSC: 13; Default||External grouping not supported 95180634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Versys Crc 17/19 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|FSC: 13; Default||Not reimbursed separately|1,317.90|FSC: 13; Default||External grouping not supported 95180635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Versys Crc 17/19 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|FSC: 13; Default||Not reimbursed separately|1,317.90|FSC: 13; Default||External grouping not supported 95180636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 13 X 210mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 17 X 230mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 17 X 200mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 13 X 250mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,744.41|FSC: 13; Default||Not reimbursed separately|16,744.41|FSC: 13; Default||External grouping not supported 95180640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 13 X 300mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 15 X 180mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,146.00|FSC: 13; Default||Not reimbursed separately|16,146.00|FSC: 13; Default||External grouping not supported 95180642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 15 X 220mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 15 X 250mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 15 X 300mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 17 X 190mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95180646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral 13.5x170mm Lg.junct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,213.62|FSC: 13; Default||Not reimbursed separately|10,213.62|FSC: 13; Default||External grouping not supported 95180647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Bowed Spline 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,444.87|FSC: 13; Default||Not reimbursed separately|9,444.87|FSC: 13; Default||External grouping not supported 95180648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115598|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bi-furcated Stretch 22x11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|FSC: 13; Default||Not reimbursed separately|2,517.00|FSC: 13; Default||External grouping not supported 95180649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95180650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95180651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95180652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115604|EAP|Custom 95115604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115608|EAP|Custom 95115608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 51mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115609|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Quinton Peritoneal Dial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.12|FSC: 13; Default||Not reimbursed separately|219.12|FSC: 13; Default||External grouping not supported 95180655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95180656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95180657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Offset 15x145|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|FSC: 13; Default||Not reimbursed separately|4,758.00|FSC: 13; Default||External grouping not supported 95180658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Off-set 18mmx145m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|FSC: 13; Default||Not reimbursed separately|4,350.54|FSC: 13; Default||External grouping not supported 95180659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Off-set 13mmx100m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|FSC: 13; Default||Not reimbursed separately|4,758.00|FSC: 13; Default||External grouping not supported 95180660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Nexgen 15mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95180661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Lock Nexgen Szg Left (re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95180662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Lcck (revis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95180663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95180664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Tibial 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95180665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Surface Articular Size Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95180666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95115621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Yellow 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95180669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Lcck W/lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95180670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Lcck (revis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95180671|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Quadra Assura Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|FSC: 13; Default||Not reimbursed separately|66,552.00|FSC: 13; Default||External grouping not supported 95115624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95180672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Proximal V-li|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.02|FSC: 13; Default||Not reimbursed separately|151.02|FSC: 13; Default||External grouping not supported 95180673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Proximal V-li|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.02|FSC: 13; Default||Not reimbursed separately|151.02|FSC: 13; Default||External grouping not supported 95180674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 12 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95180675|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Quadra Assura Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|FSC: 13; Default||Not reimbursed separately|66,552.00|FSC: 13; Default||External grouping not supported 95115628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 13 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95180676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 14 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95180677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 15 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95180678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 16 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95180679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 17 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95188438|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape 415cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95115634|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Flexima 12 Fr X 25 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185422|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 2x4 (8 Sq Cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|356.22|FSC: 13; Default||Not reimbursed separately|356.22|FSC: 13; Default||External grouping not supported 95115635|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Apd Loop 14 Fr 25 Cm Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192189|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 13.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95185421|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 2x2 (4 Sq Cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.50|FSC: 13; Default||Not reimbursed separately|562.50|FSC: 13; Default||External grouping not supported 95115637|EAP|Custom 95115637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Access Intrahepatic Ring Tra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cs16 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|FSC: 13; Default||Not reimbursed separately|1,662.00|FSC: 13; Default||External grouping not supported 95185419|EAP|HCPCS Q4195||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply 6x9 (54 Sq Cm)|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95115641|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Usg/8/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95115642|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8fr .088 Rdc I 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95115647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Humeral 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,310.00|FSC: 13; Default||Not reimbursed separately|8,310.00|FSC: 13; Default||External grouping not supported 95188442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Easy Clip Monocortical Fixation Device 8x8x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.00|FSC: 13; Default||Not reimbursed separately|4,386.00|FSC: 13; Default||External grouping not supported 95115648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95185435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 4.75 X 35 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95115683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Adapti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,827.00|FSC: 13; Default||Not reimbursed separately|1,827.00|FSC: 13; Default||External grouping not supported 95115684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|FSC: 13; Default||Not reimbursed separately|408.00|FSC: 13; Default||External grouping not supported 95180680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Humeral Xsmall 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95115685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|FSC: 13; Default||Not reimbursed separately|408.00|FSC: 13; Default||External grouping not supported 95180682|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu Zenith 32mm X 43cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 95115686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|FSC: 13; Default||Not reimbursed separately|408.00|FSC: 13; Default||External grouping not supported 95180683|EAP|Custom 95180683||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft H2 Extensure Ii 8mm|1|HUMANA [1294]||HUMANA [11839]|6,960.00|FSC: 13; Default||Not reimbursed separately|6,960.00|FSC: 13; Default||External grouping not supported 95115687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Y 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|FSC: 13; Default||Not reimbursed separately|384.00|FSC: 13; Default||External grouping not supported 95180685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95115688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm T 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|FSC: 13; Default||Not reimbursed separately|408.00|FSC: 13; Default||External grouping not supported 95180686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95115689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Strut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,521.00|FSC: 13; Default||Not reimbursed separately|1,521.00|FSC: 13; Default||External grouping not supported 95180687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5 Mm X L80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95115690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial X Ti 1.3mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|666.00|FSC: 13; Default||Not reimbursed separately|666.00|FSC: 13; Default||External grouping not supported 95180688|EAP|Custom 95180688||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide Coroent 12x22x50mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95115691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Box 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95180689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Versa Dial 46x18x53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 95115692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Mesh S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,121.00|FSC: 13; Default||Not reimbursed separately|2,121.00|FSC: 13; Default||External grouping not supported 95180690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Primary 14mm Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,244.00|FSC: 13; Default||Not reimbursed separately|14,244.00|FSC: 13; Default||External grouping not supported 95115693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95180691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Hybrid Post Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|801.00|FSC: 13; Default||Not reimbursed separately|801.00|FSC: 13; Default||External grouping not supported 95115694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Y 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95180692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Glenoid Hybrid Large 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,932.00|FSC: 13; Default||Not reimbursed separately|4,932.00|FSC: 13; Default||External grouping not supported 95115695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95180693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Std Ti Taper Versa Dial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.00|FSC: 13; Default||Not reimbursed separately|642.00|FSC: 13; Default||External grouping not supported 95115696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95180694|EAP|Custom 95180694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lasso Quickpass Curve Straight 90degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95180695|EAP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuromend 12mmid X 5.0cm Length|1|HUMANA [1294]||HUMANA [11839]|6,144.00|FSC: 13; Default||Not reimbursed separately|6,144.00|FSC: 13; Default||External grouping not supported 95115698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95180696|EAP|Custom 95180696||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Coroent 14x22x45mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95115699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Ti Y 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|FSC: 13; Default||Not reimbursed separately|441.00|FSC: 13; Default||External grouping not supported 95180697|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Ii Select Surevalve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Orbita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 95192191|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 14.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95185428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Recon Rhead Plasma Coated Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,221.00|FSC: 13; Default||Not reimbursed separately|10,221.00|FSC: 13; Default||External grouping not supported 95115702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 1.5mm 1x3-hole Low-profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95188437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95115703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Zygoma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95185433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlaymck Restoris 2-8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95115704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Zygoma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95115705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Zygoma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95185429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Capitellum Large Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,410.76|FSC: 13; Default||Not reimbursed separately|3,410.76|FSC: 13; Default||External grouping not supported 95115706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Orbita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95188444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 14mm 130 Deg 360mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95115707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Adaptation 2.0mm X 193mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|FSC: 13; Default||Not reimbursed separately|870.00|FSC: 13; Default||External grouping not supported 95185430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Recon Capitellum Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,173.00|FSC: 13; Default||Not reimbursed separately|7,173.00|FSC: 13; Default||External grouping not supported 95115708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95192192|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 14.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95185425|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 16 Cx Infinion 70ccm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95115710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95188439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95115711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Insert Acetabular P7 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.60|FSC: 13; Default||Not reimbursed separately|1,560.60|FSC: 13; Default||External grouping not supported 95185431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz 3 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95115715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Outer Acetabular 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,442.50|FSC: 13; Default||Not reimbursed separately|3,442.50|FSC: 13; Default||External grouping not supported 95185432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Onlay Mck Restoris Sz 2 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95115716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock P3 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95192193|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 15.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock P4 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95115718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock P4 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95115719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock P5 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 62064134|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Buprenorphine, Meconium - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95115720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock P5 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95115721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm S/t 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|FSC: 13; Default||Not reimbursed separately|39.00|FSC: 13; Default||External grouping not supported 62064084|EAP|CPT® 87799||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Bk Virus, Quant Pcr, Blood - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 95115725|EAP|Custom 95115725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinmann Threaded 5/64in.|1|HUMANA [1294]||HUMANA [11839]|51.09|FSC: 13; Default||Not reimbursed separately|51.09|FSC: 13; Default||External grouping not supported 95115726|EAP|Custom 95115726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinmann Threaded 3.2 Diame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterolateral Distal Tibia 2.7 3.5mm Va Lcp 10 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.45|FSC: 13; Default||Not reimbursed separately|5,148.45|FSC: 13; Default||External grouping not supported 95115727|EAP|Custom 95115727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinmann Threaded 4.8 Diame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064092|EAP|CPT® 87799||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Bk Virus, Quant Pcr, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 95115728|EAP|Custom 95115728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinmann Threaded 4.0 Diame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 32mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95115729|EAP|Custom 95115729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinmann Threaded 3.6 Diame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 38mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95115730|EAP|Custom 95115730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinmann Threaded 2.4 Diame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.35|FSC: 13; Default||Not reimbursed separately|145.35|FSC: 13; Default||External grouping not supported 95180704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95180705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95180706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,084.08|FSC: 13; Default||Not reimbursed separately|4,084.08|FSC: 13; Default||External grouping not supported 95115751|EAP|Custom 95115751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Perfusion Y Type Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,084.08|FSC: 13; Default||Not reimbursed separately|4,084.08|FSC: 13; Default||External grouping not supported 95180708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Revision 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,081.08|FSC: 13; Default||Not reimbursed separately|1,081.08|FSC: 13; Default||External grouping not supported 95115753|EAP|Custom 95115753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 18m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Oversize St 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,081.08|FSC: 13; Default||Not reimbursed separately|1,081.08|FSC: 13; Default||External grouping not supported 95115754|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Quinton Peritoneal Dial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.12|FSC: 13; Default||Not reimbursed separately|219.12|FSC: 13; Default||External grouping not supported 95180710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Straight 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|917.28|FSC: 13; Default||Not reimbursed separately|917.28|FSC: 13; Default||External grouping not supported 95115755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95180711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Midshaft Anterior 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95115757|EAP|Custom 95115757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Rotatable 29mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95180712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Biocompression 6.25 X 19.1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,140.00|FSC: 13; Default||Not reimbursed separately|1,140.00|FSC: 13; Default||External grouping not supported 95115758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95180713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 13 X 340 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95115759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg. 48x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Right 10 X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|FSC: 13; Default||Not reimbursed separately|5,964.00|FSC: 13; Default||External grouping not supported 95115760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg 56x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 11mm X 315mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95115761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 48x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180716|EAP|Custom 95180716||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Port Pin Plug|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95115762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 50x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Standard 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95115763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 56x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Peg High Compression 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 58x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Peg High Compression 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 60x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm 18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 62x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 64x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non Locking3.5mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95115768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 48x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non Locking 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 50x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180725|EAP|Custom 95180725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Side Cutting 2.0mm X40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg 58x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180726|EAP|Custom 95180726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Side Cuttung 2.5mm 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg 60x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mm X 12.0mm Va Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95115772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg 62x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mm X 10.0mm Va Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95115773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg 64x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 18mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95115774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 58x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fith Metarsal Universal Hook|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95115775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 60x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.51|FSC: 13; Default||Not reimbursed separately|138.51|FSC: 13; Default||External grouping not supported 95115776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 62x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95115777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 64x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95115778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 68x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Putty With Cancellous Chips 300 Express 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,625.00|FSC: 13; Default||Not reimbursed separately|5,625.00|FSC: 13; Default||External grouping not supported 95115779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 66x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate End Superior Lg. 11 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,458.75|FSC: 13; Default||Not reimbursed separately|16,458.75|FSC: 13; Default||External grouping not supported 95115780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 68x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Knotless Quickdraw 5mm 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|FSC: 13; Default||Not reimbursed separately|1,161.00|FSC: 13; Default||External grouping not supported 95115781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 70x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180742|EAP|Custom 95180742||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Loop Cortical Fixation 20mm|1|HUMANA [1294]||HUMANA [11839]|1,083.00|FSC: 13; Default||Not reimbursed separately|1,083.00|FSC: 13; Default||External grouping not supported 95115782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 48x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180743|EAP|Custom 95180743||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alignment Tendon Tissue Bovine Fetal Tissue 6cm X 6cm|1|HUMANA [1294]||HUMANA [11839]|5,710.56|FSC: 13; Default||Not reimbursed separately|5,710.56|FSC: 13; Default||External grouping not supported 95115783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 50x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 14hole L310mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,769.00|FSC: 13; Default||Not reimbursed separately|11,769.00|FSC: 13; Default||External grouping not supported 95115784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 56x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 62064100|EAP|CPT® 83520||0302 - LABORATORY - IMMUNOLOGY|Hb Inhibin B - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 95115785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 58x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mmxl38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95115786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 48x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95115787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 56x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95115788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 58x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180749|EAP|Custom 95180749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 62x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Acl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95115790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 64x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95180751|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Glidelight 14 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 60x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180752|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Glidelight 16 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 62x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180753|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soundstar Ultrasound G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 64x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 62062229|EAP|CPT® 88341||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Immunohistochem Stn Addl|1|HUMANA [1294]||HUMANA [11839]|223.37|FSC: 13; Default||Not reimbursed separately|223.37|FSC: 13; Default||External grouping not supported 95115794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 66x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Ts 5 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|FSC: 13; Default||Not reimbursed separately|4,387.50|FSC: 13; Default||External grouping not supported 95115795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 68x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Repair Meniscal Sequent Curved Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,652.63|FSC: 13; Default||Not reimbursed separately|2,652.63|FSC: 13; Default||External grouping not supported 95115796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 70x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95180758|EAP|Custom 95180758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 1.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 44cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95180759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire 2.0 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95115798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 46cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95180760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire 2.0 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95115799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 34cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95192194|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 15.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 34cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95115801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 36cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 80166861|EAP|CPT® 78812||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Pet Image Skullbase To Mid Thigh|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 95115802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 38cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 80166879|EAP|HCPCS G0399||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Home Sleep Test|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95115803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 40cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 62064118|EAP|CPT® 82542||0301 - LABORATORY - CHEMISTRY|Hb Pth Related Peptide - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.27|FSC: 13; Default||Not reimbursed separately|72.27|FSC: 13; Default||External grouping not supported 95115804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 42cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95115805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 44cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95115806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 15mm X 46cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95115807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 11mm X 28cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95115808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 12mm X 28cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 62064126|EAP|CPT® 84482||0301 - LABORATORY - CHEMISTRY|Hb T3 Reverse By Tms - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|47.28|FSC: 13; Default||Not reimbursed separately|47.28|FSC: 13; Default||External grouping not supported 95115809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 13mm X 28cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95115810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 13mm X 30cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95115811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 13mm X 20cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 62064142|EAP|CPT® 88366||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Fish, Multiplex|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95115812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 13mm X 34cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95115813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 13mm X 36cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95115814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 13mm X 38cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95115815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95115816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95115817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95180763|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round Profile Plus Moderate 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95115818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,740.60|FSC: 13; Default||Not reimbursed separately|10,740.60|FSC: 13; Default||External grouping not supported 95180764|EAP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epifix 14mm Disk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.25|FSC: 13; Default||Not reimbursed separately|449.25|FSC: 13; Default||External grouping not supported 95115819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180765|EAP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epifix 2cm X 3 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.25|FSC: 13; Default||Not reimbursed separately|572.25|FSC: 13; Default||External grouping not supported 95115820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180766|EAP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epifix 4cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.06|FSC: 13; Default||Not reimbursed separately|572.06|FSC: 13; Default||External grouping not supported 95115821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180767|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regerative Alloderm Contour Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.37|FSC: 13; Default||Not reimbursed separately|67.37|FSC: 13; Default||External grouping not supported 95115822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180768|EAP|Custom 95180768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Shunt Lumbar Peritoneal Nsc Pressure Adjustable|1|HUMANA [1294]||HUMANA [11839]|14,914.62|FSC: 13; Default||Not reimbursed separately|14,914.62|FSC: 13; Default||External grouping not supported 95115823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 44mm Self Tapping With Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95115824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95115825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95180772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Anterior Process Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95115826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95180773|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Duodenal W Anchor Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95115827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95180774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 405mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95115828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95115829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 80166887|EAP|CPT® 94618||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pst Six Minute Walk Test Includes Heart Rate And Oximetry|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95115830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95185441|EAP|Custom 95185441||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Verify External For Sacral Neuromodulation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95115832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95115833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|622.95|FSC: 13; Default||Not reimbursed separately|622.95|FSC: 13; Default||External grouping not supported 95115834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Extended|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|FSC: 13; Default||Not reimbursed separately|642.72|FSC: 13; Default||External grouping not supported 95185443|EAP|Custom 95185443||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Test Stimulator For Verify System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Intramedullary Extended|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|652.62|FSC: 13; Default||Not reimbursed separately|652.62|FSC: 13; Default||External grouping not supported 95180797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Biocomposite 7 X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95115836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Intramedullary Extended|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.96|FSC: 13; Default||Not reimbursed separately|711.96|FSC: 13; Default||External grouping not supported 95180798|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W Echo Ps 4.5" (11.4cm) Circle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95115837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180799|EAP|Custom 95180799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 668hp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Y Knot Rc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95115839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 80166895|EAP|HCPCS L1904||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Ankle Orthosis, Ankle Gauntlet Custom|1|HUMANA [1294]||HUMANA [11839]|660.74|FSC: 13; Default||Not reimbursed separately|660.74|FSC: 13; Default||External grouping not supported 95115840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95115841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180785|EAP|Custom 95180785||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot All Purpose Darco Xs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180786|EAP|Custom 95180786||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot All Purpose Darco Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180787|EAP|Custom 95180787||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot All Purpose Darco Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95180788|EAP|Custom 95180788||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot All Purpose Darco Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95180789|EAP|Custom 95180789||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot All Purpose Darco Xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Versys Beaded Sz-15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|FSC: 13; Default||Not reimbursed separately|11,457.72|FSC: 13; Default||External grouping not supported 95180801|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cather Picc Bioflo Single|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|FSC: 13; Default||Not reimbursed separately|594.00|FSC: 13; Default||External grouping not supported 95115847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +7 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 95180802|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cather Picc Bioflo Dual|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95115848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +10.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95180803|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Saline Style 68 Moderate Profile 510|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,776.00|FSC: 13; Default||Not reimbursed separately|1,776.00|FSC: 13; Default||External grouping not supported 95180805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95185437|EAP|Custom 95185437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Outback Re-entry 120cm Wire 300cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115853|EAP|Custom 95115853||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Spherical|1|HUMANA [1294]||HUMANA [11839]|122.64|FSC: 13; Default||Not reimbursed separately|122.64|FSC: 13; Default||External grouping not supported 95115854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pedicle M8 Break-off Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95185438|EAP|Custom 95185438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Outback Re-entry 80cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115855|EAP|Custom 95115855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Cannulated Herbert 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180820|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Otw Mini Trek Ii 2.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular P-2 28mm 15-de|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,876.50|FSC: 13; Default||Not reimbursed separately|1,876.50|FSC: 13; Default||External grouping not supported 95180853|EAP|Custom 95180853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Tornambe Super View 10 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular P-3 28mm 15d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 95180855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Standard 3 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95115859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular P-4 28mm 15deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95180856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Vitalock Cluster 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95180857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115862|EAP|Custom 95115862||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Narrow-blade Ram|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95180519|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 5mm 40mm 135cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180520|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 3 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180521|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse4 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Juggerknot 1.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,554.00|FSC: 13; Default||Not reimbursed separately|1,554.00|FSC: 13; Default||External grouping not supported 95115866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180912|EAP|Custom 95180912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Side Cutting 2.0mm X 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180913|EAP|Custom 95180913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Side Cutting 2.5mm X 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 30mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 26mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Standard 3 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95115871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 20mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95115872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 18mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180919|EAP|Custom 95180919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Guide 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 16mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95115874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95180921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95115877|EAP|Custom 95115877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Exchange Zms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95115878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 14mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 1 3rd 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95115879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 12mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180925|EAP|Custom 95180925||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire Threaded 1.4 X 150mm Asnis|1|HUMANA [1294]||HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95115880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 22mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95115881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 28mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95180526|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 6mm 40mm 80cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115882|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115883|EAP|Custom 95115883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Titanium 2.4mm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|FSC: 13; Default||Not reimbursed separately|166.38|FSC: 13; Default||External grouping not supported 95115885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|FSC: 13; Default||Not reimbursed separately|166.38|FSC: 13; Default||External grouping not supported 95115886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|FSC: 13; Default||Not reimbursed separately|207.90|FSC: 13; Default||External grouping not supported 95185442|EAP|Custom 95185442||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable 25cm Twist Lock For Verify System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.00|FSC: 13; Default||Not reimbursed separately|129.00|FSC: 13; Default||External grouping not supported 95192195|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 16.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95185440|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Opticross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95188488|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Quadripolar L Heart Endocardial/s Curve 86cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95115891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Stature Small 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|FSC: 13; Default||Not reimbursed separately|1,860.00|FSC: 13; Default||External grouping not supported 95185439|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Uromax (for Endopyelotomy)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.30|FSC: 13; Default||Not reimbursed separately|183.30|FSC: 13; Default||External grouping not supported 95115893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95185444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tibial Infinity Sz 3 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,934.00|FSC: 13; Default||Not reimbursed separately|17,934.00|FSC: 13; Default||External grouping not supported 95115894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95188490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 9.5 X 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95115895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|FSC: 13; Default||Not reimbursed separately|103.71|FSC: 13; Default||External grouping not supported 95185445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz 2+-6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,279.00|FSC: 13; Default||Not reimbursed separately|6,279.00|FSC: 13; Default||External grouping not supported 95115897|EAP|Custom 95115897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Bunion 18mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192196|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 16.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115899|EAP|Custom 95115899||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 27mm With Integral|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95185446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Talar Infinity Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,829.00|FSC: 13; Default||Not reimbursed separately|17,829.00|FSC: 13; Default||External grouping not supported 95115900|EAP|Custom 95115900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 35mm With Integral|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95115901|EAP|Custom 95115901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous 28fr.extended Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115905|EAP|Custom 95115905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Nasal Septal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115912|EAP|Custom 95115912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stone Tipless Nitinol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115913|EAP|Custom 95115913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shear Curved 5mm For Harmonic Sc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115917|EAP|Custom 95115917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid-loads 1.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95115924|EAP|Custom 95115924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Mini Forcep 110gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185456|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Woven Vicryl 30 X 30 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,618.60|FSC: 13; Default||Not reimbursed separately|6,618.60|FSC: 13; Default||External grouping not supported 95115926|EAP|Custom 95115926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic 18fr 5cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115939|EAP|Custom 95115939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Suture Loading-unit 30v M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/130 Deg 360mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95115942|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Rapid Infusion 8.5fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95115946|EAP|Custom 95115946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Peg 20 French Push|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon Three-level 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95115949|EAP|Custom 95115949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 19 X M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192197|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 17.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95115950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Unipolar Endopros. Heads|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.08|FSC: 13; Default||Not reimbursed separately|196.08|FSC: 13; Default||External grouping not supported 95185452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 6 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|FSC: 13; Default||Not reimbursed separately|3,037.50|FSC: 13; Default||External grouping not supported 95115951|EAP|Custom 95115951||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Dowel 18x31|1|HUMANA [1294]||HUMANA [11839]|2,190.00|FSC: 13; Default||Not reimbursed separately|2,190.00|FSC: 13; Default||External grouping not supported 95180530|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115957|EAP|Custom 95115957||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology Disp. W/sheath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180531|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115961|EAP|HCPCS A6154||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Wound-manager Up To 3 X 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180532|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115962|EAP|Custom 95115962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Indwelling Slit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180533|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180534|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115968|EAP|Custom 95115968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Ear Glasscock Pedia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180535|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115969|EAP|HCPCS A6154||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Wound Manager Up To 3 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180536|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Extension Mgii 43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,892.16|FSC: 13; Default||Not reimbursed separately|4,892.16|FSC: 13; Default||External grouping not supported 95180537|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115973|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180538|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 8 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ebi Cortical Pennig 70/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95188492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 8.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95115987|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180539|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115998|EAP|Custom 95115998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Fixator Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 25mm In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95180940|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Femoral Denali Vena Ivc Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95116003|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Smooth 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180941|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Jugular Denali Vena Ivc Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95116008|EAP|Custom 95116008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 4.5mm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180942|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port A Cath Clearvue Intermediate 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95116009|EAP|Custom 95116009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 3.2mm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180943|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port A Cath Clearvue Slim Low Profile 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95116010|EAP|Custom 95116010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 3/64 Inch Threade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180944|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port A Cath Clearvue Slim Low Profile 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95116011|EAP|Custom 95116011||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Stomahesive Flexible 1-3/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95116012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95180958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95116013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95180959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.5mm X 45mm Partial Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95116014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95180960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5 Titanium Right 13 X 440mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95116015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95180976|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof Restor 6.0mm Apodized D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95116016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95180977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S Fix 2.5lg 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95116017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95180979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.20|FSC: 13; Default||Not reimbursed separately|514.20|FSC: 13; Default||External grouping not supported 95180980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulation Cr Persona Fixed Bearing Left 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 6-hole 4.5 X 116mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.52|FSC: 13; Default||Not reimbursed separately|662.52|FSC: 13; Default||External grouping not supported 95180986|EAP|Custom 95180986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Prismasate Bgk 2 0 Non Pvc Bag 2 Ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116020|EAP|Custom 95116020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Body Std.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181015|EAP|Custom 95181015||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade Hyperlordotic 10x38x28mm 20 Degree|1|HUMANA [1294]||HUMANA [11839]|31,500.00|FSC: 13; Default||Not reimbursed separately|31,500.00|FSC: 13; Default||External grouping not supported 95181017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Precept 5.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95185454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 90 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|FSC: 13; Default||Not reimbursed separately|2,164.59|FSC: 13; Default||External grouping not supported 95180522|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180523|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116031|EAP|Custom 95116031||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Tri-corticle|1|HUMANA [1294]||HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 95180524|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116032|EAP|Custom 95116032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon 10mmx4cm C1030|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180525|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 6mm 20 80cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116039|EAP|Custom 95116039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinman 3.2mm Diameter X 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180527|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 6mm 60 80cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116042|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretched-ringed (dialysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,658.00|FSC: 13; Default||Not reimbursed separately|2,658.00|FSC: 13; Default||External grouping not supported 95180528|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral 10x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|FSC: 13; Default||Not reimbursed separately|5,460.00|FSC: 13; Default||External grouping not supported 95180529|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116047|EAP|Custom 95116047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Wrist Peenig-dynamic Wit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 7 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95181020|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Half Moon Split Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95181023|EAP|Custom 95181023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Load Gold Thin Profile 0.6 Gram|1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95116061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95181025|EAP|Custom 95181025||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Load Gold Thin Profile 0.8 Gram|1|HUMANA [1294]||HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95116066|EAP|Custom 95116066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Suretac-ii 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181027|EAP|Custom 95181027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Load Gold Thin Profile 1.0 Gram|1|HUMANA [1294]||HUMANA [11839]|765.00|FSC: 13; Default||Not reimbursed separately|765.00|FSC: 13; Default||External grouping not supported 95116067|EAP|Custom 95116067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Turbosonic Tipless|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181028|EAP|Custom 95181028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Load Gold Thin Profile 1.2 Gram|1|HUMANA [1294]||HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95116068|EAP|Custom 95116068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181034|EAP|Custom 95181034||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Medpore Sst-ez 18mm|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95116070|EAP|Custom 95116070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Cannula 5 X 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Comp Dbl 3 Hole 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95116073|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 8lpc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116075|EAP|Custom 95116075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Packing Absorbent Ortho Dri 8 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5 X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|FSC: 13; Default||Not reimbursed separately|1,617.00|FSC: 13; Default||External grouping not supported 95116076|EAP|Custom 95116076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer Pinnacle 9 Fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116077|EAP|Custom 95116077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cusa Pak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Epiphysis Fracture Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|FSC: 13; Default||Not reimbursed separately|59.58|FSC: 13; Default||External grouping not supported 95181085|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 10 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Small Fragment 15mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.26|FSC: 13; Default||Not reimbursed separately|73.26|FSC: 13; Default||External grouping not supported 95181088|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116144|EAP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Plate Molteno Right-eye|1|HUMANA [1294]||HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95181107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116146|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Contour-profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95181108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116147|EAP|Custom 95116147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tube Gastrostomy W/y-ext-set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4 Hole Ti One Third Tubular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.75|FSC: 13; Default||Not reimbursed separately|204.75|FSC: 13; Default||External grouping not supported 95116149|EAP|Custom 95116149||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Ph One-channel|1|HUMANA [1294]||HUMANA [11839]|117.00|FSC: 13; Default||Not reimbursed separately|117.00|FSC: 13; Default||External grouping not supported 95181110|EAP|Custom 95181110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K Wire Ti 1.6x150mm|1|HUMANA [1294]||HUMANA [11839]|46.20|FSC: 13; Default||Not reimbursed separately|46.20|FSC: 13; Default||External grouping not supported 95116153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95181111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Humeral Small 6" Long Flange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95116154|EAP|Custom 95116154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 18mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192198|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 18.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95116155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95181112|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Carto Smart Touch Fj 8fr Bi-directional|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95181113|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Carto Smart Touch Df 8fr Bi-directional|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95181114|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Carto Smart Touch D 8fr Uni-directional|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116158|EAP|Custom 95116158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Cor 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181115|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Carto Smart Touch F 8fr Uni-directional|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116159|EAP|Custom 95116159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Port-a-cath System Titanius|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181116|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Carto Smart Touch J 8fr Uni-directional|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Zps Full-thream|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|FSC: 13; Default||Not reimbursed separately|39.33|FSC: 13; Default||External grouping not supported 95181121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 16mm(fem3-11tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Guide 3.0mm 950mm With Smoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.75|FSC: 13; Default||Not reimbursed separately|561.75|FSC: 13; Default||External grouping not supported 95181123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 18mm(fem3-11tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116164|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter One-piece Silicone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.00|FSC: 13; Default||Not reimbursed separately|1,611.00|FSC: 13; Default||External grouping not supported 95181124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 11mm(fem 3-11tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.0mm14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95181140|EAP|Custom 95181140||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Powder Hemostatic Arista 5gm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116167|EAP|Custom 95116167||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bag Bile 19oz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Biocomposite 8 X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95116169|EAP|Custom 95116169||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Acromio Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 13mm(fem 3-11tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116170|EAP|Custom 95116170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tracheostomy Per-fit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 14mm(fem 3-11tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 4-hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95181127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 16mm(fem 3-11tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95181128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Right 18mm(fem 3-11tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Crc 13 X 170mm Versys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|FSC: 13; Default||Not reimbursed separately|15,784.71|FSC: 13; Default||External grouping not supported 95181129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Lft Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116178|EAP|Custom 95116178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Side-cutting 2.4 Carbide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Lft Sz A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116184|EAP|Custom 95116184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Dianeal With 4.25% Dext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Lft Sz B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116190|EAP|Custom 95116190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shear Coagulating Harmonic Scalp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Lft Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116193|EAP|Custom 95116193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Retro-femoral Drill 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Rgt Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116194|EAP|Custom 95116194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Tib/hum Drill Medium 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Rgt Sz A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116204|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Penoscrotal Ultrex-plug 15c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|FSC: 13; Default||Not reimbursed separately|11,625.00|FSC: 13; Default||External grouping not supported 95181136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Rgt Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95116205|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Package Deactivation C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95181137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Cemented Persona 29mm 8.0mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95116206|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea (processing Fee) (see Com|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95181138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Cemented Persona 41mm 10.0mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95181139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Cemented Persona 26mm 7.5mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95116212|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Symmetry 4 Fren|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116219|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Laryngectomy 10lgt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Rt (fem1-2 Tib Ab)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116220|EAP|Custom 95116220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond 1.5mm Mednext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Rt (fem1-2 Tib Ab)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116221|EAP|Custom 95116221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr 7.0mm Ball Mednext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Rt (fem1-2 Tib Ab)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116222|EAP|Custom 95116222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Sinus Frontal Rains Standa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116223|EAP|Custom 95116223||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Vent Soileau-tytan|1|HUMANA [1294]||HUMANA [11839]|50.80|FSC: 13; Default||Not reimbursed separately|50.80|FSC: 13; Default||External grouping not supported 95181193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95181194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116225|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual 1mm 18cm X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,456.00|FSC: 13; Default||Not reimbursed separately|3,456.00|FSC: 13; Default||External grouping not supported 95181195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116226|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual 1mm 20cm X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,794.00|FSC: 13; Default||Not reimbursed separately|4,794.00|FSC: 13; Default||External grouping not supported 95181196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116227|EAP|Custom 95116227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 1.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116228|EAP|Custom 95116228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 2.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116236|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon-dilator 12-4x7x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116239|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Expander Textured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 80166903|EAP|CPT® 27301||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I & D Deep Abscess|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95116241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Snap Off New D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,120.38|FSC: 13; Default||Not reimbursed separately|1,120.38|FSC: 13; Default||External grouping not supported 95181200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116242|EAP|Custom 95116242||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Low-profile Ti 5.5 31m|1|HUMANA [1294]||HUMANA [11839]|4,801.02|FSC: 13; Default||Not reimbursed separately|4,801.02|FSC: 13; Default||External grouping not supported 95181201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Fixed Cr Lft 10 Mm (fem3-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116251|EAP|Custom 95116251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bartholin Gland 10fr 5cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116259|EAP|Custom 95116259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Curled Peritoneal Dialy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116261|EAP|Custom 95116261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Infusion 6.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116262|EAP|Custom 95116262||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.25 Long Schuknecht Sl|1|HUMANA [1294]||HUMANA [11839]|246.36|FSC: 13; Default||Not reimbursed separately|246.36|FSC: 13; Default||External grouping not supported 95181205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95116263|EAP|Custom 95116263||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.75 Long Schuknecht Sl|1|HUMANA [1294]||HUMANA [11839]|246.36|FSC: 13; Default||Not reimbursed separately|246.36|FSC: 13; Default||External grouping not supported 95181206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Narrow Porous Left Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95181207|EAP|Custom 95181207||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide Coroent 12x22x45mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95116268|EAP|Custom 95116268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 37 French Broncho Cath Righ|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Decade Xlif 4hole Sz10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,530.00|FSC: 13; Default||Not reimbursed separately|16,530.00|FSC: 13; Default||External grouping not supported 95116272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,605.00|FSC: 13; Default||Not reimbursed separately|7,605.00|FSC: 13; Default||External grouping not supported 95181209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 5.5x35mmlarge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 95116273|EAP|Custom 95116273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stentube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 5.5x40mm Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 95116274|EAP|Custom 95116274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar W/non-shielded-obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 5.0x35mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 95181212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 5.0x40mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 95116277|EAP|Custom 95116277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Blunt Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mmx21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95181145|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epic Stent Vascular 6mm X 80mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95116280|EAP|Custom 95116280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116281|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Penoscrotal Ultrex 18cm C18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,995.00|FSC: 13; Default||Not reimbursed separately|10,995.00|FSC: 13; Default||External grouping not supported 95181151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116282|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Resv Plus 100ml 700-ultrex C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95181153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116283|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Malleable-600 20cmx13or 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95116284|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Malleable 600 16cmx11 Or 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95181157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116288|EAP|Custom 95116288||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Hex Fix 1.8|1|HUMANA [1294]||HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95181158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116289|EAP|Custom 95116289||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Umbilical Vein 65cmx6mm|1|HUMANA [1294]||HUMANA [11839]|4,665.00|FSC: 13; Default||Not reimbursed separately|4,665.00|FSC: 13; Default||External grouping not supported 95181159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116290|EAP|Custom 95116290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Anastomotic Microvasc. 1.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95181161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Rt (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95181162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116294|EAP|Custom 95116294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Acl Disposable Transtibial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116295|EAP|Custom 95116295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guiderod Straight Ball-tip 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116296|EAP|Custom 95116296||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Anastomotic Microvascular|1|HUMANA [1294]||HUMANA [11839]|407.50|FSC: 13; Default||Not reimbursed separately|407.50|FSC: 13; Default||External grouping not supported 95181165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116297|EAP|Custom 95116297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Laser Ocular Endo Directio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116298|EAP|Custom 95116298||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Anastomotic Microvascular|1|HUMANA [1294]||HUMANA [11839]|437.50|FSC: 13; Default||Not reimbursed separately|437.50|FSC: 13; Default||External grouping not supported 95181167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95181168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Rt (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116300|EAP|Custom 95116300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endopearl 9mm|1|HUMANA [1294]||HUMANA [11839]|176.94|FSC: 13; Default||Not reimbursed separately|176.94|FSC: 13; Default||External grouping not supported 95181169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116301|EAP|Custom 95116301||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endopearl 7mm|1|HUMANA [1294]||HUMANA [11839]|176.94|FSC: 13; Default||Not reimbursed separately|176.94|FSC: 13; Default||External grouping not supported 95181170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116302|EAP|Custom 95116302||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endopearl 8mm|1|HUMANA [1294]||HUMANA [11839]|176.94|FSC: 13; Default||Not reimbursed separately|176.94|FSC: 13; Default||External grouping not supported 95181171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116303|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super Stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116305|EAP|Custom 95116305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Gemini 4-wire 5cm 14mmx3.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95181174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116308|EAP|Custom 95116308||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 21mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95181175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Rt (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116311|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Duct Lacrimal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116312|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Tvt W/abd-guides Choice C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|FSC: 13; Default||Not reimbursed separately|3,510.00|FSC: 13; Default||External grouping not supported 95188452|EAP|HCPCS 95188452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Test Stimulation Lead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Statak Soft-tissue 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.87|FSC: 13; Default||Not reimbursed separately|541.87|FSC: 13; Default||External grouping not supported 95116314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95116315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Bio Fastak W/fiberwire 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95116326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 110mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95116327|EAP|Custom 95116327||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Wide-blade|1|HUMANA [1294]||HUMANA [11839]|1,881.00|FSC: 13; Default||Not reimbursed separately|1,881.00|FSC: 13; Default||External grouping not supported 95116328|EAP|Custom 95116328||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Low-profile|1|HUMANA [1294]||HUMANA [11839]|3,857.28|FSC: 13; Default||Not reimbursed separately|3,857.28|FSC: 13; Default||External grouping not supported 95116329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.98|FSC: 13; Default||Not reimbursed separately|4,630.98|FSC: 13; Default||External grouping not supported 95116330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.98|FSC: 13; Default||Not reimbursed separately|4,630.98|FSC: 13; Default||External grouping not supported 95116331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,816.62|FSC: 13; Default||Not reimbursed separately|4,816.62|FSC: 13; Default||External grouping not supported 95116332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,816.62|FSC: 13; Default||Not reimbursed separately|4,816.62|FSC: 13; Default||External grouping not supported 95181144|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6mm X 41mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95116333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,408.26|FSC: 13; Default||Not reimbursed separately|1,408.26|FSC: 13; Default||External grouping not supported 95181215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterlateral Distal Tibia 2.7 3.5mm Va Lcp 10 Hole Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,253.99|FSC: 13; Default||Not reimbursed separately|5,253.99|FSC: 13; Default||External grouping not supported 95116335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 130mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95181216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle Self Tapping Locking Stardrive 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95116344|EAP|Custom 95116344||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Cancellous Large|1|HUMANA [1294]||HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95181217|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm Ready To Use Contour Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.56|FSC: 13; Default||Not reimbursed separately|160.56|FSC: 13; Default||External grouping not supported 95116345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 130mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95181218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Oxinium Journey Ii Cr Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,689.00|FSC: 13; Default||Not reimbursed separately|10,689.00|FSC: 13; Default||External grouping not supported 95116346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 160mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95181219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Non Porous Journey Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 95181220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Cr Xlpe Journey Ii Size 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 95116351|EAP|Custom 95116351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Aortic 5mm Disp Rotating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181221|EAP|Custom 95181221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Speed Rim 45mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116353|EAP|Custom 95116353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol 7969-05 Plegisol Inj For Car|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181222|EAP|Custom 95181222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Speed Non Rim 65mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181223|EAP|Custom 95181223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116357|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Cardioverter Defibrillator Impla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,500.00|FSC: 13; Default||Not reimbursed separately|58,500.00|FSC: 13; Default||External grouping not supported 95181224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Fracture Anterior Proc Post Tuber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95116359|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double-j 8.5x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95116361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 50mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,444.86|FSC: 13; Default||Not reimbursed separately|1,444.86|FSC: 13; Default||External grouping not supported 95188451|EAP|Custom 95188451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Test Stimulation Lead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 12mm (fem 3-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116365|EAP|Custom 95116365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 10-0 Bv75-3 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 14mm (fem 3-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116366|EAP|Custom 95116366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 7-0 24 Cc Ms/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 16mm (fem 3-11tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116367|EAP|Custom 95116367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retrieval Trapezoid Rx-wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 12mm (fem 3-11tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116371|EAP|Custom 95116371||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Achilles|1|HUMANA [1294]||HUMANA [11839]|7,260.00|FSC: 13; Default||Not reimbursed separately|7,260.00|FSC: 13; Default||External grouping not supported 95181233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 13mm (fem 3-11tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116375|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Palmaz 30 Mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.00|FSC: 13; Default||Not reimbursed separately|2,460.00|FSC: 13; Default||External grouping not supported 95181227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 11mm (fem 3-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116376|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Specify C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,638.00|FSC: 13; Default||Not reimbursed separately|7,638.00|FSC: 13; Default||External grouping not supported 95181229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 13mm (fem 3-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116377|EAP|Custom 95116377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Screening|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181226|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex Partially Covered 23mm X 155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,290.00|FSC: 13; Default||Not reimbursed separately|7,290.00|FSC: 13; Default||External grouping not supported 95116378|EAP|Custom 95116378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Revision Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 16mm(fem7-12tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116379|EAP|Custom 95116379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Lead Dual|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181241|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Power Port Clearvue Isp 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95116380|EAP|Custom 95116380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Boots/anchors|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 18mm (fem 3-11tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116381|EAP|Custom 95116381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Neuro 15degree Offset W/si|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 11mm(fem7-12tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116382|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Pulse Component Of 772|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,040.00|FSC: 13; Default||Not reimbursed separately|35,040.00|FSC: 13; Default||External grouping not supported 95181231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 18mm (fem 3-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116383|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Programmer Patient Synergy (comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 18mm(fem7-12tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116385|EAP|Custom 95116385||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Patella|1|HUMANA [1294]||HUMANA [11839]|12,960.00|FSC: 13; Default||Not reimbursed separately|12,960.00|FSC: 13; Default||External grouping not supported 95181238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 13mm(fem7-12tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Solid 3.5x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95181234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Persona Left 14mm (fem 3-11tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solid Cortical 3.5x38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95181259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solid Corticle 3.5x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95181271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mmx18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95181267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95181262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 32.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95116392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 37.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 40mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 42.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 45mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 47.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 50mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|970.20|FSC: 13; Default||Not reimbursed separately|970.20|FSC: 13; Default||External grouping not supported 95181272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Slot 4.35mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95181283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 21.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|FSC: 13; Default||Not reimbursed separately|4,736.34|FSC: 13; Default||External grouping not supported 95181253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 25mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|FSC: 13; Default||Not reimbursed separately|4,736.34|FSC: 13; Default||External grouping not supported 95181280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 30mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95181294|EAP|Custom 95181294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Mcgrath Mac Size 2 Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 57.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|FSC: 13; Default||Not reimbursed separately|6,165.18|FSC: 13; Default||External grouping not supported 95181292|EAP|Custom 95181292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Mcgrath Mac Size 3 Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 60mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|FSC: 13; Default||Not reimbursed separately|6,165.18|FSC: 13; Default||External grouping not supported 95181293|EAP|Custom 95181293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Mcgrath Mac Size 4 Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 62.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|FSC: 13; Default||Not reimbursed separately|6,653.22|FSC: 13; Default||External grouping not supported 95181291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular Ti 1/3 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95116406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 65mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.31|FSC: 13; Default||Not reimbursed separately|6,653.31|FSC: 13; Default||External grouping not supported 95181288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap 3.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 67.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|FSC: 13; Default||Not reimbursed separately|6,653.22|FSC: 13; Default||External grouping not supported 95181289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 2.7x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95116408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 70mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,019.00|FSC: 13; Default||Not reimbursed separately|2,019.00|FSC: 13; Default||External grouping not supported 95181290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 2.7x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95116409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 72.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|FSC: 13; Default||Not reimbursed separately|6,653.22|FSC: 13; Default||External grouping not supported 95181264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 75mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|FSC: 13; Default||Not reimbursed separately|6,653.22|FSC: 13; Default||External grouping not supported 95181249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 55mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|FSC: 13; Default||Not reimbursed separately|6,165.18|FSC: 13; Default||External grouping not supported 95181252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Slot 4.35mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95181268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,237.74|FSC: 13; Default||Not reimbursed separately|1,237.74|FSC: 13; Default||External grouping not supported 95181269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Expansionhead Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95181248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116416|EAP|Custom 95116416||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Eliminator Hole Positive Stop Ax|1|HUMANA [1294]||HUMANA [11839]|356.19|FSC: 13; Default||Not reimbursed separately|356.19|FSC: 13; Default||External grouping not supported 95181257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95181273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95181284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mmx20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95181279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mmx16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95181243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,909.80|FSC: 13; Default||Not reimbursed separately|4,909.80|FSC: 13; Default||External grouping not supported 95181245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116425|EAP|Custom 95116425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peritoneal Cfs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116427|EAP|Custom 95116427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Transfer Automix Compound-ed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116428|EAP|Custom 95116428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Packing Nasal Stent Sinus Microg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116429|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Lft (fem3-7 Tib Cd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116431|EAP|Custom 95116431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Retrieval Balloon 8.5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95181278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Cemented Left Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cr Narrow Cemented Left Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95116455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Lft (fem7-12 Tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Lft (fem4-11 Tib Ef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95116459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 80166911|EAP|CPT® 10030||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Image Guided Fluid Collection Soft Tissue|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95116460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 80166929|EAP|CPT® 49405||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Image Guided Fluid Collection Visceral|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95116461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 80166937|EAP|CPT® 49406||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Image Guided Fluid Collection Percutaneous|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95116462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 80166945|EAP|CPT® 49407||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Image Guided Fluid Collection Transvaginal_rectal|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95116463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 8 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|FSC: 13; Default||Not reimbursed separately|809.55|FSC: 13; Default||External grouping not supported 95116464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 4.5 Footprint Ultra Pack|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,297.80|FSC: 13; Default||Not reimbursed separately|1,297.80|FSC: 13; Default||External grouping not supported 95116465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181276|EAP|Custom 95181276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Tissue High Viscosity Derma+flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x34mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping S/s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95116468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Knotless Quickdraw White 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|FSC: 13; Default||Not reimbursed separately|1,161.00|FSC: 13; Default||External grouping not supported 95116469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95180744|EAP|Custom 95180744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guards Noise Neonatal 6/pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181296|EAP|Custom 95181296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.7x125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95192199|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 18.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95116472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 80166952|EAP|CPT® 92579||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Visual Reinforcement Audiometry (vra)|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95116473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 75mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95188450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Hoffman3 5 Hole Pin 30 Deg Dia. 4/5/6 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,178.00|FSC: 13; Default||Not reimbursed separately|2,178.00|FSC: 13; Default||External grouping not supported 95116478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95116481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5 X 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 95116482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathlon Ps 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95116483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95180554|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 10 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181305|EAP|Custom 95181305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kimvent 13fr Bal 5/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathlon Ps 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95116486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm X 55mm Partial Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95116488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Bone 6.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95181304|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Quadripole A Curve With Auto Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Versys 11 Proximal Centra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|FSC: 13; Default||Not reimbursed separately|144.15|FSC: 13; Default||External grouping not supported 95181319|EAP|Custom 95181319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Bone Cannulated 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor W/needle 5.5.mm L15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95180540|EAP|Custom 95180540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Humidification Passive 72 Hr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180410|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 6" X 10" Oval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95181317|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated 25 X 90/120-30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95116506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal 5mm (revisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95181323|EAP|Custom 95181323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ultrabraid #2 Blue 38"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Femoral Distal 5mm Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95181318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Biocomposite 8 X 19.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,148.40|FSC: 13; Default||Not reimbursed separately|1,148.40|FSC: 13; Default||External grouping not supported 95116508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augument Distal Szg 10mm(r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95116509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Augment Distal C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95116510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Distal Augment Femoral 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95116511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Distal 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95116513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 95188453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 55mm 15mm Partial Threaded With 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95116514|EAP|Custom 95116514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tracker 150x20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Femoral Legacy Lt Szd Lc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,536.89|FSC: 13; Default||Not reimbursed separately|17,536.89|FSC: 13; Default||External grouping not supported 95116517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size-c Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95116518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Legacy Size-d Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95185461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95116520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 58x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,021.00|FSC: 13; Default||Not reimbursed separately|3,021.00|FSC: 13; Default||External grouping not supported 95116521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 60x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,021.00|FSC: 13; Default||Not reimbursed separately|3,021.00|FSC: 13; Default||External grouping not supported 95188454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 60mm 15mm Partial Threaded With 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95116524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Xlpe Acetabular 50-52 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95185459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Proximal 15-hole Left Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95116533|EAP|Custom 95116533||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Feeder Haberman 80ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Rcd Fenlin 26mmx26m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,759.50|FSC: 13; Default||Not reimbursed separately|1,759.50|FSC: 13; Default||External grouping not supported 95116535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Rcd Fenlin 26mmx32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,695.00|FSC: 13; Default||Not reimbursed separately|1,695.00|FSC: 13; Default||External grouping not supported 95116536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Duratn P-3 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|FSC: 13; Default||Not reimbursed separately|2,523.60|FSC: 13; Default||External grouping not supported 95185457|EAP|Custom 95185457||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ligament Patellar Whole 20mm|1|HUMANA [1294]||HUMANA [11839]|11,609.22|FSC: 13; Default||Not reimbursed separately|11,609.22|FSC: 13; Default||External grouping not supported 95116537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Cup Premise 28mmx52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,313.25|FSC: 13; Default||Not reimbursed separately|1,313.25|FSC: 13; Default||External grouping not supported 95116539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Mod Cocr 28mm-3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95188456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 11mm X 420mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95116540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Mod. Cocr 28mm-6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95116545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 10 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95185462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Ncb 5.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|FSC: 13; Default||Not reimbursed separately|425.19|FSC: 13; Default||External grouping not supported 95116546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 14 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95116548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 4 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95185460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95116550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 10 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95188458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cannulated 4.0 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95116552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 14 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95185458|EAP|Custom 95185458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Touhy Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 4 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Hgpii Size-f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|FSC: 13; Default||Not reimbursed separately|1,681.68|FSC: 13; Default||External grouping not supported 95185463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Cerclage W/crimp 1.8 36in Cable-ready|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.36|FSC: 13; Default||Not reimbursed separately|1,206.36|FSC: 13; Default||External grouping not supported 95116561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Elevated-rim 28mm Size-g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|FSC: 13; Default||Not reimbursed separately|1,681.68|FSC: 13; Default||External grouping not supported 95116562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 10-deg. 50x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95188457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tfna 100 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|FSC: 13; Default||Not reimbursed separately|2,062.98|FSC: 13; Default||External grouping not supported 95116563|EAP|Custom 95116563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermodilution S-tip 7f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116567|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 10 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95185468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 4.5 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95116571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95116572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95188464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Canc Lock 4.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95116573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 8 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95185469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Constrained Dcm Max 22 X79/83|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,387.00|FSC: 13; Default||Not reimbursed separately|9,387.00|FSC: 13; Default||External grouping not supported 95116575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 10 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95116578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95185470|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Aspheric Multifocal 23.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95116579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 8 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95116580|EAP|Custom 95116580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Transfer Micromix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Im Left 12mmx40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,003.55|FSC: 13; Default||Not reimbursed separately|2,003.55|FSC: 13; Default||External grouping not supported 95116664|EAP|Custom 95116664||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Cortical 11mm Hex 8mm.|1|HUMANA [1294]||HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 95188469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mmxl38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95116666|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Malleable 650 20cm V13mm Fg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95116667|EAP|Custom 95116667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress 1.8mm X 16mm Titani|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-.1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95181329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Insert Tibial Poly Crosslinked Prolong Tm Size5 Gr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|FSC: 13; Default||Not reimbursed separately|4,575.00|FSC: 13; Default||External grouping not supported 95116670|EAP|Custom 95116670||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Lp|1|HUMANA [1294]||HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95181347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Narrow 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,287.66|FSC: 13; Default||Not reimbursed separately|4,287.66|FSC: 13; Default||External grouping not supported 95181327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Talar Ankle Total Metal Trabecular Zimmer Size 5 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 95116672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.98|FSC: 13; Default||Not reimbursed separately|4,630.98|FSC: 13; Default||External grouping not supported 95181350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Standard 7 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,792.25|FSC: 13; Default||Not reimbursed separately|2,792.25|FSC: 13; Default||External grouping not supported 95116673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,801.02|FSC: 13; Default||Not reimbursed separately|4,801.02|FSC: 13; Default||External grouping not supported 95181328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Base Tibial Ankle Total Tm Size 5 Green|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|FSC: 13; Default||Not reimbursed separately|12,150.00|FSC: 13; Default||External grouping not supported 95116674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95181334|EAP|Custom 95181334||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cutter Flip Ll 9.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 55 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95116677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95181352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Wide 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|FSC: 13; Default||Not reimbursed separately|408.00|FSC: 13; Default||External grouping not supported 95181345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Narrow 3 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Orbita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|FSC: 13; Default||Not reimbursed separately|516.00|FSC: 13; Default||External grouping not supported 95181349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Standard 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Posterior Size-d 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95181331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Locking 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,843.20|FSC: 13; Default||Not reimbursed separately|1,843.20|FSC: 13; Default||External grouping not supported 95116681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior 5mm (rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95181353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Wide 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Femoral Posterior 5mm Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95181351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Standard 7 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,792.25|FSC: 13; Default||Not reimbursed separately|2,792.25|FSC: 13; Default||External grouping not supported 95116683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Post Precoat Szg5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95181330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95116685|EAP|Custom 95116685||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Angled-blade|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95181333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Vitallium Triathlon 30 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95116686|EAP|Custom 95116686||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Extended-body|1|HUMANA [1294]||HUMANA [11839]|3,792.60|FSC: 13; Default||Not reimbursed separately|3,792.60|FSC: 13; Default||External grouping not supported 95181332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Fixation Screw Triathlon Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,222.00|FSC: 13; Default||Not reimbursed separately|6,222.00|FSC: 13; Default||External grouping not supported 95116687|EAP|Custom 95116687||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Narrow-blade|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95181348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Narrow 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116688|EAP|Custom 95116688||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Narrow-blade Sma|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95181346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Narrow 3 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|FSC: 13; Default||Not reimbursed separately|2,537.25|FSC: 13; Default||External grouping not supported 95116689|EAP|Custom 95116689||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Wide-blade Small|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95116690|EAP|Custom 95116690||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Extended-body Sm|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 80168693|EAP|CPT® 92612||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Flexible Fiberoptic Endo Eval Of Swallowing By Cine Or Video Record|1|HUMANA [1294]||HUMANA [11839]|553.59|FSC: 13; Default||Not reimbursed separately|553.59|FSC: 13; Default||External grouping not supported 95116691|EAP|Custom 95116691||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Narrow-blade Sma|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95116692|EAP|Custom 95116692||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Narrow-blade Ram|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95188461|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Occulsion 10 Fr X .035 Diameter X 140 Cm-46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116693|EAP|Custom 95116693||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Wide-blade Small|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 80168701|EAP|CPT® 92616||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Flex Fiber Endo Eval Swallow Laryn Sens Cine Or Video|1|HUMANA [1294]||HUMANA [11839]|606.21|FSC: 13; Default||Not reimbursed separately|606.21|FSC: 13; Default||External grouping not supported 95116694|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116695|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116696|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116697|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95181315|EAP|Custom 95181315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology Triple Needle 10 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95181384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95181375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 20 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181367|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Crescent 300cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95116708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 25 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 30 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 35 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 40 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +0mm 27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95116712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 45 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long 1.5 Titanium Right 11 X 420mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95116713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 50 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95181361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|FSC: 13; Default||Not reimbursed separately|165.75|FSC: 13; Default||External grouping not supported 95116714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 1.5 X.12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95116715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95116716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Shape Lock 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.25|FSC: 13; Default||Not reimbursed separately|1,211.25|FSC: 13; Default||External grouping not supported 95116719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 1.5 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95116720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|FSC: 13; Default||Not reimbursed separately|359.10|FSC: 13; Default||External grouping not supported 95181369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95181380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95181363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 1.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95116723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95181370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95181354|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Guide Swartz Slo 81cm 8.5 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95181378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95181376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 95116728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 6.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|FSC: 13; Default||Not reimbursed separately|1,216.23|FSC: 13; Default||External grouping not supported 80168685|EAP|CPT® 64640||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Destruction By Neurolytic Agent; Other Peripheral Nerve Or Branch|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95116729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert 26mm Scaphoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|FSC: 13; Default||Not reimbursed separately|810.84|FSC: 13; Default||External grouping not supported 95116730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Herbert 24mm Wh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|FSC: 13; Default||Not reimbursed separately|1,285.44|FSC: 13; Default||External grouping not supported 95116731|EAP|Custom 95116731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Electrode Xtd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mmxl30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95116732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 95116733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 95116734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 95116735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x35 Multiaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 95181418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multiazial 6.5x50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 95181387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95129884|EAP|Custom 95129884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Standard 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181449|EAP|Custom 95181449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Standard Tip .9mm X 152mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181448|EAP|Custom 95181448||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Inside 2.7mm Outside 5.0mm|1|HUMANA [1294]||HUMANA [11839]|127.50|FSC: 13; Default||Not reimbursed separately|127.50|FSC: 13; Default||External grouping not supported 95116769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181451|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 22fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181462|EAP|Custom 95181462||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Leg Freedom With Hook And Loop 6 Ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95181394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116779|EAP|Custom 95116779||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tendon Hunter 4mm|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95181401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116780|EAP|Custom 95116780||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tendon Hunter 5mm|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95181405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 11 X 123 Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 12 X 130 Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,692.50|FSC: 13; Default||Not reimbursed separately|8,692.50|FSC: 13; Default||External grouping not supported 95181424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 13 X 135 Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 14 X 144 Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|379.95|FSC: 13; Default||Not reimbursed separately|379.95|FSC: 13; Default||External grouping not supported 95116785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 15 X 145 Lig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 17 X 156 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 11 X 123 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 12 X 130 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Porous 17x156st Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 14 X 144 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 16 X 148 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Locking Cannualted Cocr 2.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|FSC: 13; Default||Not reimbursed separately|446.25|FSC: 13; Default||External grouping not supported 95116792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Porous 17x156st Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95181417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Versys Beaded Sz-14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|FSC: 13; Default||Not reimbursed separately|11,457.72|FSC: 13; Default||External grouping not supported 95181441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extention Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|FSC: 13; Default||Not reimbursed separately|4,350.54|FSC: 13; Default||External grouping not supported 95181395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95116818|EAP|Custom 95116818||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink X-10|1|HUMANA [1294]||HUMANA [11839]|4,287.66|FSC: 13; Default||Not reimbursed separately|4,287.66|FSC: 13; Default||External grouping not supported 95181416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Non-locking 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116819|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Jagwire .025|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95181450|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 31mm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|FSC: 13; Default||Not reimbursed separately|49,500.00|FSC: 13; Default||External grouping not supported 95116821|EAP|Custom 95116821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Electrode Axs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking High Compression 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116823|EAP|Custom 95116823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Precise|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181420|EAP|Custom 95181420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Brk Transseptal 89cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116824|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Bifurcated 13.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95181397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116826|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Bifurcated 16.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,650.00|FSC: 13; Default||Not reimbursed separately|22,650.00|FSC: 13; Default||External grouping not supported 95181434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem #5 Accolade Plus Tmzf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,005.00|FSC: 13; Default||Not reimbursed separately|13,005.00|FSC: 13; Default||External grouping not supported 95181442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95116830|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95185472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Hinge Rotating Right Size D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|FSC: 13; Default||Not reimbursed separately|28,485.00|FSC: 13; Default||External grouping not supported 95116832|EAP|Custom 95116832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Capsule Ph Bravo W/delivery Sysm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116833|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-limb 11.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,275.00|FSC: 13; Default||Not reimbursed separately|7,275.00|FSC: 13; Default||External grouping not supported 95181468|EAP|Custom 95181468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Brk Xs Transseptal 18g 71cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116835|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 16x60 9fr C1039|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.27|FSC: 13; Default||Not reimbursed separately|2,889.27|FSC: 13; Default||External grouping not supported 95181469|EAP|Custom 95181469||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Envelope Pacemaker Antibacterial Aigis R Med|1|HUMANA [1294]||HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95116838|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 8 Fr X 20 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95181470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.7mm X 40mm Full Thread Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95116839|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Usg/8/24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95181471|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95116852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95116854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95116855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95116856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95116857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95116858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95116859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 62062231|EAP|CPT® 81050||0307 - LABORATORY - UROLOGY|Hb Urine Volume Measurement, Timed Coll -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.92|FSC: 13; Default||Not reimbursed separately|10.92|FSC: 13; Default||External grouping not supported 95116860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 62062242|EAP|CPT® 81377||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Narcolepsy Hla Dna -ref Lab|1|HUMANA [1294]||HUMANA [11839]|284.22|FSC: 13; Default||Not reimbursed separately|284.22|FSC: 13; Default||External grouping not supported 95116861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 62062253|EAP|CPT® 81400||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Plasminogen Activator Inhibitor -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.88|FSC: 13; Default||Not reimbursed separately|191.88|FSC: 13; Default||External grouping not supported 95116862|EAP|Custom 95116862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Pusher|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062264|EAP|CPT® 82656||0301 - LABORATORY - CHEMISTRY|Hb Pancreatic Elastase -ref Lab|1|HUMANA [1294]||HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95116863|EAP|Custom 95116863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Vortex 2x4cm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062275|EAP|CPT® 83993||0301 - LABORATORY - CHEMISTRY|Hb Calprotectin -ref Lab|1|HUMANA [1294]||HUMANA [11839]|58.89|FSC: 13; Default||Not reimbursed separately|58.89|FSC: 13; Default||External grouping not supported 95116870|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Cardioverter Defibrillator Impla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,065.00|FSC: 13; Default||Not reimbursed separately|43,065.00|FSC: 13; Default||External grouping not supported 62062286|EAP|CPT® 85247||0305 - LABORATORY - HEMATOLOGY|Hb Vw Factor, Factor Viii -ref Lab|1|HUMANA [1294]||HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 95116871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Shoulder Fracture 6.5 Torni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95116875|EAP|Custom 95116875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Gastric Lavage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062297|EAP|CPT® 86343||0302 - LABORATORY - IMMUNOLOGY|Hb Histamine Release (cu) -ref Lab|1|HUMANA [1294]||HUMANA [11839]|37.38|FSC: 13; Default||Not reimbursed separately|37.38|FSC: 13; Default||External grouping not supported 95116878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral 43x16 Tornier|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.00|FSC: 13; Default||Not reimbursed separately|3,570.00|FSC: 13; Default||External grouping not supported 62062308|EAP|CPT® 87254||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Viral Culture -ref Lab|1|HUMANA [1294]||HUMANA [11839]|58.68|FSC: 13; Default||Not reimbursed separately|58.68|FSC: 13; Default||External grouping not supported 95116882|EAP|Custom 95116882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Divider/sealer V Ligasure Emm La|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062319|EAP|CPT® 87633||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Respiratory Virus -ref Lab|1|HUMANA [1294]||HUMANA [11839]|1,250.34|FSC: 13; Default||Not reimbursed separately|1,250.34|FSC: 13; Default||External grouping not supported 62062320|EAP|CPT® 87799||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Ebv Quant Pcr -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 95116886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Rc Ultrafix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 62062331|EAP|CPT® 88271||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Molecular Cytogenics, Dna Probe -ref Lab|1|HUMANA [1294]||HUMANA [11839]|64.26|FSC: 13; Default||Not reimbursed separately|64.26|FSC: 13; Default||External grouping not supported 95116894|EAP|Custom 95116894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode/cord Ligasure Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062342|EAP|CPT® 88275||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Interphase Hybrid, 100-300 Cells -ref Lab|1|HUMANA [1294]||HUMANA [11839]|153.57|FSC: 13; Default||Not reimbursed separately|153.57|FSC: 13; Default||External grouping not supported 62062353|EAP|CPT® 86022||0302 - LABORATORY - IMMUNOLOGY|Hb Platelet Glycoprotein Ab -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 95116900|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Xxl/14-4/5.8/75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62062364|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Mpo (anca) Ab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95116903|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 62062375|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Pr3 (anca) Ab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95116904|EAP|Custom 95116904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Set Liver Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062386|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb B Pertussis Amp Probe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95116905|EAP|Custom 95116905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hi-flo Headhunter Hbp 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062397|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb B Parapertussis Amp Probe -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95116908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Rc Ultrafix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|535.65|FSC: 13; Default||Not reimbursed separately|535.65|FSC: 13; Default||External grouping not supported 62062408|EAP|CPT® 86147||0302 - LABORATORY - IMMUNOLOGY|Hb Cardiolipin Iga - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.35|FSC: 13; Default||Not reimbursed separately|76.35|FSC: 13; Default||External grouping not supported 95116910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Lt Tibial Conforming Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 62062419|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hb Endomysial Screen -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95116911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lt Sz-6 Oxinium Profix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 62062420|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hb Dna Ab -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95116913|EAP|Custom 95116913||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Seal Cohesive Eakin Small 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062431|EAP|CPT® 82670||0301 - LABORATORY - CHEMISTRY|Hb Estradiol Ultrasensitive -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.82|FSC: 13; Default||Not reimbursed separately|83.82|FSC: 13; Default||External grouping not supported 95116916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non Porous Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 62062442|EAP|CPT® 89125||0309 - LABORATORY - OTHER LABORATORY|Hb Fecal Fat Qual -ref Lab|1|HUMANA [1294]||HUMANA [11839]|17.64|FSC: 13; Default||Not reimbursed separately|17.64|FSC: 13; Default||External grouping not supported 62062453|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hb Iga, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 95116922|EAP|Custom 95116922||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Porp Black Oval T|1|HUMANA [1294]||HUMANA [11839]|1,148.10|FSC: 13; Default||Not reimbursed separately|1,148.10|FSC: 13; Default||External grouping not supported 95185473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating Size D 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|FSC: 13; Default||Not reimbursed separately|6,255.00|FSC: 13; Default||External grouping not supported 95116926|EAP|Custom 95116926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062464|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hb Iga, Csf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 95116928|EAP|Custom 95116928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062475|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hb Igm, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 95116929|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Internal Mammary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62062486|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hb Igm, Csf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62062497|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Norovirus, Amp Probe -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95116933|EAP|Custom 95116933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.oscillating 34 X 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062508|EAP|CPT® 80183||0301 - LABORATORY - CHEMISTRY|Hb Oxcarbezine Metabolite - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 62062519|EAP|CPT® 80171||0301 - LABORATORY - CHEMISTRY|Hb Gabapentin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|65.01|FSC: 13; Default||Not reimbursed separately|65.01|FSC: 13; Default||External grouping not supported 95116940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Poly Profix Onset 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 95116941|EAP|Custom 95116941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Epicardial Lead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116942|EAP|Custom 95116942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Aortic Perfussion Angled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 28.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|128.58|FSC: 13; Default||Not reimbursed separately|128.58|FSC: 13; Default||External grouping not supported 95181487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 36.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.72|FSC: 13; Default||Not reimbursed separately|786.72|FSC: 13; Default||External grouping not supported 95181495|EAP|Custom 95181495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Tip Pin 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Chs 4-slot 135-deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,098.24|FSC: 13; Default||Not reimbursed separately|1,098.24|FSC: 13; Default||External grouping not supported 95181493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95116950|EAP|Custom 95116950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Incision Silastic H.p.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181494|EAP|Custom 95181494||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Tip Pin 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116952|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz-coated Floppy-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181472|EAP|Custom 95181472||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Polyaxial Locking Screw 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Free Drill 2.0x5mm Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 95181497|EAP|Custom 95181497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Bone Cannulated 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181496|EAP|Custom 95181496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95116956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Free Drill 2.0x7mm Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 95181498|EAP|Custom 95181498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Bone Cannulated 6.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 24.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116960|EAP|Custom 95116960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1/32 Inch Threade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 40.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116962|EAP|Custom 95116962||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bag Ats Blood 600ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 18.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0x13mm Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95181485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 32.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95181499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 4.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95181501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Precept 6.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95116975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0x15mm Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95181476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 14.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.3x7mm Emergency Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 95181500|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8f .088 Al 1 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L-shape Long Rt Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95181480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 22.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116981|EAP|Custom 95116981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Transducer Pressure Monitoring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 34.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95181491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95116983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L-shape Long Lt Kls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95181477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 16.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 61mm 5 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|214.80|FSC: 13; Default||Not reimbursed separately|214.80|FSC: 13; Default||External grouping not supported 95181482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 26.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Beaded Fc 18x200 Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,119.36|FSC: 13; Default||Not reimbursed separately|19,119.36|FSC: 13; Default||External grouping not supported 95181502|EAP|Custom 95181502||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr Wide 10x22x60mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95116997|EAP|Custom 95116997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide-pin Trocar Tip Part Thread|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 8.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95116998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0x32 Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95181492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95117001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self-tapping 4.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95188471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Sz 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|FSC: 13; Default||Not reimbursed separately|8,016.75|FSC: 13; Default||External grouping not supported 95117004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 60mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95181474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Geminus Hook Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.40|FSC: 13; Default||Not reimbursed separately|224.40|FSC: 13; Default||External grouping not supported 95117005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 62mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95181488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 38.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95117006|EAP|Custom 95117006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Microtip Mv Abs 30k|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biorci Ha 7 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|833.85|FSC: 13; Default||Not reimbursed separately|833.85|FSC: 13; Default||External grouping not supported 95117007|EAP|Custom 95117007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Vitrectomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Geminus Hook|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|FSC: 13; Default||Not reimbursed separately|1,262.25|FSC: 13; Default||External grouping not supported 95117009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 64mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95181484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 30.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95117031|EAP|Custom 95117031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Valve Cutter In Situ Leather|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Va Low Profile 2.4mm X 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95117032|EAP|Custom 95117032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 1.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95117033|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Mycro 15cm X 19cm Oval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117034|EAP|Custom 95117034||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Vent Armstrong Beveled|1|HUMANA [1294]||HUMANA [11839]|41.78|FSC: 13; Default||Not reimbursed separately|41.78|FSC: 13; Default||External grouping not supported 95117036|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 Fr .088 Hockeym|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117037|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Guiding Veri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117041|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80166960|EAP|CPT® 32160||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Thoracotomy W Cardiac Massage Emergency|1|HUMANA [1294]||HUMANA [11839]|3,955.50|FSC: 13; Default||Not reimbursed separately|3,955.50|FSC: 13; Default||External grouping not supported 95117042|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 5.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117043|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181530|EAP|Custom 95181530||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14 X 38 X 32mm 8 Degree|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95117072|EAP|Custom 95117072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Triadapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 5.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117106|EAP|Custom 95117106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dilator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181526|EAP|Custom 95181526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Removal Tissue Myosure Xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117107|EAP|Custom 95117107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligator Speedband Superview Supe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181505|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8f .088 Al 2 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117108|EAP|Custom 95117108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Multibite 240cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181524|EAP|Custom 95181524||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Load 1.2 Grams Platinum|1|HUMANA [1294]||HUMANA [11839]|1,245.00|FSC: 13; Default||Not reimbursed separately|1,245.00|FSC: 13; Default||External grouping not supported 95117109|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Retrieval 8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 6.0mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117110|EAP|Custom 95117110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181504|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Percutaneous Trial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95117111|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 10 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95181529|EAP|Custom 95181529||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Gracilis|1|HUMANA [1294]||HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95117112|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 10 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95181516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 5.5mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117113|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95181528|EAP|Custom 95181528||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Bioccleanse Achilles Preshaped With Calcaneus|1|HUMANA [1294]||HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95117114|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95181512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 5.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117115|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Jagwire .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 6.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 7.5mm X 205mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95181518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 6.0mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 7.5x220|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95181525|EAP|Custom 95181525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Removal Tissue Lite Myosure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 7.5x230|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,684.00|FSC: 13; Default||Not reimbursed separately|3,684.00|FSC: 13; Default||External grouping not supported 95181507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 4.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Distal Femoral 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95181509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 4.5mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Ti-distal 13mm 200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95181511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 5.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Distal Femoral 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 95181515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 5.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|FSC: 13; Default||Not reimbursed separately|3,051.00|FSC: 13; Default||External grouping not supported 95181520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 6.0mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Ti-distal 13mm 360m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,312.00|FSC: 13; Default||Not reimbursed separately|3,312.00|FSC: 13; Default||External grouping not supported 95181522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 6.0mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 95181517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Partial Thread Ti 6.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95117125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mm X 270mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95181523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,017.00|FSC: 13; Default||Not reimbursed separately|1,017.00|FSC: 13; Default||External grouping not supported 95117126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mm X 285mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95181590|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95117127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mm X 315mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|FSC: 13; Default||Not reimbursed separately|1,845.00|FSC: 13; Default||External grouping not supported 95117128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mm X 400mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95117129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 270mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95117130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 300mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95181534|EAP|Custom 95181534||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Revolve Fat Transfer System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 9x230mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,684.00|FSC: 13; Default||Not reimbursed separately|3,684.00|FSC: 13; Default||External grouping not supported 95181533|EAP|HCPCS 95181533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ablation 5 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|FSC: 13; Default||Not reimbursed separately|2,312.64|FSC: 13; Default||External grouping not supported 95181531|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Classic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|FSC: 13; Default||Not reimbursed separately|2,597.22|FSC: 13; Default||External grouping not supported 95117134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 380|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,255.04|FSC: 13; Default||Not reimbursed separately|2,255.04|FSC: 13; Default||External grouping not supported 95117135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral 14x400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 95117136|EAP|Custom 95117136||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve 120-degree|1|HUMANA [1294]||HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95117137|EAP|Custom 95117137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Reaming 3.0mm 950mm With Off|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117139|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Smooth 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117140|EAP|Custom 95117140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round-cutting-carbide 1.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp 2.0mm X 42mm 8 Hole 1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95117142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp Tit. 2.0mm 7-hole C171|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.00|FSC: 13; Default||Not reimbursed separately|474.00|FSC: 13; Default||External grouping not supported 95117143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp 2.0mm X 22mm 4 Hole 1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|FSC: 13; Default||Not reimbursed separately|396.00|FSC: 13; Default||External grouping not supported 95117144|EAP|Custom 95117144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 4 French X 100cmi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117145|EAP|Custom 95117145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117146|EAP|Custom 95117146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117149|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Cross It 190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117152|EAP|Custom 95117152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117153|EAP|Custom 95117153||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117154|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Right 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117155|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Left 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117156|EAP|Custom 95117156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117166|EAP|Custom 95117166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 85mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117167|EAP|Custom 95117167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 90mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 15mm 20mm Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95117169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 12mm 20mm Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95117170|EAP|Custom 95117170||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Harpoon Suture Size-2|1|HUMANA [1294]||HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95117171|EAP|Custom 95117171||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable 1.7mm W/crimp 750mm|1|HUMANA [1294]||HUMANA [11839]|1,590.87|FSC: 13; Default||Not reimbursed separately|1,590.87|FSC: 13; Default||External grouping not supported 95181575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117172|EAP|Custom 95117172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteoset Pellet 10cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117173|EAP|Custom 95117173||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteoset Pellet 20cc|1|HUMANA [1294]||HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 95181565|EAP|Custom 95181565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117174|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Smoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95181574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117175|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95181556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117176|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Smoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95181545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117177|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95181551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117178|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Text|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95181563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117179|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Round Textured Style-168|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95181570|EAP|Custom 95181570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Trocar Tip Threaded .034 .86mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 66mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95181567|EAP|Custom 95181567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Profile Micro Compression Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95181580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95181542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117186|EAP|Custom 95117186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pigtail 4 Fr 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95181571|EAP|Custom 95181571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Trocar Tip .045 1.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117189|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Standard .035 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117190|EAP|Custom 95117190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kumpe 5fr Hnbr5.0-38-40|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117193|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Torque Olcott|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 25mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95181587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 24mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95181546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 28mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95181559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95181569|EAP|Custom 95181569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Trocar Tip .034 .86mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117200|EAP|Custom 95117200||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Holding 1.25mm|1|HUMANA [1294]||HUMANA [11839]|2,494.83|FSC: 13; Default||Not reimbursed separately|2,494.83|FSC: 13; Default||External grouping not supported 95181576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117201|EAP|Custom 95117201||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Holding 1.6mm|1|HUMANA [1294]||HUMANA [11839]|2,494.83|FSC: 13; Default||Not reimbursed separately|2,494.83|FSC: 13; Default||External grouping not supported 95181577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117202|EAP|Custom 95117202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mm X 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117203|EAP|Custom 95117203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Carbon Fiber 8.0mm X 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117204|EAP|Custom 95117204||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Connecting 3.0mm X 3.0mm|1|HUMANA [1294]||HUMANA [11839]|2,320.17|FSC: 13; Default||Not reimbursed separately|2,320.17|FSC: 13; Default||External grouping not supported 95181582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117205|EAP|Custom 95117205||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Connecting 3.0mm X 4.0mm|1|HUMANA [1294]||HUMANA [11839]|2,320.17|FSC: 13; Default||Not reimbursed separately|2,320.17|FSC: 13; Default||External grouping not supported 95181585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95181561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117210|EAP|Custom 95117210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Biopsy-port F Adapter- Valv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181572|EAP|Custom 95181572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Trocar Tip Threaded .045 1.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117212|EAP|Custom 95117212||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Centering Fem 12mm|1|HUMANA [1294]||HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95181553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fracture Femoral 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,461.00|FSC: 13; Default||Not reimbursed separately|4,461.00|FSC: 13; Default||External grouping not supported 95181573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bi-polar Ringloc 28x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95181557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117215|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Sali|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95181560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,017.00|FSC: 13; Default||Not reimbursed separately|1,017.00|FSC: 13; Default||External grouping not supported 95117216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Carving Oval Testicular S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95181566|EAP|Custom 95181566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 2.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95181562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95181568|EAP|Custom 95181568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Profile Mini Compression Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117225|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8fr Non-locking Apd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 52mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,147.11|FSC: 13; Default||Not reimbursed separately|1,147.11|FSC: 13; Default||External grouping not supported 95181547|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Main Custom Bifurcated Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95117229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Hip 32mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|FSC: 13; Default||Not reimbursed separately|3,145.80|FSC: 13; Default||External grouping not supported 95181541|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117232|EAP|Custom 95117232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ptd 5frx65cm W/fragment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117234|EAP|Custom 95117234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Harvester Graft Bone 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117235|EAP|Custom 95117235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Peripheral 2.7mm(8fr.)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base Tibial N/p Sz-2+ No C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|FSC: 13; Default||Not reimbursed separately|4,695.00|FSC: 13; Default||External grouping not supported 95181554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Single-post Sx-32mm No C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95181555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117238|EAP|Custom 95117238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Flexible Ureteroscopy 18f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117240|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilation Xxl/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti Cannulated Full Threaded 6.7mm X 115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95117241|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sos Omni 5 Fr (2).03580|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181589|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95181543|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Micro Headless Comp Ft Cannulated Ti 2.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95117249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.0mmx1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95181588|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ii Amplatzer 18 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Headless Comp Ft Cannulated Ti 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95117251|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Arterial Embolectomy Fogart|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62062551|EAP|CPT® 84075||0301 - LABORATORY - CHEMISTRY|Hb Bone Specific Alk Phos - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95117254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 62062562|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hb Alpha Subunit -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 95117259|EAP|Custom 95117259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 32 French Broncho Cath Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062584|EAP|CPT® 83520||0302 - LABORATORY - IMMUNOLOGY|Hb Gliadin Peptide Igg -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62062595|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Gliadin Peptide Iga -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62062606|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hb Glutamic Acid Decarboxylase Ab -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 62062617|EAP|CPT® 80177||0301 - LABORATORY - CHEMISTRY|Hb Keppra Levetiracetam -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 95117286|EAP|Custom 95117286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062628|EAP|CPT® 80175||0301 - LABORATORY - CHEMISTRY|Hb Lamictal (lamotrigine) -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 95117287|EAP|Custom 95117287||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Esophageal Set 8.4|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95185475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Size 3 10 Mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,107.50|FSC: 13; Default||Not reimbursed separately|5,107.50|FSC: 13; Default||External grouping not supported 95117291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patella 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 62062639|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Mag Ab Igm -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 95117292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Porous Non Profix Ri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 62062641|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hb Mitochondrial M2 Ab Igg -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95117293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Right Conforming Sz-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 62062651|EAP|CPT® 82656||0301 - LABORATORY - CHEMISTRY|Hb Elastase, Pancreatic -ref Lab|1|HUMANA [1294]||HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62062662|EAP|CPT® 82542||0301 - LABORATORY - CHEMISTRY|Hb Sulfonylurea Hypoglycemics, Urine -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.27|FSC: 13; Default||Not reimbursed separately|72.27|FSC: 13; Default||External grouping not supported 95117295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lt Sz-4 14mm Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 62062673|EAP|CPT® 84403||0301 - LABORATORY - CHEMISTRY|Hb Testosterone, Total -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|FSC: 13; Default||Not reimbursed separately|77.43|FSC: 13; Default||External grouping not supported 95117298|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Esophageal Max-force 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95117300|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 7 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 62062684|EAP|CPT® 86780||0302 - LABORATORY - IMMUNOLOGY|Hb Trep Pallidum, Pa -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 95117301|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 7 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95181623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 13mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117302|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 10 X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95181596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Perimeter Fracture Calcaneal M Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117303|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|487.89|FSC: 13; Default||Not reimbursed separately|487.89|FSC: 13; Default||External grouping not supported 95181601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Fracture Anterior Proc Post Tuber Long Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117305|EAP|Custom 95117305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 125c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117316|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Anterior Process Long Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,772.55|FSC: 13; Default||Not reimbursed separately|4,772.55|FSC: 13; Default||External grouping not supported 95181604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Anterior Process Long Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117318|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117319|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117320|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Smart 2.4mm X25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|FSC: 13; Default||Not reimbursed separately|408.99|FSC: 13; Default||External grouping not supported 95117321|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 18mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95117322|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 Fr Al2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 12mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117323|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 18mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117324|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117325|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Jr35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 14mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117326|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 18mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117327|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117328|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Hockeystick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 14mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117329|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Internal Mammary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 16mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117331|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Rcb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 10mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117332|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 11mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117333|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Perimeter Fracture Calcaneal L Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117334|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 13mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117336|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Fracture Anterior Proc Post Tuber Std Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117337|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 11mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117338|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117342|EAP|Custom 95117342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Injection Rapid-refill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 11mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117343|EAP|Custom 95117343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ultratome Double-lumen-sphinc-tl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117346|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95181630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117347|EAP|Custom 95117347||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Pushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117348|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 10mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117356|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Cro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181548|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95117358|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Leonard 10 French.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 20mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117360|EAP|Custom 95117360||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Plus Percuflex 4.8 X 24|1|HUMANA [1294]||HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95117361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 242mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,123.91|FSC: 13; Default||Not reimbursed separately|5,123.91|FSC: 13; Default||External grouping not supported 95181615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 12mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117364|EAP|Custom 95117364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 180gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117370|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 14mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117371|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 16x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,191.76|FSC: 13; Default||Not reimbursed separately|3,191.76|FSC: 13; Default||External grouping not supported 95181632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95181618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Persona 16mm Ve Rt Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117376|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 16mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117377|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Perimeter Fracture Calcaneal S Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117378|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Right 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Fracture Anterior Proc Post Tuber Std Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117379|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Left 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117382|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Anterior Process Std Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117391|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117392|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 13mm Ve Rt Fem9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117393|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 24mm For I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|FSC: 13; Default||Not reimbursed separately|583.20|FSC: 13; Default||External grouping not supported 95181629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 12mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117401|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast 400cc Sty|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95117405|EAP|Custom 95117405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cuff Catheter Percufix 10/bo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Perimeter Fracture Calcaneal Xs Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95117417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm X 18mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.37|FSC: 13; Default||Not reimbursed separately|179.37|FSC: 13; Default||External grouping not supported 95181627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uc Persona 10mm Ve Left Fem 9-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117418|EAP|Custom 95117418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117424|EAP|HCPCS A6154||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Wound Manager Up To 4 X 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Tibia Hinge Rotating Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|FSC: 13; Default||Not reimbursed separately|14,130.00|FSC: 13; Default||External grouping not supported 95117425|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Hickman 10fr Triple Luv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|934.38|FSC: 13; Default||Not reimbursed separately|934.38|FSC: 13; Default||External grouping not supported 95117433|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Straight 12mmx6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.63|FSC: 13; Default||Not reimbursed separately|1,539.63|FSC: 13; Default||External grouping not supported 95117434|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Compact Pices Quad C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,170.00|FSC: 13; Default||Not reimbursed separately|4,170.00|FSC: 13; Default||External grouping not supported 95117439|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer 9fr 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117440|EAP|Custom 95117440||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Grafton Dbm 5cc|1|HUMANA [1294]||HUMANA [11839]|1,680.00|FSC: 13; Default||Not reimbursed separately|1,680.00|FSC: 13; Default||External grouping not supported 95117441|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoure 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95117442|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Spectrum Contoued|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95117443|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 80166978|EAP|Custom 80166978||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Hospice Daily Supply & Equipment Per Diem|1|HUMANA [1294]||HUMANA [11839]|40.00|FSC: 13; Default||Not reimbursed separately|40.00|FSC: 13; Default||External grouping not supported 95117444|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Spectrum Textured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95181641|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Glidelight Excimer Sls Ii 16 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95181640|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Glidelight Excimer Sls Ii 14 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117450|EAP|Custom 95117450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Spiral 5fr 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117451|EAP|Custom 95117451||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Piston Tef-platinum|1|HUMANA [1294]||HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95117452|EAP|Custom 95117452||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Total Ossicular R|1|HUMANA [1294]||HUMANA [11839]|768.00|FSC: 13; Default||Not reimbursed separately|768.00|FSC: 13; Default||External grouping not supported 95181642|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reveal Linq System|1|HUMANA [1294]||HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95117454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95117457|EAP|Custom 95117457||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pumpset Angiojet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181644|EAP|Custom 95181644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12x38x28mm 12degree|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95117459|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Megalink 28mm|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95181645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 3 Level 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95117461|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vasoseal #7 Orange 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95181646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation Trinica|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95117466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95117468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 65mm Rt Ps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,846.00|FSC: 13; Default||Not reimbursed separately|6,846.00|FSC: 13; Default||External grouping not supported 95181643|EAP|Custom 95181643||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Set Impella Cp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial P.s. 10x71/75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95181647|EAP|Custom 95181647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Set Impella Aic 5.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117522|EAP|Custom 95117522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.fen-5.0 90de|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117523|EAP|Custom 95117523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Mini Forcep 110gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117525|EAP|Custom 95117525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Mini Forcep 110gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117526|EAP|Custom 95117526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 200gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166994|EAP|CPT® 92987||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Mitral Valvuloplasty|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95117527|EAP|Custom 95117527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.fen-5.0 90de|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117533|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ironman 190cm C1769|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95117536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 16mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.81|FSC: 13; Default||Not reimbursed separately|54.81|FSC: 13; Default||External grouping not supported 95188478|EAP|Custom 95188478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide .062 1.6mm X 9.25"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 18mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.10|FSC: 13; Default||Not reimbursed separately|56.10|FSC: 13; Default||External grouping not supported 95117539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Universal Cancellous Aceta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 95185478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95117548|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Graphix 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117551|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Extra Support .014 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117552|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Extension Cinch Qr .01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 20mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.10|FSC: 13; Default||Not reimbursed separately|56.10|FSC: 13; Default||External grouping not supported 95185479|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Ip Mri Pr Protege|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,400.00|FSC: 13; Default||Not reimbursed separately|47,400.00|FSC: 13; Default||External grouping not supported 95117559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Right Stainl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|FSC: 13; Default||Not reimbursed separately|1,242.00|FSC: 13; Default||External grouping not supported 95117560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,244.16|FSC: 13; Default||Not reimbursed separately|1,244.16|FSC: 13; Default||External grouping not supported 95188477|EAP|Custom 95188477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Acutrak 2 - 4.7 Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Proximal 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,824.00|FSC: 13; Default||Not reimbursed separately|1,824.00|FSC: 13; Default||External grouping not supported 95117564|EAP|Custom 95117564||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 300mm|1|HUMANA [1294]||HUMANA [11839]|276.15|FSC: 13; Default||Not reimbursed separately|276.15|FSC: 13; Default||External grouping not supported 95185476|EAP|Custom 95185476||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Achilles Flexigraft With Bone|1|HUMANA [1294]||HUMANA [11839]|5,410.89|FSC: 13; Default||Not reimbursed separately|5,410.89|FSC: 13; Default||External grouping not supported 95117565|EAP|Custom 95117565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grasping Coaxial-sheathfr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117566|EAP|Custom 95117566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Gemini 4mmx5frx90cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117567|EAP|Custom 95117567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Kidney Biopsy 040020 Middl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117568|EAP|Custom 95117568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Kidney Biopsy 040030 Lower|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117571|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Dual-flex Sensor .035t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 22mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.50|FSC: 13; Default||Not reimbursed separately|58.50|FSC: 13; Default||External grouping not supported 95188475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 2- 4.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.00|FSC: 13; Default||Not reimbursed separately|1,359.00|FSC: 13; Default||External grouping not supported 95117583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vsp Bone 1-slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,709.00|FSC: 13; Default||Not reimbursed separately|2,709.00|FSC: 13; Default||External grouping not supported 95117584|EAP|Custom 95117584||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 5mm|1|HUMANA [1294]||HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95185482|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Tecnis Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95117585|EAP|Custom 95117585||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Plate Tapered|1|HUMANA [1294]||HUMANA [11839]|117.00|FSC: 13; Default||Not reimbursed separately|117.00|FSC: 13; Default||External grouping not supported 95117587|EAP|Custom 95117587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Clyburn Colles|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 5.5mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95117589|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage 8 Fr Apdg/8/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,933.00|FSC: 13; Default||Not reimbursed separately|9,933.00|FSC: 13; Default||External grouping not supported 95117591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 24mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.89|FSC: 13; Default||Not reimbursed separately|52.89|FSC: 13; Default||External grouping not supported 95117593|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95188476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 2- 4.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.00|FSC: 13; Default||Not reimbursed separately|1,359.00|FSC: 13; Default||External grouping not supported 95117594|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95117595|EAP|Custom 95117595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Hnbr5.0-38-75-p-ns-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 3.7 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95117597|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sos Omni 5 Fr (2).03880|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 26mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|FSC: 13; Default||Not reimbursed separately|54.27|FSC: 13; Default||External grouping not supported 95117603|EAP|Custom 95117603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Biopsy Soft Tissue 15ga.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117606|EAP|Custom 95117606||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .035 D|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95188479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Viariable Angle 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95117609|EAP|Custom 95117609||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Lacrimal Intubation Crawford|1|HUMANA [1294]||HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95117610|EAP|Custom 95117610||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Mod 5.0mm Drum To|1|HUMANA [1294]||HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95185490|EAP|Custom 95185490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Outback Elite 80cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 28mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|FSC: 13; Default||Not reimbursed separately|54.27|FSC: 13; Default||External grouping not supported 95117612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 30mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|FSC: 13; Default||Not reimbursed separately|54.27|FSC: 13; Default||External grouping not supported 95117614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 85mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|FSC: 13; Default||Not reimbursed separately|2,571.00|FSC: 13; Default||External grouping not supported 95117615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 80mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|FSC: 13; Default||Not reimbursed separately|6,653.22|FSC: 13; Default||External grouping not supported 95185491|EAP|Custom 95185491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Outback Elite 120cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 32mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.81|FSC: 13; Default||Not reimbursed separately|45.81|FSC: 13; Default||External grouping not supported 95117623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 36mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|FSC: 13; Default||Not reimbursed separately|54.27|FSC: 13; Default||External grouping not supported 95188480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95117631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95117632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 38mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.89|FSC: 13; Default||Not reimbursed separately|52.89|FSC: 13; Default||External grouping not supported 95185492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Proxial Lateral 3 Hole L86mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,768.00|FSC: 13; Default||Not reimbursed separately|9,768.00|FSC: 13; Default||External grouping not supported 95117644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95117648|EAP|Custom 95117648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Half 36mmx15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95117650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95185493|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac 24mm X 55cm Zenith Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95117653|EAP|Custom 95117653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Driving Nail 3.2mmx80cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 20mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95188483|EAP|Custom 95188483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating . 9.12 X 25.22 X0.64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 7.0x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 95117656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 72mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.18|FSC: 13; Default||Not reimbursed separately|951.18|FSC: 13; Default||External grouping not supported 95185503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Lock Ti 2.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95117658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vsp A 1.5a Slot Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,898.00|FSC: 13; Default||Not reimbursed separately|2,898.00|FSC: 13; Default||External grouping not supported 95117659|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Contour 6frx26cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95117660|EAP|Custom 95117660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Endo 4.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117677|EAP|Custom 95117677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Protector Mall-graft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Va-lcp Olecranon 2.7/3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,365.79|FSC: 13; Default||Not reimbursed separately|3,365.79|FSC: 13; Default||External grouping not supported 95117678|EAP|Custom 95117678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bayonet 18 W/eyelet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95188485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax Narrow Straight 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95117680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.0mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95117681|EAP|Custom 95117681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 4.3mm X 254mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Proximal Olecranon 2.7/3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,992.86|FSC: 13; Default||Not reimbursed separately|2,992.86|FSC: 13; Default||External grouping not supported 95117682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95117683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95117687|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vasoseal #4 Green 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|FSC: 13; Default||Not reimbursed separately|693.00|FSC: 13; Default||External grouping not supported 95117688|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vasoseal #5 Purple 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|FSC: 13; Default||Not reimbursed separately|693.00|FSC: 13; Default||External grouping not supported 95185502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Ti 2.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95117689|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vasoseal #6 Gray 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95117691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 110mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95188487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 13mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95117693|EAP|Custom 95117693||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteotome 6mm Long-curved|1|HUMANA [1294]||HUMANA [11839]|609.00|FSC: 13; Default||Not reimbursed separately|609.00|FSC: 13; Default||External grouping not supported 95117697|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured-s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95185500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.24|FSC: 13; Default||Not reimbursed separately|408.24|FSC: 13; Default||External grouping not supported 95117698|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95117699|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95117700|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95117702|EAP|Custom 95117702||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Bandaging Four Layer [pro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95117706|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Contour 6frx24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95117708|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Smooth 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95117709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 124mm 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,151.82|FSC: 13; Default||Not reimbursed separately|1,151.82|FSC: 13; Default||External grouping not supported 95117710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spinal Kaneda Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|FSC: 13; Default||Not reimbursed separately|2,730.00|FSC: 13; Default||External grouping not supported 95185496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Recess 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95117711|EAP|Custom 95117711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Revision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117712|EAP|HCPCS Q9965||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Hypaque (250gm) Powder 1gm Chg|1|HUMANA [1294]||HUMANA [11839]|2.21|FSC: 13; Default||Not reimbursed separately|2.21|FSC: 13; Default||External grouping not supported 95117714|EAP|Custom 95117714||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Collar Cervical Tall Miami-j W/r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 20mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|FSC: 13; Default||Not reimbursed separately|661.20|FSC: 13; Default||External grouping not supported 95185498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95117757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 22mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 24mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95188482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 3-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95117759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 26mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 28mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95185501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Met Less 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95117761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 30mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|FSC: 13; Default||Not reimbursed separately|661.20|FSC: 13; Default||External grouping not supported 95117762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 34mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 36mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 38mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95185497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95117765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 40mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|FSC: 13; Default||Not reimbursed separately|661.20|FSC: 13; Default||External grouping not supported 95117766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 42mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 44mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 46mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 48mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 52mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95188486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Curved 11 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,639.00|FSC: 13; Default||Not reimbursed separately|3,639.00|FSC: 13; Default||External grouping not supported 95117771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 54mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 55mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 64mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 72mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95192200|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 19.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|FSC: 13; Default||Not reimbursed separately|680.28|FSC: 13; Default||External grouping not supported 95117776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 22mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 24mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 26mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95185511|EAP|Custom 95185511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Syringe Vertecem V+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 28mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|FSC: 13; Default||Not reimbursed separately|680.28|FSC: 13; Default||External grouping not supported 95117781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 32mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 34mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95188494|EAP|Custom 95188494||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cup Size 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 36mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 38mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|FSC: 13; Default||Not reimbursed separately|680.28|FSC: 13; Default||External grouping not supported 95117786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 44mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95185509|EAP|Custom 95185509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Vertecem It Mixing Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 46mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 48mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|FSC: 13; Default||Not reimbursed separately|680.28|FSC: 13; Default||External grouping not supported 95117790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 52mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.38|FSC: 13; Default||Not reimbursed separately|646.38|FSC: 13; Default||External grouping not supported 95117791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 54mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 56mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|FSC: 13; Default||Not reimbursed separately|680.28|FSC: 13; Default||External grouping not supported 95117794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 64mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95185510|EAP|Custom 95185510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Needle Vertebroplasty 12g Reveled Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 68mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 72mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95117797|EAP|Custom 95117797||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 10.0mm For 4.5mm Cannulat|1|HUMANA [1294]||HUMANA [11839]|96.78|FSC: 13; Default||Not reimbursed separately|96.78|FSC: 13; Default||External grouping not supported 95117798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 10mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95117799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 12mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 14mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 16mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 18mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95185512|EAP|Custom 95185512||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Interbody Aleutian Lord Ii Tlif Lum Trans 12x32x9|1|HUMANA [1294]||HUMANA [11839]|12,789.00|FSC: 13; Default||Not reimbursed separately|12,789.00|FSC: 13; Default||External grouping not supported 95117803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 20mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95117804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95192201|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 20.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 30mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95117809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 32mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 34mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95185520|EAP|Custom 95185520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 3 X 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 42mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 44mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 48mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 50mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95185517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95117819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 16mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 18mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 20mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95117822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 30mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95185514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mi Everest 6.5 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95117827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 32mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 34mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95188495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Radial Lateral Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,244.00|FSC: 13; Default||Not reimbursed separately|11,244.00|FSC: 13; Default||External grouping not supported 95117831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 42mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 44mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95185513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Screw Pedicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 95117835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 48mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 50mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117843|EAP|Custom 95117843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Microtip Mv Abs 30r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117845|EAP|Custom 95117845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.fen-3.5 Rt A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192202|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 21.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117847|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod-profile Tex G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95117848|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod-profile Tex G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95117852|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Bif. 14mmx7mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.00|FSC: 13; Default||Not reimbursed separately|2,793.00|FSC: 13; Default||External grouping not supported 95117853|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Bif 16mmx8mm Stre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.00|FSC: 13; Default||Not reimbursed separately|2,793.00|FSC: 13; Default||External grouping not supported 95185516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-contour 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95117854|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Bif. 20mmx10mm St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.00|FSC: 13; Default||Not reimbursed separately|2,793.00|FSC: 13; Default||External grouping not supported 95117855|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Round Smooth Mod Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95117857|EAP|Custom 95117857||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 11mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95117858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 3.0mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.83|FSC: 13; Default||Not reimbursed separately|142.83|FSC: 13; Default||External grouping not supported 95188496|EAP|Custom 95188496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Cannulated 4.0mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117859|EAP|Custom 95117859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.6mm X 100mm Wit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117860|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95117861|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95117863|EAP|Custom 95117863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Sew Arthro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-contour 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95117864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Sew 3mm #2 Ticron Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|690.00|FSC: 13; Default||Not reimbursed separately|690.00|FSC: 13; Default||External grouping not supported 95117867|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Monitor Ecg Subcutaneous Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,885.00|FSC: 13; Default||Not reimbursed separately|9,885.00|FSC: 13; Default||External grouping not supported 95117869|EAP|Custom 95117869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotaglide Lubricant 12/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117878|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 14x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.27|FSC: 13; Default||Not reimbursed separately|2,889.27|FSC: 13; Default||External grouping not supported 95117880|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Ct Prefill(50ml)optiray 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|FSC: 13; Default||Not reimbursed separately|0.75|FSC: 13; Default||External grouping not supported 95117881|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Ct Prefill(100ml)optiray 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.65|FSC: 13; Default||Not reimbursed separately|1.65|FSC: 13; Default||External grouping not supported 95117883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,619.16|FSC: 13; Default||Not reimbursed separately|1,619.16|FSC: 13; Default||External grouping not supported 95185518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz 5 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95117884|EAP|Custom 95117884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Irrigation Fogarty 4fr #22-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,699.41|FSC: 13; Default||Not reimbursed separately|1,699.41|FSC: 13; Default||External grouping not supported 95117886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,838.67|FSC: 13; Default||Not reimbursed separately|1,838.67|FSC: 13; Default||External grouping not supported 95117889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,036.94|FSC: 13; Default||Not reimbursed separately|2,036.94|FSC: 13; Default||External grouping not supported 95188498|EAP|Custom 95188498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Micro Asnis 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 50mm Right A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,024.38|FSC: 13; Default||Not reimbursed separately|1,024.38|FSC: 13; Default||External grouping not supported 95117893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 63mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,199.01|FSC: 13; Default||Not reimbursed separately|1,199.01|FSC: 13; Default||External grouping not supported 95117895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 74mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,253.31|FSC: 13; Default||Not reimbursed separately|1,253.31|FSC: 13; Default||External grouping not supported 95117899|EAP|Custom 95117899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Biopsy Aspiration Bone Marr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Onlay Mck Restoris Sz 6 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95117900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 63mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.78|FSC: 13; Default||Not reimbursed separately|1,203.78|FSC: 13; Default||External grouping not supported 95117903|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Omnipaque 300 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.61|FSC: 13; Default||Not reimbursed separately|11.61|FSC: 13; Default||External grouping not supported 95117909|EAP|Custom 95117909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Salography Rabinou|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117910|EAP|Custom 95117910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 14g X 16cm 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192203|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 21.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 96mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.88|FSC: 13; Default||Not reimbursed separately|1,361.88|FSC: 13; Default||External grouping not supported 95117913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp 5 Hole 57m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.36|FSC: 13; Default||Not reimbursed separately|609.36|FSC: 13; Default||External grouping not supported 95117914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp 8 Hole 93m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.07|FSC: 13; Default||Not reimbursed separately|590.07|FSC: 13; Default||External grouping not supported 95117916|EAP|Custom 95117916||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Plate Spacer 3mm|1|HUMANA [1294]||HUMANA [11839]|117.00|FSC: 13; Default||Not reimbursed separately|117.00|FSC: 13; Default||External grouping not supported 95181663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95117917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mm X 125mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|545.22|FSC: 13; Default||Not reimbursed separately|545.22|FSC: 13; Default||External grouping not supported 95117919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vsp Bone Double Half Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95181655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95117920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vsp Bone Triple Half Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95117922|EAP|Custom 95117922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Kidney Biopsy 040010 Upper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dvr Lock Standard Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.00|FSC: 13; Default||Not reimbursed separately|3,330.00|FSC: 13; Default||External grouping not supported 95117928|EAP|Custom 95117928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheeting Silicone Pharmelast Tra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp 10 Hole 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|676.35|FSC: 13; Default||Not reimbursed separately|676.35|FSC: 13; Default||External grouping not supported 95181654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95117932|EAP|Custom 95117932||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mattress Porta-warm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 60mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.90|FSC: 13; Default||Not reimbursed separately|384.90|FSC: 13; Default||External grouping not supported 95181649|EAP|Custom 95181649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaver Concave Ultra Cut Prebent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117941|EAP|Custom 95117941||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Cpc Florio 7/16 Short|1|HUMANA [1294]||HUMANA [11839]|129.75|FSC: 13; Default||Not reimbursed separately|129.75|FSC: 13; Default||External grouping not supported 95117942|EAP|Custom 95117942||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Cpc Florio 5/16 Short|1|HUMANA [1294]||HUMANA [11839]|129.75|FSC: 13; Default||Not reimbursed separately|129.75|FSC: 13; Default||External grouping not supported 95181652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Smooth Lock 2.2mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95117951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp 7.0x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|FSC: 13; Default||Not reimbursed separately|1,023.00|FSC: 13; Default||External grouping not supported 95117952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium Isola 1/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95181664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6 Hole Ti One Third Tubular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.75|FSC: 13; Default||Not reimbursed separately|204.75|FSC: 13; Default||External grouping not supported 95117953|EAP|Custom 95117953||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook-j 1/4|1|HUMANA [1294]||HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95117954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|FSC: 13; Default||Not reimbursed separately|1,289.37|FSC: 13; Default||External grouping not supported 95181660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.3 Osteoraptor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.19|FSC: 13; Default||Not reimbursed separately|1,064.19|FSC: 13; Default||External grouping not supported 95117955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 8 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|FSC: 13; Default||Not reimbursed separately|918.00|FSC: 13; Default||External grouping not supported 95117957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Beaded Full 12/14 N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|FSC: 13; Default||Not reimbursed separately|11,457.72|FSC: 13; Default||External grouping not supported 95181662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95117960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxinium Gii Rt Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 95117971|EAP|Custom 95117971||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 3.75 Long Schuknecht Sl|1|HUMANA [1294]||HUMANA [11839]|274.92|FSC: 13; Default||Not reimbursed separately|274.92|FSC: 13; Default||External grouping not supported 95181659|EAP|Custom 95191659||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 40mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95117973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 15mm 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,614.00|FSC: 13; Default||Not reimbursed separately|1,614.00|FSC: 13; Default||External grouping not supported 95117977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 2.0mm X 55mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.93|FSC: 13; Default||Not reimbursed separately|837.93|FSC: 13; Default||External grouping not supported 95181657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 6.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95117978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 68mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95117979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 9 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|FSC: 13; Default||Not reimbursed separately|786.00|FSC: 13; Default||External grouping not supported 95181653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95117980|EAP|Custom 95117980||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear T-goode T Modified|1|HUMANA [1294]||HUMANA [11839]|97.80|FSC: 13; Default||Not reimbursed separately|97.80|FSC: 13; Default||External grouping not supported 95117983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Base Tibial All-poly Cr Gii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 95181656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7.mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95117984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Patella Gii Resurface 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 95117985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Loc Slim 27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95181661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95117986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Self 14mm Slim Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95117987|EAP|Custom 95117987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slitter Catheter Guide Attain Un|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181650|EAP|Custom 95181650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Pear Linvatec Conmed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95117990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 44mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95181658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Voyager|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|FSC: 13; Default||Not reimbursed separately|993.00|FSC: 13; Default||External grouping not supported 95117992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cancellous 4mmx55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95117993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Midcoat Metal Fiber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95181673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 11mmx320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95117994|EAP|Custom 95117994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 9 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117995|EAP|Custom 95117995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dam Nail Labral Contour|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95117999|EAP|Custom 95117999||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Collar Cervical Medium Miami-j W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118000|EAP|Custom 95118000||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Collar Cervical Stout Miami-j W/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Ha Stem 52mm 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95118001|EAP|Custom 95118001||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Collar Cervical Pediatric Miami-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118002|EAP|Custom 95118002||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Collar Cervical Standard Miami-j|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ascend Flex Standard 3b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|FSC: 13; Default||Not reimbursed separately|11,290.86|FSC: 13; Default||External grouping not supported 95118004|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft Perios Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|229.56|FSC: 13; Default||Not reimbursed separately|229.56|FSC: 13; Default||External grouping not supported 95188497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95118011|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95118013|EAP|Custom 95118013||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteotome Flexible Hris 6x120mm|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95185522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Flex 51x17x4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,848.58|FSC: 13; Default||Not reimbursed separately|6,848.58|FSC: 13; Default||External grouping not supported 95118017|EAP|Custom 95118017||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Bone Fibular 6mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 62062691|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Drug Screen, Meconium -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95118018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Tibial Alta 8.25x345mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,903.35|FSC: 13; Default||Not reimbursed separately|1,903.35|FSC: 13; Default||External grouping not supported 95118019|EAP|Custom 95118019||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Bone Fibular 7mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95118020|EAP|Custom 95118020||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Bone Fibular 8mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95118024|EAP|Custom 95118024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley 26fr 30cc Ic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Micro Asnis 3.0mm 22x5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95118025|EAP|Custom 95118025||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Assembly Shunt Csf Performancele|1|HUMANA [1294]||HUMANA [11839]|1,830.00|FSC: 13; Default||Not reimbursed separately|1,830.00|FSC: 13; Default||External grouping not supported 95118026|EAP|Custom 95118026||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Assembly Csf Performance L|1|HUMANA [1294]||HUMANA [11839]|2,430.00|FSC: 13; Default||Not reimbursed separately|2,430.00|FSC: 13; Default||External grouping not supported 95181676|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powercross 2mm X 100mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118030|EAP|Custom 95118030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Salem Sump 18 French Silico|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180975|EAP|Custom 95180975||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Affinity Fusion Cardiotomy Venous Reservoir Tubing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181677|EAP|Custom 95181677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Turbinate Inferior 2 Mm 5 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118033|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Occlusion 3f-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118034|EAP|Custom 95118034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Roticular Gia Endo 30-3.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95118038|EAP|Custom 95118038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthro-lok 4mm Curved Cres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181683|EAP|Custom 95181683||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 65mm Titanium|1|HUMANA [1294]||HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95118041|EAP|HCPCS Q9964||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Renografin 60 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|1.07|FSC: 13; Default||Not reimbursed separately|1.07|FSC: 13; Default||External grouping not supported 95118042|EAP|Custom 95118042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 25.4x90.0x1.27|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Head 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,171.00|FSC: 13; Default||Not reimbursed separately|3,171.00|FSC: 13; Default||External grouping not supported 95118045|EAP|Custom 95118045||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Intubation Retrograde W/rapi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118046|EAP|Custom 95118046||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Paparella Type I|1|HUMANA [1294]||HUMANA [11839]|99.00|FSC: 13; Default||Not reimbursed separately|99.00|FSC: 13; Default||External grouping not supported 95181680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dbp Iii Screw 7.5x40mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95118047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Rt 11x440/125-deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|FSC: 13; Default||Not reimbursed separately|3,510.00|FSC: 13; Default||External grouping not supported 95118048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Large Right 11x360/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95118050|EAP|Custom 95118050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular 5 French X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Long Lt 11x340/125-de|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95118052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Long Lt 11x360/125dg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95118053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma 11x380mm 125-deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95185523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95118054|EAP|Custom 95118054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conformer Plastic Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118055|EAP|Custom 95118055||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Contour 8frx26cm W/wire|1|HUMANA [1294]||HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95118056|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Contour 8frx24cm W/wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95118058|EAP|Custom 95118058||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118061|EAP|Custom 95118061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dilator Renal Anplatz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 48mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95118062|EAP|Custom 95118062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Davis 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118064|EAP|Custom 95118064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Loop (12/pk) 24fr Yell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180033|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Burr Rotalink Plus 2.15 Mm Preconnected|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 0.6mm 8 Hole Regu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95118075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 0.6mm 90 Degree Regular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95181694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 46mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95118078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95118079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95181684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 45mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 50mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.04|FSC: 13; Default||Not reimbursed separately|50.04|FSC: 13; Default||External grouping not supported 95181691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 3.5mm X 58mm Self Tap W/stardrive Rec Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95118082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 52mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.25|FSC: 13; Default||Not reimbursed separately|77.25|FSC: 13; Default||External grouping not supported 95118083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 56mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.25|FSC: 13; Default||Not reimbursed separately|47.25|FSC: 13; Default||External grouping not supported 95181688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 55mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 58mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.57|FSC: 13; Default||Not reimbursed separately|48.57|FSC: 13; Default||External grouping not supported 95118085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95181699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 32mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular Quarter 4 Hole 31m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.90|FSC: 13; Default||Not reimbursed separately|234.90|FSC: 13; Default||External grouping not supported 95118087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular Quarter 5 Hole 39m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.05|FSC: 13; Default||Not reimbursed separately|247.05|FSC: 13; Default||External grouping not supported 95181685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 50mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular Quarter 6 Hole 47m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.30|FSC: 13; Default||Not reimbursed separately|267.30|FSC: 13; Default||External grouping not supported 95118089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Small 2.7mm Oblique Angl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|124.77|FSC: 13; Default||Not reimbursed separately|124.77|FSC: 13; Default||External grouping not supported 95181686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 38mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95118091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Adapti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|FSC: 13; Default||Not reimbursed separately|1,251.00|FSC: 13; Default||External grouping not supported 95181692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 3.5mm X 42mm Self Tap W/stardrive Rec Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95118092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Broad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95118093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Broad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95181696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 34mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Broad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95118095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Dcp 43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|FSC: 13; Default||Not reimbursed separately|867.00|FSC: 13; Default||External grouping not supported 95181689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 3.5mm X 56mm Self Tap W/stardrive Rec Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95118096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Dcp 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|FSC: 13; Default||Not reimbursed separately|591.00|FSC: 13; Default||External grouping not supported 95118097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Dcp 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|FSC: 13; Default||Not reimbursed separately|639.00|FSC: 13; Default||External grouping not supported 95181697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 36mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Dcp 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|FSC: 13; Default||Not reimbursed separately|684.00|FSC: 13; Default||External grouping not supported 95118099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Dcp 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95181690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 3.5mm X 54mm Self Tap W/stardrive Rec Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95118100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|FSC: 13; Default||Not reimbursed separately|591.00|FSC: 13; Default||External grouping not supported 95118102|EAP|Custom 95118102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Immobilizer Hand-alumi Ex-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 3.5mm X 48mm Self Tap W/stardrive Rec Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95118103|EAP|Custom 95118103||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink 1/4 L.p. L .625 Ti|1|HUMANA [1294]||HUMANA [11839]|4,407.06|FSC: 13; Default||Not reimbursed separately|4,407.06|FSC: 13; Default||External grouping not supported 95118104|EAP|Custom 95118104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Profile Low|1|HUMANA [1294]||HUMANA [11839]|4,407.06|FSC: 13; Default||Not reimbursed separately|4,407.06|FSC: 13; Default||External grouping not supported 95192204|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 22.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95118106|EAP|Custom 95118106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Multispan Profile Low|1|HUMANA [1294]||HUMANA [11839]|5,080.32|FSC: 13; Default||Not reimbursed separately|5,080.32|FSC: 13; Default||External grouping not supported 95118107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.66|FSC: 13; Default||Not reimbursed separately|2,025.66|FSC: 13; Default||External grouping not supported 95118110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ebi Cortical 130/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95118111|EAP|Custom 95118111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Puncture Lumbar 20ga X 3-1e|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181703|EAP|Custom 95181703||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Passing Flexible 13.5x2.4mm|1|HUMANA [1294]||HUMANA [11839]|357.00|FSC: 13; Default||Not reimbursed separately|357.00|FSC: 13; Default||External grouping not supported 95118121|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Synchromed|1|HUMANA [1294]||HUMANA [11839]|30,900.00|FSC: 13; Default||Not reimbursed separately|30,900.00|FSC: 13; Default||External grouping not supported 95118128|EAP|HCPCS C1818||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Kerato (eye)|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95181702|EAP|Custom 95181702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Acculif Pl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Nporus Lt Sz4 Sigma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|FSC: 13; Default||Not reimbursed separately|5,572.47|FSC: 13; Default||External grouping not supported 95118130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Dome 3-peg 38mm Sigma Pf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95181705|EAP|Custom 95181705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization Mreye .038 Diameter X 10cm Length 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Stab Sz-5 8mm Sigma Pfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95118134|EAP|Custom 95118134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Tibial Mod Sigma Pfc Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 40mm Self Tap W/2.5mm Hex Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95118140|EAP|Custom 95118140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5.5mm 11mm Visiport|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight 10mmx145|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|FSC: 13; Default||Not reimbursed separately|3,329.67|FSC: 13; Default||External grouping not supported 95181701|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Fresh Frozen Semi Tendinosus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,373.10|FSC: 13; Default||Not reimbursed separately|4,373.10|FSC: 13; Default||External grouping not supported 95118143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial Rtlat/lt.me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|FSC: 13; Default||Not reimbursed separately|3,597.06|FSC: 13; Default||External grouping not supported 95118144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial Rtlat/rt.me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|FSC: 13; Default||Not reimbursed separately|3,597.06|FSC: 13; Default||External grouping not supported 95181704|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Tendon Tissie Bovine Fetal Tissue 8cmx8cm-primatrix|1|HUMANA [1294]||HUMANA [11839]|126.57|FSC: 13; Default||Not reimbursed separately|126.57|FSC: 13; Default||External grouping not supported 95118146|EAP|Custom 95118146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Donor Radial Vacumm Baron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181700|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8f .088 Jls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118147|EAP|Custom 95118147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Donor Radial Vacumm Baron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118148|EAP|Custom 95118148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Donor Radial Vacumm Baron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Rim Elevated E/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 95118150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95181712|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 80mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118151|EAP|Custom 95118151||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Wide 9.5mm Monarch|1|HUMANA [1294]||HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95118154|EAP|Custom 95118154||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Narrow 8.0mm Monarch|1|HUMANA [1294]||HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95181715|EAP|Custom 95181715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Single Malleable Dlp 36 Fr 10bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118158|EAP|Custom 95118158||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Crossover Sz-3|1|HUMANA [1294]||HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 95118159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Bent Pre 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95181718|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 120mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95181708|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 30mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118174|EAP|Custom 95118174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Mill Cover And Spatula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Loc Slim 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95181678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dbp Iii 7.5x50mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95118185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Self 12mm Slim-lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95118190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95181714|EAP|Custom 95181714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Single Malleable Dlp 32 Fr 10bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118195|EAP|Custom 95118195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Anesthesia Epidural Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95181720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 95118198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Non-porous Oxinium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 95118199|EAP|Custom 95118199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Spinal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185524|EAP|Custom 95185524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 13.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Poly Profix Onset 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 95118202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95181713|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 100mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118203|EAP|Custom 95118203||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Infuser Pressure 1000ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femur Nonporous Qxinium Sz-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 95118212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non Porous Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95181719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterolateral Distal Tibia 2.7 3.5mm Va Lcp 8 Hole Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,204.46|FSC: 13; Default||Not reimbursed separately|5,204.46|FSC: 13; Default||External grouping not supported 95118216|EAP|Custom 95118216||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Bifurcated Exclud|1|HUMANA [1294]||HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 95118217|EAP|Custom 95118217||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Contra-leg -16x14|1|HUMANA [1294]||HUMANA [11839]|9,669.00|FSC: 13; Default||Not reimbursed separately|9,669.00|FSC: 13; Default||External grouping not supported 95181716|EAP|Custom 95181716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Xl Flexitip Arista 38 Cm 10bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181709|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 40mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118223|EAP|Custom 95118223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 60 2.5 Roticular Gia End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181698|EAP|Custom 95181698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Inoue Balloon 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181707|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 20mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118229|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Laryngectomy 8lgt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181710|EAP|Custom 95181710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Strap Absorbable Open Secure Strap 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118234|EAP|HCPCS A4338||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Cath Foley Irrigation 20fr 30 Cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181711|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 4.5mm X 60mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118235|EAP|Custom 95118235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley 24fr 30cc 3- Way|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118236|EAP|HCPCS A4346||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Foley 24fr 30cc Ic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181736|EAP|Custom 95181736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fuseforce|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95118245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Taper V40 Alumina 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,143.75|FSC: 13; Default||Not reimbursed separately|4,143.75|FSC: 13; Default||External grouping not supported 95181739|EAP|Custom 95181739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Collector Bone Anspach|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident Alumina 0.32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95118259|EAP|Custom 95118259||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Pyramesh 16x90|1|HUMANA [1294]||HUMANA [11839]|18,075.00|FSC: 13; Default||Not reimbursed separately|18,075.00|FSC: 13; Default||External grouping not supported 95181738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95118260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 90mm Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.42|FSC: 13; Default||Not reimbursed separately|7,623.42|FSC: 13; Default||External grouping not supported 95118265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vision Atlantis 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 95181737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 7 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95118267|EAP|Custom 95118267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 2-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95185525|EAP|Custom 95185525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reaming Coring Collared Pin 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118269|EAP|Custom 95118269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 3-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95118271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95118272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.20|FSC: 13; Default||Not reimbursed separately|1,750.20|FSC: 13; Default||External grouping not supported 95180035|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada Pta 14 3.0mm X 120mm X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.20|FSC: 13; Default||Not reimbursed separately|1,750.20|FSC: 13; Default||External grouping not supported 95118274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95181753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv M L Taper Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95118275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95118277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95181744|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 40mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fix Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.20|FSC: 13; Default||Not reimbursed separately|1,750.20|FSC: 13; Default||External grouping not supported 95118279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95181742|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 20mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95118280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95118282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95181751|EAP|Custom 95181751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Button Extender|1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95118283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95118285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95181748|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 120mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95118289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95181743|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 30mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95118294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac 1-2/strippu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|FSC: 13; Default||Not reimbursed separately|2,524.23|FSC: 13; Default||External grouping not supported 95181747|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 100mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118295|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Resynchronization Cardiac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,790.00|FSC: 13; Default||Not reimbursed separately|26,790.00|FSC: 13; Default||External grouping not supported 95118296|EAP|Custom 95118296||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 100mm Sharp/sharp|1|HUMANA [1294]||HUMANA [11839]|114.66|FSC: 13; Default||Not reimbursed separately|114.66|FSC: 13; Default||External grouping not supported 95181752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathlon Ps 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95118314|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Ak-25123-f Multi- Lumen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|275.40|FSC: 13; Default||Not reimbursed separately|275.40|FSC: 13; Default||External grouping not supported 95181745|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 60mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118316|EAP|Custom 95118316||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Dressing-retention Tubif|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118317|EAP|Custom 95118317||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Dressing-retention Tubif|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181746|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 80mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118319|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95181750|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 6.5mm X 40mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118324|EAP|Custom 95118324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Harvester Graft Bone 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95181754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Dinectiv 12 14 Taper Size B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95118328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Poly Profix Onset 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 95181741|EAP|Custom 95181741||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Lasso Nav Eco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118330|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Plus 26cm X 34cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|FSC: 13; Default||Not reimbursed separately|6,675.00|FSC: 13; Default||External grouping not supported 95118331|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Plus 10cm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.00|FSC: 13; Default||Not reimbursed separately|1,446.00|FSC: 13; Default||External grouping not supported 95181740|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powercross 2.0 X 150 X 150 .018 Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118332|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Plus 15cm X 19cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,682.00|FSC: 13; Default||Not reimbursed separately|2,682.00|FSC: 13; Default||External grouping not supported 95181749|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 5.5mm X 150mm X 120mm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95118336|EAP|Custom 95118336||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Soft Punctum Silicone Mini|1|HUMANA [1294]||HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95118337|EAP|Custom 95118337||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Soft Punctum Silicone Petit|1|HUMANA [1294]||HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95118340|EAP|Custom 95118340||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Soft Punctum Silicone Small|1|HUMANA [1294]||HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95118341|EAP|Custom 95118341||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Soft Punctum Silicone Mediu|1|HUMANA [1294]||HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95118342|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118346|EAP|Custom 95118346||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talar Augument Post Agility Sz-2|1|HUMANA [1294]||HUMANA [11839]|8,502.00|FSC: 13; Default||Not reimbursed separately|8,502.00|FSC: 13; Default||External grouping not supported 95118348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Ankle Agility Sz-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,592.00|FSC: 13; Default||Not reimbursed separately|2,592.00|FSC: 13; Default||External grouping not supported 95118351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Ankle Tibial Sz-2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,980.00|FSC: 13; Default||Not reimbursed separately|10,980.00|FSC: 13; Default||External grouping not supported 95181756|EAP|Custom 95181756||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bit Drill 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Self 13mm Slim-lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95118353|EAP|Custom 95118353||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Fanelli 7 French X 50cm|1|HUMANA [1294]||HUMANA [11839]|1,440.00|FSC: 13; Default||Not reimbursed separately|1,440.00|FSC: 13; Default||External grouping not supported 95181758|EAP|Custom 95181758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118354|EAP|Custom 95118354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cbde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95181762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Proximal Lateral 12 Hole 202mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,062.50|FSC: 13; Default||Not reimbursed separately|5,062.50|FSC: 13; Default||External grouping not supported 95118361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95118362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95181761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tap Cortical Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95118363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Self 15mm Slim-lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95118366|EAP|Custom 95118366||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack System Fasttrach (surg Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181757|EAP|Custom 95181757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stabilizer Olive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118367|EAP|Custom 95118367||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack System Fasttract (surg Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118369|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerable Prevail Attai|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181755|EAP|Custom 95181755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Broaching Disposable Rc Y Knot 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118370|EAP|Custom 95118370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Support Facioplasty Elastic Larg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118371|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Crurasoft 11cm X 8cm Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,668.60|FSC: 13; Default||Not reimbursed separately|1,668.60|FSC: 13; Default||External grouping not supported 95181760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tap Cortical Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95118374|EAP|Custom 95118374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Neuroendoscope Channel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.8x 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|FSC: 13; Default||Not reimbursed separately|111.00|FSC: 13; Default||External grouping not supported 95181759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95118380|EAP|Custom 95118380||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cougar 12mm 10-degree Small|1|HUMANA [1294]||HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95118382|EAP|Custom 95118382||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Wide 9.5 Monarch|1|HUMANA [1294]||HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95188505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Wedge 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|577.38|FSC: 13; Default||Not reimbursed separately|577.38|FSC: 13; Default||External grouping not supported 95118383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95118391|EAP|Custom 95118391||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cougar 10mm X 12mm 10-degre|1|HUMANA [1294]||HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95181771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mmxl60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95118394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95118398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Miami Moss 6mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95181769|EAP|Custom 95181769||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Substitute Pro Stim Injectable|1|HUMANA [1294]||HUMANA [11839]|10,782.00|FSC: 13; Default||Not reimbursed separately|10,782.00|FSC: 13; Default||External grouping not supported 95118399|EAP|Custom 95118399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 19.5mmx95mmx1.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181764|EAP|Custom 95181764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide Coroent 12x22x55mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95118414|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 300cc Style-133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|FSC: 13; Default||Not reimbursed separately|3,885.00|FSC: 13; Default||External grouping not supported 95118415|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Crurasoft 7cm X 6cm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95181767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 6.5x40mm Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 95118419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Fin Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,810.00|FSC: 13; Default||Not reimbursed separately|3,810.00|FSC: 13; Default||External grouping not supported 95118421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Shoulder 44x21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,678.00|FSC: 13; Default||Not reimbursed separately|6,678.00|FSC: 13; Default||External grouping not supported 95181763|EAP|Custom 95181763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide Coroent 10x22x50mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95118423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|566.25|FSC: 13; Default||Not reimbursed separately|566.25|FSC: 13; Default||External grouping not supported 95118425|EAP|Custom 95118425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 12mmx85mmx1.27|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 5.0x45mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 95118441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Cta Advantage Global 56x 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|FSC: 13; Default||Not reimbursed separately|6,765.00|FSC: 13; Default||External grouping not supported 95118442|EAP|Custom 95118442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Anesthesia Epidural Contino|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mmxl36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95118450|EAP|HCPCS A5063||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drainable High-output 2-1/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc 14mm Global Adva|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,355.00|FSC: 13; Default||Not reimbursed separately|11,355.00|FSC: 13; Default||External grouping not supported 95181773|EAP|Custom 95181773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ll 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118456|EAP|Custom 95118456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit Angled 2.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118457|EAP|Custom 95118457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181774|EAP|Custom 95181774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spinal Medtronic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118458|EAP|Custom 95118458||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Suspension Barium Sulphate Hd-85|1|HUMANA [1294]||HUMANA [11839]|61.34|FSC: 13; Default||Not reimbursed separately|61.34|FSC: 13; Default||External grouping not supported 95118462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95181775|EAP|Custom 95181775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Blood Centrimag Thoratec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95180775|EAP|Custom 95180775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber #2 Fiber Stick #2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118471|EAP|Custom 95118471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Aspiration 9ft.(lipo-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118475|EAP|Custom 95118475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peritoneal 11 French.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167018|EAP|HCPCS S9326||0294 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - SUPYS/DRUGS FOR DME EFFECTIVENESS (HH AGENCY ONLY)|Hb Hospice Home Pain Infusion Pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118477|EAP|Custom 95118477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181772|EAP|Custom 95181772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Knee Femoral 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tack Labral Bankart|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.00|FSC: 13; Default||Not reimbursed separately|798.00|FSC: 13; Default||External grouping not supported 95118490|EAP|Custom 95118490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Wound Vigilon 6x8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Insert Tibial Poly Crosslinked Prolong Tm Zimmer S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|FSC: 13; Default||Not reimbursed separately|4,575.00|FSC: 13; Default||External grouping not supported 95118493|EAP|Custom 95118493||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Pyramesh 13x70|1|HUMANA [1294]||HUMANA [11839]|22,050.00|FSC: 13; Default||Not reimbursed separately|22,050.00|FSC: 13; Default||External grouping not supported 95118499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial Distal Tibi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,970.76|FSC: 13; Default||Not reimbursed separately|4,970.76|FSC: 13; Default||External grouping not supported 95181786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95118500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Frs 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95166026|EAP|Custom 95166026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 2.0 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118504|EAP|Custom 95118504||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cougar 8x10mm 5-degree|1|HUMANA [1294]||HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95118506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Closed Kaneda 1/4x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,340.00|FSC: 13; Default||Not reimbursed separately|2,340.00|FSC: 13; Default||External grouping not supported 95181783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Base Tibial Ankle Total Metal Trabecular Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|FSC: 13; Default||Not reimbursed separately|12,150.00|FSC: 13; Default||External grouping not supported 95118510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Kaneda 6.35x75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95118515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Kaneda 6.35x90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95181781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95118519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated S.s. 6.5x85mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95118520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated S.s. 6.5x90mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95181785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Fibula Lateral Distal 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,898.52|FSC: 13; Default||Not reimbursed separately|1,898.52|FSC: 13; Default||External grouping not supported 95118531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95181787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rigidloop Implant Cortical Fixation Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95118532|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Enpulse Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95181780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95118535|EAP|Custom 95118535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Saber.30-deg.w/intege|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118540|EAP|Custom 95118540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand 3.5mm 90-deg W/integr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ankle Total Talus Right Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 95118543|EAP|Custom 95118543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Turbovac 90-deg W/ine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Alumina Taper V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,143.75|FSC: 13; Default||Not reimbursed separately|4,143.75|FSC: 13; Default||External grouping not supported 95181776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammerlock Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 95181777|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 10mm X 60mm X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181779|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Fortify Assura Vr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,270.70|FSC: 13; Default||Not reimbursed separately|35,270.70|FSC: 13; Default||External grouping not supported 95118571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 50x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95118573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 56x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95118576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 58x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,127.40|FSC: 13; Default||Not reimbursed separately|4,127.40|FSC: 13; Default||External grouping not supported 95118578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 60x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95118587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,921.60|FSC: 13; Default||Not reimbursed separately|3,921.60|FSC: 13; Default||External grouping not supported 95118588|EAP|Custom 95118588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Circular Hemorrhoidal Hc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95118597|EAP|Custom 95118597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Transducer Pressure Disp Tru-wak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95118600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95118602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5x90mm 16mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95118605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95181794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Delta Ceramic Ts 12 14 36mm +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,973.30|FSC: 13; Default||Not reimbursed separately|8,973.30|FSC: 13; Default||External grouping not supported 95118611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 26mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95181795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Kinectiv 12 14 Taper R2 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95118620|EAP|HCPCS A4391||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Urostomy One-piece Custom-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 30mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95181796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv M L Taper Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95118627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95181648|EAP|Custom 95181648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Holder Tube Endotracheal 10 Cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 50mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95181671|EAP|Custom 95181671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Repair Meniscal Single With Eyelet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Cannulated 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.76|FSC: 13; Default||Not reimbursed separately|110.76|FSC: 13; Default||External grouping not supported 95118640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 80mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95118641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 85mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95181808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X44mmself Tapping With 2.5hexagonal Socke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95118642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 90mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95118643|EAP|Custom 95118643||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 3.2mmx12 Threaded Poi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181800|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Super Arrow-flex Sheath 8fr 45cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin 3.2mmx9 Drill Point Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.24|FSC: 13; Default||Not reimbursed separately|67.24|FSC: 13; Default||External grouping not supported 95118647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Shoulder Resurfacting Mb Co|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,343.00|FSC: 13; Default||Not reimbursed separately|8,343.00|FSC: 13; Default||External grouping not supported 95181811|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice Lap 10cmx16cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.39|FSC: 13; Default||Not reimbursed separately|79.39|FSC: 13; Default||External grouping not supported 95118648|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95118649|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.87|FSC: 13; Default||Not reimbursed separately|165.87|FSC: 13; Default||External grouping not supported 95181766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Plate Decade Xlif 5.5x45mm Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 95118650|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial 10mm X 30mm 16fm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95118656|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial 12mm X 30mm 16fm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95181765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Decade Xlif 4 Hole Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,530.00|FSC: 13; Default||Not reimbursed separately|16,530.00|FSC: 13; Default||External grouping not supported 95118663|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181806|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 20fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118674|EAP|Custom 95118674||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Radial Evolve(kit Includesra|1|HUMANA [1294]||HUMANA [11839]|11,115.00|FSC: 13; Default||Not reimbursed separately|11,115.00|FSC: 13; Default||External grouping not supported 95118680|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour 8x22 W/o-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95181807|EAP|Custom 95181807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Block Aiming Variax Joystick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mmx22mm Selftapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95118686|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe No-thread Weil|1|HUMANA [1294]||HUMANA [11839]|681.00|FSC: 13; Default||Not reimbursed separately|681.00|FSC: 13; Default||External grouping not supported 95118687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psc 56m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95181805|EAP|Custom 95181805||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 28mm X 15cm|1|HUMANA [1294]||HUMANA [11839]|49,968.00|FSC: 13; Default||Not reimbursed separately|49,968.00|FSC: 13; Default||External grouping not supported 95118688|EAP|Custom 95118688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler M-13.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina +4mm 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95181797|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Deca Nav D Curve 7fr 2-8-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem #2 Accolade-plus Tmzf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95118693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Advantage Global 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,610.00|FSC: 13; Default||Not reimbursed separately|5,610.00|FSC: 13; Default||External grouping not supported 95181821|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Gel Memory Shape 440cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95118694|EAP|Custom 95118694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Liposuction Mercedes Pal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118697|EAP|Custom 95118697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Liposuction Mercedes Pal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181831|EAP|Custom 95181831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 22fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118701|EAP|Custom 95118701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Liposuction Mercedes Pal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118702|EAP|Custom 95118702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Liposuction Mercedes Pal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180034|EAP|Custom 95180034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Feeding Tube Jejunal Mic 18fr 45cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-deg 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95118705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina +4mm 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95180548|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 9 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118710|EAP|Custom 95118710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Reinforcement Line Sta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannula Threaded Flex 8.0x90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.21|FSC: 13; Default||Not reimbursed separately|114.21|FSC: 13; Default||External grouping not supported 95118716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm V40 Ceramic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95118717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Distal 6-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,923.57|FSC: 13; Default||Not reimbursed separately|4,923.57|FSC: 13; Default||External grouping not supported 95181135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Rgt Sz B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95118718|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 6x12 Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.33|FSC: 13; Default||Not reimbursed separately|84.33|FSC: 13; Default||External grouping not supported 95118719|EAP|Custom 95118719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Curvtek Large 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181819|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Gel Memory Shape 355cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95118721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Threaded Full 4.0x30mm Vcs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.78|FSC: 13; Default||Not reimbursed separately|2,460.78|FSC: 13; Default||External grouping not supported 95118728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Lock 4.0x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.82|FSC: 13; Default||Not reimbursed separately|425.82|FSC: 13; Default||External grouping not supported 95181830|EAP|Custom 95181830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 12mm Global Advanta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,690.00|FSC: 13; Default||Not reimbursed separately|12,690.00|FSC: 13; Default||External grouping not supported 95181825|EAP|Custom 95181825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing J Stylet 45cm .014 Blue Knob|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Fin Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,810.00|FSC: 13; Default||Not reimbursed separately|3,810.00|FSC: 13; Default||External grouping not supported 95118734|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Trunk-ipsi/main-b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 95181829|EAP|Custom 95181829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118735|EAP|Custom 95118735||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame Ti Lcc4 4cm|1|HUMANA [1294]||HUMANA [11839]|5,115.00|FSC: 13; Default||Not reimbursed separately|5,115.00|FSC: 13; Default||External grouping not supported 95118736|EAP|Custom 95118736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Internal Sundt 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181818|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast 600cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|FSC: 13; Default||Not reimbursed separately|4,725.00|FSC: 13; Default||External grouping not supported 95118737|EAP|Custom 95118737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Internal Sundt 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118741|EAP|Custom 95118741||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Internal Sundt Non|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181824|EAP|Custom 95181824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing J Stylet 45cm Lead 014 Gray Knob|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118743|EAP|Custom 95118743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar Bayonet Scoville|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118746|EAP|Custom 95118746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Rotatable Micro Oval|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181535|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast 400cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|FSC: 13; Default||Not reimbursed separately|4,725.00|FSC: 13; Default||External grouping not supported 95118747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Ultra-fix Minimite 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|437.28|FSC: 13; Default||Not reimbursed separately|437.28|FSC: 13; Default||External grouping not supported 95118748|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Cardioverter Defibrillator Impla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,480.00|FSC: 13; Default||Not reimbursed separately|39,480.00|FSC: 13; Default||External grouping not supported 95180422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 9 X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95118750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 4.0x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.82|FSC: 13; Default||Not reimbursed separately|425.82|FSC: 13; Default||External grouping not supported 95118751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95181820|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Gel Memory Shape 395cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95118752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Unit Cemented Preservati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|FSC: 13; Default||Not reimbursed separately|4,497.27|FSC: 13; Default||External grouping not supported 95118754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Allpoly Preservation 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|FSC: 13; Default||Not reimbursed separately|2,468.79|FSC: 13; Default||External grouping not supported 95181823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127 Degree V40 Accolade Hfx Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95181828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Healicoil Regenesorb Suture Anchor 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.02|FSC: 13; Default||Not reimbursed separately|1,168.02|FSC: 13; Default||External grouping not supported 95118767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95118772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95181833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 5-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95118777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95118779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95118780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95181826|EAP|Custom 95181826||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Subchondroplasty Knee With Side Targeted Accuport|1|HUMANA [1294]||HUMANA [11839]|9,885.00|FSC: 13; Default||Not reimbursed separately|9,885.00|FSC: 13; Default||External grouping not supported 95118781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Miami Moss 6mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95181840|EAP|Custom 95181840||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Va Zero-p Lordotic Height 10mm|1|HUMANA [1294]||HUMANA [11839]|10,839.00|FSC: 13; Default||Not reimbursed separately|10,839.00|FSC: 13; Default||External grouping not supported 95118786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95118790|EAP|Custom 95118790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oil Silicon 5 000 10cc-glass Syr|1|HUMANA [1294]||HUMANA [11839]|1,256.85|FSC: 13; Default||Not reimbursed separately|1,256.85|FSC: 13; Default||External grouping not supported 95181839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modular Evolve Standard 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95118798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 22mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95118799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 26mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95181836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Neck Mod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95118800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95118801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95181842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck 12-14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95118802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95181835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Hdd 4.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95118809|EAP|Custom 95118809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Tubular Net Flexible F|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118811|EAP|Custom 95118811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Relief Modified Frs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181838|EAP|Custom 95181838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Apex 3x80 Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95118817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psl 60m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95181837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv M-l Taper Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95118823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 36mmx60mm 10-deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95118828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Standard 36mm Ceramic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|FSC: 13; Default||Not reimbursed separately|4,717.50|FSC: 13; Default||External grouping not supported 95181841|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular 4-7mm Taper 10cm With Removable Rings|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.00|FSC: 13; Default||Not reimbursed separately|2,112.00|FSC: 13; Default||External grouping not supported 95118829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Restoration #8 Ps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,235.85|FSC: 13; Default||Not reimbursed separately|16,235.85|FSC: 13; Default||External grouping not supported 95118831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Si 55mm Miami Moss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95192205|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 22.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95118832|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Limb Contra 16x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,669.00|FSC: 13; Default||Not reimbursed separately|9,669.00|FSC: 13; Default||External grouping not supported 95118834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,763.16|FSC: 13; Default||Not reimbursed separately|1,763.16|FSC: 13; Default||External grouping not supported 95118836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95188506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosteon 7mmx23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.24|FSC: 13; Default||Not reimbursed separately|669.24|FSC: 13; Default||External grouping not supported 95118837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95118840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95118841|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cyliner Penile Cx 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95118854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Narrow 11-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|363.93|FSC: 13; Default||Not reimbursed separately|363.93|FSC: 13; Default||External grouping not supported 95118859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Radial Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95118865|EAP|Custom 95118865||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Bifurcated Exclud|1|HUMANA [1294]||HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 95118868|EAP|Custom 95118868||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide Short-threaded 3.2x9|1|HUMANA [1294]||HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95118872|EAP|Custom 95118872||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Contra-leg 12x14|1|HUMANA [1294]||HUMANA [11839]|9,669.00|FSC: 13; Default||Not reimbursed separately|9,669.00|FSC: 13; Default||External grouping not supported 95118878|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Resynchronization Cardiac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,400.00|FSC: 13; Default||Not reimbursed separately|59,400.00|FSC: 13; Default||External grouping not supported 95118882|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Mb2 7fr In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118884|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Multipurpo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118887|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Attain 0.016 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118890|EAP|Custom 95118890||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stimulator Implantable 2 Lead Gr|1|HUMANA [1294]||HUMANA [11839]|15,225.00|FSC: 13; Default||Not reimbursed separately|15,225.00|FSC: 13; Default||External grouping not supported 95118900|EAP|Custom 95118900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 7-0 18 Bv175-6 M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118907|EAP|Custom 95118907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circlamp 1.45cm Bell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118911|EAP|Custom 95118911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circlamp 1.3cm Bell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118912|EAP|Custom 95118912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circlamp 1.1cm Bell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118913|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Gel Texture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95118915|EAP|Custom 95118915||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Graft Bone Allomatrixc 10c|1|HUMANA [1294]||HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95118916|EAP|Custom 95118916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Reinforcement Line Sta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 64mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95118918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3-hole Doral Distal Radi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95118919|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Enpulse Sr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95118920|EAP|Custom 95118920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Lite Side 550-micron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192206|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 23.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95118929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 2 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95118932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 2 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95118933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95118935|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Style-133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95118936|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95188503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95118938|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|FSC: 13; Default||Not reimbursed separately|8,893.50|FSC: 13; Default||External grouping not supported 95118939|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95118940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis 57.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,448.00|FSC: 13; Default||Not reimbursed separately|5,448.00|FSC: 13; Default||External grouping not supported 95118941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-tap Atlantis 4.0x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95118942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-tap Atlantis 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95188504|EAP|Custom 95188504||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Perimeter 10 X 15 X 13mm|1|HUMANA [1294]||HUMANA [11839]|5,940.00|FSC: 13; Default||Not reimbursed separately|5,940.00|FSC: 13; Default||External grouping not supported 95118946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Uni Cemented Sz-3 Preser|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|FSC: 13; Default||Not reimbursed separately|4,497.27|FSC: 13; Default||External grouping not supported 95118948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Allpoly Lm/rl 7mm Preserv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|FSC: 13; Default||Not reimbursed separately|2,468.79|FSC: 13; Default||External grouping not supported 95192207|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 24.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95118951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tmzf #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95118956|EAP|Custom 95118956||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Closed Angled Rt 9.5mm|1|HUMANA [1294]||HUMANA [11839]|3,090.00|FSC: 13; Default||Not reimbursed separately|3,090.00|FSC: 13; Default||External grouping not supported 95118957|EAP|Custom 95118957||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Closed Angled Lt 9.5mm|1|HUMANA [1294]||HUMANA [11839]|3,090.00|FSC: 13; Default||Not reimbursed separately|3,090.00|FSC: 13; Default||External grouping not supported 95118959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 80169760|EAP|CPT® 44320||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Colostomy Or Skin Level Cecostomy|1|HUMANA [1294]||HUMANA [11839]|7,478.00|FSC: 13; Default||Not reimbursed separately|7,478.00|FSC: 13; Default||External grouping not supported 95118961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.17|FSC: 13; Default||Not reimbursed separately|1,357.17|FSC: 13; Default||External grouping not supported 95118965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.9x38mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95118968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0x50mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95118969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0x46mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95118970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 24mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95192208|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 25.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95118975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0x42mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95118976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger-joint W/grommet S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95118980|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Flush Omni Soft-vu 5fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118986|EAP|Custom 95118986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Humeral 40mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95118987|EAP|Custom 95118987||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Cpc Florio 7/16 Wide Longss|1|HUMANA [1294]||HUMANA [11839]|144.45|FSC: 13; Default||Not reimbursed separately|144.45|FSC: 13; Default||External grouping not supported 95118988|EAP|Custom 95118988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 29mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118990|EAP|Custom 95118990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Arterial Blue 3/8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118991|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermodilution 7.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95118993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,704.80|FSC: 13; Default||Not reimbursed separately|8,704.80|FSC: 13; Default||External grouping not supported 95118994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95118995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95188512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Concentric 40mmx6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95118996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95118997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95118998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95192209|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 26.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95118999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps E-r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,704.80|FSC: 13; Default||Not reimbursed separately|8,704.80|FSC: 13; Default||External grouping not supported 95119000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95119001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|FSC: 13; Default||Not reimbursed separately|8,023.20|FSC: 13; Default||External grouping not supported 95188513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 40xxx4mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95119003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Str. 14mm (revisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95119004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95119006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight Nexgen 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95119007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem St Nexgen 18x145|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95119008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension St Stem 20mmx146mm (re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|FSC: 13; Default||Not reimbursed separately|3,329.67|FSC: 13; Default||External grouping not supported 95119009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension St Stem 24mmx145mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|FSC: 13; Default||Not reimbursed separately|3,329.67|FSC: 13; Default||External grouping not supported 95188514|EAP|Custom 95188514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Screwdriver T10 Ao Self Retaining|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119011|EAP|Custom 95119011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Fixation Pip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119012|EAP|Custom 95119012||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbx 5cc(demineralized Bone|1|HUMANA [1294]||HUMANA [11839]|2,769.72|FSC: 13; Default||Not reimbursed separately|2,769.72|FSC: 13; Default||External grouping not supported 95119013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 20cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 24cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95192210|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 26.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 28cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 80159304|EAP|CPT® 87081||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture Presumptive Pathogenic Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.89|FSC: 13; Default||Not reimbursed separately|19.89|FSC: 13; Default||External grouping not supported 95119016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 32cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 80159312|EAP|CPT® 87077||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Aerobic Isolate, Each|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.24|FSC: 13; Default||Not reimbursed separately|24.24|FSC: 13; Default||External grouping not supported 95119017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 40cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 42cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163406|EAP|Custom 95163406||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Imp Malar Contour Ext Sm L|1|HUMANA [1294]||HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95119019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 16cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 18cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163407|EAP|Custom 95163407||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Imp Malar Contour Ext Sm R|1|HUMANA [1294]||HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95119021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 20cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 24cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis 12mm X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 95119023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 28cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 32cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok 6.0mm X 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95119025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 34cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 36cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163411|EAP|Custom 95163411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ball Cerv Ripening 18fr 40|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 38cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 40cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163414|EAP|Custom 95163414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Care Laproscope Advanc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 42cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 16cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163415|EAP|Custom 95163415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stap Insorb Absorable 30 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 18cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 20cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163498|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Cuf Aort Renu Zenth 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,645.00|FSC: 13; Default||Not reimbursed separately|15,645.00|FSC: 13; Default||External grouping not supported 95119033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 24cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 28cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163500|EAP|Custom 95163500||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube-u Tympanostomy 1.35mm|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95119035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 32cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 34cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163501|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tisu Strattice 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.37|FSC: 13; Default||Not reimbursed separately|79.37|FSC: 13; Default||External grouping not supported 95119037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 36cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 38cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163504|EAP|Custom 95163504||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sol 2b6053 Intralipid Inj|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 40cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 42cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163513|EAP|Custom 95163513||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Clamp Rubber Dam Sz 8a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 16cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral M/dn Retrograde 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163514|EAP|Custom 95163514||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Clamp Rubber Dam Sz 14a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 20cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 24cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163516|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pk Neurostinulator Interst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,385.00|FSC: 13; Default||Not reimbursed separately|29,385.00|FSC: 13; Default||External grouping not supported 95119045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 28cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 32cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163517|EAP|Custom 95163517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndle Homer Mammolok Gold 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 34cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95188515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graftbolt Tibial 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95119048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 36cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95163519|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Marker Tisu Ultraclip Coil|1|HUMANA [1294]||HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95119049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 38cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 40cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 42cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 16cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95162630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95119053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 20cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 24cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95162631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comp Fem Stabilizer Ts Tot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95119055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 28cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95192211|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 27.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 34cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95162632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tib Stabilizer Tota|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95119057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 36cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95119058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 38cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95162633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Dis Fem Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95119059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 40cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95188516|EAP|Custom 95188516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.7mm X 160mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 46cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95119061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 10mm X 19.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 10mm X 21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 10mm X 22.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162664|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cor Expr Ld 6x17x20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95119064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 10mm X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 10mm X 25.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162665|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide Mach 1 Mp 2 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 10mm X 27cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 11mm X 19.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162666|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide Mach 1 Lima 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 11mm X 21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 11mm X 22.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162667|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guid Mach 1 Lima 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 11mm X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 11mm X 25.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162668|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guid Mach 1 Rdc 7fr 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 11mm X 27cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 12mm X 19.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162669|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln Polarcath 4x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 12mm X 21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95188517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Third 12 Hole/l143mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95119075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 12mm X 22.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162670|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 7x2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95119076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 12mm X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 12mm X 25.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 12mm X 27cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162672|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bil Expr 6x14mm 150c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95119079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 13mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Im 7mmx21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162673|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Steer 0.025in 140cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 8mm X 19.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95192212|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 27.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 8mm X 21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162674|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6x27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95119083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 8mm X 22.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 8mm X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162675|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Strlg Mrail 4.5x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 8mm X 25.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 8mm X 27cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162676|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Strlg Mrail 5x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 9mm X 19.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 9mm X 21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162677|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Strlg Mrail 6x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 9mm X 22.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95188518|EAP|Custom 95188518||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Load Platinum 1.6 Gm|1|HUMANA [1294]||HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95119090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 9mm X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162678|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Strlg Mrail 7x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 9mm X 25.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95119092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Mdn Im 9mm X 27cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95162680|EAP|Custom 95162680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Intro Micro 40cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119093|EAP|Custom 95119093||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut-lock 5.5mm|1|HUMANA [1294]||HUMANA [11839]|533.97|FSC: 13; Default||Not reimbursed separately|533.97|FSC: 13; Default||External grouping not supported 95119094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 10 Hole13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|FSC: 13; Default||Not reimbursed separately|1,641.69|FSC: 13; Default||External grouping not supported 95162681|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Strlg Otw 5x60/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 12 Hole13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|FSC: 13; Default||Not reimbursed separately|1,728.84|FSC: 13; Default||External grouping not supported 95119096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 14 Hole 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|FSC: 13; Default||Not reimbursed separately|2,009.97|FSC: 13; Default||External grouping not supported 95162682|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Strlg Otw 5x80/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 3 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95119098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95162683|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Sentinol 6x40x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|FSC: 13; Default||Not reimbursed separately|4,434.00|FSC: 13; Default||External grouping not supported 95119099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|FSC: 13; Default||Not reimbursed separately|1,289.37|FSC: 13; Default||External grouping not supported 95119100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 6 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95162684|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Sentinol 6x59x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|FSC: 13; Default||Not reimbursed separately|4,758.00|FSC: 13; Default||External grouping not supported 95119101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 8 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|FSC: 13; Default||Not reimbursed separately|1,402.74|FSC: 13; Default||External grouping not supported 95119102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 10 Hole13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|FSC: 13; Default||Not reimbursed separately|1,641.69|FSC: 13; Default||External grouping not supported 95162685|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Sentinol 7x39x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|FSC: 13; Default||Not reimbursed separately|4,434.00|FSC: 13; Default||External grouping not supported 95119103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 12 Hole13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|FSC: 13; Default||Not reimbursed separately|1,728.84|FSC: 13; Default||External grouping not supported 95119104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 14 Hole 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|FSC: 13; Default||Not reimbursed separately|2,009.97|FSC: 13; Default||External grouping not supported 95162686|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr 4x15mm 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95119105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 3 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95188533|EAP|Custom 95188533||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Dbm Grafton 1 Cc|1|HUMANA [1294]||HUMANA [11839]|687.00|FSC: 13; Default||Not reimbursed separately|687.00|FSC: 13; Default||External grouping not supported 95119106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95162687|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Sentinol 6x20x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|FSC: 13; Default||Not reimbursed separately|4,434.00|FSC: 13; Default||External grouping not supported 95119107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 6 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|FSC: 13; Default||Not reimbursed separately|1,289.37|FSC: 13; Default||External grouping not supported 95119108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 8 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|FSC: 13; Default||Not reimbursed separately|1,402.74|FSC: 13; Default||External grouping not supported 95162688|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Sentinol 7x78x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|FSC: 13; Default||Not reimbursed separately|4,758.00|FSC: 13; Default||External grouping not supported 95119109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 3 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95119110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95162689|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Sentinol 8x42x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|FSC: 13; Default||Not reimbursed separately|4,434.00|FSC: 13; Default||External grouping not supported 95119111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 6 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95119112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 8 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|FSC: 13; Default||Not reimbursed separately|1,402.74|FSC: 13; Default||External grouping not supported 95162690|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr 4x19mm 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95119113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|FSC: 13; Default||Not reimbursed separately|1,289.37|FSC: 13; Default||External grouping not supported 95192213|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 28.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95162691|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr 6x18mm 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95119115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 6 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95119116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 10 Hole15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|FSC: 13; Default||Not reimbursed separately|1,641.69|FSC: 13; Default||External grouping not supported 95162692|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr 7x19mm 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95119117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 12 Hole15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|FSC: 13; Default||Not reimbursed separately|1,728.84|FSC: 13; Default||External grouping not supported 95119118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 14 Hole 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|FSC: 13; Default||Not reimbursed separately|2,009.97|FSC: 13; Default||External grouping not supported 95162693|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Synergy 4mmx10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95119120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95162694|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Nephro Vtc Pgtl 8fr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 6 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|FSC: 13; Default||Not reimbursed separately|1,104.75|FSC: 13; Default||External grouping not supported 95188534|EAP|Custom 95188534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Torque Sjm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 8 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|FSC: 13; Default||Not reimbursed separately|1,402.74|FSC: 13; Default||External grouping not supported 95162695|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Nephro Pgtl Reg 10fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95119124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95119125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|FSC: 13; Default||Not reimbursed separately|1,289.37|FSC: 13; Default||External grouping not supported 95162699|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Move Bent 0.035inx260c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95119127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95162700|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Sym Stiff 1.5mmx2cm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95119129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95162702|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln Xxl 14mmx6cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95119131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 4 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95162703|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheth Intro Brite Tip 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|FSC: 13; Default||Not reimbursed separately|1,138.53|FSC: 13; Default||External grouping not supported 95119133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression Supracond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.71|FSC: 13; Default||Not reimbursed separately|1,849.71|FSC: 13; Default||External grouping not supported 95162704|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln Synergy 6mmx4cm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression Supracond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.79|FSC: 13; Default||Not reimbursed separately|1,967.79|FSC: 13; Default||External grouping not supported 95119135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression Supracond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,821.60|FSC: 13; Default||Not reimbursed separately|1,821.60|FSC: 13; Default||External grouping not supported 95162705|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln Synergy 7mmx4cm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression Supracond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.71|FSC: 13; Default||Not reimbursed separately|1,849.71|FSC: 13; Default||External grouping not supported 95188535|EAP|Custom 95188535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Ii Port Sjm Psu Pp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression Supracond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.79|FSC: 13; Default||Not reimbursed separately|1,967.79|FSC: 13; Default||External grouping not supported 95162706|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheth Intro Brite Tip 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression Supracond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,821.60|FSC: 13; Default||Not reimbursed separately|1,821.60|FSC: 13; Default||External grouping not supported 95119139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95162708|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln Synergy 8mmx4cm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Threaded Full 4.0x34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95192214|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 28.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95162709|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 4mmx2cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95119143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 1 Inch Hexagon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|FSC: 13; Default||Not reimbursed separately|197.76|FSC: 13; Default||External grouping not supported 95162710|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 4mmx4cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 1-1/4 Inch Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|FSC: 13; Default||Not reimbursed separately|197.76|FSC: 13; Default||External grouping not supported 95188536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Offset High C-stem Amt Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95119145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 1-1/2 Inch Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|FSC: 13; Default||Not reimbursed separately|197.76|FSC: 13; Default||External grouping not supported 95162711|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln Sds 5mmx2cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 2 Inch Hexagon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|FSC: 13; Default||Not reimbursed separately|197.76|FSC: 13; Default||External grouping not supported 95119147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solid Corticle 3.5x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95162712|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 5mmx4cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Solid 3.5mm X 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95119149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Solid 3.5x42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95162713|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 6mmx4cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95119151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95162714|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 6mmx6cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95119153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95162715|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheth Intro Brite Tip 9fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95119155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95162721|EAP|Custom 95162721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fast 4.0mm Shrt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95188539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Curved Lg Mrs Revision 13mm 203mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|FSC: 13; Default||Not reimbursed separately|17,276.70|FSC: 13; Default||External grouping not supported 95119157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95162723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok 90 Deg 3.8 X 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95119158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95119159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95162725|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 8mmx4cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95119161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95162726|EAP|Custom 95162726||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide Shoulder 2.0mm|1|HUMANA [1294]||HUMANA [11839]|84.15|FSC: 13; Default||Not reimbursed separately|84.15|FSC: 13; Default||External grouping not supported 95119162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95119163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Shoulder S3 3 Hole Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 95119164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95192215|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 29.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162728|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 9mmx4cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95119167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162729|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 10mmx2cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95119169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162730|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw J Bmw 0.014 X 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95119171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162731|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Whisper Ms 0.014 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95188540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|FSC: 13; Default||Not reimbursed separately|8,016.75|FSC: 13; Default||External grouping not supported 95119173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162732|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 4mmx6cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95119175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162733|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 6mmx8cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95119181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95162734|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 7mmx6cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95119183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95162735|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 8mmx3cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95119185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95162736|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ut Sds 8mmx6cm 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95162737|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bil Expr 7x20mmx75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95119191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162738|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Synergy 6mmx10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162739|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Sys Acustk Ii J Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95188537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|346.44|FSC: 13; Default||Not reimbursed separately|346.44|FSC: 13; Default||External grouping not supported 95119196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162740|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Pigtail 5fr 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162741|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Nephstmy Vtc 10frx25c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162742|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Sos1 5fr 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162743|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Xsuprt Choice 0.014x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95192216|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 29.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162746|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Rx Maverick 2 1.5x20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162747|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheer Schon Xlg 14fr 15c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.40|FSC: 13; Default||Not reimbursed separately|257.40|FSC: 13; Default||External grouping not supported 95119207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162749|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Schon Xlg 14fr 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|217.50|FSC: 13; Default||Not reimbursed separately|217.50|FSC: 13; Default||External grouping not supported 95119209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95188538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 12mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95119210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162750|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ball Cut Pcb 5 X 2 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162753|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Accu-vu Pigtail 0.035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Cd/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162754|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Schon Xlg 14fr 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.40|FSC: 13; Default||Not reimbursed separately|257.40|FSC: 13; Default||External grouping not supported 95119215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162755|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Pigtail Non-b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162756|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Sim1 Braded 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95162757|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Mpb Non-brade|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Gh/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95119227|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour Closed End 6 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|469.86|FSC: 13; Default||Not reimbursed separately|469.86|FSC: 13; Default||External grouping not supported 95162758|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Hs1 Non-brade|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119228|EAP|Custom 95119228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Suturing Small Joint|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188519|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.00 X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119229|EAP|Custom 95119229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Cut Side Long Taper 2.0x19m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162759|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Hh1 Non-braid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 9.0mm X 25 Mm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.72|FSC: 13; Default||Not reimbursed separately|249.72|FSC: 13; Default||External grouping not supported 95119232|EAP|Custom 95119232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Gt-1-t|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162760|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Omni1 Braided|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|FSC: 13; Default||Not reimbursed separately|2,796.00|FSC: 13; Default||External grouping not supported 95119234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,964.00|FSC: 13; Default||Not reimbursed separately|2,964.00|FSC: 13; Default||External grouping not supported 95162761|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Bern Braded 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119235|EAP|Custom 95119235||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Lock|1|HUMANA [1294]||HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95119236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95162762|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ball Cut Pcb 6 X 2 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95192217|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 30.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Duraloc 28mm 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95119239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cross Int Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|903.00|FSC: 13; Default||Not reimbursed separately|903.00|FSC: 13; Default||External grouping not supported 95119240|EAP|Custom 95119240||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cages Brantigan Cfrp 9x11|1|HUMANA [1294]||HUMANA [11839]|6,570.00|FSC: 13; Default||Not reimbursed separately|6,570.00|FSC: 13; Default||External grouping not supported 95162764|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blln Qmav Otw 8mmx3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119241|EAP|Custom 95119241||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan Cfrp|1|HUMANA [1294]||HUMANA [11839]|6,570.00|FSC: 13; Default||Not reimbursed separately|6,570.00|FSC: 13; Default||External grouping not supported 95119242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95162765|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Accu-vu Pigtail 5fr 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119244|EAP|Custom 95119244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbidemedium 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119247|EAP|Custom 95119247||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Lma-fastrach Sz 3 Inclu:553|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 26mm +5mm-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95188520|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.00 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 9x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95162767|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Renegade 3/2.8fr 20/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119250|EAP|Custom 95119250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm(110mm/85mm)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119251|EAP|Custom 95119251||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shaft Screw Hexagonal|1|HUMANA [1294]||HUMANA [11839]|1,084.26|FSC: 13; Default||Not reimbursed separately|1,084.26|FSC: 13; Default||External grouping not supported 95162768|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Renegade 3/2.8fr 20/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95119253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Broad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95162769|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu 5fr 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Broad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|FSC: 13; Default||Not reimbursed separately|684.00|FSC: 13; Default||External grouping not supported 95119255|EAP|Custom 95119255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 1.1mm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162770|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occl Intlok 3mmx6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 95119257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95162771|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Jb1 Fr 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95119259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95162772|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occl Intlok 5mmx8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95119261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95162773|EAP|Custom 95162773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Line Conne High Press Non-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95119263|EAP|Custom 95119263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Shuttle Release|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162774|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fastrk 325 Trns 18 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119264|EAP|Custom 95119264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pain-buster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188521|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.50 X 6 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95162775|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast 6mm X 22 X 80c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95119266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad 7-hole 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,442.13|FSC: 13; Default||Not reimbursed separately|1,442.13|FSC: 13; Default||External grouping not supported 95119267|EAP|Custom 95119267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Clear-cut Angled 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162776|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Rengd Stc18 Str 20/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119268|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95119269|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95162781|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Bentson .035 X 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119270|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95119271|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95162784|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Vas-cath Niagra St Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.60|FSC: 13; Default||Not reimbursed separately|327.60|FSC: 13; Default||External grouping not supported 95119272|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95192218|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119273|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95162785|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Vas-cath Niagra St Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.60|FSC: 13; Default||Not reimbursed separately|327.60|FSC: 13; Default||External grouping not supported 95119274|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95119275|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95111455|EAP|Custom 95111455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stent Intro 7fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119276|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95119277|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95112201|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 10-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95119278|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95119279|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95121333|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Percuflex Amstrdam 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95119280|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95188522|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.50 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162914|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jagtone Rx 39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119283|EAP|Custom 95119283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoretract 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119285|EAP|Custom 95119285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Suture Disp. 45-degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162915|EAP|Custom 95162915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Microknive Xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Soft-tissue 3mm #2-ticron|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95162916|EAP|Custom 95162916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Nasobiliary 7.5fr Fle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revision Porous 15mm X 127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95119291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 28mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95162917|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Bili Drain 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95119292|EAP|Custom 95119292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Filtration Smoke Laparosc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Proximal Gmrs Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 95119296|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95162918|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Bili Drain 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95119297|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95181844|EAP|Custom 95181844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119298|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95162919|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Percuflex Bili Drain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95119299|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95181847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Piece Extension Gmrs 50 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95119300|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95162920|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Percuflex Bili Drain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95119301|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95181843|EAP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Amniotic Ambio Dry 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95119302|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95162921|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Percuflex Bili Drain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95119303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95119304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 20mm In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95162922|EAP|Custom 95162922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stent Intro 10fr 3.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrack 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95119307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95162923|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Stent Bili Flexima 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.07|FSC: 13; Default||Not reimbursed separately|341.07|FSC: 13; Default||External grouping not supported 95119308|EAP|Custom 95119308||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Core 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119309|EAP|Custom 95119309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter 6mm Variable-depth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162924|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Stent Bili Flexima 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.07|FSC: 13; Default||Not reimbursed separately|341.07|FSC: 13; Default||External grouping not supported 95119312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrak 14.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95119315|EAP|Custom 95119315||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheet Mini-plate Channel|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95162925|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Jagwire Hydra Stiff Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95119317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|FSC: 13; Default||Not reimbursed separately|265.29|FSC: 13; Default||External grouping not supported 95162926|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidwre Flexi W/ Striaght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119318|EAP|Custom 95119318||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Lid Lower Left Fda Approv|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95119320|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Pigtail 8x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|349.14|FSC: 13; Default||Not reimbursed separately|349.14|FSC: 13; Default||External grouping not supported 95162927|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Jagwire Hydra 0.035 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119321|EAP|Custom 95119321||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 6 X 24|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95119324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Lg Left 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,901.82|FSC: 13; Default||Not reimbursed separately|1,901.82|FSC: 13; Default||External grouping not supported 95162928|EAP|Custom 95162928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canu Ercp Contour Taptered|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119325|EAP|Custom 95119325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Arthroscopic Orthosorb|1|HUMANA [1294]||HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 95119326|EAP|Custom 95119326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Suture Disp. 60-degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 3mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95119330|EAP|Custom 95119330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Half Composite 160m Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162930|EAP|Custom 95162930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndle Sclera Interject|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119332|EAP|Custom 95119332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mmx5 Clavicle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181850|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 3.5 Mm X 16 Mm Graftmaster Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95119333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Lag 12.7mm X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|FSC: 13; Default||Not reimbursed separately|880.05|FSC: 13; Default||External grouping not supported 95162931|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ball Cre Esoph 8-9-10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119334|EAP|Custom 95119334||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Liner-locking|1|HUMANA [1294]||HUMANA [11839]|585.90|FSC: 13; Default||Not reimbursed separately|585.90|FSC: 13; Default||External grouping not supported 95181849|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8 Fr Jl 4.0 90 Cm Guiding|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162932|EAP|Custom 95162932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndle Excelong Wang|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119336|EAP|Custom 95119336||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Urolome 2.5 Endoprothesis|1|HUMANA [1294]||HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 95181857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.05|FSC: 13; Default||Not reimbursed separately|79.05|FSC: 13; Default||External grouping not supported 95119341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5x14 Clavicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95162936|EAP|Custom 95162936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide Hook Spec 7fr 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5x16 Clavicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.02|FSC: 13; Default||Not reimbursed separately|163.02|FSC: 13; Default||External grouping not supported 95181856|EAP|Custom 95181856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Monitoring And Drainage External Duet Smart Site|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 18mm Clav|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95162939|EAP|Custom 95162939||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 8 X 25mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95119347|EAP|Custom 95119347||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Fibular Cornerstone 6mm|1|HUMANA [1294]||HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95181854|EAP|Custom 95181854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Trocar Point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95162940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comp Fem 62.5 Lt Cr Por Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95119349|EAP|Custom 95119349||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Curved 1.|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95181858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 6mm L80mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95119350|EAP|Custom 95119350||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Side-angl|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95162941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tib Cr 14mm X 63/6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95119351|EAP|Custom 95119351||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Sideward-|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95181848|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8 Fr Jr 4.0 90 Cm Guiding|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119352|EAP|Custom 95119352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Curved Sl|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95162942|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endopro Viabahn Heparnized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|FSC: 13; Default||Not reimbursed separately|11,970.00|FSC: 13; Default||External grouping not supported 95119353|EAP|Custom 95119353||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Curved 1.|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95181851|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent 4.0 Mm X 16 Mm Graftmaster Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95119354|EAP|Custom 95119354||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Forward-c|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95162944|EAP|Custom 95162944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canu Inner Disp Size-5mm T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119355|EAP|Custom 95119355||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95181853|EAP|Custom 95181853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Flex 6.5x72mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119356|EAP|Custom 95119356||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95162946|EAP|Custom 95162946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bld Arthosco Incisor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119357|EAP|Custom 95119357||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95181860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm L42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95119359|EAP|Custom 95119359||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden 90-degree|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95162947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Patella Hemi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95119361|EAP|Custom 95119361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Bayonet 1|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95181859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lateral 8 Hole L202mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,802.00|FSC: 13; Default||Not reimbursed separately|11,802.00|FSC: 13; Default||External grouping not supported 95119362|EAP|Custom 95119362||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|681.00|FSC: 13; Default||Not reimbursed separately|681.00|FSC: 13; Default||External grouping not supported 95162948|EAP|Custom 95162948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bld Arthosco Acromioblaste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119363|EAP|Custom 95119363||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95119364|EAP|Custom 95119364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Notch- Blaste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162951|EAP|Custom 95162951||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Ndle Suturecut Mega|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x20 Clavicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.02|FSC: 13; Default||Not reimbursed separately|163.02|FSC: 13; Default||External grouping not supported 80167026|EAP|CPT® 31626||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Placement Fiducial Markers|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 95119368|EAP|Custom 95119368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Dispersive Rita|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162952|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic Geenen 5f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95119369|EAP|Custom 95119369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Rita Starburst Xl 3-5cm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181870|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Percutaneous Mri Surescan Vectris 1x8 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,420.00|FSC: 13; Default||Not reimbursed separately|6,420.00|FSC: 13; Default||External grouping not supported 95119370|EAP|Custom 95119370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Rita Starburst Xl 3-5cm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162953|EAP|Custom 95162953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Garment Comp Calf Lg 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119373|EAP|Custom 95119373||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Access Vascular Port- Del|1|HUMANA [1294]||HUMANA [11839]|1,245.00|FSC: 13; Default||Not reimbursed separately|1,245.00|FSC: 13; Default||External grouping not supported 95181865|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8fr Al .75 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119375|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ex Composix 6 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,256.00|FSC: 13; Default||Not reimbursed separately|2,256.00|FSC: 13; Default||External grouping not supported 95162954|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic Geenen 3f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95119376|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ex Composix 10x 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 95181864|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8fr Guideliner V3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162955|EAP|Custom 95162955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ercp Glo-tip Long Tap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181867|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8fr Ebu 4.0 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162956|EAP|Custom 95162956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology Gastrointes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160247|EAP|Custom 95160247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inserter Dilator Plug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119385|EAP|Custom 95119385||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95162960|EAP|Custom 95162960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Microbiology Disp 1m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119386|EAP|Custom 95119386||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95181869|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Battery Restore Sure Scan Mri Compatiable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|FSC: 13; Default||Not reimbursed separately|49,500.00|FSC: 13; Default||External grouping not supported 95119387|EAP|Custom 95119387||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95119388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95181868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 95119389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95162957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Ex Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,983.35|FSC: 13; Default||Not reimbursed separately|5,983.35|FSC: 13; Default||External grouping not supported 95119390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Cut 25cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,508.22|FSC: 13; Default||Not reimbursed separately|1,508.22|FSC: 13; Default||External grouping not supported 95181866|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8fr Ebu 3.5 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119391|EAP|Custom 95119391||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector 3d Small|1|HUMANA [1294]||HUMANA [11839]|3,257.70|FSC: 13; Default||Not reimbursed separately|3,257.70|FSC: 13; Default||External grouping not supported 80167034|EAP|CPT® 40800||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Drainage Mouth Abscess|1|HUMANA [1294]||HUMANA [11839]|1,738.23|FSC: 13; Default||Not reimbursed separately|1,738.23|FSC: 13; Default||External grouping not supported 95119393|EAP|Custom 95119393||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Slightly-|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95162977|EAP|Custom 95162977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Stap Prolapse And Hemo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119394|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Soft-tissue Urologic Mai3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95181874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Dense Injectable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,476.00|FSC: 13; Default||Not reimbursed separately|4,476.00|FSC: 13; Default||External grouping not supported 95119396|EAP|Custom 95119396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Pressure-monitor Leftat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Coronoid Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95119397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Closed 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95181877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 32mm +4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95119398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95162994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cort 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95119399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181876|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6 Fr 5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,185.00|FSC: 13; Default||Not reimbursed separately|19,185.00|FSC: 13; Default||External grouping not supported 95119400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95162996|EAP|Custom 95162996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bld Saggital Thin Shrt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95181880|EAP|Custom 95181880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Hemostasis Disposable Endoscopic 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95162997|EAP|Custom 95162997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Argon Abc Flex 220cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119403|EAP|Custom 95119403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181879|EAP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermoplasty Bronchial Alair Ats2 5|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162998|EAP|Custom 95162998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Capsule Video Pill Cam Sb2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119406|EAP|Custom 95119406||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Cannulated 3.5/4.0m|1|HUMANA [1294]||HUMANA [11839]|110.76|FSC: 13; Default||Not reimbursed separately|110.76|FSC: 13; Default||External grouping not supported 95181878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Hook Lcp 3.5mm 7 Hole 15mm Left Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,858.31|FSC: 13; Default||Not reimbursed separately|2,858.31|FSC: 13; Default||External grouping not supported 95119407|EAP|Custom 95119407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cautery High Temp Loop Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162999|EAP|Custom 95162999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Capsule Bravo Ph W/ Deliv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95163002|EAP|Custom 95163002||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Media Contrast Magnevist 5|1|HUMANA [1294]||HUMANA [11839]|8.80|FSC: 13; Default||Not reimbursed separately|8.80|FSC: 13; Default||External grouping not supported 95119414|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Transhepatic Palma|1|HUMANA [1294]||HUMANA [11839]|3,270.00|FSC: 13; Default||Not reimbursed separately|3,270.00|FSC: 13; Default||External grouping not supported 95181883|EAP|Custom 95181883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wire Ti 1.25x150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119416|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blue-max 7x2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163003|EAP|Custom 95163003||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Media Contrast Magnevist 1|1|HUMANA [1294]||HUMANA [11839]|8.98|FSC: 13; Default||Not reimbursed separately|8.98|FSC: 13; Default||External grouping not supported 95181882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95163004|EAP|Custom 95163004||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Media Contrast Magnevist 1|1|HUMANA [1294]||HUMANA [11839]|8.98|FSC: 13; Default||Not reimbursed separately|8.98|FSC: 13; Default||External grouping not supported 95181898|EAP|Custom 95181898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Cross-cut Fissure Carbide 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119426|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Pericardial Bovine 10cm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,149.00|FSC: 13; Default||Not reimbursed separately|1,149.00|FSC: 13; Default||External grouping not supported 95163005|EAP|Custom 95163005||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Media Contrast Magnevist 2|1|HUMANA [1294]||HUMANA [11839]|8.98|FSC: 13; Default||Not reimbursed separately|8.98|FSC: 13; Default||External grouping not supported 95119427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Peak Poly 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,760.00|FSC: 13; Default||Not reimbursed separately|2,760.00|FSC: 13; Default||External grouping not supported 95181889|EAP|Custom 95181889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration U/s Endoscopic Slimline Expect 22 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119428|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Tapered Tw 4.5mm-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.00|FSC: 13; Default||Not reimbursed separately|2,034.00|FSC: 13; Default||External grouping not supported 95163006|EAP|Custom 95163006||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Media Contrast Magnevist 1|1|HUMANA [1294]||HUMANA [11839]|9.53|FSC: 13; Default||Not reimbursed separately|9.53|FSC: 13; Default||External grouping not supported 95119429|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bilateral-stretch 24x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.00|FSC: 13; Default||Not reimbursed separately|2,793.00|FSC: 13; Default||External grouping not supported 95181895|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Mini Trek Otw 2.50mm X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 100mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95163007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95119431|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intraventional 9 French X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181885|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Fielder Xt 190cm Straight 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119433|EAP|Custom 95119433||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Outer Miami Moss|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95163008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive Self Dri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95119438|EAP|Custom 95119438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Cruciform 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181894|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hitorque Pilot 200 180cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin 3.2x12 Point Drill|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95163009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive Self Dri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95119442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 13mm X 130mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95181900|EAP|Custom 95181900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 0.76mm W/ Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 14mm X 170mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95123277|EAP|Custom 95123277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bld Saw Sagittal 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 14mm X 130mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,686.00|FSC: 13; Default||Not reimbursed separately|7,686.00|FSC: 13; Default||External grouping not supported 95181899|EAP|Custom 95181899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 02.5 Magenta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 16mm X 130mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95163017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.3 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.60|FSC: 13; Default||Not reimbursed separately|126.60|FSC: 13; Default||External grouping not supported 95119446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95181888|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Miraclebros 12 300cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95163018|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95119448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95181890|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Confianza Pro12 180cm Straight 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/pegs 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,971.66|FSC: 13; Default||Not reimbursed separately|4,971.66|FSC: 13; Default||External grouping not supported 95163019|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95119450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/pegs 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95181892|EAP|Custom 95181892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration U/s Endoscopic Slimline Expect 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/pegs 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95163020|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95119452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/keel 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95181893|EAP|Custom 95181893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration U/s Endoscopic Slimline Expect 19 Ga Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/keel 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95163025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Lck Hand Profyle Comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|888.75|FSC: 13; Default||Not reimbursed separately|888.75|FSC: 13; Default||External grouping not supported 95119454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95181891|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Sion 180cm 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95163026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok 2.3mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.75|FSC: 13; Default||Not reimbursed separately|267.75|FSC: 13; Default||External grouping not supported 95119456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95181887|EAP|Custom 95181887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration U/s Endoscopic Slimline Expect 19 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95163027|EAP|Custom 95163027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Net Roth Food Bolus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95181886|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Fielder Fc 180cm Straight 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 95163028|EAP|Custom 95163028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Net Roth Polyp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 95119461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95163029|EAP|Custom 95163029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trap Polyp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119462|EAP|Custom 95119462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Pressurizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188523|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.50 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119463|EAP|Custom 95119463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Keel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163031|EAP|Custom 95163031||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 30 X 15mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95119464|EAP|Custom 95119464||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Holding Shorthead Nexgen|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95181905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Slf-tpng With T4 Stardrive Recess 1.5mm X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95119465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 6mm X 130mm Biglian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,704.50|FSC: 13; Default||Not reimbursed separately|11,704.50|FSC: 13; Default||External grouping not supported 95163032|EAP|Custom 95163032||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mini Bio-suturetak Disp In|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95119466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 7mm X 130mm Biglian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95181908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw It Locking Slf-tpng With T4 Stardrive Recess 1.5mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95119467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 8mm X 130mm Biglian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95163033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mini Bio Pushlock 2.5 X 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95119468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 8mm X 170mm Biglian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95181903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 1.5mm Ti Lcp 6 Hole Shaft With Guides|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,675.83|FSC: 13; Default||Not reimbursed separately|1,675.83|FSC: 13; Default||External grouping not supported 95119469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 9mm X 130mm Biglian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95163053|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Bentson Fix Core .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95181901|EAP|Custom 95181901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Super Arrow Flex 8fr 60cm 2/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95163054|EAP|Custom 95163054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Picc 4f Sgl Lumen Ct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95181904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpng With T4 Stardrive Recess 1.5mm X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95119473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Bio-modular 11mm Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,984.00|FSC: 13; Default||Not reimbursed separately|6,984.00|FSC: 13; Default||External grouping not supported 95163055|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Picc 5f Dual Lumen Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95119474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95181907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking Slf-tpng With T4 Stardrive 1.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95119475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95163056|EAP|Custom 95163056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Assura Extra 2 Piece|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95181911|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95119477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 95163057|EAP|Custom 95163057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Irrig Flushing Pump (|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95181912|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95119479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95163059|EAP|Custom 95163059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ball Dbl Lumen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181909|EAP|Custom 95181909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.1mm /mini Qc/110mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163061|EAP|Custom 95163061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Endo (spot)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119483|EAP|Custom 95119483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Lindemannmedium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking Slf-tang With T4 Stardrive Recess 1.5mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95119487|EAP|Custom 95119487||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Cannulated 6.5mm|1|HUMANA [1294]||HUMANA [11839]|110.76|FSC: 13; Default||Not reimbursed separately|110.76|FSC: 13; Default||External grouping not supported 95163062|EAP|Custom 95163062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Paste Ostomy 2oz Tube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119488|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ex Composix 4 X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.00|FSC: 13; Default||Not reimbursed separately|1,071.00|FSC: 13; Default||External grouping not supported 95181910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pfr Titanium Performa Grissom Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,500.00|FSC: 13; Default||Not reimbursed separately|22,500.00|FSC: 13; Default||External grouping not supported 95119490|EAP|Custom 95119490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Spiral 4fr 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163067|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Programming Pt Precisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 6.5 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95119494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal-radius Stra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,439.79|FSC: 13; Default||Not reimbursed separately|1,439.79|FSC: 13; Default||External grouping not supported 95163069|EAP|Custom 95163069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hndpce Us 9g (3.7mm) X 12c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119495|EAP|HCPCS Q9963||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Sinografin 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|21.96|FSC: 13; Default||Not reimbursed separately|21.96|FSC: 13; Default||External grouping not supported 95181918|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Blunt Voyager|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95163070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Mtl On Mtl Aspher|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|FSC: 13; Default||Not reimbursed separately|3,408.60|FSC: 13; Default||External grouping not supported 95119507|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bmw 190cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181920|EAP|Custom 95181920||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 50mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95163071|EAP|Custom 95163071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hndpce Us 9g (3.7mm) X 12c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181916|EAP|Custom 95181916||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 12mm X 11mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,880.90|FSC: 13; Default||Not reimbursed separately|14,880.90|FSC: 13; Default||External grouping not supported 95119543|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alloderm 3cmx7cm Per Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.57|FSC: 13; Default||Not reimbursed separately|114.57|FSC: 13; Default||External grouping not supported 95163072|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Body Main 22mm X 96cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95119545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Hip Self-centering 45mm+ 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.00|FSC: 13; Default||Not reimbursed separately|2,595.00|FSC: 13; Default||External grouping not supported 95181932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95119547|EAP|Custom 95119547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Aortic Flexible Arch 24f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163074|EAP|Custom 95163074||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hndpce Us 12g (2.7mm) X 12|1|HUMANA [1294]||HUMANA [11839]|727.50|FSC: 13; Default||Not reimbursed separately|727.50|FSC: 13; Default||External grouping not supported 95119549|EAP|Custom 95119549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Radiolucent Recon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Distal Lateral Va-lcp 2.7mm/3.5mm 1hole 69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 95119557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Zirconia 1.5 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95163078|EAP|Custom 95163078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adptr Tisu Remote Filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119560|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Great Mp-joint Non-p|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95181926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95163079|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uret Contour W/ Gdw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.72|FSC: 13; Default||Not reimbursed separately|393.72|FSC: 13; Default||External grouping not supported 95119564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95181924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X L60mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95119566|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tissue Soft Ortho Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,810.00|FSC: 13; Default||Not reimbursed separately|6,810.00|FSC: 13; Default||External grouping not supported 95163080|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uret Contour W/ Gdw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.72|FSC: 13; Default||Not reimbursed separately|393.72|FSC: 13; Default||External grouping not supported 95119567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95181927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95119569|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Patch Cardiovascular 8x 7.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|678.00|FSC: 13; Default||Not reimbursed separately|678.00|FSC: 13; Default||External grouping not supported 95181922|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Jetstream Sc 1.6mm 7f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95163075|EAP|Custom 95163075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Carbide Rnd 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119572|EAP|Custom 95119572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Blake 10mm Flat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181933|EAP|Custom 95181933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lasso Quickpass Curve Left 25 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,765.50|FSC: 13; Default||Not reimbursed separately|1,765.50|FSC: 13; Default||External grouping not supported 95163110|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Microintroducer 4 Fr 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119575|EAP|Custom 95119575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Mammolok 20 G X 3.0 Cm 1x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3x95mm 32mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95119578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Proximal 3.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,434.56|FSC: 13; Default||Not reimbursed separately|5,434.56|FSC: 13; Default||External grouping not supported 95163112|EAP|Custom 95163112||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Waist Multiflap Uni|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119580|EAP|Custom 95119580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Hawkins Ii 20 Ga X 5 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95119581|EAP|Custom 95119581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Hawkins Ii 20ga X 7.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163113|EAP|Custom 95163113||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Waist Multiflap Uni|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119582|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95181928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 48m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95119583|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95163114|EAP|Custom 95163114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Stone Retr Hemisphe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119584|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95181925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 6 Hole L147mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,621.00|FSC: 13; Default||Not reimbursed separately|9,621.00|FSC: 13; Default||External grouping not supported 95119585|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95163116|EAP|Custom 95163116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Tube Otology Diego|1|HUMANA [1294]||HUMANA [11839]|59.93|FSC: 13; Default||Not reimbursed separately|59.93|FSC: 13; Default||External grouping not supported 95119586|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Sali|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95181930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Med.distal Va-lcp 2.7mm/3.5mm 1hole 72mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|FSC: 13; Default||Not reimbursed separately|3,814.23|FSC: 13; Default||External grouping not supported 95119587|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Sali|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95163117|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Acunav Us 8fr 90 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119588|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide .035 X 260 Lunderquis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5mmx46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95119590|EAP|Custom 95119590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95119592|EAP|Custom 95119592||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Urostomy Convex 1-piece A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Y 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95119593|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Textured Recon Sa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95181946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Variable Angle 3.5mmx38m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95119594|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95163125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Y Dbl 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 95119595|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-468 195- 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95181942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95119597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag One-step 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.03|FSC: 13; Default||Not reimbursed separately|1,077.03|FSC: 13; Default||External grouping not supported 95163127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Y Dbl 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 95119602|EAP|Custom 95119602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.25mm X 100mm Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95119603|EAP|Custom 95119603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button 4.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt St 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|FSC: 13; Default||Not reimbursed separately|303.00|FSC: 13; Default||External grouping not supported 95119615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 3mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95181945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Va-lcp 3.5mmx147mm/8hole/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,714.25|FSC: 13; Default||Not reimbursed separately|5,714.25|FSC: 13; Default||External grouping not supported 95119616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 3mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95163129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119619|EAP|Custom 95119619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95163130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119625|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 0.45x6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181954|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Injection Drillable Norian 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,836.95|FSC: 13; Default||Not reimbursed separately|8,836.95|FSC: 13; Default||External grouping not supported 95119627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 95163131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 95181955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight Es2 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95119629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95163132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95181950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Variable Angle 3.5mmx75m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95119631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3.0x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95163133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3.0x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95181952|EAP|Custom 95181952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Threadedrill Percutaneous 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119634|EAP|Custom 95119634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Universal Tissue 2.5/3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119635|EAP|Custom 95119635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Contour 550cc Breast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95119636|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Spectrum Style-14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95163135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95181937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 2.7x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95119638|EAP|Custom 95119638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 13.0mm 300m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95119639|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95181944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95119640|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95163137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Fract 6 Hole Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,602.00|FSC: 13; Default||Not reimbursed separately|1,602.00|FSC: 13; Default||External grouping not supported 95119641|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95181948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5mmx65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95119642|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg 1.2 X 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.00|FSC: 13; Default||Not reimbursed separately|156.00|FSC: 13; Default||External grouping not supported 95119643|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95181953|EAP|Custom 95181953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.5mmx95mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119644|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg 1.2 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.00|FSC: 13; Default||Not reimbursed separately|156.00|FSC: 13; Default||External grouping not supported 95119645|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95181949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Variable Angle 3.5mmx70m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95119646|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Calibrated 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cntr Drive 1.0 X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.00|FSC: 13; Default||Not reimbursed separately|147.00|FSC: 13; Default||External grouping not supported 95119650|EAP|Custom 95119650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 3.0mm Angled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181936|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Allure Quadra Bivent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,161.25|FSC: 13; Default||Not reimbursed separately|24,161.25|FSC: 13; Default||External grouping not supported 95119651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 3.0mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.83|FSC: 13; Default||Not reimbursed separately|142.83|FSC: 13; Default||External grouping not supported 95163141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cntr Drive 1.0 X 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.00|FSC: 13; Default||Not reimbursed separately|147.00|FSC: 13; Default||External grouping not supported 95119652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 3.0mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.83|FSC: 13; Default||Not reimbursed separately|142.83|FSC: 13; Default||External grouping not supported 95181938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 5-hole/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95119653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 3.0mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.83|FSC: 13; Default||Not reimbursed separately|142.83|FSC: 13; Default||External grouping not supported 95163142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cntr Drive 1.0 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.80|FSC: 13; Default||Not reimbursed separately|247.80|FSC: 13; Default||External grouping not supported 95119656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95181951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5mmx80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95119658|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jagtail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cntr Drive 1.0 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.60|FSC: 13; Default||Not reimbursed separately|153.60|FSC: 13; Default||External grouping not supported 95119662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 10mm X 130mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95181965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Midshaft Ulna 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95119663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 12mm X 130mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95163144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cntr Drive 1.0 X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.60|FSC: 13; Default||Not reimbursed separately|156.60|FSC: 13; Default||External grouping not supported 95119665|EAP|Custom 95119665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slitters Catheter Guide Attain R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181963|EAP|Custom 95181963||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Hoffman Universal Foot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119666|EAP|Custom 95119666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Cath Intrauterine Pressur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cntr Drive 1.0 X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.80|FSC: 13; Default||Not reimbursed separately|163.80|FSC: 13; Default||External grouping not supported 95119667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Band Tension Compression 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95181962|EAP|Custom 95181962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Nose Blunt 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial Locking Reco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.00|FSC: 13; Default||Not reimbursed separately|1,593.00|FSC: 13; Default||External grouping not supported 95163147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Square 1.5mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.00|FSC: 13; Default||Not reimbursed separately|618.00|FSC: 13; Default||External grouping not supported 95119669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial Locking Reco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,205.00|FSC: 13; Default||Not reimbursed separately|2,205.00|FSC: 13; Default||External grouping not supported 95181964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Radius 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95119671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95119672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95181961|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Corsair 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt L Rt Reg 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95119674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95119675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt L Lt Reg 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95119676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95192219|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163151|EAP|Custom 95163151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.5 X 70mm Shft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95185534|EAP|Custom 95185534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jigs Persona Psi Pref Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Fract 8 Hole Shrt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,533.00|FSC: 13; Default||Not reimbursed separately|1,533.00|FSC: 13; Default||External grouping not supported 95119680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95188524|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.00 X 6 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95119682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95185526|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 5mm X 40mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 3.9mm 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163155|EAP|Custom 95163155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecatheter 5fr Non Tapr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mmx14mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|FSC: 13; Default||Not reimbursed separately|1,282.50|FSC: 13; Default||External grouping not supported 95119686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking 2.4mmx16mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|FSC: 13; Default||Not reimbursed separately|1,282.50|FSC: 13; Default||External grouping not supported 95163156|EAP|Custom 95163156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bld Arthosco Incisor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mmx18mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.50|FSC: 13; Default||Not reimbursed separately|256.50|FSC: 13; Default||External grouping not supported 95185530|EAP|Custom 95185530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Helical Tfna 95mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119698|EAP|Custom 95119698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Irrigation Lysonic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163157|EAP|Custom 95163157||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intro Lead Percu 7fr 13cm|1|HUMANA [1294]||HUMANA [11839]|174.00|FSC: 13; Default||Not reimbursed separately|174.00|FSC: 13; Default||External grouping not supported 95119707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dorsal Oblique 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.11|FSC: 13; Default||Not reimbursed separately|1,468.11|FSC: 13; Default||External grouping not supported 95163158|EAP|Custom 95163158||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intro Lead Percu Valved 9f|1|HUMANA [1294]||HUMANA [11839]|174.00|FSC: 13; Default||Not reimbursed separately|174.00|FSC: 13; Default||External grouping not supported 95119710|EAP|Custom 95119710||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Snare Polypectomy Singular Capti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188525|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.00 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163224|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95119716|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilitation Biliary Ball|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119719|EAP|Custom 95119719||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Wehrs-incus Doubl|1|HUMANA [1294]||HUMANA [11839]|1,159.05|FSC: 13; Default||Not reimbursed separately|1,159.05|FSC: 13; Default||External grouping not supported 95163225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 95119720|EAP|Custom 95119720||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Wehrs-incus Stape|1|HUMANA [1294]||HUMANA [11839]|1,159.05|FSC: 13; Default||Not reimbursed separately|1,159.05|FSC: 13; Default||External grouping not supported 95185536|EAP|Custom 95185536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Mixing Cement Vaccum 3-dose|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119721|EAP|Custom 95119721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Inflow Illuminator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 95119723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|203.55|FSC: 13; Default||Not reimbursed separately|203.55|FSC: 13; Default||External grouping not supported 95119725|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fgs 51-60cm (ams 800)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95163227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95119726|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Pressure Regulator (ams 800|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,730.00|FSC: 13; Default||Not reimbursed separately|8,730.00|FSC: 13; Default||External grouping not supported 95181968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro-toe 4.omm X 16mm Angle 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95119727|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Press Regular (ams 800) C18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95163228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 95119729|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Programmer Patient Hand-held C17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 70 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 95119732|EAP|Custom 95119732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vials Contour Pva Particles 355-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porcoat C/r Sigma Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 95119751|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Esophageal Max-force 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95181971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 711 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95163230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|FSC: 13; Default||Not reimbursed separately|153.00|FSC: 13; Default||External grouping not supported 95119760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95192220|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95119761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|FSC: 13; Default||Not reimbursed separately|368.94|FSC: 13; Default||External grouping not supported 95163231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 2.0 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95119769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95119770|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Imf 2.0 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95119780|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 10mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Imf 2.0 X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95119781|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 14mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 5-15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95119782|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 18mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Imf 2.0 X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95119783|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 22mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188526|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.00 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119784|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 25mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Imf 2.0 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95119785|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 28mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062716|EAP|CPT® 80422||0301 - LABORATORY - CHEMISTRY|Hb Glucagon Tolerance (3 Glu, 3 Ins)|1|HUMANA [1294]||HUMANA [11839]|138.21|FSC: 13; Default||Not reimbursed separately|138.21|FSC: 13; Default||External grouping not supported 95163241|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 6.5 Diop 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95119788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Stemmed Sze Green M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,357.09|FSC: 13; Default||Not reimbursed separately|12,357.09|FSC: 13; Default||External grouping not supported 62062708|EAP|Custom 62062708||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Research Client Processing Charge|1|HUMANA [1294]||HUMANA [11839]|15.00|FSC: 13; Default||Not reimbursed separately|15.00|FSC: 13; Default||External grouping not supported 95119789|EAP|Custom 95119789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Vascu-stat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok T7 2.7 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95119790|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 8cfs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181974|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Otw Trek 1.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119794|EAP|Custom 95119794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Softjaw Insert 86mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok T7 2.7 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95119807|EAP|Custom 95119807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.fen-5.0 45de|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181972|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Corsair 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119809|EAP|Custom 95119809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Mini Forcep 110gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok T7 2.7 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95119810|EAP|Custom 95119810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Mini Ang 5mm Yasar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181978|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Endurity Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|FSC: 13; Default||Not reimbursed separately|14,904.00|FSC: 13; Default||External grouping not supported 95163253|EAP|Custom 95163253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath Cobra Sf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119823|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95181979|EAP|Custom 95181979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Steripack Fixator External Coretrack--short Ss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163265|EAP|Custom 95163265||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Isovue 370|1|HUMANA [1294]||HUMANA [11839]|0.27|FSC: 13; Default||Not reimbursed separately|0.27|FSC: 13; Default||External grouping not supported 95119838|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Donut Silicone Size 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181975|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8 Fr. Al .75 Guiding Ea|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Peritoneo-venous Shunt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95163268|EAP|Custom 95163268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canu Oral/nasal Pedi O2 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119842|EAP|Custom 95119842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 6fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181977|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guinding 8fr Jr 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119847|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163269|EAP|Custom 95163269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canu Adult/intermediate O2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119848|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95181973|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Otw Trek 2.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119849|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Corail 2 Stand W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95119857|EAP|Custom 95119857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181976|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6 Fr. Multipurpose 2 Guiding|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95119858|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue Soft Surgisis 4x7 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,256.00|FSC: 13; Default||Not reimbursed separately|2,256.00|FSC: 13; Default||External grouping not supported 95163271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetab Multihole Pinna|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|FSC: 13; Default||Not reimbursed separately|9,368.10|FSC: 13; Default||External grouping not supported 95119864|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Visipaque 320 150ml 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.81|FSC: 13; Default||Not reimbursed separately|1.81|FSC: 13; Default||External grouping not supported 95181982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95119874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral 50x19 Tornier|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.00|FSC: 13; Default||Not reimbursed separately|3,570.00|FSC: 13; Default||External grouping not supported 95163272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Mt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,757.91|FSC: 13; Default||Not reimbursed separately|4,757.91|FSC: 13; Default||External grouping not supported 95119878|EAP|Custom 95119878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Capsular Tension 14c|1|HUMANA [1294]||HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95181984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95119894|EAP|Custom 95119894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Open 9.5mm Monarch|1|HUMANA [1294]||HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 95163276|EAP|Custom 95163276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Intro Rad 6fr 13cm W/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119896|EAP|Custom 95119896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Wide 11mm Monarch|1|HUMANA [1294]||HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 95181985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95163277|EAP|Custom 95163277||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Isovue 300|1|HUMANA [1294]||HUMANA [11839]|0.36|FSC: 13; Default||Not reimbursed separately|0.36|FSC: 13; Default||External grouping not supported 95119900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixator Mini 60/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95181988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95119904|EAP|Custom 95119904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 2mm Fixator Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119911|EAP|Custom 95119911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Clamp Fixator Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181981|EAP|Custom 95181981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Entry Portal Arthroscopic Hip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119916|EAP|Custom 95119916||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stimulator Bone Osteogenisis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95119921|EAP|Custom 95119921||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator Mini Articulating|1|HUMANA [1294]||HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95163280|EAP|Custom 95163280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocr Versaport + Rpf 5-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119924|EAP|Custom 95119924||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Pin Trocar Point 3.2x9 Sm|1|HUMANA [1294]||HUMANA [11839]|67.24|FSC: 13; Default||Not reimbursed separately|67.24|FSC: 13; Default||External grouping not supported 95181986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95119931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5 32mm-thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95163281|EAP|Custom 95163281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexiport Sils Port F/5mm-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95119935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral 12mm X 90mm Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,767.43|FSC: 13; Default||Not reimbursed separately|18,767.43|FSC: 13; Default||External grouping not supported 95181987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95119938|EAP|Custom 95119938||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Restral Large|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95163282|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tisu Strattice 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.37|FSC: 13; Default||Not reimbursed separately|79.37|FSC: 13; Default||External grouping not supported 95119941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Closed Kaneda 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,340.00|FSC: 13; Default||Not reimbursed separately|2,340.00|FSC: 13; Default||External grouping not supported 95181983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95119943|EAP|Custom 95119943||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cornerstone 7mm|1|HUMANA [1294]||HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95119954|EAP|Custom 95119954||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage A Small Top Stackable|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95181991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mmx42 Selftapping With 2.5hexagonal Socket S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95119955|EAP|Custom 95119955||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage A Small Bottom Stackable|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95119960|EAP|Custom 95119960||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage C If 24mm Stackable|1|HUMANA [1294]||HUMANA [11839]|7,920.00|FSC: 13; Default||Not reimbursed separately|7,920.00|FSC: 13; Default||External grouping not supported 95181994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cancellous 4.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95119971|EAP|Custom 95119971||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Locking 60mm W/screw And Nu|1|HUMANA [1294]||HUMANA [11839]|1,181.82|FSC: 13; Default||Not reimbursed separately|1,181.82|FSC: 13; Default||External grouping not supported 95119974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sr 85x6.35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95181995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Self Tap Cortical 2.7x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95120000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sr 95x6.35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95120013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Frs 12mm X 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95181992|EAP|Custom 95181992||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Fixation Spi 3.0x285mm Wch Coated|1|HUMANA [1294]||HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95120014|EAP|Custom 95120014||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Blade Wide Monarch|1|HUMANA [1294]||HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95163287|EAP|Custom 95163287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dev Uterine Measur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120015|EAP|Custom 95120015||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Narrow Monarch|1|HUMANA [1294]||HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 95181993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cancellous 4.0x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95120023|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth Round H-p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95120031|EAP|Custom 95120031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Plasma Therapeutic Exchange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95181980|EAP|Custom 95181980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Driver Pin Half|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163289|EAP|Custom 95163289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Navigator Uret Access Shet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120142|EAP|Custom 95120142||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drainable High-output Nate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Straight 2.0mm 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.30|FSC: 13; Default||Not reimbursed separately|699.30|FSC: 13; Default||External grouping not supported 95120186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Small 2.7mm Oblique Angl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.60|FSC: 13; Default||Not reimbursed separately|156.60|FSC: 13; Default||External grouping not supported 95185532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv/ml Taper Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95120187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini T 1.5mm 50mm 4 Hole H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.75|FSC: 13; Default||Not reimbursed separately|738.75|FSC: 13; Default||External grouping not supported 95120188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 2.7mm X 57mm 7 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95120189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.7mm X 32mm 3 Hole Shaf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|FSC: 13; Default||Not reimbursed separately|194.40|FSC: 13; Default||External grouping not supported 95120190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Straight 1.5mm 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.23|FSC: 13; Default||Not reimbursed separately|781.23|FSC: 13; Default||External grouping not supported 95120191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 2.7mm X 57mm 7 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95120192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini T 2.0mm 50mm 4 Hole H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.00|FSC: 13; Default||Not reimbursed separately|357.00|FSC: 13; Default||External grouping not supported 95120193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini T 2.0mm 50mm 3 Hole H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95120194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 14mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|FSC: 13; Default||Not reimbursed separately|33.75|FSC: 13; Default||External grouping not supported 95120195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 16mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.89|FSC: 13; Default||Not reimbursed separately|40.89|FSC: 13; Default||External grouping not supported 95120196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 18mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|FSC: 13; Default||Not reimbursed separately|33.75|FSC: 13; Default||External grouping not supported 95120197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 20mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|FSC: 13; Default||Not reimbursed separately|55.50|FSC: 13; Default||External grouping not supported 95163299|EAP|Custom 95163299||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blanket Hypothermia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 22mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|FSC: 13; Default||Not reimbursed separately|31.50|FSC: 13; Default||External grouping not supported 95182001|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tornus 88 Flex 2.6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 24mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|FSC: 13; Default||Not reimbursed separately|31.50|FSC: 13; Default||External grouping not supported 95163524|EAP|Custom 95163524||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Draping Sys Multi Care|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 26mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.89|FSC: 13; Default||Not reimbursed separately|40.89|FSC: 13; Default||External grouping not supported 95120201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 28mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|FSC: 13; Default||Not reimbursed separately|55.50|FSC: 13; Default||External grouping not supported 95163529|EAP|HCPCS 95163529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Picc Powerline Dual 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 32mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|FSC: 13; Default||Not reimbursed separately|33.75|FSC: 13; Default||External grouping not supported 95182002|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graftmaster Rx 4.5 X 26 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95120203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 34mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|FSC: 13; Default||Not reimbursed separately|31.50|FSC: 13; Default||External grouping not supported 95163530|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Picc Powerline Sgl 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 38mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|FSC: 13; Default||Not reimbursed separately|31.50|FSC: 13; Default||External grouping not supported 95120205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 40mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|FSC: 13; Default||Not reimbursed separately|31.50|FSC: 13; Default||External grouping not supported 95163531|EAP|Custom 95163531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Access Spinal Endoscop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 42mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.84|FSC: 13; Default||Not reimbursed separately|51.84|FSC: 13; Default||External grouping not supported 95182019|EAP|Custom 95182019||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Prevail 8 X 16 X 14mm|1|HUMANA [1294]||HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95120207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 46mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.84|FSC: 13; Default||Not reimbursed separately|51.84|FSC: 13; Default||External grouping not supported 95163532|EAP|Custom 95163532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Video Guided|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 48mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.91|FSC: 13; Default||Not reimbursed separately|59.91|FSC: 13; Default||External grouping not supported 95120209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 54mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 95163537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tib Conform Profix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 95120210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 60mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 95182013|EAP|Custom 95182013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Plate For 3.0 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 64mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 95163538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95120212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 66mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.25|FSC: 13; Default||Not reimbursed separately|47.25|FSC: 13; Default||External grouping not supported 95120213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 68mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.57|FSC: 13; Default||Not reimbursed separately|48.57|FSC: 13; Default||External grouping not supported 95163548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tib X 3 Tri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95120214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 70mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 95182014|EAP|Custom 95182014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Plate For 3.5 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 28mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|FSC: 13; Default||Not reimbursed separately|39.00|FSC: 13; Default||External grouping not supported 95163549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95120216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 30mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|FSC: 13; Default||Not reimbursed separately|32.10|FSC: 13; Default||External grouping not supported 95120217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 32mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|FSC: 13; Default||Not reimbursed separately|32.10|FSC: 13; Default||External grouping not supported 95163550|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Occ Fogrty 4fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 34mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|FSC: 13; Default||Not reimbursed separately|32.10|FSC: 13; Default||External grouping not supported 95182005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Low Profile 6.5mm X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95120219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 36mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|FSC: 13; Default||Not reimbursed separately|32.10|FSC: 13; Default||External grouping not supported 95163551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Clav 10 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95120220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 38mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|FSC: 13; Default||Not reimbursed separately|32.10|FSC: 13; Default||External grouping not supported 95120221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 40mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|FSC: 13; Default||Not reimbursed separately|32.10|FSC: 13; Default||External grouping not supported 95163552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cort Lok 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95120222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 42mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.00|FSC: 13; Default||Not reimbursed separately|51.00|FSC: 13; Default||External grouping not supported 95182009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hexalobe Non-locking 3.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95120223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 44mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.00|FSC: 13; Default||Not reimbursed separately|45.00|FSC: 13; Default||External grouping not supported 95163553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Clav Ant Medi 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95120224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 46mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.75|FSC: 13; Default||Not reimbursed separately|48.75|FSC: 13; Default||External grouping not supported 95120225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 48mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.50|FSC: 13; Default||Not reimbursed separately|52.50|FSC: 13; Default||External grouping not supported 95163554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheth Tunneler Lg Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.98|FSC: 13; Default||Not reimbursed separately|136.98|FSC: 13; Default||External grouping not supported 95120226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 50mm 13mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.00|FSC: 13; Default||Not reimbursed separately|54.00|FSC: 13; Default||External grouping not supported 95182020|EAP|Custom 95182020||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cutter Flip Ii 9.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120227|EAP|Custom 95120227||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steiman 5.0|1|HUMANA [1294]||HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95163556|EAP|Custom 95163556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand 45 Ultra Reflex Plasm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120228|EAP|Custom 95120228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Medullary|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120233|EAP|Custom 95120233||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone 17-18mm|1|HUMANA [1294]||HUMANA [11839]|188.94|FSC: 13; Default||Not reimbursed separately|188.94|FSC: 13; Default||External grouping not supported 95163561|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ball Ultra Uromax 6cm X 4c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120234|EAP|Custom 95120234||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone 11-12mm|1|HUMANA [1294]||HUMANA [11839]|196.56|FSC: 13; Default||Not reimbursed separately|196.56|FSC: 13; Default||External grouping not supported 95182012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hexalobe Locking 3.0 Mm X 50 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95120235|EAP|Custom 95120235||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone 15-16mm|1|HUMANA [1294]||HUMANA [11839]|196.56|FSC: 13; Default||Not reimbursed separately|196.56|FSC: 13; Default||External grouping not supported 95163564|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Body Main 24mm X 111c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95120236|EAP|Custom 95120236||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone 9-10mm|1|HUMANA [1294]||HUMANA [11839]|196.56|FSC: 13; Default||Not reimbursed separately|196.56|FSC: 13; Default||External grouping not supported 95120242|EAP|Custom 95120242||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Solution Silicon|1|HUMANA [1294]||HUMANA [11839]|1,477.56|FSC: 13; Default||Not reimbursed separately|1,477.56|FSC: 13; Default||External grouping not supported 95163565|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Leg Iliac 22mm X 39cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95120244|EAP|Custom 95120244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Half 33mmx12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182015|EAP|Custom 95182015||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Allograft Puros-s29x11x14mm 7 Degree|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95120245|EAP|Custom 95120245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Half 39mmx18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163566|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Body Main 36mm X 131c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95120247|EAP|Custom 95120247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic White Great4.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163426|EAP|Custom 95163426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pk Eye Custom #1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120249|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Penoscrotal Ultrex-700 Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|FSC: 13; Default||Not reimbursed separately|11,625.00|FSC: 13; Default||External grouping not supported 95182018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95120253|EAP|Custom 95120253||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Sleeved 3.0mm (mandibular)|1|HUMANA [1294]||HUMANA [11839]|756.00|FSC: 13; Default||Not reimbursed separately|756.00|FSC: 13; Default||External grouping not supported 95163372|EAP|Custom 95163372||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drain 2-1/4 Flange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 9.0mm (m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95120255|EAP|Custom 95120255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Sma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163373|EAP|Custom 95163373||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drain 2-3/4 Flange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120256|EAP|Custom 95120256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecronon Left 3-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|FSC: 13; Default||Not reimbursed separately|2,745.00|FSC: 13; Default||External grouping not supported 95163374|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 300ml|1|HUMANA [1294]||HUMANA [11839]|0.16|FSC: 13; Default||Not reimbursed separately|0.16|FSC: 13; Default||External grouping not supported 95163383|EAP|Custom 95163383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retrac Metrix Tblr 8mm X 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120260|EAP|Custom 95120260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Medial Distal 10-hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,993.60|FSC: 13; Default||Not reimbursed separately|3,993.60|FSC: 13; Default||External grouping not supported 95120263|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Radovan Round 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95163386|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Body Main 24mm X 82mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95120266|EAP|Custom 95120266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Cutter Valvutome 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.4mm16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95163387|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Heprin Coded J .025 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120268|EAP|Custom 95120268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Cutter Valvutome 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95120302|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Multi-link Rx Ult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95163388|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidwre Ang .025 180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120310|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Multi-link Rx Ult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95120311|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Multi-link Rx Ult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95163390|EAP|HCPCS C1757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Thrombolyti C Dev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,267.01|FSC: 13; Default||Not reimbursed separately|2,267.01|FSC: 13; Default||External grouping not supported 95120312|EAP|Custom 95120312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Sma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 3.0 Mm X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95120313|EAP|Custom 95120313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163392|EAP|Custom 95163392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheth Si Brite Tip 7fr 5.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 4-hole Reg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95120315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Long 1.5 Mm 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|FSC: 13; Default||Not reimbursed separately|153.00|FSC: 13; Default||External grouping not supported 95163393|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Leg Illiac 8mm X 88cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95120316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Regular Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95182011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hexalobe Non-locking 3.5 Mm X 18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95120317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Micro Orbita Curved 0.6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95163394|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Leg Iliac 10mm X 122m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95120318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture 4 Hole 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95120319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture 4 Hole 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|FSC: 13; Default||Not reimbursed separately|519.00|FSC: 13; Default||External grouping not supported 95163395|EAP|Custom 95163395||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirsner 70mm|1|HUMANA [1294]||HUMANA [11839]|91.50|FSC: 13; Default||Not reimbursed separately|91.50|FSC: 13; Default||External grouping not supported 95182007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biocrci 7x30 8mmhead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|833.85|FSC: 13; Default||Not reimbursed separately|833.85|FSC: 13; Default||External grouping not supported 95120325|EAP|Custom 95120325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization .038 Diameter|1|HUMANA [1294]||HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95163396|EAP|Custom 95163396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stap Uniclip 11mm X 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120329|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Transcend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163397|EAP|Custom 95163397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Uniclip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120330|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Low Profile 6.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95120331|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163398|EAP|Custom 95163398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instru Biop Maxcore|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120332|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120337|EAP|Custom 95120337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cerebral Mani P5.0-35-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163399|EAP|Custom 95163399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Seal Self Disp St.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120341|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dura Tutoplast 4x10cm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,716.00|FSC: 13; Default||Not reimbursed separately|1,716.00|FSC: 13; Default||External grouping not supported 95171077|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 10 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163400|EAP|Custom 95163400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tub Morcellator Versa Cut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Flex 7.5mmx210mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95171078|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5fr X 100cm 5.0-5.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 110mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95163403|EAP|Custom 95163403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hold Body Cot W/tie Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95171079|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powercross 2.5 X 100 X 150 .018 Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 110mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95163405|EAP|Custom 95163405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hold Body Xl Ties|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ebi Cortical 110/50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.60|FSC: 13; Default||Not reimbursed separately|249.60|FSC: 13; Default||External grouping not supported 95171080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,269.01|FSC: 13; Default||Not reimbursed separately|3,269.01|FSC: 13; Default||External grouping not supported 95120355|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior 65ml Ams 700 C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163350|EAP|Custom 95163350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndle 1.7mm Sharp Tip-oblon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120365|EAP|Custom 95120365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Angular Hinge-clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95120366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 150mm Ebi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95163351|EAP|Custom 95163351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndle 2.4mm Sharp Tip-oblon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Supplemental 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95171082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95120369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ebi 150mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95163352|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Body Main 36mm X 113m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95120370|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Tiathlon #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95120371|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163353|EAP|Custom 95163353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cement Bone Gmv Smartset G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120372|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Triathlon Sz 4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95120373|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95120374|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 4-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95120375|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163355|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Ext Body Main 26mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95120376|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon Ts 19mmx150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95120377|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163356|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Ext Body Main 22mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95120378|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171087|EAP|Custom 95171087||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Hip Total Optivac|1|HUMANA [1294]||HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95120379|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163358|EAP|Custom 95163358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dev Pencil Force Triverse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120380|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95120381|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163360|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Imp Brst Gel Smoth Rnd Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95120382|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171088|EAP|Custom 95171088||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Cement Optivac 80 Gram |1|HUMANA [1294]||HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95120383|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95120384|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171089|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Safe-t-j Curved .021 180 Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120385|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163362|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Sel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95120386|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral X-long 32mm V40 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95120387|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163363|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Sel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95120392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 9.0mm X 25mm In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95171092|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.75 X 8mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95163365|EAP|Custom 95163365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cement Nano 3304-a1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 85mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|FSC: 13; Default||Not reimbursed separately|544.26|FSC: 13; Default||External grouping not supported 95171091|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.50 X 8mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Ti-end (for Distal Femoralna|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|535.80|FSC: 13; Default||Not reimbursed separately|535.80|FSC: 13; Default||External grouping not supported 95163310|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Stand .025 X 150cm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 10 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,247.04|FSC: 13; Default||Not reimbursed separately|1,247.04|FSC: 13; Default||External grouping not supported 95171093|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.00 X 8mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Soft-tissue Anchorlok 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95163311|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Stand .025 X 150cm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Soft-tissue Ancholok 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95171094|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.50 X 8mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Locking 130-degree Steril|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95163321|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Ball Evercross 7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95120419|EAP|Custom 95120419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 100mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171095|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 4.00 X 8mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120420|EAP|Custom 95120420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 105mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163322|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheth Si Brite 6fr 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120421|EAP|Custom 95120421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 110mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171096|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.50 X 12mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120422|EAP|Custom 95120422||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 115mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163323|EAP|Custom 95163323||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Isovue 370m|1|HUMANA [1294]||HUMANA [11839]|0.29|FSC: 13; Default||Not reimbursed separately|0.29|FSC: 13; Default||External grouping not supported 95171097|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.75 X 12mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 40mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163324|EAP|Custom 95163324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tub Irrig Coolflow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 30mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95171098|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.00 X 12mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 32 Mm Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95163325|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ez Steer Bidirectiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 34mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95171099|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.50 X 12mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 36mm Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95163346|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95120429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking 3.9mm X 50 Mm Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95171100|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 4.00 X 12mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|352.50|FSC: 13; Default||Not reimbursed separately|352.50|FSC: 13; Default||External grouping not supported 95163348|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ball Dilatr Rigiflex Ii Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 12mm 0mm Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95171101|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.50 X 16mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163300|EAP|Custom 95163300||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Facefull Performa Tra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 32mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171102|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.00 X 16mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163301|EAP|Custom 95163301||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Face Sm Performax Ee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 36mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171103|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.50 X 16mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 38mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163303|EAP|Custom 95163303||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Facefull Performa Tra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171104|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 4.00 X 16mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 42mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163305|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Life Bili 9mm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95120439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 44mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171105|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.50 X 20mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 46mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163307|EAP|Custom 95163307||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 1.5 65 X 90mm|1|HUMANA [1294]||HUMANA [11839]|1,318.62|FSC: 13; Default||Not reimbursed separately|1,318.62|FSC: 13; Default||External grouping not supported 95120441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Ti-locking 4.9mm 48mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171106|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.00 X 20mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 50mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163013|EAP|Custom 95163013||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Garment Comp Calf Med 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Ti-locking 4.9mm 52mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171107|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.50 X 20mmm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 56mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163567|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pk Neurostimulator Interst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,970.00|FSC: 13; Default||Not reimbursed separately|29,970.00|FSC: 13; Default||External grouping not supported 95120445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 58mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171108|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 4.00 X 20mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 60mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163568|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Program Pt Interstim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95120447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 64mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171109|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.50 X 24mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95163570|EAP|Custom 95163570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retr Twister Rotat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120449|EAP|Custom 95120449||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Needle 12-deg Radidloc|1|HUMANA [1294]||HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95171110|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.00 X 24mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.48|FSC: 13; Default||Not reimbursed separately|576.48|FSC: 13; Default||External grouping not supported 95163571|EAP|Custom 95163571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retr Twister Rotat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120451|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 4.8x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95171112|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.50 X 24mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120452|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour With Wire 6 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95163572|EAP|Custom 95163572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prost Replace Ossicular Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120454|EAP|Custom 95120454||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteotomy.10mm Tibial Opening We|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171113|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 4.00 X 24mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95163573|EAP|Custom 95163573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prost Replace Ossicular Pi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 8 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,247.04|FSC: 13; Default||Not reimbursed separately|1,247.04|FSC: 13; Default||External grouping not supported 95171114|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.50 X 28mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 130 Deg 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95163574|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Powehohn 6fr Dual Lum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,144.80|FSC: 13; Default||Not reimbursed separately|1,144.80|FSC: 13; Default||External grouping not supported 95120461|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,426.06|FSC: 13; Default||Not reimbursed separately|2,426.06|FSC: 13; Default||External grouping not supported 95171115|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.00 X 28mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120462|EAP|Custom 95120462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cholangiocath Laproscop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163582|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw Barewire Workhorse .01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Rci 7mmx25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95171116|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 3.50 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Rci 9mmx25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95171117|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 4.00 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95171118|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 8mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ant 6.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95171119|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.5x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95171120|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 60mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.66|FSC: 13; Default||Not reimbursed separately|459.66|FSC: 13; Default||External grouping not supported 95120493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 80mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|FSC: 13; Default||Not reimbursed separately|544.26|FSC: 13; Default||External grouping not supported 80159601|EAP|CPT® 43235||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Diagnostic|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95120527|EAP|Custom 95120527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Tf-032-l-90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120532|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 8f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171121|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120535|EAP|Custom 95120535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Thoracentesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171122|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95171123|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120552|EAP|Custom 95120552||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Distal-radius W/shanz Sc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171124|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element Mr Stent 2.25 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Titanium Elastic Ti 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,224.99|FSC: 13; Default||Not reimbursed separately|1,224.99|FSC: 13; Default||External grouping not supported 95171127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Gap 6.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|370.80|FSC: 13; Default||Not reimbursed separately|370.80|FSC: 13; Default||External grouping not supported 95120557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Dcp Mini 2.0 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|628.86|FSC: 13; Default||Not reimbursed separately|628.86|FSC: 13; Default||External grouping not supported 95171128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Ps 14mm X 71/75 Vanguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 95120558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 76mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-poly Sz 3 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|FSC: 13; Default||Not reimbursed separately|3,073.20|FSC: 13; Default||External grouping not supported 95120559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Back Solid Hemispherical Tritanium 50mm-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95120560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171132|EAP|Custom 95171132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Crescent 30mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95120561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|932.40|FSC: 13; Default||Not reimbursed separately|932.40|FSC: 13; Default||External grouping not supported 95171134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Solera Sextant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|903.00|FSC: 13; Default||Not reimbursed separately|903.00|FSC: 13; Default||External grouping not supported 95120563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 100mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.75|FSC: 13; Default||Not reimbursed separately|798.75|FSC: 13; Default||External grouping not supported 95171136|EAP|Custom 95171136||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Lamina 6mm|1|HUMANA [1294]||HUMANA [11839]|2,493.00|FSC: 13; Default||Not reimbursed separately|2,493.00|FSC: 13; Default||External grouping not supported 95120565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95120566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Posterior Medial Lcp 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,252.48|FSC: 13; Default||Not reimbursed separately|3,252.48|FSC: 13; Default||External grouping not supported 95120567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 115mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171141|EAP|Custom 95171141||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Intervertebral Ib Magnifuse 7.5mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95120568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 120mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 125mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120570|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.1mm Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95165791|EAP|Custom 95165791||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Suction Pro 14fr Single Lumen Dual Swivel 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120599|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Omniscan (10ml) 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|17.40|FSC: 13; Default||Not reimbursed separately|17.40|FSC: 13; Default||External grouping not supported 95171150|EAP|Custom 95171150||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Caps Lock 55mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120607|EAP|Custom 95120607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp T Ebi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95120611|EAP|Custom 95120611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Gold 10 French|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95120616|EAP|Custom 95120616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Wide Blade 6.35|1|HUMANA [1294]||HUMANA [11839]|1,356.00|FSC: 13; Default||Not reimbursed separately|1,356.00|FSC: 13; Default||External grouping not supported 95171154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120627|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Standard Anatomical Sali|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95171155|EAP|Custom 95171155||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Magnifuse Pl Lumbar 5cm|1|HUMANA [1294]||HUMANA [11839]|8,250.00|FSC: 13; Default||Not reimbursed separately|8,250.00|FSC: 13; Default||External grouping not supported 95120628|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Standard Anatomic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 80163322|EAP|CPT® 82803||0301 - LABORATORY - CHEMISTRY|Hb Poc Istat Blood Gases|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 95120629|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 80163330|EAP|CPT® 84295||0301 - LABORATORY - CHEMISTRY|Hb Poc Istat Sodium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.43|FSC: 13; Default||Not reimbursed separately|14.43|FSC: 13; Default||External grouping not supported 95120630|EAP|Custom 95120630||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Accessory Pacing Temporary Dispo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163348|EAP|CPT® 84132||0301 - LABORATORY - CHEMISTRY|Hb Poc Istat Potassium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|FSC: 13; Default||Not reimbursed separately|14.28|FSC: 13; Default||External grouping not supported 80163355|EAP|CPT® 82330||0301 - LABORATORY - CHEMISTRY|Hb Poc Istat Ion Ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.04|FSC: 13; Default||Not reimbursed separately|41.04|FSC: 13; Default||External grouping not supported 95182016|EAP|Custom 95182016||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Allograft Puros-s28x11x14mm 7 Degree|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95120640|EAP|Custom 95120640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Micro Mark 11g 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 3level 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95120643|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima 8 Fr Fi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120644|EAP|Custom 95120644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Jamshidi Disp Bone Marroy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163363|EAP|CPT® 82947||0301 - LABORATORY - CHEMISTRY|Hb Poc Istat Glucose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 95120645|EAP|Custom 95120645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sialography Rabinov Scs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163371|EAP|CPT® 85014||0305 - LABORATORY - HEMATOLOGY|Hb Poc Istat Hematocrit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.11|FSC: 13; Default||Not reimbursed separately|7.11|FSC: 13; Default||External grouping not supported 95120646|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Salivary Duct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 95120647|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Arterial Embolectomy Fogar)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 1.8 X 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.38|FSC: 13; Default||Not reimbursed separately|532.38|FSC: 13; Default||External grouping not supported 95120648|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Peel-away 8 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 1.8 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.38|FSC: 13; Default||Not reimbursed separately|532.38|FSC: 13; Default||External grouping not supported 95120651|EAP|Custom 95120651||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Catheter 18x6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm X 63mm 16 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.42|FSC: 13; Default||Not reimbursed separately|147.42|FSC: 13; Default||External grouping not supported 95120652|EAP|Custom 95120652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Gemini 4-wire 0 Tip 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Boxcare 1.5mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.56|FSC: 13; Default||Not reimbursed separately|196.56|FSC: 13; Default||External grouping not supported 95120653|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 8x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95171164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Boxcare 1.5mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.27|FSC: 13; Default||Not reimbursed separately|225.27|FSC: 13; Default||External grouping not supported 95120655|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilitation Biliary Ball|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Boxcar 1.5mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|245.70|FSC: 13; Default||Not reimbursed separately|245.70|FSC: 13; Default||External grouping not supported 95120658|EAP|Custom 95120658||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Drainage Nasal Biliary 10fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120659|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Saline Breast 690-720cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95171167|EAP|Custom 95171167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.5mm Toggleloc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120660|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Breast 500cc Style133lv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95171168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm Long Thread Stainless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95120663|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 12fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|FSC: 13; Default||Not reimbursed separately|4,247.43|FSC: 13; Default||External grouping not supported 95120665|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Anatomical Saline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95171171|EAP|Custom 95171171||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 7mm Lg|1|HUMANA [1294]||HUMANA [11839]|4,291.56|FSC: 13; Default||Not reimbursed separately|4,291.56|FSC: 13; Default||External grouping not supported 95120666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Condylar 1.5mm Pin Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|934.65|FSC: 13; Default||Not reimbursed separately|934.65|FSC: 13; Default||External grouping not supported 95171172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Oversize St 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|FSC: 13; Default||Not reimbursed separately|1,124.31|FSC: 13; Default||External grouping not supported 95120667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Condylar 1.5mm Pin Ri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|934.65|FSC: 13; Default||Not reimbursed separately|934.65|FSC: 13; Default||External grouping not supported 95171173|EAP|Custom 95171173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Rvs 3.2 Copeland|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Sulphate Calcium Stimulan 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95120694|EAP|Custom 95120694||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cement Restrictor 4043-20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171176|EAP|Custom 95171176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Drainage Line For Catheter Kit Pleurx W/lock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|FSC: 13; Default||Not reimbursed separately|591.00|FSC: 13; Default||External grouping not supported 95171177|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Nano Rx 2.25x 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95120698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95171180|EAP|HCPCS C1874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Valved 9.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 150 Deg 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95171181|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Valved 10 Fr |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 145 Deg 5 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95171182|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Endotak Reliance G 0296|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95120701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 140 Deg 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95171183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Affex Ii 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|FSC: 13; Default||Not reimbursed separately|12,249.00|FSC: 13; Default||External grouping not supported 95120702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 145 Deg 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,595.70|FSC: 13; Default||Not reimbursed separately|1,595.70|FSC: 13; Default||External grouping not supported 95171184|EAP|Custom 95171184||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Magnitude 10mm|1|HUMANA [1294]||HUMANA [11839]|15,894.00|FSC: 13; Default||Not reimbursed separately|15,894.00|FSC: 13; Default||External grouping not supported 95120703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 150 Deg 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95171185|EAP|Custom 95171185||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Magnitude 12mm|1|HUMANA [1294]||HUMANA [11839]|15,894.00|FSC: 13; Default||Not reimbursed separately|15,894.00|FSC: 13; Default||External grouping not supported 95120704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 150 Deg 5 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95171186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 5 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95171187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95120706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95171188|EAP|Custom 95171188||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Crescent 30mm X 9mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95120707|EAP|Custom 95120707||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Intramedullary X-lg|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95171189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120721|EAP|Custom 95120721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management On-q 100m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120722|EAP|Custom 95120722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management Dual-site|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120723|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Access Diastat D4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|FSC: 13; Default||Not reimbursed separately|3,726.00|FSC: 13; Default||External grouping not supported 95171193|EAP|Custom 95171193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Cannula 5mm Disposable Davinci S/si|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120724|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Access Diastat D6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,291.00|FSC: 13; Default||Not reimbursed separately|3,291.00|FSC: 13; Default||External grouping not supported 95171194|EAP|Custom 95171194||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 7mm X 26mm Vertestak|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95120725|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 3mm X 1000mm Ball-tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95120726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tack Labral Contour|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 80163389|EAP|CPT® 16020||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Drsg And Debride Partial Tck Burns Initial|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95120730|EAP|Custom 95120730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Cresent Straight Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163306|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Engage 8fr 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171198|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95120767|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pivot Ace 3.0 W/1 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165323|EAP|Custom 95165323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Pro 12fr Single Lumen Dual Swivel 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120776|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Right 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate-y 1.5mm X 17mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|131.04|FSC: 13; Default||Not reimbursed separately|131.04|FSC: 13; Default||External grouping not supported 95120805|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95171199|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 20 Pole Lasso 2515 Nav |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120806|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95171201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95120808|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95120809|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sovereign 5.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95120810|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171204|EAP|Custom 95171204||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 8 Degree 32x23x14mm|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95120811|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera Cannulated 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120812|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera Cannulated 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95120821|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120831|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerable Decapolar Dyn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171208|EAP|Custom 95171208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna Programmer Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120834|EAP|Custom 95120834||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95171209|EAP|Custom 95171209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiographic 5fr X 65cm Cerebral Scbr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120837|EAP|Custom 95120837||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Driving Nail 3.2x48|1|HUMANA [1294]||HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95171210|EAP|Custom 95171210||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins Ortholock Navigation 100cm|1|HUMANA [1294]||HUMANA [11839]|52.69|FSC: 13; Default||Not reimbursed separately|52.69|FSC: 13; Default||External grouping not supported 95120838|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 32mm X 55cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171211|EAP|Custom 95171211||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins Ortholock Navigation 150cm|1|HUMANA [1294]||HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95171212|EAP|Custom 95171212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 5fr X 65cm Cerebral Scbr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins Cross Bio-absorable C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|597.00|FSC: 13; Default||Not reimbursed separately|597.00|FSC: 13; Default||External grouping not supported 95171213|EAP|Custom 95171213||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Resuscitator Infant In-line Neo-tee With 0-40cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.96|FSC: 13; Default||Not reimbursed separately|4,452.96|FSC: 13; Default||External grouping not supported 95171202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95120854|EAP|Custom 95120854||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservoir Titan 60cc|1|HUMANA [1294]||HUMANA [11839]|3,720.00|FSC: 13; Default||Not reimbursed separately|3,720.00|FSC: 13; Default||External grouping not supported 95120855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0mm X45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95120856|EAP|Custom 95120856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphere 22 Eye Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171220|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95120859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tak Tissue 5mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95171221|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 9mm X 10cm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,747.00|FSC: 13; Default||Not reimbursed separately|9,747.00|FSC: 13; Default||External grouping not supported 95120896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95171222|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 11mm X 10cm X120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,440.00|FSC: 13; Default||Not reimbursed separately|10,440.00|FSC: 13; Default||External grouping not supported 95120897|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Access Diastat D4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,607.00|FSC: 13; Default||Not reimbursed separately|2,607.00|FSC: 13; Default||External grouping not supported 95171228|EAP|HCPCS C1727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 6mm X 60mm X 150 .018 Pta|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171229|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Nanocross 3.5mm X 80mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120902|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Textured Anatomical 310-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95171233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95120904|EAP|Custom 95120904||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere 18 Eye Silicone|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95171235|EAP|Custom 95171235||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Repair Syndesmosis Tight Rope Knotless|1|HUMANA [1294]||HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95120906|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured-s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95171237|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio Beacon 5.0fr X 90cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120908|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Titanium Surgical (harm`sca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 80163397|EAP|Custom 80163397||0998 - STATISTICAL CHARGES|Hb Spine Center No Charge F/u Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120909|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Stabilizer Balanced Perform|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120911|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Stabilizer Plus Steerable 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Low Profile 6.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95120912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5x12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95120913|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Iron Man 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182029|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilation Otw Trek 1.5mm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120921|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-153 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95120922|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured Ge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95182030|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilation Otw Trek 2.0 Mm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120923|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95120927|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alloderm 1x4cm Per Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|203.25|FSC: 13; Default||Not reimbursed separately|203.25|FSC: 13; Default||External grouping not supported 95182032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Dished Articular Xlpe Legion 13mm Size 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 95120929|EAP|Custom 95120929||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Mcgee Plat|1|HUMANA [1294]||HUMANA [11839]|393.36|FSC: 13; Default||Not reimbursed separately|393.36|FSC: 13; Default||External grouping not supported 95120930|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 400cc Style-133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95182025|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 6fr 6.5mm X 80mm X 120 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120931|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 500cc Style133mv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95120933|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Siltex Modera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95182026|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 6fr 6.5mm X 100mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120934|EAP|Custom 95120934||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 10/12mm Non Bladed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120936|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6fr Decapolar/ Livewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182027|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 6fr 6.5mm X 150mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Dhs/dcs 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.10|FSC: 13; Default||Not reimbursed separately|302.10|FSC: 13; Default||External grouping not supported 95120945|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182028|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 6fr 6.5mm X 60mm X 120 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95120951|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95120952|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Height Mo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95182035|EAP|Custom 95182035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator Membrane Diffusion Bioline Quadrox 4/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120953|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod-profile Tex G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95120959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 30cm Miami Moss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182041|EAP|Custom 95182041||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cassette Endoanchor (10) W/applier Sys Endoanchor Heli-fx|1|HUMANA [1294]||HUMANA [11839]|13,239.00|FSC: 13; Default||Not reimbursed separately|13,239.00|FSC: 13; Default||External grouping not supported 95120960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|970.20|FSC: 13; Default||Not reimbursed separately|970.20|FSC: 13; Default||External grouping not supported 95120961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|FSC: 13; Default||Not reimbursed separately|4,736.34|FSC: 13; Default||External grouping not supported 95182034|EAP|Custom 95182034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Avalon 27fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120962|EAP|Custom 95120962||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh 13mmx9mm Round|1|HUMANA [1294]||HUMANA [11839]|5,968.20|FSC: 13; Default||Not reimbursed separately|5,968.20|FSC: 13; Default||External grouping not supported 95120963|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Sali|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95182038|EAP|Custom 95182038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand Coblation Turbinator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120967|EAP|Custom 95120967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Frederick Miller|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120981|EAP|Custom 95120981||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Inj Del Thermoset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182039|EAP|Custom 95182039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Heli-fx System Endoanchor 16fr-28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120985|EAP|Custom 95120985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Barrel-abrade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182033|EAP|Custom 95182033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Avalon 31fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182040|EAP|Custom 95182040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Heli-fx System Endoanchor 16fr-22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Right 10x260x125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95120995|EAP|Custom 95120995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Sizing Radial-head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182037|EAP|Custom 95182037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tubing Perfusion State Ohio Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95120999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hum Lock Nail Spread 5x45m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95185529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Cann 10/130deg 235mm/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95121000|EAP|Custom 95121000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cuda 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121001|EAP|Custom 95121001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round 2.0 Diamond Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121002|EAP|Custom 95121002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round Cutting Zb-122|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121003|EAP|Custom 95121003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Straight 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182054|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acrysof Torric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95121007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Tridant Psl 50m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95121008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psl 52m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95182044|EAP|Custom 95182044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vent Heart Lv 16fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Solid-back Trident Pslha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95121012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Duration Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,677.50|FSC: 13; Default||Not reimbursed separately|2,677.50|FSC: 13; Default||External grouping not supported 95182046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X L70 Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95121013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Extension 80mm All-sizes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95121019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Tridant Psl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95182056|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95121020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Psl Trident|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95182063|EAP|Custom 95182063||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tendon Patellar Preshaped Biocleanse 10/10mm|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95121022|EAP|Custom 95121022||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Taylor Ankle Agility Sz-1|1|HUMANA [1294]||HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 95121023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Ankle Agility Sz-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,938.00|FSC: 13; Default||Not reimbursed separately|1,938.00|FSC: 13; Default||External grouping not supported 95182060|EAP|Custom 95182060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cardiac Cath Sterile Custom With Manifold Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Medium 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95121025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Stabilizer Left-lar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,446.40|FSC: 13; Default||Not reimbursed separately|6,446.40|FSC: 13; Default||External grouping not supported 95182048|EAP|Custom 95182048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar Maryland Single Site 5mm 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121026|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ureteral Uro-maxii+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121027|EAP|Custom 95121027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 6 X 26|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95182071|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8 Fr. Mac1 Fr5 3.5 Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121028|EAP|Custom 95121028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 7 X 28|1|HUMANA [1294]||HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95121034|EAP|Custom 95121034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 475cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Long Fluted Sharp 17 Mm X 130 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,490.50|FSC: 13; Default||Not reimbursed separately|3,490.50|FSC: 13; Default||External grouping not supported 95121035|EAP|Custom 95121035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 425cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121036|EAP|Custom 95121036||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Receiver Mattrix|1|HUMANA [1294]||HUMANA [11839]|14,730.00|FSC: 13; Default||Not reimbursed separately|14,730.00|FSC: 13; Default||External grouping not supported 95182064|EAP|Custom 95182064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Darco 1.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121037|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension In-line C1883|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95121038|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Synchromed W/fil C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,035.00|FSC: 13; Default||Not reimbursed separately|28,035.00|FSC: 13; Default||External grouping not supported 95182050|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Viper 335 Cm Bx/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121051|EAP|Custom 95121051||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Injector Bone Cement Restrictor|1|HUMANA [1294]||HUMANA [11839]|53.44|FSC: 13; Default||Not reimbursed separately|53.44|FSC: 13; Default||External grouping not supported 95121053|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.5x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95121054|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121055|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182069|EAP|Custom 95182069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Centerline Endoscopic Carpal Tunnel Release|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121056|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121057|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182072|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8 Fr. Mac1 Art4 3.5 Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121058|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121059|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Rm/ll Triathlon Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95121060|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121061|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95121062|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121063|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 2 Hole L95mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,231.00|FSC: 13; Default||Not reimbursed separately|9,231.00|FSC: 13; Default||External grouping not supported 95121064|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121065|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95121066|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121067|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182049|EAP|Custom 95182049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar Fenestrated Single Site 5mm 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121068|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121069|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95182052|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding Al 1.0 Sh 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121070|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121071|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X L65mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95121072|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121073|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182051|EAP|Custom 95182051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Irrigator Suction One Endowrist Da Vinci 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121074|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121075|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182059|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire R350 350cm 5/pk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121076|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121077|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 36mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95121078|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121079|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Small 0 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,011.00|FSC: 13; Default||Not reimbursed separately|4,011.00|FSC: 13; Default||External grouping not supported 95121080|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121081|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182053|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8fr Al 75 Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121082|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121083|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182055|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95121084|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121085|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Femoral Distal Anterior Or Posterior Sz F 5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95121086|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121087|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182074|EAP|Custom 95182074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Pin 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121088|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182086|EAP|Custom 95182086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cornea Pikpak Custom Holland|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121089|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121090|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182077|EAP|Custom 95182077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Alight Microwire .016 215cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121095|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121096|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95182076|EAP|Custom 95182076||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .035 Diameter X 7cm Length 8mm|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95121097|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft Bc 6.5mm 3 Hi Fi # 2 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.88|FSC: 13; Default||Not reimbursed separately|1,118.88|FSC: 13; Default||External grouping not supported 95121098|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182085|EAP|Custom 95182085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cornea Pikpak Custom Sanitato|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121099|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95188527|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.50 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121106|EAP|Custom 95121106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone 13-14mm|1|HUMANA [1294]||HUMANA [11839]|196.56|FSC: 13; Default||Not reimbursed separately|196.56|FSC: 13; Default||External grouping not supported 95185537|EAP|Custom 95185537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer Bipolar Malleable W/light Aquamantys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121107|EAP|Custom 95121107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone 19-20mm|1|HUMANA [1294]||HUMANA [11839]|188.94|FSC: 13; Default||Not reimbursed separately|188.94|FSC: 13; Default||External grouping not supported 95121115|EAP|Custom 95121115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tuohy Epidural 17 Gauge X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192228|EAP|Custom 95192228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Screwdriver Universal 15mm Torx T Screw Extraction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121117|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Wholey 260cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185538|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 5.0 Diopter Sensar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95182092|EAP|Custom 95182092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration Ultrasound Endo Slimeline Expert 22ga 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121122|EAP|Custom 95121122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Hemostatic Lg (hemoclip)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182098|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8 Fr. Art 3.5 Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121129|EAP|Custom 95121129||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic 25mm With Integral|1|HUMANA [1294]||HUMANA [11839]|12,585.00|FSC: 13; Default||Not reimbursed separately|12,585.00|FSC: 13; Default||External grouping not supported 95182090|EAP|Custom 95182090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Perfusion Custom Head Centrifical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182094|EAP|Custom 95182094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration Ultrasound Endo Slimeline Expert 25ga 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121157|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pulmonary Artery Thermo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188528|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.50 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121170|EAP|Custom 95121170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Infusion 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167042|EAP|CPT® 64616||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of Muscle(s); Neck Muscle(s)|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95121172|EAP|Custom 95121172||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Left Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167059|EAP|CPT® 64617||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of Muscle(s); Larynx, Unilateral, Percutaneous|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 80167067|EAP|CPT® 64642||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of One Extremity; 1-4 Muscle(s)|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95121191|EAP|Custom 95121191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Away Break .125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167075|EAP|CPT® 64643||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of One Extremity; Each Add Extremity, 1-4 Muscle|1|HUMANA [1294]||HUMANA [11839]|495.92|FSC: 13; Default||Not reimbursed separately|495.92|FSC: 13; Default||External grouping not supported 95121204|EAP|Custom 95121204||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Left Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167083|EAP|CPT® 64644||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of One Extremity; 5 Or More Muscle(s)|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95121205|EAP|Custom 95121205||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Right Sm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167091|EAP|CPT® 64645||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of One Extremity Ea Add Extremity 5 Or More Muscle|1|HUMANA [1294]||HUMANA [11839]|499.95|FSC: 13; Default||Not reimbursed separately|499.95|FSC: 13; Default||External grouping not supported 95121206|EAP|Custom 95121206||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Right Med.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167109|EAP|CPT® 64646||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of Trunk Muscle(s); 1-5 Muscle(s)|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95121207|EAP|Custom 95121207||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167117|EAP|CPT® 64647||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenervation Of Trunk Muscle(s); 6 Or More Muscle(s)|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 80167125|EAP|CPT® 95874||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Needle Electromyography For Guide With Chemodenervation|1|HUMANA [1294]||HUMANA [11839]|161.48|FSC: 13; Default||Not reimbursed separately|161.48|FSC: 13; Default||External grouping not supported 95121215|EAP|Custom 95121215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Hawkins I 20 Ga X 5 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm/l65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95121221|EAP|Custom 95121221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Vascular Robicsek 1.0mm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex3.5mm/l42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95121229|EAP|Custom 95121229||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Hex Fix|1|HUMANA [1294]||HUMANA [11839]|64.20|FSC: 13; Default||Not reimbursed separately|64.20|FSC: 13; Default||External grouping not supported 95182118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix 12/14 40 X +3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95121241|EAP|Custom 95121241||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Left X-lge.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Kinectiv 12/14 Taper D +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95121246|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff S.t. 4.0cm (ams 800) C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95182121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro-toe Size 3.2mm X 16mm Angle 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95182116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Dinectiv 12/14 Taper Size G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95121252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Hole 15mmx 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|FSC: 13; Default||Not reimbursed separately|1,107.00|FSC: 13; Default||External grouping not supported 95182115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv M/l Taper Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95121272|EAP|Custom 95121272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spool Single Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum Vivacit-e Neutral Kk 40 X 56 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95121280|EAP|Custom 95121280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous 31fr.extended Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Kinectiv 12/14 Taper J +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95121282|EAP|Custom 95121282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Applicator Dual Cannula 20ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182120|EAP|Custom 95182120||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 12mm X 11mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95121294|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6fr Jsn Quad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182112|EAP|Custom 95182112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rasp Heliocoidal Medium 3.2mmx18.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 13mmx6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.00|FSC: 13; Default||Not reimbursed separately|1,515.00|FSC: 13; Default||External grouping not supported 95182117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Tm Multi Holes 56 Mm Size Ii Poro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95121305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Axis 2-hole 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,182.00|FSC: 13; Default||Not reimbursed separately|1,182.00|FSC: 13; Default||External grouping not supported 95182126|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95121320|EAP|Custom 95121320||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Westcott 22 Ga X 9 Cm 10/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182127|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Al1 125 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121321|EAP|Custom 95121321||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame Ti|1|HUMANA [1294]||HUMANA [11839]|4,155.00|FSC: 13; Default||Not reimbursed separately|4,155.00|FSC: 13; Default||External grouping not supported 95182124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 12 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,330.00|FSC: 13; Default||Not reimbursed separately|12,330.00|FSC: 13; Default||External grouping not supported 95121322|EAP|Custom 95121322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Westcott 22 Ga X 15 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mmxl44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95121325|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182129|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Jl4 125cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121342|EAP|Custom 95121342||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Biopsy Device 18x10 Inrad Expres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0 X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95121370|EAP|Custom 95121370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector With Extention Leg For|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182125|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95121373|EAP|Custom 95121373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Multi-purpose 5 Fr P 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182128|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Mp2 125cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121374|EAP|Custom 95121374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Irrigator Bulb Pathfinder-plus 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121376|EAP|Custom 95121376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Westcott 20ga X 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95121378|EAP|Custom 95121378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill 1.1mm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Nanotack With Flex Inserter 1.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,370.70|FSC: 13; Default||Not reimbursed separately|1,370.70|FSC: 13; Default||External grouping not supported 95121379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pedicle 6.25x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.00|FSC: 13; Default||Not reimbursed separately|942.00|FSC: 13; Default||External grouping not supported 95182136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Med.distal Va-lcp 2.7mm/3.5mm 1hole/right/72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|FSC: 13; Default||Not reimbursed separately|3,814.23|FSC: 13; Default||External grouping not supported 95121384|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Vena Cava Jugular System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,196.95|FSC: 13; Default||Not reimbursed separately|3,196.95|FSC: 13; Default||External grouping not supported 95182137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Distalva-lcp 2.7mmx3.5mm 2hole/right/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 95182132|EAP|Custom 95182132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Breast Biopsy Proc 20/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121389|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Kcfw-8.0-38-40-rb-blk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182135|EAP|Custom 95182135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bir Nanotack Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121392|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii 8 Fr X 5 Mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95121394|EAP|Custom 95121394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167133|EAP|Custom 80167133||0185 - LEAVE OF ABSENCE - HOSPITALIZATION|Hb Nursing Home Hospice Loa Bed|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||Accommodation codes not reimbursed separately 95121395|EAP|Custom 95121395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Endoscopic W/seal 5 Mm Di|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182149|EAP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermis Decellularized Arhtroflex 4.0cm X 7.0cm X 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.79|FSC: 13; Default||Not reimbursed separately|225.79|FSC: 13; Default||External grouping not supported 95182147|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi-torque Pilot# 200 .014 Straight Tip 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121397|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Snare Goose Neck Amplatz 35m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121398|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Straight 260cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121406|EAP|Custom 95121406||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Cranioplastic 2 Sets|1|HUMANA [1294]||HUMANA [11839]|1,740.96|FSC: 13; Default||Not reimbursed separately|1,740.96|FSC: 13; Default||External grouping not supported 95121412|EAP|Custom 95121412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Vortex 2x3cm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121413|EAP|Custom 95121413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization .038 Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Profyle Hand 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95121414|EAP|Custom 95121414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization .038 D X 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182156|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 7fr 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95121425|EAP|Custom 95121425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fa-1 5fr (cust Item 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182151|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 6fr 40 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95182157|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 6fr 100 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95121442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-drlg 1.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95182152|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 7fr 40 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95121445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|FSC: 13; Default||Not reimbursed separately|682.29|FSC: 13; Default||External grouping not supported 95182158|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 7fr 100 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95121447|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182154|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 7fr 60 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95121448|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 8fr Ramp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182153|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 6fr 60 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95121450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Reflection 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 95182155|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 6fr 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95121452|EAP|Custom 95121452||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adaptor Bi-moore Ii Taper Standd|1|HUMANA [1294]||HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95171242|EAP|Custom 95171242||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conformer Large Sterile Without Holes|1|HUMANA [1294]||HUMANA [11839]|162.00|FSC: 13; Default||Not reimbursed separately|162.00|FSC: 13; Default||External grouping not supported 95121456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Micro 13mm With 3-0 White|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|FSC: 13; Default||Not reimbursed separately|1,437.00|FSC: 13; Default||External grouping not supported 80163405|EAP|Custom 80163405||0998 - STATISTICAL CHARGES|Hb Va Womens Cardiac Abi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121459|EAP|Custom 95121459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Osteosite Bone Biopsy 13x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163413|EAP|Custom 80163413||0998 - STATISTICAL CHARGES|Hb Va Womens Cardiac Cimt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121461|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Tesio C1881|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|FSC: 13; Default||Not reimbursed separately|915.00|FSC: 13; Default||External grouping not supported 80163421|EAP|Custom 80163421||0998 - STATISTICAL CHARGES|Hb Va Womens Cardiac Aaa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121466|EAP|Custom 95121466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Cranial Steathstat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171245|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.0 Diopter Crystalens Posterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95121467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Tibial Ankle Sz-3 Ang Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.00|FSC: 13; Default||Not reimbursed separately|10,047.00|FSC: 13; Default||External grouping not supported 95171249|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Proxi-1 Solent Angiojet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121468|EAP|Custom 95121468||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talor Agility Size-3|1|HUMANA [1294]||HUMANA [11839]|8,253.00|FSC: 13; Default||Not reimbursed separately|8,253.00|FSC: 13; Default||External grouping not supported 95171250|EAP|Custom 95171250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stainless Steel 0.025x145cm 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Agility Size-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,592.00|FSC: 13; Default||Not reimbursed separately|2,592.00|FSC: 13; Default||External grouping not supported 95171252|EAP|Custom 95171252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Endo 5 Medium-large Hemo-lok Automatic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121470|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Cannuflex.062x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171253|EAP|Custom 95171253||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accessory Pacing Ball-tipped Stylet |1|HUMANA [1294]||HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95121471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-drig 1.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95171254|EAP|Custom 95171254||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acessory Pacing Ball Tipped Stylet |1|HUMANA [1294]||HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95121477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade 90-deg Cannulated 8-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.00|FSC: 13; Default||Not reimbursed separately|1,368.00|FSC: 13; Default||External grouping not supported 95171256|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable Sprint Quattro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95121480|EAP|Custom 95121480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Iv Dianeal With 2.50%de|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171255|EAP|Custom 95171255||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accessory Pacing Pinch-on Tool For Screw-in Leads|1|HUMANA [1294]||HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95121485|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Peel Away 5fr 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171257|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Protecta Xt Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42,207.00|FSC: 13; Default||Not reimbursed separately|42,207.00|FSC: 13; Default||External grouping not supported 95121489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial Locking Reco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,071.00|FSC: 13; Default||Not reimbursed separately|4,071.00|FSC: 13; Default||External grouping not supported 95171258|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defbrillator Protecta Xt Crt-d Bi Vent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,200.00|FSC: 13; Default||Not reimbursed separately|55,200.00|FSC: 13; Default||External grouping not supported 95121492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cannulated Headless A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95171259|EAP|Custom 95171259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Relyx Unicem 2 Translucent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121493|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-limb 8.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|FSC: 13; Default||Not reimbursed separately|6,675.00|FSC: 13; Default||External grouping not supported 95171260|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Endotak Reliance G 64cm Dfy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 95121496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95171261|EAP|Custom 95171261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Uf-500 With Hematocrit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95171262|EAP|Custom 95171262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Insertion And Cdelc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95171264|EAP|Custom 95171264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Biceps |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121499|EAP|Custom 95121499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Coronary 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171265|EAP|Custom 95171265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Compression 1.6mm 10mm Thread 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Peg Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|FSC: 13; Default||Not reimbursed separately|4,215.00|FSC: 13; Default||External grouping not supported 95121506|EAP|Custom 95121506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hsg Injector 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121509|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154911|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol Plus 4.0 Diopter Acrysof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95121510|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 10mm Self Tapping |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95121524|EAP|Custom 95121524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sialography Scs-t-32-s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157301|EAP|Custom 95157301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Touch Soft Fluted Round 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121529|EAP|Custom 95121529||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Resin Acrylic Sar-901|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157319|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Platinum 24x12mm 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 95160231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Anterior Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,808.75|FSC: 13; Default||Not reimbursed separately|2,808.75|FSC: 13; Default||External grouping not supported 95121534|EAP|Custom 95121534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tracers Tcr-105|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160819|EAP|Custom 95160819||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Charging Mini Eon Ans|1|HUMANA [1294]||HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95121536|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Steerable Wire Controh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162102|EAP|Custom 95162102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Procedure Fluid Reservoir Hta System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121537|EAP|Custom 95121537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franceen 18ga X 9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162208|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Out Flow Venous Access Vascular Hero|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95121538|EAP|Custom 95121538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Renegade 130 X 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ankle Locking 10 X 210mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,290.00|FSC: 13; Default||Not reimbursed separately|7,290.00|FSC: 13; Default||External grouping not supported 95121539|EAP|Custom 95121539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ensnare 18-30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Bending Threaded For 2.4mm Locking Plates|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.09|FSC: 13; Default||Not reimbursed separately|495.09|FSC: 13; Default||External grouping not supported 95166698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm Long Thread |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95121543|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm Long Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95166700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide W/suture Eye 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95121552|EAP|Custom 95121552||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Umbilical 4.0fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,053.47|FSC: 13; Default||Not reimbursed separately|2,053.47|FSC: 13; Default||External grouping not supported 95121553|EAP|Custom 95121553||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Chest Drain|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,053.47|FSC: 13; Default||Not reimbursed separately|2,053.47|FSC: 13; Default||External grouping not supported 95121556|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Cystografin 300 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|FSC: 13; Default||Not reimbursed separately|0.20|FSC: 13; Default||External grouping not supported 95166703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,086.50|FSC: 13; Default||Not reimbursed separately|2,086.50|FSC: 13; Default||External grouping not supported 95166704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,086.50|FSC: 13; Default||Not reimbursed separately|2,086.50|FSC: 13; Default||External grouping not supported 95121567|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 4mm X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,114.79|FSC: 13; Default||Not reimbursed separately|2,114.79|FSC: 13; Default||External grouping not supported 95121572|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 8mm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,114.79|FSC: 13; Default||Not reimbursed separately|2,114.79|FSC: 13; Default||External grouping not supported 95121579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4x12mm Spider|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95166707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,147.88|FSC: 13; Default||Not reimbursed separately|2,147.88|FSC: 13; Default||External grouping not supported 95121581|EAP|Custom 95121581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Retroplegia 14fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,147.88|FSC: 13; Default||Not reimbursed separately|2,147.88|FSC: 13; Default||External grouping not supported 95121582|EAP|Custom 95121582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6.5fr H1 Scbr6.5-35-125|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,176.20|FSC: 13; Default||Not reimbursed separately|2,176.20|FSC: 13; Default||External grouping not supported 95121583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 100 Degree Right Extra L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95166711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,176.20|FSC: 13; Default||Not reimbursed separately|2,176.20|FSC: 13; Default||External grouping not supported 95121584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.5mm 7 Hole Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.00|FSC: 13; Default||Not reimbursed separately|417.00|FSC: 13; Default||External grouping not supported 95166712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,209.23|FSC: 13; Default||Not reimbursed separately|2,209.23|FSC: 13; Default||External grouping not supported 95121586|EAP|Custom 95121586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6.5fr Jb1 Scbr6.5-35-12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,209.23|FSC: 13; Default||Not reimbursed separately|2,209.23|FSC: 13; Default||External grouping not supported 95121587|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,242.29|FSC: 13; Default||Not reimbursed separately|2,242.29|FSC: 13; Default||External grouping not supported 95121588|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Access Diastat D6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,448.00|FSC: 13; Default||Not reimbursed separately|2,448.00|FSC: 13; Default||External grouping not supported 95166715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp 2.7mm 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,242.29|FSC: 13; Default||Not reimbursed separately|2,242.29|FSC: 13; Default||External grouping not supported 95121590|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super Stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95121591|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super Stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166719|EAP|Custom 95166719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Path Finder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166721|EAP|Custom 95166721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Port Rapid Lap Band|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Univ Can Acetab 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 95166724|EAP|Custom 95166724||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Banding Gastric Adjustable Lap Band Port |1|HUMANA [1294]||HUMANA [11839]|9,465.00|FSC: 13; Default||Not reimbursed separately|9,465.00|FSC: 13; Default||External grouping not supported 95121596|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Shuttle 6fr Ksaw6.0-38-90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171266|EAP|Custom 95171266||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .018 Diameter|1|HUMANA [1294]||HUMANA [11839]|323.58|FSC: 13; Default||Not reimbursed separately|323.58|FSC: 13; Default||External grouping not supported 95121599|EAP|Custom 95121599||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Leftmedium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171267|EAP|Custom 95171267||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .018 Diameter|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95171268|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bentson .018x 180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fixation 2.7x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.50|FSC: 13; Default||Not reimbursed separately|262.50|FSC: 13; Default||External grouping not supported 95171269|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Cantata Superselective 2.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95171271|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Duo Pulse Dual Pin 16cc Volume|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,451.00|FSC: 13; Default||Not reimbursed separately|50,451.00|FSC: 13; Default||External grouping not supported 95121629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fixation 2.7x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95121630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cann Headless Acutrak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95171273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 10mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95121631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cann Headless Acutrak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95171279|EAP|Custom 95171279||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal Size 7mm Small Standard|1|HUMANA [1294]||HUMANA [11839]|5,895.00|FSC: 13; Default||Not reimbursed separately|5,895.00|FSC: 13; Default||External grouping not supported 95121632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1st-mpj Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95171281|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 6mm Diameter X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spinal Kaneda Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|FSC: 13; Default||Not reimbursed separately|2,730.00|FSC: 13; Default||External grouping not supported 95171282|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expanding Biliary |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95121634|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 10mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,037.00|FSC: 13; Default||Not reimbursed separately|5,037.00|FSC: 13; Default||External grouping not supported 95171283|EAP|HCPCS C1887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Soft-vu Straight Art 5f X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|FSC: 13; Default||Not reimbursed separately|45.60|FSC: 13; Default||External grouping not supported 95121635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spinal Kaneda Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|FSC: 13; Default||Not reimbursed separately|2,730.00|FSC: 13; Default||External grouping not supported 95171284|EAP|Custom 95171284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Torcon Nb Advantage Beacon-tip .035 X 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121636|EAP|Custom 95121636||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Closed Narrow Blade 11.0mm|1|HUMANA [1294]||HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95171285|EAP|Custom 95171285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiographic 5fr X .038 Diameter |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121637|EAP|Custom 95121637||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Body Extended Miami Moss|1|HUMANA [1294]||HUMANA [11839]|2,460.00|FSC: 13; Default||Not reimbursed separately|2,460.00|FSC: 13; Default||External grouping not supported 95171286|EAP|Custom 95171286||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Gracilis Double Strand|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95121638|EAP|Custom 95121638||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Transverse Miami Moss|1|HUMANA [1294]||HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95182174|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated 25 X 110/120-30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95121656|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95182171|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Verrata 185cm J-tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121663|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95121665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|FSC: 13; Default||Not reimbursed separately|111.00|FSC: 13; Default||External grouping not supported 95171292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept 6.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95121666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wedge Opening 7.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept 6.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95121678|EAP|Custom 95121678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner Instability Shoul|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171294|EAP|Custom 95171294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire K|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121681|EAP|Custom 95121681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 6mm Long-straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|FSC: 13; Default||Not reimbursed separately|894.00|FSC: 13; Default||External grouping not supported 95121682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bi-polar 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95171296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 45mm Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95121683|EAP|Custom 95121683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hoe Ultra-drive 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 40mm Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95121684|EAP|Custom 95121684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Curvtek Med 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171298|EAP|Custom 95171298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Xlif Probe And Dilators|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121686|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171299|EAP|Custom 95171299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Maxcess Light Source Retractor Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121687|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thrombectomy 8frx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171300|EAP|Custom 95171300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Large Cordent 10 X 18 X 45|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95121688|EAP|Custom 95121688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Tf-036-l-90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95121694|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95121698|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95121705|EAP|Custom 95121705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Polar Multi Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95121706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 35mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|FSC: 13; Default||Not reimbursed separately|5,165.58|FSC: 13; Default||External grouping not supported 95171305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Armada 6.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|FSC: 13; Default||Not reimbursed separately|4,176.00|FSC: 13; Default||External grouping not supported 95121707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 82.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|FSC: 13; Default||Not reimbursed separately|2,571.00|FSC: 13; Default||External grouping not supported 95171306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Armada 7.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|FSC: 13; Default||Not reimbursed separately|4,176.00|FSC: 13; Default||External grouping not supported 95121708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 87.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|FSC: 13; Default||Not reimbursed separately|2,571.00|FSC: 13; Default||External grouping not supported 95171307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Arma 6.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|FSC: 13; Default||Not reimbursed separately|4,176.00|FSC: 13; Default||External grouping not supported 95121709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 90mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|FSC: 13; Default||Not reimbursed separately|2,571.00|FSC: 13; Default||External grouping not supported 95171308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Armada 6.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|FSC: 13; Default||Not reimbursed separately|4,176.00|FSC: 13; Default||External grouping not supported 95121710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 95mm Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|FSC: 13; Default||Not reimbursed separately|2,571.00|FSC: 13; Default||External grouping not supported 95171309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95121711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 100mm Tit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|FSC: 13; Default||Not reimbursed separately|2,694.00|FSC: 13; Default||External grouping not supported 95171310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Magnifuse Pl Lumbar 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95121712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 105mm Tit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|FSC: 13; Default||Not reimbursed separately|2,694.00|FSC: 13; Default||External grouping not supported 95171311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95121713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 110mm Tit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|FSC: 13; Default||Not reimbursed separately|2,694.00|FSC: 13; Default||External grouping not supported 95171314|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Central Venous Triple Lumen 7fr Pressure |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Z 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,224.00|FSC: 13; Default||Not reimbursed separately|7,224.00|FSC: 13; Default||External grouping not supported 95171315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95121715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Z 9cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,831.00|FSC: 13; Default||Not reimbursed separately|6,831.00|FSC: 13; Default||External grouping not supported 95171316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Distal 18 Hole Right Peri Prosthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,511.70|FSC: 13; Default||Not reimbursed separately|4,511.70|FSC: 13; Default||External grouping not supported 95121716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,092.00|FSC: 13; Default||Not reimbursed separately|7,092.00|FSC: 13; Default||External grouping not supported 95171317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 3 S 10 X 300mm X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,006.88|FSC: 13; Default||Not reimbursed separately|5,006.88|FSC: 13; Default||External grouping not supported 95121717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt 7.0x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 95171321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95121718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt W/nut Alt 7.0mmx55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.00|FSC: 13; Default||Not reimbursed separately|1,029.00|FSC: 13; Default||External grouping not supported 95171322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.5 X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95121719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ant 6.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95171323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95121720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low-prof Alt 6.5mmx55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95171324|EAP|Custom 95171324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini-quick 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Thoracic 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,604.00|FSC: 13; Default||Not reimbursed separately|5,604.00|FSC: 13; Default||External grouping not supported 95171325|EAP|Custom 95171325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini-quick 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95171329|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis 10mm X 6cm 200cm-length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|FSC: 13; Default||Not reimbursed separately|6,675.00|FSC: 13; Default||External grouping not supported 95121723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Break-off Set T25 Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|FSC: 13; Default||Not reimbursed separately|333.00|FSC: 13; Default||External grouping not supported 95121724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7.5x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,964.00|FSC: 13; Default||Not reimbursed separately|2,964.00|FSC: 13; Default||External grouping not supported 95121726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95171320|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurostimulator, Programmer And Charging System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95121727|EAP|Custom 95121727||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hooks Standard Ramp|1|HUMANA [1294]||HUMANA [11839]|1,491.00|FSC: 13; Default||Not reimbursed separately|1,491.00|FSC: 13; Default||External grouping not supported 95121728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95171331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 60 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95121729|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Titanium Surgical (harm`sca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95182176|EAP|Custom 95182176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Specific Patient Nexgen Cr-flex Pri Ct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peak Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|FSC: 13; Default||Not reimbursed separately|966.00|FSC: 13; Default||External grouping not supported 95121731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 54mm Duraloc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95121732|EAP|Custom 95121732||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talor Agility Size-4|1|HUMANA [1294]||HUMANA [11839]|8,034.00|FSC: 13; Default||Not reimbursed separately|8,034.00|FSC: 13; Default||External grouping not supported 95121733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Agility Size-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,298.00|FSC: 13; Default||Not reimbursed separately|2,298.00|FSC: 13; Default||External grouping not supported 95121734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Tibial Ankle Agility Rt Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,753.00|FSC: 13; Default||Not reimbursed separately|9,753.00|FSC: 13; Default||External grouping not supported 80159734|EAP|Custom 80159734||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Willow Miscellaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Tibial Lt Size-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,980.00|FSC: 13; Default||Not reimbursed separately|10,980.00|FSC: 13; Default||External grouping not supported 95121737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fx Global 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,812.00|FSC: 13; Default||Not reimbursed separately|10,812.00|FSC: 13; Default||External grouping not supported 95163440|EAP|Custom 95163440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Breast Biopsy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95163085|EAP|Custom 95163085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Identifier Biopsy Site 9g Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121742|EAP|Custom 95121742||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ankle Articulating Ebi|1|HUMANA [1294]||HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95182177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95121744|EAP|Custom 95121744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 1/3 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163089|EAP|Custom 95163089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Identifier Biopsy Site 9g Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121745|EAP|Custom 95121745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Ring To Fixator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159767|EAP|CPT® 28005||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incision Bone Cortex Foot|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 95121746|EAP|Custom 95121746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Carriage Wire Variable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163824|EAP|Custom 95163824||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Evicel Set 5mm|1|HUMANA [1294]||HUMANA [11839]|1,441.44|FSC: 13; Default||Not reimbursed separately|1,441.44|FSC: 13; Default||External grouping not supported 95121747|EAP|Custom 95121747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Carriage Screw Bone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163825|EAP|Custom 95163825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dialyzer Exeltra Hyflux 190|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121748|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Straight 2.0x400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163827|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,110.00|FSC: 13; Default||Not reimbursed separately|25,110.00|FSC: 13; Default||External grouping not supported 95121750|EAP|Custom 95121750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive 2.0x400mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121751|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95121753|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95121754|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95163804|EAP|Custom 95163804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Microsheath Xlt Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121757|EAP|Custom 95121757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strip Stomahesive 120mm X 15mm 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163805|EAP|Custom 95163805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Micro Introducer 5f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121764|EAP|Custom 95121764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 33x71|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163806|EAP|Custom 95163806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Breathing Heated |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121766|EAP|Custom 95121766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Contour Se Microsheres Pva Parti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163810|EAP|Custom 95163810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Humidification|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121768|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95121769|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95121770|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95121773|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95182175|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Cuff Aortic Proximal 34mm X 34mm Covered 80 Cm -o2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,865.00|FSC: 13; Default||Not reimbursed separately|14,865.00|FSC: 13; Default||External grouping not supported 95121775|EAP|Custom 95121775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Parallax Cement Delivery Sys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Mini Quik Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.00|FSC: 13; Default||Not reimbursed separately|1,068.00|FSC: 13; Default||External grouping not supported 95121777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Hum Lock 9x180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.00|FSC: 13; Default||Not reimbursed separately|2,406.00|FSC: 13; Default||External grouping not supported 95163820|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Ao|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95121779|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121791|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial Intracoil 4mm Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163812|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.38|FSC: 13; Default||Not reimbursed separately|79.38|FSC: 13; Default||External grouping not supported 95121796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip #4 /12mm Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|FSC: 13; Default||Not reimbursed separately|10,395.00|FSC: 13; Default||External grouping not supported 95163813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.90|FSC: 13; Default||Not reimbursed separately|4,848.90|FSC: 13; Default||External grouping not supported 95163814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Pushlock Peck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95163815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biocork With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95121816|EAP|Custom 95121816||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Probe Mammotome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Radial |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,382.00|FSC: 13; Default||Not reimbursed separately|5,382.00|FSC: 13; Default||External grouping not supported 95121817|EAP|Custom 95121817||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tubing Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163821|EAP|Custom 95163821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Greb Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Stabilizer Lg Rt 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,412.85|FSC: 13; Default||Not reimbursed separately|7,412.85|FSC: 13; Default||External grouping not supported 95163822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.44|FSC: 13; Default||Not reimbursed separately|4,717.44|FSC: 13; Default||External grouping not supported 95121823|EAP|Custom 95121823||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mba Subtaylor 8mm|1|HUMANA [1294]||HUMANA [11839]|6,822.27|FSC: 13; Default||Not reimbursed separately|6,822.27|FSC: 13; Default||External grouping not supported 95163828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Half Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.45|FSC: 13; Default||Not reimbursed separately|6,471.45|FSC: 13; Default||External grouping not supported 95121824|EAP|Custom 95121824||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mba Subtaylor|1|HUMANA [1294]||HUMANA [11839]|5,055.00|FSC: 13; Default||Not reimbursed separately|5,055.00|FSC: 13; Default||External grouping not supported 95163829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Half Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.45|FSC: 13; Default||Not reimbursed separately|6,471.45|FSC: 13; Default||External grouping not supported 95121825|EAP|Custom 95121825||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mba Subtalar 12mm|1|HUMANA [1294]||HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95163830|EAP|Custom 95163830||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Limited Spider Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95163831|EAP|Custom 95163831||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Universal |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121828|EAP|Custom 95121828||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mba Subtalar 10mm|1|HUMANA [1294]||HUMANA [11839]|4,498.50|FSC: 13; Default||Not reimbursed separately|4,498.50|FSC: 13; Default||External grouping not supported 95163832|EAP|Custom 95163832||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Lower Extremity |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121836|EAP|Custom 95121836||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolism|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95163833|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Ao|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95163834|EAP|Custom 95163834||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Lower Extremity|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121842|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Quad Pisces-plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95163838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95121843|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Syncromed W/filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,855.00|FSC: 13; Default||Not reimbursed separately|24,855.00|FSC: 13; Default||External grouping not supported 95163840|EAP|Custom 95163840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Powerloc Safety|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121844|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Asphere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.44|FSC: 13; Default||Not reimbursed separately|4,717.44|FSC: 13; Default||External grouping not supported 95121851|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blue Max 12x4x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gripper Rhp Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95163852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 35.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95121856|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95163853|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Radiofocus |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121857|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 300cc Style133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95163854|EAP|Custom 95163854||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 30mm X 8mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95121859|EAP|Custom 95121859||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Conray 30 50 Ml. 50-50 Ml. Vialx|1|HUMANA [1294]||HUMANA [11839]|9.82|FSC: 13; Default||Not reimbursed separately|9.82|FSC: 13; Default||External grouping not supported 95121860|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163858|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Brite 8fr 11cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121861|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95121866|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95163862|EAP|Custom 95163862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Cocr +4 28od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,266.45|FSC: 13; Default||Not reimbursed separately|1,266.45|FSC: 13; Default||External grouping not supported 95163863|EAP|Custom 95163863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121881|EAP|Custom 95121881||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Profix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163864|EAP|Custom 95163864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Expansion On Q|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Reflection Acetabular 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,137.55|FSC: 13; Default||Not reimbursed separately|3,137.55|FSC: 13; Default||External grouping not supported 95121883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Reflection Acetabular Poro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95121885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.47|FSC: 13; Default||Not reimbursed separately|43.47|FSC: 13; Default||External grouping not supported 95163869|EAP|Custom 95163869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.47|FSC: 13; Default||Not reimbursed separately|43.47|FSC: 13; Default||External grouping not supported 95163870|EAP|Custom 95163870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy Mic |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.47|FSC: 13; Default||Not reimbursed separately|43.47|FSC: 13; Default||External grouping not supported 95163871|EAP|Custom 95163871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Revision 12mmx21cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,169.00|FSC: 13; Default||Not reimbursed separately|2,169.00|FSC: 13; Default||External grouping not supported 95163873|EAP|Custom 95163873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy Mic |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Universal Cancellous Aceta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 95163874|EAP|Custom 95163874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Porp Micron|1|HUMANA [1294]||HUMANA [11839]|943.68|FSC: 13; Default||Not reimbursed separately|943.68|FSC: 13; Default||External grouping not supported 95121895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Universal Cancellous Aceta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 95163890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thrs 3d 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95121897|EAP|Custom 95121897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Half Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thrs 3d 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95121902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|FSC: 13; Default||Not reimbursed separately|207.90|FSC: 13; Default||External grouping not supported 95163892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thrs 3d 6.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95121903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95163894|EAP|Custom 95163894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95163895|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Small Thrs 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.30|FSC: 13; Default||Not reimbursed separately|3,954.30|FSC: 13; Default||External grouping not supported 95121906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade 40-deg 5-hole Stainl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.00|FSC: 13; Default||Not reimbursed separately|1,368.00|FSC: 13; Default||External grouping not supported 95163897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Thrs 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.50|FSC: 13; Default||Not reimbursed separately|514.50|FSC: 13; Default||External grouping not supported 95121908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade 5-hole 30mm Stainles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.00|FSC: 13; Default||Not reimbursed separately|1,368.00|FSC: 13; Default||External grouping not supported 95182179|EAP|Custom 95182179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wraps Compression Knee (6/case - Comes W/24 3+ Hr Gel Bags)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121910|EAP|Custom 95121910||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Decompression-colon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Mod |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 95121914|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Embolic Protection Rx Acc|1|HUMANA [1294]||HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95163905|EAP|Custom 95163905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Trumatch Spii 4t/4f/r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121918|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Shuttle 6fr X .038 Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163906|EAP|Custom 95163906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Planer Patella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Forte Small Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|FSC: 13; Default||Not reimbursed separately|1,454.46|FSC: 13; Default||External grouping not supported 95163907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nsert Xlk Curved #25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 95121923|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95163908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Mod Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 95121934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Ti Sterike|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95121935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Ti Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95163910|EAP|Custom 95163910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Planer Patella Sp2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Large 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95163912|EAP|Custom 95163912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Diameter Dilat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert Mini 1.5x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.81|FSC: 13; Default||Not reimbursed separately|1,077.81|FSC: 13; Default||External grouping not supported 95163913|EAP|Custom 95163913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 11mm Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Forte Small Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|FSC: 13; Default||Not reimbursed separately|1,454.46|FSC: 13; Default||External grouping not supported 95163900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Xlk Curved #3 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 95121942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95163914|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestent Sfa Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95121943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 22m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95163926|EAP|Custom 95163926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Loop 20 X 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163929|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.44|FSC: 13; Default||Not reimbursed separately|79.44|FSC: 13; Default||External grouping not supported 95121947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95121955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Mg Uni Mlt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|FSC: 13; Default||Not reimbursed separately|4,452.87|FSC: 13; Default||External grouping not supported 95121956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Precoat Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|FSC: 13; Default||Not reimbursed separately|8,376.57|FSC: 13; Default||External grouping not supported 95182180|EAP|Custom 95182180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wraps Compression Hip (6/case - Comes W/24 3+ Hr Gel Bags)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibibal Uni M/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 87550992|EAP|CPT® 43220||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Dilation Esophagus <30mm Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95121962|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Exchange Floppy Hi-torque30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121963|EAP|Custom 95121963||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Pericardiocentesis Pericardi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121965|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Rotowire Extra Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121966|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii 7 Fr X 4 Mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163931|EAP|Custom 95163931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Foam Nonadh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121979|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121980|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Multi-link Rx 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95163934|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Wall 5fr |1|HUMANA [1294]||HUMANA [11839]|7,710.00|FSC: 13; Default||Not reimbursed separately|7,710.00|FSC: 13; Default||External grouping not supported 95121987|EAP|HCPCS L4350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121989|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 8f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163938|EAP|Custom 95163938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm Deal New|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122004|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue Soft Surgisis 7x20c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,556.80|FSC: 13; Default||Not reimbursed separately|3,556.80|FSC: 13; Default||External grouping not supported 95163936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95122010|EAP|Custom 95122010||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Vascular Digit 1.9cmx.9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Uni Deal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,564.70|FSC: 13; Default||Not reimbursed separately|5,564.70|FSC: 13; Default||External grouping not supported 95122013|EAP|Custom 95122013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphere 12 Eye Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122017|EAP|Custom 95122017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Fetal Fs14cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163944|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerable Decap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163945|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerocath Dx Oct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122060|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pivot Ace 1.5 W/1 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122066|EAP|Custom 95122066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Body Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122069|EAP|Custom 95122069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rings Half Hex Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163955|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu 5fr |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122074|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Multi-link Rx Ult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95163957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalock Rc Plus #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,182.00|FSC: 13; Default||Not reimbursed separately|1,182.00|FSC: 13; Default||External grouping not supported 95122075|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Multi-link Rx Ult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95163958|EAP|Custom 95163958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Composite Esthet X-flow |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Summit 3.0mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95163959|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Radiofocus 0.035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163960|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Beacon Tip Nb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122093|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95163961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.95|FSC: 13; Default||Not reimbursed separately|5,128.95|FSC: 13; Default||External grouping not supported 95122098|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95163970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aculoc Narrow Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95122099|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95163971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95122102|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Round Textured Style-168|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163941|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,520.00|FSC: 13; Default||Not reimbursed separately|8,520.00|FSC: 13; Default||External grouping not supported 95122103|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Lf Saline Texture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95163953|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer Ptfe Percut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122104|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Lf Saline Texture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95163954|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Perfix Large Bard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.70|FSC: 13; Default||Not reimbursed separately|449.70|FSC: 13; Default||External grouping not supported 95122105|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Bio-dimensional S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95163956|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu Hook 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122108|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95163983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95122112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95163984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95122113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95163985|EAP|Custom 95163985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire .054|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis Ankle 10mm X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95163986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.3mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95122118|EAP|Custom 95122118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Shunt Ascites|1|HUMANA [1294]||HUMANA [11839]|5,190.00|FSC: 13; Default||Not reimbursed separately|5,190.00|FSC: 13; Default||External grouping not supported 95163987|EAP|Custom 95163987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Strut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|FSC: 13; Default||Not reimbursed separately|867.00|FSC: 13; Default||External grouping not supported 95163988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95122122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 50mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95163989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.3 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95122123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 75mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|FSC: 13; Default||Not reimbursed separately|544.26|FSC: 13; Default||External grouping not supported 95163990|EAP|Custom 95163990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Micro Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 95mm For U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95163991|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122130|EAP|Custom 95122130||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sheath Bml-4q Lithotriptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163992|EAP|Custom 95163992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocarvaport Plus Rpf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122131|EAP|Custom 95122131||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook 11.0|1|HUMANA [1294]||HUMANA [11839]|1,632.00|FSC: 13; Default||Not reimbursed separately|1,632.00|FSC: 13; Default||External grouping not supported 95163993|EAP|Custom 95163993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Micro Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122132|EAP|Custom 95122132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Closed Narrow Blade 9.5mm|1|HUMANA [1294]||HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95163994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 2 Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95122139|EAP|Custom 95122139||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 11mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95163995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.00|FSC: 13; Default||Not reimbursed separately|2,487.00|FSC: 13; Default||External grouping not supported 95122141|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95122147|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Anatomical Tex S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95163997|EAP|Custom 95163997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Ets-flex Articu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163998|EAP|Custom 95163998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163999|EAP|Custom 95163999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Contour Curved|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122191|EAP|Custom 95122191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tubing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porcoat C/r Sigma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 95122195|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Poro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 95164003|EAP|||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|HB PACK COLD SHOULDER PAD|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122197|EAP|Custom 95122197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Safeguard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95122199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 95164004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|FSC: 13; Default||Not reimbursed separately|5,782.98|FSC: 13; Default||External grouping not supported 95122204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Hole 13mmx 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,344.00|FSC: 13; Default||Not reimbursed separately|1,344.00|FSC: 13; Default||External grouping not supported 95164005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95122205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 77.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|FSC: 13; Default||Not reimbursed separately|6,653.22|FSC: 13; Default||External grouping not supported 95122206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|981.96|FSC: 13; Default||Not reimbursed separately|981.96|FSC: 13; Default||External grouping not supported 95164007|EAP|Custom 95164007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122208|EAP|Custom 95122208||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh 10x15mm|1|HUMANA [1294]||HUMANA [11839]|17,934.00|FSC: 13; Default||Not reimbursed separately|17,934.00|FSC: 13; Default||External grouping not supported 95122209|EAP|Custom 95122209||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Pyramesh 13x50mm|1|HUMANA [1294]||HUMANA [11839]|19,698.00|FSC: 13; Default||Not reimbursed separately|19,698.00|FSC: 13; Default||External grouping not supported 95122211|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.25mm X 15mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122222|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.25mm X 10mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122226|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.75mm X 15mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80160211|EAP|Custom 80160211||0998 - STATISTICAL CHARGES|Hb Room & Bd Bluegrass Hospice|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122229|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 4.0mm X 10mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 99999998|EAP|Custom 99999998||0998 - STATISTICAL CHARGES|Hb Ltac Select Medical Credit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122233|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Xlk Curved #5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 95122242|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Xmi Rapid Exch 4fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Mod Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 95122245|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Left 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porocoat C/r Sigma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 95122250|EAP|Custom 95122250||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Vent Armstrong Plain En|1|HUMANA [1294]||HUMANA [11839]|45.28|FSC: 13; Default||Not reimbursed separately|45.28|FSC: 13; Default||External grouping not supported 95164011|EAP|Custom 95164011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Planer Patella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122251|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube 6 Tracheosoft Xlt Extended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164012|EAP|HCPCS C1728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mammosite Multi 4-5cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122254|EAP|Custom 95122254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Injector Collamer Staar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122257|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95164014|EAP|Custom 95164014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Sleeve 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95164015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122260|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122262|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122271|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122273|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super Stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122274|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95122279|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95164021|EAP|Custom 95164021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Tip Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122284|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Goose Neck Microsnare Amplat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164023|EAP|Custom 95164023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 10x25mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95122290|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95164025|EAP|Custom 95164025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Cold Therapy Iceman|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122301|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95122303|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Left 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cortical Strut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95122309|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Cardioverter Defibrillator Impla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61,500.00|FSC: 13; Default||Not reimbursed separately|61,500.00|FSC: 13; Default||External grouping not supported 95122319|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164031|EAP|Custom 95164031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Targeting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122325|EAP|Custom 95122325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Pinch-on Tool F|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164033|EAP|Custom 95164033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wire Round|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122333|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95122334|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ar1.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122335|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dura Tutoplast 4x5cm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,905.00|FSC: 13; Default||Not reimbursed separately|1,905.00|FSC: 13; Default||External grouping not supported 95164036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cv Sigma Pfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95122336|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95164037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cv Sigma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95122337|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95122339|EAP|Custom 95122339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Lapra-ty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122340|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 80160229|EAP|CPT® 20500||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Sinus Tract Therapeutic|1|HUMANA [1294]||HUMANA [11839]|4,165.40|FSC: 13; Default||Not reimbursed separately|4,165.40|FSC: 13; Default||External grouping not supported 95122341|EAP|Custom 95122341||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Medporsurgical Block 13m|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122342|EAP|Custom 95122342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle R.c.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164067|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Pcb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122343|EAP|Custom 95122343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic 4.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Left Medical Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95122344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Nexgen 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,515.65|FSC: 13; Default||Not reimbursed separately|2,515.65|FSC: 13; Default||External grouping not supported 95164070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uni Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|FSC: 13; Default||Not reimbursed separately|2,889.00|FSC: 13; Default||External grouping not supported 95122345|EAP|Custom 95122345||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Third Tibial Aug Size4|1|HUMANA [1294]||HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95164071|EAP|Custom 95164071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Toomey Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122346|EAP|Custom 95122346||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge 1/3 Tibial Precoat Sz8|1|HUMANA [1294]||HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95164072|EAP|Custom 95164072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coupler 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164079|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blln Strlg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164080|EAP|Custom 95164080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Bulb And Bladder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164044|EAP|HCPCS Q4143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Dermal Acellular Repriza|1|HUMANA [1294]||HUMANA [11839]|70.63|FSC: 13; Default||Not reimbursed separately|70.63|FSC: 13; Default||External grouping not supported 95164045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 95|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95164046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Half Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.45|FSC: 13; Default||Not reimbursed separately|6,471.45|FSC: 13; Default||External grouping not supported 95122354|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95164059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95122355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 8mm X 200mm Biglian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|FSC: 13; Default||Not reimbursed separately|13,383.12|FSC: 13; Default||External grouping not supported 95164089|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Softvu Kumpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 12mm X 200mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|FSC: 13; Default||Not reimbursed separately|13,383.12|FSC: 13; Default||External grouping not supported 95164091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95122357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 14mm X 200mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|FSC: 13; Default||Not reimbursed separately|13,383.12|FSC: 13; Default||External grouping not supported 95122358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture 8 Hole 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95122359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture 4 Hole 40mm 45 De|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95164092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95122360|EAP|Custom 95122360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 120mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95122361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95164095|EAP|Custom 95164095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95164096|EAP|Custom 95164096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4fr 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 80159692|EAP|CPT® 43247||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flexible Foreign Body Removal|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95122364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 80159700|EAP|CPT® 43249||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Ballon Dilation Esophagus Less Than 30 Mm Diam.|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95122365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 72mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95188529|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.75 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 80mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95122368|EAP|Custom 95122368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Washer 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159718|EAP|Custom 80159718||0998 - STATISTICAL CHARGES|Hb No Charge Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95164099|EAP|Custom 95164099||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Nasal Thermosplint|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95164106|EAP|Custom 95164106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 1.6mm|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95122372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 3.2mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|139.50|FSC: 13; Default||Not reimbursed separately|139.50|FSC: 13; Default||External grouping not supported 95164107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95122373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 3.2mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.30|FSC: 13; Default||Not reimbursed separately|174.30|FSC: 13; Default||External grouping not supported 95122374|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular 32mm Size-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|FSC: 13; Default||Not reimbursed separately|1,681.68|FSC: 13; Default||External grouping not supported 95122376|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164109|EAP|Custom 95164109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Histofreeze 170ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Harris Femoral 300mmmedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.23|FSC: 13; Default||Not reimbursed separately|6,115.23|FSC: 13; Default||External grouping not supported 95164110|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart 6mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95122379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Harris Precoat Plus.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.68|FSC: 13; Default||Not reimbursed separately|166.68|FSC: 13; Default||External grouping not supported 95164112|EAP|Custom 95164112||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Tourniquet Single Port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 16 X 148 Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95164113|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 17 X 153 Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95164114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.96|FSC: 13; Default||Not reimbursed separately|198.96|FSC: 13; Default||External grouping not supported 95122384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 15 X 145 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95164115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.96|FSC: 13; Default||Not reimbursed separately|198.96|FSC: 13; Default||External grouping not supported 95122385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Porous 17 X 153 Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|FSC: 13; Default||Not reimbursed separately|7,475.55|FSC: 13; Default||External grouping not supported 95164116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.96|FSC: 13; Default||Not reimbursed separately|198.96|FSC: 13; Default||External grouping not supported 95164122|EAP|Custom 95164122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel B3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122390|EAP|Custom 95122390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Standard Fenestrat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164123|EAP|Custom 95164123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel B4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122391|EAP|Custom 95122391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Permanent Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163933|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu Zen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 95122392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial Locking Reco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,327.00|FSC: 13; Default||Not reimbursed separately|3,327.00|FSC: 13; Default||External grouping not supported 95163935|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Catheter Viabahn Endo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,860.00|FSC: 13; Default||Not reimbursed separately|7,860.00|FSC: 13; Default||External grouping not supported 95122393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95182182|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shetty Gastrojejunostomy Set Single Lumen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95182185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95122397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95192221|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 62x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 64x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 66x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 68x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95188530|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.75 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 70x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 48x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95185539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95122407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 50 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 56x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 58x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95122410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 60x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95185542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reunion Humeral Head 40mmx21 Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,837.75|FSC: 13; Default||Not reimbursed separately|6,837.75|FSC: 13; Default||External grouping not supported 95122411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 70x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95122412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Cup Acetabular All-poly Zca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,540.98|FSC: 13; Default||Not reimbursed separately|1,540.98|FSC: 13; Default||External grouping not supported 95188531|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 4.00 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate G.t.r. Long With Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,862.29|FSC: 13; Default||Not reimbursed separately|6,862.29|FSC: 13; Default||External grouping not supported 95122416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate G.t.r. Short With Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95185541|EAP|Custom 95185541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dilator Endovascular 16/18 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem St 12mmx200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|FSC: 13; Default||Not reimbursed separately|3,329.67|FSC: 13; Default||External grouping not supported 95122420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Radial Head Titanium 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192222|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95185544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Self Tap Cortical 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95122423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95188532|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 4.00 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95122427|EAP|Custom 95122427||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Punch Donor Radial Vacuum Baroom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reunion Ha Fracture Stem 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.25|FSC: 13; Default||Not reimbursed separately|13,061.25|FSC: 13; Default||External grouping not supported 95122428|EAP|Custom 95122428||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Glaucoma Baerveldt Plana P|1|HUMANA [1294]||HUMANA [11839]|2,541.00|FSC: 13; Default||Not reimbursed separately|2,541.00|FSC: 13; Default||External grouping not supported 95122429|EAP|Custom 95122429||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accessory Pacing Service Install|1|HUMANA [1294]||HUMANA [11839]|132.00|FSC: 13; Default||Not reimbursed separately|132.00|FSC: 13; Default||External grouping not supported 95122436|EAP|Custom 95122436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1/16 X 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122439|EAP|Custom 95122439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Graft Acl 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185540|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 26mm X 74mm Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95122440|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122441|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95122444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 58x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95122445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 60x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95185545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95122446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 62x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95192223|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 56x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95185546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95122448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 50x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95122449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Epiphysis Fracture Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|FSC: 13; Default||Not reimbursed separately|59.58|FSC: 13; Default||External grouping not supported 95122457|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122458|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192224|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122460|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122461|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122462|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122466|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122467|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122468|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122469|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122470|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192225|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122471|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122472|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122473|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122474|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122475|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122476|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122477|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122478|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122479|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122480|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192226|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122481|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122482|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122483|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122484|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Pegged Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|FSC: 13; Default||Not reimbursed separately|4,471.89|FSC: 13; Default||External grouping not supported 95122489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Pegged Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|FSC: 13; Default||Not reimbursed separately|4,471.89|FSC: 13; Default||External grouping not supported 95122490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Pegged Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|FSC: 13; Default||Not reimbursed separately|4,471.89|FSC: 13; Default||External grouping not supported 95122492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95122499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95192227|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|154.26|FSC: 13; Default||Not reimbursed separately|154.26|FSC: 13; Default||External grouping not supported 95122503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3-hole 4.5 X 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|FSC: 13; Default||Not reimbursed separately|504.30|FSC: 13; Default||External grouping not supported 95171335|EAP|Custom 95171335||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 8 Degree|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95122504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 1e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.18|FSC: 13; Default||Not reimbursed separately|603.18|FSC: 13; Default||External grouping not supported 95171336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angle Fixed 5.5 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95122505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 1e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.18|FSC: 13; Default||Not reimbursed separately|603.18|FSC: 13; Default||External grouping not supported 95171337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angle Fixed 5.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|FSC: 13; Default||Not reimbursed separately|1,980.00|FSC: 13; Default||External grouping not supported 95122506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 18e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.71|FSC: 13; Default||Not reimbursed separately|820.71|FSC: 13; Default||External grouping not supported 95171338|EAP|Custom 95171338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Osteotome Latarjet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 1e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|FSC: 13; Default||Not reimbursed separately|642.72|FSC: 13; Default||External grouping not supported 95171339|EAP|Custom 95171339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Constellation Combined 25ga + 5000 Cpm 0.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 1e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|FSC: 13; Default||Not reimbursed separately|642.72|FSC: 13; Default||External grouping not supported 95171340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Rt 13mm X 400mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95122509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 7 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95171341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Cluster Hemisherical Tritanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95171343|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 11mm X 107cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95122512|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95122515|EAP|Custom 95122515||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Roticulator Gia Endo 30-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Right 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,740.00|FSC: 13; Default||Not reimbursed separately|7,740.00|FSC: 13; Default||External grouping not supported 95122518|EAP|Custom 95122518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Navigator Procedure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122519|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8fr 40 Ebu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185550|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 5fr Tl Hf 70cm Guide 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122521|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95122523|EAP|Custom 95122523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tunneling Device Subcutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185549|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 5fr Dl 70cm Guide 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122524|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore-tex 8mrx80fe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95122525|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185558|EAP|Custom 95185558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Feeding Tube 2eas Trak2/2a 10/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122526|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122527|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192229|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122528|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122529|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185548|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 4fr Sl 70cm Guide 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122532|EAP|Custom 95122532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Injector Bone Cement Front Loadi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122533|EAP|Custom 95122533||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drainable 1-piece Post-op|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Revision 64mm Hemispherical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95122534|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Shiley Laryngectomy 6lgt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Triathlon #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95122542|EAP|Custom 95122542||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 7 X 24|1|HUMANA [1294]||HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95171347|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guiding 8fr Jl 4.5 Vista Brite Tip 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95122553|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 2.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95122554|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Triathlon #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,196.00|FSC: 13; Default||Not reimbursed separately|8,196.00|FSC: 13; Default||External grouping not supported 95122555|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95122556|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 2.5mm X 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Triathlon #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95122557|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171353|EAP|Custom 95171353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Reverse Tm 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122558|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171354|EAP|Custom 95171354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Reverse Tm 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122559|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 2.5mm X 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept 6.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95122560|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 60mm Precept |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95122561|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 70mm Precept |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95122562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 3 Hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95171358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|FSC: 13; Default||Not reimbursed separately|2,043.00|FSC: 13; Default||External grouping not supported 95122565|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 2.5mm X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95171360|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 30mm X 113mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|FSC: 13; Default||Not reimbursed separately|19,542.00|FSC: 13; Default||External grouping not supported 95122567|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Itotal Conformis 32mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95122569|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171362|EAP|Custom 95171362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauze Roll Kittner Sterile |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061569|EAP|CPT® 81332||0301 - LABORATORY - CHEMISTRY|Hb A1a Gene Variant - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|130.95|FSC: 13; Default||Not reimbursed separately|130.95|FSC: 13; Default||External grouping not supported 95122578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 62061577|EAP|CPT® 81220||0301 - LABORATORY - CHEMISTRY|Hb Cf Gene Common Variant - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|1,669.80|FSC: 13; Default||Not reimbursed separately|1,669.80|FSC: 13; Default||External grouping not supported 95122579|EAP|Custom 95122579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tuohy Epidural 20 Gauge X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061585|EAP|CPT® 81270||0301 - LABORATORY - CHEMISTRY|Hb Jak2 Gene Variant - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|274.98|FSC: 13; Default||Not reimbursed separately|274.98|FSC: 13; Default||External grouping not supported 95122580|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 2.5mm X 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 62061593|EAP|CPT® 81256||0301 - LABORATORY - CHEMISTRY|62061593|1|HUMANA [1294]||HUMANA [11839]|196.08|FSC: 13; Default||Not reimbursed separately|196.08|FSC: 13; Default||External grouping not supported 95122581|EAP|Custom 95122581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Ceea25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061601|EAP|CPT® 81383||0301 - LABORATORY - CHEMISTRY|HB NARCOLEPSY HLA CLASS II TYPING - REF LABARUP|1|HUMANA [1294]||HUMANA [11839]|327.39|FSC: 13; Default||Not reimbursed separately|327.39|FSC: 13; Default||External grouping not supported 95122583|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 62061619|EAP|CPT® 81241||0301 - LABORATORY - CHEMISTRY|Hb F5 Leiden Gene Variant|1|HUMANA [1294]||HUMANA [11839]|220.11|FSC: 13; Default||Not reimbursed separately|220.11|FSC: 13; Default||External grouping not supported 95122585|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Vena Cava S.s. 12 Fr W/fe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,196.95|FSC: 13; Default||Not reimbursed separately|3,196.95|FSC: 13; Default||External grouping not supported 62061627|EAP|CPT® 81240||0301 - LABORATORY - CHEMISTRY|Hb Prothrombin Ii Gene Analysis|1|HUMANA [1294]||HUMANA [11839]|197.07|FSC: 13; Default||Not reimbursed separately|197.07|FSC: 13; Default||External grouping not supported 95122586|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 62061635|EAP|CPT® 81275||0301 - LABORATORY - CHEMISTRY|Hb Kras Gene Analysis -clarient|1|HUMANA [1294]||HUMANA [11839]|579.75|FSC: 13; Default||Not reimbursed separately|579.75|FSC: 13; Default||External grouping not supported 95122591|EAP|Custom 95122591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Mini Forcep 110gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061643|EAP|CPT® 81401||0301 - LABORATORY - CHEMISTRY|Hb Egfr - Clarient|1|HUMANA [1294]||HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95122593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic 28mm +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,958.40|FSC: 13; Default||Not reimbursed separately|1,958.40|FSC: 13; Default||External grouping not supported 62061650|EAP|CPT® 81210||0301 - LABORATORY - CHEMISTRY|Hb Braf Gene Variant -clarient|1|HUMANA [1294]||HUMANA [11839]|526.20|FSC: 13; Default||Not reimbursed separately|526.20|FSC: 13; Default||External grouping not supported 95122594|EAP|Custom 95122594||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral 12x10|1|HUMANA [1294]||HUMANA [11839]|5,460.00|FSC: 13; Default||Not reimbursed separately|5,460.00|FSC: 13; Default||External grouping not supported 62061668|EAP|CPT® 81206||0301 - LABORATORY - CHEMISTRY|Hb Bcr/abl Major -clarient|1|HUMANA [1294]||HUMANA [11839]|491.88|FSC: 13; Default||Not reimbursed separately|491.88|FSC: 13; Default||External grouping not supported 95122595|EAP|Custom 95122595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid-loads 0.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061676|EAP|CPT® 81207||0301 - LABORATORY - CHEMISTRY|Hb Bcr/abl Minor -clarient|1|HUMANA [1294]||HUMANA [11839]|434.52|FSC: 13; Default||Not reimbursed separately|434.52|FSC: 13; Default||External grouping not supported 95122596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Sta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 62061684|EAP|CPT® 81210||0301 - LABORATORY - CHEMISTRY|Hb Braf Gene Variant - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|526.20|FSC: 13; Default||Not reimbursed separately|526.20|FSC: 13; Default||External grouping not supported 95122597|EAP|Custom 95122597||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 8.7 X 19mm Barbed|1|HUMANA [1294]||HUMANA [11839]|134.49|FSC: 13; Default||Not reimbursed separately|134.49|FSC: 13; Default||External grouping not supported 62061692|EAP|CPT® 81401||0301 - LABORATORY - CHEMISTRY|Hb Mlh1 Promotor Meth - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95122598|EAP|Custom 95122598||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 8.7 X 22mm Barbed|1|HUMANA [1294]||HUMANA [11839]|134.49|FSC: 13; Default||Not reimbursed separately|134.49|FSC: 13; Default||External grouping not supported 62061700|EAP|CPT® 88381||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Braf V600e 88381 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95122599|EAP|Custom 95122599||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 8.7 X 25.4mm Barbed|1|HUMANA [1294]||HUMANA [11839]|134.49|FSC: 13; Default||Not reimbursed separately|134.49|FSC: 13; Default||External grouping not supported 95122600|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 28m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95122601|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 28m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171363|EAP|Custom 95171363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Closer Device Mynxgrip 6 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122602|EAP|Custom 95122602||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Medporsurgical Round 18m|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95171364|EAP|Custom 95171364||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bottle Vacuum 1000ml With Drainage Line|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122627|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Simon Nitinol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95171365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.00|FSC: 13; Default||Not reimbursed separately|6,306.00|FSC: 13; Default||External grouping not supported 95171366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95122645|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.0mm X 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revision Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95122649|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus 3.5mm X 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95171368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted Revision 18mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95122659|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 4.oomm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial Proximal Tibial 4 Hole Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,751.28|FSC: 13; Default||Not reimbursed separately|4,751.28|FSC: 13; Default||External grouping not supported 95122662|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171373|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 16 50cm Infinion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95122663|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171374|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Splitter 2 X8 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95122665|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft Bc Suture 5.5 W/hi Fi Suture |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.73|FSC: 13; Default||Not reimbursed separately|1,064.73|FSC: 13; Default||External grouping not supported 95122666|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95122677|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122678|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122681|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95122684|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95122685|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95122688|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 7frx45cm 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122689|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95116987|EAP|Custom 95116987||0258 - PHARMACY - IV SOLUTIONS|Hb Solution 2d5613q Osmitrol Inj 10% (mannitol)|1|HUMANA [1294]||HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95122690|EAP|Custom 95122690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radial Jaw 3-pulm W/needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Burr Hole 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95122694|EAP|Custom 95122694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Connect Vinyl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Rt 13mm X 420mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95122696|EAP|Custom 95122696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand Hook Plasma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.3 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|FSC: 13; Default||Not reimbursed separately|165.75|FSC: 13; Default||External grouping not supported 95122699|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sepramesh 4x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95171388|EAP|Custom 95171388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini-quick 1.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122700|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95171389|EAP|Custom 95171389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini-quick 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122702|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Guiding Veri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171390|EAP|Custom 95171390||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Zuma-c Lordotic 7 X 13 X 8cm|1|HUMANA [1294]||HUMANA [11839]|10,743.00|FSC: 13; Default||Not reimbursed separately|10,743.00|FSC: 13; Default||External grouping not supported 95122709|EAP|Custom 95122709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Marker Atw 195cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Variable Double Lead 4.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.75|FSC: 13; Default||Not reimbursed separately|828.75|FSC: 13; Default||External grouping not supported 95122714|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Variable Double Lead 4.0 X 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.75|FSC: 13; Default||Not reimbursed separately|828.75|FSC: 13; Default||External grouping not supported 95122715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Assembly Needle Straight Fix Fas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.18|FSC: 13; Default||Not reimbursed separately|816.18|FSC: 13; Default||External grouping not supported 95171393|EAP|Custom 95171393||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Locking Zuma-c 8mm|1|HUMANA [1294]||HUMANA [11839]|575.25|FSC: 13; Default||Not reimbursed separately|575.25|FSC: 13; Default||External grouping not supported 95122716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Assembly Needle Curved Fix Fast|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.59|FSC: 13; Default||Not reimbursed separately|976.59|FSC: 13; Default||External grouping not supported 62061726|EAP|CPT® 82010||0301 - LABORATORY - CHEMISTRY|Hb Beta-hydroxybutyric Acid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.51|FSC: 13; Default||Not reimbursed separately|24.51|FSC: 13; Default||External grouping not supported 95122717|EAP|Custom 95122717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pusher Knot Cutter Suture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171395|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95122718|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171396|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95122719|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171397|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omnipaque 300 Ct 50ml Pluspak Bottles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|FSC: 13; Default||Not reimbursed separately|0.71|FSC: 13; Default||External grouping not supported 95122721|EAP|Custom 95122721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 60 3.5 Roticulating Gia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171400|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide 7 Fr X 100cm Length 4.5 Judkins Left Vista|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122722|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95114050|EAP|Custom 95114050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Fixation W/spike Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122723|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95147624|EAP|Custom 95147624||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Lumbar Half Roll W/attached Straps Burgundy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122726|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171401|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Cvc Dual Lumen 7fr X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122732|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171402|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Silicone Self Expanding Airway 10mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|FSC: 13; Default||Not reimbursed separately|5,595.00|FSC: 13; Default||External grouping not supported 95122738|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Guiding Sro Curve 8.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171403|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Jagwire .035 X 180 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122739|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Vision Rx 3.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95171404|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95122744|EAP|Custom 95122744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 28 French Broncho Cath Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163439|EAP|CPT® 36516||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Aquaphersis Ultrafiltration|1|HUMANA [1294]||HUMANA [11839]|11,787.20|FSC: 13; Default||Not reimbursed separately|11,787.20|FSC: 13; Default||External grouping not supported 95122746|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube 8 Tracheosoft Xlt Extended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95122747|EAP|Custom 95122747||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 33mm With Integral|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95171421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95122751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body-a 46mm-offset Proximal Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,918.40|FSC: 13; Default||Not reimbursed separately|11,918.40|FSC: 13; Default||External grouping not supported 95171422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lunate Dorsal Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,055.00|FSC: 13; Default||Not reimbursed separately|2,055.00|FSC: 13; Default||External grouping not supported 95171424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Vdr Aculoc 2 Wide Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95122760|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95171425|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Aero Dv Fully Covered Bronchial 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95171426|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Aero Fully Covered Bronchial 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95171427|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Aero Fully Covered Bronchial 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95171428|EAP|Custom 95171428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Straight Maxxwire .035 X 180cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171429|EAP|Custom 95171429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Aerosizer Tracheobronchial Stent Sizing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122768|EAP|Custom 95122768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Short-cut Satin Angled 3.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171431|EAP|Custom 95171431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Spray Applicator Extended Progel 29cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122771|EAP|Custom 95122771||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Left X-sm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171432|EAP|Custom 95171432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Spray Applicator Extended Progel 16cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122772|EAP|Custom 95122772||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Right X-lge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171433|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Layer Double 10fr - 6mm Proximal Bend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.09|FSC: 13; Default||Not reimbursed separately|582.09|FSC: 13; Default||External grouping not supported 95122773|EAP|Custom 95122773||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist D-ring Right X-sm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171406|EAP|Custom 95171406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Vapr Coolpulse 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122794|EAP|Custom 95122794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Venogram Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171407|EAP|Custom 95171407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Vapr Coolpulse 90 With Hand Controls|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122796|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fast Tracker 105cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122811|EAP|Custom 95122811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Baker Jejunostomy 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122816|EAP|Custom 95122816||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Screw Bone Individual|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171412|EAP|Custom 95171412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Half Drilling 5mm 150 X 34mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Helix 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95122820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,535.00|FSC: 13; Default||Not reimbursed separately|5,535.00|FSC: 13; Default||External grouping not supported 95171414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95122826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95171415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95122827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/keel 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95171416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Compression 8 Hole L-110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.40|FSC: 13; Default||Not reimbursed separately|572.40|FSC: 13; Default||External grouping not supported 95171417|EAP|Custom 95171417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Locking 4.0 Axsos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122831|EAP|Custom 95122831||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Transverse|1|HUMANA [1294]||HUMANA [11839]|1,710.00|FSC: 13; Default||Not reimbursed separately|1,710.00|FSC: 13; Default||External grouping not supported 95171419|EAP|Custom 95171419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2 In 1 Ao Attachment 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bur Hole 13mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95171434|EAP|Custom 95171434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Light Aras|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122842|EAP|Custom 95122842||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Bur Hole Large 18.5 X 0.5|1|HUMANA [1294]||HUMANA [11839]|573.00|FSC: 13; Default||Not reimbursed separately|573.00|FSC: 13; Default||External grouping not supported 95185563|EAP|Custom 95185563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122846|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cyliner 15cm W/pump Preconnected|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|FSC: 13; Default||Not reimbursed separately|11,625.00|FSC: 13; Default||External grouping not supported 95122847|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Preconnect 18cm 700cx C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|FSC: 13; Default||Not reimbursed separately|11,625.00|FSC: 13; Default||External grouping not supported 95122860|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 150cc Style133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95122861|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Elliptical 150cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95185564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Injection Drillable Norian 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,496.34|FSC: 13; Default||Not reimbursed separately|4,496.34|FSC: 13; Default||External grouping not supported 95122862|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel 300cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95122863|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Becker-50 400cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95192230|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122864|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Siltex/becker-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95122865|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Siltex/becker 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95185562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Piece Extension Gmrs 60 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95122876|EAP|Custom 95122876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Extension Doc .014 X 145cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Long-neck 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,106.82|FSC: 13; Default||Not reimbursed separately|1,106.82|FSC: 13; Default||External grouping not supported 95185572|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95122889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 10mm Global Advanta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,399.00|FSC: 13; Default||Not reimbursed separately|15,399.00|FSC: 13; Default||External grouping not supported 95122890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Advantage Global 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,610.00|FSC: 13; Default||Not reimbursed separately|5,610.00|FSC: 13; Default||External grouping not supported 95122893|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Round Smooth Mod Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95122894|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95185565|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95122895|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-153 360cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95122896|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel 175cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95122897|EAP|Custom 95122897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame Ti 4cm Straight|1|HUMANA [1294]||HUMANA [11839]|5,445.00|FSC: 13; Default||Not reimbursed separately|5,445.00|FSC: 13; Default||External grouping not supported 95122899|EAP|Custom 95122899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Balloon Dilitation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185573|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95122903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Hod Sz32/59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95192231|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122913|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 17gx10cm 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122914|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185566|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95122920|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122926|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Internal Mammary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122927|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pilot 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122929|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95185569|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95122930|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95122931|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95122932|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122933|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122934|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122935|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185571|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95122936|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122943|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95192270|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95122944|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95122945|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95185568|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95122946|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95122949|EAP|Custom 95122949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Illuminator Endo Shielded Bullet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95122950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 56x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95122963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 50x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95185570|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95122964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 60x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95122970|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pilot 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122972|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95122973|EAP|Custom 95122973||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Medporsurgical Round 16m|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95122986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Spring Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|239.25|FSC: 13; Default||Not reimbursed separately|239.25|FSC: 13; Default||External grouping not supported 95122991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Adaption Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95122992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5-hole 135-deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|921.00|FSC: 13; Default||Not reimbursed separately|921.00|FSC: 13; Default||External grouping not supported 95122993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Forte Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|FSC: 13; Default||Not reimbursed separately|1,454.46|FSC: 13; Default||External grouping not supported 95122994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Forte Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|FSC: 13; Default||Not reimbursed separately|1,454.46|FSC: 13; Default||External grouping not supported 95122996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial Locking Reco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,327.00|FSC: 13; Default||Not reimbursed separately|3,327.00|FSC: 13; Default||External grouping not supported 95123000|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192269|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95123002|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Right 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123003|EAP|Custom 95123003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Revision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123004|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 26m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95123011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 28m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95123013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intrafix 6mm - 8mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|FSC: 13; Default||Not reimbursed separately|702.00|FSC: 13; Default||External grouping not supported 95123014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95123019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95123020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 30m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171435|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 5mm X 20mm X 150 .018 Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171436|EAP|Custom 95171436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Neonate Disposable Pedicatric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95171441|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pacing Swan Ganz 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 28mm Fort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.95|FSC: 13; Default||Not reimbursed separately|193.95|FSC: 13; Default||External grouping not supported 95123025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95171445|EAP|Custom 95171445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Closure Fast 7fr X 60cm Vnus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intrafix 7mm - 9mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.00|FSC: 13; Default||Not reimbursed separately|669.00|FSC: 13; Default||External grouping not supported 95171446|EAP|Custom 95171446||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 12 Degree |1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95123027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mm X 150mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|545.22|FSC: 13; Default||Not reimbursed separately|545.22|FSC: 13; Default||External grouping not supported 95171447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angled Fixed 6.0 X 25cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95123030|EAP|HCPCS C1765||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Membrane Seprafilm 5 X 6|1|HUMANA [1294]||HUMANA [11839]|957.30|FSC: 13; Default||Not reimbursed separately|957.30|FSC: 13; Default||External grouping not supported 95171448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95123031|EAP|Custom 95123031||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheath Tibial Intrafix 30mm|1|HUMANA [1294]||HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95171449|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Polyflex 21mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,354.78|FSC: 13; Default||Not reimbursed separately|6,354.78|FSC: 13; Default||External grouping not supported 95171450|EAP|Custom 95171450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Emr Duette Multi-band|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123042|EAP|Custom 95123042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Contour 250cc Breast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123043|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185578|EAP|Custom 95185578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 12mm X 170mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95123059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 11mm X 130mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95123060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,353.48|FSC: 13; Default||Not reimbursed separately|4,353.48|FSC: 13; Default||External grouping not supported 95123069|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima 10fr Xt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123084|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123121|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8fr Ebu3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185580|EAP|Custom 95185580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123126|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95123133|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95123138|EAP|Custom 95123138||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeves Scd Thigh Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123166|EAP|Custom 95123166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 35mm Linear Reloadable U|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185577|EAP|Custom 95185577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 6.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123177|EAP|Custom 95123177||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Covers Foot Av-impulse Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123179|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123180|EAP|Custom 95123180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Washer Spiked 6.0mm X 13.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185584|EAP|Custom 95185584||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123188|EAP|Custom 95123188||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Mcgee Plat|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95123189|EAP|Custom 95123189||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Injector Bone Cement Restrictor|1|HUMANA [1294]||HUMANA [11839]|34.01|FSC: 13; Default||Not reimbursed separately|34.01|FSC: 13; Default||External grouping not supported 95123190|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123192|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171452|EAP|Custom 95171452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Transducer Latex Free Sterile 15.2 X 244cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123193|EAP|Custom 95123193||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95171453|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 4 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123194|EAP|Custom 95123194||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Right-ang|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95171454|EAP|Custom 95171454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Emr Duette Multi-band|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123195|EAP|Custom 95123195||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Slightly-|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95171455|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Aero Fully Covered Bronchial 12mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95123196|EAP|Custom 95123196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden 180-degre|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95171456|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Alimaxx Fully Covered Esophageal 16mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95123197|EAP|Custom 95123197||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Curved 1.|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95171457|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Alimaxx Fully Covered Esophageal 18mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95123198|EAP|Custom 95123198||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95111723|EAP|Custom 95111723||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Chamber Humidification Contiunous Water Feed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123200|EAP|Custom 95123200||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden 90-degree|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95112327|EAP|Custom 95112327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Liposuction Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123201|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171459|EAP|Custom 95171459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Closure Fast 7fr X 100cm Vnus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Left 13mm X 360mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95123203|EAP|Custom 95123203||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Mcgee Plat|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95171461|EAP|Custom 95171461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso Micro Major Bead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123210|EAP|Custom 95123210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Trocar 12mm Thorasic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Triatholon #2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95123218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Harris Precoat Medi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.96|FSC: 13; Default||Not reimbursed separately|4,803.96|FSC: 13; Default||External grouping not supported 95123219|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171465|EAP|Custom 95171465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Memory Biopro 11mmx8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123220|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171466|EAP|Custom 95171466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Staple Memory|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123221|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171468|EAP|Custom 95171468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Aq Hydrophilic 9fr .38 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 49mm 4 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.59|FSC: 13; Default||Not reimbursed separately|226.59|FSC: 13; Default||External grouping not supported 80163447|EAP|CPT® 64405||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Anesthetic Agent;greater Occipital Nerve|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95123224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171318|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 95123225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171319|EAP|Custom 95171319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Charging|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171469|EAP|Custom 95171469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Vapr 2.3 140mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 45mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|FSC: 13; Default||Not reimbursed separately|4,622.22|FSC: 13; Default||External grouping not supported 95123228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171471|EAP|Custom 95171471||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interlock 6mm|1|HUMANA [1294]||HUMANA [11839]|8,010.00|FSC: 13; Default||Not reimbursed separately|8,010.00|FSC: 13; Default||External grouping not supported 95123229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 55mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interlock 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95123230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95123231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171474|EAP|Custom 95171474||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rasps Preparation Endplate Axialif|1|HUMANA [1294]||HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95123232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 130mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171476|EAP|Custom 95171476||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Filtron 250cc Tissu-trans|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95185581|EAP|Custom 95185581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 4.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 50mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95123235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 55mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95185599|EAP|Custom 95185599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Aquamantys Bipolar 2.3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95123237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95185591|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95123238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 70mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95123239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 75mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95185596|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95123240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 80mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95123241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 85mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95123242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 90mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95123243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95123244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 100mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95185590|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95123245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171480|EAP|Custom 95171480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB PROBE LASER 25 GAUGE|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vdr Aculoc 2 Standard Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95123247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 115mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171482|EAP|Custom 95171482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Needle Nuvasive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 120mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171483|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3dmax Light Medium Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|584.49|FSC: 13; Default||Not reimbursed separately|584.49|FSC: 13; Default||External grouping not supported 95123249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 125mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95171484|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3dmax Light Medium Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|584.49|FSC: 13; Default||Not reimbursed separately|584.49|FSC: 13; Default||External grouping not supported 95123250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 130mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95171489|EAP|Custom 95171489||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Threadedwire Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123251|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171490|EAP|Custom 95171490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.8mm/95mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123252|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123253|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164851|EAP|Custom 95164851||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Pump Single Personal W/80ml Collection |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123254|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Back Solid Hemispherical Tritanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95123259|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171493|EAP|Custom 95171493||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Vapr Wedge Short 2.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123261|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff-bodied .038x 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171496|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Safire Blu Ablation Bidirectional 4mm Tip|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123265|EAP|Custom 95123265||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171498|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Safire Blu Duo Ablation Bidirectional 4mm Tip|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123268|EAP|Custom 95123268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Body Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123269|EAP|Custom 95123269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Swan Ganz S Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163454|EAP|CPT® 43238||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Upper Gi Endo W/fine Needle Asp/biopsy|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95123273|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr 90cm Vista Br|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171500|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiojet Solent Omni 6fr 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123284|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Standard .035 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171501|EAP|Custom 95171501||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Rt Small Full Finger Singl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171502|EAP|Custom 95171502||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Rt Med Full Finger Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123291|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Elliptical 75cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171504|EAP|Custom 95171504||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 16 X 42 X 30mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95123295|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filterwire Ez|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171505|EAP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound Oasis Ultra 7cm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.50|FSC: 13; Default||Not reimbursed separately|37.50|FSC: 13; Default||External grouping not supported 95123297|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Norion 5cc C171|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95123307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Norion 10cc C17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95123308|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123310|EAP|Custom 95123310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Spray Tissomat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123311|EAP|Custom 95123311||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Closed-end Sur-fit 1-3/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123312|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123314|EAP|Custom 95123314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Transgastric Jejunal Feedine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123315|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular Ii Abg N08|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95123316|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171511|EAP|Custom 95171511||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Loop Strapping Purple 2 X 25 Yd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123317|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171512|EAP|Custom 95171512||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Loop Strapping Black 2 X 25 Yd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123323|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123324|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123325|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123326|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112431|EAP|Custom 95112431||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve 0.76mm Scleral Bucking|1|HUMANA [1294]||HUMANA [11839]|34.20|FSC: 13; Default||Not reimbursed separately|34.20|FSC: 13; Default||External grouping not supported 95123342|EAP|Custom 95123342||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Packing Epistaxis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Knee Total Triathlon |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 95123344|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 6.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total Ts Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95123363|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posteror Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95123367|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp First Va-lcp Medium 5 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.15|FSC: 13; Default||Not reimbursed separately|2,889.15|FSC: 13; Default||External grouping not supported 95123369|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171520|EAP|Custom 95171520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Admin Blood Dehp-free W/150 Micron Filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123374|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95171521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Short V40 Modular Ii Abg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95123376|EAP|Custom 95123376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Supplement Ext Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123379|EAP|Custom 95123379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Short-body|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123382|EAP|Custom 95123382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Hole 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123384|EAP|Custom 95123384||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Mcgee Plat|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95123385|EAP|Custom 95123385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slider 3-hole Ext Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123386|EAP|Custom 95123386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Post Ext Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pelvic Traction 1865-01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.42|FSC: 13; Default||Not reimbursed separately|288.42|FSC: 13; Default||External grouping not supported 95123388|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Control C1815|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,980.00|FSC: 13; Default||Not reimbursed separately|7,980.00|FSC: 13; Default||External grouping not supported 95123389|EAP|Custom 95123389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Eve 59m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123390|EAP|Custom 95123390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Neuro 15degree Offset W/ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123391|EAP|Custom 95123391||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Mcgee Plat|1|HUMANA [1294]||HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95123395|EAP|Custom 95123395||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Angled 1.|1|HUMANA [1294]||HUMANA [11839]|663.00|FSC: 13; Default||Not reimbursed separately|663.00|FSC: 13; Default||External grouping not supported 95123396|EAP|Custom 95123396||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 29mm With Integral|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95123397|EAP|Custom 95123397||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 31mm With Integral|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95123398|EAP|Custom 95123398||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic-periocardial Sz.21m|1|HUMANA [1294]||HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95185593|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95123400|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95123404|EAP|Custom 95123404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphere 20 Eye Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123405|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95123412|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Exchange Choice Pt 182|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123415|EAP|Custom 95123415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter 8mm Variable-depth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123416|EAP|Custom 95123416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Clear-delivery 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123417|EAP|Custom 95123417||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Songer Double|1|HUMANA [1294]||HUMANA [11839]|870.00|FSC: 13; Default||Not reimbursed separately|870.00|FSC: 13; Default||External grouping not supported 95123418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 14mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,209.99|FSC: 13; Default||Not reimbursed separately|1,209.99|FSC: 13; Default||External grouping not supported 95123419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lactosorb 2.3x5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|FSC: 13; Default||Not reimbursed separately|126.00|FSC: 13; Default||External grouping not supported 95123421|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95123422|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123423|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123425|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123426|EAP|Custom 95123426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Micro-reciprocating 7x5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123434|EAP|Custom 95123434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Mityvac (l And D)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123436|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 140 Deg 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95123438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 145 Deg 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95123440|EAP|Custom 95123440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Micro-reciprocating 25x7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123443|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123448|EAP|Custom 95123448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123454|EAP|Custom 95123454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Sterile Plastic 30.6cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123460|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185594|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95123461|EAP|Custom 95123461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 55mm Vascular Relo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163462|EAP|CPT® 44799||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Duodenum Dilatation|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95123462|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123466|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Advantage Global Cta 44 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,301.00|FSC: 13; Default||Not reimbursed separately|8,301.00|FSC: 13; Default||External grouping not supported 95171522|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vasc Coated Heparin Propaten Ring |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,322.00|FSC: 13; Default||Not reimbursed separately|5,322.00|FSC: 13; Default||External grouping not supported 95123468|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Elite Venture 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95123469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal 69mm Short Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.21|FSC: 13; Default||Not reimbursed separately|2,235.21|FSC: 13; Default||External grouping not supported 95171525|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.0 Diopter Acrysof Toric 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Uni M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 95171526|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Precoat Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|FSC: 13; Default||Not reimbursed separately|8,376.57|FSC: 13; Default||External grouping not supported 95171527|EAP|Custom 95171527||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ventilation Activent T Tube Goode 1.4mm |1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95123472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Mg Uni Mrt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|FSC: 13; Default||Not reimbursed separately|4,452.87|FSC: 13; Default||External grouping not supported 95171529|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Half|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95123473|EAP|Custom 95123473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber #2 38 T-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171531|EAP|Custom 95171531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Ligating Titanium Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Uni M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 95171532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95123475|EAP|Custom 95123475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Component Dynamization|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95123476|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171534|EAP|Custom 95171534||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Cannulated Fixos|1|HUMANA [1294]||HUMANA [11839]|539.70|FSC: 13; Default||Not reimbursed separately|539.70|FSC: 13; Default||External grouping not supported 95123478|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Single 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95123479|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171543|EAP|Custom 95171543||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Probe Flexible Applicator|1|HUMANA [1294]||HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95123480|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Single 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95123481|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171544|EAP|Custom 95171544||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12mm X 38mm X 28mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95123482|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171546|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Two Lumen Central Venous 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123483|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95171550|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|FSC: 13; Default||Not reimbursed separately|1,530.00|FSC: 13; Default||External grouping not supported 95123484|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 32.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171552|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.72|FSC: 13; Default||Not reimbursed separately|1,890.72|FSC: 13; Default||External grouping not supported 95123485|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 34.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95171553|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Oval Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|FSC: 13; Default||Not reimbursed separately|1,830.00|FSC: 13; Default||External grouping not supported 95123486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Tibial Lt Size-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,015.00|FSC: 13; Default||Not reimbursed separately|9,015.00|FSC: 13; Default||External grouping not supported 95171554|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Oval Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.14|FSC: 13; Default||Not reimbursed separately|2,452.14|FSC: 13; Default||External grouping not supported 95123487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Precoat Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|FSC: 13; Default||Not reimbursed separately|8,376.57|FSC: 13; Default||External grouping not supported 95171556|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Oval Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,137.10|FSC: 13; Default||Not reimbursed separately|3,137.10|FSC: 13; Default||External grouping not supported 95123488|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95171558|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Oval Extra Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.25|FSC: 13; Default||Not reimbursed separately|5,075.25|FSC: 13; Default||External grouping not supported 95123489|EAP|Custom 95123489||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell 3-hole 52mm|1|HUMANA [1294]||HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 95171559|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Circle Oval Extra Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,363.00|FSC: 13; Default||Not reimbursed separately|6,363.00|FSC: 13; Default||External grouping not supported 95123490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Mg Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|FSC: 13; Default||Not reimbursed separately|8,376.57|FSC: 13; Default||External grouping not supported 95171560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Multidirection Threaded 2.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|FSC: 13; Default||Not reimbursed separately|433.50|FSC: 13; Default||External grouping not supported 95123491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Insert Tibial Mg Uni 4-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 95171561|EAP|Custom 95171561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Screw Square 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Mg Uni Mlt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|FSC: 13; Default||Not reimbursed separately|4,452.87|FSC: 13; Default||External grouping not supported 95171562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Itotal Conforms 41mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95123493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Knee Uni Me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|FSC: 13; Default||Not reimbursed separately|8,376.57|FSC: 13; Default||External grouping not supported 95171563|EAP|Custom 95171563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Distraction Sterile 12mm Ti Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123495|EAP|Custom 95123495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95123497|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gold Hemashield Arched 1-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,728.37|FSC: 13; Default||Not reimbursed separately|3,728.37|FSC: 13; Default||External grouping not supported 95171565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,680.00|FSC: 13; Default||Not reimbursed separately|1,680.00|FSC: 13; Default||External grouping not supported 95123498|EAP|Custom 95123498||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cages Brantigan 9x9mm|1|HUMANA [1294]||HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 95123499|EAP|Custom 95123499||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Pin Cross 3.3mm Femoral Rigx|1|HUMANA [1294]||HUMANA [11839]|597.00|FSC: 13; Default||Not reimbursed separately|597.00|FSC: 13; Default||External grouping not supported 95123500|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 3.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95123502|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80163470|EAP|Custom 80163470||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cvm Vas Screening Ea Exam|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 80163488|EAP|Custom 80163488||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cvm Echo Ef Screening|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 80163496|EAP|Custom 80163496||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cvm Echo Athlete Screening|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95123505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 80163504|EAP|Custom 80163504||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Cvmhu Afib Screening|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95171567|EAP|Custom 95171567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ring Malyugin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95171568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continum Metal Trabecular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95171569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|FSC: 13; Default||Not reimbursed separately|4,192.50|FSC: 13; Default||External grouping not supported 95123509|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone Femoral Revision Porous Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,040.00|FSC: 13; Default||Not reimbursed separately|14,040.00|FSC: 13; Default||External grouping not supported 95123511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire K Bold Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95171571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Taper Revision 15mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,687.50|FSC: 13; Default||Not reimbursed separately|10,687.50|FSC: 13; Default||External grouping not supported 95123512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95171572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|FSC: 13; Default||Not reimbursed separately|4,590.00|FSC: 13; Default||External grouping not supported 95123513|EAP|Custom 95123513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95123514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Knee Uni Me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|FSC: 13; Default||Not reimbursed separately|8,376.57|FSC: 13; Default||External grouping not supported 95171574|EAP|Custom 95171574||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Vbr X-core 18mm|1|HUMANA [1294]||HUMANA [11839]|26,985.00|FSC: 13; Default||Not reimbursed separately|26,985.00|FSC: 13; Default||External grouping not supported 95123515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Mg Uni Mlt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|FSC: 13; Default||Not reimbursed separately|4,452.87|FSC: 13; Default||External grouping not supported 95171575|EAP|Custom 95171575||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endcap 18 X 40|1|HUMANA [1294]||HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95123517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Insert Tibial Mg Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 95171576|EAP|Custom 95171576||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Lock Small|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123524|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Flex Size-is|1|HUMANA [1294]||HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95171577|EAP|Custom 95171577||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Superior Small |1|HUMANA [1294]||HUMANA [11839]|3,891.00|FSC: 13; Default||Not reimbursed separately|3,891.00|FSC: 13; Default||External grouping not supported 95123529|EAP|Custom 95123529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cholangiography|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171578|EAP|Custom 95171578||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Inferior Small|1|HUMANA [1294]||HUMANA [11839]|3,891.00|FSC: 13; Default||Not reimbursed separately|3,891.00|FSC: 13; Default||External grouping not supported 95123541|EAP|Custom 95123541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Inner Disp Size-6 Use Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 7.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 95123544|EAP|HCPCS V5050||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Aid Hearing|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95171580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 95123546|EAP|Custom 95123546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 100mm Reload|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123550|EAP|Custom 95123550||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Shunt Accuflo 14mm|1|HUMANA [1294]||HUMANA [11839]|1,923.72|FSC: 13; Default||Not reimbursed separately|1,923.72|FSC: 13; Default||External grouping not supported 95171581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 7.4 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 95171582|EAP|Custom 95171582||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Fixed 15mm|1|HUMANA [1294]||HUMANA [11839]|3,606.00|FSC: 13; Default||Not reimbursed separately|3,606.00|FSC: 13; Default||External grouping not supported 95123554|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Amplatz Extra Stiff35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95123556|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fast Tracker 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171584|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95123558|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Steerable Transend .01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171586|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123564|EAP|Custom 95123564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 95171588|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123628|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95171589|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95185595|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95123647|EAP|Custom 95123647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dialyzer Polysynthane Psn-210|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171591|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123650|EAP|Custom 95123650||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Basket Lithotriptor Therapeutic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171590|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Micropuncture Pedal Access 4fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123651|EAP|Custom 95123651||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tube Gastrostomy 22fr W/y-ex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171592|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171593|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Approach Hydro St Micro .014 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Oblong 57hs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,450.24|FSC: 13; Default||Not reimbursed separately|15,450.24|FSC: 13; Default||External grouping not supported 95171594|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cxi Support 4 Fr 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Universal Cancellous Aceta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 95171595|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.5 Diopter Acrysof Toric Iq 13.mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly-dail N/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95171596|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cxi Support 2.6fr 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123659|EAP|Custom 95123659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Curette Reverse 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171597|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Universal Femoral 28mm Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 95171598|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Micro Wire Approach Ct 0-6 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Set Nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95171599|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123662|EAP|Custom 95123662||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Harvester Bone 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171600|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Micro Wire Approach Ct 0-6 190cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95123663|EAP|Custom 95123663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Radiolucent Recon With Bolt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171601|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123664|EAP|Custom 95123664||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh Round 16mmx30mm|1|HUMANA [1294]||HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 95171602|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 3.0mmx8mm F/ (l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171603|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123666|EAP|Custom 95123666||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh 19mmx40mm Round|1|HUMANA [1294]||HUMANA [11839]|8,556.00|FSC: 13; Default||Not reimbursed separately|8,556.00|FSC: 13; Default||External grouping not supported 95171604|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 27.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|FSC: 13; Default||Not reimbursed separately|4,736.34|FSC: 13; Default||External grouping not supported 95171605|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Z 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,034.00|FSC: 13; Default||Not reimbursed separately|8,034.00|FSC: 13; Default||External grouping not supported 95171606|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 3.0mmx12mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171607|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 8 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|FSC: 13; Default||Not reimbursed separately|1,402.74|FSC: 13; Default||External grouping not supported 95171608|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123703|EAP|Custom 95123703||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drainable Convex 1-piecea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171609|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123717|EAP|Custom 95123717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Chest Dry|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171610|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171611|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123762|EAP|Custom 95123762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Angle 4mm|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95171612|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123763|EAP|Custom 95123763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden 90-degree|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95171613|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123766|EAP|Custom 95123766||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95171614|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123780|EAP|Custom 95123780||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Shunt Accuflo 24mm|1|HUMANA [1294]||HUMANA [11839]|1,923.72|FSC: 13; Default||Not reimbursed separately|1,923.72|FSC: 13; Default||External grouping not supported 95171615|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123781|EAP|Custom 95123781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Programmable In Line|1|HUMANA [1294]||HUMANA [11839]|16,974.00|FSC: 13; Default||Not reimbursed separately|16,974.00|FSC: 13; Default||External grouping not supported 95171616|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123810|EAP|Custom 95123810||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame 4cm-lc2 Titanium|1|HUMANA [1294]||HUMANA [11839]|5,115.00|FSC: 13; Default||Not reimbursed separately|5,115.00|FSC: 13; Default||External grouping not supported 95171617|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123844|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix E/x 8x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|FSC: 13; Default||Not reimbursed separately|3,726.00|FSC: 13; Default||External grouping not supported 95171618|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123845|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Straight 10mmx 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,466.00|FSC: 13; Default||Not reimbursed separately|2,466.00|FSC: 13; Default||External grouping not supported 95171619|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171620|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 30.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123852|EAP|Custom 95123852||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Schurring Ossicle|1|HUMANA [1294]||HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95171621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95123854|EAP|Custom 95123854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Ear 3.75 Loop Tantalum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171622|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123856|EAP|Custom 95123856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Ear 4.25 Loop Tantalum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171623|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171624|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171625|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123868|EAP|Custom 95123868||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Piston Fisch Tef- Pl|1|HUMANA [1294]||HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95171626|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123869|EAP|Custom 95123869||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Piston Tef-platinum|1|HUMANA [1294]||HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95171627|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal 69mm Short Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.21|FSC: 13; Default||Not reimbursed separately|2,235.21|FSC: 13; Default||External grouping not supported 95171628|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95171629|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95171630|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95171631|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123921|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 2.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171632|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mm X 175mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|545.22|FSC: 13; Default||Not reimbursed separately|545.22|FSC: 13; Default||External grouping not supported 95171633|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123923|EAP|Custom 95123923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Transfixation 6.0mm 225mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171634|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123924|EAP|Custom 95123924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bolt Extraction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171635|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123925|EAP|Custom 95123925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171636|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123926|EAP|Custom 95123926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5.0mm X 200|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171637|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123927|EAP|Custom 95123927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171638|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171639|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123938|EAP|Custom 95123938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Distractor-joint (for Schanz Sre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171640|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|FSC: 13; Default||Not reimbursed separately|110.01|FSC: 13; Default||External grouping not supported 95171641|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123943|EAP|Custom 95123943||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Threaded 3.0mm Titanium S|1|HUMANA [1294]||HUMANA [11839]|467.16|FSC: 13; Default||Not reimbursed separately|467.16|FSC: 13; Default||External grouping not supported 95171642|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123944|EAP|Custom 95123944||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 6.5mm|1|HUMANA [1294]||HUMANA [11839]|98.94|FSC: 13; Default||Not reimbursed separately|98.94|FSC: 13; Default||External grouping not supported 95171643|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Titanium 90-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 95171644|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Cannulated 3.5mm 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 95171645|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade 6-hole 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,578.00|FSC: 13; Default||Not reimbursed separately|1,578.00|FSC: 13; Default||External grouping not supported 95171647|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Titanium 80-deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,578.00|FSC: 13; Default||Not reimbursed separately|1,578.00|FSC: 13; Default||External grouping not supported 95171646|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Volar Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,562.28|FSC: 13; Default||Not reimbursed separately|1,562.28|FSC: 13; Default||External grouping not supported 95171648|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Dorsal Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,343.60|FSC: 13; Default||Not reimbursed separately|2,343.60|FSC: 13; Default||External grouping not supported 95171649|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 30.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Volar Left T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,720.20|FSC: 13; Default||Not reimbursed separately|1,720.20|FSC: 13; Default||External grouping not supported 95192232|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95123952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Dcp 2.0mm 5-hole 27mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95171650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 5.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95123953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp 2.7mm X 44mm 5 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|783.96|FSC: 13; Default||Not reimbursed separately|783.96|FSC: 13; Default||External grouping not supported 95171652|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable Sprint|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95123954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95171654|EAP|Custom 95171654||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 16mm X 34mm X24mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95123955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.56|FSC: 13; Default||Not reimbursed separately|3,418.56|FSC: 13; Default||External grouping not supported 95123956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 280mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95123957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|FSC: 13; Default||Not reimbursed separately|3,051.00|FSC: 13; Default||External grouping not supported 95123958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,888.78|FSC: 13; Default||Not reimbursed separately|3,888.78|FSC: 13; Default||External grouping not supported 95123959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95123960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 13mm X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.56|FSC: 13; Default||Not reimbursed separately|3,418.56|FSC: 13; Default||External grouping not supported 95171672|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95171673|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Humeral 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95171674|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95171675|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 380|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 95171676|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95171677|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 420|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95171678|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral 15x360|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,160.00|FSC: 13; Default||Not reimbursed separately|2,160.00|FSC: 13; Default||External grouping not supported 95171679|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tension 4.0 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95171680|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95171681|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Titanium Elastic Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,045.62|FSC: 13; Default||Not reimbursed separately|1,045.62|FSC: 13; Default||External grouping not supported 95171682|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Titanium Elastic 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.32|FSC: 13; Default||Not reimbursed separately|1,168.32|FSC: 13; Default||External grouping not supported 95171683|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123973|EAP|Custom 95123973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171684|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123974|EAP|Custom 95123974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Universal F/1.3/2 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171685|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Univer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95171686|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Ti Orb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,899.00|FSC: 13; Default||Not reimbursed separately|1,899.00|FSC: 13; Default||External grouping not supported 95171687|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 3.0mmx10mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171688|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 30.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 3.0mmx14mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 20mm X 155mm Conical Distal Plasma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95123982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 3.0mmx16mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 14mmx360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,154.00|FSC: 13; Default||Not reimbursed separately|8,154.00|FSC: 13; Default||External grouping not supported 95123983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 3.0mmx18mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171691|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 14mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171692|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 15mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171693|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 16mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171694|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 18mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171695|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 19mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171696|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 20mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95171697|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 21mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171698|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 24mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171699|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 25mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171700|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 28mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171701|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 29mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171702|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 30mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95171703|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 32mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171704|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 34mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171705|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95123998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 36mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171657|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol Minus 2.0 Diopter Acrysof Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95123999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 38mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171658|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 40mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95171659|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 14mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171660|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 15mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171662|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 16mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171661|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 12.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 17mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171663|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 18mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171664|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 19mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171665|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 20mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95171666|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 22mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171667|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 23mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171668|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 24mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171669|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 25mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171670|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 26mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171671|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 27mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95124014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 28mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95124015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 30mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95124016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 32mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95124017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 34mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95124018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 36mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 80163512|EAP|CPT® 27603||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I&d Leg Or Ankle Deep Abscess Or Hematoma|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95124019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 38mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95185586|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95124020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 40mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 95124021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 62mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.25|FSC: 13; Default||Not reimbursed separately|77.25|FSC: 13; Default||External grouping not supported 95171706|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soft-vu Pigtail 4fr 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 17mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171707|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 22mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171708|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 23mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171709|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 26mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171710|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 27mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171711|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 21mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171712|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 29mm Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95171713|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171714|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124045|EAP|Custom 95124045||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder X-lg 62-74 9 Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171715|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124047|EAP|Custom 95124047||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Xx-lg 72-84 12 Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171716|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124048|EAP|Custom 95124048||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Xxx-lg 82-94 12 Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171717|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 25.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124057|EAP|Custom 95124057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171718|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124061|EAP|Custom 95124061||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feeding 8 French Jejunal Fl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171719|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 26.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171721|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95171722|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 27.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171723|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171724|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95171725|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 30.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95171727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pyrophere 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,296.00|FSC: 13; Default||Not reimbursed separately|7,296.00|FSC: 13; Default||External grouping not supported 95124103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95171728|EAP|Custom 95171728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Disposable Linvatec Hall Cmc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95171729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95124105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95171730|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol Minus 1.0 Diopter Acrysof Multi |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95124106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95171731|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pronto V4 Extraction 6fr 138cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95124108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95124109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95185597|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95124111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95124112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95124114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95185610|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95124118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 22mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.38|FSC: 13; Default||Not reimbursed separately|307.38|FSC: 13; Default||External grouping not supported 95168744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm X 40mm Cannulated Long Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95124120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 38mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.76|FSC: 13; Default||Not reimbursed separately|332.76|FSC: 13; Default||External grouping not supported 95185609|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95124121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 42mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.38|FSC: 13; Default||Not reimbursed separately|307.38|FSC: 13; Default||External grouping not supported 95192233|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95124123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.95|FSC: 13; Default||Not reimbursed separately|844.95|FSC: 13; Default||External grouping not supported 95185587|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95188542|EAP|Custom 95188542||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Humidification Corrugated Comfort Flo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.95|FSC: 13; Default||Not reimbursed separately|844.95|FSC: 13; Default||External grouping not supported 80163520|EAP|CPT® 63650||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Percutaneous Implant Neurostim Electrode Array|1|HUMANA [1294]||HUMANA [11839]|19,099.54|FSC: 13; Default||Not reimbursed separately|19,099.54|FSC: 13; Default||External grouping not supported 95124127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.95|FSC: 13; Default||Not reimbursed separately|844.95|FSC: 13; Default||External grouping not supported 95171732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95171733|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soundstar Ultrasound |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124129|EAP|Custom 95124129||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Aortic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171738|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Starfix Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|FSC: 13; Default||Not reimbursed separately|6,285.00|FSC: 13; Default||External grouping not supported 95124131|EAP|Custom 95124131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Aortic Arch Wire-reinfor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Long V40 Modular Ii Abg |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95171740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Capitellum Radio Small Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,242.00|FSC: 13; Default||Not reimbursed separately|7,242.00|FSC: 13; Default||External grouping not supported 95124133|EAP|Custom 95124133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 20fr Dlp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Recon Head Cpti Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,882.45|FSC: 13; Default||Not reimbursed separately|6,882.45|FSC: 13; Default||External grouping not supported 95171742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Recon Captiellum Radio Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.85|FSC: 13; Default||Not reimbursed separately|5,474.85|FSC: 13; Default||External grouping not supported 95124135|EAP|Custom 95124135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 45-deg. 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171743|EAP|Custom 95171743||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Stainless Steel .062|1|HUMANA [1294]||HUMANA [11839]|66.30|FSC: 13; Default||Not reimbursed separately|66.30|FSC: 13; Default||External grouping not supported 95124137|EAP|Custom 95124137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Pvc Rcsp 15fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95124142|EAP|Custom 95124142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Saturation 1/2 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 80 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95124148|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular 5 French X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.50|FSC: 13; Default||Not reimbursed separately|40.50|FSC: 13; Default||External grouping not supported 95171746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 80 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|FSC: 13; Default||Not reimbursed separately|841.50|FSC: 13; Default||External grouping not supported 95124149|EAP|Custom 95124149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guidewire 4 French X 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171747|EAP|Custom 95171747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Counter Sink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124150|EAP|Custom 95124150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guidewire 5 French X 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171749|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Armada 35 6mm X 120mm X 135mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124151|EAP|Custom 95124151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guidewire 5 French X 65|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171750|EAP|Custom 95171750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Cutting Shape Match|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164751|EAP|Custom 95164751||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cover Baton For Gvl 3 Stat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124162|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilitation Biliary Balm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185588|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95124169|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Passport 4fr. 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124170|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz-coated J-tip .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Right X-small Sbi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,005.00|FSC: 13; Default||Not reimbursed separately|13,005.00|FSC: 13; Default||External grouping not supported 95171754|EAP|Custom 95171754||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Tourniquet Dual Port Single Bladder 12 Inch Ste)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171757|EAP|Custom 95171757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Active Tip Curved 20g 10mm 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124176|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour 7french X 22cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95171758|EAP|Custom 95171758||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrodes Patient Plate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124179|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour With Wire 7 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95171759|EAP|Custom 95171759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Active Tip Curved 20g 10mm 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124184|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour Closed End 7 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|469.86|FSC: 13; Default||Not reimbursed separately|469.86|FSC: 13; Default||External grouping not supported 95171760|EAP|Custom 95171760||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Maggot Medical Disinfected Larve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124185|EAP|Custom 95124185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Contour Closed End 7 X 26|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171761|EAP|Custom 95171761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Confinement Leflap Dujour 8 X8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124186|EAP|Custom 95124186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grasping Three-prong 2.4f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163538|EAP|CPT® 95972||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Electronic Analysis Neuorstim Pulse Generator|1|HUMANA [1294]||HUMANA [11839]|350.16|FSC: 13; Default||Not reimbursed separately|350.16|FSC: 13; Default||External grouping not supported 95124187|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ureteral Uro-maxii+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124195|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dt/3-2/5/135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124196|EAP|Custom 95124196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 10fr Non-locking Apd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171762|EAP|Custom 95171762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Ilm 25 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124197|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Apdl Pigtail 10fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171763|EAP|Custom 95171763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Psr Cornerstone 10 X 14 X 11mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95124198|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nephr. 8 Fr X 25 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171764|EAP|Custom 95171764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Psr Cornerstone 11 X 14 X 11mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95124199|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima 14x25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|FSC: 13; Default||Not reimbursed separately|6,426.84|FSC: 13; Default||External grouping not supported 95124206|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035x115cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171766|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035 8.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95124217|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drain Vansonnenberg 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171767|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035 8.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95124218|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Ap Flexima 6.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171768|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035 8.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95124225|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire 190cm Extra Sport C1769|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185592|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95124329|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95124336|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95124346|EAP|Custom 95124346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray General Utility|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95188546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 1.5mm 3 Hole Head/8 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.75|FSC: 13; Default||Not reimbursed separately|738.75|FSC: 13; Default||External grouping not supported 95124356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95185589|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95124366|EAP|Custom 95124366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retainer Viscera Streile Disp.sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192234|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95124367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large-thread 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95185576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post 6 X 6 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 95124370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral -3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|FSC: 13; Default||Not reimbursed separately|1,733.40|FSC: 13; Default||External grouping not supported 95188547|EAP|HCPCS C9250||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Evicel 2mm|1|HUMANA [1294]||HUMANA [11839]|626.70|FSC: 13; Default||Not reimbursed separately|626.70|FSC: 13; Default||External grouping not supported 95124373|EAP|Custom 95124373||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Canister Large Volume Collection|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171653|EAP|Custom 95171653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jejunal Feeding Tube 18fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124377|EAP|Custom 95124377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Device 18x15 Inrad Expres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171769|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95124383|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Contour 7frx24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95171770|EAP|Custom 95171770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tube Feeding Mic-key 18fr 4.5 Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171771|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.0 Ao Diopter Crystalens Posterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95124388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking T-shape 2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|FSC: 13; Default||Not reimbursed separately|1,262.25|FSC: 13; Default||External grouping not supported 95124390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95171774|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Y Intepro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|FSC: 13; Default||Not reimbursed separately|2,730.00|FSC: 13; Default||External grouping not supported 95124391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95171775|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Cragg-mcnamara 5cm 5fr 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 28mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95185579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|FSC: 13; Default||Not reimbursed separately|1,836.00|FSC: 13; Default||External grouping not supported 95124393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 35mm Part|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95124394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 20mm Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95185582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post 4.6mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,528.00|FSC: 13; Default||Not reimbursed separately|3,528.00|FSC: 13; Default||External grouping not supported 95124395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95124396|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Smooth 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188548|EAP|Custom 95188548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Strap Absorbable 12 Straps Secure Strap 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral -3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|FSC: 13; Default||Not reimbursed separately|1,733.40|FSC: 13; Default||External grouping not supported 95185583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 3.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|FSC: 13; Default||Not reimbursed separately|1,836.00|FSC: 13; Default||External grouping not supported 95124401|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 17x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192235|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95124405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Expansionhead Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95124408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171776|EAP|Custom 95171776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Colpostat Segment 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171777|EAP|Custom 95171777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Oscillating 1.27 Thickness 90mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171778|EAP|Custom 95171778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Tip Straight Extended Softflow Sarns 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171779|EAP|Custom 95171779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Tip Straight Extended Softflow Sarns 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171780|EAP|Custom 95171780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plasma Blade 1 Unit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171782|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Launcher Guide 6fr Renal Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 28mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95171783|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Launcher Guide 6fr Shepherd Crook|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95171784|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 6mm X 100mm X 150 .018pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +0 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95171786|EAP|Custom 95171786||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cap Digital Silipos Ribbed Knit Xxl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185603|EAP|Custom 95185603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding 22 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Mg Uni Mrt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|FSC: 13; Default||Not reimbursed separately|4,452.87|FSC: 13; Default||External grouping not supported 95124430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95124431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95124432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 34m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95124433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 36m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95124434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95124435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95124436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 34m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95124438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171798|EAP|Custom 95171798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Ribbed Knit Wide 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124441|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Mailman .014 X 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171804|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Self Expanding System 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|FSC: 13; Default||Not reimbursed separately|6,825.00|FSC: 13; Default||External grouping not supported 95124444|EAP|Custom 95124444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Basket-tip 33cm Bi-tec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95124448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95171806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95124449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95171808|EAP|Custom 95171808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Plexus Celiac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171809|EAP|Custom 95171809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glotip .018|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171810|EAP|Custom 95171810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphintertome Dash|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171811|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire .025 Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171812|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire .025 Angled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Head Neck 32 Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95171813|EAP|Custom 95171813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Retrieval Bouncer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Surface Articulating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95164270|EAP|Custom 95164270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Humidifier Concha Sterile Water 1650ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Headless 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.25|FSC: 13; Default||Not reimbursed separately|41.25|FSC: 13; Default||External grouping not supported 95171815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxin C/r Legion Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 95171816|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 70cm 3-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.56|FSC: 13; Default||Not reimbursed separately|6,097.56|FSC: 13; Default||External grouping not supported 95124458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 40mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95171817|EAP|Custom 95171817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Closure Suture Fixate|1|HUMANA [1294]||HUMANA [11839]|5,370.00|FSC: 13; Default||Not reimbursed separately|5,370.00|FSC: 13; Default||External grouping not supported 95124459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 45mm Pard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95171819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 60mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95124460|EAP|Custom 95124460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Periarticular 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 50mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95124464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +0 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95171821|EAP|Custom 95171821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Cannulated Fixos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95124466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 8mm Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,690.00|FSC: 13; Default||Not reimbursed separately|12,690.00|FSC: 13; Default||External grouping not supported 95171823|EAP|Custom 95171823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle/gun Bio Pince 18g X 20cm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95171824|EAP|Custom 95171824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Maxcess Shim |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171825|EAP|Custom 95171825||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cordent Large Extra 10-degree Lorotic 10x18x40|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95124474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base Tibial Cc Sz3+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|FSC: 13; Default||Not reimbursed separately|4,695.00|FSC: 13; Default||External grouping not supported 95188571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Right Medial Left Lateral Sz 3 Uni Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95124476|EAP|Custom 95124476||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Bone Dr Allomatrix 3cc C17|1|HUMANA [1294]||HUMANA [11839]|1,770.00|FSC: 13; Default||Not reimbursed separately|1,770.00|FSC: 13; Default||External grouping not supported 95124477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95185598|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Angioplasty Dual 4.5 X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124478|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set 3d Dbl-hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.17|FSC: 13; Default||Not reimbursed separately|394.17|FSC: 13; Default||External grouping not supported 95124489|EAP|Custom 95124489||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteoset Rbk 25cc|1|HUMANA [1294]||HUMANA [11839]|3,045.00|FSC: 13; Default||Not reimbursed separately|3,045.00|FSC: 13; Default||External grouping not supported 95185600|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flash Angioplasty 3.0mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124505|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thrombectomy 6frx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124509|EAP|Custom 95124509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Is-1 Unipolar C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz-c Rt Medial Lt Lateral Uni Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95124511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 95124518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95185601|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flash Angioplasty 3.5mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95124520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95192236|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95124521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95124522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95185602|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flash Angioplasty 4.0mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95124524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Uni M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 95188573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Vivacit-e Sz 3 - 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95124530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Poly Pro-onset 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 95124531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95171826|EAP|Custom 95171826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle For Bio Pince 17g X 16.8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95171827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Affix 2.45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|FSC: 13; Default||Not reimbursed separately|12,249.00|FSC: 13; Default||External grouping not supported 95124535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95171828|EAP|Custom 95171828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Platelet Autologus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95171830|EAP|Custom 95171830||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Bal Single 6.25 X 55mm|1|HUMANA [1294]||HUMANA [11839]|1,032.00|FSC: 13; Default||Not reimbursed separately|1,032.00|FSC: 13; Default||External grouping not supported 95124537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95171831|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Turbohawk Lx-c Vessel Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95171829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95124545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95171832|EAP|Custom 95171832||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Red Ball Single 6.25 X 55mm|1|HUMANA [1294]||HUMANA [11839]|1,032.00|FSC: 13; Default||Not reimbursed separately|1,032.00|FSC: 13; Default||External grouping not supported 95124550|EAP|Custom 95124550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Sterile Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long 11x420mmx125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95124551|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardioverter Atlas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,900.00|FSC: 13; Default||Not reimbursed separately|63,900.00|FSC: 13; Default||External grouping not supported 95171835|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Pcb 2.5 Mm X 1.5mm X 140cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124552|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Marker Length Floppe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171836|EAP|Custom 95171836||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 16mm X 38mm X 28mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95124559|EAP|Custom 95124559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171787|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omnipaque 300 30ml Bottles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.60|FSC: 13; Default||Not reimbursed separately|3.60|FSC: 13; Default||External grouping not supported 95124560|EAP|Custom 95124560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Single Adj|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Round 19mm Pyramesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,528.80|FSC: 13; Default||Not reimbursed separately|1,528.80|FSC: 13; Default||External grouping not supported 95124562|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95124563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Premier 4.0x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,114.26|FSC: 13; Default||Not reimbursed separately|1,114.26|FSC: 13; Default||External grouping not supported 62064159|EAP|CPT® 82397||0301 - LABORATORY - CHEMISTRY|Hb Chemiluminescent Assay|1|HUMANA [1294]||HUMANA [11839]|42.36|FSC: 13; Default||Not reimbursed separately|42.36|FSC: 13; Default||External grouping not supported 95124565|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Exchange Choice Pt 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188574|EAP|Custom 95188574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flute-three 4.2mm Qc Needle-point 145mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124566|EAP|Custom 95124566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit Bevel Dual Clearcut 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Trilogy Poly 36mm, 7mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|FSC: 13; Default||Not reimbursed separately|4,192.50|FSC: 13; Default||External grouping not supported 95124567|EAP|Custom 95124567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Sideport Bevel Dual Clearc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella Femoral Gender Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,444.00|FSC: 13; Default||Not reimbursed separately|15,444.00|FSC: 13; Default||External grouping not supported 95124570|EAP|Custom 95124570||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Tutoplast Suspend 2x18cm|1|HUMANA [1294]||HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95171841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Lateral Proximal Ts 10 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95124576|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Titanium Surgical (harm`sca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,346.00|FSC: 13; Default||Not reimbursed separately|2,346.00|FSC: 13; Default||External grouping not supported 95171842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 55mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95124580|EAP|Custom 95124580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Transverse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171843|EAP|Custom 95171843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Hydrodebrider Frontal |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|FSC: 13; Default||Not reimbursed separately|5,583.06|FSC: 13; Default||External grouping not supported 95171844|EAP|Custom 95171844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brace Ankle Xlarge Aso Stabilizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124586|EAP|Custom 95124586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 4.8 Veratack Mulitifire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxin Ps Legion Size 5 Left Nickle-free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 95171848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Flexion High Lxpe Ps Legion |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 95124590|EAP|Custom 95124590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 21mm Endoscopic Circular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064167|EAP|CPT® 82172||0301 - LABORATORY - CHEMISTRY|Hb Apolipoprotein B - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|63.27|FSC: 13; Default||Not reimbursed separately|63.27|FSC: 13; Default||External grouping not supported 95124603|EAP|Custom 95124603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand 45 Ultra Reflex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171850|EAP|Custom 95171850||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Palacos-lv|1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95124606|EAP|Custom 95124606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Dissecting 5mm Harmonic-sca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Corkscrew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95124610|EAP|Custom 95124610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Lar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95123262|EAP|Custom 95123262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Microtip Solstice|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124612|EAP|HCPCS E0218||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Foot Cryo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171855|EAP|Custom 95171855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occlusion System Interlock 2d 4mm X 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124616|EAP|Custom 95124616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pencil Triple Option Handcontrol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171857|EAP|Custom 95171857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gastromtomy Willis-oglesby 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fixed-mandibular Two Tra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,989.00|FSC: 13; Default||Not reimbursed separately|4,989.00|FSC: 13; Default||External grouping not supported 95171858|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Endotak Reliance 59cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95124621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95171859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Cemented Revision Platform Rotating Mbt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 95124622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm X 53mm 2 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|769.44|FSC: 13; Default||Not reimbursed separately|769.44|FSC: 13; Default||External grouping not supported 95171860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Full Femoral Porous Universal 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,901.00|FSC: 13; Default||Not reimbursed separately|8,901.00|FSC: 13; Default||External grouping not supported 95171861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Metaphyseal Porous Mbt Revision Size 37mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|FSC: 13; Default||Not reimbursed separately|10,248.00|FSC: 13; Default||External grouping not supported 95124625|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ex Composix 7 X 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,988.00|FSC: 13; Default||Not reimbursed separately|2,988.00|FSC: 13; Default||External grouping not supported 95171862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Universal Flute Revision 115 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 95124626|EAP|Custom 95124626||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Management Pain Palm-pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Universal Fluted Revision 115 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 95124629|EAP|Custom 95124629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 60mm Linear Heavywire Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Sigma Tc3 Cemented Size Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 95171865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Femoral Pfc 5 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,751.10|FSC: 13; Default||Not reimbursed separately|7,751.10|FSC: 13; Default||External grouping not supported 95124639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Cut 6.0cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|FSC: 13; Default||Not reimbursed separately|1,162.17|FSC: 13; Default||External grouping not supported 95171866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Adapter Femoral Pfc Sigma +2/-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,102.50|FSC: 13; Default||Not reimbursed separately|1,102.50|FSC: 13; Default||External grouping not supported 95171867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Combo Posterior Pfc Sigma Size 4-4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 95124642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Cut 4.0cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95171868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Combo Distal Pfc Sigma Size 4-16mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 95124643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Cut 5.0cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|FSC: 13; Default||Not reimbursed separately|1,162.17|FSC: 13; Default||External grouping not supported 95171869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Rp Tc3 Size 4-17.5mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 95124648|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Flexima 8 Fr Firm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95124660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Ex-small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95171872|EAP|Custom 95171872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tigerwire 2 38 White And Black With Two Tapered|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95124667|EAP|Custom 95124667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Shower Spray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124676|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior 65ml Inhibizone 700cx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.00|FSC: 13; Default||Not reimbursed separately|2,595.00|FSC: 13; Default||External grouping not supported 95124679|EAP|Custom 95124679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Prefixation Zephir|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124683|EAP|Custom 95124683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Set Osteo Site Bone Bioph|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124685|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Titanium Surgical (harm`sca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|FSC: 13; Default||Not reimbursed separately|6,765.00|FSC: 13; Default||External grouping not supported 95124689|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .018 Inch X 300cm Leng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 150/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95124705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Vertex 3.2mmx240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|FSC: 13; Default||Not reimbursed separately|1,287.00|FSC: 13; Default||External grouping not supported 95124706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95124707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Cut 8.0cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95124708|EAP|Custom 95124708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer System Accustick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124710|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 200cc Style133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95124713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-drlg 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95124714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95124718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt 7.0x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|FSC: 13; Default||Not reimbursed separately|756.00|FSC: 13; Default||External grouping not supported 95124720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.80|FSC: 13; Default||Not reimbursed separately|142.80|FSC: 13; Default||External grouping not supported 95124723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.96|FSC: 13; Default||Not reimbursed separately|4,452.96|FSC: 13; Default||External grouping not supported 95124724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 7.0cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|FSC: 13; Default||Not reimbursed separately|1,162.17|FSC: 13; Default||External grouping not supported 95124725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis Ankle 10mmx18cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,274.00|FSC: 13; Default||Not reimbursed separately|5,274.00|FSC: 13; Default||External grouping not supported 95124731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95124732|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gortex S0603|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95124733|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124744|EAP|Custom 95124744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Med Drive Star 1.5mm 66mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124751|EAP|Custom 95124751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mechanism Dfs Modular-c/d 0-5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124764|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Penile Malleable 600m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95124776|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .014 Floppy 175cm Xt J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Keyless 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 95124796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95124802|EAP|Custom 95124802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Epidual Radio-opaque Br|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124804|EAP|Custom 95124804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Hex Break Off|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,158.36|FSC: 13; Default||Not reimbursed separately|1,158.36|FSC: 13; Default||External grouping not supported 95124806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,158.36|FSC: 13; Default||Not reimbursed separately|1,158.36|FSC: 13; Default||External grouping not supported 95124809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,535.00|FSC: 13; Default||Not reimbursed separately|5,535.00|FSC: 13; Default||External grouping not supported 95124812|EAP|Custom 95124812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Groove 300-micron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124817|EAP|Custom 95124817||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x10m Recon Plat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.00|FSC: 13; Default||Not reimbursed separately|231.00|FSC: 13; Default||External grouping not supported 95124820|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Left 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Global Fx 8stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,820.00|FSC: 13; Default||Not reimbursed separately|8,820.00|FSC: 13; Default||External grouping not supported 95124825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 13mmx90-diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95124839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Dorsal Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,343.60|FSC: 13; Default||Not reimbursed separately|2,343.60|FSC: 13; Default||External grouping not supported 95124844|EAP|Custom 95124844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Iris Flexible|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Distal Size-d 10mm Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95124859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Bent 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95124860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Bent 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95124861|EAP|Custom 95124861||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Typhoon|1|HUMANA [1294]||HUMANA [11839]|765.00|FSC: 13; Default||Not reimbursed separately|765.00|FSC: 13; Default||External grouping not supported 95124865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Premier 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,797.28|FSC: 13; Default||Not reimbursed separately|6,797.28|FSC: 13; Default||External grouping not supported 95124869|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perclose The Clincher 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.50|FSC: 13; Default||Not reimbursed separately|691.50|FSC: 13; Default||External grouping not supported 95124872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,544.20|FSC: 13; Default||Not reimbursed separately|3,544.20|FSC: 13; Default||External grouping not supported 95124874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95124890|EAP|Custom 95124890||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Angioplasty Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124896|EAP|Custom 95124896||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Felt Orthopedic 1/4x21x36|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|FSC: 13; Default||Not reimbursed separately|5,583.06|FSC: 13; Default||External grouping not supported 95124905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Zephir 3.5mmx1)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,037.82|FSC: 13; Default||Not reimbursed separately|1,037.82|FSC: 13; Default||External grouping not supported 95124907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Zephir 4.0mmx1)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,226.58|FSC: 13; Default||Not reimbursed separately|1,226.58|FSC: 13; Default||External grouping not supported 95124909|EAP|Custom 95124909||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh 16mmx60mm Round|1|HUMANA [1294]||HUMANA [11839]|22,050.00|FSC: 13; Default||Not reimbursed separately|22,050.00|FSC: 13; Default||External grouping not supported 95124910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 95124911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95124912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|FSC: 13; Default||Not reimbursed separately|2,333.58|FSC: 13; Default||External grouping not supported 95124913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|FSC: 13; Default||Not reimbursed separately|2,333.58|FSC: 13; Default||External grouping not supported 95124914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|FSC: 13; Default||Not reimbursed separately|2,333.58|FSC: 13; Default||External grouping not supported 95124915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|FSC: 13; Default||Not reimbursed separately|2,333.58|FSC: 13; Default||External grouping not supported 95124916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|FSC: 13; Default||Not reimbursed separately|2,333.58|FSC: 13; Default||External grouping not supported 95124917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95124918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95124919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95124920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95124921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95124922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95124923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95124924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|FSC: 13; Default||Not reimbursed separately|2,214.93|FSC: 13; Default||External grouping not supported 95124925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95124926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95124927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95124928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95124929|EAP|Custom 95124929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 14 X M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Dcp 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95124933|EAP|Custom 95124933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Dou|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124935|EAP|Custom 95124935||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Stainless-steel 1.3mm|1|HUMANA [1294]||HUMANA [11839]|708.75|FSC: 13; Default||Not reimbursed separately|708.75|FSC: 13; Default||External grouping not supported 95124937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture 16 Hole 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,002.00|FSC: 13; Default||Not reimbursed separately|1,002.00|FSC: 13; Default||External grouping not supported 95124939|EAP|Custom 95124939||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbx 1cc (demineralized Bon|1|HUMANA [1294]||HUMANA [11839]|674.85|FSC: 13; Default||Not reimbursed separately|674.85|FSC: 13; Default||External grouping not supported 95124944|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 900e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95124951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Heaad Femoral 32mm C.c.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 95124952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Trn Femoral Rt 380mmx11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95124953|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel 150cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95124954|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gold Hemashield Arched 1-b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,727.17|FSC: 13; Default||Not reimbursed separately|3,727.17|FSC: 13; Default||External grouping not supported 95124955|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth Round Hp G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95124956|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Elliptical 250cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95124957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Shoulder 44x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|FSC: 13; Default||Not reimbursed separately|5,949.00|FSC: 13; Default||External grouping not supported 95124958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Pfc Hip 32mmx+0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.10|FSC: 13; Default||Not reimbursed separately|3,236.10|FSC: 13; Default||External grouping not supported 95124959|EAP|Custom 95124959||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Strata Regular|1|HUMANA [1294]||HUMANA [11839]|16,744.71|FSC: 13; Default||Not reimbursed separately|16,744.71|FSC: 13; Default||External grouping not supported 95124985|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95124986|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95124987|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95124988|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95124989|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95124990|EAP|Custom 95124990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid-loads 0.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124991|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.1mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95124993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 18mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95124994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intrafix 8mm - 10mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.00|FSC: 13; Default||Not reimbursed separately|669.00|FSC: 13; Default||External grouping not supported 95125002|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125003|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125004|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95125005|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125006|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125007|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125008|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95125009|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125010|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125011|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125012|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125013|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125014|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125015|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125016|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95125017|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 5.0 Diopter Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95125018|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95125019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95125021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Z 7.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,146.00|FSC: 13; Default||Not reimbursed separately|7,146.00|FSC: 13; Default||External grouping not supported 95125022|EAP|Custom 95125022||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distractor Miami Moss Rednesa|1|HUMANA [1294]||HUMANA [11839]|1,557.00|FSC: 13; Default||Not reimbursed separately|1,557.00|FSC: 13; Default||External grouping not supported 95125023|EAP|Custom 95125023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Angled Miami Moss|1|HUMANA [1294]||HUMANA [11839]|1,557.00|FSC: 13; Default||Not reimbursed separately|1,557.00|FSC: 13; Default||External grouping not supported 95125024|EAP|Custom 95125024||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Wide Miami Moss|1|HUMANA [1294]||HUMANA [11839]|1,557.00|FSC: 13; Default||Not reimbursed separately|1,557.00|FSC: 13; Default||External grouping not supported 95125025|EAP|Custom 95125025||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Narrow Miami Moss|1|HUMANA [1294]||HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95125026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 48cm Miami Moss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,191.00|FSC: 13; Default||Not reimbursed separately|1,191.00|FSC: 13; Default||External grouping not supported 95125027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95125035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,147.94|FSC: 13; Default||Not reimbursed separately|5,147.94|FSC: 13; Default||External grouping not supported 95125036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|FSC: 13; Default||Not reimbursed separately|5,583.06|FSC: 13; Default||External grouping not supported 95125037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|FSC: 13; Default||Not reimbursed separately|5,583.06|FSC: 13; Default||External grouping not supported 95125038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,829.34|FSC: 13; Default||Not reimbursed separately|4,829.34|FSC: 13; Default||External grouping not supported 95125039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,829.34|FSC: 13; Default||Not reimbursed separately|4,829.34|FSC: 13; Default||External grouping not supported 95125040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|FSC: 13; Default||Not reimbursed separately|5,583.06|FSC: 13; Default||External grouping not supported 95125041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,246.40|FSC: 13; Default||Not reimbursed separately|5,246.40|FSC: 13; Default||External grouping not supported 95125042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|FSC: 13; Default||Not reimbursed separately|6,065.22|FSC: 13; Default||External grouping not supported 95125043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|FSC: 13; Default||Not reimbursed separately|6,065.22|FSC: 13; Default||External grouping not supported 95125044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|FSC: 13; Default||Not reimbursed separately|6,065.22|FSC: 13; Default||External grouping not supported 95125045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|FSC: 13; Default||Not reimbursed separately|6,065.22|FSC: 13; Default||External grouping not supported 95125046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|FSC: 13; Default||Not reimbursed separately|6,606.18|FSC: 13; Default||External grouping not supported 95125047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|FSC: 13; Default||Not reimbursed separately|6,606.18|FSC: 13; Default||External grouping not supported 95125048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|FSC: 13; Default||Not reimbursed separately|6,606.18|FSC: 13; Default||External grouping not supported 95125049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical Zephir 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|FSC: 13; Default||Not reimbursed separately|6,606.18|FSC: 13; Default||External grouping not supported 95125050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95125051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95125052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 38cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95125053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 40cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95125054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 40cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95125055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 42cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95125056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 46cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95125057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95125058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95125060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mmx12mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|FSC: 13; Default||Not reimbursed separately|1,282.50|FSC: 13; Default||External grouping not supported 95125061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vertex 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95125066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 95125072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95125073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Femoral Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|FSC: 13; Default||Not reimbursed separately|2,333.58|FSC: 13; Default||External grouping not supported 95125075|EAP|Custom 95125075||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Cpc Florio 5/16 Long|1|HUMANA [1294]||HUMANA [11839]|122.46|FSC: 13; Default||Not reimbursed separately|122.46|FSC: 13; Default||External grouping not supported 95125084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fixed-mandibular Four Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95125086|EAP|Custom 95125086||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cornerstone 6mm Tissue Huma|1|HUMANA [1294]||HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95125096|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Guiding Veri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125098|EAP|Custom 95125098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retrieval Trapezoid Rx-wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125100|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft 4 Gold Hemashield Arched 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.75|FSC: 13; Default||Not reimbursed separately|4,368.75|FSC: 13; Default||External grouping not supported 95125101|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft 4 Gold Hemashield Arched 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,367.76|FSC: 13; Default||Not reimbursed separately|4,367.76|FSC: 13; Default||External grouping not supported 95125102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95125104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95125105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.60|FSC: 13; Default||Not reimbursed separately|858.60|FSC: 13; Default||External grouping not supported 95125106|EAP|Custom 95125106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Core 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125107|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Drill 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Cut 3.0cm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95125113|EAP|Custom 95125113||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh 13mmx30mm|1|HUMANA [1294]||HUMANA [11839]|12,348.00|FSC: 13; Default||Not reimbursed separately|12,348.00|FSC: 13; Default||External grouping not supported 95125114|EAP|Custom 95125114||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 10mm Frs|1|HUMANA [1294]||HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95125116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Tibial Ankle Agility Sz-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,015.00|FSC: 13; Default||Not reimbursed separately|9,015.00|FSC: 13; Default||External grouping not supported 95125118|EAP|Custom 95125118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cholangiography Preview|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125119|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Contour-profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95125122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Cdh 5.5x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95125123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lipped Ps Lg 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95125140|EAP|Custom 95125140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Long 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|FSC: 13; Default||Not reimbursed separately|682.29|FSC: 13; Default||External grouping not supported 95125160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.60|FSC: 13; Default||Not reimbursed separately|741.60|FSC: 13; Default||External grouping not supported 95125161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 1e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.30|FSC: 13; Default||Not reimbursed separately|384.30|FSC: 13; Default||External grouping not supported 95125164|EAP|Custom 95125164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Innovit Stand Alone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125166|EAP|Custom 95125166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Softjaw Insert 33mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125168|EAP|Custom 95125168||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Orbital Wrap Bovine-peri|1|HUMANA [1294]||HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95125169|EAP|Custom 95125169||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Orbital Ocuguard Wrap 20|1|HUMANA [1294]||HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95125171|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95125172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inner Miami Moss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95125175|EAP|Custom 95125175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB NEEDLE STIMUPLEX 21GA X 4"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125178|EAP|Custom 95125178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125184|EAP|Custom 95125184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Loading-unit Endo Ta-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Ltd Spider Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95125204|EAP|Custom 95125204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator External Mini-fix Dynafi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125205|EAP|Custom 95125205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator External Fix Mini Dynafi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95125207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95125216|EAP|Custom 95125216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endostat Disposable 6mmx18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125222|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Joint Great-toe Small 17mm Non-p|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95125235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shoulder Humeral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,833.00|FSC: 13; Default||Not reimbursed separately|7,833.00|FSC: 13; Default||External grouping not supported 95125237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral 22mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,893.00|FSC: 13; Default||Not reimbursed separately|1,893.00|FSC: 13; Default||External grouping not supported 95125238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Peg Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|FSC: 13; Default||Not reimbursed separately|4,215.00|FSC: 13; Default||External grouping not supported 95125241|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 3.2 X 450mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sol Deep-profile 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,655.00|FSC: 13; Default||Not reimbursed separately|5,655.00|FSC: 13; Default||External grouping not supported 95125250|EAP|Custom 95125250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 2/3 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125251|EAP|Custom 95125251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 1/3 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125279|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quadpolar 6 Fr 125 Cm5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95125293|EAP|Custom 95125293||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut 3/8|1|HUMANA [1294]||HUMANA [11839]|174.00|FSC: 13; Default||Not reimbursed separately|174.00|FSC: 13; Default||External grouping not supported 95125295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc-dcp Stainless Narrow 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95125296|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Humeral Smooth 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125297|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Humeral M/dn Bullet-ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125299|EAP|Custom 95125299||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 23mm|1|HUMANA [1294]||HUMANA [11839]|12,510.00|FSC: 13; Default||Not reimbursed separately|12,510.00|FSC: 13; Default||External grouping not supported 95125301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95125302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95171883|EAP|Custom 95171883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Acl Db 7mm|1|HUMANA [1294]||HUMANA [11839]|1,395.00|FSC: 13; Default||Not reimbursed separately|1,395.00|FSC: 13; Default||External grouping not supported 95125310|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gold Surgisis 13x22cm Hern|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95171884|EAP|Custom 95171884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Pin Tightrope Open Eyelet 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125311|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone-gel Styl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95171885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Qwix 5.5mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.54|FSC: 13; Default||Not reimbursed separately|1,164.54|FSC: 13; Default||External grouping not supported 95125315|EAP|Custom 95125315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bayonet 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171886|EAP|Custom 95171886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125316|EAP|Custom 95125316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Positioning Cerclage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Positioning 5.5mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.54|FSC: 13; Default||Not reimbursed separately|1,164.54|FSC: 13; Default||External grouping not supported 95125334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Neff 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 95171889|EAP|Custom 95171889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ablation 60fs3 Cryoflex 10-s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Neff 13x340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 95171890|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Catheter Picc Dual Lumen Ct 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95125336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Neff 17mmx340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,260.00|FSC: 13; Default||Not reimbursed separately|7,260.00|FSC: 13; Default||External grouping not supported 95125337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|FSC: 13; Default||Not reimbursed separately|384.00|FSC: 13; Default||External grouping not supported 95125338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95125345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis Ankle 11mmx18cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,757.00|FSC: 13; Default||Not reimbursed separately|2,757.00|FSC: 13; Default||External grouping not supported 80163553|EAP|CPT® 11765||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Wedge Excision Skin Nail Fold|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95125346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis Ankle 12mmx18cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,342.00|FSC: 13; Default||Not reimbursed separately|3,342.00|FSC: 13; Default||External grouping not supported 95110426|EAP|Custom 95110426||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Scleral Buckling 276 Style Tire Silicone|1|HUMANA [1294]||HUMANA [11839]|48.96|FSC: 13; Default||Not reimbursed separately|48.96|FSC: 13; Default||External grouping not supported 95125349|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth-round High|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95111197|EAP|Custom 95111197||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Scleral Buckling 240 Style Circling Band|1|HUMANA [1294]||HUMANA [11839]|83.83|FSC: 13; Default||Not reimbursed separately|83.83|FSC: 13; Default||External grouping not supported 95125350|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth-round High|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95128194|EAP|Custom 95128194||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Scleral Buckling 31 Style Strip Silicone|1|HUMANA [1294]||HUMANA [11839]|34.08|FSC: 13; Default||Not reimbursed separately|34.08|FSC: 13; Default||External grouping not supported 95125351|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth-round High|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95171891|EAP|Custom 95171891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Suction Closed Kimvent Y Adapter 6fr 12 In Lin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125352|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth-round High|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95171892|EAP|Custom 95171892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Suction Closed Kimvent Y Adapter 8fr 12 In Lie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125354|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel 200cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95171893|EAP|Custom 95171893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Closed Suction Mult Access Kimvent 5fr 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125357|EAP|Custom 95125357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Revision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171894|EAP|Custom 95171894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Closed Suction Mult Access Kimvent 5fr 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171896|EAP|Custom 95171896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contoured Small 8mm X 15 X 12|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95125363|EAP|Custom 95125363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Passing Calibrated 2.4mmx15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Helix-r 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|FSC: 13; Default||Not reimbursed separately|3,288.00|FSC: 13; Default||External grouping not supported 95125370|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Brite Tip 11fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,269.01|FSC: 13; Default||Not reimbursed separately|3,269.01|FSC: 13; Default||External grouping not supported 95125372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95171901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +10 25mm Modular Restore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95125373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95171905|EAP|Custom 95171905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hoop Shim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125380|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171908|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermocool Sf Cartoxp D-f,tc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125382|EAP|Custom 95125382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Infusion Peripheral .035 Di|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171909|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermocool Sf Cartoxp F,jh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 36mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.76|FSC: 13; Default||Not reimbursed separately|50.76|FSC: 13; Default||External grouping not supported 95171910|EAP|Custom 95171910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 421cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171911|EAP|Custom 95171911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 457cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera Sextant 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95171919|EAP|Custom 95171919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Composite Premise Flow Syr A1 1.7gm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163561|EAP|Custom 80163561||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Cvm Ekg Athlete Screening|1|HUMANA [1294]||HUMANA [11839]|10.00|FSC: 13; Default||Not reimbursed separately|10.00|FSC: 13; Default||External grouping not supported 95192237|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95125405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95125409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Fens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95125410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Fens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95171921|EAP|Custom 95171921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Memory Biopro 9mm X 7mm 1.5 X 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Fens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95171922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,472.10|FSC: 13; Default||Not reimbursed separately|1,472.10|FSC: 13; Default||External grouping not supported 95125412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 15mm 0mm Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95171923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,051.50|FSC: 13; Default||Not reimbursed separately|1,051.50|FSC: 13; Default||External grouping not supported 95125414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 54mm Steri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|FSC: 13; Default||Not reimbursed separately|724.14|FSC: 13; Default||External grouping not supported 95171924|EAP|Custom 95171924||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Red Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171925|EAP|Custom 95171925||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Lenght Red Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x14mm Recon Pla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95171926|EAP|Custom 95171926||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insert Orthotics Vasyli Custom Easyfit Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x16mm Recon Pla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95171927|EAP|Custom 95171927||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insert Orthotics Vasyli Custom Easyfit Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mmx8mm F/ (l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.50|FSC: 13; Default||Not reimbursed separately|256.50|FSC: 13; Default||External grouping not supported 95171928|EAP|Custom 95171928||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Magnifuse Pc Cervical |1|HUMANA [1294]||HUMANA [11839]|4,725.00|FSC: 13; Default||Not reimbursed separately|4,725.00|FSC: 13; Default||External grouping not supported 95125439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 44mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95171929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95125440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 44/45/46mm Odx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95171930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95125441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 46mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95171931|EAP|Custom 95171931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Natrelle 450cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 47mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95171932|EAP|Custom 95171932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Delivery Bone Cement Autoplex W/o Needles And Ce|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 47/48/49mm Odx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95171933|EAP|Custom 95171933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Mynxgrip Sealant 5 Fr (min Order 1 Box)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 53/54/55mm Odx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95171943|EAP|Custom 95171943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cement Vertaplex Hv Twin Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 54mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95171948|EAP|Custom 95171948||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus X-small Left Sbi|1|HUMANA [1294]||HUMANA [11839]|20,817.00|FSC: 13; Default||Not reimbursed separately|20,817.00|FSC: 13; Default||External grouping not supported 95125467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Left Offset 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,038.18|FSC: 13; Default||Not reimbursed separately|1,038.18|FSC: 13; Default||External grouping not supported 95171949|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Unify Quadra Crt-d Bi-ventricular Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|FSC: 13; Default||Not reimbursed separately|66,552.00|FSC: 13; Default||External grouping not supported 95125476|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dynamic 1.7mm 90x90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|FSC: 13; Default||Not reimbursed separately|2,796.00|FSC: 13; Default||External grouping not supported 95171953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Grtfx 8 X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,590.00|FSC: 13; Default||Not reimbursed separately|7,590.00|FSC: 13; Default||External grouping not supported 95125479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Tibial Un|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|FSC: 13; Default||Not reimbursed separately|2,109.12|FSC: 13; Default||External grouping not supported 95171954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Rod 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,882.50|FSC: 13; Default||Not reimbursed separately|4,882.50|FSC: 13; Default||External grouping not supported 95125480|EAP|Custom 95125480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Holding Collasping|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125481|EAP|Custom 95125481||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Taper|1|HUMANA [1294]||HUMANA [11839]|2,847.00|FSC: 13; Default||Not reimbursed separately|2,847.00|FSC: 13; Default||External grouping not supported 95171963|EAP|Custom 95171963||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Fixation Carpometacarpal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125486|EAP|Custom 95125486||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 11mm X 13mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95125487|EAP|Custom 95125487||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 13mm X 13mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95125491|EAP|Custom 95125491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Cath Epidural|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163579|EAP|CPT® 97113||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Aquatic Therapy 1 Or More Areas Ea 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|110.55|FSC: 13; Default||Not reimbursed separately|110.55|FSC: 13; Default||External grouping not supported 95125503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Phs #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.95|FSC: 13; Default||Not reimbursed separately|6,349.95|FSC: 13; Default||External grouping not supported 95171964|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Percuflex 4.8fr X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95171965|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Occlusion 10fr X .035 Diameter X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125549|EAP|Custom 95125549||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Manifold Preceptor Morse For Pre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95125554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Reflection 28-i.d. 62-64 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|FSC: 13; Default||Not reimbursed separately|2,818.20|FSC: 13; Default||External grouping not supported 95171969|EAP|Custom 95171969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Linear Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125565|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Accessory (ams 800) C1815|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95171971|EAP|Custom 95171971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Insertion Kit Sensation Plus 50cc Fiber |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171977|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125572|EAP|Custom 95125572||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Belt Pelvic Sacro X-large(50-58i|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171978|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Billiary Self-expanding Abolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95171979|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Hum Sz.8.5mm Select Shoulde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.00|FSC: 13; Default||Not reimbursed separately|4,959.00|FSC: 13; Default||External grouping not supported 95171980|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125587|EAP|Custom 95125587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol 5b9776 Dianeal W/2.5% Dex 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171981|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95125589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink Low Profile L-.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95125592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws 6.5x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|FSC: 13; Default||Not reimbursed separately|2,796.00|FSC: 13; Default||External grouping not supported 95125615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchor 5.0 #2 Dbs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95171985|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95125616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95171986|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95171987|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95171988|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95171989|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Harris Precoat Smal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.99|FSC: 13; Default||Not reimbursed separately|4,803.99|FSC: 13; Default||External grouping not supported 95171990|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Harris Precoat Larg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,902.00|FSC: 13; Default||Not reimbursed separately|4,902.00|FSC: 13; Default||External grouping not supported 95171991|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125623|EAP|Custom 95125623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reservoir W/lockout-valve Biofle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171992|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125628|EAP|Custom 95125628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171993|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95171994|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95125645|EAP|Custom 95125645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Right-angled 3.0x90-d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171995|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95171997|EAP|Custom 95171997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Capsule Delivery 3/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171998|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 28mm X 113cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|FSC: 13; Default||Not reimbursed separately|19,542.00|FSC: 13; Default||External grouping not supported 95125683|EAP|Custom 95125683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Insertion Gel-cap 16fr(ki|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95125690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Fix Bone Nail Smart 20mmx1.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|509.22|FSC: 13; Default||Not reimbursed separately|509.22|FSC: 13; Default||External grouping not supported 95172000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95125692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Revo Super|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|509.46|FSC: 13; Default||Not reimbursed separately|509.46|FSC: 13; Default||External grouping not supported 95172001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95125693|EAP|Custom 95125693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Passing Graft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acp Locking 3.5mm 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|668.25|FSC: 13; Default||Not reimbursed separately|668.25|FSC: 13; Default||External grouping not supported 95125695|EAP|Custom 95125695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Parallax Cement Delivery Systemp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95125702|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95172004|EAP|Custom 95172004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist Scp 3.5 X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125705|EAP|Custom 95125705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Delivery Norion Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125757|EAP|Custom 95125757||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sol 5b9770 Dianeal 1.5% Dext. 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125774|EAP|Custom 95125774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Amniocentesis 20 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Regular 17 X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95125784|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Donut Silicone Size 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tibial W/o Body Mrs 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,479.40|FSC: 13; Default||Not reimbursed separately|9,479.40|FSC: 13; Default||External grouping not supported 95125785|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Donut Silicone Size 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172022|EAP|Custom 95172022||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125786|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172023|EAP|Custom 95172023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Boot Extra Large|1|HUMANA [1294]||HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95125787|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Helix 4mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95125788|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Helix 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95125792|EAP|Custom 95125792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid-loads.1.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set End Cap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95125793|EAP|Custom 95125793||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Access Vascular Port-tiat|1|HUMANA [1294]||HUMANA [11839]|127.50|FSC: 13; Default||Not reimbursed separately|127.50|FSC: 13; Default||External grouping not supported 95172029|EAP|Custom 95172029||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endcap 7 Degree Top 15 X 12mm|1|HUMANA [1294]||HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95125796|EAP|Custom 95125796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.6mm Dynafex Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172030|EAP|Custom 95172030||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endcap 7 Degree Bottom 15 X 12mm|1|HUMANA [1294]||HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95125798|EAP|Custom 95125798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172031|EAP|Custom 95172031||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Delivery System Trim-it-spin Pin|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95125803|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Proximal Long Left 8 X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|FSC: 13; Default||Not reimbursed separately|5,491.50|FSC: 13; Default||External grouping not supported 95125804|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95125805|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 5.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95172046|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Psmx Matristem 20cm X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95125806|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Mc35 .035x70cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide Threaded Tip 2.8mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95125816|EAP|Custom 95125816||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Omega Plus 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,257.00|FSC: 13; Default||Not reimbursed separately|1,257.00|FSC: 13; Default||External grouping not supported 95125833|EAP|Custom 95125833||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Male Size 8|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hip Barrel Std Keyless 145 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,968.00|FSC: 13; Default||Not reimbursed separately|1,968.00|FSC: 13; Default||External grouping not supported 95125834|EAP|Custom 95125834||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Male Size 9|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95125845|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Unmounted Biliary Transhem|1|HUMANA [1294]||HUMANA [11839]|3,270.00|FSC: 13; Default||Not reimbursed separately|3,270.00|FSC: 13; Default||External grouping not supported 95172056|EAP|Custom 95172056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm Length 135mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125879|EAP|HCPCS C1727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Gsa 240cc C1727|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lactosorb Suspension 2.0 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95125881|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial Intracoil 7mm Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95172060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 5mm Gray Nail Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.96|FSC: 13; Default||Not reimbursed separately|789.96|FSC: 13; Default||External grouping not supported 95125882|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bridge X3|1|HUMANA [1294]||HUMANA [11839]|3,855.00|FSC: 13; Default||Not reimbursed separately|3,855.00|FSC: 13; Default||External grouping not supported 95172035|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Mariner Kumpe 5 Fr 40cm .035 Non Braided|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125890|EAP|Custom 95125890||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ventilation Shepard- Gromme|1|HUMANA [1294]||HUMANA [11839]|118.20|FSC: 13; Default||Not reimbursed separately|118.20|FSC: 13; Default||External grouping not supported 95172036|EAP|Custom 95172036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Ultrasound Endoscopic Ultra Echotip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125891|EAP|Custom 95125891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Endo Ta-30 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172037|EAP|Custom 95172037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligator Milti-band Saeed 6-shooter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172038|EAP|Custom 95172038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligator Milti-band Saeed 10-shooter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Humeral M/dn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.41|FSC: 13; Default||Not reimbursed separately|583.41|FSC: 13; Default||External grouping not supported 95172039|EAP|Custom 95172039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Afm Ag Antimicrobial 4 X 5 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125895|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bullet-tip 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Dished Articular Xlpe Legion 9mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 95125896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95125897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Sz2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,380.00|FSC: 13; Default||Not reimbursed separately|7,380.00|FSC: 13; Default||External grouping not supported 95125898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base N/p Sz-5 No C-code|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95172063|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Introducer 9fr Ultimum Act 10/box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95125899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Coated Sz-2 Left No|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95172064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|FSC: 13; Default||Not reimbursed separately|1,213.80|FSC: 13; Default||External grouping not supported 95125900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Femoral Adv Right Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,135.00|FSC: 13; Default||Not reimbursed separately|9,135.00|FSC: 13; Default||External grouping not supported 95172065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Locking Right 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|686.88|FSC: 13; Default||Not reimbursed separately|686.88|FSC: 13; Default||External grouping not supported 95125901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Coated Sz-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95172066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tapping 1.7 X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95125902|EAP|Custom 95125902||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Allomatrix Injectable 5cc|1|HUMANA [1294]||HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95172067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Back Solid Hemispherical Tritanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95125906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella 35mm Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 95172068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Revision 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|FSC: 13; Default||Not reimbursed separately|1,124.31|FSC: 13; Default||External grouping not supported 95125907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Humeral Small 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,462.46|FSC: 13; Default||Not reimbursed separately|14,462.46|FSC: 13; Default||External grouping not supported 95172027|EAP|Custom 95172027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant X-core 17-24mm|1|HUMANA [1294]||HUMANA [11839]|20,985.00|FSC: 13; Default||Not reimbursed separately|20,985.00|FSC: 13; Default||External grouping not supported 95125908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95172071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Helix-r 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|FSC: 13; Default||Not reimbursed separately|3,288.00|FSC: 13; Default||External grouping not supported 95125909|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Whittman|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|FSC: 13; Default||Not reimbursed separately|4,770.00|FSC: 13; Default||External grouping not supported 95125910|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cylinder Penile Pre-com Penoscro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,740.00|FSC: 13; Default||Not reimbursed separately|13,740.00|FSC: 13; Default||External grouping not supported 95172078|EAP|Custom 95172078||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Cable Axsos 4.0mm|1|HUMANA [1294]||HUMANA [11839]|151.20|FSC: 13; Default||Not reimbursed separately|151.20|FSC: 13; Default||External grouping not supported 95125913|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Unmounted Biliary Transhem|1|HUMANA [1294]||HUMANA [11839]|4,681.80|FSC: 13; Default||Not reimbursed separately|4,681.80|FSC: 13; Default||External grouping not supported 95172079|EAP|Custom 95172079||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 8 Degree 37 X 27 X14mm|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95125919|EAP|Custom 95125919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solb9766 Dianeal W/1.5% Dex 2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95125926|EAP|Custom 95125926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spinal 25gax15cm 10/bx ()|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 95172083|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 5mm Diameter |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125935|EAP|Custom 95125935||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Ext Venous 10f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Vectra 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.40|FSC: 13; Default||Not reimbursed separately|3,236.40|FSC: 13; Default||External grouping not supported 95172085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Temp Vectra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.80|FSC: 13; Default||Not reimbursed separately|307.80|FSC: 13; Default||External grouping not supported 95172087|EAP|Custom 95172087||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interbody Peek Cr Convex 5mm|1|HUMANA [1294]||HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 95125972|EAP|Custom 95125972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Paceport W/thromboshield|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Zero-p 3 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95125986|EAP|Custom 95125986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Thoracentesis 8fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172089|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125988|EAP|Custom 95125988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 3fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172090|EAP|Custom 95172090||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Zero-p 6mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95125989|EAP|Custom 95125989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 4fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172091|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95172092|EAP|Custom 95172092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2 X 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95172093|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95125996|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Contour 7frx26cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95172094|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95172095|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Soli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95172096|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Soli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95172097|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Soli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95172098|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126012|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064175|EAP|CPT® 83937||0301 - LABORATORY - CHEMISTRY|Hb Osteocalcin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|89.55|FSC: 13; Default||Not reimbursed separately|89.55|FSC: 13; Default||External grouping not supported 95126035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Universal Uhr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 80163587|EAP|CPT® 46946||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Hemorrhoid Banding/destruction|1|HUMANA [1294]||HUMANA [11839]|6,679.80|FSC: 13; Default||Not reimbursed separately|6,679.80|FSC: 13; Default||External grouping not supported 95126072|EAP|Custom 95126072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Abs Flared 1.1mm Round 20de|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163595|EAP|CPT® 45505||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Proctoplasty/rectopexy|1|HUMANA [1294]||HUMANA [11839]|6,679.80|FSC: 13; Default||Not reimbursed separately|6,679.80|FSC: 13; Default||External grouping not supported 95126077|EAP|Custom 95126077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Abs Flared 1.1mm Kelman 30d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vectra 4 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.40|FSC: 13; Default||Not reimbursed separately|590.40|FSC: 13; Default||External grouping not supported 95126079|EAP|Custom 95126079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 45 3.5 Roticulator Gia E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172099|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Small Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,012.30|FSC: 13; Default||Not reimbursed separately|6,012.30|FSC: 13; Default||External grouping not supported 95172100|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126100|EAP|Custom 95126100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip I/a Bent Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172101|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126101|EAP|Custom 95126101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 4fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172102|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126105|EAP|Custom 95126105||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Lateral Ril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172103|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bander Ureteral Diversion Open Ended 8.2fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.59|FSC: 13; Default||Not reimbursed separately|364.59|FSC: 13; Default||External grouping not supported 95126112|EAP|Custom 95126112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Salem Sump 18 French|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172104|EAP|Custom 95172104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Cutting Shape Match Left|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95126126|EAP|Custom 95126126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 3fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95126135|EAP|Custom 95126135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Curved Ils Detachable Hs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti 5.5mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95126156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock Acetabular 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95172107|EAP|Custom 95172107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Traxis Peek Optima |1|HUMANA [1294]||HUMANA [11839]|14,283.30|FSC: 13; Default||Not reimbursed separately|14,283.30|FSC: 13; Default||External grouping not supported 95126157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock Acetabular 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|FSC: 13; Default||Not reimbursed separately|3,726.00|FSC: 13; Default||External grouping not supported 95172106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Triathlon #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95126158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Shell Osteolock Np 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|FSC: 13; Default||Not reimbursed separately|3,726.00|FSC: 13; Default||External grouping not supported 95172111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6mm X 35mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95126159|EAP|Custom 95126159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Resector Trivex 4.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Lo 32mm +0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95126163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 12 Hole14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|FSC: 13; Default||Not reimbursed separately|1,728.84|FSC: 13; Default||External grouping not supported 95172116|EAP|Custom 95172116||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cushion Wheelchair Pre-inflated 350lb 17x17|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126165|EAP|Custom 95126165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retainer Viscera Sterile Disp.me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172117|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 6 X 120 X 150 .018 Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172118|EAP|Custom 95172118||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Passport Button 8mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Pca Ace/deep-socket 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.45|FSC: 13; Default||Not reimbursed separately|3,105.45|FSC: 13; Default||External grouping not supported 95172125|EAP|Custom 95172125||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tigertape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 5 Hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172126|EAP|Custom 95172126||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Generator Infant Flow Lp Without Prongs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126199|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95172127|EAP|Custom 95172127||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Flow Up Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126200|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95172129|EAP|Custom 95172129||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Flow Lu Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 10 Hole14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|FSC: 13; Default||Not reimbursed separately|1,641.69|FSC: 13; Default||External grouping not supported 95172128|EAP|Custom 95172128||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Flow Lp Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126213|EAP|Custom 95126213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Nose|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172131|EAP|Custom 95172131||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Flow Lp X-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95172132|EAP|Custom 95172132||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Flow Lp X-small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126233|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii 7 Fr X 4 Mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172139|EAP|Custom 95172139||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Crescent 30mm X 2mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95126293|EAP|Custom 95126293||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sheath Bml-3q Lithotriptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163603|EAP|CPT® 77372||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Linear Acc Stereo Radsur Complete Course One Session|1|HUMANA [1294]||HUMANA [11839]|22,632.06|FSC: 13; Default||Not reimbursed separately|22,632.06|FSC: 13; Default||External grouping not supported 95126294|EAP|Custom 95126294||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Basket Lithotriptor Therapeutic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126313|EAP|Custom 95126313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Support Chin Female|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163629|EAP|CPT® 77372||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Image-guided Robotic Linear Acc Comp Course One Sessn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,632.06|FSC: 13; Default||Not reimbursed separately|22,632.06|FSC: 13; Default||External grouping not supported 80163637|EAP|CPT® 77373||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Stereotactic Body Radiation Therapy Treatment 1 To 5 Fractions|1|HUMANA [1294]||HUMANA [11839]|5,039.22|FSC: 13; Default||Not reimbursed separately|5,039.22|FSC: 13; Default||External grouping not supported 95126346|EAP|Custom 95126346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Canicular Mono|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172143|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 3 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126347|EAP|Custom 95126347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 2fr 60cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126348|EAP|Custom 95126348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 6fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172144|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 4 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126349|EAP|Custom 95126349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 5fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172145|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 4 X 200 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126363|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Saftey Wire Guide 12f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172146|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 5 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126377|EAP|Custom 95126377||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Malar Med-right|1|HUMANA [1294]||HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95172147|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powercross 5 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126378|EAP|Custom 95126378||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Malar Med-left|1|HUMANA [1294]||HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95172151|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Navitus 120cm 7fr System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126380|EAP|Custom 95126380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Snare Loop Hinged|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Rod 3 Hoffman|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 95126386|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Resume Lt C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.00|FSC: 13; Default||Not reimbursed separately|5,415.00|FSC: 13; Default||External grouping not supported 95172196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Hoffman 3 350mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.75|FSC: 13; Default||Not reimbursed separately|1,068.75|FSC: 13; Default||External grouping not supported 95126388|EAP|Custom 95126388||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Female Size7|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Hoffman 3 450mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,224.00|FSC: 13; Default||Not reimbursed separately|1,224.00|FSC: 13; Default||External grouping not supported 95126389|EAP|Custom 95126389||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Female Size8|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172226|EAP|Custom 95172226||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Knee Xxl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126390|EAP|Custom 95126390||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Female Size9|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172229|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 5mm Diameter X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126391|EAP|Custom 95126391||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Female Size0|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95126392|EAP|Custom 95126392||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Male Size 10|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172236|EAP|Custom 95172236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Closure Wound Absorbable Vloc Undyed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126393|EAP|Custom 95126393||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Male Size 11|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Anterior Corail 2 Noncollar |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95126394|EAP|Custom 95126394||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Male Size 12|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95172241|EAP|Custom 95172241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Gastroscopy Tube 20 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172251|EAP|Custom 95172251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 16fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.4mmx10mm F/(l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.50|FSC: 13; Default||Not reimbursed separately|256.50|FSC: 13; Default||External grouping not supported 95172252|EAP|Custom 95172252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 18fr |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Size-c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.00|FSC: 13; Default||Not reimbursed separately|1,545.00|FSC: 13; Default||External grouping not supported 95188575|EAP|Custom 95188575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 12mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126419|EAP|Custom 95126419||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Variable|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95172253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Component Hip Unipolar Zimmer (includes All Comp |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95126420|EAP|Custom 95126420||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Slot|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95172254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Component Hip Bipolar Zimmer (includes All Compo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,756.00|FSC: 13; Default||Not reimbursed separately|9,756.00|FSC: 13; Default||External grouping not supported 95126424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x30 Multi-axial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|FSC: 13; Default||Not reimbursed separately|2,796.00|FSC: 13; Default||External grouping not supported 95119657|EAP|Custom 95119657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Guidewire 1.2mm X 30cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Locking Lt 5-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 62064183|EAP|CPT® 81328||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Statin Sensitivity - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|524.43|FSC: 13; Default||Not reimbursed separately|524.43|FSC: 13; Default||External grouping not supported 95126441|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164868|EAP|Custom 95164868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Blade Morcellator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126442|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Fully-ringed Thin-wall 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,675.00|FSC: 13; Default||Not reimbursed separately|3,675.00|FSC: 13; Default||External grouping not supported 95126446|EAP|Custom 95126446||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sled Galaxy Pull Back|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064191|EAP|CPT® 81401||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Apolipoprotein E - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95126447|EAP|Custom 95126447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Open Adjustable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7 X 40mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95126448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade 3 Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 62064209|EAP|CPT® 82172||0301 - LABORATORY - CHEMISTRY|Hb Apolipoprotein A-1 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.27|FSC: 13; Default||Not reimbursed separately|63.27|FSC: 13; Default||External grouping not supported 95126449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfn 400mm Rt 11mm/130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95192238|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95126450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ulnar Small 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,290.00|FSC: 13; Default||Not reimbursed separately|10,290.00|FSC: 13; Default||External grouping not supported 62064217|EAP|CPT® 82725||0301 - LABORATORY - CHEMISTRY|Hb Fatty Acids, Free - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|56.31|FSC: 13; Default||Not reimbursed separately|56.31|FSC: 13; Default||External grouping not supported 95126451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Rci 7mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95126457|EAP|Custom 95126457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 3mm Short Bladeless|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064225|EAP|CPT® 83520||0302 - LABORATORY - IMMUNOLOGY|Hb Adiponectin - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 95126460|EAP|Custom 95126460||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Apical Osteolock|1|HUMANA [1294]||HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 95188577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia Ss 8 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 62064233|EAP|CPT® 83735||0301 - LABORATORY - CHEMISTRY|Hb Magnesium, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.10|FSC: 13; Default||Not reimbursed separately|20.10|FSC: 13; Default||External grouping not supported 95126464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95192239|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95126465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.38|FSC: 13; Default||Not reimbursed separately|454.38|FSC: 13; Default||External grouping not supported 62064241|EAP|CPT® 84105||0301 - LABORATORY - CHEMISTRY|Hb Phosphorus, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|17.34|FSC: 13; Default||Not reimbursed separately|17.34|FSC: 13; Default||External grouping not supported 95126466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95188579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suture Genesys Press Ft 2.6 With 2 #1 Sutures|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.18|FSC: 13; Default||Not reimbursed separately|1,215.18|FSC: 13; Default||External grouping not supported 95126467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Outer 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95126468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 74mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,258.02|FSC: 13; Default||Not reimbursed separately|1,258.02|FSC: 13; Default||External grouping not supported 62064258|EAP|CPT® 84392||0301 - LABORATORY - CHEMISTRY|Hb Sulfate, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|16.47|FSC: 13; Default||Not reimbursed separately|16.47|FSC: 13; Default||External grouping not supported 95126469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 10mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95126470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 62064266|EAP|CPT® 82131||0301 - LABORATORY - CHEMISTRY|Hb Cysteine Quant, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|68.94|FSC: 13; Default||Not reimbursed separately|68.94|FSC: 13; Default||External grouping not supported 95126471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95126473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95126474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 24mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95126475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95126476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 28mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95126477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95126478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 32mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95126479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 34mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95172285|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3d Max Light Large Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.02|FSC: 13; Default||Not reimbursed separately|619.02|FSC: 13; Default||External grouping not supported 95126480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 36mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|FSC: 13; Default||Not reimbursed separately|396.45|FSC: 13; Default||External grouping not supported 95172286|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3d Max Light Large Lt |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.02|FSC: 13; Default||Not reimbursed separately|619.02|FSC: 13; Default||External grouping not supported 95126481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95172287|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3d Max Light X-large Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95126482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 40mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95172288|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3d Max Light Large Lt |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95126483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 45mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95172293|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Endoprosthesis Lt Trunk Excluder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|FSC: 13; Default||Not reimbursed separately|30,735.00|FSC: 13; Default||External grouping not supported 95126484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 50mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95172294|EAP|Custom 95172294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Uronet Semi Rigid 3.0cm X 1.25cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126497|EAP|Custom 95126497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill .7mm X 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172295|EAP|Custom 95172295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Uronet Flexible 2.5cm X 1cm Netsize 4.8fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Convergent Orion 52.5mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|FSC: 13; Default||Not reimbursed separately|6,165.18|FSC: 13; Default||External grouping not supported 95172298|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter A Josephson 5fr 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Med 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95172299|EAP|Custom 95172299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable 12 Hyp 10 Redel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126513|EAP|Custom 95126513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guard Splash|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 44mm Long Thread Stainless |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95126515|EAP|Custom 95126515||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating . 9.5x25.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172306|EAP|Custom 95172306||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interbody Peek Cr Convex 7mm|1|HUMANA [1294]||HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 95172307|EAP|Custom 95172307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill With 14mm Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126538|EAP|HCPCS A6235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Hydrocolloid 3-1/2 X 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 5-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95126555|EAP|Custom 95126555||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Oximeter Adult & Pedi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192240|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95126563|EAP|Custom 95126563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Plastic Ss-1/2x1/2 Cue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Bi-moore Ii Straight S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,569.00|FSC: 13; Default||Not reimbursed separately|1,569.00|FSC: 13; Default||External grouping not supported 95126567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95126570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 3 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|FSC: 13; Default||Not reimbursed separately|1,512.87|FSC: 13; Default||External grouping not supported 95126572|EAP|Custom 95126572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Hawkins I 20ga X 7.5cm10/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126574|EAP|Custom 95126574||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Acromio Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120533|EAP|Custom 95120533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extender Cath Iab 72in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126603|EAP|Custom 95126603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5.0mm Distal Targeting Zm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161560|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer Guidewire Safety 12fr X 50cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 12mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95172310|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bil Expr Ld 7x27mm 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95126622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Tibial A/p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,972.94|FSC: 13; Default||Not reimbursed separately|5,972.94|FSC: 13; Default||External grouping not supported 95172311|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 8mm Balloon X 37mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95126625|EAP|Custom 95126625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip I/a Straight Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Lm/rl Triathlon Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95126626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Grey Screw 5.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95172315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Rm/ll Triathlon Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95126627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 3.8mm Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95172316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press Fit Triathlon Ts 20mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95126628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Size 10 X 115mm Enha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|FSC: 13; Default||Not reimbursed separately|8,811.66|FSC: 13; Default||External grouping not supported 95172317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press Fit Triathlon 24mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95126630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 4.3mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95126631|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiojet Expedior 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95125167|EAP|Custom 95125167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evacuator Bladder-urovac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 3.8mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95172319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95126656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Trilogy 20-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.71|FSC: 13; Default||Not reimbursed separately|1,717.71|FSC: 13; Default||External grouping not supported 95172320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Posterior Medial Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.80|FSC: 13; Default||Not reimbursed separately|2,947.80|FSC: 13; Default||External grouping not supported 95126658|EAP|Custom 95126658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Oval Diamond 4mm .16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172323|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95126675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large-thread 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95172325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Elite 62.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95126676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large-thread 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95126677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large-thread 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95126678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large-thread 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95126679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large-thread 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95185624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.4mm X 22mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95126684|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|FSC: 13; Default||Not reimbursed separately|1,482.00|FSC: 13; Default||External grouping not supported 95188581|EAP|Custom 95188581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Specific Patient Fem/tib Ct Nexgen Persona|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126690|EAP|Custom 95126690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular 6fr Pigtah|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femorak Mck Restoris Sz6 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95126691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95126692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fx 130 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172338|EAP|Custom 95172338||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14mm X 34mm X 24mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95126693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fx 135 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro-toe Size 10 Degrees|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95126694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fx 135 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172349|EAP|Custom 95172349||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Charging Mobile|1|HUMANA [1294]||HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95126695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fx 135 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95126696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fx 135 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172352|EAP|Custom 95172352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Repair Syndesmosis Tight Rope Knotless Titanium|1|HUMANA [1294]||HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95126697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Versa Fx 140 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95172353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Lag-u-blade 10.5 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|FSC: 13; Default||Not reimbursed separately|2,066.40|FSC: 13; Default||External grouping not supported 95126700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Ti Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95172354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Lag-u-blade 10.5 X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,216.00|FSC: 13; Default||Not reimbursed separately|3,216.00|FSC: 13; Default||External grouping not supported 95126703|EAP|Custom 95126703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit T-loop Graft Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172363|EAP|Custom 95172363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Transseptal 89cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126704|EAP|Custom 95126704||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin T-loop Passing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172364|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guiding Long Mult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126705|EAP|Custom 95126705||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Sling Shot Cross 6.5mm X 50m|1|HUMANA [1294]||HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95172367|EAP|Custom 95172367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil 2d Intlok 15mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Premier 62.5rd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,797.28|FSC: 13; Default||Not reimbursed separately|6,797.28|FSC: 13; Default||External grouping not supported 95172369|EAP|Custom 95172369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil 2d Intlok 15mm X 40cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Z 9cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,124.00|FSC: 13; Default||Not reimbursed separately|8,124.00|FSC: 13; Default||External grouping not supported 95172370|EAP|Custom 95172370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil 2d Intlok 18mm X 40cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126712|EAP|Custom 95126712||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Lt 14x20mm|1|HUMANA [1294]||HUMANA [11839]|15,449.70|FSC: 13; Default||Not reimbursed separately|15,449.70|FSC: 13; Default||External grouping not supported 95172374|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6 X 100 X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95126718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Lactoscrew 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95172378|EAP|Custom 95172378||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Lok Arrow 3.5mm X 16mm Straight|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95126719|EAP|Custom 95126719||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 7mm|1|HUMANA [1294]||HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172379|EAP|Custom 95172379||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Fixation Lok Arrow|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95126721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5x65 Self-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172380|EAP|Custom 95172380||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 16 X 34 X 24mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95126722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 40m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Halo 88mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,313.00|FSC: 13; Default||Not reimbursed separately|14,313.00|FSC: 13; Default||External grouping not supported 95126724|EAP|Custom 95126724||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 13mm X 21mm|1|HUMANA [1294]||HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95172382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Halo 5.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95126725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95172383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Halo 5.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95126731|EAP|Custom 95126731||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Clip Fixing|1|HUMANA [1294]||HUMANA [11839]|234.00|FSC: 13; Default||Not reimbursed separately|234.00|FSC: 13; Default||External grouping not supported 95172384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Halo 6.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95126732|EAP|Custom 95126732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franceen 18 Ga X 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Dia-meta Lcp 11 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.71|FSC: 13; Default||Not reimbursed separately|5,782.71|FSC: 13; Default||External grouping not supported 95126733|EAP|Custom 95126733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franceen 20ga X 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172386|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Self Expanding Size 8mm Length 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.00|FSC: 13; Default||Not reimbursed separately|3,330.00|FSC: 13; Default||External grouping not supported 95126738|EAP|Custom 95126738||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Snare Polypectomy Sensation Micr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163645|EAP|HCPCS A9584||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Hb Datscan Ioflupane I 123|1|HUMANA [1294]||HUMANA [11839]|8,139.67|FSC: 13; Default||Not reimbursed separately|8,139.67|FSC: 13; Default||External grouping not supported 95126741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fascia-lata.6x12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95126742|EAP|Custom 95126742||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Gel Wound Dermal Spray 8oz.|1|HUMANA [1294]||HUMANA [11839]|81.10|FSC: 13; Default||Not reimbursed separately|81.10|FSC: 13; Default||External grouping not supported 95172387|EAP|Custom 95172387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon Endoscopic Powered 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95172394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Web Locking 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,338.75|FSC: 13; Default||Not reimbursed separately|1,338.75|FSC: 13; Default||External grouping not supported 95126748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Locking Ti 4.9mm 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|FSC: 13; Default||Not reimbursed separately|570.60|FSC: 13; Default||External grouping not supported 95172395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95126751|EAP|Custom 95126751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Tibial|1|HUMANA [1294]||HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95172396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95126752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident Alumina O-deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95172397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 12mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95126755|EAP|Custom 95126755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Tibial|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95172398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95126765|EAP|Custom 95126765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Core Biopsy 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Small Hs Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|FSC: 13; Default||Not reimbursed separately|1,626.90|FSC: 13; Default||External grouping not supported 95126766|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Sali|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95172400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Small Hs Stright|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|FSC: 13; Default||Not reimbursed separately|1,626.90|FSC: 13; Default||External grouping not supported 95172401|EAP|Custom 95172401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill Tip Passing 2.4mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126802|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95126803|EAP|Custom 95126803||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 26mm X 10mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95185620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Plate Tibial Onlay Mck Restoris Sz 5 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95126820|EAP|Custom 95126820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 16ga X 16 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110351|EAP|Custom 95110351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Acromionize 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126822|EAP|Custom 95126822||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Wescott 20ga X 9cm 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112426|EAP|Custom 95112426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Abrader 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 1.3mmx3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.00|FSC: 13; Default||Not reimbursed separately|183.00|FSC: 13; Default||External grouping not supported 95154456|EAP|Custom 95154456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Block Universal **(call John Brient When Orderin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95172402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5lg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95126827|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Polyflex 16mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,970.00|FSC: 13; Default||Not reimbursed separately|5,970.00|FSC: 13; Default||External grouping not supported 95172403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5lg 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|FSC: 13; Default||Not reimbursed separately|1,662.00|FSC: 13; Default||External grouping not supported 95126830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 1.3mmx6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.50|FSC: 13; Default||Not reimbursed separately|250.50|FSC: 13; Default||External grouping not supported 95172405|EAP|Custom 95172405||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Cannulated Fixos 12mm|1|HUMANA [1294]||HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95126832|EAP|Custom 95126832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 225cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 95126833|EAP|Custom 95126833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 275cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periprosthesis Axsos 5.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95126834|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Polypropylene Prolite 4 X5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|167.85|FSC: 13; Default||Not reimbursed separately|167.85|FSC: 13; Default||External grouping not supported 95172409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm L72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95126835|EAP|Custom 95126835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Schulte Hyer 3.5 X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172410|EAP|Custom 95172410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126836|EAP|Custom 95126836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter (partial Valvulotom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172411|EAP|Custom 95172411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 2.0mm X 125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126841|EAP|Custom 95126841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cautery Aa05|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Proximal Phalanx Hemi Movement Mgt Size 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95126842|EAP|Custom 95126842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Infusion Peripheral .035 Di|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Surface Metatarsal Size 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.19|FSC: 13; Default||Not reimbursed separately|623.19|FSC: 13; Default||External grouping not supported 95126843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Global Fracture 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,820.00|FSC: 13; Default||Not reimbursed separately|8,820.00|FSC: 13; Default||External grouping not supported 95126845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident Alumina 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95172414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 32mm -4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95126849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95172415|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95188583|EAP|Custom 95188583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Saline Rhp 420cc Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95126853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Impact|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95172420|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon 5mm X 120mm X135mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95172421|EAP|Custom 95172421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Loop 10 X 10 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126856|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 95172422|EAP|Custom 95172422||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Ball Disposable 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126862|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172424|EAP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermis Decelluarized Arthroflex 4.0cm X 4.0cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|347.34|FSC: 13; Default||Not reimbursed separately|347.34|FSC: 13; Default||External grouping not supported 95172425|EAP|Custom 95172425||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fix Temp Threaded|1|HUMANA [1294]||HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95126864|EAP|Custom 95126864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Applicator Dual Spray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167826|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Wallflex 10mm X 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,490.00|FSC: 13; Default||Not reimbursed separately|8,490.00|FSC: 13; Default||External grouping not supported 95126865|EAP|Custom 95126865||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Resume|1|HUMANA [1294]||HUMANA [11839]|3,570.00|FSC: 13; Default||Not reimbursed separately|3,570.00|FSC: 13; Default||External grouping not supported 95172426|EAP|Custom 95172426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Platelet Autologous |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126867|EAP|Custom 95126867||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Lateral Rim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Lcp 3.5mm X 232mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,766.18|FSC: 13; Default||Not reimbursed separately|5,766.18|FSC: 13; Default||External grouping not supported 95126870|EAP|Custom 95126870||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Lateral Lee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172435|EAP|Custom 95172435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Single-site Endoscope 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126871|EAP|Custom 95126871||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Lateral Lee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172436|EAP|Custom 95172436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Hook Cautery 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126876|EAP|Custom 95126876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemashield Ro|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95172438|EAP|Custom 95172438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Eus Echotip Procore 25 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. Y 4hole Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|FSC: 13; Default||Not reimbursed separately|651.00|FSC: 13; Default||External grouping not supported 95172439|EAP|Custom 95172439||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contoured Corodent 5mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95126885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95126886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95126887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95172446|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Optimized Polyester 8 X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.13|FSC: 13; Default||Not reimbursed separately|2,906.13|FSC: 13; Default||External grouping not supported 95126888|EAP|Custom 95126888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill .8mm X 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro-toe Size 10 Degrees Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95126889|EAP|Custom 95126889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill .9mm X 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172450|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Breast Style 6300 Height Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95126895|EAP|Custom 95126895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Torp Ear Shea Plasti-pore 7mm Le|1|HUMANA [1294]||HUMANA [11839]|625.86|FSC: 13; Default||Not reimbursed separately|625.86|FSC: 13; Default||External grouping not supported 95172451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95126897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fracture 8-hole 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|687.00|FSC: 13; Default||Not reimbursed separately|687.00|FSC: 13; Default||External grouping not supported 95126898|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretch Straight Gore-tex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95172452|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Introducer Lead Percutaneous Valved 8fr |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.70|FSC: 13; Default||Not reimbursed separately|146.70|FSC: 13; Default||External grouping not supported 95126899|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretch Straight Gore-tex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95172453|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Kit Sheath Agilis Epi 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95126900|EAP|Custom 95126900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Component Connecting L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Constrained 12mm Skyline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95126901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95172455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95126902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95172458|EAP|Custom 95172458||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Interbody Peek Prevail 2 Hole 5x16x12mm|1|HUMANA [1294]||HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95126903|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95172457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95126911|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|FSC: 13; Default||Not reimbursed separately|24,495.00|FSC: 13; Default||External grouping not supported 95126912|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172461|EAP|Custom 95172461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ruler Radiographic For Ti Cannulated Femoral Nails|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126913|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62061734|EAP|CPT® 80061||0301 - LABORATORY - CHEMISTRY|Hb Lipid Panel - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.17|FSC: 13; Default||Not reimbursed separately|40.17|FSC: 13; Default||External grouping not supported 95126914|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172462|EAP|Custom 95172462||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Demineralized Grafton Plf 2.5cm|1|HUMANA [1294]||HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95126915|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172463|EAP|Custom 95172463||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 8 Degree 16 X 32 X 23m|1|HUMANA [1294]||HUMANA [11839]|25,284.00|FSC: 13; Default||Not reimbursed separately|25,284.00|FSC: 13; Default||External grouping not supported 95126916|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Hook Lcp 3.5mm 7 Hole 18mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,858.31|FSC: 13; Default||Not reimbursed separately|2,858.31|FSC: 13; Default||External grouping not supported 95126917|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62061742|EAP|CPT® 83704||0301 - LABORATORY - CHEMISTRY|Hb Lipoprotein Quantitation - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|102.57|FSC: 13; Default||Not reimbursed separately|102.57|FSC: 13; Default||External grouping not supported 95126918|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pelvicol 2x4cm C1762|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,214.64|FSC: 13; Default||Not reimbursed separately|1,214.64|FSC: 13; Default||External grouping not supported 95172465|EAP|Custom 95172465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Monopolar Nitinol 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera Cannulated 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95126922|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62061759|EAP|CPT® 86480||0302 - LABORATORY - IMMUNOLOGY|Hb Tb Gamma Interferon|1|HUMANA [1294]||HUMANA [11839]|185.94|FSC: 13; Default||Not reimbursed separately|185.94|FSC: 13; Default||External grouping not supported 95126923|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172469|EAP|Custom 95172469||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Intervertebral Ib Magnifuse 10mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95126924|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Contour-profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 62061767|EAP|CPT® 87497||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Cmv Quant - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 95126925|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Contour-profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 62061775|EAP|CPT® 86618||0302 - LABORATORY - IMMUNOLOGY|Hb Borrelia Burgdorferi Abs, Csf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.09|FSC: 13; Default||Not reimbursed separately|51.09|FSC: 13; Default||External grouping not supported 95126926|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Contour-profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 62061783|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Norovirus Group 1 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95126927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Proximal Lcp 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,942.47|FSC: 13; Default||Not reimbursed separately|4,942.47|FSC: 13; Default||External grouping not supported 62061791|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Norovirus Group 2 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95126928|EAP|Custom 95126928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 125cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061809|EAP|CPT® 84446||0301 - LABORATORY - CHEMISTRY|Hb Vitamin E - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|42.54|FSC: 13; Default||Not reimbursed separately|42.54|FSC: 13; Default||External grouping not supported 95126945|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|FSC: 13; Default||Not reimbursed separately|21,360.00|FSC: 13; Default||External grouping not supported 62061817|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hb Lambda Qnt, Serum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 95126946|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,310.00|FSC: 13; Default||Not reimbursed separately|11,310.00|FSC: 13; Default||External grouping not supported 62061825|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hb Kappa Qnt, Serum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 95126947|EAP|Custom 95126947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retrieval Trapezoid Rx-wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131430|EAP|Custom 95131430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 18 Ga X 9 Cm 10/box |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126963|EAP|Custom 95126963||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Const Flow Med 0.86-1.45|1|HUMANA [1294]||HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95131431|EAP|Custom 95131431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 20 Ga X 9 Cm 10/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126964|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great-toe Silastic Size4|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95172473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95126985|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172474|EAP|Custom 95172474||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Caliber 10 X 26mm 10-15mm|1|HUMANA [1294]||HUMANA [11839]|17,397.00|FSC: 13; Default||Not reimbursed separately|17,397.00|FSC: 13; Default||External grouping not supported 95126986|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95126987|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|FSC: 13; Default||Not reimbursed separately|1,593.30|FSC: 13; Default||External grouping not supported 95126988|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172477|EAP|Custom 95172477||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 11mm X 9mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95126989|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172478|EAP|Custom 95172478||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 9mm X 9mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95126998|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95172479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95127000|EAP|Custom 95127000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Clear-delivery 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95127001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Duet Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.48|FSC: 13; Default||Not reimbursed separately|630.48|FSC: 13; Default||External grouping not supported 95172484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95127002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Trocanteric Left 11x360|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95172485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95127005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95172488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 13 X 400 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95127009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 10 Hole14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|FSC: 13; Default||Not reimbursed separately|1,641.69|FSC: 13; Default||External grouping not supported 95172489|EAP|Custom 95172489||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Custom Tubing Perfusion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 14 Hole 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|FSC: 13; Default||Not reimbursed separately|2,009.97|FSC: 13; Default||External grouping not supported 95172490|EAP|Custom 95172490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Biopsy Dextera Transjugular Liver Access 19g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 14 Hole 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|FSC: 13; Default||Not reimbursed separately|2,009.97|FSC: 13; Default||External grouping not supported 95172500|EAP|Custom 95172500||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 10mm X 9mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95127012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 43mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95172502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire 2.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 42mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95185625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.4mm X 26mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95127014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 41mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95127015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 40mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95172505|EAP|Custom 95172505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Concept|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 45mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95172503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire 3.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.00|FSC: 13; Default||Not reimbursed separately|489.00|FSC: 13; Default||External grouping not supported 95127017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 52mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95172504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft 4.5 With #2 Hi-fi Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,076.34|FSC: 13; Default||Not reimbursed separately|1,076.34|FSC: 13; Default||External grouping not supported 95127018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 51mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95127019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 49mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95127020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 48mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95127021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 60mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95172509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Revision 62mm Hemispherical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95127022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 57mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95172511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Off-set Armada R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,162.00|FSC: 13; Default||Not reimbursed separately|3,162.00|FSC: 13; Default||External grouping not supported 95127023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 55mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,502.64|FSC: 13; Default||Not reimbursed separately|1,502.64|FSC: 13; Default||External grouping not supported 95172512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Constrained 16mm Skyline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95127024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 53mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95172513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Oversize St 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|FSC: 13; Default||Not reimbursed separately|1,124.31|FSC: 13; Default||External grouping not supported 95127025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95172515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Tm Size 4 Right/lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95127026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95172516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Tm Size 4 Left/lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95127027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95172517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft 5.5 With #2 Hi-fi Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,076.34|FSC: 13; Default||Not reimbursed separately|1,076.34|FSC: 13; Default||External grouping not supported 95127028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Endo Unipolar Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|FSC: 13; Default||Not reimbursed separately|1,033.02|FSC: 13; Default||External grouping not supported 95172518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft 6.5 With #2 Hi-fi Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,076.34|FSC: 13; Default||Not reimbursed separately|1,076.34|FSC: 13; Default||External grouping not supported 95127029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Moore Modular Hip Stem Fens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|FSC: 13; Default||Not reimbursed separately|2,230.80|FSC: 13; Default||External grouping not supported 95172519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95127031|EAP|Custom 95127031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Piranha Ureterosco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 140 Deg 5 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95127033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vision Atlantis 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95172523|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Linear St 50cm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95127034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 42-43mm Odx22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95172524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95127035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 60-62mm Odx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.80|FSC: 13; Default||Not reimbursed separately|955.80|FSC: 13; Default||External grouping not supported 95172525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.4mm X 15mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95127036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 40-41mm Odx22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95172526|EAP|Custom 95172526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 1.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 50/51/52mm Odx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.80|FSC: 13; Default||Not reimbursed separately|955.80|FSC: 13; Default||External grouping not supported 95172527|EAP|Custom 95172527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill Thightrope Closed Eyelet 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 6mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.00|FSC: 13; Default||Not reimbursed separately|1,170.00|FSC: 13; Default||External grouping not supported 95127041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95172531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95127042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,605.00|FSC: 13; Default||Not reimbursed separately|7,605.00|FSC: 13; Default||External grouping not supported 95172533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Constrained 14mm Skyline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95127043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95172537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95127044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 28mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95185632|EAP|Custom 95185632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Natrelle 500cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95188590|EAP|Custom 95188590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.3mm/60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95185631|EAP|Custom 95185631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Natrelle 400cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95127048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95172559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95127049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95127050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95127051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95172303|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Optimized Polyester Round 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,291.01|FSC: 13; Default||Not reimbursed separately|2,291.01|FSC: 13; Default||External grouping not supported 95172304|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Optimized Polyester Round 4.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.35|FSC: 13; Default||Not reimbursed separately|1,750.35|FSC: 13; Default||External grouping not supported 95127055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95172563|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath A Josephson 5fr 110cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 57-58mm Odx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.80|FSC: 13; Default||Not reimbursed separately|955.80|FSC: 13; Default||External grouping not supported 95172565|EAP|Custom 95172565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Pain C-bloc On-q On-demand 400ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172566|EAP|Custom 95172566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Wire Loop Cutting Long 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Speedset Simplex 40gram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.65|FSC: 13; Default||Not reimbursed separately|196.65|FSC: 13; Default||External grouping not supported 95127066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95172573|EAP|Custom 95172573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive 1.1mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127067|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Weil-carver|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95172574|EAP|Custom 95172574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Thermoset Room Temp W/temp Probe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127069|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Lag 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.24|FSC: 13; Default||Not reimbursed separately|450.24|FSC: 13; Default||External grouping not supported 95127071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Lock 4.0x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95172577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Lag 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95127072|EAP|Custom 95127072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 375cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Plate Wedge Open Size 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,917.15|FSC: 13; Default||Not reimbursed separately|4,917.15|FSC: 13; Default||External grouping not supported 95127073|EAP|Custom 95127073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Passing Suture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172579|EAP|Custom 95172579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 4x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95172580|EAP|Custom 95172580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Triflat T2 3.5 X 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127075|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline H-p Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95172581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral T2 8mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95172582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full T2 4mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.00|FSC: 13; Default||Not reimbursed separately|732.00|FSC: 13; Default||External grouping not supported 95127084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95127097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 95192241|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95131425|EAP|Custom 95131425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 20ga X 20cm 10/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172585|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ekosonic Mach4 12cm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172586|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ekosonic Mach4 30cm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95172589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95172590|EAP|Custom 95172590||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannula With Graft Axillary|1|HUMANA [1294]||HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95172591|EAP|Custom 95172591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Cannulated 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172592|EAP|Custom 95172592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127112|EAP|Custom 95127112||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Injectable Invasive Mini|1|HUMANA [1294]||HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95172593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|FSC: 13; Default||Not reimbursed separately|5,031.06|FSC: 13; Default||External grouping not supported 95127121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Volar Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.33|FSC: 13; Default||Not reimbursed separately|2,505.33|FSC: 13; Default||External grouping not supported 95172595|EAP|Custom 95172595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 12mm Skyline|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.57|FSC: 13; Default||Not reimbursed separately|435.57|FSC: 13; Default||External grouping not supported 95172596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95127123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spider Off-set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95172597|EAP|Custom 95172597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Biomedicus 15fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95172598|EAP|Custom 95172598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 60mm Thick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127143|EAP|Custom 95127143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross|1|HUMANA [1294]||HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95172599|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.5 Diopter Crystalens Posterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95127144|EAP|Custom 95127144||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross Size-2|1|HUMANA [1294]||HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95127145|EAP|Custom 95127145||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Crossover Sz-4|1|HUMANA [1294]||HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95172603|EAP|Custom 95172603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127146|EAP|Custom 95127146||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross Sz-5|1|HUMANA [1294]||HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95172604|EAP|Custom 95172604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 17|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127147|EAP|Custom 95127147||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Infuse Medium|1|HUMANA [1294]||HUMANA [11839]|15,900.00|FSC: 13; Default||Not reimbursed separately|15,900.00|FSC: 13; Default||External grouping not supported 95172605|EAP|Custom 95172605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127148|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mammary Gel-filled Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95172606|EAP|Custom 95172606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127149|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mammary Gel-filled Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95172607|EAP|Custom 95172607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172608|EAP|Custom 95172608||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Jones Frosted With Hole 3.5mm X 21|1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95127151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 55mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95172609|EAP|Custom 95172609||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95172610|EAP|Custom 95172610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 23|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172611|EAP|Custom 95172611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.66|FSC: 13; Default||Not reimbursed separately|4,668.66|FSC: 13; Default||External grouping not supported 95172612|EAP|Custom 95172612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,585.38|FSC: 13; Default||Not reimbursed separately|4,585.38|FSC: 13; Default||External grouping not supported 95172613|EAP|Custom 95172613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jones Frosted With Hole 3.5mm X 26|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,612.02|FSC: 13; Default||Not reimbursed separately|4,612.02|FSC: 13; Default||External grouping not supported 95172614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Titanium U-blade Lag Set 10.5.90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|FSC: 13; Default||Not reimbursed separately|2,066.40|FSC: 13; Default||External grouping not supported 95127157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.66|FSC: 13; Default||Not reimbursed separately|4,668.66|FSC: 13; Default||External grouping not supported 95127158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,994.40|FSC: 13; Default||Not reimbursed separately|4,994.40|FSC: 13; Default||External grouping not supported 95127159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,994.40|FSC: 13; Default||Not reimbursed separately|4,994.40|FSC: 13; Default||External grouping not supported 95127160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 206mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,086.41|FSC: 13; Default||Not reimbursed separately|5,086.41|FSC: 13; Default||External grouping not supported 95172583|EAP|Custom 95172583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulae Mircsp 13fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 206mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,086.41|FSC: 13; Default||Not reimbursed separately|5,086.41|FSC: 13; Default||External grouping not supported 95172618|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 9mm X 90cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95127162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 242mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,277.63|FSC: 13; Default||Not reimbursed separately|5,277.63|FSC: 13; Default||External grouping not supported 95172620|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 9mm Diameter X 27mm Length X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95127163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 278mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,383.83|FSC: 13; Default||Not reimbursed separately|5,383.83|FSC: 13; Default||External grouping not supported 95172623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X3 Triathlon Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95127164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 314mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,676.51|FSC: 13; Default||Not reimbursed separately|5,676.51|FSC: 13; Default||External grouping not supported 95172624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triathlon Sz 1 5mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95127165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 314mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,676.51|FSC: 13; Default||Not reimbursed separately|5,676.51|FSC: 13; Default||External grouping not supported 95172625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triathlon Sz 1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95127166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 350mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,659.98|FSC: 13; Default||Not reimbursed separately|5,659.98|FSC: 13; Default||External grouping not supported 95172627|EAP|Custom 95172627||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Suspension Frontalis|1|HUMANA [1294]||HUMANA [11839]|123.98|FSC: 13; Default||Not reimbursed separately|123.98|FSC: 13; Default||External grouping not supported 95127167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Solution 13.5 10 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,525.00|FSC: 13; Default||Not reimbursed separately|15,525.00|FSC: 13; Default||External grouping not supported 95127170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95127177|EAP|Custom 95127177||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vertigraft Bone Tissue Human 7.7|1|HUMANA [1294]||HUMANA [11839]|3,361.83|FSC: 13; Default||Not reimbursed separately|3,361.83|FSC: 13; Default||External grouping not supported 95172637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Humeral Xsmall 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95127178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 24mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95172638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3-d Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,766.00|FSC: 13; Default||Not reimbursed separately|2,766.00|FSC: 13; Default||External grouping not supported 95127180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 34mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95172639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Xxl 2.5mm 5 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95127185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 11mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95172640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long Right 13 X 380 X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95127186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95172641|EAP|Custom 95172641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 10.0 Mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Corticle Ti Sterile 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95172642|EAP|Custom 95172642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tightrope Pcl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Corticle Ti Sterile4.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95172644|EAP|Custom 95172644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Shoulder Arthroscopy Abduction |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Corticle Ti Sterile4.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95110851|EAP|Custom 95110851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Reservoir 10mm Flat Drain Without Trocar Full|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 36mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95114647|EAP|Custom 95114647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femostop Compression Arch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127206|EAP|Custom 95127206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Rutner Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172649|EAP|Custom 95172649||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 9mm X 11mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95127208|EAP|Custom 95127208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 6.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95127209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pca Acetabular Low-pro 49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,460.70|FSC: 13; Default||Not reimbursed separately|1,460.70|FSC: 13; Default||External grouping not supported 95127210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Hood 32x58 61mm 10degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.00|FSC: 13; Default||Not reimbursed separately|1,545.00|FSC: 13; Default||External grouping not supported 95172652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 16 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|949.14|FSC: 13; Default||Not reimbursed separately|949.14|FSC: 13; Default||External grouping not supported 95127214|EAP|Custom 95127214||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Endotrach Pedi 2-lumen 3 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2 Hole With Tab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.15|FSC: 13; Default||Not reimbursed separately|399.15|FSC: 13; Default||External grouping not supported 95127215|EAP|Custom 95127215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Collar Dyna-ring Dynamization|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.30|FSC: 13; Default||Not reimbursed separately|489.30|FSC: 13; Default||External grouping not supported 95127216|EAP|Custom 95127216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Gia Universal Endo 45-4.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Box Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.40|FSC: 13; Default||Not reimbursed separately|590.40|FSC: 13; Default||External grouping not supported 95127217|EAP|Custom 95127217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valvulatome Expandable Lemaitre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Box Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.75|FSC: 13; Default||Not reimbursed separately|909.75|FSC: 13; Default||External grouping not supported 95172657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 4 Hole With Bar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.14|FSC: 13; Default||Not reimbursed separately|409.14|FSC: 13; Default||External grouping not supported 95127220|EAP|Custom 95127220||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman Sterile 5/64x9|1|HUMANA [1294]||HUMANA [11839]|54.00|FSC: 13; Default||Not reimbursed separately|54.00|FSC: 13; Default||External grouping not supported 95172658|EAP|Custom 95172658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Burr Hole 7mm With Tab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vsp A 1.5 Slot Stainless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,709.00|FSC: 13; Default||Not reimbursed separately|2,709.00|FSC: 13; Default||External grouping not supported 95172659|EAP|Custom 95172659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Burr Hole 10mm With Tab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Standard 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95172660|EAP|Custom 95172660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Burr Hole 14mm With Tab |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Forte Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|FSC: 13; Default||Not reimbursed separately|1,454.46|FSC: 13; Default||External grouping not supported 95172661|EAP|Custom 95172661||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Burr Hole 20mm With Tab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Forte Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|FSC: 13; Default||Not reimbursed separately|1,454.46|FSC: 13; Default||External grouping not supported 95172662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Double-y 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.83|FSC: 13; Default||Not reimbursed separately|817.83|FSC: 13; Default||External grouping not supported 95127230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Gap 6 Hole Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.36|FSC: 13; Default||Not reimbursed separately|1,023.36|FSC: 13; Default||External grouping not supported 95127231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 22m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Gap 6 Hole Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,024.92|FSC: 13; Default||Not reimbursed separately|1,024.92|FSC: 13; Default||External grouping not supported 95127232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate X 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|854.19|FSC: 13; Default||Not reimbursed separately|854.19|FSC: 13; Default||External grouping not supported 95127233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 26m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|535.62|FSC: 13; Default||Not reimbursed separately|535.62|FSC: 13; Default||External grouping not supported 95127234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 28m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172667|EAP|Custom 95172667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 1.2 X 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 30m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 1.7 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|229.74|FSC: 13; Default||Not reimbursed separately|229.74|FSC: 13; Default||External grouping not supported 95127236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 38m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172669|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Micro 60 X 60 X .1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,566.81|FSC: 13; Default||Not reimbursed separately|1,566.81|FSC: 13; Default||External grouping not supported 95127237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172670|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Micro 60 X 60 X .2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,483.74|FSC: 13; Default||Not reimbursed separately|1,483.74|FSC: 13; Default||External grouping not supported 95127238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 34m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172671|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dynamic 1.7mm 90 X 90 X .3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,749.00|FSC: 13; Default||Not reimbursed separately|4,749.00|FSC: 13; Default||External grouping not supported 95127239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 38m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172672|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dynamic 1.7mm X 90 X .3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,677.75|FSC: 13; Default||Not reimbursed separately|4,677.75|FSC: 13; Default||External grouping not supported 95127240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Forte 4.0mm 40m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 95172673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Retangle |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|881.97|FSC: 13; Default||Not reimbursed separately|881.97|FSC: 13; Default||External grouping not supported 95127247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95172674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Temporal Malleable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,345.49|FSC: 13; Default||Not reimbursed separately|2,345.49|FSC: 13; Default||External grouping not supported 95127248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Large Thread 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|FSC: 13; Default||Not reimbursed separately|959.16|FSC: 13; Default||External grouping not supported 95172675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Translabrnth Malleable Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,345.49|FSC: 13; Default||Not reimbursed separately|2,345.49|FSC: 13; Default||External grouping not supported 95127249|EAP|Custom 95127249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Umbilical Dual-lumen 6.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Subocciptal Malleable Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,485.35|FSC: 13; Default||Not reimbursed separately|2,485.35|FSC: 13; Default||External grouping not supported 95127250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Absorb Cannulated 4.5x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.78|FSC: 13; Default||Not reimbursed separately|513.78|FSC: 13; Default||External grouping not supported 95172678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shunt 14mm With Tab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.75|FSC: 13; Default||Not reimbursed separately|813.75|FSC: 13; Default||External grouping not supported 95127256|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shunt 20mm With Tab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.01|FSC: 13; Default||Not reimbursed separately|905.01|FSC: 13; Default||External grouping not supported 95127258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma 125-deg 11x400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|FSC: 13; Default||Not reimbursed separately|3,510.00|FSC: 13; Default||External grouping not supported 95172680|EAP|Custom 95172680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Burr Hole 24mm Wtih Tab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127259|EAP|Custom 95127259||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 11mm Lumbar|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95172681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Biocomposite 4mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95127260|EAP|Custom 95127260||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 11mm X 11mm X 21m|1|HUMANA [1294]||HUMANA [11839]|8,550.00|FSC: 13; Default||Not reimbursed separately|8,550.00|FSC: 13; Default||External grouping not supported 95172682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Pin 1.5 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 95127262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 32mm Med Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95172683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Cross Pin Self Drilling 1.5x5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|212.76|FSC: 13; Default||Not reimbursed separately|212.76|FSC: 13; Default||External grouping not supported 95127263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm Standard Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95185618|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127268|EAP|Custom 95127268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Neurotube Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127270|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammer-toe Carver-weil M|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95127278|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127279|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammer-toe Carver-weil S|1|HUMANA [1294]||HUMANA [11839]|681.00|FSC: 13; Default||Not reimbursed separately|681.00|FSC: 13; Default||External grouping not supported 95188585|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Specify Mri Surescan 2x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95127287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95185619|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127288|EAP|Custom 95127288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Fibered Platinum Complex/he|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Emergency 1.7mm 5mm W/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.50|FSC: 13; Default||Not reimbursed separately|157.50|FSC: 13; Default||External grouping not supported 95127294|EAP|Custom 95127294||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Endoureterotomy 7frx26|1|HUMANA [1294]||HUMANA [11839]|378.72|FSC: 13; Default||Not reimbursed separately|378.72|FSC: 13; Default||External grouping not supported 95127295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95127299|EAP|Custom 95127299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization .038 Dx8x15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127300|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Stabilizer Plus Steerable 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Shell Osteolock 52mm Np|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95172688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Substitute Cement Bone Ha Injectable Hydroset 10c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,630.10|FSC: 13; Default||Not reimbursed separately|8,630.10|FSC: 13; Default||External grouping not supported 95127305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock Np 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95172689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full 5.0mm X 57.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95127306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Osteolock Acetabular Outer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,442.50|FSC: 13; Default||Not reimbursed separately|3,442.50|FSC: 13; Default||External grouping not supported 95172690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Right 3s 10 X 420mm X 120 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,006.88|FSC: 13; Default||Not reimbursed separately|5,006.88|FSC: 13; Default||External grouping not supported 95127310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 135mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95172691|EAP|Custom 95172691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Polar-care Glacier (w/temp Control)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 140mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95172692|EAP|Custom 95172692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.4mm Sterile Guide Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127312|EAP|Custom 95127312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Packing Epistaxis 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Compression 8 Hole/151mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|505.44|FSC: 13; Default||Not reimbursed separately|505.44|FSC: 13; Default||External grouping not supported 95127313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx38mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172694|EAP|Custom 95172694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cup Cervical Vcare X-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Short Ha Tmzf Citation #6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 34mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 38mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 4.5x66mm Sel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 4.5x68mm Sel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 35mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full T2 4mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95127342|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172697|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 9mm X 20mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172701|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Ans 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95127344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx30mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172714|EAP|Custom 95172714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gel Clear Backstop 3fr Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172715|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute .035 6.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95127346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172716|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Metal Biliary 10mm 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95127347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx36mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172717|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Metal Biliary 10mm 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,123.17|FSC: 13; Default||Not reimbursed separately|4,123.17|FSC: 13; Default||External grouping not supported 95127348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172718|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Metal Biliary 8mm 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.00|FSC: 13; Default||Not reimbursed separately|3,330.00|FSC: 13; Default||External grouping not supported 95127349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx40mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172719|EAP|Custom 95172719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Infation Biliary Quantum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx45mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172720|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilation Biliary Fusion Titan 4x4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172723|EAP|Custom 95172723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilation Biliary Fusion 8.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm Lg-hex 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.38|FSC: 13; Default||Not reimbursed separately|55.38|FSC: 13; Default||External grouping not supported 95172724|EAP|Custom 95172724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology Fusion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127355|EAP|Custom 95127355||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Cortical (for Use 4.5mm Scre|1|HUMANA [1294]||HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95127356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 28mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172726|EAP|Custom 95172726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Extraction Quattro Fusion |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172721|EAP|HCPCS C1726||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Dilation Biliary Fusion Titan 6x4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95127358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 32mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172722|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilation Biliary Fusion Titan 8x4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 34mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Duet With Hi Fi Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.59|FSC: 13; Default||Not reimbursed separately|661.59|FSC: 13; Default||External grouping not supported 95127360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 36mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95127361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 38mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 40mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95127363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 42mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172729|EAP|Custom 95172729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulae Venous Femoral One-piece Bio-medicus 25fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 44mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 7 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95127365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 46mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R2.0 Titanium Left Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95127366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 50mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172732|EAP|Custom 95172732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Closure Wound Absorbable Vloc O Gs-21 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 52mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95127368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 54mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Locking Ss 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|FSC: 13; Default||Not reimbursed separately|870.48|FSC: 13; Default||External grouping not supported 95127369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 56mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172749|EAP|Custom 95172749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Central 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 58mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95120910|EAP|Custom 95120910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 22 Ga X 9cm 10/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 60mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172755|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Armada 14 Pta 2.0mm X 40mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 64mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172756|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Armada 14 Pta 2.0mm X 80mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 70mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172757|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Armada 14 Pta 2.5mm X 60mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 48mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172758|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Armada 14 Pta 2.5mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.75|FSC: 13; Default||Not reimbursed separately|51.75|FSC: 13; Default||External grouping not supported 95172759|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Armada 14 Pta 2.5mm X 200mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Short Ha Tmzf Citation #5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 145mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95172761|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.0 Ao Diopter Crystalens Posterior Chamber 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95127380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172762|EAP|Custom 95172762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Wound 15fr Round With Trocar Hemaduct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172764|EAP|Custom 95172764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Laryngectomy Provox Std 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 20mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95112488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.07|FSC: 13; Default||Not reimbursed separately|50.07|FSC: 13; Default||External grouping not supported 95127383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 22mm Pard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95185617|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 24mm Pard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95188584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graftbolt Tibial 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95127385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 26mm Pard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95185612|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 28mm Pard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95192242|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95127387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 30mm Pard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95131342|EAP|Custom 95131342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 20 X 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 50mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95127389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172727|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Extraction Quattro Fusion Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172770|EAP|Custom 95172770||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conformer Small Sterile Wo Holes|1|HUMANA [1294]||HUMANA [11839]|162.00|FSC: 13; Default||Not reimbursed separately|162.00|FSC: 13; Default||External grouping not supported 95127398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172771|EAP|Custom 95172771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conformer Medium Sterile Wo Holes|1|HUMANA [1294]||HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95127399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Helix Knotless Br 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95127400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdn 48mm/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 95127401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Restoration For Adm/mdn Cup 28/54/mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95127402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 75mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172782|EAP|HCPCS L8603||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Macroplastique Syringe 2.5ml|1|HUMANA [1294]||HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95127403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172783|EAP|Custom 95172783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Endoscopic Uroplasty Macroplastique 20ga Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ulnar Small 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,290.00|FSC: 13; Default||Not reimbursed separately|10,290.00|FSC: 13; Default||External grouping not supported 95127405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95127406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 22mm X 155mm Conical Distal Plasma Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95127407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +20 25mm Modular Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95127408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|FSC: 13; Default||Not reimbursed separately|1,059.00|FSC: 13; Default||External grouping not supported 95127409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95127410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ncb 5.0mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95127411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ncb 5.0mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95127412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95127413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172807|EAP|Custom 95172807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Posterior 12 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95127415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95127416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95127417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95110347|EAP|Custom 95110347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Suction Floor-puddle-vac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 150mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95112197|EAP|Custom 95112197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Blakemore Adult 20fr Esophageal Naso .39in Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95146449|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0mm X 28mm Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95127420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95127421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Restrosigmoid Malleable Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,472.54|FSC: 13; Default||Not reimbursed separately|2,472.54|FSC: 13; Default||External grouping not supported 95127422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aviator 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.90|FSC: 13; Default||Not reimbursed separately|6,867.90|FSC: 13; Default||External grouping not supported 95127423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Fixed Aviator 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|FSC: 13; Default||Not reimbursed separately|1,679.52|FSC: 13; Default||External grouping not supported 95127424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Fixed Aviator 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|FSC: 13; Default||Not reimbursed separately|1,679.52|FSC: 13; Default||External grouping not supported 95127425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rescue Fixed Aviator 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.75|FSC: 13; Default||Not reimbursed separately|1,761.75|FSC: 13; Default||External grouping not supported 95127426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172798|EAP|Custom 95172798||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Ave 4 Degree 6 X 12 X 14mm|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95127427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95172811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95127428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95127429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Tx Axsos 14 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,645.00|FSC: 13; Default||Not reimbursed separately|6,645.00|FSC: 13; Default||External grouping not supported 95127430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 6 Hole Bridge Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 95127431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Short Ha Tmzf Citation #7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Short Ha Tmzf Citation #8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 35mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 82.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 95127434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 40mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172818|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 10mm X 14mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|FSC: 13; Default||Not reimbursed separately|8,893.50|FSC: 13; Default||External grouping not supported 95127435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 45mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172819|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 4.0mm X 3cm|1|HUMANA [1294]||HUMANA [11839]|6,549.00|FSC: 13; Default||Not reimbursed separately|6,549.00|FSC: 13; Default||External grouping not supported 95127436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Ascension 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 55mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172821|EAP|Custom 95172821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Relief Cannulated Th Ascension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172822|EAP|Custom 95172822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Smooth Ascension|1|HUMANA [1294]||HUMANA [11839]|89.79|FSC: 13; Default||Not reimbursed separately|89.79|FSC: 13; Default||External grouping not supported 95127439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 65mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172823|EAP|Custom 95172823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Cervicel Probes 50mm Nitinol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 70mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172824|EAP|Custom 95172824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 100mm 20g 5mm Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172825|EAP|Custom 95172825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 50mm 22g 5mm Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172835|EAP|Custom 95172835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Truncated 56mm Hemi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172840|EAP|Custom 95172840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Full 56mm Hemi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 22mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172842|EAP|Custom 95172842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Full 58mm Hemi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 24mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172846|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 9mm X 56cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95127446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95127447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95172853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Triathlon #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95127449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172855|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Fibula Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,683.00|FSC: 13; Default||Not reimbursed separately|1,683.00|FSC: 13; Default||External grouping not supported 95127450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Biocomposite 3mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95127451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 75mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95127452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Lateral Proximal Tx 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95127453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Sm Hex Full-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95127454|EAP|Custom 95127454||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Ortho|1|HUMANA [1294]||HUMANA [11839]|94.95|FSC: 13; Default||Not reimbursed separately|94.95|FSC: 13; Default||External grouping not supported 95172860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95127455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 2 Hole 25mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95172861|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 12 X 11 X 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95127456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 3 Hole 37mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.03|FSC: 13; Default||Not reimbursed separately|174.03|FSC: 13; Default||External grouping not supported 95172862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis 10mm X 180mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 95127457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 4 Hole 49mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|FSC: 13; Default||Not reimbursed separately|185.91|FSC: 13; Default||External grouping not supported 95172863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Cemented Revision Platform Rotating Mbt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 95127458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 5 Hole 61mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|FSC: 13; Default||Not reimbursed separately|185.91|FSC: 13; Default||External grouping not supported 95172864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tc3 Sigma Pfc Size 3 Left |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 95127459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 6 Hole 73mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.83|FSC: 13; Default||Not reimbursed separately|193.83|FSC: 13; Default||External grouping not supported 95172865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Sigma Pfc 4mm Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 95127460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 7 Hole 85mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.83|FSC: 13; Default||Not reimbursed separately|193.83|FSC: 13; Default||External grouping not supported 95172866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Sigma Pfc Size 3-4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 95127461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 8 Hole 97mm Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|FSC: 13; Default||Not reimbursed separately|207.66|FSC: 13; Default||External grouping not supported 95172867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Rp Tc3 Size 3-15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 95127462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|158.22|FSC: 13; Default||Not reimbursed separately|158.22|FSC: 13; Default||External grouping not supported 95172868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95172869|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Breast Style 6300 Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95127464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.03|FSC: 13; Default||Not reimbursed separately|174.03|FSC: 13; Default||External grouping not supported 95172870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|FSC: 13; Default||Not reimbursed separately|185.91|FSC: 13; Default||External grouping not supported 95172871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.87|FSC: 13; Default||Not reimbursed separately|189.87|FSC: 13; Default||External grouping not supported 95172872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95172873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95172874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Straight 17mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.18|FSC: 13; Default||Not reimbursed separately|162.18|FSC: 13; Default||External grouping not supported 95172875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Straight 23mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.99|FSC: 13; Default||Not reimbursed separately|177.99|FSC: 13; Default||External grouping not supported 95172876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 20mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Straight 29mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|FSC: 13; Default||Not reimbursed separately|185.91|FSC: 13; Default||External grouping not supported 95172877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.0mm X 22mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 61mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.21|FSC: 13; Default||Not reimbursed separately|336.21|FSC: 13; Default||External grouping not supported 95172878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 73mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.88|FSC: 13; Default||Not reimbursed separately|365.88|FSC: 13; Default||External grouping not supported 95172879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 85mm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.75|FSC: 13; Default||Not reimbursed separately|375.75|FSC: 13; Default||External grouping not supported 95172881|EAP|Custom 95172881||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Blue Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 97mm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.65|FSC: 13; Default||Not reimbursed separately|385.65|FSC: 13; Default||External grouping not supported 95172882|EAP|Custom 95172882||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Blue Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 109mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.42|FSC: 13; Default||Not reimbursed separately|405.42|FSC: 13; Default||External grouping not supported 95172883|EAP|Custom 95172883||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Blue Lg |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Ect Small 5hole 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95172884|EAP|Custom 95172884||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Blue Xlg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127481|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172885|EAP|Custom 95172885||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Heel Cup Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lipped Ps Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95172886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 10 Hole 121mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|FSC: 13; Default||Not reimbursed separately|207.66|FSC: 13; Default||External grouping not supported 95172887|EAP|Custom 95172887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insole Orthotic Vasyli Heel Cup Large|1|HUMANA [1294]||HUMANA [11839]|78.18|FSC: 13; Default||Not reimbursed separately|78.18|FSC: 13; Default||External grouping not supported 95127486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Straight 35mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|FSC: 13; Default||Not reimbursed separately|207.66|FSC: 13; Default||External grouping not supported 95172888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Shaft 4.5mm Lg-hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95172890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 30mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 62061833|EAP|CPT® 87149||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Histo Id By Dna Probe - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 95127492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 6mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 62061841|EAP|CPT® 87046||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb E. Coli 0157|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.32|FSC: 13; Default||Not reimbursed separately|28.32|FSC: 13; Default||External grouping not supported 95127493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7x7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 62061858|EAP|CPT® 81291||0301 - LABORATORY - CHEMISTRY|Hb Mthfr Gene|1|HUMANA [1294]||HUMANA [11839]|196.02|FSC: 13; Default||Not reimbursed separately|196.02|FSC: 13; Default||External grouping not supported 95127494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 8mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95128523|EAP|Custom 95128523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Truncated 58mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7x9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172892|EAP|Custom 95172892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Nitinol Monpolar 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 10mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172893|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 8.0x80x135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Speedlock Peek 3.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95127498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modular Evolve Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95127499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7x24mm Sm-hex S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 46mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 32mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Digital 2.0mm X 50mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95127506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 34mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|FSC: 13; Default||Not reimbursed separately|882.24|FSC: 13; Default||External grouping not supported 95127507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 36mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|FSC: 13; Default||Not reimbursed separately|882.24|FSC: 13; Default||External grouping not supported 95127508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 38mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.0mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|FSC: 13; Default||Not reimbursed separately|882.24|FSC: 13; Default||External grouping not supported 95127509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 40mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.0mm X 12mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|FSC: 13; Default||Not reimbursed separately|882.24|FSC: 13; Default||External grouping not supported 95127510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 50mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95172909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.0mm X 14mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|FSC: 13; Default||Not reimbursed separately|882.24|FSC: 13; Default||External grouping not supported 95172910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.0mm X 16mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.75|FSC: 13; Default||Not reimbursed separately|732.75|FSC: 13; Default||External grouping not supported 95127512|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiojet Xvg140 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172911|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 6.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95127518|EAP|Custom 95127518||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 9mm X 21mm|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95172912|EAP|Custom 95172912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Complete System Control Fluid Aquilex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127519|EAP|Custom 95127519||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 11mm X 21mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95172913|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Tibia Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|FSC: 13; Default||Not reimbursed separately|19,200.00|FSC: 13; Default||External grouping not supported 95127520|EAP|Custom 95127520||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 11mm X 11mm X 25m|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95172914|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Launcher Guide 6fr Amplatz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127521|EAP|Custom 95127521||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 11mm X 13mm X 25m|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95131438|EAP|Custom 95131438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 22 X 20 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.32|FSC: 13; Default||Not reimbursed separately|976.32|FSC: 13; Default||External grouping not supported 95127523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.7mm X 14mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.32|FSC: 13; Default||Not reimbursed separately|976.32|FSC: 13; Default||External grouping not supported 95127524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|752.70|FSC: 13; Default||Not reimbursed separately|752.70|FSC: 13; Default||External grouping not supported 95127525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|752.70|FSC: 13; Default||Not reimbursed separately|752.70|FSC: 13; Default||External grouping not supported 95127526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.7mm X 20mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.32|FSC: 13; Default||Not reimbursed separately|976.32|FSC: 13; Default||External grouping not supported 95127527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quick Snap 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|752.70|FSC: 13; Default||Not reimbursed separately|752.70|FSC: 13; Default||External grouping not supported 95127528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95127529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95127530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95172925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127531|EAP|Custom 95127531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Ta45 3.5 Reloadable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 12mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127532|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Polypropylene Clear 3 X5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|FSC: 13; Default||Not reimbursed separately|126.00|FSC: 13; Default||External grouping not supported 95172927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95127534|EAP|Custom 95127534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Reloadable Single-use Ta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95127538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Volar 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95172929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 18mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127539|EAP|Custom 95127539||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sling Traction Lateral Disp.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abd Ii Cementless V40 Left No 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-deg 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95172931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abd Ii Cementless V40 Right No 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127542|EAP|Custom 95127542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Surgipro 8-0 Mv-135-5 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127543|EAP|Custom 95127543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Surgipro 8-0 Length-18 M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Psl Trident 48m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95172934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95172935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 48mm Knee Uni M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95172936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95172937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|FSC: 13; Default||Not reimbursed separately|494.49|FSC: 13; Default||External grouping not supported 95127559|EAP|Custom 95127559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip 11g Mammomark|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 10mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127560|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127561|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127562|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Hs11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 18mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127563|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guiding 7 French X 45cm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 2.3mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95127565|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Sheath Renal Pinnacle 7fe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95127570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Proximal 3.5 6-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,843.43|FSC: 13; Default||Not reimbursed separately|5,843.43|FSC: 13; Default||External grouping not supported 95172946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-poly Lps Ps Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|FSC: 13; Default||Not reimbursed separately|3,073.20|FSC: 13; Default||External grouping not supported 95127571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95172949|EAP|Custom 95172949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trial 9mm No.3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95172950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127573|EAP|Custom 95127573||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior 100ml Inhibi-zone 700|1|HUMANA [1294]||HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95172951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abg Ii Cementless V40 Right No 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127575|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express 2.5x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|FSC: 13; Default||Not reimbursed separately|3,015.00|FSC: 13; Default||External grouping not supported 95172952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|FSC: 13; Default||Not reimbursed separately|776.37|FSC: 13; Default||External grouping not supported 95127675|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Ar2.0w/sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95172962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95172963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127580|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Sheath Renal Pinnacle 7fe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95172965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 5.0mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95127586|EAP|Custom 95127586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Truncated Full 52m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127587|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express 2.5x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95172968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127588|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express 2.5x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|FSC: 13; Default||Not reimbursed separately|3,015.00|FSC: 13; Default||External grouping not supported 95172969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95172971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|653.25|FSC: 13; Default||Not reimbursed separately|653.25|FSC: 13; Default||External grouping not supported 95127593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|653.25|FSC: 13; Default||Not reimbursed separately|653.25|FSC: 13; Default||External grouping not supported 95127594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx16mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx22mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 3.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|FSC: 13; Default||Not reimbursed separately|846.96|FSC: 13; Default||External grouping not supported 95127596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx24mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx26mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx18mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95172977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 16mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127600|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95172978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 18mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 121mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|FSC: 13; Default||Not reimbursed separately|415.32|FSC: 13; Default||External grouping not supported 95172979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95172980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 2.8mm Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|FSC: 13; Default||Not reimbursed separately|708.00|FSC: 13; Default||External grouping not supported 95172981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 3.8mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|FSC: 13; Default||Not reimbursed separately|708.00|FSC: 13; Default||External grouping not supported 95172982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127608|EAP|Custom 95127608||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Infuse Small|1|HUMANA [1294]||HUMANA [11839]|11,415.00|FSC: 13; Default||Not reimbursed separately|11,415.00|FSC: 13; Default||External grouping not supported 95172983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127614|EAP|Custom 95127614||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Narrow 9.5mm|1|HUMANA [1294]||HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 95172984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95172985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127616|EAP|Custom 95127616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 8cm 2.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 34mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127617|EAP|Custom 95127617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 14cm 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127618|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Left Ventricular Implantabl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,151.00|FSC: 13; Default||Not reimbursed separately|5,151.00|FSC: 13; Default||External grouping not supported 95172989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95127619|EAP|Custom 95127619||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Bone Plif 7mm|1|HUMANA [1294]||HUMANA [11839]|6,225.00|FSC: 13; Default||Not reimbursed separately|6,225.00|FSC: 13; Default||External grouping not supported 95172990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|927.00|FSC: 13; Default||Not reimbursed separately|927.00|FSC: 13; Default||External grouping not supported 95127620|EAP|HCPCS Q4106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermagraft 5cmx7.5cm Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|85.14|FSC: 13; Default||Not reimbursed separately|85.14|FSC: 13; Default||External grouping not supported 95172991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95172992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127634|EAP|Custom 95127634||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 9mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95172993|EAP|Custom 95172993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Td Torque Line 7f 4 Lumen 110cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95172994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95172995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii Asnis Ti 6.5mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95127640|EAP|Custom 95127640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95172996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5lg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95172997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 13 X 380 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95172998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5 Titanium Rt 11 X 360mm X 125 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95172999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Ps Xlpe Legion Size 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 95173001|EAP|Custom 95173001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blower-mister Acrobat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127652|EAP|HCPCS A6550||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dressing Med Foam 18 X 12.4 X 3.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173002|EAP|Custom 95173002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulae Venous R Stage Dual Terumo 28/38fr 1/2 Flar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127660|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express 2.5 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|FSC: 13; Default||Not reimbursed separately|3,015.00|FSC: 13; Default||External grouping not supported 95173003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular 32mm Size-g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95127669|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Hockey Stick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Y-knot Blue #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.89|FSC: 13; Default||Not reimbursed separately|1,168.89|FSC: 13; Default||External grouping not supported 95127670|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Hockey Stick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 11 X 360 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95127671|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 3mj Superstiff .032|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127674|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127681|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127682|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 940-intra- Aor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95173011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tube Compression 12 Hole14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|FSC: 13; Default||Not reimbursed separately|1,728.84|FSC: 13; Default||External grouping not supported 95173012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95173013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.4mm12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95173014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 34mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127707|EAP|Custom 95127707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ankle Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95173016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Non-constrain Poly-dial 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|FSC: 13; Default||Not reimbursed separately|1,830.00|FSC: 13; Default||External grouping not supported 95173017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127717|EAP|Custom 95127717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Site Seer 5fr Mpa-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127718|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|FSC: 13; Default||Not reimbursed separately|602.79|FSC: 13; Default||External grouping not supported 95127721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Lock 4.0x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.24|FSC: 13; Default||Not reimbursed separately|513.24|FSC: 13; Default||External grouping not supported 95173021|EAP|Custom 95173021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Overdrill 2.0/2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173022|EAP|Custom 95173022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Overdrill 3.0/4.0 Tc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.96|FSC: 13; Default||Not reimbursed separately|408.96|FSC: 13; Default||External grouping not supported 95173023|EAP|Custom 95173023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Smooth 2.0/2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lok 5.0mm X 34mm Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|743.49|FSC: 13; Default||Not reimbursed separately|743.49|FSC: 13; Default||External grouping not supported 95173024|EAP|Custom 95173024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Smooth 3.0/4.0 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127733|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great-toe Mp-joint Porou|1|HUMANA [1294]||HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95173025|EAP|Custom 95173025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Threaded 3.0/4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 50mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95173026|EAP|Custom 95173026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Smooth Double Pointed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 3.3mm Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95173027|EAP|HCPCS Q4122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Dermis Decellularized Adv Dermacel Soft 4x12cm|1|HUMANA [1294]||HUMANA [11839]|91.80|FSC: 13; Default||Not reimbursed separately|91.80|FSC: 13; Default||External grouping not supported 95127741|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Stabilizer Steerable 180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173037|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Dura-onlay 3cm X 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.95|FSC: 13; Default||Not reimbursed separately|2,026.95|FSC: 13; Default||External grouping not supported 95127751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Mg Knee Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95173038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Knee Total Triathilon 15mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95173040|EAP|Custom 95173040||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Extra Large Cordent 12 X 18 X 50|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95127753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abd Ii Cementless V40 Rt No 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95173042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|FSC: 13; Default||Not reimbursed separately|5,031.06|FSC: 13; Default||External grouping not supported 95127755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Cluster Trilogy W/hole 52m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,915.52|FSC: 13; Default||Not reimbursed separately|5,915.52|FSC: 13; Default||External grouping not supported 95173043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Contrained 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 95127757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,837.56|FSC: 13; Default||Not reimbursed separately|4,837.56|FSC: 13; Default||External grouping not supported 95127758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 38mm For I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|743.49|FSC: 13; Default||Not reimbursed separately|743.49|FSC: 13; Default||External grouping not supported 95173045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95127759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95173046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95127760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95127763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articul Tibial 16mm Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95127770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Single Post 35mm No C-co|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95173048|EAP|Custom 95173048||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Red Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti. 5.0x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|743.49|FSC: 13; Default||Not reimbursed separately|743.49|FSC: 13; Default||External grouping not supported 95173049|EAP|Custom 95173049||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insert Orthotics Vasyli Custom Easyfit X-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 40mm For I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|743.49|FSC: 13; Default||Not reimbursed separately|743.49|FSC: 13; Default||External grouping not supported 95173050|EAP|Custom 95173050||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cranial Custom X-large With Backup Implant |1|HUMANA [1294]||HUMANA [11839]|48,818.40|FSC: 13; Default||Not reimbursed separately|48,818.40|FSC: 13; Default||External grouping not supported 95127773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95173062|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Bioarc-to|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95127775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 80163678|EAP|CPT® 32561||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Instillation Via Chest Tube Initial Day|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95127777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 46mm For I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|743.49|FSC: 13; Default||Not reimbursed separately|743.49|FSC: 13; Default||External grouping not supported 80163686|EAP|CPT® 32562||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Instillation Via Chest Tube Subsequent Day|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95127792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Recon 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,772.58|FSC: 13; Default||Not reimbursed separately|1,772.58|FSC: 13; Default||External grouping not supported 95185613|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 111mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,106.97|FSC: 13; Default||Not reimbursed separately|1,106.97|FSC: 13; Default||External grouping not supported 95127794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.5x6mm Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.26|FSC: 13; Default||Not reimbursed separately|1,261.26|FSC: 13; Default||External grouping not supported 95188586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Phlange Basepl-2 Holes Head-5 Holes Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,520.04|FSC: 13; Default||Not reimbursed separately|1,520.04|FSC: 13; Default||External grouping not supported 95127795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.5x8mm Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.26|FSC: 13; Default||Not reimbursed separately|1,261.26|FSC: 13; Default||External grouping not supported 95185614|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.9x8mm Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.26|FSC: 13; Default||Not reimbursed separately|1,261.26|FSC: 13; Default||External grouping not supported 95127797|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatationh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185615|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95127798|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,612.02|FSC: 13; Default||Not reimbursed separately|4,612.02|FSC: 13; Default||External grouping not supported 95173072|EAP|Custom 95173072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Closed Suction Mult Kimvent 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127800|EAP|Custom 95127800||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Size 5 8 Inch Length Sila|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95127801|EAP|Custom 95127801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Size 10 8 Inch Length Sil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173073|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 5.0mm X 40mm|1|HUMANA [1294]||HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95127802|EAP|Custom 95127802||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Screw Vertex|1|HUMANA [1294]||HUMANA [11839]|1,512.00|FSC: 13; Default||Not reimbursed separately|1,512.00|FSC: 13; Default||External grouping not supported 95173074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95127804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95173075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 16mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95127809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Taper V40 Alumina|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95173076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 24mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95127811|EAP|Custom 95127811||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Crosslink|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95173077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95127817|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Circle Ventralex Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.70|FSC: 13; Default||Not reimbursed separately|1,181.70|FSC: 13; Default||External grouping not supported 95173078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Oleranon 2.7mm/3.5mm 2 Hole Rt/90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,365.79|FSC: 13; Default||Not reimbursed separately|3,365.79|FSC: 13; Default||External grouping not supported 95127824|EAP|Custom 95127824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare 9-15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abd Ii Cementless V40 Left No 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95127826|EAP|Custom 95127826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Thermal Electro Ii Tac-c V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3.0 Degree 40mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95127831|EAP|Custom 95127831||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannula Arterial 22fr. Perfusion|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95173081|EAP|Custom 95173081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Twist In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127832|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Port-a-cath System Arte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.06|FSC: 13; Default||Not reimbursed separately|837.06|FSC: 13; Default||External grouping not supported 95173082|EAP|Custom 95173082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Washer For 3.75 Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127837|EAP|Custom 95127837||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Lumbar Peritoneal|1|HUMANA [1294]||HUMANA [11839]|1,727.40|FSC: 13; Default||Not reimbursed separately|1,727.40|FSC: 13; Default||External grouping not supported 95173083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Partially Threaded 3.75mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95127838|EAP|Custom 95127838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Broviac/hickman Repair Cath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110240|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ureteral Spiral Tip 4fr Dis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abg Ii Cementless V40 Left No 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95127840|EAP|Custom 95127840||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Anastomotic Microvascular|1|HUMANA [1294]||HUMANA [11839]|282.50|FSC: 13; Default||Not reimbursed separately|282.50|FSC: 13; Default||External grouping not supported 95110242|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Urethral Whistle Tip 5fr Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127841|EAP|Custom 95127841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Retro-femoral Drill 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|902.76|FSC: 13; Default||Not reimbursed separately|902.76|FSC: 13; Default||External grouping not supported 95127843|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95110243|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ureteral Spiral Tip 5fr Dis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95127846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws Primary 12mmx4.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|FSC: 13; Default||Not reimbursed separately|354.00|FSC: 13; Default||External grouping not supported 95171509|EAP|Custom 95171509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silicone 3-way 30cc 24 Fr Foley|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127847|EAP|Custom 95127847||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pyramesh 25mmx15mmx10mm|1|HUMANA [1294]||HUMANA [11839]|14,112.00|FSC: 13; Default||Not reimbursed separately|14,112.00|FSC: 13; Default||External grouping not supported 95173087|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Dura-onlay 4 X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,508.11|FSC: 13; Default||Not reimbursed separately|3,508.11|FSC: 13; Default||External grouping not supported 95127849|EAP|Custom 95127849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Pilot-tip Drill Distal 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173093|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95127850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx28mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95188587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95127851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 4.3mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|FSC: 13; Default||Not reimbursed separately|708.00|FSC: 13; Default||External grouping not supported 95173095|EAP|Custom 95173095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Unballoon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127852|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Hernia Gold Surgigi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,010.00|FSC: 13; Default||Not reimbursed separately|2,010.00|FSC: 13; Default||External grouping not supported 95173096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95127855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx34mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95173098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95127856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95173094|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Distal With Proform Graft Endovascular Taa6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,731.00|FSC: 13; Default||Not reimbursed separately|19,731.00|FSC: 13; Default||External grouping not supported 95173099|EAP|Custom 95173099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pencil Electrosurgical Evacuation Smoke Plume Pen (s)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95127860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4-hole Rt Radius Dorsal Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95173104|EAP|Custom 95173104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Vena Cure Never Touch 25cm .108|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx32mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95173105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95173108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95127864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Dorsal 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95173109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95173110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 7x23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95173111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127867|EAP|Custom 95127867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guiderod Ball-tip T2 3.0x1000mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95173113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95185616|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127871|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Penile Titan Scrotal 16cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,885.00|FSC: 13; Default||Not reimbursed separately|12,885.00|FSC: 13; Default||External grouping not supported 95173116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 27mm Knee Uni M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|143.82|FSC: 13; Default||Not reimbursed separately|143.82|FSC: 13; Default||External grouping not supported 95192243|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95127881|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Ebu40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185621|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95127885|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Internal Mammary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3 Mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Radial Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95173126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 24mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95173114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tridant 10-deg 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95173117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal Medial 12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.55|FSC: 13; Default||Not reimbursed separately|1,364.55|FSC: 13; Default||External grouping not supported 95173118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3 Mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127890|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Woven-double Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|FSC: 13; Default||Not reimbursed separately|1,694.28|FSC: 13; Default||External grouping not supported 95127901|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Great Por Coated Lg.|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95127909|EAP|Custom 95127909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Laparoscopic Hernia (custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial M/g 18.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95127914|EAP|Custom 95127914||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Assembly Valve Strata 120c|1|HUMANA [1294]||HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95173102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127915|EAP|Custom 95127915||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt T-tube Carotid 4x6mm|1|HUMANA [1294]||HUMANA [11839]|690.00|FSC: 13; Default||Not reimbursed separately|690.00|FSC: 13; Default||External grouping not supported 95173103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127917|EAP|Custom 95127917||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman Point Trocar 2/32|1|HUMANA [1294]||HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95173106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95127918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Lg Str S-rom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,894.72|FSC: 13; Default||Not reimbursed separately|18,894.72|FSC: 13; Default||External grouping not supported 95173107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95127919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 163mm 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.98|FSC: 13; Default||Not reimbursed separately|1,309.98|FSC: 13; Default||External grouping not supported 95173119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem #1 Accolade-plus Tmzf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95173120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 130-deg 4-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95173121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95173123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95173124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95173125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127936|EAP|Custom 95127936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrx 5x22mm(disp)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127937|EAP|Custom 95127937||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Chamber Graft Lifenet 10cc|1|HUMANA [1294]||HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95173128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95173129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127948|EAP|Custom 95127948||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Chamber Graft Lifenet 15cc|1|HUMANA [1294]||HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95173130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127949|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.3mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127950|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95127951|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95127952|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127953|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127954|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127955|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95127956|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95173133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95173138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95127959|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Circle Ventralex Me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,411.50|FSC: 13; Default||Not reimbursed separately|1,411.50|FSC: 13; Default||External grouping not supported 95173139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded T7 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127969|EAP|Custom 95127969||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade 85mm|1|HUMANA [1294]||HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95173140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded T7 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127971|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 2cmx2cm|1|HUMANA [1294]||HUMANA [11839]|3,159.45|FSC: 13; Default||Not reimbursed separately|3,159.45|FSC: 13; Default||External grouping not supported 95173141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded T7 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95127982|EAP|HCPCS Q4102||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Oasis 7cmx10cm Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|13.53|FSC: 13; Default||Not reimbursed separately|13.53|FSC: 13; Default||External grouping not supported 95188588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95127989|EAP|Custom 95127989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Contour Se Microsheres Pva Parti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127990|EAP|Custom 95127990||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Rt Rim Orbital Inferior|1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95173145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Centerpiece 2.6mm X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.76|FSC: 13; Default||Not reimbursed separately|305.76|FSC: 13; Default||External grouping not supported 95127997|EAP|Custom 95127997||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blanket Warming Lower Body|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173146|EAP|Custom 95173146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Centerpiece|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127998|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Great Mp-joint Non-p|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95128002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95173148|EAP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Micro Matristim 100mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.56|FSC: 13; Default||Not reimbursed separately|10.56|FSC: 13; Default||External grouping not supported 95173149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded T7 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95128006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Versys Crc 13/15 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|FSC: 13; Default||Not reimbursed separately|1,317.90|FSC: 13; Default||External grouping not supported 95173150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded T7 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95128021|EAP|Custom 95128021||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheeting Silicone Pharmelast 20|1|HUMANA [1294]||HUMANA [11839]|291.33|FSC: 13; Default||Not reimbursed separately|291.33|FSC: 13; Default||External grouping not supported 95173151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded T7 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95128024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 56x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95173142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95173143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Graft Centerpiece 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,949.22|FSC: 13; Default||Not reimbursed separately|1,949.22|FSC: 13; Default||External grouping not supported 95128042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 8mmx23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95173144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Centerpiece 2.6mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.76|FSC: 13; Default||Not reimbursed separately|305.76|FSC: 13; Default||External grouping not supported 95128043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 9x23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95173147|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Psm Matristem 5cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95128046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid W/keel 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.00|FSC: 13; Default||Not reimbursed separately|3,561.00|FSC: 13; Default||External grouping not supported 95128048|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Round Smooth Mod Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95128050|EAP|Custom 95128050||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Incus Necrosis 63|1|HUMANA [1294]||HUMANA [11839]|519.00|FSC: 13; Default||Not reimbursed separately|519.00|FSC: 13; Default||External grouping not supported 95128053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid W/keel 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95128056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid W/keel 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95128058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid W/keel 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95110113|EAP|Custom 95110113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Collection Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128059|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173157|EAP|Custom 95173157||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath/tip Bullet Tunneler Vascular Small Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173158|EAP|Custom 95173158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath/tip Bullet Tunneler Vascular Av Large Orange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128061|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173159|EAP|Custom 95173159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath/tip Bullet Tunneler Vascular A/v Full Curve Le|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid W/keel 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|FSC: 13; Default||Not reimbursed separately|4,589.46|FSC: 13; Default||External grouping not supported 95173161|EAP|Custom 95173161||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accessory Kit|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95128063|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173162|EAP|Custom 95173162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Ultrasound Hydromark|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128064|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173163|EAP|Custom 95173163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Indifferent Patch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128065|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173164|EAP|Custom 95173164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ep Extension Red 150cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128066|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173169|EAP|Custom 95173169||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Chin Anatomical Extended Conform Size Medium|1|HUMANA [1294]||HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95128067|EAP|Custom 95128067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular 5 French X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173170|EAP|Custom 95173170||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glove Mandibular Size Medium|1|HUMANA [1294]||HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95128068|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128069|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 90cm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173172|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6 X 120 X 120 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95128070|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173173|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6 X 61 X 120 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95128071|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio Compression 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95128072|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio Compression 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95128073|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio Compression 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95128074|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio Compression 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95128075|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95128076|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Left 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95128077|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173182|EAP|Custom 95173182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Suture Pusher Knot With Slotted Cannula Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128078|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173183|EAP|Custom 95173183||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Needle Curved 360 Degree Fast Fix|1|HUMANA [1294]||HUMANA [11839]|1,466.52|FSC: 13; Default||Not reimbursed separately|1,466.52|FSC: 13; Default||External grouping not supported 95128079|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio Compression 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95128080|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128081|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128082|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Bypass Right 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173185|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 7mm Diameter X 40mm Lengtm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128083|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173186|EAP|Custom 95173186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fusion Joint Sacroiliac Simmetry (contains - )|1|HUMANA [1294]||HUMANA [11839]|47,985.00|FSC: 13; Default||Not reimbursed separately|47,985.00|FSC: 13; Default||External grouping not supported 95128084|EAP|Custom 95128084||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Source Light Metrx (disp)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95173188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95173189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128091|EAP|Custom 95128091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.02|FSC: 13; Default||Not reimbursed separately|1,402.02|FSC: 13; Default||External grouping not supported 95173191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid 46mm Pegged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95173192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid 40mm Pegged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,971.66|FSC: 13; Default||Not reimbursed separately|4,971.66|FSC: 13; Default||External grouping not supported 95173193|EAP|Custom 95173193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickload Device Corknot (6-pouch Load)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid 52mm Pegged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95173194|EAP|Custom 95173194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Corknot Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128106|EAP|Custom 95128106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Ace Guide 2mmx9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173195|EAP|Custom 95173195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickload Device Corknot (individual Load)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128118|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Centering G3 3.5x52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128122|EAP|Custom 95128122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dynagraft 10cc|1|HUMANA [1294]||HUMANA [11839]|3,675.00|FSC: 13; Default||Not reimbursed separately|3,675.00|FSC: 13; Default||External grouping not supported 95173197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 58mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95173198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95128125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Component-pegged 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,971.66|FSC: 13; Default||Not reimbursed separately|4,971.66|FSC: 13; Default||External grouping not supported 95128129|EAP|Custom 95128129||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation Id-60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid 56mm Pegged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95128131|EAP|Custom 95128131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Grommet Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95173216|EAP|Custom 95173216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Plus Incisor Truclear 2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173217|EAP|Custom 95173217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Morcellator Reciprocating Hysterscopic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173218|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore-tex Ringed 8mm X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,454.00|FSC: 13; Default||Not reimbursed separately|2,454.00|FSC: 13; Default||External grouping not supported 95128155|EAP|Custom 95128155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gastronomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Crosslinked Longevity Acet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,916.45|FSC: 13; Default||Not reimbursed separately|5,916.45|FSC: 13; Default||External grouping not supported 95128164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 7x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|FSC: 13; Default||Not reimbursed separately|809.55|FSC: 13; Default||External grouping not supported 95128165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 8x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|FSC: 13; Default||Not reimbursed separately|809.55|FSC: 13; Default||External grouping not supported 95128166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128169|EAP|Custom 95128169||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hooks Open 6.5mm|1|HUMANA [1294]||HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 95128170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95128182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95128183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95128184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95128185|EAP|Custom 95128185||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Infuse X-large Bone Graft Bm|1|HUMANA [1294]||HUMANA [11839]|17,205.00|FSC: 13; Default||Not reimbursed separately|17,205.00|FSC: 13; Default||External grouping not supported 95128186|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Ebu35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 10mm X 38cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95128192|EAP|Custom 95128192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Spiral 3fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 66x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95128207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 68x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95128213|EAP|Custom 95128213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Am-17 Midas-rex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 70x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95128224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-deg 66x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128225|EAP|Custom 95128225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm Mini-qc 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|FSC: 13; Default||Not reimbursed separately|456.00|FSC: 13; Default||External grouping not supported 95128229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-deg 68x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-deg 70x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 66x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95128234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 66x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95128235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 66x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95128236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 48x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 62x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 64x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 66x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 68x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 20-deg 70x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Trilogy 10-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.71|FSC: 13; Default||Not reimbursed separately|1,717.71|FSC: 13; Default||External grouping not supported 95128248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-50x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-56x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 95128251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 95128254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-58x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-60x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-62x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-64x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-66x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-68x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 36mm-70x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128263|EAP|Custom 95128263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 14cm 7.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95128265|EAP|Custom 95128265||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Tailor Sjm 25m|1|HUMANA [1294]||HUMANA [11839]|6,798.00|FSC: 13; Default||Not reimbursed separately|6,798.00|FSC: 13; Default||External grouping not supported 95128266|EAP|Custom 95128266||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Tailor Sjm 27m|1|HUMANA [1294]||HUMANA [11839]|7,353.00|FSC: 13; Default||Not reimbursed separately|7,353.00|FSC: 13; Default||External grouping not supported 95128267|EAP|Custom 95128267||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Tailor Sjm 29m|1|HUMANA [1294]||HUMANA [11839]|7,353.00|FSC: 13; Default||Not reimbursed separately|7,353.00|FSC: 13; Default||External grouping not supported 95128268|EAP|Custom 95128268||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Tailor Sjm 31m|1|HUMANA [1294]||HUMANA [11839]|7,353.00|FSC: 13; Default||Not reimbursed separately|7,353.00|FSC: 13; Default||External grouping not supported 95128269|EAP|Custom 95128269||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Tailor Sjm 33m|1|HUMANA [1294]||HUMANA [11839]|7,002.00|FSC: 13; Default||Not reimbursed separately|7,002.00|FSC: 13; Default||External grouping not supported 95128270|EAP|Custom 95128270||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Tailor Sjm 35m|1|HUMANA [1294]||HUMANA [11839]|7,353.00|FSC: 13; Default||Not reimbursed separately|7,353.00|FSC: 13; Default||External grouping not supported 95128276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|FSC: 13; Default||Not reimbursed separately|4,192.50|FSC: 13; Default||External grouping not supported 95128291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128294|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95128298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lactosorb Suspension 2.0x5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.00|FSC: 13; Default||Not reimbursed separately|132.00|FSC: 13; Default||External grouping not supported 95128309|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95128311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 36mm 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95128314|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline H-p Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95128317|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Gel Profile High Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95128318|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Gel Profile High Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95128319|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth Round Hp G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95128320|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Hp 375|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95128321|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Hp 350|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95128327|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ercp Howell 5.5fr W/.0e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128328|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95128330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 9.0mm X 20mm In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95128358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped 10-deg I.d. 40mm 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|FSC: 13; Default||Not reimbursed separately|3,111.60|FSC: 13; Default||External grouping not supported 95128360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.50|FSC: 13; Default||Not reimbursed separately|2,593.50|FSC: 13; Default||External grouping not supported 95128362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95165726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 35mm Pt 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.27|FSC: 13; Default||Not reimbursed separately|639.27|FSC: 13; Default||External grouping not supported 95128365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95173219|EAP|Custom 95173219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95173220|EAP|Custom 95173220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterilization Box Lightweight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|FSC: 13; Default||Not reimbursed separately|2,892.87|FSC: 13; Default||External grouping not supported 95173227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 35mm Pt 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.27|FSC: 13; Default||Not reimbursed separately|639.27|FSC: 13; Default||External grouping not supported 95128371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|FSC: 13; Default||Not reimbursed separately|2,892.87|FSC: 13; Default||External grouping not supported 95173222|EAP|Custom 95173222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probes Spinal 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|FSC: 13; Default||Not reimbursed separately|2,892.87|FSC: 13; Default||External grouping not supported 95173228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp 1st Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,578.00|FSC: 13; Default||Not reimbursed separately|4,578.00|FSC: 13; Default||External grouping not supported 95128375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|FSC: 13; Default||Not reimbursed separately|2,892.87|FSC: 13; Default||External grouping not supported 95173229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95128383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 44mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.60|FSC: 13; Default||Not reimbursed separately|48.60|FSC: 13; Default||External grouping not supported 95173230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|FSC: 13; Default||Not reimbursed separately|364.80|FSC: 13; Default||External grouping not supported 95128384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|FSC: 13; Default||Not reimbursed separately|2,892.87|FSC: 13; Default||External grouping not supported 95173231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95128385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173232|EAP|Custom 95173232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173233|EAP|Custom 95173233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .9mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 7.0mmx35mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|FSC: 13; Default||Not reimbursed separately|684.00|FSC: 13; Default||External grouping not supported 95173235|EAP|Custom 95173235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173236|EAP|Custom 95173236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128392|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Mueller P8.3-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Claw Ii 20mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.00|FSC: 13; Default||Not reimbursed separately|4,899.00|FSC: 13; Default||External grouping not supported 95128399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95173242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,756.00|FSC: 13; Default||Not reimbursed separately|9,756.00|FSC: 13; Default||External grouping not supported 95173243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95173244|EAP|Custom 95173244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Claw Ii 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Stabilizing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.49|FSC: 13; Default||Not reimbursed separately|50.49|FSC: 13; Default||External grouping not supported 95173245|EAP|Custom 95173245||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tack Plate Claw Ii|1|HUMANA [1294]||HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95128435|EAP|Custom 95128435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 9cm 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior 6 Hole Bridge Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 95128436|EAP|Custom 95128436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 14cm 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Proximal Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,896.75|FSC: 13; Default||Not reimbursed separately|1,896.75|FSC: 13; Default||External grouping not supported 95128437|EAP|Custom 95128437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Loop 28fr Black (12/pa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 4.5 Br |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95128439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Shoulder 44x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95173249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 4.5 Br 3 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95128449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 5.5 Br |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95173251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 5.5 Br 3 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95128460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 5.5 Br With Needles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95128470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 6.5 Br |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95128496|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Z-med 24mmx4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 6.5 Br 3 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95173256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix 6.5 Br With Needles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95128518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Marathon 20-deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95173257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm Lcp 6 Hole 18mm Depth 73mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,740.29|FSC: 13; Default||Not reimbursed separately|2,740.29|FSC: 13; Default||External grouping not supported 95128519|EAP|Custom 95128519||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Enophthalmos Right Regular|1|HUMANA [1294]||HUMANA [11839]|1,914.00|FSC: 13; Default||Not reimbursed separately|1,914.00|FSC: 13; Default||External grouping not supported 95173258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Revision 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,039.50|FSC: 13; Default||Not reimbursed separately|1,039.50|FSC: 13; Default||External grouping not supported 95128520|EAP|Custom 95128520||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Fibular 10x6x0|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95173259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Sky 2 Level 32mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|FSC: 13; Default||Not reimbursed separately|4,622.22|FSC: 13; Default||External grouping not supported 95128521|EAP|Custom 95128521||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Fibular 10x7x0|1|HUMANA [1294]||HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95173260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 11 X 420 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95128522|EAP|Custom 95128522||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Fibular 10x8x0|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95173261|EAP|Custom 95173261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Anchorage 1.2mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128525|EAP|Custom 95128525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Cutting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173262|EAP|Custom 95173262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Anchorage 1.6mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128526|EAP|Custom 95128526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd Shnk 70mm 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Mtp Cp Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95128543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Duraloc 28mm 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95173264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Anchorage 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95128544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95128545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 95173265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95128551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95173267|EAP|Custom 95173267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Calibrated Anchorage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173268|EAP|Custom 95173268||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Semi Tenodesis And Gracilis Double Bundle|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95128567|EAP|Custom 95128567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Backflush Brush 20 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173269|EAP|Custom 95173269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi Orange 6.7mm X 12cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 15mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|FSC: 13; Default||Not reimbursed separately|4,158.00|FSC: 13; Default||External grouping not supported 95128587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 62mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95173271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 20mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|FSC: 13; Default||Not reimbursed separately|4,158.00|FSC: 13; Default||External grouping not supported 95128588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Multipolar 64mm Od (bipola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,444.86|FSC: 13; Default||Not reimbursed separately|1,444.86|FSC: 13; Default||External grouping not supported 95173272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 25mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|FSC: 13; Default||Not reimbursed separately|4,158.00|FSC: 13; Default||External grouping not supported 95128598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem 23mm Miller-galan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,892.16|FSC: 13; Default||Not reimbursed separately|4,892.16|FSC: 13; Default||External grouping not supported 95173273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 30mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|FSC: 13; Default||Not reimbursed separately|4,158.00|FSC: 13; Default||External grouping not supported 95128599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95128600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 20mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|FSC: 13; Default||Not reimbursed separately|5,073.00|FSC: 13; Default||External grouping not supported 95128601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-3 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 25mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|FSC: 13; Default||Not reimbursed separately|5,073.00|FSC: 13; Default||External grouping not supported 95128602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii 30mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|FSC: 13; Default||Not reimbursed separately|5,073.00|FSC: 13; Default||External grouping not supported 95128603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii T 30mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|FSC: 13; Default||Not reimbursed separately|4,614.00|FSC: 13; Default||External grouping not supported 95128604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-4 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95173287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii T 20mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|FSC: 13; Default||Not reimbursed separately|5,073.00|FSC: 13; Default||External grouping not supported 95128605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii T 25mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|FSC: 13; Default||Not reimbursed separately|5,073.00|FSC: 13; Default||External grouping not supported 95128606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii Straight 20 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|FSC: 13; Default||Not reimbursed separately|4,614.00|FSC: 13; Default||External grouping not supported 95128607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|FSC: 13; Default||Not reimbursed separately|11,076.00|FSC: 13; Default||External grouping not supported 95173289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii T 30mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|FSC: 13; Default||Not reimbursed separately|5,073.00|FSC: 13; Default||External grouping not supported 95128608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-5 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii Straight 25 X 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|FSC: 13; Default||Not reimbursed separately|4,614.00|FSC: 13; Default||External grouping not supported 95128609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii U Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|FSC: 13; Default||Not reimbursed separately|5,769.00|FSC: 13; Default||External grouping not supported 95128610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii U Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|FSC: 13; Default||Not reimbursed separately|5,769.00|FSC: 13; Default||External grouping not supported 95128611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-6 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|FSC: 13; Default||Not reimbursed separately|11,076.00|FSC: 13; Default||External grouping not supported 95173295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii U Large Lt Stra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|FSC: 13; Default||Not reimbursed separately|5,769.00|FSC: 13; Default||External grouping not supported 95128612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii U Large Rt Stra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|FSC: 13; Default||Not reimbursed separately|5,769.00|FSC: 13; Default||External grouping not supported 95128613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-7 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95173298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|FSC: 13; Default||Not reimbursed separately|11,076.00|FSC: 13; Default||External grouping not supported 95173299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|FSC: 13; Default||Not reimbursed separately|11,076.00|FSC: 13; Default||External grouping not supported 95173300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|FSC: 13; Default||Not reimbursed separately|11,076.00|FSC: 13; Default||External grouping not supported 80163702|EAP|Custom 80163702||0998 - STATISTICAL CHARGES|Hb Observation Room Per Hour Statistical Charge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-8 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|FSC: 13; Default||Not reimbursed separately|11,076.00|FSC: 13; Default||External grouping not supported 95128619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Purp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95128620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Purp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95128621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Purp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95128622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Purp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95173301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Purp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95173303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95173304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95173305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95173306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95173307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 2.7mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95173308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95173309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95173310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95173311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95173316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|FSC: 13; Default||Not reimbursed separately|594.00|FSC: 13; Default||External grouping not supported 95128633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95173318|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Otw Evercross 5 X 120 X 080 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95173319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial-cr #4x14mm Yellow N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.06|FSC: 13; Default||Not reimbursed separately|3,075.06|FSC: 13; Default||External grouping not supported 95173320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95173321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Component Femoral Cra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,619.27|FSC: 13; Default||Not reimbursed separately|17,619.27|FSC: 13; Default||External grouping not supported 95173322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128638|EAP|Custom 95128638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Elefant 5mm 6eyelets 35cm With T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128639|EAP|Custom 95128639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Harvester Graft Bone 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128640|EAP|Custom 95128640||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Bone Cancellous Allomatrix|1|HUMANA [1294]||HUMANA [11839]|3,510.00|FSC: 13; Default||Not reimbursed separately|3,510.00|FSC: 13; Default||External grouping not supported 95173325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128641|EAP|Custom 95128641||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Matrix Deminerilized 10cc M|1|HUMANA [1294]||HUMANA [11839]|5,952.00|FSC: 13; Default||Not reimbursed separately|5,952.00|FSC: 13; Default||External grouping not supported 95173326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128642|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ureteral Lumen Dual C18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128644|EAP|Custom 95128644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 13mm X 11mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Polyaxial Ortholoc Claw Ii 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95128645|EAP|Custom 95128645||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 13mm X 13mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173329|EAP|Custom 95173329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Platelet Autologus (4 Tubes)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128646|EAP|Custom 95128646||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 15mm X 11mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173330|EAP|Custom 95173330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128647|EAP|Custom 95128647||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 15mm X 13mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173331|EAP|Custom 95173331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128648|EAP|Custom 95128648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 15mm X 15mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173332|EAP|Custom 95173332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Hexflex 5.0 X 85mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128649|EAP|Custom 95128649||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 20mm X 15mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173333|EAP|Custom 95173333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Vapr Hook With Hand Control |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128650|EAP|Custom 95128650||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 20mm X 20mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173334|EAP|Custom 95173334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Vapr Premier 50 With Hand Control|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128651|EAP|Custom 95128651||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 20mm X 25mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173335|EAP|Custom 95173335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Claw Ii 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128652|EAP|Custom 95128652||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 25mm X 20mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95173336|EAP|Custom 95173336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Star 10 Self Rotating Claw Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95173337|EAP|Custom 95173337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Star 10 Claw Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95173341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial 9mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95128655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Lps Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,958.90|FSC: 13; Default||Not reimbursed separately|8,958.90|FSC: 13; Default||External grouping not supported 95173342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95128656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Lps Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|FSC: 13; Default||Not reimbursed separately|8,689.20|FSC: 13; Default||External grouping not supported 95173343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|FSC: 13; Default||Not reimbursed separately|1,452.30|FSC: 13; Default||External grouping not supported 95173344|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Absolute Pro .035 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95128659|EAP|Custom 95128659||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 13mm X 17mm Compression C|1|HUMANA [1294]||HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95128661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Eccentric 64x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95128662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Eccentric 66x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95116145|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.5 Diopter |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95128663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Eccentric Trilogy 28 Mm 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95128664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Eccentric 70x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95173350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 7.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95173351|EAP|Custom 95173351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator-c Pathfinder Nxt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 58x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95173352|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 11mm X 122mm Flex Zenight Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95128667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 60x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95173353|EAP|Custom 95173353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Liver Biopsy Patel Set Tlab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Oblique 62x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95173354|EAP|Custom 95173354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Closure Vascular Exoseal 700|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 44x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95173355|EAP|Custom 95173355||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Pip Ligament Repair Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity Standard 46x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|FSC: 13; Default||Not reimbursed separately|3,756.48|FSC: 13; Default||External grouping not supported 95173356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95128671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 44x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95173357|EAP|Custom 95173357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer French #6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 10-degree 46x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95173358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95128673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 44x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95192268|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95128674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 46x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95128675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 44x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95173360|EAP|Custom 95173360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Biom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 7mm-offset 46x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|FSC: 13; Default||Not reimbursed separately|4,645.05|FSC: 13; Default||External grouping not supported 95128677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard Acetabular Cup J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|980.40|FSC: 13; Default||Not reimbursed separately|980.40|FSC: 13; Default||External grouping not supported 95128678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Elevated Rim M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|FSC: 13; Default||Not reimbursed separately|1,681.68|FSC: 13; Default||External grouping not supported 95128679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,817.90|FSC: 13; Default||Not reimbursed separately|8,817.90|FSC: 13; Default||External grouping not supported 95128680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95185635|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Power Trialysis Straight 13 Fr 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95128681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95128682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95188591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Lo-profile 2.7x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95128683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95128684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95128685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95128686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|FSC: 13; Default||Not reimbursed separately|9,170.61|FSC: 13; Default||External grouping not supported 95185634|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Power Trialysis Straight 13 Fr 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95128687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95128688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95173291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Polyaxial Claw Ii Straight 20 X 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|FSC: 13; Default||Not reimbursed separately|4,614.00|FSC: 13; Default||External grouping not supported 95128689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95173363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 5.5 X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95128690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95173364|EAP|Custom 95173364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Packing System Balloon Vaginal Alatus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95173365|EAP|Custom 95173365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Stress Test 12 Lead Cable For Ep Med System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Beaded Sz-20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,213.62|FSC: 13; Default||Not reimbursed separately|10,213.62|FSC: 13; Default||External grouping not supported 95173366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 8mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95128693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95173367|EAP|Custom 95173367||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Va Zero-p Lordotic Height 8mm|1|HUMANA [1294]||HUMANA [11839]|7,370.52|FSC: 13; Default||Not reimbursed separately|7,370.52|FSC: 13; Default||External grouping not supported 95128694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Ct Versys 11x120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95173368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling 3.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|901.68|FSC: 13; Default||Not reimbursed separately|901.68|FSC: 13; Default||External grouping not supported 95128695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Ct 12mm X 125mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95173372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Taper Resurfacing Acing Hemicap 13.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.00|FSC: 13; Default||Not reimbursed separately|2,637.00|FSC: 13; Default||External grouping not supported 95128696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Sta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95173373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abg Ii Cementless V40 Rt No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95128697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95128698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95128699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Ct 12mm X 140mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95128700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95185636|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Power Trialysis Straight 13 Fr 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95128701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Sta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95188592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Lo-profile 2.7x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95128702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Ct Sta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|FSC: 13; Default||Not reimbursed separately|6,555.45|FSC: 13; Default||External grouping not supported 95185633|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pacemaker Cps Direct Universal Final Pack 47cm Rs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Size 11 X 120mm Enha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|FSC: 13; Default||Not reimbursed separately|8,811.66|FSC: 13; Default||External grouping not supported 95192267|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95128704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Size 13 X 130mm Enha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|FSC: 13; Default||Not reimbursed separately|8,811.66|FSC: 13; Default||External grouping not supported 95128705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Metal Fiber Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Size 12 Metal Fiber Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95185639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Precurved 2.0x300mm Flexible|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.50|FSC: 13; Default||Not reimbursed separately|724.50|FSC: 13; Default||External grouping not supported 95128713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95128715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Charlotte 2.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.00|FSC: 13; Default||Not reimbursed separately|753.00|FSC: 13; Default||External grouping not supported 95128718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Charlotte 2.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.00|FSC: 13; Default||Not reimbursed separately|738.00|FSC: 13; Default||External grouping not supported 95173374|EAP|Custom 95173374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Film Gafchromic 10 X 10 Rtqa2 1010|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128720|EAP|Custom 95128720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Visceral Hbp 5.5 38 65|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173382|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guide Shuttle Flexor 5fr Ksaw5.0-38-90-rb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128725|EAP|Custom 95128725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Turbosonics W/30degree-kelm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 78mm Right A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,354.80|FSC: 13; Default||Not reimbursed separately|1,354.80|FSC: 13; Default||External grouping not supported 80169777|EAP|Custom 80169777||0998 - STATISTICAL CHARGES|Hb Failure To Return Equipment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tubular 1/3 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|531.63|FSC: 13; Default||Not reimbursed separately|531.63|FSC: 13; Default||External grouping not supported 95128728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 2 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95128732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tibial All-poly Unit M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|FSC: 13; Default||Not reimbursed separately|3,051.00|FSC: 13; Default||External grouping not supported 95128735|EAP|Custom 95128735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannualated 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128736|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Trn Left 11x130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95128743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95128749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95128750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Charlotte 2.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95112577|EAP|Custom 95112577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Wound 15fr Round With Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Charlotte 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|714.00|FSC: 13; Default||Not reimbursed separately|714.00|FSC: 13; Default||External grouping not supported 95128757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Charlotte 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.00|FSC: 13; Default||Not reimbursed separately|663.00|FSC: 13; Default||External grouping not supported 95166139|EAP|Custom 95166139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Medium 26-32cm Infant Ncpap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Charlotte 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|714.00|FSC: 13; Default||Not reimbursed separately|714.00|FSC: 13; Default||External grouping not supported 95173395|EAP|Custom 95173395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Acculif Tl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128766|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 7mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95128772|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95128773|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95173399|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Picc Premicath 1 Fr Neonatal W/24g Iv Cannula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95128782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95173402|EAP|Custom 95173402||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Acculif Tl8 12mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|17,985.00|FSC: 13; Default||Not reimbursed separately|17,985.00|FSC: 13; Default||External grouping not supported 95128785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 360|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95173403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Curved 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,312.50|FSC: 13; Default||Not reimbursed separately|1,312.50|FSC: 13; Default||External grouping not supported 95128790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95173404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Curved 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95128791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95173411|EAP|Custom 95173411||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guides Instrument Specific Patient Nexgen Lps|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95128793|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Great Swanson 2 Tita|1|HUMANA [1294]||HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95173412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Precoat Size 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|FSC: 13; Default||Not reimbursed separately|4,212.00|FSC: 13; Default||External grouping not supported 95128794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95173413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancuellous Ncb 5.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95128797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 7.0mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95173414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95128798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Narrow 4.5 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.24|FSC: 13; Default||Not reimbursed separately|1,770.24|FSC: 13; Default||External grouping not supported 95128799|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Rou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95128801|EAP|Custom 95128801||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteoset Pellet 5cc Rbk|1|HUMANA [1294]||HUMANA [11839]|2,106.00|FSC: 13; Default||Not reimbursed separately|2,106.00|FSC: 13; Default||External grouping not supported 62061866|EAP|CPT® 87253||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Viral Culture Def. Id - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|60.60|FSC: 13; Default||Not reimbursed separately|60.60|FSC: 13; Default||External grouping not supported 95128806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95128808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95128810|EAP|Custom 95128810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Knife Bovie Cullen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118416|EAP|Custom 95118416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Wound 10fr Round With Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128811|EAP|Custom 95128811||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Curlin Medicine Administrati|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95173416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abg Ii Cementless V40 Right No 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95128817|EAP|Custom 95128817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Bifurcated Exclud|1|HUMANA [1294]||HUMANA [11839]|6,777.00|FSC: 13; Default||Not reimbursed separately|6,777.00|FSC: 13; Default||External grouping not supported 95173417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 0 Degree 40mm G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95128818|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Extender Aortic 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,777.00|FSC: 13; Default||Not reimbursed separately|6,777.00|FSC: 13; Default||External grouping not supported 95173419|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.5 Ao Diopter Crystalens Posterior Chamber 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95128824|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Teflon 3j Curve Thscf-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173422|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Sterling 2.0 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128830|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Radiopaque Reflex .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173423|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter True Path Cto|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128832|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Radiopaque Reflex .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173424|EAP|Custom 95173424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5 Fr Ima Diagnostic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|FSC: 13; Default||Not reimbursed separately|744.00|FSC: 13; Default||External grouping not supported 95173426|EAP|Custom 95173426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Custom Vacpack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128836|EAP|HCPCS A5063||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drainable High-output 1-3/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173427|EAP|Custom 95173427||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Supplemental Nursing Sns Reusable Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|FSC: 13; Default||Not reimbursed separately|786.00|FSC: 13; Default||External grouping not supported 95173429|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile Moderate |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95173430|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile Moderate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95173431|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile Moderate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95128845|EAP|Custom 95128845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 9.5mm Hol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173425|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Percutaneous Sheath 8.5fr 10cm With Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95128847|EAP|Custom 95128847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 21cm 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185640|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Main Custom Bifurcated Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95128848|EAP|Custom 95128848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 9cm 25.4m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poyaxial Starfire 5.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95128850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 6x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|363.00|FSC: 13; Default||Not reimbursed separately|363.00|FSC: 13; Default||External grouping not supported 95128853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Zephir 47.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|FSC: 13; Default||Not reimbursed separately|3,474.00|FSC: 13; Default||External grouping not supported 95173405|EAP|Custom 95173405||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Expandable Convex 25mm X 11mm X 7mm|1|HUMANA [1294]||HUMANA [11839]|18,897.00|FSC: 13; Default||Not reimbursed separately|18,897.00|FSC: 13; Default||External grouping not supported 95173433|EAP|Custom 95173433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hover Matt Disposable Single Use 34|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm X 15/4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95173437|EAP|Custom 95173437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Asnis Micro 3.0mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173438|EAP|Custom 95173438||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kwire Micro Asnis 3.0mm 1.2mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|98.70|FSC: 13; Default||Not reimbursed separately|98.70|FSC: 13; Default||External grouping not supported 95173439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm X 16/4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95173440|EAP|Custom 95173440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Asnis Micro 3.0mm Ao |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173441|EAP|Custom 95173441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Cannulated Asnis Micro 3.0mm/3.8mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95173443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95128864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3d 6.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.69|FSC: 13; Default||Not reimbursed separately|1,515.69|FSC: 13; Default||External grouping not supported 95128866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3d 6.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.69|FSC: 13; Default||Not reimbursed separately|1,515.69|FSC: 13; Default||External grouping not supported 95173449|EAP|Custom 95173449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit 2nd Fracture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173450|EAP|Custom 95173450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Ae|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-cut 3.0cmx5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|FSC: 13; Default||Not reimbursed separately|1,162.17|FSC: 13; Default||External grouping not supported 95173451|EAP|Custom 95173451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Hand Switch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173452|EAP|Custom 95173452||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteotome Straight|1|HUMANA [1294]||HUMANA [11839]|594.00|FSC: 13; Default||Not reimbursed separately|594.00|FSC: 13; Default||External grouping not supported 95173453|EAP|Custom 95173453||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Star Ablation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Break-off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95173455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm X 14/4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95128875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95173456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Open Left Low Profile 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95128877|EAP|Custom 95128877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill .6mm X 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 12mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95128886|EAP|Custom 95128886||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restrictor Cement Peek 10x22 No|1|HUMANA [1294]||HUMANA [11839]|6,378.00|FSC: 13; Default||Not reimbursed separately|6,378.00|FSC: 13; Default||External grouping not supported 95173458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 12mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95128887|EAP|Custom 95128887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restrictor Cement Peek 8x22|1|HUMANA [1294]||HUMANA [11839]|6,780.00|FSC: 13; Default||Not reimbursed separately|6,780.00|FSC: 13; Default||External grouping not supported 95173459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 20mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95128893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 30mm In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95173460|EAP|Custom 95173460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Interfernce 9mmx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95173461|EAP|Custom 95173461||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xd Expandable Convex 25mm X 9mm X7mm|1|HUMANA [1294]||HUMANA [11839]|18,297.00|FSC: 13; Default||Not reimbursed separately|18,297.00|FSC: 13; Default||External grouping not supported 95128901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Rci 8mmx25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95173462|EAP|Custom 95173462||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xd Expandable Lordotic 22mm X 9mm X 7mm|1|HUMANA [1294]||HUMANA [11839]|18,297.00|FSC: 13; Default||Not reimbursed separately|18,297.00|FSC: 13; Default||External grouping not supported 95128909|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Pigtail 8x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|349.14|FSC: 13; Default||Not reimbursed separately|349.14|FSC: 13; Default||External grouping not supported 95173463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Proximal Phlanx Hemi Movement Mgt Size 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,838.75|FSC: 13; Default||Not reimbursed separately|5,838.75|FSC: 13; Default||External grouping not supported 95128910|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Sheath Peel-away 14fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173464|EAP|Custom 95173464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Rfa Cervical Active Tip 150mm 20g 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128911|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Pigtail 7 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|349.14|FSC: 13; Default||Not reimbursed separately|349.14|FSC: 13; Default||External grouping not supported 95128912|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Pigtail 8x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|349.14|FSC: 13; Default||Not reimbursed separately|349.14|FSC: 13; Default||External grouping not supported 95128913|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Pigtail 8x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|349.14|FSC: 13; Default||Not reimbursed separately|349.14|FSC: 13; Default||External grouping not supported 95128942|EAP|Custom 95128942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator Sorin Monolyth Pro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dynamic 1.7mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 80169781|EAP|HCPCS Q0092||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Set-up Portable Xray Equipment|1|HUMANA [1294]||HUMANA [11839]|22.14|FSC: 13; Default||Not reimbursed separately|22.14|FSC: 13; Default||External grouping not supported 95128944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dynamic 1.9mmx3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 95128945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dynamic 1.7mmx5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 95185642|EAP|Custom 95185642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Kyphopak First Fracture Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Mg Knee 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95192266|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95128947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Mg Sm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95185654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral Screw 4.5mmx48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95128948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Mg Tibiallg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 80169792|EAP|HCPCS R0070||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transport Portable X-ray Equipment And Personnel One Patient Seen|1|HUMANA [1294]||HUMANA [11839]|113.51|FSC: 13; Default||Not reimbursed separately|113.51|FSC: 13; Default||External grouping not supported 95128949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Reg 8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95185655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poyaxial Starfire 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95128950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Aluminum V40 32mm Omm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,306.50|FSC: 13; Default||Not reimbursed separately|4,306.50|FSC: 13; Default||External grouping not supported 95128951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Osteolock P5 32mm 10deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,421.40|FSC: 13; Default||Not reimbursed separately|1,421.40|FSC: 13; Default||External grouping not supported 95185657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Distal 2hole/l72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95128952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-deg. 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 80169803|EAP|HCPCS R0075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transport Portable X-ray Equipment Personnel 2 Pt Seen|1|HUMANA [1294]||HUMANA [11839]|56.76|FSC: 13; Default||Not reimbursed separately|56.76|FSC: 13; Default||External grouping not supported 95128953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Harris Precoat Extr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,902.00|FSC: 13; Default||Not reimbursed separately|4,902.00|FSC: 13; Default||External grouping not supported 95185653|EAP|Custom 95185653||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Trans Medium|1|HUMANA [1294]||HUMANA [11839]|4,892.70|FSC: 13; Default||Not reimbursed separately|4,892.70|FSC: 13; Default||External grouping not supported 95128957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Revision Pca Mtk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95192265|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95128958|EAP|Custom 95128958||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pegs Fixation Femoral Distal|1|HUMANA [1294]||HUMANA [11839]|1,030.20|FSC: 13; Default||Not reimbursed separately|1,030.20|FSC: 13; Default||External grouping not supported 95128962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Stem Precoat Mgii Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,648.82|FSC: 13; Default||Not reimbursed separately|11,648.82|FSC: 13; Default||External grouping not supported 95192264|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95128963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95110817|EAP|Custom 95110817||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Reservoir 7mm Flat Drain Without Trocar Full|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95169118|EAP|Custom 95169118||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tape Medipore H 6 X 10yds|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Stem Mg-ii Size-f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,648.82|FSC: 13; Default||Not reimbursed separately|11,648.82|FSC: 13; Default||External grouping not supported 95173465|EAP|Custom 95173465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Straight Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.21|FSC: 13; Default||Not reimbursed separately|4,191.21|FSC: 13; Default||External grouping not supported 95173466|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Saphenous 66cm 4-5mm B+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,995.00|FSC: 13; Default||Not reimbursed separately|28,995.00|FSC: 13; Default||External grouping not supported 95128972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Stemmed Size-j Mill|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,648.82|FSC: 13; Default||Not reimbursed separately|11,648.82|FSC: 13; Default||External grouping not supported 95173467|EAP|Custom 95173467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer Vein Epidural 3.5 Mini Aquamantys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.21|FSC: 13; Default||Not reimbursed separately|4,191.21|FSC: 13; Default||External grouping not supported 95173468|EAP|Custom 95173468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer Bipolar Sheathed 5.0 Sbs Aquamantys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95173470|EAP|Custom 95173470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dycal Ivory Std Pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat M/g Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|FSC: 13; Default||Not reimbursed separately|17,254.86|FSC: 13; Default||External grouping not supported 95173471|EAP|Custom 95173471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ketac-cem Radio Intro Pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95128984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Compression Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.21|FSC: 13; Default||Not reimbursed separately|4,191.21|FSC: 13; Default||External grouping not supported 95173473|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Vascular Biologic Xenosure 0.8cm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|FSC: 13; Default||Not reimbursed separately|633.00|FSC: 13; Default||External grouping not supported 95129013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Long Calcar Left 3x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|FSC: 13; Default||Not reimbursed separately|10,305.00|FSC: 13; Default||External grouping not supported 95173474|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Vascular Biologic Xenosure 1cm X 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95129030|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidant Viatrac 14 Plus 6.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173475|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sj4 Icd Active Fixation 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|FSC: 13; Default||Not reimbursed separately|13,770.00|FSC: 13; Default||External grouping not supported 95129032|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidant Viatrac 14 Plus 6.5 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173476|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Ellipse Dr Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|FSC: 13; Default||Not reimbursed separately|50,625.00|FSC: 13; Default||External grouping not supported 95129038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95173477|EAP|Custom 95173477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Connector Psa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 8mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95173478|EAP|Custom 95173478||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avs 6 X 14 X 16mm|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95129040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 9mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95173479|EAP|Custom 95173479||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avs 5 X 14 X 16mm|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95173480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aviator 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,384.95|FSC: 13; Default||Not reimbursed separately|7,384.95|FSC: 13; Default||External grouping not supported 95129054|EAP|Custom 95129054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Fixator Hex-in-a-box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173481|EAP|Custom 95173481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Irrigating Occucoat 1cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95129078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 70mm X 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.52|FSC: 13; Default||Not reimbursed separately|989.52|FSC: 13; Default||External grouping not supported 95173482|EAP|Custom 95173482||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Advance Nerve|1|HUMANA [1294]||HUMANA [11839]|7,251.00|FSC: 13; Default||Not reimbursed separately|7,251.00|FSC: 13; Default||External grouping not supported 95129092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 70mm X 200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,132.86|FSC: 13; Default||Not reimbursed separately|1,132.86|FSC: 13; Default||External grouping not supported 95173483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Aviator 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|FSC: 13; Default||Not reimbursed separately|1,679.52|FSC: 13; Default||External grouping not supported 95129095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.00|FSC: 13; Default||Not reimbursed separately|723.00|FSC: 13; Default||External grouping not supported 95173484|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Safety-t-centesis Catheter Drainage Kit 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 60mmx 9hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,037.31|FSC: 13; Default||Not reimbursed separately|1,037.31|FSC: 13; Default||External grouping not supported 95129097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 60mmx 12hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,132.86|FSC: 13; Default||Not reimbursed separately|1,132.86|FSC: 13; Default||External grouping not supported 95173489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ss 4 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.96|FSC: 13; Default||Not reimbursed separately|552.96|FSC: 13; Default||External grouping not supported 95129098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.00|FSC: 13; Default||Not reimbursed separately|723.00|FSC: 13; Default||External grouping not supported 95173490|EAP|Custom 95173490||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Mcconnell Small |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 70mmx 9hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,037.31|FSC: 13; Default||Not reimbursed separately|1,037.31|FSC: 13; Default||External grouping not supported 95129104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ect 6.5mmx130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.10|FSC: 13; Default||Not reimbursed separately|332.10|FSC: 13; Default||External grouping not supported 95129107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.10|FSC: 13; Default||Not reimbursed separately|332.10|FSC: 13; Default||External grouping not supported 95173491|EAP|Custom 95173491||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Mcconnell Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|FSC: 13; Default||Not reimbursed separately|744.00|FSC: 13; Default||External grouping not supported 95173492|EAP|Custom 95173492||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Prior Sport Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.10|FSC: 13; Default||Not reimbursed separately|332.10|FSC: 13; Default||External grouping not supported 95173493|EAP|Custom 95173493||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Prior Sport Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95173494|EAP|Custom 95173494||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Prior Sport Xlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95173495|EAP|Custom 95173495||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom 3/4 Red Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95173496|EAP|Custom 95173496||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom 3/4 Red Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95173497|EAP|Custom 95173497||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom 3/4 Red Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.00|FSC: 13; Default||Not reimbursed separately|861.00|FSC: 13; Default||External grouping not supported 95173498|EAP|Custom 95173498||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Custom 3/4 Red Xlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95129121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.84|FSC: 13; Default||Not reimbursed separately|501.84|FSC: 13; Default||External grouping not supported 95173499|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 7 X 99 X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95129122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95173500|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 8 X 100 X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95129123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95173501|EAP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Connector For Reflexior Spiral Ep Cath|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 11mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95173503|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon 3mm X 40mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95173504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Rt 13mm X 340mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95129126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95173505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix Knotless Peek 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95129127|EAP|Custom 95129127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinman W/central-thread 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173506|EAP|Custom 95173506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Closure Fascial Efx Weck|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129130|EAP|Custom 95129130||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Neoprene Hinged W/ Pl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173507|EAP|Custom 95173507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Transducer Neo 30ml Closed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129142|EAP|Custom 95129142||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Patella Horseshoe Withpl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129150|EAP|Custom 95129150||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Donut Delux 1/4 El|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129155|EAP|Custom 95129155||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Donut Delux 1/4 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173513|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173514|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.25mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173515|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.75mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173516|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173517|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Surgisis Biodesign 0.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95129180|EAP|Custom 95129180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 3mm Long Bladeless|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173520|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Uri Cath 5fr W/silastic Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95185641|EAP|Custom 95185641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Trocar And Diamond Size 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900000|EAP|Custom 99900000|||Ris Link Chg Img10628|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95188604|EAP|Custom 95188604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulate Hollow 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900001|EAP|Custom 99900001|||Ris Link Chg Img10629|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95185663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Nxt Pathfinder 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,284.20|FSC: 13; Default||Not reimbursed separately|2,284.20|FSC: 13; Default||External grouping not supported 95129198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900002|EAP|Custom 99900002|||Ris Link Chg Img10734|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900003|EAP|Custom 99900003|||Ris Link Chg Img1428|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95185664|EAP|Custom 95185664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Hip Head W/insert 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900004|EAP|Custom 99900004|||Ris Link Chg Img789|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129230|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Selective|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188605|EAP|Custom 95188605||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 5mm T2|1|HUMANA [1294]||HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95111356|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 24fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 99900005|EAP|Custom 99900005|||Ris Link Chg Img790|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95111357|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 30fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95185666|EAP|Custom 95185666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Mix Triple Optivac 120gr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129264|EAP|Custom 95129264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Angioscope Disposable 7.0fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900006|EAP|Custom 99900006|||Ris Link Chg Img10379|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95192263|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129269|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Ebu40sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 99900007|EAP|Custom 99900007|||Ris Link Chg Img10380|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900008|EAP|Custom 99900008|||Ris Link Chg Img10381|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95188602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graftbolt Tibial 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95129289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900009|EAP|Custom 99900009|||Ris Link Chg Img1266|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900010|EAP|Custom 99900010|||Ris Link Chg Img10376|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 99900011|EAP|Custom 99900011|||Ris Link Chg Img10377|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Charlotte 4.3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95129301|EAP|Custom 95129301||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire 1.0 X 150mm Trocar Charlott|1|HUMANA [1294]||HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 99900012|EAP|Custom 99900012|||Ris Link Chg Img10378|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129303|EAP|Custom 95129303||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire 1.6 X 150mm Trocar Charlott|1|HUMANA [1294]||HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 95129304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp With Colla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.59|FSC: 13; Default||Not reimbursed separately|547.59|FSC: 13; Default||External grouping not supported 99900013|EAP|Custom 99900013|||Ris Link Chg Img10373|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp With Colla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.76|FSC: 13; Default||Not reimbursed separately|620.76|FSC: 13; Default||External grouping not supported 95129307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.63|FSC: 13; Default||Not reimbursed separately|1,425.63|FSC: 13; Default||External grouping not supported 99900014|EAP|Custom 99900014|||Ris Link Chg Img10374|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,874.04|FSC: 13; Default||Not reimbursed separately|1,874.04|FSC: 13; Default||External grouping not supported 95129309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,036.94|FSC: 13; Default||Not reimbursed separately|2,036.94|FSC: 13; Default||External grouping not supported 99900015|EAP|Custom 99900015|||Ris Link Chg Img10375|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 72mm 5 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.18|FSC: 13; Default||Not reimbursed separately|951.18|FSC: 13; Default||External grouping not supported 95129314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 189mm 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,963.77|FSC: 13; Default||Not reimbursed separately|1,963.77|FSC: 13; Default||External grouping not supported 99900016|EAP|Custom 99900016|||Ris Link Chg Img10370|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 67mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,201.35|FSC: 13; Default||Not reimbursed separately|1,201.35|FSC: 13; Default||External grouping not supported 95129317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 78mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.02|FSC: 13; Default||Not reimbursed separately|1,402.02|FSC: 13; Default||External grouping not supported 99900017|EAP|Custom 99900017|||Ris Link Chg Img10371|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 87mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,756.05|FSC: 13; Default||Not reimbursed separately|1,756.05|FSC: 13; Default||External grouping not supported 95129326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 63mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,241.49|FSC: 13; Default||Not reimbursed separately|1,241.49|FSC: 13; Default||External grouping not supported 99900018|EAP|Custom 99900018|||Ris Link Chg Img10372|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 96mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,406.73|FSC: 13; Default||Not reimbursed separately|1,406.73|FSC: 13; Default||External grouping not supported 95188607|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Atherectomy Hawkone Ls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 63mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.98|FSC: 13; Default||Not reimbursed separately|1,309.98|FSC: 13; Default||External grouping not supported 99900019|EAP|Custom 99900019|||Ris Link Chg Img10367|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 96mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,479.90|FSC: 13; Default||Not reimbursed separately|1,479.90|FSC: 13; Default||External grouping not supported 95192262|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,112.42|FSC: 13; Default||Not reimbursed separately|5,112.42|FSC: 13; Default||External grouping not supported 99900020|EAP|Custom 99900020|||Ris Link Chg Img10368|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,272.86|FSC: 13; Default||Not reimbursed separately|5,272.86|FSC: 13; Default||External grouping not supported 95188608|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Atherectomy Hawkone Lx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 99900021|EAP|Custom 99900021|||Ris Link Chg Img10369|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 55mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95129514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 10mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900022|EAP|Custom 99900022|||Ris Link Chg Img10540|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95188609|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Atherectomy Turbohawk Sx-c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900023|EAP|Custom 99900023|||Ris Link Chg Img10539|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129523|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192261|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95111461|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900024|EAP|Custom 99900024|||Ris Link Chg Img10538|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 80169814|EAP|HCPCS R0075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transport Portable X-ray Equipment Personnel 3 Pt Seen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.84|FSC: 13; Default||Not reimbursed separately|37.84|FSC: 13; Default||External grouping not supported 95129531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900025|EAP|Custom 99900025|||Ris Link Chg Img10382|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 24mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95129534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900026|EAP|Custom 99900026|||Ris Link Chg Img10383|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 28mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 80169825|EAP|HCPCS R0075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transport Portable X-ray Equipment Personnel 4 Pt Seen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.38|FSC: 13; Default||Not reimbursed separately|28.38|FSC: 13; Default||External grouping not supported 95129538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900027|EAP|Custom 99900027|||Ris Link Chg Img10384|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 32mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95192260|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 34mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900028|EAP|Custom 99900028|||Ris Link Chg Img10631|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129541|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 36mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95129543|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 38mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 99900029|EAP|Custom 99900029|||Ris Link Chg Img10626|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129577|EAP|Custom 95129577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm 1.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129578|EAP|Custom 95129578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900030|EAP|Custom 99900030|||Ris Link Chg Img10560|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129579|EAP|Custom 95129579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129580|EAP|Custom 95129580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900031|EAP|Custom 99900031|||Ris Link Chg Img10627|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129581|EAP|Custom 95129581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169836|EAP|HCPCS R0075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transport Portable X-ray Equipment Personnel 5 Pt Seen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.71|FSC: 13; Default||Not reimbursed separately|22.71|FSC: 13; Default||External grouping not supported 95129582|EAP|Custom 95129582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900032|EAP|Custom 99900032|||Ris Link Chg Img10285|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129584|EAP|Custom 95129584||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129585|EAP|Custom 95129585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd Shnk 70mm 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900033|EAP|Custom 99900033|||Ris Link Chg Img10286|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129586|EAP|Custom 95129586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm 5.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169847|EAP|HCPCS R0075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transport Portable X-ray Equipment Personnel 6 Or More Pt Seen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.92|FSC: 13; Default||Not reimbursed separately|18.92|FSC: 13; Default||External grouping not supported 95129587|EAP|Custom 95129587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rnd.fast Cut 70mm Sz 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900034|EAP|Custom 99900034|||Ris Link Chg Img10284|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129588|EAP|Custom 95129588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr.rosen Fast Cut 70mm Sz.10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192244|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129589|EAP|Custom 95129589||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900035|EAP|Custom 99900035|||Ris Link Chg Img10557|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129590|EAP|Custom 95129590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129591|EAP|Custom 95129591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900036|EAP|Custom 99900036|||Ris Link Chg Img10667|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129592|EAP|Custom 95129592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm 2.40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129593|EAP|Custom 95129593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 71mm 6.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900037|EAP|Custom 99900037|||Ris Link Chg Img10711|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 134mm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,472.82|FSC: 13; Default||Not reimbursed separately|1,472.82|FSC: 13; Default||External grouping not supported 99900038|EAP|Custom 99900038|||Ris Link Chg Img10668|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900039|EAP|Custom 99900039|||Ris Link Chg Img10712|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129645|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Ringed 8mmx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.00|FSC: 13; Default||Not reimbursed separately|2,373.00|FSC: 13; Default||External grouping not supported 95129646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 170mm 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,630.95|FSC: 13; Default||Not reimbursed separately|1,630.95|FSC: 13; Default||External grouping not supported 99900040|EAP|Custom 99900040|||Ris Link Chg Img10533|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129647|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Micro 18x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,435.00|FSC: 13; Default||Not reimbursed separately|3,435.00|FSC: 13; Default||External grouping not supported 99900041|EAP|Custom 99900041|||Ris Link Chg Img10618|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 32mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 99900042|EAP|Custom 99900042|||Ris Link Chg Img10672|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 42mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95129659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Lock 4.0x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.24|FSC: 13; Default||Not reimbursed separately|513.24|FSC: 13; Default||External grouping not supported 99900043|EAP|Custom 99900043|||Ris Link Chg Img10727|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95188603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse 10mmx108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95129661|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour With Wire 8 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 99900044|EAP|Custom 99900044|||Ris Link Chg Img10730|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 206mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,907.13|FSC: 13; Default||Not reimbursed separately|1,907.13|FSC: 13; Default||External grouping not supported 95192245|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 150 Deg 3 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 99900045|EAP|Custom 99900045|||Ris Link Chg Img10728|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 150 Deg 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95188613|EAP|Custom 95188613||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Solution Prismasol Bgk 0/2.5 2/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 145 Deg 3 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 99900046|EAP|Custom 99900046|||Ris Link Chg Img10716|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 140 Deg 3 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95185671|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flash Ostial 6.0 Mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 145 Deg 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 99900047|EAP|Custom 99900047|||Ris Link Chg Img10673|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 140 Deg 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95129675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 135 Deg 3 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 99900048|EAP|Custom 99900048|||Ris Link Chg Img10731|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 135 Deg 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95185668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95129677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 130 Deg 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 99900049|EAP|Custom 99900049|||Ris Link Chg Img10717|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 130 Deg 3 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95188614|EAP|Custom 95188614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Decompression Hip Perfuse Ss Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 130 Deg 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 99900050|EAP|Custom 99900050|||Ris Link Chg Img10674|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 130 Deg 2 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95185669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 99900051|EAP|Custom 99900051|||Ris Link Chg Img10715|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129782|EAP|Custom 95129782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp. Oscillating .|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192246|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 260mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,298.93|FSC: 13; Default||Not reimbursed separately|2,298.93|FSC: 13; Default||External grouping not supported 99900052|EAP|Custom 99900052|||Ris Link Chg Img10669|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/130 Deg 235mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95129788|EAP|Custom 95129788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Side-cutting 1.5 Carbide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900053|EAP|Custom 99900053|||Ris Link Chg Img10724|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129789|EAP|Custom 95129789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sternotomy Repeat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Head Radial 10.0mm X 0.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95129792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lcp 4.5mm X 170mm 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,907.13|FSC: 13; Default||Not reimbursed separately|1,907.13|FSC: 13; Default||External grouping not supported 99900054|EAP|Custom 99900054|||Ris Link Chg Img10725|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168727|EAP|Custom 80168727||0998 - STATISTICAL CHARGES|Hb Reds Vest Research N/c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lcp 4.5mm X 206mm 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,183.28|FSC: 13; Default||Not reimbursed separately|2,183.28|FSC: 13; Default||External grouping not supported 99900055|EAP|Custom 99900055|||Ris Link Chg Img10670|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129795|EAP|Custom 95129795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Fluted Sternum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900056|EAP|Custom 99900056|||Ris Link Chg Img10671|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129797|EAP|Custom 95129797||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Healing|1|HUMANA [1294]||HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95188616|EAP|Custom 95188616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Angiovac W/dilator 20 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900057|EAP|Custom 99900057|||Ris Link Chg Img10713|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Tibial Liss 140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|FSC: 13; Default||Not reimbursed separately|3,595.50|FSC: 13; Default||External grouping not supported 95192247|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129819|EAP|Custom 95129819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Fine-tip 33cm Bi-tec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900058|EAP|Custom 99900058|||Ris Link Chg Img10714|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Tibial Liss 220mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|FSC: 13; Default||Not reimbursed separately|3,595.50|FSC: 13; Default||External grouping not supported 95188617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Purple Stripe C D Lcck Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95129827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Tibial Liss 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|FSC: 13; Default||Not reimbursed separately|3,595.50|FSC: 13; Default||External grouping not supported 99900059|EAP|Custom 99900059|||Ris Link Chg Img10303|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129836|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary 10fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95129837|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Neph. 10 Fr X 25 Cm Nep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 99900060|EAP|Custom 99900060|||Ris Link Chg Img10304|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Tibial Liss 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|FSC: 13; Default||Not reimbursed separately|3,595.50|FSC: 13; Default||External grouping not supported 95188618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cone Metaphyseal Femoral Tm 35 Sm/ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,903.50|FSC: 13; Default||Not reimbursed separately|13,903.50|FSC: 13; Default||External grouping not supported 95129856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Lcp 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,147.79|FSC: 13; Default||Not reimbursed separately|5,147.79|FSC: 13; Default||External grouping not supported 99900061|EAP|Custom 99900061|||Ris Link Chg Img10305|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Lcp 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,353.14|FSC: 13; Default||Not reimbursed separately|5,353.14|FSC: 13; Default||External grouping not supported 95192248|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Lcp 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,558.49|FSC: 13; Default||Not reimbursed separately|5,558.49|FSC: 13; Default||External grouping not supported 99900062|EAP|Custom 99900062|||Ris Link Chg Img10309|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129869|EAP|Custom 95129869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Screw Standard Locking 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168735|EAP|Custom 80168735||0998 - STATISTICAL CHARGES|Hb Reds Vest Control N/c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129910|EAP|Custom 95129910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Cutting-loop Yellow 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900063|EAP|Custom 99900063|||Ris Link Chg Img10310|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129921|EAP|Custom 95129921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Pigtail 10 French X 7 Rade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188619|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Pulse Implantable W/ Controller 7 Elite Proclaim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|FSC: 13; Default||Not reimbursed separately|54,000.00|FSC: 13; Default||External grouping not supported 99900064|EAP|Custom 99900064|||Ris Link Chg Img10311|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129923|EAP|Custom 95129923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Single-use Ta45-3.5 No E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900065|EAP|Custom 99900065|||Ris Link Chg Img10315|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129935|EAP|Custom 95129935||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Single-use Ta45-48|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900066|EAP|Custom 99900066|||Ris Link Chg Img10316|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129938|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Radiopaque-double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.06|FSC: 13; Default||Not reimbursed separately|402.06|FSC: 13; Default||External grouping not supported 95188620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.64|FSC: 13; Default||Not reimbursed separately|89.64|FSC: 13; Default||External grouping not supported 95129939|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail 10 French X 5 Radi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 99900067|EAP|Custom 99900067|||Ris Link Chg Img10320|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger-joint Sz.3 C1776|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 95129969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Barrel 3-hole 130-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 99900068|EAP|Custom 99900068|||Ris Link Chg Img10321|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Barrel 105-deg 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95192249|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95129971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4-hole 140-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 99900069|EAP|Custom 99900069|||Ris Link Chg Img10322|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129976|EAP|Custom 95129976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spatula Subretinal Ultranit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 99900070|EAP|Custom 99900070|||Ris Link Chg Img10461|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95188621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.64|FSC: 13; Default||Not reimbursed separately|89.64|FSC: 13; Default||External grouping not supported 95129990|EAP|Custom 95129990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stone Basket|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900071|EAP|Custom 99900071|||Ris Link Chg Img10462|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129994|EAP|Custom 95129994||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Sampling Blood Fetal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 99900072|EAP|Custom 99900072|||Ris Link Chg Img10463|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95130003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 54mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 99900073|EAP|Custom 99900073|||Ris Link Chg Img10523|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130007|EAP|Custom 95130007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Valvulotome Includes:matkons|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 99900074|EAP|Custom 99900074|||Ris Link Chg Img10524|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95188622|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95130010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 99900075|EAP|Custom 99900075|||Ris Link Chg Img10525|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|FSC: 13; Default||Not reimbursed separately|2,056.71|FSC: 13; Default||External grouping not supported 95130015|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Optiray 300mg/ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|FSC: 13; Default||Not reimbursed separately|0.44|FSC: 13; Default||External grouping not supported 99900076|EAP|Custom 99900076|||Ris Link Chg Img10526|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|FSC: 13; Default||Not reimbursed separately|2,373.12|FSC: 13; Default||External grouping not supported 95192251|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 99900077|EAP|Custom 99900077|||Ris Link Chg Img10527|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900078|EAP|Custom 99900078|||Ris Link Chg Img10528|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188611|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000333 Prime Grafix 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|668.25|FSC: 13; Default||Not reimbursed separately|668.25|FSC: 13; Default||External grouping not supported 99900079|EAP|Custom 99900079|||Ris Link Chg Img10529|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900080|EAP|Custom 99900080|||Ris Link Chg Img10530|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900081|EAP|Custom 99900081|||Ris Link Chg Img10531|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.9x34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 99900082|EAP|Custom 99900082|||Ris Link Chg Img10635|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Connecting Ext Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95188612|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857003333 Core Grafix 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|668.25|FSC: 13; Default||Not reimbursed separately|668.25|FSC: 13; Default||External grouping not supported 95130044|EAP|Custom 95130044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Ext Fix 2x450|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900083|EAP|Custom 99900083|||Ris Link Chg Img1163|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130045|EAP|Custom 95130045||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Covers End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130046|EAP|Custom 95130046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 1/3 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900084|EAP|Custom 99900084|||Ris Link Chg Img10634|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192252|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130048|EAP|Custom 95130048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Securestrand Interspinous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900085|EAP|Custom 99900085|||Ris Link Chg Img10412|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130049|EAP|Custom 95130049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Securestrand Sublaminar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130050|EAP|Custom 95130050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar 300mm Ext Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900086|EAP|Custom 99900086|||Ris Link Chg Img10358|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130051|EAP|Custom 95130051||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Medporsurgical Barrier M|1|HUMANA [1294]||HUMANA [11839]|1,170.00|FSC: 13; Default||Not reimbursed separately|1,170.00|FSC: 13; Default||External grouping not supported 95188623|EAP|Custom 95188623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermo Cool Smart Touch Fj|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Porous 32mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 99900087|EAP|Custom 99900087|||Ris Link Chg Img10357|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Porous 35mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95130055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Porous 38mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 99900088|EAP|Custom 99900088|||Ris Link Chg Img10413|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Porous 41mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95130057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc 10mm Global Adva|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 99900089|EAP|Custom 99900089|||Ris Link Chg Img10360|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 16mm 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95130067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 16mm 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 99900090|EAP|Custom 99900090|||Ris Link Chg Img10359|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 16mm 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95188624|EAP|Custom 95188624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermo Cool Smart Touch Df|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 99900091|EAP|Custom 99900091|||Ris Link Chg Img10411|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95130071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|FSC: 13; Default||Not reimbursed separately|2,056.71|FSC: 13; Default||External grouping not supported 99900092|EAP|Custom 99900092|||Ris Link Chg Img10356|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130072|EAP|Custom 95130072||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Sling Shot Cross 6.5mm X 40m|1|HUMANA [1294]||HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 95192253|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130075|EAP|Custom 95130075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Ultra Core 14x105x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900093|EAP|Custom 99900093|||Ris Link Chg Img10355|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|FSC: 13; Default||Not reimbursed separately|2,056.71|FSC: 13; Default||External grouping not supported 95130079|EAP|Custom 95130079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Micro-reciprocating 17x4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900094|EAP|Custom 99900094|||Ris Link Chg Img10416|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130080|EAP|Custom 95130080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reciprocating 25x7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130081|EAP|Custom 95130081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Loop 26fr Red (12/pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900095|EAP|Custom 99900095|||Ris Link Chg Img10366|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|FSC: 13; Default||Not reimbursed separately|2,175.36|FSC: 13; Default||External grouping not supported 95130083|EAP|Custom 95130083||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 8.5 X 26|1|HUMANA [1294]||HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 99900096|EAP|Custom 99900096|||Ris Link Chg Img10365|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900097|EAP|Custom 99900097|||Ris Link Chg Img10415|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|FSC: 13; Default||Not reimbursed separately|2,274.24|FSC: 13; Default||External grouping not supported 95130094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|FSC: 13; Default||Not reimbursed separately|2,373.12|FSC: 13; Default||External grouping not supported 99900098|EAP|Custom 99900098|||Ris Link Chg Img10364|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|FSC: 13; Default||Not reimbursed separately|2,056.71|FSC: 13; Default||External grouping not supported 95188626|EAP|Custom 95188626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermo Cool Smart Touch J|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|FSC: 13; Default||Not reimbursed separately|2,175.36|FSC: 13; Default||External grouping not supported 99900099|EAP|Custom 99900099|||Ris Link Chg Img10363|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|FSC: 13; Default||Not reimbursed separately|2,274.24|FSC: 13; Default||External grouping not supported 95130106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|FSC: 13; Default||Not reimbursed separately|2,373.12|FSC: 13; Default||External grouping not supported 99900100|EAP|Custom 99900100|||Ris Link Chg Img10410|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130107|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 274 Nominal-length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192254|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 99900101|EAP|Custom 99900101|||Ris Link Chg Img10352|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95130117|EAP|Custom 95130117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Lock Dual|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900102|EAP|Custom 99900102|||Ris Link Chg Img10353|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95188627|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 26fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|FSC: 13; Default||Not reimbursed separately|2,452.23|FSC: 13; Default||External grouping not supported 99900103|EAP|Custom 99900103|||Ris Link Chg Img10414|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95130124|EAP|Custom 95130124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator (for Extra Small Pati|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900104|EAP|Custom 99900104|||Ris Link Chg Img10362|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130125|EAP|Custom 95130125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Blade Wide Ti 6.35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 99900105|EAP|Custom 99900105|||Ris Link Chg Img10361|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|FSC: 13; Default||Not reimbursed separately|2,452.23|FSC: 13; Default||External grouping not supported 95130128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 99900106|EAP|Custom 99900106|||Ris Link Chg Img10536|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95188628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Ti Val 1st Metcarpalplate-dorsal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,348.49|FSC: 13; Default||Not reimbursed separately|2,348.49|FSC: 13; Default||External grouping not supported 95130130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 99900107|EAP|Custom 99900107|||Ris Link Chg Img10489|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130132|EAP|Custom 95130132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 13mm X 15mm Cfrp|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95130133|EAP|Custom 95130133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 15x15|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 99900108|EAP|Custom 99900108|||Ris Link Chg Img10474|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|FSC: 13; Default||Not reimbursed separately|2,452.23|FSC: 13; Default||External grouping not supported 95192255|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 99900109|EAP|Custom 99900109|||Ris Link Chg Img10722|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130141|EAP|Custom 95130141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 9cm 3mm M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130142|EAP|Custom 95130142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 9cm 10.8m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900110|EAP|Custom 99900110|||Ris Link Chg Img10721|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W/t6 Stardrive Recess Ti 2.0mm X 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95130144|EAP|Custom 95130144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 26cm 7.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900111|EAP|Custom 99900111|||Ris Link Chg Img10502|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130145|EAP|Custom 95130145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 26cm 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130146|EAP|Custom 95130146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 26cm 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900112|EAP|Custom 99900112|||Ris Link Chg Img10613|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900113|EAP|Custom 99900113|||Ris Link Chg Img10534|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|FSC: 13; Default||Not reimbursed separately|2,254.47|FSC: 13; Default||External grouping not supported 95185682|EAP|Custom 95185682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Helical Tfna 85mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130150|EAP|Custom 95130150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Aorta 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900114|EAP|Custom 99900114|||Ris Link Chg Img580|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95130154|EAP|Custom 95130154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator External Mini Dynafix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900115|EAP|Custom 99900115|||Ris Link Chg Img10516|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|FSC: 13; Default||Not reimbursed separately|2,452.23|FSC: 13; Default||External grouping not supported 95130161|EAP|Custom 95130161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pericardiocentesis 6.0fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 99900116|EAP|Custom 99900116|||RIS LINK CHG IMG10371|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130164|EAP|Custom 95130164||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tibial Opening 15mm|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95130167|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Rou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95130168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95188630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Slf-tpngwith Stardrive Recess Ti 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95130170|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 28x2 Z-med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95192256|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130177|EAP|Custom 95130177||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide 2mm/.078 Diameter|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 99900118|EAP|Custom 99900118|||Ris Link Chg Img10729|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130178|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Quad Pisces C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,020.00|FSC: 13; Default||Not reimbursed separately|4,020.00|FSC: 13; Default||External grouping not supported 62061874|EAP|CPT® 86593||0302 - LABORATORY - IMMUNOLOGY|Hb Treponema Pallidum (vdrl), Csf Titer - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.20|FSC: 13; Default||Not reimbursed separately|13.20|FSC: 13; Default||External grouping not supported 95130180|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Ipsilate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 62061882|EAP|CPT® 88142||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Liquid Based Pap, Manual Screen Under Physician Super|1|HUMANA [1294]||HUMANA [11839]|60.78|FSC: 13; Default||Not reimbursed separately|60.78|FSC: 13; Default||External grouping not supported 95130181|EAP|Custom 95130181||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Bifurcated Exclud|1|HUMANA [1294]||HUMANA [11839]|9,669.00|FSC: 13; Default||Not reimbursed separately|9,669.00|FSC: 13; Default||External grouping not supported 80163710|EAP|CPT® 20526||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Median Nerve Injection|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95130188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 80163728|EAP|CPT® 20612||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Aspiration Of Cyst|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95130192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 80163736|EAP|CPT® 63661||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Spinal Cord Trial Lead Removal|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 95130194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95130195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95130197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95130204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95130208|EAP|Custom 95130208||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 6 X 22|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95130215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95130242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 80163744|EAP|CPT® 90935||0880 - MISCELLANEOUS DIALYSIS - GENERAL CLASSIFICATION|Hb Unscheduled Dialysis Treatment Non Esrd|1|HUMANA [1294]||HUMANA [11839]|1,823.79|FSC: 13; Default||Not reimbursed separately|1,823.79|FSC: 13; Default||External grouping not supported 95130245|EAP|Custom 95130245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adaptor Itrell-ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173522|EAP|Custom 95173522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Iv Set Strl Syr 50/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 100 Degree Right Long 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95173523|EAP|Custom 95173523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Extension Sterile 50/s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 100 Degree Left Long 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95173524|EAP|Custom 95173524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ablation Certus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mandibular Angle 60 Left L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95173528|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regener Alloderm 4cm X 12cm Thin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95130256|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 10x13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,696.00|FSC: 13; Default||Not reimbursed separately|9,696.00|FSC: 13; Default||External grouping not supported 95173529|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regener Alloderm 6cmx16cm Thin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.72|FSC: 13; Default||Not reimbursed separately|93.72|FSC: 13; Default||External grouping not supported 95130259|EAP|Custom 95130259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.0mm Three-fluted Cal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173531|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regener Alloderm 4cm X 12 Cm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95173532|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Regener Alloderm 6cm X 16cm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.72|FSC: 13; Default||Not reimbursed separately|93.72|FSC: 13; Default||External grouping not supported 95130262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95173535|EAP|Custom 95173535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath 6fr Angle Pigtail Dual Lumen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130264|EAP|Custom 95130264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Sequestering|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173536|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7fr 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95130266|EAP|Custom 95130266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Chest Tube 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130269|EAP|HCPCS Q4102||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Oasis 3cm X 7cm Per Sq Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|FSC: 13; Default||Not reimbursed separately|33.75|FSC: 13; Default||External grouping not supported 95130270|EAP|Custom 95130270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 18x30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Radial Bipolar #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,714.00|FSC: 13; Default||Not reimbursed separately|6,714.00|FSC: 13; Default||External grouping not supported 95130271|EAP|Custom 95130271||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Bifurcated Exclud|1|HUMANA [1294]||HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 99900125|EAP|Custom 99900125|||Ris Link Chg Img10746|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 111mm 8 Hole W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.12|FSC: 13; Default||Not reimbursed separately|123.12|FSC: 13; Default||External grouping not supported 95130276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95130280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95130281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95188631|EAP|Custom 95188631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm With K-wire Attachment For Gliding Hole/71mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130282|EAP|Custom 95130282||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Drainage Tubing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130284|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Tractfinder 2.3 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95173572|EAP|Custom 95173572||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .018 Diameter X 3cm Length|1|HUMANA [1294]||HUMANA [11839]|203.94|FSC: 13; Default||Not reimbursed separately|203.94|FSC: 13; Default||External grouping not supported 95130288|EAP|Custom 95130288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Peripheral 2.0mm(6fr.)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173573|EAP|Custom 95173573||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .018 Diameter X 5cm Length|1|HUMANA [1294]||HUMANA [11839]|296.61|FSC: 13; Default||Not reimbursed separately|296.61|FSC: 13; Default||External grouping not supported 95130289|EAP|Custom 95130289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Peripheral 2.3mm(7fr.)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173574|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft Vu 4fr Sidewinder 1 Box/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95173575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle 100 Gription Without Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95130292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95173576|EAP|Custom 95173576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Drill Pin Disposable |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 8 Hole Bridge Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 95130300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Right Size-2 P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,720.00|FSC: 13; Default||Not reimbursed separately|9,720.00|FSC: 13; Default||External grouping not supported 95173578|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.0 Ao Diopter Crystalens Posterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Right #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,720.00|FSC: 13; Default||Not reimbursed separately|9,720.00|FSC: 13; Default||External grouping not supported 95173556|EAP|Custom 95173556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Tool Tunneling 60cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Left #8 Pca-e Series|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,181.55|FSC: 13; Default||Not reimbursed separately|10,181.55|FSC: 13; Default||External grouping not supported 95173557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Dome Rd 3-post Pfc Sigma 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95130305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 80mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,123.50|FSC: 13; Default||Not reimbursed separately|1,123.50|FSC: 13; Default||External grouping not supported 95173558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insertibial Stabilizing Pfc Sigma Rp Size 3-20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95130311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 98mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,201.35|FSC: 13; Default||Not reimbursed separately|1,201.35|FSC: 13; Default||External grouping not supported 95173559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abg Ii Cementless V40 Left No 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95130317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 116mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,272.18|FSC: 13; Default||Not reimbursed separately|1,272.18|FSC: 13; Default||External grouping not supported 95173562|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite .035 7.0mm X 39mm Cathe Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 224mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,051.07|FSC: 13; Default||Not reimbursed separately|2,051.07|FSC: 13; Default||External grouping not supported 95173563|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 7.0mm X 59mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 296mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,688.36|FSC: 13; Default||Not reimbursed separately|2,688.36|FSC: 13; Default||External grouping not supported 95173564|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 8.0mm X 29mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130325|EAP|Custom 95130325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheet Nasal 40x9x1.1mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95173565|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 8.0mm X 39mm Cath Lenghth80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130326|EAP|Custom 95130326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wedge Enophthalmos Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173566|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 9.0mm X 59mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95173567|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 8.0mm X 59mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95173568|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 7.0mm X 29mm Cath Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95173569|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 8.0mm X 29mm Cath Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,317.80|FSC: 13; Default||Not reimbursed separately|2,317.80|FSC: 13; Default||External grouping not supported 95173570|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 8.0mm X 39mm Cath Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,579.82|FSC: 13; Default||Not reimbursed separately|2,579.82|FSC: 13; Default||External grouping not supported 95173571|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omilink Elite 9.0mm X 39mm Cath Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95130356|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Tractfinder 2.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95185701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.0 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95130357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,134.46|FSC: 13; Default||Not reimbursed separately|3,134.46|FSC: 13; Default||External grouping not supported 95130358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 4.5mm X 147mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,605.77|FSC: 13; Default||Not reimbursed separately|2,605.77|FSC: 13; Default||External grouping not supported 95130360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 4.5mm X 83mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,968.45|FSC: 13; Default||Not reimbursed separately|1,968.45|FSC: 13; Default||External grouping not supported 95118418|EAP|Custom 95118418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Wound 19fr Round With Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 25mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173581|EAP|Custom 95173581||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shears Coagulating Ace Harmonic 36cm Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 30mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95130363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 35mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 14mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95130364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 40mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Oleranon 2.7mm/3.5mm 4 Hole Left/116mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,365.79|FSC: 13; Default||Not reimbursed separately|3,365.79|FSC: 13; Default||External grouping not supported 95130365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 45mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pyrosphere 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,296.00|FSC: 13; Default||Not reimbursed separately|7,296.00|FSC: 13; Default||External grouping not supported 95130368|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great-toe Silastic Size0|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95173586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95130369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 50mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173587|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bypass Micro Trabecular Istent Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95130371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 55mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95173588|EAP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bypass Micro Trabecular Istent Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95130372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 60mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95130373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 65mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95130374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 4.5mm X 70mm Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|FSC: 13; Default||Not reimbursed separately|98.73|FSC: 13; Default||External grouping not supported 95130379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 28mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|FSC: 13; Default||Not reimbursed separately|52.08|FSC: 13; Default||External grouping not supported 95173593|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 9.0 Diopter Acrysof Toric Iq 13.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95130383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 30mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|FSC: 13; Default||Not reimbursed separately|52.08|FSC: 13; Default||External grouping not supported 95173594|EAP|Custom 95173594||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strapping Non Adhesive Loop Beige 2x25 Yds|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 32mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|FSC: 13; Default||Not reimbursed separately|52.08|FSC: 13; Default||External grouping not supported 95173595|EAP|Custom 95173595||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Loop Elastic Beige 1x 25 Yd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 34mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|FSC: 13; Default||Not reimbursed separately|52.08|FSC: 13; Default||External grouping not supported 95173597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95130389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 36mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|FSC: 13; Default||Not reimbursed separately|52.08|FSC: 13; Default||External grouping not supported 95130393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 38mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.89|FSC: 13; Default||Not reimbursed separately|40.89|FSC: 13; Default||External grouping not supported 95130401|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95130403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 40mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|FSC: 13; Default||Not reimbursed separately|52.08|FSC: 13; Default||External grouping not supported 95130406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 42mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|FSC: 13; Default||Not reimbursed separately|58.14|FSC: 13; Default||External grouping not supported 95192257|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130407|EAP|Custom 95130407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Intramedullary Brush Pulsava|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 44mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|FSC: 13; Default||Not reimbursed separately|58.14|FSC: 13; Default||External grouping not supported 95130421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 46mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|FSC: 13; Default||Not reimbursed separately|58.14|FSC: 13; Default||External grouping not supported 95130423|EAP|Custom 95130423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wedge Enophthalmos Left Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95130426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95130427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95173608|EAP|Custom 95173608||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Oxyhood Superdome Disposable W/weights |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95173613|EAP|Custom 95173613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Pin Hoffman 3 5-hole|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95173614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Hoffman 3 11 X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.75|FSC: 13; Default||Not reimbursed separately|1,068.75|FSC: 13; Default||External grouping not supported 95130430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95173615|EAP|Custom 95173615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Calibrated Speciality Ao Variax 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95173602|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Renegade Stc 150 20 Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.0mm10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95173603|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Renegade Stc 150 30 Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.0mm12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.12|FSC: 13; Default||Not reimbursed separately|108.12|FSC: 13; Default||External grouping not supported 95173604|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB GUIDEWIRE FATHOM .014 200CM STRAIGHT |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95130435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95130436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95130437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 62061890|EAP|CPT® 86780||0302 - LABORATORY - IMMUNOLOGY|Hb Treponemal Ab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 95130438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95130441|EAP|Custom 95130441||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable W/protective Caps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 40mm-4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95130443|EAP|Custom 95130443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Conization C-letz Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173619|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 7 X 119 X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95130444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 48mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|FSC: 13; Default||Not reimbursed separately|58.14|FSC: 13; Default||External grouping not supported 95173621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va Buttress Pin With T8 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95130445|EAP|Custom 95130445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lasso Suture 90-degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173622|EAP|Custom 95173622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Internal Sundt 3mm X 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 4.5mm X 50mm With 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.94|FSC: 13; Default||Not reimbursed separately|47.94|FSC: 13; Default||External grouping not supported 95185700|EAP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cervical Mobi-c Standard 13 X 15 X|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95130447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95173625|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon 4mm X 80mm X 135mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95173627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Biglian/flatow 17mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95130449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95173626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix Ti 4.5mm With Orthocord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 95130450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95173628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95130451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95173629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Translational Atlantis Fixed 4 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95130453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95173630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95130455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95173631|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 95130463|EAP|Custom 95130463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Suture Ta Prem 30-4.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130464|EAP|Custom 95130464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Salem Sump 10frx36|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163751|EAP|CPT® 93583||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Septal Ablation|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 95130470|EAP|Custom 95130470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic White Great 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188634|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95130471|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Straight 5fr X 65 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130478|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95173632|EAP|Custom 95173632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Long First Fracture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173633|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable Sprint Quattro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|FSC: 13; Default||Not reimbursed separately|9,450.00|FSC: 13; Default||External grouping not supported 95130482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95173634|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Protecta Vrm Single Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,474.00|FSC: 13; Default||Not reimbursed separately|39,474.00|FSC: 13; Default||External grouping not supported 95130487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Ect 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|131.40|FSC: 13; Default||Not reimbursed separately|131.40|FSC: 13; Default||External grouping not supported 95173635|EAP|Custom 95173635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pressure Negative Therapy Wound Pico 4x8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173637|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Ventricular Left Tendril 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95173639|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 4.0mm X 80mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173640|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 2.5mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 38mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95173642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +20 23mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95130526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 5.0x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95173643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vdr Aculoc Proximal Standard Long Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 95130533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 42mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95173644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vdr Aculoc Extension Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,893.00|FSC: 13; Default||Not reimbursed separately|1,893.00|FSC: 13; Default||External grouping not supported 95173645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Link Extension Vdr Aculock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95173649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 95173650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 95173651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Thread 6.5mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|FSC: 13; Default||Not reimbursed separately|105.84|FSC: 13; Default||External grouping not supported 95130570|EAP|Custom 95130570||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage If Wedge 9x(7x9)x21 (800 2)|1|HUMANA [1294]||HUMANA [11839]|7,785.00|FSC: 13; Default||Not reimbursed separately|7,785.00|FSC: 13; Default||External grouping not supported 95173652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95130574|EAP|Custom 95130574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instruments Scissors Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm L36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95130575|EAP|Custom 95130575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Bowel Babcock Grasper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm L65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95130576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95173655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|FSC: 13; Default||Not reimbursed separately|4,933.44|FSC: 13; Default||External grouping not supported 95130577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95173656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95173657|EAP|Custom 95173657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium 200 Tract Tip Flexi Va|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130588|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130592|EAP|Custom 95130592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Graft Acl 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 40mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130617|EAP|Custom 95130617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Oximetrix (opticath)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130623|EAP|Custom 95130623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173659|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 24mm X 113cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|FSC: 13; Default||Not reimbursed separately|19,542.00|FSC: 13; Default||External grouping not supported 95130638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 60mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95173660|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Acx-low Height Double Chamber Texture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95130639|EAP|Custom 95130639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Straight 4fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173661|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Acx-low Height Double Chamber Texture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95130646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 65mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 70mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 75mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 80mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 85mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 90mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95130653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 80163769|EAP|CPT® 78201||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Liver Imaging Static Only|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95130654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 80163777|EAP|HCPCS S2095||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcath Occ Or Embol Tumor|1|HUMANA [1294]||HUMANA [11839]|7,919.43|FSC: 13; Default||Not reimbursed separately|7,919.43|FSC: 13; Default||External grouping not supported 95130655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 80163785|EAP|CPT® 79445||0330 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - GENERAL CLASSIFICATION|Hb Radiopharm Therapy|1|HUMANA [1294]||HUMANA [11839]|676.47|FSC: 13; Default||Not reimbursed separately|676.47|FSC: 13; Default||External grouping not supported 95130661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 80163793|EAP|CPT® 77263||0330 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - GENERAL CLASSIFICATION|Hb Ther Rad Planning Complex|1|HUMANA [1294]||HUMANA [11839]|498.38|FSC: 13; Default||Not reimbursed separately|498.38|FSC: 13; Default||External grouping not supported 95130662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173663|EAP|Custom 95173663||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Nasal Adult C02/02 10/bx M2750a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173667|EAP|Custom 95173667||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant Cpr Mini Scorpion Dx|1|HUMANA [1294]||HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95130670|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173668|EAP|Custom 95173668||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Plif 11 X 9 X 23mm|1|HUMANA [1294]||HUMANA [11839]|12,765.00|FSC: 13; Default||Not reimbursed separately|12,765.00|FSC: 13; Default||External grouping not supported 95130671|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Peel-away Percutaneou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Plif 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,919.00|FSC: 13; Default||Not reimbursed separately|2,919.00|FSC: 13; Default||External grouping not supported 95130675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Head Tulip Plif 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,772.00|FSC: 13; Default||Not reimbursed separately|2,772.00|FSC: 13; Default||External grouping not supported 95130676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Single Ball 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,983.00|FSC: 13; Default||Not reimbursed separately|1,983.00|FSC: 13; Default||External grouping not supported 95130677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95173674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fusion Pip Implant Ipp-on Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.11|FSC: 13; Default||Not reimbursed separately|3,712.11|FSC: 13; Default||External grouping not supported 95130678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173664|EAP|Custom 95173664||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adapter Light Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173689|EAP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Durata Sts Df-4 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|FSC: 13; Default||Not reimbursed separately|13,081.50|FSC: 13; Default||External grouping not supported 95130685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173699|EAP|Custom 95173699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A2 Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95173694|EAP|Custom 95173694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Interaxis 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173695|EAP|Custom 95173695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A1 Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130688|EAP|Custom 95130688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Radial Artery 20ga X 4.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper 12/14 + 12 28 Mm Oxinum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.50|FSC: 13; Default||Not reimbursed separately|4,630.50|FSC: 13; Default||External grouping not supported 95130689|EAP|Custom 95130689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Super Cvc Arrowgard Blue 16g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173697|EAP|Custom 95173697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A2 Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173698|EAP|Custom 95173698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A3 Regular |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95130693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95130694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95173705|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Duraflow Chronic Dialysis 55cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|822.00|FSC: 13; Default||Not reimbursed separately|822.00|FSC: 13; Default||External grouping not supported 95130695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173707|EAP|Custom 95173707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 10.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173708|EAP|Custom 95173708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 10.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173709|EAP|Custom 95173709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 7.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95173710|EAP|Custom 95173710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 7.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95173711|EAP|Custom 95173711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 7.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,657.67|FSC: 13; Default||Not reimbursed separately|2,657.67|FSC: 13; Default||External grouping not supported 95173712|EAP|Custom 95173712||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 7.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,813.49|FSC: 13; Default||Not reimbursed separately|2,813.49|FSC: 13; Default||External grouping not supported 95173713|EAP|Custom 95173713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 8.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173714|EAP|Custom 95173714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 8.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130724|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95173715|EAP|Custom 95173715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 8.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130725|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 35.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95173716|EAP|Custom 95173716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 8.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130726|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 40.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95173717|EAP|Custom 95173717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 9.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,657.67|FSC: 13; Default||Not reimbursed separately|2,657.67|FSC: 13; Default||External grouping not supported 95173718|EAP|Custom 95173718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hanna 9.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,813.49|FSC: 13; Default||Not reimbursed separately|2,813.49|FSC: 13; Default||External grouping not supported 95173720|EAP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pentaray F Curve|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130743|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ultrasnd Atlantis Sr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173721|EAP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pentaray D Curve|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130745|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ecr40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Microstable 20 Degree Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,937.59|FSC: 13; Default||Not reimbursed separately|3,937.59|FSC: 13; Default||External grouping not supported 95130746|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173723|EAP|Custom 95173723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chamber Viewing W/luer Lok|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130747|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fusion Pip Implant Ipp-on Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,962.02|FSC: 13; Default||Not reimbursed separately|2,962.02|FSC: 13; Default||External grouping not supported 95130748|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu 3.75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173739|EAP|Custom 95173739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Microsphere Quadrasphere Orange 25cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130749|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 52.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,575.00|FSC: 13; Default||Not reimbursed separately|7,575.00|FSC: 13; Default||External grouping not supported 95130750|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Ebu5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173741|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Primewire Prestige Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130751|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Ebu30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173742|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide 6 Fr .070 Im 55 Cm Vista Brite Renal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130753|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Ebu45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112164|EAP|Custom 95112164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mmdia 140mm Le|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130754|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Mac30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173743|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide 6 Fr .070 Stk 55 Cm Vista Brite Renal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130755|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Mac35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173744|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide 6fr .070 Rdc Large 55 Cm Vista Brite Renal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130756|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr 40 Mac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173745|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guid 6fr .070 Rdci Small 55 Cm Vista Brite Renal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130757|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ecr3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173746|EAP|Custom 95173746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pressure Negative Therapy Wound Pico 6x8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,657.67|FSC: 13; Default||Not reimbursed separately|2,657.67|FSC: 13; Default||External grouping not supported 95173753|EAP|Custom 95173753||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ketac Liquid 12ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,813.49|FSC: 13; Default||Not reimbursed separately|2,813.49|FSC: 13; Default||External grouping not supported 95130766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Lcp Volar Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,657.67|FSC: 13; Default||Not reimbursed separately|2,657.67|FSC: 13; Default||External grouping not supported 95173759|EAP|Custom 95173759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Administration Protocol 2 6470|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Radius Distal Lcp 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,517.67|FSC: 13; Default||Not reimbursed separately|1,517.67|FSC: 13; Default||External grouping not supported 95173761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95130770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Radius Distal Lcp 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,581.39|FSC: 13; Default||Not reimbursed separately|1,581.39|FSC: 13; Default||External grouping not supported 95173762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95130776|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Renegade Microcatheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95173764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95130780|EAP|Custom 95130780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Retrieval Balloon 15.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95130781|EAP|Custom 95130781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Imager 5fr/jb3/100|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130782|EAP|Custom 95130782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Nasal Bipap Petite With Hep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163801|EAP|CPT® 20950||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Monitor For Compartment Syndrome|1|HUMANA [1294]||HUMANA [11839]|1,738.23|FSC: 13; Default||Not reimbursed separately|1,738.23|FSC: 13; Default||External grouping not supported 95130783|EAP|Custom 95130783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Nasal Bipap Medium Small Wr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130785|EAP|Custom 95130785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Autotome .44|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130786|EAP|Custom 95130786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Autotome .39|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130790|EAP|Custom 95130790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express Ld 37mm X 10mm|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95173758|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000300 Prime Grafix 2 X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|891.00|FSC: 13; Default||Not reimbursed separately|891.00|FSC: 13; Default||External grouping not supported 95130793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Radius 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,473.48|FSC: 13; Default||Not reimbursed separately|1,473.48|FSC: 13; Default||External grouping not supported 95173775|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Cath 5.0mm X 100mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130794|EAP|Custom 95130794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Intro Percutaneous Sheath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173779|EAP|Custom 95173779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphere Stealth Station (5pk)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173780|EAP|Custom 95173780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Iconix 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.11|FSC: 13; Default||Not reimbursed separately|1,468.11|FSC: 13; Default||External grouping not supported 95173781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Iconix 1.4mm With 1 Strand #2 Forced Fiber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95130799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,538.91|FSC: 13; Default||Not reimbursed separately|1,538.91|FSC: 13; Default||External grouping not supported 95173782|EAP|Custom 95173782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Capslock Ultra 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.11|FSC: 13; Default||Not reimbursed separately|1,468.11|FSC: 13; Default||External grouping not supported 95173783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tri-shank 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|FSC: 13; Default||Not reimbursed separately|5,370.00|FSC: 13; Default||External grouping not supported 95130801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,538.91|FSC: 13; Default||Not reimbursed separately|1,538.91|FSC: 13; Default||External grouping not supported 95173784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tri-shank 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|FSC: 13; Default||Not reimbursed separately|5,370.00|FSC: 13; Default||External grouping not supported 95173785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tri-shank 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|FSC: 13; Default||Not reimbursed separately|5,370.00|FSC: 13; Default||External grouping not supported 95173786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 95130805|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.0mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 95130806|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.0mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95165440|EAP|Custom 95165440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Pro 10fr Single Lumen Dual Swivel 12 Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130807|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173795|EAP|Custom 95173795||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 13mm X 11mm X 34mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95130808|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Zp Thread Short 3.8 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95130809|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.0mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173755|EAP|Custom 95173755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K Wire 1.4|1|HUMANA [1294]||HUMANA [11839]|42.00|FSC: 13; Default||Not reimbursed separately|42.00|FSC: 13; Default||External grouping not supported 95130812|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173756|EAP|Custom 95173756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.11|FSC: 13; Default||Not reimbursed separately|1,468.11|FSC: 13; Default||External grouping not supported 95173757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Thread Long 2.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 95130818|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173796|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Willflex 22mm Diameter 12cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 95130819|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.0mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173797|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Straight Dream 035 Stiff 450cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130820|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173798|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilation Esophageal Hercules 3 Stage 12-13.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130821|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173799|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Oval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95130822|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173800|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Acx-lowheight Double Chamber Textured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95130823|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.0mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173801|EAP|Custom 95173801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Therapy Abd Open Active Abthera|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130824|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95130825|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.5mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95173803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Triathlon #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95130826|EAP|Custom 95130826||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Ext Arterial 10f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173804|EAP|Custom 95173804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Nitinol Monpolar 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130827|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173805|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Quadra Assura Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|FSC: 13; Default||Not reimbursed separately|66,552.00|FSC: 13; Default||External grouping not supported 95130830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 100 Degree Left Extra Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95173806|EAP|Custom 95173806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 25ga With 5fr Catheter Luer Slip Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130832|EAP|Custom 95130832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Preparation Cement Bone Femo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173807|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Safire Blu Duo Ablation Large Curl|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,538.91|FSC: 13; Default||Not reimbursed separately|1,538.91|FSC: 13; Default||External grouping not supported 95173808|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Unify Bi-ventricular Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|FSC: 13; Default||Not reimbursed separately|60,912.00|FSC: 13; Default||External grouping not supported 95130840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 16 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95173809|EAP|Custom 95173809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Lead Accessory Df4 Header|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,538.91|FSC: 13; Default||Not reimbursed separately|1,538.91|FSC: 13; Default||External grouping not supported 95173810|EAP|Custom 95173810||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Prior Sport Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130844|EAP|Custom 95130844||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stimulator Bone Osteogen Implant|1|HUMANA [1294]||HUMANA [11839]|14,850.00|FSC: 13; Default||Not reimbursed separately|14,850.00|FSC: 13; Default||External grouping not supported 95173814|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Balloon With Shiley Percutanious Cuffed Tracheoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130850|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Hp 325|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95173815|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Balloon With Shiley Percutaneous Cuffed Trach|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Monoblock 0 Degre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|FSC: 13; Default||Not reimbursed separately|9,149.40|FSC: 13; Default||External grouping not supported 95173816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm X 20/5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95130854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95173817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink 2.8mm Ao Coupling |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|785.40|FSC: 13; Default||Not reimbursed separately|785.40|FSC: 13; Default||External grouping not supported 95130855|EAP|Custom 95130855||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Ureterotomy 7fr.x24cm|1|HUMANA [1294]||HUMANA [11839]|275.25|FSC: 13; Default||Not reimbursed separately|275.25|FSC: 13; Default||External grouping not supported 95173818|EAP|Custom 95173818||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Tendon Tissue Bovine Fetal Tissuemend 5cmx6cm|1|HUMANA [1294]||HUMANA [11839]|9,477.72|FSC: 13; Default||Not reimbursed separately|9,477.72|FSC: 13; Default||External grouping not supported 95130860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95173819|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Visiglide .025 450cm Angled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130861|EAP|Custom 95130861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 1.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Eccentric 64x28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|FSC: 13; Default||Not reimbursed separately|3,619.20|FSC: 13; Default||External grouping not supported 95185715|EAP|Custom 95185715||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Patellar Pre-shaped 10/10mm|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95130872|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Hig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95130873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 45mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95188636|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross Elite 1.5 X 20 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95130877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 10x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95185721|EAP|Custom 95185721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Access Pedicle Insulated Diamond Springless|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Left 2.0mm 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95130882|EAP|Custom 95130882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Mako Sterilin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192258|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 4.5x62mm Sel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95130888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Snap-off 2x13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|FSC: 13; Default||Not reimbursed separately|894.00|FSC: 13; Default||External grouping not supported 95185708|EAP|Custom 95185708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Brk Transseptal 18g 98cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf 3.5mm 6-hole 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,018.47|FSC: 13; Default||Not reimbursed separately|1,018.47|FSC: 13; Default||External grouping not supported 99900126|EAP|Custom 99900126|||Ris Link Chg Img10749|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 6mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95188637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Flex Cinch Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,363.56|FSC: 13; Default||Not reimbursed separately|1,363.56|FSC: 13; Default||External grouping not supported 95130894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 7mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 99900127|EAP|Custom 99900127|||Ris Link Chg Img10750|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 9mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95185726|EAP|Custom 95185726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Hammertoe I Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 6mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 99900128|EAP|Custom 99900128|||Ris Link Chg Img10751|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 8mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95130898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 1.5mm Left 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.96|FSC: 13; Default||Not reimbursed separately|711.96|FSC: 13; Default||External grouping not supported 95185706|EAP|Custom 95185706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Phoenix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 1.5mm Right 7-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.96|FSC: 13; Default||Not reimbursed separately|711.96|FSC: 13; Default||External grouping not supported 95188638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Meniscal Repair Truespan 12 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,140.00|FSC: 13; Default||Not reimbursed separately|1,140.00|FSC: 13; Default||External grouping not supported 95130900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H 1.5mm 4-hole 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|FSC: 13; Default||Not reimbursed separately|415.32|FSC: 13; Default||External grouping not supported 95185709|EAP|Custom 95185709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 752cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.5mm 20-holes 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95192259|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.5mm 3-hole -hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95185705|EAP|Custom 95185705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 492cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.5mm 4-hole 9-hole Shaf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.84|FSC: 13; Default||Not reimbursed separately|543.84|FSC: 13; Default||External grouping not supported 95188641|EAP|Custom 95188641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ultratape 2mm Co Braided Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 2.0mm Left 39mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|FSC: 13; Default||Not reimbursed separately|682.29|FSC: 13; Default||External grouping not supported 95185710|EAP|Custom 95185710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 659cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 4-hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|FSC: 13; Default||Not reimbursed separately|415.32|FSC: 13; Default||External grouping not supported 95130906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 5-hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.09|FSC: 13; Default||Not reimbursed separately|435.09|FSC: 13; Default||External grouping not supported 95130907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 6-hole 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.86|FSC: 13; Default||Not reimbursed separately|454.86|FSC: 13; Default||External grouping not supported 95130908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 7-hole 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.63|FSC: 13; Default||Not reimbursed separately|474.63|FSC: 13; Default||External grouping not supported 95173838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,380.25|FSC: 13; Default||Not reimbursed separately|3,380.25|FSC: 13; Default||External grouping not supported 95130909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 8-hole 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|484.53|FSC: 13; Default||Not reimbursed separately|484.53|FSC: 13; Default||External grouping not supported 95173839|EAP|Custom 95173839||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tachosil Medium 4.8cm X 4.8cm|1|HUMANA [1294]||HUMANA [11839]|1,110.77|FSC: 13; Default||Not reimbursed separately|1,110.77|FSC: 13; Default||External grouping not supported 95130910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|FSC: 13; Default||Not reimbursed separately|504.30|FSC: 13; Default||External grouping not supported 95173840|EAP|Custom 95173840||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tachosil Large 9.5cm X 4.8cm|1|HUMANA [1294]||HUMANA [11839]|1,950.51|FSC: 13; Default||Not reimbursed separately|1,950.51|FSC: 13; Default||External grouping not supported 95130911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 12-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95173841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Appia Fx Biothenodesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.36|FSC: 13; Default||Not reimbursed separately|1,032.36|FSC: 13; Default||External grouping not supported 95130912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 2.0mm 20-holes 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95173842|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Profile High/full Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95130913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 2-hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.88|FSC: 13; Default||Not reimbursed separately|365.88|FSC: 13; Default||External grouping not supported 95173843|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Profile High/full Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95130914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Left 57mm Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|FSC: 13; Default||Not reimbursed separately|721.83|FSC: 13; Default||External grouping not supported 80163819|EAP|CPT® 81003||0307 - LABORATORY - UROLOGY|Hb Poc Ua Automated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 95130915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 2-hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 62061908|EAP|CPT® 86790||0302 - LABORATORY - IMMUNOLOGY|Hb Sin Nombre Virus Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 95130916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Right 57mm Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|FSC: 13; Default||Not reimbursed separately|721.83|FSC: 13; Default||External grouping not supported 62061916|EAP|CPT® 86790||0302 - LABORATORY - IMMUNOLOGY|Hb Sin Nombre Virus Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 95130917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 4-hole 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.21|FSC: 13; Default||Not reimbursed separately|336.21|FSC: 13; Default||External grouping not supported 62061924|EAP|CPT® 84560||0301 - LABORATORY - CHEMISTRY|Hb Uric Acid, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|15.24|FSC: 13; Default||Not reimbursed separately|15.24|FSC: 13; Default||External grouping not supported 95130918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 5-hole 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.65|FSC: 13; Default||Not reimbursed separately|385.65|FSC: 13; Default||External grouping not supported 62061932|EAP|CPT® 82088||0301 - LABORATORY - CHEMISTRY|Hb Aldosterone, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|122.25|FSC: 13; Default||Not reimbursed separately|122.25|FSC: 13; Default||External grouping not supported 95130919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 6-hole 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.42|FSC: 13; Default||Not reimbursed separately|405.42|FSC: 13; Default||External grouping not supported 62061940|EAP|CPT® 87529||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Herpes Simplex Virus Pcr Qualitative - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95130920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 7-hole 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 62061957|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Drugs Of Abuse, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95130921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 8-hole 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|FSC: 13; Default||Not reimbursed separately|504.30|FSC: 13; Default||External grouping not supported 95185712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Vairable Angle 3.5mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95130922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 9-hole 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.97|FSC: 13; Default||Not reimbursed separately|533.97|FSC: 13; Default||External grouping not supported 95130923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.41|FSC: 13; Default||Not reimbursed separately|583.41|FSC: 13; Default||External grouping not supported 95130924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.7mm 12-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.52|FSC: 13; Default||Not reimbursed separately|662.52|FSC: 13; Default||External grouping not supported 95173847|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Progreat Omega Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|FSC: 13; Default||Not reimbursed separately|106.80|FSC: 13; Default||External grouping not supported 95173848|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Progreat Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.11|FSC: 13; Default||Not reimbursed separately|1,468.11|FSC: 13; Default||External grouping not supported 95173849|EAP|Custom 95173849||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Chest Contoured Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 81mm 7 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|559.38|FSC: 13; Default||Not reimbursed separately|559.38|FSC: 13; Default||External grouping not supported 95173845|EAP|Custom 95173845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Floseal 10,000u Thrombin Spray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm 3-hole Head 9-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95173846|EAP|Custom 95173846||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tisseel 10ml|1|HUMANA [1294]||HUMANA [11839]|1,669.89|FSC: 13; Default||Not reimbursed separately|1,669.89|FSC: 13; Default||External grouping not supported 95130929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm 4-hole Head 9-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.84|FSC: 13; Default||Not reimbursed separately|543.84|FSC: 13; Default||External grouping not supported 95173853|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Assura Fortify Icd Dr40 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,562.50|FSC: 13; Default||Not reimbursed separately|45,562.50|FSC: 13; Default||External grouping not supported 95130930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95173854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95130933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Oblique 3.5mm 3-hole 4-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.97|FSC: 13; Default||Not reimbursed separately|533.97|FSC: 13; Default||External grouping not supported 95173855|EAP|Custom 95173855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.1 Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 4-hole Head 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|FSC: 13; Default||Not reimbursed separately|504.30|FSC: 13; Default||External grouping not supported 95173856|EAP|Custom 95173856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6 Trocar Tip |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm.4-hole Head 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|563.64|FSC: 13; Default||Not reimbursed separately|563.64|FSC: 13; Default||External grouping not supported 95173857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis 12mm X 240mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 95130936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H 2.0mm 4-hole 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|FSC: 13; Default||Not reimbursed separately|415.32|FSC: 13; Default||External grouping not supported 95173858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95130937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mmx20mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95173859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Thread Long 2.5x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95130938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar 2.0mm Right 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|FSC: 13; Default||Not reimbursed separately|682.29|FSC: 13; Default||External grouping not supported 95173860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Thread Long 3.8x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|FSC: 13; Default||Not reimbursed separately|594.00|FSC: 13; Default||External grouping not supported 95130939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm 2-hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95173861|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 5987000301 Prime Grafix 5 X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95130940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm 3-hole 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|316.44|FSC: 13; Default||Not reimbursed separately|316.44|FSC: 13; Default||External grouping not supported 95173862|EAP|Custom 95173862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Histoacryl Clear|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 9 Hole 109mm W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|FSC: 13; Default||Not reimbursed separately|207.66|FSC: 13; Default||External grouping not supported 95173863|EAP|Custom 95173863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Histoacryl Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 12 Hole 145mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|FSC: 13; Default||Not reimbursed separately|207.66|FSC: 13; Default||External grouping not supported 95188642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Anterior Zevo 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,936.00|FSC: 13; Default||Not reimbursed separately|6,936.00|FSC: 13; Default||External grouping not supported 95130943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 4-hole Shaft 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.42|FSC: 13; Default||Not reimbursed separately|405.42|FSC: 13; Default||External grouping not supported 95130944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf Plate 5-hole 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.36|FSC: 13; Default||Not reimbursed separately|939.36|FSC: 13; Default||External grouping not supported 95130946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95130947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95130948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95130949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95130950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95130951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95173868|EAP|Custom 95173868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tube Non-filtered Circuit (3pc Red,green,blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95173869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Qwix Large 4.3mm X 55mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 95130953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 24mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95173870|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Crystalens Posterior Chamber 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95130954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95173871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Locking Ss 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|FSC: 13; Default||Not reimbursed separately|870.48|FSC: 13; Default||External grouping not supported 95130956|EAP|Custom 95130956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Drain 10fr. Sterile Tls|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Locking Ss 2.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|FSC: 13; Default||Not reimbursed separately|870.48|FSC: 13; Default||External grouping not supported 95130959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Snap-off 2x14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|FSC: 13; Default||Not reimbursed separately|894.00|FSC: 13; Default||External grouping not supported 95173873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Locking Ss 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|FSC: 13; Default||Not reimbursed separately|870.48|FSC: 13; Default||External grouping not supported 95130960|EAP|Custom 95130960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp 4.0mm X 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173874|EAP|Custom 95173874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 12.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130961|EAP|Custom 95130961||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Vascular Graft 12mm-24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173875|EAP|Custom 95173875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reaming Coring Collared Pin 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Frs 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95173876|EAP|Custom 95173876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Infusion Katzen 180cm Katzen/.035 46-197|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Frs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95173877|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95130965|EAP|Custom 95130965||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Titan Assembly|1|HUMANA [1294]||HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 95173878|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95130966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 9.0mm X 30mm In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95173879|EAP|Custom 95173879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Flexible Long Heated Wires 51 In For F&p|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.0mm16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95130968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Oblique Right 2.0mm 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95173864|EAP|Custom 95173864||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Voice Term Short Radiesse 1.0cc |1|HUMANA [1294]||HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95130971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Zephir Self-drilling 3.5x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.75|FSC: 13; Default||Not reimbursed separately|819.75|FSC: 13; Default||External grouping not supported 95173866|EAP|Custom 95173866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trap Water Bellow Oscillator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin Threaded 1.1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.00|FSC: 13; Default||Not reimbursed separately|123.00|FSC: 13; Default||External grouping not supported 95173867|EAP|Custom 95173867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cap & Diaphram Oscillator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130976|EAP|Custom 95130976||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Vertestack Lordotic 14mm|1|HUMANA [1294]||HUMANA [11839]|15,282.12|FSC: 13; Default||Not reimbursed separately|15,282.12|FSC: 13; Default||External grouping not supported 95134263|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Prodigy Sr Single Chamber Rate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|FSC: 13; Default||Not reimbursed separately|8,250.00|FSC: 13; Default||External grouping not supported 95130977|EAP|Custom 95130977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Sinus-frontal Rains Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173880|EAP|Custom 95173880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory For Spinal Cord Stimulator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 9x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95173881|EAP|Custom 95173881||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Patient Trial For Spinal Cord Stimulator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Frs 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95173884|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Prowater Flex J Diameter 180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95130982|EAP|Custom 95130982||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide Threaded 2.0mm|1|HUMANA [1294]||HUMANA [11839]|123.00|FSC: 13; Default||Not reimbursed separately|123.00|FSC: 13; Default||External grouping not supported 95173886|EAP|Custom 95173886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Tfcc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Zephir Self-drilling 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.93|FSC: 13; Default||Not reimbursed separately|1,029.93|FSC: 13; Default||External grouping not supported 95173887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant Repair Ankle Lateral Arthrobrostrom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95173888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Brigade Lordotic 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 95130985|EAP|Custom 95130985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Compression Soc 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5 X 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95130987|EAP|Custom 95130987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Distractor Fixator Ankle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5 X 30.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95130991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Distal Radius 2.4mm Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,538.91|FSC: 13; Default||Not reimbursed separately|1,538.91|FSC: 13; Default||External grouping not supported 95173893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lisfranc Small Ti Left |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95130992|EAP|Custom 95130992||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner .8 Frs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173896|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sir-spheres Microsphere |1|HUMANA [1294]||HUMANA [11839]|49,500.00|FSC: 13; Default||Not reimbursed separately|49,500.00|FSC: 13; Default||External grouping not supported 95130994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchor 5.5 L-15 #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95173897|EAP|Custom 95173897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb V-vial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 6mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95173898|EAP|Custom 95173898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb V-vial Holder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130998|EAP|Custom 95130998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Pilot-tip Drill Distal 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173899|EAP|Custom 95173899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vial Holder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Arrow Meniscus 1.1mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.90|FSC: 13; Default||Not reimbursed separately|372.90|FSC: 13; Default||External grouping not supported 95173900|EAP|Custom 95173900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Shield|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95173901|EAP|Custom 95173901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Delivery Box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173902|EAP|Custom 95173902||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hemostatic Matrix Surgiflo W/thrombin 8ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131002|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Axbifem Stretch Fully Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,653.00|FSC: 13; Default||Not reimbursed separately|13,653.00|FSC: 13; Default||External grouping not supported 95173906|EAP|Custom 95173906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Tenkman 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 8mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|FSC: 13; Default||Not reimbursed separately|357.21|FSC: 13; Default||External grouping not supported 95173907|EAP|Custom 95173907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 3mm X 5cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131005|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension C1883|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|FSC: 13; Default||Not reimbursed separately|1,980.00|FSC: 13; Default||External grouping not supported 95173908|EAP|Custom 95173908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 2mm X 2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131007|EAP|Custom 95131007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Pacing Myocardial Temporary|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173909|EAP|Custom 95173909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 2mm X 4cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131008|EAP|Custom 95131008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Cartridge 13mmx15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173910|EAP|Custom 95173910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 3mm X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131012|EAP|Custom 95131012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Introducer Splittable Atta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173911|EAP|Custom 95173911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 3mm X 2cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95173912|EAP|Custom 95173912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 4mm X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131017|EAP|Custom 95131017||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Seguin Sjm 26m|1|HUMANA [1294]||HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95173913|EAP|Custom 95173913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 4mm X 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131018|EAP|Custom 95131018||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Seguin Sjm 28m|1|HUMANA [1294]||HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95173914|EAP|Custom 95173914||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Hip/knee With Leg Lifter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131019|EAP|Custom 95131019||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Seguin Sjm 30m|1|HUMANA [1294]||HUMANA [11839]|6,798.00|FSC: 13; Default||Not reimbursed separately|6,798.00|FSC: 13; Default||External grouping not supported 95173920|EAP|Custom 95173920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Galil Ice Sphere Individual|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131020|EAP|Custom 95131020||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Seguin Sjm 32m|1|HUMANA [1294]||HUMANA [11839]|6,798.00|FSC: 13; Default||Not reimbursed separately|6,798.00|FSC: 13; Default||External grouping not supported 95173922|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Fully-ringed Thin-wall 10mmx80cm Removable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,035.00|FSC: 13; Default||Not reimbursed separately|4,035.00|FSC: 13; Default||External grouping not supported 95131021|EAP|Custom 95131021||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Seguin Sjm 34m|1|HUMANA [1294]||HUMANA [11839]|6,798.00|FSC: 13; Default||Not reimbursed separately|6,798.00|FSC: 13; Default||External grouping not supported 95173923|EAP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Tachyarrhythmia Implantable Sprint Quattro Secur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|FSC: 13; Default||Not reimbursed separately|9,450.00|FSC: 13; Default||External grouping not supported 95131022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cann Headless Acutrak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95173928|EAP|Custom 95173928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 4mm X 5cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95173929|EAP|Custom 95173929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Azur 18d System 6mm X 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131025|EAP|Custom 95131025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Silastic .062 Idx.125 Dd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|209.67|FSC: 13; Default||Not reimbursed separately|209.67|FSC: 13; Default||External grouping not supported 95131054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|209.67|FSC: 13; Default||Not reimbursed separately|209.67|FSC: 13; Default||External grouping not supported 95131056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95131057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95131058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95131061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95131062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting3mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.10|FSC: 13; Default||Not reimbursed separately|41.10|FSC: 13; Default||External grouping not supported 95131063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95131065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Pca-ace/deep-socket 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.45|FSC: 13; Default||Not reimbursed separately|3,105.45|FSC: 13; Default||External grouping not supported 80163827|EAP|CPT® 95928||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Motor Evoked Potentials (mep) Upper Limbs|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95131066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Pca Acetabular Lowpro 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,159.00|FSC: 13; Default||Not reimbursed separately|3,159.00|FSC: 13; Default||External grouping not supported 80163835|EAP|CPT® 95929||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Motor Evoked Potentials (mep) Lower Limbs|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95131067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Cup Premise 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,313.25|FSC: 13; Default||Not reimbursed separately|1,313.25|FSC: 13; Default||External grouping not supported 95173930|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Excluder 23 X 14.5 16cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95173931|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Contra 23 X 14cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95131070|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Dual Lumen Picc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173935|EAP|Custom 95173935||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Forumla Enfacare Pwd 12.8oz Can 6/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95173941|EAP|Custom 95173941||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Needle Curved 360 Degree Reversed Fas|1|HUMANA [1294]||HUMANA [11839]|1,466.52|FSC: 13; Default||Not reimbursed separately|1,466.52|FSC: 13; Default||External grouping not supported 95131076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 60mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|FSC: 13; Default||Not reimbursed separately|661.20|FSC: 13; Default||External grouping not supported 95173942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Brigade Lordotic 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,439.00|FSC: 13; Default||Not reimbursed separately|14,439.00|FSC: 13; Default||External grouping not supported 95131077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 2.4mm10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95173943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95131078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm-taper Ext-neck Lm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95173944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 6.5 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95131079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95173945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 6.5 X 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95131080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95173946|EAP|Custom 95173946||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14mm X 42mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95131568|EAP|Custom 95131568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.25mmdia 150mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Screw Bio Cork With 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95173959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.7mm X 12mm Self Tapping With T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|137.88|FSC: 13; Default||Not reimbursed separately|137.88|FSC: 13; Default||External grouping not supported 95131083|EAP|Custom 95131083||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.75 Loop Tantalum|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95173947|EAP|Custom 95173947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Jejunal 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95173954|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated Heparin Propaten Rind Removable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,033.00|FSC: 13; Default||Not reimbursed separately|9,033.00|FSC: 13; Default||External grouping not supported 95131096|EAP|Custom 95131096||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.0 Loop Tantalum|1|HUMANA [1294]||HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95173955|EAP|Custom 95173955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Ao Diameter 2.6mm Length 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131097|EAP|Custom 95131097||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.50 Loop Tantalum|1|HUMANA [1294]||HUMANA [11839]|200.25|FSC: 13; Default||Not reimbursed separately|200.25|FSC: 13; Default||External grouping not supported 95173957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar 2 Column Lcp Va Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95131103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 6.25mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95173958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.7 X 14mm Self Tapping With T8 Star|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95131106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95173960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Va Ti 2.4mm X 12mm Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95131109|EAP|Custom 95131109||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Bone 1cc Dynagraft|1|HUMANA [1294]||HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95173965|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 7mm X 60mm X 80cm Cath Leng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95131110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95173966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95131111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95173967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95131112|EAP|Custom 95131112||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Compression Soc 30mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95173968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95131113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Meniscal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95131114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 10x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95173970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp-va-lcp Small 5 Degree Left |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 95131115|EAP|Custom 95131115||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dynagraft 5cc|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95173971|EAP|Custom 95173971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Pin 5 Hole 4/5/6mm Hoffman3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Arrow Meniscus 1.1mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.90|FSC: 13; Default||Not reimbursed separately|372.90|FSC: 13; Default||External grouping not supported 95185717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical 4.5mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95131118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Harpoon W/o-stop|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95131121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131122|EAP|Custom 95131122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Pilot-tip Drill Distal 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.5mm Va-lcp Prox-tibial Small Bend 4h/87mm/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.42|FSC: 13; Default||Not reimbursed separately|4,968.42|FSC: 13; Default||External grouping not supported 95131124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95188643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Zevo Va 3.5x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95131126|EAP|Custom 95131126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nephro-stent Ureteral 2.0x6.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95185714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Viariable Angle 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95131130|EAP|Custom 95131130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Laproscopic Mini-retractoral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131131|EAP|Custom 95131131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 4.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95173973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Angled 30 Degree 1mm Hoffman3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|351.00|FSC: 13; Default||Not reimbursed separately|351.00|FSC: 13; Default||External grouping not supported 95131137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95173974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 11 X 250mm Hoffman3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,044.00|FSC: 13; Default||Not reimbursed separately|1,044.00|FSC: 13; Default||External grouping not supported 95131138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95173975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 11 X 400mm Hoffman3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,165.50|FSC: 13; Default||Not reimbursed separately|1,165.50|FSC: 13; Default||External grouping not supported 95131139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95173976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Threaded Apex 5 X 200 X 60mm S/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95131141|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 5 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95131143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 8mm Ex 39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95173978|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 39cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95131145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Zephir 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|FSC: 13; Default||Not reimbursed separately|3,474.00|FSC: 13; Default||External grouping not supported 95173979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95131146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95173982|EAP|Custom 95173982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pressure Negative Therapy Wound Pico 4x12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Screw W/lock Tue Alta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.60|FSC: 13; Default||Not reimbursed separately|219.60|FSC: 13; Default||External grouping not supported 95173983|EAP|Custom 95173983||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bur Maxima Diamonds|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shoulder Head Eccentric Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,678.00|FSC: 13; Default||Not reimbursed separately|6,678.00|FSC: 13; Default||External grouping not supported 95173984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95131149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular Quarter 2.7mm 5ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95173985|EAP|Custom 95173985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Noncannulated 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Bigliani/flatow 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|FSC: 13; Default||Not reimbursed separately|10,047.27|FSC: 13; Default||External grouping not supported 95173986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 300mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,682.88|FSC: 13; Default||Not reimbursed separately|4,682.88|FSC: 13; Default||External grouping not supported 95131151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95158220|EAP|Custom 95158220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131152|EAP|Custom 95131152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Lar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173988|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Excluder 31 X 14.5 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131154|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.0mm X 10mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173990|EAP|Custom 95173990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spinal 25g X 6 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131155|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.25mm X 10mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173991|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Y-shaped Artisyn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95131156|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.5mm X 10mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173992|EAP|Custom 95173992||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Pericardial W/termafix Process |1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95131157|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.5mm X 15mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173993|EAP|Custom 95173993||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Value Bioprosthesis Pericardial W/termafix Process|1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95131158|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.75mm X 10mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173994|EAP|Custom 95173994||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Value Bioprosthesis Pericardial W/termafix Process |1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95131159|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.75mm X 15mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173995|EAP|Custom 95173995||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Value Bioprosthesis Pericardial W/termafix Process |1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95131160|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.0mm X 10mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173996|EAP|Custom 95173996||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Value Bioprosthesis Pericardial W/termafix Process |1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95131161|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.0mm X 15mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173998|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Psm Matristem 7cm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.66|FSC: 13; Default||Not reimbursed separately|51.66|FSC: 13; Default||External grouping not supported 95131162|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.5mm X 10mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95173999|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Glaucoma Ahmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95131163|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.5mm X 15mm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 32.5mm Nuvasive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95131166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3-deg Level 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,312.00|FSC: 13; Default||Not reimbursed separately|3,312.00|FSC: 13; Default||External grouping not supported 95174001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Selft Tapping 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95131167|EAP|Custom 95131167||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Ti Bow 24mm|1|HUMANA [1294]||HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 38mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95131168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 189mm 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,963.77|FSC: 13; Default||Not reimbursed separately|1,963.77|FSC: 13; Default||External grouping not supported 95174003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95131169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Bow 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95174004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Tx Axsos 10 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95131170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inner Summit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95174005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Single 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.00|FSC: 13; Default||Not reimbursed separately|1,611.00|FSC: 13; Default||External grouping not supported 95131172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off Spin 11mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,140.00|FSC: 13; Default||Not reimbursed separately|1,140.00|FSC: 13; Default||External grouping not supported 95174006|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Micro Super Cross 150cm 120 Distal Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174007|EAP|Custom 95174007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5 X 125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95185713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Variable Angle 3.5mm X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95131190|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95188644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Zevo Va 4.0 X 13 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95131193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 85mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,012.56|FSC: 13; Default||Not reimbursed separately|1,012.56|FSC: 13; Default||External grouping not supported 95131195|EAP|Custom 95131195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Hand Access Lap-disc Late|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax Narrow Straight 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|FSC: 13; Default||Not reimbursed separately|2,484.00|FSC: 13; Default||External grouping not supported 95131196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|FSC: 13; Default||Not reimbursed separately|5,949.00|FSC: 13; Default||External grouping not supported 95131197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95112692|EAP|Custom 95112692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pezzar Propor-head 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 9mm Ex 39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95185722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Standard T2 9mmx375mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95131203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini T 1.5mm 50mm 3 Hole H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|677.43|FSC: 13; Default||Not reimbursed separately|677.43|FSC: 13; Default||External grouping not supported 95131204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 30mm With 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|FSC: 13; Default||Not reimbursed separately|33.75|FSC: 13; Default||External grouping not supported 95188645|EAP|Custom 95188645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Foot Strap Ankle Dstrctr Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ebi Cortical Pennig 80/35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95131207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95185725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe I 3 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95131208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95131210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131211|EAP|Custom 95131211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131212|EAP|Custom 95131212||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 8.7 X 16mm Barbed|1|HUMANA [1294]||HUMANA [11839]|134.49|FSC: 13; Default||Not reimbursed separately|134.49|FSC: 13; Default||External grouping not supported 95131214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131219|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-extender C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,075.00|FSC: 13; Default||Not reimbursed separately|6,075.00|FSC: 13; Default||External grouping not supported 95131222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174008|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vessel Guard Preclude Ptfe 5cm X 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95131234|EAP|Custom 95131234||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetab Deep-profile +e15 N|1|HUMANA [1294]||HUMANA [11839]|10,740.00|FSC: 13; Default||Not reimbursed separately|10,740.00|FSC: 13; Default||External grouping not supported 95174009|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vessel Guard Preclude Ptfe 6cm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95131240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Centralign Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,936.05|FSC: 13; Default||Not reimbursed separately|4,936.05|FSC: 13; Default||External grouping not supported 95174010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95131241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Centralign Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,036.79|FSC: 13; Default||Not reimbursed separately|5,036.79|FSC: 13; Default||External grouping not supported 95174011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Thread Short 2.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|601.80|FSC: 13; Default||Not reimbursed separately|601.80|FSC: 13; Default||External grouping not supported 95131242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174012|EAP|Custom 95174012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Was Autolog Medtronic (includes Atl2001,bt725,el |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131243|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Spincter-control (ams 800)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,365.00|FSC: 13; Default||Not reimbursed separately|7,365.00|FSC: 13; Default||External grouping not supported 95174014|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite .035 7.0mm X 29mm Catheter Leng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|FSC: 13; Default||Not reimbursed separately|332.31|FSC: 13; Default||External grouping not supported 95174015|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 9.0mm X 29mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|FSC: 13; Default||Not reimbursed separately|332.31|FSC: 13; Default||External grouping not supported 95174016|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 9.0mm X 39mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|FSC: 13; Default||Not reimbursed separately|332.31|FSC: 13; Default||External grouping not supported 95174017|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 6.0mm X 29mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|FSC: 13; Default||Not reimbursed separately|332.31|FSC: 13; Default||External grouping not supported 95174018|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 6.0mm X 39mm Cath Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174019|EAP|Custom 95174019||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14mm X 38 X 28mm |1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95131252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174020|EAP|Custom 95174020||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire K Precept |1|HUMANA [1294]||HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95131257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95174021|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 6.0mm X 59mm Cath Lenght 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95174022|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 7.0mm X 39mm Cath Lenght 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 10mm X 200mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|FSC: 13; Default||Not reimbursed separately|13,383.12|FSC: 13; Default||External grouping not supported 95174023|EAP|Custom 95174023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Knee Tibial 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 95174024|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Pulse Implantable Rechargable Mini Eon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,946.50|FSC: 13; Default||Not reimbursed separately|39,946.50|FSC: 13; Default||External grouping not supported 95131265|EAP|Custom 95131265||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemashield Ro|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95174025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Cinch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|202.50|FSC: 13; Default||Not reimbursed separately|202.50|FSC: 13; Default||External grouping not supported 95131266|EAP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Plate Molteno Left-eye D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95174026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus Poly Sz 2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95131268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Micromite 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.18|FSC: 13; Default||Not reimbursed separately|522.18|FSC: 13; Default||External grouping not supported 95174027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10 X 300 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95131270|EAP|Custom 95131270||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Aortic-extender|1|HUMANA [1294]||HUMANA [11839]|6,075.00|FSC: 13; Default||Not reimbursed separately|6,075.00|FSC: 13; Default||External grouping not supported 95174028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro Toe Size 2.8mm X 9mm Angle |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95131272|EAP|Custom 95131272||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Aortic-extender|1|HUMANA [1294]||HUMANA [11839]|6,075.00|FSC: 13; Default||Not reimbursed separately|6,075.00|FSC: 13; Default||External grouping not supported 95174030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 30mm Precept |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95131276|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-limb 11.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,275.00|FSC: 13; Default||Not reimbursed separately|7,275.00|FSC: 13; Default||External grouping not supported 95174029|EAP|Custom 95174029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pro Toe Vo Instrument|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 137mm 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,187.22|FSC: 13; Default||Not reimbursed separately|1,187.22|FSC: 13; Default||External grouping not supported 95174031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 35mm Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95131288|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Z-med 22mmx4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174032|EAP|Custom 95174032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastroscopy Repel 18 Fr Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 35mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95131293|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95174034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95131296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Ts Axsos 12 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95131309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131311|EAP|Custom 95131311||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Heelift Foam-heel Pressure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Ultrasorb 3.5x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95174036|EAP|Custom 95174036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twis 4.5mm/145mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174037|EAP|Custom 95174037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Central 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174038|EAP|Custom 95174038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Central 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174039|EAP|Custom 95174039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Central 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 11mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174040|EAP|Custom 95174040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Lateral 4 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174041|EAP|Custom 95174041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Lateral 5 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131331|EAP|Custom 95131331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endoclip Loading Unit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174042|EAP|Custom 95174042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Lateral 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174043|EAP|Custom 95174043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Cuspid 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174044|EAP|Custom 95174044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Cuspid 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174045|EAP|Custom 95174045||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Cuspid 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131335|EAP|Custom 95131335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Foil Supramid .8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174046|EAP|Custom 95174046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Cuspid 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131337|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95174047|EAP|Custom 95174047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Cuspid 5 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174048|EAP|Custom 95174048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Cuspid 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174051|EAP|Custom 95174051||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Pad |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 62061965|EAP|CPT® 83010||0301 - LABORATORY - CHEMISTRY|Hb Haptoglobin - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.74|FSC: 13; Default||Not reimbursed separately|37.74|FSC: 13; Default||External grouping not supported 95131346|EAP|Custom 95131346||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Patella Horseshoe Withpm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174060|EAP|Custom 95174060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compression Device R-band Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131347|EAP|Custom 95131347||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Lateral Rie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174061|EAP|Custom 95174061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compression Device R-band Extra Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131348|EAP|Custom 95131348||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Patella Horseshoe Withpe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95131351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 12mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95174063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon Ts 10mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95131353|EAP|Custom 95131353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Wescott 20gx15cm 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 5mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.00|FSC: 13; Default||Not reimbursed separately|1,206.00|FSC: 13; Default||External grouping not supported 95131355|EAP|Custom 95131355||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Patella Horseshoe Withpl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper Universal Anatomic Delta |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,318.90|FSC: 13; Default||Not reimbursed separately|6,318.90|FSC: 13; Default||External grouping not supported 95131356|EAP|Custom 95131356||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Patella Horseshoe Withpe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Thick 50mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95131358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 95174068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Titanium U-blade Lag Set 10.5 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,447.28|FSC: 13; Default||Not reimbursed separately|2,447.28|FSC: 13; Default||External grouping not supported 95131363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 95174071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95131364|EAP|Custom 95131364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Cutting Auto 18ga X 10c20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163843|EAP|CPT® 32554||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thoracentesis Aspir Of Pleural Space Wo Image|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95131373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80163850|EAP|CPT® 32555||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thoracentesis Aspir Of Pleural Space W Image|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95131379|EAP|Custom 95131379||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Belt Pelvic Sacro/lumbar Xxxlg L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80163868|EAP|CPT® 32556||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pleural Drain, Percut, W Insert Of Indwelling Cath Wo Image|1|HUMANA [1294]||HUMANA [11839]|4,807.66|FSC: 13; Default||Not reimbursed separately|4,807.66|FSC: 13; Default||External grouping not supported 95131380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.74|FSC: 13; Default||Not reimbursed separately|646.74|FSC: 13; Default||External grouping not supported 80163876|EAP|CPT® 32557||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pleural Drain, Percut, W Insert Of Indwell Cathw Imag|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95131381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80163884|EAP|CPT® 36221||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Non Select Cath Thoracic Aorta W Angio Unil Or Bil|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80163892|EAP|CPT® 36222||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath Common Carotid Or Innominate Artery |1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80163900|EAP|CPT® 36223||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath Plac Common Carotid Or Innominate Artery|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80163918|EAP|CPT® 36224||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath Internal Carotid Artery Unil W Angio|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80163926|EAP|CPT® 36225||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath Subclav Or Innominate Artery Unilat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95131387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80163934|EAP|CPT® 36226||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath Verebral Artery Unilat W Angio|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 95131388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80163942|EAP|CPT® 36227||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath External Carotid Artery Unilat W Angio|1|HUMANA [1294]||HUMANA [11839]|6,294.02|FSC: 13; Default||Not reimbursed separately|6,294.02|FSC: 13; Default||External grouping not supported 95131389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80163959|EAP|CPT® 36228||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Select Cath Each Intracranial Branch Internal Carotid|1|HUMANA [1294]||HUMANA [11839]|5,269.25|FSC: 13; Default||Not reimbursed separately|5,269.25|FSC: 13; Default||External grouping not supported 95131391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Right Large Mgii Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,512.64|FSC: 13; Default||Not reimbursed separately|15,512.64|FSC: 13; Default||External grouping not supported 80163967|EAP|CPT® 37197||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcath Retrieval Percut Intravascular Fb|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95131392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 80163975|EAP|CPT® 37211||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcath Arterial Infusion Thrombolysis Initial Treat|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 95131394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|FSC: 13; Default||Not reimbursed separately|10,409.25|FSC: 13; Default||External grouping not supported 80163983|EAP|CPT® 37212||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcath Venous Infusion Thrombolysis Initial Treat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95131395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Lc-angled Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.84|FSC: 13; Default||Not reimbursed separately|1,635.84|FSC: 13; Default||External grouping not supported 80163991|EAP|CPT® 37213||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tran Arterial Or Venous Thromb Treat Subsq Fu Cath Cont Inject|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95131396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Lc-angled Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 80164007|EAP|CPT® 37214||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trans Art Or Venous Thromb Subsq Day Inj & Closure |1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95131397|EAP|Custom 95131397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Osteosite Bone Biopsy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164015|EAP|CPT® 78012||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Thyroid Uptake, Single Or Multi Quant Measurement|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95131398|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis 9mmx5cm 754|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 80164023|EAP|CPT® 78013||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Thyroid Imaging|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95131401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80164031|EAP|CPT® 78014||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Thyroid Image Incl Vasc Flow W Single Or Multi Quant|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95131404|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide (calib Drill Point)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80164049|EAP|CPT® 90791||0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY|Hb Psychiatric Diagnositc Evaluation|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 95131405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Bigliani/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|FSC: 13; Default||Not reimbursed separately|5,078.67|FSC: 13; Default||External grouping not supported 80164056|EAP|CPT® 90792||0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY|Hb Psyciatric Diagnostic Eval With Med Services|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 95131406|EAP|Custom 95131406||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Symmix|1|HUMANA [1294]||HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 80164064|EAP|CPT® 92920||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Coronary Plasty Single Major Artery |1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95131407|EAP|Custom 95131407||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 13mm X 13mm X 25m|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 80164296|EAP|CPT® 70328||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Tmj Unilateral|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95131408|EAP|Custom 95131408||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 11mm X 13mm X 21m|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 80164304|EAP|CPT® 72120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb L-spine Bending 2-3 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95131409|EAP|Custom 95131409||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hooks Open 11mm|1|HUMANA [1294]||HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 80164312|EAP|CPT® 72200||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Si Joints < 3 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95131410|EAP|Custom 95131410||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 9mm X 13mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 80164072|EAP|CPT® 92921||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Coronary Plasty Each Add Branch|1|HUMANA [1294]||HUMANA [11839]|10,007.00|FSC: 13; Default||Not reimbursed separately|10,007.00|FSC: 13; Default||External grouping not supported 95131411|EAP|Custom 95131411||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 15mm X 15mm X 25m|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 80164080|EAP|CPT® 92924||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Coronary Ather W Plasty Single Major Art|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95131412|EAP|Custom 95131412||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brantigan 13mm X 15mm X 25m|1|HUMANA [1294]||HUMANA [11839]|8,550.00|FSC: 13; Default||Not reimbursed separately|8,550.00|FSC: 13; Default||External grouping not supported 80164098|EAP|CPT® 92925||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Tran Coronary Ather W Plasty Each Add Major |1|HUMANA [1294]||HUMANA [11839]|11,229.00|FSC: 13; Default||Not reimbursed separately|11,229.00|FSC: 13; Default||External grouping not supported 95131413|EAP|Custom 95131413||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Closed 6.5|1|HUMANA [1294]||HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 80164106|EAP|CPT® 92928||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Intracor Stent W Plasty Single Major|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95131414|EAP|Custom 95131414||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Compression 14mm|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 80164114|EAP|CPT® 92929||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Intracor Stent W Plasty Each Add|1|HUMANA [1294]||HUMANA [11839]|13,071.55|FSC: 13; Default||Not reimbursed separately|13,071.55|FSC: 13; Default||External grouping not supported 95131415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 6.25mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|FSC: 13; Default||Not reimbursed separately|915.00|FSC: 13; Default||External grouping not supported 80164122|EAP|CPT® 92933||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Coronary Ather W Ic Stent W Plasty Singl|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 95131416|EAP|Custom 95131416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Right Heart|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164130|EAP|CPT® 92934||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Coronary Ather W Ic Stent W Plasty Eac |1|HUMANA [1294]||HUMANA [11839]|12,052.50|FSC: 13; Default||Not reimbursed separately|12,052.50|FSC: 13; Default||External grouping not supported 80164148|EAP|CPT® 92941||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Revas Acute Occlu Acute Mi Coronary Art |1|HUMANA [1294]||HUMANA [11839]|18,451.94|FSC: 13; Default||Not reimbursed separately|18,451.94|FSC: 13; Default||External grouping not supported 95131421|EAP|Custom 95131421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 20x16 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164155|EAP|CPT® 92943||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Revas Chronic Total Occlu,coron Artery Single|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95131422|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 17ga X 4.6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80164163|EAP|CPT® 92944||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Revas Chronic Occlu Coron Artery Each|1|HUMANA [1294]||HUMANA [11839]|13,637.00|FSC: 13; Default||Not reimbursed separately|13,637.00|FSC: 13; Default||External grouping not supported 95131426|EAP|Custom 95131426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Wescott 22g X 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164171|EAP|CPT® 93653||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Ep Study Incl Ins And Repos Multi Elect W Induc Arr|1|HUMANA [1294]||HUMANA [11839]|63,083.28|FSC: 13; Default||Not reimbursed separately|63,083.28|FSC: 13; Default||External grouping not supported 95131427|EAP|Custom 95131427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Greene W/introducer 22gw/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164189|EAP|CPT® 93654||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Ep Study Inc Ins Repos Multi Elec W Induc Arry Rt Atr|1|HUMANA [1294]||HUMANA [11839]|63,083.28|FSC: 13; Default||Not reimbursed separately|63,083.28|FSC: 13; Default||External grouping not supported 95131429|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle 19g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80164197|EAP|CPT® 93655||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Intra Cath Ablation Discrete Mech Arrhy Distinct |1|HUMANA [1294]||HUMANA [11839]|11,146.00|FSC: 13; Default||Not reimbursed separately|11,146.00|FSC: 13; Default||External grouping not supported 95131433|EAP|Custom 95131433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Bone 16gx7.5 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164205|EAP|CPT® 93656||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Ep Transsept Cath Ins Repos Multi Elect Cath W/indu|1|HUMANA [1294]||HUMANA [11839]|63,083.28|FSC: 13; Default||Not reimbursed separately|63,083.28|FSC: 13; Default||External grouping not supported 95131434|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Nitinol 035x180 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80164213|EAP|CPT® 93657||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Add Linear Or Focal Intra Ablation Lt Or Rt Artium|1|HUMANA [1294]||HUMANA [11839]|11,000.00|FSC: 13; Default||Not reimbursed separately|11,000.00|FSC: 13; Default||External grouping not supported 95131435|EAP|Custom 95131435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 14 Ga X 10 Cm 20/b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164221|EAP|CPT® 95907||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 1-2 Studies|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95131436|EAP|Custom 95131436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Single Action 20gx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164239|EAP|CPT® 95908||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 3-4 Studies|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95131437|EAP|Custom 95131437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Trocar 16 Ga X 4.6 Cm 10/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164247|EAP|CPT® 95909||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 5-6 Studies|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95131443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Eccentric Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,678.00|FSC: 13; Default||Not reimbursed separately|6,678.00|FSC: 13; Default||External grouping not supported 80164254|EAP|CPT® 95910||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 7-8 Studies|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95131444|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Arterial Embolectomy Fogar)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80164262|EAP|CPT® 95911||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 9-10 Studies|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95131447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 80164270|EAP|CPT® 95912||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 11-12 Studies|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95131449|EAP|Custom 95131449||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Synthetic Roll Ortho-gla`|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164288|EAP|CPT® 95913||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Nerve Conduction Studies; 13 Or More Studies|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95131450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Augmented 19.5 Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,087.00|FSC: 13; Default||Not reimbursed separately|9,087.00|FSC: 13; Default||External grouping not supported 95174072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95131451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Rim Std D/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,916.45|FSC: 13; Default||Not reimbursed separately|5,916.45|FSC: 13; Default||External grouping not supported 95174073|EAP|Custom 95174073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 2.5mm X 195mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.0mm X 10mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|FSC: 13; Default||Not reimbursed separately|69.24|FSC: 13; Default||External grouping not supported 95174074|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Afx 17fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95174075|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Unibody Bifurcated 22mm X 60mm/13mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95131454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.0mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95174076|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Entension Cuff Aortic Proximal 28mm X 28mm Covered |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,105.00|FSC: 13; Default||Not reimbursed separately|12,105.00|FSC: 13; Default||External grouping not supported 95131455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95174077|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ensnare|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95174078|EAP|Custom 95174078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 0.014|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95174079|EAP|Custom 95174079||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adaptor Valve Hemostasis|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95131458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95174080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodensis Biocomposite 7mm X 19.1mm Swivelock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95131459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.20|FSC: 13; Default||Not reimbursed separately|247.20|FSC: 13; Default||External grouping not supported 95174081|EAP|Custom 95174081||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extractor Conical Hand Left Male 3.5|1|HUMANA [1294]||HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95131460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|FSC: 13; Default||Not reimbursed separately|207.66|FSC: 13; Default||External grouping not supported 95174082|EAP|Custom 95174082||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extractor Conical Hand Left Male 4 |1|HUMANA [1294]||HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95131461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95174083|EAP|Custom 95174083||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extractor Conical Hand Left Male 5|1|HUMANA [1294]||HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95131462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 11 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95174084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95131468|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95174085|EAP|Custom 95174085||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant X-core 15-20mm|1|HUMANA [1294]||HUMANA [11839]|20,985.00|FSC: 13; Default||Not reimbursed separately|20,985.00|FSC: 13; Default||External grouping not supported 95174086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 3.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95131470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxinium Right Sz-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 95174087|EAP|Custom 95174087||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector 38mm|1|HUMANA [1294]||HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95131471|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Venous 4- Lumen 8.5fr X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174088|EAP|Custom 95174088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Ao Diameter 2.0mm Lenth 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 95174089|EAP|Custom 95174089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Ao Diameter 2.6mm Lenth 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131474|EAP|Custom 95131474||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Affinity 9mm X 12mm|1|HUMANA [1294]||HUMANA [11839]|12,450.90|FSC: 13; Default||Not reimbursed separately|12,450.90|FSC: 13; Default||External grouping not supported 95174090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5lg 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|FSC: 13; Default||Not reimbursed separately|1,662.00|FSC: 13; Default||External grouping not supported 95131475|EAP|Custom 95131475||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Affinity 8mm X 12mm|1|HUMANA [1294]||HUMANA [11839]|12,450.90|FSC: 13; Default||Not reimbursed separately|12,450.90|FSC: 13; Default||External grouping not supported 95174091|EAP|Custom 95174091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vent Heart Left Dlp 10 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm Dual Core Locking T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 95131496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 3mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.50|FSC: 13; Default||Not reimbursed separately|34.50|FSC: 13; Default||External grouping not supported 95131497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 3mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.10|FSC: 13; Default||Not reimbursed separately|41.10|FSC: 13; Default||External grouping not supported 95131498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95185723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.0 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95131499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Omega 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.00|FSC: 13; Default||Not reimbursed separately|474.00|FSC: 13; Default||External grouping not supported 95131500|EAP|Custom 95131500||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sideplate Omega 130-deg 4-hole|1|HUMANA [1294]||HUMANA [11839]|834.00|FSC: 13; Default||Not reimbursed separately|834.00|FSC: 13; Default||External grouping not supported 95131501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 5mm With T40 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|842.61|FSC: 13; Default||Not reimbursed separately|842.61|FSC: 13; Default||External grouping not supported 95131519|EAP|Custom 95131519||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Durahesive 1-3/4 Natura|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131520|EAP|Custom 95131520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Durahesive 2-1/4 Natura|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131521|EAP|Custom 95131521||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer W/convex-it 5/8 Stoma 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131522|EAP|Custom 95131522||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer W Convex-it 7 8 Stoma 1-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131523|EAP|Custom 95131523||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Durahesive W/convex-it 1-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164320|EAP|CPT® 95782||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Polysomnography <6 Years 4 Or More Parameters|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95131525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 10mm With T40 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|842.61|FSC: 13; Default||Not reimbursed separately|842.61|FSC: 13; Default||External grouping not supported 80164338|EAP|CPT® 95783||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Polysomnography <6 W Cont Positive Airway Pressure|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95131528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 15mm With T40 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|842.61|FSC: 13; Default||Not reimbursed separately|842.61|FSC: 13; Default||External grouping not supported 95174093|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon 10mm X 40mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 18mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174094|EAP|Custom 95174094||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Orbital |1|HUMANA [1294]||HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95131532|EAP|Custom 95131532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 7 Hole Bridge Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|FSC: 13; Default||Not reimbursed separately|3,037.50|FSC: 13; Default||External grouping not supported 95131533|EAP|Custom 95131533||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Matrix Deminerilzed 5cc Mix|1|HUMANA [1294]||HUMANA [11839]|3,360.21|FSC: 13; Default||Not reimbursed separately|3,360.21|FSC: 13; Default||External grouping not supported 95174096|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Aorta Thoracic Decending |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,485.00|FSC: 13; Default||Not reimbursed separately|31,485.00|FSC: 13; Default||External grouping not supported 95131538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 20mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174101|EAP|Custom 95174101||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interlock 7mm|1|HUMANA [1294]||HUMANA [11839]|8,010.00|FSC: 13; Default||Not reimbursed separately|8,010.00|FSC: 13; Default||External grouping not supported 95131539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 22mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174103|EAP|Custom 95174103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epidural Touhy 20ga X 6 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 24mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174104|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Vertigraft Cervical Vg2 6.75mm X 8.22m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.19|FSC: 13; Default||Not reimbursed separately|3,299.19|FSC: 13; Default||External grouping not supported 95131545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 26mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 28mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 11 X 380 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95131548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 30mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131551|EAP|Custom 95131551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Rita Starburst Xl 3-5cm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131552|EAP|Custom 95131552||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Endostat Coaxial .6mm No C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131554|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 4.8x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95131555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 32mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174107|EAP|Custom 95174107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epidural Touhy 20ga X 6 10/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 34mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174110|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Sinuplasty Sinus Spin Relieva A |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 36mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174111|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Cath Guide Sinus Spin Relieva A |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 38mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Ps Xlpe Legion Size 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 95131598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95174114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Base Tibial Ii Genesis Cmt Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95131599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Longevity 20-degree 66x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|FSC: 13; Default||Not reimbursed separately|3,968.64|FSC: 13; Default||External grouping not supported 95174115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 3-hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95131600|EAP|Custom 95131600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cardioplegia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Gap 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95131601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 40mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174121|EAP|Custom 95174121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Cylinder Large Shape Actifuse|1|HUMANA [1294]||HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95131607|EAP|Custom 95131607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Gold 7french|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow 23mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|FSC: 13; Default||Not reimbursed separately|5,974.56|FSC: 13; Default||External grouping not supported 95131609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 42mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Anchor Healix Transtend Br/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,826.00|FSC: 13; Default||Not reimbursed separately|2,826.00|FSC: 13; Default||External grouping not supported 95131616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 44mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Anchor Healix Transtend Peek/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,701.00|FSC: 13; Default||Not reimbursed separately|1,701.00|FSC: 13; Default||External grouping not supported 95174136|EAP|Custom 95174136||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Nexgen Specific Patient Cr-flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174137|EAP|Custom 95174137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Models Bone Knee Specific Patient (femur/tibia)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Constrained Duraloc 66x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 95131623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Chin D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95131624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Chin D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95185724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 44mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95131625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Chin D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95131626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Chin D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95131627|EAP|Custom 95131627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 4.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 3-level 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95188647|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Gold Turnpike 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 46mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95185707|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Fenestrated Proximal Custom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95131634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 48mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Dcp Mini 2.0mm 4-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|FSC: 13; Default||Not reimbursed separately|396.00|FSC: 13; Default||External grouping not supported 95131637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 50mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95188648|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Spiral Turnpike 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 52mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 80168743|EAP|Custom 80168743||0998 - STATISTICAL CHARGES|Hb Iv Therapy N/c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 54mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Poly 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|FSC: 13; Default||Not reimbursed separately|857.85|FSC: 13; Default||External grouping not supported 95188649|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lp Turnpike 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Poly 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|FSC: 13; Default||Not reimbursed separately|857.85|FSC: 13; Default||External grouping not supported 95131648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Poly 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|FSC: 13; Default||Not reimbursed separately|857.85|FSC: 13; Default||External grouping not supported 95188650|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lp Turnpike 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Poly 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|FSC: 13; Default||Not reimbursed separately|857.85|FSC: 13; Default||External grouping not supported 95131650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Poly 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|FSC: 13; Default||Not reimbursed separately|857.85|FSC: 13; Default||External grouping not supported 95188651|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Standard Turnpike 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Poly 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.69|FSC: 13; Default||Not reimbursed separately|840.69|FSC: 13; Default||External grouping not supported 95131652|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Profile Low 550c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95131653|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Profile Low 650c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95174138|EAP|Custom 95174138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray On Control 6cm 11g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131654|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast H-p Smooth Gel 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95174139|EAP|Custom 95174139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray On Control 10cm 11g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131655|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast H-p Smooth Gel 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95174140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Abg Ii Cementless V40 Left No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95174141|EAP|Custom 95174141||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 12 Degree 37x27x16mm|1|HUMANA [1294]||HUMANA [11839]|25,284.00|FSC: 13; Default||Not reimbursed separately|25,284.00|FSC: 13; Default||External grouping not supported 95174142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angle Fixed 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95174143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angle Fixed 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95174144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 13 X 340 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95131672|EAP|Custom 95131672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ablator 60-deg. W/suction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174120|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sub Graft Bone Strip Large Shape Actifuse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,910.00|FSC: 13; Default||Not reimbursed separately|8,910.00|FSC: 13; Default||External grouping not supported 95131675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 56mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174122|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sub Graft Bone Cylinder Medium Shape Actifuse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95131676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 58mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174123|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Sub Graft Bone Applicator And 10cc Abx/w Actifuse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|FSC: 13; Default||Not reimbursed separately|6,825.00|FSC: 13; Default||External grouping not supported 95131677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 60mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174124|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cartridge Refill Mis 10cc Abx Actifuse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95174129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95131686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 62mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95131687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 64mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 6 5mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95131698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 66mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174132|EAP|Custom 95174132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Disposable Juggerknot 1.4mm|1|HUMANA [1294]||HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95131727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 68mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131740|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Newton .035 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 70mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 72mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 74mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14 36mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95131776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 76mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 80164346|EAP|CPT® 37785||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vein Ligation|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95131780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 78mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95188653|EAP|Custom 95188653||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Scp Foot And Ankle|1|HUMANA [1294]||HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95131781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 80mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 26mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174155|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Foxcross 6mm X 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 30mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X 3 Triathlon Sz 5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95131784|EAP|Custom 95131784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 55mm Vascular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174160|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 7mm Diameter 60mm 125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95131785|EAP|Custom 95131785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Linear 60mm Heavy Wire R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Oleranon 2.7mm/3.5mm 2 Hole Left/90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,365.79|FSC: 13; Default||Not reimbursed separately|3,365.79|FSC: 13; Default||External grouping not supported 95131798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 32mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95131804|EAP|Custom 95131804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer Side Arm 7 Fr Tuo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95174164|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Proximal Extension Zenith 32mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|FSC: 13; Default||Not reimbursed separately|15,594.00|FSC: 13; Default||External grouping not supported 95131814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 36mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131819|EAP|Custom 95131819||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Primary Iv Pump With Distal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 40mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 42mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95131828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 46mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 80164353|EAP|Custom 80164353||0998 - STATISTICAL CHARGES|Hb Contrast $0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174165|EAP|Custom 95174165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occl Intlok 10mm X 30cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 48mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174166|EAP|Custom 95174166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occl Intlok 10mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 50mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174168|EAP|Custom 95174168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quadraspheres 50-100um 10ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Xlpe Acetabular R3 20 Deagree +4 36mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 95131852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 52mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174171|EAP|Custom 95174171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer Vessel Endowrist Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 54mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174172|EAP|Custom 95174172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Juggerknot 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 56mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot 1.5 Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 95131857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 58mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174174|EAP|Custom 95174174||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Curved Sterile Juggerknot 1.5|1|HUMANA [1294]||HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95131860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 60mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Brigade Lordotic 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 95131869|EAP|Custom 95131869||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Delivery Ob 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Contoured 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,439.00|FSC: 13; Default||Not reimbursed separately|14,439.00|FSC: 13; Default||External grouping not supported 95174177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95131880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 64mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95131881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 66mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 80164361|EAP|CPT® 92937||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Revas Art Bypass Graft Ima Stent Sng Vessel|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95131907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 68mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 80164379|EAP|CPT® 92938||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percut Trans Revas Art Bypass Graft Ima Stent Add Ves|1|HUMANA [1294]||HUMANA [11839]|14,241.48|FSC: 13; Default||Not reimbursed separately|14,241.48|FSC: 13; Default||External grouping not supported 95131908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 70mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 80164387|EAP|CPT® 49411||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Of Fiducial Markers|1|HUMANA [1294]||HUMANA [11839]|3,844.33|FSC: 13; Default||Not reimbursed separately|3,844.33|FSC: 13; Default||External grouping not supported 95131912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 72mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174180|EAP|Custom 95174180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Juggerknot Flexible |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Fm Taper Extended Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|FSC: 13; Default||Not reimbursed separately|10,309.74|FSC: 13; Default||External grouping not supported 95174181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Biocomposite 3.5mm X 14.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95131917|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95174182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,985.01|FSC: 13; Default||Not reimbursed separately|1,985.01|FSC: 13; Default||External grouping not supported 95131918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial Distal Tibi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,027.43|FSC: 13; Default||Not reimbursed separately|5,027.43|FSC: 13; Default||External grouping not supported 95174183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial 9mm X 0.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95131922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal Posterior L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95174194|EAP|Custom 95174194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Helix Concerto 5mm X 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Volar Distal Lt 8 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|FSC: 13; Default||Not reimbursed separately|1,918.29|FSC: 13; Default||External grouping not supported 95174195|EAP|Custom 95174195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Helix Concerto 5mm X 20cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticualr Rt Sm T-radi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95174197|EAP|Custom 95174197||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Kwire L 60mm|1|HUMANA [1294]||HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95131929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial T Dorsal Distal Lef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|FSC: 13; Default||Not reimbursed separately|1,849.08|FSC: 13; Default||External grouping not supported 95174198|EAP|Custom 95174198||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Kwire For 5.0 System|1|HUMANA [1294]||HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 95131932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Volar Ulna Radius|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95174199|EAP|Custom 95174199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Pointcoil Gold .9x5mm 18g/20cm Needle Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 74mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174200|EAP|Custom 95174200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Pointcoil Gold Sbrt .8x5mm 19g/15cm Trocar |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95174203|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.8/2.8f 110cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 76mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174204|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.8/2.8f 110cm Angled |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 10mm X 170mm Biglia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,686.00|FSC: 13; Default||Not reimbursed separately|7,686.00|FSC: 13; Default||External grouping not supported 95174205|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.8/2.8f 110cm Swan Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131954|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95174206|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.8/2.8f 130cm Angled |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174207|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.9/2.9f 110cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 78mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174208|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.9/2.9f 110cm Angled |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131962|EAP|Custom 95131962||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Seguin Sjm 36m|1|HUMANA [1294]||HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95174209|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.9/2.9f 110cm Swan Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 80mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174211|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.9/2.9f 130cm Angled |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 85mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174210|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Maestro 2.9/2.9f 130cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131965|EAP|Custom 95131965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Multi-pin Large 6-position|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174213|EAP|Custom 95174213||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Post Op Natura Drainable Pouch 100mm 4in Cut To|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131966|EAP|Custom 95131966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Combo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp First Va-lcp Small 0 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 95131967|EAP|Custom 95131967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Multi-pin Large 4-position|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174215|EAP|Custom 95174215||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Contour Deluxe Petite Disposable W/headst|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131968|EAP|Custom 95131968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attachment Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174216|EAP|Custom 95174216||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Compression 1.6mm 25mm Thread 150mm|1|HUMANA [1294]||HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95131972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 90mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Ts Delta 12/14 + 1.5 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|FSC: 13; Default||Not reimbursed separately|8,133.30|FSC: 13; Default||External grouping not supported 95131974|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95174218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle 100 Gription Without Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95131975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 95mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Medium Left Knee Hinged Rotating Howmedica|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95131978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 100mm F/im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95174221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Proximal Small Insert Gmrs 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95131979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 38cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95131981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95131982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95131983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 2.0mm Emergency W/stard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.75|FSC: 13; Default||Not reimbursed separately|108.75|FSC: 13; Default||External grouping not supported 95192179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb Ti6al4v 4.0mmx50mm Self Tap Hexagonal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95131984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95131985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95188655|EAP|Custom 95188655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Needle Ii Injector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95131988|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95131989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95131991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95131992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 36cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95188656|EAP|Custom 95188656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flex Cinchlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95131994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 18cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95131995|EAP|Custom 95131995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Holder Pin St.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95192271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt 13mm/c-d Femur/cr Sz 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95131998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 34cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95132000|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95132001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95188657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Tm Multi Holes 36x62mm Size Nn Po|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95132003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 42cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95132004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Summit 3.5x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cancellous 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95185737|EAP|Custom 95185737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Round 5.0mm Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95188658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked Highly Longevity 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95132017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95185729|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Fortify Assura Vr Icd U Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,673.00|FSC: 13; Default||Not reimbursed separately|41,673.00|FSC: 13; Default||External grouping not supported 95132021|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Ventricular Screw-in Steroi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95132022|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Identity Adx Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,635.00|FSC: 13; Default||Not reimbursed separately|13,635.00|FSC: 13; Default||External grouping not supported 95192284|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix Cryo 20x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,834.00|FSC: 13; Default||Not reimbursed separately|12,834.00|FSC: 13; Default||External grouping not supported 95132024|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster 4.0 Mh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95132025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95185731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95132027|EAP|Custom 95132027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Disc Disp 3-finger Jack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Absorb Cannulated 4.5x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.78|FSC: 13; Default||Not reimbursed separately|513.78|FSC: 13; Default||External grouping not supported 95188659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 10mm Tib E-f Fem 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95132031|EAP|Custom 95132031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Zps 3.5mm X 60mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|FSC: 13; Default||Not reimbursed separately|73.20|FSC: 13; Default||External grouping not supported 95132032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95132035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95132041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 2.0mm Emergency W/stard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.75|FSC: 13; Default||Not reimbursed separately|114.75|FSC: 13; Default||External grouping not supported 95132044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95185736|EAP|Custom 95185736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Round 3.3mm Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial Distal Rt 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,923.57|FSC: 13; Default||Not reimbursed separately|4,923.57|FSC: 13; Default||External grouping not supported 95132047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95188667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Metaphyseal Slf Tpnw/t9 Strdrive/46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95132049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95132051|EAP|Custom 95132051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Lg Adjustable Open M/r-saf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185732|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 32mm X 125cm Flex Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95132053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Rci 8mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95192296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Full Femoral Porous Universal 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,755.80|FSC: 13; Default||Not reimbursed separately|11,755.80|FSC: 13; Default||External grouping not supported 95132055|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95132058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95185733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Straight 8 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,213.00|FSC: 13; Default||Not reimbursed separately|3,213.00|FSC: 13; Default||External grouping not supported 95132063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Rusm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95188669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7/3.5mm Va-lcp 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,838.61|FSC: 13; Default||Not reimbursed separately|4,838.61|FSC: 13; Default||External grouping not supported 95130265|EAP|Custom 95130265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Z-med 26x2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95185738|EAP|Custom 95185738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Disc Shaped 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95132075|EAP|Custom 95132075||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Chamber Graft Lifenet 5cc|1|HUMANA [1294]||HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95185740|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Sr1 8.5 Fr Swartz 63cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Rusm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Rusm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95188670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm Ti Cortex Slf-tpng With Stardrive Recess 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95132086|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95132087|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95185741|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator 104 Model Duo Demipulse 10cc Dual Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73,143.00|FSC: 13; Default||Not reimbursed separately|73,143.00|FSC: 13; Default||External grouping not supported 95132088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Rusm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132089|EAP|Custom 95132089||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemashield Ro|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95192297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Universal Flute 75mm X 18mm Knee Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 95132091|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Flat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95132098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 22.4x12mm Recon Pl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.00|FSC: 13; Default||Not reimbursed separately|231.00|FSC: 13; Default||External grouping not supported 95185742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Mod Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95132102|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95132105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Gram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95188671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm Ti Cortex Slf Tpng With T6 Stardrive Reces 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95132107|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95132110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm 1/2-thd 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95185745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press-fit Tsa Reunion 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95132111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95132113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Gram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132114|EAP|Custom 95132114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 60mm Linear Heavywire Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132115|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Xtra-support Hi-torque .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95132118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5 X18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95192298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Sigma Tc3 Gvf Uhmwpe 4 - 22.5 Mm Rotate Pltfom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 95132119|EAP|Custom 95132119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler 30mm 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,873.98|FSC: 13; Default||Not reimbursed separately|4,873.98|FSC: 13; Default||External grouping not supported 95132122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Gram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95132127|EAP|Custom 95132127||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Accessory Pacing Temporary Reusa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132128|EAP|Custom 95132128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Delivery 7.5cm X 12ga Stn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Bent 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95132130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95183668|EAP|Custom 95183668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Ruby Complex Stand 8mmx25cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Miami-moss Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95132136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Brom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95185790|EAP|Custom 95185790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Brom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Brom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95192299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.5mm Va-lcp Prox-tibial Small Bend 10h/177mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,780.37|FSC: 13; Default||Not reimbursed separately|5,780.37|FSC: 13; Default||External grouping not supported 95132142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Brom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Brom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95185785|EAP|Custom 95185785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Ac Repair|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Brom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95188673|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 6 X 15 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95132162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Blum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95185805|EAP|Custom 95185805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Accessory Vagus Demipulse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Blum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Blum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132173|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii Std Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185770|EAP|Custom 95185770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm Compression Ft Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132174|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii Lg Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188674|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 2.5 X 30 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132181|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graftmaster 3.5x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95185787|EAP|Custom 95185787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso Sd Wire Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132183|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cylinder Penile 18cm Ultrex 700|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,835.00|FSC: 13; Default||Not reimbursed separately|14,835.00|FSC: 13; Default||External grouping not supported 95132187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Blum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95192300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T15 22mmx3.5mm Metaphyseal Variable Angle Stardr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95132191|EAP|Custom 95132191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Tracheotomy Percutaneous In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132193|EAP|Custom 95132193||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shell Nasal Sz-small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185795|EAP|Custom 95185795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 575 Cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132194|EAP|Custom 95132194||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strut Nasal Sz-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132199|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cylinder Penile 18cm Approach Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,545.00|FSC: 13; Default||Not reimbursed separately|13,545.00|FSC: 13; Default||External grouping not supported 95132200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Blum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.18|FSC: 13; Default||Not reimbursed separately|1,605.18|FSC: 13; Default||External grouping not supported 95185788|EAP|Custom 95185788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tigerstick Tiger Wire #2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Blum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Grem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Grem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132206|EAP|Custom 95132206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Hand Access Lap-disc Slee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Humeral Standard Xtend Delta 38mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,344.75|FSC: 13; Default||Not reimbursed separately|4,344.75|FSC: 13; Default||External grouping not supported 95132208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bipolar Self Centering Grem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95132210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95188676|EAP|Custom 95188676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95185772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Delta Ceramic Ts 12/14 36mm +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,984.25|FSC: 13; Default||Not reimbursed separately|8,984.25|FSC: 13; Default||External grouping not supported 95132217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95192190|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 13.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Size 5 Sila|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95185780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Standard Xtend Delta 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.75|FSC: 13; Default||Not reimbursed separately|7,098.75|FSC: 13; Default||External grouping not supported 95132222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95132223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95188677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 40mm X 62mm 10 Degree +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 95132224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95185794|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Artoura Hp 300cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95132237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 16mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95185791|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Ivus: Visions® Pv .014p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95132249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95188678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Ts Delta 12/14 40mm +12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 95185792|EAP|HCPCS V2787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lens Intraocular 24.0 Tecnis Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95132258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95132259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95192250|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132260|EAP|Custom 95132260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 8.5mm Trach Murphy Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132272|EAP|Custom 95132272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 10/12mm Dilating Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185793|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95132274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95132279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95188680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Alighn 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95132281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Pinnacle M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95185786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Dog Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95132287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|FSC: 13; Default||Not reimbursed separately|4,777.23|FSC: 13; Default||External grouping not supported 95132289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|FSC: 13; Default||Not reimbursed separately|4,777.23|FSC: 13; Default||External grouping not supported 95185782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Metaglene 4.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95132298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|FSC: 13; Default||Not reimbursed separately|4,777.23|FSC: 13; Default||External grouping not supported 95132301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.54|FSC: 13; Default||Not reimbursed separately|4,320.54|FSC: 13; Default||External grouping not supported 95188681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align 10mm X 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,161.00|FSC: 13; Default||Not reimbursed separately|7,161.00|FSC: 13; Default||External grouping not supported 95132305|EAP|Custom 95132305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stays 5mm Elastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.54|FSC: 13; Default||Not reimbursed separately|4,320.54|FSC: 13; Default||External grouping not supported 95132308|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu40sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80164395|EAP|CPT® 90832||0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY|Hb Individual Therapy 16-37 Minutes|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 95132311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 80164403|EAP|CPT® 90834||0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY|Hb Individual Therapy 38-52 Minutes|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 95132316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 80164411|EAP|CPT® 90837||0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY|Hb Individual Therapy >53 Minutes|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 80164429|EAP|CPT® 90849||0916 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - FAMILY THERAPY|Hb Multi Family Group Psychotherapy|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 95132318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 95185783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Xtend Delta 4.5 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.25|FSC: 13; Default||Not reimbursed separately|911.25|FSC: 13; Default||External grouping not supported 95132319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 95192272|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 95174227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95132322|EAP|Custom 95132322||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Ecg Defibrillation Dis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174228|EAP|Custom 95174228||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 8mm X 11mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,790.00|FSC: 13; Default||Not reimbursed separately|14,790.00|FSC: 13; Default||External grouping not supported 95132334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 95174229|EAP|Custom 95174229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Access Pedicle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 95174236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Lfit C-taper Cocr 26mm + 10 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95132348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|FSC: 13; Default||Not reimbursed separately|4,160.10|FSC: 13; Default||External grouping not supported 95174235|EAP|Custom 95174235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Carto Fiber Optic Duplex 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,139.06|FSC: 13; Default||Not reimbursed separately|2,139.06|FSC: 13; Default||External grouping not supported 95174225|EAP|Custom 95174225||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feeding 18fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,139.06|FSC: 13; Default||Not reimbursed separately|2,139.06|FSC: 13; Default||External grouping not supported 95174226|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Saphenous 4mm - 6mm X 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,205.00|FSC: 13; Default||Not reimbursed separately|20,205.00|FSC: 13; Default||External grouping not supported 95132359|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu35sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Xtend Delta 4.5 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.25|FSC: 13; Default||Not reimbursed separately|911.25|FSC: 13; Default||External grouping not supported 95132360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95188682|EAP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Thera Skin 2.5 Cm X 2.5 Cm (6 Sq Sm)|1|HUMANA [1294]||HUMANA [11839]|402.50|FSC: 13; Default||Not reimbursed separately|402.50|FSC: 13; Default||External grouping not supported 95132362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95185804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95132366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132367|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx Bipolar Ventric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|FSC: 13; Default||Not reimbursed separately|1,860.00|FSC: 13; Default||External grouping not supported 95132369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|FSC: 13; Default||Not reimbursed separately|2,170.02|FSC: 13; Default||External grouping not supported 95185789|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Sinuplasty Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|FSC: 13; Default||Not reimbursed separately|2,170.02|FSC: 13; Default||External grouping not supported 95132374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|FSC: 13; Default||Not reimbursed separately|2,170.02|FSC: 13; Default||External grouping not supported 95132375|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Biliary Percuflex Amsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.36|FSC: 13; Default||Not reimbursed separately|300.36|FSC: 13; Default||External grouping not supported 95132379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|FSC: 13; Default||Not reimbursed separately|2,170.02|FSC: 13; Default||External grouping not supported 95185756|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 6 X 80 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132384|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Choice Extra Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95185752|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 4 X 60 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188683|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4 Fr 120cm Nta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132401|EAP|Custom 95132401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Linear 60mm Rl Plus Relo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185759|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 3.5 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132403|EAP|Custom 95132403||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mba Subtaylor 6mm|1|HUMANA [1294]||HUMANA [11839]|5,055.00|FSC: 13; Default||Not reimbursed separately|5,055.00|FSC: 13; Default||External grouping not supported 95192273|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95132406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 10mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,248.00|FSC: 13; Default||Not reimbursed separately|1,248.00|FSC: 13; Default||External grouping not supported 95173925|EAP|Custom 95173925||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Accessory Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 16cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95174238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Option Biolox 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,435.00|FSC: 13; Default||Not reimbursed separately|6,435.00|FSC: 13; Default||External grouping not supported 95132410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 18cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95174239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95132412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Arrow Meniscus 1.1mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.90|FSC: 13; Default||Not reimbursed separately|372.90|FSC: 13; Default||External grouping not supported 95174240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95132414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 32cm Ret|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95174242|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 6mm X 60mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132417|EAP|Custom 95132417||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Fracture 5/8 X 7/64mm|1|HUMANA [1294]||HUMANA [11839]|65.28|FSC: 13; Default||Not reimbursed separately|65.28|FSC: 13; Default||External grouping not supported 95174243|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 9mm X 40mm X 80cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132418|EAP|Custom 95132418||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Fracture 7/8 X 7/64mm|1|HUMANA [1294]||HUMANA [11839]|65.28|FSC: 13; Default||Not reimbursed separately|65.28|FSC: 13; Default||External grouping not supported 95174244|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 8mm X 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174245|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 7mm X 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95174246|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 6mm X 60mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95174248|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 10mm X 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathonm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|FSC: 13; Default||Not reimbursed separately|4,212.60|FSC: 13; Default||External grouping not supported 95174249|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 6mm X 20mm X 80cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95174250|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 8mm X 20mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95185747|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 7 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95174251|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 5mm X 120mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95132433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95174247|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foxcross Balloon 6mm X 60mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95132435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95132436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95174266|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self Expanding Nitinol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95132438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Lipped Pinnacle Marathon M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 95174267|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 9.0mm X 29mm Cath Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95132439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|FSC: 13; Default||Not reimbursed separately|2,522.10|FSC: 13; Default||External grouping not supported 95174268|EAP|Custom 95174268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Easyspray Tisseel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|FSC: 13; Default||Not reimbursed separately|2,522.10|FSC: 13; Default||External grouping not supported 95174269|EAP|Custom 95174269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Duplospray Mis 30cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Cr Sz-3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95174270|EAP|Custom 95174270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Duplotip 318mm Length 5mm Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132449|EAP|Custom 95132449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Truncated 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174271|EAP|Custom 95174271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Floseal Endoscopic Single Use Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174273|EAP|Custom 95174273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Coseal 7cm Replacement |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132454|EAP|Custom 95132454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Delivery Ob 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174274|EAP|Custom 95174274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Coseal 22cm Extended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|FSC: 13; Default||Not reimbursed separately|2,522.10|FSC: 13; Default||External grouping not supported 95174275|EAP|Custom 95174275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Cath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|FSC: 13; Default||Not reimbursed separately|2,522.10|FSC: 13; Default||External grouping not supported 95174276|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Intrathecal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,901.00|FSC: 13; Default||Not reimbursed separately|2,901.00|FSC: 13; Default||External grouping not supported 95132458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|FSC: 13; Default||Not reimbursed separately|2,522.10|FSC: 13; Default||External grouping not supported 95174253|EAP|Custom 95174253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Urostomy Post Op Natura 2 3/4 Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|FSC: 13; Default||Not reimbursed separately|2,595.60|FSC: 13; Default||External grouping not supported 95174254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 52mm Short Threaded |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.41|FSC: 13; Default||Not reimbursed separately|2,230.41|FSC: 13; Default||External grouping not supported 95174255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 54mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|FSC: 13; Default||Not reimbursed separately|2,595.60|FSC: 13; Default||External grouping not supported 95174256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 56mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132468|EAP|Custom 95132468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 30mm Linear 3.5mm Reload|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 58mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|FSC: 13; Default||Not reimbursed separately|2,595.60|FSC: 13; Default||External grouping not supported 95174258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 60mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|FSC: 13; Default||Not reimbursed separately|2,595.60|FSC: 13; Default||External grouping not supported 95174259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 64mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Colbalt Chrome Art7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,406.13|FSC: 13; Default||Not reimbursed separately|1,406.13|FSC: 13; Default||External grouping not supported 95174260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 68mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|FSC: 13; Default||Not reimbursed separately|3,328.50|FSC: 13; Default||External grouping not supported 95174261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 72mm Short Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95132479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|FSC: 13; Default||Not reimbursed separately|3,328.50|FSC: 13; Default||External grouping not supported 95174265|EAP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound Bilayer Meshed Integra Size 4 X 5|1|HUMANA [1294]||HUMANA [11839]|1,119.75|FSC: 13; Default||Not reimbursed separately|1,119.75|FSC: 13; Default||External grouping not supported 95132482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|FSC: 13; Default||Not reimbursed separately|3,328.50|FSC: 13; Default||External grouping not supported 95132483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95132485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95188685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 48 15mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95132488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95185754|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 5 X 80 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95132496|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185751|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 10 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95188686|EAP|Custom 95188686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Central Line Dressing Change - Pink Label|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132499|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 14x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185755|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 5 X 100 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132500|EAP|Custom 95132500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Sterile 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192274|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95185749|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 9 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95132507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95185768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Standard 4.0mm X 40mm Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95132509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95132511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Duofix Stan1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95185773|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 12 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Duofix Stan2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95188687|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Select Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185762|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 6.0 X 80x 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Duofix Stan8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95192275|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Duofix Stan9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95185763|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 3 X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Duofix Stan0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95188689|EAP|Custom 95188689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating Large Bone 9.12 X 25.22 X 0.64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95185771|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 8 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95132556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95188690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Metacarpal Dorsal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95132561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95185748|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 8 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95192276|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95185769|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 7 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Standard Of8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95188691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95132580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95185765|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 5 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95132587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95185750|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 10 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95188692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking Straight 6 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.54|FSC: 13; Default||Not reimbursed separately|1,215.54|FSC: 13; Default||External grouping not supported 95132597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95185764|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95192277|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Press Fit Siz8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95185761|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 5.0 X 30 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Size2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95188693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking Straight 12 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,333.56|FSC: 13; Default||Not reimbursed separately|1,333.56|FSC: 13; Default||External grouping not supported 95132608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Size3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95185776|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber Pta .018 3.0 X 60 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95132615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Size5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95185781|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber Pta .018 6.0 X 100 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Size6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95188694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking "t" Plate 3 Hole Head 5 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,333.56|FSC: 13; Default||Not reimbursed separately|1,333.56|FSC: 13; Default||External grouping not supported 95132619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Size7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95185753|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 5 X 40 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Basic Summit Cemented Size8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|FSC: 13; Default||Not reimbursed separately|4,735.50|FSC: 13; Default||External grouping not supported 95192278|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132624|EAP|Custom 95132624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Trocar-tip Partial Thre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185766|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 6 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset Hi Si1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95188695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking "y" Plate 3 Hole Head 5 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,333.56|FSC: 13; Default||Not reimbursed separately|1,333.56|FSC: 13; Default||External grouping not supported 95132635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset High 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95185777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epiphysis Centered Modular Cementless Xtend Delta Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,434.75|FSC: 13; Default||Not reimbursed separately|13,434.75|FSC: 13; Default||External grouping not supported 95132636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset High 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95132639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset High 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95185758|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 3.0 X 200 X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset High 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95188696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking Phlange Head Plate-right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,520.04|FSC: 13; Default||Not reimbursed separately|1,520.04|FSC: 13; Default||External grouping not supported 95132641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset High 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95185757|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 6 X 100 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset High 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95192279|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Cemented Of3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95185760|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 5.0 X 30 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Cemented Of4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95188697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking Strut Plate 8 Holes Oblique Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,333.56|FSC: 13; Default||Not reimbursed separately|1,333.56|FSC: 13; Default||External grouping not supported 95132649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95185779|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber Pta .018 3.0 X 100 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Cemented Of5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95132667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Cemented Of6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95185767|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 6 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132672|EAP|Custom 95132672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Trocar-tip Smooth 1.25x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking Strut Plate 8 Holes Oblique Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,333.56|FSC: 13; Default||Not reimbursed separately|1,333.56|FSC: 13; Default||External grouping not supported 95132673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Cemented Of7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95185775|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Opta Pro .035 7 X 100 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Cemented Of8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|FSC: 13; Default||Not reimbursed separately|11,619.30|FSC: 13; Default||External grouping not supported 95192280|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 17mm Extendt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95185810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Full Thread 2.7 Mm X L22 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95132685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 18mm Extendt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95188699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.3mm Ti Locking Web Plate 14 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,404.36|FSC: 13; Default||Not reimbursed separately|1,404.36|FSC: 13; Default||External grouping not supported 95132686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 9mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95185811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Asnis Iii Cannulated 5x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95132687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 10mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95132692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 11mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95185809|EAP|Custom 95185809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Micro Probe 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 12mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95188700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Straight 6 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.62|FSC: 13; Default||Not reimbursed separately|1,366.62|FSC: 13; Default||External grouping not supported 95132699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 13mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95185812|EAP|Custom 95185812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Asnis Iii Threaded Dia 2.0x150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 15mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95192281|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 17mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,922.09|FSC: 13; Default||Not reimbursed separately|8,922.09|FSC: 13; Default||External grouping not supported 95185807|EAP|Custom 95185807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Menicus 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 20mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95188701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Straight 12 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95132716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 11mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95185808|EAP|Custom 95185808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 12mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95132719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 13mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95132721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 15mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95188702|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu Jb1 5fr 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 17mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95185774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metaglene Cementless Xtend Delta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.75|FSC: 13; Default||Not reimbursed separately|5,595.75|FSC: 13; Default||External grouping not supported 95132724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 20mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95192282|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.14|FSC: 13; Default||Not reimbursed separately|6,289.14|FSC: 13; Default||External grouping not supported 95185817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 80169852|EAP|CPT® 64620||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Destruction By Neurolytic Agent Intercostal Nerve|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95132730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.14|FSC: 13; Default||Not reimbursed separately|6,289.14|FSC: 13; Default||External grouping not supported 95185822|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile 430cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95132731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 95132734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,699.00|FSC: 13; Default||Not reimbursed separately|3,699.00|FSC: 13; Default||External grouping not supported 95185821|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Octrode 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95132735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 95188703|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Low Height Moderate Plus 370cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95132745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 95185820|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Octrode 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,682.00|FSC: 13; Default||Not reimbursed separately|8,682.00|FSC: 13; Default||External grouping not supported 95132747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.72|FSC: 13; Default||Not reimbursed separately|6,540.72|FSC: 13; Default||External grouping not supported 95192283|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132749|EAP|Custom 95132749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Easyprobe Straight Assy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185814|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 28mm X 140cm Flex Zenith Z-trak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95132752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.14|FSC: 13; Default||Not reimbursed separately|6,289.14|FSC: 13; Default||External grouping not supported 95188704|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Cpx 4 Style 9200 650cc Medium Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95132757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 95185818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comoponent Patellofemoral Mck Restoris Sz3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,639.00|FSC: 13; Default||Not reimbursed separately|9,639.00|FSC: 13; Default||External grouping not supported 95132758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,652.58|FSC: 13; Default||Not reimbursed separately|7,652.58|FSC: 13; Default||External grouping not supported 95132761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,652.58|FSC: 13; Default||Not reimbursed separately|7,652.58|FSC: 13; Default||External grouping not supported 95185819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Cemented Heritage Versys 15mm X 140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95132764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|FSC: 13; Default||Not reimbursed separately|7,358.25|FSC: 13; Default||External grouping not supported 95188705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 95132768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|FSC: 13; Default||Not reimbursed separately|7,358.25|FSC: 13; Default||External grouping not supported 95184656|EAP|Custom 95184656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Trial Lead Multi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|FSC: 13; Default||Not reimbursed separately|7,358.25|FSC: 13; Default||External grouping not supported 95192285|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95185830|EAP|Custom 95185830||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Unibody Bifurcated 28mm 110/l 20-30 Iliac|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95132778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|FSC: 13; Default||Not reimbursed separately|113.25|FSC: 13; Default||External grouping not supported 95188706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Triathlon #2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95132781|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Checkflow 16fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185835|EAP|Custom 95185835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation Se Acclarent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|FSC: 13; Default||Not reimbursed separately|7,358.25|FSC: 13; Default||External grouping not supported 95132793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95185823|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile 455cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95132794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95188707|EAP|Custom 95188707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Concave 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Flex Opt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|FSC: 13; Default||Not reimbursed separately|7,358.25|FSC: 13; Default||External grouping not supported 95185824|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile 480cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95132796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95192286|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ulna X-lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.57|FSC: 13; Default||Not reimbursed separately|13,884.57|FSC: 13; Default||External grouping not supported 95185827|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Medium Height High Profile 345cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95132804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95188708|EAP|Custom 95188708||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spire 41 Mm|1|HUMANA [1294]||HUMANA [11839]|25,824.00|FSC: 13; Default||Not reimbursed separately|25,824.00|FSC: 13; Default||External grouping not supported 95132805|EAP|Custom 95132805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous 46fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185828|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Medium Height High Profile 390cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95132811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95132817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185825|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile 535cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95132819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95188709|EAP|Custom 95188709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter Ii Short 7.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185834|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Tecnis Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95132826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95192287|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95185832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Starfire 7.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95132829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95188710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 9mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95132830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95185833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar L-pspacer 30mmx12mmx12degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95132833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95132835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95185831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 90mm 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,052.67|FSC: 13; Default||Not reimbursed separately|1,052.67|FSC: 13; Default||External grouping not supported 95132838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95188711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95132842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95185826|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Irrigation Ic 22fr 30cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95132845|EAP|Custom 95132845||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Fracture 2.4mm X 16mm|1|HUMANA [1294]||HUMANA [11839]|146.37|FSC: 13; Default||Not reimbursed separately|146.37|FSC: 13; Default||External grouping not supported 95132851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95192288|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185847|EAP|Custom 95185847||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Cornerstone Psr 8 X 14 X 11|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95132864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95188712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 30mm Self Tapping W/t25 Stardrive R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.16|FSC: 13; Default||Not reimbursed separately|434.16|FSC: 13; Default||External grouping not supported 95132873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95185849|EAP|Custom 95185849||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Concord 9x11x23|1|HUMANA [1294]||HUMANA [11839]|14,796.30|FSC: 13; Default||Not reimbursed separately|14,796.30|FSC: 13; Default||External grouping not supported 95132874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95132876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185884|EAP|Custom 95185884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless 5 X 100 Stability|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95188713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Hod Sz 32/53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95132880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95185848|EAP|Custom 95185848||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 10 X 11 X 20mm 4deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95132883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95192289|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132885|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Checkflow 22fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 8 X 20 Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|FSC: 13; Default||Not reimbursed separately|771.00|FSC: 13; Default||External grouping not supported 95132895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95188714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Shell Revision Poly Tm Longevity 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,167.50|FSC: 13; Default||Not reimbursed separately|5,167.50|FSC: 13; Default||External grouping not supported 95132898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95132903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle 2.3mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95132904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95132905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 80169864|EAP|CPT® 37765||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stab Phlebectomy Of Varicose Veins 1 Extremity 10-20 Stab Incisions|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95132908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95132914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95185850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle 2.3mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95132915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95132916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95192290|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95132920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185843|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95132922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95132924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80169876|EAP|CPT® 37766||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stab Phlebectomy Of Varicose Veins 1 Extremity >20 Stab Incisions|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95132925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95132926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95185877|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95132928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95132931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|FSC: 13; Default||Not reimbursed separately|5,121.60|FSC: 13; Default||External grouping not supported 95132949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95132952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95185841|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95132957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95132959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95188759|EAP|Custom 95188759||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Conchasmart Adult Niv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95132960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95132965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95185867|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95132976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95132977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95192291|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95132979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95132981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95185838|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95132982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trilogy Non-hom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95188758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Meniscal Repair Truspan 24 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,158.00|FSC: 13; Default||Not reimbursed separately|1,158.00|FSC: 13; Default||External grouping not supported 95132988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|FSC: 13; Default||Not reimbursed separately|8,689.20|FSC: 13; Default||External grouping not supported 95132989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|FSC: 13; Default||Not reimbursed separately|8,614.32|FSC: 13; Default||External grouping not supported 95185869|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95132996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Emergency 1.7mm 6mm W/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.50|FSC: 13; Default||Not reimbursed separately|157.50|FSC: 13; Default||External grouping not supported 95132998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|FSC: 13; Default||Not reimbursed separately|8,614.32|FSC: 13; Default||External grouping not supported 95133001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|FSC: 13; Default||Not reimbursed separately|8,689.20|FSC: 13; Default||External grouping not supported 95133005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|FSC: 13; Default||Not reimbursed separately|8,689.20|FSC: 13; Default||External grouping not supported 95185858|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133008|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|FSC: 13; Default||Not reimbursed separately|8,614.32|FSC: 13; Default||External grouping not supported 95188760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Rotation Corr 6 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95133014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|FSC: 13; Default||Not reimbursed separately|8,614.32|FSC: 13; Default||External grouping not supported 95133017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|FSC: 13; Default||Not reimbursed separately|8,689.20|FSC: 13; Default||External grouping not supported 95185870|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,925.55|FSC: 13; Default||Not reimbursed separately|7,925.55|FSC: 13; Default||External grouping not supported 95133019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,925.55|FSC: 13; Default||Not reimbursed separately|7,925.55|FSC: 13; Default||External grouping not supported 95192292|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95133028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-3 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185864|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-4 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Val Straight 2.0mm 12 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,711.20|FSC: 13; Default||Not reimbursed separately|1,711.20|FSC: 13; Default||External grouping not supported 95133037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-5 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185840|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-6 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133058|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Ti Val "t"-plate 3 Hole Head 7 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,711.20|FSC: 13; Default||Not reimbursed separately|1,711.20|FSC: 13; Default||External grouping not supported 95133074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-7 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185865|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95192293|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95133088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-8 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185859|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95133101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Ti Val "y"-plate 3 Hole Head 7 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,711.20|FSC: 13; Default||Not reimbursed separately|1,711.20|FSC: 13; Default||External grouping not supported 95133105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-3 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185855|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-4 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185880|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133124|EAP|Custom 95133124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Amniocentesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95133130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Ti Val Phalangeal Base 2 Hole Head 6 Hold Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,876.44|FSC: 13; Default||Not reimbursed separately|1,876.44|FSC: 13; Default||External grouping not supported 95133133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-5 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185862|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133146|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95192294|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95133148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185839|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Gh Sz-6 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Ti Val Strut 12 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,876.44|FSC: 13; Default||Not reimbursed separately|1,876.44|FSC: 13; Default||External grouping not supported 95133170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185856|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-7 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133190|EAP|Custom 95133190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Laproscopic Mini-retractorto|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95133192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185878|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Ef Sz-8 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Ti Val Rotation Corr 6 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,348.49|FSC: 13; Default||Not reimbursed separately|2,348.49|FSC: 13; Default||External grouping not supported 95133202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185879|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-5 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95192295|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95133222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95133227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185861|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95133228|EAP|Custom 95133228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shell Nasal Sz-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95133233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95188767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 7mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.24|FSC: 13; Default||Not reimbursed separately|273.24|FSC: 13; Default||External grouping not supported 95133236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Cd Sz-6 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95185863|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt W/nut Alt 7.0mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.00|FSC: 13; Default||Not reimbursed separately|1,029.00|FSC: 13; Default||External grouping not supported 95133378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mmx26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95185876|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133525|EAP|Custom 95133525||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Rt Rim Orbital Lateral S|1|HUMANA [1294]||HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95188715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val"t" Plate 3 Hole Head 7 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95133526|EAP|Custom 95133526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Approximator Vessell 2.0mm Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95133554|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95185881|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133578|EAP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Plate Molteno Left-eye S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95133604|EAP|Custom 95133604||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Calcitek Threaded 3.75x1|1|HUMANA [1294]||HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95192302|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95133632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.8x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95133644|EAP|Custom 95133644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd Shnk 70mm Sz.00|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185860|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.8x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95133685|EAP|Custom 95133685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Reaming 3.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val "y" Plate 3 Hole Head 7 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95133686|EAP|Custom 95133686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95133770|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Z-med 20mmx4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185875|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 9x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95133786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.50|FSC: 13; Default||Not reimbursed separately|127.50|FSC: 13; Default||External grouping not supported 95133821|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95133828|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185882|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133884|EAP|Custom 95133884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repair Jejunostomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Phlange Basepl-2 Holes Head-6 Holes Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.58|FSC: 13; Default||Not reimbursed separately|1,628.58|FSC: 13; Default||External grouping not supported 95133886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95133894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.7x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95185883|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95133949|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Synchro-med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,410.00|FSC: 13; Default||Not reimbursed separately|22,410.00|FSC: 13; Default||External grouping not supported 95192317|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95134018|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134060|EAP|Custom 95134060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 4.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185844|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134162|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle 17x10.6 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95134163|EAP|Custom 95134163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Rosen Custom Item|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Condyla Basepl-2 Holes Head-6 Holes Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.78|FSC: 13; Default||Not reimbursed separately|1,557.78|FSC: 13; Default||External grouping not supported 95134171|EAP|Custom 95134171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 41gauge Dual-bore.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134173|EAP|Custom 95134173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Swivel Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185837|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134190|EAP|Custom 95134190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hickman Repair|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134200|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134204|EAP|Custom 95134204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous 26fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185842|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134222|EAP|Custom 95134222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Double Pin Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134247|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95188730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Viariable Angle 3.5x 28m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95134257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Lactosorb 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95134267|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Broviac Rt. Atrial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.00|FSC: 13; Default||Not reimbursed separately|207.00|FSC: 13; Default||External grouping not supported 95185868|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134278|EAP|Custom 95134278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Double Swivel Hex-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134313|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192316|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95134319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Breakoff T25 Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|508.62|FSC: 13; Default||Not reimbursed separately|508.62|FSC: 13; Default||External grouping not supported 95185872|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-drlg 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95188726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metacarpal 1.5mm Ti Val 1st Lateral-left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95134456|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95134484|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Pkp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95185873|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134517|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu45 Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95134563|EAP|Custom 95134563||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Intraspinal Flex-tip Plus|1|HUMANA [1294]||HUMANA [11839]|1,395.00|FSC: 13; Default||Not reimbursed separately|1,395.00|FSC: 13; Default||External grouping not supported 95134601|EAP|Custom 95134601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 2/3 150mm 2x450|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solid 2.4x6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185874|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134610|EAP|Custom 95134610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134681|EAP|Custom 95134681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolism Non-stock Must Ord|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Phlange Head Plate-right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.58|FSC: 13; Default||Not reimbursed separately|1,628.58|FSC: 13; Default||External grouping not supported 95134696|EAP|Custom 95134696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Wound 19fr 3/4 Round- Flut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185836|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134701|EAP|Custom 95134701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Assembly 11-to-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134716|EAP|Custom 95134716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Peg 20 French Pull|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192315|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95134729|EAP|Custom 95134729||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .035 D|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95134741|EAP|Custom 95134741||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Collection Cup Disp(for31|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185866|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Barrel 4-hole 135deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95134818|EAP|Custom 95134818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Wescott 22ga X 15cm 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Phalange Headplate Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.58|FSC: 13; Default||Not reimbursed separately|1,628.58|FSC: 13; Default||External grouping not supported 95134855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 95134866|EAP|Custom 95134866||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cougar 10mm X 14mm 10-degre|1|HUMANA [1294]||HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95185871|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134904|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134916|EAP|Custom 95134916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer Stomahesive Flexible 1 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134918|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 5.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95134924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Bone 6.5x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|316.20|FSC: 13; Default||Not reimbursed separately|316.20|FSC: 13; Default||External grouping not supported 95185845|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134936|EAP|Custom 95134936||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Radial Evolve (includes 1 H)|1|HUMANA [1294]||HUMANA [11839]|11,115.00|FSC: 13; Default||Not reimbursed separately|11,115.00|FSC: 13; Default||External grouping not supported 95188721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Strut Plate 8 Holes Oblique Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95134945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.5mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.50|FSC: 13; Default||Not reimbursed separately|262.50|FSC: 13; Default||External grouping not supported 95134949|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185854|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Anterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95134960|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 6.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95135006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95192314|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95135016|EAP|Custom 95135016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Lps Flex Taper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185885|EAP|Custom 95185885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Optiview 12 X 100 Stability|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135087|EAP|Custom 95135087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Intrauterine Pressure Tra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated-lag 3.5mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95135295|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Small|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95135298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95188722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Strut Plate 8 Holes Oblique Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95135299|EAP|Custom 95135299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack C Section Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135357|EAP|Custom 95135357||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Open Blade Narrow Angled Rt|1|HUMANA [1294]||HUMANA [11839]|2,670.00|FSC: 13; Default||Not reimbursed separately|2,670.00|FSC: 13; Default||External grouping not supported 95185886|EAP|Custom 95185886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Augmentation System Ivas Vertebral 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135382|EAP|Custom 95135382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Frame Retractor Square 14.6x14.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135399|EAP|Custom 95135399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ocutine Sterile 910-12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135438|EAP|Custom 95135438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hooks Blue Large/blunt Tlc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185891|EAP|Custom 95185891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Drill Ao Dia 2.0mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135456|EAP|Custom 95135456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Mini Narrow-profile 006-120|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135487|EAP|Custom 95135487||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Programmable Right Angle|1|HUMANA [1294]||HUMANA [11839]|16,974.00|FSC: 13; Default||Not reimbursed separately|16,974.00|FSC: 13; Default||External grouping not supported 95188723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Strut 1.5mm Ti Val 12 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.58|FSC: 13; Default||Not reimbursed separately|1,628.58|FSC: 13; Default||External grouping not supported 95135511|EAP|Custom 95135511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Multipin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt W/nut Alt 7.0mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.00|FSC: 13; Default||Not reimbursed separately|1,029.00|FSC: 13; Default||External grouping not supported 95185892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Headless Comp Ft 4.0 X 48m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95135548|EAP|Custom 95135548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Angled 2.5mm 081-250|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135610|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Small|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95192303|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95135623|EAP|Custom 95135623||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Access Vascular Port-tiat|1|HUMANA [1294]||HUMANA [11839]|2,040.00|FSC: 13; Default||Not reimbursed separately|2,040.00|FSC: 13; Default||External grouping not supported 95135625|EAP|Custom 95135625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Perfusion Oxygenator + H-ltu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185888|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Whole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95135645|EAP|Custom 95135645||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Unit Drive Motor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135677|EAP|HCPCS L4350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint L4350 Vaco Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Web 1.5mm Ti Val 14 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95135689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peripheral 5.0mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185889|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Pre-cut Endothelial Keratoplasty|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,850.00|FSC: 13; Default||Not reimbursed separately|11,850.00|FSC: 13; Default||External grouping not supported 95135698|EAP|Custom 95135698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Adaptor Cordis Itrell-iii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135699|EAP|Custom 95135699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 12x30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135708|EAP|Custom 95135708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp Specialty Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peripheral 5.0mmx25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95185901|EAP|Custom 95185901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mmx60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135742|EAP|Custom 95135742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wedge Enophthalmos Left Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 3.2mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.50|FSC: 13; Default||Not reimbursed separately|145.50|FSC: 13; Default||External grouping not supported 95188725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metacarpal 1.5mm Ti Val 1st Lateral-right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95135783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|FSC: 13; Default||Not reimbursed separately|111.00|FSC: 13; Default||External grouping not supported 95135817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.00|FSC: 13; Default||Not reimbursed separately|114.00|FSC: 13; Default||External grouping not supported 95185903|EAP|Custom 95185903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95135840|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192304|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95135858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95135861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ebi Corticle 150/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95185899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ss 2.7x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95135874|EAP|Custom 95135874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Hernia Ing.8cmx13cm Surgi|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95135876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95188727|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 80 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95135887|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95135910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 120/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95185893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree Accolade Ii Sz #10 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95135920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95135921|EAP|Custom 95135921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Rnd Shnk 70mm Sz.00|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135925|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95135938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated-lag 3.5mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion Revision Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,131.00|FSC: 13; Default||Not reimbursed separately|4,131.00|FSC: 13; Default||External grouping not supported 95135939|EAP|Custom 95135939||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tray Epidural 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95135967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95188728|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 150 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95135979|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95136005|EAP|Custom 95136005||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Right Offset 1/4|1|HUMANA [1294]||HUMANA [11839]|1,704.00|FSC: 13; Default||Not reimbursed separately|1,704.00|FSC: 13; Default||External grouping not supported 95185895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Rim Standard R Head Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95136017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95136025|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192305|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95136037|EAP|Custom 95136037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136048|EAP|Custom 95136048||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Left Offset 1/4|1|HUMANA [1294]||HUMANA [11839]|1,704.00|FSC: 13; Default||Not reimbursed separately|1,704.00|FSC: 13; Default||External grouping not supported 95185896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical (mod T7 Drive) 2.7mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|FSC: 13; Default||Not reimbursed separately|258.00|FSC: 13; Default||External grouping not supported 95136075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Rcd Fenlin 26mmx26m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,695.00|FSC: 13; Default||Not reimbursed separately|1,695.00|FSC: 13; Default||External grouping not supported 95136216|EAP|Custom 95136216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Surgery Cardiovascular Ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Distal Button|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95136227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 2.0mm 4-hole 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.31|FSC: 13; Default||Not reimbursed separately|326.31|FSC: 13; Default||External grouping not supported 95136246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Suspension Lactosorb 2.0x5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|387.00|FSC: 13; Default||Not reimbursed separately|387.00|FSC: 13; Default||External grouping not supported 95136254|EAP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95136273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Right 2.0mm 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95185906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Long Tn (talo-navicular)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,997.00|FSC: 13; Default||Not reimbursed separately|5,997.00|FSC: 13; Default||External grouping not supported 95136312|EAP|Custom 95136312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ph 24hr. W/infusion-port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136313|EAP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantablm|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95188731|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 40 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95136324|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Hockeystick 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95136347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 110mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.14|FSC: 13; Default||Not reimbursed separately|40.14|FSC: 13; Default||External grouping not supported 95185897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical (mod T7 Drive) 2.7mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|FSC: 13; Default||Not reimbursed separately|258.00|FSC: 13; Default||External grouping not supported 95136362|EAP|Custom 95136362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing 1/2 Inch X 6 Feet Speculu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136459|EAP|Custom 95136459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192306|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95136481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.68|FSC: 13; Default||Not reimbursed separately|112.68|FSC: 13; Default||External grouping not supported 95136531|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8fr Ebu5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical (mod T7 Drive) 2.7mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|FSC: 13; Default||Not reimbursed separately|258.00|FSC: 13; Default||External grouping not supported 95136539|EAP|Custom 95136539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Anastomosis Bear-micro Sin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95188732|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 100 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95136665|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermodilution Intelli-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114577|EAP|Custom 95114577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol 2b6023 Intralipid Inj A 20%|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95185894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-com Int Taper Tip 9 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95136718|EAP|Custom 95136718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Panel Fiberoptic Saphlite Mini S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136784|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 13x17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95136799|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great Toe Size 2 Silasti|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95188733|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 100 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95136842|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great Toe Size 3 Silasti|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95136875|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable T20 Sr Sin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|FSC: 13; Default||Not reimbursed separately|12,150.00|FSC: 13; Default||External grouping not supported 95136987|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Syncrhomed W/filte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,670.00|FSC: 13; Default||Not reimbursed separately|23,670.00|FSC: 13; Default||External grouping not supported 95137145|EAP|Custom 95137145||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bow Finger Traction 3in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95137154|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Trapezial Size 1 Silasti|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95192307|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95137282|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cube 8 Without Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95137315|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infinity 4f .038 100 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80168751|EAP|CPT® 26600||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Closed Treatment Of Metacarpal Fracture, Single; W/o Manipulation|1|HUMANA [1294]||HUMANA [11839]|665.67|FSC: 13; Default||Not reimbursed separately|665.67|FSC: 13; Default||External grouping not supported 95137345|EAP|Custom 95137345||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95137412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Locking 110mm Deg Sterie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95188734|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 200 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95137506|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Uropass 8.5fr X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95137546|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95137610|EAP|HCPCS Q4101||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apligraf (skin Graft) Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|88.30|FSC: 13; Default||Not reimbursed separately|88.30|FSC: 13; Default||External grouping not supported 95137650|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Cannon Dialysis Diatek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95188735|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 60 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95137666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin Threaded 1.1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95137709|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cube 4 Without Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185900|EAP|Custom 95185900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Stst 150mm .045"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95137749|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cube 5 Without Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95137756|EAP|Custom 95137756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Groove 550-micron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168762|EAP|CPT® 0296T||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hb Holter Monitor Record More Than 48 Hours Recording|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 95137796|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cube 6 Without Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95137841|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cube 7 Without Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192308|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95137899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95137900|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Plus Antimicrobial 15x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95188736|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 120 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95137904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 11x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95137952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 11x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95185915|EAP|Custom 95185915||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Evolution Trinity Large|1|HUMANA [1294]||HUMANA [11839]|17,475.00|FSC: 13; Default||Not reimbursed separately|17,475.00|FSC: 13; Default||External grouping not supported 95137958|EAP|Custom 95137958||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Ophthalmic Custom (dr. Cio)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168773|EAP|CPT® 0297T||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hb Holter Monitor Record More Than 48 Hours Scan Analysis|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95138012|EAP|Custom 95138012||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Carpal Scaphoid Size 3 R|1|HUMANA [1294]||HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95138077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate X Reg Lactosorb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95138091|EAP|Custom 95138091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 7fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188737|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 120 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95138098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.4mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95138128|EAP|Custom 95138128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cataract Custom (dr. Halpin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185911|EAP|Custom 95185911||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Interplate Peek 30mmx14mmx12degree|1|HUMANA [1294]||HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95138156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 42mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95192309|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95138166|EAP|Custom 95138166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 8.5 X 24|1|HUMANA [1294]||HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95185904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Distal Short Left Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95138221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fixation 2.7x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95188738|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 20 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95138227|EAP|Custom 95138227||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Fibular 7mm|1|HUMANA [1294]||HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95138247|EAP|Custom 95138247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Duet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T8 Full Thread 2.7mm/l12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95138270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Zephir Self-drilling 4.0x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.75|FSC: 13; Default||Not reimbursed separately|987.75|FSC: 13; Default||External grouping not supported 95138318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Bi-articular 16-5596-48-2828|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|FSC: 13; Default||Not reimbursed separately|1,605.00|FSC: 13; Default||External grouping not supported 95138325|EAP|Custom 95138325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Catheter 60cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bristow-latarjet Top Hat 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.00|FSC: 13; Default||Not reimbursed separately|732.00|FSC: 13; Default||External grouping not supported 95138340|EAP|Custom 95138340||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uropass 7 X 26|1|HUMANA [1294]||HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95138348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Zephir Self-drilling 4.0x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.75|FSC: 13; Default||Not reimbursed separately|987.75|FSC: 13; Default||External grouping not supported 95188739|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 80 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95138366|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 4.8x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95138421|EAP|Custom 95138421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Hex-fix 1/2 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185913|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95138430|EAP|Custom 95138430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Diffusers Air Midas Rex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138449|EAP|Custom 95138449||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Denver P-v Low|1|HUMANA [1294]||HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95192310|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95138452|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95138453|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 5.0 Ped|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185930|EAP|Custom 95185930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Menicus 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138455|EAP|Custom 95138455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hand-alumi Extra-large Disp. 13|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138501|EAP|Custom 95138501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermodilution 7 Fr 131|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188740|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 200 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95138519|EAP|Custom 95138519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Ibo Right And Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138526|EAP|Custom 95138526||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Calcitek Theaded 3.75x15|1|HUMANA [1294]||HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95185922|EAP|Custom 95185922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Lag Mini Maxlock Extreme 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138711|EAP|Custom 95138711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rnd.fast Cut 70mm Sz.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185927|EAP|Custom 95185927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Speed Non Rim 80 Mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138739|EAP|Custom 95138739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188741|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 7 Mm X 150 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95138779|EAP|Custom 95138779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95185931|EAP|Custom 95185931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Foil Supramid .35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138843|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/ Support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138887|EAP|Custom 95138887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Flexipath 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192311|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95138898|EAP|Custom 95138898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Open-entry|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138911|EAP|Custom 95138911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Eye 3.2mm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185932|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Textured Oval Base Moderate 370cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95138915|EAP|Custom 95138915||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Anastomotic Microvascular|1|HUMANA [1294]||HUMANA [11839]|437.50|FSC: 13; Default||Not reimbursed separately|437.50|FSC: 13; Default||External grouping not supported 95138934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95188742|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 20 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95138967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular 28mm Standard S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|912.00|FSC: 13; Default||Not reimbursed separately|912.00|FSC: 13; Default||External grouping not supported 95139047|EAP|Custom 95139047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cholecystectomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Oxinium Journey Ii Cr Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 95139149|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Ak-22123-f Multi- Lumen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|275.40|FSC: 13; Default||Not reimbursed separately|275.40|FSC: 13; Default||External grouping not supported 95139182|EAP|Custom 95139182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retrowash|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139187|EAP|Custom 95139187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Stop-drill 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Non Porous Journey Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 95139240|EAP|Custom 95139240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Stop-drill 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 8 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.70|FSC: 13; Default||Not reimbursed separately|185.70|FSC: 13; Default||External grouping not supported 95188743|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95139316|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95139362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 9 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95185928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 7 Hole L83mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95139400|EAP|Custom 95139400||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Compression Soc 25mm|1|HUMANA [1294]||HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95139439|EAP|Custom 95139439||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee W/open Patella Exte|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Xlpe Cr Journey Ii Size5-6 9mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 95139520|EAP|Custom 95139520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Approximator Nerve 35mm Long Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139564|EAP|Custom 95139564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Approximator Nerve Microsurgi-ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188744|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95139717|EAP|Custom 95139717||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Filter Monomer Fume|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 7x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95185929|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 480cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95139923|EAP|Custom 95139923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Central Venous Two- Lum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139927|EAP|Custom 95139927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Skin Wide Rotating- Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95139967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 80mm X 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|601.50|FSC: 13; Default||Not reimbursed separately|601.50|FSC: 13; Default||External grouping not supported 95185920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.7mmx6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95140022|EAP|Custom 95140022||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle|1|HUMANA [1294]||HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 95140054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Condylar 80mm X 200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|649.50|FSC: 13; Default||Not reimbursed separately|649.50|FSC: 13; Default||External grouping not supported 95188745|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95140092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Size-2 10mm-thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95140102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95185923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Y-plate Beta Mini Maxlock Extreme 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95140119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lactosorb Curved 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95192313|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95140262|EAP|Custom 95140262||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95185921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.7mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95140268|EAP|Custom 95140268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trap Digit Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188746|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95140307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.50|FSC: 13; Default||Not reimbursed separately|127.50|FSC: 13; Default||External grouping not supported 95140330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Sz-5 10mm Thick No|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 95185938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Fix Fast Tfcc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,736.43|FSC: 13; Default||Not reimbursed separately|1,736.43|FSC: 13; Default||External grouping not supported 95140341|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Checkflow 18fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95140392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock W/screw-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|FSC: 13; Default||Not reimbursed separately|9,284.64|FSC: 13; Default||External grouping not supported 95140528|EAP|Custom 95140528||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stackable 24mm|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95185935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Val Intercarpal 2.4mm 6 Hole/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,903.85|FSC: 13; Default||Not reimbursed separately|2,903.85|FSC: 13; Default||External grouping not supported 95140548|EAP|Custom 95140548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Beaver 4900 Total-hip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188747|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95140571|EAP|Custom 95140571||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stackable 12mm|1|HUMANA [1294]||HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95140605|EAP|Custom 95140605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Monitoring Pressure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix Br 3.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95140613|EAP|Custom 95140613||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Top Stackable|1|HUMANA [1294]||HUMANA [11839]|9,285.00|FSC: 13; Default||Not reimbursed separately|9,285.00|FSC: 13; Default||External grouping not supported 95140620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Barrel Side 135-deg 3-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95140639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Hg 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|FSC: 13; Default||Not reimbursed separately|1,161.00|FSC: 13; Default||External grouping not supported 95140655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95185936|EAP|Custom 95185936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner With Trocar Tip/80mm 1.25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95140712|EAP|Custom 95140712||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Open Blade Narrow Angled Lt|1|HUMANA [1294]||HUMANA [11839]|2,670.00|FSC: 13; Default||Not reimbursed separately|2,670.00|FSC: 13; Default||External grouping not supported 95140928|EAP|HCPCS L4350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint L4350 Vaco Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188748|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 6 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95140952|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 4.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95140991|EAP|Custom 95140991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ablation Endometrial Cont|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064274|EAP|CPT® 87631||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Resp Viral Panel 3-5 Targets|1|HUMANA [1294]||HUMANA [11839]|427.89|FSC: 13; Default||Not reimbursed separately|427.89|FSC: 13; Default||External grouping not supported 95140999|EAP|Custom 95140999||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Transporter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Lock 39 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|FSC: 13; Default||Not reimbursed separately|222.00|FSC: 13; Default||External grouping not supported 95141039|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable T60 Dr Dua|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95141072|EAP|Custom 95141072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hooks Narrow Ramp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064282|EAP|CPT® 87149||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Afb Id - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 95141081|EAP|Custom 95141081||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Telamon 12x26mm|1|HUMANA [1294]||HUMANA [11839]|11,413.08|FSC: 13; Default||Not reimbursed separately|11,413.08|FSC: 13; Default||External grouping not supported 95188749|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 7 X 020 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95141093|EAP|Custom 95141093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Inflation Breeze|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064290|EAP|CPT® 87158||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Afb Maldi - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|23.22|FSC: 13; Default||Not reimbursed separately|23.22|FSC: 13; Default||External grouping not supported 95141098|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 2.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95141105|EAP|Custom 95141105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064308|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Afb Susceptibility - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 95141230|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 0.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95188750|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 7 X 040 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95141231|EAP|Custom 95141231||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Orbital Wrap Bovine-peri|1|HUMANA [1294]||HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95185945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed Long 4.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95141258|EAP|Custom 95141258||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cougar 10mm 5-degree Small|1|HUMANA [1294]||HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95185943|EAP|Custom 95185943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter M8 Precision 15 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.25mmx40mm Pedicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95188751|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 7 X 060 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95141293|EAP|Custom 95141293||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Bipap Large Narrow Wp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185952|EAP|Custom 95185952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Short 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7.0mmx35mm Pedicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95185951|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 32.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95141366|EAP|Custom 95141366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188752|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 7 X 080 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95141421|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 18gax18cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic 5.0mml16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95141426|EAP|Custom 95141426||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cougar 12mm X 5mm|1|HUMANA [1294]||HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95141446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.41|FSC: 13; Default||Not reimbursed separately|2,230.41|FSC: 13; Default||External grouping not supported 95185950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic 5.0mm/l18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|FSC: 13; Default||Not reimbursed separately|966.00|FSC: 13; Default||External grouping not supported 95141464|EAP|Custom 95141464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188753|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 7 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95141475|EAP|Custom 95141475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit Angled 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed Long 4.0mm X 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95192318|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Momentum X4 Crt-d Is-1 / Df-1 / Is4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|FSC: 13; Default||Not reimbursed separately|64,500.00|FSC: 13; Default||External grouping not supported 95141509|EAP|Custom 95141509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed Long 4.5mm X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95141550|EAP|Custom 95141550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188754|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 7 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95185947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lateral Left 18hole/l379mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,673.00|FSC: 13; Default||Not reimbursed separately|11,673.00|FSC: 13; Default||External grouping not supported 95141573|EAP|Custom 95141573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Truncated 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141630|EAP|Custom 95141630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Calibration Cc7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic 5.0mm/l14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95141649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Oblique Left 2.0mm 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95188755|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95141689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat M/rt Lt Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,469.00|FSC: 13; Default||Not reimbursed separately|5,469.00|FSC: 13; Default||External grouping not supported 95185957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95192320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti6al4v Femoral Retrograde 13mm X 40cm Bevel Tip Purple|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,031.68|FSC: 13; Default||Not reimbursed separately|6,031.68|FSC: 13; Default||External grouping not supported 95141737|EAP|Custom 95141737||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Low-profile|1|HUMANA [1294]||HUMANA [11839]|2,673.00|FSC: 13; Default||Not reimbursed separately|2,673.00|FSC: 13; Default||External grouping not supported 95185959|EAP|Custom 95185959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Custom #2 Ft Thomas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188756|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95141791|EAP|Custom 95141791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thermodulution (latexfr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185956|EAP|Custom 95185956||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Membrane Carrier Amniotic 4cmx4cm|1|HUMANA [1294]||HUMANA [11839]|7,656.00|FSC: 13; Default||Not reimbursed separately|7,656.00|FSC: 13; Default||External grouping not supported 95141806|EAP|Custom 95141806||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Ph One-channel With Bui|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141860|EAP|Custom 95141860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle/syringe Biopsy Soft Tissu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185958|EAP|Custom 95185958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Custom #1 Ft Thomas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 25mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95188757|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95141900|EAP|Custom 95141900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Syringe Biopsy Soft Tissu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185961|EAP|Custom 95185961||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Hip Head W/insert 56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95141933|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Donut Silicone Size 45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192321|EAP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Theraskin Xlg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|499.16|FSC: 13; Default||Not reimbursed separately|499.16|FSC: 13; Default||External grouping not supported 95141990|EAP|Custom 95141990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Rosen Fast Cut 70mm Sz.24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95142003|EAP|Custom 95142003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill 1mm X 4m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142078|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95185964|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Medium Height High Profile 305cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95142096|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95188768|EAP|Custom 95188768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Block Mri 18g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95142143|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95142159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Zephir 37.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|FSC: 13; Default||Not reimbursed separately|3,474.00|FSC: 13; Default||External grouping not supported 95142196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Locking 100mm Deg Sterie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95142225|EAP|Custom 95142225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Lap-chole With Karlin B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064316|EAP|CPT® 82247||0301 - LABORATORY - CHEMISTRY|Hb Bili Total - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.06|FSC: 13; Default||Not reimbursed separately|15.06|FSC: 13; Default||External grouping not supported 95142243|EAP|Custom 95142243||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sheet Pre-punched Aquaplast 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188769|EAP|Custom 95188769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Mri 7cm Double Hook Wire 18g 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142247|EAP|Custom 95142247||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Carpal Lunate Size 5 Sil|1|HUMANA [1294]||HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 62064324|EAP|CPT® 82465||0301 - LABORATORY - CHEMISTRY|Hb Cholesterol - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.05|FSC: 13; Default||Not reimbursed separately|13.05|FSC: 13; Default||External grouping not supported 95142300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 2 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.90|FSC: 13; Default||Not reimbursed separately|138.90|FSC: 13; Default||External grouping not supported 95142321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peripheral 5.0mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62064332|EAP|CPT® 82947||0301 - LABORATORY - CHEMISTRY|Hb Glucose - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 95142350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 3 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.90|FSC: 13; Default||Not reimbursed separately|138.90|FSC: 13; Default||External grouping not supported 95188783|EAP|HCPCS 95188783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 4.35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated-lag 4.0x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 62064340|EAP|CPT® 82977||0301 - LABORATORY - CHEMISTRY|Hb Ggt - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.60|FSC: 13; Default||Not reimbursed separately|21.60|FSC: 13; Default||External grouping not supported 95142367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peripheral 5.0mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130deg 1.5 11.5mm X 38cm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95142396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 4 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 62064357|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hb Alpha 2-macroglob, Qnt - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 95142397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrack 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95188779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hat-trick Pip Fusion 3.2mm Mmprox 0deg. 4mm Mid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.70|FSC: 13; Default||Not reimbursed separately|2,702.70|FSC: 13; Default||External grouping not supported 95142400|EAP|Custom 95142400||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Hinged Wraparoundwe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064365|EAP|CPT® 84450||0301 - LABORATORY - CHEMISTRY|Hb Ast - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95142414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peripheral 5.0mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95142442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 5 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|169.35|FSC: 13; Default||Not reimbursed separately|169.35|FSC: 13; Default||External grouping not supported 62064373|EAP|CPT® 84460||0301 - LABORATORY - CHEMISTRY|Hb Alt - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.90|FSC: 13; Default||Not reimbursed separately|15.90|FSC: 13; Default||External grouping not supported 95142446|EAP|HCPCS E0190||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Lumbar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188770|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 20 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95142459|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Standard-wall Straight Cen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|FSC: 13; Default||Not reimbursed separately|1,860.00|FSC: 13; Default||External grouping not supported 62064381|EAP|CPT® 84478||0301 - LABORATORY - CHEMISTRY|Hb Trig - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.22|FSC: 13; Default||Not reimbursed separately|17.22|FSC: 13; Default||External grouping not supported 95142462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10x340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,197.00|FSC: 13; Default||Not reimbursed separately|1,197.00|FSC: 13; Default||External grouping not supported 95192322|EAP|Custom 95192322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Sleeve Rf 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142464|EAP|Custom 95142464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cardioplegia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185966|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Evera Mri S Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,350.00|FSC: 13; Default||Not reimbursed separately|40,350.00|FSC: 13; Default||External grouping not supported 95142490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 6 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95188771|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95142530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 7 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.40|FSC: 13; Default||Not reimbursed separately|179.40|FSC: 13; Default||External grouping not supported 95185980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95142556|EAP|Custom 95142556||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Positioner Shoulder Abduction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142584|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95185965|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Evera Mri Xt Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,500.00|FSC: 13; Default||Not reimbursed separately|40,500.00|FSC: 13; Default||External grouping not supported 95142650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated-lag 2.8x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95188772|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95185967|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Evera Mri Xt Vr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,700.00|FSC: 13; Default||Not reimbursed separately|41,700.00|FSC: 13; Default||External grouping not supported 95192324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95142756|EAP|Custom 95142756||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Fracture 7/8 X 1/16mm|1|HUMANA [1294]||HUMANA [11839]|65.28|FSC: 13; Default||Not reimbursed separately|65.28|FSC: 13; Default||External grouping not supported 95185969|EAP|Custom 95185969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pressurewire Aeris Agile Tip 175cm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 6.0mmx90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95188773|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Everflex Entrust 8 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95142779|EAP|Custom 95142779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb *nlu*set Perfusion Terumo Oxy-ge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Autofix Compression Mod T7 Dr 2.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|FSC: 13; Default||Not reimbursed separately|1,287.00|FSC: 13; Default||External grouping not supported 95142820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185977|EAP|Custom 95185977||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Precept Prebent Lordotic 25mm|1|HUMANA [1294]||HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95142897|EAP|Custom 95142897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Targeting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Proximal Conical Reclaim 20 X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95142903|EAP|Custom 95142903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Laser Fgl 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Tendon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95142954|EAP|Custom 95142954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Fine-tip 33cm Bi-tec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142967|EAP|Custom 95142967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Stop-drill Long 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185971|EAP|Custom 95185971||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pressurewire Receiver Cables|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95142984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Slot 4.35mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95188781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tapered Distal Reclaim 17x190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 95142999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert 28mm Scaphoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.39|FSC: 13; Default||Not reimbursed separately|462.39|FSC: 13; Default||External grouping not supported 95185972|EAP|HCPCS 95185972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Arthro Inst|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143013|EAP|Custom 95143013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Stop-drill Long 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143032|EAP|Custom 95143032||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Thyroplasty Female Size6|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95185981|EAP|Custom 95185981||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacers Peek Interplate 35mmx12mmx8degree|1|HUMANA [1294]||HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95143055|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Jl50sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Cta Duofix Global 48x18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,924.50|FSC: 13; Default||Not reimbursed separately|16,924.50|FSC: 13; Default||External grouping not supported 95185970|EAP|Custom 95185970||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pressurewire Receiver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical-lag Solid 2.4x12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95143113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated-lag 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185983|EAP|Custom 95185983||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x90mm|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95143153|EAP|Custom 95143153||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Paddle-tip 33cm Bi-tec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188774|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pacific Plus 5 X 80 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95143161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated-lag 2.8x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95185973|EAP|Custom 95185973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Bone Drivers With Staple Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143169|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Tractfinder 2.3 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95143182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger-joint Sz.6 C1776|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95185982|EAP|Custom 95185982||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Peek Interplate 35mmx14mmx8degree|1|HUMANA [1294]||HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95143193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T-shape Mini-bone 80 Angle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95188775|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pacific Plus 5 X 120 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185976|EAP|Custom 95185976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Access Pedicle Iii Springless Bevel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Multipolar 64mm Odx28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|890.61|FSC: 13; Default||Not reimbursed separately|890.61|FSC: 13; Default||External grouping not supported 95143246|EAP|Custom 95143246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Paddle-tip 45cm Bi-tec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185979|EAP|Custom 95185979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ss 0.91 X 80 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143269|EAP|Custom 95143269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188776|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pacific Plus 6 X 80 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95143282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Catera 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95188777|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pacific Plus 6 X 120 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95143318|EAP|Custom 95143318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Cerclage W/eye 1.2mmdia 500|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185984|EAP|Custom 95185984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ligasure Impact Open 18cm (reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143332|EAP|Custom 95143332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Delivery Norion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Bi-articular 28mmx46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.00|FSC: 13; Default||Not reimbursed separately|1,515.00|FSC: 13; Default||External grouping not supported 95143363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 50mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95185992|EAP|Custom 95185992||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ventilation Sheehy 1.2mm|1|HUMANA [1294]||HUMANA [11839]|46.80|FSC: 13; Default||Not reimbursed separately|46.80|FSC: 13; Default||External grouping not supported 95143375|EAP|Custom 95143375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 1/3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185985|EAP|Custom 95185985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Spherical 2.9mm For Small Joint Arthroscopy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 25mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.24|FSC: 13; Default||Not reimbursed separately|39.24|FSC: 13; Default||External grouping not supported 95188784|EAP|Custom 95188784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm X 102mm Wl 50mm Ao Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.41|FSC: 13; Default||Not reimbursed separately|2,230.41|FSC: 13; Default||External grouping not supported 95185975|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collagen Scaffold Reconstituted Arthroscopic Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 95143455|EAP|Custom 95143455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trocar 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185987|EAP|Custom 95185987||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Amnio 5.0 X 5.0cm|1|HUMANA [1294]||HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95143467|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double J 7.0 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95188785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left Locking Polyaxial Mtp Cross-plate (t8)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 95143499|EAP|Custom 95143499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Basket-tip 45cm Bi-tec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185991|EAP|Custom 95185991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Chu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95143519|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Hnbr5.0 35 65 P Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti F/im Nail 6.0mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95143571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-drlg 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|FSC: 13; Default||Not reimbursed separately|141.00|FSC: 13; Default||External grouping not supported 95188786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 12 Mm Tibia C-d/cr Fem 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95143581|EAP|HCPCS C1730||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Pacing Bipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95185989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Cann Retro 15mmx340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95143769|EAP|Custom 95143769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set White Blood Cell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185990|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Placental 1.0cc Viaflow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 92207455|EAP|Custom 92207455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dermabond Or|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188787|EAP|Custom 95188787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Thread Cartridge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95143910|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95143947|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Jl30 Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95143962|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Gold Surgisis 7x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95188788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 11mm Self Tapping With Cruciform Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|FSC: 13; Default||Not reimbursed separately|265.29|FSC: 13; Default||External grouping not supported 95144046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Forearm 10 Hole Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.95|FSC: 13; Default||Not reimbursed separately|205.95|FSC: 13; Default||External grouping not supported 95186027|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Penile Pump Ms Preconnect Penoscrotal 700 Ams 15c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,660.06|FSC: 13; Default||Not reimbursed separately|27,660.06|FSC: 13; Default||External grouping not supported 95144080|EAP|Custom 95144080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embolectomy 7fr 80cm Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144103|EAP|Custom 95144103||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 100/15 Threaded Mini Dyna|1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95186032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Proximal Humerus Nail Cannulated Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,182.00|FSC: 13; Default||Not reimbursed separately|10,182.00|FSC: 13; Default||External grouping not supported 95144151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Humeral Distal 9-holek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95188789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 12mm Self Tapping With Cruciform Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|FSC: 13; Default||Not reimbursed separately|265.29|FSC: 13; Default||External grouping not supported 95144159|EAP|Custom 95144159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Matt Suction Soft Tebbetts 1 X2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full T2 4mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95144165|EAP|Custom 95144165||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Interference Spike 20mm|1|HUMANA [1294]||HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95144181|EAP|Custom 95144181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Rigid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 10 Hole/l119mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.00|FSC: 13; Default||Not reimbursed separately|2,049.00|FSC: 13; Default||External grouping not supported 95144195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 14mm Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.00|FSC: 13; Default||Not reimbursed separately|31.00|FSC: 13; Default||External grouping not supported 95188790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 13mm Self Tapping With Cruciform Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|FSC: 13; Default||Not reimbursed separately|265.29|FSC: 13; Default||External grouping not supported 95144199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 2.0mm Emergency W/stard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.75|FSC: 13; Default||Not reimbursed separately|108.75|FSC: 13; Default||External grouping not supported 95186030|EAP|Custom 95186030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Band Electrode Frequency|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 16mm Tiv.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.00|FSC: 13; Default||Not reimbursed separately|34.00|FSC: 13; Default||External grouping not supported 95144242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-drlg 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|FSC: 13; Default||Not reimbursed separately|125.40|FSC: 13; Default||External grouping not supported 95186024|EAP|Custom 95186024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fusion Pushing 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144263|EAP|Custom 95144263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteoset Pellet Injector 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 14mm Self Tapping With Cruciform Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|FSC: 13; Default||Not reimbursed separately|265.29|FSC: 13; Default||External grouping not supported 95144266|EAP|Custom 95144266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheeting Silicone Pharmelast Tra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnin Iii 5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95144294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|FSC: 13; Default||Not reimbursed separately|120.75|FSC: 13; Default||External grouping not supported 95144298|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|FSC: 13; Default||Not reimbursed separately|1,482.00|FSC: 13; Default||External grouping not supported 95186025|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath Slender 6fr 3/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95144307|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix Kugel Oval 10cm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,921.00|FSC: 13; Default||Not reimbursed separately|6,921.00|FSC: 13; Default||External grouping not supported 95144309|EAP|Custom 95144309||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nestor .035 Di|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95186008|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144310|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Cannon Dialysis Diatek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,002.00|FSC: 13; Default||Not reimbursed separately|1,002.00|FSC: 13; Default||External grouping not supported 95144354|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Rapid Infusion7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186014|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144356|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Pinnacle-l Fee 6 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,297.00|FSC: 13; Default||Not reimbursed separately|3,297.00|FSC: 13; Default||External grouping not supported 95188792|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 4mm X 150mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186001|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144374|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore-tex 6mm X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95186016|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 26.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Valt 2.7mm X 14mm Radius D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95188793|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 5mm X 150mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95144376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Valt 2.7mm X 14mm Radius D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95186003|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Valt 2.4mm X 20mm Radius D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95144379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 10mm Radi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95186005|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 12mm Radi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95188794|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 6mm X 150mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95144381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left 4/4 Hole Radius Dista|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95186000|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144388|EAP|Custom 95144388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Threaded 4.5mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186002|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188810|EAP|Custom 95188810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Qc 4.0 X 160mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Curved 14-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,579.82|FSC: 13; Default||Not reimbursed separately|2,579.82|FSC: 13; Default||External grouping not supported 95186004|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 36mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95144411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 38mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95186017|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95188799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95144414|EAP|Custom 95144414||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 12mm X 16mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95186007|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144415|EAP|Custom 95144415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Illumination Radiance X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144416|EAP|Custom 95144416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix Tubular 7 X 26|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186009|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144450|EAP|Custom 95144450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chamber Artifical Anterior Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95144484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 52mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186011|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144485|EAP|Custom 95144485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Trocar Pt 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144486|EAP|Custom 95144486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Trocar 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186006|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95144591|EAP|Custom 95144591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Fixation 1/8 Diameter X 3 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186012|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144595|EAP|Custom 95144595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186020|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95188802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95144597|EAP|Custom 95144597||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Verastack 14mm|1|HUMANA [1294]||HUMANA [11839]|8,820.00|FSC: 13; Default||Not reimbursed separately|8,820.00|FSC: 13; Default||External grouping not supported 95186022|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144598|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Left Ventricular Implantabl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,151.00|FSC: 13; Default||Not reimbursed separately|5,151.00|FSC: 13; Default||External grouping not supported 95144600|EAP|Custom 95144600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slitters Catheter Guide Attain G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185998|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144603|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermis Porcine Pelvicol 6cm X 8c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.89|FSC: 13; Default||Not reimbursed separately|2,932.89|FSC: 13; Default||External grouping not supported 95188803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95144604|EAP|Custom 95144604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer W/convex-it 1-3/8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185999|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Cerami|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.00|FSC: 13; Default||Not reimbursed separately|4,368.00|FSC: 13; Default||External grouping not supported 95144607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Cerami|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.36|FSC: 13; Default||Not reimbursed separately|3,519.36|FSC: 13; Default||External grouping not supported 95185994|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95144608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Cerami|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,660.12|FSC: 13; Default||Not reimbursed separately|3,660.12|FSC: 13; Default||External grouping not supported 95188807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm/125 Deg 325mm Lt/sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95144611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Mg 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|FSC: 13; Default||Not reimbursed separately|5,923.02|FSC: 13; Default||External grouping not supported 95185995|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95185996|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 28 X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 95185997|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95185993|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Option Biolox 28mm +3.5/5 Deg12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,811.00|FSC: 13; Default||Not reimbursed separately|5,811.00|FSC: 13; Default||External grouping not supported 95186010|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95186021|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Meniscal Repair Truespan 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95186015|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95186018|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188813|EAP|Custom 95188813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Removal Tissue Myosure Reach|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186013|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95186023|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 1.7 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.12|FSC: 13; Default||Not reimbursed separately|213.12|FSC: 13; Default||External grouping not supported 95186033|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Acrysof 12.5mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95186034|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Anterior Chamber 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95188818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tapered Distal Reclaim 19x190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 95186019|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 28.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95188819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95186038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere 36mmx2mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95186039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center 6.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95188820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95186037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheal 4.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95186036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Straight 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95188821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95186041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 9 Hole 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.00|FSC: 13; Default||Not reimbursed separately|2,049.00|FSC: 13; Default||External grouping not supported 95186040|EAP|Custom 95186040||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Application Phenol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95186042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Bearing Fixed Uc Persona Left 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95188825|EAP|Custom 95188825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter 2 Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188828|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Turbo Elite 2.0 Mm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188829|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Turbo Elite 2.3 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186043|EAP|Custom 95186043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb T Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188830|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Turbo Elite 0.9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 2.7mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95186045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Hexalobe 2.7mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95188831|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Turbo Elite 1.4 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 2.7mmx10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95186047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acu-loc Wrist Spanning Plate Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,045.00|FSC: 13; Default||Not reimbursed separately|3,045.00|FSC: 13; Default||External grouping not supported 95188832|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Turbo Elite 1.7 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95144681|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|FSC: 13; Default||Not reimbursed separately|24,495.00|FSC: 13; Default||External grouping not supported 95186050|EAP|Custom 95186050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 90 For I-logic System Firm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144682|EAP|Custom 95144682||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Device 1|1|HUMANA [1294]||HUMANA [11839]|11,940.00|FSC: 13; Default||Not reimbursed separately|11,940.00|FSC: 13; Default||External grouping not supported 95188833|EAP|Custom 95188833||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Expandable Interbody Lordotic Extra 8x28x10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95144688|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95186049|EAP|Custom 95186049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 180 For I-logic System Firm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144689|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95144730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Psl 64mm Triden|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95184202|EAP|Custom 95184202||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Ext Co2 Olympus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident Alumina 0-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95188834|EAP|Custom 95188834||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 65mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95144733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95186061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax 7hole/l91mm W/2locking Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95144747|EAP|Custom 95144747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grieshaber End Grasping 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Recon Rhead Plasma Coated Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,978.00|FSC: 13; Default||Not reimbursed separately|12,978.00|FSC: 13; Default||External grouping not supported 95144748|EAP|Custom 95144748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Injection 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tfna 105 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|FSC: 13; Default||Not reimbursed separately|2,062.98|FSC: 13; Default||External grouping not supported 95144749|EAP|Custom 95144749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Light Pipe 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144750|EAP|Custom 95144750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Laser 25 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|FSC: 13; Default||Not reimbursed separately|2,164.59|FSC: 13; Default||External grouping not supported 95144751|EAP|Custom 95144751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Soft Tip 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Anterior Corail 2 Non-collar High-offset Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95144752|EAP|Custom 95144752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cautery Bi-polar 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 12mm/130 Deg 400mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95144753|EAP|Custom 95144753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scrapper Diamond Dusted Membrane|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144765|EAP|Custom 95144765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Soft Tissue Twist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186062|EAP|Custom 95186062||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cord And Trigger Switch 12 Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144767|EAP|Custom 95144767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Spiked 1.3mm X 14mm|1|HUMANA [1294]||HUMANA [11839]|427.29|FSC: 13; Default||Not reimbursed separately|427.29|FSC: 13; Default||External grouping not supported 95188837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Head Simpliciti Stb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95144769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Valt 2.7mm X 16mm Radius D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95186056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/130 Deg 380mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95144770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left 6/4 Hole Radius Dista|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95186060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 12mm/130 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95188838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Implant Arc Speed 11x12x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95144773|EAP|Custom 95144773||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 1.1mm Radius Dist|1|HUMANA [1294]||HUMANA [11839]|30.00|FSC: 13; Default||Not reimbursed separately|30.00|FSC: 13; Default||External grouping not supported 95144774|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|FSC: 13; Default||Not reimbursed separately|20,940.00|FSC: 13; Default||External grouping not supported 95188839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating 23mm/sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|FSC: 13; Default||Not reimbursed separately|6,255.00|FSC: 13; Default||External grouping not supported 95144775|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95144782|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone L-asr Fee 7 X 14 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95182637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 12 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95144785|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Cardioverter Defibrillator Impla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|FSC: 13; Default||Not reimbursed separately|54,000.00|FSC: 13; Default||External grouping not supported 95188840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Hinge Rotating Left Size D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|FSC: 13; Default||Not reimbursed separately|28,485.00|FSC: 13; Default||External grouping not supported 95144789|EAP|Custom 95144789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extender Bovie 11cm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating Size D 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|FSC: 13; Default||Not reimbursed separately|6,255.00|FSC: 13; Default||External grouping not supported 95144792|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Kugel Medium Oval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.00|FSC: 13; Default||Not reimbursed separately|861.00|FSC: 13; Default||External grouping not supported 95186065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Cemented Heritage Versys 14mm X 135mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95144793|EAP|Custom 95144793||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinforcem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144794|EAP|Custom 95144794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Transvaginal Sur-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Axle Fusion System Peek Insert 36mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|FSC: 13; Default||Not reimbursed separately|19,500.00|FSC: 13; Default||External grouping not supported 95144796|EAP|Custom 95144796||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Bivona 6.0mm Trach|1|HUMANA [1294]||HUMANA [11839]|330.30|FSC: 13; Default||Not reimbursed separately|330.30|FSC: 13; Default||External grouping not supported 95188842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm Qfx 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|FSC: 13; Default||Not reimbursed separately|993.00|FSC: 13; Default||External grouping not supported 95144797|EAP|Custom 95144797||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Bivona 7.0mm Trach|1|HUMANA [1294]||HUMANA [11839]|330.30|FSC: 13; Default||Not reimbursed separately|330.30|FSC: 13; Default||External grouping not supported 95186068|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Tall Moderate Plus 445cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95144798|EAP|Custom 95144798||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Bivona 8.0mm Trach|1|HUMANA [1294]||HUMANA [11839]|301.53|FSC: 13; Default||Not reimbursed separately|301.53|FSC: 13; Default||External grouping not supported 95144801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 24mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186067|EAP|Custom 95186067||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cervical Disc Prosthesis Mobi-c 15x15 H5|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95144803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 28mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Implant Titan Speed 25x20x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95144804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 36mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95144805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 40mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95144806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 42mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW IMPLANT SPEED 15X12X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,248.54|FSC: 13; Default||Not reimbursed separately|4,248.54|FSC: 13; Default||External grouping not supported 95144814|EAP|Custom 95144814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Total Plus 25 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95144816|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 5x10 Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.68|FSC: 13; Default||Not reimbursed separately|88.68|FSC: 13; Default||External grouping not supported 95144817|EAP|Custom 95144817||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Bivona 7.0mm Trach Tts Adju|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144822|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Great Pc Small Porou|1|HUMANA [1294]||HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95186069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/130 Deg 360mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95144827|EAP|Custom 95144827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Radial Jaw Maximum Capaci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp 12 Hole 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|608.94|FSC: 13; Default||Not reimbursed separately|608.94|FSC: 13; Default||External grouping not supported 95186079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Straight 2.4mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95144835|EAP|HCPCS Q4107||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Jacket Graft 4cmx4cm Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|283.97|FSC: 13; Default||Not reimbursed separately|283.97|FSC: 13; Default||External grouping not supported 95144839|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Pulse Implantable C176|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,585.00|FSC: 13; Default||Not reimbursed separately|33,585.00|FSC: 13; Default||External grouping not supported 95186077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95144845|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension C1883|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|FSC: 13; Default||Not reimbursed separately|1,980.00|FSC: 13; Default||External grouping not supported 95188845|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pronto Lp Extraction|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95144852|EAP|Custom 95144852||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 16mm Vertestack|1|HUMANA [1294]||HUMANA [11839]|8,820.00|FSC: 13; Default||Not reimbursed separately|8,820.00|FSC: 13; Default||External grouping not supported 95186075|EAP|Custom 95186075||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grafton Dbf 6cc|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95144854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,337.98|FSC: 13; Default||Not reimbursed separately|15,337.98|FSC: 13; Default||External grouping not supported 95144856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Break-off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.72|FSC: 13; Default||Not reimbursed separately|405.72|FSC: 13; Default||External grouping not supported 95186076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95144857|EAP|Custom 95144857||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 12mm 8-deg Large|1|HUMANA [1294]||HUMANA [11839]|8,820.00|FSC: 13; Default||Not reimbursed separately|8,820.00|FSC: 13; Default||External grouping not supported 95188847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 10mm 130 Deg 420mm/lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95144860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Cluster Trilogy W/hole Cer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,938.21|FSC: 13; Default||Not reimbursed separately|7,938.21|FSC: 13; Default||External grouping not supported 95186078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Locking 2.4 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95144861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Size 9 Metal Fiber Versys C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,496.07|FSC: 13; Default||Not reimbursed separately|16,496.07|FSC: 13; Default||External grouping not supported 95144866|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Single Chamber Vit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,277.00|FSC: 13; Default||Not reimbursed separately|53,277.00|FSC: 13; Default||External grouping not supported 95186083|EAP|Custom 95186083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Constellation Combined 23 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Fiber Carbon 8.0mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|343.80|FSC: 13; Default||Not reimbursed separately|343.80|FSC: 13; Default||External grouping not supported 95188848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 10mm 130 Deg 400mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95144871|EAP|Custom 95144871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Rod To Rod Open 8mm X 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 7 Hole/ 12mm /right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|FSC: 13; Default||Not reimbursed separately|6,867.00|FSC: 13; Default||External grouping not supported 95144872|EAP|Custom 95144872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Multi-pin Single Connect 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144873|EAP|Custom 95144873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drilling Self 3/4.0mm X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186081|EAP|Custom 95186081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Biopsy Core Gen Cut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144875|EAP|Custom 95144875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drilling Self 4.0mm X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144878|EAP|Custom 95144878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Edwards Carpentier|1|HUMANA [1294]||HUMANA [11839]|17,397.00|FSC: 13; Default||Not reimbursed separately|17,397.00|FSC: 13; Default||External grouping not supported 95115502|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Xxl 5.8 Fr Xxl/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95144879|EAP|Custom 95144879||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Edwards Carpentier|1|HUMANA [1294]||HUMANA [11839]|17,985.00|FSC: 13; Default||Not reimbursed separately|17,985.00|FSC: 13; Default||External grouping not supported 95186082|EAP|Custom 95186082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Changeout Oxygenator Ecmo Custom Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144880|EAP|Custom 95144880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Edwards Carpentier|1|HUMANA [1294]||HUMANA [11839]|17,397.00|FSC: 13; Default||Not reimbursed separately|17,397.00|FSC: 13; Default||External grouping not supported 95188849|EAP|Custom 95188849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Large Cannulated Flex 13.0 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144881|EAP|Custom 95144881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Edwards Carpentier|1|HUMANA [1294]||HUMANA [11839]|17,397.00|FSC: 13; Default||Not reimbursed separately|17,397.00|FSC: 13; Default||External grouping not supported 95186080|EAP|Custom 95186080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Sample Access Blood|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144882|EAP|Custom 95144882||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Edwards Carpentier|1|HUMANA [1294]||HUMANA [11839]|17,397.00|FSC: 13; Default||Not reimbursed separately|17,397.00|FSC: 13; Default||External grouping not supported 95144883|EAP|Custom 95144883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Edwards Carpentier|1|HUMANA [1294]||HUMANA [11839]|17,397.00|FSC: 13; Default||Not reimbursed separately|17,397.00|FSC: 13; Default||External grouping not supported 95186085|EAP|Custom 95186085||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Valve Heart Tf Sapien 3 Edwards 23mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95144892|EAP|Custom 95144892||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Extender|1|HUMANA [1294]||HUMANA [11839]|7,935.00|FSC: 13; Default||Not reimbursed separately|7,935.00|FSC: 13; Default||External grouping not supported 95188850|EAP|Custom 95188850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Trocar Tip 13.0mm/3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144893|EAP|Custom 95148893||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Extender|1|HUMANA [1294]||HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95186087|EAP|Custom 95186087||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Valve Heart Tf Sapien 3 Edwards 29mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95144894|EAP|Custom 95144894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Extender|1|HUMANA [1294]||HUMANA [11839]|7,935.00|FSC: 13; Default||Not reimbursed separately|7,935.00|FSC: 13; Default||External grouping not supported 95186089|EAP|Custom 95186089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Powerpick 45 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144898|EAP|HCPCS L8609||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Kerato Temporary 7mm|1|HUMANA [1294]||HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95188851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95144901|EAP|Custom 95144901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Access 26 X 80mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186086|EAP|Custom 95186086||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Valve Heart Tf Sapien 3 Edwards 26mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95144904|EAP|Custom 95144904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Port Access 26mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144910|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95186091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5mm Locking 5.0mm/l42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|FSC: 13; Default||Not reimbursed separately|864.00|FSC: 13; Default||External grouping not supported 95144911|EAP|Custom 95144911||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Quatro Bis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95144913|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95186090|EAP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound Oasis Ultra Tri-layer 3cm X 3.5cm 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.80|FSC: 13; Default||Not reimbursed separately|43.80|FSC: 13; Default||External grouping not supported 95144918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95144925|EAP|Custom 95144925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 3mm X 8mm Thin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95144926|EAP|Custom 95144926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 3mm X 10mm Thin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186093|EAP|Custom 95186093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drillbit Cannulated 6.5mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144927|EAP|Custom 95144927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 3mm X 12mm Thin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144928|EAP|Custom 95144928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 3mm X 20mm Thin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Distal Right 2hole/l72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95144929|EAP|Custom 95144929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 12mm Thin Curved|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95186094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Bipolar #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,879.00|FSC: 13; Default||Not reimbursed separately|9,879.00|FSC: 13; Default||External grouping not supported 95144930|EAP|Custom 95144930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 20mm Thin Curved|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144931|EAP|Custom 95144931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 5mm X 10mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186099|EAP|Custom 95186099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144932|EAP|Custom 95144932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome 5mm X 8 Mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95144956|EAP|Custom 95144956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit Clearcut 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186092|EAP|Custom 95186092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 8.0mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144965|EAP|Custom 95144965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Indwelling Replacement 10mm8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144970|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 14 X 11 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.64|FSC: 13; Default||Not reimbursed separately|3,329.64|FSC: 13; Default||External grouping not supported 95186097|EAP|Custom 95186097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Osteotome Short Sterile 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144971|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 14 X 11 X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95188856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95144973|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|FSC: 13; Default||Not reimbursed separately|24,495.00|FSC: 13; Default||External grouping not supported 95186098|EAP|Custom 95186098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Ostetome Long 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144974|EAP|Custom 95144974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Polypectomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95144988|EAP|Custom 95144988||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Pacing/defib/ecg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb T-plate Low Profile 2.4mm 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95188857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95145003|EAP|Custom 95145003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Tricut 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186103|EAP|Custom 95186103||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Heel Raiser Pro Ii 4/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145013|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|FSC: 13; Default||Not reimbursed separately|24,495.00|FSC: 13; Default||External grouping not supported 95145014|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95145015|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186107|EAP|Custom 95186107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter V8 Valvuloplasty 21mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lckng Slf-tpnwith T4 Stardrive Recess 1.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95145019|EAP|HCPCS A6210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Hydrofera Blue 6x6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Expedium 6x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95145021|EAP|Custom 95145021||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear T Richards Silicone Sof|1|HUMANA [1294]||HUMANA [11839]|58.49|FSC: 13; Default||Not reimbursed separately|58.49|FSC: 13; Default||External grouping not supported 95145024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.10|FSC: 13; Default||Not reimbursed separately|5,777.10|FSC: 13; Default||External grouping not supported 95186111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 5x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95145025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Venture 4.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95188859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 5mm Self Tapping With T4 Stardrive Rece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95145026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interspace Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,265.00|FSC: 13; Default||Not reimbursed separately|8,265.00|FSC: 13; Default||External grouping not supported 95186112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 5x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95186116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Reverse 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,580.00|FSC: 13; Default||Not reimbursed separately|8,580.00|FSC: 13; Default||External grouping not supported 95145031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Lateral Proximal 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95188860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 6mm Self Tapping With T4 Stardrive Rece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95145032|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95186114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95145033|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95145034|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95186113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 5x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95188861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 8mm Self Tapping With T4 Stardrive Rece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95145036|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hydra Jagwire 260cm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95145037|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurricane Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145038|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurricane Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95145039|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurricane Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62064399|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Pain Mgmt Drug Pan W/interp, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95145041|EAP|Custom 95145041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rg Needle Knife Rx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145042|EAP|Custom 95145042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management On Q 5 1/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 4.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95145044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Lcp Volar 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,130.80|FSC: 13; Default||Not reimbursed separately|3,130.80|FSC: 13; Default||External grouping not supported 95145045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|FSC: 13; Default||Not reimbursed separately|357.21|FSC: 13; Default||External grouping not supported 95186126|EAP|Custom 95186126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Lisfranc 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95145047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|FSC: 13; Default||Not reimbursed separately|121.44|FSC: 13; Default||External grouping not supported 95186127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cannulated Tfna Ti 11mmx130 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.36|FSC: 13; Default||Not reimbursed separately|4,530.36|FSC: 13; Default||External grouping not supported 95145048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95145049|EAP|Custom 95145049||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Ultraflex|1|HUMANA [1294]||HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95186128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Cemented Heritage Versys 15x140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95145050|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Tube Ringed 6 X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95186119|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Glide Path Dialysis 15cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95145051|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Tube Ringed 8 X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95188867|EAP|Custom 95188867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round Xl 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145052|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 4.5 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95145053|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145054|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 3.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 3.7 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95145055|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 36mm X 58mm 10-degree +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95145057|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 3.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145061|EAP|Custom 95145061||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cushion Heel Visco Spot Bauerfid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 12mm Tib C-d Fem 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145062|EAP|Custom 95145062||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cushion Heel Visco Spot Bauerfed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 10mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 10mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186138|EAP|Custom 95186138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Delivery And Tamp 10 Gauge X 10cm-sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 12mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188866|EAP|Custom 95188866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hip Long Plus Angled Xl 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 12mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186155|EAP|Custom 95186155||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 40 Mm X 15 Cm|1|HUMANA [1294]||HUMANA [11839]|47,625.00|FSC: 13; Default||Not reimbursed separately|47,625.00|FSC: 13; Default||External grouping not supported 95145068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 12mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 12mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186139|EAP|Custom 95186139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Delivery And Tamp 12 Gauge X 5cm-sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 12mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95188872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 7 Hole/20mm /right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|FSC: 13; Default||Not reimbursed separately|6,867.00|FSC: 13; Default||External grouping not supported 95145071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 13mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186157|EAP|Custom 95186157||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 45 Mm X 15 Cm|1|HUMANA [1294]||HUMANA [11839]|49,968.00|FSC: 13; Default||Not reimbursed separately|49,968.00|FSC: 13; Default||External grouping not supported 95145072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 13mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 14mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186133|EAP|Custom 95186133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Li 11x9x26 Mm 4 Degree|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95145074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 14mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188873|EAP|Custom 95188873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Endopath Ets- Flex 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 14mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186159|EAP|Custom 95186159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Sealer Maryland Grasper 44cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 14mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 14mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186146|EAP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Surgical Placement Prosthesis Voice Blom-singer 16fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|690.00|FSC: 13; Default||Not reimbursed separately|690.00|FSC: 13; Default||External grouping not supported 95145078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 15mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 80169888|EAP|CPT® 92511||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Nasopharyngoscopy With Endoscope|1|HUMANA [1294]||HUMANA [11839]|446.10|FSC: 13; Default||Not reimbursed separately|446.10|FSC: 13; Default||External grouping not supported 95145079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 15mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press-fit Reunion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95145080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 16mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB COMOPONENT PATELLOFEMORAL MCK RESTORIS SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95145082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 16mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95188874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 15mm Self Tapping With T4 Stardrive R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95145083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 16mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.3mm X 24mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95145084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 16mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 16mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Retaining Glenoid Head 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|FSC: 13; Default||Not reimbursed separately|4,320.00|FSC: 13; Default||External grouping not supported 95145086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 17mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 20mm Self Tapping With T4 Stardrive R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95145087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 17mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186121|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Glide Path Dialysis 23cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95145088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 18mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 18mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186130|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Glide Path Dialysis 19cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95188876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 22mm Self Tapping With T4 Stardrive Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95186131|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Glide Path Dialysis 27cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95145090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 18mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 18mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Glenoid Rsp P2 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 95145092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 18mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95188877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 24mm Self Tapping With T4 Stardrive Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95145093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 18mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral Socket 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95145094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 19mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 19mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer W/retaining Screw 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95145096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 20mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 20mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Lisfranc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95145098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 20mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral T2 9mm X 250mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 87503819|EAP|Custom 87503819||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pca Y Connector Bc-006-11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 20mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnin Iii 5x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95145101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 20mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 20mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full T2 4mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95145103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 21mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cnflx 1.0 6 X 20 Ster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95145105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 21mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 22mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral 4.5mmx44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95145107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 22mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 22mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95145109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186161|EAP|Custom 95186161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Prismasol Bk 0/0/1 2 2/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 22mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 22mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186162|EAP|Custom 95186162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ent Patient Tracker Set Non Invasive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 23mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 23mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95145114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 24mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 24mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Cortex 2.4 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95145116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 24mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz4 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95145118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 24mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 25mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Plate Tibial Onlay Mck Restoris Sz 4 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 87503801|EAP|Custom 87503801||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pca Extension Tubing 2c92|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 25mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 4-8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95145121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 26mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 26mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186179|EAP|HCPCS L8509||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Prosthesis Voice Indwelling Classic Blom Singer 16fr X 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 26mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186178|EAP|HCPCS L8509||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Prosthesis Voice Indwelling Classic Blom Singer 16fr X 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 26mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 27mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186180|EAP|HCPCS L8509||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Prosthesis Voice Indwelling Classic Blom Singer 16fr X 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 27mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 28mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186177|EAP|HCPCS L8509||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Prosthesis Voice Indwelling Classic Blom Singer 16fr X 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 28mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95186176|EAP|Custom 95186176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Captivator Ii 15mm Rounded Stiff Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 28mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 28mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186181|EAP|Custom 95186181||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hunter Passive Tendon|1|HUMANA [1294]||HUMANA [11839]|5,364.00|FSC: 13; Default||Not reimbursed separately|5,364.00|FSC: 13; Default||External grouping not supported 95145132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 28mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186188|EAP|Custom 95186188||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Stealth 12x14x8 6degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95145134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 29mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 29mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight Ti 3.5x120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95145136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 30mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 30mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial 4.0x16 Pedicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 30mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Thread Partial 2.7mm/26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95145140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 30mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 30mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervicalfalcon22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95145142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 32mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 32mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight Ti 3.5x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95145144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 32mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 32mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-tapping Variable Angle4.5x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95145146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 32mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951100350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Ii Tritanium C 46mm Screwhole Clust|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95145147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 32mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95186182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial 4.0x12pedicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 32mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 32mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial 4.0x14 Pedicle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 34mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95145151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 34mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 34mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95186192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Onlay Mck Restoris Sz 5 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95145153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 34mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95192330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 14mm Tib E-f Fem 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 34mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186171|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducter Set Performer 12 Fr 4.6 X 30 .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 34mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95145157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 36mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95186170|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducter Set Performer 14fr 4.6 X 30 .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 36mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 36mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95188889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95145160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95192335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral +4 40mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|FSC: 13; Default||Not reimbursed separately|8,156.40|FSC: 13; Default||External grouping not supported 95145162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 36mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 38mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95188890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0mm X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95145164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 38mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 38mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 38mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95188892|EAP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Precision 20 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 38mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95192331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Narrow 8 Hold / L151mm X 5.0mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,565.00|FSC: 13; Default||Not reimbursed separately|8,565.00|FSC: 13; Default||External grouping not supported 95145170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 38mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188893|EAP|Custom 95188893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Torcon Nb Advantage Beacon-tip .035 X 5fr 80cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 40mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 40mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95145173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 40mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95188895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Art Tibial Persona Fixed Bearing Uc Rt 11mm E-f 4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 42mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95192337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Asnis Iii Cannulated Titanium 46mm X 5mm X15.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95145177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 42mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 42mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95188896|EAP|Custom 95188896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterile Modified Hall Shaft 885mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 42mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 44mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 44mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95188897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail T2 Std. Tibial 11mmx390mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95145183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 44mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 44mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95192348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Regular .6 Mm 2.0mm Right Midface 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95145185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 44mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 44mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188901|EAP|Custom 95188901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ll 11.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 46mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 46mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95188902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-comp Interference 8mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95145190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 46mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95192349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Regular .6 Mm 2.0mm Left Midface 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95145192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 46mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 48mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95188903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Right 12-hole/l202mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,772.00|FSC: 13; Default||Not reimbursed separately|11,772.00|FSC: 13; Default||External grouping not supported 95145194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 48mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95145195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 48mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 48mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 48mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188904|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx 23x100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95145198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 48mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 50mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95192350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Regular .6 Mm 2.0mm 6 Hole Straight Whole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|FSC: 13; Default||Not reimbursed separately|1,287.00|FSC: 13; Default||External grouping not supported 95145200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.5mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95188905|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx 23x70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95145202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 50mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95145203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 52mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 54mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186193|EAP|Custom 95186193||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Lncs Neo Pt Adhesive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 54mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188906|EAP|Custom 95188906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round Xl 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 56mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186194|EAP|Custom 95186194||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Lncs Neo Pt-500 Non Adhesive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 56mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95192336|EAP|Custom 95192336||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Cancellous 4-9.5 Mm 30 Ml Frozen Chips|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95145208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 58mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 58mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95188907|EAP|Custom 95188907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Pear Hip Long 8-flute 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Divergence 18.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.30|FSC: 13; Default||Not reimbursed separately|6,306.30|FSC: 13; Default||External grouping not supported 95145210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 60mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 3.5 X 13mm (2 Per Pk)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 95145211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 62mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186198|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Hemostatic 14 Fr X 30 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 62mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 64mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186200|EAP|Custom 95186200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Stepped Cannulated 6mm/9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 66mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 66mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 68mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 12mm/130 Deg 360mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95145218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 68mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 70mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tfna 95 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|FSC: 13; Default||Not reimbursed separately|2,062.98|FSC: 13; Default||External grouping not supported 95192346|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Itrevia 7 Hf-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,000.00|FSC: 13; Default||Not reimbursed separately|45,000.00|FSC: 13; Default||External grouping not supported 95145220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 70mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95186202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tfna 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|FSC: 13; Default||Not reimbursed separately|2,062.98|FSC: 13; Default||External grouping not supported 95145221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 72mm 1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm X 72mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95145223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 25mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186210|EAP|Custom 95186210||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smart Toe 19mm Angled|1|HUMANA [1294]||HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95145227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 35mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186212|EAP|Custom 95186212||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smart Toe Ii 15mm Angled|1|HUMANA [1294]||HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95145229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 45mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186209|EAP|Custom 95186209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calibrated Reamer 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 45mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 45mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 Standard 32mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95145232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 50mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center 6.5mmx44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95145234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,905.00|FSC: 13; Default||Not reimbursed separately|1,905.00|FSC: 13; Default||External grouping not supported 95145235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 55mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Cemented Reunion 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|FSC: 13; Default||Not reimbursed separately|14,982.75|FSC: 13; Default||External grouping not supported 95145236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 55mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95192347|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Zipwire Nitinol Ply Hydrophilic .035 In Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 55mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186211|EAP|Custom 95186211||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smart Toe Ii 16mm Angled|1|HUMANA [1294]||HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95145238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating Size E 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|FSC: 13; Default||Not reimbursed separately|6,255.00|FSC: 13; Default||External grouping not supported 95145239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186227|EAP|Custom 95186227||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Fortex|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95145242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Tibia Hinge Rotating Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|FSC: 13; Default||Not reimbursed separately|14,130.00|FSC: 13; Default||External grouping not supported 95145243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 65mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/130 Deg 340mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95145244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95192338|EAP|Custom 95192338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill L135 Mm X 2 Mm Ao Drive Scale|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 70mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186233|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 2mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,355.00|FSC: 13; Default||Not reimbursed separately|5,355.00|FSC: 13; Default||External grouping not supported 95145246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 75mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 14 Mm Tibia E-f/cr Femu4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 75mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 10mm 130 Deg 420mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95145248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 80mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 80mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186222|EAP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Cervical Mobi-c 15x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95188913|EAP|Custom 95188913||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Pericardial 9x14cm|1|HUMANA [1294]||HUMANA [11839]|1,245.00|FSC: 13; Default||Not reimbursed separately|1,245.00|FSC: 13; Default||External grouping not supported 95145250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 85mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95192339|EAP|Custom 95192339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill L135 Mm X 2.6 Mm Ao Drive Scale|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 90mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95145254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm 125 Deg 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.36|FSC: 13; Default||Not reimbursed separately|4,530.36|FSC: 13; Default||External grouping not supported 95145255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 95mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 100mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Thread 35mm Length 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.50|FSC: 13; Default||Not reimbursed separately|427.50|FSC: 13; Default||External grouping not supported 95145257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 100mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Tibial Fix Bearing Uc Rt 10mm Tibia G-h/cr Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186216|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Artoura Hp 475cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95145259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95192332|EAP|Custom 95192332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Fixos 4.0mm Ankle Foot Cannulated Ao Drive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Fortex 6.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 105mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dorsal Spanning Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95145261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186232|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95145262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 110mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continous 5.5mm 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95145264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 115mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking Ti 3.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95145265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 115mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tfna 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|FSC: 13; Default||Not reimbursed separately|2,062.98|FSC: 13; Default||External grouping not supported 95145266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 115mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95192333|EAP|Custom 95192333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical 20 Mm Convex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 120mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fortex 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 120mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking Ti 3.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95145269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 120mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 80168790|EAP|CPT® 43266||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Stent Placement|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 95145270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 125mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 125mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 80168801|EAP|HCPCS G0121||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonscopy Screening Indiv Not Meeting Criteria For High Risk|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95145272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 125mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking Ti 3.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95145273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 130mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186230|EAP|Custom 95186230||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Valve Heart Tf Sapien 3 Edwards 20mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95145274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 130mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95192334|EAP|Custom 95192334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical 20 Mm Concave|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 130mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95184415|EAP|Custom 95184415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Disposable Flat Vitrectomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 135mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking Ti 3.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95145277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 135mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186250|EAP|Custom 95186250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Occluder Hemorrhage W/applicator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 140mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 140mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186240|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Continence Gynecare Exact|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,081.20|FSC: 13; Default||Not reimbursed separately|4,081.20|FSC: 13; Default||External grouping not supported 95145280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 145mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95188922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression Ti 3.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95145281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 145mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186239|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Continence Exact Tvt Gynecare|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,933.00|FSC: 13; Default||Not reimbursed separately|3,933.00|FSC: 13; Default||External grouping not supported 95145282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 150mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95145283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 150mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|FSC: 13; Default||Not reimbursed separately|643.20|FSC: 13; Default||External grouping not supported 95186249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz2 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95145284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95188923|EAP|Custom 95188923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.3mm X 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Fixed Bearing Uc Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continuous 5.5mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95145288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 65mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fortex8.25x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 70mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Selfdrilling Fortex 6.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 70mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95145293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.60|FSC: 13; Default||Not reimbursed separately|507.60|FSC: 13; Default||External grouping not supported 95186242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Selfdrilling Fortex 7.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 75mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95145295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 80mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95186245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Select Trinica 2l Level|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95145296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 85mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95186243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scrw Selfdrilling Fortex 7.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95145298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 90mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95145299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.60|FSC: 13; Default||Not reimbursed separately|507.60|FSC: 13; Default||External grouping not supported 95186247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Selfdrilling 5.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95145300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 95mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95145301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 100mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.60|FSC: 13; Default||Not reimbursed separately|777.60|FSC: 13; Default||External grouping not supported 95186251|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Nanocross 2.0 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 100mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 100mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186237|EAP|HCPCS C2631||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Capturing Suture Slim Capio|1|HUMANA [1294]||HUMANA [11839]|1,246.08|FSC: 13; Default||Not reimbursed separately|1,246.08|FSC: 13; Default||External grouping not supported 95145304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186252|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Amphirion Pta 2.0 L150 S=150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 105mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186253|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth Moderate 375 Cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|FSC: 13; Default||Not reimbursed separately|2,655.00|FSC: 13; Default||External grouping not supported 95145308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95188924|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Adapter Kit Bip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95145309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 110mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 115mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 115mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186260|EAP|HCPCS Q4126||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermaspan .5mm - 9mm 4x4 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95145312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 115mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95188925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 6-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95145313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 120mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Lock Ti 2.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95145314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 120mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 120mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95145316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 125mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 125mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95145318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 125mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 130mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186261|EAP|Custom 95186261||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clik X Anchor|1|HUMANA [1294]||HUMANA [11839]|843.75|FSC: 13; Default||Not reimbursed separately|843.75|FSC: 13; Default||External grouping not supported 95145320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 130mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 130mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Ti 10hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95145322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 135mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 135mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb T-plate Ti Oblique 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95145324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 135mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95116137|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95145325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 140mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 140mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186274|EAP|Custom 95186274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Subdural 1x4 Grid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 140mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 145mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186275|EAP|Custom 95186275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 145mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95188930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-tap Cortical 4.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95145330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 145mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186262|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Trulign Torric Bl1ut 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95145331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 150mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95145332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 150mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95186270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-com Int Taper Tip 8x23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95145333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm X 150mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95188931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95145334|EAP|Custom 95145334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Venous 2-lumen 9fr. 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145337|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Embolic Protection Rx Acc|1|HUMANA [1294]||HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95145338|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 6.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95186276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 2.7 X 12 Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95145340|EAP|Custom 95145340||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar Adson 5 Insulate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Ss 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95145341|EAP|Custom 95145341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Custom 25 Guage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 2.7 X 16 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95145353|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95145354|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95186277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 2.7 X 14 Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95145355|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95188933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Prostalac Rt Size 3 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 95145356|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95186273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continuous 5.5mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95145357|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95145358|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Mini Vision Rx 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95186279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 16 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95145359|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Synchromed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,900.00|FSC: 13; Default||Not reimbursed separately|30,900.00|FSC: 13; Default||External grouping not supported 95188934|EAP|Custom 95188934||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Elevate 7 X 23mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95145360|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press-fit 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95145362|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145364|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 1.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188935|EAP|Custom 95188935||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Elevate 7 X 28mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95145370|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Hernia Plug & Patch Self Fo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.91|FSC: 13; Default||Not reimbursed separately|386.91|FSC: 13; Default||External grouping not supported 62064401|EAP|CPT® 86638||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Coxiella Brunetii Titer - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.36|FSC: 13; Default||Not reimbursed separately|36.36|FSC: 13; Default||External grouping not supported 95145371|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95192351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 90mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95145372|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 62064412|EAP|CPT® 82495||0301 - LABORATORY - CHEMISTRY|Hb Chromium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|60.84|FSC: 13; Default||Not reimbursed separately|60.84|FSC: 13; Default||External grouping not supported 95188936|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 5 X 80 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 62064423|EAP|CPT® 83018||0301 - LABORATORY - CHEMISTRY|Hb Cobalt - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|65.88|FSC: 13; Default||Not reimbursed separately|65.88|FSC: 13; Default||External grouping not supported 62064434|EAP|CPT® 81229||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cytogenomic Snp Microarray - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95188937|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Armada 18 Otw 5 X 200 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62064445|EAP|CPT® 81479||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Molecular Pathology - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|499.10|FSC: 13; Default||Not reimbursed separately|499.10|FSC: 13; Default||External grouping not supported 95188938|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Armada 18 Otw 4 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80168812|EAP|CPT® 76498||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mr Unlisted Diagnostic/interventional|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95188939|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross Elite 2.0 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95186295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Matrix 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,976.00|FSC: 13; Default||Not reimbursed separately|2,976.00|FSC: 13; Default||External grouping not supported 95188940|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain General Purpose 16 Fr 21 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186294|EAP|Custom 95186294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Std Biocue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Poly Knee Hinge Rotating Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95174283|EAP|Custom 95174283||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Large Cordent 10 X 18 X 55 |1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95174284|EAP|Custom 95174284||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Lordotic 12 X 18 X 45|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95174285|EAP|Custom 95174285||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire K|1|HUMANA [1294]||HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95174286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Plif 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,424.00|FSC: 13; Default||Not reimbursed separately|2,424.00|FSC: 13; Default||External grouping not supported 95174287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Plif 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,424.00|FSC: 13; Default||Not reimbursed separately|2,424.00|FSC: 13; Default||External grouping not supported 95174288|EAP|Custom 95174288||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xd Expandable Convex 22mm X 9mm X 7mm|1|HUMANA [1294]||HUMANA [11839]|18,297.00|FSC: 13; Default||Not reimbursed separately|18,297.00|FSC: 13; Default||External grouping not supported 80164437|EAP|HCPCS C9600||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc Drug-el Cor Stent Single|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80164445|EAP|HCPCS C9601||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc Drug-el Cor Stent Branch|1|HUMANA [1294]||HUMANA [11839]|16,404.67|FSC: 13; Default||Not reimbursed separately|16,404.67|FSC: 13; Default||External grouping not supported 80164452|EAP|HCPCS C9602||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Stent Ather Single|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80164460|EAP|HCPCS C9603||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Stent Ather Branch|1|HUMANA [1294]||HUMANA [11839]|17,859.00|FSC: 13; Default||Not reimbursed separately|17,859.00|FSC: 13; Default||External grouping not supported 80164478|EAP|HCPCS C9604||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Revasc T Cabg Stent|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80164486|EAP|HCPCS C9605||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Revasc T Cabg Branch|1|HUMANA [1294]||HUMANA [11839]|18,107.00|FSC: 13; Default||Not reimbursed separately|18,107.00|FSC: 13; Default||External grouping not supported 80164494|EAP|HCPCS C9606||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Revasc W Ami Stent|1|HUMANA [1294]||HUMANA [11839]|23,460.50|FSC: 13; Default||Not reimbursed separately|23,460.50|FSC: 13; Default||External grouping not supported 80164502|EAP|HCPCS C9607||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Revasc Chronic Lesion Single|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80164510|EAP|HCPCS C9608||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc D-e Cor Revasc Chronic Lesion Add|1|HUMANA [1294]||HUMANA [11839]|17,993.50|FSC: 13; Default||Not reimbursed separately|17,993.50|FSC: 13; Default||External grouping not supported 95174289|EAP|Custom 95174289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Retrieval 3.3fr X 65cm Disposable |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tri-shank 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|FSC: 13; Default||Not reimbursed separately|5,370.00|FSC: 13; Default||External grouping not supported 95174293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 7.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95174296|EAP|Custom 95174296||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Post Op Natura 2 Piece 2-3/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174297|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Clas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 80164528|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Mesh Neb Initial Tx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 80164536|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Mesh Neb Subsequent Tx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95174298|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh St 8 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,522.00|FSC: 13; Default||Not reimbursed separately|12,522.00|FSC: 13; Default||External grouping not supported 95145426|EAP|Custom 95145426||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 2mm X 9 Inch Half B|1|HUMANA [1294]||HUMANA [11839]|54.00|FSC: 13; Default||Not reimbursed separately|54.00|FSC: 13; Default||External grouping not supported 95116306|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 34fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174299|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh St 10 X 14 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,536.00|FSC: 13; Default||Not reimbursed separately|13,536.00|FSC: 13; Default||External grouping not supported 95174300|EAP|Custom 95174300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Extra Large Coroent 8 X 18 X 55|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95174301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 120mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|FSC: 13; Default||Not reimbursed separately|1,845.00|FSC: 13; Default||External grouping not supported 95145460|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hydra Jagwire Angled T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145469|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 3.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145479|EAP|HCPCS A6021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Skin Temp Collagen 2x3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145480|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Lsr 6 X 14-11 Human-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95145502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 +5 36mm Ion Friction Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95145503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-deg 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95145504|EAP|Custom 95145504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Internal Feeding Low Prof|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 95145506|EAP|Custom 95145506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Internal Feeding Low Prof|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145507|EAP|Custom 95145507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Injection W/spinal Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 11mm X 330mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95145508|EAP|Custom 95145508||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Fluency 6 X 40|1|HUMANA [1294]||HUMANA [11839]|6,285.00|FSC: 13; Default||Not reimbursed separately|6,285.00|FSC: 13; Default||External grouping not supported 95145509|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 7mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95145510|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 8mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|FSC: 13; Default||Not reimbursed separately|6,285.00|FSC: 13; Default||External grouping not supported 95145511|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 8mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95174315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95145512|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 10mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|FSC: 13; Default||Not reimbursed separately|6,285.00|FSC: 13; Default||External grouping not supported 95174318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Metacarpophangeal Mcp Sr Size Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|FSC: 13; Default||Not reimbursed separately|10,098.00|FSC: 13; Default||External grouping not supported 95174320|EAP|Custom 95174320||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Face Xlarge Adult Performax Ee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145514|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Fluency 6 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|FSC: 13; Default||Not reimbursed separately|6,585.00|FSC: 13; Default||External grouping not supported 95174322|EAP|Custom 95174322||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Large Coroent 10 X 18 X 50|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95145515|EAP|Custom 95145515||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 14mm Vertestack|1|HUMANA [1294]||HUMANA [11839]|14,003.22|FSC: 13; Default||Not reimbursed separately|14,003.22|FSC: 13; Default||External grouping not supported 80164544|EAP|CPT® 78071||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Parathyrd Planar W/wo Subtraction W/spect|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95145517|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95145518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterial Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.10|FSC: 13; Default||Not reimbursed separately|5,777.10|FSC: 13; Default||External grouping not supported 95145519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Venture 4.0 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95174316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Ts Axsos 14 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,287.50|FSC: 13; Default||Not reimbursed separately|5,287.50|FSC: 13; Default||External grouping not supported 95145525|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Dialysis Hemosplit 23cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,510.20|FSC: 13; Default||Not reimbursed separately|1,510.20|FSC: 13; Default||External grouping not supported 95174325|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Percuflex 8fr X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95145526|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Dialysis Hemosplit 19cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95174326|EAP|Custom 95174326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel B3 Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186288|EAP|Custom 95186288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Standard 2.0mm / L110mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145529|EAP|Custom 95145529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Floseal 5,000u Thrombin Spra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ceramic Option Delta Biolox 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95145535|EAP|Custom 95145535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Infinity Vitrectomy Anterio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145536|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95186301|EAP|Custom 95186301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scraper Membrane 23 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 2.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.40|FSC: 13; Default||Not reimbursed separately|680.40|FSC: 13; Default||External grouping not supported 95145541|EAP|Custom 95145541||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer With Flange Moldable Conv4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145545|EAP|Custom 95145545||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Taylor Augment Post Agility|1|HUMANA [1294]||HUMANA [11839]|8,502.00|FSC: 13; Default||Not reimbursed separately|8,502.00|FSC: 13; Default||External grouping not supported 95186303|EAP|Custom 95186303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Delivery And Access Digital Spyscope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145546|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Array|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Taper Ceramic 0mm Opt Type 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|FSC: 13; Default||Not reimbursed separately|1,236.00|FSC: 13; Default||External grouping not supported 95145551|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145552|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guidewire 6 French X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking T8 3.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95145560|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 17gx4.6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145562|EAP|Custom 95145562||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer 5x5 Stomahesive 2-3/4 Flan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Medial Dista Tibia 2.7/3.5mm 10 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,659.50|FSC: 13; Default||Not reimbursed separately|5,659.50|FSC: 13; Default||External grouping not supported 95145563|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145568|EAP|Custom 95145568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Dilation Access 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|969.00|FSC: 13; Default||Not reimbursed separately|969.00|FSC: 13; Default||External grouping not supported 95145569|EAP|Custom 95145569||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Aquaplast Prepunched 9x10 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Ringloc E1 32mm Sz22/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95145571|EAP|Custom 95145571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Surgical Cobra Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 3.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95145574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Size 12 X 125mm Enha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|FSC: 13; Default||Not reimbursed separately|8,811.66|FSC: 13; Default||External grouping not supported 95145578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lcck Sz-f Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,536.89|FSC: 13; Default||Not reimbursed separately|17,536.89|FSC: 13; Default||External grouping not supported 95145579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Femoral Distal Augment 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95145580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Lps Nexgen Knee G L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,998.00|FSC: 13; Default||Not reimbursed separately|4,998.00|FSC: 13; Default||External grouping not supported 95186291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 3.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95145581|EAP|Custom 95145581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cord Bipolar Assembly Tube Irrig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145582|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 6.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95188944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Replacement Ringloc Sz 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|FSC: 13; Default||Not reimbursed separately|717.00|FSC: 13; Default||External grouping not supported 95145584|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145585|EAP|Custom 95145585||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Starter Blom Singer Atsvii P|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp V1 6 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|FSC: 13; Default||Not reimbursed separately|6,879.00|FSC: 13; Default||External grouping not supported 95145586|EAP|Custom 95145586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Sure Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145587|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95192354|EAP|Custom 95192354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Kirschner Medium 1.1 Mm X 102mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145594|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145596|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 3.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking T8 3.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95145599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Kompressor 26mm Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95145604|EAP|Custom 95145604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner Kompressor 0.9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Lock Acetabular Sz22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95145620|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95145624|EAP|Custom 95145624||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Lumbar With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145625|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up X-small Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145626|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up Large Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145627|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up Medium Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192355|EAP|Custom 95192355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Countersink Od5 Mm Cannulated Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145628|EAP|Custom 95145628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer Stomahesive 1-1/8 Stoma ()|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168834|EAP|HCPCS G0455||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Fecal Transplant And Prep|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95145635|EAP|Custom 95145635||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 10mm X 22mm Vertes|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95145639|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Hemoset 12fr X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186306|EAP|Custom 95186306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 8mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145640|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 18fr X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145642|EAP|Custom 95145642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Alignment Medullary With Ri|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186312|EAP|Custom 95186312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Stablecut Groun Tooth Set 110 Lg X 19 Wd X 1.19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145654|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone L-asr Fee 8 X 14 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95174327|EAP|Custom 95174327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel B4 Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145656|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone L-asr Fee 9 X 14 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 80164551|EAP|CPT® 95940||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Ionm In Operatng Room 15 Min|1|HUMANA [1294]||HUMANA [11839]|231.62|FSC: 13; Default||Not reimbursed separately|231.62|FSC: 13; Default||External grouping not supported 95145657|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Pinnacle-l Fee 5 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,297.00|FSC: 13; Default||Not reimbursed separately|3,297.00|FSC: 13; Default||External grouping not supported 80164569|EAP|CPT® 95941||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Ionm Remote/>1 Pt Or Per Hr|1|HUMANA [1294]||HUMANA [11839]|802.00|FSC: 13; Default||Not reimbursed separately|802.00|FSC: 13; Default||External grouping not supported 95145664|EAP|Custom 95145664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Fms 30-deg Kelma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164577|EAP|HCPCS G0453||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Cont Intraop Neuro Monitor 15 Min|1|HUMANA [1294]||HUMANA [11839]|196.16|FSC: 13; Default||Not reimbursed separately|196.16|FSC: 13; Default||External grouping not supported 95145665|EAP|Custom 95145665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Fms Tipless W/1.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Right 10 X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,520.00|FSC: 13; Default||Not reimbursed separately|8,520.00|FSC: 13; Default||External grouping not supported 95145666|EAP|Custom 95145666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Abs Tip 0-deg Ro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95145667|EAP|Custom 95145667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Fms 30-deg Round|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174335|EAP|Custom 95174335||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Spinal Metal Trabecular Interbody Ardis 9mm Xm|1|HUMANA [1294]||HUMANA [11839]|19,446.00|FSC: 13; Default||Not reimbursed separately|19,446.00|FSC: 13; Default||External grouping not supported 95145670|EAP|Custom 95145670||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Polytef|1|HUMANA [1294]||HUMANA [11839]|1,245.00|FSC: 13; Default||Not reimbursed separately|1,245.00|FSC: 13; Default||External grouping not supported 95174336|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Icd Incepta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,350.00|FSC: 13; Default||Not reimbursed separately|49,350.00|FSC: 13; Default||External grouping not supported 95145675|EAP|Custom 95145675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Reinforced 6mm Emg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Rod Side Loading|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|FSC: 13; Default||Not reimbursed separately|4,614.00|FSC: 13; Default||External grouping not supported 95145676|EAP|Custom 95145676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Reinforced 7mm Emg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Offset 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,820.00|FSC: 13; Default||Not reimbursed separately|2,820.00|FSC: 13; Default||External grouping not supported 95145678|EAP|Custom 95145678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Reinforced 8mm Emg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Closed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.00|FSC: 13; Default||Not reimbursed separately|606.00|FSC: 13; Default||External grouping not supported 95145679|EAP|Custom 95145679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Subdermal Pin Protecte|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95173997|EAP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Micro Matristim 200mg Per Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.87|FSC: 13; Default||Not reimbursed separately|7.87|FSC: 13; Default||External grouping not supported 95145683|EAP|HCPCS Q4102||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Oasis 3cmx3.5cm Per Sq Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.22|FSC: 13; Default||Not reimbursed separately|32.22|FSC: 13; Default||External grouping not supported 95145684|EAP|Custom 95145684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Stimulator Monopolar Stand|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95145685|EAP|Custom 95145685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Subdermal Pin Protecte|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192356|EAP|Custom 95192356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Surgical Asnis Iii 3.5mm Ao Coupling Hexagonal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186304|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 5.0cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,065.00|FSC: 13; Default||Not reimbursed separately|10,065.00|FSC: 13; Default||External grouping not supported 95186309|EAP|Custom 95186309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb #2 Fibersnare #2 Fiberwire 26|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145689|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174340|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95145690|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174341|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145691|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174342|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95145692|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174343|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145693|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174344|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145694|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174345|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145695|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174346|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Assura Fortifiy Icd Dr40 Df4 Connector|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,187.50|FSC: 13; Default||Not reimbursed separately|39,187.50|FSC: 13; Default||External grouping not supported 95145696|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174347|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.25 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145697|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174348|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.25 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145698|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174349|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.25 X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145699|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174350|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.25 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145700|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bulb-tipped 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174351|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 8 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145701|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95174352|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Lef Iliac Aaa 9mm X 74cm Flex Zenith Spiral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95145702|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,300.00|FSC: 13; Default||Not reimbursed separately|27,300.00|FSC: 13; Default||External grouping not supported 95174353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lapidus 4 Hole Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95145703|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95174354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 3-hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95145704|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,940.00|FSC: 13; Default||Not reimbursed separately|11,940.00|FSC: 13; Default||External grouping not supported 95174355|EAP|Custom 95174355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire .078 X 5.91 Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145706|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 14 X 11 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95174357|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145707|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 14 X 11 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95174358|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145708|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|FSC: 13; Default||Not reimbursed separately|8,893.50|FSC: 13; Default||External grouping not supported 95174359|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95174360|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 7.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95174361|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|485.10|FSC: 13; Default||Not reimbursed separately|485.10|FSC: 13; Default||External grouping not supported 95174362|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 2.5 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95174364|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 9 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145713|EAP|Custom 95145713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink 58mm|1|HUMANA [1294]||HUMANA [11839]|5,568.36|FSC: 13; Default||Not reimbursed separately|5,568.36|FSC: 13; Default||External grouping not supported 95174365|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95145714|EAP|Custom 95145714||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Emg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145715|EAP|Custom 95145715||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Probe Stimulator Tip Ball|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174367|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|FSC: 13; Default||Not reimbursed separately|1,902.00|FSC: 13; Default||External grouping not supported 95174368|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145717|EAP|Custom 95145717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174369|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95145719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95174370|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95174371|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95174372|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 9 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95145722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95174373|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95145723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95174374|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,051.07|FSC: 13; Default||Not reimbursed separately|2,051.07|FSC: 13; Default||External grouping not supported 95174375|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95145725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95174376|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 58mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95174377|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145727|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall Biliary 8mm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,369.62|FSC: 13; Default||Not reimbursed separately|4,369.62|FSC: 13; Default||External grouping not supported 95174378|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 4.0 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95145729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Smart 1.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|FSC: 13; Default||Not reimbursed separately|408.99|FSC: 13; Default||External grouping not supported 95145730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Smart 1.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|FSC: 13; Default||Not reimbursed separately|408.99|FSC: 13; Default||External grouping not supported 95145731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95123510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 20mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95145732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95126623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 22mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95145733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95174380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95145734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95174381|EAP|Custom 95174381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist Mri 5/16th|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95174382|EAP|Custom 95174382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Drill Vertecor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95174383|EAP|Custom 95174383||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit First Fracture Short |1|HUMANA [1294]||HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95145737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95186310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Dia 5mm X 250mm Sd/st 70 Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95145738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95145739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95188947|EAP|Custom 95188947||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Speed 13 X 10 X 10 Mm|1|HUMANA [1294]||HUMANA [11839]|3,068.37|FSC: 13; Default||Not reimbursed separately|3,068.37|FSC: 13; Default||External grouping not supported 95145740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95145741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95186311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hex 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.00|FSC: 13; Default||Not reimbursed separately|789.00|FSC: 13; Default||External grouping not supported 95145742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Advoca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|FSC: 13; Default||Not reimbursed separately|7,155.72|FSC: 13; Default||External grouping not supported 95174388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95145743|EAP|Custom 95145743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Urostomy 1 Piece Custom A6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 5mm Quickdraw Mini Delay|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|FSC: 13; Default||Not reimbursed separately|1,161.00|FSC: 13; Default||External grouping not supported 95145745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,432.00|FSC: 13; Default||Not reimbursed separately|6,432.00|FSC: 13; Default||External grouping not supported 95174391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|FSC: 13; Default||Not reimbursed separately|3,033.00|FSC: 13; Default||External grouping not supported 95145746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|FSC: 13; Default||Not reimbursed separately|8,012.01|FSC: 13; Default||External grouping not supported 95174392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.0 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95145747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|FSC: 13; Default||Not reimbursed separately|8,012.01|FSC: 13; Default||External grouping not supported 95174393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size E Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95145748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|FSC: 13; Default||Not reimbursed separately|8,012.01|FSC: 13; Default||External grouping not supported 95145749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95174396|EAP|Custom 95174396||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blanket Warming Patient Pediatric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95174397|EAP|Custom 95174397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blanket Warming Patient Cardiac Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|FSC: 13; Default||Not reimbursed separately|5,121.60|FSC: 13; Default||External grouping not supported 95174399|EAP|Custom 95174399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Clinpro Sealant Intro Syringe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95158640|EAP|Custom 95158640||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Post-op Darco Female Large Black Square Toe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,390.00|FSC: 13; Default||Not reimbursed separately|3,390.00|FSC: 13; Default||External grouping not supported 95174428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Short-thread Torque Max 4.0mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95145754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|FSC: 13; Default||Not reimbursed separately|5,121.60|FSC: 13; Default||External grouping not supported 95174429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Short-thread Torque Max 4.0mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|FSC: 13; Default||Not reimbursed separately|548.25|FSC: 13; Default||External grouping not supported 95145756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95174430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Posterior 14 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95145757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95174431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Flexible Pds|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|FSC: 13; Default||Not reimbursed separately|897.00|FSC: 13; Default||External grouping not supported 95145758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95174432|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege 6 Fr .035 10 Mm X 40 Mm 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95145759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Xlpe Cr Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95174433|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self Expanding Nitinol 6fh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95145761|EAP|Custom 95145761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Processing Angel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174434|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self Expanding Nitinol 6fh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95145772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lcck Sz D Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95174435|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self Expanding Nitinol 6fh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95145774|EAP|Custom 95145774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Adult Bronch W/10318l 6.5mp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174436|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expanding Biliary Stent M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95145789|EAP|Custom 95145789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Urostomy Kit 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174437|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expanding Biliary Stent M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95145790|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Parastomal 12.5cm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,282.74|FSC: 13; Default||Not reimbursed separately|4,282.74|FSC: 13; Default||External grouping not supported 95174441|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ensnare|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 38mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.58|FSC: 13; Default||Not reimbursed separately|41.58|FSC: 13; Default||External grouping not supported 95174445|EAP|Custom 95174445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chandelier Dual Oshima 29 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145806|EAP|Custom 95145806||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Tubing Lavage Pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174447|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated 25 X 100 16x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95145807|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 1.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174450|EAP|Custom 95174450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Specific Patient Nexgen Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145808|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total Ts Triathlon X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95145809|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 2.5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Triathlon Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95145810|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Choice Pt Ex Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Kompressor 22mm Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95145824|EAP|Custom 95145824||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Device 1|1|HUMANA [1294]||HUMANA [11839]|11,310.00|FSC: 13; Default||Not reimbursed separately|11,310.00|FSC: 13; Default||External grouping not supported 95145831|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optimark (15ml) 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|7.72|FSC: 13; Default||Not reimbursed separately|7.72|FSC: 13; Default||External grouping not supported 95192357|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 4.0 Diopter Acrysof Multipiece-expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95145832|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optimark (20ml) 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|7.72|FSC: 13; Default||Not reimbursed separately|7.72|FSC: 13; Default||External grouping not supported 95186308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Bi-cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95145855|EAP|Custom 95145855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duplocath 35cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188948|EAP|Custom 95188948||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Speed 11 X 10 X 10mm|1|HUMANA [1294]||HUMANA [11839]|3,068.37|FSC: 13; Default||Not reimbursed separately|3,068.37|FSC: 13; Default||External grouping not supported 95145871|EAP|Custom 95145871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tubing Heart/lung|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bio-screw 10 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95188949|EAP|Custom 95188949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Drill Hand / Wrist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95145902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95145909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95145910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 52mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95145923|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide Multipurpose Attain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 100 Mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|FSC: 13; Default||Not reimbursed separately|2,164.59|FSC: 13; Default||External grouping not supported 95145924|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Amplatz 7f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95145926|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerable Prevail Attai|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpnwith T6 Stardrive Recess Ti 2.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95145927|EAP|Custom 95145927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145934|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 87.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 95174458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95145937|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Pinnacle 25cm Radiopaque|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174461|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.25 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Advantage Global Cta 48 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,103.25|FSC: 13; Default||Not reimbursed separately|7,103.25|FSC: 13; Default||External grouping not supported 95174462|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.25 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145944|EAP|Custom 95145944||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter Vertestak 16mm|1|HUMANA [1294]||HUMANA [11839]|14,003.22|FSC: 13; Default||Not reimbursed separately|14,003.22|FSC: 13; Default||External grouping not supported 95174463|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.25 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95174464|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.25 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 13mm X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.00|FSC: 13; Default||Not reimbursed separately|2,595.00|FSC: 13; Default||External grouping not supported 95174465|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 08 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95174466|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95174467|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|FSC: 13; Default||Not reimbursed separately|368.94|FSC: 13; Default||External grouping not supported 95174468|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|FSC: 13; Default||Not reimbursed separately|2,373.12|FSC: 13; Default||External grouping not supported 95174469|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174470|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174471|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174472|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 2.5 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174473|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 08|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174474|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95174475|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95174478|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95174476|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95174477|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95174479|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145968|EAP|Custom 95145968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Burn Silver Acticoat 48|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174480|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.0 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145977|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174481|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 08|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145981|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 14mm Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95174482|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145984|EAP|Custom 95145984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Parallax Cement Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174483|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95174484|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145995|EAP|Custom 95145995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adaptor Sealing Extended Wing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174485|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 95174486|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95145999|EAP|Custom 95145999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Beam A Bend Argon 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174487|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146000|EAP|Custom 95146000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Vent Gromet Beveled Pop|1|HUMANA [1294]||HUMANA [11839]|39.41|FSC: 13; Default||Not reimbursed separately|39.41|FSC: 13; Default||External grouping not supported 95174488|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.5 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146001|EAP|Custom 95146001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Cardiovascular Acuseal 2.5|1|HUMANA [1294]||HUMANA [11839]|849.00|FSC: 13; Default||Not reimbursed separately|849.00|FSC: 13; Default||External grouping not supported 95174489|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 08|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146002|EAP|Custom 95146002||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Cardiovascular Acuseal 1cm|1|HUMANA [1294]||HUMANA [11839]|678.00|FSC: 13; Default||Not reimbursed separately|678.00|FSC: 13; Default||External grouping not supported 95174490|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146009|EAP|Custom 95146009||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dressing Wound Matrix Promogran|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174491|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146017|EAP|Custom 95146017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Tip Ball Nim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174492|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95174493|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95174494|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95174495|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 95174496|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 4.0 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchorlok 1.9-2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95174505|EAP|Custom 95174505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Specific Patient Nexgen Lps Ct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 10mm Ex 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 80164585|EAP|Custom 80164585||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Laser Iris Procedure Pre Cornea Transplant|1|HUMANA [1294]||HUMANA [11839]|312.01|FSC: 13; Default||Not reimbursed separately|312.01|FSC: 13; Default||External grouping not supported 95146037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 0mm With T40 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.56|FSC: 13; Default||Not reimbursed separately|691.56|FSC: 13; Default||External grouping not supported 95146038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 38mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95146039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 34mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95146040|EAP|Custom 95146040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Ex 4.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/130 Deg 380mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95146041|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft 2cm X 4cm Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|347.63|FSC: 13; Default||Not reimbursed separately|347.63|FSC: 13; Default||External grouping not supported 95146042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95188951|EAP|Custom 95188951||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slingshot 70 Degree Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 35mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|FSC: 13; Default||Not reimbursed separately|776.25|FSC: 13; Default||External grouping not supported 95146044|EAP|Custom 95146044||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Lordotic 9mm X 9mm X 27mm|1|HUMANA [1294]||HUMANA [11839]|9,706.50|FSC: 13; Default||Not reimbursed separately|9,706.50|FSC: 13; Default||External grouping not supported 95146046|EAP|Custom 95146046||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .035 D|1|HUMANA [1294]||HUMANA [11839]|294.93|FSC: 13; Default||Not reimbursed separately|294.93|FSC: 13; Default||External grouping not supported 95174515|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Armada 14 Pta 3.0mm X 20mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146047|EAP|Custom 95146047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization Nestor .038 Dl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164593|EAP|CPT® 95813||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg Extended >1hr|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95146058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Standard Metasul 32/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,644.00|FSC: 13; Default||Not reimbursed separately|4,644.00|FSC: 13; Default||External grouping not supported 95146059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Metasul 32/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,755.22|FSC: 13; Default||Not reimbursed separately|3,755.22|FSC: 13; Default||External grouping not supported 95146061|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Platinum Plus Lt .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95146062|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Platinum Plus Lt .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174522|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.5 Ao Diopter Crystalens Posterior Chamber 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146063|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174510|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Magnifuse Cervical Posterior 1cm X Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95146065|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Decapolar 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146066|EAP|Custom 95146066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Pigtail|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174511|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Rs 2cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95170244|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Enuragen 1.5mm X 3cm|1|HUMANA [1294]||HUMANA [11839]|6,549.00|FSC: 13; Default||Not reimbursed separately|6,549.00|FSC: 13; Default||External grouping not supported 95146068|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pinnacle 7fr 25cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174527|EAP|Custom 95174527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guide Adapter Sealing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146069|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Soft Vu Om|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174529|EAP|Custom 95174529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Cholangiogram W/o Bulbous Tip Taut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146070|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Sos Omni 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12mm X 125deg X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95146073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|FSC: 13; Default||Not reimbursed separately|2,274.24|FSC: 13; Default||External grouping not supported 95174532|EAP|Custom 95174532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix Tubular 6mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95146075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95146078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 7 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95146079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95146080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 40mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|FSC: 13; Default||Not reimbursed separately|776.25|FSC: 13; Default||External grouping not supported 95146083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.92|FSC: 13; Default||Not reimbursed separately|3,118.92|FSC: 13; Default||External grouping not supported 95146084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 65mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.23|FSC: 13; Default||Not reimbursed separately|391.23|FSC: 13; Default||External grouping not supported 95146085|EAP|Custom 95146085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Cutter Curved Contour|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146086|EAP|Custom 95146086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Cutter Curved Con|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146087|EAP|Custom 95146087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Cutter Curved Con|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146095|EAP|Custom 95146095||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbx 10 Cc (demineralized)9|1|HUMANA [1294]||HUMANA [11839]|4,260.03|FSC: 13; Default||Not reimbursed separately|4,260.03|FSC: 13; Default||External grouping not supported 95146096|EAP|Custom 95146096||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adhesive Dermabond Skin Topicaly|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146099|EAP|Custom 95146099||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Pacemaker Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146100|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 8.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 80164627|EAP|CPT® 44382||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ileoscopy Thru Stoma W Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95146116|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perclose Proglide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95158634|EAP|Custom 95158634||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Surgical Darco Male Black Medium Size 8.5-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146122|EAP|Custom 95146122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Drainage Urine Meter(latex R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160470|EAP|Custom 95160470||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|HB SHOE SURGICAL DARCO MALE BLACK LARGE SIZE 11.5-12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146125|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174547|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile High 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95146127|EAP|Custom 95146127||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Stomahesive W/flange 1-3/a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174548|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile High 700cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95146129|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Choice Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Lunate Suture |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,055.00|FSC: 13; Default||Not reimbursed separately|2,055.00|FSC: 13; Default||External grouping not supported 95146130|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Divergent Radial Styloid |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,055.00|FSC: 13; Default||Not reimbursed separately|2,055.00|FSC: 13; Default||External grouping not supported 95146131|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Supracore .035 X 190cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95146132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight 12 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95174560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95146133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lcck Sz C Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,536.89|FSC: 13; Default||Not reimbursed separately|17,536.89|FSC: 13; Default||External grouping not supported 95174561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95146134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95174562|EAP|Custom 95174562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0 X 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial Rt Lat 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 95174563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5 Titanium Rt 10 X 380mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95146141|EAP|Custom 95146141||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tibia A/p #3|1|HUMANA [1294]||HUMANA [11839]|7,195.50|FSC: 13; Default||Not reimbursed separately|7,195.50|FSC: 13; Default||External grouping not supported 95174566|EAP|Custom 95174566||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinmann Threaded 2.5mm|1|HUMANA [1294]||HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95146142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Tibial Augment 3/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|FSC: 13; Default||Not reimbursed separately|3,597.06|FSC: 13; Default||External grouping not supported 95174567|EAP|Custom 95174567||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Combicath Mini Bal 8f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lcck Yellow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95174558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 95146144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lcck Sz E Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95174565|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Unify Quadra Assura Bi-ventricular Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|FSC: 13; Default||Not reimbursed separately|60,912.00|FSC: 13; Default||External grouping not supported 95146145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Offset 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|FSC: 13; Default||Not reimbursed separately|4,758.00|FSC: 13; Default||External grouping not supported 95174570|EAP|Custom 95174570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Continuous Compression Implant Sizing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Pow 3.5 Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased Rt 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95174574|EAP|Custom 95174574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Continuous Compression|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174575|EAP|Custom 95174575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple 20mm X 20mm X 20mm Speed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174576|EAP|Custom 95174576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple 18mm X 18mm Speed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110118|EAP|Custom 95110118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pattie Surgical 1/2 X 3 10-pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146154|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95146155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tmzf Accolade #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95146156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|FSC: 13; Default||Not reimbursed separately|2,274.24|FSC: 13; Default||External grouping not supported 95146157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95146158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95146159|EAP|Custom 95146159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Tubular 22mm X 9cm Met|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146165|EAP|Custom 95146165||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146166|EAP|Custom 95146166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Torque Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146170|EAP|Custom 95146170||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Secour Sar-901 Ships Overnite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146171|EAP|Custom 95146171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Parallax Cement Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164635|EAP|CPT® 93303||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo 2d Congenital Complete|1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 80164643|EAP|CPT® 93304||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo 2d Congenital Limited|1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 95146173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 22mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95174578|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.25 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95174579|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.25 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95174580|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.25 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146176|EAP|Custom 95146176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload 6-row 45mm Gray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174581|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.25 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146180|EAP|Custom 95146180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade 40 Rad 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174582|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Xpedition Drug Eluting 3.25 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95146181|EAP|Custom 95146181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round Speed High 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174585|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sts Bipolar 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95146182|EAP|Custom 95146182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Taper Speed High 70|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174586|EAP|Custom 95174586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Over Top Van Schie Plus Flush Royal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146186|EAP|Custom 95146186||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensormat Bed-check Bed Size Dis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112927|EAP|Custom 95112927||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Surgicover Sterile Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146187|EAP|Custom 95146187||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensormat Bed-check Chair Size D|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174588|EAP|HCPCS C9362||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cartilage Micronized Biocartilage 1.5cc|1|HUMANA [1294]||HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95174589|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 28mm X 58cm Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95146190|EAP|Custom 95146190||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Contour Se Microsheres Pva Parti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174590|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 28mm X 58cm Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,177.39|FSC: 13; Default||Not reimbursed separately|6,177.39|FSC: 13; Default||External grouping not supported 95146192|EAP|Custom 95146192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thoracentesis Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110110|EAP|Custom 95110110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pattie Surgical 1-1/2 X 1/2 10-pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ceramic Taper V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|FSC: 13; Default||Not reimbursed separately|4,717.50|FSC: 13; Default||External grouping not supported 95174598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 5.5 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95146194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Acolade Tmzf Number|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95174599|EAP|Custom 95174599||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Extra Large Coroent 8 X 18 X 45|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95146195|EAP|Custom 95146195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Eopa 18fr W/wir|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95146197|EAP|Custom 95146197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Eopa 20fr W/wir|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 26mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95146198|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,310.00|FSC: 13; Default||Not reimbursed separately|11,310.00|FSC: 13; Default||External grouping not supported 95174602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 30mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95146199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95174604|EAP|Custom 95174604||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 1.2mm|1|HUMANA [1294]||HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95146200|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 8x12 Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.72|FSC: 13; Default||Not reimbursed separately|93.72|FSC: 13; Default||External grouping not supported 95174605|EAP|Custom 95174605||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 1.6mm|1|HUMANA [1294]||HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95146205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quickanchor Plus Gii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,413.00|FSC: 13; Default||Not reimbursed separately|1,413.00|FSC: 13; Default||External grouping not supported 95174608|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventralex Large Circle W Strap 3.2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,711.95|FSC: 13; Default||Not reimbursed separately|1,711.95|FSC: 13; Default||External grouping not supported 95146207|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bio-screw Interference Fem Bioabsorable 11mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95146213|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kr3h Mach 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116837|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 12 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.17|FSC: 13; Default||Not reimbursed separately|2,890.17|FSC: 13; Default||External grouping not supported 95146219|EAP|Custom 95146219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cannula Universal 7mm X 76mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146262|EAP|Custom 95146262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Femoral 2-stage 27 3/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174610|EAP|Custom 95174610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Syncrowate St Microthermx Microwave Antenna|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146263|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff Shaft .035 Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146264|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff Shaft .035 Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146268|EAP|Custom 95146268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Washout Rectal Proctowash|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174612|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Visiglide .025 70mm Angled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146273|EAP|Custom 95146273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 18 French Gastro Enteric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95146274|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 10.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95174614|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tibia Distal Fresh Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|FSC: 13; Default||Not reimbursed separately|19,200.00|FSC: 13; Default||External grouping not supported 95146275|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Embolic Protection Rx Acc|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95146276|EAP|Custom 95146276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 16 French Gastro Enteric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146281|EAP|Custom 95146281||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146282|EAP|Custom 95146282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizers Graft Large 24mm-38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146284|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemoshield Straight 7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,043.85|FSC: 13; Default||Not reimbursed separately|1,043.85|FSC: 13; Default||External grouping not supported 95174617|EAP|Custom 95174617||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Delivery And Mixing 3cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146285|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemoshield Straight 8mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.66|FSC: 13; Default||Not reimbursed separately|1,218.66|FSC: 13; Default||External grouping not supported 95174618|EAP|Custom 95174618||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Series 1 Acp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Eccentric Advantage Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95174619|EAP|Custom 95174619||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Funnel Acp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Radius Distal 3 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|FSC: 13; Default||Not reimbursed separately|1,425.36|FSC: 13; Default||External grouping not supported 95174621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95146290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Radius Distal 4 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,538.91|FSC: 13; Default||Not reimbursed separately|1,538.91|FSC: 13; Default||External grouping not supported 95174623|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Cuff Aortic Proximal 28mm X 28mm Covered 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,740.00|FSC: 13; Default||Not reimbursed separately|10,740.00|FSC: 13; Default||External grouping not supported 95146291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conf Pro Rt Sz 4-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95174622|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Unibody Bifurcated 28mm 100/l 16-40 Iliac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95146292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Porous Non Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 95146293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Non Porous Profix S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 95188952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Slf-tpngwith Stardrive Recess Ti 2.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95192363|EAP|Custom 95192363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Arthroscopic Q-fix 2.8mm Shoulder Drill Guide Obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146295|EAP|Custom 95146295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Midline Intermediate Perqca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146296|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Micro Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188953|EAP|Custom 95188953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slingshot 45 Degree Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146297|EAP|Custom 95146297||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 0.8mm|1|HUMANA [1294]||HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95146300|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146301|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188954|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allopatch Hd Ultra Thick 5cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.30|FSC: 13; Default||Not reimbursed separately|194.30|FSC: 13; Default||External grouping not supported 95146303|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146304|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95192370|EAP|Custom 95192370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smoother Bone Acufex Gore Od9.5 Mm Crucial Tool Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146305|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95146306|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dorsal Spanning Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95146307|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146308|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146309|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146310|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146311|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95174630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lipped Cs Large 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95146312|EAP|Custom 95146312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Thermal Split Torso Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174631|EAP|Custom 95174631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146313|EAP|Custom 95146313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Thermal Split Torso Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Reverse Tm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95146314|EAP|Custom 95146314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Thermal Split Torso Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 12mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,492.88|FSC: 13; Default||Not reimbursed separately|5,492.88|FSC: 13; Default||External grouping not supported 95146316|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95174634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm L30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95146317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Ti 38mm Nail Humera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,046.39|FSC: 13; Default||Not reimbursed separately|2,046.39|FSC: 13; Default||External grouping not supported 95174635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal Ts 14 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|FSC: 13; Default||Not reimbursed separately|4,933.44|FSC: 13; Default||External grouping not supported 95146318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Ti 42mm Nail Humera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,046.39|FSC: 13; Default||Not reimbursed separately|2,046.39|FSC: 13; Default||External grouping not supported 95174636|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Turbohawk Ls-c Vessel Large 8fr 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 7.5mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,317.42|FSC: 13; Default||Not reimbursed separately|4,317.42|FSC: 13; Default||External grouping not supported 95174637|EAP|Custom 95174637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Smoke Laparoscopic Plumeport Continuous Sucti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 0mm Nail Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.24|FSC: 13; Default||Not reimbursed separately|513.24|FSC: 13; Default||External grouping not supported 95174640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 10mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.81|FSC: 13; Default||Not reimbursed separately|1,005.81|FSC: 13; Default||External grouping not supported 95146321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 22mm For I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.02|FSC: 13; Default||Not reimbursed separately|454.02|FSC: 13; Default||External grouping not supported 95174641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 2 Triathlon Size 3-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95146322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X 26mm For I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.02|FSC: 13; Default||Not reimbursed separately|454.02|FSC: 13; Default||External grouping not supported 95174642|EAP|Custom 95174642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Needle Ez-10 45mm 15ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146323|EAP|Custom 95146323||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner Trocar Point 25 X|1|HUMANA [1294]||HUMANA [11839]|340.86|FSC: 13; Default||Not reimbursed separately|340.86|FSC: 13; Default||External grouping not supported 62061973|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Anti-mullerian Hormone - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 95146324|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 62061981|EAP|CPT® 81291||0301 - LABORATORY - CHEMISTRY|Hb Mthfr 2 Mutations - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.02|FSC: 13; Default||Not reimbursed separately|196.02|FSC: 13; Default||External grouping not supported 95146325|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174644|EAP|Custom 95174644||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Twist - In |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146326|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146327|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146328|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146329|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146330|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146331|EAP|Custom 95146331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Insertion 8fr 6 25cc Fideli|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146335|EAP|Custom 95146335||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Hammertoe Implant (includes|1|HUMANA [1294]||HUMANA [11839]|3,570.00|FSC: 13; Default||Not reimbursed separately|3,570.00|FSC: 13; Default||External grouping not supported 95146339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann Cancel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95146340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann Cancel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95146344|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 4x12 Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95146352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95146353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95120360|EAP|Custom 95120360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Iv 4 Lead Tur W/wide Bore Tubing + 130ml Drip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95174667|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventralex Small Circle With Strap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.10|FSC: 13; Default||Not reimbursed separately|1,121.10|FSC: 13; Default||External grouping not supported 95146355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95174668|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventralex Medium Circle With Strap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,348.35|FSC: 13; Default||Not reimbursed separately|1,348.35|FSC: 13; Default||External grouping not supported 95146356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95174670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|FSC: 13; Default||Not reimbursed separately|1,593.30|FSC: 13; Default||External grouping not supported 95146357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Midcoat Fiber-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95174671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10 X 320 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95146358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95174672|EAP|Custom 95174672||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Inserter Button|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95174675|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Project High Base Round 270cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95146362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +7 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.10|FSC: 13; Default||Not reimbursed separately|1,661.10|FSC: 13; Default||External grouping not supported 95174676|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Project High Base Round 320cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95146365|EAP|Custom 95146365||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour Without Wire 7 X 2|1|HUMANA [1294]||HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95174677|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Project High Base Round 235cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95146366|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour Without Wire 8 X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95174678|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Project High Base Round 255cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95146367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina Ceramic -5/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95174679|EAP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Micro Matristim 60mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|FSC: 13; Default||Not reimbursed separately|7.66|FSC: 13; Default||External grouping not supported 95146389|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95146390|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146391|EAP|Custom 95146391||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Splint Nail Inro Surgical Medium|1|HUMANA [1294]||HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95146392|EAP|Custom 95146392||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Mortez Peg Top Parti|1|HUMANA [1294]||HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95174682|EAP|Custom 95174682||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Mini Bunion|1|HUMANA [1294]||HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95146393|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Resynchronization Cardiac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65,550.00|FSC: 13; Default||Not reimbursed separately|65,550.00|FSC: 13; Default||External grouping not supported 95174683|EAP|Custom 95174683||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Pocketlock Mtp Mini Maxlock Extreme|1|HUMANA [1294]||HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95174684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95146396|EAP|Custom 95146396||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Periarticular Flat|1|HUMANA [1294]||HUMANA [11839]|50.61|FSC: 13; Default||Not reimbursed separately|50.61|FSC: 13; Default||External grouping not supported 95174691|EAP|Custom 95174691||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 8mm|1|HUMANA [1294]||HUMANA [11839]|4,291.56|FSC: 13; Default||Not reimbursed separately|4,291.56|FSC: 13; Default||External grouping not supported 95146398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 6mm Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,690.00|FSC: 13; Default||Not reimbursed separately|12,690.00|FSC: 13; Default||External grouping not supported 95174692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Reverse Tm 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95174693|EAP|Custom 95174693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146413|EAP|Custom 95146413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Sealant Dural Dura Seal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117073|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 10x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,387.00|FSC: 13; Default||Not reimbursed separately|3,387.00|FSC: 13; Default||External grouping not supported 95146414|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Soft 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146415|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Prowater 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95117101|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 28fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146416|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Grand Slam 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146421|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Shuttle Ksaw 8.0-38-90-rb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146423|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146425|EAP|Custom 95146425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plunger Cor 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146426|EAP|Custom 95146426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Delivery Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146427|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146428|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146429|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146430|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95186254|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Artoura Te 600cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95146431|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95188960|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 2.50mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95146432|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186316|EAP|Custom 95186316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Harvester Cellutome Epidermal 5.0 Cm X 5.0 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146433|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 16mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|133.89|FSC: 13; Default||Not reimbursed separately|133.89|FSC: 13; Default||External grouping not supported 95146434|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186317|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Eva Single Use 10 Fr X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|152.10|FSC: 13; Default||Not reimbursed separately|152.10|FSC: 13; Default||External grouping not supported 95146436|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146437|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146438|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146439|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146440|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95188961|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 2.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146441|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Lateral Pos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,436.56|FSC: 13; Default||Not reimbursed separately|3,436.56|FSC: 13; Default||External grouping not supported 95146444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95146445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95146446|EAP|Custom 95146446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Calibrated 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146447|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146448|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146450|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146451|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 9.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146452|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink ,035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 95146455|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Venture 4.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 95146457|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 9 X 14 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95146458|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Peripheral Cutting 5mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146459|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Peripheral Cutting 6mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Medical Distal Left 12-hole/l201mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,535.00|FSC: 13; Default||Not reimbursed separately|8,535.00|FSC: 13; Default||External grouping not supported 95146460|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Peripheral Cutting 7mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146461|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Peripheral Cutting 8mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188962|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 2.50mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mystique 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,721.64|FSC: 13; Default||Not reimbursed separately|4,721.64|FSC: 13; Default||External grouping not supported 95186321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4mm/l55/ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95146463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mystique 3.0 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.88|FSC: 13; Default||Not reimbursed separately|1,181.88|FSC: 13; Default||External grouping not supported 95146464|EAP|Custom 95146464||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Prefixation Mystique|1|HUMANA [1294]||HUMANA [11839]|320.46|FSC: 13; Default||Not reimbursed separately|320.46|FSC: 13; Default||External grouping not supported 95192361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Standard Radial Head Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,004.00|FSC: 13; Default||Not reimbursed separately|5,004.00|FSC: 13; Default||External grouping not supported 95146465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Smart 1.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|FSC: 13; Default||Not reimbursed separately|408.99|FSC: 13; Default||External grouping not supported 95186320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4mm/l32/ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95146467|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95188963|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 2.50mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146468|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95186323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma 13x420mmx125degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95146472|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Transobturator Halo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 95146474|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4mm/l30/ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95146475|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemoshield Straight 10mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.66|FSC: 13; Default||Not reimbursed separately|1,218.66|FSC: 13; Default||External grouping not supported 95188964|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 2.50mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146476|EAP|Custom 95146476||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Bone Cement Mix And Trans|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95186325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Interspinous 36mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|FSC: 13; Default||Not reimbursed separately|19,500.00|FSC: 13; Default||External grouping not supported 95146478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Kyphx Hv-r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95192362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mod T7 Drive 2.7mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95146479|EAP|Custom 95146479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Curette 8.0mm T-tip Kyphex Latit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Sz54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95146480|EAP|Custom 95146480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Inflation Xpander Kyphx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146481|EAP|Custom 95146481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tamp Bone Inflatable Xpander Kyp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146483|EAP|Custom 95146483||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Filler Bone Sz3 Kyphx|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95146499|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146501|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95188965|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.00mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146509|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Rim Elevated Continuum Trilogy Crosslink Poly 36mm Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95146510|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146511|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Tm W/holes 66mm Sz Pp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95146512|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188966|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.00mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95146513|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186332|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Axoguard Protector 5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.00|FSC: 13; Default||Not reimbursed separately|5,553.00|FSC: 13; Default||External grouping not supported 95192358|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Distl Endovascular Thoracic Alpha Zenith 28mm X160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,895.00|FSC: 13; Default||Not reimbursed separately|47,895.00|FSC: 13; Default||External grouping not supported 95186333|EAP|Custom 95186333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Biopsy Spybite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146519|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial Intracoil 6mm Dh|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95146520|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bronchial Intracoil 7mm Di|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95188967|EAP|Custom 95188967||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Biocartilage Small Joint|1|HUMANA [1294]||HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95186359|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Artoura Hp 375cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95146523|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186367|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular Taa Tx2 Z|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95146524|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188968|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.00mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95146525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Standard Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|FSC: 13; Default||Not reimbursed separately|3,063.00|FSC: 13; Default||External grouping not supported 95186366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular Taa Tx2 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95146526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95192359|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 7.1mmx201mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95146527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 3.2mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95186364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Extreme Maxlock Mini Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,796.00|FSC: 13; Default||Not reimbursed separately|5,796.00|FSC: 13; Default||External grouping not supported 95146528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 3.2mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95188969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95146529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95186365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Extreme Maxlock Mini 2.7mmx6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95146530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95146531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95186363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm/l44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95146532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 3.2mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95188971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|FSC: 13; Default||Not reimbursed separately|717.00|FSC: 13; Default||External grouping not supported 95186368|EAP|Custom 95186368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 25 Gauge Dual Port Sideflo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192364|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Ingevity L52 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95146535|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186362|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Gandras Visci-g 5fr 75cm 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146537|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Sos Omni 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188972|EAP|Custom 95188972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 2.4mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146538|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff Shaft .035 Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biorci-ha 11 X 30 Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|833.85|FSC: 13; Default||Not reimbursed separately|833.85|FSC: 13; Default||External grouping not supported 95146539|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|FSC: 13; Default||Not reimbursed separately|2,175.36|FSC: 13; Default||External grouping not supported 95186373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95146541|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 11mm Tib E-f Fem 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95146542|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum Gg Neutral 32x48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95146543|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192365|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Ingevity L59 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95146544|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146545|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188974|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 36mm X 209 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95146546|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95146548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95146549|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188975|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.00mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95146550|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146551|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192366|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Cardiac Accolade Mri Latitude .75cmx4.45cmx5.88cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,680.00|FSC: 13; Default||Not reimbursed separately|13,680.00|FSC: 13; Default||External grouping not supported 95146552|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146553|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188976|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.00mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146554|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146555|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146556|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146557|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188977|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146558|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146559|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117243|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 8x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95146560|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192367|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Accolade Sr-mri Signle Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,141.00|FSC: 13; Default||Not reimbursed separately|12,141.00|FSC: 13; Default||External grouping not supported 95146561|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117244|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Wall 10mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95146562|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146563|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95117245|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 10x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95146564|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188978|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.50mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146565|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146566|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146567|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95146568|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188979|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.50mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95146569|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192368|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen El Vr Single Chamber Rt Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,750.00|FSC: 13; Default||Not reimbursed separately|39,750.00|FSC: 13; Default||External grouping not supported 95146572|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95188980|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Absorb Gt1 Vascular Scaffold Bioresorb 3.50mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95146576|EAP|Custom 95146576||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb St Boot Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146577|EAP|Custom 95146577||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb St Boot Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146578|EAP|Custom 95146578||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Genumedi Beige Size 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146579|EAP|Custom 95146579||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Genumedi Beige Size 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Val Condylar 2 Hole Hd-6 Holes Shaft 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.78|FSC: 13; Default||Not reimbursed separately|1,557.78|FSC: 13; Default||External grouping not supported 95146580|EAP|Custom 95146580||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Genumedi Beige Size 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146581|EAP|Custom 95146581||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Genumedi Beige Size 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192369|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Momentum El Vr Single Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,250.00|FSC: 13; Default||Not reimbursed separately|44,250.00|FSC: 13; Default||External grouping not supported 95146582|EAP|Custom 95146582||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146583|EAP|Custom 95146583||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146584|EAP|Custom 95146584||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Left Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-locking Slf-tpngwith T4 Stardrive Recess 1.5mm X 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95146585|EAP|Custom 95146585||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Left Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146586|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Wholey 175cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146588|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 7.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95146589|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Dialysis Hemosplit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95146594|EAP|Custom 95146594||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Basic Compax|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95146596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade Cannulated 3.5mm 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,773.78|FSC: 13; Default||Not reimbursed separately|1,773.78|FSC: 13; Default||External grouping not supported 95146598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Psl Ceramic 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95188983|EAP|Custom 95188983||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2 X 200mm Unthreaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146605|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192371|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Vigilant El Vr Df4 Single Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,250.00|FSC: 13; Default||Not reimbursed separately|44,250.00|FSC: 13; Default||External grouping not supported 95146607|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Embolectomy 6fr Over-the-we|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146609|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Peripheral Spartacore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146610|EAP|Custom 95146610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Torque Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146611|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95188984|EAP|Custom 95188984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.0 X 170mm Cannulated With Calibrations|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146612|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95146613|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95146614|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95146634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Lcp Volar 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,657.67|FSC: 13; Default||Not reimbursed separately|2,657.67|FSC: 13; Default||External grouping not supported 95146639|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Hp L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95146640|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Hp L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95146641|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Hp L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95146642|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Supracore 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188985|EAP|Custom 95188985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 5.0mm Ao Cannulated With Calibrations|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146644|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146645|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Selective|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146646|EAP|Custom 95146646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Laryngeal Angled 15-deg Tr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95192372|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen El Dr Dual Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,750.00|FSC: 13; Default||Not reimbursed separately|45,750.00|FSC: 13; Default||External grouping not supported 95146651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non Porous Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95146653|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95146654|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95146655|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95117349|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary 10fr 35cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lcck F Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|FSC: 13; Default||Not reimbursed separately|19,734.00|FSC: 13; Default||External grouping not supported 95188986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0 X L55mm Solid Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|FSC: 13; Default||Not reimbursed separately|2,934.00|FSC: 13; Default||External grouping not supported 95146658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Femoral Distal 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95146659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lcck Yellow St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95146660|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95146664|EAP|Custom 95146664||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Anal Surgisis|1|HUMANA [1294]||HUMANA [11839]|2,344.14|FSC: 13; Default||Not reimbursed separately|2,344.14|FSC: 13; Default||External grouping not supported 95146667|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Grand Slam 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146668|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graftmaster 3.5x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95146669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Volar 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|FSC: 13; Default||Not reimbursed separately|1,918.29|FSC: 13; Default||External grouping not supported 95146670|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kr3h Mach 1 W/sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Protean Fragment Double Hockey Stick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95146671|EAP|Custom 95146671||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Left X-small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146672|EAP|Custom 95146672||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Left Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117372|EAP|Custom 95117372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146673|EAP|Custom 95146673||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Left Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146674|EAP|Custom 95146674||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Left Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146675|EAP|Custom 95146675||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right X-small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192381|EAP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pacing 4-site Reliance Gore Df4 64cm Single Coil Hv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 95146676|EAP|Custom 95146676||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146677|EAP|Custom 95146677||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146678|EAP|Custom 95146678||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Cta Advantage Global 48 X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|FSC: 13; Default||Not reimbursed separately|6,765.00|FSC: 13; Default||External grouping not supported 95146686|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146687|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered 5x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95146688|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered 6x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95146689|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered 7x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95192373|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen El Dr Is-1 Df4 Dual Chamber I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,750.00|FSC: 13; Default||Not reimbursed separately|45,750.00|FSC: 13; Default||External grouping not supported 95146702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95146703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.80|FSC: 13; Default||Not reimbursed separately|142.80|FSC: 13; Default||External grouping not supported 95146704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.80|FSC: 13; Default||Not reimbursed separately|142.80|FSC: 13; Default||External grouping not supported 95117407|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 36fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.72|FSC: 13; Default||Not reimbursed separately|126.72|FSC: 13; Default||External grouping not supported 95146706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.72|FSC: 13; Default||Not reimbursed separately|126.72|FSC: 13; Default||External grouping not supported 95146707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 14 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.36|FSC: 13; Default||Not reimbursed separately|558.36|FSC: 13; Default||External grouping not supported 95146708|EAP|Custom 95146708||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame Ti Lc4 8cm|1|HUMANA [1294]||HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95188989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 12mm/125/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95146710|EAP|Custom 95146710||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame Ti Straight 6cm|1|HUMANA [1294]||HUMANA [11839]|4,155.00|FSC: 13; Default||Not reimbursed separately|4,155.00|FSC: 13; Default||External grouping not supported 95192382|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Momentum El Dr Dual Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,250.00|FSC: 13; Default||Not reimbursed separately|50,250.00|FSC: 13; Default||External grouping not supported 95146711|EAP|Custom 95146711||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Frame Ti Straight 8cm|1|HUMANA [1294]||HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95117436|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 38fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Pilon 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|FSC: 13; Default||Not reimbursed separately|765.00|FSC: 13; Default||External grouping not supported 95146715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Fibula 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|FSC: 13; Default||Not reimbursed separately|354.00|FSC: 13; Default||External grouping not supported 95188990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-locking Self-tapping T4 1.5mm X 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95146716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95146717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95146718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95146719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95146720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95146721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95188991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-locking Self-tapping 1.5mm X 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95146724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95146725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95146726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95146727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95192383|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Vigilant El Vr Df4 Dual Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,475.00|FSC: 13; Default||Not reimbursed separately|38,475.00|FSC: 13; Default||External grouping not supported 95146728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95188992|EAP|Custom 95188992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Threaded 1.1mm X 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95117493|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 7mmx60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,522.48|FSC: 13; Default||Not reimbursed separately|3,522.48|FSC: 13; Default||External grouping not supported 95146740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95188993|EAP|Custom 95188993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit With K-wire 1.5mm X 62mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95192374|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen Acushock Df4 Bivent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|FSC: 13; Default||Not reimbursed separately|55,500.00|FSC: 13; Default||External grouping not supported 95146745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95146747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.53|FSC: 13; Default||Not reimbursed separately|109.53|FSC: 13; Default||External grouping not supported 95188994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Phalangeal Val Left 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.58|FSC: 13; Default||Not reimbursed separately|1,628.58|FSC: 13; Default||External grouping not supported 95146749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95146753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95146754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95188995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 330mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95146761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95146763|EAP|Custom 95146763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium (for Use Wit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192375|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen Acushock Df1 Bivent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|FSC: 13; Default||Not reimbursed separately|55,500.00|FSC: 13; Default||External grouping not supported 95146764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95146765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95146766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95146769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95146771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95146775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.95|FSC: 13; Default||Not reimbursed separately|844.95|FSC: 13; Default||External grouping not supported 95146776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.95|FSC: 13; Default||Not reimbursed separately|844.95|FSC: 13; Default||External grouping not supported 95192376|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen X4 Bivent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|FSC: 13; Default||Not reimbursed separately|55,500.00|FSC: 13; Default||External grouping not supported 95146784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 278mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,383.83|FSC: 13; Default||Not reimbursed separately|5,383.83|FSC: 13; Default||External grouping not supported 95146785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 350mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,789.76|FSC: 13; Default||Not reimbursed separately|5,789.76|FSC: 13; Default||External grouping not supported 95146786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 386mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,905.41|FSC: 13; Default||Not reimbursed separately|5,905.41|FSC: 13; Default||External grouping not supported 95146787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 4.5mm X 386mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,905.41|FSC: 13; Default||Not reimbursed separately|5,905.41|FSC: 13; Default||External grouping not supported 95146788|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146789|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Pee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146792|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192377|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Vigilant X4 Is4 Df4 Bivent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|FSC: 13; Default||Not reimbursed separately|64,500.00|FSC: 13; Default||External grouping not supported 95146794|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146798|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 32mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.58|FSC: 13; Default||Not reimbursed separately|41.58|FSC: 13; Default||External grouping not supported 95146800|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146801|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 10mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.22|FSC: 13; Default||Not reimbursed separately|596.22|FSC: 13; Default||External grouping not supported 95146803|EAP|Custom 95146803||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D-stat Flowable Hemostat|1|HUMANA [1294]||HUMANA [11839]|381.00|FSC: 13; Default||Not reimbursed separately|381.00|FSC: 13; Default||External grouping not supported 95146804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 12mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95146805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 14mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95146806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 18mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95146807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 20mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95146808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|614.79|FSC: 13; Default||Not reimbursed separately|614.79|FSC: 13; Default||External grouping not supported 95146809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 87mm Right A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,637.82|FSC: 13; Default||Not reimbursed separately|1,637.82|FSC: 13; Default||External grouping not supported 95146810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 96mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,312.20|FSC: 13; Default||Not reimbursed separately|1,312.20|FSC: 13; Default||External grouping not supported 95146811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 52mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,149.45|FSC: 13; Default||Not reimbursed separately|1,149.45|FSC: 13; Default||External grouping not supported 95146812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 50mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.83|FSC: 13; Default||Not reimbursed separately|76.83|FSC: 13; Default||External grouping not supported 95192378|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Momenton Is1 Df4 Bivent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|FSC: 13; Default||Not reimbursed separately|64,500.00|FSC: 13; Default||External grouping not supported 95146813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 55mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95146814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 60mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.07|FSC: 13; Default||Not reimbursed separately|65.07|FSC: 13; Default||External grouping not supported 95146815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95146816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.68|FSC: 13; Default||Not reimbursed separately|100.68|FSC: 13; Default||External grouping not supported 95146817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95146818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95146819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95146822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,722.93|FSC: 13; Default||Not reimbursed separately|4,722.93|FSC: 13; Default||External grouping not supported 95146823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,772.55|FSC: 13; Default||Not reimbursed separately|4,772.55|FSC: 13; Default||External grouping not supported 95146824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,829.13|FSC: 13; Default||Not reimbursed separately|4,829.13|FSC: 13; Default||External grouping not supported 95146825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,881.09|FSC: 13; Default||Not reimbursed separately|4,881.09|FSC: 13; Default||External grouping not supported 95146826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,829.13|FSC: 13; Default||Not reimbursed separately|4,829.13|FSC: 13; Default||External grouping not supported 95146827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,881.09|FSC: 13; Default||Not reimbursed separately|4,881.09|FSC: 13; Default||External grouping not supported 95146834|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 2.8mm X 450mm Trocar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95192379|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen X4 Df4 Bivent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|FSC: 13; Default||Not reimbursed separately|55,500.00|FSC: 13; Default||External grouping not supported 95146839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 80169899|EAP|CPT® 20240||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Biopsy, Bone, Open; Superficial|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95146846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 100mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95188996|EAP|Custom 95188996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Kit Touhy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 115mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 120mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 125mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 130mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95192380|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Ingevity Straight 45cm Mri Positive W/o Guide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95146863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 135mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 140mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 145mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 150mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95188997|EAP|Custom 95188997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 600cc Saline|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95188998|EAP|Custom 95188998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flow 20 Pull I-s 20fr 150cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95192360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 2.7mm/l28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95146879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95189000|EAP|Custom 95189000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Reload|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 6.5mm X 32mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95146887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 4-hole 4.5 X 84mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|563.64|FSC: 13; Default||Not reimbursed separately|563.64|FSC: 13; Default||External grouping not supported 95146888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5x75mm Lg-hed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95146889|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95146890|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Rx Herculink Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95146891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Malleolar 25mm.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|FSC: 13; Default||Not reimbursed separately|89.01|FSC: 13; Default||External grouping not supported 95146893|EAP|Custom 95146893||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Barbed 16 X 19mm|1|HUMANA [1294]||HUMANA [11839]|134.49|FSC: 13; Default||Not reimbursed separately|134.49|FSC: 13; Default||External grouping not supported 95189008|EAP|Custom 95189008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Cross-plate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95146896|EAP|Custom 95146896||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Aspiration Illinois Inter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146897|EAP|Custom 95146897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 3.0mm Cannulated Screws|1|HUMANA [1294]||HUMANA [11839]|110.76|FSC: 13; Default||Not reimbursed separately|110.76|FSC: 13; Default||External grouping not supported 95146899|EAP|Custom 95146899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Partial Thd Trocar 1.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192388|EAP|Custom 95192388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer/divider Bipolar Ligasure Maryland Jaw 44cm X 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146900|EAP|Custom 95146900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Smooth Shaft Trocar Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5 X 50mm Fuld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|FSC: 13; Default||Not reimbursed separately|547.20|FSC: 13; Default||External grouping not supported 95146903|EAP|Custom 95146903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Smooth Shaft Trocar Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.5mm 16mm Thdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|FSC: 13; Default||Not reimbursed separately|691.20|FSC: 13; Default||External grouping not supported 95188999|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Fusion Looptip .035 X 480cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146907|EAP|Custom 95146907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 2/3 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146908|EAP|Custom 95146908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 2/3 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146909|EAP|Custom 95146909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring 1/3 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc-dcp 3.5mm X 77mm - 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95146925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc-dcp 3.5mm X 90mm - 7 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|493.29|FSC: 13; Default||Not reimbursed separately|493.29|FSC: 13; Default||External grouping not supported 95146926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc-dcp 3.5mm X 103mm - 8 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95146927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc-dcp 3.5mm X 116mm - 9 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.88|FSC: 13; Default||Not reimbursed separately|542.88|FSC: 13; Default||External grouping not supported 95146928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc-dcp 3.5mm X 129mm - 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.93|FSC: 13; Default||Not reimbursed separately|549.93|FSC: 13; Default||External grouping not supported 95189001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Curved 5 Holes Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.00|FSC: 13; Default||Not reimbursed separately|3,357.00|FSC: 13; Default||External grouping not supported 95146929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf Thin Blade 3 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.30|FSC: 13; Default||Not reimbursed separately|606.30|FSC: 13; Default||External grouping not supported 95146930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular With Collar 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|FSC: 13; Default||Not reimbursed separately|231.45|FSC: 13; Default||External grouping not supported 95146931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular With Collar 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.05|FSC: 13; Default||Not reimbursed separately|181.05|FSC: 13; Default||External grouping not supported 95146932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular With Collar 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|214.80|FSC: 13; Default||Not reimbursed separately|214.80|FSC: 13; Default||External grouping not supported 95192389|EAP|Custom 95192389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer/divider Bipolar Ligasure Maryland Jaw 37cm X 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3 Hole Right Angle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.82|FSC: 13; Default||Not reimbursed separately|1,274.82|FSC: 13; Default||External grouping not supported 95146934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 3 Hole Head 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.46|FSC: 13; Default||Not reimbursed separately|431.46|FSC: 13; Default||External grouping not supported 95146935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 3 Hole Head 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|670.65|FSC: 13; Default||Not reimbursed separately|670.65|FSC: 13; Default||External grouping not supported 95146936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 3 Hole Head 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.84|FSC: 13; Default||Not reimbursed separately|735.84|FSC: 13; Default||External grouping not supported 95189002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|424.20|FSC: 13; Default||Not reimbursed separately|424.20|FSC: 13; Default||External grouping not supported 95146937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 24mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95146938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 26mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95146939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 28mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95146940|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95146941|EAP|Custom 95146941||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones Size 16s 3.|1|HUMANA [1294]||HUMANA [11839]|126.00|FSC: 13; Default||Not reimbursed separately|126.00|FSC: 13; Default||External grouping not supported 95146942|EAP|Custom 95146942||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones Size 18s 3.|1|HUMANA [1294]||HUMANA [11839]|111.00|FSC: 13; Default||Not reimbursed separately|111.00|FSC: 13; Default||External grouping not supported 95146943|EAP|Custom 95146943||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones Size 20s 3.|1|HUMANA [1294]||HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95146944|EAP|Custom 95146944||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones Size 21s 3.|1|HUMANA [1294]||HUMANA [11839]|111.00|FSC: 13; Default||Not reimbursed separately|111.00|FSC: 13; Default||External grouping not supported 95189003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|424.20|FSC: 13; Default||Not reimbursed separately|424.20|FSC: 13; Default||External grouping not supported 95146945|EAP|Custom 95146945||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones Size 22 3.5|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95146948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Volar 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95146949|EAP|Custom 95146949||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator Fracture Radius Distal W|1|HUMANA [1294]||HUMANA [11839]|3,315.00|FSC: 13; Default||Not reimbursed separately|3,315.00|FSC: 13; Default||External grouping not supported 95146950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Norion 3cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,510.94|FSC: 13; Default||Not reimbursed separately|2,510.94|FSC: 13; Default||External grouping not supported 95192390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Ii Tritanium D 50mm Screwhole Clust|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95146951|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Expedium 6 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95146953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|746.31|FSC: 13; Default||Not reimbursed separately|746.31|FSC: 13; Default||External grouping not supported 95146954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|FSC: 13; Default||Not reimbursed separately|776.25|FSC: 13; Default||External grouping not supported 95189004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|424.20|FSC: 13; Default||Not reimbursed separately|424.20|FSC: 13; Default||External grouping not supported 95146955|EAP|Custom 95146955||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Electrode Ensite Navix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95146956|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,894.00|FSC: 13; Default||Not reimbursed separately|21,894.00|FSC: 13; Default||External grouping not supported 95146958|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95146960|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|FSC: 13; Default||Not reimbursed separately|21,360.00|FSC: 13; Default||External grouping not supported 95146961|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95146962|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 10mm Ba|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95146964|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 95189005|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 40mm X 217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95146965|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 95146966|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 95146967|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 95146968|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|FSC: 13; Default||Not reimbursed separately|6,705.00|FSC: 13; Default||External grouping not supported 95192392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trident Ii Hex Low Profile 6.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95146969|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 95146970|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 10c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|FSC: 13; Default||Not reimbursed separately|8,205.00|FSC: 13; Default||External grouping not supported 95146971|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 95146972|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 10c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|FSC: 13; Default||Not reimbursed separately|8,205.00|FSC: 13; Default||External grouping not supported 95189007|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 40mm X 167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95146983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard Metasul 32 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,644.00|FSC: 13; Default||Not reimbursed separately|4,644.00|FSC: 13; Default||External grouping not supported 95146984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Metasul 32/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,749.94|FSC: 13; Default||Not reimbursed separately|3,749.94|FSC: 13; Default||External grouping not supported 95146985|EAP|Custom 95146985||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 12mm X 22mm Vertes|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95146991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 16 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95146992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 18 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95146993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 20 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95189009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cp 3.6mm 1.24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95146995|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95146997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 16 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95146999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 18 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95192393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 2 10mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95147000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Tibial 20 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95147002|EAP|Custom 95147002||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Barium Ez Hd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 16 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|FSC: 13; Default||Not reimbursed separately|2,353.35|FSC: 13; Default||External grouping not supported 95147004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95189010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Polyaxial Universal Cross Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,652.00|FSC: 13; Default||Not reimbursed separately|8,652.00|FSC: 13; Default||External grouping not supported 95147005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95117905|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Infusion Katzen 145 Cm Katz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95147007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibial 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|FSC: 13; Default||Not reimbursed separately|2,412.69|FSC: 13; Default||External grouping not supported 95147010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Pc C.a.p. Global 48 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,830.00|FSC: 13; Default||Not reimbursed separately|10,830.00|FSC: 13; Default||External grouping not supported 95147011|EAP|Custom 95147011||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Genumedi Beige Size 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147012|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh St 10 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,925.00|FSC: 13; Default||Not reimbursed separately|11,925.00|FSC: 13; Default||External grouping not supported 95147014|EAP|Custom 95147014||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stockinette Synthetic 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.15|FSC: 13; Default||Not reimbursed separately|654.15|FSC: 13; Default||External grouping not supported 95189011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Full Thread 2.7mm/l28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95147018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Expedium 6 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95147020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|FSC: 13; Default||Not reimbursed separately|776.25|FSC: 13; Default||External grouping not supported 95147023|EAP|Custom 95147023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Lordotic 9mm X 11mm X 23mm|1|HUMANA [1294]||HUMANA [11839]|9,706.50|FSC: 13; Default||Not reimbursed separately|9,706.50|FSC: 13; Default||External grouping not supported 95192394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Triathlon Sz 2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95147024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 45mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|FSC: 13; Default||Not reimbursed separately|776.25|FSC: 13; Default||External grouping not supported 95147025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.32|FSC: 13; Default||Not reimbursed separately|73.32|FSC: 13; Default||External grouping not supported 95147026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95147028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Size 9 X 110mm Enhan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|FSC: 13; Default||Not reimbursed separately|8,811.66|FSC: 13; Default||External grouping not supported 95188823|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 40 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95147029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Size 14 X 145mm Enha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|FSC: 13; Default||Not reimbursed separately|8,811.66|FSC: 13; Default||External grouping not supported 95147030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular Cortical 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|FSC: 13; Default||Not reimbursed separately|96.93|FSC: 13; Default||External grouping not supported 95147032|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super Stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147033|EAP|Custom 95147033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Imager Ii Shk 0.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147034|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147035|EAP|Custom 95147035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Fa1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147037|EAP|Custom 95147037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duplocath 180|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188824|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 6 Mm X 60 Mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95147041|EAP|Custom 95147041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Scorpion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 +5 36mm Frictio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95147043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-deg 36mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95147065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95192395|EAP|Custom 95192395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Electrosurgical Vapr Hook 3.5mm Nonsuction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147078|EAP|Custom 95147078||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold 10x13 1/2 Colpac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147089|EAP|Custom 95147089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Catheter Illuminating Ureter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95147109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interspace Hip Xl 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,265.00|FSC: 13; Default||Not reimbursed separately|8,265.00|FSC: 13; Default||External grouping not supported 95147110|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Repair Collagen Dermal Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,991.00|FSC: 13; Default||Not reimbursed separately|5,991.00|FSC: 13; Default||External grouping not supported 95189013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Large Pec Button|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95147111|EAP|Custom 95147111||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Synthetic Roll Ortho-gla'|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95147117|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147118|EAP|Custom 95147118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Cranial 13mm Textured Tita|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147119|EAP|Custom 95147119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Cranial 18mm Textured Tita|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147120|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex 70cm Ringed Tw 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,291.00|FSC: 13; Default||Not reimbursed separately|3,291.00|FSC: 13; Default||External grouping not supported 95147126|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95189014|EAP|Custom 95189014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Micro Asnis 2.0mm 1.7mm Ao Coupling|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal T Ra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 95147135|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|HB LENS INTRAOCULAR 1.0 DIOPTER ACR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95147140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 10mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95147143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95147148|EAP|Custom 95147148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Hot Biopsy The Shark|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Dorsal Delt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|FSC: 13; Default||Not reimbursed separately|2,135.82|FSC: 13; Default||External grouping not supported 95147152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular 2.4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95189015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Onlay Mck Restoris Sz 3 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95147153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95147154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Left J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|FSC: 13; Default||Not reimbursed separately|1,902.00|FSC: 13; Default||External grouping not supported 95147155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95147170|EAP|Custom 95147170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Salem Sump 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Ii Sector Pinnacle 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95147177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral 36mm X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.33|FSC: 13; Default||Not reimbursed separately|4,968.33|FSC: 13; Default||External grouping not supported 95189016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 3-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95147178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Metal Articuleze 26mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95147179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Sz 6 Duofix Stand Of|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95147229|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Shuttle Slip 6.5fr Jb1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147233|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express Biliary 8x17 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,574.20|FSC: 13; Default||Not reimbursed separately|3,574.20|FSC: 13; Default||External grouping not supported 95147247|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95147248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 Ceramic 36mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95147249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached #7 Hip Modular Res|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95147250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 16mm X 127mm Straight D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95147256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Norion 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,108.01|FSC: 13; Default||Not reimbursed separately|8,108.01|FSC: 13; Default||External grouping not supported 95147257|EAP|Custom 95147257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Delivery 10cm X 12ga Ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 32mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95147263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.80|FSC: 13; Default||Not reimbursed separately|76.80|FSC: 13; Default||External grouping not supported 95147264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95147265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non-porous Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 95147266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non-porous Profix Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95147267|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pronto Extraction|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147272|EAP|Custom 95147272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Gastrostomy Laparoscopic 18f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147273|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192396|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraoccular 19.0 Diopter Acrysof Restore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95147274|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147277|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95147278|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95147279|EAP|Custom 95147279||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cock Up Wrist Splint Small Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147280|EAP|Custom 95147280||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cock Up Wrist Splint Med Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147288|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147290|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 9mm Diameter X 39m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|FSC: 13; Default||Not reimbursed separately|2,175.36|FSC: 13; Default||External grouping not supported 95192409|EAP|Custom 95192409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Unthreaded 3.2mm X 230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Peg Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95147294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 95147295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rescue Venture 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 95147296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Advantage Global 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|FSC: 13; Default||Not reimbursed separately|5,949.00|FSC: 13; Default||External grouping not supported 95147298|EAP|Custom 95147298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Urostomy Convex One Piece|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147299|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 7mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95147300|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 6mm X H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95192410|EAP|Custom 95192410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Cannulated 7.0mm Large Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147301|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency 8mm X 40mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95147305|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Chilli Ii Cooled Ablati|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189028|EAP|Custom 95189028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.3mm Quick Release|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147306|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Chilli Ii Cooled Ablati|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147307|EAP|Custom 95147307||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147309|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Kcfw-10-38-40-rb-blkn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189031|EAP|Custom 95189031||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins Fixation Trinica|1|HUMANA [1294]||HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95147312|EAP|Custom 95147312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Non Invasive Hemostat V-pad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locking 5 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,813.49|FSC: 13; Default||Not reimbursed separately|2,813.49|FSC: 13; Default||External grouping not supported 95192411|EAP|Custom 95192411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Bone Cement Imbibe 10 Cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147319|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 8fr Sheath Length 40cm N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189032|EAP|Custom 95189032||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Allograft Puros-s2 6x11x14mm 7degree|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95147341|EAP|Custom 95147341||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189034|EAP|Custom 95189034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .045 Double Ended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147342|EAP|Custom 95147342||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Left Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147343|EAP|Custom 95147343||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Left Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192412|EAP|Custom 95192412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Bone Marrow Fenestrated 8g X 6in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 7.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95147347|EAP|Custom 95147347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Kypho-pak Express 10/2 Firs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189026|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.75 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95147349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Legacy 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.82|FSC: 13; Default||Not reimbursed separately|596.82|FSC: 13; Default||External grouping not supported 95147353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 11mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95147360|EAP|Custom 95147360||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hot Pack Oversized|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189018|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.25 Mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147362|EAP|Custom 95147362||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Exercise Ball Theraband Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 07.0mm/l75mm Short Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95147364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.5 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95147365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.5 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95189019|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.25 Mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147366|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Marker .014 Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147368|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Smart Ii 185 Extra Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147370|EAP|Custom 95147370||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Viatorr 8 Mm X 6cm|1|HUMANA [1294]||HUMANA [11839]|13,239.00|FSC: 13; Default||Not reimbursed separately|13,239.00|FSC: 13; Default||External grouping not supported 95189020|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.25 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147372|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Agilis 8.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Finger Swanson Finger Implan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95192408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 5.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95147378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mystique 3.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.88|FSC: 13; Default||Not reimbursed separately|1,181.88|FSC: 13; Default||External grouping not supported 95147380|EAP|Custom 95147380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Cre Wire Guided|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189021|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.75 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular Coni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|FSC: 13; Default||Not reimbursed separately|237.33|FSC: 13; Default||External grouping not supported 95147393|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Im X 98cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118165|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pezzer 32fr.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147394|EAP|Custom 95147394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Safe D Pro 15f X 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147396|EAP|Custom 95147396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Haskal Transjugular Intrahep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189022|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.75 Mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147406|EAP|Custom 95147406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Exchange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 D 1.5 Mm 12mmx38cm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95147407|EAP|Custom 95147407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Two Part Pat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147408|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Single Chamber Atl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,400.00|FSC: 13; Default||Not reimbursed separately|44,400.00|FSC: 13; Default||External grouping not supported 95189023|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.75 Mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147409|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata Dual Co|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95147417|EAP|Custom 95147417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hnb5.0-38-100-p-ns-sim1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147418|EAP|Custom 95147418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hnb5.0-38-100-p-ns-sim2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147419|EAP|Custom 95147419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hnb5.0-38-100-p-ns-sim3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189024|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.75 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147424|EAP|Custom 95147424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Mepitel Soft Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147425|EAP|Custom 95147425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Interventional Specialty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Attune Aox 4 7mm Knee Cruciate Retaining Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 95147432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio Extra Lock 8mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95147433|EAP|Custom 95147433||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone Peek 14mm X 26mm V|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95189025|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.75 Mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147437|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 3.0 Mm X 22 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95147439|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Sigma Tc3 Gvf Uhmwpe Size 4 30.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 95147441|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Small 3mm Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95189033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Invizia 3l 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95147443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95147444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95147445|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147446|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 4.0 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95147449|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Oval 20cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lcs Comp Lg Rt Cem Rotate Platform Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 95147466|EAP|Custom 95147466||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb E-z Paste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147473|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Renegade Microcatheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Hexalobe 3.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95147477|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Sos Omni 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147478|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Sos Omni 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147480|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Pt Choice Extra Suppor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147482|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Enrhythm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95189017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm X L24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95147483|EAP|Custom 95147483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 22 French Auxil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147484|EAP|Custom 95147484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 24 French Auxil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lcs Complete Lg 10mm Rotate Platform Stabilize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 95147485|EAP|Custom 95147485||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cervical Roll Rolyan 4-1/4 X 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147486|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,894.00|FSC: 13; Default||Not reimbursed separately|21,894.00|FSC: 13; Default||External grouping not supported 95147487|EAP|HCPCS E0190||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lumbar Roll Firm 4-1/2 X 11 Bu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147488|EAP|Custom 95147488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador 51mm Spine 3 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95147490|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 7mm Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147491|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 7mm Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95147492|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 6mm Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147493|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 6mm Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95189036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 4-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95147494|EAP|Custom 95147494||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Putty Exercise Soft Yellow 5lb.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147495|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Select Mb2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling 4.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95147496|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Vitality Os|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,871.00|FSC: 13; Default||Not reimbursed separately|59,871.00|FSC: 13; Default||External grouping not supported 95147497|EAP|Custom 95147497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pump Blood Cannula 32 French|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147501|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pinnacle Radiopaque 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147503|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glidecath 4fr Straightm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self Drilling/tapping 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95147504|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Stiff Shaft .035 Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147506|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147507|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Selectivet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147509|EAP|Custom 95147509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Bone Biopsy Bonopty Biops|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147510|EAP|Custom 95147510||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolism|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95147511|EAP|Custom 95147511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Fogarty Spring 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147512|EAP|Custom 95147512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Fogarty Spring 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini-monster Short Thread 2.0 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95147518|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Mp Entrust (d154atgid)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,650.00|FSC: 13; Default||Not reimbursed separately|55,650.00|FSC: 13; Default||External grouping not supported 95147519|EAP|Custom 95147519||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll 4 Foam Round Therapy Roll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147522|EAP|Custom 95147522||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Protector Heel/elbow Medium Larg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147524|EAP|Custom 95147524||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Gel Sheet 4-1/2 X 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147526|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self Expanding Nit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95147527|EAP|Custom 95147527||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mix Elastomer Putty 50/50|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147528|EAP|Custom 95147528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192406|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Azure Xt Sr Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,719.00|FSC: 13; Default||Not reimbursed separately|10,719.00|FSC: 13; Default||External grouping not supported 95147533|EAP|Custom 95147533||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Vibrator Mini Massager|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147534|EAP|Custom 95147534||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Joint Jack Finger Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147542|EAP|Custom 95147542||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Reacher 26 Euro Style|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147546|EAP|Custom 95147546||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical Firm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147547|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Standard .035 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192407|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Azure Xt Dual Chamber Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,880.00|FSC: 13; Default||Not reimbursed separately|11,880.00|FSC: 13; Default||External grouping not supported 95147550|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147551|EAP|Custom 95147551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Tissue Ultrasound 17x10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95147554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95147555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95147556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|99.00|FSC: 13; Default||Not reimbursed separately|99.00|FSC: 13; Default||External grouping not supported 95147557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Pilon 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,017.00|FSC: 13; Default||Not reimbursed separately|1,017.00|FSC: 13; Default||External grouping not supported 95147558|EAP|Custom 95147558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular 5 French O|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147559|EAP|Custom 95147559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular 5 French X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147565|EAP|Custom 95147565||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Left Small Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189037|EAP|Custom 95189037||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Contour Deluxe Petite Disp W/headstrap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147567|EAP|HCPCS L3999||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Splint Thumb Right Small Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147569|EAP|Custom 95147569||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Left Large Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147570|EAP|Custom 95147570||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Right Large Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147571|EAP|Custom 95147571||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Left Small Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm 24/6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95147574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95147575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|648.00|FSC: 13; Default||Not reimbursed separately|648.00|FSC: 13; Default||External grouping not supported 95147576|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Selective|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm Asnis Micro 26/6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95147579|EAP|Custom 95147579||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Right Small Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147580|EAP|Custom 95147580||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Left Medium Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147581|EAP|HCPCS L3999||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Splint Thumb Right Medium Comfor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Curved 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|FSC: 13; Default||Not reimbursed separately|3,822.00|FSC: 13; Default||External grouping not supported 95147583|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 6x29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147584|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 6x39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,403.00|FSC: 13; Default||Not reimbursed separately|2,403.00|FSC: 13; Default||External grouping not supported 95147585|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 7x29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,403.00|FSC: 13; Default||Not reimbursed separately|2,403.00|FSC: 13; Default||External grouping not supported 95147586|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 7x39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95189045|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 Mri Avista 74cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|FSC: 13; Default||Not reimbursed separately|6,097.50|FSC: 13; Default||External grouping not supported 95147587|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 7x59|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95147588|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 8x29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147589|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 8x39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147590|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 8x59|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95147591|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 9x29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147605|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 9x59|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95147606|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 10x19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,174.75|FSC: 13; Default||Not reimbursed separately|3,174.75|FSC: 13; Default||External grouping not supported 95147607|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 10x29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,429.75|FSC: 13; Default||Not reimbursed separately|3,429.75|FSC: 13; Default||External grouping not supported 95147608|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 10x39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95147613|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Xblad 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147614|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Jr3.5st Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147615|EAP|Custom 95147615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 18g Bare Pd Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147616|EAP|Custom 95147616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Extended 18g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147617|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147618|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147619|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147620|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147621|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147622|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147623|EAP|Custom 95147623||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Lumbar Obusforme Navy Bl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147625|EAP|HCPCS E0190||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Sitback Lumbar Roll Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147626|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147627|EAP|Custom 95147627||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147628|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147629|EAP|Custom 95147629||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147630|EAP|Custom 95147630||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147631|EAP|Custom 95147631||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147632|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147633|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147634|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147635|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147636|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147641|EAP|Custom 95147641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147644|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Selective|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147654|EAP|Custom 95147654||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tubing Mesh Wide 3x10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147656|EAP|Custom 95147656||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cover Cast Child|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147657|EAP|Custom 95147657||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Putty Exercise Theraputty Light|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147658|EAP|Custom 95147658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Rf Cool Tip 1510|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147659|EAP|Custom 95147659||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Putty Exercise Theraputty Dark B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147660|EAP|Custom 95147660||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Putty Exercise Theraputty White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147662|EAP|Custom 95147662||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Toe Great Lpt (includes One|1|HUMANA [1294]||HUMANA [11839]|6,225.00|FSC: 13; Default||Not reimbursed separately|6,225.00|FSC: 13; Default||External grouping not supported 95147663|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Great Lpt Size 1 Reg|1|HUMANA [1294]||HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95147664|EAP|Custom 95147664||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Graft Dural Plus Per Sqcm|1|HUMANA [1294]||HUMANA [11839]|2,722.17|FSC: 13; Default||Not reimbursed separately|2,722.17|FSC: 13; Default||External grouping not supported 95147665|EAP|Custom 95147665||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Marker Spot Endoscopic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147666|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Insignia Ultra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,013.00|FSC: 13; Default||Not reimbursed separately|17,013.00|FSC: 13; Default||External grouping not supported 95192414|EAP|Custom 95192414||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dowel Bone Unicortical Fully Cannulated 10mm|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95147676|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|FSC: 13; Default||Not reimbursed separately|1,437.00|FSC: 13; Default||External grouping not supported 95147677|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|FSC: 13; Default||Not reimbursed separately|1,437.00|FSC: 13; Default||External grouping not supported 95147678|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|FSC: 13; Default||Not reimbursed separately|1,437.00|FSC: 13; Default||External grouping not supported 95147679|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95147680|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95147681|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Identity Sr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95188331|EAP|Custom 95188331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Pure Prp Ii 60 Ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147682|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Identity Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95147683|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95192415|EAP|Custom 95192415||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dowel Bone Unicortical Fully Cannulated 11mm|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95147684|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Quick Site Bi Polar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|FSC: 13; Default||Not reimbursed separately|8,250.00|FSC: 13; Default||External grouping not supported 95147686|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Vascular Closure Angiosel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95188332|EAP|Custom 95188332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Pure Bmc 60ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147690|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Rate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,600.00|FSC: 13; Default||Not reimbursed separately|51,600.00|FSC: 13; Default||External grouping not supported 95147691|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95147692|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95147693|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95189047|EAP|Custom 95189047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoclip Otsc 11/6t 165cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147696|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95147698|EAP|Custom 95147698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Vitrectomy Flat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Multifix S Peek 535mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95147699|EAP|Custom 95147699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147700|EAP|Custom 95147700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189048|EAP|Custom 95189048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoclip Otsc 11/6a 165cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147701|EAP|Custom 95147701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147702|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter X-port Dual Lumen 9.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|FSC: 13; Default||Not reimbursed separately|1,590.00|FSC: 13; Default||External grouping not supported 95147703|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plating Wedge Open Anchorage Right 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95147706|EAP|Custom 95147706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Homer Mammalok Plus 5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 44mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95147708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 28mm With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95147710|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Select S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95147711|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Steerable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147713|EAP|Custom 95147713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147716|EAP|Custom 95147716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Multifix S Ultra Peek 5.5 Mm Knotless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95147717|EAP|Custom 95147717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147720|EAP|Custom 95147720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189055|EAP|Custom 95189055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Countersink 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147722|EAP|Custom 95147722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147724|EAP|Custom 95147724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing J-stylet For 52|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147727|EAP|Custom 95147727||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Ste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147728|EAP|Custom 95147728||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Ste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189056|EAP|Custom 95189056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Countersink 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147729|EAP|Custom 95147729||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Oleranon 2.7mm/3.5mm 2 Hole Right 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,992.86|FSC: 13; Default||Not reimbursed separately|2,992.86|FSC: 13; Default||External grouping not supported 95147731|EAP|Custom 95147731||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff B/p Medium Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147732|EAP|Custom 95147732||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff B/p Small Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147733|EAP|Custom 95147733||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Battery Ram|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147734|EAP|Custom 95147734||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Intervention Osteonecros|1|HUMANA [1294]||HUMANA [11839]|10,204.44|FSC: 13; Default||Not reimbursed separately|10,204.44|FSC: 13; Default||External grouping not supported 95192421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95147735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95147736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin 3.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.03|FSC: 13; Default||Not reimbursed separately|78.03|FSC: 13; Default||External grouping not supported 95147739|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.25mm X 15mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147740|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.00mm X 15mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147743|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantablg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95147744|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantablg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95147747|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Impg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|FSC: 13; Default||Not reimbursed separately|13,167.00|FSC: 13; Default||External grouping not supported 95147752|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95147759|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Crystalt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95147760|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Crystalt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95147761|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95147762|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 12mm Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95147763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95147764|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 12mm Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95147766|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Embolic Protection Rx Acc|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95147767|EAP|Custom 95147767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Curved Sl|1|HUMANA [1294]||HUMANA [11839]|839.79|FSC: 13; Default||Not reimbursed separately|839.79|FSC: 13; Default||External grouping not supported 95147768|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147769|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95147770|EAP|Custom 95147770||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Curved 1.|1|HUMANA [1294]||HUMANA [11839]|839.79|FSC: 13; Default||Not reimbursed separately|839.79|FSC: 13; Default||External grouping not supported 95147771|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Primus Gps 6mm Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95147772|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Primus Gps 7mm Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95147773|EAP|Custom 95147773||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden 45 Degree|1|HUMANA [1294]||HUMANA [11839]|864.90|FSC: 13; Default||Not reimbursed separately|864.90|FSC: 13; Default||External grouping not supported 95147774|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 12mm Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95147775|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Excellen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95147776|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Excellen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95147777|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 900|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95189065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Tm Multi Holes 56 Mm Size Ii Poro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95147778|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 900|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95147779|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 900|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95147780|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 900|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95147781|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,585.00|FSC: 13; Default||Not reimbursed separately|9,585.00|FSC: 13; Default||External grouping not supported 95189066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum Vivacit-e Neutral Ll 40 X 58 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95147782|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Kappa 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,285.00|FSC: 13; Default||Not reimbursed separately|12,285.00|FSC: 13; Default||External grouping not supported 95147783|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Sigma 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|FSC: 13; Default||Not reimbursed separately|10,050.00|FSC: 13; Default||External grouping not supported 95147784|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Sigma 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|FSC: 13; Default||Not reimbursed separately|10,050.00|FSC: 13; Default||External grouping not supported 95147785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|458.64|FSC: 13; Default||Not reimbursed separately|458.64|FSC: 13; Default||External grouping not supported 95147786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Occipital 3.2mm X 100mm Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,511.70|FSC: 13; Default||Not reimbursed separately|7,511.70|FSC: 13; Default||External grouping not supported 95147787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,246.56|FSC: 13; Default||Not reimbursed separately|1,246.56|FSC: 13; Default||External grouping not supported 95147788|EAP|Custom 95147788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Medium Adjustable|1|HUMANA [1294]||HUMANA [11839]|3,927.84|FSC: 13; Default||Not reimbursed separately|3,927.84|FSC: 13; Default||External grouping not supported 95147789|EAP|Custom 95147789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147790|EAP|Custom 95147790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Guiding 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147791|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95147793|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Omniscan (5ml) 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|17.80|FSC: 13; Default||Not reimbursed separately|17.80|FSC: 13; Default||External grouping not supported 95147794|EAP|Custom 95147794||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Putty Exercise Theraputty Light|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147801|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 300 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|FSC: 13; Default||Not reimbursed separately|0.55|FSC: 13; Default||External grouping not supported 95147802|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 7.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95147806|EAP|Custom 95147806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Recovery|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147807|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Symmetry Balloon Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147808|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Symmetry Balloon Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147809|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Symmetry Balloon Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147810|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Symmetry Balloon Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147811|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Symmetry Balloon Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147812|EAP|Custom 95147812||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom # 2 Xpe Womens|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147813|EAP|Custom 95147813||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom # 4 Xpe Womens|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147816|EAP|HCPCS C1888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Procedure Vena Cure 65cm|1|HUMANA [1294]||HUMANA [11839]|1,344.15|FSC: 13; Default||Not reimbursed separately|1,344.15|FSC: 13; Default||External grouping not supported 95147817|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drain Vansonnenberg 14f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147818|EAP|Custom 95147818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Embosphere Microsphere 700-900 M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147819|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Ansel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147823|EAP|Custom 95147823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Fibered Platinum Complex/he|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147825|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147826|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147827|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Platinum Plus .018 Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147828|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 10c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|FSC: 13; Default||Not reimbursed separately|7,350.00|FSC: 13; Default||External grouping not supported 95147833|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,840.00|FSC: 13; Default||Not reimbursed separately|6,840.00|FSC: 13; Default||External grouping not supported 95147834|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Ansel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147835|EAP|Custom 95147835||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Fibered Platinum Complex/he|1|HUMANA [1294]||HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95147836|EAP|Custom 95147836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hsg 7fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 124mm 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,151.82|FSC: 13; Default||Not reimbursed separately|1,151.82|FSC: 13; Default||External grouping not supported 95189067|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Connector Axoguard 3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95147841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 163mm 12 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.98|FSC: 13; Default||Not reimbursed separately|1,309.98|FSC: 13; Default||External grouping not supported 95147842|EAP|Custom 95147842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Snare Replacement 6fr X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147843|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle Flexor 7 Fr X 80cm Ksaw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147844|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Peripheral Spartacore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189068|EAP|Custom 95189068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Ao Connection Square Tip 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147846|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147847|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147848|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 10fr .035 X 11cm Lengt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189069|EAP|Custom 95189069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Ao Connection Polyaxial Locking Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147849|EAP|Custom 95147849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147850|EAP|Custom 95147850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Bio-composite 3.0mm Knotless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95147854|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95147855|EAP|Custom 95147855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand 70 Extra Evac Intregrated C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147856|EAP|Custom 95147856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand 55 Ultra Reflex Integrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147858|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|FSC: 13; Default||Not reimbursed separately|13,167.00|FSC: 13; Default||External grouping not supported 95189071|EAP|Custom 95189071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Step 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147859|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Deflecting Reuter Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147860|EAP|Custom 95147860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Filter Tulip Vena Cava|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147863|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Embolic Protection Rx Acc|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95147864|EAP|Custom 95147864||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sphygmomanometer Aneroid Hand Ad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147865|EAP|Custom 95147865||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sphygmomanometer Aneroid Hand Ad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147866|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 10.0mm|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95147870|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filterwire,ez Bent Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147872|EAP|Custom 95147872||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Huggar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147873|EAP|Custom 95147873||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Biofreeze Pain Relieving Gel 16o|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147889|EAP|Custom 95147889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Touhy 18x3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147894|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147896|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95147899|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147901|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147903|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147904|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 5.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95147906|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147907|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147908|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189081|EAP|Custom 95189081||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Expandable Interbody Lordotic Extra 8x23x10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95147911|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilatation Atlas Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147912|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilatation Atlas Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147913|EAP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]||HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95147914|EAP|Custom 95147914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Introducer Osteo Size 3 K|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti Mm Dia X Mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95147915|EAP|Custom 95147915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Expander 15/3 First Fractur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147916|EAP|Custom 95147916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Introducer Kyphx Ostreo O|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147919|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147920|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|FSC: 13; Default||Not reimbursed separately|8,016.75|FSC: 13; Default||External grouping not supported 95147924|EAP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]||HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95147926|EAP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]||HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95147929|EAP|Custom 95147929||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sheeting Gel Care|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147930|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|FSC: 13; Default||Not reimbursed separately|9,450.00|FSC: 13; Default||External grouping not supported 80169900|EAP|CPT® 36470||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Injection Of Sclerosing Solution Single Vein|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95147931|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|FSC: 13; Default||Not reimbursed separately|9,450.00|FSC: 13; Default||External grouping not supported 95147932|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|FSC: 13; Default||Not reimbursed separately|9,450.00|FSC: 13; Default||External grouping not supported 95147933|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|FSC: 13; Default||Not reimbursed separately|13,167.00|FSC: 13; Default||External grouping not supported 95147948|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80169911|EAP|CPT® 36471||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Injection Of Sclerosing Solution; Multiple Veins, Same Leg|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95147957|EAP|Custom 95147957||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strapping Material R Securable 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147960|EAP|Custom 95147960||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Precut Nycem Matting Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95147963|EAP|Custom 95147963||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dressing Prisma Matrix 28cm X 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femur Nonporous Profix Rt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 95147965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non Porous Profix Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95189085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Alignment 02.5mm L 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.40|FSC: 13; Default||Not reimbursed separately|365.40|FSC: 13; Default||External grouping not supported 95147967|EAP|Custom 95147967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tamp Bone Inflatable Elevate Kyp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95189086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Aequalis Perform Keeled M40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,938.62|FSC: 13; Default||Not reimbursed separately|5,938.62|FSC: 13; Default||External grouping not supported 95147972|EAP|Custom 95147972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Film Bioresorbable Wrap Surgi 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147973|EAP|Custom 95147973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tamp Bone Inflatable Express Kyp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147974|EAP|Custom 95147974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Introducer Osteo Express|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Slf-tpngwith Stardrive Recess Ti 2.0mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95147978|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Select S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95147980|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Steerable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147981|EAP|Custom 95147981||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Filler Bone Express Size|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95189088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpnwith T6 Stardrive Recess Ti 2.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95147983|EAP|Custom 95147983||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb St Boot Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147984|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035 X 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192422|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 40mm X 117mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95147985|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilitation All|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147986|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189089|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Sinuplasty Balloon Spin Plus 6x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147987|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Ansel Fcfw-6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147988|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Rosen Thscf-35-60-1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95147989|EAP|Custom 95147989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147990|EAP|Custom 95147990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147991|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 14mm Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95147994|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 10mm Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95147995|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 112mm Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95192423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L50 Mm Od3.5 Mm Syndesmotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95147997|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189091|EAP|Custom 95189091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso Sd Crescent Perforating Needle Cannula With|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral -3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,660.12|FSC: 13; Default||Not reimbursed separately|3,660.12|FSC: 13; Default||External grouping not supported 95148002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys +0 X 28mm Ceram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.37|FSC: 13; Default||Not reimbursed separately|3,519.37|FSC: 13; Default||External grouping not supported 95148003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.36|FSC: 13; Default||Not reimbursed separately|3,519.36|FSC: 13; Default||External grouping not supported 95148005|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device Resynchronization Cardiac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,400.00|FSC: 13; Default||Not reimbursed separately|59,400.00|FSC: 13; Default||External grouping not supported 95189092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Acutrak Acutwist 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|FSC: 13; Default||Not reimbursed separately|786.00|FSC: 13; Default||External grouping not supported 95148007|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Contak Renewal 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72,075.00|FSC: 13; Default||Not reimbursed separately|72,075.00|FSC: 13; Default||External grouping not supported 95148014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95192424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula 3.0x130mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95148015|EAP|Custom 95148015||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold 21 Neck Contour Blacc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148016|EAP|Custom 95148016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Uterine Curved Roberts|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Alighn 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,227.00|FSC: 13; Default||Not reimbursed separately|7,227.00|FSC: 13; Default||External grouping not supported 95148018|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lcp 4.5mm X 152mm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.78|FSC: 13; Default||Not reimbursed separately|1,557.78|FSC: 13; Default||External grouping not supported 95148020|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148021|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dart Peek 10 Degree 3x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95148022|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148023|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192435|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Implant Breast Gel Round Ex Full 700cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|FSC: 13; Default||Not reimbursed separately|2,655.00|FSC: 13; Default||External grouping not supported 95148024|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148025|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189095|EAP|Custom 95189095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Pushlock 2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148026|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.omm X 14mm Tappi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95148031|EAP|Custom 95148031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148036|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 320 Prefill 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|FSC: 13; Default||Not reimbursed separately|0.66|FSC: 13; Default||External grouping not supported 95189096|EAP|Custom 95189096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Snow 2x4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148037|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 350 Prefill 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.82|FSC: 13; Default||Not reimbursed separately|0.82|FSC: 13; Default||External grouping not supported 95148056|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Siltex High P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95192436|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Implant Breast Gel Round Ex Full 750cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|FSC: 13; Default||Not reimbursed separately|2,655.00|FSC: 13; Default||External grouping not supported 95148057|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Siltex High P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95148058|EAP|Custom 95148058||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide 1.0mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95189097|EAP|Custom 95189097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Snow 4x4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95148067|EAP|HCPCS 95148067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Endo Smart Cap Disposable Ss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95189098|EAP|HCPCS C9250||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Evicel 1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.43|FSC: 13; Default||Not reimbursed separately|338.43|FSC: 13; Default||External grouping not supported 95148090|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95148091|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95192437|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Ex Full 800cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|FSC: 13; Default||Not reimbursed separately|2,655.00|FSC: 13; Default||External grouping not supported 95148092|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95148094|EAP|Custom 95148094||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Transducer Ultrasound Water Tigh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189099|EAP|Custom 95189099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Biosure 1.2mm X 12in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148095|EAP|Custom 95148095||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Transducer Water Tight Loop Styl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95148097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 3.2mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95148098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp With Colla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|599.52|FSC: 13; Default||Not reimbursed separately|599.52|FSC: 13; Default||External grouping not supported 95148099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Fin Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,810.00|FSC: 13; Default||Not reimbursed separately|3,810.00|FSC: 13; Default||External grouping not supported 95148103|EAP|Custom 95148103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Inf Pig 125cm .038|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148107|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Coronary 8fr X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148108|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Ebu4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192425|EAP|Custom 95192425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical L195 Mm Od3.5 Mm Noncannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148109|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Ebu4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148110|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Jl4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189103|EAP|Custom 95189103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Kit Avamax 13g 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148111|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Jl50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148112|EAP|Custom 95148112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flexi Cut 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148113|EAP|Custom 95148113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flexi Cut 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148119|EAP|Custom 95148119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nerve Block Continuous Stimu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189104|EAP|Custom 95189104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Kit Avamax 13g 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148120|EAP|Custom 95148120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nerve Block Continuous Stimu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192426|EAP|Custom 95192426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Injection Eleview Submucosal Lift|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148126|EAP|Custom 95148126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace Harmonic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189105|EAP|Custom 95189105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Kit Avamax 13g 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin 3.2mm X 14 Inch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.75|FSC: 13; Default||Not reimbursed separately|96.75|FSC: 13; Default||External grouping not supported 95148133|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ball Nose 3mm X 38 Inc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189107|EAP|Custom 95189107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Proximal Size 3|1|HUMANA [1294]||HUMANA [11839]|9,900.00|FSC: 13; Default||Not reimbursed separately|9,900.00|FSC: 13; Default||External grouping not supported 95148136|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 3.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192428|EAP|Custom 95192428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Spot Ex Endoscopic Tattoo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Versa 12mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95148138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95189108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Frac Central|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95148139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|FSC: 13; Default||Not reimbursed separately|477.00|FSC: 13; Default||External grouping not supported 95148141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial All Poly Uni Preservation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|FSC: 13; Default||Not reimbursed separately|2,468.79|FSC: 13; Default||External grouping not supported 95148142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial All Poly Uni Preservation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|FSC: 13; Default||Not reimbursed separately|2,468.79|FSC: 13; Default||External grouping not supported 95148143|EAP|Custom 95148143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Uni Power Pro Bl 70 X 8.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Metal Trabecular With Cluster Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95148144|EAP|HCPCS L3908||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Aquaform Zippered S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148145|EAP|HCPCS L3908||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Aquaform Zippered S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192430|EAP|Custom 95192430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Wound Alexis O Xxl Rigid Retraction Ring 11-17 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148150|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Hp L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95189110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked Highly Longevity 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95148151|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Hp L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95148153|EAP|Custom 95148153||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Co-flex Blood Bank Color|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148154|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Savary Gilliard 250cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189111|EAP|Custom 95189111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Concave 018|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192431|EAP|Custom 95192431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Wound Alexis O 360d Large Protector 9-14cm Incisio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189112|EAP|Custom 95189112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Convex 016|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189113|EAP|Custom 95189113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Convex 014|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148169|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148170|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192432|EAP|Custom 95192432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Wound Alexis O 360d Xlg Protector 11-17cm Incisio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148172|EAP|Custom 95148172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndle T Band 21ga 15mm X 130cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148173|EAP|Custom 95148173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Kypho Pak Expander 520/3 Fi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Mtp V2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|FSC: 13; Default||Not reimbursed separately|6,879.00|FSC: 13; Default||External grouping not supported 95148175|EAP|Custom 95148175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endo Resistant Laser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148176|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ensnare 9-15mm Catheter 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148177|EAP|Custom 95148177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endo Resistant Laser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148178|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Mini En-snare 4-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3.5mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95148179|EAP|Custom 95148179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endo Resistant Laser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148180|EAP|Custom 95148180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endo Resistant Laser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148181|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148182|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Twinfix Ultra 2.8 With Needle 2-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95148183|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148184|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148185|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148186|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189117|EAP|Custom 95189117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Trocar Tip 0.9mmx150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148187|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148188|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148189|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking T Curved 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,317.80|FSC: 13; Default||Not reimbursed separately|2,317.80|FSC: 13; Default||External grouping not supported 95189118|EAP|Custom 95189118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 1.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|689.22|FSC: 13; Default||Not reimbursed separately|689.22|FSC: 13; Default||External grouping not supported 95148192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|689.22|FSC: 13; Default||Not reimbursed separately|689.22|FSC: 13; Default||External grouping not supported 95148193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 32mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.47|FSC: 13; Default||Not reimbursed separately|454.47|FSC: 13; Default||External grouping not supported 95148194|EAP|Custom 95148194||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Toe Great Lpt (includes One|1|HUMANA [1294]||HUMANA [11839]|4,665.00|FSC: 13; Default||Not reimbursed separately|4,665.00|FSC: 13; Default||External grouping not supported 95189119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|FSC: 13; Default||Not reimbursed separately|1,026.00|FSC: 13; Default||External grouping not supported 95148195|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Gold Hemshld Aortic-arched|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,782.01|FSC: 13; Default||Not reimbursed separately|3,782.01|FSC: 13; Default||External grouping not supported 95148196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95148197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking T Curved 16 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,134.46|FSC: 13; Default||Not reimbursed separately|3,134.46|FSC: 13; Default||External grouping not supported 95148200|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|FSC: 13; Default||Not reimbursed separately|1,026.00|FSC: 13; Default||External grouping not supported 95148201|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148202|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148203|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148204|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174700|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Covered 23mm X 10mm 8.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,401.27|FSC: 13; Default||Not reimbursed separately|7,401.27|FSC: 13; Default||External grouping not supported 95148205|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Explor 5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.00|FSC: 13; Default||Not reimbursed separately|4,473.00|FSC: 13; Default||External grouping not supported 95148206|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Explor 14 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,465.00|FSC: 13; Default||Not reimbursed separately|3,465.00|FSC: 13; Default||External grouping not supported 95148207|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Explor 6 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.00|FSC: 13; Default||Not reimbursed separately|4,473.00|FSC: 13; Default||External grouping not supported 95148208|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174716|EAP|Custom 95174716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Zoe B&t Powder And Liquid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148209|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Midfoot Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95148210|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95148211|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95148212|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Prowater Flex 0.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 28mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95148213|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 30mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95148214|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 32mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95148215|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174724|EAP|Custom 95174724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148216|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174725|EAP|Custom 95174725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148217|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174726|EAP|Custom 95174726||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 2.5mm|1|HUMANA [1294]||HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95148218|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95148219|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95174734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95148220|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148221|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189121|EAP|Custom 95189121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.0mmx130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148222|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148223|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148227|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.8fr X 130cm W/marker|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148228|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glidecath 18 180cm W D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148229|EAP|Custom 95148229||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Microsphere Compressible Bead Bl|1|HUMANA [1294]||HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95148232|EAP|Custom 95148232||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Ethiodol 10ml Ame|1|HUMANA [1294]||HUMANA [11839]|28.99|FSC: 13; Default||Not reimbursed separately|28.99|FSC: 13; Default||External grouping not supported 95148234|EAP|Custom 95148234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Avx 50cm Over The Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tib Conform Profix Rt Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95189122|EAP|Custom 95189122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Inst Specific Patient Fem/tib Ct Pref Ps Persona|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Canc 4.0mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95148238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95148239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95148240|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95148256|EAP|Custom 95148256||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Pacing Temporary|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148257|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 5x10 Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.68|FSC: 13; Default||Not reimbursed separately|88.68|FSC: 13; Default||External grouping not supported 95189123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Delta Ceramic Ts 12/14 36mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,973.30|FSC: 13; Default||Not reimbursed separately|8,973.30|FSC: 13; Default||External grouping not supported 95148266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 10mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148267|EAP|Custom 95148267||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Up Charge Replaced Single Chambe|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95148269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95148270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Twist Off 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95148271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Twist Off 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95148272|EAP|HCPCS A7520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Shiley Trach 6dcfn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cort 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95189127|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu Flex Zenith 28mm X 62cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,596.00|FSC: 13; Default||Not reimbursed separately|16,596.00|FSC: 13; Default||External grouping not supported 95192438|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Neurostimulator Nevro 5mm Spacing 50cm Lead Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95148309|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95148312|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Medium With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148313|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Small With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 5.0 X 38mm Djo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95148316|EAP|Custom 95148316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retrieval Pulmonary 0-tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148317|EAP|Custom 95148317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Retrieval Pulmonary 0-tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148318|EAP|Custom 95148318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Micro Introducer 4f 10cm Sti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetab 100 Pinnacle 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95148320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Pinnacle Neutral 36mm X 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|FSC: 13; Default||Not reimbursed separately|4,777.23|FSC: 13; Default||External grouping not supported 95148321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Mtl Articuleze 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95189129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Humeral Rsp Sz 36mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95148323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Stand Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95148322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Hi Offset Sz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95192439|EAP|Custom 95192439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Template Ipg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148325|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Sing Chamber Rate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|FSC: 13; Default||Not reimbursed separately|49,500.00|FSC: 13; Default||External grouping not supported 95148326|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Dual Coil Endocardial Defib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95148327|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Rate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|FSC: 13; Default||Not reimbursed separately|55,500.00|FSC: 13; Default||External grouping not supported 95189130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Humeral Rsp Sz32mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95148332|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Rate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,500.00|FSC: 13; Default||Not reimbursed separately|52,500.00|FSC: 13; Default||External grouping not supported 95148338|EAP|HCPCS L3908||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Aquaform Zippered L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148341|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Dual Coil Endocardial Defib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95148342|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148344|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148345|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148346|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148350|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachy Imp Sprint Fidelis 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95189131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Recon Rhead Non-coated Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,064.00|FSC: 13; Default||Not reimbursed separately|11,064.00|FSC: 13; Default||External grouping not supported 95148352|EAP|Custom 95148352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Net Roth Pediatric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148355|EAP|Custom 95148355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Graduated Sizing Royal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192440|EAP|Custom 95192440||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Anchor Lead N300|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95148360|EAP|Custom 95148360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dynamic Pronation/supination|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148361|EAP|Custom 95148361||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cc Etco2 Cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148365|EAP|Custom 95148365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 18.6mm X 107mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Biocomposite Ft 4.5mm W/tigertail #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95148372|EAP|Custom 95148372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Mesh Gel Coated Silipos 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148373|EAP|HCPCS A7521||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Tracheostomy 6.0mm Id Cuff|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148374|EAP|HCPCS A4623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Can Inner Disp Size 6mm Tracheo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148375|EAP|HCPCS A4623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canu Inner Disp Size-8mm Tracheo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148376|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Miracle Bros 3.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148377|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Shuttle Slip 6.5fr Jb2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148378|EAP|Custom 95148378||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Vascular Digit 2.5cm X9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148381|EAP|Custom 95148381||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Vascular Digit 3.3cm X12cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148391|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Dual Coil Endocardial Defib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95148394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augument Tibial 10mm Sz-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95174738|EAP|Custom 95174738||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Handpiece Ligasure Impact 18cm(reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148397|EAP|Custom 95148397||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Frame Thermoplastic Head Only 3.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174743|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Dual Anti Reflux Valve 25mm X 8cm|1|HUMANA [1294]||HUMANA [11839]|3,765.00|FSC: 13; Default||Not reimbursed separately|3,765.00|FSC: 13; Default||External grouping not supported 95148398|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Picc Triple Lumen 6fr Basic Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174744|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kt Generator Pulse Implantable Spectra Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,272.00|FSC: 13; Default||Not reimbursed separately|52,272.00|FSC: 13; Default||External grouping not supported 95148409|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Excellen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95174745|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Control Remote Spectra Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95148410|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Attain Extended H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174746|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Dual Anti Reflux Valve 25mm X 10cm |1|HUMANA [1294]||HUMANA [11839]|4,590.00|FSC: 13; Default||Not reimbursed separately|4,590.00|FSC: 13; Default||External grouping not supported 95174747|EAP|Custom 95174747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Or 2x8 Spectra |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,888.78|FSC: 13; Default||Not reimbursed separately|3,888.78|FSC: 13; Default||External grouping not supported 95167320|EAP|Custom 95167320||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Temper Foam Rolyan Med Density Self-adhesive Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95174749|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Kit Duramax Vascpak Dialysis 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95148435|EAP|Custom 95148435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Snare Replacement 4fr X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174750|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Kit Duramax Vascpak Dialysis 28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95174751|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cath Kit Duramax Vascpak Dialysis 32cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95148438|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis 12mm X 240mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,812.72|FSC: 13; Default||Not reimbursed separately|4,812.72|FSC: 13; Default||External grouping not supported 95148439|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174759|EAP|Custom 95174759||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Diamond Point #2 End Stainless Steel|1|HUMANA [1294]||HUMANA [11839]|60.90|FSC: 13; Default||Not reimbursed separately|60.90|FSC: 13; Default||External grouping not supported 95148440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95174760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Option Biolox 32mm +0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,811.00|FSC: 13; Default||Not reimbursed separately|5,811.00|FSC: 13; Default||External grouping not supported 95148442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 95148443|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 9mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|FSC: 13; Default||Not reimbursed separately|6,285.00|FSC: 13; Default||External grouping not supported 95148445|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intraventional 8 French X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Femoral Nexgen Trabecular Metal D H5mm Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95148446|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Checkflow 10fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148447|EAP|Custom 95148447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Transducer Cover Surgi-tip Intra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148448|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Check-flo Anse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148449|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Contralateral 6fr X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148450|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 23 Cm 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148451|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 23cm 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148452|EAP|Custom 95148452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Fibered Platinum Complex/he|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148453|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 8mm Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95192443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Femoral Nexgen Trabecular Metal D H10mm Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95148454|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 8mm Diamet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95148455|EAP|Custom 95148455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Liver Access Transjugular 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148456|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Biliary Ultrat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148457|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Biliary Ultrat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148458|EAP|Custom 95148458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Anchor Suture Gastrointestin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148459|EAP|Custom 95148459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Needle Catheter Drainage Dua|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192444|EAP|Custom 95192444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Sterile 4.2 X 340mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148460|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Multipurpose U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148461|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Multipurpose U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148462|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Tear Away W/lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148463|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Optiplast Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62064560|EAP|CPT® 80400||0301 - LABORATORY - CHEMISTRY|Hb Acth Stimulation Test-two Specimens|1|HUMANA [1294]||HUMANA [11839]|97.86|FSC: 13; Default||Not reimbursed separately|97.86|FSC: 13; Default||External grouping not supported 95148464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Volar Radia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,709.33|FSC: 13; Default||Not reimbursed separately|2,709.33|FSC: 13; Default||External grouping not supported 95148465|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Embolic Protection Rx Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192445|EAP|Custom 95192445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Sterile 4.2 X 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148466|EAP|Custom 95148466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franceen 20ga X 9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148467|EAP|Custom 95148467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 20ga X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148468|EAP|Custom 95148468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Single Action 20gp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148469|EAP|Custom 95148469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 16ga X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148470|EAP|Custom 95148470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Bone Biopsy 17ga X 5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148471|EAP|Custom 95148471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Ti 5x12 Hole Va 2.4mm/27mm Locking Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,284.68|FSC: 13; Default||Not reimbursed separately|5,284.68|FSC: 13; Default||External grouping not supported 95148472|EAP|Custom 95148472||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148473|EAP|Custom 95148473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer Co Access 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz-c Right Medial Left Lateral P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95148474|EAP|Custom 95148474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148475|EAP|Custom 95148475||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 12mm Vertestack|1|HUMANA [1294]||HUMANA [11839]|14,003.22|FSC: 13; Default||Not reimbursed separately|14,003.22|FSC: 13; Default||External grouping not supported 95148476|EAP|Custom 95148476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Aspiration|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148477|EAP|Custom 95148477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Silent 18ga X 100m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 1-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95148478|EAP|Custom 95148478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Silent 18ga X 200m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148479|EAP|Custom 95148479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spinal 20ga X 30.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95148480|EAP|Custom 95148480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Co Access Levee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148484|EAP|Custom 95148484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pre-dilution M100|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Precoat Rt Medial Left Lateral Sz-1 Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95148485|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.75mm X 10mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148486|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148488|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Judkins Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148489|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fastracker 140cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Autofix T7 Dr 2.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|FSC: 13; Default||Not reimbursed separately|1,416.00|FSC: 13; Default||External grouping not supported 95148491|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Confianza 0.014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148492|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Confianzi 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95148493|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Miracle Bros 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Autofix Mod T7 Dr 2.0x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|FSC: 13; Default||Not reimbursed separately|1,416.00|FSC: 13; Default||External grouping not supported 95148503|EAP|Custom 95148503||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Component Merit Static Progress|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148504|EAP|Custom 95148504||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hook Self Adhesive Size 1 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148506|EAP|Custom 95148506||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibialis Anterior|1|HUMANA [1294]||HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95148508|EAP|Custom 95148508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Debrider Micro Integrated Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189142|EAP|Custom 95189142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fiberlink O Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148510|EAP|Custom 95148510||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer W/convex-it 1-3/4 Flange S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148514|EAP|HCPCS A6236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Hydrocolloid Thin 7x8 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula 9-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95148517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95192449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Locking Stardrive Recess 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|503.19|FSC: 13; Default||Not reimbursed separately|503.19|FSC: 13; Default||External grouping not supported 95148519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95189144|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Drainage - Fuhrman 6.0 Fr Pigtail Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148522|EAP|Custom 95148522||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Tricofix Sixe E6 3-1/2 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148523|EAP|Custom 95148523||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|HB BANDAGE TRICOFIX SIZE G9 3-1/2" X 22 YDS|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148524|EAP|Custom 95148524||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Tricofix Sixe F7 3-1/2 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189145|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray - Drainage Fuhrman 8.5 Fr Pigtail Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148531|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95192450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95148533|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viatorr 10mm X6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,569.00|FSC: 13; Default||Not reimbursed separately|13,569.00|FSC: 13; Default||External grouping not supported 95148535|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viatorr 10mm X 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,285.00|FSC: 13; Default||Not reimbursed separately|9,285.00|FSC: 13; Default||External grouping not supported 95189146|EAP|Custom 95189146||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Pericardial 9x14cm|1|HUMANA [1294]||HUMANA [11839]|1,245.00|FSC: 13; Default||Not reimbursed separately|1,245.00|FSC: 13; Default||External grouping not supported 95148540|EAP|Custom 95148540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization .038x10cmx10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148542|EAP|Custom 95148542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Padding Polycushion 3-1/4 X 17|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189147|EAP|Custom 95189147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Sinskey Iris And Iol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148543|EAP|Custom 95148543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sim 1 5fr X 100cm Hnb5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148544|EAP|Custom 95148544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Apc 7fr X 100cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192451|EAP|Custom 95192451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Easyclip Concave Od16 Mm Surface Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148545|EAP|Custom 95148545||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Foam Medium Density Self Adhesiv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148547|EAP|Custom 95148547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Microsphere Embolic 700-900 Micr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm X L32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95148548|EAP|Custom 95148548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Microsphere Embolic 500-700 Micr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Cr Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.06|FSC: 13; Default||Not reimbursed separately|3,075.06|FSC: 13; Default||External grouping not supported 95148553|EAP|HCPCS L3999||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Splint Thumb Right Medium Comfor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148554|EAP|HCPCS L3999||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Splint Thumb Left Medium Comfort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap Off Lg 2mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95148558|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Pilot 50 .014 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148559|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Pilot 150 .014 Diametr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Humeral Comprehensive Arcomxl Standard 44-36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95148560|EAP|Custom 95148560||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lifters Leg 41 Ridgid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148562|EAP|Custom 95148562||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula 02 Oximizer Conserving P|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189150|EAP|Custom 95189150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Collection Autograft Press Bonebac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148566|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148567|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr80cm7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148568|EAP|Custom 95148568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Glenoid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148569|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr80cm9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148570|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Curve Teflon Coated.03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148571|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Teflon Coated Moveable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95148574|EAP|Custom 95148574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glidecath 5fr/jb2/38|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148575|EAP|Custom 95148575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Hawkins Ii 20 Ga X 10 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interspace Knee Large 8074|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,265.00|FSC: 13; Default||Not reimbursed separately|8,265.00|FSC: 13; Default||External grouping not supported 95148581|EAP|Custom 95148581||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Exercise Super Heavy Silve]|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148582|EAP|Custom 95148582||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold Standard Blue Vinyl Cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148584|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Ballooh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148585|EAP|Custom 95148585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Single Lumen Powerc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148586|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Dual Lumen Power Pc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148592|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Contak Renewal 3rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81,075.00|FSC: 13; Default||Not reimbursed separately|81,075.00|FSC: 13; Default||External grouping not supported 95148599|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Joint Pc M/l|1|HUMANA [1294]||HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95148600|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ptfe/heparin Coated03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148601|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Joint Pc Lg|1|HUMANA [1294]||HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95148602|EAP|Custom 95148602||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Latitude Heart Failure Mt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148603|EAP|Custom 95148603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Coude Silicone 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Reverse 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95148604|EAP|Custom 95148604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Coude Silicone 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148605|EAP|Custom 95148605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endotracheal Univent 6.5 Dn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148606|EAP|Custom 95148606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endotracheal Univent 7.0 Dn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148607|EAP|Custom 95148607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endotracheal Univent 7.5 Dn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148608|EAP|Custom 95148608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endotracheal Univent 8.0 Dn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148621|EAP|Custom 95148621||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strapping Material R Securable E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148625|EAP|Custom 95148625||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strapping Non Adhesive Loop Whis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148634|EAP|Custom 95148634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Cbm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064888|EAP|CPT® 88333||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Pathology Consult-intra Op/cyto|1|HUMANA [1294]||HUMANA [11839]|1,790.07|FSC: 13; Default||Not reimbursed separately|1,790.07|FSC: 13; Default||External grouping not supported 95148637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95148638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 4.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95189151|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95148642|EAP|Custom 95148642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Nanocrystalline Silver6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148644|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Large Vessel 1r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Frs 3.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95148646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann Cancem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|FSC: 13; Default||Not reimbursed separately|477.00|FSC: 13; Default||External grouping not supported 95189152|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Trulign Torric Bl1ut 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95148648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann Cancem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|FSC: 13; Default||Not reimbursed separately|477.00|FSC: 13; Default||External grouping not supported 95148649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann Cancem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|FSC: 13; Default||Not reimbursed separately|477.00|FSC: 13; Default||External grouping not supported 95148650|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Maxi Ld 16m 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148651|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Maxi Ld 18m 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 11mm/130 Right 400\mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95148655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial Rt Lat/lt 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|FSC: 13; Default||Not reimbursed separately|3,597.06|FSC: 13; Default||External grouping not supported 95148660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 8mm Selfd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 10mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 11mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95189154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna380mm Left 11mm/125 Deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95148663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 14mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 16mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 18mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 20mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 22mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 1.5mm X 24mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95148670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augument Distal 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95148671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non Porous P5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 95148672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Lcp Proximal Tibie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,256.45|FSC: 13; Default||Not reimbursed separately|2,256.45|FSC: 13; Default||External grouping not supported 95148673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 55mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.42|FSC: 13; Default||Not reimbursed separately|474.42|FSC: 13; Default||External grouping not supported 95148674|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French .088 Ame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95148680|EAP|Custom 95148680||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Small Joint Jack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148681|EAP|Custom 95148681||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Medium Joint Jack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148682|EAP|Custom 95148682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Perfusion Cardioplegia Come|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148683|EAP|Custom 95148683||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Large Joint Jack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148684|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Com|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95148689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 2.7mm 35mm Oblique Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95148692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 2.7mm 35mm Obilque Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95148704|EAP|HCPCS L3999||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Splint Thumb Left Large Comforc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148705|EAP|HCPCS L3999||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Splint Thumb Right Large Comfoc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148706|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Exchange Straight Tfeh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148707|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Slip W Aq1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95148709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Eage 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 95148710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Eagle 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 95148711|EAP|Custom 95148711||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation Eagle|1|HUMANA [1294]||HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95148712|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viatorr 8 Mm X 8c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 95148714|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cervical 4.75 X 6.22 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.50|FSC: 13; Default||Not reimbursed separately|3,481.50|FSC: 13; Default||External grouping not supported 95148716|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cervical 5.75 X 7.22 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.50|FSC: 13; Default||Not reimbursed separately|3,481.50|FSC: 13; Default||External grouping not supported 95148719|EAP|Custom 95148719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligator Multi-band Six Shooter D|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148720|EAP|Custom 95148720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Hand Access Lap-disc Latd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.7mm 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95148722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 23mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.87|FSC: 13; Default||Not reimbursed separately|189.87|FSC: 13; Default||External grouping not supported 95148723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 31mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|FSC: 13; Default||Not reimbursed separately|197.76|FSC: 13; Default||External grouping not supported 95189155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum Longevity 36 X58mm 7mm Offset Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95148724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 39mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95148725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 47mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.20|FSC: 13; Default||Not reimbursed separately|247.20|FSC: 13; Default||External grouping not supported 95148726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 55mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.10|FSC: 13; Default||Not reimbursed separately|257.10|FSC: 13; Default||External grouping not supported 95148727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 63mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95148728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Multiple Frag 27mm 7 Holem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.87|FSC: 13; Default||Not reimbursed separately|189.87|FSC: 13; Default||External grouping not supported 95148729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 2.7mm 32mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95148730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 2.7mm 32mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|FSC: 13; Default||Not reimbursed separately|166.14|FSC: 13; Default||External grouping not supported 95148733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Long Locking Let|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,383.89|FSC: 13; Default||Not reimbursed separately|2,383.89|FSC: 13; Default||External grouping not supported 95189169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mmxl20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95148734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Long Locking Let|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,383.89|FSC: 13; Default||Not reimbursed separately|2,383.89|FSC: 13; Default||External grouping not supported 95148735|EAP|Custom 95148735||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Neoprene Small Gray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,685.25|FSC: 13; Default||Not reimbursed separately|1,685.25|FSC: 13; Default||External grouping not supported 95148737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,720.68|FSC: 13; Default||Not reimbursed separately|1,720.68|FSC: 13; Default||External grouping not supported 95189157|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 6x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148742|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Cont Omniscan 287mg/ml Per|1|HUMANA [1294]||HUMANA [11839]|15.75|FSC: 13; Default||Not reimbursed separately|15.75|FSC: 13; Default||External grouping not supported 95148746|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Sil 585cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95148751|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Sil 530cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95148766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Twist Off 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95189158|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 6x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Twist Off 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95148778|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 10mm Ba|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,574.20|FSC: 13; Default||Not reimbursed separately|3,574.20|FSC: 13; Default||External grouping not supported 95189159|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 6x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95148779|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 7mm Bal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95148780|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 7mm X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,850.20|FSC: 13; Default||Not reimbursed separately|3,850.20|FSC: 13; Default||External grouping not supported 95192454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Syndesmotic 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95148781|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 7mmx40x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95148782|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 8mm X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95189160|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 7x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148783|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 8mmx30x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95148784|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 9mm X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95148785|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Ld Express 9mm X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,850.20|FSC: 13; Default||Not reimbursed separately|3,850.20|FSC: 13; Default||External grouping not supported 95148786|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Check Flo 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189161|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 6x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148787|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Check Flo 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192455|EAP|Custom 95192455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 4.0 Mm Cannulated Sterile Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148789|EAP|Custom 95148789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous 2-stage Femoral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148790|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189162|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 6x100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148792|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148793|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148794|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148795|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189163|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 7x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148796|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148797|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fixation L130mm Od3.8mm Fibula Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,655.00|FSC: 13; Default||Not reimbursed separately|8,655.00|FSC: 13; Default||External grouping not supported 95148798|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148799|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189164|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 7x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148800|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148801|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148802|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148803|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189165|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 6x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148804|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148805|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95148806|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148807|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189166|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent C06120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148808|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148809|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148810|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148811|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189167|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smartstent 7x100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95148812|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148813|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192460|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Aaa 30mm X 140cm Flex Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95148814|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148815|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148816|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148817|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148818|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148819|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 7 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95148820|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148821|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148822|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148823|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148824|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148825|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80170133|EAP|CPT® 97161||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hb Pt Eval Low Complex|1|HUMANA [1294]||HUMANA [11839]|246.09|FSC: 13; Default||Not reimbursed separately|246.09|FSC: 13; Default||External grouping not supported 95148826|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148827|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148828|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148829|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80170144|EAP|CPT® 97162||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hb Pt Eval Mod Complex|1|HUMANA [1294]||HUMANA [11839]|246.09|FSC: 13; Default||Not reimbursed separately|246.09|FSC: 13; Default||External grouping not supported 95148830|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148831|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95148835|EAP|Custom 95148835||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Filter Gunther Tulip Femoral|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95148837|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80170155|EAP|CPT® 97163||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hb Pt Eval High Complex|1|HUMANA [1294]||HUMANA [11839]|246.09|FSC: 13; Default||Not reimbursed separately|246.09|FSC: 13; Default||External grouping not supported 95148838|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148839|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95148840|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148841|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80170166|EAP|CPT® 97164||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hb Pt Re-eval Est Plan Care|1|HUMANA [1294]||HUMANA [11839]|168.12|FSC: 13; Default||Not reimbursed separately|168.12|FSC: 13; Default||External grouping not supported 95148843|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148844|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95148845|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148846|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80170177|EAP|CPT® 97165||0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION|Hb Ot Eval Low Complex|1|HUMANA [1294]||HUMANA [11839]|260.28|FSC: 13; Default||Not reimbursed separately|260.28|FSC: 13; Default||External grouping not supported 95148848|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148849|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148850|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148851|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80170188|EAP|CPT® 97166||0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION|Hb Ot Eval Mod Complex|1|HUMANA [1294]||HUMANA [11839]|259.35|FSC: 13; Default||Not reimbursed separately|259.35|FSC: 13; Default||External grouping not supported 95148852|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95148853|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148854|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148855|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80170199|EAP|CPT® 97167||0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION|Hb Ot Eval High Complex|1|HUMANA [1294]||HUMANA [11839]|259.35|FSC: 13; Default||Not reimbursed separately|259.35|FSC: 13; Default||External grouping not supported 95148856|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148857|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95148858|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148859|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80170200|EAP|CPT® 97168||0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION|Hb Ot Re-eval Est Plan Care|1|HUMANA [1294]||HUMANA [11839]|178.53|FSC: 13; Default||Not reimbursed separately|178.53|FSC: 13; Default||External grouping not supported 95148860|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148861|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148862|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148863|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148864|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95148865|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95148866|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95148867|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95189170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cartiva 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95148868|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95148869|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148870|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95189171|EAP|Custom 95189171||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 4.75 X 60 Mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95148871|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148872|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95186169|EAP|HCPCS Q4124||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Wound Oasis Ultra 3cm X 7cm Meshed 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.00|FSC: 13; Default||Not reimbursed separately|45.00|FSC: 13; Default||External grouping not supported 95148873|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148874|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95189172|EAP|Custom 95189172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Wire Drill 1.1mmx150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148875|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148876|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148877|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95148878|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95189173|EAP|Custom 95189173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Standard Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|FSC: 13; Default||Not reimbursed separately|3,063.00|FSC: 13; Default||External grouping not supported 95148882|EAP|Custom 95148882||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Neoprene X-large Gray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L16 Mm Spine 1 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95148884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 3.2mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95148894|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiojet Spiroflex 4fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189179|EAP|Custom 95189179||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5x60mm|1|HUMANA [1294]||HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 95148902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.52|FSC: 13; Default||Not reimbursed separately|2,216.52|FSC: 13; Default||External grouping not supported 95148907|EAP|Custom 95148907||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hook And Loop 1 White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189181|EAP|Custom 95189181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Laser 25 Ga Illuminated Directi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148908|EAP|Custom 95148908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Covac 50 3.5mm 50 Dee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148910|EAP|Custom 95148910||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Chronos Beta-tcp 10 Degrer|1|HUMANA [1294]||HUMANA [11839]|1,905.00|FSC: 13; Default||Not reimbursed separately|1,905.00|FSC: 13; Default||External grouping not supported 95192463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Reverse Glenosphere Shoulder Std 36mm Ha Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95148911|EAP|Custom 95148911||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Chronos Beta-tcp 18 Degrer|1|HUMANA [1294]||HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95148912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Standard Off4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95148913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95148914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Pinnacle Metam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.33|FSC: 13; Default||Not reimbursed separately|4,968.33|FSC: 13; Default||External grouping not supported 95148915|EAP|Custom 95148915||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Rotatable 35mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95148916|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Easyrak2 Bipolar 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95148917|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Fineline 2 Bipolar Is1 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95148921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95148922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Pilon 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|849.00|FSC: 13; Default||Not reimbursed separately|849.00|FSC: 13; Default||External grouping not supported 95148931|EAP|Custom 95148931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Lock Cap 70mm X 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148932|EAP|Custom 95148932||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Tension Capsular Cionni Mor|1|HUMANA [1294]||HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95148933|EAP|Custom 95148933||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pak Complete Aqualase 9mml|1|HUMANA [1294]||HUMANA [11839]|698.25|FSC: 13; Default||Not reimbursed separately|698.25|FSC: 13; Default||External grouping not supported 95148935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,649.85|FSC: 13; Default||Not reimbursed separately|1,649.85|FSC: 13; Default||External grouping not supported 95148937|EAP|Custom 95148937||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Xx-small (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148938|EAP|Custom 95148938||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X-small (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148939|EAP|Custom 95148939||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Small (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle 52mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95148942|EAP|Custom 95148942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Prefilled Embosphere Mil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148943|EAP|Custom 95148943||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Medium (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Offset Hi Si4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95148945|EAP|Custom 95148945||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Large (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95148946|EAP|Custom 95148946||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Large (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186386|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Crystalens Posterior Chamber 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95148947|EAP|Custom 95148947||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X-large (webly)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Pinnacle 6.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95186381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T 10 2.7mmxl20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95148951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Ii Sector Pinnacle 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95189175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95148952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Standard +4 Lateram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 95186378|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast Covered 9mm X 38mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|FSC: 13; Default||Not reimbursed separately|7,338.75|FSC: 13; Default||External grouping not supported 95148953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|FSC: 13; Default||Not reimbursed separately|4,004.70|FSC: 13; Default||External grouping not supported 95148954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Proximal Ztt S-rom 16d Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 95186385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 5.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95189176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 18mm Tib E-f Fem 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95148959|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone L-asr Fee 6 X 14 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95186382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mmxl20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95148960|EAP|Custom 95148960||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Medium Aso Stabilizr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148961|EAP|Custom 95148961||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Large Aso Stabilizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95148962|EAP|Custom 95148962||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X-small Aso Stabilir|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 5.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95148963|EAP|Custom 95148963||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Small Aso Stabilizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95148964|EAP|Custom 95148964||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strap Tennis Elbow Band-it|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Iconix 2.3mm With One Strand 1.2mm X Braid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95148972|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 6mm Duck|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax Narrow Straight 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|FSC: 13; Default||Not reimbursed separately|2,190.00|FSC: 13; Default||External grouping not supported 95148973|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 8mm Duck|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95148974|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 12mm Duc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax Straight 7 Hole/l90 With 2 Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|FSC: 13; Default||Not reimbursed separately|2,190.00|FSC: 13; Default||External grouping not supported 95148975|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 6mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148976|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 8mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189180|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95148977|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 10mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71118251|EAP|Custom 71118251||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dermabond Ed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148981|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 12mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168861|EAP|CPT® 28232||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tenotomy, Open, Tendon Flexor; Toe, Single Tendon|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 95148982|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 14mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Iconix 2.3mm With Two Strand 1.2mm X Braid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 80168872|EAP|CPT® 28272||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Capsulotomy; Interphalangeal Joint, Each Joint|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 95148984|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 18mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lipped Ap Duration Duracon 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95148985|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 22mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186390|EAP|Custom 95186390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Gastrostomy Profile Low 20 X 3.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148986|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 25mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148987|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr. 28mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186389|EAP|Custom 95186389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Gastrostomy Profile Low 20 X 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148988|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 6mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allopure Bicortical 6mm Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,044.00|FSC: 13; Default||Not reimbursed separately|4,044.00|FSC: 13; Default||External grouping not supported 95148989|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 8mm Low|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186391|EAP|Custom 95186391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy 20gx6cm 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148990|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 10mm Lo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192468|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Technis Symfony Toric 23.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95148991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|99.00|FSC: 13; Default||Not reimbursed separately|99.00|FSC: 13; Default||External grouping not supported 95186394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cancellous Crush 5cc Fd Asp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95148992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95189184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Nitinol 8 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,314.00|FSC: 13; Default||Not reimbursed separately|4,314.00|FSC: 13; Default||External grouping not supported 95148993|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 12mm Lo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186388|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Restorelle L 24cm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95148994|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 14mm Lo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148995|EAP|Custom 95148995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Cortical 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Humerus 3hole/l84mm Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95148996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Pilon 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 80169922|EAP|CPT® 36901||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Cath Dialysis Circuit|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95148997|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 18mm Lo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Easyclip 10-10-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.00|FSC: 13; Default||Not reimbursed separately|4,386.00|FSC: 13; Default||External grouping not supported 95148998|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 22mm Lo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192470|EAP|Custom 95192470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asnis Iii 300mm X 5mm X 3.2 Mm Non-threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148999|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr. 25mm Lo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Micro Asnis 3.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95149019|EAP|Custom 95149019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Donor Radial Vac Baron 8.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169933|EAP|CPT® 36902||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Cath Dialysis Circuit W Angioplasty|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95149020|EAP|Custom 95149020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Donor Radial Vac Baron 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial Lt 5 Hole/84mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,551.00|FSC: 13; Default||Not reimbursed separately|7,551.00|FSC: 13; Default||External grouping not supported 95149028|EAP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Gammagraft 5x12 Sq Cm|1|HUMANA [1294]||HUMANA [11839]|17.50|FSC: 13; Default||Not reimbursed separately|17.50|FSC: 13; Default||External grouping not supported 95149029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp With Colla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.59|FSC: 13; Default||Not reimbursed separately|547.59|FSC: 13; Default||External grouping not supported 95186387|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Restorelle Y 24cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95149031|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 7mm Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 80169944|EAP|CPT® 36903||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Cath Dialysis Circuit W Stent|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95149034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95186398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reunion Tsa Press Fit 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95149037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Bone Void Norian Rotary M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.34|FSC: 13; Default||Not reimbursed separately|4,247.34|FSC: 13; Default||External grouping not supported 95192471|EAP|Custom 95192471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Countersink Asnis Iii Cannulated Ao Fit 6.5/8 Mm S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149038|EAP|Custom 95149038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Delivery Norian 10cm X 8g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149039|EAP|Custom 95149039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Delivery Norian 10cm X 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169955|EAP|CPT® 36904||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thrombectomy Dialysis Circuit|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95149047|EAP|Custom 95149047||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Smal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169966|EAP|CPT® 36905||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thrombectomy Dialysis Circuit W Angioplasty|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95149048|EAP|Custom 95149048||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Medi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186404|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Medium High Profile 620cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95149049|EAP|Custom 95149049||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Asnis Iii Titanium Partialthread 6.5x40mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95149050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 95186405|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Plus Med Height 495cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80169977|EAP|CPT® 36906||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thrombectomy Dialysis Circuit W Stent|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 95149052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Revision Beaded Bod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,119.36|FSC: 13; Default||Not reimbursed separately|19,119.36|FSC: 13; Default||External grouping not supported 95186406|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Plus Med Height 555cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95149055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Cancellous Lagm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95149058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident Alumina 0-degreem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95186401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95149059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Taper V40 Alumina 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,454.85|FSC: 13; Default||Not reimbursed separately|4,454.85|FSC: 13; Default||External grouping not supported 80169988|EAP|CPT® 36907||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Balloon Angio Central Dialysis Segment|1|HUMANA [1294]||HUMANA [11839]|6,662.73|FSC: 13; Default||Not reimbursed separately|6,662.73|FSC: 13; Default||External grouping not supported 95149060|EAP|Custom 95149060||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95149061|EAP|Custom 95149061||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170966|EAP|CPT® 46220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Excision Of Single External Papilla Or Tag, Anus|1|HUMANA [1294]||HUMANA [11839]|3,100.01|FSC: 13; Default||Not reimbursed separately|3,100.01|FSC: 13; Default||External grouping not supported 95149062|EAP|Custom 95149062||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Exercise Deluxe Traction B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186399|EAP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Cervical Prosthesis Standard 15x17 H7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95149066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 40mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 80169999|EAP|CPT® 37246||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transluminal Angioplasty 1st Artery|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95149067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 45mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95186400|EAP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Cervical Prosthesis Standard 15x17 H5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95149068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 50mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95149069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 55mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95149071|EAP|Custom 95149071||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ball Exercise 30 Blue Sds Thera|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186408|EAP|Custom 95186408||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Inserter Demo Footprint Non-sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 60mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 80170000|EAP|CPT® 37247||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transluminal Angioplasty Add Artery|1|HUMANA [1294]||HUMANA [11839]|5,653.00|FSC: 13; Default||Not reimbursed separately|5,653.00|FSC: 13; Default||External grouping not supported 95186407|EAP|Custom 95186407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Circumcision Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 5.0mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 80170011|EAP|CPT® 37248||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transluminal Angioplasty 1st Vein|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95186410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Asnis Cannulated Screw 5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95149081|EAP|Custom 95149081||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 14mm X 22mm Vertes|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95186412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Asnis Cannulated Screw 5x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95149089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp With Colla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|FSC: 13; Default||Not reimbursed separately|572.88|FSC: 13; Default||External grouping not supported 80170022|EAP|CPT® 37249||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transluminal Angioplasty Add Vein|1|HUMANA [1294]||HUMANA [11839]|5,670.83|FSC: 13; Default||Not reimbursed separately|5,670.83|FSC: 13; Default||External grouping not supported 95186417|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Pulse Model 102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,244.00|FSC: 13; Default||Not reimbursed separately|47,244.00|FSC: 13; Default||External grouping not supported 95149091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 85mm 6 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,012.56|FSC: 13; Default||Not reimbursed separately|1,012.56|FSC: 13; Default||External grouping not supported 95149092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 111mm 8 Hole T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,106.97|FSC: 13; Default||Not reimbursed separately|1,106.97|FSC: 13; Default||External grouping not supported 95186414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95149093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 3.5mm X 137mm 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,187.22|FSC: 13; Default||Not reimbursed separately|1,187.22|FSC: 13; Default||External grouping not supported 80170033|EAP|CPT® 62320||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Interlaminar Crv/thrc W/o Imaging|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95149099|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 7mm Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95186409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Shoulder Cta 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95149100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Expedium 5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,846.25|FSC: 13; Default||Not reimbursed separately|2,846.25|FSC: 13; Default||External grouping not supported 95192473|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.25 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95186413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixation Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 95149103|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage 8 Fr Apdg/8/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,734.81|FSC: 13; Default||Not reimbursed separately|1,734.81|FSC: 13; Default||External grouping not supported 95149105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction Lcp 3.5mmx1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,810.35|FSC: 13; Default||Not reimbursed separately|1,810.35|FSC: 13; Default||External grouping not supported 95186421|EAP|Custom 95186421||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Corent Li 12 X 9 X 20mm 4 Deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95149106|EAP|Custom 95149106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Crossover Sz 8|1|HUMANA [1294]||HUMANA [11839]|3,093.75|FSC: 13; Default||Not reimbursed separately|3,093.75|FSC: 13; Default||External grouping not supported 80170044|EAP|CPT® 62321||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Interlaminar Crv/thrc W Imaging|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95149108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 50mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.78|FSC: 13; Default||Not reimbursed separately|1,059.78|FSC: 13; Default||External grouping not supported 95186428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Pca 32mm +0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95149109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 56mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.81|FSC: 13; Default||Not reimbursed separately|1,092.81|FSC: 13; Default||External grouping not supported 95192474|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.75 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 52mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,184.85|FSC: 13; Default||Not reimbursed separately|1,184.85|FSC: 13; Default||External grouping not supported 95186429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Hooded 10 Degree 32mm X52mm 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95149112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 74mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.68|FSC: 13; Default||Not reimbursed separately|913.68|FSC: 13; Default||External grouping not supported 80170055|EAP|CPT® 62322||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Interlaminar Lumb/sacral W/o Imaging|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95149113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 52mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,248.60|FSC: 13; Default||Not reimbursed separately|1,248.60|FSC: 13; Default||External grouping not supported 95186418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 5.5 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95149114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Plate Lcp 3.5mm X 74mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.25|FSC: 13; Default||Not reimbursed separately|1,364.25|FSC: 13; Default||External grouping not supported 95149115|EAP|Custom 95149115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Parts Spare Microtip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept Modular 5.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,919.00|FSC: 13; Default||Not reimbursed separately|2,919.00|FSC: 13; Default||External grouping not supported 95149119|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170066|EAP|CPT® 62323||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Interlaminar Lumb/sacral W Imaging|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95149125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X 8mm Peripr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|689.22|FSC: 13; Default||Not reimbursed separately|689.22|FSC: 13; Default||External grouping not supported 95186420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept Modular 5.5 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95149126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,457.09|FSC: 13; Default||Not reimbursed separately|2,457.09|FSC: 13; Default||External grouping not supported 95192475|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 2.75 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,865.39|FSC: 13; Default||Not reimbursed separately|2,865.39|FSC: 13; Default||External grouping not supported 95186422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metatarsal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95149128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,283.20|FSC: 13; Default||Not reimbursed separately|3,283.20|FSC: 13; Default||External grouping not supported 80170077|EAP|CPT® 62324||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Contin Inj Interlaminar Crv/thrc W/o Imaging|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95149129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Lcp 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,578.22|FSC: 13; Default||Not reimbursed separately|3,578.22|FSC: 13; Default||External grouping not supported 95186423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95149130|EAP|Custom 95149130||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Elbow Therapeutic Bandit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149133|EAP|Custom 95149133||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Indwelling Replacement 8mm B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95149134|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr 6mm Advat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170088|EAP|CPT® 62325||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Contin Inj Interlaminar Crv/thrc W Imaging|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95149135|EAP|Custom 95149135||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Indwelling Replacement 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95149136|EAP|Custom 95149136||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Indwelling Replacement 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192476|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting Wolverine (mr) 3.25 X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95186426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95149142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 80170099|EAP|CPT® 62326||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Contin Inj Interlaminar Lumb/sacral W/o Imaging|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95149155|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Identity Xld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95186427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95149156|EAP|HCPCS A6211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Polymem 4x12 Silver A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular Lcp With Colla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|559.38|FSC: 13; Default||Not reimbursed separately|559.38|FSC: 13; Default||External grouping not supported 95149158|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hohn 7fr Dual Lumen W/v|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170100|EAP|CPT® 77065||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Diagnostic Mammogram Unilateral With Cad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|253.68|FSC: 13; Default||Not reimbursed separately|253.68|FSC: 13; Default||External grouping not supported 95149159|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hohn 5fr Single Lumen W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149161|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr 10mm Adva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Shape 6mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95149164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Shape 10mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95186438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Lag-u-blade 10.5 X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|FSC: 13; Default||Not reimbursed separately|2,066.40|FSC: 13; Default||External grouping not supported 95149165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Quick Tap 1.6mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 80170111|EAP|CPT® 77066||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Diagnostic Mammogram Bilateral With Cad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.03|FSC: 13; Default||Not reimbursed separately|324.03|FSC: 13; Default||External grouping not supported 95149166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Quick Tap 1.6mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95185237|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Flush 6f/65cm .035" 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Burr Hole Cover 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95149168|EAP|Custom 95149168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Conization C-letz Smal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186430|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Mac Access Two-lumen Central Venous 2-l 9fr Dis X11.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149169|EAP|Custom 95149169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Conization C-letz Ecto|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170122|EAP|CPT® 77067||0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY|Hb Screening Mammogram Bilateral With Cad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.17|FSC: 13; Default||Not reimbursed separately|262.17|FSC: 13; Default||External grouping not supported 95149171|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Closure Vessel Suture Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|648.00|FSC: 13; Default||Not reimbursed separately|648.00|FSC: 13; Default||External grouping not supported 95186431|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Component Cvc 7fr (use W/arrow Mac Device)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149172|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Asahi Tornus 2.1fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186433|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Component Cvc 3-lumen 7fr (use Only W/arrow Mac Dev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149176|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 80170211|EAP|CPT® 99151||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed, Same Phys, Younger Than 5yrs 1st 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95149178|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 17.0mm/3.2mm 161mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186432|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Component Cvc 2-lumen 7fr (use Only W/arrow Mac Dev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95149195|EAP|Custom 95149195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Large 17.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186440|EAP|Custom 95186440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 10fr 36" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149209|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 11.0mm/3.2mm 222mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170222|EAP|CPT® 99152||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed, Same Phys, 5yrs And Older 1st 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95149226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95186441|EAP|Custom 95186441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 8fr 43" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Lag 4.0mm X 50m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95149228|EAP|Custom 95149228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 7.3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186445|EAP|Custom 95186445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 10fr 55" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149255|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Uretex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,444.07|FSC: 13; Default||Not reimbursed separately|2,444.07|FSC: 13; Default||External grouping not supported 80170233|EAP|CPT® 99153||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed, Same Phys Ea Add 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95186442|EAP|Custom 95186442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 10fr 43" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 Std 36mm Fricti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95149299|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Mini Vaxcel 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95186447|EAP|Custom 95186447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Spray Flo-tip 7 Fr X 240 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Sz C 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Sz C 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95186437|EAP|Custom 95186437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ent Patient Tracker Set Updated Version|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal Sz C 5mm Nn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 95149307|EAP|Custom 95149307||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strap Tendonitis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186446|EAP|Custom 95186446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Stent Soehendra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Sz D 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95189186|EAP|Custom 95189186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scissor Grieshaber Curved 15 Gauge Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radial Volar 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|FSC: 13; Default||Not reimbursed separately|1,849.08|FSC: 13; Default||External grouping not supported 95186439|EAP|Custom 95186439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 8fr 36" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 1.6mm X4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95149315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 1.6mm X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95186444|EAP|Custom 95186444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 8fr 55" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Emergency 2.0mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95189187|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149318|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Syringe Prefil Power Inj 320 1ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|FSC: 13; Default||Not reimbursed separately|1.04|FSC: 13; Default||External grouping not supported 95186443|EAP|Custom 95186443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Cortrak 2 12fr 43" Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149319|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Syr Prefil Inj Optiray 320 50 1m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|FSC: 13; Default||Not reimbursed separately|0.81|FSC: 13; Default||External grouping not supported 95149320|EAP|Custom 95149320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Carbonflex 3x5 Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149322|EAP|Custom 95149322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Carbonflex 3 Round Bl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189210|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Matristem Thick 30 X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,420.00|FSC: 13; Default||Not reimbursed separately|66,420.00|FSC: 13; Default||External grouping not supported 95149325|EAP|Custom 95149325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Carbonflex 3 Round Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149326|EAP|Custom 95149326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Carbonflex 3 X 5 Bl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal Sz C 10mm N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 95149333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal Sz D 5mm Ne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95189211|EAP|Custom 95189211||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14 X 16 X 10 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95149334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Sz E 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 95149335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal Sz E 10mm N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Only Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Sz F 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 95189212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fortex 8.25 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95149339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Only Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95186450|EAP|Custom 95186450||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cervical Spacer Stealth 12x14x5.6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95149340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Sz G 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149341|EAP|Custom 95149341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Injection Articulating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patellofemoral Mck Restoris Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95149342|EAP|Custom 95149342||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Aquaform Zippered S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189213|EAP|Custom 95189213||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continous 5.5mm X 90mm|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95149343|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Ti 6.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95149345|EAP|Custom 95149345||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold 11 X 14 Colpacs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149350|EAP|Custom 95149350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Radial Jaw Large C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149351|EAP|Custom 95149351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Injection Gold Probe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189214|EAP|Custom 95189214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend 21cm 3mm Ta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149360|EAP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seed Loose I-125|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95186462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Offset High C-stem Amt Sz7 12/14 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95149361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Pinnacle 6.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95149362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Standard Off5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95186459|EAP|Custom 95186459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Assistant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight 11mm X N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95189215|EAP|Custom 95189215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend 14cm 3mm Ta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight 17mm X N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95186458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlaymck Restoris 6-9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95149373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight 22mm X N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|FSC: 13; Default||Not reimbursed separately|3,329.67|FSC: 13; Default||External grouping not supported 95149374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Offset 12mm X 14n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|FSC: 13; Default||Not reimbursed separately|4,758.00|FSC: 13; Default||External grouping not supported 95186460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centraliser Void C-stem 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.90|FSC: 13; Default||Not reimbursed separately|417.90|FSC: 13; Default||External grouping not supported 95149375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Offset 14mm X 14n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|FSC: 13; Default||Not reimbursed separately|4,350.54|FSC: 13; Default||External grouping not supported 95189216|EAP|Custom 95189216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend 14cm 6mm Ac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Offset 17mm X 14n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|FSC: 13; Default||Not reimbursed separately|4,350.54|FSC: 13; Default||External grouping not supported 80169502|EAP|CPT® 12032||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intermediate Repair 2.6-7.5 Cm|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95149377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,983.00|FSC: 13; Default||Not reimbursed separately|16,983.00|FSC: 13; Default||External grouping not supported 95149378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial 10mm Sz-4 N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95186470|EAP|Custom 95186470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb-df 4.3x 300mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tib 10mm Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95189217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Proximal Right 4hole X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95186466|EAP|Custom 95186466||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated 25 X 90/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95149381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial 10mm Sz-8 N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149382|EAP|Custom 95149382||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Balloon Assembly Patient E|1|HUMANA [1294]||HUMANA [11839]|54.83|FSC: 13; Default||Not reimbursed separately|54.83|FSC: 13; Default||External grouping not supported 95186467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95149383|EAP|Custom 95149383||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Balloon Assembly Patient W|1|HUMANA [1294]||HUMANA [11839]|54.83|FSC: 13; Default||Not reimbursed separately|54.83|FSC: 13; Default||External grouping not supported 95189218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95149384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Yellow Cn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95186469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp Small 5dg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95149385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Yellow Cn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95149386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 14mm Yellow Cn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95186468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95149387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 17mm Yellow Cn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189219|EAP|Custom 95189219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter Ll Short 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Yellow Sn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95186471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Speedbridge Achilles Peek System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,980.00|FSC: 13; Default||Not reimbursed separately|4,980.00|FSC: 13; Default||External grouping not supported 95149390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Yellow Sn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95189220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Abs Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 95149391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 14 Mm Yellow N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 17mm Yellow Sn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95149393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 23mm Yellow Sn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189222|EAP|Custom 95189222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 5.0mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Green Efn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95149395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Green Efn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 95189188|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 20mm Green Efn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 23mm Green Efn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189189|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Green Stn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Green Stn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189190|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149400|EAP|Custom 95149400||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold Neck Contour Colpacs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149402|EAP|Custom 95149402||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold Oversized 11x 21 Cos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189191|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 17mm Green Stn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 20mm Green Stn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189192|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 23mm Green Stn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Blue G 7n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189193|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal Szg 5mm Nen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Blue G 7n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189194|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 14mm Blue G 7n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 17mm Blue G 7n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189195|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 20mm Blue G 7n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 23mm Blue G 7n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Posterior Only Szn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95149415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Blue Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189197|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 12mm Blue Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95149417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 14mm Blue Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189198|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 17mm Blue Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 20mm Blue Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95189199|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 23mm Blue Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|FSC: 13; Default||Not reimbursed separately|5,888.07|FSC: 13; Default||External grouping not supported 95149421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf Plate 3.5mm 3-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.06|FSC: 13; Default||Not reimbursed separately|702.06|FSC: 13; Default||External grouping not supported 95189200|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf Plate 3.5mm 4-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|751.50|FSC: 13; Default||Not reimbursed separately|751.50|FSC: 13; Default||External grouping not supported 95149428|EAP|Custom 95149428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Filter Blood Circuit Uf500 W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189201|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149430|EAP|Custom 95149430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Picc Line Insertion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149432|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189202|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149433|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149435|EAP|Custom 95149435||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll 4 Foam Round Therapy Roll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189203|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149439|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 32.0 Diopter Ae|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95149441|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 6fr Super Arrow Flex 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189204|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149442|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 8fr Super Arrow Flex 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149449|EAP|Custom 95149449||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Large With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189205|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149451|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Pigtail 7frx5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.95|FSC: 13; Default||Not reimbursed separately|220.95|FSC: 13; Default||External grouping not supported 95149452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 100 Pinnacle 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95189206|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral 36mm X L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|FSC: 13; Default||Not reimbursed separately|4,777.23|FSC: 13; Default||External grouping not supported 95149454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Tapered Offs6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95189207|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95149456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Ex 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,983.35|FSC: 13; Default||Not reimbursed separately|5,983.35|FSC: 13; Default||External grouping not supported 95189208|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149457|EAP|Custom 95149457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral 44mm Titanium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149458|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149459|EAP|Custom 95149459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Calibrated 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149461|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 18 Fr 8mm Advae|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149463|EAP|Custom 95149463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Radial Jaw Maximue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L54 Mm Spine 3 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95149464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95189223|EAP|Custom 95189223||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lid Chain 1.4 Gram Platinum|1|HUMANA [1294]||HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 95149465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 6 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|FSC: 13; Default||Not reimbursed separately|1,849.08|FSC: 13; Default||External grouping not supported 95149466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 10 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|FSC: 13; Default||Not reimbursed separately|2,017.17|FSC: 13; Default||External grouping not supported 95189224|EAP|Custom 95189224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 0.76mm X12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 12 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95192479|EAP|Custom 95192479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Dst Series Eeati Xl Circular 25mmx3.5mmx35cm Orville|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95189225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Vrsdl 42x18x46 Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,899.00|FSC: 13; Default||Not reimbursed separately|7,899.00|FSC: 13; Default||External grouping not supported 95149469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 10 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|FSC: 13; Default||Not reimbursed separately|2,017.17|FSC: 13; Default||External grouping not supported 95149470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 12 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95120751|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Symmetry 2.5mmx2cm 135c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,021.02|FSC: 13; Default||Not reimbursed separately|1,021.02|FSC: 13; Default||External grouping not supported 95149471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95189226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Primary 10mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,780.00|FSC: 13; Default||Not reimbursed separately|12,780.00|FSC: 13; Default||External grouping not supported 95149472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 3 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95149473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 5 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95189229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Ant Unite Global 135 Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 95149474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 7 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|FSC: 13; Default||Not reimbursed separately|1,849.08|FSC: 13; Default||External grouping not supported 95149475|EAP|Custom 95149475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Aspiration Lsk Evolution|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120784|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 12x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95149476|EAP|Custom 95149476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine Hanna 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unite Global 48mm X 18 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|FSC: 13; Default||Not reimbursed separately|6,039.00|FSC: 13; Default||External grouping not supported 95149477|EAP|Custom 95149477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine Hanna 8.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149478|EAP|Custom 95149478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine Hanna 8.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Steptech Global Sz48 +5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,509.75|FSC: 13; Default||Not reimbursed separately|10,509.75|FSC: 13; Default||External grouping not supported 95149479|EAP|Custom 95149479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine Hanna 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149480|EAP|Custom 95149480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine Hanna 0.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 18 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,790.00|FSC: 13; Default||Not reimbursed separately|11,790.00|FSC: 13; Default||External grouping not supported 95149481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95149482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 7 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|FSC: 13; Default||Not reimbursed separately|1,849.08|FSC: 13; Default||External grouping not supported 95189233|EAP|Custom 95189233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Locking Med 4.3x296 Mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 1 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95189264|EAP|Custom 95189264||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cancellous Chips 15cc Frozen|1|HUMANA [1294]||HUMANA [11839]|62.00|FSC: 13; Default||Not reimbursed separately|62.00|FSC: 13; Default||External grouping not supported 95149487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95149488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 4 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,866.36|FSC: 13; Default||Not reimbursed separately|1,866.36|FSC: 13; Default||External grouping not supported 95189236|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 6 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.06|FSC: 13; Default||Not reimbursed separately|1,959.06|FSC: 13; Default||External grouping not supported 95149490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 8 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.03|FSC: 13; Default||Not reimbursed separately|2,061.03|FSC: 13; Default||External grouping not supported 95189237|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 10 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95149493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 1 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95189238|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|FSC: 13; Default||Not reimbursed separately|1,769.97|FSC: 13; Default||External grouping not supported 95149495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 4 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,866.36|FSC: 13; Default||Not reimbursed separately|1,866.36|FSC: 13; Default||External grouping not supported 95189239|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 6 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.06|FSC: 13; Default||Not reimbursed separately|1,959.06|FSC: 13; Default||External grouping not supported 95149497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 8 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.03|FSC: 13; Default||Not reimbursed separately|2,061.03|FSC: 13; Default||External grouping not supported 95189240|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 10 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95192488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Mod Mas Reline 5.5 X 45mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 95149499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95189241|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149500|EAP|Custom 95149500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Injection Carr-locke|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 6 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|FSC: 13; Default||Not reimbursed separately|1,849.08|FSC: 13; Default||External grouping not supported 95189243|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 8 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|FSC: 13; Default||Not reimbursed separately|1,918.29|FSC: 13; Default||External grouping not supported 95192489|EAP|Custom 95192489||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Coroent 4 D Large Impact L26 Mm X W12 Mm X H9 Mm|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95149503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 10 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|FSC: 13; Default||Not reimbursed separately|2,017.17|FSC: 13; Default||External grouping not supported 95189244|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 12 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95149505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 2 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|FSC: 13; Default||Not reimbursed separately|1,710.63|FSC: 13; Default||External grouping not supported 95189245|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 8 Hole Distt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|FSC: 13; Default||Not reimbursed separately|1,918.29|FSC: 13; Default||External grouping not supported 95192478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Comp 5.0x70mm Titanium T15 Large Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95149507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 10 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|FSC: 13; Default||Not reimbursed separately|2,017.17|FSC: 13; Default||External grouping not supported 95189246|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular 12 Hole Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95149510|EAP|HCPCS A6246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Burn 7 Day Acticoat 4x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189247|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149516|EAP|Custom 95149516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer Flat Sur-fit 1-1/2 Flangt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192483|EAP|Custom 95192483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Nonabsorbable Ethilon 1 Ct-1 L36in Monofilament Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149519|EAP|Custom 95149519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Urostomy 1-1/2 Opaque 2 E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189248|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Sz-3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95149526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 70mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 75mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95189249|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 80mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 85mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95192485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini-monster Short Thread L50 Mm Od3 Mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95149530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 90mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149531|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Mp C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95189250|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149532|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Silicone Mp C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95149533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 95mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 100g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 110g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95189252|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 105g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149539|EAP|Custom 95149539||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Sof-stretch Large 2-1/4 E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192486|EAP|Custom 95192486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Tracar 1.1mm X150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149541|EAP|Custom 95149541||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Exerciser Wrist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189253|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Summit Duofix Standard Off3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|FSC: 13; Default||Not reimbursed separately|17,820.60|FSC: 13; Default||External grouping not supported 95149545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 42mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149547|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Identity Xl Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,589.75|FSC: 13; Default||Not reimbursed separately|11,589.75|FSC: 13; Default||External grouping not supported 95149548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 44mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95189254|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 46mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 48mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95192487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 300mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95149552|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx Bipolar Ventrim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95149553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 52mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149554|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx Bipolar Ventrim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95149555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 54mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 56mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 58mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95189256|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 60mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 65mm Seld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 70m Selfd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95149561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 42mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95189257|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 44mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 46mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 48mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 50mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95189258|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 52mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 54mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 56mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95149572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periarticular 3.5mm X 60mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|FSC: 13; Default||Not reimbursed separately|102.84|FSC: 13; Default||External grouping not supported 95189259|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149574|EAP|Custom 95149574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Super Multi Vac 3.75e|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149575|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 6.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149576|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glidecath 4fr Straightm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189260|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95149581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95149582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95149585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95189261|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95149587|EAP|Custom 95149587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Variable Aperture 11g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 32mm Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95149589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 36mm Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95189262|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95149590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Oblique 3.5mm 3-hole 3-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.20|FSC: 13; Default||Not reimbursed separately|514.20|FSC: 13; Default||External grouping not supported 95149592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Sextant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.42|FSC: 13; Default||Not reimbursed separately|861.42|FSC: 13; Default||External grouping not supported 95149593|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Blunt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149595|EAP|Custom 95149595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Source Light Quandrant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189270|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Armada 18 .018 - 2.5mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149596|EAP|Custom 95149596||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Needle Nim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149597|EAP|Custom 95149597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Disposable Nim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Oblique 3.5mm 3-hole 5-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95149599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 3-hole Head 3-holm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95189271|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Armada 18 .018 5mm X 100mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm 4-hole Head 4-holm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.31|FSC: 13; Default||Not reimbursed separately|326.31|FSC: 13; Default||External grouping not supported 95149601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm 10-holem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95149603|EAP|HCPCS C1728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Evaluation Cavity Mammose|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149604|EAP|Custom 95149604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Tubular Net Flexible 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189272|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Armada 18 .018 3mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149605|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Textured Cervical Vg2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.50|FSC: 13; Default||Not reimbursed separately|3,481.50|FSC: 13; Default||External grouping not supported 95149606|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Textured Cervical Vg2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 95149608|EAP|Custom 95149608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Resolution Clip 2.8mm Chg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189273|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Armada 18 .018 3mm X 40mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Pinnacle Metam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|FSC: 13; Default||Not reimbursed separately|4,777.23|FSC: 13; Default||External grouping not supported 95149611|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Schon Xl Acute 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95149614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 58mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95149615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 60mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95189274|EAP|Custom 95189274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Surgicel Nu Knit 3 X 4 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 62mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95149617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 64mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95149618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 66mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95149619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 68mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95189275|EAP|Custom 95189275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Original 2 X 14 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Standard I.d. 40mm 70mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|FSC: 13; Default||Not reimbursed separately|4,959.54|FSC: 13; Default||External grouping not supported 95149624|EAP|Custom 95149624||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold 10 X13-1/2 Standard C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192484|EAP|Custom 95192484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arthroscopic Flowport Ii Polymer Id 5mm Obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149625|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guide Pinnacle Straight R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189276|EAP|Custom 95189276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Original 4 X 8 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149642|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx Bipolar Ventrim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95149644|EAP|Custom 95149644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 12mm Large 8 Dege|1|HUMANA [1294]||HUMANA [11839]|14,003.22|FSC: 13; Default||Not reimbursed separately|14,003.22|FSC: 13; Default||External grouping not supported 95149645|EAP|Custom 95149645||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 16mm Large 8 Dege|1|HUMANA [1294]||HUMANA [11839]|14,003.22|FSC: 13; Default||Not reimbursed separately|14,003.22|FSC: 13; Default||External grouping not supported 95189277|EAP|Custom 95189277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Fibrillar 1 X 2 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149647|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac 12mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,253.00|FSC: 13; Default||Not reimbursed separately|5,253.00|FSC: 13; Default||External grouping not supported 95192490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Lf 10mm/g-hfemur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95149649|EAP|Custom 95149649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tamp Bone Inflatable Xpander Ky3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149650|EAP|Custom 95149650||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Line Sampling Breath Oral/nasal2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189278|EAP|Custom 95189278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Fibrillar 4 X 4 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Eagle 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 95149653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Eagle 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 95149654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Oversized Eagle 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95189279|EAP|Custom 95189279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Surgicel Original 2 X 3 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149666|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149667|EAP|Custom 95149667||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Stomahesive W/flange 1-3/)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Oxinium Od40 Mm Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,507.60|FSC: 13; Default||Not reimbursed separately|6,507.60|FSC: 13; Default||External grouping not supported 95149668|EAP|Custom 95149668||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Power Pulse Spray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149670|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Optiray 350mg/ml5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.78|FSC: 13; Default||Not reimbursed separately|0.78|FSC: 13; Default||External grouping not supported 95189280|EAP|Custom 95189280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Access Surgical Maxcess 4 Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 6.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95149673|EAP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Skin Gammagraft Sq Cm|1|HUMANA [1294]||HUMANA [11839]|51.43|FSC: 13; Default||Not reimbursed separately|51.43|FSC: 13; Default||External grouping not supported 95149674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 6.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95149675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95189282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Solid 5.0/46l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|FSC: 13; Default||Not reimbursed separately|2,934.00|FSC: 13; Default||External grouping not supported 95149676|EAP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Skin Gammagraft Sq Cm|1|HUMANA [1294]||HUMANA [11839]|30.00|FSC: 13; Default||Not reimbursed separately|30.00|FSC: 13; Default||External grouping not supported 95149682|EAP|Custom 95149682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pak Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular R3 Xlpe 20 D Od58 Mm Id40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 95149685|EAP|Custom 95149685||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp 11mm Craniofix 2 Titanium|1|HUMANA [1294]||HUMANA [11839]|37.50|FSC: 13; Default||Not reimbursed separately|37.50|FSC: 13; Default||External grouping not supported 95189283|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95149687|EAP|Custom 95149687||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp 16mm Craniofix 2 Titanium|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95149688|EAP|Custom 95149688||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp 20mm Craniofix 2 Titanium|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189284|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95149692|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Converter Aaa 24mm Proximh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,858.00|FSC: 13; Default||Not reimbursed separately|6,858.00|FSC: 13; Default||External grouping not supported 95192497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Orthopedic Smf Titanium +0 12/14 Taper Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.40|FSC: 13; Default||Not reimbursed separately|620.40|FSC: 13; Default||External grouping not supported 95149693|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Converter Aaa 28mm Proximh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,065.00|FSC: 13; Default||Not reimbursed separately|7,065.00|FSC: 13; Default||External grouping not supported 95149694|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Converter Aaa 32mm Proximh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,858.00|FSC: 13; Default||Not reimbursed separately|6,858.00|FSC: 13; Default||External grouping not supported 95189285|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95149696|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 2h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|FSC: 13; Default||Not reimbursed separately|5,661.00|FSC: 13; Default||External grouping not supported 95149698|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 2h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,253.00|FSC: 13; Default||Not reimbursed separately|5,253.00|FSC: 13; Default||External grouping not supported 95149699|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 2h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|FSC: 13; Default||Not reimbursed separately|5,661.00|FSC: 13; Default||External grouping not supported 95149700|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 2h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|FSC: 13; Default||Not reimbursed separately|5,661.00|FSC: 13; Default||External grouping not supported 80170244|EAP|CPT® 74261||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Computed Tomographic (ct) Colonography, Diagnostic Wo Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95149701|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 3h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|FSC: 13; Default||Not reimbursed separately|5,661.00|FSC: 13; Default||External grouping not supported 95149702|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 3h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|FSC: 13; Default||Not reimbursed separately|5,661.00|FSC: 13; Default||External grouping not supported 95192499|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +14.0 Diop Bcnvx Toric 14mm 6mm Pc 1 Pc Fld Asph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95149703|EAP|Custom 95149703||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Occluder Aaa 16mm X 20mm H|1|HUMANA [1294]||HUMANA [11839]|5,658.00|FSC: 13; Default||Not reimbursed separately|5,658.00|FSC: 13; Default||External grouping not supported 95149704|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Occluder Aaa 24mm X 20mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,626.50|FSC: 13; Default||Not reimbursed separately|2,626.50|FSC: 13; Default||External grouping not supported 80170255|EAP|Custom 80170255||0998 - STATISTICAL CHARGES|Hb Seeq Application Research|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149706|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 6mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95149707|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 4mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95149708|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 10mm Diamg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95149710|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 8mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 80170266|EAP|Custom 80170266||0998 - STATISTICAL CHARGES|Hb Novottf-100m Device Research|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149711|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 10mm Diamg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95149712|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 8mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95192498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Curve L70 Mm Od5.5 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95149713|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 10mm Diamg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95149714|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 6mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95149715|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Nitinol 8mm Diameg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95149722|EAP|Custom 95149722||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Knee Protec No Slip Rubber|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149723|EAP|Custom 95149723||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Kneel Free 1/2 Thick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Solid 4.0/46l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|FSC: 13; Default||Not reimbursed separately|2,934.00|FSC: 13; Default||External grouping not supported 95192491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Reline Mas 2c 50mm X 5.5mm Spine Modular Shank|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|FSC: 13; Default||Not reimbursed separately|3,087.00|FSC: 13; Default||External grouping not supported 95149729|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95189286|EAP|Custom 95189286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device - Merit Custom Compak Basik Inflation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149730|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95149731|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95149732|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95149733|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95189287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comoponent Patellofemoral Mck Restoris Sz6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95149734|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95149739|EAP|Custom 95149739||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tear Away Kit 5.5x10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Reline Titanium Mas Lordotic 75mm X 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95149744|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5fr X .031|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149755|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Embocath Catheter Lengr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 8-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95149757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.6 Straight 2 Hole 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95149760|EAP|Custom 95149760||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Thermoskin Large 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149761|EAP|Custom 95149761||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Corfit System 7500|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149762|EAP|Custom 95149762||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Resuscitator Manual Pediatric Dg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 4.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95149763|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95149774|EAP|Custom 95149774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Total Plus With Accurus Pre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189289|EAP|Custom 95189289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Non-threaded 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149780|EAP|Custom 95149780||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Small/y|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149781|EAP|Custom 95149781||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Spica Right Mediumy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149784|EAP|Custom 95149784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Infusion With Stopcock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149785|EAP|Custom 95149785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wax Bone Ostene|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149793|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 5.0 Diope|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95149806|EAP|Custom 95149806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Combo Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L18 Mm Spine 1 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95149811|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.5mm X 6mm Lene|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95121433|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 10x68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,445.20|FSC: 13; Default||Not reimbursed separately|3,445.20|FSC: 13; Default||External grouping not supported 95149812|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 3.0mm X 6mm Lene|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149814|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149816|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stimulator Osteogenisis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95149818|EAP|Custom 95149818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149819|EAP|Custom 95149819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repack Consumables|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149820|EAP|Custom 95149820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Mini Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149821|EAP|Custom 95149821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Clamp Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149827|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Implantable Enpulse De|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95149841|EAP|Custom 95149841||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Protector Gel Elbow Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149842|EAP|Custom 95149842||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Protector Gel Elbow M/l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149843|EAP|Custom 95149843||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Protector Gel Elbow Xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149846|EAP|Custom 95149846||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Material Splinting R Foam 6 X E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189290|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Trulign Torric Bl1ut 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95149849|EAP|Custom 95149849||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strap Tennis Elbow Band-it|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149855|EAP|Custom 95149855||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Shoulder Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149865|EAP|Custom 95149865||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 8mm X 26mm Vertesk|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95121472|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall 7x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,522.48|FSC: 13; Default||Not reimbursed separately|3,522.48|FSC: 13; Default||External grouping not supported 95149866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Palacos R & G Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95189295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tap Cortical 4.5mmx58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95149886|EAP|Custom 95149886||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System .045 Fixation Bone Small|1|HUMANA [1294]||HUMANA [11839]|920.55|FSC: 13; Default||Not reimbursed separately|920.55|FSC: 13; Default||External grouping not supported 95149888|EAP|Custom 95149888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail .045 Fixation Bone Small|1|HUMANA [1294]||HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95149890|EAP|Custom 95149890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Catheter Reliant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189296|EAP|Custom 95189296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 32.mm/l180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149904|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Conformexx 6 Mm X 80 Mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95149905|EAP|Custom 95149905||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Head Femoral Frozen Fh|1|HUMANA [1294]||HUMANA [11839]|4,560.00|FSC: 13; Default||Not reimbursed separately|4,560.00|FSC: 13; Default||External grouping not supported 95189297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral 9mmx280mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95149911|EAP|HCPCS Q4113||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Jacket Graft Express 1cc|1|HUMANA [1294]||HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 95189298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T2 F/t 4mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95149922|EAP|Custom 95149922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Needle Ez-io 25mm 18ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149923|EAP|Custom 95149923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Needle Ez-io 15mm 15ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149936|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Vitatron Steroid Eluting Tg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95121511|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .018 Inch X 180cm Leng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149937|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 10-12mm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95149946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mystique 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,721.64|FSC: 13; Default||Not reimbursed separately|4,721.64|FSC: 13; Default||External grouping not supported 95189299|EAP|Custom 95189299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb External Fixator Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149957|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Sds Genesis Aviator 6mm Dh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95149958|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Sds Genesis Aviator 6mm Dh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95149963|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 6mm Dm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95189300|EAP|Custom 95189300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endocuff Endoscopic Overtube Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149965|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 6mm Dm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95149973|EAP|Custom 95149973||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nervm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149974|EAP|Custom 95149974||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Hand Based Radial Nerve Se|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 7 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95121540|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon 5x4x75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|FSC: 13; Default||Not reimbursed separately|477.60|FSC: 13; Default||External grouping not supported 95149976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Advantage Global Cta 52mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,103.25|FSC: 13; Default||Not reimbursed separately|7,103.25|FSC: 13; Default||External grouping not supported 95149982|EAP|Custom 95149982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Applicator Dual Cannula 20gh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95149988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95149989|EAP|Custom 95149989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149998|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Curved 0.35 Diameter N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150007|EAP|Custom 95150007||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Hip Econo With 42 Navy Legs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150008|EAP|Custom 95150008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 4 Channel Esophageal Me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150009|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 14 X 11 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95150010|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidecath Runway 6fr .070 Curvs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150011|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidecath Model 7 Mach 1 7fr .0s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150012|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidecath Runway 6fr .070 Curvs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150013|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidecath Runway 6fr .070 Curvs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150014|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 1200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150017|EAP|Custom 95150017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 9.25 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150018|EAP|Custom 95150018||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Capsular Tension 14a|1|HUMANA [1294]||HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95150028|EAP|Custom 95150028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Amino 2.5 X 2.0cm|1|HUMANA [1294]||HUMANA [11839]|2,310.00|FSC: 13; Default||Not reimbursed separately|2,310.00|FSC: 13; Default||External grouping not supported 95150046|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Ace|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95150048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Monoblock Sizet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95150051|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.39|FSC: 13; Default||Not reimbursed separately|4,134.39|FSC: 13; Default||External grouping not supported 95150052|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.39|FSC: 13; Default||Not reimbursed separately|4,134.39|FSC: 13; Default||External grouping not supported 95150053|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150054|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150055|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150056|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95121619|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon 7x4x120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|512.70|FSC: 13; Default||Not reimbursed separately|512.70|FSC: 13; Default||External grouping not supported 95150058|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150059|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150060|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150061|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Conformexx Self Eh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150068|EAP|Custom 95150068||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Septal Nasal Doyle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189301|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Tecnis Symfony Toric 20.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95150087|EAP|Custom 95150087||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Ankle Swede-o Strap Lok9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150088|EAP|Custom 95150088||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Ankle Swede-o Strap Lok+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150089|EAP|Custom 95150089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Cool Tip 15cm Length P|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150090|EAP|Custom 95150090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Cool Tip 15cm Length P|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150091|EAP|Custom 95150091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Horizon Drain Tube Attact|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150093|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 4.5 Diope|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95150106|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|FSC: 13; Default||Not reimbursed separately|21,360.00|FSC: 13; Default||External grouping not supported 95150107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 6.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95150108|EAP|Custom 95150108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fluted-three 4.2mm Qcm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150116|EAP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dressing Wound Matrix Bi Per Sq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|860.10|FSC: 13; Default||Not reimbursed separately|860.10|FSC: 13; Default||External grouping not supported 95150117|EAP|Custom 95150117||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Accessory Guidewire Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150123|EAP|Custom 95150123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix Tubular 5mm X 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150124|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Tined Interstim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,026.00|FSC: 13; Default||Not reimbursed separately|10,026.00|FSC: 13; Default||External grouping not supported 95150125|EAP|Custom 95150125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Lead Introducer Interstim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150127|EAP|Custom 95150127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Foramen 3.5 Interstim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150128|EAP|Custom 95150128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Foramen 5 Interstim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150129|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit System Interstim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,700.00|FSC: 13; Default||Not reimbursed separately|29,700.00|FSC: 13; Default||External grouping not supported 95150130|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Interstim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150135|EAP|Custom 95150135||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Large Lumbar Roll E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,509.92|FSC: 13; Default||Not reimbursed separately|5,509.92|FSC: 13; Default||External grouping not supported 95150140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Cluster Hole 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|FSC: 13; Default||Not reimbursed separately|6,197.37|FSC: 13; Default||External grouping not supported 95150145|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150146|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular19.0 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Without Holes M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95150158|EAP|Custom 95150158||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Velocity Moderate St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150167|EAP|Custom 95150167||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ball Theraband Exercise Silver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150168|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 10mm Diamh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150170|EAP|Custom 95150170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scalpfix Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150172|EAP|Custom 95150172||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp 16mm Titanium 2 Crainofix|1|HUMANA [1294]||HUMANA [11839]|439.01|FSC: 13; Default||Not reimbursed separately|439.01|FSC: 13; Default||External grouping not supported 95150173|EAP|Custom 95150173||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp 20mm Titanium 2 Craniofix|1|HUMANA [1294]||HUMANA [11839]|527.15|FSC: 13; Default||Not reimbursed separately|527.15|FSC: 13; Default||External grouping not supported 95150174|EAP|Custom 95150174||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp 11mm Titanium 2 Craniofix|1|HUMANA [1294]||HUMANA [11839]|354.25|FSC: 13; Default||Not reimbursed separately|354.25|FSC: 13; Default||External grouping not supported 95150177|EAP|Custom 95150177||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Adult Combined Co2 Flow O|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Ltm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95150179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non Porous P4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 95150180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psl 46m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95150181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150183|EAP|Custom 95150183||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strap Tennis Elbow Aircast Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade #5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus #2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus #3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus #4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95121756|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon 7x2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|FSC: 13; Default||Not reimbursed separately|477.60|FSC: 13; Default||External grouping not supported 95150197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus #5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95189302|EAP|Custom 95189302||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty I-factor 1.0cc Syringe|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95150199|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 8mm Diameh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150200|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 8mm Diameh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95121763|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|FSC: 13; Default||Not reimbursed separately|477.60|FSC: 13; Default||External grouping not supported 95150201|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 9mm Diameh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95189303|EAP|Custom 95189303||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty I-factor 2.5cc Syringe|1|HUMANA [1294]||HUMANA [11839]|3,441.00|FSC: 13; Default||Not reimbursed separately|3,441.00|FSC: 13; Default||External grouping not supported 95150202|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 9mm Diameh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95150203|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Luminex 10mm Diamh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|FSC: 13; Default||Not reimbursed separately|3,357.12|FSC: 13; Default||External grouping not supported 95189305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95150205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Articuleze 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95150206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Lateral Poe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,748.14|FSC: 13; Default||Not reimbursed separately|3,748.14|FSC: 13; Default||External grouping not supported 95189306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mm X L48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95150207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Medial Rige|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,325.65|FSC: 13; Default||Not reimbursed separately|3,325.65|FSC: 13; Default||External grouping not supported 95150208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189307|EAP|Custom 95189307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Universal Q C T-20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95150210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem St 15mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95150211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95150212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95150213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95150214|EAP|Custom 95150214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Irrigation Wound C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189310|EAP|Custom 95189310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Airless Spray Evicel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150215|EAP|Custom 95150215||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Rostral Medium Anterior M|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95150216|EAP|Custom 95150216||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Caudal Medium Anterior Em|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95150217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anterior 5mm X 40mm Expedm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,608.20|FSC: 13; Default||Not reimbursed separately|2,608.20|FSC: 13; Default||External grouping not supported 95150218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anterior 6mm X 40mm Expedm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,608.20|FSC: 13; Default||Not reimbursed separately|2,608.20|FSC: 13; Default||External grouping not supported 95150219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anterior 6mm X 45mm Expedm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95150220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95150221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 65mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95150222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 85mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|869.40|FSC: 13; Default||Not reimbursed separately|869.40|FSC: 13; Default||External grouping not supported 95150223|EAP|Custom 95150223||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross Anterior 15mm Em|1|HUMANA [1294]||HUMANA [11839]|3,405.00|FSC: 13; Default||Not reimbursed separately|3,405.00|FSC: 13; Default||External grouping not supported 95150224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Connector Cross Expedm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95189315|EAP|Custom 95189315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coupling Tube To Rod Mri Compact 5/5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150225|EAP|Custom 95150225||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stackable Top 9mm|1|HUMANA [1294]||HUMANA [11839]|2,825.55|FSC: 13; Default||Not reimbursed separately|2,825.55|FSC: 13; Default||External grouping not supported 95150226|EAP|Custom 95150226||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stackable Bottom 9mm|1|HUMANA [1294]||HUMANA [11839]|2,825.55|FSC: 13; Default||Not reimbursed separately|2,825.55|FSC: 13; Default||External grouping not supported 95189316|EAP|Custom 95189316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Distal Compact Mri Hii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150227|EAP|Custom 95150227||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stackable 12mm|1|HUMANA [1294]||HUMANA [11839]|3,708.54|FSC: 13; Default||Not reimbursed separately|3,708.54|FSC: 13; Default||External grouping not supported 95150239|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Ultraflel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95189317|EAP|Custom 95189317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Post Straight Mri Compact Hii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150245|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95121838|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon 6x2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|FSC: 13; Default||Not reimbursed separately|477.60|FSC: 13; Default||External grouping not supported 95150246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Sector Ii Pinnacle 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 95150248|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95189318|EAP|Custom 95189318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Spanner 5 Mm Fix Ext Compact Hii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150258|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 32mm X 74cmh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95189319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Full Thread 4.0x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95121852|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Flexima 6 Fr Apd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150263|EAP|Custom 95150263||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Lumbar Half With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metatarssal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 95150269|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|FSC: 13; Default||Not reimbursed separately|21,360.00|FSC: 13; Default||External grouping not supported 95189321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Medial Distal Extended Left/right 3hole/l69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95150270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rtm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95150271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non Porous P4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 95189322|EAP|Custom 95189322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ligasure Curved Large Jaw 7.1 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non Porous Profix R3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95150277|EAP|Custom 95150277||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Toothsaver Emt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189328|EAP|Custom 95189328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral View 3.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150281|EAP|Custom 95150281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Temporary Dispt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150298|EAP|Custom 95150298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Blunt Tip L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 12x320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95150299|EAP|Custom 95150299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Diameter Bladeless 1l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150300|EAP|Custom 95150300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Sleeve 5mm Diameter Forl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Val 12 Holes 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.61|FSC: 13; Default||Not reimbursed separately|1,484.61|FSC: 13; Default||External grouping not supported 95150301|EAP|Custom 95150301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 11mm Diameter Bladeless L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150302|EAP|Custom 95150302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Sleeve 11mm Diameter Fol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150303|EAP|Custom 95150303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Bladeless L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-locking Self-tapping T4 1.5mm X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95150304|EAP|Custom 95150304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Sleeve 12mm Diameter Fol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150307|EAP|Custom 95150307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Bladeless L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-locking Self-tapping T4 1.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95150308|EAP|Custom 95150308||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 11mm Diameter Dilating Tl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150309|EAP|Custom 95150309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Dilating Tl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Short 5.5x42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|895.20|FSC: 13; Default||Not reimbursed separately|895.20|FSC: 13; Default||External grouping not supported 95150316|EAP|Custom 95150316||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nerve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150323|EAP|Custom 95150323||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wrap Coban 2 Layer Compression )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189334|EAP|Custom 95189334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 5.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150326|EAP|Custom 95150326||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone|1|HUMANA [1294]||HUMANA [11839]|2,490.00|FSC: 13; Default||Not reimbursed separately|2,490.00|FSC: 13; Default||External grouping not supported 95150328|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Dual Chamber Rate Resr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95189336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 5-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95150329|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Single Chamber Rate Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|FSC: 13; Default||Not reimbursed separately|14,400.00|FSC: 13; Default||External grouping not supported 95189337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Iconix 2.3mm Intellibraid 2.0mm Xbraid Tt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.69|FSC: 13; Default||Not reimbursed separately|1,368.69|FSC: 13; Default||External grouping not supported 95150336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Lockt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.85|FSC: 13; Default||Not reimbursed separately|4,097.85|FSC: 13; Default||External grouping not supported 95150338|EAP|Custom 95150338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 14 Gauge X 3 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189335|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graftjacket Rtm Std Thickness 4x7|1|HUMANA [1294]||HUMANA [11839]|256.93|FSC: 13; Default||Not reimbursed separately|256.93|FSC: 13; Default||External grouping not supported 95150339|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gunther Tulip Vena Cava Film|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150344|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-68 Round Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95150346|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Express Monorail P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95189340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Self Tapping T6 Stardrive Recess Ti 2.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95150352|EAP|Custom 95150352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Jumbo Radial Jwa 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150356|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5/6.0 505x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95150357|EAP|Custom 95150357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Breast 11g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150358|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 3fr Twin Pass Over Ther|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189342|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5 X 500mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95150362|EAP|Custom 95150362||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tape Retention 4x10 Yds Omnifix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150364|EAP|Custom 95150364||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical Soft Mckenzie 4 Dl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189343|EAP|Custom 95189343||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage T2 28-36 X 16mm|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95150365|EAP|Custom 95150365||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical Soft 3-1/2 X 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150366|EAP|Custom 95150366||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Lift Mens 1/4 Size Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Duofix Cementless Std Collar Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95150367|EAP|Custom 95150367||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Lift Mens 1/8 Size Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150368|EAP|Custom 95150368||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Lift Womens 1/4 Size Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Duofix Cementless High Collar Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95150369|EAP|Custom 95150369||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Lift Womens 1/8 Size Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150382|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Steer It 180 Cm 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Duofix Cementless St Collar Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95150387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus 37mm #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus 40mm #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95189347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Cementless Standard Collar Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95150389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus 40mm #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade 30mm #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95189348|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 8x16 (128 Sq Cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.83|FSC: 13; Default||Not reimbursed separately|373.83|FSC: 13; Default||External grouping not supported 95150391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade 37mm #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95150392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade 40mm #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95189349|EAP|Custom 95189349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gelfilm Opthalmic 25 X 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Xx-long 28mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.60|FSC: 13; Default||Not reimbursed separately|1,161.60|FSC: 13; Default||External grouping not supported 95150394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral X-long 28mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95189351|EAP|Custom 95189351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gelfoam Size 100 Spg 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 36mm 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95150396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.7mm X 10mm Tim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|FSC: 13; Default||Not reimbursed separately|208.50|FSC: 13; Default||External grouping not supported 95189352|EAP|Custom 95189352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gelfoam Size 50 Spg 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.7mm X 12mm Tim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|FSC: 13; Default||Not reimbursed separately|208.50|FSC: 13; Default||External grouping not supported 95150398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.7mm X 14mm Tim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|FSC: 13; Default||Not reimbursed separately|208.50|FSC: 13; Default||External grouping not supported 95189354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Y-knot Rc With Needles 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.50|FSC: 13; Default||Not reimbursed separately|1,117.50|FSC: 13; Default||External grouping not supported 95150399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.7mm X 16mm Tim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|FSC: 13; Default||Not reimbursed separately|208.50|FSC: 13; Default||External grouping not supported 95150400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 2.7mm X 18mm Tim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|FSC: 13; Default||Not reimbursed separately|208.50|FSC: 13; Default||External grouping not supported 95189355|EAP|Custom 95189355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Qc Three-fluted 2.mm/230-200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous 6.5mm X 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous 6.5mm X 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95189356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Profile Low Curved Reconplate 8-hole 88mm Rad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,529.49|FSC: 13; Default||Not reimbursed separately|1,529.49|FSC: 13; Default||External grouping not supported 95150403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous 6.5mm X 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous 6.5mm X 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95189357|EAP|Custom 95189357||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Perimeter 8mmx15mmx13mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95150405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous 6.5mm X 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150406|EAP|Custom 95150406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Hole Dome Acetabular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer Distal 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95150407|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Parastomal 12cm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,282.74|FSC: 13; Default||Not reimbursed separately|4,282.74|FSC: 13; Default||External grouping not supported 95150409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psl 62m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95189359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Prostalac Size 1 Std Offset 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 95150410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psl 66m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95150411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Trident Psl 68m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95150414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 28mm Sd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95150415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 28mm Se|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95150416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 28mm Sf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95150417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 28mm Sg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95150418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 28mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95189361|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Endologix .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 28mm Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95150420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 32mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95189362|EAP|Custom 95189362||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-90/120-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95150421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 32mm Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95150422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 32mm Sj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95189370|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Tecnis Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 36mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95150424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10-degree 36mm Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95189364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vlp 2.7mm Mtp Prim Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,855.00|FSC: 13; Default||Not reimbursed separately|3,855.00|FSC: 13; Default||External grouping not supported 95150426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident Alumina 0-degreei|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95150427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina 28mm -2.7 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95189365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vlp Lock Ost 4.omm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 95150428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper Alumina 28mm0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,454.85|FSC: 13; Default||Not reimbursed separately|4,454.85|FSC: 13; Default||External grouping not supported 95150429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina 32mm -4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95189366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vlp Lock Ost 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 95150430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina 32mm 0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95150431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina 32mm +4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95189367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vlp Lock Ost 4.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 95150432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina 36mm 0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,128.40|FSC: 13; Default||Not reimbursed separately|3,128.40|FSC: 13; Default||External grouping not supported 95150433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Alumina 36mm +5 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,128.40|FSC: 13; Default||Not reimbursed separately|3,128.40|FSC: 13; Default||External grouping not supported 95189368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|FSC: 13; Default||Not reimbursed separately|1,026.00|FSC: 13; Default||External grouping not supported 95150434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 12mm Stem 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 14mm Stem 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95189369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|FSC: 13; Default||Not reimbursed separately|1,026.00|FSC: 13; Default||External grouping not supported 95150436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 15mm Stem 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 16mm Stem 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95189363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Proximal Long T2 Right 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|FSC: 13; Default||Not reimbursed separately|5,491.50|FSC: 13; Default||External grouping not supported 95150438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 17mm Stem 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 18mm Stem 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95189371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headless 3.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,497.00|FSC: 13; Default||Not reimbursed separately|1,497.00|FSC: 13; Default||External grouping not supported 95150440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 13mm Stem 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 14mm Stem 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95189381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 11 X 320 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95150442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 15mm Stem 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 15mm Stem 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95189378|EAP|Custom 95189378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray - Turkel Pneumothorax Procedure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 16mm Stem 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Distal 17mm Stem 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95189380|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Quadra Assura Mp Icd V Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69,552.00|FSC: 13; Default||Not reimbursed separately|69,552.00|FSC: 13; Default||External grouping not supported 95150447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 30mm #2 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95150448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 35mm #3 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95189372|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express Ld 5mm X 17mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95150449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 35mm #4 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95150450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 37mm #5 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95189373|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Innova 8mm X 120mm X 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95150451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 37mm #6 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95150452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 40mm #7 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95189376|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pigtail 6.0 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150453|EAP|Custom 95150453||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Extension 110 Cassette Gems|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 40mm #7 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,478.75|FSC: 13; Default||Not reimbursed separately|8,478.75|FSC: 13; Default||External grouping not supported 95189377|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pigtail 8.5 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 37mm #6 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95150456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 37mm #5 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95189382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 11mm Tib C-d Fem 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95150457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 35mm #4 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95150458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 35mm #3 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95189383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 14mm Tib C-d/ Fem 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95150459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Accolade 30mm #2 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,478.75|FSC: 13; Default||Not reimbursed separately|8,478.75|FSC: 13; Default||External grouping not supported 95150464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Revo Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|638.25|FSC: 13; Default||Not reimbursed separately|638.25|FSC: 13; Default||External grouping not supported 95150465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.5 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95150466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95122265|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ureteral Cone-tip 12fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150467|EAP|Custom 95150467||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Synex 20-degree|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95189375|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Fluency 13.5 X 60 X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95150468|EAP|Custom 95150468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150469|EAP|Custom 95150469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Reaming 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm/l8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95150471|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150472|EAP|Custom 95150472||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Diameter Dilating Til|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150474|EAP|Custom 95150474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Speedstitch Opus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Offset High C-stem Amt Sz3 12/14 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95150476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Implant Plus Mini Opus White|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,555.00|FSC: 13; Default||Not reimbursed separately|3,555.00|FSC: 13; Default||External grouping not supported 95150478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Implant Plus Mini Opus Co-bd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|FSC: 13; Default||Not reimbursed separately|1,860.00|FSC: 13; Default||External grouping not supported 95189386|EAP|Custom 95189386||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Insert Pad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150479|EAP|Custom 95150479||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Vantage Atl Rostal Titanm|1|HUMANA [1294]||HUMANA [11839]|4,998.00|FSC: 13; Default||Not reimbursed separately|4,998.00|FSC: 13; Default||External grouping not supported 95150480|EAP|Custom 95150480||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Vantage Atl Caudal Titanm|1|HUMANA [1294]||HUMANA [11839]|4,998.00|FSC: 13; Default||Not reimbursed separately|4,998.00|FSC: 13; Default||External grouping not supported 80170355|EAP|CPT® 90899||0513 - CLINIC - PSYCHIATRIC CLINIC|Hb Bridge On Discharge Visit|1|HUMANA [1294]||HUMANA [11839]|95.34|FSC: 13; Default||Not reimbursed separately|95.34|FSC: 13; Default||External grouping not supported 95150481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vantage Atl 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.54|FSC: 13; Default||Not reimbursed separately|2,325.54|FSC: 13; Default||External grouping not supported 95150483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vantage Atl 8.0cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,077.52|FSC: 13; Default||Not reimbursed separately|12,077.52|FSC: 13; Default||External grouping not supported 80170277|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 2x2 (4 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.50|FSC: 13; Default||Not reimbursed separately|562.50|FSC: 13; Default||External grouping not supported 95150484|EAP|Custom 95150484||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Lock Vantage|1|HUMANA [1294]||HUMANA [11839]|693.84|FSC: 13; Default||Not reimbursed separately|693.84|FSC: 13; Default||External grouping not supported 95150489|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail 7fr X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 80170288|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 2x4 (8 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|356.25|FSC: 13; Default||Not reimbursed separately|356.25|FSC: 13; Default||External grouping not supported 95150490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Profile Deep 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,040.00|FSC: 13; Default||Not reimbursed separately|8,040.00|FSC: 13; Default||External grouping not supported 95150491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal 31mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|FSC: 13; Default||Not reimbursed separately|5,464.20|FSC: 13; Default||External grouping not supported 80170299|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 5x5 (25 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|FSC: 13; Default||Not reimbursed separately|384.00|FSC: 13; Default||External grouping not supported 95150492|EAP|Custom 95150492||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Full Procedure Central Catr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170300|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 6x9 (54 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.23|FSC: 13; Default||Not reimbursed separately|372.23|FSC: 13; Default||External grouping not supported 95150497|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Infusion System Lysus 5.2f M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150498|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Infusion System Lysus 5.2f M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170311|EAP|HCPCS Q4196||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply Am 8x16 (128 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.83|FSC: 13; Default||Not reimbursed separately|373.83|FSC: 13; Default||External grouping not supported 95150499|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Infusion System Lysus 5.2f M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150500|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Infusion System Lysus 5.2f M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170322|EAP|HCPCS Q4195||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply 2x4 (8 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95150501|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Infusion System Lysus 5.2f M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150502|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Infusion System Lysus 5.2f M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170333|EAP|HCPCS Q4195||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply 5x5 (25 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95150510|EAP|Custom 95150510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fluted-three 4.2mm Nem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150511|EAP|Custom 95150511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fluted-three 3.2mm Nem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170344|EAP|HCPCS Q4195||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Puraply 6x9 (54 Sq Cm)-product Sq Cm Wasted|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95150512|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 13mm X 2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|FSC: 13; Default||Not reimbursed separately|6,705.00|FSC: 13; Default||External grouping not supported 95150513|EAP|Custom 95150513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Combo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189387|EAP|Custom 95189387||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty I Factor 5cc Syringe|1|HUMANA [1294]||HUMANA [11839]|5,355.00|FSC: 13; Default||Not reimbursed separately|5,355.00|FSC: 13; Default||External grouping not supported 95150514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha C.a.p. 56mm X 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,345.00|FSC: 13; Default||Not reimbursed separately|12,345.00|FSC: 13; Default||External grouping not supported 95150515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tibial Stemmed Wedge A/p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,195.50|FSC: 13; Default||Not reimbursed separately|7,195.50|FSC: 13; Default||External grouping not supported 95189388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pelvic Cortex Self-tapping 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.64|FSC: 13; Default||Not reimbursed separately|92.64|FSC: 13; Default||External grouping not supported 95150516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial Size 4 Nexm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95150517|EAP|Custom 95150517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber 3-0 18 Diamond Poine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corterx Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|87.87|FSC: 13; Default||Not reimbursed separately|87.87|FSC: 13; Default||External grouping not supported 95150519|EAP|Custom 95150519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber 3-0 18 Tapered Neede|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150520|EAP|Custom 95150520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber 3-0 18 Rc Needle 16e|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Asnis Micro Cannulated 3.0 30/6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95150523|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff Amplatz Coated H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150525|EAP|Custom 95150525||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeves Adapter 12/14 +2|1|HUMANA [1294]||HUMANA [11839]|884.52|FSC: 13; Default||Not reimbursed separately|884.52|FSC: 13; Default||External grouping not supported 95189392|EAP|Custom 95189392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter .038 Simmons 5fr 1.65cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 48mm Asr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,378.45|FSC: 13; Default||Not reimbursed separately|12,378.45|FSC: 13; Default||External grouping not supported 95150527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Femoral Uni Size 43 Asr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.96|FSC: 13; Default||Not reimbursed separately|4,983.96|FSC: 13; Default||External grouping not supported 95189393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Small Hammertoe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95150528|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Advantage Global 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|FSC: 13; Default||Not reimbursed separately|4,710.00|FSC: 13; Default||External grouping not supported 95189394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95150539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Revision Dura Mtk Pca Lem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95150551|EAP|Custom 95150551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter General Purpose Drainad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Proximal Conical Reclaim 28 X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95150552|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 9mm Do|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95150563|EAP|Custom 95150563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5fr X .03v|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bar Tensile Assembly Reclaim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,167.00|FSC: 13; Default||Not reimbursed separately|1,167.00|FSC: 13; Default||External grouping not supported 95150573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95189397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Y-knot With Tape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,153.59|FSC: 13; Default||Not reimbursed separately|1,153.59|FSC: 13; Default||External grouping not supported 95150577|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vansonnenberg Locking 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150578|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vansonnenberg Locking 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavical Locking Small Rie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95150580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95150581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95150582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95150618|EAP|Custom 95150618||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Cold 12-1/2 X18-1/2 Oversc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150626|EAP|Custom 95150626||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Clip Palmer With Pocket Quadripl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150635|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Medial Proximal 6-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,234.70|FSC: 13; Default||Not reimbursed separately|2,234.70|FSC: 13; Default||External grouping not supported 95150638|EAP|Custom 95150638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Suction Drainage With Dl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150639|EAP|Custom 95150639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vent Thoracic For Pneumothorax E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150640|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Drainage Cholep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking Large Lee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95150644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5 X 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95150646|EAP|Custom 95150646||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cartridge Suture Speed Stitch Me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Panel Plate 1.6 Heavy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95150648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Global 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,659.00|FSC: 13; Default||Not reimbursed separately|7,659.00|FSC: 13; Default||External grouping not supported 95150649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Navicular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,534.94|FSC: 13; Default||Not reimbursed separately|2,534.94|FSC: 13; Default||External grouping not supported 95150650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cuboid Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,466.51|FSC: 13; Default||Not reimbursed separately|2,466.51|FSC: 13; Default||External grouping not supported 95150651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95150652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95150653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95150654|EAP|Custom 95150654||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Combo Medium|1|HUMANA [1294]||HUMANA [11839]|1,874.04|FSC: 13; Default||Not reimbursed separately|1,874.04|FSC: 13; Default||External grouping not supported 95150655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95150656|EAP|Custom 95150656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Bone Marrow Aspiration Ie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 1m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95150658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95150660|EAP|Custom 95150660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endovascular Pigtail S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150668|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Roc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95150669|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Roc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95150670|EAP|Custom 95150670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Adhere Xl Cobra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150671|EAP|Custom 95150671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Affirm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150672|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Intrathecal Free-flow H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.00|FSC: 13; Default||Not reimbursed separately|1,545.00|FSC: 13; Default||External grouping not supported 95150676|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 10mm Xh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95150678|EAP|Custom 95150678||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 14mm X 32mm Vertek|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95150683|EAP|Custom 95150683||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 1.6 X 150mm|1|HUMANA [1294]||HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95150684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion Left Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,216.00|FSC: 13; Default||Not reimbursed separately|3,216.00|FSC: 13; Default||External grouping not supported 95150686|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95150687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Venture Variable 4.0 X 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95150694|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95150699|EAP|Custom 95150699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Diameter Bladeless 1l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervicalm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|FSC: 13; Default||Not reimbursed separately|7,238.28|FSC: 13; Default||External grouping not supported 95192500|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Cohesive Iii Cpg 332 Memorygel 350cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95150701|EAP|Custom 95150701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Dilating Tl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150709|EAP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Glaucoma Baerveldt Area Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.00|FSC: 13; Default||Not reimbursed separately|2,406.00|FSC: 13; Default||External grouping not supported 95192501|EAP|Custom 95192501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Gore Tips 16g 10fr Guiding|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150714|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr 10mm Adve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Metal Trabeculm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95192502|EAP|Custom 95192502||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Sheath Gore Tips 10fr 40cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Metal Trabeculm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.6 Box Shape 8 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95192503|EAP|Custom 95192503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gore Tips 10fr 16g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150720|EAP|Custom 95150720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Handpiece Sologi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150721|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nephrostomy Drainage 1p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192504|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Viatorr Gore Sz 8-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.00|FSC: 13; Default||Not reimbursed separately|14,262.00|FSC: 13; Default||External grouping not supported 95150722|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter General Purppose Drainp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150723|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 9mm Dm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95192505|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viatorr L8 Cm L2 Cm Od8-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.00|FSC: 13; Default||Not reimbursed separately|14,262.00|FSC: 13; Default||External grouping not supported 95150730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 1.6mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95150731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping 1.6mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95192506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen L37.5mm Od5 Mm Femur Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 95150734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.6 X-shape 8 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95150735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.6 Straight 12 Hole 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95192507|EAP|Custom 95192507||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kyphon V 13ga Trocar Bevel Kit Xpede Mix|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95150737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Burr Hole Cover 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95150738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Burr Hole Cover 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95192508|EAP|Custom 95192508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Orthopedic Bevel Od 13ga Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Burr Hole Cover Ported 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95150740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Burr Hole Cover Slotted 1m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95150741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tms|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|FSC: 13; Default||Not reimbursed separately|396.00|FSC: 13; Default||External grouping not supported 95150742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Panel Gap 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|714.00|FSC: 13; Default||Not reimbursed separately|714.00|FSC: 13; Default||External grouping not supported 95150743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Panel Plate 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,140.00|FSC: 13; Default||Not reimbursed separately|1,140.00|FSC: 13; Default||External grouping not supported 95150744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Panel Hex 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95150752|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Titan With Attached 7 Fr Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|687.00|FSC: 13; Default||Not reimbursed separately|687.00|FSC: 13; Default||External grouping not supported 95192480|EAP|Custom 95192480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Dst Series Eea Orvil Ti Circule 25mm Linear Cutter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150759|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Ovatr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|FSC: 13; Default||Not reimbursed separately|64,500.00|FSC: 13; Default||External grouping not supported 95150761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95192509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reunion L128 Mm Od12 Mm Shoulder Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|FSC: 13; Default||Not reimbursed separately|14,982.75|FSC: 13; Default||External grouping not supported 95150762|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Dual Coil Retractable Screg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95150763|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Stelid Ii Atrial J Bipolarm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95192510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 H10 Mm Od36 Mm Shoulder Constrain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95150766|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Dual Coil Tined 65/16cm Stg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95150767|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Elapass Preformed J Atrialg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95192511|EAP|Custom 95192511||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone Cement Uhmwpe 3 L17.5 Mm Hip|1|HUMANA [1294]||HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95150768|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Symphony Dr Dual Chame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95150769|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Stelid Ii Atrial J Bipolarm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95192512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95150770|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata Dual Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|FSC: 13; Default||Not reimbursed separately|14,100.00|FSC: 13; Default||External grouping not supported 95150778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95192513|EAP|Custom 95192513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Gamma3 Small L300 Mm Od4.2 Mm Hip Ao Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95192519|EAP|Custom 95192519||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Formable Vivigen Large|1|HUMANA [1294]||HUMANA [11839]|12,096.00|FSC: 13; Default||Not reimbursed separately|12,096.00|FSC: 13; Default||External grouping not supported 95150784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95192520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fixation Tightrope Mini Inserter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 95150786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Tm 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Ext Tm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Ext Tm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95192522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Iconix 2.3mm With Three Strand 1.2mm X Braid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,695.89|FSC: 13; Default||Not reimbursed separately|2,695.89|FSC: 13; Default||External grouping not supported 95150790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Ext Tm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150791|EAP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dressing Wound Matrix Bi Per Sq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.48|FSC: 13; Default||Not reimbursed separately|216.48|FSC: 13; Default||External grouping not supported 95150792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Ext Tm 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Ext Tm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95192523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augmentation Nexgen Ti Pmma 5 Full 10mm Knee Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|FSC: 13; Default||Not reimbursed separately|4,212.00|FSC: 13; Default||External grouping not supported 95150794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Ext Tm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|FSC: 13; Default||Not reimbursed separately|10,695.51|FSC: 13; Default||External grouping not supported 95150797|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Suture 17mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95150798|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Concerto|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65,700.00|FSC: 13; Default||Not reimbursed separately|65,700.00|FSC: 13; Default||External grouping not supported 95150799|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Virtuoso Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,110.00|FSC: 13; Default||Not reimbursed separately|52,110.00|FSC: 13; Default||External grouping not supported 95150800|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Sensia Sr Single Chamr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95150801|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Adapter Dr Dual Chambr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|FSC: 13; Default||Not reimbursed separately|10,050.00|FSC: 13; Default||External grouping not supported 95192525|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 12.3x12.9cm Breast 650ml Sty 6300 Tall Cnsp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95150805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,345.00|FSC: 13; Default||Not reimbursed separately|12,345.00|FSC: 13; Default||External grouping not supported 95150807|EAP|Custom 95150807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.8mm X 5 Quick Releae|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150810|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150811|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192526|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 595cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95150812|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilation 5 Fr 120h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150813|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95150814|EAP|Custom 95150814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Thrombosis Laser Venous Endc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192527|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95150817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerous Distal Medial Lee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,656.10|FSC: 13; Default||Not reimbursed separately|3,656.10|FSC: 13; Default||External grouping not supported 95150819|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 10mm X 2m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|FSC: 13; Default||Not reimbursed separately|6,705.00|FSC: 13; Default||External grouping not supported 95150820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecrenon X-long 13 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|FSC: 13; Default||Not reimbursed separately|1,902.00|FSC: 13; Default||External grouping not supported 95150821|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 10mm X 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|FSC: 13; Default||Not reimbursed separately|6,705.00|FSC: 13; Default||External grouping not supported 95192528|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 700cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95150822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95150823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Total L 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95150824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Total 8.0mm X 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95150838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95192529|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 755cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95150842|EAP|Custom 95150842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Tubular Tricofix 2.4 Xs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150843|EAP|Custom 95150843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Tubular Tricofix 4.7 Xs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150845|EAP|Custom 95150845||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Backrest Side To Side Ok|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150847|EAP|Custom 95150847||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Astringyn 8 Gram|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150848|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurricane Rxm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95150849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Right Short 6-hoe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|FSC: 13; Default||Not reimbursed separately|1,902.00|FSC: 13; Default||External grouping not supported 95150852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeves Adaptor 12/14 +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|884.52|FSC: 13; Default||Not reimbursed separately|884.52|FSC: 13; Default||External grouping not supported 95150855|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Elapass Preformed J Atrialg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951200787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150856|EAP|Custom 95150856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Urostomy 1-3/4 Flange New|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150857|EAP|Custom 95150857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Skin Barrier 1-3/4 Flange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|FSC: 13; Default||Not reimbursed separately|5,949.00|FSC: 13; Default||External grouping not supported 95150859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,833.00|FSC: 13; Default||Not reimbursed separately|7,833.00|FSC: 13; Default||External grouping not supported 951200788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|FSC: 13; Default||Not reimbursed separately|4,710.00|FSC: 13; Default||External grouping not supported 95150861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,610.00|FSC: 13; Default||Not reimbursed separately|5,610.00|FSC: 13; Default||External grouping not supported 95150862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|FSC: 13; Default||Not reimbursed separately|4,710.00|FSC: 13; Default||External grouping not supported 95150863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Ecc Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,718.60|FSC: 13; Default||Not reimbursed separately|5,718.60|FSC: 13; Default||External grouping not supported 951200789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95150864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|FSC: 13; Default||Not reimbursed separately|4,710.00|FSC: 13; Default||External grouping not supported 95150865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,086.80|FSC: 13; Default||Not reimbursed separately|5,086.80|FSC: 13; Default||External grouping not supported 95150866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Global Advantage 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|FSC: 13; Default||Not reimbursed separately|4,710.00|FSC: 13; Default||External grouping not supported 95150867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Ecc Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|FSC: 13; Default||Not reimbursed separately|5,295.00|FSC: 13; Default||External grouping not supported 951200790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Ecc Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|FSC: 13; Default||Not reimbursed separately|5,295.00|FSC: 13; Default||External grouping not supported 95150869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Cta Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,757.50|FSC: 13; Default||Not reimbursed separately|6,757.50|FSC: 13; Default||External grouping not supported 95150870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Cta Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,830.00|FSC: 13; Default||Not reimbursed separately|7,830.00|FSC: 13; Default||External grouping not supported 95150871|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata St Dual|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 951200791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Cta Global Advantag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|FSC: 13; Default||Not reimbursed separately|6,765.00|FSC: 13; Default||External grouping not supported 95150873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Advantage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,355.00|FSC: 13; Default||Not reimbursed separately|11,355.00|FSC: 13; Default||External grouping not supported 95150874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Advantage Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|FSC: 13; Default||Not reimbursed separately|14,430.00|FSC: 13; Default||External grouping not supported 95150875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Advantage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,644.00|FSC: 13; Default||Not reimbursed separately|13,644.00|FSC: 13; Default||External grouping not supported 951200792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Advantage Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|FSC: 13; Default||Not reimbursed separately|14,430.00|FSC: 13; Default||External grouping not supported 95150877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Advantage Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|FSC: 13; Default||Not reimbursed separately|14,430.00|FSC: 13; Default||External grouping not supported 95150878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Advantage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 95150879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Advantage 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,560.00|FSC: 13; Default||Not reimbursed separately|10,560.00|FSC: 13; Default||External grouping not supported 951200793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Advantage Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|FSC: 13; Default||Not reimbursed separately|14,430.00|FSC: 13; Default||External grouping not supported 95150881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Advantage 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,560.00|FSC: 13; Default||Not reimbursed separately|10,560.00|FSC: 13; Default||External grouping not supported 95150882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Advantage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,355.00|FSC: 13; Default||Not reimbursed separately|11,355.00|FSC: 13; Default||External grouping not supported 95150883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Implant Plus Magnum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|FSC: 13; Default||Not reimbursed separately|1,860.00|FSC: 13; Default||External grouping not supported 951200794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Peg Global|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|FSC: 13; Default||Not reimbursed separately|4,215.00|FSC: 13; Default||External grouping not supported 95150885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Peg Globalm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|FSC: 13; Default||Not reimbursed separately|4,215.00|FSC: 13; Default||External grouping not supported 95150886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Shoulder End Peg Globalm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|FSC: 13; Default||Not reimbursed separately|4,215.00|FSC: 13; Default||External grouping not supported 95150887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink Xs 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951200795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.00|FSC: 13; Default||Not reimbursed separately|5,790.00|FSC: 13; Default||External grouping not supported 95150889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.00|FSC: 13; Default||Not reimbursed separately|5,790.00|FSC: 13; Default||External grouping not supported 95150890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,263.50|FSC: 13; Default||Not reimbursed separately|5,263.50|FSC: 13; Default||External grouping not supported 95150891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,263.50|FSC: 13; Default||Not reimbursed separately|5,263.50|FSC: 13; Default||External grouping not supported 951200796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95150893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink Xl 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95150894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Fx Long 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.00|FSC: 13; Default||Not reimbursed separately|12,975.00|FSC: 13; Default||External grouping not supported 95150895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Fx 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,110.00|FSC: 13; Default||Not reimbursed separately|10,110.00|FSC: 13; Default||External grouping not supported 951200797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Fx Long 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.00|FSC: 13; Default||Not reimbursed separately|12,975.00|FSC: 13; Default||External grouping not supported 95150897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Fx 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,110.00|FSC: 13; Default||Not reimbursed separately|10,110.00|FSC: 13; Default||External grouping not supported 95150898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Fx Long 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,045.00|FSC: 13; Default||Not reimbursed separately|18,045.00|FSC: 13; Default||External grouping not supported 95150899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Fx 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,519.00|FSC: 13; Default||Not reimbursed separately|12,519.00|FSC: 13; Default||External grouping not supported 951200798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Fx 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95150901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Global Fx Long 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.00|FSC: 13; Default||Not reimbursed separately|12,975.00|FSC: 13; Default||External grouping not supported 95150902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Pc Global Fx 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,944.00|FSC: 13; Default||Not reimbursed separately|16,944.00|FSC: 13; Default||External grouping not supported 95150903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Global 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951200799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Global 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 95150908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Global 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 95150912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Global 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,490.00|FSC: 13; Default||Not reimbursed separately|5,490.00|FSC: 13; Default||External grouping not supported 951200800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Cncls Scrw-6.5mmx65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Peg Anchor Global Xl 56m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,980.00|FSC: 13; Default||Not reimbursed separately|10,980.00|FSC: 13; Default||External grouping not supported 95150920|EAP|Custom 95150920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Center Peg Anchor Glol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150922|EAP|Custom 95150922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Center Peg Anchor Glo4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150924|EAP|Custom 95150924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Peripheral Peg Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150925|EAP|Custom 95150925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Powder Surgiflo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Plateau Le5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,663.92|FSC: 13; Default||Not reimbursed separately|4,663.92|FSC: 13; Default||External grouping not supported 95150971|EAP|Custom 95150971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Calibrated 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB RESTORIS Z CANCELLOUS SCREW-6.5mm X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Ltm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95150973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non-porous Profix L6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95150974|EAP|Custom 95150974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repair For Dialysis Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150975|EAP|Custom 95150975||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Cock Up Small Lefte|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150976|EAP|Custom 95150976||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Cock Up Medium Lefe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150985|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150987|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 95150988|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Riata Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95150989|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 95150992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 951200805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95150993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95150994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95150995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95186472|EAP|Custom 95186472||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Waveguide Silica Flexible Ultralase 500 Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95150997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95186473|EAP|Custom 95186473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Waveguide Silica Flexible Ultralase (oto) 300 Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150998|EAP|Custom 95150998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.9mm Twist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Short Smartlock R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|FSC: 13; Default||Not reimbursed separately|675.09|FSC: 13; Default||External grouping not supported 95186474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Acutrak Acutwist 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95151000|EAP|Custom 95151000||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Medium Aso Stabilizr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95151001|EAP|Custom 95151001||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Large Aso Stabilizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186475|EAP|Custom 95186475||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cranial Custom Peek Large|1|HUMANA [1294]||HUMANA [11839]|48,552.60|FSC: 13; Default||Not reimbursed separately|48,552.60|FSC: 13; Default||External grouping not supported 95151002|EAP|Custom 95151002||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X- Large Aso Stabilr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151007|EAP|Custom 95151007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy 10g X 118mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151008|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Coaxial 10g X 118mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151009|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95186477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz 7 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95151016|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Val|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95151017|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95186478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Plate Tibial Onlay Mck Restoris Sz 7 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95151020|EAP|Custom 95151020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cerebral 5fr X .035 Dim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151028|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Collegen Acellular 2cm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,570.14|FSC: 13; Default||Not reimbursed separately|1,570.14|FSC: 13; Default||External grouping not supported 95186479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 7-8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95151029|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Collegen Acellular 2cm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,029.32|FSC: 13; Default||Not reimbursed separately|2,029.32|FSC: 13; Default||External grouping not supported 95151030|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Collegen Acellular 2cm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,444.07|FSC: 13; Default||Not reimbursed separately|2,444.07|FSC: 13; Default||External grouping not supported 95186481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Genesys Cross Ft Suture Anchor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.73|FSC: 13; Default||Not reimbursed separately|1,064.73|FSC: 13; Default||External grouping not supported 95151031|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Half (processing Fee) (s)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95151034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 3.2 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95186476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-tapping V.a. 4.5mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95151035|EAP|Custom 95151035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retractor Scrotal Deep Sw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95151059|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Donut Silicone Size 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151066|EAP|Custom 95151066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Knee Tibial 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mold Cement Knee Tibial 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95151068|EAP|Custom 95151068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Knee Femoral 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151069|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95151080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Short Smartlock Vor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,146.50|FSC: 13; Default||Not reimbursed separately|2,146.50|FSC: 13; Default||External grouping not supported 95151081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Long Smartlock Volr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|FSC: 13; Default||Not reimbursed separately|675.09|FSC: 13; Default||External grouping not supported 95186485|EAP|Custom 95186485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 4 Spike Gravity|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Long Smartlock Vr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|FSC: 13; Default||Not reimbursed separately|675.09|FSC: 13; Default||External grouping not supported 951200809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95151083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide Short Smartlock Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,137.50|FSC: 13; Default||Not reimbursed separately|2,137.50|FSC: 13; Default||External grouping not supported 95186483|EAP|Custom 95186483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr 4.5 Lighting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide Long Smartlock Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|FSC: 13; Default||Not reimbursed separately|675.09|FSC: 13; Default||External grouping not supported 95151085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Right Smartlock L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,782.00|FSC: 13; Default||Not reimbursed separately|1,782.00|FSC: 13; Default||External grouping not supported 95186484|EAP|Custom 95186484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture #2 Hi Fi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left Smartlock Dl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide Right Smartlock Dorsl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,462.40|FSC: 13; Default||Not reimbursed separately|2,462.40|FSC: 13; Default||External grouping not supported 95186482|EAP|Custom 95186482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mako Blade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide Left Smartlock Dorsal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Smartlock Radial Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,912.50|FSC: 13; Default||Not reimbursed separately|1,912.50|FSC: 13; Default||External grouping not supported 95186486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Percutaneous 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95151092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Long Smartlock Radial Coln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,458.00|FSC: 13; Default||Not reimbursed separately|1,458.00|FSC: 13; Default||External grouping not supported 951200810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Cancellous Screw-6.5mm X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95151093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Left Smartlock Ulnan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,838.16|FSC: 13; Default||Not reimbursed separately|1,838.16|FSC: 13; Default||External grouping not supported 95151094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Left Smartlock Ulnar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,458.00|FSC: 13; Default||Not reimbursed separately|1,458.00|FSC: 13; Default||External grouping not supported 95151095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Long Right Smartlock Ulnan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,544.40|FSC: 13; Default||Not reimbursed separately|1,544.40|FSC: 13; Default||External grouping not supported 95151096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Long Left Smartlock Ulnarn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,544.40|FSC: 13; Default||Not reimbursed separately|1,544.40|FSC: 13; Default||External grouping not supported 95151097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Right Smartlock Vor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95151099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151102|EAP|Custom 95151102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Implant Flexible Transurl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151103|EAP|HCPCS L8606||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Urethral Tegress|1|HUMANA [1294]||HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95151106|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flexicut 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151107|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Flexiwire 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151108|EAP|Custom 95151108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Rotating Hemostatic 3cm 1h|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Left Smartlock Volr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Right Smartlock R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951200811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left Smartlock Vr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Right Long Smartlor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.60|FSC: 13; Default||Not reimbursed separately|2,667.60|FSC: 13; Default||External grouping not supported 95151116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Left Long Smartlocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95151117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Right Long Smartr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,284.20|FSC: 13; Default||Not reimbursed separately|2,284.20|FSC: 13; Default||External grouping not supported 95151118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left Long Smartlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.30|FSC: 13; Default||Not reimbursed separately|2,697.30|FSC: 13; Default||External grouping not supported 95151119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow X-long Smartlock Vr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.30|FSC: 13; Default||Not reimbursed separately|2,697.30|FSC: 13; Default||External grouping not supported 95151120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard X-long Smartlockr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.60|FSC: 13; Default||Not reimbursed separately|2,667.60|FSC: 13; Default||External grouping not supported 95151121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide X-long Smartlock Volr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.30|FSC: 13; Default||Not reimbursed separately|2,697.30|FSC: 13; Default||External grouping not supported 95151122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Right X-long Smar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|FSC: 13; Default||Not reimbursed separately|2,154.36|FSC: 13; Default||External grouping not supported 95151123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left X-long Smarr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|FSC: 13; Default||Not reimbursed separately|2,154.36|FSC: 13; Default||External grouping not supported 95151124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide Right X-long Smartlor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|FSC: 13; Default||Not reimbursed separately|2,154.36|FSC: 13; Default||External grouping not supported 95151125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wide Left X-long Smartlocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|FSC: 13; Default||Not reimbursed separately|2,154.36|FSC: 13; Default||External grouping not supported 95151126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking Radius 2.0 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|FSC: 13; Default||Not reimbursed separately|241.92|FSC: 13; Default||External grouping not supported 95151127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking Radius 2.0 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95151128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking Radius 2.0 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.60|FSC: 13; Default||Not reimbursed separately|210.60|FSC: 13; Default||External grouping not supported 95151129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking Radius 2.0 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.60|FSC: 13; Default||Not reimbursed separately|210.60|FSC: 13; Default||External grouping not supported 95151130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking Radius 2.0 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951200812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking Radius 2.0 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95151132|EAP|Custom 95151132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twist 2.0 X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151133|EAP|Custom 95151133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twist 2.0 X 105mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151134|EAP|Custom 95151134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twist 1.9 X 108mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151135|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Dual Chamber Rate Resr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95151137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95151138|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Ratei|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|FSC: 13; Default||Not reimbursed separately|54,000.00|FSC: 13; Default||External grouping not supported 95151139|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Ratei|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,500.00|FSC: 13; Default||Not reimbursed separately|52,500.00|FSC: 13; Default||External grouping not supported 95151140|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Single Chamber Rar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,650.00|FSC: 13; Default||Not reimbursed separately|46,650.00|FSC: 13; Default||External grouping not supported 95151141|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata St Duam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95151142|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Riata St 60cm Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|FSC: 13; Default||Not reimbursed separately|14,100.00|FSC: 13; Default||External grouping not supported 95151143|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Riata St 65cm Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95151144|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St Bipolar 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 95151145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95151146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.12|FSC: 13; Default||Not reimbursed separately|285.12|FSC: 13; Default||External grouping not supported 95151147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951200813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95151149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.12|FSC: 13; Default||Not reimbursed separately|285.12|FSC: 13; Default||External grouping not supported 95151150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.12|FSC: 13; Default||Not reimbursed separately|285.12|FSC: 13; Default||External grouping not supported 95151151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|283.50|FSC: 13; Default||Not reimbursed separately|283.50|FSC: 13; Default||External grouping not supported 95151152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.3 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.7 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95151169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95151170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95123122|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035 Diameter X 260cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 951200814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Partially Threaded Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95151179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95151180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95151181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Radius 2.7 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95151182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 951200815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|FSC: 13; Default||Not reimbursed separately|326.25|FSC: 13; Default||External grouping not supported 95151184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|FSC: 13; Default||Not reimbursed separately|241.92|FSC: 13; Default||External grouping not supported 95151185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|FSC: 13; Default||Not reimbursed separately|241.92|FSC: 13; Default||External grouping not supported 95186527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10mm X 390mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95151186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|FSC: 13; Default||Not reimbursed separately|241.92|FSC: 13; Default||External grouping not supported 95151188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|FSC: 13; Default||Not reimbursed separately|241.92|FSC: 13; Default||External grouping not supported 95186488|EAP|Custom 95186488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Saver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|FSC: 13; Default||Not reimbursed separately|241.92|FSC: 13; Default||External grouping not supported 951200816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95186522|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent Endoprosthesis 20 X 55 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,211.89|FSC: 13; Default||Not reimbursed separately|3,211.89|FSC: 13; Default||External grouping not supported 95151192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95151193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95186520|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent Endoprosthesis 18 X 60 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,211.89|FSC: 13; Default||Not reimbursed separately|3,211.89|FSC: 13; Default||External grouping not supported 95151194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95151195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95186521|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent Endoprosthesis 18 X 90 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,903.86|FSC: 13; Default||Not reimbursed separately|4,903.86|FSC: 13; Default||External grouping not supported 95151196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95151197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 95186526|EAP|Custom 95186526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 6.0 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Radius 2.3 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|FSC: 13; Default||Not reimbursed separately|198.72|FSC: 13; Default||External grouping not supported 951200817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151200|EAP|Custom 95151200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Smartlock 1.143 X 160mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mmxl48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95151205|EAP|Custom 95151205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 11mmx130 400mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95186524|EAP|Custom 95186524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Tip Guide Pin 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151229|EAP|Custom 95151229||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Stomahesive Flexible 2-1/a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151231|EAP|Custom 95151231||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Stomahesive Flexible 2-3/a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 6mm X 195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95151235|EAP|Custom 95151235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Drill Transfix Ii 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Delta Tapered M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95186525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suture Button 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95151237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Transfix Bio Long 5mm X 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|FSC: 13; Default||Not reimbursed separately|867.00|FSC: 13; Default||External grouping not supported 95151241|EAP|Custom 95151241||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Backnobber Original Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186495|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 13.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151243|EAP|Custom 95151243||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Defibrillation Cadenc)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151244|EAP|Custom 95151244||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Defibrillation Cadenc)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186511|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 21.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151245|EAP|Custom 95151245||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Defibrillation Pediat)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151246|EAP|Custom 95151246||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Defibrillation Pediat)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151247|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Schon Xl Acute 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.40|FSC: 13; Default||Not reimbursed separately|338.40|FSC: 13; Default||External grouping not supported 95186518|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 24.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151248|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Schon Xl Acute 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.40|FSC: 13; Default||Not reimbursed separately|338.40|FSC: 13; Default||External grouping not supported 95151251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 3.0 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95186506|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 18.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151252|EAP|Custom 95151252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Lithoclast Pneumatic 1.0me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151262|EAP|Custom 95151262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Turkell Thoracentesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186502|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 16.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151263|EAP|Custom 95151263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Net Retrieval 1.8mm 160cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186512|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 21.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151265|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi-torque Steelcore 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151266|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi-torque Steelcore 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186501|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 16.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151267|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatationh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151268|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatationh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186517|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 24.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151269|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatationh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151270|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Dilatationh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186492|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 11.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95151273|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Recovery Removal Cone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186516|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 23.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151275|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft Repair Ulcer 4x8|1|HUMANA [1294]||HUMANA [11839]|283.88|FSC: 13; Default||Not reimbursed separately|283.88|FSC: 13; Default||External grouping not supported 951200821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteolock Bone Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 6-he|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,893.71|FSC: 13; Default||Not reimbursed separately|2,893.71|FSC: 13; Default||External grouping not supported 95186499|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 15.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151284|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 95151285|EAP|Custom 95151285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2 X 127mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186503|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 17.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Titanium Elastic 2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,111.68|FSC: 13; Default||Not reimbursed separately|1,111.68|FSC: 13; Default||External grouping not supported 95151294|EAP|Custom 95151294||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Huggar Bucket Seat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151298|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Pole Inferior 5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951200822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unitrax C-taper Sleeve -3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95151301|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Polaris Tip Ventricular Bit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95151302|EAP|Custom 95151302||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt 9 French Loop Dual Balloon|1|HUMANA [1294]||HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95151303|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Symphony Dr Single Che|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951200823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unitrax C-taper Sleeve +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95151319|EAP|Custom 95151319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round High-speed 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151320|EAP|Custom 95151320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Oval High-speed 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lupine Dual Suture Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95151322|EAP|Custom 95151322||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator Wrist Profile Low 220 Rd|1|HUMANA [1294]||HUMANA [11839]|4,597.86|FSC: 13; Default||Not reimbursed separately|4,597.86|FSC: 13; Default||External grouping not supported 951200824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unitrax C-taper Sleeve +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95151323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95151324|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Tip Drill 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Medial Dise|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.54|FSC: 13; Default||Not reimbursed separately|4,014.54|FSC: 13; Default||External grouping not supported 95151326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951200825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unitrax C-taper Sleeve +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95151327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95151328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95151329|EAP|Custom 95151329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mystique 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,721.64|FSC: 13; Default||Not reimbursed separately|4,721.64|FSC: 13; Default||External grouping not supported 951203974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt S2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95151348|EAP|Custom 95151348||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .038 M|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95151349|EAP|Custom 95151349||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Extended 0.03m|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95151351|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tip Beacon Pig Marker M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151352|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 0.025 X 260cm Amplatz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151354|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Covered Pfte Cast 7mm X 3h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|FSC: 13; Default||Not reimbursed separately|7,338.75|FSC: 13; Default||External grouping not supported 95151355|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Zip 0.035 X 180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151356|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Plus Submam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151357|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Pta Plus Submam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151358|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151359|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Biliary Howell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151360|EAP|Custom 95151360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Biliary Howell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151361|EAP|Custom 95151361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Spiked|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151362|EAP|Custom 95151362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biliary|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global Cap 56m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,401.80|FSC: 13; Default||Not reimbursed separately|14,401.80|FSC: 13; Default||External grouping not supported 95151365|EAP|Custom 95151365||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator Mini Hinged|1|HUMANA [1294]||HUMANA [11839]|5,088.84|FSC: 13; Default||Not reimbursed separately|5,088.84|FSC: 13; Default||External grouping not supported 951200829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151366|EAP|Custom 95151366||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 12mm X 32mm Vertek|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95151367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95151368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mystique 3.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.88|FSC: 13; Default||Not reimbursed separately|1,181.88|FSC: 13; Default||External grouping not supported 95151370|EAP|Custom 95151370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy 10g X 140mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Uni Cemented Preservati4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|FSC: 13; Default||Not reimbursed separately|4,497.27|FSC: 13; Default||External grouping not supported 951200831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151396|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Covered Pfte Cast 9mm X 5h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95151398|EAP|Custom 95151398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Graduated Sizing Royalm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151399|EAP|Custom 95151399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management On Q 27r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151400|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951200832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95151406|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 6mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151407|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 5mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151408|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 5mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951203970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt S1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95151409|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 6mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151411|EAP|Custom 95151411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Impress Simmons1 5fr 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151412|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Locking Resolve 8.5fr 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151413|EAP|Custom 95151413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Catheter Fixation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt S1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95151426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,656.00|FSC: 13; Default||Not reimbursed separately|19,656.00|FSC: 13; Default||External grouping not supported 95151427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 95151428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,001.98|FSC: 13; Default||Not reimbursed separately|18,001.98|FSC: 13; Default||External grouping not supported 95151429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,742.00|FSC: 13; Default||Not reimbursed separately|14,742.00|FSC: 13; Default||External grouping not supported 951203972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt S1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95151430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,870.00|FSC: 13; Default||Not reimbursed separately|15,870.00|FSC: 13; Default||External grouping not supported 95151434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,401.80|FSC: 13; Default||Not reimbursed separately|14,401.80|FSC: 13; Default||External grouping not supported 95151435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Tapered Articuleze -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|FSC: 13; Default||Not reimbursed separately|814.80|FSC: 13; Default||External grouping not supported 95151436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Tapered Articuleze +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|FSC: 13; Default||Not reimbursed separately|814.80|FSC: 13; Default||External grouping not supported 951203973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt S1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95151437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Tapered Articuleze +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|FSC: 13; Default||Not reimbursed separately|814.80|FSC: 13; Default||External grouping not supported 95151438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Tapered Articuleze +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|FSC: 13; Default||Not reimbursed separately|814.80|FSC: 13; Default||External grouping not supported 95151439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 951203954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 18x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Vertex 3.2mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|943.74|FSC: 13; Default||Not reimbursed separately|943.74|FSC: 13; Default||External grouping not supported 95151442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 951203955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 19x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 951203956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 21x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 951203957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 23x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 95151465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Modular Cathcart 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|FSC: 13; Default||Not reimbursed separately|1,892.10|FSC: 13; Default||External grouping not supported 951203958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 10x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151467|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft 4cm X 7cm Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|303.86|FSC: 13; Default||Not reimbursed separately|303.86|FSC: 13; Default||External grouping not supported 95151473|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|FSC: 13; Default||Not reimbursed separately|6,705.00|FSC: 13; Default||External grouping not supported 95151478|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilatation Atlas Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151479|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Dilatation Atlas Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 11x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151480|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95151481|EAP|Custom 95151481||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Vega Patella Stabilie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151482|EAP|Custom 95151482||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Vega Patella Stabilie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151483|EAP|Custom 95151483||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Vega Patella Stabilie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 12x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151484|EAP|Custom 95151484||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Posture S Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151485|EAP|Custom 95151485||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Posture S Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151486|EAP|Custom 95151486||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Posture S Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 13x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Ii Hpg Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,916.45|FSC: 13; Default||Not reimbursed separately|5,916.45|FSC: 13; Default||External grouping not supported 95151497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anterior 6mm X 50mm Expedm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95151498|EAP|Custom 95151498||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Rostral Large Anterior Em|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95151499|EAP|Custom 95151499||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Caudal Large Anterior Exm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951203962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 14x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 80mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|869.40|FSC: 13; Default||Not reimbursed separately|869.40|FSC: 13; Default||External grouping not supported 95151501|EAP|Custom 95151501||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross Anterior 16mm Em|1|HUMANA [1294]||HUMANA [11839]|3,405.00|FSC: 13; Default||Not reimbursed separately|3,405.00|FSC: 13; Default||External grouping not supported 95151502|EAP|Custom 95151502||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Synex 0-degree 31-46mm|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95151507|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Tiered Therapy Atf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75,000.00|FSC: 13; Default||Not reimbursed separately|75,000.00|FSC: 13; Default||External grouping not supported 951203963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 15x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151508|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Guide Catheter Apeels|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151517|EAP|Custom 95151517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stylet Rigid Closure Rfs 2.0mm M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Head 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 951203964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB REGULAR FLUTED STEM 16X155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tmzf Accolade Plus #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95151525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Lg Right 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95186490|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 10.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95151540|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Stabilizer Balanced Perford|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151541|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9 French 4.0 Jude|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186510|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 20.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151542|EAP|Custom 95151542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Stone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 17x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151543|EAP|Custom 95151543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Lithoclast Pneumatic 2.0me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186504|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 17.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151550|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Standard .035 Diameted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186505|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 18.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Proximal Right 6-h5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,369.90|FSC: 13; Default||Not reimbursed separately|3,369.90|FSC: 13; Default||External grouping not supported 95151553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 70mm Selfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.23|FSC: 13; Default||Not reimbursed separately|391.23|FSC: 13; Default||External grouping not supported 95186493|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 12.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95151554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 75mm Selfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95151555|EAP|Custom 95151555||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186509|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 20.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151557|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Hemo Split With Bio Blr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95151558|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Hemo Split With Bio Blr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95186489|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 10.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95151559|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Hemo Split With Bio Blr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95151561|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone L-asr Fee 5 X 14 X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95186491|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 11.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95151563|EAP|Custom 95151563||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Rubber Silicone Rtv #1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 18x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151564|EAP|Custom 95151564||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catalyst #4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186496|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 13.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151566|EAP|Custom 95151566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer 1-1/2 Sur Fit Tan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151568|EAP|Custom 95151568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Ostomy 12in Opaque Sur Fi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervicalm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|FSC: 13; Default||Not reimbursed separately|7,238.28|FSC: 13; Default||External grouping not supported 95151595|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral 5fh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 19x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151596|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 7.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151597|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 6.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151598|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151599|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 6mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951203968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 21x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151601|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 6mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151603|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 7mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151605|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 7mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151606|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 7mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951203969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 23x155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95151607|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 7mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151608|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 8mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151609|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 8mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95151610|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 8mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951203232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151623|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Powerflex P3 6 X 4 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151624|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Powerflex P3 7x40 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151625|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Powerflex P3 7x40 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Locking Left 8-m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,319.26|FSC: 13; Default||Not reimbursed separately|3,319.26|FSC: 13; Default||External grouping not supported 951203233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95151628|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Powerflex P3 9x20 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151629|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Powerflex P3 9x20 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151630|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Powerflex P3 12x20 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151631|EAP|Custom 95151631||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Aquaform Zippered|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95151633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95151634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cortex S-t 2.7mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.70|FSC: 13; Default||Not reimbursed separately|305.70|FSC: 13; Default||External grouping not supported 95123670|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Flexible-tip 1cm X 0.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex S-t Peri-loc 3.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.85|FSC: 13; Default||Not reimbursed separately|53.85|FSC: 13; Default||External grouping not supported 951203235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex S-t Peri-loc 3.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.85|FSC: 13; Default||Not reimbursed separately|53.85|FSC: 13; Default||External grouping not supported 95151637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex S-t Peri-loc 3.5mmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.85|FSC: 13; Default||Not reimbursed separately|53.85|FSC: 13; Default||External grouping not supported 95151638|EAP|Custom 95151638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Point Trocar 2.0mm X 150m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151639|EAP|Custom 95151639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Connect Quick 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151640|EAP|Custom 95151640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Connect Quick 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151641|EAP|Custom 95151641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Connect Quick 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Orthosphere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,252.50|FSC: 13; Default||Not reimbursed separately|4,252.50|FSC: 13; Default||External grouping not supported 95151646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Orthosphere Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,118.85|FSC: 13; Default||Not reimbursed separately|4,118.85|FSC: 13; Default||External grouping not supported 95151647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copeland Si4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|FSC: 13; Default||Not reimbursed separately|10,017.00|FSC: 13; Default||External grouping not supported 95151658|EAP|Custom 95151658||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blade Cast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95151664|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall With Permalume 8fr Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,665.00|FSC: 13; Default||Not reimbursed separately|4,665.00|FSC: 13; Default||External grouping not supported 95151665|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi Torque Advance J Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151666|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi Torque Advance Lih|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151672|EAP|Custom 95151672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Disc Supercomfort Sterile Dispoe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151673|EAP|Custom 95151673||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151674|EAP|Custom 95151674||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151675|EAP|Custom 95151675||0258 - PHARMACY - IV SOLUTIONS|Hb Solution Iv 15% Clinsol Injectio|1|HUMANA [1294]||HUMANA [11839]|214.17|FSC: 13; Default||Not reimbursed separately|214.17|FSC: 13; Default||External grouping not supported 95151676|EAP|Custom 95151676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Sterile 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Small Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|FSC: 13; Default||Not reimbursed separately|3,063.00|FSC: 13; Default||External grouping not supported 95151678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951203240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps 7/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 951203241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151688|EAP|Custom 95151688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mystique 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Large Right 10-he|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95151703|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ae|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951203242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151711|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 8mm Do|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95151712|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 8mm Do|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95151713|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft 5cm X 10cm Per Sqcm|1|HUMANA [1294]||HUMANA [11839]|152.76|FSC: 13; Default||Not reimbursed separately|152.76|FSC: 13; Default||External grouping not supported 95151714|EAP|Custom 95151714||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Pump 40 Degree|1|HUMANA [1294]||HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 951203243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Mtp 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95151724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerous Distal Medial Rie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 95151725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95151726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 951203244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151738|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Distal Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|FSC: 13; Default||Not reimbursed separately|5,460.00|FSC: 13; Default||External grouping not supported 95151739|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Proximalm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95151744|EAP|Custom 95151744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Sz-4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 951203246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95151763|EAP|Custom 95151763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Frontrunner Xp Ct0 90cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151764|EAP|Custom 95151764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Micro Guide 90cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151765|EAP|Custom 95151765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Frontrunner Xp Cto 14m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151766|EAP|Custom 95151766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Micro Guide 140cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95151767|EAP|Custom 95151767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Outback Re-entry 120cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cr Triathilon #4 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95151777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Kneen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 95151778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Knee Total Triathm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.00|FSC: 13; Default||Not reimbursed separately|3,912.00|FSC: 13; Default||External grouping not supported 951203248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95151779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rtm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 95151789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 5.5mm With Maxbraid Neede|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95151790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Lm Ext Fullcoat Bem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,222.38|FSC: 13; Default||Not reimbursed separately|10,222.38|FSC: 13; Default||External grouping not supported 951203249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95151796|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac 14mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,040.95|FSC: 13; Default||Not reimbursed separately|6,040.95|FSC: 13; Default||External grouping not supported 95151797|EAP|Custom 95151797||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Extender|1|HUMANA [1294]||HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95151813|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Biliary 7fr X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 95151814|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Biliary 10fr X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.38|FSC: 13; Default||Not reimbursed separately|364.38|FSC: 13; Default||External grouping not supported 951203211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151815|EAP|Custom 95151815||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Rx Lithotripter Compat 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151816|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Biliary Extraction 7 Frh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151820|EAP|Custom 95151820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wave Harmonic 18cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151821|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951203212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp 4.5mmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,440.47|FSC: 13; Default||Not reimbursed separately|5,440.47|FSC: 13; Default||External grouping not supported 95151828|EAP|Custom 95151828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated Percutaneom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151831|EAP|Custom 95151831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated Percutaneom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Cemented Mbt S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 951203213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porous C/r Sigma Pfc Righ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|FSC: 13; Default||Not reimbursed separately|7,061.70|FSC: 13; Default||External grouping not supported 95151837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Dome Oval Sigma Pfc 3-pm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95151838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Signa Cv Rp Pfc Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95151839|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951203214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|FSC: 13; Default||Not reimbursed separately|7,238.28|FSC: 13; Default||External grouping not supported 95151844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 56mm Asr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,378.45|FSC: 13; Default||Not reimbursed separately|12,378.45|FSC: 13; Default||External grouping not supported 95151846|EAP|Custom 95151846||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adhesive Surgical Bio-glue|1|HUMANA [1294]||HUMANA [11839]|2,946.00|FSC: 13; Default||Not reimbursed separately|2,946.00|FSC: 13; Default||External grouping not supported 95151848|EAP|Custom 95151848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Oval Standard 2.5cm X 5.5p|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151850|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Icd Single Chamber Ovatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,300.00|FSC: 13; Default||Not reimbursed separately|51,300.00|FSC: 13; Default||External grouping not supported 95151851|EAP|Custom 95151851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Administration C02 Deliverym|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151853|EAP|Custom 95151853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Perfusion Oxygenator + H-l E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151857|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Shaft Racer 6 Mm Diameterm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 951203216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Acetabular Tm Mulm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95151863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular 28mm Standard C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.88|FSC: 13; Default||Not reimbursed separately|1,361.88|FSC: 13; Default||External grouping not supported 95151865|EAP|Custom 95151865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Short 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151866|EAP|Custom 95151866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Long 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151867|EAP|Custom 95151867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Short 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151868|EAP|Custom 95151868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Long 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151869|EAP|HCPCS C1898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Stelid Ii Atrial J Bipolarm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95151870|EAP|Custom 95151870||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Intervention Osteonecroe|1|HUMANA [1294]||HUMANA [11839]|10,204.44|FSC: 13; Default||Not reimbursed separately|10,204.44|FSC: 13; Default||External grouping not supported 951203218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151871|EAP|Custom 95151871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Disc Pruca Optical Mo Rewritablb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151873|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 100cmh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186500|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 15.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95151874|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Coronary 8fr X P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151875|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Distal Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|FSC: 13; Default||Not reimbursed separately|5,460.00|FSC: 13; Default||External grouping not supported 95151876|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Distal Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 951203219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151878|EAP|Custom 95151878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Piston Stapes Smart Flom|1|HUMANA [1294]||HUMANA [11839]|794.01|FSC: 13; Default||Not reimbursed separately|794.01|FSC: 13; Default||External grouping not supported 95151879|EAP|Custom 95151879||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Piston Stapes Smart Flom|1|HUMANA [1294]||HUMANA [11839]|794.01|FSC: 13; Default||Not reimbursed separately|794.01|FSC: 13; Default||External grouping not supported 95151880|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95151881|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951203220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151884|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency Plus 9mm X H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95151886|EAP|HCPCS Q4112||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cymetra 2cc Per 1cc|1|HUMANA [1294]||HUMANA [11839]|469.50|FSC: 13; Default||Not reimbursed separately|469.50|FSC: 13; Default||External grouping not supported 95151894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral 11mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95151895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.56|FSC: 13; Default||Not reimbursed separately|691.56|FSC: 13; Default||External grouping not supported 951203221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151896|EAP|Custom 95151896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 8mm X 22mm Vertesk|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95151897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 5.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95151910|EAP|Custom 95151910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Drainable 2 Piece 7- 7.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95151916|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Rater|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,900.00|FSC: 13; Default||Not reimbursed separately|45,900.00|FSC: 13; Default||External grouping not supported 95151917|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Riata St 65cm Icd 21cm Spag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95151919|EAP|Custom 95151919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Drain Closed End 1-1/2 Pr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spire 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,337.98|FSC: 13; Default||Not reimbursed separately|15,337.98|FSC: 13; Default||External grouping not supported 95151922|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Long 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95151924|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr 10mm Adva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151925|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151926|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151927|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151928|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151929|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95151930|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue Soft Surgisis Ablok|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,370.00|FSC: 13; Default||Not reimbursed separately|2,370.00|FSC: 13; Default||External grouping not supported 95151937|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Height Full 400c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|FSC: 13; Default||Not reimbursed separately|3,990.00|FSC: 13; Default||External grouping not supported 95151938|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Height Full 300c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|FSC: 13; Default||Not reimbursed separately|3,885.00|FSC: 13; Default||External grouping not supported 95151939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mold Cement Knee Tibial 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95151950|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95151951|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95151952|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95151953|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95151954|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95192531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6mm 55mm 32mm Axsos 3 Ti P/t Cancellous Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|FSC: 13; Default||Not reimbursed separately|228.00|FSC: 13; Default||External grouping not supported 95151955|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95151956|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95151957|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95151958|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95192532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6mm 95mm 32mm Axsos 3 Ti P/t Cancellous Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|FSC: 13; Default||Not reimbursed separately|228.00|FSC: 13; Default||External grouping not supported 95151959|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95151960|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95151961|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95151962|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95192533|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Sen Tiva Single Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95,231.70|FSC: 13; Default||Not reimbursed separately|95,231.70|FSC: 13; Default||External grouping not supported 95151963|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95151964|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95151966|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95151967|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95192534|EAP|HCPCS Q4159||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue L 1.5 Cm X W 1.5 Cm Affinity|1|HUMANA [1294]||HUMANA [11839]|742.50|FSC: 13; Default||Not reimbursed separately|742.50|FSC: 13; Default||External grouping not supported 95151968|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95151969|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95151973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|FSC: 13; Default||Not reimbursed separately|4,179.60|FSC: 13; Default||External grouping not supported 95151974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95192535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera Cocr 35 Mm 9.5 Mm Spine Multiaxial 5.5 Mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95151978|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Shaft Racer 7 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95151979|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.68|FSC: 13; Default||Not reimbursed separately|93.68|FSC: 13; Default||External grouping not supported 95151983|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 8mm Stent Diameteh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95151984|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 8mm Stent Diameteh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95192536|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc Lifestream 8mm 58mm 135cm Bln Expndble Loprfl Cvr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95151992|EAP|Custom 95151992||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ball Gymnic Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95151996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rtm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95151997|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smart Control Iliac 7 X 40 X 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95151999|EAP|Custom 95151999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Loop Ligating Polyloop Spu Detam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95152003|EAP|Custom 95152003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Side Arm Non-rotating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152005|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Beacon 5.t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152016|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 4 Fr X 50cm Single Lumc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.75|FSC: 13; Default||Not reimbursed separately|234.75|FSC: 13; Default||External grouping not supported 95152017|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152018|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.68|FSC: 13; Default||Not reimbursed separately|93.68|FSC: 13; Default||External grouping not supported 95152019|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.69|FSC: 13; Default||Not reimbursed separately|93.69|FSC: 13; Default||External grouping not supported 95152020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Cemented Mbt S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 95152022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Lf Porus C/rc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|FSC: 13; Default||Not reimbursed separately|7,061.70|FSC: 13; Default||External grouping not supported 95152024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Dome Oval 3-peg Sigma Pm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95152025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Signa Cv Rp Pfc Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95152026|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5fr 65cm )|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152027|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5fr 65cm )|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152028|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5fr 65cm )|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152029|EAP|Custom 95152029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape Quick Cast 1 X4 Roll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152030|EAP|Custom 95152030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 3.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152031|EAP|Custom 95152031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 4.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152034|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pinnacle 7f Radiopaquei|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152035|EAP|Custom 95152035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy 14g X 116mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 30mm Dart-fire Ti Aly Ft Slf Drl St Cnn Hd Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|FSC: 13; Default||Not reimbursed separately|591.00|FSC: 13; Default||External grouping not supported 95152037|EAP|Custom 95152037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy 14g X 138mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152039|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Coaxial 14g X 116mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 34mm Dart-fire Ti Aly Ft Sf Drl St Cnn Hd Dk B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|FSC: 13; Default||Not reimbursed separately|693.00|FSC: 13; Default||External grouping not supported 95152041|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Coaxial 14g X 138mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152042|EAP|Custom 95152042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium Micron 200 )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152047|EAP|Custom 95152047||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Posture S Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152048|EAP|Custom 95152048||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Posture S Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hip Femoral Chrome 28mm +3e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|FSC: 13; Default||Not reimbursed separately|3,238.20|FSC: 13; Default||External grouping not supported 95152061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular 10-degree Anglm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.50|FSC: 13; Default||Not reimbursed separately|2,848.50|FSC: 13; Default||External grouping not supported 95152064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Long 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95192539|EAP|Custom 95192539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Countersink Ortholoc 6mm Ankle 3di Tech Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,531.77|FSC: 13; Default||Not reimbursed separately|4,531.77|FSC: 13; Default||External grouping not supported 95152066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Head Radial 7.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95152067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Left 22.0 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95152068|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192541|EAP|Custom 95192541||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 17x9mm Divergence 14mm Lrdtc Nar Prfl Crv Ant Peek|1|HUMANA [1294]||HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95152069|EAP|Custom 95152069||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152070|EAP|Custom 95152070||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152071|EAP|Custom 95152071||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152072|EAP|Custom 95152072||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Extension Soft Stl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium L15 Mm Od3.5 Mm Spinal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 95152075|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Sz-6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95152092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Ex 7mm X 210mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.09|FSC: 13; Default||Not reimbursed separately|6,165.09|FSC: 13; Default||External grouping not supported 95152093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Humeral 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.42|FSC: 13; Default||Not reimbursed separately|651.42|FSC: 13; Default||External grouping not supported 95192543|EAP|Custom 95192543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Screwdriver T8 Ao Self Retain|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152094|EAP|Custom 95152094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95152100|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Anchorage T8 L28 Mm Od3.6 Mm Lag Cross Plate Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|FSC: 13; Default||Not reimbursed separately|879.00|FSC: 13; Default||External grouping not supported 95152103|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Floor Pelvic Totat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 95152104|EAP|Custom 95152104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Tympanoplasty 7.5mm W 60 E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152116|EAP|Custom 95152116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192545|EAP|Custom 95192545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4 Mm Cannulated Ao Coupling Nonsterile 4 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152121|EAP|Custom 95152121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Oscor|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95152123|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 5.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152128|EAP|Custom 95152128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Exchange 14m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152129|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Intubation Retrograde 14.0 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152130|EAP|Custom 95152130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Exchange 19m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152131|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Intubating Frova 8 Fm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Anchorage T8 L32 Mm Od3.6 Mm Lag Cross Plate St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|FSC: 13; Default||Not reimbursed separately|879.00|FSC: 13; Default||External grouping not supported 95152132|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Intubating Frova 14 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Long 3.0 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Long 3.0 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95192548|EAP|Custom 95192548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Pin Orthopedic L220 Mm Od2.5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152138|EAP|Custom 95152138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Exchange 11)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152139|EAP|Custom 95152139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Exchange 14)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell No-holes Trilogy 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95152142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flexe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95192549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Cortiloc 25 D Medium Shoulder Left Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|FSC: 13; Default||Not reimbursed separately|12,070.80|FSC: 13; Default||External grouping not supported 95152143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flexf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95152144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flexe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152146|EAP|Custom 95152146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand 3.6mm 90-deg Lo-pro E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 8mm Shm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95192550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Aequalis Ascend Flex 132.5 4b Standard 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|FSC: 13; Default||Not reimbursed separately|11,290.86|FSC: 13; Default||External grouping not supported 95152152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 9mm Shm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95152153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 10mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95152154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 11mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95152155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 12mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|FSC: 13; Default||Not reimbursed separately|651.66|FSC: 13; Default||External grouping not supported 95192552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial All-poly Cs Sz 6-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|FSC: 13; Default||Not reimbursed separately|8,887.20|FSC: 13; Default||External grouping not supported 95152156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 13mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.22|FSC: 13; Default||Not reimbursed separately|671.22|FSC: 13; Default||External grouping not supported 95152161|EAP|Custom 95152161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Minibasket Segura 2.4 Fr 120cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152162|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Siltex Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95152164|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Siltex Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95152165|EAP|Custom 95152165||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Loop Ear Flexible Oval Billeau|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Venture Variable 4.0 X 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95152185|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated Heparin Pm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,794.00|FSC: 13; Default||Not reimbursed separately|7,794.00|FSC: 13; Default||External grouping not supported 95152186|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated Heparin Pm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.00|FSC: 13; Default||Not reimbursed separately|8,775.00|FSC: 13; Default||External grouping not supported 95152187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervicalm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 95152189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 951204406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152193|EAP|Custom 95152193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy 16fr Magna Port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152197|EAP|Custom 95152197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 4fr Infinity Jl4.5 100m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152199|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95152200|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951204407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152208|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer 8.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152211|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall Biliary 10mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,369.62|FSC: 13; Default||Not reimbursed separately|4,369.62|FSC: 13; Default||External grouping not supported 95152213|EAP|Custom 95152213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Evolve 980 (for Use)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Cemented Mbt S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 95152233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Signa Cv Pfc Sizem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95152244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,227.90|FSC: 13; Default||Not reimbursed separately|4,227.90|FSC: 13; Default||External grouping not supported 951204409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 1m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,531.77|FSC: 13; Default||Not reimbursed separately|4,531.77|FSC: 13; Default||External grouping not supported 95152246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Short 3.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152247|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152257|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951204410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152259|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avaulta Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.18|FSC: 13; Default||Not reimbursed separately|4,725.18|FSC: 13; Default||External grouping not supported 95152266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 3.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152267|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 3.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152268|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 3.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152269|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Ballooh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152270|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Otw Pta Ballooh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152272|EAP|Custom 95152272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch 1 Piece Post-op And Woundr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,051.32|FSC: 13; Default||Not reimbursed separately|4,051.32|FSC: 13; Default||External grouping not supported 951204455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152275|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8fr .088 Rdc 55m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152276|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 12 X 14 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95152277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecrenon Locking 11-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|FSC: 13; Default||Not reimbursed separately|1,902.00|FSC: 13; Default||External grouping not supported 95152279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 951204456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95152281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 26m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95152284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb End Condylar Femur Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,824.14|FSC: 13; Default||Not reimbursed separately|20,824.14|FSC: 13; Default||External grouping not supported 95152288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted 16/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,617.06|FSC: 13; Default||Not reimbursed separately|10,617.06|FSC: 13; Default||External grouping not supported 951204457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Hinged Size-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,875.73|FSC: 13; Default||Not reimbursed separately|9,875.73|FSC: 13; Default||External grouping not supported 95152290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted 10.5 X 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,821.37|FSC: 13; Default||Not reimbursed separately|3,821.37|FSC: 13; Default||External grouping not supported 95152291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Hinged 2.9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,373.00|FSC: 13; Default||Not reimbursed separately|5,373.00|FSC: 13; Default||External grouping not supported 95152292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Hinge 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,255.00|FSC: 13; Default||Not reimbursed separately|15,255.00|FSC: 13; Default||External grouping not supported 951204458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152293|EAP|Custom 95152293||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Connector Snap-lid|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95152294|EAP|Custom 95152294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Pain Ambit Catheter Dual Il|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,636.01|FSC: 13; Default||Not reimbursed separately|8,636.01|FSC: 13; Default||External grouping not supported 95152296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951204459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95152300|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regen 6x16 Per Sqc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.72|FSC: 13; Default||Not reimbursed separately|93.72|FSC: 13; Default||External grouping not supported 95152301|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Opti 350 Pre 1ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|FSC: 13; Default||Not reimbursed separately|0.68|FSC: 13; Default||External grouping not supported 95152302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951204460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951204461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|FSC: 13; Default||Not reimbursed separately|568.50|FSC: 13; Default||External grouping not supported 95152307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,636.01|FSC: 13; Default||Not reimbursed separately|8,636.01|FSC: 13; Default||External grouping not supported 95152309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,636.01|FSC: 13; Default||Not reimbursed separately|8,636.01|FSC: 13; Default||External grouping not supported 95152310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951204478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Locking Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|481.50|FSC: 13; Default||Not reimbursed separately|481.50|FSC: 13; Default||External grouping not supported 95152311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95152315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951204401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Componet Femoral Porous Cr-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95152318|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Shaft Racer 7 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95152326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,741.02|FSC: 13; Default||Not reimbursed separately|7,741.02|FSC: 13; Default||External grouping not supported 95152330|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 14 X 11 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,085.00|FSC: 13; Default||Not reimbursed separately|8,085.00|FSC: 13; Default||External grouping not supported 951204402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152355|EAP|Custom 95152355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Saver Cell Bowl 70cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152375|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Textured Pluc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95152376|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Textured Pluc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 951204403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152377|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95152378|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95152379|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Profic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95152380|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Profic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 951204404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152404|EAP|Custom 95152404||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Radiesse 1.0cc (ship With #pn90)|1|HUMANA [1294]||HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95152405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Lateral Distal Lee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,116.05|FSC: 13; Default||Not reimbursed separately|2,116.05|FSC: 13; Default||External grouping not supported 95152408|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Sprinter Mx2 4.0x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152409|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Sprinter Mx2 2.5x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dome Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95152410|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Driver Mx2 3.5x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95152414|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Chest 12f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152415|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Chest 14f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152416|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Cd Horizon Cocrmo Curve L40 Mm Od5.5 Mm Nonsteril|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95152429|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Sprinter Mx2 2.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152442|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 30mm X 74mmh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95152450|EAP|Custom 95152450||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Velocity Moderate St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152451|EAP|Custom 95152451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cautery High Temp Fine Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L24 Mm Od4.5 Mm Ankle Lock Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95152459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Femoral Uni Size 49 Asr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.96|FSC: 13; Default||Not reimbursed separately|4,983.96|FSC: 13; Default||External grouping not supported 95152460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell No-holes Trilogy 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95152461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Distal Late|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,942.47|FSC: 13; Default||Not reimbursed separately|4,942.47|FSC: 13; Default||External grouping not supported 95152464|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Neuro 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,170.25|FSC: 13; Default||Not reimbursed separately|3,170.25|FSC: 13; Default||External grouping not supported 95192561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Low Profile L45 Mm Od5.5 Mm Ankle Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95152477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.03|FSC: 13; Default||Not reimbursed separately|675.03|FSC: 13; Default||External grouping not supported 95152480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copeland Si3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|FSC: 13; Default||Not reimbursed separately|10,017.00|FSC: 13; Default||External grouping not supported 95152481|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 4.5mm Diameterl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152482|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 5.0mm Diameterl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192562|EAP|Custom 95192562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Holder Plate Bb-tak Titanium Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152484|EAP|Custom 95152484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Fms 30-deg Kelmp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152488|EAP|Custom 95152488||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Sheehy Without|1|HUMANA [1294]||HUMANA [11839]|95.40|FSC: 13; Default||Not reimbursed separately|95.40|FSC: 13; Default||External grouping not supported 95152489|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152490|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192563|EAP|Custom 95192563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Dill 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152492|EAP|Custom 95152492||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Arthrex Tendonesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Cemented Mbt S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 95152495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Lf Porus C/rc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|FSC: 13; Default||Not reimbursed separately|7,061.70|FSC: 13; Default||External grouping not supported 95152496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 9-he|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.42|FSC: 13; Default||Not reimbursed separately|3,042.42|FSC: 13; Default||External grouping not supported 95192564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ankle Right Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|FSC: 13; Default||Not reimbursed separately|6,225.00|FSC: 13; Default||External grouping not supported 95152497|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 7.0mm I.d. Cut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152500|EAP|Custom 95152500||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Gelport Xe 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152501|EAP|Custom 95152501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Circumcision Gomco Sterill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152503|EAP|Custom 95152503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Circumcision Gomco Sterill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192565|EAP|Custom 95192565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Rod Orthopedic Trigen Od2 Mm Humerus Ball Tip Graduate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152504|EAP|Custom 95152504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Circumcision Gomco Sterill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152509|EAP|Custom 95152509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Set Osteo Site Bone Bioph|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Rt Non-porusc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|FSC: 13; Default||Not reimbursed separately|7,061.70|FSC: 13; Default||External grouping not supported 95152516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Signa Cv Pfc Sizem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,880.00|FSC: 13; Default||Not reimbursed separately|2,880.00|FSC: 13; Default||External grouping not supported 95192566|EAP|Custom 95192566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Pin Orthopedic Trigen Od3.2 Mm Humerus Threaded Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152531|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter 2s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95152535|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dowel Bone Bicortical 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95152539|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Copu Os 1-strip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|FSC: 13; Default||Not reimbursed separately|816.00|FSC: 13; Default||External grouping not supported 95152550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Thread Long 3.0 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95192567|EAP|Custom 95192567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Trigen Sureshot Humerus Probe Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Sz-5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95152561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 6.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95192568|EAP|Custom 95192568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Trigen Long Od3.2 Mm Graduated Brad Point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152571|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95152572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Base Tibial Ii Gns Size-5 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95192569|EAP|Custom 95192569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Trigen Sureshot Long Humerus Cannulated Probe 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Insert Tibial Art C/r Gii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 95152574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Qxin C/r Spc Gii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 95152575|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152576|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95192570|EAP|Custom 95192570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Trigen Short Od3.2 Mm Graduated Brad Point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152577|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152578|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152579|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152580|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95192571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen Titanium 24mmx4mm Humerus Cortical Selftap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.77|FSC: 13; Default||Not reimbursed separately|532.77|FSC: 13; Default||External grouping not supported 95152581|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152582|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152583|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152584|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Tapered|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95192572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Trigen Titanium 28cm X9/7.5mm Humerus Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,416.20|FSC: 13; Default||Not reimbursed separately|5,416.20|FSC: 13; Default||External grouping not supported 95152585|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Tapered|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152586|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Tapered|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152587|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Tapered|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152588|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Protection Embolic Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen Titanium 22mmx4mm Humerus Cortical Selftap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.77|FSC: 13; Default||Not reimbursed separately|532.77|FSC: 13; Default||External grouping not supported 95152589|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Protection Embolic Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152590|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Protection Embolic Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152591|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Protection Embolic Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152592|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95192574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen Titanium 49mmx5mm Humerus Cortical Selftap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|FSC: 13; Default||Not reimbursed separately|647.82|FSC: 13; Default||External grouping not supported 95152593|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152594|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95152595|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Protege Straigh|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95192575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen Titanium 46mmx5mm Humerus Cortical Selftap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|FSC: 13; Default||Not reimbursed separately|647.82|FSC: 13; Default||External grouping not supported 95152598|EAP|Custom 95152598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dissector Plus Spacemaker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152599|EAP|Custom 95152599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dissector Plus Spacemaker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152600|EAP|Custom 95152600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand 2.3mm X 35-deg Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen Titanium L42 Mm Od5 Mm Cancellous Selftap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|FSC: 13; Default||Not reimbursed separately|647.82|FSC: 13; Default||External grouping not supported 95152601|EAP|Custom 95152601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foley Coude 18fr 30cc Tiema|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Rt Non-porus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|FSC: 13; Default||Not reimbursed separately|5,572.47|FSC: 13; Default||External grouping not supported 95152608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stb Signa Pfc 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95152614|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Pre Cut Endothelial Kerat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95192580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrex Titanium L44 Mm Od4.5 Mm Lock Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95152619|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Powerport Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95152624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,095.83|FSC: 13; Default||Not reimbursed separately|5,095.83|FSC: 13; Default||External grouping not supported 95152625|EAP|Custom 95152625||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint L4350 Vaco Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 12mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95192581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrex Titanium L46 Mm Od4.5 Mm Lock Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95152634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 0-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.56|FSC: 13; Default||Not reimbursed separately|691.56|FSC: 13; Default||External grouping not supported 95152635|EAP|Custom 95152635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Pointed 5.0mm 145mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152636|EAP|Custom 95152636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 5.0mm 340mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152637|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 11 X 11 Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|FSC: 13; Default||Not reimbursed separately|8,893.50|FSC: 13; Default||External grouping not supported 95192582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Low Profile L55 Mm Od5.5 Mm Ankle Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95152638|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95152640|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Tibial Size 5 Nexm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|FSC: 13; Default||Not reimbursed separately|3,092.55|FSC: 13; Default||External grouping not supported 95152646|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile Moderatec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95192559|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Avive Soft Membrane 3cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,150.00|FSC: 13; Default||Not reimbursed separately|9,150.00|FSC: 13; Default||External grouping not supported 95152647|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile Moderatec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95152648|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile High Texc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95152649|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile High Texc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95192551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Aequalis Ascend Flex Cocr 4 Mm H23 Mm Od52 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|FSC: 13; Default||Not reimbursed separately|8,468.58|FSC: 13; Default||External grouping not supported 95152650|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile High Texc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95152651|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile High Texc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95152652|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile High Texc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95152653|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Profile High Texc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95192556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 122mm X 9mm Cmprh Por Shldr Rvrs Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,020.00|FSC: 13; Default||Not reimbursed separately|19,020.00|FSC: 13; Default||External grouping not supported 95152656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Recon Locking 8-hole 104mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,098.29|FSC: 13; Default||Not reimbursed separately|2,098.29|FSC: 13; Default||External grouping not supported 95152657|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95152667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Acetabular Durom Meta8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|FSC: 13; Default||Not reimbursed separately|8,098.56|FSC: 13; Default||External grouping not supported 95152668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ldh Metasul Cocr Taper 12/8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|FSC: 13; Default||Not reimbursed separately|2,261.79|FSC: 13; Default||External grouping not supported 95192557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Comprehensive Hybrid Small 4mm Shld Bs M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,980.00|FSC: 13; Default||Not reimbursed separately|7,980.00|FSC: 13; Default||External grouping not supported 95152670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Head Ldh Metasul Taper 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|466.77|FSC: 13; Default||Not reimbursed separately|466.77|FSC: 13; Default||External grouping not supported 95152671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|482.16|FSC: 13; Default||Not reimbursed separately|482.16|FSC: 13; Default||External grouping not supported 95192558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Comprehensive Versa-dial 46x18x53 Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,120.00|FSC: 13; Default||Not reimbursed separately|12,120.00|FSC: 13; Default||External grouping not supported 95152679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.0 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95152680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 951204400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Dome Hole Plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95152685|EAP|Custom 95152685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 7y|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152686|EAP|Custom 95152686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 7y|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152687|EAP|Custom 95152687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Tubing Lap-band|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152688|EAP|Custom 95152688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Port Access Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Biolox Option Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|FSC: 13; Default||Not reimbursed separately|5,868.00|FSC: 13; Default||External grouping not supported 95152689|EAP|Custom 95152689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Port Access Vg Profile Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152693|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Check Flo 8fre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152694|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 8 French X 55cm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152695|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Internal Mammarye|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Biolox Option Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|FSC: 13; Default||Not reimbursed separately|5,868.00|FSC: 13; Default||External grouping not supported 95152696|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152697|EAP|Custom 95152697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Pain Ambit Block Nerve Regl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Extended Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|FSC: 13; Default||Not reimbursed separately|3,063.00|FSC: 13; Default||External grouping not supported 95152699|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951204424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Biolox Option Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|FSC: 13; Default||Not reimbursed separately|5,868.00|FSC: 13; Default||External grouping not supported 95152700|EAP|Custom 95152700||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Synex -5-degree 28-40mm|1|HUMANA [1294]||HUMANA [11839]|21,159.00|FSC: 13; Default||Not reimbursed separately|21,159.00|FSC: 13; Default||External grouping not supported 95152701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecrenon Locking 9-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95152702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95152703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 951204425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Option Sleeve M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95152705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95152706|EAP|Custom 95152706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Drain Closed End 2-1/4 We|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152707|EAP|Custom 95152707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Skin Barrier 1-1/2 Sizee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152709|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Insert 16 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Option Sleeve L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95152710|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima 12fr X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152711|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima Ro 10ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152712|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima Ro 12ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152713|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951204427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Option Sleeve Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95152714|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|FSC: 13; Default||Not reimbursed separately|3,026.04|FSC: 13; Default||External grouping not supported 95152716|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152717|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regen Per Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95152718|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 34.0 Diopter Sc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951204412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152730|EAP|Custom 95152730||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wafer Durahesive 1-3/4 Natura E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152744|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Tracer Metro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152745|EAP|Custom 95152745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Needle Fusion Triple Lumen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152746|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Tracer Metro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152747|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphinctertome Fusion Pre-loadedi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152748|EAP|Custom 95152748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ercp Fusion Omni|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152753|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95152754|EAP|Custom 95152754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium Tip Conical)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152761|EAP|Custom 95152761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Universal Catheter Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152765|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951204415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152766|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95152769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tc 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95152770|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95152772|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Strut 11 X 11 Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|FSC: 13; Default||Not reimbursed separately|8,893.50|FSC: 13; Default||External grouping not supported 951204416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152773|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95152774|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95152779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95152796|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Pulmonary 8mm Xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152797|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Pulmonary 10mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152803|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurostimulator Implantable Inse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,314.00|FSC: 13; Default||Not reimbursed separately|46,314.00|FSC: 13; Default||External grouping not supported 951204418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152804|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Programmer Patient External|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152805|EAP|Custom 95152805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Recharger Patient Externl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152806|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stretch-coil Bifurcatd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.00|FSC: 13; Default||Not reimbursed separately|4,530.00|FSC: 13; Default||External grouping not supported 95152807|EAP|Custom 95152807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Mri 9g (3.7mm) X 14c)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152808|EAP|Custom 95152808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Mri 9g (3.7mm) X 14c)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152809|EAP|Custom 95152809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 9g Introducer Localization Set )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra R Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|FSC: 13; Default||Not reimbursed separately|18,925.50|FSC: 13; Default||External grouping not supported 95152810|EAP|Custom 95152810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 9g Introducer Localization Set )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152813|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Identifier Biopsy Site For Use Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951204462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Proximal Body 40mm X 20mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|FSC: 13; Default||Not reimbursed separately|17,976.00|FSC: 13; Default||External grouping not supported 95152814|EAP|Custom 95152814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pump With Quick Load Cartrie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152815|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St Bipolar 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951204463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Proximal Body 50mm X 20mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|FSC: 13; Default||Not reimbursed separately|17,976.00|FSC: 13; Default||External grouping not supported 95152816|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St Bipolar 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 95152817|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St Bipolar 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951204464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Proximal Body 60mm X 20mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|FSC: 13; Default||Not reimbursed separately|17,976.00|FSC: 13; Default||External grouping not supported 95152818|EAP|Custom 95152818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer Flat Sur Fit 2-1/4 Flangt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152819|EAP|Custom 95152819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Drainable 1-3/4 Comfort E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Proximal Body 40mm X 20mm Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|FSC: 13; Default||Not reimbursed separately|17,976.00|FSC: 13; Default||External grouping not supported 95152821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cra Right Sizn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,619.27|FSC: 13; Default||Not reimbursed separately|17,619.27|FSC: 13; Default||External grouping not supported 95152822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Lt Non-porusc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951204466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Proximal Body 50mm X 20mm Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|FSC: 13; Default||Not reimbursed separately|17,976.00|FSC: 13; Default||External grouping not supported 95152823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Signa Cv Rp Pfc Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95152824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Rt Porus C/rc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951204467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Proximal Body 60mm X 20mm Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|FSC: 13; Default||Not reimbursed separately|17,976.00|FSC: 13; Default||External grouping not supported 95152826|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152827|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951204468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 951204469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Mini Locking Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,994.43|FSC: 13; Default||Not reimbursed separately|1,994.43|FSC: 13; Default||External grouping not supported 951204470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152836|EAP|Custom 95152836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Closure Fast 7fr X 60cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.0 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95152852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.14|FSC: 13; Default||Not reimbursed separately|1,267.14|FSC: 13; Default||External grouping not supported 951204472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.0 X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95152856|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152857|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95152859|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 7mm Do|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152860|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 6.5mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95152861|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 5.5mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152865|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152866|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951204476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152867|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 4.5mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95152868|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 7.0mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M-vizion Distal Stem 140mm X 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|FSC: 13; Default||Not reimbursed separately|9,309.00|FSC: 13; Default||External grouping not supported 95152869|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 6.5mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95152870|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 5.5mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hole Plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95152871|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Sds Genesis 4.5mmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95152873|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 5mm Diameter X 15s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152874|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 5mm Diameter X 18s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95152875|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 6mm Diameter X 15s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152876|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 9mm Diameter X 39s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95186519|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 25.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95152877|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Guide 6 French X 100cmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.02|FSC: 13; Default||Not reimbursed separately|103.02|FSC: 13; Default||External grouping not supported 95152878|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186498|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 14.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95152879|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 4 French X 100cmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95186507|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 19.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95152883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95152884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95186513|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 22.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95152885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95186514|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 22.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95152887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95152888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Right 24.0mm Diametr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95186494|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 12.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95152889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95152891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95186508|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 19.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95152892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95152893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Mini Locking Lel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,994.43|FSC: 13; Default||Not reimbursed separately|1,994.43|FSC: 13; Default||External grouping not supported 95152895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95152897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial 6.0mm X 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951204435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 16.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95152900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95152902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152903|EAP|Custom 95152903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Atk2 Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking Large Lee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95152906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 951204439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|612.00|FSC: 13; Default||Not reimbursed separately|612.00|FSC: 13; Default||External grouping not supported 95152908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95152909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95152911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partiallm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 951204441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152912|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 5 Dioptere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95152913|EAP|Custom 95152913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Water Flusher|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Multi Hole Cup 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 951204453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Fully-thm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|700.68|FSC: 13; Default||Not reimbursed separately|700.68|FSC: 13; Default||External grouping not supported 95152942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951204454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Rim Hole Cup 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|FSC: 13; Default||Not reimbursed separately|9,841.50|FSC: 13; Default||External grouping not supported 95152943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152960|EAP|Custom 95152960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Bone Biopsy 17ga X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951204000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951204001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951204002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951204003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95152971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951204004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152976|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Langston 145 Pigtail 1n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95152981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 951204006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152984|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95152985|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951204007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152986|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95152987|EAP|Custom 95152987||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Perim|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 951204008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152988|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95152989|EAP|Custom 95152989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Two 29/37fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95152990|EAP|Custom 95152990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Two 32/40fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95152991|EAP|Custom 95152991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Two 36/46fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153006|EAP|Custom 95153006||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153007|EAP|Custom 95153007||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Right Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153008|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Short Ultra Fusion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153009|EAP|Custom 95153009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Introduction Stent One As|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153010|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Locking Guide Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153012|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951204013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153013|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153014|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951204014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Collared Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.88|FSC: 13; Default||Not reimbursed separately|4,607.88|FSC: 13; Default||External grouping not supported 95153020|EAP|Custom 95153020||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Perim|1|HUMANA [1294]||HUMANA [11839]|19,185.00|FSC: 13; Default||Not reimbursed separately|19,185.00|FSC: 13; Default||External grouping not supported 951204015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153021|EAP|Custom 95153021||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Perim|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95153022|EAP|Custom 95153022||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Perim|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 951204016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153023|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153024|EAP|Custom 95153024||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Perim|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 951204017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153026|EAP|Custom 95153026||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Porcm|1|HUMANA [1294]||HUMANA [11839]|16,185.00|FSC: 13; Default||Not reimbursed separately|16,185.00|FSC: 13; Default||External grouping not supported 95153028|EAP|HCPCS L8509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Voice 20 Fr 6mm Advae|1|HUMANA [1294]||HUMANA [11839]|837.00|FSC: 13; Default||Not reimbursed separately|837.00|FSC: 13; Default||External grouping not supported 951204018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153030|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 1.0 Dioptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95153031|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plain 0 Dioptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 951204019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153032|EAP|Custom 95153032||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Porcm|1|HUMANA [1294]||HUMANA [11839]|16,185.00|FSC: 13; Default||Not reimbursed separately|16,185.00|FSC: 13; Default||External grouping not supported 95153042|EAP|Custom 95153042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Tip Brad 3.0 X 98|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153044|EAP|Custom 95153044||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Porcm|1|HUMANA [1294]||HUMANA [11839]|16,185.00|FSC: 13; Default||Not reimbursed separately|16,185.00|FSC: 13; Default||External grouping not supported 95153045|EAP|Custom 95153045||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Porcm|1|HUMANA [1294]||HUMANA [11839]|16,185.00|FSC: 13; Default||Not reimbursed separately|16,185.00|FSC: 13; Default||External grouping not supported 951204021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153046|EAP|Custom 95153046||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Mitral Porcm|1|HUMANA [1294]||HUMANA [11839]|16,185.00|FSC: 13; Default||Not reimbursed separately|16,185.00|FSC: 13; Default||External grouping not supported 95153047|EAP|Custom 95153047||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Porcm|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 951204022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153048|EAP|Custom 95153048||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Stenm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95153049|EAP|Custom 95153049||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Stenm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 951204023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153050|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153051|EAP|Custom 95153051||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Synex 20-degree 37-55mm|1|HUMANA [1294]||HUMANA [11839]|23,274.00|FSC: 13; Default||Not reimbursed separately|23,274.00|FSC: 13; Default||External grouping not supported 951204024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153055|EAP|Custom 95153055||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Classic Shaftm|1|HUMANA [1294]||HUMANA [11839]|613.44|FSC: 13; Default||Not reimbursed separately|613.44|FSC: 13; Default||External grouping not supported 95153059|EAP|Custom 95153059||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Stenm|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951204025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153060|EAP|Custom 95153060||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Stenm|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95153061|EAP|Custom 95153061||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Stenm|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951204026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Standard #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153066|EAP|Custom 95153066||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Porcm|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95153067|EAP|Custom 95153067||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Porcm|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 951204027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153068|EAP|Custom 95153068||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Porcm|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95153071|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951204028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153072|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153073|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951204029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Duofix Ha Pc Global C.a.p.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,983.00|FSC: 13; Default||Not reimbursed separately|16,983.00|FSC: 13; Default||External grouping not supported 95153081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 110mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951204030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95153082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 95mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95153084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Jones 5.6 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153085|EAP|Custom 95153085||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire K Jones 228mm|1|HUMANA [1294]||HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95153087|EAP|Custom 95153087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Stb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153099|EAP|Custom 95153099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Ignite Power Mix C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153102|EAP|Custom 95153102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Powder Hemaderm 5/bx 1 Gram|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153108|EAP|Custom 95153108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Cath Intrauterine Pressue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153114|EAP|Custom 95153114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disposable Mcgrath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking Short Lee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95153116|EAP|Custom 95153116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95153118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95125850|EAP|Custom 95125850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Peristrip Sleeve 6-firing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153119|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Wallflex 22mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 95153120|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Wallflex 22mm Diah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 95153126|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Coronary Quantum Maverick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153128|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Coronary Quantum Maverick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153129|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Liberte 4.5 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 95153130|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Liberte 5.0 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 95153140|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Moderc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95153141|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,865.00|FSC: 13; Default||Not reimbursed separately|2,865.00|FSC: 13; Default||External grouping not supported 95153142|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95153147|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 14 X 11 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95153151|EAP|Custom 95153151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 11mm Venture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tapping Self 4.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|FSC: 13; Default||Not reimbursed separately|1,170.12|FSC: 13; Default||External grouping not supported 95153154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tapping Self 4.0 X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|FSC: 13; Default||Not reimbursed separately|1,170.12|FSC: 13; Default||External grouping not supported 95153155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tapping Self 4.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|FSC: 13; Default||Not reimbursed separately|1,493.52|FSC: 13; Default||External grouping not supported 95153156|EAP|Custom 95153156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Pain Ambit Infusion Site Sc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153158|EAP|Custom 95153158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Otoprobe (for Use W)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153159|EAP|Custom 95153159||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nervl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rtm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95153161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non Porous O2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,306.00|FSC: 13; Default||Not reimbursed separately|9,306.00|FSC: 13; Default||External grouping not supported 95153162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Non Porous Profix R2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 95153163|EAP|Custom 95153163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Esophageal Sclerotherapya|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153167|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester 6 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.35|FSC: 13; Default||Not reimbursed separately|1,750.35|FSC: 13; Default||External grouping not supported 95153168|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester Round 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,371.20|FSC: 13; Default||Not reimbursed separately|2,371.20|FSC: 13; Default||External grouping not supported 95153169|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester Skirted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,725.11|FSC: 13; Default||Not reimbursed separately|5,725.11|FSC: 13; Default||External grouping not supported 95153177|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153179|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153180|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,983.62|FSC: 13; Default||Not reimbursed separately|8,983.62|FSC: 13; Default||External grouping not supported 95153207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articulize 40mm Sp4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|FSC: 13; Default||Not reimbursed separately|6,157.20|FSC: 13; Default||External grouping not supported 95153209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Right 26mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95153214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Total 8.0mm X 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95153215|EAP|Custom 95153215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Nitinol Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153216|EAP|Custom 95153216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cardiac Cath Sterile Custot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153222|EAP|Custom 95153222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ultrasound 9g (3.7mm)c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153223|EAP|Custom 95153223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ultrasound 9g (3.7mm)c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153224|EAP|Custom 95153224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ultrasound 12g (2.7mmc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153226|EAP|Custom 95153226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Needle 9g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195144|EAP|Custom 95195144||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 10cm 20mm 21.5-25mm Grtx Xcldr Cntrlt Lg Ntnl Fep|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95153228|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Identifier Biopsy Site For Use Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95153229|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Identifier Biopsy Site For Use Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|218.25|FSC: 13; Default||Not reimbursed separately|218.25|FSC: 13; Default||External grouping not supported 95153230|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153231|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195146|EAP|Custom 95195146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 3.2mm Lng Cann 5mm Scr Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153232|EAP|Custom 95153232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Ultrasound Vacuum Assisty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153233|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Identifier Biopsy Site For Use E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95153234|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 12g For Use With Thee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153238|EAP|Custom 95153238||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Exerciser Power Web Light Yellow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195150|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Gd 7fr Poly Blk 12 Lf Hrt 90d Crv Tip Attn Slct Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153240|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95153241|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95153242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking J Left 8e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95195141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Platform Rotating Crs Revision Attune Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,256.00|FSC: 13; Default||Not reimbursed separately|11,256.00|FSC: 13; Default||External grouping not supported 95153243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95153249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95153250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95153254|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ultra Ice Catheter 9f 9mhz 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Roating Platform Revision Attune Size 7 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,858.00|FSC: 13; Default||Not reimbursed separately|18,858.00|FSC: 13; Default||External grouping not supported 95153255|EAP|Custom 95153255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fluid Dock Filling Device 10 Pak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153256|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Convoy Delivery Sheath 8.5f 60.p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153257|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 34.0 Diopter Ae|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95153262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral 36mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,145.32|FSC: 13; Default||Not reimbursed separately|6,145.32|FSC: 13; Default||External grouping not supported 95195143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Knee Tibial Revision Porocoat Attune 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,872.60|FSC: 13; Default||Not reimbursed separately|13,872.60|FSC: 13; Default||External grouping not supported 95153267|EAP|Custom 95153267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 15mm Diameter Bladeless H|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular 50mm Asr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,378.45|FSC: 13; Default||Not reimbursed separately|12,378.45|FSC: 13; Default||External grouping not supported 95153273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Femoral Uni Size 45 Asr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.96|FSC: 13; Default||Not reimbursed separately|4,983.96|FSC: 13; Default||External grouping not supported 95195145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 60mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95153278|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Proxis Embolic Protection|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153282|EAP|Custom 95153282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand 30 Degree Microblater|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95126218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Coated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95153284|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 5xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153285|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 5xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 38cm 125d Fem T2 Im Lck Ti Recon Rt 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|FSC: 13; Default||Not reimbursed separately|5,266.80|FSC: 13; Default||External grouping not supported 95153287|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 6xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153288|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 7xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153292|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cope Nephrouretrostomy Ule|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.83|FSC: 13; Default||Not reimbursed separately|394.83|FSC: 13; Default||External grouping not supported 95153293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Right 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95126319|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sizing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial 6.0mm X 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95195148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 90mm Ti Fem Lg Cnn Strl Brnz T2 Recon Nl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95153295|EAP|Custom 95153295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Closure Wound Star|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153297|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153298|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153300|EAP|Custom 95153300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic 16fr K|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 13mm 360cm Sp Cndl T2 Im Lng Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95153301|EAP|Custom 95153301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic Complete Care 16fk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153302|EAP|Custom 95153302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic Complete Care 18fk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153307|EAP|Custom 95153307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rapid Kit Mer 200 W/one Stop Cok|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 24mm Dart-fire Ti Aly Ft Slf Drl St Cnn Hd Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95153314|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153315|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153316|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153317|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 28mm Dart-fire Ti Aly Ft Slf Drl St Cnn Hd Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95153318|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cool Path Med Curve|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153319|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cool Path Large Curve|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153320|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cool Path Extra Large E|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153321|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cool Path Flutter Curve|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153322|EAP|Custom 95153322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Infusion Iv Tubing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153323|EAP|Custom 95153323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Interface For Prueka|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153324|EAP|Custom 95153324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153328|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Prolapse Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95153329|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hammock Subfascial Monarc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.00|FSC: 13; Default||Not reimbursed separately|2,943.00|FSC: 13; Default||External grouping not supported 95153330|EAP|Custom 95153330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endo-hernia Reloadable 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153331|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata St Opti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95153332|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata St Opti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95153333|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata St Opti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95153334|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Riata St Opti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95153336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Esc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 95153337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Chrome 36mm 14/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|FSC: 13; Default||Not reimbursed separately|5,464.20|FSC: 13; Default||External grouping not supported 95195154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Porous Fem W/oxi Hd R3 Xlpe R3 Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|FSC: 13; Default||Not reimbursed separately|14,175.00|FSC: 13; Default||External grouping not supported 95153338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Esc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|FSC: 13; Default||Not reimbursed separately|14,424.90|FSC: 13; Default||External grouping not supported 95153339|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95153340|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95195155|EAP|Custom 95195155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Kit Vetebral 13g 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153342|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel-filled Profil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95153344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Gii With Orthocord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95153345|EAP|Custom 95153345||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Injectable Ha Bone Substitut|1|HUMANA [1294]||HUMANA [11839]|3,487.50|FSC: 13; Default||Not reimbursed separately|3,487.50|FSC: 13; Default||External grouping not supported 95195162|EAP|Custom 95195162||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Mesh Frozen 232cm Sq Sterile|1|HUMANA [1294]||HUMANA [11839]|1,777.68|FSC: 13; Default||Not reimbursed separately|1,777.68|FSC: 13; Default||External grouping not supported 95153348|EAP|Custom 95153348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Atlas 20cm Hand-switch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153349|EAP|Custom 95153349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Atlas 37cm Laparoscopic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153352|EAP|Custom 95153352||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom # 6 Xpe Mens Si|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153353|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195163|EAP|Custom 95195163||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Mesh Frozen 500cm Sq Sterile|1|HUMANA [1294]||HUMANA [11839]|2,289.06|FSC: 13; Default||Not reimbursed separately|2,289.06|FSC: 13; Default||External grouping not supported 95153355|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 33.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95153359|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 3.0 Diopt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95153361|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95153363|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Multipurpose Drainage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195164|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 1.5mm 150cm 20mm Flxb Mrk Streamlne Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153364|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Drainage 12 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153367|EAP|Custom 95153367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Set Greene 19g X 10 Cm Pl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153371|EAP|Custom 95153371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber Looped 4-0 Needle Tap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195165|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 1.5mm 150cm 40mm Flxb Mrk Streamlne Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,795.72|FSC: 13; Default||Not reimbursed separately|3,795.72|FSC: 13; Default||External grouping not supported 95153379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95153380|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95153381|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95195166|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 1.5mm 150cm 80mm Flxb Mrk Streamlne Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153382|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95153384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 1000mm Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95153385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Long Right 11 X 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,266.00|FSC: 13; Default||Not reimbursed separately|4,266.00|FSC: 13; Default||External grouping not supported 95153389|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195167|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 1.5mm 150cm 120mm Flxb Mrk Streamlne Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153390|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95153391|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95153398|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Prolapse Vault Vag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95153399|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195168|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 150cm 20mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153417|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Amplatz Super Stiff|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153421|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 16x20 Sqc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.68|FSC: 13; Default||Not reimbursed separately|93.68|FSC: 13; Default||External grouping not supported 95153422|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 12x12sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.69|FSC: 13; Default||Not reimbursed separately|93.69|FSC: 13; Default||External grouping not supported 95153423|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm 8 X16 Sqc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.68|FSC: 13; Default||Not reimbursed separately|93.68|FSC: 13; Default||External grouping not supported 95195169|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 150cm 60mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153424|EAP|Custom 95153424||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Ultra Mirage Full Face Ma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153425|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Dura-flow Hemodialysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95153426|EAP|Custom 95153426||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Nasal Swift Ii Mirage I|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153427|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Dura-flow Hemodialysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95195170|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 150cm 120mm Flxb Mrk Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153430|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fetch Aspiration 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153432|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153433|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195171|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 20mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153435|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sailor Plus 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153436|EAP|Custom 95153436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinforcem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153437|EAP|Custom 95153437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Vascular Digit Middle Fingm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195172|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 40mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153438|EAP|Custom 95153438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Vascular Digit Large Fingem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153439|EAP|Custom 95153439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Vascular Digit Large Peniam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular 12mm X 1.0 X 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,842.00|FSC: 13; Default||Not reimbursed separately|7,842.00|FSC: 13; Default||External grouping not supported 95153443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Taper 8.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95195173|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 60mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153444|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153445|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Regatta Floppy Middlem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153446|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Regatta Middleweightm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153447|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Regatta Middleweight M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195174|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 80mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153448|EAP|Custom 95153448||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nerve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153451|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hickman Triple Lumen Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.15|FSC: 13; Default||Not reimbursed separately|1,593.15|FSC: 13; Default||External grouping not supported 95186515|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 23.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95153456|EAP|Custom 95153456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Peri-loc 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195175|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 20mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153457|EAP|Custom 95153457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Connect Quick 2.7mm St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186497|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 14.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95153458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95153461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95153462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Locking Right 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,799.00|FSC: 13; Default||Not reimbursed separately|2,799.00|FSC: 13; Default||External grouping not supported 95153463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lp 3.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 80168880|EAP|CPT® 10035||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Localization Device Incl Imaging 1st Lesion|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95153464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95195176|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 60mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95153466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 80168891|EAP|CPT® 10036||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Localization Device Incl Imaging Each Add Lesion|1|HUMANA [1294]||HUMANA [11839]|1,014.86|FSC: 13; Default||Not reimbursed separately|1,014.86|FSC: 13; Default||External grouping not supported 80168902|EAP|CPT® 31653||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy Incl Fluoro Ebus Guided Sampling 3 Or More Lymph Nodes|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 95153470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Sz-3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 95153471|EAP|Custom 95153471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management On-q 400r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168913|EAP|CPT® 31654||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch Incl Fluoro Ebus Bronchoscopic Dx Or Tx Peripheral Lesions|1|HUMANA [1294]||HUMANA [11839]|2,421.00|FSC: 13; Default||Not reimbursed separately|2,421.00|FSC: 13; Default||External grouping not supported 95153475|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester Round 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,771.79|FSC: 13; Default||Not reimbursed separately|2,771.79|FSC: 13; Default||External grouping not supported 95195177|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 80mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153476|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester Skirted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,327.93|FSC: 13; Default||Not reimbursed separately|3,327.93|FSC: 13; Default||External grouping not supported 80168924|EAP|CPT® 39401||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mediastinoscopy Incl Biopsy Of Mediasinal Mass|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95153477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,094.35|FSC: 13; Default||Not reimbursed separately|3,094.35|FSC: 13; Default||External grouping not supported 80168935|EAP|CPT® 39402||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mediastinoscopy W Lymph Node Biopsy|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95153480|EAP|Custom 95153480||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nervl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153483|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80168946|EAP|CPT® 43210||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Fundoplasty Partial Or Complete Incl Duodenoscopy|1|HUMANA [1294]||HUMANA [11839]|23,973.33|FSC: 13; Default||Not reimbursed separately|23,973.33|FSC: 13; Default||External grouping not supported 95153484|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153485|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80168957|EAP|CPT® 47531||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Px For Cholangiography Comp Dx Incl Image Guide Existing Access|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153486|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153487|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80168968|EAP|CPT® 47532||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Px For Cholangiography Complete Dx Incl Image Guide New Access|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153488|EAP|Custom 95153488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tearaway Introducer 8fr .03e|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153490|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80168979|EAP|CPT® 47533||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Biliary Drain Cath Incl Dx Cholangiography Incl Imaging Ext|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153491|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153492|EAP|Custom 95153492||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Temporary Pacer 6 Foot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168980|EAP|CPT® 47534||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB PLACE BILIARY DRAIN CATH INCL DX CHOLANGIOGRAPHY INCL IMAGE INT EXT|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153494|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95192590|EAP|HCPCS Q4159||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue L2.5 Cm X W2.5 Cm Affinity|1|HUMANA [1294]||HUMANA [11839]|497.50|FSC: 13; Default||Not reimbursed separately|497.50|FSC: 13; Default||External grouping not supported 95153496|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 80168991|EAP|CPT® 47535||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Conver Ext Bili Drain Cath To Int-ext Incl Dx Cholangio Incl Image|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153497|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 95153498|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 80169002|EAP|CPT® 47536||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Exchange Of Bili Drain Catheter Incl Dx Cholangio Incl Imaging|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95192591|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue 1.6 Sq Cm Nushield|1|HUMANA [1294]||HUMANA [11839]|592.50|FSC: 13; Default||Not reimbursed separately|592.50|FSC: 13; Default||External grouping not supported 95153500|EAP|Custom 95153500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prismasate Bgk 2/0 2 Each/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169013|EAP|CPT® 47537||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Bili Drain Cath Req Fluoro Incl Dx Cholangio Incl Image|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 80169024|EAP|CPT® 47538||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stent Bile Duct Dx Cholan W Image Dilat Cath Exch Rem Each Stent|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95192592|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Nushield L3 Cm X W2 Cm Ortho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.50|FSC: 13; Default||Not reimbursed separately|397.50|FSC: 13; Default||External grouping not supported 95153506|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Stiff Extra Curve Dom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80169035|EAP|CPT® 47539||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stent Bile Duct Dx Cholan Dilat Cath Exch Rem Each Stent New|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95153508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head S-rom Metal 36mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|FSC: 13; Default||Not reimbursed separately|4,004.70|FSC: 13; Default||External grouping not supported 95153515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Proximal Ztt S-rom 16f Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 80169046|EAP|CPT® 47540||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stent Bile Duct Dx Cholan Dilat Cath Rem Ea Stent New Bili Drain|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95153520|EAP|Custom 95153520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinforcmr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192593|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Nushield L4 Cm X W2 Cm Ortho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|356.25|FSC: 13; Default||Not reimbursed separately|356.25|FSC: 13; Default||External grouping not supported 95153521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Pushlock 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|FSC: 13; Default||Not reimbursed separately|918.00|FSC: 13; Default||External grouping not supported 80169057|EAP|CPT® 47541||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Plmt Access Bil Tree Sm Bowel New Access|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95153522|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 250cc Style-133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|FSC: 13; Default||Not reimbursed separately|3,885.00|FSC: 13; Default||External grouping not supported 95153523|EAP|Custom 95153523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor 02 For Metamax 3b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169068|EAP|CPT® 47542||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Balloon Dilation Of Bili Duct Of Ampulla Incl Imaging Guidance|1|HUMANA [1294]||HUMANA [11839]|3,202.14|FSC: 13; Default||Not reimbursed separately|3,202.14|FSC: 13; Default||External grouping not supported 95153526|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95153527|EAP|Custom 95153527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Cutting Pks 5mm X 33cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169079|EAP|CPT® 47543||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endoluminal Bx Of Bili Tree Any Meth Incl Imag Guid Single Or Multi|1|HUMANA [1294]||HUMANA [11839]|3,369.00|FSC: 13; Default||Not reimbursed separately|3,369.00|FSC: 13; Default||External grouping not supported 95153528|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95153529|EAP|Custom 95153529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Cutting Pks 10mm X 33cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192594|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Nushield L4 Cm X W3 Cm Ortho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 95153530|EAP|Custom 95153530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Plasma Spatula Pks 33cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169080|EAP|CPT® 47544||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Cali Debris Bili Duct Gb Of Cali Any Method Image Guide|1|HUMANA [1294]||HUMANA [11839]|3,695.00|FSC: 13; Default||Not reimbursed separately|3,695.00|FSC: 13; Default||External grouping not supported 95153531|EAP|Custom 95153531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Dissecting Lyons 33cm Pks|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153532|EAP|Custom 95153532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Fiapc Diameter 2.3mm 6.9fm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169091|EAP|CPT® 50430||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inject Ante Nephrost Urterogram Complete Dx Incl Image New Access|1|HUMANA [1294]||HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 95153533|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall Biliary Rx 10 X 60 X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,369.62|FSC: 13; Default||Not reimbursed separately|4,369.62|FSC: 13; Default||External grouping not supported 95192595|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Nushield L4 Cm X W4 Cm Allograft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.75|FSC: 13; Default||Not reimbursed separately|348.75|FSC: 13; Default||External grouping not supported 95153540|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80169102|EAP|CPT® 50431||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inject Ante Nephrost Urtero Complete Dx Incl Image Existing Access|1|HUMANA [1294]||HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 95153541|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195196|EAP|Custom 95195196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemospray Endoscopic Hemostat Hemo-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Monoblock Lps Sz-5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|FSC: 13; Default||Not reimbursed separately|12,503.25|FSC: 13; Default||External grouping not supported 80169113|EAP|CPT® 50432||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Nephrostomy Cath Incl Dx Nephrost And Or Uretero Image Guide|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95192596|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Synthetic Tissue L6 Cm X W4 Cm Ortho Nushield|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|325.00|FSC: 13; Default||Not reimbursed separately|325.00|FSC: 13; Default||External grouping not supported 95153545|EAP|Custom 95153545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Central Venous Triple R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169124|EAP|CPT® 50433||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Nephroureter Cath Dx Nephrosto Uretero Image Guide New Access|1|HUMANA [1294]||HUMANA [11839]|9,318.17|FSC: 13; Default||Not reimbursed separately|9,318.17|FSC: 13; Default||External grouping not supported 95153547|EAP|Custom 95153547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Devices Temno Evolution M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153548|EAP|Custom 95153548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Device Temno Evolution 1m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169135|EAP|CPT® 50434||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cnvrt Nephrostomy Cath Dx Nephrost Uretero Image Guide Exist Access|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95153549|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192597|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Nushield L6 Cm X W6 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.83|FSC: 13; Default||Not reimbursed separately|295.83|FSC: 13; Default||External grouping not supported 95153550|EAP|Custom 95153550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Device Temno Evolution 2m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169146|EAP|CPT® 50435||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Exchng Nephrostomy Cath I Nephrosto Uretero Imaging Guidance|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95153551|EAP|Custom 95153551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Device Temno Evolution 2m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195197|EAP|Custom 95195197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemospray Endoscopic Hemostat Hemo-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non Porous P3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 80169157|EAP|CPT® 50606||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endoluminal Biopsy Of Ureter Renal Pelvis Non-endo Incl Image|1|HUMANA [1294]||HUMANA [11839]|2,834.15|FSC: 13; Default||Not reimbursed separately|2,834.15|FSC: 13; Default||External grouping not supported 95153554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Super With Orthocord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.00|FSC: 13; Default||Not reimbursed separately|1,986.00|FSC: 13; Default||External grouping not supported 62064890|EAP|CPT® 80349||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Marijuana Metabolite, Ql, Umb Cord-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.00|FSC: 13; Default||Not reimbursed separately|55.00|FSC: 13; Default||External grouping not supported 95153555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 10 Degree X 3 36m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 80169168|EAP|CPT® 50693||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ureteral Stent Dx Nephrosto Uretero Image Guide Via Nephrostomy|1|HUMANA [1294]||HUMANA [11839]|9,318.17|FSC: 13; Default||Not reimbursed separately|9,318.17|FSC: 13; Default||External grouping not supported 95153556|EAP|Custom 95153556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Disposable Q-rid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153557|EAP|Custom 95153557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Disposable Q-rid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169179|EAP|CPT® 50694||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ureteral Stent W Dx Image Guide New Access Wo Sep Nephrosto Cath|1|HUMANA [1294]||HUMANA [11839]|9,318.17|FSC: 13; Default||Not reimbursed separately|9,318.17|FSC: 13; Default||External grouping not supported 95153559|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.1mm X 6 Thread Parl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Rattler 3mm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.00|FSC: 13; Default||Not reimbursed separately|663.00|FSC: 13; Default||External grouping not supported 80169180|EAP|CPT® 50695||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ureteral Stent W Dx Image Guide New Access W Sep Nephrostomy Cath|1|HUMANA [1294]||HUMANA [11839]|9,318.17|FSC: 13; Default||Not reimbursed separately|9,318.17|FSC: 13; Default||External grouping not supported 95153561|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95195192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 55mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95153562|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95153573|EAP|HCPCS L8509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Voice 20 Fr 10mm Adve|1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 80169191|EAP|CPT® 50705||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ureteral Embolization Or Occlusion Incl Imaging Guidance|1|HUMANA [1294]||HUMANA [11839]|3,081.50|FSC: 13; Default||Not reimbursed separately|3,081.50|FSC: 13; Default||External grouping not supported 95153574|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153575|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80169202|EAP|CPT® 50706||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Balloon Dilation Ureteral Stricture Incl Imaging Guidance|1|HUMANA [1294]||HUMANA [11839]|2,826.00|FSC: 13; Default||Not reimbursed separately|2,826.00|FSC: 13; Default||External grouping not supported 95153576|EAP|Custom 95153576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Temno Evolr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064900|EAP|CPT® 80349||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Marijuana Metabolite, Ql, Umb Cord-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.00|FSC: 13; Default||Not reimbursed separately|55.00|FSC: 13; Default||External grouping not supported 95153577|EAP|Custom 95153577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Temno Evolm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169213|EAP|CPT® 61650||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Prolonged Admin Of Rx Agent 1st|1|HUMANA [1294]||HUMANA [11839]|10,268.00|FSC: 13; Default||Not reimbursed separately|10,268.00|FSC: 13; Default||External grouping not supported 95153578|EAP|Custom 95153578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Temno Evolr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 7.5mm 35mm Rsrfcng Gen Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,556.80|FSC: 13; Default||Not reimbursed separately|3,556.80|FSC: 13; Default||External grouping not supported 95153579|EAP|Custom 95153579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Temno Evolr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169224|EAP|CPT® 61651||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Prolonged Admin Of Rx Agent Add|1|HUMANA [1294]||HUMANA [11839]|3,065.45|FSC: 13; Default||Not reimbursed separately|3,065.45|FSC: 13; Default||External grouping not supported 95153580|EAP|Custom 95153580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Temno Evolm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153581|EAP|Custom 95153581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Temno Evolr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169235|EAP|CPT® 64461||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Paravertebral Block Thoracic Single Inject Site Incl Image Guide|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95153585|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester Skirted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|FSC: 13; Default||Not reimbursed separately|1,830.00|FSC: 13; Default||External grouping not supported 95153586|EAP|Custom 95153586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Pilot Ao Short 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169246|EAP|CPT® 64462||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Paravertebral Block Thoracic Add Inject Sites Incl Image Guide|1|HUMANA [1294]||HUMANA [11839]|1,101.00|FSC: 13; Default||Not reimbursed separately|1,101.00|FSC: 13; Default||External grouping not supported 95153587|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Lead Percutaneous Vah|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153588|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Thrombectomy Angiojet Spirom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80169257|EAP|CPT® 64463||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Paravertebral Block Thoracic Continuous Infusion By Cath|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95153589|EAP|Custom 95153589||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Guide Tip Ball 3mm X 1000mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cap Hex Int 5.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|FSC: 13; Default||Not reimbursed separately|609.00|FSC: 13; Default||External grouping not supported 80169268|EAP|CPT® 69209||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Impacted Cerumen Using Irrigation Lavage Unilateral|1|HUMANA [1294]||HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 95153591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cap Hex Int 5.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|FSC: 13; Default||Not reimbursed separately|609.00|FSC: 13; Default||External grouping not supported 95195194|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Bd Mn Fenestrated Proximal30x109m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95153592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cap Hex Int 5.0mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|FSC: 13; Default||Not reimbursed separately|609.00|FSC: 13; Default||External grouping not supported 80169279|EAP|CPT® 72081||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Thoracic And Lumbar Skull Cervical And Sacral Spine 1 View|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95153593|EAP|Custom 95153593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Removal Catheter Nerve Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline Titanium Lordotic L50 Mm Od5.5 Mm Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95153603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Option Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 80169280|EAP|CPT® 72082||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Thoracic And Lumbar Skull Cervical Sacral Spine 2 Or 3 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95153604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Viscosity Low Plus G Palr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95153605|EAP|Custom 95153605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Circular Single-use 25ma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169291|EAP|CPT® 72083||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Thoracic And Lumbar Skull Cervical Sacral Spine 4 Or 5 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95153607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ant 6mm X 55mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95192599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline Titanium Lordotic L55 Mm Od5.5 Mm Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95153608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 50mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95153609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7mm X 55mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95195187|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 6mm 19mm 80cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95153610|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80169313|EAP|CPT® 73501||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Hip, Unilateral, With Pelvis 1 View|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95153611|EAP|Custom 95153611||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stackable Medium|1|HUMANA [1294]||HUMANA [11839]|4,905.00|FSC: 13; Default||Not reimbursed separately|4,905.00|FSC: 13; Default||External grouping not supported 95192600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 65mm Syndesmotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95153612|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Tag 40mm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,000.00|FSC: 13; Default||Not reimbursed separately|33,000.00|FSC: 13; Default||External grouping not supported 80169324|EAP|CPT® 73502||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Hip, Unilateral, With Pelvis 2-3 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95153613|EAP|Custom 95153613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Lobe-tri Gore|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153614|EAP|Custom 95153614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Gore 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153616|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Vascular Polyester Km|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|FSC: 13; Default||Not reimbursed separately|1,482.00|FSC: 13; Default||External grouping not supported 95192601|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx Silicone L100 Mm L90 Cm Od19 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95153617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Xlk Curved #4 10mm Sigma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 80169346|EAP|CPT® 73521||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Hips, Bilateral, With Pelvis 2 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95153618|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195188|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 7mm 19mm 80cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95153619|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80169357|EAP|CPT® 73522||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Hips, Bilateral, With Pelvis 3-4 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95153620|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192634|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Ellipse L15 Cm X W10 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|FSC: 13; Default||Not reimbursed separately|1,770.00|FSC: 13; Default||External grouping not supported 95153621|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153622|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153623|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular17.5 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80169379|EAP|CPT® 73551||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Femur 1 View|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95153624|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153628|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioimplant Fx Orthoadapt 4cm X M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,395.00|FSC: 13; Default||Not reimbursed separately|7,395.00|FSC: 13; Default||External grouping not supported 80169380|EAP|CPT® 73552||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Femur Minimum 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95153629|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95153630|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95153637|EAP|Custom 95153637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Fusion Extraction 2cm X M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continuous 5.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95153638|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153642|EAP|Custom 95153642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Fusion Extraction 3cm X M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186541|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Iconix 2 With Intellibraid Technology 2.3mm With 2 St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|FSC: 13; Default||Not reimbursed separately|1,080.00|FSC: 13; Default||External grouping not supported 95153643|EAP|Custom 95153643||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Web Extraction 7fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153644|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95186542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 36mmx6mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95153645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Versalok With Orthocord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95153647|EAP|HCPCS C1898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Bipolar Permanent Pacing 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95186539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Monoblock Rsp Sz 6 175mm Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95153650|EAP|Custom 95153650||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Padding Cell Foam Closed 1/8 X6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153653|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 2.0 Diopte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95186538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Humeral Rsp Std Sz 36mm +4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95153659|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153662|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter At|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95153663|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95153664|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 15-18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153665|EAP|Custom 95153665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Mr Ghiatas Beaded Breast 2m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153667|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Movable Core Taperedh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153669|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtremem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153670|EAP|Custom 95153670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Web Extraction 7frx23cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153671|EAP|Custom 95153671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Lithotriptor Conquest 8frm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186557|EAP|Custom 95186557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Talar Sz 1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95186552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutwist Acutrak Compression 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95153678|EAP|Custom 95153678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade 40-degree Rad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutwist Acutrak Compression 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95153679|EAP|Custom 95153679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Tricut 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195189|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 8mm 19mm 80cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95153681|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Double 2-hole 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Lockt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,337.55|FSC: 13; Default||Not reimbursed separately|4,337.55|FSC: 13; Default||External grouping not supported 95153684|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tibial Infinity Sz 4 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,471.00|FSC: 13; Default||Not reimbursed separately|18,471.00|FSC: 13; Default||External grouping not supported 95153685|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153686|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Talar Infinity Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|FSC: 13; Default||Not reimbursed separately|16,269.00|FSC: 13; Default||External grouping not supported 95153687|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153688|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz 4-6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|FSC: 13; Default||Not reimbursed separately|6,468.00|FSC: 13; Default||External grouping not supported 95153689|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Bipolar Hip Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95153690|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186543|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 5 X 40 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153691|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195190|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 9mm 19mm 80cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95153692|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186550|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 6 X 120 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153693|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Unicondylar Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.00|FSC: 13; Default||Not reimbursed separately|8,775.00|FSC: 13; Default||External grouping not supported 95153694|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186548|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 6 X 60 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153695|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153696|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186545|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 5 X 100 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153697|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Port-a-cath Power Pac E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95192658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Construct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95153698|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Port-a-cath Power Pac E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95186547|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 6 X 40 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153699|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195191|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 10mm 19mm 80cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95153700|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Port-a-cath Power Pac E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95186546|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 5 X 120 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153701|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95153702|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186551|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 6 X 150 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153703|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153704|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186544|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 5 X 60 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153705|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95153706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecrenon Locking 13-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95186549|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 6 X 100 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 95153707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95153708|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Maverick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195178|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 150cm 20mm Otw 4fr Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153709|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Liberte|1|HUMANA [1294]||HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95192661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Bipolar Hip Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 95153710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|FSC: 13; Default||Not reimbursed separately|258.00|FSC: 13; Default||External grouping not supported 95153711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95191433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 2.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95153712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95195179|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 150cm 40mm Otw 4fr Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153714|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Monste Headed Short Thread 3.0 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95153715|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Virtuoso Vr Singld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,245.00|FSC: 13; Default||Not reimbursed separately|43,245.00|FSC: 13; Default||External grouping not supported 95153716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Modular Tm Multiholed 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95192649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking Bg 2.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95153722|EAP|Custom 95153722||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Exerciser Power Web Original Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195180|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 150cm 60mm Otw 4fr Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153723|EAP|Custom 95153723||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Exerciser Power Web Original Hen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Promo Left Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,202.00|FSC: 13; Default||Not reimbursed separately|5,202.00|FSC: 13; Default||External grouping not supported 95153724|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153725|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 12mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95153726|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195181|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 150cm 80mm Otw 4fr Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153727|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192647|EAP|Custom 95192647||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Verte-stack Cornerstone Psr Peek-optima 14x14x8mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95153728|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153729|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192652|EAP|Custom 95192652||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14 X 16 X 12 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95153730|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195182|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 150cm 120mm Otw 4fr Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153731|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192653|EAP|Custom 95192653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Taper L7 Cm Od1.6 Mm Special Burr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153732|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153733|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192654|EAP|Custom 95192654||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Halter Head Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153736|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Allom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 95195183|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 150cm 40mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153741|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192655|EAP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Ambiodry2 Ambiodisk Membrane Od12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95153742|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153743|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192656|EAP|Custom 95192656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Dissection Colorado L3 Cm Straight Sleeve Latex Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153744|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195184|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 150cm 60mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153745|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153746|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153747|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153750|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153752|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195185|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 150cm 80mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153754|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153756|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153757|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195186|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 150cm 120mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153758|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153759|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153760|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153761|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153762|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153763|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153764|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153765|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153766|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153767|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153768|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153769|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153770|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153771|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153772|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153773|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153774|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153775|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153776|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153777|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153778|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153779|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153781|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153782|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153783|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153784|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153785|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153786|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153787|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 22mm 3.5mm Scr 4 Hl Lck Evos Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.80|FSC: 13; Default||Not reimbursed separately|250.80|FSC: 13; Default||External grouping not supported 95153788|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153789|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153790|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195199|EAP|Custom 95195199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sut Fbrwr 2-0 18in Brd 3/8 Crc Tp Bl Nabsb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153791|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153792|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153793|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153794|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Metacarpophangeal Mcp Sr Size Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95153795|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153796|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153797|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153798|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 50mm Cnn Blnt Tip Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95153799|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153800|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153801|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153802|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 28mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95153803|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153804|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153805|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153806|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 28mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95153807|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153808|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153809|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153810|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153811|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153812|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153813|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153814|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153815|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153816|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153817|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153818|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80171566|EAP|CPT® 11982||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Non Biodegradable Drug Delivery Implant|1|HUMANA [1294]||HUMANA [11839]|1,122.39|FSC: 13; Default||Not reimbursed separately|1,122.39|FSC: 13; Default||External grouping not supported 95153819|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153820|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153821|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95153826|EAP|Custom 95153826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Assembly Sleeve Micro 0.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153827|EAP|Custom 95153827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Stand Alone 45 Degree Kelmam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153828|EAP|Custom 95153828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit Clearcut 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153829|EAP|Custom 95153829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Tipless Sleevelm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavical Locking Short Lee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 80171577|EAP|CPT® 93286||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Peri-procedural Device Evaluation And Programming|1|HUMANA [1294]||HUMANA [11839]|181.00|FSC: 13; Default||Not reimbursed separately|181.00|FSC: 13; Default||External grouping not supported 95153851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5md|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95153853|EAP|Custom 95153853||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Disposable Adult Spo2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153865|EAP|Custom 95153865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Pin To Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153867|EAP|Custom 95153867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Rod To Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon 5 X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95153871|EAP|Custom 95153871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hd Hum 50mm 18mm Shldr Antmic Ntrl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95153872|EAP|Custom 95153872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153873|EAP|Custom 95153873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Apex 3 X 80|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153874|EAP|Custom 95153874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Apex 4 X 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,566.46|FSC: 13; Default||Not reimbursed separately|3,566.46|FSC: 13; Default||External grouping not supported 95195206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 38mm Axsos 3 Ti Ft Canc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95153876|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153877|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Left Lcp 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,846.52|FSC: 13; Default||Not reimbursed separately|2,846.52|FSC: 13; Default||External grouping not supported 95153879|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195207|EAP|Custom 95195207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 122mm 3.5mm Ao Fit Ovr Stlr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153880|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153881|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153882|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95153883|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nl 14mm 420mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,965.00|FSC: 13; Default||Not reimbursed separately|4,965.00|FSC: 13; Default||External grouping not supported 95153884|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Height Full Proc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95153885|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Height Full Proc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95153887|EAP|Custom 95153887||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Powder Hemostatic Absorbable Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153888|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95195209|EAP|Custom 95195209||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Suturing Mechanical Fixate Tissue Band|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95153889|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95153890|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|FSC: 13; Default||Not reimbursed separately|8,205.00|FSC: 13; Default||External grouping not supported 95153892|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Allom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.63|FSC: 13; Default||Not reimbursed separately|88.63|FSC: 13; Default||External grouping not supported 95153893|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon 3.0mm Diameterl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mplant Mpj Lesser Toe Hemi 12.5mm 2nd-5th Dia Cobalt Chrome|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95153895|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Liberte 3.0 X 12|1|HUMANA [1294]||HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95153922|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Dura 4cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95153925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 2mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|387.00|FSC: 13; Default||Not reimbursed separately|387.00|FSC: 13; Default||External grouping not supported 95195212|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Cor 3cm Asahi Prowater|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 2mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|FSC: 13; Default||Not reimbursed separately|396.00|FSC: 13; Default||External grouping not supported 95153927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 2.4mm X 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95153928|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Cannulated 2.0/2.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95195213|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Cor 3cm Asahi Prowater|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153937|EAP|Custom 95153937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cushion Extremity Vac Lok Pelvig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Microfix With 3.0 Ethibod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95153942|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Intrathecal Indura Oner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,001.00|FSC: 13; Default||Not reimbursed separately|2,001.00|FSC: 13; Default||External grouping not supported 95153943|EAP|Custom 95153943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Basket Extraction 3 Fr Se|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195214|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Cor To Tip J 3cm Asahi Prowater|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153944|EAP|Custom 95153944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grasping 1.2mm 3 Nail Die|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153946|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cope Nephroureterostomy 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.83|FSC: 13; Default||Not reimbursed separately|394.83|FSC: 13; Default||External grouping not supported 95195215|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Cor To Tip J 3cm Asahi Prowater|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153947|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Palindrome Sapphire Hee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153948|EAP|Custom 95153948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Band Piezo Crystal Adulte|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153949|EAP|Custom 95153949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chamber Humidification For Hc15k|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195216|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Hbrd Radopq Strg Tip 3cm Asahi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153950|EAP|Custom 95153950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Drainage Exacta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153952|EAP|Custom 95153952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cord Lock Edm Exacta With Braidd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195217|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Cor To Tip J 3cm Asahi Prowaterflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153959|EAP|Custom 95153959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Evolve 1000. (for U)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153962|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Charging Ans|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95153963|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient Ans|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95195218|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Radopq Strg Tip J 3cm A Fldr Fc Hdrph P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153964|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Battery Rechargeable Ipg Ans|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,173.00|FSC: 13; Default||Not reimbursed separately|43,173.00|FSC: 13; Default||External grouping not supported 95153965|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Electrode Tripole Lamitrode Ansc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95153966|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Ans 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95153968|EAP|Custom 95153968||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Hana Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153970|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Male Advance|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95153971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|FSC: 13; Default||Not reimbursed separately|1,170.12|FSC: 13; Default||External grouping not supported 95153972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Locking Rt 2-hoe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,846.52|FSC: 13; Default||Not reimbursed separately|2,846.52|FSC: 13; Default||External grouping not supported 95153973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Locking Rt 4-hoe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,969.25|FSC: 13; Default||Not reimbursed separately|2,969.25|FSC: 13; Default||External grouping not supported 95153974|EAP|Custom 95153974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glide 5fr .038 100cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153975|EAP|Custom 95153975||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Fusion Extraction Lithotm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153976|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fusion Quatro Extractiom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95153984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95153986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95153987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,605.00|FSC: 13; Default||Not reimbursed separately|7,605.00|FSC: 13; Default||External grouping not supported 95153990|EAP|Custom 95153990||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Small Aso Stabilizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153991|EAP|Custom 95153991||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Xx-large Aso Stabilr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95153993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95195220|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .036in Sion Blue Str Tip Hdrph 3cm Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95153995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95153996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Trabecular Monoblock Metal M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95153997|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Liberte Bare 3.04|1|HUMANA [1294]||HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95195221|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .036in Sion Blue Str Tip Hdrph 3cm Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95153998|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Liberte Bare 3.54|1|HUMANA [1294]||HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95154000|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle 15 Ga X 11 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154001|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle 13 Ga X 11 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195222|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .036in Sion Blue J Tip Hdrph Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154002|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtremem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154003|EAP|Custom 95154003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Ercp Tandem Standard Rx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154004|EAP|Custom 95154004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Tandem Rx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154007|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Steerable Fathom 25 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195223|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .036in Sion Blue J Tip Hdrph Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 8 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95154009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 10 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95154010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 9 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95154011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 11 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95195228|EAP|Custom 95195228||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Perc 65mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95154012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 10 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95154013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 9 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95154014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Matrix 11 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95154015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 16-hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.00|FSC: 13; Default||Not reimbursed separately|738.00|FSC: 13; Default||External grouping not supported 95195231|EAP|Custom 95195231||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 50mm 5.5mm Crv Ti Cp4 Ns|1|HUMANA [1294]||HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 95154016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.00|FSC: 13; Default||Not reimbursed separately|132.00|FSC: 13; Default||External grouping not supported 95154017|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coil Quadra 7fr 22-28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.02|FSC: 13; Default||Not reimbursed separately|241.02|FSC: 13; Default||External grouping not supported 95154018|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Floor Pelvic Postt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95154020|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coil Quadra 6fr 22-28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.02|FSC: 13; Default||Not reimbursed separately|241.02|FSC: 13; Default||External grouping not supported 95154021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 3 X 10-degree 36m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95154022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Minilock With 2.0 Ethibod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95154023|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95154029|EAP|Custom 95154029||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist Right Quick Tie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 45mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95154030|EAP|Custom 95154030||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist Left Quick Tie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Left Lcp 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,969.25|FSC: 13; Default||Not reimbursed separately|2,969.25|FSC: 13; Default||External grouping not supported 95154032|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thorasic 31mm X G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,225.00|FSC: 13; Default||Not reimbursed separately|36,225.00|FSC: 13; Default||External grouping not supported 95195226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 35mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95154033|EAP|Custom 95154033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Procedure Fluid Reservoir Hm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154034|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Gore 22fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154035|EAP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dressing Wound Matrix Tunnel Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95195227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw 5.5/6.0 Solera Voyager|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|FSC: 13; Default||Not reimbursed separately|993.00|FSC: 13; Default||External grouping not supported 95154036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Lockm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,439.40|FSC: 13; Default||Not reimbursed separately|4,439.40|FSC: 13; Default||External grouping not supported 95154037|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Surgical 2 X 8.50cm Prn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,783.75|FSC: 13; Default||Not reimbursed separately|15,783.75|FSC: 13; Default||External grouping not supported 95154038|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Generator Pulse Implantablen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,350.00|FSC: 13; Default||Not reimbursed separately|55,350.00|FSC: 13; Default||External grouping not supported 95154039|EAP|HCPCS C2631||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeves Suture Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.00|FSC: 13; Default||Not reimbursed separately|162.00|FSC: 13; Default||External grouping not supported 95195229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 8mm 150mm Hum Rt Prox T2 Im Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,015.00|FSC: 13; Default||Not reimbursed separately|12,015.00|FSC: 13; Default||External grouping not supported 95154040|EAP|Custom 95154040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Single Soloist Electrodem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154044|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Programmer Patient Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154048|EAP|Custom 95154048||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Charging Precision|1|HUMANA [1294]||HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 95154049|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95195230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 30mm Ti Ft Lck Strl T2 Nl Sys Unv Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95154050|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna External Patient Prograr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154051|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary 10 X 5 Pigtail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.58|FSC: 13; Default||Not reimbursed separately|164.58|FSC: 13; Default||External grouping not supported 95195232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 12mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154054|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiojet Ultra Xmi Thrr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154060|EAP|Custom 95154060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Spectra Therm 50/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154061|EAP|Custom 95154061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Reaming 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 14mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154063|EAP|Custom 95154063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Gun Evolution|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154064|EAP|Custom 95154064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biopsy Gun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154066|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 11mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154067|EAP|Custom 95154067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Boot And Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154068|EAP|Custom 95154068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Rx Breeze Inflation Encoe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154071|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Pump Sutureless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95154072|EAP|Custom 95154072||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Revision Pump Segment|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95195235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 10mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154077|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall Rx Single 10fr X 40me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,217.90|FSC: 13; Default||Not reimbursed separately|5,217.90|FSC: 13; Default||External grouping not supported 95154079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 4mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Taper 9.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,548.00|FSC: 13; Default||Not reimbursed separately|1,548.00|FSC: 13; Default||External grouping not supported 95154081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular 2.0 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95195236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 12mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154086|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Carotid Rx Acculink 9.0mme|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95154090|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Fielder 180cm Lh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95154092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Acetabular Durom Meta4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|FSC: 13; Default||Not reimbursed separately|8,098.56|FSC: 13; Default||External grouping not supported 95195237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 11mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ldh Metasul Cocr Taper 18/8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|FSC: 13; Default||Not reimbursed separately|2,261.79|FSC: 13; Default||External grouping not supported 95154099|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,150.00|FSC: 13; Default||Not reimbursed separately|9,150.00|FSC: 13; Default||External grouping not supported 95154103|EAP|Custom 95154103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .076|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154106|EAP|Custom 95154106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dental Walled Straight M|1|HUMANA [1294]||HUMANA [11839]|998.25|FSC: 13; Default||Not reimbursed separately|998.25|FSC: 13; Default||External grouping not supported 95195238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 10mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154108|EAP|Custom 95154108||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dental Walled Straight M|1|HUMANA [1294]||HUMANA [11839]|998.25|FSC: 13; Default||Not reimbursed separately|998.25|FSC: 13; Default||External grouping not supported 95154109|EAP|Custom 95154109||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dental Walled Straight M|1|HUMANA [1294]||HUMANA [11839]|1,028.25|FSC: 13; Default||Not reimbursed separately|1,028.25|FSC: 13; Default||External grouping not supported 95154110|EAP|Custom 95154110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dental Walled Straight M|1|HUMANA [1294]||HUMANA [11839]|1,028.25|FSC: 13; Default||Not reimbursed separately|1,028.25|FSC: 13; Default||External grouping not supported 95154111|EAP|Custom 95154111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collar Healing 4.0|1|HUMANA [1294]||HUMANA [11839]|170.25|FSC: 13; Default||Not reimbursed separately|170.25|FSC: 13; Default||External grouping not supported 95195239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 11mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154113|EAP|Custom 95154113||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collar Healing 5.0|1|HUMANA [1294]||HUMANA [11839]|170.25|FSC: 13; Default||Not reimbursed separately|170.25|FSC: 13; Default||External grouping not supported 95154119|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95154120|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95154121|EAP|Custom 95154121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Tissue Ultrasound 17 X 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 13mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 5mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 6mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 7mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 16mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|FSC: 13; Default||Not reimbursed separately|8,012.01|FSC: 13; Default||External grouping not supported 95154137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 4mm Extendedt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 5mm Extendedt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95195241|EAP|Custom 95195241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patient Controller Magnet|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95154139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 6mm Extendedt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|FSC: 13; Default||Not reimbursed separately|8,012.01|FSC: 13; Default||External grouping not supported 95154142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 7mm Extendedt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 9mm Extendedt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95195242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 50 Mm Mini Evos T8 Fl Thd Cntsnk Lckng Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|FSC: 13; Default||Not reimbursed separately|226.05|FSC: 13; Default||External grouping not supported 95154144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 10mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper 16mm Extendet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|FSC: 13; Default||Not reimbursed separately|8,578.92|FSC: 13; Default||External grouping not supported 95154147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Si9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95154148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acet Monoblock 10-deg 22mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|FSC: 13; Default||Not reimbursed separately|9,266.10|FSC: 13; Default||External grouping not supported 95195243|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Ip 5.3ah Scs Mri Elfu Red Gbl Pr Nsw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,500.00|FSC: 13; Default||Not reimbursed separately|52,500.00|FSC: 13; Default||External grouping not supported 95154149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.42|FSC: 13; Default||Not reimbursed separately|861.42|FSC: 13; Default||External grouping not supported 95154150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 24 Hole 1.0mm Tim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|FSC: 13; Default||Not reimbursed separately|864.00|FSC: 13; Default||External grouping not supported 95154151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 1.0mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95154153|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95195244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone 8x8x8mm Superelastic Easyclip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,265.00|FSC: 13; Default||Not reimbursed separately|5,265.00|FSC: 13; Default||External grouping not supported 95154154|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95154155|EAP|Custom 95154155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device 3 Xpose Axius Guidant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154156|EAP|Custom 95154156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Stabilizer Vacuum Suv Act|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|FSC: 13; Default||Not reimbursed separately|7,770.00|FSC: 13; Default||External grouping not supported 95195245|EAP|Custom 95195245||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grf Evas 7cm 16mm Gore Xcldr Ilc Intnl Cmpnt Aaa|1|HUMANA [1294]||HUMANA [11839]|9,456.00|FSC: 13; Default||Not reimbursed separately|9,456.00|FSC: 13; Default||External grouping not supported 95154158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Fin Crosslink 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,263.50|FSC: 13; Default||Not reimbursed separately|5,263.50|FSC: 13; Default||External grouping not supported 95154159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|FSC: 13; Default||Not reimbursed separately|7,770.00|FSC: 13; Default||External grouping not supported 95154161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95195246|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 12.7cm Mentr Memorygel P4.4cm Mdrt + Prfl Rnd Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95154162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgeg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95195247|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 13.1cm Mentr Memorygel P4.5cm Mdrt + Prfl Rnd Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95154165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|FSC: 13; Default||Not reimbursed separately|7,770.00|FSC: 13; Default||External grouping not supported 95154167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95195249|EAP|Custom 95195249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 4.4cm Md Profile Round Od12.7cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95154169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgeg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|FSC: 13; Default||Not reimbursed separately|7,770.00|FSC: 13; Default||External grouping not supported 95195250|EAP|Custom 95195250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 4.7cm Md Profile Round Od13.3cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95195251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 14mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95195252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 10mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Gsf Lsp Flex T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,332.50|FSC: 13; Default||Not reimbursed separately|8,332.50|FSC: 13; Default||External grouping not supported 95154187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95195253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 14mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexges|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95154191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|FSC: 13; Default||Not reimbursed separately|7,098.00|FSC: 13; Default||External grouping not supported 95195255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 13mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95195248|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 13.3cm Mentr Memorygel P4.7cm Mdrt + Prfl Rnd Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95154199|EAP|Custom 95154199||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoproshtesis Exculder Extendem|1|HUMANA [1294]||HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95154200|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Adapta Single Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95195278|EAP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Nushield L3 Cm X W3 Cm Ortho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.00|FSC: 13; Default||Not reimbursed separately|296.00|FSC: 13; Default||External grouping not supported 95154206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Si7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95154210|EAP|Custom 95154210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Compact Vacuum Mixing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195256|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Fielder Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154219|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cps Direct Slittable 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154220|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulator Cps Aim 90 Curve 71 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195257|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Fielder Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154222|EAP|Custom 95154222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.8mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.71|FSC: 13; Default||Not reimbursed separately|2,800.71|FSC: 13; Default||External grouping not supported 95195258|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Fielder J Tip Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 3 X 10-degree 36m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95195259|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Fielder J Tip Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95154233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Surface Articular Humeral M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,506.00|FSC: 13; Default||Not reimbursed separately|4,506.00|FSC: 13; Default||External grouping not supported 95195260|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Fielder Fc Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154235|EAP|Custom 95154235||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Back Posture Low Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154236|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter White Lumax 7.0 Fr X 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195261|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .014in Fielder Xt-a Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154238|EAP|Custom 95154238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Grollman 7.0 Fr X 38 C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154241|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 32mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,613.00|FSC: 13; Default||Not reimbursed separately|17,613.00|FSC: 13; Default||External grouping not supported 95195262|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Fielder Xt-a Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154242|EAP|Custom 95154242||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Nylatex Wrap 2-1/2 X 48|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154243|EAP|Custom 95154243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Nylatex Wrap 6 X 48|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locking Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95154253|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Passive Fixatuon Quadrupol6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95195263|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .014in Fielder Xt-r Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154254|EAP|Custom 95154254||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Inferior H Buttress E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154255|EAP|Custom 95154255||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Inferior H Buttress E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154256|EAP|Custom 95154256||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Inferior H Buttress E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154257|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195264|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Fielder Xt-r Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154261|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Triple Lumen 6 Fr Powem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154265|EAP|Custom 95154265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lithotriper Holmium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking 4-hole Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95154267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking 4-hole Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95195265|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Radopq Strg Tip 11cm Asahi Mrclbrs 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 8mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95154273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95154274|EAP|Custom 95154274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95195266|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Radopq Strg Tip 11cm Asahi Mrclbrs 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Pin Tornier|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95154277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Tornier Sz-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,470.00|FSC: 13; Default||Not reimbursed separately|13,470.00|FSC: 13; Default||External grouping not supported 95154278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Tornier Sz 0-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95154279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Left Tornier Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,900.00|FSC: 13; Default||Not reimbursed separately|9,900.00|FSC: 13; Default||External grouping not supported 95195267|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Radopq Strg Tip 20cm A Cfnz Pro 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154280|EAP|Custom 95154280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Tornier|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154281|EAP|Custom 95154281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Tornier|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195268|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Radopq Strg Tip 20cm A Cfnz Pro 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154286|EAP|HCPCS E0114||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Crutch Aluminum Child 3 9 - 4 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154287|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Passive Fixatuon Quadrupol8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95154292|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Palmaz Genesis Trh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95195270|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Cor To Tip Strg 16cm A Fldr Xt Hdrph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195271|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Strg 3cm Sion Asahi Ss Hdrph Disp Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195272|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Strg Ultimatebros 3 Ss Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154315|EAP|Custom 95154315||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Bone Cement Avax|1|HUMANA [1294]||HUMANA [11839]|2,080.80|FSC: 13; Default||Not reimbursed separately|2,080.80|FSC: 13; Default||External grouping not supported 95195273|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Strg Ultimatebros 3 Ss Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154316|EAP|Custom 95154316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Procedure Avamax With Cemet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154317|EAP|Custom 95154317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Match Ground Bevel Avamam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154318|EAP|Custom 95154318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Prep Avaprep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154325|EAP|Custom 95154325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Fine Curved 20-degree 115mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195274|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Strg Ultimatebros 3 J Tip Ss Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154326|EAP|Custom 95154326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Round 1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154328|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stretch-coil Bifurcatm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.00|FSC: 13; Default||Not reimbursed separately|4,530.00|FSC: 13; Default||External grouping not supported 95154329|EAP|Custom 95154329||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tarsi Sinus Hyprocore S7|1|HUMANA [1294]||HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 95154330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Profyle 1.2 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|FSC: 13; Default||Not reimbursed separately|183.60|FSC: 13; Default||External grouping not supported 95195275|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Strg Ultimatebros 3 J Tip Ss Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154331|EAP|Custom 95154331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.2mm Profyle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locking Rige|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95154333|EAP|Custom 95154333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Standard Cusa Excel Extendem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154342|EAP|Custom 95154342||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Small Economy With Rs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195276|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 180cm .014in Strg J Tip Radopq Cor To Tip A Grn Slm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154343|EAP|Custom 95154343||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Medium Economy With S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154344|EAP|Custom 95154344||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Large Economy With Rs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154345|EAP|Custom 95154345||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee X-large Economy Withs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195277|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Strg J Tip Radopq Cor To Tip A Grn Slm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154350|EAP|Custom 95154350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinforcem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stud Fixation 8.5mm Resurfacingp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,633.50|FSC: 13; Default||Not reimbursed separately|1,633.50|FSC: 13; Default||External grouping not supported 95154352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trochlea Femoral 20mm +2.0 X -2p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,685.00|FSC: 13; Default||Not reimbursed separately|14,685.00|FSC: 13; Default||External grouping not supported 95154353|EAP|Custom 95154353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Morcellator Laproscopic Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Anatomic 20mm 1.0mm X 4p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,962.00|FSC: 13; Default||Not reimbursed separately|1,962.00|FSC: 13; Default||External grouping not supported 95154357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide 2.0mm Hemicap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|351.00|FSC: 13; Default||Not reimbursed separately|351.00|FSC: 13; Default||External grouping not supported 95154358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular 15mm 1.5mm X 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95154360|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prothesis Vascular Woven Impregm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|FSC: 13; Default||Not reimbursed separately|1,365.54|FSC: 13; Default||External grouping not supported 95154362|EAP|Custom 95154362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Micro Cusa Excel Extended Cp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95154364|EAP|Custom 95154364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nosecone Cusa Excel Electrosurgz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154365|EAP|Custom 95154365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guard Contamination Excel Cusa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154366|EAP|Custom 95154366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Manifold 36khz Excela|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154367|EAP|Custom 95154367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Manifold 23khz Excela|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154368|EAP|Custom 95154368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Disposable Torque Sterila|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154369|EAP|Custom 95154369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Disposable Torque Sterila|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154377|EAP|Custom 95154377||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .035 Dm|1|HUMANA [1294]||HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95154378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locking Lefe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95154379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Tornier Sz-0 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95154380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Right Tornier Size-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95154381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-pom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.61|FSC: 13; Default||Not reimbursed separately|3,047.61|FSC: 13; Default||External grouping not supported 95154382|EAP|Custom 95154382||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .035 Dm|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95154383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Revision Beaded 6 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|FSC: 13; Default||Not reimbursed separately|11,457.72|FSC: 13; Default||External grouping not supported 95154386|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prothesis Vascular Woven Impregn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|FSC: 13; Default||Not reimbursed separately|1,365.54|FSC: 13; Default||External grouping not supported 95154401|EAP|Custom 95154401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Vacuum Kiwi Omnp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154402|EAP|Custom 95154402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Flotrac Vigelo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154407|EAP|Custom 95154407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology 6fr Fusion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154410|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95154411|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95154414|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95154418|EAP|Custom 95154418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Endobronchial Blocker Cohen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,983.62|FSC: 13; Default||Not reimbursed separately|8,983.62|FSC: 13; Default||External grouping not supported 95154434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Lps All-poly Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.61|FSC: 13; Default||Not reimbursed separately|3,047.61|FSC: 13; Default||External grouping not supported 95154436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95154437|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall With Permalume 10mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,217.90|FSC: 13; Default||Not reimbursed separately|5,217.90|FSC: 13; Default||External grouping not supported 95154438|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall With Permalume 10mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,217.90|FSC: 13; Default||Not reimbursed separately|5,217.90|FSC: 13; Default||External grouping not supported 95154439|EAP|Custom 95154439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 1.0 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95154449|EAP|Custom 95154449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Inner Disp Size-7mm Trat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154452|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Ms 700cx Ams|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,147.27|FSC: 13; Default||Not reimbursed separately|27,147.27|FSC: 13; Default||External grouping not supported 95154453|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester 10 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.93|FSC: 13; Default||Not reimbursed separately|3,510.93|FSC: 13; Default||External grouping not supported 95154454|EAP|Custom 95154454||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior Iz Ams|1|HUMANA [1294]||HUMANA [11839]|7,201.95|FSC: 13; Default||Not reimbursed separately|7,201.95|FSC: 13; Default||External grouping not supported 95154457|EAP|Custom 95154457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural Single Shot ****(*|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154458|EAP|Custom 95154458||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Hand Based Radial Nerve Se|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154459|EAP|Custom 95154459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Speaking Cannula Montgomem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154460|EAP|Custom 95154460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Measuring Stomasure Monty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154461|EAP|Custom 95154461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long-term Montgomery Szn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154463|EAP|Custom 95154463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long-term Montgomery Szn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154464|EAP|Custom 95154464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long-term Montgomery Szn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154475|EAP|Custom 95154475||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Hot Standard Tropic Pac 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154476|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Hernia Bioabsorbable Gore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95154477|EAP|Custom 95154477||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical 4-1/4 X 18 L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154478|EAP|Custom 95154478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Stapleline Reinforcemm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95127815|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express Biliary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95154479|EAP|Custom 95154479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple-line Reinforcem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154485|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95154488|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Wall Rx 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,369.62|FSC: 13; Default||Not reimbursed separately|4,369.62|FSC: 13; Default||External grouping not supported 95127823|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Express|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95154489|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Amplatzem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154490|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Amplatzem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154491|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Amplatzem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154492|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Amplatzem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154493|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Exchange Amplatzem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154494|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ii Amplatzer 24 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154495|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ii Amplatzer 34 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154496|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035 X 260cm Af|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Artic1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|FSC: 13; Default||Not reimbursed separately|6,157.20|FSC: 13; Default||External grouping not supported 95195281|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .036in Gaia First Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154500|EAP|Custom 95154500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Single Bevel Clear4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154501|EAP|Custom 95154501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Stand Alone 30 Degrem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154504|EAP|Custom 95154504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Y Hi-voltage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195282|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .036in Gaia First Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154509|EAP|Custom 95154509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere 14 Eye Silicone|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95154514|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurrim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154515|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurrim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154517|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,143.33|FSC: 13; Default||Not reimbursed separately|4,143.33|FSC: 13; Default||External grouping not supported 95195283|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .036in Gaia Second Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,536.48|FSC: 13; Default||Not reimbursed separately|4,536.48|FSC: 13; Default||External grouping not supported 95154522|EAP|Custom 95154522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Vertical Drain Tut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154530|EAP|Custom 95154530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Peritoneal 61cm 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154535|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valsalva Technique Sparinm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95195284|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .036in Gaia Second Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154537|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Optisense St Bipolar 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95154538|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Gianturco-roehm Birds Nem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 95154539|EAP|Custom 95154539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biospy 7 Fr X 50 Cm 2.2mw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154540|EAP|Custom 95154540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cylinder Helium Balloon Reuseabk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195285|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .036in Gaia Third Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154541|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prothesis Vascular Woven Impreg*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|FSC: 13; Default||Not reimbursed separately|1,365.54|FSC: 13; Default||External grouping not supported 95154543|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prothesis Vascular Woven Impreg*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|FSC: 13; Default||Not reimbursed separately|1,365.54|FSC: 13; Default||External grouping not supported 95195286|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .036in Gaia Third Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154546|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prothesis Vascular Woven Impreg*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|FSC: 13; Default||Not reimbursed separately|1,365.54|FSC: 13; Default||External grouping not supported 95154547|EAP|Custom 95154547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Tubular Tricofix 3.2 Xs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154549|EAP|Custom 95154549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 0.76mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154558|EAP|Custom 95154558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Drill 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195287|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 8 X150 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154559|EAP|Custom 95154559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Trufit 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154560|EAP|Custom 95154560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Sleeve 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154561|EAP|Custom 95154561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Trufit 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 6.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95195288|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 8 X 200 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154564|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Polyester Woven Impregnat*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|937.14|FSC: 13; Default||Not reimbursed separately|937.14|FSC: 13; Default||External grouping not supported 95154565|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Polyester Woven Impregnat*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|937.14|FSC: 13; Default||Not reimbursed separately|937.14|FSC: 13; Default||External grouping not supported 95154566|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smoothc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95154568|EAP|Custom 95154568||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Aquaform Zippered 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195289|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .014in Suoh03 Ptca Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154583|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Plexis Branched 28mm X 40m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.00|FSC: 13; Default||Not reimbursed separately|4,983.00|FSC: 13; Default||External grouping not supported 95154584|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Plexis Branched 30mm X 40*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.00|FSC: 13; Default||Not reimbursed separately|4,983.00|FSC: 13; Default||External grouping not supported 95154585|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Anteflo Gelweave 1-branchm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95195290|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 190cm .014in Suoh03 Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154586|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Anteflo Gelweave 1-branchm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95189399|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Tecnis Multi Focal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95154588|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Anteflo Gelweave 1-branch*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95154589|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Anteflo Gelweave 1-branch*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95189401|EAP|Custom 95189401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Bicol Collagen 10 Units|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154597|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Floor Pelvic Antet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|FSC: 13; Default||Not reimbursed separately|4,725.00|FSC: 13; Default||External grouping not supported 95189402|EAP|Custom 95189402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Gelfoam Plus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154602|EAP|Custom 95154602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Implant Contigen Periurem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189404|EAP|Custom 95189404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit 2-pod Knee Iassist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154603|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Launcher 8fr X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195291|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Suoh03 Ptca Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154607|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Dura-flow Hemodialysist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95189403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Head Hex 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.50|FSC: 13; Default||Not reimbursed separately|175.50|FSC: 13; Default||External grouping not supported 95154618|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 2.0 Diope|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95154619|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 2.5 Diope|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95189405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95154634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Med 8-hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,824.00|FSC: 13; Default||Not reimbursed separately|1,824.00|FSC: 13; Default||External grouping not supported 95189406|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Tecnis Symfony Toric 21.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95154635|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Crystalens 20.r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95154636|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Crystalens 24.r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189407|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95154637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.45|FSC: 13; Default||Not reimbursed separately|114.45|FSC: 13; Default||External grouping not supported 95195292|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 300cm .014in Suoh03 Ptca Pre-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95189408|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95154642|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154643|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154644|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154645|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065422|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Immunoassay For Analyte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95154646|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154647|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154648|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154649|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065433|EAP|CPT® 86235||0302 - LABORATORY - IMMUNOLOGY|Hb Anti Jo1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 95154650|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154651|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154652|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154653|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065444|EAP|CPT® 86235||0302 - LABORATORY - IMMUNOLOGY|Hb Anti U1 Rnp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 95154654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping Lockim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95154655|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154656|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154657|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154658|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154659|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154660|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154661|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Slim Y 5 Hole Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|FSC: 13; Default||Not reimbursed separately|4,572.00|FSC: 13; Default||External grouping not supported 95154662|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154663|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154664|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154665|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195298|EAP|Custom 95195298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg Lg Scr Trgn Intertan 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154666|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154667|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154668|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154669|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195294|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 165cm .014in Extn Wire Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154670|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154671|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Ultraverse H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154672|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154673|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195295|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 330cm .010in Rg3 Ptca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154674|EAP|Custom 95154674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Quick Connect 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154675|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154676|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154677|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hum 123mm 11mm Reunion Strl Rvrs Fx Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,899.10|FSC: 13; Default||Not reimbursed separately|15,899.10|FSC: 13; Default||External grouping not supported 95154678|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154679|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154680|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154681|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 40cm Rt Intertrochanter Intertan Im 130d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95154682|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154683|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154684|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154685|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154686|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154687|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154688|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154689|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154690|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154691|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154692|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154693|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154694|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154695|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 1h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154696|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154698|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154699|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154700|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154701|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 80 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 14mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154703|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154704|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154705|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 10mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154706|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154707|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154708|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154709|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 11mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154711|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154712|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 12mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154714|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 135m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154715|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dorado Pta 120m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95154721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95195308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 13mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154722|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Rigiflex Achalasm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154723|EAP|Custom 95154723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 7.5 Fr Iabp Insn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154727|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vascular Amplatzm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|FSC: 13; Default||Not reimbursed separately|2,496.00|FSC: 13; Default||External grouping not supported 95154729|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Amplatz 30fr X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 14mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154732|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 Biliaryh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95154733|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 Biliaryh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95154736|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 Biliaryh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95154737|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 Biliaryh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95195310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 10mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154738|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 Biliaryh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95154741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95154743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95154745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95195311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 11mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95154749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95154750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95195312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 12mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Locke|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95154756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Anterior Co3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95154757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixator Mini 70/20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95154760|EAP|Custom 95154760||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Swivel Non Fixatori|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 13mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154761|EAP|Custom 95154761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Template Fixator Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154763|EAP|Custom 95154763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench T Fixator Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154764|EAP|Custom 95154764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Screw Fixator Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154765|EAP|Custom 95154765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Fixator Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154771|EAP|Custom 95154771||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 11 Ga 6 Inch Jamsy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95154790|EAP|Custom 95154790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fast 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171600|EAP|CPT® 19282||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Loc Percut Ea Add Lesion, Includ Mammo Radar Reflector|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,160.00|FSC: 13; Default||Not reimbursed separately|1,160.00|FSC: 13; Default||External grouping not supported 95154801|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Dialysis Non-ringed Propat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95154802|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Dialysis Non-ringed Propat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,246.00|FSC: 13; Default||Not reimbursed separately|3,246.00|FSC: 13; Default||External grouping not supported 95154804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|FSC: 13; Default||Not reimbursed separately|7,238.28|FSC: 13; Default||External grouping not supported 80171599|EAP|CPT® 19281||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Loc Percut First Lesion, Includ Mammo Radar Reflector|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95154805|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154807|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stretch-coil Single 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,265.00|FSC: 13; Default||Not reimbursed separately|2,265.00|FSC: 13; Default||External grouping not supported 95154808|EAP|Custom 95154808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Peg Fast 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 80171611|EAP|CPT® 19283||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Local Perc First Lesion Includ Stereo Radar Reflector|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95154810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Frag Small Hs Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,671.00|FSC: 13; Default||Not reimbursed separately|1,671.00|FSC: 13; Default||External grouping not supported 95154811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cancellous Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95154812|EAP|Custom 95154812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated S-cp 2.9 X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154814|EAP|HCPCS C2614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spine Crawford 17 Gauge 6|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80171622|EAP|CPT® 19284||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Loc Percut Ea Add Lesion Incl Stereo Radar Reflector|1|HUMANA [1294]||HUMANA [11839]|1,409.31|FSC: 13; Default||Not reimbursed separately|1,409.31|FSC: 13; Default||External grouping not supported 95154819|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Isolated Thrombolysis T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154820|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Isolated Thrombolysis T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154823|EAP|Custom 95154823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Mini Spherica|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154832|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thorasic 37mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,500.00|FSC: 13; Default||Not reimbursed separately|34,500.00|FSC: 13; Default||External grouping not supported 80171633|EAP|CPT® 19285||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Loc Percut First Lesion Includes Us Radar Reflector|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95154835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio 8mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95154838|EAP|Custom 95154838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Access Length Fixed Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154839|EAP|Custom 95154839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Cap Seal With Accessori|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171644|EAP|CPT® 19286||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Loc Percut Ea Add Lesion Includes Us Radar Reflector|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.00|FSC: 13; Default||Not reimbursed separately|1,174.00|FSC: 13; Default||External grouping not supported 95154840|EAP|Custom 95154840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Access Length Fixed Me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154841|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster Otw 4.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95154842|EAP|Custom 95154842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Access Length Fixed La|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154843|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster Otw 4.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95195299|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ball Nose 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154845|EAP|Custom 95154845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Knee Femoral 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95154850|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Eagle Eye Gold Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154851|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nephrostomy Flexima 12f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 14mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154852|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nephrostomy Flexima 14f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154853|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Icd A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,900.00|FSC: 13; Default||Not reimbursed separately|60,900.00|FSC: 13; Default||External grouping not supported 95154858|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Asahi Miracle Bros 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 10mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154859|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster Otw 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95154860|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster Otw 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95154861|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cool Path 7 Fr Medium C|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154862|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cool Path 7 Fr Large Cu|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 11mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154864|EAP|Custom 95154864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology 7fr X 240cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Lon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,897.49|FSC: 13; Default||Not reimbursed separately|11,897.49|FSC: 13; Default||External grouping not supported 95154887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lupine Br W/dual Suture O|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95154890|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 34.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 13mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154891|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 33.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95154239|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Passive Fix Left Vem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|FSC: 13; Default||Not reimbursed separately|8,250.00|FSC: 13; Default||External grouping not supported 95154900|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Vista Brite Tip /|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154903|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thorasic 28mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,500.00|FSC: 13; Default||Not reimbursed separately|34,500.00|FSC: 13; Default||External grouping not supported 95195318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 10mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154907|EAP|Custom 95154907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Gore 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|FSC: 13; Default||Not reimbursed separately|5,820.00|FSC: 13; Default||External grouping not supported 95154910|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 3.0 Diopte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95195319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 12mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154915|EAP|Custom 95154915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canister Infov.a.c. 500ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154916|EAP|Custom 95154916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix 18mm X 3cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154923|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Retrograde Intubation 11 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154926|EAP|HCPCS L3929||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Hand Based Radial Nerve Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 13mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154927|EAP|HCPCS L3929||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Hand Based Radial Nerve Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154928|EAP|HCPCS L3929||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Hand Based Radial Nerve Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154931|EAP|Custom 95154931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch 1 Piece Wide Outlet Sen-su|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154932|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safety-t-centesis Cathe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 11mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154935|EAP|Custom 95154935||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ring Malyugin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154943|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95154945|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Septal Occluder 7 Fr 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,661.00|FSC: 13; Default||Not reimbursed separately|23,661.00|FSC: 13; Default||External grouping not supported 95195322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 13mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154959|EAP|Custom 95154959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tunneler 18fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154961|EAP|Custom 95154961||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 10mm X 32mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95154962|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Solo Reli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 14mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154965|EAP|Custom 95154965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Extension High-pressure R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154966|EAP|Custom 95154966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation Balloon Sinus R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Lt Non-porus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|FSC: 13; Default||Not reimbursed separately|5,572.47|FSC: 13; Default||External grouping not supported 95195324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 10mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95154969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Signa Stb Pfc Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95154970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95154971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Curved 4-hole Orbital 1.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.00|FSC: 13; Default||Not reimbursed separately|753.00|FSC: 13; Default||External grouping not supported 95195325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 11mm Spc Std 228x11.4x3.4mm Ss 2.7/3.5mm Scr 18 Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,162.75|FSC: 13; Default||Not reimbursed separately|6,162.75|FSC: 13; Default||External grouping not supported 95154972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Right 3 X 2 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95154974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Left 3 X 2 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95195326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95154975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Right 5 X 3 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95154976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Left 5 X 3 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95154977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3 X 2 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 95154978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 4 X 3 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95195327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular L-d 9h L 125mm 3.5 Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,219.25|FSC: 13; Default||Not reimbursed separately|2,219.25|FSC: 13; Default||External grouping not supported 95154979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Double T 11 Hole 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95154980|EAP|Custom 95154980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .7mm With 3mm Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154981|EAP|Custom 95154981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Kypho-pak Express 10/3 Firs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154982|EAP|Custom 95154982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .7mm With 5mm Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154983|EAP|Custom 95154983||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .7mm With 7mm Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154984|EAP|Custom 95154984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .8mm With 7mm Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154985|EAP|Custom 95154985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade 1.0mm Cross Drive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95154986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 1.0mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.00|FSC: 13; Default||Not reimbursed separately|168.00|FSC: 13; Default||External grouping not supported 80171677|EAP|CPT® 64455||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inject Anesthetic Agent Plantar Nerve|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95154987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 1.2mm Emergenc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.00|FSC: 13; Default||Not reimbursed separately|168.00|FSC: 13; Default||External grouping not supported 95154989|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Brite Tip 6 Fr 35 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154990|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Brite Tip 7 Fr 35 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95154991|EAP|Custom 95154991||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hamstring Tibialus Posteri|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95154992|EAP|Custom 95154992||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Md Gastroview 120|1|HUMANA [1294]||HUMANA [11839]|0.37|FSC: 13; Default||Not reimbursed separately|0.37|FSC: 13; Default||External grouping not supported 95154994|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Convertor Aaa 36mm Proxima|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,858.00|FSC: 13; Default||Not reimbursed separately|6,858.00|FSC: 13; Default||External grouping not supported 95154995|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.00|FSC: 13; Default||Not reimbursed separately|6,003.00|FSC: 13; Default||External grouping not supported 95154996|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pac Placement Catheter Dialysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155000|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Long 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.96|FSC: 13; Default||Not reimbursed separately|1,740.96|FSC: 13; Default||External grouping not supported 95155005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 10mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95155006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 14mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|229.50|FSC: 13; Default||Not reimbursed separately|229.50|FSC: 13; Default||External grouping not supported 95155007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|FSC: 13; Default||Not reimbursed separately|183.60|FSC: 13; Default||External grouping not supported 95155008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|FSC: 13; Default||Not reimbursed separately|183.60|FSC: 13; Default||External grouping not supported 95155009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|FSC: 13; Default||Not reimbursed separately|183.60|FSC: 13; Default||External grouping not supported 95155029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Head Ldh Metasul Taper 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|466.77|FSC: 13; Default||Not reimbursed separately|466.77|FSC: 13; Default||External grouping not supported 95155030|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 6mm Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95155031|EAP|Custom 95155031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ankle Complete Excaliber|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155034|EAP|Custom 95155034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Instablity|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155040|EAP|Custom 95155040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor 02 For Metamax 3b 6 Month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155043|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphincterotome Cannulating Hydra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155051|EAP|Custom 95155051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cell Saver High Speed Basic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155052|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Hi-torque Cross-it 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065450|EAP|CPT® 82374||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Total Co2|1|HUMANA [1294]||HUMANA [11839]|14.64|FSC: 13; Default||Not reimbursed separately|14.64|FSC: 13; Default||External grouping not supported 95155053|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire .014 Wiggle 190/2 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155055|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Porous Mbt Sz-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 95155058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porous C/r Lf Sigma Pfc Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|FSC: 13; Default||Not reimbursed separately|7,061.70|FSC: 13; Default||External grouping not supported 95155059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Dome 3-peg Ov Sigma Pfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95155060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cv Sigma Pfc Sz-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95155061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talar Revision Agility Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,543.50|FSC: 13; Default||Not reimbursed separately|10,543.50|FSC: 13; Default||External grouping not supported 95155062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,268.07|FSC: 13; Default||Not reimbursed separately|4,268.07|FSC: 13; Default||External grouping not supported 95195328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 11mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155064|EAP|Custom 95155064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Intubation Catalano|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155068|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Solo Reli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155069|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Solo Reli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95155081|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 15c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,680.00|FSC: 13; Default||Not reimbursed separately|10,680.00|FSC: 13; Default||External grouping not supported 95195329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 12mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155085|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gortex Ringed 30cm 14mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,183.00|FSC: 13; Default||Not reimbursed separately|3,183.00|FSC: 13; Default||External grouping not supported 95155103|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Tiered Therapy Atl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68,700.00|FSC: 13; Default||Not reimbursed separately|68,700.00|FSC: 13; Default||External grouping not supported 95155106|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Regatta Middleweight+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155107|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Regatta Middleweight N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155109|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Arch Aortic Trifurcate Gel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95155110|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Arch Aortic Trifurcate Gel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95195330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 13mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155136|EAP|Custom 95155136||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Synex 0-degree 23-31mm|1|HUMANA [1294]||HUMANA [11839]|19,809.00|FSC: 13; Default||Not reimbursed separately|19,809.00|FSC: 13; Default||External grouping not supported 95155137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vantage Atl 6.0cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,077.52|FSC: 13; Default||Not reimbursed separately|12,077.52|FSC: 13; Default||External grouping not supported 95155145|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155146|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.25 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155154|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Small Vessel Gold Moo1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155159|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bullet 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copeland Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|FSC: 13; Default||Not reimbursed separately|10,017.00|FSC: 13; Default||External grouping not supported 95155161|EAP|Custom 95155161||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint In Line Left Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 14mm Lt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155162|EAP|Custom 95155162||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint In Line Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155170|EAP|Custom 95155170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Drive Center 1.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155171|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 5mm Diameter X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155172|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155173|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive 1.2mm X 3mm Em|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95195332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 10mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.0 X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95155178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.0 X 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95155179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.0 X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95155194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial Proximal Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,751.28|FSC: 13; Default||Not reimbursed separately|4,751.28|FSC: 13; Default||External grouping not supported 95155195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial Proximal Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,812.60|FSC: 13; Default||Not reimbursed separately|4,812.60|FSC: 13; Default||External grouping not supported 95155196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95155197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95155198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95195333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 12mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155200|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155201|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Single Chamber Tempora|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95155203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,336.70|FSC: 13; Default||Not reimbursed separately|2,336.70|FSC: 13; Default||External grouping not supported 95155205|EAP|Custom 95155205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium 1000mc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155220|EAP|Custom 95155220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shear Curved 9cm-length Focus Ha|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155222|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 5.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95155223|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 6.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195335|EAP|Custom 95195335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx Krsh 3mm 285mm Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porous C/r Sigma Pfc Rt Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|FSC: 13; Default||Not reimbursed separately|7,061.70|FSC: 13; Default||External grouping not supported 95155236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Dome 3-ped Ov Sigma Pfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95155237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cv Sigma Pfc Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95155238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95155240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95155247|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.75 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155248|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155249|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195336|EAP|Custom 95195336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Freehand Twist 4.20mm 130mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis 10mm X 240mm Ri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 95155253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Arthrodesis 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.42|FSC: 13; Default||Not reimbursed separately|1,935.42|FSC: 13; Default||External grouping not supported 95155254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Arthrodesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|526.50|FSC: 13; Default||Not reimbursed separately|526.50|FSC: 13; Default||External grouping not supported 95155255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalock Rc Dual Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95155256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95155257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95155258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95195337|EAP|Custom 95195337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Locking 4.2mm X 360mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95155260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95155261|EAP|Custom 95155261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155271|EAP|Custom 95155271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Endo Ligaclip 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Nail Tibial 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.43|FSC: 13; Default||Not reimbursed separately|533.43|FSC: 13; Default||External grouping not supported 95155279|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95155280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95155281|EAP|Custom 95155281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Pin Drill Q|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 35mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95155282|EAP|Custom 95155282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin Drill Q|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95155291|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visipro Balloon Expandable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155298|EAP|Custom 95155298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrosurgical Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155306|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 8mm Diameter X 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155307|EAP|Custom 95155307||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Monitor Pressure Easy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155310|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Carey Alzate Coons 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 45mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95155325|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Convertor Aaa Renu Zenith 32mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,141.00|FSC: 13; Default||Not reimbursed separately|18,141.00|FSC: 13; Default||External grouping not supported 95155326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Non-porous C/s Sigma Pfc R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|FSC: 13; Default||Not reimbursed separately|5,572.47|FSC: 13; Default||External grouping not supported 95155327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Sigma Rp Stb Pfr S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95155329|EAP|Custom 95155329||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Lap Standard 0-10cc Port St|1|HUMANA [1294]||HUMANA [11839]|9,465.00|FSC: 13; Default||Not reimbursed separately|9,465.00|FSC: 13; Default||External grouping not supported 95155330|EAP|Custom 95155330||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Lap Standard 0-14cc Port St|1|HUMANA [1294]||HUMANA [11839]|9,465.00|FSC: 13; Default||Not reimbursed separately|9,465.00|FSC: 13; Default||External grouping not supported 95195341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 2.7mm/l60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|FSC: 13; Default||Not reimbursed separately|1,778.70|FSC: 13; Default||External grouping not supported 95155331|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 95155332|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 95155334|EAP|Custom 95155334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Esophageal Sclerotherapy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95155337|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 13mm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,409.00|FSC: 13; Default||Not reimbursed separately|8,409.00|FSC: 13; Default||External grouping not supported 95155338|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 7mm Diameter X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155339|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 8mm Diameter X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155348|EAP|Custom 95155348||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wrap Nylatex 4 X 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 32mm Dart-fire Ti Aly Ft Slf Drl St Cnn Hd Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95155349|EAP|Custom 95155349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Resuscitator Manual Adult Dispos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155360|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,337.00|FSC: 13; Default||Not reimbursed separately|23,337.00|FSC: 13; Default||External grouping not supported 95155361|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 French X 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155368|EAP|Custom 95155368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .076 X 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155369|EAP|Custom 95155369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill .076 X 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155371|EAP|Custom 95155371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Airway Laryngeal Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155373|EAP|Custom 95155373||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Extender|1|HUMANA [1294]||HUMANA [11839]|10,773.00|FSC: 13; Default||Not reimbursed separately|10,773.00|FSC: 13; Default||External grouping not supported 95155374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95195348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 34mm Dart-fire Ti Aly Ft Slf Drl St Cnn Hd Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95155375|EAP|Custom 95155375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.8 Lcp Pl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copeland Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|FSC: 13; Default||Not reimbursed separately|10,017.00|FSC: 13; Default||External grouping not supported 95155379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pack Convenience Bridge Suture A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95155383|EAP|Custom 95155383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Zinnanti Hs 7fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper Ha Coated 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper Ha Coated 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper Ha Coated 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95195342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 11mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper Ha Coated 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip M/l Taper Ha Coated 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 17.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95195343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 12mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem H/d M/l Taper Ha Coated 22.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|FSC: 13; Default||Not reimbursed separately|9,514.92|FSC: 13; Default||External grouping not supported 95155399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|FSC: 13; Default||Not reimbursed separately|9,260.01|FSC: 13; Default||External grouping not supported 95155401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|FSC: 13; Default||Not reimbursed separately|9,260.01|FSC: 13; Default||External grouping not supported 95155402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|FSC: 13; Default||Not reimbursed separately|9,260.01|FSC: 13; Default||External grouping not supported 95155403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|FSC: 13; Default||Not reimbursed separately|9,260.01|FSC: 13; Default||External grouping not supported 95155404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95155406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|FSC: 13; Default||Not reimbursed separately|9,260.01|FSC: 13; Default||External grouping not supported 95195344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 13mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155410|EAP|Custom 95155410||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bullet Concord 11 X 13 X 23|1|HUMANA [1294]||HUMANA [11839]|16,530.00|FSC: 13; Default||Not reimbursed separately|16,530.00|FSC: 13; Default||External grouping not supported 95155411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95195345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 14mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95155418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95195346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 10mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95155423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Cr-gend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95155431|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155432|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95155439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,719.00|FSC: 13; Default||Not reimbursed separately|4,719.00|FSC: 13; Default||External grouping not supported 95155440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95155443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral Alumina Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|FSC: 13; Default||Not reimbursed separately|5,158.65|FSC: 13; Default||External grouping not supported 95155446|EAP|HCPCS A7520||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Shiley Trach Disposable 6dc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155447|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Aviator Genesis Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95155448|EAP|Custom 95155448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Screwdriver Smart-lock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155451|EAP|Custom 95155451||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Absorbable Lapar|1|HUMANA [1294]||HUMANA [11839]|710.70|FSC: 13; Default||Not reimbursed separately|710.70|FSC: 13; Default||External grouping not supported 95155453|EAP|Custom 95155453||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Liberty Right Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155455|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Copu Os 3-strip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,091.00|FSC: 13; Default||Not reimbursed separately|2,091.00|FSC: 13; Default||External grouping not supported 95195334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 9mm X 315mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95155459|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Pleurx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155460|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Collection Pleurx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155461|EAP|Custom 95155461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155462|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Shiley Trach Cuffed Id 7.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155463|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95155464|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Shiley Trach Cuffed Id 6.4m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155465|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Ultraflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95155466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95195339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 37.5mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95155467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalock Rc Plus With Dua|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,041.00|FSC: 13; Default||Not reimbursed separately|1,041.00|FSC: 13; Default||External grouping not supported 95155468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalok Rc Plus With Orth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95155469|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffed Id 7.6m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155470|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffless Id 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155471|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffed Id 5.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155473|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Shiley Trach Cuffed Id 5.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155474|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffless Id 7.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 12mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155475|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffless Id 7.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155476|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffed Id 6.4m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155477|EAP|Custom 95155477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Inner Disp Size-4 Use Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155478|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Aviator Genesis Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95155481|EAP|Custom 95155481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Tunneler Catheter On-q 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155484|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurostimulator Implantable Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,997.00|FSC: 13; Default||Not reimbursed separately|44,997.00|FSC: 13; Default||External grouping not supported 95155485|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Programmer Patient External|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155486|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.75 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 13mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155488|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Gunther Celect Perm Jugul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155490|EAP|Custom 95155490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Bipolar Cobra Loading Fro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155496|EAP|Custom 95155496||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ball Exercise 55cm Red Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155512|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155513|EAP|Custom 95155513||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior Catheter Ventricular S|1|HUMANA [1294]||HUMANA [11839]|1,180.80|FSC: 13; Default||Not reimbursed separately|1,180.80|FSC: 13; Default||External grouping not supported 95155514|EAP|Custom 95155514||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior Catheter Ventricular S|1|HUMANA [1294]||HUMANA [11839]|1,180.80|FSC: 13; Default||Not reimbursed separately|1,180.80|FSC: 13; Default||External grouping not supported 95155524|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 14mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155529|EAP|Custom 95155529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Ground Radio Frequency|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155533|EAP|Custom 95155533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Radio Frequency 10cm 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155534|EAP|Custom 95155534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Radio Frequency 10cm 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Non-porous C/s Sigma Pfc R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|FSC: 13; Default||Not reimbursed separately|5,572.47|FSC: 13; Default||External grouping not supported 95155540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stb Sigma 6-10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95155541|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cutting 2.0mm X 6mm Leng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking Medium Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95155551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95195352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 12mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155564|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Situs Otw Left Ventricular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95155565|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Ovatio Crt Bi Vent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71,250.00|FSC: 13; Default||Not reimbursed separately|71,250.00|FSC: 13; Default||External grouping not supported 95155566|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Introducer Lead Quickflex Lv 86c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,425.00|FSC: 13; Default||Not reimbursed separately|7,425.00|FSC: 13; Default||External grouping not supported 95155577|EAP|Custom 95155577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vasoseal Needle Depth Indication|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155582|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Optiray 320mg/ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|FSC: 13; Default||Not reimbursed separately|0.70|FSC: 13; Default||External grouping not supported 95155594|EAP|Custom 95155594||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Thermoplastic Reinforced Ty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155598|EAP|Custom 95155598||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Abdominal 12" X 46-62"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 11mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155617|EAP|Custom 95155617||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up X-small Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155618|EAP|Custom 95155618||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up Right Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155619|EAP|Custom 95155619||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up Large Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155620|EAP|Custom 95155620||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Lace Up Right Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 13mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95155639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Evolve +2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95155642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95155653|EAP|Custom 95155653||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Immobilizer Knee Universal 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155654|EAP|Custom 95155654||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Immobilizer Knee Universal 19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155655|EAP|Custom 95155655||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Immobilizer Knee Universal 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 11mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155656|EAP|Custom 95155656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.2mm Bold|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155657|EAP|Custom 95155657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Combined Espocan Spinal And|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155673|EAP|Custom 95155673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Abs 30 Degree Kelman 1.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155674|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Cre 10-12mm 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155675|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Cre 12-15mm 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155676|EAP|Custom 95155676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber 4-0 18 Tapered Needl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155677|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155678|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Pow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 12mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155680|EAP|HCPCS C1765||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pack Procedure Seprafilm 3 X 5|1|HUMANA [1294]||HUMANA [11839]|2,188.25|FSC: 13; Default||Not reimbursed separately|2,188.25|FSC: 13; Default||External grouping not supported 95155681|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Revolution Ivus 45mhz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155684|EAP|Custom 95155684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Thermoplastic Reinforced Ty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155686|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Renegade Microcatheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155687|EAP|Custom 95155687||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nerve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155688|EAP|Custom 95155688||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Forearm-based Radial Nerve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155690|EAP|Custom 95155690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Port Access Lap-band Vg And|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 14mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.00|FSC: 13; Default||Not reimbursed separately|681.00|FSC: 13; Default||External grouping not supported 95155694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155702|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155703|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155706|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95195358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 10mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155710|EAP|HCPCS A7520||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Shiley Trach Cuffless Id 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155724|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sleuth Implantable Ecg Mo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95155726|EAP|Custom 95155726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac Granufoam Sma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155732|EAP|Custom 95155732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac Granufoam Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155733|EAP|Custom 95155733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac Granufoam Lar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155734|EAP|Custom 95155734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac V.a.c. Abdomi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155735|EAP|Custom 95155735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac Granufoam Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155736|EAP|Custom 95155736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac Granufoam Lar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 11mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155738|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Optisense St Bipolar 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95155746|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155755|EAP|Custom 95155755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Amino 2.0 X 1.5cm|1|HUMANA [1294]||HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95155756|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.25 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155768|EAP|Custom 95155768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brief Radiation Implant Fits 42-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155770|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.25mmx 150mm Non-thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155771|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.25mm X 150mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155780|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Profil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95195360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 12mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bunion Wedge Opening Bow N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,993.00|FSC: 13; Default||Not reimbursed separately|3,993.00|FSC: 13; Default||External grouping not supported 95155787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock Darco 2.7mm X 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95155789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock Darco 2.7mm X 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95155790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock Darco 2.7mm X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95155791|EAP|Custom 95155791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Darco 1.1mm X 140mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155792|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft Ext Max Per Sq Cm|1|HUMANA [1294]||HUMANA [11839]|343.71|FSC: 13; Default||Not reimbursed separately|343.71|FSC: 13; Default||External grouping not supported 95155796|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155797|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.75 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 13mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155798|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.50 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95155804|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Passive Fixatuon Quadrupola|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95155805|EAP|Custom 95155805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.8mm Long Quick Relea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5 X 50m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95155807|EAP|Custom 95155807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Needleguide 20ga With Probe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155808|EAP|Custom 95155808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Needleguide 21ga With Probe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155809|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Microintroducer 5fr With Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 14mm Rt Sphr Cngrnt Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95155810|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Microintroducer 6fr With Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155811|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc 4fr Sl With Tls - Ful|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155824|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 33.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95155826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|FSC: 13; Default||Not reimbursed separately|7,117.50|FSC: 13; Default||External grouping not supported 95155830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Locking Right 3.5 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,663.92|FSC: 13; Default||Not reimbursed separately|4,663.92|FSC: 13; Default||External grouping not supported 95195363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 10mm 4mm Asns Ti Mic Rvrs Cut Flut Ft Hnd Slf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95155833|EAP|Custom 95155833||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Probe Pneumatic Uthoclast Ultras|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155834|EAP|Custom 95155834||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Radio Frequency 10cm Curv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155835|EAP|Custom 95155835||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Disposable Disco 6-ram|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155836|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Cope Mandril .018 Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Modular Ev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|FSC: 13; Default||Not reimbursed separately|4,896.00|FSC: 13; Default||External grouping not supported 95155842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95155843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 63mm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.24|FSC: 13; Default||Not reimbursed separately|342.24|FSC: 13; Default||External grouping not supported 95155844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Oblique Left 2.0mm 2 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.37|FSC: 13; Default||Not reimbursed separately|179.37|FSC: 13; Default||External grouping not supported 95195364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 83mm 7 Hl Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95155845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.03|FSC: 13; Default||Not reimbursed separately|96.03|FSC: 13; Default||External grouping not supported 95155848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 55mm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.82|FSC: 13; Default||Not reimbursed separately|332.82|FSC: 13; Default||External grouping not supported 95155849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 47mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|311.55|FSC: 13; Default||Not reimbursed separately|311.55|FSC: 13; Default||External grouping not supported 95155850|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffed Id 8.9m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155851|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffed Id 8.9m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155852|EAP|Custom 95155852||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Inner Disp Size-10 Use W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.8mm Dia Ti W/#2 Durabraid Strx2 Ndl Twinfix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.50|FSC: 13; Default||Not reimbursed separately|976.50|FSC: 13; Default||External grouping not supported 95155853|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffless Id 8.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155854|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach Cuffless Id 8.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155855|EAP|Custom 95155855||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Inner Disp Size-10 Use W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 39mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|287.97|FSC: 13; Default||Not reimbursed separately|287.97|FSC: 13; Default||External grouping not supported 95155858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 31mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|271.44|FSC: 13; Default||Not reimbursed separately|271.44|FSC: 13; Default||External grouping not supported 95155859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Quarter 23mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95155860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Left Oblique 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.24|FSC: 13; Default||Not reimbursed separately|198.24|FSC: 13; Default||External grouping not supported 95195367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 3.5mm 20mm Ncb Ti-6al-4v Hum St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95155861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Right Oblique 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.24|FSC: 13; Default||Not reimbursed separately|198.24|FSC: 13; Default||External grouping not supported 95155862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 29mm 2.0mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|211.23|FSC: 13; Default||Not reimbursed separately|211.23|FSC: 13; Default||External grouping not supported 95155863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 23mm 2.0mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.07|FSC: 13; Default||Not reimbursed separately|197.07|FSC: 13; Default||External grouping not supported 95155864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 17mm 2.0mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.37|FSC: 13; Default||Not reimbursed separately|179.37|FSC: 13; Default||External grouping not supported 95155865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Oblique Right 2.0mm 2 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.37|FSC: 13; Default||Not reimbursed separately|179.37|FSC: 13; Default||External grouping not supported 95155866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95195368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Recon Evos 3.5mm 44mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.15|FSC: 13; Default||Not reimbursed separately|1,008.15|FSC: 13; Default||External grouping not supported 95155869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95195369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 70mm 3.5mm Scr 6 Hl Lck Evos Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|259.05|FSC: 13; Default||Not reimbursed separately|259.05|FSC: 13; Default||External grouping not supported 95155877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95155878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Proximal Tibial 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.28|FSC: 13; Default||Not reimbursed separately|4,607.28|FSC: 13; Default||External grouping not supported 95155880|EAP|Custom 95155880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Westcott 22 Ga X 20 Cm (p|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155881|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155882|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.25 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155883|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Dextrus 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|FSC: 13; Default||Not reimbursed separately|1,605.00|FSC: 13; Default||External grouping not supported 95155884|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Dextrus 53cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|FSC: 13; Default||Not reimbursed separately|1,605.00|FSC: 13; Default||External grouping not supported 95155888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 62065460|EAP|CPT® 83516||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Aquaporin-4 Receptor Ab-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95155889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Ultra Cl 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|FSC: 13; Default||Not reimbursed separately|989.10|FSC: 13; Default||External grouping not supported 95155891|EAP|Custom 95155891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Patient Safety Trunk Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Direct Fixation Devic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|FSC: 13; Default||Not reimbursed separately|913.50|FSC: 13; Default||External grouping not supported 95155893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Direct Fixation Devic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|FSC: 13; Default||Not reimbursed separately|913.50|FSC: 13; Default||External grouping not supported 95155894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Direct Fixation Devic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|FSC: 13; Default||Not reimbursed separately|913.50|FSC: 13; Default||External grouping not supported 95155895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Direct Fixation Devic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|941.85|FSC: 13; Default||Not reimbursed separately|941.85|FSC: 13; Default||External grouping not supported 95155896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endobutton Direct Fixation Devic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|FSC: 13; Default||Not reimbursed separately|913.50|FSC: 13; Default||External grouping not supported 62065470|EAP|CPT® 84252||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Vitamin B2-ref Lab|1|HUMANA [1294]||HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 95155897|EAP|Custom 95155897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtendobutton Fixation Device|1|HUMANA [1294]||HUMANA [11839]|528.84|FSC: 13; Default||Not reimbursed separately|528.84|FSC: 13; Default||External grouping not supported 95155915|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Monitor Ecg Subcutaneous Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 95155922|EAP|Custom 95155922||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Tension Capsular Morcher Mr|1|HUMANA [1294]||HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95155923|EAP|Custom 95155923||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Tension Capsular Morcher Mr|1|HUMANA [1294]||HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95155927|EAP|Custom 95155927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.6mm Surefix Dea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155932|EAP|Custom 95155932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Combitube Esophageal Tracheal Ai|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155933|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 62065480|EAP|CPT® 86001||0309 - LABORATORY - OTHER LABORATORY|Hb Rast Test Igg Allergen-ref Lab|1|HUMANA [1294]||HUMANA [11839]|23.46|FSC: 13; Default||Not reimbursed separately|23.46|FSC: 13; Default||External grouping not supported 95155934|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 32.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New 3.5mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|FSC: 13; Default||Not reimbursed separately|870.48|FSC: 13; Default||External grouping not supported 95155936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New 3.5mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,090.92|FSC: 13; Default||Not reimbursed separately|1,090.92|FSC: 13; Default||External grouping not supported 95155937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Uni Deal New 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95155939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick Deal New 4.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 95155943|EAP|Custom 95155943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Deal New|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155944|EAP|Custom 95155944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Preparation Cement Bone Femo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155945|EAP|Custom 95155945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Compact Vacuum Mixing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065490|EAP|CPT® 86341||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Zinc Transporter 8 Ab-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.71|FSC: 13; Default||Not reimbursed separately|70.71|FSC: 13; Default||External grouping not supported 95155948|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95155952|EAP|Custom 95155952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Ecg Lead Wire 5 Leads (must|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95155956|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 8mm Diameter X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155957|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 8mm Diameter X 57|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155959|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155960|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 7mm Diameter X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95155961|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Peripheral M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80171688|EAP|CPT® 93287||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Peri-procedure Device Eval And Programming|1|HUMANA [1294]||HUMANA [11839]|205.96|FSC: 13; Default||Not reimbursed separately|205.96|FSC: 13; Default||External grouping not supported 95155972|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Oximetry Venous Central|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155979|EAP|Custom 95155979||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Graft Dural Duraform 4cm|1|HUMANA [1294]||HUMANA [11839]|3,423.42|FSC: 13; Default||Not reimbursed separately|3,423.42|FSC: 13; Default||External grouping not supported 95155984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ldh Metasul Cocr Taper 18/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|FSC: 13; Default||Not reimbursed separately|2,261.79|FSC: 13; Default||External grouping not supported 95155986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Acetabular Durom Metas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|FSC: 13; Default||Not reimbursed separately|8,098.56|FSC: 13; Default||External grouping not supported 95155987|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 11mm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,409.00|FSC: 13; Default||Not reimbursed separately|8,409.00|FSC: 13; Default||External grouping not supported 95155988|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155989|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95155990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Le Mc V Angled 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 95155992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Locking Narrow 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.60|FSC: 13; Default||Not reimbursed separately|588.60|FSC: 13; Default||External grouping not supported 95155993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95155994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.75|FSC: 13; Default||Not reimbursed separately|231.75|FSC: 13; Default||External grouping not supported 95155995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95155996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Bone 6mm Cancello-pure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95155997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 12mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95155998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 9mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95155999|EAP|Custom 95155999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twist Dental 1.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156000|EAP|Custom 95156000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Lamellar 60 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio X-tra Lock 8 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95156003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Uni Deal New 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.24|FSC: 13; Default||Not reimbursed separately|4,440.24|FSC: 13; Default||External grouping not supported 95156004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Ti 3.0mm X 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95156005|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor 4fr 18/.035 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156006|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor 5fr 18/.038 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156007|EAP|Custom 95156007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Connecting To Ibi Generato|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156008|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Sheath Safl 8f 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156009|EAP|Custom 95156009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cables Safire Catheter Extenstio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156010|EAP|Custom 95156010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cables Safire Catheter Extenstio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156011|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire 7f Bi-directiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156012|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire 7f Bi-directiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156013|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire 7f Bi-directiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156014|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire 7f Bi-directiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156016|EAP|Custom 95156016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Ibi Steerable Deca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156017|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ibi Steerable Deca H La|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156018|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ibi Steerable Deca H Cu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156019|EAP|Custom 95156019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Reflexion Bi-directiona|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156020|EAP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Reflexion Bi-directiona|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156021|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Agilis Bi-directiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156023|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Agilis Bi-directiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156024|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Across Transeptal Access|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156025|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Across Transeptal Access|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156026|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Across Transeptal Access|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156027|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Across Transeptal Access|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156028|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Across Transeptal Access|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|FSC: 13; Default||Not reimbursed separately|7,117.50|FSC: 13; Default||External grouping not supported 95156032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|FSC: 13; Default||Not reimbursed separately|7,117.50|FSC: 13; Default||External grouping not supported 95156033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|FSC: 13; Default||Not reimbursed separately|7,117.50|FSC: 13; Default||External grouping not supported 95156034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|FSC: 13; Default||Not reimbursed separately|7,117.50|FSC: 13; Default||External grouping not supported 95156035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Metal Modular Trabec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|FSC: 13; Default||Not reimbursed separately|7,117.50|FSC: 13; Default||External grouping not supported 95156036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tray Trabecular Me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95156038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 95156039|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 95156040|EAP|Custom 95156040||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95156041|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Restore Ultra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,600.00|FSC: 13; Default||Not reimbursed separately|48,600.00|FSC: 13; Default||External grouping not supported 95156042|EAP|Custom 95156042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Polypectomy Spiral 230cm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156043|EAP|Custom 95156043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Gold Soft Tissue Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156044|EAP|Custom 95156044||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brief Radiation Implant Fits Siz|1|HUMANA [1294]||HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95156061|EAP|Custom 95156061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Precaution Maximum Barrier|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156062|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tigerwire Angled Floppy Tip .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156063|EAP|Custom 95156063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Loop Cutting Right Angle 24 Fr .|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Twin Fix 3.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95156065|EAP|Custom 95156065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.4 X 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156068|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Port 8fr Attachable Chrono|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,663.20|FSC: 13; Default||Not reimbursed separately|1,663.20|FSC: 13; Default||External grouping not supported 95156073|EAP|Custom 95156073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Autoclavable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Beaded Full 12/14 N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|FSC: 13; Default||Not reimbursed separately|11,457.72|FSC: 13; Default||External grouping not supported 95156082|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Closure Vessel Suture Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.00|FSC: 13; Default||Not reimbursed separately|681.00|FSC: 13; Default||External grouping not supported 95156083|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95156085|EAP|Custom 95156085||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Sitback Buckseat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156087|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Zephyr Single Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,016.00|FSC: 13; Default||Not reimbursed separately|11,016.00|FSC: 13; Default||External grouping not supported 95156095|EAP|Custom 95156095||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Adjustable Hinge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156098|EAP|Custom 95156098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Intro Flex Percutaneous Shea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156099|EAP|Custom 95156099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 41 French Broncho Cath Righ|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156100|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Solo Reli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156104|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156108|EAP|Custom 95156108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Prefilled Embosphere Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Fixed Bearing Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,688.00|FSC: 13; Default||Not reimbursed separately|2,688.00|FSC: 13; Default||External grouping not supported 95156111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Fixed Bearing Right/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,594.40|FSC: 13; Default||Not reimbursed separately|5,594.40|FSC: 13; Default||External grouping not supported 95156112|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Epicardial Pace Enpath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,620.00|FSC: 13; Default||Not reimbursed separately|1,620.00|FSC: 13; Default||External grouping not supported 95156113|EAP|Custom 95156113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Applicator 35cm Evicel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 11mm X 315mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95156117|EAP|Custom 95156117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Micron 600 Side-firing Hig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156120|EAP|Custom 95156120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Extension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Locking Le 6h 1.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95156122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95156123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95156124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|FSC: 13; Default||Not reimbursed separately|257.04|FSC: 13; Default||External grouping not supported 95195371|EAP|Custom 95195371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Freehand Twist 4.20mm 185mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 95156126|EAP|Custom 95156126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,633.84|FSC: 13; Default||Not reimbursed separately|3,633.84|FSC: 13; Default||External grouping not supported 95156131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Modular Ev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95156132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95156150|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95156151|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95156152|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 40mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95156153|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156155|EAP|Custom 95156155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinforcem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156160|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Battery Advanced Prime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,000.00|FSC: 13; Default||Not reimbursed separately|36,000.00|FSC: 13; Default||External grouping not supported 95156161|EAP|Custom 95156161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156162|EAP|Custom 95156162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Cor 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 60mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95156163|EAP|Custom 95156163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Cor 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156164|EAP|Custom 95156164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Cor 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156172|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Recto-vaginal Surgi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,478.09|FSC: 13; Default||Not reimbursed separately|2,478.09|FSC: 13; Default||External grouping not supported 95156173|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Solo Reli|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156179|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.75 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95156180|EAP|Custom 95156180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pak Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156183|EAP|Custom 95156183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slitter Adjustable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95156185|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ultrasound Peripheral A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156187|EAP|Custom 95156187||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Fistula And Wound Eakin Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156189|EAP|Custom 95156189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Radio Frequency 15cm Curv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95156195|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95156198|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95156199|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Obturator Tvt With Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,933.00|FSC: 13; Default||Not reimbursed separately|3,933.00|FSC: 13; Default||External grouping not supported 95156200|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Acellular Dermal Flex Hd 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.33|FSC: 13; Default||Not reimbursed separately|90.33|FSC: 13; Default||External grouping not supported 95195375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5d Med Gorilla Bn Mtp Rt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95156201|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Acellular Dermal Flex Hd 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.40|FSC: 13; Default||Not reimbursed separately|90.40|FSC: 13; Default||External grouping not supported 95156204|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex Nonco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,230.65|FSC: 13; Default||Not reimbursed separately|5,230.65|FSC: 13; Default||External grouping not supported 95156206|EAP|Custom 95156206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Alexis C-section Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156207|EAP|Custom 95156207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Alexis C-section X-lar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156212|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articulize 40mm Spe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|FSC: 13; Default||Not reimbursed separately|6,157.20|FSC: 13; Default||External grouping not supported 95156215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Multihole Pinnacle 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 95195376|EAP|Custom 95195376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sut Fiberlink 0 36in Loop Blk/wht 1.5in Nabsb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail-2 Vara Size-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95156229|EAP|Custom 95156229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Precaution Barrier Maximal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156230|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer 4 Fr X 10cm Lengt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156233|EAP|Custom 95156233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Felt Teflon 2 X 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156234|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Recto-vaginal Surgi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95156235|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Recto-vaginal Surgi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,478.09|FSC: 13; Default||Not reimbursed separately|2,478.09|FSC: 13; Default||External grouping not supported 95156236|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Recto-vaginal Surgi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95156240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Lock Hand Profyle 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95156241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tap 2.3 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95156242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 18mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95156243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 13mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95156248|EAP|Custom 95156248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace Harmonic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156249|EAP|Custom 95156249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace Harmonic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 12mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95156264|EAP|Custom 95156264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Cataract Safety Beaver Opt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156265|EAP|Custom 95156265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Cataract Safety Beaver Sin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156266|EAP|Custom 95156266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Intrepid Abs Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156267|EAP|Custom 95156267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ultrasound Intrepid Abs Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ldh Metasul Cocr Taper Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|FSC: 13; Default||Not reimbursed separately|2,261.79|FSC: 13; Default||External grouping not supported 95156269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Acetabular Durom Metas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|FSC: 13; Default||Not reimbursed separately|8,098.56|FSC: 13; Default||External grouping not supported 95156290|EAP|Custom 95156290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franseen 18g X 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156291|EAP|Custom 95156291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Green 22g X 15cm Without|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156292|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156298|EAP|Custom 95156298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Cervical Eto Steril Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156299|EAP|Custom 95156299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Cervical Eto Steril Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156300|EAP|Custom 95156300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Cervical Eto Steril Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95156302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix 5.5mm With Orthoco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95156304|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filterwire Ez 2.25 Mm -3.5mm 190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|FSC: 13; Default||Not reimbursed separately|4,924.62|FSC: 13; Default||External grouping not supported 95156313|EAP|Custom 95156313||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95156315|EAP|Custom 95156315||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Mediu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156316|EAP|Custom 95156316||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95156319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong Flex L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95156320|EAP|Custom 95156320||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Casting Mede-kast (case O|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156321|EAP|Custom 95156321||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Casting Medi-kast 3 With|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156322|EAP|Custom 95156322||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Casting Medi-kast 4 With|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Multihole Pinnacl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 95156327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95156328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95156332|EAP|Custom 95156332||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Pessary Gehrung Folding Size|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95156334|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Occluder Delivery|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95156335|EAP|Custom 95156335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Transseptal 11 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156336|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cardio Seal Occluder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95156339|EAP|Custom 95156339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinforcem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195377|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Gd 100cm 6fr .071in Lnchr Jl 4 Brd Nyl Lg Lum Flxb Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156341|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Specify (includes 39565|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,740.00|FSC: 13; Default||Not reimbursed separately|16,740.00|FSC: 13; Default||External grouping not supported 95156342|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 2.5 X 8 Drug Elut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156343|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 2.5 X 12 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156344|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 2.5 X 15 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156345|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 2.5 X 18 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156346|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 2.5 X 23 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156347|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 2.5 X 28 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156348|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.0 X 8 Drug Elut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156349|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.0 X 12 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156350|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.0 X 15 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156351|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.0 X 18 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156352|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.0 X 23 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156353|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.0 X 28 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156354|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.5 X 8 Drug Elut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156355|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.5 X 12 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156356|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.5 X 15 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156357|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.5 X 18 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156358|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.5 X 23 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156359|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 3.5 X 28 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156360|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 4.0 X 8 Drug Elut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156361|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 4.0 X 12 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156362|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 4.0 X 15 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156363|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 4.0 X 18 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156364|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 4.0 X 23 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156365|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience V 4.0 X 28 Drug Elu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95156366|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 7mm Diameter X 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95156371|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95156374|EAP|Custom 95156374||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brief Radiation Implant Fits 2x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 10mm X 360mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95156375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Non-porous Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 95195389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spnl 50mm 5.5mm Decade Lg Plt Xlif Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 95156385|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angio Hydrophilic Coate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156386|EAP|Custom 95156386||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Voice Term Short Radiesse 1.|1|HUMANA [1294]||HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95156387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95156388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95195380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 42mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95156389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95156390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95156391|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156392|EAP|HCPCS C1754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Spinal Interdiscal 8-pi|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 47.5mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95156393|EAP|Custom 95156393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Introducer Gen Ii 17ga 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156395|EAP|Custom 95156395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Flotrac Vigelo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156396|EAP|Custom 95156396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter 8.5fr X 20cm Cdc Ox|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 50mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95156397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tapping Self 4.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|FSC: 13; Default||Not reimbursed separately|1,493.52|FSC: 13; Default||External grouping not supported 95156401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95156402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Ex 7.5mm X 280mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.09|FSC: 13; Default||Not reimbursed separately|6,165.09|FSC: 13; Default||External grouping not supported 95156406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Humeral 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,046.39|FSC: 13; Default||Not reimbursed separately|2,046.39|FSC: 13; Default||External grouping not supported 95195383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 57.5mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95156407|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Ultraflex Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.96|FSC: 13; Default||Not reimbursed separately|5,334.96|FSC: 13; Default||External grouping not supported 95156408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Ex 7.5mm X 270mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,983.35|FSC: 13; Default||Not reimbursed separately|5,983.35|FSC: 13; Default||External grouping not supported 95156411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 95156412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara Size-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95195384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Bn 2.4mm 46mm Evos 7 Hl Stght Tine Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,013.00|FSC: 13; Default||Not reimbursed separately|2,013.00|FSC: 13; Default||External grouping not supported 95156413|EAP|Custom 95156413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Microdebrider Topaz E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156414|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95156416|EAP|Custom 95156416||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strap Universal Circumferential|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 17mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95156417|EAP|Custom 95156417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management Dual-site|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156433|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156434|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156435|EAP|Custom 95156435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 39 French Broncho Cath Righ|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannulated Hip Pin 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.75|FSC: 13; Default||Not reimbursed separately|978.75|FSC: 13; Default||External grouping not supported 95156437|EAP|Custom 95156437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spoons Speculum Small Gynova 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156438|EAP|Custom 95156438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spoons Speculum Medium Gynova 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156439|EAP|Custom 95156439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spoons Speculum Large Gynova 12c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannulated Hip Pin 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.45|FSC: 13; Default||Not reimbursed separately|900.45|FSC: 13; Default||External grouping not supported 95156452|EAP|Custom 95156452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spinal Cement Confidence System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156457|EAP|Custom 95156457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scissors Micro Curved 25ga 0.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156458|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 95195388|EAP|Custom 95195388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5mm 152mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Porous Mbt Sz-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 95156461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porocoat C/r Sigma Right S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 95156462|EAP|Custom 95156462||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheath Tibial Bio-intrafix Small|1|HUMANA [1294]||HUMANA [11839]|1,173.00|FSC: 13; Default||Not reimbursed separately|1,173.00|FSC: 13; Default||External grouping not supported 95195390|EAP|Custom 95195390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Reflector Scout 5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-intrafix 6mm - 8mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95156464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-intrafix 6mm - 7mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95156467|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Arc Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.00|FSC: 13; Default||Not reimbursed separately|4,995.00|FSC: 13; Default||External grouping not supported 95156469|EAP|Custom 95156469||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cream Elta Melting Moisturizer 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195391|EAP|Custom 95195391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Reflector Savi Scout 7.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156477|EAP|Custom 95156477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Skin Precise Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Microfix Absorbable With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,743.00|FSC: 13; Default||Not reimbursed separately|1,743.00|FSC: 13; Default||External grouping not supported 95156481|EAP|Custom 95156481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wafer W/convex-it Surfit Flange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156484|EAP|Custom 95156484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dialysis Peritoneal Adv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195392|EAP|Custom 95195392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Reflector Savi Scout 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156485|EAP|Custom 95156485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glove Therapeutic Isotoner Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95130630|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Urethral Whistle Tip 6fr Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95156491|EAP|Custom 95156491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.6mm Ss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156494|EAP|Custom 95156494||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Adult Neb-u-mask System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195393|EAP|Custom 95195393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Reflector Savi Scout 7.5cm Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156495|EAP|Custom 95156495||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nebulizer Solo Aeroneb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156497|EAP|Custom 95156497||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Nasal Cpap Interface|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156500|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95156501|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension 1x8 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|FSC: 13; Default||Not reimbursed separately|1,980.00|FSC: 13; Default||External grouping not supported 95156502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95156503|EAP|Custom 95156503||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156511|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension 1x8 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|FSC: 13; Default||Not reimbursed separately|1,980.00|FSC: 13; Default||External grouping not supported 95156512|EAP|Custom 95156512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Tunneling Tools|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerous Locking Medial Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,656.10|FSC: 13; Default||Not reimbursed separately|3,656.10|FSC: 13; Default||External grouping not supported 95156517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerous Locking Distal 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,325.65|FSC: 13; Default||Not reimbursed separately|3,325.65|FSC: 13; Default||External grouping not supported 95156518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Fixed Bearing Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,102.00|FSC: 13; Default||Not reimbursed separately|3,102.00|FSC: 13; Default||External grouping not supported 95156519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Fixed Bearing Right/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.00|FSC: 13; Default||Not reimbursed separately|6,402.00|FSC: 13; Default||External grouping not supported 95195395|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.5mm 150cm 40mm Flxb Mrkr Streamline Tip Rpd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156522|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 3.0 Diopt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95156523|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 4.0 Diopt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95156524|EAP|Custom 95156524||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Amino 1.5 X 1.0cm|1|HUMANA [1294]||HUMANA [11839]|1,680.00|FSC: 13; Default||Not reimbursed separately|1,680.00|FSC: 13; Default||External grouping not supported 95156525|EAP|Custom 95156525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Amniocentesis 20 Gauge Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195396|EAP|Custom 95195396||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 50x22x14mm Clydesdale 6d Peek Radopq Lmbr Intrbd|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95156526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Minilok Absorbable With 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.00|FSC: 13; Default||Not reimbursed separately|1,812.00|FSC: 13; Default||External grouping not supported 95156528|EAP|Custom 95156528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix Tubular 8mm X 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195397|EAP|Custom 95195397||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 75mm 4.75mm Cd Hzn Cocrmo Cap|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95156529|EAP|Custom 95156529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix Tubular 9mm X 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread 1/3 Cannulated 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95195398|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.5mm 150cm 80mm Flxb Mrkr Streamline Tip Rpd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread 1/3 Cannulated 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95156532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread 1/2 Cannulated 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95156533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread 1/2 Cannulated 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95156534|EAP|Custom 95156534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation Sphere|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195399|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 150cm 80mm Flxb Mrkr Streamline Tip Rpd Dfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156535|EAP|Custom 95156535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brief Radiation Implant Fits 3x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Part Cannulated 55m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95156537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Full Cannulated 55m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95156538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Part Cannulated 60m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95195400|EAP|Custom 95195400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Btn 12mm 4cm Psprt Sil Crv Loprfl Hip 1pc Mld 2 Dam Dsg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Full Cannulated 60m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95156542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Locking Narrow 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95156543|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95156544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|170.10|FSC: 13; Default||Not reimbursed separately|170.10|FSC: 13; Default||External grouping not supported 80170377|EAP|CPT® 99155||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed, Different Phys, Younger Than 5yrs 1st 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95156545|EAP|Custom 95156545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Scorpion Surefire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Impl 15mm 15mm Speedtitan Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.96|FSC: 13; Default||Not reimbursed separately|4,386.96|FSC: 13; Default||External grouping not supported 95156547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|170.10|FSC: 13; Default||Not reimbursed separately|170.10|FSC: 13; Default||External grouping not supported 80170388|EAP|CPT® 99156||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed, Different Phys, 5yrs And Older 1st 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95156548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 95156555|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 5mm Diameter X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 80170399|EAP|CPT® 99157||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed, Different Phys Ea Add 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95156556|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95156557|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Soft Vu Om|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170400|EAP|HCPCS G0500||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Mod Sed Endoscopy, Same Phys, 5yrs And Older 1st 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95156558|EAP|Custom 95156558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink With Stryker Shaften|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156559|EAP|Custom 95156559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Screw Removal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156561|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Scs Trial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95156565|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Stretch-coil Singl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,265.00|FSC: 13; Default||Not reimbursed separately|2,265.00|FSC: 13; Default||External grouping not supported 95195402|EAP|Custom 95195402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Sizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-intrafix 7mm - 9mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95156567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-intrafix 8mm - 10mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95156568|EAP|Custom 95156568||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheath Tibial Bio-intrafix Large|1|HUMANA [1294]||HUMANA [11839]|1,173.00|FSC: 13; Default||Not reimbursed separately|1,173.00|FSC: 13; Default||External grouping not supported 95156569|EAP|Custom 95156569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Monitoring Pressure Intra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156589|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Subcompact 1x8 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 95156594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Periarticul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95156596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95156597|EAP|Custom 95156597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Shower Spray Shiled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156599|EAP|Custom 95156599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Wittich Nitinol Stone 8.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127-degree A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 95156602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95156603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Standard 26mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95156604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|FSC: 13; Default||Not reimbursed separately|1,311.24|FSC: 13; Default||External grouping not supported 95156610|EAP|Custom 95156610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi White 6.7mm X 6cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156611|EAP|Custom 95156611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi Blue 6.7mm X 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156612|EAP|Custom 95156612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi Green 6.7mm X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156613|EAP|Custom 95156613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi Lavender 5.1mm X 6cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156614|EAP|Custom 95156614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Occluder Colpo-pneumo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156617|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95156619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 23mm Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|FSC: 13; Default||Not reimbursed separately|5,350.80|FSC: 13; Default||External grouping not supported 95156620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Atlantis 4 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 95156621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Vision 4 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 95156622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95156623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|FSC: 13; Default||Not reimbursed separately|6,117.30|FSC: 13; Default||External grouping not supported 95156624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,142.10|FSC: 13; Default||Not reimbursed separately|7,142.10|FSC: 13; Default||External grouping not supported 95156625|EAP|Custom 95156625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Laryngoscope Optical Regular Dis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full 5 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95156629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 80mm Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95156630|EAP|Custom 95156630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 4.2 X 180mm Gamma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Right Long 11 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,266.00|FSC: 13; Default||Not reimbursed separately|4,266.00|FSC: 13; Default||External grouping not supported 95156633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 85mm Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95156634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long 11 X 380|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95156635|EAP|Custom 95156635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 3mm X 285mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Select Vertex 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95195406|EAP|Custom 95195406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jjnstm 24fr Sil Mc Slk Med Port Radopq Strp Rtnt Bln|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156637|EAP|Custom 95156637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Pain C-bloc On-q On-demand|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156639|EAP|Custom 95156639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Stand Alone 45 Degree Ozil 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|FSC: 13; Default||Not reimbursed separately|1,236.00|FSC: 13; Default||External grouping not supported 95156649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 13mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95195408|EAP|Custom 95195408||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Nitinol Stone Retrieval Basket Dakota 2.4f X 120.0cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95156653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|FSC: 13; Default||Not reimbursed separately|1,463.43|FSC: 13; Default||External grouping not supported 95156654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|FSC: 13; Default||Not reimbursed separately|1,611.75|FSC: 13; Default||External grouping not supported 95156655|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Altrua 60 Dr 44 X 42 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,613.00|FSC: 13; Default||Not reimbursed separately|17,613.00|FSC: 13; Default||External grouping not supported 95156656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95156657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95156658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|FSC: 13; Default||Not reimbursed separately|1,760.07|FSC: 13; Default||External grouping not supported 95156659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|FSC: 13; Default||Not reimbursed separately|1,878.72|FSC: 13; Default||External grouping not supported 95156660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|FSC: 13; Default||Not reimbursed separately|1,236.00|FSC: 13; Default||External grouping not supported 95156661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95156662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|FSC: 13; Default||Not reimbursed separately|1,463.43|FSC: 13; Default||External grouping not supported 95156663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|FSC: 13; Default||Not reimbursed separately|1,611.75|FSC: 13; Default||External grouping not supported 95156664|EAP|Custom 95156664||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Alderson Breast Dosimetry Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156665|EAP|Custom 95156665||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Alderson Breast Dosimetry Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156666|EAP|Custom 95156666||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Alderson Breast Dosimetry Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|FSC: 13; Default||Not reimbursed separately|1,760.07|FSC: 13; Default||External grouping not supported 95156668|EAP|Custom 95156668||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Alderson Breast Dosimetry Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156669|EAP|Custom 95156669||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Alderson Breast Dosimetry Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156670|EAP|Custom 95156670||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Alderson Breast Dosimetry Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156671|EAP|Custom 95156671||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Basket Lithocrush 30mm Basket 4.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L75 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95156672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral / P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|FSC: 13; Default||Not reimbursed separately|1,878.72|FSC: 13; Default||External grouping not supported 95156674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|FSC: 13; Default||Not reimbursed separately|1,236.00|FSC: 13; Default||External grouping not supported 95156675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95156676|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.50 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195411|EAP|Custom 95195411||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 14cm 26mm 14.5mm 12mm Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 95156677|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.75 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95156682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|FSC: 13; Default||Not reimbursed separately|1,463.43|FSC: 13; Default||External grouping not supported 95156683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|FSC: 13; Default||Not reimbursed separately|1,611.75|FSC: 13; Default||External grouping not supported 95156684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|FSC: 13; Default||Not reimbursed separately|1,760.07|FSC: 13; Default||External grouping not supported 95195412|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - True Flow Valvuplasty Perfusion 20mm 3.5cm 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|FSC: 13; Default||Not reimbursed separately|1,878.72|FSC: 13; Default||External grouping not supported 95156686|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 5fr Act Ultimum 23cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156687|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 6fr Act Ultimum 23cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|FSC: 13; Default||Not reimbursed separately|1,236.00|FSC: 13; Default||External grouping not supported 95195413|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Breast Matrix 8cmx16cm 0.8-1.7mm Thk Acelluar Drm Hydr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.05|FSC: 13; Default||Not reimbursed separately|247.05|FSC: 13; Default||External grouping not supported 95156689|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Act 7fr Ultimum 23cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|FSC: 13; Default||Not reimbursed separately|1,463.43|FSC: 13; Default||External grouping not supported 95156691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|FSC: 13; Default||Not reimbursed separately|1,611.75|FSC: 13; Default||External grouping not supported 95156692|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Ultimum Act 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|FSC: 13; Default||Not reimbursed separately|1,760.07|FSC: 13; Default||External grouping not supported 95156697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Per|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|FSC: 13; Default||Not reimbursed separately|1,878.72|FSC: 13; Default||External grouping not supported 95156698|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Velour Double Mic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|FSC: 13; Default||Not reimbursed separately|2,188.80|FSC: 13; Default||External grouping not supported 95156700|EAP|Custom 95156700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Adaptor Dual Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95156714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Modular Ev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|FSC: 13; Default||Not reimbursed separately|4,896.00|FSC: 13; Default||External grouping not supported 95156722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95156723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone +10 21mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95156724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95156725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 16mm X 155mm Conical Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95156735|EAP|Custom 95156735||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stopper Cervical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 95156737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Nuetral +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95156738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,142.10|FSC: 13; Default||Not reimbursed separately|7,142.10|FSC: 13; Default||External grouping not supported 95156739|EAP|Custom 95156739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Bakri Postpartum 24 Fr 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156740|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Deca Polar 6 Fr Steerab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156743|EAP|Custom 95156743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Confidence Introducer Bev|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156744|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Zephyr Xldr Dual Chamb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,622.50|FSC: 13; Default||Not reimbursed separately|12,622.50|FSC: 13; Default||External grouping not supported 95156745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95156746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Cocr V40 26mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95156747|EAP|Custom 95156747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Reamer Modular Hall Modifi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Distal Conical Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95195415|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-410 320cc 13cm X 13.5cm X 3.8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95156749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95156750|EAP|Custom 95156750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao 4.2 X 340mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195416|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-410 410cc 13.5cm X 14cm X 6.2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95156751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 10 Deg 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95156752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Bilox 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95156756|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Genesis Aviator Biliary Sd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95195417|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-410 520cc 14cm X 12.9cm X 6.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95156760|EAP|Custom 95156760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sleeve Cable Beaded Vit 2|1|HUMANA [1294]||HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 95156761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95156762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95156763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Cocr V40 26mm/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95195418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 12mm X 360mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95156767|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quickcross .035 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156768|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quickcross .035 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Left Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 62065500|EAP|CPT® 84999||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Potassium, Stool-ref Lab|1|HUMANA [1294]||HUMANA [11839]|14.69|FSC: 13; Default||Not reimbursed separately|14.69|FSC: 13; Default||External grouping not supported 95156772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95156773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95156774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95156775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 62065510|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Alcohol, Urine, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95156776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95156777|EAP|Custom 95156777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Standard 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156778|EAP|Custom 95156778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156779|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Vascular Peripheral Vascug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95156780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Profyle H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 95156781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Pin Self Tapping 1.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95156782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 95156783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 80171699|EAP|CPT® 46600||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Anoscopy; Diagnostic Including Collect Specimen|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95156784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Self Tapping 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95156785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri Lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95156786|EAP|Custom 95156786||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tape Tex Kinesio 2 Beige|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156789|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Thruway 300cm Short Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156790|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Thruway 300cm Short Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Tibial Knee Hinged Revisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95195437|EAP|Custom 95195437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Sureform 60mm Da Vinci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bushing Femoral Knee Hinged Revi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.90|FSC: 13; Default||Not reimbursed separately|1,026.90|FSC: 13; Default||External grouping not supported 95156794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Knee Hinged Revision Howmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,515.40|FSC: 13; Default||Not reimbursed separately|3,515.40|FSC: 13; Default||External grouping not supported 95156795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bumper Knee Hinged Revisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,110.50|FSC: 13; Default||Not reimbursed separately|2,110.50|FSC: 13; Default||External grouping not supported 95156796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Hinged Rotating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|FSC: 13; Default||Not reimbursed separately|11,346.30|FSC: 13; Default||External grouping not supported 95195438|EAP|Custom 95195438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 60mm White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Knee Hinged Revisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95156798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Regular 13 X 155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95195439|EAP|Custom 95195439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 60mm Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Regular 15 X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95156800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Xs Right Knee Hinged Rot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95195440|EAP|Custom 95195440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 60mm Gree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Femoral Distal Hinged Ro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95156802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Rotating Tibial Knee H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95156803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Offset Hrhk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|FSC: 13; Default||Not reimbursed separately|3,679.20|FSC: 13; Default||External grouping not supported 95156804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Full Duracon S-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|FSC: 13; Default||Not reimbursed separately|5,216.40|FSC: 13; Default||External grouping not supported 95195441|EAP|Custom 95195441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Laparoscopic Hernia Pack 626|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95156820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 95156821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 0 Degree 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95195442|EAP|Custom 95195442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Trocar Bladless Optical Obturator 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 50mm Asns Sld Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|FSC: 13; Default||Not reimbursed separately|2,934.00|FSC: 13; Default||External grouping not supported 95156826|EAP|Custom 95156826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Small Case Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156827|EAP|Custom 95156827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vaginal Hysterectomy Steril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 45mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 95156828|EAP|Custom 95156828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Lavh Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156830|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 4.7 Fr Single Channel V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156842|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95156850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 95195421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 55mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 95156852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Peanut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95156854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95156855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking Medium Ri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95156856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95195422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 75mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 95156858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Stabilization 306 Axialif|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|FSC: 13; Default||Not reimbursed separately|29,985.00|FSC: 13; Default||External grouping not supported 95156859|EAP|Custom 95156859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractors Tissue Sterile4-pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156861|EAP|Custom 95156861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stone Perc Encircle Ni|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 34mm 2.7mm 4.5mm Cortex Self Tap Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95156862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 25mm Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|FSC: 13; Default||Not reimbursed separately|5,350.80|FSC: 13; Default||External grouping not supported 95156865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95156866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Cemente|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95195424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.3mm 28mm T8 2mm St Lck Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95156867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,869.80|FSC: 13; Default||Not reimbursed separately|2,869.80|FSC: 13; Default||External grouping not supported 95156868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial X 3 Ps Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95195425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.3mm 44mm T8 2mm St Lck Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95195426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 24m Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95156894|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Dual Chamber Curre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,615.00|FSC: 13; Default||Not reimbursed separately|57,615.00|FSC: 13; Default||External grouping not supported 95156895|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata 65 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|FSC: 13; Default||Not reimbursed separately|13,095.00|FSC: 13; Default||External grouping not supported 95195427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 28mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95156898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|FSC: 13; Default||Not reimbursed separately|4,953.90|FSC: 13; Default||External grouping not supported 95195428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 48mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95156899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95156911|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 22mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,141.00|FSC: 13; Default||Not reimbursed separately|18,141.00|FSC: 13; Default||External grouping not supported 95195429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 11mm Spc Std 195x11.4x3.4mm Ss 2.7/3.5mm Scr 15 Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.75|FSC: 13; Default||Not reimbursed separately|5,898.75|FSC: 13; Default||External grouping not supported 95156914|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff Aortic Renu Zenith 24mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,645.00|FSC: 13; Default||Not reimbursed separately|15,645.00|FSC: 13; Default||External grouping not supported 95156915|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Body Main Aaa 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.00|FSC: 13; Default||Not reimbursed separately|6,003.00|FSC: 13; Default||External grouping not supported 95195430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lng 1.3mm Ti 3mm Lck 3.5mm Nonlock Scr 8hl Loprfl Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|FSC: 13; Default||Not reimbursed separately|6,879.00|FSC: 13; Default||External grouping not supported 95156916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95156917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlon S31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95195431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 22mm Anchorage Ti Std T8 Ft/ankl Tx Hd Ns Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95156918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95156919|EAP|Custom 95156919||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tool Dissecting Legend 12cm 2.5c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 24mm Anchorage Ti Std T8 Ft/ankl Tx Hd Ns Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95156927|EAP|Custom 95156927||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Stat Padz Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156929|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Dextrus 45cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|FSC: 13; Default||Not reimbursed separately|1,605.00|FSC: 13; Default||External grouping not supported 95195433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hum 82mm Prft Aqls Ascnd Flx Ptc 127.5d 5a Std Shldr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|FSC: 13; Default||Not reimbursed separately|11,290.86|FSC: 13; Default||External grouping not supported 95156932|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Mariner Soft Radiopaque|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Cemente|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95195434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 20mm 51mm Shldr Sft Tis Bal Aqls Ascnd Flx Cocr 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|FSC: 13; Default||Not reimbursed separately|8,468.58|FSC: 13; Default||External grouping not supported 95156937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95156938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation Modular Distal Femo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,591.80|FSC: 13; Default||Not reimbursed separately|1,591.80|FSC: 13; Default||External grouping not supported 95195435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Glnd 15d Lrg Aug Cortiloc Shldr Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|FSC: 13; Default||Not reimbursed separately|12,070.80|FSC: 13; Default||External grouping not supported 95156939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Ps Tri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95156942|EAP|Custom 95156942||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Strapping Material Self Adhesive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Glnd 15d Med Aug Cortiloc Shldr Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|FSC: 13; Default||Not reimbursed separately|12,070.80|FSC: 13; Default||External grouping not supported 95156943|EAP|HCPCS A4570||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Left Large Plus Com|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156946|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire Quadripolar Medi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156947|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire Tx Quadripolar L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 30mm Dart-fire Ti Sm P/t Ft Slf Drl St Cnn Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|FSC: 13; Default||Not reimbursed separately|786.00|FSC: 13; Default||External grouping not supported 95156949|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Mariner Soft Radiopaque|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156950|EAP|HCPCS A4562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Ring Silicone W/ Support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 38mm Cocr 2.2mm Tib Dist Mldir Lck Sq Drv St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95156951|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Safire Tx 250cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156953|EAP|Custom 95156953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Vgfi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156956|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered 10mm X 38mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95189906|EAP|Custom 95189906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cntrsnk Drl 2.8mm Cnn Dart-fire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156957|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered 8mm X 59mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,075.25|FSC: 13; Default||Not reimbursed separately|8,075.25|FSC: 13; Default||External grouping not supported 95156958|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cast Covered 8mm X 38mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95195448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 65mm T10 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95156960|EAP|Custom 95156960||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Hand Minor Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195449|EAP|Custom 95195449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Headless 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95156961|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95156962|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95195450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 10mm X 15mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95156963|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Reply Dr Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,120.00|FSC: 13; Default||Not reimbursed separately|15,120.00|FSC: 13; Default||External grouping not supported 95156968|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Identifier Biopsy Site For Use I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95195451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.3mm 8.2mm 2.9mm 80mm 32mm Ss P/t Rvrs Cut Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95156977|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95156978|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95156979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|FSC: 13; Default||Not reimbursed separately|7,238.28|FSC: 13; Default||External grouping not supported 95156982|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Shuttle Slip 4.5fr Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95156984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95156985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 9 X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95156986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Pin And Reamer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95156988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Tornier Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,470.00|FSC: 13; Default||Not reimbursed separately|13,470.00|FSC: 13; Default||External grouping not supported 95156989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Right Tornier Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,990.00|FSC: 13; Default||Not reimbursed separately|9,990.00|FSC: 13; Default||External grouping not supported 95156990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Tornier Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95156993|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Bi Ventricular Car|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71,970.00|FSC: 13; Default||Not reimbursed separately|71,970.00|FSC: 13; Default||External grouping not supported 95156995|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Workhorse Balloon 6mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156996|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Workhorse Balloon 7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95156997|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Covered Cast 7mm X 59mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|FSC: 13; Default||Not reimbursed separately|8,325.00|FSC: 13; Default||External grouping not supported 95156998|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Covered Cast 9mm X 38mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95156999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95157000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95157001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95157002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95157003|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 9mm X 15c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,795.00|FSC: 13; Default||Not reimbursed separately|9,795.00|FSC: 13; Default||External grouping not supported 95157004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross-pin Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|FSC: 13; Default||Not reimbursed separately|257.04|FSC: 13; Default||External grouping not supported 95157006|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,337.00|FSC: 13; Default||Not reimbursed separately|23,337.00|FSC: 13; Default||External grouping not supported 95157007|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Exluder Entender|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,130.00|FSC: 13; Default||Not reimbursed separately|8,130.00|FSC: 13; Default||External grouping not supported 95157010|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kumpe Soft View Non Bra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157012|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Secura-dr Dual Ch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|FSC: 13; Default||Not reimbursed separately|54,000.00|FSC: 13; Default||External grouping not supported 95157013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127 Degree A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 95157014|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Secura-vr Single|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,000.00|FSC: 13; Default||Not reimbursed separately|45,000.00|FSC: 13; Default||External grouping not supported 95157015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95157016|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Consulta Cardiac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,075.00|FSC: 13; Default||Not reimbursed separately|63,075.00|FSC: 13; Default||External grouping not supported 95157017|EAP|Custom 95157017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Stimuplex 20 Ga X 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157018|EAP|Custom 95157018||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (pink/red|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157019|EAP|Custom 95157019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (purple)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157020|EAP|Custom 95157020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (yellow)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157021|EAP|Custom 95157021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (white)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157022|EAP|Custom 95157022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157023|EAP|Custom 95157023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (orange)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157024|EAP|Custom 95157024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Oxygen Delivery (green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157025|EAP|Custom 95157025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (pink/red)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157026|EAP|Custom 95157026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (purple)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157027|EAP|Custom 95157027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (yellow)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157028|EAP|Custom 95157028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (white)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157029|EAP|Custom 95157029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195452|EAP|Custom 95195452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Bn Cmnt 200mm 8ga Accuportside Dlv Strl Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157030|EAP|Custom 95157030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (orange)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157031|EAP|Custom 95157031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intubation (green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157032|EAP|Custom 95157032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (pink/red)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157033|EAP|Custom 95157033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (purple)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxail Non Locking 3.5mm X 26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95157034|EAP|Custom 95157034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (yellow)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157035|EAP|Custom 95157035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (white)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157036|EAP|Custom 95157036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157037|EAP|Custom 95157037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (orange)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195454|EAP|Custom 95195454||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Foam Pre-cln 12oz Intcp Dtrg Escp Mdvtr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157038|EAP|Custom 95157038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module I.v. Delivery (green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157039|EAP|Custom 95157039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (pink/red)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157040|EAP|Custom 95157040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (purple)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157041|EAP|Custom 95157041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (yellow)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 42mm T7 Cort Slfret Scrdrvr St Flt Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95157042|EAP|Custom 95157042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (white)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,992.86|FSC: 13; Default||Not reimbursed separately|2,992.86|FSC: 13; Default||External grouping not supported 95157044|EAP|Custom 95157044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157045|EAP|Custom 95157045||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (orange)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 11mm Spc 69x9.5x1.5mm Ss 3.5mm Scr 6h R Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,658.25|FSC: 13; Default||Not reimbursed separately|1,658.25|FSC: 13; Default||External grouping not supported 95157046|EAP|Custom 95157046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Intraosseous (green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157047|EAP|Custom 95157047||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Resuscitator Child Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157048|EAP|Custom 95157048||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Bp Infant Disposable (pink/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157049|EAP|Custom 95157049||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Bp Child Disposable (yellow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7mm Spc Loprfl 52mmx2.2mm Ss 2.7mm Scr Mn Frag 7hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,211.00|FSC: 13; Default||Not reimbursed separately|2,211.00|FSC: 13; Default||External grouping not supported 95157050|EAP|Custom 95157050||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Bp Adult Disposable Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|FSC: 13; Default||Not reimbursed separately|4,953.90|FSC: 13; Default||External grouping not supported 95192663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Unicondylar Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,350.00|FSC: 13; Default||Not reimbursed separately|10,350.00|FSC: 13; Default||External grouping not supported 95195458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 9mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95157061|EAP|Custom 95157061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Mini Acutra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sphere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95157065|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95157067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 95192665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gmk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95157068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95195459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 10mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95157070|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Regatta Sb Middle Wt N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192666|EAP|Custom 95192666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tourniquet Surgical Hemaclear Large Od30-55 Cm Orange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157072|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ball Tipped 3.0 X 800m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 15mm X 155mm Straight C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95192667|EAP|Custom 95192667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tourniquet Surgical Hemaclear/90 50-90cm Bw 160mm Hg Bp B&w|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157074|EAP|Custom 95157074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Lumbar Nim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 7mm Spc Loprfl 140mmx2.2mm Ss 2.7mm Scr Mn Frag 20hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|FSC: 13; Default||Not reimbursed separately|2,103.75|FSC: 13; Default||External grouping not supported 95157075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95192669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Titanium Curve L110 Mm Od5.5 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|FSC: 13; Default||Not reimbursed separately|1,617.00|FSC: 13; Default||External grouping not supported 95157076|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tigerwire Angled Floppy Tip .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157077|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Prolapse Elevate S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 95157078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Core +10 23mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95195461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 11mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95157079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95157080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Long 26mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95157082|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster Otw 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95157083|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster Otw 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95157086|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Protection Embolic Filter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157087|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Covered Cast 10mm X 38mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95195463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 17mm 51mm Shldr Los Sft Tis Bal Aqls Ascnd Flx Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|FSC: 13; Default||Not reimbursed separately|8,468.58|FSC: 13; Default||External grouping not supported 95157088|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filterwire Ez 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Revision 54mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95157099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Gap 6.5 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95157100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Gap 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95157101|EAP|Custom 95157101||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Neuro 6.0mm X 2.5mm Long|1|HUMANA [1294]||HUMANA [11839]|3,170.25|FSC: 13; Default||Not reimbursed separately|3,170.25|FSC: 13; Default||External grouping not supported 95195464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fil Bn Void 5ml Canc Dbm Stimublast Ptty Rvrs Phs Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.00|FSC: 13; Default||Not reimbursed separately|2,460.00|FSC: 13; Default||External grouping not supported 95157102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrak 12.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 62064911|EAP|CPT® 81263||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ighv Mutation Analysis-neogenomics|1|HUMANA [1294]||HUMANA [11839]|883.56|FSC: 13; Default||Not reimbursed separately|883.56|FSC: 13; Default||External grouping not supported 95157103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95157105|EAP|Custom 95157105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Hem-o-lok Size Large Polyme|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192671|EAP|Custom 95192671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cinchlock Flex Sterile Latex Free Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157111|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Prime 185 Cm Soft Glide 0.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fil Bn Void 5ml Dbm Stimublast Gel Rvrs Phs Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95157134|EAP|Custom 95157134||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ball Exercise 75cm Blue Scp Ther|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Right 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 80170988|EAP|CPT® 11770||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Excision Of Pilonidal Cyst Or Sinus; Simple|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95157140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Small Right 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95157141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95157142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95157143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95157144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis 4.75mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95157145|EAP|Custom 95157145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Arthrex Tenodesis 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio With Inserte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95157148|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pressurewire Certus 014 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195466|EAP|Custom 95195466||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 13x11.9cm Brst 360-430cc Smth Srfc Intgr Port Allo|1|HUMANA [1294]||HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 95157149|EAP|Custom 95157149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cables Radi Analyzer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95192672|EAP|Custom 95192672||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Clydesdale 6d Peek 55mm X12mm Lumbar Inter Fn|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95157154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95195467|EAP|Custom 95195467||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Intvrtb 18mm 7mm Pstg Lp Cspn Ti|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95157155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95192673|EAP|Custom 95192673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 3.8mm Ao Coupling Cannulated 3mm Asnis Micro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95157157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95192674|EAP|Custom 95192674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Cannulated Asnis Micro 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95195468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Tibial Uka Vit E 10mm Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95157159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95192675|EAP|Custom 95192675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speedguide For 2.4/2.7mm T8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95157161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Offset Triathlon 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|FSC: 13; Default||Not reimbursed separately|4,315.50|FSC: 13; Default||External grouping not supported 95192676|EAP|Custom 95192676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Asnis Micro 3.0/2/1mm Ao Coupling Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Offset Triathlon 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|FSC: 13; Default||Not reimbursed separately|4,315.50|FSC: 13; Default||External grouping not supported 95195469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 20mm Anchorage Ti Std T8 Ft/ankl Tx Hd Ns Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95157163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Triat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 95157164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Carolina Jones 4.5mm X 40m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|FSC: 13; Default||Not reimbursed separately|1,551.00|FSC: 13; Default||External grouping not supported 95157167|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Pro Solo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157168|EAP|Custom 95157168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Deployment Stratus Relieva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157169|EAP|Custom 95157169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spacer Micro Flow Stratus Reliev|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 400mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95157170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ps X 3 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951200001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95157171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlon S29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95157172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Tm Hole Multi P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 951200002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95157173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Head Femoral 6 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95195473|EAP|Custom 95195473||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Saphenous 3mm L = 71-80cm|1|HUMANA [1294]||HUMANA [11839]|22,475.25|FSC: 13; Default||Not reimbursed separately|22,475.25|FSC: 13; Default||External grouping not supported 95157178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 951200003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95157179|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95157180|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 951200004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95157181|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Acellular Dermal Flex Hd 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.03|FSC: 13; Default||Not reimbursed separately|91.03|FSC: 13; Default||External grouping not supported 95157182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Stainless 3.5mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951200005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95157183|EAP|Custom 95157183||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Surfix Stainless 3.5mm|1|HUMANA [1294]||HUMANA [11839]|486.48|FSC: 13; Default||Not reimbursed separately|486.48|FSC: 13; Default||External grouping not supported 95157186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Femoral Intrafix 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951200006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 46mm Od X 15mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157190|EAP|Custom 95157190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Fiapc Diameter 2.3mm 6.9fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157195|EAP|Custom 95157195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Hernia Protack 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 46mm Od X 20mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157199|EAP|Custom 95157199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Endoscopic Surgiflo 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 951200008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 46mm Od X 25mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157201|EAP|Custom 95157201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Plds 15w|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157202|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cryo-artery Aorto-ilia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70,185.00|FSC: 13; Default||Not reimbursed separately|70,185.00|FSC: 13; Default||External grouping not supported 951200009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 50mm Od X 15mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Hemispherical Clu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95157208|EAP|Custom 95157208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endocatch 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 50mm Od X 20mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Tm Multihole 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|FSC: 13; Default||Not reimbursed separately|7,372.56|FSC: 13; Default||External grouping not supported 95195474|EAP|Custom 95195474||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Cath 1.96mr Achv Adv 10 Pin Strl Lf Reprocessed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951200011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 50mm Od X 25mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157214|EAP|Custom 95157214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Milling Joint Femoral Patel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 951200012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 54mm Od X 15mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,368.15|FSC: 13; Default||Not reimbursed separately|16,368.15|FSC: 13; Default||External grouping not supported 95195475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Strg 72mmx2mm Ti 5 Hl Lck Loprfl Variax Bn Fib Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|FSC: 13; Default||Not reimbursed separately|1,213.80|FSC: 13; Default||External grouping not supported 951200013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 54mm Od X 20mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95157222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 951200014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 54mm Od X 25mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157223|EAP|Custom 95157223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Standard 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157227|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951200015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 58mm Od X 15mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157229|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95157230|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951200016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 58mm Od X 20mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Femoral Intrafix 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95157232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Subtalar 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,965.00|FSC: 13; Default||Not reimbursed separately|4,965.00|FSC: 13; Default||External grouping not supported 951200017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 58mm Od X 25mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm 2mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95157237|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Thruway 190cm 3 Straig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 62mm Od X 15mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157244|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Workhorse Balloon 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157250|EAP|Custom 95157250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Removal Explant Long 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 62mm Od X 20mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle Marathon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 95195476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 80mm Ss 3.5mm Scr 7 Hl Rt Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,806.75|FSC: 13; Default||Not reimbursed separately|1,806.75|FSC: 13; Default||External grouping not supported 95157252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951200020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 62mm Od X 25mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157253|EAP|Custom 95157253||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Knee Mueller Hinged Mediu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157254|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gold Hemashield 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|FSC: 13; Default||Not reimbursed separately|2,188.80|FSC: 13; Default||External grouping not supported 951200021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 66mm Od X 15mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157255|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Vascular Closure Angiosea|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.30|FSC: 13; Default||Not reimbursed separately|696.30|FSC: 13; Default||External grouping not supported 95195477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 15mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95157256|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Vascular Closure Angiosea|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.30|FSC: 13; Default||Not reimbursed separately|696.30|FSC: 13; Default||External grouping not supported 951200022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 66mm Od X 20mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157259|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157260|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.50 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Acetabular 66mm Od X 25mm Wedge Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|FSC: 13; Default||Not reimbursed separately|8,202.60|FSC: 13; Default||External grouping not supported 95157262|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 46mm T7 Cort Slfret Scrdrvr St Flt Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95157263|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 7x11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157264|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.25 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95131424|EAP|Custom 95131424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 18 Ga X 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157265|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.50 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.75 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 7x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157267|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157268|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.25 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 8x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157269|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.50 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157270|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.75 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 8x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157271|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 4.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157273|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 2.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 9x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157274|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065520|EAP|CPT® 86644||0302 - LABORATORY - IMMUNOLOGY|Hb Cmv Igg Avidity-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 95157275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951200029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 9x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95157278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 951200030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 10x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95195480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 3.5mm 34mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95157280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Offset Triathlon 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|FSC: 13; Default||Not reimbursed separately|4,315.50|FSC: 13; Default||External grouping not supported 951200031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 10x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95157282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 951200032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 11x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95195481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 3.5mm 30mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 951200033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 11x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95157286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,142.10|FSC: 13; Default||Not reimbursed separately|7,142.10|FSC: 13; Default||External grouping not supported 951200034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 12x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157287|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 3.5mm 32mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95157288|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.50 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 155mm Strt Stm 12x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|FSC: 13; Default||Not reimbursed separately|22,180.20|FSC: 13; Default||External grouping not supported 95157289|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 2.75 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157290|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 8x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157291|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.25 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157292|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.50 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 8x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157293|EAP|Custom 95157293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Flower Wire Guided Retrev|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157294|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 3.75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 9x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157295|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Flextome Monorail 4.00 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157297|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 951200039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 9x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157299|EAP|Custom 95157299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Touch Soft Fluted Roun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157300|EAP|Custom 95157300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Touch Soft Fluted Roun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 10x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157302|EAP|Custom 95157302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Touch Soft Fluted Roun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157304|EAP|Custom 95157304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Touch Soft Fluted Roun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 10x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157305|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,086.08|FSC: 13; Default||Not reimbursed separately|2,086.08|FSC: 13; Default||External grouping not supported 95157306|EAP|Custom 95157306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Touch Soft Fluted Roun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 11x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157307|EAP|Custom 95157307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Fluted Round 1.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157308|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 951200043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 11x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157309|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 95157310|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 951200044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 12x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157311|EAP|Custom 95157311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Fluted Round 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170411|EAP|CPT® 36908||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stent Central Dialysis Segment Thru Dialysis Circ Inc Angio Add On|1|HUMANA [1294]||HUMANA [11839]|7,396.71|FSC: 13; Default||Not reimbursed separately|7,396.71|FSC: 13; Default||External grouping not supported 95157312|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 95157313|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 80170422|EAP|CPT® 36909||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Dialysis Circuit Embolization, Add On|1|HUMANA [1294]||HUMANA [11839]|6,332.00|FSC: 13; Default||Not reimbursed separately|6,332.00|FSC: 13; Default||External grouping not supported 95157314|EAP|Custom 95157314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Fluted Round Extend Ta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 12x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157315|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,600.46|FSC: 13; Default||Not reimbursed separately|2,600.46|FSC: 13; Default||External grouping not supported 80170433|EAP|CPT® 62327||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epi Inj Incl Indwelling Cath, Cont Infusion Or Bolus|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95157316|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.45|FSC: 13; Default||Not reimbursed separately|2,085.45|FSC: 13; Default||External grouping not supported 95157317|EAP|Custom 95157317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Fluted Round Extend Ta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170444|EAP|CPT® 0440T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cryoablation Upper Extremity Nerve|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 95157318|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,599.65|FSC: 13; Default||Not reimbursed separately|2,599.65|FSC: 13; Default||External grouping not supported 951200046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 13x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157320|EAP|Custom 95157320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 1.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170455|EAP|CPT® 0441T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cryoablation Lower Extremity Nerve|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 95157321|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,523.73|FSC: 13; Default||Not reimbursed separately|1,523.73|FSC: 13; Default||External grouping not supported 95157322|EAP|Custom 95157322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 13x19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157323|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.45|FSC: 13; Default||Not reimbursed separately|1,524.45|FSC: 13; Default||External grouping not supported 95195484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 52mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95157324|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hemashield Plati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,630.59|FSC: 13; Default||Not reimbursed separately|1,630.59|FSC: 13; Default||External grouping not supported 95157325|EAP|Custom 95157325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .018 D|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 951200048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 14x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157326|EAP|Custom 95157326||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .018 D|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95189411|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Expandable Atrium Icast Balloon 6mm X 59mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|FSC: 13; Default||Not reimbursed separately|7,908.75|FSC: 13; Default||External grouping not supported 95157327|EAP|Custom 95157327||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .018 D|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95157329|EAP|Custom 95157329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189412|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Expandable Atrium Icast Balloon 6mm X 39mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|FSC: 13; Default||Not reimbursed separately|7,338.75|FSC: 13; Default||External grouping not supported 95157330|EAP|Custom 95157330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha 205mm Strt Stm 14x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 95157331|EAP|Custom 95157331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189414|EAP|Custom 95189414||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Altitude T2 13 X 22 Mm|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95157332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|FSC: 13; Default||Not reimbursed separately|1,551.00|FSC: 13; Default||External grouping not supported 95195485|EAP|Custom 95195485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Long Cannulated 4.0mm Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|FSC: 13; Default||Not reimbursed separately|1,551.00|FSC: 13; Default||External grouping not supported 95189413|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Armada 18 5.5 Mm X 200 Mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|FSC: 13; Default||Not reimbursed separately|1,551.00|FSC: 13; Default||External grouping not supported 951200050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 8x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189410|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Generator - Emblem S-icd Mri Pulse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|FSC: 13; Default||Not reimbursed separately|64,500.00|FSC: 13; Default||External grouping not supported 95157336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951200051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 9x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula 3.8mm X 180mm Left Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95157341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157342|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951200052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 10x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951200053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 11x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95157348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 7mm 23mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,394.00|FSC: 13; Default||Not reimbursed separately|2,394.00|FSC: 13; Default||External grouping not supported 95157349|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|FSC: 13; Default||Not reimbursed separately|1,551.00|FSC: 13; Default||External grouping not supported 95157350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Carolina Jones 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951200054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 12x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 8mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95157352|EAP|Custom 95157352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Oscillating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 40mm Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|FSC: 13; Default||Not reimbursed separately|5,782.98|FSC: 13; Default||External grouping not supported 95157355|EAP|Custom 95157355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix 6cm X 22mm (dis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 13x19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157360|EAP|Custom 95157360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157361|EAP|Custom 95157361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 8mmx23mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,394.00|FSC: 13; Default||Not reimbursed separately|2,394.00|FSC: 13; Default||External grouping not supported 95157362|EAP|Custom 95157362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round Course 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157363|EAP|Custom 95157363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round Course 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha Calcar 205 Stem-15mm Resection 14x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|FSC: 13; Default||Not reimbursed separately|26,029.50|FSC: 13; Default||External grouping not supported 95157364|EAP|Custom 95157364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round Course 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157365|EAP|Custom 95157365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Round Course 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157366|EAP|Custom 95157366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Tapered (stape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157367|EAP|Custom 95157367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Tapered (stape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157368|EAP|Custom 95157368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Elite Diamond Tapered (stape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157369|EAP|Custom 95157369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cassette Irrigation Core|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 9mmx23mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95157380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95157381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 951200058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95157383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95157384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95157386|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157387|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 10mmx23mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95157388|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157389|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157390|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157393|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Plus 5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95157394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 951200061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157395|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Transeptor Guiding Sr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95195491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 7mmx30mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95157397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95157398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 951200062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95157400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95157401|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157403|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157414|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer X-stop 8mm|1|HUMANA [1294]||HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95157423|EAP|Custom 95157423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Roticulator Endo Dissect|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 8mmx30mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,394.00|FSC: 13; Default||Not reimbursed separately|2,394.00|FSC: 13; Default||External grouping not supported 95157424|EAP|Custom 95157424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Versaport 11mm Stnadard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157428|EAP|HCPCS C1878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Thyroplasty Female|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951200064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157429|EAP|Custom 95157429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long Term Montogmery Sz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157430|EAP|Custom 95157430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long Term Montogmery Sz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157431|EAP|Custom 95157431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long Term Montogmery Sz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157432|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 370mg/ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|FSC: 13; Default||Not reimbursed separately|0.27|FSC: 13; Default||External grouping not supported 951200065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157433|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 370mg/ml 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|FSC: 13; Default||Not reimbursed separately|0.58|FSC: 13; Default||External grouping not supported 95157435|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 370mg/ml 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|FSC: 13; Default||Not reimbursed separately|0.25|FSC: 13; Default||External grouping not supported 95195493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 9mmx30mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,394.00|FSC: 13; Default||Not reimbursed separately|2,394.00|FSC: 13; Default||External grouping not supported 95157436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95157437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127-degree A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 951200066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157438|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95157439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitrax +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95157440|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 12mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95189415|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Sinus Regular Bioabsorbable Propel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95157441|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95189416|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Sinus Mini Bioabsorable Propel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95157443|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 14mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95195494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Tib Ftnr Intrafix Adv Br Shth And Scr 10mmx30mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95157444|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 18mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157445|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95157446|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 22mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95189417|EAP|Custom 95189417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill D2.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157447|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mm X 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Fixed Bearing Preservatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,820.00|FSC: 13; Default||Not reimbursed separately|2,820.00|FSC: 13; Default||External grouping not supported 95189418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Sonicanchor Kit 2.5mm X 10mm/force Fibre #2/c-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95157450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Fixed Bearing Pres|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|FSC: 13; Default||Not reimbursed separately|5,820.00|FSC: 13; Default||External grouping not supported 95195495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 80mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95157456|EAP|Custom 95157456||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Patella D3 51cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189419|EAP|Custom 95189419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Insert Percutaneous Pushlock 2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157457|EAP|Custom 95157457||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Patella D3 56 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157459|EAP|Custom 95157459||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Patella D3 61cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157461|EAP|Custom 95157461||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Biocomp Pushlock 2.9 X 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95157462|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 3mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157463|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 5mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patellar Resurfacing Journey 32mm 7.5 Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,440.00|FSC: 13; Default||Not reimbursed separately|1,440.00|FSC: 13; Default||External grouping not supported 95157470|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95157471|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951200072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157472|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95157475|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95157476|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.0 X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951200073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157477|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.0 X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95189423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Dish Deepjourney A/p42mm/ml60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 95157478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular Offset 25mm X 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95157479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Taper 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,548.00|FSC: 13; Default||Not reimbursed separately|1,548.00|FSC: 13; Default||External grouping not supported 951200074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|FSC: 13; Default||Not reimbursed separately|19,866.00|FSC: 13; Default||External grouping not supported 95157480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular 12mm 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95157481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular Offset 1.5mm X 2.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95189424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Constrained Poly Longevity Continuum 32mm Szkk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,647.00|FSC: 13; Default||Not reimbursed separately|10,647.00|FSC: 13; Default||External grouping not supported 95157482|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95157483|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95189425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Constrained Poly Longevity Continuum 28mm Szkk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,647.00|FSC: 13; Default||Not reimbursed separately|10,647.00|FSC: 13; Default||External grouping not supported 95157490|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 951200075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|FSC: 13; Default||Not reimbursed separately|20,021.40|FSC: 13; Default||External grouping not supported 95157491|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.00 X9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95189426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Option Biolox 32mm +7/5 Deg12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,811.00|FSC: 13; Default||Not reimbursed separately|5,811.00|FSC: 13; Default||External grouping not supported 95157492|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.00 X15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95157493|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 2.5 X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95189427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95157505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951200076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|FSC: 13; Default||Not reimbursed separately|20,021.40|FSC: 13; Default||External grouping not supported 95157506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Proximal 30p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|FSC: 13; Default||Not reimbursed separately|4,299.00|FSC: 13; Default||External grouping not supported 95189429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot 2.9 With Cutting Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.00|FSC: 13; Default||Not reimbursed separately|1,512.00|FSC: 13; Default||External grouping not supported 95157507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Proximal 20d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|FSC: 13; Default||Not reimbursed separately|4,428.00|FSC: 13; Default||External grouping not supported 95157508|EAP|Custom 95157508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Disposable Pip Linvatec/hal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosteon 7mmx23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.24|FSC: 13; Default||Not reimbursed separately|669.24|FSC: 13; Default||External grouping not supported 95157512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 951200077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|FSC: 13; Default||Not reimbursed separately|20,021.40|FSC: 13; Default||External grouping not supported 95157513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|FSC: 13; Default||Not reimbursed separately|6,117.30|FSC: 13; Default||External grouping not supported 95189431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot 2.9 With Cutting Needles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.00|FSC: 13; Default||Not reimbursed separately|1,512.00|FSC: 13; Default||External grouping not supported 95157518|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.5 X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95157520|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Illiac Aaa 8mm X 88cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick 3 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95157522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick 2 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95157523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick 2 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95157524|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.5 X18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95157525|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 8mm X 71cm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157526|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 8mm X 105cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157527|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 12mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95157528|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 10mm X 54cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95157529|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 10mm X 71cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157530|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 10mm X 88cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157531|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 12mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95157532|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 12mm X 107cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157533|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 14mm X 39cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157534|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 14mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|FSC: 13; Default||Not reimbursed separately|20,021.40|FSC: 13; Default||External grouping not supported 95157535|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 14mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95157536|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endeavorsprint 3.0 X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 95157537|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95157538|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 39cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|FSC: 13; Default||Not reimbursed separately|20,021.40|FSC: 13; Default||External grouping not supported 95157539|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95189438|EAP|Custom 95189438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Kit Ocp107 Osteocool Rf17g10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157540|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 18mm X 39cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157541|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 18mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95189442|EAP|Custom 95189442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Passer Champion Slingshot 45 Degree Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157542|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 18mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Cemented Long Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|FSC: 13; Default||Not reimbursed separately|20,021.40|FSC: 13; Default||External grouping not supported 95157543|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Jet Stream 2.1/3.0 And|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189444|EAP|Custom 95189444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Passer Champion Slingshot 70 Degree Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157544|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95157545|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95189434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X 30 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95157546|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 22mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 951200081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Vitallium Head 28+6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,205.00|FSC: 13; Default||Not reimbursed separately|2,205.00|FSC: 13; Default||External grouping not supported 95157547|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 22mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95189435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 95157548|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mm X 39cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 80171701|EAP|CPT® 10080||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I And D Pilonidal Cyst Simple|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95157550|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mm X 56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95189433|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 1.25mm Micro 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157551|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mm X 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 951200610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m Sm Grip And 2 1.6mm Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,469.20|FSC: 13; Default||Not reimbursed separately|3,469.20|FSC: 13; Default||External grouping not supported 95157554|EAP|Custom 95157554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix 4 X 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189436|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 1.50mm Solid 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157555|EAP|Custom 95157555||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix 7 X 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157556|EAP|Custom 95157556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bovie Bayonet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189437|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 1.25mm Micro 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157557|EAP|Custom 95157557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Discectomy Bayonet Bi-pola|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m Lg Grip And 2 2.0mm Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,469.20|FSC: 13; Default||Not reimbursed separately|3,469.20|FSC: 13; Default||External grouping not supported 95157558|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Dilation Soehen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157559|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Dilation Soehen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189439|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 2.00mm Classic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157560|EAP|Custom 95157560||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic Zimmon 7.0fr X|1|HUMANA [1294]||HUMANA [11839]|184.89|FSC: 13; Default||Not reimbursed separately|184.89|FSC: 13; Default||External grouping not supported 951200612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Vit Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,186.50|FSC: 13; Default||Not reimbursed separately|1,186.50|FSC: 13; Default||External grouping not supported 95157562|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189440|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 1.25mm Solid 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157563|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157564|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95189441|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 2.00mm Solid 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schantz Std 4.5mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.03|FSC: 13; Default||Not reimbursed separately|321.03|FSC: 13; Default||External grouping not supported 951200613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Vit Beaded Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 95157570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schantz Std 4.5mm X 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.03|FSC: 13; Default||Not reimbursed separately|321.03|FSC: 13; Default||External grouping not supported 95189443|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 1.25mm Solid 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schantz Std 4.5mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.81|FSC: 13; Default||Not reimbursed separately|273.81|FSC: 13; Default||External grouping not supported 95157573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|788.31|FSC: 13; Default||Not reimbursed separately|788.31|FSC: 13; Default||External grouping not supported 95189445|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 1.50mm Classic 145cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|929.97|FSC: 13; Default||Not reimbursed separately|929.97|FSC: 13; Default||External grouping not supported 951200614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 2.0mm Vit Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,186.50|FSC: 13; Default||Not reimbursed separately|1,186.50|FSC: 13; Default||External grouping not supported 95157576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlon S33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 80170466|EAP|CPT® 33340||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Percutaneous Closure Left Atrial Append With End Implant|1|HUMANA [1294]||HUMANA [11839]|16,415.00|FSC: 13; Default||Not reimbursed separately|16,415.00|FSC: 13; Default||External grouping not supported 95157577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95157578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Vertex 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.36|FSC: 13; Default||Not reimbursed separately|1,599.36|FSC: 13; Default||External grouping not supported 80170477|EAP|CPT® 93590||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc Closure Perivalvular Leak By Occ Device; Mitral Valve|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 95157579|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Small Vitallium Grip With 2 2.0mm Cables|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|FSC: 13; Default||Not reimbursed separately|4,376.40|FSC: 13; Default||External grouping not supported 95157582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibia Stabilized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 80170488|EAP|CPT® 93591||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc Closure Perivalvular Leak By Occ Device; Aortic Valve|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 95157583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Femoral Intrafix 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95157584|EAP|Custom 95157584||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Control Copilot Bleedback|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170499|EAP|CPT® 93592||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc Close Perivalvular Leak By Occ Device Add Mitral Aortic Valve|1|HUMANA [1294]||HUMANA [11839]|17,595.33|FSC: 13; Default||Not reimbursed separately|17,595.33|FSC: 13; Default||External grouping not supported 95157585|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 6 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951200616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Medium Vitallium Grip With 2 2.0mm Cables|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|FSC: 13; Default||Not reimbursed separately|4,376.40|FSC: 13; Default||External grouping not supported 95157586|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 7 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80170500|EAP|CPT® 0408T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insert Or Replace Perm Ccm System Pulse Gen With Trans Electrodes|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 95157587|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 8 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95157588|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170511|EAP|CPT® 0409T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insertion Of Ccm Pulse Generator Only|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 95157591|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.25 Diopter C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Vitallium Grip Grip Plate 100mm With 2 2.0mm Cab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|FSC: 13; Default||Not reimbursed separately|4,376.40|FSC: 13; Default||External grouping not supported 95157593|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Advance 18lp Balloon 4f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170522|EAP|CPT® 0410T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insertion Of Ccm Atrial Electrode Only|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 95157594|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Advance 18lp Balloon 4f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157598|EAP|Custom 95157598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pleurx Drainage 1000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170533|EAP|CPT® 0411T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insertion Of Ccm Ventricular Electrode Only|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 95157599|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Medium Vitallium Grip Plate 200mm With 2 2.0mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,058.10|FSC: 13; Default||Not reimbursed separately|7,058.10|FSC: 13; Default||External grouping not supported 95157600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Bio-modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,150.00|FSC: 13; Default||Not reimbursed separately|9,150.00|FSC: 13; Default||External grouping not supported 80170544|EAP|CPT® 0412T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Removal Of Ccm Generator Only|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 95157601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Offset Shoulder Biom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,909.00|FSC: 13; Default||Not reimbursed separately|3,909.00|FSC: 13; Default||External grouping not supported 95157602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 15mm X 195mm Din|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 80170555|EAP|CPT® 0413T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Removal Of Ccm Transvenous Electrode (atrial Or Ventricular)|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 95157603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick 2 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 951200619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Vitallium Grip With 2 2.0mm Cables|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|FSC: 13; Default||Not reimbursed separately|4,376.40|FSC: 13; Default||External grouping not supported 95157605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|FSC: 13; Default||Not reimbursed separately|10,017.00|FSC: 13; Default||External grouping not supported 80170566|EAP|CPT® 0414T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Removal And Replacement Of Ccm Generator Only (generator Exchange)|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 95157607|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95157608|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 80170577|EAP|CPT® 0415T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Reposition Of Prev Implant Ccm Electrode Atrial Or Ventricular|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95157609|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951200620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Vitallium Grip Plate 110mm With 2 2.0mm Ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|FSC: 13; Default||Not reimbursed separately|4,376.40|FSC: 13; Default||External grouping not supported 95157610|EAP|Custom 95157610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire K 100mm Double Ended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170588|EAP|CPT® 0416T||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Relocation Of Skin Pocket For Ccm Generator|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 95157611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95195497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 4 Level 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 95157612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95189470|EAP|Custom 95189470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nozzle Cement Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 951200621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Vitallium Grip Plate 160mm With 2 2.0mm Ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,701.50|FSC: 13; Default||Not reimbursed separately|5,701.50|FSC: 13; Default||External grouping not supported 95157620|EAP|Custom 95157620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Pneumicro Oscil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189473|EAP|Custom 95189473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157623|EAP|Custom 95157623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Pneumicro Oscil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189446|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 4.0 X 80 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157624|EAP|Custom 95157624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Pneumicro Oscil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Vitallium Grip Plate 200mm With 2 2.0mm Ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,058.10|FSC: 13; Default||Not reimbursed separately|7,058.10|FSC: 13; Default||External grouping not supported 95157625|EAP|Custom 95157625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Pneumicro Sagit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189447|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 7.0 X 60 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 37.5mm Vision Atlan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|FSC: 13; Default||Not reimbursed separately|5,782.98|FSC: 13; Default||External grouping not supported 95157627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 95189448|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote - 3mm X 60mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Vision 4 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 951200623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m Vit Cable Sleeve 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|728.70|FSC: 13; Default||Not reimbursed separately|728.70|FSC: 13; Default||External grouping not supported 95157629|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|FSC: 13; Default||Not reimbursed separately|3,026.04|FSC: 13; Default||External grouping not supported 95189449|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fg Sterling Otw 3.0 X 60 X 150 (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157630|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 11 X 11 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95157631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Rescue Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|FSC: 13; Default||Not reimbursed separately|1,446.48|FSC: 13; Default||External grouping not supported 95189450|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 5.0 X 60 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157632|EAP|Custom 95157632||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mannifold Neptune Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m Vit Grooved Button|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,113.00|FSC: 13; Default||Not reimbursed separately|1,113.00|FSC: 13; Default||External grouping not supported 95157633|EAP|Custom 95157633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Needle Cu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189451|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote - 2.5mm X 60mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Micromax 2.9 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|FSC: 13; Default||Not reimbursed separately|756.00|FSC: 13; Default||External grouping not supported 95157635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Allthread 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95189452|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote 3mm X 100mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Porous Osse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 951200625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m Vit Mini Cleat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.40|FSC: 13; Default||Not reimbursed separately|953.40|FSC: 13; Default||External grouping not supported 95157637|EAP|Custom 95157637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 8.0 X 7.5mm Threa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189453|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterling Sl Otw 2 X 150 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157638|EAP|Custom 95157638||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hook Velcro White 1 X 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Porous Ossm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95189454|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger 6.0 X 20 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157646|EAP|Custom 95157646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Minor Sterile Custo)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Vit Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,043.70|FSC: 13; Default||Not reimbursed separately|1,043.70|FSC: 13; Default||External grouping not supported 95189455|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote - 2.5mm X 100mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157649|EAP|Custom 95157649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Foot/ankle Sterile )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157652|EAP|Custom 95157652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Paracentesis 15ga5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189456|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Es Otw 1.5mm X 20mm X 142cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157653|EAP|Custom 95157653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Refill Synchromed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Constrained Insert 28f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95157655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95189457|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterling Sl Otw 2.0 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Csm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95157665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bp3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95189458|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 6.0 X 60 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 951200628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Constrained Insert 28g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95157667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Csm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95189459|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote - 2mm X 60mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157669|EAP|Custom 95157669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Tomcat 4.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195499|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stnt Urth 7fr 18cm Aq Hydr Sf Thr W/pt Unvl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.59|FSC: 13; Default||Not reimbursed separately|391.59|FSC: 13; Default||External grouping not supported 95157670|EAP|Custom 95157670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Tomcat 5.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189460|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fg Sterling Otw 2.0 X 60 X 150 (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157671|EAP|Custom 95157671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Tomcat 5.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Constrained Insert 32h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95157672|EAP|Custom 95157672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 50-s Rf Energy Serfas 3.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189461|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterling Sl Otw 2.5 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157673|EAP|Custom 95157673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Hook Rf Energy Serfas 3.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157674|EAP|Custom 95157674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round 6.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189462|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 6.0 X 60 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157675|EAP|Custom 95157675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Direct Drive 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Constrained Insert 32i|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95189463|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote - 2mm X 100mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157677|EAP|Custom 95157677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retrieval Inzll 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157678|EAP|Custom 95157678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Separator Non-threaded 11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189464|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fg Sterling Otw 2.5 X 60 X 150 (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157679|EAP|Custom 95157679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Separator Non-threaded Ki|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Constrained Insert 32j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95157680|EAP|Custom 95157680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Dual 5mm X 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189465|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterling Sl Otw 2.5 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157681|EAP|Custom 95157681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scissor Direct Drive 5mm X 35cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157682|EAP|Custom 95157682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Histoacryl 0.5 Ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Humeral Condyle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,329.00|FSC: 13; Default||Not reimbursed separately|7,329.00|FSC: 13; Default||External grouping not supported 951200632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constrained Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157684|EAP|Custom 95157684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Irrigator Suction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,204.00|FSC: 13; Default||Not reimbursed separately|18,204.00|FSC: 13; Default||External grouping not supported 95157689|EAP|Custom 95157689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Plus Angled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157690|EAP|Custom 95157690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Plus Aggres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ulna Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,052.00|FSC: 13; Default||Not reimbursed separately|20,052.00|FSC: 13; Default||External grouping not supported 95157691|EAP|Custom 95157691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Plus Aggres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constrained Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157692|EAP|Custom 95157692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Plus Aggres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189469|EAP|Custom 95189469||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone Small 6mm|1|HUMANA [1294]||HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95157693|EAP|Custom 95157693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Plus Aggres|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157694|EAP|Custom 95157694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Resector 4.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189471|EAP|Custom 95189471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cement Cobalt Medium Viscosity W/ Gent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157695|EAP|Custom 95157695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Resector 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constrained Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157696|EAP|Custom 95157696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Resector 5.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Phalangeal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|FSC: 13; Default||Not reimbursed separately|7,470.00|FSC: 13; Default||External grouping not supported 95157697|EAP|Custom 95157697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Tomcat 3.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157698|EAP|Custom 95157698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Bite Double|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constrained Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157699|EAP|Custom 95157699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Whisker Slo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 13mm Tib E-f Fem 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95157700|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157702|EAP|Custom 95157702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 6 Bur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95157703|EAP|Custom 95157703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 12 Bu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constrained Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157705|EAP|Custom 95157705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 6 Bur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189474|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 3 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157706|EAP|Custom 95157706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 6 Bur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Lock Replacement Cup Modular 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.50|FSC: 13; Default||Not reimbursed separately|181.50|FSC: 13; Default||External grouping not supported 95157707|EAP|Custom 95157707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 12 Bu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189475|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157708|EAP|Custom 95157708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 12 Bu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constrained Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157709|EAP|Custom 95157709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Radius Full|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189476|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 5 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157710|EAP|Custom 95157710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Flute 12 Bu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157711|EAP|Custom 95157711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Bur Slap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189477|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 6 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157716|EAP|Custom 95157716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Pump Arthroscopy Flostead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Constr. Acet. Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|FSC: 13; Default||Not reimbursed separately|11,029.20|FSC: 13; Default||External grouping not supported 95157717|EAP|Custom 95157717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 90-s Rf Energy Serfas 3.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189478|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 3 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157719|EAP|Custom 95157719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 90-regular Rf Energy Serfa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195502|EAP|Custom 95195502||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 14x9mm Vrtstck Crstn Psr 11mm Peek-optm Lat Port|1|HUMANA [1294]||HUMANA [11839]|4,836.30|FSC: 13; Default||Not reimbursed separately|4,836.30|FSC: 13; Default||External grouping not supported 95157720|EAP|Custom 95157720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Super 90-s Rf Energy Serfa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189479|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 4 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157721|EAP|Custom 95157721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 30-s Rf Energy Serfas 3.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157722|EAP|Custom 95157722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Aardvark Rf Energy Serfas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189480|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 5 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157723|EAP|Custom 95157723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Direct Rf Energy Serfas 3.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157724|EAP|Custom 95157724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Micro-brush Rf Energy Serf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189481|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 6x 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157725|EAP|Custom 95157725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Micro-claw Rf Energy Serfa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157727|EAP|Custom 95157727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Picc Line Insertion With Te|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189482|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 3 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157728|EAP|Custom 95157728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Formula Radius Full|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 5mm 65mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|FSC: 13; Default||Not reimbursed separately|2,076.00|FSC: 13; Default||External grouping not supported 95157730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quickanchor Mini Plus With Ortho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 95189483|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 4 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Allthread 5.5mm Cu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95189484|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 5 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.76|FSC: 13; Default||Not reimbursed separately|905.76|FSC: 13; Default||External grouping not supported 95157735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick Deal New 4.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,039.50|FSC: 13; Default||Not reimbursed separately|1,039.50|FSC: 13; Default||External grouping not supported 95189485|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 6 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157736|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Anatomical Left 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.15|FSC: 13; Default||Not reimbursed separately|510.15|FSC: 13; Default||External grouping not supported 951200642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157743|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Anatomical Right 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.15|FSC: 13; Default||Not reimbursed separately|510.15|FSC: 13; Default||External grouping not supported 95189486|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 3 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157744|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Polyester Round 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,173.69|FSC: 13; Default||Not reimbursed separately|1,173.69|FSC: 13; Default||External grouping not supported 95195504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L34 Mm Od3 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.00|FSC: 13; Default||Not reimbursed separately|2,016.00|FSC: 13; Default||External grouping not supported 95157745|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Circle Ventralex Me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.00|FSC: 13; Default||Not reimbursed separately|1,740.00|FSC: 13; Default||External grouping not supported 95189487|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 4 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157746|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157748|EAP|HCPCS Q9965||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omnipaque 180mg/m|1|HUMANA [1294]||HUMANA [11839]|11.66|FSC: 13; Default||Not reimbursed separately|11.66|FSC: 13; Default||External grouping not supported 95132333|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157749|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Narrow Medium Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|FSC: 13; Default||Not reimbursed separately|3,113.46|FSC: 13; Default||External grouping not supported 95189488|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 6 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157750|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Thoracic Medium Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|FSC: 13; Default||Not reimbursed separately|3,113.46|FSC: 13; Default||External grouping not supported 95157751|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Narrow Small Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|FSC: 13; Default||Not reimbursed separately|3,113.46|FSC: 13; Default||External grouping not supported 95189489|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 7 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157752|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Wide Small Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|FSC: 13; Default||Not reimbursed separately|3,113.46|FSC: 13; Default||External grouping not supported 951200644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,558.20|FSC: 13; Default||Not reimbursed separately|1,558.20|FSC: 13; Default||External grouping not supported 95189490|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95157755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Cemente|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95189491|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 5 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3-hole Humerus Distal Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,436.56|FSC: 13; Default||Not reimbursed separately|3,436.56|FSC: 13; Default||External grouping not supported 951200645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95189492|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 6 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95157759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 95189493|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 7 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 951200646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All Poly Constrained Insert 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95157761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Micromax 3.9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|FSC: 13; Default||Not reimbursed separately|756.00|FSC: 13; Default||External grouping not supported 95189494|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95157763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189495|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 5 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 951200647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157767|EAP|Custom 95157767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Breast Augmentation Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189496|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189497|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evercross 7 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157776|EAP|Custom 95157776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flat Atlantis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 95119805|EAP|Custom 95119805||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mouthguard Oral-protector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95157779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Offset Triathlon 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|FSC: 13; Default||Not reimbursed separately|4,315.50|FSC: 13; Default||External grouping not supported 95189504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Evans Wedge 12x22x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 95157780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 951200649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 80170599|EAP|CPT® 96377||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Application Of On-body Injector|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 95157782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95157783|EAP|Custom 95157783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Headless Sterile 1/8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95157785|EAP|Custom 95157785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Pneumicro Oscillating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157786|EAP|Custom 95157786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Nuvasive Electrode With N|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157787|EAP|Custom 95157787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Sterile Maxcess|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14 28mm +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|FSC: 13; Default||Not reimbursed separately|8,133.30|FSC: 13; Default||External grouping not supported 95157788|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Granules Graft Foma 20cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,863.00|FSC: 13; Default||Not reimbursed separately|4,863.00|FSC: 13; Default||External grouping not supported 95195506|EAP|Custom 95195506||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Canister 150ml Plus Prevena (pk/5)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157789|EAP|Custom 95157789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Xlif Neurovision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Mold Hip W/reinf 17x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,570.00|FSC: 13; Default||Not reimbursed separately|6,570.00|FSC: 13; Default||External grouping not supported 95157790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Xlp 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|FSC: 13; Default||Not reimbursed separately|10,098.00|FSC: 13; Default||External grouping not supported 951200652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Xlp 5.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,157.00|FSC: 13; Default||Not reimbursed separately|2,157.00|FSC: 13; Default||External grouping not supported 95189516|EAP|Custom 95189516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Length Neck Hip +6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Xlp 5.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,157.00|FSC: 13; Default||Not reimbursed separately|2,157.00|FSC: 13; Default||External grouping not supported 95157794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Lock Xlp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95189513|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosth Penile Pump Ms Preconnect Penoscrotal 700 Cx 15cmx12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,477.00|FSC: 13; Default||Not reimbursed separately|27,477.00|FSC: 13; Default||External grouping not supported 95157795|EAP|Custom 95157795||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coroent Large Extra 10-degree Lo|1|HUMANA [1294]||HUMANA [11839]|14,886.00|FSC: 13; Default||Not reimbursed separately|14,886.00|FSC: 13; Default||External grouping not supported 951200653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157796|EAP|Custom 95157796||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coroent Large Extra 10-degree Lo|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95189508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pelvic Cortex Self-tapping 3.5x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.64|FSC: 13; Default||Not reimbursed separately|92.64|FSC: 13; Default||External grouping not supported 95157797|EAP|Custom 95157797||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coroent Large Extra 10-degree Lo|1|HUMANA [1294]||HUMANA [11839]|14,886.00|FSC: 13; Default||Not reimbursed separately|14,886.00|FSC: 13; Default||External grouping not supported 95195507|EAP|Custom 95195507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Conical Extraction T2 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Xlp 5.5mm X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,157.00|FSC: 13; Default||Not reimbursed separately|2,157.00|FSC: 13; Default||External grouping not supported 95189509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pelvic Cortex Self-tapping 3.5x75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.64|FSC: 13; Default||Not reimbursed separately|92.64|FSC: 13; Default||External grouping not supported 95157799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Xlp 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|FSC: 13; Default||Not reimbursed separately|10,098.00|FSC: 13; Default||External grouping not supported 951200654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157802|EAP|Custom 95157802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Separator Non-threaded Ki|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pelvic Cortex Self-tapping 3.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.64|FSC: 13; Default||Not reimbursed separately|92.64|FSC: 13; Default||External grouping not supported 95157803|EAP|Custom 95157803||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula And Universal Seal 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157804|EAP|Custom 95157804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula And Universal Seal 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Recon Curved Profile Low 3.5/88mm Rad/12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,782.03|FSC: 13; Default||Not reimbursed separately|1,782.03|FSC: 13; Default||External grouping not supported 951200655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157806|EAP|Custom 95157806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar With Shielded Obturator A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 7 Hole/ 20mm /left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|FSC: 13; Default||Not reimbursed separately|5,778.00|FSC: 13; Default||External grouping not supported 95157807|EAP|Custom 95157807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Blunt Tip Non-threaded W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157808|EAP|Custom 95157808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Separator Non-threaded 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Anterolateral Distal Left 10-hole/178mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,712.00|FSC: 13; Default||Not reimbursed separately|8,712.00|FSC: 13; Default||External grouping not supported 951200656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157810|EAP|Custom 95157810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Separator Non-threaded 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189519|EAP|Custom 95189519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Screw 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157811|EAP|Custom 95157811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Separator Non-threaded 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189520|EAP|Custom 95189520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Temp Plate Fixator Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157816|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95189521|EAP|Custom 95189521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Wilson Frame Lpv Cushion Arm Cradles 6/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157821|EAP|Custom 95157821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Metrix 8mm X 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157822|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95189523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 52 20 Mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95157823|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 951200658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157824|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95189527|EAP|Custom 95189527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Shunt Artery Carotid Argyle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157825|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95157826|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95189528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revision 17mm X 127mm Body Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95157827|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 951200659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157829|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95157830|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95157831|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95157833|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 951200660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157834|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 62064600|EAP|CPT® 87483||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Meningitis Encephalitis Panel|1|HUMANA [1294]||HUMANA [11839]|1,250.34|FSC: 13; Default||Not reimbursed separately|1,250.34|FSC: 13; Default||External grouping not supported 95157851|EAP|Custom 95157851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Infusion Pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157856|EAP|Custom 95157856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Nurolon 0 8-18 M0-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Precoat Lt Medial Rt Lateral Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95157862|EAP|Custom 95157862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Skin Diamond Lock 35w|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157866|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Precoat Sz-f Lt Medial Rt Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95157872|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte 205|1|HUMANA [1294]||HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95157876|EAP|Custom 95157876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber Braided 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Duofix Cementless Std Collar Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95157881|EAP|Custom 95157881||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Compression Tubigrip 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Qwix 3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95189565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 5-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|FSC: 13; Default||Not reimbursed separately|5,136.00|FSC: 13; Default||External grouping not supported 95157884|EAP|Custom 95157884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Compression Tubigrip 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157885|EAP|Custom 95157885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157886|EAP|Custom 95157886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157887|EAP|Custom 95157887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157888|EAP|Custom 95157888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157889|EAP|Custom 95157889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189577|EAP|Custom 95189577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire 1.6mmx150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157890|EAP|Custom 95157890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157891|EAP|Custom 95157891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ekosonic Endovascular 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Simpliciti Nucles Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,315.77|FSC: 13; Default||Not reimbursed separately|13,315.77|FSC: 13; Default||External grouping not supported 95157904|EAP|Custom 95157904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Kii 5 X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157905|EAP|Custom 95157905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Fios 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189571|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Visia Af Mri Vr Surescan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,600.00|FSC: 13; Default||Not reimbursed separately|39,600.00|FSC: 13; Default||External grouping not supported 95157908|EAP|Custom 95157908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brace Knee Genumedi Beige Size 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157940|EAP|Custom 95157940||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Balloon Gelport|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189572|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Visia Af Mri Vr Surescan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,600.00|FSC: 13; Default||Not reimbursed separately|39,600.00|FSC: 13; Default||External grouping not supported 95157942|EAP|Custom 95157942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure 5 Sealer Divider 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Bn 2.4mm 37mm Evos 6 Hl Var-angl Flex Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.00|FSC: 13; Default||Not reimbursed separately|1,914.00|FSC: 13; Default||External grouping not supported 95157943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 95189574|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder - Amplatzer Pfo 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|FSC: 13; Default||Not reimbursed separately|29,985.00|FSC: 13; Default||External grouping not supported 95157944|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Occulsion 10 Fr X .035 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157948|EAP|Custom 95157948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Polyurethane Angiograph|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189575|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder - Amplatzer Pfo 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|FSC: 13; Default||Not reimbursed separately|29,985.00|FSC: 13; Default||External grouping not supported 95157952|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Workhorse Balloon 8mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157961|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 38.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95189576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral 3 Hole Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95157964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Standard Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,348.15|FSC: 13; Default||Not reimbursed separately|3,348.15|FSC: 13; Default||External grouping not supported 951200667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plt Cortical 3.5x26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95157966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95195517|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter True Flow Valvuplasty Perfusion 18mm 3.5cm 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95157967|EAP|Custom 95157967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Standard 1.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mmx 30mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95157968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial X 3 Ps Triathlon S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951200668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157969|EAP|Custom 95157969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endocatch 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plt Cancellous 4.0x32mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95157977|EAP|Custom 95157977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Compression Sequential Me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.7mm 18mm Loprfl Scr Ss Ft/ankl Cort Sld Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95189581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plt Cancellous 4.0x36mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 951200669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 80mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.23|FSC: 13; Default||Not reimbursed separately|391.23|FSC: 13; Default||External grouping not supported 95189582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plt Cancellous 4.0x40mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95157988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,798.50|FSC: 13; Default||Not reimbursed separately|4,798.50|FSC: 13; Default||External grouping not supported 95195510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 8mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95157989|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 5mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plt Cannellous Ti 4.0x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 951200670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95157991|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pleurx Peritoneal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80170600|EAP|CPT® 44361||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Small Intest Endo, Enteroscopy Beyond 2nd Portion Of Duodenum W Bx|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95157993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95158001|EAP|Custom 95158001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sterile Single-packed Kurz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187094|EAP|Custom 95187094||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Immobilizer Knee Tri-panel 19"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident 3 X 10-degree 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951200671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95189586|EAP|Custom 95189586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Hip Head W/insert 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95195512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95158011|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mold Stem Hip 17 X 200mm W/reinforcement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,570.00|FSC: 13; Default||Not reimbursed separately|6,570.00|FSC: 13; Default||External grouping not supported 95158012|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158013|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Rt/ Medial Lt/ Lateral Precoat Uni Knee Siz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95158014|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95197586|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 17.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95158015|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 3-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|FSC: 13; Default||Not reimbursed separately|5,136.00|FSC: 13; Default||External grouping not supported 95158016|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158017|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Left 2.7mm 15hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158018|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4.5mm 124mm Peri-lck Narrow Cmpr 6 Hl Non Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.60|FSC: 13; Default||Not reimbursed separately|426.60|FSC: 13; Default||External grouping not supported 95158019|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Left 2.7mm 11hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158020|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158021|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Left 2.7mm 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95158022|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158023|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Left 2.7mm 5hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95158024|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158025|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Left 2.7mm 15hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158026|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 20mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95158027|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Left 2.7mm 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95158028|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158029|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Left 2.7mm 5hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95158030|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158031|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95197587|EAP|Custom 95197587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Xen Gel Stent 6mm 45um 150um W/preloaded Injector St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158032|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158033|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158034|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 22mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95158035|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189602|EAP|Custom 95189602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Liposuction Tubing Micro Aire Pal-1200 5/pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158036|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158037|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189599|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Evera Mri Xt Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,500.00|FSC: 13; Default||Not reimbursed separately|40,500.00|FSC: 13; Default||External grouping not supported 95158038|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158039|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189597|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Amplia Mri Crt-dis-1/df-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|FSC: 13; Default||Not reimbursed separately|57,600.00|FSC: 13; Default||External grouping not supported 95158040|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158041|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189598|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Amplia Mri Crt-dis-1/df4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|FSC: 13; Default||Not reimbursed separately|57,600.00|FSC: 13; Default||External grouping not supported 95158042|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 24mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95158043|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158044|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189600|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Amplia Mri Crt-d Is4/df1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|FSC: 13; Default||Not reimbursed separately|57,600.00|FSC: 13; Default||External grouping not supported 95158045|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158046|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 95158047|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158048|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Right 2.7mm 15-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158049|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 62065530|EAP|CPT® 85300||0305 - LABORATORY - HEMATOLOGY|Hb Antithrombin Activity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.55|FSC: 13; Default||Not reimbursed separately|35.55|FSC: 13; Default||External grouping not supported 95158050|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Right 2.7mm 11-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158051|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158057|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Right 2.7mm 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95158058|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158059|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Std Right 2.7mm 5-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95158061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shaped Peanut Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951200683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Mft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,200.25|FSC: 13; Default||Not reimbursed separately|3,200.25|FSC: 13; Default||External grouping not supported 95189608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Right 2.7mm 15-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Left Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95158065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Right Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951200684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha Slotless Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,516.85|FSC: 13; Default||Not reimbursed separately|2,516.85|FSC: 13; Default||External grouping not supported 95158071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Beta Slotless Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,516.85|FSC: 13; Default||Not reimbursed separately|2,516.85|FSC: 13; Default||External grouping not supported 95189609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Right 2.7mm 11-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha 10-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95158073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha 1-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,652.00|FSC: 13; Default||Not reimbursed separately|2,652.00|FSC: 13; Default||External grouping not supported 95189610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Partially Threaded 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95158074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Beta 1-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,652.00|FSC: 13; Default||Not reimbursed separately|2,652.00|FSC: 13; Default||External grouping not supported 951200685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158075|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Check Flo 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Partially Threaded 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95158076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha 2-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,743.80|FSC: 13; Default||Not reimbursed separately|2,743.80|FSC: 13; Default||External grouping not supported 95158077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Beta 2-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,743.80|FSC: 13; Default||Not reimbursed separately|2,743.80|FSC: 13; Default||External grouping not supported 95189612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Partially Threaded 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95158078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha 3-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|FSC: 13; Default||Not reimbursed separately|2,932.50|FSC: 13; Default||External grouping not supported 951200686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Eccentric Insert 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95158079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Beta 3-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|FSC: 13; Default||Not reimbursed separately|2,932.50|FSC: 13; Default||External grouping not supported 95189613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Partially Threaded 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95158080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha 4-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95195511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 34mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95158081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Beta 4-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95189614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Partially Threaded 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95158082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha 7-slot Lps Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 951200687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Str Stm 7x11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left Tmt 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95189615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Partially Threaded 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95158084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Small Left Tmt 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95158085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Small Right Tmt 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95189616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 Partially Threaded 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95158086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Left Tmt 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 951200688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 7x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158087|EAP|Custom 95158087||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X- Large With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 Partially Threaded 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95158088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Right Tmt 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95195520|EAP|Custom 95195520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Headless 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Small Left Tmt 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95189618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 Partially Threaded 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95158094|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Reflexion 7 Fr Bi-direc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 8x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158095|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Pta Catheter 2.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 Partially Threaded 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95158097|EAP|Custom 95158097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutters Disc Tight 4 Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158098|EAP|Custom 95158098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractors Tissue Sterile 2 Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 Partially Threaded 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95158099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implants Stabilization Axia Lif|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,985.00|FSC: 13; Default||Not reimbursed separately|23,985.00|FSC: 13; Default||External grouping not supported 951200690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 8x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158100|EAP|Custom 95158100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Porp Partial Variac T|1|HUMANA [1294]||HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95189621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T7 Partially Threaded 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95158101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Vara Size 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95158102|EAP|Custom 95158102||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Torp Total Variac Ttp|1|HUMANA [1294]||HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95189622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking T7 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|FSC: 13; Default||Not reimbursed separately|339.75|FSC: 13; Default||External grouping not supported 95158103|EAP|Custom 95158103||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Clip Angular 2.25mm|1|HUMANA [1294]||HUMANA [11839]|1,278.00|FSC: 13; Default||Not reimbursed separately|1,278.00|FSC: 13; Default||External grouping not supported 951200691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 9x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158104|EAP|Custom 95158104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Clip Angular 3.25mm|1|HUMANA [1294]||HUMANA [11839]|1,278.00|FSC: 13; Default||Not reimbursed separately|1,278.00|FSC: 13; Default||External grouping not supported 95189623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking T7 2.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|FSC: 13; Default||Not reimbursed separately|339.75|FSC: 13; Default||External grouping not supported 95158105|EAP|Custom 95158105||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X-small Aso Stabiliz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158106|EAP|Custom 95158106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Blade And Drape Pentax|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking T7 2.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|FSC: 13; Default||Not reimbursed separately|339.75|FSC: 13; Default||External grouping not supported 95158107|EAP|Custom 95158107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Lag 4.0mm Mft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 9x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158108|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Taxus Express 2 Atom 2.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95189625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking T7 2.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|FSC: 13; Default||Not reimbursed separately|339.75|FSC: 13; Default||External grouping not supported 95158109|EAP|Custom 95158109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Transducer Pressure Monitori|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158110|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Taxus Express 2 Atom 2.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95189626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking T7 2.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|FSC: 13; Default||Not reimbursed separately|339.75|FSC: 13; Default||External grouping not supported 95158111|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Taxus Express 2 Atom 2.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 951200693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 10x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158112|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Taxus Express 2 Atom 2.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95189627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking T7 2.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|FSC: 13; Default||Not reimbursed separately|339.75|FSC: 13; Default||External grouping not supported 95158113|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Taxus Express 2 Atom 2.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95158114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|FSC: 13; Default||Not reimbursed separately|464.10|FSC: 13; Default||External grouping not supported 95189631|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Terumo Jacky 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|FSC: 13; Default||Not reimbursed separately|464.10|FSC: 13; Default||External grouping not supported 951200694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 10x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|FSC: 13; Default||Not reimbursed separately|519.00|FSC: 13; Default||External grouping not supported 95189632|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Terumo 2.8 Cm Progreat W/o Wire 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 80171711|EAP|CPT® 27605||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tenotomy, Percutaneous, Achilles Tendon Local Anesthesia|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 95158120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189633|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Terumo Sarah 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|FSC: 13; Default||Not reimbursed separately|464.10|FSC: 13; Default||External grouping not supported 951200695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 11x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|FSC: 13; Default||Not reimbursed separately|464.10|FSC: 13; Default||External grouping not supported 95189635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Adm Restoration Insert X 3 28mm/28/50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95158134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|FSC: 13; Default||Not reimbursed separately|519.00|FSC: 13; Default||External grouping not supported 95189636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 18 Mm Tibia E-f/cr Femu4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95158136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 11x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95158138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158139|EAP|Custom 95158139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189630|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Terumo 4/5fr Slender Radial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 951200697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 12x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95189637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95158143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Talar Inbone 10mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|FSC: 13; Default||Not reimbursed separately|4,590.00|FSC: 13; Default||External grouping not supported 95158145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 155mm Strt Stm 12x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|FSC: 13; Default||Not reimbursed separately|19,977.30|FSC: 13; Default||External grouping not supported 95158151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bio-screw Interference Fem Bioab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95189642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dome Talar Inbone Sz 4 Sulcus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,044.00|FSC: 13; Default||Not reimbursed separately|16,044.00|FSC: 13; Default||External grouping not supported 95158152|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Current Dr Rf Dual|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,550.00|FSC: 13; Default||Not reimbursed separately|53,550.00|FSC: 13; Default||External grouping not supported 95158153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tbial Cs Triathlo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95189643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Inifinty Sz4+ 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|FSC: 13; Default||Not reimbursed separately|5,696.19|FSC: 13; Default||External grouping not supported 95158155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 951200699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 8x112mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Allthread Lactosorb 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95189644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Infinity Sz 5 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|FSC: 13; Default||Not reimbursed separately|16,269.00|FSC: 13; Default||External grouping not supported 95158163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix Br 5.5mm With Orth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95158164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189645|EAP|Custom 95189645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.4mm X 228mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 8x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95189647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavical Distal 8 Hole Left Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95158169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 95158173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189648|EAP|Custom 95189648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Stealth Cervical 12x14x6 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95158175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 9x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|FSC: 13; Default||Not reimbursed separately|519.00|FSC: 13; Default||External grouping not supported 95158181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95158182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95158183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95158184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95158185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 9x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95189654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prostop Subtalar Arthroeresis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95158187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95189656|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB EXPANDER TISSUE BREAST ARTOURA HIGH ULTRA PROFILE 535CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95158189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 951200703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 10x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95158191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95158193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 10x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking It 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95158195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Troc Left Narrow Ncb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,689.56|FSC: 13; Default||Not reimbursed separately|2,689.56|FSC: 13; Default||External grouping not supported 95158197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 951200705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 11x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95189662|EAP|Custom 95189662||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Crutch Bariatric Tall Adult Guardian|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 4.0 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|FSC: 13; Default||Not reimbursed separately|464.10|FSC: 13; Default||External grouping not supported 95189663|EAP|Custom 95189663||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Crutch Bariatric Adult Guardian|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 951200706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 11x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95189664|EAP|Custom 95189664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Quadcut 4.3mm X 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95158205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95158206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|FSC: 13; Default||Not reimbursed separately|441.15|FSC: 13; Default||External grouping not supported 95158215|EAP|Custom 95158215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Indermil Topical Needs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158216|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158219|EAP|Custom 95158219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 8.5 Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158222|EAP|Custom 95158222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap All-thread 6.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158224|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158225|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158226|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95158228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95158229|EAP|Custom 95158229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Large Stimulation Dynamic N|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158230|EAP|Custom 95158230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Access Redicle Insullated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158231|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Electrode Surface Dual Ii Module|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95158232|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158233|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158234|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158236|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158237|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158238|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158239|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158240|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158241|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158242|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Poly 6.5mm X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|FSC: 13; Default||Not reimbursed separately|3,612.00|FSC: 13; Default||External grouping not supported 95158244|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158245|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158246|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95133327|EAP|Custom 95133327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158247|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158248|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Poly 6.5mm X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|FSC: 13; Default||Not reimbursed separately|3,612.00|FSC: 13; Default||External grouping not supported 95158250|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Poly 6.5mm X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,644.00|FSC: 13; Default||Not reimbursed separately|4,644.00|FSC: 13; Default||External grouping not supported 951200707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 12x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158252|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Cementless Standard Collar Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95158253|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158254|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189673|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3d Left X-large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.70|FSC: 13; Default||Not reimbursed separately|602.70|FSC: 13; Default||External grouping not supported 95158255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Ii Dbr Nuvasive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951200708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 12x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158256|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189674|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3d Right X-large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,975.02|FSC: 13; Default||Not reimbursed separately|1,975.02|FSC: 13; Default||External grouping not supported 95158257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 17.5mm Nuvasive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,231.00|FSC: 13; Default||Not reimbursed separately|3,231.00|FSC: 13; Default||External grouping not supported 95158258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 22.5mm Nuvasive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,231.00|FSC: 13; Default||Not reimbursed separately|3,231.00|FSC: 13; Default||External grouping not supported 95189675|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Low Height Mod Plus 255cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95158260|EAP|Custom 95158260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Tip Bevel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 13x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158261|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramic Resorbable Master Graft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|FSC: 13; Default||Not reimbursed separately|1,587.60|FSC: 13; Default||External grouping not supported 95189676|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Low Height Mod Plus 330cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95158262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal 3.5 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,094.35|FSC: 13; Default||Not reimbursed separately|3,094.35|FSC: 13; Default||External grouping not supported 95158263|EAP|Custom 95158263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Short 4.3mm Qwix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189677|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Low Height Mod Plus 290cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95158265|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 7.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 13x19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Intra-aortic 7.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon Two-level 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95158270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Full Duracon S-1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|FSC: 13; Default||Not reimbursed separately|5,216.40|FSC: 13; Default||External grouping not supported 95158271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Xs Left Knee Hinged Rota|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95158272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri Lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95158273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Ahrx Neutral 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|FSC: 13; Default||Not reimbursed separately|4,953.90|FSC: 13; Default||External grouping not supported 951200711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 14x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Cocr 1.7mm W/ti Crimp 750m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,546.80|FSC: 13; Default||Not reimbursed separately|1,546.80|FSC: 13; Default||External grouping not supported 95189685|EAP|Custom 95189685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable For 2.9 Short Pushlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158276|EAP|Custom 95158276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Starter Thermisense Sensor S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189686|EAP|Custom 95189686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Passer Champion Slingshot 70 Degree Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 14x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|FSC: 13; Default||Not reimbursed separately|4,953.90|FSC: 13; Default||External grouping not supported 95189687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 4-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|FSC: 13; Default||Not reimbursed separately|5,136.00|FSC: 13; Default||External grouping not supported 95158283|EAP|Custom 95158283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tube Insufflation Hi-flow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Hinged Rotating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|FSC: 13; Default||Not reimbursed separately|11,346.30|FSC: 13; Default||External grouping not supported 95189688|EAP|Custom 95189688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Irrigation Anspach Hf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158294|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 951200713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ha -5 Red Nk 205mm Strt Stm 14x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|FSC: 13; Default||Not reimbursed separately|21,159.60|FSC: 13; Default||External grouping not supported 95158295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,396.11|FSC: 13; Default||Not reimbursed separately|4,396.11|FSC: 13; Default||External grouping not supported 95189689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoralcr Ii Journey Ox Np Lt Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 95158297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial Locki|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,939.30|FSC: 13; Default||Not reimbursed separately|3,939.30|FSC: 13; Default||External grouping not supported 95158298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,836.24|FSC: 13; Default||Not reimbursed separately|4,836.24|FSC: 13; Default||External grouping not supported 95189690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Dd Xlpe Journey Lt Sz 1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 95158299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,877.20|FSC: 13; Default||Not reimbursed separately|3,877.20|FSC: 13; Default||External grouping not supported 951200714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Stem Centraliser Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,885.77|FSC: 13; Default||Not reimbursed separately|4,885.77|FSC: 13; Default||External grouping not supported 95189691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibia Journey Np Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 95158301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,885.77|FSC: 13; Default||Not reimbursed separately|4,885.77|FSC: 13; Default||External grouping not supported 95158302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,930.65|FSC: 13; Default||Not reimbursed separately|4,930.65|FSC: 13; Default||External grouping not supported 95158303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Anterolatera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,955.50|FSC: 13; Default||Not reimbursed separately|3,955.50|FSC: 13; Default||External grouping not supported 951200715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Right 4-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.28|FSC: 13; Default||Not reimbursed separately|4,607.28|FSC: 13; Default||External grouping not supported 95189692|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Expel 8fr Loop Type|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Right 8-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,718.22|FSC: 13; Default||Not reimbursed separately|4,718.22|FSC: 13; Default||External grouping not supported 95194734|EAP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Gastrostomy 18 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|214.86|FSC: 13; Default||Not reimbursed separately|214.86|FSC: 13; Default||External grouping not supported 95158308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Right 10-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,628.91|FSC: 13; Default||Not reimbursed separately|4,628.91|FSC: 13; Default||External grouping not supported 95189695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Recon Rhead Plasma Coated Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,018.00|FSC: 13; Default||Not reimbursed separately|12,018.00|FSC: 13; Default||External grouping not supported 95158309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Left 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,718.22|FSC: 13; Default||Not reimbursed separately|4,718.22|FSC: 13; Default||External grouping not supported 951200716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Left 10-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.78|FSC: 13; Default||Not reimbursed separately|4,767.78|FSC: 13; Default||External grouping not supported 95189696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Radial Bipolar #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,995.00|FSC: 13; Default||Not reimbursed separately|7,995.00|FSC: 13; Default||External grouping not supported 95158311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95197589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 40mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95158312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95189697|EAP|Custom 95189697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ascope 3 Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 951200717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95189698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Xt Femoral Distal Sz C Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,517.50|FSC: 13; Default||Not reimbursed separately|27,517.50|FSC: 13; Default||External grouping not supported 95158316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95195523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 10mm X 330mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95158317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95189699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Xt Poly Segmental Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 951200718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95189700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Post Hinge Seg Sz C 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95158320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95158321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 95189701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Fluted Precoat Str 11mm 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,757.50|FSC: 13; Default||Not reimbursed separately|12,757.50|FSC: 13; Default||External grouping not supported 95158322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 951200719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158324|EAP|Custom 95158324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Injector Mri Disposable Spec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collar Stem Tm 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,010.00|FSC: 13; Default||Not reimbursed separately|8,010.00|FSC: 13; Default||External grouping not supported 95158328|EAP|Custom 95158328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Radial Jaw 4 Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 32mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95158329|EAP|Custom 95158329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Injector Mri Disposable Sola|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Half Tibial Precoat Size 3 15mm Ll/rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.00|FSC: 13; Default||Not reimbursed separately|3,915.00|FSC: 13; Default||External grouping not supported 95158330|EAP|Custom 95158330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coils Prostate Mri|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intrafix 7mm Hard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,224.00|FSC: 13; Default||Not reimbursed separately|1,224.00|FSC: 13; Default||External grouping not supported 951200720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158333|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Generator Pulse Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,081.25|FSC: 13; Default||Not reimbursed separately|47,081.25|FSC: 13; Default||External grouping not supported 95189713|EAP|Custom 95189713||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit 3100a Humidifier Flexible W/short Heated Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158334|EAP|Custom 95158334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Elevator Passing Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 12mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95158335|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Contact 8 X 25cm P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,272.50|FSC: 13; Default||Not reimbursed separately|2,272.50|FSC: 13; Default||External grouping not supported 95134771|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pezzar Propor-head 10fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Cluster He|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158343|EAP|Custom 95158343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Ultracut 4.2m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 55mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95158344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Pmma Bone Plugs 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95158350|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 3.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158351|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quickcross .035 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158352|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 3.0mm X4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moorse/c-taper Adapter Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,478.40|FSC: 13; Default||Not reimbursed separately|1,478.40|FSC: 13; Default||External grouping not supported 95158353|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 6fr Super Arrow Flex 45cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetab Osseoti G7 Multi Hole Cementless 56mm/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,990.00|FSC: 13; Default||Not reimbursed separately|18,990.00|FSC: 13; Default||External grouping not supported 95158354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavical Anterior 6-hole R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95195527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 17mm 40mm Shldr Reunion 4mm Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95158355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Cemented Mbt Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 95189717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Wall High E1 40mm/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,410.00|FSC: 13; Default||Not reimbursed separately|10,410.00|FSC: 13; Default||External grouping not supported 95158356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Stabilized Poste|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951200724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 7mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95189718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 6-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95158359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 9mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|FSC: 13; Default||Not reimbursed separately|357.21|FSC: 13; Default||External grouping not supported 95197591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Baby Gorilla 1.1mm L2 6 Hole Right Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|FSC: 13; Default||Not reimbursed separately|2,691.00|FSC: 13; Default||External grouping not supported 95158360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 11mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 95189719|EAP|Custom 95189719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Ir Inflation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 13mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.01|FSC: 13; Default||Not reimbursed separately|380.01|FSC: 13; Default||External grouping not supported 951200725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95189720|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Aspheric Multifocal 14.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.30|FSC: 13; Default||Not reimbursed separately|171.30|FSC: 13; Default||External grouping not supported 95158364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 11mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95189721|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Aspheric Multifocal 15.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 6mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 951200726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 7mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|FSC: 13; Default||Not reimbursed separately|357.21|FSC: 13; Default||External grouping not supported 95189722|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Aspheric Multifocal 15.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 8mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|FSC: 13; Default||Not reimbursed separately|357.21|FSC: 13; Default||External grouping not supported 95197592|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 18.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95158368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 9mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 951200727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 10mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95158370|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951200728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158371|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95158372|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95158373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 11mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|FSC: 13; Default||Not reimbursed separately|357.21|FSC: 13; Default||External grouping not supported 95158374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 12mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 951200729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 13mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95158376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 14mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.44|FSC: 13; Default||Not reimbursed separately|427.44|FSC: 13; Default||External grouping not supported 95189725|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Cps Direct Universal 47cm - 135 Left Sided Outer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 16mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 951200730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Barium Prox. Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 18mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95189728|EAP|Custom 95189728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Acquire 22ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 20mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95197593|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 14.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95158380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 22mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95189729|EAP|Custom 95189729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Biopsy Needle Acquire 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127-degree V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 951200731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95189730|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Hd Navigator 11/13f X 36cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 24mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95158385|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omnipaque 300 Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|FSC: 13; Default||Not reimbursed separately|0.67|FSC: 13; Default||External grouping not supported 95189731|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Hd Navigator 11/13f X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 26mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 951200732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158387|EAP|HCPCS Q9967||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Omnipaque 300 Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|FSC: 13; Default||Not reimbursed separately|1.71|FSC: 13; Default||External grouping not supported 95189732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged All-poly E-plus 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95158388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 28mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95158389|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omnipaque 300 Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|FSC: 13; Default||Not reimbursed separately|0.69|FSC: 13; Default||External grouping not supported 95189733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 54mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95158390|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omnipaque 300 Ct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|FSC: 13; Default||Not reimbursed separately|1.80|FSC: 13; Default||External grouping not supported 951200733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mm X 30mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95189734|EAP|Custom 95189734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Step Screw Lag 10.5x495mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 6mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95197597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 55mm Solera Cd Hzn Cocr Spne Ma Ns 5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95158393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 7mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 95158394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 8mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 9mm Self Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189736|EAP|Custom 95189736||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14x16x9 6degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95158397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95158400|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62064610|EAP|CPT® 84295||0301 - LABORATORY - CHEMISTRY|Hb Sodium Whole Blood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.43|FSC: 13; Default||Not reimbursed separately|14.43|FSC: 13; Default||External grouping not supported 95158401|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158403|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 12mm Tibia G-h/cr Fem 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95158405|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158406|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189738|EAP|Custom 95189738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Biopsy Disposable Cancer Care|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158407|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158408|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Ts Delta 12/14 40mm +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 95158409|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158410|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189740|EAP|Custom 95189740||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx2 25-110/i16-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95158411|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Universal Distal Plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158412|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 11mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95158414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 13mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95158415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189742|EAP|Custom 95189742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1.9mm Dia.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.3m Profyle Lock 3-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 95158419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95158420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 2.3mm Iconix Intell 2 Strands #2force Fiber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,253.67|FSC: 13; Default||Not reimbursed separately|1,253.67|FSC: 13; Default||External grouping not supported 95158421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95158423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95158424|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Prime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189746|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collagen Scaffold Reconstituted Arthroscopic Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95158425|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Visions Pv .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 36mm X 56mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95158427|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Visions Pv 8.2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189749|EAP|Custom 95189749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Dia 2.6mmx220mm Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 34mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 36mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189750|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Tecnis Multi Focal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 38mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95158432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 40mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95189751|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Tecnis Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 31mm 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 95158434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 38mm 5-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 951200742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 45mm 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 95189754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Large Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 95158436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 52mm 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 95195479|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Vertessa Lite Y Shp Poly 26cm X 4cm X 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95158437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 59mm 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 951200743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 73mm 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.60|FSC: 13; Default||Not reimbursed separately|765.60|FSC: 13; Default||External grouping not supported 95158439|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95158440|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95189774|EAP|Custom 95189774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ijs-e Cann Distal Cutting 2.7mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Adaption 2.0mm X 81mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,345.35|FSC: 13; Default||Not reimbursed separately|1,345.35|FSC: 13; Default||External grouping not supported 951200744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.0mm X 53mm 7-hole 3-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,406.73|FSC: 13; Default||Not reimbursed separately|1,406.73|FSC: 13; Default||External grouping not supported 95189775|EAP|Custom 95189775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Universal Qc T-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Condylar 2.0mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,501.91|FSC: 13; Default||Not reimbursed separately|2,501.91|FSC: 13; Default||External grouping not supported 95195531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Mdlr Try Ibalance Sz 4 Scr Tka|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95158446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189776|EAP|Custom 95189776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endograft Ovation Limb Iliac 14 Mm X 100 Mm|1|HUMANA [1294]||HUMANA [11839]|14,997.00|FSC: 13; Default||Not reimbursed separately|14,997.00|FSC: 13; Default||External grouping not supported 95158447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 951200745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189777|EAP|Custom 95189777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Cornerstone 5x14x11mm|1|HUMANA [1294]||HUMANA [11839]|3,329.64|FSC: 13; Default||Not reimbursed separately|3,329.64|FSC: 13; Default||External grouping not supported 95158449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Rim Elevated 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|FSC: 13; Default||Not reimbursed separately|1,681.68|FSC: 13; Default||External grouping not supported 95158450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189756|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Armada 35 7mm X 120mm X 135cm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 951200746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95189757|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Armada 35 8mm X 120mm X 135cm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95195532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Tibial Cr Pls Vit E 8mm Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95158455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 34mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95189758|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Armada 18 5.5mm X 120mm X 150cm Pta Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 36mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 951200747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 38mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95189778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Sz 6 10mm Precoat Nex Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|FSC: 13; Default||Not reimbursed separately|4,212.00|FSC: 13; Default||External grouping not supported 95158458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 40mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95158459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 42mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95189779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lcck Sz Green/e F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95158460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 44mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 951200748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 46mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95189768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Humeral Rsp Sz32mm Std +4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95158462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 48mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95195533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 34mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95158463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 50mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95189769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse 8mmx108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95158465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 55mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 951200749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 60mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.07|FSC: 13; Default||Not reimbursed separately|125.07|FSC: 13; Default||External grouping not supported 95189765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon Right R1.5 10 X 360 Mm X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|FSC: 13; Default||Not reimbursed separately|5,266.80|FSC: 13; Default||External grouping not supported 95158467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95158468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 34mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95189766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cann 4.0mm/l 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 95158469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 38mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 951200750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.4mm X 36mm 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,272.18|FSC: 13; Default||Not reimbursed separately|1,272.18|FSC: 13; Default||External grouping not supported 95189770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ijs-e Base Assembly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,290.00|FSC: 13; Default||Not reimbursed separately|16,290.00|FSC: 13; Default||External grouping not supported 95158474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.4mm X 44mm 5-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|FSC: 13; Default||Not reimbursed separately|1,227.15|FSC: 13; Default||External grouping not supported 95195534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Ibalance Tka Vit E Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95158475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.4mm X 52mm 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|FSC: 13; Default||Not reimbursed separately|1,227.15|FSC: 13; Default||External grouping not supported 95189771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Non Locking 3.5mm X 26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95158476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.4mm X 60mm 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|FSC: 13; Default||Not reimbursed separately|1,227.15|FSC: 13; Default||External grouping not supported 951200751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.4mm X 68mm 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,235.13|FSC: 13; Default||Not reimbursed separately|1,235.13|FSC: 13; Default||External grouping not supported 95189772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ployaxial Non Locking 3.5mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95158478|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.4mm X 84mm 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|FSC: 13; Default||Not reimbursed separately|1,227.15|FSC: 13; Default||External grouping not supported 95189773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Ijs-e 2.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95158484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Adaption 2.4mm X 88mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,428.84|FSC: 13; Default||Not reimbursed separately|1,428.84|FSC: 13; Default||External grouping not supported 951200752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 2.4mm X 58mm 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,336.70|FSC: 13; Default||Not reimbursed separately|2,336.70|FSC: 13; Default||External grouping not supported 62064620|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Fentanyl Confirmation, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95158486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Condylar 2.4mm X 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,841.94|FSC: 13; Default||Not reimbursed separately|1,841.94|FSC: 13; Default||External grouping not supported 95195535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Ibalance Patella Vit E Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.00|FSC: 13; Default||Not reimbursed separately|8,775.00|FSC: 13; Default||External grouping not supported 95158487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm X 40mm 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,295.82|FSC: 13; Default||Not reimbursed separately|1,295.82|FSC: 13; Default||External grouping not supported 62064630|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Fentanyl Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95158488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm X 49mm 5-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 951200753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158489|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm X 58mm 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 95158491|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer X-stop 10mm|1|HUMANA [1294]||HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 951200754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle Sector W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 95158493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm X 67mm 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 95195536|EAP|Custom 95195536||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gft Sft Tiss Dist Fem Mdl Ostchnd Rt Lft Lf|1|HUMANA [1294]||HUMANA [11839]|35,880.00|FSC: 13; Default||Not reimbursed separately|35,880.00|FSC: 13; Default||External grouping not supported 95158494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm X 76mm 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 95189780|EAP|Custom 95189780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Hcs 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 2.7mm X 94mm 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 951200755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Univ. Distal Spacer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95158496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Adaption 2.7mm X 97mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.24|FSC: 13; Default||Not reimbursed separately|1,482.24|FSC: 13; Default||External grouping not supported 95189781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Lo-profile 2.7 X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95158498|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Condylar 2.7mm X 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,081.76|FSC: 13; Default||Not reimbursed separately|2,081.76|FSC: 13; Default||External grouping not supported 95189782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterolat Dis Tib Ss 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|FSC: 13; Default||Not reimbursed separately|5,460.00|FSC: 13; Default||External grouping not supported 95158500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 2.7mm X 32mm 3-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,336.70|FSC: 13; Default||Not reimbursed separately|2,336.70|FSC: 13; Default||External grouping not supported 951200756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-15mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Lcp Oblique Left 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.52|FSC: 13; Default||Not reimbursed separately|1,274.52|FSC: 13; Default||External grouping not supported 95189783|EAP|Custom 95189783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant I Fuse Si-bone 7.0mm X 35mm|1|HUMANA [1294]||HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95158502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Lcp Oblique Right 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.52|FSC: 13; Default||Not reimbursed separately|1,274.52|FSC: 13; Default||External grouping not supported 95195537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 28mm Ti Cmpr Lng Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95158503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Lpc Left 2.7mm X 32mm 3-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.52|FSC: 13; Default||Not reimbursed separately|1,274.52|FSC: 13; Default||External grouping not supported 95189785|EAP|Custom 95189785||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feeding Silicone Medium 5fr X 60cm Radiopque Stripe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Lcp Right 2.7mm X 32mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.52|FSC: 13; Default||Not reimbursed separately|1,274.52|FSC: 13; Default||External grouping not supported 951200757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-20mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 13mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.91|FSC: 13; Default||Not reimbursed separately|182.91|FSC: 13; Default||External grouping not supported 95189786|EAP|Custom 95189786||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feeding Silicone Medium 6.5fr X 60cm Radiopque Stripe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lpc Clavical Superior Shaf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95158507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Dia-me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,334.27|FSC: 13; Default||Not reimbursed separately|5,334.27|FSC: 13; Default||External grouping not supported 95189788|EAP|Custom 95189788||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feeding Silicone Medium 8fr X 60cm Radiopque Stripe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158508|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima 14fr X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-25mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158509|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cope Nephrostomy 8.2 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189799|EAP|Custom 95189799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Non-threaded 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158510|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cope Nephrostomy 10 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 30mm Ti Cmpr Lng Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95158511|EAP|Custom 95158511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Pal Disposable 3.0mm X 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189800|EAP|Custom 95189800||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Driver T8 -2.5mmscrew|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158512|EAP|Custom 95158512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Pal Disposable 2.4mm X 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-30mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158514|EAP|Custom 95158514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Pal Disposable 5.0mm X 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189794|EAP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Tricuspid/halo Xp 7f 2-8-2mm 110cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158519|EAP|Custom 95158519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Acl Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158523|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Guiding Veri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Tibial Fix Bearing Uc Rt 14mm Tibia G-h/cr Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95158527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femur Hinge Rotating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,763.40|FSC: 13; Default||Not reimbursed separately|25,763.40|FSC: 13; Default||External grouping not supported 951200760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-35mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Tibia Hinge Rotating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,445.05|FSC: 13; Default||Not reimbursed separately|12,445.05|FSC: 13; Default||External grouping not supported 95189796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Cr Size 6 Grn 14mm Nexgen (fem C-h)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95158529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,444.70|FSC: 13; Default||Not reimbursed separately|5,444.70|FSC: 13; Default||External grouping not supported 95158530|EAP|Custom 95158530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand Debrider Topaz Ifs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95158531|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Promote Rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68,550.00|FSC: 13; Default||Not reimbursed separately|68,550.00|FSC: 13; Default||External grouping not supported 951200761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-40mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95189798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Smart Toe 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95189801|EAP|Custom 95189801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 2.5depth Gauge Yellow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-45mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158541|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Stretch-coil Singl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,265.00|FSC: 13; Default||Not reimbursed separately|2,265.00|FSC: 13; Default||External grouping not supported 95189802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95158542|EAP|Custom 95158542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna External Patient Program|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158547|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thorasic 28mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,225.00|FSC: 13; Default||Not reimbursed separately|36,225.00|FSC: 13; Default||External grouping not supported 95189803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Utility Straight 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 951200763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-50mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158553|EAP|Custom 95158553||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Vaginal Large 1-3/8 35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95158557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion Right Std Slim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|FSC: 13; Default||Not reimbursed separately|3,063.00|FSC: 13; Default||External grouping not supported 95195539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib Sz 4 8mm Ankl Poly Infnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,279.00|FSC: 13; Default||Not reimbursed separately|6,279.00|FSC: 13; Default||External grouping not supported 95158559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hex Mtp 3.2mm X 16mm Charl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95189805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95158561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hex Mtp 3.2mm X 18mm Charl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951200764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-55mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95189806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 10x10x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95158572|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coronary Dilatation Voy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Anterior Corail W/o|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95158574|EAP|Custom 95158574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Wide Medium Legacy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158575|EAP|Custom 95158575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Narrow Blade Small Legacy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Locking Short Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 951200765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Bone Screw-6.5 Dia-60mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|FSC: 13; Default||Not reimbursed separately|802.20|FSC: 13; Default||External grouping not supported 95158578|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Sheath Pinnacle Destinatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158590|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Dual Lumen Picc 50c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.90|FSC: 13; Default||Not reimbursed separately|250.90|FSC: 13; Default||External grouping not supported 95195540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 50mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95158595|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158596|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Total Abscessi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder-dome Hole Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.30|FSC: 13; Default||Not reimbursed separately|468.30|FSC: 13; Default||External grouping not supported 95158597|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Total Abscessi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188326|EAP|Custom 95188326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Stop 2mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158599|EAP|Custom 95158599||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tamp Bone Inflatable Express Kyp|1|HUMANA [1294]||HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95158602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Handprofy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95189807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Healicoil Rsb Sa 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95158607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 11mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|FSC: 13; Default||Not reimbursed separately|257.04|FSC: 13; Default||External grouping not supported 951200767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal C-taper +0mm Adapter Sleeve (ti)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95158608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 16mm X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95189808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 7 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 95158609|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 14mm X 107cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 95195541|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol +8 Diop Mod C Bcnvx 13mm 6mm Pc 1 Pc Ant Asph Sq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95158610|EAP|Custom 95158610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded 6.5mm X 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170625|EAP|CPT® 94610||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Intrapulmonary Surfactant Administration By Et Tube|1|HUMANA [1294]||HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95158615|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Adapta Sr Single Chamb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 951200768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal C-taper +5mm Adapter Sleeve (ti)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95158618|EAP|Custom 95158618||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Elastic Tube Size B 2-1/|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189811|EAP|Custom 95189811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pins 2mm Non Threaded (pack Of 6)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158619|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Septal Occluder 7 Fr 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|FSC: 13; Default||Not reimbursed separately|22,323.00|FSC: 13; Default||External grouping not supported 95158623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95189812|EAP|Custom 95189812||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 60mm|1|HUMANA [1294]||HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 95158630|EAP|Custom 95158630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Penis Retractable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal C-taper +2.5mm Adapter Sleeve (ti)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95158632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.5 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95189813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 26mm+0mm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158642|EAP|Custom 95158642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manager Therapy Personal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 30mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95158643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95189816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral Reunion Rsa X3 40mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95158644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 14mm X 155mm Distal Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 951200770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal C-taper -2.5mm Adapter Sleeve (ti)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95158645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127 Degree A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 95189817|EAP|Custom 95189817||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Liquid Smartjet Harvest 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95158649|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Low Profile 20fr X 3 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189818|EAP|Custom 95189818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Applicator Spray Smartset Harvest|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158657|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158658|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Left Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 95158659|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158660|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Ti 2.4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,101.00|FSC: 13; Default||Not reimbursed separately|1,101.00|FSC: 13; Default||External grouping not supported 95158661|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158662|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlock Ti 2.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95158663|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158664|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm/xl34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95158665|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158666|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Revision Corail Std Sz 13 135deg 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 95158667|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158668|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189822|EAP|Custom 95189822||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Convex 018|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158669|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951200774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158670|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189826|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Sterling .018 3 X 60 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158671|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158672|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189827|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Sterling .018 3 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158673|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158674|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95189828|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Sterling .018 4 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158675|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95158676|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95189829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dome Talar Inbone Sz 1 Sulcus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,133.00|FSC: 13; Default||Not reimbursed separately|14,133.00|FSC: 13; Default||External grouping not supported 95158677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 951200776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158678|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95189830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tiabial Infinity Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|FSC: 13; Default||Not reimbursed separately|16,269.00|FSC: 13; Default||External grouping not supported 95158679|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95158680|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95189831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dome Talar Inbone Sz 3 Sulcus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,044.00|FSC: 13; Default||Not reimbursed separately|16,044.00|FSC: 13; Default||External grouping not supported 95158681|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158682|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158683|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158684|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158685|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158686|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62064644|EAP|CPT® 88341||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Ihc, Each Addl, Pro-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.37|FSC: 13; Default||Not reimbursed separately|223.37|FSC: 13; Default||External grouping not supported 95158687|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158688|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5 Bone Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158689|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 62064655|EAP|CPT® 88341||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Ihc, Each Addl, Tech-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.37|FSC: 13; Default||Not reimbursed separately|223.37|FSC: 13; Default||External grouping not supported 95158690|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158691|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189834|EAP|Custom 95189834||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cushion Bariatric Seat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158692|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951200780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158693|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 12x10x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95158694|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95158696|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95189836|EAP|Custom 95189836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Non Threaded 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158701|EAP|Custom 95158701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Heated Wire Dual Adult/p|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158704|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 7mm Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95189837|EAP|Custom 95189837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.6mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.42|FSC: 13; Default||Not reimbursed separately|3,042.42|FSC: 13; Default||External grouping not supported 95158715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Lon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,897.49|FSC: 13; Default||Not reimbursed separately|11,897.49|FSC: 13; Default||External grouping not supported 95189838|EAP|Custom 95189838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Depth Gauge/countersink (blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 7-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,950.35|FSC: 13; Default||Not reimbursed separately|2,950.35|FSC: 13; Default||External grouping not supported 951200782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 8-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,992.86|FSC: 13; Default||Not reimbursed separately|2,992.86|FSC: 13; Default||External grouping not supported 95189839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 4.0mm 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95158719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 11-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,143.88|FSC: 13; Default||Not reimbursed separately|3,143.88|FSC: 13; Default||External grouping not supported 95158720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 12-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.69|FSC: 13; Default||Not reimbursed separately|4,059.69|FSC: 13; Default||External grouping not supported 951200783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 14-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|FSC: 13; Default||Not reimbursed separately|3,912.30|FSC: 13; Default||External grouping not supported 95158722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 16-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,279.23|FSC: 13; Default||Not reimbursed separately|4,279.23|FSC: 13; Default||External grouping not supported 95189840|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer - Agilis Nxt Steerable 61cm 8.5f - Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Metaphyseal 3.5mm 18-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|FSC: 13; Default||Not reimbursed separately|4,189.50|FSC: 13; Default||External grouping not supported 951200784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tbial Cs Triathlo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95189841|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer - Agilis Nxt Steerable 61 Cm 8.5f Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,143.88|FSC: 13; Default||Not reimbursed separately|3,143.88|FSC: 13; Default||External grouping not supported 95195560|EAP|Custom 95195560||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Et 4mm Nsl/orl Mgl Crved Uncuf Mrph Eye Strl Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.69|FSC: 13; Default||Not reimbursed separately|4,059.69|FSC: 13; Default||External grouping not supported 95189845|EAP|Custom 95189845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.35mm Dual Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,099.80|FSC: 13; Default||Not reimbursed separately|4,099.80|FSC: 13; Default||External grouping not supported 951200785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5 Cancellous Bone Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95158729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|FSC: 13; Default||Not reimbursed separately|4,189.50|FSC: 13; Default||External grouping not supported 95189846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lo-pro 4 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95158730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.56|FSC: 13; Default||Not reimbursed separately|4,399.56|FSC: 13; Default||External grouping not supported 95158732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,482.21|FSC: 13; Default||Not reimbursed separately|4,482.21|FSC: 13; Default||External grouping not supported 95189847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lo-pro 4 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95158734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metaphyseal Lcp 4.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,685.19|FSC: 13; Default||Not reimbursed separately|4,685.19|FSC: 13; Default||External grouping not supported 951201490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 28mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158738|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189848|EAP|Custom 95189848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Fibertape 17 With Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis 12mm X 180mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 95195561|EAP|Custom 95195561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hg Pr 11.4cm 4.6cm 300ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 12mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95158743|EAP|Custom 95158743||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle X- Small With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 22.2mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158759|EAP|Custom 95158759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Closesure Ct Suture Passe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158762|EAP|Custom 95158762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Or Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158763|EAP|Custom 95158763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Tunneling Long Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189849|EAP|Custom 95189849||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12x34x24mm 12degree|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95158769|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 1.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951201492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 26mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Proximal 40p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|FSC: 13; Default||Not reimbursed separately|4,428.00|FSC: 13; Default||External grouping not supported 95189851|EAP|Custom 95189851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Mas Reline Splitter Fascial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Proximal 30p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|FSC: 13; Default||Not reimbursed separately|4,428.00|FSC: 13; Default||External grouping not supported 95195562|EAP|Custom 95195562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hg Pr 11.4cm 4.6cm 330ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158773|EAP|Custom 95158773||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Right Xx La|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Xlr-r Corent 4.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95158774|EAP|Custom 95158774||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Knee Patella Lateral Lef|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 28mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158775|EAP|Custom 95158775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cardioplegia Y-type|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Standard T2 10mmx270mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.00|FSC: 13; Default||Not reimbursed separately|4,479.00|FSC: 13; Default||External grouping not supported 95158779|EAP|HCPCS C1878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Voice 18 Fr 8mm Advan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.00|FSC: 13; Default||Not reimbursed separately|837.00|FSC: 13; Default||External grouping not supported 95189853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95158787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lipped Cs Small 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 951201494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 32mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158788|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Leg Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95189859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Precoat Sz-e Ltmedial Rt Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95158789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Multihole Pinnacl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,864.18|FSC: 13; Default||Not reimbursed separately|9,864.18|FSC: 13; Default||External grouping not supported 95195563|EAP|Custom 95195563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hg Pr 12cm 4.8cm 350ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158796|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Total Abscessi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 2-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95158798|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Savary Gilliard 200cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 26mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95189855|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 3.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158803|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158804|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189856|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 4 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158805|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 28mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158806|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21. Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95189857|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 4.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95195573|EAP|Custom 95195573||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Hydrated Lordotic 11mm|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95158813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95189858|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t 5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlon S39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 951201497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 32mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearning Tibial Cs Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95189865|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 5.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.57|FSC: 13; Default||Not reimbursed separately|2,853.57|FSC: 13; Default||External grouping not supported 95158817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Cluster He|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95189866|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 6 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 17mm X 155mm Conical Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 951201498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm +6 Lfit V40 Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158822|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189867|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 6.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158823|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 10mm Anchorage Ti Std T8 Ft/ankl Tx Hd Ns Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95158824|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189868|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t 7 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158825|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 26mm/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158826|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189869|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 7.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158827|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158828|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189871|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 8 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158829|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 28mm/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158830|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189873|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 8.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158831|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195575|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95158832|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189874|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 9 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158833|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 32mm/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158834|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189875|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 9.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158835|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80172799|EAP|CPT® 46505||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Chemodenervation Internal Anal Sphincter|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95158836|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189876|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t 10 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|FSC: 13; Default||Not reimbursed separately|49,500.00|FSC: 13; Default||External grouping not supported 95158837|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Fem Head Orthinox 36-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,059.70|FSC: 13; Default||Not reimbursed separately|3,059.70|FSC: 13; Default||External grouping not supported 95158838|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189877|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 10.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158839|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95158840|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189878|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 11 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158841|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 22mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158842|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95189879|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 11.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158843|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158844|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189880|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 12 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158845|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 951201504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 26mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158846|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189881|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 12.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158847|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158848|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189882|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 13 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158849|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158850|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189883|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 13.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158851|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158852|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189884|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 14 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158853|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 32mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158854|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189885|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 14.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158855|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158856|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189886|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t 15 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158857|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Fem Head Orthinox 36-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,059.70|FSC: 13; Default||Not reimbursed separately|3,059.70|FSC: 13; Default||External grouping not supported 95158858|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189887|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 15.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158859|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158860|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189888|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 16 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158861|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 26mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158862|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189890|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 16.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158863|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95143630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|190.95|FSC: 13; Default||Not reimbursed separately|190.95|FSC: 13; Default||External grouping not supported 95158864|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 62065540|EAP|CPT® 83785||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Manganese, Serum-ref Lab|1|HUMANA [1294]||HUMANA [11839]|79.95|FSC: 13; Default||Not reimbursed separately|79.95|FSC: 13; Default||External grouping not supported 95158865|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189891|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 17 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158866|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 28mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158867|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189892|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 17.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158868|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158869|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189893|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 18 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158870|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 32mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158871|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189894|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 18.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158872|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158873|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189895|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 19 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158874|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Fem Head Orthinox 36+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,059.70|FSC: 13; Default||Not reimbursed separately|3,059.70|FSC: 13; Default||External grouping not supported 95158888|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189896|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t Custom 19.5 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158889|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197599|EAP|Custom 95197599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Sizer Staple Fuseforce|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158890|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 22mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158891|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158892|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189897|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Therasphere - Y-90t 20 Us Comm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|FSC: 13; Default||Not reimbursed separately|48,000.00|FSC: 13; Default||External grouping not supported 95158893|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 26mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158894|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 3-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95158895|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197603|EAP|Custom 95197603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg Ao Qck Cnct Evos Mn 1.8mm Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158896|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headless 3.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95158897|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 28mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158898|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189898|EAP|Custom 95189898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer 20fr Mic-key|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158899|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158900|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189900|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artery Fem-pop Cryolife|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,850.00|FSC: 13; Default||Not reimbursed separately|20,850.00|FSC: 13; Default||External grouping not supported 95158901|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Orthinox Head 32mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95158902|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189901|EAP|Custom 95189901||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Interbody Expandable Lordic Extra 23 X 9 X 10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95158903|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197604|EAP|Custom 95197604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 100mm 1.4mm Krsh Ss Troc Pnt Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158904|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189903|EAP|Custom 95189903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wireguide Percutaneous 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158905|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 28mm Hd -3.5 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158906|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189904|EAP|Custom 95189904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Aps Sterile Plastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158907|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158908|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189907|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Express-b-i Ld Pmtd 7.0x30x75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158909|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 32mm Hd -4.0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158910|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158911|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 36mm Hd -4.0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158912|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158913|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189908|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Express-b-i Ld Pmtd 8.0x40x75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158914|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 28mm Hd 0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158915|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189909|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Express-b-i Ld Pmtd 8.0x60x75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158916|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197598|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 26.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95158917|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189910|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Express-b-i Ld Pmted 6.0x40x135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158919|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 20 Fr 10mm Adva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 32mm Hd 0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158920|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Prosthesis Voice 16 Fr 10mm Adva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189911|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Express-b-i Ld Pmtd 7.0x40x135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158933|EAP|Custom 95158933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Infusion Set Galactography|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.95|FSC: 13; Default||Not reimbursed separately|2,095.95|FSC: 13; Default||External grouping not supported 95189912|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 5 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158950|EAP|Custom 95158950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arch Femoral Compression With He|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 36mm Hd 0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Cemente|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95189913|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 5 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95158984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95158985|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 8.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189914|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 5 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158987|EAP|HCPCS A7520||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 8.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 28mm Hd +3.5 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95158990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Cluster He|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95189915|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 5 X 100 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158991|EAP|Custom 95158991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar With Shielded Obturator A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95189916|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 5 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95158999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951201523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 32mm Hd +4.0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95159002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95189917|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 6 X 20 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95159003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95197600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 14mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95159004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95189918|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 6 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95159005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951201524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix 36mm Hd +4.0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95159008|EAP|Custom 95159008||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Membrane Tympanic Left Drum Ear|1|HUMANA [1294]||HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 95189919|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 7 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95159017|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cartilage Costal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95159025|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 3mm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95189920|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 8 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95159027|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 3mm X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Inter.nk Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95159028|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 7mm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189921|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Innova 8 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95159030|EAP|Custom 95159030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Intralumenal Flo Thru|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 20mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95159037|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Timesh 4 Inch X 6inch 65gram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95189922|EAP|Custom 95189922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Auc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159038|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Timesh 12 Inch X 12 Inch 65 Gram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951201526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Inter.nk Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95159044|EAP|Custom 95159044||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tracheostomy 7.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|178.47|FSC: 13; Default||Not reimbursed separately|178.47|FSC: 13; Default||External grouping not supported 95189926|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead - Tendril Mri - 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95159049|EAP|Custom 95159049||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Belt Hernia Medium 36|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159050|EAP|Custom 95159050||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Belt Hernia Large 42|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189927|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead - Tendril Mri 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95159051|EAP|Custom 95159051||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dressing Komprim 16cm X 5mm 2 Wa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Inter.nk Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95159081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95189928|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead - Tendril Mri 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95159082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular Offset 15mm 2.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95197602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 18mm Evos T7 Lock S-t Stlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95159085|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Omnilink .035 8.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95189929|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker - Assurity Mri Sr-rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,345.50|FSC: 13; Default||Not reimbursed separately|10,345.50|FSC: 13; Default||External grouping not supported 95159099|EAP|Custom 95159099||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .035 D|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 951201528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Inter.nk Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95159102|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Pc Roadrunner Angled .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189930|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker - Assurity Mri Dr-rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95158875|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158876|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189931|EAP|HCPCS C1776||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Insert Tibial Cs Triathlon X3 Sz8-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95158877|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Lfit Inter Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158878|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158879|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Lfit Inter Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158880|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189932|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 5.0 X60 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158881|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95158882|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189933|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 8.0 X80 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158883|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Lfit Inter Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95158884|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189934|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 10.0 X 20 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158885|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80171723|EAP|CPT® 59300||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Episiotomy Or Vaginal Repair|1|HUMANA [1294]||HUMANA [11839]|7,711.60|FSC: 13; Default||Not reimbursed separately|7,711.60|FSC: 13; Default||External grouping not supported 95158886|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95189935|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 12.0 X 20 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95158887|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Lfit Inter Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95159508|EAP|Custom 95159508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Long Term Montgomery Sz-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189936|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 4.0 X 60 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial +4 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95197605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Evos 48mm 3hole Right Standard Distal Radius|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.64|FSC: 13; Default||Not reimbursed separately|2,135.64|FSC: 13; Default||External grouping not supported 95159510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,405.00|FSC: 13; Default||Not reimbursed separately|6,405.00|FSC: 13; Default||External grouping not supported 95189937|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 6.0 X 20 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interfernece Femoral Guard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.39|FSC: 13; Default||Not reimbursed separately|264.39|FSC: 13; Default||External grouping not supported 951201533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unitrax Modular Endo Head 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95159513|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Set 8 Fr Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189938|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 3.0 X 40 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159514|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Cps Direct Pl 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 36cm Lt Intertrochanter Intertan Im 130d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95159517|EAP|Custom 95159517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Total Knee Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189939|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 6.0 X 40 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 951201534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unitrax Modular Endo Head 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95159531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cross Pin Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95189940|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 7.0 X 60 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95159535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric X 3 Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95189941|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 7.0 X 100 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159541|EAP|Custom 95159541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Compression Sequential La|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159547|EAP|Custom 95159547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Vena Cure 45cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Triathlon #1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95159555|EAP|Custom 95159555||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 10mm X 22mm Vertes|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95195593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 3.5mm 36mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95159565|EAP|Custom 95159565||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Right Small Benik W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse 12mmx108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95159569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drilling Cross Head 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.07|FSC: 13; Default||Not reimbursed separately|46.07|FSC: 13; Default||External grouping not supported 951201536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Cranioplate 2 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.85|FSC: 13; Default||Not reimbursed separately|77.85|FSC: 13; Default||External grouping not supported 95189944|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Rtu Tissue Select Alloderm 16x20cm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.90|FSC: 13; Default||Not reimbursed separately|89.90|FSC: 13; Default||External grouping not supported 95159571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Stright Cranioplate 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.12|FSC: 13; Default||Not reimbursed separately|90.12|FSC: 13; Default||External grouping not supported 95159573|EAP|Custom 95159573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spatula Corneal Insertion Neusid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189945|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Rtu Tissue Select Alloderm Contour Med Perf Thick 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.54|FSC: 13; Default||Not reimbursed separately|92.54|FSC: 13; Default||External grouping not supported 95159578|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 951201537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y-y 6 Hole Crainoplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.64|FSC: 13; Default||Not reimbursed separately|155.64|FSC: 13; Default||External grouping not supported 95189946|EAP|Custom 95189946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Tendon Stripper 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159588|EAP|Custom 95159588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Peg 20 French Pull|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195594|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gft Sft Tis 2cmx7cm Repair Matrix Xenform|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.84|FSC: 13; Default||Not reimbursed separately|1,908.84|FSC: 13; Default||External grouping not supported 95159589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 13mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95189947|EAP|Custom 95189947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fiberloop #2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Retrograde 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.42|FSC: 13; Default||Not reimbursed separately|1,935.42|FSC: 13; Default||External grouping not supported 951201538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Omm Nail Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.56|FSC: 13; Default||Not reimbursed separately|691.56|FSC: 13; Default||External grouping not supported 95189948|EAP|Custom 95189948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter Ii Short 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159593|EAP|Custom 95159593||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Sof-stretch Small 1-3/4 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159594|EAP|Custom 95159594||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Sof-stretch Medium 2 Sho|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Buttress Revision Acetabular Grip Pinnacle 56mm Neu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,983.00|FSC: 13; Default||Not reimbursed separately|13,983.00|FSC: 13; Default||External grouping not supported 95159599|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Duramax Dialysis 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 951201539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/+7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159600|EAP|Custom 95159600||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Sitback Deluxe Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tf Gription 5.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 95159604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Subtalor Bioarch 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95195595|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gft Sft Tis 4cmx7cm Repair Matrix Bn Fz Dr Xenform|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,518.26|FSC: 13; Default||Not reimbursed separately|2,518.26|FSC: 13; Default||External grouping not supported 95159605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Bioarch Alignment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95189951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Flat Head 6.5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95159606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara Size-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951201540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159609|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata 60 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|FSC: 13; Default||Not reimbursed separately|13,095.00|FSC: 13; Default||External grouping not supported 95189952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ceramic Medacta 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|FSC: 13; Default||Not reimbursed separately|5,868.00|FSC: 13; Default||External grouping not supported 95159610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink 39mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,568.36|FSC: 13; Default||Not reimbursed separately|5,568.36|FSC: 13; Default||External grouping not supported 95197606|EAP|Custom 95197606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 122mm 1.6mm Scaled Ao Nonsterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 4.0 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95189953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Sleeve Taper12/14 Sz Sm -3mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95159615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Peek 5.5mm X 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951201541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 40mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159616|EAP|Custom 95159616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Piston Stapes Smart Flou|1|HUMANA [1294]||HUMANA [11839]|794.01|FSC: 13; Default||Not reimbursed separately|794.01|FSC: 13; Default||External grouping not supported 95189954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Acutrak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95159617|EAP|Custom 95159617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Piston Stapes Smart Flou|1|HUMANA [1294]||HUMANA [11839]|794.01|FSC: 13; Default||Not reimbursed separately|794.01|FSC: 13; Default||External grouping not supported 95195596|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tis 6cmx10cm Bio Matrix Ft Bv Drml Fz Dr Xenform Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,998.76|FSC: 13; Default||Not reimbursed separately|3,998.76|FSC: 13; Default||External grouping not supported 95159618|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Tear Away 12.5 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189955|EAP|Custom 95189955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Dual Opthalmic Kahook|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159619|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lumen Dual 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159620|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated Infrarena|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,385.00|FSC: 13; Default||Not reimbursed separately|32,385.00|FSC: 13; Default||External grouping not supported 95189962|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Tecnis Symfony Toric 6.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95159621|EAP|Custom 95159621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Proximal Infrarenal 25 X 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159624|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Riata St Optim 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|FSC: 13; Default||Not reimbursed separately|14,250.00|FSC: 13; Default||External grouping not supported 95189963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acu-loc Vdu Left Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.00|FSC: 13; Default||Not reimbursed separately|2,487.00|FSC: 13; Default||External grouping not supported 95159625|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Isoflex 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951201543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159626|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Current + Dr Tiere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56,250.00|FSC: 13; Default||Not reimbursed separately|56,250.00|FSC: 13; Default||External grouping not supported 95189964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Constrained Trident Sz E 22mm O Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95159629|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Kit Peel Away 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195597|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tis 8cmx12cm Bio Matrix Ft Bv Drml Fz Dr Xenform Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,465.16|FSC: 13; Default||Not reimbursed separately|5,465.16|FSC: 13; Default||External grouping not supported 95159630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vpc Mini 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|FSC: 13; Default||Not reimbursed separately|702.00|FSC: 13; Default||External grouping not supported 95189965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 6 Hole 20mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|FSC: 13; Default||Not reimbursed separately|5,778.00|FSC: 13; Default||External grouping not supported 95159631|EAP|Custom 95159631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/+10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159632|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62064660|EAP|CPT® 81381||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Hla-b5701 - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|509.70|FSC: 13; Default||Not reimbursed separately|509.70|FSC: 13; Default||External grouping not supported 95159637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 0-degree 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95159638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off 3.o X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|974.25|FSC: 13; Default||Not reimbursed separately|974.25|FSC: 13; Default||External grouping not supported 95159639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off 3.o X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|980.25|FSC: 13; Default||Not reimbursed separately|980.25|FSC: 13; Default||External grouping not supported 95197615|EAP|Custom 95197615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pulmonary Artery Volumetric Lmx4 6fr 110cl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off 3.o X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|974.25|FSC: 13; Default||Not reimbursed separately|974.25|FSC: 13; Default||External grouping not supported 951201545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/+2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|887.58|FSC: 13; Default||Not reimbursed separately|887.58|FSC: 13; Default||External grouping not supported 95189990|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead - Quartet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,385.80|FSC: 13; Default||Not reimbursed separately|9,385.80|FSC: 13; Default||External grouping not supported 95159642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off 2.7 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|893.13|FSC: 13; Default||Not reimbursed separately|893.13|FSC: 13; Default||External grouping not supported 95159643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap-off 4.3 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,039.50|FSC: 13; Default||Not reimbursed separately|1,039.50|FSC: 13; Default||External grouping not supported 95190001|EAP|Custom 95190001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Joystick For T10 Screw Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159644|EAP|Custom 95159644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 1.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/+7.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hall-uc Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.00|FSC: 13; Default||Not reimbursed separately|1,710.00|FSC: 13; Default||External grouping not supported 95189991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Standard 3mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95159649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.0 Profyles 2x2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|745.20|FSC: 13; Default||Not reimbursed separately|745.20|FSC: 13; Default||External grouping not supported 95159651|EAP|Custom 95159651||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheet Protector Tendon|1|HUMANA [1294]||HUMANA [11839]|7,857.00|FSC: 13; Default||Not reimbursed separately|7,857.00|FSC: 13; Default||External grouping not supported 95189992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,232.70|FSC: 13; Default||Not reimbursed separately|1,232.70|FSC: 13; Default||External grouping not supported 95159652|EAP|Custom 95159652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 45mm Gree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/-2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159653|EAP|Custom 95159653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 45mm Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Ft 2.4 /l20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95159655|EAP|Custom 95159655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 45mm Whit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Ft 2.4mm/l26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95159659|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter I Cross Coronary Imagin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 44mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159660|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 10mm Diameter X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95189995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Ft 2.4mm/l14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95159661|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 10mm Diameter X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95197623|EAP|Custom 95197623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plate Radiology Sz 2 Phosphor Strg Scanx Digital Imaging|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159662|EAP|Custom 95159662||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Anterior Elevate|1|HUMANA [1294]||HUMANA [11839]|6,930.00|FSC: 13; Default||Not reimbursed separately|6,930.00|FSC: 13; Default||External grouping not supported 95189996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Ft 2.4mm/l16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 95159663|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Ablation Cool Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 40mm/-3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|FSC: 13; Default||Not reimbursed separately|2,704.80|FSC: 13; Default||External grouping not supported 95159664|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dual Lumen Power Picc S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Ft 2.4mm/l16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95159684|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 7.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195599|EAP|Custom 95195599||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 14cm 23mm 14.5mm 12mm Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 95159686|EAP|Custom 95159686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Tissue Lap Sac 5 X 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cross Left Lapidus Locking Axial Poly T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 95159687|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 6.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 40mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|FSC: 13; Default||Not reimbursed separately|2,704.80|FSC: 13; Default||External grouping not supported 95159688|EAP|HCPCS A7520||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 6.0mm I.d. Cu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cp 04.1mm L26mm T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95159689|EAP|HCPCS A7520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Tracheostomy 6.0mm I.d. Cuf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159699|EAP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Galil Icerod 17g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189980|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Otw 3.0x40x150 (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 951201551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 40mm/+3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|FSC: 13; Default||Not reimbursed separately|2,704.80|FSC: 13; Default||External grouping not supported 95159701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95189981|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Sl Otw 3.0mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Allthread 6.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95195600|EAP|Custom 95195600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 10.8cm Memorygel P4.4cm Hi Prfl Rnd Brst Gel 250m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Allthread 6.8mm With Tape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|FSC: 13; Default||Not reimbursed separately|765.00|FSC: 13; Default||External grouping not supported 95189982|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Otw 4.0mmx20mmx135cm (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Micromax Flex 2.9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,167.00|FSC: 13; Default||Not reimbursed separately|1,167.00|FSC: 13; Default||External grouping not supported 951201552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 40mm/+7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|FSC: 13; Default||Not reimbursed separately|2,704.80|FSC: 13; Default||External grouping not supported 95159714|EAP|Custom 95159714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Drill & Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189983|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Otw 4.0mmx40mmx135cm (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porocoat C/r Sigma Right S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 95197625|EAP|Custom 95197625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kit Vascular Introduction 8.5f Nonimplantable Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cv Sigma Pfc Sz 4/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95189984|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Sl Otw 4.0mm X 80mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159717|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Promote Plus Biv I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72,000.00|FSC: 13; Default||Not reimbursed separately|72,000.00|FSC: 13; Default||External grouping not supported 951201553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 40mm/+10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|FSC: 13; Default||Not reimbursed separately|2,704.80|FSC: 13; Default||External grouping not supported 95159718|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Isoflex 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95189985|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Otw 5.0mmx20mmx135cm (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159719|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Isoflex 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95195601|EAP|Custom 95195601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 11.3cm Memorygel 3.4cm Smth Rnd Mod Brst Gel 250m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159720|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Quickflex Lv 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95189986|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Otw 5.0mmx100mmx135cm (4f)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159721|EAP|Custom 95159721||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Right Medium Benik|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 44mm/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159738|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cope Nephroureterostomy 8.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.83|FSC: 13; Default||Not reimbursed separately|394.83|FSC: 13; Default||External grouping not supported 95189987|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Fg Sterling Otw 5.0x120x150-hybrid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159750|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159106|EAP|Custom 95159106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization Mreye .035 Dia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189966|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote Es Otw 1.5mm X 20mm X 142cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159107|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 7 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951201555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 44mm/+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159108|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 8 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95189967|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote Es Otw 2mm X 20mm X 142cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|FSC: 13; Default||Not reimbursed separately|4,899.30|FSC: 13; Default||External grouping not supported 95195602|EAP|Custom 95195602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 11.3cm Memorygel 3.4cm Smth Rnd Mod Brst Gel 275m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara Coxa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95189968|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote Es Otw 2mm X 40mm X 144cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 951201556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 44mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Bearing Ps Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95189969|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote 2.0mm X 60mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Magnum Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95197626|EAP|Custom 95197626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Set Introducer Vascular 8.5f Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159115|EAP|Custom 95159115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Smartstitch Opus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189970|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter - Coyote 2.0mm X 80mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951201557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 40mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159123|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189971|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote 2.0mm X 100mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159124|EAP|Custom 95159124||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Lef|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 32mm T10 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95159125|EAP|Custom 95159125||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Lef|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189972|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote Es Otw 2.5mm X 20mm X 143cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159126|EAP|Custom 95159126||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Lef|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 44mm/+8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159127|EAP|Custom 95159127||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Lef|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189973|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Coyote 2.5mm X 60mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159128|EAP|Custom 95159128||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Rig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159129|EAP|Custom 95159129||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Rig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189974|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote 2.5mm X 100mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159130|EAP|Custom 95159130||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Rig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 44mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95159131|EAP|Custom 95159131||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Rig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189975|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote 2.5mm X 120mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159143|EAP|HCPCS C1898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pacing Atrial J Bipolar Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95197627|EAP|Custom 95197627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Set Introducer Vascular 8.5mml Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159145|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95189976|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote Es Otw 3mm X 20mm X 143cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159148|EAP|Custom 95159148||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Hand Based Radial Nerve Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Fem Head-40m X-4.0mm Ofset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.70|FSC: 13; Default||Not reimbursed separately|1,967.70|FSC: 13; Default||External grouping not supported 95159149|EAP|Custom 95159149||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Solution Optisol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95189977|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote 3.0mm X 120mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159157|EAP|Custom 95159157||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dissector Endoscopic Band Realiz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159158|EAP|Custom 95159158||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Adjustable Realize Curved|1|HUMANA [1294]||HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95189978|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coyote 4.0mm X 120mm X 150cm Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Multihole Pinnacl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951201561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Fem Head-40m X 0mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.70|FSC: 13; Default||Not reimbursed separately|1,967.70|FSC: 13; Default||External grouping not supported 95159160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intrafix 9mm Hard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95189979|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fg Sterling Sl Otw 2.5mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Ecc 36mm +3mm Lateral Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95159168|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Hurricane Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Fem Head-40m X+4.0mm Ofset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.70|FSC: 13; Default||Not reimbursed separately|1,967.70|FSC: 13; Default||External grouping not supported 95159171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95159172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Max Vertex 4.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95159173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Lfit Cocr C-taper 36mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 951201563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Ntrl Lnr-28mm- Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Ti Head Alumia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95190003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Staple 10x15x13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,314.00|FSC: 13; Default||Not reimbursed separately|4,314.00|FSC: 13; Default||External grouping not supported 95159175|EAP|Custom 95159175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Multifunction Adult Zo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cement Ava-tex Radiopaque|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|740.25|FSC: 13; Default||Not reimbursed separately|740.25|FSC: 13; Default||External grouping not supported 95190004|EAP|Custom 95190004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Passer Champion Slingshot 45 Degree Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159182|EAP|Custom 95159182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Inner Disp Size-4 Use Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 1 28mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159186|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190005|EAP|Custom 95190005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Extraction Quattro Fusion 8.5-15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159187|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Nit-vu Micro .018 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159188|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Nit-vu Micro .018 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190006|EAP|Custom 95190006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Extraction Quattro Fusion 12-20-xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159194|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath 5 Fr 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 1 28mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159195|EAP|Custom 95159195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Optitorque 5fr 100cm Ja|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159196|EAP|Custom 95159196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Optitorque 5 Fr 100cm R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,417.08|FSC: 13; Default||Not reimbursed separately|1,417.08|FSC: 13; Default||External grouping not supported 95159198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Small Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,001.08|FSC: 13; Default||Not reimbursed separately|12,001.08|FSC: 13; Default||External grouping not supported 951201566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Epw Lnr-28mm- Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159199|EAP|Custom 95159199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,246.56|FSC: 13; Default||Not reimbursed separately|1,246.56|FSC: 13; Default||External grouping not supported 95197607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2mm 2mm Screw 5 Hole Lock 34mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|FSC: 13; Default||Not reimbursed separately|3,540.00|FSC: 13; Default||External grouping not supported 95159201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95159202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis G-force 5mm X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|FSC: 13; Default||Not reimbursed separately|1,347.00|FSC: 13; Default||External grouping not supported 951201567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral-28mm Tpr Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159203|EAP|Custom 95159203||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Passer Suture G- Force|1|HUMANA [1294]||HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 95159208|EAP|Custom 95159208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Ot0-s (for Use With|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195614|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.4x4.6cm 300cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95159209|EAP|Custom 95159209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Gas Sterile Omniguide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159210|EAP|Custom 95159210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pencil Button With Smoke Evac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Ntrl Lnr-32mm- Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,430.00|FSC: 13; Default||Not reimbursed separately|5,430.00|FSC: 13; Default||External grouping not supported 95159296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95159299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95159300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95159301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95159302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95159303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95159304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95159305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95159306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951201569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-28mm Tprsz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95190009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti 41mm Dia X 15mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95159308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95195615|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.7x4.7cm 330cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95159309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95190010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 95159310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm Va Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951201570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst 32mm Tprsz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95190011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plate Cortical 3.5x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95159312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|715.14|FSC: 13; Default||Not reimbursed separately|715.14|FSC: 13; Default||External grouping not supported 95197609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad 2mm 4 Hole Lock 28mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|FSC: 13; Default||Not reimbursed separately|3,540.00|FSC: 13; Default||External grouping not supported 95159314|EAP|Custom 95159314||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Passer Perfect Smartst|1|HUMANA [1294]||HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95190012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Titanium 3.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95159315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Magnum 2 Opus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 951201571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq 28mm Tprsz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,430.00|FSC: 13; Default||Not reimbursed separately|5,430.00|FSC: 13; Default||External grouping not supported 95190013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plate Cancellous 4.0x38mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95159317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drilling Cross Head 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.07|FSC: 13; Default||Not reimbursed separately|46.07|FSC: 13; Default||External grouping not supported 95195616|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12x4.8cm 350cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95159318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95190014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plate Cancellous 4.0x42mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95159319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drilling Cross Head 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.72|FSC: 13; Default||Not reimbursed separately|73.72|FSC: 13; Default||External grouping not supported 951201572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 2 32mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95190015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fracture Plate Cancellous 4.0x44mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95159321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95159322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95190016|EAP|Custom 95190016||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant System Proximal Tenodesis 10029328|1|HUMANA [1294]||HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95159323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 951201573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd 28mm Tpr Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Crainoplate 2 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.85|FSC: 13; Default||Not reimbursed separately|77.85|FSC: 13; Default||External grouping not supported 95190018|EAP|Custom 95190018||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Transcatheter Evolut Us 34 Mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95159325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Crainoplate 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.12|FSC: 13; Default||Not reimbursed separately|90.12|FSC: 13; Default||External grouping not supported 95195617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer T8 & T10 Screws 2.4mm / 2.7mm / 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95159327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Drill 16mm Crainoplat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.78|FSC: 13; Default||Not reimbursed separately|204.78|FSC: 13; Default||External grouping not supported 95190019|EAP|Custom 95190019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Enveo N-us 34mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Drill 20mm Crainoplat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.78|FSC: 13; Default||Not reimbursed separately|204.78|FSC: 13; Default||External grouping not supported 951201574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Epw Lnr-32mm- Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95190020|EAP|Custom 95190020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Loading Enveo 34mm-us Comm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95197610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 42mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95190021|EAP|Custom 95190021||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interspace Knee High Medium Rel|1|HUMANA [1294]||HUMANA [11839]|11,460.00|FSC: 13; Default||Not reimbursed separately|11,460.00|FSC: 13; Default||External grouping not supported 95159332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 951201575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr Hxlpe Ntral 28mm Tpr Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Option Flex Cr Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|FSC: 13; Default||Not reimbursed separately|7,310.16|FSC: 13; Default||External grouping not supported 95190027|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Ip W/pat Controller 5 Elite Proclaim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|FSC: 13; Default||Not reimbursed separately|54,000.00|FSC: 13; Default||External grouping not supported 95159338|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195644|EAP|Custom 95195644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Intvrtb 16mm 5mm Pstg Lp Cspn Ti|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95159343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95190028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Repair Implant System Internal Brace Knee Ligament Augment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95159344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95159345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951201576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral 32mm Tpr Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoraltri-lock Bps With Gr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95190031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged All-poly E-plus 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95159347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Blade Narrow Large Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,748.50|FSC: 13; Default||Not reimbursed separately|3,748.50|FSC: 13; Default||External grouping not supported 95159348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Crosslink 22mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,801.02|FSC: 13; Default||Not reimbursed separately|4,801.02|FSC: 13; Default||External grouping not supported 95190032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Thick 50mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95159352|EAP|Custom 95159352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Seal Open 25cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Ntrl Lnr-36mm- Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porous Cr Vanguard Right 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95190033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95159355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Thin 37 3-peg Series A V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95159356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial I-beam Cc 87mm Biome|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|FSC: 13; Default||Not reimbursed separately|3,141.00|FSC: 13; Default||External grouping not supported 95190034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti 120mmx5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|FSC: 13; Default||Not reimbursed separately|1,617.00|FSC: 13; Default||External grouping not supported 95159357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cr 10 X 87|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 951201578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-28mm Tprsz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159359|EAP|Custom 95159359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Dissecting Hs Synergy Harmo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95159360|EAP|Custom 95159360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Models Bone Knee Vanguard Signat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159361|EAP|Custom 95159361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Knee Signature Vanguard 04|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Repair Ac Acute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95159365|EAP|Custom 95159365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Set Osteo-site Bone Biops|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-32mm Tprsz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159366|EAP|Custom 95159366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seed Calibrated Assay .676 Mci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95159367|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95159373|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 3mm X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Res Trinity Cup Lnr-hxlpe +4 36 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159374|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Low Profile 20fr X 2.5 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190036|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 34mm X 161mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95159383|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95159385|EAP|HCPCS Q4114||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Wound Flowable Inte Per C|1|HUMANA [1294]||HUMANA [11839]|4,247.11|FSC: 13; Default||Not reimbursed separately|4,247.11|FSC: 13; Default||External grouping not supported 95190037|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tapered Prox Endovascular Thoracic Alpha Zenith 38-34-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95159386|EAP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dressing Wnd Integra 4x10 Sqcm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.47|FSC: 13; Default||Not reimbursed separately|40.47|FSC: 13; Default||External grouping not supported 951201581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-28mm Tprsz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159387|EAP|Custom 95159387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Monitoring Neuro Synapse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190041|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Crosser Peripheral Cto 14s 146cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159388|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159389|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190042|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Support Sidekick Angle Taper 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159390|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-32mm Tprsz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159391|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190043|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Support Sidekick Strt Taper 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159392|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159393|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190044|EAP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tissue Placental Human Amniofill 250mg|1|HUMANA [1294]||HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95159394|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 3 36mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159395|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lateral Lt 6 Hole /l166mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,176.00|FSC: 13; Default||Not reimbursed separately|10,176.00|FSC: 13; Default||External grouping not supported 95159396|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159397|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2.3mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95159398|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-28mm-tpr Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159399|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Self Tapping 2.3mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|FSC: 13; Default||Not reimbursed separately|249.75|FSC: 13; Default||External grouping not supported 95159400|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159401|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190053|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Charger 7.0 X150 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159402|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-32mm-tpr Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159403|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 4-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95159404|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159405|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190055|EAP|Custom 95190055||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb End Cap 5x14x11mm|1|HUMANA [1294]||HUMANA [11839]|3,329.64|FSC: 13; Default||Not reimbursed separately|3,329.64|FSC: 13; Default||External grouping not supported 95159406|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Epw Lnr-36mm- Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159407|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibia Journey Np Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 95159408|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159409|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Dish Deep Journey Ii Xlpe Lt Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 95159410|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral-28mm-tpr Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159411|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190058|EAP|Custom 95190058||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Point Check Fem/tib Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159412|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159413|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Option Biolox 36mm 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,630.00|FSC: 13; Default||Not reimbursed separately|6,630.00|FSC: 13; Default||External grouping not supported 95159414|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral-32mm-tpr Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159415|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Latitude Size Pettite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|FSC: 13; Default||Not reimbursed separately|22,713.00|FSC: 13; Default||External grouping not supported 95159416|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195655|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vsclr .018in 60cm Acc Ii J Rn Tip Crv Fl Ntl Plt 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159417|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spool Humeral Elbow Latitude Sz Petitte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,358.00|FSC: 13; Default||Not reimbursed separately|11,358.00|FSC: 13; Default||External grouping not supported 95159418|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159419|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Ntrl Lnr-36mm- Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159420|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190062|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath - Cordis 10fr Brite Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159421|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159422|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159423|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral-40mm-tpr Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159424|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190064|EAP|Custom 95190064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Gel 325cc Resterilizable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159425|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 11mm X 405mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95159426|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159427|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-28mm Tprsz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159428|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159429|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159430|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159431|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-32mm Tprsz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159432|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95159433|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95195658|EAP|Custom 95195658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Stratafix 3-0 16cm Ply Kntls Und Rb-1 Tp Pnt 3/8 Crl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159434|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Condyle T2 5mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95159435|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951201593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 4 36mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159436|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190069|EAP|Custom 95190069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Irrigation System Rio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159437|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95197616|EAP|HCPCS C1769||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire Vascular 0.014in 190cm Coronary J-tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95159438|EAP|Custom 95159438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrodes Monitoring Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pack Pin Bone 4mm X 170mm 2-pk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|436.80|FSC: 13; Default||Not reimbursed separately|436.80|FSC: 13; Default||External grouping not supported 95159439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|FSC: 13; Default||Not reimbursed separately|4,899.30|FSC: 13; Default||External grouping not supported 951201594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-40mm Tprsz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 95190071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mold Stem Hip 13 X 145mm W/reinforcement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,163.20|FSC: 13; Default||Not reimbursed separately|3,163.20|FSC: 13; Default||External grouping not supported 95159441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,900.79|FSC: 13; Default||Not reimbursed separately|2,900.79|FSC: 13; Default||External grouping not supported 95195661|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Beacon Care Package Lung|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 95159442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3.0mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95190072|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95159443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Soft-tissue Anchorlok Edg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 951201595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-28mm Tprsz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159447|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sn 65 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|FSC: 13; Default||Not reimbursed separately|13,095.00|FSC: 13; Default||External grouping not supported 95159448|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pressure Injectable Pic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|FSC: 13; Default||Not reimbursed separately|1,446.48|FSC: 13; Default||External grouping not supported 95190074|EAP|Custom 95190074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Lap Sac Tissue 2inch X 5inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159450|EAP|Custom 95159450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Laser Omniguide Standby|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-32mm Tprsz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159452|EAP|Custom 95159452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Electrode Leveen 12cm X 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190075|EAP|Custom 95190075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Lap Sac Tissue 4inch X 6inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159456|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Viewflex Ultrasound|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195662|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Beacon Care Package Soft Tissue 17g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95159460|EAP|Custom 95159460||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 10mm X 26mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95190076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Clavicle Dual-trak 3.8mmx120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|FSC: 13; Default||Not reimbursed separately|2,889.00|FSC: 13; Default||External grouping not supported 95159467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular Metal Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 951201597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 4 36mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular Metal Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95190077|EAP|Custom 95190077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Tap Screw Clavicle 3.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159469|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Polyflex 18mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,354.78|FSC: 13; Default||Not reimbursed separately|6,354.78|FSC: 13; Default||External grouping not supported 95197617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159470|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Star Flex Septal Occlude|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95190078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Peek 5.5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95159471|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Star Flex Septal Occlude|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951201598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-40mm Tprsz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight 16 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 95190079|EAP|Custom 95190079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Permacord 2.5mm White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95159474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95195651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 24mm Ti 1 Level Trns Slct Bn Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95159476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press Fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95159477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 951201599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-28mm-tpr Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95159485|EAP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seed Loose I-125 Activity .676 M|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95159492|EAP|Custom 95159492||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159493|EAP|Custom 95159493||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159494|EAP|Custom 95159494||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-32mm-tpr Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159495|EAP|Custom 95159495||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159496|EAP|Custom 95159496||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.6mm 12mm Trinica Variable St Magenta S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95159497|EAP|Custom 95159497||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190090|EAP|Custom 95190090||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interbody Stand-alone 6deg 8 X 15 X 12mm|1|HUMANA [1294]||HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95159498|EAP|Custom 95159498||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Epw Lnr-36mm Id-sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95190091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Non Locking 3.5mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95159507|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Short He|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95197621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Standard Quadra-p Size 6 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95159752|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Admiral Xtreme|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis G-force 5mm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|FSC: 13; Default||Not reimbursed separately|1,347.00|FSC: 13; Default||External grouping not supported 951201602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-40mm-tpr Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tapping Venture 4.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|FSC: 13; Default||Not reimbursed separately|1,493.52|FSC: 13; Default||External grouping not supported 95190093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws Pack (2 Ea) Va 3.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,508.10|FSC: 13; Default||Not reimbursed separately|1,508.10|FSC: 13; Default||External grouping not supported 95159779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95195663|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Avive Soft Tissue Membrane 2cm X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95159790|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cervical Maintain Lord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95190094|EAP|Custom 95190094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable - Soundstas Eco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Globus 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,448.00|FSC: 13; Default||Not reimbursed separately|5,448.00|FSC: 13; Default||External grouping not supported 951201603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral-32mm-tpr Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angle Fixed Globus 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95190097|EAP|Custom 95190097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pins Non-threaded Guide Pins 2mm (pack Of 6)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Angle Variable Globus 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95159809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|FSC: 13; Default||Not reimbursed separately|6,117.30|FSC: 13; Default||External grouping not supported 95190098|EAP|Custom 95190098||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 12x14x7 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95159810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral S-rom 32mm 11/13 Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|FSC: 13; Default||Not reimbursed separately|2,767.80|FSC: 13; Default||External grouping not supported 951201604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Ntrl Lnr-36mm- Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner L-series Acetabular S-rom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,144.60|FSC: 13; Default||Not reimbursed separately|6,144.60|FSC: 13; Default||External grouping not supported 95190099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon Four-level 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 95159812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral Head Cruciate S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 95195664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 3mm 2 Sut Tk Fbrwr Bcmps 14.5mm Strl Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95159813|EAP|Custom 95159813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Xcel Endopath 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190100|EAP|Custom 95190100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ablation Endometrial Controlled Novasure Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159814|EAP|Custom 95159814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 22mm Bold|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Ntral-40mm-tpr Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159820|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Isoflex 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95190101|EAP|Custom 95190101||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device - Closure Watchman Lla 21mm|1|HUMANA [1294]||HUMANA [11839]|51,000.00|FSC: 13; Default||Not reimbursed separately|51,000.00|FSC: 13; Default||External grouping not supported 95159821|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Zephyr Dd Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,622.50|FSC: 13; Default||Not reimbursed separately|12,622.50|FSC: 13; Default||External grouping not supported 95197618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159822|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Ulpa Optimumm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.90|FSC: 13; Default||Not reimbursed separately|716.90|FSC: 13; Default||External grouping not supported 95190102|EAP|Custom 95190102||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device - Closure Watchman Lla 24mm|1|HUMANA [1294]||HUMANA [11839]|51,000.00|FSC: 13; Default||Not reimbursed separately|51,000.00|FSC: 13; Default||External grouping not supported 95159823|EAP|Custom 95159823||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 8mm X 26mm Vertest|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 951201606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-28mm Tprsz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159824|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Septal Occluder 7 Fr 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95190103|EAP|Custom 95190103||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device - Closure Watchman Lla 27mm|1|HUMANA [1294]||HUMANA [11839]|51,000.00|FSC: 13; Default||Not reimbursed separately|51,000.00|FSC: 13; Default||External grouping not supported 95159825|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Septal Occluder 7 Fr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,060.00|FSC: 13; Default||Not reimbursed separately|21,060.00|FSC: 13; Default||External grouping not supported 95195666|EAP|Custom 95195666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Surgical 3mmw Stainless Steel F/polyhedral Allen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159826|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Septal Occluder 7 Fr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|FSC: 13; Default||Not reimbursed separately|22,323.00|FSC: 13; Default||External grouping not supported 95190104|EAP|Custom 95190104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device - Closure Watchman Lla 30mm|1|HUMANA [1294]||HUMANA [11839]|51,000.00|FSC: 13; Default||Not reimbursed separately|51,000.00|FSC: 13; Default||External grouping not supported 95159827|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Multi-fenestrated Cribriform Sep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,060.00|FSC: 13; Default||Not reimbursed separately|21,060.00|FSC: 13; Default||External grouping not supported 951201607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-32mm Tprsz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159828|EAP|Custom 95159828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Matrix Neuro 3.0mm Diameter 2.5c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159829|EAP|Custom 95159829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Matrix Neuro 4.0mm Diameter 2.5c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 5 36mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159830|EAP|Custom 95159830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Matrix Neuro 5.0mm Diameter 2.5c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190105|EAP|Custom 95190105||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device - Closure Watchman Lla 33mm|1|HUMANA [1294]||HUMANA [11839]|51,000.00|FSC: 13; Default||Not reimbursed separately|51,000.00|FSC: 13; Default||External grouping not supported 95159832|EAP|Custom 95159832||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Neuro 2.5mm Diameter 2.5c|1|HUMANA [1294]||HUMANA [11839]|3,170.25|FSC: 13; Default||Not reimbursed separately|3,170.25|FSC: 13; Default||External grouping not supported 95159833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Ulnar Osteotom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95190106|EAP|Custom 95190106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Watchman Single Curve 14f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Hex Head 3.2mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 951201609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Ofst-40mm Tprsz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Hex Head 3.2mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.75|FSC: 13; Default||Not reimbursed separately|81.75|FSC: 13; Default||External grouping not supported 95190107|EAP|Custom 95190107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Watchman Double Curve 14f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lag Head 3.2mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95197619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159837|EAP|Custom 95159837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kwire 1.6mm X 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190108|EAP|Custom 95190108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Watchman Anterior Curve 14f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159838|EAP|Custom 95159838||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kwire 1.6mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|30.00|FSC: 13; Default||Not reimbursed separately|30.00|FSC: 13; Default||External grouping not supported 951201610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-28mm Tprsz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159839|EAP|Custom 95159839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 2.30 Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190109|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Nanocross Elite 2.0 Mm X 60 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159840|EAP|Custom 95159840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm X 50/18mm Cort Thd Slf Drilling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95159844|EAP|Custom 95159844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flex Quickset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190111|EAP|Custom 95190111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sagittal Mako Stryker Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 951201611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-32mm Tprsz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95190112|EAP|Custom 95190112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sagittal Mako Stryker Narrow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Star Head 2.7mm X 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95159852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.7 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95190113|EAP|Custom 95190113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Extraction Nail|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 951201612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hxlpe Liner Sz 5 36mm Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Screw Biocork With Fiberw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 80170633|EAP|CPT® 49185||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ir Guided Sclerotherapy|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95159859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|FSC: 13; Default||Not reimbursed separately|3,015.00|FSC: 13; Default||External grouping not supported 95195669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 70mm Ti Cort Ns Axsos 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95159860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|FSC: 13; Default||Not reimbursed separately|3,015.00|FSC: 13; Default||External grouping not supported 95190110|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Armada 18 5.0mm X 20mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 951201613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe4mm Oblq-40mm Tprsz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,751.80|FSC: 13; Default||Not reimbursed separately|6,751.80|FSC: 13; Default||External grouping not supported 95190124|EAP|Custom 95190124||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pedal - Smart Ablate (foot)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159864|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7 Fr 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95197620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95159866|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Occlusion Balloon Stand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190125|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lasso - 12mm Fixed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159867|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Occlusion Balloon Beren|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-28mm-tpr Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159869|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Stent Sd Renal Biliary Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95190126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Continuous Radius 5.5mmx100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95159870|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Mr Steriling Monorail 3m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95159876|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Road Runner Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190127|EAP|Custom 95190127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Universal Qc T-20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159877|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Road Runner Angled .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-32mm-tpr Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159878|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 3fr 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95159879|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 3fr 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95159880|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 3fr 7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|FSC: 13; Default||Not reimbursed separately|184.89|FSC: 13; Default||External grouping not supported 95159881|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 3fr 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95118964|EAP|Custom 95118964||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pacing Cardiac 2-0 24" Sh Sks-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159882|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 951201616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin Xlp Epw Lnr-36mm Id-sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159883|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95190128|EAP|Custom 95190128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vent Heart Left Dlp W/out Stylet 16 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159884|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95159885|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95190129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95159886|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 951201617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rst Trin Cup Lnr-hxlpe Elvtd-40mm-tpr Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95190131|EAP|Custom 95190131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin 4mm X 110 Mm (sterile 2-pk)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Proximal 20p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|FSC: 13; Default||Not reimbursed separately|4,428.00|FSC: 13; Default||External grouping not supported 95159892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 18mm X 155mm Conical Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 80170644|EAP|CPT® 31636||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch With Placement Of Bronchial Stents|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 95159893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Lon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,647.00|FSC: 13; Default||Not reimbursed separately|10,647.00|FSC: 13; Default||External grouping not supported 951201618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 32mm-sz 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159894|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95190133|EAP|Custom 95190133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Balloon Inove 28mm Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159904|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Riata St Optim Icd 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95190134|EAP|Custom 95190134||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tracelet - Compression Device Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159910|EAP|Custom 95159910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Nerve Block Continuous Pl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 32mm-sz 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95159951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95190135|EAP|Custom 95190135||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tracelet - Compression Device Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95159962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95159966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95190136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Mod Mas Reline 5.5 X 40mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|FSC: 13; Default||Not reimbursed separately|3,087.00|FSC: 13; Default||External grouping not supported 95159968|EAP|Custom 95159968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Straight Nim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 33mm-sz 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160051|EAP|Custom 95160051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Jones 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Mod Mas Reline 6.5 X 35mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95160052|EAP|Custom 95160052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Cannulated 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160057|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Proximal Exte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|FSC: 13; Default||Not reimbursed separately|15,594.00|FSC: 13; Default||External grouping not supported 951201621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 36mm-sz 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial I-beam 75mm Cc Biom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|FSC: 13; Default||Not reimbursed separately|3,141.00|FSC: 13; Default||External grouping not supported 95190138|EAP|Custom 95190138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Access Maxcess Mas 2 Tlif|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 57.5mm Right C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95160060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Thin 34mm 3-peg Series A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95190139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95160061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Cr 12mm X 71/75 V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 951201622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 36mm-sz 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95190141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 40mm Lordotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95160063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95160064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95190142|EAP|Custom 95190142||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tulip Reline Mod|1|HUMANA [1294]||HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 95160065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 951201623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 36mm-sz 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95190143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Reline Tulip Open 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95160067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 9mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95160068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95190144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 14mm 130 Deg 400mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95160073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951201624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Insert 36mm-sz 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95190145|EAP|Custom 95190145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fiber Force #2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95160077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Cemente|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95190140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95160078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951201625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Ins-36mm Size 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95190148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Hf Locking Sm Frag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|FSC: 13; Default||Not reimbursed separately|1,626.90|FSC: 13; Default||External grouping not supported 95160088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articulize 40mm Spe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|FSC: 13; Default||Not reimbursed separately|6,157.20|FSC: 13; Default||External grouping not supported 95160089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Disposable Pin Drill Trim-it|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95190149|EAP|Custom 95190149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fiber Force Braid With #2 Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 951201626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Inset 36mm Size 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|FSC: 13; Default||Not reimbursed separately|9,466.80|FSC: 13; Default||External grouping not supported 95160093|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95160094|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95160095|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95160096|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 951201627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Poly Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.70|FSC: 13; Default||Not reimbursed separately|2,996.70|FSC: 13; Default||External grouping not supported 95160097|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95160099|EAP|Custom 95160099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pumping Symphony Initiati|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190150|EAP|Custom 95190150||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable - Soundstas Eco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Bio 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 951201628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Stem Cementralizer D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|FSC: 13; Default||Not reimbursed separately|413.70|FSC: 13; Default||External grouping not supported 95190153|EAP|Custom 95190153||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adaptor - Latitude 3g Usb Cellular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Pinnacle Marath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 95160109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 36mm X 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95190159|EAP|Custom 95190159||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Lap Band With Rapidport Ez Ap Standard|1|HUMANA [1294]||HUMANA [11839]|10,770.00|FSC: 13; Default||Not reimbursed separately|10,770.00|FSC: 13; Default||External grouping not supported 95160110|EAP|Custom 95160110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Suture Smart Stitch Ma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160111|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Revision Spinal Segment Intr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95190160|EAP|Custom 95190160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Lap Band With Rapidport Ez Ap Large|1|HUMANA [1294]||HUMANA [11839]|10,770.00|FSC: 13; Default||Not reimbursed separately|10,770.00|FSC: 13; Default||External grouping not supported 95160112|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Intrathecal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|FSC: 13; Default||Not reimbursed separately|1,995.00|FSC: 13; Default||External grouping not supported 95160134|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Jejunal Flow 20 9fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190151|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Electrode - Acuity X4 Spiral S Lua Quad 86cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95160137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160138|EAP|Custom 95160138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Hexflex 8.0 X 85mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190152|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Valitude Crt-p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95160141|EAP|Custom 95160141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Tiger 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160144|EAP|Custom 95160144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Carbide Round 1.8mm X 51.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Ft 2.4mm/l12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95160151|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951201631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160152|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Taxus Liberte Ato|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95190155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Ft 3.5mm/l70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95160157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lpc Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 95160158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,869.27|FSC: 13; Default||Not reimbursed separately|4,869.27|FSC: 13; Default||External grouping not supported 95190156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Distal Sts Revision Mod Arcos 16mm/150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95160186|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Pocket 2 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 951201632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160187|EAP|Custom 95160187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator Bladeless 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cone Prox Body Siz B Stand Offset 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95160188|EAP|Custom 95160188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator Bladeless 8mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160189|EAP|Custom 95160189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ceramic Option Biolox Delta 40mm Type16/18 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95160190|EAP|Custom 95160190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Cover Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160198|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Lunderquist Extra Stif|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160203|EAP|Custom 95160203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Accures 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Porous 29mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95160205|EAP|Custom 95160205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Cannula 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160207|EAP|Custom 95160207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape Fiber 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160208|EAP|Custom 95160208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retractor Small 2.5-6cm A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160216|EAP|Custom 95160216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Grasper Babcock Drive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 127 Degree A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 95160230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,808.75|FSC: 13; Default||Not reimbursed separately|2,808.75|FSC: 13; Default||External grouping not supported 95160232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.57|FSC: 13; Default||Not reimbursed separately|2,853.57|FSC: 13; Default||External grouping not supported 95160233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,900.79|FSC: 13; Default||Not reimbursed separately|2,900.79|FSC: 13; Default||External grouping not supported 95160234|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Surgical 2 X 8 70cm Pre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,256.25|FSC: 13; Default||Not reimbursed separately|16,256.25|FSC: 13; Default||External grouping not supported 95160235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 95160236|EAP|Custom 95160236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Hex Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160237|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Starfix Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95190162|EAP|Custom 95190162||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Regeneration Dural Plus Duragen 4x5 In|1|HUMANA [1294]||HUMANA [11839]|4,715.91|FSC: 13; Default||Not reimbursed separately|4,715.91|FSC: 13; Default||External grouping not supported 95160238|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Ability|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95160239|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Attain Command Extende|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190163|EAP|Custom 95190163||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Positioning Fluidized Neonatal Medium Full Body|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 951201637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95190164|EAP|Custom 95190164||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Positioner Neonatal Large Tube W/cover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 95160243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 95160244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lpc Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95190168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 35mm Lordotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95160245|EAP|Custom 95160245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Collarette Monoka Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160246|EAP|Custom 95160246||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Monoka Mini|1|HUMANA [1294]||HUMANA [11839]|190.00|FSC: 13; Default||Not reimbursed separately|190.00|FSC: 13; Default||External grouping not supported 95190169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4mm X 28mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95160252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lpc Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 95160253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lpc Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 95190166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Mod Mas Reline 5.5 X 35mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95160254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lpc Clavical Superior Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 951201639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Cemented Posteri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 95190167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95160257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizing Pfc Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95160271|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tigerwire Angled Floppy Tip .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4mm X 36mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95160273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 951201640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160276|EAP|Custom 95160276||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Eyelid Dynarod|1|HUMANA [1294]||HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95190173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm X 40mm Long Threaded W/cruciform Rece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.54|FSC: 13; Default||Not reimbursed separately|738.54|FSC: 13; Default||External grouping not supported 95160288|EAP|Custom 95160288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manipulator Uterine Zumi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160290|EAP|Custom 95160290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Bladeless E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190165|EAP|Custom 95190165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device-biosentry Delivery (1) Coax Adapter (1) Hydrogel Plug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160295|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Floor Pelvic Total|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,875.00|FSC: 13; Default||Not reimbursed separately|7,875.00|FSC: 13; Default||External grouping not supported 95190174|EAP|Custom 95190174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Spine X Mazor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160296|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Floor Pelvic Anter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|FSC: 13; Default||Not reimbursed separately|5,949.00|FSC: 13; Default||External grouping not supported 95160297|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Repair Floor Pelvic Poste|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|FSC: 13; Default||Not reimbursed separately|5,949.00|FSC: 13; Default||External grouping not supported 95190171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Proximal Conical Reclaim 24 X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95160298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 21mm X 166mm Conical Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 951201642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160299|EAP|Custom 95160299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electro Lube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tapered Distal Reclaim 21 X 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 95160304|EAP|Custom 95160304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Suture Ranfac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160316|EAP|Custom 95160316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Laparoflator With Filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Distal Left 9-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95190177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 23mm X 155mm Conical Distal Plasma Modular Restorat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95160336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Fixed Bearing Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,820.00|FSC: 13; Default||Not reimbursed separately|2,820.00|FSC: 13; Default||External grouping not supported 951201644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Fixed Bearing Right/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|FSC: 13; Default||Not reimbursed separately|5,820.00|FSC: 13; Default||External grouping not supported 95190178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Humerus Postlateral Rt 11h 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95160338|EAP|Custom 95160338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Drill Pin Steinman Pfc Ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160341|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95190179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Medial 127mm Left 13 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|FSC: 13; Default||Not reimbursed separately|2,643.75|FSC: 13; Default||External grouping not supported 95160342|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 34.0 Diopter So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951201645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160343|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 34.0 Diopter So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95190180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95160344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 12mm Mmi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95160345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,105.40|FSC: 13; Default||Not reimbursed separately|2,105.40|FSC: 13; Default||External grouping not supported 95190181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95160350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.50|FSC: 13; Default||Not reimbursed separately|391.50|FSC: 13; Default||External grouping not supported 951201646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|FSC: 13; Default||Not reimbursed separately|375.84|FSC: 13; Default||External grouping not supported 95190182|EAP|Custom 95190182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patch Sealant Fibrin Evarrest 2x4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|FSC: 13; Default||Not reimbursed separately|337.50|FSC: 13; Default||External grouping not supported 95195670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Impl 30x20x20x20x20mm Secod 2.5 Bme Elt 7.1mm 4 Lg Brdg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,313.77|FSC: 13; Default||Not reimbursed separately|6,313.77|FSC: 13; Default||External grouping not supported 95160354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95160355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 951201647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160356|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Accent Rf Dr Dual Cham|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|FSC: 13; Default||Not reimbursed separately|14,904.00|FSC: 13; Default||External grouping not supported 95160357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95160358|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Cps Direct Pl 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hinge Insert Tibial Universal X-sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,819.65|FSC: 13; Default||Not reimbursed separately|10,819.65|FSC: 13; Default||External grouping not supported 95160359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Frag Small Hs Stra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.00|FSC: 13; Default||Not reimbursed separately|1,593.00|FSC: 13; Default||External grouping not supported 951201648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Variable 4.0 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95190192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Universal Fluted Revision 75 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 95160361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95195672|EAP|Custom 95195672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 24mm Prox Ft Ns Cann Surg Ss F/1.6mm K-wr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160362|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 26mm X 82mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95190193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Std Unite Global Sz12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.75|FSC: 13; Default||Not reimbursed separately|9,213.75|FSC: 13; Default||External grouping not supported 95160363|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 26mm X 96mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 951201649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160364|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 30mm X 96mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95190185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz5-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95160365|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 32mm X 82mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,919.00|FSC: 13; Default||Not reimbursed separately|26,919.00|FSC: 13; Default||External grouping not supported 95160366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 32mm X 96mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95190186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Uni Hi Flex Sz G Lm-rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95160367|EAP|Custom 95160367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Sword Plasma Gyrus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160369|EAP|Custom 95160369||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Progenix 5cc|1|HUMANA [1294]||HUMANA [11839]|1,968.00|FSC: 13; Default||Not reimbursed separately|1,968.00|FSC: 13; Default||External grouping not supported 95190187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Full Femoral Porous Universal 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,755.80|FSC: 13; Default||Not reimbursed separately|11,755.80|FSC: 13; Default||External grouping not supported 95195671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.0mm 34mm Ti Cmpr Sh Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95190188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Metaphyseal Porous Mbt Revision Size 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|FSC: 13; Default||Not reimbursed separately|10,248.00|FSC: 13; Default||External grouping not supported 951201651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160377|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac 18mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|FSC: 13; Default||Not reimbursed separately|5,661.00|FSC: 13; Default||External grouping not supported 95190189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Adapter Lps +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,047.65|FSC: 13; Default||Not reimbursed separately|2,047.65|FSC: 13; Default||External grouping not supported 95160379|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Nit-vu Shift Angled .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160380|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Nit-vu Standard Angled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Distal X-sm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,505.25|FSC: 13; Default||Not reimbursed separately|31,505.25|FSC: 13; Default||External grouping not supported 95160382|EAP|Custom 95160382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Drainage Duet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160390|EAP|HCPCS E0114||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Crutch Aluminum Tall Adult 5ft 10in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Ant Unite Global 135 Sz12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 95160391|EAP|HCPCS E0114||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Crutch Aluminum Adult 5ft 2in - 5ft 9in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Redapt 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.48|FSC: 13; Default||Not reimbursed separately|7,371.48|FSC: 13; Default||External grouping not supported 95160392|EAP|HCPCS E0114||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Crutch Aluminum Youth 4ft 6in - 5ft 2in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Std Unite Global 52x18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|FSC: 13; Default||Not reimbursed separately|6,039.00|FSC: 13; Default||External grouping not supported 95160393|EAP|HCPCS E0114||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Crutch Aluminum Child 4ft 0in - 4ft 6in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160397|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Rigiflex Ii Acha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Augmented Steptech Left 52+3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,509.75|FSC: 13; Default||Not reimbursed separately|10,509.75|FSC: 13; Default||External grouping not supported 95160398|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filterwire Ez 2.25 Mm -3.5mm 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190197|EAP|Custom 95190197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rasp Synv Stapg Sm +5 Unv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160402|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Attain Command Amplatz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160403|EAP|Custom 95160403||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Progenix 1cc|1|HUMANA [1294]||HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95195674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Broad T10 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.00|FSC: 13; Default||Not reimbursed separately|4,968.00|FSC: 13; Default||External grouping not supported 95160404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft 6.5 With #2 Hi-fi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|848.37|FSC: 13; Default||Not reimbursed separately|848.37|FSC: 13; Default||External grouping not supported 951201655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Poplok 4.5 With #2 Hi-fi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,099.08|FSC: 13; Default||Not reimbursed separately|1,099.08|FSC: 13; Default||External grouping not supported 95190198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset 46mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95160406|EAP|Custom 95160406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stabili T First Fracutre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Poplok 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.36|FSC: 13; Default||Not reimbursed separately|1,032.36|FSC: 13; Default||External grouping not supported 95190200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Humeral Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|FSC: 13; Default||Not reimbursed separately|1,560.00|FSC: 13; Default||External grouping not supported 95160408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft 5.5 With #2 Hi-fi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|848.37|FSC: 13; Default||Not reimbursed separately|848.37|FSC: 13; Default||External grouping not supported 951201656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160409|EAP|Custom 95160409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Tissue Ultrasound Wing 17|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Short 10mmx65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95160410|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95195675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Slim Y 5 Hole Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|FSC: 13; Default||Not reimbursed separately|5,367.00|FSC: 13; Default||External grouping not supported 95160411|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951201657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160412|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95190204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95160413|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95160414|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expanding Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95190205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 2-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95160415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 12mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 951201658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160417|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Cps Direct Pl 7f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Utility Straight 5hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95160420|EAP|Custom 95160420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Procedure Monthly Arthroc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 227mm Ti 16 Hl Axsos 3 Bn Tib Lt Prox Mdl S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,227.00|FSC: 13; Default||Not reimbursed separately|10,227.00|FSC: 13; Default||External grouping not supported 95160421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Turon 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95190207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Standard 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95160422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Humeral Turon Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|FSC: 13; Default||Not reimbursed separately|1,560.00|FSC: 13; Default||External grouping not supported 951201659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95190208|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Fenestrated Proximal Custom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,250.00|FSC: 13; Default||Not reimbursed separately|26,250.00|FSC: 13; Default||External grouping not supported 95160424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95160425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95190215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm Length 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95160426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon 8mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 951201660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Turon 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95190216|EAP|Custom 95190216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 1.9mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Turon 46mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95195677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 65mm T10 Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95160429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 36mm X 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 95190217|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Tecnis Multi Focal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160431|EAP|Custom 95160431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Quick Connect|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 36 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95160432|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerocath Dx Octapolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Oxinium Journey Ii Np Size 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 95160433|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Slo Transeptal 63cm Leng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160434|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 3.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patellar Resurfacing Journey 35mm 7.5 Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,440.00|FSC: 13; Default||Not reimbursed separately|1,440.00|FSC: 13; Default||External grouping not supported 951201662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 36 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95160436|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 2.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibia Journey Np Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 95195692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 1.1mm 15mm Gorilla 2h Lckng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95160441|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95190221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Dd Xlpe Journey Ii Size 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 95160444|EAP|Custom 95160444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Suture Achillon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 36 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95160455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Cocr 28mm +3mm Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,483.00|FSC: 13; Default||Not reimbursed separately|3,483.00|FSC: 13; Default||External grouping not supported 95190222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5mm Locking 5.0mm/l46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95160460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Arcomon Xl Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,715.00|FSC: 13; Default||Not reimbursed separately|5,715.00|FSC: 13; Default||External grouping not supported 95160469|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 9mm Mmi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Cementless Standard Collar Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95160471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Qwix 3.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.76|FSC: 13; Default||Not reimbursed separately|905.76|FSC: 13; Default||External grouping not supported 951201664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 36 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95160472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95190224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Thread 4.0x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.60|FSC: 13; Default||Not reimbursed separately|705.60|FSC: 13; Default||External grouping not supported 95160473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95160474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95190212|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - 6fr Radial Tig 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951201665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95160478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,985.01|FSC: 13; Default||Not reimbursed separately|1,985.01|FSC: 13; Default||External grouping not supported 95190213|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - 6 Fr Jacky 4.0 Radial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160479|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Current + Vr Tiere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,550.00|FSC: 13; Default||Not reimbursed separately|53,550.00|FSC: 13; Default||External grouping not supported 95160480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,985.01|FSC: 13; Default||Not reimbursed separately|1,985.01|FSC: 13; Default||External grouping not supported 95190214|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - 6 Fr Radial Tig 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,018.04|FSC: 13; Default||Not reimbursed separately|2,018.04|FSC: 13; Default||External grouping not supported 951202370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Rev Patella Lg Pca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,012.30|FSC: 13; Default||Not reimbursed separately|6,012.30|FSC: 13; Default||External grouping not supported 95160483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,018.04|FSC: 13; Default||Not reimbursed separately|2,018.04|FSC: 13; Default||External grouping not supported 95160484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,046.39|FSC: 13; Default||Not reimbursed separately|2,046.39|FSC: 13; Default||External grouping not supported 95160485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,046.39|FSC: 13; Default||Not reimbursed separately|2,046.39|FSC: 13; Default||External grouping not supported 95160486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 951202371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95160488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,105.40|FSC: 13; Default||Not reimbursed separately|2,105.40|FSC: 13; Default||External grouping not supported 95160489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Ps Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951202372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Periarticular Tibial Media|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|FSC: 13; Default||Not reimbursed separately|2,155.59|FSC: 13; Default||External grouping not supported 95190227|EAP|Custom 95190227||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant Nasal Absorbable Latera W/delivery Device|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95160491|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,209.23|FSC: 13; Default||Not reimbursed separately|2,209.23|FSC: 13; Default||External grouping not supported 95160492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,209.23|FSC: 13; Default||Not reimbursed separately|2,209.23|FSC: 13; Default||External grouping not supported 95190235|EAP|Custom 95190235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,242.29|FSC: 13; Default||Not reimbursed separately|2,242.29|FSC: 13; Default||External grouping not supported 951202373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lateral Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,242.29|FSC: 13; Default||Not reimbursed separately|2,242.29|FSC: 13; Default||External grouping not supported 95190236|EAP|Custom 95190236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wrist Fusion Locking Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,442.81|FSC: 13; Default||Not reimbursed separately|5,442.81|FSC: 13; Default||External grouping not supported 95160505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95190229|EAP|Custom 95190229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Mepilex Border Heel Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160510|EAP|Custom 95160510||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Shoulder Thermoskin Smal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160511|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Straight12 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190230|EAP|Custom 95190230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Sealer Maryland Grasper 37 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160513|EAP|Custom 95160513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Tunneling Tool 1x8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160514|EAP|Custom 95160514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Dual Sterile Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190231|EAP|Custom 95190231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Countersink 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160520|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Miraflex High Flow 2.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190232|EAP|Custom 95190232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Hcs 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160522|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Identifier Biopsy Site For Use W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.62|FSC: 13; Default||Not reimbursed separately|238.62|FSC: 13; Default||External grouping not supported 95190233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 1 -10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95160526|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Coronary 8fr X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160527|EAP|Custom 95160527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Positioning Crimp 5.0mm Ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Cannulated Phalinx Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|FSC: 13; Default||Not reimbursed separately|2,778.00|FSC: 13; Default||External grouping not supported 95160528|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 32mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|FSC: 13; Default||Not reimbursed separately|19,542.00|FSC: 13; Default||External grouping not supported 95160529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sextant 7.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95190237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 11/13 32mm +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.50|FSC: 13; Default||Not reimbursed separately|6,835.50|FSC: 13; Default||External grouping not supported 95160530|EAP|Custom 95160530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Drainage Duet (ten Pk)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Cruciate Cc Biomet 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|FSC: 13; Default||Not reimbursed separately|3,141.00|FSC: 13; Default||External grouping not supported 95190242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Radial Lateral Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,594.00|FSC: 13; Default||Not reimbursed separately|12,594.00|FSC: 13; Default||External grouping not supported 95160533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 65mm Cr Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95160534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Cr 10mm X 71/75 V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95190243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Radial Head Lateral Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,511.00|FSC: 13; Default||Not reimbursed separately|8,511.00|FSC: 13; Default||External grouping not supported 95160535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 62.5mm Cr Poro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 951202378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Gmrs Revision Stryker|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,523.80|FSC: 13; Default||Not reimbursed separately|3,523.80|FSC: 13; Default||External grouping not supported 95190246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 14x12x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95160537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95160538|EAP|Custom 95160538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Single 200ml 60 Conneto|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 9x8x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95160540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bushing Femur Distal Small Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,058.40|FSC: 13; Default||Not reimbursed separately|1,058.40|FSC: 13; Default||External grouping not supported 951202379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160542|EAP|Custom 95160542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Mri Injector 65 And 115|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.5mm Locking Com 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.00|FSC: 13; Default||Not reimbursed separately|549.00|FSC: 13; Default||External grouping not supported 95160543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Distal Right S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,719.10|FSC: 13; Default||Not reimbursed separately|24,719.10|FSC: 13; Default||External grouping not supported 95160544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted Revision 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95190251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95160545|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quadripolar 6 Fr W/conn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160546|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quadripolar 6 Fr Crd-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95160547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95160553|EAP|Custom 95160553||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tracker Ent Instrument Track|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190254|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 10mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,863.00|FSC: 13; Default||Not reimbursed separately|7,863.00|FSC: 13; Default||External grouping not supported 95160554|EAP|Custom 95160554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tracker Ent Patient Tracker(|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160555|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quadripolar 6 F Crd Sup|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190238|EAP|Custom 95190238||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Barrier Microplate Channel Implant 40 X 52 X 2.3mm|1|HUMANA [1294]||HUMANA [11839]|2,930.28|FSC: 13; Default||Not reimbursed separately|2,930.28|FSC: 13; Default||External grouping not supported 95160556|EAP|Custom 95160556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cables Ep Catheter Extension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160558|EAP|Custom 95160558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Ultracut 5.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Schanz Screw 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95160564|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Attain Command Hybrid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160565|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Pressure Injectable Pic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.14|FSC: 13; Default||Not reimbursed separately|318.14|FSC: 13; Default||External grouping not supported 95190240|EAP|Custom 95190240||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grafton Dbf 1cc|1|HUMANA [1294]||HUMANA [11839]|1,197.00|FSC: 13; Default||Not reimbursed separately|1,197.00|FSC: 13; Default||External grouping not supported 95160567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerous Distal Extra-arti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,815.00|FSC: 13; Default||Not reimbursed separately|4,815.00|FSC: 13; Default||External grouping not supported 95195709|EAP|Custom 95195709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 12.8cm 5.1cm 440ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7-hole Humerus Distal Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,062.06|FSC: 13; Default||Not reimbursed separately|4,062.06|FSC: 13; Default||External grouping not supported 95190241|EAP|Custom 95190241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Head Pin 2.5 X 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3-hole Humerus Distal Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951202383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160574|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Attain Hybrid 88 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160575|EAP|Custom 95160575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Transvalvular Insertion (tv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7-hole Humerus Distal Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,656.10|FSC: 13; Default||Not reimbursed separately|3,656.10|FSC: 13; Default||External grouping not supported 95195710|EAP|Custom 95195710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 13.1cm 5.2cm 470ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,815.00|FSC: 13; Default||Not reimbursed separately|4,815.00|FSC: 13; Default||External grouping not supported 95190244|EAP|Custom 95190244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Reduction Tube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 9-hole Humerous Distal Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,946.41|FSC: 13; Default||Not reimbursed separately|3,946.41|FSC: 13; Default||External grouping not supported 951202385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95190245|EAP|Custom 95190245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Long Drill 3.0 X 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160589|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 2.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190248|EAP|Custom 95190248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Drill Guide Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160590|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 4mm X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160591|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 2.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190250|EAP|Custom 95190250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Drill Guide Mallet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95160595|EAP|Custom 95160595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Small Ao 4.2 X 300|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190252|EAP|Custom 95190252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Short Drill 3 X 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm 2mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951202387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95160598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95195700|EAP|Custom 95195700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.8cm Memorygel 5.1cm Smth Txt Cnt Brst Gel 450c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160599|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|FSC: 13; Default||Not reimbursed separately|24,495.00|FSC: 13; Default||External grouping not supported 95190259|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Technic Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95160600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lcp 5-hole 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,923.57|FSC: 13; Default||Not reimbursed separately|4,923.57|FSC: 13; Default||External grouping not supported 951202388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook L4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95190260|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Technic Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.8mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.25|FSC: 13; Default||Not reimbursed separately|56.25|FSC: 13; Default||External grouping not supported 95160604|EAP|Custom 95160604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 2.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190261|EAP|Custom 95190261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Closure Wall Abdominal Abra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3-hole Humerous Distal Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951202389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5-hole Humerous Distal Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,325.65|FSC: 13; Default||Not reimbursed separately|3,325.65|FSC: 13; Default||External grouping not supported 95190262|EAP|Custom 95190262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheet Silicone Size Regular 12x17x 0.040"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 9-hole Humerous Distal Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,946.41|FSC: 13; Default||Not reimbursed separately|3,946.41|FSC: 13; Default||External grouping not supported 95195701|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndl 15cm 19ga 5fr 4 Sdprt Strg Cath Prc Perc Ss Y Cnts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerous Distal Extra-arti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,536.48|FSC: 13; Default||Not reimbursed separately|4,536.48|FSC: 13; Default||External grouping not supported 951202390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Lateral Pos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 95190263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Vit E Persona Mc Left 13mm/g-h Femur/cr Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95160610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Lateral Pos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,325.65|FSC: 13; Default||Not reimbursed separately|3,325.65|FSC: 13; Default||External grouping not supported 95160611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Lateral Pos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,656.10|FSC: 13; Default||Not reimbursed separately|3,656.10|FSC: 13; Default||External grouping not supported 95190264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95160612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Distal Posterolate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,748.14|FSC: 13; Default||Not reimbursed separately|3,748.14|FSC: 13; Default||External grouping not supported 951202391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Distal Posterolate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,062.06|FSC: 13; Default||Not reimbursed separately|4,062.06|FSC: 13; Default||External grouping not supported 95190265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,625.00|FSC: 13; Default||Not reimbursed separately|5,625.00|FSC: 13; Default||External grouping not supported 95160614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Left Lcp 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.66|FSC: 13; Default||Not reimbursed separately|3,063.66|FSC: 13; Default||External grouping not supported 95160615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Left Lcp 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,158.07|FSC: 13; Default||Not reimbursed separately|3,158.07|FSC: 13; Default||External grouping not supported 95160616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Right Lcp 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.66|FSC: 13; Default||Not reimbursed separately|3,063.66|FSC: 13; Default||External grouping not supported 95160617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Right Lcp 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,158.07|FSC: 13; Default||Not reimbursed separately|3,158.07|FSC: 13; Default||External grouping not supported 95160629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Standard Series-a Biomet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95160630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Porous Cr Vanguard Right 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95160631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Cr 14mm X 71/75 V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95160636|EAP|Custom 95160636||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurawrap 3mm X 4cm|1|HUMANA [1294]||HUMANA [11839]|4,530.00|FSC: 13; Default||Not reimbursed separately|4,530.00|FSC: 13; Default||External grouping not supported 95195704|EAP|Custom 95195704||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 12.5cm 4.5cm 385ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Qxin Ps Legio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951202392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Tibial Constrai|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 95160639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Legion Straight 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 95160640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Revision Legion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 95160641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coupler Offset Legion 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,283.40|FSC: 13; Default||Not reimbursed separately|4,283.40|FSC: 13; Default||External grouping not supported 95160642|EAP|Custom 95160642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Trocal 1/8 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160643|EAP|Custom 95160643||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Trocar 1/8 X 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95160645|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195705|EAP|Custom 95195705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 12.3cm 4.9cm 385ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160646|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190273|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 24mm X 74mm Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95160647|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Atlas Pta 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160650|EAP|Custom 95160650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Esophageal 18 Fr Minnisota|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190274|EAP|Custom 95190274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver 2.0mm Asnis Micro Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160652|EAP|Custom 95160652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dilator Ureteral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Right 11mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95190277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95160654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 951202395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160655|EAP|Custom 95160655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Suture Pusher Knot Ultra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190278|EAP|Custom 95190278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extension Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160656|EAP|Custom 95160656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Needle Straight Ultra F|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195706|EAP|Custom 95195706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 12.5cm 5cm 415ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160659|EAP|Custom 95160659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Needle Reverse Curved U|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190279|EAP|Custom 95190279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Biosentry Del Device Coax Adapters & Hydro Plugs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 30mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 951202396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ps Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160666|EAP|Custom 95160666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5mm Head Darco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190280|EAP|Custom 95190280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Shock Pulse Single Use 3.76mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160668|EAP|Custom 95160668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Collagen Enduragen 2c X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform Profix Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 95190275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 2.0mmx15/6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95160670|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Promote Plus Biv I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72,000.00|FSC: 13; Default||Not reimbursed separately|72,000.00|FSC: 13; Default||External grouping not supported 951202397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160671|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 11mm/125 Deg 170\mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.36|FSC: 13; Default||Not reimbursed separately|4,530.36|FSC: 13; Default||External grouping not supported 95160672|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Current + Dr Tiere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56,250.00|FSC: 13; Default||Not reimbursed separately|56,250.00|FSC: 13; Default||External grouping not supported 95195707|EAP|Custom 95195707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 12.5cm 5cm 415ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160673|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sj4 Icd Active Fixa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|FSC: 13; Default||Not reimbursed separately|13,081.50|FSC: 13; Default||External grouping not supported 95190287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrain Poly Gvf Pinn +4 10 Deg 28x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|FSC: 13; Default||Not reimbursed separately|14,424.90|FSC: 13; Default||External grouping not supported 95160674|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sj4 Icd Active Fixa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|FSC: 13; Default||Not reimbursed separately|13,770.00|FSC: 13; Default||External grouping not supported 951202398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160686|EAP|Custom 95160686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trackable Fusion Curved Ra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 11mm/c-d Femur/cr Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95160687|EAP|Custom 95160687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trackable Fusion Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197632|EAP|Custom 95197632||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Cobalt Mv W/gentamicin 40gm|1|HUMANA [1294]||HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95160688|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Core Movable .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190283|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Quad - Claria Mri - Dtma1qq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,000.00|FSC: 13; Default||Not reimbursed separately|57,000.00|FSC: 13; Default||External grouping not supported 95160689|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Rx 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,244.15|FSC: 13; Default||Not reimbursed separately|5,244.15|FSC: 13; Default||External grouping not supported 951202399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160693|EAP|Custom 95160693||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee With Oval Buttress 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190284|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Quad - Claria Mri - Dtma1q1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|FSC: 13; Default||Not reimbursed separately|58,995.00|FSC: 13; Default||External grouping not supported 95160694|EAP|Custom 95160694||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee With Oval Buttress 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195708|EAP|Custom 95195708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 13.2cm 4.6cm 435ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160695|EAP|Custom 95160695||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee With Oval Buttress 4x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190285|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Quad - Claria Mri - Dtma1d4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|FSC: 13; Default||Not reimbursed separately|58,995.00|FSC: 13; Default||External grouping not supported 95160696|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Laser Excimer 12fr 50cm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160701|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Locking Lead Laser Excime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190286|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Quad - Claria Mri - Dtma1d1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|FSC: 13; Default||Not reimbursed separately|58,995.00|FSC: 13; Default||External grouping not supported 95160702|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Locking Lead Laser Excime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160703|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95160704|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95190290|EAP|Custom 95190290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Liposuction Tri-port Ii 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160705|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Beacon Tip Torcon Advan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95190291|EAP|Custom 95190291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Liposuction Double Mercedes 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spin 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95195702|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gft Sft Tiss Dist Fem Mdl Ostchnd Ltrl Rgt Rt Lxf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,880.00|FSC: 13; Default||Not reimbursed separately|35,880.00|FSC: 13; Default||External grouping not supported 95160708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spin 2.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95190293|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Taper Prox Endo Thoracic Alpha Zenith38-34-167|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95160709|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Forte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160710|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Locking Lead Laser Excime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190294|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Taper Prox Endo Thoracic Alpha Zenith44-40-179|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95160711|EAP|Custom 95160711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Dual Port Dual B|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cntr 148x10.7x3.5mm Tmx 3.5mm Scr 17 Hl Antm Lck Alps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95160712|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Locking Lead Laser Excime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190295|EAP|Custom 95190295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula End Port 15 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160713|EAP|Custom 95160713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Pressure Infusor 3000ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160714|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Locking Lead Laser Excime|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160715|EAP|Custom 95160715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Lead Spectranetics|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11.5mm 38cm Intertrochanter Lt Trgn Intertan Im 125d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95160716|EAP|Custom 95160716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Spectranetics|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160717|EAP|Custom 95160717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160718|EAP|Custom 95160718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160719|EAP|Custom 95160719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160720|EAP|Custom 95160720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Prisma M100 Pre Pump Infusio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95160727|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pulmonary Artery Thermo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 16mm Cocr Tib T15 Dist Mldir Lck Sq Drv St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95160737|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Forte 10f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Medium 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160738|EAP|Custom 95160738||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical Firm Mckenzie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195712|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.9x4.6cm 415cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95160739|EAP|Custom 95160739||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Lumbar Cushion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160740|EAP|Custom 95160740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Irrigation W/trumpet Valv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160742|EAP|Custom 95160742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 8 French X 40cm Feeding Neo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 13mm X 420mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95160744|EAP|Custom 95160744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Narrow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160745|EAP|Custom 95160745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|FSC: 13; Default||Not reimbursed separately|1,617.00|FSC: 13; Default||External grouping not supported 95160746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Tornier Sz-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,120.00|FSC: 13; Default||Not reimbursed separately|3,120.00|FSC: 13; Default||External grouping not supported 951202409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Medium 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160747|EAP|Custom 95160747||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Left Tornier Sz-2|1|HUMANA [1294]||HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95190303|EAP|Custom 95190303||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Envelope Neuro Absorable Antibacterial-large|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95160748|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pisces Quad 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,963.00|FSC: 13; Default||Not reimbursed separately|3,963.00|FSC: 13; Default||External grouping not supported 95195713|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.3x4.9cm 385cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95160749|EAP|Custom 95160749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160750|EAP|Custom 95160750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95160753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Humeral Turon 7.5 Degree An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|FSC: 13; Default||Not reimbursed separately|1,560.00|FSC: 13; Default||External grouping not supported 95197635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 14mm Cocr Tib T15 Dist Mldir Lck Sq Drv St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95160754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral Turon 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95190306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95160757|EAP|Custom 95160757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Medium 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 33mm Knee Uni M/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95190307|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 10 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160767|EAP|Custom 95160767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Homer Mammolok Gold 20 G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195714|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.5x5.0cm 415cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95160768|EAP|Custom 95160768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Homer Mammolok Gold 20 G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190308|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Charger 8 X 100 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Prec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,346.00|FSC: 13; Default||Not reimbursed separately|8,346.00|FSC: 13; Default||External grouping not supported 951202412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Precoat Rt Medi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95190309|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95160771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Femoral Sz-5 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|FSC: 13; Default||Not reimbursed separately|2,889.00|FSC: 13; Default||External grouping not supported 95160772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95190310|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acrysof Restor 6.0mm Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral Metal 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,983.62|FSC: 13; Default||Not reimbursed separately|8,983.62|FSC: 13; Default||External grouping not supported 951202413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160775|EAP|Custom 95160775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy 18fr 3.0 Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190311|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Burn Meshed Matristem 7 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.93|FSC: 13; Default||Not reimbursed separately|43.93|FSC: 13; Default||External grouping not supported 95160776|EAP|Custom 95160776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Electrode Surface Navix Patc|1|HUMANA [1294]||HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95195715|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.2x4.6cm 435cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95160779|EAP|Custom 95160779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spatula Corneal Insertion Neusid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95160781|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Cps Direct Pl 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160782|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Forte Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Right Size Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 95160783|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Forte Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 20mm Cocr Tib T15 Dist Mldir Lck Sq Drv St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95160784|EAP|Custom 95160784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Albation Starburst Xl Sem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190314|EAP|Custom 95190314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stabilizer Tissue 4 Octobase|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160785|EAP|Custom 95160785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Radiofrequency 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160790|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,365.00|FSC: 13; Default||Not reimbursed separately|7,365.00|FSC: 13; Default||External grouping not supported 95190315|EAP|Custom 95190315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Positioner Heart Evo Urchin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160791|EAP|Custom 95160791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Foam Medc Pad Overlay 33 X 72|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195716|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.8x5.1cm 435cc Hsc Hg Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95160801|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tutoplast 1 X 3cm Sclera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95160802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 75mm Right Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 951202416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial I-beam 83mm Cc Biome|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|FSC: 13; Default||Not reimbursed separately|3,141.00|FSC: 13; Default||External grouping not supported 95160804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Cr 10mm X 79/83 V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95160805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Standard Series A Biomet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951202417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Medium 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 67.5mm Left Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95195717|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.1x5.2cm 470cc Hsc Hg Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95160807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Stabilizing Anter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,292.00|FSC: 13; Default||Not reimbursed separately|2,292.00|FSC: 13; Default||External grouping not supported 95160808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial I-beam 79mm Cc Biome|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|FSC: 13; Default||Not reimbursed separately|3,141.00|FSC: 13; Default||External grouping not supported 951202418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Large 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 72.5 Left Cr P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95190328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drilling Fortex Pedicle 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95160810|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|FSC: 13; Default||Not reimbursed separately|14,400.00|FSC: 13; Default||External grouping not supported 95160812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fracture Humeral Macro 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,163.00|FSC: 13; Default||Not reimbursed separately|8,163.00|FSC: 13; Default||External grouping not supported 95190329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 10mm/e-f Fem/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95160813|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,740.00|FSC: 13; Default||Not reimbursed separately|16,740.00|FSC: 13; Default||External grouping not supported 951202419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Bio-mod 48mm X 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95190330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 11mm/e-f Fem/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95160815|EAP|Custom 95160815||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Intramedullary Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cntr Tmx 10.9mmx88mm 9 Hl Rt Antm Alps Bn Elb Olcrn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95160816|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Battery Rechargable 16-channel 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,586.50|FSC: 13; Default||Not reimbursed separately|48,586.50|FSC: 13; Default||External grouping not supported 95190356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Cementless Standard Collar Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 95160817|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Tripole Lamitrode 16 60cm A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951202420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Large 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160818|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Lamitrode S-8 Lead Ans|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95190357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Fb/uc Left 13mm/e-f Fem/cr Sz 4-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95160821|EAP|Custom 95160821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Symblepharon Medium 22mm|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95160822|EAP|Custom 95160822||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spatula Brain Silicone Ans|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Pow Locking Ti 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160823|EAP|Custom 95160823||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Symblepharon Large 25mm|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 951202421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160824|EAP|Custom 95160824||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Symblepharon Small 20mm|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95190355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Cementless Standard Collar Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95160825|EAP|Custom 95160825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grieshaber Reverse Maxgri|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 30mm Cmpr Ft Ti Std Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95160828|EAP|Custom 95160828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Vfi Exchange 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190342|EAP|Custom 95190342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle - Nrg Transeptal Eeprom High Flow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160837|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Duramax Dialysis 28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 951202422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Solustaple 10mm 26 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.36|FSC: 13; Default||Not reimbursed separately|468.36|FSC: 13; Default||External grouping not supported 95190351|EAP|Custom 95190351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle - Port Access Pak W/ 20ga X 1" Power Loc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Solustaple 10mm 90 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 95197638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cntr Tmx 10.7mmx74mm 9 Hl Rt Antm Alps Bn Elb Olcrn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95160840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 20mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95160841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 2.7 X 14mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951202423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160842|EAP|Custom 95160842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm Head Darco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160845|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Talent With Xcel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,675.00|FSC: 13; Default||Not reimbursed separately|27,675.00|FSC: 13; Default||External grouping not supported 95195719|EAP|Custom 95195719||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 80mm 22mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95160846|EAP|Custom 95160846||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Lef|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160847|EAP|HCPCS L8500||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Prosthesis Voice 16 Fr 6mm Advan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160848|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Talent With Xcel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,375.00|FSC: 13; Default||Not reimbursed separately|12,375.00|FSC: 13; Default||External grouping not supported 95190371|EAP|Custom 95190371||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Implate 2mm X 0 Degree|1|HUMANA [1294]||HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95160849|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 5.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95160850|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 6.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95190372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 11mm 130 Deg 420mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95160851|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 6.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 951202425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160852|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 6.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95190373|EAP|Custom 95190373||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Implate 2mm X 7.5 Degree|1|HUMANA [1294]||HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95160853|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 6.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95195720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nl 14mm 170mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95160854|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 6.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Xlarge 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160855|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Fox Sv Catheter 6.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95160868|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Export Thrombectomy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197639|EAP|Custom 95197639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 4mm Cnn W/calibrations Srg Asns Jfx Ao Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160874|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 30mm X 125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95160876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 7mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.00|FSC: 13; Default||Not reimbursed separately|1,206.00|FSC: 13; Default||External grouping not supported 951202427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160902|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc Catheter 5fr Dl Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160903|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc Catheter 6fr Tl Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 75mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95160904|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc Catheter 5fr Tl Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190376|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Fluency Plus 10 X 60 X 117cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95160905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Lcp 3.5mm 3-hole Ster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,921.26|FSC: 13; Default||Not reimbursed separately|1,921.26|FSC: 13; Default||External grouping not supported 951202428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Xlarge 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Hex Head 3.2mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.75|FSC: 13; Default||Not reimbursed separately|81.75|FSC: 13; Default||External grouping not supported 95190377|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Fluency Plus 12 X 80 X 118 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95160907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.8mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95160908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibia Stabilized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95190378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtp Fusion Plate Medium 0 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 95160910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 7 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.11|FSC: 13; Default||Not reimbursed separately|5,176.11|FSC: 13; Default||External grouping not supported 951202429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Tornier Sz-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,120.00|FSC: 13; Default||Not reimbursed separately|3,120.00|FSC: 13; Default||External grouping not supported 95190379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged All-poly E-plus 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95160912|EAP|Custom 95160912||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 10mm X 32mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95195722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 80mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95160913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Base Tibial Ii Gns Size-3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95190380|EAP|Custom 95190380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.4 Mm Djo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160914|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Accent Rf Sr Single Ch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|FSC: 13; Default||Not reimbursed separately|13,041.00|FSC: 13; Default||External grouping not supported 951202430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon X3 Cs Tibial Insert Xlarge 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|FSC: 13; Default||Not reimbursed separately|8,322.30|FSC: 13; Default||External grouping not supported 95160915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Resurfacing Ii Gen 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,989.03|FSC: 13; Default||Not reimbursed separately|1,989.03|FSC: 13; Default||External grouping not supported 80170655|EAP|CPT® 28002||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I&d Below Fascia W Or W/o Tendon Sheath Single Bursal Space|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 95160916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Insert Tibial Flex Hi Gii S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 95197640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 8mm 1mm Fem T2 Im Fltx3 Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95160917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxin Ps Legion Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 95190392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp Medial Distal 12 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,763.84|FSC: 13; Default||Not reimbursed separately|5,763.84|FSC: 13; Default||External grouping not supported 95160918|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 3.0 Diopt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951202431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160921|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Occulsion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190393|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular +3.0 Diopter Sensar Iol With Optic Edge Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95160923|EAP|Custom 95160923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Deflux 23ga X 350mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 90mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95160924|EAP|Custom 95160924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Pre-filled 1ml Deflux|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190382|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160926|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 951202432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160927|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95190383|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160928|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 11fr Hausdorf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95160929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 42.5mm Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|FSC: 13; Default||Not reimbursed separately|5,782.98|FSC: 13; Default||External grouping not supported 95190384|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Vara Size 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951202433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160932|EAP|Custom 95160932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flexible 3.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190385|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95195724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 95mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95160934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 95190386|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 951202434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Cs Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|FSC: 13; Default||Not reimbursed separately|5,061.00|FSC: 13; Default||External grouping not supported 95160956|EAP|Custom 95160956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Cool Point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190387|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95160958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Thin 31mm 3-peg Series A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95190388|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial I-beam Cc 67mm Biome|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|FSC: 13; Default||Not reimbursed separately|3,141.00|FSC: 13; Default||External grouping not supported 951202435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95160960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Cr 10mm X 63/67|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|FSC: 13; Default||Not reimbursed separately|2,184.00|FSC: 13; Default||External grouping not supported 95190389|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95197641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 280mm Fem Im T2 R1500|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95160962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Keel Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95190390|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Lps All|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951202436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95160973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Lps All|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.61|FSC: 13; Default||Not reimbursed separately|3,047.61|FSC: 13; Default||External grouping not supported 95190391|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95160980|EAP|Custom 95160980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator Affinity With Cvr Wit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Med Nar T 1.5mm 2.3mm Scr 13 Hl Lck Precontour Variax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 95160982|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7 Fr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|FSC: 13; Default||Not reimbursed separately|22,323.00|FSC: 13; Default||External grouping not supported 95190402|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Icd - Ellipse Hv Generator|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,284.39|FSC: 13; Default||Not reimbursed separately|43,284.39|FSC: 13; Default||External grouping not supported 95160983|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7 Fr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|FSC: 13; Default||Not reimbursed separately|22,323.00|FSC: 13; Default||External grouping not supported 951202437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95160985|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Lieberte Taxus 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95190403|EAP|Custom 95190403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Gel 275cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160986|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Lieberte Taxus 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95190404|EAP|Custom 95190404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Gel 200cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160988|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Lieberte Taxus 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 951202438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95160989|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary Lieberte Taxus 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95190405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95160990|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Catheter Viabahn Endoprost|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,517.00|FSC: 13; Default||Not reimbursed separately|8,517.00|FSC: 13; Default||External grouping not supported 95195728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 15mm Variax Ti Hnd Wrst St Lck Loprfl Xpn Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95160991|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Catheter Viabahn Endoprost|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,747.00|FSC: 13; Default||Not reimbursed separately|9,747.00|FSC: 13; Default||External grouping not supported 95190406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95160992|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Catheter Viabahn Endoprost|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,517.00|FSC: 13; Default||Not reimbursed separately|8,517.00|FSC: 13; Default||External grouping not supported 951202439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95160993|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Catheter Viabahn Endoprost|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,747.00|FSC: 13; Default||Not reimbursed separately|9,747.00|FSC: 13; Default||External grouping not supported 95190407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 500mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,376.00|FSC: 13; Default||Not reimbursed separately|2,376.00|FSC: 13; Default||External grouping not supported 95160994|EAP|Custom 95160994||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cutter Patella 36mm|1|HUMANA [1294]||HUMANA [11839]|1,228.50|FSC: 13; Default||Not reimbursed separately|1,228.50|FSC: 13; Default||External grouping not supported 95197642|EAP|Custom 95197642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cplng Xtrnfx Hfmn 3 Rod To Rod Dlt 11mm Rod 15mm Apx|1|HUMANA [1294]||HUMANA [11839]|5,418.00|FSC: 13; Default||Not reimbursed separately|5,418.00|FSC: 13; Default||External grouping not supported 95160996|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Uncovered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,244.15|FSC: 13; Default||Not reimbursed separately|5,244.15|FSC: 13; Default||External grouping not supported 95190408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Insert Peek Fusion 36mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|FSC: 13; Default||Not reimbursed separately|19,500.00|FSC: 13; Default||External grouping not supported 95160997|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Uncovere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,244.15|FSC: 13; Default||Not reimbursed separately|5,244.15|FSC: 13; Default||External grouping not supported 951202440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95160998|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall Covered With Permalum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,217.90|FSC: 13; Default||Not reimbursed separately|5,217.90|FSC: 13; Default||External grouping not supported 95190409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95161201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric X 3 Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95195729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 14mm Variax Ti Hnd Wrst St Lck Loprfl Xpn Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95161202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95190412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.5mm 12 Hole Stainless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.87|FSC: 13; Default||Not reimbursed separately|804.87|FSC: 13; Default||External grouping not supported 95161203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Ts Triathlon Sz-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951202441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95161207|EAP|Custom 95161207||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cordent Large Extra 10-degree Lo|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95161208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Osteocel 5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,029.00|FSC: 13; Default||Not reimbursed separately|7,029.00|FSC: 13; Default||External grouping not supported 95190414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95161209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Xlp 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|FSC: 13; Default||Not reimbursed separately|10,098.00|FSC: 13; Default||External grouping not supported 951202442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 95190415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread 3.5mm/42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|FSC: 13; Default||Not reimbursed separately|939.00|FSC: 13; Default||External grouping not supported 95161211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 27 X 14mm Sho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95161212|EAP|Custom 95161212||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 1.2mm|1|HUMANA [1294]||HUMANA [11839]|69.00|FSC: 13; Default||Not reimbursed separately|69.00|FSC: 13; Default||External grouping not supported 95190419|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire - Verrata Plus Pressure - 185cm J Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161219|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7 Fr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|FSC: 13; Default||Not reimbursed separately|22,323.00|FSC: 13; Default||External grouping not supported 951202443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161220|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Semi Tendenosis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,435.00|FSC: 13; Default||Not reimbursed separately|6,435.00|FSC: 13; Default||External grouping not supported 95190421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7/3.5mm Va-lcp 16 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,427.08|FSC: 13; Default||Not reimbursed separately|6,427.08|FSC: 13; Default||External grouping not supported 95161222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95197628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Altivate Reverse Small 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,303.00|FSC: 13; Default||Not reimbursed separately|9,303.00|FSC: 13; Default||External grouping not supported 95161223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95190422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95161224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 951202444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 95190423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 70mm Lordotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95161226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 95161227|EAP|Custom 95161227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Total Plus 23 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190425|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix 7cmx10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,135.00|FSC: 13; Default||Not reimbursed separately|6,135.00|FSC: 13; Default||External grouping not supported 95161228|EAP|Custom 95161228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grieshaber End Grasping 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161229|EAP|Custom 95161229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Soft Green 23 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190426|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix 4x6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95161230|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Vaginal Istop|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95161235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95190427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 11 Hole / L149mm X 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95161237|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Rtps 10 Fr .03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161240|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi-torque Whisper 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190424|EAP|Custom 95190424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Trial Patient Montage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lag Head 3.2mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95161250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,933.82|FSC: 13; Default||Not reimbursed separately|2,933.82|FSC: 13; Default||External grouping not supported 95190420|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker - Allure Rf_u_pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,161.25|FSC: 13; Default||Not reimbursed separately|21,161.25|FSC: 13; Default||External grouping not supported 95161251|EAP|Custom 95161251||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuroflex 2.0 Diameter 2.5mm Lon|1|HUMANA [1294]||HUMANA [11839]|4,023.00|FSC: 13; Default||Not reimbursed separately|4,023.00|FSC: 13; Default||External grouping not supported 951202447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 95190428|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Turbo Power Laser 2.0 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Mod 4 X 150 Cont Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95197631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Lateral Quadra-p Size 3 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95161254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Ii Djd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,362.50|FSC: 13; Default||Not reimbursed separately|11,362.50|FSC: 13; Default||External grouping not supported 95190429|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Turbo Power Laser 2.3 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex 3 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951202448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Smooth Apex 3 X 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95190430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cannulated Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|FSC: 13; Default||Not reimbursed separately|2,778.00|FSC: 13; Default||External grouping not supported 95161257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.73|FSC: 13; Default||Not reimbursed separately|3,011.73|FSC: 13; Default||External grouping not supported 95161258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 95190431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna 400mm Left 10mm/130 Deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95161260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Superior Lcp 3.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,089.61|FSC: 13; Default||Not reimbursed separately|3,089.61|FSC: 13; Default||External grouping not supported 951202449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161261|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 32mm X 140cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,636.00|FSC: 13; Default||Not reimbursed separately|24,636.00|FSC: 13; Default||External grouping not supported 95190449|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular +4.0 Diopter Sensar Iol With Optic Edge Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95161262|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Ancillary Aaa Renu Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 95161263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Locking 9 Hole Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 500mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,160.00|FSC: 13; Default||Not reimbursed separately|2,160.00|FSC: 13; Default||External grouping not supported 95161264|EAP|Custom 95161264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Titanium Threaded .062|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161265|EAP|Custom 95161265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Plate Qr 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190451|EAP|Custom 95190451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ocp220 Osteal Cool Rf 17g 20mmx2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95161267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95190452|EAP|Custom 95190452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ocn002 Osteo Cool Bone Access 10g 090|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Top 3.5 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|FSC: 13; Default||Not reimbursed separately|321.00|FSC: 13; Default||External grouping not supported 951202451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161269|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral Dilatation V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Stb Simpliciti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95161279|EAP|Custom 95161279||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 8mm X 2mm Vertesta|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95195726|EAP|Custom 95195726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm X 30mm Quick Connect Ringloc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161292|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 30mm X 82cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95190454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Right Size Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 95161293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 951202452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Pin Tracker 2mmx 77mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95161303|EAP|Custom 95161303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing 3/8 X 3/32 X 6`|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197643|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 415cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95161310|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95161311|EAP|Custom 95161311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 700cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161312|EAP|Custom 95161312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 750cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190462|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath - Slender 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161313|EAP|Custom 95161313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 800cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195734|EAP|Custom 95195734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Global Cap Qc Hh Shaper 52x18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161314|EAP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Skin Gammagraft 9cm X|1|HUMANA [1294]||HUMANA [11839]|18.75|FSC: 13; Default||Not reimbursed separately|18.75|FSC: 13; Default||External grouping not supported 95190469|EAP|Custom 95190469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stopcoil - 3 Way|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161317|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr Dual Lumen Picc 50c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|274.05|FSC: 13; Default||Not reimbursed separately|274.05|FSC: 13; Default||External grouping not supported 951202454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Knee T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95190471|EAP|Custom 95190471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guiding Sheath - Pinnacle Destination|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95161333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Pressfit Triathlon T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95190470|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Maestro Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 951202455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161335|EAP|Custom 95161335||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitray 4mm|1|HUMANA [1294]||HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95190457|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161336|EAP|Custom 95161336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scrapper Diamond Dusted Membrane|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195735|EAP|Custom 95195735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 13.2cm 4.6cm 435ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161337|EAP|Custom 95161337||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Membrane Resorbable Osseoguard 2|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95190458|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161338|EAP|Custom 95161338||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuroflex 2.5mm Diameter 2.5mm L|1|HUMANA [1294]||HUMANA [11839]|4,023.00|FSC: 13; Default||Not reimbursed separately|4,023.00|FSC: 13; Default||External grouping not supported 951202456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161339|EAP|Custom 95161339||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuroflex 3.0mm Diameter 2.5mm L|1|HUMANA [1294]||HUMANA [11839]|4,023.00|FSC: 13; Default||Not reimbursed separately|4,023.00|FSC: 13; Default||External grouping not supported 95190459|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161340|EAP|Custom 95161340||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuroflex 4.0mm Diameter 2.5mm L|1|HUMANA [1294]||HUMANA [11839]|4,470.00|FSC: 13; Default||Not reimbursed separately|4,470.00|FSC: 13; Default||External grouping not supported 95197644|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit 70cm 8 Contact Trail Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95161341|EAP|Custom 95161341||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuroflex 5.0mm Diameter 2.5mm L|1|HUMANA [1294]||HUMANA [11839]|3,721.50|FSC: 13; Default||Not reimbursed separately|3,721.50|FSC: 13; Default||External grouping not supported 95190460|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161342|EAP|Custom 95161342||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuroflex 6.0mm Diameter 2.5mm L|1|HUMANA [1294]||HUMANA [11839]|3,721.50|FSC: 13; Default||Not reimbursed separately|3,721.50|FSC: 13; Default||External grouping not supported 951202457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161347|EAP|Custom 95161347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190461|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161351|EAP|Custom 95161351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spacer Microflow Stratus Relieva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161352|EAP|Custom 95161352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Deployment Spacer Microflo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190463|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951202458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.0mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95190464|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,564.08|FSC: 13; Default||Not reimbursed separately|1,564.08|FSC: 13; Default||External grouping not supported 95161356|EAP|Custom 95161356||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Plus Progenix 5cc|1|HUMANA [1294]||HUMANA [11839]|2,622.00|FSC: 13; Default||Not reimbursed separately|2,622.00|FSC: 13; Default||External grouping not supported 95161359|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Destination 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161360|EAP|Custom 95161360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flex Quickset 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190466|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95195737|EAP|Custom 95195737||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Hydrated Lordotic 12mm|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95161362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95190467|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161363|EAP|Custom 95161363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial Vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161364|EAP|Custom 95161364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pic Grieshaber 45 Degree Dsp 23|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lisfranc Left Medium Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95161365|EAP|Custom 95161365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Complete Followers Heyman St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197645|EAP|Custom 95197645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Linear Enhanced Steering 70cm W/stylet Cap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|FSC: 13; Default||Not reimbursed separately|24,495.00|FSC: 13; Default||External grouping not supported 95190483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dome Talar Inbone Sz 2 Sulcus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,044.00|FSC: 13; Default||Not reimbursed separately|16,044.00|FSC: 13; Default||External grouping not supported 95161367|EAP|Custom 95161367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Multihole Pinnacl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,864.18|FSC: 13; Default||Not reimbursed separately|9,864.18|FSC: 13; Default||External grouping not supported 95190484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz 2-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|FSC: 13; Default||Not reimbursed separately|5,696.19|FSC: 13; Default||External grouping not supported 95161369|EAP|Custom 95161369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Contact Precision Sphere Th|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.2mm 16mm Trnc Spnl Slf Drl Va Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95161370|EAP|Custom 95161370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Contact Precision Sphere Th|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 17mm Green Stripe Fem G 5-6 Lcck Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95161371|EAP|Custom 95161371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Contact Precision Sphere On|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Standard Sta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95190486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fibertak Loaded Double W/ 1.3 Suturetap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95161374|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 70cm Linear S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95161375|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 70cm Linear|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|FSC: 13; Default||Not reimbursed separately|6,097.50|FSC: 13; Default||External grouping not supported 95190487|EAP|Custom 95190487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Fibertak Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161376|EAP|Custom 95161376||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stylet Enchanced 70cm|1|HUMANA [1294]||HUMANA [11839]|393.75|FSC: 13; Default||Not reimbursed separately|393.75|FSC: 13; Default||External grouping not supported 951202463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161378|EAP|Custom 95161378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 6.5 Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190488|EAP|Custom 95190488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Fibertak 1.70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161379|EAP|Custom 95161379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Medical Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195739|EAP|Custom 95195739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 100cm 5fr .038in Crds Tmp Vert Flx Sft Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Duofix Cementless Std Collar Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95161387|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fistula Bio-a Gore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,526.00|FSC: 13; Default||Not reimbursed separately|2,526.00|FSC: 13; Default||External grouping not supported 951202464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161388|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Prime Htd Ablati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tubular Third Ti 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 95161389|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Prime Htd Ablati|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197646|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.3x4.6m 455cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95161390|EAP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Dx20 Duodecapola|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tubular Third Ti 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95161392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric X 3 Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951202465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press Fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95190497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95161396|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hickman 9.6fr Single-lu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 95195740|EAP|Custom 95195740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 65cm 5fr .038in Crds Tmp Vert Str Sft Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161397|EAP|Custom 95161397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Without Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 95161402|EAP|Custom 95161402||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom Size 2 Xpe Half|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161403|EAP|Custom 95161403||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom Size 3 Xpe Half|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161404|EAP|Custom 95161404||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom Size 4 Xpe Half|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161405|EAP|Custom 95161405||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom Size 5 Xpe Half|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161406|EAP|Custom 95161406||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Orthoses Freedom Size 6 Xpe Half|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190499|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Restor Multifocal Torri5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161408|EAP|Custom 95161408||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Quad And Patellar With Pro|1|HUMANA [1294]||HUMANA [11839]|14,160.00|FSC: 13; Default||Not reimbursed separately|14,160.00|FSC: 13; Default||External grouping not supported 951202467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Lon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,897.49|FSC: 13; Default||Not reimbursed separately|11,897.49|FSC: 13; Default||External grouping not supported 95190510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 5-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95161411|EAP|Custom 95161411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Orthotics Vasyli Custom E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161414|EAP|Custom 95161414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer Percutaneous Shea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna 12mm/130 X 340mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95161429|EAP|Custom 95161429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Transfer 2000ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161433|EAP|Custom 95161433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Custom 23 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Short 12mm X 67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95161437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pmi Performa Norris Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|FSC: 13; Default||Not reimbursed separately|19,200.00|FSC: 13; Default||External grouping not supported 95161438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 6.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95190514|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161439|EAP|Custom 95161439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Axis Mount Skull|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161440|EAP|Custom 95161440||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spacer Vertebral 8 X 25 X 4|1|HUMANA [1294]||HUMANA [11839]|9,871.32|FSC: 13; Default||Not reimbursed separately|9,871.32|FSC: 13; Default||External grouping not supported 95190515|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pa Xia3 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,217.07|FSC: 13; Default||Not reimbursed separately|4,217.07|FSC: 13; Default||External grouping not supported 95161442|EAP|Custom 95161442||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blocker Xia 3|1|HUMANA [1294]||HUMANA [11839]|702.87|FSC: 13; Default||Not reimbursed separately|702.87|FSC: 13; Default||External grouping not supported 95190516|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Rad Ti Xia3 6mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,411.35|FSC: 13; Default||Not reimbursed separately|1,411.35|FSC: 13; Default||External grouping not supported 951202470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161444|EAP|Custom 95161444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Passive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190500|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161445|EAP|Custom 95161445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Gold Sterile Soft Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161448|EAP|Custom 95161448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Hawkins I 20 Ga X 10 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190501|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161450|EAP|Custom 95161450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190502|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161452|EAP|Custom 95161452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Nasal Optiflow Adult Sma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197647|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.6x4.8m 485cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95161455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Mgii 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,972.94|FSC: 13; Default||Not reimbursed separately|5,972.94|FSC: 13; Default||External grouping not supported 95190503|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 2omm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|FSC: 13; Default||Not reimbursed separately|1,920.00|FSC: 13; Default||External grouping not supported 951202472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161457|EAP|Custom 95161457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Long Micro Atk2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190504|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Symmetric Triathlon S33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95161459|EAP|Custom 95161459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Grieshaber Ilm Tip 23 Gau|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190505|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 951202473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Variable 4 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 95190506|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161469|EAP|Custom 95161469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartride Suture Passer Perfect|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Replacement Cup Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95190507|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161473|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.25mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951202474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161474|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.25mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95161475|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 2.25mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951202475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161476|EAP|HCPCS C1764||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Monitor Ecg Subcutaneous Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 95161481|EAP|Custom 95161481||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cushion Chair Sof-care|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161483|EAP|Custom 95161483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repair Syndesmosis Tightrope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161484|EAP|Custom 95161484||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 14mm X 22mm Vertes|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95190517|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Distal Femoral Triathlo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95161486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Posterior Femoral Triat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95190518|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951202477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161489|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Monitor Confirm Icm 6.5 Cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,396.00|FSC: 13; Default||Not reimbursed separately|9,396.00|FSC: 13; Default||External grouping not supported 95190519|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161492|EAP|Custom 95161492||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Lordotic 12 X 50mm|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95190520|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161493|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Formagraft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 951202478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95161494|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cps Luminary Bideflecta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190521|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 16mm X 195mm Distal Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95197648|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.4x5.3cm 505cc Hsc Hg Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95161496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95190522|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161499|EAP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neuromend 4.0mm Diameter 2.5mm L|1|HUMANA [1294]||HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951202479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190523|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95195741|EAP|Custom 95195741||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sft Tis 160mm Flexigraft At Prst Zrc Frzn|1|HUMANA [1294]||HUMANA [11839]|3,666.90|FSC: 13; Default||Not reimbursed separately|3,666.90|FSC: 13; Default||External grouping not supported 951202480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190525|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95190526|EAP|Custom 95190526||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Patch Glaucoma|1|HUMANA [1294]||HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 951202481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 90mm Self Tapping With 3.5mm Hexagonal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95195742|EAP|Custom 95195742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Market Femoral Checkpoint Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190527|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix St Rectangular 10 X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,240.00|FSC: 13; Default||Not reimbursed separately|12,240.00|FSC: 13; Default||External grouping not supported 951202482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190528|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix St Rectangular 15 X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,190.00|FSC: 13; Default||Not reimbursed separately|23,190.00|FSC: 13; Default||External grouping not supported 95197650|EAP|Custom 95197650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 13.6cm 4.8cm 485ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190529|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix St Rectangular 20 X 25cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,100.00|FSC: 13; Default||Not reimbursed separately|38,100.00|FSC: 13; Default||External grouping not supported 951202483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190530|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix St Rectangular 25 X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56,820.00|FSC: 13; Default||Not reimbursed separately|56,820.00|FSC: 13; Default||External grouping not supported 95195743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95190531|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix St Rectangular 30 X 35cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78,600.00|FSC: 13; Default||Not reimbursed separately|78,600.00|FSC: 13; Default||External grouping not supported 951202484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190532|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix 6x8" (15.2cm X 20.3cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,595.00|FSC: 13; Default||Not reimbursed separately|17,595.00|FSC: 13; Default||External grouping not supported 95190533|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix 8x10" (20.3cm X 25.4cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,385.00|FSC: 13; Default||Not reimbursed separately|29,385.00|FSC: 13; Default||External grouping not supported 951202485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190534|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix 10x12" (25.4cm X 30.5cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,160.00|FSC: 13; Default||Not reimbursed separately|44,160.00|FSC: 13; Default||External grouping not supported 95195744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Straight Assembly 8mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,951.00|FSC: 13; Default||Not reimbursed separately|3,951.00|FSC: 13; Default||External grouping not supported 95190535|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix Square 12x12" (30cm X 30cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,995.00|FSC: 13; Default||Not reimbursed separately|52,995.00|FSC: 13; Default||External grouping not supported 951202486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95197651|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Chsv 545cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951202487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190569|EAP|Custom 95190569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece I/a Intrepid Transformer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y 7 Hole Y3 1.1mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|FSC: 13; Default||Not reimbursed separately|2,691.00|FSC: 13; Default||External grouping not supported 95190560|EAP|Custom 95190560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Sacrocolpopexy Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190561|EAP|Custom 95190561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Sacrocolpopexy Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190563|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Nd Emerge Dilitation - 3.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190564|EAP|Custom 95190564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Nd Emerge Dilitation - 3.50mm X 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195746|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochrondrix Cryo 15mm X 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|FSC: 13; Default||Not reimbursed separately|12,234.00|FSC: 13; Default||External grouping not supported 95190565|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Nd Emerge Dilitation - 3.50mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190566|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Nd Emerge Dilitation - 3.50mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Spnl Ma Impt Occipitocrvical Up Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,255.80|FSC: 13; Default||Not reimbursed separately|4,255.80|FSC: 13; Default||External grouping not supported 95190567|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Nd Emerge Dilitation - 3.50mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190568|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Nd Emerge Dilitation - 3.50mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195747|EAP|Custom 95195747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Abd Surgifoam Porcine Gel Thk 10mm 100c 12.5cm 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190559|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Saphenous 64cm X 7-7mm A+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,640.00|FSC: 13; Default||Not reimbursed separately|29,640.00|FSC: 13; Default||External grouping not supported 951202492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 951202493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95195748|EAP|Custom 95195748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Guidance Surgical Scout Single Use (bx 5)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190572|EAP|Custom 95190572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disp. Hip For 1.8mm Q-fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor All Suture 1.8mm Q Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.00|FSC: 13; Default||Not reimbursed separately|1,230.00|FSC: 13; Default||External grouping not supported 95190574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951202495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless 2.5mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|FSC: 13; Default||Not reimbursed separately|717.00|FSC: 13; Default||External grouping not supported 95190576|EAP|HCPCS Q4126||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Meshed Memoderm Acd 4cmx4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|298.60|FSC: 13; Default||Not reimbursed separately|298.60|FSC: 13; Default||External grouping not supported 951202496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Cannulated 4.0w/ Ao Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|947.10|FSC: 13; Default||Not reimbursed separately|947.10|FSC: 13; Default||External grouping not supported 95190578|EAP|Custom 95190578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle Quick Pass Tendon Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|FSC: 13; Default||Not reimbursed separately|5,785.50|FSC: 13; Default||External grouping not supported 95190579|EAP|Custom 95190579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Loading Evolutpro 26-29|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bioinductive With Arthro Del Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 95190580|EAP|Custom 95190580||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Core Pro Evolut Aortic Transcath 29mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951202498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95188097|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,095.00|FSC: 13; Default||Not reimbursed separately|19,095.00|FSC: 13; Default||External grouping not supported 95190582|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Lifestream Expandable Covered 7mm X 26mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 951202499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190583|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - True Dilatation Valvuloplasty 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190584|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - True Dilatation Valvuloplasty 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190585|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Zmed Valvuloplasty Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195749|EAP|Custom 95195749||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bn Graftlink Frzn Trpl Stnd 65mm 95mm|1|HUMANA [1294]||HUMANA [11839]|6,588.00|FSC: 13; Default||Not reimbursed separately|6,588.00|FSC: 13; Default||External grouping not supported 95190586|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath - Dryseal 16fr 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 14mm 130 Deg 400mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95190587|EAP|Custom 95190587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dilator Ureteral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190588|EAP|Custom 95190588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 8 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 92mm Ss 2.7mm Scr 4 Hl Va Loprfl Cntr Shft Lcp Cmbn Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,733.21|FSC: 13; Default||Not reimbursed separately|2,733.21|FSC: 13; Default||External grouping not supported 95190589|EAP|Custom 95190589||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 10 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190590|EAP|Custom 95190590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 12 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190591|EAP|Custom 95190591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 14 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190592|EAP|Custom 95190592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 16 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 12mm Ss T8 Elb Mtphsl St Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95190594|EAP|Custom 95190594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 20 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190595|EAP|Custom 95190595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 22 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190596|EAP|Custom 95190596||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 24 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190597|EAP|Custom 95190597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Ureteral W/sideport 30 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 50mm Ss T15 Cort St Loprfl Strdr Ns Mdl Clmn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95190598|EAP|Custom 95190598||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft (fd) Block Cancellous 20x20x30mm|1|HUMANA [1294]||HUMANA [11839]|1,248.75|FSC: 13; Default||Not reimbursed separately|1,248.75|FSC: 13; Default||External grouping not supported 951202507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190599|EAP|Custom 95190599||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant I Fuse Si-bone 7.0mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95190593|EAP|Custom 95190593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Urethral W/sideport 18 Fr (individual)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190601|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - True Flow Valvuplasty Perfusion 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065550|EAP|CPT® G0481||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Compliance Drug Panel|1|HUMANA [1294]||HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95190602|EAP|Custom 95190602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench - #2 Bidirectional Torque (orange)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190603|EAP|Custom 95190603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Is-1 Port (same As Oscar Vv-plug)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190604|EAP|Custom 95190604||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bandage Corneal Prokera Slim|1|HUMANA [1294]||HUMANA [11839]|2,847.00|FSC: 13; Default||Not reimbursed separately|2,847.00|FSC: 13; Default||External grouping not supported 951202510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190605|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer - Dryseal 16 Fr X 33 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065560|EAP|CPT® 86704||0309 - LABORATORY - OTHER LABORATORY|Hb Hepatitis B Core Ab, Total|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Humeral Head Simpliciti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 951202511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190650|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95190606|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.25 X 08mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190607|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.25 X 12mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190608|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.25 X 15mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190609|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.25 X 18mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190610|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.25 X 22mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190611|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 08mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190612|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 12mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190613|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 15mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190614|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 18mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190615|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 22mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190617|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 30mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190618|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 34mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190619|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 38mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190620|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 08mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190621|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 12mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190622|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 15mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190623|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 18mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190624|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 22mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190625|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 26mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Distal Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190626|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 30mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190627|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 34mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190628|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.0 X 38mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190629|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 08mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190630|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 12mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190631|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 15mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Posterior Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190632|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 18mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190633|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 22mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Posterior Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190634|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 26mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190635|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 30mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190636|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 34mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190637|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 3.5 X 38mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190638|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 08mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190639|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 12mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Posterior Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190640|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 15mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190641|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 18mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Posterior Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190642|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 22mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95195757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 42mm Ss T15 Cort St Loprfl Strdr Ns Mdl Clmn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95190643|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 26mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190644|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 30mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190645|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 34mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190646|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 4.0 X 38mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95190616|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System - 2.50 X 26mm Resolute Onyx Rx Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951202532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190664|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Desara Blue Short Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95190665|EAP|Custom 95190665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Beaver Edgeahead 1.75mm 60 Degree Bevel Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 951202534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190667|EAP|Custom 95190667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Angiovac Cannula W/angle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190668|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5.5 Fr Guideliner V3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Green Stripe Fem G Lcck Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95190670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 951202536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190671|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Technic Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190672|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire - Safari2 .035 X 275cm - Large Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Posterior Fem Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|FSC: 13; Default||Not reimbursed separately|3,798.90|FSC: 13; Default||External grouping not supported 95190673|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire - Safari2 .035 X 275cm - Small Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190677|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Xience Alpine 2.25 Mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951202538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190680|EAP|Custom 95190680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii 45 Degree Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190681|EAP|Custom 95190681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii 45 Degree Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190682|EAP|Custom 95190682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii 60 Degree Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190683|EAP|Custom 95190683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii 60 Degree Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190684|EAP|Custom 95190684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190678|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Xience Alpine 2.75mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951202542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190685|EAP|Custom 95190685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii Small Crescent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190686|EAP|Custom 95190686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii Medium Crescent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190687|EAP|Custom 95190687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Suture Spectrum Ii Large Crescent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190688|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Conquest 6 X 6 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190689|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Sterling 2.0 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190690|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Sterling 2.5 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95190691|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Sterling 3.0 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 8mm Variax T8 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95190692|EAP|Custom 95190692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device - Preludesync Radial Compression - 24 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190693|EAP|Custom 95190693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device - Preludesync Radial Compression - 29 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190694|EAP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tissue Placental Human Amniofill 500mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951203251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190695|EAP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tissue Placental Human Amniofill 3x5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95195765|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +9.0 Diop +2.25 Add Mod C Bcnvx 13mm 6mm Pc 1 Pc An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95190696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mm X L36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 951203252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm/l70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95190698|EAP|Custom 95190698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speed Trap Green/white 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190699|EAP|Custom 95190699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speed Trap White 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171744|EAP|CPT® 33418||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Transcatheter Mitral Valve Repair, Perc Approach;initial Prosthesis|1|HUMANA [1294]||HUMANA [11839]|20,840.70|FSC: 13; Default||Not reimbursed separately|20,840.70|FSC: 13; Default||External grouping not supported 95190700|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Spinal Coflex Sz 8|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951203254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Fusion 32.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,221.00|FSC: 13; Default||Not reimbursed separately|1,221.00|FSC: 13; Default||External grouping not supported 95190702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 10mm/e-f Femur/cr Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix Knotless 6.5mm Biocryl Rapide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 80171733|EAP|CPT® 33419||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Transcatheter Mitral Valve Repair, Perc Approach; Additional Prosthesis|1|HUMANA [1294]||HUMANA [11839]|12,060.65|FSC: 13; Default||Not reimbursed separately|12,060.65|FSC: 13; Default||External grouping not supported 95190704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 10mm/c-d Fem/cr Sz 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190705|EAP|Custom 95190705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide For 3.5mm T10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 2-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 951203257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190707|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Sinus Contour Bioabsorbable Propel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95190710|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent - Lifestream Balloon Expand Covered 8mm X 37mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 951203258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Curved Lg Mrs Revision 11mm 203mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|FSC: 13; Default||Not reimbursed separately|17,276.70|FSC: 13; Default||External grouping not supported 95190712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 9.3mm 32cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 951203259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95195767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 70mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951203260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190720|EAP|Custom 95190720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Permatap Blue 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190721|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix St 11cm Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,655.00|FSC: 13; Default||Not reimbursed separately|8,655.00|FSC: 13; Default||External grouping not supported 95195768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 8.5mm 50mm Reline-o 2s Spne Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95190722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Versys Heritage 10x115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 951203262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190723|EAP|Custom 95190723||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Clip Soft 4.0mm X 0.6mm|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95190724|EAP|Custom 95190724||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Clip Soft 4.25mm X 0.6mm|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951203263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190725|EAP|Custom 95190725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Type Bucket 4.0mm X 0.9mm|1|HUMANA [1294]||HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95195769|EAP|Custom 95195769||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lens Contact Precision Sphere Plano 12mm 8.6 Base Curve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190726|EAP|Custom 95190726||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Type Bucket 4.5mm X 0.9mm|1|HUMANA [1294]||HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 951203264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190727|EAP|Custom 95190727||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Type Bucket 4.0mm X 1.0mm|1|HUMANA [1294]||HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95190728|EAP|Custom 95190728||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Type Bucket 4.5mm X 1.0mm|1|HUMANA [1294]||HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 951203265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190729|EAP|Custom 95190729||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Stapes Piston Angular|1|HUMANA [1294]||HUMANA [11839]|1,242.00|FSC: 13; Default||Not reimbursed separately|1,242.00|FSC: 13; Default||External grouping not supported 95186174|EAP|Custom 95186174||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blnkt 64x40in Fbrc Lvl 1 Sngwrm Rdtrnslu Efct Cmft Sft Crd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reunion Tsa Press-fit 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 951203266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 951203267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #7 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95195770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 1-level 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 951203268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 65mm Unsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 951203269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190737|EAP|Custom 95190737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - First Fracture Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195771|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +9.50 Diop Bcnvx Toric 10.8mm 6mm Pc 1 Pc Fld Asph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95190738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long Right 13 X 320 X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 951203270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Tibial Fix Bear Uc Rt 12mm Tibia G-h/cr Fem 7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95190736|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire - Safari 2 275 Cm X 5ml Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190743|EAP|Custom 95190743||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Management Reflux Linx Sz 13|1|HUMANA [1294]||HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95190744|EAP|Custom 95190744||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Management Reflux Linx Sz 14|1|HUMANA [1294]||HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 951203272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190745|EAP|Custom 95190745||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Management Reflux Linx Sz 15|1|HUMANA [1294]||HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95195772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Short Thread 7.0mm L85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95190746|EAP|Custom 95190746||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Management Reflux Linx Sz 16|1|HUMANA [1294]||HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 951203273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190747|EAP|Custom 95190747||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Management Reflux Linx Sz 17|1|HUMANA [1294]||HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95190749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 10mm/e-f Femur/cr Sz 8-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Multihole Pinnacle With Gription 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 95195774|EAP|Custom 95195774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 365 100 Watts Flx Sld Hp Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetab Poly Altrx Pinn Neu 40mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951203275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Ts Delta 12/14 40mm +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 95197654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Zuk 6 Kn Lt Mdl Rl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95190750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Gryphon P Br With Permacord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951203276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #9 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 36mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95195775|EAP|Custom 95195775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 550 100 Watts Flx Sld Hp Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 40mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 951203277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 48mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95190759|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 6-7-8mm 240cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190760|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 8-9-10mm 240cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195776|EAP|Custom 95195776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 1000 100 Watts Flx Sld Hp Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190761|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenithflex 30mm X 113cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,127.00|FSC: 13; Default||Not reimbursed separately|20,127.00|FSC: 13; Default||External grouping not supported 951203279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Regenesorb 8mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 95197655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6 10mm Kn Tib Uncmp Vivacit-e Zm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95190763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Regenesorb 9mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 951203280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95195778|EAP|Custom 95195778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id Tractip 200 Micron Single Use Holmium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190765|EAP|Custom 95190765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Skin Dermabond Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Full Thread 2.7mm/l10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95197660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Lateral Quadra-p Size 3 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95190767|EAP|Custom 95190767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Cannulated T15 Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 951203284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190769|EAP|Custom 95190769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Sizing System Linx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190771|EAP|Custom 95190771||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Gel 450cc Resterilizable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Cr Tibial Insert #11 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|FSC: 13; Default||Not reimbursed separately|6,900.60|FSC: 13; Default||External grouping not supported 95190773|EAP|Custom 95190773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast 700cc Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 1.3mm 2 Y-knt 1 Ld 1 Strn Proflex Hi-fi W/bl Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95190774|EAP|Custom 95190774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast 800cc Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190770|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 3.0 X 100 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti Stb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 951203287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Mtp V1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|FSC: 13; Default||Not reimbursed separately|6,879.00|FSC: 13; Default||External grouping not supported 95190777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Anchorage 3mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 951203288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosteon Stryker 6mmx23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|851.58|FSC: 13; Default||Not reimbursed separately|851.58|FSC: 13; Default||External grouping not supported 95190779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Dist Tib Med Lt 12-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,548.25|FSC: 13; Default||Not reimbursed separately|3,548.25|FSC: 13; Default||External grouping not supported 951203289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95190781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 951203290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95197656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3mm 22mm Mini Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95190783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 951203291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp Non Locking 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 62065570|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Pcca/anna Igg Screen-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190785|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix 17mm X 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|FSC: 13; Default||Not reimbursed separately|12,234.00|FSC: 13; Default||External grouping not supported 951203292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190772|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charger - 4.0 X 100 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190786|EAP|Custom 95190786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Pleurx Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti Stb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 62065580|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Cv2.1 Screen-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 12mm/c-d Fem/cr Sz 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190795|EAP|Custom 95190795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bil Drill 2.5mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad 2.7mm 8 Hole Lock 38mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 95190796|EAP|Custom 95190796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190797|EAP|Custom 95190797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Measuring Drill 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065590|EAP|CPT® 84182||0309 - LABORATORY - OTHER LABORATORY|Hb Nn Ab(hu, Ri, Yo, Tr-dner) Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95190798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 951203296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95190800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low 3.5mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 951203297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 62065600|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Pcca Igg Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Locking Prox Rt 9-hole Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|FSC: 13; Default||Not reimbursed separately|6,390.00|FSC: 13; Default||External grouping not supported 951203298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190803|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Crosser Cto 14s Otw 106cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 11mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95190804|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Crosser S6 Cto 106cm Sfa/btk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190805|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Crosser S6 Cto 154cm Btk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065610|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Nn Ab Igg Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190806|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Sidekick Strt Taper 70cm Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190807|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Sidekick Angle Taper 110cm Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95190808|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Usher Angle Taper 83cm Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190809|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Usher Angle Taper 130cm Support|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62065620|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Cv2.1 Ab Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190810|EAP|Custom 95190810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Crosser Flowmate Procedural|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Medial Distal Rt 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.54|FSC: 13; Default||Not reimbursed separately|4,014.54|FSC: 13; Default||External grouping not supported 95197659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 11mm Variax T8 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|FSC: 13; Default||Not reimbursed separately|951.00|FSC: 13; Default||External grouping not supported 95190812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 6-hole Bridge Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 951203303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt 12mm/c-d Femur/cr Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 62065630|EAP|CPT® 83516||0309 - LABORATORY - OTHER LABORATORY|Hb Titin Ab-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95190814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comp Tibial Stem Poly Lps Ps Legacy Nexgen Size3 Yell/c D 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951203304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 951203305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 62065640|EAP|CPT® 83519||0309 - LABORATORY - OTHER LABORATORY|Hb Voltage Gated K+ Channel-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 95190855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 52 17 Mm Thkns Eccentric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 951203306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190856|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Contour 6 X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95190857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Regenesorb 7mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 951203307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nrg Ps Tibial Insert X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Offset High C-stem Amt Sz5 12/14 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95190816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt10mm/c-d Femur/cr Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Acutwist Compression 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95190818|EAP|Custom 95190818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit - Stablilit First Fracture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190819|EAP|Custom 95190819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument - Spinestar Ablation Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190820|EAP|Custom 95190820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid Chain Eyelid Weight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190821|EAP|Custom 95190821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Spray Venting Active Trufreeze For Gi Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065650|EAP|CPT® 84182||0309 - LABORATORY - OTHER LABORATORY|Hb Neuronal Ab,(amphiphysin)ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95190823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 12mm/125 Deg 170mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.36|FSC: 13; Default||Not reimbursed separately|4,530.36|FSC: 13; Default||External grouping not supported 951203311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190824|EAP|Custom 95190824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speed Trap White 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cp Lag 03.6mm L36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|FSC: 13; Default||Not reimbursed separately|879.00|FSC: 13; Default||External grouping not supported 951203312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #7 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Polyaxial Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 62065660|EAP|CPT® 83519||0309 - LABORATORY - OTHER LABORATORY|Hb Muscle-specific Kinase(musk) Ab-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 95190827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cp Lag 04.1mm L42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 951203313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190829|EAP|Custom 95190829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Mr Endorectal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Mod Mas Reline 6.5 X 45mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 951203314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 62065670|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Lgi 1 Protein Ab, Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190833|EAP|Custom 95190833||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 45mm Lordotic|1|HUMANA [1294]||HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 951203315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cann 4.0mm/l36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|FSC: 13; Default||Not reimbursed separately|2,934.00|FSC: 13; Default||External grouping not supported 95190835|EAP|Custom 95190835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Iconix Fiber Force #2 With Intellibraid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190836|EAP|Custom 95190836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set System Otsc 14/6t 220cm Adult Colonoscope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065680|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Cap-2 Ab, Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190837|EAP|Custom 95190837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set System Otsc 14/6a 220cm Adult Colonoscope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190844|EAP|Custom 95190844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic Surestep 16fr 5cc With Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190845|EAP|Custom 95190845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Surestep 18fr 5cc With Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190846|EAP|Custom 95190846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic Surestep 16fr With Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190848|EAP|Custom 95190848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic 16fr W/statlock/temp Sensor Lubri-|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190849|EAP|Custom 95190849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Add-a-foley Ic Complete Care Surestep With Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065690|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Lgi 1 Protein Ab, Igg Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-poly Lps Ps Legacy Nexgen Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951203320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetab Neu Poly Crosslinked High Longevity 40mm Sz Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95197662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 22mm 5mm Asnis Cannulated Macro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95190853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Cemented Heritage Versys 17mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 951203321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #9 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Biolox 40/3.5 5deg12/14 40mm X +3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,857.62|FSC: 13; Default||Not reimbursed separately|8,857.62|FSC: 13; Default||External grouping not supported 62064677|EAP|HCPCS P9057||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbc Lr Irr & Frozen|1|HUMANA [1294]||HUMANA [11839]|724.92|FSC: 13; Default||Not reimbursed separately|724.92|FSC: 13; Default||External grouping not supported 951203322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 62064688|EAP|HCPCS P9056||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Wb Leukoreduced & Irradiated|1|HUMANA [1294]||HUMANA [11839]|609.99|FSC: 13; Default||Not reimbursed separately|609.99|FSC: 13; Default||External grouping not supported 62065700|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Cap-2 Ab, Igg Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62064699|EAP|CPT® 86905||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Antigen Type Patient-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 951203323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 62064700|EAP|CPT® 81403||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbc Dna Type-hox|1|HUMANA [1294]||HUMANA [11839]|555.60|FSC: 13; Default||Not reimbursed separately|555.60|FSC: 13; Default||External grouping not supported 95197668|EAP|Custom 95197668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Linear Enhanced Steering 50cm W/stylet Cap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064711|EAP|CPT® 81479||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbc Dna Rh Variant-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.75|FSC: 13; Default||Not reimbursed separately|368.75|FSC: 13; Default||External grouping not supported 951203324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 62064722|EAP|CPT® 86880||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Dat Polyspecific-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62065710|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Aquaporin/neuromyelitis, Ab Igg By Ifa-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62064733|EAP|CPT® 86870||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Antibody Id-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 951203325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 62064744|EAP|CPT® 86886||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Antibody Titer-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62064755|EAP|CPT® 86860||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Elution Studies-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 951203326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 62065720|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Aquaporin/neuromyelitis, Ab Igg By Ifa, Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95190859|EAP|Custom 95190859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil - Mr Endorectal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Abs Implant Open|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95190861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Distal Taper Spl Revision Mod Arcos 17mm/190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,703.20|FSC: 13; Default||Not reimbursed separately|9,703.20|FSC: 13; Default||External grouping not supported 951203328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190862|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tapered Accuseal 4-7mm Diameter X 45mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|FSC: 13; Default||Not reimbursed separately|4,572.00|FSC: 13; Default||External grouping not supported 95190863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ceramic Modular +3 36mm Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Prox Cone Standare Por Plasma Sz B 80mm Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951203330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg X3 Ps Tibial Insert #11 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|FSC: 13; Default||Not reimbursed separately|6,919.50|FSC: 13; Default||External grouping not supported 95190865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Narrow Straight 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,438.00|FSC: 13; Default||Not reimbursed separately|3,438.00|FSC: 13; Default||External grouping not supported 95190866|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951203331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190867|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95190868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup All Poly Crossfire Trident 44mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 951203332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190757|EAP|Custom 95190757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Dxterity Tra 5fr Diagnostic Tran 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190758|EAP|Custom 95190758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Dxterity Tra 5fr Diagnostic Tran 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 62064777|EAP|CPT® 86880||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Dat C3-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62064788|EAP|CPT® 86970||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Incubation Of W/drugs-hox|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 951203334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 62064799|EAP|CPT® 86975||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Incubation Of Serum W/drugs-hox|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95195777|EAP|Custom 95195777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 200 50 Watts Flx Sld Hp Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064800|EAP|CPT® 86850||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Antibody Screen-hox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 951203335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 951203336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 58mm Trlg Hip Trb Mtl Tiv Mdlr Cup Lck Repl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.50|FSC: 13; Default||Not reimbursed separately|181.50|FSC: 13; Default||External grouping not supported 951203337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95197666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951203338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 17mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951203339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 1-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 951203340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Hum 6mm 42mm D17.5 Poly Angd Rtn Rvsr Equalis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,601.06|FSC: 13; Default||Not reimbursed separately|5,601.06|FSC: 13; Default||External grouping not supported 951203341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95197667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951203342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190869|EAP|Custom 95190869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Pulmonary Arcpoint 21ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ascend Flex Eccentric Reversed 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.84|FSC: 13; Default||Not reimbursed separately|5,160.84|FSC: 13; Default||External grouping not supported 95190871|EAP|Custom 95190871||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Pf 2.0mm X 14mm|1|HUMANA [1294]||HUMANA [11839]|702.00|FSC: 13; Default||Not reimbursed separately|702.00|FSC: 13; Default||External grouping not supported 951203343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 95190879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Sz8 10mm Precoat Nex Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|FSC: 13; Default||Not reimbursed separately|4,212.00|FSC: 13; Default||External grouping not supported 951203344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lock S-t Vlp 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95195785|EAP|Custom 95195785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Vitrtm 25+ Ga Grshbr 30d Dsp Pnt Tip Dthrmy Erg Hndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lock S-t Vlp 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 951203345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lock S-t Vlp 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 95197670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 7mm Aptus Trlk Ti Phlng Hnd Hexadrive 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 95190875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex S-t 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.15|FSC: 13; Default||Not reimbursed separately|120.15|FSC: 13; Default||External grouping not supported 951203346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous F-t Vlp 4.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95195786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 50mm Solera Cd Hzn Spne Ma Cnn Xtd Tab Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95190877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Left Narrow Vlp 2.7mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.00|FSC: 13; Default||Not reimbursed separately|4,995.00|FSC: 13; Default||External grouping not supported 951203347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 2-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Cannulated 3.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.00|FSC: 13; Default||Not reimbursed separately|1,557.00|FSC: 13; Default||External grouping not supported 95190847|EAP|Custom 95190847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic Surestep 18fr With Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Locking Polyaxial Short Left T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,368.00|FSC: 13; Default||Not reimbursed separately|7,368.00|FSC: 13; Default||External grouping not supported 95195787|EAP|Custom 95195787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inst Bx Pnk 25cm 18ga Mxcor Ang 22mm 2 Trgr Ul Shrp Tip Bvl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 8.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|FSC: 13; Default||Not reimbursed separately|4,896.00|FSC: 13; Default||External grouping not supported 95147712|EAP|Custom 95147712||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Pers Mc Rt12mm/e-f Femur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95147715|EAP|Custom 95147715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball-tipped Sty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Aptus Lock Hole10 Ti Trapezoid Hand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,736.55|FSC: 13; Default||Not reimbursed separately|1,736.55|FSC: 13; Default||External grouping not supported 951203350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 55mm Solera Cd Hzn Spne Ma Cnn Xtd Tab Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951203351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 951203352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95176688|EAP|Custom 95176688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Spand Gel Wound Sheet W/aloe 4x4 Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 90mm 4.75mm Solera Cocr Mlbdn Crv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95190890|EAP|Custom 95190890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Return Venous Tri-stage One Piece 29/29/29fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95197663|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 17.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95190892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Collared Hi Sz9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951203354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Universal Fluted Revision 75 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 95195790|EAP|Custom 95195790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Instrument Vrs Comprehensive 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Sigma Tc3 Cemented Sz5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951203355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 3-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Rp Tc3 Size 4-17.5mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 95190896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dvr Lock Standard Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,110.00|FSC: 13; Default||Not reimbursed separately|4,110.00|FSC: 13; Default||External grouping not supported 951203356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95195791|EAP|Custom 95195791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Model Bone Vrs Comprehensive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190898|EAP|Custom 95190898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Aortic 4.0 Perfect Cut Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Ulna Protean Fragment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95197664|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 21.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95190900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.4/2.7 Va-lcp 2-c Drp Nrw6h Hd/7h Shaft/105mm/rt-ster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,066.71|FSC: 13; Default||Not reimbursed separately|7,066.71|FSC: 13; Default||External grouping not supported 951203358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190901|EAP|Custom 95190901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speed Trap White 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Vrs Comprehensive Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,320.00|FSC: 13; Default||Not reimbursed separately|43,320.00|FSC: 13; Default||External grouping not supported 95190902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Acutwist Compression 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951203359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190903|EAP|Custom 95190903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Acutwist Acutrak 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190904|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Surgical 70cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 951203361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190906|EAP|HCPCS C1822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Ipg|1|HUMANA [1294]||HUMANA [11839]|64,125.00|FSC: 13; Default||Not reimbursed separately|64,125.00|FSC: 13; Default||External grouping not supported 95197669|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 13.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95190910|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Tecnis Symfony Toric 18.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951203362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 4-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190911|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Full Height 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95190912|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Full Height 495cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951203363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 5-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190916|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 6-8mm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 240mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95190918|EAP|HCPCS C2627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Catheter Malecot Drainage 14 X 30cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 5-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190907|EAP|HCPCS C1787||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Patient Remote|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190908|EAP|HCPCS C1822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Charger|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951203365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 5-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195796|EAP|Custom 95195796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 14fr Sil Med Port Radopq Strp Rtnt Bln Unv Fd Port Cnct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Radial Lateral Collar Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,594.00|FSC: 13; Default||Not reimbursed separately|12,594.00|FSC: 13; Default||External grouping not supported 951203366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 5-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Humeral Reunion Rfx 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,034.75|FSC: 13; Default||Not reimbursed separately|17,034.75|FSC: 13; Default||External grouping not supported 95190927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Right Size Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 951203367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 5-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95190929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 951203368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 5-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190932|EAP|Custom 95190932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Inoue 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Endurance Taper 12/14 Sz 2 180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,874.00|FSC: 13; Default||Not reimbursed separately|17,874.00|FSC: 13; Default||External grouping not supported 951203369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190934|EAP|Custom 95190934||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx2 25-80/l13-40|1|HUMANA [1294]||HUMANA [11839]|41,997.00|FSC: 13; Default||Not reimbursed separately|41,997.00|FSC: 13; Default||External grouping not supported 95195797|EAP|Custom 95195797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Endoscopic Instrument Biopsy Port Adjustable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt10mm/c-d Femur/cr Sz 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 80170666|EAP|CPT® 96416||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Initiation Iv Infusion Prolonged Chemotherapy Using A Pump|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 951203371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 80170677|EAP|HCPCS G0498||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Initiation Iv Infusion In Office Cont In Home Pump Provided|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 95195799|EAP|Custom 95195799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.6cm Memorygel P3.8cm Hi Prfl Rnd Brst Gel 350c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170688|EAP|CPT® 96521||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Refilling And Maintenance Of Portable Pump|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 951203372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 951203373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95197672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 4.5mm 50mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 951203374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190936|EAP|Custom 95190936||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humerus Whole Right|1|HUMANA [1294]||HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95190943|EAP|Custom 95190943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 4.3mm X 145mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 6-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190937|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Mod Hgt Extra Full 520cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95190938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 12mm 36cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 951203376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|FSC: 13; Default||Not reimbursed separately|1,617.00|FSC: 13; Default||External grouping not supported 95190941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 12mm Tibia E-f/cr Fem 4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951203377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Ncb Distal 9-hole Lt 246mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,955.20|FSC: 13; Default||Not reimbursed separately|3,955.20|FSC: 13; Default||External grouping not supported 95190944|EAP|Custom 95190944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Versaflex-z Xnic+8r Unkeyed R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 10 X 320cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 95190946|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker - Accolade Mri Dr Is-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951203379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Fracture Stem 10mm Reunion Rfx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|FSC: 13; Default||Not reimbursed separately|22,713.00|FSC: 13; Default||External grouping not supported 95190948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Cerclage Positioning Threaded 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.78|FSC: 13; Default||Not reimbursed separately|594.78|FSC: 13; Default||External grouping not supported 951203380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ncb 5.0mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 80172811|EAP|CPT® 93356||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Myocardial Strain Imaging|1|HUMANA [1294]||HUMANA [11839]|100.00|FSC: 13; Default||Not reimbursed separately|100.00|FSC: 13; Default||External grouping not supported 95190950|EAP|Custom 95190950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 4.3mm X L24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190951|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix 15mm X 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|FSC: 13; Default||Not reimbursed separately|12,234.00|FSC: 13; Default||External grouping not supported 95195798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 42cm Lt Intertrochanter Intertan Im 130d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951203382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 7-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190954|EAP|Custom 95190954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable - Inquiry Luma Cath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190955|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable - Inquiry Luma Cath - 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190952|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device - Percepta Mri Crt-p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,471.00|FSC: 13; Default||Not reimbursed separately|21,471.00|FSC: 13; Default||External grouping not supported 95195800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 1.7mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|969.00|FSC: 13; Default||Not reimbursed separately|969.00|FSC: 13; Default||External grouping not supported 95190953|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Device - Percepta Mri Quad Crt-p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,100.00|FSC: 13; Default||Not reimbursed separately|23,100.00|FSC: 13; Default||External grouping not supported 951203384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Plug Sized #1 Dia 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 80172800|EAP|CPT® 33018||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pericardial Drainage W Indwelling Cath|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95190960|EAP|Custom 95190960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acl Disposable Pack Bone-tendon-bone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190961|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prodigy Mri Ipg W/programmer And Charger|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|FSC: 13; Default||Not reimbursed separately|54,000.00|FSC: 13; Default||External grouping not supported 95195801|EAP|Custom 95195801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 12.8cm 5.1cm 440ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190962|EAP|Custom 95190962||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-80/120-40|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 951203386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Pers Mc Rt14mm/e-f Femur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95190964|EAP|Custom 95190964||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speedtrap Green/white 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Sigma Tc3 Cemented Sz4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 95195802|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod Pr 12.9cm 4.6cm 415ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95190966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Rp Tc3 Size 4-17.5mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951203388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95190968|EAP|Custom 95190968||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Unibody Bifurcated 28mm 110/l 16-30 Iliac|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 951203389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195803|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Hi Pr 12.5cm 5.0cm 415ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 62064820|EAP|CPT® 87661||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Trich Vaginalis By Tma|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951203390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 951203391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Onlay Insert-sz 8-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95195804|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod Pr 13.2cm 4.6cm 435ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951203392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 1 - 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190969|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Breast Style Height Tall 750cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95197673|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Closer Device Mynx 5 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 951203393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 1 - 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95195805|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Hi Pr 12.8cm 5.1cm 440ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95190972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 11mm 125 Deg 340mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 951203394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 1 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190975|EAP|Custom 95190975||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Esophageal "esuction" 8.6mm-10.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 11 Mm Tibia E-f/cr Femu4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951203395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 1 - 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 12mm/e-f Fem/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95195806|EAP|Custom 95195806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator Endoscopic 12mm Stapler Bladeless Endowrist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190981|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Mod Hgt Extra Full 410cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951203396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 2 - 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190982|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Mod Hgt Extra Full 445cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197674|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Closer Device Mynx 6fr 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95190983|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Mod Hgt Extra Full 470cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951203397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 2 - 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190984|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Textured Mod Hgt Extra Full 420cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95190985|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Electrode - Acuity X4 Slva Is4 Passive 86cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951203398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 2 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190993|EAP|Custom 95190993||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Li 11x9x20 Mm 4 Degree|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95197675|EAP|Custom 95197675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 50mm 18g 10mm Cs Ac0004|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Vit E Persona Mc Lt 13mm/c-d/4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951203399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 2 - 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Vit E Persona Mc Lt 13mm/c-d/cr 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95190991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 951203400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 3 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Lt 16mm/e-f Fem/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95190994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Mod Mas Reline 6.5 X 40mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 951203401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 3 - 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95197676|EAP|Custom 95197676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 100mm 18g 10mm Cs Ac0005|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95190996|EAP|Custom 95190996||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Collar Button Vent 1.27mm|1|HUMANA [1294]||HUMANA [11839]|32.11|FSC: 13; Default||Not reimbursed separately|32.11|FSC: 13; Default||External grouping not supported 951203402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 4 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190997|EAP|Custom 95190997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic 16fr Surestep Temp Sensor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064833|EAP|Custom 62064833||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Misc Lab-genetic Tests Only|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 4- 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95190999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Segmental Lps 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,752.80|FSC: 13; Default||Not reimbursed separately|5,752.80|FSC: 13; Default||External grouping not supported 80171755|EAP|Custom 80171755||0998 - STATISTICAL CHARGES|Hb Op Med Mgmt Clinic Visit Statistical Charge Non-hb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hinge Insert Tibial Universal X-sm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,819.65|FSC: 13; Default||Not reimbursed separately|10,819.65|FSC: 13; Default||External grouping not supported 951203404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 5- 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Modular Cemented Sigma Pfc 13mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 95197677|EAP|Custom 95197677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 150mm 18g 10mm Cs Ac0005|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Fibula Distal Locking Left 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 951203405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 6 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 80170699|EAP|Custom 80170699||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pacu Dressing Change|1|HUMANA [1294]||HUMANA [11839]|500.00|FSC: 13; Default||Not reimbursed separately|500.00|FSC: 13; Default||External grouping not supported 95191004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula Long 30 X 180 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 951203406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 6 - 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sonoma 2.7 X 20 Mm (sterile)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95191008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sonoma 2.7 X 16 Mm (sterile)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 951203407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 7 - 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Syndesmotic 3.5 X 55 Mm (sterile)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95195809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 1.3mm 2 Y-knt 1 Ld 1 Strn Proflex Hi-fi W/b Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95191010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mal Medial 4.0 X 45mm (sterile)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 951203408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 7 - 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mal Medial 4.0 X 50mm (sterile)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95197678|EAP|Custom 95197678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 50mm 20g 10mm Cs Ac0008|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Bio-composite Ft 6.5 X 14.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 951203409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 7 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Asnis Micro 3.0mm 11/4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95195810|EAP|Custom 95195810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 6.7cm Hg Prf Rnd Od14.8cm 790cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Elite Compression 20 X 20 X 20 Mm 2 Legs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.75|FSC: 13; Default||Not reimbursed separately|6,195.75|FSC: 13; Default||External grouping not supported 951203410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 7 - 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191005|EAP|Custom 95191005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Procedure Nail Fibulock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191006|EAP|Custom 95191006||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Nail Fibulock Sonoma|1|HUMANA [1294]||HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951203411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 8 - 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191012|EAP|Custom 95191012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Cannulated Sonoma 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195811|EAP|Custom 95195811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Ultra 6.6cm Hg Prf Rnd Od13.7cm 750c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191013|EAP|Custom 95191013||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Humidifier Flexible With Short Heated Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 8 - 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191016|EAP|Custom 95191016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Elite Compression Drill Bit 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197679|EAP|Custom 95197679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 100mm 20g 10mm Cs Ac0009|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191017|EAP|Custom 95191017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Elite Compression Drilling Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 8 - 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191019|EAP|Custom 95191019||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Psr Cornerstone 7x14x14mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95195812|EAP|Custom 95195812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Ultra 6.7cm Hg Prf Rnd Od14.1cm 800c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191020|EAP|Custom 95191020||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Psr Cornerstone 6x14x14mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951203414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mako X3 Uni Onlay Tibial Insert Size 8 - 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95191021|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Cpx 4 Style 8300 750cc Tall Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95191022|EAP|Custom 95191022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Nose Blunt Tip 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Symmetric Metal Backed Patella S31x9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 95191023|EAP|Custom 95191023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant 3-d I Fuse Si-bone 7.0mm X 45mm|1|HUMANA [1294]||HUMANA [11839]|11,850.00|FSC: 13; Default||Not reimbursed separately|11,850.00|FSC: 13; Default||External grouping not supported 95195816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 44cm Rt Intertrochanter Intertan Im 125d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95191024|EAP|Custom 95191024||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant 3-d I Fuse Si-bone 7.0mm X 40mm|1|HUMANA [1294]||HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 951203416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Symmetric Metal Backed Patella S33x9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 95191025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Iconix Tt With Intellibraid Technology 1.4mm Anchor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,907.25|FSC: 13; Default||Not reimbursed separately|1,907.25|FSC: 13; Default||External grouping not supported 95197680|EAP|Custom 95197680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 150mm 20g 10mm Cs Ac0012|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 10 14mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 951203417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Symmetric Metal Backed Patella S36x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 95191029|EAP|Custom 95191029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Intraluminal Flo Thru 1.25mm X 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195817|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 5 D +7.5 Diop Mod C Bcnvx 13mm 6mm Pc 3 Pc Ant Asph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95191030|EAP|Custom 95191030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Intraluminal Flo Thru 1.50mm X 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Symmetric Metal Backed Patella S39x11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 95191031|EAP|Custom 95191031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Intraluminal Flo Thru 1.75mm X 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm Stardrive 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|571.20|FSC: 13; Default||Not reimbursed separately|571.20|FSC: 13; Default||External grouping not supported 951203419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Recessed Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95195818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bn Simplex Hv 20ml 40gm Radiopaque Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|452.70|FSC: 13; Default||Not reimbursed separately|452.70|FSC: 13; Default||External grouping not supported 951203420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Recessed Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95197681|EAP|Custom 95197681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 50mm 22g 5mm Cs Ac0015|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191036|EAP|Custom 95191036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Bayount|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Recessed Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95191037|EAP|Custom 95191037||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Clydesdale 22mm 12mm X 55mm X 6deg|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95191038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951203422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Recessed Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95191039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95191040|EAP|Custom 95191040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool 10mh30 Legend 10cm 3mm Mh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 80170700|EAP|CPT® 46083||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Incision Of Thrombosed Hemorrhoid, External|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 95191041|EAP|Custom 95191041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillator 8.5 X 38 X 0.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95191046|EAP|Custom 95191046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Retrieval Tissue Anchor 100 Sac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95191052|EAP|Custom 95191052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Applicator Fibrijet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 1x11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95195819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 75mm 5.5mm Pthfnd Nxt Prebnt Spne Ti Perc Aprch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 95191057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allogen Amnion Large 1.00ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951200083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 1x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 951200084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 2x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95195820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 22mm T10 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95191062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 3.0mm 18mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951200085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 2x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191063|EAP|Custom 95191063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Driver T9 For 3.0mm Screws|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191064|EAP|Custom 95191064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Depth Guage 3.0mm Countersink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 3x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Straight Nexgen 13mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|FSC: 13; Default||Not reimbursed separately|3,646.50|FSC: 13; Default||External grouping not supported 95195821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 55mm Fixos Ti St Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95191066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Large 7-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|954.00|FSC: 13; Default||Not reimbursed separately|954.00|FSC: 13; Default||External grouping not supported 951200087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 3x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95191070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon Sz 8-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951200088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 4x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfn 11mm/125 Deg Right 420mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95195822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 35mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95191059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Pers Mc Rt11mm/e-f Femur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951200089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 2.5mm 14mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95191061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 2.5mm 16mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951200090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95195823|EAP|Custom 95195823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 5.2cm Md Profile Round Od15.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191073|EAP|Custom 95191073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Pre-marked Super Dimension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 5x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191074|EAP|Custom 95191074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspirating 21ga Pre-marked Super Dimension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191075|EAP|Custom 95191075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Oscillating 25 X 0.89 X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 6x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191076|EAP|Custom 95191076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Oscillating 25 X 127 X 90mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191077|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter - Quick Cross Select .018 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 6x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Constrained All Poly Trident 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|FSC: 13; Default||Not reimbursed separately|11,373.60|FSC: 13; Default||External grouping not supported 95191099|EAP|Custom 95191099||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Vent Butterfly Ent Gyrus|1|HUMANA [1294]||HUMANA [11839]|66.52|FSC: 13; Default||Not reimbursed separately|66.52|FSC: 13; Default||External grouping not supported 951200094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 7x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T8 Full Thread 2.7mm/l18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95191101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Dr Interm Extra Short Rt 49mm Variax 2 Express|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|FSC: 13; Default||Not reimbursed separately|6,450.00|FSC: 13; Default||External grouping not supported 951200095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 7x19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191102|EAP|Custom 95191102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Dr T8 Variax 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interspace Hip Short 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,825.00|FSC: 13; Default||Not reimbursed separately|12,825.00|FSC: 13; Default||External grouping not supported 951200096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 8x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191105|EAP|Custom 95191105||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-80/i16-40|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 951200097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 8x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191079|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 4.0 X 40 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Bn 2.4mm 49mm Evos 8 Hl Var-angl Flex Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.00|FSC: 13; Default||Not reimbursed separately|1,914.00|FSC: 13; Default||External grouping not supported 95191080|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 4.0 X 60 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 165mm Ti Neu Stm 9x21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|FSC: 13; Default||Not reimbursed separately|22,008.00|FSC: 13; Default||External grouping not supported 95191081|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 4.0 X 80 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191082|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 4.0 X 100 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 1x11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191083|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 4.0 X 120 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191084|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 4.0 X 150 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 1x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191085|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 5.0 X 40 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191086|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 5.0 X 60 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 2x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191087|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 5.0 X 80 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 12mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95191088|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 5.0 X 100 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 2x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191089|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 5.0 X 120 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197683|EAP|Custom 95197683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Rmr 8mm 510mm Mod Trinkle Bixcut Mdlr Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191090|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 5.0 X 150 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 3x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191091|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 6.0 X 40 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 15mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 51000966|EAP|CPT® 86580||0302 - LABORATORY - IMMUNOLOGY|Hb Tb Intradermal|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95191092|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 6.0 X 60 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 51001477|EAP|HCPCS G0257||0880 - MISCELLANEOUS DIALYSIS - GENERAL CLASSIFICATION|Hb Daily Proc (non-hemo) W/sngl Evl|1|HUMANA [1294]||HUMANA [11839]|1,823.79|FSC: 13; Default||Not reimbursed separately|1,823.79|FSC: 13; Default||External grouping not supported 951200104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 3x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 51001550|EAP|HCPCS G0009||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hb Pneumonia Vaccine Adm|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 95191093|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 6.0 X 80 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 51002152|EAP|Custom 51002152||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ot Scrub Sponge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51003606|EAP|HCPCS G0008||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hb Influenza Vaccine Adm|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 95191094|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 6.0 X 100 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 4x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191095|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 6.0 X 120 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 51005122|EAP|Custom 51005122||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ot Elastic Shoelaces|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51005155|EAP|Custom 51005155||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ot Theraband|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191096|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 6.0 X 150 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 95191097|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 7.0 X 40 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 51030583|EAP|CPT® 41010||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ankylogossia-tongue Clip|1|HUMANA [1294]||HUMANA [11839]|4,165.40|FSC: 13; Default||Not reimbursed separately|4,165.40|FSC: 13; Default||External grouping not supported 95197684|EAP|Custom 95197684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Elastic Nail Insertion Spi 08-11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51030625|EAP|Custom 51030625||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pumping Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191098|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon - Lutonix Dcb 5fr 7.0 X 60 130cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 51030633|EAP|Custom 51030633||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Starter Sns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 51030641|EAP|Custom 51030641||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nipple Shields|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191111|EAP|Custom 95191111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Echelon Flex Endoscopic Powered Stapler 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51030658|EAP|Custom 51030658||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Breast Shells|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 52200508|EAP|CPT® 54150||0723 - LABOR ROOM/DELIVERY - CIRCUMCISION|Hb Circumcision|1|HUMANA [1294]||HUMANA [11839]|1,000.00|FSC: 13; Default||Not reimbursed separately|1,000.00|FSC: 13; Default||External grouping not supported 95191112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7 X 38mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 52610003|EAP|CPT® 36450||0391 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G., TRANS|Hb Blood Exchange|1|HUMANA [1294]||HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 951200108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 5x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 52623659|EAP|Custom 52623659||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bilirubin Light|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial Ss Lt 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95195837|EAP|Custom 95195837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Orthopedic 3.2mm 300mm Threaded Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53500104|EAP|HCPCS G0277||0413 - RESPIRATORY SERVICES - HYPERBARIC OXYGEN THERAPY|Hb Hbo 30 Minute Segment|1|HUMANA [1294]||HUMANA [11839]|327.87|FSC: 13; Default||Not reimbursed separately|327.87|FSC: 13; Default||External grouping not supported 95191114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Duofix Cementless Std Collar Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 53500112|EAP|CPT® 99183||0413 - RESPIRATORY SERVICES - HYPERBARIC OXYGEN THERAPY|Hb Hbo Treatment|1|HUMANA [1294]||HUMANA [11839]|1,311.48|FSC: 13; Default||Not reimbursed separately|1,311.48|FSC: 13; Default||External grouping not supported 951200109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 6x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 53800116|EAP|HCPCS G0109||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Group Gestational 30 Min|1|HUMANA [1294]||HUMANA [11839]|45.00|FSC: 13; Default||Not reimbursed separately|45.00|FSC: 13; Default||External grouping not supported 53800231|EAP|HCPCS G0108||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Individual Trng 30 Min|1|HUMANA [1294]||HUMANA [11839]|161.55|FSC: 13; Default||Not reimbursed separately|161.55|FSC: 13; Default||External grouping not supported 95197688|EAP|Custom 95197688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 180mm 4.2mm Ao Coupling Small Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53800272|EAP|HCPCS G0270||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Mnt Ind Sub 2nd Ref Ea 15|1|HUMANA [1294]||HUMANA [11839]|93.09|FSC: 13; Default||Not reimbursed separately|93.09|FSC: 13; Default||External grouping not supported 95191117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Lateral 102mm Right 11 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|FSC: 13; Default||Not reimbursed separately|2,643.75|FSC: 13; Default||External grouping not supported 53800280|EAP|HCPCS G0271||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Mnt Grp Sub 2nd Ref Ea 30|1|HUMANA [1294]||HUMANA [11839]|48.78|FSC: 13; Default||Not reimbursed separately|48.78|FSC: 13; Default||External grouping not supported 951200110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 6x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 53850004|EAP|CPT® 97802||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Mnt Initial 15 Min|1|HUMANA [1294]||HUMANA [11839]|107.43|FSC: 13; Default||Not reimbursed separately|107.43|FSC: 13; Default||External grouping not supported 95191118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 53850012|EAP|CPT® 97803||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Mnt, Re-assess/inter, 15min|1|HUMANA [1294]||HUMANA [11839]|93.09|FSC: 13; Default||Not reimbursed separately|93.09|FSC: 13; Default||External grouping not supported 95195841|EAP|Custom 95195841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53850020|EAP|CPT® 97804||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Mnt, Group, 30 Min|1|HUMANA [1294]||HUMANA [11839]|48.78|FSC: 13; Default||Not reimbursed separately|48.78|FSC: 13; Default||External grouping not supported 95191119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Tenodesis Biocomposite L10 Mm Od4 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 53901047|EAP|Custom 53901047||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Powerade 20 Oz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 7x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 53901062|EAP|Custom 53901062||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Inst Breakfast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53901070|EAP|Custom 53901070||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Sf Inst Breakf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53901088|EAP|Custom 53901088||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Magic Cups|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53901104|EAP|Custom 53901104||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Mightyshake|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 7x19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 53901138|EAP|Custom 53901138||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Enlive 8 Oz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191120|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Trek Nc 4.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 53901229|EAP|Custom 53901229||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Beneprotein Packets|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195838|EAP|Custom 95195838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 5.5mm Cnn Qck Cnct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53901237|EAP|Custom 53901237||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Ensure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191121|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Trek Nc 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 53901245|EAP|Custom 53901245||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Ensure Plus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 8x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 53901252|EAP|Custom 53901252||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Glucerna Shake 237ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191122|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Trek Nc 4.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 53901260|EAP|Custom 53901260||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Juven|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 40mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 53901278|EAP|Custom 53901278||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Sf Mighty Shakes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Cone Sym Triathlon Size D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|FSC: 13; Default||Not reimbursed separately|15,313.20|FSC: 13; Default||External grouping not supported 53985024|EAP|Custom 53985024||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Nutren Pulmonary 250ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62056544|EAP|CPT® 82150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Amylase 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.44|FSC: 13; Default||Not reimbursed separately|19.44|FSC: 13; Default||External grouping not supported 951200114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 8x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 62056551|EAP|CPT® 82340||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Calcium 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.09|FSC: 13; Default||Not reimbursed separately|18.09|FSC: 13; Default||External grouping not supported 95191124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium 3.5 X 120 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 62056577|EAP|CPT® 84156||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Protein 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.01|FSC: 13; Default||Not reimbursed separately|11.01|FSC: 13; Default||External grouping not supported 95195839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm 65mm 22mm Cannulated Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|FSC: 13; Default||Not reimbursed separately|560.25|FSC: 13; Default||External grouping not supported 62056585|EAP|CPT® 84300||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Sodium 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.18|FSC: 13; Default||Not reimbursed separately|15.18|FSC: 13; Default||External grouping not supported 95191132|EAP|Custom 95191132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dissection & Access Pro Spacemaker Trocar Blunt/oval|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62056593|EAP|CPT® 84133||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Potassium 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.19|FSC: 13; Default||Not reimbursed separately|14.19|FSC: 13; Default||External grouping not supported 951200115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Ps 203mm Ti Neu Stm 9x21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|FSC: 13; Default||Not reimbursed separately|22,610.70|FSC: 13; Default||External grouping not supported 62056619|EAP|CPT® 84540||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Urea 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.68|FSC: 13; Default||Not reimbursed separately|16.68|FSC: 13; Default||External grouping not supported 95191133|EAP|Custom 95191133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dissection & Access Pro Spacemaker Trocal Balloon Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62056627|EAP|CPT® 80170||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gentamicin Peak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.14|FSC: 13; Default||Not reimbursed separately|49.14|FSC: 13; Default||External grouping not supported 62056635|EAP|CPT® 80170||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gentamicin Trough|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.14|FSC: 13; Default||Not reimbursed separately|49.14|FSC: 13; Default||External grouping not supported 95191125|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 34mm X 209mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 62056643|EAP|CPT® 80200||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tobramycin Peak|1|HUMANA [1294]||HUMANA [11839]|48.39|FSC: 13; Default||Not reimbursed separately|48.39|FSC: 13; Default||External grouping not supported 951200116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 29mm +0mm (std)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 62056650|EAP|CPT® 80200||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tobramycin Trough|1|HUMANA [1294]||HUMANA [11839]|48.39|FSC: 13; Default||Not reimbursed separately|48.39|FSC: 13; Default||External grouping not supported 95191128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Eccentric 40mmx6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 62056676|EAP|CPT® 84157||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Joint Fluid Protein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|FSC: 13; Default||Not reimbursed separately|12.00|FSC: 13; Default||External grouping not supported 95195840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Redapt 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.48|FSC: 13; Default||Not reimbursed separately|7,371.48|FSC: 13; Default||External grouping not supported 62056684|EAP|CPT® 82803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cord Blood Gas-arterial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 95191129|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Acuity X4 Spiral L Lva Quad Electrode Is4 Passive 86cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 62056692|EAP|CPT® 82803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cord Blood Gas-venous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 951200117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 31mm +0mm (std)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 62056700|EAP|CPT® 83070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Hemosiderin|1|HUMANA [1294]||HUMANA [11839]|14.25|FSC: 13; Default||Not reimbursed separately|14.25|FSC: 13; Default||External grouping not supported 95191130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Cemented Reunion Long 8x200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,017.00|FSC: 13; Default||Not reimbursed separately|19,017.00|FSC: 13; Default||External grouping not supported 62057542|EAP|CPT® 83525||0301 - LABORATORY - CHEMISTRY|Hb Insulin 90 Minute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.29|FSC: 13; Default||Not reimbursed separately|34.29|FSC: 13; Default||External grouping not supported 95191131|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Acuity X4 Straight L Lva Quad Electrode Is4 Passive 86c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951200118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 27mm +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95191150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 10mm/e-f Fem/cr Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95195842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 10mm Gorilla Ns R3con Nonlock Plt Gorilla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95191134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap W/stardrive Recess 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 31mm +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95191135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap W/stardrive Recess 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95197685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 9mm X 330mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 95191136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap W/stardrive Recess 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 951200120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 27mm +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 62057666|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Benzodiazepines Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self Tap W/stardrive Recess 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95195843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 1.5mm 15mm Gorilla 2h Lckng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95191138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2.0mm X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 62057690|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Barbiturate Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 951200121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 29mm +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95191139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 62057716|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Amphetamine Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62057757|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Propoxyphene Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2.0mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 951200122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 31mm +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 62057773|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Methaqualone Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95195844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 62057799|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Methadone Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 951200123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 25mm +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 62057815|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Cocaine Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95197686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Cann Cmp C-fix 3.5mmx14mm Ti Full Thrd Sf-drill Mgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95191144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 62057930|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Phencyclidine Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 951200124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 27mm +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95191145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpn W T6 Stardrive Recess Ti 2mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95195845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 62057963|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Opiate (300)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 5x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 951200125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 29mm +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 62057989|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Cannabinoid Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95191149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnin Iii 5x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 65000036|EAP|CPT® 90999||0821 - HEMODIALYSIS - OUTPATIENT OR HOME - HEMODIALYSIS COMPOSITE OR OTHER RATE|Hb Chronic Renal Dial|1|HUMANA [1294]||HUMANA [11839]|1,310.20|FSC: 13; Default||Not reimbursed separately|1,310.20|FSC: 13; Default||External grouping not supported 95191151|EAP|Custom 95191151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Cannulated Asnis Iii With Lg Ao Fitting 6.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 65000101|EAP|HCPCS G0257||0880 - MISCELLANEOUS DIALYSIS - GENERAL CLASSIFICATION|Hb Unscheduled Dialysis Treatment Esrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,823.79|FSC: 13; Default||Not reimbursed separately|1,823.79|FSC: 13; Default||External grouping not supported 951200126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Cone Body 31mm +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 65000119|EAP|HCPCS A4913||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Iv Piggy Pack Supplies|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191152|EAP|Custom 95191152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Asnis Iii For 6.5-8.0mm Screws|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 65000127|EAP|HCPCS A4657||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Iv Push Im Subcut Supplie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Baby Gorilla 1.1mm Straight 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|FSC: 13; Default||Not reimbursed separately|2,691.00|FSC: 13; Default||External grouping not supported 65000200|EAP|CPT® 36514||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Plasmapheresis|1|HUMANA [1294]||HUMANA [11839]|3,771.69|FSC: 13; Default||Not reimbursed separately|3,771.69|FSC: 13; Default||External grouping not supported 66001009|EAP|Custom 66001009||0906 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY|Hb Cd Iop|1|HUMANA [1294]||HUMANA [11839]|384.30|FSC: 13; Default||Not reimbursed separately|384.30|FSC: 13; Default||External grouping not supported 951200127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 19mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 66100140|EAP|Custom 66100140||0905 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC|Hb Psych Intensive|1|HUMANA [1294]||HUMANA [11839]|384.30|FSC: 13; Default||Not reimbursed separately|384.30|FSC: 13; Default||External grouping not supported 95191154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 10 Hole / L136mm X 4.0mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,978.00|FSC: 13; Default||Not reimbursed separately|6,978.00|FSC: 13; Default||External grouping not supported 66100207|EAP|CPT® 90853||0915 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - GROUP THERAPY|Hb Recovery Grp Continuing|1|HUMANA [1294]||HUMANA [11839]|207.72|FSC: 13; Default||Not reimbursed separately|207.72|FSC: 13; Default||External grouping not supported 95197687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Joint Toe Smrt Toe Ii X Fuse 10d 13 Prox Intphal Im Ft/ankl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 66100322|EAP|CPT® 90847||0916 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - FAMILY THERAPY|Hb Family Psychotherapy W/pa|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 951200128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 21mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 66100330|EAP|CPT® 90846||0916 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - FAMILY THERAPY|Hb Family Psych W/o Patient|1|HUMANA [1294]||HUMANA [11839]|357.90|FSC: 13; Default||Not reimbursed separately|357.90|FSC: 13; Default||External grouping not supported 95195847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Fx 10 Dg Med Drill Hammertoe Sys Strl Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 66110016|EAP|Custom 66110016||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Bh2 Adult Observ 1st Hr|1|HUMANA [1294]||HUMANA [11839]|550.00|FSC: 13; Default||Not reimbursed separately|550.00|FSC: 13; Default||External grouping not supported 951200129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 23mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 66110024|EAP|Custom 66110024||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Bh2 Adult Observ Ea Ad Hr|1|HUMANA [1294]||HUMANA [11839]|88.50|FSC: 13; Default||Not reimbursed separately|88.50|FSC: 13; Default||External grouping not supported 66110198|EAP|Custom 66110198||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ot Shoe Horn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 25mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 66110206|EAP|Custom 66110206||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bh2-ot Walker Basket|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 66120015|EAP|Custom 66120015||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Geri Psych Observ 1st Hr|1|HUMANA [1294]||HUMANA [11839]|550.00|FSC: 13; Default||Not reimbursed separately|550.00|FSC: 13; Default||External grouping not supported 951200131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 27mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 66120023|EAP|Custom 66120023||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Geri Psych Observ Ea Addtl Hr|1|HUMANA [1294]||HUMANA [11839]|88.50|FSC: 13; Default||Not reimbursed separately|88.50|FSC: 13; Default||External grouping not supported 95197689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 150mm Lt Ankl T2 Im Arthds Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|FSC: 13; Default||Not reimbursed separately|6,598.20|FSC: 13; Default||External grouping not supported 66120122|EAP|Custom 66120122||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bh1-ot Leg Lifter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 29mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 68200054|EAP|Custom 68200054||0998 - STATISTICAL CHARGES|Hb Ek Conscious Sedation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 68200179|EAP|Custom 68200179||0998 - STATISTICAL CHARGES|Hb Ek Schedule Amb-b/p-mon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195851|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Matrix Ortho Bone Viable Bio4 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,975.00|FSC: 13; Default||Not reimbursed separately|15,975.00|FSC: 13; Default||External grouping not supported 68200187|EAP|Custom 68200187||0998 - STATISTICAL CHARGES|Hb Hm Pedi Event Rec & Ana P|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 31mm Shallow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 68200195|EAP|Custom 68200195||0998 - STATISTICAL CHARGES|Hb Hm Pedi Holter Rec & Ana|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191155|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Power Xcela Lumen Dual Plastic 9.6fr W/o Suture Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 68202399|EAP|CPT® 93350||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Stress Echo|1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 68202423|EAP|CPT® 93314||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Limited Tee|1|HUMANA [1294]||HUMANA [11839]|1,682.04|FSC: 13; Default||Not reimbursed separately|1,682.04|FSC: 13; Default||External grouping not supported 95191156|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 68202449|EAP|CPT® 93320||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Doppler(echo)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|719.51|FSC: 13; Default||Not reimbursed separately|719.51|FSC: 13; Default||External grouping not supported 951200134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 19mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 68205129|EAP|Custom 68205129||0998 - STATISTICAL CHARGES|Hb Special Procedure Assist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191160|EAP|Custom 95191160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Non-threaded 6.5mm X 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 68900067|EAP|CPT® 93307||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo 2d M Mode|1|HUMANA [1294]||HUMANA [11839]|719.39|FSC: 13; Default||Not reimbursed separately|719.39|FSC: 13; Default||External grouping not supported 68900075|EAP|Custom 68900075||0998 - STATISTICAL CHARGES|Hb Echo 2d W/doppler|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 12x18x1.8-1.3mm 2mm Easyclip Ankl/ft Superelastic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.00|FSC: 13; Default||Not reimbursed separately|6,738.00|FSC: 13; Default||External grouping not supported 69000404|EAP|Custom 69000404||0998 - STATISTICAL CHARGES|Hb Ek Schedule Holter Mon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 69000412|EAP|Custom 69000412||0998 - STATISTICAL CHARGES|Hb Ek Schedule Event Monitor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 21mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 71010524|EAP|CPT® 90471||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Immun Admin, One Vaccine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 71012793|EAP|Custom 71012793||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Sane Exam|1|HUMANA [1294]||HUMANA [11839]|765.77|FSC: 13; Default||Not reimbursed separately|765.77|FSC: 13; Default||External grouping not supported 95197690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 200mm Lt Ankl T2 Im Arthds Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|FSC: 13; Default||Not reimbursed separately|6,598.20|FSC: 13; Default||External grouping not supported 75100057|EAP|Custom 75100057||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Correct Wedge Varus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100065|EAP|Custom 75100065||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Cover Roll Tape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 23mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75100248|EAP|Custom 75100248||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Metatarsal Pads|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100636|EAP|Custom 75100636||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Apex Orthotics|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195853|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +10 Diop +2.25 Add Mod C Bcnvx 13mm 6mm Pc 1 Pc Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 75100669|EAP|Custom 75100669||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Donjoy J Brace|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100693|EAP|Custom 75100693||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Donjoy Knee Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 25mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75100719|EAP|HCPCS L3908||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Wrist Splint|1|HUMANA [1294]||HUMANA [11839]|82.38|FSC: 13; Default||Not reimbursed separately|82.38|FSC: 13; Default||External grouping not supported 75100750|EAP|Custom 75100750||0998 - STATISTICAL CHARGES|Hb Un Tel Ekg Rec & Ana Pane|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100768|EAP|Custom 75100768||0998 - STATISTICAL CHARGES|Hb Un Ekg Holt Mon Rec & Ana|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100792|EAP|Custom 75100792||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Un Boone Spthpy 30 Min|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 951200138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 27mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75102970|EAP|Custom 75102970||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-theraputty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75102988|EAP|Custom 75102988||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Whp-ot Sock Aid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195854|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol +8.5 Diop Mod C Bcnvx 13mm 6mm Pc 1 Pc Ant Asph Sq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 75103044|EAP|Custom 75103044||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-duraband Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75105718|EAP|Custom 75105718||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-cervical Roll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 29mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75105775|EAP|Custom 75105775||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-insoles|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75105809|EAP|Custom 75105809||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-corrective Wedge 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 27mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 75105841|EAP|Custom 75105841||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-heel Lifts|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191162|EAP|HCPCS C1896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Electrode Emblem S-icd Subcutaneous|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 75105874|EAP|Custom 75105874||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-electrodes 1.25 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 31mm Deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75105981|EAP|Custom 75105981||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-biofeedback Sensor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191163|EAP|Custom 95191163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Insertion Electrode Emblem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75106005|EAP|CPT® 29425||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pt-sm. Short Leg Cast|1|HUMANA [1294]||HUMANA [11839]|709.44|FSC: 13; Default||Not reimbursed separately|709.44|FSC: 13; Default||External grouping not supported 75106013|EAP|Custom 75106013||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-theraband Ball Exercis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75106021|EAP|Custom 75106021||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-stockinette|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 27mm X-deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75106047|EAP|Custom 75106047||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-foam Padding|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75106054|EAP|Custom 75106054||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-sock Aid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75106070|EAP|Custom 75106070||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-reacher|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75106153|EAP|HCPCS A5126||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-foam Padding|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 29mm X-deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75125047|EAP|Custom 75125047||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-chlorazene (arm)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75125054|EAP|Custom 75125054||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-chlorazene (lb)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065740|EAP|CPT® 81001||0307 - LABORATORY - UROLOGY|Hb Urinalysis, Auto W/microscopic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.51|FSC: 13; Default||Not reimbursed separately|9.51|FSC: 13; Default||External grouping not supported 75200014|EAP|Custom 75200014||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt-cpm Soft Goods|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75200022|EAP|HCPCS E0935||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Pt-cpm Daily Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Milled Body 31mm X-deep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75200147|EAP|Custom 75200147||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Whp-pt Betadine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75200378|EAP|CPT® 97150||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Group Therapy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.13|FSC: 13; Default||Not reimbursed separately|53.13|FSC: 13; Default||External grouping not supported 95197692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 24mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 75200584|EAP|CPT® 97150||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Group Therapy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.13|FSC: 13; Default||Not reimbursed separately|53.13|FSC: 13; Default||External grouping not supported 95191164|EAP|Custom 95191164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Duplospray Mis With Snap Lock 30 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95191165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Cemented Reunion 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|FSC: 13; Default||Not reimbursed separately|14,982.75|FSC: 13; Default||External grouping not supported 75310029|EAP|Custom 75310029||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-foam Roll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065750|EAP|CPT® 89050||0305 - LABORATORY - HEMATOLOGY|Hb Body Fluid/csf Cell Count|1|HUMANA [1294]||HUMANA [11839]|14.16|FSC: 13; Default||Not reimbursed separately|14.16|FSC: 13; Default||External grouping not supported 75310037|EAP|Custom 75310037||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-cover Roll Stretch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 75310052|EAP|Custom 75310052||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-pulleys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75310102|EAP|Custom 75310102||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-corrective Wedge 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191167|EAP|Custom 95191167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink 6.0mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75310144|EAP|Custom 75310144||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-electrodes 2 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75310433|EAP|Custom 75310433||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heb-lumbar Roll Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 3-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 75500330|EAP|Custom 75500330||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-isotoner Glove|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75500348|EAP|Custom 75500348||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-mini Vibrator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Troc Right Narrow Ncb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,689.56|FSC: 13; Default||Not reimbursed separately|2,689.56|FSC: 13; Default||External grouping not supported 75500413|EAP|Custom 75500413||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-hand Exerciser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75500496|EAP|Custom 75500496||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-palm Pads|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Prox Pp Ncb Rl 245mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 75500892|EAP|Custom 75500892||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-gel Tube Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75500900|EAP|Custom 75500900||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-gel Tube Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 75500918|EAP|Custom 75500918||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-gel Digital Caps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 21mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 75500934|EAP|Custom 75500934||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-gel Sheet Whole|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 75502146|EAP|CPT® 97763||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|HB OT SPLINT MODIFICATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.41|FSC: 13; Default||Not reimbursed separately|148.41|FSC: 13; Default||External grouping not supported 951200148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75502260|EAP|Custom 75502260||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-compression Stocking|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 80171766|EAP|Custom 80171766||0995 - PATIENT CONVENIENCE ITEMS - NON-PATIENT ROOM RENTALS|Hb Dignicap Scalp Cooling Treatment|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 75502641|EAP|Custom 75502641||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-tube Foam 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75502666|EAP|Custom 75502666||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-nerf Exerciser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502682|EAP|Custom 75502682||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-kold Wrap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75503037|EAP|HCPCS L3763||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-ewho Elbow-wrist Orthosis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,091.70|FSC: 13; Default||Not reimbursed separately|1,091.70|FSC: 13; Default||External grouping not supported 95191175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Actis Cementless Standard Collar Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 951200150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Prox Broached Body Size #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 75503169|EAP|Custom 75503169||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-heelbo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 12 Hole L225mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,075.00|FSC: 13; Default||Not reimbursed separately|9,075.00|FSC: 13; Default||External grouping not supported 75503177|EAP|Custom 75503177||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-buddies|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75503201|EAP|HCPCS L3908||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-prefab Wrist Cock-up|1|HUMANA [1294]||HUMANA [11839]|82.38|FSC: 13; Default||Not reimbursed separately|82.38|FSC: 13; Default||External grouping not supported 95191177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial Rt.14-hold/201mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 75503383|EAP|HCPCS G0283||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ht-ot E-stim(unattended)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.30|FSC: 13; Default||Not reimbursed separately|39.30|FSC: 13; Default||External grouping not supported 951200151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 19mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 75700013|EAP|Custom 75700013||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-lumbar Roll Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Pers Mc Rt 14mm/cd Femur/cr Sz6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 75700054|EAP|Custom 75700054||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-leukotape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75700088|EAP|Custom 75700088||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-long Arch Pads|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191179|EAP|Custom 95191179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire W/drill Tip 2.0x234mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75700120|EAP|Custom 75700120||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-corrective Wedge Val|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 21mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 75700161|EAP|Custom 75700161||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-electrodes 3 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Third 5 Hole L59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 75700534|EAP|Custom 75700534||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-lumbar Roll Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 76750447|EAP|CPT® 75571||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Heart W/quant Eval Calcium|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95191182|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acell Pelvic Floor Matrix 10x15 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,623.50|FSC: 13; Default||Not reimbursed separately|11,623.50|FSC: 13; Default||External grouping not supported 77103059|EAP|Custom 77103059||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Tx Session/ed Material|1|HUMANA [1294]||HUMANA [11839]|18.90|FSC: 13; Default||Not reimbursed separately|18.90|FSC: 13; Default||External grouping not supported 951200153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 23mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 77301042|EAP|HCPCS V5264||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Earmold Bilateral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191183|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matristem Pelvic Floor Matrix 9cm X 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,313.60|FSC: 13; Default||Not reimbursed separately|5,313.60|FSC: 13; Default||External grouping not supported 77306009|EAP|HCPCS V5011||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Check|1|HUMANA [1294]||HUMANA [11839]|155.90|FSC: 13; Default||Not reimbursed separately|155.90|FSC: 13; Default||External grouping not supported 77405217|EAP|Custom 77405217||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ha Dispensing Fee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 77408847|EAP|HCPCS V5014||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hear Aid Maint Vis|1|HUMANA [1294]||HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 951200154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 25mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 77408854|EAP|HCPCS V5014||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Repair Of Hearing|1|HUMANA [1294]||HUMANA [11839]|251.19|FSC: 13; Default||Not reimbursed separately|251.19|FSC: 13; Default||External grouping not supported 95191186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dvr Lock Mini Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,110.00|FSC: 13; Default||Not reimbursed separately|4,110.00|FSC: 13; Default||External grouping not supported 77408862|EAP|HCPCS V5014||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Repair And Recasem|1|HUMANA [1294]||HUMANA [11839]|313.99|FSC: 13; Default||Not reimbursed separately|313.99|FSC: 13; Default||External grouping not supported 95195855|EAP|Custom 95195855||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sft Tis 5x7in Drgn + Crnl Dura Bvn Clgn Mtrx Ptch Rsrb|1|HUMANA [1294]||HUMANA [11839]|6,464.25|FSC: 13; Default||Not reimbursed separately|6,464.25|FSC: 13; Default||External grouping not supported 77408870|EAP|Custom 77408870||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hearing Aid Misc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.84|FSC: 13; Default||Not reimbursed separately|522.84|FSC: 13; Default||External grouping not supported 77409027|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Low Pressure Prosthesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 27mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 77409183|EAP|Custom 77409183||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Boone Cty Speech Therapy 15 Mins|1|HUMANA [1294]||HUMANA [11839]|37.50|FSC: 13; Default||Not reimbursed separately|37.50|FSC: 13; Default||External grouping not supported 95191187|EAP|Custom 95191187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Lengthening 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77409209|EAP|Custom 77409209||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dispensing Fee Binaural|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 23mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 77500023|EAP|HCPCS L8509||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Duckbill Prosthesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191188|EAP|Custom 95191188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Penning 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77500098|EAP|CPT® 31579||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Videostroboscopy|1|HUMANA [1294]||HUMANA [11839]|1,166.56|FSC: 13; Default||Not reimbursed separately|1,166.56|FSC: 13; Default||External grouping not supported 951200156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 29mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 77500114|EAP|Custom 77500114||0998 - STATISTICAL CHARGES|Hb Missed Appointment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191189|EAP|Custom 95191189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Penning Standard 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77600682|EAP|Custom 77600682||0998 - STATISTICAL CHARGES|Hb Un Missed Appointment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195857|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Cath 4fr 10cm Mak Plldm Tip Coaxial Echo Cr .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 77600690|EAP|Custom 77600690||0998 - STATISTICAL CHARGES|Hb Un Number Of Visits|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191191|EAP|HCPCS 95191191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Spacers|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77600708|EAP|Custom 77600708||0998 - STATISTICAL CHARGES|Hb Un Miscellaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 31mm +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80100043|EAP|CPT® 36216||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb 1st Order H&n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.26|FSC: 13; Default||Not reimbursed separately|2,995.26|FSC: 13; Default||External grouping not supported 95191192|EAP|Custom 95191192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Wire Threaded 100/15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80104896|EAP|Custom 80104896||0998 - STATISTICAL CHARGES|Hb Xx Chest (employee)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80134471|EAP|HCPCS L8015||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb External Brprosthesis Gar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 19mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80134497|EAP|HCPCS L8020||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Breast Prosthesis Mastomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195858|EAP|Custom 95195858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut Xtrnfx 91-121mm Fst Fx Short Tlt Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80134505|EAP|HCPCS L8030||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Breast Prosthesis Silico|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 21mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80134513|EAP|HCPCS L8000||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Mastectomy Bra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80134562|EAP|HCPCS L8001||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Bra W/built In Leisure Form|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 23mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80134570|EAP|HCPCS L8002||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Breast Form With Bra Both Sides|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195859|EAP|Custom 95195859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod External Fixation Ilizarov Stainless Steel L120 Mm Threa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80134596|EAP|Custom 80134596||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cranial Prosthesis Wig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 25mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 951200162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 27mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 95191190|EAP|Custom 95191190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Mini Nut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195860|EAP|Custom 95195860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Post Xtrnfx Ilz Ss 2hl M Sprt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80135007|EAP|HCPCS Q0091||0923 - OTHER DIAGNOSTIC SERVICES - PAP SMEAR|Hb Screening Papanicolaou Smear|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95191203|EAP|Custom 95191203||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Capstone Ptc 26x11mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 80135205|EAP|CPT® 47555||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bili Endo Via T-tube W/o St|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 951200163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 29mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80135213|EAP|CPT® 50592||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation, 1>renal Tumor(s),rf Perc Unl|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95191206|EAP|Custom 95191206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Guide Fast 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80135262|EAP|CPT® 36598||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Contr Inj Eval Exist Cvc Fluor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.19|FSC: 13; Default||Not reimbursed separately|567.19|FSC: 13; Default||External grouping not supported 80135387|EAP|CPT® 36561||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Central Vad W/port >5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biocomposite 5.5mm X 15mm /w Disp Driver|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951200164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 31mm +20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80135635|EAP|CPT® 36565||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB INS TUN CVA 2 CATH W/O PORT|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Medium Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 80135676|EAP|CPT® 36566||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Tun Cva 2 Cath With Port|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 62066140|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Ampa Receptor Ab, Igg Screen-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80135742|EAP|CPT® 36570||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Picvad Cath <5y/o|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral Reunion Rsa X3 40mmx6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 80135791|EAP|CPT® 36558||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tunneled Cvc Insertion >5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 951200165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 19mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80135817|EAP|CPT® 36560||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Tunneled Cv Cath <5y/o|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 80135866|EAP|CPT® 36571||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB PERI INS CVAD W/PORT >5|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 62065760|EAP|CPT® 81403||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Jak2 Exon 12 Mutation Analysis-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.60|FSC: 13; Default||Not reimbursed separately|555.60|FSC: 13; Default||External grouping not supported 80135874|EAP|CPT® 36571||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB PER INS CVAD W/PORT >5 BILATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 80135908|EAP|CPT® 36576||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB REPAIR TUNNEL CV CATH W PORT|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 951200166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 21mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80135916|EAP|CPT® 36578||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB REPLACE CV CATH W/PORT|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191207|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.25mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80135940|EAP|CPT® 36582||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB COMP REPLACE TUN CV CAT W/POR|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80135999|EAP|CPT® 36589||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Tun Cvc W/o Sub Prt/pmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95191208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 951200167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 23mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80136054|EAP|CPT® 50384||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Ureter Stent, Percut|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95191209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Ti 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 80136179|EAP|Custom 80136179||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Nurse Visit Inpatient|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 80136187|EAP|Custom 80136187||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Social Worker Inpatient|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 62065770|EAP|CPT® 81219||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Calr Exon 9 Mutation Analysis-ref Lab|1|HUMANA [1294]||HUMANA [11839]|364.89|FSC: 13; Default||Not reimbursed separately|364.89|FSC: 13; Default||External grouping not supported 80136195|EAP|Custom 80136195||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Chaplain Visit Inpatient|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95191210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 951200168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 25mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80136211|EAP|Custom 80136211||0570 - HOME HEALTH (HH) AIDE - GENERAL CLASSIFICATION|Hb Nurse Aide|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95191211|EAP|Custom 95191211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Sealer Maryland Grasper 5mm X 23 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136245|EAP|Custom 80136245||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Walker, Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62066150|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Ampa Receptor Ab Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80136260|EAP|Custom 80136260||0998 - STATISTICAL CHARGES|Hb Housekeeping|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191212|EAP|Custom 95191212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trimano Beach Chair Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136278|EAP|Custom 80136278||0542 - AMBULANCE - MEDICAL TRANSPORT|Hb Transport Ambulance|1|HUMANA [1294]||HUMANA [11839]|1,136.51|FSC: 13; Default||Not reimbursed separately|1,136.51|FSC: 13; Default||External grouping not supported 80136286|EAP|Custom 80136286||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Misc Supplies|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 27mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 95191214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Lf 12mm/g-hfemur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 80136310|EAP|Custom 80136310||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hospice Monitoring (life|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065780|EAP|CPT® 88334||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Cyto Touch Prep Exam, Each Add'l Site|1|HUMANA [1294]||HUMANA [11839]|113.00|FSC: 13; Default||Not reimbursed separately|113.00|FSC: 13; Default||External grouping not supported 80136328|EAP|Custom 80136328||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hospice Oxygen Ox/day|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191216|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Artery Carotid Bovine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.00|FSC: 13; Default||Not reimbursed separately|3,177.00|FSC: 13; Default||External grouping not supported 80136336|EAP|Custom 80136336||0650 - HOSPICE SERVICE - GENERAL CLASSIFICATION|Hb Bereavement Visit|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 80136344|EAP|Custom 80136344||0652 - HOSPICE SERVICE - CONTINUOUS HOME CARE|Hb Continuous Home Care Each 60 Min|1|HUMANA [1294]||HUMANA [11839]|116.30|FSC: 13; Default||Not reimbursed separately|116.30|FSC: 13; Default||External grouping not supported 951200170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 29mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80136351|EAP|Custom 80136351||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Hospice Physician|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191217|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Aspire Sr Single-pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85,203.90|FSC: 13; Default||Not reimbursed separately|85,203.90|FSC: 13; Default||External grouping not supported 80136369|EAP|HCPCS E0105||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Quad Cane/mo.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136377|EAP|HCPCS E0141||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Wheeled Walker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191219|EAP|Custom 95191219||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Dbm Grafton 5cc|1|HUMANA [1294]||HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 80136385|EAP|HCPCS E0163||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Commode Chair/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Calcar Body 31mm +30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|FSC: 13; Default||Not reimbursed separately|16,443.00|FSC: 13; Default||External grouping not supported 80136419|EAP|HCPCS E0274||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Over Bed Table|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191221|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collagen Scaffold Reconstituted Arthroscopic Mini Med-open|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 80136435|EAP|HCPCS E0310||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Full Rails|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065790|EAP|CPT® 81402||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Mpl Codon 515 Mutation-ref Lab|1|HUMANA [1294]||HUMANA [11839]|450.99|FSC: 13; Default||Not reimbursed separately|450.99|FSC: 13; Default||External grouping not supported 80136450|EAP|HCPCS E0443||0290 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - GENERAL CLASSIFICATION|Hb Dme O2 Tank Refill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191222|EAP|Custom 95191222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Electrode Hf-resection|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136476|EAP|HCPCS E0630||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Patient Lift/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 11mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136484|EAP|HCPCS E0910||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Trapeze/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Fusion Irix-a 38x28x12degree 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 80136492|EAP|HCPCS E1031||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Geri Chair/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62066160|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Gaba-b Receptor Ab, Igg Screen-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80136500|EAP|HCPCS E1160||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Std Wc W/leg R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-poly Lps Nexgen Sz5 Gr 17mm-fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80136518|EAP|HCPCS E1399||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Dme Delivery/setup|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 12mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136534|EAP|HCPCS G0155||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Hospice, Csw Visit, Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.35|FSC: 13; Default||Not reimbursed separately|91.35|FSC: 13; Default||External grouping not supported 95191224|EAP|Custom 95191224||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grafton Dbf 3cc|1|HUMANA [1294]||HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 80136542|EAP|Custom 80136542||0998 - STATISTICAL CHARGES|Hb Supervisory Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136559|EAP|Custom 80136559||0998 - STATISTICAL CHARGES|Hb Speech Therp Visit, Ea 15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align 7mm X 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,161.00|FSC: 13; Default||Not reimbursed separately|7,161.00|FSC: 13; Default||External grouping not supported 80136567|EAP|HCPCS G0156||0570 - HOME HEALTH (HH) AIDE - GENERAL CLASSIFICATION|Hb Hospice, Home/hospice Aid Ea 15min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.60|FSC: 13; Default||Not reimbursed separately|33.60|FSC: 13; Default||External grouping not supported 951200174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 13mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136575|EAP|CPT® 97110||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Phys Ther Visit, Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.38|FSC: 13; Default||Not reimbursed separately|88.38|FSC: 13; Default||External grouping not supported 95191226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 17 Hole Left 154mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|FSC: 13; Default||Not reimbursed separately|2,643.75|FSC: 13; Default||External grouping not supported 80136583|EAP|Custom 80136583||0998 - STATISTICAL CHARGES|Hb N/c Social Worker Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62066170|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Gaba-b Receptor Ab Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80136609|EAP|Custom 80136609||0998 - STATISTICAL CHARGES|Hb Occupational Ther Visit, Ea 15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191233|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Phasix Circle 3 In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|FSC: 13; Default||Not reimbursed separately|4,440.00|FSC: 13; Default||External grouping not supported 80136617|EAP|Custom 80136617||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb 02 Holder For W/c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 14mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136625|EAP|Custom 80136625||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Iv Stand/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191235|EAP|Custom 95191235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Spinal Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136633|EAP|Custom 80136633||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Extended Leg Rest For W/c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136658|EAP|Custom 80136658||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Pastoral Care Visit|1|HUMANA [1294]||HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95191236|EAP|Custom 95191236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Ao 5.0mm X 180mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136674|EAP|Custom 80136674||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Rn Referral Follow Up Vis|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 951200176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 15mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136682|EAP|Custom 80136682||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Rn Referral Visit|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95191237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 13 X 320 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 80136708|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Hospice, Nursing Admit Visit, Ea 15min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 62066180|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Mog Ab, Igg Screen-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80136716|EAP|HCPCS E0570||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Nebulizer Ultr/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Proximal T2 Long Left 260mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|FSC: 13; Default||Not reimbursed separately|5,491.50|FSC: 13; Default||External grouping not supported 80136724|EAP|HCPCS E0600||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Suction Machine/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 17mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136732|EAP|Custom 80136732||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Lift Chair/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136740|EAP|HCPCS E0181||0946 - OTHER THERAPEUTIC SERVICES - COMPLEX MEDICAL EQUIPMENT - ROUTINE|Hb Alt Pressure Pad/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191240|EAP|Custom 95191240||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant 3-d Ifuse Si-bone 7.0mm X 35mm|1|HUMANA [1294]||HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 80136765|EAP|HCPCS E1390||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Concentrator/month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 18mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136781|EAP|HCPCS G0155||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Hospice, Csw Admit Visit, Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.35|FSC: 13; Default||Not reimbursed separately|91.35|FSC: 13; Default||External grouping not supported 95191241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Tibial Persona 13mm Fb Uc Rt 4-11 Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80136799|EAP|Custom 80136799||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Food Pump (dme) 1 Month|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136831|EAP|Custom 80136831||0650 - HOSPICE SERVICE - GENERAL CLASSIFICATION|Hb Pedi Grief Counselor Visi|1|HUMANA [1294]||HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95181024|EAP|Custom 95181024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acid Renal Pure 3 Potassium/2.5cal Gallon 4/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136864|EAP|HCPCS Q5001||0652 - HOSPICE SERVICE - CONTINUOUS HOME CARE|Hb Hospice Contin Home Care Ea 15 Minutes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.56|FSC: 13; Default||Not reimbursed separately|27.56|FSC: 13; Default||External grouping not supported 951200179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 19mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80136914|EAP|HCPCS Q5002||0652 - HOSPICE SERVICE - CONTINUOUS HOME CARE|Hb Hospice Cont In Assist Fac Ea 15 Minutes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.56|FSC: 13; Default||Not reimbursed separately|27.56|FSC: 13; Default||External grouping not supported 95181026|EAP|Custom 95181026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acid Renal Pure 2 Potassium/2.5cal Gallon 4/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80136948|EAP|HCPCS Q5003||0652 - HOSPICE SERVICE - CONTINUOUS HOME CARE|Hb Hospice Contin,ltc Facility Or Nf, Ea 15 Minutes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.56|FSC: 13; Default||Not reimbursed separately|27.56|FSC: 13; Default||External grouping not supported 62066190|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Mog Ab, Igg Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80136989|EAP|HCPCS Q5004||0655 - HOSPICE SERVICE - INPATIENT RESPITE CARE|Hb Hospice, Ip Respite, Snfsnf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 95191239|EAP|Custom 95191239||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant 3-d Ifuse Si-bone 7.0mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 80137094|EAP|CPT® 50430||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Pyelography Via Tube/cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 951200180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 20mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80137144|EAP|CPT® 96549||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Chemo Infusion Concurrent|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 95191247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Femoral Endurance Sz 2 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 80137631|EAP|Custom 80137631||0998 - STATISTICAL CHARGES|Hb Gc St Schedule Stress Test|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80137847|EAP|CPT® 38220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bone Marrow Aspiration Only|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 951200181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 21mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80137888|EAP|CPT® 36575||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repair Tesio Catheter|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95191242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Vit E Persona Mc Left 13mm/8-11/e-f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 80137912|EAP|CPT® 74425||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Inj Proileal Conduit/ureterop|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95191248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Posterior Certex 4.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 951200182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 22mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80139322|EAP|CPT® 46040||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inc And Drainage Perirectal Abscess|1|HUMANA [1294]||HUMANA [11839]|3,100.01|FSC: 13; Default||Not reimbursed separately|3,100.01|FSC: 13; Default||External grouping not supported 95191249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 80140031|EAP|Custom 80140031||0998 - STATISTICAL CHARGES|Hb Gc Ct Schedule Ct Scan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80140221|EAP|CPT® 97535||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Adl/home Management, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.83|FSC: 13; Default||Not reimbursed separately|97.83|FSC: 13; Default||External grouping not supported 95191250|EAP|Custom 95191250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.25mm X 6"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80140379|EAP|HCPCS A9521||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Exametazime Dx/dose,up To 25mci|1|HUMANA [1294]||HUMANA [11839]|3,026.24|FSC: 13; Default||Not reimbursed separately|3,026.24|FSC: 13; Default||External grouping not supported 951200183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 23mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80140387|EAP|CPT® 96360||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Hydration Iv, Initial 31 Min-1hr|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 95191252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 375mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 80140395|EAP|CPT® 96361||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Hydration Iv, Addl Hr|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 95195856|EAP|Custom 95195856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Restraint Head Universal Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80140924|EAP|CPT® 44500||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Of Long Gi Tube|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 95191254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mal Medial 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 951200184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 24mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80142730|EAP|CPT® 51702||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB FOLEY CATHETER INSERTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.57|FSC: 13; Default||Not reimbursed separately|336.57|FSC: 13; Default||External grouping not supported 95191255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Syndesmotic 3.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 80143050|EAP|Custom 80143050||0998 - STATISTICAL CHARGES|Hb Pat Visit Charge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62066200|EAP|CPT® 83519||0309 - LABORATORY - OTHER LABORATORY|Hb N-type Calcium Channel Ab-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 80143076|EAP|Custom 80143076||0998 - STATISTICAL CHARGES|Hb Un Pt Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191256|EAP|Custom 95191256||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor/gyn|1|HUMANA [1294]||HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 80143613|EAP|Custom 80143613||0998 - STATISTICAL CHARGES|Hb Ht Visit Charge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 25mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80143753|EAP|CPT® 28820||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Amputation Toe Metatarsophal Jnt|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 95191257|EAP|Custom 95191257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Catheter Pump On-q|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80143761|EAP|Custom 80143761||0998 - STATISTICAL CHARGES|Hb Xx Shunt Series|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195861|EAP|Custom 95195861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Schockman Ozil 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191258|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Ellipse Vr Single Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|FSC: 13; Default||Not reimbursed separately|41,674.50|FSC: 13; Default||External grouping not supported 951200186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 26mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp 3.5mm Bend Low 8hole 128mm/right St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,876.35|FSC: 13; Default||Not reimbursed separately|4,876.35|FSC: 13; Default||External grouping not supported 80143811|EAP|CPT® 11044||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debrid Subq Tissue M. Bone W/wrp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95191261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Viariable Angle 3.5x 44m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 951200187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 11mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95195862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Trushot 1.3mm Y-knot All Str 2 Hi-fi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,448.52|FSC: 13; Default||Not reimbursed separately|1,448.52|FSC: 13; Default||External grouping not supported 95191262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Viariable Angle 3.5x 56m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 951200188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 12mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80143928|EAP|HCPCS A9560||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Labeled Rbcs Dx/dose,up To 30mci|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.89|FSC: 13; Default||Not reimbursed separately|65.89|FSC: 13; Default||External grouping not supported 80144041|EAP|Custom 80144041||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cc Gyn Biopsy Charge|1|HUMANA [1294]||HUMANA [11839]|1,025.75|FSC: 13; Default||Not reimbursed separately|1,025.75|FSC: 13; Default||External grouping not supported 951200189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 13mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80144132|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Pf Isovue 370 (100ml) 1ml Charge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|FSC: 13; Default||Not reimbursed separately|0.56|FSC: 13; Default||External grouping not supported 951200190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 14mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80144140|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Pf Isovue 370 (75ml) 1ml Charge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|FSC: 13; Default||Not reimbursed separately|0.56|FSC: 13; Default||External grouping not supported 95191251|EAP|Custom 95191251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Syndesmotic 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80144157|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Pf Omniscan Prefill(10ml)1ml Chg|1|HUMANA [1294]||HUMANA [11839]|7.85|FSC: 13; Default||Not reimbursed separately|7.85|FSC: 13; Default||External grouping not supported 95195863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Trushot 1.8mm Y-knot All Str With 2 Hi-fi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,479.57|FSC: 13; Default||Not reimbursed separately|1,479.57|FSC: 13; Default||External grouping not supported 80144165|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Pf Omniscan Prefill(15ml)1ml Chg|1|HUMANA [1294]||HUMANA [11839]|7.70|FSC: 13; Default||Not reimbursed separately|7.70|FSC: 13; Default||External grouping not supported 95191253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula 3.0x130mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 80144173|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Pf Omniscan Prefill(20ml)1ml Chg|1|HUMANA [1294]||HUMANA [11839]|7.50|FSC: 13; Default||Not reimbursed separately|7.50|FSC: 13; Default||External grouping not supported 951200191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 15mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80144181|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Pf Omniscan Vial (20ml) 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|6.55|FSC: 13; Default||Not reimbursed separately|6.55|FSC: 13; Default||External grouping not supported 95191259|EAP|Custom 95191259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plasmablade 3.0s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80144199|EAP|Custom 80144199||0998 - STATISTICAL CHARGES|Hb Pt Missed Appointment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62066220|EAP|CPT® 86003||0309 - LABORATORY - OTHER LABORATORY|Hb Allergen, Alpha-gal, Food-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.66|FSC: 13; Default||Not reimbursed separately|15.66|FSC: 13; Default||External grouping not supported 80144975|EAP|CPT® 96040||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Genetic Counseling Each 30 Minut|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95191264|EAP|Custom 95191264||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Mobi-c M Standard 15 X 19 H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 951200192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 16mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191265|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac 18mm X 55cm Zenith Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.00|FSC: 13; Default||Not reimbursed separately|6,003.00|FSC: 13; Default||External grouping not supported 95195864|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Orth 800mm 3.0mm Hum Ti Smth Tip T2 Nl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|FSC: 13; Default||Not reimbursed separately|562.80|FSC: 13; Default||External grouping not supported 95191266|EAP|Custom 95191266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 17mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191267|EAP|Custom 95191267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Return Venous Tri-stage 29/29/29 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 44 X 16mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 80146525|EAP|CPT® 11043||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Gc Debrid Subq Tissue M Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 951200194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 19mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Micro Asnis 3.0mmx12/4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95195865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 200cm Lt Ankl T2 Im Arthds Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|FSC: 13; Default||Not reimbursed separately|6,598.20|FSC: 13; Default||External grouping not supported 95191270|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 26fr X 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 20mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191271|EAP|Custom 95191271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Reload Flex Green 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80146681|EAP|CPT® 11044||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Gc Debride Tissue/muscle/bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 62066230|EAP|CPT® 83986||0301 - LABORATORY - CHEMISTRY|Hb Ph, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.74|FSC: 13; Default||Not reimbursed separately|10.74|FSC: 13; Default||External grouping not supported 95191229|EAP|Custom 95191229||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Compression Calf 18-24" Lrg Vasopress|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 21mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191230|EAP|Custom 95191230||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Compression Calf 24-32" Lrg Vasopress|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195866|EAP|Custom 95195866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gd Pin Orth 230mm 3.2mm Thrd Tip|1|HUMANA [1294]||HUMANA [11839]|163.50|FSC: 13; Default||Not reimbursed separately|163.50|FSC: 13; Default||External grouping not supported 80146731|EAP|CPT® 11750||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Gc Excision Nail&nail Matrix|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95191234|EAP|Custom 95191234||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Compression Thigh 0-36 Lrg Vasopress|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 22mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 80146756|EAP|CPT® 11056||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Gc Pairing Callus 2-4 Lesion|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95191263|EAP|Custom 95191263||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Connector Catheter Ureteral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 4.5 X 3 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951200198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 23mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 5.5 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95195867|EAP|Custom 95195867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Pf Pin 2.7mm 14mm Prlc Sm Frg Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951200199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 24mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Ankle Anterior Tt Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|FSC: 13; Default||Not reimbursed separately|6,225.00|FSC: 13; Default||External grouping not supported 95197695|EAP|Custom 95197695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire With Stop 1.6mm 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope K-less W/driver Repair Syndysmosis Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951200200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 25mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191293|EAP|Custom 95191293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Positioning 2.1mm X L 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Lckng Ankle Prim Rt Comp 3.5mm 67mm 3h Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 95191294|EAP|Custom 95191294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill With Stop 2.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Stem 26mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Step 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,875.00|FSC: 13; Default||Not reimbursed separately|7,875.00|FSC: 13; Default||External grouping not supported 95191296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Step 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951200202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 11mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Lo-pro Ti 5.5 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95195869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L28 Mm Od3.5 Mm Odsec6.8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95191298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 345mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 951200203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 12mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 360mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95197700|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Advance Xp Male Stress Urinary Incontinence Sur Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95191300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 30mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 951200204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 13mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 38mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95195870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 30mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95191274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 4.5 X 36 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951200205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 14mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Rotation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95191284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 14mm/c-d Fem/cr Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951200206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 15mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 7.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95195871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 55mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95191286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Reline Mas Polaxial 7.5 X 45 Mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|FSC: 13; Default||Not reimbursed separately|3,087.00|FSC: 13; Default||External grouping not supported 951200207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 16mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Reline Mas Polaxial 7.5 X 55 Mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 80148034|EAP|CPT® 19296||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Cath Breast Separate D|1|HUMANA [1294]||HUMANA [11839]|25,114.31|FSC: 13; Default||Not reimbursed separately|25,114.31|FSC: 13; Default||External grouping not supported 95197701|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 23.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 80148042|EAP|CPT® 19298||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Cath Breast Multi|1|HUMANA [1294]||HUMANA [11839]|16,167.42|FSC: 13; Default||Not reimbursed separately|16,167.42|FSC: 13; Default||External grouping not supported 95191288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Reline Mas Polyaxial 6.5 X 50mm 2c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 80148059|EAP|CPT® 21899||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insertion Of Needles|1|HUMANA [1294]||HUMANA [11839]|628.65|FSC: 13; Default||Not reimbursed separately|628.65|FSC: 13; Default||External grouping not supported 951200208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 17mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80148075|EAP|CPT® 57155||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Uterine Tandoms/vag Ovoids|1|HUMANA [1294]||HUMANA [11839]|13,186.16|FSC: 13; Default||Not reimbursed separately|13,186.16|FSC: 13; Default||External grouping not supported 95191289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 65mm Lordotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 80148091|EAP|CPT® 19297||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Cath Breast Same Day|1|HUMANA [1294]||HUMANA [11839]|3,810.50|FSC: 13; Default||Not reimbursed separately|3,810.50|FSC: 13; Default||External grouping not supported 95195872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 30mm 3.5mm 6.8 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 80148281|EAP|CPT® 29445||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Rigid Total Contact Leg Cast|1|HUMANA [1294]||HUMANA [11839]|709.44|FSC: 13; Default||Not reimbursed separately|709.44|FSC: 13; Default||External grouping not supported 95191291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 60mm Lordotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 951200209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 18mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80148455|EAP|CPT® 19000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Punc Asp Cys Breast|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95191292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 2.5mm X 18mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 80148463|EAP|CPT® 19001||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB DRAINAGE OF BREAST LESION ADDITIONAL|1|HUMANA [1294]||HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 80148489|EAP|CPT® 19030||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mm Galactagram Digital|1|HUMANA [1294]||HUMANA [11839]|612.00|FSC: 13; Default||Not reimbursed separately|612.00|FSC: 13; Default||External grouping not supported 95191302|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Command 18 St .018" 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 19mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191303|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Command 18 Lt .018" 25cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 24mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95191304|EAP|Custom 95191304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 10.5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 20mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon Three-level 44 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95197704|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sur 5.9in X 11.8in Xenmatrix Rect Aclr Clgn Mtr Rgnr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,360.00|FSC: 13; Default||Not reimbursed separately|33,360.00|FSC: 13; Default||External grouping not supported 80148596|EAP|CPT® 19020||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mm Breast Abscess Drain|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95191306|EAP|Custom 95191306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid Chain 1.2 Gram Platinum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80148752|EAP|CPT® 19100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mm Bil Non-im Guide Breast Core|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80148760|EAP|CPT® 19100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mm Uni Non-im Guide Breast Core|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 951200212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 21mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95195874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L20 Mm Od3.5 Mm Odsec 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95191309|EAP|Custom 95191309||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Patient Return Electrosurgical Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 22mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80148935|EAP|CPT® 32998||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation Tx 1 > Pulm Tumors|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95191311|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.50 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 80149040|EAP|CPT® 50390||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Asp/inj Renal Cyst/pelvis Perc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80149123|EAP|CPT® 97750||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Physical Perform Test, 15 Min|1|HUMANA [1294]||HUMANA [11839]|99.72|FSC: 13; Default||Not reimbursed separately|99.72|FSC: 13; Default||External grouping not supported 95191312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tubular Third Ti 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 80149198|EAP|CPT® 97537||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Be-comm Work Reintegration 15 Mi|1|HUMANA [1294]||HUMANA [11839]|94.47|FSC: 13; Default||Not reimbursed separately|94.47|FSC: 13; Default||External grouping not supported 951200214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 23mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80149685|EAP|CPT® 84484||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ed Troponin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.41|FSC: 13; Default||Not reimbursed separately|37.41|FSC: 13; Default||External grouping not supported 95191313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 80149800|EAP|Custom 80149800||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Wound Vac Rental|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 40mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 80149933|EAP|Custom 80149933||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Acucare Bed Rental|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 24mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80150246|EAP|CPT® 93308||0483 - CARDIOLOGY - ECHOCARDIOLOGY|HB ECHO LIMITED OR FOLLOWUP|1|HUMANA [1294]||HUMANA [11839]|719.39|FSC: 13; Default||Not reimbursed separately|719.39|FSC: 13; Default||External grouping not supported 95197705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 35mm 2x4hl Ti Strght 2mm/2.3mm Aptus Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,168.10|FSC: 13; Default||Not reimbursed separately|2,168.10|FSC: 13; Default||External grouping not supported 80151582|EAP|Custom 80151582||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Clinitron Bed Rental|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 25mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80152127|EAP|HCPCS C1717||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brachytherapy Per Source|1|HUMANA [1294]||HUMANA [11839]|872.34|FSC: 13; Default||Not reimbursed separately|872.34|FSC: 13; Default||External grouping not supported 95191314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Evans Wedge 10x22x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 80152291|EAP|CPT® 29580||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bilat Unna Boot Application|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|412.85|FSC: 13; Default||Not reimbursed separately|412.85|FSC: 13; Default||External grouping not supported 95195876|EAP|Custom 95195876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulated Power Driver 1.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80152374|EAP|CPT® 11042||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Bil Excis Les 1.1cm-2.0cm Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95191315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Polyaxial Navicular-cuneiform Left Short (t10)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.00|FSC: 13; Default||Not reimbursed separately|6,165.00|FSC: 13; Default||External grouping not supported 80152408|EAP|CPT® 11421||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Bilat Excision/biopsy|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 951200217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 26mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191316|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80152747|EAP|Custom 80152747||0570 - HOME HEALTH (HH) AIDE - GENERAL CLASSIFICATION|Hb N/c Nurse Aide|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95191317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Humeral Reunion Rfx 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|FSC: 13; Default||Not reimbursed separately|22,713.00|FSC: 13; Default||External grouping not supported 80152762|EAP|CPT® 38505||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Us Bil Need Bx Or Ex Lymph Nodes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 951200218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 11mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80153489|EAP|HCPCS A9270||0659 - HOSPICE SERVICE - OTHER HOSPICE SERVICE|HB HOSPICE RM AND BD ADDL|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 95191320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7/3.5mm Va-lcp 12 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.91|FSC: 13; Default||Not reimbursed separately|6,413.91|FSC: 13; Default||External grouping not supported 95195877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 3.4mm 10mm Fixos Ti Ft/ankl Cnn Cmpr Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95191321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951200219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 12mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 2.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95197702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Ulna 151mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|FSC: 13; Default||Not reimbursed separately|4,695.00|FSC: 13; Default||External grouping not supported 95191323|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Whole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|FSC: 13; Default||Not reimbursed separately|9,450.00|FSC: 13; Default||External grouping not supported 951200220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 13mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95195879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Angled Assembly 8mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,951.00|FSC: 13; Default||Not reimbursed separately|3,951.00|FSC: 13; Default||External grouping not supported 951200221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 14mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951200222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 15mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191324|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Pre Cut Endothelial Keratoplasty|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95195880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Broad Straight 7 Hole Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.00|FSC: 13; Default||Not reimbursed separately|4,968.00|FSC: 13; Default||External grouping not supported 95191331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 40 X 14mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 951200223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 16mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80154313|EAP|CPT® 43450||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Unguided Maloney Dilation|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95191332|EAP|Custom 95191332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Tricut 11cm X 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80154537|EAP|CPT® 95180||0924 - OTHER DIAGNOSTIC SERVICES - ALLERGY TEST|Hb Rapid Desensitization Proc Per H|1|HUMANA [1294]||HUMANA [11839]|1,036.05|FSC: 13; Default||Not reimbursed separately|1,036.05|FSC: 13; Default||External grouping not supported 95197703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non-locking 2.7mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 80154560|EAP|HCPCS L8499||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Ww Cranial Prosthesis Wig|1|HUMANA [1294]||HUMANA [11839]|203.70|FSC: 13; Default||Not reimbursed separately|203.70|FSC: 13; Default||External grouping not supported 95191333|EAP|Custom 95191333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr High Speed Diamond Curved 15cm X 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80154594|EAP|CPT® 36002||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct Bil Thrombus Inj Pseudoaneur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80154776|EAP|CPT® 96523||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Irrg Imp Vad Drug Deliv Syst|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 951200224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 17mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80154792|EAP|CPT® 50200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Renal Biopsy Perc Trc/needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95191337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Constrained Pinnacle 36mm/54mm +4 10-deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,185.10|FSC: 13; Default||Not reimbursed separately|15,185.10|FSC: 13; Default||External grouping not supported 80155047|EAP|CPT® 58300||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insertion Medicated Iud Ccc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.00|FSC: 13; Default||Not reimbursed separately|415.00|FSC: 13; Default||External grouping not supported 80155088|EAP|CPT® 11000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Exten Eczema Up To 10%|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 95191341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Alighn 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,227.00|FSC: 13; Default||Not reimbursed separately|7,227.00|FSC: 13; Default||External grouping not supported 80155096|EAP|CPT® 16025||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Burns, Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 951200225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 18mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80155104|EAP|CPT® 16030||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Burns, Large|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95191347|EAP|HCPCS Q4187||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epicord 2cm X 3cm|1|HUMANA [1294]||HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 80155112|EAP|CPT® 16035||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Escharotomy Initial Incision|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95191335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 4.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 951200226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 19mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Mas Reline 5.5 X 160mm Lordotic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95197696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 15mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 80155203|EAP|CPT® 32550||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Indw Tun Pleur Cath W/cuff|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95191338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-locking 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 80155310|EAP|CPT® 84030||0301 - LABORATORY - CHEMISTRY|Hb Newborn Screen Scn|1|HUMANA [1294]||HUMANA [11839]|123.00|FSC: 13; Default||Not reimbursed separately|123.00|FSC: 13; Default||External grouping not supported 951200227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 20mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80156003|EAP|CPT® 90901||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Sm-biofeedback Training|1|HUMANA [1294]||HUMANA [11839]|114.33|FSC: 13; Default||Not reimbursed separately|114.33|FSC: 13; Default||External grouping not supported 95191339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Non-locking Ti 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 80156144|EAP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Ke Multihance Per Unit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.00|FSC: 13; Default||Not reimbursed separately|10.00|FSC: 13; Default||External grouping not supported 80156151|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Ke Omniscan Per Unit|1|HUMANA [1294]||HUMANA [11839]|10.00|FSC: 13; Default||Not reimbursed separately|10.00|FSC: 13; Default||External grouping not supported 95191340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Ijs-e 2.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951200228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 21mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191342|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 16 Hole/l 191mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|FSC: 13; Default||Not reimbursed separately|3,033.00|FSC: 13; Default||External grouping not supported 80156367|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Kh Omnipaque 350 1ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 95191343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 26mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 80156714|EAP|CPT® 97763||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Boutique Fitting Fee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.41|FSC: 13; Default||Not reimbursed separately|148.41|FSC: 13; Default||External grouping not supported 951200229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 22mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80156722|EAP|CPT® 93306||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ec Echo Complete|1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 95191344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Button Abs 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.00|FSC: 13; Default||Not reimbursed separately|642.00|FSC: 13; Default||External grouping not supported 80156771|EAP|CPT® 20670||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Implant Superficial|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80156979|EAP|CPT® 28124||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Partial Excision Phalanx Of Toe|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 95191345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal Lateral Left 7 Hole 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951200230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 23mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal Lateral Right 9 Hole 88mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95197697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad 2.7mm 10 Hole Lock 90mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 951200231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 24mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191352|EAP|Custom 95191352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Side Cutting 2.5mm 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191353|EAP|Custom 95191353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pleur-evac Balanced Drainage System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 25mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191348|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ventralight St W/echo 2 System Position 15cm X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|FSC: 13; Default||Not reimbursed separately|3,885.00|FSC: 13; Default||External grouping not supported 80157027|EAP|Custom 80157027||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Mm Scheduled Mammography|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80157126|EAP|CPT® 47399||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct Cryo Ablation Liver Tumor|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95191349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Piece Extension Gmrs 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 80157134|EAP|CPT® 50593||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation, Renal Tumor Cryo, Perc Unl|1|HUMANA [1294]||HUMANA [11839]|25,971.11|FSC: 13; Default||Not reimbursed separately|25,971.11|FSC: 13; Default||External grouping not supported 951200233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 26mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ployaxial Non Locking 3.5mm X 32mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95191351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ployaxial Non Locking 3.5mm X 35mm It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 951200234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 11mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 20mm It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95197698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 48mm Asns Cnn Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 95191356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 8 Hole Bridge Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 951200235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 12mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191357|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 6mm X 16mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80157432|EAP|HCPCS A9579||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Mr Supp-paramagnetic Cont|1|HUMANA [1294]||HUMANA [11839]|150.82|FSC: 13; Default||Not reimbursed separately|150.82|FSC: 13; Default||External grouping not supported 80157433|EAP|HCPCS A9579||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Mr High Dose Contrast Mri|1|HUMANA [1294]||HUMANA [11839]|111.32|FSC: 13; Default||Not reimbursed separately|111.32|FSC: 13; Default||External grouping not supported 95191358|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 6mm X 26mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 951200236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 13mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191359|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 6mm X 37mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80157441|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Mr Contrast Per Ml|1|HUMANA [1294]||HUMANA [11839]|13.44|FSC: 13; Default||Not reimbursed separately|13.44|FSC: 13; Default||External grouping not supported 80157480|EAP|CPT® 44360||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Gc Push Enteroscopy|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95191360|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 6mm X 58mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 80157548|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corneal Tissue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,116.00|FSC: 13; Default||Not reimbursed separately|19,116.00|FSC: 13; Default||External grouping not supported 951200237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 14mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191361|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 7mm X 16mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80157738|EAP|HCPCS E0601||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Cpap Machine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80157746|EAP|Custom 80157746||0291 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - RENTAL|Hb Cpap Humidifier|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191362|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 7mm X 37mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80157753|EAP|CPT® 97140||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Manual Therapy, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.48|FSC: 13; Default||Not reimbursed separately|81.48|FSC: 13; Default||External grouping not supported 951200238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 15mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80157761|EAP|CPT® 97112||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ht - Ot Neuromuscular Re-ed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|101.37|FSC: 13; Default||Not reimbursed separately|101.37|FSC: 13; Default||External grouping not supported 95191363|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 7mm X 58mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80157845|EAP|CPT® 27323||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx,sft Tis Th/knee, Superficial|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95197699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 42mm Asns Cnn Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 80157852|EAP|CPT® 27323||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Us Biop Soft Tiss Thigh/knee|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95191364|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 8mm X 16mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 951200239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 16mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191365|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 8mm X 26mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80157944|EAP|CPT® 12031||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Intermediate Repair|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 80157951|EAP|CPT® 82948||0301 - LABORATORY - CHEMISTRY|Hb Glucose By Monitoring Device|1|HUMANA [1294]||HUMANA [11839]|15.12|FSC: 13; Default||Not reimbursed separately|15.12|FSC: 13; Default||External grouping not supported 95191366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 8mm X 37mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 80200280|EAP|Custom 80200280||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Nm Schedule Nuc Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 17mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80204530|EAP|Custom 80204530||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Comp Proc--30 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191367|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 8mm X 58mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80204993|EAP|HCPCS A9500||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Sest Amibi Dx/dose, Up To 40mci|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.00|FSC: 13; Default||Not reimbursed separately|140.00|FSC: 13; Default||External grouping not supported 80205404|EAP|HCPCS A9560||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|HB TC-99M LABELED RBC'S DX/DOSE,UP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.00|FSC: 13; Default||Not reimbursed separately|580.00|FSC: 13; Default||External grouping not supported 95191368|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 10mm X 38mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 80221245|EAP|Custom 80221245||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Va Carotid Well Screen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 18mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80221252|EAP|Custom 80221252||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Va Abd Aorta Well Screen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191369|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 10mm X 58mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 80230063|EAP|Custom 80230063||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Nuclear Cardiac Proced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80230220|EAP|CPT® 47801||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Placement, Bile Duct Support|1|HUMANA [1294]||HUMANA [11839]|3,028.03|FSC: 13; Default||Not reimbursed separately|3,028.03|FSC: 13; Default||External grouping not supported 95191370|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 6mm X 16mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80230337|EAP|Custom 80230337||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Screen Full Body Scan|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951200242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 19mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80230436|EAP|HCPCS A9547||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb In-111 Oxyquinoline Dx, Per 0.5mci|1|HUMANA [1294]||HUMANA [11839]|2,276.00|FSC: 13; Default||Not reimbursed separately|2,276.00|FSC: 13; Default||External grouping not supported 95191371|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 6mm X 26mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80230469|EAP|HCPCS J7325||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Sp Synvisc 16mg|1|HUMANA [1294]||HUMANA [11839]|382.99|FSC: 13; Default||Not reimbursed separately|382.99|FSC: 13; Default||External grouping not supported 80230485|EAP|CPT® 47382||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation, 1> Liver Tumor(s),rf, Perc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95191372|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 7mm X 16mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 951200243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 20mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80231269|EAP|Custom 80231269||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Cancer Care Interpreta|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191373|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 7mm X 26mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80232028|EAP|Custom 80232028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fl Epidural / Myelogram T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80232531|EAP|CPT® 36478||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovenous Laser, 1st Vein|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191374|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 7mm X 37mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80232556|EAP|CPT® 36479||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovenous Laser Vein Add On|1|HUMANA [1294]||HUMANA [11839]|4,098.00|FSC: 13; Default||Not reimbursed separately|4,098.00|FSC: 13; Default||External grouping not supported 951200244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 21mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80232663|EAP|Custom 80232663||0352 - CT SCAN - BODY SCAN|Hb Ct Coronary Angio|1|HUMANA [1294]||HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95191375|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 8mm X 16mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95191376|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestream Balloon Expand Covered 8mm X 26mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 80233703|EAP|CPT® 78815||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Nm Pet Img W/ct,skull Bs-md|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 951200245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 22mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80233711|EAP|CPT® 78816||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Nm Pet Image W/ct, Whole Body|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 95191377|EAP|Custom 95191377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Irrigation Rio System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80233729|EAP|CPT® 78814||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Pet Image W/ct,limited Area|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 80233737|EAP|Custom 80233737||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Pe Pet Master|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191378|EAP|Custom 95191378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin Bone 3.2mm X 140mm 2-pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80233828|EAP|CPT® 78608||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Nm Brain Imag Pet Metabolic|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 951200246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 23mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80233836|EAP|CPT® 78609||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Nm Brain Imag Pet Perfusion|1|HUMANA [1294]||HUMANA [11839]|3,687.36|FSC: 13; Default||Not reimbursed separately|3,687.36|FSC: 13; Default||External grouping not supported 95191379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 20mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 80233844|EAP|CPT® 78459||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Nm Myocardial Pet Meta Eval|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 80233851|EAP|CPT® 78491||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Pe Myocardial Perf Single|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 95191380|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Acc Standard 11fr Non-hemostasis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233869|EAP|CPT® 78492||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Pe Myocardial Perf Multi|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 951200247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 24mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80233919|EAP|Custom 80233919||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Pe Schedule Pet Ct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191381|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Acc Long 11fr Non-hemostasis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233943|EAP|CPT® 50080||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Nephrolithotmy < Or =2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,905.53|FSC: 13; Default||Not reimbursed separately|24,905.53|FSC: 13; Default||External grouping not supported 80233968|EAP|CPT® 50081||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Kidney Stone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,905.53|FSC: 13; Default||Not reimbursed separately|24,905.53|FSC: 13; Default||External grouping not supported 95191382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt10mm/cd Femur/cr Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|FSC: 13; Default||Not reimbursed separately|10,050.00|FSC: 13; Default||External grouping not supported 80234180|EAP|CPT® 36475||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovenous Rf, 1st Vein|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 951200248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 25mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80234206|EAP|CPT® 36476||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovenous Rf, Vein Add-on|1|HUMANA [1294]||HUMANA [11839]|3,657.52|FSC: 13; Default||Not reimbursed separately|3,657.52|FSC: 13; Default||External grouping not supported 95191386|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 19.50 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80234313|EAP|Custom 80234313||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Ct Locm 300-399 Mgi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80234347|EAP|Custom 80234347||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Ct Locm 200-299 Mgi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191387|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 17.50 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80234370|EAP|Custom 80234370||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Ct Locm 100-199 Mgi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 26mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80234982|EAP|CPT® 37184||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Prim Art Mech Thrombectomy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95191388|EAP|Custom 95191388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80235021|EAP|CPT® 37187||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Mech Thrombect W/inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 80235047|EAP|CPT® 37188||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Mech Thrmbct W/inj Repeat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Lps All-poly Size 6 17mm Green E/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80235237|EAP|HCPCS G0260||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inpro Si Jnt Arthro/ans/str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 951200250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 11mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80235310|EAP|CPT® 50200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Renal Biopsy Perc Trc/needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95191398|EAP|Custom 95191398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Ao 1.6 X 110mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80235369|EAP|CPT® 23350||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fl Shoulder Arthrogram Inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 80235401|EAP|CPT® 27093||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fl Hip Arthrogram Inj Proc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|632.00|FSC: 13; Default||Not reimbursed separately|632.00|FSC: 13; Default||External grouping not supported 95191399|EAP|Custom 95191399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Ao 2.3 X 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 12mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80235468|EAP|CPT® 34490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Throm Axill/subclav Vein Uni|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95191400|EAP|Custom 95191400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 1.2 X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80235559|EAP|Custom 80235559||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ni Nicholson Exam Master|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80236821|EAP|Custom 80236821||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Coron Angio W Ccs/interp (bh)|1|HUMANA [1294]||HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95191401|EAP|Custom 95191401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 1.6 X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80237258|EAP|CPT® 50389||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Renal Tube W/fluoro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 951200252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 13mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80237373|EAP|Custom 80237373||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Fl Schedule Fluoro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191402|EAP|Custom 95191402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Smooth 1.30mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ployaxial Non Locking 3.5mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 80300106|EAP|CPT® 77417||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Therapy Port Film-1 Port|1|HUMANA [1294]||HUMANA [11839]|326.00|FSC: 13; Default||Not reimbursed separately|326.00|FSC: 13; Default||External grouping not supported 951200253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 14mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95191384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Med.distal Va-lcp 2.7mm/3.5mm 1hole 69mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 951200254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 15mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80300254|EAP|CPT® 77321||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Teletherapy Total Body|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95191385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Med.distal Va-lcp 2.7mm/3.5mm 2hole 82mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 80300262|EAP|CPT® 77763||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Intracavity Rad Source Compl|1|HUMANA [1294]||HUMANA [11839]|2,110.14|FSC: 13; Default||Not reimbursed separately|2,110.14|FSC: 13; Default||External grouping not supported 80300320|EAP|CPT® 77750||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Rdt Infuse/inst Radioelmnt Sol|1|HUMANA [1294]||HUMANA [11839]|673.50|FSC: 13; Default||Not reimbursed separately|673.50|FSC: 13; Default||External grouping not supported 95191391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Extended 5 Hole Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|FSC: 13; Default||Not reimbursed separately|2,745.00|FSC: 13; Default||External grouping not supported 951200255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 16mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Cannulated Short Thread 3.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 80300429|EAP|CPT® 77332||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Custom Blks&immob Simp|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 95191393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 80300445|EAP|CPT® 77290||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Simulation/complex|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 951200256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 17mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 80300460|EAP|CPT® 77285||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Simulation/intermediate|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95191394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 80300486|EAP|CPT® 77280||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Simulation/simple|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 95191395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.5 X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951200257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 18mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95191396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 80300619|EAP|CPT® 77295||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Three Dim Trmt Plan|1|HUMANA [1294]||HUMANA [11839]|3,548.61|FSC: 13; Default||Not reimbursed separately|3,548.61|FSC: 13; Default||External grouping not supported 80300627|EAP|HCPCS C2641||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Palladium 103 Seeds Prost|1|HUMANA [1294]||HUMANA [11839]|180.39|FSC: 13; Default||Not reimbursed separately|180.39|FSC: 13; Default||External grouping not supported 95191397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Promo Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,202.00|FSC: 13; Default||Not reimbursed separately|5,202.00|FSC: 13; Default||External grouping not supported 80300635|EAP|CPT® 77336||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Cont Med Rad-physics Cons|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 951200962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 80300643|EAP|CPT® 77333||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Cust Blks&immob Dev Intm|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 80300650|EAP|CPT® 77334||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Custom Blks&immob Cmpx|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 80300668|EAP|CPT® 77370||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Spec Med Rad Physics Cons|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 80300676|EAP|CPT® 77331||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Special Dosimetry|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 951200963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 80300742|EAP|CPT® 77778||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Interstitial Rad/complex|1|HUMANA [1294]||HUMANA [11839]|2,110.14|FSC: 13; Default||Not reimbursed separately|2,110.14|FSC: 13; Default||External grouping not supported 80300767|EAP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Iodine Seeds Prostate|1|HUMANA [1294]||HUMANA [11839]|105.03|FSC: 13; Default||Not reimbursed separately|105.03|FSC: 13; Default||External grouping not supported 80300775|EAP|CPT® 77790||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Spv, Hand, Load Rad Source|1|HUMANA [1294]||HUMANA [11839]|523.10|FSC: 13; Default||Not reimbursed separately|523.10|FSC: 13; Default||External grouping not supported 80300783|EAP|CPT® 77470||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Special Trmt Procedure|1|HUMANA [1294]||HUMANA [11839]|1,535.40|FSC: 13; Default||Not reimbursed separately|1,535.40|FSC: 13; Default||External grouping not supported 951200964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 80300932|EAP|CPT® 77300||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Dosimetry Calculation|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 80300965|EAP|Custom 80300965||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Special Contrast|1|HUMANA [1294]||HUMANA [11839]|220.50|FSC: 13; Default||Not reimbursed separately|220.50|FSC: 13; Default||External grouping not supported 80300973|EAP|CPT® 77761||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Intracavity Rad Source Simple|1|HUMANA [1294]||HUMANA [11839]|1,535.40|FSC: 13; Default||Not reimbursed separately|1,535.40|FSC: 13; Default||External grouping not supported 80300981|EAP|CPT® 77762||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Intracavity Rad Source Interm|1|HUMANA [1294]||HUMANA [11839]|1,535.40|FSC: 13; Default||Not reimbursed separately|1,535.40|FSC: 13; Default||External grouping not supported 951200965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95191405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Znn 10mm X 34cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 951200967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 95191406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Tibial Znn 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.28|FSC: 13; Default||Not reimbursed separately|593.28|FSC: 13; Default||External grouping not supported 80301286|EAP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Iodine Seeds Neuro|1|HUMANA [1294]||HUMANA [11839]|105.03|FSC: 13; Default||Not reimbursed separately|105.03|FSC: 13; Default||External grouping not supported 80301443|EAP|CPT® 77301||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Imrt Planning|1|HUMANA [1294]||HUMANA [11839]|3,548.61|FSC: 13; Default||Not reimbursed separately|3,548.61|FSC: 13; Default||External grouping not supported 951200968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80310931|EAP|Custom 80310931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp Groshong Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80310949|EAP|Custom 80310949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hickman Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80311277|EAP|CPT® 36245||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 1st Ord Below|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,250.96|FSC: 13; Default||Not reimbursed separately|3,250.96|FSC: 13; Default||External grouping not supported 951200969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 951200970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80314156|EAP|Custom 80314156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp Special Tray Charg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80314248|EAP|Custom 80314248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp Atherectomy Cathet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80324254|EAP|CPT® 36246||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 2nd Ord Below|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,130.79|FSC: 13; Default||Not reimbursed separately|3,130.79|FSC: 13; Default||External grouping not supported 951200972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80324874|EAP|Custom 80324874||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Preop Outpatient Care Ccr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80324932|EAP|CPT® 33210||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rplc Temp Single Elect/pm Cath|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80329006|EAP|CPT® 93798||0943 - OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION|Hb Op Cardio Rehab W/ecg Mntr|1|HUMANA [1294]||HUMANA [11839]|209.02|FSC: 13; Default||Not reimbursed separately|209.02|FSC: 13; Default||External grouping not supported 80329014|EAP|Custom 80329014||0998 - STATISTICAL CHARGES|Hb Phase Iii Rehab/mo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80329022|EAP|Custom 80329022||0998 - STATISTICAL CHARGES|Hb Phase Iii Rehab/sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial Right 10 Hold / 149mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,673.00|FSC: 13; Default||Not reimbursed separately|8,673.00|FSC: 13; Default||External grouping not supported 80329287|EAP|Custom 80329287||0998 - STATISTICAL CHARGES|Hb Cc Exercise Assmt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cp 4.1mm X L40mm T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 951200974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80332448|EAP|Custom 80332448||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cc Electrophysiology/implant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191408|EAP|Custom 95191408||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Clydesdale 22mm 12mm X 45mm X 6deg|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 80332513|EAP|Custom 80332513||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Cc Cerebral Procedure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 5.5 X 45mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 80332521|EAP|Custom 80332521||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Cc Renal Procedure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Rec It 2.7mm X 10mm T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 80332596|EAP|CPT® 36002||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Va Inj Proc Perc Pseudo Bilat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 951200975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80332604|EAP|Custom 80332604||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Cc Peripheral Procedure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp Non Lock 2.7mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 80400153|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Facet Inject Cervical Or Thoracic Bilat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95191412|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Penile Ambicore Ams 16cm X 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,682.47|FSC: 13; Default||Not reimbursed separately|36,682.47|FSC: 13; Default||External grouping not supported 80400286|EAP|CPT® 64483||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epi Lumb/scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 951200976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 80502305|EAP|CPT® 50700||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Sp Ureteroplasty Plastic Op Uni|1|HUMANA [1294]||HUMANA [11839]|2,069.01|FSC: 13; Default||Not reimbursed separately|2,069.01|FSC: 13; Default||External grouping not supported 95191409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lat Ti Lcp 2.7/3.5mm 4 Hole Lt/86mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,018.04|FSC: 13; Default||Not reimbursed separately|2,018.04|FSC: 13; Default||External grouping not supported 82058052|EAP|CPT® 86709||0302 - LABORATORY - IMMUNOLOGY|Hb Hepatitis A Antibody Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.78|FSC: 13; Default||Not reimbursed separately|33.78|FSC: 13; Default||External grouping not supported 95191414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm/125 Deg 360mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 951200977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 87331393|EAP|CPT® 11042||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Subc Tissue, 1st 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95191416|EAP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Procedure Iceforce 2.1 Cx 90 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 87331401|EAP|CPT® 11043||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Muscl/fascia, 1st 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 87331427|EAP|CPT® 11730||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Avulsion Nail Plate-singl|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95191417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Altivate Anatomic 54mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 87331435|EAP|CPT® 11732||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Avulsion Addl Nail Plate|1|HUMANA [1294]||HUMANA [11839]|281.00|FSC: 13; Default||Not reimbursed separately|281.00|FSC: 13; Default||External grouping not supported 951200978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 87331450|EAP|CPT® 11721||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Addl Nail 6-more|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 95191418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Short Altivate Anatomic 16mmx78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 87331468|EAP|CPT® 11750||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Excision Nail&nail Matrix|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 87331476|EAP|CPT® 11055||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pairing Of Callus-single|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95191419|EAP|Custom 95191419||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Exclusion Laa Gillinov-cosgrove Atriclip 40mm|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 87331484|EAP|CPT® 11056||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pairing Callus 2-4 Lesion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 951200979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 87331492|EAP|CPT® 11057||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pairing Callus >4 Lesions|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95191421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Voyager L70mm Od4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 87331567|EAP|CPT® 17000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Wnd Cautery(electric) 1 L|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95191422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Irix-a 33x26x8degree 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 87331575|EAP|CPT® 17003||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Wnd Cautery(electric) 2-4|1|HUMANA [1294]||HUMANA [11839]|40.50|FSC: 13; Default||Not reimbursed separately|40.50|FSC: 13; Default||External grouping not supported 951200980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 87331583|EAP|CPT® 17250||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Wnd Cautery (chemical)|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95191426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Curve L120 Mm Od5.5 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 87331591|EAP|CPT® 15002||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Surg Prep Recipient Site|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 95191427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 18mm Tibia G-h/cr Fem 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951200981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 87331765|EAP|CPT® 82962||0301 - LABORATORY - CHEMISTRY|Hb Glucose Poc, Fda Appv Monitor Dev|1|HUMANA [1294]||HUMANA [11839]|9.84|FSC: 13; Default||Not reimbursed separately|9.84|FSC: 13; Default||External grouping not supported 95191428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Vit E Persona Mc Lt 1mm/c-d/cr 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 87331773|EAP|CPT® 11719||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trim Nondystrophic Nails|1|HUMANA [1294]||HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 95191432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.5x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 87331997|EAP|CPT® 16025||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Burn Debridement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 951200982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 87332003|EAP|CPT® 28825||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Toe Amputation|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 95191436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 2.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95197708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Hex Headed 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 87332110|EAP|CPT® 15003||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Surg Prep Site Add 100cm|1|HUMANA [1294]||HUMANA [11839]|1,724.25|FSC: 13; Default||Not reimbursed separately|1,724.25|FSC: 13; Default||External grouping not supported 95191437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 87332136|EAP|CPT® 12020||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Wound Dehiscence Simple|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 951200983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|FSC: 13; Default||Not reimbursed separately|7,255.50|FSC: 13; Default||External grouping not supported 95191438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 87332169|EAP|CPT® 97605||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Npwt <50cm Wound Size|1|HUMANA [1294]||HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95191439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 2.7mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 87332177|EAP|CPT® 97606||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Npwt >50cm Wound Size|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951200984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95191441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 0 Degree Medium Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 951200985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191430|EAP|Custom 95191430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Acquire Fine Od22 Ga Endoscopic Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191431|EAP|Custom 95191431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Acquire Fine Od19 Ga Endoscopic Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 87390787|EAP|CPT® 15004||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Surg Prep Recip Site Hands Feet|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 95191434|EAP|Custom 95191434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Ao 1.7 X 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87390795|EAP|CPT® 15005||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Surg Prep Site Add 100cm Hands|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 95197709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Psn Rev Tapered Smooth Ext 14x75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 87551024|EAP|CPT® 96372||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Botox Injection|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 951200987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 87551313|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Cervical Facet Bilat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 87551339|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Cervical Facet Addl Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 95191435|EAP|Custom 95191435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 0.9 X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87551370|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Cervical Or Thoracic Facet Inject|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 951200988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 87551396|EAP|CPT® 64479||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epi Cerv/thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95191442|EAP|Custom 95191442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Fenestration Perforator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87551453|EAP|CPT® 64484||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epil/s Addl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.01|FSC: 13; Default||Not reimbursed separately|1,261.01|FSC: 13; Default||External grouping not supported 87551560|EAP|Custom 87551560||0998 - STATISTICAL CHARGES|Hb Sp Conscious Sedation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191443|EAP|Custom 95191443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Measuring Ao 2.0 X 110mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87551875|EAP|Custom 87551875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rapid Refill Cont Injec S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191444|EAP|Custom 95191444||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Olive Smooth 1.4mm|1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95191429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Tibial Fb Uc Rt 11mm Tibia C-d/cr Fem 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951200990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Oc 3.5mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 95197710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Revision Cemented Right Plus 3+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,875.00|FSC: 13; Default||Not reimbursed separately|22,875.00|FSC: 13; Default||External grouping not supported 95191446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.0mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 951200991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mto Softsilk 10mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|FSC: 13; Default||Not reimbursed separately|1,260.00|FSC: 13; Default||External grouping not supported 95191449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Softsilk 1.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 951200992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 88109806|EAP|Custom 88109806||0290 - DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - GENERAL CLASSIFICATION|Hb Orthotic/prosthetic Devic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130 Deg 1.5 11.5mm X 40cm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,625.65|FSC: 13; Default||Not reimbursed separately|6,625.65|FSC: 13; Default||External grouping not supported 95191453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 95mm / 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 89000574|EAP|Custom 89000574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Oxygen Thpy Set Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 89047856|EAP|CPT® 99999||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Heart Lung Per Hr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191447|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avive Soft Tissue Membrane 3cm X 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,325.00|FSC: 13; Default||Not reimbursed separately|11,325.00|FSC: 13; Default||External grouping not supported 89502579|EAP|Custom 89502579||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Organ Harvest|1|HUMANA [1294]||HUMANA [11839]|1,135.58|FSC: 13; Default||Not reimbursed separately|1,135.58|FSC: 13; Default||External grouping not supported 92220193|EAP|Custom 92220193||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Optimental 240ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191450|EAP|Custom 95191450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Intertan Lag Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 92220219|EAP|Custom 92220219||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Replete 250ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 92220300|EAP|Custom 92220300||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Resource Breeze Orange 240ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191451|EAP|Custom 95191451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin 3.2 X 343mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 92220326|EAP|Custom 92220326||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Resource Breeze Berry 240ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 92220342|EAP|Custom 92220342||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Dty Resource Breeze Peach 240ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191454|EAP|Custom 95191454||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Lumbar Horizontal-vertical|1|HUMANA [1294]||HUMANA [11839]|3,921.60|FSC: 13; Default||Not reimbursed separately|3,921.60|FSC: 13; Default||External grouping not supported 951200995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 49mm Ex-srt Narrow Rt Kit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.00|FSC: 13; Default||Not reimbursed separately|6,774.00|FSC: 13; Default||External grouping not supported 95191462|EAP|Custom 95191462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Advance Pistol 44 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191457|EAP|Custom 95191457||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Ii Wedge 5.0mm With Needles|1|HUMANA [1294]||HUMANA [11839]|653.40|FSC: 13; Default||Not reimbursed separately|653.40|FSC: 13; Default||External grouping not supported 80172822|EAP|CPT® 97129||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Therapeutic Intervention Cog Func 1st 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|71.07|FSC: 13; Default||Not reimbursed separately|71.07|FSC: 13; Default||External grouping not supported 95191459|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurostimulator Rechar Adapt-stim Sure Scan Intellis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,600.00|FSC: 13; Default||Not reimbursed separately|48,600.00|FSC: 13; Default||External grouping not supported 951200997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191455|EAP|Custom 95191455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System 250 Puregraft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191456|EAP|Custom 95191456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System 850 Puregraft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191461|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Recharger Program Manager Therapy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95191460|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Controller Manager Patient Program|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951200999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Solid Back 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95191465|EAP|Custom 95191465||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Programmer Patient External Stimulator Neuro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Cluster 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95191472|EAP|Custom 95191472||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Neurostimulator External Wireless|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191466|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Contour Ureteral 4.8 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.26|FSC: 13; Default||Not reimbursed separately|403.26|FSC: 13; Default||External grouping not supported 951201001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Cluster 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95191473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Long 5th Metatarsal Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 95191467|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 36.0 Diopter Acrysof 13.0mm Length 6.0 Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 951201002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Cluster 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95191469|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80172833|EAP|CPT® 97130||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Therapeutic Intervention Cog Func Add 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|67.95|FSC: 13; Default||Not reimbursed separately|67.95|FSC: 13; Default||External grouping not supported 95191470|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951201003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Cluster 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95191471|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951201004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Psl Ha Cluster 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95191475|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Tightrail Sub-c 13fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191476|EAP|Custom 95191476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191477|EAP|Custom 95191477||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Artery Carotid Bovine 8mm X 30cm|1|HUMANA [1294]||HUMANA [11839]|6,087.00|FSC: 13; Default||Not reimbursed separately|6,087.00|FSC: 13; Default||External grouping not supported 951201006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191478|EAP|Custom 95191478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Pls A.i.m.ing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172844|EAP|HCPCS G2066||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Interrogation Device Remote 30 Days|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95191479|EAP|Custom 95191479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191483|EAP|Custom 95191483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hemostatic Matrix Surgiflo W/thrombin 8 Ml Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.8mm Q-fix All Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951201008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191485|EAP|Custom 95191485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Shoulder Q-fix 2.8mm Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191486|EAP|Custom 95191486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ultrabraid Cobraid 38 Sing.arm Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191487|EAP|Custom 95191487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Shoulder Q-fix 1.8mm Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.3x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 951201010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 80172855|EAP|CPT® 93797||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cardiac Rehab W/o Cardiac Monitoring|1|HUMANA [1294]||HUMANA [11839]|339.66|FSC: 13; Default||Not reimbursed separately|339.66|FSC: 13; Default||External grouping not supported 95191490|EAP|Custom 95191490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Ao 2.0 X 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191491|EAP|Custom 95191491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 1.1 X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191492|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Tightrail Sub-c 9fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191493|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Tightrail Sub-c 11fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191494|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 24mm X 125cm Flex Zenith Z-trak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95191495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cartiva 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 951201014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191496|EAP|Custom 95191496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 1.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172866|EAP|CPT® 78305||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Bone & Joint Imaging Multiple Areas|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95191497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 951201015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95191499|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stealth Solid Crown 30 Grit 2.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191500|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stealth Solid Crown 30 Grit 1.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191501|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stealth Solid Crown 30 Micron 1.25mm 145cm Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191503|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 20.50 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95191504|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 18.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951201018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95197712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 112mm Ti 5 Hl Axsos 3 Bn Hum Lft Prox Lat Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,768.00|FSC: 13; Default||Not reimbursed separately|9,768.00|FSC: 13; Default||External grouping not supported 951201019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191505|EAP|Custom 95191505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel B5 Short Extra Light|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Head Simpliciti Stb Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95191507|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Style-410 425cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951201021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interspace Wedge Taper Hip Short 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,185.00|FSC: 13; Default||Not reimbursed separately|13,185.00|FSC: 13; Default||External grouping not supported 95191511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Humeral Equinoxe 38 Mm +0 Mm Shoulder Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 951201022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191525|EAP|Custom 95191525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197713|EAP|Custom 95197713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 35mm 5.5mm Crv Ns|1|HUMANA [1294]||HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 95191526|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avive Soft Tissue Membrane 1cm X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 951201023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191527|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 535cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95191510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Equinoxe Shoulder Glenosphere Lock Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 951201024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Equinoxe 4.5x26mm Shdr Kit Comp Lock Cap Rev Orge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95191514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Equinoxe 4.5x38mm Shdr Kit Comp Lock Cap Rev Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 951201025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Equinoxe 4.5x46mm Shdr Kit Comp Lock Cap Rev Purp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 95191516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Equinoxe 4.5x34mm Shdr Kit Comp Lock Cap Rev Red|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 951201026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95197714|EAP|Custom 95197714||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Bn 10cc Graft Sm Dbm Matrix Grafton Lf|1|HUMANA [1294]||HUMANA [11839]|5,157.00|FSC: 13; Default||Not reimbursed separately|5,157.00|FSC: 13; Default||External grouping not supported 95191509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenosphere Expanded Rs Equinoxe 38mm+4mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 951201027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191531|EAP|Custom 95191531||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-100/i6-40|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95191532|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Technis Sym Multifocal Ext Ran|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951201028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191533|EAP|Custom 95191533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Concave -014|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191534|EAP|Custom 95191534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Anchorage Ao Torque Rev.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Standard Left 10hole Extra Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 80170712|EAP|CPT® 55100||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Drainage Of Scrotal Wall Abscess|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 951201030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191528|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 560cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 62064844|EAP|CPT® 87640||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Staphylococcus Aureus, Amplified Probe Technique|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951201031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 62064855|EAP|CPT® 87641||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Mrsa, Amplified Probe Technique|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951201032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt 13mm/e-f Femur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95191539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Dbr Iii 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 951201033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95191547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Head Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951201034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191540|EAP|Custom 95191540||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stimulator/locator Nerve Io-flex Neuro Check Wire|1|HUMANA [1294]||HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95191541|EAP|Custom 95191541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe S Ipsi I0-flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191543|EAP|Custom 95191543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaver Microblade Io-flex 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 95191544|EAP|Custom 95191544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Irrigation Io-flex Contra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191545|EAP|Custom 95191545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Boot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident All Poly Cup-crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|FSC: 13; Default||Not reimbursed separately|4,147.50|FSC: 13; Default||External grouping not supported 951201038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Short Stem 44 No 0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,216.10|FSC: 13; Default||Not reimbursed separately|11,216.10|FSC: 13; Default||External grouping not supported 95191548|EAP|Custom 95191548||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Head|1|HUMANA [1294]||HUMANA [11839]|8,100.00|FSC: 13; Default||Not reimbursed separately|8,100.00|FSC: 13; Default||External grouping not supported 95191549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 8mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 951201039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 200mm Lg 44mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|FSC: 13; Default||Not reimbursed separately|16,338.00|FSC: 13; Default||External grouping not supported 95191550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95191551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 56 X 25mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 951201040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 220mm Lg 44mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|FSC: 13; Default||Not reimbursed separately|16,338.00|FSC: 13; Default||External grouping not supported 95191552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95191553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Precoat Sz-g Rt Medial Left Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 951201041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 240mm Lg 44mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|FSC: 13; Default||Not reimbursed separately|16,338.00|FSC: 13; Default||External grouping not supported 95191554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 5-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95191555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Rt Medial Lt Lateral Sz1 Uni Knee Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 951201042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 260mm Lg 44mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|FSC: 13; Default||Not reimbursed separately|16,338.00|FSC: 13; Default||External grouping not supported 95197715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-d 20h Rt 243mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,676.00|FSC: 13; Default||Not reimbursed separately|5,676.00|FSC: 13; Default||External grouping not supported 95191556|EAP|Custom 95191556||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Allograft Tarsys 1cm X 4cm Eyelid 12 Layer Oculop|1|HUMANA [1294]||HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951201043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191557|EAP|Custom 95191557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Gryphon Anchor 2.4 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191558|EAP|Custom 95191558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Gryphon Anchor Hard Bone 2.5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Bear Fix Uc Persona Left 16mm-tib C-d/fem 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951201045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 35.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191560|EAP|Custom 95191560||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Allograft Puros S2 10x11x14mm 7 Degree|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95191561|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice Perforated 20cm X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.93|FSC: 13; Default||Not reimbursed separately|73.93|FSC: 13; Default||External grouping not supported 951201046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 37.5mm No 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Neutral 28 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 55mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 80170722|EAP|CPT® 31647||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch With Insertion Bronchial Valve Initial Lobe|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 951201047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 37.5mm No 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 80170755|EAP|CPT® 31651||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch With Insertion Bronchial Valve Ea Add Lobe|1|HUMANA [1294]||HUMANA [11839]|6,241.29|FSC: 13; Default||Not reimbursed separately|6,241.29|FSC: 13; Default||External grouping not supported 80170733|EAP|CPT® 31648||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch W Removal Bronchial Valve Initial Lobe|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 951201048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 37.5mm No 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 80170744|EAP|CPT® 31649||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch W Removal Bronchial Valve Ea Add Lobe|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 95191564|EAP|Custom 95191564||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Core Pro Evolut Aortic Transcath 26mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951201049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 37.5mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191565|EAP|Custom 95191565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Ioc 19 Gauge Disposable Packer/chang|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Short 14mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 951201050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 37.5mm No 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 54mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95197717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 42cm Lt Intertrochanter Intertan Im 125d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95191568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 12 Hole L225mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,807.00|FSC: 13; Default||Not reimbursed separately|9,807.00|FSC: 13; Default||External grouping not supported 951201051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191569|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix 3-layer Wound Cytal 5x5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.49|FSC: 13; Default||Not reimbursed separately|114.49|FSC: 13; Default||External grouping not supported 951201052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191571|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95191575|EAP|Custom 95191575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Loader And Catheter Deployment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191576|EAP|Custom 95191576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Sizing Airway Hud|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191577|EAP|Custom 95191577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Urteroscope Flexible Digital Single-use Lithovue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191572|EAP|Custom 95191572||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Airway Spiration Cartridge 9mm Hud|1|HUMANA [1294]||HUMANA [11839]|10,350.00|FSC: 13; Default||Not reimbursed separately|10,350.00|FSC: 13; Default||External grouping not supported 95197718|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 22.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95191573|EAP|Custom 95191573||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Airway Spiration Cartridge 6mm Hud|1|HUMANA [1294]||HUMANA [11839]|7,950.00|FSC: 13; Default||Not reimbursed separately|7,950.00|FSC: 13; Default||External grouping not supported 951201055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191574|EAP|Custom 95191574||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Airway Spiration Cartridge 7mm Hud|1|HUMANA [1294]||HUMANA [11839]|7,950.00|FSC: 13; Default||Not reimbursed separately|7,950.00|FSC: 13; Default||External grouping not supported 95191578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hat-trick Pip Fusion 3.7mm Mm Prox Deg 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.70|FSC: 13; Default||Not reimbursed separately|2,702.70|FSC: 13; Default||External grouping not supported 951201057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 80170766|EAP|Custom 80170766||0352 - CT SCAN - BODY SCAN|Hb Retail Low Dose Lung Ct Screening|1|HUMANA [1294]||HUMANA [11839]|99.00|FSC: 13; Default||Not reimbursed separately|99.00|FSC: 13; Default||External grouping not supported 95191579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium Cannulated 5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 951201058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 50mm No 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium Cannulated 5 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95197719|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 21.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95191581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 5.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 951201059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 50mm No 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 1.5 11.5mm X 40cm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95191583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 90mm / 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 951201060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 50mm No 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191584|EAP|Custom 95191584||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Clydesdale 8 X 50 Mm 6 Deg|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95191585|EAP|Custom 95191585||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek 8mm X 16mm X 14mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951201061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 50mm No 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95191586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Lo-profile 2.7 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95191588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Lt 11mm/g-hfemur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951201062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 50mm No 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95197720|EAP|Custom 95197720||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-100/i20-40|1|HUMANA [1294]||HUMANA [11839]|43,497.00|FSC: 13; Default||Not reimbursed separately|43,497.00|FSC: 13; Default||External grouping not supported 951201063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter 205mm Tap 44mm No 2 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|FSC: 13; Default||Not reimbursed separately|16,338.00|FSC: 13; Default||External grouping not supported 95191587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial Ss Lt 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 95191589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stablyx Cmc Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|FSC: 13; Default||Not reimbursed separately|8,925.00|FSC: 13; Default||External grouping not supported 951201064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade C Cs 132 Nk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95191590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stablyx Cmc Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|FSC: 13; Default||Not reimbursed separately|8,925.00|FSC: 13; Default||External grouping not supported 95191591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stablyx Cmc Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|FSC: 13; Default||Not reimbursed separately|8,925.00|FSC: 13; Default||External grouping not supported 951201065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade C Cs 132 Nk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95191592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Keel Midline Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 951201066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95191594|EAP|Custom 95191594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Laparoscopic Alexis Small With 12 X 100mm Kii Fios F|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 95191595|EAP|Custom 95191595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Tracker 2mm X 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Regenesorb 8mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 951201068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 80172877|EAP|HCPCS G1004||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Ndsc|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Eon 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|FSC: 13; Default||Not reimbursed separately|10,533.60|FSC: 13; Default||External grouping not supported 951201082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 1 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 2 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 3 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 4 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm/125 Deg 360mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 951201086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191598|EAP|Custom 95191598||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Exclusion Laa Gillinov-cosgrove Atriclip 35mm|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95191599|EAP|Custom 95191599||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Exclusion Laa Gillinov-cosgrove Atriclip 45mm|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951201087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 6 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191600|EAP|Custom 95191600||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Exclusion Laa Gillinov-cosgrove Atriclip 50mm|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95191601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Thick 56mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951201088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 7 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191593|EAP|Custom 95191593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Occipital|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Nitinol 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,314.00|FSC: 13; Default||Not reimbursed separately|4,314.00|FSC: 13; Default||External grouping not supported 951201089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 8 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191603|EAP|Custom 95191603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Retrieval Anchor Tissue Vats W/15mm Introducer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 Titanium 13x380mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|FSC: 13; Default||Not reimbursed separately|5,964.00|FSC: 13; Default||External grouping not supported 951201090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 9 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191605|EAP|Custom 95191605||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 23mm X 14.5mm X 12cm|1|HUMANA [1294]||HUMANA [11839]|33,825.00|FSC: 13; Default||Not reimbursed separately|33,825.00|FSC: 13; Default||External grouping not supported 95191606|EAP|Custom 95191606||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Contralateral 27mm X 14cm|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 951201091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 10 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191607|EAP|Custom 95191607||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Contralateral 27mm X 10cm|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 951201092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 11 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191608|EAP|Custom 95191608||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Branch Lilac 23x12mm X 10cm|1|HUMANA [1294]||HUMANA [11839]|33,057.00|FSC: 13; Default||Not reimbursed separately|33,057.00|FSC: 13; Default||External grouping not supported 95191609|EAP|Custom 95191609||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthese Excluder Branch Iliac 16mm X 12mm X 7cm|1|HUMANA [1294]||HUMANA [11839]|9,225.00|FSC: 13; Default||Not reimbursed separately|9,225.00|FSC: 13; Default||External grouping not supported 951201093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem-std Neck-size 12 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191610|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Dryseal 12fr X 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191613|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter Xcela Mst Nitinol Reverse Taper 5f Dl Mst 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 1 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191615|EAP|Custom 95191615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Sizing Speedshift Offset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191622|EAP|Custom 95191622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 2 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191623|EAP|Custom 95191623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.1mm X 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951201096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 3 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95197731|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Gd 6fr Lnchr Scr4 Crv Cor 100cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 951201097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 4 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95191620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 951201098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95191616|EAP|Custom 95191616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Caps Locking 2.7t|1|HUMANA [1294]||HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951201099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 6 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191625|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Generator Pulse Implantable Writer Wave Spectra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,000.00|FSC: 13; Default||Not reimbursed separately|51,000.00|FSC: 13; Default||External grouping not supported 951201100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 7 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191626|EAP|Custom 95191626||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Control Remote Freelink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191627|EAP|Custom 95191627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Entrada 4-5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 8 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Thread Short Headless 2.0 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95191629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Taper Ceramic +6 Opt Type 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|FSC: 13; Default||Not reimbursed separately|1,260.00|FSC: 13; Default||External grouping not supported 951201102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 9 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum Longevity 36 X50mm 7mm Offset Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95191631|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 30mm X 109mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 951201103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 10 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191632|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Electrophysiology Achieve Advance Od15 Mm Mapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191634|EAP|Custom 95191634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter Dragonfly Optis 20 Mm L35cm Od2.7 Imaging|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 11implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191635|EAP|Custom 95191635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter Impella Rp Us Pump Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191633|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Catheter Achieve Advance L1.96 Mr 10 Pin Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Stem-hi Offset Nk-size 12 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95191636|EAP|Custom 95191636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Control Coronary 20 Ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191639|EAP|Custom 95191639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Removal Tissue Tx2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191641|EAP|Custom 95191641||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Clydesdale 22mm 10mm X 55mm X 6deg|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95191645|EAP|Custom 95191645||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Envelope Absorbable Tyrx Polyarylate Medium 2.7in X 2.5in|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial Rt 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,171.00|FSC: 13; Default||Not reimbursed separately|9,171.00|FSC: 13; Default||External grouping not supported 95191638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 11mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 951201108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191642|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice Laparascopic 6cm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|74.13|FSC: 13; Default||Not reimbursed separately|74.13|FSC: 13; Default||External grouping not supported 95191643|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Silicone 625cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951201109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191644|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Silicone 570cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951201110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periarticular Prox Lcp 3.5mm 8 Hole Rt 199m St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.44|FSC: 13; Default||Not reimbursed separately|5,728.44|FSC: 13; Default||External grouping not supported 95191647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfn Cann 11mm /123 Deg Left 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 951201111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95197732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2mm 5mm Screw 10 Hole Lock 87mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 95191649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Dorsal Va-lcp 2.4mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,833.96|FSC: 13; Default||Not reimbursed separately|1,833.96|FSC: 13; Default||External grouping not supported 951201112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 12mm/e-f Fem/cr Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95191654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Quickfix Stainless Steel Small L10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951201113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Dished Articular Xlpe Legion 11mm Size 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 95191656|EAP|Custom 95191656||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Extender Aortic 26mm X 3.3cm|1|HUMANA [1294]||HUMANA [11839]|9,762.00|FSC: 13; Default||Not reimbursed separately|9,762.00|FSC: 13; Default||External grouping not supported 951201114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Stem Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 04.1mm X 30mm Lag Cross Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95191658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7 X 32mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951201115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 1 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191659|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 2.7mm Hole6 Ss Triangle Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|FSC: 13; Default||Not reimbursed separately|2,318.25|FSC: 13; Default||External grouping not supported 95191660|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular Stainless 80cm .018 In Mandrel Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 2 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191662|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 5x40mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191663|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 6x40mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 3 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191665|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 4x60mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110668|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Straight .025 145 Cmtsf-25-145-bh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 4 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191661|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 4x40mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191664|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 7x40mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 5 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191666|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 5x60mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 23mm T8 2mm Cort St Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95191667|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 6x60mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 6 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191668|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 7x60mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191669|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 4x80mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 7 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191670|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 5x80mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191671|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 6x80mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 8 Cementless Right V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191672|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 4x100mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191673|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 5x100mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 1 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191675|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 4x120mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Dvc Fixation Easyclip 20x16x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,503.00|FSC: 13; Default||Not reimbursed separately|7,503.00|FSC: 13; Default||External grouping not supported 95191676|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 5x120mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 2 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191677|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 6x120mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191678|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 4x150mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 3 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191679|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 5x150mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191680|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 6x150mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 4 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191681|EAP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Urological Urolift|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95191682|EAP|Custom 95191682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Wire Drill 1.6mmx150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 5 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 6.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95191684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trial Li Corent 10x9x26mm 4deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 951201128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 6 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191674|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilatation Lutonix 035 In 130cm 6x100mm Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 7 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Peek 4.75 X 19.1 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95191686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Peek-optima W/disp Shth 6x23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 951201130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abgii No 8 Cementless Left V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95191687|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular Ptfe J 035in X 70cm X3mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-standard Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191698|EAP|Custom 95191698||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Peek Tantalum 16mm X 14mm X 7mm Anatomic St|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95191699|EAP|Custom 95191699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Peek Tantalum 16mm X 14mm X 9mm Anatomic St|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951201132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-standard Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 56 X 22mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95191689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap Off Lg 2mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 951201133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cp 4.1mm X L36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95191691|EAP|Custom 95191691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Solid Compression Ratcheting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 15mm X 11mm Compression Ratchet Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95191693|EAP|Custom 95191693||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone And Cartilage Proc 15mm|1|HUMANA [1294]||HUMANA [11839]|12,234.00|FSC: 13; Default||Not reimbursed separately|12,234.00|FSC: 13; Default||External grouping not supported 951201135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2 Hole System Fixation Tightrope Bb-tak 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 951201136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium 5x44mm Self Tapp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 951201137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95191702|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Tecnis Torric One Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95191703|EAP|Custom 95191703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Trigen Long 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 5.0 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 95191705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 80mm / 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|FSC: 13; Default||Not reimbursed separately|2,115.15|FSC: 13; Default||External grouping not supported 951201843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 10s 10mm X 18cm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,964.85|FSC: 13; Default||Not reimbursed separately|4,964.85|FSC: 13; Default||External grouping not supported 80172911|EAP|CPT® 26770||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Cltx Iphal Jt Dislc W/manj W/o Anes|1|HUMANA [1294]||HUMANA [11839]|614.46|FSC: 13; Default||Not reimbursed separately|614.46|FSC: 13; Default||External grouping not supported 95191707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt 12mm/c-d Femur/cr Sz 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951201844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191708|EAP|Custom 95191708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scalpel Surgical Bayonet Annulotomy Maxcess|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191709|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951201845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191710|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95191711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 1.5 11.5mm X 34cm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 951201846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 85mm / 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 951201847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191713|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80172922|EAP|CPT® 29130||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Application Finger Splint Static|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 95191714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Post Lat Va-lcp 2.7mm/3.5mm 3hole 75mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 951201848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Med.distalva-lcp 2.7mm/3.5mm 2hole 82mm Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 95191717|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cardiac Dynagen Enduralife Df4 Vr 1 Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,750.00|FSC: 13; Default||Not reimbursed separately|39,750.00|FSC: 13; Default||External grouping not supported 951201849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Comp 35mmcx6.5mm Shoulder Central Hex Driver|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95191719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 13mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 951201850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mmx22mm Slf Tpnw/t8 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95191723|EAP|Custom 95191723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Thoracic Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191724|EAP|Custom 95191724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Straight 3.2 Mm Disposable 5 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197736|EAP|Custom 95197736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Symmetric Pds Plus Violet 0 23cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191725|EAP|Custom 95191725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 5.0 Profile Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Comp 5.0x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95191727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Comp 5.0x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 951201853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Comp 5.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95191729|EAP|Custom 95191729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .062 X 9.25 With Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191731|EAP|Custom 95191731||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Clydesdale Peek-optima 12mmx50mm 6deg Lumbar|1|HUMANA [1294]||HUMANA [11839]|18,600.00|FSC: 13; Default||Not reimbursed separately|18,600.00|FSC: 13; Default||External grouping not supported 62064866|EAP|CPT® 81511||0301 - LABORATORY - CHEMISTRY|Hb Maternal Quad Screen|1|HUMANA [1294]||HUMANA [11839]|460.50|FSC: 13; Default||Not reimbursed separately|460.50|FSC: 13; Default||External grouping not supported 951201855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197737|EAP|Custom 95197737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Symmetric Pds Plus Violet 1 15cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191733|EAP|Custom 95191733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation Barrx 360 Balloon Rea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191734|EAP|Custom 95191734||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant 3-d I Fuse Si-bone 7.0mm X 55mm|1|HUMANA [1294]||HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95191740|EAP|Custom 95191740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Cannulated Sonoma Long 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191743|EAP|Custom 95191743||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Corent Li 12 X 9 X 32mm 4 Deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95191746|EAP|Custom 95191746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Endopath Probe Plus Ii Handcontrol Pistol Grip Hd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191747|EAP|Custom 95191747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Endopath Probe Plus 5mm Spatula Hollow Tip 34cm Lh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191748|EAP|Custom 95191748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Irrigation Endopath Probe Plus Ii Pressurize Bag Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Dorsal Va-lcp +90 Deg Rt 2.4mm 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.39|FSC: 13; Default||Not reimbursed separately|2,034.39|FSC: 13; Default||External grouping not supported 95197742|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue Osteochondral Distal Femoral Medial Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,880.00|FSC: 13; Default||Not reimbursed separately|35,880.00|FSC: 13; Default||External grouping not supported 95191736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Dorsal -90 Deg Va-lcp 2.4mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.39|FSC: 13; Default||Not reimbursed separately|2,034.39|FSC: 13; Default||External grouping not supported 951201860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Straight 2.4mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95191738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 5x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 951201861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Syndesmotic 3.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95191741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fixation Sonoma Fibulock Long 3.0mm X180mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 951201862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95191742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sonoma 2.7mm X 14mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95191749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Long Midfoot Ankle Lock Polyaxial Cross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 951201863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95191750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 4.1 Mm X L20 Mm Lag Cross Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95197745|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 21.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95191744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 13mm/3-11ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951201864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95191745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Left 14mm/e-f Fem/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95191751|EAP|Custom 95191751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manipulator Endoscopic Koh-efficient Rumi Stainless St 3.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95197746|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 20.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95197749|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 33.0 Diopter Acrysof 6.0mm Anterior Asymmet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951201872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0 Deg Insert 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197750|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Glcm Crdvo Istent Lt Strl Lf Disp Trbclr Mic Byps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951201876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 2.3mm 1 Osteoraptor Ulbrd Cobraid White|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,060.95|FSC: 13; Default||Not reimbursed separately|1,060.95|FSC: 13; Default||External grouping not supported 951201880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 155mm Ss 4.5mm Scr 6 Hl Lck Prlc Bn Fem Lt Dist Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,773.25|FSC: 13; Default||Not reimbursed separately|3,773.25|FSC: 13; Default||External grouping not supported 951201884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 25mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.43|FSC: 13; Default||Not reimbursed separately|110.43|FSC: 13; Default||External grouping not supported 951201888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 80mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951201892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 7.9mm 40mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951201900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 7.9mm 42mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951201904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ X3 Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 951201908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mdm Cocr Liner 38mm D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 951201909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mdm Cocr Liner 52mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 951201910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mdm Cocr Liner 54mm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 951201911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mdm Cocr Liner 58mm J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 951201912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm Insert 28/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951201921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm X3 Insert Id 28mm For Cup Od 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 951201922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm X3 Insert Id 28mm For Cup Od 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 951201923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm X3 Insert Id 28mm For Cup Od 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 951201924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm X3 Insert Id 28mm For Cup Od 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 951201925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Adm X3 Insert Id 28mm For Cup Od 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 951201926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 951201927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 951201928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 95195881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 9mm X 345mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951201929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 951201930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 95195882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 65mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951201931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 95197751|EAP|Custom 95197751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hands Free Rrism|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 95195883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion16mm X 101mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951201933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 951201934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 95195884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 27.5mm Brigade Crnt Spne Ns Xlrf Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951201935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 95197768|EAP|Custom 95197768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cg Spnl Acis Pro 360 Ti L 9mm|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951201936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 951201937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lfit Morse Taper Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|FSC: 13; Default||Not reimbursed separately|3,036.60|FSC: 13; Default||External grouping not supported 951201938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 22mm +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 95197769|EAP|Custom 95197769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 15cm 2.2mm Match Head Burr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 26mm +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 951201940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 28mm +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 95197770|EAP|Custom 95197770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 10cm 2.2mm Match Head Burr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 32mm +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 951201942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 26mm -3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 951201943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 28mm -3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 951201944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 32mm -3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 95195885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 13mm 38cm Intertrochanter Trgn Fem Tibial Gld Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|FSC: 13; Default||Not reimbursed separately|7,950.00|FSC: 13; Default||External grouping not supported 951201945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 26mm +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 95197771|EAP|Custom 95197771||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Cannulated Adult Angled Plates 320mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 28mm +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 95195886|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Skn 10x17cm 1.5-2.2mm Flexhd Plb Perfrtd Thk Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.33|FSC: 13; Default||Not reimbursed separately|83.33|FSC: 13; Default||External grouping not supported 951201947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter Orthinox Head 32mm +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 951201948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Plug Exeter X-change 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95195887|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Skn 10x17cm 1.5-2.2mm Flexhd Plb Thk Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.33|FSC: 13; Default||Not reimbursed separately|83.33|FSC: 13; Default||External grouping not supported 951201949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Plug Exeter X-change 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95197765|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Matrix Ortho Bone Viable Bio4 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 951201950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Plug Exeter X-change 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95195888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Bn Fmrl Ncb 245mm 9h Poly Lf Prx Peri Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 951201951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Plug Exeter X-change 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 951201952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Plug Exeter X-change 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95195889|EAP|Custom 95195889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 3.3 Ncb Device Pp Femur Mis With Quick Cpl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Plug Exeter X-change 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95197766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.6mm 38mm T8 Cp Lag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|FSC: 13; Default||Not reimbursed separately|879.00|FSC: 13; Default||External grouping not supported 951201954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Screw 3.5x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 951201955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Screw 3.5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 951201956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Screw 3.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 95195890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 13mm 38cm Fem Trgn Mt-nl Im Rtrgd Ti Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 951201957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Screw 3.5x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 95197767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Retainer 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.60|FSC: 13; Default||Not reimbursed separately|777.60|FSC: 13; Default||External grouping not supported 951201958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Screw 3.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 95195894|EAP|Custom 95195894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 14x12.9cm Brst 480-575cc Smth Intgr Port Allox2|1|HUMANA [1294]||HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 951201959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Screw 3.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 951201960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Femoral Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 95195895|EAP|Custom 95195895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix Cr 20mm|1|HUMANA [1294]||HUMANA [11839]|12,834.00|FSC: 13; Default||Not reimbursed separately|12,834.00|FSC: 13; Default||External grouping not supported 951201961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Wall Mesh Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 95197772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Osteotomy Adult 110 Degree 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,796.19|FSC: 13; Default||Not reimbursed separately|1,796.19|FSC: 13; Default||External grouping not supported 951201962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Wall Mesh Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 95195896|EAP|Custom 95195896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prochondrix Disposable Instrumentation Sizer 7-20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Flat Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 951201964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Rim Mesh Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 95195897|EAP|Custom 95195897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Prochondrix Instrument 11mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Rim Mesh Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 95197773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 10mm Variax T8 Ft Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 951201966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Rim Mesh Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 95195898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 19mm 5mm Asns Ti Mic Rvrs Cut Flut Ft Hnd Slf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 951201967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-change Femoral Anatomical Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|FSC: 13; Default||Not reimbursed separately|2,152.50|FSC: 13; Default||External grouping not supported 951201968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 95195899|EAP|Custom 95195899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Holder Uronav Bk8808e/8818|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 95197774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 12mm Variax T8 Ft Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 951201970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 95195900|EAP|Custom 95195900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Plum Arty 8fr 110cm Sv02/cont Crdc Op J Tip Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 951201972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 95197775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 14mm Variax T8 Ft Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 951201973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 95195901|EAP|Custom 95195901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Quill Absor Poly Kntless 0 14cm Taper Pt 1/2 Cr 36mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 951201975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Series I Acet. Insert 20¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|FSC: 13; Default||Not reimbursed separately|3,353.70|FSC: 13; Default||External grouping not supported 95195902|EAP|Custom 95195902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Blood Warming Irrigation Single Latex-free Sterile Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii Ins 10 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 951201977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 95197776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 16mm Variax T8 Ft Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 951201978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 80171777|EAP|CPT® 91037||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophageal Function Test And Reflux Test|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 951201979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 951201980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 80171788|EAP|CPT® 91038||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophageal Function Test And Reflux Test Greater Than 1 Hour|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 951201981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii Ins 10 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 95197777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Variax T8 Full Thread L10 Mm Od2.7 Mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 951201982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 80171799|EAP|Custom 80171799||0192 - SUBACUTE CARE - LEVEL II|Hb Grant County Swing Bed Private Room & Board|1|HUMANA [1294]||HUMANA [11839]|3,500.00|FSC: 13; Default||Not reimbursed separately|3,500.00|FSC: 13; Default||Accommodation codes not reimbursed separately 951201983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 951201984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 80171800|EAP|Custom 80171800||0192 - SUBACUTE CARE - LEVEL II|Hb Grant County Swing Bed Semi-private Room & Board|1|HUMANA [1294]||HUMANA [11839]|3,500.00|FSC: 13; Default||Not reimbursed separately|3,500.00|FSC: 13; Default||Accommodation codes not reimbursed separately 951201985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 951201986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crossfire Series Ii 10¦ Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 95195903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intfr Regenesorb 25mm 10mm Full Lgth Sld Biosure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 951201987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ireland Pre-ha Secur-fit Psl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,654.90|FSC: 13; Default||Not reimbursed separately|6,654.90|FSC: 13; Default||External grouping not supported 951201988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ireland Pre-ha Secur-fit Psl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,654.90|FSC: 13; Default||Not reimbursed separately|6,654.90|FSC: 13; Default||External grouping not supported 95195904|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Bln 10mm 80cml 100mml Peri Ncmp Rpd Infl Pta Powerflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ireland Pre-ha Secur-fit Psl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,654.90|FSC: 13; Default||Not reimbursed separately|6,654.90|FSC: 13; Default||External grouping not supported 95197778|EAP|Custom 95197778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 12mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951201990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gap Plate Screws|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95195905|EAP|Custom 95195905||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Loop Cortical Fixation 30mm|1|HUMANA [1294]||HUMANA [11839]|1,083.00|FSC: 13; Default||Not reimbursed separately|1,083.00|FSC: 13; Default||External grouping not supported 951201991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gap Plate Screws|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 951201992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gap Plate Screws|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95195906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 5mm Spc Strg 38x5x1.2mm Ss 2mm Scr Mn Frag 7hl Tine Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 951201993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gap Plate Screws|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95197779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5mm 7.9mm 32mm Peri-loc Stainless Steel T25 Flu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951201994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 14mm T6 Cortx Slfret Scrdrvr St Flt Hd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 951201995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 951201996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 20mm T6 Cortx Slfret Scrdrvr St Flt Hd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 951201997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95197780|EAP|Custom 95197780||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 45mm 5.5mm Crv Ns|1|HUMANA [1294]||HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 951201998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195909|EAP|Custom 95195909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 200 50 Wt Flx Sld Hp Lf **order 95777**|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 951202000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195910|EAP|Custom 95195910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 365 100 Watts Flx Sld Hp Lf**order 9577|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95197787|EAP|Custom 95197787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 18.0cm Memorygel 4.1cm Mod Prfl Sm Brst Gel 800cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195911|EAP|Custom 95195911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 550 100 Watts Flx Sld Hp Lf**order 9577|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 951202004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195912|EAP|Custom 95195912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id 1000 100 Wts Flx Sld Hp Lf**order 95776|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95197791|EAP|Custom 95197791||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 10mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951202006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 95195913|EAP|Custom 95195913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Lsr Flexiva Id Tractip 200 Micr Sngl Holm**order 95778|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ii Acet Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|FSC: 13; Default||Not reimbursed separately|11,799.90|FSC: 13; Default||External grouping not supported 951202008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 95195915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion14mm X 98mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951202009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 95197785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad 2.7mm 4 Hole Lock 39mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 951202010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 95195917|EAP|Custom 95195917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Compass Compartment Press Monitoring 5ea/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 951202012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 951202013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 951202014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Gap Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|FSC: 13; Default||Not reimbursed separately|9,498.30|FSC: 13; Default||External grouping not supported 95197786|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prolayer Xenograft 2cmx5cm Acellular Dermal Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951202015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 95151965|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 951202722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Im Nl 300mm 13mm 125d R1.5 Lng Lt Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 951202723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 1.8mm 2 Y-knt 2 Ld 2 Strn Pro Flx Hi-fi Sft W/ribbo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 951202724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion15mm X 99mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951202726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197789|EAP|Custom 95197789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 10mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 951202727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5 Hex 4.75 X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 951202728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195924|EAP|Custom 95195924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Guide Augmented Comprehensive Reversed Shoulder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cr Insert Sz1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195925|EAP|Custom 95195925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Surgical Augment Ream Er W/screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz1 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195926|EAP|Custom 95195926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.7mm Comprehensive Augment With Stop Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz1 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz1 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Implant Large Augmented W/taper Adapter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 951202736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz1 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195928|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Cardiac Quadra Allure Mp Rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,100.00|FSC: 13; Default||Not reimbursed separately|23,100.00|FSC: 13; Default||External grouping not supported 951202738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80172944|EAP|HCPCS G1001||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Evicore|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion13mm X 97mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951202740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80172955|EAP|HCPCS G1002||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Medcurrent|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz3 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Lipped Ins. Sz3-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80172966|EAP|HCPCS G1003||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Medicalis|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz3 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz3 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz 3 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80172977|EAP|HCPCS G1005||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Nia|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80172988|EAP|HCPCS G1006||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Test Approp|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 42mm Arthx Ti T15 Lg Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 951202755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz4 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz 4 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 46mm Arthx Ti T15 Lg Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 951202757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80172999|EAP|HCPCS G1007||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Aim|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 100mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951202759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz 5 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 110mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951202761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80173000|EAP|HCPCS G1008||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Cranberry Pk|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz5 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195934|EAP|Custom 95195934||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Btn 12mm 5cm Psprt Sil Crv Loprfl Hip 1 Pc Mld 2 Dam Dsg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz5 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz 5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80173011|EAP|HCPCS G1009||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Sage Health|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195936|EAP|Custom 95195936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Implant Pip Joint Instrument Disposables Retrofusion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz6 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80173022|EAP|HCPCS G1010||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Stanson|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Trial Sz6 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 20mm Retrofusion Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951202771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 80173033|EAP|HCPCS G1011||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Cdsm Qualified Nos|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 52mm Loprfl Scr Ss T15 Ft Hexalobe Ankl Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 951202775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195940|EAP|Custom 95195940||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Srg 55x63in Opth Fld Ctch Bg Adh Strl Disp Bl 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95197793|EAP|Custom 95197793||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Handpiece Remodel Device Nasal Soft Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz7 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195941|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 13.6cm Mentr Memorygel 4.7cm Mdrt+ Prfl Rnd Sm 490|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 951202779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195942|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 13.9cm Mentr Memorygel 4.7cm Mdrt+ Prfl Rnd Sm 525|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 951202781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95197795|EAP|Custom 95197795||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Implant 10x38x28mm Ti 20degree|1|HUMANA [1294]||HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 951202782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95195943|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 14.0cm Mentr Memorygel 4.9cm Mdrt+ Prfl Rnd Sm 545|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 951202783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 95197799|EAP|Custom 95197799||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Lateral Closed 10mm|1|HUMANA [1294]||HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 951202785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cs Insert Sz8 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951202786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197801|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 39mm 16mm 5.4mm 14fr Znth Sprlz Z-trk 2 Brch Ntnl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 951202789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 70mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951202792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Infnt 5 Std Cmpnt Tl Ankl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,471.00|FSC: 13; Default||Not reimbursed separately|18,471.00|FSC: 13; Default||External grouping not supported 951202793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 11mm X 375mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951202794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195947|EAP|Custom 95195947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Surgical 25g Micro Straight Ahmed Single-use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 22mm Variax T8 Ft Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 951202797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195948|EAP|Custom 95195948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Micro Tying 23ga Ahmed Single-use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195953|EAP|Custom 95195953||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 120mm 28mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|43,497.00|FSC: 13; Default||Not reimbursed separately|43,497.00|FSC: 13; Default||External grouping not supported 951202800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 34mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951202801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.3mm 38mm T8 2mm St Lck Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951202802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.3mm 40mm T8 2mm St Lck Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951202804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 32mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951202805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195951|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 12cm Mentr Memorygel 4.8cm Ul Hi Prfl Rd Smth 375c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 951202806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial M-d 15h Rt 195mm 2.7/3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.75|FSC: 13; Default||Not reimbursed separately|5,898.75|FSC: 13; Default||External grouping not supported 951202808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197800|EAP|Custom 95197800||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-cut 3.5mm X 90mm Ccm|1|HUMANA [1294]||HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 951202809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195954|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Intro 7cm 5fr .018in 2.9fr Mpnch Chkfl Echtp Aprch 21ga|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch All Sut 1.3mm Rc Y-knt 3 Strn Pro Flx Hi-fi Sft W/rbon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951202813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 45mm Vpr Ti Spne Pa Cnn Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,856.40|FSC: 13; Default||Not reimbursed separately|10,856.40|FSC: 13; Default||External grouping not supported 951202815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197802|EAP|Custom 95197802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 40mm 4.5mm 6in Prlc Qck Cnct Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95195959|EAP|Custom 95195959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtr 5.1cm Md Prf Rnd 13.7cm 525cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197809|EAP|Custom 95197809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Resection Extramedullary Reunion Tsa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bolt Ti Base 5.0x17.5mm Fixed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951202824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 44mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951202828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4.5mm 193mm Peri-lck L-d Fem 8hl Cnt Scl Non Lck Ss Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,078.00|FSC: 13; Default||Not reimbursed separately|3,078.00|FSC: 13; Default||External grouping not supported 951202832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 16mm Prlc Ss T25 Fltx3 St Lck Lng Fgm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951202836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95197806|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 18.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 951202842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95197807|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 17.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95197808|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +34.0 Diop +2.25 Cyl Bcnvx 13mm 6mm Pc 1 Pc Fld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951202847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 80173044|EAP|Custom 80173044||0998 - STATISTICAL CHARGES|Hb Acupuncture Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95197812|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Perciva Vr Df4 Single Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,050.00|FSC: 13; Default||Not reimbursed separately|37,050.00|FSC: 13; Default||External grouping not supported 951202857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95197813|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Perciva Vr Df4 Dual Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,475.00|FSC: 13; Default||Not reimbursed separately|38,475.00|FSC: 13; Default||External grouping not supported 951202859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95195958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6mm 50mm Vpr Ti Spne Pa Cnn Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,850.40|FSC: 13; Default||Not reimbursed separately|10,850.40|FSC: 13; Default||External grouping not supported 951202864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95195960|EAP|Custom 95195960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Plasma Ovalbutton|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95195961|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5.5mm 150cm 150mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95195963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spinal Base 5.0x20.0mm Fixed Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951202870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95195964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spinal Base 5.0x20.0mm Variable Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951202872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95195970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951202874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 80158330|EAP|CPT® 99070||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|HB NUTRIMED SUPP-SANITATION DIST|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158306|EAP|Custom 80158306||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Nutrimed Supplement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158348|EAP|CPT® 99070||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|HB NUTRIMED SOUP-SANITATION DIST|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158314|EAP|Custom 80158314||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Nutrimed Soup|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 951202877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95195962|EAP|Custom 95195962||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 34x24x8mm Base 15d Ti Vrb Ns Lf|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951202885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95195973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 40mm Ti L/t Orth Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951202887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95195974|EAP|Custom 95195974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Circular Eea W/tri-staple Technology 28mm Med/thk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951203602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 15x127 Cur Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 951203603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 17x127 Cur Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 951203604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinematic Duration Patella Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,828.70|FSC: 13; Default||Not reimbursed separately|2,828.70|FSC: 13; Default||External grouping not supported 951203605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Duration Standard Bumper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|FSC: 13; Default||Not reimbursed separately|2,127.30|FSC: 13; Default||External grouping not supported 80158389|EAP|CPT® 71100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ribs Unilat 2 Vw|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 951203606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158397|EAP|CPT® 71110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Ribs Bilateral 3 Vw|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80158421|EAP|CPT® 72074||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Thoracic Spine Ap Lateral And Obli|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 951203607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158447|EAP|CPT® 72190||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Pelvis Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80158454|EAP|CPT® 73020||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Shoulder 1 View|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 951203608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158470|EAP|CPT® 73725||0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - LOWER EXTREMITIES|Hb Mri Angiogram Lower Extremity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,102.29|FSC: 13; Default||Not reimbursed separately|1,102.29|FSC: 13; Default||External grouping not supported 951203609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158488|EAP|CPT® 74185||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mri Angiogram Abdomen Wo Contrast|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|658.59|FSC: 13; Default||Not reimbursed separately|658.59|FSC: 13; Default||External grouping not supported 951203610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Duration 12.5mm Bumper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|FSC: 13; Default||Not reimbursed separately|2,127.30|FSC: 13; Default||External grouping not supported 80158413|EAP|CPT® 72070||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Thoracic Spine Ap And Lateral|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80158439|EAP|CPT® 72080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Thoracolumbar Spine Ap Lateral|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 951203611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Duration 14.5mm Bumper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|FSC: 13; Default||Not reimbursed separately|2,127.30|FSC: 13; Default||External grouping not supported 80158462|EAP|CPT® 73565||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xr Knee Bilateral Ap Standing|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95197827|EAP|Custom 95197827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Allen Ft Thomas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Duration 16.0mm Bumper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|FSC: 13; Default||Not reimbursed separately|2,127.30|FSC: 13; Default||External grouping not supported 80158363|EAP|CPT® 49451||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ir Guided Replacement Of D Or J Tube|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 951203613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158371|EAP|CPT® 49452||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ir Guided Replacement Of G J Tube Per|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 80158512|EAP|HCPCS C8924||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ec Echocardiogram Limited W Contrast|1|HUMANA [1294]||HUMANA [11839]|1,178.78|FSC: 13; Default||Not reimbursed separately|1,178.78|FSC: 13; Default||External grouping not supported 951203614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80236763|EAP|CPT® 75574||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Heart Eval Struct W/bpg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80158595|EAP|HCPCS C8923||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ec Echocardiogram 2d M Mode Complete|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 951203615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158596|EAP|CPT® 93321||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ec Echocardiogram Doppler Limited|1|HUMANA [1294]||HUMANA [11839]|431.00|FSC: 13; Default||Not reimbursed separately|431.00|FSC: 13; Default||External grouping not supported 95197831|EAP|Custom 95197831||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cg Spnl Acis Pro 360 Ti L 8mm|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 80158597|EAP|HCPCS C8928||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ec Echocardiogram Exercise Stress W|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 951203616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Met Encap Insert Duration Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|FSC: 13; Default||Not reimbursed separately|5,170.20|FSC: 13; Default||External grouping not supported 80158599|EAP|HCPCS C8925||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ec Echocardiogram Transesophageal W C|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 95195678|EAP|Custom 95195678||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Dura 14x8cm Drgrd Bvn Pricrd Strl Lf|1|HUMANA [1294]||HUMANA [11839]|2,149.53|FSC: 13; Default||Not reimbursed separately|2,149.53|FSC: 13; Default||External grouping not supported 80158600|EAP|CPT® 74246||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fl Upper Gi W Air Contrast Wo Kub|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 951203617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 9mm Tibial Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,093.50|FSC: 13; Default||Not reimbursed separately|13,093.50|FSC: 13; Default||External grouping not supported 80158601|EAP|CPT® 74240||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fl Upper Gi Water Soluble Wo Kub|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80158605|EAP|CPT® 75563||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Cardiac Stress W Wo Contrast|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 951203618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11mm Tibial Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,093.50|FSC: 13; Default||Not reimbursed separately|13,093.50|FSC: 13; Default||External grouping not supported 80158606|EAP|CPT® 75559||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Cardiac Stress Wo Contrast|1|HUMANA [1294]||HUMANA [11839]|1,372.26|FSC: 13; Default||Not reimbursed separately|1,372.26|FSC: 13; Default||External grouping not supported 95195976|EAP|Custom 95195976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Scrdrvr 2.0mm Long Strdr Slfret Srg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158607|EAP|CPT® 75565||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Cardiac W Flow Velocity W Wo Con|1|HUMANA [1294]||HUMANA [11839]|845.45|FSC: 13; Default||Not reimbursed separately|845.45|FSC: 13; Default||External grouping not supported 951203619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13mm Tibial Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,093.50|FSC: 13; Default||Not reimbursed separately|13,093.50|FSC: 13; Default||External grouping not supported 80158609|EAP|CPT® 75561||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Cardiac W Wo Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95197832|EAP|Custom 95197832||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cg Spnl Acis Pro 360 Ti L 7mm|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 80158610|EAP|CPT® 77022||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Guided Tissue Ablation|1|HUMANA [1294]||HUMANA [11839]|2,912.00|FSC: 13; Default||Not reimbursed separately|2,912.00|FSC: 13; Default||External grouping not supported 951203620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 9mm Tibial Stem W/out Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,479.40|FSC: 13; Default||Not reimbursed separately|9,479.40|FSC: 13; Default||External grouping not supported 80158611|EAP|CPT® 78650||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Csf Leak Detection|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 80158612|EAP|CPT® 78645||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Csf Shunt Evaluation|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 951203621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13mm Tibial Stm W/out Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,479.40|FSC: 13; Default||Not reimbursed separately|9,479.40|FSC: 13; Default||External grouping not supported 80158614|EAP|CPT® 76948||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Us Guided Ova Aspiration|1|HUMANA [1294]||HUMANA [11839]|551.25|FSC: 13; Default||Not reimbursed separately|551.25|FSC: 13; Default||External grouping not supported 951203622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Short Tibia Bearing Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,947.70|FSC: 13; Default||Not reimbursed separately|9,947.70|FSC: 13; Default||External grouping not supported 80158615|EAP|CPT® 76776||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Renal Transplant|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95195978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 9mm Ti Cmpr Lng Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Tibial Bearing Comp 3xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,143.00|FSC: 13; Default||Not reimbursed separately|10,143.00|FSC: 13; Default||External grouping not supported 95197829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.5mm 50mm Reline-o 2s Spine Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951203624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Sm Axle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,616.20|FSC: 13; Default||Not reimbursed separately|3,616.20|FSC: 13; Default||External grouping not supported 951203625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 40mm Humeral Bdy M/f Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|FSC: 13; Default||Not reimbursed separately|9,410.10|FSC: 13; Default||External grouping not supported 951203626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 60mm Humeral Bdy M/f Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|FSC: 13; Default||Not reimbursed separately|9,410.10|FSC: 13; Default||External grouping not supported 951203627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 80mm Humeral Bdy M/f Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|FSC: 13; Default||Not reimbursed separately|9,410.10|FSC: 13; Default||External grouping not supported 62065800|EAP|CPT® 87081||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Vre Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.89|FSC: 13; Default||Not reimbursed separately|19.89|FSC: 13; Default||External grouping not supported 951203628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 100mm Humeral Bdy M/f Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|FSC: 13; Default||Not reimbursed separately|9,410.10|FSC: 13; Default||External grouping not supported 95197830|EAP|Custom 95197830||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 300mm Cocr Straight|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951203629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 120mm Humeral Bdy M/f Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|FSC: 13; Default||Not reimbursed separately|9,410.10|FSC: 13; Default||External grouping not supported 95195984|EAP|Custom 95195984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Circular Eea W/tri-staple Technology 31mm Med/thk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 140mm Humeral Bdy M/f Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|FSC: 13; Default||Not reimbursed separately|9,410.10|FSC: 13; Default||External grouping not supported 951203631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 7mmx75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|FSC: 13; Default||Not reimbursed separately|12,392.10|FSC: 13; Default||External grouping not supported 95195985|EAP|Custom 95195985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stplr Intnl 25mmx3.5mm Ti Thk Circ Eea Dst Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 7mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|FSC: 13; Default||Not reimbursed separately|12,392.10|FSC: 13; Default||External grouping not supported 951203633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 9mmx75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|FSC: 13; Default||Not reimbursed separately|12,392.10|FSC: 13; Default||External grouping not supported 95195986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 2.4/2.7mm Med Va Lcp First Left Mtp Fn Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.70|FSC: 13; Default||Not reimbursed separately|3,299.70|FSC: 13; Default||External grouping not supported 951203634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 9mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|FSC: 13; Default||Not reimbursed separately|12,392.10|FSC: 13; Default||External grouping not supported 95197843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 12mm X3 Cs Rtn Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 11mmx75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|FSC: 13; Default||Not reimbursed separately|12,392.10|FSC: 13; Default||External grouping not supported 95195987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 24mm Ti T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 951203636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 11mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|FSC: 13; Default||Not reimbursed separately|12,392.10|FSC: 13; Default||External grouping not supported 951203637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Screw Humeral Intercalary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.60|FSC: 13; Default||Not reimbursed separately|1,545.60|FSC: 13; Default||External grouping not supported 951203638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 40mm Proximal Humeral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,121.20|FSC: 13; Default||Not reimbursed separately|12,121.20|FSC: 13; Default||External grouping not supported 951203639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 44mm Proximal Humeral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,121.20|FSC: 13; Default||Not reimbursed separately|12,121.20|FSC: 13; Default||External grouping not supported 951203640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 7x75 W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 25mm Body X 75mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 80158637|EAP|CPT® 20999||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation Bone Tumor Rf Perc|1|HUMANA [1294]||HUMANA [11839]|665.67|FSC: 13; Default||Not reimbursed separately|665.67|FSC: 13; Default||External grouping not supported 80158645|EAP|CPT® 49452||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repl Gj Tube Perc Fluor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 951203642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 25mm Body X 100mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Hum Stem W/o Bod 7mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Humeral Stem 9x75 W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 50mm Body X 75mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 95197844|EAP|Custom 95197844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Smth 5.7cm Hg Prf Rnd D14.4cm 650cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 50mm Body X 100mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Hum Stem W/o Bod 9mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 95197851|EAP|Custom 95197851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cmnt Base & Tmp Flng Kit 25g Pwd 14ml Lqu Zoe B&t|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Hum Stem W/o Bod 11mmx75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 75mm Body X 75mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 95197847|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 32.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 75mm Body X 100mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Hum Stem W/o Bod 11mmx115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 951203652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 100mm Body X 50mm Hum Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|FSC: 13; Default||Not reimbursed separately|8,975.40|FSC: 13; Default||External grouping not supported 95197848|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.0 Diopter Acrysof 6.0mm Anterior Asymmet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951203653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 50mm Proximal Hum Cap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951203654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Standard Proximal Femur Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 951203655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Trochanteric Prox Femur Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 95197849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 19mm 44mm Shldr Reunion Std Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 951203656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Std Prox Femur 15¦ Anteverted Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 95195988|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 14x5.5cm 565cc Hsc Hg Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951203657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Trochanteric Prox Femur 15¦ Anteverted Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 951203658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Std Prox Femur 15¦ Anteverted Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 95195989|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 14.3x5.6cm 590cc Hsc Hg Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951203659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Trochanteric Prox Femur 15¦ Anteverted Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 95197845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor System Tendon 10mm Holex1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951203660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm Rt Dist Fem 65mm Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,719.10|FSC: 13; Default||Not reimbursed separately|24,719.10|FSC: 13; Default||External grouping not supported 95195997|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 20x8cm Aldrm Slt 2.0-2.8mm Thk Aclr Derm Algrf Rgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.92|FSC: 13; Default||Not reimbursed separately|89.92|FSC: 13; Default||External grouping not supported 951203661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Std Lt Dist Fem 65mm Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,494.40|FSC: 13; Default||Not reimbursed separately|24,494.40|FSC: 13; Default||External grouping not supported 951203662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Std Rt Dist Fem 65mm Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,494.40|FSC: 13; Default||Not reimbursed separately|24,494.40|FSC: 13; Default||External grouping not supported 95195999|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.7x5.4cm 535cc Hsc Hg Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951203663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bushing Sm Distal Fem Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,058.40|FSC: 13; Default||Not reimbursed separately|1,058.40|FSC: 13; Default||External grouping not supported 95197846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor System Tendon 26mm Holex2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951203664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Sm Distal Femur Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,523.80|FSC: 13; Default||Not reimbursed separately|3,523.80|FSC: 13; Default||External grouping not supported 95195998|EAP|Custom 95195998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Mister/blower Clearview W/attached Tubing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Sm Tib Ins 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 951203666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Sm Tib Ins 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95195990|EAP|Custom 95195990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 13.7cm 5.4cm 535ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Sm Tib Ins 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95197850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Cann 3.2mm 4.5mm 46mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 951203668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Sm Tib Ins 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95195991|EAP|Custom 95195991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 14cm 5.5cm 565ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Sm Tib Ins 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 951203670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm Proximal Tibia Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,670.80|FSC: 13; Default||Not reimbursed separately|24,670.80|FSC: 13; Default||External grouping not supported 95195992|EAP|Custom 95195992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 14.3cm 5.6cm 590ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Standard Proximal Tibial Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,670.80|FSC: 13; Default||Not reimbursed separately|24,670.80|FSC: 13; Default||External grouping not supported 95197852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 30mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951203672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs Sm Tib Trc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,143.00|FSC: 13; Default||Not reimbursed separately|10,143.00|FSC: 13; Default||External grouping not supported 95195993|EAP|Custom 95195993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Xtrnfx 2/3 Ilz 155mm Add Hl Crc Ft Tlt Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 951203674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 95195994|EAP|Custom 95195994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod External Fixation Ilizarov Stainless St Short 150mm Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 95197853|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 470cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 95195995|EAP|Custom 95195995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nut Italian Thick Lilzarov System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 951203678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 95195996|EAP|Custom 95195996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Lead Pcng Atrial Sng Chmb Cnct Mri Cond Strle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 95197854|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 420cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 951203681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19mm Press Fit Fluted Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|FSC: 13; Default||Not reimbursed separately|15,653.40|FSC: 13; Default||External grouping not supported 951203682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95197855|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 445cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non-locking 2.7mm X 10mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951203686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non-locking 2.7mm X 14mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951203688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non-locking 2.7mm X 16mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951203690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19mm Press Fit Bowed Stem 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 32mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951203692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Fusion 18mm 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.00|FSC: 13; Default||Not reimbursed separately|2,667.00|FSC: 13; Default||External grouping not supported 951203694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Comp Lckng 2.4mm X 10mm Xs Plt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 951203696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Comp Lckng 2.4mm X 12mm Xs Plt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 951203698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 951203699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19mm Press Fit Bowed Stem 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|FSC: 13; Default||Not reimbursed separately|16,501.80|FSC: 13; Default||External grouping not supported 95196007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Comp Lckng 2.4mm X 14mm Xs Plt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 951203700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs 80mm Lt Connection Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,914.20|FSC: 13; Default||Not reimbursed separately|14,914.20|FSC: 13; Default||External grouping not supported 951203701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs 90mm Lt Connection Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,914.20|FSC: 13; Default||Not reimbursed separately|14,914.20|FSC: 13; Default||External grouping not supported 95196008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Comp Lckng 2.4mm X 16mm Xs Plt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 951203702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs 80mm Rt Connection Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,052.80|FSC: 13; Default||Not reimbursed separately|15,052.80|FSC: 13; Default||External grouping not supported 951203703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmrs 90mm Rt Connection Piece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,052.80|FSC: 13; Default||Not reimbursed separately|15,052.80|FSC: 13; Default||External grouping not supported 95196009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Comp Lckng 2.4mm X 18mm Xs Plt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 951203704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 30mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95196010|EAP|Custom 95196010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 80mm 0.8mm Krsh Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 50mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 60mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95196011|EAP|Custom 95196011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 100mm 1.6mm Krsh Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 70mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 80mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95196012|EAP|Custom 95196012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg 90mm 1.6mm Ns Lf Reuse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 100mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 120mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95196013|EAP|Custom 95196013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Fusion Cup 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 140mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 160mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 180mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 80171811|EAP|CPT® 33948||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Ecmo Daily Management Venous|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951203715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 200mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 951203716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 220mm Extension Piece - Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 80171822|EAP|CPT® 33949||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Ecmo Daily Management Veno-arterial|1|HUMANA [1294]||HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951203717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Left 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Left 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 95196014|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +22 Diop Mod L Bcnvx 13mm 6mm Pc 1 Pc Fld Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951203719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Left 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Left 180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Left 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Left 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Right 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Right 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Right 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 95196015|EAP|Custom 95196015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Fem Stm 200mm 9mm Stg1 Slct Hip Ss Sil Reinf Spcr Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Right 180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Right 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 95196016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 11mm X 330mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951203728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Distal Femoral Growing Prosthesis Right 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|FSC: 13; Default||Not reimbursed separately|102,139.80|FSC: 13; Default||External grouping not supported 951203729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Bearing Component For Distal Femoral Growing To Pedia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.20|FSC: 13; Default||Not reimbursed separately|9,286.20|FSC: 13; Default||External grouping not supported 95196017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 35mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951203730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Bearing Component For Distal Femoral Growing To Mrh K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.20|FSC: 13; Default||Not reimbursed separately|9,286.20|FSC: 13; Default||External grouping not supported 951203731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Bearing Component For Distal Femoral Growing To Gmrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.20|FSC: 13; Default||Not reimbursed separately|9,286.20|FSC: 13; Default||External grouping not supported 95196018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 37.5mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951203732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ica Fem Comp 18mm Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,732.70|FSC: 13; Default||Not reimbursed separately|11,732.70|FSC: 13; Default||External grouping not supported 951203733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wichita Nail Tib Comp 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,295.00|FSC: 13; Default||Not reimbursed separately|8,295.00|FSC: 13; Default||External grouping not supported 95196019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 40mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951203734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wichita Nail Compression Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,840.10|FSC: 13; Default||Not reimbursed separately|5,840.10|FSC: 13; Default||External grouping not supported 951203735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x25mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 95196020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 50mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951203736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x30mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 951203737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x35mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 95196021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 70mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951203738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x40mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 951203739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x45mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 95196022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 9mm Evos T6 Cort St Mn Plt Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 951203740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x50mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 951203741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x55mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 95196023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 21mm T6 Cortx Slfret Scrdrvr St Flt Hd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 951203742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wfn 6.0x60mm Full-thd Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|FSC: 13; Default||Not reimbursed separately|816.90|FSC: 13; Default||External grouping not supported 951203743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vak Tib Ins 5mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,709.90|FSC: 13; Default||Not reimbursed separately|5,709.90|FSC: 13; Default||External grouping not supported 951203744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vak Std Tib Insert 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,709.90|FSC: 13; Default||Not reimbursed separately|5,709.90|FSC: 13; Default||External grouping not supported 951203745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 80171834|EAP|CPT® 12052||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Intermediate Repair Face Ears Eyes Nose Lips 2.6cm To 5.0cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951203749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 34mm Ti Cmpr Sh Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|FSC: 13; Default||Not reimbursed separately|1,170.30|FSC: 13; Default||External grouping not supported 951203753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Sml 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Spinal Bon3e Graft 17mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.48|FSC: 13; Default||Not reimbursed separately|753.48|FSC: 13; Default||External grouping not supported 951203755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 38mm Cmpr Ft Ti Std Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951203757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196031|EAP|Custom 95196031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Acl Soft Tissue Fixation Disposable Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196032|EAP|Custom 95196032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Leg Positioner Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Med 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196033|EAP|Custom 95196033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Opth 2.2mm Clrct Ang Sng Bvl Stn Fnsh Strl Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch All Sut 1.7mm Shlw Y-knt 1 Strn Hi-fi W/ndl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,448.49|FSC: 13; Default||Not reimbursed separately|1,448.49|FSC: 13; Default||External grouping not supported 951203765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196035|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +8.5 Diop +2.5 Cyl Bcnvx 13mm 6mm Pc 1 Pc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951203767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196036|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 10 D +8.5 Diop +3 Cyl Bcnvx 13mm 6mm Pc Mlpc Fld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951203769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Lrg 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L70 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 951203771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Xlrg 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Xlrg 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 95196038|EAP|Custom 95196038||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Intvrtb 14mm 5mm Pstg Lp Cspn Ti|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 951203773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Xlrg 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Xlrg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 80171844|EAP|CPT® 12051||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Intermediate Repair Face Ears Eyes Nose Lips 2.5cm Or Less|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951203775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Xlrg 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins Xlrg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|FSC: 13; Default||Not reimbursed separately|3,565.80|FSC: 13; Default||External grouping not supported 951203777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,425.10|FSC: 13; Default||Not reimbursed separately|3,425.10|FSC: 13; Default||External grouping not supported 95196039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 8mm Gorilla R3con Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951200258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 19mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951200259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 20mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951200260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 21mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951200261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 22mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95196042|EAP|Custom 95196042||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Assembly Mini-x-fix 35mm|1|HUMANA [1294]||HUMANA [11839]|21,195.00|FSC: 13; Default||Not reimbursed separately|21,195.00|FSC: 13; Default||External grouping not supported 951200262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 23mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951200263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 24mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95196043|EAP|Custom 95196043||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Self Drilling Cortical 3.0mm 60mm 15mm|1|HUMANA [1294]||HUMANA [11839]|489.00|FSC: 13; Default||Not reimbursed separately|489.00|FSC: 13; Default||External grouping not supported 951200264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 25mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951200265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Distal Bowed Stem 26mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 95196044|EAP|Custom 95196044||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Self Drilling Cortical 3.0mm 60mm 20mm|1|HUMANA [1294]||HUMANA [11839]|489.00|FSC: 13; Default||Not reimbursed separately|489.00|FSC: 13; Default||External grouping not supported 951200266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 11mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 12mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 1-level 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 951200268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 13mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 14mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 15mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 16mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 17mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 18mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion17mm X 102mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951200274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 19mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 20mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Unipolar Cemented Low Dmd Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951200276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 21mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 22mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 23mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 24mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 25mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 26mmx127mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 11mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Broad Y 4 Hole T10 Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|FSC: 13; Default||Not reimbursed separately|5,367.00|FSC: 13; Default||External grouping not supported 951200283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 12mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 13mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196052|EAP|Custom 95196052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Biopsy Backloading Bigopsy 2.4fr 116cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 14mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 15mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196054|EAP|Custom 95196054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Driver Locking Ao 3.5t|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 16mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 17mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 95196055|EAP|Custom 95196055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic 5frx.035in Dia 80x14cm Lp Pta Adv 35lp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 18mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 19mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 20mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 21mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 22mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 23mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 24mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 25mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Stem 26mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951200298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 11mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 62065820|EAP|CPT® 86927||0309 - LABORATORY - OTHER LABORATORY|Hb Fresh Frozen Plasma, Thawing, Each Unit|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 951200299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 12mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 13mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196057|EAP|Custom 95196057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Spectra Optia Idl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 14mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 15mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196058|EAP|Custom 95196058||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Ao Qck Cnct Ovr Evos Mn 2.7mm Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 16mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 17mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 22mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 951200305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 18mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 19mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 26mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 951200307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 20mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 21mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 32mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 951200309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 22mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 23mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 22mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 951200311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 24mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 25mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 36mm 2.7mm 4.5mm Cortex Self Tap Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951200313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 26mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 11mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 2 Hl 23mm Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.00|FSC: 13; Default||Not reimbursed separately|1,419.00|FSC: 13; Default||External grouping not supported 951200315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 12mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 13mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 14mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 15mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 55mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951200319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 16mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 17mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 60mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951200321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 18mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 19mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 18x18mm Ntnl Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 951200323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 20mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 21mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 11x15/12mm Arthrex Dynanite Ntnl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951200325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 22mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 23mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951200327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 24mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 25mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 95196074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951200329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 26mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|FSC: 13; Default||Not reimbursed separately|13,087.20|FSC: 13; Default||External grouping not supported 951200330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 11mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Baby Gorilla 1.1mm Compression Straight 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|FSC: 13; Default||Not reimbursed separately|2,691.00|FSC: 13; Default||External grouping not supported 951200331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 12mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 13mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7/3.5mm Evos Ea-d Hum 16h R 195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.00|FSC: 13; Default||Not reimbursed separately|4,368.00|FSC: 13; Default||External grouping not supported 951200333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 14mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 15mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 19mm Evos Mn Ss T8 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951200335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 16mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 17mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196076|EAP|Custom 95196076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 1.2 X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 18mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197856|EAP|Custom 95197856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.9mm X 70mm Non-sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 19mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196077|EAP|Custom 95196077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Rfa 100mm 20ga Cosman 10mm Active Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 20mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 21mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196078|EAP|Custom 95196078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Rfa 100mm 20ga Cosman 5mm Active Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 22mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197857|EAP|Custom 95197857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 20.mm X 65mm Cann Ao Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 23mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196079|EAP|Custom 95196079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Rfa 150mm 20ga Cosman 10mm Active Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 24mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 25mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196080|EAP|Custom 95196080||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Grounding Cosman|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 26mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 11mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197858|EAP|Custom 95197858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Symmetric Pds Plus Violet 1 30cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 12mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 13mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 14mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 12mm Headless Compression Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|FSC: 13; Default||Not reimbursed separately|814.80|FSC: 13; Default||External grouping not supported 951200350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 15mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 16mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 40cm Rt Intertrochanter Intertan Im 130d 1.5mm 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951200352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 17mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 62065830|EAP|CPT® 81229||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Genomic Snp Microarray ,prod Of Conception-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 951200353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 18mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 19mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196114|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Psmx Gentrix 5cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|FSC: 13; Default||Not reimbursed separately|1,845.00|FSC: 13; Default||External grouping not supported 951200355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 20mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 21mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196115|EAP|Custom 95196115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Psr Xor Ew Iii W/o Hk Flx Stur Inst|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 22mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197649|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.7x4.9cm 505cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 23mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196083|EAP|Custom 95196083||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 12x11cm Brst 270-330cc Smth Srfc Intgr Port Allo|1|HUMANA [1294]||HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 951200359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 24mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 951200360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 25mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95196084|EAP|Custom 95196084||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 11x10.2cm Brst 230-280cc Smth Srfc Intgr Port Allo|1|HUMANA [1294]||HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 951200361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Fluted Distal Bowed Stem 26mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|FSC: 13; Default||Not reimbursed separately|12,728.10|FSC: 13; Default||External grouping not supported 95197861|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 38mm X 161mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,458.30|FSC: 13; Default||Not reimbursed separately|46,458.30|FSC: 13; Default||External grouping not supported 951200362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 24mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95196085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion 11mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951200363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 25mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 951200364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 26mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95196086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammer Tub 2.7mm 0deg Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 951200365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 27mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95197866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 36cm Rt Troch Intertan Im 130deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951200366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 28mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95196087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammer Tub 3.50mm 0deg Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 951200367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 14mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 951200368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 20mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95196088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammer Tub 2.75mm 10deg Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 951200369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 21mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95197867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 0d Shrt Gorilla Bn Mtp Rt 2hl Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 951200370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 22mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95196089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammer Tub 3.50mm 10deg Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 951200371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 23mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 951200372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 24mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95196090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Hammertube 2.75mm 0deg Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|FSC: 13; Default||Not reimbursed separately|4,851.00|FSC: 13; Default||External grouping not supported 951200373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 25mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95197868|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Artic Front Advance Pro Cryoablation 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 26mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95196091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Hammertube 3.50mm 0deg Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|FSC: 13; Default||Not reimbursed separately|4,851.00|FSC: 13; Default||External grouping not supported 951200375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 27mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 951200376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Stem 28mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95196092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Hammertube 2.75mm 10deg Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|FSC: 13; Default||Not reimbursed separately|4,851.00|FSC: 13; Default||External grouping not supported 951200377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 14mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95197869|EAP|HCPCS C1733||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Artic Front Advance Pro Cryoablation 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,950.00|FSC: 13; Default||Not reimbursed separately|13,950.00|FSC: 13; Default||External grouping not supported 951200378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 16mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Hammertube 3.50mm 10deg Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|FSC: 13; Default||Not reimbursed separately|4,851.00|FSC: 13; Default||External grouping not supported 951200379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 17mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 951200380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 18mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 8mm Nonlock Hexalobe Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 951200381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 19mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95197863|EAP|Custom 95197863||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aor 23mm Lotus Edge Sys Lg Lotus Intr Set|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951200382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 20mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196100|EAP|Custom 95196100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Planer Bone 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 21mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 951200384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 22mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196101|EAP|Custom 95196101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inserter Implant 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 23mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95197864|EAP|Custom 95197864||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aor 25mm Lotus Edge Sys Lg Lotus Intr Set|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951200386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 24mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196102|EAP|Custom 95196102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inserter Implant 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 25mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 951200388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 26mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196103|EAP|Custom 95196103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 27mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95197865|EAP|Custom 95197865||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aor 27mm Lotus Edge Sys Lg Lotus Intr Set|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951200390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 28mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95196104|EAP|Custom 95196104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 3.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 14mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 15mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196106|EAP|Custom 95196106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Insert Trocat Tip 1.4mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 16mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 17mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196107|EAP|Custom 95196107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Insert Trocar Tip 1.6mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 18mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 19mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196110|EAP|Custom 95196110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Tool Hammertube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 20mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 80173055|EAP|Custom 80173055||0100 - ALL INCLUSIVE RATE - ALL-INCLUSIVE ROOM & BOARD PLUS ANCILLARY|Hb Inpt All Inclusive Charge Adjustment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 21mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196111|EAP|Custom 95196111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Puller Hammertoe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 22mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 23mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196112|EAP|Custom 95196112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 24mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 25mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196113|EAP|Custom 95196113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 3.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 26mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 27mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 95196108|EAP|Custom 95196108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Trocar Smooth 1.4mm X150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Conical Distal Bowed Stem 28mmx235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|FSC: 13; Default||Not reimbursed separately|13,290.90|FSC: 13; Default||External grouping not supported 951200406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 13mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95196109|EAP|Custom 95196109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Trocar Smooth 1.6mm X150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 14mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95197872|EAP|Custom 95197872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hi Pr 13.4cm 5.3cm 505ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 15mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95196095|EAP|Custom 95196095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Trocar 1.4mm X150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 16mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 951200410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 17mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95196096|EAP|Custom 95196096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Trocar 1.6mm X150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 18mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95197875|EAP|Custom 95197875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Fixation Surgical Procedure W/380mm Glenoid K-wirex3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 19mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95196097|EAP|Custom 95196097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Blunt Smooth 1.1mm X30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 20mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 951200414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 21mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95197878|EAP|Custom 95197878||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm Surgical Long Glenoid Latarjet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 22mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95196098|EAP|Custom 95196098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Blunt Smooth 1.4mm X30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 23mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 951200417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 24mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 951200418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 25mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95196099|EAP|Custom 95196099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip K-wire Double Ended Blunt Smooth 1.6mm X30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 26mmx167mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|FSC: 13; Default||Not reimbursed separately|13,820.10|FSC: 13; Default||External grouping not supported 95197871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 18mm Axsos 3 Ti Cort Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 951200420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 13mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 14mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 15mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95197873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial M-d 18h Rt 228mm 2.7/3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,162.75|FSC: 13; Default||Not reimbursed separately|6,162.75|FSC: 13; Default||External grouping not supported 951200423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 16mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 17mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95197874|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 21.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 18mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 19mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95197876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 36mm Latarjet Titanium Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 951200427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 20mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 21mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95197877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 32mm Latarjet Titanium Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 951200429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 22mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 23mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95197811|EAP|Custom 95197811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prism Hands Free Clip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 24mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 951200432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 25mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95197879|EAP|Custom 95197879||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Presutured Tendon Versagraft 150-250mm 4-5mm Strl|1|HUMANA [1294]||HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 951200433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 26mmx217mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|FSC: 13; Default||Not reimbursed separately|14,456.40|FSC: 13; Default||External grouping not supported 95196105|EAP|Custom 95196105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Insert Trocar Tip 1.1mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion12m X 96m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951201140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95197880|EAP|Custom 95197880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Orbital Silicone 18mm Nonsterile|1|HUMANA [1294]||HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 951201141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Standard Fem Stem-sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 4.50mm Ul Pk Sm Slng Slf Lckng Ach Tnd Rp Ftp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,070.70|FSC: 13; Default||Not reimbursed separately|1,070.70|FSC: 13; Default||External grouping not supported 951201142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-lateralis Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-lateral Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196120|EAP|Custom 95196120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg 4mm Lng St F/4.5mm Footprint Anch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196121|EAP|Custom 95196121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Packed Sterile 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196122|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Penl Ams 700 Lgx Ms Pmp 10cm Infl Precnct Penoscrotal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,500.00|FSC: 13; Default||Not reimbursed separately|31,500.00|FSC: 13; Default||External grouping not supported 951201150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 202mm Ti 12 Hl Axsos 3 Bn Hum Lt Prox Lat Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,772.00|FSC: 13; Default||Not reimbursed separately|11,772.00|FSC: 13; Default||External grouping not supported 951201152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Lateral Fem Stem-sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125degree Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling/self-tapping Rescue 4.5mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951201156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Trigen Meta-nail Titanium L32cm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|FSC: 13; Default||Not reimbursed separately|4,717.50|FSC: 13; Default||External grouping not supported 951201158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196129|EAP|Custom 95196129||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 18cm 26mm 12mm Gore Xcldr C3 Trk Ipis Lg 18fr|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 951201160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7/3.5mm Evos Pl D Hum 16h R 129mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,108.50|FSC: 13; Default||Not reimbursed separately|4,108.50|FSC: 13; Default||External grouping not supported 951201162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Metafix Fem Stem-125 Degr Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 20mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 951201164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196132|EAP|Custom 95196132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Mesh 12mmx23mm 8mm Height Ti|1|HUMANA [1294]||HUMANA [11839]|11,430.00|FSC: 13; Default||Not reimbursed separately|11,430.00|FSC: 13; Default||External grouping not supported 951201172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196133|EAP|Custom 95196133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Mesh 12mmx23mm 4mm Height Ti|1|HUMANA [1294]||HUMANA [11839]|11,430.00|FSC: 13; Default||Not reimbursed separately|11,430.00|FSC: 13; Default||External grouping not supported 951201174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 132 Hip Stem #14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196138|EAP|HCPCS Q4152||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tissue 3cmx4cm Dermapure Dcellztn Strl|1|HUMANA [1294]||HUMANA [11839]|287.50|FSC: 13; Default||Not reimbursed separately|287.50|FSC: 13; Default||External grouping not supported 951201178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196139|EAP|HCPCS Q4152||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tissue 4cmx6cm Dermapure Dcellztn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|274.57|FSC: 13; Default||Not reimbursed separately|274.57|FSC: 13; Default||External grouping not supported 951201180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 95196140|EAP|HCPCS Q4152||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tissue 7cmx10cm Dermapure Dcellztn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 951201182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Max 127 Hip Stem #13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|FSC: 13; Default||Not reimbursed separately|16,014.60|FSC: 13; Default||External grouping not supported 951201183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #5/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196141|EAP|Custom 95196141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Patel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #5/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95161358|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Cath 10cm 6fr Pn Strght Cross-cut Vl Hydrop 0.038in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #7/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #7/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95197883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 30mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951201189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #9/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Im Nl 440mm 11mm Gma 125d Lng R1.5 Fem Rt Ti Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 951201192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #9/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95197884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 32mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951201193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196144|EAP|Custom 95196144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Prfsn 20fr Art 0.375in 45d 12in Slct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #10/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #11/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196145|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.25mm 15mm Cor Rx Radopq Smth Rnd Tip Tung Nc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #11/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #12/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196146|EAP|Custom 95196146||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 38x28x10mm Brigade 15d Ti Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951201198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #12/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #13/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-d 6h Rt 91mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,032.50|FSC: 13; Default||Not reimbursed separately|5,032.50|FSC: 13; Default||External grouping not supported 951201200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #13/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 80173066|EAP|CPT® 31600||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tracheostomy Planned|1|HUMANA [1294]||HUMANA [11839]|8,085.71|FSC: 13; Default||Not reimbursed separately|8,085.71|FSC: 13; Default||External grouping not supported 951201201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max#14/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95196148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 70mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 951201202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Secur-fit Plus Max #14/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951201203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #0 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 65mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 951201204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 80173077|EAP|CPT® 31603||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tracheostomy Emergency Procedure|1|HUMANA [1294]||HUMANA [11839]|4,165.40|FSC: 13; Default||Not reimbursed separately|4,165.40|FSC: 13; Default||External grouping not supported 951201205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196150|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel 11.9cm 4.1cm Xtra 325cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 951201206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 951201207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 951201208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 80173088|EAP|CPT® 31730||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ttrach Intro Ndl Wire Dil/stent/tube O2 Ther|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 951201209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Colr Actis 9 Duofix Cmt Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 951201210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 951201211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 277mm Ti 16 Hl Axsos 3 Bn Tib Lt Prox Lat Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.00|FSC: 13; Default||Not reimbursed separately|10,695.00|FSC: 13; Default||External grouping not supported 951201212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #9 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 80173099|EAP|CPT® 64488||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tap Block Bilateral By Injection(s)|1|HUMANA [1294]||HUMANA [11839]|4,028.00|FSC: 13; Default||Not reimbursed separately|4,028.00|FSC: 13; Default||External grouping not supported 951201213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #0 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 9mm 340cm Sp Cndl T2 Im Lng Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 951201214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 951201215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 38cm Lt Troch Intertan Im 130deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951201216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 80173100|EAP|CPT® 93503||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insertion Flow Directed Catheter For Monitoring|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 951201217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196156|EAP|Custom 95196156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Medical Core Decompression/delivery Kit Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 951201219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 50mm 2.5mm Ijs Axis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951201220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95197885|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 45cm Supra Cross Large Curve 8.5f Steerable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 95196158|EAP|Custom 95196158||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sizer Implant 11.3cm Memorygel P3.4cm Smooth Round Moderate|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951201222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Stem #9 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|FSC: 13; Default||Not reimbursed separately|15,859.20|FSC: 13; Default||External grouping not supported 951201223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #0 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95197886|EAP|Custom 95197886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Supra Cross Rf 180cm Od 0.035in 10ft Connector Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95197888|EAP|Custom 95197888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Opening 11.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #9 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95196179|EAP|Custom 95196179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Ao Qck Cnct Ovr Evos Mn 3.5mm Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #0 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95197889|EAP|Custom 95197889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-cut 3.5mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951201234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95196189|EAP|Custom 95196189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Drill Tip Recon 3.2mm 400mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 951201236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95196184|EAP|Custom 95196184||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 14cm 28mm 14.5mm 12cm Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 951201237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95197890|EAP|Custom 95197890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tamp Surgical Inflatable Bone Express Ii 20/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Citation Tmzf Ha Short Stem #9 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|FSC: 13; Default||Not reimbursed separately|17,140.20|FSC: 13; Default||External grouping not supported 95196169|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 10.8x4.4cm 255cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Arc/ha Collar Stem#4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 951201240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Arc/ha Collar Stem#5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 95196170|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Hi Pr 10.8cm 4.4cm 255ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Arc/ha Collar Stem#6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 95197891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Interbody Device 33mm X 26mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 951201242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Arc/ha Collar Stem#7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 95196171|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.1x4.5cm 280cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Arc/ha Collar Stem#8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 951201244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Secur-fit Arc/ha Collar Stem#9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 95196172|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Hi Pr 11.1cm 4.5cm 280ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Securfit Arc/ha Collar Stem#10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 951201246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Securfit Arc/ha Collar Stem#11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 95196173|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.7x4.0cm 305cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Securfit Arc/ha Collar Stem#12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 951201248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Securfit Arc/ha Collar Stem#13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 95196174|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod Pr 11.7cm 4.0cm 305ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Securfit Arc/ha Collar Stem#14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|FSC: 13; Default||Not reimbursed separately|16,869.30|FSC: 13; Default||External grouping not supported 951201250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #05 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196175|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.8x4.4cm 325cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #06 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #07 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196176|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod Pr 11.8cm 4.4cm 325ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #08 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #09 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Lckng Ankle Prim Rt Comp 3.5mm 92mm 5h Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|FSC: 13; Default||Not reimbursed separately|3,217.50|FSC: 13; Default||External grouping not supported 951201255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #10 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #11 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L26 Mm Od3.5 Mm Odsec6.8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 951201257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #05 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #06 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 26mm 3.5mm 6.8 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951201259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #07 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #08 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L38 Mm Od3.5 Mm Odsec6.8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 951201261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #09 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnifit Hfx Hip Stem Size #10 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 46mm 3.5mm 6.8 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951201263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Hfx Size #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 951201264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accolade Hfx Size #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|FSC: 13; Default||Not reimbursed separately|5,756.10|FSC: 13; Default||External grouping not supported 95196167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 34mm 3.5mm 6.8 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951201265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #0/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #1/11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #2/12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #3/13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 34mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951201269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #4/14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #5/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 36mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951201271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #6/16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 951201272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reliance Pf Hip #7/17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95196181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Evos Locking 3.5mm 93mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.15|FSC: 13; Default||Not reimbursed separately|1,107.15|FSC: 13; Default||External grouping not supported 951201273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 4 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 5 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11.5mm 36cm Intertrochanter Lt Trgn Intertan Im 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951201275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 6 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 6 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Broad Y-plate 7 Hole Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,904.00|FSC: 13; Default||Not reimbursed separately|5,904.00|FSC: 13; Default||External grouping not supported 951201277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 7 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 7 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 162mm 12 Hl Lck Cmpr Axsos Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,978.00|FSC: 13; Default||Not reimbursed separately|6,978.00|FSC: 13; Default||External grouping not supported 951201279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 8 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 8 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 18mm Ti Cort Lck Ns Axsos 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 951201281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 9 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 9 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 10 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 10 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 380mm Fem Gt Lt T2 Im Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,834.00|FSC: 13; Default||Not reimbursed separately|12,834.00|FSC: 13; Default||External grouping not supported 951201285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 11 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 11 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 127 Size 12 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 132 Size 12 Secur-fit Advanced Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 1 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 2 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 3 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 4 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 5 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196190|EAP|Custom 95196190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Screw Lag Recon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 6 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 7 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196191|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Spinal Coflex Sz 14mm|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951201296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 8 Right Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 1 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196192|EAP|Custom 95196192||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 15x13.8cm Brst 600-720cc Smth Intgr Port Allox2|1|HUMANA [1294]||HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 951201298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 2 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 3 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling/self-tapping Rescue 4.5mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951201300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 4 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 5 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196195|EAP|Custom 95196195||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 12x14x9mm 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951201302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 6 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 7 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Broad Y-plate 3 Hole Variax Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|FSC: 13; Default||Not reimbursed separately|5,367.00|FSC: 13; Default||External grouping not supported 951201304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 8 Right Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 1 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular L-d 11h L 147mm 3.5 Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,326.50|FSC: 13; Default||Not reimbursed separately|2,326.50|FSC: 13; Default||External grouping not supported 951201306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 2 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 3 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Unipolar High Dmd W/unipolar Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 951201308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 4 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 5 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Persona Hyb-tm Fem Cm Tb-cps Ve Sur-std-pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,118.00|FSC: 13; Default||Not reimbursed separately|17,118.00|FSC: 13; Default||External grouping not supported 951201310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 6 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 7 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95196200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tandem Bipolar Fem W/co Cr Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 951201312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 8 Left Anteverted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 1 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951202018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 95196216|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 5mm 37mm 135cm Bln Expandable Loprfl Cvr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 951202026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 95196217|EAP|Custom 95196217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ndl Bn Cmnt 13ga 4in Dm Tip Intch Mtch Grnd Blv St Cann|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Constrained Acetabular Inserts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|FSC: 13; Default||Not reimbursed separately|10,959.90|FSC: 13; Default||External grouping not supported 951202035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Ss Beaded Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 2.0mm Ss Beaded Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Ss Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 2.0mm Ss Cable/sleeve Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Ss Cable Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 2.0mm Ss Cable Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Small Stainless Steel Grip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,899.70|FSC: 13; Default||Not reimbursed separately|3,899.70|FSC: 13; Default||External grouping not supported 95196218|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Tissue Pre Cut Split For Dmek Patel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 951202042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Medium Stainless Steel Grip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,899.70|FSC: 13; Default||Not reimbursed separately|3,899.70|FSC: 13; Default||External grouping not supported 951202043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Meduim Stainless Steel Grip Plate 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,804.80|FSC: 13; Default||Not reimbursed separately|4,804.80|FSC: 13; Default||External grouping not supported 95196219|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Tissue Pre Cut Split For Dmek Patel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 951202044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Meduim Stainless Steel Grip Plate 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,302.10|FSC: 13; Default||Not reimbursed separately|6,302.10|FSC: 13; Default||External grouping not supported 951202045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Meduim Stainless Steel Grip Plate 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,807.80|FSC: 13; Default||Not reimbursed separately|7,807.80|FSC: 13; Default||External grouping not supported 95196220|EAP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drsg Bio 2x2in Intgr Bvn Clgn Gag Polysiloxane Bl Mx Mesh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,499.50|FSC: 13; Default||Not reimbursed separately|3,499.50|FSC: 13; Default||External grouping not supported 951202046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Stainless Steel Grip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,899.70|FSC: 13; Default||Not reimbursed separately|3,899.70|FSC: 13; Default||External grouping not supported 951202047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Stainless Steel Grip Plate 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,804.80|FSC: 13; Default||Not reimbursed separately|4,804.80|FSC: 13; Default||External grouping not supported 951202048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Stainless Steel Grip Plate 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,302.10|FSC: 13; Default||Not reimbursed separately|6,302.10|FSC: 13; Default||External grouping not supported 951202049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dall Miles Large Stainless Steel Grip Plate 210mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,807.80|FSC: 13; Default||Not reimbursed separately|7,807.80|FSC: 13; Default||External grouping not supported 95196222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 25mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951202050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 6.5" Ss Broad Comp Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|FSC: 13; Default||Not reimbursed separately|1,995.00|FSC: 13; Default||External grouping not supported 951202051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 8.0" Ss Broad Comp Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|FSC: 13; Default||Not reimbursed separately|1,995.00|FSC: 13; Default||External grouping not supported 95196240|EAP|Custom 95196240||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Latera Absorbable Nasal Implants System Delivery Device|1|HUMANA [1294]||HUMANA [11839]|4,517.97|FSC: 13; Default||Not reimbursed separately|4,517.97|FSC: 13; Default||External grouping not supported 951202052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 10" Ss Broad Comp Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|FSC: 13; Default||Not reimbursed separately|1,995.00|FSC: 13; Default||External grouping not supported 951202053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 12" Ss Broad Comp Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|FSC: 13; Default||Not reimbursed separately|1,995.00|FSC: 13; Default||External grouping not supported 95196223|EAP|Custom 95196223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 2.0x450mm Hoffman Ii Olive Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 1.6mm Ss Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 951202055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb D/m 2.0mm Ss Cable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|FSC: 13; Default||Not reimbursed separately|1,270.50|FSC: 13; Default||External grouping not supported 95196224|EAP|Custom 95196224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 450mm 2mm Krsh Blnt Smth Ext Fx Sys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Head 28mm Diameter +0mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 951202057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Head 28mm Diameter -5mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95196225|EAP|Custom 95196225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Xtrnfx Full 180mm Crbn Ft/ankl Fix Sys Hoffmn Ii Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Head 28mm Diameter +5mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 951202059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Head 32mm Diameter +0mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95196226|EAP|Custom 95196226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Foot Arch External Fx 180mm Aluminum Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Head 32mm Diameter -5mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 951202061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Head 32mm Diameter +5mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95196227|EAP|Custom 95196227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Foot Ext Fx 180mm Dia Long Aluminum Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Abg I Revison Hooded Acetabular Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,802.30|FSC: 13; Default||Not reimbursed separately|5,802.30|FSC: 13; Default||External grouping not supported 951202063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 54 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196228|EAP|Custom 95196228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut Xtrnfx 138-201mm Med Tlcp Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 54 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197895|EAP|Custom 95197895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 80mm|1|HUMANA [1294]||HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 951202065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 56 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 56 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 58 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95154913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Evolve +2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95196230|EAP|Custom 95196230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bolt Xtrnfx 6mm Crbn Hoffmn Ii Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 58 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197896|EAP|Custom 95197896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 90mm|1|HUMANA [1294]||HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 951202069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 60 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196231|EAP|Custom 95196231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut Xtrnfx Lng 60mm Crbn Hl 5f Ft/ankl Fx Sys Hoffmn Ii Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 60 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 62 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196232|EAP|Custom 95196232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Foot Carbon Fiber Long 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 62 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197897|EAP|Custom 95197897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Eit 6mm 8 Degree Sterlie|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951202073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 64 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196233|EAP|Custom 95196233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Surgical 7mm/10mm W/spanner F/ext Fx Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 64 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 66 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 66 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 68 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196235|EAP|Custom 95196235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bolt Xtrnfx 1.5mm-2mm Shrt Crbn Wire Hl 10 Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 68 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197898|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endo 204mm 34mm Zenith Tx2 Disct Strght Cmpnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,340.00|FSC: 13; Default||Not reimbursed separately|53,340.00|FSC: 13; Default||External grouping not supported 951202079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 70 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196236|EAP|Custom 95196236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Xtrnfx Lng Wire Bolt Offset F/limb Recon Frm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 70 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 72 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196237|EAP|Custom 95196237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Xtrnfx Shrt Wire Bolt Offset F/limb Recon Frm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 72 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197899|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 80mm 36mm Znth Tx2 Dissection Str Comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,423.00|FSC: 13; Default||Not reimbursed separately|45,423.00|FSC: 13; Default||External grouping not supported 951202083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 74 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196238|EAP|Custom 95196238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Xtrnfx Short Apex Pin F/limb Recon Fr Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 74 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 76 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196239|EAP|Custom 95196239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bolt Xtrnfx 1.5mm-2mm Med Crbn Wire Hl 5 Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 76 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 78 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 24mm Spnl Ma Impt Occipitocrvical Up Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951202088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 78 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 951202089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 80 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95196241|EAP|Custom 95196241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Hlf Xtrnfx 6mm 60mmx180mm Apex Th S/d Ss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoration Anatomic Shell Size 80 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|FSC: 13; Default||Not reimbursed separately|14,196.00|FSC: 13; Default||External grouping not supported 95197893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 28mm Spnl Ma Impt Occipitocrvical Up Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951202091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95196242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 9mm 170mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 951202092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 951202093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tritanium Revision Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95196243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Hydroset Xt Ha 15cc Injectable Sterile Latex Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,354.00|FSC: 13; Default||Not reimbursed separately|21,354.00|FSC: 13; Default||External grouping not supported 951202094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt S2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 28mm Spnl Ma Impt Occipitocrvical Up Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951202095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt S2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt S2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt M1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt M1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt M1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 80171866|EAP|CPT® 51798||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Measurement Of Post-voiding Residual Urine Ultrasound Non Imaging|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 951202100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt M1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197911|EAP|Custom 95197911||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fiberstitch Curved W/2 Polyster Implants 2-0 Fiberw|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951202101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt M2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 80171877|EAP|CPT® 12034||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intermediate Repair 7.6-12.5 Cm|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 951202102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt M2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt M2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt M2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197319|EAP|Custom 95197319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Port Precision Spectra Ipg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt L1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt L1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt L1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 343mm Ti 16 Hl Axsos 3 Bn Fem Rt Dist Lat Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,855.00|FSC: 13; Default||Not reimbursed separately|12,855.00|FSC: 13; Default||External grouping not supported 951202108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt L1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197900|EAP|Custom C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 143cm 12mm Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt L2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 12mm Ti Lck Ns Axsos 3 Periprosthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 951202110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt L2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt L2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196247|EAP|Custom 95196247||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 16x14.7cm Brst 750-900cc Smth Intgr Port Allox2|1|HUMANA [1294]||HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951202112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt L2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197901|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4.5mm 143cm 12mm Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt Xl1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196248|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 19.3x9.6cm Aldrm Slct Thk 2.0-0.4mm Thin Cntr Alg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.93|FSC: 13; Default||Not reimbursed separately|65.93|FSC: 13; Default||External grouping not supported 951202114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt Xl1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt Xl1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 227mm 12 Hl Lck Cmpr Axsos Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,078.00|FSC: 13; Default||Not reimbursed separately|9,078.00|FSC: 13; Default||External grouping not supported 951202116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt Xl1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197902|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 143cm 12mm Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt Xl2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196250|EAP|Custom 95196250||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 12cm 26mm 16mm Gore Xcldr C3 Trk Ipis Lg 16fr|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 951202118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Rt Flt Xl2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 951202119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt Xl2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95196251|EAP|Custom 95196251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape Mini Blue 39.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Tib Wedge Lt Flt Xl2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|FSC: 13; Default||Not reimbursed separately|3,124.80|FSC: 13; Default||External grouping not supported 95197903|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 143cm 15mm Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon L-2 10mm Full Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|FSC: 13; Default||Not reimbursed separately|5,216.40|FSC: 13; Default||External grouping not supported 95196252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|FSC: 13; Default||Not reimbursed separately|918.00|FSC: 13; Default||External grouping not supported 951202122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dura Uni Fem Lt Med/rt Lat Sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|FSC: 13; Default||Not reimbursed separately|4,953.90|FSC: 13; Default||External grouping not supported 951202123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 9mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196267|EAP|Custom 95196267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Intro Cath 14fr Impella Cp Dilatr Shth Gw Pnct Ndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 11mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197904|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4.5mm 143cm 15mm Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 13mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Long Thread 7.0mm L75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951202126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 16mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 22mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 33-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 25mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197905|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 143cm 15mm Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 28mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 40-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 31mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 9mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 45-15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 11mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 80173111|EAP|CPT® 97129||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Therapeutic Intervention Cog Func 1st 15 Minutes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.07|FSC: 13; Default||Not reimbursed separately|71.07|FSC: 13; Default||External grouping not supported 951202133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 44-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 16mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 19mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 46-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 80173122|EAP|CPT® 97130||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Therapeutic Intervention Cog Func Add 15 Minutes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.95|FSC: 13; Default||Not reimbursed separately|67.95|FSC: 13; Default||External grouping not supported 951202137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 25mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 48-17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 28mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 31mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 48-20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 9mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 11mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 50-18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 13mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 16mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 50-21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 19mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 22mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 52-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 25mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 28mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Humeral Sidus Stem Free Shoulder Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 951202148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 31mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 9mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Humeral Sidus Stem Free Shoulder Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 951202150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 11mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 13mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Humeral Sidus Stem Free Shoulder Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 951202152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 16mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197912|EAP|Custom 95197912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Suture Scorpion Hip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 19mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 22mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197913|EAP|Custom 95197913||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Disposable Curved Fibertak For Knotless Hip|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951202155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 25mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 28mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins L 31mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 9mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197915|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 16.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 11mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 13mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 16mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 19mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 22mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197914|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Hip Fibertak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,335.00|FSC: 13; Default||Not reimbursed separately|1,335.00|FSC: 13; Default||External grouping not supported 951202164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 25mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 28mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 31mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 80173133|EAP|HCPCS G2066||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Interrogation Device Eval Up To 30 Days|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 951202167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 9mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Sidus Stem Free Shoulder 52-23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951202168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 11mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 13mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Variax Ti Large Ft Calcaneus Mesh Polyaxi 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.30|FSC: 13; Default||Not reimbursed separately|2,295.30|FSC: 13; Default||External grouping not supported 951202170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 16mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 19mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 22mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 25mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 28mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 80171888|EAP|CPT® 12036||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intermediate Repair 20.1--30 Cm|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 951202175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 31mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 9mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 11mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 13mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 16mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197920|EAP|Custom 95197920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Opener Cortical Diameter 4.5mm Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 19mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 36mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951202181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 22mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 25mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 9mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.60|FSC: 13; Default||Not reimbursed separately|93.60|FSC: 13; Default||External grouping not supported 951202183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 28mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197922|EAP|Custom 95197922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Surgical Positioning Sys F/rumi Ii Advincula Arch Ally|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 31mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 7mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.60|FSC: 13; Default||Not reimbursed separately|93.60|FSC: 13; Default||External grouping not supported 951202185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 9mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 11mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 81mm Ss 3.5mm Scr 5 Hl L-d Evos Bn Fib Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,988.25|FSC: 13; Default||Not reimbursed separately|1,988.25|FSC: 13; Default||External grouping not supported 951202187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 13mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197917|EAP|Custom 95197917||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Idys Alif 1006mm X 30mm X 40mm Sterile|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951202188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 16mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 30mm T8 2mm Cort St Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951202189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 19mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 22mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 25mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95197918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spinal Idys Alif 10mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951202192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 28mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7mm Spc Y Loprfl 52x7.5-14.3x1.4mm Ss 2.7mm Scr 5 Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,648.25|FSC: 13; Default||Not reimbursed separately|2,648.25|FSC: 13; Default||External grouping not supported 951202193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk/dura Rev Ins R 31mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196279|EAP|Custom 95196279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Internal 25mm Curve Circle Powder 18cm Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95197919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Idys Alif Vetebral 20mm 5mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951202900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196280|EAP|Custom 95196280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Internal 29mm Curve Circle Powder 18cm Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196281|EAP|Custom 95196281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Internal 31mm Curve Circle Powder 18cm Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95197921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-d 10h Rt 134mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951202904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Unvrsl Gorilla 25mm Dog Bn Sl W/compr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 951202905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini-monster Short Thread L30 Mm Od3 Mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951202907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95197924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann 7mm 10mm Vented Bio-tenodesis Lf Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 951202908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196284|EAP|Custom 95196284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 3.0mm Dia Monster Head Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 951202910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95196285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 11mm Gorilla R3con Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951202911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|FSC: 13; Default||Not reimbursed separately|3,179.40|FSC: 13; Default||External grouping not supported 95197925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 42mm Cmpr Ft Ti Mn Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951202912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196270|EAP|Custom 95196270||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 2cds0601-xtr Large|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951202913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196271|EAP|Custom 95196271||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 2 Cds0601-ntr|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95155638|EAP|Custom 95155638||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Traction Foam Bucks Univers|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196293|EAP|Custom 95196293||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 9.5cm 16mm 13.5-14.5mm Xcldr Cntrlt Lg Grtx Ntnl|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 951202921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196294|EAP|Custom 95196294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Splint Intranasal 0.6inw X 2inl Sponge Gel Posisep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm Evos 6 Hole Hd 2 Hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.15|FSC: 13; Default||Not reimbursed separately|1,470.15|FSC: 13; Default||External grouping not supported 951202925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 11mm Evos T6 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 951202927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196300|EAP|Custom 95196300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sys Peek 2xanch F/plv Fl Rp Trnsv Scrp Fix Anch|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 951202929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196301|EAP|Custom 95196301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atomizer Bottle 20ml Capacity Positive Displacement Pump Mad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196304|EAP|Custom 95196304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Btl Replacement F/positive Displ Atomizer Madomizer Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95196307|EAP|Custom 95196307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dakota Ston Rtrvl 120cm 11mm 1.9fr 0tp Uret Ntnl Flt Dist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95197927|EAP|Custom 95197927||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 42x30x12mm Crsnt Svrgn 12d Lg Peek Cvr Plt Lmbr|1|HUMANA [1294]||HUMANA [11839]|28,380.00|FSC: 13; Default||Not reimbursed separately|28,380.00|FSC: 13; Default||External grouping not supported 951202940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95197928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Std 196mm 2.5mm Ti 3.5mm Scr Frag 8 Hl Shft Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,903.07|FSC: 13; Default||Not reimbursed separately|5,903.07|FSC: 13; Default||External grouping not supported 951202942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 95197931|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer 70cm 14fr Sheath For 15mm Stent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|FSC: 13; Default||Not reimbursed separately|4,716.60|FSC: 13; Default||External grouping not supported 951202947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197932|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer 70cm 16fr Sheath For 20-35mm Stent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197933|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Steerable 140deg Bidirectional Sterile Single Use|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197934|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 143cm 20mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197935|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4.5mm 143cm 20mm Pcta Nc Emerge Tpr Tip Ul Loprf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197936|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 143cm 20mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197937|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 143cm 8mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95196309|EAP|Custom 95196309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Ao For 3.5mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197938|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4.5mm 143cm 8mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95196315|EAP|Custom 95196315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Fusion Mri Uronav|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95196316|EAP|Custom 95196316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Spec 5.5in 2.0in Anch Tiss Rtrvl Sys C125ml 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197939|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 143cm 8mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95196317|EAP|Custom 95196317||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Patellar Preshaped 290mm|1|HUMANA [1294]||HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 951202979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 951202980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95196314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion10mm X 94mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951202981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|FSC: 13; Default||Not reimbursed separately|4,697.70|FSC: 13; Default||External grouping not supported 95197946|EAP|Custom 95197946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Orthopedic 6in .045in Stainless Steel Double Troca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 10mm Evos T6 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 951202983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 254mm Ti 16 Hl Axsos 3 Bn Hum Rt Prox Lat Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,540.00|FSC: 13; Default||Not reimbursed separately|12,540.00|FSC: 13; Default||External grouping not supported 951202985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95197947|EAP|Custom 95197947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Endoblade Plantar Fascia Release Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 22mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951202987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #3 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 24mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951202989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95197948|EAP|Custom 95197948||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Eit 7mm 8 Degree Sterlie|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951202990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 5mm 34mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|FSC: 13; Default||Not reimbursed separately|2,076.00|FSC: 13; Default||External grouping not supported 951202991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 18mm 95mm Ss 3.5mm Scr Sm Frag Set 5 Hl Hk Precntur Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|FSC: 13; Default||Not reimbursed separately|2,664.78|FSC: 13; Default||External grouping not supported 951202993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951202999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95192554|EAP|Custom 95192554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio Sim I Crv 5fr 65cm Ss Nyl Trnb Ad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.7mm 16mm Loprfl Scr Ss Ft/ankl Cort Sld Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 951203002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #7 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196319|EAP|Custom 95196319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula 3.0mm X 180mm Right Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 951203006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Fx 20mm Hammerlock 2 0d Med 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 951203008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #9 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 95196323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 2.5mm 45mm Ti Canc Wshr Hex Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 951203012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Cr Tibial Bearing Insert #11 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|FSC: 13; Default||Not reimbursed separately|5,033.70|FSC: 13; Default||External grouping not supported 951203017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196324|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Pre Cont Exchg 1.25mm Rotarpo Cath Adv Device|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196325|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Pre Cont Exchg 1.50mm Rotarpo Cath Adv Device|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196326|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Pre Cont Exchg 1.75mm Rotarpo Cath Adv Device|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196327|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Pre Cont Exchg 2.0mm Rotarpo Cath Adv Device|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196328|EAP|Custom 95196328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Pre Cont Exchg 2.15mm Rotarpo Cath Adv Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 2.7mm/l20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 951203032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 62065840|EAP|CPT® 86765||0309 - LABORATORY - OTHER LABORATORY|Hb Measles Antibody, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 951203034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95197950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 28mm Ti T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 951203037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #7 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95197952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Centric 36mm +3mm Lateral Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951203039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95197953|EAP|Custom 95197953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Escp Rsl 360 235cm 2.8mm Brd Cath Box Of 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95197954|EAP|Custom 95197954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Tsa Bone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #9 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196332|EAP|Custom 95196332||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 28mmx11mmx10mm Elev Std Peek Ti Strl|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 951203045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95197955|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 60mm Asns Cnn Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 951203047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 55mm Reline 2c Spne Mdlr Shnk Ns Lf Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,212.50|FSC: 13; Default||Not reimbursed separately|2,212.50|FSC: 13; Default||External grouping not supported 951203049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95197956|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 95196336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 36mm Rsp Glnd Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 951203051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Nrg Ps Insert #11 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|FSC: 13; Default||Not reimbursed separately|5,054.70|FSC: 13; Default||External grouping not supported 951203052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196340|EAP|Custom 95196340||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy 30 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95197958|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196341|EAP|Custom 95196341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy 50 Degree W Suction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196342|EAP|Custom 95196342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy 50 Degree W Suction 18cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95197959|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196343|EAP|Custom 95196343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy 90 Degree W Suction 18cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196344|EAP|Custom 95196344||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy 90 Degree With Suction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95197960|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196345|EAP|Custom 95196345||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy Straight Hook 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196346|EAP|Custom 95196346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Arthroscopic Energy 20 Deg Curved Hook 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95197961|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95197962|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95197963|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 14.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,425.10|FSC: 13; Default||Not reimbursed separately|3,425.10|FSC: 13; Default||External grouping not supported 951203779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca P/r Tib Ins 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,425.10|FSC: 13; Default||Not reimbursed separately|3,425.10|FSC: 13; Default||External grouping not supported 95197964|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 14.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196347|EAP|Custom 95196347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Railway Access Kit 5f Vbt Ss Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197966|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 15.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196348|EAP|Custom 95196348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Railway Access Kit 6r Vbt Ss Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196349|EAP|Custom 95196349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Railway Access Kit 7r Vbt Ss Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197967|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 16.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196356|EAP|Custom 95196356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rld Stplr 60mm 3-stpl 2 Xtr Thk Tis Artc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion 18mm X 103mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951203794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197968|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 16.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cann Mini-monster Short Thread 3.0mm 14mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951203796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196357|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth 265cc 12.25cm 3.2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197969|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196358|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth 260cc 12.25cm 2.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196359|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth 250cc 12.0cm 3.1cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197970|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196360|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth 230cc 12.0cm 2.4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196361|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth 495cc 12.5cm 6.1cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197971|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 20.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196363|EAP|Custom 95196363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Spin Access 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 60mm 5.5mm Pthfnd Nxt Prebnt Spne Ti Perc Aprch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 951203810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197972|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 20.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 65mm 5.5mm Pthfnd Nxt Prebnt Spne Ti Perc Aprch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 951203812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 951203813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95196366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1/1+ 8mm Ankl Poly Infnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,279.00|FSC: 13; Default||Not reimbursed separately|6,279.00|FSC: 13; Default||External grouping not supported 951203814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Series Ii Tibial Bear Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|FSC: 13; Default||Not reimbursed separately|3,414.60|FSC: 13; Default||External grouping not supported 95197973|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 21.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Ts Femur Sz1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95196367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spinal Base 5.0x20.0mm Variable Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951203816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Ts Femur Sz1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 951203817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Ts Femur Sz8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95196368|EAP|Custom 95196368||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 34x24x6mm Brigade 15d Ti Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951203818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197974|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 21.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196370|EAP|Custom 95196370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Platform Access Advanced Gelpoint 4cm With Isb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196371|EAP|Custom 95196371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Platform Access Advanced Gelpoint 5.5cm With Isb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197975|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196372|EAP|Custom 95196372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Platform Access Advanced Gelpoint 9cm With Isb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 1. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 2. Triathlon Ts Plus Tibial Insert X3 Poly 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197976|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 2. Triathlon Ts Plus Tibial Insert X3 Poly 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 2. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197977|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 23.0 Er Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 3. Triathlon Ts Plus Tibial Insert X3 Poly 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196369|EAP|Custom 95196369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slv Cath Pnch 80cm Unistasis Vlv Sntprne Adpr F/prv Cntmn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 3. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 4. Triathlon Ts Plus Tibial Insert X3 Poly 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.1mm 38mm T10 Lg Cx Plt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,209.00|FSC: 13; Default||Not reimbursed separately|1,209.00|FSC: 13; Default||External grouping not supported 951203831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 4. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197978|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 23.5 Er Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 5. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 320mm Fem Rt Prox Tfn-adv Lat Rlf Cut Im 130d Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 951203833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 6. Triathlon Ts Plus Tibial Insert X3 Poly 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 6. Triathlon Ts Plus Tibial Insert X3 Poly 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196377|EAP|Custom 95196377||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bone Peek Customized Cranial Kit Xl|1|HUMANA [1294]||HUMANA [11839]|49,672.80|FSC: 13; Default||Not reimbursed separately|49,672.80|FSC: 13; Default||External grouping not supported 951203835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 6. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197979|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 25.0 Er Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 7. Triathlon Ts Plus Tibial Insert X3 Poly 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196378|EAP|Custom 95196378||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 3cds0601-xtr Large|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 7. Triathlon Ts Plus Tibial Insert X3 Poly 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 7. Triathlon Ts Plus Tibial Insert X3 Poly 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 70mm 15mm Comp Hl4 Ss Hk Sh Pre Cnt 3.5 Scr Lcp Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,549.13|FSC: 13; Default||Not reimbursed separately|2,549.13|FSC: 13; Default||External grouping not supported 951203839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 7. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197980|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 24.5 Er Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 8. Triathlon Ts Plus Tibial Insert X3 Poly 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196380|EAP|Custom 95196380||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 1 Cds0601-ntr|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 8. Triathlon Ts Plus Tibial Insert X3 Poly 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951203842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 8. Triathlon Ts Plus Tibial Insert X3 Poly 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196381|EAP|Custom 95196381||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 3 Cds0601-ntr|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95156593|EAP|Custom 95156593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Pulse Oximeter Adhesive I|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 8. Triathlon Ts Plus Tibial Insert X3 Poly 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95156595|EAP|Custom 95156595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Pulse Oximeter Adhesive N|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 8. Triathlon Ts Plus Tibial Insert X3 Poly 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196382|EAP|Custom 95196382||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 1 Cds0601-xtr Large|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb No 8. Triathlon Ts Plus Tibial Insert X3 Poly 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95197957|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951203846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 5mm - Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95196383|EAP|Custom 95196383||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 1 Cds0601-ntr & 1 Cds0601 Xtr L|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 5mm - Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 951203848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 5mm - Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95196384|EAP|Custom 95196384||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 2 Cds0601-ntr & 1 Cds0601 Xtr L|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 10mm - Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95197982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Baby Gorilla 2.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951203850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 10mm - Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95196385|EAP|Custom 95196385||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mitraclip Bundle 1 Sgc0301 & 3 Cds0601-ntr & 1 Cds0601 Xtr L|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 10mm - Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 10mm - Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 10mm - Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 10mm - Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Distal Augment 15mm - Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 951203862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Post Augment Sz8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951203870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Lm/rl Tib Aug Sz8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 951203871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Rm/ll Tib Aug Sz8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 951203872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Lm/rl Tib Aug Sz1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 951203873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Rm/ll Tib Aug Sz1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 951203874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Lm/rl Tib Aug Sz7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95197984|EAP|Custom 95197984||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant System Anterolateral Reconstruction Sterile|1|HUMANA [1294]||HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951203875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Rm/ll Tib Aug Sz7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 951203876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Lm/rl Tib Aug Sz8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 951203877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Rm/ll Tib Aug Sz8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95196393|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 16x8cm Aldrm Med Aclr Derm Algrf Rgrt Slt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.88|FSC: 13; Default||Not reimbursed separately|89.88|FSC: 13; Default||External grouping not supported 951203878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Sym Cone Augment Size A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|FSC: 13; Default||Not reimbursed separately|15,313.20|FSC: 13; Default||External grouping not supported 951203879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Sym Cone Augment Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|FSC: 13; Default||Not reimbursed separately|15,313.20|FSC: 13; Default||External grouping not supported 95196394|EAP|Custom 95196394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 500cc Saline 12.8cm 5.6cm Hp Rnd Smth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size B Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 951203881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size B Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 95196398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 20mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 951203882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size C Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 95197985|EAP|Custom 95197985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 122mm 2.4mm Ao Fit Scl Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size C Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 95196399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 36mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 951203884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size D Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 951203885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size D Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 95196400|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Spinal Coflex Sz 16mm|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951203886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size E Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 95197990|EAP|Custom 95197990||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aor Corevalve Evolut Pro+ 24mm Prcn Pricrd 1 Lyr Slf|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951203887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asym Cone Augment Size E Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|FSC: 13; Default||Not reimbursed separately|16,377.90|FSC: 13; Default||External grouping not supported 95196401|EAP|Custom 95196401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 15.1cm Memorygel 5.9cm Hi Prfl Sm Brst Gel 750cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 1 & 2 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 1 & 2 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 95197991|EAP|Custom 95197991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Evolut Pro+ Catheter Delivery System Od34 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 3 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 4 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 5 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 95197992|EAP|Custom 95197992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Evolut Pro+ Loading System 34mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 6 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 6 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951203897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 7 & 8 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 95196402|EAP|Custom 95196402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable For Tenodesis Screw 2.5mm X 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Femoral Cone Augment Size 7 & 8 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 95197993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Dynaite Pip 14mm Straight W/instrument|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 951203899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cemented Stem-9mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95196403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Peek 2.5mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951203900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cemented Stem 9mmx100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 951203901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Cemented Stem 12mmx100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95196404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 343mm Ti 16 Hl Axsos 3 Bn Fem Lt Dist Lat Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,855.00|FSC: 13; Default||Not reimbursed separately|12,855.00|FSC: 13; Default||External grouping not supported 951203902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cemented Stem-9mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95197996|EAP|Custom 95197996||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951203903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cemented Stem-12mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 951203904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cemented Stem-15mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95197997|EAP|Custom 95197997||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 55mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951203905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Press-fit Stem 15x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 951203906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Press-fit Stem 20mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 62065855|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Childrens Drug Confirm, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Press-fit Stem 21x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95197986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Fusion Bone Ankle Left Anterior 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,550.00|FSC: 13; Default||Not reimbursed separately|8,550.00|FSC: 13; Default||External grouping not supported 951203908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Press-fit Stem 22mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 62065866|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Amphetamine Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Press-fit Stem 23x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 951203910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Press-fit Stem 24mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 62065877|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Barbiturate Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tri Press-fit Stem 25x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95197987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 3+ 9mm Knee Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|FSC: 13; Default||Not reimbursed separately|6,468.00|FSC: 13; Default||External grouping not supported 951203912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Patella Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.30|FSC: 13; Default||Not reimbursed separately|3,597.30|FSC: 13; Default||External grouping not supported 62065888|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Benzo Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Patella Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.30|FSC: 13; Default||Not reimbursed separately|3,597.30|FSC: 13; Default||External grouping not supported 951203914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Patella Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.30|FSC: 13; Default||Not reimbursed separately|3,597.30|FSC: 13; Default||External grouping not supported 62065899|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Fentanyl Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Xs Femoral Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|FSC: 13; Default||Not reimbursed separately|16,039.80|FSC: 13; Default||External grouping not supported 95197988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 40mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951203916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Sm Femoral Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|FSC: 13; Default||Not reimbursed separately|16,039.80|FSC: 13; Default||External grouping not supported 62065900|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Bup & Metabolite, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Med Femoral Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|FSC: 13; Default||Not reimbursed separately|16,039.80|FSC: 13; Default||External grouping not supported 951203918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avon Lg Femoral Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|FSC: 13; Default||Not reimbursed separately|16,039.80|FSC: 13; Default||External grouping not supported 62065911|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cannabinoid Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-max Plus Bseplt Assy Sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,150.10|FSC: 13; Default||Not reimbursed separately|8,150.10|FSC: 13; Default||External grouping not supported 95197989|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 109mm 32mm 26-27mm Znth Alpha Flxr Captor 6mm Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,458.30|FSC: 13; Default||Not reimbursed separately|46,458.30|FSC: 13; Default||External grouping not supported 951203920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Cemented Stem 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 62065922|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cocaine Conf. Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Cemented Stem 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Cemented Stem 155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 62065933|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Methadone Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 10mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95197994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant System Fdl 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951203924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 12mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 62065944|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Opiates Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 13mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 14mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 62065955|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Gabapentin Conf, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 16mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95197995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 46mm Cmpr Ft Ti Mn Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951203928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 17mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 62065966|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Afb Suspectibility - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 951203929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 18mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 19mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196406|EAP|Custom 95196406||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 15x6mm Divergence 12mm Lrdtc Ncl Pulposus Peek|1|HUMANA [1294]||HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 951203931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 21mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 23mmx80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 11mm Divergence Ti Spne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951203933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 10mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 11mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Monste Headed Short Thread 3.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951203935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 12mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 13mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 2.5mm 2-0 C-2 Sonicanchor Kt Frc Fibre 10mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951203937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 14mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 16mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 7x9mm Arthrex Dynanite Nitinol Titanium Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951203939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 17mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 18mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196414|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 24mm 43mm 18fr Znth Renu 7.1mm Abdm Arta Main Bd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,596.00|FSC: 13; Default||Not reimbursed separately|16,596.00|FSC: 13; Default||External grouping not supported 951203941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 19mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 21mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95196415|EAP|Custom 95196415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Delivery System Od14 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Pressfit Stem 23mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 951203944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Offset Adapter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|FSC: 13; Default||Not reimbursed separately|3,679.20|FSC: 13; Default||External grouping not supported 95196416|EAP|Custom 95196416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Enveo Pro Load 23/26/29mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Offset Adapter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|FSC: 13; Default||Not reimbursed separately|3,679.20|FSC: 13; Default||External grouping not supported 951203946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Offset Adapter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|FSC: 13; Default||Not reimbursed separately|3,679.20|FSC: 13; Default||External grouping not supported 95196417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Long Thread 7.0mm L90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951203947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 10x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 951203948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 11x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 951203949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 12x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95198011|EAP|Custom 95198011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speed Drill Kit With 2.65mm Drill Bit/enhanced Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 14x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 951203951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 15x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 951203952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 16x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 951203953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Regular Fluted Stem 17x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95198012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 36mm Ti Cmpr Sh Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|FSC: 13; Default||Not reimbursed separately|1,170.30|FSC: 13; Default||External grouping not supported 951200434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 13mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 14mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 15mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 16mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 17mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 95198003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4 10mm Kn Tib Uncmp Vivacit-e Zm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|FSC: 13; Default||Not reimbursed separately|5,136.00|FSC: 13; Default||External grouping not supported 951200439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 18mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 19mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 20mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 21mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 95198004|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 22mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 95196418|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Resonance Metalic 6fr X 26cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|FSC: 13; Default||Not reimbursed separately|3,349.14|FSC: 13; Default||External grouping not supported 951200444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 23mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 951200445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 24mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 95196419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 38mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 951200446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 25mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 95197998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 48mm Scrft X Ti T15 Cort Lck Loprfl St Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 951200447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 26mmx267mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|FSC: 13; Default||Not reimbursed separately|15,107.40|FSC: 13; Default||External grouping not supported 95196420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 30mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 951200448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 13mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 14mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95197999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 54mm 10 Hl Ti Strght 2mm/2.3mm Aptus Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,473.20|FSC: 13; Default||Not reimbursed separately|2,473.20|FSC: 13; Default||External grouping not supported 951200450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 15mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 16mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 17mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 18mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 19mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 20mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95187927|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue Iopamidol 370 6 X 200ml Bottle 6/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.85|FSC: 13; Default||Not reimbursed separately|50.85|FSC: 13; Default||External grouping not supported 951200456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 21mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95198000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 14mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951200457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 22mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95196424|EAP|Custom 95196424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg Sm Lng Ao Qck Cnct Evos 2.0mm Strl Lf Reuse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 23mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 951200459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 24mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95196422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 32cm Lt Intertrochanter Intertan Im 130d 1.5mm 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951200460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 25mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95198001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 13mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951200461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rest Mod Plasma Tri-slot Bowed Stem 26mmx317mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|FSC: 13; Default||Not reimbursed separately|15,743.70|FSC: 13; Default||External grouping not supported 95196423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 18mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 951200462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca 36mm Femoral Head -3mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|FSC: 13; Default||Not reimbursed separately|4,750.20|FSC: 13; Default||External grouping not supported 951200463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca 26mm Std Fem Head Comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95196425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Evos Locking 2.7mm 61mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,031.25|FSC: 13; Default||Not reimbursed separately|1,031.25|FSC: 13; Default||External grouping not supported 951200464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca 36mm Femoral Head 0mm Std Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|FSC: 13; Default||Not reimbursed separately|4,750.20|FSC: 13; Default||External grouping not supported 95198005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2.7mm 4mm Screw 10 Hole Lock 87mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 951200465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26mm +5mm Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95196426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Evos Locking 3.5mm 81mm 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 951200466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm +5mm Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 951200467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca 36mm Femoral Head +5mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|FSC: 13; Default||Not reimbursed separately|4,750.20|FSC: 13; Default||External grouping not supported 95196427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Midshaft Anterior 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 951200468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26mm +10 Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95198006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 15mm Variax T8 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|FSC: 13; Default||Not reimbursed separately|951.00|FSC: 13; Default||External grouping not supported 951200469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm +10mm Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95196428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 1.7mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|FSC: 13; Default||Not reimbursed separately|933.00|FSC: 13; Default||External grouping not supported 951200470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22.2mm + 2mm 252 Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 951200471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22.2mm + 5mm 252 Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95196429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 1.7mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|FSC: 13; Default||Not reimbursed separately|933.00|FSC: 13; Default||External grouping not supported 951200472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22.2mm + 10mm 252 Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95198007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 60mm Variax T8 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951200473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm-3mm Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 951200474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Femoral Head Dia .32mm Standard Neck With Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,905.20|FSC: 13; Default||Not reimbursed separately|5,905.20|FSC: 13; Default||External grouping not supported 951200475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Femoral Head Dia .32mm +5 With Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,905.20|FSC: 13; Default||Not reimbursed separately|5,905.20|FSC: 13; Default||External grouping not supported 95198008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Poly Medial Column Fusion Right Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,368.00|FSC: 13; Default||Not reimbursed separately|7,368.00|FSC: 13; Default||External grouping not supported 951200476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x40-43mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x46-49mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x52-55mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196430|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 12mm Cor Rx Radopq Smth Rnd Tip Tung Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x58-61mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95198010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Capitate 15mm 22mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|FSC: 13; Default||Not reimbursed separately|18,675.00|FSC: 13; Default||External grouping not supported 951200480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28x46-49mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196431|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 15mm Cor Rx Radopq Smth Rnd Tip Tung Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28x52-55mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28x58-61mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196432|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 11.7x10cm 350ml Sty 9200 Centerscope Sut Tp Strl Cp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951200483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28x64-67mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32x46-49mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196433|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 13.5x11.7cm 550ml Sty 9200 Centerscope Sut Tp Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951200485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32x52-55mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32x58-61mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut Dx 1 Arthx Fibertak Fbrwr Ndl Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|FSC: 13; Default||Not reimbursed separately|1,395.00|FSC: 13; Default||External grouping not supported 951200487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32x64-67mm Neutral Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x40-43mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 18mm 48mm Shldr Reunion Std Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 951200489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x46-49mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x52-55mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 80173144|EAP|Custom 80173144||0998 - STATISTICAL CHARGES|Hb Radiation Planning Ct Subsequent N/c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26x58-61mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32x52-55mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22x40-43mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196442|EAP|Custom C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5.5mm 100cm 150mm Otw 2 Lum Radopq Coax Jetcoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22x46-49mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95198013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Protean Central Column Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22x52-55mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95196443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 2.4/2.7mm Sm Va 0deg Lcp First Right Mtp Fn Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 951200496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22x58-61mm 10 Deg Ins Durat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 951200497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P2 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95196444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 2.4/2.7mm Sm Va 0deg Lcp First Left Mtp Fn Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 951200498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P3 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95198014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Protean Central Column Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P4 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 951200500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P5 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 951200501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P6 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 80171911|EAP|CPT® 12042||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Intermediate 2.6-7.5cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951200502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P7 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95198015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Protean Radial Column Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P8 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 80171922|EAP|CPT® 12005||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Superficial Wounds 12.6-20.0cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951200504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P9 28mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 951200505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P3 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95198016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Protean Radial Column Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P4 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95196445|EAP|Custom 95196445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 17ga 10mm Rf Eltx Osteocool 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P5 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 951200508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P6 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95196446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L63 Mm Spine 3 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951200509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P7 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95198018|EAP|Custom 95198018||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 4.5cm 32mm Xcldr Ntnl Ep Abdml Stnt Aaa 12 Fr|1|HUMANA [1294]||HUMANA [11839]|9,762.00|FSC: 13; Default||Not reimbursed separately|9,762.00|FSC: 13; Default||External grouping not supported 951200510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P8 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 95196447|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P9 32mm 10¦ +4mm Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|FSC: 13; Default||Not reimbursed separately|3,874.50|FSC: 13; Default||External grouping not supported 951200512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id22 Od40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id22 Od42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id22 Od44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95198017|EAP|Custom 95198017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Canthoplasty Microcather Itrack 250a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 80173155|EAP|CPT® 56420||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I&d Bartholins Gland Abscess|1|HUMANA [1294]||HUMANA [11839]|512.59|FSC: 13; Default||Not reimbursed separately|512.59|FSC: 13; Default||External grouping not supported 951200523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id28 Od60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95196448|EAP|Custom 95196448||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 11.5cm 20mm 16.5-18.5mm Grtx Xcldr Cntrlt Lg Ntnl|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 951200528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95196449|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 335cm .018in Viperwire Adv Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id32 Od60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id36 Od52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95196450|EAP|Custom 95196450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 2.4mm Dia 30cml Threaded Tip Eyeloop Drill Femoral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id36 Od54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id36 Od56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95196451|EAP|Custom 95196451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Winged Introducer Guide For Inside-out Introducers|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id36 Od58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id36 Od60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95196452|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uret 4.8fr 22cm Pgtl Crv Tpr Tip Bldr Mrk Loprfl Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 951200536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id40 Od56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id40 Od58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 95196453|EAP|Custom 95196453||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Holder Uronav Bk8808e/8819|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter X3 Rimfit Cup Id40 Od60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|FSC: 13; Default||Not reimbursed separately|7,140.00|FSC: 13; Default||External grouping not supported 951200539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 95196454|EAP|Custom 95196454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ultrasound Uronav|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 951200541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 951200542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 95198019|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Nrstm Blu Trial 50cm Nevro 5mm Spc Ld Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951200543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 951200544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 951200545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 95198021|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 27.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 12 Crossfire 10¦ 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 951200547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 95198022|EAP|Custom 95198022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit 8mm Surgical Instrument Set Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 95198023|EAP|Custom 95198023||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adhesive Scotchbond 3m Espe Universal 5ml Refill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 95196455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lck Pa Mtp Cx Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 95157385|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|FSC: 13; Default||Not reimbursed separately|5,993.40|FSC: 13; Default||External grouping not supported 951200561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|FSC: 13; Default||Not reimbursed separately|6,402.90|FSC: 13; Default||External grouping not supported 951200562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|FSC: 13; Default||Not reimbursed separately|6,402.90|FSC: 13; Default||External grouping not supported 951200563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|FSC: 13; Default||Not reimbursed separately|6,402.90|FSC: 13; Default||External grouping not supported 951200564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|FSC: 13; Default||Not reimbursed separately|6,402.90|FSC: 13; Default||External grouping not supported 95198039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate -i Evos 3.5mm Tibia Partial 8 Hole Right 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,242.25|FSC: 13; Default||Not reimbursed separately|3,242.25|FSC: 13; Default||External grouping not supported 951200565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|FSC: 13; Default||Not reimbursed separately|6,402.90|FSC: 13; Default||External grouping not supported 951200566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Elevated Rim 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|FSC: 13; Default||Not reimbursed separately|6,402.90|FSC: 13; Default||External grouping not supported 951200567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 951200568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95198043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 187mm Ti 12 Hl Lck Variax Bn Mdl Elb Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 951200569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 951200570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-p 8h Rt 113mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.25|FSC: 13; Default||Not reimbursed separately|5,090.25|FSC: 13; Default||External grouping not supported 951200571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 951200572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 80mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 951200573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95198040|EAP|Custom 95198040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calibrator Conductivity Solution 14.0cm 1 Qt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.7mm 80mm Evos Ft Strl Osteopenia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|212.85|FSC: 13; Default||Not reimbursed separately|212.85|FSC: 13; Default||External grouping not supported 951200575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 951200576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196459|EAP|Custom 95196459||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 40mm 22mm 13mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|43,497.00|FSC: 13; Default||Not reimbursed separately|43,497.00|FSC: 13; Default||External grouping not supported 951200577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95198041|EAP|Custom 95198041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Buffer Standard Solution Ph 7.00 1 Qt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196460|EAP|Custom 95196460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Quill Absor Barb Mono Kntless 0 14x14cm Taper Pt 1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 951200580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196461|EAP|Custom 95196461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hg Pr 14.5cm 5.9cm 620ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95198042|EAP|Custom 95198042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Neo-cr Cell Clean Dialyst Soln 950ml Ph1.4 1 Qt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|FSC: 13; Default||Not reimbursed separately|6,050.10|FSC: 13; Default||External grouping not supported 95196462|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 14.5x5.8cm 620cc Hsc+ Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|FSC: 13; Default||Not reimbursed separately|6,463.80|FSC: 13; Default||External grouping not supported 951200584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|FSC: 13; Default||Not reimbursed separately|6,463.80|FSC: 13; Default||External grouping not supported 951200585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|FSC: 13; Default||Not reimbursed separately|6,463.80|FSC: 13; Default||External grouping not supported 95196464|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 335cm .018in Viperwire Adv Flex Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|FSC: 13; Default||Not reimbursed separately|6,463.80|FSC: 13; Default||External grouping not supported 95198044|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|FSC: 13; Default||Not reimbursed separately|6,463.80|FSC: 13; Default||External grouping not supported 95196465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Broad Y 2 Hole T10 Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|FSC: 13; Default||Not reimbursed separately|5,367.00|FSC: 13; Default||External grouping not supported 951200588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 0¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|FSC: 13; Default||Not reimbursed separately|6,463.80|FSC: 13; Default||External grouping not supported 951200589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95196466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 18x18mm Supermx Ntnl Cmpr Loprfl Troc Tip Algn Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 951200590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95198045|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 20.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95196467|EAP|Custom 95196467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Bx Spinperc Ntnl 20cm 19ga 15.5cm 5 Ndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 951200593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95196469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr Ti 7 Hl Lck Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|FSC: 13; Default||Not reimbursed separately|765.00|FSC: 13; Default||External grouping not supported 951200594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 951200595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95198046|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 21.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 951200597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 951200598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 951200599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95198047|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 21.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95196470|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Penile Testicular Lrg 2.9cm 4.5cm Slne Fld Scr Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.00|FSC: 13; Default||Not reimbursed separately|6,165.00|FSC: 13; Default||External grouping not supported 951200601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 951200602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95196471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11.5mm 36cm Intertrochanter Rt Trgn Intertan Im 125d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951200603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|FSC: 13; Default||Not reimbursed separately|6,003.90|FSC: 13; Default||External grouping not supported 95198048|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951200604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|FSC: 13; Default||Not reimbursed separately|6,413.40|FSC: 13; Default||External grouping not supported 95196474|EAP|Custom 95196474||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Scrdrvr Axsos 4mm T15 Trq Lmt Lck Srg Nstl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|FSC: 13; Default||Not reimbursed separately|6,413.40|FSC: 13; Default||External grouping not supported 951200606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|FSC: 13; Default||Not reimbursed separately|6,413.40|FSC: 13; Default||External grouping not supported 95196475|EAP|Custom 95196475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouches 4inx12in Low Temp Tyvek Strl Self Seal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10 Deg 36mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|FSC: 13; Default||Not reimbursed separately|6,413.40|FSC: 13; Default||External grouping not supported 95198024|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95157552|EAP|Custom 95157552||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Wound Irrigation Splash C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|FSC: 13; Default||Not reimbursed separately|6,413.40|FSC: 13; Default||External grouping not supported 951200609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident X3 Eccentric 10¦ 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|FSC: 13; Default||Not reimbursed separately|6,413.40|FSC: 13; Default||External grouping not supported 95198025|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 2 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 3 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95198026|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 4 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 5 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95198027|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 6 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 7 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95198028|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anato Stem Size 8 Left Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 0 Accolade Ii 132 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95198029|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 11 Accolade Ii 132 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 0 Accolade Ii 127 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 951201324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198030|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196476|EAP|Custom 95196476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Xtrnfx 2/3 130mm Ft & Ankl Tlt Sp Frm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198031|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196478|EAP|Custom 95196478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 266mm 16mm Cnn Hlw Lg Qc Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196479|EAP|Custom 95196479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 11.4cm 4.0cm 285ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198032|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 14.00 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Hlf 150mm 6mm Ha 55mm Xtrnfx Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|FSC: 13; Default||Not reimbursed separately|569.25|FSC: 13; Default||External grouping not supported 951201334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 15mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 951201336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198033|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 15.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 38mm Loprfl Scr Ss St Ankl Fx Mgmt Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 951201338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198034|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 16.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Bn 2.4mm 53mm Evos 8 Hl T-shaped Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,864.50|FSC: 13; Default||Not reimbursed separately|1,864.50|FSC: 13; Default||External grouping not supported 951201342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196480|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.0x3.9cm 255cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196481|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 11.4x4.0cm 285cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951201346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 180mm 5.5mm Pthfnd Nxt Prebnt Spne Ti Perc Aprch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,286.00|FSC: 13; Default||Not reimbursed separately|2,286.00|FSC: 13; Default||External grouping not supported 951201353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198036|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 18.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Headed 4.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951201355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Med 1.5mm 2.3mm Scr 7 Hl Lck Variax Bn 2.3mm Hnd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 951201357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198037|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 18.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 42mm Cnn Blnt Tip Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 951201359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196489|EAP|Custom 95196489||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 14f Sapien 3 20mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198038|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196490|EAP|Custom 95196490||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 14f Sapien 3 23mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196491|EAP|Custom 95196491||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 14f Sapien 3 26mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198050|EAP|Custom 95198050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 150mm 2.0mm Asns Iii Ao Cplng Sld Cnn Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 26x58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196492|EAP|Custom 95196492||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 14f Sapien 3 29mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196493|EAP|Custom 95196493||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 18f Sapien 3 20mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 22x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198055|EAP|Custom 95198055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.3mm Dia Adjustable F/occipital Cervico Thoracic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 26x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196494|EAP|Custom 95196494||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 21f Sapien 3 23mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196495|EAP|Custom 95196495||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 21f Sapien 3 26mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 26x64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198056|EAP|Custom 95198056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Spinal Fixation Temporary Standard Top Closure Virage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95196496|EAP|Custom 95196496||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve 21f Sapien 3 29mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951201375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 26x68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95198057|EAP|Custom 95198057||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Curved Ti Virage 80mm X 3.5mm Blue|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951201379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 26x72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 28x72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uhr Bipolar 32x72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 951201382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-28mm X -3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 951201383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-28mm X -3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 95196527|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 135cm 100mm Otw Nc 2 Lum Shft Loprfl Tpr Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-28mm X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 951201385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-28mm X +3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 95196528|EAP|Custom 95196528||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aor Corevalve Evolut Pro 23mm Prcn Pricrd 1 Lyr Slf|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 951201386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-32mm X -4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 95198051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 14mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951201387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-32mm X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 951201388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-32mm X +4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 951201389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-36mm X -4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 951201390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-36mm X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 95198052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 20mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951201391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity Delta Head-36mm X +4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|FSC: 13; Default||Not reimbursed separately|4,641.00|FSC: 13; Default||External grouping not supported 951201392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 951201393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 28mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 951201394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 28mm/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 951201395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 32mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95198053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 22mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951201396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 32mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 951201397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 32mm/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 95198054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Magenta 4.5mm X 25mm Virage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951201398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 36mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.30|FSC: 13; Default||Not reimbursed separately|5,529.30|FSC: 13; Default||External grouping not supported 951201399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 36mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.30|FSC: 13; Default||Not reimbursed separately|5,529.30|FSC: 13; Default||External grouping not supported 95198059|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Alumina Head 36mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.30|FSC: 13; Default||Not reimbursed separately|5,529.30|FSC: 13; Default||External grouping not supported 951201401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 951201402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 28mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95198077|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 24.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 28mm/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 951201404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 28mm/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 951201405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 32mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 951201406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 32mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95198076|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 24.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 32mm/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 951201408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 32mm/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95198075|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 23.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 36mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|FSC: 13; Default||Not reimbursed separately|6,438.60|FSC: 13; Default||External grouping not supported 951201410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 36mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|FSC: 13; Default||Not reimbursed separately|6,438.60|FSC: 13; Default||External grouping not supported 95198074|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 20.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 36mm/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|FSC: 13; Default||Not reimbursed separately|6,438.60|FSC: 13; Default||External grouping not supported 951201412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 36mm/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|FSC: 13; Default||Not reimbursed separately|6,438.60|FSC: 13; Default||External grouping not supported 95198073|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 36mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|FSC: 13; Default||Not reimbursed separately|6,438.60|FSC: 13; Default||External grouping not supported 951201414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Biolox+ Delta Head 36mm/+7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|FSC: 13; Default||Not reimbursed separately|6,438.60|FSC: 13; Default||External grouping not supported 95198072|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 18.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 28mm Sm-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 28mm Med-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 28mm Lg-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 32mm Sm-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 32mm Med-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 32mm Lg-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 95196530|EAP|Custom 95196530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Biopsy Maci Cartilage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 32mm Xl-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 95198071|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 17.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 36mm Sm-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 95196533|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Athrcm 135cm 0.9in 6fr Tip Fb Cny Rx Elca Gw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 36mm Med-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 36mm Lg-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 95196534|EAP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Athrcm 135cm 1.4in 7fr Tip Fb Cny Rx Elca Gw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951201425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 36mm Xl-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|FSC: 13; Default||Not reimbursed separately|5,527.20|FSC: 13; Default||External grouping not supported 951201426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 40mm Sm-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|FSC: 13; Default||Not reimbursed separately|3,330.60|FSC: 13; Default||External grouping not supported 951201427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 40mm Med-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|FSC: 13; Default||Not reimbursed separately|3,330.60|FSC: 13; Default||External grouping not supported 951201428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 40mm Lg-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|FSC: 13; Default||Not reimbursed separately|3,330.60|FSC: 13; Default||External grouping not supported 951201429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-ceramic 40mm Xl-restoris|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|FSC: 13; Default||Not reimbursed separately|3,330.60|FSC: 13; Default||External grouping not supported 951201430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Universal Taper Anatomic Head Size 44+0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,318.90|FSC: 13; Default||Not reimbursed separately|6,318.90|FSC: 13; Default||External grouping not supported 951201431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Alumina Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 951201432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Alumina Head 28mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|FSC: 13; Default||Not reimbursed separately|4,731.30|FSC: 13; Default||External grouping not supported 951201433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 22mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 22mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 22mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 28mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95198070|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 16.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 28mm/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95196535|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 5mm 6fr 16mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 32mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 32mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95196545|EAP|Custom 95196545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Crescent Tm Jugular 28fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 32mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95198069|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 15.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 36mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95196546|EAP|Custom 95196546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Crescent Tm Jugular 30fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 36mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 951201444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 36mm/+2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95196547|EAP|Custom 95196547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Vascular Access Mc3 Opus Tm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 36mm/+7.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95198068|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 15.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 36mm/-2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95196536|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 6mm 6fr 16mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Lfit Head 36mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 951201448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 28mm/-3.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95196537|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 7mm 6fr 16mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 28mm/0 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95198067|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 14.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 28mm/+3.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95196538|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 6mm 7fr 38mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 28mm/+7 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 951201452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 28mm/+10.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95196539|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 6mm 7fr 59mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 32mm/-3.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95198066|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 14.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 32mm/0 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95196540|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 5mm 7fr 38mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 32mm/+3.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 951201456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 32mm/+7 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95196541|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 7mm 7fr 38mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 32mm/+10.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95198065|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 36mm/-3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95196542|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 9mm 7fr 59mm 120cm Cvr Cath Intro Icast Ss Ptfe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951201459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 36mm/0 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 951201460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 36mm/+3.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95198064|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 36mm/+7 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 951201462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Head-cocr 36mm/+10.5 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|FSC: 13; Default||Not reimbursed separately|2,150.40|FSC: 13; Default||External grouping not supported 95198063|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-32mm X 0.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951201464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-32mm X -3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951201465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-32mm X 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951201466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-32mm X7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95198060|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-36mm X 0.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951201468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-36mm X -3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951201469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-36mm X 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951201470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Femoral Head-36mm X 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95198061|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 22mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 22mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 26mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 26mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 26mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95198080|EAP|Custom 95198080||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Trauma Adult Pos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 28mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95196548|EAP|Custom 95196548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 2-0 32cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 28mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95198081|EAP|Custom 95198081||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Adult E1 Ear Pos Disposable Latex Free Nonsterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 32mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95196554|EAP|Custom 95196554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Positioner Imp 8.3fr 70cm F/antgde Or Retro Pst Urth Stnt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 32mm/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 32mm/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95196556|EAP|Custom 95196556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Nexel Elbow Torue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-taper Cocr Head 32mm/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95198083|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 24.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Head 26mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95196555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7mm/3.5m Evos P/a A-d Tibia 3h 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|FSC: 13; Default||Not reimbursed separately|3,118.50|FSC: 13; Default||External grouping not supported 951201484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Head 28mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 951201485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 26mm/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95196549|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Resonance Metalic 6fr X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|FSC: 13; Default||Not reimbursed separately|3,349.14|FSC: 13; Default||External grouping not supported 951201486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 28mm/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95198086|EAP|Custom 95198086||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Neopt Cs-s Neonatal Adhesive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 22.2mm/+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 951201489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb V40 Cocr Lfit Head 26mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95196551|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Resonance Metalic 6fr X 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|FSC: 13; Default||Not reimbursed separately|3,349.14|FSC: 13; Default||External grouping not supported 951202194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 9mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198087|EAP|Custom 95198087||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Neo Cs-2 Neonatal/adult Adhesive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 11mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196552|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Resonance Metalic 6fr X 28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|FSC: 13; Default||Not reimbursed separately|3,349.14|FSC: 13; Default||External grouping not supported 951202196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 13mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 16mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196553|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Stent Resonance Metalic 6fr X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|FSC: 13; Default||Not reimbursed separately|3,349.14|FSC: 13; Default||External grouping not supported 951202198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 19mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Size 4 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,350.00|FSC: 13; Default||Not reimbursed separately|13,350.00|FSC: 13; Default||External grouping not supported 951202200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 25mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ulnar Size 4 75mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 951202202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip 9 Scr Hl Clstr Tritanium Trdnt Ii D Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|FSC: 13; Default||Not reimbursed separately|4,638.00|FSC: 13; Default||External grouping not supported 951202203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 9mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Revision Articulation Size 4 Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951202204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 11mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Hum 10mm 40mm Shldr X3 Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 951202206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198096|EAP|Custom 95198096||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 160mm 5.5mm Pathfinder Nxt Blue Nonsterile|1|HUMANA [1294]||HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 951202207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Screw Bone Nexel Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951202208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 22mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 25mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196561|EAP|Custom 95196561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin Bone 3.2mm X 110mm 2-pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 28mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198097|EAP|Custom 95198097||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Transverse Adjustable 36-41mm Wide X 5.5mm|1|HUMANA [1294]||HUMANA [11839]|4,892.70|FSC: 13; Default||Not reimbursed separately|4,892.70|FSC: 13; Default||External grouping not supported 951202211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 31mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Headed 4.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951202212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 9mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 11mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Headed 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951202214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 13mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lk 1.3mm 2/4hl 2.0mm/2.3mm Ti Blue Trpzid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,276.55|FSC: 13; Default||Not reimbursed separately|2,276.55|FSC: 13; Default||External grouping not supported 951202215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 16mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Headed 4.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951202216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 19mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 22mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196571|EAP|Custom 95196571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twst 76mm 1.0mm Aptus Stp Ao Qc 20mm 1.2mm Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 25mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 2.4mm Screw 6 Hole Lock L 48mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951202219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 28mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196576|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 125cm 5fr Sp Torque Lf Non-radiolucent Jr4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 31mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 9mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196577|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 125cm 5fr Sp Torque Lf Non-radiolucent Jr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 11mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 28mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951202223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 13mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196583|EAP|Custom 95196583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twst 25mm 1.6mm Aptus Ao Qc Blue 2mm Lag Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 16mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 19mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196584|EAP|Custom 95196584||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twst 10mm 2.1mm Aptus Ao Qc Blue 2mm Lag Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 22mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95198091|EAP|Custom 95198091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 2.0mm 2.7mm Cannulated Ao Fit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 25mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196585|EAP|Custom 95196585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 150mm 1.2mm Krsh Aptus Wrst Ss Troc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 28mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 951202229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Neut/dura Rev Ins 31mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|FSC: 13; Default||Not reimbursed separately|9,141.30|FSC: 13; Default||External grouping not supported 95196572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 6mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951202230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95198093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 15mm Short Thread Headless Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 951202231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 8mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951202232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 10mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951202234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95198094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 17mm Short Thread Headless Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 951202235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 32mm 5 Hl Ti Strght 2mm/2.3mm Aptus Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,276.55|FSC: 13; Default||Not reimbursed separately|2,276.55|FSC: 13; Default||External grouping not supported 951202236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 10mm Ti Cort Hexa 6 Tpd Cr Fl Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951202239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 11mm Ti Cort Hexa 6 Tpr Core Fl Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951202241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 12mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951202243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lippedtibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 15mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951202245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 8mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 951202247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 10mm Ti Cort Hexa 6 Tprd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951202249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 80171934|EAP|CPT® 45905||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Dilation Of Anal Sphincter|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 951202254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 80171945|EAP|CPT® 23066||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Biopsy Soft Tissue Of Shoulder Area Deep|1|HUMANA [1294]||HUMANA [11839]|6,607.71|FSC: 13; Default||Not reimbursed separately|6,607.71|FSC: 13; Default||External grouping not supported 951202256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196592|EAP|Custom 95196592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit W/ Quick Connect 4.5mm Peri-loc Targeter H10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 95196594|EAP|Custom 95196594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 228mm 2mm Krsh Ss Troc Pnt Peri-lc Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration A/p Lipped Tibial Ins|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|FSC: 13; Default||Not reimbursed separately|3,177.30|FSC: 13; Default||External grouping not supported 951202261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 95196599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Redapt 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,764.56|FSC: 13; Default||Not reimbursed separately|8,764.56|FSC: 13; Default||External grouping not supported 951202262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 95196593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4.5mm 155mm Peri-lck L-d Fem 6hl Cnt Scl Non Lck Ss Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,455.00|FSC: 13; Default||Not reimbursed separately|7,455.00|FSC: 13; Default||External grouping not supported 951202264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 95196596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 34mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951202268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Inset Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 95196597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 64mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951202270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Inset Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Inset Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 95196600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lk 1.0mm 2/4hl 2mm/2.3mm Ti Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,391.61|FSC: 13; Default||Not reimbursed separately|1,391.61|FSC: 13; Default||External grouping not supported 951202272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Inset Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Inset Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 95196602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 13mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951202276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|FSC: 13; Default||Not reimbursed separately|2,404.50|FSC: 13; Default||External grouping not supported 951202277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 14mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951202278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 7mm Ti Cort Hexa 6 Tpd Cr Fl Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951202280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Scphd 1.2mmx0.8mm Ti 1.5mm Scr 8 Hl Aptus Trlk Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,381.71|FSC: 13; Default||Not reimbursed separately|1,381.71|FSC: 13; Default||External grouping not supported 951202282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196605|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer 10cm 6fr 21ga Glidesheath Slender .021in 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Sm 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196606|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 3.5mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196607|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 4.0mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196608|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 4.5mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Med 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196609|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 5.0mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196610|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 5.5mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196611|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 6.0mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196612|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 6.5mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Lg 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196613|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv M5 Shockwave 7.0mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xl 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xl 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196616|EAP|Custom 95196616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Suture F/meniscal Root Repair Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xl 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xl 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196617|EAP|Custom 95196617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Minitape Cobraid White 39.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xl 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xl 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 5.5mm Peek Zip W/#2 Suture Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|676.80|FSC: 13; Default||Not reimbursed separately|676.80|FSC: 13; Default||External grouping not supported 951202306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xlg 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951202307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Duration Ts Tib Ins Xlg 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95196620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm Evos 8 Hole Hd 2 Hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.15|FSC: 13; Default||Not reimbursed separately|1,470.15|FSC: 13; Default||External grouping not supported 951202308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95196624|EAP|Custom 95196624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sut Tcrn 2-0 Sc-250 30in 2 Arm Braid Coat Blue Stght Revcut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95196625|EAP|Custom 95196625||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Pulse Oximeter Monitor Interface 14ft Masimo M-lncs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95196626|EAP|Custom 95196626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Avalon Elite 210cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95198106|EAP|Custom 95198106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Graft Putty Mastergraft Biologics Latex Free Sterile|1|HUMANA [1294]||HUMANA [11839]|3,087.00|FSC: 13; Default||Not reimbursed separately|3,087.00|FSC: 13; Default||External grouping not supported 951202319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95196627|EAP|Custom 95196627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator Cardiopulmonary Hls Advanced 7.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95196628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 14mm 4mm Asns Ti Mic Rvrs Cut Flut Ft Hnd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 951202322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Lg 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95198109|EAP|Custom 95198109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Headless 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Lg 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95196629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 13mm 4mm Asns Ti Mic Rvrs Cut Flut Ft Hnd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 951202324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Lg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Lg 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Lg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 95198104|EAP|Custom 95198104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 122mm 1.6mm Scaled Ao Nonsterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duracon Cnstr Tib Ins Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 951202328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Sm 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Sm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198105|EAP|Custom 95198105||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951202330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Sm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Sm 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 8mm T10 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951202333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Baby Gorilla 2.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 951202336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Baby Gorilla 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 951202339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 80171956|EAP|CPT® 53620||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Dilation Urethral Strict By Passage Of Filiform Male|1|HUMANA [1294]||HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 951202341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Profile 2mm 4 Hole Lock 22mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|FSC: 13; Default||Not reimbursed separately|2,280.00|FSC: 13; Default||External grouping not supported 951202342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 16mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951202343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196631|EAP|Custom 95196631||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Spinal Reline-o 6mm Lamina Wide|1|HUMANA [1294]||HUMANA [11839]|4,512.00|FSC: 13; Default||Not reimbursed separately|4,512.00|FSC: 13; Default||External grouping not supported 951202345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 2mm Screw 4 Hole Lock L 23mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 951202346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196632|EAP|Custom 95196632||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Spinal Reline-o 8mm Lamina Wide|1|HUMANA [1294]||HUMANA [11839]|4,512.00|FSC: 13; Default||Not reimbursed separately|4,512.00|FSC: 13; Default||External grouping not supported 951202347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196633|EAP|Custom 95196633||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Spinal Reline-o 10mm Lamina Wide|1|HUMANA [1294]||HUMANA [11839]|4,512.00|FSC: 13; Default||Not reimbursed separately|4,512.00|FSC: 13; Default||External grouping not supported 951202349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 951202350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196634|EAP|Custom 95196634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtr 4.8cm Md Prf Rnd 14.3cm 560cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 80172000|EAP|CPT® 28122||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Partial Excision Bone Tarsal Or Metatarsal Bone|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 951202353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T6 2.0mm L6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951202354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Rev Patella Med Pca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,012.30|FSC: 13; Default||Not reimbursed separately|6,012.30|FSC: 13; Default||External grouping not supported 951202356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95198108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 8mm T10 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 951202358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Lt Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196635|EAP|Custom 95196635||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Self Inflating Tissue Sphere 1 Ml|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951202367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951202368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 95196636|EAP|Custom 95196636||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Self Inflating Tissue Sphere 2 Ml|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951202369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pca Mtk Rev Tib Ins Rt Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|FSC: 13; Default||Not reimbursed separately|8,962.80|FSC: 13; Default||External grouping not supported 951203074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95198113|EAP|Custom 95198113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Smooth Standard 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196637|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Sheath Introducer With Guidewire 8fr 11cm Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196638|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Sheath Introducer With Guidewire 7fr 11cm Orange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95198119|EAP|Custom 95198119||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Eit 8mm 8 Degree Sterlie|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951203086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196639|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Sheath Introducer With Guidewire 6fr 11cm Green|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196640|EAP|Custom 95196640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Surgical Procedure Custom Cb9b82r 5pk Jump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95198120|EAP|Custom 95198120||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cnct Nrv 10mm 2mm Axoguard Prcn Xclr Mtrx Coaptation Aid|1|HUMANA [1294]||HUMANA [11839]|3,090.00|FSC: 13; Default||Not reimbursed separately|3,090.00|FSC: 13; Default||External grouping not supported 951203090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196641|EAP|Custom 95196641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Surgical Procedure Ch Custom Bb10q76r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 12mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951203093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size1 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198121|EAP|Custom 95198121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cnct Nrv 10mm 5mm Axoguard Prcn Xclr Mtrx Coaptation Aid|1|HUMANA [1294]||HUMANA [11839]|3,090.00|FSC: 13; Default||Not reimbursed separately|3,090.00|FSC: 13; Default||External grouping not supported 951203094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size1 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size1 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size1 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198122|EAP|Custom 95198122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prtc Nrv 20mm 10mm Axoguard Xclr Mtrx Multilaminar Strl|1|HUMANA [1294]||HUMANA [11839]|5,505.00|FSC: 13; Default||Not reimbursed separately|5,505.00|FSC: 13; Default||External grouping not supported 951203098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5th Met Hook Jmf Compression 5 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,104.00|FSC: 13; Default||Not reimbursed separately|4,104.00|FSC: 13; Default||External grouping not supported 951203102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198114|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Penta Neurostimulator Sjm 3mm 60cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 951203106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62065970|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Amphetamine Panel, Quant Only, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198115|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prcn 7.9inx7.9in Xenmatrix Aquapure Rect Aclr Clgn M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,596.00|FSC: 13; Default||Not reimbursed separately|28,596.00|FSC: 13; Default||External grouping not supported 951203110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62065980|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Barbiturate Panel, Quant Only, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size3 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62065990|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Benzodiazepine Panel, Quant Only, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 2mm Screw 10 Hole Lock L 57mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 951203114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62066000|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Opioid Panel, Quant Only, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62066010|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Gabapentin, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198118|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Srg Phasix 8in St Mesh With Echo 2 Pstl System Platform|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,314.00|FSC: 13; Default||Not reimbursed separately|22,314.00|FSC: 13; Default||External grouping not supported 951203118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62066020|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Carisoprodol, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62066030|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Compliance Meprobamate, Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951203121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 62066240|EAP|CPT® 86682||0302 - LABORATORY - IMMUNOLOGY|Hb Strongyloides Ab, Igg-ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.03|FSC: 13; Default||Not reimbursed separately|39.03|FSC: 13; Default||External grouping not supported 951203122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196648|EAP|Custom 95196648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dil Hdrph Lng Tpr 45cm 14fr Evas Acpt .035in Gw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196653|EAP|Custom 95196653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Positioner Robb Leg With Aluminum Footpiece|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198123|EAP|Custom 95198123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rld Stplr 2mm 30mm 3-stpl 2 Ex Thin Vasc Tiss Artc Gray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196654|EAP|Custom 95196654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Anesthesia Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Sckt 40mm Djo Srg Rsp -4mm Shd Rtn Scr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|FSC: 13; Default||Not reimbursed separately|4,320.00|FSC: 13; Default||External grouping not supported 951203129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198124|EAP|Custom 95198124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating Saw 70mm X 8mm X 1.27|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Rsp Djo Surgical Sm Semi Cnstd Humeral Hxe+ Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 951203131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.0mm X 85mm T2 Lckng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 951203133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size7 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198125|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Ph/iol Clear 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951203134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size7 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 36mm Cmpr Ft Ti Std Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951203135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size7 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 80172011|EAP|CPT® 46900||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Dstrj Lesion Anus Simple Chemical|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 951203137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size7 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198126|EAP|Custom 95198126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 0.9mm X 95mm Cobalt Chrome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size7 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 80172022|EAP|CPT® 12055||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Repair Intermediate Face 12.6-20.0cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951203139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196655|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 6mm 29mm 135cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951203141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95198127|EAP|Custom 95198127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Max Vpc Cannulated 1.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size8 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196656|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 6mm 39mm 135cm Loprfl Thn Bln Expandable Otw Peri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951203143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size8 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951203144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X3 Triathlon Cs Ins Size8 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95196658|EAP|Custom 95196658||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Tendon Pattelar Posterior Biocleanse 9mmx10mm|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 951203145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95198128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mmx12mm Variable Pitch Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,006.86|FSC: 13; Default||Not reimbursed separately|1,006.86|FSC: 13; Default||External grouping not supported 951203147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 80172034|EAP|CPT® 12035||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Repair Intermediate Scalp, Axillae,trunk Or Extremities 12.6-20.0cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951203148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 80172044|EAP|CPT® 12041||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Repair Intermediate 2.5cm Or Less|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951203153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196665|EAP|Custom 95196665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhsv Skin Clr Sl Ty A For Precision Sp Cd Stmlr Sys Ele Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196669|EAP|Custom 95196669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cystoscope Continuous Flow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196672|EAP|Custom 95196672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Asmb Sgscp Blb Bldr No Fltr Cln Strl Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Sphere Femoral Set Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 951203166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 24mm Ti Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 951203168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 30mm Ti Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 951203170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone For Plate Connection Ncb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|FSC: 13; Default||Not reimbursed separately|415.32|FSC: 13; Default||External grouping not supported 951203172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 32mm Geminus Ti Cort Pa Ns Dist Rds|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|FSC: 13; Default||Not reimbursed separately|456.00|FSC: 13; Default||External grouping not supported 951203174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951203175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95196664|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Surgical 2 X 8 50cm Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951203176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling 4.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951203178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shrt 205mm Ss 2.7/3.5mm Scr 13 Hl Va Tpr Tip Rnd Prfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.99|FSC: 13; Default||Not reimbursed separately|3,969.99|FSC: 13; Default||External grouping not supported 951203180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shrt 137mm Ss 2.7/3.5mm Scr 6 Hl Va Tpr Tip Xtd Lcp Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|FSC: 13; Default||Not reimbursed separately|3,814.23|FSC: 13; Default||External grouping not supported 951203182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 10mm Aptus Lckng Ti Dble Fl Thd Hnd Hd4 Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951203184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 11mm X 360mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951203186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196692|EAP|Custom 95196692||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Penumbra Engine Canister For Indigo System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196693|EAP|Custom 95196693||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Penumbra Engine (tm)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shrt 111mm Ss 2.7/3.5mm Scr 4 Hl Va Tpr Tip Xtd Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|FSC: 13; Default||Not reimbursed separately|3,814.23|FSC: 13; Default||External grouping not supported 951203192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196701|EAP|Custom 95196701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Scrdrvr 55mm Strdr T8 Slf Rtn Qc Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion 9mm X 93mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951203196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Peek Omega 3.9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 951203198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196685|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seprtr Thrmb .028in 3 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95198130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 18cm Intertrochanter Trgn Intertan Im 130d Antgrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|FSC: 13; Default||Not reimbursed separately|4,440.00|FSC: 13; Default||External grouping not supported 951203201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196686|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seprtr Thrmb .028in 6 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196687|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seprtr Thrmb .028in 8 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95198131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 32.5mm Fem Loprfl Intnl Hex Trgn Im Nl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 951203205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196690|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Separator D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 951203207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196691|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Separator 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95198132|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Ns 90cm Spc Surescan 2 Clmn 16 Eltrd Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 951203209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196688|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo Rx 140cm+ Lg Lmn Aspiration Tb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Ps X3 Tib Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|FSC: 13; Default||Not reimbursed separately|6,696.90|FSC: 13; Default||External grouping not supported 95196689|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo D+ Lmn Aspiration Tb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62066250|EAP|CPT® 84166||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Electro Frac/quant, Other Flds-ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.49|FSC: 13; Default||Not reimbursed separately|53.49|FSC: 13; Default||External grouping not supported 95196694|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo 3+ Lmn Aspiration Tb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196695|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo 5+ Lmn Aspiration Tb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95198143|EAP|Custom 95198143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 25mm|1|HUMANA [1294]||HUMANA [11839]|24,600.00|FSC: 13; Default||Not reimbursed separately|24,600.00|FSC: 13; Default||External grouping not supported 95196696|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo 6+ Lmn Aspiration Tb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196697|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo 8+ Lmn Aspiration Tb Torq 85cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95198141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.5mm 30mm Reline-o 2s Spine Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95196699|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Indigo 8+ Lmn Aspiration Tb Xtorq 115cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95198142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.5mm 35mm Reline-o 2s Spine Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951203224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 951203225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 951203226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 951203227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95198140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 35mm Reline-o 2s Spne Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951203228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95196706|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 335cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 951203230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95196707|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Smooth 400cc 11.5cm 5.8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951203231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio-flex Cr X3 Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|FSC: 13; Default||Not reimbursed separately|6,680.10|FSC: 13; Default||External grouping not supported 95198133|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 10.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95196708|EAP|Custom 95196708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Orth 0.86mm De Troc Mic Cmpr Ft Scr Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198134|EAP|HCPCS V2788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Len Intraoccular 10.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95198136|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95198137|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 11.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95198139|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 21.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95198147|EAP|Custom 95198147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Mini Ao 1.1mm Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198148|EAP|Custom 95198148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Trocar 1.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198153|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb System Pacing Micra Av Transcatheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,750.00|FSC: 13; Default||Not reimbursed separately|39,750.00|FSC: 13; Default||External grouping not supported 95198144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hummerus Proximal Left 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95198146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 8mm 34mm 11.5mm Asns Iii Ss Hip Slf Drl St Cnn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95196709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 10mm 4mm Asns Ti Mic Rvrs Cut Flut Ft Bl Hnd Sl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95196714|EAP|Custom 95196714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Lsr Abrhm 66 D Cpsltmy 15mm 16.5mm Mgnf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm 12mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95196715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Implant Fiber Tak Biceps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95198150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm 13mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95198151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm 16mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95198152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.4mm Triangle 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95198154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm X 12mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95196721|EAP|Custom 95196721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Blade 2.5/2.8 Hd6 Self-holding Ao Quick Coupling|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 56mm 10 Hl Ti Strght 2mm/2.3mm Aptus Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,292.06|FSC: 13; Default||Not reimbursed separately|2,292.06|FSC: 13; Default||External grouping not supported 95198155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm X 15mm Low Profile Ti Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95196718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 17mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95196719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 7mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 95198156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm X 16mm Low Profile Ti Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95196720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 9mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 62066040|EAP|CPT® G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gabapentin, Quant, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62066050|EAP|CPT® 81306||0301 - LABORATORY - CHEMISTRY|Hb Nudt15 - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|874.08|FSC: 13; Default||Not reimbursed separately|874.08|FSC: 13; Default||External grouping not supported 80172067|EAP|CPT® 64999||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Nervous System Procedure Unlisted|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95198158|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Phasix 6x8in Echo 2 Positional System Platform|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95196735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hd Hum Offset Thick 50mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95196725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95198171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammerlock 2 15mmx7mm 10 Degree Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95196726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.0mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95196727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Oblique 5hole Compression Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|FSC: 13; Default||Not reimbursed separately|2,691.00|FSC: 13; Default||External grouping not supported 95198172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 12mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95196728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 26mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95196724|EAP|Custom 95196724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gmk Sphere Femoral Set 6+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 16mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95196737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 55mmx2.2mm Loprfl Ss 2.7mm Scr 5hl T-shp Va Evos Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|FSC: 13; Default||Not reimbursed separately|2,318.25|FSC: 13; Default||External grouping not supported 951200833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95196738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 13mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.60|FSC: 13; Default||Not reimbursed separately|93.60|FSC: 13; Default||External grouping not supported 951200834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6.5mm Low Profile Hex Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95198174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Magenta 4.5mm X 30mm Virage|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951200835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm. Universal Cement Restrictor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95196739|EAP|Custom 95196739||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 18cm 28.5mm 14.5mm 12mm Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 951200836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Md. Universal Cement Restrictor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 951200837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rv. Universal Cement Restrictor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95196740|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viabahn .035 In 79mm 135cm Od10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,710.00|FSC: 13; Default||Not reimbursed separately|10,710.00|FSC: 13; Default||External grouping not supported 951200838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm. Universal Cement Restrictor W/di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95198181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling/self-tapping Rescue 4.5mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951200839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Md. Universal Cement Restrictor W/di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95196741|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shth Intro 45cm 12fr 4.7mm 4mm Gore Dryseal Flx Hdrph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951200840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rv. Universal Cement Restrictor W/di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 951200841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Sized Cement-plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95198175|EAP|Custom 95198175||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Virage 3.5mm 400mm Strt Occipital Cervico-thor Co|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951200842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Sized Cement-plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 951200843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Sized Cement-plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 80172077|EAP|CPT® 12054||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Interm Wnd Repair Face, Ears, Eyelids, Nose, Lip And Or Mucous Membranes|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951200844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Sized Cement-plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 951200845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Sized Cement-plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 951200846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteonics Sized Cement-plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95198176|EAP|Custom 95198176||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Graft Orthoblend 5cc|1|HUMANA [1294]||HUMANA [11839]|3,579.00|FSC: 13; Default||Not reimbursed separately|3,579.00|FSC: 13; Default||External grouping not supported 951200847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-44mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-46mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-48mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198177|EAP|Custom 95198177||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Eit 8mm 8 Degree L Sterlie|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951200850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-50mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-52mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196743|EAP|Custom 95196743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Trocar 0.125in Dia Quick Release Vanguard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-54mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198178|EAP|Custom 95198178||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Emerging Implant Techonolgies 7mm 8 Degree L Strl|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951200853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-56mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196744|EAP|Custom 95196744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1/8x3.2mm Quick Release V/2 Agc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-58mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-60mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196745|EAP|Custom 95196745||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 14x12mm Vrtstck Crstn Psr 11mm Peek-optm Lat Port|1|HUMANA [1294]||HUMANA [11839]|4,935.00|FSC: 13; Default||Not reimbursed separately|4,935.00|FSC: 13; Default||External grouping not supported 951200856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-62mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198179|EAP|Custom 95198179||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Emerging Implant Techonolgies 5mm 8 Degree S Sterli|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951200857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-64mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196747|EAP|Custom 95196747||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 70mm 22mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|43,497.00|FSC: 13; Default||Not reimbursed separately|43,497.00|FSC: 13; Default||External grouping not supported 951200858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-66mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Shell-clust Hole Por-68mm Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196748|EAP|Custom 95196748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stplr Intnl 28mmx4.8mm Ti Std Circ Lnr Cut Sqz Hndl Lg Anstm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198180|EAP|Custom 95198180||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Cif Emerging Implant Techonolgies 6mm 8 Degree S Sterli|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951200861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196750|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +12.0 Diop Mod C Bcnvx 13mm 6mm Pc 1 Pc Fld Ant Asp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 12mm X 375mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951200864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198159|EAP|Custom 95198159||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ring Foot Short 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196753|EAP|Custom 95196753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Lithovue Empower Retrieval Deployment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Solidback Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Cluster Hole Cup 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 1.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|FSC: 13; Default||Not reimbursed separately|933.00|FSC: 13; Default||External grouping not supported 951200868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Cluster Hole Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198160|EAP|Custom 95198160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coupling External Fixation Hinge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Tritanium Hemi Cluster Hole Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 4mm Easystep Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951200870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 42a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 44b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Superelastic Express Easyclip 15x15x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951200872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 48d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198161|EAP|Custom 95198161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Hlf 180mm 5mm Apx Ss Thrd Slfdrl St 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 52e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196757|EAP|Custom 95196757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Skin W10mm T7.2mm L9.6cm Allograft Hemi Btb No Hl Ps|1|HUMANA [1294]||HUMANA [11839]|8,040.00|FSC: 13; Default||Not reimbursed separately|8,040.00|FSC: 13; Default||External grouping not supported 951200874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 54e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 56f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198162|EAP|Custom 95198162||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nut Orth 6mm Sh Crbn M6 Cnt Thrd Red Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 58f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196760|EAP|Custom 95196760||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Surgical 2.4mm Fluted Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 60g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 951200878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 62g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196766|EAP|Custom 95196766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 13.8cm 5.0cm 525cc Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 64h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95198163|EAP|Custom 95198163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bolt Xtrnfx 1.5mm-2mm Lng Crbn Wire Hl 5 Hoffmn Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Ii Tritanium Clusterhole 66h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95196770|EAP|Custom 95196770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hg Pr 14.7cm 5.9cm 650ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 46mm Cup Tpr Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trin 48mm Cup-tap Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196772|EAP|Custom 95196772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Hg Pr 14.9cm 6.0cm 700ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 50mm Cup-tpr Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198164|EAP|Custom 95198164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Washer Orthopedic 7mm Dia Red Hoffmann Ii Pvc-free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 52mm Cup-tpr Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196775|EAP|Custom 95196775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 14.8cm 5.4cm 650cc Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 54mm Cup-tpr Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 56mm Cup-tpr Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 14mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951200887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 58mm Cup-tpr Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198165|EAP|Custom 95198165||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Fixation 1.8mm Dia 450mml Diamond Point F/hoffmann Ii|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 951200888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 60mm Cup-tpr Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 12mm Spnl Ma Impt Occipitocrvical Up Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951200889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 62mm Cup-tpr Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Trinity 64mm Cup-tpr Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198166|EAP|Custom 95198166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Xtrnfx 6mm 60mm Crbn Ft Akl Ext Sys Hoffman Ii Lf Pvs Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spinal W/transverse Connector Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|FSC: 13; Default||Not reimbursed separately|492.00|FSC: 13; Default||External grouping not supported 951200893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196767|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.9x5.1m 540cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198167|EAP|Custom 95198167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Half Hinge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196768|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.8x5.0m 525cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196769|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 14.9x6.0cm 700cc Hsc Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Z Acetabular Shell Size 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198168|EAP|Custom 95198168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut External Fixation Short 119-161mml Telescopic Yellow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196776|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 15.1x5.5m 695cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196777|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 14.8x5.4m 650cc Hsc Mod Pls Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198169|EAP|Custom 95198169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Xtrnfx 6mm 350mm Crbn 5h Ft Akl Ext Sys Hoffman Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 14.7x5.9cm 650cc Hsc+ Smt Rnd Hg Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951200905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198170|EAP|Custom 95198170||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Large Rocker Shoe Short 180mm 210mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Solid Bk 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 13mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951200922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196783|EAP|Custom 95196783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Orth 1/8in 89mm Fltd Ltrl Accs Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196792|EAP|Custom 95196792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 250mm 4.2mm Ao Cplng Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198197|EAP|Custom 95198197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Epidural Tray Espocan Tuohy 17ga 3.5in Syringe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951200927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196786|EAP|Custom 95196786||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Ligation 45mm Flex-v F/left Atrial Appendage Occlusion|1|HUMANA [1294]||HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951200928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Superelastic Express Easyclip 25x22x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 951200930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95198182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm 75mm 22mm Cannulated Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|FSC: 13; Default||Not reimbursed separately|560.25|FSC: 13; Default||External grouping not supported 951200931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 40mm T8 2mm Cort St Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951200932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 951200933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Solid Bk 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|FSC: 13; Default||Not reimbursed separately|6,350.40|FSC: 13; Default||External grouping not supported 95196784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.5mm 60mm Loprfl Scr Ti Ankl Canc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951200934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95198183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm 80mm 22mm Cannulated Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|FSC: 13; Default||Not reimbursed separately|560.25|FSC: 13; Default||External grouping not supported 951200935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.0mm 48mm Evos Mn Ss T8 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951200936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7/3.5mm Evos Olecranon W/tines 7h Lt 114mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951200938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95198184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 34cm Right Trochanter Intertan Intramedullary 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951200939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.3mm 36mm T8 2mm St Lck Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951200940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 175mm Ti 10 Hl Lck Variax Bn Lft Post Mdl Elb Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 951200942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95198187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 14mm Variax T8 Full Thread Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 951200943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 60mml X 5.0mm Dia Compression Cannulated Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,920.50|FSC: 13; Default||Not reimbursed separately|2,920.50|FSC: 13; Default||External grouping not supported 951200944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95198189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 16mm Variax T8 Full Thread Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 951200948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 62066060|EAP|CPT® 87150||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Blood Culture Nat Gram Neg|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951200950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Cluster 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95198190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 18mm Variax T8 Full Thread Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 951200951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 62066070|EAP|CPT® 87150||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Blood Culture Nat Gram Pos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951200952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 62066080|EAP|CPT® 87150||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Blood Culture Nat Fungal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951200954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 951200957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196804|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +34 Diop +2.5 Cyl Bcnvx 13mm 6mm Pc 1 Pc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951200958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95198192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 22mm Variax T8 Full Thread Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|FSC: 13; Default||Not reimbursed separately|972.00|FSC: 13; Default||External grouping not supported 951200959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 200cm Rt Ankl T2 Im Arthds Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|FSC: 13; Default||Not reimbursed separately|6,598.20|FSC: 13; Default||External grouping not supported 951200960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95160351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.50|FSC: 13; Default||Not reimbursed separately|391.50|FSC: 13; Default||External grouping not supported 951200961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Hemispherical Ha Cluster 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|FSC: 13; Default||Not reimbursed separately|6,104.70|FSC: 13; Default||External grouping not supported 95196801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 40mm Ti Part Thrd Flx3 Lck In T2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|571.20|FSC: 13; Default||Not reimbursed separately|571.20|FSC: 13; Default||External grouping not supported 951201666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196802|EAP|Custom 95196802||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Std 5+ Mm Fem T2 Im Nl Ti Strl 12mm|1|HUMANA [1294]||HUMANA [11839]|594.30|FSC: 13; Default||Not reimbursed separately|594.30|FSC: 13; Default||External grouping not supported 951201668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 10mm X 375mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951201670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196794|EAP|Custom 95196794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rmr Srg 11mm Modhd Kn 450mm Bixcut Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196795|EAP|Custom 95196795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rmr Srg 12mm Modhd Kn 450mm Bixcut Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 62066260|EAP|CPT® 86255||0309 - LABORATORY - OTHER LABORATORY|Hb Phospholipase A2 Receptor Ab, Igg W/reflex To Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 951201675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196796|EAP|Custom 95196796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rmr Srg 12.5mm Modhd Kn 450mm Bixcut Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196797|EAP|Custom 95196797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rmr Srg 13mm Modhd Kn 450mm Bixcut Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 62066270|EAP|CPT® 86256||0309 - LABORATORY - OTHER LABORATORY|Hb Pla2r Igg Titer-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 951201679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196798|EAP|Custom 95196798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rmr Srg 13.5mm Modhd Kn 450mm Bixcut Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196811|EAP|Custom 95196811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Surgical 3.8mm Omega Reuseable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6mm 3.0mm 80mm Ti T25 Ft Fem Lck St Blnt Tip 2 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 951201684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198020|EAP|Custom 95198020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Single Syringe Bx/10 M00519221|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 28 Mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198200|EAP|Custom 95198200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Rmr 14mm Dp Flut Ss Cncl Tip Shrp Edg Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 10¦ Crossfire Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Femoral Neck 95mml Perforated Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,317.02|FSC: 13; Default||Not reimbursed separately|2,317.02|FSC: 13; Default||External grouping not supported 951201688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 951201689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95196807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 12mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 951201690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95198206|EAP|Custom 95198206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut External Fixation X-short 100-125mml Telescopic Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95196808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 45mm Reline Mas 2c Spne Mdlr Shnk Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|FSC: 13; Default||Not reimbursed separately|3,087.00|FSC: 13; Default||External grouping not supported 951201692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 951201693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95196809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 2.3mm 2 Osteoraptor Ulbrd Cobraid Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,031.76|FSC: 13; Default||Not reimbursed separately|1,031.76|FSC: 13; Default||External grouping not supported 951201694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95198198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 16mm Ti Cmpr Short Thrd Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951201695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95196810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 5.5mm Peek Zip Sz2 Absb Frc Frb Suture Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|689.34|FSC: 13; Default||Not reimbursed separately|689.34|FSC: 13; Default||External grouping not supported 951201696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 951201697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95198199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Persona Tm Fm Tm Tib Ve Surf Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,987.00|FSC: 13; Default||Not reimbursed separately|18,987.00|FSC: 13; Default||External grouping not supported 951201698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 951201699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95198201|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 951201701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 32mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|FSC: 13; Default||Not reimbursed separately|5,090.40|FSC: 13; Default||External grouping not supported 95198202|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|FSC: 13; Default||Not reimbursed separately|5,399.10|FSC: 13; Default||External grouping not supported 951201703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|FSC: 13; Default||Not reimbursed separately|5,399.10|FSC: 13; Default||External grouping not supported 951201704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|FSC: 13; Default||Not reimbursed separately|5,399.10|FSC: 13; Default||External grouping not supported 951201705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|FSC: 13; Default||Not reimbursed separately|5,399.10|FSC: 13; Default||External grouping not supported 95198203|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 13.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|FSC: 13; Default||Not reimbursed separately|5,399.10|FSC: 13; Default||External grouping not supported 951201707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Elevated Rim Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|FSC: 13; Default||Not reimbursed separately|5,399.10|FSC: 13; Default||External grouping not supported 95198205|EAP|Custom 95198205||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sft Tis 18cm 8-8mm Fem Arty Cryo Algf Lf Strl|1|HUMANA [1294]||HUMANA [11839]|12,469.32|FSC: 13; Default||Not reimbursed separately|12,469.32|FSC: 13; Default||External grouping not supported 951201708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 5 Hl Lck Bn Lng Bn 95mm Non Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 951201709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196814|EAP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pacing Imp Etak Relnc 64cm Dl Coil Helix Df4 Gr Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951201711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198207|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +20.5 Diop +1.5 Add Hpt C Bcnvx 13mm 6mm Pc 1 Pc Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951201712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 5.5 X 45mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951201713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 50mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951201715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28i|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198208|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +21.0 Diop +1.5 Add Hpt C Bcnvx 13mm 6mm Pc 1 Pc Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951201716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 28j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 5.5 X 50mm - 5.5/6.0 Sv Ats|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951201717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198209|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +21.5 Diop +1.5 Add Hpt C Bcnvx 13mm 6mm Pc 1 Pc Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951201721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32i|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 0¦ 32j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Eccentric Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Eccentric Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Eccentric Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Eccentric Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Eccentric Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ Crossfire Eccentric Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198211|EAP|Custom 95198211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Sizing Speedtriad Implant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196825|EAP|Custom 95196825||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Ekg Ldx5 Grabr Colr Intellivue Lf Reus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196826|EAP|Custom 95196826||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Ekg Shielded Telem 34in Ldx5 Grabr Aami Colr Ecg Lf Reus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198212|EAP|Custom 95198212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Speed Drill Kit With 2.0mm Drill Bit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Sut 5.5mm Zip Peek #2 Sut Force Fib Ndl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|676.80|FSC: 13; Default||Not reimbursed separately|676.80|FSC: 13; Default||External grouping not supported 951201736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28i|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 28j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95196829|EAP|Custom 95196829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Arthroscopic Anatomic Socket Flipcutter Iii Knee Dril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198217|EAP|Custom 95198217||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Graft Strip Mastergraft 12cc 2cmx10cmx0.6cm|1|HUMANA [1294]||HUMANA [11839]|3,704.40|FSC: 13; Default||Not reimbursed separately|3,704.40|FSC: 13; Default||External grouping not supported 951201739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 80172078|EAP|CPT® 12053||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|HB INTERIMEDIATE WND FACE, EAR, EYELIDS, LIPS 5.1CM TO 5.7CM|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 951201740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 95198219|EAP|Custom 95198219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dntl Syr Vitapex Reg Root Cnl Ca Hdrxd 20 Tip Premx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32i|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 32j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|FSC: 13; Default||Not reimbursed separately|4,767.00|FSC: 13; Default||External grouping not supported 951201745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 36e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 36f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 95196835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Std 145mm Ss 2.4mm Scr 10hle/hd 2hl Va Lcp Lft Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,411.35|FSC: 13; Default||Not reimbursed separately|7,411.35|FSC: 13; Default||External grouping not supported 951201747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 36g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 95198210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 3+ 11mm Knee Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|FSC: 13; Default||Not reimbursed separately|6,468.00|FSC: 13; Default||External grouping not supported 951201748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 36h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 95196836|EAP|Custom 95196836||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Template Srg Xl F/2.4/2.7mm Va Lcp Clmnx2 Volar Dstl Rds|1|HUMANA [1294]||HUMANA [11839]|944.13|FSC: 13; Default||Not reimbursed separately|944.13|FSC: 13; Default||External grouping not supported 951201749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 36i|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 951201750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident Crossfire Eccentric 10¦ 36j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|FSC: 13; Default||Not reimbursed separately|5,415.90|FSC: 13; Default||External grouping not supported 95196837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Hum 6mm 40mm Reunion Std X3 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 951201751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-28/44 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95160649|EAP|Custom 95160649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Patella 46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 2+ 8mm Ankle Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|FSC: 13; Default||Not reimbursed separately|6,468.00|FSC: 13; Default||External grouping not supported 951201752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-28/46 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196838|EAP|Custom 95196838||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cover Transducer Ultrasound Ea4015 Biplane 8848|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-28/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-28/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196839|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +16.5 Diop +1.5 Cyl Hpt C Bcnvx 13mm 6mm Pc 1 Pc Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951201755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-32/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 15mm 40mm Shldr Simpliciti Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 951201756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-32/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196840|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +22 Diop Mod C Bcnvx 13mm 6mm Pc 1 Pc Fld Ant Asph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951201757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-32/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-32/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196842|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Saphenous 7mm X 74cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,335.00|FSC: 13; Default||Not reimbursed separately|31,335.00|FSC: 13; Default||External grouping not supported 951201759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-36/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95198213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Compression Speedtriad 18x15x8mm Centered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,130.49|FSC: 13; Default||Not reimbursed separately|4,130.49|FSC: 13; Default||External grouping not supported 951201760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-36/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-36/56 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-36/58-60 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Ucl Internal Brace Implant Repair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951201763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-36/62-64 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95198214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Compression Speedtriad 18x15x8mm Centered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,130.49|FSC: 13; Default||Not reimbursed separately|4,130.49|FSC: 13; Default||External grouping not supported 951201764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly Neut-36/66-70 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Intfr Bcmps 4.75mm 6mm W/swl Lck X2 Lp Rmer 7mm Cann 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,461.00|FSC: 13; Default||Not reimbursed separately|4,461.00|FSC: 13; Default||External grouping not supported 951201765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Xlve Acetabular Liner Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-neut-40/56 Restoris Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 34mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 951201767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-neut-40x58/60 Restoris Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-neut-40x62/64 Restoris Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196846|EAP|Custom 95196846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endo 8-20fr Dia 37cm S- Crv Hydrct Ureth Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-neut-40x66/68 Restoris Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-28/44 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196847|EAP|Custom 95196847||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Head Left Fresh|1|HUMANA [1294]||HUMANA [11839]|20,716.65|FSC: 13; Default||Not reimbursed separately|20,716.65|FSC: 13; Default||External grouping not supported 951201771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-28/46 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-28/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-28/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-32/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-32/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-32/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-32/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196848|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith 36mm X 116mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,351.00|FSC: 13; Default||Not reimbursed separately|21,351.00|FSC: 13; Default||External grouping not supported 951201778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-36/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-36/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-36/56 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intfr 7mm 20mm Biocompositcp Fst Thd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951201781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-36/58-60 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-36/62-64 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196851|EAP|Custom 95196851||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 60mmx8mm Clydesdale 6d Peek-vrtbrl Tntlum Mrk Strl|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 951201783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly High-36/66-70 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restoris Xlve Acetabular Liner High Wall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 38mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951201785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-high-wall 40/56 Restoris Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-high-wall 40x58/60 Restor Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196853|EAP|Custom 95196853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ctr Ascp Antm Sckt Flipcutter Ii Shrt Kn 11mm 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-high-wall 40x62/64 Restor Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95198231|EAP|Custom 95198231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Irrigation F/gi Endoscopes Pentax Smartcap Latex-free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-high-wall 40x66/68 Restor Xlve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pack Surgical Procedure Custom Setup Acl W/device|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.01|FSC: 13; Default||Not reimbursed separately|1,013.01|FSC: 13; Default||External grouping not supported 951201789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-28/44 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-28/46 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 80172088|EAP|CPT® 28190||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Foreign Body Foot Subcutaneous|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 951201791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-28/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198233|EAP|Custom 95198233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Neurostimulator 5in 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-28/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196854|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 202mm 32mm Znth Tx2 Dissection Str Comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,786.00|FSC: 13; Default||Not reimbursed separately|51,786.00|FSC: 13; Default||External grouping not supported 951201793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-32/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-32/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196855|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 180mm 36mm Znth Tx2 Dissection Str Comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,423.00|FSC: 13; Default||Not reimbursed separately|45,423.00|FSC: 13; Default||External grouping not supported 951201795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-32/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198240|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 15.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-32/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95196856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 4.5mm 44mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 951201797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-36/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-36/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-36/56 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-36/58-60 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-36/62-64 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4off-36/66-70 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95198241|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 16.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-28/44 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-28/46 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198242|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 17.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-28/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-28/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198243|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 17.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-32/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-32/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198244|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951201809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-32/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-32/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-36/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-36/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-36/56 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-36/58-60 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-36/62-64 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95196862|EAP|Custom 95196862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Modular Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 El-36/66-70 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-28/44 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-28/46 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198245|EAP|Custom 95198245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stylet 0.016in 1235mm L F/always-on Tip Tracked|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951201819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-28/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-28/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L30 Mm Od3 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 951201821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-32/48 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-32/50 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-32/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 95198247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Anchorage Ti T8 Ft/ankl Tx Hd Lck Ns Gld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 951201824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-32/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|FSC: 13; Default||Not reimbursed separately|4,365.90|FSC: 13; Default||External grouping not supported 951201825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-36/52 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-36/54 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-36/56 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95198248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Tendon Implant Standard 4mmw X 24.5cml Hunter Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,981.00|FSC: 13; Default||Not reimbursed separately|6,981.00|FSC: 13; Default||External grouping not supported 951201828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-36/58-60 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-36/62-64 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 951201830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ace Linr-e-poly +4 Hi-36/66-70 Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|FSC: 13; Default||Not reimbursed separately|4,991.70|FSC: 13; Default||External grouping not supported 95198249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 2.3mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|FSC: 13; Default||Not reimbursed separately|918.00|FSC: 13; Default||External grouping not supported 951201831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 62066099|EAP|HCPCS 87481||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HB INFECTIOUS AGENT, AMP PROBE, C KRUSEI|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951201834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 62066100|EAP|CPT® 87481||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HB INFECTIOUS AGENT, AMP PROBE, C. GLABRATA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951201836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 62066111|EAP|CPT® 87481||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Infectious Agent, Amp Probe, 4 Candida Species|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 951201838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 62066122|EAP|CPT® 87801||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Infectious Agent, Amp Probe, 5 Markers|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.60|FSC: 13; Default||Not reimbursed separately|210.60|FSC: 13; Default||External grouping not supported 951201840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 22mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 951201841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 26mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 62066133|EAP|CPT® 80306||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rapid Drug Panel, Medtox Scanner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.42|FSC: 13; Default||Not reimbursed separately|51.42|FSC: 13; Default||External grouping not supported 951202546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 95198255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Sky 2 Level 36mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|FSC: 13; Default||Not reimbursed separately|4,622.22|FSC: 13; Default||External grouping not supported 951202551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Half Blocks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|FSC: 13; Default||Not reimbursed separately|4,097.10|FSC: 13; Default||External grouping not supported 951202554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts 10mm Full Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95198256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hd Hum 50mm 20mm Shldr Antmic Ntrl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951202555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Full Block -10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts 10mm Full Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Full Block -10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95196867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 58mm Ss 3.5mm Scr 5h Loprfl Va Evos Lft Dp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|FSC: 13; Default||Not reimbursed separately|1,519.65|FSC: 13; Default||External grouping not supported 951202558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts 10mm Full Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95198260|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 19.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts 10mm Full Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts 10mm Full Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts 10mm Full Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95198282|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 26.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95198281|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 25.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95198261|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 20.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95161301|EAP|Custom 95161301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sling Sara Plus X-large Wipedown|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Full Tibial Wedge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 951202570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 951202571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 951202572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 951202573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 951202574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 95198262|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 95196877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 40mm Ss T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951202576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 951202577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 95196861|EAP|Custom 95196861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit With Bubble Trap Pg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 95198263|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 95196873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 10mm X 345mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951202580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 951202581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Fem. W/lfit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|FSC: 13; Default||Not reimbursed separately|20,090.70|FSC: 13; Default||External grouping not supported 95196874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 10mm Easystep Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951202582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Mod. Tib. Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 95198264|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 23.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Modular Tib Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 95196875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 34mm Ss T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951202584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Mod. Tib. Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 951202585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio T/s Modular Tib Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 95196876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 36mm Ss T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 951202586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Mod. Tib. Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 95198265|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 24.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Mod. Tib. Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 951202588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Mod. Tib. Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 95198266|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 25.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio Ts Mod. Tib. Tray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|FSC: 13; Default||Not reimbursed separately|9,668.40|FSC: 13; Default||External grouping not supported 951202590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vit'canc' Screw 6.5 Dia X 16mmtriathlon Total Knee System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95196878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Navicular Ss 2.4/2.7mm Scr Vr An Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.39|FSC: 13; Default||Not reimbursed separately|3,651.39|FSC: 13; Default||External grouping not supported 951202591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Vitallium Cancellous Bone Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95198267|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 26.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Vitallium Cancellous Bone Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 80158587|EAP|CPT® 28230||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tenotomy Open Foot Single Or Mul|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 80158033|EAP|CPT® 29581||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Apply Multi Layer Wound Compress|1|HUMANA [1294]||HUMANA [11839]|412.85|FSC: 13; Default||Not reimbursed separately|412.85|FSC: 13; Default||External grouping not supported 95196879|EAP|Custom 95196879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Meniscal Root Repair Instruments Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158264|EAP|CPT® 49460||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Mech Remov Obst Mat Ostomy|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 951202593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Vitallium Cancellous Bone Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 951202594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Vitallium Cancellous Bone Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95196880|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endo 142mm 28mm Zenith Tx2 Disct Strght Cmpnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,786.00|FSC: 13; Default||Not reimbursed separately|51,786.00|FSC: 13; Default||External grouping not supported 951202595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Vitallium Cancellous Bone Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95198268|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 27.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Vitallium Cancellous Bone Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95196882|EAP|Custom 95196882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio Curve 5fr 125cm Mpa Brd Hydro Slip Cat Beacon Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 95196883|EAP|Custom 95196883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Vitrtm 25ga Cnstl Edgeplus Troc Cnn Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 95198269|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 27.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 95198270|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 28.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 95196885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 14mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951202612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|FSC: 13; Default||Not reimbursed separately|13,001.10|FSC: 13; Default||External grouping not supported 951202613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95196886|EAP|Custom 95196886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector External Fixation 35mm Angled Pin Iliarov|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 951202615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95196887|EAP|Custom 95196887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod External Fixation Ilizarov Stainless Steel L200 Mm Threa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 951202617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95198272|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 25.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951202618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95196888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 4 Level 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 951202619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 951202620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161504|EAP|Custom 95161504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3mm X 220mm Tornier|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161505|EAP|Custom 95161505||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Passer Suture Sterile Latitude|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161506|EAP|Custom 95161506||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restrictor Cement 24mm Latitude|1|HUMANA [1294]||HUMANA [11839]|987.00|FSC: 13; Default||Not reimbursed separately|987.00|FSC: 13; Default||External grouping not supported 951202622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Cemented Medium Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,495.55|FSC: 13; Default||Not reimbursed separately|8,495.55|FSC: 13; Default||External grouping not supported 95161508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spool Humeral Cemented Medium Ri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,636.55|FSC: 13; Default||Not reimbursed separately|2,636.55|FSC: 13; Default||External grouping not supported 951202623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161509|EAP|Custom 95161509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Restrictor Cement 13mm Latitude|1|HUMANA [1294]||HUMANA [11839]|496.62|FSC: 13; Default||Not reimbursed separately|496.62|FSC: 13; Default||External grouping not supported 95161510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Medium Latitude Torn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,680.01|FSC: 13; Default||Not reimbursed separately|3,680.01|FSC: 13; Default||External grouping not supported 951202624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial 6.5mm Latitude Torni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,603.50|FSC: 13; Default||Not reimbursed separately|4,603.50|FSC: 13; Default||External grouping not supported 95161512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ulnar Standard Mediu Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,723.90|FSC: 13; Default||Not reimbursed separately|6,723.90|FSC: 13; Default||External grouping not supported 951202625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95161518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Right Medial Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 951202626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|FSC: 13; Default||Not reimbursed separately|2,889.00|FSC: 13; Default||External grouping not supported 95161520|EAP|Custom 95161520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Temp Fixation 1.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161521|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95161522|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Guide Right Super Stif|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|FSC: 13; Default||Not reimbursed separately|13,135.50|FSC: 13; Default||External grouping not supported 95161523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Venture Anterior Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|FSC: 13; Default||Not reimbursed separately|7,238.28|FSC: 13; Default||External grouping not supported 95161524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 951202629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Distal Femoral Triathlo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95161526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Distal Femoral Triathlo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 951202630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161527|EAP|Custom 95161527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tubing Custom Medtronic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198273|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 25.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161528|EAP|Custom 95161528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Custom Line Vent 1/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161529|EAP|Custom 95161529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tubing Custom St Elizabeth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.3mm 42mm T8 2mm St Lck Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95161530|EAP|Custom 95161530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator 1.8m 2 Surface Area W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161533|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sj4 Icd Active Fixa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|FSC: 13; Default||Not reimbursed separately|13,081.50|FSC: 13; Default||External grouping not supported 95161539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Ps Tri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 951202633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161540|EAP|HCPCS C1779||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Temporary Transvenous Pacin|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95196901|EAP|Custom 95196901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cntrsnk Drl Mnqk Cplng 2.0mm/2.4mm Scr Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161541|EAP|Custom 95161541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Babcock With Ratchet Han|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95198274|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 26.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161547|EAP|Custom 95161547||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Liner Disposable Alvarado|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161550|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh L/p Elliptical 15.9cm X 10.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,375.05|FSC: 13; Default||Not reimbursed separately|1,375.05|FSC: 13; Default||External grouping not supported 95196900|EAP|Custom 95196900||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Generator Pacemaker Temp Pulse 2 Chamber W/acc5392|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161551|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore-tex 6-8mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,679.00|FSC: 13; Default||Not reimbursed separately|2,679.00|FSC: 13; Default||External grouping not supported 951202636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161562|EAP|Custom 95161562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Patency Urinary Silhouett|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161563|EAP|Custom 95161563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Patency Urinary Silhouett|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161569|EAP|Custom 95161569||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Surgical Ez-on Large Velcro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196910|EAP|Custom 95196910||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ritleng Bicanaliculus Lacrimal Tube L300mm D0.64mm|1|HUMANA [1294]||HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95161570|EAP|Custom 95161570||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Surgical Ez-on Medium Velcro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161571|EAP|Custom 95161571||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bra Surgical Ez-on Extra Large V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198275|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 26.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161572|EAP|Custom 95161572||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Nasal Optiflow Adult Sma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Tm Hole Multi P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,667.46|FSC: 13; Default||Not reimbursed separately|7,667.46|FSC: 13; Default||External grouping not supported 95196918|EAP|Custom 95196918||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 17x6mm Divergence 14mm Lrdtc Ncl Pulposus Peek|1|HUMANA [1294]||HUMANA [11839]|12,705.00|FSC: 13; Default||Not reimbursed separately|12,705.00|FSC: 13; Default||External grouping not supported 95161577|EAP|HCPCS C1779||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Temporary Transvenous Pacin|1|HUMANA [1294]||HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 951202640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161579|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Bioabsorbable Reinforcement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,479.00|FSC: 13; Default||Not reimbursed separately|1,479.00|FSC: 13; Default||External grouping not supported 95161584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 1.6mm Fixation Bone Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|622.20|FSC: 13; Default||Not reimbursed separately|622.20|FSC: 13; Default||External grouping not supported 951202641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95161585|EAP|Custom 95161585||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 1.6mm Fixation Bone Small|1|HUMANA [1294]||HUMANA [11839]|920.55|FSC: 13; Default||Not reimbursed separately|920.55|FSC: 13; Default||External grouping not supported 95196922|EAP|Custom 95196922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 4.0mm Dia Monster Head Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161588|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 4mm X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161590|EAP|Custom 95161590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Power-pro Uni 70 X 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198276|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 27.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161593|EAP|Custom 95161593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161594|EAP|Custom 95161594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Disposable Trigen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196911|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprsth 20mm 16fr 50mm Cook-z Trchbrnch Slf-expd Dbl|1|HUMANA [1294]||HUMANA [11839]|3,307.50|FSC: 13; Default||Not reimbursed separately|3,307.50|FSC: 13; Default||External grouping not supported 80158892|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb 1st Facet Joint Inj Cervical Or Thoracic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80158900|EAP|CPT® 64491||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb 2nd Facet Joint Inject Cervical|1|HUMANA [1294]||HUMANA [11839]|1,046.00|FSC: 13; Default||Not reimbursed separately|1,046.00|FSC: 13; Default||External grouping not supported 80158918|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Addl Facet Joint Inject Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 80158926|EAP|CPT® 64493||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb 1st Facet Joint Inject Lumbar|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80158934|EAP|CPT® 64494||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb 2nd Facet Joint Inject Lumbar|1|HUMANA [1294]||HUMANA [11839]|1,052.00|FSC: 13; Default||Not reimbursed separately|1,052.00|FSC: 13; Default||External grouping not supported 80158942|EAP|CPT® 64495||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Addl Facet Joint Inject Lumbar|1|HUMANA [1294]||HUMANA [11839]|1,004.82|FSC: 13; Default||Not reimbursed separately|1,004.82|FSC: 13; Default||External grouping not supported 80158959|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct 1st Facet Joint Inj Cervical Or Thoracic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80158967|EAP|CPT® 64491||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct 2nd Facet Joint Inject Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,046.00|FSC: 13; Default||Not reimbursed separately|1,046.00|FSC: 13; Default||External grouping not supported 80158975|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct Addl Facet Joint Inject Cervical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 80158983|EAP|CPT® 64493||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct 1st Facet Joint Inject Lumbar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80158991|EAP|CPT® 64494||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct 2nd Facet Joint Inject Lumbar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,052.00|FSC: 13; Default||Not reimbursed separately|1,052.00|FSC: 13; Default||External grouping not supported 80159007|EAP|CPT® 64495||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ct Addl Facet Joint Inject Lumbar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,004.82|FSC: 13; Default||Not reimbursed separately|1,004.82|FSC: 13; Default||External grouping not supported 77409191|EAP|Custom 77409191||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Boone Cty Speech Therapy 30 Mins|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 62056817|EAP|CPT® 85660||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R48 Hox Hgb S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.53|FSC: 13; Default||Not reimbursed separately|16.53|FSC: 13; Default||External grouping not supported 62056825|EAP|CPT® 86978||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R50 Hox Adsorption|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 80159100|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Genetic Counseling, Level 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80159101|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Genetic Counseling, Level 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80159102|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Genetic Counseling, Level 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80159103|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Genetic Counseling, Level 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80159104|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Genetic Counseling, Level 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95161595|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Lumen-multi Contura 5-6c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80159080|EAP|Custom 80159080||0126 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - DETOXIFICATION|Hb Behavioral Med Chem Dep Semi|1|HUMANA [1294]||HUMANA [11839]|2,585.75|FSC: 13; Default||Not reimbursed separately|2,585.75|FSC: 13; Default||Accommodation codes not reimbursed separately 80159098|EAP|CPT® 90853||0912 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - PARTIAL HOSPITALIZATION - LESS INTENSIVE|Hb Partial Hosp 7-24 Hrs|1|HUMANA [1294]||HUMANA [11839]|687.23|FSC: 13; Default||Not reimbursed separately|687.23|FSC: 13; Default||External grouping not supported 80159072|EAP|CPT® 90853||0906 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY|Hb Iop Session|1|HUMANA [1294]||HUMANA [11839]|207.72|FSC: 13; Default||Not reimbursed separately|207.72|FSC: 13; Default||External grouping not supported 80137896|EAP|CPT® 31575||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Laryngoscopy, Diagnostic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.28|FSC: 13; Default||Not reimbursed separately|483.28|FSC: 13; Default||External grouping not supported 80159015|EAP|Custom 80159015||0998 - STATISTICAL CHARGES|Hb Level 0 No Charge Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51000305|EAP|Custom 51000305||0171 - NURSERY - NEWBORN - LEVEL I|Hb Newborn Care|1|HUMANA [1294]||HUMANA [11839]|1,858.52|FSC: 13; Default||Not reimbursed separately|1,858.52|FSC: 13; Default||Accommodation codes not reimbursed separately 80158231|EAP|Custom 80158231||0998 - STATISTICAL CHARGES|Hb Room & Bd Ltac Select Medical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158249|EAP|Custom 80158249||0650 - HOSPICE SERVICE - GENERAL CLASSIFICATION|Hb Hospice Bluegrass|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161602|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Lumen-multi Contura 4-5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161610|EAP|Custom 95161610||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 14mm X 26mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 951202645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161613|EAP|Custom 95161613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pump Blood Cannula 32 French|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula 3.0mm X 180mm Left Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95161614|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sj4 Icd Active Fixa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 951202646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161615|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata Sj4 Icd Active Fixa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|FSC: 13; Default||Not reimbursed separately|13,770.00|FSC: 13; Default||External grouping not supported 95198277|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 27.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161616|EAP|Custom 95161616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retainer Viscera Sterile Disp. L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Osteotomy Sloped Ap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|FSC: 13; Default||Not reimbursed separately|1,560.00|FSC: 13; Default||External grouping not supported 95196913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 56mm Loprfl Scr Ss T15 Ft Hexalobe Ankl Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95161618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Substitute Graft Hatnc 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951202648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161620|EAP|Custom 95161620||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Lap-band Gast Adj Acc Prt|1|HUMANA [1294]||HUMANA [11839]|9,465.00|FSC: 13; Default||Not reimbursed separately|9,465.00|FSC: 13; Default||External grouping not supported 95161621|EAP|Custom 95161621||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Lap-band Gast Adj Acc Prt|1|HUMANA [1294]||HUMANA [11839]|9,465.00|FSC: 13; Default||Not reimbursed separately|9,465.00|FSC: 13; Default||External grouping not supported 951202649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Multihole Pinnacl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 95196914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95161629|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 50mm Linear|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|FSC: 13; Default||Not reimbursed separately|6,097.50|FSC: 13; Default||External grouping not supported 951202650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161630|EAP|Custom 95161630||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Piston Stapes Smart Flou|1|HUMANA [1294]||HUMANA [11839]|794.01|FSC: 13; Default||Not reimbursed separately|794.01|FSC: 13; Default||External grouping not supported 95198278|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 28.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161631|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor Check Flo 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mesh Module 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,001.01|FSC: 13; Default||Not reimbursed separately|1,001.01|FSC: 13; Default||External grouping not supported 95196915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 40mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95161638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|FSC: 13; Default||Not reimbursed separately|7,371.60|FSC: 13; Default||External grouping not supported 951202652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Beaded W/pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95161639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|FSC: 13; Default||Not reimbursed separately|7,371.60|FSC: 13; Default||External grouping not supported 95161640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|FSC: 13; Default||Not reimbursed separately|7,371.60|FSC: 13; Default||External grouping not supported 951202653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|FSC: 13; Default||Not reimbursed separately|7,371.60|FSC: 13; Default||External grouping not supported 95196916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 35mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95161643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Modular Tm Multihole 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|FSC: 13; Default||Not reimbursed separately|7,371.60|FSC: 13; Default||External grouping not supported 951202654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161644|EAP|Custom 95161644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cartridge Bone Augmentation Cort|1|HUMANA [1294]||HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95198279|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 28.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161645|EAP|Custom 95161645||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delivery System Aliquot Plunger|1|HUMANA [1294]||HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 951202655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161646|EAP|Custom 95161646||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delivery System Aliquot Syringe|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95161647|EAP|Custom 95161647||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delivery System Aliquot Mixtips|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 951202656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161648|EAP|Custom 95161648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delivery System Aliquot Gun|1|HUMANA [1294]||HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951202657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161664|EAP|Custom 95161664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Scoop 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 17mm Divergence Ti Spne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,080.00|FSC: 13; Default||Not reimbursed separately|4,080.00|FSC: 13; Default||External grouping not supported 95161666|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Jet Stream 2.1/3.0 And|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161668|EAP|Custom 95161668||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Kuhl Shield Size Medi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198280|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 25.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95161669|EAP|Custom 95161669||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Kuhl Shield Size Larg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161670|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Occlusion 10fr X .035 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 260mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95161671|EAP|Custom 95161671||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee Kuhl Shield Size X-la|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161672|EAP|Custom 95161672||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical Soft Mckenzie D-se|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161679|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Plus 80cm X 12.cm X 1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,179.00|FSC: 13; Default||Not reimbursed separately|1,179.00|FSC: 13; Default||External grouping not supported 951202661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161680|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 26mm X 96cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95196921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini-monster Full Thread Cannulated 4.0x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.00|FSC: 13; Default||Not reimbursed separately|711.00|FSC: 13; Default||External grouping not supported 95161682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Lock Hand Profyle 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.50|FSC: 13; Default||Not reimbursed separately|661.50|FSC: 13; Default||External grouping not supported 951202662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161683|EAP|Custom 95161683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Apc Sidefire Diameter 2.3m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161684|EAP|Custom 95161684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Irrigator Xps Straightsho|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161685|EAP|Custom 95161685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Negative Pressure Open|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161686|EAP|Custom 95161686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canister Abthera|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161687|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 28mm X 111cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95161693|EAP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Titanium Standard Xcela|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951202665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161696|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 16cm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.37|FSC: 13; Default||Not reimbursed separately|79.37|FSC: 13; Default||External grouping not supported 951202666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161699|EAP|Custom 95161699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Prismasate Egk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 2.7 X 16mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951202667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 14mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95161702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 16mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951202668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Fem Component - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95161703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon Sz 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95161704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 951202669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset 54mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951202670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ulnar Shortening 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95161728|EAP|Custom 95161728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Quickrelease Long 2.8m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95196925|EAP|Custom 95196925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Microraptor Hard Bone 1.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161731|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Pro Solo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ext 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|842.61|FSC: 13; Default||Not reimbursed separately|842.61|FSC: 13; Default||External grouping not supported 95161735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor P Gryphon Br Double Stran|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 951202673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161737|EAP|Custom 95161737||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 12mm X 32mm Vertes|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95196926|EAP|Custom 95196926||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Tissue 26mm Sapien 2 Transcatheter Bovine|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95161738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ulnar Short Small Right Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,723.90|FSC: 13; Default||Not reimbursed separately|6,723.90|FSC: 13; Default||External grouping not supported 951202674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Ulnar Small Elbow Latitude|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,675.61|FSC: 13; Default||Not reimbursed separately|2,675.61|FSC: 13; Default||External grouping not supported 95161740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Cemented Small Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,495.55|FSC: 13; Default||Not reimbursed separately|8,495.55|FSC: 13; Default||External grouping not supported 951202675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spool Humeral Centered Small Rig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,636.55|FSC: 13; Default||Not reimbursed separately|2,636.55|FSC: 13; Default||External grouping not supported 95196930|EAP|Custom 95196930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Bn 100mm Percutaneous Reprocessed Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Star Head 2.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.50|FSC: 13; Default||Not reimbursed separately|391.50|FSC: 13; Default||External grouping not supported 951202676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Ps Fem Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95161744|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Porous Osseofit 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95161750|EAP|Custom 95161750||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Pressure Relief Walker Smal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-l-sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Cemented Stabili|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 95196931|EAP|Custom 95196931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Bn 150mm Percutaneous Reprocessed Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizing Pfc Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951202678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-l-sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps With G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95161758|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Propaten 6mm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|FSC: 13; Default||Not reimbursed separately|987.00|FSC: 13; Default||External grouping not supported 951202679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-l-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161759|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Epidural Long Term Du-p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196932|EAP|Custom 95196932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Abd Surgifoam Porcine Gel Thk 8mm 100c 6.25cm 8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161761|EAP|Custom 95161761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Head Cannulated 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-r-sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161762|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round High Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95161763|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mplant Breast Gel Round High Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951202681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-r-sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161764|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 36mm X 95cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95196933|EAP|Custom 95196933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol 7.25% Dex 2000ml 1 Bg Ll Cntnr Ambu-f Ii Dlys Peritoneum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 951202682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-r-sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Proximal Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95161767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Knee Mrh Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951202683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patellofemoral-r-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95161768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Rotating Tibial Gmrs S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,143.00|FSC: 13; Default||Not reimbursed separately|10,143.00|FSC: 13; Default||External grouping not supported 95196923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Microraptor Knotless Rg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.00|FSC: 13; Default||Not reimbursed separately|1,230.00|FSC: 13; Default||External grouping not supported 95161769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Proximal Gmrs Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,670.80|FSC: 13; Default||Not reimbursed separately|24,670.80|FSC: 13; Default||External grouping not supported 951202684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Femoral-lm-rl-sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95161772|EAP|Custom 95161772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Electrode Xtd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161778|EAP|Custom 95161778||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Darco All Purpose Size S S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Femoral-lm-rl-sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95161780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95196924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 251mm Ti 14 Hl Axsos 3 Bn Tib Lt Prox Lat Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|FSC: 13; Default||Not reimbursed separately|10,395.00|FSC: 13; Default||External grouping not supported 95161781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Thick 50mm X 18mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951202686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Femoral-lm-rl-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95161782|EAP|Custom 95161782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2 Turon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ulnar Distal Volar Standar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.00|FSC: 13; Default||Not reimbursed separately|2,487.00|FSC: 13; Default||External grouping not supported 951202687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Femoral-rm-ll-sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95161784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Threaded 2.3mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95196927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intfr 8mm 20mm Biocompositcp Fst Thd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95161785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Threaded 2.3mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 951202688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Femoral-rm-ll-sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95161786|EAP|Custom 95161786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62066280|EAP|CPT® U0003||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Coronavirus 2019-sars-cov-2- Ref Lab|1|HUMANA [1294]||HUMANA [11839]|137.50|FSC: 13; Default||Not reimbursed separately|137.50|FSC: 13; Default||External grouping not supported 95161787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Self Tapping 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.07|FSC: 13; Default||Not reimbursed separately|446.07|FSC: 13; Default||External grouping not supported 951202689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Femoral-rm-ll-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95161789|EAP|Custom 95161789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 60mm Whit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196928|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprsth 15mm 14fr 50mm Cook-z Trchbrnch Slf-expd Dbl|1|HUMANA [1294]||HUMANA [11839]|3,307.50|FSC: 13; Default||Not reimbursed separately|3,307.50|FSC: 13; Default||External grouping not supported 95161790|EAP|Custom 95161790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 60mm Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis G-force 8mm X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95161795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis G-force 6mm X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951202691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 40mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95161797|EAP|Custom 95161797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Headed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161801|EAP|Custom 95161801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161807|EAP|Custom 95161807||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Wrist With Thumb Spica Rig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161808|EAP|Custom 95161808||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pressurizer Canal Femoral Withou|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161815|EAP|Custom 95161815||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Knee X-small Economy With|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161816|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Altrua 60 Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,613.00|FSC: 13; Default||Not reimbursed separately|17,613.00|FSC: 13; Default||External grouping not supported 95161826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 951202696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95161828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Triathlon Ts 10mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 951202697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibal Stabilizer Total Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95196935|EAP|Custom 95196935||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Toggleloc Pusher|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161831|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Sinus Flex Reliev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161832|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Sinus Flex Reliev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951202699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95196936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Large Hammertoe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95161843|EAP|Custom 95161843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Confidence Introducer Dia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161844|EAP|Custom 95161844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Confidence Introducer Bev|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161846|EAP|Custom 95161846||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spinal Cement Confidence System|1|HUMANA [1294]||HUMANA [11839]|1,695.00|FSC: 13; Default||Not reimbursed separately|1,695.00|FSC: 13; Default||External grouping not supported 951202701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161858|EAP|Custom 95161858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 22mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95161859|EAP|Custom 95161859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fast 4.0mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161860|EAP|Custom 95161860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 2.0mm Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.8 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 951202703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.8 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95196938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Mini 3mm 24mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95161863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 90 Degree 3.8 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 951202704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 90 Degree 3.8 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95161865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 90 Degree 3.8 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 951202705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 90 Degree 3.8 X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95196939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Int Toe 19mmx1.2mm Smrt Toe Ii 10d Ang Ntnl 1 Pc Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95161867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Snp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|275.40|FSC: 13; Default||Not reimbursed separately|275.40|FSC: 13; Default||External grouping not supported 951202706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shoulder S3 3 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 95161869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shoulder S3 4 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 951202707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 35.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 95161871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 951202708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded 4.0 X 37.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95161873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 45.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 951202709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 50.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 95196956|EAP|Custom 95196956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Ultra 5.5cm Hg Prf Rnd D13.6cm 550cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 951202710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 95161878|EAP|Custom 95161878||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bead Lc Low Compressible Blue 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Cemented Stabili|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 95196957|EAP|Custom 95196957||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Smth 5.6cm Hg Prf Rnd D14.0cm 600cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951202712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95161882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibia Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 951202713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161883|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Malecot Silicone 22 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196958|EAP|Custom 95196958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Microraptor Knotless Bone 1.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161884|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Diversion Ureteral Bander|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 951202714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161885|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Diversion Ureteral Bander|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95198283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Small Shell 8mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95161887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951202715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161897|EAP|Custom 95161897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bead Lc Low Compressible Yellow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 9mm Kn All Pe Cndrl Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|FSC: 13; Default||Not reimbursed separately|8,887.20|FSC: 13; Default||External grouping not supported 95161898|EAP|Custom 95161898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bead Lc Low Compressible Red 500|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161899|EAP|Custom 95161899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Psi With Integral Hemostasis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161902|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Anthem Rf Bi Ventricul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,161.25|FSC: 13; Default||Not reimbursed separately|21,161.25|FSC: 13; Default||External grouping not supported 951202717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161913|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 32mmx 111cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95196954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Small Shell 12mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95161914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3.0mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 951202718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Total 9mm X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95198284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 2.4mm Screw 4 Hole Lock L 28mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95161923|EAP|Custom 95161923||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Finger Pip Ligament Repai|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951202719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161924|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guideliner 5 In 6 .056|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 26mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95161925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 54mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951202720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Trithl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95161931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 22mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 951202721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Cr Tibial Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|FSC: 13; Default||Not reimbursed separately|5,352.90|FSC: 13; Default||External grouping not supported 95161932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 24mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95196942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 16mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 95161933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 32mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 951203426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95161934|EAP|Custom 95161934||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Mv Smartset 40 Gr|1|HUMANA [1294]||HUMANA [11839]|209.76|FSC: 13; Default||Not reimbursed separately|209.76|FSC: 13; Default||External grouping not supported 95198285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 14mm 39mm Shldr Aqls Ascnd Flx Cocr 1.5mm Lo Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,409.92|FSC: 13; Default||Not reimbursed separately|9,409.92|FSC: 13; Default||External grouping not supported 95161935|EAP|Custom 95161935||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Hv Smartset 40 Gr|1|HUMANA [1294]||HUMANA [11839]|209.76|FSC: 13; Default||Not reimbursed separately|209.76|FSC: 13; Default||External grouping not supported 951203427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95161936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Arthroplasty Toe Hemi K2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95196943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm X 12mm Ti Cort Hexa 6 Tapered Core Full St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95161941|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sys Emboshield Nav-6 5mm X 61941|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95161944|EAP|HCPCS C1887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Delivery System Attain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 951203429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95196944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm X 14mm Ti Cort Hexa 6 Tapered Core Full St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95161948|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Catheter Yueh Centesis 8f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95161954|EAP|Custom 95161954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Delivery Accessory Kit Is-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198288|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Nrstm Blu 70cm Nevro 5mm Spc Ld Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95161955|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rapido Advance Cs-eh 53|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95161956|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Cognis He Is-1/df-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71,970.00|FSC: 13; Default||Not reimbursed separately|71,970.00|FSC: 13; Default||External grouping not supported 95196945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm X 15mm Ti Cort Hexa 6 Tapered Core Full St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95161957|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Acuity Spiral Lva Single El|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 951203432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asymmetric Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95161958|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Evolution T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,680.00|FSC: 13; Default||Not reimbursed separately|1,680.00|FSC: 13; Default||External grouping not supported 95161959|EAP|Custom 95161959||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone 2 Cmw 20 Gr|1|HUMANA [1294]||HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 951203433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161960|EAP|Custom 95161960||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Ghv Smartset Gentami|1|HUMANA [1294]||HUMANA [11839]|734.40|FSC: 13; Default||Not reimbursed separately|734.40|FSC: 13; Default||External grouping not supported 95196948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm X 18mm Ti Cort Hexa 6 Tapered Core Full St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95161961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 951203434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161963|EAP|Custom 95161963||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Light Surgical Scintillant Sucti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161966|EAP|Custom 95161966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Stylet J For|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161969|EAP|Custom 95161969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Ventilator Bipap Vision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm X 16mm Ti Cort Hexa 6 Tapered Core Full St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95161970|EAP|Custom 95161970||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Ventilator Avian Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161971|EAP|Custom 95161971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Patient Parapac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Replacement Cup Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951203437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral 32mm 6 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.00|FSC: 13; Default||Not reimbursed separately|1,740.00|FSC: 13; Default||External grouping not supported 95196950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 11mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 95161975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 951203438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95198289|EAP|Custom 95198289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sut Grtx Cv-6 Th-13 5-0 36in 2 Arm Mfl Nabsb Lf Strl 12/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Left 14-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.75|FSC: 13; Default||Not reimbursed separately|5,553.75|FSC: 13; Default||External grouping not supported 951203439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Right 18-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,973.90|FSC: 13; Default||Not reimbursed separately|5,973.90|FSC: 13; Default||External grouping not supported 95196951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lk 2.0mm/2.3mm 6x2hl Ti Blue Trpzid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,843.20|FSC: 13; Default||Not reimbursed separately|1,843.20|FSC: 13; Default||External grouping not supported 95161980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Left 18-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,973.90|FSC: 13; Default||Not reimbursed separately|5,973.90|FSC: 13; Default||External grouping not supported 951203440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Right 14-h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.75|FSC: 13; Default||Not reimbursed separately|5,553.75|FSC: 13; Default||External grouping not supported 95161985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Left 16-ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,659.98|FSC: 13; Default||Not reimbursed separately|5,659.98|FSC: 13; Default||External grouping not supported 951203441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95161986|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Surgical Artisan 2 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95196952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm X 20mm Ti Cort Hexa 6 Tapered Core Full St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95161999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Thick Turon 42mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 951203442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95162000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Uni Deal New 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,744.00|FSC: 13; Default||Not reimbursed separately|3,744.00|FSC: 13; Default||External grouping not supported 95162001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New 3.5mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.50|FSC: 13; Default||Not reimbursed separately|877.50|FSC: 13; Default||External grouping not supported 951203443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95162002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New 3.5mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.50|FSC: 13; Default||Not reimbursed separately|877.50|FSC: 13; Default||External grouping not supported 95162003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New 3.5mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951203444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95162004|EAP|Custom 95162004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm Deal New|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162005|EAP|Custom 95162005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Cobital Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|FSC: 13; Default||Not reimbursed separately|2,144.10|FSC: 13; Default||External grouping not supported 95162017|EAP|Custom 95162017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Confidence 15g 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 50mm Loprfl Scr Ti T15 Ft Hexalobe Midfoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95162018|EAP|Custom 95162018||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxin Ps Legion Sz 4|1|HUMANA [1294]||HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951203446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95162019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Patella Gns Ii Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 95198294|EAP|Custom 95198294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture System 2-0 Adj Loop Lngt 18mm Tpr Point Needle 3/8 Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Base Tibial Ii Gns Size 5 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951203447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Symmetric X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95162021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Prefixation Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.02|FSC: 13; Default||Not reimbursed separately|391.02|FSC: 13; Default||External grouping not supported 95196962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 50mm Loprfl Scr Ti T15 Ft Midfoot Cort St Sld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95162023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Variable 4.5 X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|FSC: 13; Default||Not reimbursed separately|1,446.48|FSC: 13; Default||External grouping not supported 951203448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Asymmetric X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95162024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar Amt S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95162025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951203449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162026|EAP|Custom 95162026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Evactuaction Smoke Penada|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn Comp Lckng 2.4mm X 8mm Xs Plt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95162027|EAP|Custom 95162027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Platform Access Advanced Gelpoin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162029|EAP|Custom 95162029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pad Trac Use With V.a.c. Info|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198299|EAP|Custom 95198299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture System Cor-knot Mis Combo Kit Base Package Type|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162030|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Closer Device Mynx 6 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 951203451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 105mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196964|EAP|Custom 95196964||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Hex 1.5mm X 70mm Ao Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 110mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio M-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 115mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 105mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 125mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95198318|EAP|Custom 95198318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extremity Sheet 44in X 60in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 130mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 135mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 140mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 145mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 150mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio C-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 155mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95198319|EAP|Custom 95198319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Surgical Shoulder Convertors Drape 10in X 25in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162046|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951203457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 160mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 165mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 170mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 175mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 180mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 12mm Variax T6 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95162054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 80173166|EAP|HCPCS G2061||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 5-10min Pt|1|HUMANA [1294]||HUMANA [11839]|35.52|FSC: 13; Default||Not reimbursed separately|35.52|FSC: 13; Default||External grouping not supported 95162056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 45mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 9mm Variax T6 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.00|FSC: 13; Default||Not reimbursed separately|549.00|FSC: 13; Default||External grouping not supported 95162061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scorpio U-dome X3 Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162068|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,110.00|FSC: 13; Default||Not reimbursed separately|25,110.00|FSC: 13; Default||External grouping not supported 95162075|EAP|Custom 95162075||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hinge Phoenix Medium 4-1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Recessed Patellar Comp X3 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162076|EAP|Custom 95162076||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hinge Phoenix Large 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular T4/t4+ 14mm Kn Revision Hi Cnstrn Gldng W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,890.00|FSC: 13; Default||Not reimbursed separately|7,890.00|FSC: 13; Default||External grouping not supported 95162077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 55mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Recessed Patellar Comp X3 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 80173177|EAP|HCPCS G2062||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 11-20min Pt|1|HUMANA [1294]||HUMANA [11839]|62.67|FSC: 13; Default||Not reimbursed separately|62.67|FSC: 13; Default||External grouping not supported 95162079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Recessed Patellar Comp X3 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196968|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Cath 10cm 7fr Pn Strght Cross-cut Vl Hydrop 0.038in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Recessed Patellar Comp X3 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|FSC: 13; Default||Not reimbursed separately|3,005.10|FSC: 13; Default||External grouping not supported 95162082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patella Resurfacing Round Dome-26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|FSC: 13; Default||Not reimbursed separately|3,561.60|FSC: 13; Default||External grouping not supported 95162085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196969|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Cath 10cm 5fr Pn Strght Cross-cut Vl Hydrop 0.038in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patella Resurfacing Round Dome-29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|FSC: 13; Default||Not reimbursed separately|3,561.60|FSC: 13; Default||External grouping not supported 95162088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 80173188|EAP|HCPCS G2063||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 21>min Pt|1|HUMANA [1294]||HUMANA [11839]|98.22|FSC: 13; Default||Not reimbursed separately|98.22|FSC: 13; Default||External grouping not supported 95162089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patella Resurfacing Round Dome-32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|FSC: 13; Default||Not reimbursed separately|3,561.60|FSC: 13; Default||External grouping not supported 95162090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 115mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 27mm 1.3mm 4 Hl Ti Strght 2mm/2.3mm Apt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,872.90|FSC: 13; Default||Not reimbursed separately|1,872.90|FSC: 13; Default||External grouping not supported 95162091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 120mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patella Resurfacing Round Dome-38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|FSC: 13; Default||Not reimbursed separately|3,561.60|FSC: 13; Default||External grouping not supported 95162092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 125mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 130mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Patella Resurfacing Round Dome-41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|FSC: 13; Default||Not reimbursed separately|3,561.60|FSC: 13; Default||External grouping not supported 95162095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 135mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196971|EAP|Custom 95196971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.75cm Natrelle Inspira 5.3cm Fl Prfl Rnd 450cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 951203472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Prim Tib Baseplate - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95162103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 80173199|EAP|HCPCS G2061||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 5-10min Ot|1|HUMANA [1294]||HUMANA [11839]|35.52|FSC: 13; Default||Not reimbursed separately|35.52|FSC: 13; Default||External grouping not supported 95162104|EAP|Custom 95162104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Gigli 510mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Prim Tib Baseplate - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95162107|EAP|Custom 95162107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Copolymer Osteobond|1|HUMANA [1294]||HUMANA [11839]|201.96|FSC: 13; Default||Not reimbursed separately|201.96|FSC: 13; Default||External grouping not supported 95196972|EAP|Custom 95196972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 13cm Natrelle Inspira 5.4cm Fl Prfl Rnd 485cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162108|EAP|Custom 95162108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Support Type S Thermoplastic Imr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Prim Tib Baseplate - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95162109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Tube Std Versa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 95162110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Tube Std Versa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|FSC: 13; Default||Not reimbursed separately|1,334.88|FSC: 13; Default||External grouping not supported 951203475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Prim Tib Baseplate - Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95162111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Humeral Lateral Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.54|FSC: 13; Default||Not reimbursed separately|4,014.54|FSC: 13; Default||External grouping not supported 95196973|EAP|Custom 95196973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 13.25cm Natrelle Inspira 5.5cm Fl Prfl Rnd 520cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162112|EAP|Custom 95162112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maggot Medical Disinfected Larve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162114|EAP|Custom 95162114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Le-flap 6x6 Polyster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80173200|EAP|HCPCS G2062||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 11-20min Ot|1|HUMANA [1294]||HUMANA [11839]|62.67|FSC: 13; Default||Not reimbursed separately|62.67|FSC: 13; Default||External grouping not supported 95162115|EAP|Custom 95162115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive 1oz.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 140mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196974|EAP|Custom 95196974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 13.5cm Natrelle Inspira 5.7cm Fl Prfl Rnd 560cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 145mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 150mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 155mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 160mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196975|EAP|Custom 95196975||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 14cm Natrelle Inspira 5.8cm Fl Prfl Rnd 605cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 165mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162124|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Zephyr Xl Sr Single Ch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,016.00|FSC: 13; Default||Not reimbursed separately|11,016.00|FSC: 13; Default||External grouping not supported 80173211|EAP|HCPCS G2063||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 21>min Ot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.22|FSC: 13; Default||Not reimbursed separately|98.22|FSC: 13; Default||External grouping not supported 95162125|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Acellular Dermal Flex Hd 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.30|FSC: 13; Default||Not reimbursed separately|113.30|FSC: 13; Default||External grouping not supported 951203481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162126|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 22mm X 125cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,636.00|FSC: 13; Default||Not reimbursed separately|24,636.00|FSC: 13; Default||External grouping not supported 95162127|EAP|Custom 95162127||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cutter Patella 42mm|1|HUMANA [1294]||HUMANA [11839]|1,228.50|FSC: 13; Default||Not reimbursed separately|1,228.50|FSC: 13; Default||External grouping not supported 951203482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper Universal Ana|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,318.90|FSC: 13; Default||Not reimbursed separately|6,318.90|FSC: 13; Default||External grouping not supported 95162129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Adapter Taper V40 Univers|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 951203483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triathlon Mis Baseplate #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|FSC: 13; Default||Not reimbursed separately|7,016.10|FSC: 13; Default||External grouping not supported 95162130|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestent Sfa Self Expandi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95162131|EAP|Custom 95162131||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Microintroducer 4 Fr Stiff|1|HUMANA [1294]||HUMANA [11839]|133.68|FSC: 13; Default||Not reimbursed separately|133.68|FSC: 13; Default||External grouping not supported 951203484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Baseplate-lm/rl-sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95162133|EAP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drug Yttrium90 Zevain Kit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|94,500.00|FSC: 13; Default||Not reimbursed separately|94,500.00|FSC: 13; Default||External grouping not supported 80173222|EAP|HCPCS G2061||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 5-10min St|1|HUMANA [1294]||HUMANA [11839]|35.52|FSC: 13; Default||Not reimbursed separately|35.52|FSC: 13; Default||External grouping not supported 95162134|EAP|Custom 95162134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rectal Retractor Titanium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Baseplate-lm/rl-sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95162135|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 30mmx 111cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95162136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 170mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Baseplate-lm/rl-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95162137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 175mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162138|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|FSC: 13; Default||Not reimbursed separately|8,988.00|FSC: 13; Default||External grouping not supported 951203487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Baseplate-rm/ll-sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95162139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 180mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162140|EAP|Custom 95162140||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Reinfusion Sb Lipiguard P|1|HUMANA [1294]||HUMANA [11839]|59.91|FSC: 13; Default||Not reimbursed separately|59.91|FSC: 13; Default||External grouping not supported 951203488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Baseplate-rm/ll-sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95162141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 45mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 80173233|EAP|HCPCS G2062||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 11-20min St|1|HUMANA [1294]||HUMANA [11839]|62.67|FSC: 13; Default||Not reimbursed separately|62.67|FSC: 13; Default||External grouping not supported 95162142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 50mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mck Tibial Baseplate-rm/ll-sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95162145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 55mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Axis Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,366.30|FSC: 13; Default||Not reimbursed separately|3,366.30|FSC: 13; Default||External grouping not supported 95162147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 70mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Wedge - 7 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,041.20|FSC: 13; Default||Not reimbursed separately|2,041.20|FSC: 13; Default||External grouping not supported 95162149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 75mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 85mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Bearing - 18 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|997.50|FSC: 13; Default||Not reimbursed separately|997.50|FSC: 13; Default||External grouping not supported 95162157|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsuref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|FSC: 13; Default||Not reimbursed separately|1,437.00|FSC: 13; Default||External grouping not supported 80173244|EAP|HCPCS G2063||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Qual Nonmd Established Patient 21>min St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.22|FSC: 13; Default||Not reimbursed separately|98.22|FSC: 13; Default||External grouping not supported 95162160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Humerus Lcp 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,122.58|FSC: 13; Default||Not reimbursed separately|6,122.58|FSC: 13; Default||External grouping not supported 951203493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs/g I-ii Circlips|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,159.20|FSC: 13; Default||Not reimbursed separately|1,159.20|FSC: 13; Default||External grouping not supported 95162161|EAP|Custom 95162161||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Thermoskin Criss-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162162|EAP|Custom 95162162||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Thermoskin Criss-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Bearing Comp Rot/hin Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,767.10|FSC: 13; Default||Not reimbursed separately|9,767.10|FSC: 13; Default||External grouping not supported 95162163|EAP|Custom 95162163||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Thermoskin Criss-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162164|EAP|Custom 95162164||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Thermoskin Criss-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Standard Axle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 95162166|EAP|Custom 95162166||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Thermoskin Criss-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162167|EAP|Custom 95162167||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Thermoskin Criss-x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Xs Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162169|EAP|Custom 95162169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Quikclot Interventional|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted 12mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 951203497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Xs Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 951203498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Knee Mrh 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95196980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Hum 4mm 32mm Shldr X3 Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95162174|EAP|Custom 95162174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable ,quad Cath 12hyp/12 Redel,|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162175|EAP|Custom 95162175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Deca Polar Cath ,34 Hyp/ 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162176|EAP|Custom 95162176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patch Carto 3 External Ref|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162177|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter His Quad Fix 6f,4p,f,sd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196988|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 650cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162178|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rva/hra Quad Fix 6f,4p,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162179|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Bi Dir 7fr Def Cs,d-f,1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162180|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Bi Dir 7fr Def Cs,f-j,1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Lg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162181|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 4mm Navigational Bi-dir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95196989|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 485cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162182|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 4mm Navigational Bi-dir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Lg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162183|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8mm Navigational Bi-dir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162184|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8mm Navigational Bi-dir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Xl Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162185|EAP|Custom 95162185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable ,25 Hyp/34 Hyp,red,10' Nav|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196990|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 450cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162186|EAP|Custom 95162186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable C3 , 34 Hyp / 10 Pin Non N|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb How Rot Hng Knee Fem Xl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 95162188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Uni Cemented Preservatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|FSC: 13; Default||Not reimbursed separately|4,497.27|FSC: 13; Default||External grouping not supported 95162189|EAP|Custom 95162189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid Load Gold Thin Profile 1.4 G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Dis Fem Augment 10mm Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95162191|EAP|Custom 95162191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid Load Gold Thin Profile 1.6 G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196991|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Mod Smh Shl Srfc Sftch 445cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162193|EAP|Custom 95162193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Le-flap 3x3 Polyster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Dis Fem Augment 10mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95162205|EAP|Custom 95162205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epimed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162206|EAP|Custom 95162206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Shield 3cc Pet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Dis Fem Augment 10mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95162207|EAP|Custom 95162207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stylet 50cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196992|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Mod Smh Shl Srfc Sftch 405cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162209|EAP|Custom 95162209||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Graft Arterial Access|1|HUMANA [1294]||HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951203509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Dis Fem Augment 10mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95162210|EAP|Custom 95162210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Component Accessory Access V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162211|EAP|Custom 95162211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Box 56 Pin Cat-int|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Dis Fem Augment 10mm Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95162212|EAP|Custom 95162212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Interface Scsi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 48mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,181.00|FSC: 13; Default||Not reimbursed separately|2,181.00|FSC: 13; Default||External grouping not supported 95162214|EAP|Custom 95162214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 11mm Translational Atl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Rot Comp Xs/sm/med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95162215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Translational Atlantis 27.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|FSC: 13; Default||Not reimbursed separately|5,350.80|FSC: 13; Default||External grouping not supported 95198322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 28mm T10 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95162216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Translational Atlantis Fix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 951203512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Rot Comp Lg/xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95162217|EAP|Custom 95162217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Sphincterotome 5.0-6.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 4.5mm 48mm Cann Ncb -64 St Hex Drv Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95162277|EAP|Custom 95162277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Intramedullary Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Crossover Tib Bear Long Xs/xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95162279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 90mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Crossover Tib Bear Short Xs/xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95162281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Twin Fix 3.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,102.50|FSC: 13; Default||Not reimbursed separately|1,102.50|FSC: 13; Default||External grouping not supported 95196995|EAP|Custom 95196995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Depth For 2.0mm Screws|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162282|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestent Sfa Self Expandi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 951203515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Crossover Tib Bear Pediatric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95162283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 105mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95198323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 38mm T10 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95162284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 110mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Crossover Tib Bear Comp Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|FSC: 13; Default||Not reimbursed separately|10,153.50|FSC: 13; Default||External grouping not supported 95162285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 115mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196996|EAP|Custom 95196996||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 5.5mm 40mm Capped Voyager|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95162286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 120mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Femoral Bushing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.90|FSC: 13; Default||Not reimbursed separately|1,026.90|FSC: 13; Default||External grouping not supported 95162287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 125mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 130mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Axle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,515.40|FSC: 13; Default||Not reimbursed separately|3,515.40|FSC: 13; Default||External grouping not supported 95162289|EAP|Custom 95162289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Coagulator 10fr 6 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95196997|EAP|Custom 95196997||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 5.5mm 45mm Capped Voyager|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95162292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 135mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Bumper Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,110.50|FSC: 13; Default||Not reimbursed separately|2,110.50|FSC: 13; Default||External grouping not supported 95162293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 140mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 145mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Tib Bearing Comp. 3¦|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,110.50|FSC: 13; Default||Not reimbursed separately|2,110.50|FSC: 13; Default||External grouping not supported 95162295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 150mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95196999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion 20mm X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 95162296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 155mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tibial Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95162297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 160mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95198338|EAP|Custom 95198338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Urinary Cath Advance Foley/temperature Sensor 16fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 165mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh/gmrs Distal Femur Poly Pack|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,546.10|FSC: 13; Default||Not reimbursed separately|5,546.10|FSC: 13; Default||External grouping not supported 95162301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 175mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95197000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 10mm X3 Cs Rtn Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95162302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 180mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Tibial Baseplate S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|FSC: 13; Default||Not reimbursed separately|11,346.30|FSC: 13; Default||External grouping not supported 95162303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 25mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Tibial Baseplate S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|FSC: 13; Default||Not reimbursed separately|11,346.30|FSC: 13; Default||External grouping not supported 95162305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95197001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 16mm 48mm Shldr Los Sft Tis Bal Aqls Ascnd Flx Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|FSC: 13; Default||Not reimbursed separately|8,468.58|FSC: 13; Default||External grouping not supported 95162306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 35mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Tibial Baseplate M2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|FSC: 13; Default||Not reimbursed separately|11,346.30|FSC: 13; Default||External grouping not supported 95162307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95198357|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Porcine 19x28in Xenmatrix Ab Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,887.35|FSC: 13; Default||Not reimbursed separately|35,887.35|FSC: 13; Default||External grouping not supported 95162308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 45mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrh Tibial Baseplate L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|FSC: 13; Default||Not reimbursed separately|11,346.30|FSC: 13; Default||External grouping not supported 95162309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95197002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 2.6mm 46mm Mn Ti T10 Rvrs Cut Flut Cnn Hexalobe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95162310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 55mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 10mm Xs/s S1/s2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95162311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 65mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 13mm Xs/s S1/s2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95162313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 70mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95197003|EAP|Custom 95197003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Matchpoint|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 75mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 16mm Xs/s S1/s2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95162315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 80mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95162316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 85mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 20mm Xs/s S1/s2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95162317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 90mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95197004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse 14mmx48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95162318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 95mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951203531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 24mm Xs/s S1/s2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95162319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 4.7mm X 44.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|FSC: 13; Default||Not reimbursed separately|197.76|FSC: 13; Default||External grouping not supported 95162321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951203532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 10mm M/l M2/l2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95162322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95197005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 85mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95162323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cannulated 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951203533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 13mm M/l M2/l2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95162324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cannulated 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95198364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Hexagonal Headed 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95162325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cannulated 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951203534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 16mm M/l M2/l2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95162327|EAP|Custom 95162327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Qc 4.5mm 125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197006|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 15.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95162330|EAP|Custom 95162330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Face Full Disposable Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 20mm M/l M2/l2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95162331|EAP|Custom 95162331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Face Full Disposable Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162333|EAP|Custom 95162333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Face Full Disposable Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hrhk Tib Ins 24mm M/l M2/l2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95197008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Size 4 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,350.00|FSC: 13; Default||Not reimbursed separately|13,350.00|FSC: 13; Default||External grouping not supported 95162344|EAP|Custom 95162344||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Grip Cable Medium 2.0 Dal|1|HUMANA [1294]||HUMANA [11839]|3,469.20|FSC: 13; Default||Not reimbursed separately|3,469.20|FSC: 13; Default||External grouping not supported 951203537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Rot Hinge Femoral Bushing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,659.00|FSC: 13; Default||Not reimbursed separately|1,659.00|FSC: 13; Default||External grouping not supported 95162345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95198365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cone Central Tibial Size Fixed Persona Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|FSC: 13; Default||Not reimbursed separately|15,375.00|FSC: 13; Default||External grouping not supported 95162346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951203538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Rot Hinge Axle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,465.00|FSC: 13; Default||Not reimbursed separately|3,465.00|FSC: 13; Default||External grouping not supported 95162347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs Revis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95197009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ulnar Size 4 75mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95162348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bumper Knee Hinged Revisi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,110.50|FSC: 13; Default||Not reimbursed separately|2,110.50|FSC: 13; Default||External grouping not supported 951203539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bumper Insert 3 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95162349|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Surgical Artisan 2 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95162350|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ureteral Laser|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Rot Hinge Tibial Rotating Component|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,126.80|FSC: 13; Default||Not reimbursed separately|19,126.80|FSC: 13; Default||External grouping not supported 95162351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Press Fit Cocr 11mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95197010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial Ss Lt 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|FSC: 13; Default||Not reimbursed separately|5,460.00|FSC: 13; Default||External grouping not supported 95162354|EAP|Custom 95162354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Compression Tubular Tubi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Rot Hinge Tibial Insert 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,194.50|FSC: 13; Default||Not reimbursed separately|2,194.50|FSC: 13; Default||External grouping not supported 95162355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Met Straight 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|FSC: 13; Default||Not reimbursed separately|1,842.00|FSC: 13; Default||External grouping not supported 95198366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Fixed Non Porous Left Size E Persona Revisio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95162356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 951203542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hmrs Rot Hinge Tibial Insert 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,194.50|FSC: 13; Default||Not reimbursed separately|2,194.50|FSC: 13; Default||External grouping not supported 95162358|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Marker Tissue Ultaclip Ribbon D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.40|FSC: 13; Default||Not reimbursed separately|236.40|FSC: 13; Default||External grouping not supported 95197011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Variax Ti Medium Ft Calcaneus Mesh Polyaxi 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.30|FSC: 13; Default||Not reimbursed separately|2,295.30|FSC: 13; Default||External grouping not supported 95162361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 951203543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinematic Duration Patella Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,828.70|FSC: 13; Default||Not reimbursed separately|2,828.70|FSC: 13; Default||External grouping not supported 95162362|EAP|Custom 95162362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162363|EAP|Custom 95162363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Suture Double Arm Bone Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xs Krh All Poly Tibia 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,494.00|FSC: 13; Default||Not reimbursed separately|4,494.00|FSC: 13; Default||External grouping not supported 95162366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,494.00|FSC: 13; Default||Not reimbursed separately|4,494.00|FSC: 13; Default||External grouping not supported 951203545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xs Krh All Poly Tibia 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal Medial 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,545.93|FSC: 13; Default||Not reimbursed separately|4,545.93|FSC: 13; Default||External grouping not supported 95198367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Augment Half Block Left Lateral Sz Ef 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95162368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,545.93|FSC: 13; Default||Not reimbursed separately|4,545.93|FSC: 13; Default||External grouping not supported 951203546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xs Krh All Poly Tibia 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,588.41|FSC: 13; Default||Not reimbursed separately|4,588.41|FSC: 13; Default||External grouping not supported 95162370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,588.41|FSC: 13; Default||Not reimbursed separately|4,588.41|FSC: 13; Default||External grouping not supported 951203547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xs Krh All Poly Tibia 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 10 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,637.97|FSC: 13; Default||Not reimbursed separately|4,637.97|FSC: 13; Default||External grouping not supported 95198368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Augment Half Block Left Medial Sz Ef 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95162372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 10 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,637.97|FSC: 13; Default||Not reimbursed separately|4,637.97|FSC: 13; Default||External grouping not supported 951203548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm Krh All Poly Tibia 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162385|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 7mm Diameter X 57|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95162387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 12 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,687.53|FSC: 13; Default||Not reimbursed separately|4,687.53|FSC: 13; Default||External grouping not supported 951203549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm Krh All Poly Tibia 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162388|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Smart Injectable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95198369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Size 7 Uncoated Knee Prosthesis Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,875.00|FSC: 13; Default||Not reimbursed separately|22,875.00|FSC: 13; Default||External grouping not supported 95162389|EAP|Custom 95162389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Replacement Gastrostomy 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm Krh All Poly Tibia 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162390|EAP|Custom 95162390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Replacement Gastrostomy 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162391|EAP|Custom 95162391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Replacement Gastrostomy 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sm Krh All Poly Tibia 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162393|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Mycro 6cm X 12cm X 1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|FSC: 13; Default||Not reimbursed separately|516.00|FSC: 13; Default||External grouping not supported 95162394|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Picc Xcela 5fr Dual Mst 60-kit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Med Krh All Poly Tibia 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162395|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Mycro 20cm X 30cm X 1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|FSC: 13; Default||Not reimbursed separately|4,809.00|FSC: 13; Default||External grouping not supported 95197012|EAP|Custom 95197012||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sft Tis 21-30cm 6.6mm Angiograft Fem Art Lf Strl|1|HUMANA [1294]||HUMANA [11839]|16,243.35|FSC: 13; Default||Not reimbursed separately|16,243.35|FSC: 13; Default||External grouping not supported 95162396|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual 10cm X 15cm X 1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.00|FSC: 13; Default||Not reimbursed separately|1,230.00|FSC: 13; Default||External grouping not supported 951203553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Med Krh All Poly Tibia 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162397|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Picc Pasv 4fr Single Mst 60-kit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95198370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 16mm Polymer Left Articular Fixed Bearing Cck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95162398|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Xcela Low Profile Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|597.00|FSC: 13; Default||Not reimbursed separately|597.00|FSC: 13; Default||External grouping not supported 951203554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Med Krh All Poly Tibia 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162399|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Acellular Dermal Flex Hd 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.20|FSC: 13; Default||Not reimbursed separately|95.20|FSC: 13; Default||External grouping not supported 95197016|EAP|Custom 95197016||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sft Tis 13mm 24mm 12cm Angiograft Aortailiac Art Lf St|1|HUMANA [1294]||HUMANA [11839]|69,750.00|FSC: 13; Default||Not reimbursed separately|69,750.00|FSC: 13; Default||External grouping not supported 95162400|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Acellular Dermal Flex Hd 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|87.99|FSC: 13; Default||Not reimbursed separately|87.99|FSC: 13; Default||External grouping not supported 951203555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Med Krh All Poly Tibia 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95162405|EAP|Custom 95162405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 60mm Gold|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lg Krh All Poly Tibia 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162406|EAP|Custom 95162406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon 60mm Gree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 10mm Kn X3 Cs Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95162407|EAP|Custom 95162407||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Fixation External Pip Digit|1|HUMANA [1294]||HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951203557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lg Krh All Poly Tibia 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Flex Porou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|FSC: 13; Default||Not reimbursed separately|9,214.32|FSC: 13; Default||External grouping not supported 95162412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951203558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lg Krh All Poly Tibia 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|FSC: 13; Default||Not reimbursed separately|9,214.32|FSC: 13; Default||External grouping not supported 95197022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 10mm Kn X3 Post Stab Brng Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95162414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|FSC: 13; Default||Not reimbursed separately|9,214.32|FSC: 13; Default||External grouping not supported 951203559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lg Krh All Poly Tibia 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95162416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|FSC: 13; Default||Not reimbursed separately|9,214.32|FSC: 13; Default||External grouping not supported 951203560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xl Krh All Poly Tibia 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95197023|EAP|Custom 95197023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 23x10x10mm Elev X-lor Exp Interbdy Strl|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95162418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951203561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xl Krh All Poly Tibia 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95162420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Fle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|FSC: 13; Default||Not reimbursed separately|9,214.32|FSC: 13; Default||External grouping not supported 951203562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xl Krh All Poly Tibia 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162421|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Prelude W/guidewire 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 42mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95162423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 951203563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xl Krh All Poly Tibia 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 95162425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 951203564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Duration Bushing Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.90|FSC: 13; Default||Not reimbursed separately|1,047.90|FSC: 13; Default||External grouping not supported 95162426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 95197026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 50mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95162427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 951203565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Krh Duration Bushing Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.90|FSC: 13; Default||Not reimbursed separately|1,047.90|FSC: 13; Default||External grouping not supported 95162428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 95162429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 951203566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm Pt1 Allpoly Tib Krh Xxxs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 95197027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 65mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.38|FSC: 13; Default||Not reimbursed separately|127.38|FSC: 13; Default||External grouping not supported 95162431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 951203567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm Pt1 Allpoly Tib Krh Xxxs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Porous Lps Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|FSC: 13; Default||Not reimbursed separately|9,814.32|FSC: 13; Default||External grouping not supported 95162438|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dulex 10cm X 15cm X 1mm Ova|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,022.64|FSC: 13; Default||Not reimbursed separately|1,022.64|FSC: 13; Default||External grouping not supported 951203568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm Pt2 Allpoly Tib Krh Xxs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162439|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dulex 15cm X 19cm X 1mm Ova|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.72|FSC: 13; Default||Not reimbursed separately|1,890.72|FSC: 13; Default||External grouping not supported 95197028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 44mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95162440|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dulex 18cm X 24cm X 1mm Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,727.65|FSC: 13; Default||Not reimbursed separately|9,727.65|FSC: 13; Default||External grouping not supported 951203569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm Pt2 Allpoly Tib Krh Xxs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|FSC: 13; Default||Not reimbursed separately|5,205.90|FSC: 13; Default||External grouping not supported 95162441|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dulex 20cm X 30cm X 1mm Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,146.00|FSC: 13; Default||Not reimbursed separately|4,146.00|FSC: 13; Default||External grouping not supported 95162442|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dulex 7.5cm X 10cm X 1mm Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 951203570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Fem Stm 10x102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162443|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Soft 15cm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.10|FSC: 13; Default||Not reimbursed separately|620.10|FSC: 13; Default||External grouping not supported 95197029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y-tine 2.4mm Evos 7 Hole Shaft Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,359.50|FSC: 13; Default||Not reimbursed separately|2,359.50|FSC: 13; Default||External grouping not supported 95162444|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Sepramesh 7.6cm X 15.2cm Ip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,401.00|FSC: 13; Default||Not reimbursed separately|1,401.00|FSC: 13; Default||External grouping not supported 951203571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Fem Stm 8x102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162445|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Sepramesh 10.2cm X 20.3cm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,243.34|FSC: 13; Default||Not reimbursed separately|2,243.34|FSC: 13; Default||External grouping not supported 95162446|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Sepramesh 15.2cm X 20.3cm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,040.56|FSC: 13; Default||Not reimbursed separately|3,040.56|FSC: 13; Default||External grouping not supported 951203572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Fem Stm 9x102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162447|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Sepramesh 20.3cm X 30.5cm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,028.00|FSC: 13; Default||Not reimbursed separately|5,028.00|FSC: 13; Default||External grouping not supported 95197030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 46mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95162448|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix L/p 26.1cm X 36.1c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.00|FSC: 13; Default||Not reimbursed separately|6,306.00|FSC: 13; Default||External grouping not supported 951203573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Fem Stm 10x102 W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162449|EAP|Custom 95162449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Insertion 7fr. 40cc And 34cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Nar Strg 91mm 7hl Cmpr Variax Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|FSC: 13; Default||Not reimbursed separately|2,484.00|FSC: 13; Default||External grouping not supported 95162450|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composite L/p 11.4cm Circle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,163.00|FSC: 13; Default||Not reimbursed separately|2,163.00|FSC: 13; Default||External grouping not supported 951203574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Fem Stm 8x102 W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162452|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix L/p 15.9cm X 21.0c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.33|FSC: 13; Default||Not reimbursed separately|2,895.33|FSC: 13; Default||External grouping not supported 95197031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 14mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95162454|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix L/p 15.9cm X 26.1c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,576.00|FSC: 13; Default||Not reimbursed separately|3,576.00|FSC: 13; Default||External grouping not supported 951203575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11x127 Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162455|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix L/p 18.4cm X 23.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|FSC: 13; Default||Not reimbursed separately|3,726.00|FSC: 13; Default||External grouping not supported 95162457|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix L/p 21.0cm X 26.1c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,788.00|FSC: 13; Default||Not reimbursed separately|4,788.00|FSC: 13; Default||External grouping not supported 951203576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13x127 Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162459|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix L/p 26.1cm X 33.7c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,054.00|FSC: 13; Default||Not reimbursed separately|6,054.00|FSC: 13; Default||External grouping not supported 95197032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cnt Dist Clvcl Ss 8hl Rt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95162461|EAP|Custom 95162461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patch Reconstruction Reconix 5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 17x127 Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162464|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allomax 7cm X 10cm Rectang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,813.00|FSC: 13; Default||Not reimbursed separately|6,813.00|FSC: 13; Default||External grouping not supported 95198378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 4.0mm X 20mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95162465|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allomax 13cm X 15cm Rectan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,966.00|FSC: 13; Default||Not reimbursed separately|18,966.00|FSC: 13; Default||External grouping not supported 951203578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11x127 Fem Stm W/fem Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|FSC: 13; Default||Not reimbursed separately|8,738.10|FSC: 13; Default||External grouping not supported 95162466|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allomax 10cm X 15cm Rectan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,312.00|FSC: 13; Default||Not reimbursed separately|15,312.00|FSC: 13; Default||External grouping not supported 95197033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Distal Clavicle Repair Assembly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95162467|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Large Oval 14cm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.00|FSC: 13; Default||Not reimbursed separately|2,115.00|FSC: 13; Default||External grouping not supported 951203579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13x127 Fem Stm W/fem Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|FSC: 13; Default||Not reimbursed separately|8,738.10|FSC: 13; Default||External grouping not supported 95162469|EAP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suros 9g Rigid Delivery System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95162473|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Flexima Ro 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 15x127 Fem Stm W/fem Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|FSC: 13; Default||Not reimbursed separately|8,738.10|FSC: 13; Default||External grouping not supported 95162475|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allomax 2cm X 4cm Rectangu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 95196976|EAP|Custom 95196976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 14.5cm Natrelle Inspira 5.9cm Fl Prfl Rnd 650cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162476|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allomax 6cm X 16cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,360.00|FSC: 13; Default||Not reimbursed separately|9,360.00|FSC: 13; Default||External grouping not supported 951203581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 17x127 Fem Stm W/fem Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|FSC: 13; Default||Not reimbursed separately|8,738.10|FSC: 13; Default||External grouping not supported 95162477|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ex Composix 25cm X 33cm Ell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|FSC: 13; Default||Not reimbursed separately|4,710.00|FSC: 13; Default||External grouping not supported 95198375|EAP|Custom 95198375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Depth For 2.0mm - 2.7mm Screws|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162490|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Composix 10cm X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|FSC: 13; Default||Not reimbursed separately|1,482.00|FSC: 13; Default||External grouping not supported 951203582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Curved Fem Stm 10x102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162491|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Ck 16.0cm X 31.2cm Oval Wit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,652.00|FSC: 13; Default||Not reimbursed separately|5,652.00|FSC: 13; Default||External grouping not supported 95197024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y-shp 2.4mm Evos 5 Hole Hd 7 Hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|FSC: 13; Default||Not reimbursed separately|2,103.75|FSC: 13; Default||External grouping not supported 95162492|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Timesh 20cm X 15cm 6 5grams|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,850.00|FSC: 13; Default||Not reimbursed separately|1,850.00|FSC: 13; Default||External grouping not supported 951203583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Curved Fem Stm 8x102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162494|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sts Bipolar 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95162495|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Accent Dr Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|FSC: 13; Default||Not reimbursed separately|14,904.00|FSC: 13; Default||External grouping not supported 951203584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Curved Fem Stm 9x102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162498|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 24mm X 96cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95197034|EAP|Custom 95197034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Skin Closure Premier Exofin Fusion 4x22cm 2pc/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162500|EAP|Custom 95162500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Omniguide Oto|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Crv Fem Stm 10x102 W/o|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.8 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95198376|EAP|Custom 95198376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Depth For T8 And T10 Screws|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.8 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 951203586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11mmx203mm Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|FSC: 13; Default||Not reimbursed separately|17,276.70|FSC: 13; Default||External grouping not supported 95162503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.8 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95162504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.8 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 951203587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13mmx203mm Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|FSC: 13; Default||Not reimbursed separately|17,276.70|FSC: 13; Default||External grouping not supported 95162505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shoulder S3 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,819.50|FSC: 13; Default||Not reimbursed separately|4,819.50|FSC: 13; Default||External grouping not supported 95162506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded 4.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 951203588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 15mmx203mm Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|FSC: 13; Default||Not reimbursed separately|17,276.70|FSC: 13; Default||External grouping not supported 95162512|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rapid Duo-decca 7 Fr Md|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 6mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95162515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 951203589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 17mmx203mm Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|FSC: 13; Default||Not reimbursed separately|17,276.70|FSC: 13; Default||External grouping not supported 95162516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 95198377|EAP|Custom 95198377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink F/fixation Screw 2.0/2.3 Dental|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162517|EAP|Custom 95162517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Line Sampling Breath Nasal Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Crv Pt Fem Stm 8x102 W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162532|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allomax 4cm X 16cm Rectang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,216.00|FSC: 13; Default||Not reimbursed separately|6,216.00|FSC: 13; Default||External grouping not supported 95197038|EAP|Custom 95197038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Laryngoscope Video Polymer Macintosh #3 Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162539|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,110.00|FSC: 13; Default||Not reimbursed separately|25,110.00|FSC: 13; Default||External grouping not supported 951203591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs Sm Crv Fem Stm 9x102 W/o|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162541|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,726.73|FSC: 13; Default||Not reimbursed separately|8,726.73|FSC: 13; Default||External grouping not supported 951203592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11mmx203mm Fem/stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|FSC: 13; Default||Not reimbursed separately|13,440.00|FSC: 13; Default||External grouping not supported 95197039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 9hl Scapula Medial Border Rt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.00|FSC: 13; Default||Not reimbursed separately|7,338.00|FSC: 13; Default||External grouping not supported 95162543|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,726.73|FSC: 13; Default||Not reimbursed separately|8,726.73|FSC: 13; Default||External grouping not supported 951203593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13mmx203mm Fem/stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|FSC: 13; Default||Not reimbursed separately|13,440.00|FSC: 13; Default||External grouping not supported 95162544|EAP|Custom 95162544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cranio + V-5 2-0 Ethil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198379|EAP|Custom 95198379||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Curved Titanium Virage 90mm X 3.5mm Blue|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951203594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 15mmx203mm Fem/stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|FSC: 13; Default||Not reimbursed separately|13,440.00|FSC: 13; Default||External grouping not supported 95162551|EAP|Custom 95162551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage D-stat Dry Hemostatic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 71mm 5 Hl Lck Cmpr Axsos Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|FSC: 13; Default||Not reimbursed separately|6,765.00|FSC: 13; Default||External grouping not supported 95162556|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 10 Pole His 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 17mmx203mm Fem/stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|FSC: 13; Default||Not reimbursed separately|13,440.00|FSC: 13; Default||External grouping not supported 95162558|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vascutrak Pta Dilatatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162560|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vascutrak Pta Dilatatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951203596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11x127 Curved Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162571|EAP|Custom 95162571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrap Exoclear 3 X 500|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197042|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prcn 5.9x3.9in Xenmatrix Aquapure Rect Aclr Clgn Mtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,220.00|FSC: 13; Default||Not reimbursed separately|14,220.00|FSC: 13; Default||External grouping not supported 95162580|EAP|Custom 95162580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Band Elbow Therapeutic Bandit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13x127 Curved Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162585|EAP|Custom 95162585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Helioseal F Unit Dose 50|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198383|EAP|Custom 95198383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Belt Suture Miami Instruments|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162586|EAP|Custom 95162586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Refill Ketac-cem Liquid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951203598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 15x127 Curved Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162587|EAP|Custom 95162587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Refill Ketac-cem Powder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 15x15mm Supermx Ntnl Cmpr Loprfl Troc Tip Algn Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 95162603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cemented Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 951203599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 17x127 Curved Femoral Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|FSC: 13; Default||Not reimbursed separately|13,215.30|FSC: 13; Default||External grouping not supported 95162604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95162610|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sts Bipolar 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951203600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 11x127 Cur Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162612|EAP|Custom 95162612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Endopath Reload For Tsb35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162616|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Compact 1x8 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 951203601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mrs 13x127 Cur Fem Stem W/o Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95162617|EAP|Custom 95162617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Small Simplace Vac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162618|EAP|Custom 95162618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Medium Simplace Vac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95162620|EAP|Custom 95162620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Paracentesis Abdominal Volum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Monster Headed Short Thread 3.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951204481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3 Hole Compression Standard Lapidus Left No Arm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 951204483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197046|EAP|Custom 95197046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 2.3 X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95198385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 2.7mm 22mm Cortex Self Tap Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951204486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197047|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prcn 7.9x9.8in Xenmatrix Aquapure Rect Aclr Clgn Mtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,160.00|FSC: 13; Default||Not reimbursed separately|47,160.00|FSC: 13; Default||External grouping not supported 951204487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197048|EAP|Custom 95197048||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Sleeve 2.0mm|1|HUMANA [1294]||HUMANA [11839]|1,539.00|FSC: 13; Default||Not reimbursed separately|1,539.00|FSC: 13; Default||External grouping not supported 951204489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95198388|EAP|Custom 95198388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Retractor 2.5-6cm Sm Bl Flex 360d Lf Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197049|EAP|Custom 95197049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Double Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95162679|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cragg-mcnamara 50cm 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197050|EAP|Custom 95197050||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 180cm Lt Hindfoot Nlex Im Cnn Ti Strl Grn Arthds|1|HUMANA [1294]||HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 951204493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95198389|EAP|Custom 95198389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Retractor 5-9cm Med Bl Flex 360d Lf Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197061|EAP|Custom 95197061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4mm Darco Headed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197063|EAP|Custom 95197063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Polyester Brid F/mult Passes Supershuttle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 62066290|EAP|CPT® 83520||0309 - LABORATORY - OTHER LABORATORY|Hb Interleukin 2 Receptor (cd25) Soluable- Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 951204498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197065|EAP|Custom 95197065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Blade 1.2/1.5 Hd4 Ao Quick Coupling|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 44mm Darco Shrt Orth Ft Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 951204502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 20x20mm Fuseforce Hnd 2mm Rmr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|FSC: 13; Default||Not reimbursed separately|6,153.00|FSC: 13; Default||External grouping not supported 951204504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.5mm 45mm Reline-o 2s Spne Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951204506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95198391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cage 1.4mm 2x5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951204507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S2 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197054|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 50mm Reline-o 2s Spne Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951204508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S2 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S3 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 45mm Reline-o 2s Spne Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951204510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S3 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95198392|EAP|Custom 95198392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 4-0 Hs Blue 1x36in Sh-2 Double Armed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S4 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 40mm Reline-o 2s Spne Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951204512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S4 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S5 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 300mm Ti Strt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951204514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S5 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95198394|EAP|Custom 95198394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ethibond 2-0 Green 1x36in Mh Double Armed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Left S6 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 70mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 951204516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Std Cemented Right S6 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S2 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 8.5mm 80mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 951204518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S2 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S3 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95162745|EAP|Custom 95162745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nectar Varibar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tlif-o Modulus 8x10x25mm 4 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951204520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S3 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95162748|EAP|Custom 95162748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pudding Varibar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S4 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S4 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95162752|EAP|Custom 95162752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Honey Varibar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S5 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S5 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197066|EAP|Custom 95197066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 1.2/1.5 Dental For Cortical Screws|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S6 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S6 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197074|EAP|Custom 95197074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Navigated 2.4mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Left S7 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur P.s. Cemented Right S7 Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197077|EAP|Custom 95197077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epidural Coude Epimed 14g 4.0in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Sckt Rsp Djo Srg Std Hum Hxe+ Strl 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 951204531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198395|EAP|Custom 95198395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Mini Ao 1.2mm Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 8mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951204533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 9mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95162777|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Flexable Shaft Nitrex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162780|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Embolic Protection Spider|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95198396|EAP|Custom 95198396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Holder Plate Bb Tak Small Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 16mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951204537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162786|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Introducer Check-flo 16fr 35cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.09|FSC: 13; Default||Not reimbursed separately|357.09|FSC: 13; Default||External grouping not supported 951204538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162788|EAP|Custom 95162788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado .035|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95197071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 20mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95162789|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Torcon Nb Sim2 Beacon-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95162790|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Torcon Nb Jb1 Beacon-ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162791|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Torcon Nb Jb2 Beacon-ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 22mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95162793|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter High Flow Pigtail 4fr 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162794|EAP|Custom 95162794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Slip-cath Angled 5fr 40|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162795|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Curved Rosen Heparin C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162796|EAP|Custom 95162796||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .035 1|1|HUMANA [1294]||HUMANA [11839]|245.70|FSC: 13; Default||Not reimbursed separately|245.70|FSC: 13; Default||External grouping not supported 95197073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-cut 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162798|EAP|Custom 95162798||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .038 1|1|HUMANA [1294]||HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 951204543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162800|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver 6fr 5mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95162802|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver 6fr 6mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951204544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162803|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 6fr 10mm X 40mm 80c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95198409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Revision Cemented Right Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,375.00|FSC: 13; Default||Not reimbursed separately|21,375.00|FSC: 13; Default||External grouping not supported 95162804|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver 6fr 5mm X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951204545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162805|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver 6fr 7mm X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95197078|EAP|Custom 95197078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Double Drill Guide 3.2/4.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162806|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Intrahepatic Haskal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162808|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Shuttle H1 Slip-cath 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162809|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Check-flo 18fr 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162811|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Tfe Heparin Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197079|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 18.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95162812|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Tfe Heparin Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Fixed Nonporous Right Size G Persona Revn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95162815|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiographic Pigtail Gr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162816|EAP|Custom 95162816||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Slip-cath Jb1 5.0fr 125|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162817|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flexor 6fr 90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162820|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Introducer Guide Wire Safety|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162824|EAP|Custom 95162824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Face Large Adult Performax|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162837|EAP|Custom 95162837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Breast Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162839|EAP|Custom 95162839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Thyroid 10/pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197082|EAP|Custom 95197082||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Conventus Ph Small|1|HUMANA [1294]||HUMANA [11839]|14,235.75|FSC: 13; Default||Not reimbursed separately|14,235.75|FSC: 13; Default||External grouping not supported 95162842|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Embolic Protection Spider|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162843|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Embolic Protection Spider|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95198411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Augment Half Block Left Lateral Sz Gh 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95162844|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bil Everflex 5 X 100mm 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 951204554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162845|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross .014 2.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197083|EAP|Custom 95197083||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Conventus Ph Medium|1|HUMANA [1294]||HUMANA [11839]|14,235.75|FSC: 13; Default||Not reimbursed separately|14,235.75|FSC: 13; Default||External grouping not supported 95162849|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross .014 3.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162850|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross .014 4.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162852|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Evercross .035 4.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162853|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Catheter Dialysis Long-term|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|FSC: 13; Default||Not reimbursed separately|1,395.00|FSC: 13; Default||External grouping not supported 95197084|EAP|Custom 95197084||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Conventus Ph Large|1|HUMANA [1294]||HUMANA [11839]|14,235.75|FSC: 13; Default||Not reimbursed separately|14,235.75|FSC: 13; Default||External grouping not supported 95162854|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Catheter Dialysis Long-term|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|FSC: 13; Default||Not reimbursed separately|1,395.00|FSC: 13; Default||External grouping not supported 951204557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162855|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 5fr Single Lu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95198401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.6mm 24mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951204558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162857|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hickman Single Lumen 8f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197085|EAP|Custom 95197085||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suture Washer 3.5mm 5 Hole|1|HUMANA [1294]||HUMANA [11839]|210.60|FSC: 13; Default||Not reimbursed separately|210.60|FSC: 13; Default||External grouping not supported 95162858|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Fluency P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951204559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162859|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Fluency P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95162862|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Central Venous Multi-lu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162863|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Evercross .035 5.0 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95198402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cage 1.6mm 2x5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95162864|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Evercross .035 8.0 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162865|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Nanocross 2.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Large Ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.60|FSC: 13; Default||Not reimbursed separately|2,694.60|FSC: 13; Default||External grouping not supported 95162866|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Nanocross 3.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162867|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 3 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162868|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 3 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162869|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 4 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Ph 86mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.60|FSC: 13; Default||Not reimbursed separately|2,694.60|FSC: 13; Default||External grouping not supported 95162872|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 5 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.6mm X 18mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95162874|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6 X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162875|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6 X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Ph 112mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,234.60|FSC: 13; Default||Not reimbursed separately|3,234.60|FSC: 13; Default||External grouping not supported 95162876|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 7 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162877|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk Ss 7fr 2.6 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Cemented Stabili|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951204567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibia Stabilizer Pfc Sigm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95197089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 95162880|EAP|Custom 95162880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Patella 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Ps Tri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95198404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.6mm X 20mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95162882|EAP|Custom 95162882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repose Tongue Suspension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone With Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|FSC: 13; Default||Not reimbursed separately|966.00|FSC: 13; Default||External grouping not supported 95162886|EAP|Custom 95162886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Band Facial Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Std. 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95162889|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Te|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951204571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.6mm X 22mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951204573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.6mm X 24mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951204577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5mm 62mm Cortical Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 951204581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 951204584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 36cm Lt Troch Intertan Im 130deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951204585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Aptus Lock Hole8 0.8mm Ti Trapezoid Hand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,786.71|FSC: 13; Default||Not reimbursed separately|1,786.71|FSC: 13; Default||External grouping not supported 951204589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 951204592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95198416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 187mm 5.0mm 10hole Lock Compression Axsos Bone Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,078.00|FSC: 13; Default||Not reimbursed separately|9,078.00|FSC: 13; Default||External grouping not supported 951204593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert U.c. 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163047|EAP|Custom 95163047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Sing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 951204606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 62066310|EAP|CPT® 87631||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Respiratory Virus Mini Panel-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.89|FSC: 13; Default||Not reimbursed separately|427.89|FSC: 13; Default||External grouping not supported 951204607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163076|EAP|Custom 95163076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Needle Stereotactic Lorad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951204612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 95163082|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient Interstim Ico|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951204614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163083|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurostimulator Interstim Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,937.00|FSC: 13; Default||Not reimbursed separately|32,937.00|FSC: 13; Default||External grouping not supported 62066320|EAP|CPT® 87632||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Respiratory Viral Panel 6-11 Targets-ref Lab|1|HUMANA [1294]||HUMANA [11839]|654.18|FSC: 13; Default||Not reimbursed separately|654.18|FSC: 13; Default||External grouping not supported 95163084|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Tined Interstim 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,026.00|FSC: 13; Default||Not reimbursed separately|10,026.00|FSC: 13; Default||External grouping not supported 951204615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 95163086|EAP|Custom 95163086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charts Ez View Black Film Mount|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Asphere Spec 12/14 36 +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|FSC: 13; Default||Not reimbursed separately|3,408.60|FSC: 13; Default||External grouping not supported 95163088|EAP|Custom 95163088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Diameter Bladeless 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 95163090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Tined Interstim 41cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,026.00|FSC: 13; Default||Not reimbursed separately|10,026.00|FSC: 13; Default||External grouping not supported 951204618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95163094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Humeral Lateral Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,113.42|FSC: 13; Default||Not reimbursed separately|4,113.42|FSC: 13; Default||External grouping not supported 951204619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peri Cannulated 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95197116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 95163098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peri Cannulated 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951204620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peri Cannulated 3.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95163100|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Hd Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951204621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163103|EAP|Custom 95163103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 11mm Diameter Dilating Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 95163104|EAP|Custom 95163104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Dilating Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951204624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951204626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951204628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951204630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert P.s. 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951204631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Augment Half Block Right Medial Sz Gh 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951204637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198418|EAP|Custom 95198418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture 6-0 Prolene 4x30in C-1 Double Armed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Keeled Turon Size 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95197144|EAP|Custom 95197144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin Bay Point 1.3mm X 140mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163164|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Strut 25mm X 11mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,892.30|FSC: 13; Default||Not reimbursed separately|8,892.30|FSC: 13; Default||External grouping not supported 951204642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163165|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 9mm X 11mm X 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95163166|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 10mm X 11mm X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951204643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163168|EAP|Custom 95163168||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Isovue 300 300ml|1|HUMANA [1294]||HUMANA [11839]|3.96|FSC: 13; Default||Not reimbursed separately|3.96|FSC: 13; Default||External grouping not supported 95163170|EAP|Custom 95163170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon 60 Endopath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163179|EAP|Custom 95163179||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Isovue 300 50ml B|1|HUMANA [1294]||HUMANA [11839]|0.22|FSC: 13; Default||Not reimbursed separately|0.22|FSC: 13; Default||External grouping not supported 95198419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 4.5 X 40mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95163184|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Xcela Low Profile Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|FSC: 13; Default||Not reimbursed separately|897.00|FSC: 13; Default||External grouping not supported 951204645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163193|EAP|Custom 95163193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Endo Linear Echelon 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197141|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 16.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95163194|EAP|Custom 95163194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reciprocating 70 X 12.5 X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163195|EAP|Custom 95163195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sagittal 18 X 1.27 X 100|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163196|EAP|Custom 95163196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sagittal Dual Cut 25 X 1.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Simplex P With Tobramycin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|797.40|FSC: 13; Default||Not reimbursed separately|797.40|FSC: 13; Default||External grouping not supported 95197158|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 17.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95163199|EAP|Custom 95163199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Knee Femoral 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95198420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 5.5 X 40mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95163201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 951204649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Asphere M Spec 12/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.44|FSC: 13; Default||Not reimbursed separately|4,717.44|FSC: 13; Default||External grouping not supported 95197142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 216mm Ss 3.5mm Scr 14h Lck Loprfl 2 Cmpr Slot Bn Tib L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|FSC: 13; Default||Not reimbursed separately|3,990.00|FSC: 13; Default||External grouping not supported 95163203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Emtal Asphere 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|FSC: 13; Default||Not reimbursed separately|3,408.60|FSC: 13; Default||External grouping not supported 951204650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Block Half Tapered Tibi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,874.41|FSC: 13; Default||Not reimbursed separately|6,874.41|FSC: 13; Default||External grouping not supported 95163205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Block Half Tapered Tibi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,874.41|FSC: 13; Default||Not reimbursed separately|6,874.41|FSC: 13; Default||External grouping not supported 951204651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive Self Drilling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.00|FSC: 13; Default||Not reimbursed separately|168.00|FSC: 13; Default||External grouping not supported 95197143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 11mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.00|FSC: 13; Default||Not reimbursed separately|366.00|FSC: 13; Default||External grouping not supported 95163207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive Self Drilling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.00|FSC: 13; Default||Not reimbursed separately|174.00|FSC: 13; Default||External grouping not supported 951204652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive Self Drilling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95198421|EAP|Custom 95198421||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 500mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95163209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cross Drive Self Drilling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 951204653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.5 16 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95197159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Secondary Fixation Acl/pcl Repair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95163211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 1.5 2/2 Left Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951204654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Uc Tibial Component 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 1.5 2/2 Right Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95163213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Regular 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 951204655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Long Right 3 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95197160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 95163215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Long Left 3 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.00|FSC: 13; Default||Not reimbursed separately|489.00|FSC: 13; Default||External grouping not supported 951204656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95163216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Orbital 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 62066333|EAP|HCPCS G2023||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Specimen Collection, Swab, Covid-19|1|HUMANA [1294]||HUMANA [11839]|70.38|FSC: 13; Default||Not reimbursed separately|70.38|FSC: 13; Default||External grouping not supported 951204657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951204658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951204660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 60mm Cann Partially Theaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|FSC: 13; Default||Not reimbursed separately|513.00|FSC: 13; Default||External grouping not supported 951204662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198436|EAP|Custom 95198436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Insert Intrack Ult 66mm 20 Strl Pch 1 Pr Of Ins Per Pch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 13mm Loprfl Scr Ti T15 Ft Hexalobe Midfoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 951205441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198437|EAP|Custom 95198437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Insert Intrack Ult 86mm 20 Strl Pch 1 Pr Of Ins Per Pch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Headed 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|FSC: 13; Default||Not reimbursed separately|286.20|FSC: 13; Default||External grouping not supported 951205455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95196866|EAP|Custom 95196866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 60mm Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Bone 3 W/arthro Del Sys Adv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,722.10|FSC: 13; Default||Not reimbursed separately|6,722.10|FSC: 13; Default||External grouping not supported 951205457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Tray Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Patella Medialized Size 31 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bioinductive With Arthro Del Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951205459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Patella Medialized Size 33 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95198449|EAP|Custom 95198449||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 13x14mm Vrtstck Crstn Psr 11mm Peek-optm Lat Port|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951205460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Patella Medialized Size 36 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Patella Medialized Size 38 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951205462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Dome Patella Size 27 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Patella Implant Dome 27 X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95198448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hip Porous St/oss Cpe1 Ln/cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 951205464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Dome Patella Size 30 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Patella Implant Dome 30 X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951205466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Pf Dome Patella Size 34 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Patella Implant Dome 34 X 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95198450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular G7 Sz D 36mm Arcomxl Hip High Wall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 951205468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Patella Implant Dome 37 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular G7 Sz E 36mm Arcomxl Hip High Wall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 951205472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere 36mm +5mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951205476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 951205479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Tomcat Stl Zero Prf 4deg 16x14x7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|FSC: 13; Default||Not reimbursed separately|9,120.00|FSC: 13; Default||External grouping not supported 951205480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163433|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 7 Mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951205481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163435|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Si Brite Tip 6fr 5.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163441|EAP|Custom 95163441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Needle Core|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 95163445|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Attain Ability 78cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951205483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Thick 18mm X 50mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95198458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Tomcat Stl Zero Prf 4deg 16x14x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|FSC: 13; Default||Not reimbursed separately|9,120.00|FSC: 13; Default||External grouping not supported 95163456|EAP|Custom 95163456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163461|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Proximal Exte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|FSC: 13; Default||Not reimbursed separately|15,594.00|FSC: 13; Default||External grouping not supported 95197134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.60|FSC: 13; Default||Not reimbursed separately|318.60|FSC: 13; Default||External grouping not supported 95163463|EAP|Custom 95163463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand 3.75mm 15 Degree W/in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163467|EAP|Custom 95163467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator Rx25 Capiox Reservior|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163477|EAP|Custom 95163477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Tracheal Uncuffed 6.0mm Nas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95163481|EAP|Custom 95163481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Bandaging Three Layer [pr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 95163484|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Catheter Dialysis Long-term|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|FSC: 13; Default||Not reimbursed separately|1,395.00|FSC: 13; Default||External grouping not supported 951205487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Tomcat Stl Zero Prf 4deg 16x14x9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|FSC: 13; Default||Not reimbursed separately|9,120.00|FSC: 13; Default||External grouping not supported 951205488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Tomcat 4mm Fixed Selftap 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951205493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 80172099|EAP|CPT® 33952||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Ecmo Cannula Insertion|1|HUMANA [1294]||HUMANA [11839]|5,000.00|FSC: 13; Default||Not reimbursed separately|5,000.00|FSC: 13; Default||External grouping not supported 951205498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Tomcat 4mm Fixed Selftap 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951205499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 80172100|EAP|CPT® 33946||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Ecmo Initiation Veno-venous|1|HUMANA [1294]||HUMANA [11839]|8,000.00|FSC: 13; Default||Not reimbursed separately|8,000.00|FSC: 13; Default||External grouping not supported 951205500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 80172111|EAP|CPT® 33947||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Ecmo Initiation Veno-arterial|1|HUMANA [1294]||HUMANA [11839]|8,000.00|FSC: 13; Default||Not reimbursed separately|8,000.00|FSC: 13; Default||External grouping not supported 951205502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 80172122|EAP|CPT® 33966||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Ecmo Removal Cannula|1|HUMANA [1294]||HUMANA [11839]|2,029.80|FSC: 13; Default||Not reimbursed separately|2,029.80|FSC: 13; Default||External grouping not supported 951205504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Bearing Size 6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 1 Left-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951205506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 2 Left-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951205507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 3 Left-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95197152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 4 Left-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951205509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 5 Left-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95197164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 6 Left-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95198462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 200mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 951205511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 1 Right-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95197165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 2 Right-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951205513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 3 Right-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95197166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.40|FSC: 13; Default||Not reimbursed separately|302.40|FSC: 13; Default||External grouping not supported 951205514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 4 Right-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951205515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 5 Right-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95197193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 10mm Ti T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 951205516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Tibial Tray Size 6 Right-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951205517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 1 L-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 44mm 2.4/2.7mm 2h Sm Va 0deg Lcp First Right Mtp Fn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,929.14|FSC: 13; Default||Not reimbursed separately|2,929.14|FSC: 13; Default||External grouping not supported 951205518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 2 L-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 3 L-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 4 L-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198464|EAP|Custom 95198464||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Cryo Saphenous 3mm L = 61cm D = 5-6mm|1|HUMANA [1294]||HUMANA [11839]|22,339.14|FSC: 13; Default||Not reimbursed separately|22,339.14|FSC: 13; Default||External grouping not supported 951205521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 5 L-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 30mm Fem Loprfl Intnl Hex Trgn Im Nl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 951205522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uni Femoral Cemented Siz 6 L-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 1 R-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197163|EAP|Custom 95197163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extraction Shaft Non-sterile Reusable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 2 R-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Fixation Ti 16h 0.6mm Thk Straight 1.2/1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|932.40|FSC: 13; Default||Not reimbursed separately|932.40|FSC: 13; Default||External grouping not supported 951205525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 3 R-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197167|EAP|Custom 95197167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.062in X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 4 R-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 5 R-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197168|EAP|Custom 95197168||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 0.078in X 6in|1|HUMANA [1294]||HUMANA [11839]|48.60|FSC: 13; Default||Not reimbursed separately|48.60|FSC: 13; Default||External grouping not supported 951205528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Uka Femoral Cemented Siz 6 R-medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Fixation Ti 3x2h 0.6mm Thk Rectangular 1.2/1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.75|FSC: 13; Default||Not reimbursed separately|924.75|FSC: 13; Default||External grouping not supported 951205529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95197169|EAP|Custom 95197169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.062in X 14.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951205531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95197170|EAP|Custom 95197170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.6mm 0.062in 203mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95198467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Aptus Trilock Hole4 0.8mm Ti Straight Hand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,362.15|FSC: 13; Default||Not reimbursed separately|1,362.15|FSC: 13; Default||External grouping not supported 951205533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95197171|EAP|Custom 95197171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Sizing Colored Banded 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951205535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95197172|EAP|Custom 95197172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire 2mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95198468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Aptus Trilock Hole 8 0.8mm Ti Straight Hand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,168.10|FSC: 13; Default||Not reimbursed separately|2,168.10|FSC: 13; Default||External grouping not supported 951205537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Implant Dome 27 X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197173|EAP|Custom 95197173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire 2mm X 101mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Implant Dome 30 X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951205539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Implant Dome 34 X 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95197174|EAP|Custom 95197174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire 2.5mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Implant Dome 37x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95198469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 5mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951205541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Osteotomes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197175|EAP|Custom 95197175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire 2.5mm X 101mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Osteotomes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Osteotomes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197176|EAP|Custom 95197176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire 3mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Osteotomes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 16mm Aptus Trlk Ti Phlng Hnd Hexadrive 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 951205545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Stem Extension 10mm Dia X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|FSC: 13; Default||Not reimbursed separately|2,710.95|FSC: 13; Default||External grouping not supported 95197177|EAP|Custom 95197177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire 3mm X 101mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Stem Extension 10mm Dia X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|FSC: 13; Default||Not reimbursed separately|2,710.95|FSC: 13; Default||External grouping not supported 951205547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Stem Extension 12mm Dia X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|FSC: 13; Default||Not reimbursed separately|2,710.95|FSC: 13; Default||External grouping not supported 95197178|EAP|Custom 95197178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.9mm 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Stem Extension 12mm Dia X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|FSC: 13; Default||Not reimbursed separately|2,710.95|FSC: 13; Default||External grouping not supported 95198471|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Alloderm Slct Duo Cont Lg Perforated Lg 2.4mm X 0.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.93|FSC: 13; Default||Not reimbursed separately|182.93|FSC: 13; Default||External grouping not supported 951205549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Stem Extension 14mm Dia X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|FSC: 13; Default||Not reimbursed separately|2,710.95|FSC: 13; Default||External grouping not supported 95197179|EAP|Custom 95197179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.9mm 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Stem Extension 14mm Dia X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|FSC: 13; Default||Not reimbursed separately|2,710.95|FSC: 13; Default||External grouping not supported 951205551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 1 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197180|EAP|Custom 95197180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Solid Colored 8.2mm X 230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 2 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198473|EAP|Custom 95198473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 15fr 31.8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 3 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197181|EAP|Custom 95197181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepin 2.5mm Blunt Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 4 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 5 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197182|EAP|Custom 95197182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver H10 Solid 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 6 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198474|EAP|Custom 95198474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 17fr 31.8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 7 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197183|EAP|Custom 95197183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver H10 Solid 160mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 8 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 9 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197184|EAP|Custom 95197184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver H10 Cannulated 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 10 5mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198475|EAP|Custom 95198475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 19fr 31.8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 1 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197185|EAP|Custom 95197185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver H10 Cannulated Assembly Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 2 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 3 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197186|EAP|Custom 95197186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Ph Cavity Prep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 4 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198476|EAP|Custom 95198476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 23fr 76.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 5 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197187|EAP|Custom 95197187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.9mm Tissue Prtector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 6 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 7 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 8 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198477|EAP|Custom 95198477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 25fr 76.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 9 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197189|EAP|Custom 95197189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.062in X 0.078in Tissue Protector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 10 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 1 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197190|EAP|Custom 95197190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.9mm Threaded Sleeve Guide Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 2 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198478|EAP|Custom 95198478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 27fr 76.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 3 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197191|EAP|Custom 95197191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaft Scrdrvr 2.4mm Strdr T8 Slf Rtn Qc Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 4 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 5 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197192|EAP|Custom 95197192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handle Screwdr Qc F/cortx Scr Inst St Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 6 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198479|EAP|Custom 95198479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 21fr 60.0cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 7 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197197|EAP|Custom 95197197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator 8mm Tissue Protector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 8 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 9 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197198|EAP|Custom 95197198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Handle Ao Ratcheting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 10 10mm Rl/lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198481|EAP|Custom 95198481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction 6fr Shaft10fr Soft Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 1 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197199|EAP|Custom 95197199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Handle Ao Fixed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 2 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 3 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197200|EAP|Custom 95197200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Sleeve Guide Distal 2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 4 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198482|EAP|Custom 95198482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Ar Flowguard Long 12ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 5 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197201|EAP|Custom 95197201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 8.25mm 25 Degree Angled Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 6 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 7 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197202|EAP|Custom 95197202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 8.25mm 30 Degree Angled Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 8 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95198483|EAP|Custom 95198483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Lv Vent 13fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 9 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95197203|EAP|Custom 95197203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 8.25mm 35 Degree Angled Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ibalance Tka Tibial Augment Size 10 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 951205591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw Tibial Augment 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.55|FSC: 13; Default||Not reimbursed separately|110.55|FSC: 13; Default||External grouping not supported 95197204|EAP|Custom 95197204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizing Wire Sleeve 8.2mm/2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw Tibial Augment 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.55|FSC: 13; Default||Not reimbursed separately|110.55|FSC: 13; Default||External grouping not supported 95198484|EAP|Custom 95198484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Eopa 3d 20fr 0.375in Acpt 30.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192583|EAP|Custom 95192583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Suture Sterile Percutaneous Achilles Repair System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197205|EAP|Custom 95197205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Delivery Handle Ph|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95192585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cocr L50 Mm Od8.5 Mm Spine Multiaxial 5.5 Mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95197206|EAP|Custom 95197206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Depth 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192586|EAP|HCPCS 95192586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Surgical Photonblade L7.5 In L10.5 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95198485|EAP|Custom 95198485||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Kit Bio-medicus Insertion Ven 18ga 180cm 0.965 Ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192588|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding Guidezilla Ii Z-glide L150 Cm Od6 Fr Id.057|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197207|EAP|Custom 95197207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Depth 1.6mm 127mm Cannulated Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S2 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S2 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95197208|EAP|Custom 95197208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screw Depth Probe 3.5mm 58mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S3 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S3 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95197209|EAP|Custom 95197209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Plunger Ph|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S4 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S4 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95197210|EAP|Custom 95197210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acute Removal Extension Ph|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S5 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95198486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad 2.7mm 6 Hole Lock 56mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 951204711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S5 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95197211|EAP|Custom 95197211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acute Removal Connector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S6 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S6 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95197212|EAP|Custom 95197212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Guide Block Set Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198490|EAP|Custom 95198490||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Graft Subsititute Cortoss 5ml Cartridge|1|HUMANA [1294]||HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 951204715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197213|EAP|Custom 95197213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guided Access Jig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 11mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 11mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197214|EAP|Custom 95197214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Rotation Instrument|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198491|EAP|Custom 95198491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Gun Delivery Cortoss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197215|EAP|Custom 95197215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Delivery Tube Removal Hex Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 13mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 13mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198492|EAP|Custom 95198492||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Augmentation Material Cortoss 10ml|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197217|EAP|Custom 95197217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reduction Wire Handle Knob|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197218|EAP|Custom 95197218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert K-wire 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 80173255|EAP|CPT® 40650||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Repair Lip Full Thickness Vermilion Only|1|HUMANA [1294]||HUMANA [11839]|1,258.68|FSC: 13; Default||Not reimbursed separately|1,258.68|FSC: 13; Default||External grouping not supported 951204727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197220|EAP|Custom 95197220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jig Distal Screw Targeting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 11mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 11mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197221|EAP|Custom 95197221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jig Proximal Screw Targeting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197222|EAP|Custom 95197222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 13mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 13mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197223|EAP|Custom 95197223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Tamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197224|EAP|Custom 95197224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Access Jig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 85mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.40|FSC: 13; Default||Not reimbursed separately|389.40|FSC: 13; Default||External grouping not supported 951204739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197225|EAP|Custom 95197225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Access Jig Body|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197226|EAP|Custom 95197226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Access Jig Knob|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-p 8h Rt 113mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.25|FSC: 13; Default||Not reimbursed separately|5,090.25|FSC: 13; Default||External grouping not supported 951204743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197227|EAP|Custom 95197227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Jig Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 11mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 11mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197228|EAP|Custom 95197228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Jig Bushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197229|EAP|Custom 95197229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Access Jig Obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 13mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 13mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197230|EAP|Custom 95197230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mis Access Jig Wire Bushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197231|EAP|Custom 95197231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Release Screw Minimally Invasive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2.7mm 4mm Screw 8 Hole Lock 64mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|FSC: 13; Default||Not reimbursed separately|4,440.00|FSC: 13; Default||External grouping not supported 951204755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-p 6h Rt 91mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,032.50|FSC: 13; Default||Not reimbursed separately|5,032.50|FSC: 13; Default||External grouping not supported 951204756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 46mm 3.5mm Scr 4hl Lck Evos Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|640.47|FSC: 13; Default||Not reimbursed separately|640.47|FSC: 13; Default||External grouping not supported 951204758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 11mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 4mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.11|FSC: 13; Default||Not reimbursed separately|91.11|FSC: 13; Default||External grouping not supported 951204759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 11mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Long Thread 7.0mm L70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951204760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 13mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 13mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 200mm Hip Troch Gamma3 Im 125d Kt Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,051.00|FSC: 13; Default||Not reimbursed separately|12,051.00|FSC: 13; Default||External grouping not supported 951204764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 11mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 11mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 22mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951204774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 13mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 13mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 14mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951204778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut Sf Tissue Peek 3.9mm 10.2mm Cscr Fwr Kntls Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 951204781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 50mm Loprfl Ankl Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951204783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Internalbrace Lisfranc Implant Repair Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951204785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 11mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197242|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +22.5 Diop Mod C Bcnvx 13mm 6mm Pc 1 Pc Fld Ant Asp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 951204787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 11mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 62066340|EAP|CPT® 86769||0302 - LABORATORY - IMMUNOLOGY|Hb Antibody, Covid-19, Igg|1|HUMANA [1294]||HUMANA [11839]|42.13|FSC: 13; Default||Not reimbursed separately|42.13|FSC: 13; Default||External grouping not supported 951204790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 13mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 13mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198079|EAP|Custom 95198079||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Adult Pos Reusable 3ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 16mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951204795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 22mm Acutwist Actrk Ti Ft Tpr Ft Hnd Cmpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 951204796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Left 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Insert Flex Right 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197246|EAP|Custom 95197246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 4mm Cnn Srg Asns Jfx Ns Reuse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Tray Fixed Cemented # T3-i4 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Tray Fixed Cemented # T3-i4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Tray Fixed Cemented # T4-i3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197253|EAP|Custom 95197253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Tunneling 28cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Tray Fixed Cemented # T4-i3 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197254|EAP|Custom 95197254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Neurostimulator 4inl Spare F/insertion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197258|EAP|Custom 95197258||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 11mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|18,000.00|FSC: 13; Default||Not reimbursed separately|18,000.00|FSC: 13; Default||External grouping not supported 951204805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197259|EAP|Custom 95197259||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 9mmx9mmx23mm Coroent 4d Large Peek-optima Pstr L|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 951204807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197260|EAP|Custom 95197260||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 7mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|18,000.00|FSC: 13; Default||Not reimbursed separately|18,000.00|FSC: 13; Default||External grouping not supported 951204809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197255|EAP|Custom 95197255||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 13.5cm 20mm 16mm Xcldr Cntrlt Lg Grtx Ntnl Fep|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 951204811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197256|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 17.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951204813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur Std Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197257|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 15.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951204815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 40mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 951204817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95198510|EAP|HCPCS 95198510||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Positioners Adult Small 12in X 20in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197249|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viabahn .035 In 79mm 135cm Od8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,710.00|FSC: 13; Default||Not reimbursed separately|10,710.00|FSC: 13; Default||External grouping not supported 951204819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197250|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viabahn .035 In 59mm 135cm Od8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,765.00|FSC: 13; Default||Not reimbursed separately|9,765.00|FSC: 13; Default||External grouping not supported 951204821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95198511|EAP|Custom 95198511||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Positioners Adult Large 25in X 36in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197251|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viabahn .035 In 39mm 135cm Od8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,765.00|FSC: 13; Default||Not reimbursed separately|9,765.00|FSC: 13; Default||External grouping not supported 951204823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 95197252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 24mm Cmpr Ft Ti Std Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951204825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Femur P.s. Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|FSC: 13; Default||Not reimbursed separately|18,981.00|FSC: 13; Default||External grouping not supported 951204826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą11mm / L 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95198512|EAP|Custom 95198512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 1.7 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą11mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą11mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą13mm / L 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą13mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą13mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą16mm / L 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95197262|EAP|Custom 95197262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cmnt Tmp Zinc Oxide Eugenol Pwd 25gm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą16mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95198513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 34cm Fem Trgn Mt-nl Im Rtrgd Ti Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 951204834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą16mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95197263|EAP|Custom 95197263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Temp Repl Sz 2 Ss Ped Lower Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą19mm / L 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą19mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95197275|EAP|Custom 95197275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Morrison Steerable 21g 17cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą19mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95198522|EAP|Custom 95198522||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Humidifier Airvo Integrated Flow Us Plug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą22mm / L 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95197270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 10mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951204839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą22mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Ą22mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95197274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Hum 12mm 36mm Shldr X3 Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 951204841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fluted Extension Stem Cemented Ř 11 L 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95198515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 2.0mm Holex8 Flex Variable Angle Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|FSC: 13; Default||Not reimbursed separately|1,519.65|FSC: 13; Default||External grouping not supported 951204842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fluted Extension Stem Cemented Ř 11 L 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fluted Extension Stem Cemented Ř 13 L 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fluted Extension Stem Cemented Ř 13 L 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95197267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 28mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 951204845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fluted Extension Stem Cemented Ř 16 L 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 95198516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 40mm Evos T6 Cort St Mn Plt Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 951204846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fluted Extension Stem Cemented Ř 16 L 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|FSC: 13; Default||Not reimbursed separately|5,161.50|FSC: 13; Default||External grouping not supported 951204847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą10mm / L 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą10mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95197269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 65mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951204849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą10mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 38mm Evos T6 Cort St Mn Plt Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 951204850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą11mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95197272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 55mm Ti 3 Lvl Zevo Bn Spne Crv Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|FSC: 13; Default||Not reimbursed separately|8,250.00|FSC: 13; Default||External grouping not supported 951204851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą11mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą11mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95197273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 15m Zevo Ti Spne Crv Ant Var Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 951204853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą12mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 40mm Evos T6 Locking Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 951204854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą12mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą12mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą13mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą13mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 38mm Evos T6 Locking Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 951204858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą13mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą14mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą14mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą14mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 10mm X 390mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|FSC: 13; Default||Not reimbursed separately|9,801.00|FSC: 13; Default||External grouping not supported 951204862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą15mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą15mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą15mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą16mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 16mm Evos T7 Locking Self-tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 951204866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą16mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą16mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą18mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą18mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198523|EAP|Custom 95198523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Tissue Debakey Heavy 2-2.5mm Tip 9-1/2in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą18mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą20mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą20mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą20mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 95198524|EAP|Custom 95198524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 0.8mm 100mm Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą22mm / L 065mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą22mm / L 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cementless Extension Stem Ą22mm / L 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|FSC: 13; Default||Not reimbursed separately|5,454.00|FSC: 13; Default||External grouping not supported 951204877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Offset Connector 3 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,441.50|FSC: 13; Default||Not reimbursed separately|7,441.50|FSC: 13; Default||External grouping not supported 95198525|EAP|Custom 95198525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.6mm 95mm Quick Change Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Offset Connector 5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,441.50|FSC: 13; Default||Not reimbursed separately|7,441.50|FSC: 13; Default||External grouping not supported 951204879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 95198526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm 14mm Ti Cann Comp Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|FSC: 13; Default||Not reimbursed separately|2,190.00|FSC: 13; Default||External grouping not supported 951204882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 5mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 95198527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm 18mm Ti Cann Comp Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|FSC: 13; Default||Not reimbursed separately|2,190.00|FSC: 13; Default||External grouping not supported 951204886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951205256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197277|EAP|Custom 95197277||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 14cm 28.5mm 14.5mm Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 951205257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197278|EAP|Custom 95197278||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viabahn .035 In L59 Mm L80 Cm Od1|1|HUMANA [1294]||HUMANA [11839]|9,765.00|FSC: 13; Default||Not reimbursed separately|9,765.00|FSC: 13; Default||External grouping not supported 951205259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197282|EAP|Custom 95197282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Reunion Cannulated Center|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197283|EAP|Custom 95197283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Reunion Half Moon Tsa Cannulated Size 48|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197285|EAP|Custom 95197285||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 08mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951205265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 46mml X 5.0mm Dia Compression Cannulated Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 951205267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 47mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951205269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 60mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951205271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 4.0x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 951205273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172133|EAP|CPT® 61645||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Art Trluml M-thrombec &/nfs Intracranial|1|HUMANA [1294]||HUMANA [11839]|6,026.49|FSC: 13; Default||Not reimbursed separately|6,026.49|FSC: 13; Default||External grouping not supported 951205276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172144|EAP|CPT® 61623||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Evasc Temp Balloon Artl Occlusion Head/neck|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 951205278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172155|EAP|CPT® 61630||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Balloon Angioplasty Intracranial Percutaneous|1|HUMANA [1294]||HUMANA [11839]|15,906.51|FSC: 13; Default||Not reimbursed separately|15,906.51|FSC: 13; Default||External grouping not supported 951205280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172166|EAP|CPT® 61635||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tcat Plmt Iv Stent Icra W/balo Angiop If Pfrmd|1|HUMANA [1294]||HUMANA [11839]|32,878.04|FSC: 13; Default||Not reimbursed separately|32,878.04|FSC: 13; Default||External grouping not supported 951205282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172177|EAP|CPT® 61640||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Balloon Dilat Intracranial Vasospasm Prq Initial|1|HUMANA [1294]||HUMANA [11839]|15,906.51|FSC: 13; Default||Not reimbursed separately|15,906.51|FSC: 13; Default||External grouping not supported 951205284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172188|EAP|CPT® 61641||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Balo Dila Ic Vspsm Ea Vsl Sm Vasc Ter|1|HUMANA [1294]||HUMANA [11839]|6,904.83|FSC: 13; Default||Not reimbursed separately|6,904.83|FSC: 13; Default||External grouping not supported 951205286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80172199|EAP|CPT® 61642||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Balo Dila Ic Vspsm Ea Vsl Diff Vasc Ter|1|HUMANA [1294]||HUMANA [11839]|6,904.83|FSC: 13; Default||Not reimbursed separately|6,904.83|FSC: 13; Default||External grouping not supported 951205288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197290|EAP|Custom 95197290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ecmo Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197293|EAP|Custom 95197293||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 5.5mm 55mm Capped Voyager|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951205293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 10mm Variax T8 Full Thread Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951205294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197294|EAP|Custom 95197294||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 5.5mm 60mm Capped Voyager|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951205295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197295|EAP|Custom 95197295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Soft Flow 7mm 21fr 3/8in Arterial W/suture Bulb Vent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 10mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951205299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Trthln 6 Cone Kn Lft Tritanium Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 951205301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 34mm Loprfl Scr Ti T10 Ft Forefoot Cort St Sld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951205303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 38mm Asns Iii Ss Hip Slf Drl St Cnn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 951205304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 40mm Loprfl Scr Ti T10 Ft Forefoot Cort St Sld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951205307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Aptus Trilock Hole9 0.8mm Ti Straight Hand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,505.46|FSC: 13; Default||Not reimbursed separately|1,505.46|FSC: 13; Default||External grouping not supported 951205308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 6.5 X 50mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951205309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager Solera 7.5 X 50mm - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 951205311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 12mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951205312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 4.75mm 2 Iconix Frc Fbr 2 Ndl Intellibraid 2 Strn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 951205313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-cut 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951205315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 16mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951205316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 17mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951205318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 13mm Aptus Trlk Ti Phlng Hnd Hexadrive 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951205320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Slim Y-plate 7 Hole T8 Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|FSC: 13; Default||Not reimbursed separately|4,572.00|FSC: 13; Default||External grouping not supported 951205322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198546|EAP|Custom 95198546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sureclip Plus Repositionable 16mm 235cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198547|EAP|Custom 95198547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sureclip Max Repositionable 235cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 9 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 36mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951205328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 10 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 62066355|EAP|HCPCS P9017||0302 - LABORATORY - IMMUNOLOGY|Hb Convalescent Plasma, Covid-19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|251.25|FSC: 13; Default||Not reimbursed separately|251.25|FSC: 13; Default||External grouping not supported 951205330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 9 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 10 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197306|EAP|Custom 95197306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 22mm Prox Ft Ns Cann Surg Ss F/1.6mm K-wr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197310|EAP|Custom 95197310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer 22mm Distal Ft Ns Cann Surg Ss F/1.6mm K-wr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197317|EAP|Custom 95197317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 2.7mm Qck Cnct Ss Crt Scr Pl Lx Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Capitate 15mm 35mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|FSC: 13; Default||Not reimbursed separately|18,675.00|FSC: 13; Default||External grouping not supported 951205345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Btn Fx 14mm Tghtrp Rnd Cnv Atch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 951205347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 9 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 10 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 12mm Ti T8 St Lck Va Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 951205349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 2.4/2.7mm Sm Va 10deg Lcp First Left Mtp Fn Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.70|FSC: 13; Default||Not reimbursed separately|3,299.70|FSC: 13; Default||External grouping not supported 951205351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 21mm Ti 1 Lvl Zevo Bn Spne Crv Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,936.00|FSC: 13; Default||Not reimbursed separately|6,936.00|FSC: 13; Default||External grouping not supported 951205353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spinal 12mm Quick Start Distraction|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95198553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 200mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 951205356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spnl 30mm 5.5mm Reline Lrdtc Ti Mas Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 951205357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 9 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951205358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Size 10 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95197315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7mm Spc T 42x7.5x1.4mm Ss 2.7mm Scr Mn Frg 3hl/hd5 Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.50|FSC: 13; Default||Not reimbursed separately|2,062.50|FSC: 13; Default||External grouping not supported 951205359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 2.7mm Evos Mini Flex 56mm 8hl Ss Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|FSC: 13; Default||Not reimbursed separately|2,103.75|FSC: 13; Default||External grouping not supported 951205361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 4.5mm 44mm T8 Cort St Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951205363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197320|EAP|Custom 95197320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fcp Opth 83mm Mcphsn 4mm Disp Ss Ty Plat Dl Fnsh Srr Hdl Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95149513|EAP|Custom 95149513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Vaginal Medium 1-1/8" 29mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 8mm Ti Lck Ns Axsos 3 Periprosthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 951205374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.0mm 8mm T6 Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|FSC: 13; Default||Not reimbursed separately|951.00|FSC: 13; Default||External grouping not supported 951205376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197322|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Trnvg Blu 1.1cm X 45cm Desara Fm St Urinary Inc Surg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,838.60|FSC: 13; Default||Not reimbursed separately|2,838.60|FSC: 13; Default||External grouping not supported 951205377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197323|EAP|Custom 95197323||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue 7x14x14mm Cort/canl Blk Assmb Lrd Crnst Asr Fz|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951205379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198578|EAP|Custom 95198578||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Implant 10x34x24mm Ti 15 Degree|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951205380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197324|EAP|Custom 95197324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Srg 3mm 4mm Mp Micro100 31mm Med Crb Flt Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 40mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|FSC: 13; Default||Not reimbursed separately|4,425.00|FSC: 13; Default||External grouping not supported 951205384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Tightrope 4.75mm Bio-comp Knotless Swivelock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951205386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxail Non Locking 3.5mm X 24mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 951205388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Fixation Ti 2/4h 0.6mm Thk T-sh 1.2/1.5mm Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.75|FSC: 13; Default||Not reimbursed separately|825.75|FSC: 13; Default||External grouping not supported 951205391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 62066350|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Kratom (mitragynine) Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951205398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 62066360|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Methylphenidate-urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951205402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197327|EAP|Custom 95197327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Achieve 14ga 9cm Tip Soft Tissue Latex Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197336|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 16.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 62066370|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Pregabalin-urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951205406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197337|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 20.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197338|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Excl Bl 1.1cm X 45cm Desara Fm St Urinary Inc Surg Reu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951205409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 62066380|EAP|CPT® G0480||0301 - LABORATORY - CHEMISTRY|Hb Ets, Etg-urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 951205410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate 15mm Glen Fix Trab Mtl Shld Rev Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951205411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenosphere Trablr Mtl Reverse 3 Dia 36mm+0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951205413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 62066390|EAP|CPT® 87635||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Covid-19 Rna-poct|1|HUMANA [1294]||HUMANA [11839]|65.68|FSC: 13; Default||Not reimbursed separately|65.68|FSC: 13; Default||External grouping not supported 951205414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 4.75mm Omega Knotless System Single|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 951205415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 20mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 951205417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lk 29mm Hole7 1mm Thk Ti T-shp Gray 2.0/2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.15|FSC: 13; Default||Not reimbursed separately|1,461.15|FSC: 13; Default||External grouping not supported 951205419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 22mm Loprfl Scr Ti Ankl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951205421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 65mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 951205423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 3.5mm 70mm 4h Ltrl Proximal Tibia Prtal Artcl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|FSC: 13; Default||Not reimbursed separately|3,118.50|FSC: 13; Default||External grouping not supported 951205425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198588|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Vasc 325cm .012in .014in Viperwire Adv Coronary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198591|EAP|Custom 95198591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover For Unitrac Arm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197347|EAP|Custom 95197347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Collector Graftnet Autologus Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197349|EAP|Custom 95197349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Fibertak 1.8mm Flexible|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198598|EAP|Custom 95198598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Mini Ao 1.7mm Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197352|EAP|Custom 95197352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Cerclage Passing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197353|EAP|Custom 95197353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Suturing Neurstm Mechanical Fixate Tissue Band|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cone Central Tibial Size Medium Persona Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|FSC: 13; Default||Not reimbursed separately|15,375.00|FSC: 13; Default||External grouping not supported 951205437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197358|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Vertessa Lite Y Shp Poly 26cm X 5cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 951205438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95197345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 12mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951204663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 20mm Cortical Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 951204664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 10mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951204665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197348|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 1.3mm Fibertak Soft Knotless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|FSC: 13; Default||Not reimbursed separately|1,260.00|FSC: 13; Default||External grouping not supported 951204667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198593|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator 4.8mm Od X 4.2mm Id Double Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Cannula Meniscal Cinch Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 951204669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 44cm Rt Intertrochanter Intertan Im 130d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951204671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198594|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator 4.8mm Od X 4.2mm Id Single Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 42cm Lt Intertrochanter Intertan Im 130d 1.5mm 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951204673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spinal Distraction Quick Start 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198595|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator 4.8mm Od X 4.2mm Id Anterior Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95197351|EAP|Custom 95197351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fibertape 2mm Cerclage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Full-pe Ps Tibial Component 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95198599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 15mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951204679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Resurfacing S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951204680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Resurfacing S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,302.50|FSC: 13; Default||Not reimbursed separately|2,302.50|FSC: 13; Default||External grouping not supported 95198600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 22mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951204681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Resurfacing S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951204682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Resurfacing S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951204683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Inset Ą 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95198601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 26mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951204684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Inset Ą 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951204685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Inset Ą 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951204686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Extension Stem Ř11mm L30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Primary Extension Stem Ř11mm L65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.4mm Triangle 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951204688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95198603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm X 14mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951204692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95198604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm X 18mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951204695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95198605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm X 22mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951204699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Left S1 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951204703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Femur Cemented Right S1 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95197359|EAP|Custom 95197359||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Device Fiberoptic Illuminator 8in X 14in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 95197360|EAP|Custom 95197360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ophthalmic Canaloplasty Microcatheter Viscoinjector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 95197362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 10mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951204892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|FSC: 13; Default||Not reimbursed separately|3,603.00|FSC: 13; Default||External grouping not supported 951204893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 5mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tibia Compression 5.5mm T2 Alpha Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,233.00|FSC: 13; Default||Not reimbursed separately|1,233.00|FSC: 13; Default||External grouping not supported 951204894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 5mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 5mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Gorilla 4 Hole T-plate W/compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 951204896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 5mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 5mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197366|EAP|Custom 95197366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphr Embl Blue Embsph 300-500um Trisacryl Geltn Prefl Sal Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 5mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 80173266|EAP|Custom 80173266||0998 - STATISTICAL CHARGES|Hb Genetic Counseling N/c Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Post Fem Wedge 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 4mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197374|EAP|Custom 95197374||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 10mx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951204906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 4mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 4mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197373|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 18.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951204908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 4mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 4mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 12mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951204910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 4mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 8mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Advnd 5.0mm X 42mm T2 Lokng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|FSC: 13; Default||Not reimbursed separately|1,434.00|FSC: 13; Default||External grouping not supported 951204912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 8mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 8mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intfr Poly L Lac Acd 16mm 3-3.7mm Tpr Sm Bn Cnn Slf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 951204914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 8mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95198627|EAP|Custom 95198627||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 10x34mm 24mm Brigade 10d Base Ti|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951204915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 8mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.5mm 50mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 951204916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Dist Fem Wedge 8mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #1/ 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197378|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ep 115cm 6fr 5mm Ylw W/auto Id Qud Fx A Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #2/ 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95198628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spinal Base 6.0x17.5mm Variable Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #3/ 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197379|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ep 15mm 7fr Lasso Navistar Reprocessed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #4/ 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #5/ 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197380|EAP|HCPCS C1732||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Ep 25-15mm 4fr 115cm Lasso Variable Reprocessed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951204922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #6/ 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95198630|EAP|Custom 95198630||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 65mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951204923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #1/ 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197381|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation Ez Steer 282mm 7fr Space Fj Curve Reproces|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #2/ 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #3/ 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197382|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation Ez Steer 282mm 7fr Coronary Sinus Spacing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #4/ 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #5/ 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197383|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ultrasound 8fr Soundstar Ge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #6/ 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmenation #1/ 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95197384|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ultrasound 10fr Intracardiac Steering Han|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #2/ 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #3/ 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #4/ 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #5/ 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 951204934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augmentation #6/ 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|FSC: 13; Default||Not reimbursed separately|3,682.50|FSC: 13; Default||External grouping not supported 95198629|EAP|Custom 95198629||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 70mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951204935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 951204936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 951204937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 951204938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95198637|EAP|Custom 95198637||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 80mm 25mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|4,497.00|FSC: 13; Default||Not reimbursed separately|4,497.00|FSC: 13; Default||External grouping not supported 951204939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95197388|EAP|Custom 95197388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Central Humeral Shoulder Sidus Stem Free 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 951204941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95197389|EAP|Custom 95197389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner Shoulder Sidus 2mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95198638|EAP|Custom 95198638||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 75mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951204943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95197390|EAP|Custom 95197390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg 20mm Cnn 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 951204945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95197386|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 19.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951204946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev. Tibial Tray Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|FSC: 13; Default||Not reimbursed separately|9,349.50|FSC: 13; Default||External grouping not supported 95198639|EAP|Custom 95198639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Percutaneous 5.5mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951204947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 951204948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 951204949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95197391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate 26mm X 15mm X Trab Mtl Shld Rev Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|FSC: 13; Default||Not reimbursed separately|6,450.00|FSC: 13; Default||External grouping not supported 951204950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95198631|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath 7fr 3 Lumen 30cm 0.032 Multi-lumen Central Venous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95197392|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 18.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951204952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 951204953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 5mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95197393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula 9 Hole Left 2.7/3.5 X 125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,417.25|FSC: 13; Default||Not reimbursed separately|2,417.25|FSC: 13; Default||External grouping not supported 951204954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 951204955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95198633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4.5mm 230mm Peri-lck Ld Fem 10hl Cnt Scl Non Lck Ss Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.50|FSC: 13; Default||Not reimbursed separately|3,145.50|FSC: 13; Default||External grouping not supported 951204956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 951204957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 951204958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 80172211|EAP|CPT® 43880||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Closure Gastrocolic Fistula|1|HUMANA [1294]||HUMANA [11839]|4,705.32|FSC: 13; Default||Not reimbursed separately|4,705.32|FSC: 13; Default||External grouping not supported 951204959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95198634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 80mm Evos T7 Cortex Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.70|FSC: 13; Default||Not reimbursed separately|389.70|FSC: 13; Default||External grouping not supported 951204960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Wedge Hinge 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 80172200|EAP|CPT® 23931||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incision & Drainage Upper Arm Elbow Bursa|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 951204961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 95197395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra-p Standard Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 95198635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 32mm Evos T7 Cortex Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.70|FSC: 13; Default||Not reimbursed separately|380.70|FSC: 13; Default||External grouping not supported 951204964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 95197396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Primary Uncemented Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 951204965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 95198636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 80mm Evos T7 Cortex Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.88|FSC: 13; Default||Not reimbursed separately|107.88|FSC: 13; Default||External grouping not supported 951204968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 95198641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 2.7mm Evos Mini Flex 10hl Ss Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|FSC: 13; Default||Not reimbursed separately|2,103.75|FSC: 13; Default||External grouping not supported 951204972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Femur Hinge Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|FSC: 13; Default||Not reimbursed separately|24,192.00|FSC: 13; Default||External grouping not supported 951204973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 80173277|EAP|CPT® 93292||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Interrogation Eval In Person Wr Defibrillator|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 951204977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 95198656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cone Central Femoral Size Medium Persona Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|FSC: 13; Default||Not reimbursed separately|15,375.00|FSC: 13; Default||External grouping not supported 951204981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 95198657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 50mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|FSC: 13; Default||Not reimbursed separately|1,830.00|FSC: 13; Default||External grouping not supported 951204983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 951204984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Tibial Tray Hinge Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|FSC: 13; Default||Not reimbursed separately|12,660.00|FSC: 13; Default||External grouping not supported 95198658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 44mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951204985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 48mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951204987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198661|EAP|Custom 95198661||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.2cm Memorygel 5cm Mdrt + Prfl Rnd Brst Gel 400|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 23mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 26mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198662|EAP|Custom 95198662||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.5cm Memorygel 5.2cm High Prfl Rnd Brst Gel 425|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198663|EAP|Custom 95198663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pain Management Infusystem Pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 23mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 26mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951204999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197402|EAP|Custom 95197402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sys Bn Cmnt Vacm Mix W/2000ml Lb Drn Bg Bkwy Nl Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 23mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 26mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197403|EAP|Custom 95197403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Bn Cmnt Pre W/plg Inst Brsh Curette Fem Spng Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 50mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 951205004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197404|EAP|Custom 95197404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Prz Cmnt Med Prox Femoral Vac Mix Bl F/acm Sys 1pk/6ea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 259mm 14 Hl Lck Cmpr Axsos Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,291.00|FSC: 13; Default||Not reimbursed separately|9,291.00|FSC: 13; Default||External grouping not supported 951205007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 23mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198671|EAP|Custom 95198671||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Heated Breathing Tube And Chamber Myairvo2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 26mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 18x15mm Supermx Ntnl Cmpr Loprfl Troc Tip Algn Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 951205009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197405|EAP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pacing Imp Etak Relnc 59cm Dl Coil Helix Df4 Ngr Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951205011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198679|EAP|Custom 95198679||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 12cm 26mm 12mm 18fr Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 951205012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Standard Quadra-p Size 3 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951205013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 23mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 26mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197407|EAP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprsth 25mm 16fr 50mm Cook-z Trchbrnch Slf-expd Dbl|1|HUMANA [1294]||HUMANA [11839]|3,307.50|FSC: 13; Default||Not reimbursed separately|3,307.50|FSC: 13; Default||External grouping not supported 951205015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198680|EAP|Custom 95198680||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extender Endoprosthesis Lilac 16mm X 12mm X 7cm|1|HUMANA [1294]||HUMANA [11839]|9,735.00|FSC: 13; Default||Not reimbursed separately|9,735.00|FSC: 13; Default||External grouping not supported 951205016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Standard Quadra-p Size 5 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951205018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95198681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 60mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.79|FSC: 13; Default||Not reimbursed separately|662.79|FSC: 13; Default||External grouping not supported 951205019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 23mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 95197409|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endo 142mm 32mm Zenith Tx2 Disct Strght Cmpnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,340.00|FSC: 13; Default||Not reimbursed separately|53,340.00|FSC: 13; Default||External grouping not supported 951205020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk-hinge Insert 26mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|FSC: 13; Default||Not reimbursed separately|7,752.00|FSC: 13; Default||External grouping not supported 951205021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197410|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 22.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198682|EAP|Custom 95198682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene Blue 60cm M0.7 Usp6/0 Double Armed Bv-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197411|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 14.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Internal Brace Standard Biocomosite 4.75mm X 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951205026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 23mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198685|EAP|Custom 95198685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Non-abs 6-0 24in Monofilament 3/8 Cr C-1 Dbl Armed Bl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 26mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Primary Cemented Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 951205028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Face Change 10 Degree Angle Pe Hc 40/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|FSC: 13; Default||Not reimbursed separately|5,853.00|FSC: 13; Default||External grouping not supported 951205030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198688|EAP|Custom 95198688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 10.6-10cm Memorygel P3.3-3.9cm Mdrt Prfl Rnd 175m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 17mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 23mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 26mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 17mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 20mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 23mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 26mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 17mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 20mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 23mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197431|EAP|Custom 95197431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Fusion Cup 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 26mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198693|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular .018in 300cm Hi-torque Connect 250t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197439|EAP|Custom 95197439||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Dc-1 Adult Reusable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197440|EAP|Custom 95197440||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Dc-ip Pediatric Reusable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198694|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular .018in 300cm Hi-torque Connect Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197441|EAP|Custom 95197441||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Tc-i Tip Clip Ear Reuseable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 23mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 26mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197442|EAP|Custom 95197442||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Rainbow Set Md20-12 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198695|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular .014in 190cm Hi-torque Winn 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197443|EAP|Custom 95197443||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Rainbow Set 25r-12 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95197444|EAP|Custom 95197444||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Set Md14-12 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198696|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular .014in 300cm Hi-trq Winn 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 23mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 951205062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Semiconstrained 26mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|FSC: 13; Default||Not reimbursed separately|6,555.00|FSC: 13; Default||External grouping not supported 95198697|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular .014in 300cm Hi-trq Winn 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #1 15mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|FSC: 13; Default||Not reimbursed separately|4,285.50|FSC: 13; Default||External grouping not supported 95197445|EAP|Custom 95197445||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Set Mp-12 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #1 15mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #2 15mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197446|EAP|Custom 95197446||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Set Ge-12 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #2 15mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95198698|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 31.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951205067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #3 15mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197447|EAP|Custom 95197447||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Set Md20-1.5 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #3 15mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #4 15mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197448|EAP|Custom 95197448||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd Set Md20-12 Patient|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #4 15mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95198699|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Anterior Chamber 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951205071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #5 15mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197449|EAP|Custom 95197449||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Rd To Lnc A Dapter 1.5ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #5 15mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #6 15mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Fusion 14mm 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.00|FSC: 13; Default||Not reimbursed separately|2,667.00|FSC: 13; Default||External grouping not supported 951205074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #6 15mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95198702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Lateral Proximal 13hole Left 167mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,222.25|FSC: 13; Default||Not reimbursed separately|5,222.25|FSC: 13; Default||External grouping not supported 951205075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #1 20mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #1 20mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #2 20mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion 10 Degree Medium Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 951205078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #2 20mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95198704|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Intvn Mic 2.4fr .027in 130cm 0.8mm Coaxial Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #3 20mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 38mm Dart-fire Ti Sm P/t Ft Slf Drl St Cnn Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|FSC: 13; Default||Not reimbursed separately|786.00|FSC: 13; Default||External grouping not supported 951205080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #3 20mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #4 20mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 70mm 15mm Comp Hl4 Ss Hk Sh Pre Cnt 3.5 Scr Lcp Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,549.13|FSC: 13; Default||Not reimbursed separately|2,549.13|FSC: 13; Default||External grouping not supported 951205082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #4 20mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95198705|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Intvn Mic 2fr .027in 130cm 0.67mm Straight Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #5 20mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spnl 8mm Centerpiece Od Pt Cervical Oval Ltrl Hl Ti Cl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 951205084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #5 20mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #6 20mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95197436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Short Thread 7.0mm L90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 951205086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screwed Tibial Augmentation #6 20mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 951205087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95198706|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Intvn Mic 2fr .027in 150cm 0.67mm Straight Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197450|EAP|Custom 95197450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 10mm Disposable Boss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197452|EAP|Custom 95197452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting Legend 12cm 2.2mm Match Head Burr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95198707|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular Peripheral 0.016dia 180cml 60deg Dbl Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197455|EAP|Custom 95197455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fcp Spec Rtrvl 120cm 3fr Hk Pr Grsp Rtrct Trcp Ptfe Strl Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Right S10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197460|EAP|Custom 95197460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dual Ablation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197456|EAP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Disc Cervical Mobi-c 17mm X 17mm H5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 951205100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95198708|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Intvn Mic 2.4fr .027in 150cm 0.8mm Coaxial Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95194285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Unipolar Hip-ld Fx Por St Endo Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 951205102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post 10mm Taper Long 18.5mm Boss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,010.00|FSC: 13; Default||Not reimbursed separately|2,010.00|FSC: 13; Default||External grouping not supported 951205104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95198710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 45mm Solera Cd Hzn Cocr Spne Ma Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 951205105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95197453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 279mm Ti 18 Hl Axsos 3 Bn Tib Lt Dist Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,587.00|FSC: 13; Default||Not reimbursed separately|10,587.00|FSC: 13; Default||External grouping not supported 951205106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Femoral Cemented Left S10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951205107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95197457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 13hl Scapula Medial Border Lft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951205110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95197458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 10hl Scapula Ti Lateral Border Lft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951205112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95197459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion 19mm X 104mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951205114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Right S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Medial Tibia Tray Cemented Left S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951205123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Partial Zuk Journey Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 951205124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197462|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 750cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Hip Journey Ii Oxnm Left Med/right Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951205128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197463|EAP|Custom 95197463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Natrelle Inspira Silicone 700cc Full Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Zuk 3 Knee Journey Ii Size 9 Left Medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951205131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197468|EAP|Custom 95197468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Surgical F/4mm Dia Screw Asnis Iii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Journey Ii Uni Tibia Medial Size 9-10 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951205135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 951205136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 951205138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 36mm Cann Stainless Steel Compression Headles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 951205140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Implant Cocr Ankle Joint F/arthroeresis Subfix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|963.00|FSC: 13; Default||Not reimbursed separately|963.00|FSC: 13; Default||External grouping not supported 951205142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 32mm Cann Stainless Steel Compression Headles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 11mm 90mm Intertan Ti Subtrochanter Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,522.50|FSC: 13; Default||Not reimbursed separately|1,522.50|FSC: 13; Default||External grouping not supported 951205144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197470|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 345cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 30mm Cann Stainless Steel Compression Headles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197471|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 365cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197472|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 385cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Peek Omega 3.9mm Double-double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951205151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197473|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Mod Smh Shl Srfc Sftch 310cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197474|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Mod Smh Shl Srfc Sftch 330cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm X 14mm Low Profile Ti Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951205155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197475|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Mod Smh Shl Srfc Sftch 345cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951205156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197477|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 24.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm X 9mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197478|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 23.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.4mm X 11mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 45mm Solera Cd Hzn Cocr Spne Ma Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951205164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198730|EAP|Custom 95198730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.4mm 150mm Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 8mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 75mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 951205166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 9mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 10mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 60mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 951205168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 11mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198731|EAP|Custom 95198731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm 145mm Quick Change Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 12mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-p 10h Lt 134mm 3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951205170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Right 14mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 21mm 52mm Shldr Simpliciti Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 951205172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198733|EAP|Custom 95198733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm 145mm Quick Change Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95197484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti 2.4/2.7mm Sm Va 10deg Lcp First Right Mtp Fn Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.70|FSC: 13; Default||Not reimbursed separately|3,299.70|FSC: 13; Default||External grouping not supported 951205174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198734|EAP|Custom 95198734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.1mm 105mm Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198737|EAP|Custom 95198737||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 80mm 3.5mm Cobalt Chromium Molybdenum Plus Precut|1|HUMANA [1294]||HUMANA [11839]|2,142.00|FSC: 13; Default||Not reimbursed separately|2,142.00|FSC: 13; Default||External grouping not supported 951205178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198743|EAP|Custom 95198743||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Cannulated Revision Dowel 10mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|2,932.50|FSC: 13; Default||Not reimbursed separately|2,932.50|FSC: 13; Default||External grouping not supported 951205180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198746|EAP|Custom 95198746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 12mm 2mm Fixos Cnn Cntrsnk Ao Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.4mm 9mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951205186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198754|EAP|Custom 95198754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Urth Bdx Ic 20fr 3w Fl Bln Infct Cntrl Bacti-grd Slv Hy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198768|EAP|Custom 95198768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 25-33mm Conform Onx|1|HUMANA [1294]||HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 951205200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198771|EAP|Custom 95198771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Acis Pro 360 Lordotic Large 8mm Height|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951205202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198772|EAP|Custom 95198772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Acis Pro 360 Lordotic Large 7mm Height|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951205204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198773|EAP|Custom 95198773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Crown 10mm Dia 195mml Non-sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198775|EAP|Custom 95198775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Center Screw T25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5mm 55mm Low Profile Ankle Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951205210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.5mm 75mm Loprfl Scr Ti Ankl Canc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951205212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 8mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 90mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 951205214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 9mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 10mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198779|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gw Thrd Orth .094in Arthx Troc Tip 7mm Scr Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 11mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 12mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95198780|EAP|Custom 95198780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stplr Intnl 25mmx4.8mm Ti Xl Circ Lnr Cut Sqz Hndl Lg Anstm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Moto Tibia Insert Left 14mm S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 16mm 5 Hole Hook Bone Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|FSC: 13; Default||Not reimbursed separately|6,867.00|FSC: 13; Default||External grouping not supported 951205222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198785|EAP|Custom 95198785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 120mm 2.3mm Nonsterile Latex Free Reusable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198791|EAP|Custom 95198791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.0mm 215mm Quick Change Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198795|EAP|Custom 95198795||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue 7x14x11mm Blk Cort Spnl Lrdt Strle|1|HUMANA [1294]||HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 951205229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm X 170mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 951205230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162436|EAP|HCPCS A9579||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Omniscan 287mg/ml|1|HUMANA [1294]||HUMANA [11839]|17.40|FSC: 13; Default||Not reimbursed separately|17.40|FSC: 13; Default||External grouping not supported 95198796|EAP|Custom 95198796||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue 8x14x11mm Blk Cort Spnl Lrdt Strle|1|HUMANA [1294]||HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 951205231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162456|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 51% 50ml|1|HUMANA [1294]||HUMANA [11839]|0.27|FSC: 13; Default||Not reimbursed separately|0.27|FSC: 13; Default||External grouping not supported 95198799|EAP|Custom 95198799||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 28x8x9mm Crnt 4d Lg Impct Peek-optm Ns Lf|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95162458|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 61% 150ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|FSC: 13; Default||Not reimbursed separately|0.38|FSC: 13; Default||External grouping not supported 951205233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162460|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 61% 100ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|FSC: 13; Default||Not reimbursed separately|0.26|FSC: 13; Default||External grouping not supported 951205234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198786|EAP|Custom 95198786||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 30x42x6mm Brigade 12d Titanium Nonsterile Lx Fr|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951205235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162479|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 41% 20ml V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.81|FSC: 13; Default||Not reimbursed separately|2.81|FSC: 13; Default||External grouping not supported 95162480|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 41% 10ml V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|FSC: 13; Default||Not reimbursed separately|3.86|FSC: 13; Default||External grouping not supported 951205236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162481|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 51% 150ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|FSC: 13; Default||Not reimbursed separately|0.36|FSC: 13; Default||External grouping not supported 95198787|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm 220mm Trocar Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162482|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 61% 15ml B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.46|FSC: 13; Default||Not reimbursed separately|3.46|FSC: 13; Default||External grouping not supported 951205237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162483|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 61% 75ml B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|FSC: 13; Default||Not reimbursed separately|0.26|FSC: 13; Default||External grouping not supported 95162484|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 76% 125ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|FSC: 13; Default||Not reimbursed separately|0.41|FSC: 13; Default||External grouping not supported 951205238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198788|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.8mm 220mm Fluted Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162510|EAP|HCPCS Q9963||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Gastrografin 30 M|1|HUMANA [1294]||HUMANA [11839]|0.92|FSC: 13; Default||Not reimbursed separately|0.92|FSC: 13; Default||External grouping not supported 951205239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162511|EAP|HCPCS Q9963||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Gastrografin 120|1|HUMANA [1294]||HUMANA [11839]|0.36|FSC: 13; Default||Not reimbursed separately|0.36|FSC: 13; Default||External grouping not supported 95162549|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 6cm X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.37|FSC: 13; Default||Not reimbursed separately|79.37|FSC: 13; Default||External grouping not supported 951205240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95162550|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 6cm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.00|FSC: 13; Default||Not reimbursed separately|85.00|FSC: 13; Default||External grouping not supported 95198784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.2mm 16mm Full Thread Cortical Lag Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951205241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95163459|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 100ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|FSC: 13; Default||Not reimbursed separately|0.41|FSC: 13; Default||External grouping not supported 951205242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95163466|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 300ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|FSC: 13; Default||Not reimbursed separately|0.20|FSC: 13; Default||External grouping not supported 95198789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.5mm 38mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.5mm 40mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 20x20mm Supermx Ntnl Cmpr Loprfl Troc Tip Algn Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 951205247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 13mm 240mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 951205249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm 10mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 41mm Titanium 2 Level Zevo Bone Spine Cervical Anterio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951205253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951205254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95198798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 15mm Zevo Ti Spne Crv Ant Var Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 951205255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198803|EAP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pacing Imp Etak Relnc 64cm Dl Coil Helix Df4 Gr Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951204039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.4mm Straight 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951204041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198805|EAP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 17ga 10mm Rf Eltx Osteocool 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198806|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 30.0 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951204045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized Plus #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198807|EAP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Pacing Endotak Reliance 64cm 4 Front Single Coil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951204049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198808|EAP|Custom 95198808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Pulmonary Art Ccombo 110 Cm Od8 Fr Cont Cardiac Output|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198810|EAP|Custom 95198810||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 40mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951204053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198811|EAP|Custom 95198811||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 45mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951204055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198812|EAP|Custom 95198812||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Modulus Tlif-a 9mmx11mmx30mm 8 Degree|1|HUMANA [1294]||HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 951204057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Standard #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem-p Ami Collard Size 5 Standard Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Lck Compression 67mml Holex7 Ti 2.7mm Scrw Lcp Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 951204068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 360mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,143.23|FSC: 13; Default||Not reimbursed separately|5,143.23|FSC: 13; Default||External grouping not supported 951204070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 9mm X 375mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,443.70|FSC: 13; Default||Not reimbursed separately|9,443.70|FSC: 13; Default||External grouping not supported 951204077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Standard #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95198820|EAP|Custom 95198820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 8mmx9mmx23mm Coroent 4d Large Peek-optima Pstr L|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 951204079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229992|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Supra Core .035 Peripheral Guide Wire .035 X 145 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229993|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Spartacore 14 Peripheral Guide Wire .014 5.0 Cm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra H Sn Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229994|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Spartacore 14 Peripheral Guide Wire .014 10 Cm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #1 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229995|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Spartacore 14 Peripheral Guide Wire .014 10 Cm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #2 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #3 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229996|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Spartacore 14 Peripheral Guide Wire .014 10 Cm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #5 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229997|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Steelcore 18 Lt Peripheral Guide Wire 190 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #6 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #7 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229998|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Steelcore 18 Lt Peripheral Guide Wire 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #8 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951229999|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ht Winn 40 Guide Wire .014" X 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #1 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #2 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230000|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ht Winn 80 Guide Wire .014" X 190 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951204097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #4 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230001|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ht Winn 200t Guide Wire .014" X 190 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #5 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #6 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230002|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Connect Guide Wire .018" 145 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #7 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Minimax Ha Cementless #8 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230003|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Connect Guide Wire .018" 195 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230004|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Connect Flex Guide Wire .018" 145 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230005|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Connect Flex Guide Wire .018" 195 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230006|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Connect 250t Guide Wire .018" 145 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230007|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Connect 250t Guide Wire .018" 195 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230008|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Command 18 St Guide Wire .018" 10 Cm / 4 G 210 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230009|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Command 18 Lt Guide Wire .018" 25 Cm / 4 G 210 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230010|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Command Guide Wire .014" 190 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230011|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Command Guide Wire .014" 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem C Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230012|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Command Es Guide Wire .014" 190 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230013|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Steelcore 18 Lt Peripheral Guide Wire J Tip 190 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,199.50|FSC: 13; Default||Not reimbursed separately|9,199.50|FSC: 13; Default||External grouping not supported 951230014|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Steelcore 18 Lt Peripheral Guide Wire J Tip 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230015|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951204128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra C Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951230016|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230017|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.0 Mm X 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230018|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.0 Mm X 20 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230019|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230020|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230021|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.5 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Standard #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230022|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.5 Mm X 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230023|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.5 Mm X 20 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230024|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.5 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230025|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 4.5 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230027|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.0 Mm X 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Standard #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230028|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.0 Mm X 20 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230029|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230030|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Sn Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230052|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 7.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230031|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.5 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230032|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.5 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230033|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.5 Mm X 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra S Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22mm Cocr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230034|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.5 Mm X 20 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 22mm Cocr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Cocr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230035|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.5 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Cocr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Cocr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230036|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 5.5 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Cocr Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Cocr Head Xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230037|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Cocr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Cocr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230038|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Cocr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Cocr Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Cocr Head Xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230039|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.0 Mm X 20 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Cocr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Cocr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230040|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Cocr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Cocr Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230041|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Cocr Head Xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Cocr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230042|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.5 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Cocr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Cocr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230043|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.5 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Cocr Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Cocr Head Xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230044|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.5 Mm X 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Biolox Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Biolox Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230045|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.5 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Biolox Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Biolox Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230046|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 6.5 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Biolox Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Biolox Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230047|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 7.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Biolox Delta Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Biolox Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230048|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 7.0 Mm X 40 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Biolox Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Biolox Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230049|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 7.0 Mm X 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Biolox Delta Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Biolox Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230050|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 7.0 Mm X 20 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Biolox Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951204201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Biolox Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 951230051|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viatrac 14 Plus Peripheral Dilatation Catheter 7.0 Mm X 30 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Biolox Delta Head Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.50|FSC: 13; Default||Not reimbursed separately|5,602.50|FSC: 13; Default||External grouping not supported 951204203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 40mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230053|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 5.0 Mm X 20 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 41mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 42mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230054|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 5.0 Mm X 30 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 43mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 44mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230079|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 45mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 46mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230078|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 47mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 48mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230055|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 5.0 Mm X 40 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 49mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 50mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230056|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 6.0 Mm X 20 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 51mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 52mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230057|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 6.0 Mm X 30 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 44mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 45mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230058|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 6.0 Mm X 40 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 46mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 47mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230059|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 7.0 Mm X 20 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 48mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 49mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230060|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 7.0 Mm X 30 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230061|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 7.0 Mm X 40 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230062|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 8.0 Mm X 20 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230063|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 8.0 Mm X 40 Mm X 132 Cm Rap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951204037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Masterloc Lateralized #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230064|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotidstent System 9.0 Mm X 20 Mm X 132 Cm Rapi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951203976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230065|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 9.0 Mm X 40 Mm X 132cm Rapi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951203978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230066|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Acculink Carotid Stent System 10 Mm X 20 Mm X 132 Cm Rapi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 951203980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230067|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951203982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230068|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951203984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230069|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951203986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230070|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951203988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951203989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951230071|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951203990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amistem H Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951204222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 50mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230072|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 51mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 52mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230073|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 53mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 54mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230074|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 55mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 56mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230075|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 57mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 58mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230076|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 59mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Head 60mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230077|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 4.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951204233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230104|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Flex-t Guide Wire System With Microglide Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230105|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Flex-t Guide Wire System With Microglide Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230122|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Ii Tapered Guide Wire System With Microglide Coating .03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230121|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Ii Tapered Guide Wire System With Microglide Coating .03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230106|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Flex-t Guide Wire System With Microglide Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 46/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 48/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951230107|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Modified J Guide Wire System 145 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 50/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951230108|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Floppy Guide Wire System 145 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 54/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951230109|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Standard Guide Wire System 145 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 56/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 58/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951230110|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Floppy Guide Wire System 175 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 60/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 62/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951230111|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Modified J Guide Wire System 175 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Dm Liner Hc 64/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951204254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230112|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Floppy Guide Wire System 260 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230113|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Modified J Guide Wire System 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230114|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Standard Guide Wire System 300 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230115|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Versacore Modified J Guide Wire System 260 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230116|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Tapered Guide Wire System With Microglide Coating .035 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230117|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Tapered Guide Wire System With Microglide Coating .035 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230118|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Tapered Guide Wire System With Microglide Coating .035 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230119|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Tapered Guide Wire System With Microglide Coating .035 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230120|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tad Ii Tapered Guide Wire System With Microglide Coating .03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230123|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 6.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230124|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 6.0 Mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230125|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 7.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Cup Nh 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 22/az|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230126|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 7.0 Mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 28/b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 28/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230127|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 8.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 28/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 28/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230128|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 8.0 Mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 28/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 32/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230129|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 32/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 32/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230130|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 32/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 36/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230166|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 36/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Flat Liner Hc 36/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230165|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 9.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 22/az|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 28/b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230164|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 9.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 28/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 28/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230163|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 8.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 28/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 28/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230162|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 8.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 32/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 32/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230161|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Hooded Liner Hc 32/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230160|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230159|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230158|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versafitcup Cc Trio Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230157|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230156|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230155|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230154|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230153|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951204317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Dm Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951230152|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230151|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230150|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Omnilink Elite Vascular Balloon-expandable Stent System 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951204322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230149|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230148|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951230147|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Two Hole Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951204329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230146|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230145|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230144|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230131|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230132|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951204339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact No Hole Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951230133|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230134|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230135|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230136|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230137|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 10.0 Mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230138|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230139|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230140|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230141|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 36/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230142|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 36/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 36/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230143|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Absolute Pro Vascular Self-expanding Stent System 9.0 Mm X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951204360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 40/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 40/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,403.00|FSC: 13; Default||Not reimbursed separately|5,403.00|FSC: 13; Default||External grouping not supported 951204362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230098|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rx Accunet Embolic Protection System 4.5/300 Rapid-exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 36/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230099|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rx Accunet Embolic Protection System 5.5/300 Rapid-exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 40/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 22/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230100|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rx Accunet Embolic Protection System 6.5/300 Rapid-exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 28/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 32/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230101|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rx Accunet Embolic Protection System 7.5/300 Rapid-exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951204370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 36/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Flat Liner Hc 40/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230386|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Supera Peripheral Stent System 5 Mm X 20 Mm X 120 Cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 951204372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230387|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Supera Peripheral Stent System 5 Mm X 30 Mm X 120 Cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 951204374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230388|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Supera Peripheral Stent System 6 Mm X 20 Mm X 120 Cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 951204376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230389|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Supera Peripheral Stent System 6 Mm X 30 Mm X 120 Cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 951204378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230390|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Supera Peripheral Stent System 6.5 Mm X 20 Mm X 120 Cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 951204380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230391|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Supera Peripheral Stent System 6.5 Mm X 30 Mm X 120 Cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 951204382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230270|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Starclose Se Vcs White Sheath Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951204384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230271|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xact Carotid Stent System 9.0 Mm X 20 Mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951204386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230272|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xact Carotid Stent System 7.0 Mm X 30 Mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951204388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 36/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230273|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xact Carotid Stent System 7.0 Mm X 20 Mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951204390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 36/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 36/g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230274|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xact Carotid Stent System 10.0 Mm X 30 Mm Tapered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951204392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230275|EAP|Custom 951230275||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Vascular Plug 4 4mm Pkg Ster|1|HUMANA [1294]||HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 36/j|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230276|EAP|Custom 951230276||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Vascular Plug 4 5mm Pkg Ster|1|HUMANA [1294]||HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 22/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 28/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230277|EAP|Custom 951230277||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amplatzer Vascular Plug 4 6mm Pkg Ster|1|HUMANA [1294]||HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951204398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 32/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951204399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpact Hooded Liner Hc 36/k|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951230380|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Xt Pta Catheter 1.2 Mm X 12 Mm X 145 Cm / Over-the|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm C Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm D Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230381|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Xt Pta Catheter 1.2 Mm X 20 Mm X 145 Cm / Over-the|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm E Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm F Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230382|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Xt Pta Catheter 1.5 Mm X 12 Mm X 145 Cm / Over-the|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 50mm Arcos A Std Ofst Hip Fem Ti Mdlr Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos A Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230383|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Xt Pta Catheter 1.5 Mm X 20 Mm X 145 Cm / Over-the|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos C Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos D Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos E Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos F Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230385|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Xt Pta Catheter 2.0 Mm X 20 Mm X 145 Cm / Over-the|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos G Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 50mm Arcos A Hi Ofst Hip Fem Ti Mdlr Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230377|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdwr-tw Angled Floppy 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos A Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos B Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230378|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdwr-tw Angled Floppy 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos C Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos D Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230379|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdwr-tw Straight Floppy 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos E Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos F Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230191|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 60mm Arcos G Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos A Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951230190|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45c Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45d Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951230167|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45e Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55a Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951230168|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55b Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55c Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951230169|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55d Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55e Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951230170|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 28mm Ranawat/burnstein Hw Pg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 32mm Ranawat/burnstein Hw Pg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230171|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 32mm Ranawat/burnstein Hw Pg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 32mm Ranawat/burnstein Hw Pg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230172|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 22mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 22mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230173|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230174|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230175|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230176|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230177|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951205816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 28mm Rb Pg Hw Rmr Hip Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|FSC: 13; Default||Not reimbursed separately|2,226.00|FSC: 13; Default||External grouping not supported 951230178|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 50 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951205818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 52 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951230179|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 54 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951205820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 56 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951230180|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 58 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951205822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 60 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951230181|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 62 Std Face 36mm Alply Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951205824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Bmt Trplr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|FSC: 13; Default||Not reimbursed separately|7,647.00|FSC: 13; Default||External grouping not supported 951230182|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 25mm Bmt Trplr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|FSC: 13; Default||Not reimbursed separately|7,647.00|FSC: 13; Default||External grouping not supported 951205826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 26mm Bmt Trplr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|FSC: 13; Default||Not reimbursed separately|7,647.00|FSC: 13; Default||External grouping not supported 951230183|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 27mm 27mm Bmt Trplr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|FSC: 13; Default||Not reimbursed separately|7,647.00|FSC: 13; Default||External grouping not supported 951205828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 28mm Bmt Trplr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|FSC: 13; Default||Not reimbursed separately|7,647.00|FSC: 13; Default||External grouping not supported 951230184|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 69mm 28mm Bmt Trplr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|FSC: 13; Default||Not reimbursed separately|7,647.00|FSC: 13; Default||External grouping not supported 951205830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 42mm 26mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,766.50|FSC: 13; Default||Not reimbursed separately|3,766.50|FSC: 13; Default||External grouping not supported 951230185|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 44mm 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 46mm 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230186|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 48mm 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 50mm 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 52mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 54mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230188|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 56mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 58mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230189|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 60mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 62mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230080|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 64mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 66mm 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230081|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 42mm 26mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,766.50|FSC: 13; Default||Not reimbursed separately|3,766.50|FSC: 13; Default||External grouping not supported 951205844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 44mm 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230082|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 46mm 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 48mm 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230083|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 50mm 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 52mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230084|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 54mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 56mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230085|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 58mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 60mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230086|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 5.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 62mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 64mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951230087|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 66mm 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|FSC: 13; Default||Not reimbursed separately|4,183.50|FSC: 13; Default||External grouping not supported 951205856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Linr Ti Por Mcl Rnglc +5mm 22 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230088|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Linr Ti Por Mcl Rnglc +5mm 22 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Linr Ti Por Mcl Rnglc +5mm 23 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230089|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Linr Ti Por Mcl Rnglc +5mm 23 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Linr Ti Por Mcl Rnglc +5mm 24 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230090|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Linr Ti Por Mcl Rnglc +5mm 24 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Linr Ti Por Mcl Rnglc +5mm 23 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230091|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Linr Ti Por Mcl Rnglc +5mm 23 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Linr Ti Por Mcl Rnglc +5mm 24 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230092|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Linr Ti Por Mcl Rnglc +5mm 24 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Linr Ti Por Mcl Rnglc +5mm 25 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230093|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 6.5 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Linr Ti Por Mcl Rnglc +5mm 25 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Linr Ti Por Mcl Rnglc +5mm 26 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Linr Ti Por Mcl Rnglc +5mm 26 Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Linr Ti Por Mcl Rnglc +5mm 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230095|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 7.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Linr Ti Por Mcl Rnglc +5mm 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Linr Ti Por Mcl Rnglc +5mm 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951230096|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 7.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Linr Ti Por Mcl Rnglc +5mm 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|FSC: 13; Default||Not reimbursed separately|7,269.00|FSC: 13; Default||External grouping not supported 951205874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230097|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rx Herculink Elite Renal And Biliary Stent System 7.0 Mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951205875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230102|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Flex-t Guide Wire System With Microglide Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230103|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hi-torque Flex-t Guide Wire System With Microglide Coating .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230192|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230193|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230194|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230195|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230196|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 28mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230197|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230198|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Rb Rnglc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230199|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Lt Shrt Flng Ti Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951205896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Rt Shrt Flng Ti Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951230200|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Lt Med Flng Ti Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951205898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Rt Med Flng Ti Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951230201|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Lt Lng Flng Ti Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951205900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Rt Lng Flng Ti Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951230202|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Shrt Flng Ti Pr5 Ntrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951205902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Med Flng Ti Pr5 Ntrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951230203|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Hip Rt Lng Flng Ti Pr5 Ntrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951205904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Ti Pr5 Rnglc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,242.50|FSC: 13; Default||Not reimbursed separately|11,242.50|FSC: 13; Default||External grouping not supported 951230204|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230205|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230269|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 200 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230206|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230207|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Linr Por C Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230208|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Mlhl Rim Scr Por Rnglc Unv D 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 24mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230209|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 24mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Linr Por E Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230210|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 25mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 26mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230211|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 26mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 27mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230212|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 27mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230213|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Rnglc Unv Mlhl Rim Scr Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Actb 46mm Qd Spr Rnglc 22 Hip Recon Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951230214|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Cmpnt Recon Qd Spr 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|FSC: 13; Default||Not reimbursed separately|5,526.00|FSC: 13; Default||External grouping not supported 951205928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 48mm Healey Rnglc 22 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951230215|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 50mm Healey Rnglc 23 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951205930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 52mm Healey Rnglc 23 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951230216|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 54mm Healey Rnglc 24 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951205932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 56mm Healey Rnglc 24 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951230217|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 58mm Healey Rnglc 25 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951205934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 60mm Healey Rnglc 25 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951230218|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 62mm Healey Rnglc 26 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,517.50|FSC: 13; Default||Not reimbursed separately|6,517.50|FSC: 13; Default||External grouping not supported 951205936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 64mm Healey Rnglc 26 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951230219|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 66mm Healey Rnglc 27 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951205938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 68mm Healey Rnglc 27 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951230220|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 70mm Healey Rnglc 28 Hip Por Rev Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|FSC: 13; Default||Not reimbursed separately|6,843.00|FSC: 13; Default||External grouping not supported 951205940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Ha Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|FSC: 13; Default||Not reimbursed separately|14,166.00|FSC: 13; Default||External grouping not supported 951230221|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Ha Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|FSC: 13; Default||Not reimbursed separately|14,166.00|FSC: 13; Default||External grouping not supported 951205942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Ha Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|FSC: 13; Default||Not reimbursed separately|14,166.00|FSC: 13; Default||External grouping not supported 951230222|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Ha Pr5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|FSC: 13; Default||Not reimbursed separately|14,166.00|FSC: 13; Default||External grouping not supported 951205944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230223|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230224|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230225|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 100 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Actb 56mm Regenerex Rnglc+ 24 Hip Mlhl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230226|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230227|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 150 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230228|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 180 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230229|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230230|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 20 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951205962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Mlhl Mdlr Ti Por Regenerex Rnglc+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|FSC: 13; Default||Not reimbursed separately|7,663.50|FSC: 13; Default||External grouping not supported 951230231|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 40 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm 42mm Regenerex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm 44mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951230232|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 60 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm 46mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm 48mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951230233|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 80 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm 50mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm 52mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951230234|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 100 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm 54mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm 56mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951230235|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 120 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm 58mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm 60mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951230236|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 150 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm 62mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm 64mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm 66mm Hip Ti Por Regenerex Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|FSC: 13; Default||Not reimbursed separately|8,871.00|FSC: 13; Default||External grouping not supported 951205976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Lmt 3 Hl Osseoti G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Lmt 3 Hl Osseoti G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951230237|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Lmt 3 Hl Osseoti G7 B Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Lmt 3 Hl Osseoti G7 C Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Lmt 3 Hl Osseoti G7 D Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Lmt 3 Hl Osseoti G7 E Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951230238|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.0 Mm X 200 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Lmt 4 Hl Osseoti G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Lmt 4 Hl Osseoti G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951230239|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 20 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Lmt 4 Hl Osseoti G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Lmt 4 Hl Osseoti G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951230240|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 40 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951205986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Lmt 4 Hl Osseoti G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951206746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 26mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230241|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 60 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 27mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 28mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230242|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 80 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 29mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 30mm Arcos Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230243|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 100 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 32mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 33mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230244|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 150 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 34mm Arcos Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 35mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230245|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 36mm Arcos Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 37mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230246|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 2.5 Mm X 200 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 38mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 39mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230247|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 100 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 40mm Arcos Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 41mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230248|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 150 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 42mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 43mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230249|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 44mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 45mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230250|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 3.0 Mm X 200 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 46mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 47mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230251|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 100 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 48mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 49mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230252|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 50mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 51mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230253|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 4.0 Mm X 200 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 52mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 53mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951230254|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 150 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 54mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951206774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Mlhd Oblng Hip Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|FSC: 13; Default||Not reimbursed separately|1,530.00|FSC: 13; Default||External grouping not supported 951230255|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.0 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 40-50mm 2 Pc Mlhd Bn Hip Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 50-60mm 2 Pc Mlhd Bn Hip Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951230256|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 20 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 60-70mm 2 Pc Mlhd Bn Hip Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 45-55mm 2 Pc Mlhd Bn Hip Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951230257|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 40 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 55-65mm 2 Pc Mlhd Bn Hip Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 25mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951230258|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 60 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 30mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951206782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 35mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951230259|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 80 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mmx40mm Ti Kaessmann Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951206784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 45mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951230260|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 5.5 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 50mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951206786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 55mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951230261|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 20 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 60mm Arcos Ti Hip Fem Trnsv Fx Strl Mdlr Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|FSC: 13; Default||Not reimbursed separately|616.50|FSC: 13; Default||External grouping not supported 951206788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Rt Prox Mdlr Oss Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|FSC: 13; Default||Not reimbursed separately|17,307.00|FSC: 13; Default||External grouping not supported 951230262|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 40 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Lt Prox Mdlr Oss Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|FSC: 13; Default||Not reimbursed separately|17,307.00|FSC: 13; Default||External grouping not supported 951206790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Rt Prox Mdlr Oss Letson|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|FSC: 13; Default||Not reimbursed separately|17,307.00|FSC: 13; Default||External grouping not supported 951230263|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 60 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Lt Prox Mdlr Clw Oss Letson|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|FSC: 13; Default||Not reimbursed separately|17,307.00|FSC: 13; Default||External grouping not supported 951206792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 7cm Kn Rt Oss Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,841.60|FSC: 13; Default||Not reimbursed separately|17,841.60|FSC: 13; Default||External grouping not supported 951230264|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 80 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 7cm Kn Lt Oss Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,841.60|FSC: 13; Default||Not reimbursed separately|17,841.60|FSC: 13; Default||External grouping not supported 951206794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oss Rt Prox Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,784.00|FSC: 13; Default||Not reimbursed separately|17,784.00|FSC: 13; Default||External grouping not supported 951230265|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 100 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oss Lt Prox Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,784.00|FSC: 13; Default||Not reimbursed separately|17,784.00|FSC: 13; Default||External grouping not supported 951206796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss Osseoti Modular Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,225.00|FSC: 13; Default||Not reimbursed separately|18,225.00|FSC: 13; Default||External grouping not supported 951230266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 120 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 7cm Cmpr Finn Oss Kn Rt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|FSC: 13; Default||Not reimbursed separately|16,363.80|FSC: 13; Default||External grouping not supported 951206798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 7cm Cmpr Finn Oss Kn Lt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|FSC: 13; Default||Not reimbursed separately|16,363.80|FSC: 13; Default||External grouping not supported 951230267|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 150 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 8.5cm Cmpr Finn Oss Kn Rt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|FSC: 13; Default||Not reimbursed separately|16,862.40|FSC: 13; Default||External grouping not supported 951206800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 8.5cm Cmpr Finn Oss Kn Lt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|FSC: 13; Default||Not reimbursed separately|16,862.40|FSC: 13; Default||External grouping not supported 951230268|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 18 Pta Catheter 6.0 Mm X 180 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 10cm Cmpr Finn Oss Kn Rt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|FSC: 13; Default||Not reimbursed separately|17,476.20|FSC: 13; Default||External grouping not supported 951206802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 10cm Cmpr Finn Oss Kn Lt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|FSC: 13; Default||Not reimbursed separately|17,476.20|FSC: 13; Default||External grouping not supported 951230296|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 1.5 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 7cm Cmpr Oss Letson Kn Rt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|FSC: 13; Default||Not reimbursed separately|16,363.80|FSC: 13; Default||External grouping not supported 951206804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 7cm Cmpr Oss Letson Kn Lt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|FSC: 13; Default||Not reimbursed separately|16,363.80|FSC: 13; Default||External grouping not supported 951230297|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 1.5 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 8.5cm Cmpr Oss Letson Kn Rt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|FSC: 13; Default||Not reimbursed separately|16,862.40|FSC: 13; Default||External grouping not supported 951206806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 8.5cm Cmpr Oss Letson Kn Lt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|FSC: 13; Default||Not reimbursed separately|16,862.40|FSC: 13; Default||External grouping not supported 951230298|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 1.5 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 10cm Cmpr Oss Letson Kn Rt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|FSC: 13; Default||Not reimbursed separately|17,476.20|FSC: 13; Default||External grouping not supported 951206808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 10cm Cmpr Oss Letson Kn Lt Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|FSC: 13; Default||Not reimbursed separately|17,476.20|FSC: 13; Default||External grouping not supported 951206809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Finn Mod Prox Fmrl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,137.80|FSC: 13; Default||Not reimbursed separately|17,137.80|FSC: 13; Default||External grouping not supported 951206810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Finn Lt Prox Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,137.80|FSC: 13; Default||Not reimbursed separately|17,137.80|FSC: 13; Default||External grouping not supported 951230299|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 1.5 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Letson Mod Prox Fmrl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|FSC: 13; Default||Not reimbursed separately|17,307.00|FSC: 13; Default||External grouping not supported 951206812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Letson Mod Prox Fmrl Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|FSC: 13; Default||Not reimbursed separately|17,307.00|FSC: 13; Default||External grouping not supported 951230300|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 29cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 31cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230301|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 33cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 35cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230302|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Femur Diaphysis 37cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 39cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230303|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Femur Diaphysis 43cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 45cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230304|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 47cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 49cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230305|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 51cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Femur Diaphysis 53cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230306|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951206826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57cm Kn Diaphysis Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|FSC: 13; Default||Not reimbursed separately|21,063.60|FSC: 13; Default||External grouping not supported 951230307|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 6in 1/3 3in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951206828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 6in 1/3 4in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951230308|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 6in 1/3 5in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951206830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 6in 1/3 6in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951230309|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 6in 1/3 7in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951206832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 8in 1/3 6in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951230310|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9in 1/3 6in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951206834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10in 1/3 6in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951230311|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11in 1/3 6in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951206836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12in 1/3 6in Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|FSC: 13; Default||Not reimbursed separately|21,099.60|FSC: 13; Default||External grouping not supported 951230312|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 3.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 66/68/70mm 36mm Lngvt Hip Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 72/74mm 36mm Lngvt Hip Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951230313|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 3.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 76/78/80mm 36mm Lngvt Hip Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Hh 50mm 28mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230337|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 5 Mm X 100 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ii 52mm 28mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Jj 54mm 28mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230338|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 5 Mm X 120 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ll 58mm 28mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ll 58mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230339|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 5 Mm X 150 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Mm 60mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Mm 60mm 36mm Lngvt Hip Strl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230314|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 3.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Nn 62mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Nn 62mm 36mm Lngvt Hip Strl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230315|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 3.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Oo 64mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Oo 64mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230316|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 3.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp 66mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp 66mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230317|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 3.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Qu 68mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Qu 68mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230318|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 20 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Rr 70mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Rr 70mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230319|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 40 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ss 72mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ss 72mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230320|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 60 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Tt 74mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Tt 74mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230321|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 80 Mm X 90 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Uu 76mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Uu 76mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230322|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 120 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Vv 78/80mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Vv 78/80mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951230323|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 200 Mm X 90 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii B Std 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii C Std 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230324|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.0 Mm X 200 Mm X 150 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii F Std 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii G Std 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230325|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 2.5 Mm X 20 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii M Std 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii F 28mm Lngvt Hip Strl Prm Elev Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230326|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 20 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii G Elev 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii J Elev 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230327|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 40 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii M Elev 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii E Ntrl 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230328|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 60 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii F Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii G Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230329|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 14 Pta Catheter 4.0 Mm X 80 Mm X 150 Cm / Over-the-wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii H Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii J Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230330|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 4 Mm X 60 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii K Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii L Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230331|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 4 Mm X 80 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii N Std 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii G 32mm Lngvt Hip Strl Prm Elev Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230332|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 4 Mm X 100 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii H Ntrl 32mm Lngvt Hip Strl Prm Elev Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii J Elev 32mm Lngvt Hip Strl Prm Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230333|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 4 Mm X 120 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii K Elev 32mm Lngvt Hip Strl Prm Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii L Elev 32mm Lngvt Hip Strl Prm Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230334|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 4 Mm X 150 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii M 32mm Lngvt Hip Strl Prm Elev Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951206888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hgp Ii N Elev 32mm Lngvt Hip Strl Prm Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|FSC: 13; Default||Not reimbursed separately|4,059.00|FSC: 13; Default||External grouping not supported 951230335|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 4 Mm X 200 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 51mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 53mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230336|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 4 Mm X 250 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 55mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 57mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230376|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 14 Mm X 60 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 59mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 61mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230375|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 14 Mm X 20 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 63mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 65mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230374|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 12 Mm X 80 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 67mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 69mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230373|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 12 Mm X 60 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 71mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 73mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230372|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 12 Mm X 20 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 75mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 77mm 28mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230371|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 10 Mm X 80 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 55mm 32mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 57mm 32mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230370|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 10 Mm X 60 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 61mm 38mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 63mm 38mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230369|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 9 Mm X 80 Mm X 135 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 65mm 38mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 67mm 38mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230368|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 9 Mm X 60 Mm X 135 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 69mm 38mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951206910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 71mm 38mm Hip Cnstrn Drsl Epsln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|FSC: 13; Default||Not reimbursed separately|8,733.00|FSC: 13; Default||External grouping not supported 951230367|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 8 Mm X 60 Mm X 135 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 12/14 Sm 28mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|FSC: 13; Default||Not reimbursed separately|4,839.00|FSC: 13; Default||External grouping not supported 951206912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 Med 28mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|FSC: 13; Default||Not reimbursed separately|4,839.00|FSC: 13; Default||External grouping not supported 951230366|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 7 Mm X 200 Mm X 135 Cm / Over-the-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 12/14 Sm 32mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|FSC: 13; Default||Not reimbursed separately|4,839.00|FSC: 13; Default||External grouping not supported 951206914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 Lg 32mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|FSC: 13; Default||Not reimbursed separately|4,839.00|FSC: 13; Default||External grouping not supported 951230365|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 7 Mm X 150 Mm X 135 Cm / Over-the-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 12/14 Sm 36mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 951206916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 Lg 36mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 951230364|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 7 Mm X 80 Mm X 135 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +7mm 12/14 Xl 36mm Hip Blx D Cpt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 951206918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 12/14 Sm 40mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 951230363|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 6 Mm X 250 Mm X 135 Cm / Over-the-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 Med 40mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 951206920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 Lg 40mm Hip Blx D Optn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 951230362|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 6 Mm X 100 Mm X 135 Cm / Over-the-wir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 52mm 48mm Zca Hip Lt Ti Rev Cmnt Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 52mm 48mm Zca Hip Rt Ti Rev Cmnt Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951230361|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 5 Mm X 250 Mm X 135 Cm / Over-the-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 58mm 54mm Zca Hip Lt Ti Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 58mm 54mm Zca Hip Rt Ti Rev Cmnt Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951230360|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 5 Mm X 150 Mm X 135 Cm / Over-the-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 64mm 60mm Zca Hip Lt Ti Rev Cmnt Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 64mm 60mm Zca Hip Rt Ti Rev Cmnt Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951230359|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 4 Mm X 250 Mm X 135 Cm / Over-the-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 50mm 46mm Zca 45mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951206928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 52mm 48mm Zca 47mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951230358|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 14 Mm X 60 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 54mm 50mm Zca 49mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951206930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 56mm 52mm Zca 51mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951230357|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 14 Mm X 20 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 58mm 54mm Zca 53mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951206932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 60mm 56mm Zca 55mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951230356|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 12 Mm X 80 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 62mm 58mm Zca 57mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951206934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 64mm 60mm Zca 59mm Hip Ti Rev Cmnt Roof Recon Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|FSC: 13; Default||Not reimbursed separately|4,708.50|FSC: 13; Default||External grouping not supported 951230355|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 10 Mm X 80 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 5d Hip Trb Mtl Shim Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951206936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 10d Hip Trb Mtl Shim Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951230354|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 10 Mm X 60 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 15d Hip Trb Mtl Shim Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951208434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230353|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 9 Mm X 80 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck Aa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230352|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 9 Mm X 60 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Fem Kinectiv E Strg Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck P1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230351|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 7 Mm X 200 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck X1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230350|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 7 Mm X 150 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck K2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230340|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 5 Mm X 200 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck P2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230341|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 5 Mm X 250 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck J1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951230342|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 6 Mm X 100 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck Dd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 47mm 28mm Std Zca Prm Cmnt Hip Strl Alply Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230343|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 6 Mm X 120 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 49mm 32mm Std Zca Prm Cmnt Hip Strl Alply Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 32mm Std Zca Prm Cmnt Hip Strl Alply Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230344|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 6 Mm X 150 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 32mm Std Zca Prm Cmnt Hip Strl Alply Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 61mm 32mm Std Zca Prm Cmnt Hip Strl Alply Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230345|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 6 Mm X 200 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 47mm 28mm 10d Std Zca Prm Cmnt Incln Face Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 53mm 32mm 10d Std Zca Prm Cmnt Incln Face Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230346|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Ll Pta Catheter 6 Mm X 250 Mm X 80 Cm / Over-the-w|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 32mm 10d Std Zca Prm Cmnt Incln Face Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 47mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230347|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 7 Mm X 80 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 49mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230348|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 7 Mm X 100 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 32mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 53mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951230349|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Armada 35 Pta Catheter 7 Mm X 120 Mm X 80 Cm / Over-the-wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 53mm 32mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95198822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 11mm X 345mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,524.70|FSC: 13; Default||Not reimbursed separately|9,524.70|FSC: 13; Default||External grouping not supported 951208463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 32mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95198823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular G7 Size F 40mm Vivacit-e Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951208465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 32mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 59mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 59mm 32mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 61mm 28mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 61mm 32mm Ntrl Zca Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 47mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95198824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 7mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951208471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 49mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Prm Mlhd Intlk Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 4mm Aptus Trlk Ti Phlng Hnd Hexadrive 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951208473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 11mm Lateralize Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 15mm Lateralize Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Standard Quadra-p Size 1 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951208475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17mm Lateralize Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 125mm 9mm Intgr Hip Cocr Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198827|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 755cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 951208477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 135mm 11mm Intgr Hip Cocr Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 145mm 13mm Intgr Hip Cocr Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 155mm 15mm Intgr Hip Cocr Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 44cm Lt Intertrochanter Intertan Im 130d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951208480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 165mm 17mm Intgr Hip Cocr Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 125mm 9mm Intgr Hip Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198831|EAP|Custom 95198831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 130mm Vlp 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 135mm 11mm Intgr Hip Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 145mm 13mm Intgr Hip Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radl 8mmx2mm 31mm Align Ti Sd Ld Hbrd Hd Dsgn Unq Algn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,161.00|FSC: 13; Default||Not reimbursed separately|7,161.00|FSC: 13; Default||External grouping not supported 951208484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 155mm 15mm Intgr Hip Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 165mm 17mm Intgr Hip Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Stanmore Cocr 1 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Stanmore Cocr 2 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 26mm Ss Cort St Prlc Vlp Sm Frag Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.72|FSC: 13; Default||Not reimbursed separately|48.72|FSC: 13; Default||External grouping not supported 951208488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Stanmore Cocr 3 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Stanmore Cocr 1 Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 32.6mmx58.8mm 3.5mm Ss Scr Prm Prlc Vlp Bn Lt Mtp F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.75|FSC: 13; Default||Not reimbursed separately|2,664.75|FSC: 13; Default||External grouping not supported 951208490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Stanmore Cocr 2 Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Stanmore Cocr 4 Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 20mm Ss Cort St Prlc Vlp Sm Frag Sys Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|FSC: 13; Default||Not reimbursed separately|56.04|FSC: 13; Default||External grouping not supported 951208492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 9mm Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 10mm Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 28mm Ss Cort St Prlc Vlp Sm Frag Sys Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|FSC: 13; Default||Not reimbursed separately|56.04|FSC: 13; Default||External grouping not supported 951208494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 11mm Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 13mm Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 26mm Ss Cort St Prlc Vlp Sm Frag Sys Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|FSC: 13; Default||Not reimbursed separately|56.04|FSC: 13; Default||External grouping not supported 951208496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 15mm Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17mm Smth Rx90 Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 22mm Ss Cort St Prlc Vlp Sm Frag Sys Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|FSC: 13; Default||Not reimbursed separately|314.55|FSC: 13; Default||External grouping not supported 951208498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Lateralize Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Lateralize Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 28mm Ss Cort St Prlc Vlp Sm Frag Sys Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|FSC: 13; Default||Not reimbursed separately|314.55|FSC: 13; Default||External grouping not supported 951208500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Lateralize Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 16mm Locking Seft Tapping Peri-loc Vlp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|FSC: 13; Default||Not reimbursed separately|314.55|FSC: 13; Default||External grouping not supported 951208502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Locking Seft Tapping Peri-loc Vlp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|FSC: 13; Default||Not reimbursed separately|314.55|FSC: 13; Default||External grouping not supported 951208504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Ans Cocr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Lg Christensen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Sirius 30a Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm Cmnt Sirius 125d 32mm 16mm B Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198841|EAP|Custom 95198841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio-medicus 23fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm Cmnt Sirius 125d 34mm 18mm B Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Cmnt Sirius 125d 34mm 18mm C Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198842|EAP|Custom 95198842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio-medicus 25fr 76.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Cmnt Sirius 125d 38mm 20mm C Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Cmnt Sirius 125d 38mm 20mm D Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198843|EAP|Custom 95198843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio-medicus 27fr 76.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Cmnt Sirius 125d 38mm 20mm E Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Cmnt Sirius 125d 44mm 24mm D Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198855|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 143cm 8mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Cmnt Sirius 125d 44mm 24mm E Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Cmnt Sirius 125d 44mm 22mm F Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Humeral Flex 45x17x1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|FSC: 13; Default||Not reimbursed separately|8,468.58|FSC: 13; Default||External grouping not supported 951208517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Cmnt Sirius 125d 50mm 27mm F Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951208518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Cmnt Sirius 125d 50mm 27mm G Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95198848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Glenoid Cortiloc Pegged|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,121.32|FSC: 13; Default||Not reimbursed separately|6,121.32|FSC: 13; Default||External grouping not supported 951208519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm 6mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 11mm Kn X3 Cs Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951208521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 7.5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm 9mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198854|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Attain Stability Quad Mri 78cm Quadpole Lv Surescan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,110.00|FSC: 13; Default||Not reimbursed separately|7,110.00|FSC: 13; Default||External grouping not supported 951208523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 10mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm 11mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198850|EAP|Custom 95198850||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 12mm 20mm 63cm Nitniol Poly Bl Aero|1|HUMANA [1294]||HUMANA [11839]|6,348.00|FSC: 13; Default||Not reimbursed separately|6,348.00|FSC: 13; Default||External grouping not supported 951208525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 12.5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm 13.5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198851|EAP|Custom 95198851||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 10mm 20mm 63cm Nitniol Poly Bl Aero|1|HUMANA [1294]||HUMANA [11839]|6,348.00|FSC: 13; Default||Not reimbursed separately|6,348.00|FSC: 13; Default||External grouping not supported 951208527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17.5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198852|EAP|Custom 95198852||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Trchbr 16mm 40mm 63cm Nitniol Poly Bl Aero|1|HUMANA [1294]||HUMANA [11839]|6,348.00|FSC: 13; Default||Not reimbursed separately|6,348.00|FSC: 13; Default||External grouping not supported 951208529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 22.5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 16mm Oths Tprlk Por Lg Rt Ankl/ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198853|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Attain Stability Quad Mri 88cm Quadpole Lv Surescan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,110.00|FSC: 13; Default||Not reimbursed separately|7,110.00|FSC: 13; Default||External grouping not supported 951208533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 157mm 18.5mm Prm Tprlk Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 5mm Prm Tprlk Ti Por Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198858|EAP|Custom 95198858||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 8x9x28mm Crnt 8a Lg Pk-opt Ptr Lmbr|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 951208535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm 6mm Prm Tprlk Ti Por Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 7.5mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198859|EAP|Custom 95198859||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Panel Filmarray Me (30 Pack)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm 9mm Prm Tprlk Ti Por Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 10mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198860|EAP|Custom 95198860||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Media Bd Br Hrt Inf 15mmx100mm Agar 10 Shp Bld Gnt/chlr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm 11mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 12.5mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm 13.5mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fibertak Rc Tripoad Tape Bl/w Blk/w W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 951208543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17.5mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198873|EAP|Custom 95198873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fibertak Rc Disposables Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 22.5mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198861|EAP|Custom C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 143cm 12mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 16mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 157mm 18.5mm Prm Tprlk Ti Por Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198862|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 143cm 15mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 6mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 7mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198863|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2mm 143cm 20mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 8mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198864|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.5mm 143cm 8mm Pcta Nc Emerge Tpr Tip Ul Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 10mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198865|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.5mm 143cm 12mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 13mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198866|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.5mm 143cm 15mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 14mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198867|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 2.5mm 143cm 20mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198868|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 143cm 8mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 18mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 19mm Cmnt Mlhd Por 136.5d Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198869|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 143cm 12mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 8mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198870|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 143cm 15mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 10mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198871|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 3mm 143cm 20mm Pcta Nc Emrg Tpr Tip Ul Lorfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 13mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 14mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Synfix Evolution Fine Tip 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,324.00|FSC: 13; Default||Not reimbursed separately|3,324.00|FSC: 13; Default||External grouping not supported 951208570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198879|EAP|Custom 95198879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Synfix Evolution Thread Lock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Mlhd Por 131.5d Lateralize Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198880|EAP|Custom 95198880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Synfix Evo Protection 3-pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198881|EAP|Custom 95198881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spine Synfix Evolution Medium 10.5mm/6degree|1|HUMANA [1294]||HUMANA [11839]|30,640.80|FSC: 13; Default||Not reimbursed separately|30,640.80|FSC: 13; Default||External grouping not supported 951208576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198882|EAP|Custom 95198882||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spine Synfix Evolution Medium 15mm/14degree|1|HUMANA [1294]||HUMANA [11839]|30,640.80|FSC: 13; Default||Not reimbursed separately|30,640.80|FSC: 13; Default||External grouping not supported 951208578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198884|EAP|Custom 95198884||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spine Synfix Evolution Medium 13.5mm/10degree|1|HUMANA [1294]||HUMANA [11839]|30,640.80|FSC: 13; Default||Not reimbursed separately|30,640.80|FSC: 13; Default||External grouping not supported 951208580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Lateralize Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 12.5mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compr Ft Scrw 3.5 Mini 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951208582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm 13.5mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compr Ft Scrw 3.5 Mini 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951208584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17.5mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 22.5mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 16mm Prm Rdc Tprlk Por Std Ofst Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 12.5mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198904|EAP|Custom 95198904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Bending Digitizer Array|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm 13.5mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198905|EAP|Custom 95198905||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Propel Dbm 5cc|1|HUMANA [1294]||HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 951208592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17.5mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 28mm Loprfl Scr Ti T8 Ft Cort Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951208594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 22.5mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 32mm Loprfl Scr Ti T8 Ft Cort Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951208596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 16mm Rdc Tprlk Ti Por Lateralize Ofst Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 114mm 7mm Noncollar Bmtrc Cdh Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reline-o Polyaxial 2s 7.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951208598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 124mm 9mm Noncollar Bmtrc Cdh Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm 11mm Noncollar Bmtrc Cdh Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reline Mas Poly Iliac 2c 8.5x90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 951208600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Clrls Bmtrc Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198885|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Kit Linear St 70cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951208602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198901|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraoccular 21.5 Diopter Panoptix Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951208604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Journey Uni Knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 951208606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198909|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Full Prfl Sil Smth Sh Srfc Hi 605|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951208608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 11mm Evos T7 Locking Self-tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 951208610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Intgr Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non Locking 2.7mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 951208613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Dynaite Pip 12mm Straight W/instrument|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 951208618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95198913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula Evos 2.7/3.5mm Pl-d 5hl L 93mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,077.25|FSC: 13; Default||Not reimbursed separately|3,077.25|FSC: 13; Default||External grouping not supported 951208620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vv Ntrl 78/80mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 4.3mm 26mm T8 2mm Self Tap Locking Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951209343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ii Elev 52mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Jj Elev 54mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198915|EAP|Custom 95198915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Surgical 8inl Wide Pointed Jaw F/bone Reduction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ll Elev 58mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mm Elev 60mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198916|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Axium Stimulator Dorsal Root Ganglion 2 Lead Trail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,148.84|FSC: 13; Default||Not reimbursed separately|8,148.84|FSC: 13; Default||External grouping not supported 951209347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Nn Elev 62mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Oo Elev 64mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198917|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Neurostimulator Trial 1mm Dia 50cml Slimtip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,445.44|FSC: 13; Default||Not reimbursed separately|3,445.44|FSC: 13; Default||External grouping not supported 951209349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp Elev 66mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Qu Elev 68mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Tfna Fenestrated Helical Blade 120mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 951209351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Rr Elev 70mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ss Elev 72mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5.5mm 55mm Solera Cd Hzn Cocr Spne Ma Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 951209353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Tt Elev 74mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Uu Elev 76mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 440mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,143.23|FSC: 13; Default||Not reimbursed separately|5,143.23|FSC: 13; Default||External grouping not supported 951209355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Vv Elev 78/80mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Kk 56mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lk 2.0mm 6hl 2mm/2.3mm Srght Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|974.01|FSC: 13; Default||Not reimbursed separately|974.01|FSC: 13; Default||External grouping not supported 951209357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Mm 60mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Nn 62mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 38mm 6 Hl Ti Strght 2mm/2.3mm Aptus Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,276.55|FSC: 13; Default||Not reimbursed separately|2,276.55|FSC: 13; Default||External grouping not supported 951209359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Oo 64mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Pp 66mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 18mm Ti Cort Hexa 6 Tapered Core Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951209361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Qu 68mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Rr 70mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 4+ 9mm Ankle Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|FSC: 13; Default||Not reimbursed separately|6,468.00|FSC: 13; Default||External grouping not supported 951209363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ss Ofst 72mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Tt Ofst 74mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198925|EAP|Custom 95198925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prelude Snap Splittable Hemostatic Intro 7fr 25cm 18ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Uu Ofst 76mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Vv Ofst 78/80mm 36mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198926|EAP|Custom 95198926||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 55mm 5.5mm Precontour Titanium Capped|1|HUMANA [1294]||HUMANA [11839]|4,035.00|FSC: 13; Default||Not reimbursed separately|4,035.00|FSC: 13; Default||External grouping not supported 951209367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ii Oblq 52mm 36mm Lngvt Hip Alft Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Jj Oblq 54mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198927|EAP|Custom 95198927||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal 45mm 5.5mm Precontour Titanium Capped Prebent|1|HUMANA [1294]||HUMANA [11839]|4,035.00|FSC: 13; Default||Not reimbursed separately|4,035.00|FSC: 13; Default||External grouping not supported 951209369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Kk Oblq 56mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ll Oblq 58mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 34mm Anchorage Ti Std T8 Ft/ankl Tx Hd Ns Ylw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|652.68|FSC: 13; Default||Not reimbursed separately|652.68|FSC: 13; Default||External grouping not supported 951209371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mm Oblq 60mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Nn Oblq 62mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198930|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Cardiac Resynchronization Thrpy Visionist Crt-p X4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,525.00|FSC: 13; Default||Not reimbursed separately|18,525.00|FSC: 13; Default||External grouping not supported 951209373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Oo Oblq 64mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp Oblq 66mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198932|EAP|Custom 95198932||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Implant Fibertak Button System|1|HUMANA [1294]||HUMANA [11839]|2,367.00|FSC: 13; Default||Not reimbursed separately|2,367.00|FSC: 13; Default||External grouping not supported 951209375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Qu Oblq 68mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Rr Oblq 70mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 41mm Rsrfc Gnss Ii Uhmwpe Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,989.03|FSC: 13; Default||Not reimbursed separately|1,989.03|FSC: 13; Default||External grouping not supported 951209377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ss Oblq 72mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Tt Oblq 74mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lcking 50mm 8 Hl Ti Strght 2mm/2.3mm Aptus Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.60|FSC: 13; Default||Not reimbursed separately|2,406.60|FSC: 13; Default||External grouping not supported 951209379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Uu Oblq 76mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Vv Oblq 78/80mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 18mm Ti Cort Hexa 6 Tpd Core Fl Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951209381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 2mm Dia 9mml Titanium Cortical Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951209383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 61mm 38mm Std Hip Prm Drsl Epsln Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198937|EAP|Custom 95198937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Mini Ao 1.5mm Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 9mm Low Profile Screws Titanium Cortical S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951209388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 38x69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 44x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 10mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951209390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 44x63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 44x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 12mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951209392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 44x69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ee 44mm 28mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 13mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951209394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ff 46mm 28mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Gg Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 15mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951209396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Hh Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ii Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Straight 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951209398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ii 52mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Jj Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate-z 1.4mm 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951209400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Jj 54mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Kk Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Kk 56mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ll Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198947|EAP|Custom 95198947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reagent Bd Sar-cov-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ll 58mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Mm Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198948|EAP|Custom 95198948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer Catheter 14fr 13cm For Impella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Mm 60mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Nn Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198949|EAP|Custom 95198949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Sterile For Mdu5 Plus Motordrive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Nn 62mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Oo Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198950|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Amplatzer Torqvue 10 Fr X 45 Degree X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951209410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Oo 64mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Pp Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198953|EAP|Custom 95198953||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 21mm|1|HUMANA [1294]||HUMANA [11839]|24,600.00|FSC: 13; Default||Not reimbursed separately|24,600.00|FSC: 13; Default||External grouping not supported 951209412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Pp 66mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Qu Ntrl 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198954|EAP|Custom 95198954||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 23mm|1|HUMANA [1294]||HUMANA [11839]|24,600.00|FSC: 13; Default||Not reimbursed separately|24,600.00|FSC: 13; Default||External grouping not supported 951209414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Qu 68mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Rr 70mm 32mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198955|EAP|Custom 95198955||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 27mm|1|HUMANA [1294]||HUMANA [11839]|24,600.00|FSC: 13; Default||Not reimbursed separately|24,600.00|FSC: 13; Default||External grouping not supported 951209416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ss Ntrl 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Tt Ntrl 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198956|EAP|Custom 95198956||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 29mm|1|HUMANA [1294]||HUMANA [11839]|24,600.00|FSC: 13; Default||Not reimbursed separately|24,600.00|FSC: 13; Default||External grouping not supported 951209418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Uu Ntrl 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Vv Ntrl 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Gg Elev 44mm 28mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ff Elev 46mm 28mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Gg Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Gg Elev 48mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Hh Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Hh Elev 50mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Ii Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ii Elev 52mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Jj Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Jj Elev 54mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Kk Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Kk Elev 56mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Ll Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ll Elev 58mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95114356|EAP|Custom 95114356||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Vlv Shnt 46cm Ventricular Cl Tp W/91cm Pral Cath 14ga Lf|1|HUMANA [1294]||HUMANA [11839]|3,921.60|FSC: 13; Default||Not reimbursed separately|3,921.60|FSC: 13; Default||External grouping not supported 951209434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Mm Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ll Elev 60mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198951|EAP|Custom 95198951||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 19mm|1|HUMANA [1294]||HUMANA [11839]|24,600.00|FSC: 13; Default||Not reimbursed separately|24,600.00|FSC: 13; Default||External grouping not supported 951209436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Nn Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Nn Elev 62mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198960|EAP|Custom 95198960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm/3.0mm Headless Quick Change Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Oo Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Oo Elev 64mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 38mm Cann Stainless Steel Compression Headles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951209440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Pp Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Pp Elev 66mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198962|EAP|Custom 95198962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Jjnstm 16fr Sil Std Mc Slk Trm Dist Tip Radopq Unv Fd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e 2 Qu Elev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Qu Elev 68mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 9mm 280mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,224.23|FSC: 13; Default||Not reimbursed separately|5,224.23|FSC: 13; Default||External grouping not supported 951209444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Rr Elev 70mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ss Elev 72mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198964|EAP|Custom 95198964||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spine Synfix Evolution Small 13.5mm 14degree Strl|1|HUMANA [1294]||HUMANA [11839]|30,640.80|FSC: 13; Default||Not reimbursed separately|30,640.80|FSC: 13; Default||External grouping not supported 951209446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Tt Elev 74mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Uu Elev 76mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Synfix Evolution Fine Tip 20mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,324.00|FSC: 13; Default||Not reimbursed separately|3,324.00|FSC: 13; Default||External grouping not supported 951209448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Vv Elev 78/80mm 32mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ii Ntrl 52mm 36mm Pe Vit E Hip Hi Xlnk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ankle Joint 8mml Titanium Subtalar Mba|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|629.01|FSC: 13; Default||Not reimbursed separately|629.01|FSC: 13; Default||External grouping not supported 951209450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Jj 54mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Kk Ntrl 56mm 36mm Pe Vit E Hip Hi Xlnk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198967|EAP|Custom 95198967||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 60mm 22mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|44,997.00|FSC: 13; Default||Not reimbursed separately|44,997.00|FSC: 13; Default||External grouping not supported 951209452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ll 58mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Mm 60mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198969|EAP|Custom 95198969||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Viper 2 5.5mm 45mm Lordotic Ti Non-strl Thrclumbr|1|HUMANA [1294]||HUMANA [11839]|2,126.01|FSC: 13; Default||Not reimbursed separately|2,126.01|FSC: 13; Default||External grouping not supported 951209454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Mm 60mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Nn Ntrl 62mm 36mm Vivacit-e Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spinal Cfx Viper Poly 45mml X 6.0mm Ti Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,850.40|FSC: 13; Default||Not reimbursed separately|10,850.40|FSC: 13; Default||External grouping not supported 951209456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Nn 62mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Oo Ntrl 64mm 36mm Vivacit-e Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spinal Cfx Viper Poly 45mml X 7.0mm Ti Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,850.40|FSC: 13; Default||Not reimbursed separately|10,850.40|FSC: 13; Default||External grouping not supported 951209458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Oo 64mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Pp 66mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198972|EAP|Custom 95198972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stylet Navigation Viper Prime|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Pp 66mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Qu 68mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198974|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 15x11.5cm Brst 500-600cc Smooth Intgr Port Allox2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951209462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Qu 68mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Rr 70mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198975|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xpd Tiss 16x12cm Brst 580-690cc Smooth Intgr Port Allox2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 951209464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Rr 70mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ss 72mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Rsp Djo Surgical Standard Humeral Hxe+ 36mm St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 951209466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ss 72mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Tt 74mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198977|EAP|Custom 95198977||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Thoracic Tag Conform Sg Ac/ 31mm X 31mm X 20cm 20fr|1|HUMANA [1294]||HUMANA [11839]|58,962.00|FSC: 13; Default||Not reimbursed separately|58,962.00|FSC: 13; Default||External grouping not supported 951209468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Tt 74mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Uu 76mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198978|EAP|Custom 95198978||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Thoracic Tag Conform Sg Ac/ 31mm X 31mm X 15cm 20fr|1|HUMANA [1294]||HUMANA [11839]|58,962.00|FSC: 13; Default||Not reimbursed separately|58,962.00|FSC: 13; Default||External grouping not supported 951209470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Uu 76mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Vv 78/80mm 36mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95198979|EAP|Custom 95198979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Bio Medicus 15fr 43.2cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Vv 78/80mm 40mm Hip Ntrl Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ii Elev 52mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Jj Elev 54mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Kk Elev 56mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ll Elev 58mm 36mm Vivacit-e Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ll Elev 60mm 36mm Vivacit-e Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Nn Elev 62mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Oo Elev 64mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Qu Elev 68mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Rr Elev 70mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Ss Elev 72mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Tt Elev 74mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Uu Elev 76mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vivacit-e Vv Elev 78/80mm 36mm Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951209486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3.5mm 12/14 Tpr 26mm Hip Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 0mm 12/14 Tpr 26mm Hip Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95198984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Peek Omega 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 951209488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 Tpr 26mm Hip Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +7mm 12/14 26mm Hip Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 80173288|EAP|HCPCS C9803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hopd Covid-19 Spec Collect|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 951209490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10.5mm 12/14 Tpr 26mm Hip Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3.5d 12/14 28mm Hip Metasul Trlg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d 0 38 12/14 Tpr 28mm Cocr Mlbdn Metasul Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5d 12/14 28mm Hip Metasul Trlg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d +7mm 12/14 28mm Metasul Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3.5mm 12/14 32mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 32mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 32mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +7mm 12/14 32mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10.5mm 12/14 32mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3.5mm 12/14 36mm Metasul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 36mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 36mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +7mm 12/14 36mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10.5mm 12/14 36mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d +.5mm Sm 22mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d +3.5 Med 22mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95198931|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Opthalmic Glaucoma Sterile Non-bioabsorbable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 951209507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d +7mm Med+ 22mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d +0mm Sm 26mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95198992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip 9 Scr Hl Clstr Tritanium Trdnt Ii D Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|FSC: 13; Default||Not reimbursed separately|4,638.00|FSC: 13; Default||External grouping not supported 951209509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d 3.5mm Sm+ 26mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d 7mm Med 26mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95198994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reline-o Polyaxial 2s 7.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 951209511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d 10.5mm Med+ 26mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d 14mm Lng 26mm Hip Zml Cocr Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95198995|EAP|Custom 95198995||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 35mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951209513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d 0mm Sm 36mm Hip Zml Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 6d 3.5mm Sm+ 36mm Hip Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95198999|EAP|Custom 95198999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.3cm Memorygel P3.8cm Mod Prfl Rnd Brst Gel 325|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6 Degree Cocr Fem Head 36mm +10.5 (m+)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d -4mm 12/14 Xs 38mm Hip Protasul-20 Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d -4mm 12/14 Sm 38mm Hip Protasul-20 Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d +0mm 12/14 Med 38mm Hip Ntrl Nk Protasul-20 Lgc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d +4mm 12/14 Lg 38mm Hip Protasul-20 Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d +8mm 12/14 Xl 38mm Hip Protasul-20 Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d 38 S/-4 12/14 32mm Hip Metasul Protasul-21wf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95199002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Comp Lk 2.0mm/2.3mm 2x4hl Left Ti Blue Trpzid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.50|FSC: 13; Default||Not reimbursed separately|1,858.50|FSC: 13; Default||External grouping not supported 951209522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d 38 Xl/+8 12/14 32mm Hip Metasul Protasul-21wf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 28mm Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 32mm Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +5mm 28mm Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr Hd +5mm Neck 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10mm 28mm Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10mm 32mm Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -5mm 28mm Hip Zml Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -5mm 32mm Hip Cocr Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 Med 22mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 44mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 44mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 44mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199003|EAP|Custom 95199003||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spine Synfix Evolution Medium 13.5mm/18degree|1|HUMANA [1294]||HUMANA [11839]|30,640.80|FSC: 13; Default||Not reimbursed separately|30,640.80|FSC: 13; Default||External grouping not supported 951210295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199014|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 15cm 30fr Nphrmx Amptz 17cm Sil Ptfe Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Tomcat 3.5mm Fixed Selftap 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951210299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 14mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951210301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 40mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951210303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 52mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951210305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 24 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 46mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951210307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 25 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 26 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 4.5mm Peri-loc Femoral Mid Shaft 18 Hold Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,916.00|FSC: 13; Default||Not reimbursed separately|2,916.00|FSC: 13; Default||External grouping not supported 951210309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 27 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 28 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 7.9mm 44mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951210311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb +3mm 24 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb +3mm 25 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 2mm Screw 6 Hole Lock L 34mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,689.20|FSC: 13; Default||Not reimbursed separately|2,689.20|FSC: 13; Default||External grouping not supported 951210313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb +3mm 26 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb +3mm 27 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.0mm 10mm T6 Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|FSC: 13; Default||Not reimbursed separately|789.33|FSC: 13; Default||External grouping not supported 951210315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb +3mm 28 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 38mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 38mm 28mm Hip Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199017|EAP|Custom 95199017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Gel Resterilizable 370cc 12.6cm 4.1cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 38mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199018|EAP|Custom 95199018||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 11.5cm Memorygel X P5.8cm Hi Prfl Rnd Brst Gel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Journey Ii Uni Size 6 Left Med/lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951210335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Knee Journey Ii Size 5 Left Medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951210337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 32mm 22.2mm Act Artc A Arcomxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 36mm 22.2mm Act Artc B Arcomxl G7 2 Mbl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Journey Ii Uni Tibia Medial Size 5-6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951210339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 38mm Act Artc Arcomxl 2 Mbl 28mm Modhd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 40mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199024|EAP|Custom 95199024||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 75mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951210341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 42mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 44mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199025|EAP|Custom 95199025||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 80mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951210343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 46mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 48mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199027|EAP|Custom 95199027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 38x28x8mm Brigade 15d Ti Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951210345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 50mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 52mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199028|EAP|Custom 95199028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 38x28x12mm Brigade 15d Ti Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951210347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 54mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 56mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199030|EAP|Custom 95199030||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 45x18x8mm Crnt 10d Xl Peek Lmbr Intrbd Fs Ns Lf|1|HUMANA [1294]||HUMANA [11839]|12,762.00|FSC: 13; Default||Not reimbursed separately|12,762.00|FSC: 13; Default||External grouping not supported 951210349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 58mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 60mm Act Artc Arcomxl 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199032|EAP|Custom 95199032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 20fr Yprt Grad Shft Rnd Tip Opn Dist End Gstrm Kngr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 A Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199035|EAP|Custom 95199035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 22fr Yprt Grad Shft Rnd Tip Opn Dist End Gstrm Kngr 20m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra-p Cemented Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951210355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad 2.7mm 20 Hole Lock 176mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,930.20|FSC: 13; Default||Not reimbursed separately|4,930.20|FSC: 13; Default||External grouping not supported 951210357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 28mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E1 H Ntrl 28mm Pe Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 12mm Variax T8 Full Thread Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.57|FSC: 13; Default||Not reimbursed separately|480.57|FSC: 13; Default||External grouping not supported 951210359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spinal Base 5.0x2.5mm Fixed Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951210361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 8 Xlif 2 Hole Decade Bone Spine Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,087.00|FSC: 13; Default||Not reimbursed separately|12,087.00|FSC: 13; Default||External grouping not supported 951210363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199038|EAP|Custom 95199038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 18fr Yprt Grad Shft Rnd Tip Opn Dist End Gstrm Kngr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E1 J Ntrl 32mm Pe Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199046|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducter Flexor W/small Check Flo Valve Kcfw-9.0-38-30-rb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 24mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951210371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.7mm 36mm Loprfl Scr Ss Ft/ankl Cort Sld Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 951210373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199041|EAP|Custom 95199041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 16fr Yprt Grad Shft Rnd Tip Opn Dist End Gstrm Kngr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d A 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d B 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199047|EAP|Custom 95199047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 12mm 13.5mm 15mm-20mml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d C 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d D 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199048|EAP|Custom 95199048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 12mm 13.5mm 15mm-30mml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d E 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199049|EAP|Custom 95199049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 8mm 9mm 10mm-20mml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 28mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 28mm E1 Hip Clr Cd Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199050|EAP|Custom 95199050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 10mm 11mm 12mm-30mml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 28mm E1 Hip Clr Cd Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d B 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d C 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d D 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d E 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 32mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d D 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d E 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 36mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 A 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 28mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199061|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue 16x20cm Alloderm Perforated Medium 1.6x0.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|104.95|FSC: 13; Default||Not reimbursed separately|104.95|FSC: 13; Default||External grouping not supported 951210405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 28mm E1 Hip Clr Cd Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 28mm E1 Hip Clr Cd Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199058|EAP|Custom 95199058||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Tis Expndr 300cc Smth High Profile 11.0cm 11.0cm 6.0|1|HUMANA [1294]||HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951210407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199059|EAP|Custom 95199059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cardioflo Sensor 84in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 32mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 80173256|EAP|CPT® 12044||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Repair Of Wound 7.6 To 12.5 Cm On Wrist, Hands, Feet, And Or Gentials|1|HUMANA [1294]||HUMANA [11839]|1,416.27|FSC: 13; Default||Not reimbursed separately|1,416.27|FSC: 13; Default||External grouping not supported 951210420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 36mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 23 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 21 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 22 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 23 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 24 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Small Shell 10mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 951210440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 9mm 260mm Femoral Intramedullary T2 R1500|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,507.26|FSC: 13; Default||Not reimbursed separately|4,507.26|FSC: 13; Default||External grouping not supported 951210442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 22 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Model Bone Vrs Conprehensive Glenoid Reamer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 951210450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199094|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Trocar 1.35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5 Hexagon Comprehensive Ti 4.75mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epoly 36mm +5 Rglc Lnr Hw Sz23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm X 50mm Comp Reverse Control Rst Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bridge Straight 1.6mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951210459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199099|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Lp Ti Vortex 6fr W/attachable Bioflo Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 951210461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199100|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Lp Ti Vortex 8fr W/attachable Bioflo Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 951210463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199101|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Sid Ti Vortex 8fr W/attachable Bioflo Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 951210465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 23 32mm E-poly Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 24 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199113|EAP|Custom 95199113||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Virosafe Viro Vac Filter Smoke Evacuation Filter 3-port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral 200mm 8mm Nonporous Reverse System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 951210471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Instrument Orthopaedic Foot Peek Mini F/ligament Repair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951210473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm +5mm 21 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 24 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199106|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 200cm 130mm 2 Lum 6-fold Radopq Pcltxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199107|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 4mm 250cm 130mm 2 Lum 6-fold Radopq Pcltxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199108|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 200cm 130mm 2 Lum 6-fold Radopq Pcltxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 21 28mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 22 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199109|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 250cm 130mm 2 Lum 6-fold Radopq Pcltxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 23 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 21 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 95199110|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 6mm 200cm 130mm 2 Lum 6-fold Radopq Pcltxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 22 32mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951211249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 13mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 95199111|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 6mm 250cm 130mm 2 Lum 6-fold Radopq Pcltxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 14mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 15mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 95199112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2.7mm 3mm Screw 5 Hole Lock 47mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,934.20|FSC: 13; Default||Not reimbursed separately|3,934.20|FSC: 13; Default||External grouping not supported 951211252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 16mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 17mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 95199103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Dynanite Pip 16mm Straight W/instrument|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 951211254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 18mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 19mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 11mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 80173299|EAP|HCPCS C9764||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Revascularization Intravasc Lithotripsy|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 951211257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 12mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 13mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 80173300|EAP|HCPCS C9765||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Revascularization Intra Lithotrip-stent|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 951211259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 14mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 15mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 80173311|EAP|HCPCS C9766||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Revascularization Intra Lithotrip-atherectomy|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 951211261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 16mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 17mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 80173322|EAP|HCPCS C9767||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Revascularization Lithotrip-stent-ather|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 951211263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 18mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 19mm Prm Intgr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 95199119|EAP|Custom 95199119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical One Step 15.5mm 350mm Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951211265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R/h M/h 11x300 60%(210) Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|FSC: 13; Default||Not reimbursed separately|10,305.00|FSC: 13; Default||External grouping not supported 951211266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R/h M/h 13x300 60%(210) Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|FSC: 13; Default||Not reimbursed separately|10,305.00|FSC: 13; Default||External grouping not supported 95199128|EAP|Custom 95199128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1.9mm X 27mm 3.43in Ao End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951211267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Seg Lck Scr Rllr Hrdn Mlhd 60% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|FSC: 13; Default||Not reimbursed separately|10,305.00|FSC: 13; Default||External grouping not supported 951211268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Seg Lck Scr Rllr Hrdn Mlhd 60% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|FSC: 13; Default||Not reimbursed separately|10,305.00|FSC: 13; Default||External grouping not supported 95199120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Titanium Fusion Bone Ankle Right Anterior 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,550.00|FSC: 13; Default||Not reimbursed separately|8,550.00|FSC: 13; Default||External grouping not supported 951211269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 19mm Seg Lck Scr Rllr Hrdn Mlhd 60% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|FSC: 13; Default||Not reimbursed separately|10,305.00|FSC: 13; Default||External grouping not supported 951211270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Broad Straight 3 Hole T10 Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.36|FSC: 13; Default||Not reimbursed separately|4,641.36|FSC: 13; Default||External grouping not supported 951211271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951211272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 6mm Variax T6 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|FSC: 13; Default||Not reimbursed separately|314.16|FSC: 13; Default||External grouping not supported 951211273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951211274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 8mm Variax T6 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|FSC: 13; Default||Not reimbursed separately|314.16|FSC: 13; Default||External grouping not supported 951211275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951211276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm 6mm Variax T6 Full Thread Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.84|FSC: 13; Default||Not reimbursed separately|246.84|FSC: 13; Default||External grouping not supported 951211277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951211278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.3mm 8mm Variax T6 Full Thread Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.84|FSC: 13; Default||Not reimbursed separately|246.84|FSC: 13; Default||External grouping not supported 951211279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Seg Lck Scr Rllr Hrdn Mlhd 80% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951211280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm Seg Lck Scr Rllr Hrdn Mlhd 40% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|FSC: 13; Default||Not reimbursed separately|7,555.50|FSC: 13; Default||External grouping not supported 95199133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg T6 2.5mm 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.84|FSC: 13; Default||Not reimbursed separately|246.84|FSC: 13; Default||External grouping not supported 951211281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm Seg Lck Scr Rllr Hrdn Mlhd 40% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|FSC: 13; Default||Not reimbursed separately|7,555.50|FSC: 13; Default||External grouping not supported 951211282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm Seg Lck Scr Rllr Hrdn Mlhd 40% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|FSC: 13; Default||Not reimbursed separately|7,555.50|FSC: 13; Default||External grouping not supported 95199121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 46mm Loprfl Scr Ti Ankl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951211283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm Seg Lck Scr Rllr Hrdn Mlhd 40% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|FSC: 13; Default||Not reimbursed separately|7,555.50|FSC: 13; Default||External grouping not supported 951211284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm Seg Lck Scr Rllr Hrdn Mlhd 40% Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|FSC: 13; Default||Not reimbursed separately|7,555.50|FSC: 13; Default||External grouping not supported 951211285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 14mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 951211286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 951211287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 951211288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 951211289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 951211290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 95199134|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Cntrl Venous 4fr Sng Luman Max Br Tray Pwr Sherlock 3cg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 20mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|FSC: 13; Default||Not reimbursed separately|9,228.00|FSC: 13; Default||External grouping not supported 951211292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 14mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 95199136|EAP|Custom 95199136||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 22mmx13mm Cpstn Peek-optm Slf Dstrct Lmbr Intrbd|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 951211293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 15mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 951211294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 16mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 95199142|EAP|Custom 95199142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Drill Tip 3.2mm X 300mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951211295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 17mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 951211296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 18mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 95199146|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 7mm 90cm 20mm Otw Infl Port Tpr Tip Plq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 19mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 951211298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 20mm Rllr Hrdn Mlhd Sts Hip Clcr Mdlr Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|FSC: 13; Default||Not reimbursed separately|9,558.00|FSC: 13; Default||External grouping not supported 95199140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip 9 Scr Hl Clstr Tritanium Trdnt Ii D Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|FSC: 13; Default||Not reimbursed separately|4,638.00|FSC: 13; Default||External grouping not supported 951211299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 11mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 951211300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 95199135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 2.5mm #2 C-7 Sonicanchor Kt Frc Fibre 10mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 951211301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 13mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 951211302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 14mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 95199137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.7mm 8mm T5 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|FSC: 13; Default||Not reimbursed separately|312.84|FSC: 13; Default||External grouping not supported 951211303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 15mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 951211304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 16mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 95199138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.7mm 7mm T5 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|FSC: 13; Default||Not reimbursed separately|312.84|FSC: 13; Default||External grouping not supported 951211305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 951211306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 18mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 95199139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.7mm 10mm T5 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|FSC: 13; Default||Not reimbursed separately|312.84|FSC: 13; Default||External grouping not supported 951211307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 19mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 951211308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 20mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 95199141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4.5mm 99mm Peri-lck Prx Fmr 2hl Right Non Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.75|FSC: 13; Default||Not reimbursed separately|4,191.75|FSC: 13; Default||External grouping not supported 951211309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 21mm Rllr Hrdn Mlhd Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|FSC: 13; Default||Not reimbursed separately|6,988.50|FSC: 13; Default||External grouping not supported 951211310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 13mm Slot Mdlr Mlhd Por Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,696.00|FSC: 13; Default||Not reimbursed separately|9,696.00|FSC: 13; Default||External grouping not supported 95199143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mmx95mm Conical Cann Full Thread Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|666.90|FSC: 13; Default||Not reimbursed separately|666.90|FSC: 13; Default||External grouping not supported 951211311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 19mm Slot Mlhd Por Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,696.00|FSC: 13; Default||Not reimbursed separately|9,696.00|FSC: 13; Default||External grouping not supported 951211312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm X 90mm Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.45|FSC: 13; Default||Not reimbursed separately|765.45|FSC: 13; Default||External grouping not supported 951211313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 13mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm X 65mm Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.45|FSC: 13; Default||Not reimbursed separately|765.45|FSC: 13; Default||External grouping not supported 951211315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199147|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Chsv 525cc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951211317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 18mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Roating Platform Revision Attune Size 3 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,160.20|FSC: 13; Default||Not reimbursed separately|18,160.20|FSC: 13; Default||External grouping not supported 951211319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 19mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 20mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Platform Rotating Crs Revision Attune Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,893.60|FSC: 13; Default||Not reimbursed separately|10,893.60|FSC: 13; Default||External grouping not supported 951211321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 21mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 22mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199152|EAP|Custom 95199152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ventricular Heartmate 3 Assist Mini Apical Cuff|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951211323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 23mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 24mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199153|EAP|Custom 95199153||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Heartmate 3 Lvad Outflow W/ Bend Relief|1|HUMANA [1294]||HUMANA [11839]|14,400.00|FSC: 13; Default||Not reimbursed separately|14,400.00|FSC: 13; Default||External grouping not supported 951211325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 25mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 26mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199154|EAP|Custom 95199154||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Lvad Heartmate 3 Includes Lavd Controller|1|HUMANA [1294]||HUMANA [11839]|296,700.00|FSC: 13; Default||Not reimbursed separately|296,700.00|FSC: 13; Default||External grouping not supported 951211327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 12mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199155|EAP|HCPCS Q0481||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Controller Lvad Heartmate 3 Include Back Up Battery|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 14mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ns Tib 2 14mm Kn X3 Crcte Sub Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951211331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199161|EAP|Custom 95199161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Opth 3mm Slit Eye 45d Angld Dmd Drw Rndstck Ss Ns Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951211333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199165|EAP|Custom 95199165||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 09mmx11mmx26mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951211335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 20mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 21mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199166|EAP|Custom 95199166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set T-extension Q2 10in 2ml W/6 Check Valve Sites|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951211337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 22mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 23mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 24mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 25mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199168|EAP|HCPCS Q0506||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Battery Ventricular Assist 14v Lithium Heartmate Ii Bx/8|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 26mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 12mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199169|EAP|HCPCS Q0497||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Clip Ventricular Assist Battery 14v Lithium Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 14mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Profile 2.4mm 4 Hole Lock 26mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,141.46|FSC: 13; Default||Not reimbursed separately|2,141.46|FSC: 13; Default||External grouping not supported 951211345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Profile 2.4mm 6hole Lock 40mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,141.40|FSC: 13; Default||Not reimbursed separately|2,141.40|FSC: 13; Default||External grouping not supported 951211347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2.7mm 4mm Screw 4 Hole Lock 32mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,685.20|FSC: 13; Default||Not reimbursed separately|3,685.20|FSC: 13; Default||External grouping not supported 951211349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 20mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2.7mm 4mm Screw 6 Hole Lock 47mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,685.20|FSC: 13; Default||Not reimbursed separately|3,685.20|FSC: 13; Default||External grouping not supported 951211351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 21mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 22mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 43mm Titanium 2 Level Zevo Bone Spine Cervical Anterio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951211353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 23mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 24mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199170|EAP|HCPCS Q0477||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Power Module Patient Cables|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 25mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 26mm Slot Prft Arcos Ti Bw Tpr Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 13mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 18mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 19mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 20mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 21mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 22mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 23mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 140mm Kn X3 Cs Brng Trthln|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 951211368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 24mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 25mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 2.7mm Evos Mini Flex 6hl Ss Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|FSC: 13; Default||Not reimbursed separately|2,103.75|FSC: 13; Default||External grouping not supported 951211370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 26mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 27mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199184|EAP|HCPCS Q0496||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Battery Power Module Backup Heartmate|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 28mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 29mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 30mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 12mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 13mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 14mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 15mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 16mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 17mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 18mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 19mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 20mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 21mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 22mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 23mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 24mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 25mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 26mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 26mm 8mm Asns Iii Ti Cnn Slfdrl St P/t Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|785.88|FSC: 13; Default||Not reimbursed separately|785.88|FSC: 13; Default||External grouping not supported 951211390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 27mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 28mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Platform Rotating Crs Revision Attune Sz 4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,839.60|FSC: 13; Default||Not reimbursed separately|10,839.60|FSC: 13; Default||External grouping not supported 951211392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 29mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951211393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 30mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199182|EAP|HCPCS Q0477||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Cable Lvad Modular Heartmate 3|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 12mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199183|EAP|HCPCS Q0506||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Battery 11 Volt Lithium-ion Back Up|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 14mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199181|EAP|HCPCS Q0499||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Bag Consolidated Right Ventricle Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199171|EAP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Holster Vest Small Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199172|EAP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Holster Vest Medium Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 20mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 21mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199173|EAP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Holster Vest Large Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 22mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 23mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199174|EAP|HCPCS Q0501||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Bag Shower Heartmate Ii 2/pk|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 24mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 25mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199175|EAP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Battery Ventricular Assist Holster Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 26mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 27mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199176|EAP|HCPCS Q0499||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Bag Consolidated Left Ventricle Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 28mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 29mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 95199177|EAP|HCPCS Q0479||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Mobile Power Unit And Locking Power Cord Heartmate Ii|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951211412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 30mm Prft Spline Arcos Sts Ti Tpr Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|FSC: 13; Default||Not reimbursed separately|10,653.00|FSC: 13; Default||External grouping not supported 951211413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos A Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos B Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos C Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos D Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos E Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos F Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos A Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos B Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos C Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos D Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos E Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 60mm Arcos F Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|FSC: 13; Default||Not reimbursed separately|16,614.00|FSC: 13; Default||External grouping not supported 951211425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 50mm Arcos A Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm A Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm B Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Arcos Cal Sz C Std +0 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951212182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199185|EAP|HCPCS Q0485||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Locking Ac Power Cord For Mobile Power Unit Heartmate|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951212192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199194|EAP|Custom C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Procedure Iceforce 2.1 Cxl 23cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951212195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199200|EAP|Custom 95199200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sut Fiberloop 2-0 1/2 Crc 18in Tpr Ndl Blu 26.5mm Nabsb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199201|EAP|Custom 95199201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fiberloop 2-0 26/13in Straight Needle Blue Nonabsorab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 6.2mm 60mm Ncb Ti6al4v 3.5mm St Hex Drv Ns Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951212204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 6.2mm 55mm Ncb Ti6al4v 3.5mm St Hex Drv Ns Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 951212206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95199197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 11mm Variax T8 Full Thread Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|FSC: 13; Default||Not reimbursed separately|460.65|FSC: 13; Default||External grouping not supported 951212211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Lt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Lt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 20mm Autofix Ss T7 Ft/ankl St Slf Drl Cnn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.28|FSC: 13; Default||Not reimbursed separately|1,274.28|FSC: 13; Default||External grouping not supported 951212215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Lt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Lt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199199|EAP|Custom 95199199||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fil Bn Void 10x10x10mm Cube Demineralize Mtrx Cnfrm Flx Q-pk|1|HUMANA [1294]||HUMANA [11839]|1,752.60|FSC: 13; Default||Not reimbursed separately|1,752.60|FSC: 13; Default||External grouping not supported 951212217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Lt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn L/l Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn L/l Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn L/l Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn L/l Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn L/l Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Rt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Rt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Rt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Rt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Rt Mdl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Rl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Rl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Rl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Tomcat Stl Zero Prf 4deg 14x12x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|FSC: 13; Default||Not reimbursed separately|9,120.00|FSC: 13; Default||External grouping not supported 951212231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Rl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Rl Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Tomcat 3.5mm Fixed Selftap 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951212233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.7mm 20mm Loprfl Scr Ss Ft/ankl Cort Sld Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 951212235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Fibula 3.8mm X 180mm Right Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 951212237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Ti Npor Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199207|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith Flex 22mm X 113cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,714.31|FSC: 13; Default||Not reimbursed separately|20,714.31|FSC: 13; Default||External grouping not supported 951212255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199208|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ureteral 5fr 70cm Tiger Tail Flexible Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951212257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199213|EAP|Custom 95199213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Single Lumen Transducer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 3 Kn Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 4 Kn Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn Lt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199217|EAP|Custom 95199217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twst 66mm 1.6mm Aptus Stp Ao Qc 10mm 1.5mm Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199219|EAP|Custom 95199219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Stepdown Straight Pp F8/f5 0.8mmx1.98mmx1.5mm Bx/5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn L/l Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199227|EAP|Custom 95199227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twst 66mm 1.2mm Aptus Stp Ao Qc 10mm 1.5mm Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199231|EAP|Custom 95199231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Femoral Arterial 15fr 31.8cm W/insertion Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199215|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Bd Main Fenestrated Prox 26x94mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,891.50|FSC: 13; Default||Not reimbursed separately|28,891.50|FSC: 13; Default||External grouping not supported 951212277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn Rt Mdl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 0 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip 9 Scr Hl Clstr Tritanium Trdnt Ii D Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|FSC: 13; Default||Not reimbursed separately|4,638.00|FSC: 13; Default||External grouping not supported 951212279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 1 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 2 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L24 Mm Od3.5 Mm Odsec6.8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 951212281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 3 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 951212282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 12mm Nt Kn2 4 Kn Rl Cnstrn Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|FSC: 13; Default||Not reimbursed separately|3,406.50|FSC: 13; Default||External grouping not supported 95199221|EAP|Custom 95199221||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 08mmx11mmx31mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951212283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 0 Kn Lt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 1 Kn Lt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 95199222|EAP|Custom 95199222||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Sz 30 Metacarpophalangeal Silicone|1|HUMANA [1294]||HUMANA [11839]|4,225.35|FSC: 13; Default||Not reimbursed separately|4,225.35|FSC: 13; Default||External grouping not supported 951212285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 2 Kn Lt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 3 Kn Lt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 95199223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra-p-cemented Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951212287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 4 Kn Lt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 0 Kn L/l Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 95199224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L36mm Od3.5mm Odsec6.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 951212289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 1 Kn L/l Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 2 Kn L/l Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 95199226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 38mm 3.5mm 6.8 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951212291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 3 Kn L/l Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 4 Kn L/l Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 95199228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.2mm 14mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951212293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 0 Kn Rt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 1 Kn Rt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 95199230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 30mm Dart-fire Ti Aly Ft Slf Drl St Cnn Hd Au|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 951212295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 2 Kn Rt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 3 Kn Rt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 4 Kn Rt Mdl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 0 Kn Rl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 1 Kn Rl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 2 Kn Rl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 3 Kn Rl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 951212302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 4 Kn Rl Ti Npor Cnstrn Rev Adpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|FSC: 13; Default||Not reimbursed separately|3,790.50|FSC: 13; Default||External grouping not supported 80173333|EAP|HCPCS G0257||0880 - MISCELLANEOUS DIALYSIS - GENERAL CLASSIFICATION|Hb Dialysis Treatment Ltac Bedside|1|HUMANA [1294]||HUMANA [11839]|1,747.44|FSC: 13; Default||Not reimbursed separately|1,747.44|FSC: 13; Default||External grouping not supported 951212303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 00 Kn Mdl Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 0 Kn Mdl Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 80173344|EAP|CPT® 90935||0880 - MISCELLANEOUS DIALYSIS - GENERAL CLASSIFICATION|Hb Dialysis Treatment Ltac Dialysis Unit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,747.44|FSC: 13; Default||Not reimbursed separately|1,747.44|FSC: 13; Default||External grouping not supported 951212305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 0 Kn Lat Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 1 Kn Mdl Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199232|EAP|Custom 95199232||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Clamp Rubber Dam Size 13a Satin Steel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 1 Kn Lat Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 2 Kn Mdl Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199233|EAP|Custom 95199233||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Clamp Rubber Dam Size 12a Satin Steel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 2 Kn Lat Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 3 Kn Mdl Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199242|EAP|Custom 95199242||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Zevo Plate Holding Pin|1|HUMANA [1294]||HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 951212311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 3 Kn Lat Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 4 Kn Mdl Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.0mm X 27.5mm T2 Locking Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|FSC: 13; Default||Not reimbursed separately|1,242.00|FSC: 13; Default||External grouping not supported 951212313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 4 Kn Lat Csti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 0 Kn Mdl Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.0mm X 32.5mm T2 Locking Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|FSC: 13; Default||Not reimbursed separately|1,242.00|FSC: 13; Default||External grouping not supported 951212315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 0 Kn Lat Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 1 Kn Mdl Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.0mm X 47.5mm T2 Locking Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|FSC: 13; Default||Not reimbursed separately|1,242.00|FSC: 13; Default||External grouping not supported 951212317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 1 Kn Lat Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 2 Kn Mdl Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Retainer Screw 14mm 3.5mm Prodisc-c Spine Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.60|FSC: 13; Default||Not reimbursed separately|1,557.60|FSC: 13; Default||External grouping not supported 951212319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 2 Kn Lat Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 3 Kn Mdl Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.7mm 6mm T5 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|FSC: 13; Default||Not reimbursed separately|312.84|FSC: 13; Default||External grouping not supported 951212321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 3 Kn Lat Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 951212322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 4 Kn Mdl Csti Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|FSC: 13; Default||Not reimbursed separately|3,097.50|FSC: 13; Default||External grouping not supported 95199240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Tomcat Standalone Zero Profile 8deg 16x14x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|FSC: 13; Default||Not reimbursed separately|9,120.00|FSC: 13; Default||External grouping not supported 951212323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 00 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 0 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 63mm Ti 3 Level Zevo Bone Spine Cervical Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|FSC: 13; Default||Not reimbursed separately|8,250.00|FSC: 13; Default||External grouping not supported 951212325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 1 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 2 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Mod Cmtd Tibia Bp Spacer Sz 3 Med 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 4 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 5 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 00 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 0 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 1 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 2 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 3 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 4 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 4mm Nt Kn2 5 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 00 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 0 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 1 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 2 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 32mm Rsp Nonlocking Glenoid Baseplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 951212341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 3 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 4 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199243|EAP|Custom 95199243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Optical Module|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 5 Kn Lt Mdl Ti Uhmwpe Por Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 00 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199244|EAP|Custom 95199244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Thermal Coil Continuous Cardiac Output|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 0 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 1 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199245|EAP|Custom 95199245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Cardiac Output|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 2 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 3 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199246|EAP|Custom 95199246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Cardiac Output In-line Injectate 3ft F/3300 Coc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 4 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 951212350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Tib 8mm Nt Kn2 5 Kn L/l Ti Uhmwpe Por Cmnt Mdlr Bsplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|FSC: 13; Default||Not reimbursed separately|3,504.00|FSC: 13; Default||External grouping not supported 95199247|EAP|Custom 95199247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Triple Lumen Transducer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rot Hng Bsc Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,783.40|FSC: 13; Default||Not reimbursed separately|14,783.40|FSC: 13; Default||External grouping not supported 951212352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 38mm Ofst Kn Prox Bsc Seg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,981.60|FSC: 13; Default||Not reimbursed separately|12,981.60|FSC: 13; Default||External grouping not supported 95199255|EAP|Custom 95199255||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 38x28x6mm Brigade 15d Ti Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951212353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ofst 38mm Prox Seg Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,361.60|FSC: 13; Default||Not reimbursed separately|20,361.60|FSC: 13; Default||External grouping not supported 951212354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ofst 46mm Prox Seg Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,361.60|FSC: 13; Default||Not reimbursed separately|20,361.60|FSC: 13; Default||External grouping not supported 95199256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 35mm Pthfnd Nxt Spne Cnn Pa Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 951212355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Kn Lt Zm Strl Seg Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,215.20|FSC: 13; Default||Not reimbursed separately|26,215.20|FSC: 13; Default||External grouping not supported 951212356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Kn Zm Seg Sys Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,215.20|FSC: 13; Default||Not reimbursed separately|26,215.20|FSC: 13; Default||External grouping not supported 95199257|EAP|Custom 95199257||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spacer Spinal 14x11mm 7mm Cornerstone Crv Peek|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951212357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Zm Disp Seg Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,215.20|FSC: 13; Default||Not reimbursed separately|26,215.20|FSC: 13; Default||External grouping not supported 951212358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B 58x50mm Kn Lt Rot Hng Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,632.80|FSC: 13; Default||Not reimbursed separately|26,632.80|FSC: 13; Default||External grouping not supported 80173355|EAP|CPT® 12045||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Repair Intermediate N/h/f/xtrnl Gent 12.6-20 Cm|1|HUMANA [1294]||HUMANA [11839]|1,416.27|FSC: 13; Default||Not reimbursed separately|1,416.27|FSC: 13; Default||External grouping not supported 951212359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B 58x50mm Kn Rt Rot Hng Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,632.80|FSC: 13; Default||Not reimbursed separately|26,632.80|FSC: 13; Default||External grouping not supported 951212360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F 76x66mm Kn Rt Rot Hng Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,632.80|FSC: 13; Default||Not reimbursed separately|26,632.80|FSC: 13; Default||External grouping not supported 95199261|EAP|Custom 95199261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill Cannulated 2.0mm Cann Headless Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem C Kn Tib Rot Hng Nxgn Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|FSC: 13; Default||Not reimbursed separately|4,150.80|FSC: 13; Default||External grouping not supported 951212362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Rotating Hinge Fem Hinge Svc Parts Size D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|FSC: 13; Default||Not reimbursed separately|4,150.80|FSC: 13; Default||External grouping not supported 95199262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.0mm 20mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951212363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E Kn Tib Rot Hng Nxgn Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|FSC: 13; Default||Not reimbursed separately|4,150.80|FSC: 13; Default||External grouping not supported 951212364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F Kn Fem Tib Rot Hng Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|FSC: 13; Default||Not reimbursed separately|4,150.80|FSC: 13; Default||External grouping not supported 95199264|EAP|Custom 95199264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Laryngeal Airway Size 2 Infant Pink Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1 6mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1 9mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1 12mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1 16mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1 21mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 95199269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Two Hole Titanium Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 951212370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2 6mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2 12mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 95199278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 4.75mm Scnd Fixtion Bcmps Swivelock 19.1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 951213123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib Ng Lgc 16d 3d 6 Hlf Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 6 Hlf Flut 5mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 95199270|EAP|Custom 95199270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hand Piece Sonicision Curved Jaw 39cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 6 Hlf Flut 10mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib Ng Lgc 16d 3d 7 Hlf Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213127|EAP|HCPCS 951213127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Cut Kn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95199274|EAP|Custom 95199274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stethoscope Esph 18fr Xlong Reg Tub W/temp Sensor Probe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213128|EAP|HCPCS 951213128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Cut Kn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem C Std 63x53.5mm Kn Lt Cr Cmnt Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199272|EAP|Custom 95199272||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Interface Hewlett Packard 400 Series|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem C Std 63x53.5mm Kn Rt Crcte Rtn Cmnt Optn Nxgn Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem D Std 68x57.5mm Kn Lt Crcte Rtn Cmnt Optn Nxgn Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199276|EAP|Custom 95199276||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Temp 4070 Lf Strl Disp Ysi 400 Compatible|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem D Std 68x57.5mm Kn Rt Crcte Rtn Cmnt Optn Nxgn Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E Std 72x61.5mm Kn Lt Cr Cmnt Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199284|EAP|Custom 95199284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stylet 50cm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E Std 72x61.5mm Kn Rt Cr Cmnt Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F Std 77x65.5mm Kn Lt Cr Cmnt Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199292|EAP|Custom 95199292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stent Lucite Vaginal 12 In Set Of 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F Std 77x65.5mm Kn Rt Cr Cmnt Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G Std 81x70.5mm Kn Lt Cr Cmnt Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Sms Solid Standard #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951213138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G Std 81x70.5mm Kn Rt Crcte Rtn Cmnt Optn Nxgn Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem H Mac 85x76mm Kn Lt Cr Cmnt Prect Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Offset 4mm Pe Hc A 36f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|FSC: 13; Default||Not reimbursed separately|5,853.00|FSC: 13; Default||External grouping not supported 951213140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem H Mac 85x76mm Kn Rt Cr Cmnt Prect Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Mic 58x49.5mm Kn Lt Cmnt Post Stab Lps Nxgn Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Mic 58x49.5mm Kn Rt Cmnt Post Stab Lps Nxgn Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem A Mic 54x45.5mm Kn Lt Cmnt Post Stab Ng Lps Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem A Mic 54x45.5mm Kn Rt Cmnt Post Stab Ng Lps Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Mic 58x49.5mm Kn Lt Cmnt Post Stab Ng Lps Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Mic 58x49.5mm Kn Rt Cmnt Post Stab Ng Lps Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Lt Size 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199314|EAP|Custom 95199314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Beach Chair Surgical 162in X 103in Adhesive Fluid Cont|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Rt Size 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 0 Kn Lt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 360mm Fem Gt Lt T2 Im Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,471.60|FSC: 13; Default||Not reimbursed separately|12,471.60|FSC: 13; Default||External grouping not supported 951213150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 0 Kn Rt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Lt Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra-p Cemented Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951213152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Rt Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Lt Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra-p-cemented Lat #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951213154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 2 Kn Rt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 3 Kn Lt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Quadra-p-cemented Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951213156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 3 Kn Rt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Lt Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199305|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 12mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 4 Kn Rt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem Nt Kn2 5 Kn Lt Cmnt Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199306|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 12mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Femoral Rt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199307|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 12mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199308|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 14mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199309|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 14mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199310|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 14mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Post Stab Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199311|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 16mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199312|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 16mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199313|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Venous Veniti Vici 16mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 951213174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199315|EAP|Custom 95199315||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Medial Femoral Hemi-condyle Left|1|HUMANA [1294]||HUMANA [11839]|33,877.95|FSC: 13; Default||Not reimbursed separately|33,877.95|FSC: 13; Default||External grouping not supported 951213176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Nt Kn Flx Gndr Sol M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Gndr Sol Nt Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Lt Crcte Rtn Cmnt Nt Kn Flx Gndr Sol F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199318|EAP|Custom 95199318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload 30mm Grey Curved Tip Short Small Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rt Crcte Rtn Cmnt Nt Kn Flx Gndr Sol F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Lt Kn Gndr Sol Nt Kn Flx Npor F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199319|EAP|Custom 95199319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload 30mm White Curved Tip Short Small Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-knee Gsf Np Flex Fem Size 1-rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Crcte Rtn Cmnt Nt Kn Flx Gndr Sol F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199320|EAP|Custom 95199320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload 45mm White Curved Tip Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Crcte Rtn Cmnt Nt Kn Flx Gndr Sol F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Crcte Rtn Cmnt Nt Kn Flx Gndr Sol F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.6mm Fibertak Soft Knotless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 951213187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-knee Gsf Np Flex Fem Size 3-rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-knee Gsf Np Flex Fem Size 4-lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199322|EAP|Custom 95199322||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fil Bn Void 2.5cc Dbm Allosync Gel|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951213189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Crcte Rtn Cmnt Nt Kn Flx Gndr Sol F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G Kn Lt Cmnt Prect Ng Crflx Gndr Sol Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199323|EAP|Custom 95199323||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bn Magnifuse Dbm 1cm X 5cm|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951213191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G 76.5x70.4mm Kn Rt Cmnt Cr-flx Optn Nxgn Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem A Kn Lt Cmnt Prect Ng Lpsflx Zml Prlng Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem A Kn Rt Cmnt Prect Ng Lpsflx Zml Prlng Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Kn Lt Cmnt Ng Lpsflx Zml Prlng Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Kn Rt Cmnt Ng Lpsflx Zml Prlng Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem H Kn Rt Cmnt Prect Ng Lpsflx Zml Prlng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Lps-flex Option Femoral H-lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 95199325|EAP|Custom 95199325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Elation Pulmonary Balloon 3cml 6mm-8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Lps-flex Option Femoral H-rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951213199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G Std 81x70.5mm Kn Lt Cr Nxgn Zml Por Strl Blu Grn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199326|EAP|Custom 95199326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Elation Pulmonary Balloon 3cml 8mm-10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Mic 58x49.5mm Kn Lt Post Stab Lps Nxgn Zml Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Mic 58x49.5mm Kn Rt Post Stab Lps Nxgn Zml Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199327|EAP|Custom 95199327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Elation Pulmonary Balloon 3cml 10mm-12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Csti Porous Femoral Lt Size 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Csti Porous Femoral Rt Size 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.3mm Profyle Hand Locking 4x2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.69|FSC: 13; Default||Not reimbursed separately|2,691.69|FSC: 13; Default||External grouping not supported 951213204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 10mm Variax T6 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|FSC: 13; Default||Not reimbursed separately|314.16|FSC: 13; Default||External grouping not supported 951213207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 9mm Variax T6 Ft Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|FSC: 13; Default||Not reimbursed separately|314.16|FSC: 13; Default||External grouping not supported 951213210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 16mm Spnl Ma Impt Occipitocrvical Upr Thor Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 951213212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Csti Porous Femoral Lt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Crcte Rtn Nt Kn2 Csti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199333|EAP|Custom 95199333||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal 16mmx22mm Capstone Interbody Fusion System|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 951213214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951230757|EAP|Custom 951230757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embl 14cm 14mm Nst 3.2 Loop .035in Pltn Peri Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199339|EAP|Custom 95199339||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 7mmx11mmx31mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951213220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Retainer Screw Spine 12mm 3.5mm Ti Prodisc-c Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.60|FSC: 13; Default||Not reimbursed separately|1,557.60|FSC: 13; Default||External grouping not supported 951213222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Nt Kn Flx Gndr Sol Por M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199341|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 34mmx113mm 18f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,458.30|FSC: 13; Default||Not reimbursed separately|46,458.30|FSC: 13; Default||External grouping not supported 951213224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Lt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199342|EAP|Custom 95199342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Medical Pin Box Yellow Carto 3 System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199343|EAP|Custom 95199343||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Probe Cleartone Doppler 8mhz Ct150r-8 Rechargeable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199345|EAP|Custom 95199345||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 07mmx11mmx31mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951213230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199346|EAP|Custom 95199346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Valve Premicron Polyster Sterile 75cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Nt Kn Flx Gndr Sol Por F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Kn Lt Lpsflx Nxgn Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem B Kn Rt Lpsflx Nxgn Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F Kn Rt Ng Lpsflx Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951213237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Xs Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Sm Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230727|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Visipaque 320mg/ml 100cc Plus Pak Bottle Ndc#|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.97|FSC: 13; Default||Not reimbursed separately|1.97|FSC: 13; Default||External grouping not supported 951213239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Med Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Lg Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230728|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Visipaque 320mg/ml 150cc Bottle Ndc# 0407-222|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.81|FSC: 13; Default||Not reimbursed separately|1.81|FSC: 13; Default||External grouping not supported 951213241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Xl Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt 2xl Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230729|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 300 Mg/ml 10 Ml Bottle Ndc# 270-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|FSC: 13; Default||Not reimbursed separately|6.00|FSC: 13; Default||External grouping not supported 951213243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Xs Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Sm Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230731|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 370mg/ml 150ml Bottle Ndc# 0270-1316-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|FSC: 13; Default||Not reimbursed separately|0.25|FSC: 13; Default||External grouping not supported 951213245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Med Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt 2xl Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230733|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 300 1x10x 150ml Bottle Ndc# 0270-1315-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|FSC: 13; Default||Not reimbursed separately|0.25|FSC: 13; Default||External grouping not supported 951213247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Xs Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Sm Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230735|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue-m 200 20ml Vial Ndc# 0270-1411-25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.68|FSC: 13; Default||Not reimbursed separately|2.68|FSC: 13; Default||External grouping not supported 951213249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Med Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Lg Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230736|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue-m 200 10ml Vial Ndc# 0270-1411-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|FSC: 13; Default||Not reimbursed separately|3.86|FSC: 13; Default||External grouping not supported 951213251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Xl Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt 2xl Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230737|EAP|HCPCS Q9966||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 250 150ml Bottle Ndc# 0270-1317-09|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|FSC: 13; Default||Not reimbursed separately|0.24|FSC: 13; Default||External grouping not supported 951213253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Xs Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Sm Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230738|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue-m 300 15ml Bottle Ndc# 0270-1412-15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.46|FSC: 13; Default||Not reimbursed separately|3.46|FSC: 13; Default||External grouping not supported 951213255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Med Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Lg Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230740|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 370 125ml Bottle Ndc# 0270-1316-04|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|FSC: 13; Default||Not reimbursed separately|0.25|FSC: 13; Default||External grouping not supported 951213257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Xl Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt 2xl Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230742|EAP|HCPCS Q9963||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Gastrografin 120 Mg/ml Vial Ndc 0270-0445-40|1|HUMANA [1294]||HUMANA [11839]|0.35|FSC: 13; Default||Not reimbursed separately|0.35|FSC: 13; Default||External grouping not supported 951213259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Xs Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Med Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230744|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 370 6 X 500ml Bottle Ndc# 0270-1316-98|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|FSC: 13; Default||Not reimbursed separately|0.27|FSC: 13; Default||External grouping not supported 951213261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Xl Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt 2xl Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230747|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 300ml (dilute) Ndc 0270-1410-30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|FSC: 13; Default||Not reimbursed separately|0.16|FSC: 13; Default||External grouping not supported 951213263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Xs Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Sm Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230748|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 100ml Ndc 0270-0149-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|FSC: 13; Default||Not reimbursed separately|0.41|FSC: 13; Default||External grouping not supported 951213265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Med Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Lg Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230749|EAP|HCPCS Q9958||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Cystografin 300ml (30%) Ndc 0270-1409-57|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|FSC: 13; Default||Not reimbursed separately|0.20|FSC: 13; Default||External grouping not supported 951213267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt Xl Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951213268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 24mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951230751|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 300 61% 500ml 6/cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|FSC: 13; Default||Not reimbursed separately|0.24|FSC: 13; Default||External grouping not supported 951213269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.50|FSC: 13; Default||Not reimbursed separately|331.50|FSC: 13; Default||External grouping not supported 951213270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 12mm Ascnt 2xl Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|FSC: 13; Default||Not reimbursed separately|2,659.50|FSC: 13; Default||External grouping not supported 951230753|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Visipaque 320mg/ml 50ml Vial Plus 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.97|FSC: 13; Default||Not reimbursed separately|1.97|FSC: 13; Default||External grouping not supported 951213271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Ascnt Kn Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.50|FSC: 13; Default||Not reimbursed separately|331.50|FSC: 13; Default||External grouping not supported 951213272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 57.5mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951230754|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue Iopamidol 370 6 X 500ml Bottle 6/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|FSC: 13; Default||Not reimbursed separately|0.27|FSC: 13; Default||External grouping not supported 951213273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 62.5mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 65mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951230755|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue Iopamidol 370 6 X 200ml Bottle 6/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|FSC: 13; Default||Not reimbursed separately|0.25|FSC: 13; Default||External grouping not supported 951213275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 67.5mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 70mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 72.5mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 80mm Hsng Cr Kn Lt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 95199351|EAP|Custom 95199351||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Disc Cervical Mobi-c 17mm X 19mm H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 951213280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 55mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 57.5mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 95199353|EAP|Custom 95199353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.7mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 60mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 62.5mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 95199354|EAP|Custom 95199354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Laser Shockwave Lithotripsy Urology|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 65mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 67.5mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 70mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 72.5mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 95198958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Third Central Distal Clavical Ss 8 Hold Rt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 951213288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 951213289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 80mm Hsng Cr Kn Rt Fem Cocrmo Vngrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|FSC: 13; Default||Not reimbursed separately|2,158.50|FSC: 13; Default||External grouping not supported 95199352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Freefix Midshaft Ulna 97mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,377.00|FSC: 13; Default||Not reimbursed separately|4,377.00|FSC: 13; Default||External grouping not supported 951213290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Vngrd Ssk Kn Fem Post Stab Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 5mm Kn Fem Post Pg Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95199356|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Tis Expndr 475cc Smth High Profile 13.0cm 13.0cm 6.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951213292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 10mm Kn Fem Post Pg Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 951213293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 15mm Kn Fem Post Pg Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95199357|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Tis Expndr 500cc Smth High Profile 13.5cm 13.5cm 6.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951213294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Vngrd Kn Post Intlk Ti Bolt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|597.00|FSC: 13; Default||Not reimbursed separately|597.00|FSC: 13; Default||External grouping not supported 951213295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem Vngrd 360 2.5mm Ofst Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,092.50|FSC: 13; Default||Not reimbursed separately|2,092.50|FSC: 13; Default||External grouping not supported 95199358|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Tis Expndr 600cc Smth High Profile 14.0cm 14.0cm 7.1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951213296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem Vngrd 360 5mm Ofst Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,092.50|FSC: 13; Default||Not reimbursed separately|2,092.50|FSC: 13; Default||External grouping not supported 951213297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem Vngrd 360 7.5mm Ofst Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,092.50|FSC: 13; Default||Not reimbursed separately|2,092.50|FSC: 13; Default||External grouping not supported 951213298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Vngrd 360 Ofst Tpr Fem Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 951213299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 5mm Vngrd 360 Kn Bolt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.50|FSC: 13; Default||Not reimbursed separately|118.50|FSC: 13; Default||External grouping not supported 951213300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insrtr Srg Lck Bar Vngrd Xp G1 Tib 69-75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 951213301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insrtr Srg Lck Bar Vngrd Xp G1 Tib 79-91mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 951213302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59-67mm Vngrd Xp G2 Kn Lck Bar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 951213303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 69-75mm Vngrd Xp G2 Kn Lck Bar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 951213304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79-81mm Vngrd Xp G2 Kn Lck Bar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 951213305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Rsrfc Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,807.00|FSC: 13; Default||Not reimbursed separately|21,807.00|FSC: 13; Default||External grouping not supported 951213306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Rsrfc Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,807.00|FSC: 13; Default||Not reimbursed separately|21,807.00|FSC: 13; Default||External grouping not supported 951213307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Rsrfc Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,518.00|FSC: 13; Default||Not reimbursed separately|22,518.00|FSC: 13; Default||External grouping not supported 951213308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Rsrfc Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,518.00|FSC: 13; Default||Not reimbursed separately|22,518.00|FSC: 13; Default||External grouping not supported 951213309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Rt Seg Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Lt Seg Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 7cm Kn Rt Seg Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|FSC: 13; Default||Not reimbursed separately|25,043.40|FSC: 13; Default||External grouping not supported 951213312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 7cm Kn Lt Seg Oss Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|FSC: 13; Default||Not reimbursed separately|25,043.40|FSC: 13; Default||External grouping not supported 951213313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 8.5cm Kn Rt Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|FSC: 13; Default||Not reimbursed separately|25,043.40|FSC: 13; Default||External grouping not supported 951213314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 8.5cm Kn Lt Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|FSC: 13; Default||Not reimbursed separately|25,043.40|FSC: 13; Default||External grouping not supported 951213315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Rsrfc Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,263.40|FSC: 13; Default||Not reimbursed separately|21,263.40|FSC: 13; Default||External grouping not supported 951213316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Rsrfc Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,263.40|FSC: 13; Default||Not reimbursed separately|21,263.40|FSC: 13; Default||External grouping not supported 951213317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Rsrfc Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|FSC: 13; Default||Not reimbursed separately|21,735.00|FSC: 13; Default||External grouping not supported 951214111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 77.5mm Kn Rt Cr Vngrd Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Plsm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199403|EAP|Custom 95199403||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 17x7mm Divergence 14mm Lrdtc Ncl Pulposus Peek|1|HUMANA [1294]||HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 951214135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Lateral Quadra-p Size 8 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951214137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 25mm Peri-loc Cortical Self-tapping T25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.43|FSC: 13; Default||Not reimbursed separately|110.43|FSC: 13; Default||External grouping not supported 951214139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 76mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951214141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 50mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951214143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 95199400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 48mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 951214145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Post Stab Opn Bx Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951214146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 28mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951214156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate -i Evos 3.5mm Tibia Partial 5 Hole Left 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|FSC: 13; Default||Not reimbursed separately|3,118.50|FSC: 13; Default||External grouping not supported 951214158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hyb Hip-cem St/tm Cup/vite Liner/cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 951214160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199420|EAP|Custom 95199420||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 12x14x10 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951214162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199421|EAP|HCPCS C2622||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Penile 11mm Dia X 16cml- 25cml Dual Layer Silicon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,555.00|FSC: 13; Default||Not reimbursed separately|36,555.00|FSC: 13; Default||External grouping not supported 951214164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Mxm Arcm Kn Prm Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80173366|EAP|CPT® 33361||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Replace Aortic Valve Perq Tavr|1|HUMANA [1294]||HUMANA [11839]|33,173.00|FSC: 13; Default||Not reimbursed separately|33,173.00|FSC: 13; Default||External grouping not supported 951214174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199427|EAP|Custom 95199427||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 34x24x8mm Base 10deg Ti Vrb Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951214176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199422|EAP|Custom 95199422||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Cmnt Intspc Xlg 2 Stg Rev Arthpl Gnta Pmma 90mm 74mm Kn|1|HUMANA [1294]||HUMANA [11839]|13,446.00|FSC: 13; Default||Not reimbursed separately|13,446.00|FSC: 13; Default||External grouping not supported 951214178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199423|EAP|Custom 95199423||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Cmnt Intspc Lg 2 Stg Rev Arthpl Gnta Pmma 80mm 74mm Kn|1|HUMANA [1294]||HUMANA [11839]|13,446.00|FSC: 13; Default||Not reimbursed separately|13,446.00|FSC: 13; Default||External grouping not supported 951214180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 24mm Autofix Ss T7 Ft/ankl St Slf Drl Cnn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.28|FSC: 13; Default||Not reimbursed separately|1,274.28|FSC: 13; Default||External grouping not supported 951214182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199450|EAP|Custom 95199450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Absorbatack 5mm With 15 Tracks|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199451|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endo 142mm 30mm Zenith Tx2 Disct Strght Cmpnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,340.00|FSC: 13; Default||Not reimbursed separately|53,340.00|FSC: 13; Default||External grouping not supported 951214186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199454|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Mri Lead Interstim Surescan 28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|FSC: 13; Default||Not reimbursed separately|10,929.00|FSC: 13; Default||External grouping not supported 951214188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199456|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Mri Lead Interstim Surescan 33cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|FSC: 13; Default||Not reimbursed separately|10,929.00|FSC: 13; Default||External grouping not supported 951214190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199457|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Mri Lead Interstim Surescan 41cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|FSC: 13; Default||Not reimbursed separately|10,929.00|FSC: 13; Default||External grouping not supported 951214192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199455|EAP|Custom 95199455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Perc Extension 4.32cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 24mm Variax T8 Full Thread Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.57|FSC: 13; Default||Not reimbursed separately|480.57|FSC: 13; Default||External grouping not supported 951214210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Mxm Kn Prm Cr Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199461|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vasc 50cm 18mm 9mm Std Wl Thnwl 2 Brch Peri Grtx Strch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,492.00|FSC: 13; Default||Not reimbursed separately|3,492.00|FSC: 13; Default||External grouping not supported 951214212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199462|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vasc 50cm 12mm 6mm Std Wl Thnwl 2 Brch Peri Grtx Strch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,492.00|FSC: 13; Default||Not reimbursed separately|3,492.00|FSC: 13; Default||External grouping not supported 951214214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Third Central Distal Clavical Ss 8 Hold Lt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 951214218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrodesis Titanium 2.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|FSC: 13; Default||Not reimbursed separately|1,908.00|FSC: 13; Default||External grouping not supported 951214220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199465|EAP|Custom 95199465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.9mm X 127mm Double Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199466|EAP|Custom 95199466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 2.1mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199467|EAP|Custom 95199467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver 2.5mm Surgical Reduct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 5mm Aptus Trlk Ti Phlng Hnd Hexadrive 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 951214228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 71-75mmx16mm Ant Post Post Stab Arcm Mxm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199468|EAP|Custom 95199468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Extracting Anterior Upper Right #e 4/1/4in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199471|EAP|Custom 95199471||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Actricgel Neonata Pas 2 Pads|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199473|EAP|Custom 95199473||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spacer Spinal 14x11mm 8mm Cornerstone Crv Peek|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 951214235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199474|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 22.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951214237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 16mm 9 Hole Hook Bone Right Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,831.58|FSC: 13; Default||Not reimbursed separately|5,831.58|FSC: 13; Default||External grouping not supported 951214239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80173377|EAP|HCPCS C8937||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Cad Breast Mri|1|HUMANA [1294]||HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 951214241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 46mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|FSC: 13; Default||Not reimbursed separately|460.65|FSC: 13; Default||External grouping not supported 951214246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 5.5mm Swivelock Bc Knotless Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 951214248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Mxm Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Variax 43mm Hole5 Ti Nstrl Reconst Polyax Lt Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,202.14|FSC: 13; Default||Not reimbursed separately|3,202.14|FSC: 13; Default||External grouping not supported 951214250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199485|EAP|Custom 95199485||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cartimax Viable Cartilage Allograft|1|HUMANA [1294]||HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 951214252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199486|EAP|Custom 95199486||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adapter Tracheostomy Optiflow+ Interface Latex Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80173388|EAP|CPT® 95999||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Set Up Charge Ltm Testing For Non-registered Techs|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 951214269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199495|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Argyle Presternal Peritoneal Dialysis Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.65|FSC: 13; Default||Not reimbursed separately|1,468.65|FSC: 13; Default||External grouping not supported 951214271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199507|EAP|Custom 95199507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Foramn 3.5in 20ga 8.8cm Glbl 6pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199508|EAP|Custom 95199508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Foramn 5in 20ga Glbl 2pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 17mm 3.5mm Evos Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 951214277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Trd Agc Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 40mm T8 Evos Osteopenia T8 Partially Theaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|FSC: 13; Default||Not reimbursed separately|226.05|FSC: 13; Default||External grouping not supported 951214279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Trd Agc Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 10mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951214281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Trd Agc Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 7.9mm 85mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 951214283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Trd Agc Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 19mm Evos Mn Ss T8 Cort Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951214285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199528|EAP|Custom 95199528||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 10cm 16mm Gore Xcldr Cntrlt Lg Aaa 12fr Shth|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 951214292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate -t Evos 3.5mm P/a Pm-p Tibia 4 Hole Left 71mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|FSC: 13; Default||Not reimbursed separately|3,118.50|FSC: 13; Default||External grouping not supported 951214294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199536|EAP|Custom 95199536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Mitraclip G4 Steerable Guide Catheter Mcg40100|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951214296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95199509|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 6mm Length 40mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951214298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951215068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199510|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 6mm Length 60mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199511|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 6mm Length 80mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199512|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 7mm Length 40mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199513|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 7mm Length 60mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199514|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 7mm Length 80mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199515|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 8mm Length 40mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199516|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 8mm Length 60mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199517|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 8mm Length 80mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199518|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 9mm Length 40mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199520|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 9mm Length 80mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199521|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 10mm Length 40mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199522|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 10mm Length 60mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199523|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 10mm Length 80mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80173399|EAP|CPT® 97810||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Acupuncture 1 Or More Needles W/o Elec Init 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 951215095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80173400|EAP|CPT® 97811||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Acupuncture 1 Or More Needles W/o Elec Add 15 Min|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 951215098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80173411|EAP|CPT® 32553||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Interstitial Device Perc Intra-thoracic|1|HUMANA [1294]||HUMANA [11839]|3,844.33|FSC: 13; Default||Not reimbursed separately|3,844.33|FSC: 13; Default||External grouping not supported 951215102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199541|EAP|Custom 95199541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Razor In Dispenser Used Storage Box In One|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199542|EAP|Custom 95199542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxiris Filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199519|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stents Vascular Covered Dia 9mm Length 60mm 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 951215109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenosphere Trablr Mtl Reverse 3 Dia 36mm+2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951215111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Humeral Reunion 8mm X 92mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|FSC: 13; Default||Not reimbursed separately|19,217.25|FSC: 13; Default||External grouping not supported 951215113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hm Med 69mm 2.7mm/3.5mm Dstl Va-lcp Sh Lft 1h Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 951215115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.5mm 26mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951215117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.5mm 20mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951215119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.5mm 22mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951215121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95199560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.5mm 18mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951215123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Rt Mnscs Phs 3 Uncmp Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199563|EAP|Custom 95199563||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 32x9x10mm Crnt 4d Lg Impct Peek-optm Ns Lf|1|HUMANA [1294]||HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 951215128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199564|EAP|Custom 95199564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Revision Kit For Interstim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hum 6mm Cmnt Reunion Lng Shldr Tl Arthpl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,017.00|FSC: 13; Default||Not reimbursed separately|19,017.00|FSC: 13; Default||External grouping not supported 951215132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib B8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199566|EAP|Custom 95199566||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Optiflow+ Cannula Small 20/pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib B8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199567|EAP|Custom 95199567||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Optiflow+ Cannula Large 20/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199569|EAP|Custom 95199569||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Fresh Graft Osteochondral 10mm|1|HUMANA [1294]||HUMANA [11839]|7,125.00|FSC: 13; Default||Not reimbursed separately|7,125.00|FSC: 13; Default||External grouping not supported 951215138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib C8 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib C8 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.7mm 9mm T5 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|FSC: 13; Default||Not reimbursed separately|312.84|FSC: 13; Default||External grouping not supported 951215146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199574|EAP|Custom 95199574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nevero Passing Elevator Accessory Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199575|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Glcm Crdvo Istent Lt Strl Lf Disp Trbclr Mic Byps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951215150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vanguard M Uni Brng D7 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib 7 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199585|EAP|Custom 95199585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulas Mercedes Liposuction Flared 4mm 22cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199586|EAP|Custom 95199586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulas Mercedes Liposuction Flared 5mm 22cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Freefix Midshaft Ulna 81mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,287.00|FSC: 13; Default||Not reimbursed separately|4,287.00|FSC: 13; Default||External grouping not supported 951215162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib E8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199580|EAP|Custom 95199580||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Heart On-x Aortic 19mm|1|HUMANA [1294]||HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 951215164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib E8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199581|EAP|Custom 95199581||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Heart On-x Aortic 21mm|1|HUMANA [1294]||HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 951215166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199582|EAP|Custom 95199582||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Heart On-x Aortic 23mm|1|HUMANA [1294]||HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 951215168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199583|EAP|Custom 95199583||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Heart On-x Aortic 25mm|1|HUMANA [1294]||HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 951215170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199584|EAP|Custom 95199584||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Heart On-x Aortic 27/29mm|1|HUMANA [1294]||HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 951215172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Lt Mdl Rl Uncmp Tib A8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd M Kn Rmll Uncmp Tib A8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd A Kn Lt Mdl Rl Uncmp Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd A Kn Rmll Uncmp Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd B Lt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd B Rt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Altivate Djo Surgical Small Shell 16x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 951215179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd C Lt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd C Rt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd D Lt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199591|EAP|Custom 95199591||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Tis Expndr 750cc Smth High Profile 15.0cm 15.0cm 7.7c|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd D Rt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd E Kn Lt Mdl Uncmp Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd E Kn Rt Mdl Uncmp Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd F Lt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd F Rt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd Aa Lt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Oxfd Aa Rt Mdl Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib A3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80173422|EAP|CPT® 31231||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Nasal Endoscopy Diagnostic Uni/bi Spx|1|HUMANA [1294]||HUMANA [11839]|483.28|FSC: 13; Default||Not reimbursed separately|483.28|FSC: 13; Default||External grouping not supported 951215191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80173433|EAP|CPT® 31576||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Laryngoscopy Flexible W/biopsy(ies)|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 951215193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib B3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80173444|EAP|CPT® 92511||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Nasopharyngoscopy W/endoscope Spx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.28|FSC: 13; Default||Not reimbursed separately|483.28|FSC: 13; Default||External grouping not supported 951215195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib C3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 8mm Ti Cort Hexa 6 Tpd Cr Fl Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951215201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 20mm Ti Cort Hexa 6 Tpd Cr Fl Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 951215203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199597|EAP|Custom 95199597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Tape X Braid Tt 2.2mm Mo-6 (taper 1/2c 26mm)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199613|EAP|Custom 95199613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.1mm X 127mm Double Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib E3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199614|EAP|Custom 95199614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 2.9mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199615|EAP|Custom 95199615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver 3.5mm Surgical Reduct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199616|EAP|Custom 95199616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Freefix Midshaft Ulna 127mm|1|HUMANA [1294]||HUMANA [11839]|4,467.00|FSC: 13; Default||Not reimbursed separately|4,467.00|FSC: 13; Default||External grouping not supported 951215214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib F3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib F4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199607|EAP|Custom 95199607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Select Series 12in Art 45deg 20fr 0.375in Acpt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib F5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib F6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199608|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Strata Lumboperitoneal Kit 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951215218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn L/l Fx Tib F7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib A3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199610|EAP|HCPCS 95199610||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Bn Cmnt 5cc Prefilled Accu 11ga Kn Sd Delv Cann Strle|1|HUMANA [1294]||HUMANA [11839]|7,927.50|FSC: 13; Default||Not reimbursed separately|7,927.50|FSC: 13; Default||External grouping not supported 951215220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrodesis Titanium 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|FSC: 13; Default||Not reimbursed separately|1,908.00|FSC: 13; Default||External grouping not supported 951215222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199612|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interstim Surescan Mri Lead Kit 2.16mm Spacing - 28cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|FSC: 13; Default||Not reimbursed separately|10,929.00|FSC: 13; Default||External grouping not supported 951215224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib B3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199599|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interstim Micro Surescan Mri Rechargeable Neurostimulator|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,937.00|FSC: 13; Default||Not reimbursed separately|32,937.00|FSC: 13; Default||External grouping not supported 951215226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199602|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stimulator 50cm Surpass Lead Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 951215228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib C3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199603|EAP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Infusion Programmable Prometra 20ml Sterile Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,500.00|FSC: 13; Default||Not reimbursed separately|31,500.00|FSC: 13; Default||External grouping not supported 951215230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199604|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Interventional Non-braided Low-profile Sterile Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 951215232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199600|EAP|Custom 95199600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Recharge System Interstim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib E3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199605|EAP|Custom 95199605||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Controller Patient Therapy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199606|EAP|Custom 95199606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Tunneling Eon Ans Prometra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib F3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199617|EAP|HCPCS c1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hummerus Proximal Left 3 Hole|1|HUMANA [1294]||HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 951215245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib F4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib F5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intrmdllry 1.5mm 300mm Ti Precurved Shaft T2 Kids Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.49|FSC: 13; Default||Not reimbursed separately|620.49|FSC: 13; Default||External grouping not supported 951215247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib F6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Oxfd Kn Rl Fx Tib F7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199619|EAP|Custom C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Freefix Midshaft Radius 97mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,377.00|FSC: 13; Default||Not reimbursed separately|4,377.00|FSC: 13; Default||External grouping not supported 951215249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz B Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz C Lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80173455|EAP|CPT® 51102||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Aspiration Bladder With Insert Suprapubic Cath|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 951215251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz C Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz D Lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Variax Ti Foot Calcaneus Mesh Polyax 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,949.14|FSC: 13; Default||Not reimbursed separately|3,949.14|FSC: 13; Default||External grouping not supported 951215253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz D Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz E Lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 200cm Rt Ankl T2 Im Arthds Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.09|FSC: 13; Default||Not reimbursed separately|6,237.09|FSC: 13; Default||External grouping not supported 951215255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz E Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz F Lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 Alpha 9mm X 285mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,524.70|FSC: 13; Default||Not reimbursed separately|9,524.70|FSC: 13; Default||External grouping not supported 951215257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxf Ph3 Cementless Tib Sz F Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oxfd B Lt Mdl Pps Ha Prt Kn Repl Cmntls Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 28mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951215259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oxfd B Rt Mdl Pps Ha Prt Kn Repl Cmntls Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oxfd Lt Mdl Kn Pps Ha Prt Kn Repl Cmntls Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.5mm 40mm Reline-o 2s Spine Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951215261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oxfd C Kn Rt Mdl Cmntls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib Oxfd D Kn Lt Mdl Cmntls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 8.5mm 90mm Reline-o 2s Spine Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951215263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxford Cementless Tibia E Lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951215264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxford Cementless Tibia E Rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95199635|EAP|Custom 95199635||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Conn Reline-o 5-6/5-6mm O-h Med|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951215265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 55mm Kn Rt Post Stab Cnstrn Opn Bx Vngrd Ssk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 60mm Kn Rt Post Stab Cnstrn Opn Bx Vngrd Ssk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 95199636|EAP|Custom 95199636||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 535mm Ti Lateral Off Medium|1|HUMANA [1294]||HUMANA [11839]|3,849.00|FSC: 13; Default||Not reimbursed separately|3,849.00|FSC: 13; Default||External grouping not supported 951215267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 95199624|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Entrant Vr Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,557.00|FSC: 13; Default||Not reimbursed separately|31,557.00|FSC: 13; Default||External grouping not supported 951216025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 16mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 18mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 95199627|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Gallant Vr Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,500.00|FSC: 13; Default||Not reimbursed separately|34,500.00|FSC: 13; Default||External grouping not supported 951216027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 20mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 22mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 95199625|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Entrant Dr Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,000.00|FSC: 13; Default||Not reimbursed separately|36,000.00|FSC: 13; Default||External grouping not supported 951216029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 24mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 12mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 95199628|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Gallant Dr Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,500.00|FSC: 13; Default||Not reimbursed separately|40,500.00|FSC: 13; Default||External grouping not supported 951216031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 14mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 16mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 95199626|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Entrant Hf Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,836.00|FSC: 13; Default||Not reimbursed separately|52,836.00|FSC: 13; Default||External grouping not supported 951216033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 18mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 20mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 95199629|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Gallant Hf Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|FSC: 13; Default||Not reimbursed separately|55,500.00|FSC: 13; Default||External grouping not supported 951216035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 22mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 16mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 16mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22mm Vngrd 360 Bw Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 10mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 12mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 14mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 95199646|EAP|Custom 95199646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Pin Orthopedic Psi Psn Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 16mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 18mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 95199647|EAP|Custom 95199647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Pin Orthopedic Psi Psn Ps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 20mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 22mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 95199637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tibial Infinity Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|FSC: 13; Default||Not reimbursed separately|18,927.00|FSC: 13; Default||External grouping not supported 951216067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 24mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 95199638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Flatcut Talar Infinity Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,082.00|FSC: 13; Default||Not reimbursed separately|20,082.00|FSC: 13; Default||External grouping not supported 951216069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 95199639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz2 8mm Ankle Everlast Cross-linked|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|FSC: 13; Default||Not reimbursed separately|8,622.00|FSC: 13; Default||External grouping not supported 951216071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 20mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 95199640|EAP|Custom C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tibial Infinity Sz 3 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|FSC: 13; Default||Not reimbursed separately|18,927.00|FSC: 13; Default||External grouping not supported 951216073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 22mm Scr Ascnt Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|FSC: 13; Default||Not reimbursed separately|3,537.00|FSC: 13; Default||External grouping not supported 951216074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 40mm 12mm Spline Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|FSC: 13; Default||Not reimbursed separately|2,655.00|FSC: 13; Default||External grouping not supported 95199641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Flatcut Talar Infinity Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,082.00|FSC: 13; Default||Not reimbursed separately|20,082.00|FSC: 13; Default||External grouping not supported 951216075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 10mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 12mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 95199642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 2+ 8mm Ankle Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|FSC: 13; Default||Not reimbursed separately|8,622.00|FSC: 13; Default||External grouping not supported 951216077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 14mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 18mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 95199643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tibial Infinity Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|FSC: 13; Default||Not reimbursed separately|18,927.00|FSC: 13; Default||External grouping not supported 951216079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 20mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 22mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 95199644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Flatcut Talar Infinity Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,082.00|FSC: 13; Default||Not reimbursed separately|20,082.00|FSC: 13; Default||External grouping not supported 951216081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 24mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 3+ 7mm Ankle Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|FSC: 13; Default||Not reimbursed separately|8,622.00|FSC: 13; Default||External grouping not supported 951216083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 10mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 12mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 14mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 16mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 18mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 20mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 22mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|FSC: 13; Default||Not reimbursed separately|3,741.00|FSC: 13; Default||External grouping not supported 951216095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 16mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22mm Vngrd 360 Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 16mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22mm Vngrd 360 Bw Kn Spline Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 23mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 24mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 10mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 11mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 12mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 13mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 14mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 15mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 16mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 17mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 18mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 19mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199650|EAP|Custom 95199650||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 10mmx18mmx55mm Crnt 10d Extr Lateral Xlg Ns Lf|1|HUMANA [1294]||HUMANA [11839]|15,675.00|FSC: 13; Default||Not reimbursed separately|15,675.00|FSC: 13; Default||External grouping not supported 951216125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 20mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 21mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199654|EAP|Custom 95199652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Gel Resterilizable 555cc 13.5cm 6.7cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 22mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 23mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199655|EAP|Custom 95199655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Gel Resterilizable 620cc 14cm 6.9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 24mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 10mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199662|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tiss Contour Alloderm Sm Perforated Med 1.6 +/- 0.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.32|FSC: 13; Default||Not reimbursed separately|75.32|FSC: 13; Default||External grouping not supported 951216131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 11mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 12mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 13mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 14mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199663|EAP|Custom 95199663||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc Mciol .018in|1|HUMANA [1294]||HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951216135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 15mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 16mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199664|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Interventional Nt2 Curve Micro 2.5fr .021in 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951216137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 17mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 18mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199651|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Electrocautery Enhanced Axios System 20 X 10 10.8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,329.67|FSC: 13; Default||Not reimbursed separately|15,329.67|FSC: 13; Default||External grouping not supported 951216139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 19mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 20mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Coroent 5.5mm X 25mm Xlf Variable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 951216141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 21mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 22mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3mm 26mm Mini Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|FSC: 13; Default||Not reimbursed separately|1,567.32|FSC: 13; Default||External grouping not supported 951216143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 23mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 24mm Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 12in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 13in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 14in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 15in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 16in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 17in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 18in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 19in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sphere Efficiency J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 951216153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 20in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 21in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Dia8 X 100 Mm T2 Icf W/compression Screw Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 951216155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 22in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199671|EAP|Custom 95199671||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb End Cap Nail 8mm X 10mm T2 Icf Sterile|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951216157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 13in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199672|EAP|Custom 95199672||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb End Cap Nail 8mm X 20mm T2 Icf Sterile|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951216159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 15in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 16in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7.5mm X 90mm Proximal Conquest Fn P-l 20mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 951216161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 17in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 8.5mmx100mm Proximal Conquest Fn P-l 25mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 951216163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 19in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7.5mmx95mm Proximal Conquest Fn P-l 20mm Threade|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 951216165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 21in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 60mm 1 Hole Conquest Fn Locking Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,291.00|FSC: 13; Default||Not reimbursed separately|6,291.00|FSC: 13; Default||External grouping not supported 951216167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 13in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 24mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|FSC: 13; Default||Not reimbursed separately|789.33|FSC: 13; Default||External grouping not supported 951216169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 15in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Tomcat 3.5mm Fixed Selftap 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951216171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 17in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199686|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 19.3 X 9.6cm Aldrm Slct Thk 3.4-0.6mm Thin Cntr Alg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.12|FSC: 13; Default||Not reimbursed separately|62.12|FSC: 13; Default||External grouping not supported 951216173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 19in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199666|EAP|Custom 95199666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Scaled Ao Fit Dia2.6 X 220mm Manual|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 21in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 95199667|EAP|Custom 95199667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Manual Opening 5.5mm Nonsterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22in Vngrd 360 Kn Spline Vrsn 2 Xtn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Maxim Stem 14x40mm Extension|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,146.50|FSC: 13; Default||Not reimbursed separately|2,146.50|FSC: 13; Default||External grouping not supported 95199668|EAP|Custom 95199668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical 6.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199669|EAP|Custom 95199669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199673|EAP|Custom 95199673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation 2.5mm Dia 285mml Kirschner Smooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199674|EAP|Custom 95199674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidepen Orthopedic 2.8mm 300mm Threaded Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199675|EAP|Custom 95199675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Conquest Fn Proximal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx5mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199676|EAP|Custom 95199676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Conquest Fn Proximal Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199677|EAP|Custom 95199677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Conquest Fn Screw Compression|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 80mm 3hole Bone Humerus Left Distal Lateral Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,576.62|FSC: 13; Default||Not reimbursed separately|4,576.62|FSC: 13; Default||External grouping not supported 951216193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 46mm T10 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|878.97|FSC: 13; Default||Not reimbursed separately|878.97|FSC: 13; Default||External grouping not supported 951216195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx5mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199691|EAP|Custom 95199691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blanket Warming Mistral-air 70in X 29.9in Intraoperative|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.0mm 38mm Cann Ti Compression Headles St-36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951216199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199699|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Artegraft Bovine Collagen Carotid Artery 7mmx50cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,870.00|FSC: 13; Default||Not reimbursed separately|6,870.00|FSC: 13; Default||External grouping not supported 951216201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 42cm Right Trochanter Intertan Intramedullary 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951216203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 42cm Left Trochanter Intertan Intramedullary 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 951216205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx5mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 95199703|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Infusion Peripheral Balloon Angioplasty 12x40x80 Ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951216207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951205613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos B Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199704|EAP|Custom 95199704||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation 2.5mm Dia 150mml Kirschner Smooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos C Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos D Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199706|EAP|Custom 95199706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Wound Veralink Ultlnk0500.s 1000ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos E Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos F Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199707|EAP|Custom 95199707||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tbg Cpap Neo Pt Intfc Nsl 50mm Bbl Sys Unv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos G Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos A Hi Ofst Hip Fem Ti Mdlr Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos B Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos C Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos D Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos E Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos F Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 40mm Reline 2c Spne Pa Ns Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 951205625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 70mm Arcos G Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos A Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199710|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 18.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos C Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos D Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199712|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Uret 4.8fr 28cm Pgtl Crv Tpr Tip Bldr Mrk Loprfl Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|323.19|FSC: 13; Default||Not reimbursed separately|323.19|FSC: 13; Default||External grouping not supported 951205629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos E Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos F Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos G Std Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos A Hi Ofst Hip Fem Ti Mdlr Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos B Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos C Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos D Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199598|EAP|Custom 95199598||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Belt Fixation Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos E Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos F Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 95199713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 97mm 7 Hl Lck Cmpr Axsos Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,574.95|FSC: 13; Default||Not reimbursed separately|6,574.95|FSC: 13; Default||External grouping not supported 951205638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm Arcos G Hi Ofst Hip Ti Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951205639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 12mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 110mm 8 Hl Lck Cmpr Axsos 4.0mm Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,780.15|FSC: 13; Default||Not reimbursed separately|9,780.15|FSC: 13; Default||External grouping not supported 951205640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 13mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 14mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 15mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 16mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 17mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 18mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 19mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 20mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 21mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 22mm Blt Tip Prft Arcos Ti Strg Dist Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 13mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 18mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 19mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 20mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 21mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 22mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3.0mm 26mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951205661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 23mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 24mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cannulated7.3mm Thread 16mm X120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 951205663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 25mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 26mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199734|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Pluse 3664 Control System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,136.89|FSC: 13; Default||Not reimbursed separately|63,136.89|FSC: 13; Default||External grouping not supported 951205665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 12mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199735|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Neurostimulator 1mm Dia 50cml Slimtip Axium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,595.95|FSC: 13; Default||Not reimbursed separately|6,595.95|FSC: 13; Default||External grouping not supported 951205667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 14mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cannulated 7.3mm Thread 16mm X125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 951205669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199736|EAP|Custom 95199736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit 22cm Big Curve Delivery Sheath Neurostimulator Implantab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 20mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 21mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199727|EAP|Custom 95199727||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Solution Ophthalmic Silikon 1000 Viscoel Oil Vial 8.5ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 22mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 23mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199728|EAP|Custom 95199728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Surgical Internal Limiting Membrane Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 24mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 25mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199729|EAP|Custom 99729||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Strip Retinal 5mm Dia Silicone Round Asymmetrical Labtician|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 951205679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 26mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 12mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199730|EAP|Custom 95199730||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scleral Buckling Style 112 Meridional|1|HUMANA [1294]||HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 951205681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 14mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199743|EAP|Custom 95199743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Waste X Miscellaneous Processing Autologous Blood Recove|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199744|EAP|Custom 95199744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Reservoir Procedure Bottom Outlet 225ml W/filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 20mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199745|EAP|Custom 95199745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stand Alone Reservoir Pas Xres B W/gross Fliter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 21mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 22mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199742|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intracoluar Acrysof Iq Vivity Extended Vision Uv Absorb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951205691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 23mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 24mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 300mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,143.23|FSC: 13; Default||Not reimbursed separately|5,143.23|FSC: 13; Default||External grouping not supported 951205693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 25mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 951205694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 26mm Blt Tip Prft Arcos Ti Bw Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|FSC: 13; Default||Not reimbursed separately|9,057.00|FSC: 13; Default||External grouping not supported 95199739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Recon Evos 3.5mm 88mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|FSC: 13; Default||Not reimbursed separately|1,287.00|FSC: 13; Default||External grouping not supported 951205695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Recon Evos 3.5mm 132mm 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.75|FSC: 13; Default||Not reimbursed separately|1,443.75|FSC: 13; Default||External grouping not supported 951205697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Evos 3.5mm Washer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.32|FSC: 13; Default||Not reimbursed separately|100.32|FSC: 13; Default||External grouping not supported 951205699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 20mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 21mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199752|EAP|Custom 95199752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Pericardial Photofix 8cm X 14cm Bovine|1|HUMANA [1294]||HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951205702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 22mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 23mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199753|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Bd Mn Fenestrated Proximal30x124m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,891.50|FSC: 13; Default||Not reimbursed separately|28,891.50|FSC: 13; Default||External grouping not supported 951205704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 24mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 25mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199754|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Bd Mn Fenestrated Proximal24x109m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,891.50|FSC: 13; Default||Not reimbursed separately|28,891.50|FSC: 13; Default||External grouping not supported 951205706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 26mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Sckt Rsp Djo Srg 36mm +4 Std Hum Hxe+ Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 951205710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 2.0mm Holex6 Flex Variable Angle Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|FSC: 13; Default||Not reimbursed separately|1,519.65|FSC: 13; Default||External grouping not supported 951205712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 20mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 21mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 30mm Asns Iii Ti P/t Rvrs Cut Flut Tarsus Mtrsl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|785.88|FSC: 13; Default||Not reimbursed separately|785.88|FSC: 13; Default||External grouping not supported 951205714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 22mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 23mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 34mm Rsp Nonlocking Glenoid Baseplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 951205716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 24mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 25mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 38mm Rsp Nonlocking Glenoid Baseplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 951205718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 26mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 16mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 18mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 19mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 20mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 21mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 22mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 23mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 24mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 25mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 95199755|EAP|Custom 95199755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Graft Large Orthoblend 5cc|1|HUMANA [1294]||HUMANA [11839]|3,579.00|FSC: 13; Default||Not reimbursed separately|3,579.00|FSC: 13; Default||External grouping not supported 951205730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 26mm Intlk Prft Arcos Pps Ti Dist Strl Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|FSC: 13; Default||Not reimbursed separately|12,244.50|FSC: 13; Default||External grouping not supported 951205731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 16mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,025.00|FSC: 13; Default||Not reimbursed separately|14,025.00|FSC: 13; Default||External grouping not supported 95199760|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Cryo Saphenous - Check Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,593.44|FSC: 13; Default||Not reimbursed separately|20,593.44|FSC: 13; Default||External grouping not supported 951205732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 220mm 11mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|FSC: 13; Default||Not reimbursed separately|9,426.00|FSC: 13; Default||External grouping not supported 951205733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 220mm 13mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|FSC: 13; Default||Not reimbursed separately|9,426.00|FSC: 13; Default||External grouping not supported 95198653|EAP|Custom 95198653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fenestrated 6in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 220mm 15mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|FSC: 13; Default||Not reimbursed separately|9,426.00|FSC: 13; Default||External grouping not supported 951205735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 220mm 17mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|FSC: 13; Default||Not reimbursed separately|9,426.00|FSC: 13; Default||External grouping not supported 95199761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tlif-o Modulus 8x10x30mm 8 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 951205736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 220mm 19mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|FSC: 13; Default||Not reimbursed separately|9,426.00|FSC: 13; Default||External grouping not supported 951205737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 250mm 11mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|FSC: 13; Default||Not reimbursed separately|9,763.50|FSC: 13; Default||External grouping not supported 95199762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tlif-o Modulus 8x10x30mm 4 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 951205738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 250mm 13mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|FSC: 13; Default||Not reimbursed separately|9,763.50|FSC: 13; Default||External grouping not supported 951205739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 250mm 15mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|FSC: 13; Default||Not reimbursed separately|9,763.50|FSC: 13; Default||External grouping not supported 95199763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tlif-o Modulus 12x10x30mm 8 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 951205740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 250mm 17mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|FSC: 13; Default||Not reimbursed separately|9,763.50|FSC: 13; Default||External grouping not supported 951205741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl 250mm 19mm Mlhd Hip Clcr 80% Por Ha Mdlr Rllr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|FSC: 13; Default||Not reimbursed separately|9,763.50|FSC: 13; Default||External grouping not supported 95199764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 18mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951205742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Clrls Mdlr Reach Ha 1 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 951205743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Clrls Mdlr Reach Ha 2 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 95199765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.0mm 26mm Loprfl Scr Ti Cortical Slf Drl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951205744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Clrls Mdlr Reach Ha 3 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 951205745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Clrls Mdlr Reach Ha 4 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 95199766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.0mm Straight 8 Hole Reinforced|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951205746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Clrls Mdlr Reach Ha 5 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 951205747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Colr Mdlr Reach Ha 1 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 95199767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Titanium 2.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Colr Mdlr Reach Ha 2 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 951205749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Colr Mdlr Reach Ha 3 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 95199768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Titanium 2.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Colr Mdlr Reach Ha 4 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 951205751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Colr Mdlr Reach Ha 5 Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|FSC: 13; Default||Not reimbursed separately|19,209.00|FSC: 13; Default||External grouping not supported 95199769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Titanium 2.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 12mm Rllr Hrdn Mlhd 80% Por Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951205753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 14mm Rllr Hrdn Mlhd 80% Por Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Titanium 2.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Rllr Hrdn Mlhd 80% Por Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951205755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Rllr Hrdn Mlhd 80% Por Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 95199771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Titanium 2.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 20mm Rllr Hrdn Mlhd 80% Por Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|FSC: 13; Default||Not reimbursed separately|7,905.00|FSC: 13; Default||External grouping not supported 951205757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34a Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34b Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34c Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199782|EAP|Custom 95199782||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Percutaneous Ext For 2.16mm Interstim Surescan Mri Ld|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951205760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34d Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34e Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Offset 4mm Pe Hc A 36g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|FSC: 13; Default||Not reimbursed separately|5,853.00|FSC: 13; Default||External grouping not supported 951205762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45a Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45b Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem-p Ami Collard Size 4 Standard Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 951205764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45c Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45d Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Centric 40mm +3mm Lateral Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 951205766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45e Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55a Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tlif-o Modulus 8x11x30mm 15 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 951205768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55b Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55c Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4mm 44mm Asnis Solid Nonsterile Jfx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.24|FSC: 13; Default||Not reimbursed separately|4,755.24|FSC: 13; Default||External grouping not supported 951205770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55d Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 55e Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 95199778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4mm 48mm Asnis Solid Nonsterile Jfx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.24|FSC: 13; Default||Not reimbursed separately|4,755.24|FSC: 13; Default||External grouping not supported 951205772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 1 Biplanar Mrs Tpr Hip Ti Clrls Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 2 Biplanar Mrs Tpr Hip Ti Clrls Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 95199780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm 22mm Mini Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|FSC: 13; Default||Not reimbursed separately|1,567.32|FSC: 13; Default||External grouping not supported 951205774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 3 Biplanar Mrs Tpr Hip Ti Clrls Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 4 Biplanar Mrs Tpr Hip Ti Clrls Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 95199781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant System Fdl 5.5mm Interference Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 951205776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 5 Biplanar Mrs Tpr Hip Ti Clrls Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 6 Biplanar Mrs Tpr Hip Ti Clrls Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 95199783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 1.6mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 951205778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 1 Biplanar Mrs Tpr Hip Ti Colr Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 2 Biplanar Mrs Tpr Hip Ti Colr Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 95199784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.6mm X 9mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 3 Biplanar Mrs Tpr Hip Ti Colr Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 4 Biplanar Mrs Tpr Hip Ti Colr Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 95199785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 1.6mm X 10mm Va Locking Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951205782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 5 Biplanar Mrs Tpr Hip Ti Colr Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem Reach 6 Biplanar Mrs Tpr Hip Ti Colr Seg Lck Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|FSC: 13; Default||Not reimbursed separately|17,485.50|FSC: 13; Default||External grouping not supported 951205784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 65a Tpr Hip Clcr Por Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trial Hip Mlhd 75a Fem Clcr Mtphsl Mdlr Stm Prv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|FSC: 13; Default||Not reimbursed separately|17,812.50|FSC: 13; Default||External grouping not supported 951205786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34a Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34b Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34c Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34d Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 34e Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45a Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951205792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Mtphsl Mlhd 45b Tpr Hip Clcr Ha Mdlr Ty 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|FSC: 13; Default||Not reimbursed separately|19,401.00|FSC: 13; Default||External grouping not supported 951206552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 62/64mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 66/68/70mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 66/68/70mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 6/68/70mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 66/68/70mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 72/74mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 72/74mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 95199779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Tomcat 3.5mm Fixed Selftap 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951206559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 72/74mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 72/74mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 95199790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Distal 11 Hole Left 153mm 2.7/3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,816.25|FSC: 13; Default||Not reimbursed separately|5,816.25|FSC: 13; Default||External grouping not supported 951206561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 76/78/80mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 76/78/80mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 95199787|EAP|Custom 95199787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve Sapien 3 23mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951206563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 76/78/80mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 76/78/80mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 95199788|EAP|Custom 95199788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Aortic Valve Sapien 3 26mm Ultra Transcatheter|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 951206565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 50mm 28mm Lngvt Hip Cmnt Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 52mm 28mm Lngvt Hip Cmnt Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 54mm 32mm Lngvt Hip Cmnt Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm 1.8mm Ofst 56mm 32mm Lngvt Hip Cmnt Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 58mm 36mm Lngvt Hip Cmnt Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 95199795|EAP|Custom 95199795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator Bladeless 8mm Long Laparoscopic Optical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 60mm 36mm Lngvt Hip Cmnt Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 951206571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1mm .072in Ofst 62/64mm 36mm Lngvt Hip Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|FSC: 13; Default||Not reimbursed separately|9,286.50|FSC: 13; Default||External grouping not supported 95199791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 4.75mm Swivelock Knotless Blue Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|FSC: 13; Default||Not reimbursed separately|1,590.00|FSC: 13; Default||External grouping not supported 951206572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 32mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 4.75mm Swivelock Knotless White/black Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|FSC: 13; Default||Not reimbursed separately|1,590.00|FSC: 13; Default||External grouping not supported 951206574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 32mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Neu +5mm E1 Liner 32mm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nl 11.5mm 18cm Intertrochanter Intertan Intramedullary 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|FSC: 13; Default||Not reimbursed separately|4,440.00|FSC: 13; Default||External grouping not supported 951206576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 32mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm D Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 5.5mml Self Punching Biocomposite Polyethylene|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951206578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm E Ntrl 36mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 36mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 4.5mm Healix Br Dynacord 3 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 951206580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 36mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 36mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 4.5mm Size 2 36in Healix Br Dynacord 3 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951206582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 36mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 36mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199798|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Bone Graft Small Cellular Matrix 1ml Osteocel Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.00|FSC: 13; Default||Not reimbursed separately|1,170.00|FSC: 13; Default||External grouping not supported 951206584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 40mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 40mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199799|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Bone Graft Med Cellular Matrix 5ml Osteocel Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 951206586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 40mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 40mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199800|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Bone Graft Lg Cellular Matrix 10ml Osteocel Pro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 951206588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 40mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 44mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199802|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens In 22.5 Diopter Acryusof Iq Vivity Ext Vision Uv Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951206590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 44mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 44mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95199803|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens In 24.5 Diopter Acryusof Iq Vivity Ext Vision Uv Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951206592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 A 32mm Cocr Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 951206593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B 36mm Cocr Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 951206594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C 38mm Cocr 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 951206595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 40mm Cocr Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 95199805|EAP|Custom 95199805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cntrsnk 0.8mmx100mm Cann Ao Ft 4.56/6.5mm Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E1 S 42mm 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 951206597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 44mm Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 95199806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 95mm 8 Hole Bone Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.04|FSC: 13; Default||Not reimbursed separately|1,484.04|FSC: 13; Default||External grouping not supported 951206598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 46mm Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 951206599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 50mm 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 95199807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4mm 16mm Axsos 3 Titanium Lock Self Tap Nonsteril|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 951206600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 54mm Cocr Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 951206601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 60mm Cocr Hip 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|FSC: 13; Default||Not reimbursed separately|5,226.00|FSC: 13; Default||External grouping not supported 95199808|EAP|HCPCS C1752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb (sub) Hemodialysis Catheter Kit 15frx28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Fdm Mod Hd T12/14 32mm -3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|FSC: 13; Default||Not reimbursed separately|3,738.00|FSC: 13; Default||External grouping not supported 951206603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Fdm Mod Hd T12/14 32mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|FSC: 13; Default||Not reimbursed separately|3,738.00|FSC: 13; Default||External grouping not supported 951206604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Fdm Mod Hd T12/14 32mm +6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|FSC: 13; Default||Not reimbursed separately|3,738.00|FSC: 13; Default||External grouping not supported 951206605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Fdm Mod Hd T12/14 32mm +3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|FSC: 13; Default||Not reimbursed separately|3,738.00|FSC: 13; Default||External grouping not supported 951206606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 12/14 32mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 951206607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 12/14 32mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 951206608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 12/14 32mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 951206609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 12/14 32mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 95199812|EAP|Custom 95199812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand Werewolf Flow 50 Coblation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 32mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 951206611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 32mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 95199813|EAP|Custom 95199813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand Werewolf Flow 90 Coblation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 32mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 951206613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 32mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 95199814|EAP|Custom 95199814||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Pericardial Photofix 6cm X 8cm Bovine|1|HUMANA [1294]||HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 951206614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 32mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|FSC: 13; Default||Not reimbursed separately|3,651.00|FSC: 13; Default||External grouping not supported 951206615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 36mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 36mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 95199817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 2.4mm Screw 8 Hole Lock 56mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.20|FSC: 13; Default||Not reimbursed separately|3,187.20|FSC: 13; Default||External grouping not supported 951206617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 36mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 36mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 95199818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 40mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|FSC: 13; Default||Not reimbursed separately|789.33|FSC: 13; Default||External grouping not supported 951206619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 36mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm Ofst 36mm Hip Ty 1 Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 95199821|EAP|Custom 95199821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.5mm Cannulated Quick Connect|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 12/14 36mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 12/14 36mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 12/14 36mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 12/14 36mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 12/14 36mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm Ofst 12/14 36mm Hip Mdlr Cocr G7 Frdm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951206627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 28mm Hip Blx D Biolox Optn G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,311.50|FSC: 13; Default||Not reimbursed separately|5,311.50|FSC: 13; Default||External grouping not supported 951206628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 32mm Hip Blx D Biolox Optn G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,311.50|FSC: 13; Default||Not reimbursed separately|5,311.50|FSC: 13; Default||External grouping not supported 951206629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 40mm Hip Blx D Biolox Optn G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,106.50|FSC: 13; Default||Not reimbursed separately|6,106.50|FSC: 13; Default||External grouping not supported 951206630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 44mm Hip Skrt Blx D Biolox Optn G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,106.50|FSC: 13; Default||Not reimbursed separately|6,106.50|FSC: 13; Default||External grouping not supported 951206631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 20mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 21mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 23mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 62066410|EAP|CPT® 84182||0309 - LABORATORY - OTHER LABORATORY|Hb Sox1 Ab, Igg Immunoblot, Serum Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.70|FSC: 13; Default||Not reimbursed separately|150.70|FSC: 13; Default||External grouping not supported 951206634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 24mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 26mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95199823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular G7 Size F +5mm 40mm Vivacit-e Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 27mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 28mm Rnglc Hip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95199825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrodesis Titanium 2.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|FSC: 13; Default||Not reimbursed separately|1,908.00|FSC: 13; Default||External grouping not supported 951206638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 20 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 951206639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ringloc+ Replacement Ring Sz21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 95199826|EAP|Custom 95199826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver 2.0mm Surgical Reduct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 23 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 951206641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 24 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 95199827|EAP|Custom 95199827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Minitape Cobraid Blue 39.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 25 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 951206643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 26 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 95199824|EAP|HCPCS L8614||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Cochlear Model C1632 W/slim Modiolar Electrode|1|HUMANA [1294]||HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 951206644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 27 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 951206645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc+ 28 Hip Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|FSC: 13; Default||Not reimbursed separately|358.50|FSC: 13; Default||External grouping not supported 95199822|EAP|HCPCS L8614||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Processor Dual N7|1|HUMANA [1294]||HUMANA [11839]|41,100.00|FSC: 13; Default||Not reimbursed separately|41,100.00|FSC: 13; Default||External grouping not supported 951206646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc Ii Hip Ti Cnstrn X Rtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 951206647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 52mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 55mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 58mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 61mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 95199832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Std Brl 2hl Kyls Omg 3 Bn Hip Strl 135deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,029.50|FSC: 13; Default||Not reimbursed separately|2,029.50|FSC: 13; Default||External grouping not supported 951206651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 64mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 67mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 95199831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 13mm 105mm 22mm Omega3 Ss Std Hip Fem Lg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.90|FSC: 13; Default||Not reimbursed separately|1,032.90|FSC: 13; Default||External grouping not supported 951206653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 70mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 73mm Rcvr Hip Rt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 95199837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Xtrnfx 300mm 1.5mm Ilz Tib Ss Bynt Pnt Stpr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|706.62|FSC: 13; Default||Not reimbursed separately|706.62|FSC: 13; Default||External grouping not supported 951206655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 52mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 55mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 95199834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Spatial Frame Full 180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,366.00|FSC: 13; Default||Not reimbursed separately|3,366.00|FSC: 13; Default||External grouping not supported 951206657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 58mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 61mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 64mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 67mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 95199835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring External Fixation 180mm Circle Half Taylor Spatial Fram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,387.75|FSC: 13; Default||Not reimbursed separately|3,387.75|FSC: 13; Default||External grouping not supported 951206661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 70mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 73mm Rcvr Hip Lt Ti Lg Ilium Flng Ant Ctout Infr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|FSC: 13; Default||Not reimbursed separately|12,577.50|FSC: 13; Default||External grouping not supported 951206663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 41mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 951206664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 42mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 951206665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 43-45mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95199836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring External Fixation 180mm Long Circle Foot Taylor Spatial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 951206666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 46-47mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 951206667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 48-50mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95199838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Connection Short 3hl 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.35|FSC: 13; Default||Not reimbursed separately|328.35|FSC: 13; Default||External grouping not supported 951206668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 51-52mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 951206669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 53-55mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95199804|EAP|Custom 95199804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pedi Mouth Prop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Bp 58mm Rnglc Hip Actb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 951206671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 41 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95199828|EAP|Custom 95199828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Closed Suction Endoclear Liberator 12 Fr 10ea/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 42 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 43 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95199829|EAP|Custom 95199829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Closed Suction Replacement Endoclear Liberator 12 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 44 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 45 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 46 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 47 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 48 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb Rnglc 40 Hip Loprfl Xry Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 951206680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 52mm Mlhd Rnl Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 55mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 58mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 61mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199830|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duet With The Edm Ventricular Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 64mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 67mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199833|EAP|Custom 95199833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Omega Combination Assembly|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 70mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 73mm Mlhd Hip Rt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 19mm 44mm Shldr Reunion 4mm Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 951206688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 52mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 55mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrodesis Titanium 2.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|FSC: 13; Default||Not reimbursed separately|1,908.00|FSC: 13; Default||External grouping not supported 951206690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 58mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 61mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 85mm Evos Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 951206692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 64mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 67mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 90mm Evos Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.29|FSC: 13; Default||Not reimbursed separately|79.29|FSC: 13; Default||External grouping not supported 951206694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 70mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 951206695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 73mm Mlhd Hip Lt Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|FSC: 13; Default||Not reimbursed separately|13,765.50|FSC: 13; Default||External grouping not supported 95199845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 24mm Axsos 3 Ti Ft Canc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|199.50|FSC: 13; Default||Not reimbursed separately|199.50|FSC: 13; Default||External grouping not supported 951206696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 52mm Mlhd Hip Lt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 56mm Mlhd Hip Lt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 95199844|EAP|Custom 95199844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 10.5mm Dia 495mml Stepped F/lag Screw Gamma3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 60mm Mlhd Hip Lt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 64mm Mlhd Hip Lt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 95199846|EAP|Custom 95199846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 4mm Trgn 16.25in Lng Itrm Qc Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 68mm Mlhd Hip Lt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 72mm Mlhd Hip Lt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 95199847|EAP|Custom 95199847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealant Dural Autospray Extended Tip Sterile Single-use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 52mm Mlhd Hip Rt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 56mm Mlhd Hip Rt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 60mm Mlhd Hip Rt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 64mm Mlhd Hip Rt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 68mm Mlhd Hip Rt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 4mm 72mm Mlhd Hip Rt Pps Ti Mdlr Antero Infr Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|FSC: 13; Default||Not reimbursed separately|15,747.00|FSC: 13; Default||External grouping not supported 951206708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 6mm Mxti Flt Hip Pps Ti Ilc Flng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,914.50|FSC: 13; Default||Not reimbursed separately|2,914.50|FSC: 13; Default||External grouping not supported 951206709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 6mm Mxti Wdg Hip Pps Ti Ilc Flng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,914.50|FSC: 13; Default||Not reimbursed separately|2,914.50|FSC: 13; Default||External grouping not supported 951206710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 58mm Sm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 52mm Regenerex Sm Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 54mm Regenerex Sm Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 56mm Regenerex Sm Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 52mm Regenerex Med Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 54mm Regenerex Med Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 56mm Regenerex Med Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 58mm Regenerex Med Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 52mm Regenerex Lg Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 54mm Regenerex Lg Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 56mm Regenerex Lg Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 58mm Regenerex Lg Hip Ti Por Mlt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|FSC: 13; Default||Not reimbursed separately|6,006.00|FSC: 13; Default||External grouping not supported 951206722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb Shrt Flng Pr5 W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|FSC: 13; Default||Not reimbursed separately|2,620.50|FSC: 13; Default||External grouping not supported 951206723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Par-5 Obturator Hook|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,255.00|FSC: 13; Default||Not reimbursed separately|3,255.00|FSC: 13; Default||External grouping not supported 951206724|EAP|HCPCS 951206724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Pr5 Srg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Pr5 Hip Actb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|334.50|FSC: 13; Default||Not reimbursed separately|334.50|FSC: 13; Default||External grouping not supported 951206726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Mlhd Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|FSC: 13; Default||Not reimbursed separately|1,530.00|FSC: 13; Default||External grouping not supported 951206727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 40-50mm Ti Mdlr Sys 1 Pc Mlhd Bn Hip Clcr Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 50-60mm Ti Mdlr Sys 1 Pc Mlhd Bn Hip Clcr Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 95199848|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atherectomy H1-s Hawrone S Small Vessel 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 60-70mm Ti Mdlr Sys 1 Pc Mlhd Bn Hip Clcr Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 45-55mm Ti Mdlr Sys 1 Pc Mlhd Bn Hip Clcr Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 95199849|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atherectomy H1-s Hawkone M Multi Vessel 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951206731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 55-65mm Ti Mdlr Sys 1 Pc Mlhd Bn Hip Clcr Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 40-50mm Mlhd Hip Clcr Lat Cocr 1 Pc Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 95199851|EAP|Custom 95199851||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Spinal 5.5/5.5mm Dia Titanium Lateral Closed Side|1|HUMANA [1294]||HUMANA [11839]|4,680.00|FSC: 13; Default||Not reimbursed separately|4,680.00|FSC: 13; Default||External grouping not supported 951206733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 45-55mm Mlhd Hip Clcr Lat Cocr 1 Pc Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 50-60mm Mlhd Hip Clcr Lat Cocr 1 Pc Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 95199852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Spinal 1/4-32 Standard Titanium Cd Horizon 6.35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951206735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 55-65mm Mlhd Hip Clcr Lat Cocr 1 Pc Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 951206736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 60-70mm Mlhd Hip Clcr Lat Cocr 1 Pc Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|FSC: 13; Default||Not reimbursed separately|1,339.50|FSC: 13; Default||External grouping not supported 95199853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Lumbar 4 Screw L20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 951206737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem Mlhd Med Hip Troch Lat Cocr Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,731.00|FSC: 13; Default||Not reimbursed separately|1,731.00|FSC: 13; Default||External grouping not supported 951206738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem Mlhd Lg Hip Troch Lat Cocr Cnct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,731.00|FSC: 13; Default||Not reimbursed separately|1,731.00|FSC: 13; Default||External grouping not supported 95199854|EAP|HCPCS C1712||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 5.0mm X 25mm Harrie Sa/raven|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951206739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Sprlk Clcr Dist Seg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.50|FSC: 13; Default||Not reimbursed separately|406.50|FSC: 13; Default||External grouping not supported 951206740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Arcos Ti 3.5mm Fem Lck Hex Drv Strl Mdlr Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,134.50|FSC: 13; Default||Not reimbursed separately|2,134.50|FSC: 13; Default||External grouping not supported 951206741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 100mm Arcos Lg Hip Troch Cocrmo Mdlr Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,560.50|FSC: 13; Default||Not reimbursed separately|2,560.50|FSC: 13; Default||External grouping not supported 951206742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Claw Fem 100mm Arcos Sm Hip Troch Cocrmo Mdlr Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,560.50|FSC: 13; Default||Not reimbursed separately|2,560.50|FSC: 13; Default||External grouping not supported 95198328|EAP|Custom 95198328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape U W/adhesive 60in X 72in Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 25mm Arcos Troch Btn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,428.50|FSC: 13; Default||Not reimbursed separately|2,428.50|FSC: 13; Default||External grouping not supported 951206744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 24mm Arcos Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 95199568|EAP|Custom 95199568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mat Surgical Suction Suctionblu 36in X 56in Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951206745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth 25mm Arcos Hip Troch Cocrmo Mdlr Fem Rev Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|FSC: 13; Default||Not reimbursed separately|1,599.00|FSC: 13; Default||External grouping not supported 951207513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 43 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199859|EAP|Custom 95199859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 14.2cm Memorygel 3.4cm Mod Prfl Cl Brst Gel 405cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 44 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 45 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199860|EAP|Custom 95199860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 14.6cm Memorygel 3.4cm Mod Prfl Cl Brst Gel 425cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 46 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 47 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199861|EAP|Custom 95199861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 14.8cm Memorygel 3.5cm Mod Prfl Cl Brst Gel 445cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 48 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 43 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199868|EAP|Custom 95199868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 2.3mm X 300mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 44 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 45 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199869|EAP|Custom 95199869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Threaded 2.0mm X 72mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 46 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 47 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199870|EAP|Custom 95199870||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Modulus Tlif-a 10mmx11mmx30mm 15 Degree|1|HUMANA [1294]||HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 951207524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 48 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 21 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199871|EAP|Custom 95199871||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 50mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951207526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 22 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 23 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199872|EAP|Custom 95199872||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 55mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951207528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 24 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 25 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199857|EAP|Custom 95199857||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Harrier Alif 34x25x12mm 12 Deg|1|HUMANA [1294]||HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 951207530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 26 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 27 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 50mm Short Thread Headless Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 951207532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +5mm 28 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 40 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Joust Beam 7.2mm 125mm Cann Headless Med Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,573.00|FSC: 13; Default||Not reimbursed separately|3,573.00|FSC: 13; Default||External grouping not supported 951207534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 41 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 42 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 28mm Lock Plate Gorilla Plating System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951207536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 43 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 24 36mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm 38mm Lock Plate Gorilla Plating System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 951207538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 25 36mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 26 36mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 1.5mm Medial Column Arch Left Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,391.00|FSC: 13; Default||Not reimbursed separately|5,391.00|FSC: 13; Default||External grouping not supported 951207540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 27 36mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 28 36mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Universal Caddy Teddy Bear Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,760.20|FSC: 13; Default||Not reimbursed separately|3,760.20|FSC: 13; Default||External grouping not supported 951207542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc Impct 2 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc Impct 3 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc Impct 4 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc Impct 5 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc Impct 6 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc Impct 8 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 28 44mm 28mm Arcm Hip Hw Ttap/st|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Tprlk C 28mm Hip Strl Tap Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199874|EAP|Custom 95199874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reline-o Ti Rod 5.5x55mm Lordotic|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951207550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb E 28mm Xtd Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 28 64/68mm 28mm Arcm Hip Hw Ttap/st|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199875|EAP|Custom 95199875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 54mm 26mm Arcm Hip Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 56mm 26mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Gryphon Peek With Proknot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951207554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 44mm 28mm Arcm Hip Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 44mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 46mm 28mm Arcm Hip Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198755|EAP|Custom 95198755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Urth Bdx Lbr 14fr 2w Fl 1 Drn Eye Med Olv Cde Rbr Ddrgl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 46mm 28mm Arcm Hip Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 48mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 288mm Ti 14 Hl Axsos 3 Bn Hum Rt Prox Lat Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,186.60|FSC: 13; Default||Not reimbursed separately|12,186.60|FSC: 13; Default||External grouping not supported 951207559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Arcm 10d Ofst 48mm 28mm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 50mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 50mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 52mm 28mm Arcm Hip Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 52mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199883|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Hi Pr 11.4cm 4.6cm 300ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951207564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 54mm 28mm Arcm Hip Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 54mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199886|EAP|Custom 95199886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Endo 20mmx40mm 22g Vizishot 2 Aspiration Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 56mm 28mm Arcm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 56mm 28mm Arcm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4mm 50mm Mini Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|FSC: 13; Default||Not reimbursed separately|1,567.32|FSC: 13; Default||External grouping not supported 951207568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 58mm 28mm Arcm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 58mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199902|EAP|Custom 95199902||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Biopsy Site 18g Brevera 127.5mm Tumark Vision Standar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 60mm 28mm Arcm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 60mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199903|EAP|Custom 95199903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Brevera Single Chamber Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 62mm 28mm Arcm Hip Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 62mm 28mm Arcm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199904|EAP|Custom 95199904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Biopsy Site 18g Brevera 127.5mm Tumark Vision Standar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Arcm Km3 Km4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Ofst 56mm 32mm Arcm Km3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199905|EAP|Custom 95199905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Biopsy Site 18g Brevera 123.5mm Tumark Vision Petite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 44-50mm 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 44-50mm 26mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199906|EAP|Custom 95199906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Biopsy Site 18g Brevera 129.5mm Tumark Pro Q Stnd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 52-54mm 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199907|EAP|Custom 95199907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Biopsy Site 18g Brevera 125.5mm Tumark Prof Q Petite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199908|EAP|Custom 95199908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Needle Guidance Stage Control Panel Cover (stage Drain)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199909|EAP|Custom 95199909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Table Fischer Mammo Test Guidance Cover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199910|EAP|Custom 95199910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Urth Bard 20fr Bardex Foley 5ml 2-way Red Latex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199884|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 15fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199885|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 18fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prm Cmnt Stn Fnsh Vrsy Advct V-lign Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 9mm Prm Cmnt Plsh Vrsy Hr Cdh Zml 125d 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199888|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 21fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199889|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 24fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199890|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 27fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prm Cmnt Prox Cntrlzr Vrsy Hr Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199891|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 30fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm Prm Cmnt Plsh Cpt Zml 12/14 0mm 32mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105x7.5mm Prm Cmnt Plsh Cpt Zml 12/14 0mm 37mm Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199892|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 33fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 1mm 34mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 1mm 39mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199893|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 36fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 2mm 36mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 2mm 41mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199894|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 39fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130x9mm Prm Cmnt Plsh Cpt Zml 12/14 2mm 46mm X Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 3mm 37mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199895|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 42fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 3mm 42mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130x9mm Prm Cmnt Plsh Cpt Zml 12/14 3mm 47mm X Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199896|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 45fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130x10mm Prm Cmnt Plsh Cpt Zml 12/14 4mm 38mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 4mm 43mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199897|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 48fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 4mm 48mm X Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 5mm 40mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199898|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 51fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Cmnt Plsh Cpt Zml 12/14 5mm 45mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130x10mm Prm Cmnt Plsh Cpt Zml 12/14 5mm 50mm X Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199899|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 54fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 85x7mm Prm Cmnt Plsh Cpt Zml 12/14 28mm Xs Ofst 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130x7.5mm Prm Cmnt Plsh Cpt Zml 12/14 30mm Sm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199900|EAP|HCPCS C1729||0500 - OUTPATIENT SERVICES - GENERAL CLASSIFICATION|Hb Dilator Endoscopic 57fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Standard Stem Cem 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir Protasul-s30 2 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199901|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endoscopic 60fr Safeguide Esophageal Otw Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Standard Stem Cem 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir 4 Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 62066420|EAP|CPT® 88348||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Electron Microscopy (tc Only)-ref Lab|1|HUMANA [1294]||HUMANA [11839]|314.34|FSC: 13; Default||Not reimbursed separately|314.34|FSC: 13; Default||External grouping not supported 951207622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir 5 Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Standard Stem Cem 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 62066430|EAP|CPT® 88350||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Dif Each Addl Antibody Stn (tc Only)-ref Lab|1|HUMANA [1294]||HUMANA [11839]|55.81|FSC: 13; Default||Not reimbursed separately|55.81|FSC: 13; Default||External grouping not supported 951207624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Standard Stem Cem 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Standard Stem Cem 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 62066440|EAP|CPT® 88314||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Spec Stain On Frozen Block (tc Only)-ref Lab|1|HUMANA [1294]||HUMANA [11839]|65.91|FSC: 13; Default||Not reimbursed separately|65.91|FSC: 13; Default||External grouping not supported 951207626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Standard Stem Cem 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir 1 Hip Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Lateral Stem Cem 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Lateral Stem Cem 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir 4 Lat Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir Protasul-s30 5 Lat Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199912|EAP|Custom 95199912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Foam 4inx6in Mepilex Border Ag Silver Antimicrobia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir Protasul-s30 6 Lat Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Avenir 7 Lat Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199913|EAP|Custom 95199913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Foam 4inx8in Mepilex Border Ag Silver Antimicrobia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Lateral Stem Cem 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Avenir Lateral Stem Cem 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199914|EAP|Custom 95199914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Foam 4inx10in Mepilex Border Ag Silver Antimicrobia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Nt Hp Cocr Npor 0 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Nt Hp Cocr Npor 1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199918|EAP|Custom 95199918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Laser Shockwave Lithotripsy Urology|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Nt Hp Cocr Npor 2 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Nt Hp Cocr Npor 3 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199923|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens In 24.5 Diopter Acryusof Iq Vivity Ext Vision Uv Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951207640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmnt Prm Nt Hp Cocr 4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Nt Hp Cocr Npor 5 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199911|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Low Pr 10.5cm 2.5cm 160ml Rd Sm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951207642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Stem Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Stem Sz 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.75mm X 15mm Ti Ctd Cort Hex Fixed Nlckng Reh Shlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951207644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 28mm Loprfl Scr Ti Ankl Va St Sld Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 951207646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 34mm Loprfl Scr Ti Ankl Va St Sld Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 951207648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Titanium 4mm Screw 5 Hole Low Profile Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951207650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Premier Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Stem Sht Neck Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 2+ 6mm Ankle Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|FSC: 13; Default||Not reimbursed separately|8,622.00|FSC: 13; Default||External grouping not supported 951207652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Offset Stem Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Offset Stem Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199920|EAP|Custom 95199920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Shoulder Comprehensive Bone Modle Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Offset Stem Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Offset Stem Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Implant Medium Augmented W/taper Adapter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|FSC: 13; Default||Not reimbursed separately|6,450.00|FSC: 13; Default||External grouping not supported 951207656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Offset Stem Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Np Cocr Offset Stem Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199922|EAP|Custom 95199922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Shoulder Comprehensive Bone Modle Right Tmr+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10.5mm Prm Cmnt Apr Cocr Npor 12/14 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Cmnt Apr Cocr Npor 12/14 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13.5mm Prm Cmnt Apr Cocr Npor 12/14 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95199924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Versa-dial Ti +6 Mm Od36 Mm Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 951207661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Prm Cmnt Apr Cocr Npor 12/14 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16.5mm Prm Cmnt Apr Cocr Npor 12/14 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10.5mm Prm Cmnt Apr Cocr Npor 12/14 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Cmnt Apr Cocr Npor 12/14 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13.5mm Prm Cmnt Apr Cocr Npor 12/14 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 951207666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm Anteverted Aps Nt Hp 1 33mm Std Ofst 27mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm Anteverted Aps Nt Hp 1 33mm Std Ofst 27mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm Anteverted Aps Nt Hp 2 33mm Std Ofst 27mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm Anteverted Aps Nt Hp 2 33mm Std Ofst 27mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm Anteverted Aps Nt Hp 3 36mm Std Ofst 32mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm Anteverted Aps Nt Hp 3 36mm Std Ofst 32mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm Anteverted Aps Nt Hp 4 39mm Std Ofst 36mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm Anteverted Aps Nt Hp 4 39mm Std Ofst 36mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm Anteverted Aps Nt Hp 5 39mm Std Ofst 36mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm Anteverted Aps Nt Hp 5 39mm Std Ofst 36mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Anteverted Aps Nt Hp 6 42mm Std Ofst 41mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199937|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|HB LENS IN 21.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951207677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm Anteverted Aps Nt Hp 6 42mm Std Ofst 41mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm Anteverted Aps Nt Hp 7 42mm Std Ofst 41mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm Anteverted Aps Nt Hp 7 42mm Std Ofst 41mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm Anteverted Aps Nt Hp 8 45mm Std Ofst 45mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm Anteverted Aps Nt Hp 8 45mm Std Ofst 45mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm Anteverted Aps Nt Hp 9 45mm Std Ofst 45mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 80173466|EAP|Custom 80173466||0998 - STATISTICAL CHARGES|HB CTA VIZ|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm Anteverted Aps Nt Hp 9 45mm Std Ofst 45mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Anteverted Aps Nt Hp 10 48mm Std Ofst 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Anteverted Aps Nt Hp 10 48mm Std Ofst 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Nt Hp 11 Std Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Nt Hp 11 Std Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199938|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Full Prfl Sil Smth Sh Srfc Hi 560|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951207688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12 Std Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12 Std Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199939|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Powerpicc 5fr 3-lmn Max Barrier 55cm Guide W/shrk 3cg S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951207690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm 5mm Rdc Nk Lgth Tiv Por 36mm Tpr Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm 5mm Prm Rdc Nk Ml Tiv 41mm Xtd Ofst Tpr 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199951|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens In 15.0 Diopter Acryusof Iq Vivity Ext Vision Uv Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951207692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm 6mm Prm Rdc Nk Ml Ti Por 36mm Std Ofst Tpr 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm 6mm Prm Rdc Nk Ml Tiv 41mm Xtd Ofst Tpr 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199952|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraoccular 11.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951207694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 114mm 7.5mm Prm Ml Ti 37mm Tpr Std Ofst Rdc Nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 114mm 7.5mm Prm Rdc Nk Ml Ti 42mm Xtd Ofst Tpr 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acl Tightrope With Fibertag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 951207696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 117mm 9mm Prm Ml Ti 38mm Tpr Std Ofst Rdc Nk Lgth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 117mm 9mm Prm Rdc Nk Ml Tiv 43mm Xtd Ofst Tpr 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199957|EAP|Custom 95199957||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Aiming Arm Locking Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm 10mm Prm Rdc Nk Ml Ti Por 41mm Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm 10mm Prm Rdc Nk Ml Tiv 46mm Xtd Ofst Tpr 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199945|EAP|Custom 95199945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gas Ablation Argon Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951207700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm 11mm Prm Rdc Nk Ml Tiv Por 42mm Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199946|EAP|Custom 95199946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Ablation Disposable Sterile Minerva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199947|EAP|Custom 95199947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Nerve Block 22g 2in Echogenic Stimulating W/facet S T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199948|EAP|Custom 95199948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Nerve Block Tubular Anaesthesia 21g 4inl W/connecting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199949|EAP|Custom 95199949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Surgicel Powder 3.0 Grams Hemostat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 27mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199950|EAP|Custom 95199950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Surgicel Endoscopic Applicator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199958|EAP|Custom 95199958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epidural Epimed 18g 4.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 28mm Vs Rlc Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199961|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular +24.0 Akreos Advanced Optics Aspheric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 951208268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199966|EAP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Probe 7mm 17ga Osteocool Radiofrequency|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951208270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199959|EAP|Custom 95199959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Epidural 21ga 12inl W/accessories Racz Versa-kath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199960|EAP|Custom 95199960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epidural 18ga 3.5inl Introducer F/versa-kath Coude|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199962|EAP|Custom 95199962||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Breast Large Lined Expand A Band White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm 25mm Hip Sld Apx Hl Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199963|EAP|Custom 95199963||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Breast Extra Large Lined Expand A Band White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199964|EAP|Custom 95199964||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Breast Medium Large Lined Expand A Band White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199965|EAP|Custom 95199965||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder Breast 2x Large Lined Expand A Band White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 27mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199968|EAP|Custom 95199968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Micro Bipolar 8mm Da Vinci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199969|EAP|Custom 95199969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pls Pr 13.7cm 4.9cm 505ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199970|EAP|Custom 95199970||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grafton Injectable Dbf 3cc|1|HUMANA [1294]||HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 951208288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Unv Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199971|EAP|Custom 95199971||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grafton Injectable Dbf 6cc|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951208290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95199972|EAP|Custom 95199972||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grafton Injectable Dbf 9cc|1|HUMANA [1294]||HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip 2 Hl Wo Rim Scr Rnglc 24 Unv Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 27mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Unv 2 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Sld Apx Hl Rnglc Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 Full Hmsphr 66mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 Full Hmsphr 68mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 Full Hmsphr 70mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 Full Hmsphr 72mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 Full Hmsphr 74mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 Full Hmsphr 76mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 Full Hmsphr 78mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 Full Hmsphr 80mm Hip Sld Apx Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Lmt Hl Fin Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Lmt Hl Fin Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Lmt Hl Fin Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Lmt Hl Fin Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Lmt Hl Fin Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Lmt Hl Fin Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Lmt Hl Fin Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Lmt Hl Fin Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Lmt Hl Fin Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Lmt Hl Fin Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Ha Por 2 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 0 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 1 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 2 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199967|EAP|Custom 95199967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Force Bipolar With Dual Grip 8mm Da Vinci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951208360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 3 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 0 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199973|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens In 20.5 Diopter Acryusof Iq Vivity Ext Vision Uv Abs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951208362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 1 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 2 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199975|EAP|Custom 95199975||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 14mmx11mmx6mm Ti Ctd Cerv 12deg Ant Ptc Strl|1|HUMANA [1294]||HUMANA [11839]|7,128.00|FSC: 13; Default||Not reimbursed separately|7,128.00|FSC: 13; Default||External grouping not supported 951208364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 4 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 5 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 95199976|EAP|Custom 95199976||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 5mmx14mmx11mm Ti Ctd Peek Cerv Ant Ptc Strl|1|HUMANA [1294]||HUMANA [11839]|7,128.00|FSC: 13; Default||Not reimbursed separately|7,128.00|FSC: 13; Default||External grouping not supported 951208366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 0 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 1 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 3 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 4 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 5 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 10.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 12.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 13.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 15.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 16.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 18.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 10.5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 12.0 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 15.0 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Std Body Distally Textured Size 18.0 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 10.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 12.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 13.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 15.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 16.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 18.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 10.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 12.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 13.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 15.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 16.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Lg Body Distally Textured Size 18.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 10.5 X 12.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 12.0 X 13.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 13.5 X 15.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 15.0 X 16.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 16.5 X 18.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 10.5 X 12.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 12.0 X 13.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Ha Oversize Dist Text Size 13.5 X 15.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm 5mm Zm Ml Kinectiv 134d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm 6mm Zm Ml Kinectiv 133d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 114mm 7.5mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm 10mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm 11mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 62066450|EAP|CPT® 87637||0302 - LABORATORY - IMMUNOLOGY|Hb Sars-2 + Flu + Rsv Naat (combo)|1|HUMANA [1294]||HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 951208406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 124mm 12.5mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126mm 13.5mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 129mm 15mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 80173477|EAP|CPT® 93318||0483 - CARDIOLOGY - ECHOCARDIOLOGY|HB ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTION|1|HUMANA [1294]||HUMANA [11839]|1,486.61|FSC: 13; Default||Not reimbursed separately|1,486.61|FSC: 13; Default||External grouping not supported 951208409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm 16.25mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm 17.5mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 139mm 20mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm 22.5mm Zm Ml Kinectiv 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 5mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 6mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 7mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 8mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199991|EAP|Custom 95199991||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Acis Pro 360 Lordotic Large 7mm Height|1|HUMANA [1294]||HUMANA [11839]|4,797.96|FSC: 13; Default||Not reimbursed separately|4,797.96|FSC: 13; Default||External grouping not supported 951208418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11.25mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199980|EAP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nrv 2.5cm Neuromend 6mm Peri Bvn Clgn Rsrb Semiperm Fl|1|HUMANA [1294]||HUMANA [11839]|6,051.00|FSC: 13; Default||Not reimbursed separately|6,051.00|FSC: 13; Default||External grouping not supported 951208420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12.5mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13.75mm Brevius Cls Kinectiv Protasul-64 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199982|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +8.0 Diop Mod L Planar 13mm 6mm Pc Asph Uv Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951208422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16.25mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199983|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +8.5 Diop Mod L Planar 13mm 6mm Pc Asph Uv Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951208424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 17.5mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 20mm Cls Brevius Kinectiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199985|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +9.0 Diop Mod L Planar 13mm 6mm Pc Asph Uv Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951208426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M/l Taper Kinectiv Ha Stem Size 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M/l Taper Kinectiv Ha Stem Size 16.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199986|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +9.5 Diop Mod L Planar 13mm 6mm Pc Asph Uv Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951208428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M/l Taper Kinectiv Ha Stem Size 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 139mm 20mm Ml Kinectiv Tcp Ha 132d Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95199978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 32mm Loprfl Scr Ti T10 Ft Forefoot Cort St Sld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 951208430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M/l Taper Kinectiv Ha Stem Size 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951208431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95199979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 36mm Cmpr Ft Ti Mn Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 951208432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck K1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 951208433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Modular Neck S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95199981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.0mm X 25mm T2 Locking Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 951209157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ee Elev 46mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Gg Elev 48mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Medial Distal 12hole Right 162mm 2.7/3.5mm Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,816.25|FSC: 13; Default||Not reimbursed separately|5,816.25|FSC: 13; Default||External grouping not supported 951209159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Gg Elev 48mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Hh Elev 50mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 11mm Spc 125x10x2mm Ss 2.7/3.5mm Scr 9 Hl Loprfl Va Lc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,417.25|FSC: 13; Default||Not reimbursed separately|2,417.25|FSC: 13; Default||External grouping not supported 951209161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Elev Hh 50mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ii Elev 52mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 4.3mm 30mm T8 2mm Self Tap Locking Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951209163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ii Elev 52mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Jj Elev 54mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 4.3mm 32mm T8 2mm Self Tap Locking Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 951209165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Elev Jj 54mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Kk Elev 56mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95199990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.0mm X 30mm T2 Locking Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 951209167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Kk Elev 56mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ll Elev 58mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ll Elev 58mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Mm Elev 60mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Mm Elev 60mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Nn Elev 62mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Nn Elev 62mm 32mm Lngvt Hip Elev Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Oo Elev 64mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Oo Elev 64mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp Elev 66mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100361|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 26.5 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951209177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp Elev 66mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp Elev 68mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100362|EAP|Custom 951100362||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Harrier Alif 34x25x10mm 6 Deg|1|HUMANA [1294]||HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 951209179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Qu Elev 68mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Rr Elev 70mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100363|EAP|Custom 951100363||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Graft Putty Mastergraft Biologics 3cc Lx Fr Strl|1|HUMANA [1294]||HUMANA [11839]|1,073.10|FSC: 13; Default||Not reimbursed separately|1,073.10|FSC: 13; Default||External grouping not supported 951209181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ss Elev 72mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Tt Elev 74mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 3.5mm X 18mm Virage Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951209183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Uu Elev 76mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Vv Elev 78/80mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Spinal Polyaxial 4mm X 12mm Virage Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951209185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Cc Ofst 40mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Dd Ofst 42mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Ee 44mm 28mm Lngvt Hip Lip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ee Ofst 44mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Ff 46mm 28mm Lngvt Hip Lip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ff Ofst 46mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Gg 48mm 28mm Lngvt Hip Lip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100370|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Neurostimulator 60cm 3mm Vectris Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951209192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Gg Ofst 48mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Hh 50mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100371|EAP|Custom 951100371||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline-o 5.5mm 60mm Lordosed Ti|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951209194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Hh Ofst 50mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Ii 52mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100372|EAP|Custom 951100372||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Implant 10x38x28mm Ti 10degree|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 951209196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Ii 52mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Jj 54mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100392|EAP|Custom 51100392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Md Pr 13.3cm 4.6cm 455ml Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951209198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Jj 54mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Kk 56mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference 7mm 30mm Biocomposite Fast Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951209200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Kk 56mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Ll 58mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference 8mm 30mm Biocomposite Fast Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951209202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Ll 58mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Mm 60mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference 9mm 30mm Biocomposite Fast Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 951209204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Mm 60mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Nn 62mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 55mm Variax T8 Full Thread Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|FSC: 13; Default||Not reimbursed separately|789.33|FSC: 13; Default||External grouping not supported 951209206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Nn 62mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Oo 64mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 55mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|FSC: 13; Default||Not reimbursed separately|460.65|FSC: 13; Default||External grouping not supported 951209208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Oo 64mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Pp 66mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100384|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.0x4.8cm 350cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Pp 66mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Qu 68mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100385|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.7x4.0cm 365cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Qu 68mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ofst Rr 70mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100386|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.8x4.2cm 365cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Ss Ofst 72mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Tt Ofst 74mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100387|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.9x4.2cm 395cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Uu Ofst 76mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d 7mm Vv Ofst 78/80mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100388|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.0x4.2cm 410cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ee Oblq 44mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ff Oblq 46mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100389|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.2x4.2cm 425cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Gg Oblq 48mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Gg Oblq 48mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100390|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.4x4.2cm 440cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Hh Oblq 50mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Hh Oblq 50mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100391|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 13.7x4.3cm 470cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951209224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ii Oblq 52mm 28mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ii Oblq 52mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Jj Oblq 54mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Kk Oblq 56mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ll Oblq 58mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Mm Oblq 60mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Nn Oblq 62mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Oo Oblq 64mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Pp Oblq 66mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Qu Oblq 68mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Rr Oblq 70mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ss Oblq 72mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Tt Oblq 74mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Uu Oblq 76mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Vv Oblq 78/80mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 28mm Qu Hip Prm Alpha Rim Hood Drsl Strl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 32mm Ii 52 Std Hip Prm Alpha Drsl Strl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 32mm 54 Jj Std Hip Prm Alpha Drsl Strl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 32mm 56 Kk Std Hip Prm Alpha Drsl Strl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 58mm 32mm Ll Std Hip Prm Alpha Drsl Alft Alfts Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 60mm 32mm Mm Std Hip Prm Alpha Drsl Alft Alfts Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 62mm 32mm Nn Std Hip Prm Alpha Drsl Alft Alfts Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 64mm 32mm Oo Std Hip Prm Alpha Drsl Alft Alfts Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 66mm 32mm Pp Std Hip Prm Alpha Drsl Alft Alfts Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 68mm 32mm Qu Std Hip Prm Alpha Drsl Alft Alfts Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 52mm 32mm Ii Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 54mm 32mm Jj Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 56mm 32mm Kk Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 58mm 32mm Ll Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 60mm 32mm Mm Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 62mm 32mm Nn Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 64mm 32mm Oo Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 66mm 32mm Pp Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 68mm 32mm Qu Hip Prm Hood Alpha Drsl Alft Alfts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 22x41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sz 22/49mm Std Ins Das Epsilon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 59mm 28mm Std Hip Prm Drsl Epsln Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 28x71mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 59mm 32mm Std Hip Prm Drsl Epsln Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Neutral Liner Sz 32x69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sz 22/49mm Hod Ins Das Epsilon/durasul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 47mm 28mm Hip Prm Hood Drsl Epsln Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 53mm 28mm Hip Prm Hood Drsl Epsln Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 28x71mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Durasul Hooded Liner Sz 32x69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 15.9mm 72mm 36mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 13.9mm 72mm 40mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 16.9mm 74mm 36mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 14.9mm 74mm 40mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 17.9mm 76mm 36mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 15.9mm 76mm 40mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 18.9mm 78mm 36mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 16.9mm 78mm 40mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 19.9mm 80mm 36mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 17.9mm 80mm 40mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Std 72mm 36mm Lngvt Mdlr Cup|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 16.9mm 74mm 36mm Lngvt Hip Mdlr Cup|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 17.8mm 76mm 36mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 18.9mm 78mm 36mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d 80mm 36mm Lngvt Mdlr Cup|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Jj Ntrl 54mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Kk Ntrl 56mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mm Ntrl 60mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mm Ntrl 60mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Nn Ntrl 62mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Oo Ntrl 64mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Contin Trlg It Oo Ntrl 64mm 40mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Pp Ntrl 66mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Pp Ntrl 66mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Qu Ntrl 68mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Qu Ntrl 68mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rr Ntrl 70mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rr Ntrl 70mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ss Ntrl 72mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ss Ntrl 72mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Tt Ntrl 74mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Tt Ntrl 74mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Uu Ntrl 76mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Uu Ntrl 76mm 40mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vv Ntrl 78/80mm 36mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d A 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d B 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d C 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d D 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d E 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 28mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 28mm Arcomxl Hip Clr Cd Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 28mm Arcomxl Hip Clr Cd Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d B 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d C 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d D 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d E 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 32mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 32mm Arcomxl Hip Clr Cd Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d D 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d E 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 36mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 A 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 28mm Arcomxl Hip Hw Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 28mm Arcomxl Hip Hw Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp 3.0x22mm Cortical Mtp Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 951210133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 44mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|FSC: 13; Default||Not reimbursed separately|789.33|FSC: 13; Default||External grouping not supported 951210135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 38mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|FSC: 13; Default||Not reimbursed separately|789.33|FSC: 13; Default||External grouping not supported 951210137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Offset A 4mm 40mm Highcross Hip Flat Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|FSC: 13; Default||Not reimbursed separately|5,853.00|FSC: 13; Default||External grouping not supported 951210139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100512|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Imp 12.1x4.4cm 350cc Smt Rnd Mod Pls Prjtn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 951210141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100511|EAP|Custom 951100511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Camera Head True Hd 3mos Urology|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100513|EAP|Custom 951100513||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Mesh 12mmx23mm 10mm Height|1|HUMANA [1294]||HUMANA [11839]|11,430.00|FSC: 13; Default||Not reimbursed separately|11,430.00|FSC: 13; Default||External grouping not supported 951210145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 41 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 42 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100514|EAP|Custom 951100514||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb End Ring 12mm X 23mm Anterior 5 Degree|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951210147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 43 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 44 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100515|EAP|Custom 951100515||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Rd Set Tfa-1 Adh (bx/10)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 45 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 46 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100517|EAP|Custom 951100517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoclear Liberator Accessory Adaptor For Bronchoscopy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 47 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 48 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100518|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Acrysof Iq Vivity Toric Extend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951210155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 95198138|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Intraoccular 12.0 Diopter Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951210157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100528|EAP|Custom 951100528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Bb-tak Mtp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Joint Toe 20mm Smrt Toe Ii 10d Flt Ft/ankl Im Ntnl 1 Pc Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.24|FSC: 13; Default||Not reimbursed separately|4,440.24|FSC: 13; Default||External grouping not supported 951210161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Arthrodesis Titanium 2.5mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|FSC: 13; Default||Not reimbursed separately|1,908.00|FSC: 13; Default||External grouping not supported 951210163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp 3.0mm X20mm Cortical Mtp Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 951210165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 22 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxforce Mtp Petite 0-0 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 951210167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 23 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 24 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 Std 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 22 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100535|EAP|Custom 951100535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 63cm Fixed Curve Braided Transseptal Ml0 8.5f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100536|EAP|Custom 951100536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 63cm Fixed Curve Braided Transseptal Ml1 8.5f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100538|EAP|Custom 951100539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 81cm Fixed Curve Braided Transseptal Ml0 8.5f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100540|EAP|Custom 951100540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 81cm Fixed Curve Braided Transseptal Ml1 8.5f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100556|EAP|Custom 951100556||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Human Tissue Osteochondral 12mml|1|HUMANA [1294]||HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 951210191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100557|EAP|Custom 951100557||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Thoracic Tag Conform Sg Ac/ 34mm X 34mm X 15cm 22fr|1|HUMANA [1294]||HUMANA [11839]|58,962.00|FSC: 13; Default||Not reimbursed separately|58,962.00|FSC: 13; Default||External grouping not supported 951210193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100558|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 33cm 26fr 9.5mm 8.7mm Gore Dryseal Flex Hy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 951210195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 23 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 24 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100546|EAP|HCPCS C1822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Nrstm Senza Ipg Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,000.00|FSC: 13; Default||Not reimbursed separately|66,000.00|FSC: 13; Default||External grouping not supported 951210197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100547|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Acrysof Iq Vivity Toric Extend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951210199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100548|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Acrysof Iq Vivity Toric Extend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 951210201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 21 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 22 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.5mm 14mm Titanium Cannulated Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|FSC: 13; Default||Not reimbursed separately|1,357.80|FSC: 13; Default||External grouping not supported 951210203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 23 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 40mm Asns Sld Ns Jns Fx Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.24|FSC: 13; Default||Not reimbursed separately|4,755.24|FSC: 13; Default||External grouping not supported 951210205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 8.5mm 45mm Reline-o 2s Spine Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951210207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7.5mm 50mm Reline-o 2s Spine Polyaxial Iliac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951210209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 24 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 8.5mm 60mm Reline-o 2s Spine Polyaxial Iliac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951210211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 8.5mm 100mm Reline-o 2s Spine Polyaxial Iliac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 951210213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 10d 41 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Lck 0mm Ti Step Pre-contoured Yellow Lapidus Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,947.84|FSC: 13; Default||Not reimbursed separately|6,947.84|FSC: 13; Default||External grouping not supported 951210215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 10d 42 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 10d 43 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 10d 44 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 44 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 45 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 46 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 47 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100566|EAP|Custom 951100566||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Resilia Inspiris Aortic 23mm|1|HUMANA [1294]||HUMANA [11839]|43,500.00|FSC: 13; Default||Not reimbursed separately|43,500.00|FSC: 13; Default||External grouping not supported 951210222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 48 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm +3mm 21 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Size 3 8mm Ankle Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|FSC: 13; Default||Not reimbursed separately|8,622.00|FSC: 13; Default||External grouping not supported 951210224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm +3mm 22 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm +3mm 23 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tibial Infinity Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|FSC: 13; Default||Not reimbursed separately|18,927.00|FSC: 13; Default||External grouping not supported 951210226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 21 28mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 22 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz1/1+ 8mm Ankle Everlast Cross-linked|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|FSC: 13; Default||Not reimbursed separately|8,622.00|FSC: 13; Default||External grouping not supported 951210228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 23 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 41 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Syndesmosis Fibulink Stainless Steel Repair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951210230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 42 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 43 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Syndesmosis Fibulink Titanium Repair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951210232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 44 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 45 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100562|EAP|Custom 951100562||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Fibulink Removal Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951210234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 46 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 47 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Compression Small 9.34mm 4.15mm W/1.25 Kw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|FSC: 13; Default||Not reimbursed separately|5,832.00|FSC: 13; Default||External grouping not supported 951210236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Rx90 +5mm 48 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 42 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 43 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 44 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 45 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 46 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 47 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951100564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Compression Lg 9.34mm 4.15mm W/1.6 Kwire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|FSC: 13; Default||Not reimbursed separately|5,832.00|FSC: 13; Default||External grouping not supported 951210243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 +5mm 48 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 22 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 23 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 23 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 22 32mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 23 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 36mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J Ntrl 40mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 44mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 44mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J Ntrl 44mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 40mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 40mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 40mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 40mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 40mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 44mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 44mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 44mm Arcomxl Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 40mm Arcomxl Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951211062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 17mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 18mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 20mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 22mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 9.5mm Arcos Hi Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 11mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 12mm 1 Pc Rev Arcos Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 13mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 14mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 15mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 17mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 18mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175x20mm 1 Pc Rev Arcos Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 22mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 9.5mm Arcos Hi Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 11mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 210x12mm 1 Pc Rev Arcos Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 13mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 14mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 15mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 16mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 210x17mm 1 Pc Rev Arcos Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 18mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 20mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 22mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 9.5mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 210x11mm 1 Pc Rev Arcos Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 12mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 13mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 14mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 15mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 16mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 210x17mm 1 Pc Rev Arcos Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 18mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 20mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 22mm Arcos Hi Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Reach Por Strg Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Reach Por Strg Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Reach Por Strg Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Reach Por Strg Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Reach Por Strg Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 9mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 11mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 13mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 9mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 11mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 13mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 9mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 11mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 13mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 15mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 15mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 200mm 15mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 15mm Bmtrc Hip Rt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 15mm Bmtrc Hip Lt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 15mm Bmtrc Hip Rt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 15mm Bmtrc Hip Lt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 15mm Bmtrc Hip Rt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 15mm Bmtrc Hip Lt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 9mm Bmtrc Hip Rt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 9mm Bmtrc Hip Lt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 11mm Bmtrc Hip Rt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 11mm Bmtrc Hip Lt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 13mm Bmtrc Hip Rt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 13mm Bmtrc Hip Lt Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 9mm Bmtrc Hip Rt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 9mm Bmtrc Hip Lt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 11mm Bmtrc Hip Rt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 11mm Bmtrc Hip Lt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 13mm Bmtrc Hip Rt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 13mm Bmtrc Hip Lt Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 9mm Bmtrc Hip Rt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 9mm Bmtrc Hip Lt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 11mm Bmtrc Hip Rt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 11mm Bmtrc Hip Lt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 13mm Bmtrc Hip Rt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 250mm 13mm Bmtrc Hip Lt Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951211139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 9mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 9mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 9mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 9mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 9mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 9mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 11mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 11mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 13mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 13mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Prft Bmtrc Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Prft Bmtrc Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|FSC: 13; Default||Not reimbursed separately|21,103.50|FSC: 13; Default||External grouping not supported 951211179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 9mm Rt Hip Clrls Rev Strg Nk Por Bmtrc 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 9mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 10mm Clrls Strg Revise Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 10mm Clrls Revise Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Clrls Rev Strg Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 12mm Clrls Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 12mm Rev Clrls Strg Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Collorless Bmtrc Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 14mm Clrls Revise Bmtrc Por Hip Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 14mm Clrls Rev Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Clrls Rev Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Clrls Revise Strg Bmtrc Por Lt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Clrls Revise Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Clrls Rev Bmtrc Por Hip Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Clrls Rev Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Clrls Revise Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|FSC: 13; Default||Not reimbursed separately|21,148.50|FSC: 13; Default||External grouping not supported 951211198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 9mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 9mm Clrls Revies Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 10mm Clrls Strg Revise Bmtrc Por Lt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Clrls Rev Bmtrc Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Clrls Rev Strg Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 12mm Clrls Bmtrc Por Hip Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 12mm Clrls Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Collorless Rev Strg Bmtrc Por Lt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 14mm Collorless Rev Strg Bmtrc Por Rt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 14mm Clrls Rev Strg Bmtrc Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Clrls Rev Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Strg Clrls Revise Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm 16mm Clrls Rev Bmtrc Por Rt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Clrls Revise Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Clrls Rev Strg Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Clrls Revise Bmtrc Por Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Clrls Rev Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Collorless Revise Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|FSC: 13; Default||Not reimbursed separately|22,063.50|FSC: 13; Default||External grouping not supported 951211217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 9mm Clrls Revies Strg Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 9mm Clrls Rev Bmtrc Por Std Lt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 10mm Rev Collorless Strg Bmtrc Rt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 10mm Hip Lt Clrls Rev Strg Nk Por Bmtrc 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 11mm Clrls Strg Revise Bmtrc Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 11mm Clrls Strg Revise Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 12mm Clrls Revise Bmtrc Por Hip Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 12mm Clrls Revise Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 13mm Clrls Rev Bmtrc Por Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 13mm Clrls Strg Rev Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 14mm Clrls Resvised Bmtrc Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 14mm Clrls Rev Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Clrls Revise Strg Bmtrc Por Rt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Clrls Revise Strg Bmtrc Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm 16mm Clrls Revise Bmtrc Por Hip Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 16mm Clrls Revise Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Clrls Bmtrc Por Hip Rt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Clrls Revise Bmtrc Por Lt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 18mm Nclr Bmtrc Por Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 18mm Clrls Rev Bmtrc Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|FSC: 13; Default||Not reimbursed separately|23,565.00|FSC: 13; Default||External grouping not supported 951211237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 10mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 11mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 12mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 13mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 14mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 18mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 19mm Prm Intgr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 11mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 12mm Prm Intgr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|FSC: 13; Default||Not reimbursed separately|22,515.00|FSC: 13; Default||External grouping not supported 951211987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz3 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz4 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz4 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz4 5mm 41x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz4 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 0d 5 31x31x5mm Kn Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz5 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz5 5mm 41x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz5 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz6 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz6 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz6 5mm 41x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz6 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951212000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 0d 7 5mm 46x34x5mm Kn Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951212001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Full 10mm Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|FSC: 13; Default||Not reimbursed separately|10,888.50|FSC: 13; Default||External grouping not supported 951212002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 5mm Tib Lt Mdl Rl Trb Mtl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 20mm Rl/lm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 5mm Tib Rmll Trb Mtl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2mm 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 Full 10mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|FSC: 13; Default||Not reimbursed separately|10,888.50|FSC: 13; Default||External grouping not supported 951212007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 5mm Tib Lt Mdl Rl Trb Mtl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 10mm Rl/lm Tib Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3mm 15mm Rl/lm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 20mm Rl/lm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 5mm Tib Rmll Trb Mtl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3mm 10mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3mm 15mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3mm 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 10mm Rl/lm Tib Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4mm 15mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4mm 10mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 15mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Full 10mm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|FSC: 13; Default||Not reimbursed separately|10,888.50|FSC: 13; Default||External grouping not supported 951212026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Trab Metal Tib Agmt Blk 15mm Rlat/lmed Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5mm 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 15mm Ll/rm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5mm 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6mm 15mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Trab Metal Tib Agmt Blk 5mm Llat/rmed Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 10mm Ll/rm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 15mm Ll/rm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6mm 30mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|FSC: 13; Default||Not reimbursed separately|6,436.50|FSC: 13; Default||External grouping not supported 951212040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm Full 10mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|FSC: 13; Default||Not reimbursed separately|10,888.50|FSC: 13; Default||External grouping not supported 951212041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm 5mm Rl/lm Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 10mm Rl/lm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm 15mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 20mm Rl/lm Kn Tib Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm 5mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm 10mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm 15mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|FSC: 13; Default||Not reimbursed separately|5,470.50|FSC: 13; Default||External grouping not supported 951212048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7mm 20mm Kn Tib Trb Mtl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Lcck Nxgn Sm Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Lcck Nxgn Sm Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 40mm Lcck Nxgn Sm Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 40mm Lcck Nxgn Sm Cone Tpr Rt Trb Mtl Compete Kn Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 50mm Lcck Nxgn Sm Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 50mm Lcck Nxgn Sm Cone Tpr Rt Trb Mtl Compete Kn Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 31mm 31mm Med Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 31mm 36mm Med Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 34mm 41mm Med Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 34mm 46mm Med Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 34mm 51mm Lg Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 34mm 52mm Lg Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 36mm 55mm Lg Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 36mm 56mm Lg Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 36mm 60mm Lg Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 36mm 60mm Lg Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 38mm 67mm Lg Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 38mm 68mm Lg Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Lcck Nxgn Med Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Lcck Nxgn Med Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 40mm Lcck Nxgn Med Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 50mm Lcck Nxgn Med Cone Kn Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 50mm Lcck Nxgn Med Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 50mm Cone Lg Lt Trb Mtl Ng Lcck And Rh Kn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 50mm Lcck Nxgn Lg Cone Kn Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Sm Cone Diaphysis Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Sm Cone Kn Rt Diaphysis Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Med Cone Kn Diaphysis Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Nxgn Med Cone Kn Rt Diaphysis Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Lg Cone Diaphysis Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 30mm Lg Cone Diaphysis Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|FSC: 13; Default||Not reimbursed separately|10,975.50|FSC: 13; Default||External grouping not supported 951212080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 35mm Med Cone Metaphysis Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 35mm Med Cone Metaphysis Rt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 35mm Lg Cone Metaphysis Lt Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 35mm Nxgn Lg Cone Kn Rt Metaphysis Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|FSC: 13; Default||Not reimbursed separately|13,335.00|FSC: 13; Default||External grouping not supported 951212084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 52-15mm Sm Full Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 59-15mm Full Med Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 59-30mm Full Med Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 30-15mm Nxgn 59mm Cone Med Stp Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 15-30mm Nxgn 59mm Med Stp Cone Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 67-15mm Full Cone Lg Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 67-30mm Full Cone Lg Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 30-15mm Nxgn 67mm Cone Lg Stp Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 15-30mm Nxgn 67mm Cone Lg Stp Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|FSC: 13; Default||Not reimbursed separately|11,707.50|FSC: 13; Default||External grouping not supported 951212093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn C 5mm Post Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 10mm Nxgn C Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn C 5mm Dist Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn C 10mm Dist Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn C Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn C Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn D 5mm Fem Post Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn D 10mm Kn Dist Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn D Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn D Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 10mm Nxgn E Post Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 10mm Nxgn E Kn Dist Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Trab Metal Aug Blk Distal Only Size E 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn E Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn F Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 10mm Nxgn F Kn Post Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|FSC: 13; Default||Not reimbursed separately|5,155.50|FSC: 13; Default||External grouping not supported 951212109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 10mm Nxgn F Kn Dist Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn F Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn F Kn Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|FSC: 13; Default||Not reimbursed separately|5,805.00|FSC: 13; Default||External grouping not supported 951212112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 54x8.5mm Ib2 7d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 54x14mm Ib2 13d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 54x20.5mm Ib2 20d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 54x8.5mm Ib2 16d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 54x13mm Ib2 26d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 9.5mm Ib2 7d 59 Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 59x15mm Ib2 13d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 59x22mm Ib2 20d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 59x9mm Ib2 16d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 59x14mm Ib2 26d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 64x10mm Ib2 7d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 64x16.5mm Ib2 13d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 64x24mm Ib2 20d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 64x10mm Ib2 16d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 15mm Ib2 26d 64 Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 69x11mm Ib2 7d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 69x17.5mm Ib2 13d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 69x26mm Ib2 20d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 69x10.5mm Ib2 16d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 69x16.5mm Ib2 26d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 74x11.5mm Ib2 7d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 74x19mm Ib2 13d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 74x28mm Ib2 20d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 74x11.5mm Ib2 16d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 74x17mm Ib2 26d Kn Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|FSC: 13; Default||Not reimbursed separately|8,151.00|FSC: 13; Default||External grouping not supported 951212137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Aug Ib2 Kn Tib Tiv Atch Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|523.50|FSC: 13; Default||Not reimbursed separately|523.50|FSC: 13; Default||External grouping not supported 951212138|EAP|HCPCS 951212138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Sw Mg2 Srg Ss Kn Ptlr Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951212139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Fem Stm Lgc Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 951212140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Nxgn Tib Wdg Atch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 951212141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Aug Nxgn Kn Fem Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 951212142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn B Kn Post Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951212143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn B Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951212144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 10mm Nxgn B Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951212145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 00 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 00 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 00 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 00 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 0 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 1 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 2 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 3 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 4mm Nt Kn2 4 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 00 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 00 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 00 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 00 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 0 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn L/l Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Rt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 1 Kn Rl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Fem 8mm Nt Kn2 2 Kn Lt Mdl Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 951212936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 +4 Kn Lt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 +4mm Kn Lt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 +4mm Kn Lt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 +4mm Kn Rt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 +4mm Kn Rt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 +4mm Kn Rt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 +4m Kn Rt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 00/0 +14mm Kn Lt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0/1 +14mm Kn Lt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 .5 +14mm Kn Lt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2/3 +14mm Kn Lt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 .75 +14mm Kn Lt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 00/0 +14mm Kn Rt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 .5 +14mm Kn Rt Rev Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|FSC: 13; Default||Not reimbursed separately|11,502.00|FSC: 13; Default||External grouping not supported 951212950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 +4mm Kn Lt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 +4mm Kn Lt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 +4mm Kn Lt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 +4mm Kn Lt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 +4mm Kn Lt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 +4mm Kn Rt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 +4mm Kn Rt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 +4mm Kn Rt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 +4mm Kn Rt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 +4mm Kn Rt Cmnt Mdlr Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0-1 +14mm Kn Lt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1-2 +14mm Kn Lt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2-3 +14mm Kn Rt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3-4 +14mm Kn Lt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0-1 +14mm Kn Rt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1-2 +14mm Kn Rt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2-3 +14mm Kn Rt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3-4 +14mm Kn Rt Cmnt Mdlr Cnstrn Ti Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|FSC: 13; Default||Not reimbursed separately|9,174.00|FSC: 13; Default||External grouping not supported 951212968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 40mm 15mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 10mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Orth 75mm 12mm Ib2 Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Orth 75mm 13mm Ib2 Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 14mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Orth 75mm 15mm Ib2 Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 16mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 17mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 18mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 19mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 20mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 22mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 24mm Kn Tiv Ib2 Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|FSC: 13; Default||Not reimbursed separately|6,466.50|FSC: 13; Default||External grouping not supported 951212981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 67mm 90mm 12.7mm Kn Tiv Mg2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,598.00|FSC: 13; Default||Not reimbursed separately|5,598.00|FSC: 13; Default||External grouping not supported 951212982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 13mm Nxgn Strg Kn Tib Rot Hng 200mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|FSC: 13; Default||Not reimbursed separately|3,280.50|FSC: 13; Default||External grouping not supported 951212983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 14mm Nxgn Strg Rot Hng 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|FSC: 13; Default||Not reimbursed separately|3,280.50|FSC: 13; Default||External grouping not supported 951212984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 16mm Nxgn Strg Kn Tib Rot Hng 200mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|FSC: 13; Default||Not reimbursed separately|3,280.50|FSC: 13; Default||External grouping not supported 951212985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 200mm 17mm Nxgn Strg Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|FSC: 13; Default||Not reimbursed separately|3,280.50|FSC: 13; Default||External grouping not supported 951212986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 18mm Nxgn Strg Kn Tib Rot Hng 200mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|FSC: 13; Default||Not reimbursed separately|3,280.50|FSC: 13; Default||External grouping not supported 951212987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Straight Stem Ext 12.7mm Dia X 75mm (30mm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|FSC: 13; Default||Not reimbursed separately|3,280.50|FSC: 13; Default||External grouping not supported 951212988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 10mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 11mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 12mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 13mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 14mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 15mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 16mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 17mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 18mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 19mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 20mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951212999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 22mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 24mm Nxgn Flut Kn Tib Tiv Shrp Repl Scr 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 10mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 11mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 12mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 13mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 14mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 130mm 15mm Nxgn Kn Fem Tiv Shrp Flut Repl Scr 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 16mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 18mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 19mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 20mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 22mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 175mm 24mm Shrp Repl Scr Kn Fem Tiv Nxgn Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 30mm 75mm 13mm Cmnt Kn Tiv Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 60mm 105mm 13mm Cmnt Kn Tiv Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 100mm 145mm 13mm Cmnt Kn Tiv Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|FSC: 13; Default||Not reimbursed separately|3,139.50|FSC: 13; Default||External grouping not supported 951213016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 100mm 11mm Nxgn Ofst Kn Tib Tiv Repl Scr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,323.50|FSC: 13; Default||Not reimbursed separately|2,323.50|FSC: 13; Default||External grouping not supported 951213017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 200mm 12mm Kn Fem Tiv Nxgn Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Offset Stem Ext 13mm Dia X 200mm (155mm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 200mm 14mm Kn Fem Tiv Nxgn Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 200mm 155mm 15mm Kn Fem Tiv Nxgn Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Offset Stem Ext 16mm Dia X 200mm (155mm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 200mm 17mm Kn Fem Tiv Nxgn Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 200mm 18mm Kn Fem Tiv Nxgn Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|FSC: 13; Default||Not reimbursed separately|4,278.00|FSC: 13; Default||External grouping not supported 951213024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 60mm Nt Kn2 Tib Ti Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 90mm Nt Kn2 Kn Tib Ti Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 120mm Nt Kn2 Tib Ti Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 155mm Nt Kn2 Tib Ti Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 180mm Nt Kn2 Tib Ti Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Xtn 215mm Nt Kn2 Tib Ti Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 125mm 10.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 125mm 12.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 125mm 14.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 125mm 16.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 125mm 18.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 9.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 11.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 13.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 15.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 200mm 10.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 200mm 12.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 200mm 14.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 10.5mm Rev Smth Kn Ti Nt Kn2 Crv Bw Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 12.5mm Rev Smth Kn Ti Nt Kn2 Crv Bw Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 10.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 12.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Rev Straight Smooth Stem 14.5mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 16.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm 18.5mm Rev Smth Kn Ti Nt Kn2 Strg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|FSC: 13; Default||Not reimbursed separately|3,673.50|FSC: 13; Default||External grouping not supported 951213049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 12.5mm Rev Kn Ti Nt Kn2 Flut Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 14.5mm Rev Kn Ti Nt Kn2 Flut Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 16.5mm Rev Kn Ti Nt Kn2 Flut Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 18.5mm Rev Kn Ti Nt Kn2 Flut Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 155mm 20.5mm Rev Kn Ti Nt Kn2 Flut Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 175mm 12.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 175mm 14.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 175mm 16.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 175mm 18.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 175mm 20.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 175mm 22.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 11.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 12.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 13.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 14.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 16.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 18.5mm Rev Kn Ti Nt Kn2 Strg Flut Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|FSC: 13; Default||Not reimbursed separately|6,880.50|FSC: 13; Default||External grouping not supported 951213066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Full 10mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|FSC: 13; Default||Not reimbursed separately|3,789.00|FSC: 13; Default||External grouping not supported 951213067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Full 10mm Kn Tib Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|FSC: 13; Default||Not reimbursed separately|3,789.00|FSC: 13; Default||External grouping not supported 951213068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 16d 2 Hlf Wdg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Nxgn 26d 2 Hlf Wdg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 8.7mm Nxgn 22d 2 3rd Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 7.6mm Nxgn 7d 2 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Hlf 5mm Kn Tib Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Hlf 10mm Kn Tib Prect Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 9.5mm Nxgn 16d 3 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 15mm Nxgn 26d 3 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 9.5mm Nxgn 22d 3 3rd Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 8mm Nxgn 7d 3 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 Hlf 5mm Kn Tib Prect Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 Full 10mm Kn Tib Rot Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|FSC: 13; Default||Not reimbursed separately|3,789.00|FSC: 13; Default||External grouping not supported 951213080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 9.5mm Nxgn 16d 4 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 15mm Nxgn 26d 4 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 8mm Nxgn 7d 4 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10.5mm Nxgn 16d 5 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 17mm Nxgn 26d 5 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10mm Nxgn 22d 5 3rd Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 9mm Nxgn 7d 5 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10.5mm Nxgn 16d 6 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 17mm Nxgn 26d 6 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10mm Nxgn 22d 6 3rd Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 9mm Nxgn 7d 6 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 Hlf 5mm Kn Tib Prect Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 Full 10mm Kn Tib Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|FSC: 13; Default||Not reimbursed separately|3,789.00|FSC: 13; Default||External grouping not supported 951213093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 11.5mm Nxgn 16d 7 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 18.5mm Nxgn 26d 7 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10.5mm Nxgn 22d 7 3rd Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10mm Nxgn 7d 7 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 Hlf 5mm Kn Tib Prect Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 11.5mm Nxgn 16d 8-9 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 18.5mm Nxgn 26d 8-9 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 10mm Nxgn 7d 8 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 8-9 Hlf 5mm Kn Tib Prect Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 11mm Nxgn 7d 9 Full Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn C Kn Ant Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn D Kn Ant Tiv Pmma Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn E Kn Ant Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn F Kn Ant Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 5mm Nxgn G Kn Ant Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|FSC: 13; Default||Not reimbursed separately|2,922.00|FSC: 13; Default||External grouping not supported 951213108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 7mm Ng Lgc 3d 2 Full Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 2 Hlf Flut 5mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 2 Hlf Flut 10mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib Ng Lgc 16d 3d 3 Hlf Kn Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 7mm Ng Lgc 3d 3 Full Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 3 Hlf Flut 5mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 3 Hlf Flut 10mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib Ng Lgc 16d 3d 4 Hlf Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 7mm Ng Lgc 3d 4 Full Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 4 Hlf Flut 5mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 4 Hlf Flut 10mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib Ng Lgc 16d 3d 5 Hlf Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 7mm Ng Lgc 3d 5 Full Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 5 Hlf Flut 5mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 5 Hlf Flut 10mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951213922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 7mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 8mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 9mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 10mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 4mm Nxgn Kn Tiv Pmma Uhmwpe Prect Cmnt Mdlr Fx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Pur Pur Strp 58x40x1mm Nxgn 1 Mic Kn Tiv Pmma Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Pur Pur Strp 62x41mm Nxgn 2 Mic Kn Tiv Pmma Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 89x53mm Nxgn 9 Mac Kn Tiv Pmma Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 89x57mm Nxgn 10 Mac Kn Tiv Pmma Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 4mm 4+ Std Mtl Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Ylw Strp 66x42mm Nxgn Optn 3 Kn Tiv Cmnt Mdlr Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Ylw Ylw Strp 66x46mm Nxgn Optn 4 Kn Tiv Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Grn Grn Strp 74x46mm Nxgn Optn 5 Kn Tiv Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Grn Grn Strp 74x50mm Optn Nxgn 6 Kn Tiv Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x51mm Optn Nxgn 7 Kn Tiv Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x54mm Optn Nxgn 8 Kn Tiv Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Option Stemmed Tibial Plate Size 6+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Pur Pur Strp 48x10x1mm Optn Nxgn 7d Mic Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Pur Pur Strp 62x41x2mm Optn Nxgn 7d Mic Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Ylw Ylw Strp 66x42x3mm Optn Nxgn 7d 3 Std Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Ylw Ylw Strp 66x46x4mm Optn Nxgn 7d Std Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 3mm Nxgn Flut Kn Corundum Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Grn Grn Strp 74x46x5mm Optn Nxgn 7d Std Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Grn Grn Strp 74x50x6mm Optn Nxgn 7d 6 Std Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 5mm Nxgn Flut Kn Corundum Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x50x7mm Optn Nxgn 7d 7 Std Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x54x8mm Optn Nxgn 7d Std Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Strp 89x53x9mm Optn Nxgn 7d Mac Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 89x57x10mm Optn Nxgn 7d Mac Flut Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Pur Pur Strp 58x40x1mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Pur Pur Strp 62x41x2mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Ylw Ylw Strp 66x42x3mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Ylw Ylw Strp 74x46x4mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Grn Grn Strp 74x46x5mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Grn Grn Strp 82x50x6mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x50x7mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 89x54x8mm Optn Nxgn 3d Flut Kn Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Lt Size 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Lt Set Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 .25 Kn Lt Set Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 Kn Lt Cmnt Mdlr Stm Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Lt Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Lt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Lt Size 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Lt Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Lt Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Lt Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Lt Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Lt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Rt Size 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Rt Cmnt Mdlr Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 .25 Kn Rt Set Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 Kn Rt Cmnt Mdlr Stm Npor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Rt Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Rt Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Stem Tibial Baseplate Rt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Rt Size 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Rt Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Rt Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Rt Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Rt Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Np Pgls Stem Tibial Baseplate Rt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 00 Kn Lt Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Lt Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Lt Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Lt Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Lt Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Lt Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Lt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 00 Kn Rt Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Rt Cmnt Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Rt Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Rt Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Rt Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Rt Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Modular Cement Tibial Baseplate Rt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 1 Flut Kn Prect Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 2 Flut Kn Tib Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 2 Flut Kn Zml Prect Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 3 Flut Kn Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 3 Flut Kn Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 4 Flut Kn Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 4 Flut Kn Zml Prect Cmnt Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 5 Flut Kn Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 5 Flut Kn Zml Prect Cmnt Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn 6 Flut Kn Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 6 Flut Kn Prect Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 7 Flut Kn Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 7 Flut Kn Zml Prect Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 8 Flut Kn Zml Cmnt Mbl Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Optn Nxgn 8 Flut Kn Zml Prect Mbl Stemmable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 00 Kn Lt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Lt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 Kn Lt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 Kn Lt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 Kn Lt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 Kn Lt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Lt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 Kn Lt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 Kn Lt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 Kn Lt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 Kn Lt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 5 Kn Lt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Rt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 Kn Rt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 Kn Rt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 Kn Rt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 Kn Rt Rsrfc Mdlr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 Kn Rt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 Kn Rt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 2 Kn Rt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 3 Kn Rt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 4 Kn Rt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 5 Kn Rt Mdlr Stm Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 45mm Nxgn Kn Tib Gtt Dn Plt Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 75mm Nxgn Kn Tib Gtt Dn Plt Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mgii Knee Slf-tap Bone Str Scrw 6.5mm Diax20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mgii Knee Slf-tap Bone Str Scrw 6.5mm Diax25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Aug 30mm 6.5mm Mg2 Kn Tiv St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Aug 35mm 6.5mm Mg2 Kn Tiv St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mgii Knee Slf-tap Bone Str Scrw 6.5mm Diax40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mgii Knee Slf-tap Bone Str Scrw 6.5mm Diax55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Aug 60mm 6.5mm Mg2 Kn Tiv St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 951214045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bsplt Nxgn Kn Flx Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951214046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bsplt Nxgn Kn Mdlr Lck Flx Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 951214047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bsplt Lcck Nxgn Kn Mdlr Lck Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 951214048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm Nxgn Kn Tib Gtt Dn Plg Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,010.00|FSC: 13; Default||Not reimbursed separately|2,010.00|FSC: 13; Default||External grouping not supported 951214049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 3-4 Kn Mdlr Keel Stemmable Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,180.00|FSC: 13; Default||Not reimbursed separately|3,180.00|FSC: 13; Default||External grouping not supported 951214050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 21x42mm Kn Lt Mdl Rl Uncmp Prect Mg Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 21x42mm Kn Rmll Uncmp Prect Mg Zml Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ 21x44mm Kn Lt Mdl Rl Uncmp Prect Mg Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ 21x44mm Kn Rmll Uncmp Prect Mg Zml Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Reg+ 25x50mm Kn Rmll Uncmp Mg Zml Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ 28x56mm Kn Lt Mdl Rl Uncmp Prect Mg Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg++ 28x60mm Kn Lt Mdl Rl Uncmp Prect Mg Zml Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg++ 28x60mm Kn Rmll Uncmp Prect Mg Zml Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951214058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Mdl Prt Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Lt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Rt Mdl Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951214074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Ptlfem Cmnt Gndr Sol Nxgn Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,328.00|FSC: 13; Default||Not reimbursed separately|11,328.00|FSC: 13; Default||External grouping not supported 951214075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 25x40x8mm Kn Uncmp Mach Mld Uhmwpe Mg Strl Ser 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 25x40x12mm Kn Ser 1 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 25x40x14mm Kn Uncmp Mach Mld Uhmwpe Mg Strl Ser 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 27x44x14mm Kn Uncmp Mach Mld Uhmwpe Mg Strl Ser 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 30x48x8mm Kn Tib Uncmp Mach Mld Uhmwpe Mg Strl S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 30x48x12mm Kn Tib Uncmp Mach Mld Uhmwpe Mg Strl S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 30x48x14mm Kn S3 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 32x52x12mm Kn S4 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 32x52x14mm Kn S4 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M/g Uni Knee Tibial Articular Surf Series 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 35x56x10mm Kn Ser 5 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 35x56x12mm Kn Ser 5 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 35x56x14mm Kn Ser 5 Uncmp Mach Mld Uhmwpe Mg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4 9mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4 11mm Kn Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4 13mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5-6 9mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5-6 11mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5-6 13mm Kn Uhmwpe Uncmp Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951214097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951214871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Vngrd Mono-lck Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Vngrd Mono-lck Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Vngrd Mono-lck Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm Kn Por Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|FSC: 13; Default||Not reimbursed separately|3,069.00|FSC: 13; Default||External grouping not supported 951214970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf Por Tib Tray Xsm/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 68mm Sm Por Prfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 72mm Med Por Prfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf Por Tib Tray Large/76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 80mm Xl Por Prfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Vngrd Cmplt Kn Sys Strl Ltx Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm Vngrd Cmplt Kn Sys Strl Ltx Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm Regenerex Kn Prm Cr Post Stab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|FSC: 13; Default||Not reimbursed separately|4,269.00|FSC: 13; Default||External grouping not supported 951214985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 65x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 70x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951214999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 75x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 80x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 85x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 85x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 85x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 85x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 85x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Por 85x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|FSC: 13; Default||Not reimbursed separately|6,669.00|FSC: 13; Default||External grouping not supported 951215019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm As Mx Kn Prm I Beam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 30mm As Mx Kn Prm I Beam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm As Mx Kn Prm Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 10mm As Mx Kn Prm Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 12.5mm As Mx Kn Prm Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 15mm Prm Fin Xtn Bmt As Mx Ti Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Mdlr I-beam Shrt Lg Hip Mtphsl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm Agc Flut Kn Bs Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm Agc Flut Kn Bs Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm Agc Flut Kn Bs Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm Agc Flut Kn Bs Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 40mm Prft Mdlr Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm Mdlr Prft Regenerex Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 40mm Bmt Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm Mdlr Spline Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951215034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tibtry Tpr Cap Regenerex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951215035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tibtry Kn Stm Tpr Plg Bmt Mxm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 951215036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Agc Kn Tib Lck Mdlr Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951215037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 10mm Ti Shrt Tib Lck Plg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 951215038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Uncmp Vngrd M Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951215039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Uncmp Vngrd M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951215040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Uncmp Vngrd M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951215041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Uncmp Vngrd M Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951215042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Uncmp Pg Oxfd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Uncmp Oxfd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Uncmp Oxfd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Pg Oxfd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Kn Uncmp Oxfd Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Prt Kn Phs 3 Twn Pg Uncmp Oxfd Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Prt Kn Phs 3 Twn Pg Uncmp Oxfd Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Prt Kn Phs 3 Twn Pg Uncmp Oxfd Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Prt Kn Phs 3 Twn Pg Uncmp Oxfd Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Prt Kn Phs 3 Twn Pg Uncmp Oxfd Cocrmo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951215052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxford Ii Bearing Size 1 Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxford Ii Bearing Size 3 Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxford Ii Bearing Size 8 Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 3mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 4mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 5mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 6mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 7mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 8mm Oxfd Arcm Kn Lt Mnscs Phs 3 Uncmp Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 951215832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Ascnt Kn Prm Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Ascnt Kn Prm Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Ascnt Kn Prm Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Ascnt Kn Prm Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Ascnt Kn Prm Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Ascnt Kn Prm Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Ascnt Arcm Kn Prm Dir Cmpr Mld Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951215890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx20mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx20mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx20mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx20mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx20mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx20mm Ascnt Kn Ant Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|FSC: 13; Default||Not reimbursed separately|3,076.50|FSC: 13; Default||External grouping not supported 951215926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 1/75mmx11mm Kn Ascnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,454.50|FSC: 13; Default||Not reimbursed separately|3,454.50|FSC: 13; Default||External grouping not supported 951215927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Ascnt Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,454.50|FSC: 13; Default||Not reimbursed separately|3,454.50|FSC: 13; Default||External grouping not supported 951215928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Ascnt Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,454.50|FSC: 13; Default||Not reimbursed separately|3,454.50|FSC: 13; Default||External grouping not supported 951215929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 28mm Btn Sut Hl Construct Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|FSC: 13; Default||Not reimbursed separately|2,590.50|FSC: 13; Default||External grouping not supported 951215930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 31mm Btn Sut Hl Construct Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|FSC: 13; Default||Not reimbursed separately|2,590.50|FSC: 13; Default||External grouping not supported 951215931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 34mm Btn Sut Hl Construct Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|FSC: 13; Default||Not reimbursed separately|2,590.50|FSC: 13; Default||External grouping not supported 951215932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 37mm Btn Sut Hl Construct Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|FSC: 13; Default||Not reimbursed separately|2,590.50|FSC: 13; Default||External grouping not supported 951215933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Vngrd 360 Kn Mdlr Revison Prm 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm Vngrd 360 Kn Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm Ofst Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|FSC: 13; Default||Not reimbursed separately|6,186.00|FSC: 13; Default||External grouping not supported 951215951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Ntrl Ofst Kn Adpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,052.00|FSC: 13; Default||Not reimbursed separately|2,052.00|FSC: 13; Default||External grouping not supported 951215952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 2.5mm Ofst Kn Adpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,052.00|FSC: 13; Default||Not reimbursed separately|2,052.00|FSC: 13; Default||External grouping not supported 951215953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 5mm Ofst Kn Adpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,052.00|FSC: 13; Default||Not reimbursed separately|2,052.00|FSC: 13; Default||External grouping not supported 951215954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib Ofst Kn Adpr Plg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,087.50|FSC: 13; Default||Not reimbursed separately|1,087.50|FSC: 13; Default||External grouping not supported 951215955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib Ofst Kn Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 951215956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib Ntrl Ofst Kn Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 951215957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2.5mm Ofst Kn Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 951215958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5mm Ofst Kn Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 951215959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm Kn Intlk Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|FSC: 13; Default||Not reimbursed separately|6,807.00|FSC: 13; Default||External grouping not supported 951215968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 10mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 12mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 14mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 16mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 18mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 20mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 22mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 24mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 10mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 12mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 14mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 16mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 18mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 20mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 22mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 24mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 12mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 14mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 16mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 18mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 20mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 120mm 22mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951215990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 16mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951215999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22mm Vngrd 360 Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|FSC: 13; Default||Not reimbursed separately|4,308.00|FSC: 13; Default||External grouping not supported 951216002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 12mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 14mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 160mm 16mm Smth Rev Kn Fem Vngrd 360 Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 18mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 20mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 160mm 22mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 12mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 14mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 16mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 18mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 20mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 200mm 22mm Vngrd 360 Bw Kn Smth Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 951216014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 10mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 12mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 14mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 16mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 18mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 20mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 22mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 40mm 24mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 10mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 12mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 80mm 14mm Vngrd 360 Kn Grit Blast Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|FSC: 13; Default||Not reimbursed separately|3,670.50|FSC: 13; Default||External grouping not supported 951216775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 E-f 20mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 E-f 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x14mm Kn Tib Reg Constraint Crcte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x17mm Kn Tib Reg Constraint Cr Aug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h 58x40x10mm Kn Ant Cnstrn Cr Mach Mld Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h 58x40x12mm Kn Ant Cnstrn Cr Mach Mld Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h 58x40x14mm Kn Ant Cnstrn Cr Mach Mld Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h 58x40x20mm Kn Ant Cnstrn Cr Mach Mld Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h 58x40x23mm Kn Ant Cnstrn Cr Mach Mld Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 9mm Kn Lt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 11mm Kn Lt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 13mm Kn Lt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 16mm Kn Lt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 19mm Kn Lt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 9mm Kn Rt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 11mm Kn Rt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 13mm Kn Rt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 16mm Kn Rt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 19mm Kn Rt Prlng Srfc Cngr Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Lt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Rt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Rt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Rt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Rt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Rt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Lt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Rt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Uhmwpe Cr Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Rt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Lt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Lt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Lt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Rt Uhmwpe Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Rt Cngr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 11mm Lt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 16mm Kn Lt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 19mm Lt Prlng Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 22mm Lt Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 9mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 11mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 13mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 16mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 19mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib A 22mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 9mm Kn Lt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 11mm Kn Lt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 13mm Kn Lt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 16mm Kn Lt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 19mm Kn Lt Prlng Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 9mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 13mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 16mm Kn Rt Prlng Cr Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib B 19mm Rt Ul Cong Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Lt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Lt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Lt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Lt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 22mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 22mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .5 22mm Lt Uhmwpe Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 22mm Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Lt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 19mm Kn Lt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 22mm Kn Lt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 19mm Kn Rt Uhmwpe Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .75/5 22mm Rt Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 1/2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 1/2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 1/2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 1/2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 1/2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 1/2 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 1/2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 1/2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 1/2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Rt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 1/2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 1/2 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Lt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 3/4/5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 3/4/5 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 3/4/5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 19mm Kn Lt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 3/4/5 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Rt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 3/4/5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 3/4/5 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 22mm Kn Rt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 00/0 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 00/0 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 00/0 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 00/0 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Lt Size 00/0 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 00/0 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Rt Uhmwpe Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 00/0 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 00/0 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 00/0 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Ps Tibial Insert Rt Size 00/0 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h Mic 58x40x9mm Kn Nt Mld Uhmwpe Cr-flx Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h Mic 58x40x10mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr-flex Art Surf C-h/ 1-2 Str Purple 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr-flex Art Surf C-h/ 1-2 Str Purple 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h Mic 58x40x17mm Kn Nt Mld Uhmwpe Cr-flx Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h Mic 58x40x20mm Kn Nt Mld Uhmwpe Cr-flx Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x9mm Kn Nt Mld Uhmwpe Cr-flx Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x10mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x12mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x14mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x17mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x20mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x9mm Kn Nt Mld Uhmwpe Cr-flx Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x10mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x12mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x14mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x17mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x20mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cr Art Surf Ch7-10/blue 09mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 C-h Std 82x51x10mm Kn Nt Mld Uhmwpe Ng Crflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr-flex Art Surf C-h/7-10 Blue 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr-flex Art Surf C-h/7-10 Blue 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr-flex Art Surf C-h/7-10 Blue 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr-flex Art Surf C-h/7-10 Blue 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 14mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 16mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 18mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-11 E-f 16mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 11mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 12mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 13mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 14mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 16mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 18mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 10mm Persona 9-12 J Lt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 11mm Persona 9-12 J Lt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 9-12 J 12mm Kn Lt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 13mm Persona 9-12 J Lt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 14mm Persona 9-12 J Lt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 16mm Persona 9-12 J Lt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 18mm Persona 9-12 J Lt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95192639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador Two-level 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95192640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling 4.0x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95192641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trigen Titanium 20mm 4mm Humerus Cortical Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.77|FSC: 13; Default||Not reimbursed separately|532.77|FSC: 13; Default||External grouping not supported 95192642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Trigen Titanium 44mm 5mm Humerus Cancellous Sf Tp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|FSC: 13; Default||Not reimbursed separately|647.82|FSC: 13; Default||External grouping not supported 95192643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Trigen Titanium 24cm 8/7mm Humerus Bent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,416.20|FSC: 13; Default||Not reimbursed separately|5,416.20|FSC: 13; Default||External grouping not supported 95192644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Trigen Titanium 38mm 5mm Humerus Cancellous Sf Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|FSC: 13; Default||Not reimbursed separately|647.82|FSC: 13; Default||External grouping not supported 95192645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Trigen Titanium 44mm 5mm Humerus Cancellous Sf Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|FSC: 13; Default||Not reimbursed separately|647.82|FSC: 13; Default||External grouping not supported 951206175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 15mm Rev Prcdnt 3 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,031.00|FSC: 13; Default||Not reimbursed separately|14,031.00|FSC: 13; Default||External grouping not supported 951206176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Bw Zmr Xl Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 16.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 16.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Bw Zmr Xl Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Bw Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 18mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 18mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 19.5mm Bw Zmr Xl Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 19.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 19.5mm Bw Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 21mm Bw Zmr Xl Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 21mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 21mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 21mm Bw Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 22.5mm Bw Zmr Xl Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 22.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 22.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 22.5mm Bw Zmr Xl Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 24mm Bw Zmr Xl Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 24mm Bw Zmr Xl Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 24mm Bw Zmr Xl Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 24mm Bw Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25.5mm Bw Zmr Xl Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25.5mm Bw Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|FSC: 13; Default||Not reimbursed separately|8,523.00|FSC: 13; Default||External grouping not supported 951206202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 25.5mm Bw Zmr Xl Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|FSC: 13; Default||Not reimbursed separately|9,739.50|FSC: 13; Default||External grouping not supported 951206203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 25.5mm Bw Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|FSC: 13; Default||Not reimbursed separately|9,886.50|FSC: 13; Default||External grouping not supported 951206204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 17mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|FSC: 13; Default||Not reimbursed separately|7,305.00|FSC: 13; Default||External grouping not supported 951206205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 17mm Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 17mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 18mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|FSC: 13; Default||Not reimbursed separately|7,305.00|FSC: 13; Default||External grouping not supported 951206208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 18mm Zmr Xl Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 18mm Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 19mm Tpr Zmr Xl Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|FSC: 13; Default||Not reimbursed separately|7,305.00|FSC: 13; Default||External grouping not supported 951206211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 19mm Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 19mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 20mm Tpr Zmr Xl Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|FSC: 13; Default||Not reimbursed separately|7,305.00|FSC: 13; Default||External grouping not supported 951206214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 20mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 20mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 21mm Tpr Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|FSC: 13; Default||Not reimbursed separately|7,305.00|FSC: 13; Default||External grouping not supported 951206217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 21mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 22mm Tpr Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|FSC: 13; Default||Not reimbursed separately|7,305.00|FSC: 13; Default||External grouping not supported 951206220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 22mm Tpr Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 22mm Tpr Rev Mdlr Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 23mm Tpr Zmr Xl Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 23mm Tpr Zmr Xl Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 24mm Zmr Xl Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|FSC: 13; Default||Not reimbursed separately|8,328.00|FSC: 13; Default||External grouping not supported 951206225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 24mm Tpr Zmr Xl Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|FSC: 13; Default||Not reimbursed separately|9,156.00|FSC: 13; Default||External grouping not supported 951206226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 12mm Splined Zmr Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|FSC: 13; Default||Not reimbursed separately|8,428.50|FSC: 13; Default||External grouping not supported 951206227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 12mm Strg Splined Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 12mm Splined Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 13.5mm Strg Splined Zmr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|FSC: 13; Default||Not reimbursed separately|8,428.50|FSC: 13; Default||External grouping not supported 951206230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 168mm 13.5mm Strg Splined Zmr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13.5mm Splined Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 15mm Splined Zmr Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|FSC: 13; Default||Not reimbursed separately|8,428.50|FSC: 13; Default||External grouping not supported 951206233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 116mm 15mm Strg Splined Zmr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 15mm Splined Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Splined Bw Zmr Tiv 220mm Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 16.5mm Strg Splined Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|FSC: 13; Default||Not reimbursed separately|8,428.50|FSC: 13; Default||External grouping not supported 951206237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Splined Zmr Tiv Por Strg Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Bw Splined Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 16.5mm Splined Bw Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Bw Splined Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 18mm Splined Bw Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 218mm 19.5mm Splined Bw Zmr Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25.5mm Bw Splined Zmr Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|FSC: 13; Default||Not reimbursed separately|10,008.00|FSC: 13; Default||External grouping not supported 951206244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 12mm Strg Zmr Tiv Por Hip Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|FSC: 13; Default||Not reimbursed separately|7,744.50|FSC: 13; Default||External grouping not supported 951206245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 12mm Rev Cmpr Nut Zmr Tiv Nitrited Por Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 12mm Rev Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 13.5mm Strg Zmr Tiv Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|FSC: 13; Default||Not reimbursed separately|7,744.50|FSC: 13; Default||External grouping not supported 951206248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 12mm Bw Zmr Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13.5mm Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 15mm Strg Zmr Tiv Por Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|FSC: 13; Default||Not reimbursed separately|7,744.50|FSC: 13; Default||External grouping not supported 951206251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 15mm Rev Strg Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 15mm Bw Zmr Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm Rev Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 16.5mm Strg Zmr Tiv Por Hip Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|FSC: 13; Default||Not reimbursed separately|7,744.50|FSC: 13; Default||External grouping not supported 951206255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Rev Cmpr Nut Zmr Tiv Nitrited Por Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 16.5mm Bw Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 18mm Rev Zmr Tiv Por Strg Hip Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|FSC: 13; Default||Not reimbursed separately|7,744.50|FSC: 13; Default||External grouping not supported 951206259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Rev Cmpr Nut Zmr Tiv Nitrited Por Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Bw Zmr Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 18mm Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 19.5mm Rev Zmr Tiv Por Strg Hip Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|FSC: 13; Default||Not reimbursed separately|7,744.50|FSC: 13; Default||External grouping not supported 951206263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 19.5mm Rev Strg Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 19.5mm Rev Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19.5mm Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 21mm Rev Strg Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 21mm Bw Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 21mm Rev Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 22.5mm Rev Strg Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 22.5mm Bw Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 22.5mm Rev Zmr Tiv Por Bw Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 24mm Rev Strg Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 24mm Bw Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 24mm Bw Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25.5mm Rev Strg Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25.5mm Bw Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 25.5mm Bw Zmr Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm 3 Pnt Fx Zmr Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|FSC: 13; Default||Not reimbursed separately|7,030.50|FSC: 13; Default||External grouping not supported 951206279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 14mm Tpr Zmr Tiv Aly Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 15mm Zmr Tiv 3.5d Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|FSC: 13; Default||Not reimbursed separately|7,030.50|FSC: 13; Default||External grouping not supported 951206281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 16mm Zmr Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|FSC: 13; Default||Not reimbursed separately|7,030.50|FSC: 13; Default||External grouping not supported 951206282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 16mm Zmr Tiv Aly Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 16mm Zmr Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 17mm Tpr Zmr Tiv Aly Hip Fem Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|FSC: 13; Default||Not reimbursed separately|7,030.50|FSC: 13; Default||External grouping not supported 951206285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 17mm 3 Pnt Fx Zmr Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 17mm Tpr Rev Zmr Tiv Por 3.5d Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 18mm Tpr Zmr Tiv Aly Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|FSC: 13; Default||Not reimbursed separately|7,030.50|FSC: 13; Default||External grouping not supported 951206288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 18mm 3 Pnt Fx Zmr Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 18mm Tpr Rev Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 19mm Zmr Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|FSC: 13; Default||Not reimbursed separately|7,030.50|FSC: 13; Default||External grouping not supported 951206291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 19mm Tpr Zmr Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 19mm Tpr Rev Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 20mm Rev Zmr Tiv Por Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 20mm Tpr Zmr Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 22mm 3 Pnt Fx Zmr Tiv Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|FSC: 13; Default||Not reimbursed separately|8,019.00|FSC: 13; Default||External grouping not supported 951206296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 235mm 22mm Tpr Zmr Tiv Aly Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|FSC: 13; Default||Not reimbursed separately|8,766.00|FSC: 13; Default||External grouping not supported 951206297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 15mm Slt Bw Zmr Por Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 15mm Slt Rev Bw Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 16.5mm Slt Bw Zmr Por Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 16.5mm Slt Rev Bw Cmpr Nut Sys Zmr Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 18mm Bw Slt Zmr Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 18mm Slt Rev Bw Cmpr Nut Sys Zmr Tiv Nitrited|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 19.5mm Slt Bw Zmr Por Tiv Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 19.5mm Slt Rev Bw Cmpr Nut Sys Zmr Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 21mm Slt Bw Zmr Por Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|FSC: 13; Default||Not reimbursed separately|9,042.00|FSC: 13; Default||External grouping not supported 951206306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 25.5mm Bw Slt Zmr Tiv Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|FSC: 13; Default||Not reimbursed separately|10,632.00|FSC: 13; Default||External grouping not supported 951206307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 78mm 23mm Zmr Xl Std Ofst Tpr Hip Tiv Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 78mm Zmr Xl 23mm Hip Tiv Xtd Ofst Tpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 83mm Zmr Xl 35 Std Ofst Tpr Hip Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 83mm 23mm Zmr Xl 35 Hip Tiv Xtd Ofst Tpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 93mm Zmr Xl Tiv Por Std Ofst Tpr Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 93mm Zmr Xl 45 Xtd Ofst Tpr Hip Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 55mm Tpr Bd Std Ofst Zmr Xl Tiv Por Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 103mm Zmr Xl 55 Hip Tiv Xtd Ofst Tpr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Fem 40mm 35mm Zmr Xl Aa Hip Tiv Por Spout Bd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mmx35mm Zmr Aa Std Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 75mmx35mm 36mm Zmr 16.6mm Aa Hip Fem Tiv Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 35mm 40mm Aa Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 75mmx35mm Zmr Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 75mmx35mm Zmr 16.6mm Aa Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 40x35mm Zmr Aa Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 16.6mm Aa Hip Fem Tiv Plsm Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Fem 40mm 35mm Zmr Aa Hip Fem Tiv Por Spout Bd Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 40 17.7mm A Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr B Ofst Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 18.9mm 46mm B Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 20mm C Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 20mm 46mm C Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 21.2mm 46mm D Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 21.2mm 40mm D Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 46x45mm Zmr E Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 22.5mm 46mm E Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr F Hip Fem Tiv Por Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 80mmx35mm Zmr 23.7mm 46mm F Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm 46mm Zmr 23.7mm F Hip Fem Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr 17.7mm A Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm Zmr 18.9mm B Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr 18.9mm B Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm Zmr 20mm C Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr 20mm C Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 46x45mm Zmr D Xtd Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr 21.2mm D Fem Tiv Por Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm Zmr E Hip Fem Tiv Por Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr E Hip Fem Tiv Por Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90x45mm Zmr F Hip Fem Tiv Por Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr 23.7mm F Hip Fem Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mmx35mm 46mm Zmr 17.7mm A Hip Fem Tiv Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mmx45mm 46mm Zmr 130d A Xtd Ofst Hip Fem Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 100mmx55mm Zmr A Std Ofst Hip Fem Tiv Plsm Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 46x35mm Zmr B Xtd Ofst Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 45mm 46mm Zmr B Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 100mmx45mm 55mm Zmr 18.9mm 46mm B Hip Fem Tiv Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 46mm 35mm Zmr 20mm Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mmx45mm 45mm Zmr 130d E Xtd Ofst Hip Fem Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 46x55mm Zmr C Xtd Ofst Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mmx35mm 35mm Zmr 46mm Ofst D Hip Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mmx45mm 46mm Zmr D Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 100mmx55mm 46mm Zmr D Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm 35mm Zmr 22.5mm Hip Fem Tiv Rev Mdlr 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mm 45mm Zmr Hip Fem Tiv Rev Mdlr 46mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 100mmx55mm 46mm Zmr 130d E Xtd Ofst Hip Fem Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mm 35mm Zmr Hip Fem Tiv Rev Mdlr 46mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mmx45mm 46mm Zmr 130d F Xtd Ofst Hip Fem Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951207121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 20mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 21mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 8mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 14mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 17mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 18mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 19mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 20mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 21mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 28mm Bcld Hw Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Lmt Hl Fin Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Lmt Hl Rnglc+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Lmt Hl Clr Cd Por G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Lmt Hl Clr Cd Por G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Lmt Hl Clr Cd Por G7 B Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Lmt Hl Clr Cd Por G7 C Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Lmt Hl Clr Cd Por G7 D Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Lmt Hl Clr Cd Por G7 E Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Lmt Hl Clr Cd Por G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Lmt Hl Clr Cd Por G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Lmt Hl Clr Cd Por G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Lmt Hl Clr Cd Por G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Lmt Hl Clr Cd Por G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Lmt Hl Clr Cd Por G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Lmt Hl Clr Cd Por G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Lmt Hl Clr Cd Por G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Lmt 3 Hl Fin Por G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 23mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 23mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 24mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 24mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 25mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 25mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 26mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 26mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 27mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 27mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Mlhd Rdl 3 Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 28mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Mlhd Rnl 3 Hl Hip Nrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm 37mm Hip 2 Hl Mtl M2a Tpr Mhd Rdl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm 41mm Hip 2 Hl Mtl M2a Tpr Mhd Rdl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm 41mm Hip 2 Hl Mlhd Rdl M2a Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm 41mm Hip 2 Hl Mtl M2a Tpr Mhd Rdl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm 41mm Hip 2 Hl Mtl M2a Tpr Mhd Rdl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm 41mm Hip 2 Hl Mtl M2a Tpr Mhd Rdl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm 38mm Hip 1 Pc Flr Mtl M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm 38mm Hip 1 Pc Flr Mtl M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm 38mm Hip 1 Pc Flr Mtl M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 38mm M2a38 Nflr Hip Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 38mm M2a38 Nflr Hip Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm M2a38 Lck Ring Mlhl Hip Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm M2a38 Nflr Hip Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm 28mm Hip Mlhl Lck Ring Por M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb M2a-magnum Recap Cup 58odx52id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm 38mm Hip Mtl M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 38mm M2a Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 38mm M2a Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 38mm M2a Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 38mm M2a Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 38mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 40mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 42mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 44mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 46mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 48mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 50mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 52mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 54mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 56mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 58mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 60mm M2a Mg Prft Hip Strl Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 38mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 40mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 42mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 44mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 46mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 48mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 50mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 52mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 54mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 56mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 56mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 60mm M2a Mg Trspk Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm 40mm Hip Sld Regenerex Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm 40mm Hip Sld Regenerex Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm 40mm Hip Sld Regenerex Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm 40mm Hip Sld Regenerex Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm 40mm Hip Sld Regenerex Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm 40mm Hip Sld Regenerex Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm 40mm Hip Sld Regenerex Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm 40mm Hip Sld Regenerex Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm 40mm Hip Sld Regenerex Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm 40mm Hip Sld Regenerex Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Sld Ti Regenerex Rnglc+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Lmt Hl Ti Por Regenerex Rnglc+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Lmt 3 Hl Fin Por G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Lmt 3 Hl Fin Por G7 B Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Lmt 3 Hl Fin Por G7 C Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Lmt 3 Hl Fin Por G7 D Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Lmt 3 Hl Fin Por G7 E Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Lmt 4 Hl Fin Por G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Lmt 4 Hl Fin Por G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Lmt 4 Hl Fin Por G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Lmt 4 Hl Fin Por G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Lmt 4 Hl Fin Por G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Lmt 4 Hl Fin Por G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Lmt 4 Hl Fin Por G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Lmt 4 Hl Fin Por G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951207302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 42 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 43 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 44 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 45 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 46 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 47 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 48 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 43 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 44 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 45 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 46 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 +5mm 47 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 10.5 X 12.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 12.0 X 13.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 13.5 X 15.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 15.0 X 16.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 16.5 X 18.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 10.5 X 12.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 12.0 X 13.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 13.5 X 15.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Oversize Distal Text Sz 15.0 X 16.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Collarless Std Body Distal Text Sz 13.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Vrsy Epoch Cocr Beaded Fc 135d 36mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Vrsy Epoch Cocr Beaded Fc 135d 36mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Vrsy Epoch Cocr Beaded Fc 135d 41mm Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Vrsy Epoch Cocr Beaded Fc 135d 39mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Vrsy Epoch Cocr Beaded Fc 125d 43mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Vrsy Epoch Cocr Beaded Fc 135d 44mm Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Vrsy Epoch Cocr Beaded Fc 135d 39mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Vrsy Epoch Cocr Beaded Fc 135d 44mm Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Vrsy Epoch Comp Fc 135d 39mm Std Bd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Vrsy Epoch Comp Fc 135d 44mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Vrsy Epoch Comp Fc 135d 39mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Vrsy Epoch Comp Fc 135d 44mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Vrsy Epoch Fc 135d 36mm Rdc Bd/nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Vrsy Epoch Fc 125d 40mm Rdc Bd/nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Vrsy Epoch Comp Fc 135d 42mm Std Bd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Vrsy Epoch Comp Fc 135d 47mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Vrsy Epoch Comp Fc 135d 42mm Lmb Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Vrsy Epoch Comp Fc 135d 47mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Vrsy Epoch Fc 135d 36mm Rdc Bd/nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Vrsy Epoch Fc 125d 40mm Rdc Bd/nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Vrsy Epoch Comp Fc 135d 42mm Std Bd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Vrsy Epoch Comp Fc 135d 47mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Vrsy Epoch Comp Fc 135d 42mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Vrsy Epoch Comp Fc 135d 47mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Vrsy Epoch Fc 125d 40mm Rdc Bd/nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Vrsy Epoch Comp Fc 135d 45mm Std Bd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Vrsy Epoch Comp Fc 135d 50mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Vrsy Epoch Comp Fc 135d 45mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Vrsy Epoch Comp Fc 135d 50mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Vrsy Epoch Comp Fc 135d 45mm Std Bd Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Epoch 17mm Std Body Ext Ofs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Vrsy Epoch Comp Fc 135d 45mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Vrsy Epoch Comp Fc 135d 57mm Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 17mm Vrsy Epoch Fc 125d 43mm Rdc Bd/nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Vrsy Epoch Comp Fc 135d 48mm Std Bd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Vrsy Epoch Comp Fc 135d 53mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Vrsy Epoch Comp Fc 135d 48mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Epoch 18mm Lm Body Ext Ofs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Vrsy Epoch Comp Fc 135d 48mm Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Vrsy Epoch Comp Fc 135d 53mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Vrsy Epoch Comp Fc 135d 48mm Std Bd/ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Vrsy Epoch Comp Fc 135d 53mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 21mm Vrsy Epoch Comp Fc 135d 48mm Std Bd/ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 22mm Vrsy Epoch Comp Fc 135d 53mm Std Bd Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys 6 Inch Beaded Fc 11x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 11mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys 6 Inch Beaded Fc Stem 11x160mm Lm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 12mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 12mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 13mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 13mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 13mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 13mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 14mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 14mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 14mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Zml Beaded Fc Por 6in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys 6 Inch Beaded Fc 16x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16mm Lo Hd Cntr Prm Algn Gd Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Bead Fc Std Bd Nk Vrsy 6in Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Vrsy Zml Beaded Fc Por 6in Strg X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys 6 Inch Beaded Fc 18x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Vrsy Zml Beaded Fc Por 6in Strg X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Vrsy Zml Beaded Fc Por 6in Strg X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Colr Algn Gd Std Bd Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Vrsy Zml Beaded Fc Por 6in Strg X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 21mm Prm Algn Gd Std Bd Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 21mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 21mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 21mm Prm Vrsy Zml Beaded Fc Por 6in Strg X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 21mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 22mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 22mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 22mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 22mm Prm Vrsy Zml Beaded Fc Por 6in Strg X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 22mm Prm Algn Gd Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 140d 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 137d 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Fitmore Protasul-64 Plsm Spry 129d 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 129d 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blast Uncemented Fitmore Protasul-64 Ti Vac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rgh Blasting Fitmore Protasul-64 Plsm Spry 127d 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 129mm Avenir Mller Protasul-64wf Ha 1 38.74mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm Avenir-mller Protasul 64 5 39.17mm Ofst 55.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 141mm Avenir Mlr Protasul-64wf Ha 3 39.68mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm Avenir Mller Protasul-64wf Ha 4 40.22mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 153mm Avenir-mlr Protasul-64wf Ha 5 40.22mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm Avenir Mlr Protasul-64wf Ha 7 42.55mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 171mm Avenir-mlr Protasul-64wf Ha 8 43.66mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm Avenir-mlr Protasul-64wf Ha 9 44.54mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 129mm Lat Avenir-mlr Protasul-64wf Ha 1 44.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm Lat Avenir-mlr Protasul-64wf Ha 2 45.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 141mm Lat Avenir-mlr Protasul-64wf Ha 3 45.67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm Lat Avenir-mlr Protasul-64wf Ha 4 46.22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 153mm Avenir-mller Protasul 64 5 46.9mm Ofst 66.33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Noncollar Prft Bmtrc X Ser Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Noncollar Prm Prft Bmtrc Ti Plsm Spry|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Noncollar Prm Prft Bmtrc Ti Plsm Spry|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Noncollar Prm Prft Bmtrc Ti Plsm Spry|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Prm Clrls Lat X Ser Bmtrc Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Prm Rdc Prox Prfl Intgr X Ser Pps Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Prm Intgr X Ser Pps Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Bmtrc Ti Plsm Spry Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Noncollar Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Prm Bmtrc Ti Plsm Spry Por Hip Ser X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Prm Bmtrc Ti Plsm Spry Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Prm Bmtrc Ti Plsm Spry Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Prm Clrls Bmtrc Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Prm Colr Prft Bmtrc X Ser Intlk Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mallory-head Fem Hap 6x135mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mallory Head Fem Hap 7x140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mallory Head Fem Hap 8x145mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mallory-head Fem Hap 16x180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm 5mm Tprlk Microplasty Ti Por Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 97.5mm 6mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 7.5mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102.5mm 9mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm 10mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107.5mm 11mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 12.5mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 112.5mm 13.5mm Tprlk Microplasty Ti Por Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 15mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 17.5mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 20mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 22.5mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 25mm Tprlk Microplasty Ti Por Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm Tprlk Microplasty Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 18.5mm Tprlk Microplasty Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm 5mm Tprlk Microplasty Ti Por Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 97.5mm 6mm Tprlk Microplasty Ti Por Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 100mm 7.5mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102.5mm 9mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm 10mm Tprlk Microplasty Ti Por Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107.5mm 11mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 12.5mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 112.5mm 13.5mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 15mm Tprlk Microplasty Ti Por Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 17.5mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 20mm Tprlk Microplasty Ti Por Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 22.5mm Tprlk Microplasty Ti Por Lateralize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 25mm Tprlk Microplasty Ti Por Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm Tprlk Microplasty Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 18.5mm Tprlk Microplasty Lateralize Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 7mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 7mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 8mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 8mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 9mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 10mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 10mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 11mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 11mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 12mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 12mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 13mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 13mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 14mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 14mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 15mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 15mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 32mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951208932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 32mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951208933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 32mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951208934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 32mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951208935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 32mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951208936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d Elev 6.3mm 50/52/54mm 32mm Uhmwpe Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hgp Ii Neutral Std Poly Liner 26 Id Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hgp Ii Elevated Rim Std Poly Liner 26 Id Size D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Sulene Hod Liner Sz 32x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Epsilon Sulene Hod Liner Sz 32x61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 4.2mm 36mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 5.3mm 38mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 6.1mm 40mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 6.1mm 42mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 5.3mm 42mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 7.1mm 44mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 6.3mm 44mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 8.2mm 46mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 6.3mm 46mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 9.1mm 48mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 7.3mm 48mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 10.1mm 50/52/54mm 22mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 10.1mm 50/52/54mm 26mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 11.3mm 56mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 9.3mm 56mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 6.4mm 56mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 12.2mm 58mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 10.4mm 58mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 13.2mm 60mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 11.4mm 60mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 14.2mm 62mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 12.3mm 62mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 15.2mm 64mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 13.4mm 64mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 16.2mm 66mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 14.4mm 66mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 17.2mm 68mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 15.4mm 68mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 18.2mm 70mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 16.4mm 70mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 19.2mm 72mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 17.3mm 72mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 16.3mm 72mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 14.3mm 72mm 32mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 20.2mm 74mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 18.4mm 74mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 17.3mm 74mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 47mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 48mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 49mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 54mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 55mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 56mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head Adapter +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951209740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head Adapter -4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951209741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Lgc +4mm Hip Fem Unplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951209742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Lgc +8mm Hip Fem Unplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951209743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Rev Cmnt Vrsy Hr Zml 45mm Lng Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|FSC: 13; Default||Not reimbursed separately|12,841.50|FSC: 13; Default||External grouping not supported 951209744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Rev Cmnt Vrsy Hr Zml 45mm Lng Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|FSC: 13; Default||Not reimbursed separately|12,841.50|FSC: 13; Default||External grouping not supported 951209745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm Rev Cmnt Vrsy Hr Zml 45mm Lng Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|FSC: 13; Default||Not reimbursed separately|12,841.50|FSC: 13; Default||External grouping not supported 951209746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Rev Cmnt Vrsy Hr Zml 45mm Lng Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|FSC: 13; Default||Not reimbursed separately|12,841.50|FSC: 13; Default||External grouping not supported 951209747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130x9.5mm Rev Cmnt Cpt Zml 12/14 2mm 36mm Lng 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180x9.5mm Rev Cmnt Cpt Zml 12/14 3mm 42mm Lng 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200x11mm Rev Cmnt Cpt Zml 12/14 4mm 43mm Lng 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230x11mm Rev Cmnt Cpt Zml 12/14 4mm 43mm Lng 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230x11mm Rev Cmnt Cpt Zml 12/14 4mm 43mm Lng 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180x9.5mm Rev Cmnt Cpt Zml 12/14 2mm 36mm Lng Vlgs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180x9.5mm Rev Cmnt Cpt Zml 12/14 2mm 36mm Lng Vlgs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|FSC: 13; Default||Not reimbursed separately|13,392.00|FSC: 13; Default||External grouping not supported 951209754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 11mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 12mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|FSC: 13; Default||Not reimbursed separately|17,076.00|FSC: 13; Default||External grouping not supported 951209757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Prm Rev Algn Gd Dist Fil Vrsy Zml Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 13.5mm Prm Rev Algn Gd Dist Fil Vrsy Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 13.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|FSC: 13; Default||Not reimbursed separately|17,076.00|FSC: 13; Default||External grouping not supported 951209766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Rev Dist Fil Std Bd Vrsy Zml Beaded Fc +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 167mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,810.00|FSC: 13; Default||Not reimbursed separately|15,810.00|FSC: 13; Default||External grouping not supported 951209770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 15mm Rev Dist Fil Vrsy Beaded Fc + Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,087.50|FSC: 13; Default||Not reimbursed separately|16,087.50|FSC: 13; Default||External grouping not supported 951209772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|FSC: 13; Default||Not reimbursed separately|17,076.00|FSC: 13; Default||External grouping not supported 951209779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 167mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,810.00|FSC: 13; Default||Not reimbursed separately|15,810.00|FSC: 13; Default||External grouping not supported 951209783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 16.5mm Rev Dist Fil Vrsy C Cocr Beaded Fc +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc + Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc + Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 16.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|FSC: 13; Default||Not reimbursed separately|17,076.00|FSC: 13; Default||External grouping not supported 951209791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Rev Dist Fil Vrsy Zml Plslfn Beaded Fc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 167mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,810.00|FSC: 13; Default||Not reimbursed separately|15,810.00|FSC: 13; Default||External grouping not supported 951209795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 18mm Rev Dist Fil Vrsy C Cocr Beaded Fc + Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,087.50|FSC: 13; Default||Not reimbursed separately|16,087.50|FSC: 13; Default||External grouping not supported 951209797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 230mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 240mm 18mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|FSC: 13; Default||Not reimbursed separately|18,439.50|FSC: 13; Default||External grouping not supported 951209803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,087.50|FSC: 13; Default||Not reimbursed separately|16,087.50|FSC: 13; Default||External grouping not supported 951209807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 20mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 951209810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm 21mm Rev Dist Fil Vrsy Zml Beaded Fc Por +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|FSC: 13; Default||Not reimbursed separately|17,076.00|FSC: 13; Default||External grouping not supported 951209811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 21mm Rev Dist Fil Vrsy C Cocr Beaded Fc + Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 21mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 21mm Rev Dist Fil Vrsy Zml Beaded Fc + Por 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 22.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 22.5mm Rev Dist Fil Vrsy Zml Beaded Fc Por 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|FSC: 13; Default||Not reimbursed separately|18,601.50|FSC: 13; Default||External grouping not supported 951209816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 22.5mm Rev Dist Fil Vrsy C Cocr Beaded Fc +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|FSC: 13; Default||Not reimbursed separately|16,509.00|FSC: 13; Default||External grouping not supported 951209817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 22.5mm Rev Dist Fil Vrsy Zml Beaded Fc + Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 22.5mm Rev Dist Fil Vrsy Zml Beaded Fc + Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|FSC: 13; Default||Not reimbursed separately|17,206.50|FSC: 13; Default||External grouping not supported 951209819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 14mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 15mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 17mm Dist Fil Uncemented Wgnr Sl Rv Ti6al7nb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 18mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 19mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 190mm 20mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 15mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 16mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 18mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 19mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 20mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 21mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 22mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 14mm Dist Fil Uncemented Wgnr Sl Rv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 15mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 17mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 18mm Dist Fil Uncemented Wgnr Sl Rv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 19mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 20mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 21mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 22mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 23mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 24mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 265mm 25mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 14mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 15mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 16mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 17mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 18mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 19mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 20mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 21mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 22mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 23mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951209853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 16mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 16mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 17mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 17mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 18mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 18mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 19mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 19mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 20mm Bal Microplasty Ti Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 20mm Bal Microplasty Ti Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 75mm 7mm Rdc Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 76mm 8mm Rdc Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 75mm 7mm Rdc Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 76mm 8mm Rdc Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 75mm 7mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 76mm 8mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 77mm 9mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 78mm 10mm Echo Bmtrc Microplasty Std Ofst Full Prfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 49mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 53mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 53mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 59mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 59mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 61mm 28mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 61mm 32mm 10d Elev Zca Prm Cmnt Incln Face Spcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Prm Tiv Por Trlg Sm Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Prm Tiv Por Trlg Std Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Prm Tiv Por Trlg Std Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Prm Tiv Por Trlg Std Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Prm Tiv Por Trlg Std Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Prm Tiv Por Trlg Std Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Prm Sld Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 55mm Cnvrg Hip Por Prm Ch Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951210681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26mm +5 Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10mm 26mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 28mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 28mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +5mm 28mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10mm 28mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 32mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -5mm 32mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +5mm 32mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10mm 32mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +15mm 32mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 12/14 38mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 12/14 38mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 12/14 Std 38mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 12/14 38mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 12/14 38mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 12/14 38mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm Ofst 40mm Hip Actb Ty 1 Skrt Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm Ofst 40mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 40mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 40mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 40mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 40mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 40mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 44mm Hip Actb Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 12/14 40mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 12/14 40mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 12/14 Std 40mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 12/14 40mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 12/14 40mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 12/14 40mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 40mm Hip Sld Mdlr Cocr Slx M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 40mm Hip Sld Mdlr Cocr Slx M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 40mm Hip Sld Mdlr Cocr Slx M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 40mm Hip Sld Mdlr Cocr Slx M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 40mm Hip Sld Mdlr Cocr Slx M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 40mm Hip Mdlr Ty 1 Cocr Slx M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 28mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 28mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 28mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 32mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 32mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 32mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 32mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 36mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 36mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 36mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 36mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 38mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 38mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 38mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 38mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 38mm Hip Mdlr Blx D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Xlw-18 Ins 28/37g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951210741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 15mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 20mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 25mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 30mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 35mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 40mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 45mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 50mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 60mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 70mm 6.5mm G7 Dome Hip Actb Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 15mm Ti Dome Hip Actb Canc Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 20mm Ti Dome Hip Actb Canc Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 25mm Ti Dome Hip Actb Canc Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 40mm Ti Dome Hip Actb Canc Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 60mm Ti Dome Hip Actb Canc Loprfl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 70mm C2a-tpr Ti Dome Loprfl Hip Actb Canc St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 9mm 1.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 11mm 1.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 12mm 1.5mm Rx90 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 13mm 1.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 14mm 1.5mm Cntrlzr Rx90 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 15mm 1.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 17mm 1.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 9mm 2.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 11mm 2.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 13mm 2.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 15mm 2.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 17mm 2.5mm Rx90 Hip Smth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 951210769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 10mm G4 Echo Ans Hip Dist Pmma Pstnr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 12mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 14mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 18mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 20mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 9mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 11mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 13mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 15mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 17mm G4 Echo Ans Hip Dist Pmma Pstnr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 19mm Hip Dist Pmma Pstnr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 9mm G4 Hip Prox Pmma Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 11mm G4 Hip Prox Pmma Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 13mm G4 Hip Prox Pmma Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 15mm G4 Hip Prox Pmma Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 7mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 8mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 9mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 10mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 11mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 13mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 14mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 15mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 16mm Hip Fem Pmma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm Stanmore 1 Hip Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm Stanmore 2 Hip Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm Stanmore 3 Hip Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm Stanmore 4 Hip Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm Stanmore 5 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 951210799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm Sirius Fem Wng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 10- Mm Sirius Fem Wngls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 951210801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 42-50mm +6mm Hip Tpr Mtl M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 951210802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Actb 42-50mm +9mm Hip Tpr Mtl M2a Mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 951210803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 -3mm Ofst 12/14 Hip Ti Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 Std Ofst 12/14 Hip Ti Blx D Biolox Optn Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 +4mm Ofst 12/14 Hip Ti Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 +7mm Ofst 12/14 Hip Ti Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 -6mm Ofst Tpr Hip Ti Ty 1 Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 Std Ofst Tpr Hip Ti Ty 1 Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 +3mm Ofst Tpr Hip Ti Ty 1 Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering G7 +6mm Ofst Tpr Hip Ti Ty 1 Blx D Biolox Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 951210811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl G7 Actb Apcl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951210812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl G7 Actb Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951210813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl 3/8-24in Hip Apcl Cup|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951210814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Lg 22mm Im Cnl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intramedullary Plug Xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl 4d Tpr Hip Actb Apcl Optn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl Rnglc+ Actb Scr Lmt Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Bplg 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Bplg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Bplg 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Bplg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Bplg 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 951210823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 9mm Lateralize G4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Lateralize G4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Lateralize G4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Lateralize G4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Lateralize G4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 7mm Echo Fx Cocr Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9mm Echo Fx Cocr Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11mm Echo Fx Cocr Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13mm Echo Fx Cocr Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Echo Fx Cocr Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 17mm Echo Fx Cocr Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9mm Echo Fx Cocr Lat Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11mm Lateralize Echo Fx Cocr Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13mm Lateralize Echo Fx Cocr Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Lateralize Echo Fx Cocr Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 17mm Lateralize Echo Fx Cocr Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Sld Biomr Ii Intlk Ti Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 14mm Sld Biomr Ii Intlk Ti Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 16mm Sld Biomr Ii Intlk Ti Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Fenestrate Biomr Ii Intlk Ti Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 14mm Fenestrate Biomr Ii Intlk Ti Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 16mm Fenestrate Biomr Ii Intlk Ti Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Plsh Intrigue Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Plsh Intrigue Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Plsh Intrigue Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 9mm G4 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm G4 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm G4 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm G4 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm G4 Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951210853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 7mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 8mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 14mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 17mm Prft Echo Pf Ti Std Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951210864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Blu 41mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Blu 42mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Blu 43mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Grn 44mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Grn 45mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Grn 46mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Grn 47mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 48mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 49mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 51mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 52mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 53mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 54mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 55mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951211620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 Gh 10mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 11mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 12mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 10mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 11mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 12mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b 10mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b 12mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b 14mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b 17mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b 20mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C 10mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C 12mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C 14mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C 17mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C 20mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D 10mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D 12mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D 14mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D 17mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D 20mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 10mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 12mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 14mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 17mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 20mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F 10mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F 12mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F 14mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F 17mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F 20mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G 10mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G 12mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G 14mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G 17mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G 20mm Kn Mbl Mach Mld Pe Ng Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 9mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 11mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 13mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 16mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 19mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc .5 9mm Kn Lt Crcte Rtn Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 11mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 13mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 16mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 19mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 9mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 11mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 13mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 19mm Kn Lt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 9mm Kn Rt Cngr Crcte Rtn Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 11mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 13mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 16mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 19mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 9mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 11mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 13mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 16mm Kn Rt Cngr Crcte Rtn Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 19mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 9mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 11mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 13mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 16mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 19mm Kn Rt Cngr Cr Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 9mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 11mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 13mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 16mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 19mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 9mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 11mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 13mm Kn Lt Crcte Rtn Ul Cong Prlng Gndr Sol Nt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 16mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 19mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 9mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 11mm Kn Lt Crcte Rtn Ul Cong Prlng Gndr Sol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 13mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 16mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 19mm Kn Lt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 9mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 11mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 13mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 16mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 00-0 19mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc .5 9mm Rt Kn Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 11mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc .5 13mm Kn Rt Crcte Rtn Ul Cong Prlng Gndr Sol Nt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 16mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 19mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn Flx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nk Flx Prlng Ul Cong Art Surf Sz 3/4/5-rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 11mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 13mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 16mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 19mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 22mm Kn Rt Cr Ul Cong Prlng Gndr Sol Nt Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 10mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 12mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 14mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 17mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 20mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 23mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 20mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 23mm Kn Fx Brng Prlng Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 E 10mm Kn Fx Brng Prlng Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 E 12mm Kn Fx Brng Prlng Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Lps-flex Fixed Prolong Art Sur E 1-2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 E 17mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 E 20mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 10mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 12mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b Xl 14mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 17mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 20mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 23mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 G 10mm Kn Fx Brng Prlng Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 G 12mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 G 14mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 G 17mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 G Xl 20mm Kn Fx Brng Prlng Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .5 13mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .5 16mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .5 9mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .75/5 9mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Lt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00/0 9mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Rt Drsl Cngr Cr Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 00/0 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 00/0 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 00/0 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 00/0 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Rt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 00/0 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 00/0 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 00/0 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Rt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 1/2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 1/2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Lt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 1/2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 1/2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .5 9mm Kn Rt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 1/2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .5 13mm Kn Rt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 1/2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 1/2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Lt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 3/4/5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .75/5 13mm Kn Lt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib .75/5 16mm Kn Lt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Lt Sz 3/4/5 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 3/4/5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 3/4/5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Drsl Cr Ul Cong Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951212560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Tm Hip Flat 7mm Washe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|FSC: 13; Default||Not reimbursed separately|4,179.60|FSC: 13; Default||External grouping not supported 951212561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Inst Crv Hip 4mm Seg Wshr Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|FSC: 13; Default||Not reimbursed separately|4,179.60|FSC: 13; Default||External grouping not supported 951212562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Intercalary Segment 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|FSC: 13; Default||Not reimbursed separately|10,954.80|FSC: 13; Default||External grouping not supported 951212563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Intercalary Segment 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|FSC: 13; Default||Not reimbursed separately|10,954.80|FSC: 13; Default||External grouping not supported 951212564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seg Intercalary Segment 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|FSC: 13; Default||Not reimbursed separately|10,954.80|FSC: 13; Default||External grouping not supported 951212565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 30mm Nxgn Kn Tib Fib Tiv M To F Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segment Male-female 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 220mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-female 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segment Male-female 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|FSC: 13; Default||Not reimbursed separately|11,359.80|FSC: 13; Default||External grouping not supported 951212580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-male 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|FSC: 13; Default||Not reimbursed separately|10,954.80|FSC: 13; Default||External grouping not supported 951212581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-male 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|FSC: 13; Default||Not reimbursed separately|10,954.80|FSC: 13; Default||External grouping not supported 951212582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Fem/tib Male-male 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|FSC: 13; Default||Not reimbursed separately|10,954.80|FSC: 13; Default||External grouping not supported 951212583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr B Fem Seg Hng Svc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|FSC: 13; Default||Not reimbursed separately|6,946.20|FSC: 13; Default||External grouping not supported 951212584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr C Artcsurf Seg Hng Shld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|FSC: 13; Default||Not reimbursed separately|6,946.20|FSC: 13; Default||External grouping not supported 951212585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr Zm B Fem Hng Svc Seg Sys Xt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|FSC: 13; Default||Not reimbursed separately|6,946.20|FSC: 13; Default||External grouping not supported 951212586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr Zm C Fem Hng Svc Seg Sys Xt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|FSC: 13; Default||Not reimbursed separately|6,946.20|FSC: 13; Default||External grouping not supported 951212587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr B Artcsurf Seg Hng Shld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|FSC: 13; Default||Not reimbursed separately|5,853.60|FSC: 13; Default||External grouping not supported 951212588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr C Seg Svc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|FSC: 13; Default||Not reimbursed separately|5,853.60|FSC: 13; Default||External grouping not supported 951212589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr D Artcsurf Seg Hng Shld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|FSC: 13; Default||Not reimbursed separately|5,853.60|FSC: 13; Default||External grouping not supported 951212590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr E Artcsurf Seg Hng Shld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|FSC: 13; Default||Not reimbursed separately|5,853.60|FSC: 13; Default||External grouping not supported 951212591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tkr F Artcsurf Seg Hng Shld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|FSC: 13; Default||Not reimbursed separately|5,853.60|FSC: 13; Default||External grouping not supported 951212592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 25mm Kn Trb Mtl Colr 9-16mm Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|FSC: 13; Default||Not reimbursed separately|7,632.00|FSC: 13; Default||External grouping not supported 951212593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 35mm Kn Trb Mtl Colr 9-16mm Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|FSC: 13; Default||Not reimbursed separately|7,632.00|FSC: 13; Default||External grouping not supported 951212594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 30mm Kn Trb Mtl Colr 17-19mm Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|FSC: 13; Default||Not reimbursed separately|7,632.00|FSC: 13; Default||External grouping not supported 951212595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 35mm Kn Trb Mtl Colr 17-19mm Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|FSC: 13; Default||Not reimbursed separately|7,632.00|FSC: 13; Default||External grouping not supported 951212596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 30mm Kn Tiv Smth Colr 9-16mm Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|FSC: 13; Default||Not reimbursed separately|7,632.00|FSC: 13; Default||External grouping not supported 951212597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 30mm Kn Tiv Smth Colr 17-19mm Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|FSC: 13; Default||Not reimbursed separately|7,632.00|FSC: 13; Default||External grouping not supported 951212598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 Ab 11mm Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-5 Ab 11mm Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 Cd 11mm Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 Cd 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 Ef 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Ef 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 Ef 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Gh 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 Gh 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 11mm Kn Rt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 8mm Nt Kn Flx Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 8mm Nt Kn Flx Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 8mm Nt Kn Flx Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 8mm Nt Kn Flx Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 10mm Nt Kn Flx Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 10mm Nt Kn Flx Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Nt Kn Pe Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 Nt Kn Pe Kn Strl Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 7mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 7mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 7mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 10mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 10mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 10mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 10mm Cr Nt Kn2 Sulene-pe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 8mm Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 8mm Nt Kn Flx Prlng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 8mm Nt Kn Flx Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 8mm Nt Kn Flx Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 10mm Nt Kn Flx Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 10mm Nt Kn Flx Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 10mm Nt Kn Flx Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 10mm Nt Kn Flx Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 7.5mm 26mm Nxgn Alply Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 29mm Nxgn Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 38mm Nxgn Prlng Kn Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 41mm Nxgn Prlng Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 7.5mm 26mm Vivacit-e Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951212637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 29mm Vivacit-e Alply Kn Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951212638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 32mm Vivacit-e Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951212639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 35mm Vivacit-e Alply Kn Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951212640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 38mm Persona Vivacit-e Alply Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951212641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 10mm 41mm Vivacit-e Alply Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 951212642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 0 10mm Nt Kn2 Mtl Pe Por Csti Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 10mm Nt Kn2 Mtl Pe Por Csti Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 10mm Nt Kn2 Mtl Pe Por Csti Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 10mm Nt Kn2 Csti Mtl Pe Por Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951212646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 9mm Kn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib D 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 9mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib E 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 9mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 9mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 9mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 9mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 10mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 11mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 12mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 14mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951212686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 25x40mm Mg Kn Rmll Tiv Ultrapek Ser 1 Uncmp Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 30x48mm Mg 3 Kn Rmll Tiv Ultrapek Uncmp Mdlr S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 32x52mm Mg Kn Rmll Tiv Ultrapek S4 Uncmp Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 35x56mm Mg Kn Rmll Tiv Ultrapek Ser 5 Uncmp Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 35x56mm Mg Kn Lt Mdl Rl Tiv Ultrapek Ser 5 Uncmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona C Kn Lt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona C Kn Rt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona D Kn Lt Prt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona D Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona E Kn Lt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona E Kn Rt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona F Kn Lt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona F Kn Rt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona G Kn Lt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona G Kn Rt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona H Kn Lt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona H Kn Rt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona J Kn Lt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Persona J Kn Rt Mdl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 951212705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Knee Lcck Femoral Size C-lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Knee Lcck Femoral Size C-rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem D Kn Lt Stscr Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem D Kn Rt Stscr Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E Kn Lt Stscr Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E Kn Rt Stscr Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F Kn Lt Stscr Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,180.00|FSC: 13; Default||Not reimbursed separately|15,180.00|FSC: 13; Default||External grouping not supported 951212712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F Kn Rt Stscr Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G Kn Lt Stscr Cnstrn Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 951212714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G Kn Rt Stscr Cnstrn Lcck Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,180.00|FSC: 13; Default||Not reimbursed separately|15,180.00|FSC: 13; Default||External grouping not supported 951212715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem C 63x53.5mm Kn Rt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem D 68x57.5mm Kn Lt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E 72x61.5mm Kn Lt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem E 72x61.5mm Kn Rt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F 77x65.5mm Kn Lt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem F 77x65.5mm Kn Rt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G 81x70.5mm Kn Lt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem G 81x70.5mm Kn Rt Crcte Rtn Rev Cmnt Augmentable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|FSC: 13; Default||Not reimbursed separately|16,078.50|FSC: 13; Default||External grouping not supported 951212723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Rev Nt Kn2 Csti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|FSC: 13; Default||Not reimbursed separately|22,980.00|FSC: 13; Default||External grouping not supported 951212731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 00 Kn Lt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Lt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Lt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Crk Nonporous Femoral Rt Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Rev Cnstrn Nt Kn2 Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|FSC: 13; Default||Not reimbursed separately|19,459.50|FSC: 13; Default||External grouping not supported 951212752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d Mic 58x40x14mm Kn Rev Mach Mld Tiv Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951213523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 300mm 16.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 300mm 18.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 9mm Oss Prox Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 11mm Oss Prox Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 13mm Oss Prox Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 15mm Oss Prox Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 10.5mm Oss Prox Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 12.5mm Oss Prox Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 14.5mm Oss Prox Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 16.5mm Oss Prox Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm Colr Oss Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951213534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 11mm Colr Oss Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|FSC: 13; Default||Not reimbursed separately|5,328.00|FSC: 13; Default||External grouping not supported 951213535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 11mm Colr Oss Bw Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,327.00|FSC: 13; Default||Not reimbursed separately|6,327.00|FSC: 13; Default||External grouping not supported 951213536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 11mm Colr Oss Bw Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,327.00|FSC: 13; Default||Not reimbursed separately|6,327.00|FSC: 13; Default||External grouping not supported 951213537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 11mm Colr Oss Bw Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,327.00|FSC: 13; Default||Not reimbursed separately|6,327.00|FSC: 13; Default||External grouping not supported 951213538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 11mm Colr Oss Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|FSC: 13; Default||Not reimbursed separately|5,832.00|FSC: 13; Default||External grouping not supported 951213539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 13mm Colr Oss Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|FSC: 13; Default||Not reimbursed separately|5,832.00|FSC: 13; Default||External grouping not supported 951213540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 15mm Colr Oss Strg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|FSC: 13; Default||Not reimbursed separately|5,832.00|FSC: 13; Default||External grouping not supported 951213541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 9mm Spline Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|FSC: 13; Default||Not reimbursed separately|6,048.00|FSC: 13; Default||External grouping not supported 951213542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 10mm Spline Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|FSC: 13; Default||Not reimbursed separately|6,048.00|FSC: 13; Default||External grouping not supported 951213543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Spline Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|FSC: 13; Default||Not reimbursed separately|6,048.00|FSC: 13; Default||External grouping not supported 951213544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 12mm Spline Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|FSC: 13; Default||Not reimbursed separately|6,048.00|FSC: 13; Default||External grouping not supported 951213545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 13mm Spline Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|FSC: 13; Default||Not reimbursed separately|6,048.00|FSC: 13; Default||External grouping not supported 951213546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 14mm Spline Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|FSC: 13; Default||Not reimbursed separately|6,048.00|FSC: 13; Default||External grouping not supported 951213547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 11.5mm Finn Por Strg Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|FSC: 13; Default||Not reimbursed separately|5,369.40|FSC: 13; Default||External grouping not supported 951213548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 13.5mm Finn Por Strg Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|FSC: 13; Default||Not reimbursed separately|5,369.40|FSC: 13; Default||External grouping not supported 951213549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 15.5mm Finn Por Strg Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|FSC: 13; Default||Not reimbursed separately|5,369.40|FSC: 13; Default||External grouping not supported 951213550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 17.5mm Finn Por Strg Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|FSC: 13; Default||Not reimbursed separately|5,369.40|FSC: 13; Default||External grouping not supported 951213551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss Unv 10mm Tib 63/67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss Unv 10mm Tib 71/75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss Unv 10mm Tib 79/83mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss 20mm Tib Rmll 63/67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss 20mm Tib Lt Mdl Rl 63/67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss 20mm Tib Rmll 71/75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss 20mm Tib Lt Mdl Rl 71/75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss 20mm Tib Rmll 79/83mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Oss 20mm Tib Lt Mdl Rl 79/83mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|FSC: 13; Default||Not reimbursed separately|3,409.20|FSC: 13; Default||External grouping not supported 951213560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug 3cm Oss Ant Rsrfc Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.20|FSC: 13; Default||Not reimbursed separately|2,716.20|FSC: 13; Default||External grouping not supported 951213561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Oss Fem Rt Rsrfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Oss Fem Lt Rsrfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib Oss Sm Kn Aug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 951213564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Oss Lg Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 3.5mm Oss Ant Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 951213566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 3cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|FSC: 13; Default||Not reimbursed separately|17,577.00|FSC: 13; Default||External grouping not supported 951213567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 4cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|FSC: 13; Default||Not reimbursed separately|17,577.00|FSC: 13; Default||External grouping not supported 951213568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 5cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|FSC: 13; Default||Not reimbursed separately|17,577.00|FSC: 13; Default||External grouping not supported 951213569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 7cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|FSC: 13; Default||Not reimbursed separately|17,577.00|FSC: 13; Default||External grouping not supported 951213570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 9cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|FSC: 13; Default||Not reimbursed separately|17,577.00|FSC: 13; Default||External grouping not supported 951213571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 11cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 13cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 15cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 17cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 19cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 21cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg 23cm Oss Tpr Kn Diaphysis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|FSC: 13; Default||Not reimbursed separately|18,522.00|FSC: 13; Default||External grouping not supported 951213578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Oss Sm Tpr Kn Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 951213579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Oss Med Tpr Kn Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,143.40|FSC: 13; Default||Not reimbursed separately|6,143.40|FSC: 13; Default||External grouping not supported 951213580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Oss Lg Tpr Kn Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951213581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Oss Strg Kn Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 951213582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Oss Kn Osseoti Dphrm Plat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951213583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Oss Sm Dist Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|FSC: 13; Default||Not reimbursed separately|5,670.00|FSC: 13; Default||External grouping not supported 951213584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Oss Lg Dist Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951213585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib Oss Sm Kn Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 951213586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 47/51mmx10mm Oss Unv Kn Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951213587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 55/59mmx10mm Oss Unv Kn Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951213588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 47/51mmx20mm Oss Kn Rmll Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951213589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 47/51mmx20mm Oss Kn Lt Mdl Rl Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951213590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 55/59mmx20mm Oss Kn Rmll Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951213591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 55/59mmx20mm Oss Kn Lt Mdl Rl Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 951213592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx Oss Lck Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 951213593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 3cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss 10cm Total Fem Diaph Cplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss 30cm Total Fem Diaph Cplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 11cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 13cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 15cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 17cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 19cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 21cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 23cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Oss Sm Thrd Fem Lck Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|734.40|FSC: 13; Default||Not reimbursed separately|734.40|FSC: 13; Default||External grouping not supported 951213608|EAP|Custom 951213608||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Tib Oss Kn Pe Lfric Intfc|1|HUMANA [1294]||HUMANA [11839]|912.60|FSC: 13; Default||Not reimbursed separately|912.60|FSC: 13; Default||External grouping not supported 951213609|EAP|Custom 951213609||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Fem Oss Kn Pe Aux|1|HUMANA [1294]||HUMANA [11839]|638.10|FSC: 13; Default||Not reimbursed separately|638.10|FSC: 13; Default||External grouping not supported 951213610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx Oss Kn Pe Lck Cmpr Mld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 951213611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Tib Oss Kn Lfric Intfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,384.20|FSC: 13; Default||Not reimbursed separately|1,384.20|FSC: 13; Default||External grouping not supported 951213612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Scr Oss Fem Dphsl Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|463.50|FSC: 13; Default||Not reimbursed separately|463.50|FSC: 13; Default||External grouping not supported 951213613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4cm Kn Dphsl Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Oss Hip Fem Seg Stk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|451.80|FSC: 13; Default||Not reimbursed separately|451.80|FSC: 13; Default||External grouping not supported 951213615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Yoke Tib Oss Kn Reinf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.60|FSC: 13; Default||Not reimbursed separately|3,225.60|FSC: 13; Default||External grouping not supported 951213616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd 1cm Oss Hip Fem Dphsl Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 20cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 21cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 22cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 23cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 24cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 25cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 26cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 27cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 28cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 29cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 30cm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|FSC: 13; Default||Not reimbursed separately|9,401.40|FSC: 13; Default||External grouping not supported 951213628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx Oss Kn Pe Lck Bmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,276.20|FSC: 13; Default||Not reimbursed separately|1,276.20|FSC: 13; Default||External grouping not supported 951213629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wshr Kn Spk Oss Orth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 951213630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss 0mm Spk Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|FSC: 13; Default||Not reimbursed separately|520.20|FSC: 13; Default||External grouping not supported 951213631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss 2mm Spk Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|FSC: 13; Default||Not reimbursed separately|520.20|FSC: 13; Default||External grouping not supported 951213632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss 4mm Spk Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|FSC: 13; Default||Not reimbursed separately|520.20|FSC: 13; Default||External grouping not supported 951213633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss 6mm Spk Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|FSC: 13; Default||Not reimbursed separately|520.20|FSC: 13; Default||External grouping not supported 951213634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss 8mm Spk Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|FSC: 13; Default||Not reimbursed separately|520.20|FSC: 13; Default||External grouping not supported 951213635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss 10mm Spk Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|FSC: 13; Default||Not reimbursed separately|520.20|FSC: 13; Default||External grouping not supported 951213636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 20cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 21cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 22cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 23cm 14mm Oss Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 24cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 25cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 26cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 27cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 28cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 29cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Im 30cm 14mm Oss Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|FSC: 13; Default||Not reimbursed separately|9,828.00|FSC: 13; Default||External grouping not supported 951213647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Finn Lg Kn Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.60|FSC: 13; Default||Not reimbursed separately|642.60|FSC: 13; Default||External grouping not supported 951213648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Tib Kn Rot Hng Fn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|891.00|FSC: 13; Default||Not reimbursed separately|891.00|FSC: 13; Default||External grouping not supported 951213649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Fem Finn Kn Pe Mdlr Rot Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.10|FSC: 13; Default||Not reimbursed separately|647.10|FSC: 13; Default||External grouping not supported 951213650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx Lck Rot Hng Kn Finn Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|687.60|FSC: 13; Default||Not reimbursed separately|687.60|FSC: 13; Default||External grouping not supported 951213651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Yoke Fem Finn Lng Kn Cocr Pe Rsrfc Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951213652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Tib Finn Kn Ti Rot Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.20|FSC: 13; Default||Not reimbursed separately|1,294.20|FSC: 13; Default||External grouping not supported 951213653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 8.5cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 152x13x8.5mm Finn Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 8.5cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 8.5cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 10cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 152x12x11mm Finn Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 14cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 16cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 18cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 20cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 22cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 24cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 10cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 12cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 14cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 16cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 18cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 20cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 22cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 24cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 10cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 12cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 14cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 16cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 18cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 20cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 22cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 24cm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 10cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 12cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 14cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 16cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 18cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 20cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 22cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 152mm Kn Seg Finn Ti 24cm 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|FSC: 13; Default||Not reimbursed separately|17,683.20|FSC: 13; Default||External grouping not supported 951213689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Fem Oss Hip Pe Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,276.20|FSC: 13; Default||Not reimbursed separately|1,276.20|FSC: 13; Default||External grouping not supported 951213690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Fem Oss Kn Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,384.20|FSC: 13; Default||Not reimbursed separately|1,384.20|FSC: 13; Default||External grouping not supported 951213691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Tib Oss Poly Set Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.60|FSC: 13; Default||Not reimbursed separately|1,092.60|FSC: 13; Default||External grouping not supported 951213692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bshng Fem Oss Kn Poly Set Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 951213693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss Avl Tibial Lock Ring|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,276.20|FSC: 13; Default||Not reimbursed separately|1,276.20|FSC: 13; Default||External grouping not supported 951213694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Axle Fem Oss Kn Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,377.00|FSC: 13; Default||Not reimbursed separately|1,377.00|FSC: 13; Default||External grouping not supported 951213695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Yoke Tib 12mm Oss Kn Cocr Bshng Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,968.20|FSC: 13; Default||Not reimbursed separately|2,968.20|FSC: 13; Default||External grouping not supported 951213696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Yoke Tib 14mm Oss Kn Cocr Bshng Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,968.20|FSC: 13; Default||Not reimbursed separately|2,968.20|FSC: 13; Default||External grouping not supported 951213697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Yoke Tib 16mm Oss Kn Cocr Bshng Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,968.20|FSC: 13; Default||Not reimbursed separately|2,968.20|FSC: 13; Default||External grouping not supported 951213698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Ellipse 3cm Kn Dphsl Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|FSC: 13; Default||Not reimbursed separately|18,732.60|FSC: 13; Default||External grouping not supported 951213700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Xs Spdl With Pins 400lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Xs Spdl With Pins 600lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Xs Spdl With Pins 800lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Spdl With Pins 400lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Spdl With Pins 600lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Spdl With Pins 800lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg Spdl With Pins 400lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg Spdl With Pins 600lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg Spdl With Pins 800lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth Cmpr C400lb Std Elip Kn Antirotation Pin Slvg Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth Cmpr C600lb Std Elip Kn Antirotation Pin Slvg Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth Cmpr C800lb Std Elip Kn Antirotation Pin Slvg Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Xs Sht Spdl W Pins 400lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Xs Sht Spdl W Pins 600lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Xs Sht Spdl W Pins 800lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Sht Spdl W Pins 400lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Sht Spdl W Pins 600lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Sht Spdl W Pins 800lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg Sht Spdl W Pins 400lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg Sht Spdl W Pins 600lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg Sht Spdl W Pins 800lbf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth Cmpr C400lb Shrt Elip Kn Antirotation Pin Slvg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth Cmpr C600lb Shrt Elip Kn Antirotation Pin Slvg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth Cmpr C800lb Shrt Elip Kn Antirotation Pin Slvg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|FSC: 13; Default||Not reimbursed separately|11,412.00|FSC: 13; Default||External grouping not supported 951213724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Cmpr Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.20|FSC: 13; Default||Not reimbursed separately|277.20|FSC: 13; Default||External grouping not supported 951213725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 10mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 12mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 14mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 16mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951214485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx20mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx22mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx24mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx20mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx22mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx24mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx20mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx20mm Vngrd Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd E1 Kn Cr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd E1 Kn Cr Lip Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd E1 Kn Cr Lip Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd E1 Kn Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd E1 Kn Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd E1 Kn Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd E1 Kn Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd E1 Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd E1 Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd E-poly Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd E-poly Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd E-poly Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd E-poly Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951215452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx20mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx22mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx24mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx20mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx22mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx24mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx20mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx22mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx24mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx10mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Maxim Vi Ps Arcom Brng 12x91mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx14mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx16mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx18mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx20mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx22mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx24mm Mxm Arcm Post Stab Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 951215498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Mxm Arcm Cnstrn Vi Rev Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx20mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx22mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx24mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx20mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx22mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx24mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx20mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx22mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx24mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx20mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx22mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx24mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx20mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx22mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx24mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx20mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx22mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx24mm Mxm Arcm Kn Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|FSC: 13; Default||Not reimbursed separately|4,834.50|FSC: 13; Default||External grouping not supported 951215554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Mxm Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|FSC: 13; Default||Not reimbursed separately|4,929.00|FSC: 13; Default||External grouping not supported 951215593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx10mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx12mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx14mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx16mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx18mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx20mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx10mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx12mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx14mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx16mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx18mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx20mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx20mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx10mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx12mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx14mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx16mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx20mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx10mm Agc Kn Mdlr Dir Cmpr Mld Tib I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx12mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx14mm Agc Mdlr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx16mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx20mm Agc Kn Mdlr Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951216395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 40mm Regenerex Lg Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Xs Hlf A Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Sm Hlf A Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Med Hlf A Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Lg Hlf A Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Xs Hlf B Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Sm Hlf B Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Med Hlf B Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Lg Hlf B Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 951216404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Xs Full Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951216405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Sm Full Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951216406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Med Full Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951216407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Aug Vngrd 360 Lg Full Tib Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|FSC: 13; Default||Not reimbursed separately|6,615.00|FSC: 13; Default||External grouping not supported 951216408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 59mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 63mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 67mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 71mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 75mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 79mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 83mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 87mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Aug 91mm Mxm 10d Hemi Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|FSC: 13; Default||Not reimbursed separately|2,814.00|FSC: 13; Default||External grouping not supported 951216417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 59mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 63mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 67mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 71mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 75mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 79mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 83mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 87mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 91mmx6mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 59mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 63mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 67mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 71mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 75mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 79mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 83mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 87mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 91mmx10mm Kn Tib Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|FSC: 13; Default||Not reimbursed separately|2,668.50|FSC: 13; Default||External grouping not supported 951216435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 59mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 63mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 67mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 71mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 75mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 79mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 83mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 87mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 91mmx16mm Kn Tib Lt Mdl Rl Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 59mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 63mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 67mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 71mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 75mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 79mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216450|EAP|HCPCS 951216450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fx 6in 2mm Krsh Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 87mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug As Mx 91mmx16mm Kn Tib Rmll Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|FSC: 13; Default||Not reimbursed separately|3,904.50|FSC: 13; Default||External grouping not supported 951216453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx6mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx6mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx6mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx6mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx6mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx6mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx6mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx6mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx6mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx6mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx6mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx6mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx6mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx6mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx6mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx6mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx6mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx6mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx6mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx6mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx6mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx6mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx6mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx6mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx10mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx10mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx10mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx10mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx10mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx10mm Fem Dist Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx10mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx10mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx10mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx10mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx10mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx10mm Fem Dist Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx10mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx10mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx10mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx10mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx10mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx10mm Fem Post Lt Mdl Rl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 55mmx10mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 60mmx10mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 65mmx10mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 70mmx10mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 75mmx10mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Mxm 80mmx10mm Fem Post Rmll Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|FSC: 13; Default||Not reimbursed separately|2,737.50|FSC: 13; Default||External grouping not supported 951216501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 6mm Mxm Bolt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.50|FSC: 13; Default||Not reimbursed separately|361.50|FSC: 13; Default||External grouping not supported 951216502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Xs Kn Rt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Sm Kn Rt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Lg Kn Rt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt Xl Kn Rt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 4mm Ascnt 2xl Kn Rt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Xs Kn Lt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Sm Kn Lt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Lg Kn Lt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt Xl Kn Lt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 8mm Ascnt 2xl Kn Lt Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|FSC: 13; Default||Not reimbursed separately|2,002.50|FSC: 13; Default||External grouping not supported 951216512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Rt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Rt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Rt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Rt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Rt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Rt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Lt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Lt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mmx67nn Kn Lt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Lt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Lt Cr Prm Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Rt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Rt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x68mm Kn Rt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Rt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Rt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Lt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Lt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x68mm Kn Lt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Lt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Lt Post Stab Mxm Intlk Rf Vii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Lt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Post Stab Opn Bx Mxm Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 80mm Kn Hi Post Stab Intlk Fnsh Agc Trd Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Rt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Rt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Rt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Rt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Rt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x78mm Kn Rt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Lt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Lt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Lt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Lt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Rt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x58mm Kn Lt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Lt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Lt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x73mm Kn Lt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Lt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Rt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x58mm Kn Rt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Rt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Rt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x73mm Kn Rt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Rt Cmnt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 55mm Kn Cmnt Cr Agc Trd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 60mm Kn Cmnt Cr Agc Trd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 65mm Kn Cmnt Cr Agc Trd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x78mm Kn Lt Cr Agc Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216577|EAP|HCPCS 951216577||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splnt Orth Sm Unv 7-8in Ankl 8 Strap Lace Up Rem Mdl Lat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951216578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Post Stab Agc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 70mm Kn Cmnt Cr Agc Trd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 75mm Kn Cmnt Cr Agc Trd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 80mm Kn Cmnt Cr Agc Trd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 55mm Kn Cmnt Post Stab Agc Trd Lgc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 60mm Kn Cmnt Post Stab Agc Trd Lgc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 65mm Kn Cmnt Post Stab Agc Trd Lgc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 70mm Kn Cmnt Post Stab Agc Trd Lgc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 75mm Kn Cmnt Post Stab Agc Trd Lgc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951205987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Lmt 4 Hl Osseoti G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Lmt 4 Hl Osseoti G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Lmt 4 Hl Osseoti G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|FSC: 13; Default||Not reimbursed separately|7,627.50|FSC: 13; Default||External grouping not supported 951205990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Mlhl Osseoti G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Mlhl Osseoti G7 A Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Mlhl Osseoti G7 B Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Mlhl Osseoti G7 C Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Mlhl Osseoti G7 D Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Mlhl Osseoti G7 E Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Mlhl Osseoti G7 F Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Mlhl Osseoti G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Mlhl Osseoti G7 G Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951205999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Mlhl Osseoti G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Mlhl Osseoti G7 H Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Mlhl Osseoti G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Mlhl Osseoti G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Mlhl Osseoti G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Mlhl Osseoti G7 I Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Mlhl Osseoti G7 J Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Mlhl Osseoti G7 J Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Mlhl Osseoti G7 J Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Mlhl Osseoti G7 J Hmsphr Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|FSC: 13; Default||Not reimbursed separately|9,213.00|FSC: 13; Default||External grouping not supported 951206009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Ii 10d 23 50/52mm 32mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|FSC: 13; Default||Not reimbursed separately|6,717.00|FSC: 13; Default||External grouping not supported 951206010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Ii 10d 24 54/56mm 32mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|FSC: 13; Default||Not reimbursed separately|6,717.00|FSC: 13; Default||External grouping not supported 951206011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Ii 10d 26 62/64mm 32mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|FSC: 13; Default||Not reimbursed separately|6,717.00|FSC: 13; Default||External grouping not supported 951206012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Ii 10d 27 66/68mm 32mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|FSC: 13; Default||Not reimbursed separately|6,717.00|FSC: 13; Default||External grouping not supported 951206013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Ii 10d 28 70/80mm 32mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|FSC: 13; Default||Not reimbursed separately|6,717.00|FSC: 13; Default||External grouping not supported 951206014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 23 +5mm Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|FSC: 13; Default||Not reimbursed separately|8,518.50|FSC: 13; Default||External grouping not supported 951206015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 24 +5mm Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|FSC: 13; Default||Not reimbursed separately|8,518.50|FSC: 13; Default||External grouping not supported 951206016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 25 +5mm Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|FSC: 13; Default||Not reimbursed separately|8,518.50|FSC: 13; Default||External grouping not supported 951206017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 26 +5mm Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|FSC: 13; Default||Not reimbursed separately|8,518.50|FSC: 13; Default||External grouping not supported 951206018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 27 +5mm Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|FSC: 13; Default||Not reimbursed separately|8,518.50|FSC: 13; Default||External grouping not supported 951206019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 28 +5mm Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|FSC: 13; Default||Not reimbursed separately|8,518.50|FSC: 13; Default||External grouping not supported 951206020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 43 +5mm Std Face 36mm Arcm Hip Loprfl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 44 +5mm Std Face 36mm Arcm Hip Loprfl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 45 +5mm Std Face 36mm Arcm Hip Loprfl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 46 +5mm Std Face 36mm Arcm Hip Loprfl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 47 +5mm Std Face 36mm Arcm Hip Loprfl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 48 +5mm Std Face 36mm Arcm Hip Loprfl Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 24 Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 25 Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 26 Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 27 Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 28 Std Face 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 10d 24 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 10d 25 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 10d 26 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 10d 27 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Frdm 10d 28 36mm Arcm Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|FSC: 13; Default||Not reimbursed separately|6,261.00|FSC: 13; Default||External grouping not supported 951206036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 24 Std Face 4.8mm 36mm 22mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 25 Std Face 5.8mm 38mm 22mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 26 Std Face 5.3mm 41mm 28mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 27 Std Face 5.8mm 44mm 28mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 28 Std Face 5.8mm 48mm 28mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 24 4.8mm 36mm 22mm Poly Hip Trplr Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 25 5.8mm 38mm 22mm Poly Hip Trplr Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 26 5.3mm 41mm 28mm Poly Hip Trplr Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 27 5.8mm 44mm 28mm Poly Hip Trplr Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt 28 5.8mm 48mm 28mm Poly Hip Trplr Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt +5mm 24 9.8mm 36mm 22mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt +5mm 25 10.8mm 38mm 22mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt +5mm 26 10.3mm 41mm 28mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt +5mm 27 10.8mm 44mm 28mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Bmt +5mm 28 10.8mm 48mm 28mm Poly Hip Trplr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|FSC: 13; Default||Not reimbursed separately|5,148.00|FSC: 13; Default||External grouping not supported 951206051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 32mm Cnstrn Arcm 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,287.50|FSC: 13; Default||Not reimbursed separately|5,287.50|FSC: 13; Default||External grouping not supported 951206052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 1 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 2 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 3 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 4 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 5 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 6 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 7 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 8 28mm Arcm Hip Sup Lck Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d 2 28mm Arcm Hip Sup Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d 3 28mm Arcm Hip Sup Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d 4 28mm Arcm Hip Sup Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d 5 28mm Arcm Hip Sup Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|FSC: 13; Default||Not reimbursed separately|5,262.00|FSC: 13; Default||External grouping not supported 951206064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm A Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm B Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm C Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm D Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm E Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 28mm Arcomxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm B Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm C Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm D Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm E Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 32mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm D Ntrl 36mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm E Ntrl 36mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 36mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 36mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 36mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 36mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 36mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 40mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 40mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 40mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 40mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 40mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm H Ntrl 44mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm I Ntrl 44mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm J Ntrl 44mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|FSC: 13; Default||Not reimbursed separately|3,945.00|FSC: 13; Default||External grouping not supported 951206096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 36mm 22mm Hip Trplr Poly Bmt Rnglc 24 4.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|FSC: 13; Default||Not reimbursed separately|4,477.50|FSC: 13; Default||External grouping not supported 951206097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 38mm 22mm Hip Trplr Poly Bmt Rnglc 25 5.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|FSC: 13; Default||Not reimbursed separately|4,477.50|FSC: 13; Default||External grouping not supported 951206098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 41mm 28mm Hip Trplr Poly Bmt Rnglc 26 5.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|FSC: 13; Default||Not reimbursed separately|4,477.50|FSC: 13; Default||External grouping not supported 951206099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm 28mm Hip Trplr Poly Bmt Rnglc 27 5.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|FSC: 13; Default||Not reimbursed separately|4,477.50|FSC: 13; Default||External grouping not supported 951206100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm 28mm Hip Trplr Poly Bmt Rnglc 28 5.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|FSC: 13; Default||Not reimbursed separately|4,477.50|FSC: 13; Default||External grouping not supported 951206101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm B 32mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm C 32mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm D 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm E 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm F 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm G 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm H 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm I 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm J 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951206110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d B 32mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d C 32mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d D 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d E 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d F 36mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d G 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d H 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d I 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm 10d J 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm B 32mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm C 32mm E1 Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm D 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm E 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm F 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm G 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm H 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm I 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 Frdm +5mm J 36mm E1 Hip Cnstrn Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|FSC: 13; Default||Not reimbursed separately|5,875.50|FSC: 13; Default||External grouping not supported 951206128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm A Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm B Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm C Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm D Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm E Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm F Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm G Ntrl 28mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Neu +5mm E1 Liner 28mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Neu +5mm E1 Liner 28mm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G7 Neu +5mm E1 Liner 28mm J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm B Ntrl 32mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm C Ntrl 32mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm D Ntrl 32mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 +5mm E Ntrl 32mm E1 Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951206142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 24mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951206143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 305mm 25mm Dist Fil Wgnr Sl Rv Protasul-100 Por 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|FSC: 13; Default||Not reimbursed separately|15,763.50|FSC: 13; Default||External grouping not supported 951206144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 13mm Prm Wgnr Cone Pros Protasul-100 Por 125d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125.5mm 14mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125.7mm 15mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125.9mm 16mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.2mm 17mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.4mm 18mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.6mm 19mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.8mm 20mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127mm 21mm Prm Wgnr Cone Pros Protasul-100 Por 125d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127.2mm 22mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127.4mm 23mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127.6mm 24mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 13mm Prm Wgnr Cone Pros Protasul-100 Por 135d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125.5mm 14mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125.7mm 15mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125.9mm 16mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.2mm 17mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.4mm 18mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.6mm 19mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126.8mm 20mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127mm 21mm Prm Wgnr Cone Pros Protasul-100 Por 135d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127.2mm 22mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127.4mm 23mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 127.6mm 24mm Prm Wgnr Cone Pros Protasul-100 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|FSC: 13; Default||Not reimbursed separately|8,149.50|FSC: 13; Default||External grouping not supported 951206168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls 3 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls 4 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls 5 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls Ti Npor 6 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls Protasul-100 Por 7 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls Protasul-100 Por 8 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Rev Alcls Protasul-100 Por 10 Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|FSC: 13; Default||Not reimbursed separately|12,289.50|FSC: 13; Default||External grouping not supported 951206938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 54mm Strg Hip Trb Mtl Btrs Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|FSC: 13; Default||Not reimbursed separately|7,273.50|FSC: 13; Default||External grouping not supported 951206939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 58mm Strg Hip Trb Mtl Btrs Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|FSC: 13; Default||Not reimbursed separately|7,273.50|FSC: 13; Default||External grouping not supported 951206940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 15mm 50mm Trb Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 20mm 50mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 30mm 50mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 10mm 54mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 54mm Thk15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 20mm 54mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 30mm 54mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 10mm 58mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 15mm 58mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 20mm 58mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 30mm 58mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 10mm 62mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 15mm 62mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 20mm 62mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 30mm 62mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 10mm 66mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 15mm 66mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 20mm 66mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 30mm 66mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 10mm 70mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb 15mm 70mm Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 951206961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb Hip Rt Ant Lt Post Trb Mtl Btrs Clmn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|FSC: 13; Default||Not reimbursed separately|7,273.50|FSC: 13; Default||External grouping not supported 951206962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Actb Hip Rt Post Lt Ant Trb Mtl Btrs Clmn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|FSC: 13; Default||Not reimbursed separately|7,273.50|FSC: 13; Default||External grouping not supported 951206963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 56/58/60mm 48mm Hip Rt Trb Mtl Rev Cup Shrt Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tm Sht Flange Cage Rt 62/64 Shell/54 Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 66/68/70mm 58mm Shrt Hip Rt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 72/74mm 64mm Shrt Hip Rt Trb Mtl Rev Cup Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 76/78/80mm 68mm Shrt Hip Rt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 56/58/60mm 48mm Shrt Hip Lt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 62/64mm 54mm Hip Lt Trb Mtl Rev Cup Shrt Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 66/68/70mm 58mm Shrt Hip Lt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 72/74mm 64mm Shrt Hip Lt Trb Mtl Rev Cup Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 76/78/80mm 68mm Shrt Hip Lt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 56/58/60mm 48mm Lng Hip Rt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 62/64mm 54mm Lng Hip Rt Trb Mtl Rev Cup Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 66/68/70mm 58mm Lng Hip Rt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 72/74mm 64mm Lng Hip Rt Trb Mtl Rev Cup Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 76/78/80mm 68mm Lng Hip Rt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 56/58/60mm 48mm Lng Hip Lt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 62/64mm 54mm Hip Lt Trb Mtl Rev Cup Lng Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 66/68/70mm 58mm Lng Hip Lt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 72/74mm 64mm Lng Hip Lt Trb Mtl Rev Cup Flng Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Actb 76/78/80mm 68mm Lng Hip Lt Trb Mtl Rev Cup Flng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|FSC: 13; Default||Not reimbursed separately|8,247.00|FSC: 13; Default||External grouping not supported 951206983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Orth Zmr Lg Hip Tiv Cmpr Mdlr Jnctn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 951206984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Vrsy Hr Std Hip Prox Pmma Slv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951206985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 17mm Vrsy Hip Pmma Cmnt Cntrlzr Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951206986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 79mm 11mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 12mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 82mm 13mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 84mm 14mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 86mm 15mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 16mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 94mm 17mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 98mm 18mm Full Prfl Echo Bmtrc Microplasty Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102mm 19mm Full Prfl Echo Bmtrc Microplasty Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 106mm 20mm Full Prfl Echo Bmtrc Microplasty Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 21mm Full Prfl Echo Bmtrc Microplasty Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 75mm 7mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 76mm 8mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951206999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 77mm 9mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 78mm 10mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 79mm 11mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 80mm 12mm Echo Bmtrc Microplasty Hi Ofst Full Prfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 82mm 13mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 84mm 14mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 86mm 15mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 16mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 94mm 17mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 98mm 18mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102mm 19mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 106mm 20mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 21mm Full Prfl Echo Bmtrc Microplasty Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 7.5mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm 9mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 10mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm 11mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 12.5mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm 13.5mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17.5mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 22.5mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm 16mm Tprlk Ti Ha Por Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 10mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 13mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 14mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 18mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 19mm Prm Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 7.5mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm 9mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 10mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm 11mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12.5mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm 13.5mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 17.5mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 22.5mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 25mm Prm Lateralize Tprlk Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 10mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 13mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 14mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Prm Lateralize Mlhd Ha Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102.5mm Ty 1 Tprlk Microplasty Pps 133d 9 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm Ty 1 Tprlk Microplasty Pps 133d 10 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107.5mm Ty 1 Tprlk Microplasty Pps 133d 11 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm Ty 1 Tprlk Microplasty Pps 133d 12 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm Ty 1 Tprlk Microplasty Pps 133d 13 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 113mm Ty 1 Tprlk Microplasty Pps 133d 14 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm Ty 1 Tprlk Microplasty Pps 133d 15 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 117mm Ty 1 Tprlk Microplasty Pps 133d 16 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm Ty 1 Tprlk Microplasty Pps 133d 17 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm Ty 1 Tprlk Microplasty Pps 133d 18 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm Ty 1 Tprlk Microplasty Pps 133d 20 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 129mm Ty 1 Tprlk Microplasty Pps 133d 22 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm Ty 1 Tprlk Microplasty Pps 133d 24 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102.5mm Ty 1 Tprlk Microplasty Ti Pps 133d 9 Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm Ty 1 Tprlk Microplasty Ti Pps 133d 10 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107.5mm Ty 1 Tprlk Microplasty Ti Pps 133d 11 Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm Ty 1 Tprlk Microplasty Ti Pps 133d 12 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm Ty 1 Tprlk Microplasty Ti Pps 133d 13 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 113mm Ty 1 Tprlk Microplasty Ti Pps 133d 14 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm Ty 1 Tprlk Microplasty Ti Pps 133d 15 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 117mm Ty 1 Cmplt Microplasty Tprlk Pps Ti 133d 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm Ty 1 Tprlk Microplasty Ti Pps 133d 17 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm Ty 1 Tprlk Microplasty Ti Pps 133d 18 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm Ty 1 Tprlk Microplasty Ti Pps 133d 20 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 129mm Ty 1 Prft Tprlk Microplasty Pps 133d 22 Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm Ty 1 Prft Tprlk Microplasty Pps 133d 24 Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 93mm Ty 1 Prft Tprlk Microplasty Pps 133d 4 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm Ty 1 Prft Tprlk Microplasty Pps 133d 5 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 97.5mm Ty 1 Prft Tprlk Microplasty Pps 133d 6 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 97mm Ty 1 Prft Tprlk Microplasty Pps 133d 7 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 101mm Ty 1 Prft Tprlk Microplasty Pps 133d 8 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm Ty 1 Prft Tprlk Microplasty Pps 133d 5 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 97.5mm Ty 1 Prft Tprlk Microplasty Pps 133d 6 Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 99mm Ty 1 Prft Tprlk Microplasty Pps 133d 7 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 101mm Ty 1 Prft Tprlk Microplasty Pps 133d 8 Hi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 102.5mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 105mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107.5mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 113mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 117mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Tprlk Microplasty Xr Ser Pps 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Tprlk Microplasty Xr Ser Pps 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Tprlk Microplasty Xr Ser Pps 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 93mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 95mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 97.5mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 99mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 101mm Ty 1 Prft Tprlk Microplasty Xr Ser Pps 123d 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 7mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 8mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 9mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 11mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13mm Prm Medialize Ins Hl Nnoncollar X Ser Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 14mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Prm Medialize Ins Hl Nnoncollar X Ser Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 17mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 18mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 19mm Prm Medialize Ins Hl Noncollar Bmtrc X Ser Pps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm 11mm Prm Tiv 47mm Tpr Xtd Ofst Rdc Nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 124mm 12.5mm Prm Ml Tiv Por 42mm Std Ofst Tpr 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 124mm 12.5mm Prm Tiv 47mm Tpr Xtd Ofst Rdc Nk Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm 22.5mm Prm Ml Tiv Por 45mm Tpr Strg Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm 22.5mm Prm Tiv Por 50mm Tpr Strg Xtd Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 10x130mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 11x130mm Std Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 11x130mm Lm Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 11x130mm Lm Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 12x140mm Lm Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 13x140mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 13x140mm Std Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 13x140mm Lm Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 13x140mm Lm Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 14x140mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 14x140mm Lm Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 15x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 15x160mm Lm Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 16x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 16x160mm Lm Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 16x160mm Lm Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 17x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 17x160mm Std Body Ext Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 17x160mm Lm Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Beaded Mc Clr 18x160mm Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Colr Algn Gd Vrsy Zml Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 9mm Prm Colr Algn Gd Vrsy Tiv Fm Plslfn Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 9mm Prm Algn Gd Clrls Std Bd Vrsy Tiv Fm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Algn Gd Vrsy Tiv Fm Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Prm Algn Gd Std Bd Vrsy Tiv Fm Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Tiv Fm Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Std Bd Vrsy Tiv Fm Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Tiv Fm Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Std Bd Vrsy Tiv Fm Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Vrsy Tiv Fm Plslfn Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 19mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Vrsy Tiv Fm Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Std Bd Vrsy Tiv Fm Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Lmb Vrsy Tiv Fm Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 20mm Prm Algn Gd Clrls Lmb Vrsy Tiv Fm Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Zml Plslfn Beaded Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 9mm Prm Vrsy Tiv Fm Por 33mm Std Ofst Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Vrsy Tiv Fm Por 48mm Tpr Std Bd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Std Bd Vrsy Tiv Fm Por 53mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Vrsy Tiv Fm Beaded Por 48mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Vrsy Tiv Fm Beaded Por 53mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 20mm Prm Std Bd Vrsy Tiv Fm Por 53mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 20mm Prm Vrsy Tiv Fm Beaded Por 48mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 20mm Prm Lmb Vrsy Tiv Fm Por 53mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm Prm Alcls Sl Protasul-100 Por 0 40mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prm Alcls Sl Protasul-100 Por 01 39mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 138mm Prm Alcls Sl Protasul-100 Por 1 41mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 143mm Prm Alcls Sl Protasul-100 Por 2 42mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 147mm Prm Alcls Sl Protasul-100 Por 3 43mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 151mm Prm Alcls Sl Protasul-100 Por 4 45mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 156mm Prm Alcls Sl Protasul-100 Por 5 46mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 161mm Prm Alcls Sl Protasul-100 Por 6 47mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 166mm Prm Alcls Sl Protasul-100 Por 7 48mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 172mm Prm Alcls Sl Protasul-100 Por 8 50mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 178mm Prm Alcls Sl Protasul-100 Por 9 52mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 184mm Prm Alcls Sl Protasul-100 Por 10 53mm 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 01 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 Por 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 1 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 2 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 3 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 4 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 5 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 6 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 7 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 8 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 9 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 10 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 11 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Cmntls Prm Strg Tpr Alcls Sl Protasul-100 12 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 0 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Nt Hp Por 2 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Nt Hp Por 5 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 0 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 1 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 2 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 3 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 4 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 5 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 6 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 7 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 00 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Nt Hp Por 4 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 00 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 0 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 1 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 2 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 3 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 4 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 5 Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sht Nk Sz 1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sht Nk Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sht Nk Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sht Nk Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sht Nk Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sht Nk Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 1 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 2 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 3 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 4 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Nt Hp Por 5 Ofst Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 6 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 1 Ofst Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 2 Ofst Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 3 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 4 Ofst Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 5 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 6 Offset Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 0 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 1 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 2 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 3 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 4 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collarless Sz 5 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 1 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 2 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 3 Ofst Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 4 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Por 5 Ofst Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Collared Sz 6 Offset Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 10.5mm Prm Dist Txtr Apr Std Bd Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Std Body Distally Textured - Size 12.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13.5mm Prm Dist Txtr Apr Std Bd Hip Lt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Std Body Distally Textured - Size 15.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Std Body Distally Textured - Size 16.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Std Body Distally Textured - Size 18.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Dist Txtr Apr Std Bd Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 15mm Prm Dist Txtr Apr Std Bd Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16.5mm Prm Dist Txtr Apr Std Bd Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Std Body Distally Textured - Size 18.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Lg Body Distally Textured - Size 10.5 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Dist Txtr Apr Lg Bd Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13.5mm Prm Dist Txtr Apr Lg Bd Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Lg Body Distally Textured - Size 15.0 - Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 16.5mm Prm Dist Txtr Apr Lg Bd Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Lg Body Distally Textured - Size 10.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 12mm Prm Dist Txtr Apr Lg Bd Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 13.5mm Prm Dist Txtr Apr Lg Bd Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Lg Body Distally Textured - Size 15.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Lg Body Distally Textured - Size 16.5 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951207881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Apr Lg Body Distally Textured - Size 18.0 - Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Prm Dckbl Colr Shrp Dist Flut Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 19mm Bal Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 19mm Bal Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Bal Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Bal Por Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 7mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 7mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 8mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 8mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 9mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 10mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 10mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 11mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 12mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 13mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 14mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 18mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 18mm 3 Pnt Fx Prft Bal Por Biplanar Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Noncollar Full Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 7mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echo Por Fmrl Red Lat Nc 7x115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 15mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm 17mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 18mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175mm 19mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 20mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 185mm 21mm Noncollar Rdc Prox Prfl Prft Echo Bmtrc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 128mm Ty 1 Prft Full Prfl Tprlk Pps 133d 4 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Ty 1 Cmplt Full Prfl Tprlk Pps 133d 5 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm Ty 1 Prft Full Prfl Tprlk Pps 133d 6 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm Ty 1 Prft Full Prfl Tprlk Pps 133d 7 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 136mm Ty 1 Prft Full Prfl Tprlk Pps 133d 8 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm Ty 1 Prft Full Prfl Tprlk Pps 133d 9 Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm Ty 1 Prft Full Prfl Tprlk Pps 133d 10 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm Ty 1 Prft Full Prfl Tprlk Pps 133d 11 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm Ty 1 Prft Full Prfl Tprlk Pps 133d 12 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 146mm Ty 1 Prft Full Prfl Tprlk Pps 133d 13 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 148mm Ty 1 Prft Full Prfl Tprlk Pps 133d 14 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm Ty 1 Prft Full Prfl Tprlk Pps 133d 15 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm Ty 1 Prft Full Prfl Tprlk Pps 133d 16 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 154mm Ty 1 Prft Full Prfl Tprlk Pps 133d 17 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 156mm Ty 1 Prft Full Prfl Tprlk Pps 133d 18 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Full Prfl Tprlk Pps 133d 20 Std Ofst Hip Cmplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Full Prfl Tprlk Pps 133d 22 Std Ofst Hip Cmplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Tprlk Pps 133d 24 Std Ofst Full Prfl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Ty 1 Prft Full Prfl Tprlk Pps 133d 5 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm Ty 1 Prft Full Prfl Tprlk Pps 133d 6 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm Ty 1 Full Prfl Tprlk Pps 133d 7 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 136mm Ty 1 Prft Full Prfl Tprlk Pps 133d 7 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm Ty 1 Prft Full Prfl Tprlk Pps 133d 9 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm Ty 1 Prft Full Prfl Tprlk Pps 133d 10 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm Ty 1 Prft Full Prfl Tprlk Pps 133d 11 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm Ty 1 Prft Full Prfl Tprlk Pps 133d 12 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 146mm Ty 1 Prft Full Prfl Tprlk Pps 133d 13 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 148mm Ty 1 Prft Full Prfl Tprlk Pps 133d 14 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm Ty 1 Prft Full Prfl Tprlk Pps 133d 15 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm Ty 1 Prft Full Prfl Tprlk Pps 133d 16 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 154mm Ty 1 Prft Full Prfl Tprlk Pps 133d 17 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 156mm Ty 1 Prft Full Prfl Tprlk Pps 133d 18 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Full Prfl Tprlk Pps 133d 20 Hi Ofst Hip Cmplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Full Prfl Tprlk Pps 133d 22 Hi Ofst Hip Cmplt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Ty 1 Full Prfl Tprlk Pps 133d 24 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 128mm Prft Full Prfl Tprlk Xr Ser Por 123d 4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm Prft Full Prfl Tprlk Xr Ser Por 123d 5 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm Prft Full Prfl Tprlk Xr Ser Por 123d 6 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm Prft Full Prfl Tprlk Xr Ser Por 123d 7 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 136mm Prft Full Prfl Tprlk Xr Ser Por 123d 8 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm Prft Rdc Tprlk Pps 133d 9 Std Ofst Tpr 34.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm Prft Rdc Tprlk Pps 133d 10 Std Ofst Tpr 34.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm Ty 1 Prft Rdc Tprlk Pps 133d 11 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm Ty 1 Prft Rdc Tprlk Pps 133d 12 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 146mm Ty 1 Prft Rdc Tprlk Pps 133d 13 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 148mm Ty 1 Prft Rdc Tprlk Pps 133d 14 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm Ty 1 Prft Rdc Tprlk Pps 133d 15 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm Ty 1 Prft Rdc Tprlk Pps 133d 16 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 154mm Ty 1 Prft Rdc Tprlk Pps 133d 17 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 156mm Ty 1 Prft Rdc Tprlk Pps 133d 18 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm Ty 1 Prft Rdc Tprlk Pps 133d 20 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 164mm Ty 1 Prft Rdc Tprlk Pps 133d 22 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 167mm Ty 1 Prft Rdc Tprlk Pps 133d 24 Std Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm Ty 1 Prft Rdc Tprlk Pps 133d 9 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm Ty 1 Prft Rdc Tprlk Pps 133d 10 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm Ty 1 Prft Rdc Tprlk Pps 133d 11 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm Ty 1 Cmplt Prft Rdc Tprlk Pps 133d 12 Hi Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 146mm Ty 1 Prft Rdc Tprlk Pps 133d 13 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 148mm Ty 1 Prft Rdc Tprlk Pps 133d 14 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm Ty 1 Prft Rdc Tprlk Pps 133d 15 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm Ty 1 Prft Rdc Tprlk Pps 133d 16 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 154mm Ty 1 Prft Rdc Tprlk Pps 133d 17 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 156mm Ty 1 Prft Rdc Tprlk Pps 133d 18 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm Ty 1 Prft Rdc Tprlk Pps 133d 20 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 164mm Ty 1 Prft Rdc Tprlk Pps 133d 22 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 167mm Ty 1 Prft Rdc Tprlk Pps 133d 24 Hi Ofst Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 137mm Prft Full Prfl Tprlk Xr Ser Por 123d 9 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm Prft Full Prfl Tprlk Xr Ser Por 123d 10 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 142mm Prft Full Prfl Tprlk Xr Ser Por 123d 11 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm Prft Full Prfl Tprlk Xr Ser Por 123d 12 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 146mm Prft Full Prfl Tprlk Xr Ser Por 123d 13 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 148mm Prft Full Prfl Tprlk Xr Ser Por 123d 14 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm Prft Full Prfl Tprlk Xr Ser Por 123d 15 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 152mm Prft Full Prfl Tprlk Xr Ser Por 123d 16 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 154mm Prft Full Prfl Tprlk Xr Ser Por 123d 17 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 156mm Prft Full Prfl Tprlk Xr Ser Por 123d 18 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 5mm Ofst Tprlk Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 8mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 9mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 11mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 13mm Prm Prfl Intgr X Ser Pps Lateralize Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951209532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12/14 Cocr Femoral Head 22mm +3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +8mm 12/14 Xl 22mm Hip Cocr Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 Med 26mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12/14 Cocr Femoral Head 26mm -3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 Lg 26mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +8mm 12/14 Xl 26mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 Med 28mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -4mm 12/14 Sm 28mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +4mm 12/14 Lg 28mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +8mm 12/14 Xl 28mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12/14 Cocr Femoral Head 32mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -4mm 12/14 Sm 32mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +4mm 12/14 Lg 32mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +8mm 12/14 Xl 32mm Hip Protasul-20 Lgc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 0mm 12/14 Med 28mm Hip Protasul-21wf Metasul Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -4mm 12/14 Sm 28mm Hip Protasul-21wf Metasul Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +4mm 12/14 Lg 28mm Hip Protasul-21wf Metasul Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3.5mm 12/14 40mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 40mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3.5mm 12/14 40mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +7mm 12/14 40mm Hip Actb Metasul Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +10.5mm 12/14 40mm Metasul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d -8mm 12/14 Xs 44mm Hip Protasul-20 Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d -4mm 12/14 Sm 44mm Hip Protasul-20 Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 5d +8mm 12/14 Xl 44mm Hip Nk Cocr Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951209557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +0mm 12/14 Med 40mm Hip Actb Blx D Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951209558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +7mm 12/14 Xl 40mm Hip Actb Blx D Trlg It Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 951209559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 15mm Trlg Tiv Hip St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 20mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 25mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 30mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 35mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 40mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 50mm Trlg Tiv Hip St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 60mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 70mm Contin Trlg Trb Mtl Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 80mm Trlg Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 20mm Hgp Ii Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 35mm Hgp Ii Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 15mm Hgp Ii Tiv Hip Actb St Strl Actb Cup Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 20mm Trb Mtl Hgp Ii Hip Actb St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 25mm Trb Mtl Hgp Ii Hip Actb St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 30mm Trb Mtl Hgp Ii Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 35mm Trb Mtl Hgp Ii Canc St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 40mm Hgp Ii Tiv Hip Actb St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 50mm Hgp Ii Actb St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 60mm Hgp Ii Actb St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 45mm Trb Mtl Hip Actb Strl Mnblck Cup|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 951209580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 15mm Protasul-64wf Ft Canc Cup Cntrsnk Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 20mm Protasul-64wf Ft Canc Cup Cntrsnk Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 25mm Ti Ft Canc Cup Cntrsnk Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancl Bone Scw Ti 6.5mmx30mm Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancl Bone Scw Ti 6.5mmx35mm Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 40mm Protasul-64wf Ft Canc Cup Cntrsnk Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 45mm Protasul-64wf Ft Canc Cup Cntrsnk Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancl Bone Scw Ti 6.5mmx50mm Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancl Bone Scw Ti 6.5mmx55mm Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancl Bone Scw Ti 6.5mmx60mm Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancl Bone Scw Ti 6.5mmx70mm Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cort Bone Scw 4.5mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cort Bone Scw 4.5mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cort Bone Scw 4.5mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cort Bone Scw 4.5mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cort Bone Scw 4.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cort Bone Scw 4.5mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 32mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 34mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 36mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 38mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 40mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 42mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 44mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 46mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 48mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 50mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 52mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 54mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 56mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 58mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 60mm Cort Cnc Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 951209612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 11mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 12mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 13mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 14mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 15mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 17mm Vrsy Advct Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 12mm Vrsy Advct Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 13mm Vrsy Advct Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 14mm Vrsy Advct Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 15mm Vrsy Advct Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Vrsy Advct Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 11mm Vrsy Hr Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 12mm Vrsy Hr Hip Prox Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 13mm Vrsy Hr Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 14mm Vrsy Hr Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 15mm Vrsy Hr Std Hip Prox Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Vrsy Hr Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 17mm Vrsy Hr Std Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 13mm Vrsy Hr Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 14mm Vrsy Hr Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 15mm Vrsy Hr Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Vrsy Hr Xtd Hip Prox Pmma Cmnt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951209635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 9mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Distal Centralizer 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 11mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 12mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 13mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 14mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 16mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 18mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cntrlzr Stm 19mm Unv Hip Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 951209644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bn Cmnt Aplo 2 3202|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 951209645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl Cnvrg Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 951209646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Dome Hl Cnvrg Hip Scr Hl Sl Rev Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 951209647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Lo Dmnd Nt Hp Cocr 0 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951209648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Lo Dmnd Nt Hp Cocr 1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951209649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Lo Dmnd Nt Hp Cocr 2 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951209650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Lo Dmnd Nt Hp Cocr 3 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951209651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Lo Dmnd Nt Hp Cocr 4 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951209652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Cmnt Lo Dmnd Nt Hp Cocr 5 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 951209653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 10mm Prft Vrsy Ld/fx Zml 36mm Ofst Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 951209654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 39mm 22mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 40mm 22mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 41mm 22mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 42mm 22mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 43mm 22mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 44mm 22mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 42mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Assy Cocr 26mm Id 43mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 44mm 26mm Cntrpls Lgc Hip Zml Cmplt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 45mm 26mm Cntrpls Lgc Hip Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 46mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 47mm 26mm Cntrpls Lgc Hip Fem Zml Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 48mm 26mm Cntrpls Lgc Hip Zml Linr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 49mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Assy Cocr 26mm Id 50mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 51mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 52mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 53mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 54mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 55mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 56mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 57mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 58mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 59mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Bp 60mm 26mm Lgc Cntrpls Hip Zml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951209679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 38mm Lgc Mlplr Hip Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|FSC: 13; Default||Not reimbursed separately|1,284.00|FSC: 13; Default||External grouping not supported 951209680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 39mm Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|FSC: 13; Default||Not reimbursed separately|1,284.00|FSC: 13; Default||External grouping not supported 951209681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 66mm Lgc Mlplr Hip Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|FSC: 13; Default||Not reimbursed separately|1,284.00|FSC: 13; Default||External grouping not supported 951209682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 68mm Lgc Mlplr Hip Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|FSC: 13; Default||Not reimbursed separately|1,284.00|FSC: 13; Default||External grouping not supported 951209683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 70mm Lgc Mlplr Hip Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|FSC: 13; Default||Not reimbursed separately|1,284.00|FSC: 13; Default||External grouping not supported 951209684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 72mm Lgc Vrsy Mlplr Hip Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|FSC: 13; Default||Not reimbursed separately|1,284.00|FSC: 13; Default||External grouping not supported 951209685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 38mm 22mm Lgc Hip Poly Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 39mm 22mm Vrsy Ld/fx Hip Poly Prft Cmnt Asmb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 40/41mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 42/43mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 44/45/46mm 22mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 44/45/46mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 47/48/49mm 22mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 47/48/49mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 47/48/49mm 32mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 50/51/52mm 22mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 50/51/52mm 26mm Lgc Hip Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 50/51/52mm 32mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 53/54/55mm 22mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 53/54/55mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 53/54/55mm 32mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 57/58mm 22mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 57/58mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 57/58mm 32mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 60mm 22mm Lgc Hip Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 60/62mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 60/62mm 32mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 64/66mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 64/66mm 32mm Lgc Hip Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 68/70mm 26mm Lgc Hip Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 68/70mm 28mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 68/70mm 32mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 72mm 26mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vrsy 72mm 28mm Hip Cmnt Prft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Bp 72mm 32mm Lgc Hip Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 951209714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 12/14 49mm Hip Unplr Eprsth Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 12/14 54mm Hip Unplr Eprsth Zml Vrsy Lgc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 42mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Unipolar Femoral Head 43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 44mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 45mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951209724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 46mm Lgc Cntrpls 12/14 Hip Fem Zml Mdlr Eprsth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 23 36mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb +5mm 21 28mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm +5mm 22 32mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm +5mm 23 36mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 40mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 40mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 40mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 40mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J Ntrl 40mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 44mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 44mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J Ntrl 44mm E1 Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d F 40mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d G 40mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 40mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 40mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 40mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d H 44mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d I 44mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 10d J 44mm E1 Hip Face Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G 40mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 40mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E1 I Hw 40mm Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 40mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H 44mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I 44mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 J 44mm E1 Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 25 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 26 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 27 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc Mxrm 28 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 25 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 26 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 27 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm 28 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 25 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 26 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 27 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 28 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 24 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 25 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 26 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 27 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +3mm 28 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 24 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 25 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 26 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 27 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 28 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +3mm 25 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +3mm 26 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +3mm 27 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl +3mm 28 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 25 44mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 26 44mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 27 44mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +3mm 28 44mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 44mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 24 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 25 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 26 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 27 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 28 38mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 25 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 26 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 27 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm +5mm 28 40mm E-poly Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 38mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 27 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 40mm E-poly Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Act Artc A 32mm 22.2mm E1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 36mm 22.2mm Act Artc B E1 2 Mbl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 38mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 40mm Act Artc E1 D Uhmwpe Alpha-tocopherol 2 Mbl 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 42mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 44mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Act Artc G 46mm 28mm E1 Hip Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 48mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 50mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 52mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 54mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 56mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 58mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Hip 60mm Act Artc E1 28mm Modhd 2 Mbl Sys Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|FSC: 13; Default||Not reimbursed separately|3,351.00|FSC: 13; Default||External grouping not supported 951210588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb M2a Rnl 23 Std 28mm Hi C Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28mm 22mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28mm 23mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28mm 26mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb M2a Tpr 41mm 28mm Hi C Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm 32mm Hip Skrt Mdlr Mtl M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 28mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 28mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 28mm Hip Std Nk Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 28mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 28mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 28mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm 28mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 32mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 32mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 32mm Hip Std Nk Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 32mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 32mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 32mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm 32mm Hip Mdlr Hi C M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 38mm Hip Sld Mdlr Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 38mm Hip Sld Mdlr Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 38mm Hip Mdlr Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 38mm Hip Sld Mdlr Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 38mm Hip Mdlr No Skrt Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 38mm Hip Mdlr No Skrt Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm 38mm Hip Mdlr Skrt Cocr M2a38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 36mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 36mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 36mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 36mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 36mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm Ofst 36mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm Ofst 36mm Hip Ty 1 Skrt Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 32mm Hip Mdlr Ti Ironguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 32mm Hip Mdlr Ti Ironguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 32mm Hip Mdlr Ti Ironguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 32mm Hip Mdlr Ti Ironguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 32mm Hip Mdlr Ti Ironguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trial Hip 28mm Bmt -3 Ofst Fem Hdnk Prv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 4mm Ofst Tpr 28mm Hip Std Nk Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 4mm Ofst Tpr 28mm Hip Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 4mm Ofst Tpr 28mm Hip Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 4mm Ofst Tpr 32mm Hip Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 4mm Ofst Tpr 32mm Hip Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 4mm Ofst Tpr 32mm Hip Std Nk Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 4mm Ofst Tpr 32mm Hip Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 4mm Ofst Tpr 32mm Hip Mdlr Cocr Bmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm 26mm Hip Mdlr No Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 26mm Hip Mdlr No Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 26mm Hip Mdlr Std Nk No Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm 26mm Hip Mdlr No Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 26mm Hip Mdlr Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm 26mm Hip Mdlr Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm 26mm Hip Mdlr Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 26mm Hip Mdlr No Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 28mm Hip Mdlr No Skrt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 28mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std 22.2mm Hip Mdlr Ty 1 Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -5mm 22.2mm Hip Mdlr Ty 1 Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm 22.2mm Hip Mdlr Ty 1 Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 28mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm 28mm Hip Mdlr Nk Cocr M2a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm Ofst 28mm Hip Ty 1 Skrt Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Ofst 32mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Ofst 32mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Ofst 32mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Ofst 32mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +9mm Ofst 32mm Hip Ty 1 Skrt Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +12mm Ofst 32mm Hip Ty 1 Skrt Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Ofst 32mm Hip Ty 1 Cocr G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Tpr 26mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Tpr 26mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Tpr 26mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Tpr 26mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Tpr 26mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Tpr 28mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Tpr 28mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Tpr 28mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Tpr 28mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Tpr 28mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -6mm Tpr 32mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Tpr 32mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Std Tpr 32mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +3mm Tpr 32mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +6mm Tpr 32mm Hip Ty Ii Mdlr Cocr Ranawat/burnstein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem -3mm Lg Tpr 22mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Lg Tpr 22mm Hip Mdlr Std Nk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Shrt 28mm Hip Mdlr Al C2a-tpr Biolox Forte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 32mm Mdlr C2a-tpr Biolox Forte Al Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb C2a-tpr Lng 32mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem +5mm 22mm Hip Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951210680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 26mm +0 Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 951211429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm D Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm E Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm F Std Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 50mm Arcos +0mm A Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm A Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm B Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm C Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm D Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm E Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +0mm F Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm A Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm B Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Arcos Cal Sz C Std +10 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm D Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm E Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm F Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm A Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm B Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm C Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm D Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm E Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +10mm F Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm A Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm B Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm C Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm D Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm E Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm F Std Ofst Hip Ti Mdlr Fem Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm A Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 60mm Arcos +20mm B Hi Ofst Hip Ti Mdlr Fem Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|FSC: 13; Default||Not reimbursed separately|17,571.00|FSC: 13; Default||External grouping not supported 951211459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-7 C-d 18mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-7 C-d 20mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-11 E-f 16mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-11 E-f 20mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 11mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 13mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 14mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 16mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 20mm Kn Lt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 10mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 11mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 12mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 13mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 14mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 16mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 18mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 20mm Persona 9-12 J Lt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 10mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 11mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 12mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 10mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 11mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 12mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 10mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 11mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 12mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 10mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Ef 11mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Ef 12mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Ef 13mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 Ef 10mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 11mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 12mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 10mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 11mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 12mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 Gh 10mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 11mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 12mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 Gh 14mm Kn Lt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 G-h 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 10mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 11mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 12mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 13mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 14mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 16mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 18mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 20mm Kn Lt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 11mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 13mm Kn Rt Crcte Rtn Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 14mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 16mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-9 C-d 18mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-11 E-f 16mm Kn Rt Crcte Rtn Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-11 E-f 18mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 12mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 13mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 14mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 16mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 18mm Kn Rt Cr Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 10mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 11mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 12mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 13mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 14mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 16mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 18mm Persona 9-12 J Rt Kn Pe Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-7 C-d 16mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-7 C-d 18mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-7 C-d 20mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-11 E-f 16mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-11 E-f 20mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 11mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 13mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 16mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 18mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-12 G-h 20mm Kn Rt Ul Cong Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 10mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 11mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 12mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 13mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 14mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 16mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 18mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 20mm Persona 9-12 J Rt Kn Pe Ul Cong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 10mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 11mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 12mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 Cd 16mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 C-d 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 10mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 11mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 12mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 14mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 C-d 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 10mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 11mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 12mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 E-f 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Ef 10mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 11mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 12mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 E-f 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 Ef 10mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 11mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 Ef 12mm Kn Rt Post Stab Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 14mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 16mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 18mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 E-f 20mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 10mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 11mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 12mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 G-h 13mm Kn Rt Ps Pe Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951212372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2 16mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2 21mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3 6mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3 9mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3 12mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3 16mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3 21mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4 6mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4 9mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4 12mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4 16mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4 21mm Kn Rot Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6mm Kn Prox Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 9mm Kn Prox Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12mm Kn Prox Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 16mm Kn Prox Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 21mm Kn Prox Hng Mst Opn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|FSC: 13; Default||Not reimbursed separately|6,312.60|FSC: 13; Default||External grouping not supported 951212389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc B 12mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc B 14mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc B 17mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc B 20mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc B 23mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc B 26mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C 12mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C 14mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C 17mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C 23mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C 26mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 12mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 14mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 17mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 20mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 23mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc D 26mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E 12mm Seg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E 14mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E 17mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E 20mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E 23mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E 26mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F 12mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F 14mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F 17mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F 20mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F 23mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc F 26mm Kn Rot Hng Seg Mach Mld Most Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|FSC: 13; Default||Not reimbursed separately|6,345.00|FSC: 13; Default||External grouping not supported 951212418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-6 B 58x40x12mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-6 B 58x40x14mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-6 B 58x40x17mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-6 B 58x40x20mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-6 B 58x40x23mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-6 B 58x40x26mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-6 C 64x40x14mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-6 C 64x40x17mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-6 C 64x40x23mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-6 C 64x40x26mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-6 D 70x40x12mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-6 D 70x40x14mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-6 D 70x40x17mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-6 D 70x40x20mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-6 D 70x40x26mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 74x44x14mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 74x44x20mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 74x44x23mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E 74x44x26mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 F 77x44x12mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 F 77x44x14mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 F 77x44x20mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 F 77x44x23mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 F 77x44x26mm Kn Rot Hng Mach Mld Zml Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 951212442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Sm Ellipse Mst Opn Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.20|FSC: 13; Default||Not reimbursed separately|3,670.20|FSC: 13; Default||External grouping not supported 951212443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Med Ellipse Mst Opn Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.20|FSC: 13; Default||Not reimbursed separately|3,670.20|FSC: 13; Default||External grouping not supported 951212444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Proximal Tibia Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,074.60|FSC: 13; Default||Not reimbursed separately|28,074.60|FSC: 13; Default||External grouping not supported 951212445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 Kn Prox Seg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,074.60|FSC: 13; Default||Not reimbursed separately|28,074.60|FSC: 13; Default||External grouping not supported 951212446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Proximal Tibia Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,074.60|FSC: 13; Default||Not reimbursed separately|28,074.60|FSC: 13; Default||External grouping not supported 951212447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 56x41mm Nxgn 1 Kn Zml Pmma Uhmwpe Prect Rot Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|FSC: 13; Default||Not reimbursed separately|13,212.00|FSC: 13; Default||External grouping not supported 951212448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 62x41mm Nxgn 2 Kn Zml Pmma Uhmwpe Rot Hng Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|FSC: 13; Default||Not reimbursed separately|13,212.00|FSC: 13; Default||External grouping not supported 951212449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 67x46mm Nxgn 3 Kn Zml Pmma Uhmwpe Prect Rot Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|FSC: 13; Default||Not reimbursed separately|13,212.00|FSC: 13; Default||External grouping not supported 951212450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Nxgn 5 Kn Zml Pmma Uhmwpe Rot Hng Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|FSC: 13; Default||Not reimbursed separately|13,212.00|FSC: 13; Default||External grouping not supported 951212451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 9mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 10mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 12mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 13mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 14mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 15mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 16mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 17mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 18mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 19mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Segmental Str Fluted Stem 9x190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 10mm Seg Strg Flut Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 11mm Seg Strg Flut Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 12mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 13mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 14mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 15mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 16mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 17mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 18mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 19mm Cmnt Seg Kn Fem Trb Mtl Nxgn Strg Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 12mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 13mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 14mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 15mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 16mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 17mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 18mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 250mm 19mm Cmnt Seg Kn Fem Trb Mtl Nxgn Bw Flut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|FSC: 13; Default||Not reimbursed separately|12,155.40|FSC: 13; Default||External grouping not supported 951212480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 9mm Seg Var Stf Kn Fem Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 10mm Seg Var Stf Kn Fem Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 11mm Seg Var Stf Kn Fem Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 12mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 13mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 14mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 15mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 16mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 17mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 18mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 130mm 19mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|FSC: 13; Default||Not reimbursed separately|12,605.40|FSC: 13; Default||External grouping not supported 951212491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 9mm Seg Var Stf Kn Fem Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 10mm Seg Var Stf Kn Fem Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 11mm Seg Var Stf Kn Fem Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 12mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 13mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 14mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 15mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 16mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 17mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 18mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 190mm 19mm Seg Var Stf Kn Fem Trb Mtl Prect Nxgn Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|FSC: 13; Default||Not reimbursed separately|14,472.00|FSC: 13; Default||External grouping not supported 951212502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Most Femoral Segment 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,892.80|FSC: 13; Default||Not reimbursed separately|9,892.80|FSC: 13; Default||External grouping not supported 951212503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Most Total Femur Segment 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,137.40|FSC: 13; Default||Not reimbursed separately|12,137.40|FSC: 13; Default||External grouping not supported 951212504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 25mm 12mm Cmnt Mst Opn Csti Bw Hex Kn Im Nl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,982.60|FSC: 13; Default||Not reimbursed separately|11,982.60|FSC: 13; Default||External grouping not supported 951212505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 27mm 14mm Cmnt Mst Opn Csti Bw Hex Kn Im Nl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,982.60|FSC: 13; Default||Not reimbursed separately|11,982.60|FSC: 13; Default||External grouping not supported 951212506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Seg Mst Opn Kn Poly Repl Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,248.00|FSC: 13; Default||Not reimbursed separately|4,248.00|FSC: 13; Default||External grouping not supported 951212507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Full 10mm Kn Tib Rot Hng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|FSC: 13; Default||Not reimbursed separately|4,779.00|FSC: 13; Default||External grouping not supported 951212508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Full 10mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|FSC: 13; Default||Not reimbursed separately|4,779.00|FSC: 13; Default||External grouping not supported 951212509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Full 10mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|FSC: 13; Default||Not reimbursed separately|4,779.00|FSC: 13; Default||External grouping not supported 951212510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 Full 10mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|FSC: 13; Default||Not reimbursed separately|4,779.00|FSC: 13; Default||External grouping not supported 951212511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Full 10mm Kn Tib Rot Hng Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|FSC: 13; Default||Not reimbursed separately|13,066.20|FSC: 13; Default||External grouping not supported 951212512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 Full 10mm Kn Tib Rot Hng Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|FSC: 13; Default||Not reimbursed separately|13,066.20|FSC: 13; Default||External grouping not supported 951212513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 Full 10mm Kn Tib Rot Hng Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|FSC: 13; Default||Not reimbursed separately|13,066.20|FSC: 13; Default||External grouping not supported 951212514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Full 10mm Kn Tib Rot Hng Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|FSC: 13; Default||Not reimbursed separately|13,066.20|FSC: 13; Default||External grouping not supported 951212515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 Full 10mm Kn Tib Rot Hng Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|FSC: 13; Default||Not reimbursed separately|13,066.20|FSC: 13; Default||External grouping not supported 951212516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Sil Hng Kt Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 951212517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Impl Nxgn C Kn Tib Aug Full Blck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,895.00|FSC: 13; Default||Not reimbursed separately|23,895.00|FSC: 13; Default||External grouping not supported 951212518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Hlf 5mm Kn Tib Prect Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Tpr Hlf 10mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Tpr Hlf 15mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Tpr Hlf 20mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Tpr Hlf 15mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 1 Tpr Hlf 20mm Kn Tib Rot Hng Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Tpr Hlf 20mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 2 Tpr Hlf 15mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 3 Hlf Tpr 15mm Kn Tib Lt Mdl Rl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Tibial Augment Blk Lt Lat/rt Med 20mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 Hlf Tpr 15mm Kn Tib Lt Mdl Rl Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 Hlf Tpr 15mm Kn Tib Rmll Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 4 Hlf Tpr 20mm Kn Tib Rmll Tiv Pmma Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Tpr Hlf 15mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Tpr Hlf 20mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Tpr Hlf 15mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 5 Tpr Hlf 20mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 Tpr Hlf Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 20mm Rl/lm Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 Tpr Hlf Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 6 20mm Ll/rm Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 Tpr Hlf 15mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 Tpr Hlf 20mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 15mm Ll/rm Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 7 Tpr Hlf 20mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 8 15mm Rl/lm Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 8 20mm Rl/lm Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 8 Tpr Hlf 15mm Kn Tib Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn 8 20mm Ll/rm Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn B Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn C Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn C Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn D Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Nxgn D 20mm Fem Dist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn E Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn F Kn Dist Tiv Pmma Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn F Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 15mm Nxgn G Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem 20mm Nxgn G Kn Dist Tiv Pmma Prect Rot Hng Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|FSC: 13; Default||Not reimbursed separately|3,506.40|FSC: 13; Default||External grouping not supported 951212557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Inst Tib Prox Seg Wshr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,516.00|FSC: 13; Default||Not reimbursed separately|6,516.00|FSC: 13; Default||External grouping not supported 951212558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Hum Zm Seg Sys Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,042.20|FSC: 13; Default||Not reimbursed separately|1,042.20|FSC: 13; Default||External grouping not supported 951212559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Inst Flt Hip 4mm Seg Wshr Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|FSC: 13; Default||Not reimbursed separately|4,179.60|FSC: 13; Default||External grouping not supported 951213318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Rsrfc Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|FSC: 13; Default||Not reimbursed separately|21,735.00|FSC: 13; Default||External grouping not supported 951213319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Rsrfc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Rsrfc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Rsrfc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|FSC: 13; Default||Not reimbursed separately|23,153.40|FSC: 13; Default||External grouping not supported 951213322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Rsrfc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|FSC: 13; Default||Not reimbursed separately|23,153.40|FSC: 13; Default||External grouping not supported 951213323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Rsrfc Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|FSC: 13; Default||Not reimbursed separately|24,004.80|FSC: 13; Default||External grouping not supported 951213324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Rsrfc Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|FSC: 13; Default||Not reimbursed separately|24,004.80|FSC: 13; Default||External grouping not supported 951213325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Rt Rsrfc Seg Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,579.20|FSC: 13; Default||Not reimbursed separately|22,579.20|FSC: 13; Default||External grouping not supported 951213326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Lt Rsrfc Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,579.20|FSC: 13; Default||Not reimbursed separately|22,579.20|FSC: 13; Default||External grouping not supported 951213327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Rsrfc Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|FSC: 13; Default||Not reimbursed separately|24,004.80|FSC: 13; Default||External grouping not supported 951213328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Rsrfc Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|FSC: 13; Default||Not reimbursed separately|24,004.80|FSC: 13; Default||External grouping not supported 951213329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Rsrfc Rdc Rot Hng Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|FSC: 13; Default||Not reimbursed separately|21,250.80|FSC: 13; Default||External grouping not supported 951213330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Rsrfc Rdc Rot Hng Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|FSC: 13; Default||Not reimbursed separately|21,250.80|FSC: 13; Default||External grouping not supported 951213331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Rsrfc Rdc Rot Hng Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|FSC: 13; Default||Not reimbursed separately|21,250.80|FSC: 13; Default||External grouping not supported 951213332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Rsrfc Rdc Rot Hng Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|FSC: 13; Default||Not reimbursed separately|21,250.80|FSC: 13; Default||External grouping not supported 951213333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 7cm Kn Rt Seg Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|FSC: 13; Default||Not reimbursed separately|23,153.40|FSC: 13; Default||External grouping not supported 951213334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 7cm Kn Lt Seg Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|FSC: 13; Default||Not reimbursed separately|23,153.40|FSC: 13; Default||External grouping not supported 951213335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Rt Mdlr Seg Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Lt Mdlr Seg Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 8.5cm Kn Rt Seg Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|FSC: 13; Default||Not reimbursed separately|24,570.00|FSC: 13; Default||External grouping not supported 951213338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Ellipse 8.5cm Kn Lt Seg Rdc Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|FSC: 13; Default||Not reimbursed separately|24,570.00|FSC: 13; Default||External grouping not supported 951213339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8.5cm Kn Rt Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|FSC: 13; Default||Not reimbursed separately|24,570.00|FSC: 13; Default||External grouping not supported 951213340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8.5cm Kn Lt Seg Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|FSC: 13; Default||Not reimbursed separately|24,570.00|FSC: 13; Default||External grouping not supported 951213341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss Rs 8.5cm Seg Fmrl Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss Rs 8.5cm Seg Fmrl Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 7cm Cmpr Kn Rt Por Seg Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,909.60|FSC: 13; Default||Not reimbursed separately|21,909.60|FSC: 13; Default||External grouping not supported 951213344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 7cm Cmpr Kn Lt Por Seg Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,909.60|FSC: 13; Default||Not reimbursed separately|21,909.60|FSC: 13; Default||External grouping not supported 951213345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 8.5cm Cmpr Kn Rt Por Seg Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,050.80|FSC: 13; Default||Not reimbursed separately|23,050.80|FSC: 13; Default||External grouping not supported 951213346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 8.5cm Cmpr Kn Lt Por Seg Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,050.80|FSC: 13; Default||Not reimbursed separately|23,050.80|FSC: 13; Default||External grouping not supported 951213347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 10cm Cmpr Kn Rt Por Seg Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,188.40|FSC: 13; Default||Not reimbursed separately|24,188.40|FSC: 13; Default||External grouping not supported 951213348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Fem 10cm Cmpr Kn Lt Por Seg Rdc Resct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,188.40|FSC: 13; Default||Not reimbursed separately|24,188.40|FSC: 13; Default||External grouping not supported 951213349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|FSC: 13; Default||Not reimbursed separately|20,790.00|FSC: 13; Default||External grouping not supported 951213350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|FSC: 13; Default||Not reimbursed separately|20,790.00|FSC: 13; Default||External grouping not supported 951213351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|FSC: 13; Default||Not reimbursed separately|20,790.00|FSC: 13; Default||External grouping not supported 951213352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|FSC: 13; Default||Not reimbursed separately|20,790.00|FSC: 13; Default||External grouping not supported 951213353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 7cm Kn Rt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|FSC: 13; Default||Not reimbursed separately|21,735.00|FSC: 13; Default||External grouping not supported 951213354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 7cm Kn Lt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|FSC: 13; Default||Not reimbursed separately|21,735.00|FSC: 13; Default||External grouping not supported 951213355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Rt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|FSC: 13; Default||Not reimbursed separately|21,735.00|FSC: 13; Default||External grouping not supported 951213356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Lt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|FSC: 13; Default||Not reimbursed separately|21,735.00|FSC: 13; Default||External grouping not supported 951213357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 8.5cm Kn Rt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|FSC: 13; Default||Not reimbursed separately|22,208.40|FSC: 13; Default||External grouping not supported 951213358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 8.5cm Kn Lt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|FSC: 13; Default||Not reimbursed separately|22,208.40|FSC: 13; Default||External grouping not supported 951213359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8.5cm Kn Rt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|FSC: 13; Default||Not reimbursed separately|22,208.40|FSC: 13; Default||External grouping not supported 951213360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8.5cm Kn Lt Rdc Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|FSC: 13; Default||Not reimbursed separately|22,208.40|FSC: 13; Default||External grouping not supported 951213361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Rt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3cm Kn Lt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Rt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5cm Kn Lt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|FSC: 13; Default||Not reimbursed separately|22,680.00|FSC: 13; Default||External grouping not supported 951213365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 7cm Kn Rt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 7cm Kn Lt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Rt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7cm Kn Lt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 951213369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 8.5cm Kn Rt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|FSC: 13; Default||Not reimbursed separately|24,098.40|FSC: 13; Default||External grouping not supported 951213370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Elip 8.5cm Kn Lt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|FSC: 13; Default||Not reimbursed separately|24,098.40|FSC: 13; Default||External grouping not supported 951213371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8.5cm Kn Rt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|FSC: 13; Default||Not reimbursed separately|24,098.40|FSC: 13; Default||External grouping not supported 951213372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8.5cm Kn Lt Oss Por Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|FSC: 13; Default||Not reimbursed separately|24,098.40|FSC: 13; Default||External grouping not supported 951213373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 12mm Oss Uhmwpe Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 14mm Oss Poly Kn Tib Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 16mm Oss Poly Kn Tib Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 18mm Oss Poly Kn Tib Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 20mm Oss Poly Kn Tib Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 22mm Oss Poly Kn Tib Std Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64x12mm Uhmwpe Kn Mdlr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|FSC: 13; Default||Not reimbursed separately|3,477.60|FSC: 13; Default||External grouping not supported 951213380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 14mm Kn Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|FSC: 13; Default||Not reimbursed separately|3,477.60|FSC: 13; Default||External grouping not supported 951213381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 16mm Kn Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|FSC: 13; Default||Not reimbursed separately|3,477.60|FSC: 13; Default||External grouping not supported 951213382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 18mm Finn Kn Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|FSC: 13; Default||Not reimbursed separately|3,477.60|FSC: 13; Default||External grouping not supported 951213383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 20mm Kn Finn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|FSC: 13; Default||Not reimbursed separately|3,477.60|FSC: 13; Default||External grouping not supported 951213384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64x22mm Uhmwpe Kn Mdlr Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|FSC: 13; Default||Not reimbursed separately|3,477.60|FSC: 13; Default||External grouping not supported 951213385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 12cm Oss Uhmwpe Kn Rdc Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|FSC: 13; Default||Not reimbursed separately|2,878.20|FSC: 13; Default||External grouping not supported 951213386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 14mm Oss Poly Kn Rdc Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|FSC: 13; Default||Not reimbursed separately|2,878.20|FSC: 13; Default||External grouping not supported 951213387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 16mm Oss Poly Kn Rdc Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|FSC: 13; Default||Not reimbursed separately|2,878.20|FSC: 13; Default||External grouping not supported 951213388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 18mm Oss Poly Kn Rdc Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|FSC: 13; Default||Not reimbursed separately|2,878.20|FSC: 13; Default||External grouping not supported 951213389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 20mm Oss Poly Kn Rdc Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|FSC: 13; Default||Not reimbursed separately|2,878.20|FSC: 13; Default||External grouping not supported 951213390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 22mm Oss Poly Kn Rdc Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|FSC: 13; Default||Not reimbursed separately|2,878.20|FSC: 13; Default||External grouping not supported 951213391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 12mm Oss Uhmwpe Kn Tib Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 14mm Oss Uhmwpe Kn Tib Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 16mm Oss Uhmwpe Kn Tib Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|FSC: 13; Default||Not reimbursed separately|3,450.60|FSC: 13; Default||External grouping not supported 951213394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 12mm Oss Kn Rdc Lat Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 14mm Oss Kn Rdc Lat Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 16mm Oss Kn Rdc Lat Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 18mm Oss Kn Rdc Lat Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 20mm Oss Kn Rdc Lat Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 22mm Oss Kn Rdc Lat Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|FSC: 13; Default||Not reimbursed separately|2,892.60|FSC: 13; Default||External grouping not supported 951213400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Shrt Kn Nmod 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Shrt Kn Nmod 67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Shrt Kn Nmod 71mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Lng Kn Nmod 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Lng Kn Nmod 67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|FSC: 13; Default||Not reimbursed separately|10,778.40|FSC: 13; Default||External grouping not supported 951213406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 71mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|FSC: 13; Default||Not reimbursed separately|10,778.40|FSC: 13; Default||External grouping not supported 951213407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|FSC: 13; Default||Not reimbursed separately|10,778.40|FSC: 13; Default||External grouping not supported 951213408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 79mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|FSC: 13; Default||Not reimbursed separately|10,778.40|FSC: 13; Default||External grouping not supported 951213409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 83mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|FSC: 13; Default||Not reimbursed separately|10,778.40|FSC: 13; Default||External grouping not supported 951213410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 9mm Oss 5cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|FSC: 13; Default||Not reimbursed separately|24,667.20|FSC: 13; Default||External grouping not supported 951213411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 11mm Oss 5cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|FSC: 13; Default||Not reimbursed separately|24,667.20|FSC: 13; Default||External grouping not supported 951213412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 13mm Oss 5cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|FSC: 13; Default||Not reimbursed separately|24,667.20|FSC: 13; Default||External grouping not supported 951213413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 15mm Oss 5cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|FSC: 13; Default||Not reimbursed separately|24,667.20|FSC: 13; Default||External grouping not supported 951213414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 9mm Oss 7cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|FSC: 13; Default||Not reimbursed separately|26,289.00|FSC: 13; Default||External grouping not supported 951213415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 11mm Oss 7cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|FSC: 13; Default||Not reimbursed separately|26,289.00|FSC: 13; Default||External grouping not supported 951213416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 13mm Oss 7cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|FSC: 13; Default||Not reimbursed separately|26,289.00|FSC: 13; Default||External grouping not supported 951213417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tib 150mm 15mm Oss 7cm Prox Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|FSC: 13; Default||Not reimbursed separately|26,289.00|FSC: 13; Default||External grouping not supported 951213418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srfc Artc 90mm Oss Kn Tib Prox Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,655.80|FSC: 13; Default||Not reimbursed separately|21,655.80|FSC: 13; Default||External grouping not supported 951213419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss 240mm Kn 1 Pc 3cm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,050.80|FSC: 13; Default||Not reimbursed separately|23,050.80|FSC: 13; Default||External grouping not supported 951213420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 51mm Oss Poly Hbrd Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|FSC: 13; Default||Not reimbursed separately|11,718.00|FSC: 13; Default||External grouping not supported 951213421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 55mm Oss Poly Hbrd Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|FSC: 13; Default||Not reimbursed separately|11,718.00|FSC: 13; Default||External grouping not supported 951213422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 59mm Oss Poly Hbrd Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|FSC: 13; Default||Not reimbursed separately|11,718.00|FSC: 13; Default||External grouping not supported 951213423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 63mm Oss Poly Hbrd Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|FSC: 13; Default||Not reimbursed separately|11,718.00|FSC: 13; Default||External grouping not supported 951213424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 67mm Oss Poly Hbrd Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|FSC: 13; Default||Not reimbursed separately|11,718.00|FSC: 13; Default||External grouping not supported 951213425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 71mm Oss Poly Hbrd Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|FSC: 13; Default||Not reimbursed separately|11,718.00|FSC: 13; Default||External grouping not supported 951213426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 3cm Oss Prox Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,560.00|FSC: 13; Default||Not reimbursed separately|7,560.00|FSC: 13; Default||External grouping not supported 951213427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 5cm Oss Prox Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,406.60|FSC: 13; Default||Not reimbursed separately|11,406.60|FSC: 13; Default||External grouping not supported 951213428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 7cm Oss Prox Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,202.80|FSC: 13; Default||Not reimbursed separately|15,202.80|FSC: 13; Default||External grouping not supported 951213429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 9cm Oss Prox Osseoti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,002.60|FSC: 13; Default||Not reimbursed separately|19,002.60|FSC: 13; Default||External grouping not supported 951213430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 3cm Oss Prox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,915.60|FSC: 13; Default||Not reimbursed separately|6,915.60|FSC: 13; Default||External grouping not supported 951213431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 5cm Oss Prox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,373.40|FSC: 13; Default||Not reimbursed separately|10,373.40|FSC: 13; Default||External grouping not supported 951213432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 7cm Oss Prox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,822.20|FSC: 13; Default||Not reimbursed separately|13,822.20|FSC: 13; Default||External grouping not supported 951213433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 9cm Oss Elip Prox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,278.20|FSC: 13; Default||Not reimbursed separately|17,278.20|FSC: 13; Default||External grouping not supported 951213434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 47mm Oss Shrt Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 51mm Oss Shrt Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 55mm Oss Shrt Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tibplt 59mm Nmod Oss Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 47mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 51mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 55mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 59mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 3cm Oss Prox Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,210.80|FSC: 13; Default||Not reimbursed separately|7,210.80|FSC: 13; Default||External grouping not supported 951213443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 5cm Oss Prox Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 7cm Oss Prox Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,412.60|FSC: 13; Default||Not reimbursed separately|14,412.60|FSC: 13; Default||External grouping not supported 951213445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Tib 9cm Oss Elip Prox Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,012.60|FSC: 13; Default||Not reimbursed separately|18,012.60|FSC: 13; Default||External grouping not supported 951213446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9cm Oss Uhmwpe Kn Rdc Mdlr Bd Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|FSC: 13; Default||Not reimbursed separately|21,978.00|FSC: 13; Default||External grouping not supported 951213447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 63mm Oss Shrt Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 67mm Oss Shrt Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 63mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 67mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 71mm Oss Shrt Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 71mm Oss Lng Kn Nmod Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 75mm Oss Shrt Kn Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|FSC: 13; Default||Not reimbursed separately|10,186.20|FSC: 13; Default||External grouping not supported 951213454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 71mm Oss Lng Kn Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 75mm Oss Lng Kn Nmod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|FSC: 13; Default||Not reimbursed separately|10,578.60|FSC: 13; Default||External grouping not supported 951213456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oss-np Non-mod Tib Short 67|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,276.40|FSC: 13; Default||Not reimbursed separately|8,276.40|FSC: 13; Default||External grouping not supported 951213457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Oss Kn Tpe Mdlr Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 71mm Oss Kn Mdlr Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 75mm Oss Kn Mdlr Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 9cm Oss Cocr Kn Bd Tib Ellipse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,181.20|FSC: 13; Default||Not reimbursed separately|24,181.20|FSC: 13; Default||External grouping not supported 951213461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 79mm Oss Kn Mdlr Tpe Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 83mm Oss Kn Mdlr Tpe Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 63mm Oss Shrt Kn Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 67mm Oss Shrt Kn Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 71mm Oss Shrt Kn Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 63mm Oss Lng Kn Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,239.20|FSC: 13; Default||Not reimbursed separately|11,239.20|FSC: 13; Default||External grouping not supported 951213467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 67mm Oss Lng Kn Nmod Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,239.20|FSC: 13; Default||Not reimbursed separately|11,239.20|FSC: 13; Default||External grouping not supported 951213468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Oss Kn Mdlr 63mm Avl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|FSC: 13; Default||Not reimbursed separately|11,439.00|FSC: 13; Default||External grouping not supported 951213470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 9cm Oss Kn Mdlr Avl Antiluxation Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|FSC: 13; Default||Not reimbursed separately|21,978.00|FSC: 13; Default||External grouping not supported 951213471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 9cm Oss Kn Mdlr Avl Antiluxation Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|FSC: 13; Default||Not reimbursed separately|21,978.00|FSC: 13; Default||External grouping not supported 951213472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 9cm Oss Kn Cocr Mdlr Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|FSC: 13; Default||Not reimbursed separately|21,978.00|FSC: 13; Default||External grouping not supported 951213473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tib 9cm Oss Kn Cocr Mdlr Rdc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|FSC: 13; Default||Not reimbursed separately|21,978.00|FSC: 13; Default||External grouping not supported 951213474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 9mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 10mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 11mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 12mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 13mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 15mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 17mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|FSC: 13; Default||Not reimbursed separately|5,052.60|FSC: 13; Default||External grouping not supported 951213481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 11mm Cmnt Bw Oss Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 13mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 18mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|FSC: 13; Default||Not reimbursed separately|5,499.00|FSC: 13; Default||External grouping not supported 951213489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 11mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 13mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 15mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 225mm 17mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|FSC: 13; Default||Not reimbursed separately|5,859.00|FSC: 13; Default||External grouping not supported 951213493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 13mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,136.20|FSC: 13; Default||Not reimbursed separately|6,136.20|FSC: 13; Default||External grouping not supported 951213494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 15mm Cmnt Oss Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,136.20|FSC: 13; Default||Not reimbursed separately|6,136.20|FSC: 13; Default||External grouping not supported 951213495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 300mm 17mm Cmnt Oss Im Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,136.20|FSC: 13; Default||Not reimbursed separately|6,136.20|FSC: 13; Default||External grouping not supported 951213496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 10.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 11.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 12.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 13.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 14.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 15.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 16.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 17.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 18.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 90mm 19.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 12.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 13.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 14.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 15.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 16.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 18.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 19.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 20.5mm Oss Por Hip Im|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 150mm 21.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 150mm 22.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 225mm 12.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 225mm 14.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 225mm 16.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 225mm 18.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 300mm 12.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951213522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xtn Stm 300mm 14.5mm Cmnt Kn Fem Im Por Oss Bw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|FSC: 13; Default||Not reimbursed separately|6,492.60|FSC: 13; Default||External grouping not supported 951214299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd Arcm Kn Cr Inlay Dir Cmpr Mld Tib 3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Vngrd Arcm Kn Cr Lip Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Vngrd Kn Lip Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd Por Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx11mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd Kn Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx13mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx11mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx13mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd Kn Post Stab Tib Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx11mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx13mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Vngrd Arcm Kn Post Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd Por Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx11mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx13mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Vngrd Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd Kn Post Stab + Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Vngrd Por Kn Post Stab + Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx20mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx20mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx22mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx11mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx13mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Vngrd Arcm Kn Ant Stab Inlay Tib 0d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951215269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 55mm Kn Lt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Post Stab Opn Bx Vngrd Ssk Intlk Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib F 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib G 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib H 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 8mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 9mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 10mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 11mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 12mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib J 14mm Kn Lt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 8mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib C 9mm Kn Rt Mdl Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951215313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Vngrd 360 Por Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|FSC: 13; Default||Not reimbursed separately|17,454.00|FSC: 13; Default||External grouping not supported 951215320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Vngrd Ssk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd Ssk Kn Lt Post Stab Cnstrn Tib 55 Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd Ssk Kn Rt Post Stab Cnstrn Tib 60 Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Vngrd Ssk Kn Lt Post Stab Cnstrn Tib 60 Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Cstm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Cstm Scr Vngrd Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Cstm Scr Vngrd Ssk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Cstm Scr Vngrd Ssk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Cstm Scr Vngrd Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Cstm Scr Vngrd Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Glnd 40mm 22.2mm Bp Bmod Shldr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Bp 22.2mm 44mm Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|FSC: 13; Default||Not reimbursed separately|20,298.00|FSC: 13; Default||External grouping not supported 951215332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Lt Post Stab Cls Bx Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,593.50|FSC: 13; Default||Not reimbursed separately|14,593.50|FSC: 13; Default||External grouping not supported 951215333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2xl Kn Rt Prm Ascnt Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|FSC: 13; Default||Not reimbursed separately|10,399.50|FSC: 13; Default||External grouping not supported 951215334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Kn Lt Prm Ascnt Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|FSC: 13; Default||Not reimbursed separately|10,399.50|FSC: 13; Default||External grouping not supported 951215335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Lt Prm Ascnt Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|FSC: 13; Default||Not reimbursed separately|10,399.50|FSC: 13; Default||External grouping not supported 951215336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Lt Prm Ascnt Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|FSC: 13; Default||Not reimbursed separately|10,399.50|FSC: 13; Default||External grouping not supported 951215337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Lt Prm Ascnt Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|FSC: 13; Default||Not reimbursed separately|10,399.50|FSC: 13; Default||External grouping not supported 951215338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2xl Kn Lt Prm Ascnt Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|FSC: 13; Default||Not reimbursed separately|10,399.50|FSC: 13; Default||External grouping not supported 951215339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd Ssk Por Kn Post Stab Cnstrn Dir Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71-75mmx24mm Vngrd 360 Vngrd Ssk Por Kn Post Stab Dir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Vngrd Ssk Kn Post Stab Dir Cmpr Mld Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|FSC: 13; Default||Not reimbursed separately|5,818.50|FSC: 13; Default||External grouping not supported 951215418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Vngrd 360 Pe Kn Post Stab Nonconstrain Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951215451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Vngrd 360 Pe Kn Post Stab Cnstrn Tib Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|FSC: 13; Default||Not reimbursed separately|5,707.50|FSC: 13; Default||External grouping not supported 951216208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx5mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx10mm Fem Dist Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55x10mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx10mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx10mm Fem Dist Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|FSC: 13; Default||Not reimbursed separately|2,983.50|FSC: 13; Default||External grouping not supported 951216233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx10mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx10mm Fem Post Lt Mdl Rl Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx10mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75x10mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx10mm Fem Post Rmll Intlk Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx15mm Kn Fem Lt Mdl Rl Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 55mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 57.5mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 60mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 62.5mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 65mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 67.5mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 70mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 75mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 80mmx15mm Kn Fem Rmll Intlk Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bmt 360 Tib Sm Cruciate Wing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951216270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tibtry 360d Lg Kn Crcte Wng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951216271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 59mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 63mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 67mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 71mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 75mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 79mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 83mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 87mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 91mmx5mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 59mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 63mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 67mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 71mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 75mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 79mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 83mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 87mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 91mmx10mm Vngrd 360 Unv Kn Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 10mm Vngrd 360 Kn Bolt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.50|FSC: 13; Default||Not reimbursed separately|118.50|FSC: 13; Default||External grouping not supported 951216290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 59mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 63mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 67mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 71mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 75mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 79mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 83mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 87mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 91mmx15mm Vngrd 360 Kn Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 59mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 63mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 67mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 71mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 75mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 79mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 83mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 87mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 91mmx15mm Vngrd 360 Kn Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 951216308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 55mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 57.5mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 60mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 62.5mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 65mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 67.5mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 70mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 72.5mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 75mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 80mmx5mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 55mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 57.5mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 60mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 62.5mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 65mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 67.5mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 70mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 72.5mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 75mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 80mmx5mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 55mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 57.5mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 60mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 62.5mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 65mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 67.5mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 70mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 72.5mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 75mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 80mmx5mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 55mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 57.5mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 60mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 62.5mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 65mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 67.5mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 70mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 72.5mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 75mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 80mmx10mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 55mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 57.5mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 60mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 62.5mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 65mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 67.5mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 70mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 72.5mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 75mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 80mmx10mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 55mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 57.5mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 60mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 62.5mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 65mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 67.5mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 72.5mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 Unv 80mmx10mm Kn Fem Post Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 55mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 57.5mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 60mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 62.5mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 65mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 67.5mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 70mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 72.5mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 75mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 80mmx15mm Kn Fem Lt Mdl Rl Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 55mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 57.5mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 60mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 62.5mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 65mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 67.5mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 70mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 72.5mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 75mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Vngrd 360 80mmx15mm Kn Fem Rmll Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|FSC: 13; Default||Not reimbursed separately|2,926.50|FSC: 13; Default||External grouping not supported 951216386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Vngrd 360 Sm Kn Crcte Wng Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951216387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Fem Vngrd 360 Lg Kn Crcte Wng Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|FSC: 13; Default||Not reimbursed separately|1,917.00|FSC: 13; Default||External grouping not supported 951216388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 25mm Regenerex Xs Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 25mm Regenerex Sm Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 25mm Regenerex Med Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 25mm Regenerex Lg Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 40mm Regenerex Xs Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 40mm Regenerex Sm Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951216394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Tib 40mm Regenerex Med Cone Kn Ti Por Slv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|FSC: 13; Default||Not reimbursed separately|2,422.50|FSC: 13; Default||External grouping not supported 951206364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 100mm 55mm Zmr E Hip Fem Tiv Xtd Ofst 46mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm Zmr 130d A Xtd Ofst Hip Fem Tiv Plsm Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mmx55mm 46mm Zmr A Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm Zmr B Xtd Ofst Hip Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 55mm 46mm Zmr B Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm 46mm Zmr C Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mmx55mm 46mm Zmr C Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm Zmr 130d D Xtd Ofst Hip Fem Tiv Plsm Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mx55mm Zmr Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm 46mm Zmr E Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mmx55mm 46mm Zmr 130d E Xtd Ofst Hip Fem Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm 46mm Zmr F Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mmx55mm 46mm Zmr F Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 35mm 40mm Zmr Fem Hip Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mm 40mm Zmr 17.7mm A Hip Fem Tiv Rev Mdlr 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 100mmx55mm 40mm Zmr A 40mm Ofst Hip Tiv Por Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 35mm 40mm Zmr 35mm B Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mmx45mm 40mm Zmr B 18.9mm Hip Fem Tiv Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 55mm 40mm Zmr B Std Ofst Hip Fem Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 35mm 40mm Zmr C Hip Fem Tiv Std Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 90mm 40mm Zmr 20mm C Hip Fem Tiv Rev Mdlr 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 55mm 40mm Zmr C Hip Fem Tiv Std Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 80mmx35mm 40mm Zmr 130d D Std Ofst Hip Fem Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 45x35mm Zmr E Std Ofst Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Cone 35mm 40mm Zmr F Hip Fem Tiv Std Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm Zmr 40mm 17.7mm A Hip Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm 40mm Zmr 17.7mm A Hip Fem Tiv Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm Zmr 40mm 18.9mm B Hip Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr B 40mm Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 90mmx45mm Zmr 40mm 20mm C Hip Tiv Por Rev Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Spout 100mmx55mm Zmr 20mm C Hip Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 35mm 40mm Zmr Aa Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 80mmx35mm 17.7mm Zmr 40mm Ofst A Hip Fem Tiv Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 45mm 40mm Zmr A Hip Fem Tiv Xtd Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 55mm 40mm Zmr A Hip Fem Tiv Std Ofst Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 80mmx35mm Zmr B Fem Tiv Rev Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm 40mm Zmr B 18.9mm Ofst Hip Fem Tiv Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mmx55mm 40mm Zmr B 18.9mm Ofst Hip Fem Tiv Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 40mmx35mm 40mm Zmr C Std Ofst Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 90mmx45mm 40mm Zmr C 20mm Hip Fem Tiv Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 100mmx55mm 40mm Zmr C 20mm Hip Fem Tiv Std Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|FSC: 13; Default||Not reimbursed separately|11,649.00|FSC: 13; Default||External grouping not supported 951206405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 40mm Mlr Hip Protasul-ti Cmnt Rev Reinf Roof Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|FSC: 13; Default||Not reimbursed separately|3,930.00|FSC: 13; Default||External grouping not supported 951206406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 42mm Mlr Hip Protasul-ti Cmnt Rev Reinf Roof Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|FSC: 13; Default||Not reimbursed separately|3,930.00|FSC: 13; Default||External grouping not supported 951206407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 50mm Mlr Hip Protasul-ti Cmnt Rev Reinf Roof Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|FSC: 13; Default||Not reimbursed separately|3,930.00|FSC: 13; Default||External grouping not supported 951206408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Actb 58mm Mlr Hip Protasul-ti Cmnt Rev Reinf Roof Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|FSC: 13; Default||Not reimbursed separately|3,930.00|FSC: 13; Default||External grouping not supported 951206409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 47mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 49mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 51mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 53mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 55mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 57mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 59mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 61mm Cnvrg Hip Por Rev Mlhl Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 63mm Hip Rev Mlhl Sl Scr Hl Por Cnvrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 53mm Cnvrg Hip Por Rev Sl Scr Hl Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 55mm Cnvrg Hip Por Rev Sl Scr Hl Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 57mm Cnvrg Hip Por Rev Sl Scr Hl Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 61mm Cnvrg Hip Por Rev Sl Scr Hl Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 65mm Cnvrg Hip Por Rev Sl Scr Hl Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 69mm Cnvrg Hip Por Rev Sl Scr Hl Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951206424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Rev Trb Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Rev Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Rev Trb Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Rev Trb Mtl Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Rev Trb Mtl Tntlm Tiv Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|FSC: 13; Default||Not reimbursed separately|8,703.00|FSC: 13; Default||External grouping not supported 951206441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std 6.3mm 50/52/54mm 32mm Tiv Uhmwpe Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Ring 6.4mm 56mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 7.3mm 58mm 32mm Tiv Uhmwpe Hip Strl Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ring 8.4mm 60mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ring 9.3mm 62mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 10.3mm 64mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 11.4mm 66mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 12.4mm 68mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 13.3mm 70mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 14.4mm 72mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 15.4mm 74mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 16.3mm 76mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 17.3mm 78mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Ring 18.3mm 80mm 32mm Tiv Uhmwpe Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|FSC: 13; Default||Not reimbursed separately|4,401.00|FSC: 13; Default||External grouping not supported 951206455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Xplnt 10d 48mm 28mm Uhmwpe Hip Strl Rev Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|FSC: 13; Default||Not reimbursed separately|2,502.00|FSC: 13; Default||External grouping not supported 951206456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Xplnt 10d 52mm 28mm Uhmwpe Hip Strl Rev Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|FSC: 13; Default||Not reimbursed separately|2,502.00|FSC: 13; Default||External grouping not supported 951206457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Xplnt 20d 58mm 28mm Uhmwpe Hip Strl Rev Shl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|FSC: 13; Default||Not reimbursed separately|2,502.00|FSC: 13; Default||External grouping not supported 951206458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 53mm 32mm Zca Snp In Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|FSC: 13; Default||Not reimbursed separately|7,240.50|FSC: 13; Default||External grouping not supported 951206459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 55mm 32mm Zca Snp In Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|FSC: 13; Default||Not reimbursed separately|7,240.50|FSC: 13; Default||External grouping not supported 951206460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 32mm Zca Snp In Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|FSC: 13; Default||Not reimbursed separately|7,240.50|FSC: 13; Default||External grouping not supported 951206461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 59mm 32mm Zca Snp In Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|FSC: 13; Default||Not reimbursed separately|7,240.50|FSC: 13; Default||External grouping not supported 951206462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 61mm 32mm Zca Snp In Spcr Hip Lngvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|FSC: 13; Default||Not reimbursed separately|7,240.50|FSC: 13; Default||External grouping not supported 951206463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 47mm 28mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 49mm 28mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 51mm 28mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 55mm 28mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 59mm 28mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 51mm 32mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 51mm 28mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 55mm 32mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 57mm 32mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 59mm 32mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 61mm 32mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 61mm 32mm Uhmwpe Hip Strl Prm Enh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 49mm 28mm Pe Hip Prm Hood Enh Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 53mm 32mm Pe Hip Prm Hood Enh Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 55mm 32mm Pe Hip Prm Hood Enh Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 59mm 32mm Pe Hip Prm Hood Enh Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 61mm 32mm Pe Hip Prm Hood Enh Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 63mm 32mm Pe Hip Prm Hood Enh Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 45mm 22mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 47mm 28mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 49mm 28mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 53mm 28mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 55mm 28mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 51mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 53mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 55mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 57mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 59mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 61mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 63mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 65mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Apr Lgc 67mm 32mm Pe Hip Prm Hood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|FSC: 13; Default||Not reimbursed separately|2,452.50|FSC: 13; Default||External grouping not supported 951206495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Epsln Lgc 49mm 28mm Pe Hip Strl Prm Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951206496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Epsln Lgc 55mm 32mm Pe Hip Strl Prm Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951206497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Epsln Lgc 59mm 32mm Pe Hip Strl Prm Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951206498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Epsln Lgc 61mm 32mm Pe Hip Strl Prm Prtrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|FSC: 13; Default||Not reimbursed separately|2,388.00|FSC: 13; Default||External grouping not supported 951206499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 9.4mm 58mm 32mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 11.4mm 66mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 12.4mm 68mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 13.4mm 70mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 14.3mm 72mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 15.4mm 74mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 16.3mm 76mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 17.4mm 78mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 18.3mm 80mm 36mm Lngvt Hip Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|FSC: 13; Default||Not reimbursed separately|8,865.00|FSC: 13; Default||External grouping not supported 951206508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 48mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 50mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 52mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 54mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 54mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 56mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 56mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 58mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 58mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 58mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 60mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 60mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 60mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 62/64mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 62/64mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 62/64mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 62/64mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 66/68/70mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 66/68/70mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 66/68/70mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 66/68/70mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 72/74mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 72/74mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 72/74mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 72/74mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 76/78/80mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 76/78/80mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 76/78/80mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 0d Ntrl 76/78/80mm 40mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 48mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 50mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 52mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 54mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 56mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 56mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 58mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 58mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 58mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 60mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 60mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 60mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951206549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 62/64mm 28mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 62/64mm 32mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|FSC: 13; Default||Not reimbursed separately|4,303.50|FSC: 13; Default||External grouping not supported 951206551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d Oblq 62/64mm 36mm Lngvt Hip Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|FSC: 13; Default||Not reimbursed separately|5,034.00|FSC: 13; Default||External grouping not supported 951207314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 21 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 28mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 32mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 32mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 32mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 32mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 32mm Hip Nonarcom Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 2 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 3 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 4 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 5 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 6 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 7 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 8 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 2 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 3 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 4 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 5 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 6 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 7 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 8 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rimloc 10d 41 22mm Arcm Hip Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 42mm 22mm Hip Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 43mm 22mm Hip Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 20 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 21 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 21 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 26mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 21 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 20 22mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 21 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 22 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 21 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 22 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 32mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 23 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 24 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 25 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 26 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 27 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 10d 28 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 40 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 41 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 42 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 43 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 44 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 45 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 46 22mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 47 28mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 48 28mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 40 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 41 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 42 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 43 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 44 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 45 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 46 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 47 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 48 22mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 43 32mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 44 32mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 45 32mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 46 32mm Arcm Hip Hw Rim Loprfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 47 32mm Uhmwpe Hip Loprfl Cmpnt Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 48 32mm Uhmwpe Hip Loprfl Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 43 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 44 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 45 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 46 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 47 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rx90 2 10d 48 32mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 21 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 22 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 22mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 21 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 22 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 23 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 24 26mm Uhmwpe Hip Cmpnt Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 25 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 26 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 27 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc 28 26mm Arcm Hip Hw Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 31 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 32 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 33 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 34 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 35 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 36 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 37 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Impct 38 28mm Arcm Hip Hw Lip Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb A 28mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb B 28mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb C 28mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb D 28mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb E 28mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb C 32mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb D 32mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb E 32mm Arcm Hip Hw Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d A 28mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d B 28mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d C 28mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d D 28mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d C 32mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d D 32mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 10d E 32mm Arcm Hip Hex Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 21 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 22 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 23 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 24 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 25 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 26 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 27 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 28 28mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 23 32mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 24 32mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 25 32mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 26 32mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 27 32mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 28 32mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 21 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 22 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 23 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 24 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 25 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 26 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm: 27 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rnglc +5mm 28 28mm Arcm Hip Hw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 21 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 22 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 23 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 24 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 25 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 26 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 27 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 28 26mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 20 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 21 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 22 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 23 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 24 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 25 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 26 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 27 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mx Rngl 28 22mm Arcm Hip Flt Face|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 41 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951207512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mxrm Rx90 2 42 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 159mm Lat Avenir-mlr Protasul-64wf Ha 6 47.65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 165mm Avenir Mlr Protasul-64wf Ha 7 48.55mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 171mm Avenir Mlr Protasul-64wf Ha 8 49.66mm Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 177mm Lat Avenir-mlr Protasul-64wf Ha 9 50.54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107mm 4mm Ml Tcp Ha 35mm Tpr Std Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 107mm 4mm Prm Ml Tcp Ha 40mm Tpr Strg Xtd Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 109mm 5mm Prm Ml Tiv Tcp Ha 45mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 111mm 6mm Prm Ml Tiv Tcp Ha 45mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 114mm 7.5mm Prm Ml Tiv Tcp Ha 48mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 117mm 9mm Prm Ml Tiv Tcp Ha 48mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 119mm 10mm Prm Ml Tiv Tcp Ha 49mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 121mm 11mm Prm Ml Tiv Tcp Ha 49mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 124mm 12.5mm Ml Tcp Ha 12/14 Tpr Xtd Ofst Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 126mm 13.5mm Prm Ml Tiv Tcp Ha 50mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 129mm 15mm Prm Ml Tiv Tcp Ha 51mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm 16.25mm Prm Ml Tiv Tcp Ha 47mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 132mm 16.25mm Prm Ml Tiv Tcp Ha 52mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 134mm 17.5mm Prm Ml Tiv Tcp Ha 53mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 139mm 20mm Prm Ml Tiv Tcp Ha 54mm Tpr Strg Xtd Ofst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 144mm 22.5mm Prm Ml Tiv Tcp Ha 55mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 110mm 9mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 10mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Algn Gd Vrsy Fm Tcp Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Colr Xtd Nk Vrsy Fm Ha Tcp Mdct Std Bd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Prm Algn Gd Vrsy Fm Tcp Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Fm Tcp Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Colr Xtd Nk Vrsy Fm Ha Tcp Mdct Lmb Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Fm Tcp Plslfn Mdct Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Lmb Vrsy Tcp Mdct Fm Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Lmb Vrsy Tcp Mdct Fm Plslfn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 9mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Fm Mc Clrlss Hatcp 10x130 Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 11mm Prm Algn Gd Vrsy Fm Tcp Ha Por 36mm Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Algn Gd Vrsy Fm Tcp Ha Mdct 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 12mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Fm Mc Clrlss Hatcp 13x140 Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 13mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Fm Mc Clrlss Hatcp 14x140 Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 14mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 15mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Fm Mc Clrlss Hatcp 15x160 Lm Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 16mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Versys Fm Mc Clrlss Hatcp 17x160 Std Body Std Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 17mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Beaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 160mm 18mm Prm Algn Gd Vrsy Fm Tcp Plslfn Ha Mdct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 115mm 10mm Prm Vrsy Fm Tcp Ha Por 33mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Prm Vrsy Fm Tcp Ha Por 36mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Prm Vrsy Fm Tcp Ha Por 41mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Prm Vrsy Fm Tcp Beaded Ha Por 36mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 120mm 11mm Prm Vrsy Fm Tcp Beaded Ha Por 41mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Vrsy Fm Tcp Ha Por 39mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Vrsy Fm Tcp Ha Por 44mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Vrsy Fm Tcp Beaded Ha Por 39mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 125mm 12mm Prm Vrsy Fm Tcp Beaded Ha Por 44mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Vrsy Fm Tcp Ha Por 39mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Vrsy Fm Tcp Ha Por 44mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Vrsy Fm Tcp Bead Ha 39mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 130mm 13mm Prm Vrsy Fm Tcp Beaded Ha Por 44mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Vrsy Fm Tcp Ha Por 42mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Vrsy Fm Tcp Ha Por 47mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Vrsy Fm Tcp Bead Ha 42mm Tpr Strg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 135mm 14mm Prm Vrsy Fm Tcp Beaded Ha Por 47mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Prm Vrsy Fm Tcp Ha Por 42mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Prm Vrsy Fm Tcp Ha Por 47mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Prm Lmb Vrsy Fm Tcp Bead Ha 42mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 140mm 15mm Prm Vrsy Fm Tcp Beaded Ha Por 47mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Vrsy Fm Tcp Ha Por 45mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Vrsy Fm Tcp Ha Por 50mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Vrsy Fm Tcp Beaded Ha Por 45mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 145mm 16mm Prm Vrsy Fm Tcp Beaded Ha Por 50mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prm Vrsy Fm Tcp Ha Por 45mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prm Vrsy Fm Tcp Ha Por 50mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prm Vrsy Fm Tcp Beaded Ha Por 45mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Prm Vrsy Fm Tcp Beaded Ha Por 50mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 18mm Prm Vrsy Fm Tcp Ha Por 48mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 18mm Prm Vrsy Fm Tcp Ha Por 53mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 18mm Prm Vrsy Fm Tcp Beaded Ha Por 48mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 18mm Prm Vrsy Fm Tcp Beaded Ha Por 53mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Vrsy Fm Tcp Ha Por 48mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Vrsy Fm Tcp Ha Por 53mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 19mm Prm Vrsy Fm Tcp Beaded Ha Por 48mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 20mm Prm Vrsy Fm Tcp Ha Por 48mm Tpr Strg Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 20mm Prm Vrsy Fm Tcp Ha Por 53mm Tpr Strg Xtd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 155mm 20mm Prm Vrsy Fm Tcp Beaded Ha Por 48mm Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 98mm Prm Rev Cnsrvt Mayo Tcp Ha Por 12/14 43mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 0 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collarless Sz 1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Natural-hip Porous Ha Collared Sz 0 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem Prm Colr Nt Hp Ha Por 1 Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951208156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 28mm Bcld Hw Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 32mm Bcld Hw Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 32mm Bcld Hw Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 57mm 32mm Bcld Hw Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 51mm 32mm 10d Bcld Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 32mm 10d Bcld Pg Rmr Hip Alply|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Apx Hl Trspk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip 3 Dome Spk Apcl Hl Trspk Rnglc Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Full Hmsphr Rnglc Sld Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Full Hmsphr Rnglc Sld Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 50mm Rnglc 23 Hip Sld Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Full Hmsphr Rnglc Sld Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Full Hmsphr Rnglc Sld Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Full Hmsphr Rnglc Sld Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shl Lnr Actb 60mm Rnglc 25 Hip Sld Full Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Full Hmsphr Rnglc Sld Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 27mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Mlhd Rnl Sld Apx Hl 4 Fin Wo Rim Scr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm 24mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 56mm 24mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 58mm 25mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm 25mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 62mm 26mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 64mm 26mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 66mm 27mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 68mm 27mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 70mm 28mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 72mm 28mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 74mm 28mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm 28mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 78mm 28mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm 28mm Rb Rnglc Lmt Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Sld Linr Por Rnglc 21 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Sld Linr Por Rnglc 22 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Sld Linr Por Rnglc 23 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Sld Rnglc Unv 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Sld Linr Por Rnglc 24 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Sld Rnglc Unv 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Sld Linr Por Rnglc 26 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Sld Linr Por Rnglc 26 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Sld Linr Por Rnglc 27 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Sld Linr Por Rnglc 27 Unv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 40mm 20mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 42mm 20mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 21mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm 22mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 48mm 22mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 23mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 23mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 54mm Mlhd Rdl Sld Apx Hl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951208978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 15.4mm 74mm 32mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 21.2mm 76mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 19.3mm 76mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 18.3mm 76mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 16.3mm 76mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 22.2mm 78mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 20.4mm 78mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 19.3mm 78mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 17.4mm 78mm 32mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 23.2mm 80mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 0d Std Ntrl 21.3mm 80mm 26mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 20.3mm 80mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg Std Ntrl 18.3mm 80mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 4.2mm 36mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 5.1mm 38mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 6.1mm 40mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 6.1mm 42mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 5.3mm 42mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 7.1mm 44mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 6.3mm 44mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 8.2mm 46mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951208999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 6.3mm 46mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 9.1mm 48mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 7.3mm 48mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 10.1mm 50/52/54mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 8.2mm 50/52/54mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 11.3mm 56mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 9.4mm 56mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 12.2mm 58mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 10.3mm 58mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 13.2mm 60mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 11.4mm 60mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 14.2mm 62mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 12.4mm 62mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 15.2mm 64mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 13.4mm 64mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 16.2mm 66mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 14.4mm 66mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 17.2mm 68mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 15.4mm 68mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 18.2mm 70mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 16.4mm 70mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 19.2mm 72mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 17.3mm 72mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 16.3mm 72mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 14.4mm 72mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 20.3mm 74mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 18.4mm 74mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 17.4mm 74mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 15.4mm 74mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 21.2mm 76mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 19.3mm 76mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 18.3mm 76mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 16.3mm 76mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 22.2mm 78mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 20.4mm 78mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 19.4mm 78mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 17.4mm 78mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 23.2mm 80mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 21.3mm 80mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d Elev 20.3mm 80mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 10d 18.3mm 80mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 4.2mm 36mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 5.3mm 38mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 6.1mm 40mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 6.1mm 42mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 5.3mm 42mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 7.1mm 44mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 6.3mm 44mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 8.2mm 46mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 6.3mm 46mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 9.1mm 48mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d Elev 7.3mm 48mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 10.1mm 50/52/54mm 22mm Lngvt Hip Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 8.3mm 50/52/54mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 11.3mm 56mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 9.4mm 56mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d Elev 12.2mm 58mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 10.4mm 58mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 13.2mm 60mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 11.4mm 60mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 14.2mm 62mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 12.4mm 62mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 15.2mm 64mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 13.4mm 64mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 16.2mm 66mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 14.4mm 66mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 17.2mm 68mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 15.4mm 68mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 18.2mm 70mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 16.4mm 70mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 19.2mm 72mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 17.3mm 72mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d Elev 16.3mm 72mm 28mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 14.3mm 72mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 20.3mm 74mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 18.4mm 74mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 17.4mm 74mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 15.4mm 74mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 21.2mm 76mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 19.3mm 76mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 18.3mm 76mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 16.3mm 76mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 22.2mm 78mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 20.4mm 78mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 19.4mm 78mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 17.4mm 78mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 23.2mm 80mm 22mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 21.3mm 80mm 26mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 20.3mm 80mm 28mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 20d 18.3mm 80mm 32mm Lngvt Hip Strl Prm Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 6.1mm 40mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 6.1mm 42mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 5.3mm 42mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 7.1mm 44mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 6.3mm 44mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 8.2mm 46mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 6.3mm 46mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 9.1mm 48mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 7.3mm 48mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 5.3mm 48mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 10.1mm 50/52/54mm 22mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 8.2mm 50/52/54mm 26mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 6.3mm 50/52/54mm 32mm Lngvt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 11.2mm 56mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 9.3mm 56mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 6.4mm 56mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 12.2mm 58mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 10.3mm 58mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 7.3mm 58mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 13.2mm 60mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 11.4mm 60mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Cup 7mm Offset Liner Longevity 60x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 14.2mm 62mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 12.3mm 62mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 9.3mm 62mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 15.2mm 64mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 13.3mm 64mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 10.3mm 64mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 16.2mm 66mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 14.4mm 66mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 11.4mm 66mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 17.2mm 68mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 15.4mm 68mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 12.4mm 68mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 18.2mm 70mm 22mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 16.3mm 70mm 26mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Trlg 7mm Ofst 13.3mm 70mm 32mm Lngvt Hip Strl Prm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ntrl Ee 44mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Gg Ntrl 46mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Gg Ntrl 48mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Hh Ntrl 50mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ii Ntrl 52mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Jj Ntrl 54mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Jj Ntrl 54mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Kk Ntrl 56mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Kk Ntrl 56mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ll Ntrl 58mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ll Ntrl 58mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mm Ntrl 60mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Mm Ntrl 60mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Nn Ntrl 62mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Nn Ntrl 62mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Oo Ntrl 64mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Oo Ntrl 64mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Pp Ntrl 66mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Pp Ntrl 66mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Qu Ntrl 68mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Qu Ntrl 68mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Rr Ntrl 70mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Ss Ntrl 72mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Tt Ntrl 74mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Uu Ntrl 76mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Vv Ntrl 78/80mm 32mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Cc Elev 40mm 22mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Dd Elev 42mm 22mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ee Elev 44mm 22mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ee Elev 44mm 28mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb 45d Ff Elev 46mm 22mm Lngvt Hip Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951209903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 57mm Cnvrg Hip Por Prm Ch Sl Scr Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Cluster-hole W/ Sealed Screw Holes 69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 67mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare W/ Sealed Screw Holes 69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Hemi W/ Sealed Screw Holes 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converge Rimflare 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 36mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 38mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trilogy Acet Shell 68mm Od Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Prm Mlhl Tiv Por Trlg Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Prm Tcp Ha Por Trlg Spk Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 951209955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 38mm Hip Prm Mdlr Sld Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 38mm Hip Prm Mdlr Ch Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Prm Mdlr Sld Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Prm Mdlr Ch Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Prm Mdlr Sld Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Prm Mdlr Ch Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Prm Mdlr Sld Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm Mdlr Ch Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Prm Mdlr Sld Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 46mm Mdlr Ch Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 60mm Mdlr Ch Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Prm Mdlr Sld Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Prm Mdlr Ch Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Prm Mdlr Ch Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Prm Mdlr Ch Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Prm Mdlr Ch Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Prm Mdlr Ch Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 80mm Mdlr Ch Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Ch Snpft Lck Grv Tiv Trlg It Ff Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Ch Snpft Lck Grv Tiv Trlg It Hh Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Ch Snpft Lck Grv Tiv Trlg It Kk Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Ch Snpft Lck Grv Tiv Trlg It Ll Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Ch Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Ch Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Ch Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951209999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip 12 Sclp Ch Snpft Grv Intgr Lck Mech Trb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip 12 Sclp Ch Snpft Grv Intgr Lck Mech Trb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Unihole Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip 12 Sclp Ch Snpft Grv Intgr Lck Mech Trb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Unihole Snpft Lck Grv Trb Mtl Tiv Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Ch Snpft Grv Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Unihole Snpft Lck Grv Trb Mtl Tiv Contin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Ch Snpft Grv Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Unihole Trb Mtl Tiv Contin Ss Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Ch Trb Mtl Tiv Contin Ss Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Unihole Trb Mtl Tiv Contin Tt Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Ch Snpft Lck Grv Trb Mtl Tiv Contin Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Unihole Trb Mtl Tiv Contin Uu Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Ch Trb Mtl Tiv Contin Uu Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Unihole Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Ch Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Unihole Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Ch Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Unihole Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Ch Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 38mm Hip Prm Mdlr Mlhl Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Prm Mdlr Mlhl Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Prm Mdlr Mlhl Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Prm Mdlr Mlhl Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Prm Mdlr Mlhl Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tm Modular Cup 72mm Multi-hole Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Prm Mdlr Mlhl Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 76mm Mdlr Mlhl Rev Hip Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Prm Mdlr Mlhl Trb Mtl Tntlm Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Prm Mdlr Mlhl Trb Mtl Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 52mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 56mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 58mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 62mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 66mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Mlhl Snpft Intgr Lck Mech Tiv Fm Trlg It|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 40mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 42mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 44mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 46mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 48mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 50mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 54mm Hip Mlhl Snpft Intgr Lck Mech Trb Mtl Tiv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 60mm Hip Mlhl Snpft Trb Mtl Tiv Contin Mm Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 64mm Hip Mlhl Trb Mtl Tiv Contin Oo Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 68mm Hip Mlhl Snpft Lck Grv Trb Mtl Tiv Contin Qu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 70mm Hip Mlhl Snpft Lck Grv Trb Mtl Tiv Contin Rr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 72mm Hip Mlhl Trb Mtl Tiv Contin Tt Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 74mm Hip Mlhl Trb Mtl Tiv Contin Uu Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 76mm Hip Mlhl Snpft Lck Grv Trb Mtl Tiv Contin Uu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 78mm Hip Mlhl Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Actb 80mm Hip Mlhl Trb Mtl Tiv Contin Vv Hmsphr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 44mm 22mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 50mm 28mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Actb 52mm 32mm 0d Ntrl Prm Mnblck Ntr Hip Strl Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 951210062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 52-54mm 26mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 56-58mm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 52-54mm 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 52-54mm 28mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 56-58mm 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 56-58mm 28mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 60-64mm 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 60-64mm 28mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 66-70mm 28mm Arcm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb Intgr 10d 66-70mm 28mm Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 A Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 F Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 G Ntrl 28mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 H Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 I Ntrl 28mm Arcomxl Hip Clr Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 B Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 C Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 D Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Actb G7 E Ntrl 32mm Arcomxl Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|FSC: 13; Default||Not reimbursed separately|2,451.00|FSC: 13; Default||External grouping not supported 951210878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Wht 56mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 57mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc Srfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp Rust 58mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 59mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc Srfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 60mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc Srfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Bp 61mm 28mm Rnglc Biomr Ii Hip Actb Cocr 2 Artc Srfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|FSC: 13; Default||Not reimbursed separately|1,884.00|FSC: 13; Default||External grouping not supported 951210884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 42mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 43mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 44mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 45mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 46mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 47mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 48mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 49mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 50mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 51mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 52mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 53mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 54mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 55mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 56mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 57mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 58mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 59mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unplr 60mm E-2 Hip Actb Cocrmo Mdlr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem 61mm Hip Actb Mdlr Cocrmo E-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 951210904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endo Ii Taper Insert +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Biomr E-2 -3mm Tpr Hip Fem Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Biomr E-2 Std Tpr Hip Fem Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Biomr E-2 3+ Mm Tpr Hip Fem Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd Biomr E-2 +6mm Tpr Hip Fem Stm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 951210909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 9mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 11mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 13mm Bmtrc Hip Cocr 34mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 9mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 11mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 13mm Bmtrc Hip Cocr 45mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 9mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 11mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hdnk Fem 150mm 13mm Bmtrc Hip Cocr 55mm Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|FSC: 13; Default||Not reimbursed separately|16,623.00|FSC: 13; Default||External grouping not supported 951210918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 13mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 15mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 17mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 200mm 19mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Cmnt Rx90 Cocr Hip Rt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Cmnt Rx90 Cocr Hip Lt Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|FSC: 13; Default||Not reimbursed separately|17,521.50|FSC: 13; Default||External grouping not supported 951210934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 9mm Strg Rev Mlhd Por Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Revise Mlhd Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Rev Strg Mlhd Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Rev Mlhd Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Rev Mlhd Por Hip Lt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Strg Mlhd Por Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 150mm 17mm Rev Mlhd Por Hip Strl Ltx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|FSC: 13; Default||Not reimbursed separately|17,592.00|FSC: 13; Default||External grouping not supported 951210941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 9mm 1 Pc Hl Mlhd Ti Por Strg 34mm Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 11mm 1 Pc Hl Mlhd Ti Por Strg 34mm Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 13mm 1 Pc Hl Mlhd Ti Por Strg 34mm Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 170mm 15mm 1 Pc Hl Mlhd Ti Por Strg 34mm Hip Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 13mm Prft Resct Rev Mlhd 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 9mm Prft Rev Resct Mlhd 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 9mm Rev Prft Resct Mlhd 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 9mm Prft Rev Resct Mlhd 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 11mm Rev Prft Resct Mlhd 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 11mm Prft Resct Rev Mlhd 45mm Hip Lt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 11mm Prft Rev Resct Mlhd 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 11mm Prft Resct Rev Mlhd 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 13mm Rivision Prft Resct Lvl Mlhd 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 13mm Rev Prft Resct Mlhd Por 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 13mm Rev Prft Resct Mlhd 4 Sm 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 13mm Prft Resct Rev Mlhd 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 15mm Rev Prft Mlhd 45mm Hip Rt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 15mm Prft Rev Resct Mlhd 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 15mm Prft Rev Resct Mlhd 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 15mm Prft Resct Rev Mlhd 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm Rev Prft Resct Mlhd 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 17mm Rev Prft Resct Mal 45mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 17mm Prft Rev Resct Mal 55mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 17mm Prft Rev Resct Mal 55mm Lt Clcr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951210965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 9mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Rt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 9mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Lt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 9mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Rt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 9mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Lt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 9mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Rt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 9mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Lt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 11mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 13mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 15mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 17mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm 1 Pc Prft Hl Mlhd Ti Por 34mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm 1 Pc Prft Hl Mlhd Ti Por 45mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951210999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951211000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 220mm 19mm 1 Pc Prft Hl Mlhd Ti Por 55mm Hip Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|FSC: 13; Default||Not reimbursed separately|24,031.50|FSC: 13; Default||External grouping not supported 951211001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 19mm Hl Mlhd 45mm Hip Rt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951211002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 260mm 19mm Hl Mlhd 45mm Hip Lt Clcr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|FSC: 13; Default||Not reimbursed separately|23,617.50|FSC: 13; Default||External grouping not supported 951211003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 14mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 15mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 16mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 17mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 18mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 19mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 20mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 21mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 22mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 23mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 270mm 24mm 1 Pc Spline Plr Ti Ofst Tpr Hip Rev Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|FSC: 13; Default||Not reimbursed separately|25,932.00|FSC: 13; Default||External grouping not supported 951211014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 11mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 13mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 15mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 16mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 17mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 250mm 19mm Dckbl Colr Xtd Nk Lgth Reach Ti Por Cyl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|FSC: 13; Default||Not reimbursed separately|22,783.50|FSC: 13; Default||External grouping not supported 951211024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 11mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 12mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 13mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 14mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 15mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 16mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 17mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 18mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 180mm 19mm Rdc Prox Prfl Dckbl Colr Dist Crnl Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|FSC: 13; Default||Not reimbursed separately|19,179.00|FSC: 13; Default||External grouping not supported 951211033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 9.5mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 11mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 12mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 13mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 14mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 15mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 16mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 17mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 18mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 175x20mm 1 Pc Rev Arcos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 175mm 22mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|FSC: 13; Default||Not reimbursed separately|6,150.00|FSC: 13; Default||External grouping not supported 951211044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 9.5mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 11mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 12mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 13mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 14mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 15mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 16mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 17mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 18mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 20mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Broached 210mm 22mm Arcos Std Ofst Tpr Hip 1 Pc Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 9.5mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 11mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 12mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 13mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 14mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 15mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Clcr 210mm 16mm Arcos Std Ofst Tpr Hip 1 Pc Rev Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|FSC: 13; Default||Not reimbursed separately|19,275.00|FSC: 13; Default||External grouping not supported 951211805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 3/4/5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Durasul Ultra Cong Tib Ins Rt Sz 3/4/5 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr Flex Prolong Art Surf C-h/1 2 Spur 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-h Mic 58x40x20mm Kn Prlng Cr-flx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x17mm Kn Prlng Ng Crflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-h Std 66x42x20mm Kn Prlng Ng Crflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x17mm Kn Prlng Ng Crflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-h Std 74x46x20mm Kn Prlng Ng Crflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 C-h Std 82x51x17mm Kn Prlng Ng Crflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Cr Flex Prolong Art Surf C-h/7 10 Blue 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b Xl 10mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b Xl 12mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b Xl 14mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b Xl 17mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-3 A-b Xl 20mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C Xl 10mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C Xl 12mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C Xl 14mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C Xl 17mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 2-4 C Xl 20mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4-5 D Xl 10mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D Xl 12mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D Xl 14mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D Xl 17mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 D Xl 20mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5-6 E Xl 10mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E Xl 12mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E Xl 14mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E Xl 17mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-6 E Xl 20mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6-7 F Xl 10mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F Xl 12mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F Xl 14mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F Xl 17mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-7 F Xl 20mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7-8 G Xl 10mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G Xl 12mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G Xl 14mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-8 G Xl 17mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7-8 G Xl 20mm Kn Mbl Lps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951211845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 E-f 10mm Kn Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 C-d 11mm Kn Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 12mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 10mm Persona Vivacit-e Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 C-d 12mm Kn Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 14mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Psn Mc Ve Asf L 11mm 8-9/cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 13mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 14mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 10mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 11mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 12mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 13mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 14mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 E-f 11mm Kn Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 13mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 14mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 18mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Ef 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Ef 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 G-h 14mm Kn Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Gh 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Gh 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Gh 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 10mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 11mm Kn Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 12mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 13mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 14mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 10mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 11mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 12mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 13mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 14mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 16mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 18mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 20mm Kn Lt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 C-d 11mm Kn Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 C-d 12mm Kn Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 13mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 14mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 18mm Kn Rt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Cd 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 13mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Cd 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 C-d 11mm Kn Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 14mm Kn Rt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-9 Cd 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 10mm Kn Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 11mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 12mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 13mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 14mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 4-5 Ef 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 11mm Kn Rt Vivacit-e Persona Mdl Cngr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 12mm Kn Rt Vivacit-e Persona Mdl Cngr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 13mm Kn Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 14mm Kn Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-7 Ef 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Ef 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Ef 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 12mm Kn Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Psn Mc Ve Asf R 13mm 8-11 Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 G-h 14mm Kn Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Gh 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Gh 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 8-11 Gh 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 10mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 11mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 12mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 G-h 13mm Kn Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 14mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 18 G-h 18mm Kn Rt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 Gh 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 10mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 11mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 12mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 13mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 14mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 16mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 18mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 12 J 20mm Kn Rt Crcte Rtn Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951211954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 Ab 11mm Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-5 Ab 11mm Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 Cd 11mm Lt Vivacit-e Persona Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 Cd 11mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Cd 11mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-5 Ef 11mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Ef 11mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-11 Ef 11mm Kn Lt Vivacit-e Persona Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 6-9 Gh 11mm Kn Lt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 Gh 11mm Kn Lt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 10-12 J 11mm Kn Lt Mid Lvl Constraint Vivacit-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 951211965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 7mm Ng Lgc 3d 7 Full Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951211966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 7 Hlf Flut 5mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951211967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Aug Ng Lgc 3d 7 Hlf Flut 10mm Kn Tib Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951211968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib Ng Lgc 16d 3d 8 Hlf Flut Kn Tiv Pmma Prect Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|FSC: 13; Default||Not reimbursed separately|2,824.50|FSC: 13; Default||External grouping not supported 951211969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz2 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz2 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz3 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz3 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 31mm Lcck Nxgn 7d 4 Cone Trb Mtl Cpl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tib 36mm 31mm Lcck Nxgn 7d 4 Cone Trb Mtl Cpl Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz4 5mm 41x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz4 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz5 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz5 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz5 5mm 41x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz5 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz6 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz6 5mm 36x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz6 5mm 41x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz6 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 7d Sz7 5mm 46x34 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951211986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcck 0d Sz3 5mm 31x31 Cpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|FSC: 13; Default||Not reimbursed separately|13,884.00|FSC: 13; Default||External grouping not supported 951212753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d Mic 58x40x17mm Kn Rev Mach Mld Tiv Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d Mic 58x40x20mm Kn Rev Mach Mld Tiv Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d Mic 58x40x23mm Kn Rev Mach Mld Tiv Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d Mic 58x40x28mm Kn Rev Mach Mld Tiv Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 66x42x10mm Kn Rev Mach Mld Tiv Uhmwpe Ng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 66x42x28mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 66x42x33mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 74x46x28mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 74x46x33mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 74x46x28mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 74x46x33mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Lcck Art Surf G 5-6/stripe Green 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G 74x46x14mm Kn Ng Lcck Grn Strp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G 74x46x20mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nexgen Lcck Art Surf G 5-6/stripe Green 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G 74x46x28mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G 74x46x33mm Kn Rev Mach Mld Tiv Uhmwpe Lcck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951212770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C-d 66x42x11mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C-d 66x42x15mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C-d 66x42x17mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C-d 66x42x20mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc C-d 66x42x23mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E-f 74x46x11mm Kn Ap Lip Crcte Rtn Mach Mld Uhmwpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E-f 74x46x13mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E-f 74x46x15mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E-f 74x46x17mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E-f 74x46x20mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc E-f 74x46x23mm Kn Tib Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc G-h-j-k 82x50x9mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc G-h-j-k 82x50x11mm Kn Ap Lip Crcte Rtn Mach Mld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc G-h-j-k 82x50x13mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc G-h-j-k 82x50x15mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc G-h-j-k 82x50x20mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc G-h-j-k 82x50x23mm Kn Ap Lip Cr Mach Mld Uhmwpe Mg2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|FSC: 13; Default||Not reimbursed separately|6,352.50|FSC: 13; Default||External grouping not supported 951212787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk5.3mm 54x8mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk7.3mm 54x10mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk9.3mm 54x12mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk12.3mm 54x15mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk15.3mm 54x18mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk18.3mm 54x21mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.3mm 54x25mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk5.3mm 59x8mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk7.3mm 59x10mm Kn Post Stab Mach Mld Uhmwpe Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk9.3mm 59x12mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk12.3mm 59x15mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk15.3mm 59x18mm Kn Post Stab Mach Mld Uhmwpe Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk18.5mm 59x21mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.3mm 59x25mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk5.3mm 64x8mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk7.3mm 64x10mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk9.3mm 64x12mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk12.3mm 64x15mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk15.3mm 64x18mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk18.5mm 64x21mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.3mm 64x25mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk5.3mm 69x8mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk7.3mm 69x10mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk9.3mm 69x12mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk12.3mm 69x15mm Kn Post Stab Mach Mld Uhmwpe Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk15.3mm 69x18mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk18.5mm 69x21mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.3mm 69x25mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk5.3mm 74x8mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk7.3mm 74x10mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk9.3mm 74x12mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk12.3mm 74x15mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk15.3mm 74x18mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk18.5mm 74x21mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.3mm 74x25mm Kn Ps Mach Mld Uhmwpe Ib2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|FSC: 13; Default||Not reimbursed separately|8,661.00|FSC: 13; Default||External grouping not supported 951212822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 59/54mmx10mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 59/54mmx12mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 59/54mmx15mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 64/59mmx10mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 64/59mmx12mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 64/59mmx15mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 69/64mmx10mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 69/64mmx12mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 69/64mmx15mm Kn Tib Cndyl Ps Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|FSC: 13; Default||Not reimbursed separately|7,614.00|FSC: 13; Default||External grouping not supported 951212831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.5mm 59x25mm Kn Rev Mach Mld Tiv Uhmwpe Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,616.00|FSC: 13; Default||Not reimbursed separately|11,616.00|FSC: 13; Default||External grouping not supported 951212832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.5mm 64x25mm Kn Rev Mach Mld Tiv Uhmwpe Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,616.00|FSC: 13; Default||Not reimbursed separately|11,616.00|FSC: 13; Default||External grouping not supported 951212833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc Thk22.5mm 69x25mm Kn Rev Mach Mld Tiv Uhmwpe Ib2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,616.00|FSC: 13; Default||Not reimbursed separately|11,616.00|FSC: 13; Default||External grouping not supported 951212834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 19mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 22mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 22mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 22mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 22mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 22mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 22mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 25mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 25mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 25mm Kn Lt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 25mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 25mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 25mm Kn Rt Uhmwpe Cnstrn Rev Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 9mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 9mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 9mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 11mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 11mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 11mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 13mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 13mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 13mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 16mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 16mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 16mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 19mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 19mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 19mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 19mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 22mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 22mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 22mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 22mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 22mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 22mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 25mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 25mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 25mm Kn Lt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 00-0 25mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1-2 25mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3-4-5 25mm Kn Rt Uhmwpe Cnstrn Rev Ps Nt Kn2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|FSC: 13; Default||Not reimbursed separately|6,463.50|FSC: 13; Default||External grouping not supported 951212918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Dome 7mm 32mm 1 Pg Ib2 Uhmwpe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|FSC: 13; Default||Not reimbursed separately|5,331.00|FSC: 13; Default||External grouping not supported 951212919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Dome 8mm 34mm 1 Pg Ib2 Uhmwpe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|FSC: 13; Default||Not reimbursed separately|5,331.00|FSC: 13; Default||External grouping not supported 951212920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 8.5mm 36mm 1 Pg Ib2 Uhmwpe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|FSC: 13; Default||Not reimbursed separately|5,331.00|FSC: 13; Default||External grouping not supported 951212921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 9.5mm 38mm 1 Pg Ib2 Uhmwpe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|FSC: 13; Default||Not reimbursed separately|5,331.00|FSC: 13; Default||External grouping not supported 951212922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 10mm 40mm 1 Pg Ib2 Uhmwpe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|FSC: 13; Default||Not reimbursed separately|5,331.00|FSC: 13; Default||External grouping not supported 951212923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 11mm 41mm 3 Pg Ib2 Uhmwpe Kn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|FSC: 13; Default||Not reimbursed separately|5,331.00|FSC: 13; Default||External grouping not supported 951212924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Ptlr 22.5mm Nxgn Med Kn Trb Mtl Pe Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|FSC: 13; Default||Not reimbursed separately|8,325.00|FSC: 13; Default||External grouping not supported 951212925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Ptlr 20mm 35mm Nxgn Lg Kn Trb Mtl Pe Rev 11mm Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|FSC: 13; Default||Not reimbursed separately|8,325.00|FSC: 13; Default||External grouping not supported 951212926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aug Ptlr 23mm Nxgn Lg Trb Mtl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|FSC: 13; Default||Not reimbursed separately|8,325.00|FSC: 13; Default||External grouping not supported 951212927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x51mm Nxgn 7 Wdg Kn Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.00|FSC: 13; Default||Not reimbursed separately|6,471.00|FSC: 13; Default||External grouping not supported 951212928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Blu Blu Strp 82x54mm Nxgn 8 Wdg Kn Tiv Pmma Prect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.00|FSC: 13; Default||Not reimbursed separately|6,471.00|FSC: 13; Default||External grouping not supported 951212929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 59x44x54mm Ib2 Kn Tiv Uhmwpe Cmnt Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|FSC: 13; Default||Not reimbursed separately|11,647.50|FSC: 13; Default||External grouping not supported 951212930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 64x48x59mm Ib2 Kn Tiv Uhmwpe Cmnt Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|FSC: 13; Default||Not reimbursed separately|11,647.50|FSC: 13; Default||External grouping not supported 951212931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 70x52x64mm Ib2 Kn Tiv Uhmwpe Cmnt Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|FSC: 13; Default||Not reimbursed separately|11,647.50|FSC: 13; Default||External grouping not supported 951212932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 75x56x69mm Ib2 Kn Tiv Uhmwpe Cmnt Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|FSC: 13; Default||Not reimbursed separately|11,647.50|FSC: 13; Default||External grouping not supported 951212933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 70mmx52mmx59+ Mm Ib2 Kn Tiv Uhmwpe Cmnt Mdlr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|FSC: 13; Default||Not reimbursed separately|11,647.50|FSC: 13; Default||External grouping not supported 951212934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 0 +4mm Kn Lt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951212935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Nt Kn2 1 +4mm Kn Lt Rev Mdlr Ti Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|FSC: 13; Default||Not reimbursed separately|10,960.50|FSC: 13; Default||External grouping not supported 951213729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 18mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 20mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 22mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 24mm Std Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|FSC: 13; Default||Not reimbursed separately|2,824.20|FSC: 13; Default||External grouping not supported 951213733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm M F Spindle 12mm Pc Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm M-h F Spindle 12mm Pcha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Sm Hf Spindle 12mm Pc Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 13mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 14mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 15mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 16mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 17mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 18mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm 19mm Kn Hi Spndl Cmpr Ha Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg M F Spindle 12mm Pc Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg M-h F Spindle 12mm Pcha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Lg H F Spindle 12mm Pc Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|FSC: 13; Default||Not reimbursed separately|12,013.20|FSC: 13; Default||External grouping not supported 951213746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Orth Cmpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,006.20|FSC: 13; Default||Not reimbursed separately|1,006.20|FSC: 13; Default||External grouping not supported 951213747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 20mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 24mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 28mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 32mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 36mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 40mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 44mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 48mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 52mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 56mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 60mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 951213758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 13mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 14mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 15mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 16mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 17mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 18mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 19mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 20mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 21mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 22mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 23mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 24mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 25mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem Oss Tpr F To M Cps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|FSC: 13; Default||Not reimbursed separately|2,523.60|FSC: 13; Default||External grouping not supported 951213772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem Oss Tpr F To F Cps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|FSC: 13; Default||Not reimbursed separately|2,523.60|FSC: 13; Default||External grouping not supported 951213773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem Oss Tpr M To M Cps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|FSC: 13; Default||Not reimbursed separately|2,523.60|FSC: 13; Default||External grouping not supported 951213774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 10mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 12mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 14mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 16mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 18mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 20mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 22mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 24mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Anch Cmpr 26mm Shrt Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|FSC: 13; Default||Not reimbursed separately|3,105.00|FSC: 13; Default||External grouping not supported 951213783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 64mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|FSC: 13; Default||Not reimbursed separately|220.20|FSC: 13; Default||External grouping not supported 951213784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 68mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|FSC: 13; Default||Not reimbursed separately|220.20|FSC: 13; Default||External grouping not supported 951213785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 72mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|FSC: 13; Default||Not reimbursed separately|220.20|FSC: 13; Default||External grouping not supported 951213786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 76mm Cmpr Fem Trnsv Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|FSC: 13; Default||Not reimbursed separately|220.20|FSC: 13; Default||External grouping not supported 951213787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt 400# Sm Spindle Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt 600# Sm Spindle Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt 800# Sm Spindle Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt 400# Large Spindle Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt 600# Large Spindle Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt 800# Large Spindle Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Tpr Fem Lck Scr Cmpr Cmpr Oss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,729.80|FSC: 13; Default||Not reimbursed separately|1,729.80|FSC: 13; Default||External grouping not supported 951213794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Fem 5mm Cmpr Oss Tpr Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,815.20|FSC: 13; Default||Not reimbursed separately|2,815.20|FSC: 13; Default||External grouping not supported 951213795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt Xs 400lb Spndl W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt Xs 600lb Spndl W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt Xs 800lb Spndl W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt Ellipt 400lb Spndl W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt Ellipt 600lb Spndl W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cps Shrt Ellipt 800lb Spndl W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|FSC: 13; Default||Not reimbursed separately|11,277.00|FSC: 13; Default||External grouping not supported 951213801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 26mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 27mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slv Centering 28mm Cmpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|FSC: 13; Default||Not reimbursed separately|1,137.60|FSC: 13; Default||External grouping not supported 951213804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 25mm Mn Cmpr C400lb Std Hum Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 25mm Mn Cmpr C600lb Std Hum Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 25mm Mn Cmpr C800lb Std Hum Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 30mm Mn Cmpr C400lb Std Hum Antirotation Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 30mm Mn Cmpr C600lb Std Hum Antirotation Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 30mm Mn Cmpr C800lb Std Hum Antirotation Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 25mm Mn Cmpr C400lb Shrt Hum Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 25mm Mn Cmpr C600lb Shrt Hum Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 25mm Mn Cmpr C800lb Shrt Hum Repl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 30mm Mn Cmpr C400lb Shrt Hum Antirotation Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 30mm Mn Cmpr C600lb Shrt Hum Antirotation Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spndl Orth 30mm Mn Cmpr C800lb Shrt Hum Antirotation Repl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|FSC: 13; Default||Not reimbursed separately|12,492.00|FSC: 13; Default||External grouping not supported 951213816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd 4cm Mn Cmpr Msc Std Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,815.20|FSC: 13; Default||Not reimbursed separately|2,815.20|FSC: 13; Default||External grouping not supported 951213817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd 4cm Cmpr Msc Mn Tpr Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,815.20|FSC: 13; Default||Not reimbursed separately|2,815.20|FSC: 13; Default||External grouping not supported 951213818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd 4cm Cmpr 30d Std Tpr Hip Slfret Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.20|FSC: 13; Default||Not reimbursed separately|2,536.20|FSC: 13; Default||External grouping not supported 951213819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adpr Hd 4cm Mn Cmpr 30d Tpr Hip Slfret Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.20|FSC: 13; Default||Not reimbursed separately|2,536.20|FSC: 13; Default||External grouping not supported 951213820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Oss Fem Sd Lck Stm Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.40|FSC: 13; Default||Not reimbursed separately|986.40|FSC: 13; Default||External grouping not supported 951213821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Bmpr Oss Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.40|FSC: 13; Default||Not reimbursed separately|986.40|FSC: 13; Default||External grouping not supported 951213822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Kn Bmpr + Oss Mak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.40|FSC: 13; Default||Not reimbursed separately|986.40|FSC: 13; Default||External grouping not supported 951213823|EAP|HCPCS 951213823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Inst Lgmnt Atch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951213824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Arthro Nl 0 Deg Lck Collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Arthro Nl 5 Deg Lck Collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Arthro Nl 7 Deg Lck Collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|FSC: 13; Default||Not reimbursed separately|10,816.20|FSC: 13; Default||External grouping not supported 951213827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Orth Oss Sm Colr Lck Mdlr Arthds Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.20|FSC: 13; Default||Not reimbursed separately|151.20|FSC: 13; Default||External grouping not supported 951213828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Arthro Nl 1cm Diasl Cnctr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|FSC: 13; Default||Not reimbursed separately|9,349.20|FSC: 13; Default||External grouping not supported 951213829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cnct Jnt 1cm Oss Elip Mdlr Arthds Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|FSC: 13; Default||Not reimbursed separately|9,349.20|FSC: 13; Default||External grouping not supported 951213830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Arthro Nl 3cm Diasl Cnctr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|FSC: 13; Default||Not reimbursed separately|9,349.20|FSC: 13; Default||External grouping not supported 951213831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cnct Jnt 3cm Oss Elip Mdlr Arthds Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|FSC: 13; Default||Not reimbursed separately|9,349.20|FSC: 13; Default||External grouping not supported 951213832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Oss Sm Thrd Dphsl Lck Lng Big Hd Mdlr Arthds Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.40|FSC: 13; Default||Not reimbursed separately|473.40|FSC: 13; Default||External grouping not supported 951213833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Oss Sm Thrd Dphsl Lck Xl Big Hd Mdlr Arthds Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.40|FSC: 13; Default||Not reimbursed separately|473.40|FSC: 13; Default||External grouping not supported 951213834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 66x42x10mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 66x42x12mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 66x42x14mm Kn Alply Cmnt Cr Nxgn Strl Ylw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 66x42x17mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 66x46x12mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 66x46x17mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 74x46x10mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 74x46x12mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 74x46x14mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 74x46x17mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 74x50x10mm Kn Alply Cmnt Cr Nxgn Strl Grn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 74x50x12mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 74x50x17mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 82x51x10mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 82x51x12mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 82x51x14mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 82x51x17mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 82x54x10mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 82x54x12mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 82x54x14mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 82x54x17mm Kn Uhmwpe Cmnt Cr Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 C-d 66x42x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 C-d 66x46x12mm Kn Uhmwpe Cmnt Ng Lps Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 4 C-d 66x46x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 E-f 74x46x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 E-f 74x50x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 G-h 82x50x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 G-h 82x50x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 G-h 82x50x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 G-h 82x50x17mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 G-h 82x54x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 G-h 82x54x12mm Kn Alply Cmnt Lps Nxgn Strl Grn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 G-h 82x54x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 G-h 82x54x17mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x17mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 C-d 74x50x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 C-d 74x50x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 C-d 74x50x14mm Kn Alply Cmnt Lps Nxgn Strl Grn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 6 C-d 74x50x17mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 E-f 82x50x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 E-f 82x50x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 E-f 82x50x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 7 E-f 82x50x17mm Kn Alply Cmnt Lps Nxgn Strl Grn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 E-f 82x54x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 E-f 82x54x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 E-f 82x54x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 8 E-f 82x54x17mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 A-b 66x42x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 A-b 66x42x17mm Kn Alply Cmnt Lps Nxgn Strl Ylw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x10mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x12mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x14mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 C-d 74x46x17mm Kn Uhmwpe Cmnt Lps Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 9mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 11mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 16mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 9mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 0 11mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 11mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 9mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 11mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 13mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 19mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 9mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 11mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 13mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 16mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 9mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 11mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 2 13mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 11mm Kn Lt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 9mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 11mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 13mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 3 16mm Kn Rt Alply Ul Cong Cmnt Nt Kn2 Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Cong All-poly Tibia Rt Sz 1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Cong All-poly Tibia Rt Sz 1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nkii Cong All-poly Tibia Lt Sz 2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 1mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 2mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tibplt 3mm Cmnt Mdlr Stm Nxgn Prect Kn Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 4mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 4+ Mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 5mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951213921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib 6mm Nxgn Kn Prect Cmnt Mdlr Stm Mis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Vngrd E-poly Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx10mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx11mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx12mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx13mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx14mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx16mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx18mm Vngrd E1 Kn Ant Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 951214729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 28mm Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 31mm Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 34mm Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 37mm Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 28mm 1 Pg Wre Ascnt Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 31mm 1 Pg Wre Ascnt Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 34mm 1 Pg Wre Ascnt Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 37mm 1 Pg Wre Ascnt Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Xs 28mm 3 Post Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Sm 31mm 3 Post Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Med 34mm 3 Post Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Lg 37mm 3 Post Arcm Kn Ant Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 5/16 34mm Pg Wre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 25mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 28mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 31mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 34mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 37mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 40mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 25mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 28mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 31mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 34mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 8.5mm 37mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 25mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 28mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 25mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 28mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Asym 8mm 25mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Asym 8mm 28mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Asym 8mm 31mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Asym 8.5mm 34mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Asym 10mm 37mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Asym 10mm 40mm 3 Pg Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 23mm 1 Pg Arcm Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Thn 23mm 1 Pg Arcm Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Std 8mm 23mm 1 Pg Wre Kn Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Xs 28mm 4 Spk Arcm Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Sm 31mm 4 Spk Arcm Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Med 34mm 4 Spk Arcm Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Lg 37mm 4 Spk Arcm Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Sm 31mm 1 Pg Inset Agc Tiv Uhmwpe Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Med 34mm 1 Pg Inset Agc Tiv Uhmwpe Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr Lg 37mm 1 Pg Inset Agc Tiv Uhmwpe Por Kn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 28mm 3 Pg Regenerex Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 31mm 3 Pg Regenerex Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 34mm 3 Pg Regenerex Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 37mm 3 Pg Regenerex Ser A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 951214777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm As Mx Kn Intlk Ti Cr Prm Cmnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951214784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm Kn Cocr I Beam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm Kn Cocr I Beam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71mm Kn Cocr I Beam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm Kn Cocr I Beam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 59mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 91mm As Mx Kn Intlk Cocr 1 Pc Crcte Fin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polished Finned Tib Tray 79mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 63x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 67x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 71x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 75x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 79x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 83x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tib 87x20mm Kn Cr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951214804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx8mm Trd Agc Kn Hpps Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx8mm Trd Agc Kn Hpps Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx10mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx12mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx14mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx16mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx18mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx10mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx12mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx14mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx16mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx18mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx12mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx14mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx16mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx18mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx10mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx12mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx14mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx16mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx18mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx10mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx12mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx14mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx16mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx18mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 65mmx20mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 70mmx20mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx20mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx20mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 85mmx20mm Agc Trd Arcm Kn Hi Post Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 65x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 70x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 75x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 80x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951214870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bsplt Tib Agc Kn Post Stab Mld Prm Intlk Cocr Umhwpe 85x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 951215642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx12mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx16mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx18mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx20mm Agc Kn Mdlr Dir Cmpr Mld Tib Strl Lf Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx10mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx12mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx14mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx16mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 83mmx18mm Kn Mdlr Dir Cmpr Mld Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|FSC: 13; Default||Not reimbursed separately|2,892.00|FSC: 13; Default||External grouping not supported 951215652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Agc Trd Kn Prm Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215672|EAP|HCPCS 951215672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Crnl 1.5mm Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215682|EAP|HCPCS 951215682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rack Inst 1.5/2 Mm Std Neuro Try|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215687|EAP|HCPCS 951215687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Inst Frm Asclp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Agc Trd Kn Post Stab Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|FSC: 13; Default||Not reimbursed separately|2,811.00|FSC: 13; Default||External grouping not supported 951215690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 59x8mm Pe Pros|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 59mmx18mm Kn Agc Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 67mmx8mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 75mmx10mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79mmx14mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,413.00|FSC: 13; Default||Not reimbursed separately|1,413.00|FSC: 13; Default||External grouping not supported 951215697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx8mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx10mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx12mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx14mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87mmx18mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx10mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx12mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx14mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 91mmx18mm Agc Poly Kn Mdlr Tib Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|FSC: 13; Default||Not reimbursed separately|2,224.50|FSC: 13; Default||External grouping not supported 951215706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf Lipped C/r Tib Brng 15x64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,707.50|FSC: 13; Default||Not reimbursed separately|2,707.50|FSC: 13; Default||External grouping not supported 951215707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf Lipped C/r Tib Brng 12x72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,707.50|FSC: 13; Default||Not reimbursed separately|2,707.50|FSC: 13; Default||External grouping not supported 951215708|EAP|HCPCS 951215708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rngr 5mm Jaw Hannum Srg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951215709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf Curved C/s Tib Brng 15x60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 60mmx18mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx10mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx12mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx15mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 951215714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx18mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx10mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx12mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 951215717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx15mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 951215718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx18mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 72mmx10mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 72mmx12mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 72mmx15mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 951215722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 72mmx18mm Prfrm Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,991.00|FSC: 13; Default||Not reimbursed separately|2,991.00|FSC: 13; Default||External grouping not supported 951215723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 76mmx10mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 76mmx12mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 76mmx15mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,991.00|FSC: 13; Default||Not reimbursed separately|2,991.00|FSC: 13; Default||External grouping not supported 951215726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 76mmx18mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 951215727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx10mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 951215728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx12mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx15mm Prfrm Kn Cndrl Stab Tib Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|FSC: 13; Default||Not reimbursed separately|2,902.50|FSC: 13; Default||External grouping not supported 951215730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx10mm Prfrm Kn Post Stab Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx12mm Prfrm Kn Post Stab Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|FSC: 13; Default||Not reimbursed separately|2,947.50|FSC: 13; Default||External grouping not supported 951215732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx15mm Prfrm Kn Post Stab Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|FSC: 13; Default||Not reimbursed separately|2,947.50|FSC: 13; Default||External grouping not supported 951215733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 64mmx18mm Prfrm Kn Post Stab Tib Xs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg X/sml 22x64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx12mm Prfrm Kn Post Stab Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx15mm Prfrm Kn Post Stab Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 68mmx18mm Prfrm Kn Post Stab Tib Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Sml 22x68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Med 12x72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 72mmx15mm Prfrm Kn Post Stab Tib Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Med 18x72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Med 22x72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 76mmx10mm Prfrm Kn Post Stab Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|FSC: 13; Default||Not reimbursed separately|2,947.50|FSC: 13; Default||External grouping not supported 951215744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 76mmx12mm Prfrm Kn Post Stab Tib Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Lrg 15x76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|FSC: 13; Default||Not reimbursed separately|2,947.50|FSC: 13; Default||External grouping not supported 951215746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Lrg 18x76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Lrg 22x76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx10mm Prfrm Kn Post Stab Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Xlrg 12x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Xlrg 15x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Perf P/s Tib Brg Xlrg 18x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 80mmx22mm Prfrm Kn Post Stab Tib Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 951215753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx22mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Ascnt Arcm Kn Post Stab Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|FSC: 13; Default||Not reimbursed separately|3,190.50|FSC: 13; Default||External grouping not supported 951215791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx12mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx14mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx16mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx18mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx20mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx22mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx24mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx10mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx12mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx14mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx16mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx18mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx20mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx22mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 63/67mmx24mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx10mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx12mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx14mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx16mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx18mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx20mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 72/75mmx22mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 71/75mmx24mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx10mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx12mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx14mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx16mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx18mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx20mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx22mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 79/83mmx24mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx10mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx12mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx14mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx16mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx18mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx20mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx22mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 87/91mmx24mm Ascnt Arcm Kn Cnstrn Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|FSC: 13; Default||Not reimbursed separately|4,791.00|FSC: 13; Default||External grouping not supported 951215831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng 59mmx10mm Ascnt Arcm Kn Prm Lip Dir Cmpr Mld Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 951216591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Unv 80mm Kn Cmnt Post Stab Agc Trd Lgc Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Kn Rt Prm Intlk Fnsh Ascnt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Rt Prm Intlk Fnsh Ascnt Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Rt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Rt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Rt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2xl Kn Rt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Kn Lt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Lt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Lt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Lt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Lt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2xl Kn Lt Prm Ascnt Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Kn Rt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Rt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Rt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Rt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Rt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2xl Kn Rt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xs Kn Lt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Lt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Lt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Lt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Xl Kn Lt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2xl Kn Lt Post Stab Opn Bx Cnstrn Ascnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vg Rp Hi Flex Intlk Fml Lt 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tinbn Vg Int Cr Anat Fm R 60m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Cr Cmnt Prm Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Cmnt Post Stab Opn Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Rt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 57.5mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 62.5mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 67.5mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 72.5mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80mm Kn Lt Cmnt Post Stab Cls Bx Vngrd Intlk Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|FSC: 13; Default||Not reimbursed separately|5,562.00|FSC: 13; Default||External grouping not supported 951216677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x59mm Kn Rt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Rt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x68mm Kn Rt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fem 75mm Antm Prm Mxm Por Kn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Rt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 13mm 100mm Cptr Scr Asmb Tmx 140d Hip Sp Cndl Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x59mm Kn Lt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x68mm Kn Lt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Lt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Lt Cr Prm Mxm Ti Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Rt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x58mm Kn Rt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Rt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Rt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Rt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x78mm Kn Rt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x58mm Kn Lt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Lt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Lt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x72mm Kn Lt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x78mm Kn Lt Cr Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Lt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x58mm Kn Lt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Lt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Lt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x73mm Kn Lt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Lt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55x54mm Kn Rt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60x58mm Kn Rt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 65x63mm Kn Rt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70x67mm Kn Rt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 75x73mm Kn Rt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 80x77mm Kn Rt Cmnt Post Stab Agc Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 55mm Kn Rt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 60mm Kn Rt Cr Vngrd Por Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 70mm Kn Rt Cr Prm Vngrd Ti Cocr Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|FSC: 13; Default||Not reimbursed separately|7,518.00|FSC: 13; Default||External grouping not supported 951216716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b Std 58x40x12mm Kn Mach Mld Fx Pe Lpsflx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 10mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 12mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 14mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 17mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 20mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 A-b 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 10mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 14mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 17mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 20mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 1-2 C-d 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 14mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 Cd 17mm Kn Nt Mld Fx Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 20mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 C-d 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 10mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 12mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 14mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 17mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 20mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 A-b 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 14mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 17mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 20mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 3-4 E-f 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 14mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 17mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 20mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 E-f 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 14mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 17mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 20mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 C-d 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G-h 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6mm G-h 12mm Kn Nt Mld Fx Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G-h 14mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G-h 17mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G-h 20mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 5-6 G-h 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 G-h 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 G-h 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 G-h 14mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 G-h 17mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 G-h 20mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 G-h 23mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 E-f 10mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 E-f 12mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 Ef 14mm Kn Nt Mld Fx Uhmwpe Lpsflx Nxgn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 951216774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Artc 7-10 E-f 17mm Kn Fx Nt Mld Uhmwpe Ng Lpsflx Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95192683|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical Biodesign Collagen Sn Latex Free Rectopexy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 95192687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Titanium T9 18mm 4.1mm 3mm Sec2.1mm Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95192688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 42cm Rt Intertrochanter Intertan Im 125d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95192689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 34cm Rt Intertrochanter Intertan Im 125d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95192690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen L35 Mm Od5 Mm Femur Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95191184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cann 4.0mm/l44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95191415|EAP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Cryosurgical Icepearl 90 D Od2.1 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192685|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Artegraft Bovine Carotid Artery 6mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.00|FSC: 13; Default||Not reimbursed separately|3,570.00|FSC: 13; Default||External grouping not supported 95192691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Medial Malleolus Plate 2 Hole Anatomical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,671.00|FSC: 13; Default||Not reimbursed separately|4,671.00|FSC: 13; Default||External grouping not supported 95192692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw R3con Licking Plate 3.5x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95192694|EAP|Custom 95192694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Cannula K-wire L150 Mm Od.9 Mm 2 End Trocar Smooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Axsos 3 Titanium L14mm Od4.5mm Cortical Nonsterle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95192696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6mm 35mm 50mm Ft Cancellous St Fa Hex Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95192697|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Quartet Double Bead 86cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,385.80|FSC: 13; Default||Not reimbursed separately|9,385.80|FSC: 13; Default||External grouping not supported 95192698|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Recorder Cardiac Confirm Rx Sm Slim 1 Touch Data Monitor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95192693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L32 Mm Od3.5 Mm Nonlock Gorilla Plating System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95192699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Cannulated Compression Lthd 1.7mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|969.00|FSC: 13; Default||Not reimbursed separately|969.00|FSC: 13; Default||External grouping not supported 95192700|EAP|Custom 95192700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 0.7mm X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192701|EAP|Custom 95192701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.1mm X 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192702|EAP|Custom 95192702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Graft Hemodialysis Hero Venous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192703|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Hemodialysis Super Hero|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95192704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Curve L80 Mm Od5.5 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95192706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium 2.5 Mm L28 Mm Od4.5 Mm Cortical Hex Drv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|FSC: 13; Default||Not reimbursed separately|951.00|FSC: 13; Default||External grouping not supported 95192705|EAP|Custom 95192705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization Nester Pl Syn Fb .035in 7cm 14mm 1.6 Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trinica Select Titanium 32mm Anterior Level 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95192708|EAP|Custom 95192708||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 16x14x5mm Peek Tntlm Antm Crv Intrbd Fs Strl|1|HUMANA [1294]||HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95192715|EAP|Custom 95192715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Sps Long L195 Mm Od4.5 Mm Twist Ao Fitting Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L30 Mm Od4 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95192711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L36 Mm Od4 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95192712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 14x16x50mm Eccentric Ascend Flex High Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.60|FSC: 13; Default||Not reimbursed separately|8,943.60|FSC: 13; Default||External grouping not supported 95192713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hum 86mm Prft Aqls Ascnd Flx Ptc 132.5d 6b Std Shldr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|FSC: 13; Default||Not reimbursed separately|11,290.86|FSC: 13; Default||External grouping not supported 95192714|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Dfbr Crd Thk12mm 36j Ang 51x66mm Ellipse Vr Dynamictx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,590.79|FSC: 13; Default||Not reimbursed separately|39,590.79|FSC: 13; Default||External grouping not supported 95192716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Anchorage 2mm Step Left Lock Cross Lapidus T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|FSC: 13; Default||Not reimbursed separately|8,961.00|FSC: 13; Default||External grouping not supported 62064920|EAP|CPT® 85046||0305 - LABORATORY - HEMATOLOGY|Hb Retic Diagnostic|1|HUMANA [1294]||HUMANA [11839]|16.71|FSC: 13; Default||Not reimbursed separately|16.71|FSC: 13; Default||External grouping not supported 62064930|EAP|CPT® 85055||0305 - LABORATORY - HEMATOLOGY|Hb Immature Platelet Fraction|1|HUMANA [1294]||HUMANA [11839]|107.22|FSC: 13; Default||Not reimbursed separately|107.22|FSC: 13; Default||External grouping not supported 95192718|EAP|Custom 95192718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Implant Internalbrace Hand Wrist Kit Ligament Augmentati|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192721|EAP|Custom 95192721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Threaded 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Fx 13mm 4-2.8mm Phalinx O D Thk1.9mm Lg Cn Hammertoe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95192729|EAP|Custom 95192729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Kirschner Phalinx Large Od1.4 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L12 Mm Od2.7 Mm Cortical Distal Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95192734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Fuseforce L15 Mm X W15 Mm Hand Sterile 2 Mm Ream|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|FSC: 13; Default||Not reimbursed separately|6,153.00|FSC: 13; Default||External grouping not supported 95192735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Fuseforce L12 Mm X W12 Mm Hand Sterile 2 Mm Ream|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|FSC: 13; Default||Not reimbursed separately|4,428.00|FSC: 13; Default||External grouping not supported 95192736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.0mmx14mm Dart-fire Ti Small Partial Thread Brow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95192737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 18mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|FSC: 13; Default||Not reimbursed separately|516.00|FSC: 13; Default||External grouping not supported 95192738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Biosure Regenesorb L20 Mm Od7 Mm Open Arc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|FSC: 13; Default||Not reimbursed separately|793.80|FSC: 13; Default||External grouping not supported 95192739|EAP|Custom 95192739||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Eprsth Thor Aorta 10cm 28mm Ntnl Fep Eptfe Gore Tag|1|HUMANA [1294]||HUMANA [11839]|51,216.00|FSC: 13; Default||Not reimbursed separately|51,216.00|FSC: 13; Default||External grouping not supported 95192740|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intro 33cm 20fr 9.5mm 8.7mm Gore Dryseal Flx Hdrph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus 2.7mm/3.5mm Distal Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 95192752|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy System 2.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95192753|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Flexible Straight .035in X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192773|EAP|Custom 95192773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical L200 Mm Od 4.8 Mm Cannulated Zh Sterile Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Orthopedic Asnis Iii Stainless Steel 4 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.75|FSC: 13; Default||Not reimbursed separately|105.75|FSC: 13; Default||External grouping not supported 95192754|EAP|Custom 95192754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Round High Profile Xtra 415cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192755|EAP|Custom 95192755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Round High Profile Xtra 490cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192756|EAP|Custom 95192756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Round High Profile Xtra 450cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192758|EAP|Custom 95192758||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 35mm X 14.5mm X 14cm|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 95192759|EAP|Custom 95192759||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Contralateral 12mm X 12cm|1|HUMANA [1294]||HUMANA [11839]|14,217.00|FSC: 13; Default||Not reimbursed separately|14,217.00|FSC: 13; Default||External grouping not supported 95192760|EAP|Custom 95192760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Excluder Iliac 16mm X 12mm X 7cm|1|HUMANA [1294]||HUMANA [11839]|10,005.00|FSC: 13; Default||Not reimbursed separately|10,005.00|FSC: 13; Default||External grouping not supported 95192761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Altivate Djo Surgical 6 Standard 108mm Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95192762|EAP|Custom 95192762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Contralateral 27mm X 12cm|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95192763|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Gore Dryseal Flex Hydrophilic 33cm 18fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192764|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Gore Dryseal Flex Hydrophilic 33cm 15fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192765|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hydrophilic Coated Glidecath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192766|EAP|Custom 95192766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Sterilization Alps Od 2.5 Mm Hand Fixation System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Alps Timax T Y 55.5mm X 19.5mm X 1.65mm Hand Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|FSC: 13; Default||Not reimbursed separately|1,262.25|FSC: 13; Default||External grouping not supported 95192768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation Dvr L20 Mm Od2.5 Mm Knee Thread Multidirectiona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|FSC: 13; Default||Not reimbursed separately|433.50|FSC: 13; Default||External grouping not supported 95192769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation 26mm Od2.5mm Hand Multidirectional Thread Alps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|FSC: 13; Default||Not reimbursed separately|433.50|FSC: 13; Default||External grouping not supported 95192770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation Full Thread L28 Mm Od2.5 Mm Hand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95192772|EAP|Custom 95192772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Drill L300 Mm Od2.8 Mm Guide Pin Sterile Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192775|EAP|Custom 95192775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Cable Rep 100a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Timax L90 Mm L16 Mm Od6.5 Mm Long Bone Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|FSC: 13; Default||Not reimbursed separately|1,410.00|FSC: 13; Default||External grouping not supported 95192778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Low Profile L65 Mm Od5.5 Mm Ankle Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95192779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Fastener Tibial 8mm X 30mm Exoshape Soft Tissue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95192780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Nano Corkscrew Ft Ti W 3-0 Fw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95192781|EAP|Custom 95192781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Photon Blade Smoke Evac 10 Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192782|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Pacing Temp Bipolar 5fr 8mm Ballon Unschrouded Lx Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Ulna 108mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95192784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 16mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95192785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95192786|EAP|Custom 95192786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wires Standard Tip 2.0mm X 152mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192787|EAP|Custom 95192787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.7mm X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192788|EAP|Custom 95192788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.7mm X 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192789|EAP|Custom 95192789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 3.5mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 55mm Cd Hzn Solera Spne Ma Cnn Xtd Tab Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95192791|EAP|Custom 95192791||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 20x11x9mm Coroent 4d Large Impact Nonsterile Lat|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95192792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95192793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mmx38mm Sh Thread Headless Mini Monster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95192794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mmx44mm Sh Thread Headless Mini Monster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95192796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95192797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Slanted-t 5 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95192798|EAP|Custom 95192798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Smooth Single Ended 2.0x150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192799|EAP|Custom 95192799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Planer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 3.5x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95192795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95192801|EAP|Custom 95192801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheartip Extended Curved Singletip 36khz Clarity Cusa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192802|EAP|Custom 95192802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Standard Tip Single Pack 36khz Clarity Cusa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192803|EAP|Custom 95192803||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Connect Quick Clarity Cusa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192816|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Berman 110cm 7fr 1.5ml 2 Lumen Flow Direct End Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Orthopedic Zip-fix Peek-optima W/needle Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.00|FSC: 13; Default||Not reimbursed separately|489.00|FSC: 13; Default||External grouping not supported 95192818|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Single Lumen 7fr Balloon Wedge Pressure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192819|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Gel 265cc Smooth Cohesive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95192820|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Gel 295cc Smooth Cohesive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95192821|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Gel 325cc Smooth Cohesive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95192822|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Gel 345cc Smooth Cohesive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95192823|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Gel 365cc Smooth Cohesive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95192824|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Gel 335cc Smooth Cohesive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95192825|EAP|Custom 95192825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Natrelle Inspira Silicone 265cc Full Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 3.5mm 26mm Ncb Ti6al4v St Hex Hd Ns Lg Frag Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95192834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Arthrodesis Right 10mm X 620mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,693.80|FSC: 13; Default||Not reimbursed separately|19,693.80|FSC: 13; Default||External grouping not supported 95192835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Titanium T9 40mm 3mm Odsec4.3mm Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,866.00|FSC: 13; Default||Not reimbursed separately|1,866.00|FSC: 13; Default||External grouping not supported 95192826|EAP|Custom 95192826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Natrelle Inspira Silicone 295cc Full Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192827|EAP|Custom 95192827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Natrelle Inspira Silicone 325cc Full Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192828|EAP|Custom 95192828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Natrelle Inspira Silicone 335cc Full Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192830|EAP|Custom 95192830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Natrelle Inspira Silicone 345cc Full Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192832|EAP|Custom 95192832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Distractor Kit Medium Post Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192833|EAP|Custom 95192833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Orthopedic T2 L1250 Mm Od3 Mm Ball Tip Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mmx16mm Self Drilling Low Profile Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|640.80|FSC: 13; Default||Not reimbursed separately|640.80|FSC: 13; Default||External grouping not supported 95192837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Quickfix L14 Mm Od2 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.20|FSC: 13; Default||Not reimbursed separately|619.20|FSC: 13; Default||External grouping not supported 95192838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mmx13mm Self Drilling Low Profile Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|640.80|FSC: 13; Default||Not reimbursed separately|640.80|FSC: 13; Default||External grouping not supported 95192839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95192840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multiuse 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95192841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95192907|EAP|Custom 95192907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Hex 2.0 70mm Ao Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Short Thread Mini-monster 4.0mmx30mm Headle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95192892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Short Thread Mini-monster 4.0mmx32mm Headle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95192893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Gorilla Long Metatarsophalangeal Right Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95192894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Gorilla L16mm Od3.5mm Nonsterile R3con Non Lock P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95192906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3.5 X 45mm Cannulated Self Drill|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 95192908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Legion Gii Ps Verilast Np Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95192909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Journey 11 Oxi W/veri & Np Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95192910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Journey Ii Bcs Cocr Fem & Np Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95192911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Zuk Cem Uni W/metal Back Tibia & Std Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 95192912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Zuk Cem Uni W/metal Back Tibia Vite Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 95192896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Liner Porous Fem W/cocr Head & Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95192897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Liner Porous Fem W/oxinium Hd & Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|FSC: 13; Default||Not reimbursed separately|14,175.00|FSC: 13; Default||External grouping not supported 95192898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tandem Bipolar Cmtd Fem With Cocr Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95192899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tandem Bipolar Porous Fem W/cocr Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95192900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Porous Fem W/oxinium Head & R3 Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|FSC: 13; Default||Not reimbursed separately|14,175.00|FSC: 13; Default||External grouping not supported 95192901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Liner Biolox Delta Head W/r3 Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|FSC: 13; Default||Not reimbursed separately|14,175.00|FSC: 13; Default||External grouping not supported 95192902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Journey 11 Cr Oxi Verilast W/np Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95192904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Journey Ii Uni Oxi/zuk Uni Hybrid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 95192905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Legion Gii Cr Verilast Np Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95192895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Formable Vivigen 15cc X-large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,228.00|FSC: 13; Default||Not reimbursed separately|15,228.00|FSC: 13; Default||External grouping not supported 80171001|EAP|CPT® 11200||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Removal Of Skin Tags, Mulitiple Fibro Tags Up To 15 Lesions|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95192903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Journey Ii Cr Cocr W/cr Insert & Non Por Tibi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95192915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Legion Xlpe 3-4 H15 Mm Knee Posterior Stabiliz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 95192916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Legion L120 Mm Od16 Mm Knee Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 95192914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95192919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation F3 Full Thread L24 Mm Od2.5 Mm Foot Lock Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95192920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation Alps Dvr L28 Mm Od2.5 Mm Hand Thread Multidirec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|FSC: 13; Default||Not reimbursed separately|433.50|FSC: 13; Default||External grouping not supported 95192917|EAP|Custom 95192917||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 0mm T40 Tibial Stardrive Cannulated Sterile Gray|1|HUMANA [1294]||HUMANA [11839]|691.56|FSC: 13; Default||Not reimbursed separately|691.56|FSC: 13; Default||External grouping not supported 95192918|EAP|Custom 95192918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3flute 330mm 100mm Od3.2mm Quick Coupling Blue Gol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192922|EAP|Custom 95192922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill L300 Mm Od4.8 Mm Cannulated Sterile Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drill Cc I Threaded 1.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|FSC: 13; Default||Not reimbursed separately|933.00|FSC: 13; Default||External grouping not supported 95192924|EAP|Custom 95192924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Hex 1.2mm X 55mm Ao Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192925|EAP|Custom 95192925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Kirschner Od.8 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192933|EAP|Custom 95192933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Distractor Kit Large Post Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192936|EAP|Custom 95192936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulas Mercedes 60cc 4.6mmx30cm Cell Friendly Toomey Hub|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192937|EAP|Custom 95192937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannulas Standard 60cc 4.6mmx30cm Cell Friendly Toomey Hub|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192934|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Acrysof Iq Restor Monoflex 10 D +8.5 Diopte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95192928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen L42 Mm Od5 Mm Femur Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95192929|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Alloderm Thk.4-1.6mm Med Contour 19.3cmx9.6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.04|FSC: 13; Default||Not reimbursed separately|66.04|FSC: 13; Default||External grouping not supported 95192930|EAP|HCPCS C1779||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial All Polyethylene 7 H9 Mm Knee Condylar Stabili|1|HUMANA [1294]||HUMANA [11839]|4,176.00|FSC: 13; Default||Not reimbursed separately|4,176.00|FSC: 13; Default||External grouping not supported 95192931|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vasc 10mm 58mm 135cm Bln Expandable Loprfl Cvr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95192932|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +13 Diopter Bi Converx Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95192943|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vascular Lifestream L38 Mm L135 Cm Od12 Mm Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95192938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Unipolar Head And Adapter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95192940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Bipolar Self Centering Liner And Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95192941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Fx And Cemented Stems|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,023.00|FSC: 13; Default||Not reimbursed separately|4,023.00|FSC: 13; Default||External grouping not supported 95192944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Mop Marathon Cemented Less <= 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,561.00|FSC: 13; Default||Not reimbursed separately|12,561.00|FSC: 13; Default||External grouping not supported 95192945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Mop Marathon Porous Less <= 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,526.00|FSC: 13; Default||Not reimbursed separately|14,526.00|FSC: 13; Default||External grouping not supported 95192946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Upcharge Altrx Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95192947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Upcharge Ceramic Head Biolox Delta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|FSC: 13; Default||Not reimbursed separately|1,374.00|FSC: 13; Default||External grouping not supported 95192948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Upcharge Gription Cup Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95192949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Upcharge Bps/ha Duofix Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95192951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Upcharge S-rom Stem And Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95192974|EAP|Custom 95192974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sys Drug Delivery On-q Painbuster Silversoaker Dehp 2.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192976|EAP|Custom 95192976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Deluxe Compression Replacement Bladder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192964|EAP|Custom 95192964||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26mmx14mmx16cm|1|HUMANA [1294]||HUMANA [11839]|34,671.00|FSC: 13; Default||Not reimbursed separately|34,671.00|FSC: 13; Default||External grouping not supported 95192965|EAP|Custom 95192965||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Gore Exclr 14cm 14mm Contralateral Leg|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95192952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Timax L85 Mm L16 Mm Od6.5 Mm Long Bone Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|FSC: 13; Default||Not reimbursed separately|1,410.00|FSC: 13; Default||External grouping not supported 95192966|EAP|Custom 95192966||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Gore Excluder 10cm 12mm Contralateral Leg|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95192968|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Circle 11cm 4.5" Circle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,151.30|FSC: 13; Default||Not reimbursed separately|2,151.30|FSC: 13; Default||External grouping not supported 95192969|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Ellipse 23cmx18cm 7x9in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,817.70|FSC: 13; Default||Not reimbursed separately|4,817.70|FSC: 13; Default||External grouping not supported 95192971|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Ellipse 25cmx20cm 8x10in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,575.20|FSC: 13; Default||Not reimbursed separately|5,575.20|FSC: 13; Default||External grouping not supported 95192973|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,834.00|FSC: 13; Default||Not reimbursed separately|12,834.00|FSC: 13; Default||External grouping not supported 95192970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral 6mm X 36mm Shoulder X3 Constrain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95192953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hp Uni All Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95192954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hp Uni Metal Backed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95192956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee All Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95192957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Fb Cemented Gvf/xlink Ti Cemented Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|FSC: 13; Default||Not reimbursed separately|12,762.00|FSC: 13; Default||External grouping not supported 95192958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Fb Hybrid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95192959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Fb Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|FSC: 13; Default||Not reimbursed separately|14,100.00|FSC: 13; Default||External grouping not supported 95192961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Upcharge Attune Rp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95192962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Upcharge Sigma Rp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95192963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Upcharge Anatomic Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95192732|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dev Clsr 5fr Vascade Fem Art|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95192733|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Cmpr 6/7fr Vascade Vasc Clgn Babsr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95192978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen Low Profile L52.5 Mm Od5 Mm Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 95192981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fixation Stablyx 5 Cmc Noncement Sterile Arthroplast|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|FSC: 13; Default||Not reimbursed separately|8,925.00|FSC: 13; Default||External grouping not supported 95192982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Protean Conronoid Assembled Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95192983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non Locking 2.7mm X 12mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95192985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Fluted Locking 2.3mm X 10mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95192986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Fluted Locking 2.3mm X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95192987|EAP|Custom 95192987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Ao Connection Soikd Shaft Square Tip 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192988|EAP|Custom 95192988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray P25k Pencan Spinal Basic Support|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192998|EAP|Custom 95192998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prochondrix Disposable Instrumentation 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192999|EAP|Custom 95192999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prochondrix Disposable Instrumentation Sizers 3 Piece 15-20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193001|EAP|Custom 95193001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin External Fixation Bent Od2 Mm Thread Lcd Plate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192990|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira 520cc Smooth Shell Surface|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95192991|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Inspira Sf Touch Full Profile 560cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95192984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non Locking 2.7mm X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95192992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Roximal Ulna 73mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,690.00|FSC: 13; Default||Not reimbursed separately|3,690.00|FSC: 13; Default||External grouping not supported 95192993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 16mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95192994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95192995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 45mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95192996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 50mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxail Non Locking 3.5mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95193002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Lcp Stainless Steel 73mm 10 Hole Low Profile 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.67|FSC: 13; Default||Not reimbursed separately|911.67|FSC: 13; Default||External grouping not supported 95192997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxail Non Locking 3.5mm X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95193005|EAP|Custom 95193005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Gamma3 Small L300 Mm Od4.2 Mm Hip Ao Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Zuk Cem Knee Std Vite Poly W-insts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 95193007|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Vascular Pt2 0.14x300cm Moderate Support Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95193009|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit 11 X 20cm Medium Perf Shaped Pliable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.06|FSC: 13; Default||Not reimbursed separately|102.06|FSC: 13; Default||External grouping not supported 95193010|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast 450cc 8300 Series|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95193011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws Interference Peek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.00|FSC: 13; Default||Not reimbursed separately|1,461.00|FSC: 13; Default||External grouping not supported 95193012|EAP|Custom 95193012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dissector Visco Hubbard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193013|EAP|Custom 95193013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Micro Dose Injection|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Blue Sequoia Titanium Prebent 85mm 5.5mm Thoracol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|FSC: 13; Default||Not reimbursed separately|1,593.30|FSC: 13; Default||External grouping not supported 95193015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador Two-level 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95193018|EAP|Custom 95193018||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Amniocord Purion 3cm X 2cm|1|HUMANA [1294]||HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95193020|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 9.5 Diopter +4.5 Cylinder Modified C Biconvex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 5.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95193024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mas Reline Polyaxial 2c 6.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95193025|EAP|Custom 95193025||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dye Vert Plus Disposable Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193027|EAP|Custom 95193027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Laparoscopic 25mm Abdominal Anal Trans Eea25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Natural Nail Tibial 10mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 95193030|EAP|Custom 95193030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hand Free 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 235mm Femoral Left Proximal Tfn-adv Lateral Relief|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95193033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 1.5mm 38cm 13mm Right Inter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95193035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Omnihip Biolox Delta +4 Mm Od32 Mm Hip Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95193036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Neutral Size Med 37.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95193037|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue 4x12cm Matristem Pelvic Floor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,719.52|FSC: 13; Default||Not reimbursed separately|3,719.52|FSC: 13; Default||External grouping not supported 95192942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Stem Dual Fixation Porous Porous Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95192960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Attune Fb With Dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|FSC: 13; Default||Not reimbursed separately|12,762.00|FSC: 13; Default||External grouping not supported 95193039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral 8mm 36mm Shoulder X3 Constrain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95193040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L48 Mm Spine 3 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95193042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L40 Mm Od4 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95193048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 3.5mm 14mm Mn Ti T8 Cnn Tpr Dist Tip Hexalobe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95193049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 1.2mm 14mm Fixos Twstof Ti Ft/ankl Canc St Slf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95193041|EAP|Custom 95193041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Joystick For T8 Screw Holes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193043|EAP|Custom 95193043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Surgical T10 Od4 Mm Hexalobe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Allopure Evans Allotrue Bicortical 20mmx22mmx10mmx5.5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,290.00|FSC: 13; Default||Not reimbursed separately|7,290.00|FSC: 13; Default||External grouping not supported 95193050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Infinity 1 Standard Ankle Component Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,412.00|FSC: 13; Default||Not reimbursed separately|17,412.00|FSC: 13; Default||External grouping not supported 95193051|EAP|Custom 95193051||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Sovereign 12 D L37 Mm X W27 Mm X H14 Mm|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95193052|EAP|Custom 95193052||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Sovereign 8 D Medium L37 Mm X W27 Mm X H10 Mm|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95193073|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 7.0 Diopter 4.00 Cylinder Modified C Biconvex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Head Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95193075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95193076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95193077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95193078|EAP|Custom 95193078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needles Fenestrated Bone Morrow Vitoss 8g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Anchorage T8 L26 Mm Od3.6 Mm Foot Ankle Lag Cross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|FSC: 13; Default||Not reimbursed separately|879.00|FSC: 13; Default||External grouping not supported 95193080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Stapix Nitinol 20mm X 24mm Superelastic Staple|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95193057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervial Ambassador Two-level 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95193082|EAP|Custom 95193082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Cannulation Broken Screw 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193083|EAP|Custom 95193083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Cannulation Broken Screw 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193084|EAP|Custom 95193084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Cannulation Broken Screw 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193085|EAP|Custom 95193085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Cannulation Broken Screw 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193086|EAP|Custom 95193086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Cannulation Broken Screw 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193087|EAP|Custom 95193087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Cannulation Broken Screw 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193088|EAP|Custom 95193088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stripped Screw 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193089|EAP|Custom 95193089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stripped Screw 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193090|EAP|Custom 95193090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stripped Screw 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193091|EAP|Custom 95193091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stripped Screw 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193092|EAP|Custom 95193092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stripped Screw 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193093|EAP|Custom 95193093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stripped Screw 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193094|EAP|Custom 95193094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2mm 440a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193096|EAP|Custom 95193096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 4mm 440a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193097|EAP|Custom 95193097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 5mm 440a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193098|EAP|Custom 95193098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 6mm 440a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193099|EAP|Custom 95193099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 7mm 440a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193100|EAP|Custom 95193100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Extractor Bbs Extractor For M2 Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193102|EAP|Custom 95193102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Distractor Kit Small Post Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193095|EAP|Custom 95193095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 3mm 440a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193101|EAP|Custom 95193101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Extractor Large Stripped Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Cobalt Gentamicin 40 Gm High Viscosity Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95193106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Bicortical Block 8mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.00|FSC: 13; Default||Not reimbursed separately|1,626.00|FSC: 13; Default||External grouping not supported 95193107|EAP|Custom 95193107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Tendon Tibialis Posterior Biocleanse 290mm|1|HUMANA [1294]||HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95193109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 H12 Mm Od40 Mm Shoulder Constrain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95193110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchors Bone 3w Arthro Del System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95193111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Taper Hemicapitatetm L16 Mm Od7.5 Mm Capitate Sterile L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|FSC: 13; Default||Not reimbursed separately|1,860.00|FSC: 13; Default||External grouping not supported 95193112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component 12mm Capitate 22mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|FSC: 13; Default||Not reimbursed separately|18,675.00|FSC: 13; Default||External grouping not supported 95193115|EAP|Custom 95193115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Vitoss L6 In Od8 Ga Bone Marrow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion Va-lcp First 2.4 / 2.7mm Right 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.27|FSC: 13; Default||Not reimbursed separately|4,050.27|FSC: 13; Default||External grouping not supported 95193117|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Ultra High 590cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95193118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compr 5.0ft 65mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95193119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compr 7.0 Ft 45mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95193120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Plantar Lapius Short Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95193123|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 5 D +4 Diopter Modified C Meniscus 13mm 6mm Posteri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95193124|EAP|Custom 95193124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Smooth 1.6x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193125|EAP|Custom 95193125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Threaded 1.30mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Swivelock C Biocomposite Peek 19.1 Mm 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|FSC: 13; Default||Not reimbursed separately|1,410.00|FSC: 13; Default||External grouping not supported 95193127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Interbody Device 33mm X 15mmx 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95193130|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 32mmx155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95193131|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 32mmx201mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95193132|EAP|Custom 95193132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Od2 Mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193133|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Hd Flex Pliable Thick L16cm X W8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.93|FSC: 13; Default||Not reimbursed separately|81.93|FSC: 13; Default||External grouping not supported 95193134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 H8 Mm Od36 Mm Shoulder Constrain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95193135|EAP|Custom 95193135||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Patellar Preshaped 11/11mm|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95193136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Trigen L62.5 Mm Od5 Mm Femur Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 95193137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Meta-tan 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|704.88|FSC: 13; Default||Not reimbursed separately|704.88|FSC: 13; Default||External grouping not supported 95193138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Trauma Fixation Meta-tan 105mm /100mm Compression Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,088.90|FSC: 13; Default||Not reimbursed separately|2,088.90|FSC: 13; Default||External grouping not supported 95193139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Trauma Fixation Meta-tan 100mm /95mm Compression Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,088.90|FSC: 13; Default||Not reimbursed separately|2,088.90|FSC: 13; Default||External grouping not supported 95193140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Trigen Meta-tan 40cm 10mm Femur Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|FSC: 13; Default||Not reimbursed separately|5,821.20|FSC: 13; Default||External grouping not supported 95193141|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Allox2 Full Height 12cm X 11cm 270-330cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 95193142|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Allox2 Full Height 12cm X 11cm 360-430cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 62064940|EAP|CPT® 87449||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb (1,3)-beta-d-glucan (fungitell(r)) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62064941|EAP|CPT® 83491||0301 - LABORATORY - CHEMISTRY|Hb 17-hydroxycorticosteriods, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 62064942|EAP|CPT® 83586||0301 - LABORATORY - CHEMISTRY|Hb 17-ketosteroids, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|38.40|FSC: 13; Default||Not reimbursed separately|38.40|FSC: 13; Default||External grouping not supported 62064943|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hb 21-hydroxylase Antibody - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 62064944|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb 3-hydroxy-3-methylglutaryl Coenzyme A Reductase (hmgcr) Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064945|EAP|CPT® 83915||0301 - LABORATORY - CHEMISTRY|Hb 5' Nucleotidase - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|33.45|FSC: 13; Default||Not reimbursed separately|33.45|FSC: 13; Default||External grouping not supported 62064946|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Acetylcholine Blocking Ab - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064947|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Acetylcholine Receptor Modulating Ab - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064948|EAP|CPT® 82017||0301 - LABORATORY - CHEMISTRY|Hb Acylcarnitine Quantitative Profile, Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|50.61|FSC: 13; Default||Not reimbursed separately|50.61|FSC: 13; Default||External grouping not supported 62064949|EAP|CPT® 80145||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Adalimumab Activity And Neutralizing Antibody - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|115.71|FSC: 13; Default||Not reimbursed separately|115.71|FSC: 13; Default||External grouping not supported 62064950|EAP|CPT® 82103||0301 - LABORATORY - CHEMISTRY|Hb Alpha-1-antitrypsin, Quantitative By Elisa, Random Stool - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.32|FSC: 13; Default||Not reimbursed separately|40.32|FSC: 13; Default||External grouping not supported 62064951|EAP|HCPCS 82108||0301 - LABORATORY - CHEMISTRY|Hb Aluminum, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.44|FSC: 13; Default||Not reimbursed separately|76.44|FSC: 13; Default||External grouping not supported 62064952|EAP|CPT® 82108||0301 - LABORATORY - CHEMISTRY|Hb Aluminum, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.44|FSC: 13; Default||Not reimbursed separately|76.44|FSC: 13; Default||External grouping not supported 62064953|EAP|CPT® 82139||0301 - LABORATORY - CHEMISTRY|Hb Amino Acids Quantitative By Lc-ms/ms, Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|50.61|FSC: 13; Default||Not reimbursed separately|50.61|FSC: 13; Default||External grouping not supported 62064954|EAP|CPT® 82139||0301 - LABORATORY - CHEMISTRY|Hb Amino Acids Quantitative By Lc-ms/ms, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.61|FSC: 13; Default||Not reimbursed separately|50.61|FSC: 13; Default||External grouping not supported 62064955|EAP|CPT® 82135||0301 - LABORATORY - CHEMISTRY|Hb Aminolevulinic Acid (ala), Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|49.35|FSC: 13; Default||Not reimbursed separately|49.35|FSC: 13; Default||External grouping not supported 62064956|EAP|CPT® 82150||0301 - LABORATORY - CHEMISTRY|Hb Amylase Isoenzymes - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.44|FSC: 13; Default||Not reimbursed separately|19.44|FSC: 13; Default||External grouping not supported 62064957|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|Hb Anca Titer Bill - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62064958|EAP|CPT® 83516||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Anca Vasculitis Profile W/rflx To Titer - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064959|EAP|CPT® 82172||0301 - LABORATORY - CHEMISTRY|Hb Apolipoprotein B/a Ratio - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.27|FSC: 13; Default||Not reimbursed separately|63.27|FSC: 13; Default||External grouping not supported 62064960|EAP|CPT® 82175||0301 - LABORATORY - CHEMISTRY|Hb Arsenic, Blood - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.91|FSC: 13; Default||Not reimbursed separately|56.91|FSC: 13; Default||External grouping not supported 62064961|EAP|CPT® 82175||0301 - LABORATORY - CHEMISTRY|Hb Arsenic, Fractionated, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.91|FSC: 13; Default||Not reimbursed separately|56.91|FSC: 13; Default||External grouping not supported 62064962|EAP|CPT® 82175||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Arsenic, Urine W/ Reflex To Fractionated - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.91|FSC: 13; Default||Not reimbursed separately|56.91|FSC: 13; Default||External grouping not supported 62064963|EAP|CPT® 86606||0302 - LABORATORY - IMMUNOLOGY|Hb Aspergillus Antibody By Cf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.15|FSC: 13; Default||Not reimbursed separately|45.15|FSC: 13; Default||External grouping not supported 62064964|EAP|CPT® 86606||0302 - LABORATORY - IMMUNOLOGY|Hb Aspergillus Fumigatus Antibody, Igg By Elisa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.15|FSC: 13; Default||Not reimbursed separately|45.15|FSC: 13; Default||External grouping not supported 62064965|EAP|CPT® 87305||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Aspergillus Galactomannan Antigen - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62064966|EAP|CPT® 87305||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Aspergillus Galactomannan Eia, Broncho - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62064967|EAP|CPT® 86617||0302 - LABORATORY - IMMUNOLOGY|Hb B. Burgdorferi Ab, Igm By Immunoblot - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.47|FSC: 13; Default||Not reimbursed separately|46.47|FSC: 13; Default||External grouping not supported 62064968|EAP|CPT® 86615||0302 - LABORATORY - IMMUNOLOGY|Hb B. Pertussis Antibody, Iga Immunoblot - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 62064969|EAP|CPT® 86615||0302 - LABORATORY - IMMUNOLOGY|Hb B. Pertussis Antibody, Igg Immunoblot - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 62064970|EAP|CPT® 86615||0302 - LABORATORY - IMMUNOLOGY|Hb B. Pertussis Antibody, Igm Immunoblot - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 62064971|EAP|CPT® 86611||0302 - LABORATORY - IMMUNOLOGY|Hb Bartonella Quintana Antibodies, Igg & Igm By Ifa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 62064972|EAP|CPT® 87471||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Bartonella Species By Pcr - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62064973|EAP|CPT® 83018||0301 - LABORATORY - CHEMISTRY|Hb Beryllium, Serum Or Plasma - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.88|FSC: 13; Default||Not reimbursed separately|65.88|FSC: 13; Default||External grouping not supported 62064974|EAP|CPT® 86335||0302 - LABORATORY - IMMUNOLOGY|Hb Beta-2 Transferrin - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.05|FSC: 13; Default||Not reimbursed separately|88.05|FSC: 13; Default||External grouping not supported 62064975|EAP|CPT® 83789||0301 - LABORATORY - CHEMISTRY|Hb Bile Acids, Fractionated And Total - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.33|FSC: 13; Default||Not reimbursed separately|72.33|FSC: 13; Default||External grouping not supported 62064976|EAP|CPT® 86615||0302 - LABORATORY - IMMUNOLOGY|Hb Bordetella Pertussis Antibodies, Iga, Igg, And Igm By Elisa With Reflex To Immunoblot - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 62064977|EAP|CPT® 87476||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Borrelia Species By Pcr (lyme Disease) - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62064978|EAP|CPT® 86332||0302 - LABORATORY - IMMUNOLOGY|Hb C1q Binding Assay - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|73.11|FSC: 13; Default||Not reimbursed separately|73.11|FSC: 13; Default||External grouping not supported 62064979|EAP|CPT® 82300||0301 - LABORATORY - CHEMISTRY|Hb Cadmium, Blood - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.92|FSC: 13; Default||Not reimbursed separately|70.92|FSC: 13; Default||External grouping not supported 62064980|EAP|CPT® 82300||0301 - LABORATORY - CHEMISTRY|Hb Cadmium, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.92|FSC: 13; Default||Not reimbursed separately|70.92|FSC: 13; Default||External grouping not supported 62064981|EAP|CPT® 86628||0302 - LABORATORY - IMMUNOLOGY|Hb Candida Albicans Antibodies Iga, Igg, And Igm By Elisa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.03|FSC: 13; Default||Not reimbursed separately|36.03|FSC: 13; Default||External grouping not supported 62064982|EAP|CPT® 82378||0301 - LABORATORY - CHEMISTRY|Hb Carcinoembryonic Antigen, Fluid - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.88|FSC: 13; Default||Not reimbursed separately|56.88|FSC: 13; Default||External grouping not supported 62064983|EAP|CPT® 82380||0301 - LABORATORY - CHEMISTRY|Hb Carotene, Total, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|27.66|FSC: 13; Default||Not reimbursed separately|27.66|FSC: 13; Default||External grouping not supported 62064984|EAP|CPT® 82384||0301 - LABORATORY - CHEMISTRY|Hb Catecholamines Fractionated (epinephrine, Norepinephrine), Plasma - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.75|FSC: 13; Default||Not reimbursed separately|75.75|FSC: 13; Default||External grouping not supported 62064985|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Celiac Disease Dual Antigen Screen - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064986|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Centromere Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064987|EAP|CPT® 82482||0301 - LABORATORY - CHEMISTRY|Hb Cholinesterase, Rbc - Ratio To Hemoglobin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|29.43|FSC: 13; Default||Not reimbursed separately|29.43|FSC: 13; Default||External grouping not supported 62064988|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Chromatin Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62064989|EAP|CPT® 80159||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Clozapine And Metabolites, Serum Or Plasma, Quantitative - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|60.45|FSC: 13; Default||Not reimbursed separately|60.45|FSC: 13; Default||External grouping not supported 62064990|EAP|CPT® 83018||0301 - LABORATORY - CHEMISTRY|Hb Cobalt, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.88|FSC: 13; Default||Not reimbursed separately|65.88|FSC: 13; Default||External grouping not supported 62064991|EAP|CPT® 86635||0302 - LABORATORY - IMMUNOLOGY|Hb Coccidioides Antibody By Cf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.41|FSC: 13; Default||Not reimbursed separately|34.41|FSC: 13; Default||External grouping not supported 62064992|EAP|CPT® 82542||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Coenzyme Q10, Total - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.27|FSC: 13; Default||Not reimbursed separately|72.27|FSC: 13; Default||External grouping not supported 62064993|EAP|CPT® 86160||0302 - LABORATORY - IMMUNOLOGY|Hb Complement Component 1q Level - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 62064994|EAP|CPT® 86160||0302 - LABORATORY - IMMUNOLOGY|Hb Complement Component 2 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 62064995|EAP|CPT® 82525||0301 - LABORATORY - CHEMISTRY|Hb Copper Level Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.23|FSC: 13; Default||Not reimbursed separately|37.23|FSC: 13; Default||External grouping not supported 62064996|EAP|CPT® 84449||0301 - LABORATORY - CHEMISTRY|Hb Corticosteroid-binding Globulin (cbg) - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|54.00|FSC: 13; Default||Not reimbursed separately|54.00|FSC: 13; Default||External grouping not supported 62064997|EAP|CPT® 82530||0301 - LABORATORY - CHEMISTRY|Hb Cortisol, Urine Free By Lc-ms/ms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.13|FSC: 13; Default||Not reimbursed separately|50.13|FSC: 13; Default||External grouping not supported 62064998|EAP|CPT® 86658||0302 - LABORATORY - IMMUNOLOGY|Hb Coxsackie A9 Virus Antibodies By Cf - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.09|FSC: 13; Default||Not reimbursed separately|39.09|FSC: 13; Default||External grouping not supported 62064999|EAP|CPT® 86658||0302 - LABORATORY - IMMUNOLOGY|Hb Coxsackie B Virus Antibodies - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.09|FSC: 13; Default||Not reimbursed separately|39.09|FSC: 13; Default||External grouping not supported 62065000|EAP|CPT® 82595||0301 - LABORATORY - CHEMISTRY|Hb Cryoglobulin, Qualitative - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 62065001|EAP|CPT® 82523||0301 - LABORATORY - CHEMISTRY|Hb C-telopeptide, Beta-cross-linked, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|FSC: 13; Default||Not reimbursed separately|56.04|FSC: 13; Default||External grouping not supported 62065002|EAP|CPT® 82600||0301 - LABORATORY - CHEMISTRY|Hb Cyanide - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|58.20|FSC: 13; Default||Not reimbursed separately|58.20|FSC: 13; Default||External grouping not supported 62065003|EAP|CPT® 83520||0309 - LABORATORY - OTHER LABORATORY|Hb Cytokine Panel - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62065004|EAP|CPT® 86645||0302 - LABORATORY - IMMUNOLOGY|Hb Cytomegalovirus Antibody, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 62065005|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Diphtheria And Tetanus Antibodies, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065006|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Diphtheria Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065007|EAP|CPT® 86215||0302 - LABORATORY - IMMUNOLOGY|Hb Dnase-b Ab - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 62065008|EAP|CPT® 86753||0302 - LABORATORY - IMMUNOLOGY|Hb E. Histolytica (amebiasis), Ab, Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|37.17|FSC: 13; Default||Not reimbursed separately|37.17|FSC: 13; Default||External grouping not supported 62065009|EAP|CPT® 86663||0302 - LABORATORY - IMMUNOLOGY|Hb Ebv Ab To Early (d) Ag, Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.36|FSC: 13; Default||Not reimbursed separately|39.36|FSC: 13; Default||External grouping not supported 62065010|EAP|CPT® 86666||0302 - LABORATORY - IMMUNOLOGY|Hb Ehrlichia Chaffeensis Antibody, Igg By Ifa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 62065011|EAP|CPT® 87337||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Entamoeba Antigen By Eia - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62065012|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Epstein-barr Virus By Pcr - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065013|EAP|CPT® 82679||0301 - LABORATORY - CHEMISTRY|Hb Estrone By Tms - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|74.85|FSC: 13; Default||Not reimbursed separately|74.85|FSC: 13; Default||External grouping not supported 62065014|EAP|CPT® 80168||0301 - LABORATORY - CHEMISTRY|Hb Ethosuximide, Serum Or Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|49.02|FSC: 13; Default||Not reimbursed separately|49.02|FSC: 13; Default||External grouping not supported 62065015|EAP|CPT® 80169||0301 - LABORATORY - CHEMISTRY|Hb Everolimus By Tandem Mass Spectrometry - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|41.19|FSC: 13; Default||Not reimbursed separately|41.19|FSC: 13; Default||External grouping not supported 62065016|EAP|CPT® 82710||0301 - LABORATORY - CHEMISTRY|Hb Fecal Fat, Quantitative 24-hour Collect - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|FSC: 13; Default||Not reimbursed separately|50.40|FSC: 13; Default||External grouping not supported 62065017|EAP|CPT® 81243||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fragile X (fmr1) W/reflex To Methylation - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|171.12|FSC: 13; Default||Not reimbursed separately|171.12|FSC: 13; Default||External grouping not supported 62065018|EAP|CPT® 81244||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fragile X Status By Mpcr Bill - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|134.67|FSC: 13; Default||Not reimbursed separately|134.67|FSC: 13; Default||External grouping not supported 62065019|EAP|CPT® 86668||0302 - LABORATORY - IMMUNOLOGY|Hb Francisella Tularensis Antibodies, Igg And Igm - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|42.48|FSC: 13; Default||Not reimbursed separately|42.48|FSC: 13; Default||External grouping not supported 62065020|EAP|CPT® 86668||0302 - LABORATORY - IMMUNOLOGY|Hb Francisella Tularensis Antibody, Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|42.48|FSC: 13; Default||Not reimbursed separately|42.48|FSC: 13; Default||External grouping not supported 62065021|EAP|CPT® 82670||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Free Estradiol By Ed/lc-ms/ms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.82|FSC: 13; Default||Not reimbursed separately|83.82|FSC: 13; Default||External grouping not supported 62065022|EAP|CPT® 84439||0301 - LABORATORY - CHEMISTRY|Hb Free T4 By Equil Dialysis-tms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.06|FSC: 13; Default||Not reimbursed separately|27.06|FSC: 13; Default||External grouping not supported 62065023|EAP|CPT® 80171||0301 - LABORATORY - CHEMISTRY|Hb Gabapentin Level - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.01|FSC: 13; Default||Not reimbursed separately|65.01|FSC: 13; Default||External grouping not supported 62065024|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Ganglioside (gm1) Antibodies, Igg/igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62065025|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Gbm Ab, Igg By Multiplex Bead Assay - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62065026|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb H. Influenzae B Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065027|EAP|CPT® 83051||0301 - LABORATORY - CHEMISTRY|Hb Hemoglobin, Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|21.93|FSC: 13; Default||Not reimbursed separately|21.93|FSC: 13; Default||External grouping not supported 62065028|EAP|CPT® 83070||0301 - LABORATORY - CHEMISTRY|Hb Hemosiderin, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.25|FSC: 13; Default||Not reimbursed separately|14.25|FSC: 13; Default||External grouping not supported 62065029|EAP|CPT® 87517||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hepatitis B Virus By Quantitative Pcr - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 62065030|EAP|CPT® 87902||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hepatitis C Virus (hcv) Ns5a Drug Resistance By Sequencing - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.35|FSC: 13; Default||Not reimbursed separately|772.35|FSC: 13; Default||External grouping not supported 62065031|EAP|CPT® 85598||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hexagonal Phospholipid Neutralization - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.94|FSC: 13; Default||Not reimbursed separately|53.94|FSC: 13; Default||External grouping not supported 62065032|EAP|CPT® 83088||0301 - LABORATORY - CHEMISTRY|Hb Histamine, Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|88.59|FSC: 13; Default||Not reimbursed separately|88.59|FSC: 13; Default||External grouping not supported 62065033|EAP|CPT® 83088||0301 - LABORATORY - CHEMISTRY|Hb Histamine, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.59|FSC: 13; Default||Not reimbursed separately|88.59|FSC: 13; Default||External grouping not supported 62065034|EAP|CPT® 87385||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Histoplasma Antigen, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 62065035|EAP|CPT® 86689||0302 - LABORATORY - IMMUNOLOGY|Hb Hiv 1 Antibody Confirm, Western Blot - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 62065036|EAP|CPT® 86695||0302 - LABORATORY - IMMUNOLOGY|Hb Hsv 1 Glycoprotein G Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 62065037|EAP|CPT® 86694||0302 - LABORATORY - IMMUNOLOGY|Hb Hsv 1/2 Ab, Igg, Igm Reflex - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62065038|EAP|CPT® 86696||0302 - LABORATORY - IMMUNOLOGY|Hb Hsv 2 Glycoprotein G Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 62065039|EAP|CPT® 86689||0302 - LABORATORY - IMMUNOLOGY|Hb Htlv I/ii Antibodies Conf, Western Blot - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 62065040|EAP|CPT® 86790||0302 - LABORATORY - IMMUNOLOGY|Hb Htlv I/ii Antibodies W/reflex To Confirm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 62065041|EAP|CPT® 81271||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Huntington Disease Mutation By Pcr - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 62065042|EAP|CPT® 86334||0302 - LABORATORY - IMMUNOLOGY|Hb Immunofixation, Igd And Ige - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|FSC: 13; Default||Not reimbursed separately|67.02|FSC: 13; Default||External grouping not supported 62065043|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hb Immunoglobulin D, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62065044|EAP|CPT® 82787||0301 - LABORATORY - CHEMISTRY|Hb Immunoglobulin G Subclass 4 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.06|FSC: 13; Default||Not reimbursed separately|24.06|FSC: 13; Default||External grouping not supported 62065045|EAP|CPT® 86710||0302 - LABORATORY - IMMUNOLOGY|Hb Influenza A Virus Ab, Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.65|FSC: 13; Default||Not reimbursed separately|40.65|FSC: 13; Default||External grouping not supported 62065046|EAP|CPT® 86710||0302 - LABORATORY - IMMUNOLOGY|Hb Influenza A Virus Ab, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.65|FSC: 13; Default||Not reimbursed separately|40.65|FSC: 13; Default||External grouping not supported 62065047|EAP|CPT® 86710||0302 - LABORATORY - IMMUNOLOGY|Hb Influenza A, B Virus Abs, Igg, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.65|FSC: 13; Default||Not reimbursed separately|40.65|FSC: 13; Default||External grouping not supported 62065048|EAP|CPT® 86710||0302 - LABORATORY - IMMUNOLOGY|Hb Influenza B Virus Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.65|FSC: 13; Default||Not reimbursed separately|40.65|FSC: 13; Default||External grouping not supported 62065049|EAP|CPT® 86710||0302 - LABORATORY - IMMUNOLOGY|Hb Influenza B Virus Ab, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.65|FSC: 13; Default||Not reimbursed separately|40.65|FSC: 13; Default||External grouping not supported 62065050|EAP|CPT® 82397||0301 - LABORATORY - CHEMISTRY|Hb Insulin-like Growth Factor Binding Protein 3 (igfbp-3) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.36|FSC: 13; Default||Not reimbursed separately|42.36|FSC: 13; Default||External grouping not supported 62065051|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Interleukin/cytokine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62065052|EAP|CPT® 83018||0301 - LABORATORY - CHEMISTRY|Hb Iodine, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.88|FSC: 13; Default||Not reimbursed separately|65.88|FSC: 13; Default||External grouping not supported 62065053|EAP|CPT® 80299||0301 - LABORATORY - CHEMISTRY|Hb Itraconazole, Quantitative By Lc-ms/ms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 62065054|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Jc Virus By Pcr - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065055|EAP|CPT® 86235||0302 - LABORATORY - IMMUNOLOGY|Hb Jo-1 Antibody - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 62065056|EAP|CPT® 83605||0301 - LABORATORY - CHEMISTRY|Hb Lactic Acid Cerebrospinal Fluid - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.71|FSC: 13; Default||Not reimbursed separately|34.71|FSC: 13; Default||External grouping not supported 62065057|EAP|CPT® 83655||0301 - LABORATORY - CHEMISTRY|Hb Lead, Blood (capillary) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.33|FSC: 13; Default||Not reimbursed separately|36.33|FSC: 13; Default||External grouping not supported 62065058|EAP|CPT® 83655||0301 - LABORATORY - CHEMISTRY|Hb Lead, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.33|FSC: 13; Default||Not reimbursed separately|36.33|FSC: 13; Default||External grouping not supported 62065059|EAP|CPT® 86713||0302 - LABORATORY - IMMUNOLOGY|Hb Legionella Pneumophila Antibody 1-6, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.90|FSC: 13; Default||Not reimbursed separately|45.90|FSC: 13; Default||External grouping not supported 62065060|EAP|CPT® 87278||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Legionella Pneumophila Dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|46.80|FSC: 13; Default||Not reimbursed separately|46.80|FSC: 13; Default||External grouping not supported 62065061|EAP|CPT® 86720||0302 - LABORATORY - IMMUNOLOGY|Hb Leptospira Antibody, Igm By Dot Blot - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|48.60|FSC: 13; Default||Not reimbursed separately|48.60|FSC: 13; Default||External grouping not supported 62065062|EAP|CPT® 80176||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lidocaine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|44.07|FSC: 13; Default||Not reimbursed separately|44.07|FSC: 13; Default||External grouping not supported 62065063|EAP|CPT® 83700||0301 - LABORATORY - CHEMISTRY|Hb Lipoprotein Electrophoresis - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|33.78|FSC: 13; Default||Not reimbursed separately|33.78|FSC: 13; Default||External grouping not supported 62065064|EAP|CPT® 86376||0302 - LABORATORY - IMMUNOLOGY|Hb Liver-kidney Microsome-1 Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.65|FSC: 13; Default||Not reimbursed separately|43.65|FSC: 13; Default||External grouping not supported 62065065|EAP|CPT® 84146||0301 - LABORATORY - CHEMISTRY|Hb Macroprolactin - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|FSC: 13; Default||Not reimbursed separately|58.14|FSC: 13; Default||External grouping not supported 62065066|EAP|CPT® 83735||0301 - LABORATORY - CHEMISTRY|Hb Magnesium, Rbc - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.10|FSC: 13; Default||Not reimbursed separately|20.10|FSC: 13; Default||External grouping not supported 62065067|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hb Melanocyte Stimulation Hormone, Alpha (a-msh) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 62065068|EAP|CPT® 81405||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Men2, Ret Gene Sequencing - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|904.05|FSC: 13; Default||Not reimbursed separately|904.05|FSC: 13; Default||External grouping not supported 62065069|EAP|CPT® 83825||0301 - LABORATORY - CHEMISTRY|Hb Mercury, Blood - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.78|FSC: 13; Default||Not reimbursed separately|48.78|FSC: 13; Default||External grouping not supported 62065070|EAP|CPT® 83825||0301 - LABORATORY - CHEMISTRY|Hb Mercury, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.78|FSC: 13; Default||Not reimbursed separately|48.78|FSC: 13; Default||External grouping not supported 62065071|EAP|CPT® 86738||0302 - LABORATORY - IMMUNOLOGY|Hb Mycoplasma Pneumoniae Ab, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 62065072|EAP|CPT® 86738||0302 - LABORATORY - IMMUNOLOGY|Hb Mycoplasma Pneumoniae Ab, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 62065073|EAP|CPT® 87581||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Mycoplasma Pneumoniae By Pcr - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065074|EAP|CPT® 83874||0301 - LABORATORY - CHEMISTRY|Hb Myoglobin, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.76|FSC: 13; Default||Not reimbursed separately|38.76|FSC: 13; Default||External grouping not supported 62065075|EAP|CPT® 86316||0302 - LABORATORY - IMMUNOLOGY|Hb Neuron Specific Enolase - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 62065076|EAP|CPT® 83885||0301 - LABORATORY - CHEMISTRY|Hb Nickel, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|73.53|FSC: 13; Default||Not reimbursed separately|73.53|FSC: 13; Default||External grouping not supported 62065077|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hb N-methyl-d-aspartate Rcptr Ab, Igg, Ser - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62065078|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hb N-methyl-d-aspartate Receptor Ab, Csf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62065079|EAP|CPT® 82523||0301 - LABORATORY - CHEMISTRY|Hb N-telopeptide, Cross-linked, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|FSC: 13; Default||Not reimbursed separately|56.04|FSC: 13; Default||External grouping not supported 62065080|EAP|CPT® 83916||0301 - LABORATORY - CHEMISTRY|Hb Oligoclonal Bands In Csf And Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.17|FSC: 13; Default||Not reimbursed separately|82.17|FSC: 13; Default||External grouping not supported 62065081|EAP|CPT® 83918||0301 - LABORATORY - CHEMISTRY|Hb Organic Acids, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|70.80|FSC: 13; Default||Not reimbursed separately|70.80|FSC: 13; Default||External grouping not supported 62065082|EAP|CPT® 85555||0305 - LABORATORY - HEMATOLOGY|Hb Osmotic Fragility Erythrocyte - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|22.41|FSC: 13; Default||Not reimbursed separately|22.41|FSC: 13; Default||External grouping not supported 62065083|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hb Pancreatic Polypeptide - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 62065084|EAP|CPT® 86747||0302 - LABORATORY - IMMUNOLOGY|Hb Parvovirus B19 Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.09|FSC: 13; Default||Not reimbursed separately|45.09|FSC: 13; Default||External grouping not supported 62065085|EAP|CPT® 86747||0302 - LABORATORY - IMMUNOLOGY|Hb Parvovirus B19 Antibody, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.09|FSC: 13; Default||Not reimbursed separately|45.09|FSC: 13; Default||External grouping not supported 62065086|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Parvovirus B19 By Qualitative Pcr - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065087|EAP|CPT® 83986||0301 - LABORATORY - CHEMISTRY|Hb Ph, Fecal - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.74|FSC: 13; Default||Not reimbursed separately|10.74|FSC: 13; Default||External grouping not supported 62065088|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Pneumococcal Abs, Igg 23 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065089|EAP|CPT® 86356||0302 - LABORATORY - IMMUNOLOGY|Hb Pnh, High Sensitivity, Rbc - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.34|FSC: 13; Default||Not reimbursed separately|80.34|FSC: 13; Default||External grouping not supported 62065090|EAP|CPT® 84120||0301 - LABORATORY - CHEMISTRY|Hb Porphyrins, Fractionation And Quant, Urn - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|44.13|FSC: 13; Default||Not reimbursed separately|44.13|FSC: 13; Default||External grouping not supported 62065091|EAP|CPT® 84311||0301 - LABORATORY - CHEMISTRY|Hb Porphyrins, Total, Plasma Or Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.30|FSC: 13; Default||Not reimbursed separately|24.30|FSC: 13; Default||External grouping not supported 62065092|EAP|CPT® 84140||0301 - LABORATORY - CHEMISTRY|Hb Pregnenolone By Lc-ms/ms, Serum Or Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|62.01|FSC: 13; Default||Not reimbursed separately|62.01|FSC: 13; Default||External grouping not supported 62065093|EAP|CPT® 84600||0301 - LABORATORY - CHEMISTRY|Hb Propylene Glycol, Ser Or Plasm - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|51.33|FSC: 13; Default||Not reimbursed separately|51.33|FSC: 13; Default||External grouping not supported 62065094|EAP|CPT® 84066||0301 - LABORATORY - CHEMISTRY|Hb Prostatic Acid Phosphatase - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|28.98|FSC: 13; Default||Not reimbursed separately|28.98|FSC: 13; Default||External grouping not supported 62065095|EAP|CPT® 85302||0301 - LABORATORY - CHEMISTRY|Hb Protein C, Total Antigen - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.03|FSC: 13; Default||Not reimbursed separately|36.03|FSC: 13; Default||External grouping not supported 62065096|EAP|CPT® 85306||0301 - LABORATORY - CHEMISTRY|Hb Protein S Ag, Free - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.96|FSC: 13; Default||Not reimbursed separately|45.96|FSC: 13; Default||External grouping not supported 62065097|EAP|CPT® 85306||0301 - LABORATORY - CHEMISTRY|Hb Protein S, Free Antigen With Reflex To Protein S, Total Antigen - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.96|FSC: 13; Default||Not reimbursed separately|45.96|FSC: 13; Default||External grouping not supported 62065098|EAP|CPT® 84376||0301 - LABORATORY - CHEMISTRY|Hb Reducing Substances, Fecal - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|FSC: 13; Default||Not reimbursed separately|16.50|FSC: 13; Default||External grouping not supported 62065099|EAP|CPT® 84244||0301 - LABORATORY - CHEMISTRY|Hb Renin, Direct - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.97|FSC: 13; Default||Not reimbursed separately|65.97|FSC: 13; Default||External grouping not supported 62065100|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hb Retinol Binding Protein - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 62065101|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Rheumatoid Factors, Iga, Igg, And Igm By Elisa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62065102|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Rna Polymerase Iii Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62065103|EAP|CPT® 86762||0302 - LABORATORY - IMMUNOLOGY|Hb Rubella Antibody, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62065104|EAP|CPT® 86682||0302 - LABORATORY - IMMUNOLOGY|Hb Schistosoma Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.03|FSC: 13; Default||Not reimbursed separately|39.03|FSC: 13; Default||External grouping not supported 62065105|EAP|CPT® 84255||0301 - LABORATORY - CHEMISTRY|Hb Selenium, Serum Or Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|76.59|FSC: 13; Default||Not reimbursed separately|76.59|FSC: 13; Default||External grouping not supported 62065106|EAP|CPT® 84260||0301 - LABORATORY - CHEMISTRY|Hb Serotonin, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|92.94|FSC: 13; Default||Not reimbursed separately|92.94|FSC: 13; Default||External grouping not supported 62065107|EAP|CPT® 84260||0301 - LABORATORY - CHEMISTRY|Hb Serotonin, Whole Blood - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.94|FSC: 13; Default||Not reimbursed separately|92.94|FSC: 13; Default||External grouping not supported 62065108|EAP|CPT® 84302||0301 - LABORATORY - CHEMISTRY|Hb Sodium, Fecal - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|14.58|FSC: 13; Default||Not reimbursed separately|14.58|FSC: 13; Default||External grouping not supported 62065109|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Soluble Liver Antigen Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62065110|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Streptococcus Pneumoniae Antibodies, Igg (14 Serotypes) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065111|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Streptococcus Pneumoniae Antibodies, Igg (23 Serotypes) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065112|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hb Striated Muscle Antibodies, Igg With Reflex To Titer - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62065113|EAP|CPT® 84479||0301 - LABORATORY - CHEMISTRY|Hb T3 Uptake - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 62065114|EAP|CPT® 81342||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb T-cell Clonality Screening By Pcr - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|604.50|FSC: 13; Default||Not reimbursed separately|604.50|FSC: 13; Default||External grouping not supported 62065115|EAP|CPT® 84403||0301 - LABORATORY - CHEMISTRY|Hb Testosterone Free/total, Female/child - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|FSC: 13; Default||Not reimbursed separately|77.43|FSC: 13; Default||External grouping not supported 62065116|EAP|CPT® 84402||0301 - LABORATORY - CHEMISTRY|Hb Testosterone, Free, Adult Males By Ed/lc-ms/ms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.41|FSC: 13; Default||Not reimbursed separately|76.41|FSC: 13; Default||External grouping not supported 62065117|EAP|CPT® 84403||0301 - LABORATORY - CHEMISTRY|Hb Testosterone, Lc-ms/ms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|FSC: 13; Default||Not reimbursed separately|77.43|FSC: 13; Default||External grouping not supported 62065118|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Tetanus Antibody, Igg - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 62065119|EAP|CPT® 83018||0301 - LABORATORY - CHEMISTRY|Hb Thallium, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.88|FSC: 13; Default||Not reimbursed separately|65.88|FSC: 13; Default||External grouping not supported 62065120|EAP|CPT® 80299||0301 - LABORATORY - CHEMISTRY|Hb Thiopurine Metabolites By Lc-ms/ms - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 62065121|EAP|CPT® 82657||0301 - LABORATORY - CHEMISTRY|Hb Thiopurine Methyltransferase, Rbc - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|66.51|FSC: 13; Default||Not reimbursed separately|66.51|FSC: 13; Default||External grouping not supported 62065122|EAP|CPT® 84445||0301 - LABORATORY - CHEMISTRY|Hb Thyroid Stimulating Immunoglobulins - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|152.58|FSC: 13; Default||Not reimbursed separately|152.58|FSC: 13; Default||External grouping not supported 62065123|EAP|CPT® 84442||0301 - LABORATORY - CHEMISTRY|Hb Thyroxine Binding Globulin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|44.34|FSC: 13; Default||Not reimbursed separately|44.34|FSC: 13; Default||External grouping not supported 62065124|EAP|CPT® 84439||0301 - LABORATORY - CHEMISTRY|Hb Thyroxine, Free By Equilibrium Dialysis/hplc-tandem Mass Spectrometry - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.06|FSC: 13; Default||Not reimbursed separately|27.06|FSC: 13; Default||External grouping not supported 62065125|EAP|CPT® 86682||0302 - LABORATORY - IMMUNOLOGY|Hb Toxocara Antibody Igg By Elisa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.03|FSC: 13; Default||Not reimbursed separately|39.03|FSC: 13; Default||External grouping not supported 62065126|EAP|CPT® 86778||0302 - LABORATORY - IMMUNOLOGY|Hb Toxoplasma Gondii Ab, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.23|FSC: 13; Default||Not reimbursed separately|43.23|FSC: 13; Default||External grouping not supported 62065127|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Toxoplasma Gondii By Pcr - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065128|EAP|CPT® 81335||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tpmt Genotyping, 4 Variants - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|524.43|FSC: 13; Default||Not reimbursed separately|524.43|FSC: 13; Default||External grouping not supported 62065129|EAP|CPT® 86592||0302 - LABORATORY - IMMUNOLOGY|Hb Treponema Pallidum (vdrl), Serum With Reflex To Titer - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 62065130|EAP|CPT® 86780||0302 - LABORATORY - IMMUNOLOGY|Hb Treponema Pallidum Ab, Igg By Ifa, Csf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 62065131|EAP|CPT® 87109||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Ureaplasma Species And Mycoplasma Hominis Culture - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|46.17|FSC: 13; Default||Not reimbursed separately|46.17|FSC: 13; Default||External grouping not supported 62065132|EAP|CPT® 86787||0302 - LABORATORY - IMMUNOLOGY|Hb Varicella-zoster Virus Antibody, Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 62065133|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Vascular Endothelial Growth Factor - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62065134|EAP|CPT® 85810||0301 - LABORATORY - CHEMISTRY|Hb Viscosity, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|35.01|FSC: 13; Default||Not reimbursed separately|35.01|FSC: 13; Default||External grouping not supported 62065135|EAP|CPT® 84425||0301 - LABORATORY - CHEMISTRY|Hb Vitamin B1 (thiamine), Plasma - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.69|FSC: 13; Default||Not reimbursed separately|63.69|FSC: 13; Default||External grouping not supported 62065136|EAP|CPT® 82180||0301 - LABORATORY - CHEMISTRY|Hb Vitamin C (ascorbic Acid), Plasma - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|29.67|FSC: 13; Default||Not reimbursed separately|29.67|FSC: 13; Default||External grouping not supported 62065137|EAP|CPT® 84597||0301 - LABORATORY - CHEMISTRY|Hb Vitamin K1, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|41.16|FSC: 13; Default||Not reimbursed separately|41.16|FSC: 13; Default||External grouping not supported 62065138|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hb Voltage-gated Calcium Channel (vgcc) Ab - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 62065139|EAP|CPT® 85245||0305 - LABORATORY - HEMATOLOGY|Hb Von Willebrand Factor Activity (rcf) - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 62065140|EAP|CPT® 85246||0305 - LABORATORY - HEMATOLOGY|Hb Von Willebrand Factor Antigen - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 62065141|EAP|CPT® 85246||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Von Willebrand Factor Collagen Binding - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 62065142|EAP|CPT® 85247||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Von Willebrand Factor Multimers - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 62065143|EAP| 85245||0305 - LABORATORY - HEMATOLOGY|Hb Von Willebrand Multimeric Panel - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 62065144|EAP|CPT® 80285||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Voriconazole, Quantitation By Lc-ms/ms - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|81.33|FSC: 13; Default||Not reimbursed separately|81.33|FSC: 13; Default||External grouping not supported 62065145|EAP|CPT® 86789||0302 - LABORATORY - IMMUNOLOGY|Hb West Nile Virus Antibody, Igg By Elisa, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62065146|EAP|CPT® 86788||0302 - LABORATORY - IMMUNOLOGY|Hb West Nile Virus Antibody, Igm By Elisa, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 62065147|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb West Nile Virus By Pcr - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065148|EAP|CPT® 81403||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Y Chromosome Microdeletion - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.60|FSC: 13; Default||Not reimbursed separately|555.60|FSC: 13; Default||External grouping not supported 62065149|EAP|CPT® 84202||0301 - LABORATORY - CHEMISTRY|Hb Zinc Protoporphyrin, Industrial - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.05|FSC: 13; Default||Not reimbursed separately|43.05|FSC: 13; Default||External grouping not supported 62065150|EAP|CPT® 84202||0301 - LABORATORY - CHEMISTRY|Hb Zinc Protoporphyrins - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.05|FSC: 13; Default||Not reimbursed separately|43.05|FSC: 13; Default||External grouping not supported 62065151|EAP|CPT® 84630||0301 - LABORATORY - CHEMISTRY|Hb Zinc, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.17|FSC: 13; Default||Not reimbursed separately|34.17|FSC: 13; Default||External grouping not supported 62065152|EAP|CPT® 80203||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Zonisamide Quantitative - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 62065153|EAP|CPT® 82232||0301 - LABORATORY - CHEMISTRY|Hb Beta-2 Microglobulin, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.54|FSC: 13; Default||Not reimbursed separately|48.54|FSC: 13; Default||External grouping not supported 62065154|EAP|CPT® 82379||0301 - LABORATORY - CHEMISTRY|Hb Carnitine, Free & Total, Urine-ref Lab|1|HUMANA [1294]||HUMANA [11839]|50.61|FSC: 13; Default||Not reimbursed separately|50.61|FSC: 13; Default||External grouping not supported 62065155|EAP|CPT® 81376||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Celiac (hla-dq2)-ref Lab|1|HUMANA [1294]||HUMANA [11839]|366.66|FSC: 13; Default||Not reimbursed separately|366.66|FSC: 13; Default||External grouping not supported 62065156|EAP|CPT® 81383||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Celiac (hla-dq8)-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.39|FSC: 13; Default||Not reimbursed separately|327.39|FSC: 13; Default||External grouping not supported 62065157|EAP|CPT® 84302||0301 - LABORATORY - CHEMISTRY|Hb Sodium, Stool-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.58|FSC: 13; Default||Not reimbursed separately|14.58|FSC: 13; Default||External grouping not supported 62065158|EAP|CPT® 82525||0301 - LABORATORY - CHEMISTRY|Hb Copper, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.23|FSC: 13; Default||Not reimbursed separately|37.23|FSC: 13; Default||External grouping not supported 62065159|EAP|CPT® 84630||0301 - LABORATORY - CHEMISTRY|Hb Zinc, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.17|FSC: 13; Default||Not reimbursed separately|34.17|FSC: 13; Default||External grouping not supported 62065160|EAP|CPT® 87904||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hiv Phenotype, Drug Resistance, Each Addl-ref Lab|1|HUMANA [1294]||HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 62065161|EAP|CPT® 87903||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hiv Phenotype, Drug Resistance-ref Lab|1|HUMANA [1294]||HUMANA [11839]|1,465.98|FSC: 13; Default||Not reimbursed separately|1,465.98|FSC: 13; Default||External grouping not supported 62065162|EAP|CPT® 86671||0302 - LABORATORY - IMMUNOLOGY|Hb S. Cerevisiae Igg & Igm-ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.75|FSC: 13; Default||Not reimbursed separately|36.75|FSC: 13; Default||External grouping not supported 62065163|EAP|CPT® 82482||0301 - LABORATORY - CHEMISTRY|Hb Cholinesterase, Rbc-ref Lab|1|HUMANA [1294]||HUMANA [11839]|29.43|FSC: 13; Default||Not reimbursed separately|29.43|FSC: 13; Default||External grouping not supported 62065164|EAP|CPT® 83527||0301 - LABORATORY - CHEMISTRY|Hb Insulin Total-ref Lab|1|HUMANA [1294]||HUMANA [11839]|38.85|FSC: 13; Default||Not reimbursed separately|38.85|FSC: 13; Default||External grouping not supported 62065165|EAP|CPT® 84520||0301 - LABORATORY - CHEMISTRY|Hb Bun-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.85|FSC: 13; Default||Not reimbursed separately|11.85|FSC: 13; Default||External grouping not supported 62065166|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hb Nephlm Ea Analyte-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 62065167|EAP|CPT® 84120||0301 - LABORATORY - CHEMISTRY|Hb Porphyrins, Urine, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.13|FSC: 13; Default||Not reimbursed separately|44.13|FSC: 13; Default||External grouping not supported 62065168|EAP|CPT® 82638||0301 - LABORATORY - CHEMISTRY|Hb Dibucaine Number-ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.75|FSC: 13; Default||Not reimbursed separately|36.75|FSC: 13; Default||External grouping not supported 62065169|EAP|CPT® 86003||0301 - LABORATORY - CHEMISTRY|Hb Stachybotrys Chatarum Ab Ige-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.66|FSC: 13; Default||Not reimbursed separately|15.66|FSC: 13; Default||External grouping not supported 62065170|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Stachybotrys Chatarum Ab Iga-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62065171|EAP|CPT® 86001||0301 - LABORATORY - CHEMISTRY|Hb Stachybotrys Chatarum Ab Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.46|FSC: 13; Default||Not reimbursed separately|23.46|FSC: 13; Default||External grouping not supported 62065172|EAP|CPT® 80165||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Valproic Acid, Free - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 62065173|EAP|CPT® 80164||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Valproic Acid, Total-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 62065174|EAP|CPT® 87254||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Cmv Culture-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.68|FSC: 13; Default||Not reimbursed separately|58.68|FSC: 13; Default||External grouping not supported 62065175|EAP|CPT® 86331||0302 - LABORATORY - IMMUNOLOGY|Hb Immunodiffusion, Qual, Each-ref Lab|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62065176|EAP|CPT® 87140||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Culture Typing, Immunoflour, Each-ref Lab|1|HUMANA [1294]||HUMANA [11839]|16.71|FSC: 13; Default||Not reimbursed separately|16.71|FSC: 13; Default||External grouping not supported 95193144|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Skin 20x11cm Flexhd Thick/med Allograft Perf 2 Units|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.06|FSC: 13; Default||Not reimbursed separately|102.06|FSC: 13; Default||External grouping not supported 95193146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 40cm Right Intertrochanter Intertan Im 125d 1.5mm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95193147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5mmx57.5mm Femur Low Profile Internal Hex Trig In|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 95193148|EAP|Custom 95193148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cart Stirrup Allen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L67 Mm Od5 Mm Femur Low Profile Internal Hex Trig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 95193151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Lcp St Steel L40 Mm 4 Hole Low Profile Ctl 2.7 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 951221167|EAP|Custom 951221167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hng Fem Assm Sample Sz 5 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221168|EAP|Custom 951221168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hng Tibia Sample Sz 4 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221169|EAP|Custom 951221169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hng Gm Isrt Sample Sz 4-5 11m Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221170|EAP|Custom 951221170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Hinge 11mm Bolt Sleeve Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221171|EAP|Custom 951221171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hnge Distl Fem Wedge Samp Sz5 20m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221172|EAP|Custom 951221172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hnge Distl Fem Wedge Samp Sz5 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221173|EAP|Custom 951221173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hnge Tib Wdg Samp Sz3-4 15mm Lm Rl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221174|EAP|Custom 951221174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hnge Tib Wdg Samp Sz3-4 5mm Ll Rm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221175|EAP|Custom 951221175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Genesis Ii Dcf Repl Case Labls|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221176|EAP|Custom 951221176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscillat Saw Blade 1.27mm Fan Pwrpro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221177|EAP|Custom 951221177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscillating Blade 1.27mm Nrw Powerpro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221178|EAP|Custom 951221178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscillating Saw Blade 1.27mm {} Wide 3m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221179|EAP|Custom 951221179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osc Swbld 1.27mm Wide Stryker 2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221180|EAP|Custom 951221180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gii Stryker Sawblade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221181|EAP|Custom 951221181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscillating Saw Blade 1.27mm Wide Hall|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221182|EAP|Custom 951221182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gii Z Versipower Sawblade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221183|EAP|Custom 951221183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gii Small 3m Sawblade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221184|EAP|Custom 951221184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Saw Blade 1.27mm Fanned Hall|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221185|EAP|Custom 951221185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osc Swbld 1.27mm Narrow Hall|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221186|EAP|Custom 951221186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osc Swbld Fanned Versipower Plus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221187|EAP|Custom 951221187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gii Sm Versipower Sawblad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221188|EAP|Custom 951221188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gii Sm Old Stryker Sawbld|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221189|EAP|Custom 951221189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osc Swbld 1.27mm Narrow Stryker 2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221190|EAP|Custom 951221190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscillating Blade 1.27mm Wide Powerpro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221191|EAP|Custom 951221191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Sawblade 1.27mm Fan Strykr2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221192|EAP|Custom 951221192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osc Swbld Fanned Stryker Ortho Power|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221193|EAP|Custom 951221193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Recip Blade Double Sided Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221194|EAP|Custom 951221194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Recip Blade Single Sided Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221195|EAP|Custom 951221195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reciprocating Blade Single Sided Hall|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221196|EAP|Custom 951221196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 3 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221197|EAP|Custom 951221197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 4 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221198|EAP|Custom 951221198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 5 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221199|EAP|Custom 951221199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 6 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221200|EAP|Custom 951221200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 7 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221201|EAP|Custom 951221201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 3 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221202|EAP|Custom 951221202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trl Sz 4 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221203|EAP|Custom 951221203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 5 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221204|EAP|Custom 951221204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 6 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221205|EAP|Custom 951221205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Tibia Trial Sz 7 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221206|EAP|Custom 951221206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 3 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221207|EAP|Custom 951221207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 4 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221208|EAP|Custom 951221208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 5 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221209|EAP|Custom 951221209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 6 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221210|EAP|Custom 951221210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 7 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221211|EAP|Custom 951221211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 3 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221212|EAP|Custom 951221212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 4 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221213|EAP|Custom 951221213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 5 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221214|EAP|Custom 951221214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 6 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221215|EAP|Custom 951221215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Femoral Trial Sz 7 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221216|EAP|Custom 951221216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Fin Punch Sz 3-4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221217|EAP|Custom 951221217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Fin Punch Sz 5-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221218|EAP|Custom 951221218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Fin Punch Sz 7-8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221219|EAP|Custom 951221219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 3-4 Crhf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221220|EAP|Custom 951221220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 5-6 Crhf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221221|EAP|Custom 951221221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 7-8 Crhf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221222|EAP|Custom 951221222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 3-4 Pshf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221223|EAP|Custom 951221223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 5-6 Pshf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221224|EAP|Custom 951221224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 7-8 Pshf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221225|EAP|Custom 951221225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 3-4 Crdd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221226|EAP|Custom 951221226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 5-6 Crdd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221227|EAP|Custom 951221227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Legion Fp Isrt Trl Sz 7-8 Crdd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221229|EAP|Custom 951221229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hm St Sam 5-6 5m Ltmd Rtla|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223085|EAP|Custom 951223085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray/articular Surface Inserter Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223089|EAP|Custom 951223089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Spikes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223090|EAP|Custom 951223090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 3.2mmx76mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223093|EAP|Custom 951223093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gen Trocar Pin 1/8 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223094|EAP|Custom 951223094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gns Trocar Pin 1/8 In. X {} 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223098|EAP|Custom 951223098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Bone Spike-short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223099|EAP|Custom 951223099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Profix Bone Spikes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223100|EAP|Custom 951223100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Low Profile Bone Spikes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223101|EAP|Custom 951223101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quick Connect Troc Pin 1/8 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223102|EAP|Custom 951223102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quick Con Drill Pin 1/8 X 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223111|EAP|Custom 951223111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headless Trochar Pin 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223112|EAP|Custom 951223112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Short Headed Holding Pin 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223113|EAP|Custom 951223113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Short Headed Holding Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223114|EAP|Custom 951223114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Short Headed Holding Pin 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223115|EAP|Custom 951223115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Long Headless Smooth Pin Gold|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223116|EAP|Custom 951223116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Amk Leg I Pins 50mm (4/set)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223117|EAP|Custom 951223117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Quick Drill Pins 6pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223118|EAP|Custom 951223118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Quick Drill Pins Headed 6pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223119|EAP|Custom 951223119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Threaded Pins 6 Pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223120|EAP|Custom 951223120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Threaded Pins Headed 6 Pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223121|EAP|Custom 951223121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Strl Quick Drl Pins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223122|EAP|Custom 951223122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Strl Threaded Pins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223123|EAP|Custom 951223123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Strl Threaded Pins Headed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223124|EAP|Custom 951223124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Solo Pinning System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223125|EAP|Custom 951223125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Threaded Head Pin Systm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223126|EAP|Custom 951223126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Solo Threaded Pin Systm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223127|EAP|Custom 951223127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smooth Fix Pin 1/8x2 1/2 Pk/5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223128|EAP|Custom 951223128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Smooth 3 Inch Pins (5 Pack)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223131|EAP|Custom 951223131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*sigma*inset Pat Re/drbit25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223132|EAP|Custom 951223132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*sigma*inset Pat Re/drbit28|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223133|EAP|Custom 951223133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*sigma*inset Pat Re/drbit32|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223134|EAP|Custom 951223134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Trochlea Cutting Bit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223135|EAP|Custom 951223135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.c.l. Tibial Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223136|EAP|Custom 951223136||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lateral Patella Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223137|EAP|Custom 951223137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Uni Compartmental Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223138|EAP|Custom 951223138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.c.l. Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223139|EAP|Custom 951223139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Collateral Ligament Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223140|EAP|Custom 951223140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Distractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223141|EAP|Custom 951223141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Spec1 Patellar Caliper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223142|EAP|Custom 951223142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 5/16in Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223143|EAP|Custom 951223143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Tc3 Tuning Fork|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223144|EAP|Custom 951223144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Mbt Sleeve Remover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223145|EAP|Custom 951223145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract 7mm V Split 12in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223146|EAP|Custom 951223146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract 7mm Rev Curet 12in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223147|EAP|Custom 951223147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Offset Chisel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223148|EAP|Custom 951223148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Component Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223149|EAP|Custom 951223149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Str Osteotome 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223150|EAP|Custom 951223150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Ext Str Osteotome 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223151|EAP|Custom 951223151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Ext Str Osteotome 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223152|EAP|Custom 951223152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Removal Screw 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223153|EAP|Custom 951223153||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract 10" Cement Rongeur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223154|EAP|Custom 951223154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Tib Comp Remover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223155|EAP|Custom 951223155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Locking Pliers Adap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223156|EAP|Custom 951223156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Standard Rem Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223157|EAP|Custom 951223157||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Mbt Tray/sleeve Sep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223158|EAP|Custom 951223158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Sleeve Removal Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223159|EAP|Custom 951223159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Sleeve Rem Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223160|EAP|Custom 951223160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Extract Standard Rem Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223161|EAP|Custom 951223161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patella Caliper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223162|EAP|Custom 951223162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fem Imp/ext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223163|EAP|Custom 951223163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Slap Hammer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223164|EAP|Custom 951223164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Recut Kit Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223165|EAP|Custom 951223165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom* Case Patella Inst Ass'y|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223166|EAP|Custom 951223166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom* Reamer Broach Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223167|EAP|Custom 951223167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom*3.2mm Bone Drill Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223168|EAP|Custom 951223168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom*3.2mm Bone Drill Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223169|EAP|Custom 951223169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom*drill Bone Str Pilot 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223170|EAP|Custom 951223170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Nrh Fem Box Cut Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223171|EAP|Custom 951223171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Im Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223172|EAP|Custom 951223172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Nrh Tibial Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223173|EAP|Custom 951223173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*driver Femoral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223174|EAP|Custom 951223174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Aug Blk Cem Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223175|EAP|Custom 951223175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Cut Guide Handles|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223176|EAP|Custom 951223176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Hex Screw Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223177|EAP|Custom 951223177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*separator Femoral Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223178|EAP|Custom 951223178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Patella 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223179|EAP|Custom 951223179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Patella 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223180|EAP|Custom 951223180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Patella 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223181|EAP|Custom 951223181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Patella 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223182|EAP|Custom 951223182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pat Depth Adj 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223183|EAP|Custom 951223183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pat Depth Adj 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223184|EAP|Custom 951223184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pat Depth Adj 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223185|EAP|Custom 951223185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pat Depth Adj 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223186|EAP|Custom 951223186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Patellar Drill Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223187|EAP|Custom 951223187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Shoulder Pat 3/16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223188|EAP|Custom 951223188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Shoulder Pat 1/8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223189|EAP|Custom 951223189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pat Restrain Instr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223190|EAP|Custom 951223190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*clamp Patella Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223191|EAP|Custom 951223191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*bushing Reamer Patella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223192|EAP|Custom 951223192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pilot Shaft 11x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223193|EAP|Custom 951223193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pilot Shaft 13x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223194|EAP|Custom 951223194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pilot Shaft 15x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223195|EAP|Custom 951223195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pilot Shaft 17x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223196|EAP|Custom 951223196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pilot Shaft 19x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223197|EAP|Custom 951223197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Knee Pilot Shaft 21x100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223198|EAP|Custom 951223198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamr Knee Straight 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223199|EAP|Custom 951223199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamr Knee Straight 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223200|EAP|Custom 951223200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Mod Plus Torque Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223204|EAP|Custom 951223204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tib Insert Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223205|EAP|Custom 951223205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Bone File|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223206|EAP|Custom 951223206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfcmod Disposble Hexbit 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223207|EAP|Custom 951223207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*calibrated Pat Cut Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223208|EAP|Custom 951223208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Patellar Cementing Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223209|EAP|Custom 951223209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Patella Clamp Rubber Insrt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223210|EAP|Custom 951223210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Central Peg Pat Template 32/35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223211|EAP|Custom 951223211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Central Peg Pat Template 38/41|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223212|EAP|Custom 951223212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Central Patellar Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223885|EAP|Custom 951223885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223886|EAP|Custom 951223886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223887|EAP|Custom 951223887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223888|EAP|Custom 951223888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223889|EAP|Custom 951223889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223890|EAP|Custom 951223890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223891|EAP|Custom 951223891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223892|EAP|Custom 951223892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 26mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223893|EAP|Custom 951223893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Rod Sleeve Guide 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223894|EAP|Custom 951223894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev 13 Mm Cem Bushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223895|EAP|Custom 951223895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Primary Conical Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223896|EAP|Custom 951223896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Prep Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223897|EAP|Custom 951223897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rev Reamers Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223906|EAP|Custom 951223906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Independent Balancer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223907|EAP|Custom 951223907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sigma Flexion Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223908|EAP|Custom 951223908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knee Balancer Inst Tray Bli|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223909|EAP|Custom 951223909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem Gd Positioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223910|EAP|Custom 951223910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Std/std+ Spacer Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223911|EAP|Custom 951223911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Lg/lg++ Spacer Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223912|EAP|Custom 951223912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Std/std+ S B Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223913|EAP|Custom 951223913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Lg/lg+ Sb Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223914|EAP|Custom 951223914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Spacer Assy 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223915|EAP|Custom 951223915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Spacer Assy 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223916|EAP|Custom 951223916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Spacer Assy 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223917|EAP|Custom 951223917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Spacer Assy 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223918|EAP|Custom 951223918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Spacer Block Assy Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223919|EAP|Custom 951223919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Spacer Adapter Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223920|EAP|Custom 951223920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fem Template Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223921|EAP|Custom 951223921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem Flatness Gage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223922|EAP|Custom 951223922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Positioner Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223923|EAP|Custom 951223923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Spacer 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223924|EAP|Custom 951223924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Spacer 15.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223925|EAP|Custom 951223925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Spacer 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223926|EAP|Custom 951223926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Spacer 20.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223927|EAP|Custom 951223927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Femoral Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223928|EAP|Custom 951223928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Temp Rp Std/std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223929|EAP|Custom 951223929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Temp Rp Lg/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223930|EAP|Custom 951223930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Sz Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223931|EAP|Custom 951223931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem Temp Std/lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223932|EAP|Custom 951223932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Resec Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223933|EAP|Custom 951223933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Resc Blk 2deg V/v|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223934|EAP|Custom 951223934||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Stylus 2/6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223935|EAP|Custom 951223935||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Center Punch Sml+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223936|EAP|Custom 951223936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Center Punch Std/std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223937|EAP|Custom 951223937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Center Punch Lrg/lrg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223938|EAP|Custom 951223938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tibial Center Pilot Punch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223939|EAP|Custom 951223939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Tib Stylus 4/8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223940|EAP|Custom 951223940||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Alignment Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223941|EAP|Custom 951223941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Mdl Temp Sz Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223942|EAP|Custom 951223942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Mdl Temp Sz Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223943|EAP|Custom 951223943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Lat Mod Pat Tem Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223944|EAP|Custom 951223944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Mdl Temp Sz Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223945|EAP|Custom 951223945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Lat Mod Pat Tem Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223946|EAP|Custom 951223946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Mdl Temp Sz Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223947|EAP|Custom 951223947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Lat Mod Pat Tem Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223948|EAP|Custom 951223948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Mdl Temp Sz Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223949|EAP|Custom 951223949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Lat Mod Pat Tem Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223950|EAP|Custom 951223950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Mdl Temp Sz Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223951|EAP|Custom 951223951||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 7in 9mm Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223952|EAP|Custom 951223952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Lat Pat Tem Sz Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223953|EAP|Custom 951223953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Pat Mdl Temp Sz Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223954|EAP|Custom 951223954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223955|EAP|Custom 951223955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223956|EAP|Custom 951223956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223957|EAP|Custom 951223957||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223958|EAP|Custom 951223958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223959|EAP|Custom 951223959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem A/p Resc Gd Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223960|EAP|Custom 951223960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem Gd Yoke Lg-loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223961|EAP|Custom 951223961||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem Gd Yoke Sm-loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223962|EAP|Custom 951223962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fem Im Guide (sm Std Lg)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223963|EAP|Custom 951223963||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Dis-fmrl Resec Blk 3 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223964|EAP|Custom 951223964||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Dis-fmrl Resec Blk 4 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223965|EAP|Custom 951223965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Dis-fmrl Resec Block 5 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223966|EAP|Custom 951223966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Dis-fmrl Resec Blk 6 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223967|EAP|Custom 951223967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Dis-fmrl Resec Blk 2d V/v|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223968|EAP|Custom 951223968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Femoral Lug Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223969|EAP|Custom 951223969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs M1 Finishing Guide Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223970|EAP|Custom 951223970||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs M1 Finishing Guide Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223971|EAP|Custom 951223971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fnsh Gd Std .060in Slots|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223972|EAP|Custom 951223972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Std W Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223973|EAP|Custom 951223973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fnsh Gde Std+ .060in Slots|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223974|EAP|Custom 951223974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Std+ W Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223975|EAP|Custom 951223975||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fnsh Gde Lg .060in Slots|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223976|EAP|Custom 951223976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Guide Lg W Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223977|EAP|Custom 951223977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Fnsh Gde Lg+ .060in Slots|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223978|EAP|Custom 951223978||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Lg+ W Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223979|EAP|Custom 951223979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Med W Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223980|EAP|Custom 951223980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Sizing Caliper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223981|EAP|Custom 951223981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modular Patella Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223986|EAP|Custom 951223986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Saw Capture .060 Slot Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223987|EAP|Custom 951223987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Rot Pat Tr Pegs Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223988|EAP|Custom 951223988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Rot Pat Tr Pegs Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223989|EAP|Custom 951223989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Rot Pat Tr Pegs Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223990|EAP|Custom 951223990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Rot Pat Tr Pegs Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223991|EAP|Custom 951223991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Rot Pat Tr Pegs Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223992|EAP|Custom 951223992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Rot Pat Tr Pegs Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223993|EAP|Custom 951223993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pol Pat Tr Pegs Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223994|EAP|Custom 951223994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pol Pat Tr Pegs Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223995|EAP|Custom 951223995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pol Pat Tr Pegs Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223996|EAP|Custom 951223996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pol Pat Tr Pegs Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223997|EAP|Custom 951223997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pol Pat Tr Pegs Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223998|EAP|Custom 951223998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pol Pat Tr Pegs Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223999|EAP|Custom 951223999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Poly Pat Tr Pegs Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224000|EAP|Custom 951224000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Rot Pat Tr Pegs Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224001|EAP|Custom 951224001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Femoral Adptr Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224002|EAP|Custom 951224002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Alignment Rod Tibial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224003|EAP|Custom 951224003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Proximal Tibial Resect Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224004|EAP|Custom 951224004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb External Align Ankle Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224005|EAP|Custom 951224005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slap-hammer Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224006|EAP|Custom 951224006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Align Tower & Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224007|EAP|Custom 951224007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Pin Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224008|EAP|Custom 951224008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb N-s Amk Fixation Pin 1/8 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224009|EAP|Custom 951224009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Resection Block 7 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224010|EAP|Custom 951224010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Resection Block 10 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224011|EAP|Custom 951224011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Poly Pat Tr Pins Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224012|EAP|Custom 951224012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Poly Pat Tr Pins Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224013|EAP|Custom 951224013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Pol Pat Tr Pins Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224014|EAP|Custom 951224014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Poly Pat Tr Pins Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224015|EAP|Custom 951224015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Poly Pat Tr Pins Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224016|EAP|Custom 951224016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3 Peg Pat Temp 1/2 Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224017|EAP|Custom 951224017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Pat Temp Sz Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224018|EAP|Custom 951224018||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Reference Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224019|EAP|Custom 951224019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modular Depth Stop Ring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224020|EAP|Custom 951224020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pat Plan Rep Bask Std/std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224021|EAP|Custom 951224021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Em Tibial Alignment Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224022|EAP|Custom 951224022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Keel Punch Sz 3-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224023|EAP|Custom 951224023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Keel Punch Sz 6-8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224024|EAP|Custom 951224024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Prep Plate Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224025|EAP|Custom 951224025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Prep Plate Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224026|EAP|Custom 951224026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Prep Plate Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224027|EAP|Custom 951224027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Prep Plate Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224028|EAP|Custom 951224028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Prep Plate Sz7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224029|EAP|Custom 951224029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Prep Plate Sz8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224030|EAP|Custom 951224030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tibial Prep Tower|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224031|EAP|Custom 951224031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Cem Reamer Bushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224032|EAP|Custom 951224032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Cem Tib Stem Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224033|EAP|Custom 951224033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Cem Conical Rmr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224034|EAP|Custom 951224034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune System Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224035|EAP|Custom 951224035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224036|EAP|Custom 951224036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224037|EAP|Custom 951224037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224038|EAP|Custom 951224038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224039|EAP|Custom 951224039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224040|EAP|Custom 951224040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224041|EAP|Custom 951224041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224042|EAP|Custom 951224042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224043|EAP|Custom 951224043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224044|EAP|Custom 951224044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Cut Asmt Tool Sz 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224045|EAP|Custom 951224045||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cementless Impaction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224046|EAP|Custom 951224046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cut Assessment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224047|EAP|Custom 951224047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Med Dome Pat Clamp But|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224048|EAP|Custom 951224048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Systm Hex Attachmnt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224049|EAP|Custom 951224049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Implnt Assem Wrench|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224050|EAP|Custom 951224050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Tib Strght Stem Wrnch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224051|EAP|Custom 951224051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Wrnch Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224052|EAP|Custom 951224052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Modular Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226601|EAP|Custom 951226601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz1 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226602|EAP|Custom 951226602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz1 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226603|EAP|Custom 951226603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz1 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226604|EAP|Custom 951226604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz1.5 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226605|EAP|Custom 951226605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz1.5 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226606|EAP|Custom 951226606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz1.5 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226607|EAP|Custom 951226607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz2 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226608|EAP|Custom 951226608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz2 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226609|EAP|Custom 951226609||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz2 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226610|EAP|Custom 951226610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz2.5 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226611|EAP|Custom 951226611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz2.5 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226612|EAP|Custom 951226612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz2.5 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226613|EAP|Custom 951226613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz3 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226614|EAP|Custom 951226614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz3 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226615|EAP|Custom 951226615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz3 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226616|EAP|Custom 951226616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz4 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226617|EAP|Custom 951226617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz4 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226618|EAP|Custom 951226618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz4 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226619|EAP|Custom 951226619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz5 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226620|EAP|Custom 951226620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz5 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226621|EAP|Custom 951226621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz5 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226622|EAP|Custom 951226622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz6 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226623|EAP|Custom 951226623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz6 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226624|EAP|Custom 951226624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Step Wedge Sz6 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227378|EAP|Custom 951227378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cementralizer 17.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227379|EAP|Custom 951227379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cementralizer 18.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227380|EAP|Custom 951227380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cementralizer 19.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227381|EAP|Custom 951227381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C Stem Void Centalizer 14 Dm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227382|EAP|Custom 951227382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C Stem Void Centalizer 18 Dm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227383|EAP|Custom 951227383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Centralizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228192|EAP|Custom 951228192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Cs T Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228193|EAP|Custom 951228193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Cs M Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228194|EAP|Custom 951228194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Cs B Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228195|EAP|Custom 951228195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Grtr Bumpers/100bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228196|EAP|Custom 951228196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Case Mat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228197|EAP|Custom 951228197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228198|EAP|Custom 951228198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Std Tissue Protector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228199|EAP|Custom 951228199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 36mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228200|EAP|Custom 951228200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 37mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228201|EAP|Custom 951228201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228202|EAP|Custom 951228202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 39mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228203|EAP|Custom 951228203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228204|EAP|Custom 951228204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228205|EAP|Custom 951228205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 42mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228206|EAP|Custom 951228206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 43mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228207|EAP|Custom 951228207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 44mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228208|EAP|Custom 951228208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228209|EAP|Custom 951228209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 47mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228210|EAP|Custom 951228210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228211|EAP|Custom 951228211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 49mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228212|EAP|Custom 951228212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228213|EAP|Custom 951228213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 51mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228214|EAP|Custom 951228214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228215|EAP|Custom 951228215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 53mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228216|EAP|Custom 951228216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 54mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228217|EAP|Custom 951228217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228218|EAP|Custom 951228218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228219|EAP|Custom 951228219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 57mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228220|EAP|Custom 951228220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 58mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228221|EAP|Custom 951228221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 59mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228222|EAP|Custom 951228222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228223|EAP|Custom 951228223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228224|EAP|Custom 951228224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 62mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228225|EAP|Custom 951228225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 63mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228226|EAP|Custom 951228226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228227|EAP|Custom 951228227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228228|EAP|Custom 951228228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 66mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228229|EAP|Custom 951228229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 67mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228230|EAP|Custom 951228230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 68mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228231|EAP|Custom 951228231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 69mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228232|EAP|Custom 951228232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228233|EAP|Custom 951228233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 71mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228234|EAP|Custom 951228234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 72mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228235|EAP|Custom 951228235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 73mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228236|EAP|Custom 951228236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 74mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228237|EAP|Custom 951228237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228238|EAP|Custom 951228238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 76mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228239|EAP|Custom 951228239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 77mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228240|EAP|Custom 951228240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 78mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228241|EAP|Custom 951228241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 79mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228242|EAP|Custom 951228242||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Head 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228243|EAP|Custom 951228243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Straight Grater Hndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228244|EAP|Custom 951228244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228245|EAP|Custom 951228245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 49mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228246|EAP|Custom 951228246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228247|EAP|Custom 951228247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 51mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228248|EAP|Custom 951228248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228249|EAP|Custom 951228249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 53mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228250|EAP|Custom 951228250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 54mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228251|EAP|Custom 951228251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228252|EAP|Custom 951228252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228253|EAP|Custom 951228253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 57mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228254|EAP|Custom 951228254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 58mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228255|EAP|Custom 951228255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 59mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228256|EAP|Custom 951228256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228257|EAP|Custom 951228257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228258|EAP|Custom 951228258||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 62mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228259|EAP|Custom 951228259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 63mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228260|EAP|Custom 951228260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228261|EAP|Custom 951228261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228262|EAP|Custom 951228262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Profile Reamer 66mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228263|EAP|Custom 951228263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Low Prof Rmr Case Comp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228264|EAP|Custom 951228264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Depuy Goniometer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228265|EAP|Custom 951228265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Stem Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228266|EAP|Custom 951228266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Overlay|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228267|EAP|Custom 951228267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 36mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228268|EAP|Custom 951228268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 37mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228269|EAP|Custom 951228269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228270|EAP|Custom 951228270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 39mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228271|EAP|Custom 951228271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228272|EAP|Custom 951228272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228273|EAP|Custom 951228273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 42mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228274|EAP|Custom 951228274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 43mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228275|EAP|Custom 951228275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 44mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228276|EAP|Custom 951228276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228277|EAP|Custom 951228277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228278|EAP|Custom 951228278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 47mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228279|EAP|Custom 951228279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228280|EAP|Custom 951228280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 49mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228281|EAP|Custom 951228281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228282|EAP|Custom 951228282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 51mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228283|EAP|Custom 951228283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228284|EAP|Custom 951228284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 53mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228285|EAP|Custom 951228285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 54mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228286|EAP|Custom 951228286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228287|EAP|Custom 951228287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228288|EAP|Custom 951228288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 57mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228289|EAP|Custom 951228289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 58mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228290|EAP|Custom 951228290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 59mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228291|EAP|Custom 951228291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228292|EAP|Custom 951228292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228293|EAP|Custom 951228293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 62mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228294|EAP|Custom 951228294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 63mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228295|EAP|Custom 951228295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228296|EAP|Custom 951228296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228297|EAP|Custom 951228297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 66mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228298|EAP|Custom 951228298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 67mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228299|EAP|Custom 951228299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 68mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228300|EAP|Custom 951228300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 69mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228301|EAP|Custom 951228301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228302|EAP|Custom 951228302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 71mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228303|EAP|Custom 951228303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 72mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228304|EAP|Custom 951228304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 73mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228305|EAP|Custom 951228305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 74mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228306|EAP|Custom 951228306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228307|EAP|Custom 951228307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 76mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228308|EAP|Custom 951228308||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 77mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228309|EAP|Custom 951228309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 78mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228310|EAP|Custom 951228310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 79mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228311|EAP|Custom 951228311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xback Gb Ace Grater 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228312|EAP|Custom 951228312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Gb Offset Grater Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228313|EAP|Custom 951228313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Gb Straight Grater Hndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228314|EAP|Custom 951228314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Lateralizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228315|EAP|Custom 951228315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Univ Neck Res Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228316|EAP|Custom 951228316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Gluteus Medius Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228317|EAP|Custom 951228317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Blnt Rt Angle Pos Caps Ret|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228318|EAP|Custom 951228318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Cobra Retractor W/armrest|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228319|EAP|Custom 951228319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Superior Capsular Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228320|EAP|Custom 951228320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Sciatic Nerve Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228321|EAP|Custom 951228321||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Narrow Cobra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228322|EAP|Custom 951228322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Anterior Hohmann|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228323|EAP|Custom 951228323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Rt Angle Pos Caps Ret|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228324|EAP|Custom 951228324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Narrow Curved Hohman|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228325|EAP|Custom 951228325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi 2 Inc Sharp Cobra Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228326|EAP|Custom 951228326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sorrell Inc Ret Blades Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228327|EAP|Custom 951228327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sorrell Retractor Weight 2.5lb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228328|EAP|Custom 951228328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sorrell Retractor Weight 2.0lb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228329|EAP|Custom 951228329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Single Prong Soft Tissue Ret|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228330|EAP|Custom 951228330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blunted Cobra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228331|EAP|Custom 951228331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi 2 Inc Deaver Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228332|EAP|Custom 951228332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior Approach Case Compl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228333|EAP|Custom 951228333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Case 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228334|EAP|Custom 951228334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Base 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228335|EAP|Custom 951228335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Lid 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228336|EAP|Custom 951228336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Ins 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228337|EAP|Custom 951228337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Case 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228338|EAP|Custom 951228338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Base 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228339|EAP|Custom 951228339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tissue Sparing Fem Core Lid 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228340|EAP|Custom 951228340||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Std Straight Stem Insert Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228341|EAP|Custom 951228341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bullet Tip Stem Inserter Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228342|EAP|Custom 951228342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Universal Stem Insert Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228343|EAP|Custom 951228343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Retractor Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228344|EAP|Custom 951228344||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modular Box Osteotome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228345|EAP|Custom 951228345||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retaining Stem Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228346|EAP|Custom 951228346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Threaded Slap Hammer Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228347|EAP|Custom 951228347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Inf Pos Caps Ret-right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228348|EAP|Custom 951228348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Inf Pos Caps Ret-left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228349|EAP|Custom 951228349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Xl Femoral Nck Elevator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228350|EAP|Custom 951228350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Irving Retractor Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228351|EAP|Custom 951228351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Irving Retractor Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228352|EAP|Custom 951228352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi 2 Incision Acet Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228353|EAP|Custom 951228353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Long Handle Rongeur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228354|EAP|Custom 951228354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Long Handle Blade Holder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228355|EAP|Custom 951228355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 2 Incision Base Set Case Cmplt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228356|EAP|Custom 951228356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Retractor Light Strip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228357|EAP|Custom 951228357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Acmi Light Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228358|EAP|Custom 951228358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Wolf Light Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228359|EAP|Custom 951228359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Storz Light Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228360|EAP|Custom 951228360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tss Olympus Light Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228361|EAP|Custom 951228361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ang Rmr Drvr Housing Assembly|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228362|EAP|Custom 951228362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterilization Case 7in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228363|EAP|Custom 951228363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 5 In Sterilization Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228364|EAP|Custom 951228364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Amt Stem Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228365|EAP|Custom 951228365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Amt Collarless Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228366|EAP|Custom 951228366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Amt Collared Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228367|EAP|Custom 951228367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Amt Collarlss Sz6 Tmplt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228368|EAP|Custom 951228368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Revision Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228369|EAP|Custom 951228369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crochet Hook|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229058|EAP|Custom 951229058||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229059|EAP|Custom 951229059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229060|EAP|Custom 951229060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229061|EAP|Custom 951229061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229062|EAP|Custom 951229062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit C-stem Amt Conv Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229063|EAP|Custom 951229063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ant Broach Handle - L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229064|EAP|Custom 951229064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ant Broach Handle - R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229065|EAP|Custom 951229065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cor/tri Ant Stem Insert Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229066|EAP|Custom 951229066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Ant Stem Insert Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229067|EAP|Custom 951229067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cor/tri Post Stem Insert Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229068|EAP|Custom 951229068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Post Stem Insert Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229069|EAP|Custom 951229069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Long Posterior Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229070|EAP|Custom 951229070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extra Curved Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229071|EAP|Custom 951229071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb New Sol Sys Templ 8in Strt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229072|EAP|Custom 951229072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys 8in Strt Kit Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229073|EAP|Custom 951229073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb New Sol Sys Templ 8/9in Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229074|EAP|Custom 951229074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys 8/9in Cr Kit Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229075|EAP|Custom 951229075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb New Sol Sys Templ 8/10in Bow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229076|EAP|Custom 951229076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solsys 8/10in Bow Kit Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229077|EAP|Custom 951229077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Inst Tray Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229078|EAP|Custom 951229078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Top Tray-femur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229079|EAP|Custom 951229079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Bottom Tray-femur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229080|EAP|Custom 951229080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Case-fem Instr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229081|EAP|Custom 951229081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229082|EAP|Custom 951229082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Din Ster Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229083|EAP|Custom 951229083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Core Case 2 Lid Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229084|EAP|Custom 951229084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Core Case 1 Lid Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229085|EAP|Custom 951229085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Case Lid Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229086|EAP|Custom 951229086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Core 2 Instr Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229087|EAP|Custom 951229087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Core 1 Instr Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229088|EAP|Custom 951229088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Excel Instru Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229089|EAP|Custom 951229089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Instrument Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229090|EAP|Custom 951229090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Neck Seg For Articuleze|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229091|EAP|Custom 951229091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Amt Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229092|EAP|Custom 951229092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Amt Core Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229093|EAP|Custom 951229093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Prox Reamer Guide Post|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229094|EAP|Custom 951229094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Depth Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229095|EAP|Custom 951229095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Bolt Torq Wrench Hndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229096|EAP|Custom 951229096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Pronged Stem Stblzr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229097|EAP|Custom 951229097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dist Reamer Extension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229098|EAP|Custom 951229098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Reamer T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229099|EAP|Custom 951229099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Ream Ratchet T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229100|EAP|Custom 951229100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assembly Body|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229101|EAP|Custom 951229101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assemb Tool Adapt 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229102|EAP|Custom 951229102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assemb Tool Adapt 85mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229103|EAP|Custom 951229103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assemb Tool Adapt 95mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229104|EAP|Custom 951229104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assemb Tool Adapt105mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229105|EAP|Custom 951229105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assembly Tool Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229106|EAP|Custom 951229106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assem Upper Pull Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229107|EAP|Custom 951229107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Taper Tamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229108|EAP|Custom 951229108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Disassembly Body|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229109|EAP|Custom 951229109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Disasmbly Threaded Cap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229110|EAP|Custom 951229110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Body Collet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229111|EAP|Custom 951229111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Disassembly Pushrod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229112|EAP|Custom 951229112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Trq Shft 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229113|EAP|Custom 951229113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Trq Shft 85mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229114|EAP|Custom 951229114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Trq Shft 95mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229115|EAP|Custom 951229115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Trq Shft 105mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229116|EAP|Custom 951229116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Torque Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229117|EAP|Custom 951229117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dismbly Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229118|EAP|Custom 951229118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Distal Stem Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229119|EAP|Custom 951229119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dist Stem Slap Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229120|EAP|Custom 951229120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Reamer Extract Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229121|EAP|Custom 951229121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Finishing Rasp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229122|EAP|Custom 951229122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Proximal Reamer 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229123|EAP|Custom 951229123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Proximal Reamer 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229124|EAP|Custom 951229124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Proximal Reamer 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229125|EAP|Custom 951229125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Universal Hex Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229126|EAP|Custom 951229126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Conical Core Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229127|EAP|Custom 951229127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Conical Core Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229128|EAP|Custom 951229128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Assembly Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229129|EAP|Custom 951229129||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Disassembly Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229130|EAP|Custom 951229130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Dist Strtr Rmr Sz 13|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229149|EAP|Custom 951229149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Clear Out Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229188|EAP|Custom 951229188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Tapered Rmr Case 14-21|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229189|EAP|Custom 951229189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Taprd Rmr Index 14-21|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229190|EAP|Custom 951229190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Rmr Index Carrier14-21|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229191|EAP|Custom 951229191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Tapered Rmr Case 22-27|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229192|EAP|Custom 951229192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Tpd Rmr 28-31 Dia Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229193|EAP|Custom 951229193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Tpd Rmr Case 18-27x290|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229194|EAP|Custom 951229194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Tprd Rmr Kit 18-27x290|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229195|EAP|Custom 951229195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bantam Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229196|EAP|Custom 951229196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acet Ins Std Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229197|EAP|Custom 951229197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Proxima Mi Calcar Reamer Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229198|EAP|Custom 951229198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229199|EAP|Custom 951229199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Extractor 48 Or 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229200|EAP|Custom 951229200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Extractor 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229201|EAP|Custom 951229201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Extractor 54 Or 56|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229202|EAP|Custom 951229202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Extractor 58 Or 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229203|EAP|Custom 951229203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Extractor 62 64 66mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229204|EAP|Custom 951229204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Polyethylene Liner Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229205|EAP|Custom 951229205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229206|EAP|Custom 951229206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dur Opt Tri Lpw 62 64 Or 66x28|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229207|EAP|Custom 951229207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*driver Screw Assy 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229208|EAP|Custom 951229208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*driver Screw Assy 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229209|EAP|Custom 951229209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom* Extractor Sleeve Spa&zt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229210|EAP|Custom 951229210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail2 Straight Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229211|EAP|Custom 951229211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail2 Anterior Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229212|EAP|Custom 951229212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Revision Stem Xray 120|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218174|EAP|Custom 951218174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mtx Cem Cup P Head 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218175|EAP|Custom 951218175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ex Plastic Driving Face|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218176|EAP|Custom 951218176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Blade 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218177|EAP|Custom 951218177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Blade 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218178|EAP|Custom 951218178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Blade 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218179|EAP|Custom 951218179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Blade 17.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218180|EAP|Custom 951218180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Blade 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218249|EAP|Custom 951218249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ref Tpr Hole Cvr Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218250|EAP|Custom 951218250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ref Acet Screw Drill 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218252|EAP|Custom 951218252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rcs Cocr Swage 2.0mm Dia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218253|EAP|Custom 951218253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rcs Cocr Cable/swage 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218257|EAP|Custom 951218257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bhr Ext Kit Sterile Boxed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219881|EAP|Custom 951219881||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219882|EAP|Custom 951219882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219883|EAP|Custom 951219883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219884|EAP|Custom 951219884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219885|EAP|Custom 951219885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219886|EAP|Custom 951219886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219887|EAP|Custom 951219887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219888|EAP|Custom 951219888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219889|EAP|Custom 951219889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219890|EAP|Custom 951219890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219891|EAP|Custom 951219891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219892|EAP|Custom 951219892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 32id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219893|EAP|Custom 951219893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219894|EAP|Custom 951219894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219895|EAP|Custom 951219895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219896|EAP|Custom 951219896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219897|EAP|Custom 951219897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219898|EAP|Custom 951219898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219899|EAP|Custom 951219899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 36id Disp Trl Lnr 64od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219900|EAP|Custom 951219900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 46od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219901|EAP|Custom 951219901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219902|EAP|Custom 951219902||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219903|EAP|Custom 951219903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219904|EAP|Custom 951219904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219905|EAP|Custom 951219905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219906|EAP|Custom 951219906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219907|EAP|Custom 951219907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 28id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219908|EAP|Custom 951219908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219909|EAP|Custom 951219909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219910|EAP|Custom 951219910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219911|EAP|Custom 951219911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219912|EAP|Custom 951219912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219913|EAP|Custom 951219913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219914|EAP|Custom 951219914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219915|EAP|Custom 951219915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 32id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219916|EAP|Custom 951219916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219917|EAP|Custom 951219917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219918|EAP|Custom 951219918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219919|EAP|Custom 951219919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219920|EAP|Custom 951219920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219921|EAP|Custom 951219921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219922|EAP|Custom 951219922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0+4 36id Disp Trl Lnr 64od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219923|EAP|Custom 951219923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 46od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219924|EAP|Custom 951219924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219925|EAP|Custom 951219925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219926|EAP|Custom 951219926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219927|EAP|Custom 951219927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219928|EAP|Custom 951219928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219929|EAP|Custom 951219929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219930|EAP|Custom 951219930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 28id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219931|EAP|Custom 951219931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219932|EAP|Custom 951219932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219933|EAP|Custom 951219933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219934|EAP|Custom 951219934||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219935|EAP|Custom 951219935||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219936|EAP|Custom 951219936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219937|EAP|Custom 951219937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219938|EAP|Custom 951219938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 32id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219939|EAP|Custom 951219939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219940|EAP|Custom 951219940||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219941|EAP|Custom 951219941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219942|EAP|Custom 951219942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219943|EAP|Custom 951219943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219944|EAP|Custom 951219944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219945|EAP|Custom 951219945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20+4 36id Disp Trl Lnr 64od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219947|EAP|Custom 951219947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw Blade Attachment Amsco-hall|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219948|EAP|Custom 951219948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw Blade Attachment Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219953|EAP|Custom 951219953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dstl Fem Wedge Magnu Lm/rl 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219954|EAP|Custom 951219954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dis Only Fem Wed Xlg 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219955|EAP|Custom 951219955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dis Only Fem Wed Mag 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219956|EAP|Custom 951219956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dis Only Fem Wed Mag 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222863|EAP|Custom 951222863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Block Postr 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222864|EAP|Custom 951222864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block Post 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222865|EAP|Custom 951222865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.l 5 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222866|EAP|Custom 951222866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Blck D.l 10 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222867|EAP|Custom 951222867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 5 V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222868|EAP|Custom 951222868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222869|EAP|Custom 951222869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222870|EAP|Custom 951222870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222871|EAP|Custom 951222871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Block Postr 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222872|EAP|Custom 951222872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block Post 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222873|EAP|Custom 951222873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.l 5 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222874|EAP|Custom 951222874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Blck D.l 10 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222875|EAP|Custom 951222875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 5 V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222876|EAP|Custom 951222876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222877|EAP|Custom 951222877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222878|EAP|Custom 951222878||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222879|EAP|Custom 951222879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Block Postr 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222880|EAP|Custom 951222880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block Post 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222881|EAP|Custom 951222881||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.l 5 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222882|EAP|Custom 951222882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Blck D.l 10 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222883|EAP|Custom 951222883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 5 V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222884|EAP|Custom 951222884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222885|EAP|Custom 951222885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222886|EAP|Custom 951222886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222887|EAP|Custom 951222887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Block Postr 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222888|EAP|Custom 951222888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block Post 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222889|EAP|Custom 951222889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.l 5 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222890|EAP|Custom 951222890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Blck D.l 10 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222891|EAP|Custom 951222891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 5 V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222892|EAP|Custom 951222892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222893|EAP|Custom 951222893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222894|EAP|Custom 951222894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222895|EAP|Custom 951222895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block Post 5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222896|EAP|Custom 951222896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block Post 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222897|EAP|Custom 951222897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Blck D.l 5 Mm Vks|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222898|EAP|Custom 951222898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Block D.l 10 Mm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222899|EAP|Custom 951222899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Lt 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222900|EAP|Custom 951222900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tcrev Fem Block D.m Lt 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222901|EAP|Custom 951222901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222902|EAP|Custom 951222902||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tc Rev Fem Block D.m Rt10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222910|EAP|Custom 951222910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rt-plus Tibial Augm.block Pe 4:10 Cem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222911|EAP|Custom 951222911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Rt Solu Tibl Augmentation Block Pe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222912|EAP|Custom 951222912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Rt Solu Tibl Augmentation Block Pe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222914|EAP|Custom 951222914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Straight 8x40x1mm S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222915|EAP|Custom 951222915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Straight 10x40x1mm S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222916|EAP|Custom 951222916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Straight 10x60x1mm S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222917|EAP|Custom 951222917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Straight 12x60x1mm S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222918|EAP|Custom 951222918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Straight 8x120x1mm S Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222919|EAP|Custom 951222919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Straight 10x120x1mm S Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222920|EAP|Custom 951222920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Offset 8x27x1mm O 15 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222921|EAP|Custom 951222921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Offset 10x27x1mm O 15 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222922|EAP|Custom 951222922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Lateral 8x38x1mm - R10 C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222923|EAP|Custom 951222923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Lateral 10x35x1mm - R25 C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222924|EAP|Custom 951222924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Lateral 10x68x1mm - R100 C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222925|EAP|Custom 951222925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Radial 9x120x1mm - 12s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222926|EAP|Custom 951222926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Radial 13x120x1mm - 18s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222927|EAP|Custom 951222927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel Blade Radial 17x120x1mm - 24s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222928|EAP|Custom 951222928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw-blade Stryker2000 /4/5 14.0x23.0x0.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222929|EAP|Custom 951222929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw-blade Stryker 2000/4/5 13.4x48.0x0.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222930|EAP|Custom 951222930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw-blade Stryker S6 14.0x23.0x0.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222931|EAP|Custom 951222931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw-blade Stryker S6 13.4x48.0x0.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222932|EAP|Custom 951222932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw-blade Linvatec Hall 14.0x23.0x0.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222933|EAP|Custom 951222933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Saw-blade Linvatec Hall 13.4x48.5x0.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222938|EAP|Custom 951222938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slotted Holding Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223717|EAP|Custom 951223717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Anterior Chisel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223718|EAP|Custom 951223718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Fem Defct Shm 1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223719|EAP|Custom 951223719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Fem Defct Shm 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223720|EAP|Custom 951223720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Fem Defct Shm 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223721|EAP|Custom 951223721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Trochlea Bone File|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223722|EAP|Custom 951223722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Trochlea Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223723|EAP|Custom 951223723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Post Lat Shm 1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223724|EAP|Custom 951223724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Post Lat Shm 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223725|EAP|Custom 951223725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Tibial L-cut Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223726|EAP|Custom 951223726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Distal Cut Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223727|EAP|Custom 951223727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp System Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223728|EAP|Custom 951223728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Xsm/sm A/p Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223729|EAP|Custom 951223729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Med A/p Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223730|EAP|Custom 951223730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Hinge Fem Prep Comp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223731|EAP|Custom 951223731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Hinge Fem Prep Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223732|EAP|Custom 951223732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Hinge Fem Prep Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223733|EAP|Custom 951223733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Broach Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223734|EAP|Custom 951223734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Hinge Fem Prep Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223735|EAP|Custom 951223735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt/lcs Comp X-ray Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223736|EAP|Custom 951223736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tibial X-ray Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223737|EAP|Custom 951223737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Keelpunch Sz1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223738|EAP|Custom 951223738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Keelpunch Sz4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223739|EAP|Custom 951223739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Keelpunch Bush Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223740|EAP|Custom 951223740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Keelpunch Bushing Sz1-1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223741|EAP|Custom 951223741||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Keelpunch Bushing Sz2-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223742|EAP|Custom 951223742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Keelpunch Bushing Sz4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223743|EAP|Custom 951223743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Punch Bushing Sz1-1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223744|EAP|Custom 951223744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Punch Bushing Sz2-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223745|EAP|Custom 951223745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Punch Bushing Sz4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223746|EAP|Custom 951223746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Central Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223747|EAP|Custom 951223747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Central Stem Punch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223748|EAP|Custom 951223748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Drill Bushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223749|EAP|Custom 951223749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Tray Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223750|EAP|Custom 951223750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Tib Prep Steril Tray Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223751|EAP|Custom 951223751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Evaluation Bullet Sz1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223752|EAP|Custom 951223752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Evaluation Bullet Sz4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223753|EAP|Custom 951223753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Tray For 2178-30-126|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223754|EAP|Custom 951223754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Eval Bullet S1-3 W/o Pegs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223755|EAP|Custom 951223755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Eval Bullet S4-7 W/o Pegs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223756|EAP|Custom 951223756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Prep W/lcscompapg Ins/tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223757|EAP|Custom 951223757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Cem Keelpunch Sz 1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223758|EAP|Custom 951223758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Cem Keelpunch Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223759|EAP|Custom 951223759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Bal Devces Tray Ins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223760|EAP|Custom 951223760||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Bal+tib Tray Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223761|EAP|Custom 951223761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Bal + Tib Set Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223762|EAP|Custom 951223762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Milestone Fem Prp Try 2 Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223763|EAP|Custom 951223763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Bal+tib Prp Try Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223764|EAP|Custom 951223764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Mbt+pat Prp Try Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223765|EAP|Custom 951223765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Milestone Fem Prp Ins Try Set1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223766|EAP|Custom 951223766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Com Rev Implant Fem Prep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223767|EAP|Custom 951223767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Milestone Fem Prp Ins Try Set2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223768|EAP|Custom 951223768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Tibial Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223769|EAP|Custom 951223769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Align Tower & Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223770|EAP|Custom 951223770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Api Style Tib Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223771|EAP|Custom 951223771||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Tib Block 0 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223772|EAP|Custom 951223772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Tib Block 2 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223773|EAP|Custom 951223773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Spacer Blk Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223774|EAP|Custom 951223774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Spacer Blk Med/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223775|EAP|Custom 951223775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Fem Shim Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223776|EAP|Custom 951223776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Shim Med/std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223777|EAP|Custom 951223777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Shim Lg/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223778|EAP|Custom 951223778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Sm/sm+ 12.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223779|EAP|Custom 951223779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Sm/sm+ 15.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223780|EAP|Custom 951223780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Sm/sm+ 17.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223781|EAP|Custom 951223781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Sm/sm+ 20.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223782|EAP|Custom 951223782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Sm/sm+ 22.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223783|EAP|Custom 951223783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Sm/sm+ 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223784|EAP|Custom 951223784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Min Spac Blk Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223785|EAP|Custom 951223785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Tib Shim Med/lg+ 12.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223786|EAP|Custom 951223786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Tib Shim Med/lg+ 15.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223787|EAP|Custom 951223787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Tib Shim Med/lg+ 17.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223788|EAP|Custom 951223788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Tib Shim Med/lg+ 20.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223789|EAP|Custom 951223789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Med/lg+ 22.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223790|EAP|Custom 951223790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Tib Shim Med/lg+ 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223791|EAP|Custom 951223791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Min Spac Blk Med/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223795|EAP|Custom 951223795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Fem Fem Template Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223796|EAP|Custom 951223796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Template Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223797|EAP|Custom 951223797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Template Std/std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223798|EAP|Custom 951223798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Template Lg/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223799|EAP|Custom 951223799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Fem Impac/extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223800|EAP|Custom 951223800||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pathway Hudson Lug Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223801|EAP|Custom 951223801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pathway Im Drill 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223802|EAP|Custom 951223802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223803|EAP|Custom 951223803||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223804|EAP|Custom 951223804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223805|EAP|Custom 951223805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223806|EAP|Custom 951223806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223807|EAP|Custom 951223807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223808|EAP|Custom 951223808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Rpsflex Notch Gde Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223809|EAP|Custom 951223809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fm Shim Md/std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223810|EAP|Custom 951223810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Shim Lg/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223825|EAP|Custom 951223825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Distl Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223826|EAP|Custom 951223826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Sm/lg+ 5 Pos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223827|EAP|Custom 951223827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Sm/lg+ 10 Pos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223828|EAP|Custom 951223828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Sm/med 5 Dtl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223829|EAP|Custom 951223829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Sm/med 10 Dtl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223830|EAP|Custom 951223830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Std/lg+ 5 Dtl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223831|EAP|Custom 951223831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Std/lg+ 10dtl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223832|EAP|Custom 951223832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Fem Aug Btn Std+/lg+15dtl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223833|EAP|Custom 951223833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Ap Blck Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223834|EAP|Custom 951223834||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Ap Block Md|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223835|EAP|Custom 951223835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Ap Blck Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223836|EAP|Custom 951223836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Ap Blk Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223837|EAP|Custom 951223837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Ap Block Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223838|EAP|Custom 951223838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Ap Blck Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223839|EAP|Custom 951223839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Fin Gde Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223840|EAP|Custom 951223840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Fin Gde Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223841|EAP|Custom 951223841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Fin Gde Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223842|EAP|Custom 951223842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Fin Gd Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223843|EAP|Custom 951223843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Fin Gde Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223844|EAP|Custom 951223844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Completion Rev Fem Fin Gde Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223847|EAP|Custom 951223847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Rev 2.5mm Hex Scrwdriver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223848|EAP|Custom 951223848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Drill Bushing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223849|EAP|Custom 951223849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Reamer Depth Scale|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223850|EAP|Custom 951223850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Taperd Pressfit Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223851|EAP|Custom 951223851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tapered Cement Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223852|EAP|Custom 951223852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Revision Cem Stem Reamer 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223860|EAP|Custom 951223860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Cutting Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223863|EAP|Custom 951223863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Reamer Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223864|EAP|Custom 951223864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Wedge Cutting Attachment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223865|EAP|Custom 951223865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rev Fem/tib/sleeve Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223866|EAP|Custom 951223866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rev Fem Stem/adapt Clamp 13 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223867|EAP|Custom 951223867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modified Hudson Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223868|EAP|Custom 951223868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223869|EAP|Custom 951223869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223870|EAP|Custom 951223870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223871|EAP|Custom 951223871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223872|EAP|Custom 951223872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223873|EAP|Custom 951223873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223874|EAP|Custom 951223874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223875|EAP|Custom 951223875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223876|EAP|Custom 951223876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223877|EAP|Custom 951223877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223878|EAP|Custom 951223878||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 19mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223879|EAP|Custom 951223879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223880|EAP|Custom 951223880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 21mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223881|EAP|Custom 951223881||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223882|EAP|Custom 951223882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 23mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223883|EAP|Custom 951223883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Revision Reamer 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223884|EAP|Custom 951223884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Cem Stem Reamer 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224568|EAP|Custom 951224568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Dist Fem Mount|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224569|EAP|Custom 951224569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Dist Fem Outrigger|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224570|EAP|Custom 951224570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Femoral Im Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224571|EAP|Custom 951224571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Shim Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224572|EAP|Custom 951224572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Shim Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224573|EAP|Custom 951224573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Shim Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224574|EAP|Custom 951224574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Shim Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224575|EAP|Custom 951224575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Shim Sz 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224576|EAP|Custom 951224576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Shim Sz 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224577|EAP|Custom 951224577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Boss-stm Adptr Xtrctr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226311|EAP|Custom 951226311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Fem Adapter 7 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226312|EAP|Custom 951226312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Fem Adapter Neutral Bolt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228011|EAP|Custom 951228011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calcar Mill Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228012|EAP|Custom 951228012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calcar Mill Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228013|EAP|Custom 951228013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calcar Mill Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228014|EAP|Custom 951228014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Calcar Mill Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228015|EAP|Custom 951228015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral/humeral Head Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228016|EAP|Custom 951228016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Im Initiator Sized|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228017|EAP|Custom 951228017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calcar Planer Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228018|EAP|Custom 951228018||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calcar Planer Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228019|EAP|Custom 951228019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 8mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228020|EAP|Custom 951228020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 9mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228021|EAP|Custom 951228021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 9.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228022|EAP|Custom 951228022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 10mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228023|EAP|Custom 951228023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 10.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228024|EAP|Custom 951228024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 11mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228025|EAP|Custom 951228025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 11.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228026|EAP|Custom 951228026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 12mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228027|EAP|Custom 951228027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 12.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228028|EAP|Custom 951228028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 13mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228029|EAP|Custom 951228029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 13.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228030|EAP|Custom 951228030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 14mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228031|EAP|Custom 951228031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 14.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228032|EAP|Custom 951228032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 15.0mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228033|EAP|Custom 951228033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 15.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228034|EAP|Custom 951228034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 16.0mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228035|EAP|Custom 951228035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 16.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228036|EAP|Custom 951228036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 17mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228037|EAP|Custom 951228037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 17.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228038|EAP|Custom 951228038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 18mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228039|EAP|Custom 951228039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 18.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228040|EAP|Custom 951228040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 19mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228041|EAP|Custom 951228041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 19.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228042|EAP|Custom 951228042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 20mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228043|EAP|Custom 951228043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 20.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228044|EAP|Custom 951228044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 21mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228045|EAP|Custom 951228045||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 21.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228046|EAP|Custom 951228046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 22mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228047|EAP|Custom 951228047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 22.5mm Bullet Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228048|EAP|Custom 951228048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Version Control Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228049|EAP|Custom 951228049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228050|EAP|Custom 951228050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anteversion Osteotome Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228051|EAP|Custom 951228051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anteversion Osteotome Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228052|EAP|Custom 951228052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anteversion Osteotome Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228053|EAP|Custom 951228053||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228054|EAP|Custom 951228054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Cup Replacement Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228055|EAP|Custom 951228055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228056|EAP|Custom 951228056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Moore Pros Extr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228057|EAP|Custom 951228057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 8.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228058|EAP|Custom 951228058||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 9.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228059|EAP|Custom 951228059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 10.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228060|EAP|Custom 951228060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 10.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228061|EAP|Custom 951228061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 11.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228062|EAP|Custom 951228062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 12.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228063|EAP|Custom 951228063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 13.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228064|EAP|Custom 951228064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 13.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228065|EAP|Custom 951228065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 14.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228066|EAP|Custom 951228066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 15.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228067|EAP|Custom 951228067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 16.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228068|EAP|Custom 951228068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 16.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228069|EAP|Custom 951228069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 18.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228070|EAP|Custom 951228070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 17.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228071|EAP|Custom 951228071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 19.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228072|EAP|Custom 951228072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 11.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228073|EAP|Custom 951228073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 14.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228074|EAP|Custom 951228074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 8.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228075|EAP|Custom 951228075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 9.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228076|EAP|Custom 951228076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 12.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228077|EAP|Custom 951228077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Canal Reamer 15.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228078|EAP|Custom 951228078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Hole Gage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228079|EAP|Custom 951228079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Cem Plug Drills 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228080|EAP|Custom 951228080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Cem Plug Drills 6.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228081|EAP|Custom 951228081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Cem Plug Drills 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228082|EAP|Custom 951228082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228083|EAP|Custom 951228083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 9.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228084|EAP|Custom 951228084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 10.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228085|EAP|Custom 951228085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 11.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228086|EAP|Custom 951228086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 12.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228087|EAP|Custom 951228087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 13.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228088|EAP|Custom 951228088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 13.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228089|EAP|Custom 951228089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 14.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228090|EAP|Custom 951228090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 14.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228091|EAP|Custom 951228091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 15.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228092|EAP|Custom 951228092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 15.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228093|EAP|Custom 951228093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 16.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228094|EAP|Custom 951228094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 16.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228095|EAP|Custom 951228095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 17.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228096|EAP|Custom 951228096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228097|EAP|Custom 951228097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 18.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228098|EAP|Custom 951228098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 18.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228099|EAP|Custom 951228099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 19.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228100|EAP|Custom 951228100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 19.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228101|EAP|Custom 951228101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 20.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228102|EAP|Custom 951228102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 20.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228103|EAP|Custom 951228103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 21.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228104|EAP|Custom 951228104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 21.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228105|EAP|Custom 951228105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 22.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228106|EAP|Custom 951228106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 22.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228107|EAP|Custom 951228107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Fem Grft Tmps Str 7/8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228108|EAP|Custom 951228108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Fem Grft Tmps Ofst 3/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228109|EAP|Custom 951228109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Fem Grft Tmps Ofst 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228110|EAP|Custom 951228110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Remover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228111|EAP|Custom 951228111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modular Head Ball Remover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228112|EAP|Custom 951228112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dislocation Lever|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228113|EAP|Custom 951228113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pestle Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228114|EAP|Custom 951228114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Muller Double Angled Ret 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228115|EAP|Custom 951228115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Muller Rake Retr 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228116|EAP|Custom 951228116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228117|EAP|Custom 951228117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Suction Cup Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228118|EAP|Custom 951228118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228119|EAP|Custom 951228119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228120|EAP|Custom 951228120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228121|EAP|Custom 951228121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228122|EAP|Custom 951228122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228123|EAP|Custom 951228123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228124|EAP|Custom 951228124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Headed Drill Pin 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228125|EAP|Custom 951228125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Poly Impactor Tip 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228126|EAP|Custom 951228126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Poly Impactor Tip 44mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228127|EAP|Custom 951228127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Poly Impactor Tip 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228128|EAP|Custom 951228128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 28mm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228129|EAP|Custom 951228129||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 36mm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228130|EAP|Custom 951228130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 40mm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228131|EAP|Custom 951228131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 44mm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228132|EAP|Custom 951228132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Grater Head Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228133|EAP|Custom 951228133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Screw Set Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228134|EAP|Custom 951228134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Drill Bit Caddy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228135|EAP|Custom 951228135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Utility Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228136|EAP|Custom 951228136||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Curved Cup Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228137|EAP|Custom 951228137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ratchet Scdr Hdl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228138|EAP|Custom 951228138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Hex Scrdrvr Shaft Rigid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228139|EAP|Custom 951228139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Hex Scrdrvr Shaft Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228140|EAP|Custom 951228140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Hex Scrdrvr Shaft Cardan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228141|EAP|Custom 951228141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Drill Bit 3.8 Dia 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228142|EAP|Custom 951228142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Drill Bit 3.2 Dia 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228143|EAP|Custom 951228143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Drill Bit 3.8 Dia 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228144|EAP|Custom 951228144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Drill Bit 3.8 Dia 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228145|EAP|Custom 951228145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Flex Drill Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228146|EAP|Custom 951228146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Rigid Drill Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228147|EAP|Custom 951228147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Dome Drill 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228148|EAP|Custom 951228148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Dome Drill 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228149|EAP|Custom 951228149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc T-handle W/hudson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228150|EAP|Custom 951228150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Dome Drill 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228151|EAP|Custom 951228151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dlc Depth Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228152|EAP|Custom 951228152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Cup Tprd Drill Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228153|EAP|Custom 951228153||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 1pc Flex Drill Bit 45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228154|EAP|Custom 951228154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Dome Drill 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228155|EAP|Custom 951228155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Taper Hex Scdr Rigid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228156|EAP|Custom 951228156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Taper Hex Scdr Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228157|EAP|Custom 951228157||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Tprd Hex Scdr Cardan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228158|EAP|Custom 951228158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Screwdriver Cross Hd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228159|EAP|Custom 951228159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Flex Dr Sft Qck Cple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228160|EAP|Custom 951228160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Rgd Dr Sft Qck Cple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228161|EAP|Custom 951228161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Drill Guide Ii 3.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228162|EAP|Custom 951228162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Scr Holding Forceps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228163|EAP|Custom 951228163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 3.8 Dimtr Dr Bit 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228164|EAP|Custom 951228164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 3.8 Dimtr Dr Blt 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228165|EAP|Custom 951228165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 3.8 Dimtr Dr Bit 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228166|EAP|Custom 951228166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 3.8 Dimtr Dr Bit 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228167|EAP|Custom 951228167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Depth Gauge 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228168|EAP|Custom 951228168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Tprd Hex Scdr U-joint|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228169|EAP|Custom 951228169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Screw Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228170|EAP|Custom 951228170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 3.8dimtr Dr Bit 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228171|EAP|Custom 951228171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 3.8dimtr Dr Bit 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228172|EAP|Custom 951228172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset 1pc Flex Drill Bit 70|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228173|EAP|Custom 951228173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Dome Drill 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228174|EAP|Custom 951228174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Periph Drill Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228175|EAP|Custom 951228175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Periph Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228176|EAP|Custom 951228176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rev Dome Drill Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228177|EAP|Custom 951228177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Depuy Acetabular Scr Instr Cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228178|EAP|Custom 951228178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Apex Hole Elim Tpd Hex Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228179|EAP|Custom 951228179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Implant Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228180|EAP|Custom 951228180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Uni Ball Extractor Size I|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228181|EAP|Custom 951228181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Uni Ball Extractor Size Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228182|EAP|Custom 951228182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Uni Ball Extractor Size Iii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228183|EAP|Custom 951228183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Muller Awl Reamer W/hudson End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228184|EAP|Custom 951228184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 3.8mm Drill Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228185|EAP|Custom 951228185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 45 Deg Angle Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228186|EAP|Custom 951228186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 3.8mm Drill Bit 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228187|EAP|Custom 951228187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 3.2 Dia 25mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228188|EAP|Custom 951228188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 3.2 Dia 50mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228189|EAP|Custom 951228189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Cs Compl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228190|EAP|Custom 951228190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Case Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228191|EAP|Custom 951228191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quickset Ace Grater Case Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228906|EAP|Custom 951228906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228907|EAP|Custom 951228907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Jaw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228908|EAP|Custom 951228908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Qk Rel Nut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228909|EAP|Custom 951228909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228910|EAP|Custom 951228910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz1 115mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228911|EAP|Custom 951228911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz2 125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228912|EAP|Custom 951228912||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz3 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228913|EAP|Custom 951228913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz4 140mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228914|EAP|Custom 951228914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz5 145mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228915|EAP|Custom 951228915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz3 240 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228916|EAP|Custom 951228916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Lng Stm Mld Insr 165|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228917|EAP|Custom 951228917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Lng Stm Mld Insr 215|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228918|EAP|Custom 951228918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Mold Sz3 240 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228919|EAP|Custom 951228919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Prostalac Hip Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228920|EAP|Custom 951228920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grtbatch Off Cup Imp Mtl Hndl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228921|EAP|Custom 951228921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Gb 20 Deg Alignment Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228922|EAP|Custom 951228922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Gb Offset Impactor Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228928|EAP|Custom 951228928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Short Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228929|EAP|Custom 951228929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Univ Extractor Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228930|EAP|Custom 951228930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Universal Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228931|EAP|Custom 951228931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228932|EAP|Custom 951228932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228933|EAP|Custom 951228933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Braoch Sz1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228934|EAP|Custom 951228934||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228935|EAP|Custom 951228935||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228936|EAP|Custom 951228936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228937|EAP|Custom 951228937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228938|EAP|Custom 951228938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228939|EAP|Custom 951228939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228940|EAP|Custom 951228940||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228941|EAP|Custom 951228941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228942|EAP|Custom 951228942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Sz10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228943|EAP|Custom 951228943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Sz0/1 Tapered Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228944|EAP|Custom 951228944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Sz2/3 Tapered Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228945|EAP|Custom 951228945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit S4/5 Tapered Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228946|EAP|Custom 951228946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Sz6/7 Tapered Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228947|EAP|Custom 951228947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Sz8/9 Tapered Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228948|EAP|Custom 951228948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Sz10 Tapered Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228961|EAP|Custom 951228961||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Calcar Planer-small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228962|EAP|Custom 951228962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Calcar Planer-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228963|EAP|Custom 951228963||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mi Calcar Reamer Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228964|EAP|Custom 951228964||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Standard Imp. Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228965|EAP|Custom 951228965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Angled Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228966|EAP|Custom 951228966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Extractor Slaphammer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228967|EAP|Custom 951228967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Sterile Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228968|EAP|Custom 951228968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Basic Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228978|EAP|Custom 951228978||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Canal Sizer Sz 8/9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228979|EAP|Custom 951228979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Canal Sizer Sz 10/11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228980|EAP|Custom 951228980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Canal Sizer Sz 12/13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228981|EAP|Custom 951228981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Canal Sizer Sz 14/15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228982|EAP|Custom 951228982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Canal Sizer Sz 16/17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228983|EAP|Custom 951228983||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Broach Only Case Comple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228984|EAP|Custom 951228984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Calcar Cutting Guide 12/14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228985|EAP|Custom 951228985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Box Osteotome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228986|EAP|Custom 951228986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Neck Resection Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228987|EAP|Custom 951228987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Stepped Starter Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228988|EAP|Custom 951228988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cone Reamer Extension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228989|EAP|Custom 951228989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228990|EAP|Custom 951228990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Ream 17-14b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228991|EAP|Custom 951228991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228992|EAP|Custom 951228992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 21|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228993|EAP|Custom 951228993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 23|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228994|EAP|Custom 951228994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228995|EAP|Custom 951228995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 27|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228996|EAP|Custom 951228996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 29|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228997|EAP|Custom 951228997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Reamer 31|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228998|EAP|Custom 951228998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Band Cone Ream 17-12d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228999|EAP|Custom 951228999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Std Pilot Shaft Sz 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229000|EAP|Custom 951229000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Std Pilot Shaft Sz 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229001|EAP|Custom 951229001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Violet 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229002|EAP|Custom 951229002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Clear 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229003|EAP|Custom 951229003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Gold 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229004|EAP|Custom 951229004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Green 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229005|EAP|Custom 951229005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Blue 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229006|EAP|Custom 951229006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Black 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229007|EAP|Custom 951229007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Tri Mill Cutter Brown 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229017|EAP|Custom 951229017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Mi Triangle Mill Case Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229019|EAP|Custom 951229019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Mi Tri Mill Outer Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229020|EAP|Custom 951229020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach Case Cmplt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229021|EAP|Custom 951229021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Mi Triangle Miller Frame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229022|EAP|Custom 951229022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229023|EAP|Custom 951229023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229024|EAP|Custom 951229024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229025|EAP|Custom 951229025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229026|EAP|Custom 951229026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229027|EAP|Custom 951229027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229028|EAP|Custom 951229028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Cuttr Mi Tri Miller Sz24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229029|EAP|Custom 951229029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Starter Broach|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229030|EAP|Custom 951229030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 7x12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229031|EAP|Custom 951229031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 9x14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229032|EAP|Custom 951229032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 11x16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229033|EAP|Custom 951229033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 13x18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229034|EAP|Custom 951229034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 15x20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229035|EAP|Custom 951229035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 17x22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229036|EAP|Custom 951229036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Broach 19x24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229037|EAP|Custom 951229037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229038|EAP|Custom 951229038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229039|EAP|Custom 951229039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229040|EAP|Custom 951229040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229041|EAP|Custom 951229041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229042|EAP|Custom 951229042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229043|EAP|Custom 951229043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Lat Rasp Sz 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229044|EAP|Custom 951229044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Stem Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229045|EAP|Custom 951229045||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Inserter Fork Sml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229046|EAP|Custom 951229046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Inserter Fork Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229047|EAP|Custom 951229047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Inserter Fork Lrg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229048|EAP|Custom 951229048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Inserter Fork 30 Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229049|EAP|Custom 951229049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mi Miller Shell Ins/ext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229050|EAP|Custom 951229050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Start Inst/strt Ream Case Comp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229051|EAP|Custom 951229051||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cone And Mill Inst Case Comp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229052|EAP|Custom 951229052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Engage Nut Tightener|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229053|EAP|Custom 951229053||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Auxiliary Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217835|EAP|Custom 951217835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ccg-gf Band W.joint A.fixation Spikes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217844|EAP|Custom 951217844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sl-plus Standard Stem 5 Non-cem Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217868|EAP|Custom 951217868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Pigalileo Tkr Fem Cut Coord|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218645|EAP|Custom 951218645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218646|EAP|Custom 951218646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218647|EAP|Custom 951218647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218648|EAP|Custom 951218648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218649|EAP|Custom 951218649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218650|EAP|Custom 951218650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218651|EAP|Custom 951218651||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cpcs Dist Cent Sz 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218652|EAP|Custom 951218652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Invis Dist Cent Sz 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218653|EAP|Custom 951218653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Invis Dist Cent Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218654|EAP|Custom 951218654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Invis Dist Cent Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218655|EAP|Custom 951218655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Invis Dist Cent Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218656|EAP|Custom 951218656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Invis Dist Cent Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218657|EAP|Custom 951218657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spectron Ef Post Centralizer 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218658|EAP|Custom 951218658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spectron Ef Post Centralizer 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218659|EAP|Custom 951218659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spectron Ef Post Centralizer 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218660|EAP|Custom 951218660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spectron Ef Post Centralizer 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218661|EAP|Custom 951218661||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spectron Ef Post Centralizer 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Invis Dist Cent Sz 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218672|EAP|Custom 951218672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Invis Dist Cent Sz 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218673|EAP|Custom 951218673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Invis Dist Cent Sz 19mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Rev 12/14 Ls/nr Dist Cent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218675|EAP|Custom 951218675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Rev 12/14 Ls/nr Dist Cent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218676|EAP|Custom 951218676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Rev 12/14 Ls/nr Dist Cent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219587|EAP|Custom 951219587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Ss Cable Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219589|EAP|Custom 951219589||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Sm 75mm 3 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219590|EAP|Custom 951219590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Sm 115mm 5 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219591|EAP|Custom 951219591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Sm 185mm 8 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219592|EAP|Custom 951219592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Sm 255mm 11 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219593|EAP|Custom 951219593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc 2.0mm Cocr Cable W/clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219594|EAP|Custom 951219594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc 2.0mm Ss Cable W/clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219595|EAP|Custom 951219595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Std 85mm 3 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219596|EAP|Custom 951219596||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Std 125mm 5 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219597|EAP|Custom 951219597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Std 195mm 8 Cbl Troch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219598|EAP|Custom 951219598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acc Std 265mm 11 Cbl Trch Grip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219599|EAP|Custom 951219599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accord Low Profile Cable Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219600|EAP|Custom 951219600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Low Profile Cable Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219601|EAP|Custom 951219601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accord 2.0mm Cocr Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951220648|EAP|Custom 951220648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hk Hyperext Stop W/ax Plug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222602|EAP|Custom 951222602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Journey Fem Ox Np Bcs Lt5 Samp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223382|EAP|Custom 951223382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fe Dis Augment Spacer/4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223383|EAP|Custom 951223383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fe Dis Augment Spacer/8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223384|EAP|Custom 951223384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fe Dis Augment Spacr/12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223385|EAP|Custom 951223385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fe Dis Augment Spacr/16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223386|EAP|Custom 951223386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223387|EAP|Custom 951223387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223388|EAP|Custom 951223388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223389|EAP|Custom 951223389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223390|EAP|Custom 951223390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223391|EAP|Custom 951223391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223392|EAP|Custom 951223392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Rev A/p Cut Gde Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223393|EAP|Custom 951223393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Rev A/p Gde Bus 0mm Off5d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223394|EAP|Custom 951223394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Rev A/p Gd Bu +2/-2 Off5d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223395|EAP|Custom 951223395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Femoral Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223396|EAP|Custom 951223396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Femoral Impactor Nyl Repl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223397|EAP|Custom 951223397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Rev A/p Gd Bus 0mm Offs7d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223398|EAP|Custom 951223398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Rev A/p Gd Bus+2/-2offs7d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223399|EAP|Custom 951223399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Femoral Lug Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223400|EAP|Custom 951223400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Lug Drill W/hud End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223401|EAP|Custom 951223401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*sigma Fem Not Gd-bas Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223402|EAP|Custom 951223402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*sigma Fem Not Gd-bas Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223403|EAP|Custom 951223403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 A/p Sz/cutgd Removhd S1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223404|EAP|Custom 951223404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2a/pchamfblk Flslot Remvhds2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223405|EAP|Custom 951223405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2a/p/chamf Flslot Remvhd S6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223406|EAP|Custom 951223406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 A/p/cham Flslot Remvhds1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223407|EAP|Custom 951223407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223408|EAP|Custom 951223408||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223409|EAP|Custom 951223409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Size 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223410|EAP|Custom 951223410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Size 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223411|EAP|Custom 951223411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Size 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223412|EAP|Custom 951223412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Size 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223413|EAP|Custom 951223413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Notch Guide Size 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223414|EAP|Custom 951223414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cham Gde W/remov Hndl Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223415|EAP|Custom 951223415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cham Gde W/remov Hndl Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223416|EAP|Custom 951223416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cham Gde W/remov Hndl Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223417|EAP|Custom 951223417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cham Gde W/remov Hndl Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223418|EAP|Custom 951223418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2pfc Chamf Gde Remv Hndl Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223419|EAP|Custom 951223419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2pfc Cham Cut Gd Remvhndsz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223420|EAP|Custom 951223420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cham Gde W/rem Hndl Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223421|EAP|Custom 951223421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cham Gde W/rem Hndl Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223422|EAP|Custom 951223422||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 A/p Sizing Cut Gde Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223423|EAP|Custom 951223423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 A/p Sizing Cut Gd Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223424|EAP|Custom 951223424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pf*2 Femoral Holding Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223425|EAP|Custom 951223425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sp2 Fem Aug Holding Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223426|EAP|Custom 951223426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*torque Driver Handle Exten|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223427|EAP|Custom 951223427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2* 1mm Extension Shim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223430|EAP|Custom 951223430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intramedullary Align Device Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223431|EAP|Custom 951223431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Left Slotted Tib Cut Blk 0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223432|EAP|Custom 951223432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Left Slotted Tib Cut Blk 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223433|EAP|Custom 951223433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Left Slotted Tib Cut Blk 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223434|EAP|Custom 951223434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Slotted Tib Cut Blk 0 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223435|EAP|Custom 951223435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Slotted Tib Cut Blk 3 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223436|EAP|Custom 951223436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Slotted Tib Cut Blk 5 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223438|EAP|Custom 951223438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Right Slottd Tib Cut Blk 0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223439|EAP|Custom 951223439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Right Slottd Tib Cut Blk 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223440|EAP|Custom 951223440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Right Slottd Tib Cut Blk 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223441|EAP|Custom 951223441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Specialist*2 Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223457|EAP|Custom 951223457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2mod Tb Dr Bu Nce/1.5-3 13m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223458|EAP|Custom 951223458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2mod Tb Drl Bu Ce/1.5-3 13m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223459|EAP|Custom 951223459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2mod Tb Dr Bu Nce/sz4-6 15m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223460|EAP|Custom 951223460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2mod Tib Drlbush Np15mmsz4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223465|EAP|Custom 951223465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Universal Tb Tray Insertr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223466|EAP|Custom 951223466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Poly Tib Comp Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223467|EAP|Custom 951223467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tb Tray Impactor Nylon Replmnt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223477|EAP|Custom 951223477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2* Hemi Wedge Cut Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223478|EAP|Custom 951223478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2* Step Wedge Cut Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223479|EAP|Custom 951223479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223480|EAP|Custom 951223480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223481|EAP|Custom 951223481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223482|EAP|Custom 951223482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223483|EAP|Custom 951223483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223484|EAP|Custom 951223484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223485|EAP|Custom 951223485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Cuttg Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223486|EAP|Custom 951223486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anterior 1st Fem Cuttg Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223487|EAP|Custom 951223487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*spacer Blks 8 Mm-17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223488|EAP|Custom 951223488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*spacer Blks 20mm-30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223489|EAP|Custom 951223489||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2* Steinmann Pin Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223490|EAP|Custom 951223490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Slap Hammer Attachment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223491|EAP|Custom 951223491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Pin Puller|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223492|EAP|Custom 951223492||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Specialist*2 Universal Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223493|EAP|Custom 951223493||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tib Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223494|EAP|Custom 951223494||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Specialist*2 Reference Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223495|EAP|Custom 951223495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2fem Ntch Gdbushim5dg+2l/-2r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223496|EAP|Custom 951223496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 F Not Gd Bus Im/5d 0 Offs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223497|EAP|Custom 951223497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2fem Ntch Gdbushim5dg+2r/-2l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223498|EAP|Custom 951223498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2femntchgd Bsh13mm5dg+2l/-2r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223499|EAP|Custom 951223499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 F Not Gd Bh 13m/5d 0 Offs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223500|EAP|Custom 951223500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2femntchgd Bsh13mm5dg+2r/-2l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223501|EAP|Custom 951223501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2femntchgd Bsh15mm5dg+2l/-2r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223502|EAP|Custom 951223502||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 F Not Gd Bh 15m/5d 0 Offs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223503|EAP|Custom 951223503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2femntchgd Bsh15mm5dg+2r/-2l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223504|EAP|Custom 951223504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2fem Ntch Gdbushim7dg+2l/-2r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223505|EAP|Custom 951223505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 F Not Gd Bus Im/7d 0 Offs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223506|EAP|Custom 951223506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2fem Ntch Gdbushim7dg+2r/-2l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223513|EAP|Custom 951223513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Base Fem Instr Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223514|EAP|Custom 951223514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Auxil Fem Inst Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223515|EAP|Custom 951223515||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2pat Instr Sterile Tray-base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223516|EAP|Custom 951223516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Tibinstr Stertray Bse Only|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223517|EAP|Custom 951223517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Keelpnch Stertray Insrt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223518|EAP|Custom 951223518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2por Mod Punch Steril Tryins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223519|EAP|Custom 951223519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Cem Mod Pnch Sterl Try Ins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223520|EAP|Custom 951223520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*gen Insert Inst St Ty Ins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223521|EAP|Custom 951223521||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Rev Instr Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223522|EAP|Custom 951223522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Rod Reamer Slee Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223523|EAP|Custom 951223523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*spacer Blocks Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223524|EAP|Custom 951223524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Size 1.5 Instr Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223525|EAP|Custom 951223525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Size 6 Instr Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223526|EAP|Custom 951223526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Size 1.5 Inst Ster Tray Ins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223527|EAP|Custom 951223527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Sz 1.5 Rev Inst Ster Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223528|EAP|Custom 951223528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Patellar Drill Gd 38&41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223529|EAP|Custom 951223529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Patellar Drill Gd 32&35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223530|EAP|Custom 951223530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*dis F Ct Bk Slot 8mm Spac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223531|EAP|Custom 951223531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*dis F Ct Bk Slot 9mm Spac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223532|EAP|Custom 951223532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*dis F Ct Bk Slot 10mm Spac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223533|EAP|Custom 951223533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*dis F Ct Bk Slot 11mm Spac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223534|EAP|Custom 951223534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*reamer T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223535|EAP|Custom 951223535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*fluted Stem Reamer 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223536|EAP|Custom 951223536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2*fluted Stem Reamer 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223537|EAP|Custom 951223537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Sigma Inset Patellar Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223538|EAP|Custom 951223538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Inset Patella Depth Ring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223539|EAP|Custom 951223539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Inset Patella Depth Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223540|EAP|Custom 951223540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Inset Pat Att Slv 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223541|EAP|Custom 951223541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Insetpat Atach Slve28/32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223542|EAP|Custom 951223542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Inset Pat Sizing Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223543|EAP|Custom 951223543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Inset Patella Clamp Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223544|EAP|Custom 951223544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inset Pat Reamer Body Sz 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223545|EAP|Custom 951223545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inset Pat Reamer Body Sz 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223546|EAP|Custom 951223546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inset Pat Reamer Body Sz 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223547|EAP|Custom 951223547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 1pg Ovdome Pat Drlgd32&35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223548|EAP|Custom 951223548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 1pg Ovdome Pat Drlgd38&41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224221|EAP|Custom 951224221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Tibial Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224222|EAP|Custom 951224222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Tib Impactor Replace Parts|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224223|EAP|Custom 951224223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Fem Bow Yoke|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224224|EAP|Custom 951224224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Tib/fem Rm/ll 0 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224225|EAP|Custom 951224225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Patellar Wafer Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224226|EAP|Custom 951224226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Patellar Wafer Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224227|EAP|Custom 951224227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Cem Keel Punch Sz 1-1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224228|EAP|Custom 951224228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Cem Keel Punch Sz 2-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224229|EAP|Custom 951224229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Cem Keel Punch Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224230|EAP|Custom 951224230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Noncem Kl Pnch Sz 1-1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224231|EAP|Custom 951224231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Noncem Kl Pnch Sz 2-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224232|EAP|Custom 951224232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Noncem Kl Pnch Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224233|EAP|Custom 951224233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Cem Punch Sz 2-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224234|EAP|Custom 951224234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Cem Punch Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224235|EAP|Custom 951224235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Noncem Punch Sz 2-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224236|EAP|Custom 951224236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spiked Eval Blt Sz 1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224237|EAP|Custom 951224237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spiked Eval Blt Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224238|EAP|Custom 951224238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Keel Punch Impact|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224239|EAP|Custom 951224239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Cem Central Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224240|EAP|Custom 951224240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Noncem Central Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224241|EAP|Custom 951224241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Drill Tower|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224242|EAP|Custom 951224242||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Tibial Tray Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224243|EAP|Custom 951224243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Modular Drill Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224244|EAP|Custom 951224244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Stem Punch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224245|EAP|Custom 951224245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fbt Cem Kl Pnch Sz1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224246|EAP|Custom 951224246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fbt Cem Kl Pnch Sz4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224247|EAP|Custom 951224247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fbt Cem Kl Pnch Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224248|EAP|Custom 951224248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Noncem Kl Pnch Sz1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224249|EAP|Custom 951224249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Noncem Kl Pnch Sz 4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224250|EAP|Custom 951224250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Noncem Kl Pnch Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224251|EAP|Custom 951224251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fbt Eval Blt Sz 1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224252|EAP|Custom 951224252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Eval Blt Sz 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224253|EAP|Custom 951224253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Keel Punch Impact|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224254|EAP|Custom 951224254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Cem Drill Sz1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224255|EAP|Custom 951224255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Cem Drill Sz4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224256|EAP|Custom 951224256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Noncem Drill Sz 1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224257|EAP|Custom 951224257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Noncem Drill Sz 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224258|EAP|Custom 951224258||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Drill Tower|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224259|EAP|Custom 951224259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Std Tib Pnch Gd Sz 5-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224260|EAP|Custom 951224260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Std Tib Pnch Sz1.5-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224261|EAP|Custom 951224261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Std Tib Pnch Sz2.5-4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224262|EAP|Custom 951224262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Std Tib Pnch Sz5-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224263|EAP|Custom 951224263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Std Cm Tib Pnch Sz1.5-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224264|EAP|Custom 951224264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Std Cm Tib Pnch Sz2.5-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224265|EAP|Custom 951224265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fbt Drill Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224266|EAP|Custom 951224266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Lug Drill Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224267|EAP|Custom 951224267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Pin Impactor/extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224268|EAP|Custom 951224268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Power Pin Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224269|EAP|Custom 951224269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Step Im Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224270|EAP|Custom 951224270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Res Gd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224271|EAP|Custom 951224271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Ledge Sz1.5-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224272|EAP|Custom 951224272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Ledge Sz2.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224273|EAP|Custom 951224273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Ledge Sz4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224274|EAP|Custom 951224274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Fem Align Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224275|EAP|Custom 951224275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Fem Res Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224276|EAP|Custom 951224276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Eval Blt W/o Pegs Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224277|EAP|Custom 951224277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Eval Blt W/o Pegs Sz 1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224278|EAP|Custom 951224278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Flex Shim Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224279|EAP|Custom 951224279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Flex Shim Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224280|EAP|Custom 951224280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Flex Shim Sz 2.5-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224281|EAP|Custom 951224281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Flex Shim Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224282|EAP|Custom 951224282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224283|EAP|Custom 951224283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224284|EAP|Custom 951224284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224285|EAP|Custom 951224285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224286|EAP|Custom 951224286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224287|EAP|Custom 951224287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224288|EAP|Custom 951224288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 22.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224289|EAP|Custom 951224289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224290|EAP|Custom 951224290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fbt Spacer Blk 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224291|EAP|Custom 951224291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224292|EAP|Custom 951224292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224293|EAP|Custom 951224293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224294|EAP|Custom 951224294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224295|EAP|Custom 951224295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224296|EAP|Custom 951224296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 22.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224297|EAP|Custom 951224297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224298|EAP|Custom 951224298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Spacer Blk 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224299|EAP|Custom 951224299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224300|EAP|Custom 951224300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224301|EAP|Custom 951224301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224302|EAP|Custom 951224302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224303|EAP|Custom 951224303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224304|EAP|Custom 951224304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224305|EAP|Custom 951224305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224306|EAP|Custom 951224306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224307|EAP|Custom 951224307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224308|EAP|Custom 951224308||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224309|EAP|Custom 951224309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224310|EAP|Custom 951224310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224311|EAP|Custom 951224311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224312|EAP|Custom 951224312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224313|EAP|Custom 951224313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Rpf Hp Bal Ap Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224314|EAP|Custom 951224314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Ap Blk Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224315|EAP|Custom 951224315||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Im Rod 5 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224316|EAP|Custom 951224316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Bal Im Rod 3 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224317|EAP|Custom 951224317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Bal Rp Fem Positioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224318|EAP|Custom 951224318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Bal Fb Fem Positioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224319|EAP|Custom 951224319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Bal Fem Pos Shim 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224320|EAP|Custom 951224320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Bal Fem Pos Shim 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224321|EAP|Custom 951224321||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Bal Fem Pos Shim 15 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224322|EAP|Custom 951224322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Bal Fem Pos Shim 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224323|EAP|Custom 951224323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224324|EAP|Custom 951224324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224325|EAP|Custom 951224325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224326|EAP|Custom 951224326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224327|EAP|Custom 951224327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224328|EAP|Custom 951224328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224329|EAP|Custom 951224329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Ap Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224330|EAP|Custom 951224330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224331|EAP|Custom 951224331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224332|EAP|Custom 951224332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224333|EAP|Custom 951224333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224334|EAP|Custom 951224334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224335|EAP|Custom 951224335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224336|EAP|Custom 951224336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224337|EAP|Custom 951224337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Fixed Ref Ap Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224338|EAP|Custom 951224338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224339|EAP|Custom 951224339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224340|EAP|Custom 951224340||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224341|EAP|Custom 951224341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224342|EAP|Custom 951224342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224343|EAP|Custom 951224343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224344|EAP|Custom 951224344||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224345|EAP|Custom 951224345||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Rpf Hp Fem Notch Gde Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224346|EAP|Custom 951224346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224347|EAP|Custom 951224347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224348|EAP|Custom 951224348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224349|EAP|Custom 951224349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224350|EAP|Custom 951224350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224351|EAP|Custom 951224351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224352|EAP|Custom 951224352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224353|EAP|Custom 951224353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Hp Classic Ap Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224354|EAP|Custom 951224354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Rp/fb Bal Flex Attach|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224355|EAP|Custom 951224355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Ant 1st Remove Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224356|EAP|Custom 951224356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Sz6 Flex Ex Sp Blk Shim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224357|EAP|Custom 951224357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Duo Red Col Pin Non-ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224358|EAP|Custom 951224358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Duo Red Col Pin Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224359|EAP|Custom 951224359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Base Femur & Tibia Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224360|EAP|Custom 951224360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fixed Ref Fem Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224361|EAP|Custom 951224361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Spacer Blocks Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224362|EAP|Custom 951224362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sg Hp Rpf Fix Ref Fem Prep Cse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224363|EAP|Custom 951224363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Mbt Tibia Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224364|EAP|Custom 951224364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rp Tibia Insert Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224365|EAP|Custom 951224365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Patella & Insertion Cse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224366|EAP|Custom 951224366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rpf Class Fem Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224367|EAP|Custom 951224367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Classic Fem Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224368|EAP|Custom 951224368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Balanced Fem Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224369|EAP|Custom 951224369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Fb Tibia Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224370|EAP|Custom 951224370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Fb Curved Inserts Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224371|EAP|Custom 951224371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Bal Fem Prep Rot Plat Hprfr Sgm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224372|EAP|Custom 951224372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Block Cut Sgm Hprfr Fnsh Fem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224373|EAP|Custom 951224373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp 1 Upgrd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224374|EAP|Custom 951224374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp Bs Qck Kt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224375|EAP|Custom 951224375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl 1st Ant Sgm Hp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224376|EAP|Custom 951224376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Outlier Sgm Hp Mac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224377|EAP|Custom 951224377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp Crv +|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224378|EAP|Custom 951224378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp 2.5 1 Bioskills|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224379|EAP|Custom 951224379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ins Tib Mac Rot Plat Hprfr Sgm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224380|EAP|Custom 951224380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Fx Brng Hprfr Ins Pli|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224381|EAP|Custom 951224381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Inlay Hprfr Duofix Mac Mbt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224382|EAP|Custom 951224382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Std Hprfr Pnch Sgm Srg Tib|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224383|EAP|Custom 951224383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp Ins Inst|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224384|EAP|Custom 951224384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp Qck Kt Fx Brng|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224385|EAP|Custom 951224385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp 1 Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224386|EAP|Custom 951224386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Inst Fem Prep Ins Rev Sgm Hp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224387|EAP|Custom 951224387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Hp 2.5 2 Bioskills|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224388|EAP|Custom 951224388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl 150mm Sgm Fem Prp Fx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224389|EAP|Custom 951224389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Mic Cls Fem Prep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224390|EAP|Custom 951224390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Tib Resct Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224391|EAP|Custom 951224391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Ap Resct Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224392|EAP|Custom 951224392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Bal Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228541|EAP|Custom 951228541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Extnsn Pilot Shaft 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228542|EAP|Custom 951228542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Extnsn Pilot Shaft 19mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228543|EAP|Custom 951228543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Sleeve Introducer Sz 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228544|EAP|Custom 951228544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Sleeve Introducer Sz 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228545|EAP|Custom 951228545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*introducer Sleeve Body16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228546|EAP|Custom 951228546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*introducer Sleeve Body18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228547|EAP|Custom 951228547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*introducer Sleeve Body20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228548|EAP|Custom 951228548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*introducer Sleeve Body22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228549|EAP|Custom 951228549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*introducr Sleeve Body24m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228550|EAP|Custom 951228550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*extractor Stem Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228551|EAP|Custom 951228551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*blade Slve Extrctr 14/16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228552|EAP|Custom 951228552||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*blade Slve Extrctr 18/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228553|EAP|Custom 951228553||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*blade Slve Extrctr 22/24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228554|EAP|Custom 951228554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 14a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228555|EAP|Custom 951228555||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 14b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228556|EAP|Custom 951228556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 14d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228557|EAP|Custom 951228557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 14f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228558|EAP|Custom 951228558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 16b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228559|EAP|Custom 951228559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 16d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228560|EAP|Custom 951228560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 16f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228561|EAP|Custom 951228561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 18b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228562|EAP|Custom 951228562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 18d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228563|EAP|Custom 951228563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 18f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228564|EAP|Custom 951228564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 20b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228565|EAP|Custom 951228565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 20d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228566|EAP|Custom 951228566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 20f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228567|EAP|Custom 951228567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 22b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228568|EAP|Custom 951228568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 22d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228569|EAP|Custom 951228569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 22f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228570|EAP|Custom 951228570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 24b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228571|EAP|Custom 951228571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 24d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228572|EAP|Custom 951228572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Proximl Fem 24f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228573|EAP|Custom 951228573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Straight 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228574|EAP|Custom 951228574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Straight 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228575|EAP|Custom 951228575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 8mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228576|EAP|Custom 951228576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Reamer Blunt 6.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228577|EAP|Custom 951228577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Reamer Blunt 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228578|EAP|Custom 951228578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Bit 3.2/70mm(jmpc)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228579|EAP|Custom 951228579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*screw Depth Gauge Wire-j|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228580|EAP|Custom 951228580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*clamp Screw 6.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228581|EAP|Custom 951228581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*guide Drill 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228582|EAP|Custom 951228582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Flex 1/4 Dia Jmpc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228583|EAP|Custom 951228583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*impactor Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228584|EAP|Custom 951228584||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*handle Sleeve Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228585|EAP|Custom 951228585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*stem/sleve Separtor Wedg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228586|EAP|Custom 951228586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 9mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228587|EAP|Custom 951228587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 10mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228588|EAP|Custom 951228588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 11mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228589|EAP|Custom 951228589||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 12mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228590|EAP|Custom 951228590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 13mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228591|EAP|Custom 951228591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 14mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228592|EAP|Custom 951228592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 15mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228593|EAP|Custom 951228593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 16mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228594|EAP|Custom 951228594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 17mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228595|EAP|Custom 951228595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 18mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228596|EAP|Custom 951228596||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 19mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228597|EAP|Custom 951228597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 20mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228598|EAP|Custom 951228598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 21mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228599|EAP|Custom 951228599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 8.5mm Straight Bullet Nose Rmr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228600|EAP|Custom 951228600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 10.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228601|EAP|Custom 951228601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 11.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228602|EAP|Custom 951228602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 12.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228603|EAP|Custom 951228603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 13.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228604|EAP|Custom 951228604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 14.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228605|EAP|Custom 951228605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 15.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228606|EAP|Custom 951228606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 16.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228607|EAP|Custom 951228607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 17.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228608|EAP|Custom 951228608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 18.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228609|EAP|Custom 951228609||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 9.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228610|EAP|Custom 951228610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 20.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228611|EAP|Custom 951228611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 21.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228612|EAP|Custom 951228612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 22mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228613|EAP|Custom 951228613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 22.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228614|EAP|Custom 951228614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 23mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228615|EAP|Custom 951228615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Reamer Blunt 19.5mm Str|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228616|EAP|Custom 951228616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228617|EAP|Custom 951228617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228618|EAP|Custom 951228618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228619|EAP|Custom 951228619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228620|EAP|Custom 951228620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228621|EAP|Custom 951228621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228622|EAP|Custom 951228622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*reamer Triang Miller Sz8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228623|EAP|Custom 951228623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*cuttr Triang Miller Sz14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228624|EAP|Custom 951228624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*cuttr Triang Miller Sz16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228625|EAP|Custom 951228625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*cuttr Triang Miller Sz18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228626|EAP|Custom 951228626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*cuttr Triang Miller Sz20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228627|EAP|Custom 951228627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*cuttr Triang Miller Sz22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228628|EAP|Custom 951228628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*cuttr Triang Miller Sz24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228629|EAP|Custom 951228629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*frame Triangle Miller|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228630|EAP|Custom 951228630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smartset*univ Str Ream St Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228631|EAP|Custom 951228631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c.* Broach Hand Align Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228632|EAP|Custom 951228632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*fem Extractor Instr Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228633|EAP|Custom 951228633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*fem Inst Mill/cut Sh Try|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228634|EAP|Custom 951228634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*fem Inst/sz16-24 Try|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228635|EAP|Custom 951228635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb J-fx Bipolar Disassembly Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228636|EAP|Custom 951228636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Cem Fem Instrumnt Tray #1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228637|EAP|Custom 951228637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c. Broach Ext/imp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228638|EAP|Custom 951228638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smartset 6.0mm St Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228639|EAP|Custom 951228639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smartset 7.0mm St Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228640|EAP|Custom 951228640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smartset 8.0mm St Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228641|EAP|Custom 951228641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom/uni-rom Fem Inst Starter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228642|EAP|Custom 951228642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ultima*unipol Adaptor Rem Tee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228643|EAP|Custom 951228643||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom* 10mm Pilot Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228644|EAP|Custom 951228644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*ztt Sleeve Sampl18d-lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228645|EAP|Custom 951228645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Broach Handle New|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228646|EAP|Custom 951228646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach Handle Post Levered|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228647|EAP|Custom 951228647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 10.5mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228648|EAP|Custom 951228648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 12.0mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228649|EAP|Custom 951228649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 13.5mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228650|EAP|Custom 951228650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 15.0mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228651|EAP|Custom 951228651||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 16.5mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228652|EAP|Custom 951228652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 18.0mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228653|EAP|Custom 951228653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 19.5mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228654|EAP|Custom 951228654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach 21mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228655|EAP|Custom 951228655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach 22.5mm Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228656|EAP|Custom 951228656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 10.5mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228657|EAP|Custom 951228657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 12.0mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228658|EAP|Custom 951228658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 13.5mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228659|EAP|Custom 951228659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 15.0mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228660|EAP|Custom 951228660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 16.5mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228661|EAP|Custom 951228661||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 18.0mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228662|EAP|Custom 951228662||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 19.5mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228663|EAP|Custom 951228663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach 21mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228664|EAP|Custom 951228664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach 22.5mm Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228665|EAP|Custom 951228665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 15.0mm Xlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228666|EAP|Custom 951228666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 16.5mm Xlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228667|EAP|Custom 951228667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach 18.0mm Xlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228668|EAP|Custom 951228668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Aa Neck Resection Guide Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228669|EAP|Custom 951228669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Aa Neck Resection Guide Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228670|EAP|Custom 951228670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Protrusio Cage Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228671|EAP|Custom 951228671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Locking Pliers 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228672|EAP|Custom 951228672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Shaft Protrusio Cage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228673|EAP|Custom 951228673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Tip Protrusio Cage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228674|EAP|Custom 951228674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Straight Depth Gauge 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228675|EAP|Custom 951228675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Starter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228676|EAP|Custom 951228676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228677|EAP|Custom 951228677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228678|EAP|Custom 951228678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228679|EAP|Custom 951228679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228680|EAP|Custom 951228680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228681|EAP|Custom 951228681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228682|EAP|Custom 951228682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228683|EAP|Custom 951228683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228684|EAP|Custom 951228684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228685|EAP|Custom 951228685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228686|EAP|Custom 951228686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228687|EAP|Custom 951228687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228688|EAP|Custom 951228688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Broach Sz 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228689|EAP|Custom 951228689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Std Nk Sz0/1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228690|EAP|Custom 951228690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Hi Nk Sz0/1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228691|EAP|Custom 951228691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Std Nk Sz2/3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228692|EAP|Custom 951228692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Hi Nk Sz2/3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228693|EAP|Custom 951228693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Std Nk Sz4/5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228694|EAP|Custom 951228694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Hi Nk Sz4/5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228695|EAP|Custom 951228695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Std Nk Sz6/7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228696|EAP|Custom 951228696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Hi Nk Sz6/7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228697|EAP|Custom 951228697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Std Nk Sz8/9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228698|EAP|Custom 951228698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Hi Nk Sz8/9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228699|EAP|Custom 951228699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Std Nk Sz10/11/12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228700|EAP|Custom 951228700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Hi Nk Sz10/11/12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228701|EAP|Custom 951228701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Neck Res Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228702|EAP|Custom 951228702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tri-lock Bps Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228703|EAP|Custom 951228703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dur Const Lnr Ring Starter 28|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228704|EAP|Custom 951228704||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dur Const Lnr Ring Starter 32|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228705|EAP|Custom 951228705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dur Poly Impactor Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228706|EAP|Custom 951228706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screw Holding Forcep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228707|EAP|Custom 951228707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ult-c Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228708|EAP|Custom 951228708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Polthn Cup Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217349|EAP|Custom 951217349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Peripheral Screw Drill 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217350|EAP|Custom 951217350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Peripheral Screw Drill 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217351|EAP|Custom 951217351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Peripheral Screw Drill 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217352|EAP|Custom 951217352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Peripheral Screw Drill 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217353|EAP|Custom 951217353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ref Acet Screw Drill 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217354|EAP|Custom 951217354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Refl Acet Peg Drill 15mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217355|EAP|Custom 951217355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reflection Peg Removal Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217356|EAP|Custom 951217356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Refl Acet Screw Drill 35mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217357|EAP|Custom 951217357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexible Drill 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217358|EAP|Custom 951217358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexible Peg Drill 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217359|EAP|Custom 951217359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexible Drill 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217360|EAP|Custom 951217360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Refl Peg Drill 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217361|EAP|Custom 951217361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexible Drill 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217362|EAP|Custom 951217362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Refl Peg Drill 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217363|EAP|Custom 951217363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexible Drill 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217364|EAP|Custom 951217364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217365|EAP|Custom 951217365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pelvis Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217366|EAP|Custom 951217366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Recn Ring Trl 50/46 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217367|EAP|Custom 951217367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Recn Ring Trl 56/52 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217368|EAP|Custom 951217368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Recn Ring Trl 62/58 Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217369|EAP|Custom 951217369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Rcn Rng Trl 68od 64id Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217370|EAP|Custom 951217370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Rcn Rng Trl 74od 70id Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217371|EAP|Custom 951217371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Recn Ring Trl 50/46 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217372|EAP|Custom 951217372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Recn Ring Trl 56/52 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217373|EAP|Custom 951217373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Recn Ring Trl 62/58 Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217374|EAP|Custom 951217374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Rcn Rng Trl 68od 64id Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217375|EAP|Custom 951217375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cont Rcn Rng Trl 74od 70id Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217376|EAP|Custom 951217376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cemntd Cup Placement Head 36mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217377|EAP|Custom 951217377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Ef Gde Rod/buck Plug 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217378|EAP|Custom 951217378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Ef Gde Rod/buck Plug 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217379|EAP|Custom 951217379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec Ef Gde Rod/buck Plug 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217380|EAP|Custom 951217380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solis Hip Surgical Light|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217381|EAP|Custom 951217381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Blade 8 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217382|EAP|Custom 951217382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Blade 10 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217383|EAP|Custom 951217383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Blade 12 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217384|EAP|Custom 951217384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Blade 20 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217385|EAP|Custom 951217385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rad Osteo Blade Sz 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217386|EAP|Custom 951217386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rad Osteo Blade Sz 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217387|EAP|Custom 951217387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rad Osteo Blade Sz 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217388|EAP|Custom 951217388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rad Osteo Blade Sz 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217389|EAP|Custom 951217389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Blade 8 X 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217390|EAP|Custom 951217390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Blade 10 X 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217391|EAP|Custom 951217391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Bld Round End 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217392|EAP|Custom 951217392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteo Bld Round End 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217394|EAP|Custom 951217394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ech Ha Str Std Sz 12-17 Samp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217395|EAP|Custom 951217395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ech Ha Str +15 Sz 12-17 Samp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217396|EAP|Custom 951217396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Redapt Stem 300mm Sz 15 So Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217397|EAP|Custom 951217397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Emp Sam 13 Slv Mdcn 2 Spt Slt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217398|EAP|Custom 951217398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxinium Fem Head 22mm Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217399|EAP|Custom 951217399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Alum Cer Fem Hd 28mm+8 Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217400|EAP|Custom 951217400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Redapt Fully Porous Cup Sample 56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217401|EAP|Custom 951217401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Redapt Fully Porous Cup Sample 62mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217402|EAP|Custom 951217402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anthology So Sample Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217403|EAP|Custom 951217403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syn Select Ii Por So 10/12 Sam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217404|EAP|Custom 951217404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anthology Ho Sample Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217405|EAP|Custom 951217405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syn Sel Ii Por Ho 10/12 Sam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217406|EAP|Custom 951217406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syn Sel Ii Rf Por So 10/12 Sam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217407|EAP|Custom 951217407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Alum Cer Lnr 32 50-54 Sam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217408|EAP|Custom 951217408||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Redapt Fmd Sample Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217409|EAP|Custom 951217409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conv Bp Lnr 22id/52-56 Od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217410|EAP|Custom 951217410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conv Bp Lnr 26id/38-42 Od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217411|EAP|Custom 951217411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conv Bp Lnr 28id/43-46 Od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217412|EAP|Custom 951217412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conv Bp Lnr 28id/47-51 Od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217413|EAP|Custom 951217413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conv Bp Lnr 28id/52-56 Od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217414|EAP|Custom 951217414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conv Bp Lnr 28id/57-60 Od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217942|EAP|Custom 951217942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Polarcup Shell Ti-plasma 51 Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217943|EAP|Custom 951217943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Polarcup Shell 51 Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217977|EAP|Custom 951217977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S Bone Lever Expanded Double Curv.no. 37|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217978|EAP|Custom 951217978||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fai Template Kit 42-58|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218040|EAP|Custom 951218040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Polarstem Std W. Ti/ha 3 Non-cem Sample|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218065|EAP|Custom 951218065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Polarstem Trial Neck Collar Std 01|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218093|EAP|Custom 951218093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cc Moore Endo 40mm Ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218094|EAP|Custom 951218094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cc Moore Endo 41mm Ster|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218095|EAP|Custom 951218095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Short Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Uni 12/14 Tpr Slv + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218833|EAP|Custom 951218833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tandem Uni 12/14 Tpr Slv -3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Uni 12/14 Tpr Slv + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Uni 12/14 Tpr Slv + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Uni 12/14 Tpr Slv + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219841|EAP|Custom 951219841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spir Gigli Saw Blade 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219842|EAP|Custom 951219842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spir Gigli Saw Blade 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219843|EAP|Custom 951219843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bhr Short Alignment Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219844|EAP|Custom 951219844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bhr Long Guide Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219845|EAP|Custom 951219845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 32id Crmc Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219846|EAP|Custom 951219846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 32id Crmc Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219847|EAP|Custom 951219847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219848|EAP|Custom 951219848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219849|EAP|Custom 951219849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219850|EAP|Custom 951219850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219851|EAP|Custom 951219851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219852|EAP|Custom 951219852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219853|EAP|Custom 951219853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 36id Crmc Disp Trl Lnr 64od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219854|EAP|Custom 951219854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 46od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219855|EAP|Custom 951219855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219856|EAP|Custom 951219856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219857|EAP|Custom 951219857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219858|EAP|Custom 951219858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219859|EAP|Custom 951219859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219860|EAP|Custom 951219860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219861|EAP|Custom 951219861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 28id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219862|EAP|Custom 951219862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219863|EAP|Custom 951219863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 50d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219864|EAP|Custom 951219864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 52d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219865|EAP|Custom 951219865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 54d|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219866|EAP|Custom 951219866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219867|EAP|Custom 951219867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219868|EAP|Custom 951219868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219869|EAP|Custom 951219869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 32id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219870|EAP|Custom 951219870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219871|EAP|Custom 951219871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 54od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219872|EAP|Custom 951219872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 56od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219873|EAP|Custom 951219873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 58od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219874|EAP|Custom 951219874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 60od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219875|EAP|Custom 951219875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 62od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219876|EAP|Custom 951219876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 0 Deg 36id Disp Trl Lnr 64od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219877|EAP|Custom 951219877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 46od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219878|EAP|Custom 951219878||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 48od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219879|EAP|Custom 951219879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 50od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951219880|EAP|Custom 951219880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb R3 20 Deg 28id Disp Trl Lnr 52od|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951220766|EAP|Custom 951220766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lgn Hk Dis Fem Wedge Sz 7 20m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221663|EAP|Custom 951221663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Mallet Rplcmnt Hd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221664|EAP|Custom 951221664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Sawblade 1.35mm Fan Strykr2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221665|EAP|Custom 951221665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Sawblade-stry Old Sty Fan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221666|EAP|Custom 951221666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscillating Saw Blade 1.35mm Fan 3m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221667|EAP|Custom 951221667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Swblde 1.35mm Nrw {} Strykr2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221668|EAP|Custom 951221668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Sawblade 1.35mm Nrw Strykr Ort|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221669|EAP|Custom 951221669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Swblade 1.35mm Nrw Hall 1/2 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221670|EAP|Custom 951221670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oscill Sawblade 1.35mm Narrow 3m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221671|EAP|Custom 951221671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osc Swbld Versipower Plus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221672|EAP|Custom 951221672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Long Profix Bone Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221679|EAP|Custom 951221679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S1 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221680|EAP|Custom 951221680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S1 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221681|EAP|Custom 951221681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S2sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221682|EAP|Custom 951221682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S2lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221683|EAP|Custom 951221683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S2 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221684|EAP|Custom 951221684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S2 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221685|EAP|Custom 951221685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S3sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221686|EAP|Custom 951221686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S3lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221687|EAP|Custom 951221687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S3 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221688|EAP|Custom 951221688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S3 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221689|EAP|Custom 951221689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S4sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221690|EAP|Custom 951221690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S4lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221691|EAP|Custom 951221691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S4 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221692|EAP|Custom 951221692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S4 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221693|EAP|Custom 951221693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S5sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221694|EAP|Custom 951221694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S5lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221695|EAP|Custom 951221695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S5 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221696|EAP|Custom 951221696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S5 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221697|EAP|Custom 951221697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S6sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221698|EAP|Custom 951221698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S6lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221699|EAP|Custom 951221699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S6 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221700|EAP|Custom 951221700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S6 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221701|EAP|Custom 951221701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpro Fem Wedge S7sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221702|EAP|Custom 951221702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Nonpor Fem Wedge S7lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221703|EAP|Custom 951221703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S7 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221704|EAP|Custom 951221704||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Dst Fm Wdg S7 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221705|EAP|Custom 951221705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg S1m 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221706|EAP|Custom 951221706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg S1m 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221707|EAP|Custom 951221707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 1l2m 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221708|EAP|Custom 951221708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 1l2m10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221709|EAP|Custom 951221709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 2l3m 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221710|EAP|Custom 951221710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 2l3m10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221711|EAP|Custom 951221711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 3l4m 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221712|EAP|Custom 951221712||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 3l4m10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221713|EAP|Custom 951221713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 4l5m 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221714|EAP|Custom 951221714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 4l5m10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221715|EAP|Custom 951221715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 5l6m 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221716|EAP|Custom 951221716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 5l6m10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221717|EAP|Custom 951221717||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 6l 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221718|EAP|Custom 951221718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Np Tib Stp Wdg 6l 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221793|EAP|Custom 951221793||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mb Rotation Peg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221809|EAP|Custom 951221809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 1.75 Inch Bone Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221810|EAP|Custom 951221810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Qc Trocar Pin 1/8 X 2.25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221811|EAP|Custom 951221811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 4.8 Mm Quick Connect Drill Bit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222753|EAP|Custom 951222753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Drill 3 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222779|EAP|Custom 951222779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rt-plus Tibial Block 4/10 Cemented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222780|EAP|Custom 951222780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rt-plus Tibial Block 6/10 Cemented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222781|EAP|Custom 951222781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rt-plus Tibial Block 8/10 Cemented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222782|EAP|Custom 951222782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rt-plus Tibial Block 10/10 Cemented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222826|EAP|Custom 951222826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tc-plus Saw Blade (stryker 2000/4/5)13/1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222838|EAP|Custom 951222838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tibl Block 5mm / 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222839|EAP|Custom 951222839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tibl Block 5mm / Plus Vks 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222840|EAP|Custom 951222840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tibl Block 5mm / 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222841|EAP|Custom 951222841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tibl Block 5mm / 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222842|EAP|Custom 951222842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tibl Block 5mm / Plus Vks 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222843|EAP|Custom 951222843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Rt.lat.lt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222844|EAP|Custom 951222844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Rt.lat.lt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222845|EAP|Custom 951222845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Rt.lat.lt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222846|EAP|Custom 951222846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Rt.lat.lt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222847|EAP|Custom 951222847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Rt.lat.lt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222848|EAP|Custom 951222848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Lt.lat.rt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222849|EAP|Custom 951222849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Lt.lat.rt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222850|EAP|Custom 951222850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Lt.lat.rt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222851|EAP|Custom 951222851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Lt.lat.rt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951222852|EAP|Custom 951222852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plus Vks Rev Tib Block Lt.lat.rt.med 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223549|EAP|Custom 951223549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 3pg 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223550|EAP|Custom 951223550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 3pg 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223551|EAP|Custom 951223551||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 3pg 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223552|EAP|Custom 951223552||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 3pg 41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223553|EAP|Custom 951223553||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Rd 1pg 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223554|EAP|Custom 951223554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 1pg 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223555|EAP|Custom 951223555||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 1pg 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223556|EAP|Custom 951223556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 1pg 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223557|EAP|Custom 951223557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Ov 1pg 41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223558|EAP|Custom 951223558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Por Tib Pnch Gde Sz 1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223559|EAP|Custom 951223559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Por Tib Pnch Gde Sz 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223560|EAP|Custom 951223560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Por Tray Pnch Size 1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223561|EAP|Custom 951223561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Por Tray Pnch Size 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223562|EAP|Custom 951223562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mod Porous Tray Holding Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223563|EAP|Custom 951223563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Rd 1pg 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223564|EAP|Custom 951223564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Rd 1pg 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223565|EAP|Custom 951223565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Rd 1pg 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223566|EAP|Custom 951223566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Pat Drl Gd Rd 1pg 41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223567|EAP|Custom 951223567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 3 Post Ovdome Drlgd32&35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223568|EAP|Custom 951223568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 3 Post Ovdome Drlgd38&41mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223585|EAP|Custom 951223585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Pat Planer Depth Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223586|EAP|Custom 951223586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Pat Planer Instrument Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223587|EAP|Custom 951223587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Offset Tib Bushing Sz1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223588|EAP|Custom 951223588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Offset Tib Bushing Sz4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223589|EAP|Custom 951223589||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mod Plus Offset Sterilizat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223590|EAP|Custom 951223590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ofset Tib Tall Drl Bush S1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223591|EAP|Custom 951223591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ofset Tib Tall Drl Bush S4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223592|EAP|Custom 951223592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ofset Tib Ncem Pnch Gde S1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223593|EAP|Custom 951223593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ofset Tib Ncem Pnch Gde S4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223594|EAP|Custom 951223594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Offset Tib Cem Pnch Gde S1.5-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223595|EAP|Custom 951223595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Offset Tib Cem Pnch Gde S4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223596|EAP|Custom 951223596||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ofset Tib Cem Pnch Str Try Ins|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223597|EAP|Custom 951223597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ofset Tib Ncem Pnch Str Try In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223598|EAP|Custom 951223598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spec* Alignment Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223599|EAP|Custom 951223599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Im Rod Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223600|EAP|Custom 951223600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*cemented Rev Sleeve 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223601|EAP|Custom 951223601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*cemented Rev Sleeve 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223602|EAP|Custom 951223602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xr Positioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223603|EAP|Custom 951223603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Xr Positioner Cushion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223604|EAP|Custom 951223604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem Pat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223605|EAP|Custom 951223605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223606|EAP|Custom 951223606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223607|EAP|Custom 951223607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223608|EAP|Custom 951223608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223609|EAP|Custom 951223609||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 3.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223610|EAP|Custom 951223610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223611|EAP|Custom 951223611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 5.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223612|EAP|Custom 951223612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Fem 6.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223613|EAP|Custom 951223613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223614|EAP|Custom 951223614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223615|EAP|Custom 951223615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223616|EAP|Custom 951223616||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 3.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223617|EAP|Custom 951223617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223618|EAP|Custom 951223618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 5.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223619|EAP|Custom 951223619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Tib 6.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223620|EAP|Custom 951223620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Tray Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223621|EAP|Custom 951223621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixed Reference Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223622|EAP|Custom 951223622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibia Extension|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223623|EAP|Custom 951223623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Drill Guide Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223624|EAP|Custom 951223624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Anterior Ref Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223625|EAP|Custom 951223625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trumatch Prim Res Instr Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223626|EAP|Custom 951223626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev 4in1 Cut Blk Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223627|EAP|Custom 951223627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev 4in1 Cut Blk Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223628|EAP|Custom 951223628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev 4in1 Cut Blk Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223629|EAP|Custom 951223629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev 4in1 Cut Blk Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223630|EAP|Custom 951223630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev 4in1 Cut Blk Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223631|EAP|Custom 951223631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Notch Guide Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223632|EAP|Custom 951223632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Notch Guide Sz2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223633|EAP|Custom 951223633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Notch Guide Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223634|EAP|Custom 951223634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Notch Guide Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223635|EAP|Custom 951223635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Notch Guide Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223636|EAP|Custom 951223636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Mbt Spc Blk 10/12.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223637|EAP|Custom 951223637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Mbt Spc Blk 15/17.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223638|EAP|Custom 951223638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Mbt Spc Blk 20/22.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223639|EAP|Custom 951223639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Mbt Spc Blk 25/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223640|EAP|Custom 951223640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Distal Spacer 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223641|EAP|Custom 951223641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Distal Spacer 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223642|EAP|Custom 951223642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Distal Spacer 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223643|EAP|Custom 951223643||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Distal Spacer 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223644|EAP|Custom 951223644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Adp Rem Shaft Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223645|EAP|Custom 951223645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Femoral Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223648|EAP|Custom 951223648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Fem Adap Shift Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223649|EAP|Custom 951223649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Extension Shim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223650|EAP|Custom 951223650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Tc3 Rp Insrt/sp Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223651|EAP|Custom 951223651||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Torq Lmt Scrwdrvr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223652|EAP|Custom 951223652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Rev Screwdriver Shank|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223653|EAP|Custom 951223653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Tib Cut Blk Lm/rl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223654|EAP|Custom 951223654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Tib Cut Blk Rm/ll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223655|EAP|Custom 951223655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Tibial Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223656|EAP|Custom 951223656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Lamina Spreader|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223657|EAP|Custom 951223657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Pressure Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223658|EAP|Custom 951223658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Sterile Case 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223659|EAP|Custom 951223659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Sterile Case 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223660|EAP|Custom 951223660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni X-ray Temp Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223661|EAP|Custom 951223661||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni X-ray Lateral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223662|EAP|Custom 951223662||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Tibial Sizing Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223663|EAP|Custom 951223663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Ap Keel Osteotome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223664|EAP|Custom 951223664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Tib Peg Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223665|EAP|Custom 951223665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Fb Keel Osteotome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223666|EAP|Custom 951223666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Fem Align Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223667|EAP|Custom 951223667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Distal Shim 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223668|EAP|Custom 951223668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Distal Shim 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223669|EAP|Custom 951223669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Distal Shim 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223670|EAP|Custom 951223670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Distal Shim 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223671|EAP|Custom 951223671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Fem Peg Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223672|EAP|Custom 951223672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Femoral Introducr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223673|EAP|Custom 951223673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Femoral Spacer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223674|EAP|Custom 951223674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Femoral Tip Gouge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223675|EAP|Custom 951223675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Uni Femoral Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223676|EAP|Custom 951223676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Peg Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223677|EAP|Custom 951223677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Drill Guide Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223678|EAP|Custom 951223678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 1l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223679|EAP|Custom 951223679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 2l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223680|EAP|Custom 951223680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 3l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223681|EAP|Custom 951223681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 4l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223682|EAP|Custom 951223682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 5l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223683|EAP|Custom 951223683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 1r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223684|EAP|Custom 951223684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 2r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223685|EAP|Custom 951223685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 3r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223686|EAP|Custom 951223686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 4r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223687|EAP|Custom 951223687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Finish Guide 5r|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223688|EAP|Custom 951223688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Drill Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223689|EAP|Custom 951223689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Sterile Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223690|EAP|Custom 951223690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp System Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223713|EAP|Custom 951223713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Dstl Pilot Drl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223714|EAP|Custom 951223714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Sizing Arm 1-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223715|EAP|Custom 951223715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Sizing Arm 3-4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223716|EAP|Custom 951223716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Troch Sizing Arm 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224393|EAP|Custom 951224393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Fnsh Gd Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224394|EAP|Custom 951224394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Ptlr Prep Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224395|EAP|Custom 951224395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Gn Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224396|EAP|Custom 951224396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Hprfr Lcs 1 Sm Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224397|EAP|Custom 951224397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Hprfr Lcs 2 Sm Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224398|EAP|Custom 951224398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Impct Xtrt Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224399|EAP|Custom 951224399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Strl Prep Mbl Br Hprfr Lcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224400|EAP|Custom 951224400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Mac Sgm 150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224401|EAP|Custom 951224401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Case Strl Sgm Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224415|EAP|Custom 951224415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reach Knee Case 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224416|EAP|Custom 951224416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shim Cut Sgm Flxn Hprfr Crf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224417|EAP|Custom 951224417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tmplt Sz 1-6 Rot Plat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224418|EAP|Custom 951224418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cr150 X-ray Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224419|EAP|Custom 951224419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adpr Slv Stm Xtrt Kn Sr Noiles Rot Hng|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224420|EAP|Custom 951224420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spcr Fem 5mm Sr Kn Aug Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224421|EAP|Custom 951224421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spcr Fem 10mm Sr Kn Aug Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224422|EAP|Custom 951224422||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Cut Sr Ant Ref|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224423|EAP|Custom 951224423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Cptr Sw Sr Srg Kn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224424|EAP|Custom 951224424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Base Inst Sr Impct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224425|EAP|Custom 951224425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Orth Impct Cap Hng Lps Sr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224426|EAP|Custom 951224426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom* Handle Univ Quik Release|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224427|EAP|Custom 951224427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modular Plus Tibial Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224428|EAP|Custom 951224428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr Femoral Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224429|EAP|Custom 951224429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sig Keeled Tib Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224430|EAP|Custom 951224430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tc3 Femoral Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224431|EAP|Custom 951224431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Mod Knee Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224432|EAP|Custom 951224432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Offset Tibial Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224433|EAP|Custom 951224433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Im Mount|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224434|EAP|Custom 951224434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Cut Blck Mount|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224435|EAP|Custom 951224435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Tibial Block L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224436|EAP|Custom 951224436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Tibial Block R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224437|EAP|Custom 951224437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Broach M-l 29mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224438|EAP|Custom 951224438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Broach M-l 37mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224439|EAP|Custom 951224439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Broach M-l 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224440|EAP|Custom 951224440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Broach M-l 53mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224441|EAP|Custom 951224441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Broach M-l 61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224442|EAP|Custom 951224442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Broach M-l 69mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224443|EAP|Custom 951224443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Base Mount|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224444|EAP|Custom 951224444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Tib Prp Twr Offst Bsh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224445|EAP|Custom 951224445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Distalizing Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224446|EAP|Custom 951224446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Broach Adptr Sz 1-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224447|EAP|Custom 951224447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Broach Adptr Sz 4-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224448|EAP|Custom 951224448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Broach Adptr Sz 8-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224449|EAP|Custom 951224449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Anterior Cut Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224450|EAP|Custom 951224450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Notch Guide Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224451|EAP|Custom 951224451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Notch Guide Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224452|EAP|Custom 951224452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Notch Guide Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224453|EAP|Custom 951224453||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Notch Guide Sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224454|EAP|Custom 951224454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Notch Guide Sz7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224455|EAP|Custom 951224455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Notch Guide Sz8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224456|EAP|Custom 951224456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Dstl Spcr 4mm 3-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224457|EAP|Custom 951224457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Dstl Spcr 8mm 3-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224458|EAP|Custom 951224458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Dstl Spcr 12mm 3-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224459|EAP|Custom 951224459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Dstl Spcr 16mm 3-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224460|EAP|Custom 951224460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach M-l 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224461|EAP|Custom 951224461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach M-l 35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224462|EAP|Custom 951224462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach M-l 40|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224463|EAP|Custom 951224463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach M-l 45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224464|EAP|Custom 951224464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach M-l 50|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224465|EAP|Custom 951224465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach M-l 55|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224466|EAP|Custom 951224466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Stm Stblzr 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224467|EAP|Custom 951224467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Stm Stblzr 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224468|EAP|Custom 951224468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Stm Stblzr 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224469|EAP|Custom 951224469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Stm Stblzr 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224470|EAP|Custom 951224470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Stm Stblzr 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224471|EAP|Custom 951224471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Stm Stblzr 24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224472|EAP|Custom 951224472||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Fem 4mm Offst Gde L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224473|EAP|Custom 951224473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Fem 6mm Offst Gde L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224474|EAP|Custom 951224474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Offset Dial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224475|EAP|Custom 951224475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv Cut Guide Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224476|EAP|Custom 951224476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv Cut Guide Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224477|EAP|Custom 951224477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv Cut Guide Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224478|EAP|Custom 951224478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv Cut Guide Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224479|EAP|Custom 951224479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv Cut Guide Sz 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224480|EAP|Custom 951224480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv Cut Guide Sz 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224481|EAP|Custom 951224481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach Stop L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224482|EAP|Custom 951224482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Broach Stop Shim 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224483|EAP|Custom 951224483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Broach Stop Shim 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224484|EAP|Custom 951224484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Broach Stop Shim 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224485|EAP|Custom 951224485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Broach Stop Shim 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224486|EAP|Custom 951224486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib Reamer Ref Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224487|EAP|Custom 951224487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Reamer Ref Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224488|EAP|Custom 951224488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atune Rev Offst Reamr Ref Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224489|EAP|Custom 951224489||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision System Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224490|EAP|Custom 951224490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev T-hndl Torque Drvr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224491|EAP|Custom 951224491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Slev Contr Torq Wrnch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224492|EAP|Custom 951224492||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atune Rev Asmbly Ofst Stablizr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224493|EAP|Custom 951224493||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Assembly Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224494|EAP|Custom 951224494||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Sleve Impactr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224495|EAP|Custom 951224495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Tibial Vice|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224496|EAP|Custom 951224496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Assem Fem Implnt Post|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224497|EAP|Custom 951224497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atune Rev Slaphmr Adptr Implnt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224498|EAP|Custom 951224498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Rp Conical Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224499|EAP|Custom 951224499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fb Conical Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224500|EAP|Custom 951224500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Offset Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224501|EAP|Custom 951224501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224502|EAP|Custom 951224502||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Boss Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224503|EAP|Custom 951224503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Cem Fem Reamer 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224504|EAP|Custom 951224504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224505|EAP|Custom 951224505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224506|EAP|Custom 951224506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224507|EAP|Custom 951224507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224508|EAP|Custom 951224508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224509|EAP|Custom 951224509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224510|EAP|Custom 951224510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224511|EAP|Custom 951224511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224512|EAP|Custom 951224512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224513|EAP|Custom 951224513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224514|EAP|Custom 951224514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 19mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224515|EAP|Custom 951224515||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224516|EAP|Custom 951224516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 21mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224517|EAP|Custom 951224517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224518|EAP|Custom 951224518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 23mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224519|EAP|Custom 951224519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Reamer 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224520|EAP|Custom 951224520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Augment Wobble Bit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224521|EAP|Custom 951224521||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Fem 2mm Offst Gde L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224522|EAP|Custom 951224522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Spacer Block Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224523|EAP|Custom 951224523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224524|EAP|Custom 951224524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224525|EAP|Custom 951224525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224526|EAP|Custom 951224526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224527|EAP|Custom 951224527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224528|EAP|Custom 951224528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224529|EAP|Custom 951224529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224530|EAP|Custom 951224530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Spacer Block Shim 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224531|EAP|Custom 951224531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Spacerblk Shim 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224532|EAP|Custom 951224532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Spacerblk Shim 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224533|EAP|Custom 951224533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Spacerblk Shim 26mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224534|EAP|Custom 951224534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Femoral Positioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224535|EAP|Custom 951224535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broach Stop R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224536|EAP|Custom 951224536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Post Capture Sz 1-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224537|EAP|Custom 951224537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Post Capture Sz6-10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224538|EAP|Custom 951224538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fb Insert Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224539|EAP|Custom 951224539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Revision Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224540|EAP|Custom 951224540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Gen Tib Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224541|EAP|Custom 951224541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Gen Fem Prep Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224542|EAP|Custom 951224542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Conv&offst Fem Prep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224543|EAP|Custom 951224543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atune Rev Rem Rmr Bushing 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224544|EAP|Custom 951224544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atune Rev Rem Rmr Bushing 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224545|EAP|Custom 951224545||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Canal Reamers Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224546|EAP|Custom 951224546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Pin & Spacing Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224547|EAP|Custom 951224547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Assembly Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224548|EAP|Custom 951224548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tip Rp & Broch Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224549|EAP|Custom 951224549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Cem Fem Reamer 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224550|EAP|Custom 951224550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Fem Broaching Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224557|EAP|Custom 951224557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev 6mm Hex Driver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224558|EAP|Custom 951224558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib 0mm Offset Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224559|EAP|Custom 951224559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib 2mm Offset Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224560|EAP|Custom 951224560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib 6mm Offset Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224561|EAP|Custom 951224561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Tib 4mm Offset Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224562|EAP|Custom 951224562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Ccg Rmr Guide Sz1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224563|EAP|Custom 951224563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Ccg Rmr Guide Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224564|EAP|Custom 951224564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Rev Ccg Rmr Guide Sz8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224565|EAP|Custom 951224565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Fem 2mm Offst Gde R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224566|EAP|Custom 951224566||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Fem 4mm Offst Gde R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224567|EAP|Custom 951224567||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atun Rev Fem 6mm Offst Gde R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227142|EAP|Custom 951227142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Dist Fem Poly Bumper Xxsm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227143|EAP|Custom 951227143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Fem To Sleeve Adapter +0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227144|EAP|Custom 951227144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Fem To Sleeve Adapter +10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227839|EAP|Custom 951227839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S.s Cable 1.8mm W/sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227840|EAP|Custom 951227840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable W/cable Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227937|EAP|Custom 951227937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Grip Tf Rev Shim 5 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227938|EAP|Custom 951227938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Grip Tf Rev Shim 10 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227939|EAP|Custom 951227939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Grip Tf Rev Shim 15 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227988|EAP|Custom 951227988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rtrctr 10.25in Cbr Blnt Srg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227989|EAP|Custom 951227989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Bit 3.2/40mm(jmpc)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227990|EAP|Custom 951227990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Bit 3.2/50mm(jmpc)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227991|EAP|Custom 951227991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*hex Key Wren 6.5mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227992|EAP|Custom 951227992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Bit 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227993|EAP|Custom 951227993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*drill Bit 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227994|EAP|Custom 951227994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*holder Pin & Screw 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227995|EAP|Custom 951227995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*holder Pin & Screw 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227996|EAP|Custom 951227996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c.* Femoral Rasp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227997|EAP|Custom 951227997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c.* Canal Finder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227998|EAP|Custom 951227998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c.* Femoral Head Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951227999|EAP|Custom 951227999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c. T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228000|EAP|Custom 951228000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slotted Mallet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228001|EAP|Custom 951228001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Step Starter Dril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228002|EAP|Custom 951228002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Box Osteotome|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228003|EAP|Custom 951228003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ranawat Post Retractor Ace Rt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228004|EAP|Custom 951228004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ranawat Post Ace Lt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228005|EAP|Custom 951228005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Neck Elevator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228006|EAP|Custom 951228006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ranawat Neck Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228007|EAP|Custom 951228007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ranawat Ant Ace Retr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228008|EAP|Custom 951228008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228009|EAP|Custom 951228009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Osteotomy Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228010|EAP|Custom 951228010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Excel Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228709|EAP|Custom 951228709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acet Cement Press Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228710|EAP|Custom 951228710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mod Endo Complete Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228711|EAP|Custom 951228711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Remover Instrument|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228712|EAP|Custom 951228712||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Sizer 41-46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228713|EAP|Custom 951228713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Sizer 47-51mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228714|EAP|Custom 951228714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Sizer 52-56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228715|EAP|Custom 951228715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Sizer 57-61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228716|EAP|Custom 951228716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol Sys Thinshaft Ream 23.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228720|EAP|Custom 951228720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 44mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228721|EAP|Custom 951228721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228722|EAP|Custom 951228722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 48mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228723|EAP|Custom 951228723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228724|EAP|Custom 951228724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228725|EAP|Custom 951228725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 54mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228726|EAP|Custom 951228726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 56mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228727|EAP|Custom 951228727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 58mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228728|EAP|Custom 951228728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228729|EAP|Custom 951228729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 62mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228730|EAP|Custom 951228730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 64mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228731|EAP|Custom 951228731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extractor Body 66mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228732|EAP|Custom 951228732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Augment Adjustable Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228733|EAP|Custom 951228733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Augment Insert Tip Top|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228734|EAP|Custom 951228734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Augment Insert Tip 90 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228735|EAP|Custom 951228735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Augment Rasping Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228736|EAP|Custom 951228736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Inst Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228737|EAP|Custom 951228737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Inst Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228738|EAP|Custom 951228738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Modular Rasp Inst Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228739|EAP|Custom 951228739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Finishing Rasp Inst Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228740|EAP|Custom 951228740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rasping Strike Plate|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228741|EAP|Custom 951228741||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rasping Power Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228742|EAP|Custom 951228742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Mod Rasp 50/52|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228743|EAP|Custom 951228743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Mod Rasp 54/56|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228744|EAP|Custom 951228744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Mod Rasp 58/60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228745|EAP|Custom 951228745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Mod Rasp 62/64|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228746|EAP|Custom 951228746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Mod Rasp 66/68|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228747|EAP|Custom 951228747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Mod Rasp 70/72|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228748|EAP|Custom 951228748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Rasp +5mm Offset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228749|EAP|Custom 951228749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Rasp +10mm Offset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228750|EAP|Custom 951228750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Rasp +20mm Offset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228751|EAP|Custom 951228751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 50/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228752|EAP|Custom 951228752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 54/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228753|EAP|Custom 951228753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 58/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228754|EAP|Custom 951228754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 62/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228755|EAP|Custom 951228755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 66/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228756|EAP|Custom 951228756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 70/10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228757|EAP|Custom 951228757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 50/15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228758|EAP|Custom 951228758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 54/15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228759|EAP|Custom 951228759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 58/15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228760|EAP|Custom 951228760||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 62/15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228761|EAP|Custom 951228761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 66/15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228762|EAP|Custom 951228762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 70/15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228763|EAP|Custom 951228763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 50/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228764|EAP|Custom 951228764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 54/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228765|EAP|Custom 951228765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 58/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228766|EAP|Custom 951228766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 62/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228767|EAP|Custom 951228767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 66/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228768|EAP|Custom 951228768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 70/20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228769|EAP|Custom 951228769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 50/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228770|EAP|Custom 951228770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 54/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228771|EAP|Custom 951228771||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 58/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228772|EAP|Custom 951228772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 62/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228773|EAP|Custom 951228773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 66/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228774|EAP|Custom 951228774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Augment Fin Rasp 70/30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228775|EAP|Custom 951228775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Poly Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228776|EAP|Custom 951228776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Cup Impactor Tip 22.225|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228777|EAP|Custom 951228777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Cup Impactor Tip 26mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228778|EAP|Custom 951228778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Cup Impactor Tip 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228779|EAP|Custom 951228779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Cup Impactor Tip 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228780|EAP|Custom 951228780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Poly Impactor Tip 36mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228781|EAP|Custom 951228781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Straight Cup Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228782|EAP|Custom 951228782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Version Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228783|EAP|Custom 951228783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Bantam Cup Impactor Adapt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228784|EAP|Custom 951228784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Extract Inst Case/tray Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228785|EAP|Custom 951228785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Es3 Instrument Case Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228786|EAP|Custom 951228786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 40/44/48 Mpsec Artc 12/14 Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228787|EAP|Custom 951228787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb 40/44/48 Mpsec Artc 11/13 Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228788|EAP|Custom 951228788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Inst Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228790|EAP|Custom 951228790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Impaction Inst Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228791|EAP|Custom 951228791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Inst Case W/tray And Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228792|EAP|Custom 951228792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Revision Inst Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228793|EAP|Custom 951228793||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Es3 Inst Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228794|EAP|Custom 951228794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnrev Lnr 28/32/36 Inst Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228795|EAP|Custom 951228795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Ab Inserter Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228796|EAP|Custom 951228796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Gripper Kit Pinnacle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228797|EAP|Custom 951228797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Esc Cnstr Lnr Case Cmpt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228798|EAP|Custom 951228798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Ab Tamp Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228799|EAP|Custom 951228799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Esc Liner Extractor Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228800|EAP|Custom 951228800||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinn Esc Cons Ring Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228830|EAP|Custom 951228830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Straight Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228831|EAP|Custom 951228831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ab Curved Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228832|EAP|Custom 951228832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 44mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228833|EAP|Custom 951228833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 46mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228834|EAP|Custom 951228834||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 48mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228835|EAP|Custom 951228835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 50mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228836|EAP|Custom 951228836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 52mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228837|EAP|Custom 951228837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 54mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228838|EAP|Custom 951228838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 56mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228839|EAP|Custom 951228839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 58mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228840|EAP|Custom 951228840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 60mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228841|EAP|Custom 951228841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 62mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228842|EAP|Custom 951228842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 64mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228843|EAP|Custom 951228843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle 66mm Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228844|EAP|Custom 951228844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Core Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228845|EAP|Custom 951228845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Bantam Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228846|EAP|Custom 951228846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pinnacle Bearing Removal Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228847|EAP|Custom 951228847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Alignment Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228848|EAP|Custom 951228848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Poly Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228849|EAP|Custom 951228849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impaction Instr Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228850|EAP|Custom 951228850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Poly Ext/imp Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228851|EAP|Custom 951228851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Sizer Tray 46-65|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228852|EAP|Custom 951228852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Sizer Tray 43-45 66-74|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228853|EAP|Custom 951228853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Opt Ab Insrt Case Comp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228854|EAP|Custom 951228854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drlc Bantam Cup Impactor Adap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228855|EAP|Custom 951228855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Duraloc Str Cup Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228856|EAP|Custom 951228856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Stem Inserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228857|EAP|Custom 951228857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228858|EAP|Custom 951228858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Broach Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228860|EAP|Custom 951228860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endur Diamond Tooth Broach Sz1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228861|EAP|Custom 951228861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endur Diamond Tooth Broach Sz2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228862|EAP|Custom 951228862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endur Diamond Tooth Broach Sz3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228863|EAP|Custom 951228863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endur Diamond Tooth Broach Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228864|EAP|Custom 951228864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endur Diamond Tooth Broach Sz5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228869|EAP|Custom 951228869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endur Rev Case And Trays #1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228870|EAP|Custom 951228870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Rev Case And Tray #2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228871|EAP|Custom 951228871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Calcar Cutting Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228872|EAP|Custom 951228872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Templates W/28mm Hds|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228873|EAP|Custom 951228873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endurance Cdh & Rev Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228874|EAP|Custom 951228874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Elite Stem Introducer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221349|EAP|Custom 951221349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S1 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221350|EAP|Custom 951221350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S1 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221351|EAP|Custom 951221351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz2 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221352|EAP|Custom 951221352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz2 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221353|EAP|Custom 951221353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S2 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221354|EAP|Custom 951221354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S2 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221355|EAP|Custom 951221355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz3 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221356|EAP|Custom 951221356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz3 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221357|EAP|Custom 951221357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S3 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221358|EAP|Custom 951221358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S3 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221359|EAP|Custom 951221359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz4 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221360|EAP|Custom 951221360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz4 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221361|EAP|Custom 951221361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S4 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221362|EAP|Custom 951221362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S4 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221363|EAP|Custom 951221363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz5 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221364|EAP|Custom 951221364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz5 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221365|EAP|Custom 951221365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S5 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221366|EAP|Custom 951221366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S5 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221367|EAP|Custom 951221367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz6 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221368|EAP|Custom 951221368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz6 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221369|EAP|Custom 951221369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S6 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221370|EAP|Custom 951221370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S6 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221371|EAP|Custom 951221371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz7 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221372|EAP|Custom 951221372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro Por Fem Wedge Sz7 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221373|EAP|Custom 951221373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S7 Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951221374|EAP|Custom 951221374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pro P Dst Fem Wdg S7 Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223215|EAP|Custom 951223215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Aug Plug Puller|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223216|EAP|Custom 951223216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tibial Tray Holding Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223217|EAP|Custom 951223217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Universal Mod Stem Wrench|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223218|EAP|Custom 951223218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb P.f.c.* Press-fit Rod Wrench|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223219|EAP|Custom 951223219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc* Oval Pat Drill-single End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223220|EAP|Custom 951223220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Oval Pat Drill W/hud End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223221|EAP|Custom 951223221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Tibial Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223222|EAP|Custom 951223222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Fem Distractor S-shape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223223|EAP|Custom 951223223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rpf Instrument Case Instrmts|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223278|EAP|Custom 951223278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adp Removable Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223279|EAP|Custom 951223279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Rev Fem Broach Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223280|EAP|Custom 951223280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adpt Torque Wrench|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223281|EAP|Custom 951223281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adpt Holding Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223282|EAP|Custom 951223282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Rev Fem Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223283|EAP|Custom 951223283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Rev Fem Broach 31mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223284|EAP|Custom 951223284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Rev Fem Broach 34mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223285|EAP|Custom 951223285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Rev Fem Broach 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223286|EAP|Custom 951223286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Univ Rev Fem Broach 46mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223287|EAP|Custom 951223287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adpt Instrument Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223288|EAP|Custom 951223288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adpt Instr Case Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223289|EAP|Custom 951223289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adpt Instr Case Tray 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223290|EAP|Custom 951223290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Fem Adpt Instr Case Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223291|EAP|Custom 951223291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc*sigma 7de/f St Tr Ada Assy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223367|EAP|Custom 951223367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rp Tib Try Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223368|EAP|Custom 951223368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Femoral Locating Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223369|EAP|Custom 951223369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Fem Locat Dev Ant 1st Scrw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223370|EAP|Custom 951223370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Fem Locatg Dev Outrigger|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223371|EAP|Custom 951223371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp*2 Distal Fem Cutting Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223376|EAP|Custom 951223376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral*stem Drill W/huds 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223377|EAP|Custom 951223377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral*stem Drill W/huds 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223378|EAP|Custom 951223378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Ap Chamf Blk Popup R.h.sz6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223379|EAP|Custom 951223379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Removable Handles Pkg 2ea|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951223380|EAP|Custom 951223380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Ap/cham Blk Popup Rh Sz1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224053|EAP|Custom 951224053||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Stemmable Fb Tib Gen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224054|EAP|Custom 951224054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Attune Stemmable Fb Tib Prep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224055|EAP|Custom 951224055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Tibial Radel Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224056|EAP|Custom 951224056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224057|EAP|Custom 951224057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 2nd Gen Visualization Wing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224058|EAP|Custom 951224058||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs 3-peg Rot Pat Tr Pins Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224059|EAP|Custom 951224059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sig Cr Np Fem Lt Sz 4n Tr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224060|EAP|Custom 951224060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sig Cr Np Fem Rt Sz 4n Tr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224061|EAP|Custom 951224061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sig Rpf Np Fem Lt Sz 4n Tr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224062|EAP|Custom 951224062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pfc Sig Rpf Np Fem Rt Sz 4n Tr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224063|EAP|Custom 951224063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224064|EAP|Custom 951224064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224065|EAP|Custom 951224065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224066|EAP|Custom 951224066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224067|EAP|Custom 951224067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224068|EAP|Custom 951224068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224069|EAP|Custom 951224069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Gd Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224070|EAP|Custom 951224070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Distal Fem Outrigger|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224071|EAP|Custom 951224071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Tib Cutting Gd 0 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224072|EAP|Custom 951224072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Tib Cutting Gd 3 Deg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224073|EAP|Custom 951224073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Instrument Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224074|EAP|Custom 951224074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Pw Ant Down Fem Sz Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224075|EAP|Custom 951224075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Patella Wafer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224076|EAP|Custom 951224076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224077|EAP|Custom 951224077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224078|EAP|Custom 951224078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224079|EAP|Custom 951224079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224080|EAP|Custom 951224080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224081|EAP|Custom 951224081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224082|EAP|Custom 951224082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224083|EAP|Custom 951224083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Fem Chmf Cut Blk Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224084|EAP|Custom 951224084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Distal Fem Outrigger|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224085|EAP|Custom 951224085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Pw Post Up Fem Sz Gde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224086|EAP|Custom 951224086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sp2 Mi Distal Fem Cutting Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224087|EAP|Custom 951224087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Im Hole Locator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224088|EAP|Custom 951224088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Ant Fem Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224089|EAP|Custom 951224089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Em Alignment Tower|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224090|EAP|Custom 951224090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Fem Postion Sm/sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224091|EAP|Custom 951224091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Postion Med/lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224092|EAP|Custom 951224092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Dist Align Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224093|EAP|Custom 951224093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Dist Outrigger|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224094|EAP|Custom 951224094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw Dist Block 1.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224095|EAP|Custom 951224095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Dist Block 2 Deg Vv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224096|EAP|Custom 951224096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw A/p Block Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224097|EAP|Custom 951224097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Pw A/p Block Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224098|EAP|Custom 951224098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp A/p Block Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224099|EAP|Custom 951224099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp A/p Block Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224100|EAP|Custom 951224100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp A/p Block Std+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224101|EAP|Custom 951224101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp A/p Block Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224102|EAP|Custom 951224102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp A/p Block Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224103|EAP|Custom 951224103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Dist Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224104|EAP|Custom 951224104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp A/p Lock Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224105|EAP|Custom 951224105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pw Tibial Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224106|EAP|Custom 951224106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Pat Res Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224107|EAP|Custom 951224107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Pat Res Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224108|EAP|Custom 951224108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Slot Stylus 0/2 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224109|EAP|Custom 951224109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Nonslot Stylus 0/2 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224110|EAP|Custom 951224110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Slot Stylus 0/2 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224111|EAP|Custom 951224111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Nonslot Stylus 0/2 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224112|EAP|Custom 951224112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Handed Fem Ant Jig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224113|EAP|Custom 951224113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 0deg Lt Mi Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224114|EAP|Custom 951224114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 0deg Rt Mi Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224115|EAP|Custom 951224115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 3deg Lt Mi Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224116|EAP|Custom 951224116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 3deg Rt Mi Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224117|EAP|Custom 951224117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Blk W/o Feet Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224118|EAP|Custom 951224118||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Blk W/o Feet Sm+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224119|EAP|Custom 951224119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Med Wo Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224120|EAP|Custom 951224120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Std Wo Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224121|EAP|Custom 951224121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Std+ Wo Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224122|EAP|Custom 951224122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Lg Wo Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224123|EAP|Custom 951224123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Fin Gde Lg+ Wo Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224124|EAP|Custom 951224124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Mi Sizing Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224125|EAP|Custom 951224125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Mi Distal Fem Block|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224126|EAP|Custom 951224126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Mi Reference Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224127|EAP|Custom 951224127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Im Tibia Rotation Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224128|EAP|Custom 951224128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Im Tibia Jig|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224129|EAP|Custom 951224129||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 0deg Sym Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224130|EAP|Custom 951224130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 3deg Sym Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224131|EAP|Custom 951224131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp 7deg Sym Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224132|EAP|Custom 951224132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Alignment Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224133|EAP|Custom 951224133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Adj Tibial Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224134|EAP|Custom 951224134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Adj Tibial Stylus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224135|EAP|Custom 951224135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Slot Stylus 8/10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224136|EAP|Custom 951224136||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Nonslot Stylus 8/10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224137|EAP|Custom 951224137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Slot Stylus 8/10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224138|EAP|Custom 951224138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Nonslot Stylus 8/10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224139|EAP|Custom 951224139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Fem Notch Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224140|EAP|Custom 951224140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Fem Notch Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224141|EAP|Custom 951224141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 0deg Lt Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224142|EAP|Custom 951224142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 0deg Rt Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224143|EAP|Custom 951224143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 3deg Lt Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224144|EAP|Custom 951224144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp 3deg Rt Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224145|EAP|Custom 951224145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp 7deg Lt Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224146|EAP|Custom 951224146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp 7deg Rt Cut Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224147|EAP|Custom 951224147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Em Tibial Jig Uprod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224148|EAP|Custom 951224148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Em Tibial Jig Ankle Clamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224149|EAP|Custom 951224149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Em Tibial Jig Spiked Uprod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224150|EAP|Custom 951224150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Dis Fem Align Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224151|EAP|Custom 951224151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Dis Fem Resect Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224152|EAP|Custom 951224152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Dis Fem Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224153|EAP|Custom 951224153||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Dis Fem Connector|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224154|EAP|Custom 951224154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Hp Classic Dist Fem Blk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224155|EAP|Custom 951224155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Pat Res Stylus 12mm Rem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224156|EAP|Custom 951224156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Pat Res Stylus 32-38 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224157|EAP|Custom 951224157||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Pat Res Stylus 41 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224158|EAP|Custom 951224158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Pat Res Stylus Sm-med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224159|EAP|Custom 951224159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Pat Res Stylus Std-lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224160|EAP|Custom 951224160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lcs Hp Pat Res Stylus Lg+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224161|EAP|Custom 951224161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Pat Res Stylus 12mm Rem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224192|EAP|Custom 951224192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Ant Down Converter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224193|EAP|Custom 951224193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Post Up Converter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224194|EAP|Custom 951224194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Universal Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224195|EAP|Custom 951224195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hp Alignment Tower|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224196|EAP|Custom 951224196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Recut Kit Ref Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224197|EAP|Custom 951224197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sig Hp Recut Kit Slot Adaptor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224212|EAP|Custom 951224212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 1.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224213|EAP|Custom 951224213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224214|EAP|Custom 951224214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224215|EAP|Custom 951224215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224216|EAP|Custom 951224216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224217|EAP|Custom 951224217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 4n|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224218|EAP|Custom 951224218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951224219|EAP|Custom 951224219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sigma Cr150 Post Guide Sz 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226752|EAP|Custom 951226752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom*nrh Repl Hinge Pin/xsm/sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226753|EAP|Custom 951226753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom*nrh Repl Hinge Pin/medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226754|EAP|Custom 951226754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Nrh Replc Hinge Brg Qty2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226755|EAP|Custom 951226755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom* Bumper Noiles Mod Sml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226756|EAP|Custom 951226756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom* Bumper Noiles Mod Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226757|EAP|Custom 951226757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Nrh Dist Aug Xs/s/md 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951226758|EAP|Custom 951226758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Nrh Dist Aug Xs/s/md 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228370|EAP|Custom 951228370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flag Splitter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228371|EAP|Custom 951228371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb V Splitter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228372|EAP|Custom 951228372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Straight Gouge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228373|EAP|Custom 951228373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Modified Angled Gouge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228374|EAP|Custom 951228374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reverse Curette 6mm X 17in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228375|EAP|Custom 951228375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reverse Curette 7mm X 17in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228376|EAP|Custom 951228376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chisel 8mm X 17in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228377|EAP|Custom 951228377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reverse Curette 9mm X 17in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228378|EAP|Custom 951228378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb X Osteotome 7mm X 17in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228379|EAP|Custom 951228379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reverse Curette 11mm X 17in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228380|EAP|Custom 951228380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conical Tap 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228381|EAP|Custom 951228381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conical Tap 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228382|EAP|Custom 951228382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Twist Drill 1/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228383|EAP|Custom 951228383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Twist Drill 5/16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228384|EAP|Custom 951228384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rongeur W/serrated Teeth 300mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228385|EAP|Custom 951228385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228386|EAP|Custom 951228386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Revision Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228387|EAP|Custom 951228387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Gouge 48mm X 1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228388|EAP|Custom 951228388||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Gouge 52mm X 1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228389|EAP|Custom 951228389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Gouge 56mm X 1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228390|EAP|Custom 951228390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Curved Acetabular Chisel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228391|EAP|Custom 951228391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Round Acetab Cement Splitter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228392|EAP|Custom 951228392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slotted Mallet W/delrin Cap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228393|EAP|Custom 951228393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Component Gripper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228394|EAP|Custom 951228394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Component Forceps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228395|EAP|Custom 951228395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acetabular Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228396|EAP|Custom 951228396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hip Revision Extractor Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228397|EAP|Custom 951228397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Femoral Extractor Slap Hammer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228398|EAP|Custom 951228398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Universal Mod Stem Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228399|EAP|Custom 951228399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb One Piece Stem Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228400|EAP|Custom 951228400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Closed Looped Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228401|EAP|Custom 951228401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Stem Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228402|EAP|Custom 951228402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Locking Pliers|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228403|EAP|Custom 951228403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Locking Pliers Slap Ham Adapt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228404|EAP|Custom 951228404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Srom Extractor Loop Adapter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228405|EAP|Custom 951228405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extraction Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228406|EAP|Custom 951228406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flexible Osteotome Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228407|EAP|Custom 951228407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handle W/quick-couple End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228408|EAP|Custom 951228408||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Small Slap Hammer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228409|EAP|Custom 951228409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extra Long Osteotome 8mm X 9in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228410|EAP|Custom 951228410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 8mm X 2.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228411|EAP|Custom 951228411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 10mm X 2.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228412|EAP|Custom 951228412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 12mm X 2.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228413|EAP|Custom 951228413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 20mm X 2.5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228414|EAP|Custom 951228414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 8mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228415|EAP|Custom 951228415||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 10mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228416|EAP|Custom 951228416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 12mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228417|EAP|Custom 951228417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Chisel Blade 20mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228418|EAP|Custom 951228418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flex Osteotome Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228419|EAP|Custom 951228419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228420|EAP|Custom 951228420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Slap Hammer Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228421|EAP|Custom 951228421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quick Connect T-handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228422|EAP|Custom 951228422||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb T-bar Stem Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228423|EAP|Custom 951228423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228424|EAP|Custom 951228424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine Delivery System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228425|EAP|Custom 951228425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 11mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228426|EAP|Custom 951228426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 11.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228427|EAP|Custom 951228427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 12mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228428|EAP|Custom 951228428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 12.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228429|EAP|Custom 951228429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 13mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228430|EAP|Custom 951228430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 13.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228431|EAP|Custom 951228431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 14mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228432|EAP|Custom 951228432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 14.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228433|EAP|Custom 951228433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 15mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228434|EAP|Custom 951228434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 15.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228435|EAP|Custom 951228435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 16mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228436|EAP|Custom 951228436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 16.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228437|EAP|Custom 951228437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 17mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228438|EAP|Custom 951228438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 17.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228439|EAP|Custom 951228439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 18mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228440|EAP|Custom 951228440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 18.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228441|EAP|Custom 951228441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 19mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228442|EAP|Custom 951228442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 19.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228443|EAP|Custom 951228443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 20mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228444|EAP|Custom 951228444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 20.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228445|EAP|Custom 951228445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 21mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228446|EAP|Custom 951228446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 21.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228447|EAP|Custom 951228447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 22mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228448|EAP|Custom 951228448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 22.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228449|EAP|Custom 951228449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 23mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228450|EAP|Custom 951228450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 23.5mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228451|EAP|Custom 951228451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine 24mm Id X 8in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228452|EAP|Custom 951228452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Passer Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228453|EAP|Custom 951228453||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Con Cable 45 Corkscrew Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228454|EAP|Custom 951228454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Con Cable 90 Corkscrew Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228455|EAP|Custom 951228455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Passer Insert Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228456|EAP|Custom 951228456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Passer Insert Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228457|EAP|Custom 951228457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Tensioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228458|EAP|Custom 951228458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Crimper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228459|EAP|Custom 951228459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Cutter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228460|EAP|Custom 951228460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Tensioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228461|EAP|Custom 951228461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Tensioner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228462|EAP|Custom 951228462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Instrument Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228463|EAP|Custom 951228463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable/wire Inst Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228464|EAP|Custom 951228464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228465|EAP|Custom 951228465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Upper Inset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228466|EAP|Custom 951228466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lower Inset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228467|EAP|Custom 951228467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Control Cable Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228468|EAP|Custom 951228468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Cone Prox Body Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228469|EAP|Custom 951228469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reclaim Taperd Dist Stem Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228470|EAP|Custom 951228470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Porocoat Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228471|EAP|Custom 951228471||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Basic Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228472|EAP|Custom 951228472||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Self-cent Xray Ovly 28mm/32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228473|EAP|Custom 951228473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb New Aml Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228474|EAP|Custom 951228474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mod Cathcart X-ray Overlay|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228475|EAP|Custom 951228475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Summit Cemented Templates|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228476|EAP|Custom 951228476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Primry Acet Case Complete|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228477|EAP|Custom 951228477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Tip 22.225mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228478|EAP|Custom 951228478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Tip 26mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228479|EAP|Custom 951228479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Tip 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228480|EAP|Custom 951228480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Tip 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228481|EAP|Custom 951228481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Impactor Tip 36mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228482|EAP|Custom 951228482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Angled Acet Insertr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228483|EAP|Custom 951228483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Angled Rmr Driver Hudson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228484|EAP|Custom 951228484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acet Inserter Replac Springs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228485|EAP|Custom 951228485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acet Inserter Replac Button|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228486|EAP|Custom 951228486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Acet Insert Replac Lock Catch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228487|EAP|Custom 951228487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Replacement Suction Cup|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228488|EAP|Custom 951228488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrob Dislocating Hook|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228489|EAP|Custom 951228489||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charn Weight+24in Chain Only|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228490|EAP|Custom 951228490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charn Pin Retract+hanleset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228491|EAP|Custom 951228491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charn Retractor Pins 10.5 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228492|EAP|Custom 951228492||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charn Dbl Hnd Bone Curet Sml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228493|EAP|Custom 951228493||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charn Dbl Hnd Bone Curet Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228494|EAP|Custom 951228494||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Charn Dbl Hnd Bone Curet Lge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228495|EAP|Custom 951228495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Holding Forceps Plainbows|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228496|EAP|Custom 951228496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gigli Saw 30cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228497|EAP|Custom 951228497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gigli Saw 50 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228498|EAP|Custom 951228498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gigli Saw Handles|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228499|EAP|Custom 951228499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hardinge Cem Rest Intro Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228500|EAP|Custom 951228500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Bone Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228501|EAP|Custom 951228501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Tamp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228502|EAP|Custom 951228502||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Full Length Leg Template|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228503|EAP|Custom 951228503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Hip Sys Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228504|EAP|Custom 951228504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome 8mm X 3in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228505|EAP|Custom 951228505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome 10mm X 3in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228506|EAP|Custom 951228506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome 12mm X 3in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228507|EAP|Custom 951228507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome 20mm X 3in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228508|EAP|Custom 951228508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome Curved 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228509|EAP|Custom 951228509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome Curved 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228510|EAP|Custom 951228510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome 8mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228511|EAP|Custom 951228511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thin Osteotome 10mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228512|EAP|Custom 951228512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radial Osteotome 10mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228513|EAP|Custom 951228513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radial Osteotome 12mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228514|EAP|Custom 951228514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radial Osteotome 14mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228515|EAP|Custom 951228515||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radial Osteotome 16mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228516|EAP|Custom 951228516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radial Osteotome 20mm X 5in|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228517|EAP|Custom 951228517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*extension Reamer Hudson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228518|EAP|Custom 951228518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*adaptor Hudson To Zimmer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228519|EAP|Custom 951228519||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*handle-t Hudson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228520|EAP|Custom 951228520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*weight Hammer Slide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228521|EAP|Custom 951228521||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Hammer Slide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228522|EAP|Custom 951228522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*handle Hammer Slide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228523|EAP|Custom 951228523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*resctn Guide-templte Alm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228524|EAP|Custom 951228524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*pin Punch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228525|EAP|Custom 951228525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*impactor Stem Rotator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228526|EAP|Custom 951228526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*liner Turner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228527|EAP|Custom 951228527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*head Remover Ring+6 +12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228528|EAP|Custom 951228528||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*head Remover Ring+0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228529|EAP|Custom 951228529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*head Remover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228530|EAP|Custom 951228530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228531|EAP|Custom 951228531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228532|EAP|Custom 951228532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 14x09 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228533|EAP|Custom 951228533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 16x11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228534|EAP|Custom 951228534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 18x13|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228535|EAP|Custom 951228535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 20x15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228536|EAP|Custom 951228536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 22x17|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228537|EAP|Custom 951228537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*shaft Pilot 24x19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228538|EAP|Custom 951228538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom*extension Shaft 16x11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228539|EAP|Custom 951228539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Extnsn Pilot Shaft 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951228540|EAP|Custom 951228540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb S-rom Extnsn Pilot Shaft 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229226|EAP|Custom 951229226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ho Neck Segment Cor Amt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229227|EAP|Custom 951229227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Neck Resection Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229228|EAP|Custom 951229228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Broach For Corail Sz 6 Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229229|EAP|Custom 951229229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Sz 6 Tray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229230|EAP|Custom 951229230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Sz 6 Cover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229231|EAP|Custom 951229231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Broach Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229232|EAP|Custom 951229232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Brch Hdl Vers Cont Rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229233|EAP|Custom 951229233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Hi Off Fem Head Impactr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229234|EAP|Custom 951229234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Implant Imp/extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229235|EAP|Custom 951229235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229236|EAP|Custom 951229236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229237|EAP|Custom 951229237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229238|EAP|Custom 951229238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229239|EAP|Custom 951229239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229240|EAP|Custom 951229240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 13|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229241|EAP|Custom 951229241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 14|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229242|EAP|Custom 951229242||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229243|EAP|Custom 951229243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229244|EAP|Custom 951229244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229245|EAP|Custom 951229245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Brch Sz 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229246|EAP|Custom 951229246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ream Corail Revision Stem 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229247|EAP|Custom 951229247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ream Corail Revision Stem 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229248|EAP|Custom 951229248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ream Corail Revision Stem 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229249|EAP|Custom 951229249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ream Corail Revision Stem 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229250|EAP|Custom 951229250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Set Fem Prep Base|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229251|EAP|Custom 951229251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Set Fem Prep Bottom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229252|EAP|Custom 951229252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Set Fem Prep Middle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229253|EAP|Custom 951229253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Set Fem Prep Top|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229254|EAP|Custom 951229254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Corail Rev Set Fem Prep Lid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229255|EAP|Custom 951229255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Metphysl Sleeve Removal Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229256|EAP|Custom 951229256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Calcar Planer Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229257|EAP|Custom 951229257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Calcar Planer Lg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229258|EAP|Custom 951229258||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Distal Femoral Impactor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229259|EAP|Custom 951229259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229260|EAP|Custom 951229260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 9.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229261|EAP|Custom 951229261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229262|EAP|Custom 951229262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 10.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229263|EAP|Custom 951229263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229264|EAP|Custom 951229264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 11.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229265|EAP|Custom 951229265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229266|EAP|Custom 951229266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 12.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229267|EAP|Custom 951229267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229268|EAP|Custom 951229268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 13.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229269|EAP|Custom 951229269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229270|EAP|Custom 951229270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 14.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229271|EAP|Custom 951229271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229272|EAP|Custom 951229272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 15.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229273|EAP|Custom 951229273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229274|EAP|Custom 951229274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 16.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229275|EAP|Custom 951229275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 17mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229276|EAP|Custom 951229276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 17.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229277|EAP|Custom 951229277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229278|EAP|Custom 951229278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 18.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229279|EAP|Custom 951229279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 19mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229280|EAP|Custom 951229280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 19.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229281|EAP|Custom 951229281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229282|EAP|Custom 951229282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 20.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229283|EAP|Custom 951229283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 21mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229284|EAP|Custom 951229284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Bevel Reamer Insert 21.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229285|EAP|Custom 951229285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Disassembly Tool|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229290|EAP|Custom 951229290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Inserter Extractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229291|EAP|Custom 951229291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Inserter Version Control|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229292|EAP|Custom 951229292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Slap Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229293|EAP|Custom 951229293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Extractor Adapter Moreland|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229294|EAP|Custom 951229294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Ruler|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229295|EAP|Custom 951229295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Pilot Diap Sleeve 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229296|EAP|Custom 951229296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps 20mm Conical Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229297|EAP|Custom 951229297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps 24mm Conical Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229298|EAP|Custom 951229298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps 28mm Conical Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229299|EAP|Custom 951229299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Template Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229300|EAP|Custom 951229300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Clcr Planr Bvl Rmr Instr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229301|EAP|Custom 951229301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Instr Complete Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951229302|EAP|Custom 951229302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lps Diap & Met Sleev Instr Cas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951217036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 70-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 76-80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 66-68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 70-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 76-80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 56 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 62 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 50 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 56 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 62 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 68 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 74 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 50 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 56 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 62 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 68 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 74 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 12 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 13 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 14 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 15 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 16 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 17 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 18 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 19 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 44mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 28mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 28mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 28mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 28mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 32mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 66-68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 70-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 36mm X 76-80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951218292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 13 Lng Rev Pol +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Primary So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Primary Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Sh Rev Pol +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 15 Stem Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 15 Lng Rev Pol +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 15 Lng Rev Pol +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Sm Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Sm Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Sm Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Med Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Med Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Med Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Lg Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Lg Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp11 Slv Lg Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Sm Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Sm Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Sm Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Med Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Med Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Med Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Lg Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Lg Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp13 Slv Lg Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Sm Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Sm Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Sm Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Med Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Med Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Med Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Lg Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Lg Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp15 Slv Lg Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Sm Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Sm Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Sm Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Med Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Med Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Med Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Lg Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Lg Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp17 Slv Lg Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Sm Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Sm Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Sm Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Med Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Med Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Med Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Lg Cone1 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Lg Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp19 Slv Lg Cone3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Primary So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Primary Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13 Slv Sm Cone2 Spt Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13 Slv Med Cone1 Spt Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13 Slv Md Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15 Slv Sm Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15 Slv Sm Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15 Slv Md Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 15slv Med Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 17 Xl Cone1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Xl Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 17 Xl Cone 3 Spou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Sh Rev Pol +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,143.40|FSC: 13; Default||Not reimbursed separately|18,143.40|FSC: 13; Default||External grouping not supported 951218365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 17 Stem Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 17 Lng Rev Pol +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 17 Lng Rev Pol +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17slv Sm Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17 Slv Sm Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17slv Med Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 17slv Med Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19slv Sm Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19slv Sm Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19slv Med Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19 Slv Med Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 21slv Sm Cone1 Spou Tall Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 21slv Sm Cone2 Spou Tall Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 21slv Med Cone1 Spou Tall Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 21slv Med Cone2 Spou Tall Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 23slv Sm Cone1 Spou Tall Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 23slv Sm Cone2 Spou Tall Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 23slv Med Cone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 23slv Med Cone2 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|FSC: 13; Default||Not reimbursed separately|7,761.60|FSC: 13; Default||External grouping not supported 951218384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv11 Smcone1 Sp {} Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv11 Mdcone1 Sp Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv11 Smcone2 Sp {} Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Sm Cone2 Spou Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Smcone3 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 21 Mdcone1 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Mdcone2 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Md Cone3 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Lg Cone1 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Lg Cone2 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Lg Cone3 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Sm Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 23 Smcone 3 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Md Cone 1 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Md Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Md Cone3 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Lg Cone1 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Lg Cone2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv23 Lg Cone3 Spout Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 13 Slv Smcone1 Spou Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv21 Sm Cone1 Spou Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Primary So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Primary Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 19 Xl Cone 1 Spou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 19 Xl Cone 2 Spou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 19 Xl Cone 3 Spou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|FSC: 13; Default||Not reimbursed separately|7,385.40|FSC: 13; Default||External grouping not supported 951218410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Sh Rev Pol +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 19 Sh Rev Pol +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951218413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 19 Stem Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 19 Stem Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 19 Lng Rev Pol +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 19 Lng Rev Pol +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 21xl Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|FSC: 13; Default||Not reimbursed separately|6,520.80|FSC: 13; Default||External grouping not supported 951218420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 21xl Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|FSC: 13; Default||Not reimbursed separately|6,520.80|FSC: 13; Default||External grouping not supported 951218421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 21xl Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|FSC: 13; Default||Not reimbursed separately|6,520.80|FSC: 13; Default||External grouping not supported 951218422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Sh Rev Pol +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,008.40|FSC: 13; Default||Not reimbursed separately|15,008.40|FSC: 13; Default||External grouping not supported 951218424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Lng Rev Pol +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 21 Lng Rev Pol +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 23xl Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|FSC: 13; Default||Not reimbursed separately|6,520.80|FSC: 13; Default||External grouping not supported 951218431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 23xl Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|FSC: 13; Default||Not reimbursed separately|6,520.80|FSC: 13; Default||External grouping not supported 951218432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 23xl Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|FSC: 13; Default||Not reimbursed separately|6,520.80|FSC: 13; Default||External grouping not supported 951218433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Sh Rev Pol +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,008.40|FSC: 13; Default||Not reimbursed separately|15,008.40|FSC: 13; Default||External grouping not supported 951218435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Lng Rev Pol +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 23 Lng Rev Pol +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Dis Slv 16 Str 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,785.20|FSC: 13; Default||Not reimbursed separately|2,785.20|FSC: 13; Default||External grouping not supported 951218442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Dis Slv 16 Str 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,785.20|FSC: 13; Default||Not reimbursed separately|2,785.20|FSC: 13; Default||External grouping not supported 951218443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Dis Slv 16 Str 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,785.20|FSC: 13; Default||Not reimbursed separately|2,785.20|FSC: 13; Default||External grouping not supported 951218444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Pri Dis Slv 16/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|FSC: 13; Default||Not reimbursed separately|1,636.80|FSC: 13; Default||External grouping not supported 951218445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Pri Dis Slv 16/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|FSC: 13; Default||Not reimbursed separately|1,636.80|FSC: 13; Default||External grouping not supported 951218446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Pri Dis Slv 16/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|FSC: 13; Default||Not reimbursed separately|1,636.80|FSC: 13; Default||External grouping not supported 951218447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Flt Pri Dis Slv 16/21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|FSC: 13; Default||Not reimbursed separately|1,636.80|FSC: 13; Default||External grouping not supported 951218448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 22 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 22 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 22 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 22 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 26 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 26 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 26 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 26 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 28 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 28 -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 28 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 28 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 28 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 28 + 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|FSC: 13; Default||Not reimbursed separately|2,666.40|FSC: 13; Default||External grouping not supported 951218462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 32 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951218463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 32 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951218464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 32 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951218465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 32 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,379.20|FSC: 13; Default||Not reimbursed separately|3,379.20|FSC: 13; Default||External grouping not supported 951218466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 32 + 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,379.20|FSC: 13; Default||Not reimbursed separately|3,379.20|FSC: 13; Default||External grouping not supported 951218467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 36mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|FSC: 13; Default||Not reimbursed separately|3,682.80|FSC: 13; Default||External grouping not supported 951219172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +6 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 22 20 Deg 44-45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 22 20 Deg 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 32 20 Deg 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 32 20 Deg 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 28 20 Deg 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 28 20 Deg 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 28 20 Deg 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 26 20 Deg 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Xlpe 26 20 Deg 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|FSC: 13; Default||Not reimbursed separately|4,686.00|FSC: 13; Default||External grouping not supported 951219191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alumina 12/14 Head 36mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|FSC: 13; Default||Not reimbursed separately|4,197.60|FSC: 13; Default||External grouping not supported 951219192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alumina 12/14 Head 36mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|FSC: 13; Default||Not reimbursed separately|4,197.60|FSC: 13; Default||External grouping not supported 951219193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alumina 12/14 Head 36mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|FSC: 13; Default||Not reimbursed separately|4,197.60|FSC: 13; Default||External grouping not supported 951219194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Nh Sz 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref No Hole Shell Sz 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Nh Ha Shell Sz 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg Lat +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 22mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 22mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 22mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 28mm Id Us Crmc Forte Acet Lnr 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 951219234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 28mm Id Us Crmc Forte Acet Lnr 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 951219235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Crmc Forte Acet Lnr 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 951219236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Crmc Forte Acet Lnr 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 951219237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Crmc Forte Acet Lnr 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|FSC: 13; Default||Not reimbursed separately|5,280.00|FSC: 13; Default||External grouping not supported 951219238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 22mm X Mm40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 22mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 22mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X Mm50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 28mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Mh Sz 76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|FSC: 13; Default||Not reimbursed separately|6,778.20|FSC: 13; Default||External grouping not supported 951219263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 50 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 52 {} E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 54 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 56 {} F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 58 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 62 {} H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 64 {} H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 66 {} J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Acet Mh Sz 68 {} J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|FSC: 13; Default||Not reimbursed separately|7,563.60|FSC: 13; Default||External grouping not supported 951219273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 50mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 52mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 54mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 56mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 58mm G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 60mm G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 62mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 64mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 66mm J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Mh Shell 68mm J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Per Hole Sz 54 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Per Hole Sz 56 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Peri Hole 58mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Ha Peri Hole Sz60mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|FSC: 13; Default||Not reimbursed separately|6,171.00|FSC: 13; Default||External grouping not supported 951219287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 62mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 64mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 66mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 68mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 70mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 72mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 74mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 76mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 78mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Peripheral Hole 80mm Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 951219297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|FSC: 13; Default||Not reimbursed separately|5,550.60|FSC: 13; Default||External grouping not supported 951219298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|FSC: 13; Default||Not reimbursed separately|5,550.60|FSC: 13; Default||External grouping not supported 951219299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|FSC: 13; Default||Not reimbursed separately|5,504.40|FSC: 13; Default||External grouping not supported 951219300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell Mm46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|FSC: 13; Default||Not reimbursed separately|5,504.40|FSC: 13; Default||External grouping not supported 951219301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell Mm48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|FSC: 13; Default||Not reimbursed separately|5,405.40|FSC: 13; Default||External grouping not supported 951219308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|FSC: 13; Default||Not reimbursed separately|5,504.40|FSC: 13; Default||External grouping not supported 951219309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|FSC: 13; Default||Not reimbursed separately|5,504.40|FSC: 13; Default||External grouping not supported 951219310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|FSC: 13; Default||Not reimbursed separately|5,550.60|FSC: 13; Default||External grouping not supported 951219311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Acet Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|FSC: 13; Default||Not reimbursed separately|5,550.60|FSC: 13; Default||External grouping not supported 951219312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 66/68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 22mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 22mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 22mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 28mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Acet Th Sz 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Rc3 Sz 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951219346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Rc3 Sz 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.80|FSC: 13; Default||Not reimbursed separately|3,187.80|FSC: 13; Default||External grouping not supported 951219347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Rc3 Sz 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.80|FSC: 13; Default||Not reimbursed separately|3,187.80|FSC: 13; Default||External grouping not supported 951220080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Tib Ply Olay Xl Rm/ll 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,715.60|FSC: 13; Default||Not reimbursed separately|5,715.60|FSC: 13; Default||External grouping not supported 951220081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Thick Femoral Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,042.20|FSC: 13; Default||Not reimbursed separately|7,042.20|FSC: 13; Default||External grouping not supported 951220082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xs-sm 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xs-sm 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xs-sm 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|FSC: 13; Default||Not reimbursed separately|2,316.60|FSC: 13; Default||External grouping not supported 951220085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xs-sm 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Uni Art Isrt Med Lg 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Md-lg 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Md-lg 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Md-lg 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|FSC: 13; Default||Not reimbursed separately|2,316.60|FSC: 13; Default||External grouping not supported 951220090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Md-lg 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|FSC: 13; Default||Not reimbursed separately|2,316.60|FSC: 13; Default||External grouping not supported 951220091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xl-mg 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xl-mg 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xl-mg 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|FSC: 13; Default||Not reimbursed separately|2,547.60|FSC: 13; Default||External grouping not supported 951220094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xl-mg 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|FSC: 13; Default||Not reimbursed separately|2,316.60|FSC: 13; Default||External grouping not supported 951220095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Uni Art Insrt Xl-mg 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|FSC: 13; Default||Not reimbursed separately|2,316.60|FSC: 13; Default||External grouping not supported 951220096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|FSC: 13; Default||Not reimbursed separately|10,408.20|FSC: 13; Default||External grouping not supported 951220097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|FSC: 13; Default||Not reimbursed separately|10,408.20|FSC: 13; Default||External grouping not supported 951220098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|FSC: 13; Default||Not reimbursed separately|10,408.20|FSC: 13; Default||External grouping not supported 951220105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|FSC: 13; Default||Not reimbursed separately|10,408.20|FSC: 13; Default||External grouping not supported 951220106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii C/r Fem Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|FSC: 13; Default||Not reimbursed separately|14,269.20|FSC: 13; Default||External grouping not supported 951220113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|FSC: 13; Default||Not reimbursed separately|14,269.20|FSC: 13; Default||External grouping not supported 951220114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|FSC: 13; Default||Not reimbursed separately|14,269.20|FSC: 13; Default||External grouping not supported 951220121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|FSC: 13; Default||Not reimbursed separately|14,269.20|FSC: 13; Default||External grouping not supported 951220122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Fem Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|FSC: 13; Default||Not reimbursed separately|10,632.60|FSC: 13; Default||External grouping not supported 951220128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Non-mod Cem C/r Fem Sz8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous P/s Fem Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous P/s Fem Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Nonporous Ps Fem Sz 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Sz 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxinium Fem Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Cmt Tib Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|FSC: 13; Default||Not reimbursed separately|6,527.40|FSC: 13; Default||External grouping not supported 951220174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Cmt Tib Size 2 {} Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|FSC: 13; Default||Not reimbursed separately|6,527.40|FSC: 13; Default||External grouping not supported 951220175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Cmt Tib Size 7 {} Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951220176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Cmt Tib Size 8 {} Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951220177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cmt Tib Size 1 {} Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|FSC: 13; Default||Not reimbursed separately|6,527.40|FSC: 13; Default||External grouping not supported 951220178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cm Tib Size 2 {} Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|FSC: 13; Default||Not reimbursed separately|6,527.40|FSC: 13; Default||External grouping not supported 951220179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Non-por Tib Sz 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951220180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Cem Tib Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951220181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|FSC: 13; Default||Not reimbursed separately|8,454.60|FSC: 13; Default||External grouping not supported 951220182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|FSC: 13; Default||Not reimbursed separately|8,454.60|FSC: 13; Default||External grouping not supported 951220183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|FSC: 13; Default||Not reimbursed separately|8,454.60|FSC: 13; Default||External grouping not supported 951220190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|FSC: 13; Default||Not reimbursed separately|8,454.60|FSC: 13; Default||External grouping not supported 951220191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 4 {} Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Por Tib Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|FSC: 13; Default||Not reimbursed separately|7,121.40|FSC: 13; Default||External grouping not supported 951220197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Cr Ply Tib Sz1 9mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tib Sz 1 11mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tib Sz1 13mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 1 15mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz4 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz4 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz4 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz4 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 5 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 5 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 5 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 5 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz1 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz1 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz1 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz1 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Ply Tb Sz2 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 3 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 4 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz4 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz 4 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz5 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz5 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz5 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Poly Tb Sz5 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz6 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz7 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr All Poly Tb Sz8 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|FSC: 13; Default||Not reimbursed separately|4,554.00|FSC: 13; Default||External grouping not supported 951220260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951221065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 9mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 11mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 12mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 15mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 18mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 20mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 22mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 24mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 951221076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 9mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 10mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 11mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 12mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 15mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 16mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 20mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 22mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pressfit Stem 24mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951221085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 10mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 11mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 12mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 13mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 14mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 15mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 16mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 18mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 20mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 22mmx220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 24mm 220mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|FSC: 13; Default||Not reimbursed separately|4,831.20|FSC: 13; Default||External grouping not supported 951221096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 10mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 11mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 12mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 13mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 14mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 15mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 16mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 18mm X220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 20mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 22mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 24mmx220mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 10mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 11mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 12mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 13mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 14mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 15mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 16mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 18mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 20mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 22mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Prsft Stem 24mmx280mm Bwd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|FSC: 13; Default||Not reimbursed separately|6,989.40|FSC: 13; Default||External grouping not supported 951221118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Short Stem Ext 10 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951221119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Short Stem Ext 12 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951221120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Short Stem Ext 14 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951221121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem10mmx120mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951221122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem12mmx120mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951221123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem14mmx120mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951221124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem16mmx120mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951221125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem18mmx120mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951221126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem20mmx120mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951221127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem10mmx160mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951221128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem12mmx160mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951221129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem14mmx160mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951221130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem16mmx160mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951221131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem18mmx160mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951221132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cement Stem20mmx160mm Strt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951221133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Offset Coupler Angled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951221134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Offset Coupler 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,283.40|FSC: 13; Default||Not reimbursed separately|4,283.40|FSC: 13; Default||External grouping not supported 951221135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Locking Set Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.56|FSC: 13; Default||Not reimbursed separately|373.56|FSC: 13; Default||External grouping not supported 951221136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Por Cr Ha Fem Sz 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951221157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cocr Constrained Fem 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|FSC: 13; Default||Not reimbursed separately|20,783.40|FSC: 13; Default||External grouping not supported 951221165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 4 Sam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|308.88|FSC: 13; Default||Not reimbursed separately|308.88|FSC: 13; Default||External grouping not supported 951221228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon-p Inset Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.84|FSC: 13; Default||Not reimbursed separately|1,170.84|FSC: 13; Default||External grouping not supported 951221230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,233.80|FSC: 13; Default||Not reimbursed separately|5,233.80|FSC: 13; Default||External grouping not supported 951221235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,233.80|FSC: 13; Default||Not reimbursed separately|5,233.80|FSC: 13; Default||External grouping not supported 951221240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 951221244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 {} 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951221245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,412.00|FSC: 13; Default||Not reimbursed separately|5,412.00|FSC: 13; Default||External grouping not supported 951221246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,154.60|FSC: 13; Default||Not reimbursed separately|5,154.60|FSC: 13; Default||External grouping not supported 951221247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,154.60|FSC: 13; Default||Not reimbursed separately|5,154.60|FSC: 13; Default||External grouping not supported 951221248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,154.60|FSC: 13; Default||Not reimbursed separately|5,154.60|FSC: 13; Default||External grouping not supported 951221249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951222058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Rt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 1-2 Lt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Rt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 3-4 Lt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Rt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 5-6 Lt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Rt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 951222121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Std 7-8 Lt25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|FSC: 13; Default||Not reimbursed separately|5,299.80|FSC: 13; Default||External grouping not supported 951222125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 1-2 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Rt 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 3-4 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Isrt Ps Std 5-6 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 5-6 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Tib Isrt Ps Std Sz 5-6 Lt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,577.20|FSC: 13; Default||Not reimbursed separately|3,577.20|FSC: 13; Default||External grouping not supported 951222156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 R 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 R 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 R 13 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 R 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 Lt 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 L 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 L 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 L 13 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Tib Ins Ps Std 7-8 L 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|FSC: 13; Default||Not reimbursed separately|3,649.80|FSC: 13; Default||External grouping not supported 951222166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 1-2 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 3-4 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 5-6 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Med 7-8 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 1-2 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 3-4 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 5-6 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Ins Xlpe Lat 7-8 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz1-2 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951223042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 10mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 12mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 14mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 12mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 14mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vivacit-e Art Surf Sz 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951223086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mis Headed Screw 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.92|FSC: 13; Default||Not reimbursed separately|205.92|FSC: 13; Default||External grouping not supported 951223087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mis Headed Screw 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.92|FSC: 13; Default||Not reimbursed separately|205.92|FSC: 13; Default||External grouping not supported 951223088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pmb Isrt G2 Lt S4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 951223091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Compression Screw 16m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|512.16|FSC: 13; Default||Not reimbursed separately|512.16|FSC: 13; Default||External grouping not supported 951223092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Compression Screw 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|512.16|FSC: 13; Default||Not reimbursed separately|512.16|FSC: 13; Default||External grouping not supported 951223095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Femoral Flex Lok Pegs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|595.98|FSC: 13; Default||Not reimbursed separately|595.98|FSC: 13; Default||External grouping not supported 951223096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Pri Femoral Lugs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|251.46|FSC: 13; Default||Not reimbursed separately|251.46|FSC: 13; Default||External grouping not supported 951223097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Axle Plug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.50|FSC: 13; Default||Not reimbursed separately|445.50|FSC: 13; Default||External grouping not supported 951223103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nonrim Speed Pin 110 Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 951223104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rim Speed Pin 30mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 951223105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rim Speed Pin 45mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 951223106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rim Speed Pin 65mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 951223107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nonrim Speed Pin 65 Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 951223108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nonrim Speed Pin 80 Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 951223109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Tib Speed Pin 6m X 27m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.04|FSC: 13; Default||Not reimbursed separately|194.04|FSC: 13; Default||External grouping not supported 951223110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Tib Speed Pin 6.5mx40m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.04|FSC: 13; Default||Not reimbursed separately|194.04|FSC: 13; Default||External grouping not supported 951223129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc 2inhdles Steinmn Pinpkg10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 951223130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc 3in Steinmn Pin W/hd Pkg10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,093.00|FSC: 13; Default||Not reimbursed separately|3,093.00|FSC: 13; Default||External grouping not supported 951223201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 35mm Oval Patella Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|FSC: 13; Default||Not reimbursed separately|1,107.00|FSC: 13; Default||External grouping not supported 951223202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 38mm Oval Patella Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|FSC: 13; Default||Not reimbursed separately|1,107.00|FSC: 13; Default||External grouping not supported 951223203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 41mm Oval Patella Tr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|FSC: 13; Default||Not reimbursed separately|1,107.00|FSC: 13; Default||External grouping not supported 951223899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tibial View Plt Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|FSC: 13; Default||Not reimbursed separately|1,317.00|FSC: 13; Default||External grouping not supported 951223982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Patella Face Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,454.00|FSC: 13; Default||Not reimbursed separately|2,454.00|FSC: 13; Default||External grouping not supported 951223983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Patella Head Sm Md/lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,378.00|FSC: 13; Default||Not reimbursed separately|3,378.00|FSC: 13; Default||External grouping not supported 951223984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Patella Head Std/lg Mdl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,606.00|FSC: 13; Default||Not reimbursed separately|3,606.00|FSC: 13; Default||External grouping not supported 951223985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Patella Head Std Lg/lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|FSC: 13; Default||Not reimbursed separately|4,896.00|FSC: 13; Default||External grouping not supported 951224761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Nar Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Nar Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 10 Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Nar Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Nar Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Nar Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Nar Kn Lt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 10 Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Nar Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Nar Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Nar Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Nar Kn Rt Cmnt Post Stab Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 10 Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Nar Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Nar Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Nar Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Nar Kn Lt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 10 Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Nar Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Nar Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Nar Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Nar Kn Rt Crcte Rtn Cmntls Attune Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 951224819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 7mm Kn Uncndl Lt Mdl Rl Xlk Fx Brng Uncmp Hprfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 8mm Kn Uncndl Lt Mdl Rl Xlk Fx Brng Uncmp Hprfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 9mm Kn Uncndl Lt Mdl Rl Xlk Fx Brng Uncmp Hprfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 10mm Kn Uncndl Lt Mdl Rl Xlk Fx Brng Uncmp Hprfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 1 11mm Kn Uncndl Lt Mdl Rl Xlk Fx Brng Uncmp Hprfr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 7mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 9mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 7mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 9mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 7mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 9mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 7mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 9mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 7mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 9mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz1 7mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz1 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz1 9mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz1 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz1 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 7mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 9mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz2 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 7mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 9mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz3 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 7mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 9mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz4 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 7mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 9mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz5 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 7mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 9mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Ins Sz6 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 951224879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 1.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 1.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 2.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Gvf Ins 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 1.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951225606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Sm+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Med 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Std+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Aox Ins Lg+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|FSC: 13; Default||Not reimbursed separately|9,261.00|FSC: 13; Default||External grouping not supported 951225662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Sm+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Med 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Std+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Aox Ins Lg+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|FSC: 13; Default||Not reimbursed separately|8,103.90|FSC: 13; Default||External grouping not supported 951225711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insert Sz 1 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz4 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz5 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz7 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951226484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2.5 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S3 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S4 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S4 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S4 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S5 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod Plus Tibial Tray Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|FSC: 13; Default||Not reimbursed separately|11,627.70|FSC: 13; Default||External grouping not supported 951226513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod Plus Tibial Tray Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|FSC: 13; Default||Not reimbursed separately|11,627.70|FSC: 13; Default||External grouping not supported 951226514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod Plus Tibial Tray Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|FSC: 13; Default||Not reimbursed separately|11,627.70|FSC: 13; Default||External grouping not supported 951226515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod Plus Tibial Tray Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|FSC: 13; Default||Not reimbursed separately|11,627.70|FSC: 13; Default||External grouping not supported 951226516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod Plus Tib Tray Sz 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|FSC: 13; Default||Not reimbursed separately|11,627.70|FSC: 13; Default||External grouping not supported 951226517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod + Tib Tray Sz 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|FSC: 13; Default||Not reimbursed separately|11,627.70|FSC: 13; Default||External grouping not supported 951226518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Lm/rl S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Lm/rl S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Lm/rl S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Lm/rl S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Lm/rl S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Lm/rl S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Rm/ll S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Rm/ll S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Rm/ll S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Rm/ll S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Rm/ll S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Offset Tib Tray Rm/ll S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|FSC: 13; Default||Not reimbursed separately|11,413.50|FSC: 13; Default||External grouping not supported 951226530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Revision Cem Tib Tray Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 951226531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Revision Cem Tib Tray S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 951226532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Revision Cem Tib Tray Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 951226533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Revision Cem Tib Tray S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 951226534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Revision Cem Tib Tray Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 951226535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tib Tray Size 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|FSC: 13; Default||Not reimbursed separately|29,981.70|FSC: 13; Default||External grouping not supported 951226536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tib Tray Size 2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|FSC: 13; Default||Not reimbursed separately|29,981.70|FSC: 13; Default||External grouping not supported 951226537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tib Tray Size 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|FSC: 13; Default||Not reimbursed separately|29,981.70|FSC: 13; Default||External grouping not supported 951226538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tib Tray Size 3 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|FSC: 13; Default||Not reimbursed separately|29,981.70|FSC: 13; Default||External grouping not supported 951226539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tib Tray Size 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|FSC: 13; Default||Not reimbursed separately|29,981.70|FSC: 13; Default||External grouping not supported 951226540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Tib Tray Size 4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|FSC: 13; Default||Not reimbursed separately|29,981.70|FSC: 13; Default||External grouping not supported 951226541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Tib Cem Stm 13x60 2/2.5/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* Tib Stm Ext 4/5/6 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* Tib Stm Ext 4/5/6 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Taper Cem Stem 13x90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Taper Cem Stem 15x90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Taper Cem Stem 13x120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Taper Cem Stem 13x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|FSC: 13; Default||Not reimbursed separately|3,582.60|FSC: 13; Default||External grouping not supported 951226548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 75x10mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 75x12mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 75x20mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 75x22mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 75x24mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 115x10mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 115x12mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 115x18mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 115x20mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 115x22mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 115x24mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x10mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x12mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x14mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x16mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x18mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x20mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x22mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Stem 150x24mm Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|FSC: 13; Default||Not reimbursed separately|5,644.80|FSC: 13; Default||External grouping not supported 951226567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Tray Sleeve Por M/l 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|FSC: 13; Default||Not reimbursed separately|10,248.00|FSC: 13; Default||External grouping not supported 951226568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Tray Sleeve Por M/l 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|FSC: 13; Default||Not reimbursed separately|10,248.00|FSC: 13; Default||External grouping not supported 951226569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Tray Sleeve Por M/l 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|FSC: 13; Default||Not reimbursed separately|10,248.00|FSC: 13; Default||External grouping not supported 951226570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Tray Sleeve Cem M/l 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|FSC: 13; Default||Not reimbursed separately|10,248.00|FSC: 13; Default||External grouping not supported 951226571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Fem Sleeve Cem 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951226572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Fem Slv Dis Por 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951226573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Fem Slv Dis Por 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951226574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Fem Slv Dis Por 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951226575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Fem Slv Dis Por 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|FSC: 13; Default||Not reimbursed separately|9,975.00|FSC: 13; Default||External grouping not supported 951226576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Universal Fem Slv Ful Por 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,755.80|FSC: 13; Default||Not reimbursed separately|11,755.80|FSC: 13; Default||External grouping not supported 951226577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-10d Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-20d Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp 1omm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-15mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-10d Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-20d Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-10mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-15mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-10d Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-20d Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-10mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-15mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-10d Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Hemi-20d Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-10mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wdg Stp-15mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Hemi-10dsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Hemi-20dsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Stp 1ommsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Stp-15mmsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Hemi-10dsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Hemi-20dsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Stp 1ommsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*mod Pl Tb Wd Stp 15mmsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|FSC: 13; Default||Not reimbursed separately|5,812.80|FSC: 13; Default||External grouping not supported 951226625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Por Tray Screw 6.5/60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 951226635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem R Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem R Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem R Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem R Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Revfem Cem R Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem R Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem R Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem L Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem L Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem L Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem L Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Revfem Cem L Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem L Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Rev Fem Cem L Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|FSC: 13; Default||Not reimbursed separately|20,002.50|FSC: 13; Default||External grouping not supported 951226649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951227324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bantam Fem Head 28mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|FSC: 13; Default||Not reimbursed separately|2,721.60|FSC: 13; Default||External grouping not supported 951227325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom 28mm +0 M Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|FSC: 13; Default||Not reimbursed separately|3,328.50|FSC: 13; Default||External grouping not supported 951227326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom 28mm +3 M Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|FSC: 13; Default||Not reimbursed separately|3,328.50|FSC: 13; Default||External grouping not supported 951227327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom 28mm +6 M Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|FSC: 13; Default||Not reimbursed separately|3,328.50|FSC: 13; Default||External grouping not supported 951227328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul/eze Ball 22.225+4 Nk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,566.20|FSC: 13; Default||Not reimbursed separately|2,566.20|FSC: 13; Default||External grouping not supported 951227329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul/eze Ball 22.225+7 Nk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,566.20|FSC: 13; Default||Not reimbursed separately|2,566.20|FSC: 13; Default||External grouping not supported 951227330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*head Femoral Cocr 32+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|FSC: 13; Default||Not reimbursed separately|2,767.80|FSC: 13; Default||External grouping not supported 951227331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom Head Femoral Cocr 32+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|FSC: 13; Default||Not reimbursed separately|2,767.80|FSC: 13; Default||External grouping not supported 951227332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom Head Femoral Cocr 32+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|FSC: 13; Default||Not reimbursed separately|2,767.80|FSC: 13; Default||External grouping not supported 951227333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom M Head 36mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|FSC: 13; Default||Not reimbursed separately|4,004.70|FSC: 13; Default||External grouping not supported 951227334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom M Head 36mm +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,003.35|FSC: 13; Default||Not reimbursed separately|4,003.35|FSC: 13; Default||External grouping not supported 951227335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom M Head 36mm +9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|FSC: 13; Default||Not reimbursed separately|4,004.70|FSC: 13; Default||External grouping not supported 951227336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom M Head 36mm+12 Non Skirt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|FSC: 13; Default||Not reimbursed separately|4,004.70|FSC: 13; Default||External grouping not supported 951227337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 12/14 Articul 40mm M Spec+15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|FSC: 13; Default||Not reimbursed separately|6,157.20|FSC: 13; Default||External grouping not supported 951227338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 40mm M Spec-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|FSC: 13; Default||Not reimbursed separately|6,213.90|FSC: 13; Default||External grouping not supported 951227339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 40mm M Spec+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|FSC: 13; Default||Not reimbursed separately|6,213.90|FSC: 13; Default||External grouping not supported 951227340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 40mm M Spec+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|FSC: 13; Default||Not reimbursed separately|6,213.90|FSC: 13; Default||External grouping not supported 951227341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 40mm M Spec+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|FSC: 13; Default||Not reimbursed separately|6,213.90|FSC: 13; Default||External grouping not supported 951227342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 40mm M Spec+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|FSC: 13; Default||Not reimbursed separately|6,213.90|FSC: 13; Default||External grouping not supported 951227343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 40mm M Spec+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|FSC: 13; Default||Not reimbursed separately|6,213.90|FSC: 13; Default||External grouping not supported 951227344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 44mm M Spec-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 44mm M Spec+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 44mm M Spec+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 44mm M Spec+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 44mm M Spec+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11/13 S-rom 44mm M Spec+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 28mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 28mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 28mm +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951227353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 32mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.50|FSC: 13; Default||Not reimbursed separately|6,835.50|FSC: 13; Default||External grouping not supported 951227354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 32mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.50|FSC: 13; Default||Not reimbursed separately|6,835.50|FSC: 13; Default||External grouping not supported 951227355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 36mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|FSC: 13; Default||Not reimbursed separately|7,211.40|FSC: 13; Default||External grouping not supported 951227356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 36mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|FSC: 13; Default||Not reimbursed separately|7,211.40|FSC: 13; Default||External grouping not supported 951227357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 36mm +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|FSC: 13; Default||Not reimbursed separately|7,211.40|FSC: 13; Default||External grouping not supported 951227358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Delta Cer Head 11/13 36mm +9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|FSC: 13; Default||Not reimbursed separately|7,211.40|FSC: 13; Default||External grouping not supported 951227359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom Delta Ceramic 36mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|FSC: 13; Default||Not reimbursed separately|7,211.40|FSC: 13; Default||External grouping not supported 951227360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dlt Ts Cer Hd 12/14 44mm +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|FSC: 13; Default||Not reimbursed separately|8,507.10|FSC: 13; Default||External grouping not supported 951227361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dlt Ts Cer Hd 12/14 44mm +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|FSC: 13; Default||Not reimbursed separately|8,507.10|FSC: 13; Default||External grouping not supported 951227362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dlt Ts Cer Hd 12/14 44mm +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|FSC: 13; Default||Not reimbursed separately|8,507.10|FSC: 13; Default||External grouping not supported 951227363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dlt Ts Cer Hd 12/14 44mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|FSC: 13; Default||Not reimbursed separately|8,507.10|FSC: 13; Default||External grouping not supported 951227364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Can Bone Screw 6.5mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Can Bone Screw 6.5mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Can Bone Screw 6.5mmx65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Can Bone Screw 6.5mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 951227384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*head Femrl Alumina 32+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,239.10|FSC: 13; Default||Not reimbursed separately|6,239.10|FSC: 13; Default||External grouping not supported 951227385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*head Femrl Alumina 32+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,239.10|FSC: 13; Default||Not reimbursed separately|6,239.10|FSC: 13; Default||External grouping not supported 951227386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prostalac Lt 150 Stem Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 951227387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prostalac Lt 200 Stem Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 951227388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prostalac Lt 240 Stem Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 951227389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prostalac Rt 240 Stem Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 951227390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 14x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 14x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 951227392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 15x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 15x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 951227394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 16x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 951227395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 17x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 18x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 18x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 951227398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 19x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 20x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 21x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 14x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 15x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 16x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 16x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 17x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 17x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 18x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 18x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 18x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 19x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 19x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 19x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 20x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 20x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 20x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 21x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 21x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 21x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 22x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 22x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 23x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 23x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 23x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 24x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 24x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 25x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 25x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 25x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 26x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 26x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 27x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 27x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 27x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 29x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 29x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 29x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 31x190a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 951227438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 31x240a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Distal Tapered 31x290a|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|FSC: 13; Default||Not reimbursed separately|14,645.40|FSC: 13; Default||External grouping not supported 951227440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 20x105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 24x85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 24x95|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 24x105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 28x75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 28x95|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Prx Bdy Cone 28x105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 951227447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std36+21cr 16x11x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|FSC: 13; Default||Not reimbursed separately|15,147.30|FSC: 13; Default||External grouping not supported 951227448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std36+21cr 18x13x160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|FSC: 13; Default||Not reimbursed separately|15,147.30|FSC: 13; Default||External grouping not supported 951227449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std36+21cr 22x17x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|FSC: 13; Default||Not reimbursed separately|15,147.30|FSC: 13; Default||External grouping not supported 951227450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std36+21cr 24x19x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|FSC: 13; Default||Not reimbursed separately|15,147.30|FSC: 13; Default||External grouping not supported 951227451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 18x13x215l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 18x13x215n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 18x13x215r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 20x15x225l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 20x15x225n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 20x15x225r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 22x17x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 22x17x230n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 22x17x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 24x19x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 24x19x230n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 42 Nk 24x19x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Lg 36 Nk 14x09x205l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Lg 36 Nk 14x09x205n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Lg 36 Nk 14x09x205r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 16x11x205l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 16x11x205n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 16x11x205r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 18x13x215l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 18x13x215n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 18x13x215r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 20x15x225l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 20x15x225n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 20x15x225r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 22x17x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 22x17x230n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36nk 22x17x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|FSC: 13; Default||Not reimbursed separately|17,753.40|FSC: 13; Default||External grouping not supported 951227478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stl 36+21crnk 14x09x205n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr4l 16x11x205l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr4l 16x11x205n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr4l 16x11x205r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 18x13x215l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 18x13x215n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 18x13x215r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 20x15x225l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 20x15x225n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 20x15x225r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 22x17x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 22x17x230n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 22x17x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 24x19x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951229131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 14x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 14x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 15x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 15x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 16x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 16x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 16x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 17x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 17x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 17x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 18x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 18x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 18x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 18x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 19x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 19x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 19x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 19x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 20x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 20x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 20x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 20x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 21x140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 21x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 21x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 21x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 22x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|FSC: 13; Default||Not reimbursed separately|4,128.00|FSC: 13; Default||External grouping not supported 951229159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 22x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 22x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 23x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 23x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 23x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 24x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 24x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 24x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 25x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 25x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 25x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 26x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 26x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 26x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 27x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 27x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 27x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 28x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 28x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 28x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 29x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 29x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 29x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 30x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 30x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 30x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 31x190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 31x240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Tapered Rmr 31x290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|FSC: 13; Default||Not reimbursed separately|5,673.00|FSC: 13; Default||External grouping not supported 951229213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Broach Corail Amt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|FSC: 13; Default||Not reimbursed separately|13,731.00|FSC: 13; Default||External grouping not supported 951229224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Std Neck Segment Corail Amt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,094.00|FSC: 13; Default||Not reimbursed separately|5,094.00|FSC: 13; Default||External grouping not supported 951229225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cor Var Neck Segment Cor Amt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,094.00|FSC: 13; Default||Not reimbursed separately|5,094.00|FSC: 13; Default||External grouping not supported 951217200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 23 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 24 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 25 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 26 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 27 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 12 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 13 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 14 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 15 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 17 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 18 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 19 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 20 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 21 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 22 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 23 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 24 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 25 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 26 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 27 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 13 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 15 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 16 {} Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 17 {} Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 19 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 21 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 22 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 19 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 20 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 21 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 22 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 23 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 24 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 25 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 26 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 27 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 13 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 15 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 16 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 17 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 19 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 21 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 22 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 23 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 24 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x58-60 20 Deg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x62-64 20dg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x 66-68 20dg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x70-76 20dg Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x44 20 Deg Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26 X 46-48 20 Dg Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x 50-52 20 Dg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x 54-56 20dg Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x 58-60 Od 20dg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x 62-64 20 Dg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x 66-68 20 Dg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26x 70-76 20dg Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 20 Deg Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x50-52 20 Deg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 58-60 20dg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 62-64 20dg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 66-68 20dg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 70-76 20dg Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 50-52 20dg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 54-56 20 Dg Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 58-60 20dg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 62-64 20 Dg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 66-68 20dg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 70-76 20 Dg Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 3ref Xlpe Lnr 28/46-48 0dg Szd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951217481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe Lnr 28/62-64 0dg Szh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951217482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe Lnr 28id 66-68od 0 Deg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951217483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe Lnr 28/62-64 20dg Szh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,211.00|FSC: 13; Default||Not reimbursed separately|2,211.00|FSC: 13; Default||External grouping not supported 951217484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe Lnr 28/66-68 20dg Szj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|FSC: 13; Default||Not reimbursed separately|2,316.60|FSC: 13; Default||External grouping not supported 951217485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetlr Cup Hap 56mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetlr Cup Hap 58mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetlr Cup Hap 60mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetlr Cup Hap 62mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetlr Cup Hap 64mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetlr Cup Hap 66mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dyspl Cup Hap 58mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|FSC: 13; Default||Not reimbursed separately|18,229.20|FSC: 13; Default||External grouping not supported 951217492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dyspl Cup Hap 62mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|FSC: 13; Default||Not reimbursed separately|18,229.20|FSC: 13; Default||External grouping not supported 951217493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dyspl Cup Hap 66mm W/ Imptr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|FSC: 13; Default||Not reimbursed separately|18,229.20|FSC: 13; Default||External grouping not supported 951217494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Resurfacing Femoral Head 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|FSC: 13; Default||Not reimbursed separately|10,771.20|FSC: 13; Default||External grouping not supported 951217495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Resurfacing Femoral Head 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|FSC: 13; Default||Not reimbursed separately|10,771.20|FSC: 13; Default||External grouping not supported 951217496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Resurfacing Femoral Head 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|FSC: 13; Default||Not reimbursed separately|10,771.20|FSC: 13; Default||External grouping not supported 951217497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Head 42 Mm -8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|FSC: 13; Default||Not reimbursed separately|9,952.80|FSC: 13; Default||External grouping not supported 951217498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Head 46 Mm -8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|FSC: 13; Default||Not reimbursed separately|9,952.80|FSC: 13; Default||External grouping not supported 951217499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Head 38mm -4 (short)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|FSC: 13; Default||Not reimbursed separately|9,952.80|FSC: 13; Default||External grouping not supported 951217500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Head 42 Mm -4 (short)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|FSC: 13; Default||Not reimbursed separately|9,952.80|FSC: 13; Default||External grouping not supported 951217501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Head 46 Mm -4 (short)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.80|FSC: 13; Default||Not reimbursed separately|10,975.80|FSC: 13; Default||External grouping not supported 951217502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Modular Head 54mm {} -4 (short)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.80|FSC: 13; Default||Not reimbursed separately|10,975.80|FSC: 13; Default||External grouping not supported 951217503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Cup Hap Size 48/54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Cup Hap Size 48/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Cup Hap Size 52/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Cup Hap Size 52/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Cup Hap Size 56/62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acetabular Cup Hap Size 56/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|FSC: 13; Default||Not reimbursed separately|14,579.40|FSC: 13; Default||External grouping not supported 951217509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dysplasia Cup Hap 48/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|FSC: 13; Default||Not reimbursed separately|18,229.20|FSC: 13; Default||External grouping not supported 951217510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dysplasia Cup Hap 52/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,674.80|FSC: 13; Default||Not reimbursed separately|17,674.80|FSC: 13; Default||External grouping not supported 951217511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dysplasia Cup Hap 56/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,674.80|FSC: 13; Default||Not reimbursed separately|17,674.80|FSC: 13; Default||External grouping not supported 951217512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bridging Cup Hap Size 44/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,127.20|FSC: 13; Default||Not reimbursed separately|15,127.20|FSC: 13; Default||External grouping not supported 951217513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Head 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|FSC: 13; Default||Not reimbursed separately|10,771.20|FSC: 13; Default||External grouping not supported 951217514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Head 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|FSC: 13; Default||Not reimbursed separately|10,771.20|FSC: 13; Default||External grouping not supported 951217515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Head 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|FSC: 13; Default||Not reimbursed separately|10,771.20|FSC: 13; Default||External grouping not supported 951217516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Ide Study Mod Sleeve -4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951217517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Ide Study Mod Sleeve +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951217518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Ide Study Mod Sleeve +4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951217519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Ide Study Mod Sleeve +8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951217520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 36 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 44 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dysplasia Cup Screw - 52 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 56 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 60 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 64 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 68 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|FSC: 13; Default||Not reimbursed separately|240.24|FSC: 13; Default||External grouping not supported 951217533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 76 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 951217534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 80 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 951217535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 84 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 951217536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr Dysplasia Screw 88 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|FSC: 13; Default||Not reimbursed separately|297.00|FSC: 13; Default||External grouping not supported 951217537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem With Ti/ha 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat. W. Ti/ha 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat W. Ti/ha 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat W. Ti/ha 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Integr Mia Stem Lat W. Ti/ha 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|FSC: 13; Default||Not reimbursed separately|15,668.40|FSC: 13; Default||External grouping not supported 951217563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni Standard Stem 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Uni Std Stem 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Uni Std Stem 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Uni Std Stem 01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|FSC: 13; Default||Not reimbursed separately|5,009.40|FSC: 13; Default||External grouping not supported 951217575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Standard 52/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|FSC: 13; Default||Not reimbursed separately|4,428.60|FSC: 13; Default||External grouping not supported 951217576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Trio 48/39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|FSC: 13; Default||Not reimbursed separately|4,428.60|FSC: 13; Default||External grouping not supported 951217577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Trio 50/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|FSC: 13; Default||Not reimbursed separately|4,428.60|FSC: 13; Default||External grouping not supported 951217578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Trio 62/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|FSC: 13; Default||Not reimbursed separately|4,428.60|FSC: 13; Default||External grouping not supported 951217579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 48/39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 50/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 52/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 58/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 60/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 62/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 66/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 72/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 54/44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951218116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32mm M/+4 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32mm L/+8 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32mm Xl/+12 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36mm {} Xs/-3 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36mm {} S/+0 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36mm {} M/+4 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36mm {} L/+8 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36mm {} Xl/+12 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40mm Xs/-4 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40mm S/+0 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40mm M/+4 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40mm L/+8 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32/46mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32/48mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32/50mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36/50mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36/52mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36/54mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 36/56mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40/54mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40/56mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40/58mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40/60mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40/62mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr 14/16 Taper Sleeve +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.24|FSC: 13; Default||Not reimbursed separately|570.24|FSC: 13; Default||External grouping not supported 951218141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bhr 14/16 Taper Sleeve +4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.24|FSC: 13; Default||Not reimbursed separately|570.24|FSC: 13; Default||External grouping not supported 951218142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Ti Tpr Sleeve +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|508.20|FSC: 13; Default||Not reimbursed separately|508.20|FSC: 13; Default||External grouping not supported 951218143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Ti Tpr Sleeve +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|508.20|FSC: 13; Default||Not reimbursed separately|508.20|FSC: 13; Default||External grouping not supported 951218144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951218145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951218146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951218147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951218148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951218149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951218150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 951218151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951218152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Distal Centralizer 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|FSC: 13; Default||Not reimbursed separately|227.04|FSC: 13; Default||External grouping not supported 951218153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Sm Trun Ti Tpr Slv +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|FSC: 13; Default||Not reimbursed separately|378.84|FSC: 13; Default||External grouping not supported 951218154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Sm Trun Ti Tpr Slv +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|FSC: 13; Default||Not reimbursed separately|378.84|FSC: 13; Default||External grouping not supported 951218155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Sm Trun Ti Tpr Slv+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|FSC: 13; Default||Not reimbursed separately|378.84|FSC: 13; Default||External grouping not supported 951218156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Sm Trun Ti Tpr Slv+16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|FSC: 13; Default||Not reimbursed separately|378.84|FSC: 13; Default||External grouping not supported 951218157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Hfms Sz 8l 14/16 Taper 11dd 130l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,306.60|FSC: 13; Default||Not reimbursed separately|3,306.60|FSC: 13; Default||External grouping not supported 951218158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Proximal Centralizer 8s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 951218159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Proximal Centralizer 8l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 951218160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Hfms Sz10l 14/16 Taper 13dd 140l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,306.60|FSC: 13; Default||Not reimbursed separately|3,306.60|FSC: 13; Default||External grouping not supported 951218161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Proximal Centralizer 10s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.64|FSC: 13; Default||Not reimbursed separately|365.64|FSC: 13; Default||External grouping not supported 951218162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Proximal Centralizer 10l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.64|FSC: 13; Default||Not reimbursed separately|365.64|FSC: 13; Default||External grouping not supported 951218163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Cementra Proximal Centralizer 12s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 951218164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Cementra Rev Fem 12s 12dd 200lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,642.80|FSC: 13; Default||Not reimbursed separately|7,642.80|FSC: 13; Default||External grouping not supported 951218165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Rmhs Por Clrd Fem 12l 12dd 150lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951218166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Fem Head 22mmod +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|FSC: 13; Default||Not reimbursed separately|1,702.80|FSC: 13; Default||External grouping not supported 951218167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Fem Head 22mmod +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|FSC: 13; Default||Not reimbursed separately|1,702.80|FSC: 13; Default||External grouping not supported 951218168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Fem Head 22mmod +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|FSC: 13; Default||Not reimbursed separately|1,702.80|FSC: 13; Default||External grouping not supported 951218169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Fem Head 22mmod +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|FSC: 13; Default||Not reimbursed separately|1,702.80|FSC: 13; Default||External grouping not supported 951218170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Por Slv 10 Str 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|FSC: 13; Default||Not reimbursed separately|2,910.60|FSC: 13; Default||External grouping not supported 951218171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Por Slv 14 Str 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|FSC: 13; Default||Not reimbursed separately|2,910.60|FSC: 13; Default||External grouping not supported 951218172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Por Slv 16 Str 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|FSC: 13; Default||Not reimbursed separately|2,910.60|FSC: 13; Default||External grouping not supported 951218173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtx Por Slv 16 Str 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|FSC: 13; Default||Not reimbursed separately|2,910.60|FSC: 13; Default||External grouping not supported 951218181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ti-fit Stem #1 Collarless 115mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 951218182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ti-fit 22mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,059.20|FSC: 13; Default||Not reimbursed separately|2,059.20|FSC: 13; Default||External grouping not supported 951218183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ti-fit 22mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,059.20|FSC: 13; Default||Not reimbursed separately|2,059.20|FSC: 13; Default||External grouping not supported 951218184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ti-fit 22mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,059.20|FSC: 13; Default||Not reimbursed separately|2,059.20|FSC: 13; Default||External grouping not supported 951218185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar 42mm Shell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 28mm 57-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.60|FSC: 13; Default||Not reimbursed separately|204.60|FSC: 13; Default||External grouping not supported 951218191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Bi-polar Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951218209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni 14/16 Tpr Slv + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|FSC: 13; Default||Not reimbursed separately|372.24|FSC: 13; Default||External grouping not supported 951218210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni 14/16 Tpr Slv + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|FSC: 13; Default||Not reimbursed separately|372.24|FSC: 13; Default||External grouping not supported 951218211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni 14/16 Tpr Slv + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|FSC: 13; Default||Not reimbursed separately|372.24|FSC: 13; Default||External grouping not supported 951218212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uni 14/16 Tpr Slv + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|FSC: 13; Default||Not reimbursed separately|372.24|FSC: 13; Default||External grouping not supported 951218213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|FSC: 13; Default||Not reimbursed separately|1,676.40|FSC: 13; Default||External grouping not supported 951218214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|FSC: 13; Default||Not reimbursed separately|1,676.40|FSC: 13; Default||External grouping not supported 951218215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|FSC: 13; Default||Not reimbursed separately|1,386.00|FSC: 13; Default||External grouping not supported 951218230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|FSC: 13; Default||Not reimbursed separately|1,676.40|FSC: 13; Default||External grouping not supported 951218231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Unipolar 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|FSC: 13; Default||Not reimbursed separately|1,676.40|FSC: 13; Default||External grouping not supported 951218232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 32mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 26mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 26mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 26mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 28mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 28mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 28mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 32mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Fem Head 32mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 951218241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biofit St #1 {} 290 W/col|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,448.20|FSC: 13; Default||Not reimbursed separately|6,448.20|FSC: 13; Default||External grouping not supported 951218242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biofit St #5 {} 200 W/col|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951218243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biofit St #6 {} 340 W/col|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,448.20|FSC: 13; Default||Not reimbursed separately|6,448.20|FSC: 13; Default||External grouping not supported 951218244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer 38mm Fem Hd 14/16 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,850.80|FSC: 13; Default||Not reimbursed separately|6,850.80|FSC: 13; Default||External grouping not supported 951218245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Opti-fix Collared Stem Size-5.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,692.40|FSC: 13; Default||Not reimbursed separately|6,692.40|FSC: 13; Default||External grouping not supported 951218246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb H/a Tifit Acetabular Cup Shell Size 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.60|FSC: 13; Default||Not reimbursed separately|1,524.60|FSC: 13; Default||External grouping not supported 951218247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb H/a Tifit Acetabular Cup Shell Size 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.60|FSC: 13; Default||Not reimbursed separately|1,524.60|FSC: 13; Default||External grouping not supported 951218248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb H/a Tifit Acetabular Cup Shell Size 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.60|FSC: 13; Default||Not reimbursed separately|1,524.60|FSC: 13; Default||External grouping not supported 951218251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref I Por Acet Shell 70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951218254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Acet Fix Peg 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.32|FSC: 13; Default||Not reimbursed separately|364.32|FSC: 13; Default||External grouping not supported 951218255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tw Fem Comp Sz 5 X 210|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,438.20|FSC: 13; Default||Not reimbursed separately|7,438.20|FSC: 13; Default||External grouping not supported 951218256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tw Fem Comp Sz 6 X 270|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.40|FSC: 13; Default||Not reimbursed separately|8,507.40|FSC: 13; Default||External grouping not supported 951218258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 9 {} Ro 140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 9 So 140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Sm Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Sm Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Sm Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Md Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Md Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Md Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Lg Cone 1 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Lg Cone 2 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 9 Lg Cone 3 Spout|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|FSC: 13; Default||Not reimbursed separately|5,920.20|FSC: 13; Default||External grouping not supported 951218269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 11 Stem Primary So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 11 Stem Primary Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Slv 11m Con 2 Spt Tall|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|FSC: 13; Default||Not reimbursed separately|6,085.20|FSC: 13; Default||External grouping not supported 951218272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 11 Sh Rev Pol + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 11 Sh Rev Pol + 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emperion Stem 11 Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951218275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emperion Stem 11 Sh Rev Grit +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,421.60|FSC: 13; Default||Not reimbursed separately|8,421.60|FSC: 13; Default||External grouping not supported 951218276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emperion Stem 11 Sh Rev Grit +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,712.00|FSC: 13; Default||Not reimbursed separately|8,712.00|FSC: 13; Default||External grouping not supported 951218277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 11 Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 11 Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 11 Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 11 Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11 Lng Rev Pol +20 L Implt Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 11 Lng Rev Pol +20 R Implt Stm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Primary So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Primary Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|FSC: 13; Default||Not reimbursed separately|11,345.40|FSC: 13; Default||External grouping not supported 951218285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Sh Rev Pol +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|FSC: 13; Default||Not reimbursed separately|12,381.60|FSC: 13; Default||External grouping not supported 951218286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Sh Rev Pol +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|FSC: 13; Default||Not reimbursed separately|13,602.60|FSC: 13; Default||External grouping not supported 951218287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Lng Rev Pol +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Lng Rev Pol +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|FSC: 13; Default||Not reimbursed separately|13,365.00|FSC: 13; Default||External grouping not supported 951218289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Lng Rev Pol +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp 13 Stem Lng Rev Pol +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|FSC: 13; Default||Not reimbursed separately|17,800.20|FSC: 13; Default||External grouping not supported 951218291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Emp Stem 13 Lng Rev Pol +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|FSC: 13; Default||Not reimbursed separately|20,130.00|FSC: 13; Default||External grouping not supported 951218996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x70-76 20 Deg Lat +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|FSC: 13; Default||Not reimbursed separately|2,818.20|FSC: 13; Default||External grouping not supported 951218997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reflection Screw Hole Cover|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.96|FSC: 13; Default||Not reimbursed separately|135.96|FSC: 13; Default||External grouping not supported 951218998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951218999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Locking Head Peg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951219000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Locking Head Peg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|FSC: 13; Default||Not reimbursed separately|572.88|FSC: 13; Default||External grouping not supported 951219004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Locking Head Peg 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|FSC: 13; Default||Not reimbursed separately|572.88|FSC: 13; Default||External grouping not supported 951219009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spher Head Screw 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peripheral Screw {} 5.0 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|FSC: 13; Default||Not reimbursed separately|403.92|FSC: 13; Default||External grouping not supported 951219021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg+4 Xlpe Acet Lnr 36mm X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X Mm56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 36mm X 66/68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer 28mm Hd 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,765.20|FSC: 13; Default||Not reimbursed separately|4,765.20|FSC: 13; Default||External grouping not supported 951219031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer 28mm Hd 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,692.60|FSC: 13; Default||Not reimbursed separately|4,692.60|FSC: 13; Default||External grouping not supported 951219032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer 28mm Hd 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,692.60|FSC: 13; Default||Not reimbursed separately|4,692.60|FSC: 13; Default||External grouping not supported 951219033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer 32mm Hd 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,824.60|FSC: 13; Default||Not reimbursed separately|4,824.60|FSC: 13; Default||External grouping not supported 951219034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer 32mm Hd 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,824.60|FSC: 13; Default||Not reimbursed separately|4,824.60|FSC: 13; Default||External grouping not supported 951219035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer 32mm Hd 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,824.60|FSC: 13; Default||Not reimbursed separately|4,824.60|FSC: 13; Default||External grouping not supported 951219036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 40 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 42 B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Deg 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Deg 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|FSC: 13; Default||Not reimbursed separately|5,966.40|FSC: 13; Default||External grouping not supported 951219060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Deg 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|FSC: 13; Default||Not reimbursed separately|5,966.40|FSC: 13; Default||External grouping not supported 951219061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Deg 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Deg 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Deg 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Deg 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Deg 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|FSC: 13; Default||Not reimbursed separately|5,966.40|FSC: 13; Default||External grouping not supported 951219066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Deg 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|FSC: 13; Default||Not reimbursed separately|5,966.40|FSC: 13; Default||External grouping not supported 951219067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Deg 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951219068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Deg 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951219069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Deg 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951219070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Deg 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|FSC: 13; Default||Not reimbursed separately|6,679.20|FSC: 13; Default||External grouping not supported 951219071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Deg 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|FSC: 13; Default||Not reimbursed separately|6,679.20|FSC: 13; Default||External grouping not supported 951219072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 40 Sz A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 42 Sz B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 44 Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 46-48 Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 50-52 Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 58-60 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,689.20|FSC: 13; Default||Not reimbursed separately|5,689.20|FSC: 13; Default||External grouping not supported 951219081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Deg 70-76 Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 44 Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 46-48 Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 50-52 Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 58-60 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 46-48 Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 50-52 Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 58-60 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Deg 70-76 Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 50-52 Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 58-60 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 70-76 Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951219103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 58-60 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951219104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951219105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|FSC: 13; Default||Not reimbursed separately|6,679.20|FSC: 13; Default||External grouping not supported 951219106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 70-76 Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|FSC: 13; Default||Not reimbursed separately|6,679.20|FSC: 13; Default||External grouping not supported 951219107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 40 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 42 B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 20 Ant +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 20 Ant +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 20 Ant +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +6 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 20 Ant +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +6 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 40 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 42 B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 22 0 Lat +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 26 0 Lat +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 28 0 Lat +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +6 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|FSC: 13; Default||Not reimbursed separately|5,643.00|FSC: 13; Default||External grouping not supported 951219170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fai/pao Pr.ganz Schanzs Screw 5x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 951219949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Type Ii Fem Pat Co R Lg C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,847.40|FSC: 13; Default||Not reimbursed separately|7,847.40|FSC: 13; Default||External grouping not supported 951219950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Fm Cv Md W/tpr Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.60|FSC: 13; Default||Not reimbursed separately|4,758.60|FSC: 13; Default||External grouping not supported 951219951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Fm Cv Md W/tpr Lg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.60|FSC: 13; Default||Not reimbursed separately|4,758.60|FSC: 13; Default||External grouping not supported 951219952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Fm Cv Md W/tpr Xlg L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.60|FSC: 13; Default||Not reimbursed separately|4,758.60|FSC: 13; Default||External grouping not supported 951219957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triconii/genesis Insert Left 10mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triconii/genesis Insert Left 12mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triconii/genesis Insert Left 15mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Triconii/genesis Insert Left 18mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 10mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 12mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 15mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 18mm Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Lt 15mm Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Lt 18mm Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 15mm Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 18mm Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/genesis Insert Left 8mm Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 15mm Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tricon Ii/gen Insr Rt 18mm Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951219972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Femoral X-sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Femoral X-sm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Fem Sm Plus Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Lge Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Lge Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Xlge Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Mag Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Mag Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Mag Pl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Gns Fem Mag Pl Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|FSC: 13; Default||Not reimbursed separately|7,873.80|FSC: 13; Default||External grouping not supported 951219986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Lge Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Lge Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Xlg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Tib Base Mag Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Tib Base Sm Pl Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Tib Base Sm Pl Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Tib Bs Sm Pl Pl R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por Gns Tib Bs Sm Pl Pl L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|FSC: 13; Default||Not reimbursed separately|4,613.40|FSC: 13; Default||External grouping not supported 951219997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Uni Md/lg Art Isrt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,180.08|FSC: 13; Default||Not reimbursed separately|1,180.08|FSC: 13; Default||External grouping not supported 951219998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Tib I/m Peg 18x41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,353.00|FSC: 13; Default||Not reimbursed separately|1,353.00|FSC: 13; Default||External grouping not supported 951219999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lf 18mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.20|FSC: 13; Default||Not reimbursed separately|2,620.20|FSC: 13; Default||External grouping not supported 951220000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lf 21mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.20|FSC: 13; Default||Not reimbursed separately|2,620.20|FSC: 13; Default||External grouping not supported 951220001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Rgt 21mm Xlg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,442.00|FSC: 13; Default||Not reimbursed separately|2,442.00|FSC: 13; Default||External grouping not supported 951220002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Biconvex Pat Pros Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|FSC: 13; Default||Not reimbursed separately|1,933.80|FSC: 13; Default||External grouping not supported 951220003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Biconvex Pat Pros Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|FSC: 13; Default||Not reimbursed separately|1,933.80|FSC: 13; Default||External grouping not supported 951220004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Resurf Pat Pros Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|FSC: 13; Default||Not reimbursed separately|1,933.80|FSC: 13; Default||External grouping not supported 951220005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Resurf Pat Pros Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|FSC: 13; Default||Not reimbursed separately|1,933.80|FSC: 13; Default||External grouping not supported 951220006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Resurf Pat Pros Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|FSC: 13; Default||Not reimbursed separately|1,933.80|FSC: 13; Default||External grouping not supported 951220007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Biconvex Pat Pros Xsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|FSC: 13; Default||Not reimbursed separately|1,933.80|FSC: 13; Default||External grouping not supported 951220008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Small Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Insrt Small Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Sm Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Sm Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Sm Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Sm Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Sm Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Sm Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Med Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lg Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Large Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lg Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lg Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lg Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lg Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Lg Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Rt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Lt 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 951220038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Art Isrt Xlg Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,435.40|FSC: 13; Default||Not reimbursed separately|2,435.40|FSC: 13; Default||External grouping not supported 951220039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Rt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Rt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Rt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Lt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Rt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Sm Lt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Rt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Rt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Rt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Lt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Rt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Md Lt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Rt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Rt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Rt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Lt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Rt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Lg Lt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Rt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Rt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951220075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Rt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Lt 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Rt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Csys Art Is Xl Lt 25m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|FSC: 13; Default||Not reimbursed separately|3,953.40|FSC: 13; Default||External grouping not supported 951220079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns P/s Art Is Sm Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951220866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 6 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 7 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,282.80|FSC: 13; Default||Not reimbursed separately|10,282.80|FSC: 13; Default||External grouping not supported 951220868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 1 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 2 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 3 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 4 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 5 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 6 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 7 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 1 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 2 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 3 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 4 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 5 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 6 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Cocr Fb Fem Sz 7 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|FSC: 13; Default||Not reimbursed separately|7,623.00|FSC: 13; Default||External grouping not supported 951220882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz1lm/rl7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz2lm/rl7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz3lm/rl7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz4lm/rl7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz5lm/rl7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz6lm/rl7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz1rm/ll7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz2rm/ll7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz3rm/ll7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz4rm/ll7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz5rm/ll7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibsz6rm/ll7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Lm/rl Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Rm/ll Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Rm/ll Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Rm/ll Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Rm/ll Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Rm/ll Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Uni Tibial Base Rm/ll Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|FSC: 13; Default||Not reimbursed separately|5,042.40|FSC: 13; Default||External grouping not supported 951220906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 1-2 10mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 3-4 10mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 5-6 10mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 7-8 10mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 1-2 10mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 3-4 10mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 5-6 10mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 7-8 10mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 1-2 15mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 5-6 15mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 7-8 15mm Ltmd Rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 1-2 15mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 3-4 15mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 5-6 15mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sc Hm St 7-8 15mm Ltla Rtmd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 951220921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Full Step 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951220929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|FSC: 13; Default||Not reimbursed separately|4,976.40|FSC: 13; Default||External grouping not supported 951220930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|FSC: 13; Default||Not reimbursed separately|4,976.40|FSC: 13; Default||External grouping not supported 951220931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|FSC: 13; Default||Not reimbursed separately|4,976.40|FSC: 13; Default||External grouping not supported 951220932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|FSC: 13; Default||Not reimbursed separately|4,408.80|FSC: 13; Default||External grouping not supported 951220933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|FSC: 13; Default||Not reimbursed separately|4,976.40|FSC: 13; Default||External grouping not supported 951220934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|FSC: 13; Default||Not reimbursed separately|4,976.40|FSC: 13; Default||External grouping not supported 951220935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|FSC: 13; Default||Not reimbursed separately|4,976.40|FSC: 13; Default||External grouping not supported 951220936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Full Tib Wdge Sz7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|FSC: 13; Default||Not reimbursed separately|4,408.80|FSC: 13; Default||External grouping not supported 951220937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibial Wedge Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|398.64|FSC: 13; Default||Not reimbursed separately|398.64|FSC: 13; Default||External grouping not supported 951220938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,808.00|FSC: 13; Default||Not reimbursed separately|5,808.00|FSC: 13; Default||External grouping not supported 951220939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|FSC: 13; Default||Not reimbursed separately|5,075.40|FSC: 13; Default||External grouping not supported 951220940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|FSC: 13; Default||Not reimbursed separately|5,075.40|FSC: 13; Default||External grouping not supported 951220941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|FSC: 13; Default||Not reimbursed separately|5,075.40|FSC: 13; Default||External grouping not supported 951220942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz1 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,808.00|FSC: 13; Default||Not reimbursed separately|5,808.00|FSC: 13; Default||External grouping not supported 951220943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz2 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,808.00|FSC: 13; Default||Not reimbursed separately|5,808.00|FSC: 13; Default||External grouping not supported 951220944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz3 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|FSC: 13; Default||Not reimbursed separately|5,075.40|FSC: 13; Default||External grouping not supported 951220945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz6 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|FSC: 13; Default||Not reimbursed separately|5,075.40|FSC: 13; Default||External grouping not supported 951220946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gen Ii Mis Tib Base Cem Sz8 Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|FSC: 13; Default||Not reimbursed separately|5,075.40|FSC: 13; Default||External grouping not supported 951220947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|FSC: 13; Default||Not reimbursed separately|10,408.20|FSC: 13; Default||External grouping not supported 951220948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|FSC: 13; Default||Not reimbursed separately|10,408.20|FSC: 13; Default||External grouping not supported 951220955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Np Fem Sz 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|FSC: 13; Default||Not reimbursed separately|9,068.40|FSC: 13; Default||External grouping not supported 951220961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Np Fem Sz 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|FSC: 13; Default||Not reimbursed separately|9,358.80|FSC: 13; Default||External grouping not supported 951220975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 2l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 3l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 4l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 5l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 8l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 2r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 3r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 4r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 5r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 6r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Porous Cr Fem Sz 8r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 951220986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 11mm Sz 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 13mm Sz 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 15mm Sz 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 18mm Sz 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 951220990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 21mm Sz 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 11mm Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 13mm Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 15mm Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 18mm Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 21mm Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951220996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 11mm Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 951220997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 13mm Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 951220998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 15mm Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 951220999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 18mm Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 951221000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Rp Isrt 21mm Sz 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|FSC: 13; Default||Not reimbursed separately|5,346.00|FSC: 13; Default||External grouping not supported 951221001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 11mm Sz 2-3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 11mm Sz 2-3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 13mm Sz 2-3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 13mm Sz 2-3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 15mm Sz 2-3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 15mm Sz 2-3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 18mm Sz 2-3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 18mm Sz 2-3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 21mm Sz 2-3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 21mm Sz 2-3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 11mm Sz 4-5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 11mm Sz 4-5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 13mm Sz 4-5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 13mm Sz 4-5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 15mm Sz 4-5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 15mm Sz 4-5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 18mm Sz 4-5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 18mm Sz 4-5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 21mm Sz 4-5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 21mm Sz 4-5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|FSC: 13; Default||Not reimbursed separately|6,580.20|FSC: 13; Default||External grouping not supported 951221021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 11mm Sz 6-7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|FSC: 13; Default||Not reimbursed separately|6,263.40|FSC: 13; Default||External grouping not supported 951221022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 11mm Sz 6-7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|FSC: 13; Default||Not reimbursed separately|5,821.20|FSC: 13; Default||External grouping not supported 951221023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 13mm Sz 6-7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|FSC: 13; Default||Not reimbursed separately|6,263.40|FSC: 13; Default||External grouping not supported 951221024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 13mm Sz 6-7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|FSC: 13; Default||Not reimbursed separately|5,821.20|FSC: 13; Default||External grouping not supported 951221025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 15mm Sz 6-7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|FSC: 13; Default||Not reimbursed separately|6,263.40|FSC: 13; Default||External grouping not supported 951221026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 15mm Sz 6-7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|FSC: 13; Default||Not reimbursed separately|5,821.20|FSC: 13; Default||External grouping not supported 951221027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 18mm Sz 6-7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|FSC: 13; Default||Not reimbursed separately|6,263.40|FSC: 13; Default||External grouping not supported 951221028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 18mm Sz 6-7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|FSC: 13; Default||Not reimbursed separately|5,821.20|FSC: 13; Default||External grouping not supported 951221029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 21mm Sz 6-7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|FSC: 13; Default||Not reimbursed separately|6,263.40|FSC: 13; Default||External grouping not supported 951221030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Gd Motion Isrt 21mm Sz 6-7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|FSC: 13; Default||Not reimbursed separately|5,821.20|FSC: 13; Default||External grouping not supported 951221031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 1-2 Ll/rm 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 1-2 Ll/rm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 1-2 Ll/rm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 3-4 Ll/rm 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 3-4 Ll/rm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 3-4 Ll/rm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 5-6 Ll/rm 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 5-6 Ll/rm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 5-6 Ll/rm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 7-8 Ll/rm 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951221041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 7-8 Ll/rm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951221042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 7-8 Ll/rm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951221043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 1-2 Lm/rl 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 1-2 Lm/rl 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 1-2 Lm/rl 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 3-4 Lm/rl 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 3-4 Lm/rl 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 3-4 Lm/rl 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 5-6 Lm/rl 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 5-6 Lm/rl 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 5-6 Lm/rl 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|FSC: 13; Default||Not reimbursed separately|4,441.80|FSC: 13; Default||External grouping not supported 951221052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 7-8 Lm/rl 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951221053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 7-8 Lm/rl 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951221054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rk/hk Hemi Sz 7-8 Lm/rl 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951221055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Rev Tibia Base Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 951221859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S5 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S7 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S7 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S7 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbk Isrt Stb Pf S1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Xtb Pf S2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} S4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} S4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} S4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} S5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} S5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} Sz5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} Sz6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} Sz6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Mb Isrt Stabilz {} Sz6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt Stb Pf S7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|FSC: 13; Default||Not reimbursed separately|14,262.60|FSC: 13; Default||External grouping not supported 951221905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|FSC: 13; Default||Not reimbursed separately|14,262.60|FSC: 13; Default||External grouping not supported 951221914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|FSC: 13; Default||Not reimbursed separately|14,262.60|FSC: 13; Default||External grouping not supported 951221915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|FSC: 13; Default||Not reimbursed separately|13,615.80|FSC: 13; Default||External grouping not supported 951221923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Fem Ox Np Bcs Lt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|FSC: 13; Default||Not reimbursed separately|14,262.60|FSC: 13; Default||External grouping not supported 951221924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Fem Oxin Cem Ps Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|FSC: 13; Default||Not reimbursed separately|9,972.60|FSC: 13; Default||External grouping not supported 951221925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Fem Oxin Cem Ps Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|FSC: 13; Default||Not reimbursed separately|9,972.60|FSC: 13; Default||External grouping not supported 951221926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Fem Oxin Cem Ps Rt S 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|FSC: 13; Default||Not reimbursed separately|9,972.60|FSC: 13; Default||External grouping not supported 951221927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Fem Oxin Cem Ps Rt S 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,504.00|FSC: 13; Default||Not reimbursed separately|9,504.00|FSC: 13; Default||External grouping not supported 951221928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Fem Oxin Cem Ps Lt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,504.00|FSC: 13; Default||Not reimbursed separately|9,504.00|FSC: 13; Default||External grouping not supported 951221929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Fem Oxin Cem Ps Lt S 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|FSC: 13; Default||Not reimbursed separately|9,972.60|FSC: 13; Default||External grouping not supported 951221930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Fem Oxin Cem Ps Lt S 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|FSC: 13; Default||Not reimbursed separately|9,972.60|FSC: 13; Default||External grouping not supported 951221931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Fem Oxin Cem Ps Lt S 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|FSC: 13; Default||Not reimbursed separately|9,972.60|FSC: 13; Default||External grouping not supported 951221932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Renasys Fem Oxin Cem Ps Lt S 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,504.00|FSC: 13; Default||Not reimbursed separately|9,504.00|FSC: 13; Default||External grouping not supported 951221933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,780.60|FSC: 13; Default||Not reimbursed separately|15,780.60|FSC: 13; Default||External grouping not supported 951221942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Ox Np Lt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jour Fem Cocr Np Lt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|FSC: 13; Default||Not reimbursed separately|10,817.40|FSC: 13; Default||External grouping not supported 951221968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Fem Cocr Np Lt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951221986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,780.60|FSC: 13; Default||Not reimbursed separately|15,780.60|FSC: 13; Default||External grouping not supported 951221997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951221999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Femoral Oxin Lt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 951222006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Tibia Base Np Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Xr Baseplate Sz 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|FSC: 13; Default||Not reimbursed separately|8,547.00|FSC: 13; Default||External grouping not supported 951222030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 1-2 Lt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journ Art Ins Bcs Sm 3-4 Lt13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951222856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tc Rev Fem Comp. Rev Lt Vks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tcrev Fem Comp. Rev Lt Vks5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tcrev Fem Comp. Rev Rt Vks1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tcrev Fem Comp. Rev Rt Vks2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tcrev Fem Comp. Rev Rt Vks3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tcrev Fem Comp. Rev Rt Vks4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tc Rev Fem Comp. Rev Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Rt 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 951222904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Ps Solu Tibl Insrt Ps 2.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Ps Solu Tibl Insrt Ps 4.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 951222906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Ps Solu Tibl Insrt Ps 6.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Rt Solu Tibl Insrt W.clamp 4.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951222908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Rt Solu Tibl Insrt W.clamp 6.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951222909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Rt Solu Tibl Insrt W.clamp 8.17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|FSC: 13; Default||Not reimbursed separately|2,593.80|FSC: 13; Default||External grouping not supported 951222913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Tibia Insert 6 Lt Valgus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,794.80|FSC: 13; Default||Not reimbursed separately|5,794.80|FSC: 13; Default||External grouping not supported 951222934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 48mm Headed Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.68|FSC: 13; Default||Not reimbursed separately|196.68|FSC: 13; Default||External grouping not supported 951222935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 48mm Headless Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.68|FSC: 13; Default||Not reimbursed separately|196.68|FSC: 13; Default||External grouping not supported 951222936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 27mm Headed Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.68|FSC: 13; Default||Not reimbursed separately|196.68|FSC: 13; Default||External grouping not supported 951222937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 33mm Headed Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.92|FSC: 13; Default||Not reimbursed separately|205.92|FSC: 13; Default||External grouping not supported 951222939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 1 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 1 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 2 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 2 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 3 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 3 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 4 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 4 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 5 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 5 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 6 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tib Base Sz 6 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951222951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size A Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size A Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size B Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size B Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size C Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size C Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size D Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size D Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size E Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size E Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size F Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size F Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size G Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Size G Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|FSC: 13; Default||Not reimbursed separately|9,345.60|FSC: 13; Default||External grouping not supported 951222965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951222999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951223000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articular Surface Size 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951223001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 10mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 12mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 14mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 12mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 1 14mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 10mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 12mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 14mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 12mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 2 14mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 10mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 12mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 14mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 12mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 3 14mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 10mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 12mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 14mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 12mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 4 14mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 10mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 12mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 14mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 8mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 10mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 12mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 5 14mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb All-poly Tib Sz 6 8mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|FSC: 13; Default||Not reimbursed separately|4,844.40|FSC: 13; Default||External grouping not supported 951223792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Hp Dist Long Im Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,339.00|FSC: 13; Default||Not reimbursed separately|3,339.00|FSC: 13; Default||External grouping not supported 951223793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Fem Postnr Sm/sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,054.00|FSC: 13; Default||Not reimbursed separately|6,054.00|FSC: 13; Default||External grouping not supported 951223794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Fem Postnr Med/lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,022.00|FSC: 13; Default||Not reimbursed separately|2,022.00|FSC: 13; Default||External grouping not supported 951223812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,022.00|FSC: 13; Default||Not reimbursed separately|2,022.00|FSC: 13; Default||External grouping not supported 951223813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|FSC: 13; Default||Not reimbursed separately|1,953.00|FSC: 13; Default||External grouping not supported 951223814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|FSC: 13; Default||Not reimbursed separately|1,953.00|FSC: 13; Default||External grouping not supported 951223815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|FSC: 13; Default||Not reimbursed separately|1,953.00|FSC: 13; Default||External grouping not supported 951223816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|FSC: 13; Default||Not reimbursed separately|1,953.00|FSC: 13; Default||External grouping not supported 951223817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Collar 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|FSC: 13; Default||Not reimbursed separately|1,953.00|FSC: 13; Default||External grouping not supported 951223818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Thrd Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,439.00|FSC: 13; Default||Not reimbursed separately|5,439.00|FSC: 13; Default||External grouping not supported 951223819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Impct Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Tapered Rmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|FSC: 13; Default||Not reimbursed separately|4,623.00|FSC: 13; Default||External grouping not supported 951223821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Complet Rev Fem Bshng 5deg 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|FSC: 13; Default||Not reimbursed separately|5,235.00|FSC: 13; Default||External grouping not supported 951223822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cemented Stem Bushing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|FSC: 13; Default||Not reimbursed separately|5,235.00|FSC: 13; Default||External grouping not supported 951223823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comp Rev Cem Stem Bushing 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|FSC: 13; Default||Not reimbursed separately|5,235.00|FSC: 13; Default||External grouping not supported 951223824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Complet Rev Fem Bshng 5deg 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|FSC: 13; Default||Not reimbursed separately|5,235.00|FSC: 13; Default||External grouping not supported 951223845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Im Plate Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,070.00|FSC: 13; Default||Not reimbursed separately|5,070.00|FSC: 13; Default||External grouping not supported 951223846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Completion Rev Fem Im Plate Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,070.00|FSC: 13; Default||Not reimbursed separately|5,070.00|FSC: 13; Default||External grouping not supported 951223853|EAP|Custom 951223853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tibial Broach 29 Mm|1|HUMANA [1294]||HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951223854|EAP|Custom 951223854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tib 2 Deg Broach 37mm|1|HUMANA [1294]||HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951223855|EAP|Custom 951223855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tib 2 Deg Broach 45mm|1|HUMANA [1294]||HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951223856|EAP|Custom 951223856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tib 2 Deg Broach 53mm|1|HUMANA [1294]||HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951223857|EAP|Custom 951223857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mbt Rev Tib 2 Deg Broach 61mm|1|HUMANA [1294]||HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951223858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Pressfit Tibial Punch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.00|FSC: 13; Default||Not reimbursed separately|4,014.00|FSC: 13; Default||External grouping not supported 951223859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Rev Cemented Tibial Punch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.00|FSC: 13; Default||Not reimbursed separately|4,014.00|FSC: 13; Default||External grouping not supported 951223861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Sleeve Impactor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,467.00|FSC: 13; Default||Not reimbursed separately|7,467.00|FSC: 13; Default||External grouping not supported 951223862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Fem Sleeve/stem Impact|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|FSC: 13; Default||Not reimbursed separately|3,726.00|FSC: 13; Default||External grouping not supported 951224578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 8mm Kn Uncndl Lt Mdl Rl Cmnt Uncmp Hprfr Sgm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 8mm Kn Uncndl Lt Mdl Rl Cmnt Uncmp Hprfr Sgm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 8mm Kn Uncndl Lt Mdl Rl Cmnt Uncmp Hprfr Sgm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 8mm Kn Uncndl Lt Mdl Rl Cmnt Uncmp Hprfr Sgm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 8mm Kn Uncndl Lt Mdl Rl Cmnt Uncmp Hprfr Sgm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 8mm Kn Uncndl Lt Mdl Rl Cmnt Uncmp Hprfr Sgm Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 8mm Kn Uncndl Rmll Cmnt Uncmp Hprfr Sgm Pe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 8mm Kn Uncndl Rmll Cmnt Uncmp Hprfr Sgm Pe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 8mm Kn Uncndl Rmll Cmnt Uncmp Hprfr Sgm Pe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 8mm Kn Uncndl Rmll Cmnt Uncmp Hprfr Sgm Pe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 8mm Kn Uncndl Rmll Cmnt Uncmp Hprfr Sgm Pe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 8mm Kn Uncndl Rmll Cmnt Uncmp Hprfr Sgm Pe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|FSC: 13; Default||Not reimbursed separately|9,305.10|FSC: 13; Default||External grouping not supported 951224590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 Cmnt Hprfr Sgm Cocrmo Ptlfem Lt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 31.6mm Cmnt Sgm Cocrmo Ptlfem Lt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 Cmnt Hprfr Sgm Cocrmo Ptlfem Lt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 4 Cmnt Hprfr Sgm Cocrmo Ptlfem Lt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 5 Cmnt Hprfr Sgm Cocrmo Ptlfem Lt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 1 Cmnt Hprfr Sgm Cocrmo Ptlfem Rt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 2 31.6mm Cmnt Sgm Cocrmo Ptlfem Rt Trochlea|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 3 33.8mm Cmnt Sgm Cocrmo Ptlfem Rt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 4 Cmnt Hprfr Sgm Cocrmo Ptlfem Rt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Ptlr 5 Cmnt Hprfr Sgm Cocrmo Ptlfem Rt Trochlea Gck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|FSC: 13; Default||Not reimbursed separately|11,169.90|FSC: 13; Default||External grouping not supported 951224600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Rot Plat Hi Flxn Pfc S Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 60x56mm Kn Lt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 66x61mm Kn Lt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 78x74mm Kn Lt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 57x53mm Kn Lt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 63x59mm Kn Lt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 60x56mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 66x61mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 71x65mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 73x69mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 78x74mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 57x53mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 63x59mm Kn Rt Cmnt Cr Pfc S Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Rt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Lt Cmnt Crcte Sub Opn Bx Pfc S Uhmwpe Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|FSC: 13; Default||Not reimbursed separately|12,589.50|FSC: 13; Default||External grouping not supported 951224638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Lt Cmnt Cr Sgm Cocr Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Rt Cmnt Cr Sgm Cocr Npor Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 951224640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Lt Cmnt Rot Plat Pfc S Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Rt Cmnt Rot Plat Pfc S Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|FSC: 13; Default||Not reimbursed separately|16,816.80|FSC: 13; Default||External grouping not supported 951224642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Sgm Cocr Strl Cr150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|FSC: 13; Default||Not reimbursed separately|13,662.60|FSC: 13; Default||External grouping not supported 951224658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Lt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Lt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Rt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Rt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Post Stab Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 951224667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Lt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Rt Cmnt Post Stab Lug Sgm Cocr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|FSC: 13; Default||Not reimbursed separately|12,259.80|FSC: 13; Default||External grouping not supported 951224683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std+ Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ Kn Rt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std+ Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ Kn Lt Cmnt Lcs Cmpt Cocr Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|FSC: 13; Default||Not reimbursed separately|13,158.60|FSC: 13; Default||External grouping not supported 951224697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Rt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ Kn Rt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Rt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std Kn Rt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std+ Kn Rt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ Kn Rt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std+ Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ Kn Lt Cmnt Stab Rot Plat Flxn Lcs Cmpt Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|FSC: 13; Default||Not reimbursed separately|19,950.00|FSC: 13; Default||External grouping not supported 951224710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cr Pfc S Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Lt Cr Pfc S Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Lt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Lt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cr Pfc S Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cr Pfc S Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1.5 Kn Rt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2.5 Kn Rt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4n Kn Rt Cr Pfc S Prct Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|FSC: 13; Default||Not reimbursed separately|16,510.20|FSC: 13; Default||External grouping not supported 951224721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std+ Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ Kn Rt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Sm+ Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Med Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Std+ Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem Lg+ Kn Lt Lcs Cmpt Prct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|FSC: 13; Default||Not reimbursed separately|18,291.00|FSC: 13; Default||External grouping not supported 951224735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 10 Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Nar Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Nar Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Nar Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Nar Kn Lt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 1 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 2 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 5 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 6 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 7 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 8 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 9 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 10 Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 3 Nar Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951224760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Fem 4 Nar Kn Rt Cmnt Cr Attune Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|FSC: 13; Default||Not reimbursed separately|14,280.00|FSC: 13; Default||External grouping not supported 951225438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Lg+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Sm+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Std+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rps Ins Lg+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|FSC: 13; Default||Not reimbursed separately|7,247.10|FSC: 13; Default||External grouping not supported 951225507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rpf Aox Ins Sz 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|FSC: 13; Default||Not reimbursed separately|8,908.20|FSC: 13; Default||External grouping not supported 951225539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz1.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz1.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz3 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz4 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz6 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Crv Ins Sz6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz1.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz1.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz1.5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz2.5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz3 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz3 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951225605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Rp Aox Stb Ins Sz5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 951226296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem20x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem22x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem22x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem22x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem24x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem24x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem24x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Tc3 Fem Left Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Left S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Left S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Rt Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Rt Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Rt Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Rt Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Fem Rt Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|FSC: 13; Default||Not reimbursed separately|21,258.30|FSC: 13; Default||External grouping not supported 951226313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm/1.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm/1.5 Rigt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm/1.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm/1.5 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Post Aug 4mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 12mm/1.5left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 12mm/1.5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz2 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz2 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Fem Post Aug Sz2 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Fem Post Aug Sz2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz2left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz2rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz2left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz2rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug4mm S2.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug4mm S2.5 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug8mm S2.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug8mm S2.5 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Fem Post Aug Sz2.5 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Fem Post Aug Sz2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco 2.5 Lft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco 2.5 Rgt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco 2.5 Lft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco 2.5 Rgt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz3 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz3 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Fem Post Aug Sz3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz3left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz3rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz3left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz3rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz4 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz4 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Fem Post Aug Sz4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz4left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz4rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz4rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 4mm Sz5 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Dis Aug 8mm Sz5 Rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Fem Post Aug Sz5 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Fem Post Aug Sz5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz5left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug12mmco Sz5rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz5left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Di Aug16mmco Sz5rght|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|FSC: 13; Default||Not reimbursed separately|3,609.90|FSC: 13; Default||External grouping not supported 951226366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ins 12.5mmsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ins 17.5mmsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ins 22.5mmsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 25mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 12.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 17.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 22.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab + Ins 25mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ins 12.5mmsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ins 17.5mmsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ins 22.5mmsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 25mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 12.5mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 17.5mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 22.5mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 25mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 12.5mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 17.5mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 22.5mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 25mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 12.5mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 17.5mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 22.5mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 25mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 10mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 12.5mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 15mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 17.5mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 20mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 22.5mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 25mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Stab+ Ins 30mm Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|FSC: 13; Default||Not reimbursed separately|7,488.60|FSC: 13; Default||External grouping not supported 951226422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Insert10mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 12.5mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 15 Mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 17.5mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 20mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 22.5mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 25mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 30mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 10mm Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins12.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 15mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins17.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 20mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 22.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 25mm Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 30mm Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Insert10mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins12.5mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 15mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins17.5mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 20mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins22.5mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 25mm Sz 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 30mm Sz 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Insert10mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 12.5mm Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 15mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 17.5mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 20mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 22.5mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 25mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 30mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Insert10mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 12.5mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 15mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins17.5mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 20mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 22.5mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 25mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 30mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Insert10mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 12.5mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 15mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 17.5mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 20mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 22.5mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 25mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Ins 30mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|FSC: 13; Default||Not reimbursed separately|7,585.20|FSC: 13; Default||External grouping not supported 951226470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S1.5 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951226483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tibial Insert S2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|FSC: 13; Default||Not reimbursed separately|10,010.70|FSC: 13; Default||External grouping not supported 951227156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Sm 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Med 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 9x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 10x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 11x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 12x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 12x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 13x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 14x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 15x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 16x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cemented Stem 17x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|FSC: 13; Default||Not reimbursed separately|13,129.20|FSC: 13; Default||External grouping not supported 951227186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 10.5x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 11.5x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 12.5x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 13.5x100mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 13.5x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 14.5x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 15.5x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 16.5x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 17.5x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Porous Stem 18.5x125mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|FSC: 13; Default||Not reimbursed separately|14,101.50|FSC: 13; Default||External grouping not supported 951227196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Tib Replc Comp Xsm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,024.90|FSC: 13; Default||Not reimbursed separately|27,024.90|FSC: 13; Default||External grouping not supported 951227197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Distal Fem Comp Xsm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,036.30|FSC: 13; Default||Not reimbursed separately|30,036.30|FSC: 13; Default||External grouping not supported 951227198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Distal Fem Comp Xxsm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,036.30|FSC: 13; Default||Not reimbursed separately|30,036.30|FSC: 13; Default||External grouping not supported 951227199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Distal Fem Comp Xxsm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,036.30|FSC: 13; Default||Not reimbursed separately|30,036.30|FSC: 13; Default||External grouping not supported 951227200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951227201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951227202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951227203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951227204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951227205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951227224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951227230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951227231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|FSC: 13; Default||Not reimbursed separately|5,390.70|FSC: 13; Default||External grouping not supported 951227242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 36idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|FSC: 13; Default||Not reimbursed separately|6,027.00|FSC: 13; Default||External grouping not supported 951227243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 36idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|FSC: 13; Default||Not reimbursed separately|6,027.00|FSC: 13; Default||External grouping not supported 951227244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 36idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|FSC: 13; Default||Not reimbursed separately|6,027.00|FSC: 13; Default||External grouping not supported 951227245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 36idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|FSC: 13; Default||Not reimbursed separately|6,027.00|FSC: 13; Default||External grouping not supported 951227246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 36idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|FSC: 13; Default||Not reimbursed separately|6,027.00|FSC: 13; Default||External grouping not supported 951227247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 36idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 36idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 36idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 36idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 36idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 36idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951227262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|FSC: 13; Default||Not reimbursed separately|6,738.90|FSC: 13; Default||External grouping not supported 951227265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 36idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|FSC: 13; Default||Not reimbursed separately|6,640.20|FSC: 13; Default||External grouping not supported 951227270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,037.90|FSC: 13; Default||Not reimbursed separately|8,037.90|FSC: 13; Default||External grouping not supported 951227272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 40idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|FSC: 13; Default||Not reimbursed separately|8,156.40|FSC: 13; Default||External grouping not supported 951227280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 40idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|FSC: 13; Default||Not reimbursed separately|8,156.40|FSC: 13; Default||External grouping not supported 951227288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 40idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 951227296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 44idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 44idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 44idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 44idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 44idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 44idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 44idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 44idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|FSC: 13; Default||Not reimbursed separately|8,456.70|FSC: 13; Default||External grouping not supported 951227304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 36 X 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|FSC: 13; Default||Not reimbursed separately|8,637.30|FSC: 13; Default||External grouping not supported 951227312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ceramax Ceramic Insert 28 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|FSC: 13; Default||Not reimbursed separately|8,553.30|FSC: 13; Default||External grouping not supported 951227319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*head Femoral Cocr 28+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|FSC: 13; Default||Not reimbursed separately|2,692.20|FSC: 13; Default||External grouping not supported 951227320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*head Femoral Cocr 28+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|FSC: 13; Default||Not reimbursed separately|2,692.20|FSC: 13; Default||External grouping not supported 951227321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bantam Fem Head 22.225mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|FSC: 13; Default||Not reimbursed separately|2,721.60|FSC: 13; Default||External grouping not supported 951227322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bantam Fem Head 22.225mm+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|FSC: 13; Default||Not reimbursed separately|2,721.60|FSC: 13; Default||External grouping not supported 951227323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bantam Fem Head 28mm+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|FSC: 13; Default||Not reimbursed separately|2,721.60|FSC: 13; Default||External grouping not supported 951228885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grv 22.225+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grv 22.225+7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 26+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 26+7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 26+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 28+1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 28+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 28+8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 28+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 28+15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 32+1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 32+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 32+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 32+13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Artic/eze Tr Ball Grvd 32+17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul Tr Ball Grvd 36-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul Tr Ball Grvd 36 +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul Tr Ball Grvd 36 +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul Tr Ball Grvd 36 +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul Tr Ball Grvd 36 +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 951228905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Articul Tr Ball Grvd 36+15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,613.00|FSC: 13; Default||Not reimbursed separately|2,613.00|FSC: 13; Default||External grouping not supported 951228923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Excel X/o Segment 12/14 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,942.00|FSC: 13; Default||Not reimbursed separately|9,942.00|FSC: 13; Default||External grouping not supported 951228924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Excel X/o Segment 12/14 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|FSC: 13; Default||Not reimbursed separately|4,809.00|FSC: 13; Default||External grouping not supported 951228925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Excel X/o Segment 12/14 43mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|FSC: 13; Default||Not reimbursed separately|4,809.00|FSC: 13; Default||External grouping not supported 951228926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Excel X/o Segment 12/14 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|FSC: 13; Default||Not reimbursed separately|4,809.00|FSC: 13; Default||External grouping not supported 951228927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Excel X/o Segment 12/14 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|FSC: 13; Default||Not reimbursed separately|4,809.00|FSC: 13; Default||External grouping not supported 951228949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz0/1 Std Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz0/1 Hi Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz2/3 Std Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz2/3 Hi Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz4/5 Std Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz4/5 Hi Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz6/7 Std Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz6/7 Hi Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz8/9 Std Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz8/9 Hi Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz10 Std Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Sz10 Hi Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|FSC: 13; Default||Not reimbursed separately|3,957.00|FSC: 13; Default||External grouping not supported 951228969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 0/1 Hi Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 2/3 Std Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 2/3 Hi Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 4/5 Std Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 4/5 Hi Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 6/7 Std Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 6/7 Hi Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 8/9 Std Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951228977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit 8/9 Hi Nk Seg W/collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 951229008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 17-12d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Miller Shell Sz 17-14b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|FSC: 13; Default||Not reimbursed separately|9,840.00|FSC: 13; Default||External grouping not supported 951229054|EAP|Custom 951229054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 1|1|HUMANA [1294]||HUMANA [11839]|11,709.00|FSC: 13; Default||Not reimbursed separately|11,709.00|FSC: 13; Default||External grouping not supported 951229055|EAP|Custom 951229055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 2|1|HUMANA [1294]||HUMANA [11839]|11,709.00|FSC: 13; Default||Not reimbursed separately|11,709.00|FSC: 13; Default||External grouping not supported 951229056|EAP|Custom 951229056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 3|1|HUMANA [1294]||HUMANA [11839]|11,709.00|FSC: 13; Default||Not reimbursed separately|11,709.00|FSC: 13; Default||External grouping not supported 951229057|EAP|Custom 951229057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb C-stem Amt Broach Sz 4|1|HUMANA [1294]||HUMANA [11839]|11,709.00|FSC: 13; Default||Not reimbursed separately|11,709.00|FSC: 13; Default||External grouping not supported 951217209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 16 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 17 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 18 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 19 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 20 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 21 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 22 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 23 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 24 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 25 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 26 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 27 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 13 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 15 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 16 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 17 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 19 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 21 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 22 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 23 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 24 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 25 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951216948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 8 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951216949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 8 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951216950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 9 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951216951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 9 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951216952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 28/46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 28/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 28/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 28/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 28/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 28/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 32/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Comp 32/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 32/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Comp 32/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 32/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951216963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slve Sm Sz 11 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slve Sm Sz 12-13 Stiktitew/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Sm Sz 14-15 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Sm Sz 16-17 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Sm Sz 18-19 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Sm Sz 20-21 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Sm 22-23 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Sm Sz 24-25 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slve Sm Sz 26/27 Stktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|FSC: 13; Default||Not reimbursed separately|6,795.00|FSC: 13; Default||External grouping not supported 951216972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Med Sz 11 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Med Sz 12-13 Stiktitew/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Medsz 14-15 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Medsz 16-17 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Medsz 18-19 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slvmed Sz 20-21 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Medsz 22-23 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Med Sz 24-25 Stiktitew/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Medsz 26/27 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|FSC: 13; Default||Not reimbursed separately|6,795.00|FSC: 13; Default||External grouping not supported 951216981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 11 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 12-13 Stiktitew/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 14-15 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 16-17 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 18-19 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 20-21 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 22-23 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 24-25 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv Lg Sz 26/27 Stiktite W/ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|FSC: 13; Default||Not reimbursed separately|6,795.00|FSC: 13; Default||External grouping not supported 951216990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv 11 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Slv 12-13 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Sleeve 14-15 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt {} Mod Sleeve 16-17 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Mod Sleeve 18-19 {} Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Modular Sleeve 20-21 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951216997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Modular Sleeve 22-23 {} Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951216998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951216999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Modular Sleeve 24-25 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|FSC: 13; Default||Not reimbursed separately|6,660.00|FSC: 13; Default||External grouping not supported 951217000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 40mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Modular Sleeve 26/27 Xs Grit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|FSC: 13; Default||Not reimbursed separately|6,795.00|FSC: 13; Default||External grouping not supported 951217002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Hole Cover Kit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|FSC: 13; Default||Not reimbursed separately|279.00|FSC: 13; Default||External grouping not supported 951217014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Fully Porous Shell 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|FSC: 13; Default||Not reimbursed separately|7,312.50|FSC: 13; Default||External grouping not supported 951217020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 28mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 28mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 28mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 28mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 32mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Ante Cmt Xlpe Lnr 36mm X 66-68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 68 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 74 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 50 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 56 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 62 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 68 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 74 Mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 50 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 56 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 62 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 68 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slice Augment 74 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 50 Mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 56 Mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 62 Mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 68 Mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 74 Mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 50 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 56 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 62 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 68 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Staple Augment 74 Mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|FSC: 13; Default||Not reimbursed separately|4,729.50|FSC: 13; Default||External grouping not supported 951217087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 20 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 21 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 13 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 15 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 16 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 17 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 19 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 190mm Sz 21 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|FSC: 13; Default||Not reimbursed separately|20,910.00|FSC: 13; Default||External grouping not supported 951217099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Locking Screw 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 951217134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 66-68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 70-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 40mm X 76-80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 44mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 44mm X 66-68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 44mm X 70-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt 0 Deg Cmt Xlpe Lnr 44mm X 76-80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951217141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 12 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 13 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 14 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 15 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 16 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 17 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 18 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 19 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 20 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 21 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 22 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 23 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 24 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 25 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 26 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 27 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 12 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 13 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 14 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 15 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 16 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 17 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 18 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 19 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 20 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 21 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 22 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 23 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 24 H0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 25 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 26 H0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 240mm Sz 27 H0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|FSC: 13; Default||Not reimbursed separately|22,957.50|FSC: 13; Default||External grouping not supported 951217173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 12 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 13 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz14 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 15 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvls Mono Stem 300mm Sz 16 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|FSC: 13; Default||Not reimbursed separately|24,210.00|FSC: 13; Default||External grouping not supported 951217764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 52/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 54/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 56/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 58/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 60/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 62/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 64/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bicon-plus Pe Insert Std 3/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.76|FSC: 13; Default||Not reimbursed separately|1,211.76|FSC: 13; Default||External grouping not supported 951217772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bicon-plus Pe Insert Antil 5/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,346.20|FSC: 13; Default||Not reimbursed separately|3,346.20|FSC: 13; Default||External grouping not supported 951217773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 28 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 28l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 28xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 32xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 32xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 28 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 28 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Metal Metal Ball Hd 28 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 28xl Cone 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 28 Xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 32 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 32 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Ball Hd 32 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 32xl Cone 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 32xxl Cone 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 22m Cone 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metal Metal Ball Head 22l Cone 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|FSC: 13; Default||Not reimbursed separately|2,395.80|FSC: 13; Default||External grouping not supported 951217790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 38s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 40s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 42s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 44s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 46s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 48s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 50s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 52s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 54s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 56s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 58s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 60s Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 38m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 40m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 42m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 44m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 46m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 48m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 50m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 52m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 54m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 56m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 58m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fracture Head 60m Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 951217814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 39/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 40/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 41/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 43/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 44/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 45/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 46/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 47/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 49/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 50/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 51/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 53/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 54/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 55/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 56/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 57/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 58/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 59/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bipolar Prosthesis 60/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 53|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 57|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 59|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Cemented 63|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|FSC: 13; Default||Not reimbursed separately|3,135.00|FSC: 13; Default||External grouping not supported 951217845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Polarcup Shell Ti Coated W.pegsplus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,666.20|FSC: 13; Default||Not reimbursed separately|4,666.20|FSC: 13; Default||External grouping not supported 951217846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 43/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,199.88|FSC: 13; Default||Not reimbursed separately|1,199.88|FSC: 13; Default||External grouping not supported 951217847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 45/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 47/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 49/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 51/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 53/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 55/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|FSC: 13; Default||Not reimbursed separately|1,309.44|FSC: 13; Default||External grouping not supported 951217853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 55/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 57/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,199.88|FSC: 13; Default||Not reimbursed separately|1,199.88|FSC: 13; Default||External grouping not supported 951217855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 57/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|FSC: 13; Default||Not reimbursed separately|1,141.80|FSC: 13; Default||External grouping not supported 951217856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 59/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|FSC: 13; Default||Not reimbursed separately|1,309.44|FSC: 13; Default||External grouping not supported 951217857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 63/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|FSC: 13; Default||Not reimbursed separately|1,309.44|FSC: 13; Default||External grouping not supported 951217858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 65/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|FSC: 13; Default||Not reimbursed separately|1,309.44|FSC: 13; Default||External grouping not supported 951217859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Liner 67/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|FSC: 13; Default||Not reimbursed separately|1,309.44|FSC: 13; Default||External grouping not supported 951217860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Impacted Anchoring Peg (2pc)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 951217861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 49 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,996.20|FSC: 13; Default||Not reimbursed separately|4,996.20|FSC: 13; Default||External grouping not supported 951217862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 49 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,841.20|FSC: 13; Default||Not reimbursed separately|3,841.20|FSC: 13; Default||External grouping not supported 951217863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 51 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,841.20|FSC: 13; Default||Not reimbursed separately|3,841.20|FSC: 13; Default||External grouping not supported 951217864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 53 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|FSC: 13; Default||Not reimbursed separately|4,197.60|FSC: 13; Default||External grouping not supported 951217865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 57 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|FSC: 13; Default||Not reimbursed separately|4,197.60|FSC: 13; Default||External grouping not supported 951217866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 59 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|FSC: 13; Default||Not reimbursed separately|4,197.60|FSC: 13; Default||External grouping not supported 951217867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti Coated 67 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951217869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|FSC: 13; Default||Not reimbursed separately|4,428.60|FSC: 13; Default||External grouping not supported 951217872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Pe.insrt 56+58/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|FSC: 13; Default||Not reimbursed separately|11,853.60|FSC: 13; Default||External grouping not supported 951217875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|FSC: 13; Default||Not reimbursed separately|11,853.60|FSC: 13; Default||External grouping not supported 951217876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|FSC: 13; Default||Not reimbursed separately|11,853.60|FSC: 13; Default||External grouping not supported 951217877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|FSC: 13; Default||Not reimbursed separately|11,853.60|FSC: 13; Default||External grouping not supported 951217878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Shell 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|FSC: 13; Default||Not reimbursed separately|3,742.20|FSC: 13; Default||External grouping not supported 951217883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Mpf Mpf.primary Pe.insrt 46.54/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,194.40|FSC: 13; Default||Not reimbursed separately|3,194.40|FSC: 13; Default||External grouping not supported 951217884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 38/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 40/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 42/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 44/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 46/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 48/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 50/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 52/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 54/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 56/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 58/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 60/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 62/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Pe Cup 64/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 951217898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 43 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 45 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 47 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 49 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 51 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 53 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 55 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 57 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 59 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 61 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 63 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 65 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 67 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|FSC: 13; Default||Not reimbursed separately|7,517.40|FSC: 13; Default||External grouping not supported 951217911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 43 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 45 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 47 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 49 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 51 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 53 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 55 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 57 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 59 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 61 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 63 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|FSC: 13; Default||Not reimbursed separately|6,388.80|FSC: 13; Default||External grouping not supported 951217922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 43/22 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,887.60|FSC: 13; Default||Not reimbursed separately|1,887.60|FSC: 13; Default||External grouping not supported 951217923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 45/22 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,887.60|FSC: 13; Default||Not reimbursed separately|1,887.60|FSC: 13; Default||External grouping not supported 951217924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 47/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|FSC: 13; Default||Not reimbursed separately|2,521.20|FSC: 13; Default||External grouping not supported 951217925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 49/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|FSC: 13; Default||Not reimbursed separately|2,521.20|FSC: 13; Default||External grouping not supported 951217926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 51/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|FSC: 13; Default||Not reimbursed separately|2,402.40|FSC: 13; Default||External grouping not supported 951217927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 53/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|FSC: 13; Default||Not reimbursed separately|2,521.20|FSC: 13; Default||External grouping not supported 951217928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 55/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|FSC: 13; Default||Not reimbursed separately|2,402.40|FSC: 13; Default||External grouping not supported 951217929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 57/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|FSC: 13; Default||Not reimbursed separately|2,402.40|FSC: 13; Default||External grouping not supported 951217930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 59/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|FSC: 13; Default||Not reimbursed separately|2,521.20|FSC: 13; Default||External grouping not supported 951217931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 61/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|FSC: 13; Default||Not reimbursed separately|2,402.40|FSC: 13; Default||External grouping not supported 951217932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 63/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|FSC: 13; Default||Not reimbursed separately|2,402.40|FSC: 13; Default||External grouping not supported 951217933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 65/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|FSC: 13; Default||Not reimbursed separately|2,521.20|FSC: 13; Default||External grouping not supported 951217934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Pe Insert 67/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|FSC: 13; Default||Not reimbursed separately|2,521.20|FSC: 13; Default||External grouping not supported 951217935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Anchoring Peg (2 Each)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.36|FSC: 13; Default||Not reimbursed separately|426.36|FSC: 13; Default||External grouping not supported 951217936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Cortical Screw 4.5x40 Non Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|FSC: 13; Default||Not reimbursed separately|208.56|FSC: 13; Default||External grouping not supported 951217937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Cortical Screw 4.5x44 Non Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|FSC: 13; Default||Not reimbursed separately|208.56|FSC: 13; Default||External grouping not supported 951217938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Cortical Screw 4.5x48 Non Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|FSC: 13; Default||Not reimbursed separately|208.56|FSC: 13; Default||External grouping not supported 951217939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Cortical Screw 4.5x52 Non Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|FSC: 13; Default||Not reimbursed separately|208.56|FSC: 13; Default||External grouping not supported 951218644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim Ho 12/14 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951218677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem Bow Sz 12l 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem Bow Sz 14l 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem Bow Sz 12r 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem Bow Sz 14r 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Sel Ii Cem Ho 10/12 Sz9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,285.80|FSC: 13; Default||Not reimbursed separately|13,285.80|FSC: 13; Default||External grouping not supported 951218682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Cem Ho Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|FSC: 13; Default||Not reimbursed separately|8,553.60|FSC: 13; Default||External grouping not supported 951218700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Conq Fx Fem Comp Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|FSC: 13; Default||Not reimbursed separately|5,458.20|FSC: 13; Default||External grouping not supported 951218710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 26 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 951218711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 28 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 26 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 951218713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 28 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 22 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 951218715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 26 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 951218716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Zirc 12/14 Fem Hd 28 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 40mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 41mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 42mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 43mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 44mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 45mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 46mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 47mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 48mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 49mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 50mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 51mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 52mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 53mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 54mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Unipolar Head 55mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|FSC: 13; Default||Not reimbursed separately|4,184.40|FSC: 13; Default||External grouping not supported 951218733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 38od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 39od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 40od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 41od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 42od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 43od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 44od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 45od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 46od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 47od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 48od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 49od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 50od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 51od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 52od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 53od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 54od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 55od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 57od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Bipolar Cocr 59od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|FSC: 13; Default||Not reimbursed separately|2,996.40|FSC: 13; Default||External grouping not supported 951218753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 26id 38-42 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|FSC: 13; Default||Not reimbursed separately|353.76|FSC: 13; Default||External grouping not supported 951218754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Taper Fem Hd 28mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951218755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 28id 43-46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|FSC: 13; Default||Not reimbursed separately|353.76|FSC: 13; Default||External grouping not supported 951218756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 28id 47-51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|FSC: 13; Default||Not reimbursed separately|353.76|FSC: 13; Default||External grouping not supported 951218757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 28id 52-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|FSC: 13; Default||Not reimbursed separately|353.76|FSC: 13; Default||External grouping not supported 951218758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 28id 57-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.56|FSC: 13; Default||Not reimbursed separately|373.56|FSC: 13; Default||External grouping not supported 951218759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 38od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Con Lnr 0deg 22id 46-48od Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,289.60|FSC: 13; Default||Not reimbursed separately|8,289.60|FSC: 13; Default||External grouping not supported 951218761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 28 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 28 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 28 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 28 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 32 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 32 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr 0 Deg 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 951218768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr Adptr46-48od D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 951218769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr Adptr 62-64od H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 951218770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr Adptr 66-68od {} J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 951218771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cnstr Lnr Adptr 70-76od K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 951218772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Taper Fem Hd32mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951218773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Cocr 14/16 Taper Fem Hd32mm +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951218774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 32id 47-51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|FSC: 13; Default||Not reimbursed separately|353.76|FSC: 13; Default||External grouping not supported 951218775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 32id 52-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|FSC: 13; Default||Not reimbursed separately|353.76|FSC: 13; Default||External grouping not supported 951218776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ B-p Liner 32id 57-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.56|FSC: 13; Default||Not reimbursed separately|373.56|FSC: 13; Default||External grouping not supported 951218777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 38od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 39od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 40od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 41od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 42od 22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 43od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 44od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 45od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 46od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 47od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 48od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 49od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 50od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 51od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 52od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 53od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 54od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 55od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 57od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tandem Intl Bipolar 59od 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951218797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Shl/xlpe Lnr 39od26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 40od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 41od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 42od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 43od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 44od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 45od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 46od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 47od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 48od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 49od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 50od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 51od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 52od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 53od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 54od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 55od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 57od 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tndm Bp Shl/xlpe Lnr 590d 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 951218816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Delta Liner 48mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|FSC: 13; Default||Not reimbursed separately|6,078.60|FSC: 13; Default||External grouping not supported 951218817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Delta Liner 50mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|FSC: 13; Default||Not reimbursed separately|6,078.60|FSC: 13; Default||External grouping not supported 951218818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 52mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|FSC: 13; Default||Not reimbursed separately|6,078.60|FSC: 13; Default||External grouping not supported 951218819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 54mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|FSC: 13; Default||Not reimbursed separately|6,078.60|FSC: 13; Default||External grouping not supported 951219524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 40mm X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 40mm X 72/74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 72/74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951219527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm Id X 56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm X 58 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm X 60 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm X 62 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm X 64 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 40mm X 72-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 72-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951219535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 40mm X 56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 40mm X 58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 {} Xlpe Acet Lnr 40mm X 60m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 {} Xlpe Acet Lnr 40mm X 62m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 {} Xlpe Acet Lnr 40mm X 64m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20deg +4 Xlpe Acet Lnr 40mm X 66/70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20deg +4 Xlpe Acet Lnr 40mm X 72-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20deg +4 Xlpe Acet Lnr 36mm X 72-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951219543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mmx76-80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951219544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Crmc Liner 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 32mm Id Us Crmc Liner 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Crmc Liner 66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|FSC: 13; Default||Not reimbursed separately|5,286.60|FSC: 13; Default||External grouping not supported 951219554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Const 66-70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|FSC: 13; Default||Not reimbursed separately|8,157.60|FSC: 13; Default||External grouping not supported 951219562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 32 20 +4 54-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 32 20 +4 58-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 32 20 +4 62-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 32 20 +4 66-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 32 20 +4 70-76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 32 54-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951219568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 32 58-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951219569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 32 62-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951219570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951219573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Degree Xlpe Lnr 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951219574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 32mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 36 58-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,081.80|FSC: 13; Default||Not reimbursed separately|7,081.80|FSC: 13; Default||External grouping not supported 951219579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 36 62-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951219580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 36 66-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,081.80|FSC: 13; Default||Not reimbursed separately|7,081.80|FSC: 13; Default||External grouping not supported 951219581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 36 70-76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,081.80|FSC: 13; Default||Not reimbursed separately|7,081.80|FSC: 13; Default||External grouping not supported 951219582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 28 20 +4 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 28 20 +4 50-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 28 20 +4 54-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951219585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 28 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951219586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Refl Xlpe 35 28 50-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 951219588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acc Ss Cable Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.60|FSC: 13; Default||Not reimbursed separately|435.60|FSC: 13; Default||External grouping not supported 951219602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|FSC: 13; Default||Not reimbursed separately|20,750.40|FSC: 13; Default||External grouping not supported 951219611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 190mm Str Sz 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|FSC: 13; Default||Not reimbursed separately|20,750.40|FSC: 13; Default||External grouping not supported 951219612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|FSC: 13; Default||Not reimbursed separately|18,862.80|FSC: 13; Default||External grouping not supported 951219620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|FSC: 13; Default||Not reimbursed separately|20,750.40|FSC: 13; Default||External grouping not supported 951219621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 15mm Cal Sz 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|FSC: 13; Default||Not reimbursed separately|20,750.40|FSC: 13; Default||External grouping not supported 951219622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 32x56-62 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 32x63-70 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Str 30mm Cal Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,372.00|FSC: 13; Default||Not reimbursed separately|9,372.00|FSC: 13; Default||External grouping not supported 951219625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 12 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 13 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 14 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 15 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 16 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 17 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 18 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 19l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 20l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 21l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 22l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 12 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 13 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 14 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 15 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 16 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 17 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 18 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 19r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 20r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 21r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por Std 260mm Bow Sz 22r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15cal Sz 12l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 13l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15cal Sz 14l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 15l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 16l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 17l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 18l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 19l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 20l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 21l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 22l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x46-48 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x50-54 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x56-62 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x63-70 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 12r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 13r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 14r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 15r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 16r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz 17r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 15 Cal Sz18r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|FSC: 13; Default||Not reimbursed separately|20,849.40|FSC: 13; Default||External grouping not supported 951219669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 19r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 20r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 21r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 15 Cal Sz 22r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 12l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 13l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 14l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 15l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 16l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 17l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 18l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 19l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 20l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 21l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 22l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 28x50-54 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 28x56-62 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 28x63-70 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 12r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 13r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 14r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 15r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 16r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 17r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260bw 30 Cal Sz 18r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 19r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 20r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 21r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Por 260 Bw 30 Cal Sz 22r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|FSC: 13; Default||Not reimbursed separately|22,928.40|FSC: 13; Default||External grouping not supported 951219698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951220475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 20mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 25mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 30mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 35mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 40mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 45mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 50mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951220482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Tib Fin Fix Peg1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|FSC: 13; Default||Not reimbursed separately|568.92|FSC: 13; Default||External grouping not supported 951220483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Fin Fix Peg Size 3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|FSC: 13; Default||Not reimbursed separately|568.92|FSC: 13; Default||External grouping not supported 951220484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Fin Fix Peg Size 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|FSC: 13; Default||Not reimbursed separately|568.92|FSC: 13; Default||External grouping not supported 951220485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Fin Fix Peg Size 7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|FSC: 13; Default||Not reimbursed separately|568.92|FSC: 13; Default||External grouping not supported 951220486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Fem Offset Coup W/slv {} 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,659.60|FSC: 13; Default||Not reimbursed separately|4,659.60|FSC: 13; Default||External grouping not supported 951220487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Lt {} Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Left Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Left Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Left Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Left Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oval Resurfacing Pat 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|FSC: 13; Default||Not reimbursed separately|2,719.20|FSC: 13; Default||External grouping not supported 951220496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oval Resurfacing Pat 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|FSC: 13; Default||Not reimbursed separately|2,719.20|FSC: 13; Default||External grouping not supported 951220497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oval Resurfacing Pat 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|FSC: 13; Default||Not reimbursed separately|2,719.20|FSC: 13; Default||External grouping not supported 951220498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Oxin P/s Fem Right Siz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St Sz1-2 5mm Ltmd Rtlt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 3-4 5mm Ltmd-rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 5-6 5mm Ltmd-rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 7-8 5mm Ltmd-rtla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 1-2 5mm Ltla-rtmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 3-4 5mm Ltla-rtmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 5-6 5mm Ltla-rtmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hm St 7-8 5mm Ltla-rtmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 951220513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ox Constrained Fem 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 951220523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Ps Oxin Fem Sz8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|FSC: 13; Default||Not reimbursed separately|11,893.20|FSC: 13; Default||External grouping not supported 951220533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Cr Oxin Fem Sz8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 951220543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 3n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 4n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 5n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 6n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 3n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 4n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 5n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Cr Oxin Sz 6n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 3n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 4n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 5n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 6n Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 3n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 4n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 5n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Narrow Ps Oxin Sz 6n Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|FSC: 13; Default||Not reimbursed separately|13,318.80|FSC: 13; Default||External grouping not supported 951220559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 2 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,814.00|FSC: 13; Default||Not reimbursed separately|11,814.00|FSC: 13; Default||External grouping not supported 951220564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,088.00|FSC: 13; Default||Not reimbursed separately|11,088.00|FSC: 13; Default||External grouping not supported 951220565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Nslt10 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 951220566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Nslt12x100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 951220567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Nslt14x100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 951220568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Nslt16x100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 951220569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 10x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|FSC: 13; Default||Not reimbursed separately|4,745.40|FSC: 13; Default||External grouping not supported 951220570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 12x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|FSC: 13; Default||Not reimbursed separately|4,745.40|FSC: 13; Default||External grouping not supported 951220571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 14x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|FSC: 13; Default||Not reimbursed separately|4,745.40|FSC: 13; Default||External grouping not supported 951220572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 16x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|FSC: 13; Default||Not reimbursed separately|4,745.40|FSC: 13; Default||External grouping not supported 951220573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 18x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|FSC: 13; Default||Not reimbursed separately|4,745.40|FSC: 13; Default||External grouping not supported 951220574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 20x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|FSC: 13; Default||Not reimbursed separately|4,745.40|FSC: 13; Default||External grouping not supported 951220575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 22x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 951220576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 24x150m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 951220577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 14x200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,910.40|FSC: 13; Default||Not reimbursed separately|4,910.40|FSC: 13; Default||External grouping not supported 951220578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 16x200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,910.40|FSC: 13; Default||Not reimbursed separately|4,910.40|FSC: 13; Default||External grouping not supported 951220579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 18x200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|FSC: 13; Default||Not reimbursed separately|4,408.80|FSC: 13; Default||External grouping not supported 951220580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 20x200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|FSC: 13; Default||Not reimbursed separately|4,408.80|FSC: 13; Default||External grouping not supported 951220581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 22x200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|FSC: 13; Default||Not reimbursed separately|4,408.80|FSC: 13; Default||External grouping not supported 951220582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Pressfit Stem Slot 24x200m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|FSC: 13; Default||Not reimbursed separately|4,408.80|FSC: 13; Default||External grouping not supported 951220583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Fem Assembly Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|FSC: 13; Default||Not reimbursed separately|25,060.20|FSC: 13; Default||External grouping not supported 951220591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk 11mm Bolt - Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|FSC: 13; Default||Not reimbursed separately|2,884.20|FSC: 13; Default||External grouping not supported 951220592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk 13mm Bolt - Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|FSC: 13; Default||Not reimbursed separately|2,884.20|FSC: 13; Default||External grouping not supported 951220593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk 15mm Bolt - Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|FSC: 13; Default||Not reimbursed separately|2,884.20|FSC: 13; Default||External grouping not supported 951220594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk 18mm Bolt - Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|FSC: 13; Default||Not reimbursed separately|2,884.20|FSC: 13; Default||External grouping not supported 951220595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk 21mm Bolt - Sleeve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|FSC: 13; Default||Not reimbursed separately|2,884.20|FSC: 13; Default||External grouping not supported 951220596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 1-2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 3-4 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 3-4 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 3-4 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 3-4 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 3-4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 5-6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 7-8 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 7-8 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 7-8 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 7-8 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 7-8 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt Sz 7-8 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Hi Flex Isrt {} Sz 7-8 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 951220622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S1-2 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S1-2 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S1-2 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S1-2 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S1-2 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S3-4 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S3-4 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S3-4 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S3-4 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S3-4 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S5-6 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S5-6 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S5-6 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S5-6 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S5-6 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S7-8 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S7-8 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S7-8 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S7-8 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Deep Flex Isrt S7-8 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|FSC: 13; Default||Not reimbursed separately|4,210.80|FSC: 13; Default||External grouping not supported 951220642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Link Assy Sz 2-5 Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,095.40|FSC: 13; Default||Not reimbursed separately|3,095.40|FSC: 13; Default||External grouping not supported 951220643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Link Assy Sz 6-7 Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951220644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Weg Screw 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|FSC: 13; Default||Not reimbursed separately|432.96|FSC: 13; Default||External grouping not supported 951220645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Weg Screw 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|FSC: 13; Default||Not reimbursed separately|432.96|FSC: 13; Default||External grouping not supported 951220646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Screw 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|FSC: 13; Default||Not reimbursed separately|432.96|FSC: 13; Default||External grouping not supported 951220647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Screw 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|FSC: 13; Default||Not reimbursed separately|432.96|FSC: 13; Default||External grouping not supported 951220649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz5 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion 15mm Distal Wedge Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|FSC: 13; Default||Not reimbursed separately|369.60|FSC: 13; Default||External grouping not supported 951220663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951221460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S1 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S3 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S4 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Rt S6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S1 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S3 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 951221536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 951221538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Pl Tb Isrt Lt S6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|FSC: 13; Default||Not reimbursed separately|4,402.20|FSC: 13; Default||External grouping not supported 951221539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 10mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 12mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 14mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 16mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 18mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 20mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 10mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 12mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 14mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 16mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 18mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 20mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 30mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 951221552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 10mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 12mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 14mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 16mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 18mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 20mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 30mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 951221559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 10mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 12mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 14mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 16mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 18mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 20mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 30mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 951221566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 10mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 12mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 14mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 16mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 18mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 20mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 30mmr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 951221573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 10mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 12mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 14mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 16mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 18mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S2 20mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 10mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 12mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 14mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 16mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 18mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S3 20mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 10mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 12mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 14mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 16mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 18mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S4 20mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 10mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 12mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 14mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 16mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 18mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S5 20mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 10mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 12mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 14mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 16mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|FSC: 13; Default||Not reimbursed separately|3,920.40|FSC: 13; Default||External grouping not supported 951221601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 18mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro P/s Art Isrt S6 20mml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|FSC: 13; Default||Not reimbursed separately|3,240.60|FSC: 13; Default||External grouping not supported 951221603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Rt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Rt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Rt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Rt 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Rt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Rt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Rt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Rt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Rt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Rt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Rt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Rt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Rt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Rt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Rt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Rt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Rt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Lt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Lt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Lt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Const Isrt S2 Lt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S2 Lt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Lt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Lt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Lt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Lt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S3 Lt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,719.00|FSC: 13; Default||Not reimbursed separately|4,719.00|FSC: 13; Default||External grouping not supported 951221645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Lt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Lt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Lt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Lt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S4 Lt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Lt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,719.00|FSC: 13; Default||Not reimbursed separately|4,719.00|FSC: 13; Default||External grouping not supported 951221653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Lt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Lt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Lt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S5 Lt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Lt 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Lt 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951222456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Rt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 1-2 Lt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4-rt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Rt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 3-4 Lt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Rt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 5-6 Lt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Rt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz7-8 Lt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Xlpe Art Isrt Sz 7-8 Lt 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Rt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 1-2 Lt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Rt 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Constrd Art Isrt 3-4 Rt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 3-4 Lt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Rt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 5-6 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Rt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 5-6 Lt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt Rt 7-8 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Rt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 15m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 18m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 21m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Cnstrd Art Isrt 7-8 Lt 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|FSC: 13; Default||Not reimbursed separately|9,609.60|FSC: 13; Default||External grouping not supported 951222603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Lt 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Lt 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Lt 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pri Fixed Tibl Comp Plus Vks Lt 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,751.80|FSC: 13; Default||Not reimbursed separately|6,751.80|FSC: 13; Default||External grouping not supported 951222607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Vks Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Rt 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,794.80|FSC: 13; Default||Not reimbursed separately|5,794.80|FSC: 13; Default||External grouping not supported 951222609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Rt 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Rt 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Rt 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Vks Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Vks Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|FSC: 13; Default||Not reimbursed separately|6,375.60|FSC: 13; Default||External grouping not supported 951222614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Lt 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Lt 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Plus Vks Lt 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Lt 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Vks Lt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Vks Lt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Rt 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Rt 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Rt 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Cem Plus Vks Rt 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Vks Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plustc Pri Fixed Tibl Comp Vks Rt 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951222626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.60|FSC: 13; Default||Not reimbursed separately|2,778.60|FSC: 13; Default||External grouping not supported 951222627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 2/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951223381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Sigma Fem Insert/extract|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,683.00|FSC: 13; Default||Not reimbursed separately|16,683.00|FSC: 13; Default||External grouping not supported 951223428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2extramed Base Tib Align Dev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,928.00|FSC: 13; Default||Not reimbursed separately|17,928.00|FSC: 13; Default||External grouping not supported 951223429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Intramed Tib Alignment De|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,597.00|FSC: 13; Default||Not reimbursed separately|9,597.00|FSC: 13; Default||External grouping not supported 951223437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2*ext Alignmt Dev Base Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 951223442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hudson Modtibdrl Cem 13m 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.00|FSC: 13; Default||Not reimbursed separately|3,111.00|FSC: 13; Default||External grouping not supported 951223443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hudson Modtibdrl Cem 15m 4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.00|FSC: 13; Default||Not reimbursed separately|3,111.00|FSC: 13; Default||External grouping not supported 951223444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hudson Modtibdrl Por 13m 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.00|FSC: 13; Default||Not reimbursed separately|3,111.00|FSC: 13; Default||External grouping not supported 951223445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Std Tb Punch Gde Sz 1.5-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Std Ncem Tb Pun Sz 2.5-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Std Cem Tib Pun Sz1.5/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Std Cem Tib Pun Sz2.5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Mod Tb Ce Pun Gd Sz 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Mod Tb Ce Pun Gd Sz 4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Mod Tib Ncem Pun Sz 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Mod Tib Ncem Pun Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Mod Tib Noncem Pun Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Mod Tb Cem Pun Sz 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Mod Tb Cem Pun Sz 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pf*2 Mod Tib Cem Punch Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|FSC: 13; Default||Not reimbursed separately|7,848.00|FSC: 13; Default||External grouping not supported 951223461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Mod Tib Drl Np13mm Sz1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|FSC: 13; Default||Not reimbursed separately|3,054.00|FSC: 13; Default||External grouping not supported 951223462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Mod Tib Drl Np15mm Sz4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|FSC: 13; Default||Not reimbursed separately|3,054.00|FSC: 13; Default||External grouping not supported 951223463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2mod Tib Drl Por 13mmsz1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|FSC: 13; Default||Not reimbursed separately|3,054.00|FSC: 13; Default||External grouping not supported 951223464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2mod Tib Drill Por 15mmsz4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|FSC: 13; Default||Not reimbursed separately|3,054.00|FSC: 13; Default||External grouping not supported 951223468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Mod Tb Ncem Pun Gd/1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,326.00|FSC: 13; Default||Not reimbursed separately|7,326.00|FSC: 13; Default||External grouping not supported 951223469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec2*tb Ce St Pun1.5-3sz13x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|FSC: 13; Default||Not reimbursed separately|7,116.00|FSC: 13; Default||External grouping not supported 951223470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec2*tb Ce St Pun1.5-3sz13x60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|FSC: 13; Default||Not reimbursed separately|7,116.00|FSC: 13; Default||External grouping not supported 951223471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Tb Ce Stm Pun/sz4-6/15x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|FSC: 13; Default||Not reimbursed separately|7,116.00|FSC: 13; Default||External grouping not supported 951223472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Tb Ce Stm Pun/sz4-6/15x60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|FSC: 13; Default||Not reimbursed separately|7,116.00|FSC: 13; Default||External grouping not supported 951223473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 F Wed Cut Blk 10deg/ll/rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|FSC: 13; Default||Not reimbursed separately|4,299.00|FSC: 13; Default||External grouping not supported 951223474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 Fl Wed Cut Blk 15de/ll/rm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|FSC: 13; Default||Not reimbursed separately|4,299.00|FSC: 13; Default||External grouping not supported 951223475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 F Wed Cut Blk 10deg/lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|FSC: 13; Default||Not reimbursed separately|4,299.00|FSC: 13; Default||External grouping not supported 951223476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 F Wed Cut Blk 15deg/lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|FSC: 13; Default||Not reimbursed separately|4,299.00|FSC: 13; Default||External grouping not supported 951223507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2femntchgd Bsh13mm7dg+2l/-2r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|FSC: 13; Default||Not reimbursed separately|3,009.00|FSC: 13; Default||External grouping not supported 951223508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 F Not Gd Bh 13m/7d 0 Offs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|FSC: 13; Default||Not reimbursed separately|3,009.00|FSC: 13; Default||External grouping not supported 951223509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2femntchgd Bsh13mm7dg+2r/-2l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|FSC: 13; Default||Not reimbursed separately|3,009.00|FSC: 13; Default||External grouping not supported 951223510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2femntchgd Bsh15mm7dg+2l/-2r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|FSC: 13; Default||Not reimbursed separately|3,009.00|FSC: 13; Default||External grouping not supported 951223511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp*2 F Not Gd Bh 15m/7d 0 Offs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|FSC: 13; Default||Not reimbursed separately|3,009.00|FSC: 13; Default||External grouping not supported 951223512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2femntchgd Bsh15mm7dg+2r/-2l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|FSC: 13; Default||Not reimbursed separately|3,009.00|FSC: 13; Default||External grouping not supported 951225102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2.5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 3 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 4 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insert Sz 1 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insert Sz 2 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insert Sz3 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz5 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 9 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Fb Insrt Sz 10 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 1 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb 8mm Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb10mm Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb12.5 Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb15mm Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb8mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb10mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb12.5 Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb15mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb 8mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb10mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb12.5 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb15mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb 8mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb10mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb12.5 Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb15mm Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb 8mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb10mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb12.5 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb15mm Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 8mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb10mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb12.5 Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 15mmsz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 8mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 10mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb12.5mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 15mm Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 8mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb10mm Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb12.5 Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 15mmsz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 8mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 10mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 12.5 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 15mm Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 8mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 10mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb12.5mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 15mm Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 8mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p P/s Tb 10mm Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsig Stab Alpolytib 12.5mms5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsigma Stab Alpolytib 15mms5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|FSC: 13; Default||Not reimbursed separately|6,115.20|FSC: 13; Default||External grouping not supported 951225997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951225998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951225999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951226000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951226001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951226002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951226003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Keel Tib Tray Cem Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|FSC: 13; Default||Not reimbursed separately|8,969.10|FSC: 13; Default||External grouping not supported 951226004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Mod Tib Tray Cem Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 951226005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Tib Tray Cem Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 951226006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Mod Tib Tray Cem Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 951226007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Mod Tib Tray Cem Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 951226008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc* Mod Tib Tray Np Sz 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 951226009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Mod Tib Tray Cem Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 951226010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Primary Por Tib S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|FSC: 13; Default||Not reimbursed separately|11,547.90|FSC: 13; Default||External grouping not supported 951226017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Mod Tib Tray Cem Cocr 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 951226018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Mod Tib Tray Cem Cocr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 951226019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Mod Tib Tray Cem Cocr 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 951226020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 1 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 2 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 3 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 5 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 7 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 9 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 10 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951226030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 1 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 2 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 3 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 5 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 7 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 9 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Fb Tib Base Sz 10 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|FSC: 13; Default||Not reimbursed separately|9,426.90|FSC: 13; Default||External grouping not supported 951226040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Tibial Tray Sz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|FSC: 13; Default||Not reimbursed separately|10,067.40|FSC: 13; Default||External grouping not supported 951226049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Keel Tib Tray Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 951226050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Keel Tib Tray Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 951226051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Cem Keel Tib Tray Sz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 951226052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 1 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 2 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 3 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 5 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 7 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 9 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 10 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|FSC: 13; Default||Not reimbursed separately|9,718.80|FSC: 13; Default||External grouping not supported 951226062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Tibial Tray Sz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|FSC: 13; Default||Not reimbursed separately|11,008.20|FSC: 13; Default||External grouping not supported 951226071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Keel Tib Tray Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 951226072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Keel Tib Tray Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 951226073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Keel Tib Tray Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 951226074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Keel Tib Tray Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 951226075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Keel Tib Tray Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 951226076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mbt Por Keel Tib Tray Sz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|FSC: 13; Default||Not reimbursed separately|11,199.30|FSC: 13; Default||External grouping not supported 951226077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 1 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 2 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 3 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 4 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 5 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 6 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 7 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 8 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 9 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rp Tib Base Sz 10 Por|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|FSC: 13; Default||Not reimbursed separately|12,915.00|FSC: 13; Default||External grouping not supported 951226087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma/rd/dome Pat 3peg 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma/rd/dome Pat 3peg 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma/rd/dome Pat 3peg 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Inset Pat 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Inset Pat 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigma Inset Pat 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsig 1pst Rd/dome Pat 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsig 1pst Rd/dome Pat 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsig 1pst Rd/dome Pat 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsig 1pst Rd/dome Pat 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcsig 1pst Rd/dome Pat 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 951226098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lo Pro Pol Pat Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lo Pro Polpat Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lo Pro Polpat Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lo Pro Polpat Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lopro Polpat Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lo Pro Pol Pat Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Lo Pro Polpat Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete Poly Patella Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|FSC: 13; Default||Not reimbursed separately|4,107.60|FSC: 13; Default||External grouping not supported 951226112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Por Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|FSC: 13; Default||Not reimbursed separately|6,974.10|FSC: 13; Default||External grouping not supported 951226119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz6 8.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz6 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz6 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3n 8.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3n 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3n 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3n 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3n 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3n 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz4 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz5 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz6 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3n 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3n 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmodc/s Stab Ins Sz3n 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3n 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmodc/s Stab Ins Sz3n 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3n 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmodc/s Stab Ins Sz3n 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3n 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz1 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz1 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz2 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz3 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz3 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz4 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz5 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfcmod C/s Stab Ins Sz6 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Mod C/s Stab Ins Sz6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|FSC: 13; Default||Not reimbursed separately|6,461.70|FSC: 13; Default||External grouping not supported 951226888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std/12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std/17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std+/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std+/12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std+/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Std+/17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg/12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg/17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg+/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg+/12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg+/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Lg+/17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm/std 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm/std 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm/std 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm/std 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm+/std 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm+/std 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm+/std 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Sm+/std 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std/lg 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std/lg 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std/lg 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std/lg 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std+/lg 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std+/lg 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std+/lg 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs M Brdg Brg Std+/lg 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm/std 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm/std 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm/std 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm/std 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm/std 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm+/std 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm+/std 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm+/std 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm+/std 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brdg Brg Sm+/std 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs R Brdg Brg Std+/lg 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs R Brdg Brg Std+/lg 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs R Brdg Brg Std+/lg 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs R Brdg Brg Std+/lg 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|FSC: 13; Default||Not reimbursed separately|6,039.60|FSC: 13; Default||External grouping not supported 951226934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std/lg 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std/lg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std/lg 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std/lg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std/lg 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+/lg 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+/lg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+/lg 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+/lg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+/lg 20.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Menis Bearing Sm+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|FSC: 13; Default||Not reimbursed separately|5,898.90|FSC: 13; Default||External grouping not supported 951226972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 10.0mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 12.5mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 15.0mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 17.5mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 20.0mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 10.0mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 12.5mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 15.0mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 17.5mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Brg 20.0mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Std+ 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951227660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,319.50|FSC: 13; Default||Not reimbursed separately|15,319.50|FSC: 13; Default||External grouping not supported 951227661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,319.50|FSC: 13; Default||Not reimbursed separately|15,319.50|FSC: 13; Default||External grouping not supported 951227662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,185.10|FSC: 13; Default||Not reimbursed separately|15,185.10|FSC: 13; Default||External grouping not supported 951227663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Lnr Cons Neut +4 36idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 951227664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Lnr Cons Neut +4 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 951227665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 36idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|FSC: 13; Default||Not reimbursed separately|14,424.90|FSC: 13; Default||External grouping not supported 951227666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|FSC: 13; Default||Not reimbursed separately|14,424.90|FSC: 13; Default||External grouping not supported 951227667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 40idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 40idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 40idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 40idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 40idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 40idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 40idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 40idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|FSC: 13; Default||Not reimbursed separately|16,703.40|FSC: 13; Default||External grouping not supported 951227675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 44idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|FSC: 13; Default||Not reimbursed separately|16,401.00|FSC: 13; Default||External grouping not supported 951227676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 44idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|FSC: 13; Default||Not reimbursed separately|16,401.00|FSC: 13; Default||External grouping not supported 951227677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 44idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|FSC: 13; Default||Not reimbursed separately|16,401.00|FSC: 13; Default||External grouping not supported 951227678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 44idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|FSC: 13; Default||Not reimbursed separately|16,401.00|FSC: 13; Default||External grouping not supported 951227679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Liner 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|FSC: 13; Default||Not reimbursed separately|5,959.80|FSC: 13; Default||External grouping not supported 951227680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Liner 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|FSC: 13; Default||Not reimbursed separately|5,959.80|FSC: 13; Default||External grouping not supported 951227681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Liner 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|FSC: 13; Default||Not reimbursed separately|5,959.80|FSC: 13; Default||External grouping not supported 951227682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Liner 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|FSC: 13; Default||Not reimbursed separately|5,959.80|FSC: 13; Default||External grouping not supported 951227683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Liner 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,547.80|FSC: 13; Default||Not reimbursed separately|6,547.80|FSC: 13; Default||External grouping not supported 951227684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Liner 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,547.80|FSC: 13; Default||Not reimbursed separately|6,547.80|FSC: 13; Default||External grouping not supported 951227685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar Neut Lnr 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar 10d Lnr 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|FSC: 13; Default||Not reimbursed separately|6,022.80|FSC: 13; Default||External grouping not supported 951227701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Lnr 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|FSC: 13; Default||Not reimbursed separately|6,669.60|FSC: 13; Default||External grouping not supported 951227709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 Neut Lnr 36x66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 10d Lnr 36x54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 10d Lnr 36x58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 10d Lnr 36x60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 10d Lnr 36x62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 10d Lnr 36x64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Mar +4 10d Lnr 36x66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 951227722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Marathon Liner M 28 10deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,144.60|FSC: 13; Default||Not reimbursed separately|6,144.60|FSC: 13; Default||External grouping not supported 951227723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Mar Lnr L 32mm+3mm 10 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,144.60|FSC: 13; Default||Not reimbursed separately|6,144.60|FSC: 13; Default||External grouping not supported 951227724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 48x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 50x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 52x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 54x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 56/68x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 58/70x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 60/72x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 62/74x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 64x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 66x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Bantam 10d 22.225x38 Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 951227735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Bantam 10d 22.225x40 Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 951227736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Bantam 10d 22.225x42 Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 951227737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Bantam 10d 22.225x44 Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 951227738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Bantam 10d 22.225x46 Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 951227739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 52x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 54x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 56/68x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 58/70x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 60/72x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 62/74x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Const Liner 64x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|FSC: 13; Default||Not reimbursed separately|11,161.50|FSC: 13; Default||External grouping not supported 951227746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x44sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x46sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x48sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x52sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x54sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x56sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml/tl Endr Rep Liner 32x58sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Opt Lpw Poly Ins 28/48 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|FSC: 13; Default||Not reimbursed separately|3,294.90|FSC: 13; Default||External grouping not supported 951227754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Opt Lpw Poly Ins 28/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|FSC: 13; Default||Not reimbursed separately|3,294.90|FSC: 13; Default||External grouping not supported 951227755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Opt Lpw Poly Ins 28/54 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|FSC: 13; Default||Not reimbursed separately|3,294.90|FSC: 13; Default||External grouping not supported 951227756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Opt Lpw Poly Ins 28/58 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|FSC: 13; Default||Not reimbursed separately|3,294.90|FSC: 13; Default||External grouping not supported 951227757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Opt Lpw Poly 28/62 64 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|FSC: 13; Default||Not reimbursed separately|3,294.90|FSC: 13; Default||External grouping not supported 951227758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*head Femoral Cocr 22+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,864.40|FSC: 13; Default||Not reimbursed separately|2,864.40|FSC: 13; Default||External grouping not supported 951227759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 28mm Head +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951227760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 28mm Head +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951227761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 28mm Head +5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951227762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 32mm Head +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.10|FSC: 13; Default||Not reimbursed separately|3,236.10|FSC: 13; Default||External grouping not supported 951227763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 32mm Head +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.10|FSC: 13; Default||Not reimbursed separately|3,236.10|FSC: 13; Default||External grouping not supported 951227764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 32mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|FSC: 13; Default||Not reimbursed separately|3,145.80|FSC: 13; Default||External grouping not supported 951227765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 32mm +11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|FSC: 13; Default||Not reimbursed separately|3,145.80|FSC: 13; Default||External grouping not supported 951227766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 32mm +15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|FSC: 13; Default||Not reimbursed separately|3,145.80|FSC: 13; Default||External grouping not supported 951227767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 32mm +18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|FSC: 13; Default||Not reimbursed separately|3,145.80|FSC: 13; Default||External grouping not supported 951227768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 28mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|FSC: 13; Default||Not reimbursed separately|3,238.20|FSC: 13; Default||External grouping not supported 951227769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 28mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|FSC: 13; Default||Not reimbursed separately|3,238.20|FSC: 13; Default||External grouping not supported 951227770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 28mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|FSC: 13; Default||Not reimbursed separately|3,238.20|FSC: 13; Default||External grouping not supported 951227771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14/16 Lg Taper M Head 36mm+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|FSC: 13; Default||Not reimbursed separately|5,464.20|FSC: 13; Default||External grouping not supported 951227772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14/16 Lg Taper M Head 36mm+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|FSC: 13; Default||Not reimbursed separately|5,464.20|FSC: 13; Default||External grouping not supported 951227773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 14/16 Lg Taper M Head 36mm+11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|FSC: 13; Default||Not reimbursed separately|5,464.20|FSC: 13; Default||External grouping not supported 951227774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 28mm +11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|FSC: 13; Default||Not reimbursed separately|3,238.20|FSC: 13; Default||External grouping not supported 951227775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Total Hip Ball 28mm +15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|FSC: 13; Default||Not reimbursed separately|3,238.20|FSC: 13; Default||External grouping not supported 951227776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 28mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 28mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 32mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 32mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 28mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 32mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Modular Hd 28mm +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|FSC: 13; Default||Not reimbursed separately|3,003.00|FSC: 13; Default||External grouping not supported 951227783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dlt Ts Cer Hd 12/14 28mm +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|FSC: 13; Default||Not reimbursed separately|8,133.30|FSC: 13; Default||External grouping not supported 951227784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dlt Ts Cer Hd 12/14 28mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|FSC: 13; Default||Not reimbursed separately|8,133.30|FSC: 13; Default||External grouping not supported 951227785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 10x50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 10x54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 10x58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 10x62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 10x66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 10x70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 15x50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 15x54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 15x58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 15x62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 15x66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 15x70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 20x50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 20x54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 20x58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 20x62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 20x66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 20x70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 30x50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 30x54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 30x58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 30x62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 30x66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Augm 30x70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|FSC: 13; Default||Not reimbursed separately|8,952.30|FSC: 13; Default||External grouping not supported 951227809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 52od X 49id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 52od X 49id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 56od X 53id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 56od X 53id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 60od X 57id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 60od X 57id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 64odx61id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 64odx61id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 68odx65id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 68odx65id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 72od X 69id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 72odx69id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 48odx45id R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protrusio Cage 48odx45id L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|FSC: 13; Default||Not reimbursed separately|9,363.90|FSC: 13; Default||External grouping not supported 951227823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x14mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x16mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x18mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x20mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x22mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x24mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951229394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 36nk 16x11x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 36nk 18x13x160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std 36nk 20x15x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std 36nk 22x17x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std 36nk 24x19x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std 36nk 26x21x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 30 Nk 12x06x115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 30 Nk 12x07x115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 30 Nk 14x8x130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Std 30nk 14x09x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 30nk 14x09x130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 30 Nk 16x11x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 30 Nk 18x13x160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 42 Nk 18x13x160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 42 Nk 20x15x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 42 Nk 22x17x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 42 Nk 24x19x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm St 36+8l Nk 18x13x160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm St 36+8l Nk 20x15x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm St 36+8l Nk 22x17x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm St 36+8l Nk 24x19x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm St 30+4l Nk 14x09x130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Stm St 36+6l Nk 11x16x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm St 30+4l Nk 18x13x160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Stm Std 36+12l 13x18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Stm Std 36+12l 15x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Stm Std 36+12l 17x22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom Stm St 36+12l 19x24x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom Stm St 36+12l 21x26x175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|FSC: 13; Default||Not reimbursed separately|12,982.20|FSC: 13; Default||External grouping not supported 951229423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*16x10x150 Stem 36mm Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*18x12x160 Stem 36mm Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 951229425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 20b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 20b-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22b-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 16b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 16b-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18b-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Spa 14b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Cone Txtrd Spa14d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Spa 16b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Spa 16d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Cone Txtrd Spa16f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Spa 18b|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Spa 18d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Cone Text Spa 18f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 951229441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 14b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 14b-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 14d-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 14d-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 14f-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 14f-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 16d-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 16f-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 16f-xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18d-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18d-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18f-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18f-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 18f-xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 20d-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 20f-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 20f-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22d-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22d-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22f-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22f-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 22f-xxl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 24b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 24b-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 24d-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 24d-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 24f-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 24f-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 12b-sml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Prox Ztt 12b-larg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Prox Ztt 12d-sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*sleeve Prx Ztt 12d-lrg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 18f-sml16id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 18f-lrg16id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 18f-xxl16id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 20f-sml18id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 20f-lrg18id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 20f-xxl18id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 22f-sml20id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 22f-lrg20id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 22f-xxl20id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 24f-sml22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 24f-lrg22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*slve Zttovsz 24f-xxl22id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*sleve Ztt Unsz 24d S 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*sleve Ztt Unsz 24d L 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*sleve Ztt Unsz 24d Xl26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*sleve Ztt Unsz 24f S 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*sleve Ztt Unsz 24f L 26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*sleve Ztt Unsz 24f Xl26id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 951229491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 44od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 46od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 48od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 50od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 52od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 54od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 56od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 58od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance 20d 60od X 28id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|FSC: 13; Default||Not reimbursed separately|3,271.80|FSC: 13; Default||External grouping not supported 951229500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 300 Acet Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|FSC: 13; Default||Not reimbursed separately|6,512.10|FSC: 13; Default||External grouping not supported 951229510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Bantam Acet Cup 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|FSC: 13; Default||Not reimbursed separately|7,494.90|FSC: 13; Default||External grouping not supported 951229511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Bantam Acet Cup 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|FSC: 13; Default||Not reimbursed separately|7,494.90|FSC: 13; Default||External grouping not supported 951229512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Bantam Acet Cup 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|FSC: 13; Default||Not reimbursed separately|7,494.90|FSC: 13; Default||External grouping not supported 951229513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle Multihole Ii Cup 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|FSC: 13; Default||Not reimbursed separately|7,742.70|FSC: 13; Default||External grouping not supported 951229526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinnacle 100 Ha Acet Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Sector Ha Acet Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 951229546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Bantam W/gription 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|FSC: 13; Default||Not reimbursed separately|9,368.10|FSC: 13; Default||External grouping not supported 951229547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Bantam W/gription 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|FSC: 13; Default||Not reimbursed separately|9,368.10|FSC: 13; Default||External grouping not supported 951229548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Bantam W/gription 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|FSC: 13; Default||Not reimbursed separately|9,368.10|FSC: 13; Default||External grouping not supported 951229549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn 100 W/gription 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 951229550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn 100 W/gription 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 951229551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn 100 W/gription 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 951229552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Self Cent Hip 65x28 Grn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|FSC: 13; Default||Not reimbursed separately|3,423.00|FSC: 13; Default||External grouping not supported 951229553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Self Cntr Hip 44x22.225 Gry|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,362.10|FSC: 13; Default||Not reimbursed separately|3,362.10|FSC: 13; Default||External grouping not supported 951229554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Self Cent Hip 48x22.225 Brn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,362.10|FSC: 13; Default||Not reimbursed separately|3,362.10|FSC: 13; Default||External grouping not supported 951229555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 22.225idx38od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|FSC: 13; Default||Not reimbursed separately|4,452.00|FSC: 13; Default||External grouping not supported 951229556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 22.225idx40od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|FSC: 13; Default||Not reimbursed separately|4,452.00|FSC: 13; Default||External grouping not supported 951229557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 22.225idx42od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|FSC: 13; Default||Not reimbursed separately|4,452.00|FSC: 13; Default||External grouping not supported 951229558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 22.225idx44od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|FSC: 13; Default||Not reimbursed separately|4,452.00|FSC: 13; Default||External grouping not supported 951229559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 22.225idx46od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|FSC: 13; Default||Not reimbursed separately|4,452.00|FSC: 13; Default||External grouping not supported 951229560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx44od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,313.00|FSC: 13; Default||Not reimbursed separately|5,313.00|FSC: 13; Default||External grouping not supported 951229561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx46od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,313.00|FSC: 13; Default||Not reimbursed separately|5,313.00|FSC: 13; Default||External grouping not supported 951217235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 26 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 240mm Sz 27 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|FSC: 13; Default||Not reimbursed separately|21,862.50|FSC: 13; Default||External grouping not supported 951217237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 12 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 13 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 14 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 15 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 16 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 17 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 18 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 25 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 26 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Redapt Slvd Mono Stem 300mm Sz 27 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|FSC: 13; Default||Not reimbursed separately|23,055.00|FSC: 13; Default||External grouping not supported 951217269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 58-60od Ant +4 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 62-64od Ant +4 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 66-68od Ant +4 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 70-76od Ant +4 Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 0 Deg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22id 40 Od 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x42 20 Deg Sz B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x44 20 Deg Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x46-48 20 Deg Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x50-52 20 Deg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 22x54-56 Od 20 Deg Szf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|FSC: 13; Default||Not reimbursed separately|15,569.40|FSC: 13; Default||External grouping not supported 951217282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Porous Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|FSC: 13; Default||Not reimbursed separately|15,569.40|FSC: 13; Default||External grouping not supported 951217283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|FSC: 13; Default||Not reimbursed separately|15,569.40|FSC: 13; Default||External grouping not supported 951217296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Porous Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|FSC: 13; Default||Not reimbursed separately|15,569.40|FSC: 13; Default||External grouping not supported 951217297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology So Por Pl Ha Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anthology Ho Por Pl Ha Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|FSC: 13; Default||Not reimbursed separately|13,061.40|FSC: 13; Default||External grouping not supported 951217321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 40od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 43od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 46od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 49od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 52od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 55od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 58od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 61od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 22id 64od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,626.60|FSC: 13; Default||Not reimbursed separately|4,626.60|FSC: 13; Default||External grouping not supported 951217330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 46od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 49od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 52od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 55od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 58od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 61od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 28id 64od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 32id 49od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 32id 52od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 32id 55od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 32id 58od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 32id 61od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref All Poly 32id 64od Xlpe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe All Poly Cup Sz 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,986.40|FSC: 13; Default||Not reimbursed separately|3,986.40|FSC: 13; Default||External grouping not supported 951217344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe All Ply Cup 36 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe All Ply Cup 36 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe All Ply Cup 36 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe All Ply Cup 36 61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe All Ply Cup 36 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|FSC: 13; Default||Not reimbursed separately|4,672.80|FSC: 13; Default||External grouping not supported 951217393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Screw Hole Cover|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.36|FSC: 13; Default||Not reimbursed separately|116.36|FSC: 13; Default||External grouping not supported 951217415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 50-52 0 Dg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 54-56 0 Dg Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 58-60 0 Dg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 62-64 0 Dg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 66-68 0 Dg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 32x 70-76 0 Dg Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Cortical Screw 4.5x55 Non Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|FSC: 13; Default||Not reimbursed separately|208.56|FSC: 13; Default||External grouping not supported 951217941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Cortical Screw 4.5x60 Non Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|FSC: 13; Default||Not reimbursed separately|208.56|FSC: 13; Default||External grouping not supported 951217944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,027.00|FSC: 13; Default||Not reimbursed separately|18,027.00|FSC: 13; Default||External grouping not supported 951217947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Std. Ti/ha 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951217964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 43/22 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 45/22 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 47/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 49/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 51/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 53/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|FSC: 13; Default||Not reimbursed separately|2,732.40|FSC: 13; Default||External grouping not supported 951217970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 55/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|FSC: 13; Default||Not reimbursed separately|2,791.80|FSC: 13; Default||External grouping not supported 951217971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 57/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|FSC: 13; Default||Not reimbursed separately|2,791.80|FSC: 13; Default||External grouping not supported 951217972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 59/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|FSC: 13; Default||Not reimbursed separately|2,791.80|FSC: 13; Default||External grouping not supported 951217973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 61/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|FSC: 13; Default||Not reimbursed separately|2,791.80|FSC: 13; Default||External grouping not supported 951217974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 63/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 65/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Xlpe Insert 67/28 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951217979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 43 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 45 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 47 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 49 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 51 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 53 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 55 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 57 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 59 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 61 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 63 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 65 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma 67 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|FSC: 13; Default||Not reimbursed separately|8,203.80|FSC: 13; Default||External grouping not supported 951217992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 43 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 45 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 47 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 49 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 51 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 53 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 55 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951217999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 57 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951218000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 59 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951218001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 61 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951218002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 63 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951218003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 65 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951218004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell Ti-plasma/ha 67 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 951218005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 43 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 45 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 47 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 49 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 51 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 53 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 55 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 57 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 59 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 61 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarcup Shell 63 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|FSC: 13; Default||Not reimbursed separately|6,982.80|FSC: 13; Default||External grouping not supported 951218016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 01 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 0 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 1 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 2 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 3 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 4 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 5 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 6 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 7 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 8 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 9 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 10 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 1 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 2 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 3 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 4 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 5 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 6 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 7 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 8 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 9 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 10 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Std Ti/ha 11 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|FSC: 13; Default||Not reimbursed separately|13,213.20|FSC: 13; Default||External grouping not supported 951218039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Stem Lat.ti/ha 11 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,586.20|FSC: 13; Default||Not reimbursed separately|12,586.20|FSC: 13; Default||External grouping not supported 951218041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|FSC: 13; Default||Not reimbursed separately|13,998.60|FSC: 13; Default||External grouping not supported 951218042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|FSC: 13; Default||Not reimbursed separately|13,998.60|FSC: 13; Default||External grouping not supported 951218043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|FSC: 13; Default||Not reimbursed separately|13,998.60|FSC: 13; Default||External grouping not supported 951218044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|FSC: 13; Default||Not reimbursed separately|13,998.60|FSC: 13; Default||External grouping not supported 951218045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral W/anteverted Hole 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Sdp W/anteverted Hole 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|FSC: 13; Default||Not reimbursed separately|11,972.40|FSC: 13; Default||External grouping not supported 951218057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Valgus Ti/ha 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lat. Ti/ha 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,592.80|FSC: 13; Default||Not reimbursed separately|12,592.80|FSC: 13; Default||External grouping not supported 951218067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 1 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 2 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 3 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 4 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 5 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 6 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 7 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 8 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Lateral Ti/ha 9 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 0 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 1 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 2 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 3 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 4 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 5 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 6 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 7 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 8 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Polarstem Collar Standard Ti/ha 9 (us)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|FSC: 13; Default||Not reimbursed separately|13,219.80|FSC: 13; Default||External grouping not supported 951218086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 36 Mm 12/14 Xl / +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|FSC: 13; Default||Not reimbursed separately|6,039.00|FSC: 13; Default||External grouping not supported 951218087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 32 Mm 12/14 S / +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|FSC: 13; Default||Not reimbursed separately|5,088.60|FSC: 13; Default||External grouping not supported 951218088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 32 Mm 12/14 M / +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|FSC: 13; Default||Not reimbursed separately|5,088.60|FSC: 13; Default||External grouping not supported 951218089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 32 Mm 12/14 L / +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|FSC: 13; Default||Not reimbursed separately|5,088.60|FSC: 13; Default||External grouping not supported 951218090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 36 Mm 12/14 S / +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|FSC: 13; Default||Not reimbursed separately|5,088.60|FSC: 13; Default||External grouping not supported 951218091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 36 Mm 12/14 M / +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|FSC: 13; Default||Not reimbursed separately|5,088.60|FSC: 13; Default||External grouping not supported 951218092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 36 Mm 12/14 L / +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|FSC: 13; Default||Not reimbursed separately|5,088.60|FSC: 13; Default||External grouping not supported 951218096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh38mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 40mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 42mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 44mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 46mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 48mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 50mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 52mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 54mm Modular Femoral Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 50mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 52mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 54mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 56mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 58mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 60mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 95164124|EAP|Custom 95164124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Versess 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95164131|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.38|FSC: 13; Default||Not reimbursed separately|79.38|FSC: 13; Default||External grouping not supported 95164132|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.39|FSC: 13; Default||Not reimbursed separately|79.39|FSC: 13; Default||External grouping not supported 95164133|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.88|FSC: 13; Default||Not reimbursed separately|88.88|FSC: 13; Default||External grouping not supported 95164134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retro Femoral 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95164135|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Ultra Thin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164136|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95164137|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheo Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|FSC: 13; Default||Not reimbursed separately|7,422.00|FSC: 13; Default||External grouping not supported 95164138|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheo Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|FSC: 13; Default||Not reimbursed separately|7,422.00|FSC: 13; Default||External grouping not supported 95164139|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheo Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|FSC: 13; Default||Not reimbursed separately|7,422.00|FSC: 13; Default||External grouping not supported 95164141|EAP|Custom 95164141||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Fibula Segment|1|HUMANA [1294]||HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95164142|EAP|Custom 95164142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Straight 0.18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle 10 Hole Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 951218111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh {} 62mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 95164146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Mini 30.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95164147|EAP|Custom 95164147||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Shoulder Interspace|1|HUMANA [1294]||HUMANA [11839]|15,681.00|FSC: 13; Default||Not reimbursed separately|15,681.00|FSC: 13; Default||External grouping not supported 95164148|EAP|Custom 95164148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.2mm Non-cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164149|EAP|Custom 95164149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Vertex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 64mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 66-70mm Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|FSC: 13; Default||Not reimbursed separately|6,540.60|FSC: 13; Default||External grouping not supported 951218114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32mm Xs/-3 12/14 {} Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Odh 32mm S/+0 12/14 Fem Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|FSC: 13; Default||Not reimbursed separately|6,606.60|FSC: 13; Default||External grouping not supported 951218820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 56mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|FSC: 13; Default||Not reimbursed separately|6,078.60|FSC: 13; Default||External grouping not supported 951218821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 58mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|FSC: 13; Default||Not reimbursed separately|6,085.20|FSC: 13; Default||External grouping not supported 951218822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 60mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|FSC: 13; Default||Not reimbursed separately|6,085.20|FSC: 13; Default||External grouping not supported 951218823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 62mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|FSC: 13; Default||Not reimbursed separately|6,085.20|FSC: 13; Default||External grouping not supported 951218824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 64mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|FSC: 13; Default||Not reimbursed separately|6,085.20|FSC: 13; Default||External grouping not supported 95164150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Max Vertex 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95164151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crew Vertex Part-thread 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|FSC: 13; Default||Not reimbursed separately|4,565.82|FSC: 13; Default||External grouping not supported 95164152|EAP|HCPCS 95164152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adaptor Short Wings 5/pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951218825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 36mm Id Us Delta Liner 66 68mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|FSC: 13; Default||Not reimbursed separately|6,085.20|FSC: 13; Default||External grouping not supported 951218826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Us Delta Head 32 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951218827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Us Delta Head 32 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951218828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Us Delta Head 32 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951218829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Us Delta Head 36 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,204.00|FSC: 13; Default||Not reimbursed separately|6,204.00|FSC: 13; Default||External grouping not supported 951218830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Us Delta Head 36 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,204.00|FSC: 13; Default||Not reimbursed separately|6,204.00|FSC: 13; Default||External grouping not supported 951218831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Us Delta Head 36 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,204.00|FSC: 13; Default||Not reimbursed separately|6,204.00|FSC: 13; Default||External grouping not supported 951218837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Interfit Thrd Hole Cover|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|FSC: 13; Default||Not reimbursed separately|312.84|FSC: 13; Default||External grouping not supported 951218838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acet Shell 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|FSC: 13; Default||Not reimbursed separately|7,444.80|FSC: 13; Default||External grouping not supported 951218839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acet Shell 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|FSC: 13; Default||Not reimbursed separately|7,444.80|FSC: 13; Default||External grouping not supported 951218840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 44 X 60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 44 X 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 44 X 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 44 X 66-70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 44 X 72-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 44 X 76-80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 5 46mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 5 48mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 5 54mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf I Por Ha Acet Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|FSC: 13; Default||Not reimbursed separately|5,128.20|FSC: 13; Default||External grouping not supported 951218850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf I Por Ha Acet Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|FSC: 13; Default||Not reimbursed separately|5,128.20|FSC: 13; Default||External grouping not supported 951218851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf I Por Ha Acet Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|FSC: 13; Default||Not reimbursed separately|5,128.20|FSC: 13; Default||External grouping not supported 951218852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf I Por Ha Acet Shell 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|FSC: 13; Default||Not reimbursed separately|5,128.20|FSC: 13; Default||External grouping not supported 951218853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Nh Sz 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951218854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Nh Sz 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,164.60|FSC: 13; Default||Not reimbursed separately|4,164.60|FSC: 13; Default||External grouping not supported 951218855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Nh Sz 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951218856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Cer 28 Hd 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|FSC: 13; Default||Not reimbursed separately|4,791.60|FSC: 13; Default||External grouping not supported 951218857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Cer 28 Hd 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,514.40|FSC: 13; Default||Not reimbursed separately|4,514.40|FSC: 13; Default||External grouping not supported 951218858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Cer 28hd 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|FSC: 13; Default||Not reimbursed separately|4,791.60|FSC: 13; Default||External grouping not supported 951218859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Cer 32 Hd 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|FSC: 13; Default||Not reimbursed separately|4,791.60|FSC: 13; Default||External grouping not supported 951218860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Cer 32 Hd 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,514.40|FSC: 13; Default||Not reimbursed separately|4,514.40|FSC: 13; Default||External grouping not supported 951218861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Cer 32 Hd 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,514.40|FSC: 13; Default||Not reimbursed separately|4,514.40|FSC: 13; Default||External grouping not supported 951218862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Th Sz 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Th Sz 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951218864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Th Sz 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Intft Ha Acet Th Sz 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951218866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x46-48 0deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,696.00|FSC: 13; Default||Not reimbursed separately|3,696.00|FSC: 13; Default||External grouping not supported 951218867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x50-52 0deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951218868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x54-56 0deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951218869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x58-60 0deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951218870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x62-64 0deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951218871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x66-68 0deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951218872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x70-76 0 Deg Lat +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|FSC: 13; Default||Not reimbursed separately|3,643.20|FSC: 13; Default||External grouping not supported 951218873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso 5 Por Ha Acet 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|FSC: 13; Default||Not reimbursed separately|5,128.20|FSC: 13; Default||External grouping not supported 951218874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0deg Xlpe Acet Lnr 36 X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951218875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 56mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 58mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 60mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 62mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 64mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 66mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 68mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 70mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Fso 9 72mm Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|FSC: 13; Default||Not reimbursed separately|4,771.80|FSC: 13; Default||External grouping not supported 951218884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 O Deg Xlpe Lnr Acet 40mm Id 76x80 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|FSC: 13; Default||Not reimbursed separately|5,728.80|FSC: 13; Default||External grouping not supported 951218885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 O Deg Xlpe Lnr Acet 44mm Id 60 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 O Deg Xlpe Acet Lnr 44mm Id 62 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 O Deg Xlpe Acet Lnr 44mm Id 64 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 O Deg Xlpe Acet Lnr 44mm Id 66-70 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Lnr 44mm Id X 72-74 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Lnr 44mm Id X 76-80 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Lnr 36mm Id X 76-80 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951218892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 40mm Id X 76-80 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|FSC: 13; Default||Not reimbursed separately|5,728.80|FSC: 13; Default||External grouping not supported 951218893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 44mm Id X 60 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 44mm Id X 62 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 44mm Id X 64 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 44mm Id X 66 70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 44mm Id X 72-74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 44mm Id X 76-80od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 36mm Id X 76-80od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951218900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4xlpe Lnr 40mm Id X 76-80od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|FSC: 13; Default||Not reimbursed separately|5,728.80|FSC: 13; Default||External grouping not supported 951218901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Lnr 36mm Id X 76-80od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|FSC: 13; Default||Not reimbursed separately|5,174.40|FSC: 13; Default||External grouping not supported 951218902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Lnr 40mm Id X 76-80od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Lnr 44id X {} 60 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Lnr 44id X {} 62 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Lnr 44id X {} 64 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Lnr 44id X {} 66-70 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|FSC: 13; Default||Not reimbursed separately|5,834.40|FSC: 13; Default||External grouping not supported 951218907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Lnr 44id X {} 72-74 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 44idx76-80od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|FSC: 13; Default||Not reimbursed separately|6,415.20|FSC: 13; Default||External grouping not supported 951218909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 36mm X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951218910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951218911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|FSC: 13; Default||Not reimbursed separately|6,237.00|FSC: 13; Default||External grouping not supported 951218912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|FSC: 13; Default||Not reimbursed separately|6,679.20|FSC: 13; Default||External grouping not supported 951218913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 36 20 Ant +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951218922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951218923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951218924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|FSC: 13; Default||Not reimbursed separately|5,491.20|FSC: 13; Default||External grouping not supported 951218925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|FSC: 13; Default||Not reimbursed separately|5,491.20|FSC: 13; Default||External grouping not supported 951218926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|FSC: 13; Default||Not reimbursed separately|5,398.80|FSC: 13; Default||External grouping not supported 951218933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|FSC: 13; Default||Not reimbursed separately|5,491.20|FSC: 13; Default||External grouping not supported 951218934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|FSC: 13; Default||Not reimbursed separately|5,491.20|FSC: 13; Default||External grouping not supported 951218935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951218936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Acet Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951218937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 3 Hole Ha Ctd Acet Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,593.40|FSC: 13; Default||Not reimbursed separately|6,593.40|FSC: 13; Default||External grouping not supported 951218954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,425.20|FSC: 13; Default||Not reimbursed separately|5,425.20|FSC: 13; Default||External grouping not supported 951218961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,425.20|FSC: 13; Default||Not reimbursed separately|5,425.20|FSC: 13; Default||External grouping not supported 951218962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Fso Cer Acet Comp 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,425.20|FSC: 13; Default||Not reimbursed separately|5,425.20|FSC: 13; Default||External grouping not supported 951218963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 50-52 Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 54-56 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 58-60 Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 62-64 Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Deg 66-68 Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Xlpe 32 0 Lat +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951218973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Us Head 36mm S/+0 12/14tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|FSC: 13; Default||Not reimbursed separately|4,791.60|FSC: 13; Default||External grouping not supported 951218974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Us Hd36mm M +4 12/14 Tpr +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|FSC: 13; Default||Not reimbursed separately|4,791.60|FSC: 13; Default||External grouping not supported 951218975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Forte Us 36mm Hd L+8 12/14 Tpr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|FSC: 13; Default||Not reimbursed separately|4,791.60|FSC: 13; Default||External grouping not supported 951218976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|FSC: 13; Default||Not reimbursed separately|5,537.40|FSC: 13; Default||External grouping not supported 951218987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|FSC: 13; Default||Not reimbursed separately|5,649.60|FSC: 13; Default||External grouping not supported 951218989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Hole Ha Ctd Acet Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 951218991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x46-48 20 Deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,049.20|FSC: 13; Default||Not reimbursed separately|3,049.20|FSC: 13; Default||External grouping not supported 951218992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x50-52 20deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|FSC: 13; Default||Not reimbursed separately|2,818.20|FSC: 13; Default||External grouping not supported 951218993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x54-56 20 Deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|FSC: 13; Default||Not reimbursed separately|2,818.20|FSC: 13; Default||External grouping not supported 951218994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x58-60 20deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|FSC: 13; Default||Not reimbursed separately|2,818.20|FSC: 13; Default||External grouping not supported 951218995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Lnr 28x66-68 20deg L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|FSC: 13; Default||Not reimbursed separately|2,818.20|FSC: 13; Default||External grouping not supported 951219700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp So Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem 12/14 Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem So 12/14 Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp Ho Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp Ho Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp Ho Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp Ho Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp Ho Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Comp Ho Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Ho 12/14 Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pri Fem Ho 12/14 Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|FSC: 13; Default||Not reimbursed separately|13,642.20|FSC: 13; Default||External grouping not supported 951219715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 22mm -3 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 22mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 22mm +3 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 26mm -5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 26mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 26mm +5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 28mm -5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 28mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 28mm +5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 32mm -5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 32mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Hd 10/12 32mm +5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 11 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 12 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 13 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 14 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 15 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 16 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 17 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 18 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 19 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Pp Ha Sz 20 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x44-45 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x46-48 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x50-54 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x63-70 0 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 22 Mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 22 Mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 22 Mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 22 Mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x44-45 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x46-48 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x50-54 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x56-62 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 22x63-70 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 28 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 28 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 28 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 32 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 32 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 32 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 44mm Oxinium Modular Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,507.60|FSC: 13; Default||Not reimbursed separately|6,507.60|FSC: 13; Default||External grouping not supported 951219757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 36 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 36 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxi Fm Head 14/16 Tpr 36 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|FSC: 13; Default||Not reimbursed separately|6,316.20|FSC: 13; Default||External grouping not supported 951219760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 26 Mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 26 Mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 26 Mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 26 Mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Cocr Modular Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|FSC: 13; Default||Not reimbursed separately|4,356.00|FSC: 13; Default||External grouping not supported 951219765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 44mm Cocr Modular Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,874.00|FSC: 13; Default||Not reimbursed separately|5,874.00|FSC: 13; Default||External grouping not supported 951219766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x46-48 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x50-54 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x56-62 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 26x63-70 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 28mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,875.00|FSC: 13; Default||Not reimbursed separately|7,875.00|FSC: 13; Default||External grouping not supported 951219771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 28mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 28mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 28mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxnm Fem Hd 28mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxnm Fem Hd 28mm +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 28x50-54 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 28x56-62 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 28x63-70 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 11 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 12 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 13 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 14 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 15 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 16 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 17 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 18 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 19 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Pp Ha Sz 20 190mm +15 Cal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|FSC: 13; Default||Not reimbursed separately|19,720.80|FSC: 13; Default||External grouping not supported 951219789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 32mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 32mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 32mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 32mm +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 32 Mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 32 Mm +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 32x56-62 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acet Lnr 32x63-70 20 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951219797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium 10/12 Tpr Fem Hd 36mm -5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium 10/12 Tpr Fem Hd 36mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium 10/12 Tpr Fem Hd 36mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 36 Mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 36 Mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 36 Mm M/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 36 Mm L/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 36 Mm Xl/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Oxinium Fem Hd 12/14 36mm +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|FSC: 13; Default||Not reimbursed separately|5,775.00|FSC: 13; Default||External grouping not supported 951219806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Titanium Modular Head Slv 12/14 Tpr -4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.40|FSC: 13; Default||Not reimbursed separately|620.40|FSC: 13; Default||External grouping not supported 951219807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Titanium Modular Head Slv 12/14 Tpr +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|584.76|FSC: 13; Default||Not reimbursed separately|584.76|FSC: 13; Default||External grouping not supported 951219808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Titanium Modular Head Slv 12/14 Tpr +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|584.76|FSC: 13; Default||Not reimbursed separately|584.76|FSC: 13; Default||External grouping not supported 951219809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 40mm 12/14 Short+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,732.00|FSC: 13; Default||Not reimbursed separately|6,732.00|FSC: 13; Default||External grouping not supported 951219810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 40mm 12/14 Medium +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,732.00|FSC: 13; Default||Not reimbursed separately|6,732.00|FSC: 13; Default||External grouping not supported 951219811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biolox Delta Head 40mm 12/14 Long +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,732.00|FSC: 13; Default||Not reimbursed separately|6,732.00|FSC: 13; Default||External grouping not supported 951219812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acc 150mm Titanium Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|FSC: 13; Default||Not reimbursed separately|2,217.60|FSC: 13; Default||External grouping not supported 951219813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acc 200mm Titanium Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|FSC: 13; Default||Not reimbursed separately|2,719.20|FSC: 13; Default||External grouping not supported 951219814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acc 250mm Titanium Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,326.40|FSC: 13; Default||Not reimbursed separately|3,326.40|FSC: 13; Default||External grouping not supported 951219815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Cement Acet Com 22/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|FSC: 13; Default||Not reimbursed separately|2,026.20|FSC: 13; Default||External grouping not supported 951219823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Stem With Stiktite Sz -1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|FSC: 13; Default||Not reimbursed separately|13,866.60|FSC: 13; Default||External grouping not supported 951219824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Stem With Stiktite Ho Sz -1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|FSC: 13; Default||Not reimbursed separately|13,866.60|FSC: 13; Default||External grouping not supported 951219825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Stem With Stiktite Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|FSC: 13; Default||Not reimbursed separately|13,866.60|FSC: 13; Default||External grouping not supported 951219826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Stem With Stiktite Ho Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|FSC: 13; Default||Not reimbursed separately|13,866.60|FSC: 13; Default||External grouping not supported 951219827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 1 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 1 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 2 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 2 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 3 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 3 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 4 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 4 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 5 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 5 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 6 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 6 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,774.20|FSC: 13; Default||Not reimbursed separately|13,774.20|FSC: 13; Default||External grouping not supported 951219839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 7 So|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951219840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smf Fxd Neck Size 7 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|FSC: 13; Default||Not reimbursed separately|14,803.80|FSC: 13; Default||External grouping not supported 951220666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Scrw Dis Fem Wdg Sz8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 951220669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion 5mm Distal Wedge Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|FSC: 13; Default||Not reimbursed separately|369.60|FSC: 13; Default||External grouping not supported 951220670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion 10mm Distal Wedge Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|FSC: 13; Default||Not reimbursed separately|369.60|FSC: 13; Default||External grouping not supported 951220671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S2 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S2 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S2 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S3 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S3 5d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S3 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S3 10d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S3 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S3 15d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S4 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S4 5d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S4 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S4 10d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S4 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S4 15d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S5 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S5 5d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S5 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S5 10d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S5 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S5 15d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S6 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S6 5d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S6 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S6 10d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S6 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S6 15d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S7 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S7 5d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S7 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S7 10d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S7 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S7 15d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S8 5d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S8 5d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S8 10d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S8 10d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S8 15d X 5p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Scw Lwdg S8 15d X 10p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|FSC: 13; Default||Not reimbursed separately|6,217.20|FSC: 13; Default||External grouping not supported 951220710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 5mm Sz1-2 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 10mm Sz1-2 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 5mm Sz3-4 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 10mm Sz3-4 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 5mm Sz5-6 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 10mm Sz5-6 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 5mm Sz7-8 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Pos Fem Wdg 10mm Sz7-8 Lng|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|FSC: 13; Default||Not reimbursed separately|3,913.80|FSC: 13; Default||External grouping not supported 951220718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion 5mm Pos Wedge Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|FSC: 13; Default||Not reimbursed separately|369.60|FSC: 13; Default||External grouping not supported 951220719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion 10mm Pos Wedge Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|FSC: 13; Default||Not reimbursed separately|369.60|FSC: 13; Default||External grouping not supported 951220720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|FSC: 13; Default||Not reimbursed separately|12,526.80|FSC: 13; Default||External grouping not supported 951220724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Hk Tibial Base Sz 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,088.00|FSC: 13; Default||Not reimbursed separately|11,088.00|FSC: 13; Default||External grouping not supported 951220725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Gde Insert Lock Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|351.12|FSC: 13; Default||Not reimbursed separately|351.12|FSC: 13; Default||External grouping not supported 951220726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Axle Sz 3 Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|FSC: 13; Default||Not reimbursed separately|1,174.80|FSC: 13; Default||External grouping not supported 951220727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Axle Sz 4 Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|FSC: 13; Default||Not reimbursed separately|1,174.80|FSC: 13; Default||External grouping not supported 951220728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Axle Sz 5 Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|FSC: 13; Default||Not reimbursed separately|1,174.80|FSC: 13; Default||External grouping not supported 951220729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Axle Sz 6 Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|FSC: 13; Default||Not reimbursed separately|1,174.80|FSC: 13; Default||External grouping not supported 951220730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Axle Sz 7 Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,106.16|FSC: 13; Default||Not reimbursed separately|1,106.16|FSC: 13; Default||External grouping not supported 951220731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Tib Offset Coup W/slv 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951220732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Tib Offset Coup W/slv 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951220733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 2rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 3rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 4rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 5rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 6rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 7rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 8rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 1lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 2lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 3lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 4lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 5lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 6lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 7lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Ha Porous Fem Sz 8lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|FSC: 13; Default||Not reimbursed separately|11,404.80|FSC: 13; Default||External grouping not supported 951220748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,778.00|FSC: 13; Default||Not reimbursed separately|8,778.00|FSC: 13; Default||External grouping not supported 951220749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial Sz 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial Sz 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,778.00|FSC: 13; Default||Not reimbursed separately|8,778.00|FSC: 13; Default||External grouping not supported 951220756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii {} Ha Por Tibial {} Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ha Por Tibial {} Sz 8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|FSC: 13; Default||Not reimbursed separately|7,708.80|FSC: 13; Default||External grouping not supported 951220762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdge Sz 3-20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdge Sz 4 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdge Sz 5 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdge Sz 6 20m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|FSC: 13; Default||Not reimbursed separately|3,484.80|FSC: 13; Default||External grouping not supported 951220767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz3 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz5 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|FSC: 13; Default||Not reimbursed separately|3,729.00|FSC: 13; Default||External grouping not supported 951220776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|FSC: 13; Default||Not reimbursed separately|3,484.80|FSC: 13; Default||External grouping not supported 951220777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|FSC: 13; Default||Not reimbursed separately|3,484.80|FSC: 13; Default||External grouping not supported 951220778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|FSC: 13; Default||Not reimbursed separately|3,484.80|FSC: 13; Default||External grouping not supported 951220779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,286.80|FSC: 13; Default||Not reimbursed separately|3,286.80|FSC: 13; Default||External grouping not supported 951220780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,286.80|FSC: 13; Default||Not reimbursed separately|3,286.80|FSC: 13; Default||External grouping not supported 951220781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Hk Dis Fem Wdg Sz7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,286.80|FSC: 13; Default||Not reimbursed separately|3,286.80|FSC: 13; Default||External grouping not supported 951220782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S1-2rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S3-4rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Uni Tibinrt S5-6rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|FSC: 13; Default||Not reimbursed separately|2,653.20|FSC: 13; Default||External grouping not supported 951220806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs1rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs2rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs3rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptib S4rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs4rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs5rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6lm/rl8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6lm/rl9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6lm/rl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6lm/rl11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6rm/ll8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6rm/ll9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6rm/ll10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrnyuni Aptibs6rm/ll11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|FSC: 13; Default||Not reimbursed separately|5,656.20|FSC: 13; Default||External grouping not supported 951220854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 1 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 2 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 3 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 4 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 5 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 6 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 7 Lm Rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 1 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 2 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 3 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 4 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951220865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juni Ox Fb Fem Sz 5 Rm Ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|FSC: 13; Default||Not reimbursed separately|10,527.00|FSC: 13; Default||External grouping not supported 951221660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Lt 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Lt 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Constr Isrt S6 Lt 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|FSC: 13; Default||Not reimbursed separately|3,900.60|FSC: 13; Default||External grouping not supported 951221673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Prep Plate Lt Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|FSC: 13; Default||Not reimbursed separately|533.28|FSC: 13; Default||External grouping not supported 951221674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Prep Plate Lt Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|FSC: 13; Default||Not reimbursed separately|533.28|FSC: 13; Default||External grouping not supported 951221675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Prep Plate Lt Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|FSC: 13; Default||Not reimbursed separately|533.28|FSC: 13; Default||External grouping not supported 951221676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Prep Plate Lt Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|FSC: 13; Default||Not reimbursed separately|533.28|FSC: 13; Default||External grouping not supported 951221677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Prep Plate Lt Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|FSC: 13; Default||Not reimbursed separately|533.28|FSC: 13; Default||External grouping not supported 951221678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Prep Plate Lt Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|FSC: 13; Default||Not reimbursed separately|533.28|FSC: 13; Default||External grouping not supported 951221719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Rt Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,573.40|FSC: 13; Default||Not reimbursed separately|8,573.40|FSC: 13; Default||External grouping not supported 951221720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Zircon Oxid Np Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.00|FSC: 13; Default||Not reimbursed separately|8,943.00|FSC: 13; Default||External grouping not supported 951221722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Rt Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,910.00|FSC: 13; Default||Not reimbursed separately|8,910.00|FSC: 13; Default||External grouping not supported 951221723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 2r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,335.80|FSC: 13; Default||Not reimbursed separately|8,335.80|FSC: 13; Default||External grouping not supported 951221725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 2r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Rt Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 951221727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|FSC: 13; Default||Not reimbursed separately|14,724.60|FSC: 13; Default||External grouping not supported 951221728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 3r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 3r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Zircon Ox Np Fem Sz3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 951221731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|FSC: 13; Default||Not reimbursed separately|14,724.60|FSC: 13; Default||External grouping not supported 951221732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 4r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 4r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|FSC: 13; Default||Not reimbursed separately|14,724.60|FSC: 13; Default||External grouping not supported 951221735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 5r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 5r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|FSC: 13; Default||Not reimbursed separately|14,724.60|FSC: 13; Default||External grouping not supported 951221738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 6r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 6r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Rt Sz7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 951221741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr R 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 7r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 7r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Zircon Ox Np Fem Sz7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 951221745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Lt Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,573.40|FSC: 13; Default||Not reimbursed separately|8,573.40|FSC: 13; Default||External grouping not supported 951221746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Zircon Ox Np Fem Sz1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.00|FSC: 13; Default||Not reimbursed separately|8,943.00|FSC: 13; Default||External grouping not supported 951221748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Lt Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,777.80|FSC: 13; Default||Not reimbursed separately|10,777.80|FSC: 13; Default||External grouping not supported 951221749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 2l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,335.80|FSC: 13; Default||Not reimbursed separately|8,335.80|FSC: 13; Default||External grouping not supported 951221751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 2l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Zircon Ox Np Fem Sz2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,306.00|FSC: 13; Default||Not reimbursed separately|9,306.00|FSC: 13; Default||External grouping not supported 951221753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Lt Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 951221754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 3l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 3l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 4l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 4l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 5l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 5l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Non-por Fem Lt Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|FSC: 13; Default||Not reimbursed separately|9,312.60|FSC: 13; Default||External grouping not supported 951221764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 6l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|FSC: 13; Default||Not reimbursed separately|10,084.80|FSC: 13; Default||External grouping not supported 951221766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 6l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|FSC: 13; Default||Not reimbursed separately|12,975.60|FSC: 13; Default||External grouping not supported 951221767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Fem W/tpr L 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|FSC: 13; Default||Not reimbursed separately|12,177.00|FSC: 13; Default||External grouping not supported 951221768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/o Tpr 7l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,335.80|FSC: 13; Default||Not reimbursed separately|8,335.80|FSC: 13; Default||External grouping not supported 951221769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Np P/s Fem W/tpr 7l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,757.80|FSC: 13; Default||Not reimbursed separately|12,757.80|FSC: 13; Default||External grouping not supported 951221770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Zircon Ox Np Fem Sz7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|FSC: 13; Default||Not reimbursed separately|11,253.00|FSC: 13; Default||External grouping not supported 951221771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Tb Base Rt S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,781.60|FSC: 13; Default||Not reimbursed separately|5,781.60|FSC: 13; Default||External grouping not supported 951221772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Tib Base R S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 951221773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Tb Base Lt S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 951221774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Tb Base Lt S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|FSC: 13; Default||Not reimbursed separately|6,098.40|FSC: 13; Default||External grouping not supported 951221775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Non-por Tib Base L S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,781.60|FSC: 13; Default||Not reimbursed separately|5,781.60|FSC: 13; Default||External grouping not supported 951221776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Poly Patellar 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951221777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Poly Patellar 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|FSC: 13; Default||Not reimbursed separately|2,415.60|FSC: 13; Default||External grouping not supported 951221778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,894.00|FSC: 13; Default||Not reimbursed separately|3,894.00|FSC: 13; Default||External grouping not supported 951221779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Rt S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Por Lt S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|FSC: 13; Default||Not reimbursed separately|4,250.40|FSC: 13; Default||External grouping not supported 951221794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Rt S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,049.20|FSC: 13; Default||Not reimbursed separately|3,049.20|FSC: 13; Default||External grouping not supported 951221801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|FSC: 13; Default||Not reimbursed separately|3,333.00|FSC: 13; Default||External grouping not supported 951221807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Ha Lt S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,049.20|FSC: 13; Default||Not reimbursed separately|3,049.20|FSC: 13; Default||External grouping not supported 951221808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Base Nonpor Rt S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,861.00|FSC: 13; Default||Not reimbursed separately|3,861.00|FSC: 13; Default||External grouping not supported 951221812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S1 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S1 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S3 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S5 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S5 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S7 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S7 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S7 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S7 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Rt S8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S1 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S1 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S1 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S1 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S3 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S3 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951221858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mb Isrt G2 Lt S4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|FSC: 13; Default||Not reimbursed separately|2,118.60|FSC: 13; Default||External grouping not supported 951222656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951222666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Lt 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 2/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cs Rt 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Lt 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 2/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|FSC: 13; Default||Not reimbursed separately|2,587.20|FSC: 13; Default||External grouping not supported 951222721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 0/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|FSC: 13; Default||Not reimbursed separately|2,937.00|FSC: 13; Default||External grouping not supported 951222722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Lt 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Lt 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Lt 5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Rt 2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Rt 3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Rt 4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Fem Comp Rt 5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|FSC: 13; Default||Not reimbursed separately|8,461.20|FSC: 13; Default||External grouping not supported 951222729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|FSC: 13; Default||Not reimbursed separately|2,706.00|FSC: 13; Default||External grouping not supported 951222751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Insert Vks Cr Rt 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|FSC: 13; Default||Not reimbursed separately|2,461.80|FSC: 13; Default||External grouping not supported 951222754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Prim Femoral Comp. Left 10 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,128.00|FSC: 13; Default||Not reimbursed separately|7,128.00|FSC: 13; Default||External grouping not supported 951222755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tibial Comp Tc Sym 2 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|FSC: 13; Default||Not reimbursed separately|4,534.20|FSC: 13; Default||External grouping not supported 951222756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tibial Comp Tc Sym 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|FSC: 13; Default||Not reimbursed separately|4,534.20|FSC: 13; Default||External grouping not supported 951222757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tibial Comp Tc Sym 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|FSC: 13; Default||Not reimbursed separately|4,534.20|FSC: 13; Default||External grouping not supported 951222758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tibial Comp Tc Sym 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.00|FSC: 13; Default||Not reimbursed separately|4,983.00|FSC: 13; Default||External grouping not supported 951222759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tibial Comp Tc Sym 10 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|FSC: 13; Default||Not reimbursed separately|4,534.20|FSC: 13; Default||External grouping not supported 951222760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tibial Comp Tc Sym 12 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|FSC: 13; Default||Not reimbursed separately|4,534.20|FSC: 13; Default||External grouping not supported 951222761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 26/8mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 29/8mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 32/8mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 26/10mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 29/10mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 32/10mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Patellar Component 35/10mm Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|FSC: 13; Default||Not reimbursed separately|1,999.80|FSC: 13; Default||External grouping not supported 951222768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 4/8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 4/11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 4/14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 6/8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 6/11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 8/8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 8/11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Insert 8/14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|FSC: 13; Default||Not reimbursed separately|2,798.40|FSC: 13; Default||External grouping not supported 951222776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Component 4 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,415.40|FSC: 13; Default||Not reimbursed separately|4,415.40|FSC: 13; Default||External grouping not supported 951222777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Component 6 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,415.40|FSC: 13; Default||Not reimbursed separately|4,415.40|FSC: 13; Default||External grouping not supported 951222778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rt-plus Tibial Component 8 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,415.40|FSC: 13; Default||Not reimbursed separately|4,415.40|FSC: 13; Default||External grouping not supported 951222783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc-plus Prim Fem. Comp Left 12 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,484.20|FSC: 13; Default||Not reimbursed separately|9,484.20|FSC: 13; Default||External grouping not supported 951222784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Comp Tc Sym 2 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|FSC: 13; Default||Not reimbursed separately|5,682.60|FSC: 13; Default||External grouping not supported 951222785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Comp Tc Sym 4 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,243.60|FSC: 13; Default||Not reimbursed separately|6,243.60|FSC: 13; Default||External grouping not supported 951222786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Comp Tc Sym 6 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|FSC: 13; Default||Not reimbursed separately|5,682.60|FSC: 13; Default||External grouping not supported 951222787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Comp Tc Sym 8 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|FSC: 13; Default||Not reimbursed separately|5,682.60|FSC: 13; Default||External grouping not supported 951222788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Comp Tc Sym 10 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|FSC: 13; Default||Not reimbursed separately|5,682.60|FSC: 13; Default||External grouping not supported 951222789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Fixed Tib Comp Tc Sym 12 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|FSC: 13; Default||Not reimbursed separately|5,682.60|FSC: 13; Default||External grouping not supported 951222790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Tibial Insert Tc Cr Stand 6/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,310.00|FSC: 13; Default||Not reimbursed separately|2,310.00|FSC: 13; Default||External grouping not supported 951222791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 2/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 4/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 6/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 8/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac10/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Tibial Insert Tc Cs Ultrac 12/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 2/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 2/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 2/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.60|FSC: 13; Default||Not reimbursed separately|2,778.60|FSC: 13; Default||External grouping not supported 951222800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 2/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 4/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 4/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 4/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 4/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 6/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 6/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 6/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 6/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 8/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 8/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 8/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|FSC: 13; Default||Not reimbursed separately|3,207.60|FSC: 13; Default||External grouping not supported 951222812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 8/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac 10/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac10/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac10/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim/tc Rev Tib Ins Tc Cs Ultrac10/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Tibial Insert Tc Cs Ultrac 12/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Tibial Insert Tc Cs Ultrac 12/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Tibial Insert Tc Cs Ultrac 12/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc Prim Tibial Insert Tc Cs Ultrac 12/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|FSC: 13; Default||Not reimbursed separately|2,923.80|FSC: 13; Default||External grouping not supported 951222821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x50mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|FSC: 13; Default||Not reimbursed separately|332.64|FSC: 13; Default||External grouping not supported 951222822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x60mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|FSC: 13; Default||Not reimbursed separately|332.64|FSC: 13; Default||External grouping not supported 951222823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x35mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|FSC: 13; Default||Not reimbursed separately|332.64|FSC: 13; Default||External grouping not supported 951222824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x45mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|FSC: 13; Default||Not reimbursed separately|332.64|FSC: 13; Default||External grouping not supported 951222825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cancellous Bone Screw 6.5x55mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|319.44|FSC: 13; Default||Not reimbursed separately|319.44|FSC: 13; Default||External grouping not supported 951222827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Uc-plus Solu Femoral Component 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|FSC: 13; Default||Not reimbursed separately|5,669.40|FSC: 13; Default||External grouping not supported 951222828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tibl Comp Rev Lt Lt / Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tibl Comp Rev Lt Lt / Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tibl Comp Rev Lt Lt / Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tibl Comp Rev Lt Lt / Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tibl Comp Rev Lt Lt / Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tib Comp Rev Rt Rt / Plus V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tib Comp Rev Rt Rt / Plus V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tib Comp Rev Rt Rt / Plus V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tib Comp Rev Rt Rt / Plus V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tib Comp Rev Rt Rt / Plus V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|FSC: 13; Default||Not reimbursed separately|6,877.20|FSC: 13; Default||External grouping not supported 951222853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tc Rev Fem Comp. Rev Lt Vks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tc Rev Fem Comp. Rev Lt Vks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951222855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Vks Rev Tc Rev Fem Comp. Rev Lt Vks|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|FSC: 13; Default||Not reimbursed separately|11,688.60|FSC: 13; Default||External grouping not supported 951223569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Depth Stop|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,046.00|FSC: 13; Default||Not reimbursed separately|8,046.00|FSC: 13; Default||External grouping not supported 951223579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Body Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Body Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Body Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,226.00|FSC: 13; Default||Not reimbursed separately|14,226.00|FSC: 13; Default||External grouping not supported 951223582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Sleeve Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,856.00|FSC: 13; Default||Not reimbursed separately|11,856.00|FSC: 13; Default||External grouping not supported 951223583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Sleeve Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,856.00|FSC: 13; Default||Not reimbursed separately|11,856.00|FSC: 13; Default||External grouping not supported 951223584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Pat Planer Sleeve Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,856.00|FSC: 13; Default||Not reimbursed separately|11,856.00|FSC: 13; Default||External grouping not supported 951223646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp Rev Stem Bolt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 951223647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp Rev Sleeve Bolt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,181.00|FSC: 13; Default||Not reimbursed separately|2,181.00|FSC: 13; Default||External grouping not supported 951223691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Fem Fin Blk Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,364.00|FSC: 13; Default||Not reimbursed separately|11,364.00|FSC: 13; Default||External grouping not supported 951223692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Fem Fin Blk Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Fem Fin Blk Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Fem Fin Blk Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Fem Fin Blk Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Fem Fin Blk Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|FSC: 13; Default||Not reimbursed separately|13,338.00|FSC: 13; Default||External grouping not supported 951223697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Template Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Template Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Template Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Template Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Template Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Template Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 951223703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 1l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 2l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 3l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 4l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 5l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 1r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 2r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 3r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 4r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951223712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Troch Ant Blk Sz 5r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|FSC: 13; Default||Not reimbursed separately|6,213.00|FSC: 13; Default||External grouping not supported 951224402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3d Hprfr Lcs Bn Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3d Hprfr Lcs Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4d Hprfr Lcs Bn Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4d Hprfr Lcs Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5d Hprfr Lcs Bn Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 5d Hprfr Lcs Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6d Hprfr Lcs Bn Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6d Hprfr Lcs Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7d Hprfr Lcs Bn Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7d Hprfr Lcs Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 8d Hprfr Lcs Bn Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 8d Hprfr Lcs Bn Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 951224414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 0d Hprfr Lcs Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,511.00|FSC: 13; Default||Not reimbursed separately|2,511.00|FSC: 13; Default||External grouping not supported 951224551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rev Sld Fb Insrt Sz3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|FSC: 13; Default||Not reimbursed separately|9,552.00|FSC: 13; Default||External grouping not supported 951224552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rev Sld Fb Insrt Sz5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|FSC: 13; Default||Not reimbursed separately|9,552.00|FSC: 13; Default||External grouping not supported 951224553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rev Sld Fb Insrt Sz7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|FSC: 13; Default||Not reimbursed separately|9,552.00|FSC: 13; Default||External grouping not supported 951224554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rev Sld Rp Insrt Sz3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|FSC: 13; Default||Not reimbursed separately|9,552.00|FSC: 13; Default||External grouping not supported 951224555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rev Sld Rp Insrt Sz5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|FSC: 13; Default||Not reimbursed separately|9,552.00|FSC: 13; Default||External grouping not supported 951224556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Rev Sld Rp Insrt Sz7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|FSC: 13; Default||Not reimbursed separately|9,552.00|FSC: 13; Default||External grouping not supported 951225270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 7 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 8 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 9 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Fb Insrt Sz 10 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|FSC: 13; Default||Not reimbursed separately|6,552.00|FSC: 13; Default||External grouping not supported 951225323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sig Rpf Ins Sz 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|FSC: 13; Default||Not reimbursed separately|6,934.20|FSC: 13; Default||External grouping not supported 951225351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S6 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S6 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tb/in S6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 2.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 3 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 4 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 4 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 4 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 6 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tib In 6 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 6 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cvtbin S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 951225406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb Tb In 1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 951225411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Sm+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951225437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Rp Insert Std 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 951226123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Complete M/b Pat Cem Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|FSC: 13; Default||Not reimbursed separately|5,130.30|FSC: 13; Default||External grouping not supported 951226126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Dome Pat 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951226127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Dome Pat 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951226128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Dome Pat 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951226129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Dome Pat 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951226130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Dome Pat 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 951226131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Anat Pat 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|FSC: 13; Default||Not reimbursed separately|4,176.90|FSC: 13; Default||External grouping not supported 951226132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Anat Pat 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|FSC: 13; Default||Not reimbursed separately|4,176.90|FSC: 13; Default||External grouping not supported 951226133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Anat Pat 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|FSC: 13; Default||Not reimbursed separately|4,176.90|FSC: 13; Default||External grouping not supported 951226134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Anat Pat 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|FSC: 13; Default||Not reimbursed separately|4,176.90|FSC: 13; Default||External grouping not supported 951226135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Medial Anat Pat 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|FSC: 13; Default||Not reimbursed separately|4,176.90|FSC: 13; Default||External grouping not supported 951226136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Lt Sz 3 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Lt Sz 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Lt Sz 5 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Lt Sz 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Lt Sz 7 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Lt Sz 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Rt Sz 3 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Rt Sz 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Rt Sz 5 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Rt Sz 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Rt Sz 7 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Femoral Rt Sz 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|FSC: 13; Default||Not reimbursed separately|25,095.00|FSC: 13; Default||External grouping not supported 951226148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 3 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 4 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 5 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 6 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 7 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 8 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Dist Fem Aug Sz 8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 3 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 4 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 5 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 6 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 7 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 8 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Post Fem Aug Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|FSC: 13; Default||Not reimbursed separately|4,620.00|FSC: 13; Default||External grouping not supported 951226183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 3 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 4 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226212|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226213|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226214|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 5 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 6 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 7 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Crs Fb Insrt Sz 8 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|FSC: 13; Default||Not reimbursed separately|9,240.00|FSC: 13; Default||External grouping not supported 951226249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Crs Fb Tib Base Sz 3 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|FSC: 13; Default||Not reimbursed separately|12,390.00|FSC: 13; Default||External grouping not supported 951226250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Crs Fb Tib Base Sz 4 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|FSC: 13; Default||Not reimbursed separately|12,390.00|FSC: 13; Default||External grouping not supported 951226251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Crs Fb Tib Base Sz 5 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|FSC: 13; Default||Not reimbursed separately|12,390.00|FSC: 13; Default||External grouping not supported 951226252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Crs Fb Tib Base Sz 6 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|FSC: 13; Default||Not reimbursed separately|12,390.00|FSC: 13; Default||External grouping not supported 951226253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Crs Fb Tib Base Sz 7 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|FSC: 13; Default||Not reimbursed separately|12,390.00|FSC: 13; Default||External grouping not supported 951226254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Crs Fb Tib Base Sz 8 Cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|FSC: 13; Default||Not reimbursed separately|12,390.00|FSC: 13; Default||External grouping not supported 951226255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Univ Sz 3/4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Lm/rl Sz 3/4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Lm/rl Sz 3/4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Rm/ll Sz 3/4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Rm/ll Sz 3/4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Univ Sz 5/6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Lm/rl Sz 5/6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Lm/rl Sz 5/6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Rm/ll Sz 5/6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Rm/ll Sz 5/6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Univ Sz 7/8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Lm/rl Sz 7/8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Lm/rl Sz 7/8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Rm/ll Sz 7/8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Tib Aug Rm/ll Sz 7/8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 951226270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attun Rev Offst Stm Adptr 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 951226271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attun Rev Offst Stm Adptr 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 951226272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attun Rev Offst Stm Adptr 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 951226273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cemented Stem 14x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|FSC: 13; Default||Not reimbursed separately|3,979.50|FSC: 13; Default||External grouping not supported 951226274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cemented Stem 14x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|FSC: 13; Default||Not reimbursed separately|3,979.50|FSC: 13; Default||External grouping not supported 951226275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cemented Stem 14x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|FSC: 13; Default||Not reimbursed separately|3,979.50|FSC: 13; Default||External grouping not supported 951226276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cemented Stem 14x130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|FSC: 13; Default||Not reimbursed separately|3,979.50|FSC: 13; Default||External grouping not supported 951226277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cemented Stem 16x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|FSC: 13; Default||Not reimbursed separately|3,979.50|FSC: 13; Default||External grouping not supported 951226278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cemented Stem 16x130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|FSC: 13; Default||Not reimbursed separately|3,979.50|FSC: 13; Default||External grouping not supported 951226279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem10x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem10x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem10x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem12x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem12x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem12x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem14x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem14x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem14x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem16x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem16x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem16x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem18x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem18x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem18x160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atune Pressfit Str Stem20x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Atun Pressfit Str Stem20x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|FSC: 13; Default||Not reimbursed separately|6,289.50|FSC: 13; Default||External grouping not supported 951226988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd Rot Brg Lg+ 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd R Brdg Brg Std/lg 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd R Brdg Brg Std/lg 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd R Brdg Brg Std+/lg 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Dd R Brdg Brg Std+/lg 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|FSC: 13; Default||Not reimbursed separately|7,167.30|FSC: 13; Default||External grouping not supported 951226994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951226995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951226996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951226997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951226998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951226999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz1 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz2 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz3 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz4 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crt Ultra Tib Ins Sz5 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|FSC: 13; Default||Not reimbursed separately|9,433.20|FSC: 13; Default||External grouping not supported 951227044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 1 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Cons Tib Ins Size 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|FSC: 13; Default||Not reimbursed separately|6,337.80|FSC: 13; Default||External grouping not supported 951227071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 1 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 2 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 3 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 4 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Congr Ps Ins Size 5 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|FSC: 13; Default||Not reimbursed separately|6,827.10|FSC: 13; Default||External grouping not supported 951227121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Cruc M/b Pat Replc Gvf Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Cruc M/bpat Replc Gvf Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Cruc M/b Pat Replac Gvf Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Cruc M/b Pat Replc Gvf Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com 3 Peg M/b Pat Rep Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|FSC: 13; Default||Not reimbursed separately|2,906.40|FSC: 13; Default||External grouping not supported 951227132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk All Poly 3-peg Pat 7.5x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk All Poly 3-peg Pat 7.5x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk All Poly 3-peg Pat 8.5x34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk All Poly 3-peg Pat 9x36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk All Poly 3-peg Pat 9.5x38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk All Poly 3-peg Pat 10.0x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Poly Patella 7.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Poly Patella 10.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Amk Poly Patella 8.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|FSC: 13; Default||Not reimbursed separately|5,189.10|FSC: 13; Default||External grouping not supported 951227141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Xx-sm Hinge Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,610.70|FSC: 13; Default||Not reimbursed separately|1,610.70|FSC: 13; Default||External grouping not supported 951227145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xxsm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xxsm 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xxsm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227148|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xxsm 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xxsm 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xxsm 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Univ Tib Hin Ins Xsm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|FSC: 13; Default||Not reimbursed separately|10,315.20|FSC: 13; Default||External grouping not supported 951227829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x30mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x35mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x40mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x45mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x50mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x55mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x60mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x65mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.5x70mm Gription Tf Ste Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|FSC: 13; Default||Not reimbursed separately|537.60|FSC: 13; Default||External grouping not supported 951227838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*pin Lock 3.5mm Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.90|FSC: 13; Default||Not reimbursed separately|585.90|FSC: 13; Default||External grouping not supported 951227841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lkg Ring 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lkg Ring 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lkg Ring 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lkg Ring 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lkg Ring 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lock Ring 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lock Ring 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lock Ring 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lock Ring 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Dynamic Lock Ring 58 Or 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Dynamic Lock Ring 60 Or 72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dur Dynamic Lock Ring 62 Or 74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lock Ring 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Duraloc Dynamic Lock Ring 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 951227855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr4l16x11x240l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr4l16x11x240n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr4l16x11x240r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l18x13x255l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l18x13x255n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l18x13x255r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l20x15x270l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l20x15x270n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l20x15x270r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l22x17x275l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l22x17x275n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxlg36+21cr8l22x17x275r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|FSC: 13; Default||Not reimbursed separately|26,894.70|FSC: 13; Default||External grouping not supported 951227867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+4l 16x11x300l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+4l 16x11x300n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+4l 16x11x300r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 18x13x315l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 18x13x315n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 18x13x315r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 20x15x325l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 20x15x325n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 20x15x325r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 22x17x325l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 22x17x325n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmxxl36+21+8l 22x17x325r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|FSC: 13; Default||Not reimbursed separately|28,812.00|FSC: 13; Default||External grouping not supported 951227879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 18x13x255l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 18x13x255r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 20x15x270l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 20x15x270r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 22x17x275l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 22x17x275r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 24x19x275l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*st Xl 36+8lnk 24x19x275r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|FSC: 13; Default||Not reimbursed separately|21,581.70|FSC: 13; Default||External grouping not supported 951227887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stxxl 36+8lnk 18x13x315l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|FSC: 13; Default||Not reimbursed separately|25,445.70|FSC: 13; Default||External grouping not supported 951227888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stxxl 36+8lnk 18x13x315r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|FSC: 13; Default||Not reimbursed separately|25,445.70|FSC: 13; Default||External grouping not supported 951227889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stxxl 36+8lnk 20x15x325l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|FSC: 13; Default||Not reimbursed separately|25,445.70|FSC: 13; Default||External grouping not supported 951227890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stxxl 36+8lnk 20x15x325r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|FSC: 13; Default||Not reimbursed separately|25,445.70|FSC: 13; Default||External grouping not supported 951227891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stxxl 36+8lnk 22x17x325l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|FSC: 13; Default||Not reimbursed separately|25,445.70|FSC: 13; Default||External grouping not supported 951227892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stxxl 36+8lnk 22x17x325r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|FSC: 13; Default||Not reimbursed separately|25,445.70|FSC: 13; Default||External grouping not supported 951227893|EAP|Custom 951227893||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-romtrochanter Washer|1|HUMANA [1294]||HUMANA [11839]|1,446.90|FSC: 13; Default||Not reimbursed separately|1,446.90|FSC: 13; Default||External grouping not supported 951227894|EAP|Custom 951227894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*washer Trochanter 60x45|1|HUMANA [1294]||HUMANA [11839]|1,446.90|FSC: 13; Default||Not reimbursed separately|1,446.90|FSC: 13; Default||External grouping not supported 951227895|EAP|Custom 951227895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*washer Trochanter 54x70|1|HUMANA [1294]||HUMANA [11839]|1,446.90|FSC: 13; Default||Not reimbursed separately|1,446.90|FSC: 13; Default||External grouping not supported 951227896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw Trochanter 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.90|FSC: 13; Default||Not reimbursed separately|606.90|FSC: 13; Default||External grouping not supported 951227897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw Trochanter 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.90|FSC: 13; Default||Not reimbursed separately|606.90|FSC: 13; Default||External grouping not supported 951227898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw Trochanter 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.90|FSC: 13; Default||Not reimbursed separately|606.90|FSC: 13; Default||External grouping not supported 951227899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw.5.0mm Dia 50 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 3.5mm Dia 25 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 3.5mm Dia 30 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 3.5mm Dia 35 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 3.5mm Dia 40 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 3.5mm Dia 45 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 5.0mm Dia 25 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 5.0mm Dia 35 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 5.0mm Dia 45 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 5.0mm Dia 55 Mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 6.5mm Dia 15mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 6.5mm Dia 25mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 6.5mm Dia 30mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 6.5mm Dia 45mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 6.5mm Dia 50mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*screw 6.5mm Dia 55mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 951227915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slf Tapping Roof Pile Scrw70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 5.0mm Dia Tprd Hd Per Scrw 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|FSC: 13; Default||Not reimbursed separately|684.60|FSC: 13; Default||External grouping not supported 951227933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Locking Bolt 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 951227934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Locking Bolt 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 951227935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Locking Bolt 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 951227936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reclaim Locking Bolt 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|FSC: 13; Default||Not reimbursed separately|924.00|FSC: 13; Default||External grouping not supported 951227940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 56n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 62n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 68n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 56l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 62l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 68l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 56r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 62r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Grip Tf Rev Buttress 68r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|FSC: 13; Default||Not reimbursed separately|9,147.60|FSC: 13; Default||External grouping not supported 951227949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Std Body Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|FSC: 13; Default||Not reimbursed separately|16,791.60|FSC: 13; Default||External grouping not supported 951227950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Troc Body Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|FSC: 13; Default||Not reimbursed separately|16,791.60|FSC: 13; Default||External grouping not supported 951227951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Std Body 15deg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|FSC: 13; Default||Not reimbursed separately|16,791.60|FSC: 13; Default||External grouping not supported 951227952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Troc Bdy 15deg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|FSC: 13; Default||Not reimbursed separately|16,791.60|FSC: 13; Default||External grouping not supported 951227953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Std Body 15deg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|FSC: 13; Default||Not reimbursed separately|16,791.60|FSC: 13; Default||External grouping not supported 95164154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Vertex 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,713.00|FSC: 13; Default||Not reimbursed separately|1,713.00|FSC: 13; Default||External grouping not supported 951227954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Troc Bdy 15deg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|FSC: 13; Default||Not reimbursed separately|16,791.60|FSC: 13; Default||External grouping not supported 951227955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Segmental Component 125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|FSC: 13; Default||Not reimbursed separately|5,588.10|FSC: 13; Default||External grouping not supported 951227963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Total Fem Seg Comp 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.80|FSC: 13; Default||Not reimbursed separately|6,085.80|FSC: 13; Default||External grouping not supported 951227964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 11x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 12x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 13x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 14x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 15x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 16x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 17x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 11x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 13x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 15x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Cem Fem Stem 17x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|FSC: 13; Default||Not reimbursed separately|13,389.60|FSC: 13; Default||External grouping not supported 951227975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 11.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,545.00|FSC: 13; Default||Not reimbursed separately|13,545.00|FSC: 13; Default||External grouping not supported 951227976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 12.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 13.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 14.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 15.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 16.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 17.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 18.5x150mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 11.5x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,545.00|FSC: 13; Default||Not reimbursed separately|13,545.00|FSC: 13; Default||External grouping not supported 951227984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 12.5x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 14.5x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 16.5x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951227987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Pc Fem Stem 18.5x200mm Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|FSC: 13; Default||Not reimbursed separately|14,294.70|FSC: 13; Default||External grouping not supported 951228717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Only 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|FSC: 13; Default||Not reimbursed separately|1,590.00|FSC: 13; Default||External grouping not supported 951228718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 951228719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 951228789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Rev Liners 28/32/36 Lid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|FSC: 13; Default||Not reimbursed separately|4,140.00|FSC: 13; Default||External grouping not supported 951228801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Esc Cons Ring Insrtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|FSC: 13; Default||Not reimbursed separately|13,725.00|FSC: 13; Default||External grouping not supported 951228802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 32mm Pinn Esc Cons Ring Insrtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|FSC: 13; Default||Not reimbursed separately|13,725.00|FSC: 13; Default||External grouping not supported 951228803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Esc Cons Ring Insrtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|FSC: 13; Default||Not reimbursed separately|13,725.00|FSC: 13; Default||External grouping not supported 951228804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Pinn Esc Cons Ring Insrtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|FSC: 13; Default||Not reimbursed separately|13,725.00|FSC: 13; Default||External grouping not supported 951228805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 44mm Pinn Esc Cons Ring Insrtr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|FSC: 13; Default||Not reimbursed separately|13,725.00|FSC: 13; Default||External grouping not supported 951228806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 36mm Pinn Ab In Tr 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Pinn Ab In Tr 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Pinn Ab In Tr 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 40mm Pinn Ab In Tr 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 44mm Pinn Ab In Tr 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 44mm Pinn Ab In Tr 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 44mm Pinn Ab In Tr 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 28mm Pinn Ab In Tr 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|FSC: 13; Default||Not reimbursed separately|3,117.00|FSC: 13; Default||External grouping not supported 951228859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 1 Std Nk Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,968.00|FSC: 13; Default||Not reimbursed separately|7,968.00|FSC: 13; Default||External grouping not supported 951228865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 1 High Nk Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,968.00|FSC: 13; Default||Not reimbursed separately|7,968.00|FSC: 13; Default||External grouping not supported 951228866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 2 Rev Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,193.00|FSC: 13; Default||Not reimbursed separately|8,193.00|FSC: 13; Default||External grouping not supported 951228867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz3 Rev Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,193.00|FSC: 13; Default||Not reimbursed separately|8,193.00|FSC: 13; Default||External grouping not supported 951228868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz4 Rev Neck Segment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,193.00|FSC: 13; Default||Not reimbursed separately|8,193.00|FSC: 13; Default||External grouping not supported 951228875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 22.225mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 22.225mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 22.225mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 28mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 28mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 28mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 28mm +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 32mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 32mm +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951228884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Elite Impl Tr Hd 32mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|FSC: 13; Default||Not reimbursed separately|2,277.00|FSC: 13; Default||External grouping not supported 951229562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 28idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 28idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 28idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 28idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 28idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|FSC: 13; Default||Not reimbursed separately|4,575.90|FSC: 13; Default||External grouping not supported 951229576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|FSC: 13; Default||Not reimbursed separately|4,657.80|FSC: 13; Default||External grouping not supported 951229585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Lip Lnr 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 951229586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Lip Lnr 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 951229587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Lip Lnr 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 951229588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Lip Lnr 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 951229589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Lip Lnr 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|FSC: 13; Default||Not reimbursed separately|4,632.60|FSC: 13; Default||External grouping not supported 951229590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx74od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 32idx76od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|FSC: 13; Default||Not reimbursed separately|4,995.90|FSC: 13; Default||External grouping not supported 951229605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 36idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 951229606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 951229607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 36idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 951229608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 36idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 951229609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar Neut 36idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 951229610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 10d 36idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Mar +4 Neut 36idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|FSC: 13; Default||Not reimbursed separately|5,730.90|FSC: 13; Default||External grouping not supported 951229625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx46od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,289.90|FSC: 13; Default||Not reimbursed separately|5,289.90|FSC: 13; Default||External grouping not supported 951229626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|FSC: 13; Default||Not reimbursed separately|4,899.30|FSC: 13; Default||External grouping not supported 951229627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|FSC: 13; Default||Not reimbursed separately|4,899.30|FSC: 13; Default||External grouping not supported 951229628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|FSC: 13; Default||Not reimbursed separately|4,827.90|FSC: 13; Default||External grouping not supported 951229629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|FSC: 13; Default||Not reimbursed separately|4,827.90|FSC: 13; Default||External grouping not supported 951229630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|FSC: 13; Default||Not reimbursed separately|4,827.90|FSC: 13; Default||External grouping not supported 951229631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|FSC: 13; Default||Not reimbursed separately|4,827.90|FSC: 13; Default||External grouping not supported 951229632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|FSC: 13; Default||Not reimbursed separately|4,827.90|FSC: 13; Default||External grouping not supported 951229633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 28idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|FSC: 13; Default||Not reimbursed separately|4,827.90|FSC: 13; Default||External grouping not supported 951229634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx44od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 951229635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|FSC: 13; Default||Not reimbursed separately|5,394.90|FSC: 13; Default||External grouping not supported 951229636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|FSC: 13; Default||Not reimbursed separately|5,394.90|FSC: 13; Default||External grouping not supported 951229637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 10d 28idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951229646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951229647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951229648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|FSC: 13; Default||Not reimbursed separately|5,029.50|FSC: 13; Default||External grouping not supported 951229649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951229650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951229651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951229652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951229653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951229654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Lip Lnr 28idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|FSC: 13; Default||Not reimbursed separately|4,956.00|FSC: 13; Default||External grouping not supported 951229655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|FSC: 13; Default||Not reimbursed separately|5,394.90|FSC: 13; Default||External grouping not supported 951229656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|FSC: 13; Default||Not reimbursed separately|5,394.90|FSC: 13; Default||External grouping not supported 951229657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx +4 Neut 28idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|FSC: 13; Default||Not reimbursed separately|5,315.10|FSC: 13; Default||External grouping not supported 951229665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951229666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951229667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951229668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951229669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951229670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 951229671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Altrx Neut 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|FSC: 13; Default||Not reimbursed separately|4,880.40|FSC: 13; Default||External grouping not supported 95193128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium L52 Mm Od3.5 Mm Cortical Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95193129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Titanium Fibula Distal 4 Hole Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 951217423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 26id 0 Deg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 46-48 0 Dg Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 50-52 0 Dg Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 54-56 0 Dg Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 58-60 0 Dg Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 62-64 0 Dg Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 66-68 0 Dg Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28x 70-76 0 Dg Sz K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|FSC: 13; Default||Not reimbursed separately|3,504.60|FSC: 13; Default||External grouping not supported 951217435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 46-48od Ant +4 Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 50-52od Ant +4 Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Lnr 28id 54-56od Ant +4 Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|FSC: 13; Default||Not reimbursed separately|2,184.60|FSC: 13; Default||External grouping not supported 951217588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Shell Revision 56/44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|FSC: 13; Default||Not reimbursed separately|5,339.40|FSC: 13; Default||External grouping not supported 951217589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plus Ipm Centralizer 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|FSC: 13; Default||Not reimbursed separately|467.28|FSC: 13; Default||External grouping not supported 951217596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 39/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 41/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 44/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 44/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 48/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Standard 52/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 39/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 41/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 44/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 44/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mpf Pe Insert Hooded 48/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|FSC: 13; Default||Not reimbursed separately|1,973.40|FSC: 13; Default||External grouping not supported 951217611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 1 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 2 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 3 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 4 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 5 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 6 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 7 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 8 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 9 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 10non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem Lateral 11non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|FSC: 13; Default||Not reimbursed separately|10,916.40|FSC: 13; Default||External grouping not supported 951217622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 01 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 0 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 1 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 2 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 3 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 4 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 5 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 6 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 7 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 8 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 9 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 10 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 11 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem 12 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 1 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 2 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 3 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 4 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 5 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 6 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 7 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 8 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 9 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 10 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 11 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Mia Stem Lateral 12 Non-cem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|FSC: 13; Default||Not reimbursed separately|13,622.40|FSC: 13; Default||External grouping not supported 951217648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 1 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 1 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 2 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 2 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 3 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 3 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 4 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 4 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 5 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 5 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 6 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 6 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 7 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 7 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 8 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 8 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 9 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 9 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 10 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 10 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 11 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 12 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 01 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 01 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 0 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Standard Stem 0 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 1 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 1 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 2 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 2 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 3 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 3 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 4 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 4 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 5 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 5 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 6 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 6 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 7 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 7 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 8 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 8 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 9 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 9 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 10 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,784.40|FSC: 13; Default||Not reimbursed separately|10,784.40|FSC: 13; Default||External grouping not supported 951217693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 10 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|FSC: 13; Default||Not reimbursed separately|12,672.00|FSC: 13; Default||External grouping not supported 951217694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sl-plus Stem Lateral 11 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|FSC: 13; Default||Not reimbursed separately|12,071.40|FSC: 13; Default||External grouping not supported 951217695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 1 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|FSC: 13; Default||Not reimbursed separately|15,338.40|FSC: 13; Default||External grouping not supported 951217696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 1 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 2 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|FSC: 13; Default||Not reimbursed separately|15,338.40|FSC: 13; Default||External grouping not supported 951217698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 2 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 3 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|FSC: 13; Default||Not reimbursed separately|15,338.40|FSC: 13; Default||External grouping not supported 951217700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 3 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 4 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,378.00|FSC: 13; Default||Not reimbursed separately|15,378.00|FSC: 13; Default||External grouping not supported 951217702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 4 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 5 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|FSC: 13; Default||Not reimbursed separately|13,609.20|FSC: 13; Default||External grouping not supported 951217704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 5 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 6 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|FSC: 13; Default||Not reimbursed separately|15,338.40|FSC: 13; Default||External grouping not supported 951217706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 6 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 7 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,424.20|FSC: 13; Default||Not reimbursed separately|15,424.20|FSC: 13; Default||External grouping not supported 951217708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 7 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 8 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|FSC: 13; Default||Not reimbursed separately|13,609.20|FSC: 13; Default||External grouping not supported 951217710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 8 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 9 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|FSC: 13; Default||Not reimbursed separately|13,609.20|FSC: 13; Default||External grouping not supported 951217712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 9 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 10 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|FSC: 13; Default||Not reimbursed separately|13,609.20|FSC: 13; Default||External grouping not supported 951217714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 10 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|FSC: 13; Default||Not reimbursed separately|16,110.60|FSC: 13; Default||External grouping not supported 951217715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 11 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|FSC: 13; Default||Not reimbursed separately|13,609.20|FSC: 13; Default||External grouping not supported 951217716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Slr-plus Revision Stem 11 Non-cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,902.80|FSC: 13; Default||Not reimbursed separately|14,902.80|FSC: 13; Default||External grouping not supported 951217717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 1al|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 1as|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,774.80|FSC: 13; Default||Not reimbursed separately|7,774.80|FSC: 13; Default||External grouping not supported 951217719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 2al|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 2as|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 3al|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 3as|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 4al|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 4as|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 5bl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 6bl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 7bl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 8bl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 9cl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 10cl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 11cl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.long 12cl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 5bs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 6bs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 7bs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 8bs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 9cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 10cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 11cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Dist.short 12cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|FSC: 13; Default||Not reimbursed separately|8,586.60|FSC: 13; Default||External grouping not supported 951217741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw As|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Al|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Bs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Bl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Cl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Ax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,963.00|FSC: 13; Default||Not reimbursed separately|6,963.00|FSC: 13; Default||External grouping not supported 951217749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mod Plus Rev Stem Module Prox.w.screw Cx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|FSC: 13; Default||Not reimbursed separately|7,682.40|FSC: 13; Default||External grouping not supported 951217750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 42/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 44/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 46/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 48/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 50/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 52/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 54/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 56/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 58/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 60/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 62/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 64/28 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|FSC: 13; Default||Not reimbursed separately|1,379.40|FSC: 13; Default||External grouping not supported 951217762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 48/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951217763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pe-plus Cup 50/32 Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|FSC: 13; Default||Not reimbursed separately|1,755.60|FSC: 13; Default||External grouping not supported 951218468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 36mm -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|FSC: 13; Default||Not reimbursed separately|3,682.80|FSC: 13; Default||External grouping not supported 951218469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 36mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|FSC: 13; Default||Not reimbursed separately|3,682.80|FSC: 13; Default||External grouping not supported 951218470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cocr 12/14 Fem Head 36mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|FSC: 13; Default||Not reimbursed separately|3,682.80|FSC: 13; Default||External grouping not supported 951218471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Ho Fem Com Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Ho Pf Fem Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|FSC: 13; Default||Not reimbursed separately|14,091.00|FSC: 13; Default||External grouping not supported 951218492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Fem Comp Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha Pf Fem Comp Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|FSC: 13; Default||Not reimbursed separately|13,028.40|FSC: 13; Default||External grouping not supported 951218512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ti Pf Fem Comp Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|FSC: 13; Default||Not reimbursed separately|9,754.80|FSC: 13; Default||External grouping not supported 951218522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Frac Mgmt Fem Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,679.00|FSC: 13; Default||Not reimbursed separately|8,679.00|FSC: 13; Default||External grouping not supported 951218523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 170mm Str Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 175mm Str Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 175mm Str Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 175mm Str Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 175mm Str Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 175mm Str Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 180mm Str Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 180mm Str Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rev Por 180mm Str Sz 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|FSC: 13; Default||Not reimbursed separately|6,956.40|FSC: 13; Default||External grouping not supported 951218532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Fem Comp Sz 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|FSC: 13; Default||Not reimbursed separately|11,312.40|FSC: 13; Default||External grouping not supported 951218539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha {} So Stem Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha So Stem Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por So Stem Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|FSC: 13; Default||Not reimbursed separately|9,405.00|FSC: 13; Default||External grouping not supported 951218551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por So Stem Sz 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|FSC: 13; Default||Not reimbursed separately|9,405.00|FSC: 13; Default||External grouping not supported 951218552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ho Stem Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|FSC: 13; Default||Not reimbursed separately|9,405.00|FSC: 13; Default||External grouping not supported 951218553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Por Plus Ha Ho Stem Sz 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|FSC: 13; Default||Not reimbursed separately|15,609.00|FSC: 13; Default||External grouping not supported 951218563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Stem Sz 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|FSC: 13; Default||Not reimbursed separately|9,405.00|FSC: 13; Default||External grouping not supported 951218564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syn Ha On Por Ho Stem Sz 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|FSC: 13; Default||Not reimbursed separately|9,405.00|FSC: 13; Default||External grouping not supported 951218565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem Fem Sz 12 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem Component Sz 14 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem Component Sz 16 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem Fem Sz 12 225mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem Component Sz 14 225mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem Component Sz 16 225mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 15mm Cal Sz 12 175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem 15mm Calcar Sz 14 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem 15mm Calcar Sz 16 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 15mm Cal Sz 12 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem 15mm Calcar Sz 14 225mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Echelon Cem Fem 15mm Calcar Sz 16 225mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|FSC: 13; Default||Not reimbursed separately|14,968.80|FSC: 13; Default||External grouping not supported 951218577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 30mm Cal Sz 12 175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 30mm Cal Sz 14 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 30mm Cal Sz 16 175mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 30mm Cal Sz 12 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 30mm Cal Sz 14 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ech Cem 30mm Cal Sz 16 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|FSC: 13; Default||Not reimbursed separately|16,764.00|FSC: 13; Default||External grouping not supported 951218583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 22mm -3 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.80|FSC: 13; Default||Not reimbursed separately|3,418.80|FSC: 13; Default||External grouping not supported 951218584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 22mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 26mm -5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 26mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 26mm +5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 28mm -5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 28mm +0 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fem Hd Zirc 10/12 28mm +5 Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|FSC: 13; Default||Not reimbursed separately|4,540.80|FSC: 13; Default||External grouping not supported 951218591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Pri So 12/14 Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Pri So 12/14 Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Pri So 12/14 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Pri So 12/14 Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Pri So 12/14 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Prim Ho 12/14 Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Prim Ho 12/14 Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Prim Ho 12/14 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Prim Ho 12/14 Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef Prim Ho 12/14 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|FSC: 13; Default||Not reimbursed separately|11,180.40|FSC: 13; Default||External grouping not supported 951218601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef So Cls 12/14 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,282.80|FSC: 13; Default||Not reimbursed separately|10,282.80|FSC: 13; Default||External grouping not supported 951218602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cobra Prim So 12/14 Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|FSC: 13; Default||Not reimbursed separately|6,699.00|FSC: 13; Default||External grouping not supported 951218603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cobra Prim So 12/14 Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|FSC: 13; Default||Not reimbursed separately|6,699.00|FSC: 13; Default||External grouping not supported 951218604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cobra Prim So 12/14 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|FSC: 13; Default||Not reimbursed separately|6,699.00|FSC: 13; Default||External grouping not supported 951218605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cobra Prim So 12/14 Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|FSC: 13; Default||Not reimbursed separately|6,699.00|FSC: 13; Default||External grouping not supported 951218606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cobra Prim So 12/14 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.20|FSC: 13; Default||Not reimbursed separately|7,372.20|FSC: 13; Default||External grouping not supported 951218607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 165mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 165mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 165mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 195mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 195mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 195mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 225mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 225mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Ls 225mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 135mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 135mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 135mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 165mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 165mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 165mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 195mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 195mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 195mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 225mm S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 225mm M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spec Ef 12/14 Nr 225mm L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|FSC: 13; Default||Not reimbursed separately|13,675.20|FSC: 13; Default||External grouping not supported 951218628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Basis 12/14 Tpr Pri Clld Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|FSC: 13; Default||Not reimbursed separately|4,237.20|FSC: 13; Default||External grouping not supported 951218629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Basis 12/14 Tpr Pri Clld Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|FSC: 13; Default||Not reimbursed separately|4,237.20|FSC: 13; Default||External grouping not supported 951218630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Basis 12/14 Tpr Pri Clld Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|FSC: 13; Default||Not reimbursed separately|4,237.20|FSC: 13; Default||External grouping not supported 951218631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Basis 12/14 Tpr Pri Clld Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|FSC: 13; Default||Not reimbursed separately|4,237.20|FSC: 13; Default||External grouping not supported 951218632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Basis 12/14 Tpr Pri Clld Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 951218633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Pri So 12/14 Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951218634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim So 12/14 Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,893.00|FSC: 13; Default||Not reimbursed separately|13,893.00|FSC: 13; Default||External grouping not supported 951218635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim So 12/14 Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|FSC: 13; Default||Not reimbursed separately|13,477.20|FSC: 13; Default||External grouping not supported 951218636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim So 12/14 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|FSC: 13; Default||Not reimbursed separately|13,477.20|FSC: 13; Default||External grouping not supported 951218637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim So 12/14 Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|FSC: 13; Default||Not reimbursed separately|13,477.20|FSC: 13; Default||External grouping not supported 951218638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim So 12/14 Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|FSC: 13; Default||Not reimbursed separately|13,477.20|FSC: 13; Default||External grouping not supported 951218639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Pri Ho 12/14 Sz 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951218640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim Ho 12/14 Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951218641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim Ho 12/14 Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951218642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim Ho 12/14 Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951218643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cpcs Cocr Prim Ho 12/14 Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|FSC: 13; Default||Not reimbursed separately|14,295.60|FSC: 13; Default||External grouping not supported 951219348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Rc3 Sz 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.80|FSC: 13; Default||Not reimbursed separately|3,187.80|FSC: 13; Default||External grouping not supported 951219349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Rc3 Sz 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|FSC: 13; Default||Not reimbursed separately|2,890.80|FSC: 13; Default||External grouping not supported 951219350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole Sz 42mm B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole Sz 44mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Ha Three Hole 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|FSC: 13; Default||Not reimbursed separately|5,768.40|FSC: 13; Default||External grouping not supported 951219362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reflection Spiked Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,392.20|FSC: 13; Default||Not reimbursed separately|5,392.20|FSC: 13; Default||External grouping not supported 951219363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reflection Spiked Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reflection Spiked Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Spiked Shell Sz 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reflection Spiked Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reflection Spiked Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|FSC: 13; Default||Not reimbursed separately|5,544.00|FSC: 13; Default||External grouping not supported 951219377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Sp3 Three Hole Shell 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Three Hole Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|FSC: 13; Default||Not reimbursed separately|5,379.00|FSC: 13; Default||External grouping not supported 951219391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ref Threaded Hole Cover|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|299.64|FSC: 13; Default||Not reimbursed separately|299.64|FSC: 13; Default||External grouping not supported 951219392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Can Acet Screw 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 951219393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Univ Can Acet Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|FSC: 13; Default||Not reimbursed separately|406.56|FSC: 13; Default||External grouping not supported 951219394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 32mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg +4 Xlpe Acet Lnr 36mm X 66/68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 44/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 47/43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 50/46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 53/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 56/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 59/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 62/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 65/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Reinf Ring 68/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|FSC: 13; Default||Not reimbursed separately|7,020.00|FSC: 13; Default||External grouping not supported 951219419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 22mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 22mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 22mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recon Ring 50/46 Lft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recon Ring 56/52 Lft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recon Ring 62/58 Lft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recn Ring 68od 64id Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recn Ring 74od 70id Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recon Ring 50/46 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recon Ring 56/52 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recon Ring 62/58 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recn Ring 68od 64id Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cont Recn Ring 74od 70id Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|FSC: 13; Default||Not reimbursed separately|12,382.50|FSC: 13; Default||External grouping not supported 951219432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Optifix Xlpe Anvtd 32 +4 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951219433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Optifix Xlpe Anvtd 32 +4 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951219434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 28mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Optifix Xlpe Anvtd 26 +4 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951219443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Acet Lnr 32mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Optifix Xlpe Anvtd 36 +4 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951219452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 28mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Optifix Xlpe Anvtd 28 +4 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951219461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Optifix Xlpe Anvtd 28 +4 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|FSC: 13; Default||Not reimbursed separately|4,560.60|FSC: 13; Default||External grouping not supported 951219462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 32mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rf Interfit Tprd Id 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|FSC: 13; Default||Not reimbursed separately|6,349.20|FSC: 13; Default||External grouping not supported 951219481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer Lnr 28id 46-48 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer Lnr 28id 50-54 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer Lnr 28id 56-66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer Lnr 32id 50-54 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Intl Alum Cer Lnr 32id 56-66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer Lnr 28id 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer Lnr 32id 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alum Cer Lnr 32id 56-66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|FSC: 13; Default||Not reimbursed separately|5,273.40|FSC: 13; Default||External grouping not supported 951219489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Acet Lnr 36mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg +4 Xlpe Act Lnr 36mm X 66/68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|FSC: 13; Default||Not reimbursed separately|4,270.20|FSC: 13; Default||External grouping not supported 951219496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|FSC: 13; Default||Not reimbursed separately|5,986.20|FSC: 13; Default||External grouping not supported 951219509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|FSC: 13; Default||Not reimbursed separately|7,444.80|FSC: 13; Default||External grouping not supported 951219510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|FSC: 13; Default||Not reimbursed separately|7,444.80|FSC: 13; Default||External grouping not supported 951219511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 Multi Hole Acetabular Shell 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|FSC: 13; Default||Not reimbursed separately|7,444.80|FSC: 13; Default||External grouping not supported 951219512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Degree Xlpe Acet Lnr 40mm Id X 56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 40mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Degree Xlpe Acet Lnr 40mm Id X 60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 40mm X 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 40mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 40mm X 66/70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Acet Lnr 40mm X 72-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 0 Deg Xlpe Lnr 36mm Id X 72-74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 40mm Id X 56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 40mm Id X 60 Od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 40mm Id X 62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951219523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb R3 20 Deg Xlpe Lnr 40mm Id X 64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|FSC: 13; Default||Not reimbursed separately|5,214.00|FSC: 13; Default||External grouping not supported 951220280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 9mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 11mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 15mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz1 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz2 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz3 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz4 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tb Sz5 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz6 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii P/s All Poly Tib Sz7 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 9mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 11mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 13mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps All Poly Tib Sz8 15mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|FSC: 13; Default||Not reimbursed separately|4,309.80|FSC: 13; Default||External grouping not supported 951220324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Cr Art Ins Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,689.40|FSC: 13; Default||Not reimbursed separately|3,689.40|FSC: 13; Default||External grouping not supported 951220332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|FSC: 13; Default||Not reimbursed separately|3,768.60|FSC: 13; Default||External grouping not supported 951220342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii C/r Art Ins Sz7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|FSC: 13; Default||Not reimbursed separately|4,316.40|FSC: 13; Default||External grouping not supported 951220343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gnsii Con Ins Sz3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz3-4 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz3-4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz3-4 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Con Art Ins 9mm Sz 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz5-6 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Con Art Ins 9mm Sz 7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz7-8 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz 7-8 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Con Ins Sz7-8 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Biconvex Pat 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Biconvex Pat 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Biconvex Pat 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Biconvex Pat 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Resurf Pat 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Pat W/flex Lok 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Pat W/ Flex Lok Peg 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Pat W/ Flex Lok Peg 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Pat W/ Flex Lok 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 951220373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 12mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 14mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 16mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 18mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 20mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 22mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 24mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 10mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,564.00|FSC: 13; Default||Not reimbursed separately|3,564.00|FSC: 13; Default||External grouping not supported 951220381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 12mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,564.00|FSC: 13; Default||Not reimbursed separately|3,564.00|FSC: 13; Default||External grouping not supported 951220382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Long Stem 10x150mm W/slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 14mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Long Stem 12mx150mm W/slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 16mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 20mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,808.20|FSC: 13; Default||Not reimbursed separately|3,808.20|FSC: 13; Default||External grouping not supported 951220387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 10mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,808.20|FSC: 13; Default||Not reimbursed separately|3,808.20|FSC: 13; Default||External grouping not supported 951220388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 14mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Lng Stem 16mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 951220390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Post Fem Wdg 5-6 5 Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,385.80|FSC: 13; Default||Not reimbursed separately|3,385.80|FSC: 13; Default||External grouping not supported 951220391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz1-2 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|FSC: 13; Default||Not reimbursed separately|2,989.80|FSC: 13; Default||External grouping not supported 951220392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz3-4 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|FSC: 13; Default||Not reimbursed separately|2,989.80|FSC: 13; Default||External grouping not supported 951220393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz5-6 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|FSC: 13; Default||Not reimbursed separately|2,989.80|FSC: 13; Default||External grouping not supported 951220394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz7-8 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|FSC: 13; Default||Not reimbursed separately|2,989.80|FSC: 13; Default||External grouping not supported 951220395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz1-2 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.20|FSC: 13; Default||Not reimbursed separately|2,983.20|FSC: 13; Default||External grouping not supported 951220396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz3-4 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|FSC: 13; Default||Not reimbursed separately|2,989.80|FSC: 13; Default||External grouping not supported 951220397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz5-6 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|FSC: 13; Default||Not reimbursed separately|2,989.80|FSC: 13; Default||External grouping not supported 951220398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Step Hemi Wdg Sz7-8 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.20|FSC: 13; Default||Not reimbursed separately|2,983.20|FSC: 13; Default||External grouping not supported 951220399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|FSC: 13; Default||Not reimbursed separately|4,573.80|FSC: 13; Default||External grouping not supported 951220400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|FSC: 13; Default||Not reimbursed separately|4,573.80|FSC: 13; Default||External grouping not supported 951220401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|FSC: 13; Default||Not reimbursed separately|4,573.80|FSC: 13; Default||External grouping not supported 951220402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|FSC: 13; Default||Not reimbursed separately|4,573.80|FSC: 13; Default||External grouping not supported 951220403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|FSC: 13; Default||Not reimbursed separately|4,573.80|FSC: 13; Default||External grouping not supported 951220404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 1-2 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|FSC: 13; Default||Not reimbursed separately|4,573.80|FSC: 13; Default||External grouping not supported 951220405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 3-4 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz5-6 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 7-8 {} 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Dished Ins Sz 7-8 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|FSC: 13; Default||Not reimbursed separately|4,395.60|FSC: 13; Default||External grouping not supported 951220423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 1-2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 3-4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 5-6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951220449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gii Ps Insert Sz 7-8 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|FSC: 13; Default||Not reimbursed separately|4,336.20|FSC: 13; Default||External grouping not supported 951220451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz1 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz2 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz5 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz7 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz8 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz 1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz2 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz3 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz4 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz6 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz7 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gns Ii Porous P/s Fem Sz8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|FSC: 13; Default||Not reimbursed separately|11,305.80|FSC: 13; Default||External grouping not supported 951220467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Legion Con Art Ins 9mm Sz 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Const Insrt Sz1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Const Insrt Sz1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Const Insrt Sz1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Const Insrt Sz1-2 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Const Insrt Sz1-2 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 Const Insrt Sz1-2 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 951220474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb G2 6.5mm Screw 15mm Lngth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|FSC: 13; Default||Not reimbursed separately|357.72|FSC: 13; Default||External grouping not supported 951221260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|FSC: 13; Default||Not reimbursed separately|5,530.80|FSC: 13; Default||External grouping not supported 951221264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Cr Insert Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|FSC: 13; Default||Not reimbursed separately|5,260.20|FSC: 13; Default||External grouping not supported 951221265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 3-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 1-2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 3-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 5-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Cr High Flex Xlpe Sz 7-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 951221281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 1-2 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|FSC: 13; Default||Not reimbursed separately|4,738.80|FSC: 13; Default||External grouping not supported 951221287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 3-4 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|FSC: 13; Default||Not reimbursed separately|4,738.80|FSC: 13; Default||External grouping not supported 951221291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 5-6 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|FSC: 13; Default||Not reimbursed separately|4,738.80|FSC: 13; Default||External grouping not supported 951221297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|FSC: 13; Default||Not reimbursed separately|5,590.20|FSC: 13; Default||External grouping not supported 951221302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps High Flex Xlpe Sz 7-8 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|FSC: 13; Default||Not reimbursed separately|4,738.80|FSC: 13; Default||External grouping not supported 951221303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Ps Xlpe Insert Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|FSC: 13; Default||Not reimbursed separately|5,636.40|FSC: 13; Default||External grouping not supported 951221319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Ps Insert Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|FSC: 13; Default||Not reimbursed separately|5,372.40|FSC: 13; Default||External grouping not supported 951221321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 1-2 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 3-4 11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 3-4 13m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 3-4 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 5-6 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,827.80|FSC: 13; Default||Not reimbursed separately|5,827.80|FSC: 13; Default||External grouping not supported 951221336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|FSC: 13; Default||Not reimbursed separately|5,946.60|FSC: 13; Default||External grouping not supported 951221341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lgn Xlpe Dished Isrt Sz 7-8 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|FSC: 13; Default||Not reimbursed separately|6,230.40|FSC: 13; Default||External grouping not supported 951221342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pfj Implant X-sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pfj Implant X-sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pfj Implant Sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pf Implant Sm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pf Implant Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pf Implant Lg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pf Implant Lg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 951221375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Metaph Tib Stem 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,656.60|FSC: 13; Default||Not reimbursed separately|1,656.60|FSC: 13; Default||External grouping not supported 951221376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Metaphyseal Tib Stem 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|FSC: 13; Default||Not reimbursed separately|1,366.20|FSC: 13; Default||External grouping not supported 951221377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Metaph Tib Stem 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|FSC: 13; Default||Not reimbursed separately|1,366.20|FSC: 13; Default||External grouping not supported 951221378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Methaphyseal Stm Sm 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|FSC: 13; Default||Not reimbursed separately|1,366.20|FSC: 13; Default||External grouping not supported 951221379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib Keel Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,656.60|FSC: 13; Default||Not reimbursed separately|1,656.60|FSC: 13; Default||External grouping not supported 951221380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Metaph Tib Stem 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|FSC: 13; Default||Not reimbursed separately|1,366.20|FSC: 13; Default||External grouping not supported 951221381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Metaphyseal Stm Sm 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|FSC: 13; Default||Not reimbursed separately|1,366.20|FSC: 13; Default||External grouping not supported 951221382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Tib I-beam Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.36|FSC: 13; Default||Not reimbursed separately|1,317.36|FSC: 13; Default||External grouping not supported 951221383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 10x100 Solid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 12x100 Solid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 14x100 Solid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 16x100 Solid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 18x100 Solid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 20x100 Solid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,102.00|FSC: 13; Default||Not reimbursed separately|3,102.00|FSC: 13; Default||External grouping not supported 951221389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 10x150 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 12x150 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 14x150 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 16x150 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 18x150 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 20x150 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 10x200 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 12x200 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 14x200 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|FSC: 13; Default||Not reimbursed separately|3,570.60|FSC: 13; Default||External grouping not supported 951221398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 16x200 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 18x200 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Neut Stm 20x200 Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|FSC: 13; Default||Not reimbursed separately|2,943.60|FSC: 13; Default||External grouping not supported 951221401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Por Femoral Rt Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,041.80|FSC: 13; Default||Not reimbursed separately|11,041.80|FSC: 13; Default||External grouping not supported 951221402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Por Tib Base W/oh R4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,553.80|FSC: 13; Default||Not reimbursed separately|6,553.80|FSC: 13; Default||External grouping not supported 951221403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Profix Por Tib Base Rt S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,458.00|FSC: 13; Default||Not reimbursed separately|7,458.00|FSC: 13; Default||External grouping not supported 951221404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Por Tib Base Lt S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,458.00|FSC: 13; Default||Not reimbursed separately|7,458.00|FSC: 13; Default||External grouping not supported 951221405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S4 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Rt S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951221434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|FSC: 13; Default||Not reimbursed separately|3,801.60|FSC: 13; Default||External grouping not supported 951221444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S5 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221456|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|FSC: 13; Default||Not reimbursed separately|3,148.20|FSC: 13; Default||External grouping not supported 951221457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|FSC: 13; Default||Not reimbursed separately|3,590.40|FSC: 13; Default||External grouping not supported 951221458|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951221459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Conf Tb Isrt Lt S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|FSC: 13; Default||Not reimbursed separately|2,956.80|FSC: 13; Default||External grouping not supported 951222258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz3-4 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz5-6 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Med Sz7-8 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 1-2 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 1-2 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz1-2 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz1-2 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz1-2 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 1-2 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 1-2 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz1-2 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz1-2 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz1-2 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 3-4 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 3-4 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz3-4 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz3-4 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz3-4 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 3-4 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 3-4 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz3-4 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz3-4 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz3-4 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 5-6 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 5-6 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz5-6 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz5-6 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz5-6 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 5-6 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 5-6 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz5-6 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz5-6 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz5-6 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 7-8 Rt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 7-8 Rt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz7-8 Rt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz7-8 Rt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz7-8 Rt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 7-8 Lt 8mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz 7-8 Lt 9mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz7-8 Lt 10mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz7-8 Lt 11mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Xr Art Isrt Xlpe Lat Sz7-8 Lt 12mm -2deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|FSC: 13; Default||Not reimbursed separately|2,329.80|FSC: 13; Default||External grouping not supported 951222326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ren Pat Resrf Rd 32 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,834.80|FSC: 13; Default||Not reimbursed separately|1,834.80|FSC: 13; Default||External grouping not supported 951222336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 23 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 26 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 29 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 23 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 26 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 29 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Biconvex 32 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 26 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 29 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 32 Mm Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 26 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 29 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 32 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 35 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|FSC: 13; Default||Not reimbursed separately|3,834.00|FSC: 13; Default||External grouping not supported 951222350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 38 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Bcs Pat Resrf Rd 41 Mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|FSC: 13; Default||Not reimbursed separately|2,811.60|FSC: 13; Default||External grouping not supported 951222352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Bcs Fem Cocr Lt Sz9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|FSC: 13; Default||Not reimbursed separately|12,441.00|FSC: 13; Default||External grouping not supported 951222361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 1-2 18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 3-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 5-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222394|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222395|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222396|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222397|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 5-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222402|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 7-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222404|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222405|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Rt Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222406|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222407|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Cr Isrt Xlpe Lt Sz 7-8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 951222413|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222414|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222415|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222417|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 1-2 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 1-2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 1-2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 1-2 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,178.00|FSC: 13; Default||Not reimbursed separately|11,178.00|FSC: 13; Default||External grouping not supported 951222423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 1-2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 1-2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222432|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 3-4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222433|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 3-4 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222434|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 3-4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 3-4 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 3-4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222437|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222438|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222439|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222443|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222446|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222447|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222448|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222451|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Lt Sz 5-6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222453|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222454|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951222455|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jrny Ii Isrt Xlpe Dd Rt Sz 7-8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|FSC: 13; Default||Not reimbursed separately|8,197.20|FSC: 13; Default||External grouping not supported 951223213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 5-deg Im Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,874.00|FSC: 13; Default||Not reimbursed separately|2,874.00|FSC: 13; Default||External grouping not supported 951223214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.* 7-deg Im Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.00|FSC: 13; Default||Not reimbursed separately|3,408.00|FSC: 13; Default||External grouping not supported 951223224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma 5de/f St Tr Ada Assy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,146.00|FSC: 13; Default||Not reimbursed separately|4,146.00|FSC: 13; Default||External grouping not supported 951223225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma*sin Peg Ov/dom Pat Tr 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 951223226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma*sin Peg Ov/dom Pat Tr 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 951223227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma*sin Peg Ov/dom Pat Tr 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 951223228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma*sin Peg Ov/dom Pat Tr 41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|FSC: 13; Default||Not reimbursed separately|828.00|FSC: 13; Default||External grouping not supported 951223229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Sttb In Tr/s4/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|FSC: 13; Default||Not reimbursed separately|654.00|FSC: 13; Default||External grouping not supported 951223230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223236|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/1.5/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr Sz2/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr Sz2/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Trsz2/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr S2/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr Sz2/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr Sz2/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr Sz2/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr Sz2/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3tb In Tr/2.5/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s3/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s4/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma Tc3 Tb In Tr/s5/30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 951223292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 3 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 4 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 6 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 6 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Cv Tbin Tr 6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr Sz2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr Sz2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr Sz2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr Sz2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 2 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 2 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stbin Tr S2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 2.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 2.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S3 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 3 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 3 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S4 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 4 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 4 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 4 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 951223351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S6 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S6 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr S6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 6 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 6 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc Sigmarp Stb In Tr 6 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|FSC: 13; Default||Not reimbursed separately|3,759.00|FSC: 13; Default||External grouping not supported 951223358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr S1.5 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tc3 Rp Tib Insert Tr Sz 3 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 951223372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Im Rod 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|FSC: 13; Default||Not reimbursed separately|4,623.00|FSC: 13; Default||External grouping not supported 951223373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Im Rod 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|FSC: 13; Default||Not reimbursed separately|4,623.00|FSC: 13; Default||External grouping not supported 951223374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Im Rod 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|FSC: 13; Default||Not reimbursed separately|4,623.00|FSC: 13; Default||External grouping not supported 951223375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sp2 Im Rod 8mm To 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|FSC: 13; Default||Not reimbursed separately|4,623.00|FSC: 13; Default||External grouping not supported 951224162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fixed Ref Fem Sizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,168.00|FSC: 13; Default||Not reimbursed separately|33,168.00|FSC: 13; Default||External grouping not supported 951224163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Post Rot Gde 0deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,330.00|FSC: 13; Default||Not reimbursed separately|9,330.00|FSC: 13; Default||External grouping not supported 951224164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Post Rot Gde 3deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.00|FSC: 13; Default||Not reimbursed separately|4,668.00|FSC: 13; Default||External grouping not supported 951224165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Post Rot Gde 5deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.00|FSC: 13; Default||Not reimbursed separately|4,668.00|FSC: 13; Default||External grouping not supported 951224166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Post Rot Gde 7deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.00|FSC: 13; Default||Not reimbursed separately|4,668.00|FSC: 13; Default||External grouping not supported 951224167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Ant Rot Gde 0deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|FSC: 13; Default||Not reimbursed separately|5,616.00|FSC: 13; Default||External grouping not supported 951224168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Ant Rot Gde 3deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|FSC: 13; Default||Not reimbursed separately|5,616.00|FSC: 13; Default||External grouping not supported 951224169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Ant Rot Gde 5deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|FSC: 13; Default||Not reimbursed separately|5,616.00|FSC: 13; Default||External grouping not supported 951224170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Fixed Ref Ant Rot Gde 7deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|FSC: 13; Default||Not reimbursed separately|5,616.00|FSC: 13; Default||External grouping not supported 951224171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Classic Ant Down Fem Sizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,513.00|FSC: 13; Default||Not reimbursed separately|45,513.00|FSC: 13; Default||External grouping not supported 951224172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Classic Rot Gde 0deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951224173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Classic Rot Gde 3deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951224174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Classic Rot Gde 5deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951224175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Classic Rot Gde 7deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|FSC: 13; Default||Not reimbursed separately|6,036.00|FSC: 13; Default||External grouping not supported 951224176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hp Classic Post Up Fem Sizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,381.00|FSC: 13; Default||Not reimbursed separately|51,381.00|FSC: 13; Default||External grouping not supported 951224177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Fem Finish Blk Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|FSC: 13; Default||Not reimbursed separately|13,317.00|FSC: 13; Default||External grouping not supported 951224184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Rpf Hp Fem Fin Blk Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|FSC: 13; Default||Not reimbursed separately|15,276.00|FSC: 13; Default||External grouping not supported 951224198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Fix Ref Blk Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sig Hp 150 Classic Blk Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|FSC: 13; Default||Not reimbursed separately|15,303.00|FSC: 13; Default||External grouping not supported 951224220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pw Fem 3in1 Sz 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,637.00|FSC: 13; Default||Not reimbursed separately|17,637.00|FSC: 13; Default||External grouping not supported 951224934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 2.5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 3 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224953|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 4 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224958|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224960|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224963|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 5 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Gvf Ins 6 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|FSC: 13; Default||Not reimbursed separately|5,016.90|FSC: 13; Default||External grouping not supported 951224974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd+ Ins 1.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224975|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd+ Ins 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224976|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd+ Ins 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224977|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd+ Ins 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd+ Ins 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224985|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvdplus Ins2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvdplus Ins2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 2.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951224999|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlk Cvd Plus Ins 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225014|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Xlkcvd Plus Ins 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225015|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 1.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 1.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225022|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225023|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225024|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225026|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225028|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225031|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 2.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225038|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Pli Xlk Ins 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 1.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 1.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225070|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225071|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225072|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225073|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 2.5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225074|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 3 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 3 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 4 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225082|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 6 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 6 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 6 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Crvd Xlk Ins 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 1.5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 1.5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 1.5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 1.5 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 1.5 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Stab Xlk Ins 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 951225774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 9 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Cr Rp Insrt Sz 10 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 1 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz2 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz2 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 2 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 2 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 2 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 2 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 2 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz3 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz3 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 3 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz4 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz4 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225825|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225826|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 4 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz5 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz5 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 5 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz6 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz6 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 6 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz7 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 7 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz8 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz8 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 8 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz9 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz9 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225875|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225876|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 9 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225879|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz10 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225880|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz10 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225882|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225883|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225884|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225886|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225887|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Attune Ps Rp Insrt Sz 10 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|FSC: 13; Default||Not reimbursed separately|7,644.00|FSC: 13; Default||External grouping not supported 951225889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 8mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 9mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225892|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225893|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 8mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 9mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225897|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 8mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225898|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 9mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225899|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225900|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 8mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 9mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 8mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 9mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225907|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225908|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 8mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 9mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 10mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 11mm Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 8mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 9mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz1 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 8mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 9mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz2 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 8mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 9mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz3 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 8mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 9mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz4 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 8mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 9mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225932|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz5 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 8mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 9mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225935|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 10mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225936|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni A/p Sz6 11mm Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|FSC: 13; Default||Not reimbursed separately|5,848.50|FSC: 13; Default||External grouping not supported 951225937|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz1 Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225938|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz2 Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz3 Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz4 Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz5 Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz6 Lmrl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz1 Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz2 Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz3 Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz4 Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz5 Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sigma Hp Uni Tib Tray Sz6 Rmll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|FSC: 13; Default||Not reimbursed separately|5,649.00|FSC: 13; Default||External grouping not supported 951225949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb8mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb10mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb12.5 Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951225952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*sigma A/p Cvd Tb15mm Sz1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|FSC: 13; Default||Not reimbursed separately|5,646.90|FSC: 13; Default||External grouping not supported 951226652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Sm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Sm+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Sm+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Sm+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Sm+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Std Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Std Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226663|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Std Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Std Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Std+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Std+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 15mm Std+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Std+ Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Std+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 15mm Std+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Lg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Lg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 15mm Lg Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Lg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Lg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 15mm Lg Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Lg+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Lg+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 15mm Lg+ Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 5mm Lg+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 10mm Lg+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Dstl Aug 15mm Lg+ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226683|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Sm+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Std+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 5mm Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Com Post Aug 10mm Lg+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|FSC: 13; Default||Not reimbursed separately|3,927.00|FSC: 13; Default||External grouping not supported 951226697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Sm+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Med 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226731|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Std+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226732|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lcs Comp Vvc Ins Lg+ 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|FSC: 13; Default||Not reimbursed separately|8,874.60|FSC: 13; Default||External grouping not supported 951226746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrhfem W/pin Medlft 71x66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|FSC: 13; Default||Not reimbursed separately|23,385.60|FSC: 13; Default||External grouping not supported 951226747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrhfem W/pin Med Rt 71x66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|FSC: 13; Default||Not reimbursed separately|23,385.60|FSC: 13; Default||External grouping not supported 951226748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrhfem W/pin Sm Lft 66x62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|FSC: 13; Default||Not reimbursed separately|23,385.60|FSC: 13; Default||External grouping not supported 951226749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrhfem W/pin Sm Rt 66x62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|FSC: 13; Default||Not reimbursed separately|23,385.60|FSC: 13; Default||External grouping not supported 951226750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrhfem W/pin Xsmlft 66x58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|FSC: 13; Default||Not reimbursed separately|23,385.60|FSC: 13; Default||External grouping not supported 951226751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Fem W/pin Xsmrt 66x58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|FSC: 13; Default||Not reimbursed separately|23,385.60|FSC: 13; Default||External grouping not supported 951226759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau X-sml 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau X-sml 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau X-sml 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau X-sml 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau X-sml 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Small 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Small 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Small 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Small 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Small 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Medium 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Medium 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Medium 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Medium 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Medium 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Large 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Large 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Large 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Large 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nps Tib Plateau Large 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|FSC: 13; Default||Not reimbursed separately|6,778.80|FSC: 13; Default||External grouping not supported 951226779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Xs 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Xs 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Xs 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Xs 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Xs 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Sm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Sm 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Sm 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Sm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Sm 31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Med12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Med16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Med21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Med26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom Nrh Tib Plat Assy Med31mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|FSC: 13; Default||Not reimbursed separately|13,108.20|FSC: 13; Default||External grouping not supported 951226794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*dome Pat Uhmwpe 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|FSC: 13; Default||Not reimbursed separately|3,702.30|FSC: 13; Default||External grouping not supported 951226795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*dome Pat Uhmwpe 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|FSC: 13; Default||Not reimbursed separately|3,702.30|FSC: 13; Default||External grouping not supported 951226796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*dome Pat Uhmwpe 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|FSC: 13; Default||Not reimbursed separately|3,702.30|FSC: 13; Default||External grouping not supported 951226797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*dome Pat Uhmwpe 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|FSC: 13; Default||Not reimbursed separately|3,702.30|FSC: 13; Default||External grouping not supported 951226798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz1 8.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz1 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz1 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz1 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz2 8.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz2 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz2 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz2 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz2 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3 8.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz3 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz4 8.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz4 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz4 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz4 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz4 17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz5 8.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz5 10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz5 12.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951226819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*cvd Tb Ins Sz5 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 951227492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stmlg36+21cr8l 24x19x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|FSC: 13; Default||Not reimbursed separately|23,293.20|FSC: 13; Default||External grouping not supported 951227493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 18x13x215l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 18x13x215n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 18x13x215r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 20x15x225l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 20x15x225r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 22x17x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 22x17x230n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 22x17x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 24x19x230l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 24x19x230n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 36+8l 24x19x230r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 30+4l 14x09x205l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 30+4l 14x09x205n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 30+4l 14x09x205r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 30+4l 16x11x205l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 30+4l 16x11x205n|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Srom*stm Lg 30+4l 16x11x205r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 951227510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 3 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 951227511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 2 230mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 951227512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 3 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 951227513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 4 250mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 951227514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz 3 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 951227515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Calcar Sz3 145mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,412.00|FSC: 13; Default||Not reimbursed separately|20,412.00|FSC: 13; Default||External grouping not supported 951227516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Calcar Sz3 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,412.00|FSC: 13; Default||Not reimbursed separately|20,412.00|FSC: 13; Default||External grouping not supported 951227517|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz3 250mm Bow Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|FSC: 13; Default||Not reimbursed separately|18,559.80|FSC: 13; Default||External grouping not supported 951227518|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz3 250mm Bow Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|FSC: 13; Default||Not reimbursed separately|18,559.80|FSC: 13; Default||External grouping not supported 951227519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz3 300mm Bow Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|FSC: 13; Default||Not reimbursed separately|18,559.80|FSC: 13; Default||External grouping not supported 951227520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endurance Sz3 300mm Bow Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|FSC: 13; Default||Not reimbursed separately|18,559.80|FSC: 13; Default||External grouping not supported 951227521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 1.5x12.0 Calcar 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|FSC: 13; Default||Not reimbursed separately|27,157.20|FSC: 13; Default||External grouping not supported 951227522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 1.5x13.5 Calcar 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|FSC: 13; Default||Not reimbursed separately|27,157.20|FSC: 13; Default||External grouping not supported 951227523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 1.5x15.0 Calcar 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|FSC: 13; Default||Not reimbursed separately|27,157.20|FSC: 13; Default||External grouping not supported 951227524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 1.5x16.5 Calcar 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|FSC: 13; Default||Not reimbursed separately|27,157.20|FSC: 13; Default||External grouping not supported 951227525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 1.5x18.0 Calcar 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|FSC: 13; Default||Not reimbursed separately|27,157.20|FSC: 13; Default||External grouping not supported 951227526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 1.5x19.5 Calcar 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|FSC: 13; Default||Not reimbursed separately|27,157.20|FSC: 13; Default||External grouping not supported 951227527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/10.5 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227528|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/12.0 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/13.5 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/15.0 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/16.5 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/18.0 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/19.5 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/21.0 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/22.5 Sml St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/10.5 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227537|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/12.0 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/13.5 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/15.0 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/16.5 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/18.0 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/19.5 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/21.0 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/22.5 Lrg St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/13.5 L Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/15.0 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/16.5 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/18.0 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/19.5 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/21.0 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/22.5 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/13.5 R Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/15.0 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/16.5 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/19.5 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/21.0 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 8/22.5 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 951227558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/13.5 L Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/16.5 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/18.0 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/19.5 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/21.0 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227563|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/22.5 L Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/13.5 R Bow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227565|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/15.0 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/16.5 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/18.0 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/19.5 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227569|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/21.0 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol Sys 10/22.5 R Lrg Stat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 951227571|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x13.5 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x15.0 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x16.5 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x18.0 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x19.5 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x21.0 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x22.5 Calcar 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x13.5 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x15.0 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x16.5 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x18.0 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227582|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x19.5 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227583|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x21.0 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sol 2.25x22.5 Calcar 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|FSC: 13; Default||Not reimbursed separately|30,989.70|FSC: 13; Default||External grouping not supported 951227585|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kar Ha Femoral Stem 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|FSC: 13; Default||Not reimbursed separately|25,512.90|FSC: 13; Default||External grouping not supported 951227586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kar Ha Femoral Stem 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|FSC: 13; Default||Not reimbursed separately|25,512.90|FSC: 13; Default||External grouping not supported 951227587|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kar Ha Femoral Stem 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|FSC: 13; Default||Not reimbursed separately|25,512.90|FSC: 13; Default||External grouping not supported 951227588|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kar Ha Femoral Stem 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|FSC: 13; Default||Not reimbursed separately|25,512.90|FSC: 13; Default||External grouping not supported 951227589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kar Ha Femoral Stem 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|FSC: 13; Default||Not reimbursed separately|25,512.90|FSC: 13; Default||External grouping not supported 951227590|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227591|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227592|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227595|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Std 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227602|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail Revision Stem Ho 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 951227606|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Multihole W/gription 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951227607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Multihole W/gription 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951227608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Multihole W/gription 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951227609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Multihole W/gription 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951227610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Multihole W/gription 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951227611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Multihole W/gription 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|FSC: 13; Default||Not reimbursed separately|11,583.60|FSC: 13; Default||External grouping not supported 951227612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 78mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Revision W/gription 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|FSC: 13; Default||Not reimbursed separately|13,505.10|FSC: 13; Default||External grouping not supported 951227626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 68mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Dp Revsn W/gription 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 951227635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.*linr 48-52/10 Deg-28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|FSC: 13; Default||Not reimbursed separately|4,214.70|FSC: 13; Default||External grouping not supported 951227636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pfc*liner 28mm/ 54-58mm 10 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|FSC: 13; Default||Not reimbursed separately|4,214.70|FSC: 13; Default||External grouping not supported 951227637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.*liner 60-64/10deg-28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|FSC: 13; Default||Not reimbursed separately|4,214.70|FSC: 13; Default||External grouping not supported 951227638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb P.f.c.*liner 66-70/10deg-28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|FSC: 13; Default||Not reimbursed separately|4,214.70|FSC: 13; Default||External grouping not supported 951227639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*linr Mser 0 Deg 28mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|FSC: 13; Default||Not reimbursed separately|9,017.40|FSC: 13; Default||External grouping not supported 951227640|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*linr Lser 0 Deg 28mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|FSC: 13; Default||Not reimbursed separately|9,017.40|FSC: 13; Default||External grouping not supported 951227641|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*linr Lser 0 Deg 32mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|FSC: 13; Default||Not reimbursed separately|9,017.40|FSC: 13; Default||External grouping not supported 951227642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*linr Xl46 10 Deg 32mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|FSC: 13; Default||Not reimbursed separately|9,017.40|FSC: 13; Default||External grouping not supported 951227643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acs Poly 20d 28 Gr2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,787.60|FSC: 13; Default||Not reimbursed separately|5,787.60|FSC: 13; Default||External grouping not supported 951227644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acs Poly 20d 28 Gr3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,787.60|FSC: 13; Default||Not reimbursed separately|5,787.60|FSC: 13; Default||External grouping not supported 951227645|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acs Poly 20d 28 Gr4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,787.60|FSC: 13; Default||Not reimbursed separately|5,787.60|FSC: 13; Default||External grouping not supported 951227646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 28idx48od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 951227647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 951227648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 10d 28idx50od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|FSC: 13; Default||Not reimbursed separately|14,424.90|FSC: 13; Default||External grouping not supported 951227649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx52od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 951227650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx54od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|FSC: 13; Default||Not reimbursed separately|15,565.20|FSC: 13; Default||External grouping not supported 951227651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx56od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx58od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx60od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx62od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx64od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx66od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx68od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx70od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951227659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pinn Lnr Con +4 Neut 32idx72od|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|FSC: 13; Default||Not reimbursed separately|15,718.50|FSC: 13; Default||External grouping not supported 951229286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Dist Fem Assembly Base|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|FSC: 13; Default||Not reimbursed separately|2,754.00|FSC: 13; Default||External grouping not supported 951229287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Xxsm Dist Fem Assmbly Base|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,805.00|FSC: 13; Default||Not reimbursed separately|2,805.00|FSC: 13; Default||External grouping not supported 951229288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Prox Fem Assembly Base|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 951229289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lps Assembly Base|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,855.00|FSC: 13; Default||Not reimbursed separately|3,855.00|FSC: 13; Default||External grouping not supported 951229303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz4 Std Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz5 Std Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz6 Std Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz7 Std Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz8 Std Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz1 Hi Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz6 Hi Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb C-stem Amt Sz8 Hi Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 951229311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6in Aml Sm Stature 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6in Aml Sm Stature 12.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 13.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 16.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 18.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 19.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 21.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Sm Stature 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6in Aml Lrg Stature 10.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 6in Aml Lrg Stature 12.0 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 13.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 16.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 18.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 19.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 21.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml Lg Stature 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 13.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 15.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 16.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 18.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 19.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 21.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aml High Offset Lg Stat 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|FSC: 13; Default||Not reimbursed separately|17,241.00|FSC: 13; Default||External grouping not supported 951229336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz1 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz2 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz3 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz4 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz5 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz6 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz7 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz8 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz9 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz10 Std Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz1 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz2 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz3 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz4 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz6 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz7 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229352|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz8 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz9 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Summit Por Taper Sz10 Hi Off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 951229355|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Std Size 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229356|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Std Size 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229357|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Std Size 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229358|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Std Size 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Non Col Ho Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229360|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Non Col Ho Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229361|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Non Col Ho Size 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Non Col Ho Size 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Non Col Ho Size 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Corail2 Non Col Ho Size 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 951229365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229366|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229367|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229368|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229369|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229370|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229371|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229373|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229380|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared Std Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229381|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229392|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Actis Collared High Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|FSC: 13; Default||Not reimbursed separately|20,017.20|FSC: 13; Default||External grouping not supported 951229393|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb S-rom*stm Std 36nk 14x09x130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|FSC: 13; Default||Not reimbursed separately|12,404.70|FSC: 13; Default||External grouping not supported 95193152|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Whole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,250.00|FSC: 13; Default||Not reimbursed separately|11,250.00|FSC: 13; Default||External grouping not supported 95193153|EAP|Custom 95193153||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Aortic|1|HUMANA [1294]||HUMANA [11839]|15,897.00|FSC: 13; Default||Not reimbursed separately|15,897.00|FSC: 13; Default||External grouping not supported 95193154|EAP|Custom 95193154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Polymer Fill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193155|EAP|Custom 95193155||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Iliac Ovation Ix 12mm X 140mm|1|HUMANA [1294]||HUMANA [11839]|14,997.00|FSC: 13; Default||Not reimbursed separately|14,997.00|FSC: 13; Default||External grouping not supported 95193161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Staples With Instrument|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95193165|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000302 Prime Grafix 7.5cm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95193167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Arthrex Petite L3 Mm Plantar Right Nonsterile Fir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95193170|EAP|Custom 95193170||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Clydesdale Peek Tantalum 6 D 50mm X22mm X10mm|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95193171|EAP|Custom 95193171||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Clydesdale Peek Tantalum 6 D 50mm X22mm X12mm|1|HUMANA [1294]||HUMANA [11839]|20,400.00|FSC: 13; Default||Not reimbursed separately|20,400.00|FSC: 13; Default||External grouping not supported 95193172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 46mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95193173|EAP|Custom 95193173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Fixation L3 In Femur Distal Quick Release Smooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193174|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Skin 20x11cm Allograft Flex Hd Thick Medium Perforated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.71|FSC: 13; Default||Not reimbursed separately|53.71|FSC: 13; Default||External grouping not supported 95193169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill C L Thd 1.7 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|FSC: 13; Default||Not reimbursed separately|933.00|FSC: 13; Default||External grouping not supported 95193178|EAP|Custom 95193178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap Djo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Small Shell 10mm X 108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95193180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Rsp Djo Surgical Neutral Humeral Hxe+ Sz 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95193182|EAP|Custom 95193182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Mini L2.75 Mm Od.066 In Cannulated Open Repai|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Ti Full Thread 32mm 3.75mm Shoulder Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95193184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125deg 36cm 10mm Right Troc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 62065188|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tramadol And Met, Urine, Qnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065199|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Meperidine And Met, Urine, Qnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065200|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tapentadol And Met, Urine, Qnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065211|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Propoxyphene And Met, Urine, Qnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065222|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Carisoprodol And Met, Urine, Qnt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065233|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Zolpidem, Urine Qnt-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95193193|EAP|Custom 95193193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Small Short Od2.5 Mm Ao Quick Connect St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Fuseforce Nitinol 3 Mm L15mm X W15mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|FSC: 13; Default||Not reimbursed separately|6,153.00|FSC: 13; Default||External grouping not supported 95193204|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vascular Lifestream L38 Mm L135 Cm Od9 Mm Balloon Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95193194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 1/3 Tubular L94 Mm 8 Hole Lock Sterile 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|836.55|FSC: 13; Default||Not reimbursed separately|836.55|FSC: 13; Default||External grouping not supported 95193196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Dart-fire Small L36 Mm Od3.5 Mm Head Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.00|FSC: 13; Default||Not reimbursed separately|573.00|FSC: 13; Default||External grouping not supported 95193203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Titanium L25mm 7mm 1.5mm Acl Pcl Cannula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95193186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intertan 10s 10mm X 40cm 123 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95193188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L14 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L16 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L55 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L50 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L60 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 95193208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Tape 4.75mm Corkscrew Ft Bc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95193210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.1mm 32mm T10 Lg Cx Plt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 62065240|EAP|CPT® 87449||0302 - LABORATORY - IMMUNOLOGY|Hb Blastomyces Ab By Eia W/reflex To Id-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62065241|EAP|CPT® 86612||0302 - LABORATORY - IMMUNOLOGY|Hb Blastomyces Ab, Id-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.70|FSC: 13; Default||Not reimbursed separately|38.70|FSC: 13; Default||External grouping not supported 62065242|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Carisoprodol & Met, Urine Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065243|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Clonazepam, S/p-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065244|EAP|Custom 62065244||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cortisol Free, S/p By Ed/lc/ms/ms-ref Lab|1|HUMANA [1294]||HUMANA [11839]|69.44|FSC: 13; Default||Not reimbursed separately|69.44|FSC: 13; Default||External grouping not supported 62065245|EAP|CPT® 82552||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ck Isoenzymes -ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.17|FSC: 13; Default||Not reimbursed separately|40.17|FSC: 13; Default||External grouping not supported 62065246|EAP|CPT® 82550||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ck Total-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.53|FSC: 13; Default||Not reimbursed separately|19.53|FSC: 13; Default||External grouping not supported 62065247|EAP|CPT® 82610||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cystatin C Serum-ref Lab|1|HUMANA [1294]||HUMANA [11839]|55.56|FSC: 13; Default||Not reimbursed separately|55.56|FSC: 13; Default||External grouping not supported 62065248|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fluoxetine & Meta, S/p, Quant-ref-lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065249|EAP|HCPCS 80235||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lacosamide, S/p-ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065250|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lorazepam, S/p-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065251|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Meperidine & Meta, Urine, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065252|EAP|CPT® 87207||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Special Stain For Parasites/inclusion Bodies-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.97|FSC: 13; Default||Not reimbursed separately|17.97|FSC: 13; Default||External grouping not supported 62065253|EAP|CPT® 87015||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Conc For Infectious Agents-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|FSC: 13; Default||Not reimbursed separately|20.04|FSC: 13; Default||External grouping not supported 62065254|EAP|CPT® 86316||0302 - LABORATORY - IMMUNOLOGY|Hb Neuron Specific Enolase, Csf-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 62065255|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Nicotine + Meta, S/p-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065256|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Nicotine + Meta, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065257|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|Hb N-m-d-a Receptor Titer, Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62065258|EAP|CPT® 84999||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Osmolality, Stool-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.98|FSC: 13; Default||Not reimbursed separately|24.98|FSC: 13; Default||External grouping not supported 62065259|EAP|CPT® 88346||0302 - LABORATORY - IMMUNOLOGY|Hb Epb Zone Ab Igg 1-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62065260|EAP|CPT® 88350||0302 - LABORATORY - IMMUNOLOGY|Hb Epb Zone Ab Igg 2-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.69|FSC: 13; Default||Not reimbursed separately|171.69|FSC: 13; Default||External grouping not supported 62065261|EAP|CPT® 88346||0302 - LABORATORY - IMMUNOLOGY|Hb Epb Zone Ab Iga 1-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62065262|EAP|CPT® 88350||0302 - LABORATORY - IMMUNOLOGY|Hb Epb Zone Ab Iga 2-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.69|FSC: 13; Default||Not reimbursed separately|171.69|FSC: 13; Default||External grouping not supported 62065263|EAP|CPT® 83516||0302 - LABORATORY - IMMUNOLOGY|Hb Pb Antigens, 180 & 230, Igg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62065264|EAP|CPT® 80321||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Phosphatidylethanol(peth)-ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.41|FSC: 13; Default||Not reimbursed separately|40.41|FSC: 13; Default||External grouping not supported 62065265|EAP|CPT® 82441||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Polychlorinated Bipheyls(pcb) Panel-ref Lab|1|HUMANA [1294]||HUMANA [11839]|18.03|FSC: 13; Default||Not reimbursed separately|18.03|FSC: 13; Default||External grouping not supported 62065266|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|Hb Sma Antibody Titer, Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62065267|EAP|CPT® 80201||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Topiramate, S/p-ref Lab|1|HUMANA [1294]||HUMANA [11839]|35.76|FSC: 13; Default||Not reimbursed separately|35.76|FSC: 13; Default||External grouping not supported 62065268|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tramadol, Urine, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065269|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Trazadone, S/p-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065270|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Trycyclics, S/p, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065271|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Trycyclics, Urine, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62065272|EAP|CPT® 86593||0302 - LABORATORY - IMMUNOLOGY|Hb Vdrl Titer, Serum-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.20|FSC: 13; Default||Not reimbursed separately|13.20|FSC: 13; Default||External grouping not supported 62065274|EAP|CPT® 82232||0301 - LABORATORY - CHEMISTRY|Hb Beta-2 Microglobulin, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.54|FSC: 13; Default||Not reimbursed separately|48.54|FSC: 13; Default||External grouping not supported 62065275|EAP|CPT® 82379||0301 - LABORATORY - CHEMISTRY|Hb Carnitine, Free & Total, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.61|FSC: 13; Default||Not reimbursed separately|50.61|FSC: 13; Default||External grouping not supported 62065276|EAP|CPT® 81376||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Celiac (hla-dq2)-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.66|FSC: 13; Default||Not reimbursed separately|366.66|FSC: 13; Default||External grouping not supported 62065277|EAP|CPT® 81383||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Celiac (hla-dq8)-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.39|FSC: 13; Default||Not reimbursed separately|327.39|FSC: 13; Default||External grouping not supported 62065278|EAP|CPT® 84302||0301 - LABORATORY - CHEMISTRY|Hb Sodium, Stool-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.58|FSC: 13; Default||Not reimbursed separately|14.58|FSC: 13; Default||External grouping not supported 62065279|EAP|CPT® 82525||0301 - LABORATORY - CHEMISTRY|Hb Copper, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.23|FSC: 13; Default||Not reimbursed separately|37.23|FSC: 13; Default||External grouping not supported 62065280|EAP|CPT® 84630||0301 - LABORATORY - CHEMISTRY|Hb Zinc, Urine-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.17|FSC: 13; Default||Not reimbursed separately|34.17|FSC: 13; Default||External grouping not supported 62065281|EAP|CPT® 87904||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hiv Phenotype, Drug Resistance, Each Addl-ref Lab|1|HUMANA [1294]||HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 62065282|EAP|CPT® 87903||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hiv Phenotype, Drug Resistance-ref Lab|1|HUMANA [1294]||HUMANA [11839]|1,465.98|FSC: 13; Default||Not reimbursed separately|1,465.98|FSC: 13; Default||External grouping not supported 62065283|EAP|CPT® 86671||0302 - LABORATORY - IMMUNOLOGY|Hb S. Cerevisiae Igg & Igm-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.75|FSC: 13; Default||Not reimbursed separately|36.75|FSC: 13; Default||External grouping not supported 62065284|EAP|CPT® 82482||0301 - LABORATORY - CHEMISTRY|Hb Cholinesterase, Rbc-ref Lab|1|HUMANA [1294]||HUMANA [11839]|29.43|FSC: 13; Default||Not reimbursed separately|29.43|FSC: 13; Default||External grouping not supported 62065285|EAP|CPT® 83527||0301 - LABORATORY - CHEMISTRY|Hb Insulin Total-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.85|FSC: 13; Default||Not reimbursed separately|38.85|FSC: 13; Default||External grouping not supported 62065287|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hb Nephlm Ea Analyte-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 62065288|EAP|CPT® 84120||0301 - LABORATORY - CHEMISTRY|Hb Porphyrins, Urine, Quant-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.13|FSC: 13; Default||Not reimbursed separately|44.13|FSC: 13; Default||External grouping not supported 62065289|EAP|CPT® 82638||0301 - LABORATORY - CHEMISTRY|Hb Dibucaine Number-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.75|FSC: 13; Default||Not reimbursed separately|36.75|FSC: 13; Default||External grouping not supported 62065290|EAP|CPT® 86003||0301 - LABORATORY - CHEMISTRY|Hb Stachybotrys Chatarum Ab Ige-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.66|FSC: 13; Default||Not reimbursed separately|15.66|FSC: 13; Default||External grouping not supported 62065291|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Stachybotrys Chatarum Ab Iga-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62065292|EAP|CPT® 86001||0301 - LABORATORY - CHEMISTRY|Hb Stachybotrys Chatarum Ab Igg-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.46|FSC: 13; Default||Not reimbursed separately|23.46|FSC: 13; Default||External grouping not supported 62065293|EAP|CPT® 80165||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Valproic Acid, Free - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 62065294|EAP|CPT® 80164||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Valproic Acid, Total-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 62065295|EAP|CPT® 87254||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Cmv Culture-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.68|FSC: 13; Default||Not reimbursed separately|58.68|FSC: 13; Default||External grouping not supported 62065296|EAP|CPT® 86331||0302 - LABORATORY - IMMUNOLOGY|Hb Immunodiffusion, Qual, Each-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62065297|EAP|CPT® 87140||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Culture Typing, Immunoflour, Each-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.71|FSC: 13; Default||Not reimbursed separately|16.71|FSC: 13; Default||External grouping not supported 95193212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fixation Rigidloop Long Cortical Adjustable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95193213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 2.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95193214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 2.0x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95193219|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth Round Moderate Profile Classic 215ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95193220|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth Round Moderate Profile Classic 170ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95193230|EAP|Custom 95193230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Od1.5 Mm Ao Quick Connect Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193231|EAP|Custom 95193231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Cobalt Chrome L150 Mm Od1.25 Mm Flute Drill Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L10 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula L-d 3.5mm Evos 7h R 103mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,534.70|FSC: 13; Default||Not reimbursed separately|2,534.70|FSC: 13; Default||External grouping not supported 95193225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L40 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Bone Void Allosync Demineralized Bone Matrix 5 Cc Gel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,050.00|FSC: 13; Default||Not reimbursed separately|28,050.00|FSC: 13; Default||External grouping not supported 95193227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Dynanite Nitinol L18mm X W18mm H1mm Trocar Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95193228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Dynanite Nitinol L20mm X W20mm H1mm Trocar Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95193232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tine Evos 7h 5mm Space Straight L38mm Xw5mmxh1.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|FSC: 13; Default||Not reimbursed separately|1,815.00|FSC: 13; Default||External grouping not supported 95193233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Stainless Steel T6 L8 Mm Od2 Mm Small Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|FSC: 13; Default||Not reimbursed separately|106.71|FSC: 13; Default||External grouping not supported 95193234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T6 L16 Mm Od2 Mm Odsec3 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|FSC: 13; Default||Not reimbursed separately|106.71|FSC: 13; Default||External grouping not supported 95193235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T6 L18 Mm Od2 Mm Odsec3 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|FSC: 13; Default||Not reimbursed separately|106.71|FSC: 13; Default||External grouping not supported 95193236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.5mm 50mm Solera Cd Hori Multiaxail 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95193237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mas L45 Mm Od4.5 Mm Spine Cannulated Extension Ta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95193238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Arthrex Dynanite Nitinol Titanium L10mmxw11m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95193239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T6 L11 Mm Od2 Mm Odsec3 Mm Cortex Self Tap M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 62065300|EAP|CPT® 82438||0301 - LABORATORY - CHEMISTRY|Hb Chloride, Stool-ref Lab|1|HUMANA [1294]||HUMANA [11839]|15.00|FSC: 13; Default||Not reimbursed separately|15.00|FSC: 13; Default||External grouping not supported 62065310|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Clomipramine & Meta, S/p-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95193243|EAP|Custom 95193243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Small Short 2mm Ao Quick Connect Sterl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193247|EAP|Custom 95193247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Small Short Od3.5 Mm Ao Quick Connect|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193254|EAP|Custom 95193254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guide Surgical Scout|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7.3mm 8.2mm 2.9mm 100mm 16mm Ti Lg Hex Hmsphr Lg Bn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|FSC: 13; Default||Not reimbursed separately|847.41|FSC: 13; Default||External grouping not supported 95193240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95193241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 2.7mm X 32mm Cortex Self Tap Flat Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L12 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L15 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L14 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L46 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini L10 Mm Od2.7 Mm Odsec4.3 Mm T8 Driver L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 12mm X 2.7mm Sec4.3 Mm T8 Dr Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 2mm X16mm X2.7mm Sec4.3mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Evos 2.7mm/3.5mm Lateral Distal Fibula Plate 5h L 81mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,153.25|FSC: 13; Default||Not reimbursed separately|2,153.25|FSC: 13; Default||External grouping not supported 95193253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Reunion Standard 23mm 52mm Shoulder 1 Radi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95193261|EAP|Custom 95193261||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Intervertebral Mobi-c Cocrmo D15mm W17mm X H6mm Ti Uhm|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95193262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Lcp Combi Stainless Steel L121 Mm 5 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|FSC: 13; Default||Not reimbursed separately|3,590.85|FSC: 13; Default||External grouping not supported 95193255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Aequalis Ascend Flex Cocr 48mm X 20mm X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.60|FSC: 13; Default||Not reimbursed separately|8,943.60|FSC: 13; Default||External grouping not supported 95193256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Expedium Ti 40mm X7.5mm Spine 1 Innie Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95193257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Cortiloc 35 D Medium Shoulder Right Augmen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|FSC: 13; Default||Not reimbursed separately|12,070.80|FSC: 13; Default||External grouping not supported 95193258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Arthrex Dynanite Nitinol Titanium L10mm X W13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95193259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Arthrex Dynanite Nitinol Titanium L12mm X W15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|FSC: 13; Default||Not reimbursed separately|5,685.00|FSC: 13; Default||External grouping not supported 95193260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L34 Mm Spine 2 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95193264|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Avive Soft Tissue Membrane 2cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.00|FSC: 13; Default||Not reimbursed separately|6,375.00|FSC: 13; Default||External grouping not supported 95193265|EAP|Custom 95193265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel P5 Cm High Profile Round 12cm 375ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065320|EAP|CPT® 86664||0302 - LABORATORY - IMMUNOLOGY|Hb Epstein-barr Virus Ab/nuclear Ag-ref Lab|1|HUMANA [1294]||HUMANA [11839]|45.87|FSC: 13; Default||Not reimbursed separately|45.87|FSC: 13; Default||External grouping not supported 62065330|EAP|CPT® 84586||0301 - LABORATORY - CHEMISTRY|Hb Vasoactive Intestinal Peptide-ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.99|FSC: 13; Default||Not reimbursed separately|105.99|FSC: 13; Default||External grouping not supported 62065340|EAP|CPT® 81373||0302 - LABORATORY - IMMUNOLOGY|Hb Nmdp Hla Typing-ref Lab|1|HUMANA [1294]||HUMANA [11839]|382.29|FSC: 13; Default||Not reimbursed separately|382.29|FSC: 13; Default||External grouping not supported 62065350|EAP|CPT® 86022||0302 - LABORATORY - IMMUNOLOGY|Hb Platelet Antibody-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 62065360|EAP|CPT® 86828||0302 - LABORATORY - IMMUNOLOGY|Hb Hla Screen-ref Lab|1|HUMANA [1294]||HUMANA [11839]|192.57|FSC: 13; Default||Not reimbursed separately|192.57|FSC: 13; Default||External grouping not supported 62065370|EAP|CPT® 81403||0302 - LABORATORY - IMMUNOLOGY|Hb Rbc Dna Common Panel-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.60|FSC: 13; Default||Not reimbursed separately|555.60|FSC: 13; Default||External grouping not supported 62065380|EAP|CPT® 87624||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hpv High Risk, Non-cervical-ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065390|EAP|CPT® 87625||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hpv Genotypes 16, 18/45, Non-cervical-ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|FSC: 13; Default||Not reimbursed separately|121.65|FSC: 13; Default||External grouping not supported 95193250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 14mm X 2.7mm Sec4.3 Mm T8 Dr Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193266|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Distal Bifurcated Main Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,124.00|FSC: 13; Default||Not reimbursed separately|11,124.00|FSC: 13; Default||External grouping not supported 95193286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Slim Y 4 Hole Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|FSC: 13; Default||Not reimbursed separately|4,572.00|FSC: 13; Default||External grouping not supported 95193289|EAP|Custom 95193289||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bicortical Block 10x20mm|1|HUMANA [1294]||HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95193285|EAP|Custom 95193285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Nitinol Pilot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193290|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Matristem Pelvic Floor Matrix 5cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,938.48|FSC: 13; Default||Not reimbursed separately|1,938.48|FSC: 13; Default||External grouping not supported 95193287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 30mm Variax T8 Full Thread Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95193288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5mm 55mm Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95193291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Exoshape H30 Mm Od9 Mm Tibial Fastener|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95193292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Speedtitan L18 Mm X W18 Mm L15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,353.93|FSC: 13; Default||Not reimbursed separately|4,353.93|FSC: 13; Default||External grouping not supported 95193293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Speedtitan L15 Mm X W20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.12|FSC: 13; Default||Not reimbursed separately|5,385.12|FSC: 13; Default||External grouping not supported 95193277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Evos 2.7/3.5 M-d 21 Hole L 261mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,934.25|FSC: 13; Default||Not reimbursed separately|7,934.25|FSC: 13; Default||External grouping not supported 95193278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L34 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|FSC: 13; Default||Not reimbursed separately|443.04|FSC: 13; Default||External grouping not supported 95193279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L32 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L30 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L26 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L24 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L20 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Full Thread L44 Mm Od4.7 Mm Sterile Osteopen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.65|FSC: 13; Default||Not reimbursed separately|223.65|FSC: 13; Default||External grouping not supported 95193187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 12mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193297|EAP|Custom 95193297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Trabecular Metal 7.5mmx15mm Shoulder Baseplat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia L-p P/a Evos 3.5mm 6 Hole 91mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,919.20|FSC: 13; Default||Not reimbursed separately|3,919.20|FSC: 13; Default||External grouping not supported 95193299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L34 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L75 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L70 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L50 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L32 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|FSC: 13; Default||Not reimbursed separately|443.04|FSC: 13; Default||External grouping not supported 95193304|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Neurostimulator Artisan L70 Cm Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95193323|EAP|Custom 95193323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 7.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193324|EAP|Custom 95193324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 7.75|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193325|EAP|Custom 95193325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 8.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193326|EAP|Custom 95193326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 8.25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193327|EAP|Custom 95193327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 8.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193329|EAP|Custom 95193329||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 9.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193321|EAP|Custom 95193321||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 7.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193322|EAP|Custom 95193322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 7.25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini Stainless Steel T8 12mmx2.7mm Cortex St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini T8 38mm X2.7mm Sec4.5mm Cortex Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 50mm 2.7mm Sec4.5mm Cortex T8 St Flat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 20mm 2.7mm Sec4.3mm T8 Dr Lock Flat H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|FSC: 13; Default||Not reimbursed separately|368.49|FSC: 13; Default||External grouping not supported 95193309|EAP|Custom 95193309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation L150 Mm Od2 Mm Drill Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193310|EAP|Custom 95193310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Mini Short Od2 Mm Ao Quick Connect Dispo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193311|EAP|Custom 95193311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Mini Od2.7 Mm Ao Quick Connect Over Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 7mm Lp 70mm X 2.2mm 7.5mm 10 Hole Strength|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,545.35|FSC: 13; Default||Not reimbursed separately|2,545.35|FSC: 13; Default||External grouping not supported 95193313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate -t Evos 2.7mm 3hole Sd 5hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,492.10|FSC: 13; Default||Not reimbursed separately|2,492.10|FSC: 13; Default||External grouping not supported 95193314|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx Silicone L120 Mm L90 Cm Od19 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95193315|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx Silicone L70 Mm L90 Cm Od19 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95193316|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx Silicone L150 Mm L90 Cm Od19 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95193317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 48mm 2.7mm Sec4.5mm Cortex T8 St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|FSC: 13; Default||Not reimbursed separately|118.53|FSC: 13; Default||External grouping not supported 95193318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Protean Y Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95193319|EAP|Custom 95193319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 6.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193320|EAP|Custom 95193320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 6.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193328|EAP|Custom 95193328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Ophthalmic 8.75|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193330|EAP|Custom 95193330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 1.4-150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reunion Rfx Humeral Fracture Stem 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,899.10|FSC: 13; Default||Not reimbursed separately|15,899.10|FSC: 13; Default||External grouping not supported 95193333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb 38mm 2 Lvl Trin Select Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95193334|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Style 8200 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95193335|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +28 Diopter +3 Cylinder Modify C Biconvex 13mm 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 9 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,357.00|FSC: 13; Default||Not reimbursed separately|6,357.00|FSC: 13; Default||External grouping not supported 95193337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mini Monster Cannulated Short Thread Screw Headless 3.5x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95193338|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore Heparin Propaten Ptfe 50cmx 40cm 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,358.00|FSC: 13; Default||Not reimbursed separately|5,358.00|FSC: 13; Default||External grouping not supported 95193349|EAP|Custom 95193349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Positioning Spider Ankle Stabilization Underneath Operat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Ha L150 Mm L30 Mm Od6 Mm External Fixation System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|FSC: 13; Default||Not reimbursed separately|569.25|FSC: 13; Default||External grouping not supported 95193351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Ha L150 Mm L35 Mm Od6 Mm External Fixation System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|FSC: 13; Default||Not reimbursed separately|583.20|FSC: 13; Default||External grouping not supported 95193353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Ha L150 Mm L40 Mm Od6 Mm External Fixation System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|FSC: 13; Default||Not reimbursed separately|583.20|FSC: 13; Default||External grouping not supported 95193373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire External Fixation Ilizarov St 370 Mm Od1.8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.58|FSC: 13; Default||Not reimbursed separately|197.58|FSC: 13; Default||External grouping not supported 95193355|EAP|Custom 95193355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring External Fixation Aluminum Full Id155 Mm 7 Hole|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193357|EAP|Custom 95193357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring External Fixation Circle Half Id155 Mm Taylor Spatial F|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193360|EAP|Custom 95193360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring External Fixation Od180 Mm Id155 Mm Rocker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193361|EAP|Custom 95193361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut External Fixation Fast Fx Medium L143-205 Mm Taylor Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193362|EAP|Custom 95193362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut External Fixation Fast Fx Long L195-311 Mm Taylor Spat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193363|EAP|Custom 95193363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit External Fixation Fast Fx Identification Band Standard S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193365|EAP|Custom 95193365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve External Fixation Ilizarov Od6 Mm Center|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193366|EAP|Custom 95193366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cube External Fixation Ilizarov Rancho 1 Hole Post|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193367|EAP|Custom 95193367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cube External Fixation Ilizarov Rancho 2 Hole Post Rancho Sy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193368|EAP|Custom 95193368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cube External Fixation Ilizarov Stainless Steel 5hole Rancho|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193372|EAP|Custom 95193372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bolt External Fixation Ilizarov Russian Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193375|EAP|Custom 95193375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hinge External Fixation Ilizarov Stainless Steel Low Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193376|EAP|Custom 95193376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device External Fixation Ilizarov St Adult Thk5 Mm 1mm 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193377|EAP|Custom 95193377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Post External Fixation Ilizarov Stainless Steel 4 Hole Male|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193378|EAP|Custom 95193378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector External Fixation Short L30 Mm Extend|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193379|EAP|Custom 95193379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Rod Long L50 Mm Extend|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193380|EAP|Custom 95193380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod External Fixation Ilizarov Stainless Steel L150 Mm Threa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193382|EAP|Custom 95193382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Short Od 4.8 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193385|EAP|Custom 95193385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Dressing Acticoat Exfix Antimicrobial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193386|EAP|Custom 95193386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Pin 6 Mm Half Orange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193391|EAP|Custom 95193391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Kirschner Stainless Steel L150 Mm Od1 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193394|EAP|Custom 95193394||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline Titanium Lordotic L120 Mm Od5.5 Mm Nonster|1|HUMANA [1294]||HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95193402|EAP|Custom 95193402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Small Short Od2.7 Mm Ao Quick Connect Ov|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193403|EAP|Custom 95193403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Peri-loc Vlp Kirschner 150 Mm Od1.25 Mm Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193409|EAP|Custom 95193409||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Clydesdale Peek 6 D L55 Mm X W22 Mm X H14 Mm Rad|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95193411|EAP|Custom 95193411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical L95 Mm Od1.6 Mm Cannulated Nonsterile Latex F|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193412|EAP|Custom 95193412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 2.3 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193413|EAP|Custom 95193413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hex Driver Cannulated 1.5mm X 70mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Dynanite Nitinol 20mmx15mm 1mm Compress Lp Troc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95193410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drill Low Thread 2.3mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 95193388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Arthrex Dynanite Nitinol Titanium 20mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95193389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini Stainless Steel T8 15mm 2.7mm Sec4.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Od2 Mm L18 Mm Od2.7 Mm Odsec4.3 Mm Small Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L36 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos L52 Mm 4 Hole Compression Sterile 3.5 Mm Scr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.72|FSC: 13; Default||Not reimbursed separately|519.72|FSC: 13; Default||External grouping not supported 95193395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula L-d Evos 2.7/3.5 5h Right 81mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,153.25|FSC: 13; Default||Not reimbursed separately|2,153.25|FSC: 13; Default||External grouping not supported 95193396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130 D 1.5 Mm L38 Cm L11.5 Mm Le|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95193400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 26mm 2.7mm 4.5mm Cortex T8 Dr Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Od2 Mm L28mm Od2.7mm Odsec 4.5mm Cortex Self Tp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 1/3 Tubular 82mm Lock 7 Hole Sterile 3.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.90|FSC: 13; Default||Not reimbursed separately|471.90|FSC: 13; Default||External grouping not supported 95193405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L18 Mm Od 3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L44 Mm Od 3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L10 Mm Od 3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Fixos Titanium L26 Mm Od 5 Mm Midfoot Rearfoot Com|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,941.00|FSC: 13; Default||Not reimbursed separately|1,941.00|FSC: 13; Default||External grouping not supported 95193414|EAP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Defibrillator Optisure Optim L58 Cm L17 Cm Od8 Fr Endoc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,427.44|FSC: 13; Default||Not reimbursed separately|12,427.44|FSC: 13; Default||External grouping not supported 95193417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 22mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula L-d 2.7/3.5 Evos 7h Right 103mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|FSC: 13; Default||Not reimbursed separately|2,318.25|FSC: 13; Default||External grouping not supported 95193421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 65mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95193423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Axsos 3 Ti L227 Mm Tibia Left Distal Medial 14hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,567.00|FSC: 13; Default||Not reimbursed separately|9,567.00|FSC: 13; Default||External grouping not supported 95193424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Plantar 1st Met Ost 3mm Petite Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95193425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Ti Distal Posterior 10 Hold Right Locking Ster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95193429|EAP|Custom 95193429||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pro Chondrix Allograft Fresh Cryo 17mm X 1.0mm|1|HUMANA [1294]||HUMANA [11839]|12,534.00|FSC: 13; Default||Not reimbursed separately|12,534.00|FSC: 13; Default||External grouping not supported 95193430|EAP|Custom 95193430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Spare Tube Complete Hollow 1.5 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193431|EAP|Custom 95193431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Hollow Nonsterile 6.5 Mm 7 Mm Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193339|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Lv Attain Performa Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95193432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 50mm Arthx Ti T15 Lg Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95193433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini T8 20mm X2.7mm Sec4.5mm Cortex Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 15x15mm Dynanite Ntnl Cmpr Loprfl Troc Tip Algn Pin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95193435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5mm 80mm Asns Iii Ti Cannulated Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95193437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Axsos Narrow L223 Mm 12 Hole Lock Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,565.00|FSC: 13; Default||Not reimbursed separately|8,565.00|FSC: 13; Default||External grouping not supported 95193438|EAP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuromend Bovine Collagen 6 Mm L5 Cm|1|HUMANA [1294]||HUMANA [11839]|5,061.60|FSC: 13; Default||Not reimbursed separately|5,061.60|FSC: 13; Default||External grouping not supported 95193436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Titanium L300 Mm Od1.5 Mm Diaphysis Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|991.29|FSC: 13; Default||Not reimbursed separately|991.29|FSC: 13; Default||External grouping not supported 95193445|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +31 Diop +1.5 Cyl Bcnvx 13mm 6mm Pc 1 Pc Fld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193446|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +32 Diop +1.5 Cyl Bcnvx 13mm 6mm Pc 1 Pc Fld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193447|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +33 Diop +1.5 Cyl Bcnvx 13mm 6mm Pc 1 Pc Fld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193448|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 0 D +34 Diop +1.5 Cyl Bcnvx 13mm 6mm Pc 1 Pc Fld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95193449|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Humeral Head Simpliciti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95193468|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Matrix Hd 5mm 4cm X 6cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.62|FSC: 13; Default||Not reimbursed separately|501.62|FSC: 13; Default||External grouping not supported 95193450|EAP|Custom 95193450||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Binocular 5-35 D Tilt Observation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 10d Lg 57mm Ss 2.4/2.7mm Scr Va Fsn Loprfl Cmpr Wre Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 95193461|EAP|Custom 95193461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Frame Axsos Target System 3.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn L20mm Od2.4mm Odsec4.5mm Cortex Self Tap Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95193463|EAP|Custom 95193463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Measuring Direct Small Fragment Lcp System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193464|EAP|Custom 95193464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Measuring Nonsterile 3.5/4 Mm Cannulated Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193465|EAP|Custom 95193465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Universal Od2.7 Mm Nonsterile Small Fragment Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 24mm 2.7mm 4.5mm Cortex T8 Dr Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|FSC: 13; Default||Not reimbursed separately|118.53|FSC: 13; Default||External grouping not supported 95193471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini 50mm 2.7mm 4.5mm Cortex T8 Dr Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|FSC: 13; Default||Not reimbursed separately|368.49|FSC: 13; Default||External grouping not supported 95193472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7mm X 7hole Sft Y-tine Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,205.65|FSC: 13; Default||Not reimbursed separately|3,205.65|FSC: 13; Default||External grouping not supported 95193473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Od2 Mm L24 Mm Od2.7 Mm Odsec4.3 Mm Self Tap Lo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|FSC: 13; Default||Not reimbursed separately|368.49|FSC: 13; Default||External grouping not supported 95193474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial All Polyethylene 3 H9 Mm Knee Condylar Stabili|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|FSC: 13; Default||Not reimbursed separately|8,887.20|FSC: 13; Default||External grouping not supported 80171011|EAP|CPT® 93668||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Peripheral Arterial Disease (pad) Rehabilitation, Per Session|1|HUMANA [1294]||HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 95193481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium L34 Mm Od3.5 Mm Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|FSC: 13; Default||Not reimbursed separately|456.00|FSC: 13; Default||External grouping not supported 95193482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fx 55mm 2.5mm Ijs Axis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95193483|EAP|Custom 95193483||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Standard Tip 1.5mm X 127mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193484|EAP|Custom 95193484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Cement Stage One Silicone L125 Mm Od9 Mm Odsec51 Mm Hip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193485|EAP|Custom 95193485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Colorado Micro Dissection 4cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Plug Axsos3 Ti 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|912.00|FSC: 13; Default||Not reimbursed separately|912.00|FSC: 13; Default||External grouping not supported 95193476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex Hoffmann Ii L250 Mm L70 Mm Od5mm Cancellous Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95193477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Swivelock Biocomposite L15 Mm Od4.75 Mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95193478|EAP|Custom 95193478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Od8-12 Mm Conical Stepped|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail T2 Ti Long Retrograde 24cm 12mm Supracondylar Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95193480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Ti Med 69mm Foot Calcaneus Mesh Polyaxial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.30|FSC: 13; Default||Not reimbursed separately|2,295.30|FSC: 13; Default||External grouping not supported 95193486|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Neurostimulator Vns Therapy Perenniaflex Od2 Mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,380.00|FSC: 13; Default||Not reimbursed separately|22,380.00|FSC: 13; Default||External grouping not supported 95193487|EAP|Custom 95193487||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular 12cm 23mm 21.5-25mm Excluder Co|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95193488|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer 33cm 14fr 6.7mm 6mm Gore Dryseal Flex Hydr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95193489|EAP|Custom 95193489||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tunneler Livanova Modle 402|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 2.7mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95193492|EAP|Custom 95193492||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endograft Body Aortic Ovation 23 Mm|1|HUMANA [1294]||HUMANA [11839]|35,997.00|FSC: 13; Default||Not reimbursed separately|35,997.00|FSC: 13; Default||External grouping not supported 95193493|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Steerabel Guiding Sheath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95193494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align 7mm X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95193496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Rsp Djo Surgical Neutral Humeral Hxe+ Sz 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95193497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Shaft Sz L=120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,202.21|FSC: 13; Default||Not reimbursed separately|2,202.21|FSC: 13; Default||External grouping not supported 95193498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7.5mm 55mm Reline 2c Spine Polyaxial Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95193499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align Ti 17mm 33mm 2mm 9mm Side Load Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95193500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Roximal Ulna 73mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,690.00|FSC: 13; Default||Not reimbursed separately|3,690.00|FSC: 13; Default||External grouping not supported 95193503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 12mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95193504|EAP|Custom 95193504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Alining 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193505|EAP|Custom 95193505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Long L80 Mm Od3 Mm Nonsterile Latex Free Reus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193506|EAP|Custom 95193506||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Vivigen Formable Cellular Bone Matrix 1 Cc|1|HUMANA [1294]||HUMANA [11839]|1,745.85|FSC: 13; Default||Not reimbursed separately|1,745.85|FSC: 13; Default||External grouping not supported 95193501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 28mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193507|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memorygel P5.1cm Plus Profile Od14.7cm 630 Cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95193508|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memorygel P5.1cm Plus Profile Od14.9cm 645cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95193509|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memorygel P5.2cm Plus Profile Od15.3cm 685cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95193510|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memorygel P5.4cm Plus Profile Od15.7cm 755cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95193511|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memorygel Plus Profile 595cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95193512|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 790cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95193513|EAP|Custom 95193513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 46mm 1.3mm Mnqk Cplng Thrd Hl Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193514|EAP|Custom 95193514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Opening Spi 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193524|EAP|Custom 95193524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Small Long Od2.5 Mm Ao Quick Connect Ste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193534|EAP|Custom 95193534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Mini Od1.8 Mm Ao Quick Coupling Disposab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193535|EAP|Custom 95193535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Evos Mini Od2.4 Mm Ao Quick Connect Over Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193521|EAP|Custom 95193521||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Gore Excluder L14 Cm Od12 Mm Contralatera|1|HUMANA [1294]||HUMANA [11839]|14,217.00|FSC: 13; Default||Not reimbursed separately|14,217.00|FSC: 13; Default||External grouping not supported 95193527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 420mm 130 Deg Femoral Proximal Tfn-adv Lateral Ref|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95193520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary T2 Titanium L300 Mm Od13 Mm Supracondyla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95193526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130 D 1.5 Mm L38 Cm L13 Mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95193525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia 9-h L130mm Evos 2.7/3.5 M-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,890.55|FSC: 13; Default||Not reimbursed separately|6,890.55|FSC: 13; Default||External grouping not supported 95193537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 11mm Space T 71mmxw10.9mmxh2mm W32 Tibia Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,770.10|FSC: 13; Default||Not reimbursed separately|3,770.10|FSC: 13; Default||External grouping not supported 95193522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L48 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L38 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini T7 L24 Mm Od2.4 Mm Cortex Self Tap Ster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.56|FSC: 13; Default||Not reimbursed separately|112.56|FSC: 13; Default||External grouping not supported 95193532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T7 L40 Mm Od2.4 Mm Cortex Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.56|FSC: 13; Default||Not reimbursed separately|112.56|FSC: 13; Default||External grouping not supported 95193533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos Mini T7 L48 Mm Od2.4 Mm Cortex Self Tap Ster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.56|FSC: 13; Default||Not reimbursed separately|112.56|FSC: 13; Default||External grouping not supported 95193536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L15 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L80 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L42 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|FSC: 13; Default||Not reimbursed separately|443.04|FSC: 13; Default||External grouping not supported 95193541|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Unipolar Fx/cemented Stems|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95193542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Unipolar Porous Stems|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95193543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Bipolar Fx Cemented Stems|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95193544|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Bipolar Porous Stems|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95193545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Mop Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,561.00|FSC: 13; Default||Not reimbursed separately|12,561.00|FSC: 13; Default||External grouping not supported 95193546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Mop Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,326.00|FSC: 13; Default||Not reimbursed separately|13,326.00|FSC: 13; Default||External grouping not supported 95193548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Cop Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,926.00|FSC: 13; Default||Not reimbursed separately|13,926.00|FSC: 13; Default||External grouping not supported 95193549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Gription Cup Upcharge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95193550|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Srom Upcharge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95193551|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Bps Ha Duofix Actis Upcharge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95193562|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tandem Bipolar Porous Fem W/co Cr Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95193552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hp Uni All Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95193553|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee All Poly|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95193554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hp Uni Metal Backed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95193555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Fb Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|FSC: 13; Default||Not reimbursed separately|11,700.00|FSC: 13; Default||External grouping not supported 95193556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Fb Hybrid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95193557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Fb Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|FSC: 13; Default||Not reimbursed separately|14,100.00|FSC: 13; Default||External grouping not supported 95193561|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Anatomic Patella Upcharge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95193529|EAP|Custom 95193529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Centrifugal Angel Bone Marrow Process|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193570|EAP|Custom 95193570||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical L90 Mm Od1.8 Mm Nonsterile Latex Free Reusabl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193571|EAP|Custom 95193571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical L80 Mm Od2.3 Mm Nonsterile Latex Free Reusabl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193575|EAP|Custom 95193575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 7mm L20 Full Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193576|EAP|Custom 95193576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 7mm L25 Full Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193577|EAP|Custom 95193577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 8mm L20 Full Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193578|EAP|Custom 95193578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 8mm L25 Full Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193579|EAP|Custom 95193579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 7mm L20 Round Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193580|EAP|Custom 95193580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 7mm L25 Round Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193581|EAP|Custom 95193581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 8mm L20 Round Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193582|EAP|Custom 95193582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 8mm L25 Round Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193585|EAP|Custom 95193585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 8mm L30 Round Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193586|EAP|Custom 95193586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Compositcp 30 9mm L25 Full Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193588|EAP|Custom 95193588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Toggleloc Xl With Ziploop Inline|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193590|EAP|Custom 95193590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L6 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193591|EAP|Custom 95193591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L6.5 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193592|EAP|Custom 95193592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L7 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193593|EAP|Custom 95193593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L7.5 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Juggerknot 1.5mm W/1 #2 Blue Mb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|818.58|FSC: 13; Default||Not reimbursed separately|818.58|FSC: 13; Default||External grouping not supported 95193574|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Allox2 P5-5.7cm Full Height 230-280cc 11x10.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 95193566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Volar Bearing Plate Ti Left Wrist 3h 7 Peg Lockin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95193563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 14mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 38mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95193567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation L14 Mm Wrist Volar Thread Lock Torx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95193568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation L16 Mm Wrist Volar Thread Lock Torx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95193569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Fixation L18 Mm Wrist Volar Thread Lock Torx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95193583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 40mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193558|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Attune Fb With Dome Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95193559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Sigma Rp Upcharge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95193560|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Attune Rp Upcharge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95193572|EAP|Custom 95193572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Awl Surgical Taper Od3.8 Mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193587|EAP|Custom 95193587||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Toggleloc With Ziploop Inline|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193615|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding Runway Judkins Right 4 Curve Od6 Fr Femur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95193607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Compression Speedtitan 18x15x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,353.93|FSC: 13; Default||Not reimbursed separately|4,353.93|FSC: 13; Default||External grouping not supported 95193609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Alps Timax Contour Lt Medial 10h Proximal 97mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95193610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Hum Dist Lat Left 15h 142mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95193612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Ulna 108mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95193606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Dart-fire Ti Sm Partial Th 10mmx3.0mm Headless Br|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95193614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193605|EAP|Custom 95193605||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 26x11x13mm Coroent 4d Large Impact Peek Optima|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95193619|EAP|Custom 95193619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Short Od4.9mm Calibrated Black Orange 6mm S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193637|EAP|Custom 95193637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Depth Toggleloc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193630|EAP|Custom 95193630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L8.0 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193631|EAP|Custom 95193631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L8.5 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193632|EAP|Custom 95193632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L9.0 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193633|EAP|Custom 95193633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L9.5 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193634|EAP|Custom 95193634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical Switchcut Nitinol L10 Mm Od4.5 Mm Passer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193635|EAP|Custom 95193635||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical L11 Mm Od6 Mm Kit Switch Cut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193636|EAP|Custom 95193636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical L12 Mm Od6 Mm Kit Switch Cut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193628|EAP|Custom 95193628||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular L11.5 Cm Od18 Mm Id14.5-16.5 Mm|1|HUMANA [1294]||HUMANA [11839]|14,217.00|FSC: 13; Default||Not reimbursed separately|14,217.00|FSC: 13; Default||External grouping not supported 95193629|EAP|Custom 95193629||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular L9.5 Cm Od18 Mm Id14.5-16.5 Mm|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95193620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Z Pf Univ 12mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,884.69|FSC: 13; Default||Not reimbursed separately|4,884.69|FSC: 13; Default||External grouping not supported 95193627|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Allox2 P6.1-7.3cm Full Height 14cm 480-575c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 95193621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ncb Ti6al4v L324 Mm Femur Right Proximal 15 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95193622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Lcp St Steel Straight L170mm Wrist Nonste 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,631.00|FSC: 13; Default||Not reimbursed separately|8,631.00|FSC: 13; Default||External grouping not supported 95193611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Directional 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95193623|EAP|Custom 95193623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Transrectal Triplane Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193624|EAP|Custom 95193624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Needle Dual Biopsy Ultrasound Ua 1293-s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171022|EAP|CPT® 43193||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy, Rigid, Transoral; With Biopsy, Single Or Multiple|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95193638|EAP|Custom 95193638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation 0.9mm X 152mm Double Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 D L40 Cm Od10 Mm Left Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95193666|EAP|Custom 95193666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.3mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Oblique 5hole Compression Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|FSC: 13; Default||Not reimbursed separately|2,691.00|FSC: 13; Default||External grouping not supported 95193668|EAP|Custom 95193668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid 1.3mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95193670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Bg 2.0mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95193671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Bg 2.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95193672|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Transvaginal Desara Short Length Taper L12 Cm Midline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,297.00|FSC: 13; Default||Not reimbursed separately|3,297.00|FSC: 13; Default||External grouping not supported 95193673|EAP|Custom 95193673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspiration Endo Ultrasound 25ga Colbalt-ch F/pulm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171033|EAP|CPT® 76497||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Myeloma Bone Survey|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95193680|EAP|Custom 95193680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Radiology Spaceoar Hydrogel Rectum Anterior Synthetic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Fixation Pectoralis Inserter Large Eyelet Latex Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95193674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 40mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 30 9mm X 30mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|884.55|FSC: 13; Default||Not reimbursed separately|884.55|FSC: 13; Default||External grouping not supported 95193677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 60 9mm X 25mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|958.14|FSC: 13; Default||Not reimbursed separately|958.14|FSC: 13; Default||External grouping not supported 95193678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 60 9mm X 30mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|958.14|FSC: 13; Default||Not reimbursed separately|958.14|FSC: 13; Default||External grouping not supported 95193679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Axis 2.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 80171044|EAP|CPT® 38220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bone Marrow Aspiration Cancer Care Center|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80171055|EAP|CPT® 38221||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bone Marrow Biopsy Cancer Care Center|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80171066|EAP|CPT® 38222||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bone Marrow Biopsy And Aspiration Cancer Care Center|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95193683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 1/3 Tubular L70 Mm 6 Hole Lock Sterile 3.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.05|FSC: 13; Default||Not reimbursed separately|721.05|FSC: 13; Default||External grouping not supported 95193684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 2 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|FSC: 13; Default||Not reimbursed separately|3,750.00|FSC: 13; Default||External grouping not supported 95193685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95193687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95193688|EAP|Custom 95193688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.0mm X 165mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95193690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95193694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Znn 6.0mm X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95193695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Znn 6.0mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95193686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95193700|EAP|Custom 95193700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Entuit Medium Balloon Retention Balloon Retenti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193701|EAP|Custom 95193701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Entuit L10 Cm Od24 Fr 20 Ml Balloon Retention M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193718|EAP|Custom 95193718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.0 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193720|EAP|Custom 95193720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scraper Membrane 27 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193728|EAP|Custom 95193728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Peri-loc Od3.2 Mm Targeter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193721|EAP|Custom 95193721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 27+ Diathermy Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193722|EAP|Custom 95193722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Ophthalmic Grieshaber Revolution Dsp Fine Od27+ Ga M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193723|EAP|Custom 95193723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Ophthalmic Grieshaber Dsp 27ga Soft Tip Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193724|EAP|Custom 95193724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Vitrectomy Edgeplus 4 Mm Od27 Ga 3 Count Valved Entry|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193725|EAP|Custom 95193725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 27+ Total Plus Pak Beveled Vitrectomy 10k|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193726|EAP|Custom 95193726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Laser Purepoint Nitinol 40 D L6 Mm Od27+ Ga Flexible T|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Axsos 3 Titanium L97 Mm Tibial Left Proximal Medi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,670.00|FSC: 13; Default||Not reimbursed separately|8,670.00|FSC: 13; Default||External grouping not supported 95193719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ortholoc Titanium Nitride L10 Mm Od2.4 Mm Forefoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95193698|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gastrostomy Entuit Start Small Od12-14 Fr Odsec16 Fr Coo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95193699|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gastrostomy Entuit Start Peel-away Medium Od16-18 Fr Ods|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95193702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L14 Mm Od3 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95193703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Titanium Taper Cut Flute L16 Mm Od3 Mm Odsec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95193704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L10 Mm Od2.5 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95193705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L12 Mm Od3 Mm Head Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95193706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Evos 1/3 Tubular L22 Mm 2h Lock Sterile 3.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.65|FSC: 13; Default||Not reimbursed separately|529.65|FSC: 13; Default||External grouping not supported 95193707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial P-d P/a 3.5mm Evos 3h R 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,996.50|FSC: 13; Default||Not reimbursed separately|1,996.50|FSC: 13; Default||External grouping not supported 95193708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L44 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L46 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L38 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L28 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Fibula Ag Pl-d Evos 6h 69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,658.25|FSC: 13; Default||Not reimbursed separately|1,658.25|FSC: 13; Default||External grouping not supported 95193713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L20 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula L-d 3.5mm Evos 5h L 81mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.90|FSC: 13; Default||Not reimbursed separately|2,406.90|FSC: 13; Default||External grouping not supported 95193715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L16 Mm Od3.5 Mm Self Tap Lock Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95193716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L42 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Orthopedic Evos 2 Sterile 3.5 Mm Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.48|FSC: 13; Default||Not reimbursed separately|204.48|FSC: 13; Default||External grouping not supported 95193729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Peri-loc Stainless Steel L342 Mm Femur Left Dista|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,868.10|FSC: 13; Default||Not reimbursed separately|4,868.10|FSC: 13; Default||External grouping not supported 95193730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peri-loc Stainless Steel Full Thread L70 Mm Od6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.12|FSC: 13; Default||Not reimbursed separately|897.12|FSC: 13; Default||External grouping not supported 95193731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peri-loc Stainless Steel T25 Flute L60 Mm Od4.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|FSC: 13; Default||Not reimbursed separately|430.92|FSC: 13; Default||External grouping not supported 95193732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peri-loc Triple Lead Thread L70 Mm Od4.5 Mm Odsec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 95193733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peri-loc Stainless Steel T25 Flute L12 Mm Od4.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 95193734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peri-loc Stainless Steel T25 Flute L30 Mm Od4.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|FSC: 13; Default||Not reimbursed separately|430.92|FSC: 13; Default||External grouping not supported 95193735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Peri-loc Triple Lead Thread L22 Mm Od4.5 Mm Odsec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|FSC: 13; Default||Not reimbursed separately|430.92|FSC: 13; Default||External grouping not supported 95193748|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel P5.8 Cm High Profile Round O|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95193758|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gastrostomy Entuit Start Large Od20-24 Fr Odsec22-26 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187659|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue Iopamidol 370 6 X 500ml Bottle 6/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|FSC: 13; Default||Not reimbursed separately|0.27|FSC: 13; Default||External grouping not supported 95193808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 200mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95193809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Lcp Combi Stainless Steel L179 Mm Humerus Left Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,856.68|FSC: 13; Default||Not reimbursed separately|3,856.68|FSC: 13; Default||External grouping not supported 95193810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 60 10mm X 25mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,188.00|FSC: 13; Default||Not reimbursed separately|1,188.00|FSC: 13; Default||External grouping not supported 95193811|EAP|Custom 95193811||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester Platinum Synthetic Fiber .035 In L7|1|HUMANA [1294]||HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95193812|EAP|Custom 95193812||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester Platinum Synthetic Fiber .018 In L7|1|HUMANA [1294]||HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95193814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 60 10mm X 30mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|984.24|FSC: 13; Default||Not reimbursed separately|984.24|FSC: 13; Default||External grouping not supported 95193816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 60 11mm X 30mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,188.00|FSC: 13; Default||Not reimbursed separately|1,188.00|FSC: 13; Default||External grouping not supported 95193817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Compositicp 60 11mm X 35mm In Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,067.70|FSC: 13; Default||Not reimbursed separately|1,067.70|FSC: 13; Default||External grouping not supported 95193818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Juggerknot Maxbraid 2 Od2.9 Mm 2 Load Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|835.44|FSC: 13; Default||Not reimbursed separately|835.44|FSC: 13; Default||External grouping not supported 95193819|EAP|Custom 95193819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cook Beacon Tip Catheter Hnbrs 5.0-35-90-p-ns-rbt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193820|EAP|Custom 95193820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Entuit 12fr Balloon Retention|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193821|EAP|Custom 95193821||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Entuit 14fr Balloon Retention|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193822|EAP|Custom 95193822||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Entuit 16fr Balloon Retention|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193824|EAP|Custom 95193824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Entuit 22fr Balloon Retention|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Intramedullary Nail Tfn-advanced Ti-6al-7nb Helical L1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95193827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Reline 2c L35 Mm Od6.5 Mm Spine Polyaxial Nonster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95193828|EAP|Custom 95193828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Suture Entuit Secure Spring Coil L12 Cm Gastrointestine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193829|EAP|Custom 95193829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Juggerknot Od2.9 Mm Suture Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L25 Mm Od10 Mm Sterile Latex Free Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L30 Mm Od11 Mm Sterile Latex Free Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L30 Mm Od12 Mm Sterile Latex Free Di|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193834|EAP|Custom 95193834||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Arthroscopic Fixation Aperfix Acl Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L20mm Od7mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Cmtd Fem W/oxin Hd & R3 Xlpe Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95193872|EAP|Custom 95193872||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Defibrillator Cpr-d Padz Adult 1 Piece Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193847|EAP|Custom 95193847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Biowick Surelock 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193848|EAP|Custom 95193848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Guide Biowick Surelock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193849|EAP|Custom 95193849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator For Biowick Surlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193851|EAP|Custom 95193851||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Quattro Suture Passer Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193863|EAP|Custom 95193863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surelock 2.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193864|EAP|Custom 95193864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Surelock Center Sleeve Sterile Disp 2.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193867|EAP|Custom 95193867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surelock 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193868|EAP|Custom 95193868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Surelock Center Sleeve Sterile Disp 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biowick Surelock Anchor 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95193865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Surelock 2.2 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.20|FSC: 13; Default||Not reimbursed separately|946.20|FSC: 13; Default||External grouping not supported 95193866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Surelock 2.2 Mm Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.20|FSC: 13; Default||Not reimbursed separately|946.20|FSC: 13; Default||External grouping not supported 95193869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 12mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 38mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95193836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L25mm Od7mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L20mm Od8mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L25mm Od8mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L30mm Od8mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L20mm Od9mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L25mm Od9mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ifix L30mm Od9mm Sterile Latex Free Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|FSC: 13; Default||Not reimbursed separately|865.95|FSC: 13; Default||External grouping not supported 95193843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aperfix Tibial Implant 8mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|FSC: 13; Default||Not reimbursed separately|1,074.00|FSC: 13; Default||External grouping not supported 95193844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aperfixii Cann Tibial 9mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|FSC: 13; Default||Not reimbursed separately|1,074.00|FSC: 13; Default||External grouping not supported 95193845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aperfixii Cann Tibial 10mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|FSC: 13; Default||Not reimbursed separately|1,074.00|FSC: 13; Default||External grouping not supported 95193846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Aperfixii Cann Tibial 11mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|FSC: 13; Default||Not reimbursed separately|1,074.00|FSC: 13; Default||External grouping not supported 95193852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro Link Od2.9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|848.88|FSC: 13; Default||Not reimbursed separately|848.88|FSC: 13; Default||External grouping not supported 95193853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro Link Od 4.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.75|FSC: 13; Default||Not reimbursed separately|993.75|FSC: 13; Default||External grouping not supported 95193854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro Link Od 4.5 Mm Sp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.00|FSC: 13; Default||Not reimbursed separately|1,092.00|FSC: 13; Default||External grouping not supported 95193855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro Link Od 5.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.30|FSC: 13; Default||Not reimbursed separately|1,092.30|FSC: 13; Default||External grouping not supported 95193856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro X Force Fiber Peek 2 Od5.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|838.08|FSC: 13; Default||Not reimbursed separately|838.08|FSC: 13; Default||External grouping not supported 95193857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro 3x Force Fiber Peek 2 Od5.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95193858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro X Force Fiber Peek 2 Od 6.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|835.68|FSC: 13; Default||Not reimbursed separately|835.68|FSC: 13; Default||External grouping not supported 95193859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro Force Fiber Peek Od2.9 Mm Glenoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.00|FSC: 13; Default||Not reimbursed separately|732.00|FSC: 13; Default||External grouping not supported 95193860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Quattro Force Fiber 2 Od2.9 Mm Cobraid Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|788.40|FSC: 13; Default||Not reimbursed separately|788.40|FSC: 13; Default||External grouping not supported 95193861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Surelock Uhmwpe 2 Od1.4 Mm Preload Imp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|FSC: 13; Default||Not reimbursed separately|939.00|FSC: 13; Default||External grouping not supported 95193862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Surelock Uhmwpe 2 Od1.4 Mm Preload Flexible|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|FSC: 13; Default||Not reimbursed separately|939.00|FSC: 13; Default||External grouping not supported 95193873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium L14.5 Mm Od8 Mm Ankle Cannulated Compres|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.20|FSC: 13; Default||Not reimbursed separately|529.20|FSC: 13; Default||External grouping not supported 95193874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary T2 Titanium L15 Cm Od12 Mm Left Ankle Ar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|FSC: 13; Default||Not reimbursed separately|6,598.20|FSC: 13; Default||External grouping not supported 95193875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Fixos Titanium L70 Mm Od5 Mm Midfoot Rearfoot Com|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95193876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Trigen Meta-nail Titanium L38cm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 95193877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L65 Mm Od5 Mm Femur Low Profile Internal Hex Trig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95193878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Low Profile Screws Titanium L34 Mm Od4.5 Mm Ankle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95193879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Low Profile Screws Titanium L 50mm Od4.5mm Ankle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95193880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Low Profile Screws Titanium L 55mm Od4.5mm Ankle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95193881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5 Mm 20mm Low Profile Ankle Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95193882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5 Mm 22mm Low Profile Ankle Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95193884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 28mm Loprfl Scr Ss Ft T10 Hexalobe Ankl Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95193885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Contour L128 Mm Tibia Right Distal Medial 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|FSC: 13; Default||Not reimbursed separately|5,220.00|FSC: 13; Default||External grouping not supported 95193886|EAP|Custom 95193886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Convex 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193887|EAP|Custom 95193887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Surgical 22 Mm Concave|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193888|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline P5 Cm Moderate Plus Profile Od11.2 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95193893|EAP|Custom 95193893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 3.2mm X 300mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Trigen Meta-nail Titanium L35cm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|FSC: 13; Default||Not reimbursed separately|4,717.50|FSC: 13; Default||External grouping not supported 95193890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130 D 1.5mm L42cm L13mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95193891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130 D1.5mm L42cm L11.5mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95193892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Screw Intertan Titanium L110 Mm L105 Mm Od11 Mm Trochant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95193894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm 90mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|FSC: 13; Default||Not reimbursed separately|560.25|FSC: 13; Default||External grouping not supported 95193895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5mm 95mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|FSC: 13; Default||Not reimbursed separately|560.25|FSC: 13; Default||External grouping not supported 95193896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 28mm 3.5mm 6.8 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95193897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 18mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95193898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L20 Mm Od3.5 Mm Odsec6.8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95193899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L20 Mm Od3.5 Mm Odsec18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95193900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L50 Mm Od2.7 Mm Odsec 4.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95193901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Peri-loc Stainless Steel L81mm Left Olecranon 6h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,543.75|FSC: 13; Default||Not reimbursed separately|3,543.75|FSC: 13; Default||External grouping not supported 95193902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193903|EAP|Custom 95193903||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 110mm 28mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 30mm|1|HUMANA [1294]||HUMANA [11839]|44,997.00|FSC: 13; Default||Not reimbursed separately|44,997.00|FSC: 13; Default||External grouping not supported 95193905|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Distal Bifurcated Main Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,124.00|FSC: 13; Default||Not reimbursed separately|11,124.00|FSC: 13; Default||External grouping not supported 95193906|EAP|Custom 95193906||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Source Light Quadrant Bent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L85 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95193908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L95 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95193909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Intramedullary Nail Tfn-advanced Ti-6al-7nb Helical 85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95193911|EAP|Custom 95193911||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Hydroset Xt Ha 10cc Injectable Sterile Latex Fr|1|HUMANA [1294]||HUMANA [11839]|14,883.00|FSC: 13; Default||Not reimbursed separately|14,883.00|FSC: 13; Default||External grouping not supported 95193912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Anchorage Titanium Standard T8 L28 Mm Od3.5 Mm Fo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95193913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone Easy Clip Superelastic 2 Mm L12 Mm X W15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95193914|EAP|Custom 95193914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod External Fixation Ilizarov Stainless Steel L250 Mm Threa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193915|EAP|Custom 95193915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Washer Orthopedic Ilizarov Conical Couple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193916|EAP|Custom 95193916||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Gore Excluder L12 Cm Od14.5 Mm Contralate|1|HUMANA [1294]||HUMANA [11839]|14,217.00|FSC: 13; Default||Not reimbursed separately|14,217.00|FSC: 13; Default||External grouping not supported 95193917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium Full Thread L90 Mm Od6 Mm Odsec3.5 Mm Co|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95193918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary 12mm 34cm Femoral Piriformis Bevel Tip G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,884.69|FSC: 13; Default||Not reimbursed separately|4,884.69|FSC: 13; Default||External grouping not supported 95193919|EAP|Custom 95193919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Short Od4.3 Mm Tibia Calibrated Orange Red 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193920|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 465cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95193921|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95193922|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Xtra Smooth Rd High Profile 415cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95193924|EAP|Custom 95193924||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 16cm 35mm 14.5mm 30-32mm 12-13.5mm Gore Xcldr C3|1|HUMANA [1294]||HUMANA [11839]|34,671.00|FSC: 13; Default||Not reimbursed separately|34,671.00|FSC: 13; Default||External grouping not supported 95193925|EAP|Custom 95193925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Screwdriver Universal Od2.5 Mm Conical Hexagonal Screw E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193926|EAP|Custom 95193926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Surgical Gamma U Blade Connector Universal Lag Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Short Plantar Right Nonsterile Lapidus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95193930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Triad Evolve 1.1 Mm Full Thread L14 Mm Od1.5 Mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95193931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Triad Evolve Full Thread L16 Mm Od1.5 Mm Elbow St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95193932|EAP|Custom 95193932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Triad Evolve Od1.1 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 L18 Mm Od2.7 Mm Odsec4.5 Mm Cortex Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos L13 Mm Od3.5 Mm Cortex Self Tap Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95193937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Evos T8 2.7mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95193938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula 7 Hole Left 2.7/3.5 X 103mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|FSC: 13; Default||Not reimbursed separately|2,318.25|FSC: 13; Default||External grouping not supported 95193940|EAP|Custom 95193940||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Coroent Peek-optima 4 D Large Impact L32 Mm X W9|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95193941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Spinal Reline Titanium Lordotic L80 Mm Od5.5 Mm Nonsteri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95193942|EAP|Custom 95193942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Perfusion Oxygenator (contains Bb9l99r5/bb841)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193943|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vein Saphenous 5mm X 62cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,640.00|FSC: 13; Default||Not reimbursed separately|29,640.00|FSC: 13; Default||External grouping not supported 95193944|EAP|Custom 95193944||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer/divider Laparoscopic Ligasure L37 Cm Od5 Mm Retractab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193945|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Circle Od6 In 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95193946|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Esh Surgical Ventralight St Echo 2 Oval L25 Cm X W15 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95193947|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Circle Od20 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 95193949|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Ventralight St Echo 2 Ellipse L35 Cm X W30 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95193950|EAP|Custom 95193950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Delivery System Od 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193951|EAP|Custom 95193951||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Enveo Pro Load|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cocr L45 Mm Od9.5 Mm Spine Multiaxial 5.5 Mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95193954|EAP|Custom 95193954||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent 95mm 25mm Vela 20mm Aaa|1|HUMANA [1294]||HUMANA [11839]|12,720.00|FSC: 13; Default||Not reimbursed separately|12,720.00|FSC: 13; Default||External grouping not supported 95193955|EAP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Disc Cervical Mobi-c 17mm X 17mm H6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95193956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Tfna Fenestrated Helical 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95193958|EAP|Custom 95193958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Needle Ua 1322-s Single Biopsy Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193959|EAP|Custom 95193959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Cover Latex Free Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62065400|EAP|CPT® 87651||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Strep A Dna Amp Probe|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62065410|EAP|CPT® 80299||0301 - LABORATORY - CHEMISTRY|Hb Quant Therapeutic Drug|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 95193957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Lcp Combi St Steel L102mm Tibia Rt Prox 3.3mm 6h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,822.08|FSC: 13; Default||Not reimbursed separately|4,822.08|FSC: 13; Default||External grouping not supported 95193978|EAP|Custom 95193978||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endowrist D4.3 Mm L30 Mm Sterile Latex Free D|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193979|EAP|Custom 95193979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler L30 Mm Gray|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193982|EAP|Custom 95193982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Equipment Da Vinci Xi 21inxw19inxh10.5in 21 Lb Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193983|EAP|Custom 95193983||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Endoscopic Instrument Da Vinci Xi Universal Od5-8 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193984|EAP|Custom 95193984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape 4-arm Proximal Column Drape|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193985|EAP|Custom 95193985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Hammerfix Small L13.5 Mm L6.5 Mm Od2.8 Mm Ods|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular L-d 7h L 103mm 3.5 Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.50|FSC: 13; Default||Not reimbursed separately|2,095.50|FSC: 13; Default||External grouping not supported 95193990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Fixos Titanium Short Thread L70 Mm Od7 Mm Midfoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95193991|EAP|Custom 95193991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill L230 Mm Od3.2 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 24mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95193988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex T8 S-t Evos 2.7x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95193999|EAP|Custom 95193999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Closure Endo Stitch V Loc 180 3-0 L6 In Absorbable Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hummerus Proximal Right 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95194001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L24 Mm Od3.5 Mm Cortical Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95194002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95194003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95194005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95194006|EAP|Custom 95194006||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Caps Locking 3.5t|1|HUMANA [1294]||HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95194007|EAP|Custom 95194007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194008|EAP|Custom 95194008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193986|EAP|Custom 95193986||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fixation Hammerfix Peek L5.5 Mm Small L13.5 Mm L6.5|1|HUMANA [1294]||HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95194004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 39mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95194009|EAP|Custom 95194009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 01.6mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194010|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Vascular Lifestream L58 Mm L135 Cm Od9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95194011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone L128 Mm Tibia Left Distal Medial 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|FSC: 13; Default||Not reimbursed separately|5,220.00|FSC: 13; Default||External grouping not supported 95194013|EAP|Custom 95194013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Hex Anchor Clink 3 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194014|EAP|Custom 95194014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stimulator Spinal Cord Charge System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194015|EAP|Custom 95194015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill L220 Mm Od2.6 Mm Ao Scale|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Multi Thread Compression 3.0mmx6mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95194017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Multi Thread Locking 3.0mm X 6mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95193661|EAP|Custom 95193661||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rld Stplr 4.3mm 45mm Dvnc Xi Ewrst Strl Lf Disp Grn 1 Frng|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193662|EAP|Custom 95193662||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rld Stplr 30 Grn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193663|EAP|Custom 95193663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rld Stplr 3.5mm 45mm Dvnc Xi Ewrst Strl Lf Disp Blu 1 Frng|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193664|EAP|Custom 95193664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rld Stplr 45mm Ewrst Wht|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193980|EAP|Custom 95193980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Tip 8mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193981|EAP|Custom 95193981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator 8mm Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194018|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +33 13mm X 5mm Ultifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95194020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Ti T8 Reverse Cut Flute Taper L20mm 2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.00|FSC: 13; Default||Not reimbursed separately|1,071.00|FSC: 13; Default||External grouping not supported 95194023|EAP|Custom 95194023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Djo Surgical Cobalt 40 Gm High Viscosity Sterile|1|HUMANA [1294]||HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95194024|EAP|Custom 95194024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Reline Mas Nitinol Spine Blunt Thread|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Small Shell 8mm X 108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95194026|EAP|Custom 95194026||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Bone Void Conform Flex Q-pack Demineralize Bone Matri|1|HUMANA [1294]||HUMANA [11839]|1,549.80|FSC: 13; Default||Not reimbursed separately|1,549.80|FSC: 13; Default||External grouping not supported 95194027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Intramedullary Nail Tfn-advanced Ti-6al-7nb Helical L1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95121031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire And Guide.062|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194031|EAP|Custom 95194031||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Gore Excluder 10cm 14mm Iliac Br Comp Aaa|1|HUMANA [1294]||HUMANA [11839]|33,882.00|FSC: 13; Default||Not reimbursed separately|33,882.00|FSC: 13; Default||External grouping not supported 95194032|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Gore Viabahn .035 In L79 Mm L135 Cm Od1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,977.00|FSC: 13; Default||Not reimbursed separately|10,977.00|FSC: 13; Default||External grouping not supported 95194035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cannulated Thread 16mm X 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95193660|EAP|Custom 95193660||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Caut Dvnc Xi Ewrst Caut Mnplr Vsl Slr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95193977|EAP|Custom 95193977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vessel Sealer Extend Da Vinci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194030|EAP|Custom 95194030||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular 18cm 28.5mm 14.5mm|1|HUMANA [1294]||HUMANA [11839]|34,671.00|FSC: 13; Default||Not reimbursed separately|34,671.00|FSC: 13; Default||External grouping not supported 95194033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Anterior 7 Hole Midshaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95194036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Axsos 3 Femur Lateral Distak 4 Hole L130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,542.00|FSC: 13; Default||Not reimbursed separately|10,542.00|FSC: 13; Default||External grouping not supported 95194037|EAP|Custom 95194037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fixator Frame Dia 4.2mm Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194038|EAP|Custom 95194038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Cannula Endowrist Od12 Mm Stapler Da Vinci Xi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194039|EAP|Custom 95194039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reducer Laparoscopic Da Vinci Xi Endowrist Od8-12 Mm Cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Gorilla L20 Mm Od3.5 Mm Nonsterile R3con Lock Pla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95194042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini-monster Short Thread 3.5mm X 28mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95194043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Solera Cd Horizon Cocr L40 Mm Od4 Mm Spine Multia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95194044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary T2 Titanium L340 Mm Od10 Mm Femur Greate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|FSC: 13; Default||Not reimbursed separately|5,964.00|FSC: 13; Default||External grouping not supported 95194046|EAP|Custom 95194046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Irrigator Suction Endowrist Od8 Mm Sterile Latex Free Dispos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194047|EAP|Custom 95194047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape Equipment Da Vinci Xi Column|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194049|EAP|Custom 95194049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drug Delivery On-q Soaker Dehp L5 In Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-tapping 4.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95194051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 1-level 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95194052|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Full 345cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194053|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Full 365cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194055|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Extra Full 420cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194056|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Extra Full 445cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194057|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Extra Full 495cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194058|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Extra Full 470cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 80171077|EAP|CPT® 58120||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Dilation And Curettage, Diagnostic And/or Therapeutic|1|HUMANA [1294]||HUMANA [11839]|7,711.60|FSC: 13; Default||Not reimbursed separately|7,711.60|FSC: 13; Default||External grouping not supported 95194054|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Implant Full 385cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194060|EAP|Custom 95194060||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra P6.3 Cm High Profile Round Od13|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194061|EAP|Custom 95194061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sponge Absorbable Surgifoam Porcine Gelatin Thk2 Mm 100c L12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Altivate Anatomic 54mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95194064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Capitate 12mm 35mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|FSC: 13; Default||Not reimbursed separately|18,675.00|FSC: 13; Default||External grouping not supported 95194065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Versa-dial Ti +3 Mm Od36 Mm Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,810.00|FSC: 13; Default||Not reimbursed separately|12,810.00|FSC: 13; Default||External grouping not supported 95194074|EAP|Custom 95194074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Orthopedic Acutrak 2 Titanium L5.75 In Od.035 In E|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194078|EAP|Custom 95194078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Surgical Od10 Mm Conical Rod Universal Nail Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194079|EAP|Custom 95194079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Cohesive I P4.5 Cm High Profile Roun|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5 Hexagon Comprehensive Ti 4.75mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 95194069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 50mm Elb Hexalobe Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95194070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 50mm Nonlock Hexalobe Head Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95194071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 88mm Titanium 7 Hole Lock Bone Elbow Medial Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,182.00|FSC: 13; Default||Not reimbursed separately|4,182.00|FSC: 13; Default||External grouping not supported 95194072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L32 Mm Od2.7 Mm Elbow Hexalobe Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95194073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 65mm Elbow Hexalobe Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95194075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6mm 90mm Titanium Full Thread Cancellous Nonsteri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95194076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5mm 20mm Axsos 3 Titanium Lock Self Tap Nonsteril|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|FSC: 13; Default||Not reimbursed separately|906.00|FSC: 13; Default||External grouping not supported 95194077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Titanium L20 Mm Od5 Mm Lock Nonsterile Axsos 3 Pe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95194080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 60mm Nonlock Hexalobe Head Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95194081|EAP|Custom 95194081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Suture Cor-knot Mini Combo Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Ambassador L32 Mm Spine 2 Level Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95194083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Slim Y 3 Hole Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|FSC: 13; Default||Not reimbursed separately|4,572.00|FSC: 13; Default||External grouping not supported 95194084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cement Fem Cem Tibia Std Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Ps Fem Cem Tib Std Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|FSC: 13; Default||Not reimbursed separately|12,762.00|FSC: 13; Default||External grouping not supported 95194086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Fem Cem Tib Flex Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Fem Cem Tib Flx Prlng Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Fem Cem Tib Prlng Art Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Kneww Cement Fem Cem Tibia Std Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Fem Prct Tib Prlng Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cem Fem Cem Mb Tib Mb Prlg Sf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cem Fm Cem Tib Prlg Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flx Fem Cem Tib Flx Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flx Fem Cem Tib Prlg Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flx Fem Cem Tib Std Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flex Fem St Tib Flex Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flex Fem Cem Tib Flex Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flex Fem Cem Tib Prlng Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flx Fem Mob Lps Tib Mob Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|FSC: 13; Default||Not reimbursed separately|12,762.00|FSC: 13; Default||External grouping not supported 95194100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cem Flx Fm Cem Mb Tib Mb Prlg Sf Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cm Fm Cm Mb Tib Mprlg Sf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Cm Flx Kn Mis Pc Tb Prlg Sf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cem Fem Cem Tib Flx Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Ha L150 Mm L25 Mm Od6 Mm External Fixation System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|FSC: 13; Default||Not reimbursed separately|569.25|FSC: 13; Default||External grouping not supported 95194122|EAP|Custom 95194122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hinge External Fixation Ilizarov Stainless Steel Standard Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194124|EAP|Custom 95194124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cube External Fixation Ilizarov Stainless Steel 4 Hole Ranch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194125|EAP|Custom 95194125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cube External Fixation Ilizarov Stainless Steel 3 Hole Ranch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fem Cem Tib Ve Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95194117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cm Fm Cem Tb Cps Ve Sur Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fem Cem Tib Std Surf Ve Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95194128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fm Cem Tib Cps Ve Sur Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fem Cem Tib Ve Surf Ve Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95194130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fm Cem Tib Cps Ve Sur Ve Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fm Cem Tb Cpsve Sur Xlpe Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fm Cem Tib V E Surf Ve Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95194133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Fem Cem Tib Arc Pat St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cem Fem Cem Tib Std Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cem Fem Cem Tib Prlg Surf Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cem Fm Cem Tib Prlng Sur Xlpe Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Cr Flx Cem Fm Cem Tib Flx Sur Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cem Fm Mis Pc Tib Flx Sur Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cm Fm Mis Pc Tb Prlg Sf Xlpe Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Cem Fem Cem Tib Flx Sur Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fem Cem Tib Std Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fem Cem Tib St D Sur Prlng Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Ha 10mm X 20mm Acl Biosure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95194148|EAP|Custom 95194148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Surgical Da Vinci Xi Endowrist Harmonic Ace Curve L26|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Cr Fem Cem Tib Arc Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Ps Fem Cem Tib Arc Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95194137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Fem Cem Tib E1 Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95194138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Cr Fem Cem Tib E1 Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95194139|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hyb Knee-prolong Art Surf Xlpe Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194140|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hyb Flx Kn-cm Fm Mis Tm Tib Flx Sf St Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|FSC: 13; Default||Not reimbursed separately|15,618.00|FSC: 13; Default||External grouping not supported 95194141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Hyb-cem Fm Tm Tib Std Sur Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|FSC: 13; Default||Not reimbursed separately|15,618.00|FSC: 13; Default||External grouping not supported 95194142|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Hyb-tm Fm Cem Tb Std Surf Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|FSC: 13; Default||Not reimbursed separately|15,618.00|FSC: 13; Default||External grouping not supported 95194143|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Hyb-tm Fem Cm Ti B Ve Sur Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,518.00|FSC: 13; Default||Not reimbursed separately|16,518.00|FSC: 13; Default||External grouping not supported 95194144|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Hyb-tm Fem Cm Ti B Ve Sur Ve Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,418.00|FSC: 13; Default||Not reimbursed separately|17,418.00|FSC: 13; Default||External grouping not supported 95194145|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Fem Rgx Tib Arc Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|FSC: 13; Default||Not reimbursed separately|15,618.00|FSC: 13; Default||External grouping not supported 95194146|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hyb Kn-por Fem Cem Tib Prl Surf Xlpe Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194147|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hyb Flx Kn-por Fem Cem Tb Prlsf Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hy Fl Kn-gsf Cr Po Fm Cm Tb Nsm Sf St Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194150|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hyb Flx Gsf Por Fm Cm Tb Prlg Sf St Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194151|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hyb Flx Gsf Por Fm Cm Tb Prlg Sf Xlpe Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194152|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Por Fem Cem Tib E1 Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|FSC: 13; Default||Not reimbursed separately|15,618.00|FSC: 13; Default||External grouping not supported 95194153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Por Fem Cem Tib Arc Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95194154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Fem Mis Tm Tib Std Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Fem Mis Tm Tib Prlg Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Fem Mis Tm Tib Std Surf Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194157|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Flx Fem Por Tib Prlg Art Sur Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|FSC: 13; Default||Not reimbursed separately|15,387.00|FSC: 13; Default||External grouping not supported 95194158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Lex Fem Tm Mono Tib Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Flx Fem Mis Tm Tib Std Surf Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Flx Fm Mis Tm Tib Flx Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Flx Fem Mis Tm Tib Prl Art Sur St Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Por Flx Fem Mis Tm Tib Prlng Surf Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Por Fm Por Tib Prlng Sur Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Por Fm Por Tib Prlg Sur Xlpe Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|FSC: 13; Default||Not reimbursed separately|15,387.00|FSC: 13; Default||External grouping not supported 95194166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Por Fm Por Tib Prlng Sur Met Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|FSC: 13; Default||Not reimbursed separately|15,387.00|FSC: 13; Default||External grouping not supported 95194167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Por Fm Mis Tm Tib Prlg Sur St Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Por Fm Mis Tm Tib Prlg Sur Tm Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Gsf Flx Por Fem Tm Mono Tib Tm Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Tm Fem Tm Tb Std Surf Std Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Tm Fem Tm Tib St D Surf Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|FSC: 13; Default||Not reimbursed separately|18,087.00|FSC: 13; Default||External grouping not supported 95194172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Tm Fm Tm Tib Prl Ng Sur St Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Tm Fm Tm Tib Prlng Surf Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|FSC: 13; Default||Not reimbursed separately|18,087.00|FSC: 13; Default||External grouping not supported 95194174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Tm Fem Tm Mod Tb Prlg Surf Tm Pt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|FSC: 13; Default||Not reimbursed separately|18,087.00|FSC: 13; Default||External grouping not supported 95194175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Por Fem Rgx Tib E1 Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Por Fem Rgx Tib Arc Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194177|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Por Fem Por Tib E1 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Capt Total Knee Por Fem Cem Mon Tib Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95194179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Vg Cem Fem Cem Mon Tib Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,238.00|FSC: 13; Default||Not reimbursed separately|14,238.00|FSC: 13; Default||External grouping not supported 95194181|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Oxf Cem Fem Cem Tib Std As|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95194182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Oxf Cem Fem Mon Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95194183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Pfj Femoral Component Std Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95194184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Pfj Femoral Component Ve Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,428.00|FSC: 13; Default||Not reimbursed separately|13,428.00|FSC: 13; Default||External grouping not supported 95194185|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Pfj Fem Oral Component Xlp Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95194186|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Persona Uni Fem Persona Uni Tibia Ve Sufa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,900.00|FSC: 13; Default||Not reimbursed separately|9,900.00|FSC: 13; Default||External grouping not supported 95194187|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Hyb Hip-cem St Por Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95194188|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Hyb Hip-cem St Tm Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194189|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Hyb Hip-cem St Tm Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Hyb Hip-cem St Tm Cup Xlpe Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cup Xlpe Ln Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cup Lg Xlpe Ln Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cup Xlpe Liner Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cup Lg Xlpe Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Tm Cup Lg Xlpe Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cup Xlpe Liner Ceramic Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194199|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Porous St Tm Cup Xlpx Liner Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194200|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Tm Cup Lg Xlpe Ln Lg Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194201|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Porous St Tm Cup Vit E Liner Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Tm Cup Lg Vit E L N Lg Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Tm Cup Xlpe Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Tm Cup Vit E Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cp Xl Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St G7 Cp Xl Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St G7 Cp Lg Xl Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194209|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cp E1 Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194210|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cp Lg E1 Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194211|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Por Cp E1 Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 80171088|EAP|CPT® 55874||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB TRANSPERINEAL PLACEMENT OF BIODEGRADABLE MATERIAL, INJECTION(S|1|HUMANA [1294]||HUMANA [11839]|13,062.92|FSC: 13; Default||Not reimbursed separately|13,062.92|FSC: 13; Default||External grouping not supported 95194212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Fensetrated Tfna 80mm Sterile Tan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95194213|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding Sbs4 Curve L100 Cm Od6 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194214|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding Concierge St Ptfe Polymer Sbs35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Darco Short Thread L30 Mm Od3.5 Mm Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|FSC: 13; Default||Not reimbursed separately|471.00|FSC: 13; Default||External grouping not supported 95194228|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol Acrysof Iq Restor Stableforce Acrylic 0 D +31 Diopte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95194229|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol Iq Restor Monoflex 10 D +13 Diopter +3 Cylinder Bic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95194120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Persona Cem Fem Cem Tib Ve Surf Std Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|FSC: 13; Default||Not reimbursed separately|12,300.00|FSC: 13; Default||External grouping not supported 95194180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Uni Knee Oxf Cem Fem Cem All Poly Tib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95194217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Rgx Cp E1 Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194218|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Mom Cp E1 Aa Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,326.00|FSC: 13; Default||Not reimbursed separately|16,326.00|FSC: 13; Default||External grouping not supported 95194219|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St Mom Cp E1 Aa Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,426.00|FSC: 13; Default||Not reimbursed separately|15,426.00|FSC: 13; Default||External grouping not supported 95194220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St G7 Cp Lg E1 Ln Cerhd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St G7 Cp E1 Ln Std Hc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St G7 Lg E1 Ln Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Ha Por St Tm Cup Lg Xlpe Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Ha Por St Tm Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Ha Por St Tm Cup Xlpe Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Ha Por St Tm Cup Vit E Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fitmore St Por Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fit St Por Cup Lg Xlpe Ln Lg Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-ftmore St Tm Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fit St Tm Cup Lg Xlpe Ln Lg Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fitmore St Tm Cup Xlpe Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194240|EAP|Custom 95194240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Suturing Tfcc Mender Straight Curve Needle Wire Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194243|EAP|Custom 95194243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill L122 Mm Od2.7 Mm Ao Fit Over Nonsterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194267|EAP|Custom 95194267||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal 45x22x10mm Clydesdale 6d Peek Radiopaque Lumbar|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95194290|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Allox2 P6.4-7.9 Cm Full Height W15 Cm X H13.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 95194305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Cement Bone Biomet 40 Gm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95194306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Cement Bn Refobacin St Latex Free Disposable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|FSC: 13; Default||Not reimbursed separately|594.00|FSC: 13; Default||External grouping not supported 95194307|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Breast Expander Style 8200 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95194236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary T2 Titanium L340 Mm Od13 Mm Supracondyla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95194237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Slim Y 2 Hole Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|FSC: 13; Default||Not reimbursed separately|4,572.00|FSC: 13; Default||External grouping not supported 95194238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Variax T8 Full Thread L10 Mm Od2.7 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95194239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Variax T8 Full Thread L28 Mm Od2.7 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95194241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Variax Titanium Small Foot Calcaneus Mesh Polyaxi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,347.00|FSC: 13; Default||Not reimbursed separately|4,347.00|FSC: 13; Default||External grouping not supported 95194242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Variax T8 Full Thread L32 Mm Od2.7 Mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95194244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fit St Tm Cup Lg Xlpe Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fitmore St Tm Cup Vit E Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Avrn-fit St Tm Cup Lg Vit E Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St Por Cp Xl Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp Xl Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp Lg Xl Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp Xl Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St Por Cp E1 Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95194252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp E1 Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp Lg E1 Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp E1 Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Prem St G7 Cp Lg E1 Ln Lghd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Por Cup Xlpe Liner Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cup Xlpe Ln Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cup Lg Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cup Xlpe Liner Ceramic Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cup Vit 3 Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cup Lg Vit E Ln Lg Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cup Vit E Liner Cer Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Por Cp Xlpe Ln Cer Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cp Lg Xlpe Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Por St-nk Tm Cp Lg Vit E Ln Lg Cer Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Ha Por St-nk Tm Cup Vit E Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm St Tm Cup Lg Xlpe Ln Lg Cer Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Lg Vit E Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95194270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Por Cup Xlpe Liner Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Por Cut Lg Xlpe Ln Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 95194272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm St Por Cup Lg Xlpe Ln Lg Cer Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Xlpe Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Lg Xlpe Ln Lg Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Lg Xlpe Liner Lg Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Vit E Ln Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Lg Vit E Ln Lg Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Xlpe Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Tm Cup Vit E Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95194280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tm Por St Por Cup Xlpe Liner Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Unipolar Hio-cem Fract St Unipolr Fem Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Unipolar Hip-cement St Endo Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Unipolar Hip-ld Fx Cem St Endo Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Unipolar Hip-tm Porous St Endo Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,461.00|FSC: 13; Default||Not reimbursed separately|10,461.00|FSC: 13; Default||External grouping not supported 95194287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Porous Primary Unipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Porous Fx Unipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Cemented Fx Unipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Biplr Hip-ha Por St Mltplr Cp & Ln St Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Frac Cem St Mltplr Cup Mltplr Lnr Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Bipolar Hip-por St Mltplr Cp & Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Pressfit(ld/fx) Biplr Hp Biplr Cp Std Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Bipolar Hip-cem St Mltplr Cp & Ln Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Bipolar Hip-ld Fx Cem St Mltpl Cp & Ln Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Bipolar Hip-por St-nk Mltplr Cup & Ln St Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Bipolar Hip-tm Por St Mltplr Cp & Ln Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,461.00|FSC: 13; Default||Not reimbursed separately|10,461.00|FSC: 13; Default||External grouping not supported 95194300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Bipolar Hip Avrn-fit St Mltpl Cp & Ln St Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Por (ld/fx) St Mltplr Cup Mltplr Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Por Primary Bipolar Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Cem Fx Bipolar Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Por Fx Bipolar Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Twinfix Titanium 2 Od3.5 Mm 2 Ultrabraid Needl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|787.50|FSC: 13; Default||Not reimbursed separately|787.50|FSC: 13; Default||External grouping not supported 95194309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Strength Evos 2.0mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|FSC: 13; Default||Not reimbursed separately|1,519.65|FSC: 13; Default||External grouping not supported 95194310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 12mm Evos T6 Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 95194311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 42cm Rt Intertrochanter Intertan Im 125d 1.5mm 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95194312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone L72 Mm Od5 Mm Femur Low Profile Internal Hex Trig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95194314|EAP|Custom 95194314||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix Cr 13mm|1|HUMANA [1294]||HUMANA [11839]|14,820.00|FSC: 13; Default||Not reimbursed separately|14,820.00|FSC: 13; Default||External grouping not supported 95194315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5mm 24mm Low Profile Screws Titanium Ankle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95194316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.5mm 65mm Low Profile Screws Titanium Ankle Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95194317|EAP|Custom 95194317||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 6x10 St|1|HUMANA [1294]||HUMANA [11839]|9,286.62|FSC: 13; Default||Not reimbursed separately|9,286.62|FSC: 13; Default||External grouping not supported 95194320|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memoryshape Siltex 485cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95194334|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memoryshape Siltex 545cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95194336|EAP|Custom 95194336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Laparoscopic Endowrist Id12 Mm Stapler Da Vinci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Exoshape Angle L30 Mm Od7 Mm Deployment Cart|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95194321|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L70 Cm Od12 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95194322|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L100 Cm Od12 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194323|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L120 Cm Od12 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194324|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L70 Cm Od14 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194325|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L100 Cm Od14 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194326|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L120 Cm Od14 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194327|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L100 Cm Od16 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194328|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L120 Cm Od16 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194329|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L100 Cm Od18 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194330|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L120 Cm Od18 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194331|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L70 Cm Od 22 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194332|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L100 Cm Od 22 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194333|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Alimaxx-es L120 Cm Od 22 Mm Fully Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95194335|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Ndc 59857000320 Soft Tissue Stravix Placental Tissue L 4cm X W 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|712.50|FSC: 13; Default||Not reimbursed separately|712.50|FSC: 13; Default||External grouping not supported 95194339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L36 Mm Od3 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95194340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Tfn-advanced Titanium Cocr 130 D Long L4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95194341|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Skin Allopatch Hd Acellular Dermis Thk 4-5 Mm Xultrathi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.40|FSC: 13; Default||Not reimbursed separately|213.40|FSC: 13; Default||External grouping not supported 95194351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radl 10mmx4mm 36mm Align Ti Sd Ld Hbrd Hd Dsgn Unq Algn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95194352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 46mm 3.5mm Scr 4 Hl Lck Evos Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.80|FSC: 13; Default||Not reimbursed separately|250.80|FSC: 13; Default||External grouping not supported 95194353|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Small Shell 6mm X 108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95194354|EAP|Custom 95194354||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 45mmx10mm Clydesdale 6d Peek-optm Radopq Hlw Lmbr|1|HUMANA [1294]||HUMANA [11839]|18,600.00|FSC: 13; Default||Not reimbursed separately|18,600.00|FSC: 13; Default||External grouping not supported 95194365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 15mm 44mm Shldr Simpliciti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95194355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.1mm 44mm T10 Lag Cross Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95194356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Compression Headless 7mm L125mm Short Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95194357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Headless 4.0mm X 44 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95194358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Short Thread 7.0mm L95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95194359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 70mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95194360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 120mm Fixos Ti L/t Midfoot Rearfoot Cmpr Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95194361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Evos T8 L18 Mm Od2.7 Mm Cortex Self Tap Nonsteril|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|FSC: 13; Default||Not reimbursed separately|98.01|FSC: 13; Default||External grouping not supported 95194366|EAP|Custom 95194366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Hex Precision Anchor Clik 3 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194369|EAP|Custom 95194369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Total Knee Disposable Instrument Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194387|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Allograft Arthrocell 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95194388|EAP|Custom 95194388||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Syring Mixing 14cc With Luer Cap|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95194389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 38cm Left Trochanter Intertan Intramedullary 125d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95194390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 46mm T8 Evos Osteopenia T8 Partially Theaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|FSC: 13; Default||Not reimbursed separately|226.05|FSC: 13; Default||External grouping not supported 95194391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 50mm T8 Evos Osteopenia T8 Partially Theaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|FSC: 13; Default||Not reimbursed separately|226.05|FSC: 13; Default||External grouping not supported 95194393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm 17mm T8 2mm Self Tap Lock Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95194401|EAP|Custom 95194401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 5mm Cannulated Ao Fit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194403|EAP|Custom 95194403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rmr Srg Cal 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194404|EAP|Custom 95194404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Orth 3mm Easyclip Ft/ankle Position Superelastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194407|EAP|Custom 95194407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg Prfl Std Cmpr Ft Scr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Short Thread 7.0mm L80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95194402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5mm 36mm Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95194405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Dvc Fixation Easyclip 20x20x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,503.00|FSC: 13; Default||Not reimbursed separately|7,503.00|FSC: 13; Default||External grouping not supported 95194406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Dvce Fixation Easyclip 25x20x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,503.00|FSC: 13; Default||Not reimbursed separately|7,503.00|FSC: 13; Default||External grouping not supported 95194408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 42mm Compr Ft Ti Std Ft Cmpr St Cnn Hex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95194409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 2.5mm 12mm Ortholoc Ft Midfoot Cort Loprfl Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|FSC: 13; Default||Not reimbursed separately|279.00|FSC: 13; Default||External grouping not supported 95194410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Evos T8 S-t 2.7mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95194411|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 19.3x9.6cm Aldrm Slct Thk 1.0-0.2mm Thin Cntr Alg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.03|FSC: 13; Default||Not reimbursed separately|66.03|FSC: 13; Default||External grouping not supported 95194396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3mm 30mm Mini Head Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95194398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini L32 Mm Od3 Mm Headless Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 80171099|EAP|CPT® 43196||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy With Savory Dilation|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 95194392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.7mm 4.3mm 13mm T8 2mm Self Tap Lock Evos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95194399|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 19.3x9.6cm Alloderm Select Duo Thk.4-1.6mm Md|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.22|FSC: 13; Default||Not reimbursed separately|62.22|FSC: 13; Default||External grouping not supported 95194422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 11mm Evos Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|FSC: 13; Default||Not reimbursed separately|70.47|FSC: 13; Default||External grouping not supported 95194423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 6.5mm 13mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95194424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 118mm 3.5mm Scr 10 Hl Lck Evos Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|907.50|FSC: 13; Default||Not reimbursed separately|907.50|FSC: 13; Default||External grouping not supported 95194425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tblr 118mm 3.5mm Scr 10 Hl Evos Bn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.35|FSC: 13; Default||Not reimbursed separately|262.35|FSC: 13; Default||External grouping not supported 95194426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.0mm 44mm T8 Evos Osteopenia T8 Partially Theaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|FSC: 13; Default||Not reimbursed separately|226.05|FSC: 13; Default||External grouping not supported 95194438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb X-clip 7.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,739.00|FSC: 13; Default||Not reimbursed separately|5,739.00|FSC: 13; Default||External grouping not supported 95194439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Tfna Fenestrated Helical Blade 115mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|FSC: 13; Default||Not reimbursed separately|2,438.97|FSC: 13; Default||External grouping not supported 95194427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula Evos 2.7/3.5mm L-d 3 Hl L 59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.75|FSC: 13; Default||Not reimbursed separately|2,070.75|FSC: 13; Default||External grouping not supported 95194437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Beam Fixation 7.5mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95194428|EAP|Custom 95194428||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 0 15cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194429|EAP|Custom 95194429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 0 45cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194430|EAP|Custom 95194430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 0 30cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194431|EAP|Custom 95194431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 0 22cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194432|EAP|Custom 95194432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Large 3.2mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194433|EAP|Custom 95194433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194434|EAP|Custom 95194434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill Short Small Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194435|EAP|Custom 95194435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill Short Large Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194442|EAP|Custom 95194442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna Standard Percutaneous 20 Cm 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194443|EAP|Custom 95194443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenne Short Percutaneous 15 Cm W/thermosphere|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194444|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194445|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194446|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Pulmonary Dilation Catheter 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 4.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95194449|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel Xtra 240cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95194450|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel Xtra 215cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95194451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 20mm Ti Cort Ns Axsos 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95194452|EAP|Custom 95194452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Conical Extraction T2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 14mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95194454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stpl Bn 18x16mm Fuseforce 2mm Rmr Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|FSC: 13; Default||Not reimbursed separately|6,153.00|FSC: 13; Default||External grouping not supported 95194455|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 525cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194456|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 545cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194457|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Contour Memorygel Tall Hgt Hgh Profl 755cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95194458|EAP|Custom 95194458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stardrive Scrwdrvr Shft/t4 50mm/self-retaining/hxc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194460|EAP|Custom 95194460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Intvn 7fr 60cm 3cm Endovenous Heat Rfa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194461|EAP|Custom 95194461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill For 2.9mm Pushlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.3mm Iconix Speed 2 Strand 2 Force Fiber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95194467|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +18.5 Diop Mod C Bcnvx 13mm 6mm Pc 1 Pc Fld Ant Asp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95194459|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 2.4mm/0.4mm Alloderm Select Duo Thk.4-1.6mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|214.38|FSC: 13; Default||Not reimbursed separately|214.38|FSC: 13; Default||External grouping not supported 95194462|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Ndc 59857000322 Tissue Stravix 3cm X 6cm Frozen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.50|FSC: 13; Default||Not reimbursed separately|445.50|FSC: 13; Default||External grouping not supported 95194471|EAP|Custom 95194471||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Hydrated Lordotic 8mm|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95194478|EAP|Custom 95194478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stardrive Scrwdrvr Shft/t6 50mm/self-retaining/hxc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 34mm Ti 1 Level Trns Slct Bn Crv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95194472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 0d Lng Gorilla Bn Mtp Lt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95194473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Ulna 151mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|FSC: 13; Default||Not reimbursed separately|4,695.00|FSC: 13; Default||External grouping not supported 95194474|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 8mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95194475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 10mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95194476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gsf Flx Por Fm Por Tib Prlng Sur Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gsf Flx Por Fem Tm Mono Tib Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|FSC: 13; Default||Not reimbursed separately|17,187.00|FSC: 13; Default||External grouping not supported 95194479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Vg Por Fem Por Tib E1 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|FSC: 13; Default||Not reimbursed separately|16,287.00|FSC: 13; Default||External grouping not supported 95194480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hyb Hip-cem St Tm Cp Lg Xlpe Ln Lg St Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por St Por Cup Lg Xlpe Ln Lg Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ha Por St-nk Tm Cup Vit E Ln Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Primary Unipolar Partial Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porous Fx Unipolar Partial Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95194485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cemented Fx Unipolar Partial Hip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95194487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 26mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95194489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.7mm 14mm Loprfl Scr Ss Ft/ankl Cort Sld Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95194490|EAP|Custom 95194490||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Soft Tissue Hemi Shaped Btb Allograft|1|HUMANA [1294]||HUMANA [11839]|7,435.56|FSC: 13; Default||Not reimbursed separately|7,435.56|FSC: 13; Default||External grouping not supported 95190731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmnt Bn Hydroset Xt Ha 5cc Inj Strl Lf Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,818.00|FSC: 13; Default||Not reimbursed separately|7,818.00|FSC: 13; Default||External grouping not supported 95194486|EAP|Custom 95194486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nrstm Nevro Tunneling Tool St Lax Free Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194493|EAP|Custom 95194493||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ring Spatial Frame Full 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194494|EAP|Custom 95194494||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plate Connection Short 2hl 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194501|EAP|Custom 95194501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Cohesive High Profile 500cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Hlf 150mm 6mm Ha 45mm Xtrnfx Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|FSC: 13; Default||Not reimbursed separately|569.25|FSC: 13; Default||External grouping not supported 95194496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nl 13mm 20cm Intertrochanter Intertan Intramedullary 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|FSC: 13; Default||Not reimbursed separately|4,440.00|FSC: 13; Default||External grouping not supported 95194497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L90 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95194498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L100 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95194499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 6.25mm Swivelock Biocompostite Tenodsis 15 Ve5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95194504|EAP|Custom 95194504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Washer Bolt Fix 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194505|EAP|Custom 95194505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strut Xtrnfx 116-152mm Fst Fx Short Tlt Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Hlf 150mm 6mm Ha 50mm Xtrnfx Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|FSC: 13; Default||Not reimbursed separately|569.25|FSC: 13; Default||External grouping not supported 95194507|EAP|Custom 95194507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation 450mm 3.2mm Kirschner Stronger Thead Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 34cm Fem T2 Im Lck Ti Strl R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95194197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por St Tm Cup Lg Vit E Ln Lg Cer Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95194205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Por St Por Cp Xl Ln Std Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|FSC: 13; Default||Not reimbursed separately|12,900.00|FSC: 13; Default||External grouping not supported 95194510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow 169mm X 5.0mm 9 Hole Lock Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,078.00|FSC: 13; Default||Not reimbursed separately|9,078.00|FSC: 13; Default||External grouping not supported 95194511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 18mm 52mm Shldr Sft Tis Bal Simpliciti Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95194512|EAP|Custom 95194512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glenoid Shoulder Guide Bone Model Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194513|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 560cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194514|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Style 410 560cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194515|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 590cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194516|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Anterior Chamber 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95194520|EAP|Custom 95194520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reverse Deflection Disposable Ureteroscope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 18mm Loprfl Scr Ti Ankl Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95194502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Tibial Uka Vit E 8mm Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95194503|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Tibial Uka Vit E 9mm Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95194517|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Anterior Chamber 12.5mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95194524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 8 Hole Bridge Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95194526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fil Bn Void 1cc Dbm Allosync Gel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95194527|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 15mm 48mm Shldr Reunion Std Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 95194528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 72mm 2 Hl Bn Hum Rt Dist Lat Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95194531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Capitate 15mm 35mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|FSC: 13; Default||Not reimbursed separately|18,675.00|FSC: 13; Default||External grouping not supported 95194529|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194530|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194532|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194533|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194534|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194549|EAP|Custom 95194549||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Xtrnfx 150mm 11mm Hfmn 3 Vectran C Mdlr Cnct Mri Safe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194554|EAP|Custom 95194554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg Shrt Ao Qck Cnct Evos 1.8mm Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Evos T8 S-t 2.7mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|FSC: 13; Default||Not reimbursed separately|305.25|FSC: 13; Default||External grouping not supported 95194550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 16mm Evos T6 Cortex S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 95194551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 8mm Evos T6 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 95194552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 12mm Evos T6 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 95194553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 18mm Evos T6 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|FSC: 13; Default||Not reimbursed separately|295.35|FSC: 13; Default||External grouping not supported 95194555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 18mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95194556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.4mm Evos 3 Hole Hd 5 Hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,864.50|FSC: 13; Default||Not reimbursed separately|1,864.50|FSC: 13; Default||External grouping not supported 95194557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 18mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95194558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 18mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95194560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 16mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95194561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.0mm Evos 3 Hole Hd 5 Hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.15|FSC: 13; Default||Not reimbursed separately|1,470.15|FSC: 13; Default||External grouping not supported 95194562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7mm Evos L-d Fibula 5 Hole Right 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.55|FSC: 13; Default||Not reimbursed separately|1,628.55|FSC: 13; Default||External grouping not supported 95194563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.5mm Evos P/a P-d Tibia 3h Left 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,996.50|FSC: 13; Default||Not reimbursed separately|1,996.50|FSC: 13; Default||External grouping not supported 95194564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 30mm Evos St Lck Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.30|FSC: 13; Default||Not reimbursed separately|336.30|FSC: 13; Default||External grouping not supported 95194565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3.5mm 40mm Evos S-t Lock Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|FSC: 13; Default||Not reimbursed separately|366.30|FSC: 13; Default||External grouping not supported 95194588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 44mm Loprfl Scr Ti Ankl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95194540|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194541|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.25mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194542|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194543|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194544|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194545|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194546|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194566|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194567|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194568|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194569|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194570|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194572|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194573|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194574|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194575|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194577|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194578|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194579|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194580|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194581|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194582|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194583|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.00mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194584|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194585|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194586|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194587|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194589|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194608|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194607|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194606|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194590|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194591|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194592|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.25mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194593|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194594|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194595|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194596|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194597|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194598|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194599|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194600|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 3.50mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95194601|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194603|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194604|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194605|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194609|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 42mm X 121mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95194610|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 39cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95194612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.6mm 14mm Trinica Variable Straight Magenta S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95194613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 0 Degree Short Mtp Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95194614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95194615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 30mm Solera Cd Hzn Cocr Spne Ma Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95194616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 8.5mm 30mm Solera Cd Hzn Cocr Spne Ma Ns 5.5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95194617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 16mm Gorilla R3con Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95194618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Syndesmosis Tightrope Xp Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95194602|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 4.00mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194619|EAP|Custom 95194619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Rigid 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194633|EAP|Custom 95194633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Instruments|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194634|EAP|Custom 95194634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Neosys Single Use Instruments|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Im Nl 340mm 13mm 125d R1.5 Lng Rt Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95194623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Nar 133mmx5mm 7hl Lck Cmpr Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,481.00|FSC: 13; Default||Not reimbursed separately|8,481.00|FSC: 13; Default||External grouping not supported 95194624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Cortex 4.5mm Ti L 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95194625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Cortex 4.5mm Ti L 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95194626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Persona Tm Fem Tm Monoblock Tib Tm Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|FSC: 13; Default||Not reimbursed separately|18,087.00|FSC: 13; Default||External grouping not supported 95194627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bunionette 4 Hold 5ms|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,354.00|FSC: 13; Default||Not reimbursed separately|3,354.00|FSC: 13; Default||External grouping not supported 95194628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Colag 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|FSC: 13; Default||Not reimbursed separately|867.00|FSC: 13; Default||External grouping not supported 95194629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95194630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95194631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95194632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 24mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|FSC: 13; Default||Not reimbursed separately|354.00|FSC: 13; Default||External grouping not supported 95194636|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round Ultra High Profile 225cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95194637|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round Ultra High Profile 250cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95194638|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Round Modrt Classic Profile 255cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95194639|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.50mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194640|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Sierra Evrlmus Eluting Coronary 2.75mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95194641|EAP|Custom 95194641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Acl Bone Tendon Bone Disposable Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194642|EAP|Custom 95194642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drlbt Cntrsnk 2.8mm 2.0mm Asns Mic Cnn Ao Cplng Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194644|EAP|Custom 95194644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Cannulated Micro 2.0mm Ao Coupling Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171111|EAP|CPT® 55876||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Of Interstitial Device(s) For Rad Therapy Guide Prostate|1|HUMANA [1294]||HUMANA [11839]|3,844.33|FSC: 13; Default||Not reimbursed separately|3,844.33|FSC: 13; Default||External grouping not supported 95194647|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +19.0 Diopter +3.75 Cyl Haptic C Biconvex 13mm 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95194648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Asnis Iii Titanium L80 Mm Od6.5 Mm Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95194649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Fixation Hammerfix Peek L6.8mm Large L15 Mm L7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95194650|EAP|Custom 95194650||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Hammerfix Large L15 Mm L7.0mm Od4.0mm Ods5.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194651|EAP|Custom 95194651||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue Fresh Right Medial Hemi Condyle|1|HUMANA [1294]||HUMANA [11839]|35,010.00|FSC: 13; Default||Not reimbursed separately|35,010.00|FSC: 13; Default||External grouping not supported 95194652|EAP|Custom 95194652||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 100mm 28mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 40mm|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95194653|EAP|Custom 95194653||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stnt 70mm 25mm 16mm Afx2 2 Brch Main Bd Ilc Lmb 30mm|1|HUMANA [1294]||HUMANA [11839]|44,997.00|FSC: 13; Default||Not reimbursed separately|44,997.00|FSC: 13; Default||External grouping not supported 95194655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Fastener Tibial 10mm X 30mm Exoshape Soft Tissue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95194666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Hlf 120mm 3mm Apx Ss Thrd Slf Drl St 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95194667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Strength Tine Evos 2.4mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,013.00|FSC: 13; Default||Not reimbursed separately|2,013.00|FSC: 13; Default||External grouping not supported 95194668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 14mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95194669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 28mm Evos Mn T7 Cort St Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.03|FSC: 13; Default||Not reimbursed separately|96.03|FSC: 13; Default||External grouping not supported 95194670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2.4mm 12mm Evos T7 Lock S-t|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95194671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Small Shell 12mm X 108mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|FSC: 13; Default||Not reimbursed separately|19,374.00|FSC: 13; Default||External grouping not supported 95194673|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Matrix Ortho Bone Viable Bio4 2.5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.00|FSC: 13; Default||Not reimbursed separately|6,375.00|FSC: 13; Default||External grouping not supported 95194674|EAP|Custom 95194674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1.4mm X 27mm Ao End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194682|EAP|Custom 95194682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit W/quick Connect 2.7mm Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Med Inferior 10 Hole 117mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,944.00|FSC: 13; Default||Not reimbursed separately|1,944.00|FSC: 13; Default||External grouping not supported 95194675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tapping 1.7 X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 95194676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L20 Mm Od3.5 Mm Odsec12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95194677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L20 Mm Od3.5 Mm Odsec14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95194678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute L20 Mm Od3.5 Mm Odsec16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|FSC: 13; Default||Not reimbursed separately|326.70|FSC: 13; Default||External grouping not supported 95194679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 14mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95194680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 16mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95194681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ss T20 Cut Flute 20mm 3.5mm 6.8mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95194684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Tandem Bipolar Non Por Fem W/ Oxihd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|FSC: 13; Default||Not reimbursed separately|9,300.00|FSC: 13; Default||External grouping not supported 95194685|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Tissue Pre Cut Split For Dmek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|FSC: 13; Default||Not reimbursed separately|14,400.00|FSC: 13; Default||External grouping not supported 95194686|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000305 Core Grafix Pl 2cm X 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95194687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95194688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95194690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone 10x9mm Arthrex Dynanite Nitinol Titanium Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95194691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 64mm Ss T8 Elb Mtphsl St Strdr Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95194693|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Alloderm Slct Duo Cont Lg Perforated Med 1.6mm/0.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.89|FSC: 13; Default||Not reimbursed separately|135.89|FSC: 13; Default||External grouping not supported 95194694|EAP|Custom 95194694||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spcr Spnl 14x9mm Vrtstck Crstn Psr 11mm Peek-optm Lat Port|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95194695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dorsal Wrist Hook 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,773.00|FSC: 13; Default||Not reimbursed separately|1,773.00|FSC: 13; Default||External grouping not supported 95194696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Pin Doral Ulna 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|FSC: 13; Default||Not reimbursed separately|1,518.00|FSC: 13; Default||External grouping not supported 95194697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Dorsal 27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|FSC: 13; Default||Not reimbursed separately|702.00|FSC: 13; Default||External grouping not supported 95194698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wire Form 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95194699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 10mm Ankl Torx Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95194700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 20mm Ankl Torx Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95194701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.3mm 22mm Ank Torx Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95194703|EAP|Custom 95194703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Fiberloop 2-0 14' Tapered Needle 17.9mm 3/8 Circle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194705|EAP|Custom 95194705||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 2-0 30cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194706|EAP|Custom 95194706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 2-0 22cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95194713|EAP|Custom 95194713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 15x7mm Divergence 12mm Lrdtc Ncl Pulposus Peek|1|HUMANA [1294]||HUMANA [11839]|11,550.00|FSC: 13; Default||Not reimbursed separately|11,550.00|FSC: 13; Default||External grouping not supported 95194714|EAP|Custom 95194714||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Gore Excluder 10cm 10mm Iliac Br Comp Aaa|1|HUMANA [1294]||HUMANA [11839]|33,057.00|FSC: 13; Default||Not reimbursed separately|33,057.00|FSC: 13; Default||External grouping not supported 95194715|EAP|Custom 95194715||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grft Evas 10cm 23mm 21.5-25.5mm Xcldr Cntrlt Lg Grtx Ntnl|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95194716|EAP|Custom 95194716||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 7cm 10mm Gore Xcldr Ilc Intnl Cmpnt Aaa|1|HUMANA [1294]||HUMANA [11839]|9,456.00|FSC: 13; Default||Not reimbursed separately|9,456.00|FSC: 13; Default||External grouping not supported 95194717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 46mm Asns Cnn Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 95194719|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Ndc 59857000307 Prime 3cm X 4cm Grafix Pl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.75|FSC: 13; Default||Not reimbursed separately|303.75|FSC: 13; Default||External grouping not supported 95194720|EAP|Custom 95194720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill 3.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Bc Ft Suture Dx 4.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95194722|EAP|Custom 95194722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Bc Corkscrew 4.5mmx14mm Disps Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cmpnt Tlr Inbone 5 Dome Ankl Sulcus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,123.00|FSC: 13; Default||Not reimbursed separately|15,123.00|FSC: 13; Default||External grouping not supported 95194725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Tib 5 8mm Ankl Poly Infinity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,096.00|FSC: 13; Default||Not reimbursed separately|6,096.00|FSC: 13; Default||External grouping not supported 95194727|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Tissue Pre-cut Split For Dmek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95194728|EAP|Custom 95194728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture 9-0 12" Vicryl Cs160-8 Spatula Violet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194729|EAP|Custom 95194729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ethilon Black Mono 8-0 Bv130-4 5mm 5 3/8 Circle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194730|EAP|Custom 95194730||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extender Endoprosthesis Lilac 16mm X 10mm X 7cm|1|HUMANA [1294]||HUMANA [11839]|10,005.00|FSC: 13; Default||Not reimbursed separately|10,005.00|FSC: 13; Default||External grouping not supported 95194731|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel 14.5cm 5.1cm Xtra 605cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95194732|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel 14.3cm 4.8cm Xtra 560cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95194737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 90d Lt 90mm Ss 2.4mm Screw 2 Hole Head 5 Hole Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|FSC: 13; Default||Not reimbursed separately|1,812.63|FSC: 13; Default||External grouping not supported 95194738|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Catheter Delivery 43cm C315his|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194710|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit 50cm 8 Contact Trail Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95194711|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Neurostimulator 50cm Infinion 16 Contact Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95194723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Formable Vivigen 5cc Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,045.20|FSC: 13; Default||Not reimbursed separately|7,045.20|FSC: 13; Default||External grouping not supported 95194739|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter System Select Site Deflectable 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194741|EAP|Custom 95194741||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Hydrated Lordotic 10mm|1|HUMANA [1294]||HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95194742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 40mm Ti 2 Lvl Trnc Sl Bn Spne Crv Ant Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 36mm Variax T8 Ft Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95194744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 36mm Asns Cnn Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 95194745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 40mm Asns Cnn Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 95194746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 12mm 420mm Tib T2 Im Std Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95194747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 14mm 200mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95194748|EAP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drsg Wnd 1.6cm Puraply Disc Cm Anmc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95194749|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Ndc 59857000312 5cm X 5cm Grafixpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.80|FSC: 13; Default||Not reimbursed separately|145.80|FSC: 13; Default||External grouping not supported 95194750|EAP|Custom 95194750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Vl Mitral Pericardial Pls Perimount Thrm 25mm|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95194751|EAP|Custom 95194751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Vl Mitral Pericardial Pls Perimount Thrm 27mm|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95194752|EAP|Custom 95194752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Vl Mitral Pericardial Pls Perimount Thrm 29mm|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95194753|EAP|Custom 95194753||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Vl Mitral Pericardial Pls Perimount Thrm 31mm|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95194754|EAP|Custom 95194754||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Vl Mitral Pericardial Pls Perimount Thrm 33mm|1|HUMANA [1294]||HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95194756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7mm 115mm Cannulated Headless Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|FSC: 13; Default||Not reimbursed separately|1,971.00|FSC: 13; Default||External grouping not supported 95194758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7mm 100mm Cannulated Headless Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|FSC: 13; Default||Not reimbursed separately|1,971.00|FSC: 13; Default||External grouping not supported 95194759|EAP|Custom 95194759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 2mm Mnqk Cplng Gld Hl Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 31mm Ti 2mm Scr Mdlr Mn Frag Sys 4 Hl Loprfl Cut To|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 95194761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 12mm Lcp Ti Sm Bn Cort St Strdr Ns Mn Frag Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95194762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 18mm Lcp Ti Bn Cort St Strdr Ns Mn Frag Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95194763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 16mm Lcp Ti Bn Cort St Strdr Ns Mn Frag Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95194764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Locking 3.5mm X 45mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95194765|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol +19.5 Diop +4 Add Mod C Bcnvx 13mm 6mm Pc 1 Pc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95194766|EAP|Custom 95194766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Kit Toemotion 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Capitate 15mm 22mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|FSC: 13; Default||Not reimbursed separately|18,675.00|FSC: 13; Default||External grouping not supported 95194768|EAP|Custom 95194768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Btn 12mm 3cm Psprt Sil Crv Loprfl Hip 1 Pc Mld 2 Dam Dsg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194718|EAP|Custom 95194718||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stone Tipless Nitinol Perc N Circle 12 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194755|EAP|Custom 95194755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 5mm Cnn Qck Cnct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194656|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Tibial Uka Vit E 8mm Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95194757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 7mm 110mm Cannulated Headless Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|FSC: 13; Default||Not reimbursed separately|1,971.00|FSC: 13; Default||External grouping not supported 95194769|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 1.0 Diopter Anterior Chamber 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95194771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 97mm Ti 6 Hl Axsos 3 Bn Tib Rt Prox Mdl Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,670.00|FSC: 13; Default||Not reimbursed separately|8,670.00|FSC: 13; Default||External grouping not supported 95194772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gmk Sphere Insert Set Lt I5-t3/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95194776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 1-level 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95194778|EAP|Custom 95194778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Catheterization Foley 16fr Dia Temperature-sensing Micr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 40mm T10 Ft Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95194782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 50mm T10 Ft Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95194783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 60mm T10 Ft Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95194784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.5mm 20mm Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.00|FSC: 13; Default||Not reimbursed separately|2,016.00|FSC: 13; Default||External grouping not supported 95194787|EAP|Custom 95194787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Fibertak 1.70mm Flexible|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194789|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Acrysof Toric Iq|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95191032|EAP|Custom 95191032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Cv 18mm 2mm Flthr Intrlum Radopq Tube Atrm Blb End Sil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194790|EAP|Custom 95194790||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Collar Cervical Xsmall Miami-j W/replacement-pad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-tapping 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95194792|EAP|Custom 95194792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Cv 18mm 2.5mm Flthr Intrl Radopq Tube Atrm Blb End Sil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 2.4mm Evos 2 Hole Hd 6 Hole Sft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,864.50|FSC: 13; Default||Not reimbursed separately|1,864.50|FSC: 13; Default||External grouping not supported 95194802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 10mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95194803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 11mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|FSC: 13; Default||Not reimbursed separately|93.06|FSC: 13; Default||External grouping not supported 95194804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.4mm 8mm Evos T7 Cort St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|FSC: 13; Default||Not reimbursed separately|301.95|FSC: 13; Default||External grouping not supported 95194805|EAP|Custom 95194805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Bulldog Maxi Straight 50-60 Grams Blue Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 60mm Asns Sld Ns Jns Fxn Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|FSC: 13; Default||Not reimbursed separately|2,934.00|FSC: 13; Default||External grouping not supported 95194808|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Restor Multifocal Torric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95194657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brng Tibial Uka Vit E 8mm Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95194810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 26mm Loprfl Scr Ti Ankl Va St Sld Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95194812|EAP|Custom 95194812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Kumar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194813|EAP|Custom 95194813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Mando|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194814|EAP|Custom 95194814||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Bone 2.3mm X 110mm|1|HUMANA [1294]||HUMANA [11839]|436.80|FSC: 13; Default||Not reimbursed separately|436.80|FSC: 13; Default||External grouping not supported 95194815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 340mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95194818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Invisiknot Ankle Syndesmosis Fracture Kit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|FSC: 13; Default||Not reimbursed separately|3,510.00|FSC: 13; Default||External grouping not supported 95194822|EAP|Custom 95194822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Allogen Liquid Large 1.00ml|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95194821|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pro Chondrix Allograft Fresh Cryo 15mm X 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|FSC: 13; Default||Not reimbursed separately|12,234.00|FSC: 13; Default||External grouping not supported 95194830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 342mm Ss 4.5mm Scr 10 Hl Lck Prlc Bn Fem Lt Dist Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,056.75|FSC: 13; Default||Not reimbursed separately|4,056.75|FSC: 13; Default||External grouping not supported 95194831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 5.7mm X 80mm Cann Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95194832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 5.7mm X 85mm Cann Lck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95194833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm X 36mm Peri-loc Cortical Self-tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|FSC: 13; Default||Not reimbursed separately|62.79|FSC: 13; Default||External grouping not supported 95194834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 7.9mm 32mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 95194835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4.5mm 7.9mm 34mm Prlc Ss T25 Flut Lng Bn Sm Bn 3 Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|FSC: 13; Default||Not reimbursed separately|383.40|FSC: 13; Default||External grouping not supported 95194836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm X 85mm Peri-loc Canncellous Partial Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.98|FSC: 13; Default||Not reimbursed separately|127.98|FSC: 13; Default||External grouping not supported 95194837|EAP|Custom 95194837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit W/quick Connect 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194838|EAP|Custom 95194838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit W/ Quick Connect 4.5mm Peri-loc Targeter Lr Fragme|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194840|EAP|Custom 95194840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Crown 5mm Dia F/universal Emergency Screw Ext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194841|EAP|Custom 95194841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Surgical 3.7mm Dia Drift F/universal Em Screw Ex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194843|EAP|Custom 95194843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dilation Multi Sinus Ul Express Entellus 6mmx20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nl 14mm 400mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95194842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T10 Sht Pa Lck Bn Talonavicular Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,658.00|FSC: 13; Default||Not reimbursed separately|5,658.00|FSC: 13; Default||External grouping not supported 95194844|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel 12.6cm 4.1cm Xtra 370cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95194845|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mentor Memorygel 12.3cm 4.1cm Xtra 354cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95194861|EAP|Custom 95194861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Trinica Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 51mm Trinica 3 Level Titanium Select|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95194863|EAP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Intvrtb 15x7mm Mobi-c 15mm Spne Crv Cocrmo Ti Uhmwpe Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95194870|EAP|Custom 95194870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Single Ended Trocar Tip Smooth 2.3 X 230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194872|EAP|Custom 95194872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Juggerknot Soft Anchor 2.9mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 30mm Gorilla Ns R3con Non Lck Plt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95194868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Gorilla R3con Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95194867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Gorilla R3con Nonlock Plt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95194866|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 700cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194865|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 650cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95194874|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Fenestrated Proximal Custom 32x94mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,050.00|FSC: 13; Default||Not reimbursed separately|28,050.00|FSC: 13; Default||External grouping not supported 95194875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Two Hole Stainless Steel Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95194876|EAP|Custom 95194876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Passer Firstpass Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194877|EAP|Custom 95194877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Transrectal Biplane Simultaneous Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 17mm 40mm Reunion Std Rds T/s Arthpl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 80171122|EAP|CPT® 20680||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Deep Implant|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95194882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.6mm 20mm Anchorage T8 Ft/ankl Lg Cx Plt Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|FSC: 13; Default||Not reimbursed separately|879.00|FSC: 13; Default||External grouping not supported 95194883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4mm 50mm Asns Sld Ns Jfx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|FSC: 13; Default||Not reimbursed separately|5,841.00|FSC: 13; Default||External grouping not supported 95194884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone 10x10x10mm Superelastic Easyclip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95194896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.4mm 10mm Variax T8 Full Thread Lock Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95194885|EAP|Custom 95194885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Snap Microfx Ocd 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194886|EAP|Custom 95194886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Snap Microfx Ocd 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194887|EAP|Custom 95194887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Snap Microfx Ocd 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194888|EAP|Custom 95194888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Snap Microfx Ocd 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194889|EAP|Custom 95194889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Curette Microfx Ocd Angled Ring Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194890|EAP|Custom 95194890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Microfx Ocd 45 Deg Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194891|EAP|Custom 95194891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Microfx Ocd 70 Deg Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194892|EAP|Custom 95194892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Microfx Ocd 90 Deg Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194893|EAP|Custom 95194893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Microfx Ocd Universal Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194895|EAP|Custom 95194895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Phoenix Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171133|EAP|CPT® 28153||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Resection, Condyle(s), Distal End Of Phalanx, Each Toe|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 80171134|EAP|CPT® 52310||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cysto W Removal Of Fb From Urethra Or Bladder|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95194901|EAP|Custom 95194901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 12.7cm Mrygel X P6.3cm Hi Prfl Rnd Brst Gel 560cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194908|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Technic Torric One Piece 6mm Cyl 5.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95194909|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Technic Torric One Piece 6mm Cyl 4.50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95194902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 32mm Vrtx Mx Ti P/t Spne Ma Ns Grn Recon Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|FSC: 13; Default||Not reimbursed separately|4,565.82|FSC: 13; Default||External grouping not supported 95194903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 1.8mm Y-knot Flex With 2 Ribbons 1.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95194904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Rc Y-knot Flex With 2 Ribbons 1.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95194905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Rc Y-knot Flex With 3 Ribbons 1.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95194906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 1.8mm Y-knot Flex With 1 Ribbons White/blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95194907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 1.8mm Y-knot Flex With 1 Ribbons Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95194910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Impl 18x18x18mmsecod2.5 Bme Elt 10.4mm 2 Lg Brdg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.72|FSC: 13; Default||Not reimbursed separately|5,664.72|FSC: 13; Default||External grouping not supported 95194911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Impl 25x20x20x20x20mm Secod2.5 Bme Elt 7.1mm 4 Lg Brdg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,313.77|FSC: 13; Default||Not reimbursed separately|6,313.77|FSC: 13; Default||External grouping not supported 95194913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11.5mm 40cm Intertrochanter Lt Trgn Intertan Im 125d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95194914|EAP|Custom 95194914||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Handset Comm Tdd Prox Myptm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194917|EAP|Custom 95194917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Negative Pressure 35cm Prevena Plus System W/peel/place|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194918|EAP|Custom 95194918||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Evas 14cm 23mm 18.5-21.5mm Xcldr Cntrlt Lg Grtx Ntnl|1|HUMANA [1294]||HUMANA [11839]|14,217.00|FSC: 13; Default||Not reimbursed separately|14,217.00|FSC: 13; Default||External grouping not supported 95194919|EAP|Custom 95194919||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular 14cm 26mm 14.5mm 22-23mm 12-13.5mm Gore E|1|HUMANA [1294]||HUMANA [11839]|34,671.00|FSC: 13; Default||Not reimbursed separately|34,671.00|FSC: 13; Default||External grouping not supported 95194915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 70mm Fem Loprfl Intnl Hex Trgn Im Nl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95194916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2.7mm 13mm Gorilla R3con Lck Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95194920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 12mm Hdls Cnn Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.15|FSC: 13; Default||Not reimbursed separately|741.15|FSC: 13; Default||External grouping not supported 95194921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 13mm Headless Cann Strle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.15|FSC: 13; Default||Not reimbursed separately|741.15|FSC: 13; Default||External grouping not supported 95194922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 10mm Ti Lck Ns Axsos 3 Periprosthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|FSC: 13; Default||Not reimbursed separately|1,110.00|FSC: 13; Default||External grouping not supported 95194924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 4.1mm 48mm T10 Lag Cross Plate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95194925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Strength Evos 2.0mm 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|FSC: 13; Default||Not reimbursed separately|1,519.65|FSC: 13; Default||External grouping not supported 95194926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2mm 3mm 10mm Evos T6 Cortex Self Tap Mini Plate S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 95194927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 2mm 3mm 26mm Evos T6 Cort St Mn Plt Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|FSC: 13; Default||Not reimbursed separately|88.20|FSC: 13; Default||External grouping not supported 95194928|EAP|Custom 95194928||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adapter Gateway Y Latex Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194929|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Urn Tract 5.8fr 24fr 75cm 4cm Hi-prs Kink Rst Shft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95194931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.5mm Trilock Rsl Fusion Pi Left Dorsal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.65|FSC: 13; Default||Not reimbursed separately|4,192.65|FSC: 13; Default||External grouping not supported 95194932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 12mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 14mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 16mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 18mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 20mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 22mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.5mm X 24mm Cortical Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|FSC: 13; Default||Not reimbursed separately|305.55|FSC: 13; Default||External grouping not supported 95194939|EAP|Custom 95194939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.0mm 40mm 91mm Ao Quick Coupling|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194940|EAP|Custom 95194940||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Trocar 1.6 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171144|EAP|CPT® 0515T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Insert Wireless Cardiac Stim L Ventricle Complete System|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 80171155|EAP|CPT® 0516T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Insert Wireless Cardiac Stim L Ventricle Electrode Only|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80171166|EAP|CPT® 0517T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Insert Wireless Cardiac Stim L Ventricle Battery Only|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80171177|EAP|CPT® 0518T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Removal Pulse Generator Of Wireless Stimulator|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80171188|EAP|CPT® 0519T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Removal And Replace Pulse Wireless Stimulator W Generator|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80171199|EAP|CPT® 0520T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Removal And Replace Pulse Wireless Stimulator W Electrode|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 80171200|EAP|CPT® 0521T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Interrogation Device Eval Wireless Stim L Ventricle Pacing|1|HUMANA [1294]||HUMANA [11839]|70.98|FSC: 13; Default||Not reimbursed separately|70.98|FSC: 13; Default||External grouping not supported 80171211|EAP|CPT® 0522T||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Programming Device Wireless Cardiac Stim L Vent Pacing|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80171233|EAP|CPT® 10005||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Ultrasound First Lesion|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80171222|EAP|CPT® 10004||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W/o Guidance Add Lesion|1|HUMANA [1294]||HUMANA [11839]|120.62|FSC: 13; Default||Not reimbursed separately|120.62|FSC: 13; Default||External grouping not supported 80171244|EAP|CPT® 10006||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Ultrasound Add Lesion|1|HUMANA [1294]||HUMANA [11839]|120.62|FSC: 13; Default||Not reimbursed separately|120.62|FSC: 13; Default||External grouping not supported 80171255|EAP|CPT® 10007||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Fluor First Lesion|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80171266|EAP|CPT® 10008||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Fluor Add Lesion|1|HUMANA [1294]||HUMANA [11839]|120.62|FSC: 13; Default||Not reimbursed separately|120.62|FSC: 13; Default||External grouping not supported 80171277|EAP|CPT® 10009||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Ct Guidance First Lesion|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80171288|EAP|CPT® 10010||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Ct Guidance Add Lesion|1|HUMANA [1294]||HUMANA [11839]|120.62|FSC: 13; Default||Not reimbursed separately|120.62|FSC: 13; Default||External grouping not supported 80171300|EAP|CPT® 10012||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Mr Guidance Add Lesion|1|HUMANA [1294]||HUMANA [11839]|120.62|FSC: 13; Default||Not reimbursed separately|120.62|FSC: 13; Default||External grouping not supported 80171299|EAP|CPT® 10011||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fine Needle Aspiration Bx W Mr Guidance First Lesion|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80171311|EAP|CPT® 11102||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tangential Biopsy Of Skin Single Lesion|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 80171322|EAP|CPT® 11103||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tangential Biopsy Of Skin Each Additional Lesion|1|HUMANA [1294]||HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 80171333|EAP|CPT® 11104||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Punch Biopsy Of Skin Single Lesion|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 80171344|EAP|CPT® 11105||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Punch Biopsy Of Skin Each Additional Lesion|1|HUMANA [1294]||HUMANA [11839]|264.68|FSC: 13; Default||Not reimbursed separately|264.68|FSC: 13; Default||External grouping not supported 80171355|EAP|CPT® 11106||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incisional Biopsy Of Skin Single Lesion|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 80171366|EAP|CPT® 11107||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incisional Biopsy Of Skin Additional Lesion|1|HUMANA [1294]||HUMANA [11839]|735.68|FSC: 13; Default||Not reimbursed separately|735.68|FSC: 13; Default||External grouping not supported 80171377|EAP|CPT® 27369||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Procedure For Contrast Knee Arthrography|1|HUMANA [1294]||HUMANA [11839]|519.81|FSC: 13; Default||Not reimbursed separately|519.81|FSC: 13; Default||External grouping not supported 80171388|EAP|CPT® 33274||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcath Insert Or Replace Perm Leadless Pacemaker|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80171399|EAP|CPT® 33275||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcath Removal Perm Leadless Right Ventricular|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80171400|EAP|CPT® 33285||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insertion Subq Cardiac Rhythm Monitor W Programming|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80171411|EAP|CPT® 33286||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Subq Cardiac Rhythm Monitor|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80171422|EAP|CPT® 33289||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcatheter Implant Wireless Pulm Artery Pressure Sensor Long Term|1|HUMANA [1294]||HUMANA [11839]|88,045.39|FSC: 13; Default||Not reimbursed separately|88,045.39|FSC: 13; Default||External grouping not supported 80171433|EAP|CPT® 36572||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Picc Without Port Or Pump Under Age 5|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80171444|EAP|CPT® 36573||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Picc Without Port Or Pump Over Age 5|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80171455|EAP|CPT® 43762||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Replace Gastro Tube Perc W/o Imaging W/o Revision G-tract|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 80171466|EAP|CPT® 43763||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Replace Gastro Tube Perc W/o Imaging W Revision G-tract|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 80171477|EAP|CPT® 50436||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Dilation Existing Tract Perc Endourological Procedure|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80171488|EAP|CPT® 50437||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Dilation Existing Tract Perc Endourological Proc New Access|1|HUMANA [1294]||HUMANA [11839]|9,318.17|FSC: 13; Default||Not reimbursed separately|9,318.17|FSC: 13; Default||External grouping not supported 80171499|EAP|CPT® 77046||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Breast W/o Contrast Unilateral|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80171500|EAP|CPT® 77047||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Breast W/o Contrast Bilateral|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80171511|EAP|CPT® 77048||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Breast W W/o Contrast Unilateral Includes Cad|1|HUMANA [1294]||HUMANA [11839]|1,102.29|FSC: 13; Default||Not reimbursed separately|1,102.29|FSC: 13; Default||External grouping not supported 80171522|EAP|HCPCS C8908||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Breast W W/o Contrast Bilateral Includes Cad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95194951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 22mm Cort Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95194952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 26mm Cort Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95194953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Use 3.5mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95194954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Trident Ii - Up Charge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95194955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Mdm - Up Charge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95194957|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz 2 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,096.00|FSC: 13; Default||Not reimbursed separately|6,096.00|FSC: 13; Default||External grouping not supported 95194958|EAP|Custom 95194958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 7mm Compr Ft Xl Screw Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 7mm 85mm Arthx Ti T25 Xl Ft Cmpr Cannulation Hdls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95194962|EAP|Custom 95194962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Prestige 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194963|EAP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Intvrtb 18mm 6mm Pstg Lp Cspn Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95194964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 7mm 23cm Hum T2 Im Rtrgd Antgrd Lck Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,545.00|FSC: 13; Default||Not reimbursed separately|4,545.00|FSC: 13; Default||External grouping not supported 80171533|EAP|CPT® 33968||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Intra-aortic Balloon Assist Device, Percutaneous|1|HUMANA [1294]||HUMANA [11839]|3,391.50|FSC: 13; Default||Not reimbursed separately|3,391.50|FSC: 13; Default||External grouping not supported 95194965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 65mm Variax Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95194967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 4.0mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95194968|EAP|Custom 95194968||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spnl 45mmx12mm Clydesdale 6d Peek-optm Radopq Hlw Lmbr|1|HUMANA [1294]||HUMANA [11839]|20,460.00|FSC: 13; Default||Not reimbursed separately|20,460.00|FSC: 13; Default||External grouping not supported 95194969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Journey Pfj Oxinium W/resurf Pat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|FSC: 13; Default||Not reimbursed separately|11,100.00|FSC: 13; Default||External grouping not supported 95194971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non Locking 2.7mm X 26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95194972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Threaded Cortical Non Locking 2.7mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95194973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95194974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95194689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95194975|EAP|Custom 95194975||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repair Meniscal Root With Ultrabraid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Ti Fluted Locking 2.3mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|FSC: 13; Default||Not reimbursed separately|342.00|FSC: 13; Default||External grouping not supported 95194977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 34cm Rt Intertrochanter Intertan Im 130d 1.5mm 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95194981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 4.5mm 38mm Loprfl Scr Ti Ankl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95194982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Std 110mm Ss 2.4mm Scr 7 Hle/hd 5 Hl Sht 2 Clmn Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,066.71|FSC: 13; Default||Not reimbursed separately|7,066.71|FSC: 13; Default||External grouping not supported 95194983|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue 19.3x9.6cm Duo Alloderm Slct Thin 1.0-0.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.02|FSC: 13; Default||Not reimbursed separately|136.02|FSC: 13; Default||External grouping not supported 95194984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 6.5mm 20mm Cmprh Ti 3.5mm Cntr Hex Strl Rvrs Shldr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95194985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 4mm 38mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95194986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 3mm 26mm Mn Hd Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|FSC: 13; Default||Not reimbursed separately|1,011.00|FSC: 13; Default||External grouping not supported 95194987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Bone 12x10x10mm Superelastic Easyclip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95194988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3mm 12mm Mn Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95194989|EAP|Custom 95194989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Bn Cmnt 200mm 8ga Accuport Mlt Dlv Strl Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194990|EAP|Custom 95194990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cnn Bn Cmnt 200mm 8ga Accuport End Dlv Strl Lf Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ins Hum 8mm 70mm Shldr X3 Cnstrn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95194993|EAP|Custom 95194993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture #2 38in Co Braid Blue White Ultrabraid Latex Free St|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194994|EAP|Custom 95194994||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Eyld Berghaus/schrom Pltn Chn Flxb 1.6gm Strl|1|HUMANA [1294]||HUMANA [11839]|2,688.00|FSC: 13; Default||Not reimbursed separately|2,688.00|FSC: 13; Default||External grouping not supported 95194956|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Impl Inf Pwr Inj 6.6fr 1.3mm Id Strd 75cml Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95194998|EAP|Custom 95194998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Pt Gray 4.0mm X 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195000|EAP|Custom 95195000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Stratafix Spiral Pds Plus Violet 2-0 15cm Ct-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt 5d Med 47mm 3di Fsn Loprfl Cmpr Slot Ortholoc Bn Ft Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 95194995|EAP|Custom 95194995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gmk Sphere Femoral Set 5+|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95194996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Internalbrace System Peek Forefoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95194997|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtrx Tiss 2x4cm Regen Contr 8ssqcm Sm Alloderm Aclr Derm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|169.87|FSC: 13; Default||Not reimbursed separately|169.87|FSC: 13; Default||External grouping not supported 95195001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stm Radl 11mmx0mm 37mm Align Ti Sd Ld Hbrd Hd Dsgn Unq Algn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,161.00|FSC: 13; Default||Not reimbursed separately|7,161.00|FSC: 13; Default||External grouping not supported 95195002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 24mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95195003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression 3.5mm X 55mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95195004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hummerus Proximal Left 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95195005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 30mm Cort Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95195006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 28mm Cort Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95195007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Nar 137mmx5mm 7hl Lck Cmpr Bn Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,481.00|FSC: 13; Default||Not reimbursed separately|8,481.00|FSC: 13; Default||External grouping not supported 95195008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn Compression Headless Short Thread 7.0mm L60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95195009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 40cm Lt Troch Intertan Im 130d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95195010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anch Sut 6.5mm Frc Fbr Glnd Ndl Wdg Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|613.80|FSC: 13; Default||Not reimbursed separately|613.80|FSC: 13; Default||External grouping not supported 95195011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 3.5mm 22mm Anchorage Ti T8 Ft/ankl Tx Hd Lck Ns Ylw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95195015|EAP|Custom 95195015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 5.4cm Hg Profile Round Od10.7cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195016|EAP|Custom 95195016||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 5.5cm Hg Profile Round Od11.3cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195017|EAP|Custom 95195017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 4.1cm Md Profile Round Od12.3cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195018|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 11cm Mentr Memorygel P5.5cm Hi Prfl Rnd Smth 355cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95195019|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 11.3cm Mentr Memorygel 5.5cm Hi Prf Rnd Smth 380cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95195020|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 10.3cm Mentr Memorygel 5.4cm Hi Prf Rnd Smth 335cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95164158|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95195021|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst Natrelle Inspira Smth Shl Srfc Sftch 605cc Strl Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95195022|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Inspira 550cc Bi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95195023|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Impl Brst 15.5x13.9cm Natrelle P7.1cm Mdrt Ht X Full Prj Sil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95195025|EAP|Custom 95195025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 6.3cm Hg Prf Rnd Od12.7cm 560cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195026|EAP|Custom 95195026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 6.3cm Hg Prf Rnd Od13.1cm 595cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195027|EAP|Custom 95195027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 6.5cm Hg Prf Rnd Od13.5cm 650cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195028|EAP|Custom 95195028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 6.5cm Hg Prf Rnd Od14.1cm 700cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195033|EAP|Custom 95195033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Xtrnfx 300mm 1.8mm Ilz Tib Ss Bynt Pnt Stpr Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hd Hum 15mm 52mm Shldr Sft Tis Bal Simpliciti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95195036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Hum 21mm 52mm Shldr Rsrfc Apcl Flt Glbl Cap Cta Duofix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,431.75|FSC: 13; Default||Not reimbursed separately|16,431.75|FSC: 13; Default||External grouping not supported 95195029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn 175mm Ti 10 Hl Lck Variax Bn Rt Post Mdl Elb Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95195030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxail Non Locking 3.5mm X 28mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95195031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxail Non Locking 3.5mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95195032|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 28mm X 109mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95164159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plater Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95164160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|FSC: 13; Default||Not reimbursed separately|5,820.00|FSC: 13; Default||External grouping not supported 95164161|EAP|Custom 95164161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Diamond Point #2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159105|EAP|Custom 80159105||0998 - STATISTICAL CHARGES|Hb Prepaid Surigcal Implant $0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62058227|EAP|CPT® 80150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Amikacin Peak|1|HUMANA [1294]||HUMANA [11839]|45.24|FSC: 13; Default||Not reimbursed separately|45.24|FSC: 13; Default||External grouping not supported 62058235|EAP|CPT® 80150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Amikacin Random|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.24|FSC: 13; Default||Not reimbursed separately|45.24|FSC: 13; Default||External grouping not supported 62058243|EAP|CPT® 80150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Amikacin Trough|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.24|FSC: 13; Default||Not reimbursed separately|45.24|FSC: 13; Default||External grouping not supported 62058250|EAP|CPT® 82803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Blood Gas Venous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 62058276|EAP|CPT® 83661||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fetal Lung Maturity|1|HUMANA [1294]||HUMANA [11839]|65.97|FSC: 13; Default||Not reimbursed separately|65.97|FSC: 13; Default||External grouping not supported 62058284|EAP|CPT® 87210||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Wet Prep|1|HUMANA [1294]||HUMANA [11839]|17.46|FSC: 13; Default||Not reimbursed separately|17.46|FSC: 13; Default||External grouping not supported 62058300|EAP|CPT® 82330||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Calcium Ionized Dialysis Port|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.04|FSC: 13; Default||Not reimbursed separately|41.04|FSC: 13; Default||External grouping not supported 62058318|EAP|CPT® 82330||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Free Calcium Ionized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.04|FSC: 13; Default||Not reimbursed separately|41.04|FSC: 13; Default||External grouping not supported 62058326|EAP|CPT® 82565||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Creatinine, Blood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.36|FSC: 13; Default||Not reimbursed separately|15.36|FSC: 13; Default||External grouping not supported 62058334|EAP|CPT® 82330||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb I-stat(poc) Ionized Calcium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.04|FSC: 13; Default||Not reimbursed separately|41.04|FSC: 13; Default||External grouping not supported 62058433|EAP|CPT® 82104||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb A1a Phenotype - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|43.38|FSC: 13; Default||Not reimbursed separately|43.38|FSC: 13; Default||External grouping not supported 62058383|EAP|Custom 62058383||0998 - STATISTICAL CHARGES|HB A1A GENO/REFLEX TO PHENO-ARUP|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62058375|EAP|CPT® 84030||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Newborn Screen Flo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.00|FSC: 13; Default||Not reimbursed separately|123.00|FSC: 13; Default||External grouping not supported 80159122|EAP|CPT® 97035||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Ultrasound Therapy, 15min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.61|FSC: 13; Default||Not reimbursed separately|41.61|FSC: 13; Default||External grouping not supported 80159148|EAP|CPT® 77338||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Mlc Device Design Imrt Plan|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 80159136|EAP|HCPCS 0200T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sacroplasty Unilateral Injection|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80159171|EAP|HCPCS 0201T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sacroplasty Bilateral Injection|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80159197|EAP|CPT® 79101||0342 - NUCLEAR MEDICINE - THERAPEUTIC PROCEDURES|Hb Radiopharmaceutical By Iv|1|HUMANA [1294]||HUMANA [11839]|676.47|FSC: 13; Default||Not reimbursed separately|676.47|FSC: 13; Default||External grouping not supported 95162662|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tisu Regen Replifor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,002.67|FSC: 13; Default||Not reimbursed separately|3,002.67|FSC: 13; Default||External grouping not supported 80159205|EAP|CPT® 91110||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|HB GI IMAGING INTRALUMINAL CAPSULE|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 62056569|EAP|CPT® 82570||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Creatinine 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95162540|EAP|Custom 95162540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Iu Pressure Transducer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164165|EAP|Custom 95164165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Sleeve 5mm Diam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164167|EAP|Custom 95164167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164168|EAP|Custom 95164168||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Corticle Pro|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95164169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95164170|EAP|Custom 95164170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95164173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95164175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman Half Bay Point|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95164176|EAP|Custom 95164176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95164182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95164183|EAP|Custom 95164183||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Spacer Fusion Lumbar|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95164184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sovereign 5.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95164185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sovereign 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95164188|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Double Trocar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95164190|EAP|Custom 95164190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press Fit Triat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95164192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 80158066|EAP|Custom 80158066||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Adult Nhf 02 Initial Day|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158074|EAP|Custom 80158074||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Adult Nhf 02 Subsequent Day|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164198|EAP|Custom 95164198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5fr 65cm Non|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164199|EAP|Custom 95164199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5fr 100cmm Non|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164200|EAP|Custom 95164200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Glidecath 5fr |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164201|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Thruway .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164202|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quickcross .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164203|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95164205|EAP|Custom 95164205||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex|1|HUMANA [1294]||HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95164206|EAP|Custom 95164206||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crew Axial Multi Vertex 4.0mm|1|HUMANA [1294]||HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95164211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95164212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Medical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95164213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95164214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95164215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95164216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95164217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95164218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95164219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95164220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95164221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95164222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95164223|EAP|Custom 95164223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Shaft 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164224|EAP|Custom 95164224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Shaft 2.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,812.60|FSC: 13; Default||Not reimbursed separately|4,812.60|FSC: 13; Default||External grouping not supported 95164228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164232|EAP|Custom 95164232||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Tracheal Laser 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164238|EAP|Custom 95164238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Round Cutting Mastoid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164239|EAP|Custom 95164239||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insert Orthotic Thin Sole|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164241|EAP|HCPCS C1758||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 8fr 26cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|387.66|FSC: 13; Default||Not reimbursed separately|387.66|FSC: 13; Default||External grouping not supported 95164242|EAP|HCPCS C1758||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 8fr 24cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.90|FSC: 13; Default||Not reimbursed separately|354.90|FSC: 13; Default||External grouping not supported 95164243|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Unify Bi-ventricular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|FSC: 13; Default||Not reimbursed separately|60,912.00|FSC: 13; Default||External grouping not supported 95164244|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Fortify Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|FSC: 13; Default||Not reimbursed separately|50,625.00|FSC: 13; Default||External grouping not supported 95164245|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Fortify Single Chamb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|FSC: 13; Default||Not reimbursed separately|41,674.50|FSC: 13; Default||External grouping not supported 95164247|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Fortify Single Chamb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|FSC: 13; Default||Not reimbursed separately|41,674.50|FSC: 13; Default||External grouping not supported 95164248|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Accent Sr Single|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|FSC: 13; Default||Not reimbursed separately|13,041.00|FSC: 13; Default||External grouping not supported 95164255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hallolock Left 5 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,929.76|FSC: 13; Default||Not reimbursed separately|3,929.76|FSC: 13; Default||External grouping not supported 95164256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix 14mm X 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95164257|EAP|Custom 95164257||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Surfix Locking|1|HUMANA [1294]||HUMANA [11839]|361.26|FSC: 13; Default||Not reimbursed separately|361.26|FSC: 13; Default||External grouping not supported 95164258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Alpha 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95164259|EAP|Custom 95164259||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bit Drill 2.0 Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix 16mm X 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95164261|EAP|Custom 95164261||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Paste Dbm Trel-xc3cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164262|EAP|Custom 95164262||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Liquid Irm Chemical Restora|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164263|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Quickflex Micro Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,330.00|FSC: 13; Default||Not reimbursed separately|9,330.00|FSC: 13; Default||External grouping not supported 95163615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95163616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95163617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95163618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95163671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Arthrodesis Ankle Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.75|FSC: 13; Default||Not reimbursed separately|3,450.75|FSC: 13; Default||External grouping not supported 95163672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Arthrodesis Ankle Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,361.05|FSC: 13; Default||Not reimbursed separately|3,361.05|FSC: 13; Default||External grouping not supported 95163714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 5.0 X 22 Djo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95163715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 5.0 X 30 Djo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95163726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Locking 90 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.80|FSC: 13; Default||Not reimbursed separately|193.80|FSC: 13; Default||External grouping not supported 95163727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shoulder S3 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 95163728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded 4.0 X 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95163730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Standard 4.0 X 30.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|FSC: 13; Default||Not reimbursed separately|249.90|FSC: 13; Default||External grouping not supported 95163747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Lead Ti Double 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95163748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Lead Ti Double 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95163749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Lead Ti Double 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95163751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Lead Ti Double 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95163753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Lead Ti Double 5.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|FSC: 13; Default||Not reimbursed separately|582.00|FSC: 13; Default||External grouping not supported 95163759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95163795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 7.3mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.47|FSC: 13; Default||Not reimbursed separately|946.47|FSC: 13; Default||External grouping not supported 95163647|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vascutrak Pta Dilatatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163666|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vascutrak Pta Dilatatio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163745|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ut Sds 8mmx2.5cm 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163752|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross .014 2.5 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163650|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sinus Pro Solo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163600|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Catheter Yueh Ultra Thin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163595|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6fr Jsn Quad (reprocess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163596|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quadripolar 6 Fr Crd-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163634|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 7fr Ptd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163635|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Thrombolyti C Device 5fr W/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163636|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Unit 7fr Ptd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163653|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated Heparin Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|FSC: 13; Default||Not reimbursed separately|4,695.00|FSC: 13; Default||External grouping not supported 95163790|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Talent With Xcel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,150.00|FSC: 13; Default||Not reimbursed separately|27,150.00|FSC: 13; Default||External grouping not supported 95163791|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Talent With Xcel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,525.00|FSC: 13; Default||Not reimbursed separately|12,525.00|FSC: 13; Default||External grouping not supported 95163656|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Micro Access Tearaway|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163662|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 0.18 X 60cm Slectiva S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163756|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Micro Access Tearaway|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Half Tapered Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,472.71|FSC: 13; Default||Not reimbursed separately|6,472.71|FSC: 13; Default||External grouping not supported 95163611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Half Tapered Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,472.71|FSC: 13; Default||Not reimbursed separately|6,472.71|FSC: 13; Default||External grouping not supported 95163628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Medium Right Sbi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|FSC: 13; Default||Not reimbursed separately|14,407.50|FSC: 13; Default||External grouping not supported 95163629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base Tibial Large Sbi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,789.00|FSC: 13; Default||Not reimbursed separately|18,789.00|FSC: 13; Default||External grouping not supported 95163630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Mobile 9mm Sbi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,630.00|FSC: 13; Default||Not reimbursed separately|6,630.00|FSC: 13; Default||External grouping not supported 95163652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95163669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95163685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Joint M-p Toe Great Coat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,110.00|FSC: 13; Default||Not reimbursed separately|4,110.00|FSC: 13; Default||External grouping not supported 95163709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymmetric Triathlon 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95163711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95163716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Glenoid Rsp 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 95163717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Glenoid Rsp Djo 32mm Neutra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|FSC: 13; Default||Not reimbursed separately|4,320.00|FSC: 13; Default||External grouping not supported 95163718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Socket Humeral Rsp Djo Neu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,277.50|FSC: 13; Default||Not reimbursed separately|6,277.50|FSC: 13; Default||External grouping not supported 95163719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Humeral Rsp Djo Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95163721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Rsp Djo Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|FSC: 13; Default||Not reimbursed separately|11,407.50|FSC: 13; Default||External grouping not supported 95163736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral 60mm Left Cr I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|FSC: 13; Default||Not reimbursed separately|7,236.00|FSC: 13; Default||External grouping not supported 95163737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ssk (tm) Vangu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,284.00|FSC: 13; Default||Not reimbursed separately|25,284.00|FSC: 13; Default||External grouping not supported 95163738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Knee Splined Biomet 16 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,310.00|FSC: 13; Default||Not reimbursed separately|5,310.00|FSC: 13; Default||External grouping not supported 95163739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Dcm (tm) Vanguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,262.00|FSC: 13; Default||Not reimbursed separately|8,262.00|FSC: 13; Default||External grouping not supported 95163599|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Gel Texture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95163720|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95163722|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Covered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,401.27|FSC: 13; Default||Not reimbursed separately|7,401.27|FSC: 13; Default||External grouping not supported 95163801|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Viabahn 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,680.00|FSC: 13; Default||Not reimbursed separately|10,680.00|FSC: 13; Default||External grouping not supported 95162905|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 6 Fr Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95163649|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart 6mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95163665|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Lifestent Sfa Self Expandi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95163750|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 9mm Diameter X 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95163763|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Transhepatic 120/150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|FSC: 13; Default||Not reimbursed separately|6,825.00|FSC: 13; Default||External grouping not supported 95163674|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu Rim Non- Braide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163675|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu Straight Flush|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163684|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Sinus Relieva 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163746|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Renegade Stc 18 130x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163798|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guideliner 7 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163594|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 6cm X 6c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.83|FSC: 13; Default||Not reimbursed separately|88.83|FSC: 13; Default||External grouping not supported 95161809|EAP|Custom 95161809||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Garment Compression Calf Large 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162890|EAP|Custom 95162890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Prismaflex M100 4/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162893|EAP|Custom 95162893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Psi Statlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162895|EAP|Custom 95162895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Cholecystectomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162898|EAP|Custom 95162898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manifold 4port Rt Handed 15/bx (|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162899|EAP|Custom 95162899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Proforma Modified Hook|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162900|EAP|Custom 95162900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Garment Compression Calf Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162908|EAP|Custom 95162908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Torch Wrench|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163010|EAP|Custom 95163010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory 60 Cm Tunneling Ro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163612|EAP|Custom 95163612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Precision 35cm M-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163613|EAP|Custom 95163613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Tunneling Straw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163619|EAP|Custom 95163619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Balloon Kii Gelport 12 X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163620|EAP|Custom 95163620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rinse Asepti 1-5 Gallon/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163623|EAP|Custom 95163623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Concentric Violet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163624|EAP|Custom 95163624||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Concentric Red|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163625|EAP|Custom 95163625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Concentric Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163626|EAP|Custom 95163626||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Concentric Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163631|EAP|Custom 95163631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Tip Drill 2.4mm X 65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163632|EAP|Custom 95163632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Tip Drill 2.4mm X 15mm Threa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163633|EAP|Custom 95163633||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tubing Vaso Press 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163654|EAP|Custom 95163654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Gortex Cv5 Ttc13-needle 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163673|EAP|Custom 95163673||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 12 X 30mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95163686|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Snare Goose Neck Amplatz 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163687|EAP|Custom 95163687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device 20 Tacker Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163692|EAP|Custom 95163692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saggital Wide Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163697|EAP|Custom 95163697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pump Compounder Nutrimix Mac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163700|EAP|Custom 95163700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pain Management On Q 270|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163705|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone L-asr Fee 12 X 14 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95163713|EAP|Custom 95163713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Cement Clearcut Encore|1|HUMANA [1294]||HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95163723|EAP|Custom 95163723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5 Djo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163724|EAP|Custom 95163724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.0 Djo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163725|EAP|Custom 95163725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Fast 4.0mm Step|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163729|EAP|Custom 95163729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Mastoid Sterile 3.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163731|EAP|Custom 95163731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Mastoid Sterile 5.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163732|EAP|Custom 95163732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Mastoid Sterile 4.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163733|EAP|Custom 95163733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round Cutting Mastoid Steril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163734|EAP|Custom 95163734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Mastoid Sterile 4.0m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163735|EAP|Custom 95163735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round Cutting Mastoid Steril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163740|EAP|Custom 95163740||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire Screw Lag|1|HUMANA [1294]||HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95163741|EAP|Custom 95163741||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire Tip Bead 2.6mm X 80mm|1|HUMANA [1294]||HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95163742|EAP|Custom 95163742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163754|EAP|Custom 95163754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap End Offset 0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163755|EAP|Custom 95163755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 7mm X 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163792|EAP|Custom 95163792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Doppler Laparoscopic Dispo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163794|EAP|Custom 95163794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Composite Premise Medium Viscoit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163800|EAP|Custom 95163800||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Cutter Linear Echelon Ar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163802|EAP|Custom 95163802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saggital Narrow Thomason S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163803|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Crosser 14 P Otw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95164271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95164272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95164276|EAP|Custom 95164276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Herculite Enamel A1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164277|EAP|Custom 95164277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Herculite Enamel A2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164278|EAP|Custom 95164278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Ultrasound|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164279|EAP|Custom 95164279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Band Matrix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164280|EAP|Custom 95164280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Primer Clearfil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164264|EAP|Custom 95164264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Powder Irm Chemical Rest|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95164282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95164283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95164284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lapidus 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|FSC: 13; Default||Not reimbursed separately|662.40|FSC: 13; Default||External grouping not supported 95164301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|FSC: 13; Default||Not reimbursed separately|6,567.00|FSC: 13; Default||External grouping not supported 95164304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95164305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95164306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95164307|EAP|Custom 95164307||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Medpore Sst-ez 20mm|1|HUMANA [1294]||HUMANA [11839]|2,112.00|FSC: 13; Default||Not reimbursed separately|2,112.00|FSC: 13; Default||External grouping not supported 95164308|EAP|Custom 95164308||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere Medpore Sst-ez 22mm|1|HUMANA [1294]||HUMANA [11839]|2,010.00|FSC: 13; Default||Not reimbursed separately|2,010.00|FSC: 13; Default||External grouping not supported 95164325|EAP|Custom 95164325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Roticulator Gia Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164326|EAP|Custom 95164326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Roticulator Gia Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164327|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reinforcement Tissue Gore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,986.00|FSC: 13; Default||Not reimbursed separately|7,986.00|FSC: 13; Default||External grouping not supported 95164330|EAP|Custom 95164330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Interpulse W Fan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164331|EAP|Custom 95164331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Vena Cure Never Touch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164332|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire J Wire Movable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164333|EAP|Custom 95164333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Irrigating Corneal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164334|EAP|Custom 95164334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Soft Backflush 23 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80160856|EAP|CPT® 92507||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Speech Therapy Pedi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|230.40|FSC: 13; Default||Not reimbursed separately|230.40|FSC: 13; Default||External grouping not supported 80160857|EAP|CPT® 92507||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Communicative Rehab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|230.40|FSC: 13; Default||Not reimbursed separately|230.40|FSC: 13; Default||External grouping not supported 80160858|EAP|CPT® 92507||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Prosthesis Modification|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|230.40|FSC: 13; Default||Not reimbursed separately|230.40|FSC: 13; Default||External grouping not supported 95164337|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 10mm Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95164338|EAP|Custom 95164338||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Delivery Bone Cement|1|HUMANA [1294]||HUMANA [11839]|2,418.00|FSC: 13; Default||Not reimbursed separately|2,418.00|FSC: 13; Default||External grouping not supported 95164344|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hernia Surgisis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,600.00|FSC: 13; Default||Not reimbursed separately|21,600.00|FSC: 13; Default||External grouping not supported 95164388|EAP|HCPCS Q4143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Dermal Accelluar Repriza|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.75|FSC: 13; Default||Not reimbursed separately|68.75|FSC: 13; Default||External grouping not supported 95164394|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Bi Dir 7fr Def|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164395|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rva Hra Quad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164396|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter His Quad Fix 6f 4p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164397|EAP|Custom 95164397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thermisense Sensor Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163743|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STENT BILIARY LD EXPRESS 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.20|FSC: 13; Default||Not reimbursed separately|4,126.20|FSC: 13; Default||External grouping not supported 95164414|EAP|Custom 95164414||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 30 X 10mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95164416|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Joint M-p Toe Great Non Porous Med 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95164417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|FSC: 13; Default||Not reimbursed separately|6,426.84|FSC: 13; Default||External grouping not supported 95164418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.0 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|FSC: 13; Default||Not reimbursed separately|1,296.54|FSC: 13; Default||External grouping not supported 95164399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread 3.0 X 21mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95164400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread 3.0 X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95164401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread 3.0 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95164402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread 3.0 X 27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95164403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread 3.0 X 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95164405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread 3.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95164409|EAP|Custom 95164409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sol 5b5202 Dianeal 2.50% Dextrose 5000ml Dialysis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80158199|EAP|CPT® 95803||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Actigraphy Recording|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 92902659|EAP|Custom 92902659||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Rc Mdi 1 Puff|1|HUMANA [1294]||HUMANA [11839]|1.82|FSC: 13; Default||Not reimbursed separately|1.82|FSC: 13; Default||External grouping not supported 95164429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.75|FSC: 13; Default||Not reimbursed separately|798.75|FSC: 13; Default||External grouping not supported 95164430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95164432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95164439|EAP|Custom 95164439||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Pulse Oximeter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164421|EAP|Custom 95164421||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sealant Surgical Coseal 4ml|1|HUMANA [1294]||HUMANA [11839]|1,855.88|FSC: 13; Default||Not reimbursed separately|1,855.88|FSC: 13; Default||External grouping not supported 95164422|EAP|Custom 95164422||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sealant Surgical Coseal 8ml|1|HUMANA [1294]||HUMANA [11839]|2,166.30|FSC: 13; Default||Not reimbursed separately|2,166.30|FSC: 13; Default||External grouping not supported 95164423|EAP|Custom 95164423||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Spray Coseal Easyspray|1|HUMANA [1294]||HUMANA [11839]|153.39|FSC: 13; Default||Not reimbursed separately|153.39|FSC: 13; Default||External grouping not supported 95164424|EAP|Custom 95164424||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Stimulant Inj|1|HUMANA [1294]||HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 80159031|EAP|CPT® 85014||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Hematocrit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.11|FSC: 13; Default||Not reimbursed separately|7.11|FSC: 13; Default||External grouping not supported 95164441|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Neutral Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.90|FSC: 13; Default||Not reimbursed separately|4,848.90|FSC: 13; Default||External grouping not supported 95164440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Bantam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|FSC: 13; Default||Not reimbursed separately|9,368.10|FSC: 13; Default||External grouping not supported 95164442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axail Multi Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95164443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vertex Part Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|FSC: 13; Default||Not reimbursed separately|4,565.82|FSC: 13; Default||External grouping not supported 95164444|EAP|Custom 95164444||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Laminar|1|HUMANA [1294]||HUMANA [11839]|4,263.00|FSC: 13; Default||Not reimbursed separately|4,263.00|FSC: 13; Default||External grouping not supported 95164445|EAP|Custom 95164445||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5 X 240mm|1|HUMANA [1294]||HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95164446|EAP|Custom 95164446||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cable|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95164455|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel 700|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95164456|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel 750|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95164458|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Trach Percutaneous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164459|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Trach Percutaneous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164460|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.25|FSC: 13; Default||Not reimbursed separately|8,006.25|FSC: 13; Default||External grouping not supported 95164461|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80158181|EAP|HCPCS V5267||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Hearing Aid Blue Tooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159429|EAP|Custom 80159429||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Pretzels|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159437|EAP|Custom 80159437||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Bars|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159502|EAP|Custom 80159502||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Ready To Drink Supplement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159494|EAP|Custom 80159494||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Sample Supplement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159510|EAP|Custom 80159510||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hb Shaker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159340|EAP|CPT® 87081||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Culture Presumptive Path Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.89|FSC: 13; Default||Not reimbursed separately|19.89|FSC: 13; Default||External grouping not supported 95164474|EAP|Custom 95164474||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Fecal Management|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80160948|EAP|CPT® 20220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Biopsy Bone Needle Aspir|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95164484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Double 6 Hole 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|139.26|FSC: 13; Default||Not reimbursed separately|139.26|FSC: 13; Default||External grouping not supported 95164485|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Occluder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164487|EAP|Custom 95164487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Connecting 7-10fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164489|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Contact|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,272.50|FSC: 13; Default||Not reimbursed separately|2,272.50|FSC: 13; Default||External grouping not supported 95164490|EAP|Custom 95164490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intubation Aintree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164345|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164346|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164347|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164348|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164351|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164352|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164355|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164358|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164360|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164362|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164363|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164364|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164366|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164349|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164350|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164353|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164354|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164356|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164357|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164359|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164361|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164365|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164367|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164368|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Hb Lens Intraocular 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164369|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164370|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164371|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164372|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164373|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164374|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164375|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164376|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164377|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164378|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Hb Lens Intraocular 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164379|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164380|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164381|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164382|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164383|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164384|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164385|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5x11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95164496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95164497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95164498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95164499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95164500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Multidirection Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|FSC: 13; Default||Not reimbursed separately|433.50|FSC: 13; Default||External grouping not supported 95164501|EAP|Custom 95164501||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Threaded 2.5mm|1|HUMANA [1294]||HUMANA [11839]|63.75|FSC: 13; Default||Not reimbursed separately|63.75|FSC: 13; Default||External grouping not supported 95164502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Y-shape|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|FSC: 13; Default||Not reimbursed separately|1,262.25|FSC: 13; Default||External grouping not supported 95164503|EAP|Custom 95164503||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Trocar Double .045|1|HUMANA [1294]||HUMANA [11839]|30.00|FSC: 13; Default||Not reimbursed separately|30.00|FSC: 13; Default||External grouping not supported 95164504|EAP|Custom 95164504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Mini Quik Connect|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164505|EAP|Custom 95164505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini Quik Fast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164506|EAP|Custom 95164506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Driver 2.0/2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164507|EAP|Custom 95164507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Directional |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95164509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Directional|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95164510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shoulder S3 11 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,701.80|FSC: 13; Default||Not reimbursed separately|5,701.80|FSC: 13; Default||External grouping not supported 95164511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded 4.0 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95164512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded 4.0 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|FSC: 13; Default||Not reimbursed separately|303.45|FSC: 13; Default||External grouping not supported 95164513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95164516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 80160732|EAP|CPT® 32552||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rem Indwelling Pleural Cath|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95164518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,942.47|FSC: 13; Default||Not reimbursed separately|4,942.47|FSC: 13; Default||External grouping not supported 95164519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,013.24|FSC: 13; Default||Not reimbursed separately|5,013.24|FSC: 13; Default||External grouping not supported 95164520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,091.15|FSC: 13; Default||Not reimbursed separately|5,091.15|FSC: 13; Default||External grouping not supported 95164521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,218.62|FSC: 13; Default||Not reimbursed separately|5,218.62|FSC: 13; Default||External grouping not supported 95164522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,364.96|FSC: 13; Default||Not reimbursed separately|5,364.96|FSC: 13; Default||External grouping not supported 95164523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,570.31|FSC: 13; Default||Not reimbursed separately|5,570.31|FSC: 13; Default||External grouping not supported 95164524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,780.37|FSC: 13; Default||Not reimbursed separately|5,780.37|FSC: 13; Default||External grouping not supported 95164525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.45|FSC: 13; Default||Not reimbursed separately|5,964.45|FSC: 13; Default||External grouping not supported 95164526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,942.47|FSC: 13; Default||Not reimbursed separately|4,942.47|FSC: 13; Default||External grouping not supported 95164527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,013.24|FSC: 13; Default||Not reimbursed separately|5,013.24|FSC: 13; Default||External grouping not supported 95164528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,091.15|FSC: 13; Default||Not reimbursed separately|5,091.15|FSC: 13; Default||External grouping not supported 95164529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,218.62|FSC: 13; Default||Not reimbursed separately|5,218.62|FSC: 13; Default||External grouping not supported 95164530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,364.96|FSC: 13; Default||Not reimbursed separately|5,364.96|FSC: 13; Default||External grouping not supported 95164531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,570.31|FSC: 13; Default||Not reimbursed separately|5,570.31|FSC: 13; Default||External grouping not supported 95164532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,780.37|FSC: 13; Default||Not reimbursed separately|5,780.37|FSC: 13; Default||External grouping not supported 95164533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Periar Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.45|FSC: 13; Default||Not reimbursed separately|5,964.45|FSC: 13; Default||External grouping not supported 95164534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Head Radial 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95164535|EAP|Custom 95164535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao 3.5 X 230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Prox Long Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,368.80|FSC: 13; Default||Not reimbursed separately|5,368.80|FSC: 13; Default||External grouping not supported 95164537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95164538|EAP|Custom 95164538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Zephir|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164341|EAP|Custom 95164341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Access 13g Beveld|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164540|EAP|Custom 95164540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Inject Gold Probe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164541|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii Xp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164542|EAP|Custom 95164542||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Advance Pistol 44|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164546|EAP|Custom 95164546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Magnumwire Suture 39|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164547|EAP|Custom 95164547||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Magnumwire Suture 39|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164549|EAP|Custom 95164549||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot Single|1|HUMANA [1294]||HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95164550|EAP|Custom 95164550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nasal Epistat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164551|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 5mm Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95164555|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.37|FSC: 13; Default||Not reimbursed separately|79.37|FSC: 13; Default||External grouping not supported 95164556|EAP|Custom 95164556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164562|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vas Coated Hep Propat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|FSC: 13; Default||Not reimbursed separately|4,695.00|FSC: 13; Default||External grouping not supported 95164563|EAP|Custom 95164563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 12mm Diameter Blunt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164568|EAP|Custom 95164568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Ball 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164569|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Contour 4.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.26|FSC: 13; Default||Not reimbursed separately|403.26|FSC: 13; Default||External grouping not supported 95164571|EAP|Custom 95164571||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Delivery Bone Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Flexion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 95164575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prox Femoral Oxin C/r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 95164576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Base Tibial Ii Gene|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95164577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95164578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.95|FSC: 13; Default||Not reimbursed separately|844.95|FSC: 13; Default||External grouping not supported 95164580|EAP|Custom 95164580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Shunt Artery 6 Four|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164581|EAP|Custom 95164581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Powerpro Profix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164582|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Smooth 2.2 X 8.00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164583|EAP|Custom 95164583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao 3.5 X 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95164585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95164586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Flexion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 95164587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95164589|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Oxin Legion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|FSC: 13; Default||Not reimbursed separately|11,800.80|FSC: 13; Default||External grouping not supported 95164592|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95164595|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95164596|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xceed Biliary 6fr 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95164598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Glenoid Rsp 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|FSC: 13; Default||Not reimbursed separately|4,320.00|FSC: 13; Default||External grouping not supported 95164599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Rsp Djo Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|FSC: 13; Default||Not reimbursed separately|11,407.50|FSC: 13; Default||External grouping not supported 95164600|EAP|Custom 95164600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Cement Clearcut Encore|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 5.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95164602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Nonlocking 3.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95164603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 5.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95164604|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymmetric Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95164605|EAP|Custom 95164605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solustaple 8mm 90degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.95|FSC: 13; Default||Not reimbursed separately|5,128.95|FSC: 13; Default||External grouping not supported 95164608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Compression 1.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95164616|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .018 Sensation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164617|EAP|Custom 95164617||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Sleeve 12mm Dia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164618|EAP|Custom 95164618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Bowel Babcock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164620|EAP|Custom 95164620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Modular 9.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164621|EAP|Custom 95164621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Modular 9.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164622|EAP|Custom 95164622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Modular 10.0 Mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164623|EAP|Custom 95164623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Modular 10.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164625|EAP|Custom 95164625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stripper Laser Fiber|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164626|EAP|Custom 95164626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ceramic Cleaver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161003|EAP|CPT® 93308||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ac Limited Echo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|719.39|FSC: 13; Default||Not reimbursed separately|719.39|FSC: 13; Default||External grouping not supported 80161011|EAP|CPT® 93321||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Ac Limited Doppler|1|HUMANA [1294]||HUMANA [11839]|431.00|FSC: 13; Default||Not reimbursed separately|431.00|FSC: 13; Default||External grouping not supported 95164628|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cragg-mcnamara|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95164634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95164635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lock 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direction 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95164637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|418.50|FSC: 13; Default||Not reimbursed separately|418.50|FSC: 13; Default||External grouping not supported 95164638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Medial 88mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95164639|EAP|Custom 95164639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Approximator Rib|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161051|EAP|CPT® 85347||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Activated Clotting Time|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.84|FSC: 13; Default||Not reimbursed separately|12.84|FSC: 13; Default||External grouping not supported 80161052|EAP|CPT® 85018||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Oh Poc Hemoglobin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.11|FSC: 13; Default||Not reimbursed separately|7.11|FSC: 13; Default||External grouping not supported 80161053|EAP|CPT® 81002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Urinalysis Dipstick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.44|FSC: 13; Default||Not reimbursed separately|10.44|FSC: 13; Default||External grouping not supported 80161054|EAP|CPT® 81002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Urine For Ketones|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.44|FSC: 13; Default||Not reimbursed separately|10.44|FSC: 13; Default||External grouping not supported 80161056|EAP|CPT® 87880||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Rapid Strep|1|HUMANA [1294]||HUMANA [11839]|49.59|FSC: 13; Default||Not reimbursed separately|49.59|FSC: 13; Default||External grouping not supported 80161058|EAP|CPT® 82565||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Creatinine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.36|FSC: 13; Default||Not reimbursed separately|15.36|FSC: 13; Default||External grouping not supported 80161060|EAP|CPT® 82044||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Urine Microalbumin|1|HUMANA [1294]||HUMANA [11839]|18.69|FSC: 13; Default||Not reimbursed separately|18.69|FSC: 13; Default||External grouping not supported 80161061|EAP|CPT® 81025||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Hcg By Visual Color|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.83|FSC: 13; Default||Not reimbursed separately|25.83|FSC: 13; Default||External grouping not supported 80161062|EAP|CPT® 83986||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Vaginal Ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.74|FSC: 13; Default||Not reimbursed separately|10.74|FSC: 13; Default||External grouping not supported 80161063|EAP|CPT® 80047||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Bmp|1|HUMANA [1294]||HUMANA [11839]|41.19|FSC: 13; Default||Not reimbursed separately|41.19|FSC: 13; Default||External grouping not supported 80161064|EAP|CPT® 82805||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Oh Poc Blood Gas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.31|FSC: 13; Default||Not reimbursed separately|236.31|FSC: 13; Default||External grouping not supported 80161065|EAP|CPT® 82810||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Avox|1|HUMANA [1294]||HUMANA [11839]|29.31|FSC: 13; Default||Not reimbursed separately|29.31|FSC: 13; Default||External grouping not supported 80161066|EAP|CPT® 82270||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Hemoccult 1-3 Cards|1|HUMANA [1294]||HUMANA [11839]|13.14|FSC: 13; Default||Not reimbursed separately|13.14|FSC: 13; Default||External grouping not supported 80161067|EAP|CPT® 85610||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Poct Pt_inr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.87|FSC: 13; Default||Not reimbursed separately|12.87|FSC: 13; Default||External grouping not supported 95164640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95164641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95164645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thrs 3d 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95164650|EAP|Custom 95164650||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Thrs 3d Medium|1|HUMANA [1294]||HUMANA [11839]|4,036.62|FSC: 13; Default||Not reimbursed separately|4,036.62|FSC: 13; Default||External grouping not supported 95164651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Compote|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.75|FSC: 13; Default||Not reimbursed separately|573.75|FSC: 13; Default||External grouping not supported 95164652|EAP|Custom 95164652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tuohy Epidural 22ga |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164653|EAP|Custom 95164653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Trial Patient Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164655|EAP|Custom 95164655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Cushion View Prone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164172|EAP|Custom 95164172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95164657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95164659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95164660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Femur 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,916.70|FSC: 13; Default||Not reimbursed separately|4,916.70|FSC: 13; Default||External grouping not supported 95164661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.48|FSC: 13; Default||Not reimbursed separately|684.48|FSC: 13; Default||External grouping not supported 95164662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.48|FSC: 13; Default||Not reimbursed separately|684.48|FSC: 13; Default||External grouping not supported 95164663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.27|FSC: 13; Default||Not reimbursed separately|696.27|FSC: 13; Default||External grouping not supported 95164664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.omm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.27|FSC: 13; Default||Not reimbursed separately|696.27|FSC: 13; Default||External grouping not supported 95164665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.27|FSC: 13; Default||Not reimbursed separately|696.27|FSC: 13; Default||External grouping not supported 95164666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.70|FSC: 13; Default||Not reimbursed separately|623.70|FSC: 13; Default||External grouping not supported 95164667|EAP|Custom 95164667||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 2.0mm|1|HUMANA [1294]||HUMANA [11839]|133.35|FSC: 13; Default||Not reimbursed separately|133.35|FSC: 13; Default||External grouping not supported 95114228|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95164668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,923.57|FSC: 13; Default||Not reimbursed separately|4,923.57|FSC: 13; Default||External grouping not supported 80161110|EAP|HCPCS G0378||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Observation Per Hour|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.75|FSC: 13; Default||Not reimbursed separately|57.75|FSC: 13; Default||External grouping not supported 80161128|EAP|Custom 80161128||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Extended Recovery|1|HUMANA [1294]||HUMANA [11839]|61.85|FSC: 13; Default||Not reimbursed separately|61.85|FSC: 13; Default||External grouping not supported 80157118|EAP|CPT® 90472||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hb Each Additional Vaccine|1|HUMANA [1294]||HUMANA [11839]|54.63|FSC: 13; Default||Not reimbursed separately|54.63|FSC: 13; Default||External grouping not supported 95164672|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,371.00|FSC: 13; Default||Not reimbursed separately|37,371.00|FSC: 13; Default||External grouping not supported 95164674|EAP|Custom 95164674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Max Grip 23 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161144|EAP|Custom 80161144||0998 - STATISTICAL CHARGES|Hb Room & Bd Patient Off Floor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Standard Turon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95164676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|577.83|FSC: 13; Default||Not reimbursed separately|577.83|FSC: 13; Default||External grouping not supported 95164689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|586.50|FSC: 13; Default||Not reimbursed separately|586.50|FSC: 13; Default||External grouping not supported 95164691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95164704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.65|FSC: 13; Default||Not reimbursed separately|646.65|FSC: 13; Default||External grouping not supported 95164706|EAP|Custom 95164706||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Starter Cr Syringe Mark|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164707|EAP|Custom 95164707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Sleeve Trukor Red|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164708|EAP|Custom 95164708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Sleeve Trukor Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164709|EAP|Custom 95164709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Trufit Bgs Green 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164710|EAP|Custom 95164710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Trufit Bgs Blue 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164713|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Fortify Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|FSC: 13; Default||Not reimbursed separately|50,625.00|FSC: 13; Default||External grouping not supported 95164724|EAP|Custom 95164724||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Accessory Tunneling Rod|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95164726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 3.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical 3.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164744|EAP|Custom 95164744||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cover Baton For Gvl 4 Stat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|565.50|FSC: 13; Default||Not reimbursed separately|565.50|FSC: 13; Default||External grouping not supported 95164749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Asphere|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|FSC: 13; Default||Not reimbursed separately|3,408.60|FSC: 13; Default||External grouping not supported 95164754|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164755|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95164757|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Imp Capsure|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|FSC: 13; Default||Not reimbursed separately|1,482.00|FSC: 13; Default||External grouping not supported 95164758|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent I Cast 8x38x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95164759|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95164760|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95164761|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95164762|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 80160666|EAP|CPT® 93291||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ac Irl Interrogation|1|HUMANA [1294]||HUMANA [11839]|70.98|FSC: 13; Default||Not reimbursed separately|70.98|FSC: 13; Default||External grouping not supported 80160419|EAP|CPT® 93281||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Pacemaker Reprogram Multi|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80160450|EAP|CPT® 93284||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ac Cardio Defib Reprogram|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80160476|EAP|CPT® 93290||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ac Icm|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80160799|EAP|CPT® 93296||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ac Interrogation Remote|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80160674|EAP|CPT® 93229||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Ac Ecat|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95164763|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95164764|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95164765|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95164766|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95164767|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 8mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95164768|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164769|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164770|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Talus Right Small Sbi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|FSC: 13; Default||Not reimbursed separately|14,407.50|FSC: 13; Default||External grouping not supported 95164777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base Tibial Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|FSC: 13; Default||Not reimbursed separately|14,407.50|FSC: 13; Default||External grouping not supported 95164778|EAP|Custom 95164778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Tip Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164780|EAP|Custom 95164780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Chamfer Anterior|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164781|EAP|Custom 95164781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Cut Stable Recip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164782|EAP|Custom 95164782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Cut Stable Recip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164475|EAP|Custom 95164475||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bag Collection Replacement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164791|EAP|Custom 95164791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 45mm Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164792|EAP|Custom 95164792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler 45 Gold|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164793|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164795|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cdp Triple Lumen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80161177|EAP|CPT® 43244||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Band Ligation Esophageal/gastric Varices|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95164802|EAP|Custom 95164802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Stimuplex 22ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164803|EAP|Custom 95164803||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retainer Tofflemire Univer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164804|EAP|Custom 95164804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Primer Ketac Nano|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164805|EAP|Custom 95164805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cement Ketac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164807|EAP|Custom 95164807||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Syringe Pack Mr Fastload|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|FSC: 13; Default||Not reimbursed separately|6,426.84|FSC: 13; Default||External grouping not supported 95164812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Turon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95164813|EAP|Custom 95164813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Protesis Voice Starter Kit|1|HUMANA [1294]||HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95164814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Contrained|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,373.38|FSC: 13; Default||Not reimbursed separately|12,373.38|FSC: 13; Default||External grouping not supported 95164815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95164816|EAP|Custom 95164816||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Articulating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164823|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intra 18.0 Crystalens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95164824|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intra 9.0 Acry Rest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80161185|EAP|CPT® 50385||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rem Replace Int Uret Stent|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80161193|EAP|CPT® 50386||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rem Int Ureteral Stent|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80161201|EAP|CPT® 50387||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rem Repl Ext Trans Stent|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95164827|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intra 25.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80161243|EAP|CPT® 70486||0351 - CT SCAN - HEAD SCAN|Hb Ct Facial W/o Cont|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80161250|EAP|Custom 80161250||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lab Poct Supplies (client)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161268|EAP|Custom 80161268||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lab Trip Charge (client)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161276|EAP|CPT® 43236||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Submucosal Injection|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95164844|EAP|Custom 95164844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Penile Hyams Adj|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164846|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu 5fr 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164850|EAP|Custom 95164850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nebulizer Solo Aeroneb Cone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Distal Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 80161284|EAP|CPT® 92607||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Eval Speech Device 1st Hr|1|HUMANA [1294]||HUMANA [11839]|371.19|FSC: 13; Default||Not reimbursed separately|371.19|FSC: 13; Default||External grouping not supported 80161292|EAP|CPT® 92608||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Speech Device Eval 30 Min|1|HUMANA [1294]||HUMANA [11839]|148.50|FSC: 13; Default||Not reimbursed separately|148.50|FSC: 13; Default||External grouping not supported 80161300|EAP|CPT® 92609||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Use Of Speech Gen Device|1|HUMANA [1294]||HUMANA [11839]|311.64|FSC: 13; Default||Not reimbursed separately|311.64|FSC: 13; Default||External grouping not supported 95164865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95164866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95164870|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Cup 10 Degree Omni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|FSC: 13; Default||Not reimbursed separately|4,552.80|FSC: 13; Default||External grouping not supported 95164871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Qwix 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 80161318|EAP|HCPCS J2785||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Lexiscan 0.1mg Inj .4mg Vial Chg 4 Units|1|HUMANA [1294]||HUMANA [11839]|288.27|FSC: 13; Default||Not reimbursed separately|288.27|FSC: 13; Default||External grouping not supported 80161326|EAP|HCPCS J0280||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Aminophyllin 250mg Inj|1|HUMANA [1294]||HUMANA [11839]|2.10|FSC: 13; Default||Not reimbursed separately|2.10|FSC: 13; Default||External grouping not supported 80161334|EAP|HCPCS J0153||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Adenosine 1mg Inj|1|HUMANA [1294]||HUMANA [11839]|978.11|FSC: 13; Default||Not reimbursed separately|978.11|FSC: 13; Default||External grouping not supported 80161342|EAP|Custom 80161342||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Lopressor 5mg Inj|1|HUMANA [1294]||HUMANA [11839]|1.20|FSC: 13; Default||Not reimbursed separately|1.20|FSC: 13; Default||External grouping not supported 80161359|EAP|HCPCS J1250||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Dobutamine 250mg Inj|1|HUMANA [1294]||HUMANA [11839]|14.65|FSC: 13; Default||Not reimbursed separately|14.65|FSC: 13; Default||External grouping not supported 95164874|EAP|Custom 95164874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Articulating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164876|EAP|Custom 95164876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Splitter 2 X 4 D4|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95164877|EAP|Custom 95164877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Splitter 2 X 4 W4|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95164881|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95164882|EAP|Custom 95164882||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Irrigation 10fr|1|HUMANA [1294]||HUMANA [11839]|67.41|FSC: 13; Default||Not reimbursed separately|67.41|FSC: 13; Default||External grouping not supported 80136526|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Hospice, Nursing Visit, Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 80158173|EAP|HCPCS G0155||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Hospice, Csw Phone Call, Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.35|FSC: 13; Default||Not reimbursed separately|91.35|FSC: 13; Default||External grouping not supported 80160716|EAP|Custom 80160716||0650 - HOSPICE SERVICE - GENERAL CLASSIFICATION|Hb Bereavement Hospice Comm|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95164883|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Triple Lumen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164885|EAP|Custom 95164885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Primer Ketac Nano|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Humeral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,113.42|FSC: 13; Default||Not reimbursed separately|4,113.42|FSC: 13; Default||External grouping not supported 95164887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95164888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95164889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periarticular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95164890|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reinforcement Tissue Gore |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,991.00|FSC: 13; Default||Not reimbursed separately|5,991.00|FSC: 13; Default||External grouping not supported 95164891|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cath Viabahn Endo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,286.00|FSC: 13; Default||Not reimbursed separately|11,286.00|FSC: 13; Default||External grouping not supported 80158082|EAP|HCPCS G0424||0948 - OTHER THERAPEUTIC SERVICES - PULMONARY REHABILITATION|Hb Pr W/exer, 1hr/session|1|HUMANA [1294]||HUMANA [11839]|159.69|FSC: 13; Default||Not reimbursed separately|159.69|FSC: 13; Default||External grouping not supported 95164892|EAP|Custom 95164892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Needle Core|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164894|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Silverhawk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164896|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Powerport 9.5fr Attachable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,808.00|FSC: 13; Default||Not reimbursed separately|2,808.00|FSC: 13; Default||External grouping not supported 95164897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95164898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|FSC: 13; Default||Not reimbursed separately|1,443.54|FSC: 13; Default||External grouping not supported 95117923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Hex Stainless 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|230.40|FSC: 13; Default||Not reimbursed separately|230.40|FSC: 13; Default||External grouping not supported 95157069|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Temp Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,850.00|FSC: 13; Default||Not reimbursed separately|14,850.00|FSC: 13; Default||External grouping not supported 95157561|EAP|Custom 95157561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Barium Sulfate Ez Paste|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161947|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Catheter Yueh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95164907|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 3-4 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|FSC: 13; Default||Not reimbursed separately|6,097.50|FSC: 13; Default||External grouping not supported 95164908|EAP|Custom 95164908||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Knee Signature Model|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95164909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mini Bio Suturetak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95164913|EAP|Custom 95164913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Ils 21mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164914|EAP|Custom 95164914||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Ils 25mm Intra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164915|EAP|Custom 95164915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nosecone Cusa Excel Electro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164916|EAP|Custom 95164916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Ils 27mm Intra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164917|EAP|Custom 95164917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Ils 33mm Intra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164918|EAP|Custom 95164918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Standard Extended |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Snap-off|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|FSC: 13; Default||Not reimbursed separately|894.00|FSC: 13; Default||External grouping not supported 95164920|EAP|Custom 95164920||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wrap Rocket Shoulder/knee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164922|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast 5mm X 16 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95164928|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95164929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical 12 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 95164930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lcp 13 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,329.53|FSC: 13; Default||Not reimbursed separately|5,329.53|FSC: 13; Default||External grouping not supported 95164931|EAP|Custom 95164931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Micron 200 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164932|EAP|Custom 95164932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Micron 365|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164933|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,603.53|FSC: 13; Default||Not reimbursed separately|7,603.53|FSC: 13; Default||External grouping not supported 95164934|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,603.53|FSC: 13; Default||Not reimbursed separately|7,603.53|FSC: 13; Default||External grouping not supported 95164935|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue Natural Denovo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,010.00|FSC: 13; Default||Not reimbursed separately|14,010.00|FSC: 13; Default||External grouping not supported 95164936|EAP|Custom 95164936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Endocopic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164937|EAP|Custom 95164937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Micron 550|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164938|EAP|Custom 95164938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Micron 1000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Pinnacle Neutral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,603.53|FSC: 13; Default||Not reimbursed separately|7,603.53|FSC: 13; Default||External grouping not supported 95164940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Fem Articulize 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|FSC: 13; Default||Not reimbursed separately|6,157.20|FSC: 13; Default||External grouping not supported 95164941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articulize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|FSC: 13; Default||Not reimbursed separately|6,392.40|FSC: 13; Default||External grouping not supported 95164942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articulize|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|FSC: 13; Default||Not reimbursed separately|6,392.40|FSC: 13; Default||External grouping not supported 95164943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articuleze|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|FSC: 13; Default||Not reimbursed separately|6,392.40|FSC: 13; Default||External grouping not supported 95164944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articuleze|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|FSC: 13; Default||Not reimbursed separately|6,392.40|FSC: 13; Default||External grouping not supported 95164946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articuleze|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|FSC: 13; Default||Not reimbursed separately|6,392.40|FSC: 13; Default||External grouping not supported 95164947|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|FSC: 13; Default||Not reimbursed separately|6,117.30|FSC: 13; Default||External grouping not supported 95164948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|FSC: 13; Default||Not reimbursed separately|6,117.30|FSC: 13; Default||External grouping not supported 95164949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|FSC: 13; Default||Not reimbursed separately|6,117.30|FSC: 13; Default||External grouping not supported 95164950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,501.98|FSC: 13; Default||Not reimbursed separately|7,501.98|FSC: 13; Default||External grouping not supported 95164951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|FSC: 13; Default||Not reimbursed separately|7,494.90|FSC: 13; Default||External grouping not supported 95164952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 95164954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|FSC: 13; Default||Not reimbursed separately|6,451.20|FSC: 13; Default||External grouping not supported 95164955|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95164956|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95164959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95164964|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|FSC: 13; Default||Not reimbursed separately|18,276.30|FSC: 13; Default||External grouping not supported 95164977|EAP|Custom 95164977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Perfix Large Bard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail 2 Vara|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,610.08|FSC: 13; Default||Not reimbursed separately|9,610.08|FSC: 13; Default||External grouping not supported 95164988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Corail Collar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,610.08|FSC: 13; Default||Not reimbursed separately|9,610.08|FSC: 13; Default||External grouping not supported 95164989|EAP|Custom 95164989||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Cable And Lead Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95164990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95164992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95164993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95164994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95164995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 95164996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 95164997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,299.46|FSC: 13; Default||Not reimbursed separately|6,299.46|FSC: 13; Default||External grouping not supported 95164998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|FSC: 13; Default||Not reimbursed separately|9,584.40|FSC: 13; Default||External grouping not supported 95164945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Articuleze|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|FSC: 13; Default||Not reimbursed separately|6,392.40|FSC: 13; Default||External grouping not supported 95163621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymmetric Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,568.00|FSC: 13; Default||Not reimbursed separately|5,568.00|FSC: 13; Default||External grouping not supported 95165008|EAP|Custom 95165008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165011|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95165015|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intra 24.5 Crystalens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95165016|EAP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Monitor Ecg Sub Imp Reveal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|FSC: 13; Default||Not reimbursed separately|12,750.00|FSC: 13; Default||External grouping not supported 95165017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95165018|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Unify Bi Vent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|FSC: 13; Default||Not reimbursed separately|60,912.00|FSC: 13; Default||External grouping not supported 95165019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95165028|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tis Reg Alloderm 4x7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.93|FSC: 13; Default||Not reimbursed separately|88.93|FSC: 13; Default||External grouping not supported 95165031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|FSC: 13; Default||Not reimbursed separately|6,426.84|FSC: 13; Default||External grouping not supported 95165032|EAP|Custom 95165032||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Large|1|HUMANA [1294]||HUMANA [11839]|4,248.00|FSC: 13; Default||Not reimbursed separately|4,248.00|FSC: 13; Default||External grouping not supported 95165033|EAP|Custom 95165033||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pack Rapid Rhino Epist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10x360x125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95165038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95165039|EAP|Custom 95165039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Nose Blunt 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10x380x125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95165066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Dbm Trel-xc 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,532.00|FSC: 13; Default||Not reimbursed separately|2,532.00|FSC: 13; Default||External grouping not supported 95165067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95165068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|FSC: 13; Default||Not reimbursed separately|3,864.00|FSC: 13; Default||External grouping not supported 95165069|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95165070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|FSC: 13; Default||Not reimbursed separately|717.00|FSC: 13; Default||External grouping not supported 95165071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95165072|EAP|Custom 95165072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165073|EAP|Custom 95165073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner Blunt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.12|FSC: 13; Default||Not reimbursed separately|987.12|FSC: 13; Default||External grouping not supported 95165075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.12|FSC: 13; Default||Not reimbursed separately|987.12|FSC: 13; Default||External grouping not supported 95165076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.12|FSC: 13; Default||Not reimbursed separately|987.12|FSC: 13; Default||External grouping not supported 95165077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.04|FSC: 13; Default||Not reimbursed separately|1,013.04|FSC: 13; Default||External grouping not supported 95165078|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 250mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|992.25|FSC: 13; Default||Not reimbursed separately|992.25|FSC: 13; Default||External grouping not supported 95165079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,041.12|FSC: 13; Default||Not reimbursed separately|1,041.12|FSC: 13; Default||External grouping not supported 95165080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 350mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,041.12|FSC: 13; Default||Not reimbursed separately|1,041.12|FSC: 13; Default||External grouping not supported 95165081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 450mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.36|FSC: 13; Default||Not reimbursed separately|1,071.36|FSC: 13; Default||External grouping not supported 95165082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,048.50|FSC: 13; Default||Not reimbursed separately|1,048.50|FSC: 13; Default||External grouping not supported 95165083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 8 X 500mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,127.52|FSC: 13; Default||Not reimbursed separately|1,127.52|FSC: 13; Default||External grouping not supported 95165084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Inverted |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,856.25|FSC: 13; Default||Not reimbursed separately|1,856.25|FSC: 13; Default||External grouping not supported 95165086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Angled 30 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.50|FSC: 13; Default||Not reimbursed separately|328.50|FSC: 13; Default||External grouping not supported 95165087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|436.32|FSC: 13; Default||Not reimbursed separately|436.32|FSC: 13; Default||External grouping not supported 95165088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post 90 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|FSC: 13; Default||Not reimbursed separately|518.40|FSC: 13; Default||External grouping not supported 95165089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Pin 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|FSC: 13; Default||Not reimbursed separately|1,971.00|FSC: 13; Default||External grouping not supported 95165090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clamp Pin 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,628.00|FSC: 13; Default||Not reimbursed separately|2,628.00|FSC: 13; Default||External grouping not supported 95165095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Dia 5mm X 150mm Sd/st|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95165096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Dia 5mm X 180mm Sd/st|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95165099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95165101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95165102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95165103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95165104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95165105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95165107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95165109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.71|FSC: 13; Default||Not reimbursed separately|2,716.71|FSC: 13; Default||External grouping not supported 95165110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,801.67|FSC: 13; Default||Not reimbursed separately|2,801.67|FSC: 13; Default||External grouping not supported 95165111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Radius Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.29|FSC: 13; Default||Not reimbursed separately|2,884.29|FSC: 13; Default||External grouping not supported 95165085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod (to Coupling 8/8mm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,856.25|FSC: 13; Default||Not reimbursed separately|1,856.25|FSC: 13; Default||External grouping not supported 95150926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Anti-rotation Peg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95165117|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165124|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Memory|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95165125|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Memory|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95165126|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Silicone Self Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.69|FSC: 13; Default||Not reimbursed separately|6,048.69|FSC: 13; Default||External grouping not supported 95165127|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Silicone Self Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.69|FSC: 13; Default||Not reimbursed separately|6,048.69|FSC: 13; Default||External grouping not supported 95165128|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Silicone Self Expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.69|FSC: 13; Default||Not reimbursed separately|6,048.69|FSC: 13; Default||External grouping not supported 95165133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|FSC: 13; Default||Not reimbursed separately|1,161.00|FSC: 13; Default||External grouping not supported 95165142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Implant Repair Biceps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95165143|EAP|Custom 95165143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flex Echelon 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle 3.5mm 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Anter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 80161433|EAP|CPT® 43453||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Dilate Esophagus Over Wire|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80161441|EAP|CPT® 43244||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Up Gi Endo Band Lig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 62058888|EAP|CPT® 88104||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Ap Bill Tc Only Non Gyn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62058904|EAP|CPT® 88112||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Ap Bill Tc Only Liq Prep|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62058938|EAP|CPT® 88305||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Ap Bill Tc Only Surg Path|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62058953|EAP|CPT® 88312||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Ap Bill Tc Only Surg Stains Gr 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62058979|EAP|CPT® 88313||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Ap Bill Tc Only Surg Stains Gr 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62058995|EAP|CPT® 88342||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ap Bill Tc Only Ihc Ea Antibody|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62059001|EAP|CPT® 88342||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Ap Bill Tc Only Each Antibody|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62059019|EAP|CPT® 88360||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Morphometric Ihc, Manual|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62059068|EAP|CPT® 88365||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Ap Bill Pro Only In-situ Hybrid Ea|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62059076|EAP|Custom 62059076||0998 - STATISTICAL CHARGES|Hb Ap Bill Pqri Metastatic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62059084|EAP|Custom 62059084||0998 - STATISTICAL CHARGES|Hb Ap Pqri Bill Not Docum Ok|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62059092|EAP|Custom 62059092||0998 - STATISTICAL CHARGES|Hb Ap Bill Pqri Not Documented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62059118|EAP|Custom 62059118||0998 - STATISTICAL CHARGES|Hb Ap Bill Pqri Documented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95165677|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,975.00|FSC: 13; Default||Not reimbursed separately|18,975.00|FSC: 13; Default||External grouping not supported 95165678|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comp Prox W/proform Graft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,226.00|FSC: 13; Default||Not reimbursed separately|35,226.00|FSC: 13; Default||External grouping not supported 95165679|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comp Prox W Profor Graft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,226.00|FSC: 13; Default||Not reimbursed separately|35,226.00|FSC: 13; Default||External grouping not supported 95165681|EAP|Custom 95165681||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 4 Degree X Vbr|1|HUMANA [1294]||HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95165682|EAP|Custom 95165682||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Corpectomy Replacement|1|HUMANA [1294]||HUMANA [11839]|23,079.00|FSC: 13; Default||Not reimbursed separately|23,079.00|FSC: 13; Default||External grouping not supported 95165683|EAP|Custom 95165683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Arterial Line 20ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165684|EAP|Custom 95165684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Radial Artery|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165685|EAP|Custom 95165685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Cnetral Venous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165686|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Set 16fr W/guide Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165687|EAP|Custom 95165687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Cent Venous Quad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165688|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Cent Venous Double|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.81|FSC: 13; Default||Not reimbursed separately|353.81|FSC: 13; Default||External grouping not supported 95165689|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 8.0 Diop Acry Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95165690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate J Clavicle Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate J Clavicle Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Rsp Djo Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|FSC: 13; Default||Not reimbursed separately|11,407.50|FSC: 13; Default||External grouping not supported 95165734|EAP|Custom 95165734||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Cement Clearcut Encore|1|HUMANA [1294]||HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95165735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymetric Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95165736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymetric Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95165738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95165741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Dbm Trel-xc8cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,894.40|FSC: 13; Default||Not reimbursed separately|2,894.40|FSC: 13; Default||External grouping not supported 95165742|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 12x11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|FSC: 13; Default||Not reimbursed separately|3,026.04|FSC: 13; Default||External grouping not supported 95165743|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 10x11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|FSC: 13; Default||Not reimbursed separately|3,026.04|FSC: 13; Default||External grouping not supported 95165744|EAP|Custom 95165744||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95165745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95165746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95165748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trans Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,342.00|FSC: 13; Default||Not reimbursed separately|6,342.00|FSC: 13; Default||External grouping not supported 95165749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165705|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diop Crystalens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95165706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95165721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Solution|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|FSC: 13; Default||Not reimbursed separately|29,234.10|FSC: 13; Default||External grouping not supported 95165722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 2 Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|FSC: 13; Default||Not reimbursed separately|1,920.00|FSC: 13; Default||External grouping not supported 95165725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95165727|EAP|Custom 95165727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149671|EAP|Custom 95149671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endo Trach Pedi 2-lum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mmx55.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mmx65.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95165755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95165764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95165765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Non-toggling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95165766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165774|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.0 Diop Crystalens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95165787|EAP|Custom 95165787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Stelant Single Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165788|EAP|Custom 95165788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Needle Aspiration 22ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165789|EAP|Custom 95165789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Needle Aspiration 21ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165792|EAP|Custom 95165792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Pro 14fr Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165793|EAP|Custom 95165793||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Pro 14fr Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 22.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 26.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 28.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 35.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 40.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 50.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING THREAD FULL 5.0MM X 37MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING THREAD FULL 5.0MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB NAIL KIT LONG R1.5 TITANIUM RIGHT 10 X 340 X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95165199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 60.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95165200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LAG 10.5 X 90MM GAMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95165202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CORTICAL 2.7MM X 18.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95165203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB TALUS MEDIUM LEFT SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,902.00|FSC: 13; Default||Not reimbursed separately|13,902.00|FSC: 13; Default||External grouping not supported 95165204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB COMPONENT BEARING TIBIAL 7MM STAR SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|FSC: 13; Default||Not reimbursed separately|4,590.00|FSC: 13; Default||External grouping not supported 95165205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SHELL ACETABULAR PINNACLE 100 GRIPTION WITH OUT HOLES 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95165206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB INSERT BEARING TIBIAL PS TRIATHLON SIZE 5-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95165557|EAP|Custom 95165557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB FORCEP CUTTING PKS HALO ACMI GYRUS|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95165559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL 8 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95165560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL 6 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL 8 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,236.00|FSC: 13; Default||Not reimbursed separately|4,236.00|FSC: 13; Default||External grouping not supported 95165563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE MEDIAL DISTAL 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE MEDIAL DISTAL 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE MEDIAL DISTAL 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95165566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE MEDIAL DISTAL EXTENDED 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE MEDIAL DISTAL EXTENDED 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,236.00|FSC: 13; Default||Not reimbursed separately|4,236.00|FSC: 13; Default||External grouping not supported 95165568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL POSTERIOR 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL POSTERIOR 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL POSTERIOR 8 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95165571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL POSTERIOR 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL POSTERIOR 6 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|FSC: 13; Default||Not reimbursed separately|3,852.00|FSC: 13; Default||External grouping not supported 95165573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE LATERAL DISTAL POSTERIOR 8 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95165574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE OLECRANON 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE OLECRANON 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE OLECRANON 8 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95165577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE OLECRANON 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE OLECRANON 6 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95165579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE OLECRANON 8 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95165580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95165582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95165584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95165588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95165589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|768.00|FSC: 13; Default||Not reimbursed separately|768.00|FSC: 13; Default||External grouping not supported 95165590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95165593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95165594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95165596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95165597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95165601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 2.7 MM X L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|FSC: 13; Default||Not reimbursed separately|506.25|FSC: 13; Default||External grouping not supported 95165612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95165624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING 3.5 MM X L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95165625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|FSC: 13; Default||Not reimbursed separately|261.00|FSC: 13; Default||External grouping not supported 95165626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|FSC: 13; Default||Not reimbursed separately|441.00|FSC: 13; Default||External grouping not supported 95165628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|FSC: 13; Default||Not reimbursed separately|441.00|FSC: 13; Default||External grouping not supported 95165631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|FSC: 13; Default||Not reimbursed separately|441.00|FSC: 13; Default||External grouping not supported 95165632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95165636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95165639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95165644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|FSC: 13; Default||Not reimbursed separately|261.00|FSC: 13; Default||External grouping not supported 95165645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165646|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95165647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|FSC: 13; Default||Not reimbursed separately|261.00|FSC: 13; Default||External grouping not supported 95165649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|FSC: 13; Default||Not reimbursed separately|261.00|FSC: 13; Default||External grouping not supported 95165650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 2.7MM X L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95165653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95165660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|FSC: 13; Default||Not reimbursed separately|281.25|FSC: 13; Default||External grouping not supported 95165673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW BONE 3.5MM X L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95165674|EAP|Custom 95165674||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB GRAFT OCCLUDER AAA 24MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95165675|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB GRAFT LEG ILIAC AAA 12MM X 124CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95165147|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 12MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|FSC: 13; Default||Not reimbursed separately|7,422.00|FSC: 13; Default||External grouping not supported 95165148|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 14MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|FSC: 13; Default||Not reimbursed separately|7,422.00|FSC: 13; Default||External grouping not supported 95165149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICAL ANTERIOR 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE ANTERIOR LATERAL 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 95165152|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB IMPLANT EXPANDER CONTOUR PROFILE MEDIUM 6200 275CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95165153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE DISTAL 2.3MM RIGHT 16 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,138.00|FSC: 13; Default||Not reimbursed separately|3,138.00|FSC: 13; Default||External grouping not supported 95165154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE DISTAL 2.3MM LEFT 16 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95165155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE DISTAL 2.3MM RIGHT 13 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE DISTAL 2.3MM LEFT 13 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE STANDARD LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,886.00|FSC: 13; Default||Not reimbursed separately|2,886.00|FSC: 13; Default||External grouping not supported 95165158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE RIGHT STANDARD 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE LARGE LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|FSC: 13; Default||Not reimbursed separately|2,262.00|FSC: 13; Default||External grouping not supported 95165162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE LARGE RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.3MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95165166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE MEDIUM LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 95165168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE MEDIUM RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE SMALL LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE LOW PROFILE SMALL RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 95165173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE NARROW PROFILE LEFT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING CORTICAL 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE NARROW PROFILE RIGHT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE NARROW PROFILE STANDARD LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|FSC: 13; Default||Not reimbursed separately|2,853.00|FSC: 13; Default||External grouping not supported 95165180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE NARROW PROFILE STANDARD RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|FSC: 13; Default||Not reimbursed separately|2,262.00|FSC: 13; Default||External grouping not supported 95165181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE NARROW PROFILE LARGE LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE CLAVICLE NARROW PROFILE LARGE RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95165183|EAP|Custom 95165183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB INTRODUCER|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW CANCELLOUS 4.0MM X 16.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95150004|EAP|Custom 95150004||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tray Anesthesia Pudendal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Grip Trochanteric |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,701.50|FSC: 13; Default||Not reimbursed separately|5,701.50|FSC: 13; Default||External grouping not supported 95165800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165808|EAP|Custom 95165808||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Airway Laryngeal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165809|EAP|Custom 95165809||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Tracheal Laser 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95165812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Poster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,468.00|FSC: 13; Default||Not reimbursed separately|3,468.00|FSC: 13; Default||External grouping not supported 95165817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Poster |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,209.00|FSC: 13; Default||Not reimbursed separately|4,209.00|FSC: 13; Default||External grouping not supported 95165818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Poster |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,236.00|FSC: 13; Default||Not reimbursed separately|4,236.00|FSC: 13; Default||External grouping not supported 95165819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|FSC: 13; Default||Not reimbursed separately|282.00|FSC: 13; Default||External grouping not supported 95165822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95165825|EAP|Custom 95165825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber #2 Braided Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165826|EAP|Custom 95165826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Trocar Headless |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165827|EAP|Custom 95165827||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95165830|EAP|Custom 95165830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Quadpolar 6fr 125 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165832|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 8.9 Diop Acrysof Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95165833|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 9.5 Diop Acrysof Restor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95165840|EAP|Custom 95165840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Xcel Endo |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62058110|EAP|CPT® 87624||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hpv High Risk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62056916|EAP|CPT® 86970||0302 - LABORATORY - IMMUNOLOGY|Hb R92 Hox Zzap Treat 12 Cell|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62056718|EAP|CPT® 82570||0301 - LABORATORY - CHEMISTRY|Hb Body Fluid Creatinine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62056668|EAP|CPT® 82945||0301 - LABORATORY - CHEMISTRY|Hb Joint Body Fluid Glucose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 80161466|EAP|CPT® 52281||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cysto Cal/dil W W/o Cysto|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80161474|EAP|HCPCS J0461||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Atropine 0.4mg Inj|1|HUMANA [1294]||HUMANA [11839]|5.93|FSC: 13; Default||Not reimbursed separately|5.93|FSC: 13; Default||External grouping not supported 95165845|EAP|Custom 95165845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Urologists|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165847|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Benston|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit R1.5 Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95165849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,741.20|FSC: 13; Default||Not reimbursed separately|4,741.20|FSC: 13; Default||External grouping not supported 95165850|EAP|Custom 95165850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95165856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95165857|EAP|Custom 95165857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Shears Curved Ace|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165860|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Emboshield Protection|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165861|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Pyrosphere 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.00|FSC: 13; Default||Not reimbursed separately|5,967.00|FSC: 13; Default||External grouping not supported 95165868|EAP|Custom 95165868||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna Percut Evident Mwa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165870|EAP|Custom 95165870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Tubing For Evident Mwa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Ps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95165872|EAP|Custom 95165872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna Percut Evident Mwa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165873|EAP|Custom 95165873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealant Leak Air Pleural|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Dia 4 X 120 X 35mm Sd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95165875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Dia 5 X 150 X 50mm Sd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95165876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Transfixing 5/6 X 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.75|FSC: 13; Default||Not reimbursed separately|483.75|FSC: 13; Default||External grouping not supported 95165877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Biocomp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95165878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Biocomp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95165880|EAP|Custom 95165880||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Twist In With No|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165881|EAP|Custom 95165881||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Passport Button |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165882|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Cellular Oste|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95165883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Narrow Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95165884|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Triad Cr 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|FSC: 13; Default||Not reimbursed separately|3,885.00|FSC: 13; Default||External grouping not supported 95165885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Rt Helix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95165886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Helix 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95165887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Helix 4mmx13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95165888|EAP|Custom 95165888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation Helix|1|HUMANA [1294]||HUMANA [11839]|684.00|FSC: 13; Default||Not reimbursed separately|684.00|FSC: 13; Default||External grouping not supported 95165890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.00|FSC: 13; Default||Not reimbursed separately|417.00|FSC: 13; Default||External grouping not supported 95165893|EAP|Custom 95165893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Dual Limb Heated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163014|EAP|Custom 95163014||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Garment Compression Calf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165040|EAP|Custom 95165040||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Valve Suction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165844|EAP|Custom 95165844||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Suture Lasso 90 Degree Stra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165894|EAP|Custom 95165894||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Extension 110 Cassette|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165896|EAP|Custom 95165896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Material Filling Root Canal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165902|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Icd Dual Chamber Tel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,000.00|FSC: 13; Default||Not reimbursed separately|60,000.00|FSC: 13; Default||External grouping not supported 95165904|EAP|Custom 95165904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plat Ortho Link 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|FSC: 13; Default||Not reimbursed separately|2,932.50|FSC: 13; Default||External grouping not supported 95165906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,053.38|FSC: 13; Default||Not reimbursed separately|5,053.38|FSC: 13; Default||External grouping not supported 95165907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inter Milagro 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95165908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inter Milagro 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|FSC: 13; Default||Not reimbursed separately|1,242.00|FSC: 13; Default||External grouping not supported 95165910|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Angiosculpt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165911|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Angiosculpt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165916|EAP|Custom 95165916||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Ground Valleylab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165918|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 10.0 Diop Anterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95114223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Unitrax 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95165932|EAP|Custom 95165932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Pulse Oximeter Adh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165931|EAP|Custom 95165931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bond Clearfil Se 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165961|EAP|Custom 95165961||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Suction Pro 12fr Single Lum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165962|EAP|Custom 95165962||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Suction Pro 12fr Single Lum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114226|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95115659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitrax |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95115660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitrax |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.25|FSC: 13; Default||Not reimbursed separately|386.25|FSC: 13; Default||External grouping not supported 95115661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95115662|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Modular Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95165940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95165942|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95165941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X3 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95165943|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Adapter Taper V40 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95165944|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95165945|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 19mmx155mm Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|FSC: 13; Default||Not reimbursed separately|11,298.00|FSC: 13; Default||External grouping not supported 95165947|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Kinetix 185cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165948|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guirewire Kinetix Plus 185|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62058896|EAP|CPT® 88307||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Ap Bill Tc Only Surg Path 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95114230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95114231|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95114232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95114234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95115658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95117467|EAP|Custom 95117467||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bar Locking Tibial |1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95120740|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blazer Ii Extend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162897|EAP|Custom 95162897||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Oxygen Forehead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165034|EAP|Custom 95165034||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Packing Rapid Rhino Epist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165797|EAP|Custom 95165797||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Bf-uc160f-old|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165891|EAP|Custom 95165891||0258 - PHARMACY - IV SOLUTIONS|Hb Solution Iv 5/20 Clinimix|1|HUMANA [1294]||HUMANA [11839]|86.10|FSC: 13; Default||Not reimbursed separately|86.10|FSC: 13; Default||External grouping not supported 95165964|EAP|Custom 95165964||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Performatrak Ee Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165965|EAP|Custom 95165965||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Performatrak Ee Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165966|EAP|Custom 95165966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Rfa 10cm With 3cm Rad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165967|EAP|Custom 95165967||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Performatrak Ee Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165968|EAP|Custom 95165968||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|HB MASK NASAL CONTOUR DELUXE |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165969|EAP|Custom 95165969||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Contour Deluxe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165973|EAP|Custom 95165973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Sagittal 29.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165974|EAP|Custom 95165974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Neuro Less Aggressive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165975|EAP|Custom 95165975||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Contour Deluxe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95165977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95165978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95165979|EAP|Custom 95165979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165980|EAP|Custom 95165980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Threaded 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix W/washer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95165982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix W/washer |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95165983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix W/washer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95165984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix W/washer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95165985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix W/washer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|FSC: 13; Default||Not reimbursed separately|815.79|FSC: 13; Default||External grouping not supported 95165986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hallu Lock S Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,929.76|FSC: 13; Default||Not reimbursed separately|3,929.76|FSC: 13; Default||External grouping not supported 95165987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 95165988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cr Legion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 95165989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drill Pin Quick Connect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|343.95|FSC: 13; Default||Not reimbursed separately|343.95|FSC: 13; Default||External grouping not supported 95165990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Trocar Quick Connect|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.96|FSC: 13; Default||Not reimbursed separately|138.96|FSC: 13; Default||External grouping not supported 95165991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Base Tibial Ii |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95165992|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diop Tecnis Mult|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95165995|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Wallflex 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,244.15|FSC: 13; Default||Not reimbursed separately|5,244.15|FSC: 13; Default||External grouping not supported 80161524|EAP|CPT® 51610||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Proc Retro Urethrocysto|1|HUMANA [1294]||HUMANA [11839]|844.35|FSC: 13; Default||Not reimbursed separately|844.35|FSC: 13; Default||External grouping not supported 95166003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 95166004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannul |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95166005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannul |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|FSC: 13; Default||Not reimbursed separately|708.00|FSC: 13; Default||External grouping not supported 95166006|EAP|Custom 95166006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95166008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X3 O-degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95166009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Translational |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|FSC: 13; Default||Not reimbursed separately|6,215.16|FSC: 13; Default||External grouping not supported 62058201|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Tsh Receptor Antibody - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62056833|EAP|Custom 62056833||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R51 Hox Reference Late Fee|1|HUMANA [1294]||HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 62056908|EAP|CPT® 86971||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R91 Hox Enzyme Tx 12 Cell|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62056791|EAP|Custom 62056791||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb M20 Hox Xm Plat Per Donor|1|HUMANA [1294]||HUMANA [11839]|175.00|FSC: 13; Default||Not reimbursed separately|175.00|FSC: 13; Default||External grouping not supported 62056924|EAP|CPT® 86812||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb T93 Hox Hla Match Platelets|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|FSC: 13; Default||Not reimbursed separately|77.43|FSC: 13; Default||External grouping not supported 62056809|EAP|Custom 62056809||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ro2 Hox Rare Import Fee|1|HUMANA [1294]||HUMANA [11839]|260.00|FSC: 13; Default||Not reimbursed separately|260.00|FSC: 13; Default||External grouping not supported 95166013|EAP|Custom 95166013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Bite Block And Etco2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166017|EAP|Custom 95166017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ablator Lightwave 90 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166018|EAP|Custom 95166018||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Tip Extended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166020|EAP|Custom 95166020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Entry First Fios|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166025|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95166029|EAP|Custom 95166029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Twist In With No |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biocorkscrew Peek 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95166034|EAP|Custom 95166034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Passport Button|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166040|EAP|Custom 95166040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Twist In With No|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95166042|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95166043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Bio-composite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|FSC: 13; Default||Not reimbursed separately|915.00|FSC: 13; Default||External grouping not supported 95166044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibal Insert X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95166045|EAP|Custom 95166045||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Insertion |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166046|EAP|Custom 95166046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suturelasso 25 Degree |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166047|EAP|Custom 95166047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suturelasso 90 Degree |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biosuturetak 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95166049|EAP|Custom 95166049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Twist In With No|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166051|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Biologic Collagen |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,915.00|FSC: 13; Default||Not reimbursed separately|6,915.00|FSC: 13; Default||External grouping not supported 95166052|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Biologic Collagen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,733.50|FSC: 13; Default||Not reimbursed separately|9,733.50|FSC: 13; Default||External grouping not supported 95166053|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Biologic Collagen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95166054|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Biologic Collagen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|FSC: 13; Default||Not reimbursed separately|18,900.00|FSC: 13; Default||External grouping not supported 95166055|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Biologic Collagen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,054.26|FSC: 13; Default||Not reimbursed separately|37,054.26|FSC: 13; Default||External grouping not supported 95166057|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Eagle Eye Platinum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166058|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Primewire Prest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Left 24.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95166060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Head Radial 7.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95166061|EAP|Custom 95166061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm Long Quick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95166063|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Memory|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95166065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10x360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95166066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95166072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95166074|EAP|Custom 95166074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cresol Formo Buckley|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166075|EAP|Custom 95166075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filtek Supreme Ultra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 95166077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Base Tibial Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95166079|EAP|Custom 95166079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Pack Finesse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cr Legion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|FSC: 13; Default||Not reimbursed separately|5,926.80|FSC: 13; Default||External grouping not supported 95166081|EAP|Custom 95166081||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166082|EAP|Custom 95166082||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Glove Therapeutic Isotoner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161532|EAP|Custom 80161532||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Vascutherm Per Day|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165993|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vasc Coated Heparin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,033.00|FSC: 13; Default||Not reimbursed separately|9,033.00|FSC: 13; Default||External grouping not supported 95166090|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95166091|EAP|Custom 95166091||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Post Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95166095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Medial 88mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95166096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95166097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95166098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95166100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95166101|EAP|Custom 95166101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Marked 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166028|EAP|Custom 95166028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Multisinus Dilation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166105|EAP|Custom 95166105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fluid Management System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166107|EAP|Custom 95166107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Bone Biopsy 13g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Bio-comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95166113|EAP|Custom 95166113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiberloop W Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ii Sextant 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|FSC: 13; Default||Not reimbursed separately|6,612.06|FSC: 13; Default||External grouping not supported 95166115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Sextant 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|FSC: 13; Default||Not reimbursed separately|2,216.76|FSC: 13; Default||External grouping not supported 95166117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dorsal Radius |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95144387|EAP|Custom 95144387||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dressing Whitefoam Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166122|EAP|Custom 95166122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angio Selective|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|FSC: 13; Default||Not reimbursed separately|858.00|FSC: 13; Default||External grouping not supported 95166124|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .062 6 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166125|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .062 7 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166126|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Otw Angiosculpt Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166127|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Otw Angiosculpt Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166128|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Otw Angiosculpt Pta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166129|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiosculpt Ex Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166130|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiosculpt Ex Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166131|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiosculpt Ex Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166132|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiosculpt Ex Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166133|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiosculpt Ex Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166134|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angiosculpt Ex Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166136|EAP|Custom 95166136||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sover|1|HUMANA [1294]||HUMANA [11839]|25,284.00|FSC: 13; Default||Not reimbursed separately|25,284.00|FSC: 13; Default||External grouping not supported 95166141|EAP|Custom 95166141||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Generator Infant Ncpap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166142|EAP|Custom 95166142||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Nasal Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166143|EAP|Custom 95166143||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Nasal Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166144|EAP|Custom 95166144||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Infant Nasal Silicone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166146|EAP|Custom 95166146||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Needle Westcott 20ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166149|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Qcross .018 Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 62056601|EAP|CPT® 82043||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Microalbumin 24 Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.34|FSC: 13; Default||Not reimbursed separately|17.34|FSC: 13; Default||External grouping not supported 95166152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95166153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,777.29|FSC: 13; Default||Not reimbursed separately|1,777.29|FSC: 13; Default||External grouping not supported 95166154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95166156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.60|FSC: 13; Default||Not reimbursed separately|396.60|FSC: 13; Default||External grouping not supported 95166158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166159|EAP|Custom 95166159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95166161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95166162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere 36mm Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95166163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly Reverse Metal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95166164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|FSC: 13; Default||Not reimbursed separately|337.50|FSC: 13; Default||External grouping not supported 95166165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|FSC: 13; Default||Not reimbursed separately|337.50|FSC: 13; Default||External grouping not supported 95166166|EAP|Custom 95166166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wrist Fusion Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,442.81|FSC: 13; Default||Not reimbursed separately|5,442.81|FSC: 13; Default||External grouping not supported 95166178|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Exchange Choice|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wrist Fusion Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,442.81|FSC: 13; Default||Not reimbursed separately|5,442.81|FSC: 13; Default||External grouping not supported 95166180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10x340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95166181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95166184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95166186|EAP|Custom 95166186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.0mm Head|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166194|EAP|Custom 95166194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endotracheal Agt Nasal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166197|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95166198|EAP|Custom 95166198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Solution Irrigation |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166201|EAP|Custom 95166201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pillcam Sb2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166202|EAP|Custom 95166202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Sheath Flexor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166204|EAP|Custom 95166204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pillcam Sb2-ex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166205|EAP|Custom 95166205||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Cervical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166209|EAP|Custom 95166209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Devise Compression Radial |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166210|EAP|Custom 95166210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Devise Compression Radial |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166211|EAP|Custom 95166211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath 6fr 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166213|EAP|Custom 95166213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath Nitinol 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166214|EAP|Custom 95166214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath Nitinol 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166215|EAP|Custom 95166215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Optitorque 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166220|EAP|Custom 95166220||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 7x25mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95166221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|FSC: 13; Default||Not reimbursed separately|1,121.91|FSC: 13; Default||External grouping not supported 95166226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.62|FSC: 13; Default||Not reimbursed separately|82.62|FSC: 13; Default||External grouping not supported 95166248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|FSC: 13; Default||Not reimbursed separately|1,155.57|FSC: 13; Default||External grouping not supported 95166027|EAP|Custom 95166027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Jaweed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166030|EAP|Custom 95166030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Halpin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166032|EAP|Custom 95166032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Sanita|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166033|EAP|Custom 95166033||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Noll|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166035|EAP|Custom 95166035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Snyder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166036|EAP|Custom 95166036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Breen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166037|EAP|Custom 95166037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Zink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166038|EAP|Custom 95166038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Hater|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166039|EAP|Custom 95166039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cust Hollan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159213|EAP|CPT® 36556||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Insert Non-tunnel Cv Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.93|FSC: 13; Default||Not reimbursed separately|4,647.93|FSC: 13; Default||External grouping not supported 80161540|EAP|CPT® 62267||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Asp Interver Fluid|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95166254|EAP|Custom 95166254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Wire Snap For Aria|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166255|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Sv Cath 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Adapter Taper V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95166258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|FSC: 13; Default||Not reimbursed separately|5,728.80|FSC: 13; Default||External grouping not supported 95166260|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Test Stimulation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|FSC: 13; Default||Not reimbursed separately|915.00|FSC: 13; Default||External grouping not supported 95166267|EAP|Custom 95166267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Optitorque 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.8mm Va|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|FSC: 13; Default||Not reimbursed separately|441.39|FSC: 13; Default||External grouping not supported 95166279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Compression 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95166280|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide .045|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95166282|EAP|Custom 95166282||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fixation External|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95166283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Keel Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|FSC: 13; Default||Not reimbursed separately|10,458.00|FSC: 13; Default||External grouping not supported 95166285|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Brite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166289|EAP|Custom 95166289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Oxygenator Affinity 541|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166290|EAP|Custom 95166290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tubing Custom Medtron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166291|EAP|Custom 95166291||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprostehesis Graft|1|HUMANA [1294]||HUMANA [11839]|37,125.00|FSC: 13; Default||Not reimbursed separately|37,125.00|FSC: 13; Default||External grouping not supported 95166292|EAP|Custom 95166292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Tri-lobe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166293|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dry Sheath Gore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|FSC: 13; Default||Not reimbursed separately|4,590.00|FSC: 13; Default||External grouping not supported 95166295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.0x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95166296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.0x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95166297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95166298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Solera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|FSC: 13; Default||Not reimbursed separately|639.00|FSC: 13; Default||External grouping not supported 95166299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95166300|EAP|Custom 95166300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cancellous Chips 15cc |1|HUMANA [1294]||HUMANA [11839]|1,056.00|FSC: 13; Default||Not reimbursed separately|1,056.00|FSC: 13; Default||External grouping not supported 95166301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Adjustment Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95166302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mmx90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95166303|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quick Cross Extre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166304|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quickcross Extrem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166305|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Savvy Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166306|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Savvy Long 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80161557|EAP|CPT® 95857||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Tensilon Test|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95166318|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pioneer Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95166320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral Ex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95166321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.42|FSC: 13; Default||Not reimbursed separately|1,935.42|FSC: 13; Default||External grouping not supported 95166322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.42|FSC: 13; Default||Not reimbursed separately|1,935.42|FSC: 13; Default||External grouping not supported 95166323|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 23.0 Ao Diop Crystalens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95166324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95166325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95166326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95166329|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95166330|EAP|Custom 95166330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Mvp Crescent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166331|EAP|Custom 95166331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Mvp 45 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166332|EAP|Custom 95166332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Mvp 45 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95166334|EAP|Custom 95166334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Echelon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Solution|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|FSC: 13; Default||Not reimbursed separately|28,803.60|FSC: 13; Default||External grouping not supported 95166336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95166337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95166338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Humeral Small 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,172.00|FSC: 13; Default||Not reimbursed separately|11,172.00|FSC: 13; Default||External grouping not supported 95166339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periprosthesis Axsos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|FSC: 13; Default||Not reimbursed separately|542.16|FSC: 13; Default||External grouping not supported 95114235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95121704|EAP|Custom 95121704||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Compression Uni-clip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Axsos Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 95166341|EAP|Custom 95166341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Locking 5.0 Axsos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166342|EAP|Custom 95166342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Plug 5.0 Axsos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166343|EAP|Custom 95166343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.3mmx289mm Axsos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Trochanteric Ti 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,123.44|FSC: 13; Default||Not reimbursed separately|4,123.44|FSC: 13; Default||External grouping not supported 95166347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95166348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bilian|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95166349|EAP|Custom 95166349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao 3.2mmx230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166350|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cc Triad 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95166351|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cc Triad 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95166352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plaste Cervical 36mm Helex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|FSC: 13; Default||Not reimbursed separately|3,288.00|FSC: 13; Default||External grouping not supported 95166353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95166354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95166355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|FSC: 13; Default||Not reimbursed separately|292.50|FSC: 13; Default||External grouping not supported 95166356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Broad Comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.92|FSC: 13; Default||Not reimbursed separately|673.92|FSC: 13; Default||External grouping not supported 95166358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|FSC: 13; Default||Not reimbursed separately|4,387.50|FSC: 13; Default||External grouping not supported 95166359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95166360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95166361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95166363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166365|EAP|Custom 95166365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.1mmx204mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166366|EAP|Custom 95166366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mmx125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166367|EAP|Custom 95166367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166368|EAP|Custom 95166368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Antenna Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166369|EAP|Custom 95166369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evident Mwa System Rental|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166371|EAP|Custom 95166371||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Capsular Tension Mr|1|HUMANA [1294]||HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95166372|EAP|Custom 95166372||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Capsular Tension Mr|1|HUMANA [1294]||HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95166382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95166384|EAP|Custom 95166384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Dilator Endovascular |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166392|EAP|Custom 95166392||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Hf Loop 0.35 Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166393|EAP|Custom 95166393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Pt Gray 40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|FSC: 13; Default||Not reimbursed separately|1,416.00|FSC: 13; Default||External grouping not supported 95166395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95166396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95166397|EAP|Custom 95166397||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 9mm X 25mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95166398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Revolution Helix 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95166399|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cc Triad 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95166400|EAP|Custom 95166400||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tack|1|HUMANA [1294]||HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95166401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95166402|EAP|Custom 95166402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ablator Lightwave 90 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166406|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Sof-flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.60|FSC: 13; Default||Not reimbursed separately|417.60|FSC: 13; Default||External grouping not supported 95166407|EAP|Custom 95166407||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spinal Cemenet Confidence |1|HUMANA [1294]||HUMANA [11839]|7,326.00|FSC: 13; Default||Not reimbursed separately|7,326.00|FSC: 13; Default||External grouping not supported 95166411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella Fem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95166412|EAP|Custom 95166412||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Battery Navigation Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166413|EAP|Custom 95166413||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Compression Sequential|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166414|EAP|Custom 95166414||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Compression Venaflow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166415|EAP|Custom 95166415||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Compression Sequential|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166416|EAP|Custom 95166416||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Compression Sequential|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161690|EAP|CPT® 0253T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Aqueous Drain Device|1|HUMANA [1294]||HUMANA [11839]|11,787.10|FSC: 13; Default||Not reimbursed separately|11,787.10|FSC: 13; Default||External grouping not supported 80161675|EAP|CPT® 0238T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trluml Perip Athrc Iliac Ar|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80161674|EAP|CPT® 0237T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trluml Perip Athrc Brchioc|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161673|EAP|CPT® 0236T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trluml Perip Athrc Abd Aort|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161755|EAP|CPT® 93351||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo 2d |1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 80161672|EAP|CPT® 0235T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trluml Perip Athrc Visceral|1|HUMANA [1294]||HUMANA [11839]|7,217.19|FSC: 13; Default||Not reimbursed separately|7,217.19|FSC: 13; Default||External grouping not supported 80161671|EAP|CPT® 0234T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trluml Perip Athrc Renal Ar|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161666|EAP|CPT® 95801||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Slp Stdy Unatnd W/anal|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 80161665|EAP|CPT® 95800||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Slp Study Unattended|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95166418|EAP|Custom 95166418||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Reacher Standard 26|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166426|EAP|Custom 95166426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Cond Laparoscopic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166431|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Cent Venous Triple|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80161664|EAP|CPT® 93568||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Inject Pulm Art Hrt Cath|1|HUMANA [1294]||HUMANA [11839]|2,312.50|FSC: 13; Default||Not reimbursed separately|2,312.50|FSC: 13; Default||External grouping not supported 80161663|EAP|CPT® 93567||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Inject Suprvlv Aortograph|1|HUMANA [1294]||HUMANA [11839]|1,429.72|FSC: 13; Default||Not reimbursed separately|1,429.72|FSC: 13; Default||External grouping not supported 80161662|EAP|CPT® 93566||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Inject R Ventr/atrial Angio|1|HUMANA [1294]||HUMANA [11839]|1,932.48|FSC: 13; Default||Not reimbursed separately|1,932.48|FSC: 13; Default||External grouping not supported 80161661|EAP|CPT® 93565||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Inject L Ventr/atrial Angio|1|HUMANA [1294]||HUMANA [11839]|1,952.85|FSC: 13; Default||Not reimbursed separately|1,952.85|FSC: 13; Default||External grouping not supported 80161660|EAP|CPT® 93564||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Inject Hrt Congntl Art/grft|1|HUMANA [1294]||HUMANA [11839]|295.50|FSC: 13; Default||Not reimbursed separately|295.50|FSC: 13; Default||External grouping not supported 80161659|EAP|CPT® 93563||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Inject Congenital Card Cath|1|HUMANA [1294]||HUMANA [11839]|2,621.00|FSC: 13; Default||Not reimbursed separately|2,621.00|FSC: 13; Default||External grouping not supported 80161658|EAP|CPT® 93464||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Exercise W/hemodynamic Meas|1|HUMANA [1294]||HUMANA [11839]|1,212.00|FSC: 13; Default||Not reimbursed separately|1,212.00|FSC: 13; Default||External grouping not supported 80161657|EAP|CPT® 93463||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Drug Admin & Hemodynmic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|944.25|FSC: 13; Default||Not reimbursed separately|944.25|FSC: 13; Default||External grouping not supported 80161656|EAP|CPT® 93462||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb L Hrt Cath Transptl |1|HUMANA [1294]||HUMANA [11839]|8,330.71|FSC: 13; Default||Not reimbursed separately|8,330.71|FSC: 13; Default||External grouping not supported 80161655|EAP|CPT® 93461||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb R&l Hrt Art/vent Angio|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161654|EAP|CPT® 93460||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb R&l Hrt Art/vent Angio|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161653|EAP|CPT® 93459||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb L Hrt Art/grft Angio|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161652|EAP|CPT® 93458||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb L Hrt Artery/vent Angio|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161651|EAP|CPT® 93457||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb R Hrt Art/grft Angio|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161650|EAP|CPT® 93456||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb R Hrt Coronary Artery Angio|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161649|EAP|CPT® 93455||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Coronary Art/grft Angio S&i|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161648|EAP|CPT® 93454||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Coronary Artery Angio S&i|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161647|EAP|CPT® 93453||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb R&l Hrt Cath W/ventrgrphy|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161646|EAP|CPT® 93452||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Lt Hrt Cath W/ Ventrcgraphy|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161645|EAP|CPT® 93451||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Right Heart Cath|1|HUMANA [1294]||HUMANA [11839]|8,797.75|FSC: 13; Default||Not reimbursed separately|8,797.75|FSC: 13; Default||External grouping not supported 80161644|EAP|CPT® 92228||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Remote Retinal Imaging Mgmt|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 80161643|EAP|CPT® 92227||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Remote Dx Retinal Imaging|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 80161642|EAP|CPT® 92134||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cptr Ophth Dx Img Post Segm|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 80161641|EAP|CPT® 92133||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cmptr Ophth Img Optic Nerve|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 80161640|EAP|CPT® 92132||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cmptr Opth Dx Img Ant Seg|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 80161639|EAP|CPT® 91117||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colon Motility 6 Hr Study|1|HUMANA [1294]||HUMANA [11839]|669.36|FSC: 13; Default||Not reimbursed separately|669.36|FSC: 13; Default||External grouping not supported 80161638|EAP|CPT® 91013||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophgl Motil W/stim/perfus|1|HUMANA [1294]||HUMANA [11839]|1,578.50|FSC: 13; Default||Not reimbursed separately|1,578.50|FSC: 13; Default||External grouping not supported 80161637|EAP|CPT® 90868||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Tcranial Magn Stim Tx Deli|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161636|EAP|CPT® 90867||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Tcranial Magn Stim Tx Plan|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161630|EAP|CPT® 88172||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Cytp Dx Eval Fna 1sr Ea Sit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 80161629|EAP|CPT® 88121||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Cytp Urine 3-5 Probes Cmptr|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 80161628|EAP|CPT® 88120||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Cytp Urine 3-5 Probes Ea Sp|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95166434|EAP|Custom 95166434||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 0.54 7 Length|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95166435|EAP|Custom 95166435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Standard Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95166437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent N X T 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|FSC: 13; Default||Not reimbursed separately|1,452.30|FSC: 13; Default||External grouping not supported 95166438|EAP|Custom 95166438||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Closure Pathfinder Nxt|1|HUMANA [1294]||HUMANA [11839]|987.00|FSC: 13; Default||Not reimbursed separately|987.00|FSC: 13; Default||External grouping not supported 95166440|EAP|Custom 95166440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Nitonol Pathfinder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95166441|EAP|Custom 95166441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Tool Pedicle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Qwix Fixation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 95166445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95166447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Qwix 7.5mmx85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,376.31|FSC: 13; Default||Not reimbursed separately|1,376.31|FSC: 13; Default||External grouping not supported 95166446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Quix 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|FSC: 13; Default||Not reimbursed separately|1,135.14|FSC: 13; Default||External grouping not supported 95166448|EAP|Custom 95166448||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 2.5mm X 270mm|1|HUMANA [1294]||HUMANA [11839]|100.08|FSC: 13; Default||Not reimbursed separately|100.08|FSC: 13; Default||External grouping not supported 95166449|EAP|Custom 95166449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166450|EAP|Custom 95166450||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 2.5mm X 270mm|1|HUMANA [1294]||HUMANA [11839]|177.90|FSC: 13; Default||Not reimbursed separately|177.90|FSC: 13; Default||External grouping not supported 95166451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95166452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Tri-lock Bps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|FSC: 13; Default||Not reimbursed separately|18,589.20|FSC: 13; Default||External grouping not supported 80161623|EAP|CPT® 86902||0302 - LABORATORY - IMMUNOLOGY|Hb Blood Type Antigen Donor Ea|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.05|FSC: 13; Default||Not reimbursed separately|19.05|FSC: 13; Default||External grouping not supported 80161616|EAP|CPT® 76882||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Xtr Non-vasc Lmtd|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80161615|EAP|CPT® 76881||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Xtr Non-vasc Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80161614|EAP|CPT® 74178||0352 - CT SCAN - BODY SCAN|Hb Ct Abd&pel 1+ Section/regns|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80161613|EAP|CPT® 74177||0352 - CT SCAN - BODY SCAN|Hb Ct Abd & Pel W/contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80161612|EAP|CPT® 74176||0352 - CT SCAN - BODY SCAN|Hb Ct Abd & Pel W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80161610|EAP|CPT® 69801||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incise Inner Ear|1|HUMANA [1294]||HUMANA [11839]|4,165.40|FSC: 13; Default||Not reimbursed separately|4,165.40|FSC: 13; Default||External grouping not supported 80161609|EAP|CPT® 66175||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trnslum Dil Eye Canal W/st|1|HUMANA [1294]||HUMANA [11839]|11,787.10|FSC: 13; Default||Not reimbursed separately|11,787.10|FSC: 13; Default||External grouping not supported 80161608|EAP|CPT® 66174||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Translum Dil Eye Canal|1|HUMANA [1294]||HUMANA [11839]|11,787.10|FSC: 13; Default||Not reimbursed separately|11,787.10|FSC: 13; Default||External grouping not supported 80161607|EAP|CPT® 65779||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cover Eye W/membrane Stent|1|HUMANA [1294]||HUMANA [11839]|9,653.18|FSC: 13; Default||Not reimbursed separately|9,653.18|FSC: 13; Default||External grouping not supported 80161606|EAP|CPT® 65778||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cover Eye W/membrane|1|HUMANA [1294]||HUMANA [11839]|2,491.09|FSC: 13; Default||Not reimbursed separately|2,491.09|FSC: 13; Default||External grouping not supported 80161605|EAP|CPT® 64611||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Chemodenerv Saliv Glands|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 80161604|EAP|CPT® 64570||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Vagus N Eltrd|1|HUMANA [1294]||HUMANA [11839]|17,006.21|FSC: 13; Default||Not reimbursed separately|17,006.21|FSC: 13; Default||External grouping not supported 80161603|EAP|CPT® 64569||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Revise/repl Vagus N Eltrd|1|HUMANA [1294]||HUMANA [11839]|19,099.54|FSC: 13; Default||Not reimbursed separately|19,099.54|FSC: 13; Default||External grouping not supported 80161602|EAP|CPT® 64568||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inc For Vagus N Elect Impl|1|HUMANA [1294]||HUMANA [11839]|89,888.96|FSC: 13; Default||Not reimbursed separately|89,888.96|FSC: 13; Default||External grouping not supported 80161601|EAP|CPT® 64566||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Neuroeltrd Stim Post Tibial|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 80161597|EAP|CPT® 57156||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Vag Brachytx Device|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 80161596|EAP|CPT® 53860||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transurethral Rf Treatment|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80161595|EAP|CPT® 49418||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Tun Ip Cath Perc|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 80161594|EAP|CPT® 49327||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Lap Ins Device For Pt|1|HUMANA [1294]||HUMANA [11839]|4,773.07|FSC: 13; Default||Not reimbursed separately|4,773.07|FSC: 13; Default||External grouping not supported 80161593|EAP|CPT® 43757||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Dx Duod Intub W/asp Specs|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 80161592|EAP|CPT® 43756||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Dx Duod Intub W/asp Spec|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 80161591|EAP|CPT® 43755||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Dx Gastr Intub W/asp Specs|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161590|EAP|CPT® 43754||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Dx Gastr Intub W/asp Spec|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161589|EAP|CPT® 43753||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Tx Gastro Intub W/asp|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161588|EAP|CPT® 37235||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tib/per Revasc Stnt & Ather|1|HUMANA [1294]||HUMANA [11839]|18,242.47|FSC: 13; Default||Not reimbursed separately|18,242.47|FSC: 13; Default||External grouping not supported 80161587|EAP|CPT® 37234||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Revsc Opn/prq Tib/per Stn|1|HUMANA [1294]||HUMANA [11839]|12,533.50|FSC: 13; Default||Not reimbursed separately|12,533.50|FSC: 13; Default||External grouping not supported 80161586|EAP|CPT® 37233||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tibper Revasc W/ath Add On|1|HUMANA [1294]||HUMANA [11839]|16,621.00|FSC: 13; Default||Not reimbursed separately|16,621.00|FSC: 13; Default||External grouping not supported 80161585|EAP|CPT® 37232||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tib/er Revasc Add-on|1|HUMANA [1294]||HUMANA [11839]|10,289.37|FSC: 13; Default||Not reimbursed separately|10,289.37|FSC: 13; Default||External grouping not supported 80161584|EAP|CPT® 37231||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tib/per Revasc Stnt&ather|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80161583|EAP|CPT® 37230||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tib/per Revasc W/stent|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80161582|EAP|CPT® 37229||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tib/per Revasc W/ather|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80161581|EAP|CPT® 37228||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tib/per Revasc W/tla|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161580|EAP|CPT® 37227||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fem/popl Revasc Stnt&ather|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 80161579|EAP|CPT® 37226||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fem/popl Revasc W/stent|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161578|EAP|CPT® 37225||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fem/popl Revas W/ather|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161577|EAP|CPT® 37224||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fem/popl Revas W/tla|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 80161576|EAP|CPT® 37223||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Iliac Revasc W/stent Add-on|1|HUMANA [1294]||HUMANA [11839]|12,197.13|FSC: 13; Default||Not reimbursed separately|12,197.13|FSC: 13; Default||External grouping not supported 80161575|EAP|CPT® 37222||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Iliac Revasc Add-on|1|HUMANA [1294]||HUMANA [11839]|9,271.50|FSC: 13; Default||Not reimbursed separately|9,271.50|FSC: 13; Default||External grouping not supported 80161574|EAP|CPT® 37221||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Iliac Revasc W/stent|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80161573|EAP|CPT® 37220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Iliac Revasc |1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 80161570|EAP|CPT® 31634||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch W/balloon Occlusion|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 80161569|EAP|CPT® 31297||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sinus Endo W/balloon Dil|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 80161568|EAP|CPT® 31296||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sinus Endo W/balloon Dil|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 80161567|EAP|CPT® 31295||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sinus Endo W/balloon Dil|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 80161566|EAP|CPT® 29916||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Hip Arthro W/labral Repair|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80161565|EAP|CPT® 29915||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Hip Arthro Acetabuloplasty|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80161564|EAP|CPT® 29914||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Hip Arthro W/femoraplasty|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80161562|EAP|CPT® 11047||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Bone Add-on|1|HUMANA [1294]||HUMANA [11839]|1,997.50|FSC: 13; Default||Not reimbursed separately|1,997.50|FSC: 13; Default||External grouping not supported 80161561|EAP|CPT® 11046||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debrid Musc/fascia Add-on|1|HUMANA [1294]||HUMANA [11839]|1,123.50|FSC: 13; Default||Not reimbursed separately|1,123.50|FSC: 13; Default||External grouping not supported 80161560|EAP|CPT® 11045||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debrid Subq Tissue Add-on|1|HUMANA [1294]||HUMANA [11839]|883.67|FSC: 13; Default||Not reimbursed separately|883.67|FSC: 13; Default||External grouping not supported 95166307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|202.20|FSC: 13; Default||Not reimbursed separately|202.20|FSC: 13; Default||External grouping not supported 95166308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.0mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|FSC: 13; Default||Not reimbursed separately|385.20|FSC: 13; Default||External grouping not supported 95166311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Articular Hemi 12mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95166312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95166313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95166314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95166315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Z Spire 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,475.00|FSC: 13; Default||Not reimbursed separately|23,475.00|FSC: 13; Default||External grouping not supported 95166316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|FSC: 13; Default||Not reimbursed separately|14,700.00|FSC: 13; Default||External grouping not supported 95166317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95166456|EAP|Custom 95166456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ethibond 2-0 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166459|EAP|Custom 95166459||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator External Large|1|HUMANA [1294]||HUMANA [11839]|11,449.50|FSC: 13; Default||Not reimbursed separately|11,449.50|FSC: 13; Default||External grouping not supported 95166460|EAP|Custom 95166460||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator External Large|1|HUMANA [1294]||HUMANA [11839]|11,880.00|FSC: 13; Default||Not reimbursed separately|11,880.00|FSC: 13; Default||External grouping not supported 80161763|EAP|CPT® 47382||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Microwave Liver Tumor Abl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 80161771|EAP|CPT® 32998||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Microwave Lung Tumor Abl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95163569|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Test Stimulation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95166489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95166490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.28|FSC: 13; Default||Not reimbursed separately|4,607.28|FSC: 13; Default||External grouping not supported 95166491|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprosthesis Viab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,860.00|FSC: 13; Default||Not reimbursed separately|7,860.00|FSC: 13; Default||External grouping not supported 95166492|EAP|Custom 95166492||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Trocar Double .062|1|HUMANA [1294]||HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95166493|EAP|Custom 95166493||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Microintroducer 4fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166494|EAP|Custom 95166494||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ultrasling Medium Grey|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166495|EAP|Custom 95166495||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Bio-prep Bone Prepar|1|HUMANA [1294]||HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95166496|EAP|Custom 95166496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bowl Cement Mixing Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166465|EAP|Custom 95166465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Cus Smith|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|FSC: 13; Default||Not reimbursed separately|8,156.40|FSC: 13; Default||External grouping not supported 95166475|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead 65cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|FSC: 13; Default||Not reimbursed separately|14,400.00|FSC: 13; Default||External grouping not supported 95166476|EAP|Custom 95166476||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit-wire .035|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 95166477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Troch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95166478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 2 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95166479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95166480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak 2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|FSC: 13; Default||Not reimbursed separately|1,920.00|FSC: 13; Default||External grouping not supported 95166481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral 6 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95166482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Top 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|FSC: 13; Default||Not reimbursed separately|321.00|FSC: 13; Default||External grouping not supported 95166484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Poplock 3.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.36|FSC: 13; Default||Not reimbursed separately|1,032.36|FSC: 13; Default||External grouping not supported 95166503|EAP|Custom 95166503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reaming Patella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166504|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|FSC: 13; Default||Not reimbursed separately|11,411.40|FSC: 13; Default||External grouping not supported 95166505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Base Tibial Gns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|FSC: 13; Default||Not reimbursed separately|5,702.40|FSC: 13; Default||External grouping not supported 95166506|EAP|Custom 95166506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Electrode Cool Tip Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166508|EAP|Custom 95166508||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Tracheal Woven|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166509|EAP|Custom 95166509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Cool Tip 15cm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166510|EAP|Custom 95166510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Locking 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166513|EAP|Custom 95166513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Kit Cluster Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166514|EAP|Custom 95166514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Kit Cluster Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166515|EAP|Custom 95166515||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Controller Kit Cluster Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166516|EAP|Custom 95166516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Controller Kit Cluster Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166518|EAP|Custom 95166518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Replacement Gastro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166519|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95166520|EAP|Custom 95166520||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 9mm |1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95166521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|FSC: 13; Default||Not reimbursed separately|4,565.82|FSC: 13; Default||External grouping not supported 95115657|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95166522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95166524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95166525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95166526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95166527|EAP|Custom 95166527||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Loop 15x2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95166529|EAP|Custom 95166529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Drill Measuring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5 Mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95166532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Med Foot Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|FSC: 13; Default||Not reimbursed separately|2,280.00|FSC: 13; Default||External grouping not supported 95166533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Medfoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|FSC: 13; Default||Not reimbursed separately|2,280.00|FSC: 13; Default||External grouping not supported 95166534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Midfoot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95166536|EAP|Custom 95166536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb J-hook Plasma 33cm X 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95166538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Articulating |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|FSC: 13; Default||Not reimbursed separately|5,854.20|FSC: 13; Default||External grouping not supported 95166539|EAP|Custom 95166539||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue External |1|HUMANA [1294]||HUMANA [11839]|2,667.00|FSC: 13; Default||Not reimbursed separately|2,667.00|FSC: 13; Default||External grouping not supported 95166542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymmetric Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95166559|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Gold Small Vessel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166560|EAP|Custom 95166560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pump Ab5000 Ventricle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166561|EAP|Custom 95166561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil For Occlusion System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166564|EAP|Custom 95166564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Memory 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Socket Humeral Rsp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95166569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Non-locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95166570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Glenoid 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|FSC: 13; Default||Not reimbursed separately|4,320.00|FSC: 13; Default||External grouping not supported 95166571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|FSC: 13; Default||Not reimbursed separately|337.50|FSC: 13; Default||External grouping not supported 95166576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95166577|EAP|Custom 95166577||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Disposable Supplies Synapse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166578|EAP|Custom 95166578||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Clip Stimulation Dyn Neuro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166579|EAP|Custom 95166579||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dynamic Neurovision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95166581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95166582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95166583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95166584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95166585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95166586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95166587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross 45-60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,924.00|FSC: 13; Default||Not reimbursed separately|3,924.00|FSC: 13; Default||External grouping not supported 95166588|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,437.00|FSC: 13; Default||Not reimbursed separately|7,437.00|FSC: 13; Default||External grouping not supported 95166589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Armada|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|759.00|FSC: 13; Default||Not reimbursed separately|759.00|FSC: 13; Default||External grouping not supported 95166590|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,437.00|FSC: 13; Default||Not reimbursed separately|7,437.00|FSC: 13; Default||External grouping not supported 62059258|EAP|CPT® 87389||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hiv Ag/ab|1|HUMANA [1294]||HUMANA [11839]|72.24|FSC: 13; Default||Not reimbursed separately|72.24|FSC: 13; Default||External grouping not supported 62059142|EAP|CPT® 86022||0302 - LABORATORY - IMMUNOLOGY|Hb Hit Ab W Relex Ser Rel - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 62059217|EAP|CPT® 86022||0302 - LABORATORY - IMMUNOLOGY|Hb Ser Rel Assay Hep Dep - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 62059225|EAP|CPT® 85520||0305 - LABORATORY - HEMATOLOGY|Hb Fondaparinux Level|1|HUMANA [1294]||HUMANA [11839]|39.27|FSC: 13; Default||Not reimbursed separately|39.27|FSC: 13; Default||External grouping not supported 62059233|EAP|CPT® 85520||0305 - LABORATORY - HEMATOLOGY|Hb Hep Anti-xa Low Molec Wt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.27|FSC: 13; Default||Not reimbursed separately|39.27|FSC: 13; Default||External grouping not supported 62059241|EAP|CPT® 85520||0305 - LABORATORY - HEMATOLOGY|Hb Hep Anti-xa Unfrac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.27|FSC: 13; Default||Not reimbursed separately|39.27|FSC: 13; Default||External grouping not supported 95166591|EAP|Custom 95166591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Drainable 6in Cut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166593|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Jejunal Mic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166594|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95166595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Tap Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|201.00|FSC: 13; Default||Not reimbursed separately|201.00|FSC: 13; Default||External grouping not supported 95166596|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB GLIDESHEATH 4FR 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tap Lock 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|FSC: 13; Default||Not reimbursed separately|321.00|FSC: 13; Default||External grouping not supported 95166599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tap Lock 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|FSC: 13; Default||Not reimbursed separately|321.00|FSC: 13; Default||External grouping not supported 95166600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95166601|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,182.00|FSC: 13; Default||Not reimbursed separately|4,182.00|FSC: 13; Default||External grouping not supported 95166602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Cta Duofix Global 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,335.00|FSC: 13; Default||Not reimbursed separately|10,335.00|FSC: 13; Default||External grouping not supported 95166606|EAP|Custom 95166606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 5 Fr 100cm Cobra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166609|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Flush 4 Fr 90cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166614|EAP|Custom 95166614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basicset Vista Mp |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166615|EAP|Custom 95166615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Monitoring Set Combitrans|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,509.00|FSC: 13; Default||Not reimbursed separately|4,509.00|FSC: 13; Default||External grouping not supported 95166618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95166619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95166620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95166621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95166622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.omm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.omm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.omm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95166626|EAP|Custom 95166626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 3.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166627|EAP|Custom 95166627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166628|EAP|Custom 95166628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Tip Drill 2.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95166630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95166631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95166633|EAP|Custom 95166633||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Dbm Trel-xc1cc|1|HUMANA [1294]||HUMANA [11839]|1,065.00|FSC: 13; Default||Not reimbursed separately|1,065.00|FSC: 13; Default||External grouping not supported 95166634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95166635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Reverse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95166636|EAP|Custom 95166636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Self Sealing Steriliz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95161849|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB SHEATH VALVED PORT POWER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166637|EAP|Custom 95166637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trellisperiheral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166639|EAP|Custom 95166639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Stone Retrieval |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166640|EAP|Custom 95166640||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166641|EAP|Custom 95166641||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166642|EAP|Custom 95166642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166643|EAP|Custom 95166643||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95166644|EAP|Custom 95166644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166645|EAP|Custom 95166645||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166646|EAP|Custom 95166646||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166647|EAP|Custom 95166647||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166649|EAP|Custom 95166649||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166650|EAP|Custom 95166650||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166652|EAP|Custom 95166652||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166653|EAP|Custom 95166653||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166654|EAP|Custom 95166654||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166655|EAP|Custom 95166655||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95166656|EAP|Custom 95166656||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95166657|EAP|Custom 95166657||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95166658|EAP|Custom 95166658||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 3.0mm|1|HUMANA [1294]||HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95166659|EAP|Custom 95166659||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm|1|HUMANA [1294]||HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95166660|EAP|Custom 95166660||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm |1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95166661|EAP|Custom 95166661||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm |1|HUMANA [1294]||HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95166662|EAP|Custom 95166662||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm |1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95166663|EAP|Custom 95166663||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Tear Duct Jones 4.0mm |1|HUMANA [1294]||HUMANA [11839]|246.00|FSC: 13; Default||Not reimbursed separately|246.00|FSC: 13; Default||External grouping not supported 95166664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95166665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95166666|EAP|Custom 95166666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Carbide Fg 8 Round|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166667|EAP|Custom 95166667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Carbide Fg 1/2 Round|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166648|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Dual Verity Adx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,622.50|FSC: 13; Default||Not reimbursed separately|12,622.50|FSC: 13; Default||External grouping not supported 62059266|EAP|CPT® 83036||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hemoglobin A1c - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.13|FSC: 13; Default||Not reimbursed separately|29.13|FSC: 13; Default||External grouping not supported 95166675|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Axbifem Stretch Fully|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,456.00|FSC: 13; Default||Not reimbursed separately|6,456.00|FSC: 13; Default||External grouping not supported 95166678|EAP|Custom 95166678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Medium 25x9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166679|EAP|Custom 95166679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw 34.5 X 13 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166680|EAP|Custom 95166680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Mill Stryker Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166681|EAP|Custom 95166681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blakde Mill Stryker Fine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166682|EAP|HCPCS C2627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cysto/uro Drain Bag |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166689|EAP|Custom 95166689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Thrombix Hemostatic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166692|EAP|Custom 95166692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Passer Sizing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166693|EAP|Custom 95166693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Connector Snap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166694|EAP|Custom 95166694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anchor Pushlock Biocomp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166695|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Platinum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,600.46|FSC: 13; Default||Not reimbursed separately|2,600.46|FSC: 13; Default||External grouping not supported 80161790|EAP|CPT® 94010||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry , Adult|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161791|EAP|CPT® 94010||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry, Adult With Mvv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161792|EAP|CPT® 94011||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry, Infant Or Child|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161793|EAP|CPT® 94011||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry, Inf/child W Mvv|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161794|EAP|CPT® 94012||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry Infchild Prepost|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161795|EAP|CPT® 94012||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spiro Infchild Prepostmvv|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161796|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry Adult Prepost|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161797|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spirometry Adult Prepostmvv|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161798|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Spiro Adult Mvv Prepost|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161799|EAP|CPT® 94070||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Bronchospasm Provoc Eval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161800|EAP|CPT® 94150||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Vital Capacity Total(sep)|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161801|EAP|CPT® 94200||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Mvv/mbc (sep Proc)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 80161803|EAP|CPT® 94250||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Exp Gas Coll Quant Single|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 80161807|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Resp Flow Volume Loop|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80161808|EAP|CPT® 94400||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Breathing Response To Co2|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161809|EAP|CPT® 94450||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Breathing Resp To Hypoxia|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80161810|EAP|CPT® 94452||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb High Altitude Stim Test|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 80161811|EAP|CPT® 94453||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Hast W Supp O2 Titration|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95166725|EAP|Custom 95166725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adj Lap Port Rapid Standard|1|HUMANA [1294]||HUMANA [11839]|9,465.00|FSC: 13; Default||Not reimbursed separately|9,465.00|FSC: 13; Default||External grouping not supported 95166734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Dist Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.02|FSC: 13; Default||Not reimbursed separately|4,402.02|FSC: 13; Default||External grouping not supported 95166735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Dist Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,329.90|FSC: 13; Default||Not reimbursed separately|4,329.90|FSC: 13; Default||External grouping not supported 95166736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Dist Med Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,939.30|FSC: 13; Default||Not reimbursed separately|3,939.30|FSC: 13; Default||External grouping not supported 95166733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tib Dist Med Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,939.30|FSC: 13; Default||Not reimbursed separately|3,939.30|FSC: 13; Default||External grouping not supported 62059688|EAP|CPT® 88177||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Cytp Immed Eval, Addl|1|HUMANA [1294]||HUMANA [11839]|93.25|FSC: 13; Default||Not reimbursed separately|93.25|FSC: 13; Default||External grouping not supported 62059696|EAP|CPT® 88363||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Xm Archive Tissue Molec Ana|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 80161821|EAP|CPT® 29515||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Short Leg Splint|1|HUMANA [1294]||HUMANA [11839]|412.85|FSC: 13; Default||Not reimbursed separately|412.85|FSC: 13; Default||External grouping not supported 80161839|EAP|CPT® 33975||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cc Cardioassist Internal|1|HUMANA [1294]||HUMANA [11839]|2,484.72|FSC: 13; Default||Not reimbursed separately|2,484.72|FSC: 13; Default||External grouping not supported 95166720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent N X T 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|FSC: 13; Default||Not reimbursed separately|1,452.30|FSC: 13; Default||External grouping not supported 95166722|EAP|Custom 95166722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Tip 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Pca 32mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95166741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 9mmx360mm T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95166742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95166743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95166744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95166745|EAP|Custom 95166745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Elevator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95166755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Non-locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95166757|EAP|Custom 95166757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Strip Scleral Buckling 4mm|1|HUMANA [1294]||HUMANA [11839]|42.60|FSC: 13; Default||Not reimbursed separately|42.60|FSC: 13; Default||External grouping not supported 95166759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95166760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Acetabular Lock Sz25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95166761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Lock Acetabular Liner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,113.00|FSC: 13; Default||Not reimbursed separately|10,113.00|FSC: 13; Default||External grouping not supported 95166762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Np Stm Tib B/p Lt Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,056.00|FSC: 13; Default||Not reimbursed separately|4,056.00|FSC: 13; Default||External grouping not supported 95166763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Prolong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|FSC: 13; Default||Not reimbursed separately|4,251.00|FSC: 13; Default||External grouping not supported 95166764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,444.00|FSC: 13; Default||Not reimbursed separately|15,444.00|FSC: 13; Default||External grouping not supported 95166754|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Biliary Viab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95166769|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue 4-layer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.58|FSC: 13; Default||Not reimbursed separately|1,361.58|FSC: 13; Default||External grouping not supported 95166771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|FSC: 13; Default||Not reimbursed separately|10,017.00|FSC: 13; Default||External grouping not supported 95166772|EAP|Custom 95166772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cord Bipolar Irrigation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166773|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer 8.5 Agilis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166257|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Sv Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166607|EAP|Custom 95166607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4fr 100cm Angled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166608|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Destintation 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166610|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Levin 4fr 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166611|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Jb1 5fr 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95166777|EAP|Custom 95166777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument On-point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166778|EAP|Custom 95166778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure On-point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166779|EAP|Custom 95166779||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Corpectomy Replace|1|HUMANA [1294]||HUMANA [11839]|23,079.00|FSC: 13; Default||Not reimbursed separately|23,079.00|FSC: 13; Default||External grouping not supported 95166780|EAP|Custom 95166780||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 0 Degree X Vbr|1|HUMANA [1294]||HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95166782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.96|FSC: 13; Default||Not reimbursed separately|4,803.96|FSC: 13; Default||External grouping not supported 95166785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.36|FSC: 13; Default||Not reimbursed separately|570.36|FSC: 13; Default||External grouping not supported 95166786|EAP|Custom 95166786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Versa-close Repair|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166787|EAP|Custom 95166787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Consciousness Level |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161854|EAP|CPT® 93922||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Tcpo2/abi Limited W/pfm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95166789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95166790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95166791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Knee Mrh 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95166792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95166793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5 X 55mm For|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.96|FSC: 13; Default||Not reimbursed separately|4,803.96|FSC: 13; Default||External grouping not supported 95166794|EAP|Custom 95166794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Quick Pressure Monitor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166798|EAP|Custom 95166798||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ossicular Adjust|1|HUMANA [1294]||HUMANA [11839]|1,041.78|FSC: 13; Default||Not reimbursed separately|1,041.78|FSC: 13; Default||External grouping not supported 95166799|EAP|Custom 95166799||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Myringotomy|1|HUMANA [1294]||HUMANA [11839]|849.72|FSC: 13; Default||Not reimbursed separately|849.72|FSC: 13; Default||External grouping not supported 95166801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 2.0mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|202.20|FSC: 13; Default||Not reimbursed separately|202.20|FSC: 13; Default||External grouping not supported 95166802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95166804|EAP|Custom 95166804||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Cement Clearout Encore|1|HUMANA [1294]||HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95166805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Glenoid Rsp 36mm X Neu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|FSC: 13; Default||Not reimbursed separately|4,320.00|FSC: 13; Default||External grouping not supported 95166806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Rsp Djo Size |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|FSC: 13; Default||Not reimbursed separately|11,407.50|FSC: 13; Default||External grouping not supported 95166807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Joint M-p Toe Great|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95166808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.00|FSC: 13; Default||Not reimbursed separately|1,203.00|FSC: 13; Default||External grouping not supported 95166809|EAP|Custom 95166809||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Oblique Large Cordent|1|HUMANA [1294]||HUMANA [11839]|11,538.00|FSC: 13; Default||Not reimbursed separately|11,538.00|FSC: 13; Default||External grouping not supported 95166810|EAP|Custom 95166810||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Oblique Large Cordent |1|HUMANA [1294]||HUMANA [11839]|11,538.00|FSC: 13; Default||Not reimbursed separately|11,538.00|FSC: 13; Default||External grouping not supported 95166811|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Matrix Cellular Osteo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,322.00|FSC: 13; Default||Not reimbursed separately|14,322.00|FSC: 13; Default||External grouping not supported 95166812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95166813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95166814|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Contact|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,272.50|FSC: 13; Default||Not reimbursed separately|2,272.50|FSC: 13; Default||External grouping not supported 95166815|EAP|Custom 95166815||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Wrist Positioning|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|FSC: 13; Default||Not reimbursed separately|4,247.43|FSC: 13; Default||External grouping not supported 95166817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 95166818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Constrained 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|917.28|FSC: 13; Default||Not reimbursed separately|917.28|FSC: 13; Default||External grouping not supported 95166819|EAP|Custom 95166819||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fix Temporary|1|HUMANA [1294]||HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 80161862|EAP|HCPCS G0463||0998 - STATISTICAL CHARGES|Hb Followup Lev 2 No Charge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166825|EAP|Custom 95166825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Balloon Ivas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166826|EAP|Custom 95166826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bone Filler 10g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166827|EAP|Custom 95166827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hand Drill 10g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166828|EAP|Custom 95166828||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Luer Conf Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166829|EAP|Custom 95166829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Osseoflex 1.0 Steera|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166830|EAP|Custom 95166830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.7mm Ao Low Prof|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166831|EAP|Custom 95166831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166832|EAP|Custom 95166832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Shield 3cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166833|EAP|Custom 95166833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166834|EAP|Custom 95166834||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166835|EAP|Custom 95166835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166836|EAP|Custom 95166836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166837|EAP|Custom 95166837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166838|EAP|Custom 95166838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Smooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95166841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95166842|EAP|Custom 95166842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kittner Aspen Dual Tip |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95166844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Open Right Low |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95166845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 3.8mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95166846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Malleolar Sled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95166847|EAP|Custom 95166847||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Sled Medial Malleo|1|HUMANA [1294]||HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95166848|EAP|Custom 95166848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Sinus Kennedy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166849|EAP|Custom 95166849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Threaded |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166286|EAP|Custom 95166286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Perfusion Oxygenator |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.25|FSC: 13; Default||Not reimbursed separately|1,211.25|FSC: 13; Default||External grouping not supported 95166851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95166852|EAP|Custom 95166852||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Trocar Double|1|HUMANA [1294]||HUMANA [11839]|183.00|FSC: 13; Default||Not reimbursed separately|183.00|FSC: 13; Default||External grouping not supported 95166853|EAP|Custom 95166853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini Quik Fast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166854|EAP|Custom 95166854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166856|EAP|Custom 95166856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Threaded |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166857|EAP|Custom 95166857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166858|EAP|Custom 95166858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166859|EAP|Custom 95166859||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166860|EAP|Custom 95166860||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166861|EAP|Custom 95166861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Suture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166862|EAP|Custom 95166862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166863|EAP|Custom 95166863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Sleeve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166864|EAP|Custom 95166864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Balloon Kii Gelport|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166865|EAP|Custom 95166865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kwire 0.9 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166866|EAP|Custom 95166866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist Cannulated |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166867|EAP|Custom 95166867||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Port Ipg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166868|EAP|Custom 95166868||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Needle First Pass|1|HUMANA [1294]||HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95166869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Double Play 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95166870|EAP|Custom 95166870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scissor Grieshaber Curved |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Translational |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.10|FSC: 13; Default||Not reimbursed separately|5,777.10|FSC: 13; Default||External grouping not supported 95166872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Translational|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95166873|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Hta Hydrother|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95166874|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Pervilace Tot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,629.07|FSC: 13; Default||Not reimbursed separately|3,629.07|FSC: 13; Default||External grouping not supported 95166875|EAP|Custom 95166875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cco J Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166876|EAP|Custom 95166876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tdq J Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161870|EAP|Custom 80161870||0670 - OUTPATIENT SPECIAL RESIDENCE CHARGES - GENERAL CLASSIFICATION|Hb Residential Care Bedded Op|1|HUMANA [1294]||HUMANA [11839]|1,000.00|FSC: 13; Default||Not reimbursed separately|1,000.00|FSC: 13; Default||External grouping not supported 95166879|EAP|Custom 95166879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ball Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Femur 07 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,022.66|FSC: 13; Default||Not reimbursed separately|5,022.66|FSC: 13; Default||External grouping not supported 95166882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Femur 11 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,228.04|FSC: 13; Default||Not reimbursed separately|5,228.04|FSC: 13; Default||External grouping not supported 95166883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Femur 11 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,228.04|FSC: 13; Default||Not reimbursed separately|5,228.04|FSC: 13; Default||External grouping not supported 95166884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Femur 07 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,022.66|FSC: 13; Default||Not reimbursed separately|5,022.66|FSC: 13; Default||External grouping not supported 95166886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Conical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|486.00|FSC: 13; Default||Not reimbursed separately|486.00|FSC: 13; Default||External grouping not supported 95166887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Femur 13 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,329.53|FSC: 13; Default||Not reimbursed separately|5,329.53|FSC: 13; Default||External grouping not supported 95166888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95166889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95166890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95166891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95166892|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Double J Closed Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95166893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95166894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95166895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95166896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95166897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|736.95|FSC: 13; Default||Not reimbursed separately|736.95|FSC: 13; Default||External grouping not supported 95166903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.71|FSC: 13; Default||Not reimbursed separately|877.71|FSC: 13; Default||External grouping not supported 95166910|EAP|Custom 95166910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.1mmx60mm Qc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.32|FSC: 13; Default||Not reimbursed separately|328.32|FSC: 13; Default||External grouping not supported 95166913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.32|FSC: 13; Default||Not reimbursed separately|328.32|FSC: 13; Default||External grouping not supported 95166914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.77|FSC: 13; Default||Not reimbursed separately|318.77|FSC: 13; Default||External grouping not supported 95166918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.16|FSC: 13; Default||Not reimbursed separately|338.16|FSC: 13; Default||External grouping not supported 95166919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166923|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 9.0 Diopter Acrysof |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95166925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 1.5mm 4 Hole |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|849.72|FSC: 13; Default||Not reimbursed separately|849.72|FSC: 13; Default||External grouping not supported 95166928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 1.5mm 6 Hole |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|849.72|FSC: 13; Default||Not reimbursed separately|849.72|FSC: 13; Default||External grouping not supported 95166931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 1.5mm Adaption|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.87|FSC: 13; Default||Not reimbursed separately|1,446.87|FSC: 13; Default||External grouping not supported 95166932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp 1.5mm Adaption|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.87|FSC: 13; Default||Not reimbursed separately|1,446.87|FSC: 13; Default||External grouping not supported 95166933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Lcp 1.5mm Extended|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,465.74|FSC: 13; Default||Not reimbursed separately|1,465.74|FSC: 13; Default||External grouping not supported 95166934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Lcp 1.5mm Extended|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,465.74|FSC: 13; Default||Not reimbursed separately|1,465.74|FSC: 13; Default||External grouping not supported 95166935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 1.5mm 3 Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,531.83|FSC: 13; Default||Not reimbursed separately|1,531.83|FSC: 13; Default||External grouping not supported 95166936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 1.5mm 4 Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,531.83|FSC: 13; Default||Not reimbursed separately|1,531.83|FSC: 13; Default||External grouping not supported 95166937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Lcp 1.5mm 3 Head |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,465.74|FSC: 13; Default||Not reimbursed separately|1,465.74|FSC: 13; Default||External grouping not supported 95166938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95166954|EAP|Custom 95166954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.1mm Mqc 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166955|EAP|Custom 95166955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.1mm Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166956|EAP|Custom 95166956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Surgilon Braided |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95166959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95166960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95166961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95166962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95166963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95166964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95166965|EAP|Custom 95166965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Smart Partial Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95166902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|FSC: 13; Default||Not reimbursed separately|852.15|FSC: 13; Default||External grouping not supported 95166924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95166981|EAP|Custom 95166981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Word Bartholin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166982|EAP|Custom 95166982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pleurx Starter 1000ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166983|EAP|Custom 95166983||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95166984|EAP|Custom 95166984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Nasal Merocel 2000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166985|EAP|Custom 95166985||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95166986|EAP|Custom 95166986||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Tornado|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95166987|EAP|Custom 95166987||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Pt Care For Jackson Sp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.12|FSC: 13; Default||Not reimbursed separately|564.12|FSC: 13; Default||External grouping not supported 95166989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Large Peanut|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|FSC: 13; Default||Not reimbursed separately|2,932.50|FSC: 13; Default||External grouping not supported 95166990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Peanut |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 95166991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Narrow Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|FSC: 13; Default||Not reimbursed separately|3,187.50|FSC: 13; Default||External grouping not supported 95166992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95166995|EAP|Custom 95166995||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Liquid Fynal 15ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166996|EAP|Custom 95166996||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Powder Fynal 32 Gm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10x400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95167000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|FSC: 13; Default||Not reimbursed separately|6,426.84|FSC: 13; Default||External grouping not supported 95167001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X3 O Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95167002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|FSC: 13; Default||Not reimbursed separately|9,018.00|FSC: 13; Default||External grouping not supported 95167006|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Evans 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95167007|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Evans 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|FSC: 13; Default||Not reimbursed separately|3,165.00|FSC: 13; Default||External grouping not supported 95167008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Trochanteric Ti 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,479.40|FSC: 13; Default||Not reimbursed separately|3,479.40|FSC: 13; Default||External grouping not supported 95167009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95167010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|FSC: 13; Default||Not reimbursed separately|1,251.00|FSC: 13; Default||External grouping not supported 95167011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|FSC: 13; Default||Not reimbursed separately|1,251.00|FSC: 13; Default||External grouping not supported 95167012|EAP|Custom 95167012||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Oblique Large Cordent|1|HUMANA [1294]||HUMANA [11839]|11,538.00|FSC: 13; Default||Not reimbursed separately|11,538.00|FSC: 13; Default||External grouping not supported 95167013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95167014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Plus Gradient 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95167015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|FSC: 13; Default||Not reimbursed separately|813.00|FSC: 13; Default||External grouping not supported 95167017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|FSC: 13; Default||Not reimbursed separately|813.00|FSC: 13; Default||External grouping not supported 95167019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95167020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Slot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95167022|EAP|Custom 95167022||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Agent Bulking Injectable|1|HUMANA [1294]||HUMANA [11839]|1,096.98|FSC: 13; Default||Not reimbursed separately|1,096.98|FSC: 13; Default||External grouping not supported 95167024|EAP|Custom 95167024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Coaptite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95167026|EAP|Custom 95167026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Gemini 3 Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|FSC: 13; Default||Not reimbursed separately|4,933.44|FSC: 13; Default||External grouping not supported 95167039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95167041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95167044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167046|EAP|Custom 95167046||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Loop Elastic Beige 1x10 Yd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 95167048|EAP|Custom 95167048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167049|EAP|Custom 95167049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167050|EAP|Custom 95167050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System X-close Repair |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167051|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Brite Tip 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167052|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Destintation Carotid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167053|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guide Renal 45cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167054|EAP|Custom 95167054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Adult Smart Pad|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167055|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95167056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5x105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95167057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Rt 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95167058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Head Small Cann |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95167059|EAP|Custom 95167059||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide Threaded 3.0mm|1|HUMANA [1294]||HUMANA [11839]|257.10|FSC: 13; Default||Not reimbursed separately|257.10|FSC: 13; Default||External grouping not supported 95167061|EAP|Custom 95167061||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167062|EAP|Custom 95167062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167066|EAP|Custom 95167066||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Timesh 10cm X 15cm 35 Grams|1|HUMANA [1294]||HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95167067|EAP|Custom 95167067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape 550mm Stent |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167069|EAP|Custom 95167069||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sling Arm W/pillow |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167070|EAP|Custom 95167070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jetwire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167076|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Acunav Ultrasound 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167077|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Exodus Drainage 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167078|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Exodus Drainage 10f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167079|EAP|Custom 95167079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Stoma Tracoe 10x16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167080|EAP|Custom 95167080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Stoma Tracoe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167081|EAP|Custom 95167081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stopper Tracoe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158633|EAP|Custom 95158633||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Surgical Darco Male|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167083|EAP|Custom 95167083||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cheek Retract Spandex Chil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95167086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95167087|EAP|Custom 95167087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suturelasso 25 Degree Tight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-com In Taper Tip |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95167089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 10x400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95167090|EAP|Custom 95167090||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blanket Maxi-therm Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167091|EAP|Custom 95167091||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Inserter Poly Plug|1|HUMANA [1294]||HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95167092|EAP|Custom 95167092||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 14mmx32mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95167093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,641.70|FSC: 13; Default||Not reimbursed separately|6,641.70|FSC: 13; Default||External grouping not supported 95167094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Delta Ceramic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,973.30|FSC: 13; Default||Not reimbursed separately|8,973.30|FSC: 13; Default||External grouping not supported 95167095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Evolve 26mm + 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95167096|EAP|Custom 95167096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Electrode Bipolar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167097|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 20 Pole Lasso 2515|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167098|EAP|Custom 95167098||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Rhp 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167099|EAP|Custom 95167099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Lasso Carto 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167100|EAP|Custom 95167100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167102|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Soundstar Ultrasound|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167103|EAP|Custom 95167103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Soundstar Carto 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167104|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ez Steer Thermocool|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167105|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Matrix Cellular Osteo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,670.00|FSC: 13; Default||Not reimbursed separately|11,670.00|FSC: 13; Default||External grouping not supported 95167106|EAP|Custom 95167106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Electrode Bipolar |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Briggade 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95167108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada 6.5mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95167109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|FSC: 13; Default||Not reimbursed separately|1,251.00|FSC: 13; Default||External grouping not supported 95167110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.00|FSC: 13; Default||Not reimbursed separately|1,203.00|FSC: 13; Default||External grouping not supported 95167111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Rh Long Sz4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,816.00|FSC: 13; Default||Not reimbursed separately|3,816.00|FSC: 13; Default||External grouping not supported 95167112|EAP|Custom 95167112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Smooth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Rhp 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95167114|EAP|Custom 95167114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Smooth 12x150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167123|EAP|Custom 95167123||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Fully Threaded 1.6mm|1|HUMANA [1294]||HUMANA [11839]|134.40|FSC: 13; Default||Not reimbursed separately|134.40|FSC: 13; Default||External grouping not supported 95167124|EAP|Custom 95167124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Cholandiogram|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167125|EAP|Custom 95167125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Smooth 1.4mmx100mm|1|HUMANA [1294]||HUMANA [11839]|54.60|FSC: 13; Default||Not reimbursed separately|54.60|FSC: 13; Default||External grouping not supported 95167127|EAP|Custom 95167127||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Smooth Steinmann 2.5mm|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95167128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|FSC: 13; Default||Not reimbursed separately|194.40|FSC: 13; Default||External grouping not supported 95167139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|FSC: 13; Default||Not reimbursed separately|194.40|FSC: 13; Default||External grouping not supported 95167140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167143|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|FSC: 13; Default||Not reimbursed separately|194.40|FSC: 13; Default||External grouping not supported 95167147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|FSC: 13; Default||Not reimbursed separately|191.10|FSC: 13; Default||External grouping not supported 95167150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|FSC: 13; Default||Not reimbursed separately|194.40|FSC: 13; Default||External grouping not supported 95167151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 3.5mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|FSC: 13; Default||Not reimbursed separately|194.40|FSC: 13; Default||External grouping not supported 95167152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|FSC: 13; Default||Not reimbursed separately|430.50|FSC: 13; Default||External grouping not supported 95167162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|FSC: 13; Default||Not reimbursed separately|1,778.70|FSC: 13; Default||External grouping not supported 95167179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|FSC: 13; Default||Not reimbursed separately|1,778.70|FSC: 13; Default||External grouping not supported 95167180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|FSC: 13; Default||Not reimbursed separately|1,778.70|FSC: 13; Default||External grouping not supported 95167181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.90|FSC: 13; Default||Not reimbursed separately|1,845.90|FSC: 13; Default||External grouping not supported 95167182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,005.50|FSC: 13; Default||Not reimbursed separately|2,005.50|FSC: 13; Default||External grouping not supported 95167183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,005.50|FSC: 13; Default||Not reimbursed separately|2,005.50|FSC: 13; Default||External grouping not supported 95167184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Lateral Fibul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,005.50|FSC: 13; Default||Not reimbursed separately|2,005.50|FSC: 13; Default||External grouping not supported 95167185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5mmx105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95167186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Cephalomedul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 62059704|EAP|CPT® 82642||0301 - LABORATORY - CHEMISTRY|Hb Dihydrotestosterone (dht) - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|87.84|FSC: 13; Default||Not reimbursed separately|87.84|FSC: 13; Default||External grouping not supported 62059712|EAP|CPT® 86638||0302 - LABORATORY - IMMUNOLOGY|Hb Coxiella Burnetti Phase 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.36|FSC: 13; Default||Not reimbursed separately|36.36|FSC: 13; Default||External grouping not supported 62059720|EAP|CPT® 86638||0302 - LABORATORY - IMMUNOLOGY|HB COXIELLA BURNETTI PHASE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.36|FSC: 13; Default||Not reimbursed separately|36.36|FSC: 13; Default||External grouping not supported 62059738|EAP|CPT® 86658||0302 - LABORATORY - IMMUNOLOGY|Hb Poliovirus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.09|FSC: 13; Default||Not reimbursed separately|39.09|FSC: 13; Default||External grouping not supported 62059746|EAP|CPT® 86658||0302 - LABORATORY - IMMUNOLOGY|Hb Poliovirus 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.09|FSC: 13; Default||Not reimbursed separately|39.09|FSC: 13; Default||External grouping not supported 62059753|EAP|CPT® 86658||0302 - LABORATORY - IMMUNOLOGY|Hb Poliovirus 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.09|FSC: 13; Default||Not reimbursed separately|39.09|FSC: 13; Default||External grouping not supported 62059761|EAP|CPT® 86146||0302 - LABORATORY - IMMUNOLOGY|Hb Beta-2 Glycoprotein 1 Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|76.35|FSC: 13; Default||Not reimbursed separately|76.35|FSC: 13; Default||External grouping not supported 62059779|EAP|CPT® 86146||0302 - LABORATORY - IMMUNOLOGY|Hb Beta-2 Glycoprotein 1 Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.35|FSC: 13; Default||Not reimbursed separately|76.35|FSC: 13; Default||External grouping not supported 62059787|EAP|CPT® 86146||0302 - LABORATORY - IMMUNOLOGY|Hb Beta-2 Glycoprotein 1 Iga - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.35|FSC: 13; Default||Not reimbursed separately|76.35|FSC: 13; Default||External grouping not supported 62059795|EAP|CPT® 86352||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CHRONIC URTICARA CELL ASSAY|1|HUMANA [1294]||HUMANA [11839]|407.58|FSC: 13; Default||Not reimbursed separately|407.58|FSC: 13; Default||External grouping not supported 62059803|EAP|CPT® 86622||0302 - LABORATORY - IMMUNOLOGY|Hb Brucella Igg|1|HUMANA [1294]||HUMANA [11839]|26.79|FSC: 13; Default||Not reimbursed separately|26.79|FSC: 13; Default||External grouping not supported 62059811|EAP|CPT® 86622||0300 - LABORATORY - GENERAL CLASSIFICATION|HB BRUCELLA IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.79|FSC: 13; Default||Not reimbursed separately|26.79|FSC: 13; Default||External grouping not supported 62059829|EAP|CPT® 86622||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Brucella Antibody - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.79|FSC: 13; Default||Not reimbursed separately|26.79|FSC: 13; Default||External grouping not supported 62059837|EAP|CPT® 82634||0300 - LABORATORY - GENERAL CLASSIFICATION|HB 11-DEOXYCORTISOL QUANT|1|HUMANA [1294]||HUMANA [11839]|87.84|FSC: 13; Default||Not reimbursed separately|87.84|FSC: 13; Default||External grouping not supported 62059845|EAP|CPT® 84143||0301 - LABORATORY - CHEMISTRY|Hb 17-hydroxypregnenolone|1|HUMANA [1294]||HUMANA [11839]|68.43|FSC: 13; Default||Not reimbursed separately|68.43|FSC: 13; Default||External grouping not supported 62059852|EAP|CPT® 87110||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Chlamydia Culture|1|HUMANA [1294]||HUMANA [11839]|58.80|FSC: 13; Default||Not reimbursed separately|58.80|FSC: 13; Default||External grouping not supported 62059860|EAP|CPT® 87140||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Chlamydia Stain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.71|FSC: 13; Default||Not reimbursed separately|16.71|FSC: 13; Default||External grouping not supported 62059878|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Tryptase|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62059886|EAP|CPT® 87493||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb C Diff Amplified Probe|1|HUMANA [1294]||HUMANA [11839]|111.81|FSC: 13; Default||Not reimbursed separately|111.81|FSC: 13; Default||External grouping not supported 62059894|EAP|CPT® 87502||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Influ Virus Amp Probe|1|HUMANA [1294]||HUMANA [11839]|287.40|FSC: 13; Default||Not reimbursed separately|287.40|FSC: 13; Default||External grouping not supported 62059902|EAP|CPT® 87503||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Influ Virus Amp Probe Add|1|HUMANA [1294]||HUMANA [11839]|87.66|FSC: 13; Default||Not reimbursed separately|87.66|FSC: 13; Default||External grouping not supported 62059910|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Resp Viral Amp Probe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95167101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Briggade 4.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95167188|EAP|Custom 95167188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167189|EAP|Custom 95167189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167190|EAP|Custom 95167190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Advanced |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167191|EAP|Custom 95167191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167192|EAP|Custom 95167192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Advanced|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167193|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Catheter Dialysis Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95167195|EAP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Thera Skin 38.76 Sq Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.23|FSC: 13; Default||Not reimbursed separately|90.23|FSC: 13; Default||External grouping not supported 95167196|EAP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Thera Skin 12.76 Sq Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|235.15|FSC: 13; Default||Not reimbursed separately|235.15|FSC: 13; Default||External grouping not supported 95167194|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Cath Dialysis Long-term|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,450.80|FSC: 13; Default||Not reimbursed separately|1,450.80|FSC: 13; Default||External grouping not supported 62059928|EAP|CPT® 82042||0301 - LABORATORY - CHEMISTRY|Hb Bf Albumin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.34|FSC: 13; Default||Not reimbursed separately|23.34|FSC: 13; Default||External grouping not supported 62059936|EAP|CPT® 87541||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Legionella Amp Probe - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62059944|EAP|CPT® 87556||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb M Tuberculosis Amp Probe - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|125.04|FSC: 13; Default||Not reimbursed separately|125.04|FSC: 13; Default||External grouping not supported 95116139|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Sensar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95167198|EAP|Custom 95167198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealant Clinpro Syr Ref|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|FSC: 13; Default||Not reimbursed separately|1,452.30|FSC: 13; Default||External grouping not supported 95167201|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Biol Collagen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,244.50|FSC: 13; Default||Not reimbursed separately|3,244.50|FSC: 13; Default||External grouping not supported 95167202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95167203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|FSC: 13; Default||Not reimbursed separately|9,018.00|FSC: 13; Default||External grouping not supported 95167204|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95167205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10mm X 345mm T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95167206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon Sz 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95167207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95167208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Corkscrew Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|690.00|FSC: 13; Default||Not reimbursed separately|690.00|FSC: 13; Default||External grouping not supported 95167209|EAP|Custom 95167209||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suture Lasso 45 Degree|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95167210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Rt Helex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95167211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Helex 4x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95158635|EAP|Custom 95158635||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Surgical Darco Female|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161961|EAP|HCPCS A9580||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|HB F-18 NA FLOURIDE PER DOSE|1|HUMANA [1294]||HUMANA [11839]|580.00|FSC: 13; Default||Not reimbursed separately|580.00|FSC: 13; Default||External grouping not supported 95167241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95167242|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 6frx22cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.03|FSC: 13; Default||Not reimbursed separately|360.03|FSC: 13; Default||External grouping not supported 95167243|EAP|Custom 95167243||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hook Sharp 3mm (disposable)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167250|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regen Allod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|FSC: 13; Default||Not reimbursed separately|177.00|FSC: 13; Default||External grouping not supported 95167252|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Berenstein 5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167253|EAP|Custom 95167253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spinguard Surgical Device |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167254|EAP|Custom 95167254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needles Access 11 G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167261|EAP|Custom 95167261||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 8mmx32mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95167262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95167263|EAP|Custom 95167263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Sim 1 5frx100cm Beacon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95167265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Solera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|FSC: 13; Default||Not reimbursed separately|639.00|FSC: 13; Default||External grouping not supported 95167266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95167267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|FSC: 13; Default||Not reimbursed separately|5,550.00|FSC: 13; Default||External grouping not supported 95167268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.5x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95167269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Venture 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|FSC: 13; Default||Not reimbursed separately|1,170.12|FSC: 13; Default||External grouping not supported 95167270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,211.51|FSC: 13; Default||Not reimbursed separately|5,211.51|FSC: 13; Default||External grouping not supported 95167277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon Sz12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95167278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Prim Turon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95167279|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|86.91|FSC: 13; Default||Not reimbursed separately|86.91|FSC: 13; Default||External grouping not supported 95167280|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Contour|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95167281|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Contour|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95167282|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Bi Dir 7fr Def|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167218|EAP|Custom 95167218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Central 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167219|EAP|Custom 95167219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kinder Krown Lateral 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95167221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95167222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,981.60|FSC: 13; Default||Not reimbursed separately|3,981.60|FSC: 13; Default||External grouping not supported 95167223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95167224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Lag 125mmx12.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,109.34|FSC: 13; Default||Not reimbursed separately|1,109.34|FSC: 13; Default||External grouping not supported 95167225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 140 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,241.12|FSC: 13; Default||Not reimbursed separately|2,241.12|FSC: 13; Default||External grouping not supported 95167226|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167227|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 4.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167228|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 4.5 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167229|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167230|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167231|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167232|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167233|EAP|Custom 95167233||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14 X 34 X28|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95167234|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Quantum Apex 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 4.5mmx25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95167236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 7.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95167284|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Renegade Microcath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167285|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Renegade Microcath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167292|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Drainage General|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167293|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Drainage General|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Helex 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|FSC: 13; Default||Not reimbursed separately|3,288.00|FSC: 13; Default||External grouping not supported 95167295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drill|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95167296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Self-drill|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95167297|EAP|Custom 95167297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franseen Lung Biopsy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drill|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95167300|EAP|Custom 95167300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Coroent 5x11x14mm|1|HUMANA [1294]||HUMANA [11839]|2,913.00|FSC: 13; Default||Not reimbursed separately|2,913.00|FSC: 13; Default||External grouping not supported 95167301|EAP|Custom 95167301||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Coroent 6x11x14mm|1|HUMANA [1294]||HUMANA [11839]|2,913.00|FSC: 13; Default||Not reimbursed separately|2,913.00|FSC: 13; Default||External grouping not supported 95167302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95110583|EAP|Custom 95110583||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ace 3.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167306|EAP|Custom 95167306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Starburst Xlie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167309|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.69|FSC: 13; Default||Not reimbursed separately|93.69|FSC: 13; Default||External grouping not supported 95167310|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Percuflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|232.80|FSC: 13; Default||Not reimbursed separately|232.80|FSC: 13; Default||External grouping not supported 95167311|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore Propaten 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,831.00|FSC: 13; Default||Not reimbursed separately|3,831.00|FSC: 13; Default||External grouping not supported 95167314|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Storq Soft Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167317|EAP|Custom 95167317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Instrument Cjd Dispos|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167324|EAP|Custom 95167324||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Mini Tightrope 1.1mm|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95167338|EAP|Custom 95167338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patient Alarm Assembly|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167339|EAP|Custom 95167339||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Tube Closed Gamma 3|1|HUMANA [1294]||HUMANA [11839]|459.90|FSC: 13; Default||Not reimbursed separately|459.90|FSC: 13; Default||External grouping not supported 95167340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Rt 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95167341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|FSC: 13; Default||Not reimbursed separately|5,508.00|FSC: 13; Default||External grouping not supported 95167342|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95167343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95167344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95167346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|FSC: 13; Default||Not reimbursed separately|993.00|FSC: 13; Default||External grouping not supported 95167347|EAP|Custom 95167347||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Iii Asnis Ti 6.5-8.0|1|HUMANA [1294]||HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 80161979|EAP|Custom 80161979||0998 - STATISTICAL CHARGES|Hb Gc Ekg Resp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161987|EAP|Custom 80161987||0998 - STATISTICAL CHARGES|Hb Gc Holter Resp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80161995|EAP|Custom 80161995||0998 - STATISTICAL CHARGES|Hb Gc Event Monitor Resp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62059969|EAP|CPT® 86666||0302 - LABORATORY - IMMUNOLOGY|Hb Ehrlichia Chaff Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 62059977|EAP|CPT® 86148||0302 - LABORATORY - IMMUNOLOGY|Hb Phosphatidylserine Igm - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.21|FSC: 13; Default||Not reimbursed separately|48.21|FSC: 13; Default||External grouping not supported 62059985|EAP|CPT® 86148||0302 - LABORATORY - IMMUNOLOGY|Hb Phosphatidylserine Iga - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.21|FSC: 13; Default||Not reimbursed separately|48.21|FSC: 13; Default||External grouping not supported 62059993|EAP|CPT® 86361||0302 - LABORATORY - IMMUNOLOGY|Hb Absolute Cd4 Count - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|80.34|FSC: 13; Default||Not reimbursed separately|80.34|FSC: 13; Default||External grouping not supported 95167354|EAP|Custom 95167354||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Ostomy Nu Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167370|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Capsurefix Mri 5086 Is|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95167371|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Capsurefix Mri 5086 Is|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95167372|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Capsurefix Mri 5086 Is|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95167373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|FSC: 13; Default||Not reimbursed separately|841.50|FSC: 13; Default||External grouping not supported 95167374|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95167375|EAP|Custom 95167375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.28|FSC: 13; Default||Not reimbursed separately|4,607.28|FSC: 13; Default||External grouping not supported 95167377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mmx70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95167378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Inter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95167379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Inter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95167380|EAP|Custom 95167380||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Implant |1|HUMANA [1294]||HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95167381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95167382|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|FSC: 13; Default||Not reimbursed separately|9,018.00|FSC: 13; Default||External grouping not supported 95167383|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Xlk Curved #4 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 95167385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 95167369|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Reve Mri Dual|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,867.00|FSC: 13; Default||Not reimbursed separately|12,867.00|FSC: 13; Default||External grouping not supported 95167384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Mod Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|FSC: 13; Default||Not reimbursed separately|8,479.80|FSC: 13; Default||External grouping not supported 95167386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Full Duracon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|FSC: 13; Default||Not reimbursed separately|5,216.40|FSC: 13; Default||External grouping not supported 95167387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Ts Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|FSC: 13; Default||Not reimbursed separately|5,384.40|FSC: 13; Default||External grouping not supported 95167388|EAP|Custom 95167388||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Click Precision|1|HUMANA [1294]||HUMANA [11839]|843.75|FSC: 13; Default||Not reimbursed separately|843.75|FSC: 13; Default||External grouping not supported 95167389|EAP|Custom 95167389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Hex Precision 7.6cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167390|EAP|Custom 95167390||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Prevail 6x16x14mm|1|HUMANA [1294]||HUMANA [11839]|10,290.00|FSC: 13; Default||Not reimbursed separately|10,290.00|FSC: 13; Default||External grouping not supported 95167400|EAP|Custom 95167400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy Mic Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95158221|EAP|Custom 95158221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167401|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymmetric Triat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 80162001|EAP|CPT® 13160||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Secondary Wound Closure|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 95167413|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tutoplast 0.6x1cm Sclera|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95167414|EAP|Custom 95167414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Scleral 25ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167416|EAP|Custom 95167416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Endocrub 0 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167417|EAP|Custom 95167417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Line Cardioplegia Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167418|EAP|Custom 95167418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Cutting Pks Gyrus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167423|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Biliary Via|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95167428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Buttress Mini |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95167430|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95167435|EAP|Custom 95167435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167436|EAP|Custom 95167436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167437|EAP|Custom 95167437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167440|EAP|Custom 95167440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Wound Alexis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167441|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,060.00|FSC: 13; Default||Not reimbursed separately|21,060.00|FSC: 13; Default||External grouping not supported 95167442|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Multi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|FSC: 13; Default||Not reimbursed separately|22,323.00|FSC: 13; Default||External grouping not supported 51001634|EAP|HCPCS G0257||0880 - MISCELLANEOUS DIALYSIS - GENERAL CLASSIFICATION|Hb Crrt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,823.79|FSC: 13; Default||Not reimbursed separately|1,823.79|FSC: 13; Default||External grouping not supported 80162019|EAP|HCPCS G0177||0915 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - GROUP THERAPY|Hb Group Education|1|HUMANA [1294]||HUMANA [11839]|10.00|FSC: 13; Default||Not reimbursed separately|10.00|FSC: 13; Default||External grouping not supported 95162698|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Apd Loop Percflex10fr|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80162027|EAP|Custom 80162027||0998 - STATISTICAL CHARGES|Hb Set Up 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80159338|EAP|CPT® 96379||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Inj Lap Band Port|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 80159346|EAP|HCPCS G0269||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Of Occlusive Device|1|HUMANA [1294]||HUMANA [11839]|949.57|FSC: 13; Default||Not reimbursed separately|949.57|FSC: 13; Default||External grouping not supported 95162744|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soft-vu Pigtail 5fr 65cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162701|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Brite Tip 5fr 11cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163121|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Microintroducer 4 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162671|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 5x1|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95121563|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon 5x2|1|HUMANA [1294]||HUMANA [11839]|477.60|FSC: 13; Default||Not reimbursed separately|477.60|FSC: 13; Default||External grouping not supported 95162663|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gdw 0.18 X 60cm Nitinol M|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162818|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Check-flo 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80162035|EAP|Custom 80162035||0998 - STATISTICAL CHARGES|Hb Set Up 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163050|EAP|Custom 95163050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Tourniquet Single Port Single Bladd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62058219|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|Hb Dsdna Ab Igg Titer - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80162043|EAP|Custom 80162043||0998 - STATISTICAL CHARGES|Hb Set Up 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162050|EAP|Custom 80162050||0998 - STATISTICAL CHARGES|Hb Set Up 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162068|EAP|Custom 80162068||0998 - STATISTICAL CHARGES|Hb Set Up Robotics|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162076|EAP|CPT® 15946||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Exc Ischial Ulcer|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80162084|EAP|CPT® 33977||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Ventricular Device|1|HUMANA [1294]||HUMANA [11839]|2,029.80|FSC: 13; Default||Not reimbursed separately|2,029.80|FSC: 13; Default||External grouping not supported 80162092|EAP|CPT® 36511||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Therapeutic Apheresis Wbc|1|HUMANA [1294]||HUMANA [11839]|3,771.69|FSC: 13; Default||Not reimbursed separately|3,771.69|FSC: 13; Default||External grouping not supported 95167550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp 1st Lt|1|HUMANA [1294]||HUMANA [11839]|2,550.00|FSC: 13; Default||Not reimbursed separately|2,550.00|FSC: 13; Default||External grouping not supported 95167556|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Brite Tip 5fr 23cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167557|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 16fr Valved Peelaway|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167558|EAP|Custom 95167558||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit System Charging|1|HUMANA [1294]||HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95167444|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Non-porous C/r Sigma Pfc Left Sz 5|1|HUMANA [1294]||HUMANA [11839]|10,831.80|FSC: 13; Default||Not reimbursed separately|10,831.80|FSC: 13; Default||External grouping not supported 95167445|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Graft Aneurysm Thoracic 37mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|38,250.00|FSC: 13; Default||Not reimbursed separately|38,250.00|FSC: 13; Default||External grouping not supported 95167446|EAP|Custom 95167446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Tri-lobe Gore|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167447|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dry Seal Gor 24 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167448|EAP|Custom 95167448||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Arm Traction Lateral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Partially Threaded 3.75mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|FSC: 13; Default||Not reimbursed separately|858.00|FSC: 13; Default||External grouping not supported 95167450|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .062 12 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167451|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm 6cm X 18cm Thickness Medium Per Sq Cm 108|1|HUMANA [1294]||HUMANA [11839]|93.44|FSC: 13; Default||Not reimbursed separately|93.44|FSC: 13; Default||External grouping not supported 95167452|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm 6cm X 18cm Thickness Ultra Per Sq Cm 108|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.44|FSC: 13; Default||Not reimbursed separately|93.44|FSC: 13; Default||External grouping not supported 95167455|EAP|HCPCS C1881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Centros Chronic Dialysis 24cm Straight Basic Kit|1|HUMANA [1294]||HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95167456|EAP|Custom 95167456||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tubing Size-4 French Silastic 39 Inch|1|HUMANA [1294]||HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95167298|EAP|Custom 95167298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Franseen Lung Biopsy Bx 22g X 20l|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167463|EAP|Custom 95167463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167464|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 1.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167465|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 1.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167466|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.00mm X 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167467|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.00mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167468|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.00mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167469|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.00mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167470|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.00mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167471|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.00mm X 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167472|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.50mm X 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167473|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167474|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167475|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.50mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167476|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.50mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167477|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 2.50mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167478|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.00mm X 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167479|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.00mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167480|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.00mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167481|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.00mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167482|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.00mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167483|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.00mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167484|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.50mm X 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167485|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167486|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167487|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.50mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167488|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.50mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167489|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 3.50mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167490|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.0mm X 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167491|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167492|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167493|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167494|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.0mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167495|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167496|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167497|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 4.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167498|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 5.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167499|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Rx Trek 5.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167500|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Otw Trek 1.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167501|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Otw Trek 2.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167502|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Otw Trek 2.50mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167503|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Duramax Dialysis 32cm|1|HUMANA [1294]||HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95167510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated7.3mm X 60mm 32mm Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95167511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 95mm 16mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|932.40|FSC: 13; Default||Not reimbursed separately|932.40|FSC: 13; Default||External grouping not supported 95167512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Extra Articular Right 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.98|FSC: 13; Default||Not reimbursed separately|5,980.98|FSC: 13; Default||External grouping not supported 95167513|EAP|Custom 95167513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vascu-guard 2cm X 9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixator Ankle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|FSC: 13; Default||Not reimbursed separately|17,850.00|FSC: 13; Default||External grouping not supported 95167515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ebi Cortical 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|FSC: 13; Default||Not reimbursed separately|456.00|FSC: 13; Default||External grouping not supported 95167516|EAP|Custom 95167516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Digital 1.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95167519|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex Covered 18 Mm X 12.3 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,214.70|FSC: 13; Default||Not reimbursed separately|7,214.70|FSC: 13; Default||External grouping not supported 95167521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femur Cemented Stabilized Posterior Sigma Sz 2.5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|FSC: 13; Default||Not reimbursed separately|11,661.30|FSC: 13; Default||External grouping not supported 95167522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizing Pfc Sigma Sz 2.5-10.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|FSC: 13; Default||Not reimbursed separately|5,940.90|FSC: 13; Default||External grouping not supported 95167523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 5.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.04|FSC: 13; Default||Not reimbursed separately|554.04|FSC: 13; Default||External grouping not supported 95167524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|FSC: 13; Default||Not reimbursed separately|1,593.30|FSC: 13; Default||External grouping not supported 95167525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|FSC: 13; Default||Not reimbursed separately|1,593.30|FSC: 13; Default||External grouping not supported 95167526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167531|EAP|Custom 95167531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm Miniquick Con|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp 1st Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|FSC: 13; Default||Not reimbursed separately|2,754.00|FSC: 13; Default||External grouping not supported 95167533|EAP|Custom 95167533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Stimulating Evokes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95126624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 16mm C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95161779|EAP|Custom 95161779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Loop Leep 15cm X 0.7cm 12cm-shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166613|EAP|Custom 95166613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Set Impella 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Mobility Dual Anatomic Adm Restoration 56mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 95167546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 28mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95167547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Adm Restoration Insert X 3 28mm/28/56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95167548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167561|EAP|Custom 95167561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Esophageal Manometry|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167562|EAP|Custom 95167562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Line Sampling Breath Long |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.5x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95167564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95167565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Distal 3.5lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,965.31|FSC: 13; Default||Not reimbursed separately|3,965.31|FSC: 13; Default||External grouping not supported 95167566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95167567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Xlk Curved #4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|FSC: 13; Default||Not reimbursed separately|6,505.80|FSC: 13; Default||External grouping not supported 95167568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interplate L-ti Lumbar Ifd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95167569|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Assembly Cover Interplate|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95167570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95167571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Optima Peek Lumbar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95167572|EAP|Custom 95167572||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Prevail 7x16x14mm|1|HUMANA [1294]||HUMANA [11839]|10,290.00|FSC: 13; Default||Not reimbursed separately|10,290.00|FSC: 13; Default||External grouping not supported 95167559|EAP|Custom 95167559||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Spring Wire Safety|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Trumatch Spii 3t/4f/l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95167575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95167586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95167588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167590|EAP|Custom 95167590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 3.2mm Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95167600|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Bio-absorable Reinfor|1|HUMANA [1294]||HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 95167601|EAP|Custom 95167601||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Oblique Large Cordent|1|HUMANA [1294]||HUMANA [11839]|11,538.00|FSC: 13; Default||Not reimbursed separately|11,538.00|FSC: 13; Default||External grouping not supported 95167602|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95167605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95167607|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95167609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.00|FSC: 13; Default||Not reimbursed separately|1,365.00|FSC: 13; Default||External grouping not supported 95167612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm Left 130 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 40.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Znn 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|FSC: 13; Default||Not reimbursed separately|1,542.54|FSC: 13; Default||External grouping not supported 95167620|EAP|Custom 95167620||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Znn 0mm|1|HUMANA [1294]||HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95167621|EAP|Custom 95167621||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Znn 5mm|1|HUMANA [1294]||HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95167622|EAP|Custom 95167622||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Left Xlg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167623|EAP|Custom 95167623||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Thumb Rt Xlg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167624|EAP|Custom 95167624||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Znn 10mm|1|HUMANA [1294]||HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95167625|EAP|Custom 95167625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Znn 15mm|1|HUMANA [1294]||HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95167626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167629|EAP|Custom 95167629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Starter Thermisense|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167630|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Platinum Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167631|EAP|Custom 95167631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rumi Ii Efficient Koh 2.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167632|EAP|Custom 95167632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rumi Ii Efficient Koh 3.0cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167633|EAP|Custom 95167633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rumi Ii Efficient Koh 3.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167634|EAP|Custom 95167634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rumi Ii Efficient Koh 4.0cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167635|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Delivery Endoprosthesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|FSC: 13; Default||Not reimbursed separately|29,985.00|FSC: 13; Default||External grouping not supported 95167636|EAP|Custom 95167636||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Exc Trunk|1|HUMANA [1294]||HUMANA [11839]|25,860.00|FSC: 13; Default||Not reimbursed separately|25,860.00|FSC: 13; Default||External grouping not supported 95167637|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Curved Pfc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|FSC: 13; Default||Not reimbursed separately|5,182.80|FSC: 13; Default||External grouping not supported 95167638|EAP|Custom 95167638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Wound 15fr Hemaduct|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167639|EAP|Custom 95167639||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Verteport 10g Sys Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167640|EAP|Custom 95167640||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Hv Cement Pcd Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167641|EAP|Custom 95167641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ivas 10g Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx21.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 14.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx21.5cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167646|EAP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Amniotic Human Nucel|1|HUMANA [1294]||HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95167603|EAP|Custom 95167603||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Coroent 8x15x13mm|1|HUMANA [1294]||HUMANA [11839]|3,588.00|FSC: 13; Default||Not reimbursed separately|3,588.00|FSC: 13; Default||External grouping not supported 95167647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 14.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 14.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,903.03|FSC: 13; Default||Not reimbursed separately|3,903.03|FSC: 13; Default||External grouping not supported 95167655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 14.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 14.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,903.03|FSC: 13; Default||Not reimbursed separately|3,903.03|FSC: 13; Default||External grouping not supported 95167666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,903.03|FSC: 13; Default||Not reimbursed separately|3,903.03|FSC: 13; Default||External grouping not supported 95167667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 14.5mmx21.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|FSC: 13; Default||Not reimbursed separately|4,251.84|FSC: 13; Default||External grouping not supported 95167670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167674|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Check Flo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167675|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Check Flo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mmx30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Helix 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95167686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Helix 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95167687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Ps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95167688|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95167800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mmx38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167804|EAP|Custom 95167804||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Cps|1|HUMANA [1294]||HUMANA [11839]|75.00|FSC: 13; Default||Not reimbursed separately|75.00|FSC: 13; Default||External grouping not supported 95167805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167807|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ablation Navistar F |1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|FSC: 13; Default||Not reimbursed separately|4,905.90|FSC: 13; Default||External grouping not supported 95167809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|FSC: 13; Default||Not reimbursed separately|4,905.90|FSC: 13; Default||External grouping not supported 95167810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 38cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167811|EAP|Custom 95167811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Atlas 20cm Hand|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,580.00|FSC: 13; Default||Not reimbursed separately|5,580.00|FSC: 13; Default||External grouping not supported 95167813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 40cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95167822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95167823|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|FSC: 13; Default||Not reimbursed separately|26,136.00|FSC: 13; Default||External grouping not supported 95167824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Hooded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95167797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 80162100|EAP|CPT® 38220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Diagnostic Bone Marrow; Aspiration(s)|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80162118|EAP|CPT® 96422||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Chemo Admin Arterial 1 Hour|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 80162126|EAP|CPT® 96423||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Chemo Admin Arterial Add Hr|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 80162134|EAP|HCPCS P9612||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cath For Specimen|1|HUMANA [1294]||HUMANA [11839]|9.00|FSC: 13; Default||Not reimbursed separately|9.00|FSC: 13; Default||External grouping not supported 95167698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 30cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167699|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 13mm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,440.00|FSC: 13; Default||Not reimbursed separately|10,440.00|FSC: 13; Default||External grouping not supported 95167700|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dry Seal Gor 18 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 30cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 30cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 30cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 30cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 30cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 30cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 32cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 32cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 32cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 32cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 32cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 32cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|FSC: 13; Default||Not reimbursed separately|4,905.90|FSC: 13; Default||External grouping not supported 95167715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 32cm 123 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 32cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 32cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 32cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 32cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 32cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 32cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175068|EAP|Custom 95175068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Nitinol 100mm Monpolar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 32cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 32cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175069|EAP|Custom 95175069||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sterilzation Box Lightweight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 32cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175070|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95167725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 32cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175071|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.0 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95167726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 32cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175072|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95167728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 34cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,580.00|FSC: 13; Default||Not reimbursed separately|5,580.00|FSC: 13; Default||External grouping not supported 95175073|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Resolute Drug Eluting 3.5 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95167729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 34cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 19mm X 195mm Distal Conical Modular Restoration|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95167731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 34cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175074|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrilator Incepta Crt-d Is/1 Ds/1|1|HUMANA [1294]||HUMANA [11839]|66,000.00|FSC: 13; Default||Not reimbursed separately|66,000.00|FSC: 13; Default||External grouping not supported 95167732|EAP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Galil Icerod 90|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167733|EAP|HCPCS C1819||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Probe Starburst Semi Flex W/cable|1|HUMANA [1294]||HUMANA [11839]|7,350.00|FSC: 13; Default||Not reimbursed separately|7,350.00|FSC: 13; Default||External grouping not supported 80167141|EAP|Custom 80167141||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Hybrid Room Surgical Procedure|1|HUMANA [1294]||HUMANA [11839]|7,766.25|FSC: 13; Default||Not reimbursed separately|7,766.25|FSC: 13; Default||External grouping not supported 95167736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95175095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|FSC: 13; Default||Not reimbursed separately|5,031.06|FSC: 13; Default||External grouping not supported 95167737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|FSC: 13; Default||Not reimbursed separately|1,452.30|FSC: 13; Default||External grouping not supported 80167158|EAP|Custom 80167158||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Hybrid Room Surgical Minute|1|HUMANA [1294]||HUMANA [11839]|149.88|FSC: 13; Default||Not reimbursed separately|149.88|FSC: 13; Default||External grouping not supported 95167738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 34cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175127|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Occlusion Fogarty 5fr|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 34cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175096|EAP|Custom 95175096||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 4mm Large|1|HUMANA [1294]||HUMANA [11839]|4,463.22|FSC: 13; Default||Not reimbursed separately|4,463.22|FSC: 13; Default||External grouping not supported 95167740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 34cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175082|EAP|Custom 95175082||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Steripack D External Fixator Coretrak|1|HUMANA [1294]||HUMANA [11839]|7,065.00|FSC: 13; Default||Not reimbursed separately|7,065.00|FSC: 13; Default||External grouping not supported 95167741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 34cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175086|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 640cc|1|HUMANA [1294]||HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95167742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 34cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175088|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 680cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95167743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 34cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175090|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii Ablation 10mm Large Curve|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 34cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175091|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 750cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95167745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 34cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175092|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 800cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95167746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 34cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175134|EAP|Custom 95175134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 180 For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 34cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175135|EAP|Custom 95175135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 90 For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 34cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 34cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175138|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Arctic Front Advance 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 34cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175139|EAP|Custom 95175139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Supertrax For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 34cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175140|EAP|Custom 95175140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology Supertrax For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 34cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 62062724|EAP|CPT® 86617||0302 - LABORATORY - IMMUNOLOGY|Hb B. Burgdorferi (lyme) Igg Wb - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|46.47|FSC: 13; Default||Not reimbursed separately|46.47|FSC: 13; Default||External grouping not supported 95167753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 36cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175142|EAP|Custom 95175142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Aspirating 21ga Supertrax For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 36cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175143|EAP|Custom 95175143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Cytology Needle Tipped W/aspirating Port|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 36cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175144|EAP|Custom 95175144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Marker Superlock Cobra For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 36cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175145|EAP|Custom 95175145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Marker Delivery For I-logic System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 36cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175146|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Steerable Flexcath Advance|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 36cm 125 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175147|EAP|Custom 95175147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Coaxial Umbilical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 36cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175148|EAP|Custom 95175148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Electrical Umbilical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 36cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175149|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Achieve Mapping 15mm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 13cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175150|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Achieve Mapping 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 36cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175151|EAP|Custom 95175151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Manual Retraction|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167766|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Reconstructive Strattice Contour (for Implant Size 250-400cc)|1|HUMANA [1294]||HUMANA [11839]|56.53|FSC: 13; Default||Not reimbursed separately|56.53|FSC: 13; Default||External grouping not supported 62062732|EAP|CPT® 86617||0302 - LABORATORY - IMMUNOLOGY|Hb B. Burgdorferi (lyme) Igm Wb - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.47|FSC: 13; Default||Not reimbursed separately|46.47|FSC: 13; Default||External grouping not supported 95167767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 36cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 62062740|EAP|CPT® 88367||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Fish Computer Assisted - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95167768|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Reconstructive Strattice Contour (for Implant Size 400-550cc)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.02|FSC: 13; Default||Not reimbursed separately|48.02|FSC: 13; Default||External grouping not supported 95167769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 36cm 130 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 62062757|EAP|CPT® 88368||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Fish Manual - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95167770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 36cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95175141|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Arctic Front Advance 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 36cm 130 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 62062765|EAP|CPT® 81315||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pml/rara Pcr - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|621.93|FSC: 13; Default||Not reimbursed separately|621.93|FSC: 13; Default||External grouping not supported 95167772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 36cm 135 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 36cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95130457|EAP|Custom 95130457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Opthalmic 1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 36cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167775|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biomesh Collagen Acellular Pelvisoft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,125.43|FSC: 13; Default||Not reimbursed separately|3,125.43|FSC: 13; Default||External grouping not supported 95174765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 14mm X 340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,492.88|FSC: 13; Default||Not reimbursed separately|5,492.88|FSC: 13; Default||External grouping not supported 95167780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95167781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 36cm 135 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95174767|EAP|Custom 95174767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Post Mortem 72" X 90"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167782|EAP|Custom 95167782||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 6mm|1|HUMANA [1294]||HUMANA [11839]|4,463.22|FSC: 13; Default||Not reimbursed separately|4,463.22|FSC: 13; Default||External grouping not supported 95167783|EAP|Custom 95167783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 5mm|1|HUMANA [1294]||HUMANA [11839]|4,291.56|FSC: 13; Default||Not reimbursed separately|4,291.56|FSC: 13; Default||External grouping not supported 95174774|EAP|Custom 95174774||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tisseel 2ml|1|HUMANA [1294]||HUMANA [11839]|430.68|FSC: 13; Default||Not reimbursed separately|430.68|FSC: 13; Default||External grouping not supported 95167784|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Helix 4mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95167785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex 2 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.44|FSC: 13; Default||Not reimbursed separately|223.44|FSC: 13; Default||External grouping not supported 95174775|EAP|Custom 95174775||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tisseel 4ml|1|HUMANA [1294]||HUMANA [11839]|721.90|FSC: 13; Default||Not reimbursed separately|721.90|FSC: 13; Default||External grouping not supported 95167786|EAP|Custom 95167786||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lengthener Micro Hii|1|HUMANA [1294]||HUMANA [11839]|11,220.00|FSC: 13; Default||Not reimbursed separately|11,220.00|FSC: 13; Default||External grouping not supported 95167787|EAP|Custom 95167787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Expander Tissue External Rc Dermaclose (includes Stapler And Staple Remover)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174779|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrilator Incepta Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,000.00|FSC: 13; Default||Not reimbursed separately|66,000.00|FSC: 13; Default||External grouping not supported 95167788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10 X 420 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95167789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 38cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95174792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95167790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95167791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 38cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95174795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 6.5mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95167792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 38cm 125 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167827|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,244.15|FSC: 13; Default||Not reimbursed separately|5,244.15|FSC: 13; Default||External grouping not supported 95167829|EAP|Custom 95167829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stabili T First Fract|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167830|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver 635 6fr 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95167832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.20|FSC: 13; Default||Not reimbursed separately|4,243.20|FSC: 13; Default||External grouping not supported 95167844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,718.22|FSC: 13; Default||Not reimbursed separately|4,718.22|FSC: 13; Default||External grouping not supported 95167845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.78|FSC: 13; Default||Not reimbursed separately|4,767.78|FSC: 13; Default||External grouping not supported 95167846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,994.40|FSC: 13; Default||Not reimbursed separately|4,994.40|FSC: 13; Default||External grouping not supported 95167847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,048.67|FSC: 13; Default||Not reimbursed separately|5,048.67|FSC: 13; Default||External grouping not supported 95167848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,225.67|FSC: 13; Default||Not reimbursed separately|5,225.67|FSC: 13; Default||External grouping not supported 95167849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,663.92|FSC: 13; Default||Not reimbursed separately|4,663.92|FSC: 13; Default||External grouping not supported 95167850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,718.22|FSC: 13; Default||Not reimbursed separately|4,718.22|FSC: 13; Default||External grouping not supported 95167851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.78|FSC: 13; Default||Not reimbursed separately|4,767.78|FSC: 13; Default||External grouping not supported 95167852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,994.40|FSC: 13; Default||Not reimbursed separately|4,994.40|FSC: 13; Default||External grouping not supported 95167853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,048.67|FSC: 13; Default||Not reimbursed separately|5,048.67|FSC: 13; Default||External grouping not supported 95167854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,225.67|FSC: 13; Default||Not reimbursed separately|5,225.67|FSC: 13; Default||External grouping not supported 95167855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mmx75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95167856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 40cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167828|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Osteoconductive|1|HUMANA [1294]||HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95127213|EAP|Custom 95127213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Endotrach Pedi 2-lumen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167866|EAP|Custom 95167866||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Hand Functional|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167867|EAP|Custom 95167867||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Hand Functional|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167868|EAP|Custom 95167868||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Hand Functional|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167869|EAP|Custom 95167869||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Hand Functional|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167872|EAP|Custom 95167872||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Zinc Oxide Usp 1#|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167873|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Text|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 95167874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95167875|EAP|Custom 95167875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 275cc |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167876|EAP|Custom 95167876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 325cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167877|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95167878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,663.92|FSC: 13; Default||Not reimbursed separately|4,663.92|FSC: 13; Default||External grouping not supported 95167879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167885|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Socket Humeral Rsp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,277.50|FSC: 13; Default||Not reimbursed separately|6,277.50|FSC: 13; Default||External grouping not supported 95167886|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95167887|EAP|Custom 95167887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Medium|1|HUMANA [1294]||HUMANA [11839]|4,248.00|FSC: 13; Default||Not reimbursed separately|4,248.00|FSC: 13; Default||External grouping not supported 95167888|EAP|Custom 95167888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Acutrak-2 Mini |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167889|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprothesis Viabahn 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,185.00|FSC: 13; Default||Not reimbursed separately|10,185.00|FSC: 13; Default||External grouping not supported 95167890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5 X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167892|EAP|Custom 95167892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Bone Marrow |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167894|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Adm Restoration Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95167893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Head 3-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,171.00|FSC: 13; Default||Not reimbursed separately|3,171.00|FSC: 13; Default||External grouping not supported 95167895|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdm 42mm/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 95167896|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|FSC: 13; Default||Not reimbursed separately|5,728.80|FSC: 13; Default||External grouping not supported 80162159|EAP|CPT® 95810||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Polysomnogram < 4hrs|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 80162167|EAP|CPT® 95811||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Cpap Protocol < 4 Hrs|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95167897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 42cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Znn Set 8mm X 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.84|FSC: 13; Default||Not reimbursed separately|543.84|FSC: 13; Default||External grouping not supported 95167902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167907|EAP|HCPCS C1888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Closure Fast 7fr|1|HUMANA [1294]||HUMANA [11839]|2,535.00|FSC: 13; Default||Not reimbursed separately|2,535.00|FSC: 13; Default||External grouping not supported 95167908|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Whisper View Eds|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Altrx Pinnacle 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95167913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Altrx Pinnacle 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95167914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Altrx Pinnacle 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95167915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Altrx Pinnacle 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95167916|EAP|Custom 95167916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode/cord Ligasure Max|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167921|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerocath Dx |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167926|EAP|Custom 95167926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Endobronchial Blocker |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Straight Mrs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|FSC: 13; Default||Not reimbursed separately|9,573.90|FSC: 13; Default||External grouping not supported 95167930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Distal Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,719.10|FSC: 13; Default||Not reimbursed separately|24,719.10|FSC: 13; Default||External grouping not supported 95167931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95167933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 44cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167900|EAP|Custom 95167900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Znn 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167927|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viatorr 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,908.00|FSC: 13; Default||Not reimbursed separately|13,908.00|FSC: 13; Default||External grouping not supported 95167939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|FSC: 13; Default||Not reimbursed separately|4,905.90|FSC: 13; Default||External grouping not supported 95167941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|FSC: 13; Default||Not reimbursed separately|4,905.90|FSC: 13; Default||External grouping not supported 95167943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 46 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167951|EAP|Custom 95167951||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Mild Lumbar Decompress|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 46cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Znn 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|FSC: 13; Default||Not reimbursed separately|396.00|FSC: 13; Default||External grouping not supported 95167957|EAP|Custom 95167957||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Znn Calibrated 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167958|EAP|Custom 95167958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Znn 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 48cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167967|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cmm 11.5mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167968|EAP|Custom 95167968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Line Sampling Breath Etco2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 10mm X 48cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mm X 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95167980|EAP|Custom 95167980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tuohy Epidural 18ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167981|EAP|Custom 95167981||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Eugenol 4 Oz Usp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167984|EAP|Custom 95167984||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Finish Strip 1954 Crs/med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167987|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Catheter Dialysis Perit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.00|FSC: 13; Default||Not reimbursed separately|1,461.00|FSC: 13; Default||External grouping not supported 95167988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Gription|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|FSC: 13; Default||Not reimbursed separately|14,206.50|FSC: 13; Default||External grouping not supported 95167989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 80162175|EAP|CPT® 0275T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Laminotomy Mild Procedure|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80162183|EAP|CPT® 0275T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Laminotomy Mild Add Space|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 95174796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 7.0mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95162320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 15.8mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.96|FSC: 13; Default||Not reimbursed separately|744.96|FSC: 13; Default||External grouping not supported 95167990|EAP|Custom 95167990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Suspension Shoulder |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167991|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide Vista Brite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168008|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95168009|EAP|Custom 95168009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Asnis Iii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|FSC: 13; Default||Not reimbursed separately|1,059.00|FSC: 13; Default||External grouping not supported 95168011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Pca Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|FSC: 13; Default||Not reimbursed separately|4,750.20|FSC: 13; Default||External grouping not supported 95168012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Accomon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,288.00|FSC: 13; Default||Not reimbursed separately|6,288.00|FSC: 13; Default||External grouping not supported 95168013|EAP|Custom 95168013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Z-thread |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168016|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 Stryker|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,097.90|FSC: 13; Default||Not reimbursed separately|2,097.90|FSC: 13; Default||External grouping not supported 95168017|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdm For Insert X3 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95168018|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdm 38mm/d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 95168019|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 Stryker |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,097.90|FSC: 13; Default||Not reimbursed separately|2,097.90|FSC: 13; Default||External grouping not supported 95168014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Spiral Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.42|FSC: 13; Default||Not reimbursed separately|1,935.42|FSC: 13; Default||External grouping not supported 95168021|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95168022|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95168023|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95168024|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Profile |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95168025|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95168026|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95168027|EAP|Custom 95168027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladeless Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168028|EAP|Custom 95168028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Finger Adult Bci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|FSC: 13; Default||Not reimbursed separately|9,018.00|FSC: 13; Default||External grouping not supported 80161667|EAP|CPT® 96446||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo Admin Peritoneal Cav|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 95168037|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95168038|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Profile Low|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95168039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 9mm X 330mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95168040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95168041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radial Column Pin |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95168042|EAP|Custom 95168042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wire 1.1 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95168044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95168045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95168046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.3mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95168047|EAP|Custom 95168047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 1.75 Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168048|EAP|Custom 95168048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plate Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168049|EAP|Custom 95168049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Buttress Volar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168050|EAP|Custom 95168050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Polyp Hysterscopic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168053|EAP|Custom 95168053||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Putty Bluprint Handmixed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168054|EAP|Custom 95168054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Illuminator Handheld|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168055|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Penta Ans 3mm-60cm|1|HUMANA [1294]||HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95168056|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8fr Xb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168057|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 8fr Xb4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95165775|EAP|Custom 95165775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Quick Coupler|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168058|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Protecta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,200.00|FSC: 13; Default||Not reimbursed separately|55,200.00|FSC: 13; Default||External grouping not supported 95168059|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Protecta Xt|1|HUMANA [1294]||HUMANA [11839]|42,207.00|FSC: 13; Default||Not reimbursed separately|42,207.00|FSC: 13; Default||External grouping not supported 95168060|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Protecta|1|HUMANA [1294]||HUMANA [11839]|39,474.00|FSC: 13; Default||Not reimbursed separately|39,474.00|FSC: 13; Default||External grouping not supported 95168061|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Consulta|1|HUMANA [1294]||HUMANA [11839]|21,246.00|FSC: 13; Default||Not reimbursed separately|21,246.00|FSC: 13; Default||External grouping not supported 95168066|EAP|Custom 95168066||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Dressing Tubular Retainer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left Coronoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,896.75|FSC: 13; Default||Not reimbursed separately|1,896.75|FSC: 13; Default||External grouping not supported 95165134|EAP|Custom 95165134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao 2.7mm X 122mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165137|EAP|Custom 95165137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao 3.5mm X 122mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 11.5mm X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95168074|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Rx Mahurkar 3l|1|HUMANA [1294]||HUMANA [11839]|353.98|FSC: 13; Default||Not reimbursed separately|353.98|FSC: 13; Default||External grouping not supported 95168075|EAP|Custom 95168075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Tray Rx Mahurkar Tri|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168076|EAP|Custom 95168076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Tray Rx Mahurkar Tri|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168079|EAP|Custom 95168079||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Soft Backflush 25 Guage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168080|EAP|Custom 95168080||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chandelier 25 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drilling 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,241.04|FSC: 13; Default||Not reimbursed separately|1,241.04|FSC: 13; Default||External grouping not supported 95168082|EAP|Custom 95168082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pig Angled 4 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drilling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.93|FSC: 13; Default||Not reimbursed separately|1,029.93|FSC: 13; Default||External grouping not supported 95168084|EAP|Custom 95168084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Constell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168085|EAP|Custom 95168085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Constella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168086|EAP|Custom 95168086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Constella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168087|EAP|Custom 95168087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Constellation Vfc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168088|EAP|Custom 95168088||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Illuminator Sapphire 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168089|EAP|Custom 95168089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Illuminator Sapphire 25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168090|EAP|Custom 95168090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Constellation Frag|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95168092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95168093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 45mm Vision Atlantis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|FSC: 13; Default||Not reimbursed separately|5,782.98|FSC: 13; Default||External grouping not supported 95168094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Poplock 3.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,000.59|FSC: 13; Default||Not reimbursed separately|1,000.59|FSC: 13; Default||External grouping not supported 95168096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Titanium |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168100|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168103|EAP|Custom 95168103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Mtp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|FSC: 13; Default||Not reimbursed separately|2,664.78|FSC: 13; Default||External grouping not supported 95168106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|FSC: 13; Default||Not reimbursed separately|2,664.78|FSC: 13; Default||External grouping not supported 95168107|EAP|Custom 95168107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Delta Regular Level|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168108|EAP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Peritoneal W/slits|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.09|FSC: 13; Default||Not reimbursed separately|621.09|FSC: 13; Default||External grouping not supported 95168109|EAP|Custom 95168109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Bipolar Revolution |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168110|EAP|Custom 95168110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mem Tympanic Rt Drum Cad|1|HUMANA [1294]||HUMANA [11839]|2,721.00|FSC: 13; Default||Not reimbursed separately|2,721.00|FSC: 13; Default||External grouping not supported 95168111|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Endoprosth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|FSC: 13; Default||Not reimbursed separately|30,735.00|FSC: 13; Default||External grouping not supported 95168115|EAP|HCPCS A7520||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy 5.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95122928|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Imp Capsure 35cm|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95147726|EAP|Custom 95147726||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hand Help Exerciser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168120|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168123|EAP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Amniotic Ambio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95168124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium 5.5 Legacy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|FSC: 13; Default||Not reimbursed separately|1,443.54|FSC: 13; Default||External grouping not supported 95168125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Lt Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|FSC: 13; Default||Not reimbursed separately|3,540.00|FSC: 13; Default||External grouping not supported 95168126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95168127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Variable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|FSC: 13; Default||Not reimbursed separately|1,443.54|FSC: 13; Default||External grouping not supported 95168128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Condyle T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|587.52|FSC: 13; Default||Not reimbursed separately|587.52|FSC: 13; Default||External grouping not supported 95168129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nut T2 For Condyle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 95168130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Condyle T2 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|587.52|FSC: 13; Default||Not reimbursed separately|587.52|FSC: 13; Default||External grouping not supported 95168131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire 1.8 X 310mm Condyle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|FSC: 13; Default||Not reimbursed separately|367.50|FSC: 13; Default||External grouping not supported 95168132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,764.00|FSC: 13; Default||Not reimbursed separately|7,764.00|FSC: 13; Default||External grouping not supported 95168133|EAP|Custom 95168133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168136|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Straight Dream 260|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Trabecular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95168141|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril Sdx Bipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95168142|EAP|Custom 95168142||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 5 Std|1|HUMANA [1294]||HUMANA [11839]|4,291.56|FSC: 13; Default||Not reimbursed separately|4,291.56|FSC: 13; Default||External grouping not supported 95168143|EAP|Custom 95168143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal 4 Std|1|HUMANA [1294]||HUMANA [11839]|4,291.56|FSC: 13; Default||Not reimbursed separately|4,291.56|FSC: 13; Default||External grouping not supported 95168144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation Temp Helix R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|FSC: 13; Default||Not reimbursed separately|684.00|FSC: 13; Default||External grouping not supported 95168145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Helix-r 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|FSC: 13; Default||Not reimbursed separately|684.00|FSC: 13; Default||External grouping not supported 95168146|EAP|Custom 95168146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Tray Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95167290|EAP|Custom 95167290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168153|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.4mmx150mm Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168154|EAP|Custom 95168154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist Cann 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168156|EAP|Custom 95168156||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Casting Medi 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168157|EAP|Custom 95168157||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Casting Medi Xlg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168158|EAP|Custom 95168158||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Charcot Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168159|EAP|Custom 95168159||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Charcot X-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|FSC: 13; Default||Not reimbursed separately|2,664.78|FSC: 13; Default||External grouping not supported 95168161|EAP|Custom 95168161||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Collagen Synovis|1|HUMANA [1294]||HUMANA [11839]|13,440.00|FSC: 13; Default||Not reimbursed separately|13,440.00|FSC: 13; Default||External grouping not supported 95168162|EAP|Custom 95168162||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Porcine 25mm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95168163|EAP|Custom 95168163||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Porcine 27mm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95168164|EAP|Custom 95168164||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Porcine 29mm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95168165|EAP|Custom 95168165||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Porcine 31mm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95168166|EAP|Custom 95168166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Porcine 33mm|1|HUMANA [1294]||HUMANA [11839]|15,300.00|FSC: 13; Default||Not reimbursed separately|15,300.00|FSC: 13; Default||External grouping not supported 95168167|EAP|Custom 95168167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Adv Fix 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168168|EAP|Custom 95168168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Adv Fix 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168169|EAP|Custom 95168169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Adv Fix 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168170|EAP|Custom 95168170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Bladed Adv Fix 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162217|EAP|Custom 80162217||0998 - STATISTICAL CHARGES|Hb Fu Patient Tracker Sdc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162225|EAP|Custom 80162225||0998 - STATISTICAL CHARGES|Hb Fu Visit Level 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162233|EAP|Custom 80162233||0998 - STATISTICAL CHARGES|Hb Fu Visit Level 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162241|EAP|Custom 80162241||0998 - STATISTICAL CHARGES|Hb Fu Visit Level 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168172|EAP|Custom 95168172||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Cervical Eto Steril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168173|EAP|Custom 95168173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoserter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168174|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sys Delivery Endoprosthesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|FSC: 13; Default||Not reimbursed separately|29,985.00|FSC: 13; Default||External grouping not supported 95168175|EAP|Custom 95168175||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder|1|HUMANA [1294]||HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95168176|EAP|Custom 95168176||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder|1|HUMANA [1294]||HUMANA [11839]|11,940.00|FSC: 13; Default||Not reimbursed separately|11,940.00|FSC: 13; Default||External grouping not supported 95168177|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dry Seal 16fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168178|EAP|Custom 95168178||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Contour Medium 4mm|1|HUMANA [1294]||HUMANA [11839]|3,588.00|FSC: 13; Default||Not reimbursed separately|3,588.00|FSC: 13; Default||External grouping not supported 95168179|EAP|Custom 95168179||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Contour Medium 5mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95168180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Helix-r 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|FSC: 13; Default||Not reimbursed separately|3,540.00|FSC: 13; Default||External grouping not supported 95168181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Asnis Iii Ti 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95168182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Asnis Iii Ti 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95168183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Frict Low 22.2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95163422|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Engage 6fr Act|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168184|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Seerocath Dx Octapol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168187|EAP|Custom 95168187||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Ankle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Turon Sz42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95168192|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Prim Turon Sz8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 80162258|EAP|CPT® 59414||0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION|Hb Delivery Of Placenta|1|HUMANA [1294]||HUMANA [11839]|7,118.40|FSC: 13; Default||Not reimbursed separately|7,118.40|FSC: 13; Default||External grouping not supported 95167291|EAP|Custom 95167291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdm For Insert X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95168196|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdm 36mm/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 95168197|EAP|Custom 95168197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hoop Shim|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168198|EAP|Custom 95168198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Access Pedicle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168199|EAP|Custom 95168199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Light Angled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168200|EAP|Custom 95168200||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Impacted Large|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95168201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|FSC: 13; Default||Not reimbursed separately|2,043.00|FSC: 13; Default||External grouping not supported 95168202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 50 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95168203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tulip 6.25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95168204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95168205|EAP|Custom 95168205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Ball Dual 20mm Nuvasive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168206|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Standard Series|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|FSC: 13; Default||Not reimbursed separately|1,215.00|FSC: 13; Default||External grouping not supported 95168207|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Standard Series|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,254.00|FSC: 13; Default||Not reimbursed separately|1,254.00|FSC: 13; Default||External grouping not supported 95168208|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95168209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95168210|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart 7mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95168211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|FSC: 13; Default||Not reimbursed separately|489.60|FSC: 13; Default||External grouping not supported 95168212|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart 8mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95168213|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart 8mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95168214|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Head/neck Omnifit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|FSC: 13; Default||Not reimbursed separately|7,056.00|FSC: 13; Default||External grouping not supported 95168216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Lfit C-taper Lf Ion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95168217|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Lfit C-taper Lf Ion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95168218|EAP|Custom 95168218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Constell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168219|EAP|Custom 95168219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Vitrectomy Constell|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168220|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95168221|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Triad Cr 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95168223|EAP|Custom 95168223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Transducer Pressure Mon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168224|EAP|Custom 95168224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Transducer Pressure Mon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95168226|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Strut Center 6 X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|FSC: 13; Default||Not reimbursed separately|8,893.50|FSC: 13; Default||External grouping not supported 95168227|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr Verte|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95168228|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Verte-stack 10 X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95168229|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.25mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168230|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.25mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168232|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.25mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168233|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.25mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168234|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.50mmx08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168235|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.50mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168236|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.50mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168237|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.50mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168238|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.50mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168239|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.50mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168240|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.75mmx08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168241|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.75mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168242|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.75mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168243|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.75mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168244|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.75mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168245|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 2.75mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168246|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx09mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168247|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168248|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168249|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168250|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168251|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168252|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.00mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168253|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.50mmx09mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168254|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.50mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168255|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.50mmx15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168256|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.50mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168258|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.50mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168257|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integ Bms 3.50mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 80162266|EAP|CPT® 57452||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Colposcopy Of Cervix|1|HUMANA [1294]||HUMANA [11839]|512.59|FSC: 13; Default||Not reimbursed separately|512.59|FSC: 13; Default||External grouping not supported 95168231|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 2.25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168259|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 3.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168260|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168261|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168262|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168263|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168264|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168265|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168266|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 4.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168267|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ut Sds 8mmx8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95168272|EAP|Custom 95168272||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Porp Shea 3.0mm Head 5.5mm|1|HUMANA [1294]||HUMANA [11839]|1,038.57|FSC: 13; Default||Not reimbursed separately|1,038.57|FSC: 13; Default||External grouping not supported 95168277|EAP|Custom 95168277||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fixation Absorbable|1|HUMANA [1294]||HUMANA [11839]|2,482.20|FSC: 13; Default||Not reimbursed separately|2,482.20|FSC: 13; Default||External grouping not supported 95168279|EAP|Custom 95168279||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fixation Absorbable|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168280|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,214.70|FSC: 13; Default||Not reimbursed separately|7,214.70|FSC: 13; Default||External grouping not supported 95168281|EAP|HCPCS C1888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Perforator Vein Abla|1|HUMANA [1294]||HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95168285|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Integrity Bms 2.25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Head/neck Omnifit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|FSC: 13; Default||Not reimbursed separately|7,350.00|FSC: 13; Default||External grouping not supported 95168287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Lfit C-taper Lf Ion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95168288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ip 15mm X 195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|FSC: 13; Default||Not reimbursed separately|12,627.30|FSC: 13; Default||External grouping not supported 95168290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibal Stabilizer |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95168292|EAP|Custom 95168292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Drill E9010 With Irr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174799|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Frozen Fresh Achilles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,315.84|FSC: 13; Default||Not reimbursed separately|6,315.84|FSC: 13; Default||External grouping not supported 80162274|EAP|Custom 80162274||0998 - STATISTICAL CHARGES|Hb Chf Np N/c Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174800|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Frozen Fresh Tibialis Posterior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,000.04|FSC: 13; Default||Not reimbursed separately|5,000.04|FSC: 13; Default||External grouping not supported 95174801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Knee Total Triathlon Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 95168294|EAP|Custom 95168294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Rem Tissue Myosure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168295|EAP|Custom 95168295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Seal Hysterscope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168296|EAP|Custom 95168296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Egg Fluted 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168297|EAP|Custom 95168297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Egg Fluted 6.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168298|EAP|Custom 95168298||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contoured Cordent 6mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95168299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Helex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|FSC: 13; Default||Not reimbursed separately|3,288.00|FSC: 13; Default||External grouping not supported 95168301|EAP|Custom 95168301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168313|EAP|Custom 95168313||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Arthrowand Turbovac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168314|EAP|Custom 95168314||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Arthrowand Super Multivac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95123701|EAP|Custom 95123701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Urine-meter Pedi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95130622|EAP|Custom 95130622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Ureteral Drainage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95134177|EAP|Custom 95134177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Pedi 8fr 2cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168320|EAP|Custom 95168320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Stone Retrieval Nit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168321|EAP|Custom 95168321||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Labra Lock P|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95168322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Cone Full Metal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,645.00|FSC: 13; Default||Not reimbursed separately|12,645.00|FSC: 13; Default||External grouping not supported 95168323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Tria|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|FSC: 13; Default||Not reimbursed separately|4,752.30|FSC: 13; Default||External grouping not supported 95168324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,981.60|FSC: 13; Default||Not reimbursed separately|3,981.60|FSC: 13; Default||External grouping not supported 95168325|EAP|Custom 95168325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sheet Medpor 0.85 Ultra Thi|1|HUMANA [1294]||HUMANA [11839]|1,197.00|FSC: 13; Default||Not reimbursed separately|1,197.00|FSC: 13; Default||External grouping not supported 95130578|EAP|Custom 95130578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Converter Surgiport 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168326|EAP|Custom 95168326||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Peptamen Bari|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77500031|EAP|CPT® 92611||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Video Swallowing Eval, Mbs|1|HUMANA [1294]||HUMANA [11839]|265.74|FSC: 13; Default||Not reimbursed separately|265.74|FSC: 13; Default||External grouping not supported 95168328|EAP|Custom 95168328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pencil Triple Option Hand|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80221260|EAP|Custom 80221260||0998 - STATISTICAL CHARGES|Hb Abi Wellscreen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80230535|EAP|CPT® 93770||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Determine Venous Pressure|1|HUMANA [1294]||HUMANA [11839]|200.00|FSC: 13; Default||Not reimbursed separately|200.00|FSC: 13; Default||External grouping not supported 95168330|EAP|Custom 95168330||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade Alif |1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 89518674|EAP|CPT® 93990||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Scan Hemo Access|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 4.5mmx22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 80220106|EAP|CPT® 93880||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Carotid Art Comp Bilat|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95168332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 6.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 89518393|EAP|CPT® 93882||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Extracrn Art Unilat/ltd|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 80220544|EAP|CPT® 93924||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Noninv, Lw Extrm Art, Rst/strs|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95168334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Xlpe Acetabular 50-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,633.30|FSC: 13; Default||Not reimbursed separately|3,633.30|FSC: 13; Default||External grouping not supported 80221062|EAP|CPT® 93922||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Niv Study Low Extremity, Complete|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95168335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Universal Femoral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|FSC: 13; Default||Not reimbursed separately|3,168.00|FSC: 13; Default||External grouping not supported 80221104|EAP|CPT® 93923||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Noninv Phy Sty Extrem Art Ml Bi|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95168341|EAP|Custom 95168341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 89518518|EAP|CPT® 93970||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Extrem Veins Comp Bil|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95168342|EAP|Custom 95168342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation 22mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 89518559|EAP|CPT® 93971||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Extrem Veins Unil/ltd|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168343|EAP|Custom 95168343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87552048|EAP|CPT® 59025||0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION|Hb Fetal Nonstress|1|HUMANA [1294]||HUMANA [11839]|473.16|FSC: 13; Default||Not reimbursed separately|473.16|FSC: 13; Default||External grouping not supported 95168344|EAP|Custom 95168344||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation 28mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 89518435|EAP|CPT® 93925||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Lw Extrm Art/byg Com Bi|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95168345|EAP|Custom 95168345||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation 31mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 89518476|EAP|CPT® 93926||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Lw Extrm Art/byg Com Un|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168346|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Sizing 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 32200099|EAP|CPT® 95805||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Mslt Or Maint Of Wake Test|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95168347|EAP|Custom 95168347||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation Halo 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80700008|EAP|CPT® 92018||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Eye Exam Under Anesthesia|1|HUMANA [1294]||HUMANA [11839]|5,514.39|FSC: 13; Default||Not reimbursed separately|5,514.39|FSC: 13; Default||External grouping not supported 95168348|EAP|Custom 95168348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ablation Ultra Halo 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80220924|EAP|CPT® 93980||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Dup Ar Infl/vn Otfl Penile Com|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168349|EAP|Custom 95168349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Halo Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80137490|EAP|CPT® 93280||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Ekg Pacemaker Eval Dual|1|HUMANA [1294]||HUMANA [11839]|103.29|FSC: 13; Default||Not reimbursed separately|103.29|FSC: 13; Default||External grouping not supported 95168350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 68200302|EAP|CPT® 93279||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Pm Device Progr Eval, Sngl|1|HUMANA [1294]||HUMANA [11839]|103.29|FSC: 13; Default||Not reimbursed separately|103.29|FSC: 13; Default||External grouping not supported 95168351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 80156235|EAP|CPT® 95811||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Cpap Protocol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95168352|EAP|Custom 95168352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire .094 Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80156227|EAP|CPT® 95810||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Polysomnogram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95168353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 32000796|EAP|CPT® 95807||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Sleep Study Attended|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95168354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80155054|EAP|CPT® 95806||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Sleep Study Unattd W/resp Effort|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95168355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80220049|EAP|CPT® 93930||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Up Extrm Art/byg Com Bi|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95168356|EAP|Custom 95168356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .045 Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80221138|EAP|CPT® 93931||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Up Extrm Art/byg Com Un|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168361|EAP|Custom 95168361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Saline|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80140460|EAP|CPT® 93975||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Dup Ar Ifl/vn Ofl Ab/pl/sc,com|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95168362|EAP|Custom 95168362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Saline|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80502354|EAP|CPT® 93976||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Dup Ar Ifl/vn Ofl Ab/pl/sc,lmt|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Max Vertex Rsp 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 89518591|EAP|CPT® 93978||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Dup Aorta,ivc,ilc Vsc,byg Comp|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95168364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Rsp Djo Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|FSC: 13; Default||Not reimbursed separately|11,407.50|FSC: 13; Default||External grouping not supported 89518633|EAP|CPT® 93979||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Dup Aorta,ivc,ilc Vsc,byg Lmtd|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95168365|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,065.00|FSC: 13; Default||Not reimbursed separately|10,065.00|FSC: 13; Default||External grouping not supported 95168366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95168368|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95168369|EAP|Custom 95168369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Set 9fr Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168367|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95168370|EAP|Custom 95168370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel A1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168371|EAP|Custom 95168371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Crown Stainless Steel B1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,051.12|FSC: 13; Default||Not reimbursed separately|6,051.12|FSC: 13; Default||External grouping not supported 95168374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Elite Venture 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95168375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95168376|EAP|Custom 95168376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiberloop #2 W/curved|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168377|EAP|Custom 95168377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fiber 2-0 Fiber Stick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168378|EAP|Custom 95168378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso Micro Minor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168379|EAP|Custom 95168379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso 70 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168373|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95118497|EAP|Custom 95118497||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso 90-deg.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162591|EAP|Custom 95162591||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mandrels Soflex Popon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168381|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tendril St 52cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95168384|EAP|Custom 95168384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pcd With Hv Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162282|EAP|CPT® 96000||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Comp Based Motion Analysis|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95168385|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 6.0 Diopter|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168389|EAP|Custom 95168389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Pacing Cardia Fastloc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168390|EAP|Custom 95168390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pacing Bifurcated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95168394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95168395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168396|EAP|Custom 95168396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pacing Bifurcated Epic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168397|EAP|Custom 95168397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 4.0mm |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168398|EAP|Custom 95168398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168401|EAP|Custom 95168401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168402|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cc Triad 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95168403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Vision 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|FSC: 13; Default||Not reimbursed separately|5,350.80|FSC: 13; Default||External grouping not supported 95168404|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire Blu Ablat|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168405|EAP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Safire Blu Ablat|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168408|EAP|Custom 95168408||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Universal W/o Fene|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168410|EAP|Custom 95168410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Etch Rite Pulpdent Twin Pak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95168417|EAP|Custom 95168417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter In-line Day All|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168427|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Quickflex Micro Left V|1|HUMANA [1294]||HUMANA [11839]|8,397.00|FSC: 13; Default||Not reimbursed separately|8,397.00|FSC: 13; Default||External grouping not supported 95168428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95168430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95168431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95168434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95168435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168444|EAP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tubohawk Ls-m Lrg|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95168450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 87331278|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, New Pt, Level 1|1|HUMANA [1294]||HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOW PROFILE TI 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 87331286|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, New Pt, Level 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 87331294|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, New Pt, Level 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 87331302|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, New Pt Level 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 87331310|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb New Patient-level 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 87615092|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, Est Pt, Level 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 87331336|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, Est Pt Level 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 87331344|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, Est Pt Level 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 87331351|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, Est Pt Level 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 87331369|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Established Pt-level 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95168460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|FSC: 13; Default||Not reimbursed separately|2,664.78|FSC: 13; Default||External grouping not supported 95168461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,444.00|FSC: 13; Default||Not reimbursed separately|15,444.00|FSC: 13; Default||External grouping not supported 95168462|EAP|Custom 95168462||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adper Single Bond Plus 6gm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71000111|EAP|CPT® 99281||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|HB ER LEVEL 1|1|HUMANA [1294]||HUMANA [11839]|326.57|FSC: 13; Default||Not reimbursed separately|326.57|FSC: 13; Default||External grouping not supported 80162290|EAP|Custom 80162290||0173 - NURSERY - NEWBORN - LEVEL III|Hb Room & Bd Newborn Level Iii|1|HUMANA [1294]||HUMANA [11839]|6,951.53|FSC: 13; Default||Not reimbursed separately|6,951.53|FSC: 13; Default||Accommodation codes not reimbursed separately 71000129|EAP|CPT® 99282||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Er Level 2|1|HUMANA [1294]||HUMANA [11839]|557.00|FSC: 13; Default||Not reimbursed separately|557.00|FSC: 13; Default||External grouping not supported 95122828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Poly Pat Sz-2/7mm Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.80|FSC: 13; Default||Not reimbursed separately|1,762.80|FSC: 13; Default||External grouping not supported 95168464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,740.29|FSC: 13; Default||Not reimbursed separately|2,740.29|FSC: 13; Default||External grouping not supported 95168467|EAP|Custom 95168467||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contoured Cordent 7mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95168468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 71015531|EAP|CPT® 99283||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Sane Suspect Collect Off-site|1|HUMANA [1294]||HUMANA [11839]|250.00|FSC: 13; Default||Not reimbursed separately|250.00|FSC: 13; Default||External grouping not supported 95168469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 71012785|EAP|Custom 71012785||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Sane Suspect Collect On-site|1|HUMANA [1294]||HUMANA [11839]|200.00|FSC: 13; Default||Not reimbursed separately|200.00|FSC: 13; Default||External grouping not supported 95168470|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 71000137|EAP|CPT® 99283||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Er Level 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,004.19|FSC: 13; Default||Not reimbursed separately|1,004.19|FSC: 13; Default||External grouping not supported 95168471|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168472|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 71000145|EAP|CPT® 99284||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Er Level 4|1|HUMANA [1294]||HUMANA [11839]|1,640.83|FSC: 13; Default||Not reimbursed separately|1,640.83|FSC: 13; Default||External grouping not supported 95168474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Revision Rsp Encore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,214.50|FSC: 13; Default||Not reimbursed separately|15,214.50|FSC: 13; Default||External grouping not supported 71000152|EAP|CPT® 99285||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Er Level 5|1|HUMANA [1294]||HUMANA [11839]|2,177.13|FSC: 13; Default||Not reimbursed separately|2,177.13|FSC: 13; Default||External grouping not supported 95168466|EAP|Custom 95168466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retractor Capsule Mst|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80323744|EAP|CPT® 99291||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|HB CRITICAL CARE 30-74 MI|1|HUMANA [1294]||HUMANA [11839]|2,336.57|FSC: 13; Default||Not reimbursed separately|2,336.57|FSC: 13; Default||External grouping not supported 95168473|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self-expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 80323751|EAP|CPT® 99292||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Critical Care Add 30|1|HUMANA [1294]||HUMANA [11839]|646.00|FSC: 13; Default||Not reimbursed separately|646.00|FSC: 13; Default||External grouping not supported 62060009|EAP|CPT® 86355||0302 - LABORATORY - IMMUNOLOGY|Hb B-cells, Total Count - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|113.19|FSC: 13; Default||Not reimbursed separately|113.19|FSC: 13; Default||External grouping not supported 62060017|EAP|CPT® 86357||0302 - LABORATORY - IMMUNOLOGY|Hb Nk Cells, Total Count - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|113.19|FSC: 13; Default||Not reimbursed separately|113.19|FSC: 13; Default||External grouping not supported 62060025|EAP|CPT® 86359||0302 - LABORATORY - IMMUNOLOGY|Hb T-cells, Total Count - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|113.19|FSC: 13; Default||Not reimbursed separately|113.19|FSC: 13; Default||External grouping not supported 62060033|EAP|CPT® 86360||0302 - LABORATORY - IMMUNOLOGY|Hb Absol Cd4 Cd8 W/ratio - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|140.94|FSC: 13; Default||Not reimbursed separately|140.94|FSC: 13; Default||External grouping not supported 62060041|EAP|CPT® 80299||0301 - LABORATORY - CHEMISTRY|Hb Nordoxepin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 62060058|EAP|CPT® 86335||0302 - LABORATORY - IMMUNOLOGY|Hb Immofix Elect Oth Flds - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|88.05|FSC: 13; Default||Not reimbursed separately|88.05|FSC: 13; Default||External grouping not supported 62060066|EAP|CPT® 84156||0301 - LABORATORY - CHEMISTRY|Hb Protein, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|11.01|FSC: 13; Default||Not reimbursed separately|11.01|FSC: 13; Default||External grouping not supported 62060074|EAP|CPT® 82300||0301 - LABORATORY - CHEMISTRY|Hb Cadmium, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|70.92|FSC: 13; Default||Not reimbursed separately|70.92|FSC: 13; Default||External grouping not supported 62060082|EAP|CPT® 83615||0301 - LABORATORY - CHEMISTRY|Hb Total Ld - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|18.12|FSC: 13; Default||Not reimbursed separately|18.12|FSC: 13; Default||External grouping not supported 62060090|EAP|CPT® 86738||0302 - LABORATORY - IMMUNOLOGY|Hb Mycoplasma Igm Ab - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 62060108|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hb Igg, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62060116|EAP|CPT® 82040||0301 - LABORATORY - CHEMISTRY|Hb Albumin, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|14.85|FSC: 13; Default||Not reimbursed separately|14.85|FSC: 13; Default||External grouping not supported 62060124|EAP|CPT® 82042||0301 - LABORATORY - CHEMISTRY|Hb Albumin Other Fluids - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|23.34|FSC: 13; Default||Not reimbursed separately|23.34|FSC: 13; Default||External grouping not supported 62060132|EAP|CPT® 86747||0302 - LABORATORY - IMMUNOLOGY|Hb Parvovirus Igm - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|45.09|FSC: 13; Default||Not reimbursed separately|45.09|FSC: 13; Default||External grouping not supported 62060140|EAP|CPT® 80184||0301 - LABORATORY - CHEMISTRY|Hb Phenobarbital - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|45.90|FSC: 13; Default||Not reimbursed separately|45.90|FSC: 13; Default||External grouping not supported 62060157|EAP|CPT® 82175||0301 - LABORATORY - CHEMISTRY|Hb Arsenic, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|56.91|FSC: 13; Default||Not reimbursed separately|56.91|FSC: 13; Default||External grouping not supported 62060165|EAP|CPT® 83655||0301 - LABORATORY - CHEMISTRY|Hb Lead, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.33|FSC: 13; Default||Not reimbursed separately|36.33|FSC: 13; Default||External grouping not supported 62060173|EAP|CPT® 83825||0301 - LABORATORY - CHEMISTRY|Hb Mercury, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|48.78|FSC: 13; Default||Not reimbursed separately|48.78|FSC: 13; Default||External grouping not supported 62060181|EAP|CPT® 86789||0302 - LABORATORY - IMMUNOLOGY|Hb West Nile Igg Csf - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62060199|EAP|CPT® 86788||0302 - LABORATORY - IMMUNOLOGY|Hb West Nile Igm Csf - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 95168475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Tibial |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,509.00|FSC: 13; Default||Not reimbursed separately|4,509.00|FSC: 13; Default||External grouping not supported 95168481|EAP|Custom 95168481||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Oncontrol Power|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168482|EAP|Custom 95168482||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Oncontrol Biopsy 102mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95168484|EAP|Custom 95168484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Oncontrol Biopsy 152mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168485|EAP|Custom 95168485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Needle Oncontrol |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95168487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95168488|EAP|Custom 95168488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Drill Tip 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 48 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168498|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168499|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168501|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168502|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95168503|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc Catheter 5fr Dl|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168504|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc Catheter 6fr Dl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168505|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168507|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|FSC: 13; Default||Not reimbursed separately|10,845.00|FSC: 13; Default||External grouping not supported 95168508|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95168509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95168510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168513|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Tm 42 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|FSC: 13; Default||Not reimbursed separately|11,947.50|FSC: 13; Default||External grouping not supported 95168514|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95168515|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95168516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95168517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|FSC: 13; Default||Not reimbursed separately|337.50|FSC: 13; Default||External grouping not supported 95168518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|FSC: 13; Default||Not reimbursed separately|337.50|FSC: 13; Default||External grouping not supported 95168519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95168520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95168522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inverse/reverse 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168525|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 1.5mm|1|HUMANA [1294]||HUMANA [11839]|3,794.40|FSC: 13; Default||Not reimbursed separately|3,794.40|FSC: 13; Default||External grouping not supported 95168526|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 3.0mm|1|HUMANA [1294]||HUMANA [11839]|5,055.00|FSC: 13; Default||Not reimbursed separately|5,055.00|FSC: 13; Default||External grouping not supported 95168527|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 2.0mm|1|HUMANA [1294]||HUMANA [11839]|6,549.00|FSC: 13; Default||Not reimbursed separately|6,549.00|FSC: 13; Default||External grouping not supported 95168528|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 3.0mm|1|HUMANA [1294]||HUMANA [11839]|3,804.00|FSC: 13; Default||Not reimbursed separately|3,804.00|FSC: 13; Default||External grouping not supported 95168529|EAP|Custom 95168529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cuff Compression Sequential|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95125506|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Ultra Tib Ins Lt Sz1/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,308.80|FSC: 13; Default||Not reimbursed separately|2,308.80|FSC: 13; Default||External grouping not supported 95168530|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly Reverse Metal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95168531|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168533|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly Reverse Metal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168534|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 65 Degree Retent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95168535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 65 Degree Retent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|FSC: 13; Default||Not reimbursed separately|3,150.00|FSC: 13; Default||External grouping not supported 95168536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 65 Degree Retent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 65 Degree Retent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168539|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 65 Degree Retent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Poly 65 Degree Retent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95168541|EAP|Custom 95168541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeves Fracture Foam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168544|EAP|Custom 95168544||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Lateral |1|HUMANA [1294]||HUMANA [11839]|1,813.98|FSC: 13; Default||Not reimbursed separately|1,813.98|FSC: 13; Default||External grouping not supported 95168545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95164040|EAP|Custom 95164040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Urostomy Transparent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Prox|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95168548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95168549|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95168550|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Sv Balloon 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168551|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Balloon |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168552|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95168554|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere 40mm Shoulder|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,847.50|FSC: 13; Default||Not reimbursed separately|3,847.50|FSC: 13; Default||External grouping not supported 95168555|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Stem Humeral Trabe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.00|FSC: 13; Default||Not reimbursed separately|2,070.00|FSC: 13; Default||External grouping not supported 95168556|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Stem Humeral Trab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.00|FSC: 13; Default||Not reimbursed separately|2,070.00|FSC: 13; Default||External grouping not supported 95168557|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Dual Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95168558|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Ability Plus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95168560|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168561|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168562|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168563|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168564|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168566|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168568|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168569|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168570|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168571|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168572|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168573|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168336|EAP|Custom 95168336||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Micropuncture Stick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168338|EAP|Custom 95168338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Micropuncture Stick|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168576|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self Expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168577|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self Expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95168578|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Self Expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95168580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Mdn 46mm/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|FSC: 13; Default||Not reimbursed separately|7,085.40|FSC: 13; Default||External grouping not supported 95168581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Conform|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|FSC: 13; Default||Not reimbursed separately|3,636.60|FSC: 13; Default||External grouping not supported 95168582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95168565|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168559|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168567|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168585|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Zilver 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95168586|EAP|Custom 95168586||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Custom 12x42|1|HUMANA [1294]||HUMANA [11839]|26,460.00|FSC: 13; Default||Not reimbursed separately|26,460.00|FSC: 13; Default||External grouping not supported 95168587|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Hickman 9.5fr Dual |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168588|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.5 Diopter Toric|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95168589|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.0 Diopter Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95168592|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|605.28|FSC: 13; Default||Not reimbursed separately|605.28|FSC: 13; Default||External grouping not supported 95168593|EAP|Custom 95168593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Stent Rx Delivery |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168594|EAP|Custom 95168594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Cannulated 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168601|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Infusion Sys Trellis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168604|EAP|Custom 95168604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Suturetak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|FSC: 13; Default||Not reimbursed separately|4,247.43|FSC: 13; Default||External grouping not supported 95168606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sd 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95168607|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh St 14 X 16 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,948.00|FSC: 13; Default||Not reimbursed separately|12,948.00|FSC: 13; Default||External grouping not supported 95168608|EAP|Custom 95168608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168609|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168610|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168611|EAP|Custom 95168611||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Pin Tip 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168612|EAP|Custom 95168612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Pin Tip 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95168614|EAP|Custom 95168614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .086 Trocar Tip |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168615|EAP|Custom 95168615||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tightrope Mini Repair|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95168617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95168618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95112909|EAP|Custom 95112909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Dental Arch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168639|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|605.28|FSC: 13; Default||Not reimbursed separately|605.28|FSC: 13; Default||External grouping not supported 95168641|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168642|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168643|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168644|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,000.00|FSC: 13; Default||Not reimbursed separately|27,000.00|FSC: 13; Default||External grouping not supported 95168645|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Limb Contrala|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95168646|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168647|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168648|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168649|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168650|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168651|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168653|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168654|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95168659|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol Diopter Acry Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95168660|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95168662|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Express Mono|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|FSC: 13; Default||Not reimbursed separately|4,185.00|FSC: 13; Default||External grouping not supported 95168663|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Fathom 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95168667|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Triple Lumen Picc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168666|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Triple Lumen Picc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95118284|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Malecot 40fr|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168602|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,443.00|FSC: 13; Default||Not reimbursed separately|7,443.00|FSC: 13; Default||External grouping not supported 95168603|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,443.00|FSC: 13; Default||Not reimbursed separately|7,443.00|FSC: 13; Default||External grouping not supported 95168668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168674|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95168675|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95168676|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95168677|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168678|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168679|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Biocomp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95168692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168699|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Cath 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95168702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95168707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95168712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95174802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 7 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95168704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,532.50|FSC: 13; Default||Not reimbursed separately|12,532.50|FSC: 13; Default||External grouping not supported 95168716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168761|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95168769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Helix 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95168775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168783|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168788|EAP|Custom 95168788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Brk Transseptal |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168791|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168798|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168799|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168809|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168814|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 95168834|EAP|Custom 95168834||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168837|EAP|Custom 95168837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168839|EAP|Custom 95168839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168841|EAP|Custom 95168841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168842|EAP|Custom 95168842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168843|EAP|Custom 95168843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168844|EAP|Custom 95168844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Trocar Tip 1.35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168845|EAP|Custom 95168845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round Precision Elite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168846|EAP|Custom 95168846||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round Precision Elite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Fibula Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95168848|EAP|Custom 95168848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round Precision Elite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95168850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95168851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95168852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95168853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95168854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick 3x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168856|EAP|Custom 95168856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168857|EAP|Custom 95168857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.35 With Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168858|EAP|Custom 95168858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm Cannulated |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95168862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Biocomp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|FSC: 13; Default||Not reimbursed separately|1,410.00|FSC: 13; Default||External grouping not supported 95168863|EAP|Custom 95168863||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 9x26mm|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95168864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shark 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|FSC: 13; Default||Not reimbursed separately|2,043.00|FSC: 13; Default||External grouping not supported 95168865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shark 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95168867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tulip 6.25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,772.00|FSC: 13; Default||Not reimbursed separately|2,772.00|FSC: 13; Default||External grouping not supported 95168868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95168855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95168872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95168873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Distal Fibula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95168874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plat Hook Locking Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plat Hook Locking Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plat Hook Locking Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Locking Medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95168878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Locking Medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95168879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Locking Medial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95168880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95182189|EAP|Custom 95182189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inflation Device Caliber 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95168882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95168883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95168884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95168885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95168886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 95168887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95168889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95168890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95168891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95168892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|FSC: 13; Default||Not reimbursed separately|765.00|FSC: 13; Default||External grouping not supported 95168893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Tubular 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 95168894|EAP|Custom 95168894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Repair Syndesmosis|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95168895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95168896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95168897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95168903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95168904|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Nano Rx 2.25x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95168905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95168906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95168907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95168908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95168909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95168910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 62060389|EAP|CPT® 87496||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Cmv-pcr, Other Source|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62060397|EAP|CPT® 87529||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hsv Pcr, Genital|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62060405|EAP|CPT® 87529||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hsv Pcr, Other Source|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95168866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95168911|EAP|Custom 95168911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Fixation Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168916|EAP|Custom 95168916||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ketac-cem Radiopaque Powder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168917|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.0 Diop Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95168918|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 14.0 Diop Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95126011|EAP|Custom 95126011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Quick-combo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Speedbridge Achilles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|FSC: 13; Default||Not reimbursed separately|5,220.00|FSC: 13; Default||External grouping not supported 95168919|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Sterling Mrail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168920|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Flextome |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95168924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Low Profile Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95168928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Versys Rev|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,988.00|FSC: 13; Default||Not reimbursed separately|11,988.00|FSC: 13; Default||External grouping not supported 95168929|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dry Seal 12fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95168930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ant 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.02|FSC: 13; Default||Not reimbursed separately|2,155.02|FSC: 13; Default||External grouping not supported 95168931|EAP|Custom 95168931||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Buttress 17mm|1|HUMANA [1294]||HUMANA [11839]|861.42|FSC: 13; Default||Not reimbursed separately|861.42|FSC: 13; Default||External grouping not supported 95168932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Helix 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95168933|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Triad Cr 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,670.00|FSC: 13; Default||Not reimbursed separately|2,670.00|FSC: 13; Default||External grouping not supported 95168934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression T-shaped|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,280.38|FSC: 13; Default||Not reimbursed separately|6,280.38|FSC: 13; Default||External grouping not supported 95168935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surefix Deal New|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|796.50|FSC: 13; Default||Not reimbursed separately|796.50|FSC: 13; Default||External grouping not supported 95168936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Variable 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|FSC: 13; Default||Not reimbursed separately|1,443.54|FSC: 13; Default||External grouping not supported 95168937|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cc Triad 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95168938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Helix 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,094.00|FSC: 13; Default||Not reimbursed separately|2,094.00|FSC: 13; Default||External grouping not supported 95168939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95168961|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95168966|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vascular Amplatzer|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168967|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vascular Amplatzer |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|FSC: 13; Default||Not reimbursed separately|2,496.00|FSC: 13; Default||External grouping not supported 95168968|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vascular Amplatzer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168969|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vascular Amplatzer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|FSC: 13; Default||Not reimbursed separately|2,496.00|FSC: 13; Default||External grouping not supported 95168970|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vascular Amplatzer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|FSC: 13; Default||Not reimbursed separately|2,502.00|FSC: 13; Default||External grouping not supported 95168971|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.0 Diopter Tecnis |1|HUMANA [1294]||HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95168974|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Substitute Cement Bone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,489.20|FSC: 13; Default||Not reimbursed separately|4,489.20|FSC: 13; Default||External grouping not supported 95168975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Lateral |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95168976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95168977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95168978|EAP|Custom 95168978||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twist 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95168979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Contra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|FSC: 13; Default||Not reimbursed separately|11,115.30|FSC: 13; Default||External grouping not supported 95168980|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Aaa |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95168981|EAP|Custom 95168981||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlt Coroent |1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95168982|EAP|Custom 95168982||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlt Coroent|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95168983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95168984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95168985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95168986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95168987|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vasc Amplatzer 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|FSC: 13; Default||Not reimbursed separately|2,496.00|FSC: 13; Default||External grouping not supported 95168988|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vasc Amplatzer 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168989|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vasc Amplatzer 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95168990|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vasc Amplatzer 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|FSC: 13; Default||Not reimbursed separately|2,496.00|FSC: 13; Default||External grouping not supported 95168991|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Ii Vasc Amplatzer 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|FSC: 13; Default||Not reimbursed separately|2,496.00|FSC: 13; Default||External grouping not supported 95168992|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168993|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 6mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168994|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,660.00|FSC: 13; Default||Not reimbursed separately|3,660.00|FSC: 13; Default||External grouping not supported 95168995|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168996|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95168999|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95169000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95169001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Closed Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,040.00|FSC: 13; Default||Not reimbursed separately|2,040.00|FSC: 13; Default||External grouping not supported 95168998|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Vasc Amplatzer 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95169002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Proximal 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.66|FSC: 13; Default||Not reimbursed separately|3,915.66|FSC: 13; Default||External grouping not supported 95169003|EAP|Custom 95169003||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire 2.0mm|1|HUMANA [1294]||HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95169004|EAP|Custom 95169004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 3.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169005|EAP|Custom 95169005||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Niv Af531 W Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169006|EAP|Custom 95169006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Screw Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95169008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169009|EAP|Custom 95169009||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Niv Af 531 W Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169010|EAP|Custom 95169010||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Niv Af 531 W Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|FSC: 13; Default||Not reimbursed separately|425.19|FSC: 13; Default||External grouping not supported 95169015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95169016|EAP|Custom 95169016||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Cable Ncb Titanium|1|HUMANA [1294]||HUMANA [11839]|474.63|FSC: 13; Default||Not reimbursed separately|474.63|FSC: 13; Default||External grouping not supported 95169017|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Retrieval Extractor|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169018|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Retrieval Extractor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169019|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Retrieval Extractor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169020|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]||HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169021|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169022|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169023|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169024|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169025|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169026|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169027|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Advanix Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.31|FSC: 13; Default||Not reimbursed separately|431.31|FSC: 13; Default||External grouping not supported 95169028|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 19.5 Diopter Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169029|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Iol 20.0 Diopter Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80162308|EAP|CPT® 77399||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Image Fusion Dosimetrist|1|HUMANA [1294]||HUMANA [11839]|360.72|FSC: 13; Default||Not reimbursed separately|360.72|FSC: 13; Default||External grouping not supported 95168959|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Storq Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169040|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guiding Vista Brite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169042|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Guiding Vista Brite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169050|EAP|Custom 95169050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap For 3.5mm Screws Ao 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Modular Rejuvenate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95169052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Modular Spt Rejuvenate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95169053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Modular Rejuvenate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95169054|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 95169055|EAP|Custom 95169055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Band Electrode Resection |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169057|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Berenstein 5fr |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169058|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath C3 Beacon Tip Torcon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169060|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Introducer Brite Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169062|EAP|Custom 95169062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169063|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Tecnis |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169065|EAP|Custom 95169065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.35 W Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95169068|EAP|Custom 95169068||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Porp Off|1|HUMANA [1294]||HUMANA [11839]|1,147.80|FSC: 13; Default||Not reimbursed separately|1,147.80|FSC: 13; Default||External grouping not supported 95169059|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Sheath Pinnacle Dest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169078|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Self Fixating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.57|FSC: 13; Default||Not reimbursed separately|1,008.57|FSC: 13; Default||External grouping not supported 95169079|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Nano Rx |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95169080|EAP|Custom 95169080||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Alif Brigade 16x42|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95169081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 4.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95169082|EAP|Custom 95169082||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 16x38x28mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95169083|EAP|Custom 95169083||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 14x38x28mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95169084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.00|FSC: 13; Default||Not reimbursed separately|1,077.00|FSC: 13; Default||External grouping not supported 95169085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross 50-60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,924.00|FSC: 13; Default||Not reimbursed separately|3,924.00|FSC: 13; Default||External grouping not supported 95169087|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol Diopter Acry Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169088|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol Diopter Acry Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80162316|EAP|Custom 80162316||0998 - STATISTICAL CHARGES|Hb New Patient Tracker Sdc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169093|EAP|Custom 95169093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occlusion System Fiber|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169094|EAP|Custom 95169094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occlusion System Fiber|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169095|EAP|Custom 95169095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Occlusion System Fiber|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 3.5x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95169098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|FSC: 13; Default||Not reimbursed separately|651.00|FSC: 13; Default||External grouping not supported 95169099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|FSC: 13; Default||Not reimbursed separately|333.00|FSC: 13; Default||External grouping not supported 95169106|EAP|Custom 95169106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Pars Suture|1|HUMANA [1294]||HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95169107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169111|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169112|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Distal 12hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.66|FSC: 13; Default||Not reimbursed separately|3,915.66|FSC: 13; Default||External grouping not supported 95174804|EAP|Custom 95174804||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso Micro Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62060413|EAP|CPT® 86161||0302 - LABORATORY - IMMUNOLOGY|Hb C1est Inhib Functional - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 62060421|EAP|CPT® 87176||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Fecal Homogenization - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|17.64|FSC: 13; Default||Not reimbursed separately|17.64|FSC: 13; Default||External grouping not supported 62060439|EAP|CPT® 87276||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Influenza A-dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|48.21|FSC: 13; Default||Not reimbursed separately|48.21|FSC: 13; Default||External grouping not supported 62060447|EAP|CPT® 87275||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Influenza B-dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|36.75|FSC: 13; Default||Not reimbursed separately|36.75|FSC: 13; Default||External grouping not supported 62060454|EAP|CPT® 87279||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Parainflu Type 1-dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|49.29|FSC: 13; Default||Not reimbursed separately|49.29|FSC: 13; Default||External grouping not supported 62060462|EAP|CPT® 87279||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Parainflu Type 2-dfa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.29|FSC: 13; Default||Not reimbursed separately|49.29|FSC: 13; Default||External grouping not supported 62060470|EAP|CPT® 87279||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Parainflu Type 3-dfa - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.29|FSC: 13; Default||Not reimbursed separately|49.29|FSC: 13; Default||External grouping not supported 62060488|EAP|CPT® 87260||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Adenovirus-dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|43.29|FSC: 13; Default||Not reimbursed separately|43.29|FSC: 13; Default||External grouping not supported 62060496|EAP|CPT® 87280||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Resp Syncytial Vir-dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.26|FSC: 13; Default||Not reimbursed separately|40.26|FSC: 13; Default||External grouping not supported 62060504|EAP|CPT® 87299||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hum Metapneumovir Dfa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|48.30|FSC: 13; Default||Not reimbursed separately|48.30|FSC: 13; Default||External grouping not supported 62060512|EAP|CPT® 86356||0302 - LABORATORY - IMMUNOLOGY|Hb Percent Cd3-bal - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|80.34|FSC: 13; Default||Not reimbursed separately|80.34|FSC: 13; Default||External grouping not supported 62060520|EAP|CPT® 86356||0302 - LABORATORY - IMMUNOLOGY|Hb Percent Cd4-bal - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.34|FSC: 13; Default||Not reimbursed separately|80.34|FSC: 13; Default||External grouping not supported 62060538|EAP|CPT® 86356||0302 - LABORATORY - IMMUNOLOGY|Hb Percent Cd8-bal - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.34|FSC: 13; Default||Not reimbursed separately|80.34|FSC: 13; Default||External grouping not supported 62060546|EAP|CPT® 84478||0301 - LABORATORY - CHEMISTRY|Hb Triglyceride, Body Fluid|1|HUMANA [1294]||HUMANA [11839]|17.22|FSC: 13; Default||Not reimbursed separately|17.22|FSC: 13; Default||External grouping not supported 62060553|EAP|CPT® 83690||0301 - LABORATORY - CHEMISTRY|Hb Lipase, Body Fluid|1|HUMANA [1294]||HUMANA [11839]|20.67|FSC: 13; Default||Not reimbursed separately|20.67|FSC: 13; Default||External grouping not supported 62060561|EAP|CPT® 82247||0301 - LABORATORY - CHEMISTRY|Hb Bilirubin,total,body Fluid|1|HUMANA [1294]||HUMANA [11839]|15.06|FSC: 13; Default||Not reimbursed separately|15.06|FSC: 13; Default||External grouping not supported 62060579|EAP|CPT® 87498||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Entovir Detect Rt-pcr - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95169116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95169117|EAP|HCPCS B4088||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Tube Feeding Mic-key|1|HUMANA [1294]||HUMANA [11839]|276.12|FSC: 13; Default||Not reimbursed separately|276.12|FSC: 13; Default||External grouping not supported 95169119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95169120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95169122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95169123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Gtn T2 10x340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,440.00|FSC: 13; Default||Not reimbursed separately|7,440.00|FSC: 13; Default||External grouping not supported 95169124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Restoration For Adm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|FSC: 13; Default||Not reimbursed separately|5,581.80|FSC: 13; Default||External grouping not supported 95169125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95169126|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 95169127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10mmx315mm T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95169128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95169129|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Crosser 154cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169130|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steward Angled Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169131|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ultraverse 018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169133|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95169134|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95169135|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95182192|EAP|Custom 95182192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Shaft Mod Trinkle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62060587|EAP|CPT® 85670||0305 - LABORATORY - HEMATOLOGY|Hb Thrombin Time - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|17.31|FSC: 13; Default||Not reimbursed separately|17.31|FSC: 13; Default||External grouping not supported 62060595|EAP|CPT® 85635||0305 - LABORATORY - HEMATOLOGY|Hb Reptilase Time - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|29.55|FSC: 13; Default||Not reimbursed separately|29.55|FSC: 13; Default||External grouping not supported 62060603|EAP|CPT® 85525||0305 - LABORATORY - HEMATOLOGY|Hb Heparin Neutralization - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|35.52|FSC: 13; Default||Not reimbursed separately|35.52|FSC: 13; Default||External grouping not supported 62060611|EAP|CPT® 85598||0305 - LABORATORY - HEMATOLOGY|Hb Hexagonal Phos Neutral - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.94|FSC: 13; Default||Not reimbursed separately|53.94|FSC: 13; Default||External grouping not supported 62060629|EAP|CPT® 82570||0301 - LABORATORY - CHEMISTRY|Hb Creatinine, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62060637|EAP|CPT® 86970||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R53 Chlorq Rx(12 Cells) Hox|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62060645|EAP|CPT® 86970||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R54 Dtt Rx(12 Cells)hox|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 62060652|EAP|CPT® 86886||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R63 Htla Titer Per Cell Hox|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62060660|EAP|CPT® 86977||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R64 Htla Neut Titer Cell Hx|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62060678|EAP|CPT® 86922||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Xm Iat -hoxworth|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62060686|EAP|CPT® 86972||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb R82 Rbc Sep By Aggl Hox|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62060694|EAP|CPT® 85611||0305 - LABORATORY - HEMATOLOGY|Hb Pt Dilution|1|HUMANA [1294]||HUMANA [11839]|11.82|FSC: 13; Default||Not reimbursed separately|11.82|FSC: 13; Default||External grouping not supported 62060702|EAP|CPT® 85670||0305 - LABORATORY - HEMATOLOGY|Hb Thrombin Time|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.31|FSC: 13; Default||Not reimbursed separately|17.31|FSC: 13; Default||External grouping not supported 95174805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm Lcp 5-hole 12mm Depth Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|FSC: 13; Default||Not reimbursed separately|2,664.78|FSC: 13; Default||External grouping not supported 95182190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB COMPONENT FEMORAL PS CEMENTED TRIATHLON SZ 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95174806|EAP|Custom 95174806||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tip Applicator Bioglue 27cm|1|HUMANA [1294]||HUMANA [11839]|190.50|FSC: 13; Default||Not reimbursed separately|190.50|FSC: 13; Default||External grouping not supported 95169072|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic Advance 16fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169073|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic Advance 18fr |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169138|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Foley Irrg Ltx 3way|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169141|EAP|Custom 95169141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Rayhack Radial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169142|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169143|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tis Reg Allod 4x12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95182193|EAP|Custom 95182193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB TROCAR BLADELESS THREADED 5 X 150MM KII FIOS FIRST ENTRY|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169144|EAP|Custom 95169144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Interlock Diamond 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169145|EAP|Custom 95169145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Interlock Diamond 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169147|EAP|Custom 95169147||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Crescent 12 X 25mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95169148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95169149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 5.0x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95169150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.75 X 500mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|FSC: 13; Default||Not reimbursed separately|3,360.00|FSC: 13; Default||External grouping not supported 95169151|EAP|Custom 95169151||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink X-10 47-60|1|HUMANA [1294]||HUMANA [11839]|5,061.21|FSC: 13; Default||Not reimbursed separately|5,061.21|FSC: 13; Default||External grouping not supported 95169152|EAP|Custom 95169152||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Captone 11mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95169153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Gap 6.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95169154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95169155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|FSC: 13; Default||Not reimbursed separately|3,073.20|FSC: 13; Default||External grouping not supported 95169156|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|FSC: 13; Default||Not reimbursed separately|1,218.00|FSC: 13; Default||External grouping not supported 95169157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Distal Pp Ncb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 95169158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Distal Pp Ncb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|FSC: 13; Default||Not reimbursed separately|3,717.90|FSC: 13; Default||External grouping not supported 95169160|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95169163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95169164|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|FSC: 13; Default||Not reimbursed separately|395.52|FSC: 13; Default||External grouping not supported 95169159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95169165|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95169168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95169169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Multidirection Thre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|FSC: 13; Default||Not reimbursed separately|433.50|FSC: 13; Default||External grouping not supported 95169174|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioimplant Orthoadapt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95169175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95169177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169182|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95169183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Attachment Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,786.74|FSC: 13; Default||Not reimbursed separately|1,786.74|FSC: 13; Default||External grouping not supported 95169200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Connect For Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.48|FSC: 13; Default||Not reimbursed separately|684.48|FSC: 13; Default||External grouping not supported 95174807|EAP|Custom 95174807||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adhesive Surgical Bioglue 5ml|1|HUMANA [1294]||HUMANA [11839]|2,355.00|FSC: 13; Default||Not reimbursed separately|2,355.00|FSC: 13; Default||External grouping not supported 95182194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Midshaft 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95182196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95174810|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Classic Textured 350cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95182203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PLATE 2.OMM LCP ROTATION CORRECTION 2H HEAD/4H SHAFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.52|FSC: 13; Default||Not reimbursed separately|2,702.52|FSC: 13; Default||External grouping not supported 95174811|EAP|Custom 95174812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Overtube Gaurdus - Esophageal Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182197|EAP|Custom 95182197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Marrowmax|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174812|EAP|Custom 95174812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Overtube Gaurdus - Gastric Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95174813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hbplate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Holes 2 Head Holes 3 90 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.92|FSC: 13; Default||Not reimbursed separately|1,774.92|FSC: 13; Default||External grouping not supported 95182201|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Metal Biliary 6 Fr 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95174814|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Endoprosthesis Lef Trunk Excluder C3 Gore 23mm X 12mm X 16cm|1|HUMANA [1294]||HUMANA [11839]|30,735.00|FSC: 13; Default||Not reimbursed separately|30,735.00|FSC: 13; Default||External grouping not supported 95182205|EAP|Custom 95182205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bir Drill Cinchlock Ss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174815|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 18fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Knee Total Triathilon 15mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95174816|EAP|Custom 95174816||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Flowport|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Cinchlock Knotless Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,122.51|FSC: 13; Default||Not reimbursed separately|1,122.51|FSC: 13; Default||External grouping not supported 95174817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii Sz #3 35mm Neck 104mm Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95182198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95169201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95169202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95169204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95169206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95169207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95169211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95169213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii Asnis |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95169218|EAP|Custom 95169218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Iii Asnis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95169223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95169229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95169230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95169231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 80162340|EAP|CPT® 43231||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy W/endo Ultras|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80162357|EAP|CPT® 43232||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophag W/endo Ultras W/ Bx|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80162365|EAP|CPT® 43237||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Up Gi W/endo Ultrasnd Esoph|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80162381|EAP|CPT® 43242||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Eus Fna/biopsy|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80162399|EAP|CPT® 43259||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Eus Without Fna|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80162407|EAP|CPT® 45341||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoid W/endo Ultrasound|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 80162415|EAP|CPT® 45342||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy With Eus Fna Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 80162423|EAP|CPT® 45391||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W/endo U/s|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 80162431|EAP|CPT® 45392||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy With Eus Fna Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95169241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95169243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95169246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile Ti 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169248|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regen Allod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.72|FSC: 13; Default||Not reimbursed separately|93.72|FSC: 13; Default||External grouping not supported 95169249|EAP|Custom 95169249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Omiguide Path Beam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Clust|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 95169251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile Ti 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95169252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95169254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95169258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95169259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95169260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile Ti 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile Ti 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate H Low Profile Ti 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Summit Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|FSC: 13; Default||Not reimbursed separately|16,100.70|FSC: 13; Default||External grouping not supported 95169264|EAP|Custom 95169264||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Acl Db 9mm|1|HUMANA [1294]||HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95169265|EAP|Custom 95169265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Pin Retrobutton|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Nanocross 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169267|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xpert Biliary 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95169268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 3.5mm X 30lmm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|FSC: 13; Default||Not reimbursed separately|258.75|FSC: 13; Default||External grouping not supported 95174821|EAP|Custom 95174821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Physio Ii 40mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95182199|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95169278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169277|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169290|EAP|Custom 95169290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Ultrasound Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169291|EAP|Custom 95169291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Ultrasound Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169293|EAP|HCPCS 95169293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Ultrasound Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Proximal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|FSC: 13; Default||Not reimbursed separately|17,152.80|FSC: 13; Default||External grouping not supported 95169298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|FSC: 13; Default||Not reimbursed separately|390.00|FSC: 13; Default||External grouping not supported 95169303|EAP|Custom 95169303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .045 Trocar Tip |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169307|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Enodvasc Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|FSC: 13; Default||Not reimbursed separately|15,594.00|FSC: 13; Default||External grouping not supported 95169308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95169309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Threaded |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95169310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169316|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sys Delivery Amplatz Torq|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169317|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Endovascular 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dula 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95169322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Poly 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|FSC: 13; Default||Not reimbursed separately|3,612.00|FSC: 13; Default||External grouping not supported 95169323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Dbr2 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95169324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Dbr2 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95169325|EAP|Custom 95169325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Cardioxyl 2-0 3x7cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169328|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Nano Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95169329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169338|EAP|Custom 95169338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ss .086 W/laser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169339|EAP|Custom 95169339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Doral Acu-lock Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95169341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Titanium 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95169342|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Parietex Self-fixating|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95169343|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Thermodilution S-tip |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169344|EAP|Custom 95169344||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Side Short |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quickfix Ti 2mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95174822|EAP|Custom 95174822||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hip Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quickfix Ti 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 95169348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quickfix Ti 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95169350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Quickfix Ti 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95169356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Cannulated 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95169357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Cannulated 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95169358|EAP|HCPCS 95169358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Quickfix System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Stainless Steel 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.30|FSC: 13; Default||Not reimbursed separately|96.30|FSC: 13; Default||External grouping not supported 95169383|EAP|Custom 95169383||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Cup Right Angled|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169385|EAP|Custom 95169385||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Anatomic 6x14x11mm|1|HUMANA [1294]||HUMANA [11839]|3,643.38|FSC: 13; Default||Not reimbursed separately|3,643.38|FSC: 13; Default||External grouping not supported 95169386|EAP|Custom 95169386||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Anatomic 7x14x11mm|1|HUMANA [1294]||HUMANA [11839]|3,643.38|FSC: 13; Default||Not reimbursed separately|3,643.38|FSC: 13; Default||External grouping not supported 95169387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 95169388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95169390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Distraction Bengal 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95169391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed St 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|FSC: 13; Default||Not reimbursed separately|1,260.00|FSC: 13; Default||External grouping not supported 95169389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95169392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Oversize St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|FSC: 13; Default||Not reimbursed separately|1,124.31|FSC: 13; Default||External grouping not supported 95169393|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169394|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Fox Plus Pta Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169396|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95169399|EAP|Custom 95169399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape Fiber 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162456|EAP|Custom 80162456||0998 - STATISTICAL CHARGES|Hb Total Joint Center Class|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spanning Wrist 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,432.00|FSC: 13; Default||Not reimbursed separately|6,432.00|FSC: 13; Default||External grouping not supported 95174823|EAP|Custom 95174823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Incisor Plus Elite Long 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95169408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 95169409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|FSC: 13; Default||Not reimbursed separately|501.00|FSC: 13; Default||External grouping not supported 95169410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Rh Short Sz2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,816.00|FSC: 13; Default||Not reimbursed separately|3,816.00|FSC: 13; Default||External grouping not supported 95169414|EAP|Custom 95169414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Vein |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95169415|EAP|Custom 95169415||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 9mmx26mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95169416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Antegrade |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,388.54|FSC: 13; Default||Not reimbursed separately|5,388.54|FSC: 13; Default||External grouping not supported 95169417|EAP|Custom 95169417||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 12x34x24mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95169418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95169419|EAP|Custom 95169419||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lumbar Interbody Tlif 12mm|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95169424|EAP|Custom 95169424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Umbilical Vessel Cath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169425|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95169426|EAP|Custom 95169426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Galil Iceshere 90|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169412|EAP|HCPCS Q4122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Dermis Dermacel 6x16|1|HUMANA [1294]||HUMANA [11839]|92.19|FSC: 13; Default||Not reimbursed separately|92.19|FSC: 13; Default||External grouping not supported 95169413|EAP|HCPCS Q4122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tissue Dermis Dermacel 6x16|1|HUMANA [1294]||HUMANA [11839]|91.80|FSC: 13; Default||Not reimbursed separately|91.80|FSC: 13; Default||External grouping not supported 95169345|EAP|Custom 95169345||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner W/trocar|1|HUMANA [1294]||HUMANA [11839]|252.93|FSC: 13; Default||Not reimbursed separately|252.93|FSC: 13; Default||External grouping not supported 95169395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Self-tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95169431|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Foxcross 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169432|EAP|Custom 95169432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Oncontrol Biopsy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169384|EAP|Custom 95169384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Jugger Knot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169434|EAP|Custom 95169434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 5 Precision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169435|EAP|Custom 95169435||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Mesh St 10 X 12mm|1|HUMANA [1294]||HUMANA [11839]|12,522.00|FSC: 13; Default||Not reimbursed separately|12,522.00|FSC: 13; Default||External grouping not supported 95169436|EAP|Custom 95169436||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 95mm Expedium|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95169437|EAP|Custom 95169437||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 30mm Expedium|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95169438|EAP|Custom 95169438||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Y-shape 1.5mm|1|HUMANA [1294]||HUMANA [11839]|1,211.25|FSC: 13; Default||Not reimbursed separately|1,211.25|FSC: 13; Default||External grouping not supported 95169439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95169440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95169441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95169442|EAP|Custom 95169442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wire Trocar Double .028x6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169443|EAP|Custom 95169443||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Eagle 32mm|1|HUMANA [1294]||HUMANA [11839]|3,966.30|FSC: 13; Default||Not reimbursed separately|3,966.30|FSC: 13; Default||External grouping not supported 95169444|EAP|Custom 95169444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Eagle 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws St 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95169447|EAP|Custom 95169447||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12 X 34 X 24|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95182207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Intermediate 2 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95174824|EAP|Custom 95174824||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Perineal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182211|EAP|Custom 95182211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 90 For I-logic System Firm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174827|EAP|Custom 95174827||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Compression Stainless 15i X 15l|1|HUMANA [1294]||HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95182210|EAP|Custom 95182210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 180 For I-logic System Firm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174828|EAP|Custom 95174828||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Compression Stainless 20i X 20l|1|HUMANA [1294]||HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95182214|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Contour 4.8x26|1|HUMANA [1294]||HUMANA [11839]|403.26|FSC: 13; Default||Not reimbursed separately|403.26|FSC: 13; Default||External grouping not supported 95169448|EAP|Custom 95169448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Kit Atrieve Vascular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169449|EAP|Custom 95169449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Accessory|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169450|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymetric Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|FSC: 13; Default||Not reimbursed separately|2,870.70|FSC: 13; Default||External grouping not supported 95169451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Ft 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95169452|EAP|Custom 95169452||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cotton Wedge 5mm|1|HUMANA [1294]||HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95169453|EAP|Custom 95169453||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Arch Wedge 7mm|1|HUMANA [1294]||HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 95174829|EAP|Custom 95174829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.2mm X 100mm Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182216|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Uni Knee Size 4 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95182217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Ncb 5.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|FSC: 13; Default||Not reimbursed separately|425.19|FSC: 13; Default||External grouping not supported 95174831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Holes 3 Head Holes 2 90 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95182209|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Contour Injection 4.8/26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.74|FSC: 13; Default||Not reimbursed separately|415.74|FSC: 13; Default||External grouping not supported 95174832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro-toe Size 4.0mm X 16mm Angle 1o Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95182220|EAP|Custom 95182220||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Port Ipg Spectra Precision|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95174833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro-toe Size 3.2mm X 16mm Angle 1o Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95182221|EAP|Custom 95182221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Up 45 Degrees Capsulepass|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174834|EAP|Custom 95174834||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Accessory Anchor|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95182218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174835|EAP|Custom 95174835||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Raptor Grasping Sterile 2.4mm Diameter 230 Cm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182215|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB COMPONENT FEMORAL FLEX HIGH PRECOAT SZ-F RT MEDIAL LEFT LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95174836|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Endovascular Snare 25mm X 120 Cm 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182212|EAP|Custom 95182212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Edge 45 For I-logic System Firm Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174837|EAP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Direx Steerable 8f 71cm Small 50 Degree Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95174846|EAP|Custom 95174846||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb System Oscillatory Pep Therapy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174847|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical Xenmatrix 19cm X 28cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,871.85|FSC: 13; Default||Not reimbursed separately|34,871.85|FSC: 13; Default||External grouping not supported 95174848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Holes 5 Head Radial Column 46mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,741.89|FSC: 13; Default||Not reimbursed separately|1,741.89|FSC: 13; Default||External grouping not supported 95174849|EAP|Custom 95174849||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Double Acp System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148732|EAP|Custom 95148732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Roll Lumbar Half Size|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166002|EAP|Custom 95166002||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K Wire Trocar Double .035|1|HUMANA [1294]||HUMANA [11839]|42.00|FSC: 13; Default||Not reimbursed separately|42.00|FSC: 13; Default||External grouping not supported 95174861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial T2 9mm X 315mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95174863|EAP|Custom 95174863||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 10mm T2|1|HUMANA [1294]||HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95174864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95182191|EAP|Custom 95182191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Nail Insertion Elastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Ts Axsos 16 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95174866|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 9mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95174867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Mobility Dual Anatomic Adm Restoration 56mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|FSC: 13; Default||Not reimbursed separately|4,830.00|FSC: 13; Default||External grouping not supported 95174869|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hydrophilic Zipwire .035 Angled Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174870|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hydrophilic Zipwire .035 Straight Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174874|EAP|Custom 95174874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 10 X 38 X 28mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95174875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Implate Metacarpal 4.0 Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|FSC: 13; Default||Not reimbursed separately|2,295.00|FSC: 13; Default||External grouping not supported 95174876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Implate Distal Radius Long Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|FSC: 13; Default||Not reimbursed separately|2,295.00|FSC: 13; Default||External grouping not supported 95174877|EAP|Custom 95174877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Implate 2mm X 22 Degree|1|HUMANA [1294]||HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95174878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set 3.0mm X 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95174879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical 2.8mm X 6.0mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical 2.8mm X 8.0mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical 2.8mm X 10.0mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical 2.8mm X 12.0mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drill Implate Unicortical 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Implate Metacarpal 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Implate Metacarpal 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95174887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Pyramid 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,975.00|FSC: 13; Default||Not reimbursed separately|18,975.00|FSC: 13; Default||External grouping not supported 95174888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.80|FSC: 13; Default||Not reimbursed separately|1,441.80|FSC: 13; Default||External grouping not supported 95174889|EAP|Custom 95174889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Viper 6.0 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,910.72|FSC: 13; Default||Not reimbursed separately|5,910.72|FSC: 13; Default||External grouping not supported 95174890|EAP|Custom 95174890||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174883|EAP|Custom 95174883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Standard Tip 1.5mm X 127mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186568|EAP|Custom 95186568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Stim Tipped Ball 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sequoia 8.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,512.00|FSC: 13; Default||Not reimbursed separately|4,512.00|FSC: 13; Default||External grouping not supported 95174892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sequoia 8.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,512.00|FSC: 13; Default||Not reimbursed separately|4,512.00|FSC: 13; Default||External grouping not supported 95186567|EAP|Custom 95186567||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Opal 10x28x10 Mm|1|HUMANA [1294]||HUMANA [11839]|15,510.00|FSC: 13; Default||Not reimbursed separately|15,510.00|FSC: 13; Default||External grouping not supported 95174893|EAP|Custom 95174893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Barrel Long 4.0mm X 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174894|EAP|Custom 95174894||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Transport 8mm Length 4,5,6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186562|EAP|Custom 95186562||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Jamshidi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174895|EAP|Custom 95174895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Samurai Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174896|EAP|Custom 95174896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nanopass Cresent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186561|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Hernia Hybrid Zenapro 10x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95174897|EAP|Custom 95174897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Inflation Quantum|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174898|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Esophageal Hercules 3-stage 10-11-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Precoat Sz 4 Rt Medial/left Lateral Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95174899|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilitation Esophageal Hercules 3-stage 8-9-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mmx17/4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95174900|EAP|Custom 95174900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Nanotack 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182251|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Roadrunner Uniglide 0.18x 150cm Bx/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95174901|EAP|Custom 95174901||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Inserter Nanotack With Suture Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Kinectiv 12/14 Taper Size P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95174902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 4-10mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95182256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95174904|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 8mm X 30mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95174905|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 10mm X 20mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Screw Hub Cap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95174906|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 8mm X 30mm Tapered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182260|EAP|Custom 95182260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Head Hub Cap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174907|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 9mm X 30mm Tapered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95174908|EAP|Custom 95174908||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Charging Le Mini Eon Ans|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95182263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95182264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95174911|EAP|Custom 95174911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Closesure Ct Suture Passer (reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hub Cap Wrist Fusion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|FSC: 13; Default||Not reimbursed separately|2,655.00|FSC: 13; Default||External grouping not supported 95174912|EAP|Custom 95174912||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stalif Midline 36mmx 13mm X 8 Degree|1|HUMANA [1294]||HUMANA [11839]|25,200.00|FSC: 13; Default||Not reimbursed separately|25,200.00|FSC: 13; Default||External grouping not supported 95186565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Viper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.05|FSC: 13; Default||Not reimbursed separately|841.05|FSC: 13; Default||External grouping not supported 95174913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Staflif Midline Abo 6mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95174914|EAP|Custom 95174914||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Bi-wing|1|HUMANA [1294]||HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95174916|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Covered 10mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.40|FSC: 13; Default||Not reimbursed separately|8,006.40|FSC: 13; Default||External grouping not supported 95182266|EAP|Custom 95182266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Blunt Nose 5mm (reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174917|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Covered 10mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.40|FSC: 13; Default||Not reimbursed separately|8,006.40|FSC: 13; Default||External grouping not supported 95174918|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Covered 10mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.40|FSC: 13; Default||Not reimbursed separately|8,006.40|FSC: 13; Default||External grouping not supported 95174919|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Uncovered 10mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|FSC: 13; Default||Not reimbursed separately|5,295.00|FSC: 13; Default||External grouping not supported 95174920|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Uncovered 10mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|FSC: 13; Default||Not reimbursed separately|5,295.00|FSC: 13; Default||External grouping not supported 95174921|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Uncovered 10mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|FSC: 13; Default||Not reimbursed separately|5,295.00|FSC: 13; Default||External grouping not supported 95174922|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Biliary Th Uncovered 10mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|FSC: 13; Default||Not reimbursed separately|5,295.00|FSC: 13; Default||External grouping not supported 95163972|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Engage Act 7fr .038 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95167239|EAP|Custom 95167239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Escape Nitinol Stone Retrieval|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174925|EAP|Custom 95174925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastro With Y Port 24 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110109|EAP|Custom 95110109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pattie Surgical 1 X 3 10-pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174941|EAP|Custom 95174941||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 6mm X 20mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182277|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 555cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95174942|EAP|Custom 95174942||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tendon Tibialis Anterior Aseptic Non-irradiated|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95182272|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 425cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95174943|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical Xenmatrix 10cm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|FSC: 13; Default||Not reimbursed separately|8,205.00|FSC: 13; Default||External grouping not supported 95182274|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 470cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95174946|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 5-10mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95182273|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 445cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95182275|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 490cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95182271|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 405cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95174145|EAP|Custom 95174145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182276|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 510cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95174952|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Embolic Protection Spiderfx 4.0 X 320cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6 Hole Midshaft Ulna|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95174954|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vertex Part-thread 3.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|FSC: 13; Default||Not reimbursed separately|4,565.82|FSC: 13; Default||External grouping not supported 95174955|EAP|Custom 95174955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174956|EAP|Custom 95174956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Surgical Bayonet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174959|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Modular Evolve 20mm+2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95174960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Toggleloc With #7 Pe Ziploop Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 95186563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Viper 6.0 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,910.72|FSC: 13; Default||Not reimbursed separately|5,910.72|FSC: 13; Default||External grouping not supported 95174961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial 6.0mm X 0.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95174969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft Bc 5.5 3 W/hi Fi # 2 Suture With Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.88|FSC: 13; Default||Not reimbursed separately|1,118.88|FSC: 13; Default||External grouping not supported 95186564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Viper 80 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,126.01|FSC: 13; Default||Not reimbursed separately|2,126.01|FSC: 13; Default||External grouping not supported 95150956|EAP|Custom 95150956||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Lumbar Full Round With Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95163663|EAP|Custom 95163663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pattie Surgical 1/2 X 2 10-pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182284|EAP|Custom 95182284||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Concord 9x7x23|1|HUMANA [1294]||HUMANA [11839]|14,227.20|FSC: 13; Default||Not reimbursed separately|14,227.20|FSC: 13; Default||External grouping not supported 95174970|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprothesis Wallgraft 12mmx50mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95182285|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile High 600cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95174971|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprothesis Wallgraft 14mmx50mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95182279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 7.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95174972|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endoprothesis Wallgraft 14mmx70mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|FSC: 13; Default||Not reimbursed separately|7,950.00|FSC: 13; Default||External grouping not supported 95182280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.76|FSC: 13; Default||Not reimbursed separately|905.76|FSC: 13; Default||External grouping not supported 95174973|EAP|Custom 95174973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Two Part Titanium Luer Dialysis Peritoneal Argyle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Constrained Co-cr 26mm 50-52 Mm O.d.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,289.60|FSC: 13; Default||Not reimbursed separately|8,289.60|FSC: 13; Default||External grouping not supported 95174974|EAP|Custom 95174974||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Rental System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adaptor Liner Constrained Reflection 50-52 Mm O.d.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 95174979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Plus Omega 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|FSC: 13; Default||Not reimbursed separately|1,347.00|FSC: 13; Default||External grouping not supported 95182283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Piece Extension Gmrs 30 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|FSC: 13; Default||Not reimbursed separately|10,367.70|FSC: 13; Default||External grouping not supported 95174980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|FSC: 13; Default||Not reimbursed separately|336.00|FSC: 13; Default||External grouping not supported 95186575|EAP|Custom 95186575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Checkpoint Tibial Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tsp Omega 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|FSC: 13; Default||Not reimbursed separately|3,540.00|FSC: 13; Default||External grouping not supported 95174989|EAP|Custom 95174989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Marrow Bone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Distal Lateral Rt 6 Hole /l166mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,544.00|FSC: 13; Default||Not reimbursed separately|11,544.00|FSC: 13; Default||External grouping not supported 95174990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95174991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Healix Br. 4.5 3 Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 62062773|EAP|CPT® 87535||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hiv-1 Rvs Transcript Amp Probe - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95174992|EAP|Custom 95174992||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Passport Button 10mm X 40cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz 6 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95174993|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bard Mesh Perfix Tm Light Medium 1.3" X 1.6" (3.3cm X 3.9cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|FSC: 13; Default||Not reimbursed separately|519.00|FSC: 13; Default||External grouping not supported 95174994|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bard Mesh Perfix Tm Light Large 1.6" X 1.9" (4.1cm X 4.8cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95186574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Fixed Cr Left 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95174995|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bard Mesh Perfix Tm Light Extra Large 1.5" X 2.0" (3.8cm X 5.0cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95174996|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Bard Soft 4" X 6" (10cm X 15cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.41|FSC: 13; Default||Not reimbursed separately|162.41|FSC: 13; Default||External grouping not supported 95174997|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Bard Soft 12" X 12" (30.5cm X 30.5cm)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|515.10|FSC: 13; Default||Not reimbursed separately|515.10|FSC: 13; Default||External grouping not supported 95174998|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 4" X 6" (10.2cm X 15.2cm) Elliptical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,090.80|FSC: 13; Default||Not reimbursed separately|1,090.80|FSC: 13; Default||External grouping not supported 95174999|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 6" X 8" (15.2cm X 20.3cm) Elliptical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,186.79|FSC: 13; Default||Not reimbursed separately|5,186.79|FSC: 13; Default||External grouping not supported 95175000|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 7" X 9" (17.8cm X 22.9cm) Elliptical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,772.25|FSC: 13; Default||Not reimbursed separately|4,772.25|FSC: 13; Default||External grouping not supported 95186586|EAP|Custom 95186586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Foam Mepilex Border Ag Post Op 4x12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175001|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 8" X 10" (20.3cm X 25.4cm) Elliptical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.75|FSC: 13; Default||Not reimbursed separately|5,529.75|FSC: 13; Default||External grouping not supported 95175002|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 10" X 13" (25.4cm X 33cm) Elliptical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95175003|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dulex 26cm X 34cm X 1mm Rectangular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95175004|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Bard Ventralight St W/echo Ps Tm 4.5" (11.4cm) Circle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,257.45|FSC: 13; Default||Not reimbursed separately|1,257.45|FSC: 13; Default||External grouping not supported 95175009|EAP|Custom 95175009||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Hip Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175010|EAP|Custom 95175010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Integrated Probe Ablator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Bioraptor Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,266.00|FSC: 13; Default||Not reimbursed separately|1,266.00|FSC: 13; Default||External grouping not supported 95175014|EAP|Custom 95175014||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Hip Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175015|EAP|Custom 95175015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Ao Diameter 3.5mm Length 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Medial Distal Ts 14 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.32|FSC: 13; Default||Not reimbursed separately|4,162.32|FSC: 13; Default||External grouping not supported 95175019|EAP|Custom 95175019||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Contrast Management System Small Bore W/o Stopcock 10/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175020|EAP|Custom 95175020||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Laparosconic Introducer Mic G18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175023|EAP|Custom 95175023||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blocker Endobroncial Ez-blocker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182287|EAP|Custom 95182287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Dual On-q 500ml 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175024|EAP|Custom 95175024||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 24mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95182288|EAP|Custom 95182288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Custom Fusion Medtronic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175025|EAP|Custom 95175025||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 26mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95182289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 4-22 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95175026|EAP|Custom 95175026||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 28mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95175027|EAP|Custom 95175027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 30mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95175028|EAP|Custom 95175028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 32mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95175029|EAP|Custom 95175029||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 34mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95175030|EAP|Custom 95175030||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier-edwards Tricuspid Physio 36mm|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95182295|EAP|Custom 95182295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Intraline Biosteon 5.5 Mm 2 Suture W/ Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|FSC: 13; Default||Not reimbursed separately|1,366.20|FSC: 13; Default||External grouping not supported 95175036|EAP|Custom 95175036||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Glenoid Tm 2.5mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95182296|EAP|Custom 95182296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Revolve Fat Transfer System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175037|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Quadra Assura Ddqp+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70,800.00|FSC: 13; Default||Not reimbursed separately|70,800.00|FSC: 13; Default||External grouping not supported 95182301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3 Xia 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.36|FSC: 13; Default||Not reimbursed separately|1,359.36|FSC: 13; Default||External grouping not supported 95175041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Bb 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,333.58|FSC: 13; Default||Not reimbursed separately|5,333.58|FSC: 13; Default||External grouping not supported 95182297|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Main Custom Bifurcated Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95175042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5lg 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,476.00|FSC: 13; Default||Not reimbursed separately|1,476.00|FSC: 13; Default||External grouping not supported 95182304|EAP|Custom 95182304||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Silicone Facial Submalar Binder Small|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95175043|EAP|Custom 95175043||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Semi Tenosis Aseptic Non-irradiated|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95182305|EAP|Custom 95182305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Flexible Passer Suture 360 Rp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175044|EAP|Custom C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95182300|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95175045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Short Es2 6.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95182298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Xia 6.5x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,733.20|FSC: 13; Default||Not reimbursed separately|3,733.20|FSC: 13; Default||External grouping not supported 95175046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Short Es2 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95182299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Xia Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.25|FSC: 13; Default||Not reimbursed separately|449.25|FSC: 13; Default||External grouping not supported 95175047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight Es2 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95182302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3 Xia 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.36|FSC: 13; Default||Not reimbursed separately|1,359.36|FSC: 13; Default||External grouping not supported 95175048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Blocker Es2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|712.05|FSC: 13; Default||Not reimbursed separately|712.05|FSC: 13; Default||External grouping not supported 95182307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Intermediate Dr Volar 10 Hole Left Extra Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,574.00|FSC: 13; Default||Not reimbursed separately|5,574.00|FSC: 13; Default||External grouping not supported 95175049|EAP|Custom 95175049||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Sharp Es2|1|HUMANA [1294]||HUMANA [11839]|132.87|FSC: 13; Default||Not reimbursed separately|132.87|FSC: 13; Default||External grouping not supported 95175051|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|FSC: 13; Default||Not reimbursed separately|57.00|FSC: 13; Default||External grouping not supported 95175052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Combo Medium Left 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,649.00|FSC: 13; Default||Not reimbursed separately|2,649.00|FSC: 13; Default||External grouping not supported 95186580|EAP|Custom 95186580||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Circuit Conchasmart Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175053|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5 Titanium Right 11 X 400mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95175054|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 14 Pta 4.0mm X 200mm X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Contrained Genesis Ii 13mm Size1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 95175057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Femoral Screw-on Distal Legion Size 3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 95182314|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast Covered 7mmx38mmx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|FSC: 13; Default||Not reimbursed separately|7,338.75|FSC: 13; Default||External grouping not supported 95175058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Constrained Oxinum Legion Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 95182311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drill Flexible Hgp 3.2 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95175059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coupler Offset Legion 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,283.40|FSC: 13; Default||Not reimbursed separately|4,283.40|FSC: 13; Default||External grouping not supported 95182316|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast Covered 8mmx38mmx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|FSC: 13; Default||Not reimbursed separately|7,338.75|FSC: 13; Default||External grouping not supported 95175060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle 100 Gription Without Holes 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95182310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum U-e Neural 36 X 52 Mm Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95175061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Inser Tibial Platform Rotating Lcs 20mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|FSC: 13; Default||Not reimbursed separately|5,628.00|FSC: 13; Default||External grouping not supported 95182317|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast Covered 8mmx59mmx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|FSC: 13; Default||Not reimbursed separately|7,908.75|FSC: 13; Default||External grouping not supported 95175062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tray Tibial Cemented Revision Platform Rotating Mbt Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|FSC: 13; Default||Not reimbursed separately|17,936.10|FSC: 13; Default||External grouping not supported 95182315|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast Covered 7mmx59mmx80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|FSC: 13; Default||Not reimbursed separately|7,908.75|FSC: 13; Default||External grouping not supported 95175065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95182318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adaptor Stem Humeral Rsp 6 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,979.00|FSC: 13; Default||Not reimbursed separately|2,979.00|FSC: 13; Default||External grouping not supported 95175066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95182313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Subtalar Mba 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,272.09|FSC: 13; Default||Not reimbursed separately|7,272.09|FSC: 13; Default||External grouping not supported 95175067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95182319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement W/gentamicin Simplex Hv Full Dose 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|685.50|FSC: 13; Default||Not reimbursed separately|685.50|FSC: 13; Default||External grouping not supported 95182326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Insert Tibial Poly Crosslinked Prolong Tm Zimmer S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|FSC: 13; Default||Not reimbursed separately|4,575.00|FSC: 13; Default||External grouping not supported 95175173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95175174|EAP|Custom 95175174||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Spinal Metal Trabecular Interbody Ardis 8mm X 30mm X 9mm|1|HUMANA [1294]||HUMANA [11839]|16,200.00|FSC: 13; Default||Not reimbursed separately|16,200.00|FSC: 13; Default||External grouping not supported 95175176|EAP|Custom 95175176||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Inconel .035 5cm X 3mm|1|HUMANA [1294]||HUMANA [11839]|294.93|FSC: 13; Default||Not reimbursed separately|294.93|FSC: 13; Default||External grouping not supported 95175152|EAP|Custom 95175152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastro Feeding 22fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175155|EAP|Custom 95175155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Dental Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ankle Total Talus Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 95182329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Medial Distal 14hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,648.50|FSC: 13; Default||Not reimbursed separately|4,648.50|FSC: 13; Default||External grouping not supported 95175180|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Bard Ventralight St 6" X 8" (15.2cm X 20.3cm) Ellipse|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95182330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Dbr Iii 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95182328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95175182|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Talar Ankle Total Metal Trabecular Zimmer Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 95175183|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Base Tibial Ankle Total Metal Trbeculare Zimmer Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|FSC: 13; Default||Not reimbursed separately|12,150.00|FSC: 13; Default||External grouping not supported 95175184|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Insert Tibial Poly Crosslinked Prolong Tm Zimmer Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|FSC: 13; Default||Not reimbursed separately|4,575.00|FSC: 13; Default||External grouping not supported 95175185|EAP|Custom 95175185||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Calcaneus Ankle Total Tm Zimmer|1|HUMANA [1294]||HUMANA [11839]|1,041.00|FSC: 13; Default||Not reimbursed separately|1,041.00|FSC: 13; Default||External grouping not supported 95175186|EAP|Custom 95175186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Ankle Total Tm Zimmer 1.6 Mm|1|HUMANA [1294]||HUMANA [11839]|24.30|FSC: 13; Default||Not reimbursed separately|24.30|FSC: 13; Default||External grouping not supported 95175187|EAP|Custom 95175187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drilling Self Ankle Total Tm Zimmer 4mm 150 Length 40|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175188|EAP|Custom 95175188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Protective Ankle Total Tm Zimmer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175189|EAP|Custom 95175189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Sterile Ankle Total Tm Zimmer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175190|EAP|Custom 95175190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Drilling Self Ankle Tm Zimmer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175191|EAP|Custom 95175191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175192|EAP|Custom 95175192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Quik Connect 2.7 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Fibular Distal 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,977.60|FSC: 13; Default||Not reimbursed separately|1,977.60|FSC: 13; Default||External grouping not supported 95175194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 Mm X 14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95175195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 Mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95182332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Left 2.7mm 11hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95175196|EAP|Custom 95175196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer G-20 Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175198|EAP|Custom 95175198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Jejunal Mic 20fr 28cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175199|EAP|Custom 95175199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rubicon Support .035 90cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175200|EAP|Custom 95175200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rubicon Support .035 135cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175201|EAP| 95175201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rubicon Support 0.018 135cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175202|EAP|Custom 95175202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175203|EAP|Custom 95175203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Decompression Metatarsal Co Cr Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95175214|EAP|Custom 95175214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 3d Eopa 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink 2.0mm Ao Coupling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.90|FSC: 13; Default||Not reimbursed separately|711.90|FSC: 13; Default||External grouping not supported 95182320|EAP|Custom 95182320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidescope 3-4 Baton Holder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167166|EAP|Custom 80167166||0995 - PATIENT CONVENIENCE ITEMS - NON-PATIENT ROOM RENTALS|Hb Falmouth Room And Meal Charge For Php|1|HUMANA [1294]||HUMANA [11839]|129.00|FSC: 13; Default||Not reimbursed separately|129.00|FSC: 13; Default||External grouping not supported 95182338|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel 315cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95175231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95182337|EAP|Custom 95182337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Trocar Tip Threaded 0.86mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum U-e Neural 36 X 54 Size Jj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95175234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Reduction 6.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95175235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Reduction 6.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95175236|EAP|Custom 95175236||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire K|1|HUMANA [1294]||HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95175240|EAP|Custom 95175240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Power G3 Ez-io|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118727|EAP|Custom 95118727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Threaded Vcs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95149170|EAP|Custom 95149170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm Qc 125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.50|FSC: 13; Default||Not reimbursed separately|1,762.50|FSC: 13; Default||External grouping not supported 95175230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95182342|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Angio Sculpt 3mm X 40mm 155 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175244|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Biliary Drainage 7fr 7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|178.29|FSC: 13; Default||Not reimbursed separately|178.29|FSC: 13; Default||External grouping not supported 95175245|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Biliary Drainage 10fr 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|178.29|FSC: 13; Default||Not reimbursed separately|178.29|FSC: 13; Default||External grouping not supported 95175246|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Biliary Drainage 10fr 7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|178.29|FSC: 13; Default||Not reimbursed separately|178.29|FSC: 13; Default||External grouping not supported 95175251|EAP|Custom 95175251||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Spinal Metal Trabecular Interbody Ardis 8mm X 34mm X 11mm|1|HUMANA [1294]||HUMANA [11839]|16,200.00|FSC: 13; Default||Not reimbursed separately|16,200.00|FSC: 13; Default||External grouping not supported 95175252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 7.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95175253|EAP|Custom 95175253||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 7mm X 22mm Vertestak|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95175255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 40mm X 58mm 10 Degree 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|FSC: 13; Default||Not reimbursed separately|8,156.40|FSC: 13; Default||External grouping not supported 95175256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va Lcp Oleranon 2.7mm/3.5mm 2 Hole Left 73mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,992.86|FSC: 13; Default||Not reimbursed separately|2,992.86|FSC: 13; Default||External grouping not supported 95175257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 13mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95175259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 18mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95175260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 7mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95175261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 9mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95175262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 11mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95175263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.0mm X 13mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.66|FSC: 13; Default||Not reimbursed separately|105.66|FSC: 13; Default||External grouping not supported 95175264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 6mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.50|FSC: 13; Default||Not reimbursed separately|160.50|FSC: 13; Default||External grouping not supported 95175265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 7mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.50|FSC: 13; Default||Not reimbursed separately|160.50|FSC: 13; Default||External grouping not supported 95175266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 8mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95175267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 9mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.50|FSC: 13; Default||Not reimbursed separately|160.50|FSC: 13; Default||External grouping not supported 95175268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 11mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.50|FSC: 13; Default||Not reimbursed separately|160.50|FSC: 13; Default||External grouping not supported 95175269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 13mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.50|FSC: 13; Default||Not reimbursed separately|160.50|FSC: 13; Default||External grouping not supported 95175270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 16mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95175271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 18mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95175272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reduction 1.25mm Wire Threaded Tip With Small Stop 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|557.04|FSC: 13; Default||Not reimbursed separately|557.04|FSC: 13; Default||External grouping not supported 95175273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reduction 1.25mm Wire Threaded Tip With Large Stop 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.86|FSC: 13; Default||Not reimbursed separately|619.86|FSC: 13; Default||External grouping not supported 95182345|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 2.25mm X 135cm Length X 0.58|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95144786|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Cardioverter-defibrillator Endo-cardial Single Coil|1|HUMANA [1294]||HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95175286|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Covered Fully Aero 14mm 40mm 16fr X 61cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95175287|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STENT TRACHEOBRONCHIAL COVERED FULLY AERO 16MM-60MM/22FR X 56CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95175288|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STENT TRACHEOBRONCHIAL COVERED FULLY AERO 18MM-60MM/22FR X 59CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95175289|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STENT TRACHEOBRONCHIAL COVERED FULLY AERO 20MM-60MM/22FR X 59CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95175290|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Smooth Plus Moderate 375cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95175291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 1.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95175292|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus Profile Moderate 425cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95175293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95175294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size D Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95175233|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol12.5 Diopter Single Piece Pmma 13.5mm Length 7.0mm Biconvex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95175243|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pigtail Biliary Drainage 7fr 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|178.29|FSC: 13; Default||Not reimbursed separately|178.29|FSC: 13; Default||External grouping not supported 95175274|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB PATCH HERNIA ST VENTRIO OVAL EXTRA LARGE 7.7" X 9.7"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,242.00|FSC: 13; Default||Not reimbursed separately|4,242.00|FSC: 13; Default||External grouping not supported 95175275|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia St Ventrio Oval Midline 6.1 X 10.1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95175279|EAP|Custom 95175279||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Crescent 30mm X 15mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95175280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95175297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Lcp 1.5mm 3 Hole Head 8 Hole Shaft With Guides Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,465.74|FSC: 13; Default||Not reimbursed separately|1,465.74|FSC: 13; Default||External grouping not supported 95175298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 7mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95175299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 9mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95175300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 110mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95175301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 7mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95175302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 8mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95175303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 9mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95175304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 10mm Self Tapping With T4 Stardrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95175306|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patella Resurfacing Genesis Oval 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|FSC: 13; Default||Not reimbursed separately|2,719.20|FSC: 13; Default||External grouping not supported 95175307|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Ellipse Dr Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|FSC: 13; Default||Not reimbursed separately|50,625.00|FSC: 13; Default||External grouping not supported 95175309|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cable Achieve Mapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175312|EAP|Custom 95175312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 3d Eopa 22fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175313|EAP|Custom 95175313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Drill Continuous Compression|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Speed 9 X 7 X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95175321|EAP|HCPCS C1752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tray Mahurkar 24 Cm 12fr Tl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175326|EAP|Custom 95175326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.3mm Y-knot Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 1.3mm Y-knot Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|898.20|FSC: 13; Default||Not reimbursed separately|898.20|FSC: 13; Default||External grouping not supported 95175328|EAP| 95175328||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Battery Pack Lithium Head Light|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175329|EAP|Custom 95175329||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Null Modem Cryocath|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Gap 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|FSC: 13; Default||Not reimbursed separately|478.80|FSC: 13; Default||External grouping not supported 95131023|EAP|Custom 95131023||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 22 X 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95131423|EAP| 95131423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Chiba 18 Ga X 15 Cm 10/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175317|EAP|Custom 95175317||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Concord 9 X 9 X 23|1|HUMANA [1294]||HUMANA [11839]|14,796.30|FSC: 13; Default||Not reimbursed separately|14,796.30|FSC: 13; Default||External grouping not supported 95175318|EAP|Custom 95175318||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Concord 9 X 8 X 23|1|HUMANA [1294]||HUMANA [11839]|13,740.00|FSC: 13; Default||Not reimbursed separately|13,740.00|FSC: 13; Default||External grouping not supported 95182341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Metal Trabecular With Cluster Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95175332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 26cm Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95175333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 30cm Retrograde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|FSC: 13; Default||Not reimbursed separately|4,311.18|FSC: 13; Default||External grouping not supported 95175334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral 0 X 28mm Ceramic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.00|FSC: 13; Default||Not reimbursed separately|4,368.00|FSC: 13; Default||External grouping not supported 95175335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 35mm Prolong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,123.20|FSC: 13; Default||Not reimbursed separately|1,123.20|FSC: 13; Default||External grouping not supported 95175336|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 13mm X 107cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 95175337|EAP|Custom 95175337||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Expandable Convex 29mm X 11mm X 7mm|1|HUMANA [1294]||HUMANA [11839]|18,897.00|FSC: 13; Default||Not reimbursed separately|18,897.00|FSC: 13; Default||External grouping not supported 95175338|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Archon Acdf 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,551.00|FSC: 13; Default||Not reimbursed separately|4,551.00|FSC: 13; Default||External grouping not supported 95175339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Archon 4 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95175340|EAP|Custom 95175340||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lock Cover|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95175341|EAP|Custom 95175341||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Small 7 X 4 X 11mm|1|HUMANA [1294]||HUMANA [11839]|3,588.00|FSC: 13; Default||Not reimbursed separately|3,588.00|FSC: 13; Default||External grouping not supported 95175343|EAP|Custom 95175343||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|HB LIQUID POLIBAR PLUS 4/CS|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182343|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Angio Sculpt 3mm X 15mm 137 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175346|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Snare Filter Removal 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175350|EAP|Custom 95175350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Ear Single Patient Use Lncs E1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175351|EAP|Custom 95175351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Single Malleable Dlp 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175352|EAP|Custom 95175352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Single Malleable Dlp 26fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175353|EAP|Custom 95175353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Single Malleable Dlp 28fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175355|EAP|Custom 95175355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Stage Single Malleable Dlp 34fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175356|EAP|Custom 95175356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Transport 8mm Length 7,8,9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175358|EAP|Custom 95175358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nanopass Right 45 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175359|EAP|Custom 95175359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Barrel Long 5.5mm X 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175360|EAP|Custom 95175360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bonecutter Platinum Full Radius 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175361|EAP|Custom 95175361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Taper Option Biolox -3 Neck|1|HUMANA [1294]||HUMANA [11839]|1,062.00|FSC: 13; Default||Not reimbursed separately|1,062.00|FSC: 13; Default||External grouping not supported 95175362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Ceramic Option Delta Biolox 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,536.00|FSC: 13; Default||Not reimbursed separately|10,536.00|FSC: 13; Default||External grouping not supported 62061999|EAP|CPT® 82533||0301 - LABORATORY - CHEMISTRY|Hb Cortisol - 90 Min|1|HUMANA [1294]||HUMANA [11839]|48.90|FSC: 13; Default||Not reimbursed separately|48.90|FSC: 13; Default||External grouping not supported 62062005|EAP|CPT® 82533||0301 - LABORATORY - CHEMISTRY|Hb Cortisol - 120 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.90|FSC: 13; Default||Not reimbursed separately|48.90|FSC: 13; Default||External grouping not supported 62062013|EAP|CPT® 81015||0307 - LABORATORY - UROLOGY|Hb Ua Microscopic|1|HUMANA [1294]||HUMANA [11839]|9.15|FSC: 13; Default||Not reimbursed separately|9.15|FSC: 13; Default||External grouping not supported 62062021|EAP|CPT® 83789||0301 - LABORATORY - CHEMISTRY|Hb Mass Spec Quant - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|72.33|FSC: 13; Default||Not reimbursed separately|72.33|FSC: 13; Default||External grouping not supported 62062039|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hb Gbm Ab Igg, Ifa - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95182344|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Optisure Defibrillation 58cm|1|HUMANA [1294]||HUMANA [11839]|12,427.44|FSC: 13; Default||Not reimbursed separately|12,427.44|FSC: 13; Default||External grouping not supported 95175363|EAP|Custom 95175363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Pediatric 4 Jaw Radial With Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175364|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton-huibregtse10fr X 7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175365|EAP|Custom 95175365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hood Protector Body Foreign|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175367|EAP|Custom 95175367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Torcon Nb Advantage Sim1 5fr 65cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175368|EAP|Custom 95175368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Torcon Nb Advantage Sim2 5fr 65cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95175371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95175372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 11mm X 345mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95175379|EAP|Custom 95175379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Lisfranc 2.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 3.7mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95175388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Cemented Persona 35mm 8.5mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95175389|EAP|Custom 95175389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Percutaneous Y-knot Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Repair Augmentation Ligament Internal Brace|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95175393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 11mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.00|FSC: 13; Default||Not reimbursed separately|1,206.00|FSC: 13; Default||External grouping not supported 95175394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95175396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95175398|EAP|Custom 95175398||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feed With Y-prt 16fr 5 Cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175399|EAP|Custom 95175399||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feed Gast/sili W/y Port 18 Fr Cs/5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95174927|EAP|Custom 95174927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Gastrostomy Feeding W/y-ports 20 Fr 20cc Kangaroo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175374|EAP|Custom 95175374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Nasal Universal 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 32mm Prolong|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.80|FSC: 13; Default||Not reimbursed separately|1,762.80|FSC: 13; Default||External grouping not supported 95175401|EAP|Custom 95175401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.0mm Double Ended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175402|EAP|Custom 95175402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm Double Ended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175403|EAP|Custom 95175403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.25mm Double Ended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Long Es2 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95175405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Long Es2 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95175406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight Es2 5.5 X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95175408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 40mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95175409|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 46mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95175410|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 46mm X 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95175411|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 52mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95175412|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Glenoid Trabecular Metal 52mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 80164695|EAP|HCPCS G8990||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt/ot Primary Functional Limitation First Visit (g8990) Pt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80164751|EAP|HCPCS G8991||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt/ot Primary Functional Limitation Will Be After 10 Visits/30 Days (g8991) Pt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95175420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross Sfx 5.5 Ti Medium Size A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,732.80|FSC: 13; Default||Not reimbursed separately|4,732.80|FSC: 13; Default||External grouping not supported 95175421|EAP|Custom 95175421||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gun Meniscal Deployment|1|HUMANA [1294]||HUMANA [11839]|459.00|FSC: 13; Default||Not reimbursed separately|459.00|FSC: 13; Default||External grouping not supported 95175422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Meniscal Repair Omnispan 27 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95175423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95175427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Metal Trabecular With Cluster Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.50|FSC: 13; Default||Not reimbursed separately|5,986.50|FSC: 13; Default||External grouping not supported 95175428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked Highly Longevity 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,412.50|FSC: 13; Default||Not reimbursed separately|3,412.50|FSC: 13; Default||External grouping not supported 95175429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Taper Revision Wagner Sl 265mm Protasul 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,847.50|FSC: 13; Default||Not reimbursed separately|21,847.50|FSC: 13; Default||External grouping not supported 95175441|EAP|Custom 95175441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural White Label 24/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175442|EAP|Custom 95175442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural Pink 24/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175447|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Z Med Ii 20mm X 4 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175449|EAP|Custom 95175449||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Mini Ft|1|HUMANA [1294]||HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95175450|EAP|Custom 95175450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Biopsy Alligator Jaw Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 100 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,142.00|FSC: 13; Default||Not reimbursed separately|2,142.00|FSC: 13; Default||External grouping not supported 95182347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow 19mmx56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 80165624|EAP|HCPCS C8927||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Tee W/ Wo Contrast Cardiac Pumping|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 80165632|EAP|HCPCS C8929||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Tte W/ Wo Contrast W Color Flow|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 80165640|EAP|HCPCS C8930||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Tte W/ Wo Contrast With Stress|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 95175452|EAP|Custom 95175452||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Lock|1|HUMANA [1294]||HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95175453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion 30mm Acutrak 6mm Nose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95175454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Brigade Lordotic 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,439.00|FSC: 13; Default||Not reimbursed separately|14,439.00|FSC: 13; Default||External grouping not supported 95169136|EAP|Custom 95169136||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Surgical Darco Female Black Small Size 4-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175459|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 12x 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175460|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Long Gen/pro 79 X 10 Bil 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,304.80|FSC: 13; Default||Not reimbursed separately|3,304.80|FSC: 13; Default||External grouping not supported 95175461|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Long Gen/pro 59 X 10 Bil 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,304.80|FSC: 13; Default||Not reimbursed separately|3,304.80|FSC: 13; Default||External grouping not supported 95182348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 3-15mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95182349|EAP|Custom 95182349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Access Pedicle I-pas Nv Tip Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept 6.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95175468|EAP|Custom 95175468||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Apex Transfix 4 X 25o Pin 5 X 50 Thr|1|HUMANA [1294]||HUMANA [11839]|427.50|FSC: 13; Default||Not reimbursed separately|427.50|FSC: 13; Default||External grouping not supported 95175479|EAP|Custom 95175479||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Mreye .035 Diameter X 5cm Length 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon Ts 23mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95175487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5 Titanium Right 11 X 320mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95175490|EAP|Custom 95175490||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire Tip Drill 300mm|1|HUMANA [1294]||HUMANA [11839]|228.96|FSC: 13; Default||Not reimbursed separately|228.96|FSC: 13; Default||External grouping not supported 95175492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interlock 4 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,179.00|FSC: 13; Default||Not reimbursed separately|1,179.00|FSC: 13; Default||External grouping not supported 95175493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tulip Precept Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|FSC: 13; Default||Not reimbursed separately|3,969.00|FSC: 13; Default||External grouping not supported 95175494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95175495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Precept 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95182351|EAP|Custom 95182351||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Lc 12 X 11 X 25 8 Degrees|1|HUMANA [1294]||HUMANA [11839]|10,284.00|FSC: 13; Default||Not reimbursed separately|10,284.00|FSC: 13; Default||External grouping not supported 95182352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 11mmx380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95182355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Reduction 7.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95175497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 12mm X 125 Deg X 235mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,385.43|FSC: 13; Default||Not reimbursed separately|4,385.43|FSC: 13; Default||External grouping not supported 95175498|EAP|Custom 95175498||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB BUTTON CERLAGE HEX T25/3.5|1|HUMANA [1294]||HUMANA [11839]|594.78|FSC: 13; Default||Not reimbursed separately|594.78|FSC: 13; Default||External grouping not supported 95175499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 7.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95175500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5 Titanium Right 13 X 400mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95175502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp First Va-lcp Medium 0 Degree Left 2.4 2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 95175503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 54mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95175504|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base 400cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95175505|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Oval 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95175506|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Oval 500cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95175507|EAP|Custom 95175507||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cutter Flip Ii 11.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175512|EAP|Custom 95175512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammelock Medium Angled|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 95175514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 7mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,488.00|FSC: 13; Default||Not reimbursed separately|1,488.00|FSC: 13; Default||External grouping not supported 95175515|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Port Injectable Power Smartport W/sheath Titanium Poly Floro Max|1|HUMANA [1294]||HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95175516|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Fixation Screw Triathlon Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95175517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Cementless Vitallium Triathlon 6.5 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95175216|EAP|Custom 95175216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Bentson Star 035 150 10 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182354|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total X 3 Poly Sz 6 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95175525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossft Bc 4.5mm 3 Hi Fi # 2 Suture With Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.73|FSC: 13; Default||Not reimbursed separately|1,064.73|FSC: 13; Default||External grouping not supported 95175526|EAP|Custom 95175526||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire Fixos 1.4mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|98.70|FSC: 13; Default||Not reimbursed separately|98.70|FSC: 13; Default||External grouping not supported 95175527|EAP|Custom 95175527||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Calibrated Anchorage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixos Mv 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,476.00|FSC: 13; Default||Not reimbursed separately|1,476.00|FSC: 13; Default||External grouping not supported 95175529|EAP|HCPCS Q4130||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Tissue Strattaice Firm 6cm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|FSC: 13; Default||Not reimbursed separately|79.20|FSC: 13; Default||External grouping not supported 95175530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.3mm X 26mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95175531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Open Right Low Profile Wedge 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95175532|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Head Radial 7.0mm X 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95175533|EAP|Custom 95175533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Concave 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175534|EAP|Custom 95175534||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidewire .059 X 5 St|1|HUMANA [1294]||HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95175535|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 9mm X 15cm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|FSC: 13; Default||Not reimbursed separately|11,970.00|FSC: 13; Default||External grouping not supported 95175536|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Interthecal Segment Spinal|1|HUMANA [1294]||HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95175543|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Maestro 2.8f 110 Length 45 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175545|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Maestro 2.8f 110 Length 45 Degree No Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80165657|EAP|CPT® 93303||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo Transthoracic Complete Nicu|1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 80165665|EAP|CPT® 93320||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Doppler Study, Complete Nicu|1|HUMANA [1294]||HUMANA [11839]|719.51|FSC: 13; Default||Not reimbursed separately|719.51|FSC: 13; Default||External grouping not supported 80165673|EAP|CPT® 93325||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Color Flow Doppler Nicu|1|HUMANA [1294]||HUMANA [11839]|610.78|FSC: 13; Default||Not reimbursed separately|610.78|FSC: 13; Default||External grouping not supported 95182359|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Half Tibial Tm Rt Lateral/lt Medical Sz 6-5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95182357|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Ao Diopter Crystalens Posterior Chambe|1|HUMANA [1294]||HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95182358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 95113850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 1.6mm Dia 150mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.28|FSC: 13; Default||Not reimbursed separately|33.28|FSC: 13; Default||External grouping not supported 95123972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Kirschner 2.0mm 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.28|FSC: 13; Default||Not reimbursed separately|33.28|FSC: 13; Default||External grouping not supported 95175247|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Stent Rx Delivery Naviflex 7 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.53|FSC: 13; Default||Not reimbursed separately|265.53|FSC: 13; Default||External grouping not supported 95175554|EAP|Custom 95175554||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 10fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175555|EAP|Custom 95175555||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Follower Heyman 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175556|EAP|Custom 95175556||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Or 1 X 16 Spectra|1|HUMANA [1294]||HUMANA [11839]|15.00|FSC: 13; Default||Not reimbursed separately|15.00|FSC: 13; Default||External grouping not supported 95175557|EAP|Custom 95175557||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Tissue Fixate Dual Pack|1|HUMANA [1294]||HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95175558|EAP|Custom 95175558||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xd Expandable Lordotic 29mm X 5mm X 7mm|1|HUMANA [1294]||HUMANA [11839]|18,297.00|FSC: 13; Default||Not reimbursed separately|18,297.00|FSC: 13; Default||External grouping not supported 95186592|EAP|Custom 95186592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Twist Drill 1.2mmx25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175559|EAP|Custom 95175559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needles 100mm 18g 10mm 10 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shank Plif Mas 6.5 X 30mm 3z Blast|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 95175563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex 4 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95175564|EAP|Custom 95175564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Welding Thermal Tonsilar Entceps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175565|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Vertigraft Cervical Vg2 7mm X 9mm Freezed Dried|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.19|FSC: 13; Default||Not reimbursed separately|3,299.19|FSC: 13; Default||External grouping not supported 95175566|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh St 8 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,522.00|FSC: 13; Default||Not reimbursed separately|12,522.00|FSC: 13; Default||External grouping not supported 95175567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Vitallium Triathlon 25 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|FSC: 13; Default||Not reimbursed separately|321.30|FSC: 13; Default||External grouping not supported 95175568|EAP|Custom 95175568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Ao Diameter 2.4 2.7mm Length 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95175570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 20mm Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95175571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Third 10 Hole Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.75|FSC: 13; Default||Not reimbursed separately|222.75|FSC: 13; Default||External grouping not supported 95175572|EAP|Custom 95175572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide Ao Diameter 2.0mm Length 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175576|EAP|Custom 95175576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Rubber Dam Premolar Satin Finish 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175577|EAP|Custom 95175577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175501|EAP|Custom 95175501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stimulator Locator Checkpoint|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175574|EAP|Custom 95175574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Insertion Percutaneous Venous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|FSC: 13; Default||Not reimbursed separately|3,037.50|FSC: 13; Default||External grouping not supported 95175580|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Fixation Screw Triathlon Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95175582|EAP|Custom 95175582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Juggerknot Large Shank 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB ANCHOR CROSSFT BC 4.5MM 3 HI FI 2 SUTURE WITH NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.88|FSC: 13; Default||Not reimbursed separately|1,118.88|FSC: 13; Default||External grouping not supported 95175584|EAP|Custom 95175584||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Loop T-lif 11 X 32.5mm X 6 Degrees|1|HUMANA [1294]||HUMANA [11839]|21,897.00|FSC: 13; Default||Not reimbursed separately|21,897.00|FSC: 13; Default||External grouping not supported 95175585|EAP|Custom 95175585||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty 300 Xpress 10cc|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95175586|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 5.0mm X 120mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175589|EAP|Custom 95175589||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Va Zero-p Lordotic Height 7mm|1|HUMANA [1294]||HUMANA [11839]|10,839.00|FSC: 13; Default||Not reimbursed separately|10,839.00|FSC: 13; Default||External grouping not supported 95175590|EAP|Custom 95175590||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Va Zero-p Lordotic Height 5mm|1|HUMANA [1294]||HUMANA [11839]|10,839.00|FSC: 13; Default||Not reimbursed separately|10,839.00|FSC: 13; Default||External grouping not supported 95175591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95175592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175595|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Oval Isnare|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175596|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Hexagonal Isnare|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtc Standard Extreme Maxlock Neutral Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,080.00|FSC: 13; Default||Not reimbursed separately|4,080.00|FSC: 13; Default||External grouping not supported 95175598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95175599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95175600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95175603|EAP|Custom 95175603||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Segment Fibular Approximately 10cm Frozen Cryo|1|HUMANA [1294]||HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95175604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Femoral Intrafix 8mm Hard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95175605|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 14 Pta 3.0 Mm X 200mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175614|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expanding Biliary Stent 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95175619|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable Sprint Quattro Secure 72cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|FSC: 13; Default||Not reimbursed separately|13,167.00|FSC: 13; Default||External grouping not supported 95175624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterolateral Distal Tibia 2.7/3.5mm Va-lcp 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,150.16|FSC: 13; Default||Not reimbursed separately|5,150.16|FSC: 13; Default||External grouping not supported 95175625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175628|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 28mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95175633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 16mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95175634|EAP|Custom 95175634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95175636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95175637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95186596|EAP|Custom 95186596||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Helical Tfna 110 Mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Fixation Screw Triathlon Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95175639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 11 X 400 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95175446|EAP|Custom 95175446||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Catheter Manoshield Eg Disp 20 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175642|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Viva Quad C Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,200.00|FSC: 13; Default||Not reimbursed separately|55,200.00|FSC: 13; Default||External grouping not supported 95175644|EAP|Custom 95175644||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Mic G-12 Laparoscopic Introducer Includes 16 Fr Dilator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175645|EAP|Custom 95175645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Mic Jejunal Feeding 12 Fr 3-5ml Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm X 28mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95175654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm X 30mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95175655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Large X Ti 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95175661|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Metal Asphere 12/14 36mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,544.95|FSC: 13; Default||Not reimbursed separately|3,544.95|FSC: 13; Default||External grouping not supported 95175662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 100mm Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95175663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 95mm Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95186589|EAP|Custom 95186589||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Tissuemend 3cm X 3cm|1|HUMANA [1294]||HUMANA [11839]|4,383.36|FSC: 13; Default||Not reimbursed separately|4,383.36|FSC: 13; Default||External grouping not supported 95175669|EAP|Custom 95175669||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Erin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7/3.5mm Va-lcp 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,786.65|FSC: 13; Default||Not reimbursed separately|4,786.65|FSC: 13; Default||External grouping not supported 95175671|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175672|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 9cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175673|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 5fr 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175674|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 7fr 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175675|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 7fr 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175676|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 7fr 7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95175677|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 7fr 9cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175678|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 7fr 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175679|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic 7fr 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175680|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 26mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95175681|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 30mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95175682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 36mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95175683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 40mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95175684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 8 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95175688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95175689|EAP|Custom 95175689||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Large Coroent 10 X 22 X 60|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95175690|EAP|Custom 95175690||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Large Coroent 12 X 22 X 60|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95175691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95175692|EAP|Custom 95175692||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Infuse Extra Small|1|HUMANA [1294]||HUMANA [11839]|5,715.00|FSC: 13; Default||Not reimbursed separately|5,715.00|FSC: 13; Default||External grouping not supported 95175693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Fixation Screw Triathlon Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95175694|EAP|Custom 95175694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Retracta Detachalble Embolization 35 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175695|EAP|Custom 95175695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Retracta Detachalble Embolization 35 8fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts Total Sz 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95175697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 7 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95175698|EAP|Custom 95175698||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interlock 5mm|1|HUMANA [1294]||HUMANA [11839]|8,010.00|FSC: 13; Default||Not reimbursed separately|8,010.00|FSC: 13; Default||External grouping not supported 95175699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Coroent 12 X 3.5mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95175700|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Ansel Flexor 6fr .035 Diameter 55cm Multipurpose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175701|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Ansel Flexor 7fr .035 Diameter 55cm Multipurpose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175702|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Ansel Flexor Rtps 6fr .035 Diameter 70cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Caddy Vuepoint|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.00|FSC: 13; Default||Not reimbursed separately|711.00|FSC: 13; Default||External grouping not supported 95175705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Tulip 3.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,080.00|FSC: 13; Default||Not reimbursed separately|4,080.00|FSC: 13; Default||External grouping not supported 95175706|EAP|Custom 95175706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Suture Hoffee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80165699|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Bubble Infant Initial Day|1|HUMANA [1294]||HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 80165707|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Bubble Infant Subseq Day|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95175560|EAP|Custom 95175560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needles 150mm 18g 10mm 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175707|EAP|Custom 95175707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ultraverse 4 X 30 X 150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175708|EAP|Custom 95175708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ultraverse 5 X 30 X 150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175709|EAP|Custom 95175709||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ultraverse 5 X 15 X 150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175710|EAP|Custom 95175710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ultraverse 3.5 X 30 X 150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175711|EAP|Custom 95175711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Rival 8 X 8 X 80|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175712|EAP|Custom 95175712||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Rival 6 X 4 X 80|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175713|EAP|Custom 95175713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Rival 3 X 10 X 135|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175714|EAP|Custom 95175714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Rival 4 X15 X 135|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175715|EAP| 95175715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Rival 6 X 15 X 135|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175716|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Fluency Plus 10mm X 60mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95175717|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Tracheobronchial Fluency Plus 8mm X 40mm X 117cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4.0 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95175719|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 590cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95175721|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Rx 2.8 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95175722|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Rx 4.5 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95175725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Injex Bumpy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95175726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneus Step 7.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95175727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 14mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.50|FSC: 13; Default||Not reimbursed separately|148.50|FSC: 13; Default||External grouping not supported 95175728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 6mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95175729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 7mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95175730|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 7 Fr X 5 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175731|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 7 Fr X 7 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175732|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 7 Fr X 9 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95175733|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 7 Fr X 12 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175734|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 7 Fr X 15 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175735|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 10 Fr X 5 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95175736|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 10 Fr X 9 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175737|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Cotton Huebregise 10 Fr X 15 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.0mm 39mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95175739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 10mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95175740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 12mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|FSC: 13; Default||Not reimbursed separately|231.45|FSC: 13; Default||External grouping not supported 95175741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.0mm X 14mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.38|FSC: 13; Default||Not reimbursed separately|238.38|FSC: 13; Default||External grouping not supported 95175742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 6mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95175743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 7mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95175744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 8mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95175745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 10mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95175746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.3mm X 14mm Self Tapping Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.20|FSC: 13; Default||Not reimbursed separately|250.20|FSC: 13; Default||External grouping not supported 95175748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 6 Hole 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|637.29|FSC: 13; Default||Not reimbursed separately|637.29|FSC: 13; Default||External grouping not supported 95175749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Web 2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.50|FSC: 13; Default||Not reimbursed separately|1,402.50|FSC: 13; Default||External grouping not supported 95175750|EAP|Custom 95175750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Putty With Cancellous Chips 300 Express 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,940.00|FSC: 13; Default||Not reimbursed separately|8,940.00|FSC: 13; Default||External grouping not supported 95182361|EAP|Custom 95182361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Connecting 3mm X 50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95175753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hammetoe Vo Pro Size 2.8mm X 9mm 10degree Angel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95175754|EAP|Custom 95175754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Labraltape White 1.5mm 36 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182362|EAP|Custom 95182362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin/rod Clamp Micro Hii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182364|EAP|Custom 95182364||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shears Coagulating Harmonic 23cm Length With Adaptive Tissu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixos Mv 4.0 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95182376|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Stent And Delivery Colonic Wallflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95182366|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ensnare 9-15mm Catheter 6fr X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixos Mv 4.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95182369|EAP|Custom 95182369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Fixos 1.4mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182346|EAP|Custom 95182346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Swiftset Topical Skin 0.8ml Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182368|EAP|Custom 95182368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Nasojejunal 5 Fr 22" Non Weighted W/stylet 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182365|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ensnare 12-20mm Catheter 6fr X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182367|EAP|Custom 95182367||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Impact Spikeright Plus 6 X 1000ml 6/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182370|EAP|Custom 95182370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Nasojejunal 6 Fr 22" 1 Gr Weighted W/stylet 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 46mm Self Tapping With Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95175755|EAP|Custom 95175755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire 0.9mm X 70mm Fixo's|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95175757|EAP|Custom 95175757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Cannulated Fixo's 3.5 X 17mm|1|HUMANA [1294]||HUMANA [11839]|583.80|FSC: 13; Default||Not reimbursed separately|583.80|FSC: 13; Default||External grouping not supported 95175759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 40mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95175760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Medial Distal Ts 16 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,648.50|FSC: 13; Default||Not reimbursed separately|4,648.50|FSC: 13; Default||External grouping not supported 95175761|EAP|Custom 95175761||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Infant Delivery|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Journey Pf Med Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|FSC: 13; Default||Not reimbursed separately|12,599.40|FSC: 13; Default||External grouping not supported 95175763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Gns Ii Resuf 29mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|FSC: 13; Default||Not reimbursed separately|2,409.00|FSC: 13; Default||External grouping not supported 95175767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 14mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95175768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Component Stabilizer Ts Total Sz 2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95175769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Distal Augment Triathlon 3 10mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95175770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copeland Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,323.00|FSC: 13; Default||Not reimbursed separately|19,323.00|FSC: 13; Default||External grouping not supported 95175771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femoral Stem Taper Uncemented Wagner Sl 5 Degree Protasul 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,847.50|FSC: 13; Default||Not reimbursed separately|21,847.50|FSC: 13; Default||External grouping not supported 95175772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Edgelock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,081.00|FSC: 13; Default||Not reimbursed separately|3,081.00|FSC: 13; Default||External grouping not supported 95175775|EAP|Custom 95175775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bonnet Infant Midline 17cm-22cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175776|EAP|Custom 95175776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bonnet Infant Midline 22cm-25cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175777|EAP|Custom 95175777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bonnet Infant Midline 25cm-29cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Cannulated 13mm Ex 375mm Ts|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,720.59|FSC: 13; Default||Not reimbursed separately|4,720.59|FSC: 13; Default||External grouping not supported 95175779|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Acutrak 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95175780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 12x340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95175781|EAP|Custom 95175781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stalif Midline 33 Mmx 15 Mm X 8 Degree|1|HUMANA [1294]||HUMANA [11839]|25,200.00|FSC: 13; Default||Not reimbursed separately|25,200.00|FSC: 13; Default||External grouping not supported 95182374|EAP|Custom 95182374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Nasojejunal 8 Fr 36" Weighted W/stylet 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182375|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Stent And Delivery Colonic Wallflex 25mm X 90 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95175790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Web 2.5mm Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.50|FSC: 13; Default||Not reimbursed separately|1,402.50|FSC: 13; Default||External grouping not supported 95175792|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Allofit Trilogy Continuum Longevity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|FSC: 13; Default||Not reimbursed separately|4,192.50|FSC: 13; Default||External grouping not supported 95175796|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Extra Large Check Flo 20fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175797|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Hd Navigator 12 14fr X 36cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175798|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Hd Navigator 12 14fr X 46cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175773|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 6.0 Diopter Acrysof Toric Iq 13.0mm Length 6.0mm Aspheric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95175774|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 6.5 Diopter Acrysof Toric Iq 13.0mm Length 6.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95175785|EAP|Custom 95175785||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Solution Vitrebond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175786|EAP|Custom 95175786||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Conditioner Cavity|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182389|EAP|Custom 95182389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon Endoscopic Powered 45mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95165184|EAP|Custom 95165184||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Arm Freedom Medium With Hook And Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175788|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Metal Biliary 10mm 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182380|EAP|Custom 95182380||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Cobalt Mv 40gm|1|HUMANA [1294]||HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95175816|EAP|Custom 95175816||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Patellar Ligament 10mm Dowel Aseptic|1|HUMANA [1294]||HUMANA [11839]|9,900.00|FSC: 13; Default||Not reimbursed separately|9,900.00|FSC: 13; Default||External grouping not supported 95175817|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Evera Xtvr Single Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,974.00|FSC: 13; Default||Not reimbursed separately|40,974.00|FSC: 13; Default||External grouping not supported 95175818|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Evera Xtvr Single Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,500.00|FSC: 13; Default||Not reimbursed separately|37,500.00|FSC: 13; Default||External grouping not supported 95175819|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Evera Xtdr Dual Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,100.00|FSC: 13; Default||Not reimbursed separately|38,100.00|FSC: 13; Default||External grouping not supported 95175820|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Evera Xtdr Dual Chamber Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,100.00|FSC: 13; Default||Not reimbursed separately|38,100.00|FSC: 13; Default||External grouping not supported 95175822|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Advisadual Chamber Mri|1|HUMANA [1294]||HUMANA [11839]|12,096.00|FSC: 13; Default||Not reimbursed separately|12,096.00|FSC: 13; Default||External grouping not supported 95175823|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Viva Xt Crt-d Bi-vent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|FSC: 13; Default||Not reimbursed separately|50,100.00|FSC: 13; Default||External grouping not supported 95175824|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defribrillator Viva Xt Crt-d Bi-vent Icd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|FSC: 13; Default||Not reimbursed separately|50,100.00|FSC: 13; Default||External grouping not supported 95175825|EAP|Custom 95175825||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Arm Freedom Small With Hook And Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175826|EAP|Custom 95175826||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Arm Freedom Large With Hook And Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175800|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Sinuplasty Balloon Frontal Spin Relieva|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175801|EAP|Custom 95175801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Replacement Gastroscopy Tube 20 Fr Curved Rt Angle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Metatarsal Movement Size 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,814.40|FSC: 13; Default||Not reimbursed separately|7,814.40|FSC: 13; Default||External grouping not supported 95175803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Proximal Phalanx Total Movement Mgt Size 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,095.16|FSC: 13; Default||Not reimbursed separately|6,095.16|FSC: 13; Default||External grouping not supported 95175804|EAP|Custom 95175804||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Surface Metatarsal Size 30/40|1|HUMANA [1294]||HUMANA [11839]|623.19|FSC: 13; Default||Not reimbursed separately|623.19|FSC: 13; Default||External grouping not supported 95175805|EAP|Custom 95175805||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reamer Surface Phalanx Proximal Size 30/40|1|HUMANA [1294]||HUMANA [11839]|623.19|FSC: 13; Default||Not reimbursed separately|623.19|FSC: 13; Default||External grouping not supported 95175806|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Catheter Guide Sinus Spin Relieva Maxillary|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175807|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Catheter Guide Sinus Spin Relieva Sphenoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175808|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix Knotless 4.75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95175812|EAP|Custom 95175812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Optiseal 7fr X 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175813|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Graft Stent Endurant Ii Bifurcated 28mm X 16mm X 128cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,925.00|FSC: 13; Default||Not reimbursed separately|29,925.00|FSC: 13; Default||External grouping not supported 95175814|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Graft Stent Endurant Ii Limb Contralateral 16 10 X 93cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,775.00|FSC: 13; Default||Not reimbursed separately|14,775.00|FSC: 13; Default||External grouping not supported 95175815|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Graft Stent Endurant Ii Limb Contralateral 16 10 X 156cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|FSC: 13; Default||Not reimbursed separately|19,200.00|FSC: 13; Default||External grouping not supported 95175836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 O Degree 32mm E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95182379|EAP|Custom 95182379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cartridge Capacity Maximum Dbl. Mix Optivac 80gr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Orthocord Mo-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95175838|EAP|Custom 95175838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Orthocord Mo-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175839|EAP|Custom 95175839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 9.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patella Resurfacing Genesis Oval 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|FSC: 13; Default||Not reimbursed separately|2,719.20|FSC: 13; Default||External grouping not supported 95175841|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 10.0mm X 29mm Catheter Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95175842|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Micro Valet 1.8f 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175843|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 10.0mm X 39mm Catheter Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95175844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Tibial Constrained Legion Size 3-4 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 95175845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tibial Long Genesis Ii 10mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|FSC: 13; Default||Not reimbursed separately|3,999.60|FSC: 13; Default||External grouping not supported 95175846|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 10.0mm X 59mm Catheter Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95175847|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 10.0mm X 29mm Catheter Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95175848|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 10.0mm X 39mm Catheter Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95182378|EAP|Custom 95182378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Shoulder Std 8 46x18x53|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175849|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Omnilink Elite 10.0mm X 59mm Catheter Length 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95175850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Marathon Duraloc Poly +4 10 Degree 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|FSC: 13; Default||Not reimbursed separately|7,629.30|FSC: 13; Default||External grouping not supported 95175851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Lock Dynamic Duracon 56 Or 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|FSC: 13; Default||Not reimbursed separately|1,169.70|FSC: 13; Default||External grouping not supported 95175852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx Pinnacle Poly +4 10 Degree 32 Mm 50 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|FSC: 13; Default||Not reimbursed separately|5,472.60|FSC: 13; Default||External grouping not supported 95175853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ts Delta Ceramic Ts 12 14 32mm +9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,563.80|FSC: 13; Default||Not reimbursed separately|8,563.80|FSC: 13; Default||External grouping not supported 95175854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Meniscal Repair Omnispan 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95175855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Meniscal Repair Omnispan 12 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95175856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix Knotless 4.75mm Biocryl Rapide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95175857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Advance Healix Knotless 5.5mm Biocryl Rapide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95175858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95175861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95175862|EAP|Custom 95175862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Locking Reamer Irrigator/aspirator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175863|EAP|Custom 95175863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Shaft Drive Sterile Ria For 314.743|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175864|EAP|Custom 95175864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Tube Ria 520mm Fir 314.743|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175865|EAP|Custom 95175865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Reamer 15.0mm For Reamer Irrigator Aspirator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175867|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular 30 X 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95175868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 13h 104mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95175869|EAP|Custom 95175869||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calib 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175866|EAP|Custom 95175866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Reamer 16.0mm For Reamer Irrigator Aspirator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95175871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Locking 3.5mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95175872|EAP|Custom 95175872||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Absorbable Vitasure 3 Gram|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175874|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 9f Vista Brite Ar 1 .098 98 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175875|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding 9f Vista Brite Al 1 .098 98 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175876|EAP|Custom 95175876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Curette Kyphon Size 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175877|EAP|Custom 95175877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Papella Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175878|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Monoblock Rsp Size 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95175880|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Zenith Fenestrated Proximal Main Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95175881|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Distal Bifurcated Main Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95175882|EAP|Custom 95175882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Tube Venaflow Elite Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062054|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Drug Panel Ql, Umb Cord - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62062062|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Pain Mgmt Drug Panel, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62062088|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Amphetamine Confirmation, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062096|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Barbiturate Confirmation, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062104|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Benzodiazepines Confirmation, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062112|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cannabinoid Confirmation, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062120|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cocaine Confirmation, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062138|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Methadone Confirmation, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062146|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Pcp Confirmation, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062153|EAP|CPT® 82542||0301 - LABORATORY - CHEMISTRY|Hb Antidepressant Panel, Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|72.27|FSC: 13; Default||Not reimbursed separately|72.27|FSC: 13; Default||External grouping not supported 95182387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation Block Aming Dr Variax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|FSC: 13; Default||Not reimbursed separately|913.50|FSC: 13; Default||External grouping not supported 95182381|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 80165715|EAP|Custom 80165715||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Minor Surgical Procedure|1|HUMANA [1294]||HUMANA [11839]|5,722.50|FSC: 13; Default||Not reimbursed separately|5,722.50|FSC: 13; Default||External grouping not supported 80165723|EAP|Custom 80165723||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Major Surgical Procedure|1|HUMANA [1294]||HUMANA [11839]|6,676.25|FSC: 13; Default||Not reimbursed separately|6,676.25|FSC: 13; Default||External grouping not supported 80165731|EAP|Custom 80165731||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Complex Surgical Procedure|1|HUMANA [1294]||HUMANA [11839]|7,766.25|FSC: 13; Default||Not reimbursed separately|7,766.25|FSC: 13; Default||External grouping not supported 80165749|EAP|Custom 80165749||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Lap Surgical Procedure|1|HUMANA [1294]||HUMANA [11839]|7,766.25|FSC: 13; Default||Not reimbursed separately|7,766.25|FSC: 13; Default||External grouping not supported 80165756|EAP|Custom 80165756||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb C-section Surgical Procedure|1|HUMANA [1294]||HUMANA [11839]|7,766.25|FSC: 13; Default||Not reimbursed separately|7,766.25|FSC: 13; Default||External grouping not supported 80165764|EAP|Custom 80165764||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Minor Surgical Minute|1|HUMANA [1294]||HUMANA [11839]|106.28|FSC: 13; Default||Not reimbursed separately|106.28|FSC: 13; Default||External grouping not supported 80165772|EAP|Custom 80165772||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Major Surgical Minute|1|HUMANA [1294]||HUMANA [11839]|138.98|FSC: 13; Default||Not reimbursed separately|138.98|FSC: 13; Default||External grouping not supported 80165780|EAP|Custom 80165780||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Complex Surgical Minute|1|HUMANA [1294]||HUMANA [11839]|149.88|FSC: 13; Default||Not reimbursed separately|149.88|FSC: 13; Default||External grouping not supported 80165798|EAP| 80165798||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Lap Surgical Minute|1|HUMANA [1294]||HUMANA [11839]|149.88|FSC: 13; Default||Not reimbursed separately|149.88|FSC: 13; Default||External grouping not supported 80165806|EAP| 80165806||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb C-section Surgical Minute|1|HUMANA [1294]||HUMANA [11839]|149.88|FSC: 13; Default||Not reimbursed separately|149.88|FSC: 13; Default||External grouping not supported 95175884|EAP|Custom 95175884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Bidirectional 12-pin 10-stp Blue 10'|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175885|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tcool Sf Carto 3uni D Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175886|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tcool Sf Carto Tc, F Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175887|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Tcool Sf Carto Tc, J Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175888|EAP|Custom 95175888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable 34hyp 34lemo 10'|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175889|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lassonav 15mm 10 Pole 7 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175890|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lassonav 20mm 7 Fr Sh 12p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175891|EAP|Custom 95175891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Lasso 9' Split Handle Ext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175892|EAP|Custom 95175892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Sp02 Sensor Finger Adult Reusable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175893|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Worley Adv Telescopic Lvi 7fr 62 Cm Renal System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182382|EAP|Custom 95182382||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated Badger 10.0mm X 22.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175894|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Kit Worley Adv Std W/braided Core 9fr 50cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175895|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Kit Worley Jumbo W/braided Core 9fr 59cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175896|EAP|Custom 95175896||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vein Selector Coronary Standard 5fr 75cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80165814|EAP|CPT® 43999||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Lap Band Adjustment|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 95175897|EAP|Custom 95175897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vein Selector Coronary Standard 5fr 75cm Vertebral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175898|EAP|Custom 95175898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vein Selector Coronary Standard 5fr 75cm Hook|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Insert Tibial Flex Hi Gii Sz 3 4 18mm Nickel Free|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|FSC: 13; Default||Not reimbursed separately|4,098.60|FSC: 13; Default||External grouping not supported 95175903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Constrained Oxinum Legion Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 95175904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Legion Straight 18mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 95175905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Revision Legion Sz 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 95175906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Legion Straight 10mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 95175907|EAP|Custom 95175907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Chisel Straight 12 X 40 X 1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182383|EAP|Custom 95182383||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Radiesse 1.0cc (ship With Percutaneous Needle #pn9001m0)|1|HUMANA [1294]||HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95175908|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Swartz Braided Transseptal 8.5fr 63cm Sl0|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175909|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Swartz Braided Transseptal 8.5fr 63cm Sl1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175910|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Safe-t-j Curved .032 145 Length 3mm Tip Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175911|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Avanti 10fr 23cm Box 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175912|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Avanti 11fr 23cm Box 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175913|EAP|Custom 95175913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Transseptal 135cm Radiopaque Coil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Unite Global Standard Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.75|FSC: 13; Default||Not reimbursed separately|9,213.75|FSC: 13; Default||External grouping not supported 95175915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collar Unite Global Size 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,701.00|FSC: 13; Default||Not reimbursed separately|1,701.00|FSC: 13; Default||External grouping not supported 95175916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Unite Global Size 10 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,194.00|FSC: 13; Default||Not reimbursed separately|4,194.00|FSC: 13; Default||External grouping not supported 95175917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unite Global 44mm X 18 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|FSC: 13; Default||Not reimbursed separately|6,039.00|FSC: 13; Default||External grouping not supported 80165822|EAP|Custom 80165822||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Aprn In Home Visit|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 80165830|EAP|Custom 80165830||0650 - HOSPICE SERVICE - GENERAL CLASSIFICATION|Hb Aprn In Unit Visit|1|HUMANA [1294]||HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 95171880|EAP|Custom 95171880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Medium-large Hem-o-lok Green 6 Cartridge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175899|EAP|Custom 95175899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Contrast Injection System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175900|EAP|Custom 95175900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Impress Azygous Left 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175901|EAP|Custom 95175901||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Impress Azygous Right 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175920|EAP|Custom 95175920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vein Impress Coronary|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175921|EAP|Custom 95175921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Transport 8mm Length 1,2,3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Advance Milagro 8mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95175923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Advance Milagro 9mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95175924|EAP|Custom 95175924||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Spectron Ptk|1|HUMANA [1294]||HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95175925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Small 5 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95175926|EAP|Custom 95175926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95175928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95175929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|FSC: 13; Default||Not reimbursed separately|279.00|FSC: 13; Default||External grouping not supported 95175930|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Y Upsylon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|FSC: 13; Default||Not reimbursed separately|1,770.00|FSC: 13; Default||External grouping not supported 95175931|EAP|Custom 95175931||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Positioning Vaginal Colpassist Upsylon|1|HUMANA [1294]||HUMANA [11839]|1,083.75|FSC: 13; Default||Not reimbursed separately|1,083.75|FSC: 13; Default||External grouping not supported 95175932|EAP|Custom 95175932||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Path Gel Point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Dbr Iii 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95175934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Dbr Iii 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95175935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95175936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95175937|EAP|Custom 95175937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Milling 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175938|EAP|Custom 95175938||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prodisc Large 5mm|1|HUMANA [1294]||HUMANA [11839]|17,697.00|FSC: 13; Default||Not reimbursed separately|17,697.00|FSC: 13; Default||External grouping not supported 95175940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.60|FSC: 13; Default||Not reimbursed separately|777.60|FSC: 13; Default||External grouping not supported 95126847|EAP|Custom 95126847||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Needle Curved|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166138|EAP|Custom 95166138||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Device Fixation Small 21-26cm Infant Ncpap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95166140|EAP|Custom 95166140||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Device Fixation Large 32-37cm Infant Ncpap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175943|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Maestro 2.9 2.9f 130cm Swan Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175944|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Maestro 2.8f 130 Length Swan Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Fibular Peri 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,977.60|FSC: 13; Default||Not reimbursed separately|1,977.60|FSC: 13; Default||External grouping not supported 95175946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.78|FSC: 13; Default||Not reimbursed separately|276.78|FSC: 13; Default||External grouping not supported 95175947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95175948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Talar Ankle Total Metal Trabecular Zimmer Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|FSC: 13; Default||Not reimbursed separately|16,050.00|FSC: 13; Default||External grouping not supported 95175950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Base Tibial Ankle Total Metal Trabecular Zimmer Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|FSC: 13; Default||Not reimbursed separately|12,150.00|FSC: 13; Default||External grouping not supported 95175951|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Insert Tibial Poly Crosslinked Prolong Tm Zimmer Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|FSC: 13; Default||Not reimbursed separately|4,575.00|FSC: 13; Default||External grouping not supported 95175952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Sulphate Calcium Stimulan Rapid Cure 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,557.00|FSC: 13; Default||Not reimbursed separately|4,557.00|FSC: 13; Default||External grouping not supported 95175953|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Worley Telescopic Braided Hockey Stick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175954|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Ultraverse 3.0 X 30 X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175956|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Steerable Fathom 14 Cm Straight Tip Length 200 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175958|EAP|Custom 95175958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Polygrab Disposable 5 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80165848|EAP|CPT® 15115||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidermal Autograft Face/scalp/hands/feet First 100sqcm|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80165857|EAP|CPT® 84703||0301 - LABORATORY - CHEMISTRY|Hb Poc Urine Preg Automated|1|HUMANA [1294]||HUMANA [11839]|22.56|FSC: 13; Default||Not reimbursed separately|22.56|FSC: 13; Default||External grouping not supported 62062161|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Buprenorphine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62062179|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb 6 Am (heroin)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80165863|EAP|CPT® 20520||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Foreign Body|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95175970|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 190cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95175971|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 235cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95175972|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 275cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95175974|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Classic Textured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95175975|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone Projection Moderate Base Classic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95175976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 10mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95175977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 12mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95175978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Straight 2.4mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95182385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex 3 X 60 10 Cont Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95175973|EAP|Custom 95175973||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Stabilization Shoulder Marcolina|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175980|EAP|Custom 95175980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blanks Lead Spare Scs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95175982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95175983|EAP|Custom 95175983||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Void Bone Sulphate Calcium Cure Rapid Stimulan 5cc|1|HUMANA [1294]||HUMANA [11839]|3,582.00|FSC: 13; Default||Not reimbursed separately|3,582.00|FSC: 13; Default||External grouping not supported 95175991|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Osteochondral Chondrofix 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,388.00|FSC: 13; Default||Not reimbursed separately|8,388.00|FSC: 13; Default||External grouping not supported 95175992|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Osteochondral Chondrofix 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,920.00|FSC: 13; Default||Not reimbursed separately|10,920.00|FSC: 13; Default||External grouping not supported 95175993|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Osteochondral Chondrofix 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,049.00|FSC: 13; Default||Not reimbursed separately|11,049.00|FSC: 13; Default||External grouping not supported 95175994|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Osteochondral Chondrofix 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,231.00|FSC: 13; Default||Not reimbursed separately|12,231.00|FSC: 13; Default||External grouping not supported 95175995|EAP|Custom 95175995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Jones 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95175996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent Nxt 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|FSC: 13; Default||Not reimbursed separately|1,452.30|FSC: 13; Default||External grouping not supported 95182386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Intermediate Dr Volar 14 Hole Left Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.00|FSC: 13; Default||Not reimbursed separately|4,755.00|FSC: 13; Default||External grouping not supported 80165871|EAP|CPT® 92990||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Percutaneous Pulmonary Valve Valvuplasty|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95176003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 45mm Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95176004|EAP|Custom 95176004||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 50mm Cancellous|1|HUMANA [1294]||HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95176005|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Osteo Osferion 15mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95176006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 4.5 X 32mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95176007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 4.5 X 36mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95176008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti 4.5 X 48mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95176009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wedge Sloped Hto Contourlock 15mm Lf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95176014|EAP|||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Handpiece Ligasure Impact Open 18cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176026|EAP|Custom 95176026||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread 6.5mm X 85mm|1|HUMANA [1294]||HUMANA [11839]|112.50|FSC: 13; Default||Not reimbursed separately|112.50|FSC: 13; Default||External grouping not supported 95176027|EAP|Custom 95176027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Cpx3 Contour Height Low Textured 550cc|1|HUMANA [1294]||HUMANA [11839]|4,785.00|FSC: 13; Default||Not reimbursed separately|4,785.00|FSC: 13; Default||External grouping not supported 95176028|EAP|Custom 95176028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xd Expandable Convex 29mm X 9mm X 7mm|1|HUMANA [1294]||HUMANA [11839]|18,297.00|FSC: 13; Default||Not reimbursed separately|18,297.00|FSC: 13; Default||External grouping not supported 95176030|EAP|Custom 95176030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tube Feeding Mic-key 18fr 3.5 Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Dbr Iii 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95176032|EAP|Custom 95176032||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Spherx Long|1|HUMANA [1294]||HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95176033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95176034|EAP|Custom 95176034||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nanopass Cresent Reach|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95176036|EAP|Custom 95176036||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Loop T-lif 8 X 32 Mm X 6 Degrees|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95114054|EAP|Custom 95114054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Fixation W Spike X-sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114055|EAP|Custom 95114055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Fixation W Spike Sm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176019|EAP|Custom 95176019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Extraction Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 15mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95176021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Mod 4 X 150 50 Cont Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95176022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting Mri Compact 5mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.75|FSC: 13; Default||Not reimbursed separately|357.75|FSC: 13; Default||External grouping not supported 95186591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Ulna 3hole/l65mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95176040|EAP|Custom 95176040||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 13mm|1|HUMANA [1294]||HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95176041|EAP|Custom 95176041||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Multidirection Threaded 2.5 X 16mm|1|HUMANA [1294]||HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95186594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 1.5 Trilock 09mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|FSC: 13; Default||Not reimbursed separately|409.05|FSC: 13; Default||External grouping not supported 95182393|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guiding Ansel Flexor Straight W/ Check Flo Valve/high|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176042|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ablation Only Kit No Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176044|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace Harmonic 45cm Handle Ergonomic Reprocessed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182394|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guiding Ansel Flexor Multi-purpose W/ Check Flo Valve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175939|EAP|Custom 95175939||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Inserter Tip For Large Deep Implants|1|HUMANA [1294]||HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95176045|EAP|Custom 95176045||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nail Fixation Trochanteric Ti 11mm Sterile|1|HUMANA [1294]||HUMANA [11839]|1,838.67|FSC: 13; Default||Not reimbursed separately|1,838.67|FSC: 13; Default||External grouping not supported 95176046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Bb 2.5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,844.45|FSC: 13; Default||Not reimbursed separately|2,844.45|FSC: 13; Default||External grouping not supported 95176047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 10 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95182395|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff Amplatz Coated Tfe .035 Diameter X 260cm Len|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176048|EAP|Custom 95176048||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Drainage 7 Fr X 10 Cm|1|HUMANA [1294]||HUMANA [11839]|242.61|FSC: 13; Default||Not reimbursed separately|242.61|FSC: 13; Default||External grouping not supported 95176049|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Double Pigtail 7fr X 10 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|FSC: 13; Default||Not reimbursed separately|242.61|FSC: 13; Default||External grouping not supported 95176050|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Double Pigtail 10fr X 10 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|FSC: 13; Default||Not reimbursed separately|242.61|FSC: 13; Default||External grouping not supported 95182396|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cxi Support 4 Fr 90 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|FSC: 13; Default||Not reimbursed separately|228.00|FSC: 13; Default||External grouping not supported 95182403|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Head Radial Evolve Size 20mm +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95182404|EAP|Custom 95182404||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Mp Large 11x9x28 8 Degree|1|HUMANA [1294]||HUMANA [11839]|15,996.00|FSC: 13; Default||Not reimbursed separately|15,996.00|FSC: 13; Default||External grouping not supported 95182405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 5.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95176057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Universal Knee Total Triathlon Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|FSC: 13; Default||Not reimbursed separately|9,244.20|FSC: 13; Default||External grouping not supported 95176058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 8 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95176060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95176061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal Trabecular 16mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Oxinium Journey Ii Cr Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 95176063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Non Porous Journey Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 95176064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular M/l 68mm A/p 48mm Xlpe Cr Journey Ii Size3 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 95176065|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Unite Global Standard Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.75|FSC: 13; Default||Not reimbursed separately|9,213.75|FSC: 13; Default||External grouping not supported 95176066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collar Unite Global Size 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,701.00|FSC: 13; Default||Not reimbursed separately|1,701.00|FSC: 13; Default||External grouping not supported 95176067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Unite Global 48mm X 15 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|FSC: 13; Default||Not reimbursed separately|6,039.00|FSC: 13; Default||External grouping not supported 95159377|EAP|Custom 95159377||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Airway Laryngeal Disposable Size 2 Unique Standard Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176069|EAP|Custom 95176069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flex Quickset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176075|EAP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Incepta Icd Single Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,450.00|FSC: 13; Default||Not reimbursed separately|45,450.00|FSC: 13; Default||External grouping not supported 95176076|EAP|Custom 95176076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Management Incision Pressure Negative Prevena|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182408|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Metal Trabecular Size 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,109.50|FSC: 13; Default||Not reimbursed separately|12,109.50|FSC: 13; Default||External grouping not supported 95176080|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Curved .035" X 50cm Amplatz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176082|EAP|Custom 95176082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Hydrogel Neonatal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176083|EAP|Custom 95176083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Needle Low Impedance Neonatal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 40mm 12 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95176089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 4.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 95176090|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus Profile Moderate 475cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95176091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shank Mas Plif 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95176092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shank Mas Plif 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|FSC: 13; Default||Not reimbursed separately|2,520.00|FSC: 13; Default||External grouping not supported 95176093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shank Mas Plif 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95176094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shank Mas Plif 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95176095|EAP|Custom 95176095||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide Coroent 12 X 22 X 60mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95176096|EAP|Custom 95176096||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tulip Plif Mas Modular|1|HUMANA [1294]||HUMANA [11839]|3,693.00|FSC: 13; Default||Not reimbursed separately|3,693.00|FSC: 13; Default||External grouping not supported 95176097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Fixation Plif Mas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95176098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Conventional Spherx Ii 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,314.00|FSC: 13; Default||Not reimbursed separately|1,314.00|FSC: 13; Default||External grouping not supported 95176099|EAP|Custom 95176099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Plus Incisor Long Curved Elite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176100|EAP|Custom 95176100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cresent Shuttle Straight Accu Pass|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176101|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Extra Articular Right 12 Hole Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,479.58|FSC: 13; Default||Not reimbursed separately|6,479.58|FSC: 13; Default||External grouping not supported 95176102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Extra Articular Right 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,835.30|FSC: 13; Default||Not reimbursed separately|5,835.30|FSC: 13; Default||External grouping not supported 95176103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Extra Articular Left 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,769.46|FSC: 13; Default||Not reimbursed separately|4,769.46|FSC: 13; Default||External grouping not supported 95176104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Extra Articular Left 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,302.38|FSC: 13; Default||Not reimbursed separately|5,302.38|FSC: 13; Default||External grouping not supported 95176105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal 3.5 Lcp Extra Articular Left 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,866.56|FSC: 13; Default||Not reimbursed separately|5,866.56|FSC: 13; Default||External grouping not supported 95176106|EAP|Custom 95176106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Hd Navigator 13 15 Fr X 46cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Tm Multi Holes 52 Mm Size Ii Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,741.50|FSC: 13; Default||Not reimbursed separately|7,741.50|FSC: 13; Default||External grouping not supported 95176108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Muller Avenir Standard Uncemented Ha Taper 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,594.00|FSC: 13; Default||Not reimbursed separately|9,594.00|FSC: 13; Default||External grouping not supported 95176109|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 6.7mm X 85mm Cannulated Full Threaded 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95176111|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsurefix Novus 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|FSC: 13; Default||Not reimbursed separately|1,437.00|FSC: 13; Default||External grouping not supported 95176112|EAP|Custom 95176112||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Accessory Pacing Ball-tipped Stylet For 110cm Lead|1|HUMANA [1294]||HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95176113|EAP|Custom 95176113||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Accessory Pacing Ball-tipped Stylet For 110cm Lead|1|HUMANA [1294]||HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95176114|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Tachyarrhythmia Implantable Sprint Quattro Secure 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,152.00|FSC: 13; Default||Not reimbursed separately|10,152.00|FSC: 13; Default||External grouping not supported 95176115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked Highly Longevity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,412.50|FSC: 13; Default||Not reimbursed separately|3,412.50|FSC: 13; Default||External grouping not supported 95176116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Uncemented Taper 12 14 5 Degree Size 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95176117|EAP|Custom 95176117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Gemini Sr8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176118|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Performa 88cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95186595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 1.5 Trilock 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 95176122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 72.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 95176123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95176124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 48mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95176125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 20mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 80165897|EAP|Custom 80165897||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii In Pacu|1|HUMANA [1294]||HUMANA [11839]|508.74|FSC: 13; Default||Not reimbursed separately|508.74|FSC: 13; Default||External grouping not supported 80165905|EAP|Custom 80165905||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii Add Hr In Pacu|1|HUMANA [1294]||HUMANA [11839]|194.75|FSC: 13; Default||Not reimbursed separately|194.75|FSC: 13; Default||External grouping not supported 95176131|EAP|Custom 95176131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Olive Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176138|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Opta/pta Pro 10mm X 2cm 80mm Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Bb 1.2cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,659.42|FSC: 13; Default||Not reimbursed separately|1,659.42|FSC: 13; Default||External grouping not supported 95176140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 10 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95176141|EAP|Custom 95176141||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 10mm X 16mm X 26mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95176143|EAP|Custom 95176143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retaining Tube Nasal Bridle Amt 8fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176144|EAP|Custom 95176144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retaining Tube Nasal Bridle Amt 18fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 28mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95176154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Knotless Cinchlock 2.4mm W Inserter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,458.00|FSC: 13; Default||Not reimbursed separately|1,458.00|FSC: 13; Default||External grouping not supported 95176155|EAP|Custom 95176155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cinchlock 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176156|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95176163|EAP|Custom 95176163||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage T-lif Loop 10 X 32 5mm 6 Degree|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95176166|EAP|Custom 95176166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner Blunt Trocar 1.1mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176167|EAP|Custom 95176167||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.2mm Dartfire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176168|EAP|Custom 95176168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.5mm Dartfire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.00|FSC: 13; Default||Not reimbursed separately|573.00|FSC: 13; Default||External grouping not supported 95176170|EAP|Custom 95176170||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Crown Stainless Steel A4 Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95176172|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Performa 88cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95176173|EAP|Custom 95176173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray On Control 15cm 11g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176174|EAP|Custom 95176174||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tubing Irrigation Suction Strykerflow 2ps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 1.8mm Y Knot Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|FSC: 13; Default||Not reimbursed separately|897.00|FSC: 13; Default||External grouping not supported 95176176|EAP|Custom 95176176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.8mm Y Knot Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176177|EAP|Custom 95176177||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Obturator Blunt Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95176179|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 31mm X 14.5mm X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|FSC: 13; Default||Not reimbursed separately|30,735.00|FSC: 13; Default||External grouping not supported 95176180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 Anatomic Lfit 40mm 4 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|FSC: 13; Default||Not reimbursed separately|5,103.00|FSC: 13; Default||External grouping not supported 95176181|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Contralateral 16mm X 11.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95176182|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 12fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176183|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Endoprosthesis Lef Trunk Excluder C3 Gore 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|FSC: 13; Default||Not reimbursed separately|30,735.00|FSC: 13; Default||External grouping not supported 95176184|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 7fr 115cm Lasso 2515 Nav|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176187|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Blazer Ii Ablation 8fr 8mm Standard Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176188|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi Torque Whisper Ms Wire .14" X 190 Cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176189|EAP|Custom 95176189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Kit Stockert T Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7 3.5mm Va Lcp 6 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,838.61|FSC: 13; Default||Not reimbursed separately|4,838.61|FSC: 13; Default||External grouping not supported 95176191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 24mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95176192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 34mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95176194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95176195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Fibula 2.7mm 3 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,615.19|FSC: 13; Default||Not reimbursed separately|2,615.19|FSC: 13; Default||External grouping not supported 95176196|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 14mm Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95176197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95176198|EAP|Custom 95176198||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Nerve Advance 2 3mm X 15mm|1|HUMANA [1294]||HUMANA [11839]|7,251.00|FSC: 13; Default||Not reimbursed separately|7,251.00|FSC: 13; Default||External grouping not supported 95176199|EAP|Custom 95176199||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Nerve Advance 1 2mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|10,650.00|FSC: 13; Default||Not reimbursed separately|10,650.00|FSC: 13; Default||External grouping not supported 95176200|EAP|Custom 95176200||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Nerve Advance 2 3mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|11,184.00|FSC: 13; Default||Not reimbursed separately|11,184.00|FSC: 13; Default||External grouping not supported 95176201|EAP|Custom 95176201||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Nerve Advance 4 5mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|11,184.00|FSC: 13; Default||Not reimbursed separately|11,184.00|FSC: 13; Default||External grouping not supported 95176202|EAP|Custom 95176202||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 8mm X 9mm X 22mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95176203|EAP|Custom 95176203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176206|EAP|Custom 95176206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Esu Link To Smoke Evacuation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176207|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast 7mm X 22mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.75|FSC: 13; Default||Not reimbursed separately|7,167.75|FSC: 13; Default||External grouping not supported 95176208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95176209|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular 32 X 140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,371.00|FSC: 13; Default||Not reimbursed separately|37,371.00|FSC: 13; Default||External grouping not supported 95175204|EAP|Custom 95175204||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Mreye .038 Diameter X 5cm Length 10mm|1|HUMANA [1294]||HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95175205|EAP|Custom 95175205||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Mreye .035 Diameter X 3cm Length 5mm|1|HUMANA [1294]||HUMANA [11839]|294.93|FSC: 13; Default||Not reimbursed separately|294.93|FSC: 13; Default||External grouping not supported 95176212|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug 4 Vascular Amplatzer 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95176213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Holes 3 Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95176214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95176215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bold 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 95176216|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Performa 78cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95176222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal Trabecular 18mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95176223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal Trabecular 14mm X 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Metal Trabecular 16mm X 170mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95186593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 1.5 Trilock 06mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 95186605|EAP|Custom 95186605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.0mm X 70mm Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160467|EAP|Custom 95160467||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Filter Ventilator Esprit (old Part #1038401)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176210|EAP|||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Nerve Advance 3-4mm X 15mm|1|HUMANA [1294]||HUMANA [11839]|7,251.00|FSC: 13; Default||Not reimbursed separately|7,251.00|FSC: 13; Default||External grouping not supported 95176211|EAP|Custom 95176211||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Nerve Advance 4-5mm X 15mm|1|HUMANA [1294]||HUMANA [11839]|7,251.00|FSC: 13; Default||Not reimbursed separately|7,251.00|FSC: 13; Default||External grouping not supported 95176225|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Self Expanding Biliary Stent 6fr Diameter 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95176228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Allthread 5.5mm Peek Iii Tpd Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.00|FSC: 13; Default||Not reimbursed separately|942.00|FSC: 13; Default||External grouping not supported 95176229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95176230|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Monoblock Rsp Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95176231|EAP|Custom 95176231||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Clip Otsc Ovesco Model 12/6t|1|HUMANA [1294]||HUMANA [11839]|1,629.00|FSC: 13; Default||Not reimbursed separately|1,629.00|FSC: 13; Default||External grouping not supported 95186604|EAP|Custom 95186604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Post Straight 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176233|EAP|Custom 95176233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Radius Mto 5.5 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176234|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 3 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176235|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 3 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176236|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176237|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176238|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176239|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176240|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176241|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 4 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176242|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176243|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176244|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176245|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176249|EAP|||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Canister Prevena 45ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176250|EAP|Custom 95176250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Fistula And Wound Eakin W Tap Closure 9.7 X 6.3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95176252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95186601|EAP|Custom 95186601||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 45mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|49,968.00|FSC: 13; Default||Not reimbursed separately|49,968.00|FSC: 13; Default||External grouping not supported 95186606|EAP|Custom 95186606||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Infuse Xx Small|1|HUMANA [1294]||HUMANA [11839]|2,775.00|FSC: 13; Default||Not reimbursed separately|2,775.00|FSC: 13; Default||External grouping not supported 95186598|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.2/1.5 Trilock Scaphoid 3x2h T0.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,058.00|FSC: 13; Default||Not reimbursed separately|2,058.00|FSC: 13; Default||External grouping not supported 95186600|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fortex 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 80170777|EAP|HCPCS G0300||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Lpn Skilled Hh Or Hospice Nursing Each 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95186603|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Delta 12/14 32mm +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,563.80|FSC: 13; Default||Not reimbursed separately|8,563.80|FSC: 13; Default||External grouping not supported 95186599|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 4-9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95191753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Platform Rotationg Stab Aox Sz3 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|FSC: 13; Default||Not reimbursed separately|7,795.20|FSC: 13; Default||External grouping not supported 95186609|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95182414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Intermediate Left 11 Hole Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,574.00|FSC: 13; Default||Not reimbursed separately|5,574.00|FSC: 13; Default||External grouping not supported 95182412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg Crosspin 2.5x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|FSC: 13; Default||Not reimbursed separately|272.25|FSC: 13; Default||External grouping not supported 95182413|EAP|Custom 95182413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182409|EAP|Custom 95182409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Shoulder Sterile Custom 2/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg Crosspin 2.5x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|FSC: 13; Default||Not reimbursed separately|272.25|FSC: 13; Default||External grouping not supported 95182410|EAP|Custom 95182410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Bulldog Maxi Angled 45 Degree Blue Disposable 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182415|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex Covered Stent 23mmx12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,210.20|FSC: 13; Default||Not reimbursed separately|7,210.20|FSC: 13; Default||External grouping not supported 95191761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 3-14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95186608|EAP|Custom 95186608||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Cutimed Off-loader Select Synthetic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186612|EAP|Custom 95186612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.3mm Hard Bone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 105mm /100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95191765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 1.5 11.5mm X 38cm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95191766|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Intertan Titanium 85mm X 11mm Subtroch Low Profile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,700.97|FSC: 13; Default||Not reimbursed separately|1,700.97|FSC: 13; Default||External grouping not supported 951201056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Exeter V40 Stem 44mm No 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|FSC: 13; Default||Not reimbursed separately|10,892.70|FSC: 13; Default||External grouping not supported 95182425|EAP|Custom 95182425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Centurion Vitrectomy Anterior Probe 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182420|EAP|Custom 95182420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 5.5 X 25.5 X .6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182419|EAP|Custom 95182419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 9.5 X 30 X .64|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182421|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95182423|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95182422|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95182424|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95182418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii Sz #1 27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 80167182|EAP|Custom 80167182||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Prevention And Wellness 10 Classes 2 Hra|1|HUMANA [1294]||HUMANA [11839]|50.00|FSC: 13; Default||Not reimbursed separately|50.00|FSC: 13; Default||External grouping not supported 80167190|EAP|Custom 80167190||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Prevention And Wellness 10 Classes 1 Hra|1|HUMANA [1294]||HUMANA [11839]|35.00|FSC: 13; Default||Not reimbursed separately|35.00|FSC: 13; Default||External grouping not supported 80167208|EAP|Custom 80167208||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Prevention And Wellness Single Class|1|HUMANA [1294]||HUMANA [11839]|5.00|FSC: 13; Default||Not reimbursed separately|5.00|FSC: 13; Default||External grouping not supported 80167216|EAP|Custom 80167216||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cvm Vas Screening Exam Nc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169391|EAP|CPT® 77767||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Remote Hdr Skin Surf Brachytx Lesion Diam Up To 2.0cm Or 1 Channel|1|HUMANA [1294]||HUMANA [11839]|673.50|FSC: 13; Default||Not reimbursed separately|673.50|FSC: 13; Default||External grouping not supported 95191767|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 5.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|FSC: 13; Default||Not reimbursed separately|669.06|FSC: 13; Default||External grouping not supported 80169402|EAP|CPT® 77768||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Hdr Skin Surf Brachytx Up To 2 Cm Or 2 More Chan Or Mult Lesions|1|HUMANA [1294]||HUMANA [11839]|673.50|FSC: 13; Default||Not reimbursed separately|673.50|FSC: 13; Default||External grouping not supported 951201865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Trident 0¦ X3 Insert 36mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 80169413|EAP|CPT® 77770||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Remote Hdr Interstitial Or Intracavitary Brachytx 1 Channel|1|HUMANA [1294]||HUMANA [11839]|2,110.14|FSC: 13; Default||Not reimbursed separately|2,110.14|FSC: 13; Default||External grouping not supported 80169424|EAP|CPT® 77771||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Remote Hdr Interstitial Or Intracavitary Brachytx 2-12 Channels|1|HUMANA [1294]||HUMANA [11839]|2,110.14|FSC: 13; Default||Not reimbursed separately|2,110.14|FSC: 13; Default||External grouping not supported 95191769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Turon 46mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 80169435|EAP|CPT® 77772||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Remote Hdr Interstitial Or Intracavitary Brachytx Over 12 Channels|1|HUMANA [1294]||HUMANA [11839]|2,110.14|FSC: 13; Default||Not reimbursed separately|2,110.14|FSC: 13; Default||External grouping not supported 95191770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged All-poly E-plus 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 80169446|EAP|CPT® 78265||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Gastric Emptying Imaging Study With Small Bowel Transit|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95182430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 7.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95182433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Poly 7.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|FSC: 13; Default||Not reimbursed separately|3,612.00|FSC: 13; Default||External grouping not supported 95182435|EAP|Custom 95182435||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade Hyperlordotic 8x38x28mm 20degree|1|HUMANA [1294]||HUMANA [11839]|31,500.00|FSC: 13; Default||Not reimbursed separately|31,500.00|FSC: 13; Default||External grouping not supported 95182436|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted Revision 15mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95182434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Poly 7.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|FSC: 13; Default||Not reimbursed separately|3,612.00|FSC: 13; Default||External grouping not supported 95182432|EAP|Custom 95182432||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Asf26t Rod-rod 6.5h-5.5o|1|HUMANA [1294]||HUMANA [11839]|4,923.00|FSC: 13; Default||Not reimbursed separately|4,923.00|FSC: 13; Default||External grouping not supported 95182429|EAP|Custom 95182429||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Lordotic 10 X 11 X 25 8 Degree|1|HUMANA [1294]||HUMANA [11839]|10,284.00|FSC: 13; Default||Not reimbursed separately|10,284.00|FSC: 13; Default||External grouping not supported 95182426|EAP|Custom 95182426||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating Large Bone 9.5 X 30 X 0.64|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Posterior 12hole/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95182428|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guiding Ansel Flexor 7 Fr. X 55 Cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182427|EAP|Custom 95182427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating Large Bone 5.5 X 25.5 X 0.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Driver Ti Armada 6.25 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|FSC: 13; Default||Not reimbursed separately|771.00|FSC: 13; Default||External grouping not supported 80169457|EAP|CPT® 78266||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Gastric Empty Image Study W Small Bowel Colon Transit Multi Days|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 95182453|EAP|Custom 95182453||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Envelope Pacemaker Antibacterial Aigis Rx Large|1|HUMANA [1294]||HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95182452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aviator 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,384.95|FSC: 13; Default||Not reimbursed separately|7,384.95|FSC: 13; Default||External grouping not supported 95182450|EAP|Custom 95182450||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avg 4degree 5x12x14|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95182444|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95182449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recovery Variable Trimcor 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|FSC: 13; Default||Not reimbursed separately|1,128.00|FSC: 13; Default||External grouping not supported 95182446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Trimcor 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 95182443|EAP|HCPCS C1881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Kit Duramax Vascpak Dialysis 40cm|1|HUMANA [1294]||HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95182445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 3level 66 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,401.40|FSC: 13; Default||Not reimbursed separately|6,401.40|FSC: 13; Default||External grouping not supported 95182447|EAP|Custom 95182447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Standard Trimcor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182451|EAP|Custom 95182451||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avg 0degree 5x12x14|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95182455|EAP|Custom 95182455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Harmonic Ace 7 Laparoscopic 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182457|EAP|Custom 95182457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pillcam Sb3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recovery Fixed Trimcor 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|FSC: 13; Default||Not reimbursed separately|1,128.00|FSC: 13; Default||External grouping not supported 95182454|EAP|Custom 95182454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Harmonic Focus Shear 9cm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182462|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Battery Advanced Prime Non-recharable|1|HUMANA [1294]||HUMANA [11839]|36,000.00|FSC: 13; Default||Not reimbursed separately|36,000.00|FSC: 13; Default||External grouping not supported 95182468|EAP|Custom 95182468||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182460|EAP|Custom 95182460||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cuda 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182467|EAP|Custom 95182467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Non-threaded 1.6 220mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182458|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Duo Loop Lasso D/f Curve 25mm 3-8-3 Spacing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191771|EAP|Custom 95191771||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tubing Custom Rx X-coated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread Long 4.5x54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|FSC: 13; Default||Not reimbursed separately|1,170.30|FSC: 13; Default||External grouping not supported 95182459|EAP|Custom 95182459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cuda2.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread Long 4.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.33|FSC: 13; Default||Not reimbursed separately|1,047.33|FSC: 13; Default||External grouping not supported 95182466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread Long 4.5x56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|FSC: 13; Default||Not reimbursed separately|1,170.30|FSC: 13; Default||External grouping not supported 95182469|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel Memory Shape 480cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95182461|EAP|Custom 95182461||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pillcam Sb 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169468|EAP|CPT® 93050||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Arterial Pressure Waveform Analys Assess Central Arterial Pressures|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95182470|EAP|Custom 95182470||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Surgical Baxano Io-flex 10 Lpsi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167224|EAP|CPT® 36660||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cath Umbilical Artery Nicu|1|HUMANA [1294]||HUMANA [11839]|235.58|FSC: 13; Default||Not reimbursed separately|235.58|FSC: 13; Default||External grouping not supported 80167232|EAP|CPT® 36510||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cath Umbilical Vein Nicu|1|HUMANA [1294]||HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 80167240|EAP|CPT® 31500||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endotracheal Intubation Nicu|1|HUMANA [1294]||HUMANA [11839]|628.65|FSC: 13; Default||Not reimbursed separately|628.65|FSC: 13; Default||External grouping not supported 95182477|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retrieval Set Needle's Eye Snare 94cm 16fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182463|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Pocket 1 X 4|1|HUMANA [1294]||HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95182480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow 19mmx56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow 23mmx56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Cocr 28mm +9mm Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,284.00|FSC: 13; Default||Not reimbursed separately|4,284.00|FSC: 13; Default||External grouping not supported 95182484|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu Zenith 30mm X 43cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 95182485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 2 5mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95182486|EAP|Custom 95182486||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cancellous Chips 15cc|1|HUMANA [1294]||HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95182487|EAP|Custom 95182487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Closed Trachael Suction 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixos Mv 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95182482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixos Mv 4.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|FSC: 13; Default||Not reimbursed separately|1,033.20|FSC: 13; Default||External grouping not supported 95182483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Femoral Distal Anterior Or Posterior Sz E 5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95182488|EAP|Custom 95182488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Septal Entact|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191772|EAP|Custom 95191772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reservior Af And Oxygenator Advance Fx25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169479|EAP|CPT® 31652||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch W Ebus One Or Two Medial And Or Hilar Lymph Node Stations|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 80169480|EAP|CPT® 37252||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Intravascular Us During Diag Eval And Or Tx Interv Initial Vessel|1|HUMANA [1294]||HUMANA [11839]|4,323.82|FSC: 13; Default||Not reimbursed separately|4,323.82|FSC: 13; Default||External grouping not supported 95191762|EAP|Custom 95191762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical Trigen Intertan 11mm Lag Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169491|EAP|CPT® 37253||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Intravascular Us During Diag Eval And Or Tx Interv Each Add Vessel|1|HUMANA [1294]||HUMANA [11839]|3,481.48|FSC: 13; Default||Not reimbursed separately|3,481.48|FSC: 13; Default||External grouping not supported 80169512|EAP|CPT® 76499||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Laryngography, Contrast Radiological S And I|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95191754|EAP|Custom 95191754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handle Manual Std Endo Gia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182490|EAP|Custom 95182490||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 9mm X 9mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95182489|EAP|Custom 95182489||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 11mm X 11mm X 34mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95182491|EAP|Custom 95182491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Endo 3.0 T 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Locking 3 Hole Right 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|FSC: 13; Default||Not reimbursed separately|2,745.00|FSC: 13; Default||External grouping not supported 95182493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95182494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Knectiv Modular Neck 12/14 Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95182508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Gtn T2 10x400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|FSC: 13; Default||Not reimbursed separately|5,964.00|FSC: 13; Default||External grouping not supported 95182509|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Hinge Rotating Right Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|FSC: 13; Default||Not reimbursed separately|28,485.00|FSC: 13; Default||External grouping not supported 95182510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Tibia Hinge Rotating Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|FSC: 13; Default||Not reimbursed separately|14,130.00|FSC: 13; Default||External grouping not supported 95182511|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Size 4 10 Mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,107.50|FSC: 13; Default||Not reimbursed separately|5,107.50|FSC: 13; Default||External grouping not supported 95182512|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating Size E 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|FSC: 13; Default||Not reimbursed separately|6,255.00|FSC: 13; Default||External grouping not supported 95186618|EAP|Custom 95186618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Retrograde Femur Calibrated 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191755|EAP|Custom 95191755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Reinforced 2.0 Stapler 60mm Purple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186619|EAP|Custom 95186619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Retrograde Femur Calibrated 4.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186621|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nephrostomy Edelmann 18fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191756|EAP|Custom 95191756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler Tri 30mm Tan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182525|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Standard 44-36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,810.00|FSC: 13; Default||Not reimbursed separately|6,810.00|FSC: 13; Default||External grouping not supported 95182530|EAP|Custom 95182530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Bone Marrow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182524|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Humeral Reverse 44mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,679.00|FSC: 13; Default||Not reimbursed separately|8,679.00|FSC: 13; Default||External grouping not supported 95182526|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Reverse 6.5x30mmst/rst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95182522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Reverse 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,630.00|FSC: 13; Default||Not reimbursed separately|9,630.00|FSC: 13; Default||External grouping not supported 95182523|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoshere 36mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,540.00|FSC: 13; Default||Not reimbursed separately|12,540.00|FSC: 13; Default||External grouping not supported 95182520|EAP|Custom 95182520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glide Sheath Slender A Kit 6fr 10cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5hexagonal 4.75x15 St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95182528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5hexagonal 4.75x25st|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95182531|EAP|Custom 95182531||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Retaining Tube Nasal Bridle Amt 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182529|EAP|Custom 95182529||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Steinmann Threaded 3.2mm 9"|1|HUMANA [1294]||HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95186620|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hematuria 3 Way 22 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Retrograde Femoral 11.5mm X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,031.68|FSC: 13; Default||Not reimbursed separately|6,031.68|FSC: 13; Default||External grouping not supported 95191757|EAP|Custom 95191757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Reinforced Stapler 60mm Purple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0 X 85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|613.08|FSC: 13; Default||Not reimbursed separately|613.08|FSC: 13; Default||External grouping not supported 95186615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95191758|EAP|Custom 95191758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler Curved 30mm Tan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0 X 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|613.08|FSC: 13; Default||Not reimbursed separately|613.08|FSC: 13; Default||External grouping not supported 95191760|EAP|Custom 95191760||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler Tri 60mm Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182544|EAP|Custom 95182544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Mini Qc T-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182534|EAP|Custom 95182534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Sanitato Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182538|EAP|Custom 95182538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Jaweed Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182543|EAP|Custom 95182543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Implate Metacarpal 1 2.7mmx87mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182532|EAP|Custom 95182532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Zink Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182533|EAP|Custom 95182533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Breen Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182537|EAP|Custom 95182537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Noll Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical 2.8mmx5.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95182541|EAP|Custom 95182541||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Implate 7mmx15 Degree|1|HUMANA [1294]||HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95182536|EAP|Custom 95182536||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Holland Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Implant Distal Radius Short Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,268.00|FSC: 13; Default||Not reimbursed separately|2,268.00|FSC: 13; Default||External grouping not supported 95182539|EAP|Custom 95182539||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Nester Embolization 7-6|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95182556|EAP|Custom 95182556||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Scaled 2.6mmx135mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182550|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Nitinol 7 X 60 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95182565|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 2 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182566|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182568|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95116208|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Blue Max 6 X 4 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182561|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balln Mustang 6 X 4 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182557|EAP|Custom 95182557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Overdrill 3.5mmx12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182571|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 8 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mmxl22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mmxl22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182555|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Nitinol Se 8 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95182559|EAP|Custom 95182559||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide 2.6mm X L30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182553|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express Ld 6 X 27 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95182560|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express Ld 6 X 37 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95182548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Cvd 12hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|FSC: 13; Default||Not reimbursed separately|3,822.00|FSC: 13; Default||External grouping not supported 95182551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mmxl20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182570|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 8 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182572|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mmxl24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182563|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balln Charger 5 X 4 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182564|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balln Charger 6 X 2 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95182569|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 2.5 X 60 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Va-lcp 3.5mm X 117mm Small Bend 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,022.66|FSC: 13; Default||Not reimbursed separately|5,022.66|FSC: 13; Default||External grouping not supported 95182546|EAP|Custom 95182546||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm Drill Tip 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182567|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182558|EAP|Custom 95182558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide 2.0 X L30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot 1.0mm Mini 3-0 Ndls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95182581|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 4 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182588|EAP|Custom 95182588||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nifometer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182583|EAP|HCPCS C1786||0624 - MEDICAL SURGICAL SUPPLIES - EXTENSION OF 027X - FDA INVESTIGATIONAL DEVICES|Hb Pacemaker Leadless Nanostim|1|HUMANA [1294]||HUMANA [11839]|25,500.00|FSC: 13; Default||Not reimbursed separately|25,500.00|FSC: 13; Default||External grouping not supported 95182584|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95182587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3hole Small Curvature Radial Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,171.00|FSC: 13; Default||Not reimbursed separately|3,171.00|FSC: 13; Default||External grouping not supported 95182579|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 4 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182573|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 10 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182576|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182575|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 7 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182582|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182578|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 5 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182580|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 2.5 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182577|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 2.5 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182574|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182593|EAP|Custom 95182593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Moxy Xps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95182595|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Cardiovascular 0.4 X 3 Mm X 6 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 95182594|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Cardiovascular 0.4 X 3 Mm X 3 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95182590|EAP|Custom 95182590||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Perimeter 7x15x13mm|1|HUMANA [1294]||HUMANA [11839]|4,007.73|FSC: 13; Default||Not reimbursed separately|4,007.73|FSC: 13; Default||External grouping not supported 62062781|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Custom Pdm Panel - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62062799|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Mphenidate Qt-wo/mm-u-quest- Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062807|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Amphet-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062815|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Benzo-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062823|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Caris Metab-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062831|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Cocaine Met-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062849|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Gabapentin-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062856|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Methadone-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062864|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Opiates-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62062872|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Proproxy-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95182603|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Entension Cuff Aortic Proximal 28mm X 28mm Covered 95mm Open|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,497.00|FSC: 13; Default||Not reimbursed separately|16,497.00|FSC: 13; Default||External grouping not supported 95182601|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Bearing Persona Nexgen Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182597|EAP|Custom 95182597||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avs 5x14x16mm|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95182598|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Distal Sz E 20mm Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.00|FSC: 13; Default||Not reimbursed separately|3,915.00|FSC: 13; Default||External grouping not supported 95182600|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Rt Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182599|EAP|Custom 95182599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Specific Patient Nexgen Persona Ps|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169520|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vital Cough Charge Initial|1|HUMANA [1294]||HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95182606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg. Crosspin 2.5x6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|FSC: 13; Default||Not reimbursed separately|272.25|FSC: 13; Default||External grouping not supported 95182641|EAP|Custom 95182641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Irrigation Hybrid Endogator 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182615|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 12 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 11 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182611|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182613|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 10 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182619|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182625|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182608|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 5 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182609|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 6 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182605|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emerg.crosspin 2.5x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|FSC: 13; Default||Not reimbursed separately|272.25|FSC: 13; Default||External grouping not supported 95182639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182617|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182629|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 4 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182633|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,418.00|FSC: 13; Default||Not reimbursed separately|8,418.00|FSC: 13; Default||External grouping not supported 95182634|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 9 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182612|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 9 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182622|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182616|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182635|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 10 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182638|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182626|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow 24mmx56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182636|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 11 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182607|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182631|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182610|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 7 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182620|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182621|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182632|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Standard Size 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182618|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Standard Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow 27mmx56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182628|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Command Mp-r|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182646|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Moderate Height Full Projection 335cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95182647|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Cpx 4 Style 8300 350cc Tall Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 95182642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X L46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95182643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10mm X 375mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95182604|EAP|Custom 95182604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Suture Pure Silver 6 Per Pouch 10 Pouch/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Corticle 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|FSC: 13; Default||Not reimbursed separately|951.00|FSC: 13; Default||External grouping not supported 95182645|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Breast 300cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|FSC: 13; Default||Not reimbursed separately|3,990.00|FSC: 13; Default||External grouping not supported 95186622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Archon Self Tap Variable4.5x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95182658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Archon Selftap Fixed4.5x17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95182648|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 6mm X 80 X 80cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Archon Self Tap Fixed4.0x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95182651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Tap Cortical Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95182656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Archon 4 Level 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,792.00|FSC: 13; Default||Not reimbursed separately|3,792.00|FSC: 13; Default||External grouping not supported 95182659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Poly Crosslink Vivacit-e Persona Fixed Ps|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Archonself-tap Variable 4.5x15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95182657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammerlock Dip 12mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 95182678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182692|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182682|EAP|Custom 95182682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Stand Alone 23 Gauge 12/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182683|EAP|Custom 95182683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug 23 Gauge 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182687|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182674|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182667|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182669|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182681|EAP|Custom 95182681||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Perimeter 6mmx15mmx13mm|1|HUMANA [1294]||HUMANA [11839]|4,007.73|FSC: 13; Default||Not reimbursed separately|4,007.73|FSC: 13; Default||External grouping not supported 95182685|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182688|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182676|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182690|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182666|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182680|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Cemented Ps Standard Lt Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182677|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Rt Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Implate 2mmx15. 0degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95182729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Implate Metacarpal Mini 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|FSC: 13; Default||Not reimbursed separately|2,295.00|FSC: 13; Default||External grouping not supported 95182731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical 2.8mm X 7.0mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95182732|EAP|Custom 95182732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Implate Metacarpal 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182708|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182709|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182702|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Left Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182691|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Cemented Narrow Right Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95182699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182700|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182701|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182693|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182694|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182695|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182696|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182697|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182698|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Ps Porous Narrow Left Sz 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95182710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182711|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182712|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182769|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm (fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182791|EAP|Custom 95182791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Band Electrode Frequency High 24 Fr 12 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182789|EAP|Custom 95182789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Button Electrode Frequency High 30 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182792|EAP|Custom 95182792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Loop Electrode Frequency High 24 Fr .2w 12|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182739|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182764|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182747|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem 6-9tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem 6-9tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem 6-9tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182740|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem 6-9tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182765|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182774|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182733|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182743|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182767|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16mm (fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182734|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182737|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem 6-9tibef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem 6-9tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem 6-9tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem 6-9tibgh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182766|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182738|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182744|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 11mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182798|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm (fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem 6-9tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 10mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 12mm (fem10-11tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182768|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem10-12tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem10-12tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18mm (fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem 6-9tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem 6-9tib Gh)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182713|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 13mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182714|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 14mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182715|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182724|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 16mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182716|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182725|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 18mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182717|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem 3-5tibcd)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Left 20mm (fem 3-5tibef)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182805|EAP|Custom 95182805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endocuff Endoscopic Overtube Green 8/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182806|EAP|Custom 95182806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endocuff Endoscopic Overtube Purple 8/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182807|EAP|Custom 95182807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endocuff Endoscopic Overtube Orange 8/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion Zero Degree Medium Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|FSC: 13; Default||Not reimbursed separately|4,134.00|FSC: 13; Default||External grouping not supported 95182830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95182832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Mod Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95182826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182829|EAP|Custom 95182829||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer 5mmx15mmx13mm|1|HUMANA [1294]||HUMANA [11839]|4,007.73|FSC: 13; Default||Not reimbursed separately|4,007.73|FSC: 13; Default||External grouping not supported 95182818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm/l12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax Narrow Straight 8holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95182808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz-b Lt Medial Rt Lateral Precoa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,346.00|FSC: 13; Default||Not reimbursed separately|8,346.00|FSC: 13; Default||External grouping not supported 95182810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182827|EAP|Custom 95182827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 3.2mmx400mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Mod Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95182809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm (fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm/l16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon Left Ri.5 10x360mmx125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|FSC: 13; Default||Not reimbursed separately|5,266.80|FSC: 13; Default||External grouping not supported 95182837|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182858|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18 (fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182875|EAP|Custom 95182875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Skin Liquiband Flow Butyl 0.5 Gram 12/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182877|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Acrysof 6.0mm Anterior Asymmetr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95182844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182841|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182856|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182864|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182853|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182857|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16m (fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182866|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182840|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182859|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20 Fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182868|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 10mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182873|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 18mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182834|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 14mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182835|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182842|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182854|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182871|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 14mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182860|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 10 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95182872|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 16mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 16 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182848|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182874|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 20mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182836|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm (fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182852|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 20mm (fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182843|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 18mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182870|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Cpx4 Low Height Style 81 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95182838|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 11mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 13 Fem10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182839|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Fixed Persona Rt 12mm (fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95182869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 12mm (fem3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182883|EAP|Custom 95182883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nanopass Left 45 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro-dense Injectable 20cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,411.00|FSC: 13; Default||Not reimbursed separately|12,411.00|FSC: 13; Default||External grouping not supported 95182890|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum Longevity 36 Mm 7mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182881|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Attain Performa 88cm 4298|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95182879|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Generator Viva Quad Xt-d Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|FSC: 13; Default||Not reimbursed separately|50,100.00|FSC: 13; Default||External grouping not supported 95182888|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus Profile Moderate 750cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95182892|EAP|Custom 95182892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hgp 3.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182898|EAP|Custom 95182898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Mtf Patellar Preshaped 10mm Dowels|1|HUMANA [1294]||HUMANA [11839]|7,807.59|FSC: 13; Default||Not reimbursed separately|7,807.59|FSC: 13; Default||External grouping not supported 95182893|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 7.0mm X 2cm|1|HUMANA [1294]||HUMANA [11839]|5,055.00|FSC: 13; Default||Not reimbursed separately|5,055.00|FSC: 13; Default||External grouping not supported 95182894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acu-loc 2 Vdr Pit Wide Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95182885|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Mid-urethral Suprapubic Lynx|1|HUMANA [1294]||HUMANA [11839]|3,093.75|FSC: 13; Default||Not reimbursed separately|3,093.75|FSC: 13; Default||External grouping not supported 95182896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95182880|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Viva Quad Xt-d Crt-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|FSC: 13; Default||Not reimbursed separately|50,100.00|FSC: 13; Default||External grouping not supported 95182884|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sling Self-fixating Sparc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.00|FSC: 13; Default||Not reimbursed separately|2,943.00|FSC: 13; Default||External grouping not supported 95182897|EAP|Custom 95182897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 02.7mm Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182891|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv M/l Taper Sz 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95182895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acu-loc 2 Vdr Pit Narrow Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95182902|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 12mm (fem3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182905|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 18mm (fem3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95182907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-com Int Taper Tip 7x23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95182903|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 14mm (fem3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182901|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 10mm (fem3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 20mm (fem3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182904|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 16mm (fem3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182908|EAP|Custom 95182908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sealer Bipolar Sheathed 6.0 Sbs Aquamantys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182909|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 10mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182920|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 20mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 12mm Fem 10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182945|EAP|Custom 95182945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Endoscopic Esophageal Tts Rfa Channel Barrx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182939|EAP|Custom 95182939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Overdrill 2.7mmx12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182938|EAP|Custom 95182938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Dia 2.0x135mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Straight 8holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95182936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95182940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95182937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95182944|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Moderate Ply Profile 800cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95182914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 20mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 14mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mm/l18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95182913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 18mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182925|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 18mm Fem 10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182910|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 12mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182931|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Standard Cocr 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 95182915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 10mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182918|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 16mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Straight Ti 7mm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 95182941|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Backed Metal Asymmetric Triathlon A35mm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.00|FSC: 13; Default||Not reimbursed separately|1,959.00|FSC: 13; Default||External grouping not supported 95182927|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 10mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182911|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 14mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 18mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182926|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 20mm Fem 10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182928|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 12mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 12mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182912|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 16mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182921|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 10mm Fem 10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 14mm Fem 10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182924|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 16mm Fem 10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182917|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fixed Persona Lft 14mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95182959|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Cp X 4 Low Height Style 8100 7500cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95182951|EAP|Custom 95182951||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round 5 X 38mm Fine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182952|EAP|Custom 95182952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Round 2 X 30mm 6 Flutes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182954|EAP|Custom 95182954||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Optimum Round 4 X 30mm Fluted Low Speed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182956|EAP|Custom 95182956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Optimum Round 6.5 X 30mm Fluted Low Speed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182949|EAP|Custom 95182949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round 2.0 X 38mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182953|EAP|Custom 95182953||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Optimum Round 3 X 30mm Fluted Low Speed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182950|EAP|Custom 95182950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round 3.0 X 38mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182947|EAP|Custom 95182947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round 1.0 X 38mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182955|EAP|Custom 95182955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Optimum Round 5 X 30mm Fluted Low Speed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182957|EAP|Custom 95182957||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Needle/catheter W/4 (100mm) Needle Non-stimulating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182946|EAP|Custom 95182946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Diamond Round Fine 4 X 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial All-poly Cs Sz 4-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|FSC: 13; Default||Not reimbursed separately|8,887.20|FSC: 13; Default||External grouping not supported 95182964|EAP|Custom 95182964||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Stalif Midline 33mm X 13mm X 12 Degree|1|HUMANA [1294]||HUMANA [11839]|25,200.00|FSC: 13; Default||Not reimbursed separately|25,200.00|FSC: 13; Default||External grouping not supported 95182961|EAP|Custom 95182961||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide Coroent 10x22x45mm|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95182960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Decade 2 Hole Sz10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,431.00|FSC: 13; Default||Not reimbursed separately|13,431.00|FSC: 13; Default||External grouping not supported 95182963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Variax Straight 7 Holes/l90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|FSC: 13; Default||Not reimbursed separately|2,484.00|FSC: 13; Default||External grouping not supported 95182971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Constrained Durasul Epsilon Sz 32mm/59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,491.00|FSC: 13; Default||Not reimbursed separately|10,491.00|FSC: 13; Default||External grouping not supported 95182970|EAP|Custom 95182970||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Lordotic 10 X 9 X 25 8 Degree|1|HUMANA [1294]||HUMANA [11839]|10,284.00|FSC: 13; Default||Not reimbursed separately|10,284.00|FSC: 13; Default||External grouping not supported 95182965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Staflif Midline Abo 6mm X 30 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95182987|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Tightrail 11fr|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182990|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Mini Tightrail 11fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182986|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Tightrail 9fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182989|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Mini Tightrail 9fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182988|EAP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Rotating Tightrail 13fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182975|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Venogram 90 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 95186628|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Centraliser Void C-stem 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.90|FSC: 13; Default||Not reimbursed separately|417.90|FSC: 13; Default||External grouping not supported 95186626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|FSC: 13; Default||Not reimbursed separately|279.00|FSC: 13; Default||External grouping not supported 95191759|EAP|Custom 95191759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler Curved Tip 45mm Purple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Biosure Ha 9mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95191774|EAP|Custom 95191774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Point Match Psi Shoulder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95182999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 8 Hole Bridge Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 95182994|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Compli Soft Tip 6fr 4p 5mm Fixed 115cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95182996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Pushlock Biocomposite 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95182991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Medium 0 Degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95182992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|FSC: 13; Default||Not reimbursed separately|261.00|FSC: 13; Default||External grouping not supported 95182998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Femoral Distal Hinged Rotating Medular 10mm Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|FSC: 13; Default||Not reimbursed separately|2,412.90|FSC: 13; Default||External grouping not supported 95182997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Cocr 15 Mm X 155 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|FSC: 13; Default||Not reimbursed separately|3,173.10|FSC: 13; Default||External grouping not supported 95183002|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Style 8200 Height Medium Cpx 550cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95183000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Monoblock Rsp Size 8 175 Long Revision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95182993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 26mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95183003|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Style 8200 Height Medium Cpx 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95183004|EAP|Custom 95183004||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avs 6x14x16|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 95183007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rescue Fixed Aviator 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.75|FSC: 13; Default||Not reimbursed separately|1,761.75|FSC: 13; Default||External grouping not supported 95183014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis 6.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|FSC: 13; Default||Not reimbursed separately|1,059.00|FSC: 13; Default||External grouping not supported 95183017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis 6.5mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|FSC: 13; Default||Not reimbursed separately|1,059.00|FSC: 13; Default||External grouping not supported 95183012|EAP|Custom 95183012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Retaining Nasal Tube 12fr (5/bx)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis 6.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|FSC: 13; Default||Not reimbursed separately|1,059.00|FSC: 13; Default||External grouping not supported 95183015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis 6.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95183011|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Urethral Dilation Balloon 7.0fr 29cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 115mm Tl20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95183005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aviator 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.90|FSC: 13; Default||Not reimbursed separately|6,867.90|FSC: 13; Default||External grouping not supported 95183010|EAP|Custom 95183010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 475cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Fixed Aviator 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|FSC: 13; Default||Not reimbursed separately|1,679.52|FSC: 13; Default||External grouping not supported 95183013|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm Ready To Use 6cm X 18cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.44|FSC: 13; Default||Not reimbursed separately|93.44|FSC: 13; Default||External grouping not supported 95183050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 16mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183065|EAP|Custom 95183065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Clear Threaded 7.0 Mm X 75 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183067|EAP|Custom 95183067||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Nova Flex (thv) Sapien Xt Edwards 26mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95183066|EAP|Custom 95183066||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Nova Flex (thv) Sapien Xt Edwards 23mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95183070|EAP|Custom 95183070||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 3 Ascendra (thv) Sapien Edwards 26mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95183071|EAP|Custom 95183071||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Ascendra + (thv) Sapien Xt Edwards 29mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95183069|EAP|Custom 95183069||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System 3 Ascendra (thv) Sapien Edwards 23mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95183068|EAP|Custom 95183068||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Nova Flex (thv)sapien Xt Edwards 29mm|1|HUMANA [1294]||HUMANA [11839]|97,500.00|FSC: 13; Default||Not reimbursed separately|97,500.00|FSC: 13; Default||External grouping not supported 95183021|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 18mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183063|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|FSC: 13; Default||Not reimbursed separately|841.50|FSC: 13; Default||External grouping not supported 95183039|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 20mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 10mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183051|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 18mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 16mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183041|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 12mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 18mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 20mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183056|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183053|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183044|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 16mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 12mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 14mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183043|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 14mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183052|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 20mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183059|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Lft 10mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 3-5 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183060|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 3-5 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Translational Atlantis Fixed 4 X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 95183029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95183037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95183038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|FSC: 13; Default||Not reimbursed separately|841.50|FSC: 13; Default||External grouping not supported 95183034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 8.0mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|FSC: 13; Default||Not reimbursed separately|1,047.00|FSC: 13; Default||External grouping not supported 95183024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95183025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Iii Asnis Ti 6.5mm X 115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 95183076|EAP|Custom 95183076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Peak Prp 30ml System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183081|EAP|Custom 95183081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Guidance Matched Patient Rsp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183082|EAP|Custom 95183082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Guidance Matched Patient Turon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183077|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183073|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gold Hemashield Arched 1-branch 32mm X 50cm/10mm Branc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,727.41|FSC: 13; Default||Not reimbursed separately|3,727.41|FSC: 13; Default||External grouping not supported 95183075|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Backed Metal Asymmetric Triathlon A38mm 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.00|FSC: 13; Default||Not reimbursed separately|1,959.00|FSC: 13; Default||External grouping not supported 95183078|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183074|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gold Hemashield Arched 1-branch 34mm X 50cm/10mm Branc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,727.41|FSC: 13; Default||Not reimbursed separately|3,727.41|FSC: 13; Default||External grouping not supported 95183080|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95183079|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183072|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 7 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95183083|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183090|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95183123|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183088|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183105|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95191778|EAP|Custom 95191778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Peek Tantalum 16mm X 14mm X 8mm Anatomic St|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95183120|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,169.00|FSC: 13; Default||Not reimbursed separately|5,169.00|FSC: 13; Default||External grouping not supported 95183121|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183098|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183114|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183122|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183117|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183085|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183124|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183107|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183101|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem 6-9 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem 6-9 Tib Cd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183087|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 6-9 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 10mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183110|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 12mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 18mm Fem10-11 Tib Ef|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 14mm Fem 10-12 Tib J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183115|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Lf Sz C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183106|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 16mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cps Fxd Persona Rt 20mm Fem 10-12 Tib Gh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95183125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95183127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Natural Persona Tm 2-peg Porous Fixed Bearing Rt Sz J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,169.00|FSC: 13; Default||Not reimbursed separately|5,169.00|FSC: 13; Default||External grouping not supported 95186634|EAP|Custom 95186634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Non-locking Short 2.5 X 216 Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191779|EAP|Custom 95191779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Vein Harvesting Vasoview Hemopro St Cone Blt 30x5ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000093|EAP|Custom 32000093||0998 - STATISTICAL CHARGES|Hb Hhn Asthma Protocol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000101|EAP|Custom 32000101||0998 - STATISTICAL CHARGES|Hb Mdi Asthma Protocol|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000127|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Mobil/broncho/sput|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000143|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Ippb Tx-initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95186632|EAP|Custom 95186632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Atomizer Glass Clear With Metal Top|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000168|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Mdi Tx-initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000184|EAP|Custom 32000184||0998 - STATISTICAL CHARGES|Hb Vital Capacity, Total|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000192|EAP|Custom 32000192||0998 - STATISTICAL CHARGES|Hb Is Tx-subsequent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191781|EAP|Custom 95191781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Tri-staple 2mmx45mm Extra Thick Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000200|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosal Mobil/broncho/sput|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000226|EAP|CPT® 94667||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Manipulation Chest Wall, Init|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 32000234|EAP|CPT® 94668||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Manipulation Chest Wall, Subsq|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 32000267|EAP|CPT® 94664||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|HB VIBRATORY PEP TX-INITIAL|1|HUMANA [1294]||HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000275|EAP|CPT® 94664||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vibratory Pep Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95186624|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem C Amt Std Offset Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 32000283|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Tx Initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000291|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Tx Subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000309|EAP|CPT® 94642||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pentamidine Aerosol Tx|1|HUMANA [1294]||HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000317|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Mixed Gas Thpy|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000325|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Dpi Tx Initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000333|EAP|Custom 32000333||0998 - STATISTICAL CHARGES|Hb Code Blue/15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000341|EAP|Custom 32000341||0998 - STATISTICAL CHARGES|Hb Rt Monitor Patient Off Unit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186639|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Fb Uc Rt 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 32000358|EAP|Custom 32000358||0998 - STATISTICAL CHARGES|Hb Ba Test|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000366|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Dpi Tx Subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000374|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Breathing Re-trng Huff|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000382|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Breathing Re-trng Segment|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95191782|EAP|Custom 95191782||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endo Gia Tri-staple Titanium 45 Purple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000390|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Breathing Re-trn Diaphram|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000408|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Breathing Re-trng Cough|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000515|EAP|Custom 32000515||0998 - STATISTICAL CHARGES|HB VENTILATOR TRANSPORT SET|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186638|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated 10mm/130 360mm/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 32000648|EAP|CPT® 94150||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Test Ventilatory Adequacy|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000655|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pmtsv Installation|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000663|EAP|Custom 32000663||0998 - STATISTICAL CHARGES|Hb Airway Care/15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000671|EAP|Custom 32000671||0998 - STATISTICAL CHARGES|Hb Pt Care Stand-by/15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000762|EAP|CPT® 94762||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Cont Overnight|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32000770|EAP|CPT® 94760||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Single Determ|1|HUMANA [1294]||HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 32000788|EAP|CPT® 94761||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Mult Determ|1|HUMANA [1294]||HUMANA [11839]|175.39|FSC: 13; Default||Not reimbursed separately|175.39|FSC: 13; Default||External grouping not supported 32000804|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Bedside Spirometry|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 32000812|EAP|Custom 32000812||0998 - STATISTICAL CHARGES|Hb Peak Flow Measurement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62000344|EAP|Custom 62000344||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Misc Lab Charge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000820|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Sputum Induction|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000838|EAP|CPT® 36600||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Abg Blood Collection|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95186636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Speed 9 X 12 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 32000846|EAP|Custom 32000846||0998 - STATISTICAL CHARGES|Hb Stat Ekg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000853|EAP|Custom 32000853||0998 - STATISTICAL CHARGES|Hb Intake Assessment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000861|EAP|Custom 32000861||0998 - STATISTICAL CHARGES|Hb Pt Assessment-follow Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191783|EAP|Custom 95191783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endo Gia Tri-staple Tip Curve2.0 Ta N 45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000887|EAP|CPT® 94760||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Single Determ|1|HUMANA [1294]||HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 32000895|EAP|CPT® 94669||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vest Pd/cpt Tx-initial|1|HUMANA [1294]||HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32000903|EAP|CPT® 94669||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vest Pd/cpt Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95186635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 10mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|FSC: 13; Default||Not reimbursed separately|756.00|FSC: 13; Default||External grouping not supported 32001661|EAP|Custom 32001661||0998 - STATISTICAL CHARGES|Hb Ed Assess And Treat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32001711|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Icpap-hf Cannula Initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32001729|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Icpap-hr Can Subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32100018|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Resp Flow Volume Loop|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 32100067|EAP|CPT® 94618||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pst Six Minute Walk Test Includes Heart Rate And Oximetry|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 32100075|EAP|CPT® 94070||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Broncho Provocation Eval|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95186629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Fibula 2.7mm Va-lcp 4-hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,733.21|FSC: 13; Default||Not reimbursed separately|2,733.21|FSC: 13; Default||External grouping not supported 32100083|EAP|Custom 32100083||0998 - STATISTICAL CHARGES|Hb Mip/mep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32100109|EAP|CPT® 94200||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Maximum Vol Vent|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 32100125|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Bronchospasn Eval-prolong|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 32100141|EAP|CPT® 94621||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulmonary Stress Test, Comlx|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 32100174|EAP|CPT® 94750||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulmonry Compliance Study|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32100182|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Bronchospasm Evaluation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 32100190|EAP|CPT® 94799||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb A-a Gradient|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32100257|EAP|CPT® 94762||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Cont Overnight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32100265|EAP|CPT® 94761||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Mult Determ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.39|FSC: 13; Default||Not reimbursed separately|175.39|FSC: 13; Default||External grouping not supported 32100273|EAP|CPT® 94760||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Single Determ|1|HUMANA [1294]||HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95191763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130 Deg 1.5 13mm X 40cm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 32100281|EAP|CPT® 94799||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Asthma Education/15 Min|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32100299|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Thpy Tx-initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32100315|EAP|Custom 32100315||0998 - STATISTICAL CHARGES|Hb Airway Care/15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32100406|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Mdi Tx-initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32100455|EAP|Custom 32100455||0998 - STATISTICAL CHARGES|Hb Peak Flow Measurement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32100505|EAP|CPT® 94690||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb O2 Uptk,exp Gas Anl, Rest Indir|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 32200065|EAP|CPT® 95810||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Polysomnography, 4 Or>param|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95183154|EAP|Custom 95183154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotaglide Lubricant 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200073|EAP|CPT® 95811||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Polysomnography, 4/> Parm, Cpap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95183152|EAP|Custom 95183152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Nail Insertion Elastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200081|EAP|Custom 32200081||0998 - STATISTICAL CHARGES|Hb Somnolence Risk Assmt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 9mmx345mmstd T2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 80167265|EAP|CPT® 95971||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Electronic Analysis Neuorstim Pulse Generator Simple|1|HUMANA [1294]||HUMANA [11839]|350.16|FSC: 13; Default||Not reimbursed separately|350.16|FSC: 13; Default||External grouping not supported 32200123|EAP|Custom 32200123||0998 - STATISTICAL CHARGES|Hb Beck Depression Index|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200230|EAP|CPT® 99245||0998 - STATISTICAL CHARGES|Hb Initial Consult Level 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167273|EAP|CPT® 43248||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Guide Wire Insertion And Dilation|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 32200248|EAP|CPT® 99244||0998 - STATISTICAL CHARGES|Hb Initial Consult Level 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200255|EAP|Custom 32200255||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Prolonged Md E&m Service|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200263|EAP|HCPCS G0463||0998 - STATISTICAL CHARGES|Hb Est Pt Follow-up Level 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200289|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, Est Pt Level 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95183178|EAP|Custom 95183178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Ao 1.8mm Diameter X 45mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200297|EAP|HCPCS G0463||0998 - STATISTICAL CHARGES|Hb Est Pt Follow-up Level 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32200321|EAP|HCPCS G0463||0998 - STATISTICAL CHARGES|Hb Est Pt Follow-up Level 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 32200354|EAP|CPT® 99242||0998 - STATISTICAL CHARGES|Hb Initial Consult Level 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300055|EAP|CPT® 94799||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Asthma Education Assmt|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183172|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 24.mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 32300063|EAP|CPT® 94799||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Asthma Education/15 Min|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183183|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite Vision 72.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 32300170|EAP|CPT® 94761||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Oximetry Multiple Determination|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.39|FSC: 13; Default||Not reimbursed separately|175.39|FSC: 13; Default||External grouping not supported 95183164|EAP|Custom 95183164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stays Elastic 12mm Blunt Hook (8-pk)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300188|EAP|CPT® 94760||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Oximetry Single Determination|1|HUMANA [1294]||HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 32300196|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Thpy Tx-initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95183174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95183180|EAP|Custom 95183180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K- Wire 1.25mm Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Rt Standard 3 Hole Volar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|FSC: 13; Default||Not reimbursed separately|2,274.24|FSC: 13; Default||External grouping not supported 32300261|EAP|Custom 32300261||0998 - STATISTICAL CHARGES|Hb Code Blue/15 Min|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300287|EAP|CPT® 94667||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vibratory Pep Tx-initial|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183184|EAP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Amino 3.5 X 3.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 32300295|EAP|CPT® 94668||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Flutter Tx-subsequent|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 24.mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 32300469|EAP|Custom 32300469||0998 - STATISTICAL CHARGES|Hb Phase Iii Pulm Rehab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plates Vdr Proximal Narrow Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 32300477|EAP|||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Cont Oxygen Thpy Initial 24 Hours|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300485|EAP|Custom 32300485||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Contaerosol Thpy Initial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183162|EAP|Custom 95183162||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene Ps Gynemesh Gynecare 10cm X 15cm|1|HUMANA [1294]||HUMANA [11839]|1,693.05|FSC: 13; Default||Not reimbursed separately|1,693.05|FSC: 13; Default||External grouping not supported 32300493|EAP|Custom 32300493||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Cont Head Hood Set Up|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300501|EAP|CPT® 94644||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cbt, 1st Hour|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183169|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 2.4mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 32300519|EAP|CPT® 94002||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Mgmt Inpat, Init Day|1|HUMANA [1294]||HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 95183165|EAP|Custom 95183165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Foley Lawrence Supra 16fr (orange Shield)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300527|EAP|CPT® 94002||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Mgmt Inpat, Init Day, Newborn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 32300535|EAP|CPT® 94002||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Mgmt Inpat, Init Day|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 95183177|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powercross 2mm X 200mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 32300543|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Non-invasive Initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32300550|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Therapy Adult Initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95183170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 2.4mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|FSC: 13; Default||Not reimbursed separately|181.95|FSC: 13; Default||External grouping not supported 32300568|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Initiation And Mgmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95183176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 32300576|EAP|CPT® 94770||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Co2, Exp Gas Deter Infrar Analyser|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183179|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Sv 4mm X 20 Mmm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 32300584|EAP|Custom 32300584||0998 - STATISTICAL CHARGES|Hb Co2, Exp Gas Deter Infrar Analyser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300592|EAP|CPT® 94762||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Cont Overnight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183171|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 24.mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 32300600|EAP|CPT® 94772||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Circadian Resp Rec 12-24hr;inf|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 32300618|EAP|Custom 32300618||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Cont Oxygen Thpy Subsequent 24 Hours|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183168|EAP|Custom 95183168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Stabilizer Heart Vacuum Acobat-i|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300626|EAP|||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Cont Aerosol Thpy Subseqy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300634|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cont Head Hood Subsequens|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot 1.0mm Mini 2-0 Ndls|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 32300642|EAP|CPT® 94645||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|HB CONT BD THPY 2ND HOUR|1|HUMANA [1294]||HUMANA [11839]|202.50|FSC: 13; Default||Not reimbursed separately|202.50|FSC: 13; Default||External grouping not supported 32300659|EAP|CPT® 94003||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Mgmt Inpat, Subq Day|1|HUMANA [1294]||HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 32300667|EAP|CPT® 94003||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Mgmt Inpat, Subq Day, Newborn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 95191775|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 7-10mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 32300675|EAP|CPT® 94003||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Mgmt Inpat, Subq Day|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 32300683|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vent Non-invasive Subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95186649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp Non Lock 2.7mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 32300691|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Initiation And Mgmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32300709|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Cpap Initiation And Mgmt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32300717|EAP|CPT® 94681||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb O2 Uptk, Exp Gas Anl, Co2 Otpt|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 32300725|EAP|Custom 32300725||0998 - STATISTICAL CHARGES|Hb Co2, Exp Gas Deter Infrar Analyser|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186637|EAP|Custom 95186637||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Continuous Compression Implant Sizing Sg-3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300733|EAP|CPT® 94762||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Cont Overnight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 32300741|EAP|CPT® 94772||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Circadian Resp Rec 12-24hr;inf|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 32300758|EAP|Custom 32300758||0998 - STATISTICAL CHARGES|Hb Sb Trial Assessment Subsequent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191776|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Concentric 40mm X 2mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 32300766|EAP|Custom 32300766||0998 - STATISTICAL CHARGES|Hb Sb Trial Assessment Initial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300774|EAP|Custom 32300774||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Md Interp. Slp Study Uattended|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300782|EAP|Custom 32300782||0998 - STATISTICAL CHARGES|Hb Rrteam Standby X 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32300808|EAP|CPT® 99406||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Smoke/tobac Counsel 3-10m|1|HUMANA [1294]||HUMANA [11839]|77.85|FSC: 13; Default||Not reimbursed separately|77.85|FSC: 13; Default||External grouping not supported 95183185|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera 6.5mm X 120mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 32300816|EAP|CPT® 99407||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hb Smoke/tobac Counsel >10mi|1|HUMANA [1294]||HUMANA [11839]|77.85|FSC: 13; Default||Not reimbursed separately|77.85|FSC: 13; Default||External grouping not supported 33200023|EAP|CPT® 99243||0998 - STATISTICAL CHARGES|Hb Initial Consult Level 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186654|EAP|Custom 95186654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Thread Cap Cta Global 6inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51000115|EAP|Custom 51000115||0206 - INTENSIVE CARE - INTERMEDIATE ICU|Hb Room & Bd Tcu Semi-private|1|HUMANA [1294]||HUMANA [11839]|3,696.24|FSC: 13; Default||Not reimbursed separately|3,696.24|FSC: 13; Default||Accommodation codes not reimbursed separately 51000297|EAP|Custom 51000297||0171 - NURSERY - NEWBORN - LEVEL I|Hb Newborn Care|1|HUMANA [1294]||HUMANA [11839]|1,858.52|FSC: 13; Default||Not reimbursed separately|1,858.52|FSC: 13; Default||Accommodation codes not reimbursed separately 51000313|EAP|Custom 51000313||0172 - NURSERY - NEWBORN - LEVEL II|Hb Room & Bd Newborn Level Ii|1|HUMANA [1294]||HUMANA [11839]|5,237.37|FSC: 13; Default||Not reimbursed separately|5,237.37|FSC: 13; Default||Accommodation codes not reimbursed separately 95183197|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 35.0 Diopter Acrysof 13.0mm Length 6.0 Ante|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 51000818|EAP|HCPCS G0379||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Direct Referral For Observation Svcs|1|HUMANA [1294]||HUMANA [11839]|502.00|FSC: 13; Default||Not reimbursed separately|502.00|FSC: 13; Default||External grouping not supported 51000834|EAP|Custom 51000834||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii|1|HUMANA [1294]||HUMANA [11839]|508.74|FSC: 13; Default||Not reimbursed separately|508.74|FSC: 13; Default||External grouping not supported 95183198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammelock Small Angled 16mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|FSC: 13; Default||Not reimbursed separately|3,630.00|FSC: 13; Default||External grouping not supported 51000842|EAP|Custom 51000842||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii Add Hr|1|HUMANA [1294]||HUMANA [11839]|194.75|FSC: 13; Default||Not reimbursed separately|194.75|FSC: 13; Default||External grouping not supported 51001022|EAP|HCPCS G0378||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Obsrv 1st Hr|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 51001030|EAP|HCPCS G0378||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Obsrv Rm-ea Add Hr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.75|FSC: 13; Default||Not reimbursed separately|57.75|FSC: 13; Default||External grouping not supported 95183203|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 10cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,010.00|FSC: 13; Default||Not reimbursed separately|11,010.00|FSC: 13; Default||External grouping not supported 51001360|EAP|CPT® 11042||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debridement Skin Simple|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 51001584|EAP|Custom 51001584||0123 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - PEDIATRIC|Hb Room & Bd Peds Semi Private|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 95183200|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Style 8200 Height Medium Cpx 350cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 51001618|EAP|Custom 51001618||0206 - INTENSIVE CARE - INTERMEDIATE ICU|Hb Room & Bd Tcu Private|1|HUMANA [1294]||HUMANA [11839]|3,696.24|FSC: 13; Default||Not reimbursed separately|3,696.24|FSC: 13; Default||Accommodation codes not reimbursed separately 51001626|EAP|Custom 51001626||0200 - INTENSIVE CARE - GENERAL CLASSIFICATION|Hb Room & Bd Icu|1|HUMANA [1294]||HUMANA [11839]|7,496.75|FSC: 13; Default||Not reimbursed separately|7,496.75|FSC: 13; Default||Accommodation codes not reimbursed separately 95183211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed Hybrid Reflex 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,424.52|FSC: 13; Default||Not reimbursed separately|1,424.52|FSC: 13; Default||External grouping not supported 51004257|EAP|Custom 51004257||0210 - CORONARY CARE - GENERAL CLASSIFICATION|Hb Room & Bd Csr|1|HUMANA [1294]||HUMANA [11839]|7,822.70|FSC: 13; Default||Not reimbursed separately|7,822.70|FSC: 13; Default||Accommodation codes not reimbursed separately 51004463|EAP|Custom 51004463||0113 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - PEDIATRIC|Hb Room & Bd Peds Private|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 95183212|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Renal Infra Vela 34-34/c100v|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,865.00|FSC: 13; Default||Not reimbursed separately|14,865.00|FSC: 13; Default||External grouping not supported 51005056|EAP|Custom 51005056||0115 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - HOSPICE|Hb Room & Bd Hospice Private Gc|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 51005064|EAP|Custom 51005064||0115 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - HOSPICE|Hb Room & Bd Hospice Respite Gc|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||Accommodation codes not reimbursed separately 95183201|EAP|Custom 95183201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Loop 230cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 51010312|EAP|HCPCS G0379||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Direct Referral For Observation Svcs|1|HUMANA [1294]||HUMANA [11839]|502.00|FSC: 13; Default||Not reimbursed separately|502.00|FSC: 13; Default||External grouping not supported 52200516|EAP|CPT® 54160||0723 - LABOR ROOM/DELIVERY - CIRCUMCISION|Hb Nursery Circumcision|1|HUMANA [1294]||HUMANA [11839]|1,000.00|FSC: 13; Default||Not reimbursed separately|1,000.00|FSC: 13; Default||External grouping not supported 95183210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hybrid Reflex Level 1 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,825.76|FSC: 13; Default||Not reimbursed separately|5,825.76|FSC: 13; Default||External grouping not supported 52681269|EAP|CPT® 59412||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb External Version|1|HUMANA [1294]||HUMANA [11839]|7,711.60|FSC: 13; Default||Not reimbursed separately|7,711.60|FSC: 13; Default||External grouping not supported 95183213|EAP|Custom 95183213||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Small|1|HUMANA [1294]||HUMANA [11839]|4,248.00|FSC: 13; Default||Not reimbursed separately|4,248.00|FSC: 13; Default||External grouping not supported 52681301|EAP|CPT® 59070||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tranabd Amnioinfusion Us|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 52681319|EAP|CPT® 59001||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Amnio Therapeutic Us|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 95183205|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 10cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,010.00|FSC: 13; Default||Not reimbursed separately|11,010.00|FSC: 13; Default||External grouping not supported 52681327|EAP|CPT® 59076||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fetal Shunt Placement Us|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 52681335|EAP|CPT® 59074||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fetal Fluid Drainage Us|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 95183207|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 25cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,160.00|FSC: 13; Default||Not reimbursed separately|20,160.00|FSC: 13; Default||External grouping not supported 52681418|EAP|CPT® 76377||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct 3d Reconst W/indep Wrkst|1|HUMANA [1294]||HUMANA [11839]|771.50|FSC: 13; Default||Not reimbursed separately|771.50|FSC: 13; Default||External grouping not supported 52681483|EAP|CPT® 53899||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ftl Bladder Shunt Procedure|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 95183204|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 15cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,270.00|FSC: 13; Default||Not reimbursed separately|12,270.00|FSC: 13; Default||External grouping not supported 52681491|EAP|CPT® 21899||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fetal Chest Shunt Procedure|1|HUMANA [1294]||HUMANA [11839]|628.65|FSC: 13; Default||Not reimbursed separately|628.65|FSC: 13; Default||External grouping not supported 52681582|EAP|CPT® 59012||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pubs/cordo|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 95183206|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 15cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,270.00|FSC: 13; Default||Not reimbursed separately|12,270.00|FSC: 13; Default||External grouping not supported 52690047|EAP|CPT® 76818||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Fetal Bio W/nonstress Test|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 52690062|EAP|CPT® 76946||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Amniocentesis Us Guidance|1|HUMANA [1294]||HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95183208|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 5.0cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,065.00|FSC: 13; Default||Not reimbursed separately|10,065.00|FSC: 13; Default||External grouping not supported 52690146|EAP|CPT® 76820||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Doppler Umb Artery|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 52690153|EAP|CPT® 76945||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guidance Chorionic Villus|1|HUMANA [1294]||HUMANA [11839]|585.42|FSC: 13; Default||Not reimbursed separately|585.42|FSC: 13; Default||External grouping not supported 95183215|EAP|Custom 95183215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Biopsy 20g X 10cm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 52690161|EAP|CPT® 76941||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guide Intrauter Transf/cor|1|HUMANA [1294]||HUMANA [11839]|367.13|FSC: 13; Default||Not reimbursed separately|367.13|FSC: 13; Default||External grouping not supported 52690179|EAP|CPT® 76825||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Fetal Echo|1|HUMANA [1294]||HUMANA [11839]|1,372.26|FSC: 13; Default||Not reimbursed separately|1,372.26|FSC: 13; Default||External grouping not supported 95183209|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 10cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,010.00|FSC: 13; Default||Not reimbursed separately|11,010.00|FSC: 13; Default||External grouping not supported 52690203|EAP|CPT® 76826||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Follow-up Fetal Echo|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 53901021|EAP|CPT® 43201||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Endo Submucosal Injection|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95183217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Biocomposite Ite 5.5 X 14.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 53901286|EAP|CPT® 43250||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Removal Of Tumor W/hot Biops|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 53901294|EAP|CPT® 43217||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Tumor Removal W/snare|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 53901310|EAP|CPT® 45335||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoid W/dir Submuc Inj Any Subs|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95186655|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Cta Duofix Global 52x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,924.50|FSC: 13; Default||Not reimbursed separately|16,924.50|FSC: 13; Default||External grouping not supported 53901328|EAP|CPT® 45337||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoid W/decomp Of Volvulus|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 53901336|EAP|CPT® 45381||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonos W/dir Submuc Inj Any Sub|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95191777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cp 4.1mm X L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95186627|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff 5.0|1|HUMANA [1294]||HUMANA [11839]|15,881.40|FSC: 13; Default||Not reimbursed separately|15,881.40|FSC: 13; Default||External grouping not supported 66110008|EAP|Custom 66110008||0114 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - PSYCHIATRIC|Hb Room & Bd Bh2 Adult Private|1|HUMANA [1294]||HUMANA [11839]|2,585.75|FSC: 13; Default||Not reimbursed separately|2,585.75|FSC: 13; Default||Accommodation codes not reimbursed separately 66110040|EAP|Custom 66110040||0124 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - PSYCHIATRIC|Hb Room & Bd Bh2 Adult Semi-private|1|HUMANA [1294]||HUMANA [11839]|2,585.75|FSC: 13; Default||Not reimbursed separately|2,585.75|FSC: 13; Default||Accommodation codes not reimbursed separately 66120007|EAP|Custom 66120007||0114 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - PSYCHIATRIC|Hb Room & Bd Geri Psych Private|1|HUMANA [1294]||HUMANA [11839]|2,585.75|FSC: 13; Default||Not reimbursed separately|2,585.75|FSC: 13; Default||Accommodation codes not reimbursed separately 66120114|EAP|Custom 66120114||0124 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - PSYCHIATRIC|Hb Room & Bd Geri Psych Semi-private|1|HUMANA [1294]||HUMANA [11839]|2,585.75|FSC: 13; Default||Not reimbursed separately|2,585.75|FSC: 13; Default||Accommodation codes not reimbursed separately 95186652|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Cta Duofix Global 52x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,924.50|FSC: 13; Default||Not reimbursed separately|16,924.50|FSC: 13; Default||External grouping not supported 66120221|EAP|Custom 66120221||0180 - LEAVE OF ABSENCE - GENERAL CLASSIFICATION|Hb Bh1 Geriatric Loa Bed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||Accommodation codes not reimbursed separately 67000018|EAP|CPT® 95864||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg, 4 Ext W/ W/o Paraspinal|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 67000059|EAP|CPT® 95860||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg, 1 Ext W/w/o Paraspinal|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 67000075|EAP|CPT® 95869||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Thoracic Paraspinal Muscle|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95186642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 5.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 67000133|EAP|CPT® 95937||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Neuromuscular Junct Tst,ea Nrv|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 67000141|EAP|CPT® 51785||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg-anal Sphincter|1|HUMANA [1294]||HUMANA [11839]|669.36|FSC: 13; Default||Not reimbursed separately|669.36|FSC: 13; Default||External grouping not supported 67000158|EAP|CPT® 95933||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg-blink Reflex|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 67000182|EAP|CPT® 95868||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Bilateral Cranial Nerve|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 67100115|EAP|CPT® 95870||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Lmtd 1 Ext/non-limb Muscle|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 67100206|EAP|CPT® 95861||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg, 2 Ext W/ W/o Paraspinal|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 67100305|EAP|CPT® 95863||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg, 3 Ext W/ W/o Paraspinal|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95186648|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp Non Lock 2.7mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 68200013|EAP|CPT® 93786||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Amb Bp Monitor 24+,rec|1|HUMANA [1294]||HUMANA [11839]|336.57|FSC: 13; Default||Not reimbursed separately|336.57|FSC: 13; Default||External grouping not supported 68200021|EAP|CPT® 93788||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Amb Bp Monitor 24+,scan An|1|HUMANA [1294]||HUMANA [11839]|336.57|FSC: 13; Default||Not reimbursed separately|336.57|FSC: 13; Default||External grouping not supported 68200039|EAP|CPT® 95816||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg,awake And Drowsy|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 68200138|EAP|CPT® 93701||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Bioimpedance,thoracic,electric|1|HUMANA [1294]||HUMANA [11839]|336.57|FSC: 13; Default||Not reimbursed separately|336.57|FSC: 13; Default||External grouping not supported 68201003|EAP|CPT® 93041||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Rhythm Ecg 1-3 Lead Trace Only|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 68201839|EAP|CPT® 93225||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hb Holter Monitor Record Up To 48 Hours|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 68201847|EAP|CPT® 93226||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hb Holter Mon Scan/rept Up To 48 Hrs|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 68202357|EAP|CPT® 93271||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hb Event Mon Trans/anal Up To 30 Days|1|HUMANA [1294]||HUMANA [11839]|323.22|FSC: 13; Default||Not reimbursed separately|323.22|FSC: 13; Default||External grouping not supported 95186644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peri Locking 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 68202373|EAP|CPT® 93270||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hb Event Monitor Up To 30 Days|1|HUMANA [1294]||HUMANA [11839]|103.29|FSC: 13; Default||Not reimbursed separately|103.29|FSC: 13; Default||External grouping not supported 68202415|EAP|CPT® 93278||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Signal-averaged Ecg (saecg)|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 68202431|EAP|CPT® 92978||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Ivus Coronary, Init Vessel|1|HUMANA [1294]||HUMANA [11839]|4,682.09|FSC: 13; Default||Not reimbursed separately|4,682.09|FSC: 13; Default||External grouping not supported 68300128|EAP|CPT® 93017||0482 - CARDIOLOGY - STRESS TEST|Hb Cardio Stress Test Tracing Only|1|HUMANA [1294]||HUMANA [11839]|781.30|FSC: 13; Default||Not reimbursed separately|781.30|FSC: 13; Default||External grouping not supported 62062880|EAP|CPT® 86703||0302 - LABORATORY - IMMUNOLOGY|Hb Hiv1, Hiv2 Ab Single Result|1|HUMANA [1294]||HUMANA [11839]|41.13|FSC: 13; Default||Not reimbursed separately|41.13|FSC: 13; Default||External grouping not supported 68300151|EAP|CPT® 93041||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Ekg Strip W Swanz Ganz Cath Placement|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 68900018|EAP|CPT® 93005||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Ecg 12 Lead, Tracing Only|1|HUMANA [1294]||HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 62062898|EAP|CPT® 87899||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Rapid Hiv Ag|1|HUMANA [1294]||HUMANA [11839]|48.21|FSC: 13; Default||Not reimbursed separately|48.21|FSC: 13; Default||External grouping not supported 69000305|EAP|CPT® 95824||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Cerebral Death Evaluation|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95183224|EAP|Custom 95183224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Implate Metacarpal 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 69000339|EAP|CPT® 95819||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg, Awake And Asleep|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 71000202|EAP|Custom 71000202||0459 - EMERGENCY ROOM - OTHER EMERGENCY ROOM|Hb Decontamination Sh|1|HUMANA [1294]||HUMANA [11839]|50.60|FSC: 13; Default||Not reimbursed separately|50.60|FSC: 13; Default||External grouping not supported 95183233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant I Fuse Si-bone 7.0mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 71000210|EAP|Custom 71000210||0998 - STATISTICAL CHARGES|Hb Decontam Shower-co|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71000335|EAP|Custom 71000335||0998 - STATISTICAL CHARGES|Hb Oximetry/hour Er|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183232|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant I Fuse Si-bone 7.0mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 71000343|EAP|Custom 71000343||0998 - STATISTICAL CHARGES|Hb Oximetry Er|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71000400|EAP|CPT® 46614||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Anoscopy W/ctrl Bleeding Any|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183234|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant I Fuse Si-bone 7.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95183223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Implatemetacarpal Standard 4.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|FSC: 13; Default||Not reimbursed separately|2,295.00|FSC: 13; Default||External grouping not supported 71001291|EAP|CPT® 32551||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Tube Thoracostomy|1|HUMANA [1294]||HUMANA [11839]|4,647.93|FSC: 13; Default||Not reimbursed separately|4,647.93|FSC: 13; Default||External grouping not supported 71001317|EAP|CPT® 31500||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endotracheal Intubation Emerg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|628.65|FSC: 13; Default||Not reimbursed separately|628.65|FSC: 13; Default||External grouping not supported 95183230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 6.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 71001333|EAP|CPT® 31605||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Emergency Tracheostomy Cricoth|1|HUMANA [1294]||HUMANA [11839]|580.29|FSC: 13; Default||Not reimbursed separately|580.29|FSC: 13; Default||External grouping not supported 71001341|EAP|CPT® 92960||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Cardioversion Elective, Extern|1|HUMANA [1294]||HUMANA [11839]|1,528.65|FSC: 13; Default||Not reimbursed separately|1,528.65|FSC: 13; Default||External grouping not supported 95183231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept 6.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 71001358|EAP|CPT® 92953||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Temp/transcutaneous Pacing|1|HUMANA [1294]||HUMANA [11839]|1,528.65|FSC: 13; Default||Not reimbursed separately|1,528.65|FSC: 13; Default||External grouping not supported 71001366|EAP|CPT® 92977||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Thrombolysis Iv Infusiton|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 95183220|EAP|Custom 95183220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cassette Impella Purge 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71001374|EAP|CPT® 92950||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Cardiopulmonary Resuscitation|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 6.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 71001408|EAP|CPT® 36569||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Picc Wo Sub Prt/pmp >5 Y/o|1|HUMANA [1294]||HUMANA [11839]|4,647.93|FSC: 13; Default||Not reimbursed separately|4,647.93|FSC: 13; Default||External grouping not supported 71001457|EAP|CPT® 62270||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Lumbar Puncture, Diagnostic|1|HUMANA [1294]||HUMANA [11839]|1,781.10|FSC: 13; Default||Not reimbursed separately|1,781.10|FSC: 13; Default||External grouping not supported 95183221|EAP|Custom 95183221||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Pump Connector Impella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71001564|EAP|CPT® 69210||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Impacted Cerumen One Or Both Ears|1|HUMANA [1294]||HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 95183225|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Tendon Tissue Bovine Fetal Tissue Perforated 4cmx4cm|1|HUMANA [1294]||HUMANA [11839]|174.22|FSC: 13; Default||Not reimbursed separately|174.22|FSC: 13; Default||External grouping not supported 71001606|EAP|CPT® 36680||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Needle Place Intraosseous Inf|1|HUMANA [1294]||HUMANA [11839]|1,036.05|FSC: 13; Default||Not reimbursed separately|1,036.05|FSC: 13; Default||External grouping not supported 71001614|EAP|CPT® 37195||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Thrombolysis Cerebral Iv Infus|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 71002729|EAP|Custom 71002729||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Blood Alcohol Legal|1|HUMANA [1294]||HUMANA [11839]|31.88|FSC: 13; Default||Not reimbursed separately|31.88|FSC: 13; Default||External grouping not supported 71002737|EAP|Custom 71002737||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Drug Screen Legal|1|HUMANA [1294]||HUMANA [11839]|38.12|FSC: 13; Default||Not reimbursed separately|38.12|FSC: 13; Default||External grouping not supported 95183235|EAP|Custom 95183235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 20 Natrelle 700cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71005003|EAP|Custom 71005003||0459 - EMERGENCY ROOM - OTHER EMERGENCY ROOM|Hb Decontamination Group|1|HUMANA [1294]||HUMANA [11839]|167.47|FSC: 13; Default||Not reimbursed separately|167.47|FSC: 13; Default||External grouping not supported 71005052|EAP|Custom 71005052||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Orthopedic Closed Procedure|1|HUMANA [1294]||HUMANA [11839]|390.82|FSC: 13; Default||Not reimbursed separately|390.82|FSC: 13; Default||External grouping not supported 95183243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3 Hole Left/right Humerus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 71005060|EAP|Custom 71005060||0998 - STATISTICAL CHARGES|Hb Level 0 Left Not Seen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183239|EAP|Custom 95183239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural Reg 25/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71005300|EAP|CPT® 36593||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Declot Vad, Thromolytic|1|HUMANA [1294]||HUMANA [11839]|955.73|FSC: 13; Default||Not reimbursed separately|955.73|FSC: 13; Default||External grouping not supported 71005318|EAP|CPT® 20610||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Aspiration/inj In Joing|1|HUMANA [1294]||HUMANA [11839]|745.92|FSC: 13; Default||Not reimbursed separately|745.92|FSC: 13; Default||External grouping not supported 95183246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5 X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 71005326|EAP|CPT® 31575||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Flex Laryngoscopy Fiber Diag|1|HUMANA [1294]||HUMANA [11839]|446.10|FSC: 13; Default||Not reimbursed separately|446.10|FSC: 13; Default||External grouping not supported 71010607|EAP|Custom 71010607||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Orthopedic Open Procedure|1|HUMANA [1294]||HUMANA [11839]|2,570.18|FSC: 13; Default||Not reimbursed separately|2,570.18|FSC: 13; Default||External grouping not supported 95183236|EAP|Custom 95183236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 20 Natrelle 800cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71010615|EAP|Custom 71010615||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Splinting/strapping|1|HUMANA [1294]||HUMANA [11839]|390.82|FSC: 13; Default||Not reimbursed separately|390.82|FSC: 13; Default||External grouping not supported 71010623|EAP|Custom 71010623||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Ed Gi/gu|1|HUMANA [1294]||HUMANA [11839]|197.39|FSC: 13; Default||Not reimbursed separately|197.39|FSC: 13; Default||External grouping not supported 95183237|EAP|Custom 95183237||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adhesive Dermabond Skin Advanced 12/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71010631|EAP|Custom 71010631||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Ed Ent Procedure|1|HUMANA [1294]||HUMANA [11839]|390.82|FSC: 13; Default||Not reimbursed separately|390.82|FSC: 13; Default||External grouping not supported 71010649|EAP|Custom 71010649||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Ed Wound Care/i&d/pbr|1|HUMANA [1294]||HUMANA [11839]|294.12|FSC: 13; Default||Not reimbursed separately|294.12|FSC: 13; Default||External grouping not supported 95183241|EAP|Custom 95183241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Picc Line Insertion 8/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 71010664|EAP|Custom 71010664||0459 - EMERGENCY ROOM - OTHER EMERGENCY ROOM|Hb Decontamination Personal|1|HUMANA [1294]||HUMANA [11839]|167.47|FSC: 13; Default||Not reimbursed separately|167.47|FSC: 13; Default||External grouping not supported 71010722|EAP|CPT® 62273||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidural Inj Blood Patch|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95183244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 75100644|EAP|HCPCS L1830||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Knee Immobilizer 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm/l50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 75100651|EAP|HCPCS L4350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Air Cast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100677|EAP|HCPCS L3999||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Tennis Elbow Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 14mmx340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 75100685|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Rocket Soc/aso/act|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75100701|EAP|Custom 75100701||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Un Pt Donjoy Horseshoe|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Axial Multi Vertex 3.5mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|FSC: 13; Default||Not reimbursed separately|4,254.18|FSC: 13; Default||External grouping not supported 75106112|EAP|HCPCS L0140||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pt Cervical Collar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502849|EAP|HCPCS L3720||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-elbow Orthosis-hinged|1|HUMANA [1294]||HUMANA [11839]|994.61|FSC: 13; Default||Not reimbursed separately|994.61|FSC: 13; Default||External grouping not supported 75502872|EAP|HCPCS L3808||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-whfo Static|1|HUMANA [1294]||HUMANA [11839]|459.27|FSC: 13; Default||Not reimbursed separately|459.27|FSC: 13; Default||External grouping not supported 75502930|EAP|HCPCS L3906||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-wrist Hand Orthosis Static|1|HUMANA [1294]||HUMANA [11839]|580.07|FSC: 13; Default||Not reimbursed separately|580.07|FSC: 13; Default||External grouping not supported 95183254|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Long 5 X 120 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 75503011|EAP|HCPCS L3671||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-fracture Orthosis Hume|1|HUMANA [1294]||HUMANA [11839]|1,238.96|FSC: 13; Default||Not reimbursed separately|1,238.96|FSC: 13; Default||External grouping not supported 75503045|EAP|HCPCS L3702||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-elbow Orthosis|1|HUMANA [1294]||HUMANA [11839]|397.05|FSC: 13; Default||Not reimbursed separately|397.05|FSC: 13; Default||External grouping not supported 95183252|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 4 X 150 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 75503052|EAP|HCPCS L3764||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-dynamic Elbow Sup/pron|1|HUMANA [1294]||HUMANA [11839]|1,088.73|FSC: 13; Default||Not reimbursed separately|1,088.73|FSC: 13; Default||External grouping not supported 75503094|EAP|HCPCS L3905||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-wrist Orthosis-dynamic|1|HUMANA [1294]||HUMANA [11839]|1,363.62|FSC: 13; Default||Not reimbursed separately|1,363.62|FSC: 13; Default||External grouping not supported 95183260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtp Fusion Plate Small 0 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,894.00|FSC: 13; Default||Not reimbursed separately|3,894.00|FSC: 13; Default||External grouping not supported 75503219|EAP|HCPCS L3912||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-flexion Glove|1|HUMANA [1294]||HUMANA [11839]|132.15|FSC: 13; Default||Not reimbursed separately|132.15|FSC: 13; Default||External grouping not supported 75503235|EAP|HCPCS L3929||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-dyn Hb Finger Prefab (hfo|1|HUMANA [1294]||HUMANA [11839]|115.76|FSC: 13; Default||Not reimbursed separately|115.76|FSC: 13; Default||External grouping not supported 95183261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Darco Headless Screw 3.5x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 75503243|EAP|HCPCS L3925||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-dyn Finger Prefab (fo)|1|HUMANA [1294]||HUMANA [11839]|72.63|FSC: 13; Default||Not reimbursed separately|72.63|FSC: 13; Default||External grouping not supported 75503276|EAP|HCPCS L3995||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-entire Arm Stockinette|1|HUMANA [1294]||HUMANA [11839]|47.04|FSC: 13; Default||Not reimbursed separately|47.04|FSC: 13; Default||External grouping not supported 95183259|EAP|Custom 95183259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Ball Tapered Straight Stylet For 45cm Lead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75504159|EAP|CPT® 97763||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Checkout Orth/prost Use, 15 Min|1|HUMANA [1294]||HUMANA [11839]|148.41|FSC: 13; Default||Not reimbursed separately|148.41|FSC: 13; Default||External grouping not supported 75700203|EAP|HCPCS L3908||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stm-resting Wrist Splint|1|HUMANA [1294]||HUMANA [11839]|82.38|FSC: 13; Default||Not reimbursed separately|82.38|FSC: 13; Default||External grouping not supported 95183262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 10x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|FSC: 13; Default||Not reimbursed separately|809.55|FSC: 13; Default||External grouping not supported 75700609|EAP|HCPCS L3030||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Custom Orthotics-in House|1|HUMANA [1294]||HUMANA [11839]|115.32|FSC: 13; Default||Not reimbursed separately|115.32|FSC: 13; Default||External grouping not supported 76800002|EAP|CPT® 19100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bil Mammo Core Bx|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183250|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber Dilatation 3.0 X 80 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 77103000|EAP|CPT® 92587||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Distortion Product Evoked Otoacoustic Emissions With Interpret|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183253|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 2.5 X 150 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 77301034|EAP|CPT® 92585||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Auditory Evoked Potentials, Comprehensive|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 77302008|EAP|CPT® 92551||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Screening Test, Pure Tone Air Only|1|HUMANA [1294]||HUMANA [11839]|55.56|FSC: 13; Default||Not reimbursed separately|55.56|FSC: 13; Default||External grouping not supported 95183258|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraoccular 20.0 Diopter Technis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 77303006|EAP|CPT® 92586||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Auditory Evoked Potentials, Limited|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 77304004|EAP|CPT® 92591||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Exam And Selection; Binaural|1|HUMANA [1294]||HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95183251|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 2.5 X 60 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 77305001|EAP|CPT® 92557||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Comprehensive Audiometry Eval And Speech Recognition|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 77307007|EAP|CPT® 92567||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Tympanometry (impedance Testing)|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 80167299|EAP|CPT® 49999||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Unlisted Procedure Abdomen, Peritoneum, Omentum|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 77408904|EAP|CPT® 92568||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Acoustic Reflex Testing, Threshold|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 77409019|EAP|CPT® 92596||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Musician Earplugs (pair)|1|HUMANA [1294]||HUMANA [11839]|91.74|FSC: 13; Default||Not reimbursed separately|91.74|FSC: 13; Default||External grouping not supported 95183265|EAP|Custom 95183265||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Small 5x17x12mm 10degree|1|HUMANA [1294]||HUMANA [11839]|4,908.00|FSC: 13; Default||Not reimbursed separately|4,908.00|FSC: 13; Default||External grouping not supported 77409035|EAP|HCPCS V5050||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Standard Mon|1|HUMANA [1294]||HUMANA [11839]|1,773.92|FSC: 13; Default||Not reimbursed separately|1,773.92|FSC: 13; Default||External grouping not supported 95183266|EAP|Custom 95183266||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Small 4x17x12mm 10degree|1|HUMANA [1294]||HUMANA [11839]|4,908.00|FSC: 13; Default||Not reimbursed separately|4,908.00|FSC: 13; Default||External grouping not supported 77409068|EAP|HCPCS V5259||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Superior Bin|1|HUMANA [1294]||HUMANA [11839]|6,430.88|FSC: 13; Default||Not reimbursed separately|6,430.88|FSC: 13; Default||External grouping not supported 77409076|EAP|HCPCS V5255||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Superior Mon|1|HUMANA [1294]||HUMANA [11839]|3,415.55|FSC: 13; Default||Not reimbursed separately|3,415.55|FSC: 13; Default||External grouping not supported 95183268|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Capsurefix Novus 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 77409084|EAP|HCPCS V5252||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Advanced Bin|1|HUMANA [1294]||HUMANA [11839]|4,622.78|FSC: 13; Default||Not reimbursed separately|4,622.78|FSC: 13; Default||External grouping not supported 77409092|EAP|HCPCS V5245||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Advanced Mon|1|HUMANA [1294]||HUMANA [11839]|2,620.64|FSC: 13; Default||Not reimbursed separately|2,620.64|FSC: 13; Default||External grouping not supported 77409100|EAP|HCPCS V5130||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Standard Bin|1|HUMANA [1294]||HUMANA [11839]|3,277.73|FSC: 13; Default||Not reimbursed separately|3,277.73|FSC: 13; Default||External grouping not supported 77409118|EAP|HCPCS V5267||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hearing Aid Warranty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77409126|EAP|HCPCS V5264||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Earmold-unilateral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77409134|EAP|CPT® 92555||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Speech Audiometry Threshold|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 77409159|EAP|CPT® 92582||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Conditioning Play Audiometry|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 77409167|EAP|CPT® 92565||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Stenger Test, Pure Tone|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 77409175|EAP|CPT® 92620||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Evaluation Of Central Auditory Function Initial 60 Min|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 77600716|EAP|CPT® 99070||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Educational Material|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80000102|EAP|Custom 80000102||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Consultation|1|HUMANA [1294]||HUMANA [11839]|46.39|FSC: 13; Default||Not reimbursed separately|46.39|FSC: 13; Default||External grouping not supported 80100662|EAP|CPT® 74415||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ivp W/tomo|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80104086|EAP|CPT® 37183||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Revise Hepatic Shunt|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 80104466|EAP|CPT® 74251||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Enteroclysis|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80104862|EAP|CPT® 76100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Laminograph|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80104870|EAP|CPT® 70390||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sialogram|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80105018|EAP|HCPCS G0378||0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A)|Hb Observation Room - Per Hour|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.75|FSC: 13; Default||Not reimbursed separately|57.75|FSC: 13; Default||External grouping not supported 80105026|EAP|Custom 80105026||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii|1|HUMANA [1294]||HUMANA [11839]|508.74|FSC: 13; Default||Not reimbursed separately|508.74|FSC: 13; Default||External grouping not supported 80105034|EAP|Custom 80105034||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii Add Hr|1|HUMANA [1294]||HUMANA [11839]|194.75|FSC: 13; Default||Not reimbursed separately|194.75|FSC: 13; Default||External grouping not supported 80120371|EAP|CPT® 10021||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB FINE NEEDLE ASP W/O GU|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 80135221|EAP|CPT® 50592||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Renal Tumor Ablation Bilat|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 80135239|EAP|CPT® 21501||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inc/drn Deep Abs Sft Neck/thx|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 80135254|EAP|CPT® 75842||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Bilat Adrenal Venography|1|HUMANA [1294]||HUMANA [11839]|13,096.95|FSC: 13; Default||Not reimbursed separately|13,096.95|FSC: 13; Default||External grouping not supported 80135296|EAP|CPT® 36598||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Contr Inj Eval Exist Cvc Fluor|1|HUMANA [1294]||HUMANA [11839]|567.19|FSC: 13; Default||Not reimbursed separately|567.19|FSC: 13; Default||External grouping not supported 80135304|EAP|CPT® 36013||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Cath Rt Heart/pulm Art|1|HUMANA [1294]||HUMANA [11839]|1,384.00|FSC: 13; Default||Not reimbursed separately|1,384.00|FSC: 13; Default||External grouping not supported 80135353|EAP|CPT® 72270||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Myelography Two Or More|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 80135437|EAP|CPT® 96411||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo Iv Push, Sequential|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 80135452|EAP|CPT® 96417||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Chemo Iv Inf Sequential 1 Hr|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 80135528|EAP|CPT® 74301||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cholangio/panc Addl Set Oper|1|HUMANA [1294]||HUMANA [11839]|367.44|FSC: 13; Default||Not reimbursed separately|367.44|FSC: 13; Default||External grouping not supported 80135593|EAP|CPT® 77021||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mr Guide For Needle Placement|1|HUMANA [1294]||HUMANA [11839]|2,102.53|FSC: 13; Default||Not reimbursed separately|2,102.53|FSC: 13; Default||External grouping not supported 80135601|EAP|CPT® 36557||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tunneled Cvc Insertion <5|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80135627|EAP|CPT® 36557||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB INSERT TUN CV CATH <5 BILATERAL|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80135668|EAP|CPT® 36565||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB INS TUN CVA 2 CAT W/O PORT BILATERAL|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80135700|EAP|CPT® 36566||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB INS TUN CVA 2 CATH W/PORT BILATERAL|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80135718|EAP|CPT® 36593||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Declot Vad, Thrombolytic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.73|FSC: 13; Default||Not reimbursed separately|955.73|FSC: 13; Default||External grouping not supported 80135734|EAP|CPT® 36556||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Central Venous Access >5|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80135775|EAP|CPT® 36570||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Picvad Cath <5y/o|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80135833|EAP|CPT® 36560||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Tunneled Cv Cath <5y/o|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80135858|EAP|CPT® 36569||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Picc Insertion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80135924|EAP|CPT® 36580||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB COMP REPLACE NON-TUN CV CATH|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80135957|EAP|CPT® 36584||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Replace Picc W/o Sub Prt/pmp|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80135973|EAP|CPT® 36589||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Tun Cvc W/o Sub Prt/pmp|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80136047|EAP|CPT® 46020||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Of Seton|1|HUMANA [1294]||HUMANA [11839]|7,236.45|FSC: 13; Default||Not reimbursed separately|7,236.45|FSC: 13; Default||External grouping not supported 80136088|EAP|CPT® 50384||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Rem Int Dwell Uret Stent Bil|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80136096|EAP|Custom 80136096||0651 - HOSPICE SERVICE - ROUTINE HOME CARE|Hb Room & Bd Hospice Return Home|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80136104|EAP|Custom 80136104||0656 - HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE|Hb Room & Bd Hospice Day Of Death|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||External grouping not supported 80136294|EAP|HCPCS Q5007||0155 - ROOM AND BOARD - WARD (MEDICAL OR GENERAL) - HOSPICE|Hb Hospice Nursing Hm Charge|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||Accommodation codes not reimbursed separately 80136815|EAP|HCPCS Q5001||0651 - HOSPICE SERVICE - ROUTINE HOME CARE|Hb Hospice, Routine, Home/residence|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80136856|EAP|HCPCS Q5001||0651 - HOSPICE SERVICE - ROUTINE HOME CARE|Hb Hospice Routine Home Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80136880|EAP|HCPCS Q5002||0651 - HOSPICE SERVICE - ROUTINE HOME CARE|Hb Hospice Routine Assist Living Facility|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80136930|EAP|HCPCS Q5003||0651 - HOSPICE SERVICE - ROUTINE HOME CARE|Hb Hospice Routine In Ltc Facility|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80136963|EAP|HCPCS Q5004||0651 - HOSPICE SERVICE - ROUTINE HOME CARE|Hb Hospice Routine Care In Snf|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80137003|EAP|HCPCS Q5005||0655 - HOSPICE SERVICE - INPATIENT RESPITE CARE|Hb Hospice, Ip Respite, Hospital|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 80137029|EAP|HCPCS Q5005||0656 - HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE|Hb Hospice, Ip General, Hospital|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||External grouping not supported 80137045|EAP|HCPCS Q5006||0656 - HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE|Hb Hospice General Ip Per Diem|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||External grouping not supported 80137052|EAP|HCPCS Q5006||0656 - HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE|Hb Hospice Inpatient Hospice|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||External grouping not supported 80137078|EAP|Custom 80137078||0656 - HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE|Hb Room & Bd Hospice Private|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||External grouping not supported 80137086|EAP|Custom 80137086||0655 - HOSPICE SERVICE - INPATIENT RESPITE CARE|Hb Hospice Ip Respite Per Diem|1|HUMANA [1294]||HUMANA [11839]|900.20|FSC: 13; Default||Not reimbursed separately|900.20|FSC: 13; Default||External grouping not supported 80137698|EAP|CPT® 76816||0402 - OTHER IMAGING SERVICES - ULTRASOUND|HB PN F/U US SINGLE OR 1ST BABY|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80137706|EAP|CPT® 76817||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Uterus, Transvaginal|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80139298|EAP|CPT® 96373||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Thera Or Diag Intra-art Inj|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 80139314|EAP|CPT® 20615||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Aspir/inj Bone Cyst|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80140403|EAP|CPT® 75957||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Endo Rpr Des Thor Arta, W/o Sbclv|1|HUMANA [1294]||HUMANA [11839]|2,481.00|FSC: 13; Default||Not reimbursed separately|2,481.00|FSC: 13; Default||External grouping not supported 80140411|EAP|CPT® 75741||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Pulmonary Uni Sel|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 80140775|EAP|CPT® 74280||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Barium Enema W/ac W/w/o Kub|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80140817|EAP|CPT® 74290||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cholecystography Oral|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80140833|EAP|CPT® 74220||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Esophagus|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80140890|EAP|CPT® 74400||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ivp W/or W/o Tomo|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80140916|EAP|CPT® 74230||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Swal Func W/cine/video|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80140932|EAP|CPT® 74250||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Small Intestine|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80141633|EAP|CPT® 74300||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cholangio/pancreat Operative|1|HUMANA [1294]||HUMANA [11839]|768.50|FSC: 13; Default||Not reimbursed separately|768.50|FSC: 13; Default||External grouping not supported 80142250|EAP|CPT® 70310||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Teeth Partial|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80142664|EAP|CPT® 27216||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Treat Pelvic Ring Fracture|1|HUMANA [1294]||HUMANA [11839]|3,445.33|FSC: 13; Default||Not reimbursed separately|3,445.33|FSC: 13; Default||External grouping not supported 80142698|EAP|CPT® 96105||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Aphasia Assess W/report,per Hr|1|HUMANA [1294]||HUMANA [11839]|300.69|FSC: 13; Default||Not reimbursed separately|300.69|FSC: 13; Default||External grouping not supported 80143118|EAP|HCPCS 0042T||0351 - CT SCAN - HEAD SCAN|Hb Ct Perfusion W/contrast, Cbf|1|HUMANA [1294]||HUMANA [11839]|1,877.73|FSC: 13; Default||Not reimbursed separately|1,877.73|FSC: 13; Default||External grouping not supported 80143142|EAP|CPT® 74262||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Medicare Virtual Colon Diag|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95186647|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Square 2.7mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|FSC: 13; Default||Not reimbursed separately|423.00|FSC: 13; Default||External grouping not supported 80143175|EAP|CPT® 97533||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Sensory Integration 15 Minute|1|HUMANA [1294]||HUMANA [11839]|145.59|FSC: 13; Default||Not reimbursed separately|145.59|FSC: 13; Default||External grouping not supported 80143621|EAP|HCPCS L3913||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht Hand Based Static Finger|1|HUMANA [1294]||HUMANA [11839]|372.42|FSC: 13; Default||Not reimbursed separately|372.42|FSC: 13; Default||External grouping not supported 95191792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Crossfit Knotless 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 80143639|EAP|HCPCS L3933||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-static Finger/thumb Splint|1|HUMANA [1294]||HUMANA [11839]|293.39|FSC: 13; Default||Not reimbursed separately|293.39|FSC: 13; Default||External grouping not supported 80143647|EAP|HCPCS L3935||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-finger Based Dynamic|1|HUMANA [1294]||HUMANA [11839]|303.81|FSC: 13; Default||Not reimbursed separately|303.81|FSC: 13; Default||External grouping not supported 95183283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rigidloop Cortical Fixation Implant 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,083.00|FSC: 13; Default||Not reimbursed separately|1,083.00|FSC: 13; Default||External grouping not supported 80143654|EAP|HCPCS L3921||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-hb Dynamic 1 Or More Finger J|1|HUMANA [1294]||HUMANA [11839]|441.63|FSC: 13; Default||Not reimbursed separately|441.63|FSC: 13; Default||External grouping not supported 80143662|EAP|HCPCS L3806||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht-fb Dynamic 1 Or More Finger J|1|HUMANA [1294]||HUMANA [11839]|624.59|FSC: 13; Default||Not reimbursed separately|624.59|FSC: 13; Default||External grouping not supported 95183273|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 4.0 X 40 X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80143670|EAP|HCPCS L3763||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ht Ewho Elbow-wrist-hand Ortho|1|HUMANA [1294]||HUMANA [11839]|1,091.70|FSC: 13; Default||Not reimbursed separately|1,091.70|FSC: 13; Default||External grouping not supported 80144207|EAP|CPT® 93580||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Per Close Cong Interatrial|1|HUMANA [1294]||HUMANA [11839]|49,206.37|FSC: 13; Default||Not reimbursed separately|49,206.37|FSC: 13; Default||External grouping not supported 95183270|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Long 8 X 60 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 80144223|EAP|CPT® 76377||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct 3d Reconst W/indep Wrkst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.50|FSC: 13; Default||Not reimbursed separately|771.50|FSC: 13; Default||External grouping not supported 80146202|EAP|CPT® 64445||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Sciatic Nerve Block Incl Poplite|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95183281|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 6 X 40 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80146210|EAP|CPT® 64520||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Lumbar Plexus Block|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183271|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Long 8 X 150 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95183279|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 2.5 X 100 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80146285|EAP|CPT® 64416||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Brachial Plexus Catheter|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183276|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 3.0 X 150 X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80146293|EAP|CPT® 64448||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Femoral Nerve Block Catheter|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80146301|EAP|CPT® 64449||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Lumbar Plexus Nerve Block Cath|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183277|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 4 X 60 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80146319|EAP|CPT® 64446||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Sciatic Nerve Block Catheter|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80146335|EAP|CPT® 64520||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Paravertebral Block|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183272|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Opta Pro .35 Pta 5 X 80 110cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80146343|EAP|CPT® 51702||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Temp Indwelling Cath|1|HUMANA [1294]||HUMANA [11839]|336.57|FSC: 13; Default||Not reimbursed separately|336.57|FSC: 13; Default||External grouping not supported 80146384|EAP|CPT® 21899||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Neck Or Thorax Procedure|1|HUMANA [1294]||HUMANA [11839]|628.65|FSC: 13; Default||Not reimbursed separately|628.65|FSC: 13; Default||External grouping not supported 95183275|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Long 6 X 80 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 80146392|EAP|CPT® 24999||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Humerus Or Elbow|1|HUMANA [1294]||HUMANA [11839]|665.67|FSC: 13; Default||Not reimbursed separately|665.67|FSC: 13; Default||External grouping not supported 80146400|EAP|CPT® 27299||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Pelvis Or Hip Joint|1|HUMANA [1294]||HUMANA [11839]|665.67|FSC: 13; Default||Not reimbursed separately|665.67|FSC: 13; Default||External grouping not supported 95183280|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Long 6 X 40 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 80146418|EAP|CPT® 27599||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Femur Or Knee|1|HUMANA [1294]||HUMANA [11839]|665.67|FSC: 13; Default||Not reimbursed separately|665.67|FSC: 13; Default||External grouping not supported 80146426|EAP|CPT® 27899||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Leg Or Ankle|1|HUMANA [1294]||HUMANA [11839]|665.67|FSC: 13; Default||Not reimbursed separately|665.67|FSC: 13; Default||External grouping not supported 95183284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Implate 12mm X 15.0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|892.50|FSC: 13; Default||Not reimbursed separately|892.50|FSC: 13; Default||External grouping not supported 80146442|EAP|CPT® 36589||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Central Venous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80147309|EAP|CPT® 77065||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Diagnostic Mammography Unilateral Including Cad|1|HUMANA [1294]||HUMANA [11839]|253.68|FSC: 13; Default||Not reimbursed separately|253.68|FSC: 13; Default||External grouping not supported 95183269|EAP|Custom 95183269||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Trainer Expiratory Emst150|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80147366|EAP|CPT® 77066||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Diagnostic Mammography Bilateral Including Cad|1|HUMANA [1294]||HUMANA [11839]|324.03|FSC: 13; Default||Not reimbursed separately|324.03|FSC: 13; Default||External grouping not supported 80147713|EAP|CPT® 77067||0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY|Hb Screening Mammography Bilateral Including Cad|1|HUMANA [1294]||HUMANA [11839]|262.17|FSC: 13; Default||Not reimbursed separately|262.17|FSC: 13; Default||External grouping not supported 95183282|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 5 X 40 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80148000|EAP|CPT® 42550||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Salivography Inj Proc|1|HUMANA [1294]||HUMANA [11839]|553.84|FSC: 13; Default||Not reimbursed separately|553.84|FSC: 13; Default||External grouping not supported 80148018|EAP|CPT® 75958||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Plcmt Extnsn Prost Desc Thorac|1|HUMANA [1294]||HUMANA [11839]|883.10|FSC: 13; Default||Not reimbursed separately|883.10|FSC: 13; Default||External grouping not supported 95183278|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Long 5 X 100 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 80148109|EAP|HCPCS L3931||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wrist Hand Finger Orthosis|1|HUMANA [1294]||HUMANA [11839]|280.04|FSC: 13; Default||Not reimbursed separately|280.04|FSC: 13; Default||External grouping not supported 80148117|EAP|HCPCS L3927||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Finger Pip Dip Orthosis|1|HUMANA [1294]||HUMANA [11839]|48.12|FSC: 13; Default||Not reimbursed separately|48.12|FSC: 13; Default||External grouping not supported 95183285|EAP|Custom 95183285||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cutter Flip Ii 10.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80148174|EAP|CPT® 36591||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Collection Blood Speciment Ivad|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 80148182|EAP|CPT® 36592||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Collect Blood Ext Vad|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183286|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 2 X 150 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80148190|EAP|CPT® 36593||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Declotting Ivad Or Cath W/agent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.73|FSC: 13; Default||Not reimbursed separately|955.73|FSC: 13; Default||External grouping not supported 80148315|EAP|CPT® 93280||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Pm Device Progr Eval, Dual|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95183295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Clavicle Short Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 80148323|EAP|CPT® 93279||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Pm Device Eprogr Eval, Sngl|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80148331|EAP|CPT® 93288||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Pm Device Eval In Person|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95183290|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 4 X 60 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80148356|EAP|CPT® 93282||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Icd Device Prog Eval, 1 Sngl|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80148364|EAP|CPT® 93289||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Icd Device Interrogate|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95183297|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 7 X 40 X 80 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80148372|EAP|CPT® 93283||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Icd Device Progr Eval, Dual|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80148448|EAP|CPT® 76098||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Xray Surgical Specimen|1|HUMANA [1294]||HUMANA [11839]|1,372.26|FSC: 13; Default||Not reimbursed separately|1,372.26|FSC: 13; Default||External grouping not supported 95183291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Ti Straight 8mm Radial 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 80148653|EAP|CPT® 77054||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Mammo Ductogram Mlt Duct Uct|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80148695|EAP|CPT® 77053||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Mammo Ductogram Sngl Duct Ct|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Right 11 X 380|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|FSC: 13; Default||Not reimbursed separately|5,964.00|FSC: 13; Default||External grouping not supported 80148844|EAP|CPT® 20552||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Single/multiple Trigger Pt|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95183294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 6 Hole Bridge Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 80148901|EAP|CPT® 82805||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Arterial Blood Gas Analysis Pos|1|HUMANA [1294]||HUMANA [11839]|236.31|FSC: 13; Default||Not reimbursed separately|236.31|FSC: 13; Default||External grouping not supported 95183296|EAP|Custom 95183296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire .062 X 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80148927|EAP|CPT® 49450||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Replace G/c Tube Perc|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 80148950|EAP|CPT® 32998||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation Tx 1 > Pulm Tumors|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95183288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Radial Recon Size3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,404.00|FSC: 13; Default||Not reimbursed separately|7,404.00|FSC: 13; Default||External grouping not supported 80149032|EAP|CPT® 50435||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Change Neph/pyelostomy Tube|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 80149651|EAP|Custom 80149651||0998 - STATISTICAL CHARGES|Hb Pt Ventilator Assessment|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Standard Cocr 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 80151632|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Resp Flow Volume Loop|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Radial Recon 6mm Collar Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,408.00|FSC: 13; Default||Not reimbursed separately|9,408.00|FSC: 13; Default||External grouping not supported 80151665|EAP|Custom 80151665||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Gc Mip/mep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Backed Metal Asymmetric Triathlon A32mm 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.00|FSC: 13; Default||Not reimbursed separately|1,959.00|FSC: 13; Default||External grouping not supported 80151681|EAP|CPT® 94200||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Maximum Vol Vent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 95186643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder N X T 5.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 80151715|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Mdi Tx-initial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 80151947|EAP|CPT® 49465||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Fluoro Exam Of G/colon Tube|1|HUMANA [1294]||HUMANA [11839]|719.39|FSC: 13; Default||Not reimbursed separately|719.39|FSC: 13; Default||External grouping not supported 95183299|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread 6mm 6.0mm/l70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80151954|EAP|CPT® 93463||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Nitric Oxide Challenge|1|HUMANA [1294]||HUMANA [11839]|944.25|FSC: 13; Default||Not reimbursed separately|944.25|FSC: 13; Default||External grouping not supported 95183300|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 12hole /l274mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,330.00|FSC: 13; Default||Not reimbursed separately|12,330.00|FSC: 13; Default||External grouping not supported 80152010|EAP|CPT® 10121||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inc/remove Fb, Subq, Comp|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5mmxl32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 80152200|EAP|CPT® 76857||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Pelvis (nonob) Limit Or F/u|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80152218|EAP|CPT® 11042||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Debrid Part Thick W/comp Wrp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 80152226|EAP|CPT® 11043||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Debrid Full Thick W/comp Wrp|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 80152234|EAP|CPT® 11042||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Debrid Sub-q W/comp Wrp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95183302|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 5 X 300 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80152242|EAP|CPT® 11043||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Debr Sub-q Mus W/comp Wrp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 80152259|EAP|CPT® 13120||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Wound Closure 2.5 Cm Or Less|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 95183305|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 5 X 120 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80152267|EAP|CPT® 97597||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Selec Debride 20 Cm Or Less|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 80152275|EAP|CPT® 97598||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Selec Debride >than 20cm|1|HUMANA [1294]||HUMANA [11839]|368.98|FSC: 13; Default||Not reimbursed separately|368.98|FSC: 13; Default||External grouping not supported 95183303|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 4 X 300 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80152283|EAP|CPT® 97602||0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hb Non-selective Debridement|1|HUMANA [1294]||HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 80152309|EAP|CPT® 29580||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unilat Unna Boot Application|1|HUMANA [1294]||HUMANA [11839]|412.85|FSC: 13; Default||Not reimbursed separately|412.85|FSC: 13; Default||External grouping not supported 95183307|EAP|Custom 95183307||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade Alif16x38x28 12 Degree|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 80152325|EAP|CPT® 10061||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incision & Drainage Complicated|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95183310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 80152358|EAP|CPT® 11720||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Debride Nails 1 To 5|1|HUMANA [1294]||HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 95183308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 80152366|EAP|CPT® 11721||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Debride Nails 6-more|1|HUMANA [1294]||HUMANA [11839]|169.81|FSC: 13; Default||Not reimbursed separately|169.81|FSC: 13; Default||External grouping not supported 80152382|EAP|CPT® 11042||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Uni Excis Les 1.1cm-2.0cm Dia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 95183304|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 10 X 40 X 80 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80152390|EAP|CPT® 11622||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Excision Malign Lesion|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80152416|EAP|CPT® 11421||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Unilat Excision/biopsy|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95183309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 80152424|EAP|CPT® 10120||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Foreign Body|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 80152432|EAP|CPT® 12001||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Surgical Closure|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95183306|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Cpx4 Low Height Style 8100 350cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 80152473|EAP|CPT® 10140||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Incision & Drain Hematoma|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183318|EAP|Custom 95183318||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Brigade 16 X 38 X 32mm 8 Degree|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 80152515|EAP|CPT® 76965||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guide Interst Plc Radioelmt|1|HUMANA [1294]||HUMANA [11839]|1,156.00|FSC: 13; Default||Not reimbursed separately|1,156.00|FSC: 13; Default||External grouping not supported 80152523|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb New Pt Level 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95183319|EAP|Custom 95183319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Fiapc Diameter 1.5mm 4.5fr Length 4'11" 150cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80152531|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|HB NEW PATIENT-LEVEL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80152549|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, New Pt,level 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95183326|EAP|Custom 95183326||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Co Cr 5.5 X 480 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,317.49|FSC: 13; Default||Not reimbursed separately|3,317.49|FSC: 13; Default||External grouping not supported 80152556|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|HB NEW PATIENT-LEVEL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80152564|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Op Visit, Est Pt, Level 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95183321|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 6 X 20 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80152572|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|HB FACILITY CHARGE LEVEL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80152580|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|HB FACILITY CHARGE LEVEL 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95183333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R 1/5 Ti Left 11 X 440mm X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 80152598|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|HB ESTABLISHED PT-LEVEL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 80152606|EAP|CPT® 11044||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vi Debrid Subq Tiss Musc Bone|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183323|EAP|Custom 95183323||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Nutrihep Unflavored 24 X 250ml 24/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80152739|EAP|CPT® 44366||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sm Bowel Endo W/controlled Bleed|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80152754|EAP|CPT® 95867||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Unilateral Cranial Nerve|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183336|EAP|Custom 95183336||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Stool Management Dignishield With Med Delivery|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80152770|EAP|CPT® 96450||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo Inj W/spinal Puncture|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 80153059|EAP|Custom 80153059||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Missed Appointment Sleep Disorder|1|HUMANA [1294]||HUMANA [11839]|55.13|FSC: 13; Default||Not reimbursed separately|55.13|FSC: 13; Default||External grouping not supported 95183320|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 5 X 8 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183322|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Allure Rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,161.25|FSC: 13; Default||Not reimbursed separately|21,161.25|FSC: 13; Default||External grouping not supported 80153539|EAP|CPT® 74270||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Barium Enema W/or W/o Kub|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80153547|EAP|CPT® 74360||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Intralum Dilation Strict/obst|1|HUMANA [1294]||HUMANA [11839]|782.05|FSC: 13; Default||Not reimbursed separately|782.05|FSC: 13; Default||External grouping not supported 95183325|EAP|Custom 95183325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Co Cr 5.5 X 600 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,317.49|FSC: 13; Default||Not reimbursed separately|3,317.49|FSC: 13; Default||External grouping not supported 80153745|EAP|CPT® 96420||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Intra Art Push Chemo Admin|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 95183332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant I Fuse Si-bone 7.0mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 80153984|EAP|CPT® 96376||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Iv Push, Sequential, Same Drug +30 Mins|1|HUMANA [1294]||HUMANA [11839]|163.42|FSC: 13; Default||Not reimbursed separately|163.42|FSC: 13; Default||External grouping not supported 80154008|EAP|CPT® 99195||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hb Phlebotomy, Therapeutic|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Radial Stem 30mm Straight Ti 9mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 80154040|EAP|CPT® 51705||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Change Cystostomy Tube Simple|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 95183334|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 6 Hole M Profyle Hand Compression|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95183328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 8.0 X 50 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,489.60|FSC: 13; Default||Not reimbursed separately|6,489.60|FSC: 13; Default||External grouping not supported 80154297|EAP|CPT® 50390||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Asp/inj Renal Cyst/pelvis Perc|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95183330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Radial Head Cocr 2mm Ht Extension/15.5mm Ster 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 80154370|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Resp Flow Volume Loop|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183329|EAP|Custom 95183329||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Spacer Bengal Large 9mm|1|HUMANA [1294]||HUMANA [11839]|4,463.22|FSC: 13; Default||Not reimbursed separately|4,463.22|FSC: 13; Default||External grouping not supported 95183324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Narrow Left 8-hole Ex Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|FSC: 13; Default||Not reimbursed separately|5,208.00|FSC: 13; Default||External grouping not supported 95183327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 8.0 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,489.60|FSC: 13; Default||Not reimbursed separately|6,489.60|FSC: 13; Default||External grouping not supported 80154404|EAP|Custom 80154404||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Gc Mip/mep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80154420|EAP|CPT® 94200||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Maximum Vol Vent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 95183339|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Palmaz Genesis Bx 6mm X 18 Mm Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,403.00|FSC: 13; Default||Not reimbursed separately|2,403.00|FSC: 13; Default||External grouping not supported 80154438|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Broncho Provocation Eval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183338|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sleek Otw 2.5 X 80 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183340|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber Pta .018 3.0 X 40 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80154453|EAP|CPT® 94621||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulmonary Stress Testing,comlx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183342|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 4 X 80 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80154479|EAP|CPT® 94762||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Cont Overnight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183341|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 6 X 300 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80154487|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|HB MDI TX-INITIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95183351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X L50mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 80154495|EAP|CPT® 94760||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Single Determ|1|HUMANA [1294]||HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95183352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis G-force 6mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.00|FSC: 13; Default||Not reimbursed separately|1,461.00|FSC: 13; Default||External grouping not supported 80154503|EAP|CPT® 94761||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Pulse Oximetry, Mult Determ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.39|FSC: 13; Default||Not reimbursed separately|175.39|FSC: 13; Default||External grouping not supported 62062906|EAP|CPT® 87149||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Blood Culture Nucleic Acid Test|1|HUMANA [1294]||HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 80154545|EAP|CPT® 10060||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I & D Abscess/cyst Smpl Sngl|1|HUMANA [1294]||HUMANA [11839]|539.40|FSC: 13; Default||Not reimbursed separately|539.40|FSC: 13; Default||External grouping not supported 95183354|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 50cm Infinion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 80154644|EAP|CPT® 36002||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Pro Perc Trtmt Ext Pseudo|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80154651|EAP|Custom 80154651||0998 - STATISTICAL CHARGES|Hb Respiratory Oxygen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183355|EAP|Custom 95183355||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Markers Ta Coroent Small 6x17x12mm 10 Degree|1|HUMANA [1294]||HUMANA [11839]|4,908.00|FSC: 13; Default||Not reimbursed separately|4,908.00|FSC: 13; Default||External grouping not supported 80154669|EAP|Custom 80154669||0998 - STATISTICAL CHARGES|Hb Respiratory Medications|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80154677|EAP|Custom 80154677||0998 - STATISTICAL CHARGES|Hb Respiratory Ventilator/bipap/cpa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peek Vented Tenodesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 80154685|EAP|Custom 80154685||0998 - STATISTICAL CHARGES|Hb Respiratory Evaluate & Treat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80154693|EAP|Custom 80154693||0998 - STATISTICAL CHARGES|Hb Respiratory All Other|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183353|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber 3.0 X 300 X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80154891|EAP|CPT® 93572||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Intravasc Doppler Coron, Ea Addl|1|HUMANA [1294]||HUMANA [11839]|1,748.32|FSC: 13; Default||Not reimbursed separately|1,748.32|FSC: 13; Default||External grouping not supported 95183369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw T10 Locking Full Thread 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 80154917|EAP|HCPCS A4641||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb I-123 Adreview Per Dose Comm|1|HUMANA [1294]||HUMANA [11839]|7,305.38|FSC: 13; Default||Not reimbursed separately|7,305.38|FSC: 13; Default||External grouping not supported 80154925|EAP|HCPCS C9399||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb I-123 Adreview Per Dose Med|1|HUMANA [1294]||HUMANA [11839]|3,850.00|FSC: 13; Default||Not reimbursed separately|3,850.00|FSC: 13; Default||External grouping not supported 95183370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Standard Right 10 Hole Extra Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,866.00|FSC: 13; Default||Not reimbursed separately|4,866.00|FSC: 13; Default||External grouping not supported 95183367|EAP|Custom 95183367||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 60mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95183365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm X 30mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 80155179|EAP|CPT® 16025||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Burn Care And Debridgement Ed|1|HUMANA [1294]||HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 80155187|EAP|Custom 80155187||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Closed Treatment Of Fracture|1|HUMANA [1294]||HUMANA [11839]|257.75|FSC: 13; Default||Not reimbursed separately|257.75|FSC: 13; Default||External grouping not supported 95183366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Ti Straight 3.0mm 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 80155195|EAP|Custom 80155195||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Wound Care Complex Ed|1|HUMANA [1294]||HUMANA [11839]|390.82|FSC: 13; Default||Not reimbursed separately|390.82|FSC: 13; Default||External grouping not supported 80155211|EAP|CPT® 32550||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Indw Tun Pleur Cath W/cuff|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95183364|EAP|Custom 95183364||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Mini Repair|1|HUMANA [1294]||HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80155237|EAP|CPT® 32601||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thoracoscopy Diagnostic|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95183368|EAP|Custom 95183368||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 65mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 80155278|EAP|CPT® 60000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Drain Thyroid/tongue Cyst|1|HUMANA [1294]||HUMANA [11839]|4,165.40|FSC: 13; Default||Not reimbursed separately|4,165.40|FSC: 13; Default||External grouping not supported 95183372|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Tritanium Asymetric Metal Backed A32 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 80155774|EAP|CPT® 99499||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Cardiac Score|1|HUMANA [1294]||HUMANA [11839]|100.00|FSC: 13; Default||Not reimbursed separately|100.00|FSC: 13; Default||External grouping not supported 80156011|EAP|CPT® 49421||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Intra Cannula Or Cath Per|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 80156078|EAP|CPT® 93662||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Intracardiac Echo (ice)|1|HUMANA [1294]||HUMANA [11839]|5,192.08|FSC: 13; Default||Not reimbursed separately|5,192.08|FSC: 13; Default||External grouping not supported 80156201|EAP|Custom 80156201||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Dv Exam|1|HUMANA [1294]||HUMANA [11839]|337.37|FSC: 13; Default||Not reimbursed separately|337.37|FSC: 13; Default||External grouping not supported 95186650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 6hole/l71mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 80156342|EAP|CPT® 76376||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct 3d Reconst W/o Indep Wrkst|1|HUMANA [1294]||HUMANA [11839]|614.62|FSC: 13; Default||Not reimbursed separately|614.62|FSC: 13; Default||External grouping not supported 80156359|EAP|CPT® 76377||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri 3d Rendering W Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.50|FSC: 13; Default||Not reimbursed separately|771.50|FSC: 13; Default||External grouping not supported 80156417|EAP|CPT® 60699||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Procedure Endocrine Sys|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 80156433|EAP|CPT® 70170||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Dacryocystography|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95191793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Y-knot Rc With White/black Tape Hifi Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,153.59|FSC: 13; Default||Not reimbursed separately|1,153.59|FSC: 13; Default||External grouping not supported 80156599|EAP|Custom 80156599||0998 - STATISTICAL CHARGES|Hb Pulrehab Phase Iii Visit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80156680|EAP|Custom 80156680||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cc Aborted Procedure|1|HUMANA [1294]||HUMANA [11839]|1,012.18|FSC: 13; Default||Not reimbursed separately|1,012.18|FSC: 13; Default||External grouping not supported 80156869|EAP|CPT® 70555||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM|Hb Mri Functional Brain W Md|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95186653|EAP|Custom 95186653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Cap Cta Global Linvatec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80156870|EAP|CPT® 70554||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM|Hb Mri Functional Brian W/o Md|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80156898|EAP|CPT® 76390||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Spectroscopy|1|HUMANA [1294]||HUMANA [11839]|2,159.50|FSC: 13; Default||Not reimbursed separately|2,159.50|FSC: 13; Default||External grouping not supported 80200157|EAP|HCPCS A9505||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tl-201 Thallous Chloride Dx, Per Mci|1|HUMANA [1294]||HUMANA [11839]|125.00|FSC: 13; Default||Not reimbursed separately|125.00|FSC: 13; Default||External grouping not supported 95183380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.4 X 26 Mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 80201056|EAP|CPT® 78215||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Liver & Spleen Imag Static|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183384|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Amplatz Extra Stiff J Curve 260cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80201502|EAP|CPT® 78605||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Brain Imag Min 4 Staic Vws|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80201650|EAP|CPT® 78195||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Lymphoscintigraphy|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 95183385|EAP|Custom 95183385||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Dbm Plus Putty 5cc|1|HUMANA [1294]||HUMANA [11839]|3,561.24|FSC: 13; Default||Not reimbursed separately|3,561.24|FSC: 13; Default||External grouping not supported 80201759|EAP|CPT® 78580||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Pulm Perf Imag Particulate|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80202757|EAP|CPT® 78018||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Thyroid Ca Img Whole Body|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 95183381|EAP|Custom 95183381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiberwire # 0 38 Inch With Tappered Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80203854|EAP|CPT® 78707||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Kidney Img/flw Sgl W/o Phr|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80203912|EAP|CPT® 78452||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Myocard Perf Spect Mult|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95183379|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Metal Backed Tritanium Aasymmetric A 35 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 80203920|EAP|HCPCS A9521||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Exametazime Dx/dose, Up To 25mci|1|HUMANA [1294]||HUMANA [11839]|2,504.00|FSC: 13; Default||Not reimbursed separately|2,504.00|FSC: 13; Default||External grouping not supported 80203938|EAP|HCPCS A9556||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Gallium Ga-67 Citrate Dx, Per Mci|1|HUMANA [1294]||HUMANA [11839]|84.00|FSC: 13; Default||Not reimbursed separately|84.00|FSC: 13; Default||External grouping not supported 95183383|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graftmaster Rx 2.8 X 26 Mm Rx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 80204159|EAP|CPT® 78290||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Abdominal (meckels) Scan|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80204209|EAP|CPT® 78306||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Bone/jnt Imaging Whole Body|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183403|EAP|Custom 95183403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Phalinx .9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80204555|EAP|CPT® 78701||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Kidney Imag W/vasc Flow|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80204605|EAP|CPT® 78466||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Myocard Img Infarct Avid|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183404|EAP|Custom 95183404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Phalinx 1.1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80204613|EAP|CPT® 78453||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Myocard Perf Planar Single|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 80204621|EAP|CPT® 78454||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Myocard Perf Planar Mult|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95183402|EAP|Custom 95183402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hammertoe Cannulated Phalinx 2.55|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80204647|EAP|CPT® 78472||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Muga Single Study|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80204654|EAP|CPT® 78800||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Localize Tumor Lmtd Area|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183400|EAP|Custom 95183400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hammertoe Cannulated Phalinx 2.25|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80204688|EAP|CPT® 79005||0342 - NUCLEAR MEDICINE - THERAPEUTIC PROCEDURES|Hb Nm Radpharm Ther By Oral Admin|1|HUMANA [1294]||HUMANA [11839]|676.47|FSC: 13; Default||Not reimbursed separately|676.47|FSC: 13; Default||External grouping not supported 95183401|EAP|Custom 95183401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hammertoe Cannulated Phalinx 2.45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80204704|EAP|CPT® 78740||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Ureteral Reflux Study|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80204712|EAP|CPT® 78761||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Testicular Scan|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 80204720|EAP|CPT® 78278||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Gi Bleeding Scan|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80204746|EAP|CPT® 78630||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Cisternography|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 95183388|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 4 X 40 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80204795|EAP|CPT® 78264||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Gastric Emptying|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183386|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Nanocross 2.5mm X 20mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80204803|EAP|CPT® 78262||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Gastric Reflux|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80204837|EAP|CPT® 78300||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Bone/inj Imaging Lmtd Area|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183391|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 5 X 150 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 80204944|EAP|CPT® 78451||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Myocard Perf Spect Single|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95183410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 80204977|EAP|CPT® 78803||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Localize Tumor Spect|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95183396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis G-force 4mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|FSC: 13; Default||Not reimbursed separately|1,374.00|FSC: 13; Default||External grouping not supported 80204985|EAP|HCPCS A9562||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Mertiatide Dx/dose, Up To 15mci|1|HUMANA [1294]||HUMANA [11839]|1,180.00|FSC: 13; Default||Not reimbursed separately|1,180.00|FSC: 13; Default||External grouping not supported 80205008|EAP|HCPCS A9503||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Medronate Dx/dose, Up To 30mci|1|HUMANA [1294]||HUMANA [11839]|57.00|FSC: 13; Default||Not reimbursed separately|57.00|FSC: 13; Default||External grouping not supported 95183406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.00|FSC: 13; Default||Not reimbursed separately|6,306.00|FSC: 13; Default||External grouping not supported 80205016|EAP|HCPCS A9517||0344 - NUCLEAR MEDICINE - THERAPEUTIC RADIOPHARMACEUTICALS|Hb I-131 Sodium Iodide Caps Tx, Per Mci|1|HUMANA [1294]||HUMANA [11839]|122.10|FSC: 13; Default||Not reimbursed separately|122.10|FSC: 13; Default||External grouping not supported 80205024|EAP|HCPCS A9516||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb I-123 Sodium Iodide Caps Dx, Per 100uci|1|HUMANA [1294]||HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95183411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 52.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 80205032|EAP|CPT® 78315||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Bone/jnt Imag 3 Phase Study|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 80205057|EAP|CPT® 78708||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Kidney Img/flw Sgl W/phr|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80205099|EAP|CPT® 78070||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Parathyroid Imaging|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 80205107|EAP|HCPCS A9572||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb In-111 Pentetreotide Dx/dose Up To 6mci|1|HUMANA [1294]||HUMANA [11839]|13,696.00|FSC: 13; Default||Not reimbursed separately|13,696.00|FSC: 13; Default||External grouping not supported 80205115|EAP|HCPCS A9558||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Xenon Xe-133 Gas Dx, Per 10mci|1|HUMANA [1294]||HUMANA [11839]|304.00|FSC: 13; Default||Not reimbursed separately|304.00|FSC: 13; Default||External grouping not supported 95183389|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber Pta .018 2.0 X 60 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80205123|EAP|HCPCS A9502||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Tetrofosmn Dx/dose|1|HUMANA [1294]||HUMANA [11839]|140.00|FSC: 13; Default||Not reimbursed separately|140.00|FSC: 13; Default||External grouping not supported 80205370|EAP|HCPCS A9540||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Maa Dx/dose, Up To 10mci|1|HUMANA [1294]||HUMANA [11839]|56.80|FSC: 13; Default||Not reimbursed separately|56.80|FSC: 13; Default||External grouping not supported 95183392|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 4 X 100 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80205388|EAP|HCPCS A9537||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Mebrofenin Dx/dose,up To 15mci|1|HUMANA [1294]||HUMANA [11839]|145.00|FSC: 13; Default||Not reimbursed separately|145.00|FSC: 13; Default||External grouping not supported 80205396|EAP|HCPCS A9541||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Sulfur Colloid Dx/dose,up To 20mc|1|HUMANA [1294]||HUMANA [11839]|427.00|FSC: 13; Default||Not reimbursed separately|427.00|FSC: 13; Default||External grouping not supported 95183398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Cannulated Phalinx Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 80205412|EAP|HCPCS A9560||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Labeled Rbcs Dx/dose, Up To 30mci|1|HUMANA [1294]||HUMANA [11839]|580.00|FSC: 13; Default||Not reimbursed separately|580.00|FSC: 13; Default||External grouping not supported 80205420|EAP|HCPCS A9550||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Sodium Glucept Dx/dose,up To 25mc|1|HUMANA [1294]||HUMANA [11839]|67.25|FSC: 13; Default||Not reimbursed separately|67.25|FSC: 13; Default||External grouping not supported 95183415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 80205552|EAP|HCPCS A9507||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb In-111 Capro Pend Dx/dose,up To 10mci|1|HUMANA [1294]||HUMANA [11839]|7,782.50|FSC: 13; Default||Not reimbursed separately|7,782.50|FSC: 13; Default||External grouping not supported 80220965|EAP|CPT® 76936||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guidance For Artery Repair|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183394|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sleek Otw 2.5 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80221203|EAP|HCPCS G0166||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hb Ecp, Per Treatment Session|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Cannulated Phalinx Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|FSC: 13; Default||Not reimbursed separately|2,778.00|FSC: 13; Default||External grouping not supported 80221211|EAP|CPT® 94681||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb St Exhaled Air Analysis 02/c02|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80221229|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb St Evaluation Of Wheezing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95183405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Humerus Postlateral Rt 9h 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95183409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,816.00|FSC: 13; Default||Not reimbursed separately|6,816.00|FSC: 13; Default||External grouping not supported 80230212|EAP|CPT® 47556||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bili Endo Via T-tube W/stent|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95183414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 67.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 80230253|EAP|CPT® 78709||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Kidney Img/flw Mult W/w/o|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80230279|EAP|CPT® 47801||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement, Bile Duct Support|1|HUMANA [1294]||HUMANA [11839]|3,028.03|FSC: 13; Default||Not reimbursed separately|3,028.03|FSC: 13; Default||External grouping not supported 95183387|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Opta Pro .35 Pta 5 X 40 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80230345|EAP|CPT® 43246||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Placement G-tube|1|HUMANA [1294]||HUMANA [11839]|4,807.66|FSC: 13; Default||Not reimbursed separately|4,807.66|FSC: 13; Default||External grouping not supported 95183395|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sleek Otw 2.0 X 40 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Cannulated Phalinx Extra Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|FSC: 13; Default||Not reimbursed separately|2,778.00|FSC: 13; Default||External grouping not supported 80230428|EAP|CPT® 75898||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Thru Exist Cath F/u|1|HUMANA [1294]||HUMANA [11839]|4,647.93|FSC: 13; Default||Not reimbursed separately|4,647.93|FSC: 13; Default||External grouping not supported 80230477|EAP|CPT® 76940||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Ablation Guidance|1|HUMANA [1294]||HUMANA [11839]|708.00|FSC: 13; Default||Not reimbursed separately|708.00|FSC: 13; Default||External grouping not supported 95183390|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Flex Reg 6 X 100 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 80230493|EAP|CPT® 77013||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Guide Parenchyml Tissue Abl|1|HUMANA [1294]||HUMANA [11839]|1,918.00|FSC: 13; Default||Not reimbursed separately|1,918.00|FSC: 13; Default||External grouping not supported 80230527|EAP|CPT® 47382||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Percut Ablate Liver Rf|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95183393|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Opta Pro .35 Pta 7 X 40 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80230543|EAP|CPT® 75889||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Hepatic Venography Hemo Eval|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 80230568|EAP|CPT® 64430||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Anes Pudendal Nerve|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80167307|EAP|CPT® 28010||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tenotomy, Percutaneous, Toe; Single Tendon|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 80230584|EAP|CPT® 49424||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Assess Abs/cyst Via Cath|1|HUMANA [1294]||HUMANA [11839]|702.00|FSC: 13; Default||Not reimbursed separately|702.00|FSC: 13; Default||External grouping not supported 80230592|EAP|CPT® 49423||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Exchange Prev Plc Drn Cathtr|1|HUMANA [1294]||HUMANA [11839]|4,807.66|FSC: 13; Default||Not reimbursed separately|4,807.66|FSC: 13; Default||External grouping not supported 80230766|EAP|CPT® 49440||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Gastrostomy Tube Perc|1|HUMANA [1294]||HUMANA [11839]|4,807.66|FSC: 13; Default||Not reimbursed separately|4,807.66|FSC: 13; Default||External grouping not supported 95183418|EAP|Custom 95183418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Bayonet Pt Single 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80230857|EAP|CPT® 36576||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Revise Access Device|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80230865|EAP|CPT® 34421||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thrombectomy/leg Vein|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|FSC: 13; Default||Not reimbursed separately|1,493.52|FSC: 13; Default||External grouping not supported 80230915|EAP|CPT® 36481||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Portal Vein Cath|1|HUMANA [1294]||HUMANA [11839]|2,701.14|FSC: 13; Default||Not reimbursed separately|2,701.14|FSC: 13; Default||External grouping not supported 95183433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80230923|EAP|CPT® 75885||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Perc Transhep Portogram W/hemo|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 80230931|EAP|CPT® 70015||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cisternography Posi Cont|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 95183421|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reinforcement Tissue Gore Bio-a Flat Sheet 20 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,012.00|FSC: 13; Default||Not reimbursed separately|12,012.00|FSC: 13; Default||External grouping not supported 80230956|EAP|CPT® 37182||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Insertion Of Tips|1|HUMANA [1294]||HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95183435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80231111|EAP|CPT® 31628||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Biopsy|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 95183440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 80231137|EAP|CPT® 74740||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Hysterosalpingiogram|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80231145|EAP|CPT® 20501||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Sinus Tract Diag/sinogram|1|HUMANA [1294]||HUMANA [11839]|583.00|FSC: 13; Default||Not reimbursed separately|583.00|FSC: 13; Default||External grouping not supported 95183417|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Guiding Mullins 6fr 48cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80231277|EAP|CPT® 77080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Dxa 1 Or More Sites Axial Skel|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80231285|EAP|CPT® 77081||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Dxa 1 Or More Sites Appnd Skl|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 80231293|EAP|CPT® 75833||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venography Renal Bilat Sele|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 77.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 80231509|EAP|CPT® 75831||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Renal Venogram Unilateral|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 80231525|EAP|CPT® 75893||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Renal Vien (renins)|1|HUMANA [1294]||HUMANA [11839]|13,096.95|FSC: 13; Default||Not reimbursed separately|13,096.95|FSC: 13; Default||External grouping not supported 95183419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extension Stem Persona Tapered Cemented 14mm +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 80231533|EAP|CPT® 36500||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Venous Cath Sel Orgn Bld Smp|1|HUMANA [1294]||HUMANA [11839]|1,989.00|FSC: 13; Default||Not reimbursed separately|1,989.00|FSC: 13; Default||External grouping not supported 80231558|EAP|CPT® 36015||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Seg/sub Pulm Art|1|HUMANA [1294]||HUMANA [11839]|2,871.57|FSC: 13; Default||Not reimbursed separately|2,871.57|FSC: 13; Default||External grouping not supported 95183432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 82.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80231574|EAP|CPT® 75901||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Removal Pericatheter Obstruct|1|HUMANA [1294]||HUMANA [11839]|868.77|FSC: 13; Default||Not reimbursed separately|868.77|FSC: 13; Default||External grouping not supported 95183443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 80231590|EAP|CPT® 74420||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|HB RETRO PYELOGRAM BILAT|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80231608|EAP|CPT® 74450||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Urethrocystogram Retro|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|FSC: 13; Default||Not reimbursed separately|1,493.52|FSC: 13; Default||External grouping not supported 80231632|EAP|CPT® 20982||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation, Bone Tumor(s),rf,perc W/ct|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 80231640|EAP|CPT® 75705||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Spinal Selective|1|HUMANA [1294]||HUMANA [11839]|13,096.95|FSC: 13; Default||Not reimbursed separately|13,096.95|FSC: 13; Default||External grouping not supported 95183422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Backed Metal Tritanium Asymmetric A 38 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 80231657|EAP|CPT® 74485||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Dilation Nephro/ureters/uthra|1|HUMANA [1294]||HUMANA [11839]|5,048.07|FSC: 13; Default||Not reimbursed separately|5,048.07|FSC: 13; Default||External grouping not supported 80231707|EAP|CPT® 36568||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Picc Cath <5y/o|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95183431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80231749|EAP|CPT® 36555||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Central Venous Access <5|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80231756|EAP|CPT® 36558||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tunneled Cvc Insertion >5|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|FSC: 13; Default||Not reimbursed separately|1,170.12|FSC: 13; Default||External grouping not supported 80231764|EAP|CPT® 36557||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB INSERT TUNNEL CV CATH|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80231772|EAP|CPT® 36561||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Central Vad W/port >5|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183436|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 100 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80231780|EAP|CPT® 36560||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Tunneled Cv Cath <5y/o|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80231798|EAP|CPT® 36575||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repair Tunneled Cv Cat|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 95183442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4 X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 80231806|EAP|CPT® 36576||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB REPAIR TUNNEL CV CATH|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80231814|EAP|CPT® 36578||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB REPLACE TUNNEL CV CATH|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 67.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 80231830|EAP|CPT® 36584||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Replace Picc W/o Sub Prt/pmp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80231848|EAP|CPT® 36581||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB COMP REPLACE TUNN CV C|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 110 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80231871|EAP|CPT® 36590||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Tun Cvcw/sub Prt/pmp|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80231889|EAP|CPT® 36595||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mech Rmvl Pericth Obs Mat Cvc|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Translational Atlantis Fixed 4 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 80231897|EAP|CPT® 36596||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mech Rmvl Intral Obs Mat Cvc|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80231905|EAP|CPT® 75902||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Mech Rmv Intralum Obs Cvc Rs&i|1|HUMANA [1294]||HUMANA [11839]|610.50|FSC: 13; Default||Not reimbursed separately|610.50|FSC: 13; Default||External grouping not supported 95183420|EAP|HCPCS 95183420||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Prebent Nxt 75mm|1|HUMANA [1294]||HUMANA [11839]|1,593.30|FSC: 13; Default||Not reimbursed separately|1,593.30|FSC: 13; Default||External grouping not supported 80231921|EAP|CPT® 36597||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Reposition Cv Cath W F|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80231954|EAP|CPT® 76937||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guide Vasc Acc Req Us Eval|1|HUMANA [1294]||HUMANA [11839]|516.83|FSC: 13; Default||Not reimbursed separately|516.83|FSC: 13; Default||External grouping not supported 95183430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 85 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 80231996|EAP|HCPCS G0288||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Recontstruction Ct Angio Aorta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,376.25|FSC: 13; Default||Not reimbursed separately|1,376.25|FSC: 13; Default||External grouping not supported 80232044|EAP|CPT® 72275||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Epidurography|1|HUMANA [1294]||HUMANA [11839]|982.11|FSC: 13; Default||Not reimbursed separately|982.11|FSC: 13; Default||External grouping not supported 95183426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|FSC: 13; Default||Not reimbursed separately|1,493.52|FSC: 13; Default||External grouping not supported 80232077|EAP|CPT® 36585||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Replace Peri Cvad W Po|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80232085|EAP|CPT® 44500||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Long Gi Tube|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 80232119|EAP|CPT® 47555||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bili Endo Via T-tube W/o St|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95183441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|FSC: 13; Default||Not reimbursed separately|1,343.58|FSC: 13; Default||External grouping not supported 80232127|EAP|CPT® 61624||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Transcath Occ Or Embol Cns|1|HUMANA [1294]||HUMANA [11839]|7,510.15|FSC: 13; Default||Not reimbursed separately|7,510.15|FSC: 13; Default||External grouping not supported 80232135|EAP|CPT® 61626||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Trnscath Occ/embol Non Cns|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95183437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 105 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|FSC: 13; Default||Not reimbursed separately|8,169.00|FSC: 13; Default||External grouping not supported 80232390|EAP|CPT® 37799||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Unlisted Proc Vascular Surgery|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80232481|EAP|CPT® 74263||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Virtual Colonoscopy|1|HUMANA [1294]||HUMANA [11839]|1,705.00|FSC: 13; Default||Not reimbursed separately|1,705.00|FSC: 13; Default||External grouping not supported 95183447|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Flex Reg 6 X 120 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 80232523|EAP|CPT® 77001||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fluoro Guide Cvc Plcmt/rpl/rmv|1|HUMANA [1294]||HUMANA [11839]|679.52|FSC: 13; Default||Not reimbursed separately|679.52|FSC: 13; Default||External grouping not supported 80232549|EAP|CPT® 36478||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB ENDOVENOUS LASER 1ST BILATERAL|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183446|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 5 X 100 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80232564|EAP|CPT® 36479||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovenous Laser Vein Add On|1|HUMANA [1294]||HUMANA [11839]|4,098.00|FSC: 13; Default||Not reimbursed separately|4,098.00|FSC: 13; Default||External grouping not supported 80232572|EAP|CPT® 32999||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Lung Ablation Procedure|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80167315|EAP|HCPCS V5050||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Economy Monoaural|1|HUMANA [1294]||HUMANA [11839]|1,000.00|FSC: 13; Default||Not reimbursed separately|1,000.00|FSC: 13; Default||External grouping not supported 80232580|EAP|CPT® 74340||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Intro Of Long Gi Tube|1|HUMANA [1294]||HUMANA [11839]|651.76|FSC: 13; Default||Not reimbursed separately|651.76|FSC: 13; Default||External grouping not supported 80232622|EAP|HCPCS A9548||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Indium In-111pentetate Dx, Per 0.5mci|1|HUMANA [1294]||HUMANA [11839]|739.69|FSC: 13; Default||Not reimbursed separately|739.69|FSC: 13; Default||External grouping not supported 80167323|EAP|HCPCS V5130||0470 - AUDIOLOGY - GENERAL CLASSIFICATION|Hb Hearing Aid Economy Binaural|1|HUMANA [1294]||HUMANA [11839]|2,000.00|FSC: 13; Default||Not reimbursed separately|2,000.00|FSC: 13; Default||External grouping not supported 80232630|EAP|HCPCS A9541||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Lymphosci Rm Per Study Dose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.25|FSC: 13; Default||Not reimbursed separately|1,849.25|FSC: 13; Default||External grouping not supported 80232648|EAP|HCPCS A9512||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Pertechnetate Dx, Per Mci|1|HUMANA [1294]||HUMANA [11839]|57.00|FSC: 13; Default||Not reimbursed separately|57.00|FSC: 13; Default||External grouping not supported 80232705|EAP|CPT® 38505||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx/exc Lymph Node Ndl Suprfcl|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80232713|EAP|CPT® 61070||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Punc Shunt Tube/resv Asp/inj|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 80232788|EAP|CPT® 78804||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Lclze Umr Whl Bdy 2 Or >day|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 80232796|EAP|HCPCS A9542||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb In-111ibritumomab Dx/dose, Up To 5mci|1|HUMANA [1294]||HUMANA [11839]|8,750.00|FSC: 13; Default||Not reimbursed separately|8,750.00|FSC: 13; Default||External grouping not supported 80232812|EAP|CPT® 70336||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Temporal Mandibular Joint|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80232820|EAP|CPT® 70540||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Orbit/face/neck W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80232838|EAP|CPT® 70542||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Orbit/face/neck W/cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80232846|EAP|CPT® 70543||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Orbit/face/neck W/w/ocon|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80232853|EAP|CPT® 70544||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hb Mra Head W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183457|EAP|Custom 95183457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 2.0 X 228|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80232861|EAP|CPT® 70545||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hb Mra Head With Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80232879|EAP|CPT® 70546||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hb Mra Head W/w/o Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183456|EAP|Custom 95183456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 2.4 X 228|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80232887|EAP|CPT® 70547||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hb Mra Neck W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80232895|EAP|CPT® 70548||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hb Mra Neck With Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183465|EAP|Custom 95183465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Body Rail Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80232903|EAP|CPT® 70549||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hb Mra Neck W/w/o Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80232929|EAP|CPT® 70552||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM|Hb Mri Brain With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183458|EAP|Custom 95183458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Body Rail Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80232937|EAP|CPT® 70553||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM|Hb Mri Brain Inc Stem W/w/o Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80232952|EAP|CPT® 71551||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Chest With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 95183459|EAP|Custom 95183459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Step 4.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80232986|EAP|HCPCS C8909||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Chest W Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80232994|EAP|HCPCS C8910||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Chest W/o Contrast|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183466|EAP|Custom 95183466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamps Rail|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80233000|EAP|HCPCS C8911||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Chest W & W/o Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233018|EAP|CPT® 72141||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Cervical Spine W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Salvation 5.0 X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,926.00|FSC: 13; Default||Not reimbursed separately|4,926.00|FSC: 13; Default||External grouping not supported 80233026|EAP|CPT® 72146||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Thoracic Spine W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80233034|EAP|CPT® 72148||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Lumbar Spine W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 13 X 380 X 125 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 80233042|EAP|CPT® 72156||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Cerv Spine W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233059|EAP|CPT® 72157||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Thoracic Spine W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Beam Salvation 7.0 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,992.00|FSC: 13; Default||Not reimbursed separately|4,992.00|FSC: 13; Default||External grouping not supported 80233067|EAP|CPT® 72158||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Lumbar Spine W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233075|EAP|CPT® 72159||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mra Spine W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,220.28|FSC: 13; Default||Not reimbursed separately|1,220.28|FSC: 13; Default||External grouping not supported 95183462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Salvation 5.0 X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,926.00|FSC: 13; Default||Not reimbursed separately|4,926.00|FSC: 13; Default||External grouping not supported 80233125|EAP|HCPCS C8918||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Pelvis With Contra|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233133|EAP|HCPCS C8919||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Pelvis W/o Contras|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183469|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Cpx4 Low Height Style 8100 550cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 80233141|EAP|HCPCS C8920||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Pelvis W & W/o Con|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233158|EAP|CPT® 73218||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Up Ext Non Jt W/o Con|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Lag-u-blade 10.5 X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|FSC: 13; Default||Not reimbursed separately|2,066.40|FSC: 13; Default||External grouping not supported 80233166|EAP|CPT® 73219||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Up Ext Non Jt W/con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233174|EAP|CPT® 73220||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Up Ext Non Jt W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins Half 3mm 100mm/20mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 80233182|EAP|CPT® 73221||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Up Ext Jt W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80233190|EAP|CPT® 73222||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Up Ext Jt W/con|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 95183467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins Half 3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 80233208|EAP|CPT® 73223||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Up Ext Jt W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233216|EAP|CPT® 73225||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mra Upp Ext Combo|1|HUMANA [1294]||HUMANA [11839]|1,220.28|FSC: 13; Default||Not reimbursed separately|1,220.28|FSC: 13; Default||External grouping not supported 80167331|EAP|CPT® 92227||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Remote Imaging For Retinal Disease|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 80233224|EAP|CPT® 73718||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Low Ext Non Jt W/o Con|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80233232|EAP|CPT® 73719||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Low Ext Non Jt W/con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183483|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Saber .018 Pta 2.5 X 40 X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233240|EAP|CPT® 73720||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Low Ext Non Jt W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233257|EAP|CPT® 73721||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Low Ext Any Jt W/o Con|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon 5 Mm Sz 8 Mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 80233265|EAP|CPT® 73722||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Low Ext Jt W/con|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 80233273|EAP|CPT® 73723||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Low Ext Jt W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183482|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035pta 4 X 80 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233299|EAP|HCPCS C8912||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Lower Ext With Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233307|EAP|HCPCS C8913||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Lower Ext W/o Cont|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183474|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 6 X 80 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233315|EAP|HCPCS C8914||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Lower Ext W&w/o Co|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233323|EAP|CPT® 74181||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Abdomen W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183477|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 8 X 40 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233331|EAP|CPT® 74182||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Abdomen With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233349|EAP|CPT® 74183||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Abdomen W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183473|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 6 X 60 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233364|EAP|HCPCS C8900||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Abdomen W Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233372|EAP|HCPCS C8901||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Abdomen W/o Contra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183475|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035 Pta 6 X 120 X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233380|EAP|HCPCS C8902||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hb Mr Mra Abd W & W/o Contra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233430|EAP|CPT® 75557||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Card Imaging W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183476|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Opta Pro .35 Pta 6 X 40 110 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233455|EAP|HCPCS C8903||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mr Breast Unilat With Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 04.0 Mm/l28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 80233471|EAP|HCPCS C8905||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mr Breast Unilat W&w/o Co|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233497|EAP|HCPCS C8906||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mr Breast Bilat W/contras|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts Total Sz 8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 80233513|EAP|HCPCS C8908||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mr Breast Bilat W&w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183481|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerflex Pro .035pta 5 X 22 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80233760|EAP|CPT® 72142||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Cervical Spine With Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233778|EAP|CPT® 72147||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Thoracic Spine With Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80233786|EAP|CPT® 72149||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)|Hb Mri Lumbar Spine With Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95186651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dvr Lock Mini L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,606.00|FSC: 13; Default||Not reimbursed separately|3,606.00|FSC: 13; Default||External grouping not supported 80233794|EAP|CPT® 34203||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Embolectomy Or Thrombectomy|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80233877|EAP|HCPCS A9552||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Fdg Per Dose|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 80233885|EAP|HCPCS A9555||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Rubidium Rb-82 Dx/dose, Up To 60mci|1|HUMANA [1294]||HUMANA [11839]|627.86|FSC: 13; Default||Not reimbursed separately|627.86|FSC: 13; Default||External grouping not supported 80233927|EAP|CPT® 70551||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM|Hb Mri Brain W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80233950|EAP|CPT® 50080||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Nephrolithotmy |HUMANA [11839]|24,905.53|FSC: 13; Default||Not reimbursed separately|24,905.53|FSC: 13; Default||External grouping not supported 80233976|EAP|CPT® 50081||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB BILAT PERC NEPHROSTOL OVER 2C|1|HUMANA [1294]||HUMANA [11839]|24,905.53|FSC: 13; Default||Not reimbursed separately|24,905.53|FSC: 13; Default||External grouping not supported 95183484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kinectiv Ml Taper Stem Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 80234016|EAP|CPT® 58340||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sonohysterogram Inj Proc|1|HUMANA [1294]||HUMANA [11839]|516.00|FSC: 13; Default||Not reimbursed separately|516.00|FSC: 13; Default||External grouping not supported 95183485|EAP|Custom 95183485||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Solution Htk Custodiol 1000cc Bag|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183490|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scaffold Dermal Rep Antimicrobial Primatrix Ag Fen 4x4 Cm|1|HUMANA [1294]||HUMANA [11839]|108.00|FSC: 13; Default||Not reimbursed separately|108.00|FSC: 13; Default||External grouping not supported 95183486|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scaffold Dermal Repair Primatrix Meshed 3cm X 3cm|1|HUMANA [1294]||HUMANA [11839]|171.67|FSC: 13; Default||Not reimbursed separately|171.67|FSC: 13; Default||External grouping not supported 80234099|EAP|CPT® 74455||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Urethrocystogram Voiding|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183488|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scaffold Dermal Repair Primatrix Meshed 4cm X 4cm|1|HUMANA [1294]||HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 80234107|EAP|CPT® 74430||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cystography Min Of 3v|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183491|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scaffold Dermal Rep Antimicrobial Primatrix Ag Mesh 4x4 Cm|1|HUMANA [1294]||HUMANA [11839]|108.00|FSC: 13; Default||Not reimbursed separately|108.00|FSC: 13; Default||External grouping not supported 80234198|EAP|CPT® 36475||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovenous Rf, 1st Vein|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183487|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scaffold Dermal Repair Primatrix Fenestrated 4cm X 4cm|1|HUMANA [1294]||HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 80234214|EAP|CPT® 36476||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Endovenous Rf, Vein Add-on|1|HUMANA [1294]||HUMANA [11839]|3,657.52|FSC: 13; Default||Not reimbursed separately|3,657.52|FSC: 13; Default||External grouping not supported 80234412|EAP|CPT® 49426||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Revise Peri-ven Shunt|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 95183489|EAP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scaffold Dermal Repair Primatrix Meshed 5cm X 5cm|1|HUMANA [1294]||HUMANA [11839]|119.40|FSC: 13; Default||Not reimbursed separately|119.40|FSC: 13; Default||External grouping not supported 80234438|EAP|CPT® 49425||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Insert Peri-ven Shunt|1|HUMANA [1294]||HUMANA [11839]|5,539.53|FSC: 13; Default||Not reimbursed separately|5,539.53|FSC: 13; Default||External grouping not supported 80234446|EAP|CPT® 49429||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Peri-ven Shunt|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80234453|EAP|CPT® 75809||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Shuntogram Non-vas Rs&i|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80234685|EAP|CPT® 75840||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venogram Adrenal Uni Sel|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.7 Mm X L18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 80234800|EAP|CPT® 21116||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arthrogram Tmj Inj Proc|1|HUMANA [1294]||HUMANA [11839]|449.15|FSC: 13; Default||Not reimbursed separately|449.15|FSC: 13; Default||External grouping not supported 95183495|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.4 Mm X L20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 80234933|EAP|CPT® 62270||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Spinal Puncture Lumbar Diag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 80234966|EAP|CPT® 47000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ndl Biopsy Liver Per|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183500|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular M/l Dinectiv Pf Plasma Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 80234990|EAP|CPT® 37184||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Prim Art Mech Thrombectomy|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80235005|EAP|CPT® 37185||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Prim Art M-thrombect Add-on|1|HUMANA [1294]||HUMANA [11839]|5,821.50|FSC: 13; Default||Not reimbursed separately|5,821.50|FSC: 13; Default||External grouping not supported 95183494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.4 Mm X L18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 80235013|EAP|CPT® 37186||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sec Art M-thrombect Add-on|1|HUMANA [1294]||HUMANA [11839]|6,399.50|FSC: 13; Default||Not reimbursed separately|6,399.50|FSC: 13; Default||External grouping not supported 80235039|EAP|CPT® 37187||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Mech Thrombect W/inj|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95183497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Full Thread 2.7 Mm X L14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 80235054|EAP|CPT® 37188||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Mech Trmbct W/inj Repeat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80235088|EAP|CPT® 60300||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Asp/inj Thyroid Cyst|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95183499|EAP|Custom 95183499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 14mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80235112|EAP|CPT® 43761||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Reposition Gastric Feed Tube|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 80235138|EAP|Custom 80235138||0998 - STATISTICAL CHARGES|Hb Schedule Mri/mra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183498|EAP|Custom 95183498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill As Scaled 2.0mm X 135mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80235252|EAP|CPT® 62287||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Percutaneous Diskectomy|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 95183507|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape 555cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80235336|EAP|CPT® 21925||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Sft Tissue Back/flnk Deep|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183508|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Style 8200 Height Medium Cpx4 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 80235435|EAP|CPT® 82565||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fl Creatinine|1|HUMANA [1294]||HUMANA [11839]|15.36|FSC: 13; Default||Not reimbursed separately|15.36|FSC: 13; Default||External grouping not supported 80235476|EAP|CPT® 34490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Throm Axill/subclav Vein Bilateral|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95183504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tiself Tap Cortical 2.7x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95183505|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape 440cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80235534|EAP|CPT® 37215||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Perc Carotid Stenting W/protec|1|HUMANA [1294]||HUMANA [11839]|10,248.80|FSC: 13; Default||Not reimbursed separately|10,248.80|FSC: 13; Default||External grouping not supported 95183501|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 9fr Jcl 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80235542|EAP|CPT® 37216||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perc Carotid Stenting W/o Prot|1|HUMANA [1294]||HUMANA [11839]|10,661.00|FSC: 13; Default||Not reimbursed separately|10,661.00|FSC: 13; Default||External grouping not supported 80236771|EAP|CPT® 75572||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Heart Cardiac Function|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183506|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape 495cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 80236805|EAP|CPT® 75574||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Cta Heart W/o Ccs|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80236813|EAP|CPT® 75572||0352 - CT SCAN - BODY SCAN|Hb Ct Heart, Eval Struct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183502|EAP|Custom 95183502||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Monitor Patient Mycarelink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80236847|EAP|CPT® 49427||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Proc Peritoneal-ven Shunt|1|HUMANA [1294]||HUMANA [11839]|797.00|FSC: 13; Default||Not reimbursed separately|797.00|FSC: 13; Default||External grouping not supported 80236862|EAP|CPT® 78291||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Peri-ven Shunt Patency Test|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95183516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Utilitys Straight 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,007.00|FSC: 13; Default||Not reimbursed separately|5,007.00|FSC: 13; Default||External grouping not supported 80236870|EAP|CPT® 62273||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epi Inj Of Blood Patch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 80236904|EAP|CPT® 71552||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Chest W/w/o Cont|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 95183517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 80236912|EAP|CPT® 71550||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Chest W/o Cont|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80236920|EAP|CPT® 76811||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Uter-detail Exm; Sngle|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Standard 3.5mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 80236953|EAP|CPT® 76812||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Uter-detail Ex;ea Addl|1|HUMANA [1294]||HUMANA [11839]|608.23|FSC: 13; Default||Not reimbursed separately|608.23|FSC: 13; Default||External grouping not supported 80236987|EAP|CPT® 76805||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Utrs Sng Gest >1st Tri|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Standard 3.5mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 80237043|EAP|CPT® 76801||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Uterus <14wk-0, Sngl|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80237068|EAP|CPT® 76802||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Uterus <14wk-0, Ead Add|1|HUMANA [1294]||HUMANA [11839]|370.50|FSC: 13; Default||Not reimbursed separately|370.50|FSC: 13; Default||External grouping not supported 95183509|EAP|Custom 95183509||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Wrench Assem-bly Us|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80237092|EAP|CPT® 72196||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Pelvis With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80237100|EAP|CPT® 72195||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Pelvis W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95183515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Mtp Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|FSC: 13; Default||Not reimbursed separately|6,879.00|FSC: 13; Default||External grouping not supported 80237118|EAP|CPT® 72197||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hb Mri Pelvis W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80237159|EAP|CPT® 74328||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ercp Biliary|1|HUMANA [1294]||HUMANA [11839]|1,124.13|FSC: 13; Default||Not reimbursed separately|1,124.13|FSC: 13; Default||External grouping not supported 95183520|EAP|Custom 95183520||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Calibrated Anchorage 2.5mmx110mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80237167|EAP|CPT® 74329||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ercp Pancreas|1|HUMANA [1294]||HUMANA [11839]|1,066.80|FSC: 13; Default||Not reimbursed separately|1,066.80|FSC: 13; Default||External grouping not supported 80237191|EAP|CPT® 62281||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidural Cervical Or Thoracic|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95191797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp 2.4/2.7mm Mtp Fusion Med 5 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 80237225|EAP|CPT® 62282||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidural Lumbar, Sacral|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80237233|EAP|CPT® 75572||0352 - CT SCAN - BODY SCAN|Hb Ct Heart, Mass Evaluation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95186645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail T2 Supracondylar 10x340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 80237241|EAP|CPT® 75573||0352 - CT SCAN - BODY SCAN|Hb Ct Heart, Eval Struct Cong|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80237266|EAP|CPT® 50389||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Renal Tube W/fluoro|1|HUMANA [1294]||HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 80237274|EAP|CPT® 58300||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Iud Insertion|1|HUMANA [1294]||HUMANA [11839]|415.00|FSC: 13; Default||Not reimbursed separately|415.00|FSC: 13; Default||External grouping not supported 80237282|EAP|CPT® 58301||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Iud Removal|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 80237290|EAP|CPT® 38221||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bone Marrow Biopsy|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 95183522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread 2.7mm/l14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 80240047|EAP|CPT® 70496||0351 - CT SCAN - HEAD SCAN|Hb Cta Head W/con Inc Img Pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80240054|EAP|CPT® 70498||0351 - CT SCAN - HEAD SCAN|Hb Cta Neck W/con Inc Img Pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Bone Demineralized Evo3 Accell Integra 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|FSC: 13; Default||Not reimbursed separately|2,244.00|FSC: 13; Default||External grouping not supported 80240062|EAP|CPT® 71275||0352 - CT SCAN - BODY SCAN|Hb Cta Chest W/con Inc Img Pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80240070|EAP|CPT® 72191||0352 - CT SCAN - BODY SCAN|Hb Cta Pelvis W/con W/img Pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183528|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 6fr 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,785.00|FSC: 13; Default||Not reimbursed separately|7,785.00|FSC: 13; Default||External grouping not supported 80240104|EAP|CPT® 73206||0352 - CT SCAN - BODY SCAN|Hb Cta Up Ext W/con W/pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80240146|EAP|CPT® 73706||0352 - CT SCAN - BODY SCAN|Hb Cta Low Ext W/con W/pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 1.5mm Ti Lcp 3h Head 8 Hole Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.62|FSC: 13; Default||Not reimbursed separately|1,366.62|FSC: 13; Default||External grouping not supported 80240161|EAP|CPT® 74175||0352 - CT SCAN - BODY SCAN|Hb Ct Angio W/con W/img Pp|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80240179|EAP|CPT® 75635||0352 - CT SCAN - BODY SCAN|Hb Cta Aa Bil Iliofem W/cont|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183526|EAP|Custom 95183526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Y-knot 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread 2.7mm/l16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 80250327|EAP|CPT® 70488||0351 - CT SCAN - HEAD SCAN|Hb Ct Maxillofacial W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80250400|EAP|CPT® 70490||0351 - CT SCAN - HEAD SCAN|Hb Ct Soft Tissue Neck W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread 2.7mm/12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 80250418|EAP|CPT® 70491||0351 - CT SCAN - HEAD SCAN|Hb Ct Soft Tissue Neck With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80250426|EAP|CPT® 70492||0351 - CT SCAN - HEAD SCAN|Hb Ct Soft Tissue Neck W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 11mm Self Tapping With T4 Stardrive R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 80250509|EAP|CPT® 71250||0352 - CT SCAN - BODY SCAN|Hb Ct Chest W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80250517|EAP|CPT® 71260||0352 - CT SCAN - BODY SCAN|Hb Ct Chest With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 62062911|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Benzo-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80250525|EAP|CPT® 71270||0352 - CT SCAN - BODY SCAN|Hb Ct Thorax W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 62062922|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Oxycodone-w/cf-w/mm-u- Quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80250608|EAP|CPT® 72125||0352 - CT SCAN - BODY SCAN|Hb Ct Cervical Spine W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80250616|EAP|CPT® 72126||0352 - CT SCAN - BODY SCAN|Hb Ct Cervical Spine With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62062933|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Mphenidate-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80250624|EAP|CPT® 72127||0352 - CT SCAN - BODY SCAN|Hb Ct Cervical Spine Combined|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80250707|EAP|CPT® 72128||0352 - CT SCAN - BODY SCAN|Hb Ct Thoracic Spine W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 62062944|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm 6 Am-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80250715|EAP|CPT® 72129||0352 - CT SCAN - BODY SCAN|Hb Ct Thoracic Spine With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80250723|EAP|CPT® 72130||0352 - CT SCAN - BODY SCAN|Hb Ct Thoracic Spine W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 62062955|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Opiates-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80250806|EAP|CPT® 72131||0352 - CT SCAN - BODY SCAN|Hb Ct Lumbar Spine Without Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80250814|EAP|CPT® 72132||0352 - CT SCAN - BODY SCAN|Hb Ct Lumbar Spine With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62062966|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Amphet-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80250822|EAP|CPT® 72133||0352 - CT SCAN - BODY SCAN|Hb Ct Lumbar Spine W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80250905|EAP|CPT® 72192||0352 - CT SCAN - BODY SCAN|Hb Ct Pelvis Without Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 62062977|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Cocaine-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80250913|EAP|CPT® 72193||0352 - CT SCAN - BODY SCAN|Hb Ct Pelvis With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80250921|EAP|CPT® 72194||0352 - CT SCAN - BODY SCAN|Hb Ct Pelvis Combined|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 62062988|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Methadone-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80251002|EAP|CPT® 73200||0352 - CT SCAN - BODY SCAN|Hb Ct Upper Extremity W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80251010|EAP|CPT® 73201||0352 - CT SCAN - BODY SCAN|Hb Ct Upper Extremity With Contrast|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62062999|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Marijuana Met-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80251028|EAP|CPT® 73202||0352 - CT SCAN - BODY SCAN|Hb Ct Up Ext W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251101|EAP|CPT® 73700||0352 - CT SCAN - BODY SCAN|Hb Ct Lower Extremity W/o Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 62063000|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 1-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80251119|EAP|CPT® 73701||0352 - CT SCAN - BODY SCAN|Hb Ct Lower Extremity With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251127|EAP|CPT® 73702||0352 - CT SCAN - BODY SCAN|Hb Ct Low Ex W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 62063011|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 1-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80251200|EAP|CPT® 74150||0352 - CT SCAN - BODY SCAN|Hb Ct Abdomen Without Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80251218|EAP|CPT® 74160||0352 - CT SCAN - BODY SCAN|Hb Ct Abdomen With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 62063022|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 5-w/cf-wo/ Mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80251226|EAP|CPT® 74170||0352 - CT SCAN - BODY SCAN|Hb Ct Abdomen W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251317|EAP|CPT® 77012||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Guide Needle Bx/asp|1|HUMANA [1294]||HUMANA [11839]|2,042.50|FSC: 13; Default||Not reimbursed separately|2,042.50|FSC: 13; Default||External grouping not supported 62063033|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 5-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80251507|EAP|CPT® 70487||0351 - CT SCAN - HEAD SCAN|Hb Ct Maxillofacial W/con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251531|EAP|CPT® 76380||0351 - CT SCAN - HEAD SCAN|Hb Ct Limited Or Local Follow-up|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80251705|EAP|CPT® 70450||0351 - CT SCAN - HEAD SCAN|Hb Ct Head/brain W/o Con|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80251713|EAP|CPT® 70460||0351 - CT SCAN - HEAD SCAN|Hb Ct Head/brain W/cont|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251721|EAP|CPT® 70470||0351 - CT SCAN - HEAD SCAN|Hb Ct Head/brain W/w/o Con|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251903|EAP|CPT® 70480||0351 - CT SCAN - HEAD SCAN|Hb Ct Orbit/ear/fossa/ Without Contrast|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183529|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Backed Metal Tritanium Asymmetric A 40 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 80251911|EAP|CPT® 70481||0351 - CT SCAN - HEAD SCAN|Hb Ct Orbits With Contrast|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95183531|EAP|Custom 95183531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Combo 4.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80251929|EAP|CPT® 70482||0351 - CT SCAN - HEAD SCAN|Hb Ct Orb/pst Foss/ear W/w/o Cont|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 80251960|EAP|CPT® 77011||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Stereotactics Localization|1|HUMANA [1294]||HUMANA [11839]|1,579.82|FSC: 13; Default||Not reimbursed separately|1,579.82|FSC: 13; Default||External grouping not supported 95183540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 80251978|EAP|CPT® 76380||0351 - CT SCAN - HEAD SCAN|Hb Ct Limited Or Local Follow-up|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80251986|EAP|CPT® 75989||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Perc Drn Abs/coll W/plc Cath|1|HUMANA [1294]||HUMANA [11839]|1,478.50|FSC: 13; Default||Not reimbursed separately|1,478.50|FSC: 13; Default||External grouping not supported 95183541|EAP|Custom 95183541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Optical 15m X 150cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80251994|EAP|Custom 80251994||0998 - STATISTICAL CHARGES|Hb Ct Diabetes Survey|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80252257|EAP|CPT® 94770||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Etc02 Monitoring Ed|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183539|EAP|Custom 95183539||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Fixation Temp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80252307|EAP|CPT® 96367||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Iv Infusion, Sequent, Up To 1 Hr|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 80300270|EAP|HCPCS A9604||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Samarium Sm-153 Lexidronam Up 150mic|1|HUMANA [1294]||HUMANA [11839]|25,427.73|FSC: 13; Default||Not reimbursed separately|25,427.73|FSC: 13; Default||External grouping not supported 95183530|EAP|Custom 95183530||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Ti For 2.7/3.5/4.0 Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|FSC: 13; Default||Not reimbursed separately|117.00|FSC: 13; Default||External grouping not supported 80300338|EAP|HCPCS A9600||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Strontium Sr-89 Chloride,per Millicurie|1|HUMANA [1294]||HUMANA [11839]|3,529.23|FSC: 13; Default||Not reimbursed separately|3,529.23|FSC: 13; Default||External grouping not supported 95183542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 80301054|EAP|CPT® 72295||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Diskography Lumbar|1|HUMANA [1294]||HUMANA [11839]|4,899.33|FSC: 13; Default||Not reimbursed separately|4,899.33|FSC: 13; Default||External grouping not supported 80301070|EAP|CPT® 62290||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Proc Discopgraphy, Ea Level Lumbar|1|HUMANA [1294]||HUMANA [11839]|2,030.00|FSC: 13; Default||Not reimbursed separately|2,030.00|FSC: 13; Default||External grouping not supported 95183537|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 445cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 80301278|EAP|CPT® 77014||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct Guide Plc Rad Therp Field|1|HUMANA [1294]||HUMANA [11839]|1,044.95|FSC: 13; Default||Not reimbursed separately|1,044.95|FSC: 13; Default||External grouping not supported 80301526|EAP|CPT® 76376||0351 - CT SCAN - HEAD SCAN|Hb Image Fusion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|614.62|FSC: 13; Default||Not reimbursed separately|614.62|FSC: 13; Default||External grouping not supported 95183538|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ablation 5f Rf Marinr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80301567|EAP|CPT® 79403||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hb Nm Radphrm Thr,radio Antbdy Iv|1|HUMANA [1294]||HUMANA [11839]|676.47|FSC: 13; Default||Not reimbursed separately|676.47|FSC: 13; Default||External grouping not supported 80301575|EAP|HCPCS A9543||0344 - NUCLEAR MEDICINE - THERAPEUTIC RADIOPHARMACEUTICALS|Hb Ytrrium-90 Ibritumomab Up To 40mic|1|HUMANA [1294]||HUMANA [11839]|149,795.10|FSC: 13; Default||Not reimbursed separately|149,795.10|FSC: 13; Default||External grouping not supported 95183532|EAP|Custom 95183532||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rigidloop Adjustable Button Standard|1|HUMANA [1294]||HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 80310428|EAP|CPT® 73115||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Arthrogram Wrist|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80310444|EAP|CPT® 73085||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Arthrogram Elbow|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62063044|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 5-w/o Cf-w/o Mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80310469|EAP|CPT® 73615||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Arthrogram Ankle|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80310485|EAP|CPT® 73525||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Arthrogram Hip|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62063055|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 1-w/o Cf-w/o Mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80310519|EAP|CPT® 70332||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Tmj Jt Arthrogram|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80310535|EAP|CPT® 73040||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Arthrogram Shoulder|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62063066|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Clonazepam Meta Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80310543|EAP|CPT® 73580||0322 - RADIOLOGY - DIAGNOSTIC - ARTHROGRAPHY|Hb Arthrogram Knee|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80310568|EAP|CPT® 75743||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Pulmonary Bil Sel|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 62063077|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Clonazepam Meta Qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62063088|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Zolpidem Qt-w/o Mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80310857|EAP|CPT® 74330||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ercp Bili/panc Ductal Sys|1|HUMANA [1294]||HUMANA [11839]|1,376.00|FSC: 13; Default||Not reimbursed separately|1,376.00|FSC: 13; Default||External grouping not supported 62063099|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Benzo Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311160|EAP|CPT® 36014||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Lt/rt Pulm Art|1|HUMANA [1294]||HUMANA [11839]|1,980.33|FSC: 13; Default||Not reimbursed separately|1,980.33|FSC: 13; Default||External grouping not supported 80311178|EAP|CPT® 36100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Need Cath Carotid|1|HUMANA [1294]||HUMANA [11839]|1,963.00|FSC: 13; Default||Not reimbursed separately|1,963.00|FSC: 13; Default||External grouping not supported 62063100|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Tramadol Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311186|EAP|CPT® 36140||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Int Ndl/cath Retro Brachl Art|1|HUMANA [1294]||HUMANA [11839]|1,963.00|FSC: 13; Default||Not reimbursed separately|1,963.00|FSC: 13; Default||External grouping not supported 80311194|EAP|CPT® 36140||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Int Ndl/cath Extremity Art|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,963.00|FSC: 13; Default||Not reimbursed separately|1,963.00|FSC: 13; Default||External grouping not supported 62063111|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Tramadol Qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311210|EAP|CPT® 36160||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Int Ndl/cath Aortic Trans Lum|1|HUMANA [1294]||HUMANA [11839]|2,667.00|FSC: 13; Default||Not reimbursed separately|2,667.00|FSC: 13; Default||External grouping not supported 62063122|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Oxycodone Qt- W/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311228|EAP|CPT® 36200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Of Cath Aorta|1|HUMANA [1294]||HUMANA [11839]|2,568.23|FSC: 13; Default||Not reimbursed separately|2,568.23|FSC: 13; Default||External grouping not supported 80311244|EAP|CPT® 36216||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 2nd Ord Above|1|HUMANA [1294]||HUMANA [11839]|2,995.26|FSC: 13; Default||Not reimbursed separately|2,995.26|FSC: 13; Default||External grouping not supported 62063133|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Oxycodone Qt- Wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311285|EAP|CPT® 36246||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 2nd Ord Below|1|HUMANA [1294]||HUMANA [11839]|3,130.79|FSC: 13; Default||Not reimbursed separately|3,130.79|FSC: 13; Default||External grouping not supported 80311293|EAP|CPT® 36247||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 3rd Ord Below|1|HUMANA [1294]||HUMANA [11839]|3,603.54|FSC: 13; Default||Not reimbursed separately|3,603.54|FSC: 13; Default||External grouping not supported 62063155|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Fentanylqt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311301|EAP|CPT® 36248||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cath Plc Art Add 2nd/3rd Below|1|HUMANA [1294]||HUMANA [11839]|1,747.83|FSC: 13; Default||Not reimbursed separately|1,747.83|FSC: 13; Default||External grouping not supported 80311319|EAP|CPT® 36405||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Venipuncture <3yrs Sca|1|HUMANA [1294]||HUMANA [11839]|113.00|FSC: 13; Default||Not reimbursed separately|113.00|FSC: 13; Default||External grouping not supported 62063166|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Fentanylqt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311327|EAP|CPT® 36425||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Venipuncture Cutdown >1yr|1|HUMANA [1294]||HUMANA [11839]|1,122.39|FSC: 13; Default||Not reimbursed separately|1,122.39|FSC: 13; Default||External grouping not supported 62063177|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Gabapentin Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62063188|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Opiates-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311376|EAP|CPT® 50396||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Manometric Stdy Via Neph Tube|1|HUMANA [1294]||HUMANA [11839]|1,717.98|FSC: 13; Default||Not reimbursed separately|1,717.98|FSC: 13; Default||External grouping not supported 62063199|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Pregabalin Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311392|EAP|CPT® 50684||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Pro Ureterogram Via Cath|1|HUMANA [1294]||HUMANA [11839]|744.50|FSC: 13; Default||Not reimbursed separately|744.50|FSC: 13; Default||External grouping not supported 80311400|EAP|CPT® 50690||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj For Vis Of Ileal Conduit|1|HUMANA [1294]||HUMANA [11839]|894.68|FSC: 13; Default||Not reimbursed separately|894.68|FSC: 13; Default||External grouping not supported 62063200|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Pregabalin Qt-wo/ Mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62063211|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Caris Metab Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62063222|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Amphetamines Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311491|EAP|CPT® 47490||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Percutaneous Cholecystestomy|1|HUMANA [1294]||HUMANA [11839]|9,598.49|FSC: 13; Default||Not reimbursed separately|9,598.49|FSC: 13; Default||External grouping not supported 62063233|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm 6 Am,qt,wo/mm,u, Quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80311525|EAP|CPT® 50688||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Change Of Ureostomy Tu|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 62063244|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Heroin Met-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063255|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Heroin Met-w/cf-wo/mm,u, Quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063266|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 2-w/cf-w/o/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80311814|EAP|CPT® 77003||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fluoro Loc Needle/cath Spine|1|HUMANA [1294]||HUMANA [11839]|672.18|FSC: 13; Default||Not reimbursed separately|672.18|FSC: 13; Default||External grouping not supported 62063277|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 2-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312101|EAP|CPT® 20220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Bone, Trocar/ndl Suprficial|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 62063288|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 2-w/o/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312119|EAP|CPT® 20225||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Bone, Trocar/ndl Deep|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80312127|EAP|CPT® 32400||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Pleura Perc Needle|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 62063299|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 3-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312135|EAP|CPT® 32405||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Lun/mediastmn Perc|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80312150|EAP|CPT® 48102||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Biopsy Pancreas Perc Needle|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 62063300|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 3-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312168|EAP|CPT® 50200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Renal Biopsy|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80312176|EAP|CPT® 60100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Thyroid Biopsy|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 62063311|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 3-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312184|EAP|CPT® 20206||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Muscle Perc Needle|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80312192|EAP|CPT® 49180||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Abd/retroperitonl Perc Ndl|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 62063322|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 4-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063333|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 4-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063344|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Profile 4-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063355|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Base Profile-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312325|EAP|CPT® 20600||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arthrocentesis Sm Jt/bursa|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 62063366|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Base Profile-wo/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312333|EAP|CPT® 20605||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arthrocentesis Intmed Jt W/o Us|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 80312382|EAP|CPT® 72265||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Myelogram Lumbar|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 62063377|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Base Profile-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063388|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Synthetic Cannabinoids-wo/mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063399|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Buprenorphine Qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80312523|EAP|CPT® 78802||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Localize Tumor Whole Body|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 62063400|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Buprenorphine Qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80312531|EAP|CPT® 78801||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Localize Tumor Mult Areas|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 62063411|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Buprenorphine-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312648|EAP|CPT® 74022||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Aas Flt/up/decub/w/pa Cxr|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80312705|EAP|CPT® 27648||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ankle Arthrogram Injection|1|HUMANA [1294]||HUMANA [11839]|500.86|FSC: 13; Default||Not reimbursed separately|500.86|FSC: 13; Default||External grouping not supported 62063433|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Mdma/mda-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80312721|EAP|CPT® 27093||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Pro Hip Arthro W/o Anes|1|HUMANA [1294]||HUMANA [11839]|632.00|FSC: 13; Default||Not reimbursed separately|632.00|FSC: 13; Default||External grouping not supported 80312754|EAP|CPT® 23350||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Shouldr Arthrogram Injection|1|HUMANA [1294]||HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 62063444|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Mdma/mda-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80312762|EAP|CPT® 76831||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Sonohysterogram|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 80312804|EAP|CPT® 75989||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Drainage With Placement Of Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,478.50|FSC: 13; Default||Not reimbursed separately|1,478.50|FSC: 13; Default||External grouping not supported 62063455|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Mdma/mda-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312853|EAP|CPT® 51600||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Proc Cysto/void Urethrocyst|1|HUMANA [1294]||HUMANA [11839]|712.72|FSC: 13; Default||Not reimbursed separately|712.72|FSC: 13; Default||External grouping not supported 62063466|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Mdma/mda-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80312861|EAP|CPT® 51605||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Proc Chain Urethrocyst|1|HUMANA [1294]||HUMANA [11839]|1,321.00|FSC: 13; Default||Not reimbursed separately|1,321.00|FSC: 13; Default||External grouping not supported 80312887|EAP|CPT® 36005||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Pro Ext Venogram|1|HUMANA [1294]||HUMANA [11839]|1,135.00|FSC: 13; Default||Not reimbursed separately|1,135.00|FSC: 13; Default||External grouping not supported 62063477|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Alcohol Met-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80312937|EAP|CPT® 36010||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Of Cath Svc Ivc|1|HUMANA [1294]||HUMANA [11839]|2,247.00|FSC: 13; Default||Not reimbursed separately|2,247.00|FSC: 13; Default||External grouping not supported 80312978|EAP|CPT® 74425||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Urogram Ante (pyel/nephro/loopo)|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 62063488|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Alcohol Met-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80312986|EAP|CPT® 36011||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Venous 1st Order|1|HUMANA [1294]||HUMANA [11839]|1,989.24|FSC: 13; Default||Not reimbursed separately|1,989.24|FSC: 13; Default||External grouping not supported 80312994|EAP|CPT® 36012||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Venous 2nd Ord|1|HUMANA [1294]||HUMANA [11839]|2,480.00|FSC: 13; Default||Not reimbursed separately|2,480.00|FSC: 13; Default||External grouping not supported 62063499|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Tricyclics-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80313042|EAP|CPT® 74445||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Corpus Cavernosagram|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 62063500|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Meperdine-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80313125|EAP|CPT® 75894||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transcath Ther Embol|1|HUMANA [1294]||HUMANA [11839]|4,136.45|FSC: 13; Default||Not reimbursed separately|4,136.45|FSC: 13; Default||External grouping not supported 62063511|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Meperdine-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62063522|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Barbiturates-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80313406|EAP|CPT® 25246||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arthrgrm Wrist Injection|1|HUMANA [1294]||HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 80313422|EAP|CPT® 24220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arthrgrm Elbow Injection|1|HUMANA [1294]||HUMANA [11839]|559.35|FSC: 13; Default||Not reimbursed separately|559.35|FSC: 13; Default||External grouping not supported 62063533|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Barbiturates-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80313455|EAP|CPT® 37200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcatheter Biopsy|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 62063544|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Barbiturates-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80313505|EAP|CPT® 75822||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venogram Ext Bil|1|HUMANA [1294]||HUMANA [11839]|4,647.93|FSC: 13; Default||Not reimbursed separately|4,647.93|FSC: 13; Default||External grouping not supported 80313547|EAP|HCPCS G0260||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Sacroiliac Joint Bilat|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 62063577|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Cocaine,w/cf, Wo/mm,u,quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063588|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Marijuana Met, W/cf,wo/mm,u,quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80314032|EAP|CPT® 75825||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Inferior Venacava|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 80314073|EAP|CPT® 75860||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venogram Sinus Or Jugular|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 62063599|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Marijuana Met-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80314099|EAP|CPT® 75880||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venogram Orbital|1|HUMANA [1294]||HUMANA [11839]|1,796.64|FSC: 13; Default||Not reimbursed separately|1,796.64|FSC: 13; Default||External grouping not supported 80314115|EAP|CPT® 75810||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Splenoportogram|1|HUMANA [1294]||HUMANA [11839]|4,647.93|FSC: 13; Default||Not reimbursed separately|4,647.93|FSC: 13; Default||External grouping not supported 62063600|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Marijuana Met-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80314263|EAP|CPT® 43752||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ng Tube Placement W/fluoro|1|HUMANA [1294]||HUMANA [11839]|1,122.39|FSC: 13; Default||Not reimbursed separately|1,122.39|FSC: 13; Default||External grouping not supported 62063611|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Methadone,w/cf,wo/mm,u, Quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063622|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Methadone-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80314669|EAP|CPT® 75970||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Transcath Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,865.56|FSC: 13; Default||Not reimbursed separately|2,865.56|FSC: 13; Default||External grouping not supported 80314685|EAP|CPT® 62272||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Spinal Punc Therapeutic/drain|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 62063633|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Pcp-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80314743|EAP|CPT® 75726||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Visceral Sel/supra|1|HUMANA [1294]||HUMANA [11839]|13,096.95|FSC: 13; Default||Not reimbursed separately|13,096.95|FSC: 13; Default||External grouping not supported 62063644|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Pcp-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80314776|EAP|CPT® 75984||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Change Perc Tube/drain|1|HUMANA [1294]||HUMANA [11839]|980.89|FSC: 13; Default||Not reimbursed separately|980.89|FSC: 13; Default||External grouping not supported 80314792|EAP|CPT® 75989||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Chest Tube Insertion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,478.50|FSC: 13; Default||Not reimbursed separately|1,478.50|FSC: 13; Default||External grouping not supported 62063655|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Pcp-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80314818|EAP|CPT® 75736||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Pelvic Sel Or Supra|1|HUMANA [1294]||HUMANA [11839]|13,096.95|FSC: 13; Default||Not reimbursed separately|13,096.95|FSC: 13; Default||External grouping not supported 80314842|EAP|CPT® 74363||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Prc Trnshp Dil Bili W/w/o Stnt|1|HUMANA [1294]||HUMANA [11839]|2,066.00|FSC: 13; Default||Not reimbursed separately|2,066.00|FSC: 13; Default||External grouping not supported 62063666|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Pcp-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80314867|EAP|CPT® 76080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Abscess/fistula/sinus Tract St|1|HUMANA [1294]||HUMANA [11839]|1,372.26|FSC: 13; Default||Not reimbursed separately|1,372.26|FSC: 13; Default||External grouping not supported 62063677|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Propoxy-w/cf-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80314891|EAP|CPT® 77002||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fluoro Guid Nedle Plcmt|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 62063688|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Propoxy-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80314982|EAP|CPT® 36620||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arterial Press W/o|1|HUMANA [1294]||HUMANA [11839]|775.95|FSC: 13; Default||Not reimbursed separately|775.95|FSC: 13; Default||External grouping not supported 80315146|EAP|CPT® 42400||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Biopsy Of Salivary Glnd Ndl|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 62063699|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Propoxy-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80315153|EAP|CPT® 10160||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Punc Asp Abscess/hem/bull/cyst|1|HUMANA [1294]||HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 80315252|EAP|CPT® 75827||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venogram Superior Vena Cava|1|HUMANA [1294]||HUMANA [11839]|1,796.64|FSC: 13; Default||Not reimbursed separately|1,796.64|FSC: 13; Default||External grouping not supported 62063700|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Tapentadol-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80315393|EAP|CPT® 93571||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Intravasc Doppler Coron, Int Ves|1|HUMANA [1294]||HUMANA [11839]|3,467.31|FSC: 13; Default||Not reimbursed separately|3,467.31|FSC: 13; Default||External grouping not supported 62063711|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Tapentadol-qt-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80320252|EAP|CPT® 76000||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fluoro Up To 1 Hr|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 62063722|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Amphet, W/cf, Wo/mm, U, Quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80320492|EAP|CPT® 33967||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cc Iabp Insertion|1|HUMANA [1294]||HUMANA [11839]|3,862.00|FSC: 13; Default||Not reimbursed separately|3,862.00|FSC: 13; Default||External grouping not supported 62063733|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Benzo-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063744|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Opiates-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62063755|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Tricyclics-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80321557|EAP|CPT® 93505||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Endomyocardial Biopsy|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 95186646|EAP|Custom 95186646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.2 Mm Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183553|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stealth Solid Crown 30 Grit 2.00mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80322050|EAP|CPT® 93024||0482 - CARDIOLOGY - STRESS TEST|Hb Ergonovine Provocation Test|1|HUMANA [1294]||HUMANA [11839]|1,122.39|FSC: 13; Default||Not reimbursed separately|1,122.39|FSC: 13; Default||External grouping not supported 80322068|EAP|CPT® 92950||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|HB CARDIOPULMONARY RESUSCITATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.30|FSC: 13; Default||Not reimbursed separately|781.30|FSC: 13; Default||External grouping not supported 95183555|EAP|Custom 95183555||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Viperslide Lubricant 100ml Bags 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80322423|EAP|CPT® 93503||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insert/placment Swan-ganz Cath|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95183554|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Diamondback 360 Micro Oas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183552|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stealth Solid Crown 30 Grit 1.50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183557|EAP|Custom 95183557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Entrada|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80322910|EAP|CPT® 92953||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Temp/transcutaneous Pacing|1|HUMANA [1294]||HUMANA [11839]|1,656.04|FSC: 13; Default||Not reimbursed separately|1,656.04|FSC: 13; Default||External grouping not supported 95183556|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 16 Cx Infinion 50ccm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 80322951|EAP|HCPCS G0278||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Angio, Iliac/fem(s), Ns Performed W/cc|1|HUMANA [1294]||HUMANA [11839]|2,761.44|FSC: 13; Default||Not reimbursed separately|2,761.44|FSC: 13; Default||External grouping not supported 95183558|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Percutaneous Mri Surescan Vectris 1x8 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,420.00|FSC: 13; Default||Not reimbursed separately|6,420.00|FSC: 13; Default||External grouping not supported 80323009|EAP|CPT® 92960||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Cardioversion Elective, Extern|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,656.04|FSC: 13; Default||Not reimbursed separately|1,656.04|FSC: 13; Default||External grouping not supported 80323124|EAP|CPT® 93620||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Comp Ep Eval W/induct Or Attempt|1|HUMANA [1294]||HUMANA [11839]|18,169.06|FSC: 13; Default||Not reimbursed separately|18,169.06|FSC: 13; Default||External grouping not supported 95191798|EAP|Custom 95191798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Compression 1.6mm 30mm Thread 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80323132|EAP|CPT® 93621||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb La Pac&rec From Coron Sinus/la|1|HUMANA [1294]||HUMANA [11839]|8,252.00|FSC: 13; Default||Not reimbursed separately|8,252.00|FSC: 13; Default||External grouping not supported 80323140|EAP|CPT® 93622||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Lv Pacing And Recording|1|HUMANA [1294]||HUMANA [11839]|7,922.00|FSC: 13; Default||Not reimbursed separately|7,922.00|FSC: 13; Default||External grouping not supported 80323157|EAP|CPT® 93623||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Prog Stim & Pacng Aft Iv Drug|1|HUMANA [1294]||HUMANA [11839]|5,567.76|FSC: 13; Default||Not reimbursed separately|5,567.76|FSC: 13; Default||External grouping not supported 80323165|EAP|CPT® 93624||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ep Follow Up Incl Induction|1|HUMANA [1294]||HUMANA [11839]|18,169.06|FSC: 13; Default||Not reimbursed separately|18,169.06|FSC: 13; Default||External grouping not supported 80323215|EAP|CPT® 93650||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Intracar Cath Ablation Av Node|1|HUMANA [1294]||HUMANA [11839]|18,169.06|FSC: 13; Default||Not reimbursed separately|18,169.06|FSC: 13; Default||External grouping not supported 95183561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Vdr Proximal Right Long Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 80323249|EAP|CPT® 93660||0482 - CARDIOLOGY - STRESS TEST|Hb Ep Tilt Table Evaluation|1|HUMANA [1294]||HUMANA [11839]|1,499.06|FSC: 13; Default||Not reimbursed separately|1,499.06|FSC: 13; Default||External grouping not supported 95183562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Locking 2.3 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 80323348|EAP|CPT® 93289||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Anl Card/defib|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80323355|EAP|CPT® 93282||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Icd Device Prog Eval, 1 Sngl|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95183563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Humerus 10hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 80323629|EAP|CPT® 92973||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Perc Tran Coronary Thrombectmy|1|HUMANA [1294]||HUMANA [11839]|6,438.38|FSC: 13; Default||Not reimbursed separately|6,438.38|FSC: 13; Default||External grouping not supported 95183564|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Cpx4 Low Height Style 8100 450cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 80323967|EAP|CPT® 33210||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cc Pacemaker Temp Insert|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 62063763|EAP|CPT® 81400||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Accutype Il28b - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|191.88|FSC: 13; Default||Not reimbursed separately|191.88|FSC: 13; Default||External grouping not supported 80323975|EAP|CPT® 93283||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Icd Device Progr Eval, Dual|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80324007|EAP|CPT® 93613||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Intracardiac Ep 3-d Mapping|1|HUMANA [1294]||HUMANA [11839]|8,153.80|FSC: 13; Default||Not reimbursed separately|8,153.80|FSC: 13; Default||External grouping not supported 62063771|EAP|CPT® 87521||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hcv Amp Probe, Rvs Trans - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 80324015|EAP|CPT® 93609||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Intraventr/atrial Map Tachy|1|HUMANA [1294]||HUMANA [11839]|5,484.50|FSC: 13; Default||Not reimbursed separately|5,484.50|FSC: 13; Default||External grouping not supported 80324023|EAP|CPT® 93619||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Comp Ep Eval W/o Induct Or Attempt|1|HUMANA [1294]||HUMANA [11839]|18,169.06|FSC: 13; Default||Not reimbursed separately|18,169.06|FSC: 13; Default||External grouping not supported 80167391|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Hospice Nurse Visit Hc|1|HUMANA [1294]||HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 80167402|EAP|HCPCS G0155||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Hospice Csw Admit Visit Hc|1|HUMANA [1294]||HUMANA [11839]|91.35|FSC: 13; Default||Not reimbursed separately|91.35|FSC: 13; Default||External grouping not supported 80324080|EAP|HCPCS G0278||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angio, Iliac/fem(s),ns,performed W/cc|1|HUMANA [1294]||HUMANA [11839]|2,761.44|FSC: 13; Default||Not reimbursed separately|2,761.44|FSC: 13; Default||External grouping not supported 80167413|EAP|HCPCS G0155||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Hospice Csw Visit Hc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.35|FSC: 13; Default||Not reimbursed separately|91.35|FSC: 13; Default||External grouping not supported 80167424|EAP|HCPCS G0155||0560 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - GENERAL CLASSIFICATION|Hb Hospice Csw Phone Call Hc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|91.35|FSC: 13; Default||Not reimbursed separately|91.35|FSC: 13; Default||External grouping not supported 80167435|EAP|HCPCS G0156||0570 - HOME HEALTH (HH) AIDE - GENERAL CLASSIFICATION|Hb Hospice Home-hospice Aide Hc|1|HUMANA [1294]||HUMANA [11839]|33.60|FSC: 13; Default||Not reimbursed separately|33.60|FSC: 13; Default||External grouping not supported 80324288|EAP|CPT® 36248||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Ab-le Art Add 2nd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,747.83|FSC: 13; Default||Not reimbursed separately|1,747.83|FSC: 13; Default||External grouping not supported 80324296|EAP|CPT® 36247||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 3rd Ord Below|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.54|FSC: 13; Default||Not reimbursed separately|3,603.54|FSC: 13; Default||External grouping not supported 80167446|EAP|Custom 80136658||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Pastoral Care Visit Hc|1|HUMANA [1294]||HUMANA [11839]|52.50|FSC: 13; Default||Not reimbursed separately|52.50|FSC: 13; Default||External grouping not supported 80324304|EAP|CPT® 36246||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Ab-le Art 2nd Orde|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,130.79|FSC: 13; Default||Not reimbursed separately|3,130.79|FSC: 13; Default||External grouping not supported 80324312|EAP|CPT® 36245||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 1st Ord Below|1|HUMANA [1294]||HUMANA [11839]|3,250.96|FSC: 13; Default||Not reimbursed separately|3,250.96|FSC: 13; Default||External grouping not supported 80324320|EAP|CPT® 36200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Cath Aorta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,568.23|FSC: 13; Default||Not reimbursed separately|2,568.23|FSC: 13; Default||External grouping not supported 80324338|EAP|CPT® 75605||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Thoracic Aortagram S&i|1|HUMANA [1294]||HUMANA [11839]|13,096.95|FSC: 13; Default||Not reimbursed separately|13,096.95|FSC: 13; Default||External grouping not supported 95183571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm X 12mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 80324346|EAP|CPT® 75625||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Aorta Abdominal|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm X 12mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95183566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Backed Metal Tritanium Asymmetric A 29 X 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|FSC: 13; Default||Not reimbursed separately|3,870.30|FSC: 13; Default||External grouping not supported 80324361|EAP|CPT® 75630||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Aorto Abd W/bil Iliofem Runoff|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 18mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 80324379|EAP|CPT® 75710||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Extremity Uni|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Ti Std Left 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 80324387|EAP|CPT® 75716||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Arterio Ext Bil|1|HUMANA [1294]||HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183568|EAP|Custom 95183568||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.5mm Calibrated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183576|EAP|Custom 95183576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Variable Angle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle 2.3x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95183578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle 2.3x14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 80324437|EAP|CPT® 36215||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB SEL ART 1ST ORD ABOVE|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95183575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Locking 2.4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 80324445|EAP|CPT® 36216||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 2nd Ord Above|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.26|FSC: 13; Default||Not reimbursed separately|2,995.26|FSC: 13; Default||External grouping not supported 80324452|EAP|CPT® 36217||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Thor Art 3rd Order|1|HUMANA [1294]||HUMANA [11839]|3,142.00|FSC: 13; Default||Not reimbursed separately|3,142.00|FSC: 13; Default||External grouping not supported 95183574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Extra-articular Lcp 3.5mm 194mm /8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,973.13|FSC: 13; Default||Not reimbursed separately|4,973.13|FSC: 13; Default||External grouping not supported 80324460|EAP|CPT® 36218||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cath Plc Art Add 2nd/3rd Above|1|HUMANA [1294]||HUMANA [11839]|1,970.08|FSC: 13; Default||Not reimbursed separately|1,970.08|FSC: 13; Default||External grouping not supported 80324478|EAP|CPT® 36140||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Need Ext Art|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,963.00|FSC: 13; Default||Not reimbursed separately|1,963.00|FSC: 13; Default||External grouping not supported 80167455|EAP|CPT® 93750||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Interrogation Of Vad|1|HUMANA [1294]||HUMANA [11839]|350.16|FSC: 13; Default||Not reimbursed separately|350.16|FSC: 13; Default||External grouping not supported 95183585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm/l55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95183584|EAP|Custom 95183584||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Vista-s 7x14x14|1|HUMANA [1294]||HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95183583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rescue Variable 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|FSC: 13; Default||Not reimbursed separately|1,128.00|FSC: 13; Default||External grouping not supported 95183582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 3 Level 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95183586|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular 12/14 Taper Size Bb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 80324619|EAP|CPT® 36140||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intro Axi/sub/brachial Artery|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,963.00|FSC: 13; Default||Not reimbursed separately|1,963.00|FSC: 13; Default||External grouping not supported 80324775|EAP|CPT® 75774||0321 - RADIOLOGY - DIAGNOSTIC - ANGIOCARDIOGRAPHY|Hb Angiogram Sel Ea Addl Vessel|1|HUMANA [1294]||HUMANA [11839]|2,538.00|FSC: 13; Default||Not reimbursed separately|2,538.00|FSC: 13; Default||External grouping not supported 95191780|EAP|Custom 95191780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Airway Spiration Ibv Deployment Loader|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80324908|EAP|CPT® 33206||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rplc Perm Pm W/elect-atrial|1|HUMANA [1294]||HUMANA [11839]|31,647.53|FSC: 13; Default||Not reimbursed separately|31,647.53|FSC: 13; Default||External grouping not supported 80324916|EAP|CPT® 33207||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rplc Per Pm W/elect-vent|1|HUMANA [1294]||HUMANA [11839]|31,647.53|FSC: 13; Default||Not reimbursed separately|31,647.53|FSC: 13; Default||External grouping not supported 80324924|EAP|CPT® 33208||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rplc Per Pm W/elect-atrl And Vent|1|HUMANA [1294]||HUMANA [11839]|31,647.53|FSC: 13; Default||Not reimbursed separately|31,647.53|FSC: 13; Default||External grouping not supported 80324940|EAP|CPT® 33211||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB MP DUAL TEMP ELECT.|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80324957|EAP|CPT® 33212||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rplc Pm Gen Singl Chm|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80324965|EAP|CPT® 33213||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rplc Pm Gen Dual Chm|1|HUMANA [1294]||HUMANA [11839]|31,647.53|FSC: 13; Default||Not reimbursed separately|31,647.53|FSC: 13; Default||External grouping not supported 80324981|EAP|CPT® 33215||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rpstn Pm/icd Electrode|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80324999|EAP|CPT® 33216||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Sngl Elect Perm Pm/icd|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80325004|EAP|CPT® 33217||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert 2 Elect Perm Pm/icd|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80325012|EAP|CPT® 33218||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repair Sngl Elect Sngl Cham Pm/icd|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80325020|EAP|CPT® 33220||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repair 2 Elect Dual Cham Pm/icd|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80325038|EAP|CPT® 33222||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Revsn/reloc Skin Pocket Pm|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80325046|EAP|CPT® 33223||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rev Skin Pockt Icd|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80325053|EAP|CPT® 33224||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Lv Elect W/attach Prev Pm/icd|1|HUMANA [1294]||HUMANA [11839]|31,647.53|FSC: 13; Default||Not reimbursed separately|31,647.53|FSC: 13; Default||External grouping not supported 62063144|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Oxycodone-wo/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80325061|EAP|CPT® 33225||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Lv Elect At Time Pm/icd Insert|1|HUMANA [1294]||HUMANA [11839]|15,145.75|FSC: 13; Default||Not reimbursed separately|15,145.75|FSC: 13; Default||External grouping not supported 80325079|EAP|CPT® 33226||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repos Prev Lv Elect|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 62063422|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Buprenorphine-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80325087|EAP|CPT® 33233||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rmvl Perm Pmker Generator|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80325095|EAP|CPT® 33240||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Sngl/dual Icd Genr|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 62063555|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Barbiturates-w/cf-wo/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 80325103|EAP|CPT® 33241||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sub Rmvl Sngl/dual Icd Gen|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80325129|EAP|CPT® 33244||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mp Defib Lead Ext/transv|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 62063566|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pm Cocaine Met-qt-w/mm-u-quest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80325137|EAP|CPT® 33249||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins/rpstn Elect W/insert Gen Sngl/dual|1|HUMANA [1294]||HUMANA [11839]|99,655.86|FSC: 13; Default||Not reimbursed separately|99,655.86|FSC: 13; Default||External grouping not supported 80167463|EAP|CPT® 92961||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Internal Cardioversion Elective|1|HUMANA [1294]||HUMANA [11839]|1,656.04|FSC: 13; Default||Not reimbursed separately|1,656.04|FSC: 13; Default||External grouping not supported 80325160|EAP|CPT® 33999||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Mp Unlisted Procedure|1|HUMANA [1294]||HUMANA [11839]|1,946.36|FSC: 13; Default||Not reimbursed separately|1,946.36|FSC: 13; Default||External grouping not supported 80325178|EAP|CPT® 36005||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Pro Ext Venogram|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.00|FSC: 13; Default||Not reimbursed separately|1,135.00|FSC: 13; Default||External grouping not supported 80325186|EAP|CPT® 36620||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arterial Cath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|775.95|FSC: 13; Default||Not reimbursed separately|775.95|FSC: 13; Default||External grouping not supported 80167471|EAP|CPT® 24200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Of Foreign Body, Upper Arm Or Elbow Area; Subcutaneous|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80325202|EAP|CPT® 75820||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Venograpm Ext Uni|1|HUMANA [1294]||HUMANA [11839]|1,796.64|FSC: 13; Default||Not reimbursed separately|1,796.64|FSC: 13; Default||External grouping not supported 80325210|EAP|CPT® 93640||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ep Cardio-defib Lead, Initial|1|HUMANA [1294]||HUMANA [11839]|2,834.27|FSC: 13; Default||Not reimbursed separately|2,834.27|FSC: 13; Default||External grouping not supported 80325228|EAP|CPT® 93641||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ep Car-defib Leads&gen, Initial|1|HUMANA [1294]||HUMANA [11839]|3,316.89|FSC: 13; Default||Not reimbursed separately|3,316.89|FSC: 13; Default||External grouping not supported 80325236|EAP|CPT® 93642||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ep Eval Pacing Cardio-defib|1|HUMANA [1294]||HUMANA [11839]|3,048.57|FSC: 13; Default||Not reimbursed separately|3,048.57|FSC: 13; Default||External grouping not supported 80325244|EAP|CPT® 93724||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Elec Analy Antitachy Pcmkr Sys|1|HUMANA [1294]||HUMANA [11839]|836.29|FSC: 13; Default||Not reimbursed separately|836.29|FSC: 13; Default||External grouping not supported 80325251|EAP|CPT® 93285||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ilr Analysis|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80325269|EAP|CPT® 93280||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Analysis Dual Ppm|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95183597|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3.5 Locking 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 80325293|EAP|CPT® 93288||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Ppm Analysis W/reprog|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 80325301|EAP|CPT® 93293||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Single Tele Analysis|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95183596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,108.80|FSC: 13; Default||Not reimbursed separately|4,108.80|FSC: 13; Default||External grouping not supported 80325350|EAP|CPT® 33235||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rmvl Pm Elect Dual Lead|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80325368|EAP|CPT® 33234||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rmvl Pm Elect Sngl Lead|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 95183593|EAP|Custom 95183593||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Interbody Sovereign Large 8 Degree 42mmx30mmx18mm|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 80325434|EAP|CPT® 76942||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Doppler Needle Placement|1|HUMANA [1294]||HUMANA [11839]|827.93|FSC: 13; Default||Not reimbursed separately|827.93|FSC: 13; Default||External grouping not supported 80326457|EAP|CPT® 94770||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Etc02 Monitoring|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95183592|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Bio-absorbable Reinforcement Tissue Gore 8cm X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,257.00|FSC: 13; Default||Not reimbursed separately|1,257.00|FSC: 13; Default||External grouping not supported 95183589|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stealth Solid Crown 30 Micron 1.25mm 145cm Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80326507|EAP|CPT® 36556||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Central Venous Catheter Insertion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 80326515|EAP|CPT® 96368||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Iv Infusion, Concurrent|1|HUMANA [1294]||HUMANA [11839]|163.42|FSC: 13; Default||Not reimbursed separately|163.42|FSC: 13; Default||External grouping not supported 95183591|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular 28 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 80327810|EAP|CPT® 76706||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Aaa Screen Exam (medicare)|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4 Hole 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,525.00|FSC: 13; Default||Not reimbursed separately|15,525.00|FSC: 13; Default||External grouping not supported 80331606|EAP|CPT® 94617||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Exercise Test For Bronchospasm, Including Pre Post-spirometry, Ekg Recording(s), And Pulse Ox|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95183595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,440.00|FSC: 13; Default||Not reimbursed separately|1,440.00|FSC: 13; Default||External grouping not supported 80331648|EAP|HCPCS G0238||0419 - RESPIRATORY SERVICES - OTHER RESPIRATORY SERVICES|Hb Edurance Training Per 15 Minutes|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 80331655|EAP|HCPCS G0239||0419 - RESPIRATORY SERVICES - OTHER RESPIRATORY SERVICES|Hb Group Exercise 2 Or More|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 80331663|EAP|HCPCS G0237||0419 - RESPIRATORY SERVICES - OTHER RESPIRATORY SERVICES|Hb Resp Muscle Training Per 15 Min|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 80331671|EAP|HCPCS G0463||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|HB FACILITY CHARGE LEVEL 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.50|FSC: 13; Default||Not reimbursed separately|110.50|FSC: 13; Default||External grouping not supported 95183606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Precept 7.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95183608|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 57mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|FSC: 13; Default||Not reimbursed separately|5,031.06|FSC: 13; Default||External grouping not supported 80331812|EAP|CPT® 72114||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Lumbar W/bend Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80331838|EAP|CPT® 72052||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Cerv Com W/obl/flex/ext|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183607|EAP|Custom 95183607||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contour Coroent 8mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 80331861|EAP|CPT® 32551||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Int Pro Tube Thoracostomy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95183603|EAP|Custom 95183603||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Phalangeal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|FSC: 13; Default||Not reimbursed separately|7,470.00|FSC: 13; Default||External grouping not supported 95183605|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Fixation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|FSC: 13; Default||Not reimbursed separately|3,096.00|FSC: 13; Default||External grouping not supported 95183616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 80332307|EAP|CPT® 64447||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Anes Agent Femoral Nerve|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95183617|EAP|Custom 95183617||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tap 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167489|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Hospice, Nursing Admit Visit, Ea 15min Hc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|FSC: 13; Default||Not reimbursed separately|105.00|FSC: 13; Default||External grouping not supported 80332745|EAP|CPT® 59200||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insertion Of Cervical Dilator|1|HUMANA [1294]||HUMANA [11839]|835.71|FSC: 13; Default||Not reimbursed separately|835.71|FSC: 13; Default||External grouping not supported 80332752|EAP|CPT® 20610||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Arthrocentesis Major Jt W/o Us|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95183623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 7 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|FSC: 13; Default||Not reimbursed separately|1,416.00|FSC: 13; Default||External grouping not supported 80332778|EAP|CPT® 76813||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Nt Singleton Or 1st Baby|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80332786|EAP|CPT® 76814||0402 - OTHER IMAGING SERVICES - ULTRASOUND|HB PN NT EACH ADDITIONAL BABY|1|HUMANA [1294]||HUMANA [11839]|318.50|FSC: 13; Default||Not reimbursed separately|318.50|FSC: 13; Default||External grouping not supported 95183621|EAP|Custom 95183621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Irrigation Ipsi Io-flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80400112|EAP|CPT® 72240||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Myelogram Cervical|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 95183622|EAP|Custom 95183622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ipsi 5.5 Io-flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80400120|EAP|CPT® 72255||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Myelogram Thoracic|1|HUMANA [1294]||HUMANA [11839]|1,940.01|FSC: 13; Default||Not reimbursed separately|1,940.01|FSC: 13; Default||External grouping not supported 80400146|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Or Thoracic Facet Inject Addl|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183619|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Cover Edge 32 Contact Paddle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 80400161|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Facet Inj Cervical Or Thoracic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80400187|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Facet Addl|1|HUMANA [1294]||HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 95183620|EAP|Custom 95183620||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaver Microblade Io-flex 7.5 W/side Cutter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80400203|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Facet Inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 80400229|EAP|CPT® 64480||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epi C/t Addl|1|HUMANA [1294]||HUMANA [11839]|1,176.50|FSC: 13; Default||Not reimbursed separately|1,176.50|FSC: 13; Default||External grouping not supported 95183638|EAP|Custom 95183638||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Boot Heel Raiser Pro Heel 4/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80400245|EAP|CPT® 64479||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epi Cerv/thr|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183640|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Qwix Fixation 4.3mm X 45mm Lg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 80400278|EAP|CPT® 64484||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epi L/s Addl|1|HUMANA [1294]||HUMANA [11839]|1,261.01|FSC: 13; Default||Not reimbursed separately|1,261.01|FSC: 13; Default||External grouping not supported 80400302|EAP|CPT® 64483||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anes/sterd Trans Epilum/scr|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left Wide Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 80400328|EAP|CPT® 73592||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Low Ext Infant Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80400344|EAP|CPT® 73092||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Up Ex Infant Min 2v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183639|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 12mm X 315mm Ts2 Std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 80400351|EAP|CPT® 76010||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Nose To Rec Fb 1 View Child|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80400369|EAP|CPT® 72020||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Iv (specify Level)|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Locking Ss 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|FSC: 13; Default||Not reimbursed separately|870.48|FSC: 13; Default||External grouping not supported 80400385|EAP|CPT® 71048||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hb Chest Front/lat W/obliques|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80400393|EAP|CPT® 75716||0323 - RADIOLOGY - DIAGNOSTIC - ARTERIOGRAPHY|Hb Angiogram Extremity Bil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,896.81|FSC: 13; Default||Not reimbursed separately|7,896.81|FSC: 13; Default||External grouping not supported 95183641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Surfix Locking Ss 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.72|FSC: 13; Default||Not reimbursed separately|966.72|FSC: 13; Default||External grouping not supported 80400435|EAP|CPT® 72285||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Diskography Crevical/thoracic|1|HUMANA [1294]||HUMANA [11839]|4,899.33|FSC: 13; Default||Not reimbursed separately|4,899.33|FSC: 13; Default||External grouping not supported 80400443|EAP|CPT® 62291||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Proc Discography, Ea Level Cerv/thor|1|HUMANA [1294]||HUMANA [11839]|1,702.00|FSC: 13; Default||Not reimbursed separately|1,702.00|FSC: 13; Default||External grouping not supported 95183643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Orthoblast 1cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.57|FSC: 13; Default||Not reimbursed separately|681.57|FSC: 13; Default||External grouping not supported 80400450|EAP|CPT® 62284||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Myelogram Injection|1|HUMANA [1294]||HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 80400500|EAP|CPT® 78635||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Nm Csf Imag Ventriculography|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80500077|EAP|CPT® 76506||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Head Evaluation|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80500101|EAP|CPT® 76604||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Chest|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80500168|EAP|Custom 80500168||0998 - STATISTICAL CHARGES|Hb Us Schedule Us|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80500226|EAP|CPT® 76830||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Non-ob Transvaginal|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80500382|EAP|CPT® 76870||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Scrotum|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80500457|EAP|CPT® 76536||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Head/neck|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80500754|EAP|CPT® 76775||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Retroperitoneal Limited|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80500903|EAP|CPT® 76770||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Retroperitoneal Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80501133|EAP|CPT® 76810||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Preg Uter Mlt Gest >1st Tri|1|HUMANA [1294]||HUMANA [11839]|585.73|FSC: 13; Default||Not reimbursed separately|585.73|FSC: 13; Default||External grouping not supported 95191784|EAP|Custom 95191784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Tri-staple Tip Curve 30 Tan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80501257|EAP|CPT® 76856||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Pelvis (nonob) Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80501448|EAP|CPT® 76800||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Spinal Canal And Contents|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502115|EAP|CPT® 76705||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Abdomen Limited|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502123|EAP|CPT® 76700||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Abdomen Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502313|EAP|CPT® 50700||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Ureteroplasty Plastic Op|1|HUMANA [1294]||HUMANA [11839]|2,069.01|FSC: 13; Default||Not reimbursed separately|2,069.01|FSC: 13; Default||External grouping not supported 80502321|EAP|CPT® 76821||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Mca Doppler|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502347|EAP|CPT® 76827||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Fetal Echo Doppler|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502362|EAP|CPT® 76828||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Pn Repeat Doppler|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502370|EAP|CPT® 76376||0350 - CT SCAN - GENERAL CLASSIFICATION|Hb Ct 3d Reconst W/o Indep Wrkst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|614.62|FSC: 13; Default||Not reimbursed separately|614.62|FSC: 13; Default||External grouping not supported 80502388|EAP|CPT® 76819||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Fetal Bio W/o Nonstress Test|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80502404|EAP|CPT® 21550||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Sft Tissue Neck/thorax|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80502412|EAP|CPT® 36215||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Plc Art 1st Ord Above|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 80502420|EAP|CPT® 36217||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Art 3rd Ord Bil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,142.00|FSC: 13; Default||Not reimbursed separately|3,142.00|FSC: 13; Default||External grouping not supported 80502438|EAP|CPT® 36245||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Art 1st Abd Bilateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,250.96|FSC: 13; Default||Not reimbursed separately|3,250.96|FSC: 13; Default||External grouping not supported 80502446|EAP|CPT® 36218||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sel Cath Art Add 2/3 Bil|1|HUMANA [1294]||HUMANA [11839]|1,970.08|FSC: 13; Default||Not reimbursed separately|1,970.08|FSC: 13; Default||External grouping not supported 95186667|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Plus Matristem 7x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,166.00|FSC: 13; Default||Not reimbursed separately|5,166.00|FSC: 13; Default||External grouping not supported 80510001|EAP|CPT® 74018||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Examination, Abdomen; 1 View|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510019|EAP|CPT® 73050||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ac Jts Bil W/w/o Wght|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510043|EAP|CPT® 77072||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Bone Age Studies|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510050|EAP|CPT® 77073||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Bone Length Studies|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510068|EAP|CPT® 77076||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Osseous Survey Infant|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510076|EAP|CPT® 72040||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Cervical 2 Or 3 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510084|EAP|CPT® 72050||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Cervical Min 4v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510092|EAP|CPT® 71045||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hb Radiologic Examination, Chest; Single View|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183751|EAP|Custom 95183751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accumix Mixing System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80510118|EAP|CPT® 71047||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hb Radiologic Examination, Chest; 3 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95176749|EAP|Custom 95176749||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Peptamen 1.5 With Prebio 24 X 250 Ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80510126|EAP|CPT® 71046||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hb Radiologic Examination, Chest; 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510134|EAP|CPT® 71048||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hb Radiologic Examination, Chest; 4 Or More Views|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bio Composite Swivelock Tenodesis 7x19.1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 80510159|EAP|CPT® 77075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Osseous Survey Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510167|EAP|CPT® 72072||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Thoracic 3 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Speedbridge Implant System With Bio Comp Swivel Lock 4.75x1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|FSC: 13; Default||Not reimbursed separately|5,220.00|FSC: 13; Default||External grouping not supported 80510209|EAP|CPT® 70150||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Facial Bones Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510225|EAP|CPT® 74021||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Abd Comp W/decub/erct|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183710|EAP|Custom 95183710||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Cancellous Chips 5cc|1|HUMANA [1294]||HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 80510324|EAP|CPT® 72100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Lumbar 2 Or 3 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183711|EAP|Custom 95183711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valvulatome Lemaitre Expandable 1009-00|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80510332|EAP|CPT® 72110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Spine Lumbar Min 4 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510340|EAP|CPT® 70110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Mandible Comp Min 4v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 80510357|EAP|CPT® 70130||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Mastoids Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510365|EAP|CPT® 77074||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Osseous Survey Limited|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Lockdown Ac 11cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|FSC: 13; Default||Not reimbursed separately|7,485.00|FSC: 13; Default||External grouping not supported 80510373|EAP|CPT® 70160||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Nose Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510381|EAP|CPT® 70190||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Optic Foramen|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183648|EAP|Custom 95183648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cortical Tap Ao 3.5mm Diameter 130mm Length Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80510399|EAP|CPT® 70200||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Orbits Comp Min 4v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510415|EAP|CPT® 72170||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Pelvis 1/2 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183647|EAP|Custom 95183647||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Ao 2.5mm Diameter Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80510431|EAP|CPT® 71111||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ribs Bil Min 4v W/pa Chest|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183645|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw And Washer Lockdown 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|FSC: 13; Default||Not reimbursed separately|150.00|FSC: 13; Default||External grouping not supported 80510449|EAP|CPT® 72202||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sacroiliac Jts Min 3v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510456|EAP|CPT® 72220||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sacrum & Coccyx Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 30.mm 32/6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 80510464|EAP|CPT® 70380||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Salivary Gland Calc|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm 36/7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 80510506|EAP|CPT® 70220||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sinuses Paranasal Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510514|EAP|CPT® 70260||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Skull Comp Min 4v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183646|EAP|Custom 95183646||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gauge Lockdown Length Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80510522|EAP|CPT® 70360||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Soft Tissue Of The Neck|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510530|EAP|CPT® 71130||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sternal Clavicle Jt(s) Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 80510548|EAP|CPT® 71120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sternum Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510555|EAP|CPT® 70330||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Tmj Jt Open/closed Bil|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183660|EAP|Custom 95183660||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 4mmx30cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510589|EAP|CPT® 73130||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Hand 3 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510597|EAP|CPT® 73120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Hand 2 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183655|EAP|Custom 95183655||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 3mmx12cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 80510605|EAP|CPT® 73090||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Forearm 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510613|EAP|CPT® 73630||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Foot Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183675|EAP|Custom 95183675||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 16mmx60cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510639|EAP|CPT® 70030||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Eye Foreign Body|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183665|EAP|Custom 95183665||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 6mmx20cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 80510647|EAP|CPT® 73070||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Elbow 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510654|EAP|CPT® 73080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Elbow Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183680|EAP|Custom 95183680||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 32mmx60cm|1|HUMANA [1294]||HUMANA [11839]|4,170.00|FSC: 13; Default||Not reimbursed separately|4,170.00|FSC: 13; Default||External grouping not supported 80510662|EAP|CPT® 73000||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Clavicle Complete|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510670|EAP|CPT® 73600||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ankle 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183698|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pxslim Delivery 025 - 130(j)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80510688|EAP|CPT® 73610||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ankle Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510696|EAP|CPT® 73060||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Humerus Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183664|EAP|Custom 95183664||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 5mmx30cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510704|EAP|CPT® 73564||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Knee Comp Min 4v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510712|EAP|CPT® 73560||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Knee 1-2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183690|EAP|Custom 95183690||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 8mmx35cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510720|EAP|CPT® 73590||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Tibia & Fibula 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510738|EAP|CPT® 73650||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Calcaneus Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183661|EAP|Custom 95183661||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 4mmx35cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510746|EAP|CPT® 73010||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Scapula Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80510753|EAP|CPT® 73030||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Shoulder Comp Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183692|EAP|Custom 95183692||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 16mmx50cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510761|EAP|CPT® 73110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Wrist Comp Min 3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510779|EAP|CPT® 73100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Wrist 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Medial Tibia 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|FSC: 13; Default||Not reimbursed separately|7,635.00|FSC: 13; Default||External grouping not supported 80510803|EAP|CPT® 73562||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Knee 3 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510829|EAP|CPT® 73660||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Toe(s) Min 2v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183663|EAP|Custom 95183663||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 5mmx20cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 80510845|EAP|CPT® 73140||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Finger(s) Min 2views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510852|EAP|CPT® 71101||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Ribs Uni Min 3v W/pa Cxr|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 80510860|EAP|CPT® 73620||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Foot 2 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510878|EAP|CPT® 70140||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Facial Bones <3 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95183707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.4 Mm X L22 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 80510886|EAP|CPT® 70210||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Sinuses Paranasal <3v|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80510894|EAP|CPT® 70250||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Skull <4v|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183672|EAP|Custom 95183672||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 12mmx40cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 80510902|EAP|CPT® 70100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Mandible <4 Views|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 86500000|EAP|Custom 86500000||0990 - PATIENT CONVENIENCE ITEMS - GENERAL CLASSIFICATION|Hb Personal Care Respite Gc|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 95183685|EAP|Custom 95183685||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 3mmx15cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 95183695|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pxslim Delivery 025 Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183666|EAP|Custom 95183666||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 6mmx30cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95183674|EAP|Custom 95183674||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 14mmx60cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95183676|EAP|Custom 95183676||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 18mmx57cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95183677|EAP|Custom 95183677||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 20mmx60cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95183681|EAP|Custom 95183681||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 2mmx1cm|1|HUMANA [1294]||HUMANA [11839]|2,397.00|FSC: 13; Default||Not reimbursed separately|2,397.00|FSC: 13; Default||External grouping not supported 95183683|EAP|Custom 95183683||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 2mmx4cm|1|HUMANA [1294]||HUMANA [11839]|2,970.00|FSC: 13; Default||Not reimbursed separately|2,970.00|FSC: 13; Default||External grouping not supported 95183694|EAP|Custom 95183694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Detachment Handle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183657|EAP|Custom 95183657||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 4mmx10cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 95183706|EAP|Custom 95183706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Bit1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183670|EAP|Custom 95183670||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 9mmx30cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95183689|EAP|Custom 95183689||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 6mmx30cm|1|HUMANA [1294]||HUMANA [11839]|4,170.00|FSC: 13; Default||Not reimbursed separately|4,170.00|FSC: 13; Default||External grouping not supported 95183679|EAP|Custom 95183679||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 28mmx60cm|1|HUMANA [1294]||HUMANA [11839]|4,170.00|FSC: 13; Default||Not reimbursed separately|4,170.00|FSC: 13; Default||External grouping not supported 95183682|EAP|Custom 95183682||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 2mmx2cm|1|HUMANA [1294]||HUMANA [11839]|2,397.00|FSC: 13; Default||Not reimbursed separately|2,397.00|FSC: 13; Default||External grouping not supported 95183686|EAP|Custom 95183686||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 4mmx6cm|1|HUMANA [1294]||HUMANA [11839]|2,397.00|FSC: 13; Default||Not reimbursed separately|2,397.00|FSC: 13; Default||External grouping not supported 95183688|EAP|Custom 95183688||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 6mmx20cm|1|HUMANA [1294]||HUMANA [11839]|3,270.00|FSC: 13; Default||Not reimbursed separately|3,270.00|FSC: 13; Default||External grouping not supported 95183699|EAP|Custom 95183699||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Liquid Protein 48/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95183705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95183703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95183696|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pxslim Delivery 025 - 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183697|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pxslim Delivery 025 - 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 86500047|EAP|Custom AAA00||0022 - SKILLED NURSING FACILITY|Hb Rug Code|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95183700|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Mullins Check-flo 6fr 63cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183654|EAP|Custom 95183654||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 3mmx5cm|1|HUMANA [1294]||HUMANA [11839]|2,397.00|FSC: 13; Default||Not reimbursed separately|2,397.00|FSC: 13; Default||External grouping not supported 95183701|EAP|Custom 95183701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Navvus Rx Ffr Micro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183687|EAP|Custom 95183687||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 4mmx15cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 86500057|EAP|Custom 86500057||0998 - STATISTICAL CHARGES|Hb Outpatient In Bed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 86500058|EAP|Custom 86500058||0111 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - MEDICAL/SURGICAL/GYN|Hb Room & Bd Med Surg Private|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 95183658|EAP|Custom 95183658||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 4mmx15cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 86500060|EAP|Custom 86500060||0121 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - MEDICAL/SURGICAL/GYN|Hb Room & Bd Med Surg Semi-private|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 95183671|EAP|Custom 95183671||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 10mmx35cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95183693|EAP|Custom 95183693||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 20mmx60cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 95191785|EAP|Custom 95191785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Tri-staple 2.0 Black 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 86500066|EAP|Custom 86500066||0192 - SUBACUTE CARE - LEVEL II|HB ROOM & BD SKILLED NURSING PRIV|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 95183659|EAP|Custom 95183659||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 4mmx20cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 86500067|EAP|Custom 86500067||0121 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - MEDICAL/SURGICAL/GYN|Hb Room & Bd Skilled Nursing Semi|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||Accommodation codes not reimbursed separately 87550554|EAP|CPT® 76872||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Transrectal|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95183667|EAP|Custom 95183667||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 7mmx25cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 87550687|EAP|CPT® 45378||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Diagnostic|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95183678|EAP|Custom 95183678||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 24mmx57cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 87550695|EAP|CPT® 45379||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Fb Removal|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550703|EAP|CPT® 45380||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183691|EAP|Custom 95183691||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 8mmx60cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 87550711|EAP|CPT® 45382||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Control Bleeding|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183656|EAP|Custom 95183656||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 3mmx20cm|1|HUMANA [1294]||HUMANA [11839]|3,270.00|FSC: 13; Default||Not reimbursed separately|3,270.00|FSC: 13; Default||External grouping not supported 87550737|EAP|CPT® 45384||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Tumor Removal Hot F|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550745|EAP|CPT® 45385||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Tumor Removal Snare|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183662|EAP|Custom 95183662||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 5mmx12cm|1|HUMANA [1294]||HUMANA [11839]|2,997.00|FSC: 13; Default||Not reimbursed separately|2,997.00|FSC: 13; Default||External grouping not supported 87550752|EAP|CPT® 44388||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Stoma Colonoscopy|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87550760|EAP|CPT® 44389||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Stoma Colonoscopy W Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183669|EAP|Custom 95183669||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Stand 8mmx40cm|1|HUMANA [1294]||HUMANA [11839]|3,897.00|FSC: 13; Default||Not reimbursed separately|3,897.00|FSC: 13; Default||External grouping not supported 87550778|EAP|CPT® 44390||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Stoma Colonoscopy Fb Removal|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87550786|EAP|CPT® 44391||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Stoma Colonoscopy W Control Bleed|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183684|EAP|Custom 95183684||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby Complex Soft 3mmx5cm|1|HUMANA [1294]||HUMANA [11839]|2,397.00|FSC: 13; Default||Not reimbursed separately|2,397.00|FSC: 13; Default||External grouping not supported 87550794|EAP|CPT® 44394||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Thru Stoma,lesn Rmvl W/snare|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550810|EAP|CPT® 44392||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Stoma Rmvl Les By Hot Biopsy Forceps|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550828|EAP|CPT® 45330||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy Diagnostic|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87550836|EAP|CPT® 45331||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87550844|EAP|CPT® 45332||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Removal Fb|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550851|EAP|CPT® 45333||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy Flx W/rmvl Tumor By Hot Bx Forceps|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95186668|EAP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Powder Micromatrix Matristem 1000mg Per Mg|1|HUMANA [1294]||HUMANA [11839]|6.64|FSC: 13; Default||Not reimbursed separately|6.64|FSC: 13; Default||External grouping not supported 87550869|EAP|CPT® 45334||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Control Bleeding|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550877|EAP|CPT® 45338||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy Remv Lesn Snare|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95191786|EAP|Custom 95191786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shell Signia Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87550885|EAP|CPT® 45300||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Proctosigmoidoscopy Diagnostic|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87550893|EAP|CPT® 45305||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Proctosigmoidoscopy W Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87550901|EAP|CPT® 43200||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy Flexible Transoral Diagnostic|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 87550919|EAP|CPT® 43239||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Biopsy|1|HUMANA [1294]||HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 95183735|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii Sz #7 35mm Ne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 87550927|EAP|CPT® 43204||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Sclerosis Of Varices|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 87550935|EAP|CPT® 43205||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Band Ligation Of Varices|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 87550943|EAP|CPT® 43245||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Dilation Gastric Outlet|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 87550950|EAP|CPT® 43246||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Direct Placement Percutaneo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95191787|EAP|Custom 95191787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Tri-staple Tip 30 Tan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87550968|EAP|CPT® 43215||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy Flexible Removal Foreign Body|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 87550976|EAP|CPT® 43226||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Guidewire C Dilation Of Eso|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95183748|EAP|Custom 95183748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Flip Ii 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87550984|EAP|CPT® 43220||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Balloon Dilation <30mm Diam|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 87551008|EAP|CPT® 43227||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd W Control Bleeding Any Method|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95183738|EAP|Custom 95183738||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage As Avs 8x14x16|1|HUMANA [1294]||HUMANA [11839]|8,798.49|FSC: 13; Default||Not reimbursed separately|8,798.49|FSC: 13; Default||External grouping not supported 87551032|EAP|CPT® 49446||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd-convert J-peg To J-tube|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95183740|EAP|Custom 95183740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accu-pass Suture Shuttle 70 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87551040|EAP|CPT® 43260||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp Diagnostic|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 87551057|EAP|CPT® 43261||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp W Biopsy|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 95183742|EAP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allopatch Hd Thick 5 X 5cm|1|HUMANA [1294]||HUMANA [11839]|195.36|FSC: 13; Default||Not reimbursed separately|195.36|FSC: 13; Default||External grouping not supported 87551065|EAP|CPT® 43262||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp W Sphincterotomy/papillotomy|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 87551073|EAP|CPT® 43264||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp W Removal Stone/biliary Or P|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 95183743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 87551081|EAP|CPT® 43265||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp Destruction Lithotripsy Ston|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 95183741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Healicoil Regenesorb Suture Anchor 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.02|FSC: 13; Default||Not reimbursed separately|1,168.02|FSC: 13; Default||External grouping not supported 95183737|EAP|Custom 95183737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating Stablecut 0.89mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87551123|EAP|CPT® 31622||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy Diagnostic|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 87551131|EAP|CPT® 31615||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy Thru Trach|1|HUMANA [1294]||HUMANA [11839]|1,363.57|FSC: 13; Default||Not reimbursed separately|1,363.57|FSC: 13; Default||External grouping not supported 95183739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 3hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 87551149|EAP|CPT® 31623||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Brushings|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 87551156|EAP|CPT® 31624||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Lavage|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 95183745|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Ptrcoat A/p Wedged Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,195.50|FSC: 13; Default||Not reimbursed separately|7,195.50|FSC: 13; Default||External grouping not supported 87551164|EAP|CPT® 31628||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Biopsy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 87551172|EAP|CPT® 31625||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Lung Biops|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 95183736|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Ha Copeland Sz 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,153.00|FSC: 13; Default||Not reimbursed separately|12,153.00|FSC: 13; Default||External grouping not supported 87551180|EAP|CPT® 31629||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Needle Asp|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 87551198|EAP|CPT® 31630||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Dilation &|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 95183744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 87551206|EAP|CPT® 31635||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy W Fb Removal|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 87551214|EAP|CPT® 31641||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy Laser|1|HUMANA [1294]||HUMANA [11839]|9,066.17|FSC: 13; Default||Not reimbursed separately|9,066.17|FSC: 13; Default||External grouping not supported 95183715|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Rapidcross 3mmx60mmx170cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 87551222|EAP|CPT® 31645||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch Drain Abscess Init|1|HUMANA [1294]||HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 87551230|EAP|CPT® 31645||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy Drain Abscess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,416.26|FSC: 13; Default||Not reimbursed separately|4,416.26|FSC: 13; Default||External grouping not supported 95183712|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Assurity Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|FSC: 13; Default||Not reimbursed separately|14,904.00|FSC: 13; Default||External grouping not supported 87551255|EAP|CPT® 49450||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb G-tube Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 95183726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti Asnis Iii 4.0x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 87551305|EAP|CPT® 64492||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Facet Inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.06|FSC: 13; Default||Not reimbursed separately|1,013.06|FSC: 13; Default||External grouping not supported 95183714|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross Elite .014 3mmx100mmx150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 87551362|EAP|CPT® 64490||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Or Thoracic Facet Injection Addl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Continuum U-e Neural 32 Mm Sz Hh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 87551388|EAP|CPT® 64479||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Foramina Inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 87551404|EAP|CPT® 64480||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Cervical Foramina Addl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,176.50|FSC: 13; Default||Not reimbursed separately|1,176.50|FSC: 13; Default||External grouping not supported 95183731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm/l32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 87551420|EAP|CPT® 64483||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Lumbar Foramina Inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 87551479|EAP|HCPCS G0260||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sp Sacroiliac Joint Inj|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95183721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adaptor Liner Constrained Reflection 54-56 Mm O.d. F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 87551586|EAP|CPT® 62273||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidural Inj Blood Patch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95183719|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adaptor Liner Constrained Reflection 58-60 Mm O.d. G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|FSC: 13; Default||Not reimbursed separately|7,695.60|FSC: 13; Default||External grouping not supported 87551594|EAP|CPT® 64450||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Other Peripheral Nerv|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 87551602|EAP|CPT® 64425||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ilioinguinal Nerve Block|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95183718|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Constrained 0 Degree 28mm 58-60 Mm O.d. G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|FSC: 13; Default||Not reimbursed separately|8,236.80|FSC: 13; Default||External grouping not supported 87551644|EAP|CPT® 20550||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tendon Injection Sheath|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 87551651|EAP|CPT® 20551||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Tendon Inj Origin/insert|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95183729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm/l26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 87551669|EAP|CPT® 64420||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intercostal Nerve Blk Sng|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 87551677|EAP|CPT® 64421||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inj Anes Intercostal Nrv Mult|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95183722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Modular Cementless Kinectiv M/ltaper Sz 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 87551719|EAP|CPT® 45386||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colon Balloon Dilation|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 87551941|EAP|CPT® 45340||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Dil By Bal|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95183727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Curved 16 Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,289.00|FSC: 13; Default||Not reimbursed separately|5,289.00|FSC: 13; Default||External grouping not supported 87551958|EAP|CPT® 91035||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Insertion Ph Capsule Gerd|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 87552022|EAP|CPT® 81002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Dip Analysis|1|HUMANA [1294]||HUMANA [11839]|10.44|FSC: 13; Default||Not reimbursed separately|10.44|FSC: 13; Default||External grouping not supported 95183728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm/l32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 87590634|EAP|HCPCS G0104||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Screen Sigmoidoscopy|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87590642|EAP|HCPCS G0105||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Screen Colonoscopy High Risk|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95183713|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross 2.5mmx80mmx150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 87600326|EAP|CPT® 76815||0402 - OTHER IMAGING SERVICES - ULTRASOUND|HB PN LIMITED ULTRASOUND|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 87615068|EAP|CPT® 96402||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo Admin Sq/im Hormonal|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 95183730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T 10 Full Thread 3.5mm/l30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 87615076|EAP|CPT® 96375||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Iv Push Sequential New Drug|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 87615118|EAP|CPT® 96366||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Ther/proph Diag Iv Inf Addl Hrs|1|HUMANA [1294]||HUMANA [11839]|108.60|FSC: 13; Default||Not reimbursed separately|108.60|FSC: 13; Default||External grouping not supported 87615142|EAP|CPT® 96401||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo, Subq/im, Non Hormonal|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 87615159|EAP|CPT® 96409||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo Iv Push, Initial|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 62063789|EAP|CPT® 87491||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Chlamydia Amp Probe -ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 87615167|EAP|CPT® 96413||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Chemo Iv Inf, Initial Up To 1hr|1|HUMANA [1294]||HUMANA [11839]|882.21|FSC: 13; Default||Not reimbursed separately|882.21|FSC: 13; Default||External grouping not supported 87615175|EAP|CPT® 96415||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hb Chemo Iv Inf, Addl Hr|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 62063797|EAP|CPT® 87591||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Neisseria Amp Probe -ref Lab|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 89000103|EAP|CPT® 91010||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esopheal Motility|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 80167490|EAP|CPT® 20604||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Drain Or Inj Small Joint Bursa W Us Guidance|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 89000129|EAP|CPT® 91034||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb 24 Hr Ph Monitoring|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 89000160|EAP|CPT® 64510||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stellate Ganglion|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80167501|EAP|CPT® 20606||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Drain Or Inj Intermediate Joint Bursa W Us Guidance|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 89000194|EAP|CPT® 64530||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Celiac Plx Blk W/f|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 89000228|EAP|CPT® 64415||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Brachial Plexus Blk|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80167512|EAP|CPT® 20611||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Drain Or Inj Major Joint Bursa W Us Guidance|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 89000236|EAP|CPT® 62280||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Neurolytic Procedures|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80167523|EAP|CPT® 20983||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation Bone Tumors Perq W Imaging|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 89000285|EAP|CPT® 64400||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Nerve Blk Trigeminal Nerve|1|HUMANA [1294]||HUMANA [11839]|745.92|FSC: 13; Default||Not reimbursed separately|745.92|FSC: 13; Default||External grouping not supported 80167534|EAP|CPT® 22510||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Vertebroplasty Cervicothoracic W Imaging|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 89070031|EAP|CPT® 62270||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Spinal Tap (lp) Diag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 80167545|EAP|CPT® 22511||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Vertebroplasty Lumboscral W Imaging|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 89070080|EAP|CPT® 10140||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I & D Hematoma/seroma/fluid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80167556|EAP|CPT® 22512||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vertebroplasty Addl Inject W Imaging|1|HUMANA [1294]||HUMANA [11839]|4,865.26|FSC: 13; Default||Not reimbursed separately|4,865.26|FSC: 13; Default||External grouping not supported 89070098|EAP|CPT® 10160||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Punc Asp Abscess/hem/bull/cyst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.31|FSC: 13; Default||Not reimbursed separately|986.31|FSC: 13; Default||External grouping not supported 89070122|EAP|CPT® 96374||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Iv Push Initial|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 80167567|EAP|CPT® 22513||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Vertebral Augmentation Thoracic W Imaging|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 89070148|EAP|CPT® 96365||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Iv Infus Initial Up To 1 Hour|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 89070163|EAP|CPT® 47000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Liver Biopsy Percutaneous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80167578|EAP|CPT® 22514||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Vertebral Augmentation Lumbar W Imaging|1|HUMANA [1294]||HUMANA [11839]|18,466.18|FSC: 13; Default||Not reimbursed separately|18,466.18|FSC: 13; Default||External grouping not supported 89070171|EAP|CPT® 96372||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hb Injection Sc/im|1|HUMANA [1294]||HUMANA [11839]|172.32|FSC: 13; Default||Not reimbursed separately|172.32|FSC: 13; Default||External grouping not supported 89400287|EAP|Custom 89400287||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase I|1|HUMANA [1294]||HUMANA [11839]|911.49|FSC: 13; Default||Not reimbursed separately|911.49|FSC: 13; Default||External grouping not supported 80167589|EAP|CPT® 22515||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Vertebral Augmentation Addl Level W Imaging|1|HUMANA [1294]||HUMANA [11839]|6,800.10|FSC: 13; Default||Not reimbursed separately|6,800.10|FSC: 13; Default||External grouping not supported 89400295|EAP|Custom 89400295||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase I Add Hr|1|HUMANA [1294]||HUMANA [11839]|222.57|FSC: 13; Default||Not reimbursed separately|222.57|FSC: 13; Default||External grouping not supported 80167590|EAP|CPT® 47383||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Ablation 1 Or More Liver Tumor Cryoablation|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 89518310|EAP|CPT® 76942||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guide For Needle Placement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|827.93|FSC: 13; Default||Not reimbursed separately|827.93|FSC: 13; Default||External grouping not supported 89518351|EAP|CPT® 76998||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Us Guide Intraoperative|1|HUMANA [1294]||HUMANA [11839]|850.03|FSC: 13; Default||Not reimbursed separately|850.03|FSC: 13; Default||External grouping not supported 80167601|EAP|CPT® 62302||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Myelography Lumbar Inj Cervical|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 89531008|EAP|CPT® 92979||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Ivus Coronary, Add Vessel|1|HUMANA [1294]||HUMANA [11839]|2,886.33|FSC: 13; Default||Not reimbursed separately|2,886.33|FSC: 13; Default||External grouping not supported 80167612|EAP|CPT® 62303||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Myelography Lumbar Inj Thoracic|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 80167623|EAP|CPT® 62304||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Myelography Lumbar Inj Lumbosacral|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 80167634|EAP|CPT® 62305||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Myelography Lumabr Inj 2 Or More Regions|1|HUMANA [1294]||HUMANA [11839]|2,101.68|FSC: 13; Default||Not reimbursed separately|2,101.68|FSC: 13; Default||External grouping not supported 80167645|EAP|CPT® 91200||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Liver Elastography Wo Imaging|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80167656|EAP|CPT® 93895||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Carotid Intima Atheroma Eval|1|HUMANA [1294]||HUMANA [11839]|162.63|FSC: 13; Default||Not reimbursed separately|162.63|FSC: 13; Default||External grouping not supported 92902212|EAP|Custom 92902212||0250 - PHARMACY - GENERAL CLASSIFICATION|Hb Rc Budseon/formot 160/4.5mcg 2 P|1|HUMANA [1294]||HUMANA [11839]|17.49|FSC: 13; Default||Not reimbursed separately|17.49|FSC: 13; Default||External grouping not supported 80167667|EAP|CPT® 76641||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Ultrasound Breast Complete|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80167678|EAP|CPT® 76642||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Ultrasound Breast Limited|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 80167689|EAP|CPT® 77085||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Dxa Bone Density Study 1 Or More Sites Axial Skeleton|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80167690|EAP|CPT® 77086||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Fracture Assessment Via Dxa|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 95111023|EAP|Custom 95111023||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Bipap Full Face Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183755|EAP|Custom 95183755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.1mm (.045in. )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111161|EAP|Custom 95111161||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nebulizer Medication Continuous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated 3.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|FSC: 13; Default||Not reimbursed separately|1,023.00|FSC: 13; Default||External grouping not supported 95111173|EAP|Custom 95111173||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Pulse Oximeter Forehead|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167712|EAP|CPT® 33270||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Rep Perm Subq Imp Defibrillator|1|HUMANA [1294]||HUMANA [11839]|99,655.86|FSC: 13; Default||Not reimbursed separately|99,655.86|FSC: 13; Default||External grouping not supported 80167723|EAP|CPT® 33271||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Subq Implantable Defib Electrode|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 95169456|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Blazer Dx Duocapolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169457|EAP|Custom 95169457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seamguard Staple Line Reinf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169458|EAP|Custom 95169458||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 9x10x26|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95169459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95169460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95169461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ulnar Small Extra|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95120615|EAP|Custom 95120615||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Chamber Mdi With Medium Mask|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169464|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mmx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,361.00|FSC: 13; Default||Not reimbursed separately|11,361.00|FSC: 13; Default||External grouping not supported 95121161|EAP|Custom 95121161||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Chamber Mdi With Small Mask|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169465|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,361.00|FSC: 13; Default||Not reimbursed separately|11,361.00|FSC: 13; Default||External grouping not supported 95169618|EAP|Custom 95169618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Oncontrol Sterile Pro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169619|EAP|Custom 95169619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Comprehensive 152mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169621|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Mac30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124331|EAP|Custom 95124331||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Bipap Full Face Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169622|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Mac40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95124332|EAP|Custom 95124332||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Bipap Full Face Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169623|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articulating Gen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|FSC: 13; Default||Not reimbursed separately|3,042.60|FSC: 13; Default||External grouping not supported 95124556|EAP|Custom 95124556||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Nasal Bipap Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169624|EAP|Custom 95169624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reaming Patella|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95124578|EAP|Custom 95124578||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Nasal Bipap Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Cr Legion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|FSC: 13; Default||Not reimbursed separately|5,484.60|FSC: 13; Default||External grouping not supported 95169628|EAP|Custom 95169628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reaming Patella Resur|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95169631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.0x14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95169632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95169633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.00|FSC: 13; Default||Not reimbursed separately|1,203.00|FSC: 13; Default||External grouping not supported 95133194|EAP|Custom 95133194||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Filter Bacteria Exhalation(for84|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169635|EAP|Custom 95169635||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Performatrak Se|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95136931|EAP|Custom 95136931||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Chamber Mdi With Large Mask|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95138588|EAP|Custom 95138588||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Pulse Oximeter Infant I-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169651|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95169652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95169653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95145851|EAP|Custom 95145851||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Line Inspiratory Heated 60 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169656|EAP|Custom 95169656||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contoured Small 6mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95145852|EAP|Custom 95145852||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Circuit Bipap Nppv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145853|EAP|Custom 95145853||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Circuit Heated Wire Dual Adult/p|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145856|EAP|Custom 95145856||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Infant Hiflow Cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169659|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Pca 32mm +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95169660|EAP|Custom 95169660||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Frequency Radio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147416|EAP|Custom 95147416||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nasal Shell Puff|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147458|EAP|Custom 95147458||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nasal Cpap Pillow Small ( Nasal)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169662|EAP|Custom 95169662||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Grounding Rf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147459|EAP|Custom 95147459||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nasal Cpap Pillow Medium Nasal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147460|EAP|Custom 95147460||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nasal Cpap Pillow Large Nasal Pu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169664|EAP|Custom 95169664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Endo Stitch Bralon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147461|EAP|Custom 95147461||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb If Circuit/generator For F&p 850|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169665|EAP|Custom 95169665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Endo Stitch Bralon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147472|EAP|Custom 95147472||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pmv 2000 Clear Low Profile Low R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169666|EAP|Custom 95169666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Endo Stitch Polys|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95147738|EAP|Custom 95147738||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Resuscitator Automatic Bvm Mode|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169668|EAP|Custom 95169668||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Endo Retract|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148174|EAP|HCPCS A9500||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|Hb Tc-99m Sest Amibi Dx/dose, Up To 40mci|1|HUMANA [1294]||HUMANA [11839]|296.10|FSC: 13; Default||Not reimbursed separately|296.10|FSC: 13; Default||External grouping not supported 95169669|EAP|Custom 95169669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Thoracoport 11.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148259|EAP|Custom 95148259||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Oxygen Therapy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169467|EAP|Custom 95169467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Suture Expressew Iii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148556|EAP|Custom 95148556||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wrap Size Medium For The Vest|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169634|EAP|Custom 95169634||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pathproof Surgical Specimen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148557|EAP|Custom 95148557||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Wrap Size Large For The Vest|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95148906|EAP|Custom 95148906||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Circuit Heated Wire Dual Adult/0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169648|EAP|Custom 95169648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Endo Ligaclip Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95149856|EAP|Custom 95149856||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pneumotach Disposable Pediatrict|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Thread Full T2 Scn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|581.70|FSC: 13; Default||Not reimbursed separately|581.70|FSC: 13; Default||External grouping not supported 95149857|EAP|Custom 95149857||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Flow C02 Combined Adult )|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Helix-r 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|FSC: 13; Default||Not reimbursed separately|3,288.00|FSC: 13; Default||External grouping not supported 95149858|EAP|Custom 95149858||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Non Invasive Co2 (nico)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169657|EAP|Custom 95169657||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Contoured Small 7mm|1|HUMANA [1294]||HUMANA [11839]|3,732.00|FSC: 13; Default||Not reimbursed separately|3,732.00|FSC: 13; Default||External grouping not supported 95149949|EAP|Custom 95149949||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Nebulizer System Respiguard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Duratin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,772.00|FSC: 13; Default||Not reimbursed separately|2,772.00|FSC: 13; Default||External grouping not supported 95169661|EAP|Custom 95169661||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Probe Frequency Radio Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169663|EAP|Custom 95169663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Endo Stitch Sofsil|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150592|EAP|Custom 95150592||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Gel Comfort Select Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169667|EAP|Custom 95169667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endo Hernia Mult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169673|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112691|EAP|Custom 95112691 ||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoclip 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150596|EAP|Custom 95150596||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hb Mask Nasal Profile Lite With Hm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150599|EAP|Custom 95150599||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Profile Lite With He|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169678|EAP|Custom 95169678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Endopath 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169680|EAP|Custom 95169680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Curved Harmonic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169714|EAP|Custom 95169714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Transseptal 71cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95120737|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 8fr Swartz Sl1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169677|EAP|Custom 95169677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dissector Endopath Curved |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169722|EAP|Custom 95169722||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Nicom Noninvasive|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95150780|EAP|Custom 95150780||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Ventilator Portable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95162474|EAP|Custom 95162474||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Filter Mositure Trap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169723|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95169724|EAP|Custom 95169724||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire .062|1|HUMANA [1294]||HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95151668|EAP|HCPCS A7520||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy Xlt Cuffless Y|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95151686|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intro Tunneler On-q|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95151818|EAP|Custom 95151818||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal Flexifit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecronon Rt 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|FSC: 13; Default||Not reimbursed separately|2,745.00|FSC: 13; Default||External grouping not supported 95151819|EAP|Custom 95151819||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Nasal For Osa Cpap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95169730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95169731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95152465|EAP|Custom 95152465||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sensor Pediatric/adult Series 3w|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95169733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95169734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95169736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 5 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|FSC: 13; Default||Not reimbursed separately|2,745.00|FSC: 13; Default||External grouping not supported 95169737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95156084|EAP|Custom 95156084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flowmeter Oxygen W/adapter Power|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|FSC: 13; Default||Not reimbursed separately|990.00|FSC: 13; Default||External grouping not supported 95169739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95169740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x18mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95169741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95169742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95169743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Vision Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|FSC: 13; Default||Not reimbursed separately|1,128.96|FSC: 13; Default||External grouping not supported 95183757|EAP|Custom 95183757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini Maxlock Extreme 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183761|EAP|Custom 95183761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Trinica Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162464|EAP|Custom 80162464||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Transport Chair|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169744|EAP|Custom 95169744||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Crown Stainless Steel B2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169745|EAP|Custom 95169745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retaining Tube Nasal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169746|EAP|Custom 95169746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Placed Endo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169747|EAP|Custom 95169747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Cap Lock 55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Short V40 Modular Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95169758|EAP|Custom 95169758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Long Renal 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169759|EAP|Custom 95169759||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurawrap 10mmx4cm|1|HUMANA [1294]||HUMANA [11839]|4,794.00|FSC: 13; Default||Not reimbursed separately|4,794.00|FSC: 13; Default||External grouping not supported 95169749|EAP|Custom 95169749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Decompression Gastric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95169769|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plae Coronoid Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,896.75|FSC: 13; Default||Not reimbursed separately|1,896.75|FSC: 13; Default||External grouping not supported 95183760|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recovery Fixed Trimcor 14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|FSC: 13; Default||Not reimbursed separately|1,128.00|FSC: 13; Default||External grouping not supported 95169771|EAP|Custom 95169771||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Peptamen 1.5 Ultra Pak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169772|EAP|Custom 95169772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 12x38x28mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95169773|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95169775|EAP|Custom 95169775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringe Dilation Hercules|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169777|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Esophageal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169780|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.5 Diopter Acrysof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169781|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.0 Diopter Acrysof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169782|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 22.5 Ao Diop Crystalens|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95169790|EAP|Custom 95169790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Repair Meniscal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169791|EAP|Custom 95169791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Suture Sequent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169070|EAP|Custom 95169070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169071|EAP|Custom 95169071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Urine Meter Ic |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169793|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Porous Osseo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95169794|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Porous Osseo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95169800|EAP|Custom 95169800||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pillow Abduction Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169802|EAP|Custom 95169802||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pillow Abduction Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95169807|EAP|Custom 95169807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Laser 25 Gauge |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169808|EAP|Custom 95169808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Serrated Revolution|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169810|EAP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cope Nephroureter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.83|FSC: 13; Default||Not reimbursed separately|394.83|FSC: 13; Default||External grouping not supported 95169811|EAP|Custom 95169811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Vessel Jcd 16fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169812|EAP|Custom 95169812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Processing Elite 225ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169813|EAP|Custom 95169813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Processing Elite 125ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169814|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95169815|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169818|EAP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Balloon Cutting Pcb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,598.00|FSC: 13; Default||Not reimbursed separately|2,598.00|FSC: 13; Default||External grouping not supported 95169819|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Carotid Wallstent |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,710.00|FSC: 13; Default||Not reimbursed separately|7,710.00|FSC: 13; Default||External grouping not supported 95169820|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Reinforcement Inforce|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,771.60|FSC: 13; Default||Not reimbursed separately|6,771.60|FSC: 13; Default||External grouping not supported 95169821|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Reinforcement Inforce|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,771.60|FSC: 13; Default||Not reimbursed separately|6,771.60|FSC: 13; Default||External grouping not supported 95169822|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Carotid Wallstent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,710.00|FSC: 13; Default||Not reimbursed separately|7,710.00|FSC: 13; Default||External grouping not supported 95169816|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169824|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Esophageal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169825|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Lumen Multi Flex Contura|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169826|EAP|Custom 95169826||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tip Rumi Yellow 5.1mmx4cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183753|EAP|Custom 95183753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 13g Access Bx/5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated 30.x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|FSC: 13; Default||Not reimbursed separately|1,023.00|FSC: 13; Default||External grouping not supported 95183762|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Extension Leg Iliac 16mm X 55cm Zenith Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|FSC: 13; Default||Not reimbursed separately|5,829.00|FSC: 13; Default||External grouping not supported 95183756|EAP|Custom 95183756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95121948|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Mg-ii Lipped 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,336.09|FSC: 13; Default||Not reimbursed separately|6,336.09|FSC: 13; Default||External grouping not supported 95169817|EAP|Custom 95169817||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Processing Elite 70ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169840|EAP|Custom 95169840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.7mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atlantis Fixed 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|FSC: 13; Default||Not reimbursed separately|1,446.48|FSC: 13; Default||External grouping not supported 95169842|EAP|Custom 95169842||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Polypectomy Micro |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169871|EAP|Custom 95169871||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Dianeal 2.5%|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169874|EAP|Custom 95169874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Dianeal 4.25%|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169875|EAP|Custom 95169875||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Automated Peritoneal |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169877|EAP|Custom 95169877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Manifold 5 Prong|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169809|EAP|Custom 95169809||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 9mmx22mm|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95169888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95169911|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11. Diop Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169912|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11. Diop Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95183759|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 3level 63mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,401.40|FSC: 13; Default||Not reimbursed separately|6,401.40|FSC: 13; Default||External grouping not supported 95183764|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Style 8200 Height Medium Cpx4 800cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95183752|EAP|Custom 95183752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Reg General Biopsy 12/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169921|EAP|Custom 95169921||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Toggleloc|1|HUMANA [1294]||HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 95169922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95169923|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Long V40 Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95169924|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Attain Ability Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 62060710|EAP|CPT® 83020||0301 - LABORATORY - CHEMISTRY|Hb Acid Hgb Electro - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|38.61|FSC: 13; Default||Not reimbursed separately|38.61|FSC: 13; Default||External grouping not supported 62060728|EAP|CPT® 83020||0301 - LABORATORY - CHEMISTRY|Hb Alkaline Hgb Electro - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.61|FSC: 13; Default||Not reimbursed separately|38.61|FSC: 13; Default||External grouping not supported 62060736|EAP|CPT® 85660||0305 - LABORATORY - HEMATOLOGY|Hb Sickle Cell Sol - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|16.53|FSC: 13; Default||Not reimbursed separately|16.53|FSC: 13; Default||External grouping not supported 62060744|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|Hb Anca Igg Titer - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62060752|EAP|CPT® 87077||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Aerobic Id - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|24.24|FSC: 13; Default||Not reimbursed separately|24.24|FSC: 13; Default||External grouping not supported 62060769|EAP|CPT® 87076||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Anaerobic Id - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|24.24|FSC: 13; Default||Not reimbursed separately|24.24|FSC: 13; Default||External grouping not supported 62060777|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Susceptability - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 95169928|EAP|Custom 95169928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Insertion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169935|EAP|Custom 95169935||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12x38x28mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95169936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95169937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95169938|EAP|Custom 95169938||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12x42x30mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95169939|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Ps Cement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|FSC: 13; Default||Not reimbursed separately|10,615.50|FSC: 13; Default||External grouping not supported 95169940|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95169943|EAP|Custom 95169943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Drainer Centesis |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169946|EAP|Custom 95169946||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Cushions Size 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169947|EAP|Custom 95169947||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Cushions Size 2 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169948|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11.0 Diop Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169950|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 11.5 Diop Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95169951|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 15.5 Diop Acrysof Toric|1|HUMANA [1294]||HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95169953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|FSC: 13; Default||Not reimbursed separately|5,508.00|FSC: 13; Default||External grouping not supported 95169954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periprosthesis Axsos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|FSC: 13; Default||Not reimbursed separately|542.16|FSC: 13; Default||External grouping not supported 95169955|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periprosthesis Axsos|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|FSC: 13; Default||Not reimbursed separately|542.16|FSC: 13; Default||External grouping not supported 95169956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Threa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|FSC: 13; Default||Not reimbursed separately|105.84|FSC: 13; Default||External grouping not supported 95169957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon T2 Left 13x350|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,509.00|FSC: 13; Default||Not reimbursed separately|7,509.00|FSC: 13; Default||External grouping not supported 95169958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Recon T2 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95169959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Recon T2 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95169960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Recon T2 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|963.00|FSC: 13; Default||Not reimbursed separately|963.00|FSC: 13; Default||External grouping not supported 95169961|EAP|Custom 95169961||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Recon T2 Solid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95169963|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95169966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stayfuse Screw 6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95169967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Revision |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|FSC: 13; Default||Not reimbursed separately|11,442.90|FSC: 13; Default||External grouping not supported 95169969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy 6.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95169970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Doral Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95169971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Lps Opit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,288.90|FSC: 13; Default||Not reimbursed separately|6,288.90|FSC: 13; Default||External grouping not supported 95169973|EAP|Custom 95169973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ligasure Sealer Divider |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169980|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.5x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95169981|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.5x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 80167734|EAP|CPT® 33272||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rmvl Of Subq Defibrillator|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80167745|EAP|CPT® 33273||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Repos Prev Implanted Subq Defib Eletrode|1|HUMANA [1294]||HUMANA [11839]|9,211.57|FSC: 13; Default||Not reimbursed separately|9,211.57|FSC: 13; Default||External grouping not supported 80167756|EAP|CPT® 37218||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Stent Placement Open Or Perc Antegrade Carotid|1|HUMANA [1294]||HUMANA [11839]|10,119.30|FSC: 13; Default||Not reimbursed separately|10,119.30|FSC: 13; Default||External grouping not supported 80167767|EAP|CPT® 93260||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Prgrmg Dev Eval Implantable Subq Implantable Lead Defib System|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95169919|EAP|Custom 95169919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Stay Safe Luer |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169982|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Cantata Superselective|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95169983|EAP|Custom 95169983||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 6fr Multipack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169986|EAP|Custom 95169986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Compression 1.6mm 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169987|EAP|Custom 95169987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Compression 1.6mm 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate X Locking Extra Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,066.03|FSC: 13; Default||Not reimbursed separately|3,066.03|FSC: 13; Default||External grouping not supported 95169989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Tmt First|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|FSC: 13; Default||Not reimbursed separately|3,210.03|FSC: 13; Default||External grouping not supported 95169990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Ang|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95169998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannul Locking Var|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95169999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannul Locking Var|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|FSC: 13; Default||Not reimbursed separately|5,778.00|FSC: 13; Default||External grouping not supported 95170001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|FSC: 13; Default||Not reimbursed separately|5,778.00|FSC: 13; Default||External grouping not supported 95170002|EAP|Custom 95170002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Tip Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95170004|EAP|Custom 95170004||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 13mm Titanium|1|HUMANA [1294]||HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95170006|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guiding Xb Lad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170009|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170010|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170011|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170012|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170013|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170014|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170015|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170017|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170016|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rx Herculink Elite |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 80167778|EAP|CPT® 93261||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Interrogation Subq Defib|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95170019|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Graft Aneur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,125.00|FSC: 13; Default||Not reimbursed separately|43,125.00|FSC: 13; Default||External grouping not supported 95170020|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Graft Aneur|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,125.00|FSC: 13; Default||Not reimbursed separately|43,125.00|FSC: 13; Default||External grouping not supported 95170021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Cobalt 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|FSC: 13; Default||Not reimbursed separately|1,251.00|FSC: 13; Default||External grouping not supported 95170022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95170023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|FSC: 13; Default||Not reimbursed separately|3,033.00|FSC: 13; Default||External grouping not supported 95170024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|FSC: 13; Default||Not reimbursed separately|3,033.00|FSC: 13; Default||External grouping not supported 95170025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.5 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|FSC: 13; Default||Not reimbursed separately|3,033.00|FSC: 13; Default||External grouping not supported 95170026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 4.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|FSC: 13; Default||Not reimbursed separately|3,033.00|FSC: 13; Default||External grouping not supported 95170027|EAP|Custom 95170027||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross 36mm|1|HUMANA [1294]||HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95170028|EAP|Custom 95170028||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Cross 34mm|1|HUMANA [1294]||HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 95170029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95170382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Distal Lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95170383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95170384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5mmx26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95170385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle 3.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|FSC: 13; Default||Not reimbursed separately|72.00|FSC: 13; Default||External grouping not supported 95170386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mmx38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mmx42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95170389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Articular 15mm 2.5mmx5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170390|EAP|Custom 95170390||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Disposable Pin Drill Trim-it |1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95170391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Distal Femoral Triathlon Sz5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95170398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Micro Ft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95170399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Elite Atlantis 57.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|FSC: 13; Default||Not reimbursed separately|6,885.00|FSC: 13; Default||External grouping not supported 95170400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,314.00|FSC: 13; Default||Not reimbursed separately|1,314.00|FSC: 13; Default||External grouping not supported 95170401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mmx13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95170404|EAP|Custom 95170404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Justice Ozil |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162472|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Ipv Metaneb Initial Tx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 80162480|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Ipv Metaneb Subsequent Tx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95112652|EAP|Custom 95112652||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170405|EAP|Custom 95170405||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Peptamen Bariatic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170407|EAP|Custom 95170407||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Positive Airway Pressure |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170408|EAP|Custom 95170408||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95170409|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mmx56cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95170410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95170411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 6.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|FSC: 13; Default||Not reimbursed separately|4,026.00|FSC: 13; Default||External grouping not supported 95170414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick Deal New 4.3mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 95170415|EAP|Custom 95170415||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Tissue Trifecta 25mm|1|HUMANA [1294]||HUMANA [11839]|17,700.00|FSC: 13; Default||Not reimbursed separately|17,700.00|FSC: 13; Default||External grouping not supported 95170416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95170417|EAP|Custom 95170417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 6mm With Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170418|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Distal 18mmx195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|FSC: 13; Default||Not reimbursed separately|11,963.70|FSC: 13; Default||External grouping not supported 95170419|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95110708|EAP|Custom 95110708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.25mm Dia 150mm Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170423|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Delivery System Attain Select Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170424|EAP|Custom 95170424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Closure Absorbale Vloc Violet 3-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170425|EAP|Custom 95170425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Closure Wound Absorbable Vloc Undyed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Posterior 4 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95170427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plateral Posterior 6 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95170428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Posterior 8 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,747.00|FSC: 13; Default||Not reimbursed separately|6,747.00|FSC: 13; Default||External grouping not supported 95170429|EAP|Custom 95170429||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Syringes Dual Pack 20/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170434|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170435|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170438|EAP|Custom 95170438||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Crescent |1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95170439|EAP|Custom 95170439||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Splint Sof-stretch X-large 2-3/4 Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon T2 11x380 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,887.00|FSC: 13; Default||Not reimbursed separately|7,887.00|FSC: 13; Default||External grouping not supported 95170441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon T2 11x380 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,887.00|FSC: 13; Default||Not reimbursed separately|7,887.00|FSC: 13; Default||External grouping not supported 80167845|EAP|CPT® 93355||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo Transesophageal Tee|1|HUMANA [1294]||HUMANA [11839]|2,935.63|FSC: 13; Default||Not reimbursed separately|2,935.63|FSC: 13; Default||External grouping not supported 95170031|EAP|Custom 95170031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hp Triple Lumen 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167856|EAP|CPT® 93644||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Electrophysiology Eval Subq Impl Defib|1|HUMANA [1294]||HUMANA [11839]|2,299.99|FSC: 13; Default||Not reimbursed separately|2,299.99|FSC: 13; Default||External grouping not supported 95170038|EAP|Custom 95170038||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neurawrap 5mm X 4cm|1|HUMANA [1294]||HUMANA [11839]|4,713.00|FSC: 13; Default||Not reimbursed separately|4,713.00|FSC: 13; Default||External grouping not supported 80167867|EAP|HCPCS G0279||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Digital Breast Tomosynthesis Unil|1|HUMANA [1294]||HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95170039|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 6.0mm X 3cm|1|HUMANA [1294]||HUMANA [11839]|6,549.00|FSC: 13; Default||Not reimbursed separately|6,549.00|FSC: 13; Default||External grouping not supported 80167878|EAP|HCPCS G0279||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Digital Breast Tomosynthesis Bil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95170040|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Taper Short 440 Modular Abg Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 80167889|EAP|CPT® 77063||0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY|Hb Screen Digital Breast Tomosynthesis Bilat|1|HUMANA [1294]||HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95170054|EAP|Custom 95170054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Biopsy Ivas 10g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80167890|EAP|HCPCS G0279||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hb Diagnostic Digital Tomosysnthesis Unilat Or Bilat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95170058|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Replacement 20fr X 1cm Endovive Low Prof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80167901|EAP|CPT® 43180||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy Rigid Transoral|1|HUMANA [1294]||HUMANA [11839]|13,821.69|FSC: 13; Default||Not reimbursed separately|13,821.69|FSC: 13; Default||External grouping not supported 95170059|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Replacement 20fr X 1.5cm Endovive Low Prof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80167912|EAP|CPT® 44381||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ileoscopy Thru Stoma W Transendo Balloon Dilation|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95170060|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Replacement 20fr X 2cm Endovive Low Prof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80167923|EAP|CPT® 44384||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ileoscopy Thru Stoma W Place Of Stent|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 95170061|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Replacement 20fr X 2.5cm Endovive Low Prof|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80167945|EAP|CPT® 44402||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonscopy Thru Stoma W Stent Plcmt|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 95170062|EAP|Custom 95170062||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Li 12 X 11 X 26mm|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 80167934|EAP|CPT® 44401||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonscopy Thru Stoma W Ablation Of Tumor, Polyp Or Other Lesion|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170064|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Periprosthesis Axsos 5.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|FSC: 13; Default||Not reimbursed separately|542.16|FSC: 13; Default||External grouping not supported 80167956|EAP|CPT® 44403||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonscopy Thru Stoma W Mucosal Resection|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread 6.5mm X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|FSC: 13; Default||Not reimbursed separately|105.84|FSC: 13; Default||External grouping not supported 80167967|EAP|CPT® 44404||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonscopy Thru Stoma W Submucosal Inj|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170066|EAP|Custom 95170066||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seamguard Staple Line Reinforcement Material Bioabsorbable Echelon 60|1|HUMANA [1294]||HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 80167978|EAP|CPT® 44405||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Thru Stoma W Dilation|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170067|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Advantage Sling Transvaginal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|FSC: 13; Default||Not reimbursed separately|2,262.00|FSC: 13; Default||External grouping not supported 80167989|EAP|CPT® 44406||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Thru Stoma W Us|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170070|EAP|Custom 95170070||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Varibar Thin Honey 12/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169530|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Rn Service Intensity Add On Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95170071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95170072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 80167990|EAP|CPT® 44407||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Thru Stoma W Fna Bx|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5 X 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|FSC: 13; Default||Not reimbursed separately|1,134.00|FSC: 13; Default||External grouping not supported 80168001|EAP|CPT® 44408||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy Thru Stoma W Decompression|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95170076|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular Ii Abg N04 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 80168012|EAP|CPT® 45346||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Ablation|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170077|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bone Xpanse Small R 20mm X 5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 80168023|EAP|CPT® 45347||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Stent Plcmt|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 95170080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coupling Pinto Rod Mri Compact 3-4/5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,116.00|FSC: 13; Default||Not reimbursed separately|1,116.00|FSC: 13; Default||External grouping not supported 95170081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coupling Rod To Rod Mri Compact 5/5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,116.00|FSC: 13; Default||Not reimbursed separately|1,116.00|FSC: 13; Default||External grouping not supported 95170082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting Mri Compact 5mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.75|FSC: 13; Default||Not reimbursed separately|357.75|FSC: 13; Default||External grouping not supported 80168034|EAP|CPT® 45349||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Endo Mucosal Resection|1|HUMANA [1294]||HUMANA [11839]|6,679.80|FSC: 13; Default||Not reimbursed separately|6,679.80|FSC: 13; Default||External grouping not supported 95170083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex 3 X 80 20 Cont Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 80168045|EAP|CPT® 45350||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy W Band Ligation|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170084|EAP|Custom 95170084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Pt Gray 3.2mm X 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168056|EAP|CPT® 45388||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Ablation|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170085|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Ba 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,100.85|FSC: 13; Default||Not reimbursed separately|4,100.85|FSC: 13; Default||External grouping not supported 80168078|EAP|CPT® 45390||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Endo Resection|1|HUMANA [1294]||HUMANA [11839]|6,679.80|FSC: 13; Default||Not reimbursed separately|6,679.80|FSC: 13; Default||External grouping not supported 95170086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Mini Bio-comp With Needles W/2 Of Wire 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 80169541|EAP|HCPCS G0155||0561 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - VISIT CHARGE|Hb Lsw Service Intensity Add On Ea 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95170103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Cluster Hemispherical Tritanium B 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 80168067|EAP|CPT® 45389||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Stent Plcmt|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 95170110|EAP|Custom 95170110||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare Polypectomy Acusnare|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168089|EAP|CPT® 45393||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Decompression|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170112|EAP|Custom 95170112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Sure Link 10 Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168090|EAP|CPT® 45398||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Colonoscopy W Band Ligation|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170113|EAP|Custom 95170113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Chest Dry Suction Control Infant/pediatric In-line Pat Tube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168101|EAP|CPT® 45399||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Unlisted Procedure Colon|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 95170114|EAP|Custom 95170114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Lock Pericardiocentesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168112|EAP|CPT® 46601||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Diagnostic Anoscopy|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95170115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Lateral Proximal 8 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 80168123|EAP|CPT® 46607||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Diagnostic Anoscopy W Bx|1|HUMANA [1294]||HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95170116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95170117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 80168145|EAP|CPT® 77306||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Teletx Isodose Plan Simple 1 Or 2 Ports Incl Basic Dosimetry|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95170118|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal Ts 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|FSC: 13; Default||Not reimbursed separately|4,933.44|FSC: 13; Default||External grouping not supported 80168156|EAP|CPT® 77307||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Teletx Isodose Plan Complex Multi Areas Incl Basic Dosimetry|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95170119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 80168167|EAP|CPT® 77316||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Brachytx Isodose Simple 1 To 4 Sources Incl Basic Dosimetry|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95170121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 80168178|EAP|CPT® 77317||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Brachytx Isodose Intermed 5 To 10 Incl Basic Dosimetry|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95170122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|FSC: 13; Default||Not reimbursed separately|69.12|FSC: 13; Default||External grouping not supported 80168189|EAP|CPT® 77318||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Brachytx Isodose Complex Over 10 Incl Basic Dosimetry|1|HUMANA [1294]||HUMANA [11839]|955.05|FSC: 13; Default||Not reimbursed separately|955.05|FSC: 13; Default||External grouping not supported 95170125|EAP|Custom 95170125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Cervical Anterior Profile Zero 8mm|1|HUMANA [1294]||HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 80168190|EAP|CPT® 77385||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Imrt Incl Guidance And Tracking Simple|1|HUMANA [1294]||HUMANA [11839]|1,535.40|FSC: 13; Default||Not reimbursed separately|1,535.40|FSC: 13; Default||External grouping not supported 95170126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Zero-p 3 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 80168201|EAP|CPT® 77386||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Imrt Incl Guidance And Tracking Complex|1|HUMANA [1294]||HUMANA [11839]|1,535.40|FSC: 13; Default||Not reimbursed separately|1,535.40|FSC: 13; Default||External grouping not supported 95170127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Taper Short V40 Modular Ii Abg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 80168223|EAP|CPT® 97607||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Neg Press Wnd Tx Up To 50sq Cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 95170133|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 30 Degree 32mm B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95170134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Long V40 Modular Ii Abg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 80168230|EAP|CPT® 97608||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Neg Press Wnd Tx Over 50sq Cm|1|HUMANA [1294]||HUMANA [11839]|910.44|FSC: 13; Default||Not reimbursed separately|910.44|FSC: 13; Default||External grouping not supported 95170137|EAP|Custom 95170137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Silicone Hubless Round Blake 19fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183767|EAP|Custom 95183767||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170138|EAP|Custom 95170138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Silicone Hubless Round Blake 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183766|EAP|Custom 95183766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Bronchoscope Edge Olympus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170145|EAP|Custom 95170145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pak Sterile Ankle Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Decade 2hole Sz14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,431.00|FSC: 13; Default||Not reimbursed separately|13,431.00|FSC: 13; Default||External grouping not supported 95170146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Lateral Proximal Ts 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95183770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Beta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,495.00|FSC: 13; Default||Not reimbursed separately|3,495.00|FSC: 13; Default||External grouping not supported 95170147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95183769|EAP|Custom 95183769||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Wide 14x22x50mm Lordotic|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95170148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Ba 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,570.80|FSC: 13; Default||Not reimbursed separately|7,570.80|FSC: 13; Default||External grouping not supported 95183765|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix 035 Pta 6mm X 100mm X 130 Cm|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Asymmetric Triathlon X 3 A38 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95183771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Healicoil Regenesorb Suture Anchor 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.48|FSC: 13; Default||Not reimbursed separately|1,200.48|FSC: 13; Default||External grouping not supported 95170152|EAP|HCPCS L8509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Voice 20 Fr 8mm Advantage|1|HUMANA [1294]||HUMANA [11839]|941.70|FSC: 13; Default||Not reimbursed separately|941.70|FSC: 13; Default||External grouping not supported 95183777|EAP|Custom 95183777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Avaflex Curve Augmentation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117976|EAP|Custom 95117976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Mini Qc 2.4mm 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183780|EAP|Custom 95183780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium 1000 Flexiva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170154|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular Ii Abg N06 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95183775|EAP|Custom 95183775||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Avamax Bone Biopsy 13g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170155|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular Ii Abg N07 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95183781|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000306 Prime Grafix 2 X 3 Cm|1|HUMANA [1294]||HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95170156|EAP|Custom 95170156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill A0 Sterile Gamma 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183783|EAP|Custom 95183783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 50mm Precept|1|HUMANA [1294]||HUMANA [11839]|1,947.00|FSC: 13; Default||Not reimbursed separately|1,947.00|FSC: 13; Default||External grouping not supported 95170157|EAP|Custom 95170157||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Insole Orthotic Vasyli Custom Full Length Red Med|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183774|EAP|Custom 95183774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Avamax Trocar 11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170171|EAP|Custom 95170171||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Heel Guard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183773|EAP|Custom 95183773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Avamax Trocar 13g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Right 13mm X 380mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95183776|EAP|Custom 95183776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Avamax Bone Biopsy 11g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Thread Full 2.5 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95183772|EAP|Custom 95183772||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Iv Angiocath 14ga X 3.25"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/ Flatow 19mm X 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95183782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Precept 7.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95183778|EAP|Custom 95183778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium 365 Flexiva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183779|EAP|Custom 95183779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium 550 Flexiva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62063805|EAP|CPT® 87625||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Hpv Genotyping (16 & 18)|1|HUMANA [1294]||HUMANA [11839]|121.65|FSC: 13; Default||Not reimbursed separately|121.65|FSC: 13; Default||External grouping not supported 95111811|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Malecot 36fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170183|EAP|Custom 95170183||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xlr 14 X 34 X 24mm|1|HUMANA [1294]||HUMANA [11839]|13,956.00|FSC: 13; Default||Not reimbursed separately|13,956.00|FSC: 13; Default||External grouping not supported 95170184|EAP|Custom 95170184||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hbcage Brigade 12 X 42 X 30mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95183819|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon Sz 5-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hbrod Pre Bent 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95183790|EAP|Custom 95183790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle Suture Ideal 45 Degree Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95183787|EAP|Custom 95183787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Non-locking 2.5mm X 216mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170193|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice Pliable 6 X 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|74.13|FSC: 13; Default||Not reimbursed separately|74.13|FSC: 13; Default||External grouping not supported 95183789|EAP|HCPCS Q4133||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Matrix Ndc 59857000309 Prime Grafix 5x5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95170194|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 20cm X 30cm Firm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.36|FSC: 13; Default||Not reimbursed separately|79.36|FSC: 13; Default||External grouping not supported 95183791|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Extension Guidezilla 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170195|EAP|Custom 95170195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm Trim It|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Ps Triathlon Sz 1-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170196|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 20cm X 40cm Firm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.36|FSC: 13; Default||Not reimbursed separately|79.36|FSC: 13; Default||External grouping not supported 95183817|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 3-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170197|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 25cm X 40cm Firm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.36|FSC: 13; Default||Not reimbursed separately|79.36|FSC: 13; Default||External grouping not supported 95183824|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 7-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170198|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular 32mm Size-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95183807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial X 3 Ps Triathlon Sz 4 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170203|EAP|Custom 95170203||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist 1.4mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183812|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #2 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95170204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 5.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95183803|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triathlon Ps 19mm #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170205|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95183823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 7-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Distal 15 Hole Right Peri Prosthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|FSC: 13; Default||Not reimbursed separately|4,152.96|FSC: 13; Default||External grouping not supported 95183799|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Primary Cemented Triathlon Sz 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|FSC: 13; Default||Not reimbursed separately|6,272.70|FSC: 13; Default||External grouping not supported 95170207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95183797|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95170208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95183793|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|FSC: 13; Default||Not reimbursed separately|1,023.00|FSC: 13; Default||External grouping not supported 95170209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Ncb 5.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|FSC: 13; Default||Not reimbursed separately|425.19|FSC: 13; Default||External grouping not supported 95183784|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 10 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,370.00|FSC: 13; Default||Not reimbursed separately|2,370.00|FSC: 13; Default||External grouping not supported 95170210|EAP|Custom 95170210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Opticath Extra Port Flow Latex Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183821|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 6-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170213|EAP|Custom 95170213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Tissue High Viscosity Sure+close Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183810|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #8 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95170215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95183813|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #8 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95170216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixed 4.5mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95183805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triathlon Ps 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95183818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tbial Cs Triathlon X 3 Sz 4-19m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170218|EAP|Custom 95170218||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Optic Laser Mox4 Greenlight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 6-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Prostalac Size 1 Hi Offset 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 95183785|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent 18 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,211.89|FSC: 13; Default||Not reimbursed separately|3,211.89|FSC: 13; Default||External grouping not supported 95170221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 12mm X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95183808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Bearing Ps Triathlon X 3 Sz 6-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 12mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,492.88|FSC: 13; Default||Not reimbursed separately|5,492.88|FSC: 13; Default||External grouping not supported 95183811|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95170223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full 5.0mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95183814|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon Size 2-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full 5.0mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95183815|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon Size 2-16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|FSC: 13; Default||Not reimbursed separately|393.12|FSC: 13; Default||External grouping not supported 95183816|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon Size 2-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95191788|EAP|Custom 95191788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endo Gia Tri-staple 60mm Purple|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Use Multi Headless Charlotte Cannulated 7.0mm X 45mm X 16mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|FSC: 13; Default||Not reimbursed separately|2,754.00|FSC: 13; Default||External grouping not supported 95186672|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Gold Surgisis 8-ply W/o Perferations 8x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.00|FSC: 13; Default||Not reimbursed separately|5,940.00|FSC: 13; Default||External grouping not supported 95170234|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6mm Diameter X 40mm Length Usable Shaft Length 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186671|EAP|Custom 95186671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170235|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 7 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191791|EAP|Custom 95191791||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Arthroscopic Crossft Standard Knotless Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Kompressor 22mm Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.49|FSC: 13; Default||Not reimbursed separately|1,364.49|FSC: 13; Default||External grouping not supported 95186659|EAP|Custom 95186659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Firstpass St Suture Passer Self Capture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170246|EAP|Custom 95170246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.9mm X 6 .035|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Kompressor 20mm Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.49|FSC: 13; Default||Not reimbursed separately|1,364.49|FSC: 13; Default||External grouping not supported 95183820|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon X 3 Sz 6-13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Radius Aculoc Long Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95170251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon Ts 22mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95183806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triathlon Sz-2 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170252|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hbstent Ion Monorail 2.50 Mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triathlon Ps 16mm #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170257|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Triathlon #1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|FSC: 13; Default||Not reimbursed separately|15,976.80|FSC: 13; Default||External grouping not supported 95170258|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 4.00 Mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Ps Triathlon Sz 1-19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170259|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 2.50 Mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183792|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|FSC: 13; Default||Not reimbursed separately|1,023.00|FSC: 13; Default||External grouping not supported 95170260|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183794|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95170261|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 4.00 Mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95170262|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 2.50 Mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Medial Tibia Left 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|FSC: 13; Default||Not reimbursed separately|7,635.00|FSC: 13; Default||External grouping not supported 95170263|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.0 Mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95170264|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.50 Mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183795|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95170265|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 4.00 Mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183834|EAP|Custom 95183834||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle Suture Ideal 45 Dedree Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170266|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 2.50 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilizer Ts Total Sz 7 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|FSC: 13; Default||Not reimbursed separately|23,998.80|FSC: 13; Default||External grouping not supported 95170267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Atk2 Micro 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|FSC: 13; Default||Not reimbursed separately|1,920.00|FSC: 13; Default||External grouping not supported 95183827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 14mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95170268|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triathlon Sz 7 5mm Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95170269|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.50 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press Fit Triathlon Ts 25mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95170270|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 4.00 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183825|EAP|Custom 95183825||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Probe V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170271|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 2.50 Mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Posterior Femoral Triathlon Sz 7 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95170272|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 7 5mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95170273|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.50 Mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Standard Tibial T2 11mmx375mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95170274|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 4.00 Mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 2.4mm X 8mm Cortex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95170275|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 2.50 Mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183832|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tibial Triathlon Sz 7 5mm Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|FSC: 13; Default||Not reimbursed separately|3,956.40|FSC: 13; Default||External grouping not supported 95170276|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183836|EAP|Custom 95183836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ideal Grasper 30 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170277|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.50 Mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95170278|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 4.00 Mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183837|EAP|Custom 95183837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 5.5x75|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170279|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 2.50 Mm X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth 2.3mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95170280|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Narrow Right 8 Hole Extra Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,574.00|FSC: 13; Default||Not reimbursed separately|5,574.00|FSC: 13; Default||External grouping not supported 95170281|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.50 Mm X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183804|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathlon Ps 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170282|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.00 Mm X 38 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95170283|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ion Monorail 3.50 Mm X 38 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95183847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated Nexfix 3.0x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95170285|EAP|Custom 95170285||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Gel Arctic Sun Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183849|EAP|Custom 95183849||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Graft Stent Endurant Ii Limb Contralateral 16/20 X 15|1|HUMANA [1294]||HUMANA [11839]|19,200.00|FSC: 13; Default||Not reimbursed separately|19,200.00|FSC: 13; Default||External grouping not supported 95170286|EAP|Custom 95170286||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Gel Arctic Sun Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183858|EAP|HCPCS 95183858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170287|EAP|Custom 95170287||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Gel Arctic Sun Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183852|EAP|Custom 95183852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Oto-s Omniguide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170289|EAP|Custom 95170289||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pad Gel Arctic Sun Universal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 3.5 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95170290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 95183853|EAP|Custom 95183853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Sterile Omniguide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170291|EAP|Custom 95170291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon Endoscopic Powered 60mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183857|EAP|Custom 95183857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.45mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Short V40 Modular Iii Abg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95183851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Standard 28mm Size-e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95170293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalok Armed Dual 3.5mm W/orthocord #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,698.00|FSC: 13; Default||Not reimbursed separately|1,698.00|FSC: 13; Default||External grouping not supported 95183855|EAP|Custom 95183855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.2mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170294|EAP|Custom 95170294||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Precision 55cm|1|HUMANA [1294]||HUMANA [11839]|2,340.00|FSC: 13; Default||Not reimbursed separately|2,340.00|FSC: 13; Default||External grouping not supported 95183845|EAP|Custom 95183845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Xpeeda Dsl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170295|EAP|Custom 95170295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 3.2 X 400mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183844|EAP|Custom 95183844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Maxcore 18 Ga X 20 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon T2 11 X 340 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,887.00|FSC: 13; Default||Not reimbursed separately|7,887.00|FSC: 13; Default||External grouping not supported 95183850|EAP|Custom 95183850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Sentrunt 16 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170297|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 27mm Length X 135mm Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95183848|EAP|Custom 95183848||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Graft Stent Endurant Ii Bifurcated 36mm X 16mm X 166c|1|HUMANA [1294]||HUMANA [11839]|29,925.00|FSC: 13; Default||Not reimbursed separately|29,925.00|FSC: 13; Default||External grouping not supported 95170298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Single 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|FSC: 13; Default||Not reimbursed separately|939.00|FSC: 13; Default||External grouping not supported 95183856|EAP|Custom 95183856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head V40 Ceramic Delta Biolox 36mm +7.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|FSC: 13; Default||Not reimbursed separately|5,844.30|FSC: 13; Default||External grouping not supported 95186670|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95170301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Hole Cluster Hemispherical Tritanium G 62mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95183861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 04.0mm / L46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95170302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 0 Degree 36mm G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|FSC: 13; Default||Not reimbursed separately|5,980.80|FSC: 13; Default||External grouping not supported 95183865|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Fixed Bearing Ps Left 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95170303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mold Stem Hip 9 X 125mm W/reinforcement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,024.00|FSC: 13; Default||Not reimbursed separately|6,024.00|FSC: 13; Default||External grouping not supported 95183860|EAP|Custom 95183860||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Blanket Warming Underbody Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170304|EAP|Custom 95170304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Neck Hip Standard Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183862|EAP|Custom 95183862||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore34 Mm X 20 Cm|1|HUMANA [1294]||HUMANA [11839]|48,750.00|FSC: 13; Default||Not reimbursed separately|48,750.00|FSC: 13; Default||External grouping not supported 95170305|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Standard 28mm Size-d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95183864|EAP|Custom 95183864||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Limb Contralateral 16mm X 13.5cm|1|HUMANA [1294]||HUMANA [11839]|13,869.00|FSC: 13; Default||Not reimbursed separately|13,869.00|FSC: 13; Default||External grouping not supported 95170306|EAP|Custom 95170306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mold Head Hip With Insert 52mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183863|EAP|Custom 95183863||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 31mm X 14.5mm X 13cm|1|HUMANA [1294]||HUMANA [11839]|33,300.00|FSC: 13; Default||Not reimbursed separately|33,300.00|FSC: 13; Default||External grouping not supported 95170309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Universal C/m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|FSC: 13; Default||Not reimbursed separately|939.00|FSC: 13; Default||External grouping not supported 95183866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneus Step 7.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95170310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hbplug With Nozzle C/m 16mm & 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95183859|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Command|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Ulnar Small 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|FSC: 13; Default||Not reimbursed separately|11,400.00|FSC: 13; Default||External grouping not supported 95183867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire 2.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.00|FSC: 13; Default||Not reimbursed separately|459.00|FSC: 13; Default||External grouping not supported 95170312|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 74cm Flex Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95183885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6 Hole Bridge Left Superior|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|FSC: 13; Default||Not reimbursed separately|3,712.50|FSC: 13; Default||External grouping not supported 95170313|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 13mm X 56cm Flex Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 95183884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Template Mpfl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|FSC: 13; Default||Not reimbursed separately|1,185.00|FSC: 13; Default||External grouping not supported 95170228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Threaded 2.5mm X 230mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|FSC: 13; Default||Not reimbursed separately|60.00|FSC: 13; Default||External grouping not supported 95183882|EAP|Custom 95183882||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Percutaneous Chia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170229|EAP|Custom 95170229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 7.0mm Muc 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183887|EAP|Custom 95183887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Pin Red|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170230|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Bone Allograft Evans Allopure 12 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95183886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixator Mini 70/30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.60|FSC: 13; Default||Not reimbursed separately|270.60|FSC: 13; Default||External grouping not supported 95170231|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Bone Allograft Cotton Allopure 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|FSC: 13; Default||Not reimbursed separately|3,813.00|FSC: 13; Default||External grouping not supported 95183880|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 7mm Diameter X 17mm Length X 135mm Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95170232|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm 4cm X 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.69|FSC: 13; Default||Not reimbursed separately|88.69|FSC: 13; Default||External grouping not supported 95183881|EAP|Custom 95183881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Graft Stent Endurant Ii Limb Contralateral 16/20x156|1|HUMANA [1294]||HUMANA [11839]|19,200.00|FSC: 13; Default||Not reimbursed separately|19,200.00|FSC: 13; Default||External grouping not supported 95170322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95183883|EAP|Custom 95183883||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic 4.2 Ultrafrr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170323|EAP|Custom 95170323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Tunneling Eon, Ans|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183894|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Distal Bifurcated Main Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95170324|EAP|Custom 95170324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anchor Lock Swift|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183890|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Branch 4 Arch Aortic Woven Platinum Hemoshield 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,499.82|FSC: 13; Default||Not reimbursed separately|4,499.82|FSC: 13; Default||External grouping not supported 95170325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stabilized Posterior Scorpio 12mm Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,690.00|FSC: 13; Default||Not reimbursed separately|3,690.00|FSC: 13; Default||External grouping not supported 95183893|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95170326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 6 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|FSC: 13; Default||Not reimbursed separately|4,334.40|FSC: 13; Default||External grouping not supported 95183843|EAP|Custom 95183843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Needle Endocavity Sterile W/3.5 X 20cm Latex Cover|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 6 15mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95191794|EAP|Custom 95191794||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manipulator Endoscopic Koh-efficient Rumi Stainless St 2.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Knee Total Triathilon 12mm X 50m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|FSC: 13; Default||Not reimbursed separately|4,386.90|FSC: 13; Default||External grouping not supported 95183889|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Lipped Cs Medium 9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|FSC: 13; Default||Not reimbursed separately|3,693.90|FSC: 13; Default||External grouping not supported 95170329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon Ts 21mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|FSC: 13; Default||Not reimbursed separately|4,594.80|FSC: 13; Default||External grouping not supported 95183891|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Branch 4 Arch Aortic Woven Platinum 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,445.99|FSC: 13; Default||Not reimbursed separately|5,445.99|FSC: 13; Default||External grouping not supported 95170332|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 13mm X 74mm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 80168245|EAP|CPT® 77402||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Radiation Treatment Delivery, =1 Mev; Simple|1|HUMANA [1294]||HUMANA [11839]|349.65|FSC: 13; Default||Not reimbursed separately|349.65|FSC: 13; Default||External grouping not supported 95170333|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 74mm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 80168256|EAP|CPT® 77407||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Radiation Treatment Delivery, =1 Mev; Intermediate|1|HUMANA [1294]||HUMANA [11839]|673.50|FSC: 13; Default||Not reimbursed separately|673.50|FSC: 13; Default||External grouping not supported 95170335|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mm X 56cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 80168267|EAP|CPT® 77412||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Radiation Treatment Delivery, =1 Mev; Complex|1|HUMANA [1294]||HUMANA [11839]|673.50|FSC: 13; Default||Not reimbursed separately|673.50|FSC: 13; Default||External grouping not supported 95170336|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 56cm Flex Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 95186658|EAP|Custom 95186658||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cup Size 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170337|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mm X 74mm Flex Zenith|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95170331|EAP|Custom 95170331||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 3.5mm X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95170341|EAP|Custom 95170341||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Accessory Disposable 4 Arm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191795|EAP|Custom 95191795||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manipulator Endoscopic Koh-efficient Rumi Stainless St 3.0cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186656|EAP|Custom 95186656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cup Size 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Primary Turon Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|FSC: 13; Default||Not reimbursed separately|8,640.00|FSC: 13; Default||External grouping not supported 95186665|EAP|Custom 95186665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Cap Cta Global 2.4x42mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95191796|EAP|Custom 95191796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manipulator Endoscopic Koh-efficient Rumi Stainless St 4.0cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170349|EAP|Custom 95170349||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Crosslink Small|1|HUMANA [1294]||HUMANA [11839]|4,163.04|FSC: 13; Default||Not reimbursed separately|4,163.04|FSC: 13; Default||External grouping not supported 95186660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm 130 Deg 380mm/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95170351|EAP|Custom 95170351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Profile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mm Lcp 4-hole 12 Depth 44mm/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,241.45|FSC: 13; Default||Not reimbursed separately|2,241.45|FSC: 13; Default||External grouping not supported 95186657|EAP|Custom 95186657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pessary Cup Size 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aculoc Standard Right Vdr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95170334|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mm X 90cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95170354|EAP|Custom 95170354||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Interbody Crescent|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95170355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Drill Frag-loc 2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|531.00|FSC: 13; Default||Not reimbursed separately|531.00|FSC: 13; Default||External grouping not supported 95170356|EAP|Custom 95170356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Compression Frag-loc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186677|EAP|Custom 95186677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ultratape 2mm Blue 38 Pkg Of 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Frag-loc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|FSC: 13; Default||Not reimbursed separately|321.00|FSC: 13; Default||External grouping not supported 95170358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95186676|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Hernia Gold Surgisis 8-ply W/o Perfs 8 X 20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.00|FSC: 13; Default||Not reimbursed separately|5,940.00|FSC: 13; Default||External grouping not supported 95170360|EAP|Custom 95170360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Galil Icerod Multipack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170361|EAP|Custom 95170361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Galil Icerod Plus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170367|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Psi With Integral Hemostasis Valve Side Port For Use With 9.0 Fr Catheters|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191789|EAP|Custom 95191789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Tri-staple 2.0 Purple 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170368|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Total Abscession 6.5f X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170369|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainage Total Abscession 12f X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170340|EAP|Custom 95170340||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Envelope Pacemaker Antibacterial Aigis Rx|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95170373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|FSC: 13; Default||Not reimbursed separately|4,247.43|FSC: 13; Default||External grouping not supported 95170374|EAP|Custom 95170374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nebulizer With Circiut Meta-neb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186699|EAP|Custom 95186699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoclip Otsc 12/6a 220cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170375|EAP|Custom 95170375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Interlock Diamond 8mm X 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191790|EAP|Custom 95191790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Tri-staple 2.0 Black 60 Latex Free|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170376|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 15mm X 120mm Heprin Bioactive Surface|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|FSC: 13; Default||Not reimbursed separately|11,970.00|FSC: 13; Default||External grouping not supported 95186691|EAP|Custom 95186691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Scorpion Knee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170377|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 6mm X 15mm X 120mm Heprin Bioactive Surface|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|FSC: 13; Default||Not reimbursed separately|11,970.00|FSC: 13; Default||External grouping not supported 95170378|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 5mm X 120mm Heprin Bioactive Surface|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,649.00|FSC: 13; Default||Not reimbursed separately|8,649.00|FSC: 13; Default||External grouping not supported 95186704|EAP|Custom 95186704||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cancellous Dowel Plug Size 9|1|HUMANA [1294]||HUMANA [11839]|1,192.56|FSC: 13; Default||Not reimbursed separately|1,192.56|FSC: 13; Default||External grouping not supported 95170379|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 5mm X 120mm Heprin Bioactive Surface|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,065.00|FSC: 13; Default||Not reimbursed separately|10,065.00|FSC: 13; Default||External grouping not supported 95191799|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prochondrix 20mm X 1.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,834.00|FSC: 13; Default||Not reimbursed separately|12,834.00|FSC: 13; Default||External grouping not supported 95170380|EAP|Custom 95170380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Type S Thermoplastic Neck And Shoulder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169869|EAP|Custom 95169869||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sol Dianeal 1.5% Dextrose Low Calcium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186706|EAP|Custom 95186706||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cancellous Dowel Plug Size 11|1|HUMANA [1294]||HUMANA [11839]|1,192.56|FSC: 13; Default||Not reimbursed separately|1,192.56|FSC: 13; Default||External grouping not supported 95186702|EAP|Custom 95186702||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cancellous Dowel Plug Size 7|1|HUMANA [1294]||HUMANA [11839]|1,192.56|FSC: 13; Default||Not reimbursed separately|1,192.56|FSC: 13; Default||External grouping not supported 95160888|EAP|Custom 95160888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Point Guard Clear 2.5cm Circle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170443|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 24.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170444|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 19.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170445|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Icast 5mmx22x80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95170446|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 8.0x20x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170447|EAP|Custom 95170447||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coil Embolization .035 Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Pinnacle Gription|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|FSC: 13; Default||Not reimbursed separately|8,769.60|FSC: 13; Default||External grouping not supported 95170468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Rt 11mmx400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|FSC: 13; Default||Not reimbursed separately|6,009.12|FSC: 13; Default||External grouping not supported 95170469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Left Long 13x400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95170470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.00|FSC: 13; Default||Not reimbursed separately|1,611.00|FSC: 13; Default||External grouping not supported 95170471|EAP|Custom 95170471||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 9x11x26mm|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95170472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting Mri Compact 5mmx200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.75|FSC: 13; Default||Not reimbursed separately|357.75|FSC: 13; Default||External grouping not supported 95170473|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Half Apex 4x120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|FSC: 13; Default||Not reimbursed separately|371.25|FSC: 13; Default||External grouping not supported 95170474|EAP|Custom 95170474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Pt Gray 2.2mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170453|EAP|Custom 95170453||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 11x11x32mm|1|HUMANA [1294]||HUMANA [11839]|10,986.00|FSC: 13; Default||Not reimbursed separately|10,986.00|FSC: 13; Default||External grouping not supported 95170455|EAP|Custom 95170455||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Small 7x14x11mm|1|HUMANA [1294]||HUMANA [11839]|2,913.00|FSC: 13; Default||Not reimbursed separately|2,913.00|FSC: 13; Default||External grouping not supported 95170457|EAP|Custom 95170457||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stocking Thigh 361 Bariatric |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170458|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 6-8mm 5.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170459|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Replacement 20fr X 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp Curved 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,414.52|FSC: 13; Default||Not reimbursed separately|5,414.52|FSC: 13; Default||External grouping not supported 95170461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|556.83|FSC: 13; Default||Not reimbursed separately|556.83|FSC: 13; Default||External grouping not supported 95170464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95170466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking 5.0x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|733.11|FSC: 13; Default||Not reimbursed separately|733.11|FSC: 13; Default||External grouping not supported 95170055|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170056|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 13.0 Diopter Acrysof Toric |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170187|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170188|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170189|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 29.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170190|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.5 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170201|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 28.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170253|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.o Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170254|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170255|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170256|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 21.5 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170475|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95170476|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Biliary Protege Gps Self Expanding|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 62060801|EAP|CPT® 86960||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Volume Reduct Blood/prod|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62060819|EAP|HCPCS P9059||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Plasma 5 Day|1|HUMANA [1294]||HUMANA [11839]|227.73|FSC: 13; Default||Not reimbursed separately|227.73|FSC: 13; Default||External grouping not supported 62060827|EAP|CPT® 84153||0301 - LABORATORY - CHEMISTRY|Hb Psa Total - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|55.17|FSC: 13; Default||Not reimbursed separately|55.17|FSC: 13; Default||External grouping not supported 62060835|EAP|CPT® 88304||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Ap Bill Tc Only Surg Path Level Iii|1|HUMANA [1294]||HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62060843|EAP|CPT® 88307||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Ap Bill Tc Only Surg Path Level V|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62060850|EAP|CPT® 88361||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Morphometric Ihc, Computer|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62060918|EAP|CPT® 88381||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Kras 88381 -clarient|1|HUMANA [1294]||HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95170403|EAP|Custom 95170403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ocular Plastic Sterile Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170477|EAP|Custom 95170477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 2.8mm Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170478|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 18.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170483|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Attain 4fr To Lft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62060983|EAP|CPT® 88381||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Egfr 88381 -clarient|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 62061163|EAP|CPT® 88381||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Braf 88381 -clarient|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 62061171|EAP|CPT® 88342||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Msi By Ihc - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95167948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Znn-cm 13mmx46cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|FSC: 13; Default||Not reimbursed separately|6,387.66|FSC: 13; Default||External grouping not supported 95170486|EAP|Custom 95170486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Collection Cell Paker Vitagel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170490|EAP|Custom 95170490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hemostat Surgical 4.5ml Vitagel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170491|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 50cm 3-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|FSC: 13; Default||Not reimbursed separately|6,097.50|FSC: 13; Default||External grouping not supported 95170492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Taper 6 Degrees |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.50|FSC: 13; Default||Not reimbursed separately|2,593.50|FSC: 13; Default||External grouping not supported 95170493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hat Top Latarjet 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95170494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hat Top Latarjet 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|FSC: 13; Default||Not reimbursed separately|1,104.00|FSC: 13; Default||External grouping not supported 95170495|EAP|Custom 95170495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Latarjet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170496|EAP|Custom 95170496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Short Caracoid Latarjet|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170499|EAP|Custom 95170499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mask Type S Thermoplastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170500|EAP|Custom 95170500||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Envelope Pacemaker Antibacterial Aigis|1|HUMANA [1294]||HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95170501|EAP|Custom 95170501||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Envelope Pacemaker Antibacterial Aigis |1|HUMANA [1294]||HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95170502|EAP|Custom 95170502||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repair Syndesmosis Tightrope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170503|EAP|Custom 95170503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Stimulation Dynamic Activator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191807|EAP|Custom 95191807||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Solid Measuring Long 2.4 X 140mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170504|EAP|Custom 95170504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Module Needle Emg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Dual 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|FSC: 13; Default||Not reimbursed separately|3,462.00|FSC: 13; Default||External grouping not supported 95170506|EAP|Custom 95170506||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 10x11x32mm|1|HUMANA [1294]||HUMANA [11839]|10,986.00|FSC: 13; Default||Not reimbursed separately|10,986.00|FSC: 13; Default||External grouping not supported 95170507|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|FSC: 13; Default||Not reimbursed separately|4,387.50|FSC: 13; Default||External grouping not supported 95170508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95170510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coupling Rod To Pin Mri 4-5/8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,766.88|FSC: 13; Default||Not reimbursed separately|1,766.88|FSC: 13; Default||External grouping not supported 95170512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Curved Semi Circular 8x174mm Mri Safe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95170513|EAP|Custom 95170513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cap Tip Protective White 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170514|EAP|Custom 95170514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Capt Tip Proctective Blue 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fusion Acutrak 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95170516|EAP|Custom 95170516||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .062x6 Acutrak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170517|EAP|Custom 95170517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Screw 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170518|EAP|Custom 95170518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.5mm X 96mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170521|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95170523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,770.92|FSC: 13; Default||Not reimbursed separately|5,770.92|FSC: 13; Default||External grouping not supported 95170524|EAP|Custom 95170524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Connecting Mri Compact 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|FSC: 13; Default||Not reimbursed separately|4,933.44|FSC: 13; Default||External grouping not supported 95170526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 5.0mm L50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|FSC: 13; Default||Not reimbursed separately|423.36|FSC: 13; Default||External grouping not supported 95170527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|FSC: 13; Default||Not reimbursed separately|105.84|FSC: 13; Default||External grouping not supported 95186701|EAP|Custom 95186701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patch Wittmann|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170534|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endopyelotomy Plus Retromax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.70|FSC: 13; Default||Not reimbursed separately|572.70|FSC: 13; Default||External grouping not supported 95170535|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Endopyelotomy Plus Retromax|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.70|FSC: 13; Default||Not reimbursed separately|572.70|FSC: 13; Default||External grouping not supported 95170536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.96|FSC: 13; Default||Not reimbursed separately|552.96|FSC: 13; Default||External grouping not supported 95170538|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Itotal Conformis 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95170539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Condylar 1.5mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,782.03|FSC: 13; Default||Not reimbursed separately|1,782.03|FSC: 13; Default||External grouping not supported 95170540|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Short V40 Modular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95170541|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95170542|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95170543|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Knee Rt Cr Conformis |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,497.00|FSC: 13; Default||Not reimbursed separately|19,497.00|FSC: 13; Default||External grouping not supported 95170544|EAP|Custom 95170544||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump Set Impella Aic 2.5 |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170545|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella Itotal Conformis 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95170546|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Implant Knee Left Cr Conformis Itotal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,497.00|FSC: 13; Default||Not reimbursed separately|19,497.00|FSC: 13; Default||External grouping not supported 95170548|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Breast |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95170549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Supracondylar T2 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95170550|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 13mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95170551|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 16mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 95170552|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 20mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|FSC: 13; Default||Not reimbursed separately|9,600.57|FSC: 13; Default||External grouping not supported 95170553|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.0 Diopter Acrysof Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170554|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mmx90cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95170555|EAP|Custom 95170555||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Supplement Peptamen W/prebio|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186689|EAP|Custom 95186689||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Morcellator Piranha Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170561|EAP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Protection Embolic |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170562|EAP|Custom 95170562||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 12 X 38 X 28mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95170563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|FSC: 13; Default||Not reimbursed separately|1,251.00|FSC: 13; Default||External grouping not supported 95170565|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170566|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170569|EAP|Custom 95170569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Never Touch Kit Sub Pk-02|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95145621|EAP|Custom 95145621||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Lumbar Full Without Strap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170574|EAP|Custom 95170574||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sclera Tissue(processing Fee)|1|HUMANA [1294]||HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95170575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Kit Arthrosurface Pf Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|FSC: 13; Default||Not reimbursed separately|567.00|FSC: 13; Default||External grouping not supported 95170576|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dome Patella Hemicap 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,064.00|FSC: 13; Default||Not reimbursed separately|2,064.00|FSC: 13; Default||External grouping not supported 95170577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Trochlea |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,635.00|FSC: 13; Default||Not reimbursed separately|16,635.00|FSC: 13; Default||External grouping not supported 95170578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post Taper 11mm Resurfacing Hemicap|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,851.00|FSC: 13; Default||Not reimbursed separately|1,851.00|FSC: 13; Default||External grouping not supported 95170579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augument Distal Femoral Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95170581|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Stabilizer Total |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95170582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95170583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95170586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Head Radial Evolves Sz|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,816.00|FSC: 13; Default||Not reimbursed separately|3,816.00|FSC: 13; Default||External grouping not supported 95170587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cortical 2.7mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95170588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cortical 2.7mmx22mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95191808|EAP|Custom 95191808||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Ao 2.6 X 130mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170592|EAP|Custom 95170592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Target Pathfinder Tip Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170593|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Biocomposite Ft |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95170595|EAP|Custom 95170595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm X-fuse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170596|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant X-fuse Arthro Ipj Hallux |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,307.50|FSC: 13; Default||Not reimbursed separately|3,307.50|FSC: 13; Default||External grouping not supported 95170597|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant X-fuse Arthro Ipj Hallux|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,307.50|FSC: 13; Default||Not reimbursed separately|3,307.50|FSC: 13; Default||External grouping not supported 95170598|EAP|Custom 95170598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Extremity X-fuse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111258|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ureteral Cone Tip 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Micro Qa 3-0 Orthocord |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,683.00|FSC: 13; Default||Not reimbursed separately|1,683.00|FSC: 13; Default||External grouping not supported 95170613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tenodesis Biocomposite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95170622|EAP|Custom 95170622||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Cath Passive Cranial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170623|EAP|Custom 95170623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Root Aortic With Vent Line|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170624|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Dilatation Nc Trek 2.5mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170625|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Dilatation Nc Trek 3.0mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 75mm Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95170627|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 50mmx22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95170628|EAP|Custom 95170628||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Cement Clearcut Encore|1|HUMANA [1294]||HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95170629|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Conical Cannulated 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.87|FSC: 13; Default||Not reimbursed separately|276.87|FSC: 13; Default||External grouping not supported 95170630|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Offset Bigliani/flatow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95170631|EAP|Custom 95170631||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 16mmx38mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95170632|EAP|Custom 95170632||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14mmx38mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95170633|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 7.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95170634|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Armada Poly 7.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|FSC: 13; Default||Not reimbursed separately|3,870.00|FSC: 13; Default||External grouping not supported 95170635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|FSC: 13; Default||Not reimbursed separately|876.00|FSC: 13; Default||External grouping not supported 95170636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|FSC: 13; Default||Not reimbursed separately|1,326.00|FSC: 13; Default||External grouping not supported 95170584|EAP|Custom 95170584||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tuohy Contiplex 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170585|EAP|Custom 95170585||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tuohy Contiplex 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95170642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 62061239|EAP|CPT® 86022||0302 - LABORATORY - IMMUNOLOGY|Hb Sra, Unfractionated Heparin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 62061247|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hb Alpha Subunit Pgh - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62061254|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Buprenorphine And Metabolites, Serum - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061262|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Buprenorphine And Metabolites, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061270|EAP|CPT® 80299||0301 - LABORATORY - CHEMISTRY|Hb Dexamethasone - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 62061288|EAP|CPT® 86337||0302 - LABORATORY - IMMUNOLOGY|Hb Insulin Antibody - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|64.23|FSC: 13; Default||Not reimbursed separately|64.23|FSC: 13; Default||External grouping not supported 62061296|EAP|CPT® 86341||0302 - LABORATORY - IMMUNOLOGY|Hb Islet Cell Antibody, Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|70.71|FSC: 13; Default||Not reimbursed separately|70.71|FSC: 13; Default||External grouping not supported 62061304|EAP|CPT® 84206||0301 - LABORATORY - CHEMISTRY|Hb Proinsulin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|80.07|FSC: 13; Default||Not reimbursed separately|80.07|FSC: 13; Default||External grouping not supported 62061312|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Sulfonylurea Hypoglycemics Panel, Blood - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061320|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Sulfonylurea Hypoglycemics, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061338|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Ethyl Glucuronide, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62061346|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Ethyl Glucuronide Urine Confirmation - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 80162498|EAP|CPT® 47460||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Transduodenal Sphincterotomy Or Sphincterplasty|1|HUMANA [1294]||HUMANA [11839]|3,187.85|FSC: 13; Default||Not reimbursed separately|3,187.85|FSC: 13; Default||External grouping not supported 95164924|EAP|Custom 95164924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Mandrels Pop On Soflex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170033|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Radial For Us Scope 20/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170034|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Radial For Us Scope 20/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95170656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 10-hole 79mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95170657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95170662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fix Quick Deal New 4.3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 95170663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aculoc Narrow Left Vdr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95170664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.00|FSC: 13; Default||Not reimbursed separately|234.00|FSC: 13; Default||External grouping not supported 95170665|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bearing Tibial Ps 18mmx71/75 Vanguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|FSC: 13; Default||Not reimbursed separately|2,565.00|FSC: 13; Default||External grouping not supported 95170666|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 11mmx90cm Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95170667|EAP|Custom 95170667||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Bengal Size 6 Std|1|HUMANA [1294]||HUMANA [11839]|4,291.56|FSC: 13; Default||Not reimbursed separately|4,291.56|FSC: 13; Default||External grouping not supported 95170668|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Straight 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|FSC: 13; Default||Not reimbursed separately|882.00|FSC: 13; Default||External grouping not supported 95170669|EAP|Custom 95170669||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sis Solyx|1|HUMANA [1294]||HUMANA [11839]|3,935.40|FSC: 13; Default||Not reimbursed separately|3,935.40|FSC: 13; Default||External grouping not supported 95170670|EAP|Custom 95170670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon Endoscopic Powered |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186692|EAP|Custom 95186692||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Anchor Otsc 220cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186705|EAP|Custom 95186705||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cancellous Dowel Plug Size 10|1|HUMANA [1294]||HUMANA [11839]|1,192.56|FSC: 13; Default||Not reimbursed separately|1,192.56|FSC: 13; Default||External grouping not supported 95191809|EAP|Custom 95191809||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Threaded 1.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186698|EAP|Custom 95186698||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endoclip Otsc 12/6a 165cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95117309|EAP|Custom 95117309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath 5fr X 100cm Length 3 Drc Infiniti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170673|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 8-10mm 5.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170674|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 10-12mm 5.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170675|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 3.0 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170676|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 3.0 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170677|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 2.5 X 33 |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170678|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 2.5 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170679|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 3.5 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170680|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 3.5 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170681|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 4.0 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170682|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Prime 4.0 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|FSC: 13; Default||Not reimbursed separately|4,650.00|FSC: 13; Default||External grouping not supported 95170683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic Va Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|830.82|FSC: 13; Default||Not reimbursed separately|830.82|FSC: 13; Default||External grouping not supported 95170698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic Va Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|830.82|FSC: 13; Default||Not reimbursed separately|830.82|FSC: 13; Default||External grouping not supported 95170699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic Va Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|830.82|FSC: 13; Default||Not reimbursed separately|830.82|FSC: 13; Default||External grouping not supported 95170700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic Va Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|830.82|FSC: 13; Default||Not reimbursed separately|830.82|FSC: 13; Default||External grouping not supported 95170701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Periprosthetic Va Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|830.82|FSC: 13; Default||Not reimbursed separately|830.82|FSC: 13; Default||External grouping not supported 95170702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.41|FSC: 13; Default||Not reimbursed separately|592.41|FSC: 13; Default||External grouping not supported 95170703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp Curved 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,414.52|FSC: 13; Default||Not reimbursed separately|5,414.52|FSC: 13; Default||External grouping not supported 95170704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp Curved 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.72|FSC: 13; Default||Not reimbursed separately|5,520.72|FSC: 13; Default||External grouping not supported 95170705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp Curved 4.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.72|FSC: 13; Default||Not reimbursed separately|5,520.72|FSC: 13; Default||External grouping not supported 95170706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.39|FSC: 13; Default||Not reimbursed separately|5,898.39|FSC: 13; Default||External grouping not supported 95170707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.39|FSC: 13; Default||Not reimbursed separately|5,898.39|FSC: 13; Default||External grouping not supported 95170708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,294.93|FSC: 13; Default||Not reimbursed separately|6,294.93|FSC: 13; Default||External grouping not supported 95170709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,294.93|FSC: 13; Default||Not reimbursed separately|6,294.93|FSC: 13; Default||External grouping not supported 95170710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,417.63|FSC: 13; Default||Not reimbursed separately|6,417.63|FSC: 13; Default||External grouping not supported 95170711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,417.63|FSC: 13; Default||Not reimbursed separately|6,417.63|FSC: 13; Default||External grouping not supported 95170712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.38|FSC: 13; Default||Not reimbursed separately|6,835.38|FSC: 13; Default||External grouping not supported 95170713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Curved Lcp Variable Angle 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.38|FSC: 13; Default||Not reimbursed separately|6,835.38|FSC: 13; Default||External grouping not supported 95170714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170715|EAP|Custom 95170715||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Roll Lumbar Soft 4-1/2x11|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170723|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 80162506|EAP|CPT® 15100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB SPLIT THICKNESS AUTOGRAFT FIRST|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 95170462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|556.83|FSC: 13; Default||Not reimbursed separately|556.83|FSC: 13; Default||External grouping not supported 95170726|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|FSC: 13; Default||Not reimbursed separately|1,059.00|FSC: 13; Default||External grouping not supported 95170728|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Locking Variable Angle 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.47|FSC: 13; Default||Not reimbursed separately|802.47|FSC: 13; Default||External grouping not supported 95170729|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 6.5x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|FSC: 13; Default||Not reimbursed separately|850.50|FSC: 13; Default||External grouping not supported 95170730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.3mmx16mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95170731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wedge Opening Low Profile 5.5mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Corkscrew Mini Ft 2-0 Fiberwire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95170735|EAP|Custom 95170735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Extraction Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Gamma Long Rt 15mm X 340mm X 125 Degrees|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|FSC: 13; Default||Not reimbursed separately|6,393.60|FSC: 13; Default||External grouping not supported 95170737|EAP|Custom 95170737||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitue Graft Bone Bioactive Foam Pack|1|HUMANA [1294]||HUMANA [11839]|9,954.63|FSC: 13; Default||Not reimbursed separately|9,954.63|FSC: 13; Default||External grouping not supported 95170738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Aculoc Standard Proximal Left Vdr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95170740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Peg 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.00|FSC: 13; Default||Not reimbursed separately|234.00|FSC: 13; Default||External grouping not supported 95170741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Neuro Low Profile Ti Straight 4 Hole 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95170742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Standard 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95170743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Neuro Low Profile Ti Orbital Rim |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|FSC: 13; Default||Not reimbursed separately|987.00|FSC: 13; Default||External grouping not supported 95170744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Neuro Low Profile Ti Double Y 6-hole 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|FSC: 13; Default||Not reimbursed separately|813.00|FSC: 13; Default||External grouping not supported 95170745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Mandible Large Ti 20-hole 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,246.00|FSC: 13; Default||Not reimbursed separately|3,246.00|FSC: 13; Default||External grouping not supported 95170746|EAP|Custom 95170746||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filling Temporary Powder Refill 25g Bottle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170747|EAP|Custom 95170747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filling Temporary Liquid Refill 14ml Bottle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.0mm Self Tapping 10mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|FSC: 13; Default||Not reimbursed separately|385.20|FSC: 13; Default||External grouping not supported 95170749|EAP|Custom 95170749||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Dam Ivory Rubber Stainless Steel #12a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170750|EAP|Custom 95170750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Dam Ivory Rubber Stainless Steel #13a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.0mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|FSC: 13; Default||Not reimbursed separately|385.20|FSC: 13; Default||External grouping not supported 95170752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti 2.0mm Self Tapping |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|FSC: 13; Default||Not reimbursed separately|385.20|FSC: 13; Default||External grouping not supported 95170753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Neuro Low Profile Self Drilling 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.50|FSC: 13; Default||Not reimbursed separately|262.50|FSC: 13; Default||External grouping not supported 95170754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Milagro 9mm X30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.00|FSC: 13; Default||Not reimbursed separately|1,170.00|FSC: 13; Default||External grouping not supported 95170755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95170756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95170757|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95170758|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95170759|EAP|Custom 95170759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 1.4x150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170760|EAP|Custom 95170760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Asnis Iii 4.0mm|1|HUMANA [1294]||HUMANA [11839]|94.50|FSC: 13; Default||Not reimbursed separately|94.50|FSC: 13; Default||External grouping not supported 95170761|EAP|Custom 95170761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack 3/8 A/v Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170762|EAP|Custom 95170762||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Shunt Dlp Emergency (5kits Per Pack)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170763|EAP|Custom 95170763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Radial Non Latex For U/s Scope 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110475|EAP|Custom 95110475||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Knee Beaver #94 Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95118465|EAP|Custom 95118465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Meniscus 95|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170769|EAP|Custom 95170769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scissor Valve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170776|EAP|Custom 95170776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tak-bb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170777|EAP|Custom 95170777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lasso Suture Banana Curved Handle Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170778|EAP|Custom 95170778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 10mm X 34mm X24mm|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95112649|EAP|Custom 95112649||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove 32mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95112650|EAP|Custom 95112650||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove 34mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95112651|EAP|Custom 95112651||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove 36mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95112655|EAP|Custom 95112655||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove 28mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95112654|EAP|Custom 95112654||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove 26mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95112656|EAP|Custom 95112656||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Cosgrove 30mm|1|HUMANA [1294]||HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170782|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Delivery Endoprosthesis Left Trunk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|FSC: 13; Default||Not reimbursed separately|30,735.00|FSC: 13; Default||External grouping not supported 95170783|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dry Seal 20fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170784|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Extender Aortic |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95170785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 4.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95170786|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 4.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95170787|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Legacy Axial Multi 5.0 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|FSC: 13; Default||Not reimbursed separately|4,709.88|FSC: 13; Default||External grouping not supported 95170788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Backsolid Hemispherical Tritanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95170789|EAP|Custom 95170789||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tak-bb Threaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,093.34|FSC: 13; Default||Not reimbursed separately|11,093.34|FSC: 13; Default||External grouping not supported 95170791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Pca 28mm +0 Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|FSC: 13; Default||Not reimbursed separately|2,832.90|FSC: 13; Default||External grouping not supported 95170793|EAP|Custom 95170793||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170794|EAP|Custom 95170794||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170796|EAP|Custom 95170796||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170797|EAP|Custom 95170797||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170798|EAP|Custom 95170798||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170799|EAP|Custom 95170799||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170800|EAP|Custom 95170800||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170801|EAP|Custom 95170801||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Carpentier Edwards Physio|1|HUMANA [1294]||HUMANA [11839]|8,985.00|FSC: 13; Default||Not reimbursed separately|8,985.00|FSC: 13; Default||External grouping not supported 95170805|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 9.0x40x80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186690|EAP|Custom 95186690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Extraction Contained Alexis 12mm X 100mm W/kbbt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170806|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6x80x135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170809|EAP|Custom 95170809||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Aortic Pericardial |1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95170810|EAP|Custom 95170810||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Aortic Pericardial|1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95170811|EAP|Custom 95170811||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Aortic Pericardial|1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95170812|EAP|Custom 95170812||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Aortic Pericardial|1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95170813|EAP|Custom 95170813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Aortic Pericardial|1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 95170814|EAP|Custom 95170814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter Aspiration|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170808|EAP|Custom 95170808||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Tendon Tibial Posterior|1|HUMANA [1294]||HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95170826|EAP|Custom 95170826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Wildcat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170827|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Back Solid Hemispherical Tritanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|FSC: 13; Default||Not reimbursed separately|8,043.00|FSC: 13; Default||External grouping not supported 95170828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Long V40 Modular Ii Abg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95170830|EAP|Custom 95170830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Eus Echo Tip Procore 19 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170831|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular Ii Abg No8 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95170832|EAP|Custom 95170832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Tracheal Tube 10fr 70mm Straight Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62061353|EAP|CPT® 82175||0301 - LABORATORY - CHEMISTRY|Hb Arsenic, Fractionated, Urine - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.91|FSC: 13; Default||Not reimbursed separately|56.91|FSC: 13; Default||External grouping not supported 62061361|EAP|CPT® 82533||0301 - LABORATORY - CHEMISTRY|Hb Cortisol - 60 Minute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.90|FSC: 13; Default||Not reimbursed separately|48.90|FSC: 13; Default||External grouping not supported 62061478|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Amphetamine Confirmation, Meconium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061486|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Barbiturate Confirmation, Meconium - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061494|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Benzodiazepines Confirmation, Meconium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061502|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cannabinoid Confirmation, Meconium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061510|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cocaine Confirmation, Meconium - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061528|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Methadone Confirmation, Meconium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061536|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Opiate Confirmation, Meconium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061544|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Pcp Confirmation, Meconium - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62061551|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Propoxyphene Confirmation, Meconium - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95191814|EAP|Custom 95191814||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Tubing Irrigation Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186697|EAP|Custom 95186697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Twin Otsc 165cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186703|EAP|Custom 95186703||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cancellous Dowel Plug Size 8|1|HUMANA [1294]||HUMANA [11839]|1,192.56|FSC: 13; Default||Not reimbursed separately|1,192.56|FSC: 13; Default||External grouping not supported 95191815|EAP|Custom 95191815||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Tool Dissecting Taper 7cm X 2.1mm Special Burr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186696|EAP|Custom 95186696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Twin Otsc 220cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Voyager 5.5 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95170833|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Neutral 54mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95170834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 95170835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|FSC: 13; Default||Not reimbursed separately|1,371.00|FSC: 13; Default||External grouping not supported 95170838|EAP|Custom 95170838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Glenoid 6mm W/ Stop Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170839|EAP|Custom 95170839||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bond Gluma Comfort 4ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170855|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal W/proform Graft Endovascular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95170845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Titanium Set 1x17.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.60|FSC: 13; Default||Not reimbursed separately|507.60|FSC: 13; Default||External grouping not supported 95170850|EAP|Custom 95170850||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kitty Cat 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170853|EAP|Custom 95170853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar Irrigating 8.5 - 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191819|EAP|Custom 95191819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Midas Rex Legend Mednext Carbide Ball 7cm X 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162514|EAP|CPT® 15271||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skin Sub Graft Trnk/arm/leg|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80162522|EAP|CPT® 15272||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skin Sub Graft T/a/l Add-on |1|HUMANA [1294]||HUMANA [11839]|964.00|FSC: 13; Default||Not reimbursed separately|964.00|FSC: 13; Default||External grouping not supported 80162530|EAP|CPT® 15273||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skin Sub Grft T/ar/lg Child|1|HUMANA [1294]||HUMANA [11839]|9,190.84|FSC: 13; Default||Not reimbursed separately|9,190.84|FSC: 13; Default||External grouping not supported 80162548|EAP|CPT® 15274||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skn Sub Grft T/a/l Child Add On|1|HUMANA [1294]||HUMANA [11839]|1,838.98|FSC: 13; Default||Not reimbursed separately|1,838.98|FSC: 13; Default||External grouping not supported 80162555|EAP|CPT® 15275||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skin Sub Graft Face/nk/hf/g|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80162563|EAP|CPT® 15276||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skin Sub Graft F/n/hf/g Addl |1|HUMANA [1294]||HUMANA [11839]|1,254.33|FSC: 13; Default||Not reimbursed separately|1,254.33|FSC: 13; Default||External grouping not supported 80162571|EAP|CPT® 15277||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skn Sub Grft F/n/hf/g Child|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80162589|EAP|CPT® 15278||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Skn Sub Grft F/n/hf/g Ch Add|1|HUMANA [1294]||HUMANA [11839]|2,607.09|FSC: 13; Default||Not reimbursed separately|2,607.09|FSC: 13; Default||External grouping not supported 80162597|EAP|CPT® 15777||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Acellular Derm Matrix Implt|1|HUMANA [1294]||HUMANA [11839]|4,898.50|FSC: 13; Default||Not reimbursed separately|4,898.50|FSC: 13; Default||External grouping not supported 80162662|EAP|CPT® 29584||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Appl Multlay Comprs Arm/hand|1|HUMANA [1294]||HUMANA [11839]|412.85|FSC: 13; Default||Not reimbursed separately|412.85|FSC: 13; Default||External grouping not supported 80162688|EAP|CPT® 33221||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insert Pulse Gen Mult Leads|1|HUMANA [1294]||HUMANA [11839]|56,532.55|FSC: 13; Default||Not reimbursed separately|56,532.55|FSC: 13; Default||External grouping not supported 80162696|EAP|CPT® 33227||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove & Replace Pm Gen Singl|1|HUMANA [1294]||HUMANA [11839]|23,590.22|FSC: 13; Default||Not reimbursed separately|23,590.22|FSC: 13; Default||External grouping not supported 80162704|EAP|CPT® 33228||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remv & Replc Pm Gen Dual Lead|1|HUMANA [1294]||HUMANA [11839]|31,647.53|FSC: 13; Default||Not reimbursed separately|31,647.53|FSC: 13; Default||External grouping not supported 80162712|EAP|CPT® 33229||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remv & Replc Pm Gen Mult Leads|1|HUMANA [1294]||HUMANA [11839]|56,532.55|FSC: 13; Default||Not reimbursed separately|56,532.55|FSC: 13; Default||External grouping not supported 80162720|EAP|CPT® 33230||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insrt Pulse Gen W/dual Leads|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 80162738|EAP|CPT® 33231||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Insrt Pulse Gen W/mult Leads|1|HUMANA [1294]||HUMANA [11839]|99,655.86|FSC: 13; Default||Not reimbursed separately|99,655.86|FSC: 13; Default||External grouping not supported 80162746|EAP|CPT® 33262||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remv & Replc Cvd Gen Sing Lead|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 80162753|EAP|CPT® 33263||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remv & Replc Cvd Gen Dual Lead|1|HUMANA [1294]||HUMANA [11839]|70,114.23|FSC: 13; Default||Not reimbursed separately|70,114.23|FSC: 13; Default||External grouping not supported 80162761|EAP|CPT® 33264||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remv & Replc Cve Gen Mult Lead|1|HUMANA [1294]||HUMANA [11839]|99,655.86|FSC: 13; Default||Not reimbursed separately|99,655.86|FSC: 13; Default||External grouping not supported 80162779|EAP|CPT® 36251||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Cath Ren Art 1st Unilat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80162787|EAP|CPT® 36252||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Cath Ren Art 1st Bilat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80162795|EAP|CPT® 36253||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Cath Ren Art 2nd Unilat|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80162803|EAP|CPT® 36254||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Cath Ren Art 2nd Bilat|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80162811|EAP|CPT® 37191||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ins Endovas Vena Cava Filter|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80162829|EAP|CPT® 37192||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Redo Endovas Vena Cava Filter|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80162837|EAP|CPT® 37193||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rem Endovas Vena Cava Filter|1|HUMANA [1294]||HUMANA [11839]|8,554.88|FSC: 13; Default||Not reimbursed separately|8,554.88|FSC: 13; Default||External grouping not supported 80162845|EAP|CPT® 37619||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ligation Of Inf Vena Cava|1|HUMANA [1294]||HUMANA [11839]|14,188.36|FSC: 13; Default||Not reimbursed separately|14,188.36|FSC: 13; Default||External grouping not supported 80162910|EAP|CPT® 74174||0352 - CT SCAN - BODY SCAN|Hb Ct Angio Abd & Pelv W/o & W/dye|1|HUMANA [1294]||HUMANA [11839]|1,088.10|FSC: 13; Default||Not reimbursed separately|1,088.10|FSC: 13; Default||External grouping not supported 80162928|EAP|CPT® 77424||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Io Rad Tx Delivery By X-ray|1|HUMANA [1294]||HUMANA [11839]|22,632.06|FSC: 13; Default||Not reimbursed separately|22,632.06|FSC: 13; Default||External grouping not supported 80162936|EAP|CPT® 77425||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Io Rad Tx Deliver By Elctrns|1|HUMANA [1294]||HUMANA [11839]|22,632.06|FSC: 13; Default||Not reimbursed separately|22,632.06|FSC: 13; Default||External grouping not supported 80162944|EAP|CPT® 77469||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Io Radiation Rx Management|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 80162951|EAP|CPT® 78226||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Hepatobiliary System Imaging|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80162969|EAP|CPT® 78227||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Hepatobil Syst Image W/drug|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80162977|EAP|CPT® 78579||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Lung Ventilation Imaging|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80162985|EAP|CPT® 78582||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Lung Ventilat & Perfus Imaging|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80162993|EAP|CPT® 78597||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Lung Perfusion Differential|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 80163009|EAP|CPT® 78598||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Lung Perf & Ventilat Diferentl|1|HUMANA [1294]||HUMANA [11839]|1,344.93|FSC: 13; Default||Not reimbursed separately|1,344.93|FSC: 13; Default||External grouping not supported 80163017|EAP|CPT® 92558||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Evoked Otoacoustic Emissions, Screening Automated Analysis|1|HUMANA [1294]||HUMANA [11839]|203.54|FSC: 13; Default||Not reimbursed separately|203.54|FSC: 13; Default||External grouping not supported 80163025|EAP|CPT® 94726||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulm Funct Tst Plethysmograp|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80163033|EAP|CPT® 94727||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulm Function N2 Washout|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 80163041|EAP|CPT® 94728||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Pulm Funct Test Oscillometry|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80163058|EAP|CPT® 94729||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb C02/membane Diffuse Capacity|1|HUMANA [1294]||HUMANA [11839]|351.08|FSC: 13; Default||Not reimbursed separately|351.08|FSC: 13; Default||External grouping not supported 95186681|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,707.00|FSC: 13; Default||Not reimbursed separately|7,707.00|FSC: 13; Default||External grouping not supported 80163082|EAP|CPT® 49082||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Abd Paracentesis|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 80163090|EAP|CPT® 49083||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Abd Paracentesis W/imaging|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 80163108|EAP|CPT® 49084||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Peritoneal Lavage|1|HUMANA [1294]||HUMANA [11839]|2,426.13|FSC: 13; Default||Not reimbursed separately|2,426.13|FSC: 13; Default||External grouping not supported 95195040|EAP|Custom 95195040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80162852|EAP|CPT® 62369||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anal Sp Inf Pmp W/reprg & Fill |1|HUMANA [1294]||HUMANA [11839]|836.29|FSC: 13; Default||Not reimbursed separately|836.29|FSC: 13; Default||External grouping not supported 80162860|EAP|CPT® 62370||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Anl Sp Inf Pmp W/mdreprg & Fil|1|HUMANA [1294]||HUMANA [11839]|836.29|FSC: 13; Default||Not reimbursed separately|836.29|FSC: 13; Default||External grouping not supported 80162878|EAP|CPT® 64633||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rf Destroy Cerv/thor Facet Jnt|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 80162886|EAP|CPT® 64634||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rf Destroy C/th Facet Jnt Addl|1|HUMANA [1294]||HUMANA [11839]|1,591.00|FSC: 13; Default||Not reimbursed separately|1,591.00|FSC: 13; Default||External grouping not supported 80162894|EAP|CPT® 64635||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rf Destroy Lumb/sac Facet Jnt|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 80162902|EAP|CPT® 64636||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Rf Destroy L/s Facet Jnt Addl|1|HUMANA [1294]||HUMANA [11839]|1,830.00|FSC: 13; Default||Not reimbursed separately|1,830.00|FSC: 13; Default||External grouping not supported 80163066|EAP|CPT® 95938||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Somatosensory Testing|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 80163074|EAP|CPT® 95939||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb C Motor Evoked Upr & Lwr Limbs|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95186686|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Connector Axoguard 3mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.00|FSC: 13; Default||Not reimbursed separately|5,553.00|FSC: 13; Default||External grouping not supported 95191818|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 5-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95170861|EAP|Custom 95170861||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Albation Talon Semiflex |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Semi Constrained Cequence 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Self Tap 4.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95170864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self Drill Self Tap 4.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95170865|EAP|Custom 95170865||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer C-plus 14.5 X 17 X 7mm|1|HUMANA [1294]||HUMANA [11839]|7,530.00|FSC: 13; Default||Not reimbursed separately|7,530.00|FSC: 13; Default||External grouping not supported 95170866|EAP|Custom 95170866||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer C-plus 14.5 X 17 X 6mm|1|HUMANA [1294]||HUMANA [11839]|7,530.00|FSC: 13; Default||Not reimbursed separately|7,530.00|FSC: 13; Default||External grouping not supported 95170877|EAP|Custom 95170877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bandage Cohesive Coban 2 Layer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170879|EAP|Custom 95170879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidesheath 5fr .074 Diameter 21g Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170880|EAP|Custom 95170880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Nrg Transseptal 8 Or 8.5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170881|EAP|Custom 95170881||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Rfp Test Box |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170882|EAP|Custom 95170882||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Connector Cable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170883|EAP|Custom 95170883||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Footswitch Pmg/rfp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170885|EAP|Custom 95170885||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Passport Button 8mm X 50cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170886|EAP|Custom 95170886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retrieval Tissue 1550ml Anchor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170887|EAP|Custom 95170887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Shoulder Interspace Size Small|1|HUMANA [1294]||HUMANA [11839]|15,375.00|FSC: 13; Default||Not reimbursed separately|15,375.00|FSC: 13; Default||External grouping not supported 95170888|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Septal Amplatzer 7fr 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,661.00|FSC: 13; Default||Not reimbursed separately|23,661.00|FSC: 13; Default||External grouping not supported 95170890|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Graft Fluency 7mm X 40mm X 117cm Catheter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95170893|EAP|Custom 95170893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy Encor 10g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170897|EAP|Custom 95170897||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Suture (organizer Gabby-frater Suture)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170898|EAP|Custom 95170898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy Ultrasound 14g X 105mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 9mm X 14mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 95170903|EAP|Custom 95170903||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Sovereign 12 X 32 X 23mm|1|HUMANA [1294]||HUMANA [11839]|25,800.00|FSC: 13; Default||Not reimbursed separately|25,800.00|FSC: 13; Default||External grouping not supported 95170908|EAP|Custom 95170908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Biomedicus 17fr Neck Drainage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170910|EAP|Custom 95170910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Biomedicus 19fr Neck Drainage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170911|EAP|Custom 95170911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Biomedicus 21fr Neck Drainage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170912|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Flowguard With 14ga Standard Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,269.01|FSC: 13; Default||Not reimbursed separately|3,269.01|FSC: 13; Default||External grouping not supported 95170920|EAP|Custom 95170920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pacing Temporary|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170922|EAP|Custom 95170922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Femoral Venous 22fr 61.5cm L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170923|EAP|Custom 95170923||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Femoral Venous 23/25fr 65.5cm L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170924|EAP|Custom 95170924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dilator Vascular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170925|EAP|Custom 95170925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Wiggly|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170926|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ablation 60sf2 Cryomaze Ats 10cm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170900|EAP|Custom 95170900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Strut Center 5mm|1|HUMANA [1294]||HUMANA [11839]|9,702.00|FSC: 13; Default||Not reimbursed separately|9,702.00|FSC: 13; Default||External grouping not supported 95170899|EAP|Custom 95170899||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Suture (organizer Gabby-frater Suture)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186700|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Visiglide .035" 270cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80163165|EAP|CPT® 62263||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidural Lysis Mult Sessions|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80163173|EAP|CPT® 62264||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidural Lysis On Single Day |1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80163181|EAP|CPT® 64680||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Desctruct By Neuro Agent Celiac Plexus|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80163199|EAP|CPT® 64681||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Destruct By Neuro Agent Super Hypogastric Plexus|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80163215|EAP|CPT® 64610||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Destruct By Neuro Agent Trigeminal Nerve 2nd And 3rd Division|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 80163223|EAP|CPT® 64632||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Destruct By Neuro Agent Plantar Common Digital Nerve|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 80163249|EAP|CPT® 20553||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inject Single Or Mult Trigger Points 3 Or More|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 80163272|EAP|CPT® 64517||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Inject Anesthetic Agent Superior Hypogastric Plexus|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95170928|EAP|Custom 95170928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sensor Nir Oxyalert Adult Disposable Sensor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170929|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ligament Patellar Pre Shaped Central Third 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,900.00|FSC: 13; Default||Not reimbursed separately|9,900.00|FSC: 13; Default||External grouping not supported 95170930|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Ps Triathlon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95170931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Sky 2 Level 30mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,444.44|FSC: 13; Default||Not reimbursed separately|4,444.44|FSC: 13; Default||External grouping not supported 95170932|EAP|Custom 95170932||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek 6mm X 16mm X 14mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95170933|EAP|Custom 95170933||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek 7mm X 16mm 14mm |1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95170934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fa 4mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,314.00|FSC: 13; Default||Not reimbursed separately|1,314.00|FSC: 13; Default||External grouping not supported 95170901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End 8mm X 14mm X 11mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|FSC: 13; Default||Not reimbursed separately|5,292.00|FSC: 13; Default||External grouping not supported 80163256|EAP|CPT® 22526||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Int Elect Annuloplasty Unil Or Bilat W/fluoro Single|1|HUMANA [1294]||HUMANA [11839]|19,302.40|FSC: 13; Default||Not reimbursed separately|19,302.40|FSC: 13; Default||External grouping not supported 80163264|EAP|CPT® 22527||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Intra Elect Annuloplasty Unil/bilat W/fluoro 1 Or Mor|1|HUMANA [1294]||HUMANA [11839]|19,302.40|FSC: 13; Default||Not reimbursed separately|19,302.40|FSC: 13; Default||External grouping not supported 95170952|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Uncemented Taper 12/14 5 Degree Size B/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95170954|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 4 X 40 X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170955|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Endotak Reliance G 64cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95170939|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 6mm Diameter |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170961|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Safe T-j Curved .021 145 Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Ba|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.75|FSC: 13; Default||Not reimbursed separately|4,731.75|FSC: 13; Default||External grouping not supported 95170963|EAP|Custom 95170963||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lead Stylet Straight 70cm Tachy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 4.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95170965|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Embolectomy Over The Wire 4fr X80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170966|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Embolectomy Over The Wire 5fr X80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170969|EAP|Custom 95170969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi Sacrocervicalpexy End Distal Concave|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170970|EAP|Custom 95170970||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Rumi Sacrocervicalpexy Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170972|EAP|Custom 95170972||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Stabilization Axialif With Axial Universal |1|HUMANA [1294]||HUMANA [11839]|26,985.00|FSC: 13; Default||Not reimbursed separately|26,985.00|FSC: 13; Default||External grouping not supported 95170973|EAP|Custom 95170973||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Bone Granules Bi-ostetic 10cc 14 Dowels|1|HUMANA [1294]||HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95170976|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 8.0 X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95170981|EAP|Custom 95170981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Biopsy Ultrasound 10g X 105mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170982|EAP|Custom 95170982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedure Sterile Slide Thd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Imf 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|284.49|FSC: 13; Default||Not reimbursed separately|284.49|FSC: 13; Default||External grouping not supported 95170985|EAP|Custom 95170985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Infusion Plus 25 Gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170986|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.5 Diopter Acrysof Toric Iq 13.mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170987|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 20.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95170988|EAP|Custom 95170988||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone Mixer Xpede Tm Kyphon|1|HUMANA [1294]||HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95170989|EAP|Custom 95170989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Kypho-pak Express First Fracture Cds|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170991|EAP|Custom 95170991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill All Suture Y-knot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor All Suture Y-knot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|FSC: 13; Default||Not reimbursed separately|726.00|FSC: 13; Default||External grouping not supported 95170993|EAP|Custom 95170993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Light Path Assist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170994|EAP|Custom 95170994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Sidearm Large Bore Tuohy Borst|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95169137|EAP|Custom 95169137||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Shoe Surgical Darco Male Black Xlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95170995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 10 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|FSC: 13; Default||Not reimbursed separately|4,410.00|FSC: 13; Default||External grouping not supported 95170996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Right 3s 10 X 380mm X 120 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,006.88|FSC: 13; Default||Not reimbursed separately|5,006.88|FSC: 13; Default||External grouping not supported 95170997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Titanium U-blade Lag Set 10.5 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,447.28|FSC: 13; Default||Not reimbursed separately|2,447.28|FSC: 13; Default||External grouping not supported 95171000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Radial Head Modular Evolve 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|FSC: 13; Default||Not reimbursed separately|4,662.00|FSC: 13; Default||External grouping not supported 95186682|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 7mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,863.00|FSC: 13; Default||Not reimbursed separately|7,863.00|FSC: 13; Default||External grouping not supported 95191810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 24mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95171003|EAP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Defibrillator Endotak Reliance|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95171006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 X 65mm Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95171008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Delta Ceramic Tx 12/14 32mm |1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,563.80|FSC: 13; Default||Not reimbursed separately|8,563.80|FSC: 13; Default||External grouping not supported 95171009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Cementless Modular Ii Abg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95171010|EAP|Custom 95171010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Short 54mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171011|EAP|Custom 95171011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Explant Long 54mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Axsos 4.0mm L32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95186680|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,707.00|FSC: 13; Default||Not reimbursed separately|7,707.00|FSC: 13; Default||External grouping not supported 80163280|EAP|CPT® 88738||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Noninvasive Hemoglobin (sphb)|1|HUMANA [1294]||HUMANA [11839]|15.06|FSC: 13; Default||Not reimbursed separately|15.06|FSC: 13; Default||External grouping not supported 80163298|EAP|CPT® 95885||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Each Extremity With Nerve Cond Limited|1|HUMANA [1294]||HUMANA [11839]|256.35|FSC: 13; Default||Not reimbursed separately|256.35|FSC: 13; Default||External grouping not supported 80163306|EAP|CPT® 95886||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Ea Extremity 5 Or More Muscles Complete|1|HUMANA [1294]||HUMANA [11839]|317.85|FSC: 13; Default||Not reimbursed separately|317.85|FSC: 13; Default||External grouping not supported 80163314|EAP|CPT® 95887||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Non Extemity With Nerve Conduction|1|HUMANA [1294]||HUMANA [11839]|235.02|FSC: 13; Default||Not reimbursed separately|235.02|FSC: 13; Default||External grouping not supported 95171013|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defib Unify Quadra Crt-d Bi-ventricular Icd Df4comp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|FSC: 13; Default||Not reimbursed separately|66,552.00|FSC: 13; Default||External grouping not supported 95171014|EAP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Quad Lv W/s Curve Fix 86cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95171020|EAP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Seed Loose I-125 W/xray Marker .623mci|1|HUMANA [1294]||HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95171021|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Meridian Ivc Filter Femoral Deployment|1|HUMANA [1294]||HUMANA [11839]|4,335.00|FSC: 13; Default||Not reimbursed separately|4,335.00|FSC: 13; Default||External grouping not supported 95171022|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Meridian Ivc Filter Jugular Deployment|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,335.00|FSC: 13; Default||Not reimbursed separately|4,335.00|FSC: 13; Default||External grouping not supported 95171026|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 12 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95171027|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Stem Head Radial Modular Evole Size 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95171028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.00|FSC: 13; Default||Not reimbursed separately|6,306.00|FSC: 13; Default||External grouping not supported 95171029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va 4 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,509.00|FSC: 13; Default||Not reimbursed separately|1,509.00|FSC: 13; Default||External grouping not supported 95195041|EAP|Custom 95195041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Long Cannulated 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186684|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95191811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95186687|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Connector Axoguard 7mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.00|FSC: 13; Default||Not reimbursed separately|5,553.00|FSC: 13; Default||External grouping not supported 95186678|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|FSC: 13; Default||Not reimbursed separately|6,480.00|FSC: 13; Default||External grouping not supported 95191812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95186695|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Connector Axoguard 2mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.00|FSC: 13; Default||Not reimbursed separately|5,553.00|FSC: 13; Default||External grouping not supported 95195042|EAP|Custom 95195042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant System Fibulock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186679|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,630.00|FSC: 13; Default||Not reimbursed separately|6,630.00|FSC: 13; Default||External grouping not supported 95191813|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Mtp 0 Degree Short Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95186683|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 3mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95186685|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nerve Protector Axoguard 7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|FSC: 13; Default||Not reimbursed separately|5,025.00|FSC: 13; Default||External grouping not supported 95191816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 10s 10mm X38cm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95186688|EAP|Custom 95186688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Container Tissue Pump Piranha Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186708|EAP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornea Whole|1|HUMANA [1294]||HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95191817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Trigen 5.0 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95186710|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95186712|EAP|Custom 95186712||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Stone Pfister-schwartz 4 Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95186715|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Aortic 19 Mm V8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191800|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 14mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95186713|EAP|Custom 95186713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stone Atlas Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186716|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Aortic 23 Mm V8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191801|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95186714|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Aortic 17 Mm V8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191802|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95186726|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound Multilayer Matristem 7 X 10cm|1|HUMANA [1294]||HUMANA [11839]|43.93|FSC: 13; Default||Not reimbursed separately|43.93|FSC: 13; Default||External grouping not supported 95186727|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound Multilayer Matristem 10 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.90|FSC: 13; Default||Not reimbursed separately|36.90|FSC: 13; Default||External grouping not supported 95191803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95186724|EAP|Custom 95186724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin Bone 4mm X 140mm 2-pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186723|EAP|Custom 95186723||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin Bone 4mm X 80mm 2-pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191804|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95186722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 10mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95186725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Phalangeal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|FSC: 13; Default||Not reimbursed separately|7,470.00|FSC: 13; Default||External grouping not supported 95191805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95186717|EAP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Galil Ice Sphere 90 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186741|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 5mm X 5cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,065.00|FSC: 13; Default||Not reimbursed separately|10,065.00|FSC: 13; Default||External grouping not supported 95191806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 0 Degree Medium Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95186731|EAP|Custom 95186731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Brush Tracked Always On Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186735|EAP|Custom 95186735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Cystology Anso 21ga Tracked Always On Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80171544|EAP|CPT® 43202||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy, Flexible, Transoral; With Biopsy, Single Or Multiple|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95186733|EAP|Custom 95186733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Tracked Cup Serrated Always On Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186737|EAP|Custom 95186737||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Spinperc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186743|EAP|Custom 95186743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Infiltration Single Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186732|EAP|Custom 95186732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Tracked Cup Oval Always On Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186736|EAP|Custom 95186736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spinflex Anso Tracked 22ga Always On Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186729|EAP|Custom 95186729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tracker Patient Vpad 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186734|EAP|Custom 95186734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Histology Anso 19ga Tracked Always On Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191820|EAP|Custom 95191820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Midas Tapered 7cm X 1.6 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191826|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Microintroducer Stien Fluent Silicone 4 Ft 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95191830|EAP|Custom 95191830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Shaver Merlin Great White 15 Deg Bendable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170799|EAP|CPT® 34701||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Of Infrarenal Aorta Other Than Rupture Aortic Bifur|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 80170800|EAP|CPT® 34702||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Of Infrarenal Aorta For Rupture Aortic Bifurcation|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 80170811|EAP|CPT® 34703||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Rep Infrarenal Aorta Other Than Rupt Iliac Bifur Uni-iliac|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 80170822|EAP|CPT® 34704||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Of Infrarenal Aorta For Rupt Iliac Bifur Uni-iliac|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95195051|EAP|Custom 95195051||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Graft Bn Harvester Morselizing 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80700529|EAP|Custom 80700529||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Anesthesia Ea 1/2 Hr|1|HUMANA [1294]||HUMANA [11839]|237.15|FSC: 13; Default||Not reimbursed separately|237.15|FSC: 13; Default||External grouping not supported 51002509|EAP|Custom 51002509||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase I|1|HUMANA [1294]||HUMANA [11839]|911.49|FSC: 13; Default||Not reimbursed separately|911.49|FSC: 13; Default||External grouping not supported 51002517|EAP|Custom 51002517||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase I Add Hr|1|HUMANA [1294]||HUMANA [11839]|222.57|FSC: 13; Default||Not reimbursed separately|222.57|FSC: 13; Default||External grouping not supported 52680527|EAP|Custom 52680527||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii|1|HUMANA [1294]||HUMANA [11839]|508.74|FSC: 13; Default||Not reimbursed separately|508.74|FSC: 13; Default||External grouping not supported 52680535|EAP|Custom 52680535||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hb Post Service Phase Ii Add Hr|1|HUMANA [1294]||HUMANA [11839]|194.75|FSC: 13; Default||Not reimbursed separately|194.75|FSC: 13; Default||External grouping not supported 80170833|EAP|CPT® 34705||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Infrarenal Aorta Other Th Rupt Iliac Bifur Bi-iliac|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 80170844|EAP|CPT® 34706||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Of Infrarenal Aorta For Rupt Iliac Bifur Bi-iliac|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95195052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Monster Headless Cannulated Short Thread 3.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95191831|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 36mm X 161mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 80170855|EAP|CPT® 34707||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Of Iliac Artery Ilio-iliac Other Than Rupture Uni|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95195053|EAP|Custom 95195053||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Srg Lng 140mm Sld Ao 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 2-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 80170866|EAP|CPT® 34708||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endovasc Repair Of Iliac Artery Ilio-iliac For Rupture Unilateral|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95186748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz D L/m Rl Knee Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95191832|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Exchanged Curve Double X-stiff Lunderquist|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186753|EAP|Custom 95186753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 4.3 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186750|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.0 X 42.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95195056|EAP|Custom 95195056||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Geuder Glass Cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186751|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.0 X 32.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 80170877|EAP|CPT® 34709||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Placement Of Extension Prosthesis Distal To The Common Iliac Artery|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95186749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 9.3mm 36cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 95191833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 10mm X 280cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,228.28|FSC: 13; Default||Not reimbursed separately|5,228.28|FSC: 13; Default||External grouping not supported 95195057|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol +24 Diop +2.75 Add C Hpt Bcnvx 13mm 6mm Pc 1 Pc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.90|FSC: 13; Default||Not reimbursed separately|153.90|FSC: 13; Default||External grouping not supported 95191844|EAP|Custom 95191844||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manifold Neptune 3 Stryker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Irix-a Lumbar Integrated Fusion System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95186752|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Nail Tibial Znn 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.28|FSC: 13; Default||Not reimbursed separately|593.28|FSC: 13; Default||External grouping not supported 95191834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Yellow Znn 8.3mm X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|FSC: 13; Default||Not reimbursed separately|4,647.36|FSC: 13; Default||External grouping not supported 95186756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fortex Self Drilling 7.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95186755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fortex 6.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 80170888|EAP|CPT® 34710||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Delayed Placement Of Distal Or Prox Exten Prosthesis Initial Vessel|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95191835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn 4.0mm X 32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|FSC: 13; Default||Not reimbursed separately|553.74|FSC: 13; Default||External grouping not supported 95191836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Fa Znn 4.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|599.64|FSC: 13; Default||Not reimbursed separately|599.64|FSC: 13; Default||External grouping not supported 95197485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Fixation Ti 4/6h 0.6mm Thk T-sh 1.2/1.5mm Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.36|FSC: 13; Default||Not reimbursed separately|786.36|FSC: 13; Default||External grouping not supported 80169550|EAP|CPT® 15110||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Epidermal Autograft-trunk/arm/legs|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80170899|EAP|CPT® 34711||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Delayed Place Of Distal Or Prox Extens Prosthesis Additional Vessel|1|HUMANA [1294]||HUMANA [11839]|2,428.75|FSC: 13; Default||Not reimbursed separately|2,428.75|FSC: 13; Default||External grouping not supported 95186767|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Bi Ventricular Viva Crt-p|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,584.00|FSC: 13; Default||Not reimbursed separately|16,584.00|FSC: 13; Default||External grouping not supported 95186764|EAP|Custom 95186764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Anchorage 1.6mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 100mm/95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95186769|EAP|Custom 95186769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Single Shot Repair Flap Osteocondral|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Curved 4.5mm 20 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,227.30|FSC: 13; Default||Not reimbursed separately|4,227.30|FSC: 13; Default||External grouping not supported 95191840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130deg 1.5 13mm X 38cm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95186762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mmxl28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95186765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Self Tap Cortical 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95191841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Trigen 5.0 X 47.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95186770|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Hs Y Sm Frag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|FSC: 13; Default||Not reimbursed separately|1,626.90|FSC: 13; Default||External grouping not supported 95197486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 9mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95186763|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mmxl26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95191842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Va-lcp 2.4/2.7mm Standard Shaft 6 Hold 109mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,066.71|FSC: 13; Default||Not reimbursed separately|7,066.71|FSC: 13; Default||External grouping not supported 95186768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dart Chondral Arthrex 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|363.00|FSC: 13; Default||Not reimbursed separately|363.00|FSC: 13; Default||External grouping not supported 80169562|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Vital Cough Charge Subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95191843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Fixation Speedbridge Jumpstart Biocomposite Achilles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 95186777|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Fixed Cr Left 12m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|400.50|FSC: 13; Default||Not reimbursed separately|400.50|FSC: 13; Default||External grouping not supported 80170900|EAP|CPT® 74019||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Examination, Abdomen; 2 Views|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95186778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Fixed Bearing Uc Rt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 13mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 62064450|EAP|CPT® 85651||0305 - LABORATORY - HEMATOLOGY|Hb Sed Rate, Non-automated|1|HUMANA [1294]||HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 80170911|EAP|CPT® 74021||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Examination, Abdomen; 3 Or More Views|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95186782|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low 3.5mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 95191850|EAP|Custom 95191850||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Spinal Peek Tantalum 16mm X14mmxh6mm Anatomic Cervic|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95186780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Self Tap Cortical 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95195062|EAP|Custom 95195062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Memorygel Xtra 6.7cm Hg Prf Rnd Od14.4cm 755cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186779|EAP|Custom 95186779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cover Zero Gravity Equipment Cover 20/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191854|EAP|Custom 95191854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endo Gia Tri-staple Medium Vascular 45 Tan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 14mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95186781|EAP|Custom 95186781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Marking Preinked Disposable Robotip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191858|EAP|Custom 95191858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Twist Scp 2.9mm X 70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 5mm 60mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|FSC: 13; Default||Not reimbursed separately|2,076.00|FSC: 13; Default||External grouping not supported 95191852|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Restor Toric Multifocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95186788|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Lateral Humerus 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,768.00|FSC: 13; Default||Not reimbursed separately|9,768.00|FSC: 13; Default||External grouping not supported 95191853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130deg 1.5 13mm X 36cm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95195084|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit 50cm 8 Contact Lead|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95197489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Monster Headed Short Thread 3.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95191857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm X 46m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|FSC: 13; Default||Not reimbursed separately|119.25|FSC: 13; Default||External grouping not supported 95186789|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm/l44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95195090|EAP|Custom 95195090||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Fx 1.4mm Ortholoc 3di Lg Temp Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186790|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95195091|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Poly Lghtwght Flex Str 10cmw X 22 Cml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95186785|EAP|Custom 95186785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Vertigraft Cervical Vg2 5mm X 7mm (freeze Dr|1|HUMANA [1294]||HUMANA [11839]|3,299.19|FSC: 13; Default||Not reimbursed separately|3,299.19|FSC: 13; Default||External grouping not supported 95197490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 44mm Fixos Ti Midfoot Rearfoot Cmpr Hdls Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|FSC: 13; Default||Not reimbursed separately|1,848.00|FSC: 13; Default||External grouping not supported 95186786|EAP|Custom 95186786||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Vertigraft Cervical Vg2 8mm X10mm (freeze Dr|1|HUMANA [1294]||HUMANA [11839]|3,299.19|FSC: 13; Default||Not reimbursed separately|3,299.19|FSC: 13; Default||External grouping not supported 95186792|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Biliary Stent 6fr X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95186794|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Biliary Stent 7fr X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95186791|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Biliary Stent 6fr X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 80171555|EAP|CPT® 43241||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flex, Transoral; With Insert Of Intralum Tube Or Cath|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95197491|EAP|Custom 95197491||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Drill 3.5mm Dia Monster Head Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186795|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Biliary Stent 8fr X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95191862|EAP|Custom 95191862||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186796|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.5mm Va-lcp Prox-tibial Small Bend 4h/87mm/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.42|FSC: 13; Default||Not reimbursed separately|4,968.42|FSC: 13; Default||External grouping not supported 95191864|EAP|Custom 95191864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Orthopedic Arthrex 2.4mm X 9.25in Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186798|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Surgical Matristem Psmx 10 X 15 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,070.00|FSC: 13; Default||Not reimbursed separately|11,070.00|FSC: 13; Default||External grouping not supported 95197492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 50d Med Gorilla Bn Mtp Rt Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,211.00|FSC: 13; Default||Not reimbursed separately|5,211.00|FSC: 13; Default||External grouping not supported 95186793|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex Biliary Stent 7fr X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|FSC: 13; Default||Not reimbursed separately|2,445.00|FSC: 13; Default||External grouping not supported 95191855|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 52 X19mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95195092|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Legion Gii Cr All Poly Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|FSC: 13; Default||Not reimbursed separately|10,200.00|FSC: 13; Default||External grouping not supported 95186797|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Plus Surgical Matristem 10 X 15 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,070.00|FSC: 13; Default||Not reimbursed separately|11,070.00|FSC: 13; Default||External grouping not supported 95191860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Mtp First Va-lcp Large 5 Degree Right 2.4/2.7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.09|FSC: 13; Default||Not reimbursed separately|4,185.09|FSC: 13; Default||External grouping not supported 95197498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 12 Xlif 2 Hl Decade Bn Spne Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,431.00|FSC: 13; Default||Not reimbursed separately|13,431.00|FSC: 13; Default||External grouping not supported 95186799|EAP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Powder Matrix Micro Matristem 500mg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.26|FSC: 13; Default||Not reimbursed separately|7.26|FSC: 13; Default||External grouping not supported 95191861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Comp 5.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 95195093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2mm 8mm Ortholoc Ti Ntrd Forefoot Lck Au Mag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.00|FSC: 13; Default||Not reimbursed separately|1,137.00|FSC: 13; Default||External grouping not supported 95186801|EAP|Custom 95186801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Biopince System Needle 17g X 11.8cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression 7.0mm X 75mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95186806|EAP|Custom 95186806||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Jaw Short Synergy Isolator Artricure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip 18mm X 167mm Straight Distal Plasma Modular Restora|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|FSC: 13; Default||Not reimbursed separately|12,413.10|FSC: 13; Default||External grouping not supported 95191865|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Neurostimulator 63cm 6.5fr Percutaneous Lead Introducer|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Fixed Bearing Uc Rt 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95195094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Scr Bn 2mm 16mm Ortholoc Ti Ntrd Forefoot Lck Au Mag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.00|FSC: 13; Default||Not reimbursed separately|1,137.00|FSC: 13; Default||External grouping not supported 95197499|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Spnl 55mm 5.5mm Decade Lg Plt Xlif Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 95186803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95191866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Insertion Suturetak Hip Knotless Xl 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95186805|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Substitute Graft Bone Bioactive Foam Pack Vitoss Ba 2 X 2.5c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|FSC: 13; Default||Not reimbursed separately|2,523.60|FSC: 13; Default||External grouping not supported 95195095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plt Bn Ortholac 6 Hole T-plateortholoc 3di Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 80172744|EAP|CPT® 10081||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Incision & Drainage Pilonidal Cyst Complicated|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 95195096|EAP|Custom 95195096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drl 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170922|EAP|CPT® 32994||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ablation Therapy Pulmonary Tumor(s) Unilateral Cyro|1|HUMANA [1294]||HUMANA [11839]|14,921.56|FSC: 13; Default||Not reimbursed separately|14,921.56|FSC: 13; Default||External grouping not supported 95195097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Ambassador 4 Level 72mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|FSC: 13; Default||Not reimbursed separately|5,100.00|FSC: 13; Default||External grouping not supported 80170933|EAP|CPT® 38222||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Diagnostic Bone Marrow; Biopsy(ies) And Aspiration(s)|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95195098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 6.5mm 50mm Solera Cd Hzn Cocr Spne Ma Ns 5mm Rod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95186814|EAP|Custom 95186814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191876|EAP|Custom 95191876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Block Llium Tricortical 20mm X15mm|1|HUMANA [1294]||HUMANA [11839]|1,920.00|FSC: 13; Default||Not reimbursed separately|1,920.00|FSC: 13; Default||External grouping not supported 95186813|EAP|Custom 95186813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Torpedo Curved 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Joint Toe Smrt Toe Ii X Fuse 10d 11 Prox Intphal Im Ft/ankl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|FSC: 13; Default||Not reimbursed separately|4,395.00|FSC: 13; Default||External grouping not supported 95186819|EAP|HCPCS 95186819||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Line Cp Custom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191879|EAP|Custom 95191879||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Marker Fiducial Biozorb 3cm X 4cm Soft Tissue Implantable|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95186812|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Flexible Pre-curved 2.5 X 450 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|764.40|FSC: 13; Default||Not reimbursed separately|764.40|FSC: 13; Default||External grouping not supported 95195101|EAP|Custom 95195101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.6mm Bioraptor 2.3 Sut Anc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186815|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed Dartfire 2.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95191880|EAP|Custom 95191880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Marker Fiducial Biozorb 2cm X 3cm Soft Tissue Implantable|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95186811|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Flexible Pre-curved 2.0 X 300 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|FSC: 13; Default||Not reimbursed separately|693.00|FSC: 13; Default||External grouping not supported 95195104|EAP|Custom 95195104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chord-x Chordal Sizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Dartfire 2.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95191881|EAP|Custom 95191881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Marker Fiducial Biozorb Lp 2cmx3cmx1cm Soft Tissue Imp|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95186816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Dartfire 2.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95191870|EAP|Custom 95191870||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hammertoe Cannulated Phalinx 2.65mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195105|EAP|Custom 95195105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chord-x Pre-measured Loops12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191871|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 14.0mm X 40mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Right 10 X 440mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95186822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia 2.7/3.5mm Va-lcp 8 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.55|FSC: 13; Default||Not reimbursed separately|4,607.55|FSC: 13; Default||External grouping not supported 95191872|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 14.0mm X 40mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195107|EAP|Custom 95195107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chord-x Pre-measured Loops 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186823|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Strattice Perforated 16 X 20 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.07|FSC: 13; Default||Not reimbursed separately|80.07|FSC: 13; Default||External grouping not supported 95191873|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 14.0mm X 80mm X 80cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95191874|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 14.0mm X 80mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95195108|EAP|Custom 95195108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chord-x Pre-measured Loops 24mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191875|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 26mm X 105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95186836|EAP|Custom 95186836||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Comp Rvs 2.7mm Dia Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186826|EAP|Custom 95186826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Needle For Bio Pince 17 G X 6.8cm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191878|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Collagen Scaffold Reconstituted Arthroscopic Mini-open Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95186831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lk 3.5 Hex 4.75 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95186834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lk 35. Hex 4.75 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95191883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Slim Straight 5 Hole T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95186833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lk 3.5 Hex 4.75 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 80172755|EAP|CPT® 76981||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hb Ultrasound Elastography Parenchyma|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95186832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lk 3.5 Hex 4.75 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|FSC: 13; Default||Not reimbursed separately|774.00|FSC: 13; Default||External grouping not supported 95191884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.4 Mm X L12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 95186824|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Psm Surgical Matristem 10 X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,749.00|FSC: 13; Default||Not reimbursed separately|7,749.00|FSC: 13; Default||External grouping not supported 95194980|EAP|Custom 95194980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Appl 12.5in Fibrijet Dual Lumen Endo 5mm Can Semi-flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186825|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Rebel Bare Metal 4.5 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|FSC: 13; Default||Not reimbursed separately|2,610.00|FSC: 13; Default||External grouping not supported 95191885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.4 Mm X L 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 95186828|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Rvsr Shldr Glnsp 3 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,326.00|FSC: 13; Default||Not reimbursed separately|7,326.00|FSC: 13; Default||External grouping not supported 95191886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T8 2.4 Mm X L14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 95195106|EAP|Custom 95195106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chord-x Pre-measured Loops 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172766|EAP|CPT® 64408||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Injection Anesthetic Agent Vagus Nerve|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95186830|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Rvs Cntrl 6.5x25mm St/rst|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|FSC: 13; Default||Not reimbursed separately|762.00|FSC: 13; Default||External grouping not supported 95191887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Slim Straight 4 Hole T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95186829|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Rvrs Shdr Glen Bsplt Ha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|FSC: 13; Default||Not reimbursed separately|7,770.00|FSC: 13; Default||External grouping not supported 95195109|EAP|Custom 95195109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chord-x Adjustable Suture System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Rev Shldr 9 In Steinmann|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|FSC: 13; Default||Not reimbursed separately|639.00|FSC: 13; Default||External grouping not supported 95191888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Slim Straight 3 Hole T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95186843|EAP|Custom 95186843||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Tapered Cannulated 10 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186848|EAP|Custom 95186848||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Nasopore 4cm Firm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 8mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95191877|EAP|Custom 95191877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Block Ilium Tricortical 25mm X30mm X14mm|1|HUMANA [1294]||HUMANA [11839]|2,310.00|FSC: 13; Default||Not reimbursed separately|2,310.00|FSC: 13; Default||External grouping not supported 95186846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 7mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95195110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Self-drilling/self-tapping Rescue 4.5mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95186839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm/l90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95191882|EAP|Custom 95191882||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Marker Fiducial Biozorb 3cm X 3cm Soft Tissue Implantable|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95186840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm/l95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95191903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Viariable Angle 3.5x56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95195111|EAP|Custom 95195111||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Navigated 2.4mm Vertex Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm/l55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95191905|EAP|Custom 95191905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cable Achieve Mapping (reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant 3-d I Fuse Si-bone 7.0mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|FSC: 13; Default||Not reimbursed separately|9,750.00|FSC: 13; Default||External grouping not supported 95186842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Ti Straight 3.0mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95195112|EAP|Custom 95195112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Surgical Od13 Mm Conical Rod Universal Nail Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184337|EAP|Custom 95184337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Locking Medium 3.1 X 238mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186852|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 25cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,860.00|FSC: 13; Default||Not reimbursed separately|19,860.00|FSC: 13; Default||External grouping not supported 95186847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 10 X 440mm X 125 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95197503|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prolayer Xenograft 4cmx4cm Acellular Dermal Matrix|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,890.00|FSC: 13; Default||Not reimbursed separately|7,890.00|FSC: 13; Default||External grouping not supported 95186851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Fixed Bearing Uc Rt 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95186849|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti 52mm Dia X 23mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95186850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Nucleus Simpliciti Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,315.77|FSC: 13; Default||Not reimbursed separately|13,315.77|FSC: 13; Default||External grouping not supported 95197504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Nar Ti 120mm Geminus Bn Rds Lt Volr Dist Ns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|FSC: 13; Default||Not reimbursed separately|7,350.00|FSC: 13; Default||External grouping not supported 95186863|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Trident X 3 0 Degree 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|FSC: 13; Default||Not reimbursed separately|5,474.70|FSC: 13; Default||External grouping not supported 95197507|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Precision S8 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186861|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabuler Marathon S-rom 28mm+3 10 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.75|FSC: 13; Default||Not reimbursed separately|6,153.75|FSC: 13; Default||External grouping not supported 95186862|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral S-rom Cocr 28mm +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95186859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 4.5 Healixadv Br Anc Pcord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95197508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin 2.4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|334.80|FSC: 13; Default||Not reimbursed separately|334.80|FSC: 13; Default||External grouping not supported 95186853|EAP|Custom 95186853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kit 22ga X 51mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186854|EAP|Custom 95186854||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kit 22ga X 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186855|EAP|Custom 95186855||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Kit 22ga X 132mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186858|EAP|HCPCS 95186858||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Retractor Octobase Holder Suture Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Osteotomy Cotton Peek 6.6mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,964.00|FSC: 13; Default||Not reimbursed separately|8,964.00|FSC: 13; Default||External grouping not supported 95197505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Straight Slim 6 Hole T8 Non-sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|FSC: 13; Default||Not reimbursed separately|4,173.00|FSC: 13; Default||External grouping not supported 95197506|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-cut 3.5mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95197535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 11mm Spc Std 162x11.4x3.4mm Ss 2.7/3.5mm Scr 12 Hl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,816.25|FSC: 13; Default||Not reimbursed separately|5,816.25|FSC: 13; Default||External grouping not supported 95197517|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Len Iol 21.5 Diop Panoptix Toric Nat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95195113|EAP|Custom 95195113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Gft Hrvt Acl 8mm 9mm Colr Pin Tube Oats Disp Strl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197510|EAP|Custom 95197510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Surform 45 Robotic Surgical Cutting Single-use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer For 3.5/4.0mm Screw Dart-fire Small Screw System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95197511|EAP|Custom 95197511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 4.6mm X 45mm Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195115|EAP|Custom C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Shth 6fr Dia 45cm Jydro Ctd Ptef Inn Layer St Sl Cl Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95186856|EAP|Custom 95186856||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter E-cath Acc Tsui Kit 18ga X 83mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195116|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Shth 7fr Dia 45cm Jydro Ctd Ptef Inn Layer St Sl Cl Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197512|EAP|Custom 95197512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 4.6mm X 45mm White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186869|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Smr Cocr 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95195119|EAP|Custom 95195119||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gd Rod Orth 1000mm 3mm Ball Tip Strl Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5 X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95197513|EAP|Custom 95197513||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 4.6mm X 45mm Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cann. 12mm/130 360mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95195123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 11mm 300mm Sp Cndl T2 Im Lck Rtrgd Ti Strl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95186868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 12mm 125 Deg 380mm/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95186886|EAP|Custom 95186886||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Carotid Loop Lumen Single|1|HUMANA [1294]||HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95186867|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Revision Corail Std 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|FSC: 13; Default||Not reimbursed separately|30,334.50|FSC: 13; Default||External grouping not supported 95197514|EAP|Custom 95197514||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Da Vinci Sureform 4.6mm X 45mm Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cann. 11mm/125 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95195125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 10mm 20cm Intertrochanter Trgn Intertan Im 125d Antgrd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|FSC: 13; Default||Not reimbursed separately|4,440.00|FSC: 13; Default||External grouping not supported 95186878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cervical Posterior Certex 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95186879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Certex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95195126|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 5mm 22.5mm Fem Loprfl Intnl Hex Trgn Im Nl Sys|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95186882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|FSC: 13; Default||Not reimbursed separately|2,164.59|FSC: 13; Default||External grouping not supported 95197518|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 6cm X 6cm Xenmatrix Square Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 95186885|EAP|Custom 95186885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Abrahamson Ft Thomas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195138|EAP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Disc Cervical Mobi-c 13mm X 15mm H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95186884|EAP|Custom 95186884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cataract Ft Thomas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95195139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 5 Hole Narrow Straight Compression Variax Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|FSC: 13; Default||Not reimbursed separately|2,484.00|FSC: 13; Default||External grouping not supported 95197519|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 6cm X 10cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197520|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 6cm X 16cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,840.00|FSC: 13; Default||Not reimbursed separately|6,840.00|FSC: 13; Default||External grouping not supported 95197521|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 8cm X 8cm Xenmatrix Squr Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95197522|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 10cmx10cm Xenmatrix Squr Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95186888|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patellofemoral Mck Restoris Sz 4 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95186887|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Command Veh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95197523|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 10cm X 20cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|FSC: 13; Default||Not reimbursed separately|13,770.00|FSC: 13; Default||External grouping not supported 95186889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 5.5 Healixadv Br Anc Pcord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95191937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Solera 8.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|FSC: 13; Default||Not reimbursed separately|5,046.00|FSC: 13; Default||External grouping not supported 95186891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 6.5 Healixadv Br3sutancp Cord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95186890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor 5.5 Healixadv Br3sutancp Cord|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|FSC: 13; Default||Not reimbursed separately|1,005.00|FSC: 13; Default||External grouping not supported 95197524|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 10cm X 28cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|FSC: 13; Default||Not reimbursed separately|19,500.00|FSC: 13; Default||External grouping not supported 95186894|EAP|Custom 95186894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Ti 1.25 X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186908|EAP|Custom 95186908||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disposable Insertion Percutaneous Suture Tak 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186895|EAP|Custom 95186895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.8mm Dia 150mm Length With Trocar Point|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197525|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 15cm X 20cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,550.00|FSC: 13; Default||Not reimbursed separately|20,550.00|FSC: 13; Default||External grouping not supported 95186892|EAP|Custom 95186892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Foam Ag Border Mepilex 4 X 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186838|EAP|Custom 95186838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Glide Ez 21fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186903|EAP|Custom 95186903||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Pad Onestep Pediatric|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95197526|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 15cm X 25cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,650.00|FSC: 13; Default||Not reimbursed separately|25,650.00|FSC: 13; Default||External grouping not supported 95186901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar 2 Column Lcp Va Titanium 7 Hole Hd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95186902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95197527|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 19cm X 28cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,871.88|FSC: 13; Default||Not reimbursed separately|34,871.88|FSC: 13; Default||External grouping not supported 95186907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Bio-composite 3.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95186897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 16mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95197528|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 19cm X 35cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,671.40|FSC: 13; Default||Not reimbursed separately|45,671.40|FSC: 13; Default||External grouping not supported 95186898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp 10 Degree Valgus 8 Degree Dorsifl.std|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95186915|EAP|Custom 95186915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scraper Finesse Membrane 25 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186910|EAP|Custom 95186910||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Supercore 20g X 6cm 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197529|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 20cmx20cm Xenmatrix Squr Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,450.00|FSC: 13; Default||Not reimbursed separately|27,450.00|FSC: 13; Default||External grouping not supported 95186913|EAP|Custom 95186913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Perfusion Oxygenator + Hl Tubing Pack Medtronic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186916|EAP|Custom 95186916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Soft 25 Gauge Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186919|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Cone Sym Triathlon Size C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|FSC: 13; Default||Not reimbursed separately|15,313.20|FSC: 13; Default||External grouping not supported 95197530|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 20cm X 25cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,320.00|FSC: 13; Default||Not reimbursed separately|34,320.00|FSC: 13; Default||External grouping not supported 95186918|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Thick Surgical Matristem 20x20cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,520.00|FSC: 13; Default||Not reimbursed separately|29,520.00|FSC: 13; Default||External grouping not supported 95186911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acculoc 2 Standard Long Left Vdr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 95197531|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 20cm X 40cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,948.00|FSC: 13; Default||Not reimbursed separately|54,948.00|FSC: 13; Default||External grouping not supported 95186924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 14mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 6mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 24mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95197532|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 25cm X 40cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68,656.50|FSC: 13; Default||Not reimbursed separately|68,656.50|FSC: 13; Default||External grouping not supported 95186923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 12mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 18mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 20mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 22mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95197533|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 30cm X 30cm Xenmatrix Squr Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61,816.50|FSC: 13; Default||Not reimbursed separately|61,816.50|FSC: 13; Default||External grouping not supported 95186922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 10mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186929|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 26mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 8mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95197534|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Surgical 30cm X 45cm Xenmatrix Rect Aclr Clgn Mtrx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92,710.50|FSC: 13; Default||Not reimbursed separately|92,710.50|FSC: 13; Default||External grouping not supported 95186917|EAP|Custom 95186917||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tip Soft 23 Gauge Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186942|EAP|Custom 95186942||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Double Wire Sternotomy Closure|1|HUMANA [1294]||HUMANA [11839]|86.83|FSC: 13; Default||Not reimbursed separately|86.83|FSC: 13; Default||External grouping not supported 95186940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 28mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 30mm Self Tapping W/t8 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95186938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.40|FSC: 13; Default||Not reimbursed separately|113.40|FSC: 13; Default||External grouping not supported 95186936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.40|FSC: 13; Default||Not reimbursed separately|113.40|FSC: 13; Default||External grouping not supported 95186937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95186953|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Psmx Surgical Matristem 7x10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,166.00|FSC: 13; Default||Not reimbursed separately|5,166.00|FSC: 13; Default||External grouping not supported 95186950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 80172222|EAP|CPT® 95700||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg Cont Rec W/video By Tech Min 8 Channels|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95186943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95186951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4mm X75mm Left Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95186946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 80172233|EAP|CPT® 95705||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg W/o Video By Tech 2-12 Hr Unmonitored|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95186947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Buttress Locking Va Titanium 1.8mm T8 Stardrive Recess 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 80172244|EAP|CPT® 95706||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg W/o Video By Tech 2-12 Hr Intermittent Mntr|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80172255|EAP|CPT® 95707||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg W/o Video By Tech 2-12hr Continuous R-t Mntr|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80172266|EAP|CPT® 95708||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg W/o Vid By Tech Ea Incr 12-26hr Unmonitored|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95186964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Stimublast 2.5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95186965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Stimublast 2.5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95186966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95186967|EAP|Custom 95186967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Mpb Torcon Advantage|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172277|EAP|CPT® 95709||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg W/o Vid By Tech Ea Incr 12-26 Hr Intmt Mntr|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95186990|EAP|Custom 95186990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Prevena Peel And Place 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95186973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95186986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 7h Hd/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95186974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 80172288|EAP|CPT® 95710||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg W/o Vid Tech Ea Incr 12-26 Hr Cont R-t Mntr|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95186992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Valgus Standard 10 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95186984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 7h Hd/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95186993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Dbm Stimublast 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95186991|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Plus Surgical Matristem 5x7cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,583.00|FSC: 13; Default||Not reimbursed separately|2,583.00|FSC: 13; Default||External grouping not supported 95186972|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95186979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95186982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95186987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 7h Hd/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 80172299|EAP|CPT® 95711||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Veeg By Tech 2-12 Hours Unmonitored|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95186970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95186976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95186985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 7h Hd/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95186971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95186975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95186978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 80172300|EAP|CPT® 95712||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Veeg By Tech 2-12 Hr Intermittent Monitoring|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95186988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 7h Hd/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95186969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95186983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 7h Hd/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95186980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.39|FSC: 13; Default||Not reimbursed separately|3,363.39|FSC: 13; Default||External grouping not supported 95186968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Nrw 2 Col Va-lcp Titanium 6h Hd/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 80172311|EAP|CPT® 95713||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Veeg By Tech 2-12 Hr Continuous R-t Monitoring|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 80169572|EAP|CPT® 64486||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transversus Abdominis Plane (tap) Block Unilateral|1|HUMANA [1294]||HUMANA [11839]|2,395.98|FSC: 13; Default||Not reimbursed separately|2,395.98|FSC: 13; Default||External grouping not supported 95186999|EAP|Custom 95186999||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Morcellator Rotation Piranha Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187000|EAP|Custom 95187000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Semitendinosus 220mm+|1|HUMANA [1294]||HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95186996|EAP|Custom 95186996||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pedal Foot Tm Dimension Super|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Ts Large Duration Duracon 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|FSC: 13; Default||Not reimbursed separately|8,414.70|FSC: 13; Default||External grouping not supported 80172322|EAP|CPT® 95714||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Veeg By Tech Ea Incr 12-26 Hr Unmonitored|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95186981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Vlr 2 Col Va-lcp Titanium 6h Hd/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95186998|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Perforated Strattice 10x16cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.97|FSC: 13; Default||Not reimbursed separately|73.97|FSC: 13; Default||External grouping not supported 95187004|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Acrysof 6.0mm Anterior Asymmet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95187003|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acrysof 6.0mm Anterior Asymmet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95187002|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Acrysof 6.0mm Anterior Asymmet|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95187001|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acrysof 6.0mm Anterior Asymmetr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95187014|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lantern Delivery Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 5h Hd/3h Shaft/rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 80172333|EAP|CPT® 95715||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Veeg By Tech Ea Incr 12-26 Hr Intermittent Mntr|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 95187018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 5h Hd/5h Shaft/rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95187020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 5h Hd/5h Shaft/lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95187013|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super Stiff .035 X 260cm X 1cm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 5h Hd/3h Shaft/lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95187010|EAP|Custom 95187010||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 32mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95187012|EAP|Custom 95187012||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 36mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95187009|EAP|Custom 95187009||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 30mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95187007|EAP|Custom 95187007||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 26mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 80172344|EAP|CPT® 95716||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Veeg By Tech Ea Incr 12-26 Hr Cont R-t Mntr|1|HUMANA [1294]||HUMANA [11839]|2,590.08|FSC: 13; Default||Not reimbursed separately|2,590.08|FSC: 13; Default||External grouping not supported 95187011|EAP|Custom 95187011||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 34mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95187008|EAP|Custom 95187008||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 28mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95187015|EAP|Custom 95187015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Conquest Bit Bite 3.4mm 15 Deg Upbite|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187006|EAP|Custom 95187006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Edge Firm Tip Medial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95186730|EAP|Custom 95186730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Peripheral View|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187005|EAP|Custom 95187005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Edge Firm Tip 190|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187038|EAP|Custom 95187038||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Tension Capsular Morcher 14|1|HUMANA [1294]||HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95187025|EAP|Custom 95187025||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kirschner Wire 1.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197548|EAP|Custom 95197548||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Grasper Surg Robotic Cobra 8mm Sngl Site Endowrist Da Vinci|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187021|EAP|Custom 95187021||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Liver Access 16g 50.5cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187026|EAP|Custom 95187026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cross-plate Reamer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 3.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|FSC: 13; Default||Not reimbursed separately|562.80|FSC: 13; Default||External grouping not supported 95187031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 3.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|FSC: 13; Default||Not reimbursed separately|562.80|FSC: 13; Default||External grouping not supported 95187036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cann. 12mmx130deg 340mm/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95187023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allopure Plus Cotton 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,044.00|FSC: 13; Default||Not reimbursed separately|4,044.00|FSC: 13; Default||External grouping not supported 95187027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lapidus Cp Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.00|FSC: 13; Default||Not reimbursed separately|4,179.00|FSC: 13; Default||External grouping not supported 95197555|EAP|Custom 95197555||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Spinal Tlx20 09mmx11mmx31mm 20degree|1|HUMANA [1294]||HUMANA [11839]|16,800.00|FSC: 13; Default||Not reimbursed separately|16,800.00|FSC: 13; Default||External grouping not supported 95187024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro 3.0mmx26mm Cort|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95187037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Proximal T2long Right 260mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|FSC: 13; Default||Not reimbursed separately|5,491.50|FSC: 13; Default||External grouping not supported 95187028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking T8 35.x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.40|FSC: 13; Default||Not reimbursed separately|386.40|FSC: 13; Default||External grouping not supported 95187030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 3.0x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95187035|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Size 2 10 Mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|FSC: 13; Default||Not reimbursed separately|14,130.00|FSC: 13; Default||External grouping not supported 95187034|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Full Tibial Size 2 10 Mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,107.50|FSC: 13; Default||Not reimbursed separately|5,107.50|FSC: 13; Default||External grouping not supported 95187032|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|FSC: 13; Default||Not reimbursed separately|6,255.00|FSC: 13; Default||External grouping not supported 95187022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Sz50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95197563|EAP|Custom 95197563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Impl 14.8cm Memorygel 5.8cm Hi Prfl Sm Brst Gel 700cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187033|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Hinge Rotating Right Size C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|FSC: 13; Default||Not reimbursed separately|28,485.00|FSC: 13; Default||External grouping not supported 95187048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Cone Femoral Triathlon Sz 5/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|FSC: 13; Default||Not reimbursed separately|17,440.50|FSC: 13; Default||External grouping not supported 95187047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Cone Sym Triathlon Size B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|FSC: 13; Default||Not reimbursed separately|15,313.20|FSC: 13; Default||External grouping not supported 95187049|EAP|Custom 95187049||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Cervical Disc 13x17xh5|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95187043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Cb Stimublast 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.00|FSC: 13; Default||Not reimbursed separately|2,460.00|FSC: 13; Default||External grouping not supported 95187044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Tib Osteo Openwedge 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|FSC: 13; Default||Not reimbursed separately|1,560.00|FSC: 13; Default||External grouping not supported 95187039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 4h Hd/3h Shaft/rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95197562|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sur 5.9in X 7.9in Xenmatrix Rect Aclr Clgn Mtr Rgnr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,572.85|FSC: 13; Default||Not reimbursed separately|21,572.85|FSC: 13; Default||External grouping not supported 95187046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Osteo Osferion 10mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95187042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 4h Hd/5h Shaft/lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95187041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 4h Hd/3h Shaft/lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.69|FSC: 13; Default||Not reimbursed separately|3,240.69|FSC: 13; Default||External grouping not supported 95187040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Vlr Va-lcp Titanium 4h Hd/5h Shaft/rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,488.49|FSC: 13; Default||Not reimbursed separately|3,488.49|FSC: 13; Default||External grouping not supported 95187050|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187051|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187067|EAP|Custom 95187067||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Frozen Peroneus Longus Tendon|1|HUMANA [1294]||HUMANA [11839]|4,210.56|FSC: 13; Default||Not reimbursed separately|4,210.56|FSC: 13; Default||External grouping not supported 95197561|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Sur 9.8in X 11.8in Xenmatrix Rect Aclr Clgn Mtr Rgnr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,695.00|FSC: 13; Default||Not reimbursed separately|52,695.00|FSC: 13; Default||External grouping not supported 95187065|EAP|Custom 95187065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cuda 15 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187064|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Lps All-poly Sz 4 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95187068|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Knitted Vicryl 15 X 15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,129.40|FSC: 13; Default||Not reimbursed separately|3,129.40|FSC: 13; Default||External grouping not supported 95187058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp T-plate 3h Hd/3h Sha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,833.96|FSC: 13; Default||Not reimbursed separately|1,833.96|FSC: 13; Default||External grouping not supported 95187070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Rad Col Va-lcp 6h Shaft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95187056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp +90 Deg 3h Hd/5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,867.02|FSC: 13; Default||Not reimbursed separately|1,867.02|FSC: 13; Default||External grouping not supported 95187060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp +20 Deg 3h Hd/3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.92|FSC: 13; Default||Not reimbursed separately|1,774.92|FSC: 13; Default||External grouping not supported 95187062|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp +20 Deg 3h Hd/5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,867.02|FSC: 13; Default||Not reimbursed separately|1,867.02|FSC: 13; Default||External grouping not supported 80172355|EAP|CPT® 90912||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Bfb Traing W/emg &/manometry 1st 15 Min Cntct|1|HUMANA [1294]||HUMANA [11839]|226.86|FSC: 13; Default||Not reimbursed separately|226.86|FSC: 13; Default||External grouping not supported 95187061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp -20 Deg 3h Hd/3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.92|FSC: 13; Default||Not reimbursed separately|1,774.92|FSC: 13; Default||External grouping not supported 95187057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp -90 Deg 3h Hd/5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,867.02|FSC: 13; Default||Not reimbursed separately|1,867.02|FSC: 13; Default||External grouping not supported 95187059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp T-plate 3h Hd/5h Sha|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95187069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Rad Col Va-lcp 5h Shaft Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,833.96|FSC: 13; Default||Not reimbursed separately|1,833.96|FSC: 13; Default||External grouping not supported 95187063|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp -20 Deg 3h Hd/5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,867.02|FSC: 13; Default||Not reimbursed separately|1,867.02|FSC: 13; Default||External grouping not supported 95187066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T 10 Full Thread 3.5mm/l50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187078|EAP|Custom 95187078||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cancellous Cortical Assembled 6x15x9.4 Mm 6deg|1|HUMANA [1294]||HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95197556|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Blndil 5mm 135cm 12mm Cor Rx Gw 2 Bln Syr Lf Flashmini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187083|EAP|Custom 95187083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Loading Enveo R 26/29 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187081|EAP|Custom 95187081||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Transcatheter Evolut R 26 Mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95187082|EAP|Custom 95187082||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Enveo R|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Sd 3.5 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|FSC: 13; Default||Not reimbursed separately|3,016.20|FSC: 13; Default||External grouping not supported 95187079|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Divergence 16.5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.30|FSC: 13; Default||Not reimbursed separately|6,306.30|FSC: 13; Default||External grouping not supported 95197557|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 7mm 135cml Flash Ostial 12mm Otw Pta 0.035in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp +90 Deg 2h Hd/3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95187072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp -90 Deg 2h Hd/3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95187073|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp +90 Deg 2h Hd/4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,985.01|FSC: 13; Default||Not reimbursed separately|1,985.01|FSC: 13; Default||External grouping not supported 95187074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal 2.4mm Drsl Va-lcp -90 Deg 2h Hd/4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,985.01|FSC: 13; Default||Not reimbursed separately|1,985.01|FSC: 13; Default||External grouping not supported 95187077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nailtibail Std T2 9mmx285mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95187087|EAP|Custom 95187087||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Epg Trial 2 Prt Hdr Non-ce|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197558|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Angio 6mm 135cml Flash Ostial 12mm Otw Pta 0.035in|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187086|EAP|Custom 95187086||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Tibialis Posterior|1|HUMANA [1294]||HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95187089|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Adjustment Neck Unitrax V40 Offset +12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|FSC: 13; Default||Not reimbursed separately|598.50|FSC: 13; Default||External grouping not supported 95187092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Apex Transfix 4 X 300 Pin 5 X 40 Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.50|FSC: 13; Default||Not reimbursed separately|427.50|FSC: 13; Default||External grouping not supported 95187085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187100|EAP|Custom 95187100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle 14 G 6" Sjm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187099|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiojet Zelante Dvt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95187104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continous 5.5mm 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95197549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bn Fixation Ti 3/5h 0.6mm Thk T-sh 1.2/1.5mm Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.36|FSC: 13; Default||Not reimbursed separately|786.36|FSC: 13; Default||External grouping not supported 95187107|EAP|Custom 95187107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ring Annuloplasty Mc3 Tricuspid 38mm|1|HUMANA [1294]||HUMANA [11839]|7,650.00|FSC: 13; Default||Not reimbursed separately|7,650.00|FSC: 13; Default||External grouping not supported 95187105|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Amplia Quad|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|FSC: 13; Default||Not reimbursed separately|57,600.00|FSC: 13; Default||External grouping not supported 95187106|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Amplia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,300.00|FSC: 13; Default||Not reimbursed separately|60,300.00|FSC: 13; Default||External grouping not supported 95187119|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 52mm Self Tapping With Stardrive Reces|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.33|FSC: 13; Default||Not reimbursed separately|408.33|FSC: 13; Default||External grouping not supported 95187115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm/40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95187113|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm/38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95187112|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000315 Core Grafix 14mm|1|HUMANA [1294]||HUMANA [11839]|742.50|FSC: 13; Default||Not reimbursed separately|742.50|FSC: 13; Default||External grouping not supported 95187117|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000311 Core Grafix 3cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.75|FSC: 13; Default||Not reimbursed separately|303.75|FSC: 13; Default||External grouping not supported 80172366|EAP|CPT® 90913||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Bfb Traing W/emg&/manometry Ea Addl 15 Min Cntct|1|HUMANA [1294]||HUMANA [11839]|93.72|FSC: 13; Default||Not reimbursed separately|93.72|FSC: 13; Default||External grouping not supported 95187116|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000305 Core Grafix 2cm X 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95187114|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000310 Core Grafix 1.5cm X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 95187118|EAP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000304 Core Grafix 5cm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95187109|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000316 Prime Grafix 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|742.50|FSC: 13; Default||Not reimbursed separately|742.50|FSC: 13; Default||External grouping not supported 95187111|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000307 Prime Grafix 3cm X 4cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.75|FSC: 13; Default||Not reimbursed separately|303.75|FSC: 13; Default||External grouping not supported 95187110|EAP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Ndc 59857000308 Prime Grafix 1.5cm X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 95197550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 4mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95187128|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Rim Elev Poly Longevity Trilogy Continuum 36mm Sz Kk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95187126|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz D R/m Ll Knee Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|FSC: 13; Default||Not reimbursed separately|6,537.00|FSC: 13; Default||External grouping not supported 95197551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 5mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95187125|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 4-8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|FSC: 13; Default||Not reimbursed separately|5,136.00|FSC: 13; Default||External grouping not supported 95187130|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Persona Fixed Bearing Uc Rt 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95187131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Pca 36mm +10mm Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|FSC: 13; Default||Not reimbursed separately|4,750.20|FSC: 13; Default||External grouping not supported 95187129|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Acetabular Revision Tm 50mm -10mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,722.00|FSC: 13; Default||Not reimbursed separately|7,722.00|FSC: 13; Default||External grouping not supported 95187127|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Tm Multi Holes 56 Mm Size Kk Poro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95187133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acu-loc 2vdr Prox Standard Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95187138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 9mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95187137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 80172377|EAP|CPT® 20560||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Needle Insertion W/o Injection 1 Or 2 Muscles|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95187135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Onlay Mck Restoris Sz 4 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95187134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz 4 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95197552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bn 1.5mm 9mm Aptus Lckng Ti Dble Fl Thd Hnd Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|FSC: 13; Default||Not reimbursed separately|252.45|FSC: 13; Default||External grouping not supported 95187139|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Artoura Te 850cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95187140|EAP|Custom 95187140||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant Round Smooth Hp Sterile 630cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187132|EAP|Custom 95187132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System 2 Lead Trial|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95187141|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Cemented Offset High C-stem Amt Sz2 12/14 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95197553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Locking 2mm Dia 7mml Titanium Cortical Hexadrive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 95187096|EAP|Custom 95187096||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Immobilizer Knee Tri-panel 22"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Lckng 2mm X 16mm Ti Cort Hexa 6 Tpd Cr Fl Gold|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|FSC: 13; Default||Not reimbursed separately|240.51|FSC: 13; Default||External grouping not supported 80172388|EAP|CPT® 20561||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Needle Insertion W/o Injection 3 Or More Muscles|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95187172|EAP|Custom 95187172||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Nester Embolization .35 14 X 14|1|HUMANA [1294]||HUMANA [11839]|350.52|FSC: 13; Default||Not reimbursed separately|350.52|FSC: 13; Default||External grouping not supported 95187161|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187169|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187185|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172399|EAP|CPT® 33016||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pericardiocentesis W/img Guidance When Performed|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95187163|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187165|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187177|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172400|EAP|CPT® 33017||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Prcrd Drg 6yr+ W/o Congenit W Indwelling Cath|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95187158|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187159|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187154|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.25mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187160|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172411|EAP|CPT® 33019||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Perq Pericardial Drg W/insj Ndwellg Cath W/ct|1|HUMANA [1294]||HUMANA [11839]|5,035.26|FSC: 13; Default||Not reimbursed separately|5,035.26|FSC: 13; Default||External grouping not supported 95187182|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187157|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187178|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187152|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.25mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172422|EAP|HCPCS C9758||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Blinded Procedure For Nyha Class Iii/iv Heart Failure, W/rhc And Echo|1|HUMANA [1294]||HUMANA [11839]|38,588.78|FSC: 13; Default||Not reimbursed separately|38,588.78|FSC: 13; Default||External grouping not supported 95187183|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187156|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187184|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187180|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187170|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187175|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172433|EAP|CPT® 78830||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Rp Loclzj Tum Spect W/ct 1 Area 1 Day Imaging|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95187164|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187166|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187168|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187167|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.0mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172444|EAP|CPT® 78831||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Rp Loclzj Tum Spect 2 Area 1d Img/1 Area Img>2+days|1|HUMANA [1294]||HUMANA [11839]|3,625.14|FSC: 13; Default||Not reimbursed separately|3,625.14|FSC: 13; Default||External grouping not supported 95187151|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy Everolimus-eluting 2.25x 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187187|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187153|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.25mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187171|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172455|EAP|CPT® 78832||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Rp Loclzj Tum Spect Ct 2area 1d Img/1 Ar Img>2+d|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 95187174|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 3.50mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187155|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187162|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 2.50mm X 38 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95187191|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 80172466|EAP|CPT® 78835||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Radiopharmaceutical Quantification Measurement 1 Area|1|HUMANA [1294]||HUMANA [11839]|1,370.62|FSC: 13; Default||Not reimbursed separately|1,370.62|FSC: 13; Default||External grouping not supported 95187192|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Flexible Pre-curved 2.25 X 300 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|FSC: 13; Default||Not reimbursed separately|716.10|FSC: 13; Default||External grouping not supported 95187213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 5.5 Footprint Ultra Pack|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 80172477|EAP|CPT® 93985||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Scan Artl Infl&ven O/f Hemo Compl Bi Std|1|HUMANA [1294]||HUMANA [11839]|664.05|FSC: 13; Default||Not reimbursed separately|664.05|FSC: 13; Default||External grouping not supported 95187203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Flexible Pre-curved 1.75 X 300 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.90|FSC: 13; Default||Not reimbursed separately|669.90|FSC: 13; Default||External grouping not supported 95187208|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187207|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187202|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172488|EAP|CPT® 93986||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hb Duplex Scan Artl Infl&ven O/f Hemo Compl Uni Std|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 95187209|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 38 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 80172499|EAP|CPT® 62328||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Diagnostic Lumbar Spinal Puncture W/fluor Or Ct|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95187204|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Synergy(mr) Everolimus-eluting 4.00mm X 24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|FSC: 13; Default||Not reimbursed separately|4,050.00|FSC: 13; Default||External grouping not supported 95187216|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 26.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95187219|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 27.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80172500|EAP|CPT® 62329||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Therapeutic Spinal Pnxr Drainage Csf W/fluor/ct|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95187220|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 28.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95187221|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 28.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95187215|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 25.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95187222|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 29.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80172511|EAP|CPT® 64451||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Injection Aa&/strd Nerves Nrvtg Si Joint W/img|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95187224|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 30.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95187217|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 26.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95187218|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 27.0 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 95187223|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Preloaded 29.5 Diopter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|FSC: 13; Default||Not reimbursed separately|402.00|FSC: 13; Default||External grouping not supported 80172522|EAP|CPT® 64454||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Injection Aa&/strd Genicular Nrv Branches W/img|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95187240|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Cath Vista Brite Coronary Jl 7fr 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95187242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 80172533|EAP|CPT® 64624||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Destruction Neurolytic Agt Genicular Nerve W/img|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 95187241|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm Thick Rtu 6 X 12cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.63|FSC: 13; Default||Not reimbursed separately|88.63|FSC: 13; Default||External grouping not supported 95187252|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Diamondback Coronary Classic 1.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187253|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Viperwire Advance 325cm 5/box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80172544|EAP|CPT® 64625||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Radiofrequency Abltj Nrv Nrvtg Si Jt W/img Gdn|1|HUMANA [1294]||HUMANA [11839]|5,307.61|FSC: 13; Default||Not reimbursed separately|5,307.61|FSC: 13; Default||External grouping not supported 95187247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95187248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|FSC: 13; Default||Not reimbursed separately|348.00|FSC: 13; Default||External grouping not supported 95187246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Met|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95187250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 80172555|EAP|CPT® 74221||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Exam Esophagus Double Contrast Study|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95187249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.4mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 80172566|EAP|CPT® 74248||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Radiologic Small Intestine Follow-through Study|1|HUMANA [1294]||HUMANA [11839]|519.24|FSC: 13; Default||Not reimbursed separately|519.24|FSC: 13; Default||External grouping not supported 95187260|EAP|Custom 95187260||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-90/116-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95187257|EAP|Custom 95187257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Custom Supply Oxygen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172577|EAP|CPT® 78429||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Myocrd Img Pet Metab Eval Single Study Cncrnt Ct|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 95187265|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187264|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Holes 5 Hea|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,269.01|FSC: 13; Default||Not reimbursed separately|3,269.01|FSC: 13; Default||External grouping not supported 95187261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm L50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 80172588|EAP|CPT® 78430||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Myocrd Img Pet Prfuj 1std Rest/stress Cncrnt Ct|1|HUMANA [1294]||HUMANA [11839]|4,112.10|FSC: 13; Default||Not reimbursed separately|4,112.10|FSC: 13; Default||External grouping not supported 95187258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mm X L40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95187262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm X L28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fortex 8.25x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 80172599|EAP|CPT® 78431||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Myocrd Img Pet Prfuj Mlt Std Rst&strs Cncrnt Ct|1|HUMANA [1294]||HUMANA [11839]|6,412.83|FSC: 13; Default||Not reimbursed separately|6,412.83|FSC: 13; Default||External grouping not supported 80169593|EAP|CPT® 41800||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Drainage Of Abscess, Cyst, Hematoma From Dentoalveolar Structures|1|HUMANA [1294]||HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95187267|EAP|Custom 95187267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Cannulated Asnis Micro 3.0mm Ao Coupling 3.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172600|EAP|CPT® 78432||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Myocrd Img Pet Prfuj W/metab Dual Radiotracer|1|HUMANA [1294]||HUMANA [11839]|7,837.59|FSC: 13; Default||Not reimbursed separately|7,837.59|FSC: 13; Default||External grouping not supported 95187271|EAP|Custom 95187271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide 2.6mm X L70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 4.75x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 95187270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 4.75x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|FSC: 13; Default||Not reimbursed separately|2,079.00|FSC: 13; Default||External grouping not supported 95187272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm L55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 80172611|EAP|CPT® 78433||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Myocrd Img Pet Prfuj W/metab 2rtracer Cncrnt Ct|1|HUMANA [1294]||HUMANA [11839]|7,837.59|FSC: 13; Default||Not reimbursed separately|7,837.59|FSC: 13; Default||External grouping not supported 95187268|EAP|HCPCS C2624||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Cardiomems Pa Sensor And Delivery W/cm2000 Cm1000|1|HUMANA [1294]||HUMANA [11839]|63,000.00|FSC: 13; Default||Not reimbursed separately|63,000.00|FSC: 13; Default||External grouping not supported 95187282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Swivelock Dx Sl 3.5 X 8.5mm With Fork|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95187285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 80172622|EAP|CPT® 78434||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hb Aqmbf Pet Rest And Pharmacologic Stress|1|HUMANA [1294]||HUMANA [11839]|2,000.00|FSC: 13; Default||Not reimbursed separately|2,000.00|FSC: 13; Default||External grouping not supported 95187292|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Alloderm 2x4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|124.13|FSC: 13; Default||Not reimbursed separately|124.13|FSC: 13; Default||External grouping not supported 95187281|EAP|Custom 95187281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Swivelock Dx 3.5 X 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187275|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi-torque Command Es 300cm .014"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Rad Stem Collar Lateral Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,244.00|FSC: 13; Default||Not reimbursed separately|11,244.00|FSC: 13; Default||External grouping not supported 80172633|EAP|CPT® 20700||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Manual Prep And Insertion Deep Drug Delivery Dev|1|HUMANA [1294]||HUMANA [11839]|1,077.41|FSC: 13; Default||Not reimbursed separately|1,077.41|FSC: 13; Default||External grouping not supported 95187284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Right 22.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95187283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 5-9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95187276|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Supera Peripheral 6 X 80 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|FSC: 13; Default||Not reimbursed separately|3,075.00|FSC: 13; Default||External grouping not supported 80172644|EAP|CPT® 20701||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Deep Drug Delivery Device|1|HUMANA [1294]||HUMANA [11839]|1,077.41|FSC: 13; Default||Not reimbursed separately|1,077.41|FSC: 13; Default||External grouping not supported 95187278|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Accolade Dr Is-1 Dual Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|FSC: 13; Default||Not reimbursed separately|15,000.00|FSC: 13; Default||External grouping not supported 95187311|EAP|Custom 95187311||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Perimeter 12mm Medium 8 Degree|1|HUMANA [1294]||HUMANA [11839]|10,604.25|FSC: 13; Default||Not reimbursed separately|10,604.25|FSC: 13; Default||External grouping not supported 95187314|EAP|HCPCS 95187314||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Conchasmart Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187307|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Uncemented 12 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 80172655|EAP|CPT® 20702||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Manual Prep&insj Intramedullary Drug Dlvr Device|1|HUMANA [1294]||HUMANA [11839]|1,077.41|FSC: 13; Default||Not reimbursed separately|1,077.41|FSC: 13; Default||External grouping not supported 95187303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dome Centric Domelock Antaomical Shoulder Ti6a17nb/ti6a14v|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95187304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Domelock 48-17 Rt 26.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95187310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Component Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95187298|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 6fr X120 X125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 80172666|EAP|CPT® 20703||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Intramedullary Drug Delivery Device|1|HUMANA [1294]||HUMANA [11839]|1,077.41|FSC: 13; Default||Not reimbursed separately|1,077.41|FSC: 13; Default||External grouping not supported 95187312|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 8fr X 100 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95187299|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 7fr X 40 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95187302|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 7fr X 100 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95187313|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 8fr X 120 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 80172677|EAP|CPT® 20704||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Manual Prep&insj I-artic Drug Delivery Device|1|HUMANA [1294]||HUMANA [11839]|1,077.41|FSC: 13; Default||Not reimbursed separately|1,077.41|FSC: 13; Default||External grouping not supported 95187296|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 6fr 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95187301|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 7fr X 80 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95187305|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 7fr X 120 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|FSC: 13; Default||Not reimbursed separately|5,985.00|FSC: 13; Default||External grouping not supported 95187295|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 6fr 60 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 80172688|EAP|CPT® 20705||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Removal Intra-articular Drug Delivery Device|1|HUMANA [1294]||HUMANA [11839]|1,077.41|FSC: 13; Default||Not reimbursed separately|1,077.41|FSC: 13; Default||External grouping not supported 95187297|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 6fr 100 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95187309|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 8fr X 80 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95187294|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 6fr 40 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 95187306|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 8fr X 40 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 80172699|EAP|CPT® 46948||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Int Hrhc Transanal Hroid Dartlzj 2+ W/us Gdn|1|HUMANA [1294]||HUMANA [11839]|7,236.45|FSC: 13; Default||Not reimbursed separately|7,236.45|FSC: 13; Default||External grouping not supported 95187300|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 7fr X 60 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95187308|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting 35 8fr X 60 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 95187323|EAP|Custom 95187323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Battery Powerdriver P2 Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187320|EAP|Custom 95187320||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine Clearing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172700|EAP|CPT® 0587T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Percutaneous Implantation/replacement Isdns Ptn|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95187318|EAP|Custom 95187318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cannulated 3.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|FSC: 13; Default||Not reimbursed separately|1,836.00|FSC: 13; Default||External grouping not supported 95187321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Post X Small 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,528.00|FSC: 13; Default||Not reimbursed separately|3,528.00|FSC: 13; Default||External grouping not supported 95187319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Small X Post|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 80172711|EAP|CPT® 0588T||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Revision Or Removal Isdns Posterior Tibial Nrv|1|HUMANA [1294]||HUMANA [11839]|808.08|FSC: 13; Default||Not reimbursed separately|808.08|FSC: 13; Default||External grouping not supported 95187316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Short Threaded Cannulated 3.0mm X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|FSC: 13; Default||Not reimbursed separately|1,836.00|FSC: 13; Default||External grouping not supported 95187322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 5.0mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|FSC: 13; Default||Not reimbursed separately|1,836.00|FSC: 13; Default||External grouping not supported 95187317|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80172722|EAP|CPT® 0589T||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Elec Alys Smpl Prgrmg Iins Ptn 1-3 Parameters|1|HUMANA [1294]||HUMANA [11839]|323.22|FSC: 13; Default||Not reimbursed separately|323.22|FSC: 13; Default||External grouping not supported 95187335|EAP|Custom 95187335||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Segment Fibular L=100mm|1|HUMANA [1294]||HUMANA [11839]|1,887.60|FSC: 13; Default||Not reimbursed separately|1,887.60|FSC: 13; Default||External grouping not supported 95187332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 12mm/170 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.36|FSC: 13; Default||Not reimbursed separately|4,530.36|FSC: 13; Default||External grouping not supported 95187328|EAP|Custom 95187328||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Core Shark 25 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80172733|EAP|CPT® 0590T||0510 - CLINIC - GENERAL CLASSIFICATION|Hb Elec Alys Cplx Prgrmg Iins Ptn 4+ Parameters|1|HUMANA [1294]||HUMANA [11839]|323.22|FSC: 13; Default||Not reimbursed separately|323.22|FSC: 13; Default||External grouping not supported 95187325|EAP|Custom 95187325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Core System Delivery 22 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187327|EAP|Custom 95187327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Core Shark 22 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187324|EAP|Custom 95187324||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Liver System Delivery 19 Ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187333|EAP|Custom 95187333||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Flex Perc Cannulated 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comoponent Patellofemoral Mck Restoris Sz5 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95187345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 3.5mm X L38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187343|EAP|Custom 95187343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ultrabraid 2-0 Cobraid 24 10pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187344|EAP|Custom 95187344||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Implant Hat-trick Mtp Bilateral Procedure Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187358|EAP|Custom 95187358||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Anterior Tibialis|1|HUMANA [1294]||HUMANA [11839]|4,373.10|FSC: 13; Default||Not reimbursed separately|4,373.10|FSC: 13; Default||External grouping not supported 95187351|EAP|Custom 95187351||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Tendon Bone Hemi With Quad|1|HUMANA [1294]||HUMANA [11839]|7,435.56|FSC: 13; Default||Not reimbursed separately|7,435.56|FSC: 13; Default||External grouping not supported 95187357|EAP|Custom 95187357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Sharp 2mm Ao Lg 70|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187350|EAP|Custom 95187350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Formula Similac Alimentum 12.1 Oz Pwd 6/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight 5.5mm 180mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95187356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fortex 8.25 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95197565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2mm 4mm Screw 5 Hole Lock 41mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|FSC: 13; Default||Not reimbursed separately|4,140.00|FSC: 13; Default||External grouping not supported 95187355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight 5.5mmx300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95187352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Scp Knee Complete W/accuport Side Delivery Cannula|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,927.50|FSC: 13; Default||Not reimbursed separately|7,927.50|FSC: 13; Default||External grouping not supported 95197566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini Monster Headed Short Thread 3.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95187375|EAP|Custom 95187375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 0.9mm X 102mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95197567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone 10 Degree Medium Mtp Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|FSC: 13; Default||Not reimbursed separately|4,257.00|FSC: 13; Default||External grouping not supported 95187369|EAP|Custom 95187369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Helical Tfna 75 Mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187370|EAP|Custom 95187370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Helical Tfna 80 Mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187367|EAP|Custom 95187367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hammerfix Sizing Key|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187359|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Minus 2.0 Diopter Acrysof Multipiece-expand|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95197568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Spinal 12mm Quick Start Distraction|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95187365|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Prostalac 42 X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,654.40|FSC: 13; Default||Not reimbursed separately|2,654.40|FSC: 13; Default||External grouping not supported 95187364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Prostalac Rt Size 3 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|FSC: 13; Default||Not reimbursed separately|13,320.30|FSC: 13; Default||External grouping not supported 95187368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 12mm/130 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95187377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 4 Hole/l47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95197569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 35mm Ti 2 Lvl Zevo Bn Spne Crv Ant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|FSC: 13; Default||Not reimbursed separately|7,500.00|FSC: 13; Default||External grouping not supported 95187383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Ft 2.7mm/l42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 12mm/130 Right 235mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95187381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Ft 2.7mm/l36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95187384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Ft 2.7mm/l44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95197570|EAP|Custom 95197570||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue 5x14x11mm Cortical Freeze Dried|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95187361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate X 8-hole Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,436.00|FSC: 13; Default||Not reimbursed separately|2,436.00|FSC: 13; Default||External grouping not supported 95187374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|FSC: 13; Default||Not reimbursed separately|2,778.00|FSC: 13; Default||External grouping not supported 95187378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4-hole Straight Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,803.00|FSC: 13; Default||Not reimbursed separately|1,803.00|FSC: 13; Default||External grouping not supported 95187363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Jl 8-hole Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|FSC: 13; Default||Not reimbursed separately|2,280.00|FSC: 13; Default||External grouping not supported 95197571|EAP|Custom 95197571||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Tissue 6x14x11mm Blk Cort Spnl Lrdt Strle|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95187366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap Off Lg 2mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95187373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Extra Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|FSC: 13; Default||Not reimbursed separately|2,697.00|FSC: 13; Default||External grouping not supported 95187379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Anterolateral Distal Left 4-hole/102mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,917.00|FSC: 13; Default||Not reimbursed separately|7,917.00|FSC: 13; Default||External grouping not supported 95187380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 8-hole Straight Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95197572|EAP|Custom 95197572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forceps Retrieval Endo Grasping 2.4mm 8mm Rat Th Lf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Box 4-hole Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,803.00|FSC: 13; Default||Not reimbursed separately|1,803.00|FSC: 13; Default||External grouping not supported 95187362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 4-hole 100 Degree Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,803.00|FSC: 13; Default||Not reimbursed separately|1,803.00|FSC: 13; Default||External grouping not supported 95187376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 3 Hole/l35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95187382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Ft 2.7mm/l40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95197573|EAP|Custom 95197573||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Endo 5.5cmx3cm 230cm 2.5 Cath F/quk Rmvl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187396|EAP|Custom 95187396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wires 01.2.150mm Trocar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187392|EAP|Custom 95187392||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Body Main Bifurcated Afx 28-110/i20-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|FSC: 13; Default||Not reimbursed separately|37,425.00|FSC: 13; Default||External grouping not supported 95187399|EAP|Custom 95187399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Low Profile 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187401|EAP|Custom 95187401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast 400cc Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187389|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.25 Diopter Crystalens Posterior Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187400|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press Fit Reunion 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95197575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow T 2.7mm 4mm Screw 5 Hole Lock 47mm Nonsterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|FSC: 13; Default||Not reimbursed separately|4,740.00|FSC: 13; Default||External grouping not supported 95187390|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comoponent Patellofemoral Mck Restoris Sz5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95187391|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Pegged Sz 542|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|FSC: 13; Default||Not reimbursed separately|5,664.00|FSC: 13; Default||External grouping not supported 95187387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ladder 12 Hole Sternalock Blu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,553.00|FSC: 13; Default||Not reimbursed separately|2,553.00|FSC: 13; Default||External grouping not supported 95187388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ladder Wide 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,553.00|FSC: 13; Default||Not reimbursed separately|2,553.00|FSC: 13; Default||External grouping not supported 95197576|EAP|Custom 95197576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgical 105mm 2.0mm Scaled Ao Nonsterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 08mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|FSC: 13; Default||Not reimbursed separately|389.46|FSC: 13; Default||External grouping not supported 95187395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|FSC: 13; Default||Not reimbursed separately|471.00|FSC: 13; Default||External grouping not supported 95197577|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Standard Quadra-p Size 2 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95187394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|FSC: 13; Default||Not reimbursed separately|471.00|FSC: 13; Default||External grouping not supported 95187398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 7 Hole 12mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|FSC: 13; Default||Not reimbursed separately|5,778.00|FSC: 13; Default||External grouping not supported 95197578|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Offset 4mm Pe Hc A 36g|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|FSC: 13; Default||Not reimbursed separately|5,853.00|FSC: 13; Default||External grouping not supported 95187417|EAP|Custom 95187417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Transfusion Exchange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187402|EAP|Custom 95187402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Linq Custom Sterile 6/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 20mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95197579|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Lateral Quadra-p Size 6 Cementless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|FSC: 13; Default||Not reimbursed separately|5,700.00|FSC: 13; Default||External grouping not supported 95187407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 16mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous 2.7mm X 12mm (magenta)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous 2.7mm X 14mm (magenta)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 10mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 12mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous 2.7mm X 8mm (magenta)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 8mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous 2.7mm X 16mm (magenta)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 14mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous 2.7mm X 10mm (magenta)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous Self Drilling 2.4mm X 18mm (gold)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cancellous 2.7mm X 20mm (magenta)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|FSC: 13; Default||Not reimbursed separately|291.00|FSC: 13; Default||External grouping not supported 95187426|EAP|Custom 95187426||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Transcatheter Evolut R 29 Mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95187425|EAP|Custom 95187425||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Transcatheter Evolut R 23 Mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95187427|EAP|Custom 95187427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Loading Enveo R 23 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 5-10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95187420|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Hooded 10 Degree 32mm X46mm 49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95187372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95187424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Fixation 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,302.00|FSC: 13; Default||Not reimbursed separately|1,302.00|FSC: 13; Default||External grouping not supported 95187423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem 8.0mm X 0.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|FSC: 13; Default||Not reimbursed separately|4,674.00|FSC: 13; Default||External grouping not supported 95187422|EAP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermis Decellularized Arthroflex 40 X 70mm|1|HUMANA [1294]||HUMANA [11839]|395.84|FSC: 13; Default||Not reimbursed separately|395.84|FSC: 13; Default||External grouping not supported 95187435|EAP|Custom 95187435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 9mm Divergence|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187432|EAP|Custom 95187432||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Transcatheter Corevalve 31mm|1|HUMANA [1294]||HUMANA [11839]|90,000.00|FSC: 13; Default||Not reimbursed separately|90,000.00|FSC: 13; Default||External grouping not supported 95187429|EAP|Custom 95187429||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tubing Set Spectra Optia Exchange 6/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187431|EAP|Custom 95187431||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Performa Berenstein 5fr 40cm 5/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187434|EAP|Custom 95187434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Loading Corevalve 18 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4.5mm X 11mm Angle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|FSC: 13; Default||Not reimbursed separately|1,496.46|FSC: 13; Default||External grouping not supported 95183898|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Covers Pin 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183899|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink(blue)7.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bolt Decade Xlif 5.5x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|FSC: 13; Default||Not reimbursed separately|3,591.00|FSC: 13; Default||External grouping not supported 95183902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Coroent Xl-w 10 Degree Bulleted 12x22x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,392.00|FSC: 13; Default||Not reimbursed separately|22,392.00|FSC: 13; Default||External grouping not supported 95183906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 6.0xl85mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95183903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Constrained 4x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 95187433|EAP|Custom 95187433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery 18 Fr Corvalve 26/29/31mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187436|EAP|Custom 95187436||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mini Divergence 19.5mm|1|HUMANA [1294]||HUMANA [11839]|6,306.30|FSC: 13; Default||Not reimbursed separately|6,306.30|FSC: 13; Default||External grouping not supported 95183896|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pins Transfixing 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Intermediate Dr Right 10 Hole Extra Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,574.00|FSC: 13; Default||Not reimbursed separately|5,574.00|FSC: 13; Default||External grouping not supported 95183904|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183905|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Pump Day Use Ecoflow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168276|EAP|CPT® 77387||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Guidance For Loc Of Target Volume For Delivery Of Radiation Rx|1|HUMANA [1294]||HUMANA [11839]|617.67|FSC: 13; Default||Not reimbursed separately|617.67|FSC: 13; Default||External grouping not supported 95183914|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Aspiration 132cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammerlock Proximal 15mm-distal7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95183926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammerlock Proximal12mmxdistal5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|FSC: 13; Default||Not reimbursed separately|4,350.00|FSC: 13; Default||External grouping not supported 95183912|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wallstent Unistep Plus Halo 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,633.83|FSC: 13; Default||Not reimbursed separately|4,633.83|FSC: 13; Default||External grouping not supported 95183918|EAP|Custom 95183918||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 36 Mm X 4.5 Cm|1|HUMANA [1294]||HUMANA [11839]|9,075.00|FSC: 13; Default||Not reimbursed separately|9,075.00|FSC: 13; Default||External grouping not supported 95183920|EAP|Custom 95183920||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Extraction Nail Cannulated Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183915|EAP|Custom 95183915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Aspiration|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183916|EAP|Custom 95183916||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore34 Mm X 15 Cm|1|HUMANA [1294]||HUMANA [11839]|48,750.00|FSC: 13; Default||Not reimbursed separately|48,750.00|FSC: 13; Default||External grouping not supported 95183921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dart Peek 10degree 2.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|FSC: 13; Default||Not reimbursed separately|1,785.00|FSC: 13; Default||External grouping not supported 95183923|EAP|Custom 95183923||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Plif Wave 11mm X 24 Mm|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95183924|EAP|Custom 95183924||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Kit Hammerlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183919|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dryseal Coating Hydrophilic Gore 24 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183922|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Radial Head Cocr 24mm Ht Standard/13.0mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 95183917|EAP|Custom 95183917||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Thoracic Tag Gore 37mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|47,625.00|FSC: 13; Default||Not reimbursed separately|47,625.00|FSC: 13; Default||External grouping not supported 95183913|EAP|Custom 95183913||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183927|EAP|Custom 95183927||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Covers 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mini Variable 2.4mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95183939|EAP|Custom 95183939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Mini Extreme 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183941|EAP|Custom 95183941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Ideal Suture Shuttle 90 Degrees|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183938|EAP|Custom 95183938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver And Ring Mini Peek|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Extreme 2.4mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95183933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ortholink Mini Extreme 3hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95183928|EAP|Custom 95183928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hood Surgical Flyte Stryker Peelaway|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mini Variable 2.4mmmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95183931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade Plate 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95183935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mini Extreme 2.4mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95183932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 6.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|FSC: 13; Default||Not reimbursed separately|2,187.00|FSC: 13; Default||External grouping not supported 95183930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Long Kit Right 13x360mmx125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95183940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Plate 7 Hole 16mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|FSC: 13; Default||Not reimbursed separately|6,867.00|FSC: 13; Default||External grouping not supported 95187439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 5.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95187430|EAP|Custom 95187430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Perform Bentson 5fr 100cm 5/box|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187437|EAP|Custom 95187437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ar-scope Measurement 220mm X 60 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187438|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Surgical Trans-obturator Aris Coloplast|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Dbm Stimublast 1cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95187442|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem C Amt Std Offset Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95187441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated 12mm/130 360mm/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95187444|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cartiform 20mm Disc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,500.00|FSC: 13; Default||Not reimbursed separately|25,500.00|FSC: 13; Default||External grouping not supported 95187453|EAP|Custom 95187453||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Surgical Am Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Ti 14mm 130 Deg 424mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95187445|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cartiform 10mm Disc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95187451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 115 Mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|FSC: 13; Default||Not reimbursed separately|2,164.59|FSC: 13; Default||External grouping not supported 95187452|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Comoponent Patellofemoral Mck Restoris Sz6 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95183947|EAP|Custom 95183947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stabilit Vertebroplasty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183950|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Neuflex Mcp Size 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,422.00|FSC: 13; Default||Not reimbursed separately|4,422.00|FSC: 13; Default||External grouping not supported 95183946|EAP|Custom 95183946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding G Low Profile Button 24fr 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183943|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 7fr Ar 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183942|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 7fr Ar2 W/sideholes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95183949|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Pip Neuflex Mcp Size 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,422.00|FSC: 13; Default||Not reimbursed separately|4,422.00|FSC: 13; Default||External grouping not supported 95183958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibula Distal Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|FSC: 13; Default||Not reimbursed separately|3,822.00|FSC: 13; Default||External grouping not supported 95183951|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular Taa Tx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95183959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Column Fusion Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|FSC: 13; Default||Not reimbursed separately|4,189.50|FSC: 13; Default||External grouping not supported 95187456|EAP|Custom 95187456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Atomic Edge 550 Micron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183952|EAP|Custom 95183952||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Surgical Baxano Io-flex 7.5 Ipsi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183957|EAP|Custom 95183957||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Source Light Fiber Optic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187455|EAP|Custom 95187455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Atomic Edge 600 Micron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183960|EAP|Custom 95183960||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adapter Single Use Edge Ba Olympus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183954|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 4.00 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95183955|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 3.50 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95183953|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Premier Platinum 2.50 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95187457|EAP|Custom 95187457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 4.50mm Arthroscopy Tripledam|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187473|EAP|Custom 95187473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Polarius 3.2 8mm Surgibit Short Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187468|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95187470|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3mmx42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95187471|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 80168289|EAP|Custom 80168289||0250 - PHARMACY - GENERAL CLASSIFICATION|HB122 - HB HOSPICE NON-INJECTABLE MEDS|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187472|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 3.5x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|FSC: 13; Default||Not reimbursed separately|228.00|FSC: 13; Default||External grouping not supported 62063896|EAP|CPT® 88373||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Fish-computer Assisted, Each Addl|1|HUMANA [1294]||HUMANA [11839]|321.19|FSC: 13; Default||Not reimbursed separately|321.19|FSC: 13; Default||External grouping not supported 95183969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Long Thread 7.0mm/l100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 95187465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95183966|EAP|Custom 95183966||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Stabilit Vp Vertebroplasty|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183970|EAP|Custom 95183970||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Threaded 3.2mmx230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Met Less 4- Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,310.00|FSC: 13; Default||Not reimbursed separately|2,310.00|FSC: 13; Default||External grouping not supported 95183972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Surface Articulating Hinge Rotating Size E 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|FSC: 13; Default||Not reimbursed separately|5,850.00|FSC: 13; Default||External grouping not supported 95183973|EAP|Custom 95183973||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Non Dehp Epidural Yellow Striped W/filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lock 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.00|FSC: 13; Default||Not reimbursed separately|1,068.00|FSC: 13; Default||External grouping not supported 95183974|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Moderate Plus Profile 275cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95183971|EAP|Custom 95183971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Large Ao 4.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Lock Ti 2.0x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95183968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Ti 8.0x110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|FSC: 13; Default||Not reimbursed separately|841.50|FSC: 13; Default||External grouping not supported 95187463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Polarius Posterior Plate 6 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|FSC: 13; Default||Not reimbursed separately|3,990.00|FSC: 13; Default||External grouping not supported 95187464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe Screw|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|FSC: 13; Default||Not reimbursed separately|228.00|FSC: 13; Default||External grouping not supported 62063870|EAP|HCPCS G0416||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Prostate Biopsy|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62063888|EAP|CPT® 88364||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Ap Bill Pro Only In-situ Hybrid, Each Addl|1|HUMANA [1294]||HUMANA [11839]|282.54|FSC: 13; Default||Not reimbursed separately|282.54|FSC: 13; Default||External grouping not supported 95187466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 62063904|EAP|CPT® 88374||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Fish, Multiplex, Computer-ref Lab|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95187467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3mmx36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 62063912|EAP|CPT® 88369||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Fish Manual, Each Addl|1|HUMANA [1294]||HUMANA [11839]|304.96|FSC: 13; Default||Not reimbursed separately|304.96|FSC: 13; Default||External grouping not supported 62063920|EAP|CPT® 88377||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Fish, Multiplex, Manual-ref Lab|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95187469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Hexalobe 4.3x34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95187478|EAP|Custom 95187478||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Trocar Point 1 End 1.25mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168305|EAP|CPT® 50590||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Lithotripsy, Extracorporeal Shock Wave|1|HUMANA [1294]||HUMANA [11839]|1,120.00|FSC: 13; Default||Not reimbursed separately|1,120.00|FSC: 13; Default||External grouping not supported 80168313|EAP|CPT® 33990||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Insertion Of Ventricular Assist Device Arterial Access Only|1|HUMANA [1294]||HUMANA [11839]|30,000.00|FSC: 13; Default||Not reimbursed separately|30,000.00|FSC: 13; Default||External grouping not supported 95187474|EAP|Custom 95187474||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Mega 30cc 7.5 Fr Iab|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168321|EAP|CPT® 33992||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Removal Of Percutaneous Ventricular Assist Device|1|HUMANA [1294]||HUMANA [11839]|2,029.80|FSC: 13; Default||Not reimbursed separately|2,029.80|FSC: 13; Default||External grouping not supported 80168339|EAP|CPT® 33993||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Repositioning Of Percutaneous Ventricular Assist Device|1|HUMANA [1294]||HUMANA [11839]|2,029.80|FSC: 13; Default||Not reimbursed separately|2,029.80|FSC: 13; Default||External grouping not supported 95187475|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Quadra Assura Mp Crt-d Df4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,997.50|FSC: 13; Default||Not reimbursed separately|57,997.50|FSC: 13; Default||External grouping not supported 95183978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95183981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Tibial Medial Distal 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,993.60|FSC: 13; Default||Not reimbursed separately|3,993.60|FSC: 13; Default||External grouping not supported 95187489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Apex Transfixing 5/6mm 40mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95183982|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95183980|EAP|Custom 95183980||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb End Cap T2+15mm|1|HUMANA [1294]||HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95187483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95183987|EAP|Custom 95183987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Phalinx 1.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183998|EAP|Custom 95183998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Jejunal Ttp 12 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187486|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95184002|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Med Height 775cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95183984|EAP|Custom 95183984||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Acl Btb|1|HUMANA [1294]||HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95187479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Locking 3 Hole Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|FSC: 13; Default||Not reimbursed separately|2,294.04|FSC: 13; Default||External grouping not supported 95183997|EAP|Custom 95183997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Prismasate Egk 2/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mm/l75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95187477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/125 Deg Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95183999|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Plus Med Height 475cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95183992|EAP|Custom 95183992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Peg 27 French Pull|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95183989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mm/l65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95183929|EAP|Custom 95183929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Toga Flyte Peelaway Stryker Xxlarge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95183990|EAP|Custom 95183990||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Jejunal Ttp 8.5 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183995|EAP|Custom 95183995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Connecting 11 X 200mm Hoffman3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187488|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95183983|EAP|Custom 95183983||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Presutured|1|HUMANA [1294]||HUMANA [11839]|6,519.00|FSC: 13; Default||Not reimbursed separately|6,519.00|FSC: 13; Default||External grouping not supported 95183986|EAP|Custom 95183986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hammertoe Phalinx 2.45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Ulnar 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,116.05|FSC: 13; Default||Not reimbursed separately|2,116.05|FSC: 13; Default||External grouping not supported 95183993|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mm/l80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95183985|EAP|Custom 95183985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Hammertoe Phalinx 2.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187484|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 Mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95184000|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Plus Med Height 525cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95184001|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Med Height 640cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95187485|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95183996|EAP|Custom 95183996||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Plate Retention Autocapture Expressew Iii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95183988|EAP|Custom 95183988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187487|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|FSC: 13; Default||Not reimbursed separately|306.54|FSC: 13; Default||External grouping not supported 95183994|EAP|Custom 95183994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coupling Inverted Rod To Pin Hoffmann 3 4/5/6 Dia 5/8/11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal Humerus 3hole/l84mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95184014|EAP|Custom 95184014||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Twist Cannulated 3.5mm Dia.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184005|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Nanocross 2.5mm X 210mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184015|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Asnis 2.0x150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Reduction Precept 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|FSC: 13; Default||Not reimbursed separately|5,514.00|FSC: 13; Default||External grouping not supported 95187490|EAP|Custom 95187490||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pulm Wedge Press Monito 5pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184010|EAP|Custom 95184010||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Asnis Micro K-wire 2.0mm 0.8x100mm Sterile|1|HUMANA [1294]||HUMANA [11839]|98.70|FSC: 13; Default||Not reimbursed separately|98.70|FSC: 13; Default||External grouping not supported 95184012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Asnis Cannulated Screw 5x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95187493|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 14 Hole Left 3.5 Lcp Low Bend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,748.91|FSC: 13; Default||Not reimbursed separately|4,748.91|FSC: 13; Default||External grouping not supported 95184013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Asnis Cannulated 5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 95184009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw S-fix 2.5lg 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95187494|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 10 Hole/ L119mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95184006|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Nanocross 2.5mm X 60mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blade Helical Tfna 120mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|FSC: 13; Default||Not reimbursed separately|2,164.59|FSC: 13; Default||External grouping not supported 95187497|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.75 Ao Diopter Crystalens Posterior Chamb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187495|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Trulign Torric Sphere 24.50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95187496|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Afinity Collamer Single Piece Diopter 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95187499|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix 3-layer Wound Cytal 10x15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.96|FSC: 13; Default||Not reimbursed separately|63.96|FSC: 13; Default||External grouping not supported 95187509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mm X L22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95187500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Self-drilling Variable Angle4.0x12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95187503|EAP|Custom 95187503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Disposal Awl Starter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187510|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Eccentric 36mm X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95187501|EAP|Custom 95187501||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jigs Persona Psi Pref Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184017|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Cae Wire Guided 12-15mm 240 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184019|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 Fr Ar2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184030|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mold Stem Hip 11 X 135 Mm W/reinforcement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,736.00|FSC: 13; Default||Not reimbursed separately|5,736.00|FSC: 13; Default||External grouping not supported 95187518|EAP|Custom 95187518||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Integrated Fusion Irix-a 33x26x8degree 11mm|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95184018|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Cae Wire Guided 15-18mm 240 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184027|EAP|Custom 95184027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide .62|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187517|EAP|Custom 95187517||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continuous 5.5mmx80mm|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95184028|EAP|Custom 95184028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Wire Olive .45|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184026|EAP|Custom 95184026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187519|EAP|Custom 95187519||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Integrated Fusion33x26x8degree 13mm|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95184016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Interference Bioabsorable Matryx Genesys 7.0mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|FSC: 13; Default||Not reimbursed separately|717.00|FSC: 13; Default||External grouping not supported 95184029|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Metatarsal Head Sz 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,985.00|FSC: 13; Default||Not reimbursed separately|11,985.00|FSC: 13; Default||External grouping not supported 95187521|EAP|Custom 95187521||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 6 Hole /12mm/right|1|HUMANA [1294]||HUMANA [11839]|6,357.00|FSC: 13; Default||Not reimbursed separately|6,357.00|FSC: 13; Default||External grouping not supported 95184020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headed 3.5x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95184022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5x14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95187516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pedicale Fortex6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95184031|EAP|Custom 95184031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Hip Total Optivac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lapidus 1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95187522|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Artoura Hp 500cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|FSC: 13; Default||Not reimbursed separately|5,475.00|FSC: 13; Default||External grouping not supported 95184024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95184023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5x14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95187540|EAP|Custom 95187540||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Alpha Extreme Mini Maxlock 2-hole|1|HUMANA [1294]||HUMANA [11839]|3,640.80|FSC: 13; Default||Not reimbursed separately|3,640.80|FSC: 13; Default||External grouping not supported 95184025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 3.5x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|FSC: 13; Default||Not reimbursed separately|261.00|FSC: 13; Default||External grouping not supported 95183979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4mm 4.0/l24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95187520|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Bearing Fixed Uc Persona Left 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80168347|EAP|CPT® 28090||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Excision Of Lesion, Tendon, Tendon Sheath, Or Capsule Foot|1|HUMANA [1294]||HUMANA [11839]|4,184.05|FSC: 13; Default||Not reimbursed separately|4,184.05|FSC: 13; Default||External grouping not supported 95184032|EAP|Custom 95184032||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Body Rail - Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.4mm X10mm Mini Maxlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|FSC: 13; Default||Not reimbursed separately|364.80|FSC: 13; Default||External grouping not supported 95187559|EAP|Custom 95187559||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swift Non-ce|1|HUMANA [1294]||HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95184063|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95184045|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.25mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95187562|EAP|Custom 95187562||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Anterolateral Distal Rt 6-hole/127mm|1|HUMANA [1294]||HUMANA [11839]|8,097.00|FSC: 13; Default||Not reimbursed separately|8,097.00|FSC: 13; Default||External grouping not supported 95184050|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184051|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Extreme Mini Maxlock 2.4mmx14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|FSC: 13; Default||Not reimbursed separately|364.80|FSC: 13; Default||External grouping not supported 95184037|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184066|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95187565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Ft 2.7mm/l46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95184068|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184039|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187535|EAP|Custom 95187535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lantern Delivery Micro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184041|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184054|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95184060|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184064|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95187525|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic Axios System 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,936.05|FSC: 13; Default||Not reimbursed separately|13,936.05|FSC: 13; Default||External grouping not supported 95184056|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184058|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95187567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Ft 2.7mm/l44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95184059|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184062|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187526|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Pancreatic Axios System 15 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,936.05|FSC: 13; Default||Not reimbursed separately|13,936.05|FSC: 13; Default||External grouping not supported 95184067|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184071|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95187608|EAP|Custom 95187608||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Loop Hf 12 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184069|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184033|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.25mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187596|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Affinity Collamer Single Piece Diopter 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95184065|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184040|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187610|EAP|Custom 95187610||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Loop Hf Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184046|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.25mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95184048|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187593|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Body Cone Proximal +10 29mm Modular Restoration|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|FSC: 13; Default||Not reimbursed separately|15,768.90|FSC: 13; Default||External grouping not supported 95184072|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184036|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187606|EAP|Custom 95187606||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Tapered Midas Legend 2.3mm X 16mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184044|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.25mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95184047|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187609|EAP|Custom 95187609||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Resuscitator Infant Neo-tee With In-line/override Button|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184035|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.25mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184038|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184043|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.25mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95184055|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184061|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184042|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.25mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95184049|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.5mm X 33mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|FSC: 13; Default||Not reimbursed separately|3,036.00|FSC: 13; Default||External grouping not supported 95184053|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184070|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 4.0mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95184034|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.25mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95187614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 11mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95184052|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184057|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95187613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washers Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.68|FSC: 13; Default||Not reimbursed separately|817.68|FSC: 13; Default||External grouping not supported 95184080|EAP|Custom 95184080||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lens Contact Precision Sphere Plano 22mm 9.0 Base Curve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184073|EAP|Custom 95184073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Salem Sump 18 Fr W/multifunction Port 10/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Substitute Cement Bone Ha Injectable Hydroset 15cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,384.00|FSC: 13; Default||Not reimbursed separately|12,384.00|FSC: 13; Default||External grouping not supported 95184086|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Versa-dial 42 X 18 X 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|FSC: 13; Default||Not reimbursed separately|5,508.00|FSC: 13; Default||External grouping not supported 95184074|EAP|Custom 95184074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Wehmann|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169601|EAP|CPT® 31632||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronch With Transbronchial Lung Biopsy|1|HUMANA [1294]||HUMANA [11839]|1,829.67|FSC: 13; Default||Not reimbursed separately|1,829.67|FSC: 13; Default||External grouping not supported 95184081|EAP|Custom 95184081||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lens Contact Precision Sphere Plano 18mm 9.0 Base Curve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184084|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Comp Primary 10mm Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,244.00|FSC: 13; Default||Not reimbursed separately|14,244.00|FSC: 13; Default||External grouping not supported 32000135|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Thpy Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 80169612|EAP|CPT® 43255||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Control Of Bleeding Any Method|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 32000150|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Ippb Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 95184076|EAP|Custom 95184076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Suture Novo Stitch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32000176|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Mdi Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32001653|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Opmc Aerosol Thpy 3rd|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32100240|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Opmc F-v Loop Repeat|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95184078|EAP|Custom 95184078||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lens Contact Precision Sphere Plano 16mm 8.6 Base Curve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 32100307|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Thpy Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 32300204|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Aerosol Thpy Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 80169623|EAP|CPT® 43253||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|HB EGD WITH EUS WITHOUT FNA, WITH CELIAC PLEXUS|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 32300378|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Mdi Tx-subsequent|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.19|FSC: 13; Default||Not reimbursed separately|524.19|FSC: 13; Default||External grouping not supported 51002764|EAP|CPT® 59050||0732 - EKG/ECG (ELECTROCARDIOGRAM) - TELEMETRY|Hb Fetal Monitoring W/report, S&i|1|HUMANA [1294]||HUMANA [11839]|359.17|FSC: 13; Default||Not reimbursed separately|359.17|FSC: 13; Default||External grouping not supported 95184087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman Threaded Tip .125 X 2.5 In 2pk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|FSC: 13; Default||Not reimbursed separately|993.00|FSC: 13; Default||External grouping not supported 52000106|EAP|CPT® 59409||0722 - LABOR ROOM/DELIVERY - DELIVERY ROOM|Hb Vaginal Delivery Only|1|HUMANA [1294]||HUMANA [11839]|5,335.98|FSC: 13; Default||Not reimbursed separately|5,335.98|FSC: 13; Default||External grouping not supported 52000205|EAP|Custom 52000205||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hb Anes-vag/epidural|1|HUMANA [1294]||HUMANA [11839]|200.00|FSC: 13; Default||Not reimbursed separately|200.00|FSC: 13; Default||External grouping not supported 52200623|EAP|CPT® 59025||0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION|Hb Fetal Nonstress Ldrp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.16|FSC: 13; Default||Not reimbursed separately|473.16|FSC: 13; Default||External grouping not supported 95184094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Talor Small Sz Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|FSC: 13; Default||Not reimbursed separately|14,407.50|FSC: 13; Default||External grouping not supported 52200631|EAP|CPT® 59020||0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION|Hb Contraction Stress Ldrp|1|HUMANA [1294]||HUMANA [11839]|473.16|FSC: 13; Default||Not reimbursed separately|473.16|FSC: 13; Default||External grouping not supported 80169634|EAP|CPT® 43243||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Injection Of Sclerosing Agents (botox)|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 52681293|EAP|CPT® 59000||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Amniocentesis Diagnostic|1|HUMANA [1294]||HUMANA [11839]|1,970.90|FSC: 13; Default||Not reimbursed separately|1,970.90|FSC: 13; Default||External grouping not supported 95184091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Thread 4.0x32.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 52681467|EAP|CPT® 59015||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Pn Cvs Procedure|1|HUMANA [1294]||HUMANA [11839]|1,970.90|FSC: 13; Default||Not reimbursed separately|1,970.90|FSC: 13; Default||External grouping not supported 52690195|EAP|CPT® 93325||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Doppler Echo Color Flow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|610.78|FSC: 13; Default||Not reimbursed separately|610.78|FSC: 13; Default||External grouping not supported 95184092|EAP|Custom 95184092||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Gold 4.0|1|HUMANA [1294]||HUMANA [11839]|583.20|FSC: 13; Default||Not reimbursed separately|583.20|FSC: 13; Default||External grouping not supported 52690229|EAP|CPT® 93325||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Pn F/u Fetal Echo W/c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|610.78|FSC: 13; Default||Not reimbursed separately|610.78|FSC: 13; Default||External grouping not supported 80169644|EAP|CPT® 43273||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp With Cann Of Papilla W Direct Vis Of Panc/comm Bile Duct|1|HUMANA [1294]||HUMANA [11839]|3,015.29|FSC: 13; Default||Not reimbursed separately|3,015.29|FSC: 13; Default||External grouping not supported 59000604|EAP|CPT® 93325||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Echo Doppler, Color Flow Map|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|610.78|FSC: 13; Default||Not reimbursed separately|610.78|FSC: 13; Default||External grouping not supported 59000612|EAP|CPT® 93312||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hb Tee 2d, Probe/imag/inr/rpt|1|HUMANA [1294]||HUMANA [11839]|1,486.62|FSC: 13; Default||Not reimbursed separately|1,486.62|FSC: 13; Default||External grouping not supported 95184093|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Core Sliding 7 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|FSC: 13; Default||Not reimbursed separately|4,590.00|FSC: 13; Default||External grouping not supported 80169655|EAP|CPT® 43278||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp With Ablation|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 80169666|EAP|CPT® 43263||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp With Sphinctero Of Oddi Measurement|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 80169677|EAP|CPT® 91120||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Anal Rectal Manometry Balloon Expulsion Test|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 62000187|EAP|CPT® 84702||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CHG ONLY QUANT HCG|1|HUMANA [1294]||HUMANA [11839]|45.15|FSC: 13; Default||Not reimbursed separately|45.15|FSC: 13; Default||External grouping not supported 95187616|EAP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Allure Mp Rf|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,303.18|FSC: 13; Default||Not reimbursed separately|24,303.18|FSC: 13; Default||External grouping not supported 62000195|EAP|CPT® 82677||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CHG ONLY ESTRIOL|1|HUMANA [1294]||HUMANA [11839]|72.54|FSC: 13; Default||Not reimbursed separately|72.54|FSC: 13; Default||External grouping not supported 95184098|EAP|Custom 95184098||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Small 4x19x14mm 20degree|1|HUMANA [1294]||HUMANA [11839]|4,908.00|FSC: 13; Default||Not reimbursed separately|4,908.00|FSC: 13; Default||External grouping not supported 95184100|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Contour 6 X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 62000328|EAP|CPT® 36415||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Collect Venous Blood By Venipuncture|1|HUMANA [1294]||HUMANA [11839]|9.00|FSC: 13; Default||Not reimbursed separately|9.00|FSC: 13; Default||External grouping not supported 95187619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95184097|EAP|Custom 95184097||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Small 3x19x14mm 15degree|1|HUMANA [1294]||HUMANA [11839]|4,908.00|FSC: 13; Default||Not reimbursed separately|4,908.00|FSC: 13; Default||External grouping not supported 62000419|EAP|HCPCS P9037||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Pltpher Lr & Irr|1|HUMANA [1294]||HUMANA [11839]|1,904.07|FSC: 13; Default||Not reimbursed separately|1,904.07|FSC: 13; Default||External grouping not supported 95184099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable 4x18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|FSC: 13; Default||Not reimbursed separately|953.97|FSC: 13; Default||External grouping not supported 62000427|EAP|HCPCS P9040||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbc L/r Irr|1|HUMANA [1294]||HUMANA [11839]|788.28|FSC: 13; Default||Not reimbursed separately|788.28|FSC: 13; Default||External grouping not supported 62000443|EAP|HCPCS P9054||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbc Lr & Frozen|1|HUMANA [1294]||HUMANA [11839]|843.30|FSC: 13; Default||Not reimbursed separately|843.30|FSC: 13; Default||External grouping not supported 95187620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center 6.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 62000450|EAP|HCPCS P9033||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Plt Conc Lr & Irr|1|HUMANA [1294]||HUMANA [11839]|651.36|FSC: 13; Default||Not reimbursed separately|651.36|FSC: 13; Default||External grouping not supported 95184096|EAP|Custom 95184096||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Small 7x17x12mm 10degree|1|HUMANA [1294]||HUMANA [11839]|4,908.00|FSC: 13; Default||Not reimbursed separately|4,908.00|FSC: 13; Default||External grouping not supported 62000682|EAP|HCPCS P9016||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbc Leuko Reduced|1|HUMANA [1294]||HUMANA [11839]|565.05|FSC: 13; Default||Not reimbursed separately|565.05|FSC: 13; Default||External grouping not supported 62000708|EAP|HCPCS P9010||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Wb Processing Fee|1|HUMANA [1294]||HUMANA [11839]|381.60|FSC: 13; Default||Not reimbursed separately|381.60|FSC: 13; Default||External grouping not supported 62000724|EAP|CPT® 36600||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Arterial Coll Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.68|FSC: 13; Default||Not reimbursed separately|310.68|FSC: 13; Default||External grouping not supported 95184106|EAP|Custom 95184106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle Accu Pass Curved Right 45 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62000930|EAP|HCPCS P9035||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Pltpheresis Leukoreduced|1|HUMANA [1294]||HUMANA [11839]|1,498.83|FSC: 13; Default||Not reimbursed separately|1,498.83|FSC: 13; Default||External grouping not supported 95184105|EAP|Custom 95184105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shuttle Accu Pass Curved Left 45 Degree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050018|EAP|CPT® 83519||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Acetylchol Rec Ab - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|55.20|FSC: 13; Default||Not reimbursed separately|55.20|FSC: 13; Default||External grouping not supported 62050026|EAP|CPT® 82024||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ACTH|1|HUMANA [1294]||HUMANA [11839]|115.86|FSC: 13; Default||Not reimbursed separately|115.86|FSC: 13; Default||External grouping not supported 62050034|EAP|CPT® 82085||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ALDOLASE|1|HUMANA [1294]||HUMANA [11839]|29.13|FSC: 13; Default||Not reimbursed separately|29.13|FSC: 13; Default||External grouping not supported 62050042|EAP|CPT® 82088||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Aldosterone - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|122.25|FSC: 13; Default||Not reimbursed separately|122.25|FSC: 13; Default||External grouping not supported 62050059|EAP|CPT® 82108||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ALUMINUM|1|HUMANA [1294]||HUMANA [11839]|76.44|FSC: 13; Default||Not reimbursed separately|76.44|FSC: 13; Default||External grouping not supported 62050075|EAP|CPT® 82164||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ANGIOTEN CONVERT ENZ|1|HUMANA [1294]||HUMANA [11839]|43.80|FSC: 13; Default||Not reimbursed separately|43.80|FSC: 13; Default||External grouping not supported 62050083|EAP|CPT® 85301||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ANTITHROMBIN 3 AG|1|HUMANA [1294]||HUMANA [11839]|32.43|FSC: 13; Default||Not reimbursed separately|32.43|FSC: 13; Default||External grouping not supported 62050091|EAP|CPT® 86160||0300 - LABORATORY - GENERAL CLASSIFICATION|HB C1 ESTERASE INHIB|1|HUMANA [1294]||HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95184107|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Denali Ivc Filter Retrieval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62050117|EAP|CPT® 82384||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MC CATECHOLAMINES URINE F|1|HUMANA [1294]||HUMANA [11839]|75.75|FSC: 13; Default||Not reimbursed separately|75.75|FSC: 13; Default||External grouping not supported 95187625|EAP|Custom 95187625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Cervical Disc 13 X 17 X H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 62050125|EAP|CPT® 82390||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CERULOPLASMIN|1|HUMANA [1294]||HUMANA [11839]|32.22|FSC: 13; Default||Not reimbursed separately|32.22|FSC: 13; Default||External grouping not supported 95184115|EAP|Custom 95184115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Glidescope Lo Pro Single Use #4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050166|EAP|CPT® 86162||0300 - LABORATORY - GENERAL CLASSIFICATION|HB COMPLEMENT CH50|1|HUMANA [1294]||HUMANA [11839]|60.96|FSC: 13; Default||Not reimbursed separately|60.96|FSC: 13; Default||External grouping not supported 62050174|EAP|CPT® 82530||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CORTISOL, FREE|1|HUMANA [1294]||HUMANA [11839]|50.13|FSC: 13; Default||Not reimbursed separately|50.13|FSC: 13; Default||External grouping not supported 95184116|EAP|Custom 95184116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Glidescope Mac Single Use #3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050216|EAP|CPT® 80299||0300 - LABORATORY - GENERAL CLASSIFICATION|HB DISOPYRAMIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 62050232|EAP|CPT® 86225||0300 - LABORATORY - GENERAL CLASSIFICATION|HB DSDNA AB IGG BY ELISA/REFLEX|1|HUMANA [1294]||HUMANA [11839]|41.22|FSC: 13; Default||Not reimbursed separately|41.22|FSC: 13; Default||External grouping not supported 62050257|EAP|CPT® 82668||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ERYTHROPOIETIN|1|HUMANA [1294]||HUMANA [11839]|56.37|FSC: 13; Default||Not reimbursed separately|56.37|FSC: 13; Default||External grouping not supported 62050273|EAP|CPT® 85240||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Factor Viiic - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95184117|EAP|Custom 95184117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Glidescope Mac Single Use #4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050281|EAP|CPT® 82705||0300 - LABORATORY - GENERAL CLASSIFICATION|HB QUAL FECAL FAT|1|HUMANA [1294]||HUMANA [11839]|15.30|FSC: 13; Default||Not reimbursed separately|15.30|FSC: 13; Default||External grouping not supported 62050299|EAP|CPT® 86780||0300 - LABORATORY - GENERAL CLASSIFICATION|HB FTA|1|HUMANA [1294]||HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 62050307|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fluphenazine|1|HUMANA [1294]||HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62050323|EAP|CPT® 80173||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HALOPERIDOL|1|HUMANA [1294]||HUMANA [11839]|47.34|FSC: 13; Default||Not reimbursed separately|47.34|FSC: 13; Default||External grouping not supported 95184120|EAP|Custom 95184120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Over Top Van Schie Plus Flush Royal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169684|EAP|CPT® 44369||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Push Enteroscopy With Ablation|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 62050349|EAP|CPT® 82175||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ARSENIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.91|FSC: 13; Default||Not reimbursed separately|56.91|FSC: 13; Default||External grouping not supported 62050356|EAP|CPT® 83655||0300 - LABORATORY - GENERAL CLASSIFICATION|HB LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.33|FSC: 13; Default||Not reimbursed separately|36.33|FSC: 13; Default||External grouping not supported 95184123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii 5x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 62050364|EAP|CPT® 83825||0300 - LABORATORY - GENERAL CLASSIFICATION|HB QUANT MERCURY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.78|FSC: 13; Default||Not reimbursed separately|48.78|FSC: 13; Default||External grouping not supported 62050380|EAP|CPT® 83021||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEMOGLOBIN EVAL|1|HUMANA [1294]||HUMANA [11839]|54.18|FSC: 13; Default||Not reimbursed separately|54.18|FSC: 13; Default||External grouping not supported 62050398|EAP|CPT® 83021||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEMOGLOBIN S EVAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.18|FSC: 13; Default||Not reimbursed separately|54.18|FSC: 13; Default||External grouping not supported 95184124|EAP|Custom 95184124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Iii Asnis 5.0mm|1|HUMANA [1294]||HUMANA [11839]|101.25|FSC: 13; Default||Not reimbursed separately|101.25|FSC: 13; Default||External grouping not supported 62050406|EAP|CPT® 86704||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEP B CORE TOTAL|1|HUMANA [1294]||HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80169696|EAP|CPT® 44373||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Peg To Pej|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 62050414|EAP|CPT® 86804||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEP C AB RIBA|1|HUMANA [1294]||HUMANA [11839]|46.47|FSC: 13; Default||Not reimbursed separately|46.47|FSC: 13; Default||External grouping not supported 95184109|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 12x 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62050422|EAP|CPT® 86022||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEPARIN INDUCED AB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 62050430|EAP|CPT® 83497||0300 - LABORATORY - GENERAL CLASSIFICATION|HB 5 HIAA|1|HUMANA [1294]||HUMANA [11839]|38.70|FSC: 13; Default||Not reimbursed separately|38.70|FSC: 13; Default||External grouping not supported 95184121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Square 20 Mm Comp Doble 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 62050448|EAP|CPT® 86812||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HLA B27|1|HUMANA [1294]||HUMANA [11839]|77.43|FSC: 13; Default||Not reimbursed separately|77.43|FSC: 13; Default||External grouping not supported 95187642|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Cr 48mm Xlpe Journey Ii Size 5-6 13mm Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|FSC: 13; Default||Not reimbursed separately|8,745.00|FSC: 13; Default||External grouping not supported 62050455|EAP|CPT® 83090||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HOMOCYSTEINE TOTAL|1|HUMANA [1294]||HUMANA [11839]|53.76|FSC: 13; Default||Not reimbursed separately|53.76|FSC: 13; Default||External grouping not supported 95184119|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Converter Aaa Renu Zenith Flex 28mm X 113cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|FSC: 13; Default||Not reimbursed separately|19,542.00|FSC: 13; Default||External grouping not supported 62050471|EAP|CPT® 82785||0300 - LABORATORY - GENERAL CLASSIFICATION|HB IGE|1|HUMANA [1294]||HUMANA [11839]|49.38|FSC: 13; Default||Not reimbursed separately|49.38|FSC: 13; Default||External grouping not supported 95184122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnin Iii 5x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|FSC: 13; Default||Not reimbursed separately|591.75|FSC: 13; Default||External grouping not supported 62050497|EAP|CPT® 83625||0300 - LABORATORY - GENERAL CLASSIFICATION|HB LD ISOENZYMES|1|HUMANA [1294]||HUMANA [11839]|38.37|FSC: 13; Default||Not reimbursed separately|38.37|FSC: 13; Default||External grouping not supported 95187643|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Oxinium Journey Ii Np Size 6 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|FSC: 13; Default||Not reimbursed separately|16,163.40|FSC: 13; Default||External grouping not supported 95184114|EAP|Custom 95184114||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Glidescope Lo Pro Single Use #3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050521|EAP|CPT® 84202||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC PROTOPROPHYRIN|1|HUMANA [1294]||HUMANA [11839]|43.05|FSC: 13; Default||Not reimbursed separately|43.05|FSC: 13; Default||External grouping not supported 62050539|EAP|CPT® 86713||0300 - LABORATORY - GENERAL CLASSIFICATION|HB LEGIONELLA IGG|1|HUMANA [1294]||HUMANA [11839]|45.90|FSC: 13; Default||Not reimbursed separately|45.90|FSC: 13; Default||External grouping not supported 62050547|EAP|CPT® 86713||0300 - LABORATORY - GENERAL CLASSIFICATION|HB LEGIONELLA IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.90|FSC: 13; Default||Not reimbursed separately|45.90|FSC: 13; Default||External grouping not supported 95184118|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 10mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187644|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Non Porous Journey Size 5 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|FSC: 13; Default||Not reimbursed separately|6,487.80|FSC: 13; Default||External grouping not supported 62050570|EAP|CPT® 85610||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pt - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|12.87|FSC: 13; Default||Not reimbursed separately|12.87|FSC: 13; Default||External grouping not supported 95184108|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 12x 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62050588|EAP|CPT® 85730||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ptt - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|18.03|FSC: 13; Default||Not reimbursed separately|18.03|FSC: 13; Default||External grouping not supported 80108350|EAP|HCPCS G0297||0352 - CT SCAN - BODY SCAN|Hb Low-dose Computed Tomography For Lung Cancer Screening|1|HUMANA [1294]||HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 62050646|EAP|CPT® 86765||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MEASLES IGG|1|HUMANA [1294]||HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 62050653|EAP|CPT® 83835||0300 - LABORATORY - GENERAL CLASSIFICATION|HB UR METANEPH FRAC|1|HUMANA [1294]||HUMANA [11839]|50.82|FSC: 13; Default||Not reimbursed separately|50.82|FSC: 13; Default||External grouping not supported 95187645|EAP|Custom 95187645||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Drill And Pin Genesis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050661|EAP|CPT® 83921||0300 - LABORATORY - GENERAL CLASSIFICATION|HB METHYLMALONIC ACID URINE|1|HUMANA [1294]||HUMANA [11839]|63.63|FSC: 13; Default||Not reimbursed separately|63.63|FSC: 13; Default||External grouping not supported 62050687|EAP|CPT® 83516||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MITOCHONDRIAL M2 IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95184129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medialmax Pocketlock 8degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|FSC: 13; Default||Not reimbursed separately|4,189.50|FSC: 13; Default||External grouping not supported 62050729|EAP|CPT® 83873||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MYELIN BASIC PROTEIN|1|HUMANA [1294]||HUMANA [11839]|51.60|FSC: 13; Default||Not reimbursed separately|51.60|FSC: 13; Default||External grouping not supported 62050737|EAP|CPT® 83916||0300 - LABORATORY - GENERAL CLASSIFICATION|HB OLIGOCLONAL BANDING|1|HUMANA [1294]||HUMANA [11839]|82.17|FSC: 13; Default||Not reimbursed separately|82.17|FSC: 13; Default||External grouping not supported 62050752|EAP|CPT® 80188||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PRIMIDONE & METABOLITE|1|HUMANA [1294]||HUMANA [11839]|49.77|FSC: 13; Default||Not reimbursed separately|49.77|FSC: 13; Default||External grouping not supported 95184131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink Medialmax Pocketlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 62050760|EAP|CPT® 85306||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PROTEIN S FUNCTIONAL|1|HUMANA [1294]||HUMANA [11839]|45.96|FSC: 13; Default||Not reimbursed separately|45.96|FSC: 13; Default||External grouping not supported 62050786|EAP|CPT® 84244||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Renin Activity - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|65.97|FSC: 13; Default||Not reimbursed separately|65.97|FSC: 13; Default||External grouping not supported 62050802|EAP|CPT® 82365||0300 - LABORATORY - GENERAL CLASSIFICATION|HB STONE ANALYSIS|1|HUMANA [1294]||HUMANA [11839]|38.70|FSC: 13; Default||Not reimbursed separately|38.70|FSC: 13; Default||External grouping not supported 95184132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Thread 4.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|FSC: 13; Default||Not reimbursed separately|588.00|FSC: 13; Default||External grouping not supported 62050828|EAP|CPT® 84466||0300 - LABORATORY - GENERAL CLASSIFICATION|HB TRANSFERRIN|1|HUMANA [1294]||HUMANA [11839]|38.28|FSC: 13; Default||Not reimbursed separately|38.28|FSC: 13; Default||External grouping not supported 95184130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable 3.5x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 62050844|EAP|CPT® 86592||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VDRL, CSF|1|HUMANA [1294]||HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 62050869|EAP|CPT® 84585||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VMA URINE|1|HUMANA [1294]||HUMANA [11839]|46.50|FSC: 13; Default||Not reimbursed separately|46.50|FSC: 13; Default||External grouping not supported 95184127|EAP|Custom 95184127||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Gastric/colonic Irrigation And Aspiration|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050885|EAP|CPT® 86787||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VZV ANTIBODY IGG|1|HUMANA [1294]||HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 95184128|EAP|Custom 95184128||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Formula Alimentum Advance 16 Oz Can 6/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62050893|EAP|CPT® 86787||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VZV ANTIBODY IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 62050919|EAP|CPT® 86147||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CARDIOLIPIN IGG|1|HUMANA [1294]||HUMANA [11839]|76.35|FSC: 13; Default||Not reimbursed separately|76.35|FSC: 13; Default||External grouping not supported 62050927|EAP|CPT® 86147||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CARDIOLIPIN IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.35|FSC: 13; Default||Not reimbursed separately|76.35|FSC: 13; Default||External grouping not supported 62050943|EAP|CPT® 85613||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Drvvt - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|28.74|FSC: 13; Default||Not reimbursed separately|28.74|FSC: 13; Default||External grouping not supported 95184137|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pentaray Nav Eco 7fr D 2-6-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62050984|EAP|CPT® 85303||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PROTEIN C FUNCTIONAL|1|HUMANA [1294]||HUMANA [11839]|41.52|FSC: 13; Default||Not reimbursed separately|41.52|FSC: 13; Default||External grouping not supported 95184139|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix 035 Pta 6mm X 40mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62051008|EAP|CPT® 85302||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PROTEIN C TOTAL|1|HUMANA [1294]||HUMANA [11839]|36.03|FSC: 13; Default||Not reimbursed separately|36.03|FSC: 13; Default||External grouping not supported 62051016|EAP|CPT® 85305||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PROTEIN S TOTAL|1|HUMANA [1294]||HUMANA [11839]|34.83|FSC: 13; Default||Not reimbursed separately|34.83|FSC: 13; Default||External grouping not supported 95184141|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Convertor Aaa Renu Zenith Flex 32mm X 113cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,714.31|FSC: 13; Default||Not reimbursed separately|20,714.31|FSC: 13; Default||External grouping not supported 62051115|EAP|CPT® 86778||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC TOX PLASMA IGM|1|HUMANA [1294]||HUMANA [11839]|43.23|FSC: 13; Default||Not reimbursed separately|43.23|FSC: 13; Default||External grouping not supported 95184133|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pentaray Nav Eco 7fr F 4-4-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62051156|EAP|CPT® 86695||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HSV TYPE 1|1|HUMANA [1294]||HUMANA [11839]|39.57|FSC: 13; Default||Not reimbursed separately|39.57|FSC: 13; Default||External grouping not supported 95184135|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pentaray Nav Eco 7fr F 1-8-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62051172|EAP|CPT® 86777||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC TOX PLASMA IGG|1|HUMANA [1294]||HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62051214|EAP|CPT® 82300||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cadmium, Blood - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.92|FSC: 13; Default||Not reimbursed separately|70.92|FSC: 13; Default||External grouping not supported 95184136|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pentaray Nav Eco 7fr D 4-4-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62051230|EAP|CPT® 82232||0300 - LABORATORY - GENERAL CLASSIFICATION|HB BETA 2 MICROGLOBULIN|1|HUMANA [1294]||HUMANA [11839]|48.54|FSC: 13; Default||Not reimbursed separately|48.54|FSC: 13; Default||External grouping not supported 62051271|EAP|CPT® 86800||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Thryoglobulin Antibody - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|47.73|FSC: 13; Default||Not reimbursed separately|47.73|FSC: 13; Default||External grouping not supported 95184134|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pentaray Nav Eco 7fr F 2-6-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62051289|EAP|CPT® 84432||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC THYROGLOBULIN|1|HUMANA [1294]||HUMANA [11839]|48.18|FSC: 13; Default||Not reimbursed separately|48.18|FSC: 13; Default||External grouping not supported 62051305|EAP|CPT® 86376||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Thyroid Peroxidase - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|43.65|FSC: 13; Default||Not reimbursed separately|43.65|FSC: 13; Default||External grouping not supported 62051347|EAP|CPT® 82787||0300 - LABORATORY - GENERAL CLASSIFICATION|HB IMMUNO SUBCLASS|1|HUMANA [1294]||HUMANA [11839]|24.06|FSC: 13; Default||Not reimbursed separately|24.06|FSC: 13; Default||External grouping not supported 62051354|EAP|CPT® 82436||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MC URINE CHLORIDE|1|HUMANA [1294]||HUMANA [11839]|17.25|FSC: 13; Default||Not reimbursed separately|17.25|FSC: 13; Default||External grouping not supported 62051362|EAP|CPT® 86738||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Mycoplasma Igg Ab - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.72|FSC: 13; Default||Not reimbursed separately|39.72|FSC: 13; Default||External grouping not supported 62051388|EAP|CPT® 86747||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Parvovirus Igg Ab - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.09|FSC: 13; Default||Not reimbursed separately|45.09|FSC: 13; Default||External grouping not supported 62051446|EAP|CPT® 86235||0300 - LABORATORY - GENERAL CLASSIFICATION|HB SSA (RO)(ENA) IGG|1|HUMANA [1294]||HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 62051453|EAP|CPT® 86235||0300 - LABORATORY - GENERAL CLASSIFICATION|HB SSB (LA)(ENA) IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 62051461|EAP|CPT® 86334||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Immunofix Elect, Serum|1|HUMANA [1294]||HUMANA [11839]|67.02|FSC: 13; Default||Not reimbursed separately|67.02|FSC: 13; Default||External grouping not supported 62051479|EAP|CPT® 82043||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC UR QNT MICROALB|1|HUMANA [1294]||HUMANA [11839]|17.34|FSC: 13; Default||Not reimbursed separately|17.34|FSC: 13; Default||External grouping not supported 62051487|EAP|CPT® 83883||0300 - LABORATORY - GENERAL CLASSIFICATION|HB NEPHLM EA ANALYTE|1|HUMANA [1294]||HUMANA [11839]|40.80|FSC: 13; Default||Not reimbursed separately|40.80|FSC: 13; Default||External grouping not supported 62051511|EAP|CPT® 84165||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Electrophoretic Fractionation|1|HUMANA [1294]||HUMANA [11839]|32.22|FSC: 13; Default||Not reimbursed separately|32.22|FSC: 13; Default||External grouping not supported 95184148|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.7mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 62051552|EAP|CPT® 80053||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Comp Metabolic Panel|1|HUMANA [1294]||HUMANA [11839]|31.68|FSC: 13; Default||Not reimbursed separately|31.68|FSC: 13; Default||External grouping not supported 62051578|EAP|CPT® 82710||0300 - LABORATORY - GENERAL CLASSIFICATION|HB QUANT FECAL FAT|1|HUMANA [1294]||HUMANA [11839]|50.40|FSC: 13; Default||Not reimbursed separately|50.40|FSC: 13; Default||External grouping not supported 62051719|EAP|CPT® 82947||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gluc Whole Blood|1|HUMANA [1294]||HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 95184153|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cotton Flat 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,513.00|FSC: 13; Default||Not reimbursed separately|3,513.00|FSC: 13; Default||External grouping not supported 62051800|EAP|CPT® 85300||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC AT3 ENZYMATIC|1|HUMANA [1294]||HUMANA [11839]|35.55|FSC: 13; Default||Not reimbursed separately|35.55|FSC: 13; Default||External grouping not supported 62051818|EAP|CPT® 85306||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC PROTEIN S FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.96|FSC: 13; Default||Not reimbursed separately|45.96|FSC: 13; Default||External grouping not supported 95184144|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xience Alpine Drug Eluting 2.25mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 62051826|EAP|CPT® 85307||0300 - LABORATORY - GENERAL CLASSIFICATION|HB APC RESIST PROFILE|1|HUMANA [1294]||HUMANA [11839]|45.96|FSC: 13; Default||Not reimbursed separately|45.96|FSC: 13; Default||External grouping not supported 95184147|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.4mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 62051891|EAP|CPT® 82248||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bilirubin Direct|1|HUMANA [1294]||HUMANA [11839]|15.06|FSC: 13; Default||Not reimbursed separately|15.06|FSC: 13; Default||External grouping not supported 95184149|EAP|Custom 95184149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Mini Maxlock Extreme|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62051909|EAP|CPT® 84154||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PSA FREE|1|HUMANA [1294]||HUMANA [11839]|55.17|FSC: 13; Default||Not reimbursed separately|55.17|FSC: 13; Default||External grouping not supported 62051917|EAP|CPT® 85379||0300 - LABORATORY - GENERAL CLASSIFICATION|HB D-DIMER SENSITIVE|1|HUMANA [1294]||HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 62051958|EAP|CPT® 87107||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Chg Fungus Mold Id|1|HUMANA [1294]||HUMANA [11839]|30.96|FSC: 13; Default||Not reimbursed separately|30.96|FSC: 13; Default||External grouping not supported 95184155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlock 3.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 62051966|EAP|CPT® 87076||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Chg Anaerobic Id|1|HUMANA [1294]||HUMANA [11839]|24.24|FSC: 13; Default||Not reimbursed separately|24.24|FSC: 13; Default||External grouping not supported 62051974|EAP|CPT® 86140||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb C-reactive Protein|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62051982|EAP|CPT® 87077||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Aerobic Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.24|FSC: 13; Default||Not reimbursed separately|24.24|FSC: 13; Default||External grouping not supported 62051990|EAP|CPT® 87015||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Conc Inf Agents|1|HUMANA [1294]||HUMANA [11839]|20.04|FSC: 13; Default||Not reimbursed separately|20.04|FSC: 13; Default||External grouping not supported 95184151|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Universal Mini Maxlock Extreme 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 62052022|EAP|CPT® 87168||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Macro Arthropod Id|1|HUMANA [1294]||HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 95187649|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound 6-layer Cytal 7cm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.48|FSC: 13; Default||Not reimbursed separately|106.48|FSC: 13; Default||External grouping not supported 62052030|EAP|CPT® 87169||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Macro Parasite Id|1|HUMANA [1294]||HUMANA [11839]|12.93|FSC: 13; Default||Not reimbursed separately|12.93|FSC: 13; Default||External grouping not supported 95184150|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.4mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 62052063|EAP|CPT® 86606||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pc Aspergillus - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|45.15|FSC: 13; Default||Not reimbursed separately|45.15|FSC: 13; Default||External grouping not supported 62052071|EAP|CPT® 86612||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC BLASTOMYCES|1|HUMANA [1294]||HUMANA [11839]|38.70|FSC: 13; Default||Not reimbursed separately|38.70|FSC: 13; Default||External grouping not supported 62052089|EAP|CPT® 86635||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PC COCCIDIODIES|1|HUMANA [1294]||HUMANA [11839]|34.41|FSC: 13; Default||Not reimbursed separately|34.41|FSC: 13; Default||External grouping not supported 95184152|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Thread 4.0x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 62052105|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Igg, Csf - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 95187650|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Interference 7 X 25 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|921.00|FSC: 13; Default||Not reimbursed separately|921.00|FSC: 13; Default||External grouping not supported 95184145|EAP|Custom 95184145||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Prevail 9 X 16 X 14mm|1|HUMANA [1294]||HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 62052170|EAP|CPT® 87341||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CHG HBSAB CONFIRM|1|HUMANA [1294]||HUMANA [11839]|30.99|FSC: 13; Default||Not reimbursed separately|30.99|FSC: 13; Default||External grouping not supported 62052196|EAP|CPT® 87536||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hiv-1 Rna/dna Qnt - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|255.30|FSC: 13; Default||Not reimbursed separately|255.30|FSC: 13; Default||External grouping not supported 95184146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Straight 2.4mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 62052204|EAP|CPT® 82507||0300 - LABORATORY - GENERAL CLASSIFICATION|HB URINE CITRIC ACID|1|HUMANA [1294]||HUMANA [11839]|83.40|FSC: 13; Default||Not reimbursed separately|83.40|FSC: 13; Default||External grouping not supported 62052212|EAP|CPT® 83945||0300 - LABORATORY - GENERAL CLASSIFICATION|HB UR TOTAL OXALATE|1|HUMANA [1294]||HUMANA [11839]|43.35|FSC: 13; Default||Not reimbursed separately|43.35|FSC: 13; Default||External grouping not supported 62052220|EAP|CPT® 84445||0300 - LABORATORY - GENERAL CLASSIFICATION|HB THYROID STIM IMMUNO|1|HUMANA [1294]||HUMANA [11839]|152.58|FSC: 13; Default||Not reimbursed separately|152.58|FSC: 13; Default||External grouping not supported 95184154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 3.5x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 62052238|EAP|CPT® 82525||0300 - LABORATORY - GENERAL CLASSIFICATION|HB SERUM COPPER|1|HUMANA [1294]||HUMANA [11839]|37.23|FSC: 13; Default||Not reimbursed separately|37.23|FSC: 13; Default||External grouping not supported 62052253|EAP|CPT® 84402||0300 - LABORATORY - GENERAL CLASSIFICATION|HB FREE TESTOSTERONE MALE|1|HUMANA [1294]||HUMANA [11839]|76.41|FSC: 13; Default||Not reimbursed separately|76.41|FSC: 13; Default||External grouping not supported 62052261|EAP|CPT® 84681||0300 - LABORATORY - GENERAL CLASSIFICATION|HB SERUM C-PEPTIDE|1|HUMANA [1294]||HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 62052279|EAP|CPT® 82103||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Alpha 1-antitrypsin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.32|FSC: 13; Default||Not reimbursed separately|40.32|FSC: 13; Default||External grouping not supported 62052287|EAP|CPT® 86316||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Nmp22 - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 95187654|EAP|Custom 95187654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Impress 5fr 65cm Shepherd Hook 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62052295|EAP|CPT® 80194||0300 - LABORATORY - GENERAL CLASSIFICATION|HB QUINIDINE|1|HUMANA [1294]||HUMANA [11839]|43.80|FSC: 13; Default||Not reimbursed separately|43.80|FSC: 13; Default||External grouping not supported 62052311|EAP|CPT® 80192||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PROCAINIMIDE|1|HUMANA [1294]||HUMANA [11839]|50.25|FSC: 13; Default||Not reimbursed separately|50.25|FSC: 13; Default||External grouping not supported 95187657|EAP|Custom 95187657||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Psr 7x14x11mm|1|HUMANA [1294]||HUMANA [11839]|4,836.30|FSC: 13; Default||Not reimbursed separately|4,836.30|FSC: 13; Default||External grouping not supported 95187655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 6.5 X 55 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 62052394|EAP|CPT® 80158||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CYCLOSPORINE A|1|HUMANA [1294]||HUMANA [11839]|54.15|FSC: 13; Default||Not reimbursed separately|54.15|FSC: 13; Default||External grouping not supported 95184156|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Pacing Implantable Sil Bip Active Fix Vent 58cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|FSC: 13; Default||Not reimbursed separately|1,269.00|FSC: 13; Default||External grouping not supported 62052436|EAP|CPT® 82306||0301 - LABORATORY - CHEMISTRY|Hb Vitamin D,25 Hydroxy|1|HUMANA [1294]||HUMANA [11839]|88.80|FSC: 13; Default||Not reimbursed separately|88.80|FSC: 13; Default||External grouping not supported 95187652|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound 6-layer Cytal 5cmx5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.84|FSC: 13; Default||Not reimbursed separately|132.84|FSC: 13; Default||External grouping not supported 62052444|EAP|CPT® 82652||0301 - LABORATORY - CHEMISTRY|HB VITAMIN D,1, 25 HYDROXY|1|HUMANA [1294]||HUMANA [11839]|115.50|FSC: 13; Default||Not reimbursed separately|115.50|FSC: 13; Default||External grouping not supported 95184157|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 14 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62052451|EAP|CPT® 87529||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hsv Pcr, Blood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95184158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 4-hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 62052477|EAP|CPT® 87252||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Viral Culture - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 95187653|EAP|Custom 95187653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Impress Bentson 5fr 65cm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62052493|EAP|CPT® 87522||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Hepatitis C Rna Qnt/pcr|1|HUMANA [1294]||HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 62052501|EAP|CPT® 80299||0300 - LABORATORY - GENERAL CLASSIFICATION|HB AMIODARONE & METABOLITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 95184159|EAP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Visions Ivus Pv 0.35|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62052568|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|HB TRANSGLUT REFLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95187658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfn 10mm/130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 62052576|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|HB ENDOMYSIAL TITER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62052592|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|HB PC GLIADIN PEPTIDE IGA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62052600|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|HB PC GLIADIN PEPTIDE IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95184163|EAP|Custom 95184163||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Dbm Allograft 5cc|1|HUMANA [1294]||HUMANA [11839]|2,856.00|FSC: 13; Default||Not reimbursed separately|2,856.00|FSC: 13; Default||External grouping not supported 62052626|EAP|CPT® 86631||0302 - LABORATORY - IMMUNOLOGY|HB CHLAMYDIA IGG|1|HUMANA [1294]||HUMANA [11839]|35.46|FSC: 13; Default||Not reimbursed separately|35.46|FSC: 13; Default||External grouping not supported 62052634|EAP|CPT® 86632||0302 - LABORATORY - IMMUNOLOGY|HB CHLAMYDIA IGM|1|HUMANA [1294]||HUMANA [11839]|38.04|FSC: 13; Default||Not reimbursed separately|38.04|FSC: 13; Default||External grouping not supported 95187651|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Cardiomems .018 In/260 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62052642|EAP|CPT® 80202||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Vancomycin Random|1|HUMANA [1294]||HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 62052659|EAP|CPT® 80202||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Vancomycin Trough|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 95184160|EAP|Custom 95184160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Closure Skin Prineo Dermabond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62052667|EAP|CPT® 80202||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Vancomycin Peak|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 62052675|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Yeast Mic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 95184164|EAP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Oculo 2x2 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.00|FSC: 13; Default||Not reimbursed separately|1,740.00|FSC: 13; Default||External grouping not supported 95187656|EAP|Custom 95187656||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Maxbraid #2 Blue Needle Tapered C-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Radial Stem 32mm Straight Ti 10mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|FSC: 13; Default||Not reimbursed separately|5,467.50|FSC: 13; Default||External grouping not supported 62052733|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|HB ASM IGG TITER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 80168362|EAP|CPT® 96542||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hb Chemo Injection, Subarachnoid Or Intraventricular Via Subq Res|1|HUMANA [1294]||HUMANA [11839]|523.56|FSC: 13; Default||Not reimbursed separately|523.56|FSC: 13; Default||External grouping not supported 62052758|EAP|CPT® 82627||0301 - LABORATORY - CHEMISTRY|Hb Dhea Sulfate|1|HUMANA [1294]||HUMANA [11839]|66.69|FSC: 13; Default||Not reimbursed separately|66.69|FSC: 13; Default||External grouping not supported 62052766|EAP|CPT® 83970||0301 - LABORATORY - CHEMISTRY|Hb Pth Turbo|1|HUMANA [1294]||HUMANA [11839]|123.84|FSC: 13; Default||Not reimbursed separately|123.84|FSC: 13; Default||External grouping not supported 95184170|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Proximal Lateral Humerus Ts 5 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|FSC: 13; Default||Not reimbursed separately|4,387.50|FSC: 13; Default||External grouping not supported 62052774|EAP|CPT® 86336||0302 - LABORATORY - IMMUNOLOGY|HB INHIBIN A|1|HUMANA [1294]||HUMANA [11839]|46.77|FSC: 13; Default||Not reimbursed separately|46.77|FSC: 13; Default||External grouping not supported 62052808|EAP|CPT® 86902||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Confirmed Ag Typing -hox|1|HUMANA [1294]||HUMANA [11839]|19.05|FSC: 13; Default||Not reimbursed separately|19.05|FSC: 13; Default||External grouping not supported 95184172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Versa -dial 50x24x52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|FSC: 13; Default||Not reimbursed separately|5,508.00|FSC: 13; Default||External grouping not supported 62052832|EAP|CPT® 85014||0305 - LABORATORY - HEMATOLOGY|Hb Hematocrit|1|HUMANA [1294]||HUMANA [11839]|7.11|FSC: 13; Default||Not reimbursed separately|7.11|FSC: 13; Default||External grouping not supported 62052857|EAP|CPT® 87804||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Influenza B|1|HUMANA [1294]||HUMANA [11839]|49.65|FSC: 13; Default||Not reimbursed separately|49.65|FSC: 13; Default||External grouping not supported 95184171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Comp Primary 15mm Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,244.00|FSC: 13; Default||Not reimbursed separately|14,244.00|FSC: 13; Default||External grouping not supported 62052873|EAP|CPT® 86880||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Dat-igg|1|HUMANA [1294]||HUMANA [11839]|16.17|FSC: 13; Default||Not reimbursed separately|16.17|FSC: 13; Default||External grouping not supported 95187666|EAP|Custom 95187666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ultrabraid 2-0 White 24 10 Pack|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62052881|EAP|CPT® 86880||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Dat-c3d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.17|FSC: 13; Default||Not reimbursed separately|16.17|FSC: 13; Default||External grouping not supported 95184113|EAP|Custom 95184113||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Laser Holmium 200 Flexiva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62052907|EAP|CPT® 85732||0305 - LABORATORY - HEMATOLOGY|Hb Ptt 1:1 Mix - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 62052915|EAP|CPT® 85597||0305 - LABORATORY - HEMATOLOGY|Hb Plt Neutralization - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.94|FSC: 13; Default||Not reimbursed separately|53.94|FSC: 13; Default||External grouping not supported 95184165|EAP|Custom 95184165||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Ruby 60cm|1|HUMANA [1294]||HUMANA [11839]|5,970.00|FSC: 13; Default||Not reimbursed separately|5,970.00|FSC: 13; Default||External grouping not supported 62052923|EAP|CPT® 85613||0305 - LABORATORY - HEMATOLOGY|Hb Drvvt 1:1 Mix - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.74|FSC: 13; Default||Not reimbursed separately|28.74|FSC: 13; Default||External grouping not supported 95187671|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 62052931|EAP|CPT® 85613||0305 - LABORATORY - HEMATOLOGY|Hb Drvvt Confirmation - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.74|FSC: 13; Default||Not reimbursed separately|28.74|FSC: 13; Default||External grouping not supported 95184169|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hydrophilic Zipwire .038 Angled Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62052949|EAP|CPT® 87804||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Influenza A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.65|FSC: 13; Default||Not reimbursed separately|49.65|FSC: 13; Default||External grouping not supported 62052972|EAP|CPT® 86923||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Electronic Crossmatch|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95187673|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 52 20 Mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95184177|EAP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epifix 2cm X 4cm|1|HUMANA [1294]||HUMANA [11839]|482.06|FSC: 13; Default||Not reimbursed separately|482.06|FSC: 13; Default||External grouping not supported 62053061|EAP|CPT® 82731||0301 - LABORATORY - CHEMISTRY|Hb Fetal Fibronectin|1|HUMANA [1294]||HUMANA [11839]|193.23|FSC: 13; Default||Not reimbursed separately|193.23|FSC: 13; Default||External grouping not supported 95184176|EAP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epifix 2cm X 2cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|739.13|FSC: 13; Default||Not reimbursed separately|739.13|FSC: 13; Default||External grouping not supported 62053087|EAP|CPT® 80197||0300 - LABORATORY - GENERAL CLASSIFICATION|HB TACROLIMUS|1|HUMANA [1294]||HUMANA [11839]|41.19|FSC: 13; Default||Not reimbursed separately|41.19|FSC: 13; Default||External grouping not supported 95187670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 52 20mm Reunion Ts4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 62053129|EAP|CPT® 87046||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Campy Culture|1|HUMANA [1294]||HUMANA [11839]|28.32|FSC: 13; Default||Not reimbursed separately|28.32|FSC: 13; Default||External grouping not supported 62053137|EAP|CPT® 87045||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Shig/salmonella Culture|1|HUMANA [1294]||HUMANA [11839]|28.32|FSC: 13; Default||Not reimbursed separately|28.32|FSC: 13; Default||External grouping not supported 62053145|EAP|CPT® 87427||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Shiga Toxin-ecoli|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 95184182|EAP|Custom 95184182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Rvs 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62053152|EAP|HCPCS P9022||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Rbcs Washed|1|HUMANA [1294]||HUMANA [11839]|1,139.19|FSC: 13; Default||Not reimbursed separately|1,139.19|FSC: 13; Default||External grouping not supported 62053178|EAP|CPT® 83970||0301 - LABORATORY - CHEMISTRY|Hb Pth Intact|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.84|FSC: 13; Default||Not reimbursed separately|123.84|FSC: 13; Default||External grouping not supported 62053186|EAP|CPT® 87185||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Microbe Enzyme Detection|1|HUMANA [1294]||HUMANA [11839]|14.25|FSC: 13; Default||Not reimbursed separately|14.25|FSC: 13; Default||External grouping not supported 62053194|EAP|CPT® 85732||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ptt Dilution|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 95184181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5 Hexagonal 4.75x30st|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|FSC: 13; Default||Not reimbursed separately|720.00|FSC: 13; Default||External grouping not supported 62053202|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|HB ANCA IFA|1|HUMANA [1294]||HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95184175|EAP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Epifix 18mm Disk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|685.50|FSC: 13; Default||Not reimbursed separately|685.50|FSC: 13; Default||External grouping not supported 62053228|EAP|CPT® 87184||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Disk Susceptibility|1|HUMANA [1294]||HUMANA [11839]|22.44|FSC: 13; Default||Not reimbursed separately|22.44|FSC: 13; Default||External grouping not supported 95187663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5 X 120mm Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 62053236|EAP|CPT® 87181||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Vancomycin Screen|1|HUMANA [1294]||HUMANA [11839]|14.25|FSC: 13; Default||Not reimbursed separately|14.25|FSC: 13; Default||External grouping not supported 95184180|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guides Instrument Specific Patient Fem/tib Nexgen Persona|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 62053285|EAP|CPT® 84311||0301 - LABORATORY - CHEMISTRY|Hb Spectro Analyte|1|HUMANA [1294]||HUMANA [11839]|24.30|FSC: 13; Default||Not reimbursed separately|24.30|FSC: 13; Default||External grouping not supported 62053293|EAP|CPT® 86788||0302 - LABORATORY - IMMUNOLOGY|Hb Wnv Igm Ab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 62053301|EAP|CPT® 86789||0302 - LABORATORY - IMMUNOLOGY|HB WNV IGG AB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 95184179|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Kinectiv 12/14 Taper Size E1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mmx130 340mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95184178|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 62053350|EAP|CPT® 88112||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Ngyn Liq Based Prep|1|HUMANA [1294]||HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62053368|EAP|CPT® 87101||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Culture Fungus Skin|1|HUMANA [1294]||HUMANA [11839]|23.13|FSC: 13; Default||Not reimbursed separately|23.13|FSC: 13; Default||External grouping not supported 62053376|EAP|CPT® 87101||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Culture Fungus Hair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.13|FSC: 13; Default||Not reimbursed separately|23.13|FSC: 13; Default||External grouping not supported 62053384|EAP|CPT® 87101||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Culture Fungus Nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.13|FSC: 13; Default||Not reimbursed separately|23.13|FSC: 13; Default||External grouping not supported 95184187|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soundstar Eco Ge 8f|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62053392|EAP|CPT® 87147||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Agglutination Grouping|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95187664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 8hole/l95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95184193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 2.4 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 62053426|EAP|HCPCS G0145||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Pap Auto/man Rescreen|1|HUMANA [1294]||HUMANA [11839]|79.47|FSC: 13; Default||Not reimbursed separately|79.47|FSC: 13; Default||External grouping not supported 62053442|EAP|CPT® 86901||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rh Type|1|HUMANA [1294]||HUMANA [11839]|8.97|FSC: 13; Default||Not reimbursed separately|8.97|FSC: 13; Default||External grouping not supported 95184199|EAP|Custom 95184199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Skin Liquiband Flex Octyl 0.8 Gram 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187672|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hockey Stick 2 5fr 100cm .035 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62053509|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Amitriptyline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95184184|EAP|Custom 95184184||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Fortifier Human Milk Prolact+6 30ml (order Must Be Asst. Of4)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62053517|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Nortriptyline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62053533|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Desipramine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95184196|EAP|Custom 95184196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62053541|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Doxepin & Metabolite|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95187669|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Hockey Stick 2 5fr 65cm .038 5/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.3mm X 14mmss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 62053632|EAP|HCPCS P9044||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Cryo Reduced Plasma|1|HUMANA [1294]||HUMANA [11839]|274.23|FSC: 13; Default||Not reimbursed separately|274.23|FSC: 13; Default||External grouping not supported 95184191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 62053640|EAP|CPT® 86927||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Plasma Thawing Fee|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62053657|EAP|CPT® 87808||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Trichomonas Antigen|1|HUMANA [1294]||HUMANA [11839]|45.87|FSC: 13; Default||Not reimbursed separately|45.87|FSC: 13; Default||External grouping not supported 95184186|EAP|Custom 95184186||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Fortifier Human Milk Prolact 10ml (must Order Asst. Of 4 Ea)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80169702|EAP|CPT® 76499||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Body Composition Scan Research|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|FSC: 13; Default||Not reimbursed separately|227.43|FSC: 13; Default||External grouping not supported 62053715|EAP|CPT® 86965||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pooling Bbprod Fee|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95184197|EAP|Custom 95184197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Steripack Fixator External Coretrack Articulating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62053723|EAP|CPT® 86300||0302 - LABORATORY - IMMUNOLOGY|HB CANCER ANTIGEN 27.29|1|HUMANA [1294]||HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 62053731|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|HB TTGA IGA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95184185|EAP|Custom 95184185||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Fortifier Human Milk Prolact+8 40ml (order Must Be Asst Of 4)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62053749|EAP|CPT® 84305||0301 - LABORATORY - CHEMISTRY|HB IGF-1|1|HUMANA [1294]||HUMANA [11839]|63.78|FSC: 13; Default||Not reimbursed separately|63.78|FSC: 13; Default||External grouping not supported 95187675|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Tibial Persona Fixed Bearing Uc Rt 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 62053756|EAP|CPT® 80175||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lamotrigine|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 62053764|EAP|CPT® 83695||0301 - LABORATORY - CHEMISTRY|Hb Liprotein (a) - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|42.96|FSC: 13; Default||Not reimbursed separately|42.96|FSC: 13; Default||External grouping not supported 95184192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 2.4 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,101.00|FSC: 13; Default||Not reimbursed separately|1,101.00|FSC: 13; Default||External grouping not supported 62053772|EAP|CPT® 86235||0302 - LABORATORY - IMMUNOLOGY|HB SCLERODERMA IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 62053780|EAP|CPT® 80195||0300 - LABORATORY - GENERAL CLASSIFICATION|HB SIROLIMUS|1|HUMANA [1294]||HUMANA [11839]|41.19|FSC: 13; Default||Not reimbursed separately|41.19|FSC: 13; Default||External grouping not supported 62053806|EAP|CPT® 86696||0302 - LABORATORY - IMMUNOLOGY|HB HSV TYPE 2|1|HUMANA [1294]||HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 95184194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock 2.4 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 62053848|EAP|CPT® 86141||0302 - LABORATORY - IMMUNOLOGY|Hb Crp-high Sensitivity|1|HUMANA [1294]||HUMANA [11839]|38.85|FSC: 13; Default||Not reimbursed separately|38.85|FSC: 13; Default||External grouping not supported 95187674|EAP|Custom 95187674||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Cervical Prosthesis Standard 15x19 H5|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 62053863|EAP|CPT® 82533||0301 - LABORATORY - CHEMISTRY|Hb Cortisol - 30 Minute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.90|FSC: 13; Default||Not reimbursed separately|48.90|FSC: 13; Default||External grouping not supported 95184189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plaple 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|FSC: 13; Default||Not reimbursed separately|1,155.00|FSC: 13; Default||External grouping not supported 62053897|EAP|CPT® 86694||0302 - LABORATORY - IMMUNOLOGY|HB HSV ANTIBODY IGM|1|HUMANA [1294]||HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 95184195|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock 2.4 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 62053913|EAP|CPT® 84075||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Total Alk Phos|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62053921|EAP|CPT® 84078||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Heat Stable Alk Phos|1|HUMANA [1294]||HUMANA [11839]|24.78|FSC: 13; Default||Not reimbursed separately|24.78|FSC: 13; Default||External grouping not supported 95187676|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 20cm X 20cm Perforated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.70|FSC: 13; Default||Not reimbursed separately|77.70|FSC: 13; Default||External grouping not supported 62053947|EAP|CPT® 80061||0301 - LABORATORY - CHEMISTRY|Hb Lipid Panel (screening)|1|HUMANA [1294]||HUMANA [11839]|40.17|FSC: 13; Default||Not reimbursed separately|40.17|FSC: 13; Default||External grouping not supported 62063938|EAP|CPT® 84145||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Procalcitonin|1|HUMANA [1294]||HUMANA [11839]|81.66|FSC: 13; Default||Not reimbursed separately|81.66|FSC: 13; Default||External grouping not supported 62053954|EAP|CPT® 88184||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Flow Cyto Tech Comp|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62053962|EAP|CPT® 88185||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Flow Cyto Tech Add Marker|1|HUMANA [1294]||HUMANA [11839]|113.56|FSC: 13; Default||Not reimbursed separately|113.56|FSC: 13; Default||External grouping not supported 95184209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|FSC: 13; Default||Not reimbursed separately|1,260.00|FSC: 13; Default||External grouping not supported 62053970|EAP|Custom 62053970||0998 - STATISTICAL CHARGES|Hb Flow Cyto Intp 2-8 Marker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187677|EAP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Strattice 20cm X 25cm Perforated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.16|FSC: 13; Default||Not reimbursed separately|76.16|FSC: 13; Default||External grouping not supported 62053988|EAP|Custom 62053988||0998 - STATISTICAL CHARGES|Hb Flow Cyto Intp 9-15 Markr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184204|EAP|Custom 95184204||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Blank Lead Edge Cover|1|HUMANA [1294]||HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 62053996|EAP|Custom 62053996||0998 - STATISTICAL CHARGES|Hb Flow Cyto Intp 16 Or More|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184211|EAP|Custom 95184211||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Bioprosthesis Aortic Pericardial Perimount Carpentier|1|HUMANA [1294]||HUMANA [11839]|18,885.00|FSC: 13; Default||Not reimbursed separately|18,885.00|FSC: 13; Default||External grouping not supported 62054051|EAP|CPT® 86060||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Aso Titer|1|HUMANA [1294]||HUMANA [11839]|21.90|FSC: 13; Default||Not reimbursed separately|21.90|FSC: 13; Default||External grouping not supported 95187665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hat-trick Pip Fusion 2.7mmprox 0 Deg. 4mm Mid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.70|FSC: 13; Default||Not reimbursed separately|2,702.70|FSC: 13; Default||External grouping not supported 62054069|EAP|CPT® 80061||0301 - LABORATORY - CHEMISTRY|Hb Lipid Panel (reflex)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.17|FSC: 13; Default||Not reimbursed separately|40.17|FSC: 13; Default||External grouping not supported 62054093|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cannabinoid Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62054101|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Cocaine Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62054119|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Opiate Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95184200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Headless Comp Ft 4.0 X 44m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 62054127|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Pcp Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62054135|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Amphetamine Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95187682|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 8mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 62054150|EAP|CPT® 84402||0300 - LABORATORY - GENERAL CLASSIFICATION|HB FREE TESTOST FEM/CHILD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.41|FSC: 13; Default||Not reimbursed separately|76.41|FSC: 13; Default||External grouping not supported 62054168|EAP|CPT® 88323||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Consult Referred Block|1|HUMANA [1294]||HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62054176|EAP|CPT® 84153||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Psa,total (tumor Marker)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.17|FSC: 13; Default||Not reimbursed separately|55.17|FSC: 13; Default||External grouping not supported 62054184|EAP|HCPCS G0103||0301 - LABORATORY - CHEMISTRY|Hb Psa,total (screening)|1|HUMANA [1294]||HUMANA [11839]|57.93|FSC: 13; Default||Not reimbursed separately|57.93|FSC: 13; Default||External grouping not supported 62054192|EAP|CPT® 86301||0302 - LABORATORY - IMMUNOLOGY|HB CA 19-9|1|HUMANA [1294]||HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 95184210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Medial Rt 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,966.00|FSC: 13; Default||Not reimbursed separately|6,966.00|FSC: 13; Default||External grouping not supported 62054200|EAP|CPT® 83498||0300 - LABORATORY - GENERAL CLASSIFICATION|HB 17-HYDROXYPROGESTERONE|1|HUMANA [1294]||HUMANA [11839]|81.51|FSC: 13; Default||Not reimbursed separately|81.51|FSC: 13; Default||External grouping not supported 62054218|EAP|CPT® 86157||0302 - LABORATORY - IMMUNOLOGY|Hb Cold Agglutinins - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|24.18|FSC: 13; Default||Not reimbursed separately|24.18|FSC: 13; Default||External grouping not supported 95187679|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Generator Pulse Implantable Novi Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 62054226|EAP|CPT® 82985||0301 - LABORATORY - CHEMISTRY|HB FRUCTOSAMINE|1|HUMANA [1294]||HUMANA [11839]|50.28|FSC: 13; Default||Not reimbursed separately|50.28|FSC: 13; Default||External grouping not supported 62054242|EAP|CPT® 86698||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HISTOPLASMA ABS/ID|1|HUMANA [1294]||HUMANA [11839]|41.37|FSC: 13; Default||Not reimbursed separately|41.37|FSC: 13; Default||External grouping not supported 62054259|EAP|CPT® 86698||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HISTOPLASMA MYCELIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.37|FSC: 13; Default||Not reimbursed separately|41.37|FSC: 13; Default||External grouping not supported 62054267|EAP|CPT® 86698||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HISTOPLASMA YEAST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.37|FSC: 13; Default||Not reimbursed separately|41.37|FSC: 13; Default||External grouping not supported 95184208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture 2.9 Osteoraptor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|984.00|FSC: 13; Default||Not reimbursed separately|984.00|FSC: 13; Default||External grouping not supported 62054317|EAP|CPT® 85246||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Vw Factor Antigen - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 62054325|EAP|CPT® 85245||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Vw Factor Activity - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 95187680|EAP|Custom 95187680||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Control Remote Freelink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62054333|EAP|CPT® 84110||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Porphobilinogen Qnt Urine - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|25.32|FSC: 13; Default||Not reimbursed separately|25.32|FSC: 13; Default||External grouping not supported 62054366|EAP|CPT® 86611||0302 - LABORATORY - IMMUNOLOGY|HB B HEMSELAE IGG BY IFA|1|HUMANA [1294]||HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 95184203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 62054374|EAP|CPT® 86611||0302 - LABORATORY - IMMUNOLOGY|HB B HEMSELAE IGM BY IFA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 95187681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 10 Mm Tibia C-d/cr Fem 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 62054390|EAP|CPT® 80186||0300 - LABORATORY - GENERAL CLASSIFICATION|HB FREE PHENYTOIN|1|HUMANA [1294]||HUMANA [11839]|41.28|FSC: 13; Default||Not reimbursed separately|41.28|FSC: 13; Default||External grouping not supported 62054408|EAP|CPT® 80185||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PHENYTOIN TOTAL|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 62054440|EAP|CPT® 83516||0300 - LABORATORY - GENERAL CLASSIFICATION|HB F-ACTIN IGG REFLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62054457|EAP|CPT® 85014||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Hematocrit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.11|FSC: 13; Default||Not reimbursed separately|7.11|FSC: 13; Default||External grouping not supported 62054499|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CELIAC DISEASE REFLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62054523|EAP|CPT® 86003||0300 - LABORATORY - GENERAL CLASSIFICATION|HB LATEX ALLERGEN|1|HUMANA [1294]||HUMANA [11839]|15.66|FSC: 13; Default||Not reimbursed separately|15.66|FSC: 13; Default||External grouping not supported 62054531|EAP|CPT® 83516||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MAG IGM TITER/ELISA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62054549|EAP|CPT® 86735||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MUMPS VIRUS IGG|1|HUMANA [1294]||HUMANA [11839]|39.15|FSC: 13; Default||Not reimbursed separately|39.15|FSC: 13; Default||External grouping not supported 62054556|EAP|CPT® 86735||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MUMPS VIRUS IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.15|FSC: 13; Default||Not reimbursed separately|39.15|FSC: 13; Default||External grouping not supported 95184206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio-com Int Ft 7 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 62054564|EAP|CPT® 80299||0300 - LABORATORY - GENERAL CLASSIFICATION|HB OXCARBAZEPINE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.92|FSC: 13; Default||Not reimbursed separately|55.92|FSC: 13; Default||External grouping not supported 62054572|EAP|CPT® 84270||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Sex Hormone Bglobulin - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|65.19|FSC: 13; Default||Not reimbursed separately|65.19|FSC: 13; Default||External grouping not supported 62054580|EAP|CPT® 86757||0300 - LABORATORY - GENERAL CLASSIFICATION|HB RMSF IGG ANTIBODY|1|HUMANA [1294]||HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 95184190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.0 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 62054598|EAP|CPT® 86757||0300 - LABORATORY - GENERAL CLASSIFICATION|HB RMSF IGM ANTIBODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 62054614|EAP|CPT® 86757||0300 - LABORATORY - GENERAL CLASSIFICATION|HB TYPHUS FEVER IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 62054622|EAP|CPT® 86757||0300 - LABORATORY - GENERAL CLASSIFICATION|HB TYPHUS FEVER IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 62054648|EAP|CPT® 84425||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VIT B1 (THIAMINE) WB|1|HUMANA [1294]||HUMANA [11839]|63.69|FSC: 13; Default||Not reimbursed separately|63.69|FSC: 13; Default||External grouping not supported 95184201|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95187684|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound 6-layer Cytal 10x15cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.28|FSC: 13; Default||Not reimbursed separately|85.28|FSC: 13; Default||External grouping not supported 62054713|EAP|CPT® 81003||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Ketones|1|HUMANA [1294]||HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 95184207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Lock Swivel Biocomposite With Out Tape 4.75 X 19.1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 62054721|EAP|CPT® 87088||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Presump Id|1|HUMANA [1294]||HUMANA [11839]|24.27|FSC: 13; Default||Not reimbursed separately|24.27|FSC: 13; Default||External grouping not supported 95187685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Iconix 2 Tt With Intellibraid Technology 2.3mm Anchor With 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|FSC: 13; Default||Not reimbursed separately|1,080.00|FSC: 13; Default||External grouping not supported 62054747|EAP|CPT® 84481||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Free T3|1|HUMANA [1294]||HUMANA [11839]|50.82|FSC: 13; Default||Not reimbursed separately|50.82|FSC: 13; Default||External grouping not supported 62054754|EAP|CPT® 84207||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VITAMIN B6|1|HUMANA [1294]||HUMANA [11839]|84.30|FSC: 13; Default||Not reimbursed separately|84.30|FSC: 13; Default||External grouping not supported 62054762|EAP|CPT® 84703||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Serum Hcg(pregnancy)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.56|FSC: 13; Default||Not reimbursed separately|22.56|FSC: 13; Default||External grouping not supported 62054776|EAP|CPT® 82575||0301 - LABORATORY - CHEMISTRY|Hb Creatinine Clearance|1|HUMANA [1294]||HUMANA [11839]|28.38|FSC: 13; Default||Not reimbursed separately|28.38|FSC: 13; Default||External grouping not supported 95184213|EAP|Custom 95184213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Set Ez-io 45mm + Stabilizer 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62054796|EAP|CPT® 82105||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MATERNAL SCREEN AFP ONLY|1|HUMANA [1294]||HUMANA [11839]|50.31|FSC: 13; Default||Not reimbursed separately|50.31|FSC: 13; Default||External grouping not supported 95187687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trinica 4 Level 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.80|FSC: 13; Default||Not reimbursed separately|6,880.80|FSC: 13; Default||External grouping not supported 62054812|EAP|CPT® 87798||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PCR VARICELLA-ZOSTER|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95184221|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Legion Straight 13mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 62054861|EAP|CPT® 83013||0300 - LABORATORY - GENERAL CLASSIFICATION|HB H PYLORI BREATH|1|HUMANA [1294]||HUMANA [11839]|202.08|FSC: 13; Default||Not reimbursed separately|202.08|FSC: 13; Default||External grouping not supported 95187688|EAP|Custom 95187688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wand Ii Coblation Max Procise|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184224|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Femoral Screw-on Distal Legion Size 3 -5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|FSC: 13; Default||Not reimbursed separately|4,243.80|FSC: 13; Default||External grouping not supported 95187692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti Cann Tfn 11mm/125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 62054929|EAP|CPT® 83880||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Nt Probnp|1|HUMANA [1294]||HUMANA [11839]|117.78|FSC: 13; Default||Not reimbursed separately|117.78|FSC: 13; Default||External grouping not supported 62054937|EAP|CPT® 82043||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ur Microalbumin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.34|FSC: 13; Default||Not reimbursed separately|17.34|FSC: 13; Default||External grouping not supported 95184220|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wedge Tibial 15mm Sz3-4 Lt/mdl-rt/lat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|FSC: 13; Default||Not reimbursed separately|4,752.00|FSC: 13; Default||External grouping not supported 62054978|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Oxycodone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62054994|EAP|CPT® 80074||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Acute Hepatitis Panel|1|HUMANA [1294]||HUMANA [11839]|142.89|FSC: 13; Default||Not reimbursed separately|142.89|FSC: 13; Default||External grouping not supported 62055009|EAP|CPT® 86644||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CMV IGG|1|HUMANA [1294]||HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62055017|EAP|CPT® 86645||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CMV IGM|1|HUMANA [1294]||HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 62055025|EAP|CPT® 84436||0300 - LABORATORY - GENERAL CLASSIFICATION|HB THYROXINE (T4)|1|HUMANA [1294]||HUMANA [11839]|20.61|FSC: 13; Default||Not reimbursed separately|20.61|FSC: 13; Default||External grouping not supported 62055033|EAP|CPT® 84590||0300 - LABORATORY - GENERAL CLASSIFICATION|HB VITAMIN A (RETINOL)|1|HUMANA [1294]||HUMANA [11839]|34.83|FSC: 13; Default||Not reimbursed separately|34.83|FSC: 13; Default||External grouping not supported 62055058|EAP|CPT® 82274||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fecal Heme Diagnostic|1|HUMANA [1294]||HUMANA [11839]|47.76|FSC: 13; Default||Not reimbursed separately|47.76|FSC: 13; Default||External grouping not supported 62055066|EAP|CPT® 82595||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CRYOGLOBULIN REFLEX|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 62055074|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|HB IGA CRYOGLOBULIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62055082|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|HB IGM CRYOGLOBULIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62055090|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|HB IGG CRYOGLOBULIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62055116|EAP|CPT® 86850||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Antibody Screen|1|HUMANA [1294]||HUMANA [11839]|29.31|FSC: 13; Default||Not reimbursed separately|29.31|FSC: 13; Default||External grouping not supported 95184215|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix 035 Pta 6mm X 60mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Reelx Stt 4.5mm Knotless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,447.53|FSC: 13; Default||Not reimbursed separately|1,447.53|FSC: 13; Default||External grouping not supported 62055199|EAP|CPT® 86003||0302 - LABORATORY - IMMUNOLOGY|HB ALLERGEN A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.66|FSC: 13; Default||Not reimbursed separately|15.66|FSC: 13; Default||External grouping not supported 95184225|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Construct Oxinum Legion Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 95187696|EAP|Custom 95187696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maggot Biobag 200|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184223|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Straight 13mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|FSC: 13; Default||Not reimbursed separately|4,296.60|FSC: 13; Default||External grouping not supported 62055256|EAP|CPT® 88262||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|HB POC CHROM 15-20 ANALYSIS|1|HUMANA [1294]||HUMANA [11839]|376.47|FSC: 13; Default||Not reimbursed separately|376.47|FSC: 13; Default||External grouping not supported 62055264|EAP|CPT® 88233||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|HB POC TISSUE CULTURE/SKIN/BIOPSY|1|HUMANA [1294]||HUMANA [11839]|422.19|FSC: 13; Default||Not reimbursed separately|422.19|FSC: 13; Default||External grouping not supported 95184217|EAP|Custom 95184217||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endograft Ovation Limb Iniac 10 Mm X 140 Mm|1|HUMANA [1294]||HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 62055272|EAP|CPT® 88264||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|HB BM CHROM 20-25 ANAL|1|HUMANA [1294]||HUMANA [11839]|433.83|FSC: 13; Default||Not reimbursed separately|433.83|FSC: 13; Default||External grouping not supported 95187700|EAP|Custom 95187700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Nosebleed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62055280|EAP|CPT® 88237||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|HB BM TISSUE CULTURE|1|HUMANA [1294]||HUMANA [11839]|431.25|FSC: 13; Default||Not reimbursed separately|431.25|FSC: 13; Default||External grouping not supported 62055298|EAP|CPT® 88262||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|HB PB CHROM 15-20 ANAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.47|FSC: 13; Default||Not reimbursed separately|376.47|FSC: 13; Default||External grouping not supported 95184216|EAP|Custom 95184216||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endograft Body Aortic Ovation 34 Mm|1|HUMANA [1294]||HUMANA [11839]|21,000.00|FSC: 13; Default||Not reimbursed separately|21,000.00|FSC: 13; Default||External grouping not supported 62055306|EAP|CPT® 88230||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|HB PB TISSUE CULTURE|1|HUMANA [1294]||HUMANA [11839]|349.47|FSC: 13; Default||Not reimbursed separately|349.47|FSC: 13; Default||External grouping not supported 95187694|EAP|Custom 95187694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maggot Biobag 50|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184222|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articular Tibial Constrained Genesis Size 3-4 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|FSC: 13; Default||Not reimbursed separately|7,174.20|FSC: 13; Default||External grouping not supported 95187702|EAP|Custom 95187702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr 100cm Bentson 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184212|EAP|Custom 95184212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Set Ez-io 25mm + Stabilizer 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187703|EAP|Custom 95187703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 5fr 65cm Modifiedshepard Hook 1.07mm 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62055389|EAP|CPT® 87385||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HB HISTOPLASMA ANTIGEN URINE|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 95187695|EAP|Custom 95187695||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maggot Biobag 100|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184230|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Cuff Aortic Renu Flex Zenith 32mm X 43cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|FSC: 13; Default||Not reimbursed separately|16,113.00|FSC: 13; Default||External grouping not supported 62055470|EAP|CPT® 85610||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Prothrombin Time|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.87|FSC: 13; Default||Not reimbursed separately|12.87|FSC: 13; Default||External grouping not supported 62055488|EAP|CPT® 85730||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ptt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.03|FSC: 13; Default||Not reimbursed separately|18.03|FSC: 13; Default||External grouping not supported 95187697|EAP|Custom 95187697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maggot Biobag 300|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157121|EAP|Custom 95157121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cup Cervical Vcare Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62055546|EAP|CPT® 82164||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ACE CSF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.80|FSC: 13; Default||Not reimbursed separately|43.80|FSC: 13; Default||External grouping not supported 62055553|EAP|CPT® 83921||0300 - LABORATORY - GENERAL CLASSIFICATION|HB MMA QUANTITATIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.63|FSC: 13; Default||Not reimbursed separately|63.63|FSC: 13; Default||External grouping not supported 95157123|EAP|Custom 95157123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cup Cervical Vcare Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187699|EAP|Custom 95187699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maggot Biobag 400|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62055579|EAP|Custom 62055579||0998 - STATISTICAL CHARGES|Hb Touch Prep|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62055587|EAP|Custom 62055587||0998 - STATISTICAL CHARGES|Hb Touch Prep Each Additional Site|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95157122|EAP|Custom 95157122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cup Cervical Vcare Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187701|EAP|Custom 95187701||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Impress 5fr 65cm Braided 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 2 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 95184238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 5-hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 62055694|EAP|CPT® 87496||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cmv Pcr, Blood|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95187713|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Trulign Torric Sphere 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Profile Low 3.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 62055827|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Barbiturate Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62055835|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Benzodiazepine Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62055843|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Methadone Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 62055850|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Propoxyphene Confirmation, Serum - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95184237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Profile Low 3.5mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|FSC: 13; Default||Not reimbursed separately|132.75|FSC: 13; Default||External grouping not supported 62055868|EAP|CPT® 82671||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ESTROGENS BY MASS SPEC|1|HUMANA [1294]||HUMANA [11839]|96.90|FSC: 13; Default||Not reimbursed separately|96.90|FSC: 13; Default||External grouping not supported 95187714|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm 4cm X7cm Thickness Thin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.86|FSC: 13; Default||Not reimbursed separately|30.86|FSC: 13; Default||External grouping not supported 95184234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Post Lateral Left 9 Hole 74mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 62055926|EAP|CPT® 80177||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Keppra Levetriacetam|1|HUMANA [1294]||HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 95184235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Direct 3.5mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 62055934|EAP|CPT® 86200||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CYCLIC CITRUL PEPTIDE AB IGG|1|HUMANA [1294]||HUMANA [11839]|38.85|FSC: 13; Default||Not reimbursed separately|38.85|FSC: 13; Default||External grouping not supported 95187698|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Mariner Kumpe 5 Fr 65cm .035 Non Braided|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62055959|EAP|CPT® 86255||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PARIETAL CELL ANTIBODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62055967|EAP|CPT® 87902||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEPATITIS C GENOTYPING BY PCR &|1|HUMANA [1294]||HUMANA [11839]|772.35|FSC: 13; Default||Not reimbursed separately|772.35|FSC: 13; Default||External grouping not supported 95184246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 62055983|EAP|CPT® 81003||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ua Dipstick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 95187719|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 18-19-20mm 180 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62055991|EAP|CPT® 81001||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urinalysis W/micro, Auto|1|HUMANA [1294]||HUMANA [11839]|9.51|FSC: 13; Default||Not reimbursed separately|9.51|FSC: 13; Default||External grouping not supported 95184254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tak Bb Threaded Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62056023|EAP|CPT® 86235||0300 - LABORATORY - GENERAL CLASSIFICATION|HB RIBONUCLEIC PROTEIN (ENA) IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 62056031|EAP|CPT® 86235||0300 - LABORATORY - GENERAL CLASSIFICATION|HB SMITH (ENA) ANTIBODY IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.79|FSC: 13; Default||Not reimbursed separately|53.79|FSC: 13; Default||External grouping not supported 95187716|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 10-11-12mm 180 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62056056|EAP|CPT® 84238||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Soluble Transferrin Receptor - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|109.71|FSC: 13; Default||Not reimbursed separately|109.71|FSC: 13; Default||External grouping not supported 62056064|EAP|CPT® 84080||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bone Specific Alkaline Phosphata - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|44.34|FSC: 13; Default||Not reimbursed separately|44.34|FSC: 13; Default||External grouping not supported 95184245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 4.5 X 40 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 62056080|EAP|CPT® 80069||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Renal Functional Panel|1|HUMANA [1294]||HUMANA [11839]|26.04|FSC: 13; Default||Not reimbursed separately|26.04|FSC: 13; Default||External grouping not supported 62056098|EAP|CPT® 86316||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CHROMOGRANIN A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 95187720|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 10-11-12mm 240 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62056106|EAP|CPT® 82533||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CORTISOL SALIVA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.90|FSC: 13; Default||Not reimbursed separately|48.90|FSC: 13; Default||External grouping not supported 62056114|EAP|CPT® 82747||0300 - LABORATORY - GENERAL CLASSIFICATION|HB FOLATE RBC|1|HUMANA [1294]||HUMANA [11839]|52.95|FSC: 13; Default||Not reimbursed separately|52.95|FSC: 13; Default||External grouping not supported 62056122|EAP|CPT® 82955||0300 - LABORATORY - GENERAL CLASSIFICATION|HB G6PD|1|HUMANA [1294]||HUMANA [11839]|29.10|FSC: 13; Default||Not reimbursed separately|29.10|FSC: 13; Default||External grouping not supported 62056130|EAP|CPT® 83003||0300 - LABORATORY - GENERAL CLASSIFICATION|HB GROWTH HORMONE|1|HUMANA [1294]||HUMANA [11839]|50.01|FSC: 13; Default||Not reimbursed separately|50.01|FSC: 13; Default||External grouping not supported 95184258|EAP|Custom 95184258||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Device Accupap Mouthpiece With 7 Ft Tubing 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187717|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 12-13.5-15mm 180 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Traction Distractor Joint Mini 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 62056163|EAP|CPT® 86340||0302 - LABORATORY - IMMUNOLOGY|HB INTRINSIC FACTOR BLOCKING AB|1|HUMANA [1294]||HUMANA [11839]|45.24|FSC: 13; Default||Not reimbursed separately|45.24|FSC: 13; Default||External grouping not supported 62056171|EAP|CPT® 85549||0305 - LABORATORY - HEMATOLOGY|HB LYSOZYME|1|HUMANA [1294]||HUMANA [11839]|56.25|FSC: 13; Default||Not reimbursed separately|56.25|FSC: 13; Default||External grouping not supported 62056189|EAP|CPT® 82523||0300 - LABORATORY - GENERAL CLASSIFICATION|HB N-TELOPEPTIDE X-LINKED URINE|1|HUMANA [1294]||HUMANA [11839]|56.04|FSC: 13; Default||Not reimbursed separately|56.04|FSC: 13; Default||External grouping not supported 62056197|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|HB PANCREATIC ELAS FECAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.81|FSC: 13; Default||Not reimbursed separately|51.81|FSC: 13; Default||External grouping not supported 62056205|EAP|CPT® 86022||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PLATELET ABS INDIRECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.11|FSC: 13; Default||Not reimbursed separately|55.11|FSC: 13; Default||External grouping not supported 95184247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X030mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 62056213|EAP|CPT® 84630||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ZINC SERUM|1|HUMANA [1294]||HUMANA [11839]|34.17|FSC: 13; Default||Not reimbursed separately|34.17|FSC: 13; Default||External grouping not supported 95187718|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 15-16.5-18mm 180 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95184250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low 4.5 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95187715|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 8-9-10mm 180 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 62056353|EAP|CPT® 86341||0302 - LABORATORY - IMMUNOLOGY|HB IA-2 ANTIBODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.71|FSC: 13; Default||Not reimbursed separately|70.71|FSC: 13; Default||External grouping not supported 62056361|EAP|CPT® 85460||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Kleihauer Stain|1|HUMANA [1294]||HUMANA [11839]|23.19|FSC: 13; Default||Not reimbursed separately|23.19|FSC: 13; Default||External grouping not supported 62056379|EAP|CPT® 86905||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Antigen Patient Typing|1|HUMANA [1294]||HUMANA [11839]|11.49|FSC: 13; Default||Not reimbursed separately|11.49|FSC: 13; Default||External grouping not supported 95184251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 62056387|EAP|CPT® 82330||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CALCIUM IONIZED SERUM|1|HUMANA [1294]||HUMANA [11839]|41.04|FSC: 13; Default||Not reimbursed separately|41.04|FSC: 13; Default||External grouping not supported 95187721|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilatation Cre Wireguided 18-19-20mm 240 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62056395|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|Hb Opiate Confirmation Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95184252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 5.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 62056411|EAP|CPT® 86790||0302 - LABORATORY - IMMUNOLOGY|HB HANTAVIRUS AB IGG|1|HUMANA [1294]||HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 62056429|EAP|CPT® 86790||0302 - LABORATORY - IMMUNOLOGY|HB HANTAVIRUS AB IGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.64|FSC: 13; Default||Not reimbursed separately|38.64|FSC: 13; Default||External grouping not supported 95184255|EAP|Custom 95184255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Calibrated 3.0 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lat Ti Lcp 2.7mm 3.5mm 6 Hole Right 112|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 62056460|EAP|CPT® 87653||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Group B Amplified Probe|1|HUMANA [1294]||HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62056528|EAP|CPT® 82105||0301 - LABORATORY - CHEMISTRY|HB MC AFP TUMOR MARKER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.31|FSC: 13; Default||Not reimbursed separately|50.31|FSC: 13; Default||External grouping not supported 95184256|EAP|Custom 95184256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62056536|EAP|CPT® 84702||0301 - LABORATORY - CHEMISTRY|HB MC BETA-HCG TUMOR MARKER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.15|FSC: 13; Default||Not reimbursed separately|45.15|FSC: 13; Default||External grouping not supported 62056734|EAP|CPT® 87480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Candida|1|HUMANA [1294]||HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 62056742|EAP|CPT® 87510||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gardnerella|1|HUMANA [1294]||HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 95184257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fusion Ankle Lateral Tt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|FSC: 13; Default||Not reimbursed separately|6,225.00|FSC: 13; Default||External grouping not supported 62056759|EAP|CPT® 87660||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Trichomonas|1|HUMANA [1294]||HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 95187705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Lock 2.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,101.00|FSC: 13; Default||Not reimbursed separately|1,101.00|FSC: 13; Default||External grouping not supported 62057021|EAP|CPT® 82626||0301 - LABORATORY - CHEMISTRY|HB DHEA TMS|1|HUMANA [1294]||HUMANA [11839]|75.81|FSC: 13; Default||Not reimbursed separately|75.81|FSC: 13; Default||External grouping not supported 62057039|EAP|CPT® 86341||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Glutamic Acid Decarboxylase-ab Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.71|FSC: 13; Default||Not reimbursed separately|70.71|FSC: 13; Default||External grouping not supported 62057054|EAP|CPT® 87350||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEPATITIS BE ANTIGEN|1|HUMANA [1294]||HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 95187707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm X 12mm Ti Locking Slf-tpng With T8 Stardrive Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 62057062|EAP|CPT® 86707||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEPATITIS BE ANTIBODY|1|HUMANA [1294]||HUMANA [11839]|34.71|FSC: 13; Default||Not reimbursed separately|34.71|FSC: 13; Default||External grouping not supported 62057070|EAP|CPT® 85420||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PLASMINOGEN ACTIVITY|1|HUMANA [1294]||HUMANA [11839]|19.59|FSC: 13; Default||Not reimbursed separately|19.59|FSC: 13; Default||External grouping not supported 62057088|EAP|CPT® 85410||0300 - LABORATORY - GENERAL CLASSIFICATION|HB ALPHA-2 ANTIPLASMIN ACTIVITY|1|HUMANA [1294]||HUMANA [11839]|23.13|FSC: 13; Default||Not reimbursed separately|23.13|FSC: 13; Default||External grouping not supported 62057096|EAP|CPT® 82157||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Androstenedione|1|HUMANA [1294]||HUMANA [11839]|87.84|FSC: 13; Default||Not reimbursed separately|87.84|FSC: 13; Default||External grouping not supported 95187704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking 2.0x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.00|FSC: 13; Default||Not reimbursed separately|1,068.00|FSC: 13; Default||External grouping not supported 62057104|EAP|CPT® 82239||0300 - LABORATORY - GENERAL CLASSIFICATION|HB BILE ACIDS TOTAL|1|HUMANA [1294]||HUMANA [11839]|51.36|FSC: 13; Default||Not reimbursed separately|51.36|FSC: 13; Default||External grouping not supported 62057112|EAP|CPT® 87801||0300 - LABORATORY - GENERAL CLASSIFICATION|HB B PERTUSSIS/PARATUSSIS/PCR|1|HUMANA [1294]||HUMANA [11839]|210.60|FSC: 13; Default||Not reimbursed separately|210.60|FSC: 13; Default||External grouping not supported 62057120|EAP|CPT® 86618||0300 - LABORATORY - GENERAL CLASSIFICATION|HB BORRELIA BURGDORFERI ABS|1|HUMANA [1294]||HUMANA [11839]|51.09|FSC: 13; Default||Not reimbursed separately|51.09|FSC: 13; Default||External grouping not supported 62057138|EAP|CPT® 86300||0302 - LABORATORY - IMMUNOLOGY|HB CA 15-3 CANCER ANTIGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 95187710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate-t Profyle Hand Lock Reg 7hole 1.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|FSC: 13; Default||Not reimbursed separately|1,462.50|FSC: 13; Default||External grouping not supported 62057146|EAP|CPT® 82308||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CALCITONIN|1|HUMANA [1294]||HUMANA [11839]|80.37|FSC: 13; Default||Not reimbursed separately|80.37|FSC: 13; Default||External grouping not supported 95184259|EAP|Custom 95184259||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 9mm X 9mm X 22mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 62057153|EAP|CPT® 82384||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CATECHOLAMINE PANEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.75|FSC: 13; Default||Not reimbursed separately|75.75|FSC: 13; Default||External grouping not supported 95184260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|FSC: 13; Default||Not reimbursed separately|1,213.80|FSC: 13; Default||External grouping not supported 62057187|EAP|CPT® 86255||0300 - LABORATORY - GENERAL CLASSIFICATION|HB GBM IGA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62057195|EAP|CPT® 86255||0300 - LABORATORY - GENERAL CLASSIFICATION|HB GBM IGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 62057203|EAP|CPT® 87517||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HB HBV DNA ULTRASENS QNT REAL TIME|1|HUMANA [1294]||HUMANA [11839]|128.52|FSC: 13; Default||Not reimbursed separately|128.52|FSC: 13; Default||External grouping not supported 95187711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tap 1.7 X 5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 62057211|EAP|CPT® 86317||0300 - LABORATORY - GENERAL CLASSIFICATION|HB PNEUMOCOCCAL ABS IGG ORDER X 14|1|HUMANA [1294]||HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 80168376|EAP|CPT® 43240||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flexible Transoral W Transmural Drainage Of Pseudocyst|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 95184273|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dreamwire F/g .035/stiff450cm/str Bx/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62057278|EAP|CPT® 82941||0300 - LABORATORY - GENERAL CLASSIFICATION|HB GASTRIN|1|HUMANA [1294]||HUMANA [11839]|52.89|FSC: 13; Default||Not reimbursed separately|52.89|FSC: 13; Default||External grouping not supported 95184271|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Wallflex 30/25 X 12 230cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,609.14|FSC: 13; Default||Not reimbursed separately|7,609.14|FSC: 13; Default||External grouping not supported 62057286|EAP|CPT® 87206||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Modified Acid Fast Smear|1|HUMANA [1294]||HUMANA [11839]|16.17|FSC: 13; Default||Not reimbursed separately|16.17|FSC: 13; Default||External grouping not supported 62057310|EAP|CPT® 86666||0302 - LABORATORY - IMMUNOLOGY|Hb Ehrlichia Chaff Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|30.54|FSC: 13; Default||Not reimbursed separately|30.54|FSC: 13; Default||External grouping not supported 95184268|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline/gel 280cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95187709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws Locking Cross-pin 1.7x11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|FSC: 13; Default||Not reimbursed separately|317.25|FSC: 13; Default||External grouping not supported 95184267|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Gel 245cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 62057377|EAP|CPT® 86708||0300 - LABORATORY - GENERAL CLASSIFICATION|HB HEPATITIS A ABS TOTAL|1|HUMANA [1294]||HUMANA [11839]|37.17|FSC: 13; Default||Not reimbursed separately|37.17|FSC: 13; Default||External grouping not supported 95184272|EAP|Custom 95184272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Tandem Xl Ercp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62057385|EAP|CPT® 86689||0302 - LABORATORY - IMMUNOLOGY|Hb Hiv-1 Ab Confirm Wblot - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|58.05|FSC: 13; Default||Not reimbursed separately|58.05|FSC: 13; Default||External grouping not supported 95187712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Cb Stimublast 1cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 62057393|EAP|HCPCS G0480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Imipramine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.43|FSC: 13; Default||Not reimbursed separately|114.43|FSC: 13; Default||External grouping not supported 95184270|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Wallflex 27/22 X 12 230cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 95184274|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Wallflex 27/22 X 6 230cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 62057427|EAP|CPT® 83835||0301 - LABORATORY - CHEMISTRY|HB METANEPHRINES FREE BLOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.82|FSC: 13; Default||Not reimbursed separately|50.82|FSC: 13; Default||External grouping not supported 95187723|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Stent Pancreatic Advanix 4fr 3cm Pigtail/no Leading Barb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.90|FSC: 13; Default||Not reimbursed separately|594.90|FSC: 13; Default||External grouping not supported 62057443|EAP|CPT® 86148||0302 - LABORATORY - IMMUNOLOGY|Hb Phosphatidylserine Igg - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|48.21|FSC: 13; Default||Not reimbursed separately|48.21|FSC: 13; Default||External grouping not supported 95184269|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Colonic Wallflex 30/25 X 6 230cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|FSC: 13; Default||Not reimbursed separately|7,725.00|FSC: 13; Default||External grouping not supported 62057450|EAP|CPT® 85415||0305 - LABORATORY - HEMATOLOGY|HB PLASMINOGEN ACT INHIBITOR|1|HUMANA [1294]||HUMANA [11839]|51.57|FSC: 13; Default||Not reimbursed separately|51.57|FSC: 13; Default||External grouping not supported 62057468|EAP|CPT® 82480||0301 - LABORATORY - CHEMISTRY|Hb Pseudocholinesterase Total - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|23.61|FSC: 13; Default||Not reimbursed separately|23.61|FSC: 13; Default||External grouping not supported 62057476|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|HB TT IGG ANTIBODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62057484|EAP|CPT® 82232||0301 - LABORATORY - CHEMISTRY|Hb Beta-2 Microglobulin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.54|FSC: 13; Default||Not reimbursed separately|48.54|FSC: 13; Default||External grouping not supported 62057492|EAP|CPT® 83525||0301 - LABORATORY - CHEMISTRY|Hb Insulin Random - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|34.29|FSC: 13; Default||Not reimbursed separately|34.29|FSC: 13; Default||External grouping not supported 62057500|EAP|CPT® 83525||0301 - LABORATORY - CHEMISTRY|Hb Insulin Fasting|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.29|FSC: 13; Default||Not reimbursed separately|34.29|FSC: 13; Default||External grouping not supported 95184279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Darco 4.0x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 62057518|EAP|CPT® 83525||0301 - LABORATORY - CHEMISTRY|Hb Insulin 30 Minute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.29|FSC: 13; Default||Not reimbursed separately|34.29|FSC: 13; Default||External grouping not supported 62057526|EAP|CPT® 83525||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Insulin 60 Minute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.29|FSC: 13; Default||Not reimbursed separately|34.29|FSC: 13; Default||External grouping not supported 95187725|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0 X 18 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|611.28|FSC: 13; Default||Not reimbursed separately|611.28|FSC: 13; Default||External grouping not supported 62057534|EAP|CPT® 83525||0301 - LABORATORY - CHEMISTRY|Hb Insulin 120 Minute|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.29|FSC: 13; Default||Not reimbursed separately|34.29|FSC: 13; Default||External grouping not supported 95184277|EAP|Custom 95184277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Elite Elevate Ent Omni Guide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62100409|EAP|CPT® 86886||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ab Titer Baseline|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62100417|EAP|CPT® 86886||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ab Titer Comparative|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95184278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lapidus 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 62100474|EAP|CPT® 87901||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HB HIV1 DRUG R MUTATION|1|HUMANA [1294]||HUMANA [11839]|772.35|FSC: 13; Default||Not reimbursed separately|772.35|FSC: 13; Default||External grouping not supported 95187728|EAP|Custom 95187728||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Burr 15mm|1|HUMANA [1294]||HUMANA [11839]|403.29|FSC: 13; Default||Not reimbursed separately|403.29|FSC: 13; Default||External grouping not supported 95184275|EAP|Custom 95184275||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cable Ablation For Smartablate 4"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184276|EAP|Custom 95184276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Set Smartablate Irrigation 13'|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62100607|EAP|CPT® 86880||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Coombs Direct|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.17|FSC: 13; Default||Not reimbursed separately|16.17|FSC: 13; Default||External grouping not supported 95187729|EAP|Custom 95187729||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Burr W/shunt 15mm|1|HUMANA [1294]||HUMANA [11839]|319.17|FSC: 13; Default||Not reimbursed separately|319.17|FSC: 13; Default||External grouping not supported 62100797|EAP|HCPCS P9017||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Fresh Frozen Plasma|1|HUMANA [1294]||HUMANA [11839]|251.25|FSC: 13; Default||Not reimbursed separately|251.25|FSC: 13; Default||External grouping not supported 62100813|EAP|HCPCS P9012||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Cryoprecipitate|1|HUMANA [1294]||HUMANA [11839]|151.32|FSC: 13; Default||Not reimbursed separately|151.32|FSC: 13; Default||External grouping not supported 95184280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Darco 4.0x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 62100839|EAP|HCPCS P9031||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Lr Platelet @unit|1|HUMANA [1294]||HUMANA [11839]|379.05|FSC: 13; Default||Not reimbursed separately|379.05|FSC: 13; Default||External grouping not supported 62100854|EAP|Custom 62100854||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Dir Donor Surchg@u|1|HUMANA [1294]||HUMANA [11839]|409.50|FSC: 13; Default||Not reimbursed separately|409.50|FSC: 13; Default||External grouping not supported 62100870|EAP|CPT® 86890||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Auto Bld Donation|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 62100888|EAP|CPT® 86985||0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION|Hb Split Blood Prod@u|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95187727|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm/l46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 80168389|EAP|CPT® 77293||0333 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY|Hb Respiratory Motion Management Simulation|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 62101027|EAP|CPT® 85461||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Inv Pp Rhogam|1|HUMANA [1294]||HUMANA [11839]|28.08|FSC: 13; Default||Not reimbursed separately|28.08|FSC: 13; Default||External grouping not supported 62101803|EAP|CPT® 86906||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rh Phenotype|1|HUMANA [1294]||HUMANA [11839]|23.25|FSC: 13; Default||Not reimbursed separately|23.25|FSC: 13; Default||External grouping not supported 95184282|EAP|Custom 95184282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bead Lc 70-150um-2ml Black V10742|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62101902|EAP|HCPCS J2790||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Rhogam Proc Fee - Rx|1|HUMANA [1294]||HUMANA [11839]|264.58|FSC: 13; Default||Not reimbursed separately|264.58|FSC: 13; Default||External grouping not supported 62101910|EAP|CPT® 80055||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Obstetric Panel|1|HUMANA [1294]||HUMANA [11839]|143.43|FSC: 13; Default||Not reimbursed separately|143.43|FSC: 13; Default||External grouping not supported 95187730|EAP|Custom 95187730||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Hole Burr 22mm|1|HUMANA [1294]||HUMANA [11839]|631.89|FSC: 13; Default||Not reimbursed separately|631.89|FSC: 13; Default||External grouping not supported 62102108|EAP|CPT® 86900||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Abo Type|1|HUMANA [1294]||HUMANA [11839]|8.97|FSC: 13; Default||Not reimbursed separately|8.97|FSC: 13; Default||External grouping not supported 95184283|EAP|Custom 95184283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Orthocord Violet/blue W/os-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62200050|EAP|CPT® 83050||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Methemoglobin|1|HUMANA [1294]||HUMANA [11839]|24.60|FSC: 13; Default||Not reimbursed separately|24.60|FSC: 13; Default||External grouping not supported 62200100|EAP|CPT® 82010||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Acetone|1|HUMANA [1294]||HUMANA [11839]|24.51|FSC: 13; Default||Not reimbursed separately|24.51|FSC: 13; Default||External grouping not supported 62200118|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Alcohol Medical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62200142|EAP|CPT® 82040||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Albumin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.85|FSC: 13; Default||Not reimbursed separately|14.85|FSC: 13; Default||External grouping not supported 62200159|EAP|CPT® 82140||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ammonia|1|HUMANA [1294]||HUMANA [11839]|43.71|FSC: 13; Default||Not reimbursed separately|43.71|FSC: 13; Default||External grouping not supported 62200183|EAP|CPT® 84134||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Prealbumin|1|HUMANA [1294]||HUMANA [11839]|43.77|FSC: 13; Default||Not reimbursed separately|43.77|FSC: 13; Default||External grouping not supported 62200308|EAP|CPT® 84520||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bun|1|HUMANA [1294]||HUMANA [11839]|11.85|FSC: 13; Default||Not reimbursed separately|11.85|FSC: 13; Default||External grouping not supported 62200340|EAP|CPT® 83986||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Ph|1|HUMANA [1294]||HUMANA [11839]|10.74|FSC: 13; Default||Not reimbursed separately|10.74|FSC: 13; Default||External grouping not supported 62200381|EAP|CPT® 82150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Amylase|1|HUMANA [1294]||HUMANA [11839]|19.44|FSC: 13; Default||Not reimbursed separately|19.44|FSC: 13; Default||External grouping not supported 62200399|EAP|CPT® 82945||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Csf Glucose|1|HUMANA [1294]||HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 62200548|EAP|CPT® 84484||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Troponin|1|HUMANA [1294]||HUMANA [11839]|37.41|FSC: 13; Default||Not reimbursed separately|37.41|FSC: 13; Default||External grouping not supported 62200571|EAP|CPT® 82800||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cord Venous Ph|1|HUMANA [1294]||HUMANA [11839]|33.00|FSC: 13; Default||Not reimbursed separately|33.00|FSC: 13; Default||External grouping not supported 62200589|EAP|CPT® 82800||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cord Arterial Ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.00|FSC: 13; Default||Not reimbursed separately|33.00|FSC: 13; Default||External grouping not supported 62200704|EAP|CPT® 82465||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cholesterol|1|HUMANA [1294]||HUMANA [11839]|13.05|FSC: 13; Default||Not reimbursed separately|13.05|FSC: 13; Default||External grouping not supported 62200753|EAP|CPT® 83722||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Direct Ldl Chol|1|HUMANA [1294]||HUMANA [11839]|102.57|FSC: 13; Default||Not reimbursed separately|102.57|FSC: 13; Default||External grouping not supported 62200944|EAP|CPT® 80305||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Saliva Alcohol|1|HUMANA [1294]||HUMANA [11839]|37.80|FSC: 13; Default||Not reimbursed separately|37.80|FSC: 13; Default||External grouping not supported 62201207|EAP|CPT® 82565||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Creatinine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.36|FSC: 13; Default||Not reimbursed separately|15.36|FSC: 13; Default||External grouping not supported 62201256|EAP|CPT® 82570||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Creatinine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 80168390|EAP|CPT® 99221||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Initial Hospital Care--30 Minutes|1|HUMANA [1294]||HUMANA [11839]|175.00|FSC: 13; Default||Not reimbursed separately|175.00|FSC: 13; Default||External grouping not supported 62201405|EAP|CPT® 85384||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fibrinogen|1|HUMANA [1294]||HUMANA [11839]|29.16|FSC: 13; Default||Not reimbursed separately|29.16|FSC: 13; Default||External grouping not supported 95187724|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable Angle Self Tap 5.0 X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|611.28|FSC: 13; Default||Not reimbursed separately|611.28|FSC: 13; Default||External grouping not supported 62201454|EAP|CPT® 82977||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gamma G T|1|HUMANA [1294]||HUMANA [11839]|21.60|FSC: 13; Default||Not reimbursed separately|21.60|FSC: 13; Default||External grouping not supported 62201553|EAP|CPT® 82947||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Glucose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 80168401|EAP|CPT® 99222||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Initial Hospital Care--50 Minutes|1|HUMANA [1294]||HUMANA [11839]|237.00|FSC: 13; Default||Not reimbursed separately|237.00|FSC: 13; Default||External grouping not supported 62201603|EAP|CPT® 82950||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Glucose 2 Hr P.c.|1|HUMANA [1294]||HUMANA [11839]|14.25|FSC: 13; Default||Not reimbursed separately|14.25|FSC: 13; Default||External grouping not supported 62201728|EAP|CPT® 82951||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Glucose Base 3 Spe|1|HUMANA [1294]||HUMANA [11839]|38.61|FSC: 13; Default||Not reimbursed separately|38.61|FSC: 13; Default||External grouping not supported 80168412|EAP|CPT® 99223||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Initial Hospital Care--70 Minutes|1|HUMANA [1294]||HUMANA [11839]|350.00|FSC: 13; Default||Not reimbursed separately|350.00|FSC: 13; Default||External grouping not supported 62201736|EAP|CPT® 82952||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gluc Spec>3|1|HUMANA [1294]||HUMANA [11839]|11.76|FSC: 13; Default||Not reimbursed separately|11.76|FSC: 13; Default||External grouping not supported 95187726|EAP|Custom 95187726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rod Semi Circular 11mm X 220mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168423|EAP|CPT® 99231||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Subsequent Hospital Care--15 Minutes|1|HUMANA [1294]||HUMANA [11839]|68.00|FSC: 13; Default||Not reimbursed separately|68.00|FSC: 13; Default||External grouping not supported 62202056|EAP|CPT® 83036||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Glycohemoglobin|1|HUMANA [1294]||HUMANA [11839]|29.13|FSC: 13; Default||Not reimbursed separately|29.13|FSC: 13; Default||External grouping not supported 80168434|EAP|CPT® 99232||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Subsequent Hospital Care--25 Minutes|1|HUMANA [1294]||HUMANA [11839]|125.00|FSC: 13; Default||Not reimbursed separately|125.00|FSC: 13; Default||External grouping not supported 62202452|EAP|CPT® 86431||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rheumatoid Titer|1|HUMANA [1294]||HUMANA [11839]|17.01|FSC: 13; Default||Not reimbursed separately|17.01|FSC: 13; Default||External grouping not supported 62202502|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Salicylate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 62202601|EAP|CPT® 83664||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lamellar Bodies|1|HUMANA [1294]||HUMANA [11839]|57.96|FSC: 13; Default||Not reimbursed separately|57.96|FSC: 13; Default||External grouping not supported 62202700|EAP|CPT® 84550||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Uric Acid|1|HUMANA [1294]||HUMANA [11839]|13.56|FSC: 13; Default||Not reimbursed separately|13.56|FSC: 13; Default||External grouping not supported 80168445|EAP|CPT® 99233||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Subsequent Hospital Care--35 Minutes|1|HUMANA [1294]||HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 62202916|EAP|CPT® 84300||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urinary Sodium|1|HUMANA [1294]||HUMANA [11839]|15.18|FSC: 13; Default||Not reimbursed separately|15.18|FSC: 13; Default||External grouping not supported 62202924|EAP|CPT® 84133||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urinary Potassium|1|HUMANA [1294]||HUMANA [11839]|14.19|FSC: 13; Default||Not reimbursed separately|14.19|FSC: 13; Default||External grouping not supported 95187737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Gap 6 Hole 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.96|FSC: 13; Default||Not reimbursed separately|618.96|FSC: 13; Default||External grouping not supported 80168456|EAP|CPT® 99238||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Hospital Discharge Day Management; 30 Minutes Or Less|1|HUMANA [1294]||HUMANA [11839]|125.00|FSC: 13; Default||Not reimbursed separately|125.00|FSC: 13; Default||External grouping not supported 62203005|EAP|CPT® 81002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ur Bilirubin/bile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.44|FSC: 13; Default||Not reimbursed separately|10.44|FSC: 13; Default||External grouping not supported 62203088|EAP|CPT® 87205||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Eosinophils|1|HUMANA [1294]||HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 62203104|EAP|CPT® 83986||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fecal Ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.74|FSC: 13; Default||Not reimbursed separately|10.74|FSC: 13; Default||External grouping not supported 62203153|EAP|CPT® 84376||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fecal Reducing Sub|1|HUMANA [1294]||HUMANA [11839]|16.50|FSC: 13; Default||Not reimbursed separately|16.50|FSC: 13; Default||External grouping not supported 80168467|EAP|CPT® 99239||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Hospital Discharge Day Management; More Than 30 Minutes|1|HUMANA [1294]||HUMANA [11839]|184.00|FSC: 13; Default||Not reimbursed separately|184.00|FSC: 13; Default||External grouping not supported 62210208|EAP|CPT® 82803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Blood Gases|1|HUMANA [1294]||HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 95187731|EAP|Custom 95187731||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Regeneration Dural Plus Duragen 2x2 In|1|HUMANA [1294]||HUMANA [11839]|1,349.22|FSC: 13; Default||Not reimbursed separately|1,349.22|FSC: 13; Default||External grouping not supported 80168478|EAP|CPT® 99334||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Domicil/r-home Visit Est Pat--15 Minutes|1|HUMANA [1294]||HUMANA [11839]|103.00|FSC: 13; Default||Not reimbursed separately|103.00|FSC: 13; Default||External grouping not supported 62210307|EAP|CPT® 82310||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Calcium|1|HUMANA [1294]||HUMANA [11839]|15.48|FSC: 13; Default||Not reimbursed separately|15.48|FSC: 13; Default||External grouping not supported 62210331|EAP|CPT® 80048||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Basic Metabolic Pan|1|HUMANA [1294]||HUMANA [11839]|25.38|FSC: 13; Default||Not reimbursed separately|25.38|FSC: 13; Default||External grouping not supported 80168489|EAP|CPT® 99335||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Domicil/r-home Visit Est Pat--25 Minutes|1|HUMANA [1294]||HUMANA [11839]|163.00|FSC: 13; Default||Not reimbursed separately|163.00|FSC: 13; Default||External grouping not supported 62210406|EAP|CPT® 82435||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Chloride|1|HUMANA [1294]||HUMANA [11839]|13.80|FSC: 13; Default||Not reimbursed separately|13.80|FSC: 13; Default||External grouping not supported 95187740|EAP|Custom 95187740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Kyphopak Express Ii15/2 Ibt Osteo Introducer System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62210505|EAP|CPT® 80051||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Electrolyte Series|1|HUMANA [1294]||HUMANA [11839]|21.03|FSC: 13; Default||Not reimbursed separately|21.03|FSC: 13; Default||External grouping not supported 80168490|EAP|CPT® 99336||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Domicil/r-home Visit Est Pat--40 Minutes|1|HUMANA [1294]||HUMANA [11839]|231.00|FSC: 13; Default||Not reimbursed separately|231.00|FSC: 13; Default||External grouping not supported 62210604|EAP|CPT® 80178||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lithium|1|HUMANA [1294]||HUMANA [11839]|19.83|FSC: 13; Default||Not reimbursed separately|19.83|FSC: 13; Default||External grouping not supported 62210703|EAP|CPT® 83735||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Magnesium|1|HUMANA [1294]||HUMANA [11839]|20.10|FSC: 13; Default||Not reimbursed separately|20.10|FSC: 13; Default||External grouping not supported 80168501|EAP|CPT® 99337||0657 - HOSPICE SERVICE - PHYSICIAN SERVICES|Hb Domicil/r-home Visit Est Pat--60 Minutes|1|HUMANA [1294]||HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 62210802|EAP|CPT® 83930||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Osmolality/serum|1|HUMANA [1294]||HUMANA [11839]|19.83|FSC: 13; Default||Not reimbursed separately|19.83|FSC: 13; Default||External grouping not supported 95187732|EAP|Custom 95187732||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Regeneration Dural Plus Duragen 1x3 In|1|HUMANA [1294]||HUMANA [11839]|1,312.89|FSC: 13; Default||Not reimbursed separately|1,312.89|FSC: 13; Default||External grouping not supported 62210851|EAP|CPT® 83935||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Osmolality Urine|1|HUMANA [1294]||HUMANA [11839]|20.46|FSC: 13; Default||Not reimbursed separately|20.46|FSC: 13; Default||External grouping not supported 95184292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 62211008|EAP|CPT® 82800||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.00|FSC: 13; Default||Not reimbursed separately|33.00|FSC: 13; Default||External grouping not supported 95184289|EAP|Custom 95184289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Oto-m Omniguide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62211206|EAP|CPT® 84100||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Phosphorus|1|HUMANA [1294]||HUMANA [11839]|14.22|FSC: 13; Default||Not reimbursed separately|14.22|FSC: 13; Default||External grouping not supported 62211305|EAP|CPT® 84132||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Potassium|1|HUMANA [1294]||HUMANA [11839]|14.28|FSC: 13; Default||Not reimbursed separately|14.28|FSC: 13; Default||External grouping not supported 95187735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Emergency 1.9 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.01|FSC: 13; Default||Not reimbursed separately|179.01|FSC: 13; Default||External grouping not supported 62211313|EAP|CPT® 84132||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Potassium, Wb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|FSC: 13; Default||Not reimbursed separately|14.28|FSC: 13; Default||External grouping not supported 95184287|EAP|Custom 95184287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Tour Aptus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62211404|EAP|CPT® 84155||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Protein-serum|1|HUMANA [1294]||HUMANA [11839]|11.01|FSC: 13; Default||Not reimbursed separately|11.01|FSC: 13; Default||External grouping not supported 62211503|EAP|CPT® 84295||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Sodium|1|HUMANA [1294]||HUMANA [11839]|14.43|FSC: 13; Default||Not reimbursed separately|14.43|FSC: 13; Default||External grouping not supported 95184293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 3.5mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 62211560|EAP|CPT® 84540||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Urea|1|HUMANA [1294]||HUMANA [11839]|16.68|FSC: 13; Default||Not reimbursed separately|16.68|FSC: 13; Default||External grouping not supported 95187734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Self1.6 X 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.01|FSC: 13; Default||Not reimbursed separately|179.01|FSC: 13; Default||External grouping not supported 62212105|EAP|CPT® 82803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Blood Gas Dir Meas O2 Sat Only|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.21|FSC: 13; Default||Not reimbursed separately|78.21|FSC: 13; Default||External grouping not supported 95184288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.5x42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 62212204|EAP|CPT® 82375||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Carboxy Hemaglobin|1|HUMANA [1294]||HUMANA [11839]|36.96|FSC: 13; Default||Not reimbursed separately|36.96|FSC: 13; Default||External grouping not supported 62220207|EAP|CPT® 84075||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Alk Phosphatase|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 62220405|EAP|CPT® 82150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Amylase Serum|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.44|FSC: 13; Default||Not reimbursed separately|19.44|FSC: 13; Default||External grouping not supported 62220413|EAP|CPT® 82150||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Amylase Urine|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.44|FSC: 13; Default||Not reimbursed separately|19.44|FSC: 13; Default||External grouping not supported 95184290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterolateral Diatal Tibia Va-lcp 6 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,150.16|FSC: 13; Default||Not reimbursed separately|5,150.16|FSC: 13; Default||External grouping not supported 62220702|EAP|CPT® 82550||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ck|1|HUMANA [1294]||HUMANA [11839]|19.53|FSC: 13; Default||Not reimbursed separately|19.53|FSC: 13; Default||External grouping not supported 62220751|EAP|CPT® 82553||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CKMB QUANT|1|HUMANA [1294]||HUMANA [11839]|34.65|FSC: 13; Default||Not reimbursed separately|34.65|FSC: 13; Default||External grouping not supported 95187736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Long 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|200.58|FSC: 13; Default||Not reimbursed separately|200.58|FSC: 13; Default||External grouping not supported 62220801|EAP|CPT® 83615||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.12|FSC: 13; Default||Not reimbursed separately|18.12|FSC: 13; Default||External grouping not supported 95184286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Toe Vo Hammertoe Implant 2.4x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|FSC: 13; Default||Not reimbursed separately|1,392.00|FSC: 13; Default||External grouping not supported 62221007|EAP|CPT® 83690||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lipase|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.67|FSC: 13; Default||Not reimbursed separately|20.67|FSC: 13; Default||External grouping not supported 62221106|EAP|CPT® 84450||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ast|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95184294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Low Profile Self Tapping Stardrive 3.5 Mm X 60m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 62221205|EAP|CPT® 84460||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Alt (sgpt)|1|HUMANA [1294]||HUMANA [11839]|15.90|FSC: 13; Default||Not reimbursed separately|15.90|FSC: 13; Default||External grouping not supported 95176254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 14mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 62230412|EAP|HCPCS G0328||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fecal Heme Screening|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.15|FSC: 13; Default||Not reimbursed separately|54.15|FSC: 13; Default||External grouping not supported 95176255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 20mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 62230610|EAP|CPT® 82271||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gastric Occult|1|HUMANA [1294]||HUMANA [11839]|15.96|FSC: 13; Default||Not reimbursed separately|15.96|FSC: 13; Default||External grouping not supported 95176256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 40mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95176257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hexalobe 3.5 X 12mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 62240791|EAP|CPT® 82247||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bilirubin Total|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.06|FSC: 13; Default||Not reimbursed separately|15.06|FSC: 13; Default||External grouping not supported 95176258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hexalobe 3.5 X 24mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 62240908|EAP|CPT® 82340||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urinary Calcium|1|HUMANA [1294]||HUMANA [11839]|18.09|FSC: 13; Default||Not reimbursed separately|18.09|FSC: 13; Default||External grouping not supported 95176259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Hexalobe 2.7 X 16mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 62240916|EAP|CPT® 89125||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urinary Fat|1|HUMANA [1294]||HUMANA [11839]|17.64|FSC: 13; Default||Not reimbursed separately|17.64|FSC: 13; Default||External grouping not supported 62241609|EAP|CPT® 84157||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Csf Protein|1|HUMANA [1294]||HUMANA [11839]|12.00|FSC: 13; Default||Not reimbursed separately|12.00|FSC: 13; Default||External grouping not supported 95176262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|571.20|FSC: 13; Default||Not reimbursed separately|571.20|FSC: 13; Default||External grouping not supported 62241807|EAP|CPT® 81003||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Urobilinogen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 62241955|EAP|CPT® 80164||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Valproic Acid|1|HUMANA [1294]||HUMANA [11839]|40.62|FSC: 13; Default||Not reimbursed separately|40.62|FSC: 13; Default||External grouping not supported 95176263|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62300652|EAP|CPT® 82607||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb B-12|1|HUMANA [1294]||HUMANA [11839]|45.24|FSC: 13; Default||Not reimbursed separately|45.24|FSC: 13; Default||External grouping not supported 95176264|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 5 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62300835|EAP|CPT® 83718||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hdl Cholesterol|1|HUMANA [1294]||HUMANA [11839]|24.57|FSC: 13; Default||Not reimbursed separately|24.57|FSC: 13; Default||External grouping not supported 62300868|EAP|CPT® 82378||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cea|1|HUMANA [1294]||HUMANA [11839]|56.88|FSC: 13; Default||Not reimbursed separately|56.88|FSC: 13; Default||External grouping not supported 95176265|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62300876|EAP|CPT® 86304||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ca-125|1|HUMANA [1294]||HUMANA [11839]|62.43|FSC: 13; Default||Not reimbursed separately|62.43|FSC: 13; Default||External grouping not supported 95176266|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62300918|EAP|CPT® 86160||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Complement C3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95176267|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62300926|EAP|CPT® 86160||0302 - LABORATORY - IMMUNOLOGY|Hb Complement C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95176268|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Ti Press Fit Size 10 125mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,496.64|FSC: 13; Default||Not reimbursed separately|10,496.64|FSC: 13; Default||External grouping not supported 62301072|EAP|CPT® 82670||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Estradiol|1|HUMANA [1294]||HUMANA [11839]|83.82|FSC: 13; Default||Not reimbursed separately|83.82|FSC: 13; Default||External grouping not supported 95176270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread Long 4.5 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|FSC: 13; Default||Not reimbursed separately|1,170.30|FSC: 13; Default||External grouping not supported 62301106|EAP|CPT® 82533||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cortisol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.90|FSC: 13; Default||Not reimbursed separately|48.90|FSC: 13; Default||External grouping not supported 95176271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless Thread Long 4.5 X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|FSC: 13; Default||Not reimbursed separately|1,170.30|FSC: 13; Default||External grouping not supported 62301155|EAP|CPT® 80162||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Digoxin|1|HUMANA [1294]||HUMANA [11839]|39.84|FSC: 13; Default||Not reimbursed separately|39.84|FSC: 13; Default||External grouping not supported 62301213|EAP|CPT® 80185||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Dilantin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.75|FSC: 13; Default||Not reimbursed separately|39.75|FSC: 13; Default||External grouping not supported 95176272|EAP|Custom 95176272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176273|EAP|Custom 95176273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Threaded 1.6mm 220mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62301411|EAP|CPT® 82728||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ferritin|1|HUMANA [1294]||HUMANA [11839]|40.89|FSC: 13; Default||Not reimbursed separately|40.89|FSC: 13; Default||External grouping not supported 95176274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Triathlon Ts Plus X 3 Poly Sz 3 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|FSC: 13; Default||Not reimbursed separately|8,775.90|FSC: 13; Default||External grouping not supported 62301445|EAP|CPT® 82746||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Folic Acid|1|HUMANA [1294]||HUMANA [11839]|44.10|FSC: 13; Default||Not reimbursed separately|44.10|FSC: 13; Default||External grouping not supported 80165913|EAP|CPT® 31627||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchoscopy Navigation|1|HUMANA [1294]||HUMANA [11839]|2,331.54|FSC: 13; Default||Not reimbursed separately|2,331.54|FSC: 13; Default||External grouping not supported 95176275|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 6 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176276|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 6f 13 Cm .083 Green 5 Box|1|HUMANA [1294]||HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62301577|EAP|CPT® 80170||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gentamicin|1|HUMANA [1294]||HUMANA [11839]|49.14|FSC: 13; Default||Not reimbursed separately|49.14|FSC: 13; Default||External grouping not supported 95176277|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 7f 13 Cm .092 Orange 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176278|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 8f 13 Cm .0105 Blue 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62301981|EAP|CPT® 84146||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Prolactin|1|HUMANA [1294]||HUMANA [11839]|58.14|FSC: 13; Default||Not reimbursed separately|58.14|FSC: 13; Default||External grouping not supported 62302104|EAP|CPT® 83010||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Haptoglobin|1|HUMANA [1294]||HUMANA [11839]|37.74|FSC: 13; Default||Not reimbursed separately|37.74|FSC: 13; Default||External grouping not supported 95176279|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 8.5f 13 Cm .112 Lt Blue 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62302203|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Iga Level|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 62302302|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Igg Level|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 95176280|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 9f 13 Cm .118 Black 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62302401|EAP|CPT® 82784||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Igm Level|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|FSC: 13; Default||Not reimbursed separately|27.90|FSC: 13; Default||External grouping not supported 95176281|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 9.5f 13 Cm .125 White 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62302450|EAP|CPT® 83605||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lactic Acid|1|HUMANA [1294]||HUMANA [11839]|34.71|FSC: 13; Default||Not reimbursed separately|34.71|FSC: 13; Default||External grouping not supported 95176282|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 10f 13 Cm .131 White 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62302849|EAP|CPT® 83002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Lh|1|HUMANA [1294]||HUMANA [11839]|55.56|FSC: 13; Default||Not reimbursed separately|55.56|FSC: 13; Default||External grouping not supported 95176283|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 10.5f 13 Cm .138 White 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62302856|EAP|CPT® 83001||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fsh|1|HUMANA [1294]||HUMANA [11839]|55.74|FSC: 13; Default||Not reimbursed separately|55.74|FSC: 13; Default||External grouping not supported 62302872|EAP|CPT® 80184||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Phenobarbital|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.90|FSC: 13; Default||Not reimbursed separately|45.90|FSC: 13; Default||External grouping not supported 95187738|EAP|Custom 95187738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Bone Biopsy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62302930|EAP|CPT® 80200||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tobramycin|1|HUMANA [1294]||HUMANA [11839]|48.39|FSC: 13; Default||Not reimbursed separately|48.39|FSC: 13; Default||External grouping not supported 95176284|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 11f 13 Cm .144 White 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62303169|EAP|CPT® 84144||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Progesterone|1|HUMANA [1294]||HUMANA [11839]|62.58|FSC: 13; Default||Not reimbursed separately|62.58|FSC: 13; Default||External grouping not supported 62303268|EAP|CPT® 84703||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hcg, Qual|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.56|FSC: 13; Default||Not reimbursed separately|22.56|FSC: 13; Default||External grouping not supported 95176285|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 12f 13 Cm .158 White 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62303292|EAP|CPT® 84702||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hcg Qnt/non Tumor|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.15|FSC: 13; Default||Not reimbursed separately|45.15|FSC: 13; Default||External grouping not supported 62303318|EAP|CPT® 80156||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tegretol|1|HUMANA [1294]||HUMANA [11839]|43.71|FSC: 13; Default||Not reimbursed separately|43.71|FSC: 13; Default||External grouping not supported 95176286|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 12.5f 13 Cm .164 White 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62303334|EAP|CPT® 84403||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Testosterone/total|1|HUMANA [1294]||HUMANA [11839]|77.43|FSC: 13; Default||Not reimbursed separately|77.43|FSC: 13; Default||External grouping not supported 62303409|EAP|CPT® 84478||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Triglyceride|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.22|FSC: 13; Default||Not reimbursed separately|17.22|FSC: 13; Default||External grouping not supported 95176287|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 7f 25 Cm .092 Orange 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62303615|EAP|CPT® 84439||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Free T4|1|HUMANA [1294]||HUMANA [11839]|27.06|FSC: 13; Default||Not reimbursed separately|27.06|FSC: 13; Default||External grouping not supported 62303631|EAP|CPT® 84480||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb T-3 Total|1|HUMANA [1294]||HUMANA [11839]|42.54|FSC: 13; Default||Not reimbursed separately|42.54|FSC: 13; Default||External grouping not supported 95176288|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 8f 25 Cm .0105 Blue 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62303656|EAP|CPT® 84443||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tsh|1|HUMANA [1294]||HUMANA [11839]|50.40|FSC: 13; Default||Not reimbursed separately|50.40|FSC: 13; Default||External grouping not supported 62303706|EAP|CPT® 84443||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tsh Reflexive|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|FSC: 13; Default||Not reimbursed separately|50.40|FSC: 13; Default||External grouping not supported 95176289|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Classic 9f 25 Cm .118 Black 5 Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62303755|EAP|CPT® 80198||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Theophylline|1|HUMANA [1294]||HUMANA [11839]|42.42|FSC: 13; Default||Not reimbursed separately|42.42|FSC: 13; Default||External grouping not supported 95176290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Lordotic Va Xero P 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,839.00|FSC: 13; Default||Not reimbursed separately|10,839.00|FSC: 13; Default||External grouping not supported 62303953|EAP|CPT® 85347||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Activated Coagulation Time|1|HUMANA [1294]||HUMANA [11839]|12.84|FSC: 13; Default||Not reimbursed separately|12.84|FSC: 13; Default||External grouping not supported 95176291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|FSC: 13; Default||Not reimbursed separately|10,376.10|FSC: 13; Default||External grouping not supported 95176293|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Ansel Flexor Hi 12fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Screw 2.5 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 62400072|EAP|CPT® 84157||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Protein|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|FSC: 13; Default||Not reimbursed separately|12.00|FSC: 13; Default||External grouping not supported 62400080|EAP|CPT® 83615||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Ld|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.12|FSC: 13; Default||Not reimbursed separately|18.12|FSC: 13; Default||External grouping not supported 95176299|EAP|Custom 95176299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Inflow Patient Single-use Arthroscopy Flo Eco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62400098|EAP|CPT® 82945||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Glucose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 95176301|EAP|Custom 95176301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Morcellator Tissue Sigma Morcellex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62400106|EAP|CPT® 85540||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Alk Phos Stain|1|HUMANA [1294]||HUMANA [11839]|25.80|FSC: 13; Default||Not reimbursed separately|25.80|FSC: 13; Default||External grouping not supported 62400155|EAP|CPT® 80307||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Acetaminaphen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95176302|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Irrigation Sinus 2 Vortex Relieva|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62400205|EAP|CPT® 85002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bleeding Time|1|HUMANA [1294]||HUMANA [11839]|14.46|FSC: 13; Default||Not reimbursed separately|14.46|FSC: 13; Default||External grouping not supported 95176303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Medial Distal Ts 16 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,648.50|FSC: 13; Default||Not reimbursed separately|4,648.50|FSC: 13; Default||External grouping not supported 95176304|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 1.25mm X 135cm Length X 0.58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62400544|EAP|CPT® 85025||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb C.b.c.|1|HUMANA [1294]||HUMANA [11839]|23.31|FSC: 13; Default||Not reimbursed separately|23.31|FSC: 13; Default||External grouping not supported 95176306|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 1.50mm X 135cm Length X 0.58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62400700|EAP|CPT® 85004||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Eosinophil Count|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 62400809|EAP|CPT® 85027||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hemogram|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 95176311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6 Hole With Guide 1.5mm Ti Lcp Adaption|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.87|FSC: 13; Default||Not reimbursed separately|1,446.87|FSC: 13; Default||External grouping not supported 95176312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 11mm Self Tapping With T4 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 62401005|EAP|CPT® 85018||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hemoglobin|1|HUMANA [1294]||HUMANA [11839]|7.11|FSC: 13; Default||Not reimbursed separately|7.11|FSC: 13; Default||External grouping not supported 62401401|EAP|CPT® 87207||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Malarial Prep|1|HUMANA [1294]||HUMANA [11839]|17.97|FSC: 13; Default||Not reimbursed separately|17.97|FSC: 13; Default||External grouping not supported 95176313|EAP|Custom 95176313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Cryo-ablation Malleable 10cm Artricure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62401427|EAP|CPT® 83874||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Myoglobin Urine|1|HUMANA [1294]||HUMANA [11839]|38.76|FSC: 13; Default||Not reimbursed separately|38.76|FSC: 13; Default||External grouping not supported 95176314|EAP|Custom 95176314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Jawlong Synergy Isolator Artricure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 4 Hole L 130mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,542.00|FSC: 13; Default||Not reimbursed separately|10,542.00|FSC: 13; Default||External grouping not supported 62401609|EAP|CPT® 85049||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Platelet Count|1|HUMANA [1294]||HUMANA [11839]|13.44|FSC: 13; Default||Not reimbursed separately|13.44|FSC: 13; Default||External grouping not supported 95176316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5mm X L28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62401708|EAP|CPT® 85041||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Red Blood Count|1|HUMANA [1294]||HUMANA [11839]|9.06|FSC: 13; Default||Not reimbursed separately|9.06|FSC: 13; Default||External grouping not supported 95176317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5mm X L85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62401906|EAP|CPT® 85045||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Reticulocyte Count|1|HUMANA [1294]||HUMANA [11839]|11.97|FSC: 13; Default||Not reimbursed separately|11.97|FSC: 13; Default||External grouping not supported 95176318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5mm X L90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62402102|EAP|CPT® 85652||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Sedrate|1|HUMANA [1294]||HUMANA [11839]|8.10|FSC: 13; Default||Not reimbursed separately|8.10|FSC: 13; Default||External grouping not supported 62402409|EAP|CPT® 85048||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb White Blood Count|1|HUMANA [1294]||HUMANA [11839]|7.62|FSC: 13; Default||Not reimbursed separately|7.62|FSC: 13; Default||External grouping not supported 95176319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 62402508|EAP|CPT® 84156||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Protein Quantitativ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.01|FSC: 13; Default||Not reimbursed separately|11.01|FSC: 13; Default||External grouping not supported 62402995|EAP|CPT® 89051||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Joint Fluid Cell Count/df|1|HUMANA [1294]||HUMANA [11839]|16.80|FSC: 13; Default||Not reimbursed separately|16.80|FSC: 13; Default||External grouping not supported 95176320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 62403001|EAP|CPT® 89060||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Joint Fl Crystal|1|HUMANA [1294]||HUMANA [11839]|21.99|FSC: 13; Default||Not reimbursed separately|21.99|FSC: 13; Default||External grouping not supported 95176321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 62403043|EAP|CPT® 89051||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Csf Cell Count W/diff|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.80|FSC: 13; Default||Not reimbursed separately|16.80|FSC: 13; Default||External grouping not supported 62403050|EAP|CPT® 89051||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fl Cell Cnt W/diff|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.80|FSC: 13; Default||Not reimbursed separately|16.80|FSC: 13; Default||External grouping not supported 95176322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 10 Hole L238mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,066.00|FSC: 13; Default||Not reimbursed separately|12,066.00|FSC: 13; Default||External grouping not supported 62403076|EAP|CPT® 81003||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine-ph|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 95176323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62403084|EAP|CPT® 81003||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ur Spec Gravity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|FSC: 13; Default||Not reimbursed separately|6.75|FSC: 13; Default||External grouping not supported 62403092|EAP|CPT® 84315||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bf Spec Gravity|1|HUMANA [1294]||HUMANA [11839]|9.84|FSC: 13; Default||Not reimbursed separately|9.84|FSC: 13; Default||External grouping not supported 95176324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62403100|EAP|CPT® 81005||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Reducing Sub|1|HUMANA [1294]||HUMANA [11839]|6.51|FSC: 13; Default||Not reimbursed separately|6.51|FSC: 13; Default||External grouping not supported 95176325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62500103|EAP|CPT® 88000||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Autopsy|1|HUMANA [1294]||HUMANA [11839]|2,205.00|FSC: 13; Default||Not reimbursed separately|2,205.00|FSC: 13; Default||External grouping not supported 95110956|EAP|Custom 95110956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Ic 16fr 5cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111001|EAP|Custom 95111001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Urine Meter Drainage Ic 350cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Zp Thread Short 3.2 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 62501309|EAP|Custom 62501309||0998 - STATISTICAL CHARGES|Hb Pap Intrp By Path|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Zp Thread Short 3.2 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 62505011|EAP|CPT® 88300||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Surg Path Gross|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95184285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pro Toe Vo Hammertoe Implant 2.0x13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.00|FSC: 13; Default||Not reimbursed separately|1,626.00|FSC: 13; Default||External grouping not supported 62505029|EAP|CPT® 88302||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Surg Path 2, One|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 95176342|EAP|Custom 95176342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Green 2.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62505037|EAP|CPT® 88304||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Surg Path 3, One|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62505045|EAP|CPT® 88305||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Surg Path 4, One|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 95176345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ball Single 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 62505052|EAP|CPT® 88307||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Surg Path 5, One|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95176353|EAP|Custom 95176353||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Trocar Double 1.1 Green/blue|1|HUMANA [1294]||HUMANA [11839]|42.00|FSC: 13; Default||Not reimbursed separately|42.00|FSC: 13; Default||External grouping not supported 62505060|EAP|CPT® 88309||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Surg Path 6, One|1|HUMANA [1294]||HUMANA [11839]|1,790.07|FSC: 13; Default||Not reimbursed separately|1,790.07|FSC: 13; Default||External grouping not supported 95176354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Kit Fuseforce 10 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.00|FSC: 13; Default||Not reimbursed separately|4,311.00|FSC: 13; Default||External grouping not supported 62505078|EAP|CPT® 88311||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Decalcification|1|HUMANA [1294]||HUMANA [11839]|80.64|FSC: 13; Default||Not reimbursed separately|80.64|FSC: 13; Default||External grouping not supported 95176355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Kit Fuseforce 12 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|FSC: 13; Default||Not reimbursed separately|3,585.00|FSC: 13; Default||External grouping not supported 62505144|EAP|CPT® 88331||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Frozen Section One|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95176356|EAP|Custom 95176356||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill 2.0mm X 122mm Wl50mm Ao Shaft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62505151|EAP|CPT® 88332||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Frozen Section Add|1|HUMANA [1294]||HUMANA [11839]|136.50|FSC: 13; Default||Not reimbursed separately|136.50|FSC: 13; Default||External grouping not supported 62505169|EAP|CPT® 88342||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Immunohistochem Stn|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95176358|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Saline Style 468 Textured Moderate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|FSC: 13; Default||Not reimbursed separately|1,770.00|FSC: 13; Default||External grouping not supported 62505193|EAP|CPT® 88104||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Cyto Fl Intrp/path|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 95176359|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Natrelle Saline Style 468 Textured Moderate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|FSC: 13; Default||Not reimbursed separately|1,770.00|FSC: 13; Default||External grouping not supported 95176360|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue 500cc Style133mv W Suture Tab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|FSC: 13; Default||Not reimbursed separately|4,485.00|FSC: 13; Default||External grouping not supported 62505284|EAP|CPT® 88160||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hb Cyto Othr Non Gyn|1|HUMANA [1294]||HUMANA [11839]|65.52|FSC: 13; Default||Not reimbursed separately|65.52|FSC: 13; Default||External grouping not supported 62505326|EAP|CPT® 88173||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Fna Intrp By Path|1|HUMANA [1294]||HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62505342|EAP|CPT® 85060||0998 - STATISTICAL CHARGES|Hb Periph Smear/path|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal2.7mm X 54mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 62505359|EAP|CPT® 85097||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Bm Smear Interp|1|HUMANA [1294]||HUMANA [11839]|1,790.07|FSC: 13; Default||Not reimbursed separately|1,790.07|FSC: 13; Default||External grouping not supported 95176361|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 2.50 X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176362|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 3.0x 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176363|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 3.5x 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176364|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 4.0x 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176365|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 2.5 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176366|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 3.0x 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176367|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent 3.5x 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176368|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Element De Stent4.0x 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0mm X L70mm Tl16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 95176370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 14 Hole L310mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,779.00|FSC: 13; Default||Not reimbursed separately|10,779.00|FSC: 13; Default||External grouping not supported 95176371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|801.00|FSC: 13; Default||Not reimbursed separately|801.00|FSC: 13; Default||External grouping not supported 95176372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 95176373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95176374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 62506373|EAP|CPT® 86078||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Trans Rxn/path|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95176375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X 310 Ao|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 62506399|EAP|CPT® 88321||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Consult Referred Slides|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 95176376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Dorsal L Plate 2.4mm 90 Degree 2 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,867.02|FSC: 13; Default||Not reimbursed separately|1,867.02|FSC: 13; Default||External grouping not supported 62506407|EAP|CPT® 88325||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Consult Comprehensive|1|HUMANA [1294]||HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 95176377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Dorsal T Plate 2.4mm 90 Degree 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.18|FSC: 13; Default||Not reimbursed separately|1,914.18|FSC: 13; Default||External grouping not supported 95176378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Dorsal L Plate 2.4mm 20 Degree 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,867.02|FSC: 13; Default||Not reimbursed separately|1,867.02|FSC: 13; Default||External grouping not supported 62506449|EAP|CPT® 88108||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Bf Interp By Path|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 95176379|EAP|Custom 95176379||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filler Voidbone Phospate Calcium Otomimix 2 Gm|1|HUMANA [1294]||HUMANA [11839]|1,134.12|FSC: 13; Default||Not reimbursed separately|1,134.12|FSC: 13; Default||External grouping not supported 62506456|EAP|CPT® 88172||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Fna Adeq First Eval Each Site|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95176380|EAP|Custom 95176380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dressing Sensatrac Granufoam Large Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176381|EAP|Custom 95176381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insole Orthotic Vasyli Custom Full Length Red Xxlg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62506472|EAP|CPT® 88305||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Cyto Cell Block/path|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 95176386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Metatarsal Movement Mgt Size 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,899.28|FSC: 13; Default||Not reimbursed separately|6,899.28|FSC: 13; Default||External grouping not supported 62600507|EAP|CPT® 87328||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cryptosporidium|1|HUMANA [1294]||HUMANA [11839]|41.46|FSC: 13; Default||Not reimbursed separately|41.46|FSC: 13; Default||External grouping not supported 95176389|EAP|Custom 95176389||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Gastrostomy Profile Low Mic Key 20fr 2.3cm 5cc Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62600754|EAP|CPT® 87430||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Throat Strep Scrn|1|HUMANA [1294]||HUMANA [11839]|50.43|FSC: 13; Default||Not reimbursed separately|50.43|FSC: 13; Default||External grouping not supported 95176390|EAP|Custom 95176390||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Gastrostomy Profile Low Mic Key 20fr 2.5cm 5cc Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176391|EAP|Custom 95176391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Gastrostomy Profile Low Mic Key 20fr 2.7cm 5cc Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62601323|EAP|CPT® 87177||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb O&p Concentration - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|26.70|FSC: 13; Default||Not reimbursed separately|26.70|FSC: 13; Default||External grouping not supported 62601331|EAP|CPT® 87209||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb O&p Trichrome - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|53.94|FSC: 13; Default||Not reimbursed separately|53.94|FSC: 13; Default||External grouping not supported 95176392|EAP|Custom 95176392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Gastrostomy Profile Low Mic Key 20fr 3.0cm 5cc Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62601406|EAP|CPT® 87172||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Pinworm Exam|1|HUMANA [1294]||HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 62601539|EAP|CPT® 87807||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rsv|1|HUMANA [1294]||HUMANA [11839]|39.30|FSC: 13; Default||Not reimbursed separately|39.30|FSC: 13; Default||External grouping not supported 95176393|EAP|Custom 95176393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Feeding Gastrostomy Profile Low Mic Key 20fr 3.5cm 5cc Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62601554|EAP|CPT® 87425||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rotovirus|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62601604|EAP|CPT® 87186||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gram Neg Sensitivity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 80165921|EAP|CPT® 94002||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Hfov Initial Day|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 62601612|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Gram Pos Sensitivity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 80165939|EAP|CPT® 94003||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hb Hfov Subsequent Day|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.69|FSC: 13; Default||Not reimbursed separately|1,323.69|FSC: 13; Default||External grouping not supported 62601620|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Anaerobic Sensitivity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.95|FSC: 13; Default||Not reimbursed separately|25.95|FSC: 13; Default||External grouping not supported 62601703|EAP|CPT® 87205||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Gram Stain|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 95175285|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Fox Sv Catheter 5mm X 60mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62601729|EAP|CPT® 87220||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Koh Prep|1|HUMANA [1294]||HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 62601737|EAP|CPT® 89321||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Smear For Sperm|1|HUMANA [1294]||HUMANA [11839]|36.15|FSC: 13; Default||Not reimbursed separately|36.15|FSC: 13; Default||External grouping not supported 95175601|EAP|Custom 95175601||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace Harmonic 36cm Length With Adaptive Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62601745|EAP|CPT® 87206||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Stain, Afb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.17|FSC: 13; Default||Not reimbursed separately|16.17|FSC: 13; Default||External grouping not supported 95176395|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 26 Ga S L Silicone Picc 50cm And Statlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62601752|EAP|CPT® 83630||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fecal Wbcs|1|HUMANA [1294]||HUMANA [11839]|59.10|FSC: 13; Default||Not reimbursed separately|59.10|FSC: 13; Default||External grouping not supported 95176396|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 26 Ga Introsyte Autoguard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62601760|EAP|CPT® 89190||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Nasal Smear - Eos|1|HUMANA [1294]||HUMANA [11839]|17.37|FSC: 13; Default||Not reimbursed separately|17.37|FSC: 13; Default||External grouping not supported 95176397|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit For Neonate Picc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62605084|EAP|CPT® 88312||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Special Stains 1|1|HUMANA [1294]||HUMANA [11839]|140.97|FSC: 13; Default||Not reimbursed separately|140.97|FSC: 13; Default||External grouping not supported 62605092|EAP|CPT® 88313||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Special Stains 2|1|HUMANA [1294]||HUMANA [11839]|95.25|FSC: 13; Default||Not reimbursed separately|95.25|FSC: 13; Default||External grouping not supported 95176398|EAP|Custom 95176398||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Achilles Preshaped 10mm|1|HUMANA [1294]||HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 62700208|EAP|CPT® 86063||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Antistreptolysin-o Screen|1|HUMANA [1294]||HUMANA [11839]|17.31|FSC: 13; Default||Not reimbursed separately|17.31|FSC: 13; Default||External grouping not supported 62700216|EAP|CPT® 86038||0302 - LABORATORY - IMMUNOLOGY|Hb Anitnuclear Ab|1|HUMANA [1294]||HUMANA [11839]|36.27|FSC: 13; Default||Not reimbursed separately|36.27|FSC: 13; Default||External grouping not supported 95176399|EAP|Custom 95176399||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Patellar Preshaped 10mm|1|HUMANA [1294]||HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 62700224|EAP|CPT® 86039||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ana Titer|1|HUMANA [1294]||HUMANA [11839]|33.48|FSC: 13; Default||Not reimbursed separately|33.48|FSC: 13; Default||External grouping not supported 95176400|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured Gel Filled Mod Profile 320cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 62700323|EAP|CPT® 86665||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ebv-vca Igg|1|HUMANA [1294]||HUMANA [11839]|54.42|FSC: 13; Default||Not reimbursed separately|54.42|FSC: 13; Default||External grouping not supported 62700331|EAP|CPT® 86665||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ebv-vca Igm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.42|FSC: 13; Default||Not reimbursed separately|54.42|FSC: 13; Default||External grouping not supported 95176401|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured Gel Filled Mod Profile 340cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 62700349|EAP|CPT® 86677||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb H Pylori Igg Ab|1|HUMANA [1294]||HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 62700588|EAP|CPT® 80076||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hepatic Panel|1|HUMANA [1294]||HUMANA [11839]|24.51|FSC: 13; Default||Not reimbursed separately|24.51|FSC: 13; Default||External grouping not supported 95176403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 4 Hole L121mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,429.00|FSC: 13; Default||Not reimbursed separately|9,429.00|FSC: 13; Default||External grouping not supported 62700620|EAP|CPT® 86706||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hepatitis Bs Ab|1|HUMANA [1294]||HUMANA [11839]|32.22|FSC: 13; Default||Not reimbursed separately|32.22|FSC: 13; Default||External grouping not supported 62700646|EAP|CPT® 86709||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hepatitis A Igm Ab|1|HUMANA [1294]||HUMANA [11839]|33.78|FSC: 13; Default||Not reimbursed separately|33.78|FSC: 13; Default||External grouping not supported 95176402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 62700653|EAP|CPT® 87340||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hepatitis Bs Ag|1|HUMANA [1294]||HUMANA [11839]|30.99|FSC: 13; Default||Not reimbursed separately|30.99|FSC: 13; Default||External grouping not supported 62700661|EAP|CPT® 86705||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hepatitis Bcore Ab|1|HUMANA [1294]||HUMANA [11839]|35.31|FSC: 13; Default||Not reimbursed separately|35.31|FSC: 13; Default||External grouping not supported 95187739|EAP|Custom 95187739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Osteo Introducer Express|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62700679|EAP|CPT® 86803||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Hepatitis C Ab|1|HUMANA [1294]||HUMANA [11839]|42.81|FSC: 13; Default||Not reimbursed separately|42.81|FSC: 13; Default||External grouping not supported 95176404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 62700752|EAP|CPT® 86701||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rapid Hiv|1|HUMANA [1294]||HUMANA [11839]|26.67|FSC: 13; Default||Not reimbursed separately|26.67|FSC: 13; Default||External grouping not supported 95176406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10mm X 380mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95176407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10mm X 330mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 62701206|EAP|CPT® 86308||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Mono Screen|1|HUMANA [1294]||HUMANA [11839]|15.54|FSC: 13; Default||Not reimbursed separately|15.54|FSC: 13; Default||External grouping not supported 95176408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Third 4 Hole Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|200.25|FSC: 13; Default||Not reimbursed separately|200.25|FSC: 13; Default||External grouping not supported 62701602|EAP|CPT® 86430||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rheumatoid Factor|1|HUMANA [1294]||HUMANA [11839]|18.42|FSC: 13; Default||Not reimbursed separately|18.42|FSC: 13; Default||External grouping not supported 62702402|EAP|CPT® 86592||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rpr Qualitative|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.81|FSC: 13; Default||Not reimbursed separately|12.81|FSC: 13; Default||External grouping not supported 62702501|EAP|CPT® 86593||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rpr Quantitative|1|HUMANA [1294]||HUMANA [11839]|13.20|FSC: 13; Default||Not reimbursed separately|13.20|FSC: 13; Default||External grouping not supported 62702865|EAP|CPT® 86762||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rubella Igg|1|HUMANA [1294]||HUMANA [11839]|43.17|FSC: 13; Default||Not reimbursed separately|43.17|FSC: 13; Default||External grouping not supported 62800008|EAP|CPT® 87116||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Afb Culture - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|32.40|FSC: 13; Default||Not reimbursed separately|32.40|FSC: 13; Default||External grouping not supported 62800040|EAP|CPT® 87116||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Afb Bld Culture - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.40|FSC: 13; Default||Not reimbursed separately|32.40|FSC: 13; Default||External grouping not supported 62800065|EAP|CPT® 87040||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture Blood|1|HUMANA [1294]||HUMANA [11839]|30.96|FSC: 13; Default||Not reimbursed separately|30.96|FSC: 13; Default||External grouping not supported 62800156|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture, Ear|1|HUMANA [1294]||HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 62800206|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture, Eye|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 95176413|EAP|Custom 95176413||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Visiglide .025 450cm Straight|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800255|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Body Fluid Culture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 62800289|EAP|CPT® 87106||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Fungus Id|1|HUMANA [1294]||HUMANA [11839]|30.96|FSC: 13; Default||Not reimbursed separately|30.96|FSC: 13; Default||External grouping not supported 95176415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Advance Milagro 10mm X 23mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|FSC: 13; Default||Not reimbursed separately|1,374.00|FSC: 13; Default||External grouping not supported 62800297|EAP|CPT® 87103||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture Fungus/bld|1|HUMANA [1294]||HUMANA [11839]|61.38|FSC: 13; Default||Not reimbursed separately|61.38|FSC: 13; Default||External grouping not supported 62800305|EAP|CPT® 87102||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture Fungus|1|HUMANA [1294]||HUMANA [11839]|25.23|FSC: 13; Default||Not reimbursed separately|25.23|FSC: 13; Default||External grouping not supported 95176416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,421.10|FSC: 13; Default||Not reimbursed separately|1,421.10|FSC: 13; Default||External grouping not supported 62800339|EAP|CPT® 87081||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Gc Screen|1|HUMANA [1294]||HUMANA [11839]|19.89|FSC: 13; Default||Not reimbursed separately|19.89|FSC: 13; Default||External grouping not supported 95176417|EAP|Custom 95176417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wrench Bi Directional Torque Orange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800354|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Upper Resp Culture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 95176418|EAP|Custom 95176418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stylet 52cm Wide Radius J Tapered|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176419|EAP|Custom 95176419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stylet 52cm Straight Soft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800388|EAP|CPT® 87338||0300 - LABORATORY - GENERAL CLASSIFICATION|HB H PYLORIC STOOL ANTIGEN|1|HUMANA [1294]||HUMANA [11839]|43.14|FSC: 13; Default||Not reimbursed separately|43.14|FSC: 13; Default||External grouping not supported 95176420|EAP|Custom 95176420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Flextend Fixation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800404|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture, Spinal Fl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 62800453|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Sputum Culture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 95176421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Juggerknot 2.9 With Tapered Needles|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 62800503|EAP|Custom 62800503||0998 - STATISTICAL CHARGES|Hb Culture, Sterility|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800511|EAP|Custom 62800511||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Sterility/dr Office|1|HUMANA [1294]||HUMANA [11839]|20.59|FSC: 13; Default||Not reimbursed separately|20.59|FSC: 13; Default||External grouping not supported 95176422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Speed 9 X 10 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,068.37|FSC: 13; Default||Not reimbursed separately|3,068.37|FSC: 13; Default||External grouping not supported 95176423|EAP|Custom 95176423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fusion Pushing 7fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800628|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture Tips|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 95176424|EAP|Custom 95176424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ercp Classic 5.5 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800651|EAP|CPT® 87086||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture, Urine|1|HUMANA [1294]||HUMANA [11839]|24.21|FSC: 13; Default||Not reimbursed separately|24.21|FSC: 13; Default||External grouping not supported 95176425|EAP|Custom 95176425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Geenen Graduated Dilation 7 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62800685|EAP|CPT® 87075||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture Anaerobic|1|HUMANA [1294]||HUMANA [11839]|28.41|FSC: 13; Default||Not reimbursed separately|28.41|FSC: 13; Default||External grouping not supported 62800701|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Culture, Genital|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 62800750|EAP|CPT® 87070||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Wound Culture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.86|FSC: 13; Default||Not reimbursed separately|25.86|FSC: 13; Default||External grouping not supported 62800800|EAP|CPT® 87327||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cryptococcol Ag|1|HUMANA [1294]||HUMANA [11839]|40.26|FSC: 13; Default||Not reimbursed separately|40.26|FSC: 13; Default||External grouping not supported 80165947|EAP|CPT® 69210||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Rmvl Impact Cerumen 1/both Ears Ed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.75|FSC: 13; Default||Not reimbursed separately|156.75|FSC: 13; Default||External grouping not supported 62800859|EAP|CPT® 87329||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Giardia Lamblia Ag|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 80165954|EAP|CPT® 97597||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Selec Debride 20 Cm Or Less Ed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 80165962|EAP|CPT® 49082||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Abd Paracentesis Ed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,239.50|FSC: 13; Default||Not reimbursed separately|2,239.50|FSC: 13; Default||External grouping not supported 62800883|EAP|CPT® 87176||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tissue Homogenization|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.64|FSC: 13; Default||Not reimbursed separately|17.64|FSC: 13; Default||External grouping not supported 62800909|EAP|CPT® 87077||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Clotest|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.24|FSC: 13; Default||Not reimbursed separately|24.24|FSC: 13; Default||External grouping not supported 62801006|EAP|CPT® 87449||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ur Legionella Ag|1|HUMANA [1294]||HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 62801196|EAP|CPT® 87591||0300 - LABORATORY - GENERAL CLASSIFICATION|HB CHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95153299|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Add-a-foley Ic Complete Care 2000cc With Statlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62801212|EAP|CPT® 87149||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Mycobacterium Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.15|FSC: 13; Default||Not reimbursed separately|60.15|FSC: 13; Default||External grouping not supported 62801220|EAP|CPT® 87190||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Myco Sensitivity|1|HUMANA [1294]||HUMANA [11839]|21.93|FSC: 13; Default||Not reimbursed separately|21.93|FSC: 13; Default||External grouping not supported 62801238|EAP|CPT® 87491||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Chlamydia Dna Amplified Probe|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 95176426|EAP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Durata 65 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|FSC: 13; Default||Not reimbursed separately|13,095.00|FSC: 13; Default||External grouping not supported 62850508|EAP|CPT® 87449||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Ur Strep Pneumo Ag|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.94|FSC: 13; Default||Not reimbursed separately|35.94|FSC: 13; Default||External grouping not supported 95176436|EAP|Custom 95176436||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Semitendinosus|1|HUMANA [1294]||HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 62860028|EAP|CPT® 86870||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Antibody Id|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 62860036|EAP|CPT® 86902||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Antigen Typing|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.05|FSC: 13; Default||Not reimbursed separately|19.05|FSC: 13; Default||External grouping not supported 95176437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Archon 4 X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,572.00|FSC: 13; Default||Not reimbursed separately|1,572.00|FSC: 13; Default||External grouping not supported 62860044|EAP|CPT® 86922||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Chg Only, Ahg-xm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95184297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Speedbridge Achilles Mid-subatance|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|FSC: 13; Default||Not reimbursed separately|2,925.00|FSC: 13; Default||External grouping not supported 62860259|EAP|CPT® 83550||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Tibc|1|HUMANA [1294]||HUMANA [11839]|26.22|FSC: 13; Default||Not reimbursed separately|26.22|FSC: 13; Default||External grouping not supported 95187733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Drilling Self1.6 X 4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.01|FSC: 13; Default||Not reimbursed separately|179.01|FSC: 13; Default||External grouping not supported 62860267|EAP|CPT® 83540||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Iron|1|HUMANA [1294]||HUMANA [11839]|19.41|FSC: 13; Default||Not reimbursed separately|19.41|FSC: 13; Default||External grouping not supported 95176440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 62860671|EAP|CPT® 86920||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Chg Only, Is-xm|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95176441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lockng 4.0mm X L85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 62860796|EAP|CPT® 82950||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Preg Gluc Screen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.25|FSC: 13; Default||Not reimbursed separately|14.25|FSC: 13; Default||External grouping not supported 75100412|EAP|CPT® 97535||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Adl/hom Mgmt, 15 Min|1|HUMANA [1294]||HUMANA [11839]|97.83|FSC: 13; Default||Not reimbursed separately|97.83|FSC: 13; Default||External grouping not supported 95176442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lockng 4.0mm X L90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 75100727|EAP|CPT® 92597||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Eval Use/fit Voice Prosthesis|1|HUMANA [1294]||HUMANA [11839]|213.72|FSC: 13; Default||Not reimbursed separately|213.72|FSC: 13; Default||External grouping not supported 75102574|EAP|CPT® 97034||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Contrast Bath|1|HUMANA [1294]||HUMANA [11839]|43.50|FSC: 13; Default||Not reimbursed separately|43.50|FSC: 13; Default||External grouping not supported 95176445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headless 3.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95176446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 75102921|EAP|CPT® 97016||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt-vasponeumatic Device|1|HUMANA [1294]||HUMANA [11839]|35.52|FSC: 13; Default||Not reimbursed separately|35.52|FSC: 13; Default||External grouping not supported 75105965|EAP|CPT® 97542||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Wheelchair Mgmt, 15 Min|1|HUMANA [1294]||HUMANA [11839]|95.40|FSC: 13; Default||Not reimbursed separately|95.40|FSC: 13; Default||External grouping not supported 80165988|EAP|CPT® 45541||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Correct Rectal Prolapse|1|HUMANA [1294]||HUMANA [11839]|6,679.80|FSC: 13; Default||Not reimbursed separately|6,679.80|FSC: 13; Default||External grouping not supported 75200519|EAP|CPT® 97034||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Contrast Bath, 15 Min|1|HUMANA [1294]||HUMANA [11839]|43.50|FSC: 13; Default||Not reimbursed separately|43.50|FSC: 13; Default||External grouping not supported 75502237|EAP|CPT® 97018||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Paraffin|1|HUMANA [1294]||HUMANA [11839]|16.86|FSC: 13; Default||Not reimbursed separately|16.86|FSC: 13; Default||External grouping not supported 80165996|EAP|CPT® 46221||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ligation Of Hemorrhoids|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 75502716|EAP|CPT® 97110||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Ther Exercise 15 Min|1|HUMANA [1294]||HUMANA [11839]|88.38|FSC: 13; Default||Not reimbursed separately|88.38|FSC: 13; Default||External grouping not supported 95118214|EAP|Custom 95118214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Ic 12fr 5cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502724|EAP|CPT® 97760||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Ortho Mgmt & Train, 15 Min|1|HUMANA [1294]||HUMANA [11839]|139.23|FSC: 13; Default||Not reimbursed separately|139.23|FSC: 13; Default||External grouping not supported 95176449|EAP|Custom 95176449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Radius Concave Ep 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502732|EAP|CPT® 97761||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Prosthetics Training|1|HUMANA [1294]||HUMANA [11839]|119.34|FSC: 13; Default||Not reimbursed separately|119.34|FSC: 13; Default||External grouping not supported 95184295|EAP|Custom 95184295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Micro-autografting Xpansion|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502757|EAP|CPT® 97530||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Therapeutic Activities, 15 Min|1|HUMANA [1294]||HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95176450|EAP|Custom 95176450||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Bio-composite Dx 2 0 Fw|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 75502765|EAP|CPT® 97597||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Wnd Debride Select, 1st 20 Sc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95176451|EAP|Custom 95176451||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Instrument Disposable For Small Joint Suturetak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502773|EAP|CPT® 97597||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Debride Select, 1st 20 Sc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95176452|EAP|Custom 95176452||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Suture Pusher Knot Fast Fix 360 Degree With Slotted Cannula|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75502781|EAP|CPT® 97602||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Non-selective Debridement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95176453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 9 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|FSC: 13; Default||Not reimbursed separately|809.55|FSC: 13; Default||External grouping not supported 75502799|EAP|CPT® 97602||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Non-selective Debridement|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|FSC: 13; Default||Not reimbursed separately|497.91|FSC: 13; Default||External grouping not supported 95176454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Clavicle Hook Lcp 3.5mm 7 Hole 15mm Right Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,858.31|FSC: 13; Default||Not reimbursed separately|2,858.31|FSC: 13; Default||External grouping not supported 75502823|EAP|CPT® 97010||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Hot Pack/cold Pack|1|HUMANA [1294]||HUMANA [11839]|17.79|FSC: 13; Default||Not reimbursed separately|17.79|FSC: 13; Default||External grouping not supported 75503367|EAP|CPT® 97022||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Fluidotherapy|1|HUMANA [1294]||HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 95176456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 26mm Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 75503391|EAP|CPT® 97032||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot E-stim (attended)|1|HUMANA [1294]||HUMANA [11839]|43.11|FSC: 13; Default||Not reimbursed separately|43.11|FSC: 13; Default||External grouping not supported 75503417|EAP|CPT® 97035||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Phonophoresis, 15 Min|1|HUMANA [1294]||HUMANA [11839]|41.61|FSC: 13; Default||Not reimbursed separately|41.61|FSC: 13; Default||External grouping not supported 95176457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 75503425|EAP|CPT® 97033||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Iontophoresis, 15 Min|1|HUMANA [1294]||HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 75503433|EAP|CPT® 97598||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Wound Debridement 20cm/more|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.98|FSC: 13; Default||Not reimbursed separately|368.98|FSC: 13; Default||External grouping not supported 95176458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Round Spiked 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,638.00|FSC: 13; Default||Not reimbursed separately|1,638.00|FSC: 13; Default||External grouping not supported 75503441|EAP|CPT® 97598||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hb Ot Wound Debridement 20cm/more|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.98|FSC: 13; Default||Not reimbursed separately|368.98|FSC: 13; Default||External grouping not supported 75504241|EAP|CPT® 97018||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Paraffin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.86|FSC: 13; Default||Not reimbursed separately|16.86|FSC: 13; Default||External grouping not supported 95176459|EAP|Custom 95176459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Delivery Needle Straight 360 Degree Fast Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75700229|EAP|HCPCS G0283||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Elect Stim (unattended)|1|HUMANA [1294]||HUMANA [11839]|39.30|FSC: 13; Default||Not reimbursed separately|39.30|FSC: 13; Default||External grouping not supported 75700237|EAP|CPT® 97032||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb E-stim (attended), 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.11|FSC: 13; Default||Not reimbursed separately|43.11|FSC: 13; Default||External grouping not supported 95176460|EAP|Custom 95176460||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Wide Coroent 14 X 22 X 50|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 75700336|EAP|CPT® 97530||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Funct Activities, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.90|FSC: 13; Default||Not reimbursed separately|111.90|FSC: 13; Default||External grouping not supported 95176461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 75700393|EAP|CPT® 97761||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Prosthetic Training, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.34|FSC: 13; Default||Not reimbursed separately|119.34|FSC: 13; Default||External grouping not supported 95176462|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallflex Esophageal Partially Covered 23 Mm X 125 Cm 18.5 Fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.55|FSC: 13; Default||Not reimbursed separately|7,121.55|FSC: 13; Default||External grouping not supported 75700427|EAP|CPT® 97022||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Whirlpool|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.55|FSC: 13; Default||Not reimbursed separately|50.55|FSC: 13; Default||External grouping not supported 75700443|EAP|CPT® 97124||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Massage, 15 Min|1|HUMANA [1294]||HUMANA [11839]|83.28|FSC: 13; Default||Not reimbursed separately|83.28|FSC: 13; Default||External grouping not supported 95184296|EAP|Custom 95184296||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tubing Irrigation Suction Core 5mm Cannula Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 75700450|EAP|CPT® 97110||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Ther Exercise 15 Minutes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.38|FSC: 13; Default||Not reimbursed separately|88.38|FSC: 13; Default||External grouping not supported 95187744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 75700468|EAP|CPT® 97116||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Gait Training, 15 Min|1|HUMANA [1294]||HUMANA [11839]|87.42|FSC: 13; Default||Not reimbursed separately|87.42|FSC: 13; Default||External grouping not supported 75700484|EAP|CPT® 97140||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Manual Therapy, 15 Min|1|HUMANA [1294]||HUMANA [11839]|81.48|FSC: 13; Default||Not reimbursed separately|81.48|FSC: 13; Default||External grouping not supported 75700492|EAP|CPT® 97010||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Hot Pack/cold Pack|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.79|FSC: 13; Default||Not reimbursed separately|17.79|FSC: 13; Default||External grouping not supported 95187742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Dorsal Left 2.4mm 20 Degree 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.92|FSC: 13; Default||Not reimbursed separately|1,774.92|FSC: 13; Default||External grouping not supported 75700500|EAP|CPT® 97012||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Mechanical Traction|1|HUMANA [1294]||HUMANA [11839]|44.04|FSC: 13; Default||Not reimbursed separately|44.04|FSC: 13; Default||External grouping not supported 75700518|EAP|CPT® 97112||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Neuromusc Re-educ, 15 Min|1|HUMANA [1294]||HUMANA [11839]|101.37|FSC: 13; Default||Not reimbursed separately|101.37|FSC: 13; Default||External grouping not supported 75700575|EAP|CPT® 97035||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Phonophoresis, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.61|FSC: 13; Default||Not reimbursed separately|41.61|FSC: 13; Default||External grouping not supported 75700583|EAP|CPT® 97033||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Iotonphoresis, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|FSC: 13; Default||Not reimbursed separately|59.34|FSC: 13; Default||External grouping not supported 95187743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|FSC: 13; Default||Not reimbursed separately|1,213.80|FSC: 13; Default||External grouping not supported 75700617|EAP|CPT® 97760||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Ortho Mgmt & Train, 15 Min|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|139.23|FSC: 13; Default||Not reimbursed separately|139.23|FSC: 13; Default||External grouping not supported 95110946|EAP|Custom 95110946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Coude 16fr 5cc Carson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77600633|EAP|CPT® 92508||0443 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GROUP|Hb Treat Speech Lang Voice, Group|1|HUMANA [1294]||HUMANA [11839]|68.82|FSC: 13; Default||Not reimbursed separately|68.82|FSC: 13; Default||External grouping not supported 95176463|EAP|Custom 95176463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Infusion Autofuse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 77600757|EAP|CPT® 92507||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Treat Speech Lang Voice, Indiv|1|HUMANA [1294]||HUMANA [11839]|230.40|FSC: 13; Default||Not reimbursed separately|230.40|FSC: 13; Default||External grouping not supported 95176464|EAP|Custom 95176464||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Sheath Introducer Iabp 7.5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80140346|EAP|CPT® 92018||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hb Eye Exam Under Anesthesia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.39|FSC: 13; Default||Not reimbursed separately|5,514.39|FSC: 13; Default||External grouping not supported 95176466|EAP|Custom 95176466||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Flexible Disposable Y Knot Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80142706|EAP|CPT® 92610||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Eval Clinical Dysphagia|1|HUMANA [1294]||HUMANA [11839]|251.16|FSC: 13; Default||Not reimbursed separately|251.16|FSC: 13; Default||External grouping not supported 80142722|EAP|CPT® 92526||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Dysphagia Therapy|1|HUMANA [1294]||HUMANA [11839]|252.72|FSC: 13; Default||Not reimbursed separately|252.72|FSC: 13; Default||External grouping not supported 95176467|EAP|Custom 95176467||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extender Lead Bulldog|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Continuum Metal Trabecular With Cluster Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95176469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked Highly Longevity|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95176470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Taper Revision Uncemented Wagner Sl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,847.50|FSC: 13; Default||Not reimbursed separately|21,847.50|FSC: 13; Default||External grouping not supported 80143597|EAP|CPT® 95851||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Romm Ea Ext/exc Hnd Ea Trnk/re|1|HUMANA [1294]||HUMANA [11839]|60.81|FSC: 13; Default||Not reimbursed separately|60.81|FSC: 13; Default||External grouping not supported 95176472|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Visisheath Small Diameter 33cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80143605|EAP|CPT® 95852||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Remm Hnd W & W/o Nrml Comp/rep|1|HUMANA [1294]||HUMANA [11839]|52.56|FSC: 13; Default||Not reimbursed separately|52.56|FSC: 13; Default||External grouping not supported 80144066|EAP|CPT® 64415||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Brachial Plexus Injection|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 95176473|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Visisheath Medium Diameter 33cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80144074|EAP|CPT® 64417||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Axillary Nerve Injection|1|HUMANA [1294]||HUMANA [11839]|2,506.79|FSC: 13; Default||Not reimbursed separately|2,506.79|FSC: 13; Default||External grouping not supported 80144082|EAP|CPT® 64418||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Suprascapular Nerve Injection|1|HUMANA [1294]||HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95176474|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Dilator Visisheath Large Diameter 33cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80144090|EAP|CPT® 64447||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Femoral Nerve Injection|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 80146228|EAP|CPT® 62273||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Epidural Inj Blood Patch|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,929.53|FSC: 13; Default||Not reimbursed separately|1,929.53|FSC: 13; Default||External grouping not supported 95176476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Rectanguler Compression 27mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.00|FSC: 13; Default||Not reimbursed separately|2,643.00|FSC: 13; Default||External grouping not supported 80151590|EAP|HCPCS G0281||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hb Pt Estim Unattended Wound Care|1|HUMANA [1294]||HUMANA [11839]|39.30|FSC: 13; Default||Not reimbursed separately|39.30|FSC: 13; Default||External grouping not supported 80151707|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Opmc F-v Loop Repeat|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95176477|EAP|Custom 95176477||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80152499|EAP|CPT® 81025||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Urine Preg Test, Visual Color|1|HUMANA [1294]||HUMANA [11839]|25.83|FSC: 13; Default||Not reimbursed separately|25.83|FSC: 13; Default||External grouping not supported 80154461|EAP|CPT® 94375||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hb Opmc F-v Loop Repeat|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 80155039|EAP|CPT® 41010||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Ankylogossia-tongue Clip|1|HUMANA [1294]||HUMANA [11839]|4,165.40|FSC: 13; Default||Not reimbursed separately|4,165.40|FSC: 13; Default||External grouping not supported 80156037|EAP|CPT® 95992||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|HB CANALITH REPOSITIONING PROCEDURE|1|HUMANA [1294]||HUMANA [11839]|130.14|FSC: 13; Default||Not reimbursed separately|130.14|FSC: 13; Default||External grouping not supported 95187745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 80700057|EAP|Custom 80700057||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Aborted Procedure Charge|1|HUMANA [1294]||HUMANA [11839]|616.69|FSC: 13; Default||Not reimbursed separately|616.69|FSC: 13; Default||External grouping not supported 80700073|EAP|CPT® 66821||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Laser Treatment Eye|1|HUMANA [1294]||HUMANA [11839]|1,564.88|FSC: 13; Default||Not reimbursed separately|1,564.88|FSC: 13; Default||External grouping not supported 80700370|EAP|CPT® 0232T||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Plasma Apheresis|1|HUMANA [1294]||HUMANA [11839]|1,122.39|FSC: 13; Default||Not reimbursed separately|1,122.39|FSC: 13; Default||External grouping not supported 83100255|EAP|CPT® 90870||0901 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - ELECTROSHOCK TREATMENT|Hb Ect Procedure|1|HUMANA [1294]||HUMANA [11839]|1,383.75|FSC: 13; Default||Not reimbursed separately|1,383.75|FSC: 13; Default||External grouping not supported 87100020|EAP|CPT® 85347||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Act|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.84|FSC: 13; Default||Not reimbursed separately|12.84|FSC: 13; Default||External grouping not supported 87900148|EAP|Custom 87900148||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Aborted Cardiac Procedure Charge|1|HUMANA [1294]||HUMANA [11839]|847.29|FSC: 13; Default||Not reimbursed separately|847.29|FSC: 13; Default||External grouping not supported 95187746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peek Inter 9 X 23mm With Disp Shth|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 89501506|EAP|Custom 89501506||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Std Perfusion Chg Spc-100|1|HUMANA [1294]||HUMANA [11839]|1,768.61|FSC: 13; Default||Not reimbursed separately|1,768.61|FSC: 13; Default||External grouping not supported 89501530|EAP|Custom 89501530||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Pump Stand-by Pps-201|1|HUMANA [1294]||HUMANA [11839]|267.57|FSC: 13; Default||Not reimbursed separately|267.57|FSC: 13; Default||External grouping not supported 80168511|EAP|Custom 80168511||0998 - STATISTICAL CHARGES|Hb Platelet Gel Stat Charge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 89501548|EAP|Custom 89501548||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Cell Saver W/bypass Cs-300|1|HUMANA [1294]||HUMANA [11839]|385.31|FSC: 13; Default||Not reimbursed separately|385.31|FSC: 13; Default||External grouping not supported 89501555|EAP|Custom 89501555||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Cell Saver Cs-301|1|HUMANA [1294]||HUMANA [11839]|610.04|FSC: 13; Default||Not reimbursed separately|610.04|FSC: 13; Default||External grouping not supported 89501563|EAP|Custom 89501563||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Intr.aort.bal.pump-insrt Iab-400|1|HUMANA [1294]||HUMANA [11839]|733.13|FSC: 13; Default||Not reimbursed separately|733.13|FSC: 13; Default||External grouping not supported 89501571|EAP|Custom 89501571||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Intr.aort.bal.pump-on Bypass|1|HUMANA [1294]||HUMANA [11839]|420.08|FSC: 13; Default||Not reimbursed separately|420.08|FSC: 13; Default||External grouping not supported 89502009|EAP|Custom 89502009||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Cell Saver Standby Chg|1|HUMANA [1294]||HUMANA [11839]|148.50|FSC: 13; Default||Not reimbursed separately|148.50|FSC: 13; Default||External grouping not supported 89513451|EAP|CPT® 85610||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Prothombin Time Osc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.87|FSC: 13; Default||Not reimbursed separately|12.87|FSC: 13; Default||External grouping not supported 89514368|EAP|CPT® 95925||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Somatosensory Evoked Bil Upper Ex|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95184308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw Crosspinselft 1.2x5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.75|FSC: 13; Default||Not reimbursed separately|213.75|FSC: 13; Default||External grouping not supported 89514376|EAP|CPT® 95926||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Somatosensory Evoked Bil Lower Ex|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 89514442|EAP|CPT® 95869||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Emg Thoracic Paraspinal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 89514491|EAP|CPT® 95868||0922 - OTHER DIAGNOSTIC SERVICES - ELECTROMYELGRAM|Hb Cranial Nerve Bilateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 89514533|EAP|CPT® 92585||0471 - AUDIOLOGY - DIAGNOSTIC|Hb Brainstem Auditory Evoked Potenti|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 62064521|EAP|HCPCS G0472||0302 - LABORATORY - IMMUNOLOGY|Hb Hepatitis C Ab-screening|1|HUMANA [1294]||HUMANA [11839]|139.05|FSC: 13; Default||Not reimbursed separately|139.05|FSC: 13; Default||External grouping not supported 89514616|EAP|CPT® 95955||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg For Iom 1-3 Hrs|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 99000044|EAP|CPT® 86860||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Elution Studies|1|HUMANA [1294]||HUMANA [11839]|408.90|FSC: 13; Default||Not reimbursed separately|408.90|FSC: 13; Default||External grouping not supported 95184309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw Crosspinselft 1.2x6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.75|FSC: 13; Default||Not reimbursed separately|213.75|FSC: 13; Default||External grouping not supported 95187748|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fix Cr Left 10mm Tib C-d Fem 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95184301|EAP|Custom 95184301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Retractor Titan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184302|EAP|Custom 95184302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Assembly Titan|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187751|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx 23x120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95111104|EAP|Custom 95111104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Ic 14fr 5cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176471|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 33.0 Diopter Acrysof Toric Iq 13.0mm Length 6.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 80166002|EAP|Custom 80166002||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Cvmhu Lipid/glucose Poc|1|HUMANA [1294]||HUMANA [11839]|25.00|FSC: 13; Default||Not reimbursed separately|25.00|FSC: 13; Default||External grouping not supported 95184304|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set /w Pump Cylinder Titan 16cm|1|HUMANA [1294]||HUMANA [11839]|23,400.00|FSC: 13; Default||Not reimbursed separately|23,400.00|FSC: 13; Default||External grouping not supported 95176480|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Port Xcela Low Profile Titanium 8fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95176482|EAP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rotalink Plus System Burr Size 1.75mm X 135cm Length X 0.58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176484|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Hernia Gold Surgisis 8 Ply Wo Perferations 8 X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95176489|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Dbr Iii 6.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95176492|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Rad Es2 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95176493|EAP|Custom 95176493||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K Wire Blunt Es2|1|HUMANA [1294]||HUMANA [11839]|132.87|FSC: 13; Default||Not reimbursed separately|132.87|FSC: 13; Default||External grouping not supported 95176496|EAP|Custom 95176496||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tube Acculif Combo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Interbody Fusion Acculif Pl 6 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,985.00|FSC: 13; Default||Not reimbursed separately|17,985.00|FSC: 13; Default||External grouping not supported 95176499|EAP|Custom 95176499||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Loop Ti Lif 9 X 32mm X 6 Degrees|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95176500|EAP|Custom 95176500||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Large Coroent 12 X 18 X 55|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95176501|EAP|Custom 95176501||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xtra Wide Coroent 14 X 22 X 55|1|HUMANA [1294]||HUMANA [11839]|15,738.00|FSC: 13; Default||Not reimbursed separately|15,738.00|FSC: 13; Default||External grouping not supported 95176502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Long Es2 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95176503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Rad Es2 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 80166010|EAP|CPT® 50382||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Change Ureter Stent Percut|1|HUMANA [1294]||HUMANA [11839]|5,468.74|FSC: 13; Default||Not reimbursed separately|5,468.74|FSC: 13; Default||External grouping not supported 95176498|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 10.8mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95176504|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Dorsal L Plate 2.4mm 20 Degree 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.92|FSC: 13; Default||Not reimbursed separately|1,774.92|FSC: 13; Default||External grouping not supported 95176505|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Atlantis Elite 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|FSC: 13; Default||Not reimbursed separately|6,195.00|FSC: 13; Default||External grouping not supported 95176507|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Contour 6 X 22cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95184310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw Crosspinselft 1.2x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.75|FSC: 13; Default||Not reimbursed separately|213.75|FSC: 13; Default||External grouping not supported 95187750|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Set Performer 12fr 30mm .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm Long Thread Stainless Steel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95176514|EAP|Custom 95176514||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hose Vaccum 7/8 X 6 Ns|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Profyles Xs T 90dg Narrow|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95110227|EAP|Custom 95110227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Foley Coude 18fr 5cc Carson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176521|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 33.0 Diopter Acrysof Toric Iq 13.0mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95176524|EAP|Custom 95176524||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Oval Mc2 2 Stage 32 40 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187752|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maxxwire Stiff Super .035x260cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176526|EAP|Custom 95176526||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Trial Patient Spectra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Straight 2.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|FSC: 13; Default||Not reimbursed separately|1,262.25|FSC: 13; Default||External grouping not supported 95176529|EAP|Custom 95176529||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ao Sterile 4.2 X 230mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral T2 R1500 13mm X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|FSC: 13; Default||Not reimbursed separately|5,153.40|FSC: 13; Default||External grouping not supported 95176532|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 14 Pta 4.0mm X 120mm X 150 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Schanz 5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95176534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Perimeter Large Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95176535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Perimeter Medium Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95176538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate End Superior Large 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,458.75|FSC: 13; Default||Not reimbursed separately|16,458.75|FSC: 13; Default||External grouping not supported 95176540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate End Inferior Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,458.75|FSC: 13; Default||Not reimbursed separately|16,458.75|FSC: 13; Default||External grouping not supported 95176541|EAP|Custom 95176541||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Inlay Polyethlene W Tantalum Marker Large 10mm|1|HUMANA [1294]||HUMANA [11839]|2,964.00|FSC: 13; Default||Not reimbursed separately|2,964.00|FSC: 13; Default||External grouping not supported 95176542|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size D Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95176543|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Arthrodesis Hindfoot Ti 10mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,010.90|FSC: 13; Default||Not reimbursed separately|5,010.90|FSC: 13; Default||External grouping not supported 95176544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 6.0mm X 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|FSC: 13; Default||Not reimbursed separately|726.96|FSC: 13; Default||External grouping not supported 95184303|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservior Titan 75cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95184306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Iii Ti 4.0 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|FSC: 13; Default||Not reimbursed separately|324.00|FSC: 13; Default||External grouping not supported 95187749|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Persona Fxd Cr Lt 10mm Tib-g-h Fem 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95176517|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Tecnis Single Focus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95176549|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 9mm X 107cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95176551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 7 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|FSC: 13; Default||Not reimbursed separately|3,037.50|FSC: 13; Default||External grouping not supported 95176552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 8 Hole L173mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,258.00|FSC: 13; Default||Not reimbursed separately|9,258.00|FSC: 13; Default||External grouping not supported 95176553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|FSC: 13; Default||Not reimbursed separately|858.00|FSC: 13; Default||External grouping not supported 95176554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95176555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95176556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|FSC: 13; Default||Not reimbursed separately|138.00|FSC: 13; Default||External grouping not supported 95176557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 2 Hole L95mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,231.00|FSC: 13; Default||Not reimbursed separately|9,231.00|FSC: 13; Default||External grouping not supported 95176558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95176562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95176563|EAP|Custom 95176563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Osteotomy Hub Style|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly Long Es2 6.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|FSC: 13; Default||Not reimbursed separately|7,159.35|FSC: 13; Default||External grouping not supported 95176550|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 9mm X 122cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|FSC: 13; Default||Not reimbursed separately|9,255.00|FSC: 13; Default||External grouping not supported 95176577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent Dbr Iii 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95176578|EAP|Custom 95176578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Nvm5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 10 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95176580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Increased 8 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95176581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Driver Cannulated 2.0mm Ao Coupling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|688.80|FSC: 13; Default||Not reimbursed separately|688.80|FSC: 13; Default||External grouping not supported 95176582|EAP|Custom 95176582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K Wire 0.8mm X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 2.0mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95176584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro Toe Size 2.4mm X 16mm Angle 1o Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95176585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe Vo Pro Toe Size 2.0mm X 13mm Angle 1o Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|FSC: 13; Default||Not reimbursed separately|1,392.00|FSC: 13; Default||External grouping not supported 95176586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headless 3.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95176587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headless 3.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|FSC: 13; Default||Not reimbursed separately|696.00|FSC: 13; Default||External grouping not supported 95184311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Joint Patella Femoral Trochlea Right Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95176596|EAP|Custom 95176596||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lead Bs Ecg 5lead Set 5xvi 1.5m Carto 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176597|EAP|Custom 95176597||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Lead Bs Ecg 5 Lead 4 Limbs 1.8 M X1.5 Carto 3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176607|EAP|Custom 95176607||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 11mm X 22mm Vertestak|1|HUMANA [1294]||HUMANA [11839]|12,098.10|FSC: 13; Default||Not reimbursed separately|12,098.10|FSC: 13; Default||External grouping not supported 95176610|EAP|Custom 95176610||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Loop 10mm X 32.5mm|1|HUMANA [1294]||HUMANA [11839]|17,002.02|FSC: 13; Default||Not reimbursed separately|17,002.02|FSC: 13; Default||External grouping not supported 95176611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera Cannulated 7.5 X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|FSC: 13; Default||Not reimbursed separately|7,083.00|FSC: 13; Default||External grouping not supported 95176612|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,035.00|FSC: 13; Default||Not reimbursed separately|4,035.00|FSC: 13; Default||External grouping not supported 95176613|EAP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dermis Decellularized Arhtroflex 4.0cm X 7.0cm X 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.20|FSC: 13; Default||Not reimbursed separately|240.20|FSC: 13; Default||External grouping not supported 95176614|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triathlon Ps 13mm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95176616|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus Profile Moderate 520cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95176617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Rad Es2 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|FSC: 13; Default||Not reimbursed separately|2,527.95|FSC: 13; Default||External grouping not supported 95176619|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Rx 3.5 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95176621|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Rx 4.0 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95184312|EAP|Custom 95184312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Cannulated Asnis Micro 3.0mm Ao Coupling Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176623|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Attain Command Multipurpose W Surevalve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.3mm X 10mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95176631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.3mm X 12mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95176632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Open Left Low Profile Wedge 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95176633|EAP|Custom 95176633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Capsule System Patency Agile Given|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176634|EAP|Custom 95176634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Removal Tissue Tx1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176642|EAP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb System Pacing Ingenio Is 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95176643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Twinfix Ultra 4.5 With 2 Sutures Blue And Black|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|FSC: 13; Default||Not reimbursed separately|870.00|FSC: 13; Default||External grouping not supported 95176644|EAP|Custom 95176644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Achilles Preshaped 11mm|1|HUMANA [1294]||HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95176648|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer X-stop 14mm|1|HUMANA [1294]||HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95176649|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Icd Incepta Dr Df4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,850.00|FSC: 13; Default||Not reimbursed separately|47,850.00|FSC: 13; Default||External grouping not supported 95176650|EAP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Bi V Icd Incepta Df4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62,700.00|FSC: 13; Default||Not reimbursed separately|62,700.00|FSC: 13; Default||External grouping not supported 80166021|EAP|CPT® 91299||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Patency Agile Procedure|1|HUMANA [1294]||HUMANA [11839]|394.23|FSC: 13; Default||Not reimbursed separately|394.23|FSC: 13; Default||External grouping not supported 95176652|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intella Tip Xp 7f 8mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176653|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intella Tip Xp 7f 10mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176654|EAP|Custom 95176654||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Module For Intellatip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176655|EAP|Custom 95176655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable 10 For Intellatip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini Affex Ii 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|FSC: 13; Default||Not reimbursed separately|12,249.00|FSC: 13; Default||External grouping not supported 95176657|EAP|Custom 95176657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pressure Negative Therapy Wound Pico 6 X 8 With Sterile Pump|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176663|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intella Tip Xp 7f 8mm Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176664|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intella Tip Xp 7f 10mm Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,444.44|FSC: 13; Default||Not reimbursed separately|4,444.44|FSC: 13; Default||External grouping not supported 95176666|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mtn 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,606.72|FSC: 13; Default||Not reimbursed separately|3,606.72|FSC: 13; Default||External grouping not supported 95176667|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Inner|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.36|FSC: 13; Default||Not reimbursed separately|477.36|FSC: 13; Default||External grouping not supported 95176668|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Component Hip Bipolar With Advocate Stem Includes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,756.00|FSC: 13; Default||Not reimbursed separately|9,756.00|FSC: 13; Default||External grouping not supported 95176669|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Titanium 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,103.22|FSC: 13; Default||Not reimbursed separately|1,103.22|FSC: 13; Default||External grouping not supported 95176670|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Component Hip Unipolar With Advocate Stem Includes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,756.00|FSC: 13; Default||Not reimbursed separately|9,756.00|FSC: 13; Default||External grouping not supported 95176671|EAP|Custom 95176671||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Feeding G Low Profile Button 18fr 2.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176672|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Precoat Lps Flex Nexgen Prolong Right Size H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95176673|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guides Pin Pri Lps Flex Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95176676|EAP|Custom 95176676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bonnet Infant Midline 29cm 36cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176678|EAP|Custom 95176678||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Micropuncture Stick Mini Ii 4 Fr Standard Wire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176679|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Smooth Plus Profile Moderate 575cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95176681|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 13mm X 122mm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|FSC: 13; Default||Not reimbursed separately|9,534.00|FSC: 13; Default||External grouping not supported 95176683|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176684|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176686|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Versys Beaded 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,692.00|FSC: 13; Default||Not reimbursed separately|10,692.00|FSC: 13; Default||External grouping not supported 95176687|EAP|Custom 95176687||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Positioner Precise Bite Small Bx 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176689|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Access Ureteral Hd Navigator 13 15fr X 36cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176691|EAP|Custom 95176691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Management Pain On Q 400ml Hr Silver Soaker|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Advance Milagro 11mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|FSC: 13; Default||Not reimbursed separately|1,524.00|FSC: 13; Default||External grouping not supported 95176693|EAP|Custom 95176693||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Head Gear 40 45cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed Ptrcoat A/p Wedged Sz6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,195.50|FSC: 13; Default||Not reimbursed separately|7,195.50|FSC: 13; Default||External grouping not supported 80166036|EAP|Custom 80166036||0656 - HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE|Hb Hospice Room And Board Linked Addl|1|HUMANA [1294]||HUMANA [11839]|1,777.71|FSC: 13; Default||Not reimbursed separately|1,777.71|FSC: 13; Default||External grouping not supported 95176110|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Command Eh Xl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tapping 2.3 X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95176696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Cross Pin Self Tapping 2.3 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95176697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Narrow T 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95176698|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .045 X 6.84 Double Trocar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 2.4mm X 35mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|948.81|FSC: 13; Default||Not reimbursed separately|948.81|FSC: 13; Default||External grouping not supported 95176700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 10mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95176701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 12mm Self Tapping|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.79|FSC: 13; Default||Not reimbursed separately|155.79|FSC: 13; Default||External grouping not supported 95184313|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross .014 2.5 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176690|EAP|Custom 95176690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 200mm 20g 15mm 10 Pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176702|EAP|Custom 95176702||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Intrauterine Mirena Medical Necessity Only|1|HUMANA [1294]||HUMANA [11839]|2,091.54|FSC: 13; Default||Not reimbursed separately|2,091.54|FSC: 13; Default||External grouping not supported 95176705|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Resurfacing Shoulder Smr Spalla Tibia14v Dia 13 L 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95176706|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Monoblock Rsp Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95176707|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Resurfacing Shoulder Codr Smr Dia 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95176717|EAP|Custom 95176717||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Large Extra 10 Degree Lordotic 12x 18 X 55mm|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95176718|EAP|Custom 95176718||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft H2 Extensure Ii 10mm|1|HUMANA [1294]||HUMANA [11839]|6,960.00|FSC: 13; Default||Not reimbursed separately|6,960.00|FSC: 13; Default||External grouping not supported 95176719|EAP|Custom 95176719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Injection Cystoscopic Precision Injetak Laborie|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176720|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95176721|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Left Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95176722|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Poly Persona Fixed Bearing Cr Left 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95176723|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer X Stop 12mm|1|HUMANA [1294]||HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95176694|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 7fr Ebu 4.0 With Sideholes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176724|EAP|Custom 95176724||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cuff Blood Pressure Thigh Dura Cuf Reusable 1tube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176726|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Adapter Neck Hip 6mm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,212.00|FSC: 13; Default||Not reimbursed separately|1,212.00|FSC: 13; Default||External grouping not supported 95176727|EAP|Custom 95176727||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Cartridge Capacity Maximum Triple Mix Optivac 120 Gram|1|HUMANA [1294]||HUMANA [11839]|318.00|FSC: 13; Default||Not reimbursed separately|318.00|FSC: 13; Default||External grouping not supported 95176728|EAP|Custom 95176728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Obturator Blunt Y Knot Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166044|EAP|CPT® 92986||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Aortic Valvuloplasty|1|HUMANA [1294]||HUMANA [11839]|15,292.62|FSC: 13; Default||Not reimbursed separately|15,292.62|FSC: 13; Default||External grouping not supported 95176729|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Cocr 12 14 36mm 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,836.20|FSC: 13; Default||Not reimbursed separately|2,836.20|FSC: 13; Default||External grouping not supported 95176730|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|FSC: 13; Default||Not reimbursed separately|1,213.80|FSC: 13; Default||External grouping not supported 95176731|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Xpert Biliary 4.0mm X 30mm X 135cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95176732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 10hole 199mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,904.00|FSC: 13; Default||Not reimbursed separately|8,904.00|FSC: 13; Default||External grouping not supported 95176733|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176495|EAP|Custom 95176495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Insertion Kit Sensation Plus 7.5fr 40cc Fiber Optic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176737|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter True Dilatation Balloon 22mmx 4.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176738|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter True Dilatation Balloon 24mmx 4.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95176739|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter True Dilatation Balloon 20mm X 4.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62062187|EAP|CPT® 80306||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb Rapid Drug Panel, Medtox Scanner|1|HUMANA [1294]||HUMANA [11839]|51.42|FSC: 13; Default||Not reimbursed separately|51.42|FSC: 13; Default||External grouping not supported 62062195|EAP|CPT® 83021||0301 - LABORATORY - CHEMISTRY|Hb Capillary Electrophoresis - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.18|FSC: 13; Default||Not reimbursed separately|54.18|FSC: 13; Default||External grouping not supported 95176740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 10 Hole L199mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,904.00|FSC: 13; Default||Not reimbursed separately|8,904.00|FSC: 13; Default||External grouping not supported 95176741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176742|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|FSC: 13; Default||Not reimbursed separately|816.00|FSC: 13; Default||External grouping not supported 95176743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95176745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95176747|EAP|Custom 95176747||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Coroent 14 X 18 X 55mm|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95176748|EAP|Custom 95176748||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Xl Coroent 14 X 18 X 50mm|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95176750|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size C Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95176751|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size C Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95176752|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size G Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95176753|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Lps Flex Tinidium Nexgen Size G Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|FSC: 13; Default||Not reimbursed separately|13,981.50|FSC: 13; Default||External grouping not supported 95176754|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Left Size G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95176755|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95176756|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Personafixed Bearing Uc Left 13mm Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95176757|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Cemented Persona 38mm 9.5mm Thickness|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95176758|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95176759|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Right Size F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|FSC: 13; Default||Not reimbursed separately|4,399.20|FSC: 13; Default||External grouping not supported 95176760|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 10mm Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95176761|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95176762|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 11mm Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95176763|EAP|Custom 95176763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Contact Precision Sphere Plano 16mm B.c. 8.00|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176768|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Trochanteric 10mm X 130deg X 360mm Locking Fixation|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,146.19|FSC: 13; Default||Not reimbursed separately|6,146.19|FSC: 13; Default||External grouping not supported 95176769|EAP|Custom 95176769||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Guide 2.5mm|1|HUMANA [1294]||HUMANA [11839]|528.00|FSC: 13; Default||Not reimbursed separately|528.00|FSC: 13; Default||External grouping not supported 95176770|EAP|Custom 95176770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95176771|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 1.5mm 3 Hole Head 8 Hole Shaft With Guides Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,531.83|FSC: 13; Default||Not reimbursed separately|1,531.83|FSC: 13; Default||External grouping not supported 95176772|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 112mm Self Tapping With T4 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95176773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 113mm Self Tapping With T4 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95176774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 114mm Self Tapping With T4 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95176775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 12mm Self Tapping With T4 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95176776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 14mm Self Tapping With T4 Stardrive Recess|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95176778|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 6mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176779|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 8mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176780|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 9mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176781|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 10mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 11mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95176783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 12mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 13mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|FSC: 13; Default||Not reimbursed separately|16,500.00|FSC: 13; Default||External grouping not supported 95176785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 14mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 15mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 16mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95176788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reverse Non-porous 18mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 80166051|EAP|Custom 80166051||0116 - ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - DETOXIFICATION|Hb Behavioral Med Chem Dep Private|1|HUMANA [1294]||HUMANA [11839]|2,585.75|FSC: 13; Default||Not reimbursed separately|2,585.75|FSC: 13; Default||Accommodation codes not reimbursed separately 80166069|EAP|CPT® 27096||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Sacroiliac Injection|1|HUMANA [1294]||HUMANA [11839]|803.57|FSC: 13; Default||Not reimbursed separately|803.57|FSC: 13; Default||External grouping not supported 95187762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|343.74|FSC: 13; Default||Not reimbursed separately|343.74|FSC: 13; Default||External grouping not supported 80166077|EAP|HCPCS H0015||0906 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY|Hb Iop Chemical Dependency|1|HUMANA [1294]||HUMANA [11839]|384.30|FSC: 13; Default||Not reimbursed separately|384.30|FSC: 13; Default||External grouping not supported 80166085|EAP|Custom 80166085||0998 - STATISTICAL CHARGES|Hb Misc Charge Fbp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 7 5mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|FSC: 13; Default||Not reimbursed separately|4,126.50|FSC: 13; Default||External grouping not supported 95180017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10x440mmx125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95180001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral T2 7mm X 260mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95180018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reserve Non-porou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|FSC: 13; Default||Not reimbursed separately|17,707.50|FSC: 13; Default||External grouping not supported 95180002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Extreme Maxlock Mini|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,962.00|FSC: 13; Default||Not reimbursed separately|4,962.00|FSC: 13; Default||External grouping not supported 95180019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Charging Sensor Restore|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|FSC: 13; Default||Not reimbursed separately|4,500.00|FSC: 13; Default||External grouping not supported 95180020|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Stemmed All-poly Lps Nexgen Size 5 Green/e|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|FSC: 13; Default||Not reimbursed separately|3,073.20|FSC: 13; Default||External grouping not supported 95180003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 3s Right 10 X0340mm X 130 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95180021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 6mmx45mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|FSC: 13; Default||Not reimbursed separately|3,822.00|FSC: 13; Default||External grouping not supported 95180004|EAP|HCPCS 95180004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Concave 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Inner Set|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|746.31|FSC: 13; Default||Not reimbursed separately|746.31|FSC: 13; Default||External grouping not supported 95180005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95180023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 35mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95180024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Gamma 10 X 360mm X 130 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95180026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 12mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95180006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Washer 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.40|FSC: 13; Default||Not reimbursed separately|197.40|FSC: 13; Default||External grouping not supported 95180027|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 10mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95180007|EAP|Custom 95180007||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Large Extra 10 De|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95180028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 16mm Hex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95180008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Xlp 5.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.00|FSC: 13; Default||Not reimbursed separately|2,103.00|FSC: 13; Default||External grouping not supported 95180029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 10mm Hex Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95180030|EAP|Custom 95180030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.8 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Xlp 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.00|FSC: 13; Default||Not reimbursed separately|2,103.00|FSC: 13; Default||External grouping not supported 95180031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Dorsolateral12-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95180010|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bolt Xlp 5.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.00|FSC: 13; Default||Not reimbursed separately|2,103.00|FSC: 13; Default||External grouping not supported 95180032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ulna Midshaft 12-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95180011|EAP|Custom 95180011||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Coroent Xl 12x18x45mm|1|HUMANA [1294]||HUMANA [11839]|14,514.00|FSC: 13; Default||Not reimbursed separately|14,514.00|FSC: 13; Default||External grouping not supported 95180037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guides Pin Pri Lps-flex Instrument Specific Patient|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95180012|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bolt Lateral Xlp 5.5x35m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.00|FSC: 13; Default||Not reimbursed separately|2,103.00|FSC: 13; Default||External grouping not supported 95180014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Sky 2 Level 28mm Titaniu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|FSC: 13; Default||Not reimbursed separately|4,622.22|FSC: 13; Default||External grouping not supported 95180015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Affix Ii 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|FSC: 13; Default||Not reimbursed separately|12,249.00|FSC: 13; Default||External grouping not supported 95180016|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 10.5x115mm Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|FSC: 13; Default||Not reimbursed separately|1,420.20|FSC: 13; Default||External grouping not supported 95176029|EAP|Custom 95176029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Support Cxi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180036|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Straight 15mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,371.69|FSC: 13; Default||Not reimbursed separately|4,371.69|FSC: 13; Default||External grouping not supported 95180038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R1.5titanium Rt. 11x340mmx125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95180039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Brigade 5.5x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95180040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Affix Ii S Bladed 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|FSC: 13; Default||Not reimbursed separately|12,249.00|FSC: 13; Default||External grouping not supported 95180041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Affix 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|FSC: 13; Default||Not reimbursed separately|12,249.00|FSC: 13; Default||External grouping not supported 95180042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial 3z Plif Mas 5.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,586.00|FSC: 13; Default||Not reimbursed separately|5,586.00|FSC: 13; Default||External grouping not supported 95180043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial 3z Plif Mas 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,586.00|FSC: 13; Default||Not reimbursed separately|5,586.00|FSC: 13; Default||External grouping not supported 95180049|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Revsion Legion Size 3 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|FSC: 13; Default||Not reimbursed separately|9,022.20|FSC: 13; Default||External grouping not supported 95180044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent Fixation Plif Mas 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,191.00|FSC: 13; Default||Not reimbursed separately|1,191.00|FSC: 13; Default||External grouping not supported 95180045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre Bent Fixation Plif Mas 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,191.00|FSC: 13; Default||Not reimbursed separately|1,191.00|FSC: 13; Default||External grouping not supported 95180050|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Straight 14mm X 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|FSC: 13; Default||Not reimbursed separately|4,177.80|FSC: 13; Default||External grouping not supported 95180047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Pressfit Straight 15mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,371.69|FSC: 13; Default||Not reimbursed separately|4,371.69|FSC: 13; Default||External grouping not supported 95180051|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Charger And Ipg Precsion|1|HUMANA [1294]||HUMANA [11839]|47,400.00|FSC: 13; Default||Not reimbursed separately|47,400.00|FSC: 13; Default||External grouping not supported 95180048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Construct Oxinum Legion Size 4 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|FSC: 13; Default||Not reimbursed separately|22,572.00|FSC: 13; Default||External grouping not supported 95180052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 6.7 X 75mm Cannulated Fully Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95180054|EAP|Custom 95180054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .094 X 8 Trocar Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Left 20.0mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|FSC: 13; Default||Not reimbursed separately|7,677.00|FSC: 13; Default||External grouping not supported 95180056|EAP|Custom 95180056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Samurai|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180057|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Bipolar Head Universal Uhr 26mmx56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|FSC: 13; Default||Not reimbursed separately|3,624.60|FSC: 13; Default||External grouping not supported 95180058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Skyline 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|FSC: 13; Default||Not reimbursed separately|5,031.06|FSC: 13; Default||External grouping not supported 95180061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Perimeter Tracture Calcaneal S Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|FSC: 13; Default||Not reimbursed separately|3,285.00|FSC: 13; Default||External grouping not supported 95180062|EAP|Custom 95180062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flowport Ii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180063|EAP|Custom 95180063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Cannulated Fixos 2.5 X 32mm Ao|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm L80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95180076|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Mini Trek Otw 1.50mm X 15 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180078|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Victory Str 30g .018 195cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180079|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Victory Str 30g .018 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180080|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Victory Str 18g .018 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180081|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X3 Triathlon Ps Size 7 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95180082|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient Advanced Prime|1|HUMANA [1294]||HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95180077|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Victory Str 18g .018 195cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95175873|EAP|Custom 95175873||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Fracture First Express 10/2 10mm Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg 2.5 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95180084|EAP|Custom 95180084||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Repair Peri-patch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biocrci 9x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95180086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biocrci 7x25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|FSC: 13; Default||Not reimbursed separately|771.00|FSC: 13; Default||External grouping not supported 95180088|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Heartrail Ii 6fr 100cm Il3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180089|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Heartrail Ii 6fr 100cm Il4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180091|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial X 3 Triathlon Ps 11mm #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|FSC: 13; Default||Not reimbursed separately|7,312.20|FSC: 13; Default||External grouping not supported 95180092|EAP|Custom 95180092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Pear Linvatec Conmed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180093|EAP|Custom 95180093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shaver Concave White Great Prebent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mini X-core 25-40mm 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,035.00|FSC: 13; Default||Not reimbursed separately|22,035.00|FSC: 13; Default||External grouping not supported 95180095|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock Mini Ti X-core 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95180096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acp Archon 62mm 3level|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,307.00|FSC: 13; Default||Not reimbursed separately|5,307.00|FSC: 13; Default||External grouping not supported 95180097|EAP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Defibrillator Fortify Assura Dr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,562.50|FSC: 13; Default||Not reimbursed separately|45,562.50|FSC: 13; Default||External grouping not supported 95180098|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Ramp 8.5fr .038 60cm Sheath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180099|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95180100|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Cr Persona Fixed Bearing Cr Left 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|FSC: 13; Default||Not reimbursed separately|4,270.50|FSC: 13; Default||External grouping not supported 95184321|EAP|Custom 95184321||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Tornier 3mmx170mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180101|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Occlusion 9fr X .035 Diameter X 120cm Length Coda-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180102|EAP|Custom 95180102||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Support Mbrace Wrist Grey|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180103|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.5 X 35 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95180104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|FSC: 13; Default||Not reimbursed separately|792.00|FSC: 13; Default||External grouping not supported 95180105|EAP|Custom 95180105||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Spiked 14mm|1|HUMANA [1294]||HUMANA [11839]|1,590.00|FSC: 13; Default||Not reimbursed separately|1,590.00|FSC: 13; Default||External grouping not supported 95180106|EAP|Custom 95180106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Cannula Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180107|EAP|Custom 95180107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Vent Heart Left Dlp W Out Stylet 16 Fr 20 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180108|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated Heparin Propaten 8 Mm X 50 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|FSC: 13; Default||Not reimbursed separately|5,541.00|FSC: 13; Default||External grouping not supported 95180109|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Coated Heparin Propaten 6mm X 50cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,358.00|FSC: 13; Default||Not reimbursed separately|5,358.00|FSC: 13; Default||External grouping not supported 95180110|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Propaten Accuseal Hd 6 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,987.00|FSC: 13; Default||Not reimbursed separately|3,987.00|FSC: 13; Default||External grouping not supported 95180111|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Right Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95180112|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Right Size H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180113|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Cr Fixed Bearing Persona Right 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180114|EAP|Custom 95180114||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Band Tissue Fixate Single Pack|1|HUMANA [1294]||HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95180115|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Freezor Med Blue 7fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180116|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standare Porous Left Size 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95180118|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Cr Fixed Bearing Persona Left 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|FSC: 13; Default||Not reimbursed separately|4,399.20|FSC: 13; Default||External grouping not supported 95180119|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degreee Stemmed Right Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180121|EAP|Custom 95180121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fusion Lumbar Sovereign 12 Degree 18 X 23 X 32mm|1|HUMANA [1294]||HUMANA [11839]|25,284.00|FSC: 13; Default||Not reimbursed separately|25,284.00|FSC: 13; Default||External grouping not supported 95180122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Elite Vision 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|FSC: 13; Default||Not reimbursed separately|7,821.00|FSC: 13; Default||External grouping not supported 95180124|EAP|Custom 95180124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Flex 8.0x72mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180125|EAP|Custom 95180125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Percutaneous Double Loaded|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62062203|EAP|CPT® 83516||0302 - LABORATORY - IMMUNOLOGY|Hb Celiac Disease Dual Antigen Screen - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.59|FSC: 13; Default||Not reimbursed separately|34.59|FSC: 13; Default||External grouping not supported 62062211|EAP|CPT® 85576||0305 - LABORATORY - HEMATOLOGY|Hb Platelet Aggregation|1|HUMANA [1294]||HUMANA [11839]|74.73|FSC: 13; Default||Not reimbursed separately|74.73|FSC: 13; Default||External grouping not supported 95180129|EAP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guide Nerve Neuragen 7mmidx3cm|1|HUMANA [1294]||HUMANA [11839]|5,610.00|FSC: 13; Default||Not reimbursed separately|5,610.00|FSC: 13; Default||External grouping not supported 95180130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0mm X 44mm Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95180131|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Fluted Press-fit Triathlon Ts 18mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,704.40|FSC: 13; Default||Not reimbursed separately|3,704.40|FSC: 13; Default||External grouping not supported 80166119|EAP|CPT® 11971||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Remove Tissue Expander|1|HUMANA [1294]||HUMANA [11839]|7,158.35|FSC: 13; Default||Not reimbursed separately|7,158.35|FSC: 13; Default||External grouping not supported 95180132|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Right Size G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Non Locking 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95180197|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Proximal Lateral 12 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,727.00|FSC: 13; Default||Not reimbursed separately|8,727.00|FSC: 13; Default||External grouping not supported 95180198|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|FSC: 13; Default||Not reimbursed separately|816.00|FSC: 13; Default||External grouping not supported 95180200|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95180201|EAP|Custom 95180201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guides Instrument Specific Patient Persona Cr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180202|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Cemented Ps Narrow Persona Left Size 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95180203|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibia Cemented Stemmed Persona 5 Degree Left Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180204|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Poly Persona Fixed Bearing Cps Left 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180205|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Poly Persona Fixed Bearing Cr Left 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Shank 5.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|FSC: 13; Default||Not reimbursed separately|2,043.00|FSC: 13; Default||External grouping not supported 95180207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Dbr Iii 5.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95180208|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Leg Iliac Aaa 24mm X 39cm Flex Zenith Spiral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|FSC: 13; Default||Not reimbursed separately|25,374.00|FSC: 13; Default||External grouping not supported 95180209|EAP|Custom 95180209||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 10mm X 11mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95180210|EAP|HCPCS C1724||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Burr Rotalink Plus 2.00 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95180211|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster 4.8mm X 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95180212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Universal 4-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,204.00|FSC: 13; Default||Not reimbursed separately|3,204.00|FSC: 13; Default||External grouping not supported 95180213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y R20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,495.00|FSC: 13; Default||Not reimbursed separately|3,495.00|FSC: 13; Default||External grouping not supported 95180214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95180215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Variable 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95180217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Thread 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95180218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Long Thread 7.0 X 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,084.80|FSC: 13; Default||Not reimbursed separately|1,084.80|FSC: 13; Default||External grouping not supported 95187747|EAP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix 3-layer Wound Cytal 7x10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.95|FSC: 13; Default||Not reimbursed separately|79.95|FSC: 13; Default||External grouping not supported 95184319|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Entovis Sr-t Pro Mri Sc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|FSC: 13; Default||Not reimbursed separately|13,800.00|FSC: 13; Default||External grouping not supported 80166120|EAP|CPT® 19081||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB BX BREAST W PLACE OF BREAST LOCALIZATION DEVICE FIRST LESION W STEREOW STEREO|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80166131|EAP|CPT® 19082||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Breast W Place Of Breast Localization Device Add Lesion W Stereo|1|HUMANA [1294]||HUMANA [11839]|2,538.75|FSC: 13; Default||Not reimbursed separately|2,538.75|FSC: 13; Default||External grouping not supported 80166142|EAP|CPT® 19083||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Breast W Place Localization Device Percut First Lesion Incl Us|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80166153|EAP|CPT® 19084||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Breast W Place Localization Device Percut Ea Add Lesion Incl Us|1|HUMANA [1294]||HUMANA [11839]|2,033.05|FSC: 13; Default||Not reimbursed separately|2,033.05|FSC: 13; Default||External grouping not supported 80166164|EAP|CPT® 19085||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Breast W Place Localization Device Percut First Lesion Incl Mri|1|HUMANA [1294]||HUMANA [11839]|4,237.19|FSC: 13; Default||Not reimbursed separately|4,237.19|FSC: 13; Default||External grouping not supported 80166175|EAP|CPT® 19086||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bx Breast W Place Localization Device Percut Ea Add Lesion Incl Mri|1|HUMANA [1294]||HUMANA [11839]|2,905.10|FSC: 13; Default||Not reimbursed separately|2,905.10|FSC: 13; Default||External grouping not supported 80166186|EAP|CPT® 19281||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut First Lesion, Includ Mammo|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80166197|EAP|CPT® 19282||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut Ea Add Lesion, Includ Mammo|1|HUMANA [1294]||HUMANA [11839]|1,160.00|FSC: 13; Default||Not reimbursed separately|1,160.00|FSC: 13; Default||External grouping not supported 80166208|EAP|CPT® 19283||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut First Lesion, Includ Stereo|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80166219|EAP|CPT® 19284||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut Ea Add Lesion Incl Stereo|1|HUMANA [1294]||HUMANA [11839]|1,409.31|FSC: 13; Default||Not reimbursed separately|1,409.31|FSC: 13; Default||External grouping not supported 80166220|EAP|CPT® 19285||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut First Lesion, Includes Us|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80166231|EAP|CPT® 19286||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut Ea Add Lesion, Includes Us|1|HUMANA [1294]||HUMANA [11839]|1,174.00|FSC: 13; Default||Not reimbursed separately|1,174.00|FSC: 13; Default||External grouping not supported 80166242|EAP|CPT® 19287||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut First Lesion, Includes Mri|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80166473|EAP|CPT® 19288||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Place Breast Localization Device Percut Ea Add Lesion, Includes Mri|1|HUMANA [1294]||HUMANA [11839]|1,883.08|FSC: 13; Default||Not reimbursed separately|1,883.08|FSC: 13; Default||External grouping not supported 80166253|EAP|CPT® 37236||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcatheter Placement Of An Intravascular Stent Initial Artery|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80166264|EAP|CPT® 37237||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcatheter Placement Of An Intravascular Stent Each Add Artery|1|HUMANA [1294]||HUMANA [11839]|10,901.00|FSC: 13; Default||Not reimbursed separately|10,901.00|FSC: 13; Default||External grouping not supported 80166275|EAP|CPT® 37238||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcatheter Placement Of An Intravascular Stent(s), Initial Vein|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80166286|EAP|CPT® 37239||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Transcatheter Placement Of An Intravascular Stent(s), Ea Add Vein|1|HUMANA [1294]||HUMANA [11839]|10,803.33|FSC: 13; Default||Not reimbursed separately|10,803.33|FSC: 13; Default||External grouping not supported 80166297|EAP|CPT® 37241||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vascular Embolization Or Occlusion, Venous|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80166306|EAP|CPT® 37242||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Vascular Embolization Or Occlusion, Arterial|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 95184320|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 25cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,185.00|FSC: 13; Default||Not reimbursed separately|19,185.00|FSC: 13; Default||External grouping not supported 95180025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Apex 3 X 110 Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95180216|EAP|Custom 95180216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Guide Drill Ring/cone Peek 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180219|EAP|Custom 95180219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Blue 2.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180220|EAP|Custom 95180220||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Square Blue 4.7 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180223|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Proximal With Proform Graft Endovascular 30 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|FSC: 13; Default||Not reimbursed separately|36,282.00|FSC: 13; Default||External grouping not supported 95180224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Titanium U-blade Lag Set 10.5 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|FSC: 13; Default||Not reimbursed separately|2,066.40|FSC: 13; Default||External grouping not supported 95180225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Plus Omega 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|808.20|FSC: 13; Default||Not reimbursed separately|808.20|FSC: 13; Default||External grouping not supported 95180226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hip Barrel Standard Keyed 135 Degree 3-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,252.80|FSC: 13; Default||Not reimbursed separately|1,252.80|FSC: 13; Default||External grouping not supported 95180227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hip Barrel Short Keyed 135 Degree 4-holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,252.80|FSC: 13; Default||Not reimbursed separately|1,252.80|FSC: 13; Default||External grouping not supported 95180228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 3.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95180229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 9mm X 300mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95180230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full 5.0mm X 27.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|FSC: 13; Default||Not reimbursed separately|554.40|FSC: 13; Default||External grouping not supported 95180231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95180232|EAP|Custom 95180232||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Interbody 42mm X 30mm X 8 Degrees|1|HUMANA [1294]||HUMANA [11839]|25,284.00|FSC: 13; Default||Not reimbursed separately|25,284.00|FSC: 13; Default||External grouping not supported 95180233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Solera 6.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|FSC: 13; Default||Not reimbursed separately|1,764.00|FSC: 13; Default||External grouping not supported 95180234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Solera 4.75mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95180235|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 18 32mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95180236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 95180237|EAP|Custom 95180237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10mm X 360mm X 130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95180239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5mm/l85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95180240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Friction Low 40mm +0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,090.00|FSC: 13; Default||Not reimbursed separately|3,090.00|FSC: 13; Default||External grouping not supported 95180241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Long 32mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|FSC: 13; Default||Not reimbursed separately|1,590.00|FSC: 13; Default||External grouping not supported 80166319|EAP|CPT® 37243||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB VASC EMBOLIZE/OCCLUDE INTERVENTION FOR TUMORS, ORGAN|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80166320|EAP|CPT® 37244||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|HB VASC EMBOLIZE/OCCLUDE INTERVENTION FOR ARTERIAL OR VENOUS|1|HUMANA [1294]||HUMANA [11839]|30,587.28|FSC: 13; Default||Not reimbursed separately|30,587.28|FSC: 13; Default||External grouping not supported 80166331|EAP|CPT® 43212||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy Flexible Transoral W Placement Of Endoscopic Stent|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 80166342|EAP|CPT® 43214||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy Flexible Transoral W Dilation 30 Mm Or Larger|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80166353|EAP|CPT® 43229||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy Flexible Transoral W Ablation Tumor Polyp Or Lesion|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 80166364|EAP|CPT® 43233||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flexible Transoral W Dilation Of Esophagus 30 Mm Or Larger|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80166375|EAP|CPT® 43270||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flexible Transoral W Ablation Of Tumor Polyps Or Lesion|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 80166386|EAP|CPT® 43274||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|HB ERCP W ENDO STENT BILIARY OR PANCREATIC DUCT INC PRE POST DILATION|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 80166397|EAP|CPT® 43275||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp With Removal Of Foreign Body Or Stent Biliary Pancreatic Duct|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 80166481|EAP|CPT® 27600||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Decompression Fasciotomy|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 80166408|EAP|CPT® 43276||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|HB ERCP W REMOVAL EXCH STENT BILI PANCR DUCT INCL PRE POST DILATION|1|HUMANA [1294]||HUMANA [11839]|13,623.06|FSC: 13; Default||Not reimbursed separately|13,623.06|FSC: 13; Default||External grouping not supported 95187756|EAP|Custom 95187756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Clear Threaded 5.5mm X 75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166419|EAP|CPT® 43277||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp W Trans Endo Dilation Bili Pancr Duct Or Ampulla Each Duct|1|HUMANA [1294]||HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 80166420|EAP|CPT® 92521||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Evaluation Of Speech Fluency Eg, Stuttering, Cluttering|1|HUMANA [1294]||HUMANA [11839]|327.24|FSC: 13; Default||Not reimbursed separately|327.24|FSC: 13; Default||External grouping not supported 80166431|EAP|CPT® 92522||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Eval Speech Sound Articulation Phono Process Apraxia Dysarthri|1|HUMANA [1294]||HUMANA [11839]|267.99|FSC: 13; Default||Not reimbursed separately|267.99|FSC: 13; Default||External grouping not supported 80166442|EAP|CPT® 92523||0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION|Hb Eval Speech Sound W Eval Of Language Comprehension Expression|1|HUMANA [1294]||HUMANA [11839]|560.85|FSC: 13; Default||Not reimbursed separately|560.85|FSC: 13; Default||External grouping not supported 80166453|EAP|CPT® 92524||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Behavioral And Qualitative Analysis Of Voice And Resonance|1|HUMANA [1294]||HUMANA [11839]|262.29|FSC: 13; Default||Not reimbursed separately|262.29|FSC: 13; Default||External grouping not supported 95180242|EAP|Custom 95180242||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Feeder Bottle Special Needs 80ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180243|EAP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Occluder Amplatzer Septal 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|FSC: 13; Default||Not reimbursed separately|19,869.00|FSC: 13; Default||External grouping not supported 95180244|EAP|Custom 95180244||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Feeder Collar Haberman|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180245|EAP|Custom 95180245||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Feeder Nipple Haberman|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180246|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.25x 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180247|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.25x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180248|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.25x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180249|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180250|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180251|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180252|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180253|EAP|Custom 95180253||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Substitute Pro-stim Injectable|1|HUMANA [1294]||HUMANA [11839]|5,955.00|FSC: 13; Default||Not reimbursed separately|5,955.00|FSC: 13; Default||External grouping not supported 95180254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Left Size F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180255|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona Stemmed 5 Degree Right Size D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180257|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Cr Fixed Bearing Persona Right 10 Mm Heig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180259|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180261|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180262|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180263|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180264|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180265|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180266|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180267|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180268|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.00x38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180269|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180270|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 2.50x38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180271|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Semi Tendonosis Frozen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,657.94|FSC: 13; Default||Not reimbursed separately|5,657.94|FSC: 13; Default||External grouping not supported 80166499|EAP|CPT® 62252||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Reprogramming Cerebrospinal Shunt|1|HUMANA [1294]||HUMANA [11839]|836.29|FSC: 13; Default||Not reimbursed separately|836.29|FSC: 13; Default||External grouping not supported 95180260|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Upgrade|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180272|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180273|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180274|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180275|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180276|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180277|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180278|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180279|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 3.50x38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180280|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95180281|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster 4.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95180282|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Jostent Graftmaster 4.8mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|FSC: 13; Default||Not reimbursed separately|7,185.00|FSC: 13; Default||External grouping not supported 95184322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Calotte 43mmx16mm Low Cocr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|FSC: 13; Default||Not reimbursed separately|8,468.58|FSC: 13; Default||External grouping not supported 95180283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp Non Locking 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95180284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dvr Lock Narrow Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95180285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Smooth Locking 2.2mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95180286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Smooth Locking 2.2mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95180287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95180288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Md 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95180289|EAP|Custom 95180289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95180291|EAP|Custom 95180291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adapter Drive Line 100/cs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166598|EAP|CPT® 51720||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bladder Instillation Anticarcinogenic Agent|1|HUMANA [1294]||HUMANA [11839]|725.14|FSC: 13; Default||Not reimbursed separately|725.14|FSC: 13; Default||External grouping not supported 95180292|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 Fr Rbu 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180293|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 Fr Rbu 3.5 Sideholes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180294|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 Fr Rbu 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180296|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Wallflex Covered 18 Mm X 10.3 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,443.00|FSC: 13; Default||Not reimbursed separately|7,443.00|FSC: 13; Default||External grouping not supported 95180297|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Airway Pulmonary 22 Mm X 80 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,135.00|FSC: 13; Default||Not reimbursed separately|6,135.00|FSC: 13; Default||External grouping not supported 95180298|EAP|Custom 95180298||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bioprosthesis Valve Aortic Porcine Sav Edwards 29mm|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95180299|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Uniglide 0.18 Diameter X 150cm Length|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180300|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180301|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180302|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180303|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180304|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180305|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180306|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95180307|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Promus Platinum 4.00x38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 80166606|EAP|CPT® 31660||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchial Thermoplasty 1 Lobe|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 80166614|EAP|CPT® 31661||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Bronchial Thermoplasty 2 Or More Lobes|1|HUMANA [1294]||HUMANA [11839]|16,794.28|FSC: 13; Default||Not reimbursed separately|16,794.28|FSC: 13; Default||External grouping not supported 95180295|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6 Fr Rbu 4.0 Sideholes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Articulating Genisus Ps Medium Right 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,490.00|FSC: 13; Default||Not reimbursed separately|5,490.00|FSC: 13; Default||External grouping not supported 95180309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 11mmx360mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95180310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95180311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 4.5 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95180312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression Locking Narrow 9-hole/l169mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.00|FSC: 13; Default||Not reimbursed separately|621.00|FSC: 13; Default||External grouping not supported 95180313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft 4 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,985.01|FSC: 13; Default||Not reimbursed separately|1,985.01|FSC: 13; Default||External grouping not supported 95180314|EAP|Custom 95180314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instruments Scissors Disp (reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Superior 7 Hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95180316|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Intella Tip Mi 7fr 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180317|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Round Smooth Profile High 550cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|FSC: 13; Default||Not reimbursed separately|2,781.00|FSC: 13; Default||External grouping not supported 95180318|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Bone Shaft Tibia Distal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,022.00|FSC: 13; Default||Not reimbursed separately|5,022.00|FSC: 13; Default||External grouping not supported 95180320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Va Lcp 2.4mm Rim Shaft Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,833.96|FSC: 13; Default||Not reimbursed separately|1,833.96|FSC: 13; Default||External grouping not supported 95180322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pins 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|834.00|FSC: 13; Default||Not reimbursed separately|834.00|FSC: 13; Default||External grouping not supported 95180323|EAP|Custom 95180323||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inserter Tip For Large And Xl Deep Implants|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180324|EAP|Custom 95180324||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Prodisc Xl Deep 6mm|1|HUMANA [1294]||HUMANA [11839]|17,697.00|FSC: 13; Default||Not reimbursed separately|17,697.00|FSC: 13; Default||External grouping not supported 95180325|EAP|Custom 95180325||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Optima Ardis 11mm X 11mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|14,790.90|FSC: 13; Default||Not reimbursed separately|14,790.90|FSC: 13; Default||External grouping not supported 95180326|EAP|Custom 95180326||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Lasso Sc Wire Loop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius Distal Volar Xxl Narrow Right 2.7mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|FSC: 13; Default||Not reimbursed separately|4,275.00|FSC: 13; Default||External grouping not supported 95180328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Poly 7mm X 45 Mm Expedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|FSC: 13; Default||Not reimbursed separately|3,974.88|FSC: 13; Default||External grouping not supported 95180329|EAP|Custom 95180329||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interbody Concorde 9mm X 10 Mm X 27 Mm|1|HUMANA [1294]||HUMANA [11839]|14,227.20|FSC: 13; Default||Not reimbursed separately|14,227.20|FSC: 13; Default||External grouping not supported 95180330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti Expedium 5.5 Mm X 85 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95184325|EAP|Custom 95184325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Novasure Endometrial Ablation Kit 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187755|EAP|Custom 95187755||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Optical View|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180331|EAP|Custom 95180331||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wire Expedium|1|HUMANA [1294]||HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95180332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Cr Persona Standard Porous Left Size 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95180333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tibia Cemented Persona 5 Degree Stemmed Left Size H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95180334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulation Cr Persona Fixed Bearing Left 14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Standard Porous Right Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|FSC: 13; Default||Not reimbursed separately|8,400.00|FSC: 13; Default||External grouping not supported 95180336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Cr Fixed Bearing Persona Right 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Tm Persona Cr Narrow Porous Right Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|FSC: 13; Default||Not reimbursed separately|9,000.00|FSC: 13; Default||External grouping not supported 95180338|EAP|Custom 95180338||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Mastergraft 6cc|1|HUMANA [1294]||HUMANA [11839]|2,013.90|FSC: 13; Default||Not reimbursed separately|2,013.90|FSC: 13; Default||External grouping not supported 95180339|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spider 2.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95184323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB STEM HUMERAL PTC STANDARD 127 5 DEGREE X66MM SIZE 1A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|FSC: 13; Default||Not reimbursed separately|11,290.86|FSC: 13; Default||External grouping not supported 80166501|EAP|HCPCS C5271||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub Total Up To 100 Sq Cm - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 95184318|EAP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Setrox S 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|FSC: 13; Default||Not reimbursed separately|1,425.00|FSC: 13; Default||External grouping not supported 80166512|EAP|HCPCS C5272||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub Total To 100 Cm Add 25cm - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|1,183.21|FSC: 13; Default||Not reimbursed separately|1,183.21|FSC: 13; Default||External grouping not supported 95187754|EAP|Custom 95187754||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Dbm Stryker 2.5cc|1|HUMANA [1294]||HUMANA [11839]|1,498.68|FSC: 13; Default||Not reimbursed separately|1,498.68|FSC: 13; Default||External grouping not supported 80168529|EAP|CPT® 58100||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Endometrial (biopsy) W/ Or W/o Endocervical Sampling W/o Cerv Dil|1|HUMANA [1294]||HUMANA [11839]|512.59|FSC: 13; Default||Not reimbursed separately|512.59|FSC: 13; Default||External grouping not supported 80166523|EAP|HCPCS C5273||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub Total To 100 Cm;add 25 Cm - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|5,009.36|FSC: 13; Default||Not reimbursed separately|5,009.36|FSC: 13; Default||External grouping not supported 80166534|EAP|HCPCS C5274||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub To 100 Cm;add 100 - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|1,801.42|FSC: 13; Default||Not reimbursed separately|1,801.42|FSC: 13; Default||External grouping not supported 95187760|EAP|Custom 95187760||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168537|EAP|CPT® 76120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hb Cineradiography|1|HUMANA [1294]||HUMANA [11839]|319.38|FSC: 13; Default||Not reimbursed separately|319.38|FSC: 13; Default||External grouping not supported 80166545|EAP|HCPCS C5275||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub 100 Cm First 25 Cm Or Less Medicare Only|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 80166556|EAP|HCPCS C5276||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub To 100 Cm Add 25 Cm - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|1,583.63|FSC: 13; Default||Not reimbursed separately|1,583.63|FSC: 13; Default||External grouping not supported 80166567|EAP|HCPCS C5277||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub To 100 Cm; First 100 Cm - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|1,534.29|FSC: 13; Default||Not reimbursed separately|1,534.29|FSC: 13; Default||External grouping not supported 80166578|EAP|HCPCS C5278||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb App Of Low Cost Skin Sub > Than 100 Cm Add 100 Cm - Medicare Only|1|HUMANA [1294]||HUMANA [11839]|2,123.67|FSC: 13; Default||Not reimbursed separately|2,123.67|FSC: 13; Default||External grouping not supported 80166589|EAP|CPT® 95812||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hb Eeg Extended Monitoring 41-60 Minutes|1|HUMANA [1294]||HUMANA [11839]|721.20|FSC: 13; Default||Not reimbursed separately|721.20|FSC: 13; Default||External grouping not supported 95184335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti Full Thread 4mmxl44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|FSC: 13; Default||Not reimbursed separately|186.00|FSC: 13; Default||External grouping not supported 95184329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.7mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95184327|EAP|Custom 95184327||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 200mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184334|EAP|Custom 95184334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Radius 20cm Curved 8g X 10cm (single Pick Carton)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Medial Distal 4hole L97mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|FSC: 13; Default||Not reimbursed separately|7,635.00|FSC: 13; Default||External grouping not supported 95184331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mimi Maxlock Extreme 2.7mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|FSC: 13; Default||Not reimbursed separately|364.80|FSC: 13; Default||External grouping not supported 95184332|EAP|Custom 95184332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Convex 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Substitute Cement Bone Ha Injectable Hydroset 3cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,799.30|FSC: 13; Default||Not reimbursed separately|2,799.30|FSC: 13; Default||External grouping not supported 95184328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Mini Maxlock Extreme 2.7mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95184330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mini Maxlock Extreme 2.7mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95184342|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 7.5mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95184344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Plate Broad Crvd. 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95184343|EAP|Custom 95184343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Screwdriver T-15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T10 Full Thread 3.5mm / L12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95184341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 7.5mm X 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95184346|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 Full Thread 3.5mm/ L14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95184340|EAP|Custom 95184340||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Concave 18mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Locking Screw T10 Full Thread 3.5mm/l10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95184362|EAP|Custom 95184362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plug Port Spectra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184361|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Workhorse 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184367|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184366|EAP|Custom 95184366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 90-s Xl Rf Energy Serfas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184357|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Picc Triple Lumen 6fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Joint Pc Medium/small 18.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 62063946|EAP|CPT® 87900||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Infectious Agent Drug Sus -ref Lab|1|HUMANA [1294]||HUMANA [11839]|391.05|FSC: 13; Default||Not reimbursed separately|391.05|FSC: 13; Default||External grouping not supported 62063953|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Infectious Agent Detection, Amp Probe -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.27|FSC: 13; Default||Not reimbursed separately|105.27|FSC: 13; Default||External grouping not supported 62063961|EAP|CPT® 86023||0302 - LABORATORY - IMMUNOLOGY|Hb Platelet Associated Assay -ref Lab|1|HUMANA [1294]||HUMANA [11839]|37.38|FSC: 13; Default||Not reimbursed separately|37.38|FSC: 13; Default||External grouping not supported 95184281|EAP|Custom 95184281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Scorpion Multifire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184371|EAP|Custom 95184371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Stepdrill Solid Recon T2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular Ti 1/3 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.75|FSC: 13; Default||Not reimbursed separately|168.75|FSC: 13; Default||External grouping not supported 95184369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95184373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Recon T2 6.5 X 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95184368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cancellous 4.0 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95184372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Recon Left Ri.5 10 X 400mm X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|FSC: 13; Default||Not reimbursed separately|5,266.80|FSC: 13; Default||External grouping not supported 95184374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Recon T2 6.5 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|FSC: 13; Default||Not reimbursed separately|718.20|FSC: 13; Default||External grouping not supported 95184384|EAP|Custom 95184384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Rail Mini 2.75rx (03-5000)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184381|EAP|Custom 95184381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Smooth Tip 2.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184376|EAP|Custom 95184376||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Imlant Viper|1|HUMANA [1294]||HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95184379|EAP|Custom 95184379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Non-locking 2.5mm X 216mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Fixation 80/20 (03-5015)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95184383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prodense Injectable 10cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|FSC: 13; Default||Not reimbursed separately|8,514.00|FSC: 13; Default||External grouping not supported 95184377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95184382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7.0 X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|FSC: 13; Default||Not reimbursed separately|2,754.00|FSC: 13; Default||External grouping not supported 95184375|EAP|Custom 95184375||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Dbm Allograft 1cc|1|HUMANA [1294]||HUMANA [11839]|966.00|FSC: 13; Default||Not reimbursed separately|966.00|FSC: 13; Default||External grouping not supported 95162194|EAP|Custom 95162194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Container Evacuated 1000ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95184386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Straight 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.50|FSC: 13; Default||Not reimbursed separately|1,774.50|FSC: 13; Default||External grouping not supported 95187765|EAP|Custom 95187765||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Splitter Kit M-4 Hv 15-l Ce Mk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168545|EAP|CPT® 43211||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Esophagoscopy, Flexible, Transoral With Endo Mucosal Resec|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95187767|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Nanocross Elite 2.0 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184387|EAP|Custom 95184387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Scatpad Sterile 10/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187768|EAP|Custom 95187768||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Sims2 5fr 65cm .038|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187771|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti 43mm Dia X 16mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95187764|EAP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Lead Transvene-cs/svc|1|HUMANA [1294]||HUMANA [11839]|2,049.00|FSC: 13; Default||Not reimbursed separately|2,049.00|FSC: 13; Default||External grouping not supported 95187770|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti 48mm Dia X 18mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95187775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 4.0 X44mm Ti Cannulated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95187772|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Nucleus Simpliciti Sz 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,315.77|FSC: 13; Default||Not reimbursed separately|13,315.77|FSC: 13; Default||External grouping not supported 95184409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|FSC: 13; Default||Not reimbursed separately|864.00|FSC: 13; Default||External grouping not supported 95184398|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Accolade Ii 127 Degree Size 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95187773|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Third 14 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|FSC: 13; Default||Not reimbursed separately|2,835.00|FSC: 13; Default||External grouping not supported 95184408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm X L24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95184416|EAP|Custom 95184416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Line Transducer Sterile Medtronic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187774|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw T 10 Full Thread 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95184380|EAP|Custom 95184380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Locking 4.0mm X 296mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184394|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm/125 Deg 235mm Right Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95184403|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184404|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187785|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Radius Continuous 5.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95184397|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184393|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187776|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Atlas 16 X 6 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184412|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184407|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 6x40x75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187779|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent Endoprosthesis 20 X 80 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,903.86|FSC: 13; Default||Not reimbursed separately|4,903.86|FSC: 13; Default||External grouping not supported 95184392|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 3 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 10mm/125 Deg 235mm Left Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95184413|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 7 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184401|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187782|EAP|Custom 95187782||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Coflex Xlarge 4 X 5.4 Yds Foam Unstretch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184402|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187777|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pta Atlas 12 X 6 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184411|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 6 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184389|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Charger 3 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187778|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 7fr 12 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184396|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187788|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 535cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184390|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 3 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184405|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187787|EAP|Custom 95187787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Aortic Heartstring 4.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184410|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 6 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184399|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187786|EAP|Custom 95187786||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Cervical Prosthesis Standard 15x17 H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95184395|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184391|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 3 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184400|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 4 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184406|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184414|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 7 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184428|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 8 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184421|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184438|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 7fr 12 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184429|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 9 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184442|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95187801|EAP|Custom 95187801||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cassette V.a.c. Ulta Veralink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184435|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 7fr 12 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184436|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 7fr 12 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187803|EAP|Custom 95187803||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Tube V.a.c. Vera T.r.a.c. Duo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184448|EAP|Custom 95184448||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Ss 0.91 X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184425|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 8 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187805|EAP|Custom 95187805||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Light Surgical Bent Tip Dual Scintillant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184423|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Sheath Lead Extraction Curve 16fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184431|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 9 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184420|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 7 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Autofix Compression Mod T7 Dr 2.0 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,683.00|FSC: 13; Default||Not reimbursed separately|1,683.00|FSC: 13; Default||External grouping not supported 95184450|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Steerable Tourguide 7 Fr 45 Cm X 17 Mm Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187807|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 13mm Self Tapping With T8 Stardrive Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95184445|EAP|Custom 95184445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner Blunt Trocar 1.4mm X 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184443|EAP|Custom 95184443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire With Drill Tip 2.0 X234mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187806|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 2.0mm X 16/7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95184451|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Steerable Tourguide 7 Fr 55 Cm X 17 Mm Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187796|EAP|Custom 95187796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Veraflo V.a.c. Ulta Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184452|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Steerable Tourguide 7 Fr 55 Cm X 9 Mm Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184433|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 10 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187799|EAP|Custom 95187799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Veraflo Cleanse V.a.c. Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184434|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 10 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184439|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti Ft 4.0mm X48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95187792|EAP|Custom 95187792||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Veraflo V.a.c. Ulta Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184424|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 8 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Autofix Compression Mod T7 Dr 2.0 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|FSC: 13; Default||Not reimbursed separately|858.00|FSC: 13; Default||External grouping not supported 95187793|EAP|Custom 95187793||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dressing Veraflo V.a.c. Ulta Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184432|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 9 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184426|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 8 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187809|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Smooth Round High Profile 250cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mtp Fusion Plate Medium 5 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|FSC: 13; Default||Not reimbursed separately|3,780.00|FSC: 13; Default||External grouping not supported 95184422|EAP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Lead Extraction Curve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187817|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Ultra High Profile 350cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184440|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One Third Ti 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95184419|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 7 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187816|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Ultra High Profile 320cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184427|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 8 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187814|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Ultra High Profile 270cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184430|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 6fr 9 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184441|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Medial Tibia 149mm Right 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|FSC: 13; Default||Not reimbursed separately|7,635.00|FSC: 13; Default||External grouping not supported 95187813|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Ultra High Profile 240cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 6 Hole/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|FSC: 13; Default||Not reimbursed separately|3,037.50|FSC: 13; Default||External grouping not supported 95184417|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 7 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187815|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Smooth Ultra High Profile 295cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184437|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 7fr 12 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187811|EAP|Custom 95187811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Gel 270cc Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184418|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 7 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187818|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Angiojet Spiroflex Vg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 62063987|EAP|CPT® 87046||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hb Stool Culture Vibrio & Aeromonas|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.32|FSC: 13; Default||Not reimbursed separately|28.32|FSC: 13; Default||External grouping not supported 95184463|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Moderate Med Height 530cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95187821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95184458|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 8mm X 20mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184453|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 5 Mm X 30mm X 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187823|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cone Metaphyseal Femoral Tm 35 Sm/ Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,903.50|FSC: 13; Default||Not reimbursed separately|13,903.50|FSC: 13; Default||External grouping not supported 95184459|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 8mm X 30mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184455|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 7mm X 40mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187822|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Hinge Rotating Left Size C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|FSC: 13; Default||Not reimbursed separately|28,485.00|FSC: 13; Default||External grouping not supported 95184456|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 7mm X 60mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187820|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Distal Endovascular Thoracic Alpha Zenith 44mm X 211 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95184461|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 8mm X 60mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184460|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 8mm X 40mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95187819|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Prox Endovascular Thoracic Alpha Zenith 44mm X 233 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|FSC: 13; Default||Not reimbursed separately|46,500.00|FSC: 13; Default||External grouping not supported 95184462|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 9mm X 40mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184467|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 10mm X 30mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184205|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Uringe Meter Ic 16fr W/statlock/temp Sensor Late|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187812|EAP|Custom 95187812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Micra Sheath W/hydrophillic Coating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 8hole/l202mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,802.00|FSC: 13; Default||Not reimbursed separately|11,802.00|FSC: 13; Default||External grouping not supported 95187810|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Transcatheter Mirca Pacing System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,250.00|FSC: 13; Default||Not reimbursed separately|32,250.00|FSC: 13; Default||External grouping not supported 95184475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stem Radial Lateral Size 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,594.00|FSC: 13; Default||Not reimbursed separately|12,594.00|FSC: 13; Default||External grouping not supported 95184465|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Endurity Sr Single Chamber Pacemaker|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|FSC: 13; Default||Not reimbursed separately|14,904.00|FSC: 13; Default||External grouping not supported 95184476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Radial Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,511.00|FSC: 13; Default||Not reimbursed separately|8,511.00|FSC: 13; Default||External grouping not supported 95184470|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 6mm X 30mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184472|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 7mm X 30mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95187834|EAP|Custom 95187834||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Extender Aortic Aaa Excluder 23mm X 3.3cm|1|HUMANA [1294]||HUMANA [11839]|9,762.00|FSC: 13; Default||Not reimbursed separately|9,762.00|FSC: 13; Default||External grouping not supported 95184468|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 10mm X 60mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95187837|EAP|Custom 95187837||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Aortic Heartstring 3.8mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184474|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 8mm X 30mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187832|EAP|Custom 95187832||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coroent Li 10x9x20mm 4deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95184469|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 6mm X 20mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184473|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 8mm X 20mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187836|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloonstent-graft Plus Q50 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184466|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 9mm X 60mm X 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dc-lcp 2.4mm 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.57|FSC: 13; Default||Not reimbursed separately|1,071.57|FSC: 13; Default||External grouping not supported 95184471|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 6fr 7mm X 20mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95187831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept Modualr 5.5 X 50 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95187833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 4hole/l47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95184504|EAP|Custom 95184504||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Shaft Stardrive T105mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95184505|EAP|Custom 95184505||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthroscopic Blade Powerasp 3.5mm X 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184499|EAP|Custom 95184499||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Awl Quick Release 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 5.5 X 50 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95184506|EAP|Custom 95184506||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthroscopic Blade Blurr 5.0mm X 13cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184498|EAP|Custom 95184498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Collar 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187844|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Align 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,227.00|FSC: 13; Default||Not reimbursed separately|7,227.00|FSC: 13; Default||External grouping not supported 95184500|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 18mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95184501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 12mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95187846|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Alighn 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,227.00|FSC: 13; Default||Not reimbursed separately|7,227.00|FSC: 13; Default||External grouping not supported 95184502|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping Stardrive 3.5mm X 10mm Low Profi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|FSC: 13; Default||Not reimbursed separately|116.82|FSC: 13; Default||External grouping not supported 95187845|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align 8mm X 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95184503|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self Tapping 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.56|FSC: 13; Default||Not reimbursed separately|85.56|FSC: 13; Default||External grouping not supported 95184497|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 12 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187847|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align 9mm X 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,161.00|FSC: 13; Default||Not reimbursed separately|7,161.00|FSC: 13; Default||External grouping not supported 95184480|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular Fr 6mm X 60mm X 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184477|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 9mm X 30mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95187838|EAP|Custom 95187838||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cloth Skin Prep Preoperative And Nasal 20/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184488|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 9 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184490|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187843|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Media Contrast Isovue 300 200ml Ibp 10/ca|1|HUMANA [1294]||HUMANA [11839]|52.65|FSC: 13; Default||Not reimbursed separately|52.65|FSC: 13; Default||External grouping not supported 95184492|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184485|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 8 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tfna 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|FSC: 13; Default||Not reimbursed separately|2,062.98|FSC: 13; Default||External grouping not supported 95187850|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem C Amt Std Offset Size 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|FSC: 13; Default||Not reimbursed separately|12,959.10|FSC: 13; Default||External grouping not supported 95184478|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Bili Expr Ld 7fr 10mm X 30mm X 135 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95184482|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 7 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187851|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Centralizer Void C-stem 12dm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.90|FSC: 13; Default||Not reimbursed separately|417.90|FSC: 13; Default||External grouping not supported 95184484|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 8 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184486|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 9 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95184487|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 9 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184495|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95184481|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular Fr 6mm X 80mm X 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184483|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 7 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 5.0mm X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|FSC: 13; Default||Not reimbursed separately|464.76|FSC: 13; Default||External grouping not supported 95184496|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 12 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184479|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular Fr 6mm X 40mm X 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Lcp 2.0mm / 45mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.42|FSC: 13; Default||Not reimbursed separately|795.42|FSC: 13; Default||External grouping not supported 80168552|EAP|CPT® 91122||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Anorectal Manometry|1|HUMANA [1294]||HUMANA [11839]|669.36|FSC: 13; Default||Not reimbursed separately|669.36|FSC: 13; Default||External grouping not supported 95187889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Ti Self-tapping 2.0mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.93|FSC: 13; Default||Not reimbursed separately|372.93|FSC: 13; Default||External grouping not supported 95184523|EAP|Custom 95184523||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit With Qc 2.0mmx106mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184517|EAP|Custom 95184517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Picc 5fr Triple Lumen Hf 3cg Max Barrier 3/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0mmx9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95180340|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Attain Command|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Poly Persona Fixed Bearing Cr Left 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95180343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Femur Persona Metal Trabecular Cr Narrow Porous Left Size|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|FSC: 13; Default||Not reimbursed separately|9,570.00|FSC: 13; Default||External grouping not supported 95180344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95180345|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubeular One Third 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|200.25|FSC: 13; Default||Not reimbursed separately|200.25|FSC: 13; Default||External grouping not supported 95184508|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 7mm X 80mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184515|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 12mm X 60mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tapping 2.0mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95184507|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 7mm X 40mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95184522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Radial Stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,244.00|FSC: 13; Default||Not reimbursed separately|11,244.00|FSC: 13; Default||External grouping not supported 95184510|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10mm X 40mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187879|EAP|Custom 95187879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Bridge Accessory Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184512|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10mm X 80mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184513|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10mm X 100mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187880|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Occlusion Bridge 90 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184511|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 10mm X 60mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184509|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 8mm X 120mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184514|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Epic Vascular 6fr 12mm X 40mm X 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Short Thread 4.0x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95184528|EAP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Ascenda Intrathecal Implant|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,901.00|FSC: 13; Default||Not reimbursed separately|2,901.00|FSC: 13; Default||External grouping not supported 95184529|EAP|Custom 95184529||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Acc 800|1|HUMANA [1294]||HUMANA [11839]|3,840.00|FSC: 13; Default||Not reimbursed separately|3,840.00|FSC: 13; Default||External grouping not supported 95184526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Small 0 Degree Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,011.00|FSC: 13; Default||Not reimbursed separately|4,011.00|FSC: 13; Default||External grouping not supported 95184531|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,117.31|FSC: 13; Default||Not reimbursed separately|17,117.31|FSC: 13; Default||External grouping not supported 95187898|EAP|Custom 95187898||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Countersink Cannulated Asnis Micro 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184530|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Control|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,930.00|FSC: 13; Default||Not reimbursed separately|18,930.00|FSC: 13; Default||External grouping not supported 95184533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral T2 8mm X 260mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95187903|EAP|Custom 95187903||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Neonatal 21v Dual Heated Limb 60"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95184539|EAP|Custom 95184539||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14x16x7|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95187899|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Fixed Core J Curved .025 X 260|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T2 4mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95184538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95187895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Achorage Locking 3.5mmx10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95184536|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Altrx 40mm X 56mm 10 Degree +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|FSC: 13; Default||Not reimbursed separately|8,156.40|FSC: 13; Default||External grouping not supported 95184535|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral Socket Sz32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|FSC: 13; Default||Not reimbursed separately|3,240.00|FSC: 13; Default||External grouping not supported 95187897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mmxl36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95184545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T8 Full Thread 2.7mm/l18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95184364|EAP|Custom 95184364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe 50-s Xl Rf Energy Serfas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 2.mm 14/6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95184365|EAP|Custom 95184365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Accelerator 90-s Rf Energy Serfas 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184548|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Augment Femoral Distal Anterior Or Posterior Sz E 5 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95187896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mmxl30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95184547|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Femoral Hinge Rotating Left Size E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|FSC: 13; Default||Not reimbursed separately|28,485.00|FSC: 13; Default||External grouping not supported 95184543|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Full Thread 2.7mm/l24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95187900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Asnis Micro 2.mm 13/6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95184544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T8 Full Thread 2.7mm/l16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95184550|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Cable Ncb|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.63|FSC: 13; Default||Not reimbursed separately|474.63|FSC: 13; Default||External grouping not supported 95187894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Utility Straight 3hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95184553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Ncb 5.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|FSC: 13; Default||Not reimbursed separately|425.19|FSC: 13; Default||External grouping not supported 95184541|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Full Thread 2.8mm/l20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 80169712|EAP|CPT® 63688||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hb Rev Rem Impl Spinal Neuro Generator|1|HUMANA [1294]||HUMANA [11839]|9,719.35|FSC: 13; Default||Not reimbursed separately|9,719.35|FSC: 13; Default||External grouping not supported 95184552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Shaft Femur Curved Ncb 12 Hole 249mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,789.74|FSC: 13; Default||Not reimbursed separately|1,789.74|FSC: 13; Default||External grouping not supported 95184546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bone Screw T8 Full Thread 2.7mm/l20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95187893|EAP|Custom 95187893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Unthreaded 1.4mmx150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Full Thread 2.7mm/l22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95184549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Button Pectoralis Repair|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95187905|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape 395cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95187904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 3.0mm Asnis Micro Cannulated 24/6mm Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|FSC: 13; Default||Not reimbursed separately|623.25|FSC: 13; Default||External grouping not supported 95184555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.00|FSC: 13; Default||Not reimbursed separately|2,505.00|FSC: 13; Default||External grouping not supported 95184551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ncb 4.0mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|FSC: 13; Default||Not reimbursed separately|296.64|FSC: 13; Default||External grouping not supported 95187907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Smooth Locking Radius 2.0mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95187908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Peg Threaded Locking 2.3mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|FSC: 13; Default||Not reimbursed separately|277.95|FSC: 13; Default||External grouping not supported 95187909|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Mini Trek Rx 1.50mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184565|EAP|Custom 95184565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Procedure Smart Prep 2 - 30|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184564|EAP|Custom 95184564||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Procedure Smart Prep 2 - 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184563|EAP|Custom 95184563||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Procedure Smart Prep 2 - 120|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184557|EAP|Custom 95184557||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator 22fr Peel A Way|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184561|EAP|Custom 95184561||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape C-armor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184566|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip Angle Neck 132 Degree V40 Accolade Ii Sz # 35mm Ne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|FSC: 13; Default||Not reimbursed separately|16,814.70|FSC: 13; Default||External grouping not supported 95187919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95184569|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Lgx Ms 700cx Ams|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,660.06|FSC: 13; Default||Not reimbursed separately|27,660.06|FSC: 13; Default||External grouping not supported 95184562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Right 4-hole/l99mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,740.00|FSC: 13; Default||Not reimbursed separately|7,740.00|FSC: 13; Default||External grouping not supported 95187918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tfna Cannulated Ti 12mm/125 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95184568|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Resevior Conceal Ams 100ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,923.91|FSC: 13; Default||Not reimbursed separately|6,923.91|FSC: 13; Default||External grouping not supported 95187916|EAP|Custom 95187916||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Graduated Sizing Royal Pig Marker 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184559|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Round Moderate 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95184556|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Smart Flex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95187920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95184558|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast 700cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|FSC: 13; Default||Not reimbursed separately|4,725.00|FSC: 13; Default||External grouping not supported 95184560|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hammock Subfascial Monarc With Tensioning Suture|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.00|FSC: 13; Default||Not reimbursed separately|2,943.00|FSC: 13; Default||External grouping not supported 95187917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Irix-a 38x28x8 Degree 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95184572|EAP|Custom 95184572||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Dual Connect Cable & Leadwire Disposable 50/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187925|EAP|Custom 95187925||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Day Set 15/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184580|EAP|Custom 95184580||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Passing 3mm Spade Tip Sterile|1|HUMANA [1294]||HUMANA [11839]|777.00|FSC: 13; Default||Not reimbursed separately|777.00|FSC: 13; Default||External grouping not supported 95184577|EAP|Custom 95184577||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler 60mm Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95184574|EAP|Custom 95184574||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon Flex Endoscopic Powered Plus 60mm Std|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184578|EAP|Custom 95184578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler 60mm Black|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064530|EAP|CPT® 80050||0301 - LABORATORY - CHEMISTRY|Hb General Health Panel Cmp-cbc-tsh|1|HUMANA [1294]||HUMANA [11839]|134.67|FSC: 13; Default||Not reimbursed separately|134.67|FSC: 13; Default||External grouping not supported 95184575|EAP|Custom 95184575||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Echelon Flex Endoscopic Powered Plus 60mm Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184576|EAP|Custom 95184576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler 60mm White|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187930|EAP|Custom 95187930||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Quick Connect Cannulated 1.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184581|EAP|Custom 95184581||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Avamax Vertebral 11g 15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184582|EAP|Custom 95184582||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187929|EAP|Custom 95187929||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Wire Hcs Tip .9mm X 152mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 4.5x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95184583|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lisfranc 4.5x32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|FSC: 13; Default||Not reimbursed separately|2,664.00|FSC: 13; Default||External grouping not supported 95187933|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent System Xact Carotid 9mm X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95184589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|FSC: 13; Default||Not reimbursed separately|3,960.00|FSC: 13; Default||External grouping not supported 95187947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread 4.0mmxl42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95184593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mmxl55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95187931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 28mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184591|EAP|Custom 95184591||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Ablation Cryo Malleable 10cm Atricure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184586|EAP|Custom 95184586||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Prismaflex Hf1400 4/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187949|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184588|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cervical Vg2 Vertigraft 4.75x6.22mm Freeze Dried|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.19|FSC: 13; Default||Not reimbursed separately|3,299.19|FSC: 13; Default||External grouping not supported 95184590|EAP|Custom 95184590||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ablation Surgical Access Synergy Isolator Atricure|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 24mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 62063995|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hb Drug Panel, Blood -ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95184595|EAP|Custom 95184595||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bur Carbide Oval 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184594|EAP|Custom 95184594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Prismaflex Filter M150 4/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 18mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184598|EAP|Custom 95184598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handle Laryngoscope Mini Brite Pro Solo Disposable 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184597|EAP|Custom 95184597||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handle Laryngoscope Brite Pro Solo Disposable 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184599|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bead Resorbable Osteocure 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95187941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 10mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184611|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Right Ulna 3 Hole L65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|FSC: 13; Default||Not reimbursed separately|4,569.00|FSC: 13; Default||External grouping not supported 95184615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Decreased 10 Hole/right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95184612|EAP|Custom 95184612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Agg.plus Long Hip Blade 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 10mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184610|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Visi-pro 6mm Diameter X 37mm Length X 135mm Balloon|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95184619|EAP|Custom 95184619||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stentbody Main Afx 22-90/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95187945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 14mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184613|EAP|Custom 95184613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Long Hip Pear Bur Flute F-series 4.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Self Tap Cortical 3.5x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95184617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cancellous 4.0x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95184618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cancellous 4.0x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95187952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 28mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 12 Hole/l 143mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.00|FSC: 13; Default||Not reimbursed separately|2,049.00|FSC: 13; Default||External grouping not supported 95187948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 20mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 24mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 22mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 12mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95187953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia 4mm Cancellous Rt 6 Hole/l147mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,902.00|FSC: 13; Default||Not reimbursed separately|7,902.00|FSC: 13; Default||External grouping not supported 95184629|EAP|Custom 95184629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Threaded 2.3mm (blue)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 14mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Long Thread 7.0x75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|903.00|FSC: 13; Default||Not reimbursed separately|903.00|FSC: 13; Default||External grouping not supported 95184625|EAP|Custom 95184625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Square 3.7mm (green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Short 5.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|745.50|FSC: 13; Default||Not reimbursed separately|745.50|FSC: 13; Default||External grouping not supported 95184626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Maxlock Extreme 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95187938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 16mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Thread Short 5.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|745.50|FSC: 13; Default||Not reimbursed separately|745.50|FSC: 13; Default||External grouping not supported 95184628|EAP|Custom 95184628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.9mm (green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 26mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184631|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95184634|EAP|Custom 95184634||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Endopath Vascular White 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 3.5mm X 16mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184630|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread 6mm 6.0mm/l75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95187928|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 2.5mm X 30mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|FSC: 13; Default||Not reimbursed separately|1,192.50|FSC: 13; Default||External grouping not supported 95184633|EAP|Custom 95184633||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Vascular Powered Flex Echelon W/tip Placement Adv 35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184636|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Mentor Low Height Mod Plus 515c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95187955|EAP|Custom 95187955||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Femoral Head|1|HUMANA [1294]||HUMANA [11839]|3,321.03|FSC: 13; Default||Not reimbursed separately|3,321.03|FSC: 13; Default||External grouping not supported 95184632|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Brace Internal Ligament|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|FSC: 13; Default||Not reimbursed separately|3,225.00|FSC: 13; Default||External grouping not supported 95184635|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Mentor Low Height Mod Plus 465c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95187962|EAP|Custom 95187962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Pin 4 Hole Mri Compact Hii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T10 Full Thread 3.5mm/l36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95184639|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soundstar 8fr Eco|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184640|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 6 X 14 X 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95187959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Selftapping Stardrive Variable Angle 3.5mmx32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95184642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral T2 9mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95184641|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cornerstone Psr 7 X 14 X 11 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95187956|EAP|Custom 95187956||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Gryphon Proknot Fish|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Thread Full T2 4mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|FSC: 13; Default||Not reimbursed separately|550.20|FSC: 13; Default||External grouping not supported 95184644|EAP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Soundstar Eco 10f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Prox Va-lcp 3.5x 147mm Sm Bend 8 Hole /rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,714.25|FSC: 13; Default||Not reimbursed separately|5,714.25|FSC: 13; Default||External grouping not supported 95184649|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95184645|EAP|Custom 95184645||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Balloon Expulsion Anorectal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187960|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lat Ti Lcp 2.7/3.5mm 6 Hole Lt/112|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95187963|EAP|Custom 95187963||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Post Angled 30 Deg Mri Compact Hii|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187973|EAP|Custom 95187973||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Mri X Clik|1|HUMANA [1294]||HUMANA [11839]|843.75|FSC: 13; Default||Not reimbursed separately|843.75|FSC: 13; Default||External grouping not supported 95187969|EAP|Custom 95187969||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Hcs Tip 1.4mm X 165mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187971|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Contact 8 56cm Mri Avista|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|FSC: 13; Default||Not reimbursed separately|6,097.50|FSC: 13; Default||External grouping not supported 95187972|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Generator Pulse Implantable Mri Montage Precision|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,900.00|FSC: 13; Default||Not reimbursed separately|48,900.00|FSC: 13; Default||External grouping not supported 95187970|EAP|Custom 95187970||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Quick Connect Cannulated 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T8 Full Thread 2.7 Mm X L24 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95184653|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Ip Protege 3.0.1 Pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,100.00|FSC: 13; Default||Not reimbursed separately|47,100.00|FSC: 13; Default||External grouping not supported 95184654|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient Protege|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95187977|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 2.7mm X L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95184655|EAP|Custom 95184655||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Charging Protege Nema-1-15 Nonce|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T8 Full Thread 2.7mm/l26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|FSC: 13; Default||Not reimbursed separately|930.00|FSC: 13; Default||External grouping not supported 95184659|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Superior Lateral 4hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95187965|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Micra Single Chamber Surescan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,250.00|FSC: 13; Default||Not reimbursed separately|32,250.00|FSC: 13; Default||External grouping not supported 95184657|EAP|Custom 95184657||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Plume Pen Pro Surgical Smoke Esu Pencil 20/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184658|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Head Radial Lateral 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,181.75|FSC: 13; Default||Not reimbursed separately|5,181.75|FSC: 13; Default||External grouping not supported 95187974|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Control Remote Freelink|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95184661|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Repair Peyronie's Surgisis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,478.25|FSC: 13; Default||Not reimbursed separately|1,478.25|FSC: 13; Default||External grouping not supported 95187979|EAP|Custom 95187979||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accucath 20g 2.25" Basic 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187980|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Countersink 3.8 Hcs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|604.80|FSC: 13; Default||Not reimbursed separately|604.80|FSC: 13; Default||External grouping not supported 95184663|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast 300cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|FSC: 13; Default||Not reimbursed separately|4,725.00|FSC: 13; Default||External grouping not supported 95187981|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Stimulator Sure Scan Specify Mri 65cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,400.00|FSC: 13; Default||Not reimbursed separately|17,400.00|FSC: 13; Default||External grouping not supported 95184662|EAP|Custom 95184662||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast Natrelle 350cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184665|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Right 10-hole/l176mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,931.00|FSC: 13; Default||Not reimbursed separately|8,931.00|FSC: 13; Default||External grouping not supported 95187978|EAP|Custom 95187978||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accucath 20g 1.25" Basic 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184664|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Metacarpophangeal Mcp Sr Size Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,250.00|FSC: 13; Default||Not reimbursed separately|11,250.00|FSC: 13; Default||External grouping not supported 95184666|EAP|Custom 95184666||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Unibody Bifurcated 28mm 120/l 16-40 Iliac|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95184670|EAP|Custom 95184670||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Auto Inflate Dlp Pvc 15 Fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184667|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Power Picc Catheter 6fr Tl W/maximal Barrier|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pathfinder Nxt 5.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|FSC: 13; Default||Not reimbursed separately|6,330.00|FSC: 13; Default||External grouping not supported 95184668|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 4fr Sl 70cm Guide 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184669|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 6fr Tl 70cm Guide 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95187991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Medial 12 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,182.00|FSC: 13; Default||Not reimbursed separately|4,182.00|FSC: 13; Default||External grouping not supported 95184671|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking 2.7 X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95184673|EAP|Custom 95184673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bushing Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Hexalobe 3.5mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|FSC: 13; Default||Not reimbursed separately|426.00|FSC: 13; Default||External grouping not supported 95184672|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dartfire Headed 3.5mm X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|FSC: 13; Default||Not reimbursed separately|522.00|FSC: 13; Default||External grouping not supported 95184676|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Cpx 4 Style 8300 650cc Tall Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95187992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Hexalob 3.5mm X 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95184674|EAP|Custom 95184674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scp Knee Kit With End Targeted Accuport|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184675|EAP|Custom 95184675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula End-targeted 11ga.x120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight Perc Nxt Pathfinder 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|FSC: 13; Default||Not reimbursed separately|2,955.00|FSC: 13; Default||External grouping not supported 95187985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Extended 5 Hole Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|FSC: 13; Default||Not reimbursed separately|2,745.00|FSC: 13; Default||External grouping not supported 95184681|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 32mmx6mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95187987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Healicoil Rsb Sa 4.75mm W/1 Ut & 1 Ub Bk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,255.25|FSC: 13; Default||Not reimbursed separately|2,255.25|FSC: 13; Default||External grouping not supported 95184682|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,374.25|FSC: 13; Default||Not reimbursed separately|6,374.25|FSC: 13; Default||External grouping not supported 95184683|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 10cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,010.00|FSC: 13; Default||Not reimbursed separately|11,010.00|FSC: 13; Default||External grouping not supported 95187983|EAP|Custom 95187983||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Assembly Hook Up Olympus 2k|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184684|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheal 4.5mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95184685|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral 4.5mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95187982|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Expander Tissue Cpx 4 Style 9200 450cc Medium Height|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95184686|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral 4.5mmx24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95184687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral 4.5mmx36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95187986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 2-11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95184688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center 6.5mmx36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95184689|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere Concentric 32mmx6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95187984|EAP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Uretheral Mid Halo Obtryx Ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,465.00|FSC: 13; Default||Not reimbursed separately|3,465.00|FSC: 13; Default||External grouping not supported 95184678|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press-fit Reunion 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95184679|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Humeral 32mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95184690|EAP|Custom 95184690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Pilot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184691|EAP|Custom 95184691||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Peripheral Screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Starfire 6.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95184693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Starfire 6.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95184694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95184695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95187996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Corticle Locking 3.5mm X 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95184696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Starfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95184697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar 33x26x12degree 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95187994|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suturetak Bio-composite 3.0mm W/2 #2 Tigertail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|FSC: 13; Default||Not reimbursed separately|1,020.00|FSC: 13; Default||External grouping not supported 95184698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Selfdrilling 5.5x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95184699|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 32xxx4mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95187995|EAP|Custom 95187995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter 2 Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral 4.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95184701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peripheral 4.5mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95187997|EAP|Custom 95187997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cloth Skin Prep Antisepsis And Nasal Antisepsis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center 6.5mmx28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 95184703|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere 32mmx2mm Concentric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95187998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Suprscondylar T2 10 X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|FSC: 13; Default||Not reimbursed separately|6,052.20|FSC: 13; Default||External grouping not supported 95184704|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press Fit Reunion 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95184705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 3.5x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|FSC: 13; Default||Not reimbursed separately|546.00|FSC: 13; Default||External grouping not supported 80169723|EAP|CPT® 78399||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hb Unlisted Musculoskeletal Procedure, Diagnostic Nuclear Medicine|1|HUMANA [1294]||HUMANA [11839]|1,048.98|FSC: 13; Default||Not reimbursed separately|1,048.98|FSC: 13; Default||External grouping not supported 95184706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Right Standard Long Vdr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|FSC: 13; Default||Not reimbursed separately|3,411.00|FSC: 13; Default||External grouping not supported 95184707|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Trulign Torric Sphere 16.0 Cylinder 1.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95188001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95184733|EAP|Custom 95184733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Locking Short 03.1x216mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184729|EAP|Custom 95184729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blocks Guide Specific Px|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188005|EAP|Custom 95188005||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Ebus-tbna 19ga Flex Vizishot|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184720|EAP|Custom 95184720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184724|EAP|Custom 95184724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Corner Tibial 4.8 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lat Ti Lcp 2.7/3.5mm 5 Hole Rt/99mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,046.39|FSC: 13; Default||Not reimbursed separately|2,046.39|FSC: 13; Default||External grouping not supported 95184719|EAP|Custom 95184719||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Narrow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184723|EAP|Custom 95184723||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 2.4 Mm|1|HUMANA [1294]||HUMANA [11839]|96.00|FSC: 13; Default||Not reimbursed separately|96.00|FSC: 13; Default||External grouping not supported 95188004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm X 20mm Ti Locking Slf-tpng With T8 Stardrive Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95188000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mm X L46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95184725|EAP|Custom 95184725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Peg Talar 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Condyle Hemi Femoral Lateral Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,985.00|FSC: 13; Default||Not reimbursed separately|38,985.00|FSC: 13; Default||External grouping not supported 95184722|EAP|Custom 95184722||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screw Removal Bone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184721|EAP|Custom 95184721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Fixation Temp Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95187999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mm L60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95184731|EAP|Custom 95184731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Gator Microblade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184730|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Talar Infinity Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,829.00|FSC: 13; Default||Not reimbursed separately|17,829.00|FSC: 13; Default||External grouping not supported 95188006|EAP|Custom 95188006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Speedguide 2.0mm X L70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95184713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 4.5 X 28 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95188008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Standard 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95184714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 4.5 X 32 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95184711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar 38x28x12degree 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95188007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left Anchorage Mtp Cp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,792.00|FSC: 13; Default||Not reimbursed separately|6,792.00|FSC: 13; Default||External grouping not supported 95184715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95184710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screws Selfdrilling Variable Angle 4.0mmx16mm|1|HUMANA [1294]||HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95188009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|FSC: 13; Default||Not reimbursed separately|675.00|FSC: 13; Default||External grouping not supported 95184709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 2level 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95184718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Ttc Fusion Ankle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,525.00|FSC: 13; Default||Not reimbursed separately|6,525.00|FSC: 13; Default||External grouping not supported 95184728|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz 4-6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|FSC: 13; Default||Not reimbursed separately|6,468.00|FSC: 13; Default||External grouping not supported 95188018|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Stingray Lp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Ti 4.5 X 26 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95184726|EAP|Custom 95184726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Talar Sz 4-5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188017|EAP|Custom 95188017||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer 8 Degree 14 X 30mm|1|HUMANA [1294]||HUMANA [11839]|10,604.25|FSC: 13; Default||Not reimbursed separately|10,604.25|FSC: 13; Default||External grouping not supported 95184708|EAP|Custom 95184708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Screwdriver Cannulated Asnis Iii 5.0 Hexagonal Ao Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Profile Low Ti 4.5 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|FSC: 13; Default||Not reimbursed separately|585.00|FSC: 13; Default||External grouping not supported 95188019|EAP|Custom 95188019||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer 8 Degree 12 X 30mm|1|HUMANA [1294]||HUMANA [11839]|10,602.00|FSC: 13; Default||Not reimbursed separately|10,602.00|FSC: 13; Default||External grouping not supported 95184732|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Proximal Left 10 Hole/l176mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,931.00|FSC: 13; Default||Not reimbursed separately|8,931.00|FSC: 13; Default||External grouping not supported 95184727|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tiabial Infinity Sz 4 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,471.00|FSC: 13; Default||Not reimbursed separately|18,471.00|FSC: 13; Default||External grouping not supported 95188014|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 7.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|FSC: 13; Default||Not reimbursed separately|4,896.00|FSC: 13; Default||External grouping not supported 95184738|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Recess 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95188015|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 5.5 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|FSC: 13; Default||Not reimbursed separately|1,470.00|FSC: 13; Default||External grouping not supported 95184748|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95184734|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal Self Tapping Star Recess 2.7x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95188010|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 7-9 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95184744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95188011|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Plate Tibial Onlay Mck Restoris Sz 3 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95184751|EAP|Custom 95184751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manoshield Ar-3d 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188012|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Plate Tibial Onlay Mck Restoris Sz 3 Lm/rl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95184745|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95188013|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Mck Restoris 3-8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95184743|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Radius 2.4mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.93|FSC: 13; Default||Not reimbursed separately|3,117.93|FSC: 13; Default||External grouping not supported 95188024|EAP|Custom 95188024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheet Arthroscopy (to Be Used With Item 44981)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184736|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Recess 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 51000420|EAP|CPT® 36430||0391 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G., TRANS|Hb Blood Transfusion,components|1|HUMANA [1294]||HUMANA [11839]|1,105.74|FSC: 13; Default||Not reimbursed separately|1,105.74|FSC: 13; Default||External grouping not supported 87904108|EAP|Custom 87904108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cell-saver Electrometics|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 53901211|EAP|CPT® 43201||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Diagnostic W/addtl Proc|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 53901351|EAP|CPT® 43246||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd With Peg Placement Percutaneous Placement Gastrostomy Tube|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 87551685|EAP|CPT® 45337||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy With Decompression With Placement Decompression Tube|1|HUMANA [1294]||HUMANA [11839]|2,176.68|FSC: 13; Default||Not reimbursed separately|2,176.68|FSC: 13; Default||External grouping not supported 87551263|EAP|CPT® 45381||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|HB GI TATOOINGHB COLONOSCOPY WITH DIRECTED SUBMUCOSAL INJECTION ANY SUBSTANCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 53901369|EAP|CPT® 43260||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Ercp W/brushings|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,545.95|FSC: 13; Default||Not reimbursed separately|8,545.95|FSC: 13; Default||External grouping not supported 87551289|EAP|CPT® 45334||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Sigmoidoscopy Flx Control Bleeding Any Method|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,861.55|FSC: 13; Default||Not reimbursed separately|2,861.55|FSC: 13; Default||External grouping not supported 95184737|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Star Drive Recess 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95188020|EAP|Custom 95188020||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Breathing Neonatal With Column|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Star Drive Recess 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95188022|EAP|Custom 95188022||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend 10cm X 4cm Oval Fluted|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184749|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook Clavicle 3.5mmlcp6hole 15mm/73mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,740.29|FSC: 13; Default||Not reimbursed separately|2,740.29|FSC: 13; Default||External grouping not supported 95184741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7mm/3.5mm Medial -long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|FSC: 13; Default||Not reimbursed separately|3,814.23|FSC: 13; Default||External grouping not supported 95188016|EAP|Custom 95188016||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Set Screw Break Off|1|HUMANA [1294]||HUMANA [11839]|639.00|FSC: 13; Default||Not reimbursed separately|639.00|FSC: 13; Default||External grouping not supported 95184746|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95184740|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus 2.7mm/3.5mm -short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 95184747|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.4mm Ti Va Locking Stardrive 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.28|FSC: 13; Default||Not reimbursed separately|434.28|FSC: 13; Default||External grouping not supported 95184753|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Conform Flex 16mm X 16mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|FSC: 13; Default||Not reimbursed separately|2,415.00|FSC: 13; Default||External grouping not supported 95184755|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Rialto 12x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|FSC: 13; Default||Not reimbursed separately|13,200.00|FSC: 13; Default||External grouping not supported 95184735|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Metaphyseal Self Tapping Star Recess 2.7x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|FSC: 13; Default||Not reimbursed separately|148.68|FSC: 13; Default||External grouping not supported 95184754|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression 7 Hole/ L90mm With 4 Locking Holes|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|FSC: 13; Default||Not reimbursed separately|2,484.00|FSC: 13; Default||External grouping not supported 95184752|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Classic Moderate Smooth 130cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|FSC: 13; Default||Not reimbursed separately|2,790.00|FSC: 13; Default||External grouping not supported 95127816|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Express 9 X 37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,850.20|FSC: 13; Default||Not reimbursed separately|3,850.20|FSC: 13; Default||External grouping not supported 95184756|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Ti 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|FSC: 13; Default||Not reimbursed separately|1,419.60|FSC: 13; Default||External grouping not supported 95184757|EAP|Custom 95184757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Accu Port Side|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188034|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95161945|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Catheter Yueh Centesis 5f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95161946|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Catheter Yueh Centesis 5f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95162792|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Beacon Tip Pigtail 4fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95162856|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Powerport Mri 8fr W/chronoflex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|FSC: 13; Default||Not reimbursed separately|1,380.00|FSC: 13; Default||External grouping not supported 95162873|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Evercross 5 X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95163677|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 3MM J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184764|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg 2.5x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95184758|EAP|Custom 95184758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler 60mm Gold|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188032|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95184765|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Peg Full Thread 2.5x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|FSC: 13; Default||Not reimbursed separately|244.80|FSC: 13; Default||External grouping not supported 95160563|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fox Plus Pta Balloon 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184761|EAP|Custom 95184761||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiber Robotic Omniguide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95160879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mtp Fusion Left Standard S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|FSC: 13; Default||Not reimbursed separately|3,063.00|FSC: 13; Default||External grouping not supported 95160878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Darco Headed 4.0 X 34mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95160877|EAP|Custom 95160877||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184762|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center 6.5mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|FSC: 13; Default||Not reimbursed separately|580.50|FSC: 13; Default||External grouping not supported 87202347|EAP|Custom 87202347||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode 3 Per Pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95184760|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Thermocool Sf D-f Curve W/curved Visualization|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 87314050|EAP|Custom 87314050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack C-section|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 87101812|EAP|Custom 87101812||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drape 3m C-section|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184763|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Monoblock Rsp Size 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|FSC: 13; Default||Not reimbursed separately|17,685.00|FSC: 13; Default||External grouping not supported 95158533|EAP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Contrast Mri Multihance 5x5 Ml V|1|HUMANA [1294]||HUMANA [11839]|6.30|FSC: 13; Default||Not reimbursed separately|6.30|FSC: 13; Default||External grouping not supported 95158534|EAP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Contrast Mri Multihance 5x10 Ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.12|FSC: 13; Default||Not reimbursed separately|6.12|FSC: 13; Default||External grouping not supported 95188033|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Proximal Left 3hole 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95158535|EAP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Contrast Mri Multihance 5x15 Ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|FSC: 13; Default||Not reimbursed separately|6.18|FSC: 13; Default||External grouping not supported 95158536|EAP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Contrast Mri Multihance 5x20 Ml|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|FSC: 13; Default||Not reimbursed separately|6.18|FSC: 13; Default||External grouping not supported 95184759|EAP|Custom 95184759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Echelon Stapler 60mm Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110010|EAP|Custom 95110010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Medi-flow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110011|EAP|Custom 95110011||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pump Arterial Hepatic Model 3000|1|HUMANA [1294]||HUMANA [11839]|15,825.00|FSC: 13; Default||Not reimbursed separately|15,825.00|FSC: 13; Default||External grouping not supported 95110015|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene Extended|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,499.78|FSC: 13; Default||Not reimbursed separately|2,499.78|FSC: 13; Default||External grouping not supported 95110016|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene Large|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,354.51|FSC: 13; Default||Not reimbursed separately|2,354.51|FSC: 13; Default||External grouping not supported 95184773|EAP|Custom 95184773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Filter Graft Ria Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110017|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Marlex Polyknit 6 Inch X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|167.70|FSC: 13; Default||Not reimbursed separately|167.70|FSC: 13; Default||External grouping not supported 95110018|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Marlex Polyknit 3 Inch X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.14|FSC: 13; Default||Not reimbursed separately|115.14|FSC: 13; Default||External grouping not supported 95110019|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Mycro 5cm X 10cm Ingui-nal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95110020|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene 12 X 12 Pm-l|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.84|FSC: 13; Default||Not reimbursed separately|1,717.84|FSC: 13; Default||External grouping not supported 95188037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95110027|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Biliary Probe 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110028|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Biliary Probe 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110031|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene 6x6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.37|FSC: 13; Default||Not reimbursed separately|774.37|FSC: 13; Default||External grouping not supported 95184774|EAP|Custom 95184774||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Reamer 12.0mm (for Reamer/irrigator/aspirator)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110035|EAP|Custom 95110035||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 30mm Linear Vascular Rel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110036|EAP|Custom 95110036||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 55mm Reload-unitbl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110037|EAP|Custom 95110037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 75mm Reload Blue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110039|EAP|Custom 95110039||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 75mm Reload Green|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184775|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95110074|EAP|Custom 95110074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Radius-loop 1.0cmx 1.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110075|EAP|Custom 95110075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Radius-loop 2.0cmx1.0c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95110087|EAP|Custom 95110087||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110088|EAP|Custom 95110088||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 22fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110089|EAP|Custom 95110089||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 18fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110090|EAP|Custom 95110090||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 16fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumber Irix-a 38x28x8degree 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95110091|EAP|Custom 95110091||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 8fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110092|EAP|Custom 95110092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Straight 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110093|EAP|Custom 95110093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Straight 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110094|EAP|Custom 95110094||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Straight 3fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110095|EAP|Custom 95110095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Straight 2fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110096|EAP|Custom 95110096||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Spiral 2fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110097|EAP|Custom 95110097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Supra Percu 14fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184777|EAP|Custom 95184777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cortical Opener Ao Fitting 3.5mm Dia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110105|EAP|Custom 95110105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dermacarriers Ii 1.5 To 1 Dermac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110106|EAP|Custom 95110106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dermacarriers Ii 3 To 1 Dermacar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110107|EAP|Custom 95110107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dermacarriers Ii 6 To 1 Dermacar|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188031|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95110108|EAP|Custom 95110108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Fluted Neuro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110116|EAP|Custom 95110116||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Gigli 12 Round|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184781|EAP|Custom 95184781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Hemostatic Electrosurgical Single Use|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110117|EAP|Custom 95110117||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Dermatone|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110120|EAP|Custom 95110120||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pattie Surgical 1/4 X 1/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110121|EAP|Custom 95110121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Reservoir Holter Ventriculos- To|1|HUMANA [1294]||HUMANA [11839]|739.80|FSC: 13; Default||Not reimbursed separately|739.80|FSC: 13; Default||External grouping not supported 95110149|EAP|Custom 95110149||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Adhesive Dermabond Skin Topical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184784|EAP|Custom 95184784||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tlif Mas|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110172|EAP|Custom 95110172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Veress Ultra 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110188|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Central Venous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188035|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95110208|EAP|Custom 95110208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conformer Plastic Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110209|EAP|Custom 95110209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Conformer Plastic Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184779|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 680cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95110210|EAP|Custom 95110210||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sphere 16 Eye Silicone|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95110212|EAP|Custom 95110212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 6.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110213|EAP|Custom 95110213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 7.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110214|EAP|Custom 95110214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110215|EAP|Custom 95110215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 8.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184780|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 750cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95110219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Im Hs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|FSC: 13; Default||Not reimbursed separately|477.00|FSC: 13; Default||External grouping not supported 95110220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Im Hs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.85|FSC: 13; Default||Not reimbursed separately|56.85|FSC: 13; Default||External grouping not supported 95188023|EAP|Custom 95188023||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fmt Lower Delivery (colonoscopy Sigmoidoscopy Or Enema)|1|HUMANA [1294]||HUMANA [11839]|5,085.00|FSC: 13; Default||Not reimbursed separately|5,085.00|FSC: 13; Default||External grouping not supported 95110221|EAP|Custom 95110221||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 22mm X 19mm Barbed|1|HUMANA [1294]||HUMANA [11839]|134.49|FSC: 13; Default||Not reimbursed separately|134.49|FSC: 13; Default||External grouping not supported 95110222|EAP|Custom 95110222||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Tracheal Laser 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110234|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double J 6.0 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95110235|EAP|Custom 95110235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Tracheal Laser 6.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184778|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 615cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95110236|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double J 6.0 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95110237|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double J 6.0 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95110238|EAP|Custom 95110238||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Urinary Diversion 7 X 90|1|HUMANA [1294]||HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 95110239|EAP|Custom 95110239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Whistle Tip 3fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110244|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ureteral 5 French Polla|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110245|EAP|Custom 95110245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Aneuroplastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110246|EAP|Custom 95110246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Cranioplastic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184785|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Advanix Pigtail Double 10fr 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|178.29|FSC: 13; Default||Not reimbursed separately|178.29|FSC: 13; Default||External grouping not supported 95110247|EAP|Custom 95110247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110248|EAP|Custom 95110248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Assistant|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188029|EAP|Custom 95188029||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accucath 22g 2.25" Basic 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110250|EAP|Custom 95110250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dissector Blunt-tip 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184783|EAP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Jacket Graft 5x5cm Maxforce|1|HUMANA [1294]||HUMANA [11839]|301.68|FSC: 13; Default||Not reimbursed separately|301.68|FSC: 13; Default||External grouping not supported 95110251|EAP|Custom 95110251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Specimen Endo Catch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110253|EAP|Custom 95110253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Endoscopic Multi Me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110257|EAP|Custom 95110257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Sternum Saw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110259|EAP|Custom 95110259||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Pacing Adult|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184787|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110260|EAP|Custom 95110260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 10mm Structural Balloon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110261|EAP|Custom 95110261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 10mm Endo Stitch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110262|EAP|Custom 95110262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Auto Stitch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110263|EAP|Custom 95110263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 10/11mm Dilating Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188030|EAP|Custom 95188030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110264|EAP|Custom 95110264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hook Dissection(harmonic-scapel)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110265|EAP|Custom 95110265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Colo/illeo W/acc-flange2t|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110266|EAP|Custom 95110266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Purstring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110270|EAP|Custom 95110270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Curved Ils Detachable Hs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184849|EAP|Custom 95184849||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14x16x6 6degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95110271|EAP|Custom 95110271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Curved Ils Detachable-hs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110272|EAP|Custom 95110272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Curved Ils Detachable Hs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110273|EAP|Custom 95110273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 30mm Linear Vascular Rel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110274|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Prolene 3x5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.67|FSC: 13; Default||Not reimbursed separately|699.67|FSC: 13; Default||External grouping not supported 95184851|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Body Main Fenestrated Proximal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95110278|EAP|Custom 95110278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Roticulator 55-3.5 Ax55b|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110279|EAP|Custom 95110279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Roticulator 55-4.8 Ax55g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188025|EAP|Custom 95188025||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Headgear Infant Flow Lp X-large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110280|EAP|Custom 95110280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110281|EAP|Custom 95110281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endoscopic Linear Cutter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110282|EAP|Custom 95110282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 75mm Thick Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184853|EAP|Custom 95184853||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Perfusion Fx25 Oxygenator + Fx Tubing Pack Terumo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110284|EAP|Custom 95110284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Linear Cutter 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110286|EAP|Custom 95110286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 75mm W/safety- Loc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110287|EAP|Custom 95110287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 55mm W/safety- Loc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110288|EAP|Custom 95110288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 90mm Linear Reloadable U|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110289|EAP|Custom 95110289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 90mm Linear Reloadable U|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110290|EAP|Custom 95110290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Endoscopic Vasc/th|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110291|EAP|Custom 95110291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Linear Reload Unit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110292|EAP|Custom 95110292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Tl Stapler 90mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184852|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Custom Distal Bifurcated Main Body|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|FSC: 13; Default||Not reimbursed separately|10,485.00|FSC: 13; Default||External grouping not supported 95110294|EAP|Custom 95110294||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Loops Luque(cerclage)1.22mm|1|HUMANA [1294]||HUMANA [11839]|111.74|FSC: 13; Default||Not reimbursed separately|111.74|FSC: 13; Default||External grouping not supported 95110295|EAP|Custom 95110295||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Loop Luque(cerclage)1.2mmdi|1|HUMANA [1294]||HUMANA [11839]|111.74|FSC: 13; Default||Not reimbursed separately|111.74|FSC: 13; Default||External grouping not supported 95110296|EAP|Custom 95110296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Skull Mayfield|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188027|EAP|Custom 95188027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accucath 22g 1.25" Basic 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110299|EAP|Custom 95110299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Perforator 14mm With Hudson End|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 2level 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|FSC: 13; Default||Not reimbursed separately|4,260.00|FSC: 13; Default||External grouping not supported 95110302|EAP|Custom 95110302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 7.0 Mm Trach Murphy Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110303|EAP|Custom 95110303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 8.0 Mm Trach Murphy Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110305|EAP|Custom 95110305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connection Patient Line-assembly|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184803|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110306|EAP|Custom 95110306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reservoir Cardiotomy Non- Filter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110317|EAP|Custom 95110317||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Interceed Adhesive Barrier 3mm X|1|HUMANA [1294]||HUMANA [11839]|978.25|FSC: 13; Default||Not reimbursed separately|978.25|FSC: 13; Default||External grouping not supported 95110318|EAP|Custom 95110318||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Double|1|HUMANA [1294]||HUMANA [11839]|2,137.38|FSC: 13; Default||Not reimbursed separately|2,137.38|FSC: 13; Default||External grouping not supported 95110319|EAP|Custom 95110319||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 13mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188026|EAP|Custom 95188026||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accucath 18g 1.25" Basic 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110322|EAP|Custom 95110322||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 6.0 Mm Trach Murphy Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110335|EAP|Custom 95110335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Softjaw Insert 61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184837|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110337|EAP|Custom 95110337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 7-0 24 Bv-1 Ms/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110348|EAP|Custom 95110348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 35 French Broncho Cath Righ|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110354|EAP|Custom 95110354||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 41 French Broncho Cath Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110355|EAP|Custom 95110355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 39 French Broncho Cath Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110367|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Standard .035 Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110373|EAP|Custom 95110373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 90mm Linear Heavywire Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110376|EAP|Custom 95110376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Urostomy 1-3/4 Sur-fit Na|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184800|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110377|EAP|HCPCS A5061||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Drainable One-piece 2-1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188028|EAP|Custom 95188028||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accucath 18g 2.25" Basic 20/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110379|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accessory Pacing Is B1 Implantab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95110380|EAP|Custom 95110380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Lead End Pin Ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184847|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110381|EAP|Custom 95110381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Medical|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110382|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Flex Hinge 5 With Gr|1|HUMANA [1294]||HUMANA [11839]|1,635.00|FSC: 13; Default||Not reimbursed separately|1,635.00|FSC: 13; Default||External grouping not supported 95110384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger-joint Sz.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|FSC: 13; Default||Not reimbursed separately|1,755.00|FSC: 13; Default||External grouping not supported 95110385|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Size 1 Sila|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|FSC: 13; Default||Not reimbursed separately|2,640.00|FSC: 13; Default||External grouping not supported 95110386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Size 2 Sila|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|FSC: 13; Default||Not reimbursed separately|2,850.00|FSC: 13; Default||External grouping not supported 95110387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Size 3 Sila|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,249.00|FSC: 13; Default||Not reimbursed separately|3,249.00|FSC: 13; Default||External grouping not supported 95184796|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110388|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger-joint Sz.4 C1776|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95110389|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Size 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|FSC: 13; Default||Not reimbursed separately|1,575.00|FSC: 13; Default||External grouping not supported 95110391|EAP|Custom 95110391||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 2-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110392|EAP|Custom 95110392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 2-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110393|EAP|Custom 95110393||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 0 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110394|EAP|Custom 95110394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Bralon 0 48 Endo-stitch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110398|EAP|Custom 95110398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife V-lance Full-handle 20ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184843|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110399|EAP|Custom 95110399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Chopper Nucleous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110401|EAP|Custom 95110401||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Eye Crescent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110402|EAP|Custom 95110402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Versaport 10-15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184788|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110433|EAP|Custom 95110433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedural Perfluoron 7ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110434|EAP|Custom 95110434||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scrapper Membrane Dusted Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110435|EAP|Custom 95110435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.oscillating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184798|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110436|EAP|Custom 95110436||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Graft Acl 11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110437|EAP|Custom 95110437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Graft Acl 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110438|EAP|Custom 95110438||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Graft Acl 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110454|EAP|Custom 95110454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Retrieval Pouch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110455|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Kugel Oval Small 8c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,247.99|FSC: 13; Default||Not reimbursed separately|2,247.99|FSC: 13; Default||External grouping not supported 95110456|EAP|Custom 95110456||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Dural Repair 4cm X 4cm (du|1|HUMANA [1294]||HUMANA [11839]|1,010.43|FSC: 13; Default||Not reimbursed separately|1,010.43|FSC: 13; Default||External grouping not supported 95110457|EAP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dura Tutoplast 7x8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,646.19|FSC: 13; Default||Not reimbursed separately|1,646.19|FSC: 13; Default||External grouping not supported 95184823|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110458|EAP|Custom 95110458||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Passer Catheter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110460|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Dual Mesh 26cm X 34cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,321.00|FSC: 13; Default||Not reimbursed separately|6,321.00|FSC: 13; Default||External grouping not supported 95110461|EAP|Custom 95110461||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Spinal Endura|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Tunneling|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|FSC: 13; Default||Not reimbursed separately|270.00|FSC: 13; Default||External grouping not supported 95110463|EAP|Custom 95110463||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Catheter-access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110465|EAP|Custom 95110465||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Neurosurgery 20mhz|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184826|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110469|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalock Rc W/(panacryl)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95110473|EAP|Custom 95110473||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Smoother 7.9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110474|EAP|Custom 95110474||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Smoother Gore 9.5mm|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95184845|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110476|EAP|Custom 95110476||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthro-lok 4mm Banana Curv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Bio-screw Interference Fem Bioab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95110481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Panalock 3.5 With 2 Ethib|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,122.00|FSC: 13; Default||Not reimbursed separately|1,122.00|FSC: 13; Default||External grouping not supported 95110482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Quickanchor Super W/#2 Su|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|FSC: 13; Default||Not reimbursed separately|744.00|FSC: 13; Default||External grouping not supported 95184794|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110487|EAP|Custom 95110487||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Fluid Warming 8'|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110488|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 4fen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110500|EAP|Custom 95110500||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Anesthesia Spinal Marcaine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110501|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Bone 40gr Radiopaque Full|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.65|FSC: 13; Default||Not reimbursed separately|196.65|FSC: 13; Default||External grouping not supported 95184809|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110502|EAP|Custom 95110502||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 51x63.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110503|EAP|Custom 95110503||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 19.5x71mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110506|EAP|Custom 95110506||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Vena Cava Partial Occlusion|1|HUMANA [1294]||HUMANA [11839]|738.00|FSC: 13; Default||Not reimbursed separately|738.00|FSC: 13; Default||External grouping not supported 95188040|EAP|Custom 95188040||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Circuit Adult Breathing Heated Wire Niv|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110507|EAP|Custom 95110507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110510|EAP|Custom 95110510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184833|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110516|EAP|Custom 95110516||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Fluid Pump Dual Spike|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110517|EAP|Custom 95110517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ventricular 4 French X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110518|EAP|Custom 95110518||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Blade Endotrac Hook Blade An|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Polarus 3.5x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95110521|EAP|Custom 95110521||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bowl Vacuum Mixing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Polarus 8mmx200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95110523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cable 6-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,868.85|FSC: 13; Default||Not reimbursed separately|1,868.85|FSC: 13; Default||External grouping not supported 95110525|EAP|Custom 95110525||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable G.t.r. Distal 1.8mmx635mmm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184805|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Polarus 5x45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95110528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cable 10-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,966.40|FSC: 13; Default||Not reimbursed separately|2,966.40|FSC: 13; Default||External grouping not supported 95110529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cable 8-hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,432.46|FSC: 13; Default||Not reimbursed separately|2,432.46|FSC: 13; Default||External grouping not supported 95188041|EAP|Custom 95188041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Positioning Ez Clip 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110530|EAP|Custom 95110530||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable 25 G.t.r.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110532|EAP|Custom 95110532||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Stainless-steel 1.8mm|1|HUMANA [1294]||HUMANA [11839]|1,048.14|FSC: 13; Default||Not reimbursed separately|1,048.14|FSC: 13; Default||External grouping not supported 95184793|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110535|EAP|Custom 95110535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 150gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110538|EAP|Custom 95110538||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Curved 5mm Scapel Harmonic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110541|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.00|FSC: 13; Default||Not reimbursed separately|42.00|FSC: 13; Default||External grouping not supported 95184801|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.00|FSC: 13; Default||Not reimbursed separately|42.00|FSC: 13; Default||External grouping not supported 95110543|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95110544|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95188050|EAP|Custom 95188050||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Cervial Disc Prothesis Mobi-c 15x19 H7|1|HUMANA [1294]||HUMANA [11839]|21,750.00|FSC: 13; Default||Not reimbursed separately|21,750.00|FSC: 13; Default||External grouping not supported 95110545|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|FSC: 13; Default||Not reimbursed separately|57.00|FSC: 13; Default||External grouping not supported 95110546|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.00|FSC: 13; Default||Not reimbursed separately|51.00|FSC: 13; Default||External grouping not supported 95110547|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95110548|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Micro Orbita Curved 0.6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95184795|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110549|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 1mm Thick 4 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95110550|EAP|Custom 95110550||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Denver P-v Std.|1|HUMANA [1294]||HUMANA [11839]|1,965.00|FSC: 13; Default||Not reimbursed separately|1,965.00|FSC: 13; Default||External grouping not supported 95110551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.00|FSC: 13; Default||Not reimbursed separately|54.00|FSC: 13; Default||External grouping not supported 95110552|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95110553|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.00|FSC: 13; Default||Not reimbursed separately|54.00|FSC: 13; Default||External grouping not supported 95110554|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95184791|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|FSC: 13; Default||Not reimbursed separately|57.00|FSC: 13; Default||External grouping not supported 95110556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|FSC: 13; Default||Not reimbursed separately|57.00|FSC: 13; Default||External grouping not supported 95188044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Standard Anchorage 3.5mm X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95110557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 0.6mm Left Medium Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95110558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 0.6mm Right Medium Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95184799|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 0.6mm 4 Hole Regu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95110560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 1mm Thick 4 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95110561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95110564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95110565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95184848|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110568|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95110569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95188042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plating Lapidus Anchorage 0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|FSC: 13; Default||Not reimbursed separately|6,429.00|FSC: 13; Default||External grouping not supported 95110570|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95110571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95110572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95184844|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95110576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95184814|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95110578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95188045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixation Device Easyclip 15x15x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95110579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95110580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95110581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cancellous Sm.10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95110584|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|FSC: 13; Default||Not reimbursed separately|397.20|FSC: 13; Default||External grouping not supported 95184831|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 14.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110585|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.00|FSC: 13; Default||Not reimbursed separately|156.00|FSC: 13; Default||External grouping not supported 95110586|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.80|FSC: 13; Default||Not reimbursed separately|160.80|FSC: 13; Default||External grouping not supported 95110587|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|418.50|FSC: 13; Default||Not reimbursed separately|418.50|FSC: 13; Default||External grouping not supported 95110588|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticle Lagmedium 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95110589|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95110590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95110591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95110592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95184840|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95110594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|FSC: 13; Default||Not reimbursed separately|300.00|FSC: 13; Default||External grouping not supported 95110595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95188047|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Wedge Evans 8x22x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 95110596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellousm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|FSC: 13; Default||Not reimbursed separately|273.00|FSC: 13; Default||External grouping not supported 95110604|EAP|Custom 95110604||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1/16 Inch Threade|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184817|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110605|EAP|Custom 95110605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Steinmann Threaded 2.8 Diame|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110606|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Im Hs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.60|FSC: 13; Default||Not reimbursed separately|33.60|FSC: 13; Default||External grouping not supported 95110613|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95184838|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 95110615|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 95110616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95110617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95188049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Fixation Easyclip 18x14x14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|FSC: 13; Default||Not reimbursed separately|5,943.00|FSC: 13; Default||External grouping not supported 95110618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 95110619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95110620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95110621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|FSC: 13; Default||Not reimbursed separately|576.00|FSC: 13; Default||External grouping not supported 95184790|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95110623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95110624|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 95110625|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95110626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95110627|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95110630|EAP|Custom 95110630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated Ace 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184789|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110631|EAP|Custom 95110631||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm 145mm/120mm Qc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110632|EAP|Custom 95110632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Anchorage 3.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95110635|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 1.3mmx4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.50|FSC: 13; Default||Not reimbursed separately|250.50|FSC: 13; Default||External grouping not supported 95110636|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti Self-tap 1.3mmx5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.00|FSC: 13; Default||Not reimbursed separately|183.00|FSC: 13; Default||External grouping not supported 95184807|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110637|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95110641|EAP|Custom 95110641||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Syringe/gauge 60ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 34mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.48|FSC: 13; Default||Not reimbursed separately|54.48|FSC: 13; Default||External grouping not supported 95110658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1/3 Tubular 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.71|FSC: 13; Default||Not reimbursed separately|181.71|FSC: 13; Default||External grouping not supported 95110659|EAP|Custom 95110659||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 7.0mm For Small Screws St|1|HUMANA [1294]||HUMANA [11839]|91.92|FSC: 13; Default||Not reimbursed separately|91.92|FSC: 13; Default||External grouping not supported 95110660|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 73mm 6 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.84|FSC: 13; Default||Not reimbursed separately|213.84|FSC: 13; Default||External grouping not supported 95184804|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110661|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 85mm 7 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|248.19|FSC: 13; Default||Not reimbursed separately|248.19|FSC: 13; Default||External grouping not supported 95110662|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 97mm 8 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.33|FSC: 13; Default||Not reimbursed separately|231.33|FSC: 13; Default||External grouping not supported 95110663|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Proximal Left 8-hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,869.00|FSC: 13; Default||Not reimbursed separately|1,869.00|FSC: 13; Default||External grouping not supported 95110664|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,720.68|FSC: 13; Default||Not reimbursed separately|1,720.68|FSC: 13; Default||External grouping not supported 95188046|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Fixation Device Monocortical Easyclip 12x10x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.00|FSC: 13; Default||Not reimbursed separately|4,386.00|FSC: 13; Default||External grouping not supported 95110665|EAP|Custom 95110665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.5mm(110mm/85mm)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110666|EAP|Custom 95110666||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.wire Pass Drill 1.5x19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110667|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Rosen Thscf-35-180-1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184792|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110669|EAP|Custom 95110669||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fogarty Irrigation 6fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110671|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110673|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Esophageal Max-force 10m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110674|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184797|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95110675|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Cre 18-20mm 8cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110677|EAP|Custom 95110677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Fluro-tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188048|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Anchorage 3.5mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95110680|EAP|Custom 95110680||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Papillotome Needle Knife Huibree|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110681|EAP|Custom 95110681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ercp-1-hkb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110682|EAP|Custom 95110682||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Ercp Tandem Xl Triple-lu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184816|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110683|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Jagwire Straight .035c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110684|EAP|Custom 95110684||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Extractor Stone Basket 2x4cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188051|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Xxl Dilation 16x 60 X 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110685|EAP|Custom 95110685||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Stonetome 20mm X 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110686|EAP|Custom 95110686||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ultratome Xl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184834|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110687|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 46mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95110688|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 48mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110689|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 50mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|FSC: 13; Default||Not reimbursed separately|644.52|FSC: 13; Default||External grouping not supported 95110690|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110691|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 16mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95184829|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 13.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110692|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 30mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110693|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 28mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110694|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 32mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|709.17|FSC: 13; Default||Not reimbursed separately|709.17|FSC: 13; Default||External grouping not supported 95110695|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 36mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95188052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Healicoil Rsb Sa 5.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|FSC: 13; Default||Not reimbursed separately|2,325.00|FSC: 13; Default||External grouping not supported 95110696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 34mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 38mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 42mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|709.17|FSC: 13; Default||Not reimbursed separately|709.17|FSC: 13; Default||External grouping not supported 95110699|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 40mm Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.87|FSC: 13; Default||Not reimbursed separately|663.87|FSC: 13; Default||External grouping not supported 95110700|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95184836|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110703|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|FSC: 13; Default||Not reimbursed separately|67.62|FSC: 13; Default||External grouping not supported 95110704|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95188053|EAP|Custom 95188053||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Laparoscopic Intro Gast Feeding Tube|1|HUMANA [1294]||HUMANA [11839]|667.50|FSC: 13; Default||Not reimbursed separately|667.50|FSC: 13; Default||External grouping not supported 95110705|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 56mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 68mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95110709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 34mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95184839|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110710|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 36mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.46|FSC: 13; Default||Not reimbursed separately|77.46|FSC: 13; Default||External grouping not supported 95110711|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 38mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.77|FSC: 13; Default||Not reimbursed separately|79.77|FSC: 13; Default||External grouping not supported 95110712|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 40mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95188055|EAP|Custom 95188055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Hs Amica 14g 15cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110713|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 42mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.77|FSC: 13; Default||Not reimbursed separately|79.77|FSC: 13; Default||External grouping not supported 95110714|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 44mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110715|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 46mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110716|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 48mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110717|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 50mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95110718|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95110719|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5 75mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95110720|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95110721|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95110722|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95184841|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110727|EAP|Custom 95110727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm 100mm/75mm Qc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110729|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Glidewire .035mmx180cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188056|EAP|HCPCS 95188056||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate One Third Tubular 6 Hole/l 71mm|1|HUMANA [1294]||HUMANA [11839]|1,527.00|FSC: 13; Default||Not reimbursed separately|1,527.00|FSC: 13; Default||External grouping not supported 95110732|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Polarus|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110735|EAP|Custom 95110735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Ace Threaded Guide Large ***|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110741|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 16 Hole Regular T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95110742|EAP|Custom 95110742||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Psi 8.5fr 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110744|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 56mm Right A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,057.44|FSC: 13; Default||Not reimbursed separately|1,057.44|FSC: 13; Default||External grouping not supported 95110747|EAP|HCPCS L4350||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Brace Ankle Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110785|EAP|Custom 95110785||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthro-lok 4mm Retrograde|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110787|EAP|Custom 95110787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Splint Nasal Reuter Bivalve 0.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110788|EAP|Custom 95110788||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Packing Sinus Kennedy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110789|EAP|Custom 95110789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Goode T 1.1mm I.d. 12mm|1|HUMANA [1294]||HUMANA [11839]|140.40|FSC: 13; Default||Not reimbursed separately|140.40|FSC: 13; Default||External grouping not supported 95110795|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Venous Infusion Thermod|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184842|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110796|EAP|Custom 95110796||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Endobronchial Blocker Arndt|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110799|EAP|Custom 95110799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Spring Wire Guide Duoflex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110813|EAP|Custom 95110813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Ultra-sharp 681.05|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110820|EAP|Custom 95110820||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trap Digit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110826|EAP|Custom 95110826||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Torp Ear Plasti-pore Off-centere|1|HUMANA [1294]||HUMANA [11839]|624.57|FSC: 13; Default||Not reimbursed separately|624.57|FSC: 13; Default||External grouping not supported 95184835|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110827|EAP|Custom 95110827||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Piston .6mm 4.25mm Plat|1|HUMANA [1294]||HUMANA [11839]|454.32|FSC: 13; Default||Not reimbursed separately|454.32|FSC: 13; Default||External grouping not supported 95110829|EAP|Custom 95110829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Multi Short Sm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188058|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Align 10mm X 2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|FSC: 13; Default||Not reimbursed separately|6,900.00|FSC: 13; Default||External grouping not supported 95110830|EAP|Custom 95110830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Multi Large|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110831|EAP|Custom 95110831||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Multi Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110833|EAP|Custom 95110833||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Femoral 4 French X 100c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110841|EAP|Custom 95110841||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Foley Ic 16fr 5cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184820|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110845|EAP|Custom 95110845||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arch Femoral Compression|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110852|EAP|Custom 95110852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 4 French X 110cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110857|EAP|Custom 95110857||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 37 French Broncho Cath Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110862|EAP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Vascular Closure Angiosea|1|HUMANA [1294]||HUMANA [11839]|627.00|FSC: 13; Default||Not reimbursed separately|627.00|FSC: 13; Default||External grouping not supported 95110864|EAP|Custom 95110864||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Surgiport 5mm Radiolucent|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184832|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110866|EAP|Custom 95110866||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Vicryl Endoloop 0 18|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110874|EAP|Custom 95110874||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Radius-loop 2.0cmx .8c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188059|EAP|Custom 95188059||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Posterior Distal 14 Hl/lt|1|HUMANA [1294]||HUMANA [11839]|4,162.50|FSC: 13; Default||Not reimbursed separately|4,162.50|FSC: 13; Default||External grouping not supported 95184846|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110894|EAP|Custom 95110894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 7.5 Mm Trach Murphy Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110895|EAP|Custom 95110895||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 6.5 Mm Trach Murphy Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articulating Vivacit-e Sz 3 -10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95110903|EAP|Custom 95110903||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Dermabrader Straight 7.0x1.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110904|EAP|Custom 95110904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Dermabrader Tapered 10x15 .|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188062|EAP|Custom 95188062||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Driver Hcs 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110905|EAP|Custom 95110905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 25m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110909|EAP|Custom 95110909||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Ball 5mmdia X12cm Shaf|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110918|EAP|Custom 95110918||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbide Long 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110919|EAP|Custom 95110919||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp. Neuro Wire Pass Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184913|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Reunion Tsa Press Fit 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95110922|EAP|Custom 95110922||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine Vaccum Barron Hessburg|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110923|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bio-stinger 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95110924|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bio-stinger 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|FSC: 13; Default||Not reimbursed separately|285.00|FSC: 13; Default||External grouping not supported 95110925|EAP|Custom 95110925||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Artroscopic Incisor 4.5 Mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110926|EAP|Custom 95110926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Procutter 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110928|EAP|Custom 95110928||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Full Radius3.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110929|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Bioscrew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110930|EAP|Custom 95110930||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Absorbable Orthosorb|1|HUMANA [1294]||HUMANA [11839]|493.50|FSC: 13; Default||Not reimbursed separately|493.50|FSC: 13; Default||External grouping not supported 95184916|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenosphere 36mmx2mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95110931|EAP|Custom 95110931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retreiver Suture|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Statak Soft-tissue 5.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.87|FSC: 13; Default||Not reimbursed separately|541.87|FSC: 13; Default||External grouping not supported 95110933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Device Statak Soft-tissue Attach|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.87|FSC: 13; Default||Not reimbursed separately|541.87|FSC: 13; Default||External grouping not supported 95188057|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Lp Vena Cava System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,865.00|FSC: 13; Default||Not reimbursed separately|2,865.00|FSC: 13; Default||External grouping not supported 95110934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Ultrafix Rc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.36|FSC: 13; Default||Not reimbursed separately|507.36|FSC: 13; Default||External grouping not supported 95110936|EAP|Custom 95110936||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Pre-dilution Prisma M60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Vit E Persona Mc Rt 16mm/e-f Femur/cr Sz 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95110937|EAP|Custom 95110937||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cuda 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110938|EAP|Custom 95110938||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Mini 2.9mm Fu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184919|EAP|Custom 95184919||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated 25-70/120-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95110939|EAP|Custom 95110939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Abrader 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110941|EAP|Custom 95110941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Abrader 4.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110942|EAP|Custom 95110942||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthrodcopic Abrader 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110945|EAP|Custom 95110945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Evacuator Ellick Bladder Disp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110947|EAP|Custom 95110947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Cutting Sterile.24fron|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110948|EAP|Custom 95110948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 14 Gauge X 4.5 Inc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184915|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 36mmx4mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95110951|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ureteral Axxcess 6frx78|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110958|EAP|Custom 95110958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Helical Bagley 1.9fr.x 9c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110959|EAP|Custom 95110959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Parachute 3.1cmx0-tipx90c|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110960|EAP|Custom 95110960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Minibasket 2.4fr. 90cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110962|EAP|Custom 95110962||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Pumping Urological Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184914|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Humeral 36mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|FSC: 13; Default||Not reimbursed separately|5,793.75|FSC: 13; Default||External grouping not supported 95110963|EAP|Custom 95110963||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Plus Percuflex 4.8 X 26|1|HUMANA [1294]||HUMANA [11839]|331.74|FSC: 13; Default||Not reimbursed separately|331.74|FSC: 13; Default||External grouping not supported 95110965|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilitation Track Nephro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking T10 Full Thread 3.5mmxl24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95110967|EAP|Custom 95110967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adaptor Urolok|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110968|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Usg/8/26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95184918|EAP|Custom 95184918||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14x16x5 6degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95110969|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Sheath And Dialator 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110970|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double J 7.0 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95191970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Lt Medial Rt Lateral Sz1 Uni Knee Precoat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95110971|EAP|Custom 95110971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbide Long 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110974|EAP|Custom 95110974||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy 14 Gauge X 6 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184885|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110976|EAP|Custom 95110976||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 55mm Linear Reloadable U|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110977|EAP|Custom 95110977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear 55mm Thick Tissue|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110978|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Expansionhead Self-tap. 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95110979|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.25|FSC: 13; Default||Not reimbursed separately|68.25|FSC: 13; Default||External grouping not supported 95184909|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95110981|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Guide 6fr Ebu40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95110985|EAP|Custom 95110985||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dissector 10mm Blunt Cherry|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191971|EAP|Custom 95191971||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Wrench Torque|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110986|EAP|Custom 95110986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Loading Unit Endo Hernia|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110987|EAP|Custom 95110987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Secondary Hunt Reich|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95110988|EAP|Custom 95110988||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Long Dilating Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111009|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pneumothorax 9fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184861|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 26.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111012|EAP|Custom 95111012||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 4.5 Xm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111013|EAP|Custom 95111013||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 9.2 X2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111015|EAP|Custom 95111015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Oval Carbidemedium 5.5x10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111017|EAP|Custom 95111017||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Bunion 13.5 X 25.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111019|EAP|Custom 95111019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Biopsy Aspiration Bone Ma|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111027|EAP|Custom 95111027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 6-0 18 C-1 Ms/4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111029|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Magic Torque .035 Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111030|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Tractfinder 2.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|FSC: 13; Default||Not reimbursed separately|555.00|FSC: 13; Default||External grouping not supported 95184802|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Anterior Chamber Duralens Ii Iol Diopter 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95111031|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Safety Straight Fixed|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111032|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stiff-bodied .038x150c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111034|EAP|Custom 95111034||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Cath 053000|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111048|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Vascular Gelsoft 20x10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,721.16|FSC: 13; Default||Not reimbursed separately|1,721.16|FSC: 13; Default||External grouping not supported 95111049|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Bi-furcated 24m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,437.35|FSC: 13; Default||Not reimbursed separately|2,437.35|FSC: 13; Default||External grouping not supported 95111050|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Rr 8-8mmx110 90<|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|FSC: 13; Default||Not reimbursed separately|5,595.00|FSC: 13; Default||External grouping not supported 95184856|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111051|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft 4-6mmx40cm Lined|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,398.00|FSC: 13; Default||Not reimbursed separately|1,398.00|FSC: 13; Default||External grouping not supported 95111052|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Ringed Fep 6mmx4d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,427.00|FSC: 13; Default||Not reimbursed separately|2,427.00|FSC: 13; Default||External grouping not supported 95111053|EAP|Custom 95111053||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stripper Vein|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111055|EAP|Custom 95111055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Snare Goose Neck Amplatz 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111060|EAP|Custom 95111060||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Pruitt-inhara Carotid|1|HUMANA [1294]||HUMANA [11839]|1,797.00|FSC: 13; Default||Not reimbursed separately|1,797.00|FSC: 13; Default||External grouping not supported 95111064|EAP|Custom 95111064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Patch Hemashield Finesse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184871|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111066|EAP|Custom 95111066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Head Cutter Valvutome 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111069|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Cardiovascular 2cm X 9cm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.00|FSC: 13; Default||Not reimbursed separately|753.00|FSC: 13; Default||External grouping not supported 95111070|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Felt Hard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,401.00|FSC: 13; Default||Not reimbursed separately|1,401.00|FSC: 13; Default||External grouping not supported 95191972|EAP|Custom 95191972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Bowl 2 Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111074|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Straight 8mmx6c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.63|FSC: 13; Default||Not reimbursed separately|1,539.63|FSC: 13; Default||External grouping not supported 95111075|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Straight 6mmx6c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.51|FSC: 13; Default||Not reimbursed separately|1,539.51|FSC: 13; Default||External grouping not supported 95111076|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Woven-double Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|FSC: 13; Default||Not reimbursed separately|1,694.28|FSC: 13; Default||External grouping not supported 95111077|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Woven-double Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|FSC: 13; Default||Not reimbursed separately|1,694.28|FSC: 13; Default||External grouping not supported 95184882|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111078|EAP|Custom 95111078||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Retractor Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111093|EAP|Custom 95111093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 7-0 Needle Taper|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188068|EAP|Custom 95188068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ring Malyugin 6.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111105|EAP|Custom 95111105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbide Long 2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111106|EAP|Custom 95111106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Acromionizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111107|EAP|Custom 95111107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Threaded Clear-track 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111108|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 350 Prefill Syr 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|FSC: 13; Default||Not reimbursed separately|0.95|FSC: 13; Default||External grouping not supported 95184901|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111109|EAP|Custom 95111109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inserter Straight Bio-stinger|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111110|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Bio-stinger 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95111121|EAP|Custom 95111121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Micro-oscillating 10x12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111122|EAP|Custom 95111122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Passing 4mm Spader Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184862|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111125|EAP|Custom 95111125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 10x|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111134|EAP|Custom 95111134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reciprocating 12.5x73.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm +10-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95188070|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Shape Tall Moderate Plus 420cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|FSC: 13; Default||Not reimbursed separately|3,375.00|FSC: 13; Default||External grouping not supported 95111136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm +5mm-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95111137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95111138|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 26mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|FSC: 13; Default||Not reimbursed separately|1,323.00|FSC: 13; Default||External grouping not supported 95111147|EAP|Custom 95111147||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Cable 2.0mm 750mm|1|HUMANA [1294]||HUMANA [11839]|1,043.70|FSC: 13; Default||Not reimbursed separately|1,043.70|FSC: 13; Default||External grouping not supported 95184891|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111148|EAP|Custom 95111148||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sleeve Cable Medium 2.0mm|1|HUMANA [1294]||HUMANA [11839]|454.50|FSC: 13; Default||Not reimbursed separately|454.50|FSC: 13; Default||External grouping not supported 95111149|EAP|Custom 95111149||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Grip Cable Medium 2.0mm|1|HUMANA [1294]||HUMANA [11839]|2,049.60|FSC: 13; Default||Not reimbursed separately|2,049.60|FSC: 13; Default||External grouping not supported 95111150|EAP|Custom 95111150||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Grip Cable Large 2.0mm|1|HUMANA [1294]||HUMANA [11839]|2,049.60|FSC: 13; Default||Not reimbursed separately|2,049.60|FSC: 13; Default||External grouping not supported 95111151|EAP|Custom 95111151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Varipulse|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191977|EAP|Custom 95191977||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stimulator Ezstim On Q|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111160|EAP|Custom 95111160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Cable 1.6mm 750mm|1|HUMANA [1294]||HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95111163|EAP|Custom 95111163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Forcep Bipolar 8-1/2 Hardy 0.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111164|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Colonic 12mmx5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111165|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Colonic 14mmx5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184884|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111166|EAP|Custom 95111166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Decompression Colon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111167|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Colonic 16mmx5.m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111168|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Colonic 18mmx55m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111169|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Dilator Colonic 20mmx5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188067|EAP|Custom 95188067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpiece Backflush Aspiration|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111174|EAP|Custom 95111174||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Cotton-leung Biliary 7fr9c|1|HUMANA [1294]||HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95111175|EAP|Custom 95111175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneursym Stand.fen-3.5 Rt 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111176|EAP|Custom 95111176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.wire Pass Drill 1.0x19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184863|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111177|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Flex Size-3|1|HUMANA [1294]||HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95111179|EAP|Custom 95111179||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Sleeve Cable Small 1.6mm|1|HUMANA [1294]||HUMANA [11839]|728.70|FSC: 13; Default||Not reimbursed separately|728.70|FSC: 13; Default||External grouping not supported 95111180|EAP|Custom 95111180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.oscillating 32x63.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111181|EAP|Custom 95111181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 5.m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111183|EAP|Custom 95111183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 19 X M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184866|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111184|EAP|Custom 95111184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Small 277-031-101|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111185|EAP|Custom 95111185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.diamond 6.0medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111186|EAP|Custom 95111186||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Exercise 50yd Black/spec.hy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111187|EAP|Custom 95111187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.oscillating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188064|EAP|Custom 95188064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Check Flo Performer 10 Fr X 40 Cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111188|EAP|Custom 95111188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Bunion 9x12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111190|EAP|Custom 95111190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 150gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111191|EAP|Custom 95111191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 200gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184890|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111192|EAP|Custom 95111192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 180gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111194|EAP|Custom 95111194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Permanent Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111201|EAP|Custom 95111201||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Guide Light Fiber-optic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191974|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95111202|EAP|Custom 95111202||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Exercise 50yd Blue/extra Hy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111203|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Perfix Medium Bard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.11|FSC: 13; Default||Not reimbursed separately|415.11|FSC: 13; Default||External grouping not supported 95111204|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Perfix Large Bard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.11|FSC: 13; Default||Not reimbursed separately|415.11|FSC: 13; Default||External grouping not supported 95111208|EAP|Custom 95111208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 45mm Wide Cutter Linear|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184898|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111209|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth 325|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95111210|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Smoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95111211|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Smoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95111212|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth Rou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95188065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon 17-hole 154mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|FSC: 13; Default||Not reimbursed separately|2,643.75|FSC: 13; Default||External grouping not supported 95111213|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|FSC: 13; Default||Not reimbursed separately|2,475.00|FSC: 13; Default||External grouping not supported 95111214|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Smoo|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|FSC: 13; Default||Not reimbursed separately|1,935.00|FSC: 13; Default||External grouping not supported 95111215|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth 350|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95111216|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Inplant Breast Saline Smooth 425|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95184869|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111217|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Smooth 475|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95111218|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Radovan Round 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95111219|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Radovan Round Re|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95111220|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Expander Textured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|FSC: 13; Default||Not reimbursed separately|3,525.00|FSC: 13; Default||External grouping not supported 95111221|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Expander Textured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95111222|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Textured Anatomical 230-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95111223|EAP|Custom 95111223||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 175cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111224|EAP|Custom 95111224||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Exercise 50yd Green/heavy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184874|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111225|EAP|Custom 95111225||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 5.m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111226|EAP|Custom 95111226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 5.m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111227|EAP|Custom 95111227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Condyloma 1.0x.07cm5.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111236|EAP|Custom 95111236||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Exercise 50yd Red/medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188063|EAP|Custom 95188063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Pls A.i.m.ing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111237|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ureteral Olive Tip 6fr Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111238|EAP|Custom 95111238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Free Lock 3.5 Diameter|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111240|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Marlex Polyknit 10 Inch X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|293.40|FSC: 13; Default||Not reimbursed separately|293.40|FSC: 13; Default||External grouping not supported 95111241|EAP|Custom 95111241||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Dural Repair 10cm X 16cm (|1|HUMANA [1294]||HUMANA [11839]|2,296.35|FSC: 13; Default||Not reimbursed separately|2,296.35|FSC: 13; Default||External grouping not supported 95184897|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111242|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 4cfs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111243|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Hernia Kugel Circle Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,546.46|FSC: 13; Default||Not reimbursed separately|2,546.46|FSC: 13; Default||External grouping not supported 95111244|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Oval Mesh 15cmx19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,286.00|FSC: 13; Default||Not reimbursed separately|2,286.00|FSC: 13; Default||External grouping not supported 95191975|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95111246|EAP|Custom 95111246||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Grafton Dbm 10cc|1|HUMANA [1294]||HUMANA [11839]|2,460.00|FSC: 13; Default||Not reimbursed separately|2,460.00|FSC: 13; Default||External grouping not supported 95111247|EAP|Custom 95111247||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Band Exercise 50yd Yellow/thin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111248|EAP|Custom 95111248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Baker Jejunostomy 16fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111249|EAP|Custom 95111249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 18 French Gastrostomy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184899|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111250|EAP|Custom 95111250||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Infuser Pressure 500ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111251|EAP|Custom 95111251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Irrigating Normothermic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188066|EAP|Custom 95188066||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip I-prism View Stabilizer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111256|EAP|Custom 95111256||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Tube Elastic Size C|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111257|EAP|Custom 95111257||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Tube Elastic Size D|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111260|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Urethral Whistle Tip 4fr Dp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111261|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Ureteral Olive Tip 5fr Disp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184867|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111263|EAP|Custom 95111263||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Foley 20fr 5cc Councill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111265|EAP|Custom 95111265||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111266|EAP|Custom 95111266||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bandage Compression Tubular 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111267|EAP|HCPCS A4352||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Foley 16fr 5cc Councill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111268|EAP|HCPCS A4352||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Foley 18fr 5cc Councill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111269|EAP|HCPCS A4352||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Foley 22fr 5cc Councill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111270|EAP|Custom 95111270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Ear Ambrus 15mm X 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111272|EAP|Custom 95111272||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Wehrs-incus Singl|1|HUMANA [1294]||HUMANA [11839]|1,246.29|FSC: 13; Default||Not reimbursed separately|1,246.29|FSC: 13; Default||External grouping not supported 95184872|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111273|EAP|Custom 95111273||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Wehrs Incus Stape|1|HUMANA [1294]||HUMANA [11839]|1,246.29|FSC: 13; Default||Not reimbursed separately|1,246.29|FSC: 13; Default||External grouping not supported 95111275|EAP|Custom 95111275||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Piston .6mm 3.75mm Plat|1|HUMANA [1294]||HUMANA [11839]|381.00|FSC: 13; Default||Not reimbursed separately|381.00|FSC: 13; Default||External grouping not supported 95111276|EAP|Custom 95111276||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Piston .6mm 4.0mm Plati|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95111277|EAP|Custom 95111277||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Flouroplas|1|HUMANA [1294]||HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95188069|EAP|Custom 95188069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Ring Malyugin 7.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111282|EAP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Filter Simon Nitinol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95111283|EAP|Custom 95111283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Dermatome (model Ab Or Con|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111285|EAP|Custom 95111285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 0 P|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111286|EAP|Custom 95111286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cholangiogram Laproscop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191976|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Active Focus Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95111287|EAP|Custom 95111287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Endo-shears Disp.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111288|EAP|Custom 95111288||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pulley Shoulder|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111289|EAP|Custom 95111289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Multi Roticulatin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endo-button|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|FSC: 13; Default||Not reimbursed separately|560.70|FSC: 13; Default||External grouping not supported 95184875|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 13.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111293|EAP|Custom 95111293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 2-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111298|EAP|Custom 95111298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Anticoagulation Basic A|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111337|EAP|Custom 95111337||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Spiral 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Medial Distal Tibia Ss 4 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|FSC: 13; Default||Not reimbursed separately|5,160.00|FSC: 13; Default||External grouping not supported 95111341|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Urolome Endoprosthesis 2.0 C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,160.00|FSC: 13; Default||Not reimbursed separately|14,160.00|FSC: 13; Default||External grouping not supported 95111351|EAP|Custom 95111351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 180gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184868|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111353|EAP|Custom 95111353||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Delta Level 2 Regular Perf|1|HUMANA [1294]||HUMANA [11839]|5,376.00|FSC: 13; Default||Not reimbursed separately|5,376.00|FSC: 13; Default||External grouping not supported 95111361|EAP|Custom 95111361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Urostomy Postoperative 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111362|EAP|Custom 95111362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr 3.0mm Ball Mednext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111363|EAP|Custom 95111363||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond 3.0mm Mednext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111365|EAP|Custom 95111365||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr 5.0mm Ball Mednext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111366|EAP|Custom 95111366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond 4.0mm Mednext|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111372|EAP|Custom 95111372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Arthrowand 2.3mm 35 Degree Short|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184896|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95111373|EAP|HCPCS Q9965||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Visipaque 320 (50ml) 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|2.29|FSC: 13; Default||Not reimbursed separately|2.29|FSC: 13; Default||External grouping not supported 95111374|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Visipaque 320 (100ml) 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.97|FSC: 13; Default||Not reimbursed separately|1.97|FSC: 13; Default||External grouping not supported 95111385|EAP|Custom 95111385||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 0 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111389|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Patch Soft Tissue 5cm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.00|FSC: 13; Default||Not reimbursed separately|837.00|FSC: 13; Default||External grouping not supported 95188089|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 16 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95111398|EAP|Custom 95111398||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 10-0 Needle Stc-6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111400|EAP|Custom 95111400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Measuring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184905|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111401|EAP|Custom 95111401||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Urolome 3.0 Endoprothesis|1|HUMANA [1294]||HUMANA [11839]|15,009.00|FSC: 13; Default||Not reimbursed separately|15,009.00|FSC: 13; Default||External grouping not supported 95111402|EAP|Custom 95111402||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Sheath-set Percutaneous|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95191969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Stablyx Cmc Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|FSC: 13; Default||Not reimbursed separately|8,925.00|FSC: 13; Default||External grouping not supported 95111403|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz-coated J-tip .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184908|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111410|EAP|Custom 95111410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Csf-cath 3 Way|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111411|EAP|Custom 95111411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Assembly Shunt Delta Regular Per|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188092|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro Tm Ss Cortex 2.7 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95111420|EAP|Custom 95111420||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Fluid Warmer Level 1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111421|EAP|Custom 95111421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Arterial/venous 18 Gaug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111426|EAP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Occlusion 12 French|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184854|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111427|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Ringed Tw 6mmx70c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,951.00|FSC: 13; Default||Not reimbursed separately|3,951.00|FSC: 13; Default||External grouping not supported 95111429|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretched-step-down (dialy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|FSC: 13; Default||Not reimbursed separately|1,890.00|FSC: 13; Default||External grouping not supported 95111433|EAP|Custom 95111433||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Curved 14cm Ultracision|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111435|EAP|Custom 95111435||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Trocar 15mm Thorasic Flex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111440|EAP|Custom 95111440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Gfi Vented|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111444|EAP|Custom 95111444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Procedural Perfluoron 5ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111445|EAP|Custom 95111445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Fragmatome Access|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184859|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111448|EAP|Custom 95111448||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Instrument Hemostatic Eraser 23g|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111449|EAP|Custom 95111449||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Strip Scleral Buckling 4mm|1|HUMANA [1294]||HUMANA [11839]|36.00|FSC: 13; Default||Not reimbursed separately|36.00|FSC: 13; Default||External grouping not supported 95111450|EAP|Custom 95111450||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Transfer Pd Extended Life|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7 X 36mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95111463|EAP|Custom 95111463||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Grip Cable Small 1.6mm|1|HUMANA [1294]||HUMANA [11839]|2,049.60|FSC: 13; Default||Not reimbursed separately|2,049.60|FSC: 13; Default||External grouping not supported 95111475|EAP|Custom 95111475||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tendon Hunter 3mm|1|HUMANA [1294]||HUMANA [11839]|360.00|FSC: 13; Default||Not reimbursed separately|360.00|FSC: 13; Default||External grouping not supported 95111476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Radial Head 2 Silastic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95184888|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Radial Head 1 Silastic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95111478|EAP|Custom 95111478||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tendon Hunter 6mm|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95111480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Carpal Lunate Size 1 Sil|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,302.00|FSC: 13; Default||Not reimbursed separately|10,302.00|FSC: 13; Default||External grouping not supported 95111482|EAP|Custom 95111482||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Carpal Lunate Size 3 Sil|1|HUMANA [1294]||HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95111484|EAP|Custom 95111484||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Support Facioplasty Elastic Medi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111485|EAP|Custom 95111485||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Contour 450cc Breast|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111486|EAP|Custom 95111486||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Breast Implant 325cc Salin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111487|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great-toe Silastic Size2|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95184903|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 26.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111488|EAP|Custom 95111488||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheet Micro-plate Channel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111490|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 7x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95111494|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.6mm Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111495|EAP|Custom 95111495||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188093|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ss 2.7 X 30mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95111496|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partially|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95111497|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partially|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95111498|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.5mm Partially|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.03|FSC: 13; Default||Not reimbursed separately|681.03|FSC: 13; Default||External grouping not supported 95184877|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 14.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111502|EAP|Custom 95111502||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 10.0mm For 4.5mm Cannulat|1|HUMANA [1294]||HUMANA [11839]|90.36|FSC: 13; Default||Not reimbursed separately|90.36|FSC: 13; Default||External grouping not supported 95111508|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Lcp 3.5mm X 67mm Right A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,120.23|FSC: 13; Default||Not reimbursed separately|1,120.23|FSC: 13; Default||External grouping not supported 95111509|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 40mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.53|FSC: 13; Default||Not reimbursed separately|61.53|FSC: 13; Default||External grouping not supported 95111510|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 45mm 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95192026|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Self Drill Headless 3.0mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95111511|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 50mm 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95111512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.53|FSC: 13; Default||Not reimbursed separately|61.53|FSC: 13; Default||External grouping not supported 95111513|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 30mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95111514|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 26mm 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95184881|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111515|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 22mm 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95111516|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95111517|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95111518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95188091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro Tm Ss Cortex 2.7 X 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95111519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 40mm Calcaneal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111522|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 45mm Calcaneal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95184893|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111523|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111524|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 35mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111525|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 22mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111526|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|FSC: 13; Default||Not reimbursed separately|54.99|FSC: 13; Default||External grouping not supported 95111527|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|FSC: 13; Default||Not reimbursed separately|54.99|FSC: 13; Default||External grouping not supported 95111528|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111529|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95111530|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|FSC: 13; Default||Not reimbursed separately|67.02|FSC: 13; Default||External grouping not supported 95184906|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 28.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111531|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95111532|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.83|FSC: 13; Default||Not reimbursed separately|76.83|FSC: 13; Default||External grouping not supported 95111533|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95188095|EAP|Custom 95188095||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm Calibrated Long|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111534|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95111535|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|FSC: 13; Default||Not reimbursed separately|67.02|FSC: 13; Default||External grouping not supported 95111536|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95184858|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111537|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.14|FSC: 13; Default||Not reimbursed separately|79.14|FSC: 13; Default||External grouping not supported 95111538|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95111539|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 34mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95111540|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 38mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.83|FSC: 13; Default||Not reimbursed separately|76.83|FSC: 13; Default||External grouping not supported 95192027|EAP|Custom 95192027||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.1mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111541|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111542|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95111545|EAP|HCPCS L8330||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Suspensory Extra Large 0-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184879|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111548|EAP|Custom 95111548||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Coventry 3/16 Inch|1|HUMANA [1294]||HUMANA [11839]|61.56|FSC: 13; Default||Not reimbursed separately|61.56|FSC: 13; Default||External grouping not supported 95111549|EAP|Custom 95111549||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Coventry 3/8 Inch|1|HUMANA [1294]||HUMANA [11839]|61.56|FSC: 13; Default||Not reimbursed separately|61.56|FSC: 13; Default||External grouping not supported 95111550|EAP|Custom 95111550||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Coventry 9/16 Inch|1|HUMANA [1294]||HUMANA [11839]|61.56|FSC: 13; Default||Not reimbursed separately|61.56|FSC: 13; Default||External grouping not supported 95111551|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 7.0mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95111553|EAP|Custom 95111553||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Half 33mmx12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111555|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm X 70mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.66|FSC: 13; Default||Not reimbursed separately|69.66|FSC: 13; Default||External grouping not supported 95111556|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting 3mmx120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|FSC: 13; Default||Not reimbursed separately|48.00|FSC: 13; Default||External grouping not supported 95111557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Connecting3mmx90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.10|FSC: 13; Default||Not reimbursed separately|41.10|FSC: 13; Default||External grouping not supported 95184895|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111558|EAP|Custom 95111558||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Holder Pin Offset|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111559|EAP|Custom 95111559||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 13mm|1|HUMANA [1294]||HUMANA [11839]|91.47|FSC: 13; Default||Not reimbursed separately|91.47|FSC: 13; Default||External grouping not supported 95111560|EAP|Custom 95111560||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0mm 145mm/120mm Qc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111562|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Silicone-gel Styl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95192028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Variax Compression Broad Curved 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|FSC: 13; Default||Not reimbursed separately|3,645.00|FSC: 13; Default||External grouping not supported 95111563|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Contoured|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95111564|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem 20x15x165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|FSC: 13; Default||Not reimbursed separately|15,147.30|FSC: 13; Default||External grouping not supported 95111565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5x40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 95111566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 6.5x35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 95184900|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111567|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 5.0mmx30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 95111568|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Femoral Long Straight 20x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|FSC: 13; Default||Not reimbursed separately|18,337.20|FSC: 13; Default||External grouping not supported 95111569|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone 6.5x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|FSC: 13; Default||Not reimbursed separately|619.50|FSC: 13; Default||External grouping not supported 95111570|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Proximal Coated Porous S-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 95111571|EAP|Custom 95111571||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve 20-fxxl|1|HUMANA [1294]||HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 95111572|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Prox Ztt Por Coated 24f X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|FSC: 13; Default||Not reimbursed separately|6,335.70|FSC: 13; Default||External grouping not supported 95111573|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm +12mm S-rom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|FSC: 13; Default||Not reimbursed separately|2,692.20|FSC: 13; Default||External grouping not supported 95111574|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral S-rom 32mm +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|FSC: 13; Default||Not reimbursed separately|2,767.80|FSC: 13; Default||External grouping not supported 95184865|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111575|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ball Hip +0 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|FSC: 13; Default||Not reimbursed separately|2,692.20|FSC: 13; Default||External grouping not supported 95111576|EAP|Custom 95111576||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Passing 2.7mm X 15 Inch Dril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111578|EAP|Custom 95111578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ectra Disp.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111590|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrak 12 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 80170944|EAP|CPT® 92978||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Oct Coronary, Initial Vessel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,682.09|FSC: 13; Default||Not reimbursed separately|4,682.09|FSC: 13; Default||External grouping not supported 95111591|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrak 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95111592|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation Acutrak 22.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.75|FSC: 13; Default||Not reimbursed separately|879.75|FSC: 13; Default||External grouping not supported 95111593|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Fixation 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95111594|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Mini 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|FSC: 13; Default||Not reimbursed separately|705.00|FSC: 13; Default||External grouping not supported 95184870|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111595|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Mini 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95111596|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95111598|EAP|Custom 95111598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Suture Hewson|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111599|EAP|Custom 95111599||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Oats 7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111603|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Emergency 1.7mm 3mm W/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.50|FSC: 13; Default||Not reimbursed separately|157.50|FSC: 13; Default||External grouping not supported 95111604|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Contou|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,221.00|FSC: 13; Default||Not reimbursed separately|4,221.00|FSC: 13; Default||External grouping not supported 95111613|EAP|Custom 95111613||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Plate Holding|1|HUMANA [1294]||HUMANA [11839]|216.00|FSC: 13; Default||Not reimbursed separately|216.00|FSC: 13; Default||External grouping not supported 95111614|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Bone Hole 13mmx2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|FSC: 13; Default||Not reimbursed separately|1,107.00|FSC: 13; Default||External grouping not supported 95184873|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111615|EAP|Custom 95111615||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Hook Pedicle M8 Standard-blade R|1|HUMANA [1294]||HUMANA [11839]|3,148.74|FSC: 13; Default||Not reimbursed separately|3,148.74|FSC: 13; Default||External grouping not supported 95111616|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|479.22|FSC: 13; Default||Not reimbursed separately|479.22|FSC: 13; Default||External grouping not supported 95111617|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95111618|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95184883|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111619|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|FSC: 13; Default||Not reimbursed separately|477.00|FSC: 13; Default||External grouping not supported 95111620|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95188102|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma 13x440mmx125degree Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95111621|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|970.20|FSC: 13; Default||Not reimbursed separately|970.20|FSC: 13; Default||External grouping not supported 95111622|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.3mm Box 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95184886|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95111623|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Emergency 1.7mm 4mm W/f|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95111625|EAP|Custom 95111625||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Cruciform 1.3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80170955|EAP|CPT® 92979||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hb Oct Coronary, Add Vessel|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,886.33|FSC: 13; Default||Not reimbursed separately|2,886.33|FSC: 13; Default||External grouping not supported 95111626|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Adapti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|FSC: 13; Default||Not reimbursed separately|600.00|FSC: 13; Default||External grouping not supported 95111629|EAP|Custom 95111629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Implant Breast With Do|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184889|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111649|EAP|Custom 95111649||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Transducer Nasal Oxygen Adult Di|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111652|EAP|Custom 95111652||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Passing 2.4mm X 15 Inch Dril|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cannulated 4.0 X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|FSC: 13; Default||Not reimbursed separately|864.00|FSC: 13; Default||External grouping not supported 95111659|EAP|Custom 95111659||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthro Mini Meniscus|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184855|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111672|EAP|Custom 95111672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Straight 7.3mmx 9m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111674|EAP|Custom 95111674||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111675|EAP|Custom 95111675||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Stand.force 180gms|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111676|EAP|Custom 95111676||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184864|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 28.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111677|EAP|Custom 95111677||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Permanent Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111686|EAP|Custom 95111686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Multimedium 11-1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188108|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 56x19 Mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95111692|EAP|Custom 95111692||0258 - PHARMACY - IV SOLUTIONS|Hb Solution Osmitrol Inj 20% Mannit|1|HUMANA [1294]||HUMANA [11839]|96.42|FSC: 13; Default||Not reimbursed separately|96.42|FSC: 13; Default||External grouping not supported 95184876|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111694|EAP|Custom 95111694||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strap Ankle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111695|EAP|Custom 95111695||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Medporsurgical Round 20m|1|HUMANA [1294]||HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95192030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Fibertak With Number 1 Fiberwire And Needle|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95111696|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dcr Lacricath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111697|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Itrell-iii C1767|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,215.00|FSC: 13; Default||Not reimbursed separately|22,215.00|FSC: 13; Default||External grouping not supported 95184878|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111698|EAP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Programmer Patient Hand Held C17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111699|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension C1883|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|FSC: 13; Default||Not reimbursed separately|1,980.00|FSC: 13; Default||External grouping not supported 95188100|EAP|Custom 95188100||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Snap Dressing With Foam 10 X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111700|EAP|Custom 95111700||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pouch Mesh For Pump|1|HUMANA [1294]||HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95184894|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111710|EAP|Custom 95111710||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Introducer Percut. Sheath 6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111711|EAP|Custom 95111711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Eye 59s|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111713|EAP|Custom 95111713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Maintainer Chamber Anterior Self|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184902|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111721|EAP|Custom 95111721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Lacrimal Intubation Crawford|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188101|EAP|Custom 95188101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Strap Medium For Snap Therapy System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111729|EAP|Custom 95111729||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 20fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111730|EAP|Custom 95111730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Spiral 6fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184904|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111731|EAP|Custom 95111731||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 10fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111732|EAP|Custom 95111732||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 12fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192031|EAP|Custom 95192031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Dx Fibertak|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111733|EAP|Custom 95111733||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Follower 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111734|EAP|Custom 95111734||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Fili Spiral 4fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184910|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95188105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Ti 4.0 X 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|FSC: 13; Default||Not reimbursed separately|540.00|FSC: 13; Default||External grouping not supported 95111741|EAP|Custom 95111741||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cholangiography Taut|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111745|EAP|Custom 95111745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endo Gia 3.5 Multifire|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184860|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111747|EAP|Custom 95111747||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Pds 0 18 Endoloop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111748|EAP|Custom 95111748||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 0 S|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111750|EAP|Custom 95111750||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endoscopic Multi Feed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184892|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95188104|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Proximal Conical Reclaim 20x95mm 95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95111756|EAP|Custom 95111756||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 60mm Linear Reloadable U|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111757|EAP|Custom 95111757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 30mm Linear Heavywire Re|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184907|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111758|EAP|Custom 95111758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe Laparoscopic Abc 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111759|EAP|Custom 95111759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Veress Ultra 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192033|EAP|Custom 95192033||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Interbody 38mm X 15mm X 8 Degree|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95111764|EAP|Custom 95111764||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Trocar 7mm Thorasic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184857|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111772|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretched-non-ringed (dial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|FSC: 13; Default||Not reimbursed separately|1,617.00|FSC: 13; Default||External grouping not supported 95111773|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore-tex 6mmx70cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,060.00|FSC: 13; Default||Not reimbursed separately|3,060.00|FSC: 13; Default||External grouping not supported 95188103|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tapered Distal Reclaim 16x140mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|FSC: 13; Default||Not reimbursed separately|13,832.70|FSC: 13; Default||External grouping not supported 95111774|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Gore-tex 8mmx70cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,060.00|FSC: 13; Default||Not reimbursed separately|3,060.00|FSC: 13; Default||External grouping not supported 95111775|EAP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Portal Peritoneal 15fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.06|FSC: 13; Default||Not reimbursed separately|837.06|FSC: 13; Default||External grouping not supported 95111776|EAP|Custom 95111776||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape Glow`n-tell Radiopaque- Adh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111777|EAP|Custom 95111777||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 1.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111778|EAP|Custom 95111778||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 2.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111779|EAP|Custom 95111779||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 2.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111780|EAP|Custom 95111780||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm X 2.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111781|EAP|Custom 95111781||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Vascular 30mm 3.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188099|EAP|Custom 95188099||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cartridge Snap 125mm Hg 10/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111783|EAP|Custom 95111783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Vascu-statts (midi-st)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111786|EAP|Custom 95111786||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Acupak 3/96 B-1005 Replaces|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184880|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 3-piece Diopter 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95111788|EAP|HCPCS L8330||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Suspensory Medium 0-2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192034|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 23.0 Restor Toric Mulitfocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95111790|EAP|Custom 95111790||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Intro Hemoset 12fr X 12cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184932|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 9 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111798|EAP|Custom 95111798||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applier Clip Allport 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111800|EAP|Custom 95111800||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ilm-ett 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Anchorage Locking 3.5mm X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95111801|EAP|Custom 95111801||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Ilm-ett 8.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111807|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Malecot 32fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184934|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111816|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 40cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111817|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 38cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111818|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 36cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111819|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 44cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95184926|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111820|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 40cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111821|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 38cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95188109|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 95111822|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 36cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111823|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 34cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95184923|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 4 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111824|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 8mm X 38cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111825|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 8mm X 36cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95192035|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 20.5 Restor Toric Mulitfocal|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95111826|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 9mm X 32cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111827|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 9mm X 30cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95184928|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111828|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 9mm X 28cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111829|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 10mm X 36cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111830|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 10mm X 34cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111831|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 10mm X 32cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95184924|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111832|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 11mm X 32cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111833|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 12mm X 38cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111834|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 12mm X 36cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111835|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 12mm X 34cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 12mm X 32cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 12mm X 30cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111838|EAP|Custom 95111838||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Dermatone Brown #699 Staid|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111839|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thrombectomy Graft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184929|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 7 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 10mm X 30cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 10mm X 28cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95188133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterolat Distal Tibia Ss 6 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|FSC: 13; Default||Not reimbursed separately|5,520.00|FSC: 13; Default||External grouping not supported 95111842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 34cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 11mm X 30cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95192043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cann Lp 4 X 28mm Blunt Tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95111844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 11mm X 38cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 11mm X 36cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 11mm X 34cm Expa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111847|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 3.0 Ped|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184931|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111848|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 3.5 Ped|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111849|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 4.0 Ped|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 46cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 44cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95184925|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 42cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 38cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 14mm X 36cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 46cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95184933|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 4 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 44cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 42cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95188134|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Radial Arh Slide-loc Right 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,959.00|FSC: 13; Default||Not reimbursed separately|7,959.00|FSC: 13; Default||External grouping not supported 95111859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 40cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95192042|EAP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Programmer Patient Prodigy|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|FSC: 13; Default||Not reimbursed separately|4,875.00|FSC: 13; Default||External grouping not supported 95111860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 38cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 13mm X 36cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 44cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95184930|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 7 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 12mm X 42cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 11mm X 34cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95188130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro Tm Ss 2.7 X 46mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95111865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 42cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 36cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95184941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Implant Repair Pectoralis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|FSC: 13; Default||Not reimbursed separately|3,540.00|FSC: 13; Default||External grouping not supported 95111867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Mdn 10mm X 34cm Exp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|FSC: 13; Default||Not reimbursed separately|3,005.97|FSC: 13; Default||External grouping not supported 95111868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 8mm X 34cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 8mm X 32cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95184940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Distal Medial Tibia Left 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|FSC: 13; Default||Not reimbursed separately|7,635.00|FSC: 13; Default||External grouping not supported 95111870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 8mm X 30cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 8mm X 28cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95188135|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Radial Long Arh Slide-loc Right 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,019.00|FSC: 13; Default||Not reimbursed separately|5,019.00|FSC: 13; Default||External grouping not supported 95111872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 9mm X 38cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 9mm X 36cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95184935|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Variable Angle Self Drilling 4.0mmx18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|FSC: 13; Default||Not reimbursed separately|855.00|FSC: 13; Default||External grouping not supported 95111874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Mdn 9mm X 34cm Expan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|FSC: 13; Default||Not reimbursed separately|3,085.08|FSC: 13; Default||External grouping not supported 95111879|EAP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Sheath Peel-away 12fr 37cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression Ti 3.0mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95111880|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire M Glidewire .025x150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111881|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz Super-stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95184936|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95111882|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Amplatz-coated Straigh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Val Ti 3.0 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95111885|EAP|Custom 95111885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111886|EAP|Custom 95111886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184937|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5 X 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95111887|EAP|Custom 95111887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial Vaccum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111888|EAP|Custom 95111888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111889|EAP|Custom 95111889||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Trephine Radial-vacuum Barro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111891|EAP|Custom 95111891||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shield Corneal Collagen Proshiel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184938|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Ti Self Tap 3.5x44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95111893|EAP|Custom 95111893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Gemini 4mmx0-tipx90cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111894|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dilator Balloon Passport 3fr. 4m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188137|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Radial Arh Slide-loc +1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,299.00|FSC: 13; Default||Not reimbursed separately|1,299.00|FSC: 13; Default||External grouping not supported 95111895|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Moderate Round 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95111896|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Rectangle 400cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95192045|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression Ti 3.0mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95111898|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Moderate Round 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95111906|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Corkscrew Adherent Clot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Cloverleaf 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.30|FSC: 13; Default||Not reimbursed separately|576.30|FSC: 13; Default||External grouping not supported 95111908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Buttress Angled Lt 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|FSC: 13; Default||Not reimbursed separately|721.83|FSC: 13; Default||External grouping not supported 95111909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spoon 4.5mm X 100mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|622.95|FSC: 13; Default||Not reimbursed separately|622.95|FSC: 13; Default||External grouping not supported 95111910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Buttress 5hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.71|FSC: 13; Default||Not reimbursed separately|820.71|FSC: 13; Default||External grouping not supported 95111911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Buttress 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|899.82|FSC: 13; Default||Not reimbursed separately|899.82|FSC: 13; Default||External grouping not supported 95111912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Buttress Angled Rt 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|FSC: 13; Default||Not reimbursed separately|721.83|FSC: 13; Default||External grouping not supported 95111913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Buttress 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|800.94|FSC: 13; Default||Not reimbursed separately|800.94|FSC: 13; Default||External grouping not supported 95111916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 6 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95111917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 5 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95184939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti Full Thread 4mmxl46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95111918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 8 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|FSC: 13; Default||Not reimbursed separately|642.72|FSC: 13; Default||External grouping not supported 95111925|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.20|FSC: 13; Default||Not reimbursed separately|514.20|FSC: 13; Default||External grouping not supported 95188126|EAP|Custom 95188126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hyrdocoil Azur 35d System 6mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111926|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 9 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|FSC: 13; Default||Not reimbursed separately|642.72|FSC: 13; Default||External grouping not supported 95111927|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Broad 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|FSC: 13; Default||Not reimbursed separately|642.72|FSC: 13; Default||External grouping not supported 95184949|EAP|Custom 95184949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Therapeutic Phlebotomy W/17ga X 1 Inch Needle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111930|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111931|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95192054|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetab Poly Altrx Pinn Neu 40mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|FSC: 13; Default||Not reimbursed separately|8,036.70|FSC: 13; Default||External grouping not supported 95111932|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95111933|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95184944|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 2.5 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111934|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111939|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95188129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro Tm Ss 2.7 X 44mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95111940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95184945|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 3 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111945|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111946|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95111947|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95111948|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95184946|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 3 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111950|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95111951|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95188132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro Tm Ss 2.7 X 50mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95111952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cancellous Sm.22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95184947|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 3 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111954|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cancellous Sm.20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95111958|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. Y 4hole Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95111959|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95111962|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95184948|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 3 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111964|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95111965|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95188127|EAP|Custom 95188127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Hyrdocoil Azur 35d System 6mm X 10cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111966|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111968|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cortical Sm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95184943|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 2.5 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111969|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95111970|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95192055|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlay Uni Mako X3 Sz 4-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|FSC: 13; Default||Not reimbursed separately|3,402.00|FSC: 13; Default||External grouping not supported 95111971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95184927|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Sterling 6 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111975|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95188131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lo-pro Tm Ss 2.7 X 48mm Cortex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|FSC: 13; Default||Not reimbursed separately|135.00|FSC: 13; Default||External grouping not supported 95111976|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95111981|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cancellous Sm.24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95184942|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Coyote .014 2 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95111982|EAP|Custom 95111982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin K-wire 1.6mmx6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111983|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. Y 2hole Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95111984|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mmx46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95111985|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95111986|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. 1/3 Tubular 5hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95111987|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. 1/3 Tubular 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|FSC: 13; Default||Not reimbursed separately|189.00|FSC: 13; Default||External grouping not supported 95184952|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept 6.5 X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,919.00|FSC: 13; Default||Not reimbursed separately|2,919.00|FSC: 13; Default||External grouping not supported 95111988|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. 1/3 Tubular 7hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|201.00|FSC: 13; Default||Not reimbursed separately|201.00|FSC: 13; Default||External grouping not supported 95192056|EAP|Custom 95192056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Olive Threaded 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95111989|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. 1/3 Tubular 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95184953|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Precept Polyaxial 6.5mm X 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|FSC: 13; Default||Not reimbursed separately|4,629.00|FSC: 13; Default||External grouping not supported 95111990|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm.str.3hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95111991|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm.str.4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|FSC: 13; Default||Not reimbursed separately|438.00|FSC: 13; Default||External grouping not supported 95111992|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm.str.6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|FSC: 13; Default||Not reimbursed separately|456.00|FSC: 13; Default||External grouping not supported 95184954|EAP|Custom 95184954||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Peek Impacted Large 8 X 9 X 20 4 Deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95111995|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95111996|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|FSC: 13; Default||Not reimbursed separately|552.00|FSC: 13; Default||External grouping not supported 95184955|EAP|HCPCS C2622||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Penile Spectra Tm Ams 12mm X 20cm|1|HUMANA [1294]||HUMANA [11839]|21,306.00|FSC: 13; Default||Not reimbursed separately|21,306.00|FSC: 13; Default||External grouping not supported 95111997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.00|FSC: 13; Default||Not reimbursed separately|621.00|FSC: 13; Default||External grouping not supported 95188146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dx Swivelock 3.5x13.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95111998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace L Leftmedium 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95184956|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Right 8-hole/l151mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,931.00|FSC: 13; Default||Not reimbursed separately|8,931.00|FSC: 13; Default||External grouping not supported 95111999|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace L Leftmedium 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|FSC: 13; Default||Not reimbursed separately|651.00|FSC: 13; Default||External grouping not supported 95192057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Mini-monster Full Thread Cannulated 3.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95112000|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace L Rightmedium 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|FSC: 13; Default||Not reimbursed separately|504.00|FSC: 13; Default||External grouping not supported 95184957|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 4.0mm X L42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95112001|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace L Rightmedium 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95188141|EAP|Custom 95188141||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cannula Nasal Medium Heated High Flow|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95112004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95112005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|FSC: 13; Default||Not reimbursed separately|264.00|FSC: 13; Default||External grouping not supported 95184958|EAP|Custom 95184958||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Isi Pin Plug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112006|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95188145|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Flexible Pre Curved 2.5x450mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.90|FSC: 13; Default||Not reimbursed separately|795.90|FSC: 13; Default||External grouping not supported 95112007|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95192058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Full Thread Head 3.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95112008|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. 1/3 Tubular 3hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95184959|EAP|Custom 95184959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trocar Sterile 10fr 10/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112009|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Sm. 1/3 Tubular 4hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|FSC: 13; Default||Not reimbursed separately|165.00|FSC: 13; Default||External grouping not supported 95188142|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Fluency Graft 12mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|FSC: 13; Default||Not reimbursed separately|6,300.00|FSC: 13; Default||External grouping not supported 95112013|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Solidmedium 4.5mm 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.00|FSC: 13; Default||Not reimbursed separately|42.00|FSC: 13; Default||External grouping not supported 95184960|EAP|Custom 95184960||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Trocar Sterile 8fr 10/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112017|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spoon 4.5mm X 120mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.39|FSC: 13; Default||Not reimbursed separately|672.39|FSC: 13; Default||External grouping not supported 95112018|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95184961|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Primary 13mm Micro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,596.00|FSC: 13; Default||Not reimbursed separately|13,596.00|FSC: 13; Default||External grouping not supported 95112019|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95188147|EAP|Custom 95188147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Disp Kit For Dx Swivelock 3.5x13.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112020|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 5-hole 4.5 X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.28|FSC: 13; Default||Not reimbursed separately|593.28|FSC: 13; Default||External grouping not supported 95184962|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Versa -dial 46x24x47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|FSC: 13; Default||Not reimbursed separately|5,508.00|FSC: 13; Default||External grouping not supported 95112021|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 8-hole 4.5 X 148mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|889.92|FSC: 13; Default||Not reimbursed separately|889.92|FSC: 13; Default||External grouping not supported 95112022|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 95192059|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95112023|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 95188148|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent W/ Unistep Plus 16 X 19 100 75 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,903.86|FSC: 13; Default||Not reimbursed separately|4,903.86|FSC: 13; Default||External grouping not supported 95112024|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Large 6.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|FSC: 13; Default||Not reimbursed separately|444.00|FSC: 13; Default||External grouping not supported 80168560|EAP|CPT® 15120||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Split Thickness Autograft Face Hands Feet 1st|1|HUMANA [1294]||HUMANA [11839]|9,190.84|FSC: 13; Default||Not reimbursed separately|9,190.84|FSC: 13; Default||External grouping not supported 95112025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated 8.0x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95112030|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ect 4.0x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|FSC: 13; Default||Not reimbursed separately|39.33|FSC: 13; Default||External grouping not supported 95184971|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Phalangeal Insert|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|FSC: 13; Default||Not reimbursed separately|7,470.00|FSC: 13; Default||External grouping not supported 95112037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated 8.0x90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95188149|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Simpliciti 46mm Dia X 17mm Thick|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|FSC: 13; Default||Not reimbursed separately|10,268.55|FSC: 13; Default||External grouping not supported 95112038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated 8.0x100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|FSC: 13; Default||Not reimbursed separately|462.00|FSC: 13; Default||External grouping not supported 95184972|EAP|Custom 95184972||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Profile Mini Cmp Ft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112040|EAP|Custom 95112040||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192060|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Promo Left Size 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,202.00|FSC: 13; Default||Not reimbursed separately|5,202.00|FSC: 13; Default||External grouping not supported 95112041|EAP|Custom 95112041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ect 3.5x110mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95129664|EAP|Custom 95129664||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valve Chest Drain Pneumostat W/30ml Collection|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112061|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Zps Full-thream|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|FSC: 13; Default||Not reimbursed separately|39.33|FSC: 13; Default||External grouping not supported 95171031|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 16.5 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95112065|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ect Full-thream|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|FSC: 13; Default||Not reimbursed separately|39.33|FSC: 13; Default||External grouping not supported 95171035|EAP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Iol 17.0 Diopter Acrysof Toric Iq 13.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95112068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf 3hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|536.91|FSC: 13; Default||Not reimbursed separately|536.91|FSC: 13; Default||External grouping not supported 95171037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone T7 2.7 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|FSC: 13; Default||Not reimbursed separately|369.00|FSC: 13; Default||External grouping not supported 95112069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Ect 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|404.79|FSC: 13; Default||Not reimbursed separately|404.79|FSC: 13; Default||External grouping not supported 95171038|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95112070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Ect Small 5hole Oblique|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|416.04|FSC: 13; Default||Not reimbursed separately|416.04|FSC: 13; Default||External grouping not supported 95171039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95112072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Ect Small 4hole 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|206.52|FSC: 13; Default||Not reimbursed separately|206.52|FSC: 13; Default||External grouping not supported 95171040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95112076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Compression 3.5mm X 145mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.75|FSC: 13; Default||Not reimbursed separately|345.75|FSC: 13; Default||External grouping not supported 95171041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tapping 3.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95112081|EAP|Custom 95112081||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthro-lok Curved Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171042|EAP|Custom 95171042||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.0 X 125mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Locking Compression 6 Hole L-84mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.84|FSC: 13; Default||Not reimbursed separately|483.84|FSC: 13; Default||External grouping not supported 95112083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Epiphysis Oblique Righ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|FSC: 13; Default||Not reimbursed separately|59.58|FSC: 13; Default||External grouping not supported 95171044|EAP|Custom 95171044||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Inserter Tibial Pfj Disposable |1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Epiphysis Oblique Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|FSC: 13; Default||Not reimbursed separately|59.58|FSC: 13; Default||External grouping not supported 95171045|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Flex High Sz-b Rt Medial Lt Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,346.00|FSC: 13; Default||Not reimbursed separately|8,346.00|FSC: 13; Default||External grouping not supported 95112085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ect Epiphysis Left Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|FSC: 13; Default||Not reimbursed separately|59.58|FSC: 13; Default||External grouping not supported 95171046|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Tibial Rt Medial Lt Lateral Precoat Uni Kne|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|FSC: 13; Default||Not reimbursed separately|3,954.00|FSC: 13; Default||External grouping not supported 95171047|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Cr Cemented Triathlon #1 Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|FSC: 13; Default||Not reimbursed separately|10,508.40|FSC: 13; Default||External grouping not supported 95171048|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Bearing Tibial Cs Triathlon Sz 1-9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|FSC: 13; Default||Not reimbursed separately|7,711.20|FSC: 13; Default||External grouping not supported 95171049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile 2.3mm X 22mm Cortical|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95171050|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Meta Open Rt Low Profile 6mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95171052|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral Proximal Long Rt 8 X 220mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|FSC: 13; Default||Not reimbursed separately|5,491.50|FSC: 13; Default||External grouping not supported 95112104|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Ect Small 3hole 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.44|FSC: 13; Default||Not reimbursed separately|196.44|FSC: 13; Default||External grouping not supported 95171053|EAP|Custom 95171053||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Teflon Sterile Humeral T2|1|HUMANA [1294]||HUMANA [11839]|774.90|FSC: 13; Default||Not reimbursed separately|774.90|FSC: 13; Default||External grouping not supported 95112105|EAP|Custom 95112105||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 2.7mmx100mm 2410-7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171054|EAP|Custom 95171054||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guiderod Ball-tip 2.2 X 800mm|1|HUMANA [1294]||HUMANA [11839]|562.80|FSC: 13; Default||Not reimbursed separately|562.80|FSC: 13; Default||External grouping not supported 95112106|EAP|Custom 95112106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Ect Drill 3.5mm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95171055|EAP|Custom 95171055||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Zuma 26mm X 24mm X 16mm 8 Degree|1|HUMANA [1294]||HUMANA [11839]|17,334.00|FSC: 13; Default||Not reimbursed separately|17,334.00|FSC: 13; Default||External grouping not supported 95112117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 1.5x8mm Hext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95171056|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Zuma 5.5mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,827.00|FSC: 13; Default||Not reimbursed separately|1,827.00|FSC: 13; Default||External grouping not supported 95112120|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171057|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Zuma 5.5mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,827.00|FSC: 13; Default||Not reimbursed separately|1,827.00|FSC: 13; Default||External grouping not supported 95112121|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171058|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cover Locking Zuma 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|FSC: 13; Default||Not reimbursed separately|630.00|FSC: 13; Default||External grouping not supported 95112122|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171059|EAP|Custom 95171059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB DRILL ZUMA|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95112124|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95112125|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171061|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Balloon Evercross 5mm Diameter|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171063|EAP|Custom 95171063||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.7mm Cannulated|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 7.3mm X 80mm X 16mm Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|FSC: 13; Default||Not reimbursed separately|872.82|FSC: 13; Default||External grouping not supported 95112129|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171067|EAP|Custom 95171067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pro-toe Vo Intrument|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112130|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe, Vo, Pro-toe Size Zero Degrees|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|FSC: 13; Default||Not reimbursed separately|1,392.00|FSC: 13; Default||External grouping not supported 95112131|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Hammertoe, Vo, Pro-toe Size Zero Degrees|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|FSC: 13; Default||Not reimbursed separately|1,350.00|FSC: 13; Default||External grouping not supported 95112132|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171070|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Synfix 4 X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|926.25|FSC: 13; Default||Not reimbursed separately|926.25|FSC: 13; Default||External grouping not supported 95112133|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Synfix 4 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|926.25|FSC: 13; Default||Not reimbursed separately|926.25|FSC: 13; Default||External grouping not supported 95112134|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95171072|EAP|Custom 95171072||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Inner Body With Plate Synfix Lr 26mm|1|HUMANA [1294]||HUMANA [11839]|19,305.00|FSC: 13; Default||Not reimbursed separately|19,305.00|FSC: 13; Default||External grouping not supported 95112135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95112136|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Corticlemedium 4.5mm 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|FSC: 13; Default||Not reimbursed separately|252.00|FSC: 13; Default||External grouping not supported 95112137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4.5mm3h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|FSC: 13; Default||Not reimbursed separately|276.00|FSC: 13; Default||External grouping not supported 95112138|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4.5mm4h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95112139|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4.5mm6h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95112140|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4.5mm8h|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95112141|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4.5mm10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|FSC: 13; Default||Not reimbursed separately|396.00|FSC: 13; Default||External grouping not supported 95112142|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace Reconstructive 4.5mm12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95112144|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ace Cannulated Cancellous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|FSC: 13; Default||Not reimbursed separately|453.00|FSC: 13; Default||External grouping not supported 95112152|EAP|Custom 95112152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar Versaport 5mm-12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 2.0x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95112155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 6mmx2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95112157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace L Leftmedium 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|FSC: 13; Default||Not reimbursed separately|579.00|FSC: 13; Default||External grouping not supported 95112158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ace L Rightmedium 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|FSC: 13; Default||Not reimbursed separately|651.00|FSC: 13; Default||External grouping not supported 95112159|EAP|Custom 95112159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 2.5mm Dia 150mm L|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112160|EAP|Custom 95112160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mmdia 60mm Leh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184974|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb T-plate Low Profile 3.0mm 3 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95112161|EAP|Custom 95112161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mm X 80mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188151|EAP|Custom 95188151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Custom Hip Anterior|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112162|EAP|Custom 95112162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mmdia 100mm Lh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112163|EAP|Custom 95112163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mm X 120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184969|EAP|HCPCS Q4126||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Memoderm 4x8|1|HUMANA [1294]||HUMANA [11839]|250.36|FSC: 13; Default||Not reimbursed separately|250.36|FSC: 13; Default||External grouping not supported 95112165|EAP|Custom 95112165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mmdia 160mm Lh|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112166|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz Self-drilling 4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|545.22|FSC: 13; Default||Not reimbursed separately|545.22|FSC: 13; Default||External grouping not supported 95112167|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mmx100mm Diamond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.89|FSC: 13; Default||Not reimbursed separately|280.89|FSC: 13; Default||External grouping not supported 95112168|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mmx120mm Diamond|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.89|FSC: 13; Default||Not reimbursed separately|280.89|FSC: 13; Default||External grouping not supported 95184973|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cervical Falcon 54mm 3level|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|FSC: 13; Default||Not reimbursed separately|4,800.00|FSC: 13; Default||External grouping not supported 95112169|EAP|Custom 95112169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bar Connecting 4.0mm X 180mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112170|EAP|Custom 95112170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp 4.0mm X 2.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188156|EAP|Custom 95188156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bir Drill Three-fluted 4.2mmx330mm/100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 2.7x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95184970|EAP|Custom 95184970||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Drainer Centesis 6 F 9cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112180|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 2.8mm X 300mm Threade|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192046|EAP|Custom 95192046||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Gator Stealth 3.5 9264|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112182|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112183|EAP|Custom 95112183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.oscillating|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 8.0mm X 220mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.43|FSC: 13; Default||Not reimbursed separately|533.43|FSC: 13; Default||External grouping not supported 95112185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95188152|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Expander Tissue Breast Profile Contour Height Low 650cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|FSC: 13; Default||Not reimbursed separately|4,125.00|FSC: 13; Default||External grouping not supported 95112186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 36mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95112187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 40mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.14|FSC: 13; Default||Not reimbursed separately|79.14|FSC: 13; Default||External grouping not supported 95184975|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Charger 5fr 5 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 45mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95112189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mm 3.0mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|545.22|FSC: 13; Default||Not reimbursed separately|545.22|FSC: 13; Default||External grouping not supported 95112190|EAP|Custom 95112190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reciprocating 12.5x89mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112191|EAP|Custom 95112191||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Drainage Nasal Biliary 5fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184977|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Powerpicc 5fr Tl 70cm Guide 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112196|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Jagwire.025 #5656|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188164|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Venous Infusion Thermodilution 7.5fr No Heparin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112202|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cancellous Solid 4.0x3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|FSC: 13; Default||Not reimbursed separately|78.00|FSC: 13; Default||External grouping not supported 95112203|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Canc Solid 4.0mmx35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95112204|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|FSC: 13; Default||Not reimbursed separately|288.00|FSC: 13; Default||External grouping not supported 95112205|EAP|Custom 95112205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.7mm(100mm/75mm)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112206|EAP|Custom 95112206||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112207|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95192047|EAP|Custom 95192047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Full Radius Stealth 3.5 Sc9248|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95184980|EAP|Custom 95184980||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Securmark Eviva 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95188153|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95112214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95184981|EAP|Custom 95184981||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trimark Eviva 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95184982|EAP|Custom 95184982||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trimark Eviva 2s 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx130mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95188159|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Tm Size 5 Rt/lat-lt/med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|FSC: 13; Default||Not reimbursed separately|5,733.00|FSC: 13; Default||External grouping not supported 95112222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95112223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95184983|EAP|Custom 95184983||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpieces Stx Eviva 12t 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx115mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95112225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95192048|EAP|Custom 95192048||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Great White Stealth 3.5 9399a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95184984|EAP|Custom 95184984||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handpieces Stx Eviva 20 5/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95188160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Block Tm Size 5 Lt/lat-rt/med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.45|FSC: 13; Default||Not reimbursed separately|3,645.45|FSC: 13; Default||External grouping not supported 95112230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95184988|EAP|Custom 95184988||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 11 X 11 X 26mm 4 Deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95112232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95112233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx105mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95112234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95112235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Recon 5.5mmx95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|FSC: 13; Default||Not reimbursed separately|781.17|FSC: 13; Default||External grouping not supported 95184990|EAP|Custom 95184990||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Plif Wave 10mm X 24 Mm 4 Deg|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95112236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95112241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Mdn Interlocking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|FSC: 13; Default||Not reimbursed separately|524.07|FSC: 13; Default||External grouping not supported 95188155|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial Rt 6hole L 123mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,860.00|FSC: 13; Default||Not reimbursed separately|7,860.00|FSC: 13; Default||External grouping not supported 95112242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Distal Nail Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|FSC: 13; Default||Not reimbursed separately|333.00|FSC: 13; Default||External grouping not supported 95112243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Nail 6.28 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|FSC: 13; Default||Not reimbursed separately|333.00|FSC: 13; Default||External grouping not supported 95192049|EAP|Custom 95192049||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Great White Stealth 4.2 S9299a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Nail 6.28 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95112245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Nail 6.28 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95184992|EAP|Custom 95184992||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jigs Persona Aref Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Lag Nail 12 X 85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95112247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 12x90 Gamma-nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95188154|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 8mm X 255mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95112248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 95mm Nail-gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95112249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag 12x100 Nail Gamma|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95184993|EAP|Custom 95184993||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Models Bone Knee Psi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Cap Nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95112252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Troch 125mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|FSC: 13; Default||Not reimbursed separately|2,025.00|FSC: 13; Default||External grouping not supported 95112253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Troch Gamma 130-deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|FSC: 13; Default||Not reimbursed separately|1,911.00|FSC: 13; Default||External grouping not supported 95112254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Gamma Nail 12 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|FSC: 13; Default||Not reimbursed separately|741.00|FSC: 13; Default||External grouping not supported 95188158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti 4.0 X L48mm Full Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|FSC: 13; Default||Not reimbursed separately|180.00|FSC: 13; Default||External grouping not supported 95112255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Lag Nail 120mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|FSC: 13; Default||Not reimbursed separately|780.00|FSC: 13; Default||External grouping not supported 95112256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 8.0mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.43|FSC: 13; Default||Not reimbursed separately|533.43|FSC: 13; Default||External grouping not supported 95192050|EAP|Custom 95192050||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic 4.2 Ultrafrr Stealth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112266|EAP|Custom 95112266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tube Gastrostomy W/y-ext Set|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112276|EAP|Custom 95112276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Epidural 17 Gauge X 4 1/2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184995|EAP|Custom 95184995||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Core Biopsy Marquee 12g 5/ca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112299|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 6cfs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112300|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 4lpc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188162|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 3.5mm Prox Tibia Va-lcp Small Bend 6 Hole 117mm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,022.66|FSC: 13; Default||Not reimbursed separately|5,022.66|FSC: 13; Default||External grouping not supported 95112301|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 10lpc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112302|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 6lpc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184997|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intererence Milagro 5x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,422.00|FSC: 13; Default||Not reimbursed separately|1,422.00|FSC: 13; Default||External grouping not supported 95112309|EAP|Custom 95112309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Disp. 8.4x75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112332|EAP|Custom 95112332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Cholangiocath Laparosco|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112334|EAP|Custom 95112334||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbide Long 6.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95184998|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Comp Dbl 3 Hole 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95112335|EAP|Custom 95112335||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbide 6.5medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112341|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Herbert Whipple|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188161|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Self Tapping Stardrive Variable Angle 3.5 X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|490.95|FSC: 13; Default||Not reimbursed separately|490.95|FSC: 13; Default||External grouping not supported 95112342|EAP|Custom 95112342||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopy Cuda 4.8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112343|EAP|Custom 95112343||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cannula Small Joint Tubing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185002|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Solera 6.5mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|FSC: 13; Default||Not reimbursed separately|8,025.00|FSC: 13; Default||External grouping not supported 95112346|EAP|Custom 95112346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cutter 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192052|EAP|Custom 95192052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Ultracut Stealth 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112351|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Double J 7.0 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|FSC: 13; Default||Not reimbursed separately|373.89|FSC: 13; Default||External grouping not supported 95185003|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Voyager|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|FSC: 13; Default||Not reimbursed separately|993.00|FSC: 13; Default||External grouping not supported 95112355|EAP|Custom 95112355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cable Screening Twist-lock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188163|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated 12mm/380mm/right 125 Deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95112360|EAP|Custom 95112360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 2-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185004|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95112361|EAP|Custom 95112361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 4-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112362|EAP|Custom 95112362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Load-unit Endo-stitch 3-0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112364|EAP|Custom 95112364||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Grip Cable/sleeve Stainle|1|HUMANA [1294]||HUMANA [11839]|810.00|FSC: 13; Default||Not reimbursed separately|810.00|FSC: 13; Default||External grouping not supported 95112366|EAP|Custom 95112366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 2.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185005|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 7 Hole Locking Compression Narrow L133mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.00|FSC: 13; Default||Not reimbursed separately|621.00|FSC: 13; Default||External grouping not supported 95112367|EAP|Custom 95112367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 2.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112368|EAP|Custom 95112368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 1.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188157|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna Deg 10mm/130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.36|FSC: 13; Default||Not reimbursed separately|4,530.36|FSC: 13; Default||External grouping not supported 95112369|EAP|Custom 95112369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 2.00mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112370|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Felt Soft|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|FSC: 13; Default||Not reimbursed separately|1,023.00|FSC: 13; Default||External grouping not supported 95185008|EAP|Custom 95185008||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HB PIN DISTRACTION TITANIUM DISPOSABLE 14MM YELLOW|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112371|EAP|Custom 95112371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Cutting Micro-mill 19mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192053|EAP|Custom 95192053||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Cuda Great White Stealth 5.5 S9599a|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112375|EAP|Custom 95112375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Angled Shortcut 4.1mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112377|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Esophageal Maxforce Dila|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185009|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Securmark Eviva 13 10/bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112378|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sphincterotome Double Lumen With|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112386|EAP|Custom 95112386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Basket Extraction Double-lumen W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188171|EAP|Custom 95188171||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Elevate 8x23mmx10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95112387|EAP|Custom 95112387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Assembly Compression Hip Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185011|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Accufil 5cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|FSC: 13; Default||Not reimbursed separately|8,850.00|FSC: 13; Default||External grouping not supported 95112393|EAP|Custom 95112393||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Delta Level 1 Regular Perf|1|HUMANA [1294]||HUMANA [11839]|4,677.12|FSC: 13; Default||Not reimbursed separately|4,677.12|FSC: 13; Default||External grouping not supported 95112394|EAP|Custom 95112394||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Anesthesia Spinal Lidocaine|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112395|EAP|Custom 95112395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Assembly Compression Hip Fix|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112399|EAP|Custom 95112399||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endostat Disposable 6mmx12`|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112400|EAP|Custom 95112400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Endostat Fiber Sculptured 10-522|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112405|EAP|Custom 95112405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Turbotrim- Me|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112406|EAP|Custom 95112406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Barrel-bar3mm 24fr.yel|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112407|EAP|Custom 95112407||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade St.flute Neuro|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112409|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Duct Lacrimal 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112414|EAP|Custom 95112414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Pneumothorax 8 Frx16cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188166|EAP|Custom 95188166||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Phoxillum Bk4/2.5 2/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112416|EAP|Custom 95112416||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Probe V-pacing W/thromboshield|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 951100343|EAP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Prodigy Mri Ipg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95,775.00|FSC: 13; Default||Not reimbursed separately|95,775.00|FSC: 13; Default||External grouping not supported 95112417|EAP|Custom 95112417||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 035 X 6 Style-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112418|EAP|Custom 95112418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 045 X 6 Style-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168578|EAP|CPT® 84295||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc Sodium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.43|FSC: 13; Default||Not reimbursed separately|14.43|FSC: 13; Default||External grouping not supported 95112419|EAP|Custom 95112419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 062 X 6 Style-1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112423|EAP|Custom 95112423||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 14 X 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188165|EAP|Custom 95188165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Solution Phoxillum B22k 2/case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112424|EAP|Custom 95112424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-oscillating 10m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112425|EAP|Custom 95112425||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 19.5x71mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168586|EAP|CPT® 82435||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc Chloride|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.80|FSC: 13; Default||Not reimbursed separately|13.80|FSC: 13; Default||External grouping not supported 95112430|EAP|Custom 95112430||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Tls Sz. 7|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112432|EAP|Custom 95112432||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Beaver Slit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112442|EAP|Custom 95112442||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dermacarriers Graft Skin 8 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168594|EAP|CPT® 82947||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc Glucose|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.79|FSC: 13; Default||Not reimbursed separately|11.79|FSC: 13; Default||External grouping not supported 95112443|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 135 Deg 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95112444|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95188169|EAP|Custom 95188169||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Nester Embolization 35-14-16|1|HUMANA [1294]||HUMANA [11839]|245.70|FSC: 13; Default||Not reimbursed separately|245.70|FSC: 13; Default||External grouping not supported 95112445|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112446|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 80168602|EAP|CPT® 83605||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc Lactic Acid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.71|FSC: 13; Default||Not reimbursed separately|34.71|FSC: 13; Default||External grouping not supported 95112447|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112448|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 951100344|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Thread Compression Ti 3.0mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95112449|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112450|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 80168610|EAP|CPT® 84132||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc Potassium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|FSC: 13; Default||Not reimbursed separately|14.28|FSC: 13; Default||External grouping not supported 95112451|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95188167|EAP|Custom 95188167||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Retracta Embolization 35-14-14|1|HUMANA [1294]||HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95112453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 80168628|EAP|CPT® 82330||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc Ionized Ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.04|FSC: 13; Default||Not reimbursed separately|41.04|FSC: 13; Default||External grouping not supported 95112455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112457|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112458|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112459|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112460|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112461|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112462|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112463|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 12.7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.50|FSC: 13; Default||Not reimbursed separately|1,267.50|FSC: 13; Default||External grouping not supported 95112464|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112465|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112466|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95188168|EAP|Custom 95188168||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Nester Embolization 35-20-20|1|HUMANA [1294]||HUMANA [11839]|354.00|FSC: 13; Default||Not reimbursed separately|354.00|FSC: 13; Default||External grouping not supported 95112467|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Dhs Dcs Lag One-step 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,409.10|FSC: 13; Default||Not reimbursed separately|1,409.10|FSC: 13; Default||External grouping not supported 95112469|EAP|Custom 95112469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 5mm Dilating Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192061|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Acell Pelvic Floor Matrix 7cm X 10cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,424.30|FSC: 13; Default||Not reimbursed separately|5,424.30|FSC: 13; Default||External grouping not supported 95112470|EAP|Custom 95112470||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Ear Shepard Grommet|1|HUMANA [1294]||HUMANA [11839]|49.20|FSC: 13; Default||Not reimbursed separately|49.20|FSC: 13; Default||External grouping not supported 95112473|EAP|HCPCS A7520||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 4.5 Ped|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking It 3.5 X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95112474|EAP|Custom 95112474||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tube Sheehy Without|1|HUMANA [1294]||HUMANA [11839]|46.80|FSC: 13; Default||Not reimbursed separately|46.80|FSC: 13; Default||External grouping not supported 95112475|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 130 Deg 4 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95188172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Ts Delta 12/14 40mm +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|FSC: 13; Default||Not reimbursed separately|8,736.00|FSC: 13; Default||External grouping not supported 95112476|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 130 Deg 5 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95112477|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Standard Dhs 130 Deg 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95185038|EAP|Custom 95185038||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Prevail 5 X 16 X 14mm|1|HUMANA [1294]||HUMANA [11839]|10,500.00|FSC: 13; Default||Not reimbursed separately|10,500.00|FSC: 13; Default||External grouping not supported 95112478|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 140 Deg 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95112479|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 140 Deg 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95112480|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 145 Deg 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95112481|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 145 Deg 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95185037|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Hi Torque .018 300cm 5/pk|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112482|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 150 Deg 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,895.31|FSC: 13; Default||Not reimbursed separately|1,895.31|FSC: 13; Default||External grouping not supported 95112483|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Short Barrel Dhs 150 Deg 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|FSC: 13; Default||Not reimbursed separately|936.00|FSC: 13; Default||External grouping not supported 95188170|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 14 Pta 3.0mm X 60mm X 150cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Bi-moore Modular 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|FSC: 13; Default||Not reimbursed separately|3,534.00|FSC: 13; Default||External grouping not supported 95185035|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent 12 X 60 X 75 Endoprosthesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.27|FSC: 13; Default||Not reimbursed separately|2,889.27|FSC: 13; Default||External grouping not supported 95112517|EAP|Custom 95112517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Aortic Root 12ga|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192068|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 2.5mm X 22mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|FSC: 13; Default||Not reimbursed separately|747.00|FSC: 13; Default||External grouping not supported 95112522|EAP|Custom 95112522||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Gt-1-st|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112525|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Pathfinder .018x450cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185039|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Proximal 12-hole Left Lateral|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.66|FSC: 13; Default||Not reimbursed separately|3,915.66|FSC: 13; Default||External grouping not supported 95112528|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wall Endoscopic 7.5fr 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|FSC: 13; Default||Not reimbursed separately|4,005.00|FSC: 13; Default||External grouping not supported 95112531|EAP|Custom 95112531||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 1mm Dlp Ima|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T-shape Lock 1.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.25|FSC: 13; Default||Not reimbursed separately|1,211.25|FSC: 13; Default||External grouping not supported 95112532|EAP|Custom 95112532||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 1.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112533|EAP|Custom 95112533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 1.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185036|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent 14 X 90 X 75 Endoprosthesis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,633.83|FSC: 13; Default||Not reimbursed separately|4,633.83|FSC: 13; Default||External grouping not supported 95112534|EAP|Custom 95112534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 1.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112537|EAP|Custom 95112537||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tape Retracto|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112538|EAP|Custom 95112538||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannula Arterial 18fr Perfusion.|1|HUMANA [1294]||HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95112539|EAP|Custom 95112539||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cannula Arterial 20fr. Perfusion|1|HUMANA [1294]||HUMANA [11839]|60.72|FSC: 13; Default||Not reimbursed separately|60.72|FSC: 13; Default||External grouping not supported 95185045|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 7mm X 15cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,270.00|FSC: 13; Default||Not reimbursed separately|12,270.00|FSC: 13; Default||External grouping not supported 95112540|EAP|Custom 95112540||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Perfusion 24fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112541|EAP|Custom 95112541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sump Cardiac|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188177|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 4.0mm X L26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95112543|EAP|Custom 95112543||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Venous Return 2-stage 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185040|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femoral Troc Left Wide|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,887.32|FSC: 13; Default||Not reimbursed separately|2,887.32|FSC: 13; Default||External grouping not supported 95112545|EAP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Dilation Xxlarg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112548|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Intraventional 8 French X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192069|EAP|HCPCS C1896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Electrode Defibrillator Emblem S-icd Subcutaneous|1|HUMANA [1294]||HUMANA [11839]|13,500.00|FSC: 13; Default||Not reimbursed separately|13,500.00|FSC: 13; Default||External grouping not supported 95112549|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-extender C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,075.00|FSC: 13; Default||Not reimbursed separately|6,075.00|FSC: 13; Default||External grouping not supported 95112554|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Aaa Iliac-limb 8.5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|FSC: 13; Default||Not reimbursed separately|6,675.00|FSC: 13; Default||External grouping not supported 95185041|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking It 3.5 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|FSC: 13; Default||Not reimbursed separately|286.77|FSC: 13; Default||External grouping not supported 95112556|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire .035 145cm 15j Curvete|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112557|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Amplatz Super Stiff .0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188176|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Cotton Wedge 6 X 24 X 14 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|FSC: 13; Default||Not reimbursed separately|4,290.00|FSC: 13; Default||External grouping not supported 95112558|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare 25mm Goose Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185043|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|FSC: 13; Default||Not reimbursed separately|63.30|FSC: 13; Default||External grouping not supported 95112564|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidecath 4 French X .038 Guidew|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112572|EAP|Custom 95112572||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Cell Saver High Speed Basic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112578|EAP|Custom 95112578||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Venous Return 46fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112580|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Woven-double Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|FSC: 13; Default||Not reimbursed separately|1,694.28|FSC: 13; Default||External grouping not supported 95185044|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Unicortical Ncb 5.0mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|FSC: 13; Default||Not reimbursed separately|425.19|FSC: 13; Default||External grouping not supported 95112581|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Woven-double Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|FSC: 13; Default||Not reimbursed separately|1,694.28|FSC: 13; Default||External grouping not supported 95112584|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Goose Neck Microsnare Amplat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Anchorage 3.5mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|FSC: 13; Default||Not reimbursed separately|978.00|FSC: 13; Default||External grouping not supported 95112585|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Goose Neck Microsnare Amplat|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112586|EAP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Snare 15mm Goose Neck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192070|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Surgical Restorelle Smartmesh Y Contour 24cm X 3cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|FSC: 13; Default||Not reimbursed separately|2,895.00|FSC: 13; Default||External grouping not supported 95112589|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Curved .035x50cm Ampl|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112590|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Stiff Shaft .0.18 Diam|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188173|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 12mm/130 Deg 400mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95112592|EAP|Custom 95112592||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Quick-pressure Monitor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112593|EAP|Custom 95112593||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Florester Coronary 12mm 3.50mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112595|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Bif. 12mmx6mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.00|FSC: 13; Default||Not reimbursed separately|2,793.00|FSC: 13; Default||External grouping not supported 95112596|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Woven-double Ve|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|FSC: 13; Default||Not reimbursed separately|1,694.28|FSC: 13; Default||External grouping not supported 80169730|EAP|Custom 80169730||0998 - STATISTICAL CHARGES|Hb Forensic Other|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112600|EAP|Custom 95112600||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Inner Disp Size-8 Use Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112602|EAP|Custom 95112602||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 14french Jejunostomy Mic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112607|EAP|Custom 95112607||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Wrench Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112608|EAP|HCPCS A7521||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hb Tube Tracheostomy Cuffed Non-fem|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185061|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patellofemoral Mck Restoris Sz 3 Lt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|FSC: 13; Default||Not reimbursed separately|15,884.40|FSC: 13; Default||External grouping not supported 95112613|EAP|Custom 95112613||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 19mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95112620|EAP|Custom 95112620||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic High Pressure Rotat|1|HUMANA [1294]||HUMANA [11839]|16,194.00|FSC: 13; Default||Not reimbursed separately|16,194.00|FSC: 13; Default||External grouping not supported 95112621|EAP|Custom 95112621||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 25mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95112622|EAP|Custom 95112622||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 27mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95185049|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Headless Compression 04.0mm / L48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95112623|EAP|Custom 95112623||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 29mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95112624|EAP|Custom 95112624||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 31mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95112626|EAP|Custom 95112626||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bag Endopouch Specimen- Retrieva|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112627|EAP|Custom 95112627||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemoshield Ro|1|HUMANA [1294]||HUMANA [11839]|17,034.00|FSC: 13; Default||Not reimbursed separately|17,034.00|FSC: 13; Default||External grouping not supported 95185062|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Patella Mck Restoris Sz 35 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|FSC: 13; Default||Not reimbursed separately|3,561.60|FSC: 13; Default||External grouping not supported 95112628|EAP|Custom 95112628||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemoshield Ro|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95112629|EAP|Custom 95112629||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemashiels Ro|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95112630|EAP|Custom 95112630||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Graft Hemashield Ro|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95185055|EAP|Custom 95185055||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Checkpoint Femoral/tibial (sterile)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112636|EAP|Custom 95112636||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Rotatable 27mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95185052|EAP|Custom 95185052||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Tracking Knee Vizadisc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112638|EAP|Custom 95112638||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic 29mm With Integral|1|HUMANA [1294]||HUMANA [11839]|12,585.00|FSC: 13; Default||Not reimbursed separately|12,585.00|FSC: 13; Default||External grouping not supported 95112639|EAP|Custom 95112639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic 31mm With Integral|1|HUMANA [1294]||HUMANA [11839]|12,585.00|FSC: 13; Default||Not reimbursed separately|12,585.00|FSC: 13; Default||External grouping not supported 95112640|EAP|Custom 95112640||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic-periocardial Sz.19m|1|HUMANA [1294]||HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95112641|EAP|Custom 95112641||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic-periocardial Sz.23m|1|HUMANA [1294]||HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95185056|EAP|Custom 95185056||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Ball Fluted Anspach 6 Mm (lhd-6b-m)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112642|EAP|Custom 95112642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Rotatable 25mm|1|HUMANA [1294]||HUMANA [11839]|15,543.00|FSC: 13; Default||Not reimbursed separately|15,543.00|FSC: 13; Default||External grouping not supported 95112643|EAP|Custom 95112643||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Rotatable 31mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95112644|EAP|Custom 95112644||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral Rotatable 33mm|1|HUMANA [1294]||HUMANA [11839]|15,855.00|FSC: 13; Default||Not reimbursed separately|15,855.00|FSC: 13; Default||External grouping not supported 95112646|EAP|Custom 95112646||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic 21mm W Ith Integral|1|HUMANA [1294]||HUMANA [11839]|12,585.00|FSC: 13; Default||Not reimbursed separately|12,585.00|FSC: 13; Default||External grouping not supported 95185057|EAP|Custom 95185057||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Irrigation Emax 2 Anspach (irr-clip-40)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112647|EAP|Custom 95112647||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic 23mm With Integral|1|HUMANA [1294]||HUMANA [11839]|12,585.00|FSC: 13; Default||Not reimbursed separately|12,585.00|FSC: 13; Default||External grouping not supported 95112648|EAP|Custom 95112648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Mitral 25mm With Integral|1|HUMANA [1294]||HUMANA [11839]|14,085.00|FSC: 13; Default||Not reimbursed separately|14,085.00|FSC: 13; Default||External grouping not supported 95112659|EAP|Custom 95112659||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic High Pressure Rotat|1|HUMANA [1294]||HUMANA [11839]|16,194.00|FSC: 13; Default||Not reimbursed separately|16,194.00|FSC: 13; Default||External grouping not supported 95112660|EAP|Custom 95112660||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic High Pressure Rotat|1|HUMANA [1294]||HUMANA [11839]|15,876.00|FSC: 13; Default||Not reimbursed separately|15,876.00|FSC: 13; Default||External grouping not supported 95185054|EAP|Custom 95185054||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin 4 X 140mm Sterile (2-pk)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112661|EAP|Custom 95112661||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Rotatable 23mm|1|HUMANA [1294]||HUMANA [11839]|15,543.00|FSC: 13; Default||Not reimbursed separately|15,543.00|FSC: 13; Default||External grouping not supported 95112665|EAP|Custom 95112665||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing 1/2 Inch X 3/32 Inch X 8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112668|EAP|Custom 95112668||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Set Cricothyrotomy Melker Emerge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112669|EAP|Custom 95112669||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Lma-fastrach Sz 4 Inclu:554|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185059|EAP|Custom 95185059||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Irrigation Flow High Anspach|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112672|EAP|Custom 95112672||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Fluid Warmer Level I|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112674|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Glidewire Stiff Shaft .035 Diame|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112675|EAP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Steerocath-t Temperatue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112683|EAP|Custom 95112683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tube Arthroscopy|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192071|EAP|Custom 95192071||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Brigade 14x34x24mm 12 Degree|1|HUMANA [1294]||HUMANA [11839]|23,625.00|FSC: 13; Default||Not reimbursed separately|23,625.00|FSC: 13; Default||External grouping not supported 95112687|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 8cfn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112688|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 10cfs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112696|EAP|Custom 95112696||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Dermacarriers Graft Skin 16 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112697|EAP|Custom 95112697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Punct Lumbar Pedi 21ga X 22|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112699|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 4.8 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95112705|EAP|Custom 95112705||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Stethoscope Esophageal Pacing|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185069|EAP|Custom 95185069||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiberlink|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112715|EAP|Custom 95112715||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Gia 60|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112719|EAP|Custom 95112719||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Catheter Iv Angiocath 12 Gauge X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112740|EAP|Custom 95112740||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler M-11.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185065|EAP|Custom 95185065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Pin 4 X 80mm Sterile (2-pk)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112743|EAP|Custom 95112743||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Curved 6980|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112744|EAP|Custom 95112744||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Retrograde Flat 6086|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192072|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 1.5 13mm X 40cm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95112796|EAP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Lead Resume-ii C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,788.00|FSC: 13; Default||Not reimbursed separately|4,788.00|FSC: 13; Default||External grouping not supported 95112797|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension Itrel-ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95185068|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Mck Restoris Sz 5 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|FSC: 13; Default||Not reimbursed separately|8,790.60|FSC: 13; Default||External grouping not supported 95112798|EAP|Custom 95112798||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Dual-4 Extension Bifurcated|1|HUMANA [1294]||HUMANA [11839]|2,985.00|FSC: 13; Default||Not reimbursed separately|2,985.00|FSC: 13; Default||External grouping not supported 95112799|EAP|Custom 95112799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Wrench/screw|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112800|EAP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Generator Itrel-ii|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,550.00|FSC: 13; Default||Not reimbursed separately|20,550.00|FSC: 13; Default||External grouping not supported 95112801|EAP|Custom 95112801||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Transmitter Mattrix|1|HUMANA [1294]||HUMANA [11839]|14,070.00|FSC: 13; Default||Not reimbursed separately|14,070.00|FSC: 13; Default||External grouping not supported 95185070|EAP|Custom 95185070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit 2.8mm X 5 In|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112802|EAP|Custom 95112802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112803|EAP|Custom 95112803||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cable Single W/intergral-crimp|1|HUMANA [1294]||HUMANA [11839]|1,675.80|FSC: 13; Default||Not reimbursed separately|1,675.80|FSC: 13; Default||External grouping not supported 95112810|EAP|Custom 95112810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112811|EAP|Custom 95112811||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Aneurysm Temporary Standard|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185066|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Onlaymck Restoris 6 X 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|FSC: 13; Default||Not reimbursed separately|2,536.80|FSC: 13; Default||External grouping not supported 95112813|EAP|Custom 95112813||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Aesculap|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112815|EAP|Custom 95112815||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool M-8 Dissecting Midas Rex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112818|EAP|Custom 95112818||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Dissecting M-3 Midas Rex|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112822|EAP|Custom 95112822||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd Shnk.70mm Sz.2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185067|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Onlay Mck Restoris Sz 6 Rm/ll|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|FSC: 13; Default||Not reimbursed separately|5,197.50|FSC: 13; Default||External grouping not supported 95112823|EAP|Custom 95112823||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd.shnk.70mm Sz.4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112824|EAP|Custom 95112824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Diamond Rnd Shnk 70mm 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112830|EAP|Custom 95112830||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reservoir Cardiotomy Filtered 20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192073|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Fenestrated Proximal Custom 34x107mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,250.00|FSC: 13; Default||Not reimbursed separately|26,250.00|FSC: 13; Default||External grouping not supported 95112832|EAP|Custom 95112832||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Disp.micro-sagittal 5.5 Xm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112835|EAP|HCPCS A5073||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Pouch Urostomy 1-3/4 Natura|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112840|EAP|Custom 95112840||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Handle Universal Endo Gia 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112884|EAP|Custom 95112884||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Urinometer|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185073|EAP|Custom 95185073||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Laparosconic Introducer Mickey G 18f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112885|EAP|Custom 95112885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Venous Dual-drainage Ope|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112904|EAP|Custom 95112904||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Karlin 1.5mm Ultra-tip Dis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112905|EAP|Custom 95112905||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Prolene 8-0 24 Bv130-5 M|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112911|EAP|Custom 95112911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Saw Sagittal 4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185077|EAP|Custom 95185077||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Echo Bright Regional Block 20 Ga X 100mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112928|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretch Straight Gore-tex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95112929|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Soft-tissue 26cmx34cmx1.0m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,074.00|FSC: 13; Default||Not reimbursed separately|7,074.00|FSC: 13; Default||External grouping not supported 95192074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ti-6al-4v Full Thread Cancellous Fixangle6.0x60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95112932|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretch Straight Gore-tex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95112934|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Bif. 18mmx9mm Str|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.00|FSC: 13; Default||Not reimbursed separately|2,793.00|FSC: 13; Default||External grouping not supported 95185075|EAP|Custom 95185075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Coupling Pin To Rod Hoffman 4/5/6mmx5/8/11mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112935|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretch Straight Gore-tex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95112936|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stretch Straight Gore-tex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|FSC: 13; Default||Not reimbursed separately|1,290.00|FSC: 13; Default||External grouping not supported 95112937|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Vascular Hybrid Ptfe Dia6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|FSC: 13; Default||Not reimbursed separately|1,560.00|FSC: 13; Default||External grouping not supported 95112939|EAP|Custom 95112939||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lumber Edm Barium Impre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185074|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Hammertoe 4.5mm Middle Phalanx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95112941|EAP|Custom 95112941||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Evergrip 61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112943|EAP|Custom 95112943||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Accessory Pacing Adaptor Kit For|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112947|EAP|Custom 95112947||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Angioscope Disposable 4.5fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112948|EAP|Custom 95112948||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reservoir Jackson-pratt 400ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Apex 5x250 50 Thread|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95112950|EAP|Custom 95112950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Schulte Heyer 3 X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112954|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Corkscrew Adherent Clot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188182|EAP|Custom 95188182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula 200m 20g 10.0mm 10/pk|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112955|EAP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Corkscrew Adherent Clot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 80168636|EAP|CPT® 82810||0301 - LABORATORY - CHEMISTRY|Hb Oh Poc O2 Saturation|1|HUMANA [1294]||HUMANA [11839]|29.31|FSC: 13; Default||Not reimbursed separately|29.31|FSC: 13; Default||External grouping not supported 95112987|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Femoral Threaded 3.2mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95112997|EAP|Custom 95112997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Insert Evergrip 86mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192075|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Ti6al4v Femoral Retrograde 13mm X 38cm Bevel Tip Purple|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,031.68|FSC: 13; Default||Not reimbursed separately|6,031.68|FSC: 13; Default||External grouping not supported 95112998|EAP|Custom 95112998||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Lindemann Sm.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95112999|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 6cfn|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064001|EAP|CPT® 86701||0302 - LABORATORY - IMMUNOLOGY|Hb Hiv 1 - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.67|FSC: 13; Default||Not reimbursed separately|26.67|FSC: 13; Default||External grouping not supported 95113002|EAP|Custom 95113002||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pouch Tissue Lap Sac 8 X 10|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113003|EAP|Custom 95113003||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Straight 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188189|EAP|Custom 95188189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Drill Measuring 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113010|EAP|Custom 95113010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Balloon Uterine [gyneca|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113025|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin Threaded-tip 2.4mmx305m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.17|FSC: 13; Default||Not reimbursed separately|250.17|FSC: 13; Default||External grouping not supported 62064019|EAP|CPT® 86702||0302 - LABORATORY - IMMUNOLOGY|Hb Hiv 2 - Ref Lab|1|HUMANA [1294]||HUMANA [11839]|40.56|FSC: 13; Default||Not reimbursed separately|40.56|FSC: 13; Default||External grouping not supported 95113064|EAP|Custom 95113064||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guiderod Straight Spade-tip 3.2m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113065|EAP|Custom 95113065||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guiderod Straight 4.0mmx900mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064027|EAP|CPT® 36416||0300 - LABORATORY - GENERAL CLASSIFICATION|Hb-capillary Blood Collection|1|HUMANA [1294]||HUMANA [11839]|10.50|FSC: 13; Default||Not reimbursed separately|10.50|FSC: 13; Default||External grouping not supported 95113067|EAP|Custom 95113067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guiderod Curved Ball-tip 3.2mmx9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113068|EAP|Custom 95113068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2.5 Calcaneal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Augment Distal Femoral Triathlon Sz 2 15mm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|FSC: 13; Default||Not reimbursed separately|4,546.50|FSC: 13; Default||External grouping not supported 95113069|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Im Hs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.65|FSC: 13; Default||Not reimbursed separately|223.65|FSC: 13; Default||External grouping not supported 95113070|EAP|Custom 95113070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Im Hs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064035|EAP|CPT® 81050||0307 - LABORATORY - UROLOGY|Hb-volume Measurement-timed|1|HUMANA [1294]||HUMANA [11839]|10.92|FSC: 13; Default||Not reimbursed separately|10.92|FSC: 13; Default||External grouping not supported 95113071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Im Hs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,663.00|FSC: 13; Default||Not reimbursed separately|3,663.00|FSC: 13; Default||External grouping not supported 95113097|EAP|Custom 95113097||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide 2.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192076|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ti-6al-4v Full Thread Cancellous Fixangle6.0x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95113099|EAP|Custom 95113099||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nut Lock Stable|1|HUMANA [1294]||HUMANA [11839]|321.00|FSC: 13; Default||Not reimbursed separately|321.00|FSC: 13; Default||External grouping not supported 95113112|EAP|Custom 95113112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Shortcut 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 62064043|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hb Infectious Agent, Qnt - Ref Lab|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.97|FSC: 13; Default||Not reimbursed separately|44.97|FSC: 13; Default||External grouping not supported 95113113|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shunt Glucoma Baerveldt|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95113143|EAP|Custom 95113143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 5.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188191|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Persona Cr Fixed Right 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95113144|EAP|Custom 95113144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 8.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113145|EAP|Custom 95113145||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Meridional 12mm X 12mm C|1|HUMANA [1294]||HUMANA [11839]|66.00|FSC: 13; Default||Not reimbursed separately|66.00|FSC: 13; Default||External grouping not supported 62064050|EAP|CPT® 88344||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hb Immunohistochem Stain, Multiplex|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95113147|EAP|Custom 95113147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 7.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113148|EAP|Custom 95113148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 11.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113149|EAP|Custom 95113149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 9.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113150|EAP|Custom 95113150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 10.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188190|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Hooded 10 Degree 32mm /d|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|FSC: 13; Default||Not reimbursed separately|3,546.90|FSC: 13; Default||External grouping not supported 95113169|EAP|Custom 95113169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 5.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113171|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Coronary 3.0mm Diameter X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|FSC: 13; Default||Not reimbursed separately|4,950.00|FSC: 13; Default||External grouping not supported 95192077|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Ti-6al-4v Full Thread Cancellous Fixangle6.0x70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|FSC: 13; Default||Not reimbursed separately|573.51|FSC: 13; Default||External grouping not supported 95113173|EAP|Custom 95113173||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tutoplast 1.5cm Paracardium L861|1|HUMANA [1294]||HUMANA [11839]|870.00|FSC: 13; Default||Not reimbursed separately|870.00|FSC: 13; Default||External grouping not supported 95113178|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95188184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95113179|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95113180|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113181|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95188181|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Meniscal Repair Truespan 24 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95113182|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113183|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113184|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95113185|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95188179|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Meniscal Repair Truespan 0 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|FSC: 13; Default||Not reimbursed separately|1,125.00|FSC: 13; Default||External grouping not supported 95113186|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95113187|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113188|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113189|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113190|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95113191|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95185086|EAP|Custom 95185086||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113192|EAP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Ahmed C1783|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|FSC: 13; Default||Not reimbursed separately|1,725.00|FSC: 13; Default||External grouping not supported 95113197|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95188180|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Meniscal Repair Truespan 12 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,158.00|FSC: 13; Default||Not reimbursed separately|1,158.00|FSC: 13; Default||External grouping not supported 95113198|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113199|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95185071|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lateral Distal 3 Hole Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|FSC: 13; Default||Not reimbursed separately|3,262.50|FSC: 13; Default||External grouping not supported 95113200|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95113201|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95192080|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lcp Proximal Humerus Long 268x12x3.7mm 12 Hole 3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.45|FSC: 13; Default||Not reimbursed separately|5,964.45|FSC: 13; Default||External grouping not supported 95113202|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113203|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95185087|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Viabahn 8mm X 15cm X 120cm W/radiopaque Mark|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,270.00|FSC: 13; Default||Not reimbursed separately|12,270.00|FSC: 13; Default||External grouping not supported 95113204|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|FSC: 13; Default||Not reimbursed separately|376.59|FSC: 13; Default||External grouping not supported 95113205|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95188187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Canc. Locking 4.0mmx46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95113206|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95113207|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|FSC: 13; Default||Not reimbursed separately|301.59|FSC: 13; Default||External grouping not supported 95185085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock 2.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95113208|EAP|Custom 95113208||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Eye|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.7mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.83|FSC: 13; Default||Not reimbursed separately|106.83|FSC: 13; Default||External grouping not supported 95113210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95185082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Gryphon Br With Proknot|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95113212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 80mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95188185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5x30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95113214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Self-tapping 90mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113215|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|FSC: 13; Default||Not reimbursed separately|54.99|FSC: 13; Default||External grouping not supported 95185083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight Met Less 6- Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,241.00|FSC: 13; Default||Not reimbursed separately|2,241.00|FSC: 13; Default||External grouping not supported 95113216|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 16mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.10|FSC: 13; Default||Not reimbursed separately|56.10|FSC: 13; Default||External grouping not supported 95113217|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 18mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.68|FSC: 13; Default||Not reimbursed separately|55.68|FSC: 13; Default||External grouping not supported 95192081|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 22mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95113218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 20mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.68|FSC: 13; Default||Not reimbursed separately|55.68|FSC: 13; Default||External grouping not supported 95113219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 22mm 6mm Thr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.25|FSC: 13; Default||Not reimbursed separately|59.25|FSC: 13; Default||External grouping not supported 95185084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lock 2.4 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113220|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 24mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.45|FSC: 13; Default||Not reimbursed separately|63.45|FSC: 13; Default||External grouping not supported 95113221|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 26mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.94|FSC: 13; Default||Not reimbursed separately|47.94|FSC: 13; Default||External grouping not supported 95188186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Canc Lock 4.0mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95113222|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 28mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.75|FSC: 13; Default||Not reimbursed separately|30.75|FSC: 13; Default||External grouping not supported 95113223|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 30mm 10mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.75|FSC: 13; Default||Not reimbursed separately|30.75|FSC: 13; Default||External grouping not supported 62064068|EAP|CPT® 88346||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Imfluor Std Ea Antb Dir Meth-ref Lab|1|HUMANA [1294]||HUMANA [11839]|807.57|FSC: 13; Default||Not reimbursed separately|807.57|FSC: 13; Default||External grouping not supported 95113224|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 32mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.94|FSC: 13; Default||Not reimbursed separately|47.94|FSC: 13; Default||External grouping not supported 95113225|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 34mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.00|FSC: 13; Default||Not reimbursed separately|33.00|FSC: 13; Default||External grouping not supported 95113226|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 36mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.00|FSC: 13; Default||Not reimbursed separately|33.00|FSC: 13; Default||External grouping not supported 95113227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shaft 3.5mm X 38mm 12mm Th|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.50|FSC: 13; Default||Not reimbursed separately|58.50|FSC: 13; Default||External grouping not supported 62064076|EAP|CPT® 88348||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hb Electron Microscopy-um|1|HUMANA [1294]||HUMANA [11839]|1,790.07|FSC: 13; Default||Not reimbursed separately|1,790.07|FSC: 13; Default||External grouping not supported 95113228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 10mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 12mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|FSC: 13; Default||Not reimbursed separately|67.02|FSC: 13; Default||External grouping not supported 95188188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Canc Locking 4.0mmx50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95113230|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113232|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 18mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.30|FSC: 13; Default||Not reimbursed separately|42.30|FSC: 13; Default||External grouping not supported 95192082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated 4.0mm X 26mm Short Thread Headless|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95113234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113235|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95188195|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Uni Lm/rl Sz E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95113236|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113237|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 28mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95185091|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Intererence Milagro 6x12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,329.00|FSC: 13; Default||Not reimbursed separately|1,329.00|FSC: 13; Default||External grouping not supported 95113238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 30mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113239|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 32mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113240|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 34mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113241|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 36mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95185099|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-lock 2.0 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|FSC: 13; Default||Not reimbursed separately|435.00|FSC: 13; Default||External grouping not supported 95113242|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 38mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113243|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 40mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95188207|EAP|Custom 95188207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Ucl Suture Passing Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113244|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 45mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.03|FSC: 13; Default||Not reimbursed separately|69.03|FSC: 13; Default||External grouping not supported 95113245|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 3.5mm X 50mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|FSC: 13; Default||Not reimbursed separately|67.02|FSC: 13; Default||External grouping not supported 95185107|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95192084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95113248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95185103|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 20mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95188194|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Base Tibial Sm/rl Sz 4 Uni|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95113252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 22mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 24mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95185110|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 26mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 28mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 30mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 35mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95185113|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113258|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 45mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95188199|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.5 Mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 55mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95113261|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.64|FSC: 13; Default||Not reimbursed separately|56.64|FSC: 13; Default||External grouping not supported 95185111|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113262|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 10mm 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|FSC: 13; Default||Not reimbursed separately|52.14|FSC: 13; Default||External grouping not supported 95113263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 12mm 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95192085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 2.7mm X 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95113264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 14mm 5m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95113265|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 16mm 6m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95185100|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113266|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 18mm 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95113267|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 20mm 8m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|FSC: 13; Default||Not reimbursed separately|52.14|FSC: 13; Default||External grouping not supported 95113268|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Cancellous Partially-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95113269|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 24mm 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95185106|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113270|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 26mm 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95113271|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 28mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95188212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113272|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 30mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95113273|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 35mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|FSC: 13; Default||Not reimbursed separately|52.14|FSC: 13; Default||External grouping not supported 95185114|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 40mm 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.63|FSC: 13; Default||Not reimbursed separately|51.63|FSC: 13; Default||External grouping not supported 95113275|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 45mm 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95192086|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95113276|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0mm X 50mm 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.70|FSC: 13; Default||Not reimbursed separately|53.70|FSC: 13; Default||External grouping not supported 95113277|EAP|Custom 95113277||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer 7mm|1|HUMANA [1294]||HUMANA [11839]|91.92|FSC: 13; Default||Not reimbursed separately|91.92|FSC: 13; Default||External grouping not supported 95185109|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113278|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 3.5mm 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.60|FSC: 13; Default||Not reimbursed separately|438.60|FSC: 13; Default||External grouping not supported 95113279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 3.5mm 7hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.85|FSC: 13; Default||Not reimbursed separately|473.85|FSC: 13; Default||External grouping not supported 95188215|EAP|Custom 95188215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Adhesive Tissue High Viscosity Exofin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 3.5mm 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.85|FSC: 13; Default||Not reimbursed separately|476.85|FSC: 13; Default||External grouping not supported 95113281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 3.5mm 9hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|451.20|FSC: 13; Default||Not reimbursed separately|451.20|FSC: 13; Default||External grouping not supported 95185101|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lc Dcp 3.5mm 10hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|FSC: 13; Default||Not reimbursed separately|510.00|FSC: 13; Default||External grouping not supported 95113283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm X 50mm 3 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|344.04|FSC: 13; Default||Not reimbursed separately|344.04|FSC: 13; Default||External grouping not supported 95113284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3.5mm X 67mm 4 Hole Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.98|FSC: 13; Default||Not reimbursed separately|391.98|FSC: 13; Default||External grouping not supported 95113285|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Oblique T 3 Hole Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|589.38|FSC: 13; Default||Not reimbursed separately|589.38|FSC: 13; Default||External grouping not supported 95185095|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Oblique T 4 Hole Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|742.50|FSC: 13; Default||Not reimbursed separately|742.50|FSC: 13; Default||External grouping not supported 95113287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Oblique T 5 Hole Small|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|742.50|FSC: 13; Default||Not reimbursed separately|742.50|FSC: 13; Default||External grouping not supported 95188204|EAP|Custom 95188204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Rosen Blunt Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113288|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 25mm 2 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|187.65|FSC: 13; Default||Not reimbursed separately|187.65|FSC: 13; Default||External grouping not supported 95113289|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 37mm 3 Hole Wi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.36|FSC: 13; Default||Not reimbursed separately|192.36|FSC: 13; Default||External grouping not supported 95185104|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113290|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 5hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.18|FSC: 13; Default||Not reimbursed separately|210.18|FSC: 13; Default||External grouping not supported 95113291|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 6hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|218.70|FSC: 13; Default||Not reimbursed separately|218.70|FSC: 13; Default||External grouping not supported 95192087|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95113292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 7hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|FSC: 13; Default||Not reimbursed separately|228.00|FSC: 13; Default||External grouping not supported 95113293|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular One-third 8hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.09|FSC: 13; Default||Not reimbursed separately|243.09|FSC: 13; Default||External grouping not supported 95185096|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113294|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tubular 1/3 121mm 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.09|FSC: 13; Default||Not reimbursed separately|243.09|FSC: 13; Default||External grouping not supported 95113295|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal 60mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,666.38|FSC: 13; Default||Not reimbursed separately|1,666.38|FSC: 13; Default||External grouping not supported 95113296|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Calcaneal 70mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,706.43|FSC: 13; Default||Not reimbursed separately|1,706.43|FSC: 13; Default||External grouping not supported 95113297|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Calcaneal 87mm Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,706.43|FSC: 13; Default||Not reimbursed separately|1,706.43|FSC: 13; Default||External grouping not supported 95185112|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113298|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Cloverleaf 88mm 3 Hole Thi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|FSC: 13; Default||Not reimbursed separately|543.00|FSC: 13; Default||External grouping not supported 95113300|EAP|Custom 95113300||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 5.0mm W/central Hea|1|HUMANA [1294]||HUMANA [11839]|467.37|FSC: 13; Default||Not reimbursed separately|467.37|FSC: 13; Default||External grouping not supported 95188208|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113301|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 4.0mm 3.0mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.89|FSC: 13; Default||Not reimbursed separately|280.89|FSC: 13; Default||External grouping not supported 95113302|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 5.0mm X 150mm Blunt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.18|FSC: 13; Default||Not reimbursed separately|309.18|FSC: 13; Default||External grouping not supported 95185094|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Schanz 5.0mm X 170mm Blunt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.74|FSC: 13; Default||Not reimbursed separately|358.74|FSC: 13; Default||External grouping not supported 95113304|EAP|Custom 95113304||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Schanz 5mm|1|HUMANA [1294]||HUMANA [11839]|358.74|FSC: 13; Default||Not reimbursed separately|358.74|FSC: 13; Default||External grouping not supported 95192088|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Plate R3con 3.5 X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95113305|EAP|Custom 95113305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Tube-to-tube|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113307|EAP|Custom 95113307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Ring/rod|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185105|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113308|EAP|Custom 95113308||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Wire Pin|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|788.31|FSC: 13; Default||Not reimbursed separately|788.31|FSC: 13; Default||External grouping not supported 95188211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 150mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|788.31|FSC: 13; Default||Not reimbursed separately|788.31|FSC: 13; Default||External grouping not supported 95113311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 250mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.35|FSC: 13; Default||Not reimbursed separately|847.35|FSC: 13; Default||External grouping not supported 95185102|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.35|FSC: 13; Default||Not reimbursed separately|847.35|FSC: 13; Default||External grouping not supported 95113313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Carbon Fiber 11.0mm X 350mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.35|FSC: 13; Default||Not reimbursed separately|847.35|FSC: 13; Default||External grouping not supported 95113315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 84mm 4 Hole Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|FSC: 13; Default||Not reimbursed separately|405.00|FSC: 13; Default||External grouping not supported 95113316|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 116mm 6 Hole Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95185093|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 148mm 8 Hole Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|FSC: 13; Default||Not reimbursed separately|744.00|FSC: 13; Default||External grouping not supported 95113318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Buttress Angled Left 4 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|679.68|FSC: 13; Default||Not reimbursed separately|679.68|FSC: 13; Default||External grouping not supported 95188198|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 3.0 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 10 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.00|FSC: 13; Default||Not reimbursed separately|804.00|FSC: 13; Default||External grouping not supported 95113320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 11 Ho|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|FSC: 13; Default||Not reimbursed separately|819.00|FSC: 13; Default||External grouping not supported 95185097|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 5 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|FSC: 13; Default||Not reimbursed separately|729.00|FSC: 13; Default||External grouping not supported 95113322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 6 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|FSC: 13; Default||Not reimbursed separately|843.00|FSC: 13; Default||External grouping not supported 95192090|EAP|Custom 95192090||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Bone Intergro Demineralized Bone Matrix 5 Cc Paste|1|HUMANA [1294]||HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95113323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Reconstruction 3.5mm 7 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.00|FSC: 13; Default||Not reimbursed separately|723.00|FSC: 13; Default||External grouping not supported 95113326|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Finger Joint Size 6 Sila|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|FSC: 13; Default||Not reimbursed separately|1,305.00|FSC: 13; Default||External grouping not supported 95185108|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Herbert Scaphoid 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|FSC: 13; Default||Not reimbursed separately|810.84|FSC: 13; Default||External grouping not supported 95113328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert 20mm Scaphoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|FSC: 13; Default||Not reimbursed separately|810.84|FSC: 13; Default||External grouping not supported 95188201|EAP|Custom 95188201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shears Coagulating Ace+7 Harmonic Tech Adaptive 36cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113329|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert 22mm Scaphoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|FSC: 13; Default||Not reimbursed separately|810.84|FSC: 13; Default||External grouping not supported 95113330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert 24mm Scaphoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|FSC: 13; Default||Not reimbursed separately|810.84|FSC: 13; Default||External grouping not supported 95185098|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Acrysof Restor 2.5 Apodized|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Herbert 30mm Scaphoid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|FSC: 13; Default||Not reimbursed separately|810.84|FSC: 13; Default||External grouping not supported 95113332|EAP|Custom 95113332||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wristjacket Agee|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113333|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Vsp Bone 7.0mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.00|FSC: 13; Default||Not reimbursed separately|942.00|FSC: 13; Default||External grouping not supported 95113335|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Closed 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,145.00|FSC: 13; Default||Not reimbursed separately|2,145.00|FSC: 13; Default||External grouping not supported 95185090|EAP|Custom 95185090||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Condyle Hemi Femoral Medial Right 70 X 26|1|HUMANA [1294]||HUMANA [11839]|32,985.00|FSC: 13; Default||Not reimbursed separately|32,985.00|FSC: 13; Default||External grouping not supported 95113336|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Coupler 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|FSC: 13; Default||Not reimbursed separately|2,235.00|FSC: 13; Default||External grouping not supported 95188202|EAP|Custom 95188202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Instrument Retractor Paddle Endo 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192092|EAP|Custom 95192092||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Lens Device Fragmentation Miloop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113344|EAP|Custom 95113344||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Miller Abbott 16|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188205|EAP|Custom 95188205||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Rosen Sharp Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113346|EAP|Custom 95113346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Lindemann Lge.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113347|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 100 Degree Left Medium 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95185115|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Ti Narrow Right 3hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95113348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Right Long Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95113351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/ 1.8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.80|FSC: 13; Default||Not reimbursed separately|247.80|FSC: 13; Default||External grouping not supported 95185116|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm X 10mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|FSC: 13; Default||Not reimbursed separately|255.00|FSC: 13; Default||External grouping not supported 95113353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 100 Degree Right Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95188206|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 6-hole Reg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|FSC: 13; Default||Not reimbursed separately|537.00|FSC: 13; Default||External grouping not supported 95113355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L Left Long Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|FSC: 13; Default||Not reimbursed separately|303.00|FSC: 13; Default||External grouping not supported 95185117|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Volar Distal Radius Ti Std. Right 3 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|FSC: 13; Default||Not reimbursed separately|2,385.00|FSC: 13; Default||External grouping not supported 95113356|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Double Regular Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95113357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Regular Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|FSC: 13; Default||Not reimbursed separately|384.00|FSC: 13; Default||External grouping not supported 95192093|EAP|Custom 95192093||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Zepto Surgical Single Use Hand Held Device|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/5.0mm(5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|FSC: 13; Default||Not reimbursed separately|126.00|FSC: 13; Default||External grouping not supported 95113359|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/4.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.80|FSC: 13; Default||Not reimbursed separately|247.80|FSC: 13; Default||External grouping not supported 95188209|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113360|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/3.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.80|FSC: 13; Default||Not reimbursed separately|109.80|FSC: 13; Default||External grouping not supported 95113361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/6.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.80|FSC: 13; Default||Not reimbursed separately|118.80|FSC: 13; Default||External grouping not supported 95113362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.60|FSC: 13; Default||Not reimbursed separately|105.60|FSC: 13; Default||External grouping not supported 95113363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.40|FSC: 13; Default||Not reimbursed separately|92.40|FSC: 13; Default||External grouping not supported 95188197|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.5 Mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|FSC: 13; Default||Not reimbursed separately|397.20|FSC: 13; Default||External grouping not supported 95113366|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 0.6mm 4 Hole Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|FSC: 13; Default||Not reimbursed separately|825.00|FSC: 13; Default||External grouping not supported 95113367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.80|FSC: 13; Default||Not reimbursed separately|163.80|FSC: 13; Default||External grouping not supported 95113368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|FSC: 13; Default||Not reimbursed separately|397.20|FSC: 13; Default||External grouping not supported 95188210|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|FSC: 13; Default||Not reimbursed separately|885.00|FSC: 13; Default||External grouping not supported 95113369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|FSC: 13; Default||Not reimbursed separately|138.00|FSC: 13; Default||External grouping not supported 95113370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.00|FSC: 13; Default||Not reimbursed separately|129.00|FSC: 13; Default||External grouping not supported 95113371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|FSC: 13; Default||Not reimbursed separately|397.20|FSC: 13; Default||External grouping not supported 95113372|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.80|FSC: 13; Default||Not reimbursed separately|157.80|FSC: 13; Default||External grouping not supported 95113373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 0.6mm Right Long Titaniu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95113374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L 0.6mm Left Long Itianium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|FSC: 13; Default||Not reimbursed separately|699.00|FSC: 13; Default||External grouping not supported 95113375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Double 0.6mm Regular Tit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|FSC: 13; Default||Not reimbursed separately|918.00|FSC: 13; Default||External grouping not supported 95113376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 40mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95188213|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 2.7mmxl48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113381|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95185123|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Magnum 2 Plus White|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,555.00|FSC: 13; Default||Not reimbursed separately|3,555.00|FSC: 13; Default||External grouping not supported 95113383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 75mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95185124|EAP|Custom 95185124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Ultrabraid 2 White 38 Length Single|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 65mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95188214|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mm X L44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95113389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 70mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 75mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95185132|EAP|Custom 95185132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Slit Cataract Safety Beaver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113391|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 80mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|FSC: 13; Default||Not reimbursed separately|111.15|FSC: 13; Default||External grouping not supported 95113393|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 30mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 35mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95185128|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Locking 2.4x20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|FSC: 13; Default||Not reimbursed separately|375.00|FSC: 13; Default||External grouping not supported 95113395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 85mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95113396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 90mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|FSC: 13; Default||Not reimbursed separately|111.15|FSC: 13; Default||External grouping not supported 95188200|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 4.0 Mm X 20 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95113398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|FSC: 13; Default||Not reimbursed separately|111.15|FSC: 13; Default||External grouping not supported 95185137|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Kit Long R 1.5 Titanium Rt. 13x420mmx125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95113399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95113400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|FSC: 13; Default||Not reimbursed separately|111.15|FSC: 13; Default||External grouping not supported 95113401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 95mm 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95185135|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile T 2.4mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95113403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 100mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|FSC: 13; Default||Not reimbursed separately|111.15|FSC: 13; Default||External grouping not supported 95113404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 105mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.48|FSC: 13; Default||Not reimbursed separately|114.48|FSC: 13; Default||External grouping not supported 95188193|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Tibial Persona Fix Bear Uc Rt 14mm-c-d/3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95113405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 110mm 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|FSC: 13; Default||Not reimbursed separately|111.15|FSC: 13; Default||External grouping not supported 95113406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 55mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95185131|EAP|Custom 95185131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Sideport Cataract Safety Beaver|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 60mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95113409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95113410|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95113411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.30|FSC: 13; Default||Not reimbursed separately|537.30|FSC: 13; Default||External grouping not supported 95185130|EAP|Custom 95185130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Presutured Ankle Tendon|1|HUMANA [1294]||HUMANA [11839]|3,795.00|FSC: 13; Default||Not reimbursed separately|3,795.00|FSC: 13; Default||External grouping not supported 95113412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 7 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.00|FSC: 13; Default||Not reimbursed separately|306.00|FSC: 13; Default||External grouping not supported 95188196|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Dilatation Nc Trek 2.0 Mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 25mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95185136|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Neck Femoral Modular Kinectiv 12/14 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95113414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 35mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 95113415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 40mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95185127|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Lateral Proximal Left 4-hole/l99mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,127.00|FSC: 13; Default||Not reimbursed separately|8,127.00|FSC: 13; Default||External grouping not supported 95113416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 45mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.20|FSC: 13; Default||Not reimbursed separately|106.20|FSC: 13; Default||External grouping not supported 80169715|EAP|Custom 80169715||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb Spine Center Prp|1|HUMANA [1294]||HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95113417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 50mm Fu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|FSC: 13; Default||Not reimbursed separately|103.11|FSC: 13; Default||External grouping not supported 95185125|EAP|Custom 95185125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Probe V Endocare|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 4 Hole Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.58|FSC: 13; Default||Not reimbursed separately|179.58|FSC: 13; Default||External grouping not supported 95192078|EAP|Custom 95192078||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Endoprosthesis Excluder Trunk 26mm X 14.5mm X 12cm|1|HUMANA [1294]||HUMANA [11839]|33,825.00|FSC: 13; Default||Not reimbursed separately|33,825.00|FSC: 13; Default||External grouping not supported 95113419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 5 Hole Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|99.00|FSC: 13; Default||Not reimbursed separately|99.00|FSC: 13; Default||External grouping not supported 95188216|EAP|Custom 95188216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sleeve Drill Measuring 2.7mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 6 Hole Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.00|FSC: 13; Default||Not reimbursed separately|108.00|FSC: 13; Default||External grouping not supported 95113421|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Semi Tubular 7 Hole Titani|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|FSC: 13; Default||Not reimbursed separately|117.00|FSC: 13; Default||External grouping not supported 95188237|EAP|Custom 95188237||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Elevate 9x28x10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95113422|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.30|FSC: 13; Default||Not reimbursed separately|537.30|FSC: 13; Default||External grouping not supported 95113423|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 9 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95192083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate R3con 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|FSC: 13; Default||Not reimbursed separately|558.00|FSC: 13; Default||External grouping not supported 95113424|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 10 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95113425|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 11 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|FSC: 13; Default||Not reimbursed separately|378.00|FSC: 13; Default||External grouping not supported 95188232|EAP|Custom 95188232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Fiberloop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113426|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Narrow Lc Dcp 4.5mm 12 Hol|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|FSC: 13; Default||Not reimbursed separately|315.00|FSC: 13; Default||External grouping not supported 95113427|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 106mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|FSC: 13; Default||Not reimbursed separately|327.00|FSC: 13; Default||External grouping not supported 95113428|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 124mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.90|FSC: 13; Default||Not reimbursed separately|549.90|FSC: 13; Default||External grouping not supported 95113429|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 142mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95188235|EAP|Custom 95188235||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Elevate 8 X 28mm X 10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95113430|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 160mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95185146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 2.7mm X 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95113431|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate L-buttress Angled-right 4-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.00|FSC: 13; Default||Not reimbursed separately|618.00|FSC: 13; Default||External grouping not supported 95192094|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosure Ha 6mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.62|FSC: 13; Default||Not reimbursed separately|817.62|FSC: 13; Default||External grouping not supported 95113432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 250mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|FSC: 13; Default||Not reimbursed separately|432.00|FSC: 13; Default||External grouping not supported 95185147|EAP|Custom 95185147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Headless 3"|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 178mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95188236|EAP|Custom 95188236||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Voyager 45mm|1|HUMANA [1294]||HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95113434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 196mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|FSC: 13; Default||Not reimbursed separately|516.00|FSC: 13; Default||External grouping not supported 95185148|EAP|Custom 95185148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Jigs Persona Aref Right|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113435|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Broad Lc Dcp 4.5mm X 214mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95113437|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Blade 16-hole 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,325.65|FSC: 13; Default||Not reimbursed separately|3,325.65|FSC: 13; Default||External grouping not supported 95185149|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Deltoid Ligament Reconstruction Implant System|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,865.00|FSC: 13; Default||Not reimbursed separately|5,865.00|FSC: 13; Default||External grouping not supported 95113438|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Lcp 95 Deg 80mm X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,098.29|FSC: 13; Default||Not reimbursed separately|2,098.29|FSC: 13; Default||External grouping not supported 95188231|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Assurity Single Chamber|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|FSC: 13; Default||Not reimbursed separately|13,041.00|FSC: 13; Default||External grouping not supported 95185150|EAP|Custom 95185150||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Separator 5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113440|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral 28 Diameter Sh|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|FSC: 13; Default||Not reimbursed separately|1,733.40|FSC: 13; Default||External grouping not supported 95192095|EAP|Custom 95192095||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Dbm 5cc|1|HUMANA [1294]||HUMANA [11839]|5,250.00|FSC: 13; Default||Not reimbursed separately|5,250.00|FSC: 13; Default||External grouping not supported 95113443|EAP|Custom 95113443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Ankle Articulating Radiolu|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113444|EAP|Custom 95113444||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Bone Plif 9mm|1|HUMANA [1294]||HUMANA [11839]|6,225.00|FSC: 13; Default||Not reimbursed separately|6,225.00|FSC: 13; Default||External grouping not supported 95188233|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 4.5mm Ti L16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95113445|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Black Oval Torp Dense Hydro|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,234.53|FSC: 13; Default||Not reimbursed separately|1,234.53|FSC: 13; Default||External grouping not supported 95113446|EAP|Custom 95113446||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Joint Applebaum S|1|HUMANA [1294]||HUMANA [11839]|1,046.13|FSC: 13; Default||Not reimbursed separately|1,046.13|FSC: 13; Default||External grouping not supported 95113447|EAP|Custom 95113447||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Joint Applebaum L|1|HUMANA [1294]||HUMANA [11839]|1,046.13|FSC: 13; Default||Not reimbursed separately|1,046.13|FSC: 13; Default||External grouping not supported 95185161|EAP|Custom 95185161||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Angular 0.2 X 3.25 X 0.5mm Ti|1|HUMANA [1294]||HUMANA [11839]|1,344.00|FSC: 13; Default||Not reimbursed separately|1,344.00|FSC: 13; Default||External grouping not supported 95113448|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3dmax Large Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.02|FSC: 13; Default||Not reimbursed separately|550.02|FSC: 13; Default||External grouping not supported 95113449|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3dmax Large Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|500.85|FSC: 13; Default||Not reimbursed separately|500.85|FSC: 13; Default||External grouping not supported 95188234|EAP|Custom 95188234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bit Non Locking Short 03.2x16mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113450|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3dmax Medium Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.56|FSC: 13; Default||Not reimbursed separately|460.56|FSC: 13; Default||External grouping not supported 95185159|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibia Distal Medial 14hole L 227mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,567.00|FSC: 13; Default||Not reimbursed separately|9,567.00|FSC: 13; Default||External grouping not supported 95113451|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh 3dmax Medium Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.56|FSC: 13; Default||Not reimbursed separately|460.56|FSC: 13; Default||External grouping not supported 95192096|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Cp 4.1mm X L28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|FSC: 13; Default||Not reimbursed separately|1,053.00|FSC: 13; Default||External grouping not supported 95113452|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Plus 20cm X 30cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|FSC: 13; Default||Not reimbursed separately|5,367.00|FSC: 13; Default||External grouping not supported 95185157|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Wallstent 10 X 68 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,445.20|FSC: 13; Default||Not reimbursed separately|3,445.20|FSC: 13; Default||External grouping not supported 95113453|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Dual Corduroy Antimicrobial|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,861.00|FSC: 13; Default||Not reimbursed separately|3,861.00|FSC: 13; Default||External grouping not supported 95188229|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 3hole 5mmx59mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,543.00|FSC: 13; Default||Not reimbursed separately|3,543.00|FSC: 13; Default||External grouping not supported 95113454|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod-profile Tex 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95185158|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Hook 7 Hole/16mm/left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|FSC: 13; Default||Not reimbursed separately|6,867.00|FSC: 13; Default||External grouping not supported 95113455|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast.round Textured Ge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95113456|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured Ge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|FSC: 13; Default||Not reimbursed separately|2,940.00|FSC: 13; Default||External grouping not supported 95188228|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cancellous 4.0x38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95113457|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Saline Text|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95113458|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95192097|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Trigen 5.0mm X 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95113459|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95113460|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Round Textured St|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95188227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Self Tap Cortical 3.5 X 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95113461|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Profile Mod.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95113462|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Mod-profile Tex G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95113463|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured-s|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95113464|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Round Text|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|FSC: 13; Default||Not reimbursed separately|1,800.00|FSC: 13; Default||External grouping not supported 95188219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Canc Lock 4.0mmx20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95113465|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|FSC: 13; Default||Not reimbursed separately|1,950.00|FSC: 13; Default||External grouping not supported 95185167|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Biliary Abcession Drainage 8f X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113466|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Textured Recons S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95192098|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 1.5 13mm X 44cm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95113467|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Full-anatomical S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95185175|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Set Everest Mi|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 95113470|EAP|Custom 95113470||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Ear Piston Flouroplas|1|HUMANA [1294]||HUMANA [11839]|454.32|FSC: 13; Default||Not reimbursed separately|454.32|FSC: 13; Default||External grouping not supported 95188218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Lp T15 3.5x22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|FSC: 13; Default||Not reimbursed separately|249.00|FSC: 13; Default||External grouping not supported 95113475|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Mycro 5cm X 10cm X 1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|FSC: 13; Default||Not reimbursed separately|414.00|FSC: 13; Default||External grouping not supported 95185178|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-contour 5.5 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,455.00|FSC: 13; Default||Not reimbursed separately|1,455.00|FSC: 13; Default||External grouping not supported 95113479|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Mycro 10cm X 15cm Oval|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|FSC: 13; Default||Not reimbursed separately|1,194.00|FSC: 13; Default||External grouping not supported 95113480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm -3mm-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95185174|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Mi Everest 6.5 X 45 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95113481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.00|FSC: 13; Default||Not reimbursed separately|1,539.00|FSC: 13; Default||External grouping not supported 95188230|EAP|HCPCS C1878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Injectable Plus Prolaryn 1.0cc|1|HUMANA [1294]||HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95113482|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm +5mm-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.00|FSC: 13; Default||Not reimbursed separately|1,539.00|FSC: 13; Default||External grouping not supported 95185176|EAP|Custom 95185176||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Interbody Aleutian Lordotic Ii Tlif Lumbar Transfora|1|HUMANA [1294]||HUMANA [11839]|12,789.00|FSC: 13; Default||Not reimbursed separately|12,789.00|FSC: 13; Default||External grouping not supported 95113483|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm +10mm-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.60|FSC: 13; Default||Not reimbursed separately|1,359.60|FSC: 13; Default||External grouping not supported 95192099|EAP|Custom 95192099||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Capstone 13mm X 26mm Vertestak|1|HUMANA [1294]||HUMANA [11839]|16,358.16|FSC: 13; Default||Not reimbursed separately|16,358.16|FSC: 13; Default||External grouping not supported 95113484|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 26mm +10-stem|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|FSC: 13; Default||Not reimbursed separately|1,275.00|FSC: 13; Default||External grouping not supported 95185162|EAP|Custom 95185162||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Prosthesis Angular 0.2 X 2.25 X 0.5mm Ti|1|HUMANA [1294]||HUMANA [11839]|1,311.00|FSC: 13; Default||Not reimbursed separately|1,311.00|FSC: 13; Default||External grouping not supported 95113485|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head D-taper Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|FSC: 13; Default||Not reimbursed separately|2,683.80|FSC: 13; Default||External grouping not supported 95188225|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Swan-ganz Cco 7.5fr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113486|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Vitalock Cluster 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95185177|EAP|Custom 95185177||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Interbody Aleutian Lordotic Ii Tlif Lumbar Transfora|1|HUMANA [1294]||HUMANA [11839]|12,789.00|FSC: 13; Default||Not reimbursed separately|12,789.00|FSC: 13; Default||External grouping not supported 95113487|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Vitalock Cluster 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95113488|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Vitalock Cluster 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95185164|EAP|Custom 95185164||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tendon Biocleanse Patellar Preshaped 10/10mm|1|HUMANA [1294]||HUMANA [11839]|10,800.00|FSC: 13; Default||Not reimbursed separately|10,800.00|FSC: 13; Default||External grouping not supported 95113489|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Acetabular Cluster Vitaloc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95188224|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Memory Gel Med Height High Profile 685cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95113490|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell Vitalock Cluster 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95185163|EAP|Custom 95185163||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Omega 1.5 X 0.8 X 0.5mm (fl=0.5mm)|1|HUMANA [1294]||HUMANA [11839]|645.00|FSC: 13; Default||Not reimbursed separately|645.00|FSC: 13; Default||External grouping not supported 95113491|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular P3 10-degree 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 95192100|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 24.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113492|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular P4 10-deg 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 95185166|EAP|Custom 95185166||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Filter Televac2 Multi-port Ulpa|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113493|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert 10 Degree 28mm Crossfire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|FSC: 13; Default||Not reimbursed separately|4,424.70|FSC: 13; Default||External grouping not supported 95188221|EAP|Custom 95188221||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dowel Bone Unicortical Fully Cannulated 14mm|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95113494|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Duratn P4 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|FSC: 13; Default||Not reimbursed separately|1,875.00|FSC: 13; Default||External grouping not supported 95185168|EAP|Custom 95185168||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cushion Chair Wc Seat Air Lock 19 X 19|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113495|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Duratn P-5 32m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95113496|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Duration P-6 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,876.50|FSC: 13; Default||Not reimbursed separately|1,876.50|FSC: 13; Default||External grouping not supported 95185171|EAP|Custom 95185171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Tip Diamond Double System Retractor Mi Serengeti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113497|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Acetabular Duratn P3 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|FSC: 13; Default||Not reimbursed separately|2,227.50|FSC: 13; Default||External grouping not supported 95188222|EAP|Custom 95188222||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dowel Bone Unicortical Fully Cannulated 16mm|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95113520|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Base Non-beaded Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|FSC: 13; Default||Not reimbursed separately|3,975.00|FSC: 13; Default||External grouping not supported 95192101|EAP|Custom 95192101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dissection & Access Pro Spacemaker Trocar Blunt/rnd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113521|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Base Tibial Non-beaded Med|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,136.10|FSC: 13; Default||Not reimbursed separately|4,136.10|FSC: 13; Default||External grouping not supported 95185169|EAP|Custom 95185169||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Add-on Serengeti Mi System Retractor|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113522|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Non-bead Lg-2 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,467.60|FSC: 13; Default||Not reimbursed separately|4,467.60|FSC: 13; Default||External grouping not supported 95188220|EAP|Custom 95188220||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Dowel Bone Unicortical Fully Cannulated 12mm|1|HUMANA [1294]||HUMANA [11839]|2,100.00|FSC: 13; Default||Not reimbursed separately|2,100.00|FSC: 13; Default||External grouping not supported 95185173|EAP|Custom 95185173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Tip Bevel System Retractor Mi Serengeti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113557|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.30|FSC: 13; Default||Not reimbursed separately|96.30|FSC: 13; Default||External grouping not supported 95113558|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.60|FSC: 13; Default||Not reimbursed separately|345.60|FSC: 13; Default||External grouping not supported 95185170|EAP|Custom 95185170||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Level 1 Everest 04.4mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113559|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|FSC: 13; Default||Not reimbursed separately|93.00|FSC: 13; Default||External grouping not supported 95188226|EAP|Custom 95188226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Retraction Laparoscopic "t" Lift|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113560|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.90|FSC: 13; Default||Not reimbursed separately|120.90|FSC: 13; Default||External grouping not supported 95185172|EAP|Custom 95185172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Scapel Perfect System Spinal Everest|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113561|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|124.50|FSC: 13; Default||Not reimbursed separately|124.50|FSC: 13; Default||External grouping not supported 95192102|EAP|Custom 95192102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Dissection & Access Pro Spacemaker Trocal Balloon Rd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113562|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mandibular Angle 60 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|FSC: 13; Default||Not reimbursed separately|534.00|FSC: 13; Default||External grouping not supported 95185165|EAP|Custom 95185165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb System Management Prevena Neg Pressure Customizable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113563|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T 90 Deg Long Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95188242|EAP|Custom 95188242||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valved Valsalva Hp Masters 21mm|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95113564|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4-hole Lactosorb 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95185194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking 4.0 X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.50|FSC: 13; Default||Not reimbursed separately|514.50|FSC: 13; Default||External grouping not supported 95113565|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lactosorb 1.5x5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|FSC: 13; Default||Not reimbursed separately|138.00|FSC: 13; Default||External grouping not supported 95113566|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lactosorb 1.5x4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|FSC: 13; Default||Not reimbursed separately|138.00|FSC: 13; Default||External grouping not supported 95185184|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Oc Adjustable|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,170.00|FSC: 13; Default||Not reimbursed separately|16,170.00|FSC: 13; Default||External grouping not supported 95113571|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.50|FSC: 13; Default||Not reimbursed separately|103.50|FSC: 13; Default||External grouping not supported 95188245|EAP|Custom 95188245||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valved Valsalva Hp Masters 27mm|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95113572|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|FSC: 13; Default||Not reimbursed separately|100.50|FSC: 13; Default||External grouping not supported 95185193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Pocket Neutral Beta|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|FSC: 13; Default||Not reimbursed separately|4,189.50|FSC: 13; Default||External grouping not supported 95113573|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.50|FSC: 13; Default||Not reimbursed separately|106.50|FSC: 13; Default||External grouping not supported 95192103|EAP|Custom 95192103||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flowport Ii With Obturator|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113574|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 3.2mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.50|FSC: 13; Default||Not reimbursed separately|136.50|FSC: 13; Default||External grouping not supported 95185186|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.0 X 10 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 95113575|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mandibular Angle 60 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|FSC: 13; Default||Not reimbursed separately|570.00|FSC: 13; Default||External grouping not supported 95188258|EAP|Custom 95188258||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.1mm/ K-wire Attchm For Threaded Hole/70mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113576|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Mandibular Angle 60 Left S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|FSC: 13; Default||Not reimbursed separately|561.00|FSC: 13; Default||External grouping not supported 95185192|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated 3.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95113577|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Double Regular|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95113578|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Y Staple Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|FSC: 13; Default||Not reimbursed separately|312.00|FSC: 13; Default||External grouping not supported 95185187|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 5.0 X 12 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 95113579|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Suspension Lacto-sorb 2.0x|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|139.50|FSC: 13; Default||Not reimbursed separately|139.50|FSC: 13; Default||External grouping not supported 95188243|EAP|Custom 95188243||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valved Valsalva Hp Masters 23mm|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95113580|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lactosorb 2.0x6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|FSC: 13; Default||Not reimbursed separately|120.00|FSC: 13; Default||External grouping not supported 95185191|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Cannulated 3.0 X 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|FSC: 13; Default||Not reimbursed separately|975.00|FSC: 13; Default||External grouping not supported 95113581|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4-hole 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95113582|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 4-hole Long 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|FSC: 13; Default||Not reimbursed separately|240.00|FSC: 13; Default||External grouping not supported 95185185|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5 X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|FSC: 13; Default||Not reimbursed separately|1,308.00|FSC: 13; Default||External grouping not supported 95113588|EAP|Custom 95113588||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Perfix Extra Large Bard|1|HUMANA [1294]||HUMANA [11839]|517.50|FSC: 13; Default||Not reimbursed separately|517.50|FSC: 13; Default||External grouping not supported 95188260|EAP|Custom 95188260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 1.0mm Dia 150mm Length Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113589|EAP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Polypropylene Clear 14 X9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95185188|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Curved Vertex 3.5 X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,142.00|FSC: 13; Default||Not reimbursed separately|2,142.00|FSC: 13; Default||External grouping not supported 95113612|EAP|Custom 95113612||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler 20w Fascia Dfs|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113613|EAP|Custom 95113613||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Tubing Vfi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185190|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap Off 2.0 X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95188244|EAP|Custom 95188244||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valved Valsalva Hp Masters 25mm|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95185189|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap Off 2.0 X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|FSC: 13; Default||Not reimbursed separately|945.00|FSC: 13; Default||External grouping not supported 95113641|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|FSC: 13; Default||Not reimbursed separately|102.00|FSC: 13; Default||External grouping not supported 95192105|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Profile Low Trigen 5.0 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|FSC: 13; Default||Not reimbursed separately|603.00|FSC: 13; Default||External grouping not supported 95113642|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.00|FSC: 13; Default||Not reimbursed separately|108.00|FSC: 13; Default||External grouping not supported 95113643|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|FSC: 13; Default||Not reimbursed separately|111.00|FSC: 13; Default||External grouping not supported 95188241|EAP|Custom 95188241||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valved Valsalva Hp Masters 19mm|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95113644|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 8 Hole Regular Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.00|FSC: 13; Default||Not reimbursed separately|183.00|FSC: 13; Default||External grouping not supported 95185209|EAP|Custom 95185209||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Device Inflation|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.50|FSC: 13; Default||Not reimbursed separately|52.50|FSC: 13; Default||External grouping not supported 95113653|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|FSC: 13; Default||Not reimbursed separately|55.50|FSC: 13; Default||External grouping not supported 95185207|EAP|Custom 95185207||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stent Bifurcated 25 X 110/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95113654|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.00|FSC: 13; Default||Not reimbursed separately|63.00|FSC: 13; Default||External grouping not supported 95192106|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Compression Intertan Trigen 115mm / 110mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|FSC: 13; Default||Not reimbursed separately|2,115.15|FSC: 13; Default||External grouping not supported 95113655|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.00|FSC: 13; Default||Not reimbursed separately|132.00|FSC: 13; Default||External grouping not supported 95185208|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 700cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95113656|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 4 Hole Regular Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|FSC: 13; Default||Not reimbursed separately|750.00|FSC: 13; Default||External grouping not supported 95113657|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 6 Hole Regular Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|FSC: 13; Default||Not reimbursed separately|210.00|FSC: 13; Default||External grouping not supported 95188246|EAP|Custom 95188246||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valved Valsalva Hp Masters 29mm|1|HUMANA [1294]||HUMANA [11839]|17,376.00|FSC: 13; Default||Not reimbursed separately|17,376.00|FSC: 13; Default||External grouping not supported 95113658|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 6 Hole Long Titanium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|FSC: 13; Default||Not reimbursed separately|198.00|FSC: 13; Default||External grouping not supported 80168644|EAP|CPT® 93799||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hb Unlisted Cardiovascular Service Or Procedure|1|HUMANA [1294]||HUMANA [11839]|427.08|FSC: 13; Default||Not reimbursed separately|427.08|FSC: 13; Default||External grouping not supported 95113668|EAP|Custom 95113668||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sling Tutoplast Suspend Facia-la|1|HUMANA [1294]||HUMANA [11839]|1,080.00|FSC: 13; Default||Not reimbursed separately|1,080.00|FSC: 13; Default||External grouping not supported 95113670|EAP|Custom 95113670||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Electrode Single-bar Disp.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185210|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Armada 35 Pta 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113671|EAP|Custom 95113671||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Electrode Ball|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188248|EAP|Custom 95188248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reamer Convex 20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113673|EAP|Custom 95113673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Nephro-stent Ureteral 2.8x8.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185211|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Advance Milagro 9mm X 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|FSC: 13; Default||Not reimbursed separately|1,416.00|FSC: 13; Default||External grouping not supported 95113674|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral 4.8x26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95192107|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 125 Deg 1.5 13mm X 46cm Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|FSC: 13; Default||Not reimbursed separately|6,628.65|FSC: 13; Default||External grouping not supported 95113680|EAP|Custom 95113680||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Knife Micro Ent Spear Edge Angle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185212|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Integrated Fusion Sytem 33 X 26 X 12 Degree 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95113681|EAP|Custom 95113681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Heart Lt Curved 9.5cm V|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188250|EAP|Custom 95188250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Apex S/d Half 5x200 50 Thread|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113683|EAP|Custom 95113683||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Coronary Universal Tipso|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185216|EAP|Custom 95185216||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endowrist Si Blue 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113686|EAP|Custom 95113686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Cartridge 16mmx25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113687|EAP|Custom 95113687||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Cartridge 16mmx15mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185217|EAP|Custom 95185217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Endowrist Si Green 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113688|EAP|Custom 95113688||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Cartridge 16mmx20mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188259|EAP|Custom 95188259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Kirschner 0.8mm Dia 70mm Length Ti|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113689|EAP|Custom 95113689||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb System Grip Cable/sleeve Stainle|1|HUMANA [1294]||HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95185214|EAP|Custom 95185214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Seal Si Cannula Stapler Endowrist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113690|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Alta 3.2x1000mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192114|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Intramedullary Intertan 130deg 1.5 13mm X 36cm Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|FSC: 13; Default||Not reimbursed separately|5,925.00|FSC: 13; Default||External grouping not supported 95113691|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide Ball-tip|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185215|EAP|Custom 95185215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath 45 Stapler Endowrist|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188261|EAP|Custom 95188261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Spinal Medtronic|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113693|EAP|Custom 95113693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Occlusion 9 French.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185218|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Metatarsal Low Profile T 2.4mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95113696|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 1.5mm Obliqu|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|FSC: 13; Default||Not reimbursed separately|465.00|FSC: 13; Default||External grouping not supported 95113697|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm Adapti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|FSC: 13; Default||Not reimbursed separately|795.00|FSC: 13; Default||External grouping not supported 95113698|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Maxillofacial 2.0mm X 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|FSC: 13; Default||Not reimbursed separately|399.00|FSC: 13; Default||External grouping not supported 95185227|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suture Anchor Biocomp-site Pushlock 2.9 X 15.5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95113701|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp 2.7mm X 36mm 4 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|694.02|FSC: 13; Default||Not reimbursed separately|694.02|FSC: 13; Default||External grouping not supported 95188247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Acu-loc 2vdr Prox Narrow Long Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|FSC: 13; Default||Not reimbursed separately|2,952.00|FSC: 13; Default||External grouping not supported 95113702|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp 2.7mm X 52mm 6 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|919.32|FSC: 13; Default||Not reimbursed separately|919.32|FSC: 13; Default||External grouping not supported 95185232|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 800cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|FSC: 13; Default||Not reimbursed separately|2,175.00|FSC: 13; Default||External grouping not supported 95113706|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wrist Fusion Standard Bend|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,656.80|FSC: 13; Default||Not reimbursed separately|2,656.80|FSC: 13; Default||External grouping not supported 95192160|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Premium Cemented Stem Wth Unipolar / Bipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|FSC: 13; Default||Not reimbursed separately|9,600.00|FSC: 13; Default||External grouping not supported 95113707|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wrist Fusion Short Bend Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,897.10|FSC: 13; Default||Not reimbursed separately|2,897.10|FSC: 13; Default||External grouping not supported 95185228|EAP|Custom 95185228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Disp For Pushlock|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113708|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Wrist Fusion Straight Tita|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,481.30|FSC: 13; Default||Not reimbursed separately|2,481.30|FSC: 13; Default||External grouping not supported 95188251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95113709|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Self Compression Narrow 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|FSC: 13; Default||Not reimbursed separately|355.98|FSC: 13; Default||External grouping not supported 95185230|EAP|Custom 95185230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Labral Tape White/black 1.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113715|EAP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pacing Bipolar 5french|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113726|EAP|Custom 95113726||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patch Carotid Pericardial Bovine|1|HUMANA [1294]||HUMANA [11839]|533.58|FSC: 13; Default||Not reimbursed separately|533.58|FSC: 13; Default||External grouping not supported 95185231|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Humeral T2 7mm X 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95113730|EAP|Custom 95113730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Rush 4in.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95113731|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral G/k Left 12mmx38cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,254.00|FSC: 13; Default||Not reimbursed separately|1,254.00|FSC: 13; Default||External grouping not supported 95185219|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Paste Orthoblast 3cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,498.68|FSC: 13; Default||Not reimbursed separately|1,498.68|FSC: 13; Default||External grouping not supported 95113735|EAP|Custom 95113735||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 4.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192161|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Standard Fracture Stem Wth Unipolar / Bipolar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|FSC: 13; Default||Not reimbursed separately|7,950.00|FSC: 13; Default||External grouping not supported 95185226|EAP|Custom 95185226||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Neuroline 30g 1 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95113739|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Acutrak Mini 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|FSC: 13; Default||Not reimbursed separately|735.00|FSC: 13; Default||External grouping not supported 95185233|EAP|Custom 95185233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reaming Coring Collard Pin 12mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113740|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff S.t. 4.5cm (ams800) C1815|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,425.00|FSC: 13; Default||Not reimbursed separately|7,425.00|FSC: 13; Default||External grouping not supported 95113741|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mmmedium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,417.50|FSC: 13; Default||Not reimbursed separately|1,417.50|FSC: 13; Default||External grouping not supported 95185234|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Tightrope Button Abs 8 X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|FSC: 13; Default||Not reimbursed separately|429.00|FSC: 13; Default||External grouping not supported 95113742|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Vit Taper 32mm -4 5-40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.00|FSC: 13; Default||Not reimbursed separately|1,593.00|FSC: 13; Default||External grouping not supported 95188256|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces 1.5mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95113743|EAP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Resevoir Prefilled 65ml C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,310.00|FSC: 13; Default||Not reimbursed separately|2,310.00|FSC: 13; Default||External grouping not supported 95185235|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Zilver Ptx Drug Eluting .035 8fr 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|FSC: 13; Default||Not reimbursed separately|5,385.00|FSC: 13; Default||External grouping not supported 95113744|EAP|Custom 95113744||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone Artisan Large|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95192162|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Premium Primary Cementless Stem Cup Head Inser|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|FSC: 13; Default||Not reimbursed separately|15,600.00|FSC: 13; Default||External grouping not supported 95113745|EAP|Custom 95113745||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire Nail Gamma 3.2x450mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185238|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tiself Tap Cortical 2.7x26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95113746|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 32mm Xx-lg 5-deg 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|FSC: 13; Default||Not reimbursed separately|1,282.50|FSC: 13; Default||External grouping not supported 95188249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pocketlock With A Slot Mtp|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.20|FSC: 13; Default||Not reimbursed separately|5,923.20|FSC: 13; Default||External grouping not supported 95113749|EAP|Custom 95113749||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Imp Piston Schuk Tef-wire|1|HUMANA [1294]||HUMANA [11839]|363.00|FSC: 13; Default||Not reimbursed separately|363.00|FSC: 13; Default||External grouping not supported 95185236|EAP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Deca Nav F 7f Curve 2-8-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113750|EAP|Custom 95113750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Piston Schuknecht Te|1|HUMANA [1294]||HUMANA [11839]|363.00|FSC: 13; Default||Not reimbursed separately|363.00|FSC: 13; Default||External grouping not supported 95113751|EAP|Custom 95113751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Piston Tef Wire 0.6m|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95113755|EAP|Custom 95113755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Piston Tef Wire 0.6m|1|HUMANA [1294]||HUMANA [11839]|309.00|FSC: 13; Default||Not reimbursed separately|309.00|FSC: 13; Default||External grouping not supported 95188252|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Va-locking Slf-with T4 Stardrive Reces1.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.25|FSC: 13; Default||Not reimbursed separately|401.25|FSC: 13; Default||External grouping not supported 95113756|EAP|Custom 95113756||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.0 Long Schuknecht Sli|1|HUMANA [1294]||HUMANA [11839]|280.98|FSC: 13; Default||Not reimbursed separately|280.98|FSC: 13; Default||External grouping not supported 95185242|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 1.6mm With Ball|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113757|EAP|Custom 95113757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Wire Ear 4.50 Long Schuknecht Sl|1|HUMANA [1294]||HUMANA [11839]|274.92|FSC: 13; Default||Not reimbursed separately|274.92|FSC: 13; Default||External grouping not supported 95192163|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Standar Primary Cementless Stem Cup Head Inser|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|FSC: 13; Default||Not reimbursed separately|14,400.00|FSC: 13; Default||External grouping not supported 95185246|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate T Mini Maxlock Extreme Flat 4 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|FSC: 13; Default||Not reimbursed separately|2,751.00|FSC: 13; Default||External grouping not supported 95113763|EAP|Custom 95113763||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tool Legend Twist Drill 1.2mm X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188257|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Ti Val Metacarpal Neckplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,077.08|FSC: 13; Default||Not reimbursed separately|2,077.08|FSC: 13; Default||External grouping not supported 95113765|EAP|Custom 95113765||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Forward-a|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95185253|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pedicale Starfire Polyaxial 6.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95113766|EAP|Custom 95113766||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95113767|EAP|Custom 95113767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Right-ang|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95185247|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Nonlocking Mini Maxlock Extreme 2.7mmx12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95113768|EAP|Custom 95113768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|636.00|FSC: 13; Default||Not reimbursed separately|636.00|FSC: 13; Default||External grouping not supported 95188238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Fb Uc Persona Left 10 Mm Tibia G-h/cr Fem 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95113769|EAP|Custom 95113769||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Clip Aneurysm Mcfadden Straight|1|HUMANA [1294]||HUMANA [11839]|711.00|FSC: 13; Default||Not reimbursed separately|711.00|FSC: 13; Default||External grouping not supported 95185254|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95113770|EAP|Custom 95113770||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ventricular 35cm Edm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192164|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Unicondylar Keen Standard Primary Cemented Uni-knee|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|FSC: 13; Default||Not reimbursed separately|12,450.00|FSC: 13; Default||External grouping not supported 95113775|EAP|Custom 95113775||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Connector Accu-flow Straight Ste|1|HUMANA [1294]||HUMANA [11839]|364.56|FSC: 13; Default||Not reimbursed separately|364.56|FSC: 13; Default||External grouping not supported 95185248|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Mini Maxlock Extreme 2.7x14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|FSC: 13; Default||Not reimbursed separately|364.80|FSC: 13; Default||External grouping not supported 95113776|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Nail Distal 6.28 X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95188239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Body Proximal Conical Reclaim 20 X 85mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|FSC: 13; Default||Not reimbursed separately|16,543.80|FSC: 13; Default||External grouping not supported 95113777|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Gamma Nail Distal 6.28 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|FSC: 13; Default||Not reimbursed separately|345.00|FSC: 13; Default||External grouping not supported 95185250|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mini Variable 2.4mmx16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95113778|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Long Right 11x380 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,829.00|FSC: 13; Default||Not reimbursed separately|2,829.00|FSC: 13; Default||External grouping not supported 95113779|EAP|Custom 95113779||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail 130-deg 11x340 Gamma|1|HUMANA [1294]||HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95185255|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Rescue 6.0x25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|FSC: 13; Default||Not reimbursed separately|900.00|FSC: 13; Default||External grouping not supported 95113780|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma 11x400 130-deg.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95188240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Tapered Distal Reclaim 20 X 190mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|FSC: 13; Default||Not reimbursed separately|14,490.00|FSC: 13; Default||External grouping not supported 95113781|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 11x360/130-deg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|FSC: 13; Default||Not reimbursed separately|3,309.00|FSC: 13; Default||External grouping not supported 95185249|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Mini Maxlock Extreme 2.7x16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95113782|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Reliance 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95192165|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Premium Prim Cementless Femur Tibia Insert Pa|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,650.00|FSC: 13; Default||Not reimbursed separately|16,650.00|FSC: 13; Default||External grouping not supported 95113783|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Reliance 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95185251|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pedicle Starfire Polyaxial 6.5x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95113784|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Reliance 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95188263|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Catheter Viabahn Endoprosthesis 13mm X 5cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,525.00|FSC: 13; Default||Not reimbursed separately|9,525.00|FSC: 13; Default||External grouping not supported 95113785|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Reliance 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95185264|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm X 38mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95113786|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Reliance 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|FSC: 13; Default||Not reimbursed separately|5,176.50|FSC: 13; Default||External grouping not supported 95113787|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95185260|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Shank Precept 6.5 X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|FSC: 13; Default||Not reimbursed separately|3,006.00|FSC: 13; Default||External grouping not supported 95113788|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95188262|EAP|Custom 95188262||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Spire 36mm|1|HUMANA [1294]||HUMANA [11839]|25,824.00|FSC: 13; Default||Not reimbursed separately|25,824.00|FSC: 13; Default||External grouping not supported 95113789|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95185261|EAP|Custom 95185261||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 9 X 9 X 20mmx 4deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95113790|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95192166|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Premium Prim Cementrd Femur Cementless Tibia|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,450.00|FSC: 13; Default||Not reimbursed separately|15,450.00|FSC: 13; Default||External grouping not supported 95113791|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95185262|EAP|Custom 95185262||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cage Impacted Large 10 X 11 X 26mm 4deg|1|HUMANA [1294]||HUMANA [11839]|11,424.00|FSC: 13; Default||Not reimbursed separately|11,424.00|FSC: 13; Default||External grouping not supported 95113793|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Dist Type A Modifie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|FSC: 13; Default||Not reimbursed separately|226.80|FSC: 13; Default||External grouping not supported 95188253|EAP|Custom 95188253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Positioner Heart Evo Urchin And Stabilizer Tissue 4 Octobase|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113794|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95185259|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod 55mm Precept|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|FSC: 13; Default||Not reimbursed separately|2,061.00|FSC: 13; Default||External grouping not supported 95113795|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95113796|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95185258|EAP|Custom 95185258||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb External Drainage & Monitoring Lumbar Drainage Kit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113797|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Femoral Distal 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|FSC: 13; Default||Not reimbursed separately|445.20|FSC: 13; Default||External grouping not supported 95188265|EAP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cuff /w Iz 800 Ams|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,117.31|FSC: 13; Default||Not reimbursed separately|17,117.31|FSC: 13; Default||External grouping not supported 95113800|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Cemented #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|FSC: 13; Default||Not reimbursed separately|6,750.00|FSC: 13; Default||External grouping not supported 95185263|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.0mm X 28mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|FSC: 13; Default||Not reimbursed separately|330.00|FSC: 13; Default||External grouping not supported 95113801|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Med 28mm V-40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95192167|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Standard Prim Cementrd Femur Tibia Insert P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|FSC: 13; Default||Not reimbursed separately|12,600.00|FSC: 13; Default||External grouping not supported 95113802|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Long 28mm V-40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95113803|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95113805|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Shell Osteolock Np 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|FSC: 13; Default||Not reimbursed separately|2,862.00|FSC: 13; Default||External grouping not supported 95113806|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Std 28mm V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 62064540|EAP|CPT® 81002||0307 - LABORATORY - UROLOGY|Hb Urine Protein, Qual, Visual Read|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.44|FSC: 13; Default||Not reimbursed separately|10.44|FSC: 13; Default||External grouping not supported 95113807|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral 28mm +16 5-40 Taper|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|FSC: 13; Default||Not reimbursed separately|1,674.00|FSC: 13; Default||External grouping not supported 95185274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Replacement Tri-lock Aml Profile Standard 32x50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,231.80|FSC: 13; Default||Not reimbursed separately|7,231.80|FSC: 13; Default||External grouping not supported 95113808|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral V40 28mm X-longneck|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95113809|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Std 28mm -40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|FSC: 13; Default||Not reimbursed separately|2,039.10|FSC: 13; Default||External grouping not supported 95192168|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Ts Baseplate|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|FSC: 13; Default||Not reimbursed separately|1,200.00|FSC: 13; Default||External grouping not supported 95113810|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95185278|EAP|Custom 95185278||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb K-wires 100 X 1.1mm|1|HUMANA [1294]||HUMANA [11839]|91.80|FSC: 13; Default||Not reimbursed separately|91.80|FSC: 13; Default||External grouping not supported 95113826|EAP|Custom 95113826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suction Floor Water Bug|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Neutral Poly Crosslinked Highly Longevity 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95113830|EAP|Custom 95113830||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Valve Aortic Pericardial Perimou|1|HUMANA [1294]||HUMANA [11839]|14,985.00|FSC: 13; Default||Not reimbursed separately|14,985.00|FSC: 13; Default||External grouping not supported 95185281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Plate 2.2mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|736.83|FSC: 13; Default||Not reimbursed separately|736.83|FSC: 13; Default||External grouping not supported 95185279|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tarsalis 3 Hole Straight Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|FSC: 13; Default||Not reimbursed separately|5,121.60|FSC: 13; Default||External grouping not supported 95113847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Dcp 2.7mm X 60mm 7 Hole Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.10|FSC: 13; Default||Not reimbursed separately|939.10|FSC: 13; Default||External grouping not supported 95188269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Hrhk 24mm Xs/s S1/s2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95113848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 16mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|FSC: 13; Default||Not reimbursed separately|166.38|FSC: 13; Default||External grouping not supported 95185287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|FSC: 13; Default||Not reimbursed separately|480.00|FSC: 13; Default||External grouping not supported 95113849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 24mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|FSC: 13; Default||Not reimbursed separately|207.90|FSC: 13; Default||External grouping not supported 95192177|EAP|Custom 95192177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Falcon Rotatable Retrieval Basket|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 11mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.31|FSC: 13; Default||Not reimbursed separately|113.31|FSC: 13; Default||External grouping not supported 95185280|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tarsalis 4 Hole Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|FSC: 13; Default||Not reimbursed separately|5,121.60|FSC: 13; Default||External grouping not supported 95113852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 22mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95188271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Ceramic Option Biolox 40mm +5 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,630.30|FSC: 13; Default||Not reimbursed separately|6,630.30|FSC: 13; Default||External grouping not supported 95113853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 20mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95185283|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Lag 2.2mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.54|FSC: 13; Default||Not reimbursed separately|513.54|FSC: 13; Default||External grouping not supported 95113854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 26mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.99|FSC: 13; Default||Not reimbursed separately|261.99|FSC: 13; Default||External grouping not supported 95113857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 2.7x10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|FSC: 13; Default||Not reimbursed separately|192.00|FSC: 13; Default||External grouping not supported 95185290|EAP|Custom 95185290||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Inspira Chamber Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Guidepin 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95188267|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 5 X 150 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113879|EAP|Custom 95113879||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Net Retrieval 2.5mm 230cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185284|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Lag 2.2mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.54|FSC: 13; Default||Not reimbursed separately|513.54|FSC: 13; Default||External grouping not supported 95113880|EAP|Custom 95113880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer Epidural Sca 15gauge|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192108|EAP|Custom 95192108||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Ncb 3.3mm X 245mm Quick Coupling|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113882|EAP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Kit Extension In-line|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|FSC: 13; Default||Not reimbursed separately|1,485.00|FSC: 13; Default||External grouping not supported 95185289|EAP|Custom 95185289||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Mask Inspira Chamber Medium|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 10mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95188266|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 4 X 150 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185285|EAP|Custom 95185285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.5mm W/ao (lt.green)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95113898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Plate Lag 2.2mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.54|FSC: 13; Default||Not reimbursed separately|513.54|FSC: 13; Default||External grouping not supported 95113899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95188268|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 6 X 150 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 3.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95113901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95192109|EAP|Custom 95192109||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Reload Stapler Tri-staple 2mmx45mm Medium Vascular Curve Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185296|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 5mm X 60mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95113904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185293|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 4mm X 80mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95113906|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185304|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Pedicle Star Fire Polyaxial 8.5x35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95113907|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95188275|EAP|Custom 95188275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial Bio-medicus 21fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Corticle 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 95113909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95192115|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113910|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185308|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 3.5 X 34mm Non Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95113911|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95113912|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185301|EAP|Custom 95185301||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Gel Dbm Allograft 10cc|1|HUMANA [1294]||HUMANA [11839]|4,893.00|FSC: 13; Default||Not reimbursed separately|4,893.00|FSC: 13; Default||External grouping not supported 95113913|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95113914|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Hexalobe 2.7mm X 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95113915|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95188273|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Esophageal Endomaxx 23x150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|FSC: 13; Default||Not reimbursed separately|7,050.00|FSC: 13; Default||External grouping not supported 95113916|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185298|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 5mm X 100mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113917|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95192116|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113918|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Hexalobe 2.7mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|FSC: 13; Default||Not reimbursed separately|219.00|FSC: 13; Default||External grouping not supported 95113919|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95188274|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tfna 10mm/130 Right 340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95113920|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Hexalobe 1.5mm X 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95113921|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95113922|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185291|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 4mm X 40mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188276|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter 3 Piece Silicone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95185294|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 4mm X 100mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113934|EAP|Custom 95113934||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Slotted- Whis|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192117|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113939|EAP|Custom 95113939||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cement Palacos-r|1|HUMANA [1294]||HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95185309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 3.5mm X 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|FSC: 13; Default||Not reimbursed separately|411.00|FSC: 13; Default||External grouping not supported 95113940|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fixation 7mmx25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95188277|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter 3 Piece Silicone|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|FSC: 13; Default||Not reimbursed separately|483.00|FSC: 13; Default||External grouping not supported 95113941|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fixation 7x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95185292|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 4mm X 60mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113942|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 9x20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95113943|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 9x25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95185303|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Tiself Tap Cortical 3.5x36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95113944|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Fixation 9mmx30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|FSC: 13; Default||Not reimbursed separately|434.25|FSC: 13; Default||External grouping not supported 95113945|EAP|Custom 95113945||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbidemedium 5.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95113946|EAP|Custom 95113946||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd.carbide Long 3mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185312|EAP|Custom 95185312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Surgibit Qr 2.0mm X 3.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188279|EAP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Ureteral Sof-flex 10fr X 26cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|400.41|FSC: 13; Default||Not reimbursed separately|400.41|FSC: 13; Default||External grouping not supported 95113948|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great-toe Silastic Size3|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95185305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Pre-bent 6.0x80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95113949|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Great-toe Silastic Size1|1|HUMANA [1294]||HUMANA [11839]|660.00|FSC: 13; Default||Not reimbursed separately|660.00|FSC: 13; Default||External grouping not supported 95192118|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113950|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Flex Hinge O With Gr|1|HUMANA [1294]||HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95185310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Olecranon Standard 7-hole Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|FSC: 13; Default||Not reimbursed separately|3,114.00|FSC: 13; Default||External grouping not supported 95113951|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Toe Flex-hinge|1|HUMANA [1294]||HUMANA [11839]|2,463.00|FSC: 13; Default||Not reimbursed separately|2,463.00|FSC: 13; Default||External grouping not supported 95188282|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Straight 5.5mm 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95185297|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 5mm X 80mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113965|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95188287|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left Hook 6 Hole 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|FSC: 13; Default||Not reimbursed separately|6,867.00|FSC: 13; Default||External grouping not supported 95113966|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95185295|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 5mm X 40mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113967|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95192119|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113968|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95185299|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Lutonix Dcb 6mm X 80mm X 130 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95113969|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95188281|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mm/125 Deg 340mm Rt|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|FSC: 13; Default||Not reimbursed separately|6,349.47|FSC: 13; Default||External grouping not supported 95113970|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95185315|EAP|Custom 95185315||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Embolization Nester .018 Diameter X 2cm Length 3mm|1|HUMANA [1294]||HUMANA [11839]|431.43|FSC: 13; Default||Not reimbursed separately|431.43|FSC: 13; Default||External grouping not supported 95113971|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95113972|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95113973|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head-adaptor Versys Endo-pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.75|FSC: 13; Default||Not reimbursed separately|399.75|FSC: 13; Default||External grouping not supported 95113974|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head-adaptor Versys Endo-pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.60|FSC: 13; Default||Not reimbursed separately|291.60|FSC: 13; Default||External grouping not supported 95185314|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lag Hexalobe 1.5mm X 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95113978|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95188286|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Left Hook 6 Hole 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|FSC: 13; Default||Not reimbursed separately|5,400.00|FSC: 13; Default||External grouping not supported 95113979|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|FSC: 13; Default||Not reimbursed separately|341.25|FSC: 13; Default||External grouping not supported 95192120|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 8.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113980|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Distal 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95188283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Extender Stem Fluted Revision 13mm X 80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|FSC: 13; Default||Not reimbursed separately|3,880.80|FSC: 13; Default||External grouping not supported 95113981|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head-adaptor Versys Endo-pr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.60|FSC: 13; Default||Not reimbursed separately|291.60|FSC: 13; Default||External grouping not supported 95113982|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95113983|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95113984|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Cemented|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95188290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Poly Infinity Sz 1/ 1+ 6mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|FSC: 13; Default||Not reimbursed separately|5,696.19|FSC: 13; Default||External grouping not supported 95113986|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95185323|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Hexalobe 2.3mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95113987|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95192121|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113988|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95185319|EAP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Endovascular Body Fenestrated Proximal Custom|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|FSC: 13; Default||Not reimbursed separately|25,485.00|FSC: 13; Default||External grouping not supported 95113989|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95188289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Tray Tiabial Infinity Sz 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,795.00|FSC: 13; Default||Not reimbursed separately|15,795.00|FSC: 13; Default||External grouping not supported 95113990|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 47|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95185320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Low Profile Ti 3.5mm X 46mm Locking|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95113991|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95113992|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95185321|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Neutral Total Wrist Fusion|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|FSC: 13; Default||Not reimbursed separately|3,015.00|FSC: 13; Default||External grouping not supported 95113993|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95188285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Artic Bear Fix Uc Persona Left 13mm-tib C-d/fem 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|FSC: 13; Default||Not reimbursed separately|4,200.00|FSC: 13; Default||External grouping not supported 95113994|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95185322|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Multi Hexalobe 2.3mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|FSC: 13; Default||Not reimbursed separately|267.00|FSC: 13; Default||External grouping not supported 95113995|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95192122|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 9.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95113996|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 53|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95113997|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95113998|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95185325|EAP|Custom 95185325||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Epidural W/chloraprep And New Bd Needle For Ir Specials|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114000|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95188284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Tibial Knee Hinged Revision Howmedica 16mm X Xs/s S1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|FSC: 13; Default||Not reimbursed separately|3,922.80|FSC: 13; Default||External grouping not supported 95114001|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95185332|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Ti Full Thread 4.0mm / L14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|FSC: 13; Default||Not reimbursed separately|171.00|FSC: 13; Default||External grouping not supported 95114002|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95192123|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114003|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95185330|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap Ti 3.5x46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95114004|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95188288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Dome Talar Infinity Size 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,758.00|FSC: 13; Default||Not reimbursed separately|16,758.00|FSC: 13; Default||External grouping not supported 95114005|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95185326|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Rosen 1.5fc 180-035 Pg 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114006|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|FSC: 13; Default||Not reimbursed separately|1,050.00|FSC: 13; Default||External grouping not supported 95114007|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 57|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95185327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Suture Anchor Peek Mini Pushlock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|FSC: 13; Default||Not reimbursed separately|1,080.00|FSC: 13; Default||External grouping not supported 95114008|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95188291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular 10mm Purple Stripe C D Lcck Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|FSC: 13; Default||Not reimbursed separately|6,864.00|FSC: 13; Default||External grouping not supported 95114009|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Endo Femoral 63|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|FSC: 13; Default||Not reimbursed separately|1,117.80|FSC: 13; Default||External grouping not supported 95192124|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114017|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 10fen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114028|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Facial Oral Maxillo Cranio|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|FSC: 13; Default||Not reimbursed separately|397.20|FSC: 13; Default||External grouping not supported 95185331|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Self Tap Ti 2.7x28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|FSC: 13; Default||Not reimbursed separately|81.00|FSC: 13; Default||External grouping not supported 95114029|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 7mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95188297|EAP|Custom 95188297||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Attrax 5cc Synthetic|1|HUMANA [1294]||HUMANA [11839]|3,825.00|FSC: 13; Default||Not reimbursed separately|3,825.00|FSC: 13; Default||External grouping not supported 95114030|EAP|Custom 95114030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 4.0mm Three-fluted 195|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192125|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114036|EAP|Custom 95114036||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Binder X-lg 62-74 12 Wide|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185345|EAP|Custom 95185345||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Manifold Neptune (reprocessed)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114037|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mmx40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|FSC: 13; Default||Not reimbursed separately|39.00|FSC: 13; Default||External grouping not supported 95188292|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous It 6.0mm/l70mm/tl32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95114042|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95185343|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Kit Fuseforce 18mm X 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|FSC: 13; Default||Not reimbursed separately|6,285.00|FSC: 13; Default||External grouping not supported 95114051|EAP|Custom 95114051||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 13mm Wide X 16mm Leg Leng|1|HUMANA [1294]||HUMANA [11839]|361.68|FSC: 13; Default||Not reimbursed separately|361.68|FSC: 13; Default||External grouping not supported 95114052|EAP|Custom 95114052||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple 16mm X 22mm Leg Length Fi|1|HUMANA [1294]||HUMANA [11839]|297.15|FSC: 13; Default||Not reimbursed separately|297.15|FSC: 13; Default||External grouping not supported 95185339|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 430cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95114056|EAP|Custom 95114056||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Staple Fixation With Spike Mediu|1|HUMANA [1294]||HUMANA [11839]|1,029.00|FSC: 13; Default||Not reimbursed separately|1,029.00|FSC: 13; Default||External grouping not supported 95188295|EAP|Custom 95188295||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sealant Spine Duraseal|1|HUMANA [1294]||HUMANA [11839]|3,883.51|FSC: 13; Default||Not reimbursed separately|3,883.51|FSC: 13; Default||External grouping not supported 95114066|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mmx36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|FSC: 13; Default||Not reimbursed separately|39.00|FSC: 13; Default||External grouping not supported 95185340|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Gel Ultra High Profile Smooth 455cc|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|FSC: 13; Default||Not reimbursed separately|2,250.00|FSC: 13; Default||External grouping not supported 95114067|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical 4.5mmx38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|FSC: 13; Default||Not reimbursed separately|39.00|FSC: 13; Default||External grouping not supported 95192126|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114072|EAP|Custom 95114072||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Grommet Goode-t 1.25mm I.d. Sili|1|HUMANA [1294]||HUMANA [11839]|136.80|FSC: 13; Default||Not reimbursed separately|136.80|FSC: 13; Default||External grouping not supported 95114073|EAP|Custom 95114073||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Ear Malleus To Footplate|1|HUMANA [1294]||HUMANA [11839]|798.00|FSC: 13; Default||Not reimbursed separately|798.00|FSC: 13; Default||External grouping not supported 95114074|EAP|Custom 95114074||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp Rnd.carbide Long 2mmzb|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114075|EAP|Custom 95114075||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.rnd Carbidemedium 3.0|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114076|EAP|Custom 95114076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Burr Disp.oval Carbidemedium 4|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114082|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosorbable 3.5x28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95185336|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Advisa Sr Mri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,119.00|FSC: 13; Default||Not reimbursed separately|10,119.00|FSC: 13; Default||External grouping not supported 95114083|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosorbable 3.5x24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95188296|EAP|Custom 95188296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Applicator Micromyst Sealant Duraseal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114084|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Biosorbable 3.5x32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 80168669|EAP|CPT® 43251||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flex W/removal Of Tumor Or Polyps By Snare|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95114085|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bioabsorable 3.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|FSC: 13; Default||Not reimbursed separately|439.02|FSC: 13; Default||External grouping not supported 95192127|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114108|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 6.5mmx45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 80168651|EAP|CPT® 43254||0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION|Hb Egd Flexible, Transoral; With Endoscopic Mucosal Resection|1|HUMANA [1294]||HUMANA [11839]|4,437.84|FSC: 13; Default||Not reimbursed separately|4,437.84|FSC: 13; Default||External grouping not supported 95114128|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Gore-tex Cv Patch 5cmx 15c|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|FSC: 13; Default||Not reimbursed separately|1,902.00|FSC: 13; Default||External grouping not supported 95114130|EAP|Custom 95114130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Softjaw Insert 45mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185346|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Venture Rapid Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114131|EAP|Custom 95114131||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Punch Aortic 4mm Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188301|EAP|Custom 95188301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter 9mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114132|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Hemashield Straight 10mmx6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.63|FSC: 13; Default||Not reimbursed separately|1,539.63|FSC: 13; Default||External grouping not supported 95192128|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114137|EAP|Custom 95114137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Chest Dry 2500ml|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185350|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Mesh Polyform 15 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,465.10|FSC: 13; Default||Not reimbursed separately|2,465.10|FSC: 13; Default||External grouping not supported 95114141|EAP|Custom 95114141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Infusion Emergency 8.5fr.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188302|EAP|Custom 95188302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter 10mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114142|EAP|Custom 95114142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Cath Femoral Arterial/ Venou|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114143|EAP|Custom 95114143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube 35 French Broncho Cath Left|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114146|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95114193|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95192159|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 8.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114194|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cannulated Magna Fx 7.0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|FSC: 13; Default||Not reimbursed separately|672.00|FSC: 13; Default||External grouping not supported 95114198|EAP|Custom 95114198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sterna Band 14 Inch|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114201|EAP|Custom 95114201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Hip Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188304|EAP|Custom 95188304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thoracic Trocar 20fr Soft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114227|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax 45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95188316|EAP|Custom 95188316||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.0mm/ K-wire Attchm For Threaded Hole/61mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114229|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax 42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95114233|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Modular Endo Unitrax 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|FSC: 13; Default||Not reimbursed separately|2,748.90|FSC: 13; Default||External grouping not supported 95192129|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114236|EAP|Custom 95114236||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plug Bone Artisan Medium|1|HUMANA [1294]||HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95114237|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Head Neck 32 Short|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95188307|EAP|Custom 95188307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drain Express Single Chest Mini|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114238|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Head Neck 32 Long|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95185353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HB SCREW LOCKING MINI MAXEXTREME 2.4MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95114239|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95114240|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95185354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Mini Max Extreme 2.4mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95114241|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95188303|EAP|Custom 95188303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thoracic Trocar 12fr Soft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114242|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95114243|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95192158|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 7.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114244|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95184830|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Monofocal Tecnis 1 Preload Diopter 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|FSC: 13; Default||Not reimbursed separately|447.00|FSC: 13; Default||External grouping not supported 95114245|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95188306|EAP|Custom 95188306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thoracic Trocar 32fr Soft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114246|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95114247|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cup Acetabular Ti-bac-46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|FSC: 13; Default||Not reimbursed separately|2,487.75|FSC: 13; Default||External grouping not supported 95114248|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95185355|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb T2 Humeral Nail 8mmx230mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|FSC: 13; Default||Not reimbursed separately|4,515.00|FSC: 13; Default||External grouping not supported 95114249|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95188314|EAP|Custom 95188314||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.0mm/ K-wire Attchm For Threaded Hole/75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114250|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95192130|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114251|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114252|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114253|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95188305|EAP|Custom 95188305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Thoracic Trocar 28fr Soft|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114254|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95192157|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 7.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114255|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95185351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Y-plate Beta Mini Max Lock Extreme 2 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|FSC: 13; Default||Not reimbursed separately|3,034.50|FSC: 13; Default||External grouping not supported 95114256|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95188319|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Trimcor Select 1level 22mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95114257|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114258|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114259|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114260|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95185352|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking Mini Max Lock Extreme 2.4mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|FSC: 13; Default||Not reimbursed separately|304.50|FSC: 13; Default||External grouping not supported 95114261|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114262|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95192131|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114263|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114264|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95188320|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfn 11mm/125 Deg. Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95114265|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114266|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114267|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114268|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95188318|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Select Trinica 2l Level 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|FSC: 13; Default||Not reimbursed separately|3,600.00|FSC: 13; Default||External grouping not supported 95114269|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114270|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95192156|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 6.5 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114271|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114272|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114273|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114274|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114275|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114276|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114277|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95188309|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Cortex Slf-tpnwith T4 Stardrive Recess 1.3mm X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.89|FSC: 13; Default||Not reimbursed separately|136.89|FSC: 13; Default||External grouping not supported 95114278|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114279|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95192132|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114280|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114281|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114282|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Lps Flex Ef/7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|FSC: 13; Default||Not reimbursed separately|4,348.02|FSC: 13; Default||External grouping not supported 95114283|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95188310|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking Slf-tpngwith T4 Stardrive Recess 1.3mm X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95114284|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114285|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95192155|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular Diopter 6.0 Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114286|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ps Nexgen Stri|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|FSC: 13; Default||Not reimbursed separately|2,937.78|FSC: 13; Default||External grouping not supported 95114287|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,711.27|FSC: 13; Default||Not reimbursed separately|6,711.27|FSC: 13; Default||External grouping not supported 95114288|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Ps Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95188311|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking Slf-tpngwith T4 Stardrive Recess 1.3mm X 7m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95114289|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|FSC: 13; Default||Not reimbursed separately|6,770.40|FSC: 13; Default||External grouping not supported 95192133|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114290|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Cemented Lps Nexgen|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95114291|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114292|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114293|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114294|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95188312|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking Slf-tpngwith T4 Stardrive Recess 1.3mm X 9m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95114295|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95192134|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114296|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114297|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Cemented Plus 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114298|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Extended Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114299|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Extended Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95114300|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Extended Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95188313|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Ti Locking Phalange Headplate 1.3 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,520.04|FSC: 13; Default||Not reimbursed separately|1,520.04|FSC: 13; Default||External grouping not supported 95114301|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Extended Offset|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|FSC: 13; Default||Not reimbursed separately|6,817.68|FSC: 13; Default||External grouping not supported 95192135|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114302|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95114303|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95188315|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ti Locking Slf-tpngwith T4 Stardrive Recess 1.3mm X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.11|FSC: 13; Default||Not reimbursed separately|361.11|FSC: 13; Default||External grouping not supported 95114304|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95114305|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x40 .|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95114306|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.27|FSC: 13; Default||Not reimbursed separately|276.27|FSC: 13; Default||External grouping not supported 95114307|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.27|FSC: 13; Default||Not reimbursed separately|276.27|FSC: 13; Default||External grouping not supported 95114308|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95188317|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Troch For 3 S Nail|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,496.40|FSC: 13; Default||Not reimbursed separately|4,496.40|FSC: 13; Default||External grouping not supported 95114309|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114310|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95192136|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114311|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114312|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 80169742|EAP|CPT® 42000||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hb Drainage Of Abscess Of Palate, Uvula|1|HUMANA [1294]||HUMANA [11839]|580.29|FSC: 13; Default||Not reimbursed separately|580.29|FSC: 13; Default||External grouping not supported 95114313|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114314|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114315|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114316|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114317|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114318|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95188321|EAP|Custom 95188321||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Nester Embolization .35 7 X 12|1|HUMANA [1294]||HUMANA [11839]|222.48|FSC: 13; Default||Not reimbursed separately|222.48|FSC: 13; Default||External grouping not supported 95114319|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95114320|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95192138|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114321|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95114322|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-52-20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95114323|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95188322|EAP|Custom 95188322||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Coil Mri Embolization .038 Diameter X 5cm Length 12mm|1|HUMANA [1294]||HUMANA [11839]|247.50|FSC: 13; Default||Not reimbursed separately|247.50|FSC: 13; Default||External grouping not supported 95114324|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W Hole 6200-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95192139|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114325|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/hole 6200-58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|FSC: 13; Default||Not reimbursed separately|6,247.50|FSC: 13; Default||External grouping not supported 95114326|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95114327|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95114328|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Trilogy 6.5x15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95114329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +7 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95114330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +10.5 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.10|FSC: 13; Default||Not reimbursed separately|1,661.10|FSC: 13; Default||External grouping not supported 95114331|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114332|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Shell W/cluster-hole 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|FSC: 13; Default||Not reimbursed separately|3,601.89|FSC: 13; Default||External grouping not supported 95114333|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114334|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114335|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Centralizer Versys Proximal V-li|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.02|FSC: 13; Default||Not reimbursed separately|151.02|FSC: 13; Default||External grouping not supported 95114336|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +0 X 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95114337|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral -2.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|FSC: 13; Default||Not reimbursed separately|1,733.40|FSC: 13; Default||External grouping not supported 95188325|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Snap Off Lg 2mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|FSC: 13; Default||Not reimbursed separately|1,761.00|FSC: 13; Default||External grouping not supported 95114338|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Versys Femoral +3.0 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95192140|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114339|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114340|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95188330|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Humeral Press Fit Reunion 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|FSC: 13; Default||Not reimbursed separately|15,752.25|FSC: 13; Default||External grouping not supported 95114341|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114342|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114343|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114344|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114345|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Metal Fiber Lm Hacoated 14m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,261.44|FSC: 13; Default||Not reimbursed separately|16,261.44|FSC: 13; Default||External grouping not supported 95188327|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 48 21 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95114346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95192141|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114348|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95188328|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|FSC: 13; Default||Not reimbursed separately|9,121.50|FSC: 13; Default||External grouping not supported 95114350|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|FSC: 13; Default||Not reimbursed separately|8,700.00|FSC: 13; Default||External grouping not supported 95114351|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Midcoat Fiber M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|FSC: 13; Default||Not reimbursed separately|10,854.00|FSC: 13; Default||External grouping not supported 95114358|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Tracheostomy Double-cuff 80|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188329|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Insert Humeral X3 36mmx4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|FSC: 13; Default||Not reimbursed separately|4,635.00|FSC: 13; Default||External grouping not supported 95114360|EAP|Custom 95114360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Size 6 8 Inch Length Sila|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192142|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114361|EAP|Custom 95114361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tubing Size 8 8 Inch Length Sila|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114362|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Med Neck 22mm 9026-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|948.78|FSC: 13; Default||Not reimbursed separately|948.78|FSC: 13; Default||External grouping not supported 95188323|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducers Micro 4f .018 X 40cm Tungsten Tip 7cm 10/bx|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114363|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Femoral Long Neck 22mm 9026|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|FSC: 13; Default||Not reimbursed separately|1,740.03|FSC: 13; Default||External grouping not supported 95114364|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Head Femoral 28 Diameter Me|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95114372|EAP|Custom 95114372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Arterial 16fr Perfusion.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114375|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95114376|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|FSC: 13; Default||Not reimbursed separately|5,727.00|FSC: 13; Default||External grouping not supported 95114377|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Versys Ld/fx Press Fit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|FSC: 13; Default||Not reimbursed separately|3,000.00|FSC: 13; Default||External grouping not supported 95114378|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Liner Acetabular Trilogy 28mm Id|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,042.04|FSC: 13; Default||Not reimbursed separately|2,042.04|FSC: 13; Default||External grouping not supported 95114383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Center Drive 1.5mm/emer 1.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.80|FSC: 13; Default||Not reimbursed separately|100.80|FSC: 13; Default||External grouping not supported 95114384|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 8 Hole Regular Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|FSC: 13; Default||Not reimbursed separately|294.00|FSC: 13; Default||External grouping not supported 95114385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 4 Hole Medium Tit|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|FSC: 13; Default||Not reimbursed separately|354.00|FSC: 13; Default||External grouping not supported 95192143|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114386|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Orbital 10 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,248.00|FSC: 13; Default||Not reimbursed separately|1,248.00|FSC: 13; Default||External grouping not supported 95114387|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Orbital 6 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.00|FSC: 13; Default||Not reimbursed separately|357.00|FSC: 13; Default||External grouping not supported 95188324|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tfna Ti Cannulated 11mmx130 235mm Left Sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,209.20|FSC: 13; Default||Not reimbursed separately|5,209.20|FSC: 13; Default||External grouping not supported 95114388|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Orbital 8 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|FSC: 13; Default||Not reimbursed separately|495.00|FSC: 13; Default||External grouping not supported 95114389|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Straight 4 Hole Long Titan|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|FSC: 13; Default||Not reimbursed separately|195.00|FSC: 13; Default||External grouping not supported 95114391|EAP|Custom 95114391||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Cover Foot Av-impulse Regular|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114392|EAP|Custom 95114392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill Cannulated 2.0mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114393|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.1mm Non Threaded|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114394|EAP|Custom 95114394||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hemoconcentrator No-rinse .96 Su|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188337|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lockng 4.0mm X L95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|FSC: 13; Default||Not reimbursed separately|909.00|FSC: 13; Default||External grouping not supported 95114395|EAP|Custom 95114395||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 32mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192144|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114396|EAP|Custom 95114396||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 35mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114397|EAP|Custom 95114397||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Patella Reamer 38mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping Mgii 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95114399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Self-tapping Mgii 7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95188341|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Apex S/d Half Pin 35 Thread 5 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|FSC: 13; Default||Not reimbursed separately|461.25|FSC: 13; Default||External grouping not supported 95114400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 55 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95192145|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw M/g Ii6.5 X 60 Self Tappin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|FSC: 13; Default||Not reimbursed separately|252.24|FSC: 13; Default||External grouping not supported 95114411|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|FSC: 13; Default||Not reimbursed separately|4,399.20|FSC: 13; Default||External grouping not supported 95114412|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|FSC: 13; Default||Not reimbursed separately|4,399.20|FSC: 13; Default||External grouping not supported 95114413|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95114414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95188340|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Rod Hoffmann 3 Connecting 11x100mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,014.75|FSC: 13; Default||Not reimbursed separately|1,014.75|FSC: 13; Default||External grouping not supported 95114415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95114416|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95192146|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114417|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95114418|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95188338|EAP|Custom 95188338||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Disc Cervical Lp Prestige 6 Mm X 16 Mm|1|HUMANA [1294]||HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95114419|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95114420|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Porous Pegged Nexge|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|FSC: 13; Default||Not reimbursed separately|5,410.56|FSC: 13; Default||External grouping not supported 95114421|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95114422|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,080.80|FSC: 13; Default||Not reimbursed separately|8,080.80|FSC: 13; Default||External grouping not supported 95188339|EAP|Custom 95188339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Rail|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114423|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|FSC: 13; Default||Not reimbursed separately|2,524.23|FSC: 13; Default||External grouping not supported 95114424|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|FSC: 13; Default||Not reimbursed separately|2,524.23|FSC: 13; Default||External grouping not supported 95192147|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114425|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114426|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114427|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114428|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95188348|EAP|Custom 95188348||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 2.55mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114429|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95192148|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114430|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114431|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114432|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Pegged Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|FSC: 13; Default||Not reimbursed separately|4,471.89|FSC: 13; Default||External grouping not supported 95114433|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Pegged Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|FSC: 13; Default||Not reimbursed separately|4,471.89|FSC: 13; Default||External grouping not supported 95114434|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Pegged Nexg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|FSC: 13; Default||Not reimbursed separately|4,471.89|FSC: 13; Default||External grouping not supported 95114435|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.80|FSC: 13; Default||Not reimbursed separately|1,762.80|FSC: 13; Default||External grouping not supported 95188346|EAP|Custom 95188346||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Flipcutter 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114436|EAP|Custom 95114436||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Meridional 6mm X 10.5mm|1|HUMANA [1294]||HUMANA [11839]|64.80|FSC: 13; Default||Not reimbursed separately|64.80|FSC: 13; Default||External grouping not supported 95192149|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114437|EAP|Custom 95114437||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trephine Lacrimal 21gauge X 5/8|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114439|EAP|Custom 95114439||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 8.25mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188353|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 1.5mm X 4mm Self Tapping With T4 Stardrive Rece|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.34|FSC: 13; Default||Not reimbursed separately|146.34|FSC: 13; Default||External grouping not supported 95114440|EAP|Custom 95114440||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 7.5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114441|EAP|Custom 95114441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Trephine 7.75mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114442|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95114452|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|FSC: 13; Default||Not reimbursed separately|4,399.20|FSC: 13; Default||External grouping not supported 95114453|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95114454|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95188351|EAP|Custom 95188351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Passer Standard Dfp|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114455|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|FSC: 13; Default||Not reimbursed separately|3,900.00|FSC: 13; Default||External grouping not supported 95114456|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Tibial Precoat Stemmed Nex|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|FSC: 13; Default||Not reimbursed separately|4,399.20|FSC: 13; Default||External grouping not supported 95192150|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114457|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,080.80|FSC: 13; Default||Not reimbursed separately|8,080.80|FSC: 13; Default||External grouping not supported 95114459|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95114460|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95114461|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95188359|EAP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Putty Attrax 1cc Synthetic|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,014.00|FSC: 13; Default||Not reimbursed separately|1,014.00|FSC: 13; Default||External grouping not supported 95114462|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,080.80|FSC: 13; Default||Not reimbursed separately|8,080.80|FSC: 13; Default||External grouping not supported 95114463|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95114464|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95114465|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95188358|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Ti 4.5mm X L65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|FSC: 13; Default||Not reimbursed separately|144.00|FSC: 13; Default||External grouping not supported 95114466|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Porous Cr Nexgen Si|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|FSC: 13; Default||Not reimbursed separately|7,800.00|FSC: 13; Default||External grouping not supported 95114467|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Blue|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.21|FSC: 13; Default||Not reimbursed separately|2,625.21|FSC: 13; Default||External grouping not supported 95114468|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114469|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95114470|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114471|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|FSC: 13; Default||Not reimbursed separately|2,700.00|FSC: 13; Default||External grouping not supported 95114472|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|FSC: 13; Default||Not reimbursed separately|2,542.80|FSC: 13; Default||External grouping not supported 95114473|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Gree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,539.80|FSC: 13; Default||Not reimbursed separately|2,539.80|FSC: 13; Default||External grouping not supported 95188360|EAP|Custom 95188360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Tube Closed|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114474|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|FSC: 13; Default||Not reimbursed separately|2,524.23|FSC: 13; Default||External grouping not supported 95192151|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114475|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Surface Articular Ac Nexgen Yell|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|FSC: 13; Default||Not reimbursed separately|2,524.23|FSC: 13; Default||External grouping not supported 95114476|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95188357|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous Full Thread 6mm 6.0mm/l40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|FSC: 13; Default||Not reimbursed separately|213.00|FSC: 13; Default||External grouping not supported 95114477|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95114478|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Patella All Poly Nexgen 41mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|FSC: 13; Default||Not reimbursed separately|1,500.00|FSC: 13; Default||External grouping not supported 95114479|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|FSC: 13; Default||Not reimbursed separately|6,000.00|FSC: 13; Default||External grouping not supported 95114480|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95114481|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Femoral Precoat Cr Nexgen S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|FSC: 13; Default||Not reimbursed separately|6,608.31|FSC: 13; Default||External grouping not supported 95114487|EAP|Custom 95114487||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Umbilical Vessel 3-1/2f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192152|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114489|EAP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ureteral Filiform 5fr S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114497|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95188387|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Glenoid Self-pressurizing Size 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|FSC: 13; Default||Not reimbursed separately|8,016.75|FSC: 13; Default||External grouping not supported 95114507|EAP|Custom 95114507||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Bone Screw 3.2mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114511|EAP|Custom 95114511||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Manipulator Uterine Injector 5mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114512|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anterior Cervical 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|FSC: 13; Default||Not reimbursed separately|1,374.00|FSC: 13; Default||External grouping not supported 95188384|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 48 18 Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|FSC: 13; Default||Not reimbursed separately|7,076.25|FSC: 13; Default||External grouping not supported 95114518|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 9mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95114519|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bio 8mm X 25mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|FSC: 13; Default||Not reimbursed separately|289.11|FSC: 13; Default||External grouping not supported 95192153|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 29.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114520|EAP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Trapezium Silastic 4|1|HUMANA [1294]||HUMANA [11839]|840.00|FSC: 13; Default||Not reimbursed separately|840.00|FSC: 13; Default||External grouping not supported 95188386|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Head Humeral Radius Single Size 52 17 Mm Thkns|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|FSC: 13; Default||Not reimbursed separately|6,774.75|FSC: 13; Default||External grouping not supported 95114533|EAP|Custom 95114533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guide Clear-delivery 6mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185357|EAP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Lead Attain P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95114534|EAP|Custom 95114534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter 4mm Variable-depth|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114535|EAP|Custom 95114535||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Skin Regular Rotating He|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7mm Ti Lcp (tm) 10 Holes/94mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 95114541|EAP|Custom 95114541||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clamp Biopsy 12mm Muscle|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188381|EAP|HCPCS c1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Lp Non Lock 2.7mmx14mm|1|HUMANA [1294]||HUMANA [11839]|225.00|FSC: 13; Default||Not reimbursed separately|225.00|FSC: 13; Default||External grouping not supported 95114550|EAP|Custom 95114550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pin Guide Cannulated Herbert 1.6|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185362|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm X 18mm Ti Locking Slf-tpng With T8 Stardrive Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95114553|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 320 Prefill Syr 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|FSC: 13; Default||Not reimbursed separately|0.93|FSC: 13; Default||External grouping not supported 95192154|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 30.0 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114565|EAP|Custom 95114565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Parts Spare Legacy Series-20|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185366|EAP|Custom 95185366||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Stentbody Main Afx 22-70/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|FSC: 13; Default||Not reimbursed separately|34,740.00|FSC: 13; Default||External grouping not supported 95114566|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 320 (150ml) 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|FSC: 13; Default||Not reimbursed separately|0.64|FSC: 13; Default||External grouping not supported 95188390|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Double Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.00|FSC: 13; Default||Not reimbursed separately|798.00|FSC: 13; Default||External grouping not supported 95185363|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm Ti Cortex Stardrive Recess 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|FSC: 13; Default||Not reimbursed separately|123.90|FSC: 13; Default||External grouping not supported 95114573|EAP|Custom 95114573||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Snare Polypectomy 240cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185369|EAP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Graft Valsalva Technique Sparing Valve Gel Weave 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|FSC: 13; Default||Not reimbursed separately|7,350.00|FSC: 13; Default||External grouping not supported 95114602|EAP|HCPCS A4397||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Irrigation 1-3/4 Visi-fl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Lumbar Fusion Irix-a 38x18x12degree 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|FSC: 13; Default||Not reimbursed separately|20,700.00|FSC: 13; Default||External grouping not supported 95114604|EAP|HCPCS A4397||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Irrigation 2-1/4 Visi-fl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185367|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Short Thread 4.0x18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.60|FSC: 13; Default||Not reimbursed separately|705.60|FSC: 13; Default||External grouping not supported 95114607|EAP|HCPCS A4397||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeve Irrigation 2-3/4 Visi-fl|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192104|EAP|Custom 95192104||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Fixation Kirschner Ncb 2mmx280mm Femur Distal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185364|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 2.7mm Ti Lcp(tm) 8 Holes/76mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|FSC: 13; Default||Not reimbursed separately|1,343.01|FSC: 13; Default||External grouping not supported 95188382|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humeral Proxiaml Hi Right 3hole X80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|FSC: 13; Default||Not reimbursed separately|6,600.00|FSC: 13; Default||External grouping not supported 95114619|EAP|Custom 95114619||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Groshong Catheter Red|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185368|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Alpha Medialmax 4 Degree|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|FSC: 13; Default||Not reimbursed separately|4,189.50|FSC: 13; Default||External grouping not supported 95114621|EAP|Custom 95114621||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Decompression Colon|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114622|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 3 French Picc Mid Line|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95185361|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw 2.7mm X 16mm Ti Locking Slf-tpng With T8 Stardrive Rec|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.75|FSC: 13; Default||Not reimbursed separately|384.75|FSC: 13; Default||External grouping not supported 95114635|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 320 (50ml) 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|FSC: 13; Default||Not reimbursed separately|0.68|FSC: 13; Default||External grouping not supported 95188385|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95114642|EAP|Custom 95114642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Myleogram 22 Gauge X 3.5|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80168678|EAP|CPT® 28003||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hb I&d Below Fascia, W And Wo Tendon Sheath Invol Foot Mult Areas|1|HUMANA [1294]||HUMANA [11839]|8,450.46|FSC: 13; Default||Not reimbursed separately|8,450.46|FSC: 13; Default||External grouping not supported 95114649|EAP|Custom 95114649||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bed Specialty Clinitron Unit- C1|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192169|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Coated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|FSC: 13; Default||Not reimbursed separately|9,561.00|FSC: 13; Default||External grouping not supported 95114652|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex 2.4mm X 14mm Self T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|FSC: 13; Default||Not reimbursed separately|159.00|FSC: 13; Default||External grouping not supported 95114653|EAP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Optiray 320 (100ml) 1ml Chg|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|FSC: 13; Default||Not reimbursed separately|0.67|FSC: 13; Default||External grouping not supported 95188379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Anchorage Mtp V2 Left S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|FSC: 13; Default||Not reimbursed separately|6,879.00|FSC: 13; Default||External grouping not supported 95114654|EAP|Custom 95114654||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bed Specialty Flexicair Unit- I3|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114656|EAP|Custom 95114656||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bed Specialty Flexicair Unit- Mc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114665|EAP|HCPCS Q9965||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|Hb Omnipaque 180 1ml Chg|1|HUMANA [1294]||HUMANA [11839]|8.95|FSC: 13; Default||Not reimbursed separately|8.95|FSC: 13; Default||External grouping not supported 95114667|EAP|Custom 95114667||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bed Specialty Magnum System-iimd|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188383|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Canc 4.0 X 34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|FSC: 13; Default||Not reimbursed separately|310.50|FSC: 13; Default||External grouping not supported 95185370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Starfire 7.5x40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95114679|EAP|Custom 95114679||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sheath Needle Introducer 1.9|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192170|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Partial Hip Uncoated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|FSC: 13; Default||Not reimbursed separately|6,084.00|FSC: 13; Default||External grouping not supported 95114683|EAP|Custom 95114683||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bed Specialty Flexicair Unit- Ec|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185371|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Polyaxial Starfire 7.5x45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|FSC: 13; Default||Not reimbursed separately|3,480.00|FSC: 13; Default||External grouping not supported 95114690|EAP|Custom 95114690||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Retrieval Balloon 11.5m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpnwith T6 Stardrive Recess Ti 2.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95114697|EAP|Custom 95114697||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cannula Fluro-tip Ultra|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185372|EAP|Custom 95185372||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Osteotomy Truss 18x18mm 14degree 6.5height|1|HUMANA [1294]||HUMANA [11839]|7,110.00|FSC: 13; Default||Not reimbursed separately|7,110.00|FSC: 13; Default||External grouping not supported 95114700|EAP|Custom 95114700||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Connector Groshong Catheter Whit|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114702|EAP|Custom 95114702||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Umbilical Vessel 8fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114703|EAP|Custom 95114703||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Umbilical Vessel 5fr 15|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188400|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpnwith T6 Stardrive Recess Ti 2.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95114711|EAP|Custom 95114711||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Lumbar Pedi/infant #4302c 2|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185378|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95114713|EAP|Custom 95114713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tray Transfusion Exchange|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192137|EAP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Restor Toric|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|FSC: 13; Default||Not reimbursed separately|2,685.00|FSC: 13; Default||External grouping not supported 95114719|EAP|Custom 95114719||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|Hb Media Contrast Md Gastroview 121|1|HUMANA [1294]||HUMANA [11839]|0.36|FSC: 13; Default||Not reimbursed separately|0.36|FSC: 13; Default||External grouping not supported 95185380|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Hexalobe 3.5mmx32mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95188398|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortex Slf-tpngwith Stardrive Recess Ti 2.0mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.05|FSC: 13; Default||Not reimbursed separately|115.05|FSC: 13; Default||External grouping not supported 95114726|EAP|Custom 95114726||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Crutch Wood Adult Extra-large Wi|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185379|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non-locking Hexalobe 2.7mmx8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|FSC: 13; Default||Not reimbursed separately|339.00|FSC: 13; Default||External grouping not supported 95114728|EAP|Custom 95114728||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Sleeves Scd Knee Length|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114729|EAP|Custom 95114729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Support Facioplasty Elastic Smal|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Humerus Med.distal Va-lcp 2.7mm/3.5mm 1hole/right/69mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|FSC: 13; Default||Not reimbursed separately|3,698.58|FSC: 13; Default||External grouping not supported 95114732|EAP|Custom 95114732||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hoods Replacement Large Size (fo|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188399|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va-lcking Slf-tpnwith T6 Stardrive Recess Ti 2.0mm X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.41|FSC: 13; Default||Not reimbursed separately|415.41|FSC: 13; Default||External grouping not supported 95114733|EAP|Custom 95114733||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Hoods Replacement Regular Size(f|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95185377|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95114742|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Guide 1.1mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95192171|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Coated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,526.00|FSC: 13; Default||Not reimbursed separately|14,526.00|FSC: 13; Default||External grouping not supported 95185376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Va Lock 2.7mm X 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.60|FSC: 13; Default||Not reimbursed separately|462.60|FSC: 13; Default||External grouping not supported 95188396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Fibular Distal Lat Ti Lcp 2.7/3.5mm 9 Hole Rt/151mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,209.23|FSC: 13; Default||Not reimbursed separately|2,209.23|FSC: 13; Default||External grouping not supported 95114782|EAP|Custom 95114782||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Kit Arterial Line 20ga X12cm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114801|EAP|Custom 95114801||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 10.5mm Thoracoport|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114802|EAP|Custom 95114802||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon Preperitoneal Distention|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114803|EAP|Custom 95114803||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Trocar 10mm Blunt Tip|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pin Steinman 5.0mm With Central Thread 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.05|FSC: 13; Default||Not reimbursed separately|520.05|FSC: 13; Default||External grouping not supported 95114810|EAP|Custom 95114810||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stimulator Nerve|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114819|EAP|Custom 95114819||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Overlay Relief Pressure (geo-mat|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95192172|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Hip Uncoated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,561.00|FSC: 13; Default||Not reimbursed separately|12,561.00|FSC: 13; Default||External grouping not supported 95114824|EAP|Custom 95114824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cutter Linear Endoscopic35|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95188402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Condylar Val 2 Holes Head-6 Holes Shaft Ti 2.omm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,829.22|FSC: 13; Default||Not reimbursed separately|1,829.22|FSC: 13; Default||External grouping not supported 95114826|EAP|Custom 95114826||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stapler Endocutter Linear Standm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114827|EAP|Custom 95114827||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Staple Reload-unit Endocutter Sm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114830|EAP|Custom 95114830||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Bottle Collect. Safetouch Disp W|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114836|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95188403|EAP|Custom 95188403||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 1.5mm K-wire Attchm For Threaded Hole/88mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114837|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95185405|EAP|Custom 95185405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Drill Cannulated 3.5mmmm Ao Fitting|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114838|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 280mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 95192173|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Knee Unicondylar|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|FSC: 13; Default||Not reimbursed separately|12,528.00|FSC: 13; Default||External grouping not supported 95114839|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,258.20|FSC: 13; Default||Not reimbursed separately|4,258.20|FSC: 13; Default||External grouping not supported 95188405|EAP|Custom 95188405||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Spacer Cervical Stealth 14x16x11 6 Degree|1|HUMANA [1294]||HUMANA [11839]|3,450.00|FSC: 13; Default||Not reimbursed separately|3,450.00|FSC: 13; Default||External grouping not supported 95114840|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|FSC: 13; Default||Not reimbursed separately|3,051.00|FSC: 13; Default||External grouping not supported 95114841|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Solid 9mm X 360mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95188404|EAP|Custom 95188404||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb K-wire 1.0mm W/trocar Point 150mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114842|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Solid 9mm X 400mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95192174|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Coated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|FSC: 13; Default||Not reimbursed separately|15,387.00|FSC: 13; Default||External grouping not supported 95114843|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Solid 9mm X 420mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 95185410|EAP|Custom 95185410||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 2mm Tracker System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114844|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 320|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|FSC: 13; Default||Not reimbursed separately|1,842.00|FSC: 13; Default||External grouping not supported 95188414|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Bone Full Thread T10 2.7mmxl30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|FSC: 13; Default||Not reimbursed separately|564.00|FSC: 13; Default||External grouping not supported 95114845|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185411|EAP|Custom 95185411||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Bit Drill 3.2mm Tracker System|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114846|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 360|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95114847|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185404|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Unthreaded Guide 2.0 X 150mm Asnis|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114848|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 420|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95188415|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking Full Thread T10 3.5mm X L34mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|FSC: 13; Default||Not reimbursed separately|1,035.00|FSC: 13; Default||External grouping not supported 95114849|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 10mm 440|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185409|EAP|Custom 95185409||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Biopsy Tool Coring|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114850|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 420|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|FSC: 13; Default||Not reimbursed separately|1,650.00|FSC: 13; Default||External grouping not supported 95192175|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Hybrid|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|FSC: 13; Default||Not reimbursed separately|14,718.00|FSC: 13; Default||External grouping not supported 95114851|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 11mm 320|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185414|EAP|Custom 95185414||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Pack Eye Pikpak Custom Wiakhom|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114852|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 11mm 340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95114853|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 11mm 360|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185398|EAP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Power Tl 20cm St Acute Dial Kit 5/ca|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|FSC: 13; Default||Not reimbursed separately|420.00|FSC: 13; Default||External grouping not supported 95114854|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 11mm 380|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|FSC: 13; Default||Not reimbursed separately|1,842.00|FSC: 13; Default||External grouping not supported 95114855|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Cannulated Ti 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185386|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 5 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114856|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 11mm 420|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95188419|EAP|Custom 95188419||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Device Endoscopic Amplif Eye Small|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114857|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 11mm 440|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|FSC: 13; Default||Not reimbursed separately|1,665.00|FSC: 13; Default||External grouping not supported 95185402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Compression Headless 4.0mm X L42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|FSC: 13; Default||Not reimbursed separately|1,767.00|FSC: 13; Default||External grouping not supported 95114858|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Femoral 12mm 320|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|FSC: 13; Default||Not reimbursed separately|1,842.00|FSC: 13; Default||External grouping not supported 95192176|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap Total Knee Uncoated|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|FSC: 13; Default||Not reimbursed separately|12,762.00|FSC: 13; Default||External grouping not supported 95114859|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,258.20|FSC: 13; Default||Not reimbursed separately|4,258.20|FSC: 13; Default||External grouping not supported 95185384|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 4 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114860|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 95188421|EAP|Custom 95188421||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Resolution 360|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114861|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 12mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180346|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon 1 Left|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95114862|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180347|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Component Femoral Stabilized Posterior Triathlon 1 Right|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|FSC: 13; Default||Not reimbursed separately|16,142.70|FSC: 13; Default||External grouping not supported 95114863|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180348|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Inlay Polyethylene W.tantalum Marker Medium 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,120.00|FSC: 13; Default||Not reimbursed separately|3,120.00|FSC: 13; Default||External grouping not supported 95114864|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 280mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,598.32|FSC: 13; Default||Not reimbursed separately|3,598.32|FSC: 13; Default||External grouping not supported 95180349|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Baseplate Tibial Tritanium Triathlon Size 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|FSC: 13; Default||Not reimbursed separately|7,200.00|FSC: 13; Default||External grouping not supported 95114865|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180351|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate End Inferior Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,325.00|FSC: 13; Default||Not reimbursed separately|17,325.00|FSC: 13; Default||External grouping not supported 95114866|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180352|EAP|Custom 95180352||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Polibar 14oz 24 Case|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114867|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 95180350|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate End Superior Medium|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,325.00|FSC: 13; Default||Not reimbursed separately|17,325.00|FSC: 13; Default||External grouping not supported 95114868|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 95180353|EAP|Custom 95180353||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Suture Pds Ii O Ct 2 Vil Mono 27 36 Bx|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114869|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180354|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Low Profile Straight 2.4mm 5 Hole|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|FSC: 13; Default||Not reimbursed separately|2,085.00|FSC: 13; Default||External grouping not supported 95114870|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 11mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180355|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Kit Cath Central Venous Double Lumen Flex Tip 4fr X 12 5 Cs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114871|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 380mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 80166622|EAP|CPT® 90471||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hb Immun Admin Newborn Services|1|HUMANA [1294]||HUMANA [11839]|19.93|FSC: 13; Default||Not reimbursed separately|19.93|FSC: 13; Default||External grouping not supported 95114872|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 320mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.56|FSC: 13; Default||Not reimbursed separately|3,418.56|FSC: 13; Default||External grouping not supported 95180356|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex .035 6mm 200mm 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|FSC: 13; Default||Not reimbursed separately|6,825.00|FSC: 13; Default||External grouping not supported 95114873|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 340mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|FSC: 13; Default||Not reimbursed separately|2,763.00|FSC: 13; Default||External grouping not supported 95180357|EAP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stent Protege Everflex .35 8mm 200mm 120cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|FSC: 13; Default||Not reimbursed separately|6,825.00|FSC: 13; Default||External grouping not supported 95114874|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 360mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,258.20|FSC: 13; Default||Not reimbursed separately|4,258.20|FSC: 13; Default||External grouping not supported 95185385|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 5 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114875|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 200mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180359|EAP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Tissue Regenerative Alloderm 1cm X 4cm Thin|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|FSC: 13; Default||Not reimbursed separately|90.00|FSC: 13; Default||External grouping not supported 95114876|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 240mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180360|EAP|Custom 95180360||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Allograft Gracilis Single Strand|1|HUMANA [1294]||HUMANA [11839]|3,300.00|FSC: 13; Default||Not reimbursed separately|3,300.00|FSC: 13; Default||External grouping not supported 95114877|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Ti Distal 10mm 280m|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|FSC: 13; Default||Not reimbursed separately|2,904.00|FSC: 13; Default||External grouping not supported 95114878|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 300mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180364|EAP|Custom 95180364||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Vascular Otw Indy 8.0 Fr/100cm/40mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114879|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Distal 10mm X 400mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|FSC: 13; Default||Not reimbursed separately|2,625.00|FSC: 13; Default||External grouping not supported 95180365|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial 10mm X 300mm T2 Standard|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|FSC: 13; Default||Not reimbursed separately|4,479.30|FSC: 13; Default||External grouping not supported 95114880|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mmx345mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|FSC: 13; Default||Not reimbursed separately|1,845.00|FSC: 13; Default||External grouping not supported 95180366|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Cornerstone Psr 6 X 14 X 11mm|1|HUMANA [1294]||HUMANA [11839]|4,395.30|FSC: 13; Default||Not reimbursed separately|4,395.30|FSC: 13; Default||External grouping not supported 95114881|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 8mm X 380mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180367|EAP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Cornerstone Psr 7 X 14 X 11|1|HUMANA [1294]||HUMANA [11839]|4,935.00|FSC: 13; Default||Not reimbursed separately|4,935.00|FSC: 13; Default||External grouping not supported 95114882|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 315mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95180369|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Anchor Suture Knotless Quickdraw 8 Mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|FSC: 13; Default||Not reimbursed separately|1,161.00|FSC: 13; Default||External grouping not supported 95114883|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 360mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|FSC: 13; Default||Not reimbursed separately|2,232.00|FSC: 13; Default||External grouping not supported 95180370|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Gamma Left 10 Mm X 400 Mm X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|FSC: 13; Default||Not reimbursed separately|6,028.20|FSC: 13; Default||External grouping not supported 95114884|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 380mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95114885|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Tibial Solid 9mm X 400mm Ti|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|FSC: 13; Default||Not reimbursed separately|1,752.00|FSC: 13; Default||External grouping not supported 95180372|EAP|Custom 95180372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Meniscus Mender Ii Disposable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114886|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95180373|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cancellous 4.0 Ss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|FSC: 13; Default||Not reimbursed separately|78.75|FSC: 13; Default||External grouping not supported 95114887|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.49|FSC: 13; Default||Not reimbursed separately|2,312.49|FSC: 13; Default||External grouping not supported 95180374|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate Femur Lateral Distal 10hole/l238mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,066.00|FSC: 13; Default||Not reimbursed separately|12,066.00|FSC: 13; Default||External grouping not supported 95114888|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|FSC: 13; Default||Not reimbursed separately|2,597.22|FSC: 13; Default||External grouping not supported 95180375|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mmxl40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|FSC: 13; Default||Not reimbursed separately|960.00|FSC: 13; Default||External grouping not supported 95114889|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|FSC: 13; Default||Not reimbursed separately|2,597.22|FSC: 13; Default||External grouping not supported 95180376|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 5.0mm/l95mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|FSC: 13; Default||Not reimbursed separately|776.25|FSC: 13; Default||External grouping not supported 95114890|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|FSC: 13; Default||Not reimbursed separately|2,312.64|FSC: 13; Default||External grouping not supported 95185394|EAP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Balloon In.pact Admiral Paclitaxel 7 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114891|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,968.00|FSC: 13; Default||Not reimbursed separately|1,968.00|FSC: 13; Default||External grouping not supported 95114892|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 10mm X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|FSC: 13; Default||Not reimbursed separately|2,312.64|FSC: 13; Default||External grouping not supported 80166630|EAP|Custom 80166630||0998 - STATISTICAL CHARGES|Hb Study Drug Infusion Ccc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114893|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95114894|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95180388|EAP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Matrix Wound Oasis Ultra 5cm X 7cm Meshed 5/bx|1|HUMANA [1294]||HUMANA [11839]|37.50|FSC: 13; Default||Not reimbursed separately|37.50|FSC: 13; Default||External grouping not supported 95114895|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|FSC: 13; Default||Not reimbursed separately|2,597.22|FSC: 13; Default||External grouping not supported 95180385|EAP|Custom 95180385||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb System Casting Medi-kast 5-3" & 5-4" Without Boots|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114896|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|FSC: 13; Default||Not reimbursed separately|2,312.64|FSC: 13; Default||External grouping not supported 95180386|EAP|Custom 95180386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 20 Naturalle 600cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114897|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|FSC: 13; Default||Not reimbursed separately|2,262.00|FSC: 13; Default||External grouping not supported 95180387|EAP|Custom 95180387||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Sizer Implant Breast For Style 15 Naturalle 700cc|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114898|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|FSC: 13; Default||Not reimbursed separately|2,597.22|FSC: 13; Default||External grouping not supported 95180389|EAP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter 7 Fr Ar1 Launcher Guiding|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114899|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 11mm X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95180390|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 12 Fr Hausdorf Sheath|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114900|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95180391|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Introducer 11 Fr Sheath 5/ Box|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114901|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95180379|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Crossboss|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114902|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|FSC: 13; Default||Not reimbursed separately|1,779.00|FSC: 13; Default||External grouping not supported 95180380|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stingray Hpc 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114903|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|FSC: 13; Default||Not reimbursed separately|2,067.00|FSC: 13; Default||External grouping not supported 95180381|EAP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Stingray|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114904|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Cannulated Tibial 12mm X 34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|FSC: 13; Default||Not reimbursed separately|2,312.64|FSC: 13; Default||External grouping not supported 95180382|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire Stingray Hpc 185 Cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95114905|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Cap End Ti 12mm 10mm Ext|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|FSC: 13; Default||Not reimbursed separately|243.00|FSC: 13; Default||External grouping not supported 95180383|EAP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|Hb Pacemaker Ingenio Sr Is-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|FSC: 13; Default||Not reimbursed separately|12,000.00|FSC: 13; Default||External grouping not supported 95114906|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Sleeve Locking 120mm Deg Sterie|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|FSC: 13; Default||Not reimbursed separately|615.00|FSC: 13; Default||External grouping not supported 95180384|EAP|Custom 95180384||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Stylet 52cm Tapered Limber-fine Line|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95114907|EAP|Custom 95114907||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Spiral Ti 80mm Sterile|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166641|EAP|HCPCS G0155||0561 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - VISIT CHARGE|Hb Inpatient Hospice Social Worker Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114908|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Solid 9mm X 320mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 80166652|EAP|HCPCS G0155||0561 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - VISIT CHARGE|Hb General Inpatient Social Worker Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114909|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Nail Femoral Solid 9mm X 340mm T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|FSC: 13; Default||Not reimbursed separately|1,320.00|FSC: 13; Default||External grouping not supported 80166663|EAP|HCPCS G0155||0561 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - VISIT CHARGE|Hb Skilled Facility Social Worker Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114927|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166674|EAP|HCPCS G0155||0561 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - VISIT CHARGE|Hb Long Term Care Social Worker Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114928|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166685|EAP|HCPCS G0155||0561 - HOME HEALTH (HH) - MEDICAL SOCIAL SERVICES - VISIT CHARGE|Hb Home Hospice Social Worker Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114929|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166696|EAP|HCPCS G0156||0571 - HOME HEALTH (HH) AIDE - VISIT CHARGE|Hb Inpatient Hospice Nurse Assistant Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114932|EAP|HCPCS A4351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Pedi 6 French|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166707|EAP|HCPCS G0156||0571 - HOME HEALTH (HH) AIDE - VISIT CHARGE|Hb General Inpatient Nurse Assistant Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114933|EAP|Custom 95114933||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Monitoring Arterial Pre|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166718|EAP|HCPCS G0156||0571 - HOME HEALTH (HH) AIDE - VISIT CHARGE|Hb Skilled Facility Nurse Assistant Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114975|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166729|EAP|HCPCS G0156||0571 - HOME HEALTH (HH) AIDE - VISIT CHARGE|Hb Long Term Care Nurse Assistant Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114976|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166730|EAP|HCPCS G0156||0571 - HOME HEALTH (HH) AIDE - VISIT CHARGE|Hb Home Hospice Nurse Assistant Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114977|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166741|EAP|Custom 80166741||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Inpatient Hospice Chaplain Ea 15 Pm Care|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114978|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166752|EAP|Custom 80166752||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb General Inpatient Chaplain Ea 15 Pm Care|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114980|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166763|EAP|Custom 80166763||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Skilled Facility Chaplain Ea 15 Pm Care|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114981|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166774|EAP|Custom 80166774||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Long Term Care Chaplain Ea 15 Pm Care|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114982|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166785|EAP|Custom 80166785||0580 - HOME HEALTH (HH) - OTHER VISITS - GENERAL CLASSIFICATION|Hb Home Hospice Chaplain Ea 15 Pm Care|1|HUMANA [1294]||HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114983|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166796|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Inpatient Hospice Nurse Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114984|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166807|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb General Inpatient Nurse Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114985|EAP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter An|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 80166818|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Skilled Facility Nurse Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 80166829|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Long Term Care Nurse Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114987|EAP|Custom 95114987||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Clip Titanium Small Horizon (24|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 80166830|EAP|HCPCS G0299||0551 - HOME HEALTH (HH) - SKILLED NURSING - VISIT CHARGE|Hb Home Hospice Nurse Ea 15 Pm Care|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.55|FSC: 13; Default||Not reimbursed separately|11.55|FSC: 13; Default||External grouping not supported 95114988|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 6.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180392|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 7 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95114989|EAP|Custom 95114989||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 19.5x81mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180394|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Cannulated 30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|FSC: 13; Default||Not reimbursed separately|471.00|FSC: 13; Default||External grouping not supported 95114991|EAP|Custom 95114991||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Nozzle Flexible Injector Cement|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180395|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Cannulated 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|FSC: 13; Default||Not reimbursed separately|471.00|FSC: 13; Default||External grouping not supported 95114992|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180396|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Washer Screw Corticle 36mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|FSC: 13; Default||Not reimbursed separately|1,008.00|FSC: 13; Default||External grouping not supported 95180397|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Ha Biorci 8 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|FSC: 13; Default||Not reimbursed separately|525.00|FSC: 13; Default||External grouping not supported 95180399|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Block Half Augment Tiabial Lm/rl Triathlon Size 2-10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|FSC: 13; Default||Not reimbursed separately|2,995.20|FSC: 13; Default||External grouping not supported 95114997|EAP|Custom 95114997||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Arthroscopic Full Radius2.|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180400|EAP|Custom 95180400||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 2mm With Stop|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180401|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Plate 1.5mm Web Lock|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,338.75|FSC: 13; Default||Not reimbursed separately|1,338.75|FSC: 13; Default||External grouping not supported 95115001|EAP|Custom 95115001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Retriever Stonetome 20mm X 30mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180402|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5mm X 8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115002|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|FSC: 13; Default||Not reimbursed separately|372.00|FSC: 13; Default||External grouping not supported 95180403|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5mm X 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115003|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180404|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Non Locking 1.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115004|EAP|Custom 95115004||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Needle Infusion Bone Marrow 15 G|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180405|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115005|EAP|HCPCS A7521||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hb Tube Shiley Trach 8fen|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95180406|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115006|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95180407|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115009|EAP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Catheter Hickman Dual-lumen Adul|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|971.85|FSC: 13; Default||Not reimbursed separately|971.85|FSC: 13; Default||External grouping not supported 95180408|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115012|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Catheter Ventricular Cfs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95180409|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Locking 1.5mm X 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|FSC: 13; Default||Not reimbursed separately|204.00|FSC: 13; Default||External grouping not supported 95115015|EAP|Custom 95115015||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Set Drainage Nasal Biliary 7fr|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115019|EAP|Custom 95115019||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Valvulotome Lemaitre Expandable|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115020|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 7.0 Diopter Acr|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|FSC: 13; Default||Not reimbursed separately|450.00|FSC: 13; Default||External grouping not supported 95115022|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Wire Graphix 300cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115024|EAP|Custom 95115024||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Eye 56m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115027|EAP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Implant Breast Saline Textured 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|FSC: 13; Default||Not reimbursed separately|2,400.00|FSC: 13; Default||External grouping not supported 95115030|EAP|Custom 95115030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Oscillating 90mmx25mmx1.27|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115031|EAP|Custom 95115031||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Blade Reciprocating 12.5x76x.09m|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115033|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115034|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 10.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115035|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115036|EAP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Screw Cortical Bone 2.7x8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|FSC: 13; Default||Not reimbursed separately|36.54|FSC: 13; Default||External grouping not supported 95115038|EAP|Custom 95115038||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Cath Peripheral 3.0mm(9fr.)|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115039|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Guidewire 235|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|FSC: 13; Default||Not reimbursed separately|0.01|FSC: 13; Default||External grouping not supported 95115041|EAP|Custom 95115041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Tube Nasal Mark Iv Moss|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115043|EAP|Custom 95115043||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Shunt Carotid Schulte Heyer 4 X|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115046|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 11.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115047|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115048|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 12.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115049|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115050|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 13.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115051|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115053|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 14.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115054|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115055|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 15.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115056|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115057|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 16.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115058|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115059|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 17.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115060|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115061|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 18.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115062|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115063|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 19.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115064|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115065|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 20.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115066|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115067|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 21.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115068|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115069|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 22.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115070|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115071|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 23.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115072|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115073|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 24.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115074|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115075|EAP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 25.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115076|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115077|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 26.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115078|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115079|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 27.5 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115080|EAP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|Hb Lens Intraocular 28.0 Diopter Ac|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|FSC: 13; Default||Not reimbursed separately|468.00|FSC: 13; Default||External grouping not supported 95115083|EAP|Custom 95115083||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hb Osteotome Flexible Hris 12x120mm|1|HUMANA [1294]||HUMANA [11839]|0.00|FSC: 13; Default||Not reimbursed separately|0.00|FSC: 13; Default||External grouping not supported 95115094|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Meridian Porous Hip #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|FSC: 13; Default||Not reimbursed separately|10,395.00|FSC: 13; Default||External grouping not supported 95115095|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Pros Stem Hip Meridian #4-12mm P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|FSC: 13; Default||Not reimbursed separately|10,395.00|FSC: 13; Default||External grouping not supported 95115096|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Meridian Hip #5/13mm Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|FSC: 13; Default||Not reimbursed separately|10,395.00|FSC: 13; Default||External grouping not supported 95115097|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Meridian #7 15mm Por Straig|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,259.00|FSC: 13; Default||Not reimbursed separately|11,259.00|FSC: 13; Default||External grouping not supported 80166846|EAP|CPT® 96125||0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hb Standardized Cognitive Performance Testing|1|HUMANA [1294]||HUMANA [11839]|316.14|FSC: 13; Default||Not reimbursed separately|316.14|FSC: 13; Default||External grouping not supported 95115102|EAP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hb Stem Hip #3 11mm Porous|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,976.50|FSC: 13; Default||Not reimbursed separately|9,976.50|FSC: 13; Default||External grouping not supported 1000|ERX|HCPCS A9270|00603-2439-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 1000|ERX|HCPCS A9270|60687-0379-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 1000|ERX|HCPCS A9270|60687-0379-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|63323-0104-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|PHR: 408101; CHG: 26||Not reimbursed separately|111.15|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|00143-9510-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.92|PHR: 408101; CHG: 26||Not reimbursed separately|25.92|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|00703-5653-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|25.92|PHR: 408101; CHG: 26||Not reimbursed separately|25.92|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|16729-0114-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.92|PHR: 408101; CHG: 26||Not reimbursed separately|25.92|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|68001-0265-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.92|PHR: 408101; CHG: 26||Not reimbursed separately|25.92|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|00143-9512-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|PHR: 408101; CHG: 26||Not reimbursed separately|210.00|PHR: 408101; CHG: 26||External grouping not supported 10000|ERX|HCPCS J9181|63323-0104-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|PHR: 408101; CHG: 26||Not reimbursed separately|210.00|PHR: 408101; CHG: 26||External grouping not supported 100008|ERX|HCPCS RX015|00536-1057-75|0250 - PHARMACY - GENERAL CLASSIFICATION|BENZOYL PEROXIDE 5 % LOTION|29.5 mL|HUMANA [1294]||HUMANA [11839]|4.08|PHR: 408101; CHG: 26||Not reimbursed separately|4.08|PHR: 408101; CHG: 26||External grouping not supported 10001|ERX|HCPCS J8560|00378-3266-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETOPOSIDE 50 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|208.25|PHR: 408101; CHG: 26||Not reimbursed separately|208.25|PHR: 408101; CHG: 26||External grouping not supported 100016|ERX|HCPCS A9270|00378-3350-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.75|PHR: 408101; CHG: 26||Not reimbursed separately|40.75|PHR: 408101; CHG: 26||External grouping not supported 100016|ERX|HCPCS A9270|00378-3350-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.75|PHR: 408101; CHG: 26||Not reimbursed separately|40.75|PHR: 408101; CHG: 26||External grouping not supported 100016|ERX|HCPCS A9270|47781-0206-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.75|PHR: 408101; CHG: 26||Not reimbursed separately|40.75|PHR: 408101; CHG: 26||External grouping not supported 100016|ERX|HCPCS A9270|47781-0206-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.75|PHR: 408101; CHG: 26||Not reimbursed separately|40.75|PHR: 408101; CHG: 26||External grouping not supported 10010|ERX|HCPCS A9270|68180-0150-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|1.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.18|PHR: 408101; CHG: 26||Not reimbursed separately|10.18|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|00172-5728-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|00904-5780-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|16837-0855-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|16837-0855-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|24385-0385-71|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|46122-0168-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|50268-0303-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|50268-0303-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|51079-0966-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|51079-0966-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|62332-0001-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|62332-0001-91|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|63739-0645-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|65862-0859-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|68001-0397-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|68001-0397-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|87701-0402-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10011|ERX|HCPCS A9270|87701-0411-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 10012|ERX|HCPCS A9270|00172-5729-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 10012|ERX|HCPCS A9270|50268-0304-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 10012|ERX|HCPCS A9270|62332-0002-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 10012|ERX|HCPCS A9270|65862-0860-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 10012|ERX|HCPCS A9270|68001-0398-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMOTIDINE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 10014|ERX|HCPCS RX001|00338-0519-09|0250 - PHARMACY - GENERAL CLASSIFICATION|FAT EMULSION 20 % INTRAVENOUS|125 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 10025|ERX|HCPCS A9270|51525-0431-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELBAMATE 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 100314|ERX|HCPCS A9270|59212-0423-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG/5 ML ELIXIR|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.32|PHR: 408101; CHG: 26||Not reimbursed separately|2.32|PHR: 408101; CHG: 26||External grouping not supported 100314|ERX|HCPCS A9270|71914-0162-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG/5 ML ELIXIR|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.32|PHR: 408101; CHG: 26||Not reimbursed separately|2.32|PHR: 408101; CHG: 26||External grouping not supported 10036|ERX|HCPCS J1442|55513-0530-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|778.92|PHR: 408101; CHG: 26||Not reimbursed separately|778.92|PHR: 408101; CHG: 26||External grouping not supported 10036|ERX|HCPCS J1442|55513-0530-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|778.92|PHR: 408101; CHG: 26||Not reimbursed separately|778.92|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|16729-0090-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|16729-0090-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|31722-0525-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|50268-0314-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|50268-0314-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|60687-0428-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10037|ERX|HCPCS A9270|60687-0428-65|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FINASTERIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 10039|ERX|HCPCS A9270|00574-0115-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLAVOXATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 10039|ERX|HCPCS A9270|50268-0324-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLAVOXATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 10039|ERX|HCPCS A9270|50268-0324-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLAVOXATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 10041|ERX|HCPCS A9270|00054-0011-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.70|PHR: 408101; CHG: 26||Not reimbursed separately|1.70|PHR: 408101; CHG: 26||External grouping not supported 10041|ERX|HCPCS A9270|50268-0321-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.70|PHR: 408101; CHG: 26||Not reimbursed separately|1.70|PHR: 408101; CHG: 26||External grouping not supported 10041|ERX|HCPCS A9270|50268-0321-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.70|PHR: 408101; CHG: 26||Not reimbursed separately|1.70|PHR: 408101; CHG: 26||External grouping not supported 10041|ERX|HCPCS A9270|65862-0622-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.70|PHR: 408101; CHG: 26||Not reimbursed separately|1.70|PHR: 408101; CHG: 26||External grouping not supported 10043|ERX|HCPCS A9270|00054-0010-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 10043|ERX|HCPCS A9270|00054-0010-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 10043|ERX|HCPCS A9270|00054-0010-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 10043|ERX|HCPCS A9270|65162-0641-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLECAINIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 10044|ERX|HCPCS A9270|00904-6500-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.74|PHR: 408101; CHG: 26||Not reimbursed separately|2.74|PHR: 408101; CHG: 26||External grouping not supported 10044|ERX|HCPCS A9270|68084-0728-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.74|PHR: 408101; CHG: 26||Not reimbursed separately|2.74|PHR: 408101; CHG: 26||External grouping not supported 10044|ERX|HCPCS A9270|68084-0728-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.74|PHR: 408101; CHG: 26||Not reimbursed separately|2.74|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|00904-6501-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|50268-0339-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|55111-0146-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|67405-0604-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|68001-0254-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|68084-0735-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10045|ERX|HCPCS A9270|68084-0735-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 10046|ERX|HCPCS A9270|68462-0101-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|00338-6046-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|00409-4688-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|00409-4688-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|25021-0113-82|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|25021-0184-82|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|70655-0002-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10049|ERX|HCPCS J1450|70655-0002-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|00338-6045-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]||HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|00409-4688-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|00409-4688-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|25021-0113-87|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|25021-0184-87|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|70655-0088-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 10050|ERX|HCPCS J1450|70655-0088-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 100501|ERX|HCPCS RX001|00338-1138-03|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACID 5 % IN 20 % DEXTROSE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|96.00|PHR: 408101; CHG: 26||Not reimbursed separately|96.00|PHR: 408101; CHG: 26||External grouping not supported 100501|ERX|HCPCS RX001|00338-1101-04|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACID 5 % IN 20 % DEXTROSE INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|174.00|PHR: 408101; CHG: 26||Not reimbursed separately|174.00|PHR: 408101; CHG: 26||External grouping not supported 10051|ERX|HCPCS A9270|60687-0352-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCYTOSINE 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.20|PHR: 408101; CHG: 26||Not reimbursed separately|163.20|PHR: 408101; CHG: 26||External grouping not supported 10052|ERX|HCPCS A9270|00187-3555-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCYTOSINE 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.24|PHR: 408101; CHG: 26||Not reimbursed separately|296.24|PHR: 408101; CHG: 26||External grouping not supported 10052|ERX|HCPCS A9270|42494-0340-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCYTOSINE 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.24|PHR: 408101; CHG: 26||Not reimbursed separately|296.24|PHR: 408101; CHG: 26||External grouping not supported 10052|ERX|HCPCS A9270|60687-0363-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCYTOSINE 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.24|PHR: 408101; CHG: 26||Not reimbursed separately|296.24|PHR: 408101; CHG: 26||External grouping not supported 10052|ERX|HCPCS A9270|60687-0363-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCYTOSINE 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.24|PHR: 408101; CHG: 26||Not reimbursed separately|296.24|PHR: 408101; CHG: 26||External grouping not supported 10054|ERX|HCPCS A9270|00115-7033-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUDROCORTISONE 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10054|ERX|HCPCS A9270|00115-7033-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUDROCORTISONE 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10054|ERX|HCPCS A9270|00555-0997-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUDROCORTISONE 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10054|ERX|HCPCS A9270|50268-0330-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUDROCORTISONE 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10054|ERX|HCPCS A9270|68084-0288-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUDROCORTISONE 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10054|ERX|HCPCS A9270|68084-0288-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUDROCORTISONE 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10059|ERX|HCPCS RX001|00065-0092-65|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|132.65|PHR: 408101; CHG: 26||Not reimbursed separately|132.65|PHR: 408101; CHG: 26||External grouping not supported 10059|ERX|HCPCS RX001|17478-0253-10|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|132.65|PHR: 408101; CHG: 26||Not reimbursed separately|132.65|PHR: 408101; CHG: 26||External grouping not supported 10065|ERX|HCPCS A9270|51672-4118-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOROURACIL 5 % TOPICAL CREAM|40 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.84|PHR: 408101; CHG: 26||Not reimbursed separately|129.84|PHR: 408101; CHG: 26||External grouping not supported 100662|ERX|HCPCS RX001|00009-0433-04|0250 - PHARMACY - GENERAL CLASSIFICATION|GELATIN ABSORBABLE MUCOSAL POWDER|1 g|HUMANA [1294]||HUMANA [11839]|172.41|PHR: 408101; CHG: 26||Not reimbursed separately|172.41|PHR: 408101; CHG: 26||External grouping not supported 10069|ERX|HCPCS A9270|00904-5784-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOXETINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 10070|ERX|HCPCS A9270|00904-5785-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOXETINE 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 100769|ERX|HCPCS RX011|52565-0010-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 0.025 % LOTION|60 mL|HUMANA [1294]||HUMANA [11839]|80.46|PHR: 408101; CHG: 26||Not reimbursed separately|80.46|PHR: 408101; CHG: 26||External grouping not supported 100769|ERX|HCPCS RX011|60432-0560-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 0.025 % LOTION|60 mL|HUMANA [1294]||HUMANA [11839]|80.46|PHR: 408101; CHG: 26||Not reimbursed separately|80.46|PHR: 408101; CHG: 26||External grouping not supported 10080|ERX|HCPCS A9270|69292-0722-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLURBIPROFEN 0.03 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.72|PHR: 408101; CHG: 26||Not reimbursed separately|72.72|PHR: 408101; CHG: 26||External grouping not supported 100811|ERX|HCPCS A9270|63736-0037-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 20 % TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.08|PHR: 408101; CHG: 26||Not reimbursed separately|10.08|PHR: 408101; CHG: 26||External grouping not supported 100811|ERX|HCPCS A9270|63736-0041-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 20 % TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.08|PHR: 408101; CHG: 26||Not reimbursed separately|10.08|PHR: 408101; CHG: 26||External grouping not supported 10084|ERX|HCPCS A9270|62559-0160-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVOXAMINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 10085|ERX|HCPCS A9270|00832-1671-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVOXAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 10085|ERX|HCPCS A9270|51079-0992-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVOXAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 10085|ERX|HCPCS A9270|51079-0992-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVOXAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 10085|ERX|HCPCS A9270|60505-0165-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVOXAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 10085|ERX|HCPCS A9270|62559-0159-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVOXAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 10093|ERX|HCPCS J1455|76310-0024-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]||HUMANA [11839]|1,226.25|PHR: 408101; CHG: 26||Not reimbursed separately|1,226.25|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|00450-0496-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|00904-6773-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|37864-0001-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|50580-0600-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|50580-0600-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|51645-0703-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 101|ERX|HCPCS A9270|63739-0440-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 10101|ERX|HCPCS J1570|42023-0173-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|113.40|PHR: 408101; CHG: 26||Not reimbursed separately|113.40|PHR: 408101; CHG: 26||External grouping not supported 10101|ERX|HCPCS J1570|42023-0173-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|113.40|PHR: 408101; CHG: 26||Not reimbursed separately|113.40|PHR: 408101; CHG: 26||External grouping not supported 10101|ERX|HCPCS J1570|63323-0315-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|113.40|PHR: 408101; CHG: 26||Not reimbursed separately|113.40|PHR: 408101; CHG: 26||External grouping not supported 10116|ERX|HCPCS A9270|51079-0811-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 10116|ERX|HCPCS A9270|51079-0811-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 10116|ERX|HCPCS A9270|60505-0142-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 10117|ERX|HCPCS A9270|00591-0460-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10117|ERX|HCPCS A9270|00904-6637-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10117|ERX|HCPCS A9270|51079-0810-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10117|ERX|HCPCS A9270|51079-0810-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10117|ERX|HCPCS A9270|60505-0141-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 101246|ERX|HCPCS J0834|00548-5900-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION|0.25 mg|HUMANA [1294]||HUMANA [11839]|49.77|PHR: 408101; CHG: 26||Not reimbursed separately|49.77|PHR: 408101; CHG: 26||External grouping not supported 101246|ERX|HCPCS J0834|00781-3440-71|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION|0.25 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.77|PHR: 408101; CHG: 26||Not reimbursed separately|49.77|PHR: 408101; CHG: 26||External grouping not supported 101246|ERX|HCPCS J0834|67457-0227-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION|0.25 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.77|PHR: 408101; CHG: 26||Not reimbursed separately|49.77|PHR: 408101; CHG: 26||External grouping not supported 10126|ERX|HCPCS A9270|00093-9433-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10126|ERX|HCPCS A9270|23155-0057-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10126|ERX|HCPCS A9270|51079-0872-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10126|ERX|HCPCS A9270|51079-0872-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10126|ERX|HCPCS A9270|65862-0029-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10130|ERX|HCPCS A9270|13107-0014-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYCOPYRROLATE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 10137|ERX|HCPCS J9202|70720-0950-36|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|3.6 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,905.75|PHR: 408101; CHG: 26||Not reimbursed separately|1,905.75|PHR: 408101; CHG: 26||External grouping not supported 101413|ERX|HCPCS A9270|24385-0106-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 300 MG (750 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 101413|ERX|HCPCS A9270|87701-0444-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 300 MG (750 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 10144|ERX|HCPCS A9270|00904-5154-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 101441|ERX|HCPCS RX001|62991-1106-03|0250 - PHARMACY - GENERAL CLASSIFICATION|NIFEDIPINE (BULK) POWDER|100,000 mg|HUMANA [1294]||HUMANA [11839]|645.00|PHR: 408101; CHG: 26||Not reimbursed separately|645.00|PHR: 408101; CHG: 26||External grouping not supported 10149|ERX|HCPCS A9270|00378-1160-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUANFACINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 10149|ERX|HCPCS A9270|00591-0444-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUANFACINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 10149|ERX|HCPCS A9270|65162-0711-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUANFACINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 10149|ERX|HCPCS A9270|68084-0748-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUANFACINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 10149|ERX|HCPCS A9270|68084-0748-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUANFACINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 10153|ERX|HCPCS 90647|00006-4897-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HAEMOPH B POLYSAC CONJ-MENING (PF) 7.5 MCG/0.5 ML INTRAMUSCULAR SOLN|2 Vial|HUMANA [1294]||HUMANA [11839]|145.77|PHR: 408101; CHG: 26||Not reimbursed separately|145.77|PHR: 408101; CHG: 26||External grouping not supported 10162|ERX|HCPCS J1631|25021-0833-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|81.30|PHR: 408101; CHG: 26||Not reimbursed separately|81.30|PHR: 408101; CHG: 26||External grouping not supported 10162|ERX|HCPCS J1631|63323-0471-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|81.30|PHR: 408101; CHG: 26||Not reimbursed separately|81.30|PHR: 408101; CHG: 26||External grouping not supported 10163|ERX|HCPCS J1631|63323-0469-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|44.70|PHR: 408101; CHG: 26||Not reimbursed separately|44.70|PHR: 408101; CHG: 26||External grouping not supported 10175|ERX|HCPCS J1642|63323-0545-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 101758|ERX|HCPCS J1652|55111-0678-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|30.44|PHR: 408101; CHG: 26||Not reimbursed separately|30.44|PHR: 408101; CHG: 26||External grouping not supported 101758|ERX|HCPCS J1652|55150-0230-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.44|PHR: 408101; CHG: 26||Not reimbursed separately|30.44|PHR: 408101; CHG: 26||External grouping not supported 101758|ERX|HCPCS J1652|55150-0230-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.44|PHR: 408101; CHG: 26||Not reimbursed separately|30.44|PHR: 408101; CHG: 26||External grouping not supported 101758|ERX|HCPCS J1652|67457-0582-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.44|PHR: 408101; CHG: 26||Not reimbursed separately|30.44|PHR: 408101; CHG: 26||External grouping not supported 101758|ERX|HCPCS J1652|67457-0582-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.44|PHR: 408101; CHG: 26||Not reimbursed separately|30.44|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00069-0058-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00409-2720-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00409-2720-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00409-2720-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00409-2720-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00641-0391-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|00641-0391-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|25021-0400-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|25021-0400-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|25021-0400-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|25021-0400-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|25021-0400-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|63323-0540-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|63739-0931-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|63739-0931-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0372-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0372-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0384-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0384-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0385-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0385-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0948-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0953-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|67457-0956-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|71288-0402-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|71288-0402-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|71288-0402-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10176|ERX|HCPCS J1644|71288-0402-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.07|PHR: 408101; CHG: 26||Not reimbursed separately|3.07|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|00409-2723-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|00641-0400-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|25021-0402-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|67457-0374-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|67457-0374-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|67457-0949-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|71288-0403-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|71288-0403-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|71288-0422-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 10181|ERX|HCPCS J1644|25021-0402-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 10183|ERX|HCPCS 90371|59730-4202-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B IMMUNE GLOBULIN GREATR THAN 312 UNIT/ML INTRAMUSCULAR SOLN|3 mL|HUMANA [1294]||HUMANA [11839]|1,213.38|PHR: 408101; CHG: 26||Not reimbursed separately|1,213.38|PHR: 408101; CHG: 26||External grouping not supported 101933|ERX|HCPCS RX001|00517-0375-01|0250 - PHARMACY - GENERAL CLASSIFICATION|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|400.86|PHR: 408101; CHG: 26||Not reimbursed separately|400.86|PHR: 408101; CHG: 26||External grouping not supported 101933|ERX|HCPCS RX001|00517-0375-05|0250 - PHARMACY - GENERAL CLASSIFICATION|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|400.86|PHR: 408101; CHG: 26||Not reimbursed separately|400.86|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|00904-1983-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|00904-6730-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|37864-0001-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|37864-0001-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|37864-0001-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|50580-0412-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102|ERX|HCPCS A9270|50580-0412-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 102025|ERX|HCPCS J1160|00641-1410-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 102025|ERX|HCPCS J1160|00641-1410-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 102025|ERX|HCPCS J1160|00781-3059-72|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 102027|ERX|HCPCS A9270|00904-6640-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 102027|ERX|HCPCS A9270|60687-0349-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 102027|ERX|HCPCS A9270|60687-0349-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 102027|ERX|HCPCS A9270|63739-0665-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 102038|ERX|HCPCS A9270|00023-5992-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TESTOSTERONE 4 MG/24 HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.76|PHR: 408101; CHG: 26||Not reimbursed separately|56.76|PHR: 408101; CHG: 26||External grouping not supported 102042|ERX|HCPCS J8540|00054-3176-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)|1 mL|HUMANA [1294]||HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 102064|ERX|HCPCS J0587|10454-0712-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RIMABOTULINUMTOXINB 10,000 UNIT/2 ML INTRAMUSCULAR SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3,486.00|PHR: 408101; CHG: 26||Not reimbursed separately|3,486.00|PHR: 408101; CHG: 26||External grouping not supported 10209|ERX|HCPCS A9270|00009-0012-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 10209|ERX|HCPCS A9270|42543-0140-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 10209|ERX|HCPCS A9270|59762-0073-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 10210|ERX|HCPCS A9270|62559-0138-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 100 MG/60 ML ENEMA|1 Enema|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.22|PHR: 408101; CHG: 26||Not reimbursed separately|59.22|PHR: 408101; CHG: 26||External grouping not supported 102113|ERX|HCPCS A9270|00225-0550-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 0.65 % NASAL DROPS|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 102123|ERX|HCPCS J1240|63323-0366-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|13.94|PHR: 408101; CHG: 26||Not reimbursed separately|13.94|PHR: 408101; CHG: 26||External grouping not supported 102158|ERX|HCPCS RX001|00009-0396-05|0250 - PHARMACY - GENERAL CLASSIFICATION|GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 4 TOPICAL SPONGE|1 Each|HUMANA [1294]||HUMANA [11839]|37.00|PHR: 408101; CHG: 26||Not reimbursed separately|37.00|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|17478-0540-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.66|PHR: 408101; CHG: 26||Not reimbursed separately|5.66|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|00409-2634-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.70|PHR: 408101; CHG: 26||Not reimbursed separately|15.70|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|17478-0540-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.70|PHR: 408101; CHG: 26||Not reimbursed separately|15.70|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|63323-0851-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.70|PHR: 408101; CHG: 26||Not reimbursed separately|15.70|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|00703-0113-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|5.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.70|PHR: 408101; CHG: 26||Not reimbursed separately|15.70|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|00703-0018-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.25|PHR: 408101; CHG: 26||Not reimbursed separately|164.25|PHR: 408101; CHG: 26||External grouping not supported 10224|ERX|HCPCS J1170|17478-0540-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.25|PHR: 408101; CHG: 26||Not reimbursed separately|164.25|PHR: 408101; CHG: 26||External grouping not supported 102254|ERX|HCPCS J3250|42023-0119-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|107.63|PHR: 408101; CHG: 26||Not reimbursed separately|107.63|PHR: 408101; CHG: 26||External grouping not supported 102256|ERX|HCPCS J1815|00002-8501-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN REGULAR HUMAN U-500"CONCENTRATE" 500 UNIT/ML SUBCUTANEOUS SOLN|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,069.74|PHR: 408101; CHG: 26||Not reimbursed separately|4,069.74|PHR: 408101; CHG: 26||External grouping not supported 10227|ERX|HCPCS A9270|00574-7224-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROMORPHONE 3 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.62|PHR: 408101; CHG: 26||Not reimbursed separately|25.62|PHR: 408101; CHG: 26||External grouping not supported 102273|ERX|HCPCS A9270|43900-0976-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAR GUM ORAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|00781-5994-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|42292-0011-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|57664-0761-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|63304-0296-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|66993-0057-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|66993-0057-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|68084-0269-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|68084-0269-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|68382-0096-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 10235|ERX|HCPCS A9270|69238-1544-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYCHLOROQUINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 102353|ERX|HCPCS J3240|58468-0030-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THYROTROPIN ALFA 1.1 MG (0.9 MG/ML FINAL CONC.) INTRAMUSCULAR SOLUTION|0.9 mg|HUMANA [1294]||HUMANA [11839]|5,325.08|PHR: 408101; CHG: 26||Not reimbursed separately|5,325.08|PHR: 408101; CHG: 26||External grouping not supported 102353|ERX|HCPCS J3240|58468-0030-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THYROTROPIN ALFA 1.1 MG (0.9 MG/ML FINAL CONC.) INTRAMUSCULAR SOLUTION|0.9 mg|HUMANA [1294]||HUMANA [11839]|5,325.08|PHR: 408101; CHG: 26||Not reimbursed separately|5,325.08|PHR: 408101; CHG: 26||External grouping not supported 10236|ERX|HCPCS A9270|68084-0284-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYUREA 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.78|PHR: 408101; CHG: 26||Not reimbursed separately|1.78|PHR: 408101; CHG: 26||External grouping not supported 10236|ERX|HCPCS A9270|68084-0284-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYUREA 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.78|PHR: 408101; CHG: 26||Not reimbursed separately|1.78|PHR: 408101; CHG: 26||External grouping not supported 102373|ERX|HCPCS J1170|63323-0852-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 102373|ERX|HCPCS J1170|63323-0852-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10239|ERX|HCPCS J1980|00037-9001-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|82.94|PHR: 408101; CHG: 26||Not reimbursed separately|82.94|PHR: 408101; CHG: 26||External grouping not supported 10239|ERX|HCPCS J1980|54288-0111-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.94|PHR: 408101; CHG: 26||Not reimbursed separately|82.94|PHR: 408101; CHG: 26||External grouping not supported 10239|ERX|HCPCS J1980|54288-0111-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.94|PHR: 408101; CHG: 26||Not reimbursed separately|82.94|PHR: 408101; CHG: 26||External grouping not supported 10246|ERX|HCPCS A9270|00121-1836-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10246|ERX|HCPCS A9270|68094-0494-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 10248|ERX|HCPCS J9208|63323-0142-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]||HUMANA [11839]|69.72|PHR: 408101; CHG: 26||Not reimbursed separately|69.72|PHR: 408101; CHG: 26||External grouping not supported 10249|ERX|HCPCS J9208|10019-0926-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION|3 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.87|PHR: 408101; CHG: 26||Not reimbursed separately|240.87|PHR: 408101; CHG: 26||External grouping not supported 10249|ERX|HCPCS J9208|10019-0926-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION|3 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.87|PHR: 408101; CHG: 26||Not reimbursed separately|240.87|PHR: 408101; CHG: 26||External grouping not supported 102581|ERX|HCPCS 90713|49281-0860-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION|0.5 mL|HUMANA [1294]||HUMANA [11839]|92.64|PHR: 408101; CHG: 26||Not reimbursed separately|92.64|PHR: 408101; CHG: 26||External grouping not supported 10264|ERX|HCPCS A9270|00378-0069-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 1.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10264|ERX|HCPCS A9270|62559-0510-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 1.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10266|ERX|HCPCS RX001|17238-0424-06|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|188.46|PHR: 408101; CHG: 26||Not reimbursed separately|188.46|PHR: 408101; CHG: 26||External grouping not supported 10266|ERX|HCPCS RX001|17238-0424-25|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|188.46|PHR: 408101; CHG: 26||Not reimbursed separately|188.46|PHR: 408101; CHG: 26||External grouping not supported 10266|ERX|HCPCS RX001|17478-0701-25|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|188.46|PHR: 408101; CHG: 26||Not reimbursed separately|188.46|PHR: 408101; CHG: 26||External grouping not supported 10266|ERX|HCPCS RX001|70100-0424-01|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|188.46|PHR: 408101; CHG: 26||Not reimbursed separately|188.46|PHR: 408101; CHG: 26||External grouping not supported 10266|ERX|HCPCS RX001|70100-0424-02|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|188.46|PHR: 408101; CHG: 26||Not reimbursed separately|188.46|PHR: 408101; CHG: 26||External grouping not supported 10267|ERX|HCPCS RX001|63323-0659-03|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOMETHACIN 1 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|977.43|PHR: 408101; CHG: 26||Not reimbursed separately|977.43|PHR: 408101; CHG: 26||External grouping not supported 10267|ERX|HCPCS RX001|68382-0470-01|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOMETHACIN 1 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|977.43|PHR: 408101; CHG: 26||Not reimbursed separately|977.43|PHR: 408101; CHG: 26||External grouping not supported 102670|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|7.58|PHR: 408101; CHG: 26||Not reimbursed separately|7.58|PHR: 408101; CHG: 26||External grouping not supported 102670|ERX|HCPCS RX001|00409-6625-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|7.58|PHR: 408101; CHG: 26||Not reimbursed separately|7.58|PHR: 408101; CHG: 26||External grouping not supported 102670|ERX|HCPCS RX001|51754-5001-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|7.58|PHR: 408101; CHG: 26||Not reimbursed separately|7.58|PHR: 408101; CHG: 26||External grouping not supported 102670|ERX|HCPCS RX001|51754-5001-05|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|7.58|PHR: 408101; CHG: 26||Not reimbursed separately|7.58|PHR: 408101; CHG: 26||External grouping not supported 102670|ERX|HCPCS RX001|63323-0089-50|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|7.58|PHR: 408101; CHG: 26||Not reimbursed separately|7.58|PHR: 408101; CHG: 26||External grouping not supported 102670|ERX|HCPCS RX001|70324-0301-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|7.58|PHR: 408101; CHG: 26||Not reimbursed separately|7.58|PHR: 408101; CHG: 26||External grouping not supported 102675|ERX|HCPCS RX001|61314-0126-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETOROLAC 0.5 % EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|38.88|PHR: 408101; CHG: 26||Not reimbursed separately|38.88|PHR: 408101; CHG: 26||External grouping not supported 102675|ERX|HCPCS RX001|17478-0209-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETOROLAC 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|19.44|PHR: 408101; CHG: 26||Not reimbursed separately|19.44|PHR: 408101; CHG: 26||External grouping not supported 102675|ERX|HCPCS RX001|47335-0220-90|0250 - PHARMACY - GENERAL CLASSIFICATION|KETOROLAC 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|19.44|PHR: 408101; CHG: 26||Not reimbursed separately|19.44|PHR: 408101; CHG: 26||External grouping not supported 102675|ERX|HCPCS RX001|60505-1003-01|0250 - PHARMACY - GENERAL CLASSIFICATION|KETOROLAC 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|19.44|PHR: 408101; CHG: 26||Not reimbursed separately|19.44|PHR: 408101; CHG: 26||External grouping not supported 102675|ERX|HCPCS RX001|61314-0126-05|0250 - PHARMACY - GENERAL CLASSIFICATION|KETOROLAC 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|19.44|PHR: 408101; CHG: 26||Not reimbursed separately|19.44|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-10|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-17|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00517-3010-25|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|63323-0185-10|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-25|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|8.10|PHR: 408101; CHG: 26||Not reimbursed separately|8.10|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-99|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|8.10|PHR: 408101; CHG: 26||Not reimbursed separately|8.10|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|50242-0901-24|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|8.10|PHR: 408101; CHG: 26||Not reimbursed separately|8.10|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-20|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-23|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|63323-0185-20|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-24|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|00409-4887-50|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 102786|ERX|HCPCS RX001|63323-0185-50|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INJECTION SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 102835|ERX|HCPCS RX011|63323-0404-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA [1294]||HUMANA [11839]|212.40|PHR: 408101; CHG: 26||Not reimbursed separately|212.40|PHR: 408101; CHG: 26||External grouping not supported 102835|ERX|HCPCS RX011|67457-0404-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA [1294]||HUMANA [11839]|212.40|PHR: 408101; CHG: 26||Not reimbursed separately|212.40|PHR: 408101; CHG: 26||External grouping not supported 102835|ERX|HCPCS RX011|70860-0118-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA [1294]||HUMANA [11839]|212.40|PHR: 408101; CHG: 26||Not reimbursed separately|212.40|PHR: 408101; CHG: 26||External grouping not supported 102839|ERX|HCPCS 90375|13533-0618-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2,173.92|PHR: 408101; CHG: 26||Not reimbursed separately|2,173.92|PHR: 408101; CHG: 26||External grouping not supported 10284|ERX|HCPCS J1815|00002-8805-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.00|PHR: 408101; CHG: 26||Not reimbursed separately|37.00|PHR: 408101; CHG: 26||External grouping not supported 10284|ERX|HCPCS J1815|00002-8805-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.00|PHR: 408101; CHG: 26||Not reimbursed separately|37.00|PHR: 408101; CHG: 26||External grouping not supported 10286|ERX|HCPCS J1815|99999-2222-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|0.05 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 10286|ERX|HCPCS J1815|00002-8715-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.23|PHR: 408101; CHG: 26||Not reimbursed separately|43.23|PHR: 408101; CHG: 26||External grouping not supported 10286|ERX|HCPCS J1815|00169-1837-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.23|PHR: 408101; CHG: 26||Not reimbursed separately|43.23|PHR: 408101; CHG: 26||External grouping not supported 102864|ERX|HCPCS RX001|67457-0162-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM TETRADECYL SULFATE 1 % (10 MG/ML) INTRAVENOUS SOLUTION|1 Each|HUMANA [1294]||HUMANA [11839]|205.13|PHR: 408101; CHG: 26||Not reimbursed separately|205.13|PHR: 408101; CHG: 26||External grouping not supported 10299|ERX|HCPCS J9214|00085-4350-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INTERFERON ALFA-2B 10 MILLION UNIT (1 ML) SOLUTION FOR INJECTION|10,000,000 Units|HUMANA [1294]||HUMANA [11839]|896.55|PHR: 408101; CHG: 26||Not reimbursed separately|896.55|PHR: 408101; CHG: 26||External grouping not supported 102991|ERX|HCPCS A9270|00363-0165-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE-PSEUDOEPHEDRINE ER 10 MG-240 MG TABLET,EXTENDED RELEASE24HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 102991|ERX|HCPCS A9270|46122-0167-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE-PSEUDOEPHEDRINE ER 10 MG-240 MG TABLET,EXTENDED RELEASE24HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 103|ERX|HCPCS A9270|45802-0732-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 103|ERX|HCPCS A9270|45802-0732-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 103045|ERX|HCPCS RX001|38779-0584-08|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROCHLORIC ACID (BULK) 37 % LIQUID|500 mL|HUMANA [1294]||HUMANA [11839]|73.50|PHR: 408101; CHG: 26||Not reimbursed separately|73.50|PHR: 408101; CHG: 26||External grouping not supported 103141|ERX|HCPCS A9270|42799-0123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 103209|ERX|HCPCS RX001|00409-5555-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|12.11|PHR: 408101; CHG: 26||Not reimbursed separately|12.11|PHR: 408101; CHG: 26||External grouping not supported 103209|ERX|HCPCS RX001|00409-5555-12|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|12.11|PHR: 408101; CHG: 26||Not reimbursed separately|12.11|PHR: 408101; CHG: 26||External grouping not supported 103209|ERX|HCPCS RX001|63323-0083-05|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|12.11|PHR: 408101; CHG: 26||Not reimbursed separately|12.11|PHR: 408101; CHG: 26||External grouping not supported 103410|ERX|HCPCS RX001|62991-1202-04|0250 - PHARMACY - GENERAL CLASSIFICATION|NEOMYCIN SULFATE (BULK) POWDER|500 g|HUMANA [1294]||HUMANA [11839]|555.00|PHR: 408101; CHG: 26||Not reimbursed separately|555.00|PHR: 408101; CHG: 26||External grouping not supported 103456|ERX|HCPCS RX001|60793-0217-20|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION|1 Each|HUMANA [1294]||HUMANA [11839]|508.62|PHR: 408101; CHG: 26||Not reimbursed separately|508.62|PHR: 408101; CHG: 26||External grouping not supported 103467|ERX|HCPCS J3315|00023-5902-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIPTORELIN PAMOATE 3.75 MG INTRAMUSCULAR SUSPENSION|2 mL|HUMANA [1294]||HUMANA [11839]|1,798.56|PHR: 408101; CHG: 26||Not reimbursed separately|1,798.56|PHR: 408101; CHG: 26||External grouping not supported 103513|ERX|HCPCS J2997|50242-0085-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,675.08|PHR: 408101; CHG: 26||Not reimbursed separately|25,675.08|PHR: 408101; CHG: 26||External grouping not supported 103513|ERX|HCPCS J2997|50242-0085-27|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,675.08|PHR: 408101; CHG: 26||Not reimbursed separately|25,675.08|PHR: 408101; CHG: 26||External grouping not supported 10356|ERX|HCPCS A9270|00228-2631-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 103608|ERX|HCPCS A9270|00093-0018-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLTERODINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.36|PHR: 408101; CHG: 26||Not reimbursed separately|2.36|PHR: 408101; CHG: 26||External grouping not supported 103608|ERX|HCPCS A9270|59762-0800-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLTERODINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.36|PHR: 408101; CHG: 26||Not reimbursed separately|2.36|PHR: 408101; CHG: 26||External grouping not supported 10362|ERX|HCPCS A9270|16252-0539-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISRADIPINE 2.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.53|PHR: 408101; CHG: 26||Not reimbursed separately|2.53|PHR: 408101; CHG: 26||External grouping not supported 10363|ERX|HCPCS A9270|16252-0540-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISRADIPINE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.70|PHR: 408101; CHG: 26||Not reimbursed separately|3.70|PHR: 408101; CHG: 26||External grouping not supported 10364|ERX|HCPCS A9270|49884-0239-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.01|PHR: 408101; CHG: 26||Not reimbursed separately|4.01|PHR: 408101; CHG: 26||External grouping not supported 10364|ERX|HCPCS A9270|60687-0299-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.01|PHR: 408101; CHG: 26||Not reimbursed separately|4.01|PHR: 408101; CHG: 26||External grouping not supported 10364|ERX|HCPCS A9270|60687-0299-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.01|PHR: 408101; CHG: 26||Not reimbursed separately|4.01|PHR: 408101; CHG: 26||External grouping not supported 10364|ERX|HCPCS A9270|65162-0630-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.01|PHR: 408101; CHG: 26||Not reimbursed separately|4.01|PHR: 408101; CHG: 26||External grouping not supported 10364|ERX|HCPCS A9270|67877-0454-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.01|PHR: 408101; CHG: 26||Not reimbursed separately|4.01|PHR: 408101; CHG: 26||External grouping not supported 10369|ERX|HCPCS A9270|51672-4026-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOCONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.92|PHR: 408101; CHG: 26||Not reimbursed separately|2.92|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|00409-3796-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|47781-0585-46|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|63323-0162-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|63323-0162-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|70860-0701-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|70860-0701-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|70860-0701-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10370|ERX|HCPCS J1885|72611-0725-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 10371|ERX|HCPCS A9270|00093-0314-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOROLAC 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.09|PHR: 408101; CHG: 26||Not reimbursed separately|2.09|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|00143-9320-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|00143-9622-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|00409-2267-20|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|17478-0420-20|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|47781-0586-29|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|51991-0934-98|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10372|ERX|HCPCS RX001|72266-0102-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|00185-0010-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|00904-5928-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|49884-0122-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|51079-0928-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|51079-0928-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|60687-0439-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|60687-0439-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10373|ERX|HCPCS A9270|68001-0381-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 10374|ERX|HCPCS A9270|00904-5929-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.82|PHR: 408101; CHG: 26||Not reimbursed separately|0.82|PHR: 408101; CHG: 26||External grouping not supported 10374|ERX|HCPCS A9270|51079-0929-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.82|PHR: 408101; CHG: 26||Not reimbursed separately|0.82|PHR: 408101; CHG: 26||External grouping not supported 10374|ERX|HCPCS A9270|60687-0450-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LABETALOL 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.82|PHR: 408101; CHG: 26||Not reimbursed separately|0.82|PHR: 408101; CHG: 26||External grouping not supported 103741|ERX|HCPCS A9270|00904-0250-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIPROLIDINE-PSEUDOEPHEDRINE 2.5 MG-60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 103743|ERX|HCPCS RX001|00517-6710-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|22.14|PHR: 408101; CHG: 26||Not reimbursed separately|22.14|PHR: 408101; CHG: 26||External grouping not supported 103743|ERX|HCPCS RX001|00517-6710-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|22.14|PHR: 408101; CHG: 26||Not reimbursed separately|22.14|PHR: 408101; CHG: 26||External grouping not supported 10380|ERX|HCPCS A9270|51672-1300-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMMONIUM LACTATE 12 % LOTION|225 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.14|PHR: 408101; CHG: 26||Not reimbursed separately|8.14|PHR: 408101; CHG: 26||External grouping not supported 10380|ERX|HCPCS A9270|00904-5984-26|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMMONIUM LACTATE 12 % LOTION|226 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.14|PHR: 408101; CHG: 26||Not reimbursed separately|8.14|PHR: 408101; CHG: 26||External grouping not supported 10380|ERX|HCPCS A9270|45802-0525-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMMONIUM LACTATE 12 % LOTION|227 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.28|PHR: 408101; CHG: 26||Not reimbursed separately|16.28|PHR: 408101; CHG: 26||External grouping not supported 10384|ERX|HCPCS A9270|64980-0146-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTOBACILLUS 100 MILLION CELL ORAL GRANULES PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.84|PHR: 408101; CHG: 26||Not reimbursed separately|3.84|PHR: 408101; CHG: 26||External grouping not supported 10384|ERX|HCPCS A9270|64980-0146-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTOBACILLUS 100 MILLION CELL ORAL GRANULES PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.84|PHR: 408101; CHG: 26||Not reimbursed separately|3.84|PHR: 408101; CHG: 26||External grouping not supported 103925|ERX|HCPCS J2270|00641-6127-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 10 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.00|PHR: 408101; CHG: 26||Not reimbursed separately|5.00|PHR: 408101; CHG: 26||External grouping not supported 103925|ERX|HCPCS J2270|00641-6127-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.00|PHR: 408101; CHG: 26||Not reimbursed separately|5.00|PHR: 408101; CHG: 26||External grouping not supported 10394|ERX|HCPCS A9270|24208-0505-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOBUNOLOL 0.5 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 103971|ERX|HCPCS A9270|00065-0345-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LODOXAMIDE TROMETHAMINE 0.1 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|472.95|PHR: 408101; CHG: 26||Not reimbursed separately|472.95|PHR: 408101; CHG: 26||External grouping not supported 104|ERX|HCPCS A9270|51672-2116-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 104|ERX|HCPCS A9270|51672-2116-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 10403|ERX|HCPCS A9270|00074-6594-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 88 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 10403|ERX|HCPCS A9270|00527-1344-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 88 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 10403|ERX|HCPCS A9270|42292-0038-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 88 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 10403|ERX|HCPCS A9270|60687-0486-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 88 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 10403|ERX|HCPCS A9270|60687-0486-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 88 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 10403|ERX|HCPCS A9270|69238-1833-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 88 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|00074-9296-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|00527-1346-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|00781-5185-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|42292-0039-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|42292-0039-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|60687-0508-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|60687-0508-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10404|ERX|HCPCS A9270|69238-1835-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 112 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 10405|ERX|HCPCS A9270|00074-3727-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 137 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 10405|ERX|HCPCS A9270|00527-1638-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 137 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 10405|ERX|HCPCS A9270|60687-0563-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 137 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 10405|ERX|HCPCS A9270|69238-1837-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 137 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 10406|ERX|HCPCS A9270|00074-7070-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 175 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 10406|ERX|HCPCS A9270|00378-1817-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 175 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 10406|ERX|HCPCS A9270|42292-0040-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 175 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 10406|ERX|HCPCS A9270|60687-0541-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 175 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 10406|ERX|HCPCS A9270|60687-0541-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 175 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 10406|ERX|HCPCS A9270|69238-1839-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 175 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|00409-4713-42|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|55150-0161-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-04|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|00409-4279-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|00409-4279-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|55150-0163-30|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-07|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-26|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-31|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-37|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|00143-9595-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|00409-4713-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|00409-4713-75|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|55150-0159-74|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|55150-0162-05|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-09|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-36|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-43|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|63323-0492-57|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 10418|ERX|HCPCS RX001|65282-1605-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|4.29|PHR: 408101; CHG: 26||Not reimbursed separately|4.29|PHR: 408101; CHG: 26||External grouping not supported 104184|ERX|HCPCS A9270|00173-0388-79|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BECLOMETHASONE DIPROPIONATE (AQUEOUS) 42 MCG (0.042 %) NASAL SPRAY|25 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.95|PHR: 408101; CHG: 26||Not reimbursed separately|802.95|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|00409-4282-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|5.76|PHR: 408101; CHG: 26||Not reimbursed separately|5.76|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|00409-4282-12|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|5.76|PHR: 408101; CHG: 26||Not reimbursed separately|5.76|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|55150-0160-72|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|55150-0164-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|00143-9594-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|00409-2066-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|55150-0165-05|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|63323-0495-07|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 10420|ERX|HCPCS RX001|63323-0495-26|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 104284|ERX|HCPCS J2270|00409-1134-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 50 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.24|PHR: 408101; CHG: 26||Not reimbursed separately|3.24|PHR: 408101; CHG: 26||External grouping not supported 104284|ERX|HCPCS J2270|00409-1134-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 50 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.24|PHR: 408101; CHG: 26||Not reimbursed separately|3.24|PHR: 408101; CHG: 26||External grouping not supported 1043|ERX|HCPCS A9270|00832-0511-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETHANECHOL CHLORIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.03|PHR: 408101; CHG: 26||Not reimbursed separately|1.03|PHR: 408101; CHG: 26||External grouping not supported 10430|ERX|HCPCS RX001|66312-0176-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE|1.7 mL|HUMANA [1294]||HUMANA [11839]|3.57|PHR: 408101; CHG: 26||Not reimbursed separately|3.57|PHR: 408101; CHG: 26||External grouping not supported 10431|ERX|HCPCS RX001|00409-3183-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 10431|ERX|HCPCS RX001|63323-0489-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 10431|ERX|HCPCS RX001|63323-0489-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 10431|ERX|HCPCS RX001|63323-0489-17|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 10431|ERX|HCPCS RX001|63323-0489-21|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 10431|ERX|HCPCS RX001|63323-0489-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 104395|ERX|HCPCS J7195|58394-0633-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS KIT|250 Units|HUMANA [1294]||HUMANA [11839]|817.50|PHR: 408101; CHG: 26||Not reimbursed separately|817.50|PHR: 408101; CHG: 26||External grouping not supported 1044|ERX|HCPCS A9270|68084-0704-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETHANECHOL CHLORIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.03|PHR: 408101; CHG: 26||Not reimbursed separately|2.03|PHR: 408101; CHG: 26||External grouping not supported 1044|ERX|HCPCS A9270|68084-0704-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETHANECHOL CHLORIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.03|PHR: 408101; CHG: 26||Not reimbursed separately|2.03|PHR: 408101; CHG: 26||External grouping not supported 10443|ERX|HCPCS A9270|42794-0018-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIOTHYRONINE 5 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 10443|ERX|HCPCS A9270|42794-0018-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIOTHYRONINE 5 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 10449|ERX|HCPCS A9270|00591-0407-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 10449|ERX|HCPCS A9270|00904-6798-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 10449|ERX|HCPCS A9270|60687-0325-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 10449|ERX|HCPCS A9270|60687-0325-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 10449|ERX|HCPCS A9270|63739-0349-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 10449|ERX|HCPCS A9270|68001-0334-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 1045|ERX|HCPCS A9270|00527-1332-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETHANECHOL CHLORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 1045|ERX|HCPCS A9270|65162-0571-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETHANECHOL CHLORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10450|ERX|HCPCS A9270|68001-0337-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10450|ERX|HCPCS A9270|68084-0199-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10450|ERX|HCPCS A9270|68084-0199-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10451|ERX|HCPCS A9270|68001-0333-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 10451|ERX|HCPCS A9270|68084-0196-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 10451|ERX|HCPCS A9270|68084-0196-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 10451|ERX|HCPCS A9270|68180-0513-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 10454|ERX|HCPCS A9270|00054-0021-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 10454|ERX|HCPCS A9270|51079-0180-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 10455|ERX|HCPCS A9270|00054-0020-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 10455|ERX|HCPCS A9270|68462-0224-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 10459|ERX|HCPCS A9270|58181-3040-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOMUSTINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|251.49|PHR: 408101; CHG: 26||Not reimbursed separately|251.49|PHR: 408101; CHG: 26||External grouping not supported 104597|ERX|HCPCS A9270|00591-2729-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 104597|ERX|HCPCS A9270|42543-0407-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 104597|ERX|HCPCS A9270|68084-0850-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 104597|ERX|HCPCS A9270|68382-0537-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 10461|ERX|HCPCS A9270|58181-3041-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOMUSTINE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.98|PHR: 408101; CHG: 26||Not reimbursed separately|1,005.98|PHR: 408101; CHG: 26||External grouping not supported 104626|ERX|HCPCS A9270|99999-2222-94|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE-PHENYLEPHRINE-CODEINE 6.25 MG-5 MG-10 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 104626|ERX|HCPCS A9270|99999-2222-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE-PHENYLEPHRINE-CODEINE 6.25 MG-5 MG-10 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 10466|ERX|HCPCS A9270|51079-0246-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 10466|ERX|HCPCS A9270|51079-0246-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 10466|ERX|HCPCS A9270|68084-0248-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 10466|ERX|HCPCS A9270|68084-0248-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00409-6778-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00409-6778-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00641-6044-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00641-6046-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00641-6207-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|17478-0040-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|76329-8261-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|76329-8261-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00409-6778-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10467|ERX|HCPCS J2060|00641-6046-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.44|PHR: 408101; CHG: 26||Not reimbursed separately|2.44|PHR: 408101; CHG: 26||External grouping not supported 10468|ERX|HCPCS J2060|00641-6047-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 4 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|PHR: 408101; CHG: 26||Not reimbursed separately|16.50|PHR: 408101; CHG: 26||External grouping not supported 10470|ERX|HCPCS A9270|00185-0072-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 10471|ERX|HCPCS A9270|00185-0074-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 104735|ERX|HCPCS A9270|24385-0439-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMOXINE-ZINC ACETATE 1 %-0.1 % LOTION|177 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.31|PHR: 408101; CHG: 26||Not reimbursed separately|5.31|PHR: 408101; CHG: 26||External grouping not supported 104735|ERX|HCPCS A9270|87701-0400-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMOXINE-ZINC ACETATE 1 %-0.1 % LOTION|177 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.31|PHR: 408101; CHG: 26||Not reimbursed separately|5.31|PHR: 408101; CHG: 26||External grouping not supported 10475|ERX|HCPCS J7504|00009-7224-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|6,062.70|PHR: 408101; CHG: 26||Not reimbursed separately|6,062.70|PHR: 408101; CHG: 26||External grouping not supported 104765|ERX|HCPCS J1815|99999-1111-98|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION|0.05 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 104765|ERX|HCPCS J1815|00169-7501-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.84|PHR: 408101; CHG: 26||Not reimbursed separately|132.84|PHR: 408101; CHG: 26||External grouping not supported 104779|ERX|HCPCS RX001|46122-0149-03|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 1 % NASAL SPRAY|30 mL|HUMANA [1294]||HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 104779|ERX|HCPCS RX001|87701-0412-52|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 1 % NASAL SPRAY|30 mL|HUMANA [1294]||HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 10491|ERX|HCPCS A9270|10006-0700-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 10491|ERX|HCPCS A9270|10006-0730-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 10491|ERX|HCPCS A9270|57896-0634-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 10491|ERX|HCPCS A9270|60258-0171-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 10491|ERX|HCPCS A9270|63739-0354-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 10491|ERX|HCPCS A9270|64980-0339-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 10498|ERX|HCPCS J3475|00409-6729-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 10498|ERX|HCPCS J3475|63323-0106-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 10498|ERX|HCPCS J3475|99999-5555-47|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 105|ERX|HCPCS A9270|45802-0730-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 105|ERX|HCPCS A9270|45802-0730-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 105|ERX|HCPCS A9270|45802-0730-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 10502|ERX|HCPCS RX001|51672-5294-04|0250 - PHARMACY - GENERAL CLASSIFICATION|MALATHION 0.5 % LOTION|59 mL|HUMANA [1294]||HUMANA [11839]|542.33|PHR: 408101; CHG: 26||Not reimbursed separately|542.33|PHR: 408101; CHG: 26||External grouping not supported 10512|ERX|HCPCS 90707|00006-4681-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT|1 Vial|HUMANA [1294]||HUMANA [11839]|218.59|PHR: 408101; CHG: 26||Not reimbursed separately|218.59|PHR: 408101; CHG: 26||External grouping not supported 10512|ERX|HCPCS 90707|00006-4681-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT|1 Vial|HUMANA [1294]||HUMANA [11839]|218.59|PHR: 408101; CHG: 26||Not reimbursed separately|218.59|PHR: 408101; CHG: 26||External grouping not supported 105187|ERX|HCPCS A9270|00536-1286-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 105187|ERX|HCPCS A9270|00904-1313-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 105187|ERX|HCPCS A9270|99999-1111-69|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 105191|ERX|HCPCS J7194|68516-3202-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FACTOR IX CPLX(PCC)NO.4, 3FACTOR 1,000 (+/-) UNIT INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|3,966.30|PHR: 408101; CHG: 26||Not reimbursed separately|3,966.30|PHR: 408101; CHG: 26||External grouping not supported 10523|ERX|HCPCS J8600|52609-0001-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELPHALAN 2 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|31.41|PHR: 408101; CHG: 26||Not reimbursed separately|31.41|PHR: 408101; CHG: 26||External grouping not supported 105263|ERX|HCPCS J2265|70842-0160-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MINOCYCLINE 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|533.86|PHR: 408101; CHG: 26||Not reimbursed separately|533.86|PHR: 408101; CHG: 26||External grouping not supported 105263|ERX|HCPCS J2265|70842-0160-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MINOCYCLINE 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|533.86|PHR: 408101; CHG: 26||Not reimbursed separately|533.86|PHR: 408101; CHG: 26||External grouping not supported 105294|ERX|HCPCS A9270|66993-0877-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIPOTRIENE 0.005 % TOPICAL CREAM|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|158.40|PHR: 408101; CHG: 26||Not reimbursed separately|158.40|PHR: 408101; CHG: 26||External grouping not supported 105294|ERX|HCPCS A9270|68462-0501-65|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIPOTRIENE 0.005 % TOPICAL CREAM|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|158.40|PHR: 408101; CHG: 26||Not reimbursed separately|158.40|PHR: 408101; CHG: 26||External grouping not supported 10531|ERX|HCPCS A9270|00054-4581-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MERCAPTOPURINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.79|PHR: 408101; CHG: 26||Not reimbursed separately|3.79|PHR: 408101; CHG: 26||External grouping not supported 10531|ERX|HCPCS A9270|00378-3547-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MERCAPTOPURINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.79|PHR: 408101; CHG: 26||Not reimbursed separately|3.79|PHR: 408101; CHG: 26||External grouping not supported 10533|ERX|HCPCS A9270|54092-0189-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE CR 250 MG CAPSULE,CONTROLLED RELEASE|2 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.79|PHR: 408101; CHG: 26||Not reimbursed separately|16.79|PHR: 408101; CHG: 26||External grouping not supported 10535|ERX|HCPCS A9270|45802-0098-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.32|PHR: 408101; CHG: 26||Not reimbursed separately|22.32|PHR: 408101; CHG: 26||External grouping not supported 10535|ERX|HCPCS A9270|45802-0098-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.32|PHR: 408101; CHG: 26||Not reimbursed separately|22.32|PHR: 408101; CHG: 26||External grouping not supported 105350|ERX|HCPCS J3490|00173-0857-02|0250 - PHARMACY - GENERAL CLASSIFICATION|DILUENT FOR EPOPROSTENOL (GLYCINE) INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.53|PHR: 408101; CHG: 26||Not reimbursed separately|10.53|PHR: 408101; CHG: 26||External grouping not supported 10537|ERX|HCPCS J9209|25021-0201-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MESNA 100 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|22.56|PHR: 408101; CHG: 26||Not reimbursed separately|22.56|PHR: 408101; CHG: 26||External grouping not supported 10537|ERX|HCPCS J9209|25021-0201-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MESNA 100 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.56|PHR: 408101; CHG: 26||Not reimbursed separately|22.56|PHR: 408101; CHG: 26||External grouping not supported 10537|ERX|HCPCS J9209|70860-0209-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MESNA 100 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.56|PHR: 408101; CHG: 26||Not reimbursed separately|22.56|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|23155-0102-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|50228-0105-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|51079-0172-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|51079-0172-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|60687-0155-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|60687-0155-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|63739-0640-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10544|ERX|HCPCS A9270|67877-0561-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 10546|ERX|HCPCS J1230|17478-0380-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHADONE 10 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|33.69|PHR: 408101; CHG: 26||Not reimbursed separately|33.69|PHR: 408101; CHG: 26||External grouping not supported 10546|ERX|HCPCS J1230|67457-0217-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHADONE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|33.69|PHR: 408101; CHG: 26||Not reimbursed separately|33.69|PHR: 408101; CHG: 26||External grouping not supported 10546|ERX|HCPCS J1230|99999-1111-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHADONE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|33.69|PHR: 408101; CHG: 26||Not reimbursed separately|33.69|PHR: 408101; CHG: 26||External grouping not supported 10546|ERX|HCPCS J1230|99999-1111-79|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHADONE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|33.69|PHR: 408101; CHG: 26||Not reimbursed separately|33.69|PHR: 408101; CHG: 26||External grouping not supported 10546|ERX|HCPCS J1230|99999-3333-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHADONE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|33.69|PHR: 408101; CHG: 26||Not reimbursed separately|33.69|PHR: 408101; CHG: 26||External grouping not supported 105468|ERX|HCPCS A9270|00168-0053-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL OINTMENT|28.35 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.51|PHR: 408101; CHG: 26||Not reimbursed separately|4.51|PHR: 408101; CHG: 26||External grouping not supported 105518|ERX|HCPCS J1815|99999-1111-97|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|0.05 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 105518|ERX|HCPCS J1815|00002-8215-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.37|PHR: 408101; CHG: 26||Not reimbursed separately|41.37|PHR: 408101; CHG: 26||External grouping not supported 105518|ERX|HCPCS J1815|00169-1833-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.37|PHR: 408101; CHG: 26||Not reimbursed separately|41.37|PHR: 408101; CHG: 26||External grouping not supported 10552|ERX|HCPCS A9270|23155-0071-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHIMAZOLE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 10552|ERX|HCPCS A9270|49884-0641-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHIMAZOLE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 10553|ERX|HCPCS A9270|23155-0070-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHIMAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 10553|ERX|HCPCS A9270|49884-0640-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHIMAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 10553|ERX|HCPCS A9270|60687-0357-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHIMAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 105619|ERX|HCPCS A9270|51079-0767-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 105619|ERX|HCPCS A9270|65862-0595-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 105619|ERX|HCPCS A9270|68084-0415-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 105619|ERX|HCPCS A9270|68084-0415-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.23|PHR: 408101; CHG: 26||Not reimbursed separately|3.23|PHR: 408101; CHG: 26||External grouping not supported 105667|ERX|HCPCS Q9968|67457-0220-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.18|PHR: 408101; CHG: 26||Not reimbursed separately|2,793.18|PHR: 408101; CHG: 26||External grouping not supported 105667|ERX|HCPCS Q9968|67457-0220-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,793.18|PHR: 408101; CHG: 26||Not reimbursed separately|2,793.18|PHR: 408101; CHG: 26||External grouping not supported 105686|ERX|HCPCS RX001|17478-0703-11|0250 - PHARMACY - GENERAL CLASSIFICATION|POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|11.91|PHR: 408101; CHG: 26||Not reimbursed separately|11.91|PHR: 408101; CHG: 26||External grouping not supported 105686|ERX|HCPCS RX001|60758-0908-10|0250 - PHARMACY - GENERAL CLASSIFICATION|POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|11.91|PHR: 408101; CHG: 26||Not reimbursed separately|11.91|PHR: 408101; CHG: 26||External grouping not supported 105686|ERX|HCPCS RX001|61314-0628-10|0250 - PHARMACY - GENERAL CLASSIFICATION|POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|11.91|PHR: 408101; CHG: 26||Not reimbursed separately|11.91|PHR: 408101; CHG: 26||External grouping not supported 10571|ERX|HCPCS J2210|00517-0740-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.74|PHR: 408101; CHG: 26||Not reimbursed separately|49.74|PHR: 408101; CHG: 26||External grouping not supported 10571|ERX|HCPCS J2210|00517-0740-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|49.74|PHR: 408101; CHG: 26||Not reimbursed separately|49.74|PHR: 408101; CHG: 26||External grouping not supported 10571|ERX|HCPCS J2210|51991-0144-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.74|PHR: 408101; CHG: 26||Not reimbursed separately|49.74|PHR: 408101; CHG: 26||External grouping not supported 10572|ERX|HCPCS A9270|00054-0639-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLERGONOVINE 0.2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.10|PHR: 408101; CHG: 26||Not reimbursed separately|172.10|PHR: 408101; CHG: 26||External grouping not supported 10572|ERX|HCPCS A9270|00093-3655-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLERGONOVINE 0.2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.10|PHR: 408101; CHG: 26||Not reimbursed separately|172.10|PHR: 408101; CHG: 26||External grouping not supported 10572|ERX|HCPCS A9270|27437-0050-57|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLERGONOVINE 0.2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.10|PHR: 408101; CHG: 26||Not reimbursed separately|172.10|PHR: 408101; CHG: 26||External grouping not supported 10572|ERX|HCPCS A9270|69238-1605-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLERGONOVINE 0.2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.10|PHR: 408101; CHG: 26||Not reimbursed separately|172.10|PHR: 408101; CHG: 26||External grouping not supported 10575|ERX|HCPCS A9270|59746-0015-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPREDNISOLONE 32 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.66|PHR: 408101; CHG: 26||Not reimbursed separately|9.66|PHR: 408101; CHG: 26||External grouping not supported 10577|ERX|HCPCS J2930|00009-0698-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1 g|HUMANA [1294]||HUMANA [11839]|66.30|PHR: 408101; CHG: 26||Not reimbursed separately|66.30|PHR: 408101; CHG: 26||External grouping not supported 10578|ERX|HCPCS J2930|63323-0258-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|125 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.18|PHR: 408101; CHG: 26||Not reimbursed separately|32.18|PHR: 408101; CHG: 26||External grouping not supported 10579|ERX|HCPCS J2930|00009-0850-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION|2,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|212.04|PHR: 408101; CHG: 26||Not reimbursed separately|212.04|PHR: 408101; CHG: 26||External grouping not supported 10580|ERX|HCPCS J2920|63323-0255-03|0250 - PHARMACY - GENERAL CLASSIFICATION|METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION|40 mg|HUMANA [1294]||HUMANA [11839]|16.79|PHR: 408101; CHG: 26||Not reimbursed separately|16.79|PHR: 408101; CHG: 26||External grouping not supported 10581|ERX|HCPCS J2930|00009-0758-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.50|PHR: 408101; CHG: 26||Not reimbursed separately|58.50|PHR: 408101; CHG: 26||External grouping not supported 10587|ERX|HCPCS A9270|00185-5050-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 10587|ERX|HCPCS A9270|51079-0023-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 10587|ERX|HCPCS A9270|51079-0023-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 10587|ERX|HCPCS A9270|60687-0536-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 10587|ERX|HCPCS A9270|60687-0536-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 10588|ERX|HCPCS A9270|00185-0055-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10588|ERX|HCPCS A9270|51079-0024-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10588|ERX|HCPCS A9270|51079-0024-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10588|ERX|HCPCS A9270|60687-0547-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10588|ERX|HCPCS A9270|60687-0547-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOLAZONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10592|ERX|HCPCS A9270|00245-0860-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 0.75 % VAGINAL GEL|70 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|259.14|PHR: 408101; CHG: 26||Not reimbursed separately|259.14|PHR: 408101; CHG: 26||External grouping not supported 10592|ERX|HCPCS A9270|00781-7077-87|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 0.75 % VAGINAL GEL|70 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|259.14|PHR: 408101; CHG: 26||Not reimbursed separately|259.14|PHR: 408101; CHG: 26||External grouping not supported 10592|ERX|HCPCS A9270|45802-0139-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 0.75 % VAGINAL GEL|70 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|259.14|PHR: 408101; CHG: 26||Not reimbursed separately|259.14|PHR: 408101; CHG: 26||External grouping not supported 10592|ERX|HCPCS A9270|68682-0455-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 0.75 % VAGINAL GEL|70 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|259.14|PHR: 408101; CHG: 26||Not reimbursed separately|259.14|PHR: 408101; CHG: 26||External grouping not supported 10595|ERX|HCPCS A9270|00093-8739-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEXILETINE 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 10596|ERX|HCPCS A9270|00093-8740-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEXILETINE 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.09|PHR: 408101; CHG: 26||Not reimbursed separately|2.09|PHR: 408101; CHG: 26||External grouping not supported 10599|ERX|HCPCS A9270|46122-0039-27|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL POWDER|71 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10599|ERX|HCPCS A9270|46122-0444-27|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL POWDER|71 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 10599|ERX|HCPCS A9270|00316-0225-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL POWDER|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.36|PHR: 408101; CHG: 26||Not reimbursed separately|12.36|PHR: 408101; CHG: 26||External grouping not supported 10599|ERX|HCPCS A9270|11701-0038-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL POWDER|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.36|PHR: 408101; CHG: 26||Not reimbursed separately|12.36|PHR: 408101; CHG: 26||External grouping not supported 10599|ERX|HCPCS A9270|11017-0250-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL POWDER|90 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.36|PHR: 408101; CHG: 26||Not reimbursed separately|12.36|PHR: 408101; CHG: 26||External grouping not supported 10599|ERX|HCPCS A9270|11523-0919-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL POWDER|90 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.36|PHR: 408101; CHG: 26||Not reimbursed separately|12.36|PHR: 408101; CHG: 26||External grouping not supported 10603|ERX|HCPCS A9270|00472-1736-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.61|PHR: 408101; CHG: 26||Not reimbursed separately|2.61|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|00641-6057-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|00641-6059-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|00641-6209-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|00641-6210-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|47781-0588-46|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|47781-0588-68|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|63323-0411-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|63323-0411-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|63323-0411-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|70860-0600-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|00641-6057-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|00641-6059-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|63323-0411-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|63323-0411-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10607|ERX|HCPCS J2250|99999-4444-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6060-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6060-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6061-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6061-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6063-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6063-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00641-6211-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|17478-0524-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|23155-0601-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|47781-0589-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|47781-0589-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|63323-0412-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|63323-0412-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|70860-0601-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|70860-0601-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|63323-0412-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 10608|ERX|HCPCS J2250|00409-2596-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 5 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.04|PHR: 408101; CHG: 26||Not reimbursed separately|5.04|PHR: 408101; CHG: 26||External grouping not supported 10609|ERX|HCPCS A9270|00115-4211-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 10609|ERX|HCPCS A9270|00245-0211-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 10609|ERX|HCPCS A9270|60505-1320-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|00245-0212-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|00245-0212-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|00378-1902-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|49884-0849-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|51079-0453-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|51079-0453-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|60505-1321-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 10610|ERX|HCPCS A9270|60687-0398-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDODRINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 106107|ERX|HCPCS J1815|99999-2222-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|0.05 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 106107|ERX|HCPCS J1815|00002-8315-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.23|PHR: 408101; CHG: 26||Not reimbursed separately|43.23|PHR: 408101; CHG: 26||External grouping not supported 106107|ERX|HCPCS J1815|00169-1834-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.23|PHR: 408101; CHG: 26||Not reimbursed separately|43.23|PHR: 408101; CHG: 26||External grouping not supported 106216|ERX|HCPCS RX011|63323-0854-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|4.48|PHR: 408101; CHG: 26||Not reimbursed separately|4.48|PHR: 408101; CHG: 26||External grouping not supported 106216|ERX|HCPCS RX011|63323-0854-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|4.48|PHR: 408101; CHG: 26||Not reimbursed separately|4.48|PHR: 408101; CHG: 26||External grouping not supported 106234|ERX|HCPCS A9270|00904-6700-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-25 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 106234|ERX|HCPCS A9270|65197-0300-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-25 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 10628|ERX|HCPCS A9270|43386-0160-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.78|PHR: 408101; CHG: 26||Not reimbursed separately|3.78|PHR: 408101; CHG: 26||External grouping not supported 10628|ERX|HCPCS A9270|43386-0160-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.78|PHR: 408101; CHG: 26||Not reimbursed separately|3.78|PHR: 408101; CHG: 26||External grouping not supported 10628|ERX|HCPCS A9270|59762-5007-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.78|PHR: 408101; CHG: 26||Not reimbursed separately|3.78|PHR: 408101; CHG: 26||External grouping not supported 10628|ERX|HCPCS A9270|59762-5007-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.78|PHR: 408101; CHG: 26||Not reimbursed separately|3.78|PHR: 408101; CHG: 26||External grouping not supported 10628|ERX|HCPCS A9270|68084-0040-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.78|PHR: 408101; CHG: 26||Not reimbursed separately|3.78|PHR: 408101; CHG: 26||External grouping not supported 10628|ERX|HCPCS A9270|68084-0040-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.78|PHR: 408101; CHG: 26||Not reimbursed separately|3.78|PHR: 408101; CHG: 26||External grouping not supported 10629|ERX|HCPCS A9270|43386-0161-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 10629|ERX|HCPCS A9270|59762-5008-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 10629|ERX|HCPCS A9270|59762-5008-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 10629|ERX|HCPCS A9270|68084-0041-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 10629|ERX|HCPCS A9270|68084-0041-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 10630|ERX|HCPCS J9280|00143-9279-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|873.59|PHR: 408101; CHG: 26||Not reimbursed separately|873.59|PHR: 408101; CHG: 26||External grouping not supported 10630|ERX|HCPCS J9280|16729-0108-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|873.59|PHR: 408101; CHG: 26||Not reimbursed separately|873.59|PHR: 408101; CHG: 26||External grouping not supported 10630|ERX|HCPCS J9280|67457-0519-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|873.59|PHR: 408101; CHG: 26||Not reimbursed separately|873.59|PHR: 408101; CHG: 26||External grouping not supported 10632|ERX|HCPCS J9280|16729-0115-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.66|PHR: 408101; CHG: 26||Not reimbursed separately|312.66|PHR: 408101; CHG: 26||External grouping not supported 10632|ERX|HCPCS J9280|67457-0518-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.66|PHR: 408101; CHG: 26||Not reimbursed separately|312.66|PHR: 408101; CHG: 26||External grouping not supported 10633|ERX|HCPCS A9270|00015-3080-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MITOTANE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.23|PHR: 408101; CHG: 26||Not reimbursed separately|13.23|PHR: 408101; CHG: 26||External grouping not supported 10634|ERX|HCPCS J9293|00703-4685-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS|10 mL|HUMANA [1294]||HUMANA [11839]|341.97|PHR: 408101; CHG: 26||Not reimbursed separately|341.97|PHR: 408101; CHG: 26||External grouping not supported 10634|ERX|HCPCS J9293|63323-0132-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS|10 mL|HUMANA [1294]||HUMANA [11839]|341.97|PHR: 408101; CHG: 26||Not reimbursed separately|341.97|PHR: 408101; CHG: 26||External grouping not supported 106382|ERX|HCPCS A9270|50268-0375-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLUCOSAMINE SULFATE 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|00054-0404-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|00054-0404-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|00054-0517-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|00406-8003-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|99999-2222-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|99999-2222-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10655|ERX|HCPCS A9270|99999-2222-82|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 106726|ERX|HCPCS A9270|00378-0330-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERPHENAZINE-AMITRIPTYLINE 2 MG-10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.19|PHR: 408101; CHG: 26||Not reimbursed separately|3.19|PHR: 408101; CHG: 26||External grouping not supported 106729|ERX|HCPCS A9270|00054-3185-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 5 MG/ML ORAL CONCENTRATE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.60|PHR: 408101; CHG: 26||Not reimbursed separately|2.60|PHR: 408101; CHG: 26||External grouping not supported 10674|ERX|HCPCS RX001|09999-3333-65|0250 - PHARMACY - GENERAL CLASSIFICATION|MUPIROCIN 2 % TOPICAL OINTMENT|1 g|HUMANA [1294]||HUMANA [11839]|9.31|PHR: 408101; CHG: 26||Not reimbursed separately|9.31|PHR: 408101; CHG: 26||External grouping not supported 10674|ERX|HCPCS RX001|45802-0112-22|0250 - PHARMACY - GENERAL CLASSIFICATION|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HUMANA [1294]||HUMANA [11839]|9.31|PHR: 408101; CHG: 26||Not reimbursed separately|9.31|PHR: 408101; CHG: 26||External grouping not supported 10674|ERX|HCPCS RX001|51672-1312-00|0250 - PHARMACY - GENERAL CLASSIFICATION|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HUMANA [1294]||HUMANA [11839]|9.31|PHR: 408101; CHG: 26||Not reimbursed separately|9.31|PHR: 408101; CHG: 26||External grouping not supported 10674|ERX|HCPCS RX001|68462-0180-22|0250 - PHARMACY - GENERAL CLASSIFICATION|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HUMANA [1294]||HUMANA [11839]|9.31|PHR: 408101; CHG: 26||Not reimbursed separately|9.31|PHR: 408101; CHG: 26||External grouping not supported 10676|ERX|HCPCS A9270|00591-3670-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NABUMETONE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 10676|ERX|HCPCS A9270|60687-0374-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NABUMETONE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 10676|ERX|HCPCS A9270|60687-0374-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NABUMETONE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 10676|ERX|HCPCS A9270|69097-0965-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NABUMETONE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 10677|ERX|HCPCS A9270|00591-3671-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NABUMETONE 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 106783|ERX|HCPCS A9270|00085-1288-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MOMETASONE 50 MCG/ACTUATION NASAL SPRAY|17 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|733.44|PHR: 408101; CHG: 26||Not reimbursed separately|733.44|PHR: 408101; CHG: 26||External grouping not supported 106791|ERX|HCPCS RX001|00338-1089-04|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|144.00|PHR: 408101; CHG: 26||Not reimbursed separately|144.00|PHR: 408101; CHG: 26||External grouping not supported 10685|ERX|HCPCS A9270|00406-1170-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NALTREXONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.62|PHR: 408101; CHG: 26||Not reimbursed separately|1.62|PHR: 408101; CHG: 26||External grouping not supported 10685|ERX|HCPCS A9270|68084-0291-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NALTREXONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.62|PHR: 408101; CHG: 26||Not reimbursed separately|1.62|PHR: 408101; CHG: 26||External grouping not supported 106950|ERX|HCPCS A9270|99999-5555-97|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.23|PHR: 408101; CHG: 26||Not reimbursed separately|79.23|PHR: 408101; CHG: 26||External grouping not supported 106950|ERX|HCPCS A9270|00065-0359-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.23|PHR: 408101; CHG: 26||Not reimbursed separately|79.23|PHR: 408101; CHG: 26||External grouping not supported 106952|ERX|HCPCS J0795|55566-0302-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CORTICORELIN OVINE TRIFLUTATE 100 MCG INTRAVENOUS SOLUTION|100 mcg|HUMANA [1294]||HUMANA [11839]|420.47|PHR: 408101; CHG: 26||Not reimbursed separately|420.47|PHR: 408101; CHG: 26||External grouping not supported 10700|ERX|HCPCS A9270|00713-0268-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.86|PHR: 408101; CHG: 26||Not reimbursed separately|4.86|PHR: 408101; CHG: 26||External grouping not supported 10703|ERX|HCPCS A9270|24208-0790-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|128.70|PHR: 408101; CHG: 26||Not reimbursed separately|128.70|PHR: 408101; CHG: 26||External grouping not supported 10712|ERX|HCPCS A9270|42806-0501-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICARDIPINE 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.27|PHR: 408101; CHG: 26||Not reimbursed separately|34.27|PHR: 408101; CHG: 26||External grouping not supported 10713|ERX|HCPCS A9270|00378-1430-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICARDIPINE 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.07|PHR: 408101; CHG: 26||Not reimbursed separately|7.07|PHR: 408101; CHG: 26||External grouping not supported 10713|ERX|HCPCS A9270|42806-0502-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICARDIPINE 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.07|PHR: 408101; CHG: 26||Not reimbursed separately|7.07|PHR: 408101; CHG: 26||External grouping not supported 10717|ERX|HCPCS A9270|00536-1362-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE (POLACRILEX) 2 MG GUM|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 10717|ERX|HCPCS A9270|00536-3029-34|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE (POLACRILEX) 2 MG GUM|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 107180165|ERX|HCPCS A9270||0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL OINTMENT - SURGERY|5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.37|PHR: 408101; CHG: 26||Not reimbursed separately|2.37|PHR: 408101; CHG: 26||External grouping not supported 10722|ERX|HCPCS A9270|23155-0512-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIMODIPINE 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 10722|ERX|HCPCS A9270|62559-0210-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIMODIPINE 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 10722|ERX|HCPCS A9270|68084-0912-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIMODIPINE 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 10722|ERX|HCPCS A9270|68084-0912-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIMODIPINE 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 10723|ERX|HCPCS A9270|70408-0239-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.92|PHR: 408101; CHG: 26||Not reimbursed separately|247.92|PHR: 408101; CHG: 26||External grouping not supported 10724|ERX|HCPCS A9270|00185-0122-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 10724|ERX|HCPCS A9270|47781-0303-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 10724|ERX|HCPCS A9270|51079-0348-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 10724|ERX|HCPCS A9270|68084-0446-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 10724|ERX|HCPCS A9270|68084-0446-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 107285|ERX|HCPCS A9270|00486-1125-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 107285|ERX|HCPCS A9270|39328-0107-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 107285|ERX|HCPCS A9270|64980-0104-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 107330|ERX|HCPCS A9270|50924-0145-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIPLE URINE TESTS STRIPS|1 Strip|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|00409-3375-04|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|00409-3375-14|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|00703-1153-01|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|00703-1153-03|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|36000-0162-01|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|36000-0162-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|67457-0852-00|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 10734|ERX|HCPCS RX001|70121-1576-01|0250 - PHARMACY - GENERAL CLASSIFICATION|NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|18.66|PHR: 408101; CHG: 26||Not reimbursed separately|18.66|PHR: 408101; CHG: 26||External grouping not supported 107345|ERX|HCPCS A9270|00472-1738-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.16|PHR: 408101; CHG: 26||Not reimbursed separately|32.16|PHR: 408101; CHG: 26||External grouping not supported 107360|ERX|HCPCS J1650|00075-2915-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|0.87 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.76|PHR: 408101; CHG: 26||Not reimbursed separately|30.76|PHR: 408101; CHG: 26||External grouping not supported 107360|ERX|HCPCS J1650|00075-8025-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|0.87 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.76|PHR: 408101; CHG: 26||Not reimbursed separately|30.76|PHR: 408101; CHG: 26||External grouping not supported 107360|ERX|HCPCS J1650|00703-8510-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|0.87 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.76|PHR: 408101; CHG: 26||Not reimbursed separately|30.76|PHR: 408101; CHG: 26||External grouping not supported 107360|ERX|HCPCS J1650|00703-8510-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|0.87 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.76|PHR: 408101; CHG: 26||Not reimbursed separately|30.76|PHR: 408101; CHG: 26||External grouping not supported 107360|ERX|HCPCS J1650|00955-1015-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|0.87 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.76|PHR: 408101; CHG: 26||Not reimbursed separately|30.76|PHR: 408101; CHG: 26||External grouping not supported 10747|ERX|HCPCS A9270|68462-0304-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORETHINDRONE ACETATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.68|PHR: 408101; CHG: 26||Not reimbursed separately|2.68|PHR: 408101; CHG: 26||External grouping not supported 10752|ERX|HCPCS A9270|51862-0564-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORGESTREL 0.3 MG-ETHINYL ESTRADIOL 30 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 10752|ERX|HCPCS A9270|51862-0564-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORGESTREL 0.3 MG-ETHINYL ESTRADIOL 30 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 107650|ERX|HCPCS J0640|63323-0711-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|217.62|PHR: 408101; CHG: 26||Not reimbursed separately|217.62|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|00143-9890-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|00143-9890-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|00409-4759-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|16729-0298-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|23155-0549-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|23155-0550-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|25021-0782-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|67457-0441-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10777|ERX|HCPCS J2405|70860-0777-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|00904-6551-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|57237-0075-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|63304-0458-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|65862-0187-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|68084-0220-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|68084-0220-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10778|ERX|HCPCS Q0162|71930-0017-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 10779|ERX|HCPCS Q0162|68084-0221-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.13|PHR: 408101; CHG: 26||Not reimbursed separately|1.13|PHR: 408101; CHG: 26||External grouping not supported 10779|ERX|HCPCS Q0162|68084-0221-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.13|PHR: 408101; CHG: 26||Not reimbursed separately|1.13|PHR: 408101; CHG: 26||External grouping not supported 107806|ERX|HCPCS RX001|38779-0625-05|0250 - PHARMACY - GENERAL CLASSIFICATION|FLEXIBLE COLLODION (BULK) LIQUID|10 mL|HUMANA [1294]||HUMANA [11839]|12.60|PHR: 408101; CHG: 26||Not reimbursed separately|12.60|PHR: 408101; CHG: 26||External grouping not supported 107806|ERX|HCPCS RX001|99999-2222-44|0250 - PHARMACY - GENERAL CLASSIFICATION|FLEXIBLE COLLODION (BULK) LIQUID|30 mL|HUMANA [1294]||HUMANA [11839]|12.60|PHR: 408101; CHG: 26||Not reimbursed separately|12.60|PHR: 408101; CHG: 26||External grouping not supported 107968|ERX|HCPCS A9270|27808-0033-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION|18.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 1080|ERX|HCPCS A9270|00536-1238-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 10 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1080|ERX|HCPCS A9270|00574-7050-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 10 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1080|ERX|HCPCS A9270|00574-7050-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 10 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1080|ERX|HCPCS A9270|46122-0384-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 10 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1080|ERX|HCPCS A9270|87701-0428-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 10 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10803|ERX|HCPCS A9270|49884-0301-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXANDROLONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.38|PHR: 408101; CHG: 26||Not reimbursed separately|6.38|PHR: 408101; CHG: 26||External grouping not supported 108040|ERX|HCPCS J0697|00143-9977-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1.5 g|HUMANA [1294]||HUMANA [11839]|9.84|PHR: 408101; CHG: 26||Not reimbursed separately|9.84|PHR: 408101; CHG: 26||External grouping not supported 108040|ERX|HCPCS J0697|00143-9977-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.84|PHR: 408101; CHG: 26||Not reimbursed separately|9.84|PHR: 408101; CHG: 26||External grouping not supported 108040|ERX|HCPCS J0697|25021-0119-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.84|PHR: 408101; CHG: 26||Not reimbursed separately|9.84|PHR: 408101; CHG: 26||External grouping not supported 10806|ERX|HCPCS RX009|63713-0019-61|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CELLULOSE, OXIDIZED 2" X 1" X 1" PADS|1 Each|HUMANA [1294]||HUMANA [11839]|211.21|PHR: 408101; CHG: 26||Not reimbursed separately|211.21|PHR: 408101; CHG: 26||External grouping not supported 10810|ERX|HCPCS A9270|54838-0510-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 10812|ERX|HCPCS A9270|43386-0920-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 20 MG/ML ORAL CONCENTRATE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 10812|ERX|HCPCS A9270|66689-0025-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 20 MG/ML ORAL CONCENTRATE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 10812|ERX|HCPCS A9270|99999-1111-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 20 MG/ML ORAL CONCENTRATE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 10812|ERX|HCPCS A9270|99999-1111-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 20 MG/ML ORAL CONCENTRATE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 10812|ERX|HCPCS A9270|99999-2222-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 20 MG/ML ORAL CONCENTRATE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|00121-4827-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|00121-4839-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|00121-4839-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|60687-0406-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|60687-0406-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|64950-0354-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10813|ERX|HCPCS A9270|66689-0401-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|00406-0552-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|00406-0552-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|00904-6966-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|10702-0018-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|10702-0018-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|13107-0055-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|42806-0005-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|42858-0001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|42858-0001-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|68084-0354-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 10814|ERX|HCPCS A9270|68084-0354-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 108212|ERX|HCPCS J1815|00002-7510-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|155.64|PHR: 408101; CHG: 26||Not reimbursed separately|155.64|PHR: 408101; CHG: 26||External grouping not supported 10825|ERX|HCPCS A9270|00093-0924-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXAPROZIN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 108251|ERX|HCPCS RX001|49502-0102-02|0250 - PHARMACY - GENERAL CLASSIFICATION|EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR|0.3 mL|HUMANA [1294]||HUMANA [11839]|414.66|PHR: 408101; CHG: 26||Not reimbursed separately|414.66|PHR: 408101; CHG: 26||External grouping not supported 108251|ERX|HCPCS RX001|49502-0500-02|0250 - PHARMACY - GENERAL CLASSIFICATION|EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR|0.3 mL|HUMANA [1294]||HUMANA [11839]|414.66|PHR: 408101; CHG: 26||Not reimbursed separately|414.66|PHR: 408101; CHG: 26||External grouping not supported 10839|ERX|HCPCS RX001|10572-0100-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION|4,000 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 10839|ERX|HCPCS RX001|10572-0101-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION|4,000 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 10839|ERX|HCPCS RX001|52268-0100-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION|4,000 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 10839|ERX|HCPCS RX001|52268-0101-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION|4,000 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 10843|ERX|HCPCS J9267|47781-0595-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.15|PHR: 408101; CHG: 26||Not reimbursed separately|90.15|PHR: 408101; CHG: 26||External grouping not supported 10843|ERX|HCPCS J9267|61703-0342-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS|50 mL|HUMANA [1294]||HUMANA [11839]|90.15|PHR: 408101; CHG: 26||Not reimbursed separately|90.15|PHR: 408101; CHG: 26||External grouping not supported 10843|ERX|HCPCS J9267|63323-0763-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.15|PHR: 408101; CHG: 26||Not reimbursed separately|90.15|PHR: 408101; CHG: 26||External grouping not supported 10854|ERX|HCPCS A9270|57664-0175-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROMOMYCIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.72|PHR: 408101; CHG: 26||Not reimbursed separately|7.72|PHR: 408101; CHG: 26||External grouping not supported 108540|ERX|HCPCS RX001|00338-1147-03|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACIDS 5 %-DEXTROSE 15 %-ELECTROLYTES INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|93.00|PHR: 408101; CHG: 26||Not reimbursed separately|93.00|PHR: 408101; CHG: 26||External grouping not supported 108540|ERX|HCPCS RX001|00338-1123-04|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACIDS 5 %-DEXTROSE 15 %-ELECTROLYTES INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|174.00|PHR: 408101; CHG: 26||Not reimbursed separately|174.00|PHR: 408101; CHG: 26||External grouping not supported 10855|ERX|HCPCS A9270|00904-5677-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 10855|ERX|HCPCS A9270|68084-0045-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 10855|ERX|HCPCS A9270|68084-0045-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 10856|ERX|HCPCS A9270|50268-0642-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 10856|ERX|HCPCS A9270|50268-0642-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 10856|ERX|HCPCS A9270|68084-0046-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 10856|ERX|HCPCS A9270|68084-0046-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 10894|ERX|HCPCS A9270|25010-0705-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLAMINE 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.99|PHR: 408101; CHG: 26||Not reimbursed separately|723.99|PHR: 408101; CHG: 26||External grouping not supported 10897|ERX|HCPCS J0561|60793-0700-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|274.73|PHR: 408101; CHG: 26||Not reimbursed separately|274.73|PHR: 408101; CHG: 26||External grouping not supported 10897|ERX|HCPCS J0561|60793-0700-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|274.73|PHR: 408101; CHG: 26||Not reimbursed separately|274.73|PHR: 408101; CHG: 26||External grouping not supported 10902|ERX|HCPCS J0558|60793-0602-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE,PROCAIN 900,000 UNIT-300K UNIT/2 ML IM SYRINGE|2 mL|HUMANA [1294]||HUMANA [11839]|379.32|PHR: 408101; CHG: 26||Not reimbursed separately|379.32|PHR: 408101; CHG: 26||External grouping not supported 10902|ERX|HCPCS J0558|60793-0602-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE,PROCAIN 900,000 UNIT-300K UNIT/2 ML IM SYRINGE|2 mL|HUMANA [1294]||HUMANA [11839]|379.32|PHR: 408101; CHG: 26||Not reimbursed separately|379.32|PHR: 408101; CHG: 26||External grouping not supported 10903|ERX|HCPCS J0558|60793-0600-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE|2 mL|HUMANA [1294]||HUMANA [11839]|379.32|PHR: 408101; CHG: 26||Not reimbursed separately|379.32|PHR: 408101; CHG: 26||External grouping not supported 10903|ERX|HCPCS J0558|60793-0600-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE|2 mL|HUMANA [1294]||HUMANA [11839]|379.32|PHR: 408101; CHG: 26||Not reimbursed separately|379.32|PHR: 408101; CHG: 26||External grouping not supported 10904|ERX|HCPCS J2510|60793-0130-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G PROCAINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|91.72|PHR: 408101; CHG: 26||Not reimbursed separately|91.72|PHR: 408101; CHG: 26||External grouping not supported 109047|ERX|HCPCS J2820|00024-5843-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION|250 mcg|HUMANA [1294]||HUMANA [11839]|746.32|PHR: 408101; CHG: 26||Not reimbursed separately|746.32|PHR: 408101; CHG: 26||External grouping not supported 109047|ERX|HCPCS J2820|00024-5843-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION|250 mcg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|746.32|PHR: 408101; CHG: 26||Not reimbursed separately|746.32|PHR: 408101; CHG: 26||External grouping not supported 10910|ERX|HCPCS J9268|00409-0801-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENTOSTATIN 10 MG INTRAVENOUS SOLUTION|10 mg|HUMANA [1294]||HUMANA [11839]|5,808.93|PHR: 408101; CHG: 26||Not reimbursed separately|5,808.93|PHR: 408101; CHG: 26||External grouping not supported 109127|ERX|HCPCS RX001|65649-0701-41|0250 - PHARMACY - GENERAL CLASSIFICATION|SOD PHOS MONO-SOD PHOS DIBASIC 1.5 GRAM (1.102-0.398) TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|20.13|PHR: 408101; CHG: 26||Not reimbursed separately|20.13|PHR: 408101; CHG: 26||External grouping not supported 10917|ERX|HCPCS A9270|45802-0269-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERMETHRIN 5 % TOPICAL CREAM|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.78|PHR: 408101; CHG: 26||Not reimbursed separately|39.78|PHR: 408101; CHG: 26||External grouping not supported 10918|ERX|HCPCS A9270|46122-0108-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERMETHRIN 1 % TOPICAL LIQUID|59 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.99|PHR: 408101; CHG: 26||Not reimbursed separately|13.99|PHR: 408101; CHG: 26||External grouping not supported 10918|ERX|HCPCS A9270|63736-0120-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERMETHRIN 1 % TOPICAL LIQUID|59 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.99|PHR: 408101; CHG: 26||Not reimbursed separately|13.99|PHR: 408101; CHG: 26||External grouping not supported 10918|ERX|HCPCS A9270|63736-0120-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERMETHRIN 1 % TOPICAL LIQUID|59 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.99|PHR: 408101; CHG: 26||Not reimbursed separately|13.99|PHR: 408101; CHG: 26||External grouping not supported 10918|ERX|HCPCS A9270|87701-0411-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERMETHRIN 1 % TOPICAL LIQUID|59 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.99|PHR: 408101; CHG: 26||Not reimbursed separately|13.99|PHR: 408101; CHG: 26||External grouping not supported 109185|ERX|HCPCS A9270|41679-0365-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEDIUM CHAIN TRIGLYCERIDES (MCT) 7.7 KCAL/ML ORAL OIL|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 10919|ERX|HCPCS A9270|74300-0004-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERMETHRIN 0.5 % SPRAY|141.8 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.49|PHR: 408101; CHG: 26||Not reimbursed separately|11.49|PHR: 408101; CHG: 26||External grouping not supported 109211|ERX|HCPCS RX001|00338-1137-03|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACID 5 % IN 15 % DEXTROSE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|93.00|PHR: 408101; CHG: 26||Not reimbursed separately|93.00|PHR: 408101; CHG: 26||External grouping not supported 109211|ERX|HCPCS RX001|00338-1099-04|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACID 5 % IN 15 % DEXTROSE INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|168.00|PHR: 408101; CHG: 26||Not reimbursed separately|168.00|PHR: 408101; CHG: 26||External grouping not supported 109408|ERX|HCPCS J2997|50242-0041-64|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|2 mg|HUMANA [1294]||HUMANA [11839]|446.58|PHR: 408101; CHG: 26||Not reimbursed separately|446.58|PHR: 408101; CHG: 26||External grouping not supported 109429|ERX|HCPCS A9270|00904-5823-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 109429|ERX|HCPCS A9270|50268-0863-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 10947|ERX|HCPCS J2760|00143-9564-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENTOLAMINE 5 MG INJECTION SOLUTION|5 mg|HUMANA [1294]||HUMANA [11839]|938.75|PHR: 408101; CHG: 26||Not reimbursed separately|938.75|PHR: 408101; CHG: 26||External grouping not supported 10947|ERX|HCPCS J2760|00143-9564-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENTOLAMINE 5 MG INJECTION SOLUTION|5 mg|HUMANA [1294]||HUMANA [11839]|938.75|PHR: 408101; CHG: 26||Not reimbursed separately|938.75|PHR: 408101; CHG: 26||External grouping not supported 109610|ERX|HCPCS J0640|00143-9553-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.36|PHR: 408101; CHG: 26||Not reimbursed separately|66.36|PHR: 408101; CHG: 26||External grouping not supported 109610|ERX|HCPCS J0640|25021-0815-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.36|PHR: 408101; CHG: 26||Not reimbursed separately|66.36|PHR: 408101; CHG: 26||External grouping not supported 109610|ERX|HCPCS J0640|25021-0815-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.36|PHR: 408101; CHG: 26||Not reimbursed separately|66.36|PHR: 408101; CHG: 26||External grouping not supported 109610|ERX|HCPCS J0640|63323-0710-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.36|PHR: 408101; CHG: 26||Not reimbursed separately|66.36|PHR: 408101; CHG: 26||External grouping not supported 109610|ERX|HCPCS J0640|67457-0529-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.36|PHR: 408101; CHG: 26||Not reimbursed separately|66.36|PHR: 408101; CHG: 26||External grouping not supported 109651|ERX|HCPCS A9270|00378-3352-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.16|PHR: 408101; CHG: 26||Not reimbursed separately|39.16|PHR: 408101; CHG: 26||External grouping not supported 109651|ERX|HCPCS A9270|00378-3352-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.16|PHR: 408101; CHG: 26||Not reimbursed separately|39.16|PHR: 408101; CHG: 26||External grouping not supported 109651|ERX|HCPCS A9270|47781-0209-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.16|PHR: 408101; CHG: 26||Not reimbursed separately|39.16|PHR: 408101; CHG: 26||External grouping not supported 109651|ERX|HCPCS A9270|47781-0209-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.16|PHR: 408101; CHG: 26||Not reimbursed separately|39.16|PHR: 408101; CHG: 26||External grouping not supported 109814|ERX|HCPCS RX004|00338-0221-04|0258 - PHARMACY - IV SOLUTIONS|ELECTROLYTE-A INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 109814|ERX|HCPCS RX004|00338-0221-03|0258 - PHARMACY - IV SOLUTIONS|ELECTROLYTE-A INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 110123|ERX|HCPCS RX001|00904-6305-21|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HUMANA [1294]||HUMANA [11839]|4.25|PHR: 408101; CHG: 26||Not reimbursed separately|4.25|PHR: 408101; CHG: 26||External grouping not supported 110123|ERX|HCPCS RX001|87701-0425-81|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HUMANA [1294]||HUMANA [11839]|4.25|PHR: 408101; CHG: 26||Not reimbursed separately|4.25|PHR: 408101; CHG: 26||External grouping not supported 110161|ERX|HCPCS J3315|00023-5904-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIPTORELIN PAMOATE 11.25 MG INTRAMUSCULAR SUSPENSION|1 Syringe|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,395.71|PHR: 408101; CHG: 26||Not reimbursed separately|5,395.71|PHR: 408101; CHG: 26||External grouping not supported 110161|ERX|HCPCS J3315|00023-5904-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIPTORELIN PAMOATE 11.25 MG INTRAMUSCULAR SUSPENSION|1 Syringe|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,395.71|PHR: 408101; CHG: 26||Not reimbursed separately|5,395.71|PHR: 408101; CHG: 26||External grouping not supported 11018|ERX|HCPCS A9270|51079-0129-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 50 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 11018|ERX|HCPCS A9270|51079-0129-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 50 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 11018|ERX|HCPCS A9270|51672-4146-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 50 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 11018|ERX|HCPCS A9270|60687-0156-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 50 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 11018|ERX|HCPCS A9270|60687-0156-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 50 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 11019|ERX|HCPCS A9270|00071-3740-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE|4 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.98|PHR: 408101; CHG: 26||Not reimbursed separately|12.98|PHR: 408101; CHG: 26||External grouping not supported 110201|ERX|HCPCS RX001|99999-2222-87|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENOL LIQUID|10 mL|HUMANA [1294]||HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 11023|ERX|HCPCS J3430|00409-9158-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.78|PHR: 408101; CHG: 26||Not reimbursed separately|18.78|PHR: 408101; CHG: 26||External grouping not supported 11023|ERX|HCPCS J3430|00409-9158-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.78|PHR: 408101; CHG: 26||Not reimbursed separately|18.78|PHR: 408101; CHG: 26||External grouping not supported 11023|ERX|HCPCS J3430|43598-0405-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.78|PHR: 408101; CHG: 26||Not reimbursed separately|18.78|PHR: 408101; CHG: 26||External grouping not supported 11023|ERX|HCPCS J3430|43598-0405-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.78|PHR: 408101; CHG: 26||Not reimbursed separately|18.78|PHR: 408101; CHG: 26||External grouping not supported 11023|ERX|HCPCS J3430|00409-9158-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|93.86|PHR: 408101; CHG: 26||Not reimbursed separately|93.86|PHR: 408101; CHG: 26||External grouping not supported 11024|ERX|HCPCS A9270|00187-1704-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHYTONADIONE (VITAMIN K1) 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.45|PHR: 408101; CHG: 26||Not reimbursed separately|162.45|PHR: 408101; CHG: 26||External grouping not supported 11024|ERX|HCPCS A9270|60687-0381-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHYTONADIONE (VITAMIN K1) 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.45|PHR: 408101; CHG: 26||Not reimbursed separately|162.45|PHR: 408101; CHG: 26||External grouping not supported 11024|ERX|HCPCS A9270|70710-1014-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHYTONADIONE (VITAMIN K1) 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.45|PHR: 408101; CHG: 26||Not reimbursed separately|162.45|PHR: 408101; CHG: 26||External grouping not supported 110244|ERX|HCPCS A9270|00536-1995-53|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SELENIUM SULFIDE 1 % SHAMPOO|207 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.21|PHR: 408101; CHG: 26||Not reimbursed separately|6.21|PHR: 408101; CHG: 26||External grouping not supported 11037|ERX|HCPCS 90732|00006-4943-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|306.90|PHR: 408101; CHG: 28||Not reimbursed separately|306.90|PHR: 408101; CHG: 28||External grouping not supported 11037|ERX|HCPCS 90732|00006-4943-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.90|PHR: 408101; CHG: 28||Not reimbursed separately|306.90|PHR: 408101; CHG: 28||External grouping not supported 11046|ERX|HCPCS A9270|24385-0125-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM POLYCARBOPHIL 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 11046|ERX|HCPCS A9270|57896-0449-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM POLYCARBOPHIL 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 11046|ERX|HCPCS A9270|77333-0118-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM POLYCARBOPHIL 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 11046|ERX|HCPCS A9270|77333-0118-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM POLYCARBOPHIL 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 11046|ERX|HCPCS A9270|87701-0705-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM POLYCARBOPHIL 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 110512|ERX|HCPCS J0744|00409-4777-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 110512|ERX|HCPCS J0744|00781-3239-46|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 110512|ERX|HCPCS J0744|36000-0008-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 11074|ERX|HCPCS J3480|00338-0709-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.80|PHR: 408101; CHG: 26||Not reimbursed separately|7.80|PHR: 408101; CHG: 26||External grouping not supported 11074|ERX|HCPCS J3480|00990-7074-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.80|PHR: 408101; CHG: 26||Not reimbursed separately|7.80|PHR: 408101; CHG: 26||External grouping not supported 110763|ERX|HCPCS A9270|61924-0174-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM|106 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.50|PHR: 408101; CHG: 26||Not reimbursed separately|79.50|PHR: 408101; CHG: 26||External grouping not supported 110763|ERX|HCPCS A9270|92771-0600-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM|113 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|PHR: 408101; CHG: 26||Not reimbursed separately|159.00|PHR: 408101; CHG: 26||External grouping not supported 11077|ERX|HCPCS J3480|00338-0703-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 20 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.50|PHR: 408101; CHG: 26||Not reimbursed separately|7.50|PHR: 408101; CHG: 26||External grouping not supported 11077|ERX|HCPCS J3480|00990-7077-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 20 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.50|PHR: 408101; CHG: 26||Not reimbursed separately|7.50|PHR: 408101; CHG: 26||External grouping not supported 110878|ERX|HCPCS RX001|00942-0641-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CITRATE DEXTROSE SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|43.56|PHR: 408101; CHG: 26||Not reimbursed separately|43.56|PHR: 408101; CHG: 26||External grouping not supported 110920|ERX|HCPCS RX001|99999-5555-50|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHYL ALCOHOL (BULK) LIQUID|5 mL|HUMANA [1294]||HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 110921|ERX|HCPCS J2510|60793-0131-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G PROCAINE 1.2 MILLION UNIT/2 ML INTRAMUSCULAR SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|152.74|PHR: 408101; CHG: 26||Not reimbursed separately|152.74|PHR: 408101; CHG: 26||External grouping not supported 110921|ERX|HCPCS J2510|60793-0131-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G PROCAINE 1.2 MILLION UNIT/2 ML INTRAMUSCULAR SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|152.74|PHR: 408101; CHG: 26||Not reimbursed separately|152.74|PHR: 408101; CHG: 26||External grouping not supported 110962|ERX|HCPCS J2543|00206-8862-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.90|PHR: 408101; CHG: 26||Not reimbursed separately|36.90|PHR: 408101; CHG: 26||External grouping not supported 110962|ERX|HCPCS J2543|00206-8862-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.90|PHR: 408101; CHG: 26||Not reimbursed separately|36.90|PHR: 408101; CHG: 26||External grouping not supported 11110|ERX|HCPCS A9270|00904-5891-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11110|ERX|HCPCS A9270|60687-0169-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11110|ERX|HCPCS A9270|60687-0169-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11111|ERX|HCPCS A9270|00904-5892-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 11111|ERX|HCPCS A9270|60687-0178-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 11111|ERX|HCPCS A9270|60687-0178-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 111168|ERX|HCPCS A9270|51672-2062-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 2 % VAGINAL CREAM|21 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.55|PHR: 408101; CHG: 26||Not reimbursed separately|13.55|PHR: 408101; CHG: 26||External grouping not supported 111168|ERX|HCPCS A9270|87701-0454-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 2 % VAGINAL CREAM|21 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.55|PHR: 408101; CHG: 26||Not reimbursed separately|13.55|PHR: 408101; CHG: 26||External grouping not supported 11117|ERX|HCPCS J7510|50383-0042-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION|1.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 11117|ERX|HCPCS J7510|50383-0042-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 11117|ERX|HCPCS J7510|99999-2222-88|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 111177|ERX|HCPCS A9270|12980-0020-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM-ZINC TOPICAL PASTE|57 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.80|PHR: 408101; CHG: 26||Not reimbursed separately|73.80|PHR: 408101; CHG: 26||External grouping not supported 111177|ERX|HCPCS A9270|08212-4271-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM-ZINC TOPICAL PASTE|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.80|PHR: 408101; CHG: 26||Not reimbursed separately|73.80|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|00527-1301-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|00904-5559-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|50268-0686-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|50268-0686-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|53746-0544-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|68084-0202-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11129|ERX|HCPCS A9270|68084-0202-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11138|ERX|HCPCS A9270|00574-7226-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.60|PHR: 408101; CHG: 26||Not reimbursed separately|17.60|PHR: 408101; CHG: 26||External grouping not supported 11143|ERX|HCPCS A9270|45802-0758-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.80|PHR: 408101; CHG: 26||Not reimbursed separately|15.80|PHR: 408101; CHG: 26||External grouping not supported 11143|ERX|HCPCS A9270|45802-0758-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.80|PHR: 408101; CHG: 26||Not reimbursed separately|15.80|PHR: 408101; CHG: 26||External grouping not supported 11143|ERX|HCPCS A9270|51672-5296-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.80|PHR: 408101; CHG: 26||Not reimbursed separately|15.80|PHR: 408101; CHG: 26||External grouping not supported 11144|ERX|HCPCS A9270|45802-0759-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 25 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.69|PHR: 408101; CHG: 26||Not reimbursed separately|9.69|PHR: 408101; CHG: 26||External grouping not supported 11144|ERX|HCPCS A9270|51672-5297-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 25 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.69|PHR: 408101; CHG: 26||Not reimbursed separately|9.69|PHR: 408101; CHG: 26||External grouping not supported 11144|ERX|HCPCS A9270|51672-5297-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 25 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.69|PHR: 408101; CHG: 26||Not reimbursed separately|9.69|PHR: 408101; CHG: 26||External grouping not supported 11145|ERX|HCPCS A9270|60432-0604-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 11145|ERX|HCPCS A9270|99999-2222-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 11146|ERX|HCPCS A9270|00591-0582-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 11146|ERX|HCPCS A9270|62559-0230-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|00409-4699-53|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|00409-4699-54|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|25021-0608-20|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|25021-0608-51|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|43598-0265-20|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-59|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-94|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|1 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-10|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|10 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-65|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|100 mL|HUMANA [1294]||HUMANA [11839]|30.90|PHR: 408101; CHG: 26||Not reimbursed separately|30.90|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-69|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|100 mL|HUMANA [1294]||HUMANA [11839]|30.90|PHR: 408101; CHG: 26||Not reimbursed separately|30.90|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-29|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|20 mL|HUMANA [1294]||HUMANA [11839]|6.18|PHR: 408101; CHG: 26||Not reimbursed separately|6.18|PHR: 408101; CHG: 26||External grouping not supported 11150|ERX|HCPCS RX001|63323-0269-50|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL 10 MG/ML INTRAVENOUS EMULSION|50 mL|HUMANA [1294]||HUMANA [11839]|15.45|PHR: 408101; CHG: 26||Not reimbursed separately|15.45|PHR: 408101; CHG: 26||External grouping not supported 11156|ERX|HCPCS A9270|00378-0731-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 40 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.55|PHR: 408101; CHG: 26||Not reimbursed separately|2.55|PHR: 408101; CHG: 26||External grouping not supported 11237|ERX|HCPCS RX001|00781-3040-95|0250 - PHARMACY - GENERAL CLASSIFICATION|PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]||HUMANA [11839]|14.99|PHR: 408101; CHG: 26||Not reimbursed separately|14.99|PHR: 408101; CHG: 26||External grouping not supported 11238|ERX|HCPCS A9270|00187-3012-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP|1.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.07|PHR: 408101; CHG: 26||Not reimbursed separately|13.07|PHR: 408101; CHG: 26||External grouping not supported 11239|ERX|HCPCS A9270|68084-0494-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 11239|ERX|HCPCS A9270|68084-0494-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 11239|ERX|HCPCS A9270|68682-0302-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 11239|ERX|HCPCS A9270|71930-0028-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 11240|ERX|HCPCS A9270|00115-1404-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.73|PHR: 408101; CHG: 26||Not reimbursed separately|38.73|PHR: 408101; CHG: 26||External grouping not supported 11240|ERX|HCPCS A9270|47781-0335-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.73|PHR: 408101; CHG: 26||Not reimbursed separately|38.73|PHR: 408101; CHG: 26||External grouping not supported 11240|ERX|HCPCS A9270|68682-0301-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOSTIGMINE BROMIDE ER 180 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.73|PHR: 408101; CHG: 26||Not reimbursed separately|38.73|PHR: 408101; CHG: 26||External grouping not supported 11246|ERX|HCPCS RX015|69413-0330-30|0250 - PHARMACY - GENERAL CLASSIFICATION|PYRIMETHAMINE 25 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|2,250.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,250.00|PHR: 408101; CHG: 26||External grouping not supported 11251|ERX|HCPCS A9270|59762-5020-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUINAPRIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 11252|ERX|HCPCS A9270|59762-5021-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUINAPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 11254|ERX|HCPCS A9270|59762-5019-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUINAPRIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 112579|ERX|HCPCS RX001|00281-0205-43|0250 - PHARMACY - GENERAL CLASSIFICATION|SURGICAL LUBRICANT JELLY TOPICAL|3 g|HUMANA [1294]||HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 112579|ERX|HCPCS RX001|00281-0205-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SURGICAL LUBRICANT JELLY TOPICAL|56.7 g|HUMANA [1294]||HUMANA [11839]|5.11|PHR: 408101; CHG: 26||Not reimbursed separately|5.11|PHR: 408101; CHG: 26||External grouping not supported 112579|ERX|HCPCS RX001|00281-0205-12|0250 - PHARMACY - GENERAL CLASSIFICATION|SURGICAL LUBRICANT JELLY TOPICAL|56.7 g|HUMANA [1294]||HUMANA [11839]|5.11|PHR: 408101; CHG: 26||Not reimbursed separately|5.11|PHR: 408101; CHG: 26||External grouping not supported 11261|ERX|HCPCS A9270|68180-0590-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RAMIPRIL 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 11285|ERX|HCPCS RX001|00187-0007-14|0250 - PHARMACY - GENERAL CLASSIFICATION|RIBAVIRIN 6 GRAM SOLUTION FOR INHALATION|1 Each|HUMANA [1294]||HUMANA [11839]|17,371.89|PHR: 408101; CHG: 26||Not reimbursed separately|17,371.89|PHR: 408101; CHG: 26||External grouping not supported 11286|ERX|HCPCS A9270|68382-0260-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIBAVIRIN 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.60|PHR: 408101; CHG: 26||Not reimbursed separately|4.60|PHR: 408101; CHG: 26||External grouping not supported 11291|ERX|HCPCS RX001|00068-0597-01|0250 - PHARMACY - GENERAL CLASSIFICATION|RIFAMPIN 600 MG INTRAVENOUS SOLUTION|600 mg|HUMANA [1294]||HUMANA [11839]|218.85|PHR: 408101; CHG: 26||Not reimbursed separately|218.85|PHR: 408101; CHG: 26||External grouping not supported 11291|ERX|HCPCS RX001|63323-0351-20|0250 - PHARMACY - GENERAL CLASSIFICATION|RIFAMPIN 600 MG INTRAVENOUS SOLUTION|600 mg|HUMANA [1294]||HUMANA [11839]|218.85|PHR: 408101; CHG: 26||Not reimbursed separately|218.85|PHR: 408101; CHG: 26||External grouping not supported 11291|ERX|HCPCS RX001|67457-0445-60|0250 - PHARMACY - GENERAL CLASSIFICATION|RIFAMPIN 600 MG INTRAVENOUS SOLUTION|600 mg|HUMANA [1294]||HUMANA [11839]|218.85|PHR: 408101; CHG: 26||Not reimbursed separately|218.85|PHR: 408101; CHG: 26||External grouping not supported 11293|ERX|HCPCS A9270|00904-5282-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIFAMPIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 11293|ERX|HCPCS A9270|68084-0358-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIFAMPIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 11293|ERX|HCPCS A9270|68084-0358-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIFAMPIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 112988|ERX|HCPCS RX011|62935-0753-75|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE|7.5 mg|HUMANA [1294]||HUMANA [11839]|351.00|PHR: 408101; CHG: 26||Not reimbursed separately|351.00|PHR: 408101; CHG: 26||External grouping not supported 112988|ERX|HCPCS RX011|62935-0754-74|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE|7.5 mg|HUMANA [1294]||HUMANA [11839]|351.00|PHR: 408101; CHG: 26||Not reimbursed separately|351.00|PHR: 408101; CHG: 26||External grouping not supported 113|ERX|HCPCS A9270|51672-4023-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAZOLAMIDE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.91|PHR: 408101; CHG: 26||Not reimbursed separately|6.91|PHR: 408101; CHG: 26||External grouping not supported 113|ERX|HCPCS A9270|68084-0541-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAZOLAMIDE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.91|PHR: 408101; CHG: 26||Not reimbursed separately|6.91|PHR: 408101; CHG: 26||External grouping not supported 113|ERX|HCPCS A9270|68084-0541-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAZOLAMIDE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.91|PHR: 408101; CHG: 26||Not reimbursed separately|6.91|PHR: 408101; CHG: 26||External grouping not supported 113026|ERX|HCPCS J3285|42023-0206-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|185.64|PHR: 408101; CHG: 26||Not reimbursed separately|185.64|PHR: 408101; CHG: 26||External grouping not supported 113027|ERX|HCPCS J3285|42023-0207-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|460.59|PHR: 408101; CHG: 26||Not reimbursed separately|460.59|PHR: 408101; CHG: 26||External grouping not supported 113028|ERX|HCPCS J3285|42023-0208-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|921.16|PHR: 408101; CHG: 26||Not reimbursed separately|921.16|PHR: 408101; CHG: 26||External grouping not supported 113029|ERX|HCPCS J3285|42023-0209-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|1,842.33|PHR: 408101; CHG: 26||Not reimbursed separately|1,842.33|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00075-0624-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00075-8013-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00548-5601-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00703-8530-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00703-8530-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00781-3133-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00955-1003-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113032|ERX|HCPCS J1650|00955-1003-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 113033|ERX|HCPCS J1650|00075-8016-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.93|PHR: 408101; CHG: 26||Not reimbursed separately|11.93|PHR: 408101; CHG: 26||External grouping not supported 113033|ERX|HCPCS J1650|00703-8560-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.93|PHR: 408101; CHG: 26||Not reimbursed separately|11.93|PHR: 408101; CHG: 26||External grouping not supported 113033|ERX|HCPCS J1650|00955-1006-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.93|PHR: 408101; CHG: 26||Not reimbursed separately|11.93|PHR: 408101; CHG: 26||External grouping not supported 113033|ERX|HCPCS J1650|00955-1006-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.93|PHR: 408101; CHG: 26||Not reimbursed separately|11.93|PHR: 408101; CHG: 26||External grouping not supported 113033|ERX|HCPCS J1650|00075-0621-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.31|PHR: 408101; CHG: 26||Not reimbursed separately|14.31|PHR: 408101; CHG: 26||External grouping not supported 113034|ERX|HCPCS J1650|00075-8018-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.03|PHR: 408101; CHG: 26||Not reimbursed separately|16.03|PHR: 408101; CHG: 26||External grouping not supported 113034|ERX|HCPCS J1650|00703-8680-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.03|PHR: 408101; CHG: 26||Not reimbursed separately|16.03|PHR: 408101; CHG: 26||External grouping not supported 113034|ERX|HCPCS J1650|00781-3428-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.03|PHR: 408101; CHG: 26||Not reimbursed separately|16.03|PHR: 408101; CHG: 26||External grouping not supported 113034|ERX|HCPCS J1650|00955-1008-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.03|PHR: 408101; CHG: 26||Not reimbursed separately|16.03|PHR: 408101; CHG: 26||External grouping not supported 113034|ERX|HCPCS J1650|00955-1008-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.03|PHR: 408101; CHG: 26||Not reimbursed separately|16.03|PHR: 408101; CHG: 26||External grouping not supported 113034|ERX|HCPCS J1650|00075-0622-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.32|PHR: 408101; CHG: 26||Not reimbursed separately|18.32|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00075-8020-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.37|PHR: 408101; CHG: 26||Not reimbursed separately|21.37|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00548-5605-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.37|PHR: 408101; CHG: 26||Not reimbursed separately|21.37|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00703-8580-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.37|PHR: 408101; CHG: 26||Not reimbursed separately|21.37|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00781-3500-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.37|PHR: 408101; CHG: 26||Not reimbursed separately|21.37|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00955-1010-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.37|PHR: 408101; CHG: 26||Not reimbursed separately|21.37|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00955-1010-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.37|PHR: 408101; CHG: 26||Not reimbursed separately|21.37|PHR: 408101; CHG: 26||External grouping not supported 113035|ERX|HCPCS J1650|00075-0623-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.75|PHR: 408101; CHG: 26||Not reimbursed separately|23.75|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00075-0620-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]||HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00075-8014-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00548-5602-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00703-8540-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00703-8540-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00955-1004-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113036|ERX|HCPCS J1650|00955-1004-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.21|PHR: 408101; CHG: 26||Not reimbursed separately|9.21|PHR: 408101; CHG: 26||External grouping not supported 113073|ERX|HCPCS RX001|11701-0161-16|0250 - PHARMACY - GENERAL CLASSIFICATION|GEL DRESSING TOPICAL|1 Each|HUMANA [1294]||HUMANA [11839]|32.51|PHR: 408101; CHG: 26||Not reimbursed separately|32.51|PHR: 408101; CHG: 26||External grouping not supported 113073|ERX|HCPCS RX001|40565-0115-27|0250 - PHARMACY - GENERAL CLASSIFICATION|GEL DRESSING TOPICAL|2 Each|HUMANA [1294]||HUMANA [11839]|65.02|PHR: 408101; CHG: 26||Not reimbursed separately|65.02|PHR: 408101; CHG: 26||External grouping not supported 113173|ERX|HCPCS A4455|00496-0513-04|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|ADHESIVE REMOVER LIQUID|120 mL|HUMANA [1294]||HUMANA [11839]|21.60|PHR: 408101; CHG: 26||Not reimbursed separately|21.60|PHR: 408101; CHG: 26||External grouping not supported 11323|ERX|HCPCS A9270|75137-0591-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SALICYLIC ACID 17 % TOPICAL LIQUID|9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.53|PHR: 408101; CHG: 26||Not reimbursed separately|16.53|PHR: 408101; CHG: 26||External grouping not supported 113342|ERX|HCPCS A9270|00904-0262-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVITAMIN, STRESS FORMULA TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|00904-6522-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|00904-6725-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|37864-0000-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|37864-0000-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|46122-0575-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|51645-0851-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|57896-0450-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|57896-0451-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|57896-0454-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|69618-0048-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|69618-0640-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11349|ERX|HCPCS A9270|87701-0431-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 11350|ERX|HCPCS A9270|59762-4910-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11350|ERX|HCPCS A9270|60687-0253-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11350|ERX|HCPCS A9270|60687-0253-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11350|ERX|HCPCS A9270|65862-0013-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11350|ERX|HCPCS A9270|65862-0013-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11350|ERX|HCPCS A9270|65862-0013-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|16729-0216-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|59762-4900-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|60687-0242-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|60687-0242-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|65862-0012-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|65862-0012-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|68180-0352-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|68180-0352-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11351|ERX|HCPCS A9270|69097-0834-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 113551|ERX|HCPCS A9270|00904-7752-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINERAL OIL-ISOPROPYL MYRISTAT LOTION|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.52|PHR: 408101; CHG: 26||Not reimbursed separately|8.52|PHR: 408101; CHG: 26||External grouping not supported 11364|ERX|HCPCS A9270|68084-0511-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 11364|ERX|HCPCS A9270|68180-0478-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 11365|ERX|HCPCS A9270|16729-0005-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 11367|ERX|HCPCS A9270|16714-0681-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMVASTATIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 11368|ERX|HCPCS J2805|00270-0556-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HUMANA [1294]||HUMANA [11839]|302.49|PHR: 408101; CHG: 26||Not reimbursed separately|302.49|PHR: 408101; CHG: 26||External grouping not supported 114|ERX|HCPCS J1120|67457-0853-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.11|PHR: 408101; CHG: 26||Not reimbursed separately|31.11|PHR: 408101; CHG: 26||External grouping not supported 114|ERX|HCPCS J1120|00143-9503-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.11|PHR: 408101; CHG: 26||Not reimbursed separately|31.11|PHR: 408101; CHG: 26||External grouping not supported 114|ERX|HCPCS J1120|39822-0190-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]||HUMANA [11839]|31.11|PHR: 408101; CHG: 26||Not reimbursed separately|31.11|PHR: 408101; CHG: 26||External grouping not supported 11403|ERX|HCPCS RX007|00338-0048-03|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 11403|ERX|HCPCS RX007|00338-0048-04|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 11403|ERX|HCPCS RX007|00409-6138-03|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 114192|ERX|HCPCS RX001|00517-9203-25|0250 - PHARMACY - GENERAL CLASSIFICATION|TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS|3 mL|HUMANA [1294]||HUMANA [11839]|28.06|PHR: 408101; CHG: 26||Not reimbursed separately|28.06|PHR: 408101; CHG: 26||External grouping not supported 11420|ERX|HCPCS A9270|60505-0082-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 240 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 11421|ERX|HCPCS A9270|60505-0080-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.49|PHR: 408101; CHG: 26||Not reimbursed separately|2.49|PHR: 408101; CHG: 26||External grouping not supported 11421|ERX|HCPCS A9270|68084-0654-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.49|PHR: 408101; CHG: 26||Not reimbursed separately|2.49|PHR: 408101; CHG: 26||External grouping not supported 11421|ERX|HCPCS A9270|68084-0654-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.49|PHR: 408101; CHG: 26||Not reimbursed separately|2.49|PHR: 408101; CHG: 26||External grouping not supported 11421|ERX|HCPCS A9270|76385-0114-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.49|PHR: 408101; CHG: 26||Not reimbursed separately|2.49|PHR: 408101; CHG: 26||External grouping not supported 11425|ERX|HCPCS A9270|51079-0980-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11425|ERX|HCPCS A9270|53489-0329-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11425|ERX|HCPCS A9270|53746-0515-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11425|ERX|HCPCS A9270|59746-0218-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11425|ERX|HCPCS A9270|60687-0487-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11425|ERX|HCPCS A9270|60687-0487-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 11426|ERX|HCPCS A9270|51079-0979-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11426|ERX|HCPCS A9270|51079-0979-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11426|ERX|HCPCS A9270|53489-0328-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11426|ERX|HCPCS A9270|59746-0217-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11426|ERX|HCPCS A9270|60687-0476-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 11426|ERX|HCPCS A9270|63739-0545-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 114287|ERX|HCPCS 90732|00006-4837-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.90|PHR: 408101; CHG: 28||Not reimbursed separately|306.90|PHR: 408101; CHG: 28||External grouping not supported 114351|ERX|HCPCS RX001|00409-4902-34|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE|25 mL|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 114351|ERX|HCPCS RX001|00409-4902-64|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE|25 mL|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 114351|ERX|HCPCS RX001|00409-7517-16|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE|25 mL|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 114351|ERX|HCPCS RX001|00409-7517-66|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE|25 mL|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 114351|ERX|HCPCS RX001|76329-3301-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE|25 mL|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|00009-5140-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]||HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|00009-5140-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|00009-7807-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|00009-7807-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|25021-0169-87|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|55150-0242-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|57664-0683-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|66794-0219-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 114382|ERX|HCPCS J2020|66794-0219-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.40|PHR: 408101; CHG: 26||Not reimbursed separately|50.40|PHR: 408101; CHG: 26||External grouping not supported 11441|ERX|HCPCS A9270|00254-1011-96|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 100 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.60|PHR: 408101; CHG: 26||Not reimbursed separately|6.60|PHR: 408101; CHG: 26||External grouping not supported 11441|ERX|HCPCS A9270|58914-0170-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 100 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.60|PHR: 408101; CHG: 26||Not reimbursed separately|6.60|PHR: 408101; CHG: 26||External grouping not supported 11441|ERX|HCPCS A9270|65162-0062-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 100 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.60|PHR: 408101; CHG: 26||Not reimbursed separately|6.60|PHR: 408101; CHG: 26||External grouping not supported 11441|ERX|HCPCS A9270|99999-3333-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 100 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.60|PHR: 408101; CHG: 26||Not reimbursed separately|6.60|PHR: 408101; CHG: 26||External grouping not supported 11442|ERX|HCPCS A9270|00093-2210-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11442|ERX|HCPCS A9270|00093-2210-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11442|ERX|HCPCS A9270|51079-0753-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11442|ERX|HCPCS A9270|51079-0753-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11442|ERX|HCPCS A9270|59762-0401-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11442|ERX|HCPCS A9270|59762-0401-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 11443|ERX|HCPCS RX001|17478-0050-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION|0.2 mL|HUMANA [1294]||HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 11443|ERX|HCPCS RX001|17478-0050-05|0250 - PHARMACY - GENERAL CLASSIFICATION|SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION|0.2 mL|HUMANA [1294]||HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 114479|ERX|HCPCS J3360|00409-1273-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIAZEPAM 5 MG/ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.90|PHR: 408101; CHG: 26||Not reimbursed separately|32.90|PHR: 408101; CHG: 26||External grouping not supported 114479|ERX|HCPCS J3360|00409-1273-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIAZEPAM 5 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|32.90|PHR: 408101; CHG: 26||Not reimbursed separately|32.90|PHR: 408101; CHG: 26||External grouping not supported 11448|ERX|HCPCS A9270|00023-0313-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFACETAMIDE-PREDNISOLONE 10 %-0.2 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.22|PHR: 408101; CHG: 26||Not reimbursed separately|402.22|PHR: 408101; CHG: 26||External grouping not supported 114620|ERX|HCPCS J1170|00409-1283-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 1 MG/ML INJECTION SYRINGE|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 114620|ERX|HCPCS J1170|00409-1283-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 1 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.07|PHR: 408101; CHG: 26||Not reimbursed separately|5.07|PHR: 408101; CHG: 26||External grouping not supported 114625|ERX|HCPCS J1442|55513-0924-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|782.88|PHR: 408101; CHG: 26||Not reimbursed separately|782.88|PHR: 408101; CHG: 26||External grouping not supported 114625|ERX|HCPCS J1442|55513-0924-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|782.88|PHR: 408101; CHG: 26||Not reimbursed separately|782.88|PHR: 408101; CHG: 26||External grouping not supported 114627|ERX|HCPCS J1650|00075-2912-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.74 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.60|PHR: 408101; CHG: 26||Not reimbursed separately|25.60|PHR: 408101; CHG: 26||External grouping not supported 114627|ERX|HCPCS J1650|00075-8022-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.74 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.60|PHR: 408101; CHG: 26||Not reimbursed separately|25.60|PHR: 408101; CHG: 26||External grouping not supported 114627|ERX|HCPCS J1650|00703-8610-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.74 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.60|PHR: 408101; CHG: 26||Not reimbursed separately|25.60|PHR: 408101; CHG: 26||External grouping not supported 114627|ERX|HCPCS J1650|00703-8610-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.74 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.60|PHR: 408101; CHG: 26||Not reimbursed separately|25.60|PHR: 408101; CHG: 26||External grouping not supported 114627|ERX|HCPCS J1650|00955-1012-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.74 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.60|PHR: 408101; CHG: 26||Not reimbursed separately|25.60|PHR: 408101; CHG: 26||External grouping not supported 114628|ERX|HCPCS J0561|60793-0702-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.80|PHR: 408101; CHG: 26||Not reimbursed separately|243.80|PHR: 408101; CHG: 26||External grouping not supported 114628|ERX|HCPCS J0561|60793-0702-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.80|PHR: 408101; CHG: 26||Not reimbursed separately|243.80|PHR: 408101; CHG: 26||External grouping not supported 114629|ERX|HCPCS J0561|60793-0701-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.94|PHR: 408101; CHG: 26||Not reimbursed separately|237.94|PHR: 408101; CHG: 26||External grouping not supported 114629|ERX|HCPCS J0561|60793-0701-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.94|PHR: 408101; CHG: 26||Not reimbursed separately|237.94|PHR: 408101; CHG: 26||External grouping not supported 114659|ERX|HCPCS J2310|00409-1782-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SYRINGE|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.08|PHR: 408101; CHG: 26||Not reimbursed separately|10.08|PHR: 408101; CHG: 26||External grouping not supported 114659|ERX|HCPCS J2310|00409-1782-69|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SYRINGE|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.08|PHR: 408101; CHG: 26||Not reimbursed separately|10.08|PHR: 408101; CHG: 26||External grouping not supported 114903|ERX|HCPCS J1815|00169-3696-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.97|PHR: 408101; CHG: 26||Not reimbursed separately|47.97|PHR: 408101; CHG: 26||External grouping not supported 114918|ERX|HCPCS J9217|62935-0221-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE|22.5 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,053.00|PHR: 408101; CHG: 26||External grouping not supported 114918|ERX|HCPCS J9217|62935-0222-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE|22.5 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,053.00|PHR: 408101; CHG: 26||External grouping not supported 114918|ERX|HCPCS J9217|62935-0223-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE|22.5 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,053.00|PHR: 408101; CHG: 26||External grouping not supported 11500|ERX|HCPCS A9270|00904-6436-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 7.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.37|PHR: 408101; CHG: 26||Not reimbursed separately|8.37|PHR: 408101; CHG: 26||External grouping not supported 11500|ERX|HCPCS A9270|68084-0549-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 7.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.37|PHR: 408101; CHG: 26||Not reimbursed separately|8.37|PHR: 408101; CHG: 26||External grouping not supported 115057|ERX|HCPCS J2430|61703-0325-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|55.59|PHR: 408101; CHG: 26||Not reimbursed separately|55.59|PHR: 408101; CHG: 26||External grouping not supported 11507|ERX|HCPCS J3105|00143-9746-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.13|PHR: 408101; CHG: 26||Not reimbursed separately|3.13|PHR: 408101; CHG: 26||External grouping not supported 11507|ERX|HCPCS J3105|63323-0665-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|3.13|PHR: 408101; CHG: 26||Not reimbursed separately|3.13|PHR: 408101; CHG: 26||External grouping not supported 11507|ERX|HCPCS J3105|00143-9746-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.13|PHR: 408101; CHG: 26||Not reimbursed separately|3.13|PHR: 408101; CHG: 26||External grouping not supported 11509|ERX|HCPCS A9270|00115-2622-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERBUTALINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.87|PHR: 408101; CHG: 26||Not reimbursed separately|12.87|PHR: 408101; CHG: 26||External grouping not supported 11509|ERX|HCPCS A9270|00527-1311-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERBUTALINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.87|PHR: 408101; CHG: 26||Not reimbursed separately|12.87|PHR: 408101; CHG: 26||External grouping not supported 11510|ERX|HCPCS A9270|51672-1304-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERCONAZOLE 0.4 % VAGINAL CREAM|45 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.92|PHR: 408101; CHG: 26||Not reimbursed separately|79.92|PHR: 408101; CHG: 26||External grouping not supported 11511|ERX|HCPCS A9270|51672-1302-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERCONAZOLE 0.8 % VAGINAL CREAM|20 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.92|PHR: 408101; CHG: 26||Not reimbursed separately|79.92|PHR: 408101; CHG: 26||External grouping not supported 11517|ERX|HCPCS RX001|17478-0045-32|0250 - PHARMACY - GENERAL CLASSIFICATION|TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|209.94|PHR: 408101; CHG: 26||Not reimbursed separately|209.94|PHR: 408101; CHG: 26||External grouping not supported 11561|ERX|HCPCS A9270|61314-0226-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.25 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.54|PHR: 408101; CHG: 26||Not reimbursed separately|15.54|PHR: 408101; CHG: 26||External grouping not supported 11561|ERX|HCPCS A9270|60758-0802-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.77|PHR: 408101; CHG: 26||Not reimbursed separately|7.77|PHR: 408101; CHG: 26||External grouping not supported 11561|ERX|HCPCS A9270|61314-0226-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.77|PHR: 408101; CHG: 26||Not reimbursed separately|7.77|PHR: 408101; CHG: 26||External grouping not supported 11561|ERX|HCPCS A9270|64980-0513-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.77|PHR: 408101; CHG: 26||Not reimbursed separately|7.77|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|17478-0288-11|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|40.98|PHR: 408101; CHG: 26||Not reimbursed separately|40.98|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|61314-0227-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|40.98|PHR: 408101; CHG: 26||Not reimbursed separately|40.98|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|61314-0227-15|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|61.47|PHR: 408101; CHG: 26||Not reimbursed separately|61.47|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|17478-0288-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|20.49|PHR: 408101; CHG: 26||Not reimbursed separately|20.49|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|60758-0801-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|20.49|PHR: 408101; CHG: 26||Not reimbursed separately|20.49|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|61314-0227-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|20.49|PHR: 408101; CHG: 26||Not reimbursed separately|20.49|PHR: 408101; CHG: 26||External grouping not supported 11562|ERX|HCPCS RX001|64980-0514-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|20.49|PHR: 408101; CHG: 26||Not reimbursed separately|20.49|PHR: 408101; CHG: 26||External grouping not supported 11565|ERX|HCPCS J3260|39822-0412-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION|1,200 mg|HUMANA [1294]||HUMANA [11839]|171.27|PHR: 408101; CHG: 26||Not reimbursed separately|171.27|PHR: 408101; CHG: 26||External grouping not supported 11565|ERX|HCPCS J3260|39822-0412-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION|1,200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.27|PHR: 408101; CHG: 26||Not reimbursed separately|171.27|PHR: 408101; CHG: 26||External grouping not supported 11566|ERX|HCPCS RX001|00065-0648-35|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT|3.5 g|HUMANA [1294]||HUMANA [11839]|630.91|PHR: 408101; CHG: 26||Not reimbursed separately|630.91|PHR: 408101; CHG: 26||External grouping not supported 11567|ERX|HCPCS RX001|00065-0647-25|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|2.5 mL|HUMANA [1294]||HUMANA [11839]|112.86|PHR: 408101; CHG: 26||Not reimbursed separately|112.86|PHR: 408101; CHG: 26||External grouping not supported 11567|ERX|HCPCS RX001|24208-0295-25|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|2.5 mL|HUMANA [1294]||HUMANA [11839]|112.86|PHR: 408101; CHG: 26||Not reimbursed separately|112.86|PHR: 408101; CHG: 26||External grouping not supported 11584|ERX|HCPCS J3301|00003-0494-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.69|PHR: 408101; CHG: 26||Not reimbursed separately|6.69|PHR: 408101; CHG: 26||External grouping not supported 11588|ERX|HCPCS A9270|59212-0002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMTERENE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.57|PHR: 408101; CHG: 26||Not reimbursed separately|30.57|PHR: 408101; CHG: 26||External grouping not supported 115932|ERX|HCPCS A9270|00054-0188-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 115932|ERX|HCPCS A9270|50268-0144-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 115932|ERX|HCPCS A9270|50268-0144-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 115933|ERX|HCPCS A9270|00054-0189-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.88|PHR: 408101; CHG: 26||Not reimbursed separately|8.88|PHR: 408101; CHG: 26||External grouping not supported 115933|ERX|HCPCS A9270|00406-8020-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.88|PHR: 408101; CHG: 26||Not reimbursed separately|8.88|PHR: 408101; CHG: 26||External grouping not supported 115933|ERX|HCPCS A9270|50268-0145-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.88|PHR: 408101; CHG: 26||Not reimbursed separately|8.88|PHR: 408101; CHG: 26||External grouping not supported 115933|ERX|HCPCS A9270|50268-0145-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.88|PHR: 408101; CHG: 26||Not reimbursed separately|8.88|PHR: 408101; CHG: 26||External grouping not supported 115933|ERX|HCPCS A9270|65162-0415-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.88|PHR: 408101; CHG: 26||Not reimbursed separately|8.88|PHR: 408101; CHG: 26||External grouping not supported 115943|ERX|HCPCS A9270|67546-0212-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITAZOXANIDE 100 MG/5 ML ORAL SUSPENSION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.06|PHR: 408101; CHG: 26||Not reimbursed separately|1,443.06|PHR: 408101; CHG: 26||External grouping not supported 115944|ERX|HCPCS A9270|00054-0176-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 115944|ERX|HCPCS A9270|00228-3156-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 115944|ERX|HCPCS A9270|42858-0501-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 115944|ERX|HCPCS A9270|60687-0481-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 115944|ERX|HCPCS A9270|62756-0459-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 115945|ERX|HCPCS A9270|00228-3153-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.59|PHR: 408101; CHG: 26||Not reimbursed separately|3.59|PHR: 408101; CHG: 26||External grouping not supported 115945|ERX|HCPCS A9270|62756-0460-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.59|PHR: 408101; CHG: 26||Not reimbursed separately|3.59|PHR: 408101; CHG: 26||External grouping not supported 11595|ERX|HCPCS A9270|61314-0044-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLURIDINE 1 % EYE DROPS|7.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|493.02|PHR: 408101; CHG: 26||Not reimbursed separately|493.02|PHR: 408101; CHG: 26||External grouping not supported 116058|ERX|HCPCS J1442|55513-0546-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,240.32|PHR: 408101; CHG: 26||Not reimbursed separately|1,240.32|PHR: 408101; CHG: 26||External grouping not supported 116058|ERX|HCPCS J1442|55513-0546-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,240.32|PHR: 408101; CHG: 26||Not reimbursed separately|1,240.32|PHR: 408101; CHG: 26||External grouping not supported 116203|ERX|HCPCS RX011|62935-0303-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 30 MG (4 MONTH) SUBCUTANEOUS SYRINGE|30 mg|HUMANA [1294]||HUMANA [11839]|1,404.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,404.00|PHR: 408101; CHG: 26||External grouping not supported 11624|ERX|HCPCS A9270|60687-0100-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|URSODIOL 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.42|PHR: 408101; CHG: 26||Not reimbursed separately|8.42|PHR: 408101; CHG: 26||External grouping not supported 11627|ERX|HCPCS J3370|00409-6510-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|PHR: 408101; CHG: 26||Not reimbursed separately|77.43|PHR: 408101; CHG: 26||External grouping not supported 11627|ERX|HCPCS J3370|25021-0158-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|PHR: 408101; CHG: 26||Not reimbursed separately|77.43|PHR: 408101; CHG: 26||External grouping not supported 11627|ERX|HCPCS J3370|63323-0314-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|PHR: 408101; CHG: 26||Not reimbursed separately|77.43|PHR: 408101; CHG: 26||External grouping not supported 11627|ERX|HCPCS J3370|63323-0314-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|PHR: 408101; CHG: 26||Not reimbursed separately|77.43|PHR: 408101; CHG: 26||External grouping not supported 11627|ERX|HCPCS J3370|63323-0314-68|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|PHR: 408101; CHG: 26||Not reimbursed separately|77.43|PHR: 408101; CHG: 26||External grouping not supported 11627|ERX|HCPCS J3370|67457-0342-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.43|PHR: 408101; CHG: 26||Not reimbursed separately|77.43|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|00703-2914-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|00703-2914-03|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|47335-0931-40|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|55150-0235-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|63323-0781-10|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|63323-0781-21|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|67457-0438-00|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 11634|ERX|HCPCS RX001|67457-0438-10|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION|10 mg|HUMANA [1294]||HUMANA [11839]|11.89|PHR: 408101; CHG: 26||Not reimbursed separately|11.89|PHR: 408101; CHG: 26||External grouping not supported 116487|ERX|HCPCS A9270|00781-5312-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 2 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 116487|ERX|HCPCS A9270|49884-0401-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 2 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 116487|ERX|HCPCS A9270|49884-0401-91|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 2 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 11664|ERX|HCPCS A9270|00832-1211-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 11664|ERX|HCPCS A9270|00832-1211-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 116667|ERX|HCPCS J1956|00143-9720-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.85|PHR: 408101; CHG: 26||Not reimbursed separately|5.85|PHR: 408101; CHG: 26||External grouping not supported 116667|ERX|HCPCS J1956|25021-0132-68|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.85|PHR: 408101; CHG: 26||Not reimbursed separately|5.85|PHR: 408101; CHG: 26||External grouping not supported 116667|ERX|HCPCS J1956|25021-0132-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.85|PHR: 408101; CHG: 26||Not reimbursed separately|5.85|PHR: 408101; CHG: 26||External grouping not supported 116667|ERX|HCPCS J1956|36000-0048-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.85|PHR: 408101; CHG: 26||Not reimbursed separately|5.85|PHR: 408101; CHG: 26||External grouping not supported 116668|ERX|HCPCS J1956|00143-9722-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 116668|ERX|HCPCS J1956|25021-0132-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 116668|ERX|HCPCS J1956|36000-0046-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 116885|ERX|HCPCS RX001|10356-0103-02|0250 - PHARMACY - GENERAL CLASSIFICATION|ZINC OXIDE 4" X 10 YARD BANDAGE|1 Each|HUMANA [1294]||HUMANA [11839]|21.45|PHR: 408101; CHG: 26||Not reimbursed separately|21.45|PHR: 408101; CHG: 26||External grouping not supported 116885|ERX|HCPCS RX001|68455-0107-64|0250 - PHARMACY - GENERAL CLASSIFICATION|ZINC OXIDE 4" X 10 YARD BANDAGE|1 Each|HUMANA [1294]||HUMANA [11839]|21.45|PHR: 408101; CHG: 26||Not reimbursed separately|21.45|PHR: 408101; CHG: 26||External grouping not supported 11691|ERX|HCPCS J3485|49702-0213-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|81.00|PHR: 408101; CHG: 26||Not reimbursed separately|81.00|PHR: 408101; CHG: 26||External grouping not supported 11692|ERX|HCPCS A9270|65862-0107-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIDOVUDINE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.19|PHR: 408101; CHG: 26||Not reimbursed separately|4.19|PHR: 408101; CHG: 26||External grouping not supported 11693|ERX|HCPCS A9270|65862-0048-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIDOVUDINE 10 MG/ML ORAL SYRUP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.17|PHR: 408101; CHG: 26||Not reimbursed separately|4.17|PHR: 408101; CHG: 26||External grouping not supported 11701|ERX|HCPCS A9270|00904-6082-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLPIDEM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 11701|ERX|HCPCS A9270|51079-0724-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLPIDEM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 11701|ERX|HCPCS A9270|68084-0189-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLPIDEM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 117143|ERX|HCPCS A9270|12547-0238-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM TOPICAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 117143|ERX|HCPCS A9270|69968-0060-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM TOPICAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 117498|ERX|HCPCS A9270|00185-0939-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 117498|ERX|HCPCS A9270|00245-0036-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 117498|ERX|HCPCS A9270|00245-0036-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 117498|ERX|HCPCS A9270|68382-0529-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 117505|ERX|HCPCS J0587|10454-0710-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RIMABOTULINUMTOXINB 2,500 UNIT/0.5 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|871.50|PHR: 408101; CHG: 26||Not reimbursed separately|871.50|PHR: 408101; CHG: 26||External grouping not supported 117506|ERX|HCPCS J0587|10454-0711-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1,743.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,743.00|PHR: 408101; CHG: 26||External grouping not supported 117556|ERX|HCPCS J0280|00409-5922-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.36|PHR: 408101; CHG: 26||Not reimbursed separately|18.36|PHR: 408101; CHG: 26||External grouping not supported 117556|ERX|HCPCS J0280|00409-5922-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.36|PHR: 408101; CHG: 26||Not reimbursed separately|18.36|PHR: 408101; CHG: 26||External grouping not supported 118039|ERX|HCPCS RX001|72140-0031-47|0250 - PHARMACY - GENERAL CLASSIFICATION|WHITE PETROLATUM 41 % TOPICAL OINTMENT|396 g|HUMANA [1294]||HUMANA [11839]|30.89|PHR: 408101; CHG: 26||Not reimbursed separately|30.89|PHR: 408101; CHG: 26||External grouping not supported 118039|ERX|HCPCS RX001|72140-0633-77|0250 - PHARMACY - GENERAL CLASSIFICATION|WHITE PETROLATUM 41 % TOPICAL OINTMENT|85 g|HUMANA [1294]||HUMANA [11839]|6.63|PHR: 408101; CHG: 26||Not reimbursed separately|6.63|PHR: 408101; CHG: 26||External grouping not supported 118039|ERX|HCPCS RX001|72140-0032-63|0250 - PHARMACY - GENERAL CLASSIFICATION|WHITE PETROLATUM 41 % TOPICAL OINTMENT|99 g|HUMANA [1294]||HUMANA [11839]|7.73|PHR: 408101; CHG: 26||Not reimbursed separately|7.73|PHR: 408101; CHG: 26||External grouping not supported 118474|ERX|HCPCS A9270|00299-3918-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VIT E-GLYCERIN-DIMETHICONE LOTION|237 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.36|PHR: 408101; CHG: 26||Not reimbursed separately|16.36|PHR: 408101; CHG: 26||External grouping not supported 118481|ERX|HCPCS A9270|00904-5844-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PARABEN-CETYL ALCOHOL-STEARYL ALCOHOL-PROPY GLYCOL-SLS TOPICAL CLEANER|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.68|PHR: 408101; CHG: 26||Not reimbursed separately|5.68|PHR: 408101; CHG: 26||External grouping not supported 119018|ERX|HCPCS RX001|00065-0800-50|0250 - PHARMACY - GENERAL CLASSIFICATION|BALANCED SALT SOLUTION COMBINATION NO.1 INTRAOCULAR IRRIGATION|500 mL|HUMANA [1294]||HUMANA [11839]|175.50|PHR: 408101; CHG: 26||Not reimbursed separately|175.50|PHR: 408101; CHG: 26||External grouping not supported 11931|ERX|HCPCS 90648|58160-0816-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN|0.5 mL|HUMANA [1294]||HUMANA [11839]|28.71|PHR: 408101; CHG: 26||Not reimbursed separately|28.71|PHR: 408101; CHG: 26||External grouping not supported 11931|ERX|HCPCS 90648|58160-0818-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.71|PHR: 408101; CHG: 26||Not reimbursed separately|28.71|PHR: 408101; CHG: 26||External grouping not supported 119397|ERX|HCPCS A9270|51672-2044-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN ZINC 500 UNIT-POLYMYXIN B 10,000 UNIT/GRAM TOPICAL OINTMENT|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.45|PHR: 408101; CHG: 26||Not reimbursed separately|20.45|PHR: 408101; CHG: 26||External grouping not supported 12024|ERX|HCPCS A9270|00536-1178-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 12024|ERX|HCPCS A9270|50268-0522-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 12024|ERX|HCPCS A9270|50268-0522-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 12024|ERX|HCPCS A9270|68084-0490-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 12025|ERX|HCPCS A9270|50268-0523-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.28|PHR: 408101; CHG: 26||Not reimbursed separately|1.28|PHR: 408101; CHG: 26||External grouping not supported 12025|ERX|HCPCS A9270|50268-0523-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.28|PHR: 408101; CHG: 26||Not reimbursed separately|1.28|PHR: 408101; CHG: 26||External grouping not supported 12025|ERX|HCPCS A9270|59746-0121-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MECLIZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.28|PHR: 408101; CHG: 26||Not reimbursed separately|1.28|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|00074-7804-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|00245-5316-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|00245-5316-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|00378-4561-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|00574-0275-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|00781-1526-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 12184|ERX|HCPCS A9270|65862-0987-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 121877|ERX|HCPCS RX001|00065-0795-15|0250 - PHARMACY - GENERAL CLASSIFICATION|BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION|15 mL|HUMANA [1294]||HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 121877|ERX|HCPCS RX001|00065-0795-50|0250 - PHARMACY - GENERAL CLASSIFICATION|BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION|500 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 121877|ERX|HCPCS RX001|00065-1795-40|0250 - PHARMACY - GENERAL CLASSIFICATION|BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION|500 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 12197|ERX|HCPCS A9270|53489-0141-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.06|PHR: 408101; CHG: 26||Not reimbursed separately|14.06|PHR: 408101; CHG: 26||External grouping not supported 122|ERX|HCPCS J7608|00517-7504-25|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|14.93|PHR: 408101; CHG: 26||Not reimbursed separately|14.93|PHR: 408101; CHG: 26||External grouping not supported 12203|ERX|HCPCS A9270|68084-0896-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 12203|ERX|HCPCS A9270|68084-0896-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 12203|ERX|HCPCS A9270|68382-0018-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 12204|ERX|HCPCS A9270|57664-0394-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 12204|ERX|HCPCS A9270|68382-0020-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 12205|ERX|HCPCS A9270|57237-0176-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 12205|ERX|HCPCS A9270|57664-0396-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 12205|ERX|HCPCS A9270|68382-0101-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 12206|ERX|HCPCS A9270|51079-0482-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 12206|ERX|HCPCS A9270|68084-0856-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 12206|ERX|HCPCS A9270|68084-0856-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 12207|ERX|HCPCS A9270|68084-0844-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 37.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 12207|ERX|HCPCS A9270|68084-0844-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE 37.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 122094|ERX|HCPCS RX001|00065-0530-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BALANCED SALT SOLUTION NON-SURGICAL NO.3 EYE WASH|30 mL|HUMANA [1294]||HUMANA [11839]|52.65|PHR: 408101; CHG: 26||Not reimbursed separately|52.65|PHR: 408101; CHG: 26||External grouping not supported 12211|ERX|HCPCS J7639|50242-0100-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION|2.5 mL|HUMANA [1294]||HUMANA [11839]|335.28|PHR: 408101; CHG: 26||Not reimbursed separately|335.28|PHR: 408101; CHG: 26||External grouping not supported 12211|ERX|HCPCS J7639|50242-0100-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION|2.5 mL|HUMANA [1294]||HUMANA [11839]|335.28|PHR: 408101; CHG: 26||Not reimbursed separately|335.28|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|00409-1159-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|00409-1159-18|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|00409-1159-19|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|55150-0167-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|55150-0168-30|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|63323-0464-17|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1222|ERX|HCPCS J3490|63323-0464-37|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|55150-0169-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|00409-1162-18|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|00409-1162-19|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|63323-0466-17|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|00409-1162-02|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|55150-0170-30|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 1223|ERX|HCPCS J3490|63323-0466-37|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 1224|ERX|HCPCS J3490|00409-1165-18|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.58|PHR: 408101; CHG: 26||Not reimbursed separately|5.58|PHR: 408101; CHG: 26||External grouping not supported 1224|ERX|HCPCS J3490|00409-1165-19|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.58|PHR: 408101; CHG: 26||Not reimbursed separately|5.58|PHR: 408101; CHG: 26||External grouping not supported 1224|ERX|HCPCS J3490|55150-0172-30|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.58|PHR: 408101; CHG: 26||Not reimbursed separately|5.58|PHR: 408101; CHG: 26||External grouping not supported 1224|ERX|HCPCS J3490|63323-0472-37|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.58|PHR: 408101; CHG: 26||Not reimbursed separately|5.58|PHR: 408101; CHG: 26||External grouping not supported 122462|ERX|HCPCS J7611|00487-9901-30|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|1 Each|HUMANA [1294]||HUMANA [11839]|1.89|PHR: 408101; CHG: 26||Not reimbursed separately|1.89|PHR: 408101; CHG: 26||External grouping not supported 122737|ERX|HCPCS A9270|24385-0634-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIPER.BUT-PYRETHRINS-PERMETHRN 4 %-0.33 %-0.5 % TOPICAL KIT|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.71|PHR: 408101; CHG: 26||Not reimbursed separately|28.71|PHR: 408101; CHG: 26||External grouping not supported 122752|ERX|HCPCS RX001|00065-8064-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL|0.0667 g|HUMANA [1294]||HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 122752|ERX|HCPCS RX001|00078-0429-57|0250 - PHARMACY - GENERAL CLASSIFICATION|ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL|0.0667 g|HUMANA [1294]||HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 122752|ERX|HCPCS RX001|00078-0429-47|0250 - PHARMACY - GENERAL CLASSIFICATION|ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL|10 g|HUMANA [1294]||HUMANA [11839]|17.97|PHR: 408101; CHG: 26||Not reimbursed separately|17.97|PHR: 408101; CHG: 26||External grouping not supported 122764|ERX|HCPCS A9270|00574-0121-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION|240 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.68|PHR: 408101; CHG: 26||Not reimbursed separately|67.68|PHR: 408101; CHG: 26||External grouping not supported 122764|ERX|HCPCS A9270|00574-0121-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION|240 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.68|PHR: 408101; CHG: 26||Not reimbursed separately|67.68|PHR: 408101; CHG: 26||External grouping not supported 122764|ERX|HCPCS A9270|66689-0201-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION|240 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.68|PHR: 408101; CHG: 26||Not reimbursed separately|67.68|PHR: 408101; CHG: 26||External grouping not supported 12295|ERX|HCPCS J0585|00023-1145-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|100 Units|HUMANA [1294]||HUMANA [11839]|1,803.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,803.00|PHR: 408101; CHG: 26||External grouping not supported 122975|ERX|HCPCS RX001|59584-0138-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.77|PHR: 408101; CHG: 26||Not reimbursed separately|5.77|PHR: 408101; CHG: 26||External grouping not supported 122975|ERX|HCPCS RX001|99999-3333-18|0250 - PHARMACY - GENERAL CLASSIFICATION|CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.77|PHR: 408101; CHG: 26||Not reimbursed separately|5.77|PHR: 408101; CHG: 26||External grouping not supported 123|ERX|HCPCS J7608|00409-3308-03|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.45|PHR: 408101; CHG: 26||Not reimbursed separately|11.45|PHR: 408101; CHG: 26||External grouping not supported 123|ERX|HCPCS J7608|00517-7604-25|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.45|PHR: 408101; CHG: 26||Not reimbursed separately|11.45|PHR: 408101; CHG: 26||External grouping not supported 123|ERX|HCPCS J7608|63323-0694-04|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.45|PHR: 408101; CHG: 26||Not reimbursed separately|11.45|PHR: 408101; CHG: 26||External grouping not supported 123|ERX|HCPCS J7608|63323-0690-30|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.90|PHR: 408101; CHG: 26||Not reimbursed separately|22.90|PHR: 408101; CHG: 26||External grouping not supported 123383|ERX|HCPCS RX001|54643-5646-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN|5 mL|HUMANA [1294]||HUMANA [11839]|34.50|PHR: 408101; CHG: 26||Not reimbursed separately|34.50|PHR: 408101; CHG: 26||External grouping not supported 123454|ERX|HCPCS A9270|00386-0008-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY|116 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.92|PHR: 408101; CHG: 26||Not reimbursed separately|84.92|PHR: 408101; CHG: 26||External grouping not supported 1235|ERX|HCPCS A9270|00591-3546-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CODEINE-BUTALBITAL-ASA-CAFFEINE 30 MG-50 MG-325 MG-40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.81|PHR: 408101; CHG: 26||Not reimbursed separately|3.81|PHR: 408101; CHG: 26||External grouping not supported 123501|ERX|HCPCS RX001|00065-1432-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PEG 400-PROPYLENE GLYCOL (PF) 0.4 %-0.3 % EYE DROPS IN A DROPPERETTE|1 Each|HUMANA [1294]||HUMANA [11839]|1.21|PHR: 408101; CHG: 26||Not reimbursed separately|1.21|PHR: 408101; CHG: 26||External grouping not supported 123571|ERX|HCPCS J1652|55111-0679-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123571|ERX|HCPCS J1652|55150-0231-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123571|ERX|HCPCS J1652|67457-0583-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123572|ERX|HCPCS J1652|55150-0233-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123572|ERX|HCPCS J1652|67457-0585-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123572|ERX|HCPCS J1652|67457-0585-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123572|ERX|HCPCS J1652|67457-0595-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.27|PHR: 408101; CHG: 26||Not reimbursed separately|97.27|PHR: 408101; CHG: 26||External grouping not supported 123574|ERX|HCPCS J1652|55150-0232-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.91|PHR: 408101; CHG: 26||Not reimbursed separately|69.91|PHR: 408101; CHG: 26||External grouping not supported 123574|ERX|HCPCS J1652|55150-0232-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.91|PHR: 408101; CHG: 26||Not reimbursed separately|69.91|PHR: 408101; CHG: 26||External grouping not supported 123574|ERX|HCPCS J1652|67457-0584-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.91|PHR: 408101; CHG: 26||Not reimbursed separately|69.91|PHR: 408101; CHG: 26||External grouping not supported 123574|ERX|HCPCS J1652|67457-0584-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.91|PHR: 408101; CHG: 26||Not reimbursed separately|69.91|PHR: 408101; CHG: 26||External grouping not supported 123619|ERX|HCPCS J7198|64193-0424-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTI-INHIBITOR COAGULANT COMPLEX 651 UNIT-1,200 UNIT INTRAVENOUS SOLN|1,000 Units|HUMANA [1294]||HUMANA [11839]|5,460.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,460.00|PHR: 408101; CHG: 26||External grouping not supported 123620|ERX|HCPCS J7198|64193-0423-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTI-INHIBITOR COAGULANT COMPLEX 400 UNIT-650 UNIT INTRAVENOUS SOLN|500 Units|HUMANA [1294]||HUMANA [11839]|2,730.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,730.00|PHR: 408101; CHG: 26||External grouping not supported 12370|ERX|HCPCS RX001|00143-9542-01|0250 - PHARMACY - GENERAL CLASSIFICATION|NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|44.19|PHR: 408101; CHG: 26||Not reimbursed separately|44.19|PHR: 408101; CHG: 26||External grouping not supported 12370|ERX|HCPCS RX001|00143-9689-01|0250 - PHARMACY - GENERAL CLASSIFICATION|NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|44.19|PHR: 408101; CHG: 26||Not reimbursed separately|44.19|PHR: 408101; CHG: 26||External grouping not supported 12370|ERX|HCPCS RX001|00143-9689-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|44.19|PHR: 408101; CHG: 26||Not reimbursed separately|44.19|PHR: 408101; CHG: 26||External grouping not supported 123921|ERX|HCPCS A9270|24208-0358-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOBRAMYCIN 0.3 %-LOTEPRED 0.5 % EYE DROPS,SUSPENSION|100 Drop|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.95|PHR: 408101; CHG: 26||Not reimbursed separately|724.95|PHR: 408101; CHG: 26||External grouping not supported 124085|ERX|HCPCS A9270|00225-0525-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE-ALOE VERA NASAL GEL|14.1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.07|PHR: 408101; CHG: 26||Not reimbursed separately|7.07|PHR: 408101; CHG: 26||External grouping not supported 12411|ERX|HCPCS A9270|00378-8020-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVASTATIN 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.70|PHR: 408101; CHG: 26||Not reimbursed separately|9.70|PHR: 408101; CHG: 26||External grouping not supported 12412|ERX|HCPCS A9270|00378-8021-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUVASTATIN 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.42|PHR: 408101; CHG: 26||Not reimbursed separately|9.42|PHR: 408101; CHG: 26||External grouping not supported 124125|ERX|HCPCS RX015|31604-0027-61|0250 - PHARMACY - GENERAL CLASSIFICATION|LACTOBACILLUS ACIDOPHILUS 500 MILLION CELL TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 124159|ERX|HCPCS A9270|00121-4766-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.55|PHR: 408101; CHG: 26||Not reimbursed separately|2.55|PHR: 408101; CHG: 26||External grouping not supported 124517|ERX|HCPCS J7313|24208-0416-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOCINOLONE 0.59 MG INTRAVITREAL IMPLANT|1 Packet|HUMANA [1294]||HUMANA [11839]|57,075.00|PHR: 408101; CHG: 26||Not reimbursed separately|57,075.00|PHR: 408101; CHG: 26||External grouping not supported 124591|ERX|HCPCS RX001|00310-6512-01|0250 - PHARMACY - GENERAL CLASSIFICATION|EXENATIDE 5 MCG/DOSE (250 MCG/ML)1.2 ML SUBCUTANEOUS PEN INJECTOR|1.2 mL|HUMANA [1294]||HUMANA [11839]|2,015.26|PHR: 408101; CHG: 26||Not reimbursed separately|2,015.26|PHR: 408101; CHG: 26||External grouping not supported 124688|ERX|HCPCS J9263|00703-3986-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.12|PHR: 408101; CHG: 26||Not reimbursed separately|228.12|PHR: 408101; CHG: 26||External grouping not supported 124688|ERX|HCPCS J9263|00955-1727-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.12|PHR: 408101; CHG: 26||Not reimbursed separately|228.12|PHR: 408101; CHG: 26||External grouping not supported 124688|ERX|HCPCS J9263|61703-0363-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.12|PHR: 408101; CHG: 26||Not reimbursed separately|228.12|PHR: 408101; CHG: 26||External grouping not supported 124688|ERX|HCPCS J9263|70860-0201-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.12|PHR: 408101; CHG: 26||Not reimbursed separately|228.12|PHR: 408101; CHG: 26||External grouping not supported 124730|ERX|HCPCS A9270|49483-0687-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PARICALCITOL 1 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 124730|ERX|HCPCS A9270|69452-0145-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PARICALCITOL 1 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 124784|ERX|HCPCS J0592|12496-0757-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|35.55|PHR: 408101; CHG: 26||Not reimbursed separately|35.55|PHR: 408101; CHG: 26||External grouping not supported 124784|ERX|HCPCS J0592|42023-0179-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|35.55|PHR: 408101; CHG: 26||Not reimbursed separately|35.55|PHR: 408101; CHG: 26||External grouping not supported 124784|ERX|HCPCS J0592|42023-0179-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|35.55|PHR: 408101; CHG: 26||Not reimbursed separately|35.55|PHR: 408101; CHG: 26||External grouping not supported 124802|ERX|HCPCS 90378|60574-4114-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALIVIZUMAB 50 MG/0.5 ML INTRAMUSCULAR SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|4,719.66|PHR: 408101; CHG: 26||Not reimbursed separately|4,719.66|PHR: 408101; CHG: 26||External grouping not supported 124803|ERX|HCPCS 90378|60574-4113-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|8,912.04|PHR: 408101; CHG: 26||Not reimbursed separately|8,912.04|PHR: 408101; CHG: 26||External grouping not supported 124874|ERX|HCPCS J2850|67066-0005-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION|0.2 mcg|HUMANA [1294]||HUMANA [11839]|19.69|PHR: 408101; CHG: 26||Not reimbursed separately|19.69|PHR: 408101; CHG: 26||External grouping not supported 12491|ERX|HCPCS A9270|51862-0332-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 124928|ERX|HCPCS A9270|00904-0270-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN E (DL, ACETATE) 100 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 125141|ERX|HCPCS A9270|00536-1206-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 260 MG CALCIUM (648 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 125198|ERX|HCPCS A9270|50289-3250-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 125368|ERX|HCPCS A9270|16500-0040-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN-SOD BICARB-CITRIC ACID 325 MG-1,916 MG-1,000 MG EFFERVES TAB|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 125368|ERX|HCPCS A9270|16500-0040-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN-SOD BICARB-CITRIC ACID 325 MG-1,916 MG-1,000 MG EFFERVES TAB|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 125401|ERX|HCPCS RX001|68803-0612-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|210.15|PHR: 408101; CHG: 26||Not reimbursed separately|210.15|PHR: 408101; CHG: 26||External grouping not supported 125412|ERX|HCPCS RX001|00187-0658-20|0250 - PHARMACY - GENERAL CLASSIFICATION|DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT|1 Each|HUMANA [1294]||HUMANA [11839]|632.82|PHR: 408101; CHG: 26||Not reimbursed separately|632.82|PHR: 408101; CHG: 26||External grouping not supported 125440|ERX|HCPCS J2175|00641-6052-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.02|PHR: 408101; CHG: 26||Not reimbursed separately|7.02|PHR: 408101; CHG: 26||External grouping not supported 125440|ERX|HCPCS J2175|00641-6052-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.02|PHR: 408101; CHG: 26||Not reimbursed separately|7.02|PHR: 408101; CHG: 26||External grouping not supported 125443|ERX|HCPCS RX001|00409-1176-03|0250 - PHARMACY - GENERAL CLASSIFICATION|MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|15.43|PHR: 408101; CHG: 26||Not reimbursed separately|15.43|PHR: 408101; CHG: 26||External grouping not supported 125443|ERX|HCPCS RX001|00409-1176-30|0250 - PHARMACY - GENERAL CLASSIFICATION|MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|15.43|PHR: 408101; CHG: 26||Not reimbursed separately|15.43|PHR: 408101; CHG: 26||External grouping not supported 125444|ERX|HCPCS RX001|00409-1178-03|0250 - PHARMACY - GENERAL CLASSIFICATION|MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|15.96|PHR: 408101; CHG: 26||Not reimbursed separately|15.96|PHR: 408101; CHG: 26||External grouping not supported 125444|ERX|HCPCS RX001|00409-1178-30|0250 - PHARMACY - GENERAL CLASSIFICATION|MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|15.96|PHR: 408101; CHG: 26||Not reimbursed separately|15.96|PHR: 408101; CHG: 26||External grouping not supported 125446|ERX|HCPCS RX001|00409-1179-03|0250 - PHARMACY - GENERAL CLASSIFICATION|MEPERIDINE (PF) 75 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|16.45|PHR: 408101; CHG: 26||Not reimbursed separately|16.45|PHR: 408101; CHG: 26||External grouping not supported 125446|ERX|HCPCS RX001|00409-1179-30|0250 - PHARMACY - GENERAL CLASSIFICATION|MEPERIDINE (PF) 75 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|16.45|PHR: 408101; CHG: 26||Not reimbursed separately|16.45|PHR: 408101; CHG: 26||External grouping not supported 125448|ERX|HCPCS J2175|00409-1180-69|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPERIDINE (PF) 100 MG/ML INJECTION SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|16.45|PHR: 408101; CHG: 26||Not reimbursed separately|16.45|PHR: 408101; CHG: 26||External grouping not supported 125498|ERX|HCPCS A9270|00904-1882-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE-VITAMIN D3 250 MG-125 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 125498|ERX|HCPCS A9270|20555-0025-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE-VITAMIN D3 250 MG-125 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 125548|ERX|HCPCS RX004|00338-0553-11|0258 - PHARMACY - IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 125548|ERX|HCPCS RX004|00338-0553-18|0258 - PHARMACY - IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 12556|ERX|HCPCS A9270|50580-0534-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 125716|ERX|HCPCS RX001|10122-0510-03|0250 - PHARMACY - GENERAL CLASSIFICATION|PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION|3 mL|HUMANA [1294]||HUMANA [11839]|2,455.47|PHR: 408101; CHG: 26||Not reimbursed separately|2,455.47|PHR: 408101; CHG: 26||External grouping not supported 12580|ERX|HCPCS J7644|00378-7970-31|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 12580|ERX|HCPCS J7644|00487-9801-01|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 126018|ERX|HCPCS J7198|64193-0425-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN|2,500 Units|HUMANA [1294]||HUMANA [11839]|13,650.00|PHR: 408101; CHG: 26||Not reimbursed separately|13,650.00|PHR: 408101; CHG: 26||External grouping not supported 126020|ERX|HCPCS J1815|00088-2500-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.01|PHR: 408101; CHG: 26||Not reimbursed separately|314.01|PHR: 408101; CHG: 26||External grouping not supported 126128|ERX|HCPCS J7187|99999-1111-89|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION|1 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 126130|ERX|HCPCS J7187||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION|1 Units|HUMANA [1294]||HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 126140|ERX|HCPCS J1644|00409-1316-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.24|PHR: 408101; CHG: 26||Not reimbursed separately|2.24|PHR: 408101; CHG: 26||External grouping not supported 126140|ERX|HCPCS J1644|00409-1316-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.24|PHR: 408101; CHG: 26||Not reimbursed separately|2.24|PHR: 408101; CHG: 26||External grouping not supported 1262|ERX|HCPCS RX001|00517-2502-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN|1 mL|HUMANA [1294]||HUMANA [11839]|51.24|PHR: 408101; CHG: 26||Not reimbursed separately|51.24|PHR: 408101; CHG: 26||External grouping not supported 1262|ERX|HCPCS RX001|00517-2502-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN|2 mL|HUMANA [1294]||HUMANA [11839]|51.24|PHR: 408101; CHG: 26||Not reimbursed separately|51.24|PHR: 408101; CHG: 26||External grouping not supported 126224|ERX|HCPCS RX001|00395-1031-16|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCERIN 99.5 % TOPICAL SOLUTION|473 mL|HUMANA [1294]||HUMANA [11839]|45.41|PHR: 408101; CHG: 26||Not reimbursed separately|45.41|PHR: 408101; CHG: 26||External grouping not supported 126329|ERX|HCPCS A9270|68012-0052-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 20 MG-SODIUM BICARBONATE 1,680 MG ORAL PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.26|PHR: 408101; CHG: 26||Not reimbursed separately|64.26|PHR: 408101; CHG: 26||External grouping not supported 126329|ERX|HCPCS A9270|68682-0990-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 20 MG-SODIUM BICARBONATE 1,680 MG ORAL PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.26|PHR: 408101; CHG: 26||Not reimbursed separately|64.26|PHR: 408101; CHG: 26||External grouping not supported 126330|ERX|HCPCS A9270|68012-0054-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 40 MG-SODIUM BICARBONATE 1,680 MG ORAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.73|PHR: 408101; CHG: 26||Not reimbursed separately|304.73|PHR: 408101; CHG: 26||External grouping not supported 126330|ERX|HCPCS A9270|68682-0991-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 40 MG-SODIUM BICARBONATE 1,680 MG ORAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.73|PHR: 408101; CHG: 26||Not reimbursed separately|304.73|PHR: 408101; CHG: 26||External grouping not supported 126358|ERX|HCPCS RX015|77333-0835-25|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 126366|ERX|HCPCS J3473|18657-0117-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|141.92|PHR: 408101; CHG: 26||Not reimbursed separately|141.92|PHR: 408101; CHG: 26||External grouping not supported 126366|ERX|HCPCS J3473|18657-0117-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.92|PHR: 408101; CHG: 26||Not reimbursed separately|141.92|PHR: 408101; CHG: 26||External grouping not supported 126366|ERX|HCPCS J3473|18657-0117-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.92|PHR: 408101; CHG: 26||Not reimbursed separately|141.92|PHR: 408101; CHG: 26||External grouping not supported 126640|ERX|HCPCS RX001|00409-4278-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 126641|ERX|HCPCS RX001|63323-0208-05|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION|3 Vial|HUMANA [1294]||HUMANA [11839]|2.51|PHR: 408101; CHG: 26||Not reimbursed separately|2.51|PHR: 408101; CHG: 26||External grouping not supported 126720|ERX|HCPCS A9270|00069-0469-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VARENICLINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.84|PHR: 408101; CHG: 26||Not reimbursed separately|21.84|PHR: 408101; CHG: 26||External grouping not supported 126721|ERX|HCPCS A9270|00069-0468-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VARENICLINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.84|PHR: 408101; CHG: 26||Not reimbursed separately|21.84|PHR: 408101; CHG: 26||External grouping not supported 126754|ERX|HCPCS RX001|00378-1270-93|0250 - PHARMACY - GENERAL CLASSIFICATION|RASAGILINE 0.5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|19.38|PHR: 408101; CHG: 26||Not reimbursed separately|19.38|PHR: 408101; CHG: 26||External grouping not supported 126754|ERX|HCPCS RX001|47781-0683-30|0250 - PHARMACY - GENERAL CLASSIFICATION|RASAGILINE 0.5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|19.38|PHR: 408101; CHG: 26||Not reimbursed separately|19.38|PHR: 408101; CHG: 26||External grouping not supported 126754|ERX|HCPCS RX001|67877-0259-30|0250 - PHARMACY - GENERAL CLASSIFICATION|RASAGILINE 0.5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|19.38|PHR: 408101; CHG: 26||Not reimbursed separately|19.38|PHR: 408101; CHG: 26||External grouping not supported 127047|ERX|HCPCS J2783|00024-5151-74|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RASBURICASE 7.5 MG INTRAVENOUS SOLUTION|7.5 mg|HUMANA [1294]||HUMANA [11839]|12,604.29|PHR: 408101; CHG: 26||Not reimbursed separately|12,604.29|PHR: 408101; CHG: 26||External grouping not supported 127047|ERX|HCPCS J2783|00024-5151-75|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RASBURICASE 7.5 MG INTRAVENOUS SOLUTION|7.5 mg|HUMANA [1294]||HUMANA [11839]|12,604.29|PHR: 408101; CHG: 26||Not reimbursed separately|12,604.29|PHR: 408101; CHG: 26||External grouping not supported 127223|ERX|HCPCS J0881|55513-0028-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,335.66|PHR: 408101; CHG: 26||Not reimbursed separately|4,335.66|PHR: 408101; CHG: 26||External grouping not supported 12723|ERX|HCPCS A9270|65162-0436-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 50 MG-MISOPROSTOL 200 MCG TABLET,IMMED.AND DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.51|PHR: 408101; CHG: 26||Not reimbursed separately|4.51|PHR: 408101; CHG: 26||External grouping not supported 12723|ERX|HCPCS A9270|68001-0231-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 50 MG-MISOPROSTOL 200 MCG TABLET,IMMED.AND DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.51|PHR: 408101; CHG: 26||Not reimbursed separately|4.51|PHR: 408101; CHG: 26||External grouping not supported 127230|ERX|HCPCS J0881|55513-0025-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,167.83|PHR: 408101; CHG: 26||Not reimbursed separately|2,167.83|PHR: 408101; CHG: 26||External grouping not supported 127230|ERX|HCPCS J0881|55513-0025-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,167.83|PHR: 408101; CHG: 26||Not reimbursed separately|2,167.83|PHR: 408101; CHG: 26||External grouping not supported 12724|ERX|HCPCS A9270|51991-0526-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERBINAFINE HCL 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 12724|ERX|HCPCS A9270|65862-0079-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERBINAFINE HCL 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|00143-9250-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|00143-9250-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|00409-9558-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|00409-9558-11|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|00781-3220-75|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|39822-4200-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|39822-4200-02|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|43066-0007-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|47781-0616-20|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|55150-0225-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|63323-0426-02|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|63323-0426-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|67457-0228-00|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 12734|ERX|HCPCS RX001|67457-0228-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 127355|ERX|HCPCS A9270|51991-0703-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IRON ASPGL AND PS CMPLX 150 MG-VIT C 50 MG-SUCCINIC ACID 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 127383|ERX|HCPCS A9270|51991-0543-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IRON ASP-C-B12-CALCIUM-SA-STOMACH 70 MG-150 MG-10 MCG-2 MG-75MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 127504|ERX|HCPCS A9270|45802-0143-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 127512|ERX|HCPCS RX001|00436-0672-16|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HUMANA [1294]||HUMANA [11839]|24.13|PHR: 408101; CHG: 26||Not reimbursed separately|24.13|PHR: 408101; CHG: 26||External grouping not supported 127512|ERX|HCPCS RX001|39328-0064-12|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HUMANA [1294]||HUMANA [11839]|24.13|PHR: 408101; CHG: 26||Not reimbursed separately|24.13|PHR: 408101; CHG: 26||External grouping not supported 127546|ERX|HCPCS RX001|65649-0201-75|0250 - PHARMACY - GENERAL CLASSIFICATION|PEG3350 100 GRAM-SOD SULF 7.5 GRAM-NACL-KCL-ASCORBATE-C ORAL PWDR PACK|1 Kit|HUMANA [1294]||HUMANA [11839]|154.89|PHR: 408101; CHG: 26||Not reimbursed separately|154.89|PHR: 408101; CHG: 26||External grouping not supported 127579|ERX|HCPCS RX007|00496-0523-48|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|GUM MASTIC-STORAX-METHYLSALICYLATE-ALCOHOL DROPS,DROPPERETTE|1 Each|HUMANA [1294]||HUMANA [11839]|6.16|PHR: 408101; CHG: 26||Not reimbursed separately|6.16|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|00536-3334-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|00904-5824-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|20555-0033-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|37864-0919-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|48433-0104-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|80681-0168-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|80681-0169-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127584|ERX|HCPCS A9270|87701-0407-49|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 127630|ERX|HCPCS RX001|00941-0433-52|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITON. DIALYSIS SOLN 8-4.25 % DEXTROSE CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|1,500 mL|HUMANA [1294]||HUMANA [11839]|52.45|PHR: 408101; CHG: 26||Not reimbursed separately|52.45|PHR: 408101; CHG: 26||External grouping not supported 127630|ERX|HCPCS RX001|00941-0459-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITON. DIALYSIS SOLN 8-4.25 % DEXTROSE CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|1,500 mL|HUMANA [1294]||HUMANA [11839]|52.45|PHR: 408101; CHG: 26||Not reimbursed separately|52.45|PHR: 408101; CHG: 26||External grouping not supported 127648|ERX|HCPCS RX001|63402-0911-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HUMANA [1294]||HUMANA [11839]|36.58|PHR: 408101; CHG: 26||Not reimbursed separately|36.58|PHR: 408101; CHG: 26||External grouping not supported 127652|ERX|HCPCS RX001|00941-0430-52|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|2,000 mL|HUMANA [1294]||HUMANA [11839]|69.27|PHR: 408101; CHG: 26||Not reimbursed separately|69.27|PHR: 408101; CHG: 26||External grouping not supported 127652|ERX|HCPCS RX001|00941-0430-55|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|3,000 mL|HUMANA [1294]||HUMANA [11839]|82.68|PHR: 408101; CHG: 26||Not reimbursed separately|82.68|PHR: 408101; CHG: 26||External grouping not supported 127652|ERX|HCPCS RX001|00941-0457-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|6,000 mL|HUMANA [1294]||HUMANA [11839]|58.86|PHR: 408101; CHG: 26||Not reimbursed separately|58.86|PHR: 408101; CHG: 26||External grouping not supported 127660|ERX|HCPCS RX001|00941-0413-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITON. DIALYSIS SOLN 13-2.5 % DEXTROSE CALC 3.5 MEQ/L-MAG 0.5 MEQ/L|2,000 mL|HUMANA [1294]||HUMANA [11839]|47.34|PHR: 408101; CHG: 26||Not reimbursed separately|47.34|PHR: 408101; CHG: 26||External grouping not supported 127680|ERX|HCPCS RX001|00941-0411-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITONEAL DIALYSIS SOLN 4-1.5 % DEXTR CA+ 3.5 MEQ/L-LOW MAG 0.5 MEQ/L|2,000 mL|HUMANA [1294]||HUMANA [11839]|39.57|PHR: 408101; CHG: 26||Not reimbursed separately|39.57|PHR: 408101; CHG: 26||External grouping not supported 127723|ERX|HCPCS RX001|00941-0424-52|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|2,000 mL|HUMANA [1294]||HUMANA [11839]|62.10|PHR: 408101; CHG: 26||Not reimbursed separately|62.10|PHR: 408101; CHG: 26||External grouping not supported 127723|ERX|HCPCS RX001|00941-0409-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L|6,000 mL|HUMANA [1294]||HUMANA [11839]|55.44|PHR: 408101; CHG: 26||Not reimbursed separately|55.44|PHR: 408101; CHG: 26||External grouping not supported 127740|ERX|HCPCS J2248|00469-3211-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.01|PHR: 408101; CHG: 26||Not reimbursed separately|156.01|PHR: 408101; CHG: 26||External grouping not supported 127740|ERX|HCPCS J2248|63323-0729-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.01|PHR: 408101; CHG: 26||Not reimbursed separately|156.01|PHR: 408101; CHG: 26||External grouping not supported 127740|ERX|HCPCS J2248|63323-0729-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.01|PHR: 408101; CHG: 26||Not reimbursed separately|156.01|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|00409-4755-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|00409-4755-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|00641-6078-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|23155-0547-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|23155-0547-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|23155-0548-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|23155-0548-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|23155-0548-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|36000-0012-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|60505-6130-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|60505-6130-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|67457-0440-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|67457-0440-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127763|ERX|HCPCS J2405|70860-0776-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 127825|ERX|HCPCS A9270|74300-0081-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM|57 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.63|PHR: 408101; CHG: 26||Not reimbursed separately|6.63|PHR: 408101; CHG: 26||External grouping not supported 127825|ERX|HCPCS A9270|41167-0600-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.63|PHR: 408101; CHG: 26||Not reimbursed separately|6.63|PHR: 408101; CHG: 26||External grouping not supported 127825|ERX|HCPCS A9270|45802-0174-53|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.63|PHR: 408101; CHG: 26||Not reimbursed separately|6.63|PHR: 408101; CHG: 26||External grouping not supported 127825|ERX|HCPCS A9270|87701-0400-48|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.63|PHR: 408101; CHG: 26||Not reimbursed separately|6.63|PHR: 408101; CHG: 26||External grouping not supported 127841|ERX|HCPCS A9270|00007-3373-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL PHOSPHATE ER 80 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.12|PHR: 408101; CHG: 26||Not reimbursed separately|25.12|PHR: 408101; CHG: 26||External grouping not supported 127955|ERX|HCPCS RX001|58914-0214-60|0250 - PHARMACY - GENERAL CLASSIFICATION|PEDIATRIC MULTIVITAMIN NO.40-PHYTONADIONE 400 MCG/ML ORAL DROPS|1 mL|HUMANA [1294]||HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 127982|ERX|HCPCS J0171|54288-0103-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.55|PHR: 408101; CHG: 26||Not reimbursed separately|26.55|PHR: 408101; CHG: 26||External grouping not supported 127982|ERX|HCPCS J0171|54288-0103-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.55|PHR: 408101; CHG: 26||Not reimbursed separately|26.55|PHR: 408101; CHG: 26||External grouping not supported 12803|ERX|HCPCS A9270|00228-2801-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PILOCARPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.93|PHR: 408101; CHG: 26||Not reimbursed separately|2.93|PHR: 408101; CHG: 26||External grouping not supported 12803|ERX|HCPCS A9270|00527-1313-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PILOCARPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.93|PHR: 408101; CHG: 26||Not reimbursed separately|2.93|PHR: 408101; CHG: 26||External grouping not supported 128039|ERX|HCPCS J1100|63323-0506-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.65|PHR: 408101; CHG: 26||Not reimbursed separately|4.65|PHR: 408101; CHG: 26||External grouping not supported 128039|ERX|HCPCS J1100|70069-0021-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.65|PHR: 408101; CHG: 26||Not reimbursed separately|4.65|PHR: 408101; CHG: 26||External grouping not supported 128039|ERX|HCPCS J1100|70069-0021-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.65|PHR: 408101; CHG: 26||Not reimbursed separately|4.65|PHR: 408101; CHG: 26||External grouping not supported 128039|ERX|HCPCS J1100|63323-0506-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.65|PHR: 408101; CHG: 26||Not reimbursed separately|4.65|PHR: 408101; CHG: 26||External grouping not supported 128066|ERX|HCPCS A9270|00093-7684-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLOPATADINE 0.2 % EYE DROPS|1 Bottle|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.08|PHR: 408101; CHG: 26||Not reimbursed separately|333.08|PHR: 408101; CHG: 26||External grouping not supported 128066|ERX|HCPCS A9270|60505-0586-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLOPATADINE 0.2 % EYE DROPS|1 Bottle|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.08|PHR: 408101; CHG: 26||Not reimbursed separately|333.08|PHR: 408101; CHG: 26||External grouping not supported 128145|ERX|HCPCS 90633|58160-0825-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|72.23|PHR: 408101; CHG: 26||Not reimbursed separately|72.23|PHR: 408101; CHG: 26||External grouping not supported 128145|ERX|HCPCS 90633|58160-0825-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|72.23|PHR: 408101; CHG: 26||Not reimbursed separately|72.23|PHR: 408101; CHG: 26||External grouping not supported 128262|ERX|HCPCS RX020|13533-0636-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|254.82|PHR: 408101; CHG: 26||Not reimbursed separately|254.82|PHR: 408101; CHG: 26||External grouping not supported 128487|ERX|HCPCS J1300|25682-0001-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|19,568.97|PHR: 408101; CHG: 26||Not reimbursed separately|19,568.97|PHR: 408101; CHG: 26||External grouping not supported 128543|ERX|HCPCS 90746|58160-0821-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE|1 Syringe|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.11|PHR: 408101; CHG: 26||Not reimbursed separately|118.11|PHR: 408101; CHG: 26||External grouping not supported 128543|ERX|HCPCS 90746|58160-0821-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|118.11|PHR: 408101; CHG: 26||Not reimbursed separately|118.11|PHR: 408101; CHG: 26||External grouping not supported 128562|ERX|HCPCS RX001|54629-4097-60|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 600 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 128562|ERX|HCPCS RX001|79854-0040-97|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCYSTEINE 600 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 128711|ERX|HCPCS J3489|00409-4228-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.90|PHR: 408101; CHG: 26||Not reimbursed separately|114.90|PHR: 408101; CHG: 26||External grouping not supported 128711|ERX|HCPCS J3489|25021-0830-82|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.90|PHR: 408101; CHG: 26||Not reimbursed separately|114.90|PHR: 408101; CHG: 26||External grouping not supported 128711|ERX|HCPCS J3489|55111-0688-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.90|PHR: 408101; CHG: 26||Not reimbursed separately|114.90|PHR: 408101; CHG: 26||External grouping not supported 128711|ERX|HCPCS J3489|63323-0966-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.90|PHR: 408101; CHG: 26||Not reimbursed separately|114.90|PHR: 408101; CHG: 26||External grouping not supported 128711|ERX|HCPCS J3489|67457-0794-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.90|PHR: 408101; CHG: 26||Not reimbursed separately|114.90|PHR: 408101; CHG: 26||External grouping not supported 128711|ERX|HCPCS J3489|70860-0802-82|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.90|PHR: 408101; CHG: 26||Not reimbursed separately|114.90|PHR: 408101; CHG: 26||External grouping not supported 128808|ERX|HCPCS RX001|00409-5779-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV|20 mL|HUMANA [1294]||HUMANA [11839]|16.62|PHR: 408101; CHG: 26||Not reimbursed separately|16.62|PHR: 408101; CHG: 26||External grouping not supported 128829|ERX|HCPCS 90744|58160-0820-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|42.70|PHR: 408101; CHG: 28||Not reimbursed separately|42.70|PHR: 408101; CHG: 28||External grouping not supported 128829|ERX|HCPCS 90744|58160-0820-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|42.70|PHR: 408101; CHG: 28||Not reimbursed separately|42.70|PHR: 408101; CHG: 28||External grouping not supported 128833|ERX|HCPCS 90747|58160-0821-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.11|PHR: 408101; CHG: 28||Not reimbursed separately|118.11|PHR: 408101; CHG: 28||External grouping not supported 128843|ERX|HCPCS RX001|00869-3851-10|0250 - PHARMACY - GENERAL CLASSIFICATION|IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE|30 mL|HUMANA [1294]||HUMANA [11839]|3.24|PHR: 408101; CHG: 26||Not reimbursed separately|3.24|PHR: 408101; CHG: 26||External grouping not supported 12886|ERX|HCPCS A9270|00781-6023-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.90|PHR: 408101; CHG: 26||Not reimbursed separately|17.90|PHR: 408101; CHG: 26||External grouping not supported 128947|ERX|HCPCS RX001|00186-0372-20|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER|2 Puff|HUMANA [1294]||HUMANA [11839]|4.02|PHR: 408101; CHG: 26||Not reimbursed separately|4.02|PHR: 408101; CHG: 26||External grouping not supported 128947|ERX|HCPCS RX001|00186-0372-28|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER|2 Puff|HUMANA [1294]||HUMANA [11839]|4.02|PHR: 408101; CHG: 26||Not reimbursed separately|4.02|PHR: 408101; CHG: 26||External grouping not supported 128947|ERX|HCPCS RX001|00310-7372-20|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER|2 Puff|HUMANA [1294]||HUMANA [11839]|4.02|PHR: 408101; CHG: 26||Not reimbursed separately|4.02|PHR: 408101; CHG: 26||External grouping not supported 128948|ERX|HCPCS RX001|00186-0370-20|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER|2 Puff|HUMANA [1294]||HUMANA [11839]|4.63|PHR: 408101; CHG: 26||Not reimbursed separately|4.63|PHR: 408101; CHG: 26||External grouping not supported 128948|ERX|HCPCS RX001|00186-0370-28|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER|2 Puff|HUMANA [1294]||HUMANA [11839]|4.63|PHR: 408101; CHG: 26||Not reimbursed separately|4.63|PHR: 408101; CHG: 26||External grouping not supported 128948|ERX|HCPCS RX001|00310-7370-20|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER|2 Puff|HUMANA [1294]||HUMANA [11839]|4.63|PHR: 408101; CHG: 26||Not reimbursed separately|4.63|PHR: 408101; CHG: 26||External grouping not supported 128966|ERX|HCPCS 90723|58160-0811-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|168.92|PHR: 408101; CHG: 26||Not reimbursed separately|168.92|PHR: 408101; CHG: 26||External grouping not supported 128966|ERX|HCPCS 90723|58160-0811-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|168.92|PHR: 408101; CHG: 26||Not reimbursed separately|168.92|PHR: 408101; CHG: 26||External grouping not supported 128978|ERX|HCPCS J1170|00641-6151-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.47|PHR: 408101; CHG: 26||Not reimbursed separately|3.47|PHR: 408101; CHG: 26||External grouping not supported 128978|ERX|HCPCS J1170|63323-0853-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.47|PHR: 408101; CHG: 26||Not reimbursed separately|3.47|PHR: 408101; CHG: 26||External grouping not supported 128978|ERX|HCPCS J1170|63323-0853-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.47|PHR: 408101; CHG: 26||Not reimbursed separately|3.47|PHR: 408101; CHG: 26||External grouping not supported 128999|ERX|HCPCS 90632|58160-0826-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|172.11|PHR: 408101; CHG: 26||Not reimbursed separately|172.11|PHR: 408101; CHG: 26||External grouping not supported 128999|ERX|HCPCS 90632|58160-0826-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|172.11|PHR: 408101; CHG: 26||Not reimbursed separately|172.11|PHR: 408101; CHG: 26||External grouping not supported 129003|ERX|HCPCS RX001|54162-0100-02|0250 - PHARMACY - GENERAL CLASSIFICATION|BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE|58 mL|HUMANA [1294]||HUMANA [11839]|8.18|PHR: 408101; CHG: 26||Not reimbursed separately|8.18|PHR: 408101; CHG: 26||External grouping not supported 129254|ERX|HCPCS RX001|00023-4554-30|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 Each|HUMANA [1294]||HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 129254|ERX|HCPCS RX001|58790-0002-28|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 Each|HUMANA [1294]||HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 129254|ERX|HCPCS RX001|58790-0003-30|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 Each|HUMANA [1294]||HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 12933|ERX|HCPCS J7507|00781-2103-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 12933|ERX|HCPCS J7507|16729-0042-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 12933|ERX|HCPCS J7507|42291-0753-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 12933|ERX|HCPCS J7507|51079-0818-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 12933|ERX|HCPCS J7507|68084-0450-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 12933|ERX|HCPCS J7507|68084-0450-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 12934|ERX|HCPCS J7507|00781-2104-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.58|PHR: 408101; CHG: 26||Not reimbursed separately|8.58|PHR: 408101; CHG: 26||External grouping not supported 12935|ERX|HCPCS J7525|00469-3016-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|574.77|PHR: 408101; CHG: 26||Not reimbursed separately|574.77|PHR: 408101; CHG: 26||External grouping not supported 129390|ERX|HCPCS 90636|58160-0815-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.77|PHR: 408101; CHG: 26||Not reimbursed separately|250.77|PHR: 408101; CHG: 26||External grouping not supported 129390|ERX|HCPCS 90636|58160-0815-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|250.77|PHR: 408101; CHG: 26||Not reimbursed separately|250.77|PHR: 408101; CHG: 26||External grouping not supported 129403|ERX|HCPCS J9330|00008-1179-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN|2.5 mL|HUMANA [1294]||HUMANA [11839]|4,850.10|PHR: 408101; CHG: 26||Not reimbursed separately|4,850.10|PHR: 408101; CHG: 26||External grouping not supported 129403|ERX|HCPCS J9330|00008-1279-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,850.10|PHR: 408101; CHG: 26||Not reimbursed separately|4,850.10|PHR: 408101; CHG: 26||External grouping not supported 129403|ERX|HCPCS J9330|16729-0221-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,850.10|PHR: 408101; CHG: 26||Not reimbursed separately|4,850.10|PHR: 408101; CHG: 26||External grouping not supported 129403|ERX|HCPCS J9330|16729-0223-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,850.10|PHR: 408101; CHG: 26||Not reimbursed separately|4,850.10|PHR: 408101; CHG: 26||External grouping not supported 129521|ERX|HCPCS RX001|00088-2219-05|0250 - PHARMACY - GENERAL CLASSIFICATION|INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN|3 mL|HUMANA [1294]||HUMANA [11839]|74.31|PHR: 408101; CHG: 26||Not reimbursed separately|74.31|PHR: 408101; CHG: 26||External grouping not supported 129912|ERX|HCPCS J9208|00703-3427-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.88|PHR: 408101; CHG: 26||Not reimbursed separately|95.88|PHR: 408101; CHG: 26||External grouping not supported 129913|ERX|HCPCS J9208|00143-9530-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.72|PHR: 408101; CHG: 26||Not reimbursed separately|279.72|PHR: 408101; CHG: 26||External grouping not supported 129913|ERX|HCPCS J9208|00703-3429-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.72|PHR: 408101; CHG: 26||Not reimbursed separately|279.72|PHR: 408101; CHG: 26||External grouping not supported 1300|ERX|HCPCS A9270|00904-1883-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 1300|ERX|HCPCS A9270|20555-0003-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 1300|ERX|HCPCS A9270|37864-0827-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 1300|ERX|HCPCS A9270|51645-0827-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 130011|ERX|HCPCS A9270|00904-2533-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.72|PHR: 408101; CHG: 26||Not reimbursed separately|3.72|PHR: 408101; CHG: 26||External grouping not supported 130035|ERX|HCPCS J0348|00049-0116-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|219.36|PHR: 408101; CHG: 26||Not reimbursed separately|219.36|PHR: 408101; CHG: 26||External grouping not supported 130053|ERX|HCPCS J1580|63323-0173-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 130053|ERX|HCPCS J1580|63323-0173-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 130199|ERX|HCPCS A9270|31722-0551-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOCETIRIZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 130199|ERX|HCPCS A9270|47335-0175-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOCETIRIZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 130199|ERX|HCPCS A9270|68462-0346-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOCETIRIZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 130246|ERX|HCPCS 90632|58160-0826-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS A VIRUS VACCINE (PF) 1,440 ELISA UNIT/ML IM SUSPENSION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|86.29|PHR: 408101; CHG: 26||Not reimbursed separately|86.29|PHR: 408101; CHG: 26||External grouping not supported 130269|ERX|HCPCS J7192|00944-3051-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 250 (+/-) UNIT IV SOLUTION|250 Units|HUMANA [1294]||HUMANA [11839]|922.50|PHR: 408101; CHG: 26||Not reimbursed separately|922.50|PHR: 408101; CHG: 26||External grouping not supported 130275|ERX|HCPCS J7186|68516-4601-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 250 (100 VWF) UNIT/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|720.00|PHR: 408101; CHG: 26||Not reimbursed separately|720.00|PHR: 408101; CHG: 26||External grouping not supported 130275|ERX|HCPCS J7186|68516-4611-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 250 (100 VWF) UNIT/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|720.00|PHR: 408101; CHG: 26||Not reimbursed separately|720.00|PHR: 408101; CHG: 26||External grouping not supported 130276|ERX|HCPCS J7186|68516-4602-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|1,440.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,440.00|PHR: 408101; CHG: 26||External grouping not supported 130276|ERX|HCPCS J7186|68516-4612-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|1,440.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,440.00|PHR: 408101; CHG: 26||External grouping not supported 130277|ERX|HCPCS J7186|68516-4603-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|2,880.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,880.00|PHR: 408101; CHG: 26||External grouping not supported 130277|ERX|HCPCS J7186|68516-4613-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|2,880.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,880.00|PHR: 408101; CHG: 26||External grouping not supported 130278|ERX|HCPCS J7186|68516-4604-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|4,320.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,320.00|PHR: 408101; CHG: 26||External grouping not supported 130278|ERX|HCPCS J7186|68516-4614-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|4,320.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,320.00|PHR: 408101; CHG: 26||External grouping not supported 130405|ERX|HCPCS RX001|60793-0215-05|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION|5,000 Units|HUMANA [1294]||HUMANA [11839]|128.97|PHR: 408101; CHG: 26||Not reimbursed separately|128.97|PHR: 408101; CHG: 26||External grouping not supported 130478|ERX|HCPCS A9270|00904-6488-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.43|PHR: 408101; CHG: 26||Not reimbursed separately|17.43|PHR: 408101; CHG: 26||External grouping not supported 130478|ERX|HCPCS A9270|17478-0062-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.43|PHR: 408101; CHG: 26||Not reimbursed separately|17.43|PHR: 408101; CHG: 26||External grouping not supported 130513|ERX|HCPCS A9270|00781-5669-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 50 MG-LEVODOPA 200 MG-ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 130521|ERX|HCPCS J1930|15054-1120-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|21,747.00|PHR: 408101; CHG: 26||Not reimbursed separately|21,747.00|PHR: 408101; CHG: 26||External grouping not supported 130578|ERX|HCPCS A9270|00006-0227-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RALTEGRAVIR 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.39|PHR: 408101; CHG: 26||Not reimbursed separately|80.39|PHR: 408101; CHG: 26||External grouping not supported 1306|ERX|HCPCS RX001|00409-1631-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|23.49|PHR: 408101; CHG: 26||Not reimbursed separately|23.49|PHR: 408101; CHG: 26||External grouping not supported 1306|ERX|HCPCS RX001|76329-3304-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|23.49|PHR: 408101; CHG: 26||Not reimbursed separately|23.49|PHR: 408101; CHG: 26||External grouping not supported 1306|ERX|HCPCS RX001|00409-4928-34|0250 - PHARMACY - GENERAL CLASSIFICATION|CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE|5 mL|HUMANA [1294]||HUMANA [11839]|23.49|PHR: 408101; CHG: 26||Not reimbursed separately|23.49|PHR: 408101; CHG: 26||External grouping not supported 130608|ERX|HCPCS J9207|70020-1910-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IXABEPILONE 15 MG INTRAVENOUS SOLUTION|15 mg|HUMANA [1294]||HUMANA [11839]|4,446.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,446.00|PHR: 408101; CHG: 26||External grouping not supported 130608|ERX|HCPCS J9207|70020-1910-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IXABEPILONE 15 MG INTRAVENOUS SOLUTION|15 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,446.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,446.00|PHR: 408101; CHG: 26||External grouping not supported 130609|ERX|HCPCS J9207|70020-1911-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IXABEPILONE 45 MG INTRAVENOUS SOLUTION|45 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|PHR: 408101; CHG: 26||Not reimbursed separately|13,338.00|PHR: 408101; CHG: 26||External grouping not supported 130609|ERX|HCPCS J9207|70020-1911-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IXABEPILONE 45 MG INTRAVENOUS SOLUTION|45 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|PHR: 408101; CHG: 26||Not reimbursed separately|13,338.00|PHR: 408101; CHG: 26||External grouping not supported 130615|ERX|HCPCS RX001|00641-6022-01|0250 - PHARMACY - GENERAL CLASSIFICATION|FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 130615|ERX|HCPCS RX001|00641-6022-25|0250 - PHARMACY - GENERAL CLASSIFICATION|FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 130615|ERX|HCPCS RX001|63323-0739-11|0250 - PHARMACY - GENERAL CLASSIFICATION|FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 130615|ERX|HCPCS RX001|63323-0739-12|0250 - PHARMACY - GENERAL CLASSIFICATION|FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 130615|ERX|HCPCS RX001|63323-0739-16|0250 - PHARMACY - GENERAL CLASSIFICATION|FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 130615|ERX|HCPCS RX001|67457-0433-00|0250 - PHARMACY - GENERAL CLASSIFICATION|FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|00025-1891-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|00378-1411-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|51079-0869-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|51079-0869-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|57664-0118-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|68462-0260-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|68462-0260-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 13073|ERX|HCPCS A9270|75834-0159-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 130771|ERX|HCPCS A9270|60258-0006-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 130771|ERX|HCPCS A9270|60258-0006-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 1308|ERX|HCPCS A9270|00904-5062-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CITRATE 200 MG (950 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 13089|ERX|HCPCS A9270|00591-0405-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 13089|ERX|HCPCS A9270|68001-0332-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 13089|ERX|HCPCS A9270|68084-0765-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 13089|ERX|HCPCS A9270|68084-0765-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 13089|ERX|HCPCS A9270|76282-0417-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 130911|ERX|HCPCS RX001|00023-9211-05|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.2 %-TIMOLOL 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|511.62|PHR: 408101; CHG: 26||Not reimbursed separately|511.62|PHR: 408101; CHG: 26||External grouping not supported 130922|ERX|HCPCS RX001|00409-4164-03|0250 - PHARMACY - GENERAL CLASSIFICATION|PARENTERAL AMINO ACID 10 % COMBINATION NO.1 INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|45.00|PHR: 408101; CHG: 26||Not reimbursed separately|45.00|PHR: 408101; CHG: 26||External grouping not supported 131041|ERX|HCPCS A9270|00574-0118-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROSPIUM ER 60 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.74|PHR: 408101; CHG: 26||Not reimbursed separately|11.74|PHR: 408101; CHG: 26||External grouping not supported 131041|ERX|HCPCS A9270|00591-3636-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROSPIUM ER 60 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.74|PHR: 408101; CHG: 26||Not reimbursed separately|11.74|PHR: 408101; CHG: 26||External grouping not supported 131062|ERX|HCPCS A9270|55111-0789-27|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SEVELAMER CARBONATE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 131062|ERX|HCPCS A9270|58468-0130-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SEVELAMER CARBONATE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 131062|ERX|HCPCS A9270|65162-0058-27|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SEVELAMER CARBONATE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 131062|ERX|HCPCS A9270|65862-0921-27|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SEVELAMER CARBONATE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|00378-8750-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|21922-0009-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|45802-0160-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|46122-0646-54|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|63481-0684-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|65162-0833-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|69097-0524-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131106|ERX|HCPCS A9270|76282-0663-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 1 % TOPICAL GEL|1 Tube|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.30|PHR: 408101; CHG: 26||Not reimbursed separately|114.30|PHR: 408101; CHG: 26||External grouping not supported 131110|ERX|HCPCS J3475|63323-0106-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 40 GRAM/1,000 ML (4 %) IN WATER INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 131124|ERX|HCPCS A9270|00456-1405-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEBIVOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.12|PHR: 408101; CHG: 26||Not reimbursed separately|14.12|PHR: 408101; CHG: 26||External grouping not supported 131124|ERX|HCPCS A9270|00456-1405-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEBIVOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.12|PHR: 408101; CHG: 26||Not reimbursed separately|14.12|PHR: 408101; CHG: 26||External grouping not supported 131124|ERX|HCPCS A9270|00456-1405-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEBIVOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.12|PHR: 408101; CHG: 26||Not reimbursed separately|14.12|PHR: 408101; CHG: 26||External grouping not supported 131124|ERX|HCPCS A9270|00456-1405-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEBIVOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.12|PHR: 408101; CHG: 26||Not reimbursed separately|14.12|PHR: 408101; CHG: 26||External grouping not supported 131125|ERX|HCPCS A9270|00456-1402-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEBIVOLOL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.86|PHR: 408101; CHG: 26||Not reimbursed separately|13.86|PHR: 408101; CHG: 26||External grouping not supported 131176|ERX|HCPCS J1626|63323-0318-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|7.89|PHR: 408101; CHG: 26||Not reimbursed separately|7.89|PHR: 408101; CHG: 26||External grouping not supported 131176|ERX|HCPCS J1626|67457-0863-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.89|PHR: 408101; CHG: 26||Not reimbursed separately|7.89|PHR: 408101; CHG: 26||External grouping not supported 131183|ERX|HCPCS J1626|00143-9744-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.67|PHR: 408101; CHG: 26||Not reimbursed separately|6.67|PHR: 408101; CHG: 26||External grouping not supported 131183|ERX|HCPCS J1626|00143-9744-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.67|PHR: 408101; CHG: 26||Not reimbursed separately|6.67|PHR: 408101; CHG: 26||External grouping not supported 131183|ERX|HCPCS J1626|17478-0546-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.67|PHR: 408101; CHG: 26||Not reimbursed separately|6.67|PHR: 408101; CHG: 26||External grouping not supported 131185|ERX|HCPCS J9305|00002-7640-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEMETREXED 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,045.10|PHR: 408101; CHG: 26||Not reimbursed separately|2,045.10|PHR: 408101; CHG: 26||External grouping not supported 1312|ERX|HCPCS J0610|63323-0360-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|19.20|PHR: 408101; CHG: 26||Not reimbursed separately|19.20|PHR: 408101; CHG: 26||External grouping not supported 1312|ERX|HCPCS J0610|63323-0360-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.20|PHR: 408101; CHG: 26||Not reimbursed separately|19.20|PHR: 408101; CHG: 26||External grouping not supported 1312|ERX|HCPCS J0610|63323-0360-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.20|PHR: 408101; CHG: 26||Not reimbursed separately|19.20|PHR: 408101; CHG: 26||External grouping not supported 1312|ERX|HCPCS J0610|63323-0360-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.20|PHR: 408101; CHG: 26||Not reimbursed separately|19.20|PHR: 408101; CHG: 26||External grouping not supported 1312|ERX|HCPCS J0610|63323-0360-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.20|PHR: 408101; CHG: 26||Not reimbursed separately|19.20|PHR: 408101; CHG: 26||External grouping not supported 131229|ERX|HCPCS RX001|00338-0644-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|132.00|PHR: 408101; CHG: 26||Not reimbursed separately|132.00|PHR: 408101; CHG: 26||External grouping not supported 131243|ERX|HCPCS RX001|43825-0006-41|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION|5,000 Units|HUMANA [1294]||HUMANA [11839]|178.32|PHR: 408101; CHG: 26||Not reimbursed separately|178.32|PHR: 408101; CHG: 26||External grouping not supported 131243|ERX|HCPCS RX001|43825-0606-41|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION|5,000 Units|HUMANA [1294]||HUMANA [11839]|178.32|PHR: 408101; CHG: 26||Not reimbursed separately|178.32|PHR: 408101; CHG: 26||External grouping not supported 131253|ERX|HCPCS A9270|59676-0570-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETRAVIRINE 100 MG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.29|PHR: 408101; CHG: 26||Not reimbursed separately|67.29|PHR: 408101; CHG: 26||External grouping not supported 131282|ERX|HCPCS RX001|51552-0051-06|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETIC ACID (BULK) 3 % LIQUID|500 mL|HUMANA [1294]||HUMANA [11839]|43.50|PHR: 408101; CHG: 26||Not reimbursed separately|43.50|PHR: 408101; CHG: 26||External grouping not supported 131282|ERX|HCPCS RX001|99999-2222-09|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETIC ACID (BULK) 3 % LIQUID|60 mL|HUMANA [1294]||HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 13133|ERX|HCPCS A9270|00781-5208-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALACYCLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 13133|ERX|HCPCS A9270|57237-0042-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALACYCLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 13133|ERX|HCPCS A9270|63739-0525-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALACYCLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 13133|ERX|HCPCS A9270|65862-0448-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALACYCLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 13133|ERX|HCPCS A9270|65862-0448-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALACYCLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 13133|ERX|HCPCS A9270|68084-0215-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALACYCLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 131347|ERX|HCPCS J9206|25021-0230-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.35|PHR: 408101; CHG: 26||Not reimbursed separately|19.35|PHR: 408101; CHG: 26||External grouping not supported 131347|ERX|HCPCS J9206|45963-0614-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.35|PHR: 408101; CHG: 26||Not reimbursed separately|19.35|PHR: 408101; CHG: 26||External grouping not supported 131347|ERX|HCPCS J9206|63323-0193-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.35|PHR: 408101; CHG: 26||Not reimbursed separately|19.35|PHR: 408101; CHG: 26||External grouping not supported 131436|ERX|HCPCS 90714|49281-0215-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.69|PHR: 408101; CHG: 26||Not reimbursed separately|84.69|PHR: 408101; CHG: 26||External grouping not supported 131436|ERX|HCPCS 90714|49281-0215-88|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.69|PHR: 408101; CHG: 26||Not reimbursed separately|84.69|PHR: 408101; CHG: 26||External grouping not supported 131437|ERX|HCPCS 90714|49281-0215-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SUSP|0.5 mL|HUMANA [1294]||HUMANA [11839]|84.69|PHR: 408101; CHG: 26||Not reimbursed separately|84.69|PHR: 408101; CHG: 26||External grouping not supported 131472|ERX|HCPCS A9270|59676-0562-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARUNAVIR ETHANOLATE 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.86|PHR: 408101; CHG: 26||Not reimbursed separately|85.86|PHR: 408101; CHG: 26||External grouping not supported 131509|ERX|HCPCS A9270|00378-2098-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NISOLDIPINE ER 25.5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.41|PHR: 408101; CHG: 26||Not reimbursed separately|13.41|PHR: 408101; CHG: 26||External grouping not supported 131515|ERX|HCPCS A9270|00008-1211-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.87|PHR: 408101; CHG: 26||Not reimbursed separately|1.87|PHR: 408101; CHG: 26||External grouping not supported 131515|ERX|HCPCS A9270|00054-0400-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.87|PHR: 408101; CHG: 26||Not reimbursed separately|1.87|PHR: 408101; CHG: 26||External grouping not supported 131516|ERX|HCPCS A9270|00008-1222-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESVENLAFAXINE SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 131516|ERX|HCPCS A9270|00054-0401-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESVENLAFAXINE SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 131588|ERX|HCPCS J0641|68152-0101-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOLEUCOVORIN CALCIUM 50 MG INTRAVENOUS POWDER FOR SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|684.00|PHR: 408101; CHG: 26||Not reimbursed separately|684.00|PHR: 408101; CHG: 26||External grouping not supported 13160|ERX|HCPCS A9270|00054-0111-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERINDOPRIL ERBUMINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.83|PHR: 408101; CHG: 26||Not reimbursed separately|1.83|PHR: 408101; CHG: 26||External grouping not supported 131629|ERX|HCPCS J9178|00009-5093-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|326.70|PHR: 408101; CHG: 26||Not reimbursed separately|326.70|PHR: 408101; CHG: 26||External grouping not supported 131666|ERX|HCPCS RX001|00942-9505-10|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|250 mL|HUMANA [1294]||HUMANA [11839]|18.57|PHR: 408101; CHG: 26||Not reimbursed separately|18.57|PHR: 408101; CHG: 26||External grouping not supported 131681|ERX|HCPCS RX001|00338-1130-03|0250 - PHARMACY - GENERAL CLASSIFICATION|PARENTERAL AMINO ACID 10 % COMBINATION NO.7 INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|79.50|PHR: 408101; CHG: 26||Not reimbursed separately|79.50|PHR: 408101; CHG: 26||External grouping not supported 131798|ERX|HCPCS J0717|50474-0700-62|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT|1 Kit|HUMANA [1294]||HUMANA [11839]|7,597.02|PHR: 408101; CHG: 26||Not reimbursed separately|7,597.02|PHR: 408101; CHG: 26||External grouping not supported 131801|ERX|HCPCS RX015|37000-0143-43|0250 - PHARMACY - GENERAL CLASSIFICATION|BIFIDOBACTERIUM INFANTIS 4 MG CAPSULE|1 Each|HUMANA [1294]||HUMANA [11839]|1.94|PHR: 408101; CHG: 26||Not reimbursed separately|1.94|PHR: 408101; CHG: 26||External grouping not supported 131802|ERX|HCPCS J3300|00065-0543-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION|0.03 mL|HUMANA [1294]||HUMANA [11839]|20.80|PHR: 408101; CHG: 26||Not reimbursed separately|20.80|PHR: 408101; CHG: 26||External grouping not supported 131808|ERX|HCPCS 90747|00006-4992-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP|1 mL|HUMANA [1294]||HUMANA [11839]|294.00|PHR: 408101; CHG: 28||Not reimbursed separately|294.00|PHR: 408101; CHG: 28||External grouping not supported 131810|ERX|HCPCS 90744|00006-4981-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B VIRUS VACCINE RECOMB (PF) 5 MCG/0.5 ML INTRAMUSCULAR SUSP|0.5 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: ||Not reimbursed separately|0.00|PHR: 408101; CHG: ||External grouping not supported 13184|ERX|HCPCS A9270|51079-0894-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 13184|ERX|HCPCS A9270|51079-0894-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 13184|ERX|HCPCS A9270|57664-0116-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 13184|ERX|HCPCS A9270|68462-0292-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 131876|ERX|HCPCS A9270|64764-0080-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LUBIPROSTONE 8 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.93|PHR: 408101; CHG: 26||Not reimbursed separately|16.93|PHR: 408101; CHG: 26||External grouping not supported 131887|ERX|HCPCS J1670|13533-0634-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TETANUS IMMUNE GLOBULIN (PF) 250 UNIT INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|1,521.30|PHR: 408101; CHG: 26||Not reimbursed separately|1,521.30|PHR: 408101; CHG: 26||External grouping not supported 131887|ERX|HCPCS J1670|13533-0634-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TETANUS IMMUNE GLOBULIN (PF) 250 UNIT INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|1,521.30|PHR: 408101; CHG: 26||Not reimbursed separately|1,521.30|PHR: 408101; CHG: 26||External grouping not supported 131908|ERX|HCPCS A9270|07610-0155-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELATONIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 131908|ERX|HCPCS A9270|31604-0027-43|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELATONIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 131908|ERX|HCPCS A9270|50268-0533-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELATONIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 131908|ERX|HCPCS A9270|50268-0533-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELATONIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 131908|ERX|HCPCS A9270|77333-0520-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELATONIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 131908|ERX|HCPCS A9270|87701-0408-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELATONIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 131937|ERX|HCPCS J7189|00169-7202-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION|2 mg|HUMANA [1294]||HUMANA [11839]|12,240.00|PHR: 408101; CHG: 26||Not reimbursed separately|12,240.00|PHR: 408101; CHG: 26||External grouping not supported 131938|ERX|HCPCS J7189|00169-7205-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION|5 mg|HUMANA [1294]||HUMANA [11839]|30,600.00|PHR: 408101; CHG: 26||Not reimbursed separately|30,600.00|PHR: 408101; CHG: 26||External grouping not supported 131982|ERX|HCPCS J2212|65649-0551-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION|0.4 mL|HUMANA [1294]||HUMANA [11839]|137.86|PHR: 408101; CHG: 26||Not reimbursed separately|137.86|PHR: 408101; CHG: 26||External grouping not supported 132001|ERX|HCPCS J0670|63323-0294-27|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 132001|ERX|HCPCS J0670|00409-1067-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.24|PHR: 408101; CHG: 26||Not reimbursed separately|18.24|PHR: 408101; CHG: 26||External grouping not supported 132003|ERX|HCPCS J0670|63323-0260-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.69|PHR: 408101; CHG: 26||Not reimbursed separately|12.69|PHR: 408101; CHG: 26||External grouping not supported 132003|ERX|HCPCS J0670|00409-1036-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|12.69|PHR: 408101; CHG: 26||Not reimbursed separately|12.69|PHR: 408101; CHG: 26||External grouping not supported 132022|ERX|HCPCS J2785|00469-6501-89|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE|1 Syringe|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|626.76|PHR: 408101; CHG: 26||Not reimbursed separately|626.76|PHR: 408101; CHG: 26||External grouping not supported 132029|ERX|HCPCS RX001|66312-0181-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:50,000 INJECTION CARTRIDGE|1.7 mL|HUMANA [1294]||HUMANA [11839]|3.57|PHR: 408101; CHG: 26||Not reimbursed separately|3.57|PHR: 408101; CHG: 26||External grouping not supported 132035|ERX|HCPCS RX001|43825-0007-41|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION|1 Each|HUMANA [1294]||HUMANA [11839]|713.25|PHR: 408101; CHG: 26||Not reimbursed separately|713.25|PHR: 408101; CHG: 26||External grouping not supported 132035|ERX|HCPCS RX001|43825-0707-41|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION|1 Each|HUMANA [1294]||HUMANA [11839]|713.25|PHR: 408101; CHG: 26||Not reimbursed separately|713.25|PHR: 408101; CHG: 26||External grouping not supported 132038|ERX|HCPCS A9270|30103-0040-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC OXIDE-VITAMIN B5-VIT E 11.3% TOPICAL CREAM|56 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.11|PHR: 408101; CHG: 26||Not reimbursed separately|7.11|PHR: 408101; CHG: 26||External grouping not supported 132293|ERX|HCPCS J9190|16729-0276-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.28|PHR: 408101; CHG: 26||Not reimbursed separately|11.28|PHR: 408101; CHG: 26||External grouping not supported 132293|ERX|HCPCS J9190|63323-0117-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.28|PHR: 408101; CHG: 26||Not reimbursed separately|11.28|PHR: 408101; CHG: 26||External grouping not supported 132293|ERX|HCPCS J9190|63323-0117-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.28|PHR: 408101; CHG: 26||Not reimbursed separately|11.28|PHR: 408101; CHG: 26||External grouping not supported 132294|ERX|HCPCS J9190|00703-3018-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.75|PHR: 408101; CHG: 26||Not reimbursed separately|21.75|PHR: 408101; CHG: 26||External grouping not supported 132294|ERX|HCPCS J9190|63323-0117-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.75|PHR: 408101; CHG: 26||Not reimbursed separately|21.75|PHR: 408101; CHG: 26||External grouping not supported 132294|ERX|HCPCS J9190|63323-0117-58|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.75|PHR: 408101; CHG: 26||Not reimbursed separately|21.75|PHR: 408101; CHG: 26||External grouping not supported 132294|ERX|HCPCS J9190|68001-0266-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.75|PHR: 408101; CHG: 26||Not reimbursed separately|21.75|PHR: 408101; CHG: 26||External grouping not supported 132295|ERX|HCPCS J9190|16729-0276-38|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.30|PHR: 408101; CHG: 26||Not reimbursed separately|48.30|PHR: 408101; CHG: 26||External grouping not supported 132295|ERX|HCPCS J9190|25021-0215-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.30|PHR: 408101; CHG: 26||Not reimbursed separately|48.30|PHR: 408101; CHG: 26||External grouping not supported 132295|ERX|HCPCS J9190|63323-0117-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.30|PHR: 408101; CHG: 26||Not reimbursed separately|48.30|PHR: 408101; CHG: 26||External grouping not supported 132295|ERX|HCPCS J9190|63323-0117-68|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.30|PHR: 408101; CHG: 26||Not reimbursed separately|48.30|PHR: 408101; CHG: 26||External grouping not supported 132295|ERX|HCPCS J9190|68001-0266-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.30|PHR: 408101; CHG: 26||Not reimbursed separately|48.30|PHR: 408101; CHG: 26||External grouping not supported 132303|ERX|HCPCS J7185|58394-0015-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR VIII,REC B-DOMAIN DELET 2,000 (+/-) UNIT IV SOLN|500 Units|HUMANA [1294]||HUMANA [11839]|1,365.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,365.00|PHR: 408101; CHG: 26||External grouping not supported 132319|ERX|HCPCS A9270|31604-0025-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 132319|ERX|HCPCS A9270|50268-0867-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 132319|ERX|HCPCS A9270|50268-0867-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 132319|ERX|HCPCS A9270|69618-0009-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 132319|ERX|HCPCS A9270|80681-0009-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 132615|ERX|HCPCS RX001|10122-0313-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NICARDIPINE 20 MG/200 ML(0.1 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN|200 mL|HUMANA [1294]||HUMANA [11839]|153.60|PHR: 408101; CHG: 26||Not reimbursed separately|153.60|PHR: 408101; CHG: 26||External grouping not supported 132656|ERX|HCPCS A9270|67919-0020-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALVIMOPAN 12 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.54|PHR: 408101; CHG: 26||Not reimbursed separately|519.54|PHR: 408101; CHG: 26||External grouping not supported 132658|ERX|HCPCS J9390|25021-0204-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.89|PHR: 408101; CHG: 26||Not reimbursed separately|118.89|PHR: 408101; CHG: 26||External grouping not supported 132658|ERX|HCPCS J9390|64370-0532-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.89|PHR: 408101; CHG: 26||Not reimbursed separately|118.89|PHR: 408101; CHG: 26||External grouping not supported 132663|ERX|HCPCS J2796|55513-0222-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,697.90|PHR: 408101; CHG: 26||Not reimbursed separately|11,697.90|PHR: 408101; CHG: 26||External grouping not supported 132664|ERX|HCPCS J2796|55513-0221-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|5,848.95|PHR: 408101; CHG: 26||Not reimbursed separately|5,848.95|PHR: 408101; CHG: 26||External grouping not supported 132674|ERX|HCPCS A9270|48582-0511-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SALIVA STIMULANT COMBINATION NO.2 ORAL MUCOSAL LIQUID|44.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.78|PHR: 408101; CHG: 26||Not reimbursed separately|12.78|PHR: 408101; CHG: 26||External grouping not supported 132676|ERX|HCPCS A9270|48582-0001-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.76|PHR: 408101; CHG: 26||Not reimbursed separately|12.76|PHR: 408101; CHG: 26||External grouping not supported 132685|ERX|HCPCS J1212|67457-0177-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|1,710.15|PHR: 408101; CHG: 26||Not reimbursed separately|1,710.15|PHR: 408101; CHG: 26||External grouping not supported 132705|ERX|HCPCS RX001|25021-0673-77|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|5 mL|HUMANA [1294]||HUMANA [11839]|8.12|PHR: 408101; CHG: 26||Not reimbursed separately|8.12|PHR: 408101; CHG: 26||External grouping not supported 132705|ERX|HCPCS RX001|76329-3013-05|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|5 mL|HUMANA [1294]||HUMANA [11839]|8.12|PHR: 408101; CHG: 26||Not reimbursed separately|8.12|PHR: 408101; CHG: 26||External grouping not supported 132714|ERX|HCPCS RX001|00065-9240-07|0250 - PHARMACY - GENERAL CLASSIFICATION|DIFLUPREDNATE 0.05 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|544.08|PHR: 408101; CHG: 26||Not reimbursed separately|544.08|PHR: 408101; CHG: 26||External grouping not supported 132717|ERX|HCPCS J9370|00703-4412-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.87|PHR: 408101; CHG: 26||Not reimbursed separately|27.87|PHR: 408101; CHG: 26||External grouping not supported 132717|ERX|HCPCS J9370|61703-0309-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.87|PHR: 408101; CHG: 26||Not reimbursed separately|27.87|PHR: 408101; CHG: 26||External grouping not supported 132719|ERX|HCPCS J9303|55513-0956-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,971.02|PHR: 408101; CHG: 26||Not reimbursed separately|14,971.02|PHR: 408101; CHG: 26||External grouping not supported 132754|ERX|HCPCS A9270|00224-1855-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSYLLIUM HUSK (ASPARTAME) 3.5 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 132801|ERX|HCPCS J0692|00338-1301-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.60|PHR: 408101; CHG: 26||Not reimbursed separately|30.60|PHR: 408101; CHG: 26||External grouping not supported 132802|ERX|HCPCS J0692|00338-1301-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 2 GRAM/100 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.00|PHR: 408101; CHG: 26||Not reimbursed separately|51.00|PHR: 408101; CHG: 26||External grouping not supported 132812|ERX|HCPCS C9248|10122-0610-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION|50 mL|HUMANA [1294]||HUMANA [11839]|198.15|PHR: 408101; CHG: 26||Not reimbursed separately|198.15|PHR: 408101; CHG: 26||External grouping not supported 132812|ERX|HCPCS C9248|10122-0610-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION|50 mL|HUMANA [1294]||HUMANA [11839]|198.15|PHR: 408101; CHG: 26||Not reimbursed separately|198.15|PHR: 408101; CHG: 26||External grouping not supported 132840|ERX|HCPCS A9270|68001-0113-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 132877|ERX|HCPCS J9000|00069-3032-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.60|PHR: 408101; CHG: 26||Not reimbursed separately|39.60|PHR: 408101; CHG: 26||External grouping not supported 132877|ERX|HCPCS J9000|00069-4026-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.60|PHR: 408101; CHG: 26||Not reimbursed separately|39.60|PHR: 408101; CHG: 26||External grouping not supported 132877|ERX|HCPCS J9000|00143-9547-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.60|PHR: 408101; CHG: 26||Not reimbursed separately|39.60|PHR: 408101; CHG: 26||External grouping not supported 132877|ERX|HCPCS J9000|70860-0208-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.60|PHR: 408101; CHG: 26||Not reimbursed separately|39.60|PHR: 408101; CHG: 26||External grouping not supported 132878|ERX|HCPCS J9000|00069-3030-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|16.23|PHR: 408101; CHG: 26||Not reimbursed separately|16.23|PHR: 408101; CHG: 26||External grouping not supported 132879|ERX|HCPCS J9000|00143-9548-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.25|PHR: 408101; CHG: 26||Not reimbursed separately|44.25|PHR: 408101; CHG: 26||External grouping not supported 132945|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|BICARBONATE HEMODIALYSIS SOLN WITHOUT CALCIUM 8 POT 2 MEQ-MAG 1 MEQ/L|5,000 mL|HUMANA [1294]||HUMANA [11839]|96.00|PHR: 408101; CHG: 26||Not reimbursed separately|96.00|PHR: 408101; CHG: 26||External grouping not supported 132945|ERX|HCPCS RX001|24571-0102-06|0250 - PHARMACY - GENERAL CLASSIFICATION|BICARBONATE HEMODIALYSIS SOLN WITHOUT CALCIUM 8 POT 2 MEQ-MAG 1 MEQ/L|5,000 mL|HUMANA [1294]||HUMANA [11839]|96.00|PHR: 408101; CHG: 26||Not reimbursed separately|96.00|PHR: 408101; CHG: 26||External grouping not supported 132946|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L|5,000 mL|HUMANA [1294]||HUMANA [11839]|96.00|PHR: 408101; CHG: 26||Not reimbursed separately|96.00|PHR: 408101; CHG: 26||External grouping not supported 133001|ERX|HCPCS RX015|17478-0792-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 3.5 % EYE GEL|1 mL|HUMANA [1294]||HUMANA [11839]|52.77|PHR: 408101; CHG: 26||Not reimbursed separately|52.77|PHR: 408101; CHG: 26||External grouping not supported 133115|ERX|HCPCS J1250|00409-2344-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.46|PHR: 408101; CHG: 26||Not reimbursed separately|14.46|PHR: 408101; CHG: 26||External grouping not supported 133115|ERX|HCPCS J1250|00409-2344-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.46|PHR: 408101; CHG: 26||Not reimbursed separately|14.46|PHR: 408101; CHG: 26||External grouping not supported 133115|ERX|HCPCS J1250|00409-2344-62|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.46|PHR: 408101; CHG: 26||Not reimbursed separately|14.46|PHR: 408101; CHG: 26||External grouping not supported 133162|ERX|HCPCS RX001|38779-0082-09|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL (BULK) 100 % POWDER|1,000 g|HUMANA [1294]||HUMANA [11839]|276.00|PHR: 408101; CHG: 26||Not reimbursed separately|276.00|PHR: 408101; CHG: 26||External grouping not supported 133181|ERX|HCPCS J1265|00143-9254-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|PHR: 408101; CHG: 26||Not reimbursed separately|14.28|PHR: 408101; CHG: 26||External grouping not supported 133181|ERX|HCPCS J1265|00409-9104-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|PHR: 408101; CHG: 26||Not reimbursed separately|14.28|PHR: 408101; CHG: 26||External grouping not supported 133238|ERX|HCPCS RX001|10122-0325-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN|200 mL|HUMANA [1294]||HUMANA [11839]|250.20|PHR: 408101; CHG: 26||Not reimbursed separately|250.20|PHR: 408101; CHG: 26||External grouping not supported 133246|ERX|HCPCS J9055|66733-0958-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,684.90|PHR: 408101; CHG: 26||Not reimbursed separately|3,684.90|PHR: 408101; CHG: 26||External grouping not supported 133268|ERX|HCPCS A9270|00904-0274-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 133268|ERX|HCPCS A9270|80681-0008-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 133268|ERX|HCPCS A9270|87701-0407-54|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 133286|ERX|HCPCS A9270|68585-0005-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 133292|ERX|HCPCS A9270|00078-0685-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ELTROMBOPAG 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|527.14|PHR: 408101; CHG: 26||Not reimbursed separately|527.14|PHR: 408101; CHG: 26||External grouping not supported 133317|ERX|HCPCS A9270|39328-0057-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.30|PHR: 408101; CHG: 26||Not reimbursed separately|6.30|PHR: 408101; CHG: 26||External grouping not supported 133398|ERX|HCPCS J2562|00024-5862-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION|1.2 mL|HUMANA [1294]||HUMANA [11839]|25,277.29|PHR: 408101; CHG: 26||Not reimbursed separately|25,277.29|PHR: 408101; CHG: 26||External grouping not supported 133470|ERX|HCPCS A9270|52817-0160-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 133471|ERX|HCPCS A9270|16729-0109-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 133471|ERX|HCPCS A9270|71093-0136-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 13358|ERX|HCPCS A9270|00093-8119-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMCICLOVIR 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.15|PHR: 408101; CHG: 26||Not reimbursed separately|5.15|PHR: 408101; CHG: 26||External grouping not supported 133596|ERX|HCPCS A9270|64764-0171-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXLANSOPRAZOLE 30 MG CAPSULE,BIPHASE DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.55|PHR: 408101; CHG: 26||Not reimbursed separately|26.55|PHR: 408101; CHG: 26||External grouping not supported 133597|ERX|HCPCS A9270|64764-0175-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.55|PHR: 408101; CHG: 26||Not reimbursed separately|26.55|PHR: 408101; CHG: 26||External grouping not supported 133611|ERX|HCPCS A9270|41100-0811-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|113 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.11|PHR: 408101; CHG: 26||Not reimbursed separately|6.11|PHR: 408101; CHG: 26||External grouping not supported 133611|ERX|HCPCS A9270|45802-0395-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|113 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.11|PHR: 408101; CHG: 26||Not reimbursed separately|6.11|PHR: 408101; CHG: 26||External grouping not supported 13393|ERX|HCPCS RX001|00338-0520-13|0250 - PHARMACY - GENERAL CLASSIFICATION|FAT EMULSION 30 % INTRAVENOUS|500 mL|HUMANA [1294]||HUMANA [11839]|78.00|PHR: 408101; CHG: 26||Not reimbursed separately|78.00|PHR: 408101; CHG: 26||External grouping not supported 13410|ERX|HCPCS A9270|00904-5769-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN ER 650 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 13444|ERX|HCPCS A9270|00093-1024-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEFAZODONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 13446|ERX|HCPCS A9270|00093-1025-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEFAZODONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.03|PHR: 408101; CHG: 26||Not reimbursed separately|3.03|PHR: 408101; CHG: 26||External grouping not supported 1350|ERX|HCPCS A9270|00536-2525-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.38|PHR: 408101; CHG: 26||Not reimbursed separately|7.38|PHR: 408101; CHG: 26||External grouping not supported 1355|ERX|HCPCS A9270|00904-3854-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 1355|ERX|HCPCS A9270|51079-0870-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 1355|ERX|HCPCS A9270|51079-0870-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 1355|ERX|HCPCS A9270|60687-0479-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 13562|ERX|HCPCS A9270|57664-0600-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE ER 40 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 1357|ERX|HCPCS A9270|00904-6172-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 1357|ERX|HCPCS A9270|51079-0385-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 1357|ERX|HCPCS A9270|51079-0385-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 1357|ERX|HCPCS A9270|68084-0444-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 1357|ERX|HCPCS A9270|68084-0444-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 13577|ERX|HCPCS A9270|59762-5017-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.37|PHR: 408101; CHG: 26||Not reimbursed separately|3.37|PHR: 408101; CHG: 26||External grouping not supported 13577|ERX|HCPCS A9270|67405-0603-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.37|PHR: 408101; CHG: 26||Not reimbursed separately|3.37|PHR: 408101; CHG: 26||External grouping not supported 13577|ERX|HCPCS A9270|68001-0253-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.37|PHR: 408101; CHG: 26||Not reimbursed separately|3.37|PHR: 408101; CHG: 26||External grouping not supported 13577|ERX|HCPCS A9270|68001-0253-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.37|PHR: 408101; CHG: 26||Not reimbursed separately|3.37|PHR: 408101; CHG: 26||External grouping not supported 13577|ERX|HCPCS A9270|68462-0103-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.37|PHR: 408101; CHG: 26||Not reimbursed separately|3.37|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|00904-6627-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|42037-0104-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|42037-0104-79|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|46122-0249-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|46122-0557-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|78112-0736-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|78112-0736-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|87701-0425-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 1359|ERX|HCPCS A9270|87701-0431-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 13632|ERX|HCPCS A9270|00904-6407-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 13632|ERX|HCPCS A9270|00904-6748-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 13632|ERX|HCPCS A9270|57896-0441-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 13632|ERX|HCPCS A9270|87701-0430-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 13654|ERX|HCPCS A9270|46122-0596-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 13654|ERX|HCPCS A9270|57896-0921-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 13654|ERX|HCPCS A9270|63739-0523-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 13654|ERX|HCPCS A9270|69618-0015-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 13671|ERX|HCPCS J9178|59923-0701-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|152.25|PHR: 408101; CHG: 26||Not reimbursed separately|152.25|PHR: 408101; CHG: 26||External grouping not supported 13691|ERX|HCPCS J1950|00074-3641-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT|3.75 mg|HUMANA [1294]||HUMANA [11839]|4,074.60|PHR: 408101; CHG: 26||Not reimbursed separately|4,074.60|PHR: 408101; CHG: 26||External grouping not supported 13748|ERX|HCPCS A9270|00121-1744-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 13748|ERX|HCPCS A9270|50383-0063-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 13748|ERX|HCPCS A9270|00121-1488-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 13748|ERX|HCPCS A9270|50383-0063-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 13846|ERX|HCPCS RX001|24385-0116-03|0250 - PHARMACY - GENERAL CLASSIFICATION|PYRETHRINS-PIPERONYL BUTOXIDE 0.33 %-4 % SHAMPOO|118 mL|HUMANA [1294]||HUMANA [11839]|7.79|PHR: 408101; CHG: 26||Not reimbursed separately|7.79|PHR: 408101; CHG: 26||External grouping not supported 13846|ERX|HCPCS RX001|87701-0533-80|0250 - PHARMACY - GENERAL CLASSIFICATION|PYRETHRINS-PIPERONYL BUTOXIDE 0.33 %-4 % SHAMPOO|118 mL|HUMANA [1294]||HUMANA [11839]|7.79|PHR: 408101; CHG: 26||Not reimbursed separately|7.79|PHR: 408101; CHG: 26||External grouping not supported 13884|ERX|HCPCS A9270|00009-0450-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLESTIPOL 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.11|PHR: 408101; CHG: 26||Not reimbursed separately|2.11|PHR: 408101; CHG: 26||External grouping not supported 13884|ERX|HCPCS A9270|59762-0450-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLESTIPOL 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.11|PHR: 408101; CHG: 26||Not reimbursed separately|2.11|PHR: 408101; CHG: 26||External grouping not supported 1395|ERX|HCPCS A9270|00591-5513-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARISOPRODOL 350 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 1395|ERX|HCPCS A9270|50228-0109-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARISOPRODOL 350 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 1395|ERX|HCPCS A9270|69584-0111-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARISOPRODOL 350 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 13981|ERX|HCPCS A9270|51672-4130-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 13981|ERX|HCPCS A9270|68084-0318-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 13981|ERX|HCPCS A9270|68084-0318-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 13982|ERX|HCPCS A9270|51079-0499-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 13982|ERX|HCPCS A9270|51079-0499-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 13982|ERX|HCPCS A9270|68084-0319-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 13982|ERX|HCPCS A9270|68084-0319-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 13983|ERX|HCPCS A9270|29300-0114-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 13983|ERX|HCPCS A9270|59746-0248-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 13983|ERX|HCPCS A9270|68382-0010-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 13983|ERX|HCPCS A9270|69097-0152-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 14100|ERX|HCPCS A9270|00378-6060-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM ER 60 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.29|PHR: 408101; CHG: 26||Not reimbursed separately|7.29|PHR: 408101; CHG: 26||External grouping not supported 14100|ERX|HCPCS A9270|51079-0924-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM ER 60 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.29|PHR: 408101; CHG: 26||Not reimbursed separately|7.29|PHR: 408101; CHG: 26||External grouping not supported 14100|ERX|HCPCS A9270|51079-0924-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM ER 60 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.29|PHR: 408101; CHG: 26||Not reimbursed separately|7.29|PHR: 408101; CHG: 26||External grouping not supported 14101|ERX|HCPCS A9270|00378-6090-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.57|PHR: 408101; CHG: 26||Not reimbursed separately|8.57|PHR: 408101; CHG: 26||External grouping not supported 14101|ERX|HCPCS A9270|51079-0925-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.57|PHR: 408101; CHG: 26||Not reimbursed separately|8.57|PHR: 408101; CHG: 26||External grouping not supported 14101|ERX|HCPCS A9270|51079-0925-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.57|PHR: 408101; CHG: 26||Not reimbursed separately|8.57|PHR: 408101; CHG: 26||External grouping not supported 14132|ERX|HCPCS A9270|45802-0465-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOCONAZOLE 2 % SHAMPOO|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.16|PHR: 408101; CHG: 26||Not reimbursed separately|29.16|PHR: 408101; CHG: 26||External grouping not supported 14196|ERX|HCPCS A9270|00046-1107-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CONJ ESTROGEN-MEDROXYPROGESTERONE 0.625 MG-2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.03|PHR: 408101; CHG: 26||Not reimbursed separately|20.03|PHR: 408101; CHG: 26||External grouping not supported 14203|ERX|HCPCS J9390|25021-0204-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.26|PHR: 408101; CHG: 26||Not reimbursed separately|31.26|PHR: 408101; CHG: 26||External grouping not supported 14203|ERX|HCPCS J9390|64370-0532-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|31.26|PHR: 408101; CHG: 26||Not reimbursed separately|31.26|PHR: 408101; CHG: 26||External grouping not supported 14233|ERX|HCPCS A9270|00054-0003-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 40 MG/ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.87|PHR: 408101; CHG: 26||Not reimbursed separately|2.87|PHR: 408101; CHG: 26||External grouping not supported 14233|ERX|HCPCS A9270|57237-0150-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 40 MG/ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.87|PHR: 408101; CHG: 26||Not reimbursed separately|2.87|PHR: 408101; CHG: 26||External grouping not supported 14233|ERX|HCPCS A9270|59762-5030-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUCONAZOLE 40 MG/ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.87|PHR: 408101; CHG: 26||Not reimbursed separately|2.87|PHR: 408101; CHG: 26||External grouping not supported 14266|ERX|HCPCS A9270|29300-0113-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 14266|ERX|HCPCS A9270|51079-0865-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 14266|ERX|HCPCS A9270|51079-0865-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 14266|ERX|HCPCS A9270|69097-0151-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMOTRIGINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|25021-0101-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|00143-9924-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|00781-3451-96|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|25021-0101-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|44567-0707-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|60505-0749-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|60505-6142-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 1445|ERX|HCPCS J0690|60505-6142-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14471|ERX|HCPCS A9270|00006-3519-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|PHR: 408101; CHG: 26||Not reimbursed separately|27.90|PHR: 408101; CHG: 26||External grouping not supported 14471|ERX|HCPCS A9270|24208-0485-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|PHR: 408101; CHG: 26||Not reimbursed separately|27.90|PHR: 408101; CHG: 26||External grouping not supported 14471|ERX|HCPCS A9270|42571-0141-26|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|PHR: 408101; CHG: 26||Not reimbursed separately|27.90|PHR: 408101; CHG: 26||External grouping not supported 14471|ERX|HCPCS A9270|50383-0232-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|PHR: 408101; CHG: 26||Not reimbursed separately|27.90|PHR: 408101; CHG: 26||External grouping not supported 14471|ERX|HCPCS A9270|61314-0019-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.90|PHR: 408101; CHG: 26||Not reimbursed separately|27.90|PHR: 408101; CHG: 26||External grouping not supported 1448|ERX|HCPCS J0690|00143-9923-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]||HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 1448|ERX|HCPCS J0690|00781-3450-70|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 1448|ERX|HCPCS J0690|00781-3450-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 1448|ERX|HCPCS J0690|25021-0100-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 1448|ERX|HCPCS J0690|25021-0100-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 14551|ERX|HCPCS A9270|51079-0937-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERAZOSIN 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 14626|ERX|HCPCS A9270|51079-0899-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 14626|ERX|HCPCS A9270|51079-0899-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 14626|ERX|HCPCS A9270|68462-0293-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 14628|ERX|HCPCS A9270|10702-0016-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 14628|ERX|HCPCS A9270|68462-0325-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 14632|ERX|HCPCS A9270|51079-0991-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14632|ERX|HCPCS A9270|51079-0991-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14632|ERX|HCPCS A9270|68084-0808-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14632|ERX|HCPCS A9270|68084-0808-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14634|ERX|HCPCS J0850|44206-0532-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|4,236.60|PHR: 408101; CHG: 26||Not reimbursed separately|4,236.60|PHR: 408101; CHG: 26||External grouping not supported 14643|ERX|HCPCS J0885|55513-0478-01|0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO)<10,000 UNITS|EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|421.04|PHR: 408101; CHG: 26||Not reimbursed separately|421.04|PHR: 408101; CHG: 26||External grouping not supported 14643|ERX|HCPCS J0885|55513-0478-10|0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO)<10,000 UNITS|EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|421.04|PHR: 408101; CHG: 26||Not reimbursed separately|421.04|PHR: 408101; CHG: 26||External grouping not supported 14643|ERX|HCPCS J0885|59676-0320-00|0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO)<10,000 UNITS|EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|421.04|PHR: 408101; CHG: 26||Not reimbursed separately|421.04|PHR: 408101; CHG: 26||External grouping not supported 14643|ERX|HCPCS J0885|59676-0320-04|0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO)<10,000 UNITS|EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|421.04|PHR: 408101; CHG: 26||Not reimbursed separately|421.04|PHR: 408101; CHG: 26||External grouping not supported 1465|ERX|HCPCS J0697|00143-9979-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.09|PHR: 408101; CHG: 26||Not reimbursed separately|8.09|PHR: 408101; CHG: 26||External grouping not supported 14678|ERX|HCPCS 90691|49281-0790-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|291.21|PHR: 408101; CHG: 26||Not reimbursed separately|291.21|PHR: 408101; CHG: 26||External grouping not supported 14678|ERX|HCPCS 90691|49281-0790-88|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML INTRAMUSCULAR SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|291.21|PHR: 408101; CHG: 26||Not reimbursed separately|291.21|PHR: 408101; CHG: 26||External grouping not supported 14719|ERX|HCPCS A9270|60687-0143-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 850 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14720|ERX|HCPCS Q0166|00054-0143-08|0250 - PHARMACY - GENERAL CLASSIFICATION|GRANISETRON HCL 1 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|14.46|PHR: 408101; CHG: 26||Not reimbursed separately|14.46|PHR: 408101; CHG: 26||External grouping not supported 14757|ERX|HCPCS 90716|00006-4827-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP|1 Vial|HUMANA [1294]||HUMANA [11839]|396.00|PHR: 408101; CHG: 26||Not reimbursed separately|396.00|PHR: 408101; CHG: 26||External grouping not supported 14776|ERX|HCPCS RX001|12870-0001-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK|1 Each|HUMANA [1294]||HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 14776|ERX|HCPCS RX001|12870-0001-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK|1 Each|HUMANA [1294]||HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 14778|ERX|HCPCS A9270|00093-8035-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE MICRONIZED 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 14778|ERX|HCPCS A9270|00143-9919-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE MICRONIZED 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 14793|ERX|HCPCS A9270|00904-6418-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIZANIDINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 14793|ERX|HCPCS A9270|55111-0180-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIZANIDINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 14793|ERX|HCPCS A9270|68084-0645-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIZANIDINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 14793|ERX|HCPCS A9270|68084-0645-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIZANIDINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|13668-0113-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|31722-0700-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|50268-0516-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|65862-0201-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|68084-0346-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|68084-0346-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|68180-0376-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14823|ERX|HCPCS A9270|68382-0135-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|31722-0701-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|63739-0686-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|65862-0202-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|65862-0202-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|68084-0347-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|68084-0347-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|68180-0377-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14824|ERX|HCPCS A9270|68382-0136-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.68|PHR: 408101; CHG: 26||Not reimbursed separately|0.68|PHR: 408101; CHG: 26||External grouping not supported 14845|ERX|HCPCS J1265|00338-1007-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN|250 mL|HUMANA [1294]||HUMANA [11839]|19.50|PHR: 408101; CHG: 26||Not reimbursed separately|19.50|PHR: 408101; CHG: 26||External grouping not supported 14845|ERX|HCPCS J1265|00409-7809-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.50|PHR: 408101; CHG: 26||Not reimbursed separately|19.50|PHR: 408101; CHG: 26||External grouping not supported 14845|ERX|HCPCS J1265|00409-7809-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.50|PHR: 408101; CHG: 26||Not reimbursed separately|19.50|PHR: 408101; CHG: 26||External grouping not supported 14858|ERX|HCPCS RX004|00264-7652-00|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 14858|ERX|HCPCS RX004|00338-0803-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 14859|ERX|HCPCS RX004|00338-0807-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 40 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA [1294]||HUMANA [11839]|27.00|PHR: 408101; CHG: 26||Not reimbursed separately|27.00|PHR: 408101; CHG: 26||External grouping not supported 14861|ERX|HCPCS RX001|00264-7634-00|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 14861|ERX|HCPCS RX001|00338-0669-04|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 14862|ERX|HCPCS RX004|00338-0663-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 14863|ERX|HCPCS RX004|00338-0671-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 14866|ERX|HCPCS RX004|00338-0675-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 14868|ERX|HCPCS J2001|00338-0409-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|13.50|PHR: 408101; CHG: 26||Not reimbursed separately|13.50|PHR: 408101; CHG: 26||External grouping not supported 14870|ERX|HCPCS RX001|00409-3177-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14870|ERX|HCPCS RX001|63323-0481-57|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 14903|ERX|HCPCS RX004|00264-7625-00|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 14903|ERX|HCPCS RX004|00338-0683-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 14953|ERX|HCPCS A9270|00173-0547-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.23|PHR: 408101; CHG: 26||Not reimbursed separately|70.23|PHR: 408101; CHG: 26||External grouping not supported 14953|ERX|HCPCS A9270|66689-0062-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.23|PHR: 408101; CHG: 26||Not reimbursed separately|70.23|PHR: 408101; CHG: 26||External grouping not supported 14953|ERX|HCPCS A9270|66689-0062-42|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.23|PHR: 408101; CHG: 26||Not reimbursed separately|70.23|PHR: 408101; CHG: 26||External grouping not supported 14958|ERX|HCPCS A9270|00093-7367-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14958|ERX|HCPCS A9270|00781-5206-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14958|ERX|HCPCS A9270|59746-0337-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14958|ERX|HCPCS A9270|62332-0048-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14958|ERX|HCPCS A9270|65862-0468-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14958|ERX|HCPCS A9270|68180-0215-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 14983|ERX|HCPCS RX001|00409-9042-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 14983|ERX|HCPCS RX001|00409-9042-11|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 14983|ERX|HCPCS RX001|00409-9042-16|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 14983|ERX|HCPCS RX001|63323-0468-17|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 14983|ERX|HCPCS RX001|63323-0468-37|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|00409-1749-70|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|00409-9045-11|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|00409-9045-16|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|00409-9045-17|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|63323-0462-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|63323-0462-04|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|63323-0462-17|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|63323-0462-31|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|63323-0462-37|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 14984|ERX|HCPCS RX001|99999-5555-68|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 15026|ERX|HCPCS A9270|68462-0208-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MOEXIPRIL 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 15053|ERX|HCPCS A9270|46122-0221-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYCERIN (ADULT) RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 15053|ERX|HCPCS A9270|87701-0425-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYCERIN (ADULT) RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 15113|ERX|HCPCS J7517|00093-7334-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 15113|ERX|HCPCS J7517|16729-0094-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 15113|ERX|HCPCS J7517|51079-0721-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 15113|ERX|HCPCS J7517|51079-0721-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 15113|ERX|HCPCS J7517|67877-0266-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 15113|ERX|HCPCS J7517|70748-0186-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 15114|ERX|HCPCS RX015|76478-0001-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TIMOLOL 0.25 % EYE DROPS|0.05 mL|HUMANA [1294]||HUMANA [11839]|3.54|PHR: 408101; CHG: 26||Not reimbursed separately|3.54|PHR: 408101; CHG: 26||External grouping not supported 15119|ERX|HCPCS RX001|10019-0651-64|0250 - PHARMACY - GENERAL CLASSIFICATION|SEVOFLURANE INHALATION LIQUID|250 mL|HUMANA [1294]||HUMANA [11839]|207.00|PHR: 408101; CHG: 26||Not reimbursed separately|207.00|PHR: 408101; CHG: 26||External grouping not supported 15157|ERX|HCPCS J1190|00143-9248-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|646.71|PHR: 408101; CHG: 26||Not reimbursed separately|646.71|PHR: 408101; CHG: 26||External grouping not supported 15168|ERX|HCPCS A9270|00536-1266-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.8 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 15168|ERX|HCPCS A9270|48433-0211-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.8 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 15168|ERX|HCPCS A9270|54162-0007-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.8 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 15168|ERX|HCPCS A9270|57896-0452-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.8 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 15168|ERX|HCPCS A9270|57896-0462-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.8 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 15168|ERX|HCPCS A9270|99999-3333-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.8 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 15235|ERX|HCPCS J1642|08290-3064-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 15235|ERX|HCPCS J1642|08290-3065-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 15235|ERX|HCPCS J1642|63807-0600-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 15235|ERX|HCPCS J1642|63807-0600-55|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 15235|ERX|HCPCS J1642|64253-0333-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 15327|ERX|HCPCS A9270|63304-0097-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 15327|ERX|HCPCS A9270|65862-0146-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 15328|ERX|HCPCS A9270|55111-0292-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 15328|ERX|HCPCS A9270|55111-0292-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 15328|ERX|HCPCS A9270|62756-0521-69|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 15328|ERX|HCPCS A9270|63304-0098-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 15328|ERX|HCPCS A9270|65862-0147-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 15330|ERX|HCPCS J0153|00703-8776-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.36|PHR: 408101; CHG: 26||Not reimbursed separately|93.36|PHR: 408101; CHG: 26||External grouping not supported 15330|ERX|HCPCS J0153|00409-1932-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.04|PHR: 408101; CHG: 26||Not reimbursed separately|140.04|PHR: 408101; CHG: 26||External grouping not supported 15330|ERX|HCPCS J0153|00703-8777-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.04|PHR: 408101; CHG: 26||Not reimbursed separately|140.04|PHR: 408101; CHG: 26||External grouping not supported 15330|ERX|HCPCS J0153|17478-0544-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.04|PHR: 408101; CHG: 26||Not reimbursed separately|140.04|PHR: 408101; CHG: 26||External grouping not supported 15330|ERX|HCPCS J0153|67457-0857-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.04|PHR: 408101; CHG: 26||Not reimbursed separately|140.04|PHR: 408101; CHG: 26||External grouping not supported 15339|ERX|HCPCS A9270|00781-1785-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 25 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.60|PHR: 408101; CHG: 26||Not reimbursed separately|2.60|PHR: 408101; CHG: 26||External grouping not supported 15339|ERX|HCPCS A9270|68001-0279-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 25 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.60|PHR: 408101; CHG: 26||Not reimbursed separately|2.60|PHR: 408101; CHG: 26||External grouping not supported 15340|ERX|HCPCS A9270|51079-0466-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 15340|ERX|HCPCS A9270|51079-0466-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 15340|ERX|HCPCS A9270|68001-0280-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 15341|ERX|HCPCS A9270|51079-0224-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 15341|ERX|HCPCS A9270|51079-0224-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 15341|ERX|HCPCS A9270|68084-0333-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 15341|ERX|HCPCS A9270|68084-0333-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 15474|ERX|HCPCS A9270|00173-0719-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|1 Puff|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.37|PHR: 408101; CHG: 26||Not reimbursed separately|5.37|PHR: 408101; CHG: 26||External grouping not supported 15475|ERX|HCPCS A9270|00173-0720-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|1 Puff|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.34|PHR: 408101; CHG: 26||Not reimbursed separately|8.34|PHR: 408101; CHG: 26||External grouping not supported 15476|ERX|HCPCS RX001|00173-0718-20|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER|1 Puff|HUMANA [1294]||HUMANA [11839]|4.01|PHR: 408101; CHG: 26||Not reimbursed separately|4.01|PHR: 408101; CHG: 26||External grouping not supported 15500|ERX|HCPCS A9270|00406-1473-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.72|PHR: 408101; CHG: 26||Not reimbursed separately|2.72|PHR: 408101; CHG: 26||External grouping not supported 15500|ERX|HCPCS A9270|10702-0076-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.72|PHR: 408101; CHG: 26||Not reimbursed separately|2.72|PHR: 408101; CHG: 26||External grouping not supported 1562|ERX|HCPCS A9270|00395-2662-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.80|PHR: 408101; CHG: 26||Not reimbursed separately|29.80|PHR: 408101; CHG: 26||External grouping not supported 15661|ERX|HCPCS A9270|64980-0340-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 15661|ERX|HCPCS A9270|64980-0340-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 15706|ERX|HCPCS A9270|00121-0595-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 15706|ERX|HCPCS A9270|00121-0595-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 15706|ERX|HCPCS A9270|00121-0595-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 15723|ERX|HCPCS A9270|60505-0159-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 120 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 15723|ERX|HCPCS A9270|60505-0223-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOTALOL 120 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 15738|ERX|HCPCS A9270|60505-0823-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.70|PHR: 408101; CHG: 26||Not reimbursed separately|39.70|PHR: 408101; CHG: 26||External grouping not supported 15746|ERX|HCPCS A9270|00904-6019-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BICALUTAMIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 15746|ERX|HCPCS A9270|16729-0023-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BICALUTAMIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 15747|ERX|HCPCS A9270|00904-6301-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 6.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 15747|ERX|HCPCS A9270|51079-0930-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 6.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 15747|ERX|HCPCS A9270|51079-0930-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 6.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 15748|ERX|HCPCS A9270|00904-6303-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 15748|ERX|HCPCS A9270|51079-0932-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 15748|ERX|HCPCS A9270|51079-0932-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 15749|ERX|HCPCS A9270|00378-3633-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 15749|ERX|HCPCS A9270|00904-6302-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 15749|ERX|HCPCS A9270|51079-0931-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 15749|ERX|HCPCS A9270|51079-0931-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 15749|ERX|HCPCS A9270|65862-0144-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 15749|ERX|HCPCS A9270|68001-0151-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 15796|ERX|HCPCS A9270|00093-2027-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.36|PHR: 408101; CHG: 26||Not reimbursed separately|5.36|PHR: 408101; CHG: 26||External grouping not supported 15797|ERX|HCPCS A9270|00093-2026-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.39|PHR: 408101; CHG: 26||Not reimbursed separately|33.39|PHR: 408101; CHG: 26||External grouping not supported 15846|ERX|HCPCS J1644|00264-9587-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV|250 mL|HUMANA [1294]||HUMANA [11839]|39.00|PHR: 408101; CHG: 26||Not reimbursed separately|39.00|PHR: 408101; CHG: 26||External grouping not supported 15847|ERX|HCPCS J1644|00264-9872-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 15847|ERX|HCPCS J1644|00409-7620-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 15847|ERX|HCPCS J1644|00409-7620-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 15848|ERX|HCPCS J1644|00409-7651-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 25,000 UNIT/500 ML IN 0.45 % SODIUM CHLORIDE IV SOLN|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|PHR: 408101; CHG: 26||Not reimbursed separately|16.50|PHR: 408101; CHG: 26||External grouping not supported 15849|ERX|HCPCS J1644|00409-7650-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|PHR: 408101; CHG: 26||Not reimbursed separately|16.50|PHR: 408101; CHG: 26||External grouping not supported 15849|ERX|HCPCS J1644|00409-7650-62|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|PHR: 408101; CHG: 26||Not reimbursed separately|16.50|PHR: 408101; CHG: 26||External grouping not supported 15849|ERX|HCPCS J1644|63323-0517-74|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|PHR: 408101; CHG: 26||Not reimbursed separately|16.50|PHR: 408101; CHG: 26||External grouping not supported 15849|ERX|HCPCS J1644|99999-3333-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 25,000 UNIT/250 ML IN 0.45 % SODIUM CHLORIDE IV SOLN|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.50|PHR: 408101; CHG: 26||Not reimbursed separately|16.50|PHR: 408101; CHG: 26||External grouping not supported 15852|ERX|HCPCS J2274|00409-3815-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 1 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 15852|ERX|HCPCS J2274|00409-3815-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 1 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 15852|ERX|HCPCS J2274|00641-6019-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 1 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 15859|ERX|HCPCS RX001|00338-1049-02|0250 - PHARMACY - GENERAL CLASSIFICATION|NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS|250 mL|HUMANA [1294]||HUMANA [11839]|36.00|PHR: 408101; CHG: 26||Not reimbursed separately|36.00|PHR: 408101; CHG: 26||External grouping not supported 15861|ERX|HCPCS J7042|00338-0085-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 15861|ERX|HCPCS J7042|00338-0085-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 15863|ERX|HCPCS RX004|00338-0077-04|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 15863|ERX|HCPCS RX004|00338-0077-03|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 15881|ERX|HCPCS RX001|49702-0205-48|0250 - PHARMACY - GENERAL CLASSIFICATION|LAMIVUDINE 10 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 15881|ERX|HCPCS RX001|54838-0566-70|0250 - PHARMACY - GENERAL CLASSIFICATION|LAMIVUDINE 10 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 15881|ERX|HCPCS RX001|65862-0055-24|0250 - PHARMACY - GENERAL CLASSIFICATION|LAMIVUDINE 10 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 15882|ERX|HCPCS J7042|00338-0089-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 15882|ERX|HCPCS J7042|00338-0089-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 15895|ERX|HCPCS A9270|64380-0759-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACARBOSE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 15897|ERX|HCPCS J1325|00173-0517-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|52.38|PHR: 408101; CHG: 26||Not reimbursed separately|52.38|PHR: 408101; CHG: 26||External grouping not supported 15897|ERX|HCPCS J1325|00703-1985-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|52.38|PHR: 408101; CHG: 26||Not reimbursed separately|52.38|PHR: 408101; CHG: 26||External grouping not supported 15898|ERX|HCPCS J1325|00173-0519-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|170.79|PHR: 408101; CHG: 26||Not reimbursed separately|170.79|PHR: 408101; CHG: 26||External grouping not supported 15898|ERX|HCPCS J1325|00703-1995-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|170.79|PHR: 408101; CHG: 26||Not reimbursed separately|170.79|PHR: 408101; CHG: 26||External grouping not supported 15950|ERX|HCPCS A9270|39328-0063-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM HYPOCHLORITE 0.25 % SOLUTION|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.13|PHR: 408101; CHG: 26||Not reimbursed separately|24.13|PHR: 408101; CHG: 26||External grouping not supported 15954|ERX|HCPCS RX001|00409-3182-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 15954|ERX|HCPCS RX001|00409-3182-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 15954|ERX|HCPCS RX001|63323-0483-03|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 15954|ERX|HCPCS RX001|63323-0483-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|00409-3178-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|00409-3178-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|00409-3178-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-03|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-17|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-26|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-41|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15955|ERX|HCPCS RX001|63323-0482-57|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 15956|ERX|HCPCS RX001|00409-1209-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.28|PHR: 408101; CHG: 26||Not reimbursed separately|1.28|PHR: 408101; CHG: 26||External grouping not supported 15980|ERX|HCPCS J1250|00338-1075-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|PHR: 408101; CHG: 26||Not reimbursed separately|31.50|PHR: 408101; CHG: 26||External grouping not supported 15980|ERX|HCPCS J1250|00409-2347-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|PHR: 408101; CHG: 26||Not reimbursed separately|31.50|PHR: 408101; CHG: 26||External grouping not supported 15985|ERX|HCPCS RX001|63323-0487-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 15985|ERX|HCPCS RX001|63323-0487-07|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 15985|ERX|HCPCS RX001|63323-0487-17|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 15985|ERX|HCPCS RX001|63323-0487-31|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 15985|ERX|HCPCS RX001|63323-0487-37|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 16005|ERX|HCPCS A9270|68084-0075-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.00|PHR: 408101; CHG: 26||Not reimbursed separately|56.00|PHR: 408101; CHG: 26||External grouping not supported 16005|ERX|HCPCS A9270|68084-0075-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.00|PHR: 408101; CHG: 26||Not reimbursed separately|56.00|PHR: 408101; CHG: 26||External grouping not supported 16013|ERX|HCPCS RX001|00869-1156-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ISOPROPYL ALCOHOL 70 % SOLUTION|473 mL|HUMANA [1294]||HUMANA [11839]|2.84|PHR: 408101; CHG: 26||Not reimbursed separately|2.84|PHR: 408101; CHG: 26||External grouping not supported 16014|ERX|HCPCS RX004|00338-0811-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L-LACTATED RINGERS-5 % DEXTROSE INTRAVENOUS|1,000 mL|HUMANA [1294]||HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 16025|ERX|HCPCS A9270|68084-0373-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 300 MG-CODEINE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.54|PHR: 408101; CHG: 26||Not reimbursed separately|1.54|PHR: 408101; CHG: 26||External grouping not supported 16052|ERX|HCPCS A9270|69918-0101-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESMOPRESSIN 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 16070|ERX|HCPCS A9270|00054-0045-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IPRATROPIUM BROMIDE 0.03 % NASAL SPRAY|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.73|PHR: 408101; CHG: 26||Not reimbursed separately|71.73|PHR: 408101; CHG: 26||External grouping not supported 16070|ERX|HCPCS A9270|24208-0398-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IPRATROPIUM BROMIDE 0.03 % NASAL SPRAY|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.73|PHR: 408101; CHG: 26||Not reimbursed separately|71.73|PHR: 408101; CHG: 26||External grouping not supported 16071|ERX|HCPCS A9270|00054-0046-41|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.78|PHR: 408101; CHG: 26||Not reimbursed separately|71.78|PHR: 408101; CHG: 26||External grouping not supported 16081|ERX|HCPCS A9270|00093-8118-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FAMCICLOVIR 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 16156|ERX|HCPCS J1742|00009-3794-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|225.42|PHR: 408101; CHG: 26||Not reimbursed separately|225.42|PHR: 408101; CHG: 26||External grouping not supported 16156|ERX|HCPCS J1742|67457-0366-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.42|PHR: 408101; CHG: 26||Not reimbursed separately|225.42|PHR: 408101; CHG: 26||External grouping not supported 16162|ERX|HCPCS J3475|00409-6727-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 16162|ERX|HCPCS J3475|44567-0410-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 16162|ERX|HCPCS J3475|63323-0108-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 16162|ERX|HCPCS J3475|63323-0108-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 16162|ERX|HCPCS J3475|63323-0108-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00074-4380-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00074-4380-79|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00409-1208-11|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00781-3152-70|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|63323-0417-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|70069-0161-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|71288-0714-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|27.12|PHR: 408101; CHG: 26||Not reimbursed separately|27.12|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00074-4378-05|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|14.61|PHR: 408101; CHG: 26||Not reimbursed separately|14.61|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00074-4378-24|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|14.61|PHR: 408101; CHG: 26||Not reimbursed separately|14.61|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|00409-1098-12|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|14.61|PHR: 408101; CHG: 26||Not reimbursed separately|14.61|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|63323-0416-05|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|14.61|PHR: 408101; CHG: 26||Not reimbursed separately|14.61|PHR: 408101; CHG: 26||External grouping not supported 16168|ERX|HCPCS RX001|71288-0712-05|0250 - PHARMACY - GENERAL CLASSIFICATION|CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|14.61|PHR: 408101; CHG: 26||Not reimbursed separately|14.61|PHR: 408101; CHG: 26||External grouping not supported 16205|ERX|HCPCS A9270|00904-6195-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANASTROZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 16205|ERX|HCPCS A9270|16729-0035-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANASTROZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 16205|ERX|HCPCS A9270|51991-0620-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANASTROZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 16205|ERX|HCPCS A9270|60687-0112-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANASTROZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 16205|ERX|HCPCS A9270|68001-0155-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANASTROZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 16205|ERX|HCPCS A9270|68382-0209-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANASTROZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 1622|ERX|HCPCS A9270|00555-0033-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 1622|ERX|HCPCS A9270|51079-0375-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 1622|ERX|HCPCS A9270|51079-0375-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 1623|ERX|HCPCS A9270|00555-0159-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.39|PHR: 408101; CHG: 26||Not reimbursed separately|1.39|PHR: 408101; CHG: 26||External grouping not supported 1623|ERX|HCPCS A9270|00555-0159-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.39|PHR: 408101; CHG: 26||Not reimbursed separately|1.39|PHR: 408101; CHG: 26||External grouping not supported 1623|ERX|HCPCS A9270|51079-0141-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.39|PHR: 408101; CHG: 26||Not reimbursed separately|1.39|PHR: 408101; CHG: 26||External grouping not supported 1623|ERX|HCPCS A9270|51079-0141-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.39|PHR: 408101; CHG: 26||Not reimbursed separately|1.39|PHR: 408101; CHG: 26||External grouping not supported 1624|ERX|HCPCS A9270|00555-0158-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.68|PHR: 408101; CHG: 26||Not reimbursed separately|1.68|PHR: 408101; CHG: 26||External grouping not supported 1624|ERX|HCPCS A9270|51079-0374-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.68|PHR: 408101; CHG: 26||Not reimbursed separately|1.68|PHR: 408101; CHG: 26||External grouping not supported 1624|ERX|HCPCS A9270|51079-0374-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.68|PHR: 408101; CHG: 26||Not reimbursed separately|1.68|PHR: 408101; CHG: 26||External grouping not supported 16254|ERX|HCPCS J9202|70720-0951-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT|10.8 mg|HUMANA [1294]||HUMANA [11839]|5,445.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,445.00|PHR: 408101; CHG: 26||External grouping not supported 16299|ERX|HCPCS A9270|00904-5354-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 16299|ERX|HCPCS A9270|45802-0358-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 16299|ERX|HCPCS A9270|24385-0210-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.22|PHR: 408101; CHG: 26||Not reimbursed separately|6.22|PHR: 408101; CHG: 26||External grouping not supported 16299|ERX|HCPCS A9270|87701-0552-84|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.22|PHR: 408101; CHG: 26||Not reimbursed separately|6.22|PHR: 408101; CHG: 26||External grouping not supported 1635|ERX|HCPCS J2400|00143-9210-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 1635|ERX|HCPCS J2400|63323-0478-27|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 16355|ERX|HCPCS A9270|16729-0001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 16356|ERX|HCPCS A9270|16729-0002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16356|ERX|HCPCS A9270|51079-0425-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16356|ERX|HCPCS A9270|51079-0425-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16356|ERX|HCPCS A9270|68084-0326-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16356|ERX|HCPCS A9270|68084-0326-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16357|ERX|HCPCS A9270|51079-0426-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 16357|ERX|HCPCS A9270|51079-0426-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 16357|ERX|HCPCS A9270|68084-0327-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 16357|ERX|HCPCS A9270|68084-0327-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 16357|ERX|HCPCS A9270|69543-0125-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIMEPIRIDE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 16369|ERX|HCPCS J0692|60505-6146-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.66|PHR: 408101; CHG: 26||Not reimbursed separately|8.66|PHR: 408101; CHG: 26||External grouping not supported 16369|ERX|HCPCS J0692|60505-6146-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.66|PHR: 408101; CHG: 26||Not reimbursed separately|8.66|PHR: 408101; CHG: 26||External grouping not supported 16369|ERX|HCPCS J0692|25021-0121-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]||HUMANA [11839]|8.66|PHR: 408101; CHG: 26||Not reimbursed separately|8.66|PHR: 408101; CHG: 26||External grouping not supported 16369|ERX|HCPCS J0692|25021-0121-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.66|PHR: 408101; CHG: 26||Not reimbursed separately|8.66|PHR: 408101; CHG: 26||External grouping not supported 16371|ERX|HCPCS J0692|25021-0122-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.74|PHR: 408101; CHG: 26||Not reimbursed separately|15.74|PHR: 408101; CHG: 26||External grouping not supported 16371|ERX|HCPCS J0692|25021-0122-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.74|PHR: 408101; CHG: 26||Not reimbursed separately|15.74|PHR: 408101; CHG: 26||External grouping not supported 16371|ERX|HCPCS J0692|44567-0241-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.74|PHR: 408101; CHG: 26||Not reimbursed separately|15.74|PHR: 408101; CHG: 26||External grouping not supported 16371|ERX|HCPCS J0692|60505-6147-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.74|PHR: 408101; CHG: 26||Not reimbursed separately|15.74|PHR: 408101; CHG: 26||External grouping not supported 16371|ERX|HCPCS J0692|71288-0009-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.74|PHR: 408101; CHG: 26||Not reimbursed separately|15.74|PHR: 408101; CHG: 26||External grouping not supported 16426|ERX|HCPCS J3480|00264-7865-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA [1294]||HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 16426|ERX|HCPCS J3480|00338-0691-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 16427|ERX|HCPCS J3480|00338-0695-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 16440|ERX|HCPCS RX015|00074-1940-63|0250 - PHARMACY - GENERAL CLASSIFICATION|RITONAVIR 80 MG/ML ORAL SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|70.04|PHR: 408101; CHG: 26||Not reimbursed separately|70.04|PHR: 408101; CHG: 26||External grouping not supported 1645|ERX|HCPCS A9270|00904-0012-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPHENIRAMINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 1649|ERX|HCPCS J3230|00641-1397-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|70.44|PHR: 408101; CHG: 26||Not reimbursed separately|70.44|PHR: 408101; CHG: 26||External grouping not supported 1649|ERX|HCPCS J3230|00641-1397-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|70.44|PHR: 408101; CHG: 26||Not reimbursed separately|70.44|PHR: 408101; CHG: 26||External grouping not supported 165162|ERX|HCPCS RX001|00941-0679-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITONEAL DIALYSIS 28 AND ICODEXTRIN 7.5 % CA 3.5 MEQ/L-MAG 0.5 MEQ/L|2,000 mL|HUMANA [1294]||HUMANA [11839]|174.30|PHR: 408101; CHG: 26||Not reimbursed separately|174.30|PHR: 408101; CHG: 26||External grouping not supported 165162|ERX|HCPCS RX001|00941-0679-52|0250 - PHARMACY - GENERAL CLASSIFICATION|PERITONEAL DIALYSIS 28 AND ICODEXTRIN 7.5 % CA 3.5 MEQ/L-MAG 0.5 MEQ/L|2,000 mL|HUMANA [1294]||HUMANA [11839]|174.30|PHR: 408101; CHG: 26||Not reimbursed separately|174.30|PHR: 408101; CHG: 26||External grouping not supported 165175|ERX|HCPCS A9270|46122-0081-72|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CITRATE 315 MG CALCIUM-VITAMIN D3 6.25 MCG (250 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 165175|ERX|HCPCS A9270|46122-0081-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CITRATE 315 MG CALCIUM-VITAMIN D3 6.25 MCG (250 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 165175|ERX|HCPCS A9270|77333-0113-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CITRATE 315 MG CALCIUM-VITAMIN D3 6.25 MCG (250 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 165175|ERX|HCPCS A9270|77333-0113-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CITRATE 315 MG CALCIUM-VITAMIN D3 6.25 MCG (250 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 165175|ERX|HCPCS A9270|87701-0407-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CITRATE 315 MG CALCIUM-VITAMIN D3 6.25 MCG (250 UNIT) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 165181|ERX|HCPCS RX001|00517-4810-25|0250 - PHARMACY - GENERAL CLASSIFICATION|NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|33.06|PHR: 408101; CHG: 26||Not reimbursed separately|33.06|PHR: 408101; CHG: 26||External grouping not supported 165217|ERX|HCPCS A9270|60687-0249-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.96|PHR: 408101; CHG: 26||Not reimbursed separately|11.96|PHR: 408101; CHG: 26||External grouping not supported 165217|ERX|HCPCS A9270|00121-4799-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.96|PHR: 408101; CHG: 26||Not reimbursed separately|11.96|PHR: 408101; CHG: 26||External grouping not supported 165231|ERX|HCPCS A9270|00378-3925-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 165231|ERX|HCPCS A9270|64764-0918-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 165231|ERX|HCPCS A9270|72205-0028-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 165233|ERX|HCPCS A9270|00378-3926-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 165233|ERX|HCPCS A9270|47335-0722-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 165233|ERX|HCPCS A9270|64764-0677-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 165233|ERX|HCPCS A9270|72205-0029-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEBUXOSTAT 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 165263|ERX|HCPCS A9270|00023-6147-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.92|PHR: 408101; CHG: 26||Not reimbursed separately|1.92|PHR: 408101; CHG: 26||External grouping not supported 165263|ERX|HCPCS A9270|33342-0384-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.92|PHR: 408101; CHG: 26||Not reimbursed separately|1.92|PHR: 408101; CHG: 26||External grouping not supported 165263|ERX|HCPCS A9270|59651-0095-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.92|PHR: 408101; CHG: 26||Not reimbursed separately|1.92|PHR: 408101; CHG: 26||External grouping not supported 165263|ERX|HCPCS A9270|72205-0009-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.92|PHR: 408101; CHG: 26||Not reimbursed separately|1.92|PHR: 408101; CHG: 26||External grouping not supported 165264|ERX|HCPCS A9270|00023-6142-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 8 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.95|PHR: 408101; CHG: 26||Not reimbursed separately|22.95|PHR: 408101; CHG: 26||External grouping not supported 165264|ERX|HCPCS A9270|33342-0385-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 8 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.95|PHR: 408101; CHG: 26||Not reimbursed separately|22.95|PHR: 408101; CHG: 26||External grouping not supported 165264|ERX|HCPCS A9270|59651-0096-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 8 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.95|PHR: 408101; CHG: 26||Not reimbursed separately|22.95|PHR: 408101; CHG: 26||External grouping not supported 165264|ERX|HCPCS A9270|72205-0010-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILODOSIN 8 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.95|PHR: 408101; CHG: 26||Not reimbursed separately|22.95|PHR: 408101; CHG: 26||External grouping not supported 1653|ERX|HCPCS A9270|00832-0300-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.32|PHR: 408101; CHG: 26||Not reimbursed separately|6.32|PHR: 408101; CHG: 26||External grouping not supported 1653|ERX|HCPCS A9270|51079-0518-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.32|PHR: 408101; CHG: 26||Not reimbursed separately|6.32|PHR: 408101; CHG: 26||External grouping not supported 1653|ERX|HCPCS A9270|51079-0518-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.32|PHR: 408101; CHG: 26||Not reimbursed separately|6.32|PHR: 408101; CHG: 26||External grouping not supported 1653|ERX|HCPCS A9270|60687-0419-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.32|PHR: 408101; CHG: 26||Not reimbursed separately|6.32|PHR: 408101; CHG: 26||External grouping not supported 1653|ERX|HCPCS A9270|60687-0419-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.32|PHR: 408101; CHG: 26||Not reimbursed separately|6.32|PHR: 408101; CHG: 26||External grouping not supported 1653|ERX|HCPCS A9270|69238-1054-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.32|PHR: 408101; CHG: 26||Not reimbursed separately|6.32|PHR: 408101; CHG: 26||External grouping not supported 165357|ERX|HCPCS A9270|00131-2477-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACOSAMIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.87|PHR: 408101; CHG: 26||Not reimbursed separately|28.87|PHR: 408101; CHG: 26||External grouping not supported 165359|ERX|HCPCS RX015|00131-2478-35|0250 - PHARMACY - GENERAL CLASSIFICATION|LACOSAMIDE 100 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|41.02|PHR: 408101; CHG: 26||Not reimbursed separately|41.02|PHR: 408101; CHG: 26||External grouping not supported 165361|ERX|HCPCS A9270|00131-2480-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACOSAMIDE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.81|PHR: 408101; CHG: 26||Not reimbursed separately|47.81|PHR: 408101; CHG: 26||External grouping not supported 165469|ERX|HCPCS C9488|66220-0160-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CONIVAPTAN 20 MG/100 ML IN 5 % DEXTROSE IV|100 mL|HUMANA [1294]||HUMANA [11839]|2,112.60|PHR: 408101; CHG: 26||Not reimbursed separately|2,112.60|PHR: 408101; CHG: 26||External grouping not supported 1656|ERX|HCPCS A9270|00832-0301-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 1656|ERX|HCPCS A9270|00832-0301-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 1656|ERX|HCPCS A9270|51079-0519-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 1656|ERX|HCPCS A9270|60687-0430-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 1656|ERX|HCPCS A9270|69238-1056-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 165631|ERX|HCPCS RX011|61703-0305-58|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION|0.75 mL|HUMANA [1294]||HUMANA [11839]|12.83|PHR: 408101; CHG: 26||Not reimbursed separately|12.83|PHR: 408101; CHG: 26||External grouping not supported 165631|ERX|HCPCS RX011|61703-0305-38|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|12.83|PHR: 408101; CHG: 26||Not reimbursed separately|12.83|PHR: 408101; CHG: 26||External grouping not supported 165692|ERX|HCPCS RX001|00078-0568-45|0250 - PHARMACY - GENERAL CLASSIFICATION|ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|14.13|PHR: 408101; CHG: 26||Not reimbursed separately|14.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|00832-0302-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|00832-0302-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|00832-0302-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|51079-0130-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|51079-0130-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|60687-0441-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 1657|ERX|HCPCS A9270|69238-1058-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORPROMAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.13|PHR: 408101; CHG: 26||Not reimbursed separately|8.13|PHR: 408101; CHG: 26||External grouping not supported 165738|ERX|HCPCS C9254|00131-1810-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|150.72|PHR: 408101; CHG: 26||Not reimbursed separately|150.72|PHR: 408101; CHG: 26||External grouping not supported 165773|ERX|HCPCS A9270|68094-0756-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 40 MG/4 ML ORAL SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.73|PHR: 408101; CHG: 26||Not reimbursed separately|4.73|PHR: 408101; CHG: 26||External grouping not supported 165773|ERX|HCPCS A9270|68094-0756-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 40 MG/4 ML ORAL SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.73|PHR: 408101; CHG: 26||Not reimbursed separately|4.73|PHR: 408101; CHG: 26||External grouping not supported 165869|ERX|HCPCS RX001|54838-0006-50|0250 - PHARMACY - GENERAL CLASSIFICATION|CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS|1 mL|HUMANA [1294]||HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 165869|ERX|HCPCS RX001|69618-0019-59|0250 - PHARMACY - GENERAL CLASSIFICATION|CHOLECALCIFEROL (VITAMIN D3) 10 MCG/ML (400 UNIT/ML) ORAL DROPS|1 mL|HUMANA [1294]||HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 165904|ERX|HCPCS RX001|76329-1911-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MORPHINE 30 MG/30 ML (1 MG/ML) INTRAVENOUS PCA SYRINGE|30 mL|HUMANA [1294]||HUMANA [11839]|27.63|PHR: 408101; CHG: 26||Not reimbursed separately|27.63|PHR: 408101; CHG: 26||External grouping not supported 165960|ERX|HCPCS J0717|50474-0710-79|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT|1 Kit|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,608.58|PHR: 408101; CHG: 26||Not reimbursed separately|12,608.58|PHR: 408101; CHG: 26||External grouping not supported 166026|ERX|HCPCS A9270|59148-0021-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLVAPTAN 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|812.75|PHR: 408101; CHG: 26||Not reimbursed separately|812.75|PHR: 408101; CHG: 26||External grouping not supported 166026|ERX|HCPCS A9270|60505-4705-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLVAPTAN 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|812.75|PHR: 408101; CHG: 26||Not reimbursed separately|812.75|PHR: 408101; CHG: 26||External grouping not supported 166039|ERX|HCPCS A9270|24208-0446-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|496.29|PHR: 408101; CHG: 26||Not reimbursed separately|496.29|PHR: 408101; CHG: 26||External grouping not supported 1661|ERX|HCPCS A9270|51079-0058-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORTHALIDONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.21|PHR: 408101; CHG: 26||Not reimbursed separately|4.21|PHR: 408101; CHG: 26||External grouping not supported 1661|ERX|HCPCS A9270|51079-0058-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORTHALIDONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.21|PHR: 408101; CHG: 26||Not reimbursed separately|4.21|PHR: 408101; CHG: 26||External grouping not supported 1661|ERX|HCPCS A9270|64980-0303-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORTHALIDONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.21|PHR: 408101; CHG: 26||Not reimbursed separately|4.21|PHR: 408101; CHG: 26||External grouping not supported 166164|ERX|HCPCS A9270|24510-0100-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAPENTADOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.10|PHR: 408101; CHG: 26||Not reimbursed separately|30.10|PHR: 408101; CHG: 26||External grouping not supported 166184|ERX|HCPCS A9270|00032-1206-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.88|PHR: 408101; CHG: 26||Not reimbursed separately|4.88|PHR: 408101; CHG: 26||External grouping not supported 166185|ERX|HCPCS A9270|00032-1212-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.75|PHR: 408101; CHG: 26||Not reimbursed separately|9.75|PHR: 408101; CHG: 26||External grouping not supported 166185|ERX|HCPCS A9270|00032-1212-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIPASE-PROTEASE-AMYLASE 12,000-38,000-60,000 UNIT CAPSULE,DELAYED REL|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.75|PHR: 408101; CHG: 26||Not reimbursed separately|9.75|PHR: 408101; CHG: 26||External grouping not supported 166186|ERX|HCPCS A9270|00032-1224-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.32|PHR: 408101; CHG: 26||Not reimbursed separately|19.32|PHR: 408101; CHG: 26||External grouping not supported 1662|ERX|HCPCS A9270|00378-0213-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORTHALIDONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.97|PHR: 408101; CHG: 26||Not reimbursed separately|2.97|PHR: 408101; CHG: 26||External grouping not supported 166237|ERX|HCPCS Q0138|59338-0775-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION|17 mL|HUMANA [1294]||HUMANA [11839]|2,961.98|PHR: 408101; CHG: 26||Not reimbursed separately|2,961.98|PHR: 408101; CHG: 26||External grouping not supported 166276|ERX|HCPCS A9270|00024-4142-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONEDARONE 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.73|PHR: 408101; CHG: 26||Not reimbursed separately|29.73|PHR: 408101; CHG: 26||External grouping not supported 166305|ERX|HCPCS A9270|00574-0302-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.80|PHR: 408101; CHG: 26||Not reimbursed separately|29.80|PHR: 408101; CHG: 26||External grouping not supported 166307|ERX|HCPCS A9270|00378-5185-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRASUGREL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 166307|ERX|HCPCS A9270|60505-4642-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRASUGREL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 166309|ERX|HCPCS A9270|00002-5123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRASUGREL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 166309|ERX|HCPCS A9270|00378-5186-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRASUGREL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 166309|ERX|HCPCS A9270|60505-4643-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRASUGREL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 166309|ERX|HCPCS A9270|67877-0605-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRASUGREL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 16632|ERX|HCPCS A9270|00904-5676-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16632|ERX|HCPCS A9270|50268-0640-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16632|ERX|HCPCS A9270|68084-0044-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 16632|ERX|HCPCS A9270|68382-0097-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 166370|ERX|HCPCS A9270|62756-0718-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVONORGESTREL 1.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.49|PHR: 408101; CHG: 26||Not reimbursed separately|23.49|PHR: 408101; CHG: 26||External grouping not supported 166370|ERX|HCPCS A9270|68180-0852-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVONORGESTREL 1.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.49|PHR: 408101; CHG: 26||Not reimbursed separately|23.49|PHR: 408101; CHG: 26||External grouping not supported 166370|ERX|HCPCS A9270|69536-0146-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVONORGESTREL 1.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.49|PHR: 408101; CHG: 26||Not reimbursed separately|23.49|PHR: 408101; CHG: 26||External grouping not supported 166389|ERX|HCPCS J1741|66220-0287-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBUPROFEN 800 MG/8 ML (100 MG/ML) INTRAVENOUS SOLUTION|800 mg|HUMANA [1294]||HUMANA [11839]|47.98|PHR: 408101; CHG: 26||Not reimbursed separately|47.98|PHR: 408101; CHG: 26||External grouping not supported 1664|ERX|HCPCS A9270|00591-2520-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORZOXAZONE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 166404|ERX|HCPCS A9270|42192-0329-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THYROID (PORK) 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 166405|ERX|HCPCS A9270|42192-0330-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THYROID (PORK) 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 166477|ERX|HCPCS J2426|50458-0563-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|5,347.41|PHR: 408101; CHG: 26||Not reimbursed separately|5,347.41|PHR: 408101; CHG: 26||External grouping not supported 166478|ERX|HCPCS J2426|50458-0564-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE|1.5 mL|HUMANA [1294]||HUMANA [11839]|8,020.93|PHR: 408101; CHG: 26||Not reimbursed separately|8,020.93|PHR: 408101; CHG: 26||External grouping not supported 166550|ERX|HCPCS RX001|65862-0931-90|0250 - PHARMACY - GENERAL CLASSIFICATION|SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]||HUMANA [11839]|19.70|PHR: 408101; CHG: 26||Not reimbursed separately|19.70|PHR: 408101; CHG: 26||External grouping not supported 166559|ERX|HCPCS RX011||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TREPROSTINIL 1.74 MG/2.9 ML (0.6 MG/ML) SOLUTION FOR NEBULIZATION|2.9 mL|HUMANA [1294]||HUMANA [11839]|1,743.75|PHR: 408101; CHG: 26||Not reimbursed separately|1,743.75|PHR: 408101; CHG: 26||External grouping not supported 166622|ERX|HCPCS A9270|00456-2410-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASENAPINE 10 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.30|PHR: 408101; CHG: 26||Not reimbursed separately|55.30|PHR: 408101; CHG: 26||External grouping not supported 166622|ERX|HCPCS A9270|00456-2410-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASENAPINE 10 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.30|PHR: 408101; CHG: 26||Not reimbursed separately|55.30|PHR: 408101; CHG: 26||External grouping not supported 166632|ERX|HCPCS A9270|37000-0024-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 166632|ERX|HCPCS A9270|37000-0024-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 166632|ERX|HCPCS A9270|37000-0741-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 166672|ERX|HCPCS J7312|00023-3348-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 0.7 MG INTRAVITREAL IMPLANT|1 Each|HUMANA [1294]||HUMANA [11839]|3,999.00|PHR: 408101; CHG: 26||Not reimbursed separately|3,999.00|PHR: 408101; CHG: 26||External grouping not supported 166726|ERX|HCPCS A9270|00088-1175-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 166731|ERX|HCPCS A9270|64980-0129-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 166731|ERX|HCPCS A9270|71351-0012-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 166736|ERX|HCPCS A9270|68094-0007-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 166736|ERX|HCPCS A9270|99999-4444-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 166963|ERX|HCPCS J3095|62847-0001-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TELAVANCIN 750 MG INTRAVENOUS SOLUTION|750 mg|HUMANA [1294]||HUMANA [11839]|1,324.71|PHR: 408101; CHG: 26||Not reimbursed separately|1,324.71|PHR: 408101; CHG: 26||External grouping not supported 167018|ERX|HCPCS RX001|68803-0672-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TRYPAN BLUE 0.15 % INTRAOCULAR SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|398.25|PHR: 408101; CHG: 26||Not reimbursed separately|398.25|PHR: 408101; CHG: 26||External grouping not supported 168764|ERX|HCPCS J9155|55566-8303-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEGARELIX 80 MG SUBCUTANEOUS SOLUTION|80 mg|HUMANA [1294]||HUMANA [11839]|837.21|PHR: 408101; CHG: 26||Not reimbursed separately|837.21|PHR: 408101; CHG: 26||External grouping not supported 168765|ERX|HCPCS J9155|55566-8403-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEGARELIX 120 MG SUBCUTANEOUS SOLUTION|6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,224.86|PHR: 408101; CHG: 26||Not reimbursed separately|5,224.86|PHR: 408101; CHG: 26||External grouping not supported 168766|ERX|HCPCS J9328|00085-1381-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION|40 mL|HUMANA [1294]||HUMANA [11839]|2,926.59|PHR: 408101; CHG: 26||Not reimbursed separately|2,926.59|PHR: 408101; CHG: 26||External grouping not supported 168779|ERX|HCPCS A9270|00121-1781-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION|10.16 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.89|PHR: 408101; CHG: 26||Not reimbursed separately|6.89|PHR: 408101; CHG: 26||External grouping not supported 168779|ERX|HCPCS A9270|00121-1781-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION|10.16 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.89|PHR: 408101; CHG: 26||Not reimbursed separately|6.89|PHR: 408101; CHG: 26||External grouping not supported 168779|ERX|HCPCS A9270|68094-0015-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION|10.16 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.89|PHR: 408101; CHG: 26||Not reimbursed separately|6.89|PHR: 408101; CHG: 26||External grouping not supported 168783|ERX|HCPCS A9270|00121-0657-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION|11 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.27|PHR: 408101; CHG: 26||Not reimbursed separately|6.27|PHR: 408101; CHG: 26||External grouping not supported 168785|ERX|HCPCS A9270|00121-1971-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|10.15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 168785|ERX|HCPCS A9270|66689-0056-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|10.15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 168785|ERX|HCPCS A9270|66689-0056-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|10.15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 168785|ERX|HCPCS A9270|00121-1971-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|20.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 168787|ERX|HCPCS J9302|00078-0669-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|1,668.02|PHR: 408101; CHG: 26||Not reimbursed separately|1,668.02|PHR: 408101; CHG: 26||External grouping not supported 169092|ERX|HCPCS A9270|43068-0102-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ILOPERIDONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.58|PHR: 408101; CHG: 26||Not reimbursed separately|58.58|PHR: 408101; CHG: 26||External grouping not supported 169138|ERX|HCPCS J9033|63459-0390-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BENDAMUSTINE 25 MG INTRAVENOUS POWDER FOR SOLUTION|25 mg|HUMANA [1294]||HUMANA [11839]|1,653.39|PHR: 408101; CHG: 26||Not reimbursed separately|1,653.39|PHR: 408101; CHG: 26||External grouping not supported 169250|ERX|HCPCS J3262|50242-0135-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|1,345.44|PHR: 408101; CHG: 26||Not reimbursed separately|1,345.44|PHR: 408101; CHG: 26||External grouping not supported 169251|ERX|HCPCS J3262|50242-0136-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,363.60|PHR: 408101; CHG: 26||Not reimbursed separately|3,363.60|PHR: 408101; CHG: 26||External grouping not supported 169252|ERX|HCPCS J3262|50242-0137-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,727.20|PHR: 408101; CHG: 26||Not reimbursed separately|6,727.20|PHR: 408101; CHG: 26||External grouping not supported 169262|ERX|HCPCS A9270|77333-0308-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 169264|ERX|HCPCS J2920|00009-0039-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION|0.25 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.47|PHR: 408101; CHG: 26||Not reimbursed separately|13.47|PHR: 408101; CHG: 26||External grouping not supported 169264|ERX|HCPCS J2920|00009-0039-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION|0.25 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.47|PHR: 408101; CHG: 26||Not reimbursed separately|13.47|PHR: 408101; CHG: 26||External grouping not supported 169264|ERX|HCPCS J2920|00009-0039-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.47|PHR: 408101; CHG: 26||Not reimbursed separately|13.47|PHR: 408101; CHG: 26||External grouping not supported 169265|ERX|HCPCS J2930|00009-0047-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.42|PHR: 408101; CHG: 26||Not reimbursed separately|21.42|PHR: 408101; CHG: 26||External grouping not supported 169265|ERX|HCPCS J2930|00009-0047-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.42|PHR: 408101; CHG: 26||Not reimbursed separately|21.42|PHR: 408101; CHG: 26||External grouping not supported 169265|ERX|HCPCS J2930|00009-0047-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.42|PHR: 408101; CHG: 26||Not reimbursed separately|21.42|PHR: 408101; CHG: 26||External grouping not supported 169300|ERX|HCPCS J3357|57894-0061-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|67,344.21|PHR: 408101; CHG: 26||Not reimbursed separately|67,344.21|PHR: 408101; CHG: 26||External grouping not supported 169308|ERX|HCPCS RX001|00004-0039-09|0250 - PHARMACY - GENERAL CLASSIFICATION|VALGANCICLOVIR 50 MG/ML ORAL SOLUTION|88 mL|HUMANA [1294]||HUMANA [11839]|2,088.77|PHR: 408101; CHG: 26||Not reimbursed separately|2,088.77|PHR: 408101; CHG: 26||External grouping not supported 169308|ERX|HCPCS RX001|00591-2579-20|0250 - PHARMACY - GENERAL CLASSIFICATION|VALGANCICLOVIR 50 MG/ML ORAL SOLUTION|88 mL|HUMANA [1294]||HUMANA [11839]|2,088.77|PHR: 408101; CHG: 26||Not reimbursed separately|2,088.77|PHR: 408101; CHG: 26||External grouping not supported 169327|ERX|HCPCS RX001|00169-4060-12|0250 - PHARMACY - GENERAL CLASSIFICATION|LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR|3 mL|HUMANA [1294]||HUMANA [11839]|891.90|PHR: 408101; CHG: 26||Not reimbursed separately|891.90|PHR: 408101; CHG: 26||External grouping not supported 169412|ERX|HCPCS A9270|00054-0407-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RITONAVIR 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.44|PHR: 408101; CHG: 26||Not reimbursed separately|5.44|PHR: 408101; CHG: 26||External grouping not supported 169412|ERX|HCPCS A9270|00074-3333-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RITONAVIR 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.44|PHR: 408101; CHG: 26||Not reimbursed separately|5.44|PHR: 408101; CHG: 26||External grouping not supported 169412|ERX|HCPCS A9270|31722-0597-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RITONAVIR 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.44|PHR: 408101; CHG: 26||Not reimbursed separately|5.44|PHR: 408101; CHG: 26||External grouping not supported 169416|ERX|HCPCS A9270|74300-0000-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE|57 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.55|PHR: 408101; CHG: 26||Not reimbursed separately|8.55|PHR: 408101; CHG: 26||External grouping not supported 169502|ERX|HCPCS 90734|58160-0955-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML INTRAMUSCULAR KIT|0.5 mL|HUMANA [1294]||HUMANA [11839]|273.45|PHR: 408101; CHG: 26||Not reimbursed separately|273.45|PHR: 408101; CHG: 26||External grouping not supported 169548|ERX|HCPCS 90670|00005-1971-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|558.62|PHR: 408101; CHG: 28||Not reimbursed separately|558.62|PHR: 408101; CHG: 28||External grouping not supported 169548|ERX|HCPCS 90670|00005-1971-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.62|PHR: 408101; CHG: 28||Not reimbursed separately|558.62|PHR: 408101; CHG: 28||External grouping not supported 169676|ERX|HCPCS J9315|59572-0984-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|9,595.95|PHR: 408101; CHG: 26||Not reimbursed separately|9,595.95|PHR: 408101; CHG: 26||External grouping not supported 169875|ERX|HCPCS J3315|00023-5906-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIPTORELIN PAMOATE 22.5 MG INTRAMUSCULAR SUSPENSION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,791.39|PHR: 408101; CHG: 26||Not reimbursed separately|10,791.39|PHR: 408101; CHG: 26||External grouping not supported 169875|ERX|HCPCS J3315|00023-5906-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIPTORELIN PAMOATE 22.5 MG INTRAMUSCULAR SUSPENSION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,791.39|PHR: 408101; CHG: 26||Not reimbursed separately|10,791.39|PHR: 408101; CHG: 26||External grouping not supported 169887|ERX|HCPCS RX015|24208-0535-35|0250 - PHARMACY - GENERAL CLASSIFICATION|GANCICLOVIR 0.15 % EYE GEL|5 g|HUMANA [1294]||HUMANA [11839]|1,029.36|PHR: 408101; CHG: 26||Not reimbursed separately|1,029.36|PHR: 408101; CHG: 26||External grouping not supported 169896|ERX|HCPCS J1720|00009-0013-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|PHR: 408101; CHG: 26||Not reimbursed separately|85.20|PHR: 408101; CHG: 26||External grouping not supported 169897|ERX|HCPCS J1720|00009-0011-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.31|PHR: 408101; CHG: 26||Not reimbursed separately|20.31|PHR: 408101; CHG: 26||External grouping not supported 169897|ERX|HCPCS J1720|00009-0011-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.31|PHR: 408101; CHG: 26||Not reimbursed separately|20.31|PHR: 408101; CHG: 26||External grouping not supported 169942|ERX|HCPCS A9270|65649-0303-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIFAXIMIN 550 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.75|PHR: 408101; CHG: 26||Not reimbursed separately|117.75|PHR: 408101; CHG: 26||External grouping not supported 169942|ERX|HCPCS A9270|65649-0303-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIFAXIMIN 550 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.75|PHR: 408101; CHG: 26||Not reimbursed separately|117.75|PHR: 408101; CHG: 26||External grouping not supported 170034|ERX|HCPCS A9270|00591-3720-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRANEXAMIC ACID 650 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.21|PHR: 408101; CHG: 26||Not reimbursed separately|6.21|PHR: 408101; CHG: 26||External grouping not supported 170034|ERX|HCPCS A9270|60505-3638-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRANEXAMIC ACID 650 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.21|PHR: 408101; CHG: 26||Not reimbursed separately|6.21|PHR: 408101; CHG: 26||External grouping not supported 170034|ERX|HCPCS A9270|69918-0301-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRANEXAMIC ACID 650 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.21|PHR: 408101; CHG: 26||Not reimbursed separately|6.21|PHR: 408101; CHG: 26||External grouping not supported 170072|ERX|HCPCS RX015|66869-0204-90|0250 - PHARMACY - GENERAL CLASSIFICATION|PITAVASTATIN CALCIUM 2 MG TABLET|1 Each|HUMANA [1294]||HUMANA [11839]|27.61|PHR: 408101; CHG: 26||Not reimbursed separately|27.61|PHR: 408101; CHG: 26||External grouping not supported 17010|ERX|HCPCS A9270|43199-0014-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYOSCYAMINE ER 0.375 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 17012|ERX|HCPCS J9040|00703-3155-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION|2 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.88|PHR: 408101; CHG: 26||Not reimbursed separately|9.88|PHR: 408101; CHG: 26||External grouping not supported 17012|ERX|HCPCS J9040|63323-0137-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION|2 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.88|PHR: 408101; CHG: 26||Not reimbursed separately|9.88|PHR: 408101; CHG: 26||External grouping not supported 170154|ERX|HCPCS A9270|99999-5555-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACOSAMIDE 10 MG/ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.50|PHR: 408101; CHG: 26||Not reimbursed separately|25.50|PHR: 408101; CHG: 26||External grouping not supported 170188|ERX|HCPCS J0897|55513-0710-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|60 mg|HUMANA [1294]||HUMANA [11839]|3,730.89|PHR: 408101; CHG: 26||Not reimbursed separately|3,730.89|PHR: 408101; CHG: 26||External grouping not supported 17023|ERX|HCPCS A9270|43199-0011-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 17121|ERX|HCPCS J9201|00409-0185-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 17121|ERX|HCPCS J9201|25021-0234-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 17121|ERX|HCPCS J9201|63323-0102-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 17121|ERX|HCPCS J9201|71288-0113-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 17122|ERX|HCPCS J9201|25021-0235-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.63|PHR: 408101; CHG: 26||Not reimbursed separately|45.63|PHR: 408101; CHG: 26||External grouping not supported 17122|ERX|HCPCS J9201|63323-0125-53|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.63|PHR: 408101; CHG: 26||Not reimbursed separately|45.63|PHR: 408101; CHG: 26||External grouping not supported 17122|ERX|HCPCS J9201|70860-0205-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.63|PHR: 408101; CHG: 26||Not reimbursed separately|45.63|PHR: 408101; CHG: 26||External grouping not supported 17122|ERX|HCPCS J9201|71288-0114-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.63|PHR: 408101; CHG: 26||Not reimbursed separately|45.63|PHR: 408101; CHG: 26||External grouping not supported 171544|ERX|HCPCS RX001|23155-0290-31|0250 - PHARMACY - GENERAL CLASSIFICATION|AMIKACIN 500 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|32.19|PHR: 408101; CHG: 26||Not reimbursed separately|32.19|PHR: 408101; CHG: 26||External grouping not supported 171544|ERX|HCPCS RX001|25021-0173-02|0250 - PHARMACY - GENERAL CLASSIFICATION|AMIKACIN 500 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|32.19|PHR: 408101; CHG: 26||Not reimbursed separately|32.19|PHR: 408101; CHG: 26||External grouping not supported 171544|ERX|HCPCS RX001|63323-0815-02|0250 - PHARMACY - GENERAL CLASSIFICATION|AMIKACIN 500 MG/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|32.19|PHR: 408101; CHG: 26||Not reimbursed separately|32.19|PHR: 408101; CHG: 26||External grouping not supported 171572|ERX|HCPCS J2370|69374-0957-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.79|PHR: 408101; CHG: 26||Not reimbursed separately|0.79|PHR: 408101; CHG: 26||External grouping not supported 171599|ERX|HCPCS J9043|00024-5824-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION|6 mL|HUMANA [1294]||HUMANA [11839]|31,906.50|PHR: 408101; CHG: 26||Not reimbursed separately|31,906.50|PHR: 408101; CHG: 26||External grouping not supported 171602|ERX|HCPCS RX001|00085-7206-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MOMETASONE-FORMOTEROL HFA 100 MCG-5 MCG/ACTUATION AEROSOL INHALER|1 Puff|HUMANA [1294]||HUMANA [11839]|4.31|PHR: 408101; CHG: 26||Not reimbursed separately|4.31|PHR: 408101; CHG: 26||External grouping not supported 171602|ERX|HCPCS RX001|00085-7206-07|0250 - PHARMACY - GENERAL CLASSIFICATION|MOMETASONE-FORMOTEROL HFA 100 MCG-5 MCG/ACTUATION AEROSOL INHALER|1 Puff|HUMANA [1294]||HUMANA [11839]|4.31|PHR: 408101; CHG: 26||Not reimbursed separately|4.31|PHR: 408101; CHG: 26||External grouping not supported 171603|ERX|HCPCS RX001|00085-4610-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER|1 Puff|HUMANA [1294]||HUMANA [11839]|4.31|PHR: 408101; CHG: 26||Not reimbursed separately|4.31|PHR: 408101; CHG: 26||External grouping not supported 171603|ERX|HCPCS RX001|00085-4610-05|0250 - PHARMACY - GENERAL CLASSIFICATION|MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER|1 Puff|HUMANA [1294]||HUMANA [11839]|4.31|PHR: 408101; CHG: 26||Not reimbursed separately|4.31|PHR: 408101; CHG: 26||External grouping not supported 171603|ERX|HCPCS RX001|99999-1111-59|0250 - PHARMACY - GENERAL CLASSIFICATION|MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER|1 Puff|HUMANA [1294]||HUMANA [11839]|4.31|PHR: 408101; CHG: 26||Not reimbursed separately|4.31|PHR: 408101; CHG: 26||External grouping not supported 171709|ERX|HCPCS A9270|37864-0905-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 171709|ERX|HCPCS A9270|50268-0851-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 171709|ERX|HCPCS A9270|51645-0905-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 171709|ERX|HCPCS A9270|77333-0934-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 171709|ERX|HCPCS A9270|77333-0934-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 171709|ERX|HCPCS A9270|79854-0200-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 171712|ERX|HCPCS A9270|33342-0061-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 23 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.83|PHR: 408101; CHG: 26||Not reimbursed separately|3.83|PHR: 408101; CHG: 26||External grouping not supported 171712|ERX|HCPCS A9270|43547-0382-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 23 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.83|PHR: 408101; CHG: 26||Not reimbursed separately|3.83|PHR: 408101; CHG: 26||External grouping not supported 171712|ERX|HCPCS A9270|55111-0302-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 23 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.83|PHR: 408101; CHG: 26||Not reimbursed separately|3.83|PHR: 408101; CHG: 26||External grouping not supported 172194|ERX|HCPCS A9270|99999-2222-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANOLIN EX OINTMENT|0.25 ounce (avoirdupois)|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.52|PHR: 408101; CHG: 26||Not reimbursed separately|5.52|PHR: 408101; CHG: 26||External grouping not supported 172197|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|LET GEL 1.5 G SYRINGE|1.5 g|HUMANA [1294]||HUMANA [11839]|43.56|PHR: 408101; CHG: 26||Not reimbursed separately|43.56|PHR: 408101; CHG: 26||External grouping not supported 172199|ERX|HCPCS RX001|99999-2222-72|0250 - PHARMACY - GENERAL CLASSIFICATION|MEMBRANE BLUE SYRINGE .15%|1 Syringe|HUMANA [1294]||HUMANA [11839]|168.00|PHR: 408101; CHG: 26||Not reimbursed separately|168.00|PHR: 408101; CHG: 26||External grouping not supported 172200|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|BICOL SPONGE|1 Each|HUMANA [1294]||HUMANA [11839]|283.50|PHR: 408101; CHG: 26||Not reimbursed separately|283.50|PHR: 408101; CHG: 26||External grouping not supported 172201|ERX|HCPCS RX001|85445-0084-21|0250 - PHARMACY - GENERAL CLASSIFICATION|HEALON 10MG/ML INTRAOCULAR SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|396.00|PHR: 408101; CHG: 26||Not reimbursed separately|396.00|PHR: 408101; CHG: 26||External grouping not supported 172202|ERX|HCPCS RX001|99999-9999-40|0250 - PHARMACY - GENERAL CLASSIFICATION|SURGIFLO-EVITHROM 2ML KIT|1 Kit|HUMANA [1294]||HUMANA [11839]|486.39|PHR: 408101; CHG: 26||Not reimbursed separately|486.39|PHR: 408101; CHG: 26||External grouping not supported 172208|ERX|HCPCS RX001|99999-2222-63|0250 - PHARMACY - GENERAL CLASSIFICATION|LAMINARIA JAPONICA 3MM STICK|1 Stick|HUMANA [1294]||HUMANA [11839]|39.03|PHR: 408101; CHG: 26||Not reimbursed separately|39.03|PHR: 408101; CHG: 26||External grouping not supported 172214|ERX|HCPCS RX018|99999-9999-66|0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|LIPIODOL ULTRA FLUIDE 480 MG/ML VIAL|10 Vial|HUMANA [1294]||HUMANA [11839]|3,672.00|PHR: 408101; CHG: 26||Not reimbursed separately|3,672.00|PHR: 408101; CHG: 26||External grouping not supported 172223|ERX|HCPCS A9270|99999-3333-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ILEX/DERMAPHOR TOPICAL|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.60|PHR: 408101; CHG: 26||Not reimbursed separately|21.60|PHR: 408101; CHG: 26||External grouping not supported 172245|ERX|HCPCS J1610|00597-0053-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.12|PHR: 408101; CHG: 26||Not reimbursed separately|236.12|PHR: 408101; CHG: 26||External grouping not supported 172245|ERX|HCPCS J1610|00597-0053-45|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|236.12|PHR: 408101; CHG: 26||Not reimbursed separately|236.12|PHR: 408101; CHG: 26||External grouping not supported 172245|ERX|HCPCS J1610|00597-0260-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.12|PHR: 408101; CHG: 26||Not reimbursed separately|236.12|PHR: 408101; CHG: 26||External grouping not supported 172419|ERX|HCPCS J0572|12496-1202-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM|1 Each|HUMANA [1294]||HUMANA [11839]|13.86|PHR: 408101; CHG: 26||Not reimbursed separately|13.86|PHR: 408101; CHG: 26||External grouping not supported 172419|ERX|HCPCS J0572|12496-1202-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.86|PHR: 408101; CHG: 26||Not reimbursed separately|13.86|PHR: 408101; CHG: 26||External grouping not supported 172419|ERX|HCPCS J0572|43598-0579-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.86|PHR: 408101; CHG: 26||Not reimbursed separately|13.86|PHR: 408101; CHG: 26||External grouping not supported 172420|ERX|HCPCS J0574|12496-1208-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM|1 Film|HUMANA [1294]||HUMANA [11839]|8.26|PHR: 408101; CHG: 26||Not reimbursed separately|8.26|PHR: 408101; CHG: 26||External grouping not supported 172420|ERX|HCPCS J0574|12496-1208-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM|1 Film|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.26|PHR: 408101; CHG: 26||Not reimbursed separately|8.26|PHR: 408101; CHG: 26||External grouping not supported 172420|ERX|HCPCS J0574|43598-0582-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM|1 Film|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.26|PHR: 408101; CHG: 26||Not reimbursed separately|8.26|PHR: 408101; CHG: 26||External grouping not supported 172420|ERX|HCPCS J0574|43598-0582-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM|1 Film|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.26|PHR: 408101; CHG: 26||Not reimbursed separately|8.26|PHR: 408101; CHG: 26||External grouping not supported 172454|ERX|HCPCS A9270|24208-0432-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMINS A,C,E-ZINC-COPPER 7,160 UNIT-113 MG-100 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 172498|ERX|HCPCS A9270|00023-3205-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BIMATOPROST 0.01 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|571.50|PHR: 408101; CHG: 26||Not reimbursed separately|571.50|PHR: 408101; CHG: 26||External grouping not supported 172552|ERX|HCPCS J0257|00944-2884-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALPHA-1-PROTEINASE INHIBITOR(HUMAN) 1 GRAM/50 ML(2 %) INTRAVENOUS SOLN|50 mL|HUMANA [1294]||HUMANA [11839]|1,500.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,500.00|PHR: 408101; CHG: 26||External grouping not supported 172667|ERX|HCPCS J9171|00955-1020-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|38.85|PHR: 408101; CHG: 26||Not reimbursed separately|38.85|PHR: 408101; CHG: 26||External grouping not supported 172667|ERX|HCPCS J9171|16729-0267-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.85|PHR: 408101; CHG: 26||Not reimbursed separately|38.85|PHR: 408101; CHG: 26||External grouping not supported 172668|ERX|HCPCS J9171|00955-1021-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.84|PHR: 408101; CHG: 26||Not reimbursed separately|162.84|PHR: 408101; CHG: 26||External grouping not supported 172668|ERX|HCPCS J9171|16729-0267-64|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.84|PHR: 408101; CHG: 26||Not reimbursed separately|162.84|PHR: 408101; CHG: 26||External grouping not supported 172672|ERX|HCPCS RX001|68094-0764-59|0250 - PHARMACY - GENERAL CLASSIFICATION|MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP|1 mL|HUMANA [1294]||HUMANA [11839]|2.91|PHR: 408101; CHG: 26||Not reimbursed separately|2.91|PHR: 408101; CHG: 26||External grouping not supported 172672|ERX|HCPCS RX001|68094-0764-62|0250 - PHARMACY - GENERAL CLASSIFICATION|MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP|1 mL|HUMANA [1294]||HUMANA [11839]|2.91|PHR: 408101; CHG: 26||Not reimbursed separately|2.91|PHR: 408101; CHG: 26||External grouping not supported 172727|ERX|HCPCS A9270|00597-0360-82|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DABIGATRAN ETEXILATE 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.02|PHR: 408101; CHG: 26||Not reimbursed separately|19.02|PHR: 408101; CHG: 26||External grouping not supported 17280|ERX|HCPCS A9270|60505-0055-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SELEGILINE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 173155|ERX|HCPCS A9270|99999-2222-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE ORAL SUSP 2MG/ML (PEDI) (NICU)|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.37|PHR: 408101; CHG: 26||Not reimbursed separately|29.37|PHR: 408101; CHG: 26||External grouping not supported 173224|ERX|HCPCS A9270|00597-0355-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DABIGATRAN ETEXILATE 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.02|PHR: 408101; CHG: 26||Not reimbursed separately|19.02|PHR: 408101; CHG: 26||External grouping not supported 173284|ERX|HCPCS J1453|00006-3061-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|1 Each|HUMANA [1294]||HUMANA [11839]|169.23|PHR: 408101; CHG: 26||Not reimbursed separately|169.23|PHR: 408101; CHG: 26||External grouping not supported 173284|ERX|HCPCS J1453|00006-3061-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|169.23|PHR: 408101; CHG: 26||Not reimbursed separately|169.23|PHR: 408101; CHG: 26||External grouping not supported 173288|ERX|HCPCS J9179|62856-0389-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3,540.00|PHR: 408101; CHG: 26||Not reimbursed separately|3,540.00|PHR: 408101; CHG: 26||External grouping not supported 173327|ERX|HCPCS J0897|55513-0730-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|1.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,862.71|PHR: 408101; CHG: 26||Not reimbursed separately|6,862.71|PHR: 408101; CHG: 26||External grouping not supported 173493|ERX|HCPCS J2507|75987-0080-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION|8 mg|HUMANA [1294]||HUMANA [11839]|55,749.66|PHR: 408101; CHG: 26||Not reimbursed separately|55,749.66|PHR: 408101; CHG: 26||External grouping not supported 173495|ERX|HCPCS J0712|00456-0400-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|274.65|PHR: 408101; CHG: 26||Not reimbursed separately|274.65|PHR: 408101; CHG: 26||External grouping not supported 173495|ERX|HCPCS J0712|00456-0400-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|274.65|PHR: 408101; CHG: 26||Not reimbursed separately|274.65|PHR: 408101; CHG: 26||External grouping not supported 173496|ERX|HCPCS J0712|00456-0600-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION|600 mg|HUMANA [1294]||HUMANA [11839]|549.30|PHR: 408101; CHG: 26||Not reimbursed separately|549.30|PHR: 408101; CHG: 26||External grouping not supported 173496|ERX|HCPCS J0712|00456-0600-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION|600 mg|HUMANA [1294]||HUMANA [11839]|549.30|PHR: 408101; CHG: 26||Not reimbursed separately|549.30|PHR: 408101; CHG: 26||External grouping not supported 173562|ERX|HCPCS A9270|64597-0301-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN 20 MG-QUINIDINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.62|PHR: 408101; CHG: 26||Not reimbursed separately|57.62|PHR: 408101; CHG: 26||External grouping not supported 173592|ERX|HCPCS J0131|43825-0102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|129.00|PHR: 408101; CHG: 26||Not reimbursed separately|129.00|PHR: 408101; CHG: 26||External grouping not supported 173672|ERX|HCPCS A9270|63402-0304-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LURASIDONE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.72|PHR: 408101; CHG: 26||Not reimbursed separately|114.72|PHR: 408101; CHG: 26||External grouping not supported 173672|ERX|HCPCS A9270|63402-0304-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LURASIDONE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.72|PHR: 408101; CHG: 26||Not reimbursed separately|114.72|PHR: 408101; CHG: 26||External grouping not supported 173672|ERX|HCPCS A9270|63402-0304-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LURASIDONE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.72|PHR: 408101; CHG: 26||Not reimbursed separately|114.72|PHR: 408101; CHG: 26||External grouping not supported 173673|ERX|HCPCS A9270|63402-0308-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LURASIDONE 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.72|PHR: 408101; CHG: 26||Not reimbursed separately|114.72|PHR: 408101; CHG: 26||External grouping not supported 173708|ERX|HCPCS J0475|66794-0155-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BACLOFEN 10,000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|504.90|PHR: 408101; CHG: 26||Not reimbursed separately|504.90|PHR: 408101; CHG: 26||External grouping not supported 17377|ERX|HCPCS A9270|00054-0063-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG/ML ORAL SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 17377|ERX|HCPCS A9270|13668-0589-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG/ML ORAL SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 17377|ERX|HCPCS A9270|23155-0317-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG/ML ORAL SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 17377|ERX|HCPCS A9270|50458-0596-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG/ML ORAL SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 17379|ERX|HCPCS J2185|00069-0313-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 500 MG INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.38|PHR: 408101; CHG: 26||Not reimbursed separately|10.38|PHR: 408101; CHG: 26||External grouping not supported 17379|ERX|HCPCS J2185|00069-0313-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 500 MG INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.38|PHR: 408101; CHG: 26||Not reimbursed separately|10.38|PHR: 408101; CHG: 26||External grouping not supported 17379|ERX|HCPCS J2185|55150-0207-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 500 MG INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.38|PHR: 408101; CHG: 26||Not reimbursed separately|10.38|PHR: 408101; CHG: 26||External grouping not supported 17379|ERX|HCPCS J2185|63323-0507-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 500 MG INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]||HUMANA [11839]|10.38|PHR: 408101; CHG: 26||Not reimbursed separately|10.38|PHR: 408101; CHG: 26||External grouping not supported 17379|ERX|HCPCS J2185|63323-0507-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 500 MG INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.38|PHR: 408101; CHG: 26||Not reimbursed separately|10.38|PHR: 408101; CHG: 26||External grouping not supported 17379|ERX|HCPCS J2185|70121-1454-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 500 MG INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.38|PHR: 408101; CHG: 26||Not reimbursed separately|10.38|PHR: 408101; CHG: 26||External grouping not supported 17380|ERX|HCPCS J2185|00409-1391-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 17380|ERX|HCPCS J2185|70121-1453-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 17380|ERX|HCPCS J2185|63323-0508-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 17380|ERX|HCPCS J2185|70121-1453-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 17387|ERX|HCPCS A9270|51224-0222-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.08|PHR: 408101; CHG: 26||Not reimbursed separately|11.08|PHR: 408101; CHG: 26||External grouping not supported 17387|ERX|HCPCS A9270|60687-0314-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.08|PHR: 408101; CHG: 26||Not reimbursed separately|11.08|PHR: 408101; CHG: 26||External grouping not supported 17387|ERX|HCPCS A9270|68180-0162-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.08|PHR: 408101; CHG: 26||Not reimbursed separately|11.08|PHR: 408101; CHG: 26||External grouping not supported 173960|ERX|HCPCS RX011|00002-0002-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 1MG/3ML ORAL SOLN|30 mL|HUMANA [1294]||HUMANA [11839]|38.16|PHR: 408101; CHG: 26||Not reimbursed separately|38.16|PHR: 408101; CHG: 26||External grouping not supported 173968|ERX|HCPCS RX011|63323-0477-27|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|51.42|PHR: 408101; CHG: 26||Not reimbursed separately|51.42|PHR: 408101; CHG: 26||External grouping not supported 1740|ERX|HCPCS A9270|00904-5959-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN HCL 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 1740|ERX|HCPCS A9270|42292-0018-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN HCL 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 1740|ERX|HCPCS A9270|42292-0018-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN HCL 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 1740|ERX|HCPCS A9270|68084-0243-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN HCL 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 174029|ERX|HCPCS RX001|00065-0741-14|0250 - PHARMACY - GENERAL CLASSIFICATION|TETRACAINE HCL (PF) 0.5 % EYE DROPS|4 mL|HUMANA [1294]||HUMANA [11839]|29.14|PHR: 408101; CHG: 26||Not reimbursed separately|29.14|PHR: 408101; CHG: 26||External grouping not supported 17403|ERX|HCPCS A9270|51991-0331-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEVIRAPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 174095|ERX|HCPCS J1644|63323-0543-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.08|PHR: 408101; CHG: 26||Not reimbursed separately|7.08|PHR: 408101; CHG: 26||External grouping not supported 174095|ERX|HCPCS J1644|63323-0543-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.08|PHR: 408101; CHG: 26||Not reimbursed separately|7.08|PHR: 408101; CHG: 26||External grouping not supported 174138|ERX|HCPCS J9351|00409-0302-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|110.32|PHR: 408101; CHG: 26||Not reimbursed separately|110.32|PHR: 408101; CHG: 26||External grouping not supported 174138|ERX|HCPCS J9351|00703-4714-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.32|PHR: 408101; CHG: 26||Not reimbursed separately|110.32|PHR: 408101; CHG: 26||External grouping not supported 174138|ERX|HCPCS J9351|00703-4714-71|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.32|PHR: 408101; CHG: 26||Not reimbursed separately|110.32|PHR: 408101; CHG: 26||External grouping not supported 174138|ERX|HCPCS J9351|67457-0662-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.32|PHR: 408101; CHG: 26||Not reimbursed separately|110.32|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|00009-0775-20|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|00009-0775-26|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|00009-0902-11|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|00009-0902-18|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|25021-0115-06|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|25021-0115-51|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|63323-0282-60|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|67457-0815-00|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|67457-0816-00|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 1743|ERX|HCPCS J3490|67457-0816-06|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 150 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 174362|ERX|HCPCS A9270|00005-0005-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 15MG/ML ORAL SUSP (CUSTOM CMPD)|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.18|PHR: 408101; CHG: 26||Not reimbursed separately|15.18|PHR: 408101; CHG: 26||External grouping not supported 174390|ERX|HCPCS RX011|48433-0110-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.47|PHR: 408101; CHG: 26||Not reimbursed separately|0.47|PHR: 408101; CHG: 26||External grouping not supported 174472|ERX|HCPCS A9270|00005-4344-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 174472|ERX|HCPCS A9270|00054-0344-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 174472|ERX|HCPCS A9270|69618-0008-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 174472|ERX|HCPCS A9270|99999-4444-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 174472|ERX|HCPCS A9270|99999-4444-42|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 17450|ERX|HCPCS J9206|00143-9701-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.13|PHR: 408101; CHG: 26||Not reimbursed separately|83.13|PHR: 408101; CHG: 26||External grouping not supported 17450|ERX|HCPCS J9206|45963-0614-55|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.13|PHR: 408101; CHG: 26||Not reimbursed separately|83.13|PHR: 408101; CHG: 26||External grouping not supported 17450|ERX|HCPCS J9206|45963-0614-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.13|PHR: 408101; CHG: 26||Not reimbursed separately|83.13|PHR: 408101; CHG: 26||External grouping not supported 17450|ERX|HCPCS J9206|60505-6128-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.13|PHR: 408101; CHG: 26||Not reimbursed separately|83.13|PHR: 408101; CHG: 26||External grouping not supported 17450|ERX|HCPCS J9206|61703-0349-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|83.13|PHR: 408101; CHG: 26||Not reimbursed separately|83.13|PHR: 408101; CHG: 26||External grouping not supported 174631|ERX|HCPCS A9270|68094-0109-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 174631|ERX|HCPCS A9270|68094-0109-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 174631|ERX|HCPCS A9270|74312-0278-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 174631|ERX|HCPCS A9270|87701-0408-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 174631|ERX|HCPCS A9270|87701-0408-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA 3-DHA-EPA-FISH OIL 300 MG-1,000 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|00093-1003-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|00093-1003-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|16729-0203-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|16729-0203-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|51079-0960-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|64380-0743-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17464|ERX|HCPCS A9270|68382-0182-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 17465|ERX|HCPCS A9270|68084-0120-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 17465|ERX|HCPCS A9270|68084-0120-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 17466|ERX|HCPCS A9270|00904-6519-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 17466|ERX|HCPCS A9270|68084-0119-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 17466|ERX|HCPCS A9270|68084-0119-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 174696|ERX|HCPCS J0490|49401-0101-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BELIMUMAB 120 MG INTRAVENOUS SOLUTION|120 mg|HUMANA [1294]||HUMANA [11839]|1,625.64|PHR: 408101; CHG: 26||Not reimbursed separately|1,625.64|PHR: 408101; CHG: 26||External grouping not supported 174697|ERX|HCPCS J0490|49401-0102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BELIMUMAB 400 MG INTRAVENOUS SOLUTION|400 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,418.63|PHR: 408101; CHG: 26||Not reimbursed separately|5,418.63|PHR: 408101; CHG: 26||External grouping not supported 174737|ERX|HCPCS A9270|10006-0730-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE ER 140 MG (45 MG IRON) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|00781-8090-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|50111-0788-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|51224-0122-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|60687-0271-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|65862-0642-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|65862-0642-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|68180-0161-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 17482|ERX|HCPCS A9270|68180-0161-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 175097|ERX|HCPCS J9228|00003-2327-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|22,504.23|PHR: 408101; CHG: 26||Not reimbursed separately|22,504.23|PHR: 408101; CHG: 26||External grouping not supported 175098|ERX|HCPCS J9228|00003-2328-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION|40 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90,016.68|PHR: 408101; CHG: 26||Not reimbursed separately|90,016.68|PHR: 408101; CHG: 26||External grouping not supported 175216|ERX|HCPCS C9399|00085-4347-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGINTERFERON ALFA-2B 200 MCG SUBCUTANEOUS KIT|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.22|PHR: 408101; CHG: 26||Not reimbursed separately|5,777.22|PHR: 408101; CHG: 26||External grouping not supported 175218|ERX|HCPCS C9399|00085-4348-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGINTERFERON ALFA-2B 300 MCG SUBCUTANEOUS KIT|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,665.89|PHR: 408101; CHG: 26||Not reimbursed separately|8,665.89|PHR: 408101; CHG: 26||External grouping not supported 175330|ERX|HCPCS A9270|00310-0095-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROFLUMILAST 500 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.23|PHR: 408101; CHG: 26||Not reimbursed separately|28.23|PHR: 408101; CHG: 26||External grouping not supported 175339|ERX|HCPCS A9270|00597-0140-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINAGLIPTIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.35|PHR: 408101; CHG: 26||Not reimbursed separately|38.35|PHR: 408101; CHG: 26||External grouping not supported 175339|ERX|HCPCS A9270|00597-0140-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINAGLIPTIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.35|PHR: 408101; CHG: 26||Not reimbursed separately|38.35|PHR: 408101; CHG: 26||External grouping not supported 175358|ERX|HCPCS RX015|00051-8462-33|0250 - PHARMACY - GENERAL CLASSIFICATION|TESTOSTERONE 20.25 MG/1.25 GRAM (1.62 %) TRANSDERMAL GEL PUMP|75 g|HUMANA [1294]||HUMANA [11839]|1,811.93|PHR: 408101; CHG: 26||Not reimbursed separately|1,811.93|PHR: 408101; CHG: 26||External grouping not supported 175388|ERX|HCPCS A9270|00456-1110-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VILAZODONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.33|PHR: 408101; CHG: 26||Not reimbursed separately|26.33|PHR: 408101; CHG: 26||External grouping not supported 175389|ERX|HCPCS A9270|00456-1120-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VILAZODONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.33|PHR: 408101; CHG: 26||Not reimbursed separately|26.33|PHR: 408101; CHG: 26||External grouping not supported 1755|ERX|HCPCS A9270|00228-2127-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE HCL 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 1755|ERX|HCPCS A9270|62332-0054-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE HCL 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 1755|ERX|HCPCS A9270|68001-0237-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE HCL 0.1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 1757|ERX|HCPCS A9270|68001-0239-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE HCL 0.3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 175783|ERX|HCPCS J0282|43066-0150-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 175784|ERX|HCPCS J0282|43066-0360-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.20|PHR: 408101; CHG: 26||Not reimbursed separately|55.20|PHR: 408101; CHG: 26||External grouping not supported 1758|ERX|HCPCS A9270|51672-4044-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLORAZEPATE DIPOTASSIUM 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.00|PHR: 408101; CHG: 26||Not reimbursed separately|8.00|PHR: 408101; CHG: 26||External grouping not supported 175803|ERX|HCPCS A9270|50458-0580-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 175803|ERX|HCPCS A9270|50458-0580-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 175850|ERX|HCPCS RX001|68180-0678-01|0250 - PHARMACY - GENERAL CLASSIFICATION|OSELTAMIVIR 6 MG/ML ORAL SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 175850|ERX|HCPCS RX001|70710-1165-06|0250 - PHARMACY - GENERAL CLASSIFICATION|OSELTAMIVIR 6 MG/ML ORAL SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 175850|ERX|HCPCS RX001|99999-3333-61|0250 - PHARMACY - GENERAL CLASSIFICATION|OSELTAMIVIR 6 MG/ML ORAL SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|11.40|PHR: 408101; CHG: 26||Not reimbursed separately|11.40|PHR: 408101; CHG: 26||External grouping not supported 175941|ERX|HCPCS RX001|00186-0777-39|0250 - PHARMACY - GENERAL CLASSIFICATION|TICAGRELOR 90 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|18.02|PHR: 408101; CHG: 26||Not reimbursed separately|18.02|PHR: 408101; CHG: 26||External grouping not supported 1760|ERX|HCPCS A9270|00378-0040-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.47|PHR: 408101; CHG: 26||Not reimbursed separately|3.47|PHR: 408101; CHG: 26||External grouping not supported 176010|ERX|HCPCS J0171|42023-0159-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.62|PHR: 408101; CHG: 26||Not reimbursed separately|11.62|PHR: 408101; CHG: 26||External grouping not supported 176010|ERX|HCPCS J0171|42023-0159-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.62|PHR: 408101; CHG: 26||Not reimbursed separately|11.62|PHR: 408101; CHG: 26||External grouping not supported 176068|ERX|HCPCS J0485|00003-0371-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BELATACEPT 250 MG INTRAVENOUS SOLUTION|250 mg|HUMANA [1294]||HUMANA [11839]|2,838.66|PHR: 408101; CHG: 26||Not reimbursed separately|2,838.66|PHR: 408101; CHG: 26||External grouping not supported 176072|ERX|HCPCS A9270|00904-6255-49|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 176072|ERX|HCPCS A9270|63824-0710-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 176072|ERX|HCPCS A9270|63824-0715-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 176086|ERX|HCPCS J9042|51144-0050-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|25,778.97|PHR: 408101; CHG: 26||Not reimbursed separately|25,778.97|PHR: 408101; CHG: 26||External grouping not supported 176205|ERX|HCPCS A9270|61958-1101-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EMTRICITABINE 200 MG-RILPIVIRINE 25 MG-TENOFOVIR DISPROX 300 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.61|PHR: 408101; CHG: 26||Not reimbursed separately|286.61|PHR: 408101; CHG: 26||External grouping not supported 176217|ERX|HCPCS A9270|00904-2137-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 176218|ERX|HCPCS RX015|46122-0083-65|0250 - PHARMACY - GENERAL CLASSIFICATION|FERROUS SULFATE, DRIED ER 159 MG (45 MG IRON) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]||HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 176218|ERX|HCPCS RX015|87701-0407-76|0250 - PHARMACY - GENERAL CLASSIFICATION|FERROUS SULFATE, DRIED ER 159 MG (45 MG IRON) TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]||HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 176221|ERX|HCPCS A9270|52015-0080-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FIDAXOMICIN 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|290.15|PHR: 408101; CHG: 26||Not reimbursed separately|290.15|PHR: 408101; CHG: 26||External grouping not supported 176302|ERX|HCPCS J9217|00074-3473-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,133.39|PHR: 408101; CHG: 26||Not reimbursed separately|29,133.39|PHR: 408101; CHG: 26||External grouping not supported 176303|ERX|HCPCS J9217|00074-3642-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,855.53|PHR: 408101; CHG: 26||Not reimbursed separately|4,855.53|PHR: 408101; CHG: 26||External grouping not supported 176479|ERX|HCPCS A9270|59676-0278-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RILPIVIRINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.33|PHR: 408101; CHG: 26||Not reimbursed separately|113.33|PHR: 408101; CHG: 26||External grouping not supported 176481|ERX|HCPCS J2795|17478-0081-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.77|PHR: 408101; CHG: 26||Not reimbursed separately|13.77|PHR: 408101; CHG: 26||External grouping not supported 176481|ERX|HCPCS J2795|63323-0286-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.77|PHR: 408101; CHG: 26||Not reimbursed separately|13.77|PHR: 408101; CHG: 26||External grouping not supported 176481|ERX|HCPCS J2795|70069-0064-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.77|PHR: 408101; CHG: 26||Not reimbursed separately|13.77|PHR: 408101; CHG: 26||External grouping not supported 176481|ERX|HCPCS J2795|63323-0286-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.77|PHR: 408101; CHG: 26||Not reimbursed separately|13.77|PHR: 408101; CHG: 26||External grouping not supported 1767|ERX|HCPCS A9270|00904-7822-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 1 % TOPICAL CREAM|14.17 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 1767|ERX|HCPCS A9270|45802-0434-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.28|PHR: 408101; CHG: 26||Not reimbursed separately|5.28|PHR: 408101; CHG: 26||External grouping not supported 1769|ERX|HCPCS A9270|00472-0220-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 1 % VAGINAL CREAM|45 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.43|PHR: 408101; CHG: 26||Not reimbursed separately|7.43|PHR: 408101; CHG: 26||External grouping not supported 177293|ERX|HCPCS RX001|63323-0649-07|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION|100 mcg|HUMANA [1294]||HUMANA [11839]|232.44|PHR: 408101; CHG: 26||Not reimbursed separately|232.44|PHR: 408101; CHG: 26||External grouping not supported 177293|ERX|HCPCS RX001|63323-0649-94|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION|100 mcg|HUMANA [1294]||HUMANA [11839]|232.44|PHR: 408101; CHG: 26||Not reimbursed separately|232.44|PHR: 408101; CHG: 26||External grouping not supported 177293|ERX|HCPCS RX001|70860-0451-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION|100 mcg|HUMANA [1294]||HUMANA [11839]|232.44|PHR: 408101; CHG: 26||Not reimbursed separately|232.44|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|00641-6135-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|14789-0700-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|14789-0700-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|23155-0294-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|23155-0523-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|70860-0778-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|70860-0778-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 177339|ERX|HCPCS J0780|23155-0294-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.83|PHR: 408101; CHG: 26||Not reimbursed separately|13.83|PHR: 408101; CHG: 26||External grouping not supported 177369|ERX|HCPCS C9290|65250-0133-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.05|PHR: 408101; CHG: 26||Not reimbursed separately|541.05|PHR: 408101; CHG: 26||External grouping not supported 177369|ERX|HCPCS C9290|65250-0133-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.05|PHR: 408101; CHG: 26||Not reimbursed separately|541.05|PHR: 408101; CHG: 26||External grouping not supported 177369|ERX|HCPCS C9290|65250-0133-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.05|PHR: 408101; CHG: 26||Not reimbursed separately|541.05|PHR: 408101; CHG: 26||External grouping not supported 177369|ERX|HCPCS C9290|65250-0266-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,002.54|PHR: 408101; CHG: 26||Not reimbursed separately|1,002.54|PHR: 408101; CHG: 26||External grouping not supported 177369|ERX|HCPCS C9290|65250-0266-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION|20 mL|HUMANA [1294]||HUMANA [11839]|1,002.54|PHR: 408101; CHG: 26||Not reimbursed separately|1,002.54|PHR: 408101; CHG: 26||External grouping not supported 177467|ERX|HCPCS A9270|17433-9876-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 283 MG/5 ML ENEMA|1 Enema|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.89|PHR: 408101; CHG: 26||Not reimbursed separately|4.89|PHR: 408101; CHG: 26||External grouping not supported 177467|ERX|HCPCS A9270|17433-9876-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 283 MG/5 ML ENEMA|1 Enema|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.89|PHR: 408101; CHG: 26||Not reimbursed separately|4.89|PHR: 408101; CHG: 26||External grouping not supported 177492|ERX|HCPCS J1325|66215-0402-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOPROSTENOL (ARGININE) 1.5 MG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|175.65|PHR: 408101; CHG: 26||Not reimbursed separately|175.65|PHR: 408101; CHG: 26||External grouping not supported 177572|ERX|HCPCS RX001|11704-0370-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HUMANA [1294]||HUMANA [11839]|2,361.36|PHR: 408101; CHG: 26||Not reimbursed separately|2,361.36|PHR: 408101; CHG: 26||External grouping not supported 17764|ERX|HCPCS Q2009|00069-6001-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|5.75|PHR: 408101; CHG: 26||Not reimbursed separately|5.75|PHR: 408101; CHG: 26||External grouping not supported 17764|ERX|HCPCS Q2009|00069-6001-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.75|PHR: 408101; CHG: 26||Not reimbursed separately|5.75|PHR: 408101; CHG: 26||External grouping not supported 17764|ERX|HCPCS Q2009|67457-0516-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.75|PHR: 408101; CHG: 26||Not reimbursed separately|5.75|PHR: 408101; CHG: 26||External grouping not supported 17764|ERX|HCPCS Q2009|67457-0516-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.75|PHR: 408101; CHG: 26||Not reimbursed separately|5.75|PHR: 408101; CHG: 26||External grouping not supported 177739|ERX|HCPCS A9270|50458-0578-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 177739|ERX|HCPCS A9270|50458-0578-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 177740|ERX|HCPCS A9270|50458-0579-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 177740|ERX|HCPCS A9270|50458-0579-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 177740|ERX|HCPCS A9270|50458-0579-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 177844|ERX|HCPCS RX015|00023-5990-02|0250 - PHARMACY - GENERAL CLASSIFICATION|TESTOSTERONE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|36.93|PHR: 408101; CHG: 26||Not reimbursed separately|36.93|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|00013-1114-01|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|00013-1114-20|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|00517-0960-01|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|00517-0960-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|23155-0166-31|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|23155-0166-41|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|23155-0524-31|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|47781-0601-22|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|55150-0188-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|67457-0197-00|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|70860-0400-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 177854|ERX|HCPCS RX001|70860-0400-41|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|13.56|PHR: 408101; CHG: 26||Not reimbursed separately|13.56|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|00173-0682-20|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|200 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|50090-1159-00|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|200 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|66993-0019-68|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|200 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|00085-1132-04|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|75 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|00254-1007-52|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|75 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|00173-0682-24|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|89 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|00093-3174-31|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|95 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|45802-0088-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|95 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17837|ERX|HCPCS RX001|59310-0579-22|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|95 Puff|HUMANA [1294]||HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 17856|ERX|HCPCS RX004|00338-0673-04|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 17856|ERX|HCPCS RX004|00409-7903-09|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 178593|ERX|HCPCS A9270|60687-0423-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBAZAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.90|PHR: 408101; CHG: 26||Not reimbursed separately|60.90|PHR: 408101; CHG: 26||External grouping not supported 178593|ERX|HCPCS A9270|67386-0314-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBAZAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.90|PHR: 408101; CHG: 26||Not reimbursed separately|60.90|PHR: 408101; CHG: 26||External grouping not supported 178629|ERX|HCPCS A9270|00121-1154-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 20 GRAM/30 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 178629|ERX|HCPCS A9270|50383-0779-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 20 GRAM/30 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 178629|ERX|HCPCS A9270|50383-0779-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 20 GRAM/30 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 178629|ERX|HCPCS A9270|66689-0038-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 20 GRAM/30 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 178629|ERX|HCPCS A9270|50383-0779-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 20 GRAM/30 ML ORAL SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 178630|ERX|HCPCS A9270|00121-4675-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 178630|ERX|HCPCS A9270|00121-4675-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 178783|ERX|HCPCS J7185|58394-0023-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FVIII,REC B-DOMAIN DELETED 500 (+/-) UNIT IV SYRINGE|500 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,365.00|PHR: 408101; CHG: 26||External grouping not supported 17881|ERX|HCPCS RX001|24208-0411-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.2 % EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|9.18|PHR: 408101; CHG: 26||Not reimbursed separately|9.18|PHR: 408101; CHG: 26||External grouping not supported 17881|ERX|HCPCS RX001|61314-0143-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.2 % EYE DROPS|10 mL|HUMANA [1294]||HUMANA [11839]|9.18|PHR: 408101; CHG: 26||Not reimbursed separately|9.18|PHR: 408101; CHG: 26||External grouping not supported 17881|ERX|HCPCS RX001|17478-0715-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 17881|ERX|HCPCS RX001|24208-0411-05|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 17881|ERX|HCPCS RX001|61314-0143-05|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 179085|ERX|HCPCS A9270|65628-0080-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 3 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 179085|ERX|HCPCS A9270|65628-0080-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 3 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 179085|ERX|HCPCS A9270|65628-0080-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 3 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 179085|ERX|HCPCS A9270|99999-3333-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 3 MG/ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|14789-0220-08|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|43598-0636-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|43598-0636-52|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|55150-0247-47|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|67457-0265-00|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|67457-0265-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179088|ERX|HCPCS J1953|70860-0603-82|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.60|PHR: 408101; CHG: 26||Not reimbursed separately|45.60|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|14789-0110-08|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|43598-0635-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|43598-0635-52|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|55150-0246-47|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|67457-0255-00|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|67457-0255-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|70860-0602-41|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179090|ERX|HCPCS J1953|70860-0602-82|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.40|PHR: 408101; CHG: 26||Not reimbursed separately|29.40|PHR: 408101; CHG: 26||External grouping not supported 179103|ERX|HCPCS J2212|65649-0551-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|206.79|PHR: 408101; CHG: 26||Not reimbursed separately|206.79|PHR: 408101; CHG: 26||External grouping not supported 17936|ERX|HCPCS A9270|43598-0164-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 17936|ERX|HCPCS A9270|60505-3111-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 17936|ERX|HCPCS A9270|68084-0723-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 17936|ERX|HCPCS A9270|69543-0381-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 17937|ERX|HCPCS A9270|00093-5770-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 17937|ERX|HCPCS A9270|00904-6376-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 17937|ERX|HCPCS A9270|60505-3113-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 17937|ERX|HCPCS A9270|68084-0740-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 17938|ERX|HCPCS A9270|43598-0165-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 180154|ERX|HCPCS A9270|10019-0360-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOFLURANE 99.9 % INHALATION LIQUID|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.30|PHR: 408101; CHG: 26||Not reimbursed separately|66.30|PHR: 408101; CHG: 26||External grouping not supported 180165|ERX|HCPCS A9270|51672-3020-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL OINTMENT|35.44 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.59|PHR: 408101; CHG: 26||Not reimbursed separately|16.59|PHR: 408101; CHG: 26||External grouping not supported 180165|ERX|HCPCS A9270|65162-0918-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL OINTMENT|35.44 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.59|PHR: 408101; CHG: 26||Not reimbursed separately|16.59|PHR: 408101; CHG: 26||External grouping not supported 180165|ERX|HCPCS A9270|69680-0120-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL OINTMENT|35.44 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.59|PHR: 408101; CHG: 26||Not reimbursed separately|16.59|PHR: 408101; CHG: 26||External grouping not supported 1802|ERX|HCPCS A9270|00054-0244-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CODEINE SULFATE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 180261|ERX|HCPCS A9270|10006-0700-43|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN E (DL, ACETATE) 200 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 180261|ERX|HCPCS A9270|50268-0869-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN E (DL, ACETATE) 200 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 18031|ERX|HCPCS A9270|00187-0245-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIHYDROERGOTAMINE 0.5 MG/PUMP ACT. (4 MG/ML) NASAL SPRAY|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,321.07|PHR: 408101; CHG: 26||Not reimbursed separately|1,321.07|PHR: 408101; CHG: 26||External grouping not supported 180313|ERX|HCPCS RX001|99999-2222-03|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 10 % IV BOLUS (NICU)|1 mL|HUMANA [1294]||HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 181104|ERX|HCPCS C9293|50633-0210-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLUCARPIDASE 1,000 UNIT INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]||HUMANA [11839]|94,974.00|PHR: 408101; CHG: 26||Not reimbursed separately|94,974.00|PHR: 408101; CHG: 26||External grouping not supported 181209|ERX|HCPCS A9270|54162-0000-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT IN A PACKET|5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 181260|ERX|HCPCS J1644|99999-1111-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 2 UNIT/ML IV SYRINGE (NICU)|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 181264|ERX|HCPCS RX011|99999-1111-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE 0.2% EPIDURAL (CURLIN 6000)|100 mL|HUMANA [1294]||HUMANA [11839]|105.00|PHR: 408101; CHG: 26||Not reimbursed separately|105.00|PHR: 408101; CHG: 26||External grouping not supported 181264|ERX|HCPCS RX011|99999-1111-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE 0.2% EPIDURAL (CURLIN 6000)|200 mL|HUMANA [1294]||HUMANA [11839]|198.00|PHR: 408101; CHG: 26||Not reimbursed separately|198.00|PHR: 408101; CHG: 26||External grouping not supported 181367|ERX|HCPCS J7315|49771-0002-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MITOMYCIN 0.2 MG OPHTHALMIC KIT|1 Each|HUMANA [1294]||HUMANA [11839]|1,094.46|PHR: 408101; CHG: 26||Not reimbursed separately|1,094.46|PHR: 408101; CHG: 26||External grouping not supported 181372|ERX|HCPCS A9270|00904-0539-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 181638|ERX|HCPCS J9306|50242-0145-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION|14 mL|HUMANA [1294]||HUMANA [11839]|15,876.05|PHR: 408101; CHG: 26||Not reimbursed separately|15,876.05|PHR: 408101; CHG: 26||External grouping not supported 181654|ERX|HCPCS A9270|99999-3333-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 181701|ERX|HCPCS RX001|99999-1111-45|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCERIN LIQUID ENEMA (NICU)|1 Each|HUMANA [1294]||HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 181755|ERX|HCPCS J9047|76075-0101-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARFILZOMIB 60 MG INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|7,306.26|PHR: 408101; CHG: 26||Not reimbursed separately|7,306.26|PHR: 408101; CHG: 26||External grouping not supported 181776|ERX|HCPCS J9171|16729-0267-65|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION|8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|349.54|PHR: 408101; CHG: 26||Not reimbursed separately|349.54|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|63323-0285-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|104.70|PHR: 408101; CHG: 26||Not reimbursed separately|104.70|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|00409-9300-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.94|PHR: 408101; CHG: 26||Not reimbursed separately|8.94|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|00409-9300-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.94|PHR: 408101; CHG: 26||Not reimbursed separately|8.94|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|63323-0285-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.94|PHR: 408101; CHG: 26||Not reimbursed separately|8.94|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|63323-0285-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|8.94|PHR: 408101; CHG: 26||Not reimbursed separately|8.94|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|63323-0285-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|133.80|PHR: 408101; CHG: 26||Not reimbursed separately|133.80|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|63323-0285-73|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|133.80|PHR: 408101; CHG: 26||Not reimbursed separately|133.80|PHR: 408101; CHG: 26||External grouping not supported 18192|ERX|HCPCS J2795|69374-0987-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|PHR: 408101; CHG: 26||Not reimbursed separately|150.00|PHR: 408101; CHG: 26||External grouping not supported 182052|ERX|HCPCS J9354|50242-0088-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,463.47|PHR: 408101; CHG: 26||Not reimbursed separately|9,463.47|PHR: 408101; CHG: 26||External grouping not supported 1821|ERX|HCPCS A9270|00254-2008-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLCHICINE 0.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.48|PHR: 408101; CHG: 26||Not reimbursed separately|15.48|PHR: 408101; CHG: 26||External grouping not supported 1821|ERX|HCPCS A9270|64764-0119-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLCHICINE 0.6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.48|PHR: 408101; CHG: 26||Not reimbursed separately|15.48|PHR: 408101; CHG: 26||External grouping not supported 182161|ERX|HCPCS A9270|61958-1201-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO DISOPRO 300 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.36|PHR: 408101; CHG: 26||Not reimbursed separately|330.36|PHR: 408101; CHG: 26||External grouping not supported 182220|ERX|HCPCS A9270|00469-2601-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.33|PHR: 408101; CHG: 26||Not reimbursed separately|37.33|PHR: 408101; CHG: 26||External grouping not supported 182220|ERX|HCPCS A9270|00469-2601-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.33|PHR: 408101; CHG: 26||Not reimbursed separately|37.33|PHR: 408101; CHG: 26||External grouping not supported 182221|ERX|HCPCS A9270|00469-2602-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.33|PHR: 408101; CHG: 26||Not reimbursed separately|37.33|PHR: 408101; CHG: 26||External grouping not supported 182232|ERX|HCPCS RX001|60793-0217-22|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY SYRINGE|1 Each|HUMANA [1294]||HUMANA [11839]|534.06|PHR: 408101; CHG: 26||Not reimbursed separately|534.06|PHR: 408101; CHG: 26||External grouping not supported 182519|ERX|HCPCS RX011|49281-0225-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TETANUS,DIPHTHERIA TOXOID PED (PF) 5 LF UNIT-25 LF UNIT/0.5 ML IM SUSP|0.5 mL|HUMANA [1294]||HUMANA [11839]|159.45|PHR: 408101; CHG: 26||Not reimbursed separately|159.45|PHR: 408101; CHG: 26||External grouping not supported 182549|ERX|HCPCS A9270|00168-0053-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 182549|ERX|HCPCS A9270|67777-0211-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 182549|ERX|HCPCS A9270|84521-0006-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 18259|ERX|HCPCS RX001|00517-8201-25|0250 - PHARMACY - GENERAL CLASSIFICATION|TRACE ELEMENTS CR-CU-MN-SE-ZN 10 MCG-1 MG-0.5 MG-60 MCG-5MG/ML IV SOLN|1 mL|HUMANA [1294]||HUMANA [11839]|32.63|PHR: 408101; CHG: 26||Not reimbursed separately|32.63|PHR: 408101; CHG: 26||External grouping not supported 18259|ERX|HCPCS RX001|00517-8210-25|0250 - PHARMACY - GENERAL CLASSIFICATION|TRACE ELEMENTS CR-CU-MN-SE-ZN 10 MCG-1 MG-0.5 MG-60 MCG-5MG/ML IV SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|58.44|PHR: 408101; CHG: 26||Not reimbursed separately|58.44|PHR: 408101; CHG: 26||External grouping not supported 18267|ERX|HCPCS RX001|00517-6202-25|0250 - PHARMACY - GENERAL CLASSIFICATION|TRACE ELEMENTS CR-CU-MN-ZN 0.85 MCG-0.1 MG-25 MCG-1.5MG/ML INTRAVENOUS|2 mL|HUMANA [1294]||HUMANA [11839]|26.76|PHR: 408101; CHG: 26||Not reimbursed separately|26.76|PHR: 408101; CHG: 26||External grouping not supported 18288|ERX|HCPCS A9270|29300-0126-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISOPROLOL FUMARATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.56|PHR: 408101; CHG: 26||Not reimbursed separately|1.56|PHR: 408101; CHG: 26||External grouping not supported 18288|ERX|HCPCS A9270|29300-0126-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISOPROLOL FUMARATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.56|PHR: 408101; CHG: 26||Not reimbursed separately|1.56|PHR: 408101; CHG: 26||External grouping not supported 18289|ERX|HCPCS A9270|29300-0189-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 18290|ERX|HCPCS A9270|29300-0188-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 18291|ERX|HCPCS A9270|29300-0187-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 18292|ERX|HCPCS A9270|31722-0530-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 18292|ERX|HCPCS A9270|50111-0916-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 18292|ERX|HCPCS A9270|50268-0755-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|00054-0077-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|31722-0531-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|50111-0917-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|50268-0756-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|57237-0140-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|68084-0539-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18293|ERX|HCPCS A9270|68084-0539-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18294|ERX|HCPCS A9270|31722-0532-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18294|ERX|HCPCS A9270|50268-0757-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18294|ERX|HCPCS A9270|50268-0757-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18294|ERX|HCPCS A9270|57237-0141-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 18294|ERX|HCPCS A9270|65862-0128-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TORSEMIDE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 182949|ERX|HCPCS RX001|61703-0421-53|0250 - PHARMACY - GENERAL CLASSIFICATION|MVI, PEDI NO.2 WITH VIT K 80 MG-400 UNIT-200 MCG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|24.42|PHR: 408101; CHG: 26||Not reimbursed separately|24.42|PHR: 408101; CHG: 26||External grouping not supported 183013|ERX|HCPCS A9270|00078-0503-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.22|PHR: 408101; CHG: 26||Not reimbursed separately|8.22|PHR: 408101; CHG: 26||External grouping not supported 183013|ERX|HCPCS A9270|00781-7313-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.22|PHR: 408101; CHG: 26||Not reimbursed separately|8.22|PHR: 408101; CHG: 26||External grouping not supported 183013|ERX|HCPCS A9270|47781-0405-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.22|PHR: 408101; CHG: 26||Not reimbursed separately|8.22|PHR: 408101; CHG: 26||External grouping not supported 18302|ERX|HCPCS J2543|63323-0982-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|4.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.83|PHR: 408101; CHG: 26||Not reimbursed separately|13.83|PHR: 408101; CHG: 26||External grouping not supported 18302|ERX|HCPCS J2543|63323-0982-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|4.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.83|PHR: 408101; CHG: 26||Not reimbursed separately|13.83|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|00409-3385-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|25021-0165-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|55150-0120-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|61990-0120-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|63323-0983-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|63323-0983-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|63323-0983-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18303|ERX|HCPCS J2543|64679-0056-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18304|ERX|HCPCS J2543|25021-0164-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|2.25 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18304|ERX|HCPCS J2543|63323-0981-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|2.25 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18304|ERX|HCPCS J2543|64679-0034-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|2.25 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18304|ERX|HCPCS J2543|64679-0034-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|2.25 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.92|PHR: 408101; CHG: 26||Not reimbursed separately|6.92|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|00904-6667-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|50228-0181-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|60505-0114-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|63739-0984-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|67877-0224-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|68084-0774-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18307|ERX|HCPCS A9270|68084-0774-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 400 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|00904-6666-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|45963-0556-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|45963-0556-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|60505-0113-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|65162-0102-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|65162-0102-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|65862-0199-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|67877-0223-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|68084-0762-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18308|ERX|HCPCS A9270|68084-0762-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|00904-6665-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|45963-0555-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|50228-0179-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|60505-0112-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|65162-0101-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|67877-0222-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|68084-0783-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18309|ERX|HCPCS A9270|68084-0783-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 18310|ERX|HCPCS A9270|00904-6362-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 18310|ERX|HCPCS A9270|68084-0277-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 18310|ERX|HCPCS A9270|68084-0277-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 183101|ERX|HCPCS RX001|08290-3065-53|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % SYRINGE (STERILE)|10 mL|HUMANA [1294]||HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 183101|ERX|HCPCS RX001|63807-0100-91|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % SYRINGE (STERILE)|10 mL|HUMANA [1294]||HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 18311|ERX|HCPCS A9270|00904-6360-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 18311|ERX|HCPCS A9270|68084-0273-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 18311|ERX|HCPCS A9270|68084-0273-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 18312|ERX|HCPCS A9270|00904-6361-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 18313|ERX|HCPCS A9270|00904-6359-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 183201|ERX|HCPCS A9270|00121-4811-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML (5 ML) ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.98|PHR: 408101; CHG: 26||Not reimbursed separately|16.98|PHR: 408101; CHG: 26||External grouping not supported 183201|ERX|HCPCS A9270|99999-2222-53|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML (5 ML) ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.98|PHR: 408101; CHG: 26||Not reimbursed separately|16.98|PHR: 408101; CHG: 26||External grouping not supported 183488|ERX|HCPCS A9270|68094-0757-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CITRATE 8 MEQ/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.75|PHR: 408101; CHG: 26||Not reimbursed separately|2.75|PHR: 408101; CHG: 26||External grouping not supported 183488|ERX|HCPCS A9270|68094-0757-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CITRATE 8 MEQ/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.75|PHR: 408101; CHG: 26||Not reimbursed separately|2.75|PHR: 408101; CHG: 26||External grouping not supported 183499|ERX|HCPCS A9270|00121-4776-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 183499|ERX|HCPCS A9270|00121-4776-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 183499|ERX|HCPCS A9270|68094-0250-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 183519|ERX|HCPCS RX001|54643-5649-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|22.08|PHR: 408101; CHG: 26||Not reimbursed separately|22.08|PHR: 408101; CHG: 26||External grouping not supported 183519|ERX|HCPCS RX001|54643-7862-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|22.08|PHR: 408101; CHG: 26||Not reimbursed separately|22.08|PHR: 408101; CHG: 26||External grouping not supported 183701|ERX|HCPCS J0573|12496-1204-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM|1 Each|HUMANA [1294]||HUMANA [11839]|24.83|PHR: 408101; CHG: 26||Not reimbursed separately|24.83|PHR: 408101; CHG: 26||External grouping not supported 183701|ERX|HCPCS J0573|12496-1204-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM|1 Each|HUMANA [1294]||HUMANA [11839]|24.83|PHR: 408101; CHG: 26||Not reimbursed separately|24.83|PHR: 408101; CHG: 26||External grouping not supported 183701|ERX|HCPCS J0573|43598-0580-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM|1 Each|HUMANA [1294]||HUMANA [11839]|24.83|PHR: 408101; CHG: 26||Not reimbursed separately|24.83|PHR: 408101; CHG: 26||External grouping not supported 183724|ERX|HCPCS A9270|59676-0566-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARUNAVIR ETHANOLATE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.72|PHR: 408101; CHG: 26||Not reimbursed separately|171.72|PHR: 408101; CHG: 26||External grouping not supported 183782|ERX|HCPCS A9270|00456-1201-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINACLOTIDE 145 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.99|PHR: 408101; CHG: 26||Not reimbursed separately|40.99|PHR: 408101; CHG: 26||External grouping not supported 183783|ERX|HCPCS A9270|00456-1202-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINACLOTIDE 290 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.99|PHR: 408101; CHG: 26||Not reimbursed separately|40.99|PHR: 408101; CHG: 26||External grouping not supported 18385|ERX|HCPCS A9270|00185-0410-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 18385|ERX|HCPCS A9270|43547-0288-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 18385|ERX|HCPCS A9270|68084-0697-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 18385|ERX|HCPCS A9270|68084-0697-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 18386|ERX|HCPCS A9270|00904-6585-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 18386|ERX|HCPCS A9270|43547-0289-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 18386|ERX|HCPCS A9270|68084-0708-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 18400|ERX|HCPCS RX001|63323-0724-01|0250 - PHARMACY - GENERAL CLASSIFICATION|REMIFENTANIL 2 MG INTRAVENOUS SOLUTION|2,000 mcg|HUMANA [1294]||HUMANA [11839]|67.78|PHR: 408101; CHG: 26||Not reimbursed separately|67.78|PHR: 408101; CHG: 26||External grouping not supported 18400|ERX|HCPCS RX001|63323-0724-05|0250 - PHARMACY - GENERAL CLASSIFICATION|REMIFENTANIL 2 MG INTRAVENOUS SOLUTION|2,000 mcg|HUMANA [1294]||HUMANA [11839]|67.78|PHR: 408101; CHG: 26||Not reimbursed separately|67.78|PHR: 408101; CHG: 26||External grouping not supported 18400|ERX|HCPCS RX001|67457-0198-05|0250 - PHARMACY - GENERAL CLASSIFICATION|REMIFENTANIL 2 MG INTRAVENOUS SOLUTION|2,000 mcg|HUMANA [1294]||HUMANA [11839]|67.78|PHR: 408101; CHG: 26||Not reimbursed separately|67.78|PHR: 408101; CHG: 26||External grouping not supported 18400|ERX|HCPCS RX001|67457-0198-99|0250 - PHARMACY - GENERAL CLASSIFICATION|REMIFENTANIL 2 MG INTRAVENOUS SOLUTION|2,000 mcg|HUMANA [1294]||HUMANA [11839]|67.78|PHR: 408101; CHG: 26||Not reimbursed separately|67.78|PHR: 408101; CHG: 26||External grouping not supported 184034|ERX|HCPCS A9270|50383-0079-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.81|PHR: 408101; CHG: 26||Not reimbursed separately|2.81|PHR: 408101; CHG: 26||External grouping not supported 184034|ERX|HCPCS A9270|50383-0079-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.81|PHR: 408101; CHG: 26||Not reimbursed separately|2.81|PHR: 408101; CHG: 26||External grouping not supported 184034|ERX|HCPCS A9270|00121-0504-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 120 MG-CODEINE 12 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.81|PHR: 408101; CHG: 26||Not reimbursed separately|2.81|PHR: 408101; CHG: 26||External grouping not supported 184112|ERX|HCPCS J1644|25021-0400-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION FOR HD BOLUS|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 184212|ERX|HCPCS A9270|24208-0503-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOTEPREDNOL ETABONATE 0.5 % EYE GEL DROPS|5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.87|PHR: 408101; CHG: 26||Not reimbursed separately|558.87|PHR: 408101; CHG: 26||External grouping not supported 184369|ERX|HCPCS RX001|00065-1750-07|0250 - PHARMACY - GENERAL CLASSIFICATION|NEPAFENAC 0.3 % EYE DROPS,SUSPENSION|1.7 mL|HUMANA [1294]||HUMANA [11839]|802.29|PHR: 408101; CHG: 26||Not reimbursed separately|802.29|PHR: 408101; CHG: 26||External grouping not supported 184369|ERX|HCPCS RX001|00065-1750-14|0250 - PHARMACY - GENERAL CLASSIFICATION|NEPAFENAC 0.3 % EYE DROPS,SUSPENSION|3 mL|HUMANA [1294]||HUMANA [11839]|802.29|PHR: 408101; CHG: 26||Not reimbursed separately|802.29|PHR: 408101; CHG: 26||External grouping not supported 184438|ERX|HCPCS A9270|00003-0893-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|APIXABAN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.28|PHR: 408101; CHG: 26||Not reimbursed separately|16.28|PHR: 408101; CHG: 26||External grouping not supported 184438|ERX|HCPCS A9270|00003-0893-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|APIXABAN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.28|PHR: 408101; CHG: 26||Not reimbursed separately|16.28|PHR: 408101; CHG: 26||External grouping not supported 184439|ERX|HCPCS A9270|00003-0894-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|APIXABAN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.28|PHR: 408101; CHG: 26||Not reimbursed separately|16.28|PHR: 408101; CHG: 26||External grouping not supported 184439|ERX|HCPCS A9270|00003-0894-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|APIXABAN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.28|PHR: 408101; CHG: 26||Not reimbursed separately|16.28|PHR: 408101; CHG: 26||External grouping not supported 184439|ERX|HCPCS A9270|00003-0894-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|APIXABAN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.28|PHR: 408101; CHG: 26||Not reimbursed separately|16.28|PHR: 408101; CHG: 26||External grouping not supported 185298|ERX|HCPCS RX015|00525-8049-18|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOMEFOLATE CA 3 MG-B6 35 MG-MEB12 2 MG-ALGAL OIL 90.314 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|8.19|PHR: 408101; CHG: 26||Not reimbursed separately|8.19|PHR: 408101; CHG: 26||External grouping not supported 185298|ERX|HCPCS RX015|00525-8049-90|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOMEFOLATE CA 3 MG-B6 35 MG-MEB12 2 MG-ALGAL OIL 90.314 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|8.19|PHR: 408101; CHG: 26||Not reimbursed separately|8.19|PHR: 408101; CHG: 26||External grouping not supported 185338|ERX|HCPCS J9354|50242-0087-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION|160 mg|HUMANA [1294]||HUMANA [11839]|15,141.54|PHR: 408101; CHG: 26||Not reimbursed separately|15,141.54|PHR: 408101; CHG: 26||External grouping not supported 185379|ERX|HCPCS J0401|59148-0019-70|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ARIPIPRAZOLE ER 400 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE|400 mg|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 18551|ERX|HCPCS A9270|00781-5221-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 3.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 18551|ERX|HCPCS A9270|00904-6300-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 3.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 18551|ERX|HCPCS A9270|51079-0771-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 3.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 18551|ERX|HCPCS A9270|51079-0771-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 3.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 18551|ERX|HCPCS A9270|68001-0153-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARVEDILOL 3.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 186006|ERX|HCPCS A9270|50458-0140-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CANAGLIFLOZIN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 186007|ERX|HCPCS A9270|50458-0141-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CANAGLIFLOZIN 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 186111|ERX|HCPCS RX001|00409-1660-50|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 200 MCG/50 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV|50 mL|HUMANA [1294]||HUMANA [11839]|80.70|PHR: 408101; CHG: 26||Not reimbursed separately|80.70|PHR: 408101; CHG: 26||External grouping not supported 186111|ERX|HCPCS RX001|00409-1660-55|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 200 MCG/50 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV|50 mL|HUMANA [1294]||HUMANA [11839]|80.70|PHR: 408101; CHG: 26||Not reimbursed separately|80.70|PHR: 408101; CHG: 26||External grouping not supported 186113|ERX|HCPCS RX001|99999-5555-74|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV|100 mL|HUMANA [1294]||HUMANA [11839]|449.10|PHR: 408101; CHG: 26||Not reimbursed separately|449.10|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|00013-8303-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|17478-0625-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|24208-0463-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|59762-0333-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|61314-0547-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|61314-0547-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 18621|ERX|HCPCS A9270|64980-0516-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 186297|ERX|HCPCS RX001|49100-0363-74|0250 - PHARMACY - GENERAL CLASSIFICATION|LACTOBACILLUS RHAMNOSUS GG 15 BILLION CELL SPRINKLE CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 186360|ERX|HCPCS A9606|50419-0208-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN|180 microcurie|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,836.40|PHR: 408101; CHG: 32||Not reimbursed separately|33,836.40|PHR: 408101; CHG: 32||External grouping not supported 186871|ERX|HCPCS 90715|58160-0842-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE|1 Syringe|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.48|PHR: 408101; CHG: 26||Not reimbursed separately|96.48|PHR: 408101; CHG: 26||External grouping not supported 186871|ERX|HCPCS 90715|58160-0842-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|96.48|PHR: 408101; CHG: 26||Not reimbursed separately|96.48|PHR: 408101; CHG: 26||External grouping not supported 186872|ERX|HCPCS 90715|58160-0842-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHTH,PERTUSSIS(ACELL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5 ML IM SUSP|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.48|PHR: 408101; CHG: 28||Not reimbursed separately|96.48|PHR: 408101; CHG: 28||External grouping not supported 186898|ERX|HCPCS A9270|00603-1161-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 186979|ERX|HCPCS J2710|00548-9602-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 186979|ERX|HCPCS J2710|00641-6149-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 186979|ERX|HCPCS J2710|42023-0189-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 186979|ERX|HCPCS J2710|42023-0189-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 186979|ERX|HCPCS J2710|00641-6149-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 186979|ERX|HCPCS J2710|63323-0415-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 187055|ERX|HCPCS RX015|31604-0026-65|0250 - PHARMACY - GENERAL CLASSIFICATION|OMEGA 3S 300 MG-DHA-EPA-FISH OIL 1,000 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 187212|ERX|HCPCS J1602|57894-0350-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|5,562.72|PHR: 408101; CHG: 26||Not reimbursed separately|5,562.72|PHR: 408101; CHG: 26||External grouping not supported 187270|ERX|HCPCS J1439|00517-0650-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|2,531.21|PHR: 408101; CHG: 26||Not reimbursed separately|2,531.21|PHR: 408101; CHG: 26||External grouping not supported 187306|ERX|HCPCS A9270|46122-0103-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.13|PHR: 408101; CHG: 26||Not reimbursed separately|5.13|PHR: 408101; CHG: 26||External grouping not supported 187306|ERX|HCPCS A9270|87701-0411-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.13|PHR: 408101; CHG: 26||Not reimbursed separately|5.13|PHR: 408101; CHG: 26||External grouping not supported 187346|ERX|HCPCS A9270|49702-0228-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOLUTEGRAVIR 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.31|PHR: 408101; CHG: 26||Not reimbursed separately|168.31|PHR: 408101; CHG: 26||External grouping not supported 18743|ERX|HCPCS A9270|00378-9720-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENCICLOVIR 1 % TOPICAL CREAM|5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.75|PHR: 408101; CHG: 26||Not reimbursed separately|2,244.75|PHR: 408101; CHG: 26||External grouping not supported 18786|ERX|HCPCS A9270|00904-6477-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 18786|ERX|HCPCS A9270|13668-0102-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 18787|ERX|HCPCS A9270|00904-6478-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 18787|ERX|HCPCS A9270|13668-0103-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 18787|ERX|HCPCS A9270|60687-0303-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 18787|ERX|HCPCS A9270|60687-0303-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 18787|ERX|HCPCS A9270|62332-0093-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DONEPEZIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 187934|ERX|HCPCS J7195|58394-0635-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COAGULATION FACTOR IX (RECOMB) 1,000 UNIT INTRAVENOUS SOLUTION|1,000 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,270.00|PHR: 408101; CHG: 26||Not reimbursed separately|3,270.00|PHR: 408101; CHG: 26||External grouping not supported 187935|ERX|HCPCS J7195|58394-0636-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION|2,000 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.00|PHR: 408101; CHG: 26||Not reimbursed separately|6,540.00|PHR: 408101; CHG: 26||External grouping not supported 18794|ERX|HCPCS A9270|00591-0398-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 75 MG-MISOPROSTOL 200 MCG TABLET,IMMEDIATE,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 188088|ERX|HCPCS A9270|67618-0151-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 7.5 % TOPICAL SOLUTION|118 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.50|PHR: 408101; CHG: 26||Not reimbursed separately|8.50|PHR: 408101; CHG: 26||External grouping not supported 188088|ERX|HCPCS A9270|52380-1855-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 7.5 % TOPICAL SOLUTION|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.36|PHR: 408101; CHG: 26||Not reimbursed separately|11.36|PHR: 408101; CHG: 26||External grouping not supported 188088|ERX|HCPCS A9270|67618-0151-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 7.5 % TOPICAL SOLUTION|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.36|PHR: 408101; CHG: 26||Not reimbursed separately|11.36|PHR: 408101; CHG: 26||External grouping not supported 188110|ERX|HCPCS A9270|64764-0720-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VORTIOXETINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.76|PHR: 408101; CHG: 26||Not reimbursed separately|36.76|PHR: 408101; CHG: 26||External grouping not supported 188111|ERX|HCPCS A9270|64764-0730-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VORTIOXETINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.76|PHR: 408101; CHG: 26||Not reimbursed separately|36.76|PHR: 408101; CHG: 26||External grouping not supported 188112|ERX|HCPCS A9270|64764-0750-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VORTIOXETINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.76|PHR: 408101; CHG: 26||Not reimbursed separately|36.76|PHR: 408101; CHG: 26||External grouping not supported 188226|ERX|HCPCS J3262|50242-0138-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOCILIZUMAB 162 MG/0.9 ML SUBCUTANEOUS SYRINGE|0.9 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.92|PHR: 408101; CHG: 26||Not reimbursed separately|3,047.92|PHR: 408101; CHG: 26||External grouping not supported 188562|ERX|HCPCS A9270|00904-6718-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 188562|ERX|HCPCS A9270|63824-0008-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 188562|ERX|HCPCS A9270|63824-0008-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 188562|ERX|HCPCS A9270|68084-0572-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 188562|ERX|HCPCS A9270|68084-0572-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 188574|ERX|HCPCS J2250|00409-2305-17|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 188597|ERX|HCPCS J9301|50242-0070-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|1,994.79|PHR: 408101; CHG: 26||Not reimbursed separately|1,994.79|PHR: 408101; CHG: 26||External grouping not supported 188630|ERX|HCPCS A9270|00536-1143-97|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM 42 % TOPICAL OINTMENT|100 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 188630|ERX|HCPCS A9270|54162-0500-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM 42 % TOPICAL OINTMENT|100 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 188630|ERX|HCPCS A9270|00536-1143-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM 42 % TOPICAL OINTMENT|454 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|PHR: 408101; CHG: 26||Not reimbursed separately|75.00|PHR: 408101; CHG: 26||External grouping not supported 188630|ERX|HCPCS A9270|54162-0500-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM 42 % TOPICAL OINTMENT|454 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|PHR: 408101; CHG: 26||Not reimbursed separately|75.00|PHR: 408101; CHG: 26||External grouping not supported 188647|ERX|HCPCS J1447|63459-0910-17|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|771.18|PHR: 408101; CHG: 26||Not reimbursed separately|771.18|PHR: 408101; CHG: 26||External grouping not supported 188648|ERX|HCPCS J1447|63459-0912-17|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA [1294]||HUMANA [11839]|1,228.08|PHR: 408101; CHG: 26||Not reimbursed separately|1,228.08|PHR: 408101; CHG: 26||External grouping not supported 188659|ERX|HCPCS A9270|00573-2883-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 188713|ERX|HCPCS A9270|00254-2045-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POSACONAZOLE 100 MG TABLET,DELAYED RELEASE|3 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.73|PHR: 408101; CHG: 26||Not reimbursed separately|224.73|PHR: 408101; CHG: 26||External grouping not supported 188713|ERX|HCPCS A9270|00527-2133-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POSACONAZOLE 100 MG TABLET,DELAYED RELEASE|3 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.73|PHR: 408101; CHG: 26||Not reimbursed separately|224.73|PHR: 408101; CHG: 26||External grouping not supported 18877|ERX|HCPCS S0119|00054-0064-47|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 18877|ERX|HCPCS S0119|51672-4091-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 18877|ERX|HCPCS S0119|54838-0555-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 189042|ERX|HCPCS A9270|00310-6205-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DAPAGLIFLOZIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.21|PHR: 408101; CHG: 26||Not reimbursed separately|35.21|PHR: 408101; CHG: 26||External grouping not supported 189043|ERX|HCPCS A9270|00310-6210-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DAPAGLIFLOZIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.21|PHR: 408101; CHG: 26||Not reimbursed separately|35.21|PHR: 408101; CHG: 26||External grouping not supported 18908|ERX|HCPCS RX001|14789-0012-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|40.11|PHR: 408101; CHG: 26||Not reimbursed separately|40.11|PHR: 408101; CHG: 26||External grouping not supported 18908|ERX|HCPCS RX001|42571-0265-75|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|40.11|PHR: 408101; CHG: 26||Not reimbursed separately|40.11|PHR: 408101; CHG: 26||External grouping not supported 18908|ERX|HCPCS RX001|70069-0261-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|40.11|PHR: 408101; CHG: 26||Not reimbursed separately|40.11|PHR: 408101; CHG: 26||External grouping not supported 18918|ERX|HCPCS A9270|00904-6351-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 18918|ERX|HCPCS A9270|65862-0536-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 18919|ERX|HCPCS A9270|00904-6352-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 18919|ERX|HCPCS A9270|65862-0537-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 18919|ERX|HCPCS A9270|68084-0482-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 18920|ERX|HCPCS A9270|68084-0342-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 18920|ERX|HCPCS A9270|68084-0342-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 18920|ERX|HCPCS A9270|68382-0138-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 18922|ERX|HCPCS A9270|68084-0344-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 18922|ERX|HCPCS A9270|68084-0344-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 18922|ERX|HCPCS A9270|68462-0109-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 18924|ERX|HCPCS J1956|00143-9721-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 18924|ERX|HCPCS J1956|25021-0132-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 18924|ERX|HCPCS J1956|25021-0132-82|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 18924|ERX|HCPCS J1956|36000-0047-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 189240|ERX|HCPCS RX015|49230-0645-51|0250 - PHARMACY - GENERAL CLASSIFICATION|SUCROFERRIC OXYHYDROXIDE 500 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|40.35|PHR: 408101; CHG: 26||Not reimbursed separately|40.35|PHR: 408101; CHG: 26||External grouping not supported 18925|ERX|HCPCS J1956|17478-0107-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOFLOXACIN 25 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|36.18|PHR: 408101; CHG: 26||Not reimbursed separately|36.18|PHR: 408101; CHG: 26||External grouping not supported 189305|ERX|HCPCS RX001|63402-0202-30|0250 - PHARMACY - GENERAL CLASSIFICATION|ESLICARBAZEPINE 200 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|93.58|PHR: 408101; CHG: 26||Not reimbursed separately|93.58|PHR: 408101; CHG: 26||External grouping not supported 189307|ERX|HCPCS RX001|63402-0204-30|0250 - PHARMACY - GENERAL CLASSIFICATION|ESLICARBAZEPINE 400 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|93.58|PHR: 408101; CHG: 26||Not reimbursed separately|93.58|PHR: 408101; CHG: 26||External grouping not supported 189461|ERX|HCPCS J2860|57894-0420-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SILTUXIMAB 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|3,214.41|PHR: 408101; CHG: 26||Not reimbursed separately|3,214.41|PHR: 408101; CHG: 26||External grouping not supported 189511|ERX|HCPCS J3145|67979-0511-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TESTOSTERONE UNDECANOATE 750 MG/3 ML (250MG/ML) INTRAMUSCULAR SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|3,866.34|PHR: 408101; CHG: 26||Not reimbursed separately|3,866.34|PHR: 408101; CHG: 26||External grouping not supported 189525|ERX|HCPCS J2270|00409-1890-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 2 MG/ML INTRAVENOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 189525|ERX|HCPCS J2270|00409-1890-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 2 MG/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 189526|ERX|HCPCS J2270|00409-1891-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML INTRAVENOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 189526|ERX|HCPCS J2270|00409-1891-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 189774|ERX|HCPCS A9270|52800-0488-26|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EMOLLIENT COMBINATION NO.92 TOPICAL LOTION|177 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.85|PHR: 408101; CHG: 26||Not reimbursed separately|5.85|PHR: 408101; CHG: 26||External grouping not supported 189912|ERX|HCPCS J9308|00002-7669-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|3,622.50|PHR: 408101; CHG: 26||Not reimbursed separately|3,622.50|PHR: 408101; CHG: 26||External grouping not supported 189912|ERX|HCPCS J9308|00002-7678-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,112.50|PHR: 408101; CHG: 26||Not reimbursed separately|18,112.50|PHR: 408101; CHG: 26||External grouping not supported 190212|ERX|HCPCS C9132|63833-0386-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION|1,000 Units|HUMANA [1294]||HUMANA [11839]|5,520.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,520.00|PHR: 408101; CHG: 26||External grouping not supported 190212|ERX|HCPCS C9132|63833-0396-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION|1,000 Units|HUMANA [1294]||HUMANA [11839]|5,520.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,520.00|PHR: 408101; CHG: 26||External grouping not supported 190238|ERX|HCPCS J3380|64764-0300-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION|300 mg|HUMANA [1294]||HUMANA [11839]|20,182.50|PHR: 408101; CHG: 26||Not reimbursed separately|20,182.50|PHR: 408101; CHG: 26||External grouping not supported 190385|ERX|HCPCS J8530|00054-0382-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|16.24|PHR: 408101; CHG: 26||Not reimbursed separately|16.24|PHR: 408101; CHG: 26||External grouping not supported 190385|ERX|HCPCS J8530|54879-0021-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|16.24|PHR: 408101; CHG: 26||Not reimbursed separately|16.24|PHR: 408101; CHG: 26||External grouping not supported 190386|ERX|HCPCS J8530|00054-0383-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 50 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|17.49|PHR: 408101; CHG: 26||Not reimbursed separately|17.49|PHR: 408101; CHG: 26||External grouping not supported 190386|ERX|HCPCS J8530|43975-0308-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 50 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|17.49|PHR: 408101; CHG: 26||Not reimbursed separately|17.49|PHR: 408101; CHG: 26||External grouping not supported 190386|ERX|HCPCS J8530|54879-0022-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 50 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|17.49|PHR: 408101; CHG: 26||Not reimbursed separately|17.49|PHR: 408101; CHG: 26||External grouping not supported 190409|ERX|HCPCS J0875|57970-0100-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DALBAVANCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|2,764.50|PHR: 408101; CHG: 26||Not reimbursed separately|2,764.50|PHR: 408101; CHG: 26||External grouping not supported 190538|ERX|HCPCS J3090|67919-0040-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEDIZOLID 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|897.82|PHR: 408101; CHG: 26||Not reimbursed separately|897.82|PHR: 408101; CHG: 26||External grouping not supported 190557|ERX|HCPCS C9132|63833-0387-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION|1,000 Units|HUMANA [1294]||HUMANA [11839]|5,520.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,520.00|PHR: 408101; CHG: 26||External grouping not supported 191335|ERX|HCPCS A9270|49702-0231-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.41|PHR: 408101; CHG: 26||Not reimbursed separately|279.41|PHR: 408101; CHG: 26||External grouping not supported 19146|ERX|HCPCS RX001|00591-0347-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 19146|ERX|HCPCS RX001|29300-0130-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 19146|ERX|HCPCS RX001|51079-0776-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 19146|ERX|HCPCS RX001|51079-0776-20|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 19146|ERX|HCPCS RX001|57237-0002-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 191536|ERX|HCPCS J1595|00781-3234-34|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLATIRAMER 20 MG/ML SUBCUTANEOUS SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|124.41|PHR: 408101; CHG: 26||Not reimbursed separately|124.41|PHR: 408101; CHG: 26||External grouping not supported 191536|ERX|HCPCS J1595|00781-3234-71|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLATIRAMER 20 MG/ML SUBCUTANEOUS SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|124.41|PHR: 408101; CHG: 26||Not reimbursed separately|124.41|PHR: 408101; CHG: 26||External grouping not supported 191540|ERX|HCPCS J1568|68982-0850-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,250.00|PHR: 408101; CHG: 26||External grouping not supported 191540|ERX|HCPCS J1568|68982-0850-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,500.00|PHR: 408101; CHG: 26||External grouping not supported 191540|ERX|HCPCS J1568|68982-0850-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|1,125.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,125.00|PHR: 408101; CHG: 26||External grouping not supported 191543|ERX|HCPCS A9270|00327-0001-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.72|PHR: 408101; CHG: 26||Not reimbursed separately|13.72|PHR: 408101; CHG: 26||External grouping not supported 191560|ERX|HCPCS J7186|68516-4609-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|5,760.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,760.00|PHR: 408101; CHG: 26||External grouping not supported 191560|ERX|HCPCS J7186|68516-4615-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN|10 mL|HUMANA [1294]||HUMANA [11839]|5,760.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,760.00|PHR: 408101; CHG: 26||External grouping not supported 191566|ERX|HCPCS J2407|70842-0140-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ORITAVANCIN 400 MG INTRAVENOUS SOLUTION|400 mg|HUMANA [1294]||HUMANA [11839]|2,746.08|PHR: 408101; CHG: 26||Not reimbursed separately|2,746.08|PHR: 408101; CHG: 26||External grouping not supported 191566|ERX|HCPCS J2407|70842-0140-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ORITAVANCIN 400 MG INTRAVENOUS SOLUTION|400 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,746.08|PHR: 408101; CHG: 26||Not reimbursed separately|2,746.08|PHR: 408101; CHG: 26||External grouping not supported 19176|ERX|HCPCS A9270|51079-0208-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 19176|ERX|HCPCS A9270|68084-0097-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 19176|ERX|HCPCS A9270|68084-0097-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|00093-5058-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|00904-6292-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|51079-0210-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|51079-0210-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|60505-2580-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|68084-0099-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19177|ERX|HCPCS A9270|68084-0099-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 19178|ERX|HCPCS A9270|50268-0094-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 19178|ERX|HCPCS A9270|51079-0209-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 19178|ERX|HCPCS A9270|68084-0098-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 19178|ERX|HCPCS A9270|68084-0098-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 19179|ERX|HCPCS A9270|60505-0833-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.37|PHR: 408101; CHG: 26||Not reimbursed separately|26.37|PHR: 408101; CHG: 26||External grouping not supported 19179|ERX|HCPCS A9270|65162-0676-84|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.37|PHR: 408101; CHG: 26||Not reimbursed separately|26.37|PHR: 408101; CHG: 26||External grouping not supported 191920|ERX|HCPCS A9270|00597-0100-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION|2 Puff|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 191920|ERX|HCPCS A9270|00597-0100-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION|2 Puff|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 191930|ERX|HCPCS RX001|00597-0024-02|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|1 Puff|HUMANA [1294]||HUMANA [11839]|8.40|PHR: 408101; CHG: 26||Not reimbursed separately|8.40|PHR: 408101; CHG: 26||External grouping not supported 192021|ERX|HCPCS J2270|00409-1892-03|0250 - PHARMACY - GENERAL CLASSIFICATION|MORPHINE 8 MG/ML INTRAVENOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 192021|ERX|HCPCS J2270|00409-1892-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MORPHINE 8 MG/ML INTRAVENOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 192022|ERX|HCPCS J2270|00409-1893-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 10 MG/ML INTRAVENOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.09|PHR: 408101; CHG: 26||Not reimbursed separately|2.09|PHR: 408101; CHG: 26||External grouping not supported 192022|ERX|HCPCS J2270|00409-1893-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 10 MG/ML INTRAVENOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.09|PHR: 408101; CHG: 26||Not reimbursed separately|2.09|PHR: 408101; CHG: 26||External grouping not supported 19226|ERX|HCPCS A9270|00093-5420-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CABERGOLINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.99|PHR: 408101; CHG: 26||Not reimbursed separately|24.99|PHR: 408101; CHG: 26||External grouping not supported 19226|ERX|HCPCS A9270|49884-0673-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CABERGOLINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.99|PHR: 408101; CHG: 26||Not reimbursed separately|24.99|PHR: 408101; CHG: 26||External grouping not supported 19226|ERX|HCPCS A9270|50742-0118-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CABERGOLINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.99|PHR: 408101; CHG: 26||Not reimbursed separately|24.99|PHR: 408101; CHG: 26||External grouping not supported 192302|ERX|HCPCS RX001|42023-0164-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|135.74|PHR: 408101; CHG: 26||Not reimbursed separately|135.74|PHR: 408101; CHG: 26||External grouping not supported 192302|ERX|HCPCS RX001|42023-0164-10|0250 - PHARMACY - GENERAL CLASSIFICATION|VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|135.74|PHR: 408101; CHG: 26||Not reimbursed separately|135.74|PHR: 408101; CHG: 26||External grouping not supported 192302|ERX|HCPCS RX001|42023-0164-25|0250 - PHARMACY - GENERAL CLASSIFICATION|VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|542.94|PHR: 408101; CHG: 26||Not reimbursed separately|542.94|PHR: 408101; CHG: 26||External grouping not supported 192467|ERX|HCPCS 90620|58160-0976-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|416.65|PHR: 408101; CHG: 26||Not reimbursed separately|416.65|PHR: 408101; CHG: 26||External grouping not supported 192467|ERX|HCPCS 90620|58160-0976-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|416.65|PHR: 408101; CHG: 26||Not reimbursed separately|416.65|PHR: 408101; CHG: 26||External grouping not supported 192481|ERX|HCPCS A9270|59011-0410-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.84|PHR: 408101; CHG: 26||Not reimbursed separately|9.84|PHR: 408101; CHG: 26||External grouping not supported 192483|ERX|HCPCS A9270|10702-0803-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.33|PHR: 408101; CHG: 26||Not reimbursed separately|18.33|PHR: 408101; CHG: 26||External grouping not supported 192483|ERX|HCPCS A9270|59011-0420-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.33|PHR: 408101; CHG: 26||Not reimbursed separately|18.33|PHR: 408101; CHG: 26||External grouping not supported 192485|ERX|HCPCS A9270|59011-0440-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.38|PHR: 408101; CHG: 26||Not reimbursed separately|31.38|PHR: 408101; CHG: 26||External grouping not supported 192487|ERX|HCPCS A9270|59011-0480-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.77|PHR: 408101; CHG: 26||Not reimbursed separately|54.77|PHR: 408101; CHG: 26||External grouping not supported 192508|ERX|HCPCS J2501|00143-9625-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PARICALCITOL 2 MCG/ML SOLUTION FOR HEMODIALYSIS PORT INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.97|PHR: 408101; CHG: 26||Not reimbursed separately|10.97|PHR: 408101; CHG: 26||External grouping not supported 192508|ERX|HCPCS J2501|00143-9625-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PARICALCITOL 2 MCG/ML SOLUTION FOR HEMODIALYSIS PORT INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.97|PHR: 408101; CHG: 26||Not reimbursed separately|10.97|PHR: 408101; CHG: 26||External grouping not supported 192586|ERX|HCPCS 90649|00006-4119-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION|0.5 mL|HUMANA [1294]||HUMANA [11839]|645.17|PHR: 408101; CHG: 26||Not reimbursed separately|645.17|PHR: 408101; CHG: 26||External grouping not supported 192631|ERX|HCPCS J0695|67919-0030-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION|1.5 g|HUMANA [1294]||HUMANA [11839]|365.34|PHR: 408101; CHG: 26||Not reimbursed separately|365.34|PHR: 408101; CHG: 26||External grouping not supported 192651|ERX|HCPCS J9299|00003-3772-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|3,290.16|PHR: 408101; CHG: 26||Not reimbursed separately|3,290.16|PHR: 408101; CHG: 26||External grouping not supported 192652|ERX|HCPCS J9299|00003-3774-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,225.55|PHR: 408101; CHG: 26||Not reimbursed separately|8,225.55|PHR: 408101; CHG: 26||External grouping not supported 192738|ERX|HCPCS J2505|55513-0192-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,038.04|PHR: 408101; CHG: 26||Not reimbursed separately|12,038.04|PHR: 408101; CHG: 26||External grouping not supported 192769|ERX|HCPCS J9271|00006-3026-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|14,804.88|PHR: 408101; CHG: 26||Not reimbursed separately|14,804.88|PHR: 408101; CHG: 26||External grouping not supported 192769|ERX|HCPCS J9271|00006-3026-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,804.88|PHR: 408101; CHG: 26||Not reimbursed separately|14,804.88|PHR: 408101; CHG: 26||External grouping not supported 193075|ERX|HCPCS A9270|59676-0575-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.27|PHR: 408101; CHG: 26||Not reimbursed separately|196.27|PHR: 408101; CHG: 26||External grouping not supported 193111|ERX|HCPCS RX001|00409-1660-20|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV|20 mL|HUMANA [1294]||HUMANA [11839]|34.86|PHR: 408101; CHG: 26||Not reimbursed separately|34.86|PHR: 408101; CHG: 26||External grouping not supported 193111|ERX|HCPCS RX001|00409-1660-22|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV|20 mL|HUMANA [1294]||HUMANA [11839]|34.86|PHR: 408101; CHG: 26||Not reimbursed separately|34.86|PHR: 408101; CHG: 26||External grouping not supported 19333|ERX|HCPCS J0735|00143-9724-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION|1.5 mL|HUMANA [1294]||HUMANA [11839]|25.56|PHR: 408101; CHG: 26||Not reimbursed separately|25.56|PHR: 408101; CHG: 26||External grouping not supported 19333|ERX|HCPCS J0735|67457-0218-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION|1.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.56|PHR: 408101; CHG: 26||Not reimbursed separately|25.56|PHR: 408101; CHG: 26||External grouping not supported 19333|ERX|HCPCS J0735|39822-2000-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.56|PHR: 408101; CHG: 26||Not reimbursed separately|25.56|PHR: 408101; CHG: 26||External grouping not supported 193460|ERX|HCPCS J1833|00469-0420-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION|372 mg|HUMANA [1294]||HUMANA [11839]|870.54|PHR: 408101; CHG: 26||Not reimbursed separately|870.54|PHR: 408101; CHG: 26||External grouping not supported 193463|ERX|HCPCS A9270|00469-0520-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISAVUCONAZONIUM SULFATE 186 MG CAPSULE|2 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|511.60|PHR: 408101; CHG: 26||Not reimbursed separately|511.60|PHR: 408101; CHG: 26||External grouping not supported 193498|ERX|HCPCS RX001|09999-5555-12|0250 - PHARMACY - GENERAL CLASSIFICATION|L. ACIDOPHILUS-B. ANIMALIS-FOS 5 BILLION CELL ORAL POWDER PACKET|1 mL|HUMANA [1294]||HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 193498|ERX|HCPCS RX001|52061-0004-00|0250 - PHARMACY - GENERAL CLASSIFICATION|L. ACIDOPHILUS-B. ANIMALIS-FOS 5 BILLION CELL ORAL POWDER PACKET|5 mL|HUMANA [1294]||HUMANA [11839]|2.81|PHR: 408101; CHG: 26||Not reimbursed separately|2.81|PHR: 408101; CHG: 26||External grouping not supported 193498|ERX|HCPCS RX001|52061-0004-01|0250 - PHARMACY - GENERAL CLASSIFICATION|L. ACIDOPHILUS-B. ANIMALIS-FOS 5 BILLION CELL ORAL POWDER PACKET|5 mL|HUMANA [1294]||HUMANA [11839]|2.81|PHR: 408101; CHG: 26||Not reimbursed separately|2.81|PHR: 408101; CHG: 26||External grouping not supported 1935|ERX|HCPCS A9270|00143-9700-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CORTISONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.97|PHR: 408101; CHG: 26||Not reimbursed separately|5.97|PHR: 408101; CHG: 26||External grouping not supported 193657|ERX|HCPCS RX001|55513-0800-60|0250 - PHARMACY - GENERAL CLASSIFICATION|IVABRADINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|22.35|PHR: 408101; CHG: 26||Not reimbursed separately|22.35|PHR: 408101; CHG: 26||External grouping not supported 193660|ERX|HCPCS J2353|00078-0818-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE|20 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.87|PHR: 408101; CHG: 26||Not reimbursed separately|11,853.87|PHR: 408101; CHG: 26||External grouping not supported 193661|ERX|HCPCS J2353|00078-0804-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE|1 Each|HUMANA [1294]||HUMANA [11839]|17,750.28|PHR: 408101; CHG: 26||Not reimbursed separately|17,750.28|PHR: 408101; CHG: 26||External grouping not supported 193661|ERX|HCPCS J2353|00078-0825-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,750.28|PHR: 408101; CHG: 26||Not reimbursed separately|17,750.28|PHR: 408101; CHG: 26||External grouping not supported 193662|ERX|HCPCS J2353|00078-0811-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE|10 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,047.58|PHR: 408101; CHG: 26||Not reimbursed separately|9,047.58|PHR: 408101; CHG: 26||External grouping not supported 193672|ERX|HCPCS J0714|00456-2700-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION|2.5 g|HUMANA [1294]||HUMANA [11839]|1,075.89|PHR: 408101; CHG: 26||Not reimbursed separately|1,075.89|PHR: 408101; CHG: 26||External grouping not supported 193672|ERX|HCPCS J0714|00456-2700-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION|2.5 g|HUMANA [1294]||HUMANA [11839]|1,075.89|PHR: 408101; CHG: 26||Not reimbursed separately|1,075.89|PHR: 408101; CHG: 26||External grouping not supported 193674|ERX|HCPCS RX032|58160-0958-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MENINGOCOCCAL A CONJ VACC 2 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|273.45|PHR: 408101; CHG: 26||Not reimbursed separately|273.45|PHR: 408101; CHG: 26||External grouping not supported 193675|ERX|HCPCS RX032|58160-0959-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MENINGOCO C,Y,W-135 VACC 1 OF 2(PF) 5 MCG X3/0.5 ML(FINAL) IM SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|273.45|PHR: 408101; CHG: 26||Not reimbursed separately|273.45|PHR: 408101; CHG: 26||External grouping not supported 193982|ERX|HCPCS RX001|17518-0060-04|0250 - PHARMACY - GENERAL CLASSIFICATION|POVIDONE-IODINE 5 % KIT|1 Kit|HUMANA [1294]||HUMANA [11839]|43.92|PHR: 408101; CHG: 26||Not reimbursed separately|43.92|PHR: 408101; CHG: 26||External grouping not supported 194005|ERX|HCPCS J1610|63323-0596-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.30|PHR: 408101; CHG: 26||Not reimbursed separately|306.30|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|275.40|PHR: 408101; CHG: 26||Not reimbursed separately|275.40|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,754.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,754.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,508.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,508.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|688.50|PHR: 408101; CHG: 26||Not reimbursed separately|688.50|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,262.00|PHR: 408101; CHG: 26||Not reimbursed separately|8,262.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|300 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,262.00|PHR: 408101; CHG: 26||Not reimbursed separately|8,262.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,377.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,377.00|PHR: 408101; CHG: 26||External grouping not supported 194219|ERX|HCPCS J1569|00944-2700-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,377.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,377.00|PHR: 408101; CHG: 26||External grouping not supported 194220|ERX|HCPCS J1459|44206-0437-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,637.00|PHR: 408101; CHG: 26||External grouping not supported 194220|ERX|HCPCS J1459|44206-0437-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,637.00|PHR: 408101; CHG: 26||External grouping not supported 194220|ERX|HCPCS J1459|44206-0438-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,274.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,274.00|PHR: 408101; CHG: 26||External grouping not supported 194220|ERX|HCPCS J1459|44206-0438-92|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,274.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,274.00|PHR: 408101; CHG: 26||External grouping not supported 194220|ERX|HCPCS J1459|44206-0436-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|1,318.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,318.50|PHR: 408101; CHG: 26||External grouping not supported 194220|ERX|HCPCS J1459|44206-0436-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,318.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,318.50|PHR: 408101; CHG: 26||External grouping not supported 19433|ERX|HCPCS A9270|00093-1715-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 19433|ERX|HCPCS A9270|00832-1214-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 19433|ERX|HCPCS A9270|00832-1214-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 19434|ERX|HCPCS A9270|00832-1217-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 19434|ERX|HCPCS A9270|00832-1217-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 6 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 19451|ERX|HCPCS 90700|58160-0810-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPH,PERTUS(ACEL),TET PEDI (PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SUSP|0.5 mL|HUMANA [1294]||HUMANA [11839]|54.96|PHR: 408101; CHG: 26||Not reimbursed separately|54.96|PHR: 408101; CHG: 26||External grouping not supported 19451|ERX|HCPCS 90700|58160-0810-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPH,PERTUS(ACEL),TET PEDI (PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SUSP|0.5 mL|HUMANA [1294]||HUMANA [11839]|54.96|PHR: 408101; CHG: 26||Not reimbursed separately|54.96|PHR: 408101; CHG: 26||External grouping not supported 19452|ERX|HCPCS A9270|51293-0838-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLOPATADINE 0.1 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.92|PHR: 408101; CHG: 26||Not reimbursed separately|13.92|PHR: 408101; CHG: 26||External grouping not supported 19452|ERX|HCPCS A9270|60505-0575-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLOPATADINE 0.1 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.92|PHR: 408101; CHG: 26||Not reimbursed separately|13.92|PHR: 408101; CHG: 26||External grouping not supported 19452|ERX|HCPCS A9270|61314-0271-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLOPATADINE 0.1 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.92|PHR: 408101; CHG: 26||Not reimbursed separately|13.92|PHR: 408101; CHG: 26||External grouping not supported 19452|ERX|HCPCS A9270|70069-0007-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLOPATADINE 0.1 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.92|PHR: 408101; CHG: 26||Not reimbursed separately|13.92|PHR: 408101; CHG: 26||External grouping not supported 194571|ERX|HCPCS J1460|13533-0635-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA(IGG) 15 %-18 % RANGE-GLYCINE INTRAMUSCULAR SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1,283.10|PHR: 408101; CHG: 26||Not reimbursed separately|1,283.10|PHR: 408101; CHG: 26||External grouping not supported 194571|ERX|HCPCS J1460|13533-0635-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA(IGG) 15 %-18 % RANGE-GLYCINE INTRAMUSCULAR SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|276.84|PHR: 408101; CHG: 26||Not reimbursed separately|276.84|PHR: 408101; CHG: 26||External grouping not supported 194576|ERX|HCPCS J1568|68982-0840-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,125.00|PHR: 408101; CHG: 26||External grouping not supported 194576|ERX|HCPCS J1568|68982-0840-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,250.00|PHR: 408101; CHG: 26||External grouping not supported 194583|ERX|HCPCS J1566|00944-2658-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|3,817.80|PHR: 408101; CHG: 26||Not reimbursed separately|3,817.80|PHR: 408101; CHG: 26||External grouping not supported 194583|ERX|HCPCS J1566|00944-2659-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,817.80|PHR: 408101; CHG: 26||Not reimbursed separately|3,817.80|PHR: 408101; CHG: 26||External grouping not supported 194606|ERX|HCPCS C9460|10122-0620-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CANGRELOR 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|2,065.08|PHR: 408101; CHG: 26||Not reimbursed separately|2,065.08|PHR: 408101; CHG: 26||External grouping not supported 194606|ERX|HCPCS C9460|10122-0620-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CANGRELOR 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|2,065.08|PHR: 408101; CHG: 26||Not reimbursed separately|2,065.08|PHR: 408101; CHG: 26||External grouping not supported 194676|ERX|HCPCS A9270|00078-0659-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.11|PHR: 408101; CHG: 26||Not reimbursed separately|25.11|PHR: 408101; CHG: 26||External grouping not supported 194677|ERX|HCPCS A9270|00078-0777-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.11|PHR: 408101; CHG: 26||Not reimbursed separately|25.11|PHR: 408101; CHG: 26||External grouping not supported 194678|ERX|HCPCS A9270|00078-0696-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.11|PHR: 408101; CHG: 26||Not reimbursed separately|25.11|PHR: 408101; CHG: 26||External grouping not supported 194702|ERX|HCPCS A9270|59148-0036-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BREXPIPRAZOLE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.35|PHR: 408101; CHG: 26||Not reimbursed separately|107.35|PHR: 408101; CHG: 26||External grouping not supported 194703|ERX|HCPCS A9270|59148-0037-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BREXPIPRAZOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.35|PHR: 408101; CHG: 26||Not reimbursed separately|107.35|PHR: 408101; CHG: 26||External grouping not supported 194704|ERX|HCPCS A9270|59148-0038-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BREXPIPRAZOLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.35|PHR: 408101; CHG: 26||Not reimbursed separately|107.35|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|00904-5460-72|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|00904-5460-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|10006-0700-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|37864-0000-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|37864-0082-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|51645-0828-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19483|ERX|HCPCS A9270|63739-0291-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 500 MG (1,250 MG)-VITAMIN D3 200 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 19486|ERX|HCPCS RX001|24208-0830-60|0250 - PHARMACY - GENERAL CLASSIFICATION|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|41.91|PHR: 408101; CHG: 26||Not reimbursed separately|41.91|PHR: 408101; CHG: 26||External grouping not supported 19486|ERX|HCPCS RX001|61314-0630-06|0250 - PHARMACY - GENERAL CLASSIFICATION|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|41.91|PHR: 408101; CHG: 26||Not reimbursed separately|41.91|PHR: 408101; CHG: 26||External grouping not supported 19495|ERX|HCPCS A9270|00574-4160-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.88|PHR: 408101; CHG: 26||Not reimbursed separately|42.88|PHR: 408101; CHG: 26||External grouping not supported 19495|ERX|HCPCS A9270|24208-0795-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.88|PHR: 408101; CHG: 26||Not reimbursed separately|42.88|PHR: 408101; CHG: 26||External grouping not supported 19495|ERX|HCPCS A9270|61314-0631-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.88|PHR: 408101; CHG: 26||Not reimbursed separately|42.88|PHR: 408101; CHG: 26||External grouping not supported 195385|ERX|HCPCS Q5101|61314-0326-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.03|PHR: 408101; CHG: 26||Not reimbursed separately|1,284.03|PHR: 408101; CHG: 26||External grouping not supported 195386|ERX|HCPCS Q5101|61314-0318-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|802.53|PHR: 408101; CHG: 26||Not reimbursed separately|802.53|PHR: 408101; CHG: 26||External grouping not supported 195464|ERX|HCPCS RX011|00186-0776-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TICAGRELOR 60 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|18.02|PHR: 408101; CHG: 26||Not reimbursed separately|18.02|PHR: 408101; CHG: 26||External grouping not supported 195816|ERX|HCPCS C9480|59676-0610-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRABECTEDIN 1 MG INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|9,109.65|PHR: 408101; CHG: 26||Not reimbursed separately|9,109.65|PHR: 408101; CHG: 26||External grouping not supported 195850|ERX|HCPCS J2270|00641-6125-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.45|PHR: 408101; CHG: 26||Not reimbursed separately|2.45|PHR: 408101; CHG: 26||External grouping not supported 195850|ERX|HCPCS J2270|00641-6125-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.45|PHR: 408101; CHG: 26||Not reimbursed separately|2.45|PHR: 408101; CHG: 26||External grouping not supported 195851|ERX|HCPCS J2270|00641-6126-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 8 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.77|PHR: 408101; CHG: 26||Not reimbursed separately|2.77|PHR: 408101; CHG: 26||External grouping not supported 195851|ERX|HCPCS J2270|00641-6126-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 8 MG/ML INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.77|PHR: 408101; CHG: 26||Not reimbursed separately|2.77|PHR: 408101; CHG: 26||External grouping not supported 195962|ERX|HCPCS RX011|00597-0197-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|6,009.00|PHR: 408101; CHG: 26||Not reimbursed separately|6,009.00|PHR: 408101; CHG: 26||External grouping not supported 195979|ERX|HCPCS C9474|15054-0043-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS|43 mg|HUMANA [1294]||HUMANA [11839]|7,098.00|PHR: 408101; CHG: 26||Not reimbursed separately|7,098.00|PHR: 408101; CHG: 26||External grouping not supported 196271|ERX|HCPCS RX001|53436-0084-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]||HUMANA [11839]|82.76|PHR: 408101; CHG: 26||Not reimbursed separately|82.76|PHR: 408101; CHG: 26||External grouping not supported 196271|ERX|HCPCS RX001|53436-0084-30|0250 - PHARMACY - GENERAL CLASSIFICATION|PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]||HUMANA [11839]|82.76|PHR: 408101; CHG: 26||Not reimbursed separately|82.76|PHR: 408101; CHG: 26||External grouping not supported 196272|ERX|HCPCS A9270|53436-0168-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.76|PHR: 408101; CHG: 26||Not reimbursed separately|82.76|PHR: 408101; CHG: 26||External grouping not supported 196272|ERX|HCPCS A9270|53436-0168-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.76|PHR: 408101; CHG: 26||Not reimbursed separately|82.76|PHR: 408101; CHG: 26||External grouping not supported 196273|ERX|HCPCS A9270|53436-0252-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PATIROMER CALCIUM SORBITEX 25.2 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.76|PHR: 408101; CHG: 26||Not reimbursed separately|82.76|PHR: 408101; CHG: 26||External grouping not supported 196273|ERX|HCPCS A9270|53436-0252-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PATIROMER CALCIUM SORBITEX 25.2 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.76|PHR: 408101; CHG: 26||Not reimbursed separately|82.76|PHR: 408101; CHG: 26||External grouping not supported 196282|ERX|HCPCS J2182|00173-0881-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|9,222.24|PHR: 408101; CHG: 26||Not reimbursed separately|9,222.24|PHR: 408101; CHG: 26||External grouping not supported 196289|ERX|HCPCS A9270|61958-1901-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFENAM 10 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.93|PHR: 408101; CHG: 26||Not reimbursed separately|314.93|PHR: 408101; CHG: 26||External grouping not supported 196296|ERX|HCPCS J0690|00338-3508-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.90|PHR: 408101; CHG: 26||Not reimbursed separately|18.90|PHR: 408101; CHG: 26||External grouping not supported 196300|ERX|HCPCS A9270|00574-0311-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COMPOUNDING VEHICLE SUSPENSION NO.19 ORAL|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.99|PHR: 408101; CHG: 26||Not reimbursed separately|43.99|PHR: 408101; CHG: 26||External grouping not supported 196304|ERX|HCPCS RX001|00574-0303-16|0250 - PHARMACY - GENERAL CLASSIFICATION|COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL|473 mL|HUMANA [1294]||HUMANA [11839]|39.74|PHR: 408101; CHG: 26||Not reimbursed separately|39.74|PHR: 408101; CHG: 26||External grouping not supported 196348|ERX|HCPCS J9145|57894-0502-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,668.16|PHR: 408101; CHG: 26||Not reimbursed separately|6,668.16|PHR: 408101; CHG: 26||External grouping not supported 196348|ERX|HCPCS J9145|57894-0502-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|1,667.04|PHR: 408101; CHG: 26||Not reimbursed separately|1,667.04|PHR: 408101; CHG: 26||External grouping not supported 19636|ERX|HCPCS RX001|17478-0206-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 10 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|95.52|PHR: 408101; CHG: 26||Not reimbursed separately|95.52|PHR: 408101; CHG: 26||External grouping not supported 19636|ERX|HCPCS RX001|42702-0103-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 10 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|95.52|PHR: 408101; CHG: 26||Not reimbursed separately|95.52|PHR: 408101; CHG: 26||External grouping not supported 196552|ERX|HCPCS J9176|00003-2291-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION|300 mg|HUMANA [1294]||HUMANA [11839]|5,825.88|PHR: 408101; CHG: 26||Not reimbursed separately|5,825.88|PHR: 408101; CHG: 26||External grouping not supported 196553|ERX|HCPCS J9176|00003-4522-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION|400 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,767.81|PHR: 408101; CHG: 26||Not reimbursed separately|7,767.81|PHR: 408101; CHG: 26||External grouping not supported 196561|ERX|HCPCS A9270|69547-0353-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|343.86|PHR: 408101; CHG: 26||Not reimbursed separately|343.86|PHR: 408101; CHG: 26||External grouping not supported 196590|ERX|HCPCS J9034|42367-0520-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,018.12|PHR: 408101; CHG: 26||Not reimbursed separately|6,018.12|PHR: 408101; CHG: 26||External grouping not supported 196590|ERX|HCPCS J9034|63459-0348-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|6,018.12|PHR: 408101; CHG: 26||Not reimbursed separately|6,018.12|PHR: 408101; CHG: 26||External grouping not supported 196846|ERX|HCPCS RX001|63713-0390-22|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (HUM PLAS)-FIBRINOGEN-CA 800-1,200 UNIT/ML(2 ML X 2) TOP SOLN|2 mL|HUMANA [1294]||HUMANA [11839]|596.52|PHR: 408101; CHG: 26||Not reimbursed separately|596.52|PHR: 408101; CHG: 26||External grouping not supported 196847|ERX|HCPCS RX001|63713-0390-55|0250 - PHARMACY - GENERAL CLASSIFICATION|THROMBIN (HUM PLAS)-FIBRINOGEN-CA 800-1,200 UNIT/ML(5 ML X 2) TOP SOLN|5 mL|HUMANA [1294]||HUMANA [11839]|1,547.19|PHR: 408101; CHG: 26||Not reimbursed separately|1,547.19|PHR: 408101; CHG: 26||External grouping not supported 196853|ERX|HCPCS RX001|00006-5423-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|305.51|PHR: 408101; CHG: 26||Not reimbursed separately|305.51|PHR: 408101; CHG: 26||External grouping not supported 196853|ERX|HCPCS RX001|00006-5423-12|0250 - PHARMACY - GENERAL CLASSIFICATION|SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|305.51|PHR: 408101; CHG: 26||Not reimbursed separately|305.51|PHR: 408101; CHG: 26||External grouping not supported 196853|ERX|HCPCS RX001|00006-5425-05|0250 - PHARMACY - GENERAL CLASSIFICATION|SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|559.56|PHR: 408101; CHG: 26||Not reimbursed separately|559.56|PHR: 408101; CHG: 26||External grouping not supported 196853|ERX|HCPCS RX001|00006-5425-15|0250 - PHARMACY - GENERAL CLASSIFICATION|SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|559.56|PHR: 408101; CHG: 26||Not reimbursed separately|559.56|PHR: 408101; CHG: 26||External grouping not supported 196861|ERX|HCPCS A9270|00904-5313-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 196861|ERX|HCPCS A9270|00904-5313-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 196866|ERX|HCPCS A9270|45802-0040-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SELENIUM SULFIDE 2.5 % LOTION|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.44|PHR: 408101; CHG: 26||Not reimbursed separately|19.44|PHR: 408101; CHG: 26||External grouping not supported 19690|ERX|HCPCS A9270|00573-0218-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 10 % MUCOSAL GEL|9 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.62|PHR: 408101; CHG: 26||Not reimbursed separately|19.62|PHR: 408101; CHG: 26||External grouping not supported 196922|ERX|HCPCS RX001|24571-0116-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L|5,000 mL|HUMANA [1294]||HUMANA [11839]|103.95|PHR: 408101; CHG: 26||Not reimbursed separately|103.95|PHR: 408101; CHG: 26||External grouping not supported 196922|ERX|HCPCS RX001|24571-0116-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PHOSPHATE DIALYSIS SOLN WITHOUT DEXTR K 4 MEQ-CA 2.5 MEQ-PO4 1 MMOL/L|5,000 mL|HUMANA [1294]||HUMANA [11839]|103.95|PHR: 408101; CHG: 26||Not reimbursed separately|103.95|PHR: 408101; CHG: 26||External grouping not supported 19704|ERX|HCPCS RX001|00065-0023-15|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBACHOL 0.01 % INTRAOCULAR SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|12.67|PHR: 408101; CHG: 26||Not reimbursed separately|12.67|PHR: 408101; CHG: 26||External grouping not supported 19711|ERX|HCPCS A9270|59762-3744-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN 1 % LOTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|178.02|PHR: 408101; CHG: 26||Not reimbursed separately|178.02|PHR: 408101; CHG: 26||External grouping not supported 19714|ERX|HCPCS A9270|17478-0892-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 0.1 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.94|PHR: 408101; CHG: 26||Not reimbursed separately|8.94|PHR: 408101; CHG: 26||External grouping not supported 19714|ERX|HCPCS A9270|61314-0014-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOFENAC 0.1 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.94|PHR: 408101; CHG: 26||Not reimbursed separately|8.94|PHR: 408101; CHG: 26||External grouping not supported 19722|ERX|HCPCS A9270|11980-0228-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOROMETHOLONE 0.25 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.43|PHR: 408101; CHG: 26||Not reimbursed separately|443.43|PHR: 408101; CHG: 26||External grouping not supported 19735|ERX|HCPCS RX032|00009-0626-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDROXYPROGESTERONE 400 MG/ML INTRAMUSCULAR SUSPENSION|1 mL|HUMANA [1294]||HUMANA [11839]|595.60|PHR: 408101; CHG: 26||Not reimbursed separately|595.60|PHR: 408101; CHG: 26||External grouping not supported 19736|ERX|HCPCS J1050|00548-5400-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.64|PHR: 408101; CHG: 26||Not reimbursed separately|155.64|PHR: 408101; CHG: 26||External grouping not supported 19736|ERX|HCPCS J1050|59762-4537-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION|1 mL|HUMANA [1294]||HUMANA [11839]|155.64|PHR: 408101; CHG: 26||Not reimbursed separately|155.64|PHR: 408101; CHG: 26||External grouping not supported 19736|ERX|HCPCS J1050|59762-4537-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.64|PHR: 408101; CHG: 26||Not reimbursed separately|155.64|PHR: 408101; CHG: 26||External grouping not supported 19736|ERX|HCPCS J1050|67457-0887-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.64|PHR: 408101; CHG: 26||Not reimbursed separately|155.64|PHR: 408101; CHG: 26||External grouping not supported 19740|ERX|HCPCS A9270|24385-0466-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLCELLULOSE (LAXATIVE) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 19740|ERX|HCPCS A9270|87701-0709-94|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLCELLULOSE (LAXATIVE) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 19741|ERX|HCPCS A9270|51672-4116-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 0.75 % TOPICAL GEL|45 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.00|PHR: 408101; CHG: 26||Not reimbursed separately|108.00|PHR: 408101; CHG: 26||External grouping not supported 19746|ERX|HCPCS A9270|17478-0713-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OFLOXACIN 0.3 % EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.98|PHR: 408101; CHG: 26||Not reimbursed separately|37.98|PHR: 408101; CHG: 26||External grouping not supported 19746|ERX|HCPCS A9270|17478-0713-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.99|PHR: 408101; CHG: 26||Not reimbursed separately|18.99|PHR: 408101; CHG: 26||External grouping not supported 19746|ERX|HCPCS A9270|24208-0434-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.99|PHR: 408101; CHG: 26||Not reimbursed separately|18.99|PHR: 408101; CHG: 26||External grouping not supported 19746|ERX|HCPCS A9270|64980-0515-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.99|PHR: 408101; CHG: 26||Not reimbursed separately|18.99|PHR: 408101; CHG: 26||External grouping not supported 197479|ERX|HCPCS A9270|61874-0115-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 1.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197479|ERX|HCPCS A9270|61874-0115-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 1.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197479|ERX|HCPCS A9270|61874-0115-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 1.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197480|ERX|HCPCS A9270|61874-0130-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 3 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197480|ERX|HCPCS A9270|61874-0130-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 3 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197480|ERX|HCPCS A9270|61874-0130-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 3 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197481|ERX|HCPCS A9270|61874-0145-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 4.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 197482|ERX|HCPCS A9270|61874-0160-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARIPRAZINE 6 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.82|PHR: 408101; CHG: 26||Not reimbursed separately|112.82|PHR: 408101; CHG: 26||External grouping not supported 19749|ERX|HCPCS A9270|51862-0180-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMOXINE 1 % TOPICAL FOAM|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.19|PHR: 408101; CHG: 26||Not reimbursed separately|112.19|PHR: 408101; CHG: 26||External grouping not supported 197623|ERX|HCPCS RX001|71285-0202-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CARDIOPLEGIC SOLUTION NO.16 26 MEQ/1,052.8 ML(POTASSIUM) FOR PERFUSION|1,000 mL|HUMANA [1294]||HUMANA [11839]|210.00|PHR: 408101; CHG: 26||Not reimbursed separately|210.00|PHR: 408101; CHG: 26||External grouping not supported 19769|ERX|HCPCS A9270|00065-0644-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOBRAMYCIN 0.3 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.62|PHR: 408101; CHG: 26||Not reimbursed separately|592.62|PHR: 408101; CHG: 26||External grouping not supported 19791|ERX|HCPCS RX001|00065-0411-30|0250 - PHARMACY - GENERAL CLASSIFICATION|POVIDONE-IODINE 5 % EYE SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|26.19|PHR: 408101; CHG: 26||Not reimbursed separately|26.19|PHR: 408101; CHG: 26||External grouping not supported 197937|ERX|HCPCS J1726|00517-1767-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|440.91|PHR: 408101; CHG: 26||Not reimbursed separately|440.91|PHR: 408101; CHG: 26||External grouping not supported 197937|ERX|HCPCS J1726|64011-0247-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL|1 mL|HUMANA [1294]||HUMANA [11839]|440.91|PHR: 408101; CHG: 26||Not reimbursed separately|440.91|PHR: 408101; CHG: 26||External grouping not supported 19805|ERX|HCPCS A9270|00168-0323-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 0.75 % TOPICAL CREAM|45 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|124.34|PHR: 408101; CHG: 26||Not reimbursed separately|124.34|PHR: 408101; CHG: 26||External grouping not supported 198205|ERX|HCPCS J2786|59310-0610-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|2,796.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,796.00|PHR: 408101; CHG: 26||External grouping not supported 198251|ERX|HCPCS A9270|61958-2002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.17|PHR: 408101; CHG: 26||Not reimbursed separately|179.17|PHR: 408101; CHG: 26||External grouping not supported 198263|ERX|HCPCS Q2004|00327-0012-30|0250 - PHARMACY - GENERAL CLASSIFICATION|CITRIC AC 1980.6 MG-GLUCONO 59.4 MG-MAG CARB 980.4 MG/30 ML IRRIG.SOLN|30 mL|HUMANA [1294]||HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 198652|ERX|HCPCS J3490|50474-0970-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.87|PHR: 408101; CHG: 26||Not reimbursed separately|69.87|PHR: 408101; CHG: 26||External grouping not supported 198655|ERX|HCPCS A9270|50474-0470-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BRIVARACETAM 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.34|PHR: 408101; CHG: 26||Not reimbursed separately|54.34|PHR: 408101; CHG: 26||External grouping not supported 198656|ERX|HCPCS A9270|50474-0570-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BRIVARACETAM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.34|PHR: 408101; CHG: 26||Not reimbursed separately|54.34|PHR: 408101; CHG: 26||External grouping not supported 198763|ERX|HCPCS RX001|42023-0216-01|0250 - PHARMACY - GENERAL CLASSIFICATION|EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|3.32|PHR: 408101; CHG: 26||Not reimbursed separately|3.32|PHR: 408101; CHG: 26||External grouping not supported 198763|ERX|HCPCS RX001|42023-0216-25|0250 - PHARMACY - GENERAL CLASSIFICATION|EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|3.32|PHR: 408101; CHG: 26||Not reimbursed separately|3.32|PHR: 408101; CHG: 26||External grouping not supported 198763|ERX|HCPCS RX001|76014-0005-30|0250 - PHARMACY - GENERAL CLASSIFICATION|EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|3.32|PHR: 408101; CHG: 26||Not reimbursed separately|3.32|PHR: 408101; CHG: 26||External grouping not supported 198774|ERX|HCPCS J9022|50242-0917-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|27,582.12|PHR: 408101; CHG: 26||Not reimbursed separately|27,582.12|PHR: 408101; CHG: 26||External grouping not supported 19882|ERX|HCPCS A9270|60687-0231-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 19882|ERX|HCPCS A9270|60687-0231-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 19882|ERX|HCPCS A9270|65862-0011-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 19882|ERX|HCPCS A9270|68180-0351-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 19882|ERX|HCPCS A9270|69097-0833-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SERTRALINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 198972|ERX|HCPCS A9270|00023-5853-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|2 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.19|PHR: 408101; CHG: 26||Not reimbursed separately|9.19|PHR: 408101; CHG: 26||External grouping not supported 198972|ERX|HCPCS A9270|00093-5907-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|2 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.19|PHR: 408101; CHG: 26||Not reimbursed separately|9.19|PHR: 408101; CHG: 26||External grouping not supported 199058|ERX|HCPCS J9047|76075-0102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARFILZOMIB 30 MG INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,653.13|PHR: 408101; CHG: 26||Not reimbursed separately|3,653.13|PHR: 408101; CHG: 26||External grouping not supported 19928|ERX|HCPCS A9270|50458-0295-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 10 MG/ML ORAL SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.68|PHR: 408101; CHG: 26||Not reimbursed separately|61.68|PHR: 408101; CHG: 26||External grouping not supported 19928|ERX|HCPCS A9270|65162-0087-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ITRACONAZOLE 10 MG/ML ORAL SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.68|PHR: 408101; CHG: 26||Not reimbursed separately|61.68|PHR: 408101; CHG: 26||External grouping not supported 199313|ERX|HCPCS RX001|61553-0500-79|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 100 MG/2 ML (50 MG/ML) INTRAVENOUS SYRINGE|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 199514|ERX|HCPCS RX001|63323-0820-00|0250 - PHARMACY - GENERAL CLASSIFICATION|FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS|100 mL|HUMANA [1294]||HUMANA [11839]|50.10|PHR: 408101; CHG: 26||Not reimbursed separately|50.10|PHR: 408101; CHG: 26||External grouping not supported 199514|ERX|HCPCS RX001|63323-0820-01|0250 - PHARMACY - GENERAL CLASSIFICATION|FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS|100 mL|HUMANA [1294]||HUMANA [11839]|50.10|PHR: 408101; CHG: 26||Not reimbursed separately|50.10|PHR: 408101; CHG: 26||External grouping not supported 199544|ERX|HCPCS A9270|09999-5555-54|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.10|PHR: 408101; CHG: 26||Not reimbursed separately|44.10|PHR: 408101; CHG: 26||External grouping not supported 199544|ERX|HCPCS A9270|46287-0006-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.10|PHR: 408101; CHG: 26||Not reimbursed separately|44.10|PHR: 408101; CHG: 26||External grouping not supported 199544|ERX|HCPCS A9270|46287-0006-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.10|PHR: 408101; CHG: 26||Not reimbursed separately|44.10|PHR: 408101; CHG: 26||External grouping not supported 199547|ERX|HCPCS A9270|46287-0006-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOD POLYSTYRENE SULFONATE 30 GRAM-SORBITOL 40 GRAM/120 ML ENEMA|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.32|PHR: 408101; CHG: 26||Not reimbursed separately|193.32|PHR: 408101; CHG: 26||External grouping not supported 19974|ERX|HCPCS A9270|00591-0395-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENTAZOCINE 50 MG-NALOXONE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.29|PHR: 408101; CHG: 26||Not reimbursed separately|5.29|PHR: 408101; CHG: 26||External grouping not supported 199829|ERX|HCPCS Q9968|00517-0374-01|0250 - PHARMACY - GENERAL CLASSIFICATION|METHYLENE BLUE (ANTIDOTE) 5 MG/ML (0.5 %) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.12|PHR: 408101; CHG: 26||Not reimbursed separately|57.12|PHR: 408101; CHG: 26||External grouping not supported 199829|ERX|HCPCS Q9968|00517-0374-05|0250 - PHARMACY - GENERAL CLASSIFICATION|METHYLENE BLUE (ANTIDOTE) 5 MG/ML (0.5 %) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.12|PHR: 408101; CHG: 26||Not reimbursed separately|57.12|PHR: 408101; CHG: 26||External grouping not supported 199954|ERX|HCPCS J3358|57894-0054-27|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION|26 mL|HUMANA [1294]||HUMANA [11839]|5,035.20|PHR: 408101; CHG: 26||Not reimbursed separately|5,035.20|PHR: 408101; CHG: 26||External grouping not supported 200109|ERX|HCPCS J1170|00409-2552-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.73|PHR: 408101; CHG: 26||Not reimbursed separately|1.73|PHR: 408101; CHG: 26||External grouping not supported 200112|ERX|HCPCS Q5103|00069-0809-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|1,550.25|PHR: 408101; CHG: 26||Not reimbursed separately|1,550.25|PHR: 408101; CHG: 26||External grouping not supported 20032|ERX|HCPCS A9270|63010-0010-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NELFINAVIR 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.19|PHR: 408101; CHG: 26||Not reimbursed separately|11.19|PHR: 408101; CHG: 26||External grouping not supported 20038|ERX|HCPCS A9270|00781-6524-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUMATRIPTAN 5 MG/ACTUATION NASAL SPRAY|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.02|PHR: 408101; CHG: 26||Not reimbursed separately|136.02|PHR: 408101; CHG: 26||External grouping not supported 200452|ERX|HCPCS A9270|61958-2301-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TENOFOVIR ALAFENAMIDE 25 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.04|PHR: 408101; CHG: 26||Not reimbursed separately|114.04|PHR: 408101; CHG: 26||External grouping not supported 200603|ERX|HCPCS J0565|00006-3025-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION|40 mL|HUMANA [1294]||HUMANA [11839]|11,400.00|PHR: 408101; CHG: 26||Not reimbursed separately|11,400.00|PHR: 408101; CHG: 26||External grouping not supported 2007|ERX|HCPCS J3420|00517-0031-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.31|PHR: 408101; CHG: 26||Not reimbursed separately|6.31|PHR: 408101; CHG: 26||External grouping not supported 2007|ERX|HCPCS J3420|63323-0044-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.31|PHR: 408101; CHG: 26||Not reimbursed separately|6.31|PHR: 408101; CHG: 26||External grouping not supported 2007|ERX|HCPCS J3420|63323-0044-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.31|PHR: 408101; CHG: 26||Not reimbursed separately|6.31|PHR: 408101; CHG: 26||External grouping not supported 2007|ERX|HCPCS J3420|00517-0031-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|6.31|PHR: 408101; CHG: 26||Not reimbursed separately|6.31|PHR: 408101; CHG: 26||External grouping not supported 2008|ERX|HCPCS A9270|80681-0071-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|11845-0069-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|37864-0914-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|51645-0914-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|74312-0013-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|74312-0528-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|77333-0938-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 2009|ERX|HCPCS A9270|79854-0200-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 201011|ERX|HCPCS 92211408|76045-0009-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJECTION SYRINGE|0.1 mL|HUMANA [1294]||HUMANA [11839]|1.12|PHR: 408101; CHG: 26||Not reimbursed separately|1.12|PHR: 408101; CHG: 26||External grouping not supported 201011|ERX|HCPCS 92211408|76045-0009-96|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJECTION SYRINGE|0.1 mL|HUMANA [1294]||HUMANA [11839]|1.12|PHR: 408101; CHG: 26||Not reimbursed separately|1.12|PHR: 408101; CHG: 26||External grouping not supported 2012|ERX|HCPCS A9270|10006-0700-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 2012|ERX|HCPCS A9270|37864-0913-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 2012|ERX|HCPCS A9270|87701-0407-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 201274|ERX|HCPCS RX001|46122-0254-15|0250 - PHARMACY - GENERAL CLASSIFICATION|NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE|1 Lozenge|HUMANA [1294]||HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 201274|ERX|HCPCS RX001|46122-0254-16|0250 - PHARMACY - GENERAL CLASSIFICATION|NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE|1 Lozenge|HUMANA [1294]||HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 201274|ERX|HCPCS RX001|87701-0425-67|0250 - PHARMACY - GENERAL CLASSIFICATION|NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE|1 Lozenge|HUMANA [1294]||HUMANA [11839]|0.73|PHR: 408101; CHG: 26||Not reimbursed separately|0.73|PHR: 408101; CHG: 26||External grouping not supported 201404|ERX|HCPCS J9023|44087-3535-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|4,933.59|PHR: 408101; CHG: 26||Not reimbursed separately|4,933.59|PHR: 408101; CHG: 26||External grouping not supported 201418|ERX|HCPCS J2350|50242-0150-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|48,750.00|PHR: 408101; CHG: 26||Not reimbursed separately|48,750.00|PHR: 408101; CHG: 26||External grouping not supported 20156|ERX|HCPCS J9100|63323-0120-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|33.36|PHR: 408101; CHG: 26||Not reimbursed separately|33.36|PHR: 408101; CHG: 26||External grouping not supported 2017|ERX|HCPCS A9270|43547-0400-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOBENZAPRINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 2017|ERX|HCPCS A9270|43547-0400-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOBENZAPRINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 2017|ERX|HCPCS A9270|51079-0644-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOBENZAPRINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 2017|ERX|HCPCS A9270|51079-0644-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOBENZAPRINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 2017|ERX|HCPCS A9270|63739-0531-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOBENZAPRINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 2017|ERX|HCPCS A9270|69097-0846-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOBENZAPRINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 202223|ERX|HCPCS J9355|50242-0132-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION|150 mg|HUMANA [1294]||HUMANA [11839]|4,675.26|PHR: 408101; CHG: 26||Not reimbursed separately|4,675.26|PHR: 408101; CHG: 26||External grouping not supported 202271|ERX|HCPCS J9173|00310-4611-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,160.00|PHR: 408101; CHG: 26||Not reimbursed separately|11,160.00|PHR: 408101; CHG: 26||External grouping not supported 202271|ERX|HCPCS J9173|00310-4500-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION|2.4 mL|HUMANA [1294]||HUMANA [11839]|2,678.40|PHR: 408101; CHG: 26||Not reimbursed separately|2,678.40|PHR: 408101; CHG: 26||External grouping not supported 2025|ERX|HCPCS RX001|00065-0396-02|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 1 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|10.98|PHR: 408101; CHG: 26||Not reimbursed separately|10.98|PHR: 408101; CHG: 26||External grouping not supported 2025|ERX|HCPCS RX001|17478-0100-02|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 1 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|10.98|PHR: 408101; CHG: 26||Not reimbursed separately|10.98|PHR: 408101; CHG: 26||External grouping not supported 2025|ERX|HCPCS RX001|61314-0396-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 1 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|10.98|PHR: 408101; CHG: 26||Not reimbursed separately|10.98|PHR: 408101; CHG: 26||External grouping not supported 202506|ERX|HCPCS J9311|50242-0108-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN|11.7 mL|HUMANA [1294]||HUMANA [11839]|19,729.74|PHR: 408101; CHG: 26||Not reimbursed separately|19,729.74|PHR: 408101; CHG: 26||External grouping not supported 202528|ERX|HCPCS A9270|62530-0000-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|UREA 15 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.63|PHR: 408101; CHG: 26||Not reimbursed separately|9.63|PHR: 408101; CHG: 26||External grouping not supported 202582|ERX|HCPCS J1640|55292-0702-55|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION|350 mg|HUMANA [1294]||HUMANA [11839]|23,706.36|PHR: 408101; CHG: 26||Not reimbursed separately|23,706.36|PHR: 408101; CHG: 26||External grouping not supported 202585|ERX|HCPCS J9311|50242-0109-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN|13.4 mL|HUMANA [1294]||HUMANA [11839]|22,548.27|PHR: 408101; CHG: 26||Not reimbursed separately|22,548.27|PHR: 408101; CHG: 26||External grouping not supported 202936|ERX|HCPCS RX001|05466-1126-01|0250 - PHARMACY - GENERAL CLASSIFICATION|C.I. ACID BLUE 90 (PF) 0.025 % IN 0.9 % NACL INTRAOCULAR SOLUTION|0.8 mL|HUMANA [1294]||HUMANA [11839]|172.50|PHR: 408101; CHG: 26||Not reimbursed separately|172.50|PHR: 408101; CHG: 26||External grouping not supported 202974|ERX|HCPCS RX001|76154-0487-05|0250 - PHARMACY - GENERAL CLASSIFICATION|VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV|100 mL|HUMANA [1294]||HUMANA [11839]|611.40|PHR: 408101; CHG: 26||Not reimbursed separately|611.40|PHR: 408101; CHG: 26||External grouping not supported 202993|ERX|HCPCS Q5104|00006-4305-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|2,049.42|PHR: 408101; CHG: 26||Not reimbursed separately|2,049.42|PHR: 408101; CHG: 26||External grouping not supported 202993|ERX|HCPCS Q5104|00006-4305-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.42|PHR: 408101; CHG: 26||Not reimbursed separately|2,049.42|PHR: 408101; CHG: 26||External grouping not supported 2032|ERX|HCPCS A9270|39328-0044-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 2032|ERX|HCPCS A9270|64980-0504-48|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 203221|ERX|HCPCS A9270|00074-2625-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLECAPREVIR 100 MG-PIBRENTASVIR 40 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|458.47|PHR: 408101; CHG: 26||Not reimbursed separately|458.47|PHR: 408101; CHG: 26||External grouping not supported 2033|ERX|HCPCS A9270|10135-0638-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYPROHEPTADINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 2033|ERX|HCPCS A9270|50742-0190-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYPROHEPTADINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 2033|ERX|HCPCS A9270|51991-0838-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYPROHEPTADINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 203414|ERX|HCPCS RX001|54643-7862-08|0250 - PHARMACY - GENERAL CLASSIFICATION|MVI,ADULT NO.4,VIT K,COMP(VIAL 1 OF 2) 3,300 UNIT-150 MCG/5 ML IV SOLN|5 mL|HUMANA [1294]||HUMANA [11839]|11.04|PHR: 408101; CHG: 26||Not reimbursed separately|11.04|PHR: 408101; CHG: 26||External grouping not supported 203415|ERX|HCPCS RX001|54643-7862-09|0250 - PHARMACY - GENERAL CLASSIFICATION|MVI, ADULT NO.4, VIT K (VIAL 2 OF 2) 600 MCG-60 MCG-5 MCG/5 ML IV SOLN|5 mL|HUMANA [1294]||HUMANA [11839]|11.04|PHR: 408101; CHG: 26||Not reimbursed separately|11.04|PHR: 408101; CHG: 26||External grouping not supported 203451|ERX|HCPCS J9057|50419-0385-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COPANLISIB 60 MG INTRAVENOUS SOLUTION|60 mg|HUMANA [1294]||HUMANA [11839]|13,995.84|PHR: 408101; CHG: 26||Not reimbursed separately|13,995.84|PHR: 408101; CHG: 26||External grouping not supported 203454|ERX|HCPCS RX001|32909-0711-03|0250 - PHARMACY - GENERAL CLASSIFICATION|BARIUM SULFATE 2 % (W/V) ORAL SUSPENSION|450 mL|HUMANA [1294]||HUMANA [11839]|9.60|PHR: 408101; CHG: 26||Not reimbursed separately|9.60|PHR: 408101; CHG: 26||External grouping not supported 203454|ERX|HCPCS RX001|32909-0724-03|0250 - PHARMACY - GENERAL CLASSIFICATION|BARIUM SULFATE 2 % (W/V) ORAL SUSPENSION|450 mL|HUMANA [1294]||HUMANA [11839]|9.60|PHR: 408101; CHG: 26||Not reimbursed separately|9.60|PHR: 408101; CHG: 26||External grouping not supported 203694|ERX|HCPCS 90750|58160-0819-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT|1 Each|HUMANA [1294]||HUMANA [11839]|397.65|PHR: 408101; CHG: 26||Not reimbursed separately|397.65|PHR: 408101; CHG: 26||External grouping not supported 203694|ERX|HCPCS 90750|58160-0823-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT|1 Each|HUMANA [1294]||HUMANA [11839]|397.65|PHR: 408101; CHG: 26||Not reimbursed separately|397.65|PHR: 408101; CHG: 26||External grouping not supported 203696|ERX|HCPCS 90750|58160-0828-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION|0.5 mL|HUMANA [1294]||HUMANA [11839]|397.65|PHR: 408101; CHG: 26||Not reimbursed separately|397.65|PHR: 408101; CHG: 26||External grouping not supported 203974|ERX|HCPCS J0185|47426-0201-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 7.2 MG/ML INTRAVENOUS EMULSION|18 mL|HUMANA [1294]||HUMANA [11839]|727.17|PHR: 408101; CHG: 26||Not reimbursed separately|727.17|PHR: 408101; CHG: 26||External grouping not supported 203982|ERX|HCPCS J0517|00310-1730-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|15,131.16|PHR: 408101; CHG: 26||Not reimbursed separately|15,131.16|PHR: 408101; CHG: 26||External grouping not supported 204387|ERX|HCPCS J9299|00003-3734-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION|24 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,741.32|PHR: 408101; CHG: 26||Not reimbursed separately|19,741.32|PHR: 408101; CHG: 26||External grouping not supported 204394|ERX|HCPCS J0256|13533-0705-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|1,396.56|PHR: 408101; CHG: 26||Not reimbursed separately|1,396.56|PHR: 408101; CHG: 26||External grouping not supported 20446|ERX|HCPCS A9270|00172-5241-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ANAGRELIDE 0.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 204710|ERX|HCPCS A9270|65628-0206-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VANCOMYCIN 50 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 204710|ERX|HCPCS A9270|65628-0208-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VANCOMYCIN 50 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 204710|ERX|HCPCS A9270|99999-3333-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VANCOMYCIN 50 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 204710|ERX|HCPCS A9270|99999-3333-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VANCOMYCIN 50 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 204710|ERX|HCPCS A9270|99999-3333-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VANCOMYCIN 50 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 204717|ERX|HCPCS J3101|50242-0120-47|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TENECTEPLASE 50 MG INTRAVENOUS SOLUTION|30 mg|HUMANA [1294]||HUMANA [11839]|10,886.13|PHR: 408101; CHG: 26||Not reimbursed separately|10,886.13|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00143-9506-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00143-9506-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00143-9507-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00143-9507-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00409-6695-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00409-6695-11|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00409-6695-12|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|00517-0780-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|23155-0160-32|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|23155-0160-42|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|55150-0222-20|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|67457-0902-00|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|67457-0902-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|67457-0903-00|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|70860-0652-20|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 20472|ERX|HCPCS RX001|72266-0147-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 204729|ERX|HCPCS RX001|67157-0101-50|0250 - PHARMACY - GENERAL CLASSIFICATION|ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|12.72|PHR: 408101; CHG: 26||Not reimbursed separately|12.72|PHR: 408101; CHG: 26||External grouping not supported 204756|ERX|HCPCS A9270|00904-2621-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PEDIATRIC MULTIVITAMIN NO.17 CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 204766|ERX|HCPCS A9270|61958-2501-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.93|PHR: 408101; CHG: 26||Not reimbursed separately|314.93|PHR: 408101; CHG: 26||External grouping not supported 204876|ERX|HCPCS RX001|62327-0222-42|0250 - PHARMACY - GENERAL CLASSIFICATION|STERILE TALC 2 GRAM INTRAPLEURAL SUSPENSION|1 Each|HUMANA [1294]||HUMANA [11839]|216.00|PHR: 408101; CHG: 26||Not reimbursed separately|216.00|PHR: 408101; CHG: 26||External grouping not supported 204878|ERX|HCPCS RX001|62327-0444-04|0250 - PHARMACY - GENERAL CLASSIFICATION|STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION|1 Each|HUMANA [1294]||HUMANA [11839]|447.00|PHR: 408101; CHG: 26||Not reimbursed separately|447.00|PHR: 408101; CHG: 26||External grouping not supported 205189|ERX|HCPCS 90375|13533-0318-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,151.93|PHR: 408101; CHG: 26||Not reimbursed separately|2,151.93|PHR: 408101; CHG: 26||External grouping not supported 205189|ERX|HCPCS 90375|13533-0318-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,151.93|PHR: 408101; CHG: 26||Not reimbursed separately|2,151.93|PHR: 408101; CHG: 26||External grouping not supported 205460|ERX|HCPCS RX011|63323-0454-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|3.45|PHR: 408101; CHG: 26||Not reimbursed separately|3.45|PHR: 408101; CHG: 26||External grouping not supported 205465|ERX|HCPCS RX001|64950-0362-04|0250 - PHARMACY - GENERAL CLASSIFICATION|COCAINE 4 % NASAL SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|537.72|PHR: 408101; CHG: 26||Not reimbursed separately|537.72|PHR: 408101; CHG: 26||External grouping not supported 205466|ERX|HCPCS J1750|00023-6082-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRON DEXTRAN 50 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|80.72|PHR: 408101; CHG: 26||Not reimbursed separately|80.72|PHR: 408101; CHG: 26||External grouping not supported 20566|ERX|HCPCS A9270|29300-0124-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 20566|ERX|HCPCS A9270|50268-0525-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 20566|ERX|HCPCS A9270|50268-0525-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 20566|ERX|HCPCS A9270|63739-0701-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 20566|ERX|HCPCS A9270|68382-0050-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 205780|ERX|HCPCS Q5106|00069-1305-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|54.98|PHR: 408101; CHG: 26||Not reimbursed separately|54.98|PHR: 408101; CHG: 26||External grouping not supported 205781|ERX|HCPCS Q5106|00069-1306-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|82.47|PHR: 408101; CHG: 26||Not reimbursed separately|82.47|PHR: 408101; CHG: 26||External grouping not supported 205782|ERX|HCPCS Q5106|00069-1307-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|109.96|PHR: 408101; CHG: 26||Not reimbursed separately|109.96|PHR: 408101; CHG: 26||External grouping not supported 205783|ERX|HCPCS Q5106|00069-1308-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|274.89|PHR: 408101; CHG: 26||Not reimbursed separately|274.89|PHR: 408101; CHG: 26||External grouping not supported 205784|ERX|HCPCS Q5106|00069-1309-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1,099.53|PHR: 408101; CHG: 26||Not reimbursed separately|1,099.53|PHR: 408101; CHG: 26||External grouping not supported 205784|ERX|HCPCS Q5106|00069-1309-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1,099.53|PHR: 408101; CHG: 26||Not reimbursed separately|1,099.53|PHR: 408101; CHG: 26||External grouping not supported 20580|ERX|HCPCS A9270|50268-0526-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 20580|ERX|HCPCS A9270|50268-0526-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MELOXICAM 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 206046|ERX|HCPCS Q5108|67457-0833-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA [1294]||HUMANA [11839]|10,237.50|PHR: 408101; CHG: 26||Not reimbursed separately|10,237.50|PHR: 408101; CHG: 26||External grouping not supported 206118|ERX|HCPCS A9270|59676-0800-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARUNAVIR 800 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.28|PHR: 408101; CHG: 26||Not reimbursed separately|378.28|PHR: 408101; CHG: 26||External grouping not supported 206426|ERX|HCPCS J9047|76075-0103-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARFILZOMIB 10 MG INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,217.70|PHR: 408101; CHG: 26||Not reimbursed separately|1,217.70|PHR: 408101; CHG: 26||External grouping not supported 206433|ERX|HCPCS J3245|47335-0177-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TILDRAKIZUMAB-ASMN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|41,745.00|PHR: 408101; CHG: 26||Not reimbursed separately|41,745.00|PHR: 408101; CHG: 26||External grouping not supported 206436|ERX|HCPCS RX015|00310-1105-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|10.57|PHR: 408101; CHG: 26||Not reimbursed separately|10.57|PHR: 408101; CHG: 26||External grouping not supported 206436|ERX|HCPCS RX015|00310-1105-39|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|10.57|PHR: 408101; CHG: 26||Not reimbursed separately|10.57|PHR: 408101; CHG: 26||External grouping not supported 206437|ERX|HCPCS RX015|00310-1110-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|10.57|PHR: 408101; CHG: 26||Not reimbursed separately|10.57|PHR: 408101; CHG: 26||External grouping not supported 206453|ERX|HCPCS J0135|00074-0124-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADALIMUMAB 80 MG/0.8 ML SUBCUTANEOUS PEN KIT|1 mL|HUMANA [1294]||HUMANA [11839]|20,265.65|PHR: 408101; CHG: 26||Not reimbursed separately|20,265.65|PHR: 408101; CHG: 26||External grouping not supported 206723|ERX|HCPCS Q5110|00069-0291-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|410.67|PHR: 408101; CHG: 26||Not reimbursed separately|410.67|PHR: 408101; CHG: 26||External grouping not supported 206724|ERX|HCPCS Q5110|00069-0292-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA [1294]||HUMANA [11839]|657.10|PHR: 408101; CHG: 26||Not reimbursed separately|657.10|PHR: 408101; CHG: 26||External grouping not supported 206754|ERX|HCPCS RX001|69374-0982-33|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 30 MG/3 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC INJ SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|2.00|PHR: 408101; CHG: 26||Not reimbursed separately|2.00|PHR: 408101; CHG: 26||External grouping not supported 207003|ERX|HCPCS A9270|50458-0577-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.27|PHR: 408101; CHG: 26||Not reimbursed separately|8.27|PHR: 408101; CHG: 26||External grouping not supported 207003|ERX|HCPCS A9270|50458-0577-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVAROXABAN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.27|PHR: 408101; CHG: 26||Not reimbursed separately|8.27|PHR: 408101; CHG: 26||External grouping not supported 207040|ERX|HCPCS J9119|61755-0008-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION|350 mg|HUMANA [1294]||HUMANA [11839]|27,300.00|PHR: 408101; CHG: 26||Not reimbursed separately|27,300.00|PHR: 408101; CHG: 26||External grouping not supported 207067|ERX|HCPCS RX001|11743-0022-75|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 6 GRAM/15 ML ORAL GEL|15 mL|HUMANA [1294]||HUMANA [11839]|2.88|PHR: 408101; CHG: 26||Not reimbursed separately|2.88|PHR: 408101; CHG: 26||External grouping not supported 207104|ERX|HCPCS A9270|58980-0780-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.16|PHR: 408101; CHG: 26||Not reimbursed separately|56.16|PHR: 408101; CHG: 26||External grouping not supported 207104|ERX|HCPCS A9270|58980-0780-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.32|PHR: 408101; CHG: 26||Not reimbursed separately|112.32|PHR: 408101; CHG: 26||External grouping not supported 207552|ERX|HCPCS J2357|50242-0214-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,692.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,692.72|PHR: 408101; CHG: 26||External grouping not supported 207554|ERX|HCPCS J2357|50242-0215-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,385.44|PHR: 408101; CHG: 26||Not reimbursed separately|3,385.44|PHR: 408101; CHG: 26||External grouping not supported 207619|ERX|HCPCS J1447|63459-0920-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TBO-FILGRASTIM 480 MCG/1.6 ML SUBCUTANEOUS SOLUTION|1.6 mL|HUMANA [1294]||HUMANA [11839]|770.28|PHR: 408101; CHG: 26||Not reimbursed separately|770.28|PHR: 408101; CHG: 26||External grouping not supported 207620|ERX|HCPCS J1447|63459-0918-53|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TBO-FILGRASTIM 300 MCG/ML SUBCUTANEOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|483.66|PHR: 408101; CHG: 26||Not reimbursed separately|483.66|PHR: 408101; CHG: 26||External grouping not supported 207624|ERX|HCPCS Q5111|70114-0101-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA [1294]||HUMANA [11839]|8,775.00|PHR: 408101; CHG: 26||Not reimbursed separately|8,775.00|PHR: 408101; CHG: 26||External grouping not supported 207784|ERX|HCPCS J1303|25682-0022-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RAVULIZUMAB-CWVZ 300 MG/30 ML (10 MG/ML) INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|19,212.03|PHR: 408101; CHG: 26||Not reimbursed separately|19,212.03|PHR: 408101; CHG: 26||External grouping not supported 20799|ERX|HCPCS A9270|00009-5012-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIGLITOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.56|PHR: 408101; CHG: 26||Not reimbursed separately|7.56|PHR: 408101; CHG: 26||External grouping not supported 208193|ERX|HCPCS RX015|54092-0546-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PRUCALOPRIDE 1 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|40.24|PHR: 408101; CHG: 26||Not reimbursed separately|40.24|PHR: 408101; CHG: 26||External grouping not supported 208454|ERX|HCPCS J9022|50242-0918-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION|14 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,307.45|PHR: 408101; CHG: 26||Not reimbursed separately|19,307.45|PHR: 408101; CHG: 26||External grouping not supported 208621|ERX|HCPCS J9356|50242-0077-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|14,025.72|PHR: 408101; CHG: 26||Not reimbursed separately|14,025.72|PHR: 408101; CHG: 26||External grouping not supported 208661|ERX|HCPCS RX011|55513-0880-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE|1 Each|HUMANA [1294]||HUMANA [11839]|5,475.01|PHR: 408101; CHG: 26||Not reimbursed separately|5,475.01|PHR: 408101; CHG: 26||External grouping not supported 208683|ERX|HCPCS A9270|59676-0030-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERDAFITINIB 3 MG TABLET|3 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,770.20|PHR: 408101; CHG: 26||Not reimbursed separately|2,770.20|PHR: 408101; CHG: 26||External grouping not supported 208684|ERX|HCPCS A9270|59676-0040-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERDAFITINIB 4 MG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,462.40|PHR: 408101; CHG: 26||Not reimbursed separately|2,462.40|PHR: 408101; CHG: 26||External grouping not supported 208685|ERX|HCPCS A9270|59676-0050-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERDAFITINIB 5 MG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,078.00|PHR: 408101; CHG: 26||Not reimbursed separately|3,078.00|PHR: 408101; CHG: 26||External grouping not supported 208860|ERX|HCPCS J0270|00009-5182-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALPROSTADIL 20 MCG INTRACAVERNOSAL SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|274.40|PHR: 408101; CHG: 26||Not reimbursed separately|274.40|PHR: 408101; CHG: 26||External grouping not supported 20887|ERX|HCPCS RX001|00143-9785-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 20887|ERX|HCPCS RX001|00143-9785-10|0250 - PHARMACY - GENERAL CLASSIFICATION|VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 20887|ERX|HCPCS RX001|63323-0494-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 20887|ERX|HCPCS RX001|63323-0494-05|0250 - PHARMACY - GENERAL CLASSIFICATION|VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 20887|ERX|HCPCS RX001|63323-0494-16|0250 - PHARMACY - GENERAL CLASSIFICATION|VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 20887|ERX|HCPCS RX001|63323-0494-41|0250 - PHARMACY - GENERAL CLASSIFICATION|VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 2091|ERX|HCPCS J9130|00703-5075-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DACARBAZINE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|42.60|PHR: 408101; CHG: 26||Not reimbursed separately|42.60|PHR: 408101; CHG: 26||External grouping not supported 209123|ERX|HCPCS J9309|50242-0105-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION|140 mg|HUMANA [1294]||HUMANA [11839]|45,000.00|PHR: 408101; CHG: 26||Not reimbursed separately|45,000.00|PHR: 408101; CHG: 26||External grouping not supported 20919|ERX|HCPCS A9270|00406-8390-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.25|PHR: 408101; CHG: 26||Not reimbursed separately|9.25|PHR: 408101; CHG: 26||External grouping not supported 20919|ERX|HCPCS A9270|00406-8390-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.25|PHR: 408101; CHG: 26||Not reimbursed separately|9.25|PHR: 408101; CHG: 26||External grouping not supported 20920|ERX|HCPCS A9270|00228-4270-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20920|ERX|HCPCS A9270|00406-8315-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20920|ERX|HCPCS A9270|68084-0157-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20920|ERX|HCPCS A9270|68084-0157-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20920|ERX|HCPCS A9270|68084-0403-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20920|ERX|HCPCS A9270|68084-0403-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20921|ERX|HCPCS A9270|00228-4271-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 20921|ERX|HCPCS A9270|00406-8330-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 20921|ERX|HCPCS A9270|00904-6558-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 20921|ERX|HCPCS A9270|68084-0158-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 20922|ERX|HCPCS A9270|00406-8380-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 60 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.31|PHR: 408101; CHG: 26||Not reimbursed separately|5.31|PHR: 408101; CHG: 26||External grouping not supported 20922|ERX|HCPCS A9270|00406-8380-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE ER 60 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.31|PHR: 408101; CHG: 26||Not reimbursed separately|5.31|PHR: 408101; CHG: 26||External grouping not supported 209283|ERX|HCPCS Q5107|55513-0207-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION|16 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,846.32|PHR: 408101; CHG: 26||Not reimbursed separately|7,846.32|PHR: 408101; CHG: 26||External grouping not supported 209283|ERX|HCPCS Q5107|55513-0206-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|1,961.62|PHR: 408101; CHG: 26||Not reimbursed separately|1,961.62|PHR: 408101; CHG: 26||External grouping not supported 209318|ERX|HCPCS Q5117|55513-0132-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION|420 mg|HUMANA [1294]||HUMANA [11839]|10,706.37|PHR: 408101; CHG: 26||Not reimbursed separately|10,706.37|PHR: 408101; CHG: 26||External grouping not supported 209333|ERX|HCPCS A9270|44677-0102-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MODIFIED LANOLIN 100 % TOPICAL CREAM|7 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.46|PHR: 408101; CHG: 26||Not reimbursed separately|5.46|PHR: 408101; CHG: 26||External grouping not supported 209357|ERX|HCPCS A9270|72237-0101-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SELINEXOR 80 MG/WEEK (20 MG X 4) TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,304.00|PHR: 408101; CHG: 26||Not reimbursed separately|17,304.00|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|50111-0787-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|50111-0787-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|50268-0098-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|51224-0022-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|60687-0282-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|64679-0961-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|68180-0160-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20943|ERX|HCPCS A9270|68180-0160-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 20952|ERX|HCPCS A9270|50383-0172-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOCARNITINE 330 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20952|ERX|HCPCS A9270|54482-0144-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOCARNITINE 330 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 20954|ERX|HCPCS J1955|54482-0147-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|49.77|PHR: 408101; CHG: 26||Not reimbursed separately|49.77|PHR: 408101; CHG: 26||External grouping not supported 210037|ERX|HCPCS RX011|43825-0102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETAMINOPHEN 10 MG/ML SYRINGE (NICU)|100 mL|HUMANA [1294]||HUMANA [11839]|129.00|PHR: 408101; CHG: 26||Not reimbursed separately|129.00|PHR: 408101; CHG: 26||External grouping not supported 210060|ERX|HCPCS Q5115|63459-0103-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RITUXIMAB-ABBS 10 MG/ML CONCENTRATE,INTRAVENOUS|10 mL|HUMANA [1294]||HUMANA [11839]|1,980.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,980.00|PHR: 408101; CHG: 26||External grouping not supported 210060|ERX|HCPCS Q5115|63459-0104-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RITUXIMAB-ABBS 10 MG/ML CONCENTRATE,INTRAVENOUS|50 mL|HUMANA [1294]||HUMANA [11839]|9,900.00|PHR: 408101; CHG: 26||Not reimbursed separately|9,900.00|PHR: 408101; CHG: 26||External grouping not supported 210227|ERX|HCPCS Q5117|55513-0141-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION|150 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,823.71|PHR: 408101; CHG: 26||Not reimbursed separately|3,823.71|PHR: 408101; CHG: 26||External grouping not supported 210412|ERX|HCPCS Q5114|67457-0847-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION|420 mg|HUMANA [1294]||HUMANA [11839]|9,841.20|PHR: 408101; CHG: 26||Not reimbursed separately|9,841.20|PHR: 408101; CHG: 26||External grouping not supported 210414|ERX|HCPCS Q5114|67457-0991-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRASTUZUMAB-DKST 150 MG INTRAVENOUS SOLUTION|150 mg|HUMANA [1294]||HUMANA [11839]|3,525.93|PHR: 408101; CHG: 26||Not reimbursed separately|3,525.93|PHR: 408101; CHG: 26||External grouping not supported 21044|ERX|HCPCS J1950|00074-3663-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT|11.25 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,223.86|PHR: 408101; CHG: 26||Not reimbursed separately|12,223.86|PHR: 408101; CHG: 26||External grouping not supported 21045|ERX|HCPCS J9217|00074-3346-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT|22.5 mg|HUMANA [1294]||HUMANA [11839]|14,566.47|PHR: 408101; CHG: 26||Not reimbursed separately|14,566.47|PHR: 408101; CHG: 26||External grouping not supported 210487|ERX|HCPCS J0896|59572-0711-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION|25 mg|HUMANA [1294]||HUMANA [11839]|10,323.54|PHR: 408101; CHG: 26||Not reimbursed separately|10,323.54|PHR: 408101; CHG: 26||External grouping not supported 210488|ERX|HCPCS J0896|59572-0775-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION|75 mg|HUMANA [1294]||HUMANA [11839]|30,970.59|PHR: 408101; CHG: 26||Not reimbursed separately|30,970.59|PHR: 408101; CHG: 26||External grouping not supported 21057|ERX|HCPCS A9270|00904-6283-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 21057|ERX|HCPCS A9270|60505-3110-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 21061|ERX|HCPCS A9270|68084-0853-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 21061|ERX|HCPCS A9270|68084-0853-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 21061|ERX|HCPCS A9270|68462-0138-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 21062|ERX|HCPCS A9270|00904-6085-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CITALOPRAM 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 21062|ERX|HCPCS A9270|13668-0010-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CITALOPRAM 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 21062|ERX|HCPCS A9270|68084-0744-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CITALOPRAM 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|00069-3150-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|00069-3150-84|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|55150-0174-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|62756-0512-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|62756-0512-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|63323-0398-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|63323-0398-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|63323-0398-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|63323-0398-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|67457-0860-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|70436-0019-82|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|70860-0100-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 21063|ERX|HCPCS J0456|70860-0100-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.01|PHR: 408101; CHG: 26||Not reimbursed separately|7.01|PHR: 408101; CHG: 26||External grouping not supported 210833|ERX|HCPCS A9270|63323-0254-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINERAL OIL, LIGHT STERILE|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.82|PHR: 408101; CHG: 26||Not reimbursed separately|23.82|PHR: 408101; CHG: 26||External grouping not supported 210917|ERX|HCPCS J9358|65597-0406-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|6,887.91|PHR: 408101; CHG: 26||Not reimbursed separately|6,887.91|PHR: 408101; CHG: 26||External grouping not supported 2110|ERX|HCPCS RX001|39328-0062-50|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYPOCHLORITE 0.5 % SOLUTION|473 mL|HUMANA [1294]||HUMANA [11839]|24.13|PHR: 408101; CHG: 26||Not reimbursed separately|24.13|PHR: 408101; CHG: 26||External grouping not supported 21108|ERX|HCPCS J9217|00074-3683-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT|30 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,422.00|PHR: 408101; CHG: 26||Not reimbursed separately|19,422.00|PHR: 408101; CHG: 26||External grouping not supported 211162|ERX|HCPCS J3241|75987-0130-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|44,700.00|PHR: 408101; CHG: 26||Not reimbursed separately|44,700.00|PHR: 408101; CHG: 26||External grouping not supported 21135|ERX|HCPCS A9270|47335-0788-91|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.35|PHR: 408101; CHG: 26||Not reimbursed separately|241.35|PHR: 408101; CHG: 26||External grouping not supported 211870|ERX|HCPCS C9066|55135-0132-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION|18 mL|HUMANA [1294]||HUMANA [11839]|10,867.50|PHR: 408101; CHG: 26||Not reimbursed separately|10,867.50|PHR: 408101; CHG: 26||External grouping not supported 2120|ERX|HCPCS A9270|00527-1369-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DANAZOL 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.20|PHR: 408101; CHG: 26||Not reimbursed separately|7.20|PHR: 408101; CHG: 26||External grouping not supported 2120|ERX|HCPCS A9270|00555-0635-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DANAZOL 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.20|PHR: 408101; CHG: 26||Not reimbursed separately|7.20|PHR: 408101; CHG: 26||External grouping not supported 212051|ERX|HCPCS C9062|57894-0503-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN|15 mL|HUMANA [1294]||HUMANA [11839]|22,721.99|PHR: 408101; CHG: 26||Not reimbursed separately|22,721.99|PHR: 408101; CHG: 26||External grouping not supported 212093|ERX|HCPCS C9399|61958-2902-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|REMDESIVIR 100 MG/20 ML (5 MG/ML) IV SOLN (FOR PTS 40 KG OR MORE)|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 21228|ERX|HCPCS J0270|52244-0020-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALPROSTADIL 20 MCG INTRACAVERNOSAL KIT|20 mcg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.20|PHR: 408101; CHG: 26||Not reimbursed separately|241.20|PHR: 408101; CHG: 26||External grouping not supported 212293|ERX|HCPCS C9399|61958-2901-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|PHR: 408101; CHG: 26||Not reimbursed separately|1,560.00|PHR: 408101; CHG: 26||External grouping not supported 212312|ERX|HCPCS A9270|00087-0405-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PEDIATRIC MULTIVITAMIN NO.189-FERROUS SULFATE 11 MG/ML ORAL DROPS|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 212416|ERX|HCPCS C9399|68727-0712-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION|4 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,899.00|PHR: 408101; CHG: 26||Not reimbursed separately|19,899.00|PHR: 408101; CHG: 26||External grouping not supported 212594|ERX|HCPCS 90686|58160-0885-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|56.43|PHR: 408101; CHG: 26||Not reimbursed separately|56.43|PHR: 408101; CHG: 26||External grouping not supported 212594|ERX|HCPCS 90686|58160-0885-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.43|PHR: 408101; CHG: 26||Not reimbursed separately|56.43|PHR: 408101; CHG: 26||External grouping not supported 212597|ERX|HCPCS RX001|00173-0857-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DILUENT FOR EPOPROSTENOL (GLYCINE) PH 11.7 - 12.3 INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|53.10|PHR: 408101; CHG: 26||Not reimbursed separately|53.10|PHR: 408101; CHG: 26||External grouping not supported 212598|ERX|HCPCS 90682|49281-0720-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLU VACCINE QV2020(18YR UP)RCMB(PF)180 MCG(45 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|153.30|PHR: 408101; CHG: 26||Not reimbursed separately|153.30|PHR: 408101; CHG: 26||External grouping not supported 212598|ERX|HCPCS 90682|49281-0720-88|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLU VACCINE QV2020(18YR UP)RCMB(PF)180 MCG(45 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.30|PHR: 408101; CHG: 26||Not reimbursed separately|153.30|PHR: 408101; CHG: 26||External grouping not supported 212601|ERX|HCPCS 90662|49281-0120-65|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLU VACCINE QS2020-21(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE|0.7 mL|HUMANA [1294]||HUMANA [11839]|153.30|PHR: 408101; CHG: 26||Not reimbursed separately|153.30|PHR: 408101; CHG: 26||External grouping not supported 212601|ERX|HCPCS 90662|49281-0120-88|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLU VACCINE QS2020-21(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.30|PHR: 408101; CHG: 26||Not reimbursed separately|153.30|PHR: 408101; CHG: 26||External grouping not supported 212639|ERX|HCPCS A9270|00087-0402-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 21284|ERX|HCPCS A9270|00185-0831-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 21284|ERX|HCPCS A9270|00406-8891-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 21284|ERX|HCPCS A9270|00555-0971-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 21287|ERX|HCPCS A9270|13668-0091-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 0.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 21287|ERX|HCPCS A9270|68462-0330-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 0.125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 21288|ERX|HCPCS A9270|13668-0094-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 21288|ERX|HCPCS A9270|68462-0333-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 21289|ERX|HCPCS A9270|13668-0095-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 1.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 21290|ERX|HCPCS A9270|13668-0092-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 21290|ERX|HCPCS A9270|68462-0331-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 212958|ERX|HCPCS J7674|69374-0542-06|0250 - PHARMACY - GENERAL CLASSIFICATION|METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN|18 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|140.01|PHR: 408101; CHG: 26||Not reimbursed separately|140.01|PHR: 408101; CHG: 26||External grouping not supported 21300|ERX|HCPCS A9270|00904-5448-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 21300|ERX|HCPCS A9270|60505-0033-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 21300|ERX|HCPCS A9270|68682-0101-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 2131|ERX|HCPCS A9270|13925-0505-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DAPSONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 2132|ERX|HCPCS A9270|13925-0504-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DAPSONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 2132|ERX|HCPCS A9270|29033-0036-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DAPSONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 2132|ERX|HCPCS A9270|49938-0102-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DAPSONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.28|PHR: 408101; CHG: 26||Not reimbursed separately|2.28|PHR: 408101; CHG: 26||External grouping not supported 21372|ERX|HCPCS A9270|00832-1215-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 21372|ERX|HCPCS A9270|00832-1215-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 21509|ERX|HCPCS A9270|00093-7620-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LETROZOLE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 21509|ERX|HCPCS A9270|16729-0034-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LETROZOLE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 21509|ERX|HCPCS A9270|51991-0759-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LETROZOLE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 21529|ERX|HCPCS A9270|45802-0425-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEXOFENADINE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 21672|ERX|HCPCS RX002|24338-0050-08|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CARMUSTINE IN POLIFEPROSAN 7.7 MG WAFER FOR IMPLANT|1 Wafer|HUMANA [1294]||HUMANA [11839]|12,011.10|PHR: 408101; CHG: 26||Not reimbursed separately|12,011.10|PHR: 408101; CHG: 26||External grouping not supported 21688|ERX|HCPCS A9270|00904-6373-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 21688|ERX|HCPCS A9270|43547-0268-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 21688|ERX|HCPCS A9270|68462-0253-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 21689|ERX|HCPCS A9270|00904-6374-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 21689|ERX|HCPCS A9270|43547-0270-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 21689|ERX|HCPCS A9270|62332-0032-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 21689|ERX|HCPCS A9270|68462-0255-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 21690|ERX|HCPCS A9270|62332-0033-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 21690|ERX|HCPCS A9270|68462-0256-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 21726|ERX|HCPCS RX001|66490-0650-20|0250 - PHARMACY - GENERAL CLASSIFICATION|DIAZEPAM 2.5 MG RECTAL KIT|1 Each|HUMANA [1294]||HUMANA [11839]|271.20|PHR: 408101; CHG: 26||Not reimbursed separately|271.20|PHR: 408101; CHG: 26||External grouping not supported 21800|ERX|HCPCS A9270|62332-0031-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 21800|ERX|HCPCS A9270|68462-0254-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 21810|ERX|HCPCS A9270|31722-0506-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.82|PHR: 408101; CHG: 26||Not reimbursed separately|5.82|PHR: 408101; CHG: 26||External grouping not supported 21823|ERX|HCPCS A9270|00054-0220-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 21823|ERX|HCPCS A9270|00904-6638-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 21823|ERX|HCPCS A9270|60687-0327-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 21823|ERX|HCPCS A9270|60687-0327-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 21825|ERX|HCPCS A9270|00904-6641-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.78|PHR: 408101; CHG: 26||Not reimbursed separately|0.78|PHR: 408101; CHG: 26||External grouping not supported 21825|ERX|HCPCS A9270|60687-0360-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.78|PHR: 408101; CHG: 26||Not reimbursed separately|0.78|PHR: 408101; CHG: 26||External grouping not supported 21825|ERX|HCPCS A9270|63739-0677-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.78|PHR: 408101; CHG: 26||Not reimbursed separately|0.78|PHR: 408101; CHG: 26||External grouping not supported 21827|ERX|HCPCS A9270|00093-5031-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIAGABINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.49|PHR: 408101; CHG: 26||Not reimbursed separately|15.49|PHR: 408101; CHG: 26||External grouping not supported 21900|ERX|HCPCS J0289|00469-3051-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION|50 mg|HUMANA [1294]||HUMANA [11839]|285.60|PHR: 408101; CHG: 26||Not reimbursed separately|285.60|PHR: 408101; CHG: 26||External grouping not supported 22120|ERX|HCPCS 90675|58160-0964-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP|1 Kit|HUMANA [1294]||HUMANA [11839]|959.61|PHR: 408101; CHG: 26||Not reimbursed separately|959.61|PHR: 408101; CHG: 26||External grouping not supported 22120|ERX|HCPCS 90675|58160-0966-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP|1 Kit|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.61|PHR: 408101; CHG: 26||Not reimbursed separately|959.61|PHR: 408101; CHG: 26||External grouping not supported 22142|ERX|HCPCS A9270|00904-6294-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOPIDOGREL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 22142|ERX|HCPCS A9270|65862-0357-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOPIDOGREL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 22142|ERX|HCPCS A9270|68084-0536-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOPIDOGREL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 22142|ERX|HCPCS A9270|68084-0536-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOPIDOGREL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 22143|ERX|HCPCS A9270|43598-0505-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RALOXIFENE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.34|PHR: 408101; CHG: 26||Not reimbursed separately|6.34|PHR: 408101; CHG: 26||External grouping not supported 22143|ERX|HCPCS A9270|43598-0505-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RALOXIFENE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.34|PHR: 408101; CHG: 26||Not reimbursed separately|6.34|PHR: 408101; CHG: 26||External grouping not supported 22144|ERX|HCPCS J9211|00703-4155-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|158.70|PHR: 408101; CHG: 26||Not reimbursed separately|158.70|PHR: 408101; CHG: 26||External grouping not supported 22144|ERX|HCPCS J9211|00703-4154-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|142.38|PHR: 408101; CHG: 26||Not reimbursed separately|142.38|PHR: 408101; CHG: 26||External grouping not supported 22149|ERX|HCPCS J9312|50242-0051-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS|10 mL|HUMANA [1294]||HUMANA [11839]|2,818.56|PHR: 408101; CHG: 26||Not reimbursed separately|2,818.56|PHR: 408101; CHG: 26||External grouping not supported 22149|ERX|HCPCS J9312|50242-0053-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,092.80|PHR: 408101; CHG: 26||Not reimbursed separately|14,092.80|PHR: 408101; CHG: 26||External grouping not supported 22185|ERX|HCPCS J1451|67457-0211-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION|1.5 mL|HUMANA [1294]||HUMANA [11839]|1,576.77|PHR: 408101; CHG: 26||Not reimbursed separately|1,576.77|PHR: 408101; CHG: 26||External grouping not supported 22185|ERX|HCPCS J1451|70710-1478-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION|1.5 mL|HUMANA [1294]||HUMANA [11839]|1,576.77|PHR: 408101; CHG: 26||Not reimbursed separately|1,576.77|PHR: 408101; CHG: 26||External grouping not supported 22220|ERX|HCPCS A9270|50484-0810-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BECAPLERMIN 0.01 % TOPICAL GEL|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,247.20|PHR: 408101; CHG: 26||Not reimbursed separately|3,247.20|PHR: 408101; CHG: 26||External grouping not supported 22240|ERX|HCPCS A9270|17478-0340-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.00|PHR: 408101; CHG: 26||Not reimbursed separately|27.00|PHR: 408101; CHG: 26||External grouping not supported 22251|ERX|HCPCS A9270|68462-0564-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MUPIROCIN CALCIUM 2 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.36|PHR: 408101; CHG: 26||Not reimbursed separately|441.36|PHR: 408101; CHG: 26||External grouping not supported 22257|ERX|HCPCS A9270|24208-0410-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OFLOXACIN 0.3 % EAR DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.38|PHR: 408101; CHG: 26||Not reimbursed separately|22.38|PHR: 408101; CHG: 26||External grouping not supported 22257|ERX|HCPCS A9270|60505-0363-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OFLOXACIN 0.3 % EAR DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.38|PHR: 408101; CHG: 26||Not reimbursed separately|22.38|PHR: 408101; CHG: 26||External grouping not supported 22289|ERX|HCPCS A9270|00093-3160-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFDINIR 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 22289|ERX|HCPCS A9270|00781-2176-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFDINIR 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 22289|ERX|HCPCS A9270|65862-0177-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFDINIR 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 22289|ERX|HCPCS A9270|68001-0362-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFDINIR 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 22469|ERX|HCPCS A9270|00904-5224-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTASE 3,000 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|00338-0072-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|00409-3795-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|00409-3795-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|00641-6042-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|00641-6042-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|25021-0701-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|47781-0584-93|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|63323-0162-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|70860-0701-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|70860-0701-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|70860-0701-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|72266-0118-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|72611-0722-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22473|ERX|HCPCS J1885|63323-0162-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|2.27|PHR: 408101; CHG: 26||Not reimbursed separately|2.27|PHR: 408101; CHG: 26||External grouping not supported 22509|ERX|HCPCS A9270|55111-0725-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 22509|ERX|HCPCS A9270|68001-0361-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 22509|ERX|HCPCS A9270|68084-0875-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 22509|ERX|HCPCS A9270|68084-0875-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 22510|ERX|HCPCS A9270|00093-7425-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 5 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 22510|ERX|HCPCS A9270|00781-5555-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 5 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 22510|ERX|HCPCS A9270|31722-0728-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 5 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 22532|ERX|HCPCS Q3028|44087-0044-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INTERFERON BETA-1A (ALBUMIN) 44 MCG/0.5 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|1,928.58|PHR: 408101; CHG: 26||Not reimbursed separately|1,928.58|PHR: 408101; CHG: 26||External grouping not supported 22532|ERX|HCPCS Q3028|44087-0044-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INTERFERON BETA-1A (ALBUMIN) 44 MCG/0.5 ML SUBCUTANEOUS SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|1,928.58|PHR: 408101; CHG: 26||Not reimbursed separately|1,928.58|PHR: 408101; CHG: 26||External grouping not supported 22560|ERX|HCPCS A9270|00121-0854-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 22560|ERX|HCPCS A9270|50383-0824-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 22560|ERX|HCPCS A9270|65862-0496-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 22560|ERX|HCPCS A9270|99999-2222-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 22584|ERX|HCPCS A9270|00574-0240-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|REPAGLINIDE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 22584|ERX|HCPCS A9270|57237-0157-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|REPAGLINIDE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 22585|ERX|HCPCS A9270|00574-0242-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|REPAGLINIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 22585|ERX|HCPCS A9270|57664-0747-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|REPAGLINIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 22586|ERX|HCPCS A9270|00574-0241-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|REPAGLINIDE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 22586|ERX|HCPCS A9270|57664-0745-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|REPAGLINIDE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|00904-6389-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|13668-0115-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|50268-0518-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|50268-0518-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|65862-0203-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|65862-0203-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|68084-0348-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|68084-0348-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|68382-0137-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22588|ERX|HCPCS A9270|68382-0137-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOSARTAN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 22646|ERX|HCPCS RX001|00121-0676-16|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 22719|ERX|HCPCS A9270|13668-0093-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAMIPEXOLE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 22776|ERX|HCPCS RX001|00406-1520-53|0250 - PHARMACY - GENERAL CLASSIFICATION|COCAINE (BULK) 100 % CRYSTALS|0.2 g|HUMANA [1294]||HUMANA [11839]|34.14|PHR: 408101; CHG: 26||Not reimbursed separately|34.14|PHR: 408101; CHG: 26||External grouping not supported 22776|ERX|HCPCS RX001|99999-2222-34|0250 - PHARMACY - GENERAL CLASSIFICATION|COCAINE (BULK) 100 % CRYSTALS|200 mg|HUMANA [1294]||HUMANA [11839]|34.14|PHR: 408101; CHG: 26||Not reimbursed separately|34.14|PHR: 408101; CHG: 26||External grouping not supported 2283|ERX|HCPCS A9270|45963-0341-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 2283|ERX|HCPCS A9270|50742-0112-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 2283|ERX|HCPCS A9270|62559-0710-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 2286|ERX|HCPCS A9270|45963-0342-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.54|PHR: 408101; CHG: 26||Not reimbursed separately|2.54|PHR: 408101; CHG: 26||External grouping not supported 2286|ERX|HCPCS A9270|50742-0113-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.54|PHR: 408101; CHG: 26||Not reimbursed separately|2.54|PHR: 408101; CHG: 26||External grouping not supported 2286|ERX|HCPCS A9270|62559-0711-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.54|PHR: 408101; CHG: 26||Not reimbursed separately|2.54|PHR: 408101; CHG: 26||External grouping not supported 2286|ERX|HCPCS A9270|69238-1055-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESIPRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.54|PHR: 408101; CHG: 26||Not reimbursed separately|2.54|PHR: 408101; CHG: 26||External grouping not supported 22953|ERX|HCPCS A9270|00065-0275-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|899.43|PHR: 408101; CHG: 26||Not reimbursed separately|899.43|PHR: 408101; CHG: 26||External grouping not supported 22953|ERX|HCPCS A9270|00065-0275-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,798.86|PHR: 408101; CHG: 26||Not reimbursed separately|1,798.86|PHR: 408101; CHG: 26||External grouping not supported 22959|ERX|HCPCS RX015|60505-0402-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PAROXETINE 10 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|19.91|PHR: 408101; CHG: 26||Not reimbursed separately|19.91|PHR: 408101; CHG: 26||External grouping not supported 22960|ERX|HCPCS J2501|00074-1658-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|28.89|PHR: 408101; CHG: 26||Not reimbursed separately|28.89|PHR: 408101; CHG: 26||External grouping not supported 22981|ERX|HCPCS J0287|57665-0101-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPHOTERICIN B LIPID COMPLEX 5 MG/ML INTRAVENOUS SUSPENSION|20 mL|HUMANA [1294]||HUMANA [11839]|246.78|PHR: 408101; CHG: 26||Not reimbursed separately|246.78|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|17478-0605-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|24208-0486-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|42571-0147-26|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|50383-0233-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|60429-0115-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|61314-0030-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22982|ERX|HCPCS A9270|70069-0051-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 22986|ERX|HCPCS A9270|00065-8531-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|873.24|PHR: 408101; CHG: 26||Not reimbursed separately|873.24|PHR: 408101; CHG: 26||External grouping not supported 22992|ERX|HCPCS A9270|00781-1874-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.42|PHR: 408101; CHG: 26||Not reimbursed separately|4.42|PHR: 408101; CHG: 26||External grouping not supported 22994|ERX|HCPCS A9270|00093-7474-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPECITABINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.81|PHR: 408101; CHG: 26||Not reimbursed separately|39.81|PHR: 408101; CHG: 26||External grouping not supported 22994|ERX|HCPCS A9270|60687-0149-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPECITABINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.81|PHR: 408101; CHG: 26||Not reimbursed separately|39.81|PHR: 408101; CHG: 26||External grouping not supported 22994|ERX|HCPCS A9270|60687-0149-94|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPECITABINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.81|PHR: 408101; CHG: 26||Not reimbursed separately|39.81|PHR: 408101; CHG: 26||External grouping not supported 23063|ERX|HCPCS A9270|00316-0229-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION|222 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 23063|ERX|HCPCS A9270|00536-1268-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION|222 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 23063|ERX|HCPCS A9270|46122-0573-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION|222 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 23063|ERX|HCPCS A9270|54162-0550-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION|222 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 23063|ERX|HCPCS A9270|73462-0062-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION|222 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 23082|ERX|HCPCS J0480|00078-0331-84|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BASILIXIMAB 20 MG INTRAVENOUS SOLUTION|20 mg|HUMANA [1294]||HUMANA [11839]|10,872.06|PHR: 408101; CHG: 26||Not reimbursed separately|10,872.06|PHR: 408101; CHG: 26||External grouping not supported 23122|ERX|HCPCS A9270|43598-0349-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROGESTERONE MICRONIZED 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|00085-1136-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|00338-9558-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|25021-0408-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|55150-0218-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|67457-0631-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|70121-1003-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23123|ERX|HCPCS J1327|70436-0027-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|PHR: 408101; CHG: 26||Not reimbursed separately|177.00|PHR: 408101; CHG: 26||External grouping not supported 23128|ERX|HCPCS J0133|55150-0154-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.97|PHR: 408101; CHG: 26||Not reimbursed separately|8.97|PHR: 408101; CHG: 26||External grouping not supported 23128|ERX|HCPCS J0133|63323-0325-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|8.97|PHR: 408101; CHG: 26||Not reimbursed separately|8.97|PHR: 408101; CHG: 26||External grouping not supported 23128|ERX|HCPCS J0133|63323-0325-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.97|PHR: 408101; CHG: 26||Not reimbursed separately|8.97|PHR: 408101; CHG: 26||External grouping not supported 23128|ERX|HCPCS J0133|55150-0155-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.94|PHR: 408101; CHG: 26||Not reimbursed separately|17.94|PHR: 408101; CHG: 26||External grouping not supported 23128|ERX|HCPCS J0133|63323-0325-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.94|PHR: 408101; CHG: 26||Not reimbursed separately|17.94|PHR: 408101; CHG: 26||External grouping not supported 23128|ERX|HCPCS J0133|63323-0325-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.94|PHR: 408101; CHG: 26||Not reimbursed separately|17.94|PHR: 408101; CHG: 26||External grouping not supported 2320|ERX|HCPCS J8540|00054-3177-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 2322|ERX|HCPCS J8540|00054-4179-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 2322|ERX|HCPCS J8540|00054-8179-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 2323|ERX|HCPCS J8540|00054-8180-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 0.75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 23232|ERX|HCPCS A9270|49884-0661-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CANDESARTAN 32 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.14|PHR: 408101; CHG: 26||Not reimbursed separately|5.14|PHR: 408101; CHG: 26||External grouping not supported 23233|ERX|HCPCS A9270|49884-0902-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAFENIDE 50 GRAM TOPICAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.27|PHR: 408101; CHG: 26||Not reimbursed separately|210.27|PHR: 408101; CHG: 26||External grouping not supported 23233|ERX|HCPCS A9270|49884-0902-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAFENIDE 50 GRAM TOPICAL PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.27|PHR: 408101; CHG: 26||Not reimbursed separately|210.27|PHR: 408101; CHG: 26||External grouping not supported 23234|ERX|HCPCS A9270|00065-0654-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|592.62|PHR: 408101; CHG: 26||Not reimbursed separately|592.62|PHR: 408101; CHG: 26||External grouping not supported 2324|ERX|HCPCS J8540|00054-4181-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 2324|ERX|HCPCS J8540|00054-8174-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 2326|ERX|HCPCS J8540|00054-4183-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 2326|ERX|HCPCS J8540|00054-8176-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 2327|ERX|HCPCS J8540|00054-4184-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.38|PHR: 408101; CHG: 26||Not reimbursed separately|2.38|PHR: 408101; CHG: 26||External grouping not supported 2327|ERX|HCPCS J8540|00054-8175-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.38|PHR: 408101; CHG: 26||Not reimbursed separately|2.38|PHR: 408101; CHG: 26||External grouping not supported 2327|ERX|HCPCS J8540|48102-0047-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.38|PHR: 408101; CHG: 26||Not reimbursed separately|2.38|PHR: 408101; CHG: 26||External grouping not supported 2331|ERX|HCPCS J1100|00641-0367-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.40|PHR: 408101; CHG: 26||Not reimbursed separately|3.40|PHR: 408101; CHG: 26||External grouping not supported 2331|ERX|HCPCS J1100|63323-0516-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.40|PHR: 408101; CHG: 26||Not reimbursed separately|3.40|PHR: 408101; CHG: 26||External grouping not supported 2331|ERX|HCPCS J1100|67457-0420-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.40|PHR: 408101; CHG: 26||Not reimbursed separately|3.40|PHR: 408101; CHG: 26||External grouping not supported 2331|ERX|HCPCS J1100|00641-0367-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|3.40|PHR: 408101; CHG: 26||Not reimbursed separately|3.40|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|00641-6145-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|00641-6145-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|55150-0239-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|67457-0421-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|67457-0421-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|67457-0422-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|67457-0423-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|55150-0237-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.15|PHR: 408101; CHG: 26||Not reimbursed separately|2.15|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|63323-0165-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.15|PHR: 408101; CHG: 26||Not reimbursed separately|2.15|PHR: 408101; CHG: 26||External grouping not supported 2332|ERX|HCPCS J1100|67457-0422-54|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.15|PHR: 408101; CHG: 26||Not reimbursed separately|2.15|PHR: 408101; CHG: 26||External grouping not supported 2335|ERX|HCPCS A9270|24208-0720-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|133.65|PHR: 408101; CHG: 26||Not reimbursed separately|133.65|PHR: 408101; CHG: 26||External grouping not supported 23377|ERX|HCPCS A9270|68462-0466-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 23449|ERX|HCPCS A9270|16729-0007-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 23461|ERX|HCPCS RX015|24357-0701-05|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 4 % TOPICAL CREAM|1 Each|HUMANA [1294]||HUMANA [11839]|7.47|PHR: 408101; CHG: 26||Not reimbursed separately|7.47|PHR: 408101; CHG: 26||External grouping not supported 23490|ERX|HCPCS A9270|13668-0011-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CITALOPRAM 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 2357|ERX|HCPCS RX004|00338-0023-04|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2357|ERX|HCPCS RX004|00338-0023-02|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2357|ERX|HCPCS RX004|00338-0023-03|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2359|ERX|HCPCS RX011|00990-7935-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|37.50|PHR: 408101; CHG: 26||Not reimbursed separately|37.50|PHR: 408101; CHG: 26||External grouping not supported 2361|ERX|HCPCS RX001|00409-1775-10|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|22.05|PHR: 408101; CHG: 26||Not reimbursed separately|22.05|PHR: 408101; CHG: 26||External grouping not supported 2364|ERX|HCPCS J7060|00338-0017-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2364|ERX|HCPCS J7060|00338-0017-38|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2364|ERX|HCPCS J7060|00338-0017-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2364|ERX|HCPCS J7060|00338-0017-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2364|ERX|HCPCS J7060|00338-0017-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 2365|ERX|HCPCS RX004|00409-6648-02|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|3.53|PHR: 408101; CHG: 26||Not reimbursed separately|3.53|PHR: 408101; CHG: 26||External grouping not supported 2365|ERX|HCPCS RX004|00409-6648-16|0258 - PHARMACY - IV SOLUTIONS|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|3.53|PHR: 408101; CHG: 26||Not reimbursed separately|3.53|PHR: 408101; CHG: 26||External grouping not supported 2367|ERX|HCPCS RX001|00338-0719-06|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|42.00|PHR: 408101; CHG: 26||Not reimbursed separately|42.00|PHR: 408101; CHG: 26||External grouping not supported 23796|ERX|HCPCS J1745|57894-0030-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INFLIXIMAB 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|3,405.42|PHR: 408101; CHG: 26||Not reimbursed separately|3,405.42|PHR: 408101; CHG: 26||External grouping not supported 23814|ERX|HCPCS A9270|68001-0245-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.81|PHR: 408101; CHG: 26||Not reimbursed separately|7.81|PHR: 408101; CHG: 26||External grouping not supported 23814|ERX|HCPCS A9270|68001-0245-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOVAQUONE 250 MG-PROGUANIL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.81|PHR: 408101; CHG: 26||Not reimbursed separately|7.81|PHR: 408101; CHG: 26||External grouping not supported 23872|ERX|HCPCS A9270|60505-2502-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEFLUNOMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.73|PHR: 408101; CHG: 26||Not reimbursed separately|1.73|PHR: 408101; CHG: 26||External grouping not supported 23872|ERX|HCPCS A9270|62332-0061-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEFLUNOMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.73|PHR: 408101; CHG: 26||Not reimbursed separately|1.73|PHR: 408101; CHG: 26||External grouping not supported 23876|ERX|HCPCS J7100|00409-7419-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|81.00|PHR: 408101; CHG: 26||Not reimbursed separately|81.00|PHR: 408101; CHG: 26||External grouping not supported 23876|ERX|HCPCS J7100|00409-7419-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|81.00|PHR: 408101; CHG: 26||Not reimbursed separately|81.00|PHR: 408101; CHG: 26||External grouping not supported 23898|ERX|HCPCS A9270|00056-0470-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EFAVIRENZ 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.50|PHR: 408101; CHG: 26||Not reimbursed separately|7.50|PHR: 408101; CHG: 26||External grouping not supported 23900|ERX|HCPCS A9270|00056-0474-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EFAVIRENZ 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.13|PHR: 408101; CHG: 26||Not reimbursed separately|30.13|PHR: 408101; CHG: 26||External grouping not supported 23968|ERX|HCPCS RX001|00004-0298-09|0250 - PHARMACY - GENERAL CLASSIFICATION|MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|221.16|PHR: 408101; CHG: 26||Not reimbursed separately|221.16|PHR: 408101; CHG: 26||External grouping not supported 23968|ERX|HCPCS RX001|00004-0298-30|0250 - PHARMACY - GENERAL CLASSIFICATION|MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|221.16|PHR: 408101; CHG: 26||Not reimbursed separately|221.16|PHR: 408101; CHG: 26||External grouping not supported 23968|ERX|HCPCS RX001|42023-0172-04|0250 - PHARMACY - GENERAL CLASSIFICATION|MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|221.16|PHR: 408101; CHG: 26||Not reimbursed separately|221.16|PHR: 408101; CHG: 26||External grouping not supported 2403|ERX|HCPCS A9270|00172-3927-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 2403|ERX|HCPCS A9270|51079-0286-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 2403|ERX|HCPCS A9270|51079-0286-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 2404|ERX|HCPCS A9270|00172-3925-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 2404|ERX|HCPCS A9270|51079-0284-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 2404|ERX|HCPCS A9270|51079-0284-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 2404|ERX|HCPCS A9270|51862-0062-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 2405|ERX|HCPCS A9270|00172-3926-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 2405|ERX|HCPCS A9270|00904-5880-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 2405|ERX|HCPCS A9270|51079-0285-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 2405|ERX|HCPCS A9270|51079-0285-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIAZEPAM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 24119|ERX|HCPCS A9270|00597-0047-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.18|PHR: 408101; CHG: 26||Not reimbursed separately|45.18|PHR: 408101; CHG: 26||External grouping not supported 2412|ERX|HCPCS A9270|00536-1211-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIBUCAINE 1 % TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.34|PHR: 408101; CHG: 26||Not reimbursed separately|10.34|PHR: 408101; CHG: 26||External grouping not supported 2412|ERX|HCPCS A9270|45802-0050-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIBUCAINE 1 % TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.34|PHR: 408101; CHG: 26||Not reimbursed separately|10.34|PHR: 408101; CHG: 26||External grouping not supported 2412|ERX|HCPCS A9270|54162-0011-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIBUCAINE 1 % TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.34|PHR: 408101; CHG: 26||Not reimbursed separately|10.34|PHR: 408101; CHG: 26||External grouping not supported 2414|ERX|HCPCS A9270|00093-3123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICLOXACILLIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|00641-6173-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.48|PHR: 408101; CHG: 26||Not reimbursed separately|27.48|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|14789-0010-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.48|PHR: 408101; CHG: 26||Not reimbursed separately|27.48|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|14789-0010-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.48|PHR: 408101; CHG: 26||Not reimbursed separately|27.48|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|58914-0080-52|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|27.48|PHR: 408101; CHG: 26||Not reimbursed separately|27.48|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|63323-0842-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.48|PHR: 408101; CHG: 26||Not reimbursed separately|27.48|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|63323-0842-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.48|PHR: 408101; CHG: 26||Not reimbursed separately|27.48|PHR: 408101; CHG: 26||External grouping not supported 2417|ERX|HCPCS J0500|00641-6173-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.96|PHR: 408101; CHG: 26||Not reimbursed separately|54.96|PHR: 408101; CHG: 26||External grouping not supported 24176|ERX|HCPCS A9270|00574-0150-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDAZOLAM 2 MG/ML ORAL SYRUP|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.99|PHR: 408101; CHG: 26||Not reimbursed separately|0.99|PHR: 408101; CHG: 26||External grouping not supported 24176|ERX|HCPCS A9270|99999-2222-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIDAZOLAM 2 MG/ML ORAL SYRUP|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.99|PHR: 408101; CHG: 26||Not reimbursed separately|0.99|PHR: 408101; CHG: 26||External grouping not supported 2418|ERX|HCPCS A9270|00527-0586-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2418|ERX|HCPCS A9270|00591-0794-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2418|ERX|HCPCS A9270|51079-0118-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2418|ERX|HCPCS A9270|51079-0118-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2418|ERX|HCPCS A9270|60687-0369-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2418|ERX|HCPCS A9270|60687-0369-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 24188|ERX|HCPCS RX001|00006-5424-02|0250 - PHARMACY - GENERAL CLASSIFICATION|ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR INJECTION|1 Each|HUMANA [1294]||HUMANA [11839]|33.26|PHR: 408101; CHG: 26||Not reimbursed separately|33.26|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|00378-1620-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|00527-1282-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|00591-0795-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|51079-0119-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|51079-0119-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|60687-0380-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 2420|ERX|HCPCS A9270|60687-0380-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DICYCLOMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|00536-1248-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|46122-0343-72|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|46122-0344-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|46122-0567-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|51645-0850-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|57896-0458-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|60258-0951-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|63739-0432-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|63739-0432-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|67618-0110-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|67618-0310-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|67618-0310-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24216|ERX|HCPCS A9270|87701-0427-57|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 24268|ERX|HCPCS A9270|00904-6450-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 24268|ERX|HCPCS A9270|50268-0452-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 24268|ERX|HCPCS A9270|50268-0452-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 24268|ERX|HCPCS A9270|62175-0119-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 24268|ERX|HCPCS A9270|68084-0592-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 24268|ERX|HCPCS A9270|68084-0592-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 24276|ERX|HCPCS J1438|58406-0425-34|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETANERCEPT 25 MG (1 ML) SUBCUTANEOUS POWDER FOR SOLUTION|1 Each|HUMANA [1294]||HUMANA [11839]|2,026.56|PHR: 408101; CHG: 26||Not reimbursed separately|2,026.56|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|00143-9638-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|00143-9638-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|55150-0173-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|63323-0273-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|64679-0728-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|64679-0728-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|67457-0880-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24326|ERX|HCPCS J3030|67457-0880-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.85|PHR: 408101; CHG: 26||Not reimbursed separately|8.85|PHR: 408101; CHG: 26||External grouping not supported 24335|ERX|HCPCS A9270|00597-0040-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TELMISARTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.89|PHR: 408101; CHG: 26||Not reimbursed separately|19.89|PHR: 408101; CHG: 26||External grouping not supported 24336|ERX|HCPCS A9270|00597-0041-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TELMISARTAN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.89|PHR: 408101; CHG: 26||Not reimbursed separately|19.89|PHR: 408101; CHG: 26||External grouping not supported 24336|ERX|HCPCS A9270|13668-0158-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TELMISARTAN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.89|PHR: 408101; CHG: 26||Not reimbursed separately|19.89|PHR: 408101; CHG: 26||External grouping not supported 2436|ERX|HCPCS A9270|00093-0755-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIFLUNISAL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.41|PHR: 408101; CHG: 26||Not reimbursed separately|2.41|PHR: 408101; CHG: 26||External grouping not supported 24398|ERX|HCPCS A9270|60687-0162-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 1,000 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 24398|ERX|HCPCS A9270|60687-0162-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN 1,000 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|00944-0491-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]||HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|44206-0310-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|44206-0310-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|44206-0310-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|44206-0310-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|68516-5214-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|68516-5214-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|68516-5214-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|68516-5214-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|68982-0623-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 244|ERX|HCPCS P9045|68982-0623-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 2443|ERX|HCPCS A9270|00054-0057-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|325.26|PHR: 408101; CHG: 26||Not reimbursed separately|325.26|PHR: 408101; CHG: 26||External grouping not supported 24438|ERX|HCPCS RX015|00378-4105-91|0250 - PHARMACY - GENERAL CLASSIFICATION|ABACAVIR 300 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|3.75|PHR: 408101; CHG: 26||Not reimbursed separately|3.75|PHR: 408101; CHG: 26||External grouping not supported 24438|ERX|HCPCS RX015|65862-0073-60|0250 - PHARMACY - GENERAL CLASSIFICATION|ABACAVIR 300 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|3.75|PHR: 408101; CHG: 26||Not reimbursed separately|3.75|PHR: 408101; CHG: 26||External grouping not supported 2444|ERX|HCPCS A9270|00143-1240-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 125 MCG (0.125 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 2444|ERX|HCPCS A9270|00904-5921-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 125 MCG (0.125 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 2444|ERX|HCPCS A9270|42292-0003-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 125 MCG (0.125 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 2444|ERX|HCPCS A9270|42292-0003-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 125 MCG (0.125 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 2444|ERX|HCPCS A9270|68084-0366-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 125 MCG (0.125 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 2444|ERX|HCPCS A9270|68084-0366-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 125 MCG (0.125 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.22|PHR: 408101; CHG: 26||Not reimbursed separately|2.22|PHR: 408101; CHG: 26||External grouping not supported 2445|ERX|HCPCS A9270|00904-5922-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 250 MCG (0.25 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 2445|ERX|HCPCS A9270|42292-0002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 250 MCG (0.25 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 2445|ERX|HCPCS A9270|68084-0680-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 250 MCG (0.25 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 2445|ERX|HCPCS A9270|68084-0680-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIGOXIN 250 MCG (0.25 MG) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 24470|ERX|HCPCS A9270|51079-0722-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.48|PHR: 408101; CHG: 26||Not reimbursed separately|7.48|PHR: 408101; CHG: 26||External grouping not supported 24473|ERX|HCPCS A9270|00054-0028-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CILOSTAZOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 24473|ERX|HCPCS A9270|00093-2065-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CILOSTAZOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 24473|ERX|HCPCS A9270|60505-2521-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CILOSTAZOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 24474|ERX|HCPCS A9270|00054-0044-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CILOSTAZOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 24474|ERX|HCPCS A9270|00093-2064-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CILOSTAZOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 24474|ERX|HCPCS A9270|50268-0177-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CILOSTAZOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 24501|ERX|HCPCS A9270|00093-7166-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CELECOXIB 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 24501|ERX|HCPCS A9270|00904-6503-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CELECOXIB 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 24501|ERX|HCPCS A9270|51079-0215-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CELECOXIB 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 24501|ERX|HCPCS A9270|51079-0215-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CELECOXIB 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 24501|ERX|HCPCS A9270|60687-0447-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CELECOXIB 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 24513|ERX|HCPCS Q4081|59676-0340-00|0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO)<10,000 UNITS|EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,684.17|PHR: 408101; CHG: 26||Not reimbursed separately|1,684.17|PHR: 408101; CHG: 26||External grouping not supported 24513|ERX|HCPCS Q4081|59676-0340-01|0634 - PHARMACY - EXTENSION OF 025X - ERYTHROPOIETIN (EPO)<10,000 UNITS|EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,684.17|PHR: 408101; CHG: 26||Not reimbursed separately|1,684.17|PHR: 408101; CHG: 26||External grouping not supported 24521|ERX|HCPCS A9270|50268-0451-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 24521|ERX|HCPCS A9270|50268-0451-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 24521|ERX|HCPCS A9270|68084-0591-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 24575|ERX|HCPCS A9270|61314-0224-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.25 % EYE GEL FORMING SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.70|PHR: 408101; CHG: 26||Not reimbursed separately|386.70|PHR: 408101; CHG: 26||External grouping not supported 24576|ERX|HCPCS A9270|24208-0816-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.63|PHR: 408101; CHG: 26||Not reimbursed separately|453.63|PHR: 408101; CHG: 26||External grouping not supported 24576|ERX|HCPCS A9270|61314-0225-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.63|PHR: 408101; CHG: 26||Not reimbursed separately|453.63|PHR: 408101; CHG: 26||External grouping not supported 24695|ERX|HCPCS J0594|59148-0070-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUSULFAN 60 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|829.35|PHR: 408101; CHG: 26||Not reimbursed separately|829.35|PHR: 408101; CHG: 26||External grouping not supported 24702|ERX|HCPCS A9270|68084-0621-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MODAFINIL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.65|PHR: 408101; CHG: 26||Not reimbursed separately|13.65|PHR: 408101; CHG: 26||External grouping not supported 24702|ERX|HCPCS A9270|68084-0621-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MODAFINIL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.65|PHR: 408101; CHG: 26||Not reimbursed separately|13.65|PHR: 408101; CHG: 26||External grouping not supported 24703|ERX|HCPCS A9270|60505-2527-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MODAFINIL 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.78|PHR: 408101; CHG: 26||Not reimbursed separately|20.78|PHR: 408101; CHG: 26||External grouping not supported 24703|ERX|HCPCS A9270|68084-0721-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MODAFINIL 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.78|PHR: 408101; CHG: 26||Not reimbursed separately|20.78|PHR: 408101; CHG: 26||External grouping not supported 24703|ERX|HCPCS A9270|68084-0721-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MODAFINIL 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.78|PHR: 408101; CHG: 26||Not reimbursed separately|20.78|PHR: 408101; CHG: 26||External grouping not supported 24731|ERX|HCPCS A9270|00574-7040-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.67|PHR: 408101; CHG: 26||Not reimbursed separately|65.67|PHR: 408101; CHG: 26||External grouping not supported 24731|ERX|HCPCS A9270|00574-7040-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.67|PHR: 408101; CHG: 26||Not reimbursed separately|65.67|PHR: 408101; CHG: 26||External grouping not supported 2475|ERX|HCPCS A9270|00093-0318-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 2475|ERX|HCPCS A9270|51079-0745-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 2475|ERX|HCPCS A9270|51079-0745-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 2475|ERX|HCPCS A9270|63739-0079-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 2475|ERX|HCPCS A9270|68682-0006-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 2475|ERX|HCPCS A9270|68682-0006-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|00093-0319-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|00378-0045-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|42799-0130-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|51079-0746-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|51079-0746-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|63739-0080-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2476|ERX|HCPCS A9270|68682-0007-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 2477|ERX|HCPCS A9270|00093-0320-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 90 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 2477|ERX|HCPCS A9270|51079-0747-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 90 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 2477|ERX|HCPCS A9270|51079-0747-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 90 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 2477|ERX|HCPCS A9270|68682-0008-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM 90 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 2485|ERX|HCPCS A9270|00904-2051-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIMENHYDRINATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 24914|ERX|HCPCS J7507|00378-2045-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 0.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 24914|ERX|HCPCS J7507|00781-2102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 0.5 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 24914|ERX|HCPCS J7507|16729-0041-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 0.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 24914|ERX|HCPCS J7507|51079-0817-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TACROLIMUS 0.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 24915|ERX|HCPCS RX001|43598-0410-25|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24915|ERX|HCPCS RX001|66993-0022-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24915|ERX|HCPCS RX001|66993-0022-35|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24915|ERX|HCPCS RX001|76204-0800-15|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24915|ERX|HCPCS RX001|76204-0800-25|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24916|ERX|HCPCS RX001|66993-0023-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24916|ERX|HCPCS RX001|66993-0023-35|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24916|ERX|HCPCS RX001|76204-0900-15|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24916|ERX|HCPCS RX001|76204-0900-25|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 24932|ERX|HCPCS J2916|00024-2792-10|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HUMANA [1294]||HUMANA [11839]|24.89|PHR: 408101; CHG: 26||Not reimbursed separately|24.89|PHR: 408101; CHG: 26||External grouping not supported 24984|ERX|HCPCS A9270|41100-0820-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER|238 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.86|PHR: 408101; CHG: 26||Not reimbursed separately|12.86|PHR: 408101; CHG: 26||External grouping not supported 24984|ERX|HCPCS A9270|43386-0312-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER|238 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.86|PHR: 408101; CHG: 26||Not reimbursed separately|12.86|PHR: 408101; CHG: 26||External grouping not supported 24984|ERX|HCPCS A9270|45802-0868-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER|238 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.86|PHR: 408101; CHG: 26||Not reimbursed separately|12.86|PHR: 408101; CHG: 26||External grouping not supported 24984|ERX|HCPCS A9270|87701-0405-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER|238 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.86|PHR: 408101; CHG: 26||Not reimbursed separately|12.86|PHR: 408101; CHG: 26||External grouping not supported 24984|ERX|HCPCS A9270|87701-0405-87|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER|510 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.56|PHR: 408101; CHG: 26||Not reimbursed separately|38.56|PHR: 408101; CHG: 26||External grouping not supported 250|ERX|HCPCS RX001|00378-8270-52|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 250|ERX|HCPCS RX001|00378-8270-62|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 250|ERX|HCPCS RX001|00378-8270-64|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 250|ERX|HCPCS RX001|00378-8270-93|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 250|ERX|HCPCS RX001|00487-9501-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 250|ERX|HCPCS RX001|60687-0395-79|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 25005|ERX|HCPCS J7517|66689-0307-08|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SUSPENSION|1.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.43|PHR: 408101; CHG: 26||Not reimbursed separately|14.43|PHR: 408101; CHG: 26||External grouping not supported 25005|ERX|HCPCS J7517|67877-0230-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SUSPENSION|1.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.43|PHR: 408101; CHG: 26||Not reimbursed separately|14.43|PHR: 408101; CHG: 26||External grouping not supported 2505|ERX|HCPCS A9270|00536-1214-29|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 2505|ERX|HCPCS A9270|00904-5551-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENHYDRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 2508|ERX|HCPCS J1200|00641-0376-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 2508|ERX|HCPCS J1200|63323-0664-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 2508|ERX|HCPCS J1200|63323-0664-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 2508|ERX|HCPCS J1200|63323-0664-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 2508|ERX|HCPCS J1200|63323-0664-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 2508|ERX|HCPCS J1200|00641-0376-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 2509|ERX|HCPCS Q0163|00904-5306-61|0250 - PHARMACY - GENERAL CLASSIFICATION|DIPHENHYDRAMINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 251|ERX|HCPCS RX001|50383-0741-20|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION|20 mL|HUMANA [1294]||HUMANA [11839]|133.50|PHR: 408101; CHG: 26||Not reimbursed separately|133.50|PHR: 408101; CHG: 26||External grouping not supported 2510|ERX|HCPCS Q0163|00904-2056-61|0250 - PHARMACY - GENERAL CLASSIFICATION|DIPHENHYDRAMINE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 2511|ERX|HCPCS Q0163|00121-0489-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 2511|ERX|HCPCS Q0163|00121-0489-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HUMANA [1294]||HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 25119|ERX|HCPCS A9270|00904-6378-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 25119|ERX|HCPCS A9270|16571-0412-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 25119|ERX|HCPCS A9270|51079-0182-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 25119|ERX|HCPCS A9270|51079-0182-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 25119|ERX|HCPCS A9270|63739-0559-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 25119|ERX|HCPCS A9270|68084-0070-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 25120|ERX|HCPCS A9270|16252-0516-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 25120|ERX|HCPCS A9270|55111-0128-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 25120|ERX|HCPCS A9270|68084-0071-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 25120|ERX|HCPCS A9270|68084-0071-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 2515|ERX|HCPCS A9270|00054-3194-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG/5 ML ORAL LIQUID|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|169.92|PHR: 408101; CHG: 26||Not reimbursed separately|169.92|PHR: 408101; CHG: 26||External grouping not supported 2516|ERX|HCPCS A9270|00378-0415-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 2516|ERX|HCPCS A9270|59762-1061-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 2516|ERX|HCPCS A9270|62559-0490-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 25174|ERX|HCPCS RX001|00264-1965-10|0250 - PHARMACY - GENERAL CLASSIFICATION|HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|79.50|PHR: 408101; CHG: 26||Not reimbursed separately|79.50|PHR: 408101; CHG: 26||External grouping not supported 25174|ERX|HCPCS RX001|00409-7248-13|0250 - PHARMACY - GENERAL CLASSIFICATION|HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|79.50|PHR: 408101; CHG: 26||Not reimbursed separately|79.50|PHR: 408101; CHG: 26||External grouping not supported 252|ERX|HCPCS A9270|00472-0825-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 252|ERX|HCPCS A9270|70752-0102-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 25238|ERX|HCPCS RX015|00591-2880-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]||HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 25246|ERX|HCPCS A9270|00093-4161-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 25246|ERX|HCPCS A9270|00143-9887-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 25246|ERX|HCPCS A9270|00781-6157-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 25246|ERX|HCPCS A9270|65862-0071-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 2528|ERX|HCPCS A9270|64980-0133-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIPYRIDAMOLE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 2535|ERX|HCPCS A9270|00093-3127-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DISOPYRAMIDE PHOSPHATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.02|PHR: 408101; CHG: 26||Not reimbursed separately|3.02|PHR: 408101; CHG: 26||External grouping not supported 2536|ERX|HCPCS A9270|00093-3129-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.20|PHR: 408101; CHG: 26||Not reimbursed separately|4.20|PHR: 408101; CHG: 26||External grouping not supported 25365|ERX|HCPCS J0690|00338-3503-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 2537|ERX|HCPCS A9270|00025-2732-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.09|PHR: 408101; CHG: 26||Not reimbursed separately|11.09|PHR: 408101; CHG: 26||External grouping not supported 2540|ERX|HCPCS A9270|47781-0607-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DISULFIRAM 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.88|PHR: 408101; CHG: 26||Not reimbursed separately|4.88|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|00904-6931-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|00904-6931-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|11523-7234-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|11523-7268-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|45802-0868-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|51079-0306-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|51079-0306-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|60687-0431-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|68084-0430-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|68084-0430-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25424|ERX|HCPCS A9270|69784-0180-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.64|PHR: 408101; CHG: 26||Not reimbursed separately|2.64|PHR: 408101; CHG: 26||External grouping not supported 25425|ERX|HCPCS A9270|49348-0968-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEXOFENADINE 180 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 25471|ERX|HCPCS A9270|24208-0601-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOTIFEN 0.025 % (0.035 %) EYE DROPS|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.62|PHR: 408101; CHG: 26||Not reimbursed separately|31.62|PHR: 408101; CHG: 26||External grouping not supported 25471|ERX|HCPCS A9270|00065-4011-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOTIFEN 0.025 % (0.035 %) EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.81|PHR: 408101; CHG: 26||Not reimbursed separately|15.81|PHR: 408101; CHG: 26||External grouping not supported 25471|ERX|HCPCS A9270|17478-0717-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOTIFEN 0.025 % (0.035 %) EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.81|PHR: 408101; CHG: 26||Not reimbursed separately|15.81|PHR: 408101; CHG: 26||External grouping not supported 2551|ERX|HCPCS A9270|62756-0796-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 25518|ERX|HCPCS J0720|63323-0011-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLORAMPHENICOL SODIUM SUCCINATE 1 GRAM INTRAVENOUS SOLUTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|106.59|PHR: 408101; CHG: 26||Not reimbursed separately|106.59|PHR: 408101; CHG: 26||External grouping not supported 25519|ERX|HCPCS A9270|00904-6357-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 25519|ERX|HCPCS A9270|68084-0270-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 25519|ERX|HCPCS A9270|68084-0270-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 2552|ERX|HCPCS A9270|00832-7123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 2552|ERX|HCPCS A9270|00832-7123-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 2552|ERX|HCPCS A9270|68084-0776-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 25520|ERX|HCPCS A9270|00904-6358-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 25520|ERX|HCPCS A9270|68084-0271-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|00781-5420-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|00781-5420-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|16729-0020-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|16729-0020-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|33342-0054-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|33342-0054-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|51079-0513-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25528|ERX|HCPCS A9270|60687-0391-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 25529|ERX|HCPCS A9270|00781-5421-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 25529|ERX|HCPCS A9270|00781-5421-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 25529|ERX|HCPCS A9270|16729-0021-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 25529|ERX|HCPCS A9270|33342-0055-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 25529|ERX|HCPCS A9270|33342-0055-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 2553|ERX|HCPCS A9270|00832-7124-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 2553|ERX|HCPCS A9270|00832-7124-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 2553|ERX|HCPCS A9270|29300-0140-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 2553|ERX|HCPCS A9270|68084-0782-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 2553|ERX|HCPCS A9270|68084-0782-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 25530|ERX|HCPCS A9270|00093-7273-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 45 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 25530|ERX|HCPCS A9270|00781-5422-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 45 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 25530|ERX|HCPCS A9270|00781-5422-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 45 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 25530|ERX|HCPCS A9270|16729-0022-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 45 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 25530|ERX|HCPCS A9270|33342-0056-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIOGLITAZONE 45 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 25557|ERX|HCPCS J1815|00002-7511-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (75-25) SUBCUTANEOUS SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.64|PHR: 408101; CHG: 26||Not reimbursed separately|155.64|PHR: 408101; CHG: 26||External grouping not supported 2565|ERX|HCPCS A9270|00536-1065-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE CALCIUM 240 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|00904-6455-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|00904-6457-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|46122-0451-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|60687-0129-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|69618-0044-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|69618-0044-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2566|ERX|HCPCS A9270|87701-0430-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 2569|ERX|HCPCS A9270|00121-0544-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 2569|ERX|HCPCS A9270|50383-0771-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 257|ERX|HCPCS RX001|17478-0503-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHANOL (ETHYL ALCOHOL) 98 % INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|244.98|PHR: 408101; CHG: 26||Not reimbursed separately|244.98|PHR: 408101; CHG: 26||External grouping not supported 25893|ERX|HCPCS 92211408|16729-0049-53|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMOZOLOMIDE 20 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|145.50|PHR: 408101; CHG: 26||Not reimbursed separately|145.50|PHR: 408101; CHG: 26||External grouping not supported 25894|ERX|HCPCS J8700|00781-2693-75|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMOZOLOMIDE 100 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|40.93|PHR: 408101; CHG: 26||Not reimbursed separately|40.93|PHR: 408101; CHG: 26||External grouping not supported 25894|ERX|HCPCS J8700|16729-0050-54|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMOZOLOMIDE 100 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|40.93|PHR: 408101; CHG: 26||Not reimbursed separately|40.93|PHR: 408101; CHG: 26||External grouping not supported 25895|ERX|HCPCS J8700|47335-0893-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMOZOLOMIDE 250 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|594.39|PHR: 408101; CHG: 26||Not reimbursed separately|594.39|PHR: 408101; CHG: 26||External grouping not supported 25896|ERX|HCPCS A9270|62856-0243-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RABEPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.33|PHR: 408101; CHG: 26||Not reimbursed separately|48.33|PHR: 408101; CHG: 26||External grouping not supported 2594|ERX|HCPCS RX011|00517-1305-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOPAMINE 800 MG/5 ML (160 MG/ML) INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|7.20|PHR: 408101; CHG: 26||Not reimbursed separately|7.20|PHR: 408101; CHG: 26||External grouping not supported 2607|ERX|HCPCS RX001|00641-6018-06|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXAPRAM 20 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|133.86|PHR: 408101; CHG: 26||Not reimbursed separately|133.86|PHR: 408101; CHG: 26||External grouping not supported 2608|ERX|HCPCS A9270|51079-0436-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 2608|ERX|HCPCS A9270|51079-0436-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 2609|ERX|HCPCS A9270|51079-0651-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 2609|ERX|HCPCS A9270|51079-0651-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 2611|ERX|HCPCS A9270|00378-3125-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 2611|ERX|HCPCS A9270|49884-0218-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 2611|ERX|HCPCS A9270|51079-0437-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 2611|ERX|HCPCS A9270|51079-0437-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.55|PHR: 408101; CHG: 26||Not reimbursed separately|1.55|PHR: 408101; CHG: 26||External grouping not supported 2612|ERX|HCPCS A9270|51079-0438-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.15|PHR: 408101; CHG: 26||Not reimbursed separately|2.15|PHR: 408101; CHG: 26||External grouping not supported 2612|ERX|HCPCS A9270|51079-0438-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.15|PHR: 408101; CHG: 26||Not reimbursed separately|2.15|PHR: 408101; CHG: 26||External grouping not supported 2614|ERX|HCPCS A9270|60432-0651-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXEPIN 10 MG/ML ORAL CONCENTRATE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 2619|ERX|HCPCS J9000|67457-0436-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|727.17|PHR: 408101; CHG: 26||Not reimbursed separately|727.17|PHR: 408101; CHG: 26||External grouping not supported 2622|ERX|HCPCS J3490|63323-0130-02|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.10|PHR: 408101; CHG: 26||Not reimbursed separately|46.10|PHR: 408101; CHG: 26||External grouping not supported 2622|ERX|HCPCS J3490|63323-0130-11|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.10|PHR: 408101; CHG: 26||Not reimbursed separately|46.10|PHR: 408101; CHG: 26||External grouping not supported 2622|ERX|HCPCS J3490|63323-0130-17|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.10|PHR: 408101; CHG: 26||Not reimbursed separately|46.10|PHR: 408101; CHG: 26||External grouping not supported 2622|ERX|HCPCS J3490|67457-0437-00|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.10|PHR: 408101; CHG: 26||Not reimbursed separately|46.10|PHR: 408101; CHG: 26||External grouping not supported 2622|ERX|HCPCS J3490|67457-0437-10|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.10|PHR: 408101; CHG: 26||Not reimbursed separately|46.10|PHR: 408101; CHG: 26||External grouping not supported 2622|ERX|HCPCS J3490|68382-0910-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.10|PHR: 408101; CHG: 26||Not reimbursed separately|46.10|PHR: 408101; CHG: 26||External grouping not supported 26224|ERX|HCPCS A9270|50268-0636-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 26224|ERX|HCPCS A9270|68084-0643-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 26224|ERX|HCPCS A9270|68084-0643-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|00378-6689-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|31722-0713-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|50268-0639-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|51079-0051-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|62175-0617-43|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|65162-0637-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|66993-0068-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26225|ERX|HCPCS A9270|68084-0813-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|00008-0923-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]||HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|00008-0923-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|00008-4001-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|00143-9284-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|55150-0202-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|55150-0202-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 26226|ERX|HCPCS C9113|62756-0129-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|1 Vial|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 2625|ERX|HCPCS A9270|00143-2112-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXYCYCLINE HYCLATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.11|PHR: 408101; CHG: 26||Not reimbursed separately|4.11|PHR: 408101; CHG: 26||External grouping not supported 2625|ERX|HCPCS A9270|00904-0430-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXYCYCLINE HYCLATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.11|PHR: 408101; CHG: 26||Not reimbursed separately|4.11|PHR: 408101; CHG: 26||External grouping not supported 2625|ERX|HCPCS A9270|42806-0312-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXYCYCLINE HYCLATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.11|PHR: 408101; CHG: 26||Not reimbursed separately|4.11|PHR: 408101; CHG: 26||External grouping not supported 2625|ERX|HCPCS A9270|53489-0120-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXYCYCLINE HYCLATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.11|PHR: 408101; CHG: 26||Not reimbursed separately|4.11|PHR: 408101; CHG: 26||External grouping not supported 2625|ERX|HCPCS A9270|62584-0693-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXYCYCLINE HYCLATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.11|PHR: 408101; CHG: 26||Not reimbursed separately|4.11|PHR: 408101; CHG: 26||External grouping not supported 26336|ERX|HCPCS J7520|00008-1030-04|0250 - PHARMACY - GENERAL CLASSIFICATION|SIROLIMUS 1 MG/ML ORAL SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|166.52|PHR: 408101; CHG: 26||Not reimbursed separately|166.52|PHR: 408101; CHG: 26||External grouping not supported 26336|ERX|HCPCS J7520|66689-0347-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SIROLIMUS 1 MG/ML ORAL SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.52|PHR: 408101; CHG: 26||Not reimbursed separately|166.52|PHR: 408101; CHG: 26||External grouping not supported 26371|ERX|HCPCS A9270|51079-0923-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 26371|ERX|HCPCS A9270|51079-0923-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 26371|ERX|HCPCS A9270|62756-0457-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.09|PHR: 408101; CHG: 26||Not reimbursed separately|1.09|PHR: 408101; CHG: 26||External grouping not supported 2654|ERX|HCPCS J1790|00517-9702-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DROPERIDOL 2.5 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.30|PHR: 408101; CHG: 26||Not reimbursed separately|2.30|PHR: 408101; CHG: 26||External grouping not supported 2654|ERX|HCPCS J1790|00517-9702-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DROPERIDOL 2.5 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|2.30|PHR: 408101; CHG: 26||Not reimbursed separately|2.30|PHR: 408101; CHG: 26||External grouping not supported 26546|ERX|HCPCS A9270|00004-0800-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.01|PHR: 408101; CHG: 26||Not reimbursed separately|6.01|PHR: 408101; CHG: 26||External grouping not supported 26546|ERX|HCPCS A9270|33342-0258-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.01|PHR: 408101; CHG: 26||Not reimbursed separately|6.01|PHR: 408101; CHG: 26||External grouping not supported 26546|ERX|HCPCS A9270|47781-0470-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.01|PHR: 408101; CHG: 26||Not reimbursed separately|6.01|PHR: 408101; CHG: 26||External grouping not supported 26546|ERX|HCPCS A9270|64380-0799-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.01|PHR: 408101; CHG: 26||Not reimbursed separately|6.01|PHR: 408101; CHG: 26||External grouping not supported 26546|ERX|HCPCS A9270|68180-0677-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.01|PHR: 408101; CHG: 26||Not reimbursed separately|6.01|PHR: 408101; CHG: 26||External grouping not supported 26546|ERX|HCPCS A9270|69238-1266-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.01|PHR: 408101; CHG: 26||Not reimbursed separately|6.01|PHR: 408101; CHG: 26||External grouping not supported 26547|ERX|HCPCS A9270|51079-0273-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.66|PHR: 408101; CHG: 26||Not reimbursed separately|9.66|PHR: 408101; CHG: 26||External grouping not supported 26547|ERX|HCPCS A9270|60687-0188-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.66|PHR: 408101; CHG: 26||Not reimbursed separately|9.66|PHR: 408101; CHG: 26||External grouping not supported 26547|ERX|HCPCS A9270|60687-0188-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.66|PHR: 408101; CHG: 26||Not reimbursed separately|9.66|PHR: 408101; CHG: 26||External grouping not supported 26551|ERX|HCPCS A9270|59762-2858-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EXEMESTANE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.39|PHR: 408101; CHG: 26||Not reimbursed separately|10.39|PHR: 408101; CHG: 26||External grouping not supported 26771|ERX|HCPCS J1642|08290-3064-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 26771|ERX|HCPCS J1642|63807-0500-55|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 26771|ERX|HCPCS J1642|64253-0222-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 26816|ERX|HCPCS A9270|63739-0795-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 26816|ERX|HCPCS A9270|68084-0859-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 26816|ERX|HCPCS A9270|68084-0859-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|00904-6052-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|13668-0015-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|51079-0821-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|51079-0821-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|63739-0411-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|68001-0403-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|68084-0870-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|68084-0870-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26817|ERX|HCPCS A9270|71930-0063-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 26818|ERX|HCPCS A9270|68084-0882-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 26818|ERX|HCPCS A9270|68084-0882-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 26818|ERX|HCPCS A9270|69102-0102-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVETIRACETAM 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 26854|ERX|HCPCS A9270|55111-0112-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MOXIFLOXACIN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.96|PHR: 408101; CHG: 26||Not reimbursed separately|21.96|PHR: 408101; CHG: 26||External grouping not supported 26952|ERX|HCPCS A9270|00904-6286-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 26952|ERX|HCPCS A9270|68084-0528-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 26965|ERX|HCPCS A9270|42794-0044-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 125 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26965|ERX|HCPCS A9270|51862-0125-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 125 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26965|ERX|HCPCS A9270|59762-0037-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 125 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26965|ERX|HCPCS A9270|69452-0131-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 125 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26966|ERX|HCPCS A9270|42794-0045-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 250 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26966|ERX|HCPCS A9270|51862-0025-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 250 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26966|ERX|HCPCS A9270|59762-0038-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 250 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26967|ERX|HCPCS A9270|42794-0046-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 500 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26967|ERX|HCPCS A9270|51862-0005-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 500 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26967|ERX|HCPCS A9270|59762-0039-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 500 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 26967|ERX|HCPCS A9270|69452-0133-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOFETILIDE 500 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 27023|ERX|HCPCS A9270|51672-2080-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TERBINAFINE HCL 1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.78|PHR: 408101; CHG: 26||Not reimbursed separately|17.78|PHR: 408101; CHG: 26||External grouping not supported 27032|ERX|HCPCS J7674|64281-0100-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|209.94|PHR: 408101; CHG: 26||Not reimbursed separately|209.94|PHR: 408101; CHG: 26||External grouping not supported 27032|ERX|HCPCS J7674|64281-0100-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION|100 mg|HUMANA [1294]||HUMANA [11839]|209.94|PHR: 408101; CHG: 26||Not reimbursed separately|209.94|PHR: 408101; CHG: 26||External grouping not supported 27038|ERX|HCPCS A9270|11980-0174-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|844.62|PHR: 408101; CHG: 26||Not reimbursed separately|844.62|PHR: 408101; CHG: 26||External grouping not supported 27038|ERX|HCPCS A9270|11980-0174-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|422.31|PHR: 408101; CHG: 26||Not reimbursed separately|422.31|PHR: 408101; CHG: 26||External grouping not supported 27047|ERX|HCPCS RX001|10122-0510-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION|1.5 mL|HUMANA [1294]||HUMANA [11839]|1,261.76|PHR: 408101; CHG: 26||Not reimbursed separately|1,261.76|PHR: 408101; CHG: 26||External grouping not supported 27049|ERX|HCPCS A9270|68084-0845-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 27049|ERX|HCPCS A9270|68084-0845-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 27049|ERX|HCPCS A9270|68462-0137-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 27096|ERX|HCPCS A9270|45802-0210-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL|4.9 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.20|PHR: 408101; CHG: 26||Not reimbursed separately|401.20|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|00143-9532-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|00143-9532-25|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|00409-1638-02|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|16729-0239-30|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|42023-0146-25|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|55150-0209-02|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|63323-0421-02|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|67457-0251-00|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|70860-0605-02|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|70860-0605-03|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27103|ERX|HCPCS RX001|70860-0605-41|0250 - PHARMACY - GENERAL CLASSIFICATION|DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.96|PHR: 408101; CHG: 26||Not reimbursed separately|8.96|PHR: 408101; CHG: 26||External grouping not supported 27113|ERX|HCPCS J0735|39822-2010-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLONIDINE (PF) 5,000 MCG/10 ML EPIDURAL SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.29|PHR: 408101; CHG: 26||Not reimbursed separately|12.29|PHR: 408101; CHG: 26||External grouping not supported 27178|ERX|HCPCS A9270|63459-0402-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIAGABINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.57|PHR: 408101; CHG: 26||Not reimbursed separately|21.57|PHR: 408101; CHG: 26||External grouping not supported 27182|ERX|HCPCS A9270|47335-0614-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIACIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.56|PHR: 408101; CHG: 26||Not reimbursed separately|1.56|PHR: 408101; CHG: 26||External grouping not supported 27234|ERX|HCPCS A9270|00054-0288-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 4 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 27234|ERX|HCPCS A9270|00093-7424-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MONTELUKAST 4 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 27345|ERX|HCPCS A9270|00121-1276-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.45|PHR: 408101; CHG: 26||Not reimbursed separately|3.45|PHR: 408101; CHG: 26||External grouping not supported 27345|ERX|HCPCS A9270|00121-1276-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.45|PHR: 408101; CHG: 26||Not reimbursed separately|3.45|PHR: 408101; CHG: 26||External grouping not supported 27345|ERX|HCPCS A9270|00121-0638-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 27392|ERX|HCPCS J2274|00641-6040-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 25 MG/ML INJECTION SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|977.70|PHR: 408101; CHG: 26||Not reimbursed separately|977.70|PHR: 408101; CHG: 26||External grouping not supported 27396|ERX|HCPCS RX001|00409-4712-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|24.47|PHR: 408101; CHG: 26||Not reimbursed separately|24.47|PHR: 408101; CHG: 26||External grouping not supported 27418|ERX|HCPCS A9270|50474-0100-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 27418|ERX|HCPCS A9270|52244-0100-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 27419|ERX|HCPCS A9270|50474-0200-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 200 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.92|PHR: 408101; CHG: 26||Not reimbursed separately|9.92|PHR: 408101; CHG: 26||External grouping not supported 27419|ERX|HCPCS A9270|52244-0200-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 200 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.92|PHR: 408101; CHG: 26||Not reimbursed separately|9.92|PHR: 408101; CHG: 26||External grouping not supported 27421|ERX|HCPCS A9270|50474-0300-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 300 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.19|PHR: 408101; CHG: 26||Not reimbursed separately|12.19|PHR: 408101; CHG: 26||External grouping not supported 27421|ERX|HCPCS A9270|52244-0300-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 300 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.19|PHR: 408101; CHG: 26||Not reimbursed separately|12.19|PHR: 408101; CHG: 26||External grouping not supported 27430|ERX|HCPCS RX001|13925-0515-10|0250 - PHARMACY - GENERAL CLASSIFICATION|PENTAMIDINE 300 MG SOLUTION FOR INJECTION|300 mg|HUMANA [1294]||HUMANA [11839]|314.10|PHR: 408101; CHG: 26||Not reimbursed separately|314.10|PHR: 408101; CHG: 26||External grouping not supported 27430|ERX|HCPCS RX001|63323-0113-10|0250 - PHARMACY - GENERAL CLASSIFICATION|PENTAMIDINE 300 MG SOLUTION FOR INJECTION|300 mg|HUMANA [1294]||HUMANA [11839]|314.10|PHR: 408101; CHG: 26||Not reimbursed separately|314.10|PHR: 408101; CHG: 26||External grouping not supported 27431|ERX|HCPCS Q2050|00338-0063-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,588.92|PHR: 408101; CHG: 26||Not reimbursed separately|1,588.92|PHR: 408101; CHG: 26||External grouping not supported 27431|ERX|HCPCS Q2050|43598-0283-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,588.92|PHR: 408101; CHG: 26||Not reimbursed separately|1,588.92|PHR: 408101; CHG: 26||External grouping not supported 27431|ERX|HCPCS Q2050|00338-0067-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.45|PHR: 408101; CHG: 26||Not reimbursed separately|9,156.45|PHR: 408101; CHG: 26||External grouping not supported 27431|ERX|HCPCS Q2050|43598-0541-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.45|PHR: 408101; CHG: 26||Not reimbursed separately|9,156.45|PHR: 408101; CHG: 26||External grouping not supported 27431|ERX|HCPCS Q2050|47335-0050-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION|25 mL|HUMANA [1294]||HUMANA [11839]|9,156.45|PHR: 408101; CHG: 26||Not reimbursed separately|9,156.45|PHR: 408101; CHG: 26||External grouping not supported 27461|ERX|HCPCS RX015|00078-0346-62|0250 - PHARMACY - GENERAL CLASSIFICATION|ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|46.15|PHR: 408101; CHG: 26||Not reimbursed separately|46.15|PHR: 408101; CHG: 26||External grouping not supported 27462|ERX|HCPCS A9270|00378-3349-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.10|PHR: 408101; CHG: 26||Not reimbursed separately|38.10|PHR: 408101; CHG: 26||External grouping not supported 27462|ERX|HCPCS A9270|00378-3349-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.10|PHR: 408101; CHG: 26||Not reimbursed separately|38.10|PHR: 408101; CHG: 26||External grouping not supported 27462|ERX|HCPCS A9270|47781-0204-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.10|PHR: 408101; CHG: 26||Not reimbursed separately|38.10|PHR: 408101; CHG: 26||External grouping not supported 27462|ERX|HCPCS A9270|47781-0204-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.10|PHR: 408101; CHG: 26||Not reimbursed separately|38.10|PHR: 408101; CHG: 26||External grouping not supported 27463|ERX|HCPCS A9270|00378-3351-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.44|PHR: 408101; CHG: 26||Not reimbursed separately|45.44|PHR: 408101; CHG: 26||External grouping not supported 27463|ERX|HCPCS A9270|00378-3351-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.44|PHR: 408101; CHG: 26||Not reimbursed separately|45.44|PHR: 408101; CHG: 26||External grouping not supported 27463|ERX|HCPCS A9270|47781-0208-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.44|PHR: 408101; CHG: 26||Not reimbursed separately|45.44|PHR: 408101; CHG: 26||External grouping not supported 27463|ERX|HCPCS A9270|47781-0208-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.44|PHR: 408101; CHG: 26||Not reimbursed separately|45.44|PHR: 408101; CHG: 26||External grouping not supported 27464|ERX|HCPCS A9270|68968-0514-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.68|PHR: 408101; CHG: 26||Not reimbursed separately|71.68|PHR: 408101; CHG: 26||External grouping not supported 27466|ERX|HCPCS A9270|00574-0069-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROSE 40 % ORAL GEL|37.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 27466|ERX|HCPCS A9270|00574-0069-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROSE 40 % ORAL GEL|37.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 27466|ERX|HCPCS A9270|00574-0070-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROSE 40 % ORAL GEL|37.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 27466|ERX|HCPCS A9270|99999-5555-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROSE 40 % ORAL GEL|37.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 27467|ERX|HCPCS RX001|55566-2800-00|0250 - PHARMACY - GENERAL CLASSIFICATION|DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE|1 Tab|HUMANA [1294]||HUMANA [11839]|1,173.12|PHR: 408101; CHG: 26||Not reimbursed separately|1,173.12|PHR: 408101; CHG: 26||External grouping not supported 27467|ERX|HCPCS RX001|55566-2800-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE|1 Tab|HUMANA [1294]||HUMANA [11839]|1,173.12|PHR: 408101; CHG: 26||Not reimbursed separately|1,173.12|PHR: 408101; CHG: 26||External grouping not supported 27471|ERX|HCPCS A9270|00378-9102-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 27471|ERX|HCPCS A9270|00378-9102-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 27471|ERX|HCPCS A9270|47781-0296-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 27472|ERX|HCPCS A9270|68382-0309-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 27472|ERX|HCPCS A9270|68382-0309-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 27473|ERX|HCPCS A9270|50742-0515-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|86.82|PHR: 408101; CHG: 26||Not reimbursed separately|86.82|PHR: 408101; CHG: 26||External grouping not supported 27473|ERX|HCPCS A9270|50742-0515-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|86.82|PHR: 408101; CHG: 26||Not reimbursed separately|86.82|PHR: 408101; CHG: 26||External grouping not supported 27474|ERX|HCPCS A9270|47781-0298-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.38|PHR: 408101; CHG: 26||Not reimbursed separately|2.38|PHR: 408101; CHG: 26||External grouping not supported 27474|ERX|HCPCS A9270|68382-0310-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.38|PHR: 408101; CHG: 26||Not reimbursed separately|2.38|PHR: 408101; CHG: 26||External grouping not supported 27475|ERX|HCPCS A9270|47781-0299-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.32|PHR: 408101; CHG: 26||Not reimbursed separately|2.32|PHR: 408101; CHG: 26||External grouping not supported 27475|ERX|HCPCS A9270|68382-0311-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.32|PHR: 408101; CHG: 26||Not reimbursed separately|2.32|PHR: 408101; CHG: 26||External grouping not supported 27480|ERX|HCPCS A9270|60687-0195-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 27480|ERX|HCPCS A9270|60687-0195-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 27480|ERX|HCPCS A9270|63304-0718-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 27489|ERX|HCPCS A9270|68462-0233-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 27490|ERX|HCPCS A9270|13668-0133-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELODIPINE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 27490|ERX|HCPCS A9270|23155-0049-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELODIPINE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 27490|ERX|HCPCS A9270|68462-0234-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELODIPINE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 27491|ERX|HCPCS A9270|59746-0371-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 27491|ERX|HCPCS A9270|68462-0235-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FELODIPINE ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 27493|ERX|HCPCS A9270|00378-2222-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NISOLDIPINE ER 20 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.75|PHR: 408101; CHG: 26||Not reimbursed separately|32.75|PHR: 408101; CHG: 26||External grouping not supported 27496|ERX|HCPCS A9270|62175-0485-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.01|PHR: 408101; CHG: 26||Not reimbursed separately|9.01|PHR: 408101; CHG: 26||External grouping not supported 27505|ERX|HCPCS A9270|00591-3508-54|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.60|PHR: 408101; CHG: 26||Not reimbursed separately|27.60|PHR: 408101; CHG: 26||External grouping not supported 27505|ERX|HCPCS A9270|51862-0453-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.60|PHR: 408101; CHG: 26||Not reimbursed separately|27.60|PHR: 408101; CHG: 26||External grouping not supported 27505|ERX|HCPCS A9270|51862-0453-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.60|PHR: 408101; CHG: 26||Not reimbursed separately|27.60|PHR: 408101; CHG: 26||External grouping not supported 27506|ERX|HCPCS A9270|51862-0454-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.50|PHR: 408101; CHG: 26||Not reimbursed separately|40.50|PHR: 408101; CHG: 26||External grouping not supported 27506|ERX|HCPCS A9270|51862-0454-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.50|PHR: 408101; CHG: 26||Not reimbursed separately|40.50|PHR: 408101; CHG: 26||External grouping not supported 27520|ERX|HCPCS A9270|00573-2660-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 5 MG-PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE,12HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 27520|ERX|HCPCS A9270|00573-2660-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 5 MG-PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE,12HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 27522|ERX|HCPCS A9270|41167-4310-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEXOFENADINE 60 MG-PSEUDOEPHEDRINE ER 120 MG TABLET,EXT.RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.97|PHR: 408101; CHG: 26||Not reimbursed separately|1.97|PHR: 408101; CHG: 26||External grouping not supported 27529|ERX|HCPCS A9270|63824-0057-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE-GUAIFENESIN ER 60 MG-600 MG TABLET,EXTEND RELEASE 12HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.43|PHR: 408101; CHG: 26||Not reimbursed separately|1.43|PHR: 408101; CHG: 26||External grouping not supported 27543|ERX|HCPCS A9270|63824-0056-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.12|PHR: 408101; CHG: 26||Not reimbursed separately|1.12|PHR: 408101; CHG: 26||External grouping not supported 27543|ERX|HCPCS A9270|63824-0056-34|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.12|PHR: 408101; CHG: 26||Not reimbursed separately|1.12|PHR: 408101; CHG: 26||External grouping not supported 27543|ERX|HCPCS A9270|63824-0056-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.12|PHR: 408101; CHG: 26||Not reimbursed separately|1.12|PHR: 408101; CHG: 26||External grouping not supported 27629|ERX|HCPCS A9270|51991-0362-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27629|ERX|HCPCS A9270|51991-0362-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27629|ERX|HCPCS A9270|68462-0467-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27629|ERX|HCPCS A9270|69452-0156-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27630|ERX|HCPCS A9270|51991-0363-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 10 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27630|ERX|HCPCS A9270|51991-0363-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIZATRIPTAN 10 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27631|ERX|HCPCS A9270|68084-0313-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.58|PHR: 408101; CHG: 26||Not reimbursed separately|1.58|PHR: 408101; CHG: 26||External grouping not supported 27631|ERX|HCPCS A9270|68084-0313-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.58|PHR: 408101; CHG: 26||Not reimbursed separately|1.58|PHR: 408101; CHG: 26||External grouping not supported 27631|ERX|HCPCS A9270|68382-0106-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.58|PHR: 408101; CHG: 26||Not reimbursed separately|1.58|PHR: 408101; CHG: 26||External grouping not supported 27632|ERX|HCPCS A9270|60505-2806-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.26|PHR: 408101; CHG: 26||Not reimbursed separately|4.26|PHR: 408101; CHG: 26||External grouping not supported 27632|ERX|HCPCS A9270|66993-0408-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.26|PHR: 408101; CHG: 26||Not reimbursed separately|4.26|PHR: 408101; CHG: 26||External grouping not supported 27634|ERX|HCPCS A9270|00078-0510-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 27634|ERX|HCPCS A9270|00781-8016-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 27634|ERX|HCPCS A9270|51672-4123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 27635|ERX|HCPCS A9270|00781-5987-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.54|PHR: 408101; CHG: 26||Not reimbursed separately|7.54|PHR: 408101; CHG: 26||External grouping not supported 27635|ERX|HCPCS A9270|68084-0561-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.54|PHR: 408101; CHG: 26||Not reimbursed separately|7.54|PHR: 408101; CHG: 26||External grouping not supported 27635|ERX|HCPCS A9270|68084-0561-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.54|PHR: 408101; CHG: 26||Not reimbursed separately|7.54|PHR: 408101; CHG: 26||External grouping not supported 27636|ERX|HCPCS A9270|68084-0562-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.01|PHR: 408101; CHG: 26||Not reimbursed separately|13.01|PHR: 408101; CHG: 26||External grouping not supported 27636|ERX|HCPCS A9270|68084-0562-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.01|PHR: 408101; CHG: 26||Not reimbursed separately|13.01|PHR: 408101; CHG: 26||External grouping not supported 27644|ERX|HCPCS A9270|00597-0001-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 27644|ERX|HCPCS A9270|65162-0596-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 27644|ERX|HCPCS A9270|68462-0405-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 27659|ERX|HCPCS A9270|62175-0261-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.17|PHR: 408101; CHG: 26||Not reimbursed separately|5.17|PHR: 408101; CHG: 26||External grouping not supported 27659|ERX|HCPCS A9270|68084-0598-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.17|PHR: 408101; CHG: 26||Not reimbursed separately|5.17|PHR: 408101; CHG: 26||External grouping not supported 27659|ERX|HCPCS A9270|68084-0598-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.17|PHR: 408101; CHG: 26||Not reimbursed separately|5.17|PHR: 408101; CHG: 26||External grouping not supported 27659|ERX|HCPCS A9270|68682-0109-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.17|PHR: 408101; CHG: 26||Not reimbursed separately|5.17|PHR: 408101; CHG: 26||External grouping not supported 27660|ERX|HCPCS A9270|68084-0603-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.52|PHR: 408101; CHG: 26||Not reimbursed separately|6.52|PHR: 408101; CHG: 26||External grouping not supported 27660|ERX|HCPCS A9270|68084-0603-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 90 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.52|PHR: 408101; CHG: 26||Not reimbursed separately|6.52|PHR: 408101; CHG: 26||External grouping not supported 27662|ERX|HCPCS RX001|17478-0403-03|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUORESCEIN 0.6 MG EYE STRIPS|1 Strip|HUMANA [1294]||HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 27663|ERX|HCPCS RX001|17238-0900-11|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUORESCEIN 1 MG EYE STRIPS|1 Each|HUMANA [1294]||HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 27663|ERX|HCPCS RX001|17238-0900-99|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUORESCEIN 1 MG EYE STRIPS|1 Each|HUMANA [1294]||HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 27663|ERX|HCPCS RX001|17478-0404-01|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUORESCEIN 1 MG EYE STRIPS|1 Each|HUMANA [1294]||HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 27680|ERX|HCPCS A9270|41167-0730-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.02|PHR: 408101; CHG: 26||Not reimbursed separately|10.02|PHR: 408101; CHG: 26||External grouping not supported 27680|ERX|HCPCS A9270|45802-0356-53|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.02|PHR: 408101; CHG: 26||Not reimbursed separately|10.02|PHR: 408101; CHG: 26||External grouping not supported 27680|ERX|HCPCS A9270|87701-0552-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|85 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.02|PHR: 408101; CHG: 26||Not reimbursed separately|10.02|PHR: 408101; CHG: 26||External grouping not supported 27691|ERX|HCPCS A9270|68001-0111-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 27692|ERX|HCPCS A9270|51079-0121-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 27692|ERX|HCPCS A9270|51079-0121-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 27692|ERX|HCPCS A9270|60687-0123-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 27692|ERX|HCPCS A9270|68001-0112-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 27694|ERX|HCPCS A9270|63739-0358-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 27695|ERX|HCPCS A9270|62175-0136-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 40 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|00067-4345-09|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|00378-6470-16|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|00378-6470-99|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|10019-0553-03|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|10019-0553-04|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|10019-0553-90|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|45802-0580-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|45802-0580-84|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27696|ERX|HCPCS RX001|66758-0208-54|0250 - PHARMACY - GENERAL CLASSIFICATION|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|1 Patch|HUMANA [1294]||HUMANA [11839]|29.31|PHR: 408101; CHG: 26||Not reimbursed separately|29.31|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|00378-7732-93|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|00781-5238-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|00781-5238-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|00781-5238-64|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|57237-0077-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|65862-0390-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|68001-0246-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|68001-0246-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|68001-0246-17|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|68462-0157-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27697|ERX|HCPCS Q0162|68462-0157-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|00781-5239-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|00781-5239-64|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|62756-0356-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|65862-0391-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|68001-0247-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|68462-0158-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27698|ERX|HCPCS Q0162|68462-0158-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ONDANSETRON 8 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.76|PHR: 408101; CHG: 26||Not reimbursed separately|1.76|PHR: 408101; CHG: 26||External grouping not supported 27780|ERX|HCPCS A9270|60687-0230-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZONISAMIDE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 27780|ERX|HCPCS A9270|60687-0230-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZONISAMIDE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 27780|ERX|HCPCS A9270|68001-0244-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZONISAMIDE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 27780|ERX|HCPCS A9270|68462-0130-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZONISAMIDE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.16|PHR: 408101; CHG: 26||Not reimbursed separately|1.16|PHR: 408101; CHG: 26||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-9543-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27838|ERX|HCPCS J7050|00338-0049-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 27856|ERX|HCPCS A9270|00904-6401-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMSULOSIN 0.4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 27856|ERX|HCPCS A9270|51079-0294-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMSULOSIN 0.4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 27856|ERX|HCPCS A9270|51079-0294-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMSULOSIN 0.4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 27856|ERX|HCPCS A9270|68084-0299-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMSULOSIN 0.4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 27856|ERX|HCPCS A9270|68084-0299-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMSULOSIN 0.4 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 27857|ERX|HCPCS A9270|68084-0698-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 27857|ERX|HCPCS A9270|68084-0698-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 27858|ERX|HCPCS A9270|00093-7385-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 27858|ERX|HCPCS A9270|65862-0528-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 27858|ERX|HCPCS A9270|65862-0528-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 27858|ERX|HCPCS A9270|68084-0709-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 27858|ERX|HCPCS A9270|68084-0709-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 27858|ERX|HCPCS A9270|68382-0035-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 27859|ERX|HCPCS A9270|00904-6470-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 27859|ERX|HCPCS A9270|65862-0697-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 27859|ERX|HCPCS A9270|68084-0713-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 27859|ERX|HCPCS A9270|68084-0713-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 27860|ERX|HCPCS A9270|00536-5894-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.34|PHR: 408101; CHG: 26||Not reimbursed separately|3.34|PHR: 408101; CHG: 26||External grouping not supported 27860|ERX|HCPCS A9270|60505-7061-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.34|PHR: 408101; CHG: 26||Not reimbursed separately|3.34|PHR: 408101; CHG: 26||External grouping not supported 27862|ERX|HCPCS A9270|00536-1107-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 27862|ERX|HCPCS A9270|00536-5895-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 27862|ERX|HCPCS A9270|43598-0447-71|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 27862|ERX|HCPCS A9270|43598-0447-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 27862|ERX|HCPCS A9270|46122-0352-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 27862|ERX|HCPCS A9270|60505-7062-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 27863|ERX|HCPCS A9270|00536-1108-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.44|PHR: 408101; CHG: 26||Not reimbursed separately|3.44|PHR: 408101; CHG: 26||External grouping not supported 27863|ERX|HCPCS A9270|00536-5896-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.44|PHR: 408101; CHG: 26||Not reimbursed separately|3.44|PHR: 408101; CHG: 26||External grouping not supported 27863|ERX|HCPCS A9270|43598-0448-71|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.44|PHR: 408101; CHG: 26||Not reimbursed separately|3.44|PHR: 408101; CHG: 26||External grouping not supported 27863|ERX|HCPCS A9270|60505-7063-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.44|PHR: 408101; CHG: 26||Not reimbursed separately|3.44|PHR: 408101; CHG: 26||External grouping not supported 27863|ERX|HCPCS A9270|87701-0427-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.44|PHR: 408101; CHG: 26||Not reimbursed separately|3.44|PHR: 408101; CHG: 26||External grouping not supported 27898|ERX|HCPCS A9270|50383-0775-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE HCL 2 % MUCOSAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.03|PHR: 408101; CHG: 26||Not reimbursed separately|2.03|PHR: 408101; CHG: 26||External grouping not supported 27898|ERX|HCPCS A9270|00054-3500-49|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE HCL 2 % MUCOSAL SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.05|PHR: 408101; CHG: 26||Not reimbursed separately|4.05|PHR: 408101; CHG: 26||External grouping not supported 27898|ERX|HCPCS A9270|50383-0775-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE HCL 2 % MUCOSAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.03|PHR: 408101; CHG: 26||Not reimbursed separately|2.03|PHR: 408101; CHG: 26||External grouping not supported 27898|ERX|HCPCS A9270|50383-0775-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE HCL 2 % MUCOSAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.03|PHR: 408101; CHG: 26||Not reimbursed separately|2.03|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|00378-9121-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|00406-9025-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|47781-0424-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|47781-0424-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|60505-7006-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|60505-7006-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|60505-7081-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27905|ERX|HCPCS A9270|60505-7081-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.12|PHR: 408101; CHG: 26||Not reimbursed separately|4.12|PHR: 408101; CHG: 26||External grouping not supported 27906|ERX|HCPCS A9270|00378-9122-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.42|PHR: 408101; CHG: 26||Not reimbursed separately|8.42|PHR: 408101; CHG: 26||External grouping not supported 27906|ERX|HCPCS A9270|00406-9050-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.42|PHR: 408101; CHG: 26||Not reimbursed separately|8.42|PHR: 408101; CHG: 26||External grouping not supported 27906|ERX|HCPCS A9270|60505-7007-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.42|PHR: 408101; CHG: 26||Not reimbursed separately|8.42|PHR: 408101; CHG: 26||External grouping not supported 27906|ERX|HCPCS A9270|60505-7082-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.42|PHR: 408101; CHG: 26||Not reimbursed separately|8.42|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|00378-9123-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|00406-9075-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|47781-0427-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|47781-0427-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|60505-7008-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|60505-7008-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27907|ERX|HCPCS A9270|60505-7083-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.56|PHR: 408101; CHG: 26||Not reimbursed separately|9.56|PHR: 408101; CHG: 26||External grouping not supported 27908|ERX|HCPCS A9270|00378-9124-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.68|PHR: 408101; CHG: 26||Not reimbursed separately|13.68|PHR: 408101; CHG: 26||External grouping not supported 27908|ERX|HCPCS A9270|00406-9000-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.68|PHR: 408101; CHG: 26||Not reimbursed separately|13.68|PHR: 408101; CHG: 26||External grouping not supported 27908|ERX|HCPCS A9270|47781-0428-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.68|PHR: 408101; CHG: 26||Not reimbursed separately|13.68|PHR: 408101; CHG: 26||External grouping not supported 27908|ERX|HCPCS A9270|60505-7009-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.68|PHR: 408101; CHG: 26||Not reimbursed separately|13.68|PHR: 408101; CHG: 26||External grouping not supported 27908|ERX|HCPCS A9270|60505-7084-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.68|PHR: 408101; CHG: 26||Not reimbursed separately|13.68|PHR: 408101; CHG: 26||External grouping not supported 27974|ERX|HCPCS A9270|49100-0381-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27974|ERX|HCPCS A9270|49100-0400-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 27994|ERX|HCPCS A9270|17478-0060-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POLYVINYL ALCOHOL 1.4 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.81|PHR: 408101; CHG: 26||Not reimbursed separately|14.81|PHR: 408101; CHG: 26||External grouping not supported 28018|ERX|HCPCS RX001|00009-0315-08|0250 - PHARMACY - GENERAL CLASSIFICATION|GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE|1 Each|HUMANA [1294]||HUMANA [11839]|11.54|PHR: 408101; CHG: 26||Not reimbursed separately|11.54|PHR: 408101; CHG: 26||External grouping not supported 28024|ERX|HCPCS RX001|00009-0323-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE|1 Each|HUMANA [1294]||HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 28025|ERX|HCPCS RX001|00009-0342-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE|1 Each|HUMANA [1294]||HUMANA [11839]|52.70|PHR: 408101; CHG: 26||Not reimbursed separately|52.70|PHR: 408101; CHG: 26||External grouping not supported 28028|ERX|HCPCS RX001|00009-0297-03|0250 - PHARMACY - GENERAL CLASSIFICATION|GELATIN ABSORBABLE EYE FILM|1 Strip|HUMANA [1294]||HUMANA [11839]|618.53|PHR: 408101; CHG: 26||Not reimbursed separately|618.53|PHR: 408101; CHG: 26||External grouping not supported 28030|ERX|HCPCS A9270|51991-0635-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS FUM 110 MG IRON-B12-INT.FACTOR-VIT C-FOLIC ACID 0.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 28134|ERX|HCPCS A9270|59212-0425-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARB-HYOSCYAMN-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.76|PHR: 408101; CHG: 26||Not reimbursed separately|28.76|PHR: 408101; CHG: 26||External grouping not supported 28134|ERX|HCPCS A9270|75826-0118-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARB-HYOSCYAMN-ATROPINE-SCOP 16.2 MG-0.1037 MG-0.0194 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.76|PHR: 408101; CHG: 26||Not reimbursed separately|28.76|PHR: 408101; CHG: 26||External grouping not supported 28159|ERX|HCPCS A9270|49884-0320-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 28159|ERX|HCPCS A9270|55111-0262-79|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 28159|ERX|HCPCS A9270|59746-0306-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 28159|ERX|HCPCS A9270|59746-0306-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 28159|ERX|HCPCS A9270|60505-3275-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 28159|ERX|HCPCS A9270|60505-3275-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 28160|ERX|HCPCS A9270|59746-0307-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 10 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.02|PHR: 408101; CHG: 26||Not reimbursed separately|3.02|PHR: 408101; CHG: 26||External grouping not supported 28160|ERX|HCPCS A9270|59746-0307-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLANZAPINE 10 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.02|PHR: 408101; CHG: 26||Not reimbursed separately|3.02|PHR: 408101; CHG: 26||External grouping not supported 28188|ERX|HCPCS RX001|00116-1061-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID|118 mL|HUMANA [1294]||HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 28188|ERX|HCPCS RX001|00234-0575-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID|118 mL|HUMANA [1294]||HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 28188|ERX|HCPCS RX001|00234-0575-41|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID|118 mL|HUMANA [1294]||HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 28188|ERX|HCPCS RX001|67618-0200-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID|118 mL|HUMANA [1294]||HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 28188|ERX|HCPCS RX001|52380-1272-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID|120 mL|HUMANA [1294]||HUMANA [11839]|7.20|PHR: 408101; CHG: 26||Not reimbursed separately|7.20|PHR: 408101; CHG: 26||External grouping not supported 28188|ERX|HCPCS RX001|00234-0575-17|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID|15 mL|HUMANA [1294]||HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 28203|ERX|HCPCS A9270|00591-3525-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.44|PHR: 408101; CHG: 26||Not reimbursed separately|6.44|PHR: 408101; CHG: 26||External grouping not supported 28203|ERX|HCPCS A9270|00591-3525-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.44|PHR: 408101; CHG: 26||Not reimbursed separately|6.44|PHR: 408101; CHG: 26||External grouping not supported 28203|ERX|HCPCS A9270|00603-1880-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE 5 % TOPICAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.44|PHR: 408101; CHG: 26||Not reimbursed separately|6.44|PHR: 408101; CHG: 26||External grouping not supported 28224|ERX|HCPCS A9270|00904-6553-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINEZOLID 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 28224|ERX|HCPCS A9270|59762-1307-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINEZOLID 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 28224|ERX|HCPCS A9270|60687-0309-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINEZOLID 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 28224|ERX|HCPCS A9270|60687-0309-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINEZOLID 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.22|PHR: 408101; CHG: 26||Not reimbursed separately|5.22|PHR: 408101; CHG: 26||External grouping not supported 28225|ERX|HCPCS A9270|00054-0319-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINEZOLID 100 MG/5 ML ORAL SUSPENSION|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|881.10|PHR: 408101; CHG: 26||Not reimbursed separately|881.10|PHR: 408101; CHG: 26||External grouping not supported 28225|ERX|HCPCS A9270|59762-1308-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINEZOLID 100 MG/5 ML ORAL SUSPENSION|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|881.10|PHR: 408101; CHG: 26||Not reimbursed separately|881.10|PHR: 408101; CHG: 26||External grouping not supported 28235|ERX|HCPCS RX001|63323-0877-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PENTAMIDINE 300 MG SOLUTION FOR INHALATION|300 mg|HUMANA [1294]||HUMANA [11839]|298.53|PHR: 408101; CHG: 26||Not reimbursed separately|298.53|PHR: 408101; CHG: 26||External grouping not supported 28245|ERX|HCPCS A9270|00173-0681-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.14|PHR: 408101; CHG: 26||Not reimbursed separately|163.14|PHR: 408101; CHG: 26||External grouping not supported 28246|ERX|HCPCS A9270|00173-0520-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SALMETEROL 50 MCG/DOSE BLISTER POWDER FOR INHALATION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.96|PHR: 408101; CHG: 26||Not reimbursed separately|644.96|PHR: 408101; CHG: 26||External grouping not supported 28252|ERX|HCPCS A9270|42858-0660-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.51|PHR: 408101; CHG: 26||Not reimbursed separately|3.51|PHR: 408101; CHG: 26||External grouping not supported 28252|ERX|HCPCS A9270|50268-0313-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.51|PHR: 408101; CHG: 26||Not reimbursed separately|3.51|PHR: 408101; CHG: 26||External grouping not supported 28252|ERX|HCPCS A9270|50268-0313-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.51|PHR: 408101; CHG: 26||Not reimbursed separately|3.51|PHR: 408101; CHG: 26||External grouping not supported 28252|ERX|HCPCS A9270|63304-0901-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.51|PHR: 408101; CHG: 26||Not reimbursed separately|3.51|PHR: 408101; CHG: 26||External grouping not supported 28252|ERX|HCPCS A9270|68084-0328-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.51|PHR: 408101; CHG: 26||Not reimbursed separately|3.51|PHR: 408101; CHG: 26||External grouping not supported 28264|ERX|HCPCS A9270|00378-0088-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 28264|ERX|HCPCS A9270|62756-0461-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 28264|ERX|HCPCS A9270|68084-0281-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 28264|ERX|HCPCS A9270|68084-0281-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 28278|ERX|HCPCS A9270|51991-0793-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 1.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 28278|ERX|HCPCS A9270|60687-0574-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 1.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 28278|ERX|HCPCS A9270|63739-0576-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 1.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.40|PHR: 408101; CHG: 26||Not reimbursed separately|6.40|PHR: 408101; CHG: 26||External grouping not supported 28279|ERX|HCPCS A9270|51991-0794-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 3 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.18|PHR: 408101; CHG: 26||Not reimbursed separately|1.18|PHR: 408101; CHG: 26||External grouping not supported 28280|ERX|HCPCS A9270|51991-0795-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 4.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 28351|ERX|HCPCS A9270|47335-0938-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZELASTINE 0.05 % EYE DROPS|6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.62|PHR: 408101; CHG: 26||Not reimbursed separately|19.62|PHR: 408101; CHG: 26||External grouping not supported 28351|ERX|HCPCS A9270|60505-0578-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZELASTINE 0.05 % EYE DROPS|6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.62|PHR: 408101; CHG: 26||Not reimbursed separately|19.62|PHR: 408101; CHG: 26||External grouping not supported 28351|ERX|HCPCS A9270|61314-0308-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZELASTINE 0.05 % EYE DROPS|6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.62|PHR: 408101; CHG: 26||Not reimbursed separately|19.62|PHR: 408101; CHG: 26||External grouping not supported 28357|ERX|HCPCS RX001|59365-6065-00|0250 - PHARMACY - GENERAL CLASSIFICATION|FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION|8 g|HUMANA [1294]||HUMANA [11839]|40.04|PHR: 408101; CHG: 26||Not reimbursed separately|40.04|PHR: 408101; CHG: 26||External grouping not supported 28357|ERX|HCPCS RX001|59365-6065-01|0250 - PHARMACY - GENERAL CLASSIFICATION|FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION|8 g|HUMANA [1294]||HUMANA [11839]|40.04|PHR: 408101; CHG: 26||Not reimbursed separately|40.04|PHR: 408101; CHG: 26||External grouping not supported 28372|ERX|HCPCS A9270|51660-0996-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLESEVELAM 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.37|PHR: 408101; CHG: 26||Not reimbursed separately|2.37|PHR: 408101; CHG: 26||External grouping not supported 28372|ERX|HCPCS A9270|65597-0701-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLESEVELAM 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.37|PHR: 408101; CHG: 26||Not reimbursed separately|2.37|PHR: 408101; CHG: 26||External grouping not supported 28372|ERX|HCPCS A9270|68382-0619-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLESEVELAM 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.37|PHR: 408101; CHG: 26||Not reimbursed separately|2.37|PHR: 408101; CHG: 26||External grouping not supported 28372|ERX|HCPCS A9270|68462-0433-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLESEVELAM 625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.37|PHR: 408101; CHG: 26||Not reimbursed separately|2.37|PHR: 408101; CHG: 26||External grouping not supported 28384|ERX|HCPCS A9270|00406-0125-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 28384|ERX|HCPCS A9270|00406-0125-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 28384|ERX|HCPCS A9270|13107-0021-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 28384|ERX|HCPCS A9270|50268-0402-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 28384|ERX|HCPCS A9270|60687-0418-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 28384|ERX|HCPCS A9270|60687-0418-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 28400|ERX|HCPCS RX007|00338-0013-04|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 28400|ERX|HCPCS RX007|00990-7990-09|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 28400|ERX|HCPCS RX007|00338-0013-06|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 2848|ERX|HCPCS J0171|00409-4921-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.76|PHR: 408101; CHG: 26||Not reimbursed separately|20.76|PHR: 408101; CHG: 26||External grouping not supported 2848|ERX|HCPCS J0171|76329-3316-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|20.76|PHR: 408101; CHG: 26||Not reimbursed separately|20.76|PHR: 408101; CHG: 26||External grouping not supported 2850|ERX|HCPCS J0171|42023-0168-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.67|PHR: 408101; CHG: 26||Not reimbursed separately|15.67|PHR: 408101; CHG: 26||External grouping not supported 2851|ERX|HCPCS RX001|00487-2784-01|0250 - PHARMACY - GENERAL CLASSIFICATION|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|1 Vial|HUMANA [1294]||HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 2851|ERX|HCPCS RX001|00487-5901-99|0250 - PHARMACY - GENERAL CLASSIFICATION|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|1 Vial|HUMANA [1294]||HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 2851|ERX|HCPCS RX001|05431-0091-02|0250 - PHARMACY - GENERAL CLASSIFICATION|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|1 Vial|HUMANA [1294]||HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 2863|ERX|HCPCS A9270|69452-0151-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 28643|ERX|HCPCS A9270|50268-0597-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 28643|ERX|HCPCS A9270|62175-0260-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 28643|ERX|HCPCS A9270|68084-0597-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 28643|ERX|HCPCS A9270|68084-0597-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.96|PHR: 408101; CHG: 26||Not reimbursed separately|1.96|PHR: 408101; CHG: 26||External grouping not supported 28645|ERX|HCPCS A9270|00904-6293-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 28645|ERX|HCPCS A9270|51079-0211-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 28645|ERX|HCPCS A9270|68084-0590-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 28645|ERX|HCPCS A9270|68084-0590-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATORVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 28715|ERX|HCPCS A9270|58468-0021-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SEVELAMER HCL 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.52|PHR: 408101; CHG: 26||Not reimbursed separately|11.52|PHR: 408101; CHG: 26||External grouping not supported 28715|ERX|HCPCS A9270|68462-0447-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SEVELAMER HCL 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.52|PHR: 408101; CHG: 26||Not reimbursed separately|11.52|PHR: 408101; CHG: 26||External grouping not supported 28723|ERX|HCPCS A9270|65862-0080-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 1.25 MG-METFORMIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 28724|ERX|HCPCS A9270|65862-0081-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 2.5 MG-METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.09|PHR: 408101; CHG: 26||Not reimbursed separately|0.09|PHR: 408101; CHG: 26||External grouping not supported 28725|ERX|HCPCS A9270|65862-0082-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 5 MG-METFORMIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 28747|ERX|HCPCS A9270|51672-4053-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETODOLAC ER 600 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.73|PHR: 408101; CHG: 26||Not reimbursed separately|2.73|PHR: 408101; CHG: 26||External grouping not supported 28750|ERX|HCPCS A9270|62175-0310-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.38|PHR: 408101; CHG: 26||Not reimbursed separately|21.38|PHR: 408101; CHG: 26||External grouping not supported 28751|ERX|HCPCS A9270|00406-0136-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.57|PHR: 408101; CHG: 26||Not reimbursed separately|5.57|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|00093-6815-45|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|00093-6815-73|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|00115-1687-74|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|00115-1687-76|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|00781-7515-14|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|00781-7515-87|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|69097-0318-86|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28774|ERX|HCPCS J7626|69097-0318-87|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.31|PHR: 408101; CHG: 26||Not reimbursed separately|11.31|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|00093-6816-45|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|00093-6816-73|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|00115-1689-76|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|00186-1989-04|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]||HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|00781-7516-14|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|00781-7516-87|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|69097-0319-32|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|69097-0319-53|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|69097-0319-86|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28775|ERX|HCPCS J7626|69097-0319-87|0250 - PHARMACY - GENERAL CLASSIFICATION|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.73|PHR: 408101; CHG: 26||Not reimbursed separately|10.73|PHR: 408101; CHG: 26||External grouping not supported 28809|ERX|HCPCS A9270|53329-0068-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL JELLY|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 28809|ERX|HCPCS A9270|84389-0111-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL JELLY|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 28809|ERX|HCPCS A9270|08884-4302-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WHITE PETROLATUM TOPICAL JELLY|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 28810|ERX|HCPCS A9270|24208-0635-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.75|PHR: 408101; CHG: 26||Not reimbursed separately|129.75|PHR: 408101; CHG: 26||External grouping not supported 28810|ERX|HCPCS A9270|61314-0645-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.75|PHR: 408101; CHG: 26||Not reimbursed separately|129.75|PHR: 408101; CHG: 26||External grouping not supported 28824|ERX|HCPCS A9270|10631-0407-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR|28.35 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.40|PHR: 408101; CHG: 26||Not reimbursed separately|41.40|PHR: 408101; CHG: 26||External grouping not supported 28824|ERX|HCPCS A9270|62559-0431-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.40|PHR: 408101; CHG: 26||Not reimbursed separately|41.40|PHR: 408101; CHG: 26||External grouping not supported 28824|ERX|HCPCS A9270|64980-0301-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.40|PHR: 408101; CHG: 26||Not reimbursed separately|41.40|PHR: 408101; CHG: 26||External grouping not supported 28824|ERX|HCPCS A9270|64980-0324-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.40|PHR: 408101; CHG: 26||Not reimbursed separately|41.40|PHR: 408101; CHG: 26||External grouping not supported 28836|ERX|HCPCS A9270|00904-0788-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 28836|ERX|HCPCS A9270|00904-6846-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 28836|ERX|HCPCS A9270|66689-0053-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 28836|ERX|HCPCS A9270|66689-0053-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 28836|ERX|HCPCS A9270|00121-0431-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 28842|ERX|HCPCS J7515|00093-5740-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE MODIFIED 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|1.13|PHR: 408101; CHG: 26||Not reimbursed separately|1.13|PHR: 408101; CHG: 26||External grouping not supported 28842|ERX|HCPCS J7515|00093-5740-65|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE MODIFIED 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|1.13|PHR: 408101; CHG: 26||Not reimbursed separately|1.13|PHR: 408101; CHG: 26||External grouping not supported 28843|ERX|HCPCS J7502|00093-5742-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE MODIFIED 100 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|4.23|PHR: 408101; CHG: 26||Not reimbursed separately|4.23|PHR: 408101; CHG: 26||External grouping not supported 28843|ERX|HCPCS J7502|00093-5742-65|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE MODIFIED 100 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|4.23|PHR: 408101; CHG: 26||Not reimbursed separately|4.23|PHR: 408101; CHG: 26||External grouping not supported 28844|ERX|HCPCS J7502|00172-7313-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|5.45|PHR: 408101; CHG: 26||Not reimbursed separately|5.45|PHR: 408101; CHG: 26||External grouping not supported 28847|ERX|HCPCS A9270|45802-0144-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE-PRAMOXINE 1 %-1 % RECTAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|335.07|PHR: 408101; CHG: 26||Not reimbursed separately|335.07|PHR: 408101; CHG: 26||External grouping not supported 28848|ERX|HCPCS A9270|45802-0472-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|253.26|PHR: 408101; CHG: 26||Not reimbursed separately|253.26|PHR: 408101; CHG: 26||External grouping not supported 28848|ERX|HCPCS A9270|75834-0197-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|253.26|PHR: 408101; CHG: 26||Not reimbursed separately|253.26|PHR: 408101; CHG: 26||External grouping not supported 28849|ERX|HCPCS A9270|00037-6822-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM|10 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.52|PHR: 408101; CHG: 26||Not reimbursed separately|413.52|PHR: 408101; CHG: 26||External grouping not supported 28863|ERX|HCPCS J1442|55513-0209-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,240.36|PHR: 408101; CHG: 26||Not reimbursed separately|1,240.36|PHR: 408101; CHG: 26||External grouping not supported 28872|ERX|HCPCS RX001|17478-0106-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOFLOXACIN 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|317.64|PHR: 408101; CHG: 26||Not reimbursed separately|317.64|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|00574-4024-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|17478-0070-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|24208-0910-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|00574-4024-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|00574-4024-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|17478-0070-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 2888|ERX|HCPCS A9270|24208-0910-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.18|PHR: 408101; CHG: 26||Not reimbursed separately|18.18|PHR: 408101; CHG: 26||External grouping not supported 28899|ERX|HCPCS A9270|00406-8515-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.56|PHR: 408101; CHG: 26||Not reimbursed separately|2.56|PHR: 408101; CHG: 26||External grouping not supported 28899|ERX|HCPCS A9270|68084-0184-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.56|PHR: 408101; CHG: 26||Not reimbursed separately|2.56|PHR: 408101; CHG: 26||External grouping not supported 28899|ERX|HCPCS A9270|68084-0184-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.56|PHR: 408101; CHG: 26||Not reimbursed separately|2.56|PHR: 408101; CHG: 26||External grouping not supported 28899|ERX|HCPCS A9270|68084-0975-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.56|PHR: 408101; CHG: 26||Not reimbursed separately|2.56|PHR: 408101; CHG: 26||External grouping not supported 28899|ERX|HCPCS A9270|68094-0005-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.56|PHR: 408101; CHG: 26||Not reimbursed separately|2.56|PHR: 408101; CHG: 26||External grouping not supported 2891|ERX|HCPCS A9270|24338-0122-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.33|PHR: 408101; CHG: 26||Not reimbursed separately|19.33|PHR: 408101; CHG: 26||External grouping not supported 2891|ERX|HCPCS A9270|69238-1471-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.33|PHR: 408101; CHG: 26||Not reimbursed separately|19.33|PHR: 408101; CHG: 26||External grouping not supported 28911|ERX|HCPCS J9050|23155-0261-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARMUSTINE 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA [1294]||HUMANA [11839]|4,160.04|PHR: 408101; CHG: 26||Not reimbursed separately|4,160.04|PHR: 408101; CHG: 26||External grouping not supported 28912|ERX|HCPCS J9120|39822-2100-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION|500 mcg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.99|PHR: 408101; CHG: 26||Not reimbursed separately|2,316.99|PHR: 408101; CHG: 26||External grouping not supported 28912|ERX|HCPCS J9120|55292-0811-55|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION|500 mcg|HUMANA [1294]||HUMANA [11839]|2,316.99|PHR: 408101; CHG: 26||Not reimbursed separately|2,316.99|PHR: 408101; CHG: 26||External grouping not supported 28912|ERX|HCPCS J9120|66993-0489-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION|500 mcg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.99|PHR: 408101; CHG: 26||Not reimbursed separately|2,316.99|PHR: 408101; CHG: 26||External grouping not supported 28913|ERX|HCPCS RX001|85445-0085-81|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE|0.55 mL|HUMANA [1294]||HUMANA [11839]|285.03|PHR: 408101; CHG: 26||Not reimbursed separately|285.03|PHR: 408101; CHG: 26||External grouping not supported 28913|ERX|HCPCS RX001|08065-1830-85|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 10 MG/ML INTRAOCULAR SYRINGE|0.85 mL|HUMANA [1294]||HUMANA [11839]|208.41|PHR: 408101; CHG: 26||Not reimbursed separately|208.41|PHR: 408101; CHG: 26||External grouping not supported 28914|ERX|HCPCS RX001|85445-0085-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 14 MG/ML INTRAOCULAR SYRINGE|0.55 mL|HUMANA [1294]||HUMANA [11839]|399.72|PHR: 408101; CHG: 26||Not reimbursed separately|399.72|PHR: 408101; CHG: 26||External grouping not supported 28914|ERX|HCPCS RX001|85445-0085-41|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 14 MG/ML INTRAOCULAR SYRINGE|0.85 mL|HUMANA [1294]||HUMANA [11839]|542.49|PHR: 408101; CHG: 26||Not reimbursed separately|542.49|PHR: 408101; CHG: 26||External grouping not supported 28917|ERX|HCPCS RX001|08065-1831-50|0250 - PHARMACY - GENERAL CLASSIFICATION|CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING|1.05 mL|HUMANA [1294]||HUMANA [11839]|275.72|PHR: 408101; CHG: 26||Not reimbursed separately|275.72|PHR: 408101; CHG: 26||External grouping not supported 2892|ERX|HCPCS A9270|24338-0124-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.34|PHR: 408101; CHG: 26||Not reimbursed separately|24.34|PHR: 408101; CHG: 26||External grouping not supported 28922|ERX|HCPCS J9070|10019-0957-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION|2,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,941.18|PHR: 408101; CHG: 26||Not reimbursed separately|1,941.18|PHR: 408101; CHG: 26||External grouping not supported 28923|ERX|HCPCS RX001|08065-1839-05|0250 - PHARMACY - GENERAL CLASSIFICATION|CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|181.32|PHR: 408101; CHG: 26||Not reimbursed separately|181.32|PHR: 408101; CHG: 26||External grouping not supported 28929|ERX|HCPCS A9270|00527-1947-48|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOPINAVIR-RITONAVIR 400 MG-100 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.91|PHR: 408101; CHG: 26||Not reimbursed separately|28.91|PHR: 408101; CHG: 26||External grouping not supported 28947|ERX|HCPCS J0883|00143-9674-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|585.42|PHR: 408101; CHG: 26||Not reimbursed separately|585.42|PHR: 408101; CHG: 26||External grouping not supported 28947|ERX|HCPCS J0883|42023-0182-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|585.42|PHR: 408101; CHG: 26||Not reimbursed separately|585.42|PHR: 408101; CHG: 26||External grouping not supported 28958|ERX|HCPCS J7520|68084-0915-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SIROLIMUS 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.74|PHR: 408101; CHG: 26||Not reimbursed separately|22.74|PHR: 408101; CHG: 26||External grouping not supported 28958|ERX|HCPCS J7520|68084-0915-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SIROLIMUS 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.74|PHR: 408101; CHG: 26||Not reimbursed separately|22.74|PHR: 408101; CHG: 26||External grouping not supported 28964|ERX|HCPCS A9270|00904-6353-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 28964|ERX|HCPCS A9270|55111-0281-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 28964|ERX|HCPCS A9270|65862-0538-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 28964|ERX|HCPCS A9270|69097-0287-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOFLOXACIN 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 2899|ERX|HCPCS A9270|00254-1020-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|PHR: 408101; CHG: 26||Not reimbursed separately|14.28|PHR: 408101; CHG: 26||External grouping not supported 2899|ERX|HCPCS A9270|24338-0134-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|PHR: 408101; CHG: 26||Not reimbursed separately|14.28|PHR: 408101; CHG: 26||External grouping not supported 2899|ERX|HCPCS A9270|62559-0440-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.28|PHR: 408101; CHG: 26||Not reimbursed separately|14.28|PHR: 408101; CHG: 26||External grouping not supported 28995|ERX|HCPCS A9270|51224-0007-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 28995|ERX|HCPCS A9270|62756-0142-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 28995|ERX|HCPCS A9270|67877-0159-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 2903|ERX|HCPCS J1364|00409-6482-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|211.16|PHR: 408101; CHG: 26||Not reimbursed separately|211.16|PHR: 408101; CHG: 26||External grouping not supported 29048|ERX|HCPCS A9270|65862-0329-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 70 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.69|PHR: 408101; CHG: 26||Not reimbursed separately|6.69|PHR: 408101; CHG: 26||External grouping not supported 29048|ERX|HCPCS A9270|69543-0131-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 70 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.69|PHR: 408101; CHG: 26||Not reimbursed separately|6.69|PHR: 408101; CHG: 26||External grouping not supported 29048|ERX|HCPCS A9270|69543-0131-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 70 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.69|PHR: 408101; CHG: 26||Not reimbursed separately|6.69|PHR: 408101; CHG: 26||External grouping not supported 29072|ERX|HCPCS A9270|64980-0341-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 35 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 29072|ERX|HCPCS A9270|69097-0223-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 35 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 29072|ERX|HCPCS A9270|69543-0130-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 35 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 29132|ERX|HCPCS J1756|00517-2340-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.47|PHR: 408101; CHG: 26||Not reimbursed separately|88.47|PHR: 408101; CHG: 26||External grouping not supported 29132|ERX|HCPCS J1756|00517-2340-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.47|PHR: 408101; CHG: 26||Not reimbursed separately|88.47|PHR: 408101; CHG: 26||External grouping not supported 29132|ERX|HCPCS J1756|00517-2340-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|88.47|PHR: 408101; CHG: 26||Not reimbursed separately|88.47|PHR: 408101; CHG: 26||External grouping not supported 29167|ERX|HCPCS A9270|49702-0217-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|74.17|PHR: 408101; CHG: 26||Not reimbursed separately|74.17|PHR: 408101; CHG: 26||External grouping not supported 29169|ERX|HCPCS A9270|42192-0608-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 29169|ERX|HCPCS A9270|50383-0311-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 29267|ERX|HCPCS A9270|00054-0223-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 29267|ERX|HCPCS A9270|00904-6642-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 29267|ERX|HCPCS A9270|60687-0371-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 29267|ERX|HCPCS A9270|60687-0371-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 29267|ERX|HCPCS A9270|60687-0393-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 29267|ERX|HCPCS A9270|68001-0183-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.92|PHR: 408101; CHG: 26||Not reimbursed separately|0.92|PHR: 408101; CHG: 26||External grouping not supported 29272|ERX|HCPCS A9270|10370-0830-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 29272|ERX|HCPCS A9270|60687-0206-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 29272|ERX|HCPCS A9270|60687-0206-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 29272|ERX|HCPCS A9270|63739-0015-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 29274|ERX|HCPCS A9270|10370-0831-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 29274|ERX|HCPCS A9270|60687-0217-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 29274|ERX|HCPCS A9270|60687-0217-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 29274|ERX|HCPCS A9270|63739-0016-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 29276|ERX|HCPCS A9270|60687-0228-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.39|PHR: 408101; CHG: 26||Not reimbursed separately|3.39|PHR: 408101; CHG: 26||External grouping not supported 29299|ERX|HCPCS A9270|00054-0079-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BALSALAZIDE 750 MG CAPSULE|3 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.83|PHR: 408101; CHG: 26||Not reimbursed separately|5.83|PHR: 408101; CHG: 26||External grouping not supported 29299|ERX|HCPCS A9270|50268-0102-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BALSALAZIDE 750 MG CAPSULE|3 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.83|PHR: 408101; CHG: 26||Not reimbursed separately|5.83|PHR: 408101; CHG: 26||External grouping not supported 29299|ERX|HCPCS A9270|50268-0102-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BALSALAZIDE 750 MG CAPSULE|3 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.83|PHR: 408101; CHG: 26||Not reimbursed separately|5.83|PHR: 408101; CHG: 26||External grouping not supported 29299|ERX|HCPCS A9270|60505-2575-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BALSALAZIDE 750 MG CAPSULE|3 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.83|PHR: 408101; CHG: 26||Not reimbursed separately|5.83|PHR: 408101; CHG: 26||External grouping not supported 29302|ERX|HCPCS J7510|00121-0759-08|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION|3.34 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 29313|ERX|HCPCS J0840|50633-0110-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION|1 Vial|HUMANA [1294]||HUMANA [11839]|8,839.50|PHR: 408101; CHG: 26||Not reimbursed separately|8,839.50|PHR: 408101; CHG: 26||External grouping not supported 29335|ERX|HCPCS J1800|00143-9872-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|4.21|PHR: 408101; CHG: 26||Not reimbursed separately|4.21|PHR: 408101; CHG: 26||External grouping not supported 29335|ERX|HCPCS J1800|00143-9872-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|4.21|PHR: 408101; CHG: 26||Not reimbursed separately|4.21|PHR: 408101; CHG: 26||External grouping not supported 29335|ERX|HCPCS J1800|63323-0604-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|4.21|PHR: 408101; CHG: 26||Not reimbursed separately|4.21|PHR: 408101; CHG: 26||External grouping not supported 2938|ERX|HCPCS A9270|00046-1104-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CONJUGATED ESTROGENS 1.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.33|PHR: 408101; CHG: 26||Not reimbursed separately|16.33|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|00409-8300-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]||HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|00409-8300-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|16729-0275-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|16729-0275-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|55150-0210-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|63323-0562-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|70860-0402-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29396|ERX|HCPCS J0583|70860-0402-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.99|PHR: 408101; CHG: 26||Not reimbursed separately|234.99|PHR: 408101; CHG: 26||External grouping not supported 29424|ERX|HCPCS A9270|00168-0258-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.92|PHR: 408101; CHG: 26||Not reimbursed separately|12.92|PHR: 408101; CHG: 26||External grouping not supported 29424|ERX|HCPCS A9270|51672-4048-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.92|PHR: 408101; CHG: 26||Not reimbursed separately|12.92|PHR: 408101; CHG: 26||External grouping not supported 29424|ERX|HCPCS A9270|68462-0298-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.92|PHR: 408101; CHG: 26||Not reimbursed separately|12.92|PHR: 408101; CHG: 26||External grouping not supported 29435|ERX|HCPCS A9270|00093-7164-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 29435|ERX|HCPCS A9270|00093-7164-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.78|PHR: 408101; CHG: 26||Not reimbursed separately|5.78|PHR: 408101; CHG: 26||External grouping not supported 29437|ERX|HCPCS A9270|00591-3354-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NATEGLINIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 29437|ERX|HCPCS A9270|49884-0984-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NATEGLINIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 29437|ERX|HCPCS A9270|55111-0328-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NATEGLINIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 29437|ERX|HCPCS A9270|68382-0721-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NATEGLINIDE 60 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 29438|ERX|HCPCS A9270|00591-3355-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NATEGLINIDE 120 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.69|PHR: 408101; CHG: 26||Not reimbursed separately|1.69|PHR: 408101; CHG: 26||External grouping not supported 29438|ERX|HCPCS A9270|49884-0985-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NATEGLINIDE 120 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.69|PHR: 408101; CHG: 26||Not reimbursed separately|1.69|PHR: 408101; CHG: 26||External grouping not supported 29464|ERX|HCPCS J2274|99999-4444-92|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 29464|ERX|HCPCS J2274|00409-3814-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.07|PHR: 408101; CHG: 26||Not reimbursed separately|17.07|PHR: 408101; CHG: 26||External grouping not supported 29464|ERX|HCPCS J2274|00641-6020-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.07|PHR: 408101; CHG: 26||Not reimbursed separately|17.07|PHR: 408101; CHG: 26||External grouping not supported 29464|ERX|HCPCS J2274|99999-4444-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.84|PHR: 408101; CHG: 26||Not reimbursed separately|6.84|PHR: 408101; CHG: 26||External grouping not supported 29531|ERX|HCPCS A9270|57237-0011-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 15 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 29531|ERX|HCPCS A9270|65862-0021-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MIRTAZAPINE 15 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 29567|ERX|HCPCS J0637|00006-3822-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|171.00|PHR: 408101; CHG: 26||Not reimbursed separately|171.00|PHR: 408101; CHG: 26||External grouping not supported 29567|ERX|HCPCS J0637|47781-0613-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|171.00|PHR: 408101; CHG: 26||Not reimbursed separately|171.00|PHR: 408101; CHG: 26||External grouping not supported 29567|ERX|HCPCS J0637|72611-0700-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|171.00|PHR: 408101; CHG: 26||Not reimbursed separately|171.00|PHR: 408101; CHG: 26||External grouping not supported 29568|ERX|HCPCS J0637|00006-3823-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION|70 mg|HUMANA [1294]||HUMANA [11839]|171.39|PHR: 408101; CHG: 26||Not reimbursed separately|171.39|PHR: 408101; CHG: 26||External grouping not supported 29568|ERX|HCPCS J0637|47781-0614-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION|70 mg|HUMANA [1294]||HUMANA [11839]|171.39|PHR: 408101; CHG: 26||Not reimbursed separately|171.39|PHR: 408101; CHG: 26||External grouping not supported 29568|ERX|HCPCS J0637|67457-0832-70|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION|70 mg|HUMANA [1294]||HUMANA [11839]|171.39|PHR: 408101; CHG: 26||Not reimbursed separately|171.39|PHR: 408101; CHG: 26||External grouping not supported 29568|ERX|HCPCS J0637|72266-0107-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION|70 mg|HUMANA [1294]||HUMANA [11839]|171.39|PHR: 408101; CHG: 26||Not reimbursed separately|171.39|PHR: 408101; CHG: 26||External grouping not supported 29676|ERX|HCPCS A9270|00904-3865-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.85|PHR: 408101; CHG: 26||Not reimbursed separately|1.85|PHR: 408101; CHG: 26||External grouping not supported 29676|ERX|HCPCS A9270|87701-0552-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.85|PHR: 408101; CHG: 26||Not reimbursed separately|1.85|PHR: 408101; CHG: 26||External grouping not supported 29746|ERX|HCPCS A9270|00186-5040-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.49|PHR: 408101; CHG: 26||Not reimbursed separately|24.49|PHR: 408101; CHG: 26||External grouping not supported 29778|ERX|HCPCS A9270|00904-6269-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.79|PHR: 408101; CHG: 26||Not reimbursed separately|5.79|PHR: 408101; CHG: 26||External grouping not supported 29778|ERX|HCPCS A9270|68084-0103-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.79|PHR: 408101; CHG: 26||Not reimbursed separately|5.79|PHR: 408101; CHG: 26||External grouping not supported 29778|ERX|HCPCS A9270|68084-0103-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.79|PHR: 408101; CHG: 26||Not reimbursed separately|5.79|PHR: 408101; CHG: 26||External grouping not supported 29779|ERX|HCPCS A9270|68084-0104-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.06|PHR: 408101; CHG: 26||Not reimbursed separately|5.06|PHR: 408101; CHG: 26||External grouping not supported 29779|ERX|HCPCS A9270|68084-0104-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.06|PHR: 408101; CHG: 26||Not reimbursed separately|5.06|PHR: 408101; CHG: 26||External grouping not supported 29780|ERX|HCPCS A9270|68084-0105-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 60 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.06|PHR: 408101; CHG: 26||Not reimbursed separately|5.06|PHR: 408101; CHG: 26||External grouping not supported 29780|ERX|HCPCS A9270|68084-0105-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 60 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.06|PHR: 408101; CHG: 26||Not reimbursed separately|5.06|PHR: 408101; CHG: 26||External grouping not supported 29781|ERX|HCPCS A9270|68084-0106-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 80 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.06|PHR: 408101; CHG: 26||Not reimbursed separately|5.06|PHR: 408101; CHG: 26||External grouping not supported 29781|ERX|HCPCS A9270|68084-0106-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZIPRASIDONE 80 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.06|PHR: 408101; CHG: 26||Not reimbursed separately|5.06|PHR: 408101; CHG: 26||External grouping not supported 29805|ERX|HCPCS RX001|10019-0055-61|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV|250 mL|HUMANA [1294]||HUMANA [11839]|381.75|PHR: 408101; CHG: 26||Not reimbursed separately|381.75|PHR: 408101; CHG: 26||External grouping not supported 29805|ERX|HCPCS RX001|10019-0670-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV|250 mL|HUMANA [1294]||HUMANA [11839]|381.75|PHR: 408101; CHG: 26||Not reimbursed separately|381.75|PHR: 408101; CHG: 26||External grouping not supported 29806|ERX|HCPCS A9270|68084-0729-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 29806|ERX|HCPCS A9270|68084-0729-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 29807|ERX|HCPCS A9270|51079-0853-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.75|PHR: 408101; CHG: 26||Not reimbursed separately|1.75|PHR: 408101; CHG: 26||External grouping not supported 29807|ERX|HCPCS A9270|51079-0853-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.75|PHR: 408101; CHG: 26||Not reimbursed separately|1.75|PHR: 408101; CHG: 26||External grouping not supported 29807|ERX|HCPCS A9270|65862-0459-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.75|PHR: 408101; CHG: 26||Not reimbursed separately|1.75|PHR: 408101; CHG: 26||External grouping not supported 29808|ERX|HCPCS A9270|00054-0092-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE 12 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 29858|ERX|HCPCS A9270|00904-6322-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 29858|ERX|HCPCS A9270|50268-0540-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 29858|ERX|HCPCS A9270|55111-0466-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 29858|ERX|HCPCS A9270|60687-0390-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 29858|ERX|HCPCS A9270|60687-0390-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 29868|ERX|HCPCS A9270|68382-0715-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLMITRIPTAN 2.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.17|PHR: 408101; CHG: 26||Not reimbursed separately|4.17|PHR: 408101; CHG: 26||External grouping not supported 29868|ERX|HCPCS A9270|68462-0499-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLMITRIPTAN 2.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.17|PHR: 408101; CHG: 26||Not reimbursed separately|4.17|PHR: 408101; CHG: 26||External grouping not supported 30070|ERX|HCPCS A9270|00904-6323-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 30070|ERX|HCPCS A9270|60687-0402-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 30070|ERX|HCPCS A9270|60687-0402-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 30071|ERX|HCPCS A9270|00904-6324-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 30071|ERX|HCPCS A9270|55111-0468-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 30071|ERX|HCPCS A9270|60687-0413-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 30071|ERX|HCPCS A9270|60687-0413-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 30071|ERX|HCPCS A9270|63739-0454-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 30072|ERX|HCPCS A9270|45963-0678-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.27|PHR: 408101; CHG: 26||Not reimbursed separately|3.27|PHR: 408101; CHG: 26||External grouping not supported 30072|ERX|HCPCS A9270|50268-0543-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.27|PHR: 408101; CHG: 26||Not reimbursed separately|3.27|PHR: 408101; CHG: 26||External grouping not supported 30072|ERX|HCPCS A9270|50268-0543-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL SUCCINATE ER 200 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.27|PHR: 408101; CHG: 26||Not reimbursed separately|3.27|PHR: 408101; CHG: 26||External grouping not supported 30148|ERX|HCPCS A9270|00603-6330-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALGANCICLOVIR 450 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.41|PHR: 408101; CHG: 26||Not reimbursed separately|7.41|PHR: 408101; CHG: 26||External grouping not supported 30148|ERX|HCPCS A9270|55111-0762-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALGANCICLOVIR 450 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.41|PHR: 408101; CHG: 26||Not reimbursed separately|7.41|PHR: 408101; CHG: 26||External grouping not supported 30183|ERX|HCPCS A9270|24357-0701-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.39|PHR: 408101; CHG: 26||Not reimbursed separately|9.39|PHR: 408101; CHG: 26||External grouping not supported 30264|ERX|HCPCS A9270|00904-6084-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CITALOPRAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 30322|ERX|HCPCS A9270|00378-5246-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALMOTRIPTAN MALATE 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.83|PHR: 408101; CHG: 26||Not reimbursed separately|49.83|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9093-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9093-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9093-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9093-45|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-17|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00641-6027-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00641-6028-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00641-6028-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00641-6029-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00641-6030-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|17478-0030-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|17478-0030-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|63323-0806-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|63323-0806-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|63323-0806-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9093-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00409-9094-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|00641-6027-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 3037|ERX|HCPCS J3010|99999-4444-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 30479|ERX|HCPCS A9270|00054-0199-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|PHR: 408101; CHG: 26||Not reimbursed separately|705.00|PHR: 408101; CHG: 26||External grouping not supported 30479|ERX|HCPCS A9270|00078-0357-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|PHR: 408101; CHG: 26||Not reimbursed separately|705.00|PHR: 408101; CHG: 26||External grouping not supported 30479|ERX|HCPCS A9270|00781-6270-43|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|PHR: 408101; CHG: 26||Not reimbursed separately|705.00|PHR: 408101; CHG: 26||External grouping not supported 30479|ERX|HCPCS A9270|65162-0649-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|PHR: 408101; CHG: 26||Not reimbursed separately|705.00|PHR: 408101; CHG: 26||External grouping not supported 3059|ERX|HCPCS RX001|51552-0357-03|0250 - PHARMACY - GENERAL CLASSIFICATION|FERRIC SUBSULFATE (BULK) 20 TO 22 GRAM/100 ML SOLUTION|6,300 mg|HUMANA [1294]||HUMANA [11839]|11.79|PHR: 408101; CHG: 26||Not reimbursed separately|11.79|PHR: 408101; CHG: 26||External grouping not supported 3066|ERX|HCPCS RX015|00574-0508-11|0250 - PHARMACY - GENERAL CLASSIFICATION|FERROUS GLUCONATE 324 MG (38 MG IRON) TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 30699|ERX|HCPCS A9270|68462-0257-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROPINIROLE 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 3071|ERX|HCPCS A9270|00121-0530-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|00904-7590-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|00904-7590-82|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|00904-7591-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|00904-7591-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|00904-7591-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|00904-7591-82|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|37864-0760-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 3074|ERX|HCPCS A9270|51645-0760-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FERROUS SULFATE 325 MG (65 MG IRON) TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 30961|ERX|HCPCS A9270|00054-0088-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 30961|ERX|HCPCS A9270|00781-2081-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 30961|ERX|HCPCS A9270|62135-0191-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 30961|ERX|HCPCS A9270|69097-0862-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|00904-6571-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|29300-0349-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|51079-0205-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|53489-0156-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|62584-0988-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|62584-0988-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 310|ERX|HCPCS A9270|63739-0410-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 311|ERX|HCPCS A9270|51079-0206-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 311|ERX|HCPCS A9270|62584-0713-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 311|ERX|HCPCS A9270|62584-0713-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALLOPURINOL 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.00|PHR: 408101; CHG: 26||Not reimbursed separately|1.00|PHR: 408101; CHG: 26||External grouping not supported 31158|ERX|HCPCS RX001|61314-0144-05|0250 - PHARMACY - GENERAL CLASSIFICATION|BRIMONIDINE 0.15 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|365.79|PHR: 408101; CHG: 26||Not reimbursed separately|365.79|PHR: 408101; CHG: 26||External grouping not supported 31177|ERX|HCPCS A9270|00143-9853-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 31177|ERX|HCPCS A9270|00781-6139-57|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 31209|ERX|HCPCS A9270|50268-0784-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.33|PHR: 408101; CHG: 26||Not reimbursed separately|2.33|PHR: 408101; CHG: 26||External grouping not supported 31209|ERX|HCPCS A9270|59746-0361-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.33|PHR: 408101; CHG: 26||Not reimbursed separately|2.33|PHR: 408101; CHG: 26||External grouping not supported 31209|ERX|HCPCS A9270|62332-0045-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.33|PHR: 408101; CHG: 26||Not reimbursed separately|2.33|PHR: 408101; CHG: 26||External grouping not supported 31210|ERX|HCPCS A9270|00378-5814-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 31210|ERX|HCPCS A9270|33342-0064-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 31210|ERX|HCPCS A9270|59746-0362-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 31210|ERX|HCPCS A9270|62332-0046-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 31210|ERX|HCPCS A9270|67877-0417-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 31239|ERX|HCPCS A9270|00450-0204-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 5 MG-PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE,12HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.68|PHR: 408101; CHG: 26||Not reimbursed separately|1.68|PHR: 408101; CHG: 26||External grouping not supported 31270|ERX|HCPCS Q9957|11994-0011-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS SUSPENSION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|311.52|PHR: 408101; CHG: 26||Not reimbursed separately|311.52|PHR: 408101; CHG: 26||External grouping not supported 31270|ERX|HCPCS Q9957|11994-0011-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS SUSPENSION|2 mL|HUMANA [1294]||HUMANA [11839]|311.52|PHR: 408101; CHG: 26||Not reimbursed separately|311.52|PHR: 408101; CHG: 26||External grouping not supported 31288|ERX|HCPCS A9270|57664-0537-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 31288|ERX|HCPCS A9270|68084-0825-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 31288|ERX|HCPCS A9270|68084-0825-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 31336|ERX|HCPCS A9270|42858-0454-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 54 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 31336|ERX|HCPCS A9270|63304-0900-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 54 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 31336|ERX|HCPCS A9270|68084-0827-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 54 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 31336|ERX|HCPCS A9270|68084-0827-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENOFIBRATE 54 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 31432|ERX|HCPCS J1162|50633-0120-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION|5 Vial|HUMANA [1294]||HUMANA [11839]|52,815.90|PHR: 408101; CHG: 26||Not reimbursed separately|52,815.90|PHR: 408101; CHG: 26||External grouping not supported 31470|ERX|HCPCS A9270|59746-0462-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLMITRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.43|PHR: 408101; CHG: 26||Not reimbursed separately|12.43|PHR: 408101; CHG: 26||External grouping not supported 31470|ERX|HCPCS A9270|68382-0717-82|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLMITRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.43|PHR: 408101; CHG: 26||Not reimbursed separately|12.43|PHR: 408101; CHG: 26||External grouping not supported 31470|ERX|HCPCS A9270|68462-0500-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZOLMITRIPTAN 5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.43|PHR: 408101; CHG: 26||Not reimbursed separately|12.43|PHR: 408101; CHG: 26||External grouping not supported 31576|ERX|HCPCS A9270|00378-7155-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.47|PHR: 408101; CHG: 26||Not reimbursed separately|1.47|PHR: 408101; CHG: 26||External grouping not supported 31576|ERX|HCPCS A9270|00574-9855-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.47|PHR: 408101; CHG: 26||Not reimbursed separately|1.47|PHR: 408101; CHG: 26||External grouping not supported 31576|ERX|HCPCS A9270|51862-0582-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.47|PHR: 408101; CHG: 26||Not reimbursed separately|1.47|PHR: 408101; CHG: 26||External grouping not supported 31577|ERX|HCPCS RX001|00378-6991-52|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE 0.63 MG/3 ML SOLUTION FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 31587|ERX|HCPCS A9270|00781-2335-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULE,EXTEND RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.81|PHR: 408101; CHG: 26||Not reimbursed separately|3.81|PHR: 408101; CHG: 26||External grouping not supported 31588|ERX|HCPCS A9270|00228-3060-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE ER 20 MG 24HR CAPSULE,EXTEND RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.43|PHR: 408101; CHG: 26||Not reimbursed separately|3.43|PHR: 408101; CHG: 26||External grouping not supported 31589|ERX|HCPCS A9270|00555-0789-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE ER 30 MG 24HR CAPSULE,EXTEND RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.61|PHR: 408101; CHG: 26||Not reimbursed separately|11.61|PHR: 408101; CHG: 26||External grouping not supported 31684|ERX|HCPCS A9270|61958-0401-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.84|PHR: 408101; CHG: 26||Not reimbursed separately|3.84|PHR: 408101; CHG: 26||External grouping not supported 31684|ERX|HCPCS A9270|65862-0421-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.84|PHR: 408101; CHG: 26||Not reimbursed separately|3.84|PHR: 408101; CHG: 26||External grouping not supported 31684|ERX|HCPCS A9270|69076-0105-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.84|PHR: 408101; CHG: 26||Not reimbursed separately|3.84|PHR: 408101; CHG: 26||External grouping not supported 31684|ERX|HCPCS A9270|69097-0533-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.84|PHR: 408101; CHG: 26||Not reimbursed separately|3.84|PHR: 408101; CHG: 26||External grouping not supported 31688|ERX|HCPCS J2501|00074-4637-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.56|PHR: 408101; CHG: 26||Not reimbursed separately|11.56|PHR: 408101; CHG: 26||External grouping not supported 31688|ERX|HCPCS J2501|67457-0379-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.56|PHR: 408101; CHG: 26||Not reimbursed separately|11.56|PHR: 408101; CHG: 26||External grouping not supported 31783|ERX|HCPCS A9270|52244-0400-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THEOPHYLLINE ER 400 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.15|PHR: 408101; CHG: 26||Not reimbursed separately|17.15|PHR: 408101; CHG: 26||External grouping not supported 31863|ERX|HCPCS A9270|00406-0522-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 31863|ERX|HCPCS A9270|00904-6438-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 31863|ERX|HCPCS A9270|68084-0699-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 31863|ERX|HCPCS A9270|68308-0475-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 31864|ERX|HCPCS A9270|00406-0523-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.30|PHR: 408101; CHG: 26||Not reimbursed separately|2.30|PHR: 408101; CHG: 26||External grouping not supported 31864|ERX|HCPCS A9270|68084-0710-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.30|PHR: 408101; CHG: 26||Not reimbursed separately|2.30|PHR: 408101; CHG: 26||External grouping not supported 31864|ERX|HCPCS A9270|68084-0710-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.30|PHR: 408101; CHG: 26||Not reimbursed separately|2.30|PHR: 408101; CHG: 26||External grouping not supported 31864|ERX|HCPCS A9270|68308-0480-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.30|PHR: 408101; CHG: 26||Not reimbursed separately|2.30|PHR: 408101; CHG: 26||External grouping not supported 3187|ERX|HCPCS A9270|00093-0262-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.37|PHR: 408101; CHG: 26||Not reimbursed separately|22.37|PHR: 408101; CHG: 26||External grouping not supported 3187|ERX|HCPCS A9270|51672-1386-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.37|PHR: 408101; CHG: 26||Not reimbursed separately|22.37|PHR: 408101; CHG: 26||External grouping not supported 3187|ERX|HCPCS A9270|51862-0494-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.37|PHR: 408101; CHG: 26||Not reimbursed separately|22.37|PHR: 408101; CHG: 26||External grouping not supported 31875|ERX|HCPCS A9270|65162-0873-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BOSENTAN 62.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.12|PHR: 408101; CHG: 26||Not reimbursed separately|45.12|PHR: 408101; CHG: 26||External grouping not supported 31875|ERX|HCPCS A9270|66215-0101-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BOSENTAN 62.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.12|PHR: 408101; CHG: 26||Not reimbursed separately|45.12|PHR: 408101; CHG: 26||External grouping not supported 31876|ERX|HCPCS A9270|65162-0874-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BOSENTAN 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.60|PHR: 408101; CHG: 26||Not reimbursed separately|53.60|PHR: 408101; CHG: 26||External grouping not supported 31876|ERX|HCPCS A9270|66215-0102-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BOSENTAN 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.60|PHR: 408101; CHG: 26||Not reimbursed separately|53.60|PHR: 408101; CHG: 26||External grouping not supported 3188|ERX|HCPCS A9270|51672-1279-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL GEL|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.49|PHR: 408101; CHG: 26||Not reimbursed separately|50.49|PHR: 408101; CHG: 26||External grouping not supported 3189|ERX|HCPCS A9270|00093-0264-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.93|PHR: 408101; CHG: 26||Not reimbursed separately|33.93|PHR: 408101; CHG: 26||External grouping not supported 3189|ERX|HCPCS A9270|51672-1264-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.93|PHR: 408101; CHG: 26||Not reimbursed separately|33.93|PHR: 408101; CHG: 26||External grouping not supported 3189|ERX|HCPCS A9270|52565-0040-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.93|PHR: 408101; CHG: 26||Not reimbursed separately|33.93|PHR: 408101; CHG: 26||External grouping not supported 3189|ERX|HCPCS A9270|52565-0040-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.72|PHR: 408101; CHG: 26||Not reimbursed separately|135.72|PHR: 408101; CHG: 26||External grouping not supported 3190|ERX|HCPCS A9270|00472-0829-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.20|PHR: 408101; CHG: 26||Not reimbursed separately|97.20|PHR: 408101; CHG: 26||External grouping not supported 3190|ERX|HCPCS A9270|64980-0452-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOCINONIDE 0.05 % TOPICAL SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|97.20|PHR: 408101; CHG: 26||Not reimbursed separately|97.20|PHR: 408101; CHG: 26||External grouping not supported 31922|ERX|HCPCS J1335|00006-3843-71|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]||HUMANA [11839]|150.67|PHR: 408101; CHG: 26||Not reimbursed separately|150.67|PHR: 408101; CHG: 26||External grouping not supported 31922|ERX|HCPCS J1335|42023-0221-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.67|PHR: 408101; CHG: 26||Not reimbursed separately|150.67|PHR: 408101; CHG: 26||External grouping not supported 31922|ERX|HCPCS J1335|42023-0221-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.67|PHR: 408101; CHG: 26||Not reimbursed separately|150.67|PHR: 408101; CHG: 26||External grouping not supported 31922|ERX|HCPCS J1335|42023-0221-89|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.67|PHR: 408101; CHG: 26||Not reimbursed separately|150.67|PHR: 408101; CHG: 26||External grouping not supported 31922|ERX|HCPCS J1335|55150-0282-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.67|PHR: 408101; CHG: 26||Not reimbursed separately|150.67|PHR: 408101; CHG: 26||External grouping not supported 32019|ERX|HCPCS A9270|62756-0523-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DESLORATADINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 32052|ERX|HCPCS A9270|00187-5100-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIMECROLIMUS 1 % TOPICAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.33|PHR: 408101; CHG: 26||Not reimbursed separately|561.33|PHR: 408101; CHG: 26||External grouping not supported 32052|ERX|HCPCS A9270|68682-0110-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIMECROLIMUS 1 % TOPICAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.33|PHR: 408101; CHG: 26||Not reimbursed separately|561.33|PHR: 408101; CHG: 26||External grouping not supported 3208|ERX|HCPCS A9270|60758-0880-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.84|PHR: 408101; CHG: 26||Not reimbursed separately|189.84|PHR: 408101; CHG: 26||External grouping not supported 32128|ERX|HCPCS A9270|00093-7270-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 32128|ERX|HCPCS A9270|60505-1323-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 32128|ERX|HCPCS A9270|68180-0488-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3215|ERX|HCPCS J2680|42023-0129-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|44.23|PHR: 408101; CHG: 26||Not reimbursed separately|44.23|PHR: 408101; CHG: 26||External grouping not supported 3215|ERX|HCPCS J2680|63323-0272-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUPHENAZINE DECANOATE 25 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|44.23|PHR: 408101; CHG: 26||Not reimbursed separately|44.23|PHR: 408101; CHG: 26||External grouping not supported 3216|ERX|HCPCS RX001|63323-0281-10|0250 - PHARMACY - GENERAL CLASSIFICATION|FLUPHENAZINE 2.5 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|12.56|PHR: 408101; CHG: 26||Not reimbursed separately|12.56|PHR: 408101; CHG: 26||External grouping not supported 3218|ERX|HCPCS A9270|00527-1788-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUPHENAZINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.60|PHR: 408101; CHG: 26||Not reimbursed separately|8.60|PHR: 408101; CHG: 26||External grouping not supported 3218|ERX|HCPCS A9270|51079-0485-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUPHENAZINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.60|PHR: 408101; CHG: 26||Not reimbursed separately|8.60|PHR: 408101; CHG: 26||External grouping not supported 3220|ERX|HCPCS A9270|00527-1789-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUPHENAZINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.32|PHR: 408101; CHG: 26||Not reimbursed separately|13.32|PHR: 408101; CHG: 26||External grouping not supported 3221|ERX|HCPCS A9270|00527-1790-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUPHENAZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.01|PHR: 408101; CHG: 26||Not reimbursed separately|18.01|PHR: 408101; CHG: 26||External grouping not supported 3224|ERX|HCPCS A9270|00378-4430-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLURAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 32267|ERX|HCPCS J2505|55513-0190-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA [1294]||HUMANA [11839]|12,038.04|PHR: 408101; CHG: 26||Not reimbursed separately|12,038.04|PHR: 408101; CHG: 26||External grouping not supported 32298|ERX|HCPCS A9270|00056-0510-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EFAVIRENZ 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.20|PHR: 408101; CHG: 26||Not reimbursed separately|33.20|PHR: 408101; CHG: 26||External grouping not supported 32298|ERX|HCPCS A9270|31722-0504-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EFAVIRENZ 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.20|PHR: 408101; CHG: 26||Not reimbursed separately|33.20|PHR: 408101; CHG: 26||External grouping not supported 3232|ERX|HCPCS RX001|63323-0184-10|0250 - PHARMACY - GENERAL CLASSIFICATION|FOLIC ACID 5 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]||HUMANA [11839]|1.28|PHR: 408101; CHG: 26||Not reimbursed separately|1.28|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|10135-0182-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|62584-0897-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|62584-0897-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|63739-0537-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|65162-0361-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|69315-0127-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3233|ERX|HCPCS A9270|69315-0127-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 3234|ERX|HCPCS A9270|37864-0932-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 3234|ERX|HCPCS A9270|50268-0346-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 3234|ERX|HCPCS A9270|50268-0346-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 3234|ERX|HCPCS A9270|51645-0932-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 3234|ERX|HCPCS A9270|80681-0099-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 3234|ERX|HCPCS A9270|87701-0407-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOLIC ACID 400 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 32375|ERX|HCPCS A9270|24208-0344-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUNISOLIDE 25 MCG (0.025 %) NASAL SPRAY|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.53|PHR: 408101; CHG: 26||Not reimbursed separately|156.53|PHR: 408101; CHG: 26||External grouping not supported 324|ERX|HCPCS A9270|51079-0788-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 324|ERX|HCPCS A9270|59762-3719-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|00049-0024-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|00641-6118-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|25021-0188-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|44567-0212-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|55150-0118-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|66794-0208-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|67457-0649-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32469|ERX|HCPCS J0295|71288-0007-75|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.55|PHR: 408101; CHG: 26||Not reimbursed separately|56.55|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|00049-0013-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|00049-0013-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]||HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|00641-6116-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|25021-0186-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|44567-0210-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|55150-0116-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|66794-0206-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32470|ERX|HCPCS J0295|71288-0005-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|00049-0014-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|00049-0014-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|00641-6117-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|25021-0143-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|25021-0187-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|44567-0211-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|55150-0117-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|66794-0207-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|67457-0349-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|71288-0006-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 32471|ERX|HCPCS J0295|71288-0006-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.59|PHR: 408101; CHG: 26||Not reimbursed separately|9.59|PHR: 408101; CHG: 26||External grouping not supported 325|ERX|HCPCS A9270|00228-2029-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 325|ERX|HCPCS A9270|51079-0789-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 325|ERX|HCPCS A9270|51079-0789-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 325|ERX|HCPCS A9270|51991-0705-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 325|ERX|HCPCS A9270|59762-3720-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 325|ERX|HCPCS A9270|59762-3720-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 32559|ERX|HCPCS RX001|24208-0539-20|0250 - PHARMACY - GENERAL CLASSIFICATION|ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT|1 mL|HUMANA [1294]||HUMANA [11839]|171.87|PHR: 408101; CHG: 26||Not reimbursed separately|171.87|PHR: 408101; CHG: 26||External grouping not supported 32589|ERX|HCPCS J2430|61703-0324-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.06|PHR: 408101; CHG: 26||Not reimbursed separately|48.06|PHR: 408101; CHG: 26||External grouping not supported 32589|ERX|HCPCS J2430|67457-0430-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.06|PHR: 408101; CHG: 26||Not reimbursed separately|48.06|PHR: 408101; CHG: 26||External grouping not supported 326|ERX|HCPCS A9270|00904-5860-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALPRAZOLAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 32631|ERX|HCPCS A9270|00378-2003-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE ER 12.5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.55|PHR: 408101; CHG: 26||Not reimbursed separately|5.55|PHR: 408101; CHG: 26||External grouping not supported 32632|ERX|HCPCS A9270|00378-2004-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PAROXETINE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.79|PHR: 408101; CHG: 26||Not reimbursed separately|5.79|PHR: 408101; CHG: 26||External grouping not supported 32654|ERX|HCPCS A9270|00406-0127-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.27|PHR: 408101; CHG: 26||Not reimbursed separately|5.27|PHR: 408101; CHG: 26||External grouping not supported 32761|ERX|HCPCS A9270|65597-0101-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OLMESARTAN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.42|PHR: 408101; CHG: 26||Not reimbursed separately|17.42|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|00310-0720-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]||HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|00781-3079-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|00781-3079-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|25021-0462-74|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|63323-0715-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|63323-0715-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|67457-0311-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|67457-0311-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|68462-0317-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|70860-0211-74|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32767|ERX|HCPCS J9395|71288-0555-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|PHR: 408101; CHG: 26||Not reimbursed separately|525.30|PHR: 408101; CHG: 26||External grouping not supported 32855|ERX|HCPCS J2430|61703-0326-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION|6.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.95|PHR: 408101; CHG: 26||Not reimbursed separately|52.95|PHR: 408101; CHG: 26||External grouping not supported 32855|ERX|HCPCS J2430|67457-0446-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION|6.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.95|PHR: 408101; CHG: 26||Not reimbursed separately|52.95|PHR: 408101; CHG: 26||External grouping not supported 32895|ERX|HCPCS A9270|60505-3165-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISEDRONATE 35 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.60|PHR: 408101; CHG: 26||Not reimbursed separately|16.60|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-36|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.83|PHR: 408101; CHG: 26||Not reimbursed separately|4.83|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|00409-6102-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|00409-6102-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|00409-6102-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|23155-0473-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|23155-0473-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|36000-0282-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|36000-0283-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|36000-0284-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|55150-0322-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|64679-0759-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.99|PHR: 408101; CHG: 26||Not reimbursed separately|2.99|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|23155-0473-42|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 3291|ERX|HCPCS J1940|63323-0280-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 3292|ERX|HCPCS A9270|00054-3294-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 10 MG/ML ORAL SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 3294|ERX|HCPCS A9270|00054-8297-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 3294|ERX|HCPCS A9270|51079-0072-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 3294|ERX|HCPCS A9270|51079-0072-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 3294|ERX|HCPCS A9270|69315-0116-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 3295|ERX|HCPCS A9270|51079-0073-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 3295|ERX|HCPCS A9270|51079-0073-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 3295|ERX|HCPCS A9270|69315-0117-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 32950|ERX|HCPCS J2260|00143-9719-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK|100 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 32950|ERX|HCPCS J2260|00143-9719-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK|100 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 32950|ERX|HCPCS J2260|00409-2776-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK|100 mL|HUMANA [1294]||HUMANA [11839]|20.70|PHR: 408101; CHG: 26||Not reimbursed separately|20.70|PHR: 408101; CHG: 26||External grouping not supported 3296|ERX|HCPCS A9270|00054-4301-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 3296|ERX|HCPCS A9270|00378-0232-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 3296|ERX|HCPCS A9270|51079-0527-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 3296|ERX|HCPCS A9270|51079-0527-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 3296|ERX|HCPCS A9270|69315-0118-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FUROSEMIDE 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 32979|ERX|HCPCS A9270|00078-0401-34|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMATINIB 100 MG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.46|PHR: 408101; CHG: 26||Not reimbursed separately|1,035.46|PHR: 408101; CHG: 26||External grouping not supported 33009|ERX|HCPCS A9270|00904-6471-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VORICONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.08|PHR: 408101; CHG: 26||Not reimbursed separately|4.08|PHR: 408101; CHG: 26||External grouping not supported 33009|ERX|HCPCS A9270|43547-0378-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VORICONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.08|PHR: 408101; CHG: 26||Not reimbursed separately|4.08|PHR: 408101; CHG: 26||External grouping not supported 33009|ERX|HCPCS A9270|68462-0573-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VORICONAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.08|PHR: 408101; CHG: 26||Not reimbursed separately|4.08|PHR: 408101; CHG: 26||External grouping not supported 33010|ERX|HCPCS J3465|00049-3190-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VORICONAZOLE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]||HUMANA [11839]|82.95|PHR: 408101; CHG: 26||Not reimbursed separately|82.95|PHR: 408101; CHG: 26||External grouping not supported 33010|ERX|HCPCS J3465|47781-0466-71|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VORICONAZOLE 200 MG INTRAVENOUS SOLUTION|200 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.95|PHR: 408101; CHG: 26||Not reimbursed separately|82.95|PHR: 408101; CHG: 26||External grouping not supported 33109|ERX|HCPCS RX001|85446-0369-91|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 23 MG/ML INTRAOCULAR SYRINGE|0.6 mL|HUMANA [1294]||HUMANA [11839]|356.88|PHR: 408101; CHG: 26||Not reimbursed separately|356.88|PHR: 408101; CHG: 26||External grouping not supported 33175|ERX|HCPCS J3486|00049-1203-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION|10 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.94|PHR: 408101; CHG: 26||Not reimbursed separately|108.94|PHR: 408101; CHG: 26||External grouping not supported 33175|ERX|HCPCS J3486|00049-1203-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION|10 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.94|PHR: 408101; CHG: 26||Not reimbursed separately|108.94|PHR: 408101; CHG: 26||External grouping not supported 33175|ERX|HCPCS J3486|00049-3920-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION|10 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.94|PHR: 408101; CHG: 26||Not reimbursed separately|108.94|PHR: 408101; CHG: 26||External grouping not supported 33175|ERX|HCPCS J3486|00049-3920-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION|20 mg|HUMANA [1294]||HUMANA [11839]|108.94|PHR: 408101; CHG: 26||Not reimbursed separately|108.94|PHR: 408101; CHG: 26||External grouping not supported 33227|ERX|HCPCS A9270|00093-2274-34|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 33227|ERX|HCPCS A9270|65862-0502-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 33227|ERX|HCPCS A9270|66685-1002-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 33228|ERX|HCPCS A9270|65862-0503-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.65|PHR: 408101; CHG: 26||Not reimbursed separately|0.65|PHR: 408101; CHG: 26||External grouping not supported 33229|ERX|HCPCS A9270|00143-9981-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|PHR: 408101; CHG: 26||Not reimbursed separately|0.26|PHR: 408101; CHG: 26||External grouping not supported 33229|ERX|HCPCS A9270|65862-0533-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|PHR: 408101; CHG: 26||Not reimbursed separately|0.26|PHR: 408101; CHG: 26||External grouping not supported 33230|ERX|HCPCS A9270|16714-0293-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 33230|ERX|HCPCS A9270|00143-9982-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 33512|ERX|HCPCS A9270|00093-5851-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESCITALOPRAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 33512|ERX|HCPCS A9270|00904-6426-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESCITALOPRAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 33512|ERX|HCPCS A9270|43547-0281-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESCITALOPRAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 33512|ERX|HCPCS A9270|68001-0196-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESCITALOPRAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 33512|ERX|HCPCS A9270|68084-0617-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESCITALOPRAM 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 33513|ERX|HCPCS A9270|00904-6427-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESCITALOPRAM 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 33541|ERX|HCPCS A9270|00378-5807-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 33541|ERX|HCPCS A9270|33342-0062-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 33541|ERX|HCPCS A9270|59746-0360-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 33541|ERX|HCPCS A9270|67877-0415-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALSARTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 33591|ERX|HCPCS J2783|00024-5150-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RASBURICASE 1.5 MG INTRAVENOUS SOLUTION|1.5 mg|HUMANA [1294]||HUMANA [11839]|3,327.54|PHR: 408101; CHG: 26||Not reimbursed separately|3,327.54|PHR: 408101; CHG: 26||External grouping not supported 33591|ERX|HCPCS J2783|00024-5150-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RASBURICASE 1.5 MG INTRAVENOUS SOLUTION|2 mg|HUMANA [1294]||HUMANA [11839]|4,159.43|PHR: 408101; CHG: 26||Not reimbursed separately|4,159.43|PHR: 408101; CHG: 26||External grouping not supported 33666|ERX|HCPCS J1815|99999-2222-57|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN|0.05 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 33666|ERX|HCPCS J1815|00169-3685-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.84|PHR: 408101; CHG: 26||Not reimbursed separately|132.84|PHR: 408101; CHG: 26||External grouping not supported 3378|ERX|HCPCS A9270|60687-0224-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GEMFIBROZIL 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 3378|ERX|HCPCS A9270|60687-0224-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GEMFIBROZIL 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 33862|ERX|HCPCS A9270|00781-1943-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.45|PHR: 408101; CHG: 26||Not reimbursed separately|11.45|PHR: 408101; CHG: 26||External grouping not supported 33862|ERX|HCPCS A9270|43598-0220-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.45|PHR: 408101; CHG: 26||Not reimbursed separately|11.45|PHR: 408101; CHG: 26||External grouping not supported 33937|ERX|HCPCS A9270|60505-3252-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMIVUDINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.75|PHR: 408101; CHG: 26||Not reimbursed separately|2.75|PHR: 408101; CHG: 26||External grouping not supported 33937|ERX|HCPCS A9270|68180-0603-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LAMIVUDINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.75|PHR: 408101; CHG: 26||Not reimbursed separately|2.75|PHR: 408101; CHG: 26||External grouping not supported 33963|ERX|HCPCS A9270|00591-2341-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METAXALONE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.18|PHR: 408101; CHG: 26||Not reimbursed separately|10.18|PHR: 408101; CHG: 26||External grouping not supported 33963|ERX|HCPCS A9270|68084-0135-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METAXALONE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.18|PHR: 408101; CHG: 26||Not reimbursed separately|10.18|PHR: 408101; CHG: 26||External grouping not supported 33963|ERX|HCPCS A9270|68084-0135-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METAXALONE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.18|PHR: 408101; CHG: 26||Not reimbursed separately|10.18|PHR: 408101; CHG: 26||External grouping not supported 34089|ERX|HCPCS A9270|00173-0712-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DUTASTERIDE 0.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.08|PHR: 408101; CHG: 26||Not reimbursed separately|18.08|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|00591-3713-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|00781-5690-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|00781-5690-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|60505-2945-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|60505-2945-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|67877-0490-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|67877-0490-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 34153|ERX|HCPCS A9270|69238-1154-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 3423|ERX|HCPCS A9270|45802-0056-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.23|PHR: 408101; CHG: 26||Not reimbursed separately|63.23|PHR: 408101; CHG: 26||External grouping not supported 3424|ERX|HCPCS A9270|45802-0046-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GENTAMICIN 0.1 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.68|PHR: 408101; CHG: 26||Not reimbursed separately|72.68|PHR: 408101; CHG: 26||External grouping not supported 3424|ERX|HCPCS A9270|52565-0090-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GENTAMICIN 0.1 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.68|PHR: 408101; CHG: 26||Not reimbursed separately|72.68|PHR: 408101; CHG: 26||External grouping not supported 3426|ERX|HCPCS J1580|63323-0010-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 3426|ERX|HCPCS J1580|63323-0010-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 3426|ERX|HCPCS J1580|63323-0010-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 3427|ERX|HCPCS A9270|17478-0284-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.40|PHR: 408101; CHG: 26||Not reimbursed separately|78.40|PHR: 408101; CHG: 26||External grouping not supported 3428|ERX|HCPCS A9270|17478-0283-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GENTAMICIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.90|PHR: 408101; CHG: 26||Not reimbursed separately|9.90|PHR: 408101; CHG: 26||External grouping not supported 3428|ERX|HCPCS A9270|60758-0188-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GENTAMICIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.90|PHR: 408101; CHG: 26||Not reimbursed separately|9.90|PHR: 408101; CHG: 26||External grouping not supported 34369|ERX|HCPCS A9270|60505-2674-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34369|ERX|HCPCS A9270|62332-0099-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34369|ERX|HCPCS A9270|62332-0099-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34370|ERX|HCPCS A9270|43598-0557-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34370|ERX|HCPCS A9270|60505-2675-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34370|ERX|HCPCS A9270|62332-0100-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34370|ERX|HCPCS A9270|67877-0433-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 15 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 34371|ERX|HCPCS RX015|67877-0434-03|0250 - PHARMACY - GENERAL CLASSIFICATION|ARIPIPRAZOLE 20 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.77|PHR: 408101; CHG: 26||Not reimbursed separately|0.77|PHR: 408101; CHG: 26||External grouping not supported 34418|ERX|HCPCS A9270|51079-0766-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 34418|ERX|HCPCS A9270|51079-0766-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 34418|ERX|HCPCS A9270|68084-0310-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.10|PHR: 408101; CHG: 26||Not reimbursed separately|2.10|PHR: 408101; CHG: 26||External grouping not supported 34447|ERX|HCPCS A9270|00002-3229-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.54|PHR: 408101; CHG: 26||Not reimbursed separately|20.54|PHR: 408101; CHG: 26||External grouping not supported 34447|ERX|HCPCS A9270|60687-0326-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.54|PHR: 408101; CHG: 26||Not reimbursed separately|20.54|PHR: 408101; CHG: 26||External grouping not supported 34447|ERX|HCPCS A9270|64980-0376-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.54|PHR: 408101; CHG: 26||Not reimbursed separately|20.54|PHR: 408101; CHG: 26||External grouping not supported 34447|ERX|HCPCS A9270|68462-0268-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.54|PHR: 408101; CHG: 26||Not reimbursed separately|20.54|PHR: 408101; CHG: 26||External grouping not supported 34448|ERX|HCPCS A9270|00002-3239-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 60 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.81|PHR: 408101; CHG: 26||Not reimbursed separately|6.81|PHR: 408101; CHG: 26||External grouping not supported 34448|ERX|HCPCS A9270|00093-3546-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 60 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.81|PHR: 408101; CHG: 26||Not reimbursed separately|6.81|PHR: 408101; CHG: 26||External grouping not supported 34448|ERX|HCPCS A9270|64980-0377-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 60 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.81|PHR: 408101; CHG: 26||Not reimbursed separately|6.81|PHR: 408101; CHG: 26||External grouping not supported 34448|ERX|HCPCS A9270|68462-0269-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATOMOXETINE 60 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.81|PHR: 408101; CHG: 26||Not reimbursed separately|6.81|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|00023-6002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|00406-0123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|00406-0123-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|00406-0123-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|00904-6824-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|68084-0895-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34505|ERX|HCPCS A9270|68084-0895-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 34523|ERX|HCPCS J2543|00206-8860-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.65|PHR: 408101; CHG: 26||Not reimbursed separately|22.65|PHR: 408101; CHG: 26||External grouping not supported 34523|ERX|HCPCS J2543|00206-8860-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|22.65|PHR: 408101; CHG: 26||Not reimbursed separately|22.65|PHR: 408101; CHG: 26||External grouping not supported 34524|ERX|HCPCS J2543|00206-8861-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.00|PHR: 408101; CHG: 26||Not reimbursed separately|30.00|PHR: 408101; CHG: 26||External grouping not supported 34524|ERX|HCPCS J2543|00206-8861-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.00|PHR: 408101; CHG: 26||Not reimbursed separately|30.00|PHR: 408101; CHG: 26||External grouping not supported 34544|ERX|HCPCS A9270|00406-0124-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 34544|ERX|HCPCS A9270|13107-0020-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 34544|ERX|HCPCS A9270|50268-0400-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 34544|ERX|HCPCS A9270|51079-0778-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 34544|ERX|HCPCS A9270|60687-0407-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 34544|ERX|HCPCS A9270|68084-0863-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.89|PHR: 408101; CHG: 26||Not reimbursed separately|0.89|PHR: 408101; CHG: 26||External grouping not supported 34594|ERX|HCPCS A9270|64764-0543-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.25|PHR: 408101; CHG: 26||Not reimbursed separately|38.25|PHR: 408101; CHG: 26||External grouping not supported 34594|ERX|HCPCS A9270|64764-0543-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38.25|PHR: 408101; CHG: 26||Not reimbursed separately|38.25|PHR: 408101; CHG: 26||External grouping not supported 34595|ERX|HCPCS A9270|00093-3009-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.55|PHR: 408101; CHG: 26||Not reimbursed separately|23.55|PHR: 408101; CHG: 26||External grouping not supported 34595|ERX|HCPCS A9270|00093-3009-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.55|PHR: 408101; CHG: 26||Not reimbursed separately|23.55|PHR: 408101; CHG: 26||External grouping not supported 34595|ERX|HCPCS A9270|00378-6982-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.55|PHR: 408101; CHG: 26||Not reimbursed separately|23.55|PHR: 408101; CHG: 26||External grouping not supported 34595|ERX|HCPCS A9270|00378-6982-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.55|PHR: 408101; CHG: 26||Not reimbursed separately|23.55|PHR: 408101; CHG: 26||External grouping not supported 34595|ERX|HCPCS A9270|64764-0544-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.55|PHR: 408101; CHG: 26||Not reimbursed separately|23.55|PHR: 408101; CHG: 26||External grouping not supported 34595|ERX|HCPCS A9270|64764-0544-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.55|PHR: 408101; CHG: 26||Not reimbursed separately|23.55|PHR: 408101; CHG: 26||External grouping not supported 34684|ERX|HCPCS A9270|00049-2340-79|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ELETRIPTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.93|PHR: 408101; CHG: 26||Not reimbursed separately|21.93|PHR: 408101; CHG: 26||External grouping not supported 34684|ERX|HCPCS A9270|59762-2322-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ELETRIPTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.93|PHR: 408101; CHG: 26||Not reimbursed separately|21.93|PHR: 408101; CHG: 26||External grouping not supported 34684|ERX|HCPCS A9270|59762-2322-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ELETRIPTAN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.93|PHR: 408101; CHG: 26||Not reimbursed separately|21.93|PHR: 408101; CHG: 26||External grouping not supported 34770|ERX|HCPCS RX001|45802-0873-05|0250 - PHARMACY - GENERAL CLASSIFICATION|NICOTINE (POLACRILEX) 4 MG BUCCAL LOZENGE|1 Lozenge|HUMANA [1294]||HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 34770|ERX|HCPCS RX001|46122-0255-16|0250 - PHARMACY - GENERAL CLASSIFICATION|NICOTINE (POLACRILEX) 4 MG BUCCAL LOZENGE|1 Lozenge|HUMANA [1294]||HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 3489|ERX|HCPCS A9270|00093-8344-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 3489|ERX|HCPCS A9270|00093-9364-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 3489|ERX|HCPCS A9270|51079-0873-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 3489|ERX|HCPCS A9270|63739-0119-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYBURIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 3491|ERX|HCPCS A9270|46122-0222-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYCERIN (CHILD) RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.99|PHR: 408101; CHG: 26||Not reimbursed separately|0.99|PHR: 408101; CHG: 26||External grouping not supported 3491|ERX|HCPCS A9270|87701-0425-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLYCERIN (CHILD) RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.99|PHR: 408101; CHG: 26||Not reimbursed separately|0.99|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|00143-9680-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|00143-9682-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|63323-0578-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|63323-0578-03|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|63323-0578-41|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|70069-0011-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|70069-0011-25|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|70069-0013-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|70069-0013-25|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|71288-0407-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|00143-9680-25|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|00517-4601-25|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 3497|ERX|HCPCS J3490|00517-4605-25|0250 - PHARMACY - GENERAL CLASSIFICATION|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.08|PHR: 408101; CHG: 26||Not reimbursed separately|8.08|PHR: 408101; CHG: 26||External grouping not supported 35126|ERX|HCPCS A9270|61314-0641-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP|7.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.80|PHR: 408101; CHG: 26||Not reimbursed separately|307.80|PHR: 408101; CHG: 26||External grouping not supported 35134|ERX|HCPCS A9270|13668-0180-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 35134|ERX|HCPCS A9270|27808-0156-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 35134|ERX|HCPCS A9270|57237-0169-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 35134|ERX|HCPCS A9270|60687-0245-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 35134|ERX|HCPCS A9270|68462-0262-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 35134|ERX|HCPCS A9270|70377-0007-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 35135|ERX|HCPCS A9270|13668-0181-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 35135|ERX|HCPCS A9270|16729-0286-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 35135|ERX|HCPCS A9270|27808-0157-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 35135|ERX|HCPCS A9270|31722-0884-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 35135|ERX|HCPCS A9270|57237-0170-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 35135|ERX|HCPCS A9270|70377-0008-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 35136|ERX|HCPCS A9270|13668-0182-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.47|PHR: 408101; CHG: 26||Not reimbursed separately|0.47|PHR: 408101; CHG: 26||External grouping not supported 35136|ERX|HCPCS A9270|57237-0171-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.47|PHR: 408101; CHG: 26||Not reimbursed separately|0.47|PHR: 408101; CHG: 26||External grouping not supported 35136|ERX|HCPCS A9270|68462-0264-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.47|PHR: 408101; CHG: 26||Not reimbursed separately|0.47|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|00591-3256-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|10702-0006-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|43547-0399-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|50268-0190-11|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|68084-0753-25|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|68084-0753-95|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35184|ERX|HCPCS RX001|69097-0845-07|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOBENZAPRINE 5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 35209|ERX|HCPCS A9270|00023-9163-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.94|PHR: 408101; CHG: 26||Not reimbursed separately|26.94|PHR: 408101; CHG: 26||External grouping not supported 35209|ERX|HCPCS A9270|00023-9163-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.94|PHR: 408101; CHG: 26||Not reimbursed separately|26.94|PHR: 408101; CHG: 26||External grouping not supported 35488|ERX|HCPCS J8501|00781-2322-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 80 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.25|PHR: 408101; CHG: 26||Not reimbursed separately|257.25|PHR: 408101; CHG: 26||External grouping not supported 35488|ERX|HCPCS J8501|00781-2322-46|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 80 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.25|PHR: 408101; CHG: 26||Not reimbursed separately|257.25|PHR: 408101; CHG: 26||External grouping not supported 35488|ERX|HCPCS J8501|68462-0584-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 80 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.25|PHR: 408101; CHG: 26||Not reimbursed separately|257.25|PHR: 408101; CHG: 26||External grouping not supported 35488|ERX|HCPCS J8501|68462-0584-76|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 80 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.25|PHR: 408101; CHG: 26||Not reimbursed separately|257.25|PHR: 408101; CHG: 26||External grouping not supported 35489|ERX|HCPCS J8501|00781-2323-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 125 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.97|PHR: 408101; CHG: 26||Not reimbursed separately|401.97|PHR: 408101; CHG: 26||External grouping not supported 35489|ERX|HCPCS J8501|00781-2323-68|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 125 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.97|PHR: 408101; CHG: 26||Not reimbursed separately|401.97|PHR: 408101; CHG: 26||External grouping not supported 35489|ERX|HCPCS J8501|68462-0585-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 125 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.97|PHR: 408101; CHG: 26||Not reimbursed separately|401.97|PHR: 408101; CHG: 26||External grouping not supported 35489|ERX|HCPCS J8501|68462-0585-76|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 125 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|401.97|PHR: 408101; CHG: 26||Not reimbursed separately|401.97|PHR: 408101; CHG: 26||External grouping not supported 35495|ERX|HCPCS A9270|00023-6153-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN 3.9 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.94|PHR: 408101; CHG: 26||Not reimbursed separately|234.94|PHR: 408101; CHG: 26||External grouping not supported 35495|ERX|HCPCS A9270|00023-6153-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN 3.9 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.94|PHR: 408101; CHG: 26||Not reimbursed separately|234.94|PHR: 408101; CHG: 26||External grouping not supported 35613|ERX|HCPCS A9270|53746-0145-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-IBUPROFEN 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.86|PHR: 408101; CHG: 26||Not reimbursed separately|0.86|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|00409-4215-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|00409-4215-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|25021-0801-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|54288-0100-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|55111-0685-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|55150-0266-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35640|ERX|HCPCS J3489|67457-0390-54|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.65|PHR: 408101; CHG: 26||Not reimbursed separately|121.65|PHR: 408101; CHG: 26||External grouping not supported 35686|ERX|HCPCS A9270|00781-5310-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 35686|ERX|HCPCS A9270|00781-5310-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 35686|ERX|HCPCS A9270|49884-0311-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 35686|ERX|HCPCS A9270|49884-0311-91|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 35686|ERX|HCPCS A9270|59746-0010-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 0.5 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 35687|ERX|HCPCS A9270|00781-5311-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 35687|ERX|HCPCS A9270|00781-5311-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 35687|ERX|HCPCS A9270|49884-0315-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 35687|ERX|HCPCS A9270|49884-0315-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 35687|ERX|HCPCS A9270|59746-0020-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RISPERIDONE 1 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 35699|ERX|HCPCS RX001|00065-4013-03|0250 - PHARMACY - GENERAL CLASSIFICATION|MOXIFLOXACIN 0.5 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|94.03|PHR: 408101; CHG: 26||Not reimbursed separately|94.03|PHR: 408101; CHG: 26||External grouping not supported 35699|ERX|HCPCS RX001|00378-5430-35|0250 - PHARMACY - GENERAL CLASSIFICATION|MOXIFLOXACIN 0.5 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|94.03|PHR: 408101; CHG: 26||Not reimbursed separately|94.03|PHR: 408101; CHG: 26||External grouping not supported 35699|ERX|HCPCS RX001|00781-7135-93|0250 - PHARMACY - GENERAL CLASSIFICATION|MOXIFLOXACIN 0.5 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|94.03|PHR: 408101; CHG: 26||Not reimbursed separately|94.03|PHR: 408101; CHG: 26||External grouping not supported 35699|ERX|HCPCS RX001|60505-0582-04|0250 - PHARMACY - GENERAL CLASSIFICATION|MOXIFLOXACIN 0.5 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|94.03|PHR: 408101; CHG: 26||Not reimbursed separately|94.03|PHR: 408101; CHG: 26||External grouping not supported 35699|ERX|HCPCS RX001|62332-0505-03|0250 - PHARMACY - GENERAL CLASSIFICATION|MOXIFLOXACIN 0.5 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|94.03|PHR: 408101; CHG: 26||Not reimbursed separately|94.03|PHR: 408101; CHG: 26||External grouping not supported 35699|ERX|HCPCS RX001|68180-0422-01|0250 - PHARMACY - GENERAL CLASSIFICATION|MOXIFLOXACIN 0.5 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|94.03|PHR: 408101; CHG: 26||Not reimbursed separately|94.03|PHR: 408101; CHG: 26||External grouping not supported 35771|ERX|HCPCS A9270|62756-0143-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 3578|ERX|HCPCS A9270|00378-0351-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 3578|ERX|HCPCS A9270|51079-0733-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 3579|ERX|HCPCS A9270|00378-0257-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 3579|ERX|HCPCS A9270|51079-0734-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 3579|ERX|HCPCS A9270|51079-0734-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 3580|ERX|HCPCS A9270|68084-0249-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.87|PHR: 408101; CHG: 26||Not reimbursed separately|1.87|PHR: 408101; CHG: 26||External grouping not supported 3580|ERX|HCPCS A9270|68084-0249-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.87|PHR: 408101; CHG: 26||Not reimbursed separately|1.87|PHR: 408101; CHG: 26||External grouping not supported 3580|ERX|HCPCS A9270|68382-0080-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.87|PHR: 408101; CHG: 26||Not reimbursed separately|1.87|PHR: 408101; CHG: 26||External grouping not supported 3581|ERX|HCPCS A9270|00378-0214-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 3581|ERX|HCPCS A9270|51079-0735-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 3581|ERX|HCPCS A9270|51079-0735-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 3583|ERX|HCPCS A9270|00781-1396-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 3583|ERX|HCPCS A9270|51079-0736-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 3583|ERX|HCPCS A9270|51079-0736-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 3583|ERX|HCPCS A9270|60687-0161-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 3583|ERX|HCPCS A9270|60687-0161-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 3583|ERX|HCPCS A9270|68382-0079-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 35839|ERX|HCPCS J9041|63020-0049-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION|3.6 mL|HUMANA [1294]||HUMANA [11839]|5,020.60|PHR: 408101; CHG: 26||Not reimbursed separately|5,020.60|PHR: 408101; CHG: 26||External grouping not supported 3584|ERX|HCPCS J1630|00143-9319-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 3584|ERX|HCPCS J1630|00143-9501-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 3584|ERX|HCPCS J1630|63323-0474-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 3584|ERX|HCPCS J1630|67457-0426-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 3584|ERX|HCPCS J1630|00143-9501-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 3584|ERX|HCPCS J1630|63323-0474-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 3585|ERX|HCPCS A9270|54838-0501-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.97|PHR: 408101; CHG: 26||Not reimbursed separately|5.97|PHR: 408101; CHG: 26||External grouping not supported 3585|ERX|HCPCS A9270|00121-0581-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.97|PHR: 408101; CHG: 26||Not reimbursed separately|5.97|PHR: 408101; CHG: 26||External grouping not supported 35942|ERX|HCPCS RX015|00245-5317-89|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|1 Tab|HUMANA [1294]||HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 35942|ERX|HCPCS RX015|00832-5324-11|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|1 Tab|HUMANA [1294]||HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 35942|ERX|HCPCS RX015|63739-0446-10|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|1 Tab|HUMANA [1294]||HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 36063|ERX|HCPCS RX004|00338-0704-34|0258 - PHARMACY - IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN|1,000 mL|HUMANA [1294]||HUMANA [11839]|12.00|PHR: 408101; CHG: 26||Not reimbursed separately|12.00|PHR: 408101; CHG: 26||External grouping not supported 36092|ERX|HCPCS A9270|00093-7630-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMATINIB 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.97|PHR: 408101; CHG: 26||Not reimbursed separately|11.97|PHR: 408101; CHG: 26||External grouping not supported 36092|ERX|HCPCS A9270|00378-2246-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMATINIB 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.97|PHR: 408101; CHG: 26||Not reimbursed separately|11.97|PHR: 408101; CHG: 26||External grouping not supported 36092|ERX|HCPCS A9270|47335-0475-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMATINIB 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.97|PHR: 408101; CHG: 26||Not reimbursed separately|11.97|PHR: 408101; CHG: 26||External grouping not supported 36092|ERX|HCPCS A9270|60505-2901-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMATINIB 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.97|PHR: 408101; CHG: 26||Not reimbursed separately|11.97|PHR: 408101; CHG: 26||External grouping not supported 36092|ERX|HCPCS A9270|72485-0203-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMATINIB 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.97|PHR: 408101; CHG: 26||Not reimbursed separately|11.97|PHR: 408101; CHG: 26||External grouping not supported 36093|ERX|HCPCS A9270|00591-3216-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET|2 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.48|PHR: 408101; CHG: 26||Not reimbursed separately|18.48|PHR: 408101; CHG: 26||External grouping not supported 36093|ERX|HCPCS A9270|00591-3216-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET|2 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18.48|PHR: 408101; CHG: 26||Not reimbursed separately|18.48|PHR: 408101; CHG: 26||External grouping not supported 36135|ERX|HCPCS A9270|00781-5613-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 12.5 MG-LEVODOPA 50 MG-ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 36136|ERX|HCPCS A9270|00781-5637-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 100 MG-ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 36137|ERX|HCPCS A9270|00781-5654-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 37.5 MG-LEVODOPA 150 MG-ENTACAPONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 36149|ERX|HCPCS A9270|00003-3624-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATAZANAVIR 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.11|PHR: 408101; CHG: 26||Not reimbursed separately|34.11|PHR: 408101; CHG: 26||External grouping not supported 36150|ERX|HCPCS A9270|00003-3631-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATAZANAVIR 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.42|PHR: 408101; CHG: 26||Not reimbursed separately|67.42|PHR: 408101; CHG: 26||External grouping not supported 36151|ERX|HCPCS J2357|50242-0040-62|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION|150 mg|HUMANA [1294]||HUMANA [11839]|3,385.44|PHR: 408101; CHG: 26||Not reimbursed separately|3,385.44|PHR: 408101; CHG: 26||External grouping not supported 36252|ERX|HCPCS A9270|61958-0601-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EMTRICITABINE 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.18|PHR: 408101; CHG: 26||Not reimbursed separately|52.18|PHR: 408101; CHG: 26||External grouping not supported 3626|ERX|HCPCS J1642|63323-0544-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN LOCK FLUSH (PORCINE) 10 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 36267|ERX|HCPCS A9270|00378-3360-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.94|PHR: 408101; CHG: 26||Not reimbursed separately|43.94|PHR: 408101; CHG: 26||External grouping not supported 36267|ERX|HCPCS A9270|00378-3360-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.94|PHR: 408101; CHG: 26||Not reimbursed separately|43.94|PHR: 408101; CHG: 26||External grouping not supported 36267|ERX|HCPCS A9270|47781-0205-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.94|PHR: 408101; CHG: 26||Not reimbursed separately|43.94|PHR: 408101; CHG: 26||External grouping not supported 36267|ERX|HCPCS A9270|47781-0205-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.94|PHR: 408101; CHG: 26||Not reimbursed separately|43.94|PHR: 408101; CHG: 26||External grouping not supported 364|ERX|HCPCS A9270|42543-0493-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMANTADINE HCL 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.47|PHR: 408101; CHG: 26||Not reimbursed separately|2.47|PHR: 408101; CHG: 26||External grouping not supported 364|ERX|HCPCS A9270|50268-0069-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMANTADINE HCL 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.47|PHR: 408101; CHG: 26||Not reimbursed separately|2.47|PHR: 408101; CHG: 26||External grouping not supported 364|ERX|HCPCS A9270|50268-0069-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMANTADINE HCL 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.47|PHR: 408101; CHG: 26||Not reimbursed separately|2.47|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|27241-0052-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|43598-0555-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|60505-2673-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|62332-0098-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|62332-0098-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|65862-0662-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36438|ERX|HCPCS A9270|67877-0431-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 365|ERX|HCPCS A9270|00121-0646-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 36576|ERX|HCPCS A9270|00065-8533-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION|7.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|628.20|PHR: 408101; CHG: 26||Not reimbursed separately|628.20|PHR: 408101; CHG: 26||External grouping not supported 36576|ERX|HCPCS A9270|00781-6186-67|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION|7.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|628.20|PHR: 408101; CHG: 26||Not reimbursed separately|628.20|PHR: 408101; CHG: 26||External grouping not supported 36590|ERX|HCPCS RX015|51991-0651-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 100 MG/ML ORAL SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|00409-2504-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|00703-4094-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|25021-0783-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|55111-0694-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|55150-0186-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|60505-6193-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|62856-0797-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|63323-0673-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|63323-0942-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|67457-0317-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|69097-0439-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36591|ERX|HCPCS J2469|69543-0371-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.04|PHR: 408101; CHG: 26||Not reimbursed separately|20.04|PHR: 408101; CHG: 26||External grouping not supported 36612|ERX|HCPCS A9270|13668-0179-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 36612|ERX|HCPCS A9270|27808-0155-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 36612|ERX|HCPCS A9270|31722-0882-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 36612|ERX|HCPCS A9270|57237-0168-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 36612|ERX|HCPCS A9270|70377-0006-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ROSUVASTATIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 36663|ERX|HCPCS A9270|00121-1775-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36663|ERX|HCPCS A9270|50383-0087-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36663|ERX|HCPCS A9270|50383-0087-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36952|ERX|HCPCS A9270|56184-0121-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.125 % NASAL DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 36959|ERX|HCPCS A9270|00245-0144-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 36959|ERX|HCPCS A9270|00245-0144-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 36959|ERX|HCPCS A9270|51672-4055-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 36959|ERX|HCPCS A9270|51862-0240-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.38|PHR: 408101; CHG: 26||Not reimbursed separately|1.38|PHR: 408101; CHG: 26||External grouping not supported 36966|ERX|HCPCS A9270|00456-3210-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36966|ERX|HCPCS A9270|00904-6506-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36966|ERX|HCPCS A9270|60687-0184-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 36966|ERX|HCPCS A9270|60687-0184-57|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.81|PHR: 408101; CHG: 26||Not reimbursed separately|0.81|PHR: 408101; CHG: 26||External grouping not supported 3697|ERX|HCPCS J0360|17478-0934-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDRALAZINE 20 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.38|PHR: 408101; CHG: 26||Not reimbursed separately|9.38|PHR: 408101; CHG: 26||External grouping not supported 3697|ERX|HCPCS J0360|63323-0614-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDRALAZINE 20 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.38|PHR: 408101; CHG: 26||Not reimbursed separately|9.38|PHR: 408101; CHG: 26||External grouping not supported 3697|ERX|HCPCS J0360|63323-0614-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDRALAZINE 20 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.38|PHR: 408101; CHG: 26||Not reimbursed separately|9.38|PHR: 408101; CHG: 26||External grouping not supported 3697|ERX|HCPCS J0360|67457-0291-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDRALAZINE 20 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.38|PHR: 408101; CHG: 26||Not reimbursed separately|9.38|PHR: 408101; CHG: 26||External grouping not supported 3697|ERX|HCPCS J0360|63323-0614-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDRALAZINE 20 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|9.38|PHR: 408101; CHG: 26||Not reimbursed separately|9.38|PHR: 408101; CHG: 26||External grouping not supported 3698|ERX|HCPCS A9270|00904-6440-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3698|ERX|HCPCS A9270|50111-0398-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 36983|ERX|HCPCS A9270|00378-1030-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EPLERENONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.60|PHR: 408101; CHG: 26||Not reimbursed separately|9.60|PHR: 408101; CHG: 26||External grouping not supported 36983|ERX|HCPCS A9270|59762-1710-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EPLERENONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.60|PHR: 408101; CHG: 26||Not reimbursed separately|9.60|PHR: 408101; CHG: 26||External grouping not supported 36987|ERX|HCPCS A9270|68462-0128-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZONISAMIDE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 36989|ERX|HCPCS J0878|43598-0413-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|211.17|PHR: 408101; CHG: 26||Not reimbursed separately|211.17|PHR: 408101; CHG: 26||External grouping not supported 36989|ERX|HCPCS J0878|67919-0012-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|211.17|PHR: 408101; CHG: 26||Not reimbursed separately|211.17|PHR: 408101; CHG: 26||External grouping not supported 36989|ERX|HCPCS J0878|67919-0012-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|211.17|PHR: 408101; CHG: 26||Not reimbursed separately|211.17|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|00904-6441-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|23155-0002-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|31722-0520-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|51079-0075-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|62584-0733-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|62584-0733-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|63739-0126-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3700|ERX|HCPCS A9270|64380-0734-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3701|ERX|HCPCS A9270|00904-6442-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3701|ERX|HCPCS A9270|62584-0734-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3701|ERX|HCPCS A9270|63739-0127-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDRALAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 37170|ERX|HCPCS A9270|00904-6505-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 37170|ERX|HCPCS A9270|00904-6505-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 37170|ERX|HCPCS A9270|60687-0173-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEMANTINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.80|PHR: 408101; CHG: 26||Not reimbursed separately|0.80|PHR: 408101; CHG: 26||External grouping not supported 37182|ERX|HCPCS A9270|00378-3520-91|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FOSAMPRENAVIR 700 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.47|PHR: 408101; CHG: 26||Not reimbursed separately|41.47|PHR: 408101; CHG: 26||External grouping not supported 3720|ERX|HCPCS A9270|00172-2083-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 3720|ERX|HCPCS A9270|16729-0183-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 3720|ERX|HCPCS A9270|29300-0128-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 3720|ERX|HCPCS A9270|63739-0128-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 3721|ERX|HCPCS A9270|00172-2089-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCHLOROTHIAZIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 3721|ERX|HCPCS A9270|16729-0184-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCHLOROTHIAZIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 37237|ERX|HCPCS J2794|50458-0306-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE|2 mL|HUMANA [1294]||HUMANA [11839]|1,453.89|PHR: 408101; CHG: 26||Not reimbursed separately|1,453.89|PHR: 408101; CHG: 26||External grouping not supported 37238|ERX|HCPCS J2794|50458-0307-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RISPERIDONE MICROSPHERES ER 37.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,180.94|PHR: 408101; CHG: 26||Not reimbursed separately|2,180.94|PHR: 408101; CHG: 26||External grouping not supported 37238|ERX|HCPCS J2794|50458-0307-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RISPERIDONE MICROSPHERES ER 37.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,180.94|PHR: 408101; CHG: 26||Not reimbursed separately|2,180.94|PHR: 408101; CHG: 26||External grouping not supported 37239|ERX|HCPCS J2794|50458-0308-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,907.96|PHR: 408101; CHG: 26||Not reimbursed separately|2,907.96|PHR: 408101; CHG: 26||External grouping not supported 3724|ERX|HCPCS A9270|00472-1030-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 3724|ERX|HCPCS A9270|50383-0043-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 3726|ERX|HCPCS A9270|00472-0343-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.28|PHR: 408101; CHG: 26||Not reimbursed separately|3.28|PHR: 408101; CHG: 26||External grouping not supported 3726|ERX|HCPCS A9270|00904-7623-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.28|PHR: 408101; CHG: 26||Not reimbursed separately|3.28|PHR: 408101; CHG: 26||External grouping not supported 3726|ERX|HCPCS A9270|45802-0438-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.28|PHR: 408101; CHG: 26||Not reimbursed separately|3.28|PHR: 408101; CHG: 26||External grouping not supported 3726|ERX|HCPCS A9270|24385-0021-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % TOPICAL CREAM|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.56|PHR: 408101; CHG: 26||Not reimbursed separately|6.56|PHR: 408101; CHG: 26||External grouping not supported 3726|ERX|HCPCS A9270|87701-0981-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % TOPICAL CREAM|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.56|PHR: 408101; CHG: 26||Not reimbursed separately|6.56|PHR: 408101; CHG: 26||External grouping not supported 3727|ERX|HCPCS A9270|00168-0080-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.29|PHR: 408101; CHG: 26||Not reimbursed separately|7.29|PHR: 408101; CHG: 26||External grouping not supported 3728|ERX|HCPCS A9270|63736-0339-42|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % LOTION|118 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.64|PHR: 408101; CHG: 26||Not reimbursed separately|16.64|PHR: 408101; CHG: 26||External grouping not supported 3728|ERX|HCPCS A9270|00096-0732-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % LOTION|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.20|PHR: 408101; CHG: 26||Not reimbursed separately|34.20|PHR: 408101; CHG: 26||External grouping not supported 3729|ERX|HCPCS A9270|45802-0937-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % LOTION|59 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.70|PHR: 408101; CHG: 26||Not reimbursed separately|14.70|PHR: 408101; CHG: 26||External grouping not supported 3731|ERX|HCPCS A9270|00472-0345-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 1 % TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.62|PHR: 408101; CHG: 26||Not reimbursed separately|3.62|PHR: 408101; CHG: 26||External grouping not supported 3732|ERX|HCPCS A9270|45802-0014-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL OINTMENT|20 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.50|PHR: 408101; CHG: 26||Not reimbursed separately|4.50|PHR: 408101; CHG: 26||External grouping not supported 3732|ERX|HCPCS A9270|00168-0146-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2.5 % TOPICAL OINTMENT|28.35 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 3733|ERX|HCPCS A9270|00009-0031-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 3733|ERX|HCPCS A9270|42543-0141-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 3733|ERX|HCPCS A9270|59762-0074-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 3733|ERX|HCPCS A9270|60687-0511-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 3734|ERX|HCPCS A9270|42543-0142-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 3734|ERX|HCPCS A9270|59762-0075-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 37343|ERX|HCPCS A9270|04142-0000-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SACCHAROMYCES BOULARDII 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 37343|ERX|HCPCS A9270|57896-0869-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SACCHAROMYCES BOULARDII 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 37343|ERX|HCPCS A9270|77333-0800-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SACCHAROMYCES BOULARDII 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 3738|ERX|HCPCS A9270|00574-7090-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.04|PHR: 408101; CHG: 26||Not reimbursed separately|5.04|PHR: 408101; CHG: 26||External grouping not supported 3738|ERX|HCPCS A9270|42494-0301-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.04|PHR: 408101; CHG: 26||Not reimbursed separately|5.04|PHR: 408101; CHG: 26||External grouping not supported 3743|ERX|HCPCS J1720|00009-0825-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION|50 mg|HUMANA [1294]||HUMANA [11839]|14.66|PHR: 408101; CHG: 26||Not reimbursed separately|14.66|PHR: 408101; CHG: 26||External grouping not supported 3752|ERX|HCPCS A9270|00869-0871-34|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROGEN PEROXIDE 3 % SOLUTION|237 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 3752|ERX|HCPCS A9270|49348-0031-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROGEN PEROXIDE 3 % SOLUTION|237 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 3752|ERX|HCPCS A9270|00869-4706-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROGEN PEROXIDE 3 % SOLUTION|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.42|PHR: 408101; CHG: 26||Not reimbursed separately|1.42|PHR: 408101; CHG: 26||External grouping not supported 3758|ERX|HCPCS J1170|00409-3365-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.00|PHR: 408101; CHG: 26||Not reimbursed separately|4.00|PHR: 408101; CHG: 26||External grouping not supported 3758|ERX|HCPCS J1170|00641-0121-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.00|PHR: 408101; CHG: 26||Not reimbursed separately|4.00|PHR: 408101; CHG: 26||External grouping not supported 3758|ERX|HCPCS J1170|00409-3365-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.00|PHR: 408101; CHG: 26||Not reimbursed separately|4.00|PHR: 408101; CHG: 26||External grouping not supported 3758|ERX|HCPCS J1170|00641-0121-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|4.00|PHR: 408101; CHG: 26||Not reimbursed separately|4.00|PHR: 408101; CHG: 26||External grouping not supported 3758|ERX|HCPCS J1170|00641-2341-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.00|PHR: 408101; CHG: 26||Not reimbursed separately|8.00|PHR: 408101; CHG: 26||External grouping not supported 3759|ERX|HCPCS J1170|00409-1304-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 4 MG/ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.07|PHR: 408101; CHG: 26||Not reimbursed separately|5.07|PHR: 408101; CHG: 26||External grouping not supported 3759|ERX|HCPCS J1170|00409-1304-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 4 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.07|PHR: 408101; CHG: 26||Not reimbursed separately|5.07|PHR: 408101; CHG: 26||External grouping not supported 3760|ERX|HCPCS A9270|42858-0301-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROMORPHONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 3761|ERX|HCPCS A9270|42858-0302-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROMORPHONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 3761|ERX|HCPCS A9270|68084-0472-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROMORPHONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 37616|ERX|HCPCS A9270|68084-0343-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 37616|ERX|HCPCS A9270|68084-0343-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 37616|ERX|HCPCS A9270|68462-0153-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 37616|ERX|HCPCS A9270|69097-0123-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOPIRAMATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 37637|ERX|HCPCS A9270|51079-0255-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 37637|ERX|HCPCS A9270|51079-0255-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 37637|ERX|HCPCS A9270|62584-0265-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 37642|ERX|HCPCS A9270|65862-0596-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 37643|ERX|HCPCS A9270|60687-0185-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.95|PHR: 408101; CHG: 26||Not reimbursed separately|17.95|PHR: 408101; CHG: 26||External grouping not supported 37643|ERX|HCPCS A9270|60687-0185-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.95|PHR: 408101; CHG: 26||Not reimbursed separately|17.95|PHR: 408101; CHG: 26||External grouping not supported 37643|ERX|HCPCS A9270|68462-0408-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.95|PHR: 408101; CHG: 26||Not reimbursed separately|17.95|PHR: 408101; CHG: 26||External grouping not supported 37644|ERX|HCPCS A9270|66993-0115-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.48|PHR: 408101; CHG: 26||Not reimbursed separately|20.48|PHR: 408101; CHG: 26||External grouping not supported 37644|ERX|HCPCS A9270|68084-0917-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.48|PHR: 408101; CHG: 26||Not reimbursed separately|20.48|PHR: 408101; CHG: 26||External grouping not supported 37648|ERX|HCPCS A9270|65862-0888-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 37648|ERX|HCPCS A9270|68084-0295-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 37648|ERX|HCPCS A9270|68084-0295-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 37649|ERX|HCPCS A9270|00591-0844-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 37649|ERX|HCPCS A9270|64980-0280-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 37649|ERX|HCPCS A9270|68084-0111-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 37649|ERX|HCPCS A9270|68084-0111-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 37650|ERX|HCPCS A9270|10370-0746-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.85|PHR: 408101; CHG: 26||Not reimbursed separately|1.85|PHR: 408101; CHG: 26||External grouping not supported 37650|ERX|HCPCS A9270|68084-0112-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.85|PHR: 408101; CHG: 26||Not reimbursed separately|1.85|PHR: 408101; CHG: 26||External grouping not supported 37650|ERX|HCPCS A9270|68084-0112-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.85|PHR: 408101; CHG: 26||Not reimbursed separately|1.85|PHR: 408101; CHG: 26||External grouping not supported 37653|ERX|HCPCS A9270|00025-2742-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DISOPYRAMIDE PHOSPHATE ER 150 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.11|PHR: 408101; CHG: 26||Not reimbursed separately|13.11|PHR: 408101; CHG: 26||External grouping not supported 37661|ERX|HCPCS A9270|51991-0820-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 160 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 3771|ERX|HCPCS A9270|54838-0502-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 3771|ERX|HCPCS A9270|60432-0150-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.20|PHR: 408101; CHG: 26||Not reimbursed separately|1.20|PHR: 408101; CHG: 26||External grouping not supported 3772|ERX|HCPCS A9270|00093-5060-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 3772|ERX|HCPCS A9270|63739-0483-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 3772|ERX|HCPCS A9270|68084-0253-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 3772|ERX|HCPCS A9270|68084-0253-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 3774|ERX|HCPCS A9270|42806-0160-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 3774|ERX|HCPCS A9270|68084-0254-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE HCL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 3777|ERX|HCPCS Q0177|00115-1803-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROXYZINE PAMOATE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3777|ERX|HCPCS Q0177|00115-1803-02|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROXYZINE PAMOATE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3777|ERX|HCPCS Q0177|00185-0674-01|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROXYZINE PAMOATE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3777|ERX|HCPCS Q0177|00555-0323-02|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROXYZINE PAMOATE 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3777|ERX|HCPCS Q0177|68084-0847-11|0250 - PHARMACY - GENERAL CLASSIFICATION|HYDROXYZINE PAMOATE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 3778|ERX|HCPCS A9270|00115-1804-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE PAMOATE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3778|ERX|HCPCS A9270|00185-0615-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE PAMOATE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3778|ERX|HCPCS A9270|51079-0078-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE PAMOATE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3778|ERX|HCPCS A9270|51079-0078-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROXYZINE PAMOATE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3782|ERX|HCPCS A9270|54838-0506-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYOSCYAMINE 0.125 MG/ML ORAL DROPS|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.41|PHR: 408101; CHG: 26||Not reimbursed separately|0.41|PHR: 408101; CHG: 26||External grouping not supported 37848|ERX|HCPCS A9270|00121-0772-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 37848|ERX|HCPCS A9270|60687-0417-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 37848|ERX|HCPCS A9270|60687-0417-71|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 37848|ERX|HCPCS A9270|66689-0023-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 37848|ERX|HCPCS A9270|66689-0023-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 37894|ERX|HCPCS J9305|00002-7623-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PEMETREXED 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|10,225.50|PHR: 408101; CHG: 26||Not reimbursed separately|10,225.50|PHR: 408101; CHG: 26||External grouping not supported 37989|ERX|HCPCS J9055|66733-0948-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|1,842.45|PHR: 408101; CHG: 26||Not reimbursed separately|1,842.45|PHR: 408101; CHG: 26||External grouping not supported 38022|ERX|HCPCS J9035|50242-0061-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|16 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,563.28|PHR: 408101; CHG: 26||Not reimbursed separately|9,563.28|PHR: 408101; CHG: 26||External grouping not supported 38022|ERX|HCPCS J9035|50242-0060-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|2,390.82|PHR: 408101; CHG: 26||Not reimbursed separately|2,390.82|PHR: 408101; CHG: 26||External grouping not supported 38092|ERX|HCPCS A9270|17238-0610-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYPROMELLOSE 2.5 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.74|PHR: 408101; CHG: 26||Not reimbursed separately|48.74|PHR: 408101; CHG: 26||External grouping not supported 38092|ERX|HCPCS A9270|17478-0064-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYPROMELLOSE 2.5 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.74|PHR: 408101; CHG: 26||Not reimbursed separately|48.74|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|16729-0440-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|16729-0440-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|55513-0073-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|65862-0831-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|67877-0503-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|69097-0410-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38100|ERX|HCPCS A9270|70436-0007-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CINACALCET 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 38213|ERX|HCPCS A9270|00115-2011-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 38213|ERX|HCPCS A9270|00185-0022-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 38213|ERX|HCPCS A9270|43386-0480-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 38224|ERX|HCPCS A9270|60687-0215-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.71|PHR: 408101; CHG: 26||Not reimbursed separately|4.71|PHR: 408101; CHG: 26||External grouping not supported 38224|ERX|HCPCS A9270|60687-0215-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.71|PHR: 408101; CHG: 26||Not reimbursed separately|4.71|PHR: 408101; CHG: 26||External grouping not supported 38225|ERX|HCPCS A9270|00527-4117-37|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 38225|ERX|HCPCS A9270|60687-0226-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 38225|ERX|HCPCS A9270|60687-0226-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 38226|ERX|HCPCS A9270|51991-0819-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 120 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 38226|ERX|HCPCS A9270|62559-0532-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL ER 120 MG CAPSULE,24 HR,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 38245|ERX|HCPCS A9270|00121-0577-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 38245|ERX|HCPCS A9270|00121-0873-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 38245|ERX|HCPCS A9270|50383-0779-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 38245|ERX|HCPCS A9270|60432-0037-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 38263|ERX|HCPCS RX001|00781-3159-72|0250 - PHARMACY - GENERAL CLASSIFICATION|OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION|10 mg|HUMANA [1294]||HUMANA [11839]|62.22|PHR: 408101; CHG: 26||Not reimbursed separately|62.22|PHR: 408101; CHG: 26||External grouping not supported 38263|ERX|HCPCS RX001|00002-7597-01|0250 - PHARMACY - GENERAL CLASSIFICATION|OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION|2.5 mg|HUMANA [1294]||HUMANA [11839]|62.22|PHR: 408101; CHG: 26||Not reimbursed separately|62.22|PHR: 408101; CHG: 26||External grouping not supported 38263|ERX|HCPCS RX001|00517-0955-01|0250 - PHARMACY - GENERAL CLASSIFICATION|OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION|2.5 mg|HUMANA [1294]||HUMANA [11839]|62.22|PHR: 408101; CHG: 26||Not reimbursed separately|62.22|PHR: 408101; CHG: 26||External grouping not supported 38263|ERX|HCPCS RX001|00781-9105-72|0250 - PHARMACY - GENERAL CLASSIFICATION|OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION|2.5 mg|HUMANA [1294]||HUMANA [11839]|62.22|PHR: 408101; CHG: 26||Not reimbursed separately|62.22|PHR: 408101; CHG: 26||External grouping not supported 38270|ERX|HCPCS J9070|00781-3244-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,822.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,822.50|PHR: 408101; CHG: 26||External grouping not supported 38270|ERX|HCPCS J9070|10019-0944-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,822.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,822.50|PHR: 408101; CHG: 26||External grouping not supported 38270|ERX|HCPCS J9070|10019-0956-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,822.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,822.50|PHR: 408101; CHG: 26||External grouping not supported 38270|ERX|HCPCS J9070|10019-0956-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,822.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,822.50|PHR: 408101; CHG: 26||External grouping not supported 38271|ERX|HCPCS J9070|00781-3233-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|485.31|PHR: 408101; CHG: 26||Not reimbursed separately|485.31|PHR: 408101; CHG: 26||External grouping not supported 38271|ERX|HCPCS J9070|10019-0955-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|485.31|PHR: 408101; CHG: 26||Not reimbursed separately|485.31|PHR: 408101; CHG: 26||External grouping not supported 38271|ERX|HCPCS J9070|10019-0955-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|485.31|PHR: 408101; CHG: 26||Not reimbursed separately|485.31|PHR: 408101; CHG: 26||External grouping not supported 38303|ERX|HCPCS J0132|00574-0805-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|134.91|PHR: 408101; CHG: 26||Not reimbursed separately|134.91|PHR: 408101; CHG: 26||External grouping not supported 38303|ERX|HCPCS J0132|25021-0812-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|134.91|PHR: 408101; CHG: 26||Not reimbursed separately|134.91|PHR: 408101; CHG: 26||External grouping not supported 38303|ERX|HCPCS J0132|63323-0963-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|134.91|PHR: 408101; CHG: 26||Not reimbursed separately|134.91|PHR: 408101; CHG: 26||External grouping not supported 38303|ERX|HCPCS J0132|63323-0963-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|134.91|PHR: 408101; CHG: 26||Not reimbursed separately|134.91|PHR: 408101; CHG: 26||External grouping not supported 3841|ERX|HCPCS A9270|00904-6747-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 3841|ERX|HCPCS A9270|00904-7914-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 3843|ERX|HCPCS A9270|00904-5853-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3843|ERX|HCPCS A9270|60687-0446-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3843|ERX|HCPCS A9270|63739-0672-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3843|ERX|HCPCS A9270|65162-0464-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3843|ERX|HCPCS A9270|68084-0658-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3843|ERX|HCPCS A9270|68084-0658-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3844|ERX|HCPCS A9270|00904-5854-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3844|ERX|HCPCS A9270|11788-0009-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3844|ERX|HCPCS A9270|60687-0457-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3844|ERX|HCPCS A9270|63739-0684-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 600 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.17|PHR: 408101; CHG: 26||Not reimbursed separately|0.17|PHR: 408101; CHG: 26||External grouping not supported 3845|ERX|HCPCS A9270|00904-5855-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3845|ERX|HCPCS A9270|60687-0468-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3845|ERX|HCPCS A9270|63739-0691-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 3845|ERX|HCPCS A9270|64380-0807-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBUPROFEN 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 38488|ERX|HCPCS A9270|00121-4721-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.53|PHR: 408101; CHG: 26||Not reimbursed separately|9.53|PHR: 408101; CHG: 26||External grouping not supported 38488|ERX|HCPCS A9270|60687-0244-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.53|PHR: 408101; CHG: 26||Not reimbursed separately|9.53|PHR: 408101; CHG: 26||External grouping not supported 38488|ERX|HCPCS A9270|60687-0244-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.53|PHR: 408101; CHG: 26||Not reimbursed separately|9.53|PHR: 408101; CHG: 26||External grouping not supported 3860|ERX|HCPCS A9270|53489-0330-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 3860|ERX|HCPCS A9270|69315-0133-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 3861|ERX|HCPCS A9270|00781-1764-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3861|ERX|HCPCS A9270|69315-0134-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 3862|ERX|HCPCS A9270|00781-1766-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 3862|ERX|HCPCS A9270|49884-0056-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 3862|ERX|HCPCS A9270|69315-0135-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IMIPRAMINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 38701|ERX|HCPCS A9270|00574-4250-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.40|PHR: 408101; CHG: 26||Not reimbursed separately|15.40|PHR: 408101; CHG: 26||External grouping not supported 38701|ERX|HCPCS A9270|24208-0780-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.40|PHR: 408101; CHG: 26||Not reimbursed separately|15.40|PHR: 408101; CHG: 26||External grouping not supported 3879|ERX|HCPCS A9270|00228-2571-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 3879|ERX|HCPCS A9270|43975-0304-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 3879|ERX|HCPCS A9270|51079-0868-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 3879|ERX|HCPCS A9270|51079-0868-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 3879|ERX|HCPCS A9270|62559-0511-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDAPAMIDE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 38830|ERX|HCPCS A9270|00054-0338-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXERCALCIFEROL 0.5 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.21|PHR: 408101; CHG: 26||Not reimbursed separately|33.21|PHR: 408101; CHG: 26||External grouping not supported 38830|ERX|HCPCS A9270|00955-1720-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXERCALCIFEROL 0.5 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.21|PHR: 408101; CHG: 26||Not reimbursed separately|33.21|PHR: 408101; CHG: 26||External grouping not supported 3897|ERX|HCPCS A9270|31722-0542-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 3897|ERX|HCPCS A9270|68462-0406-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 38977|ERX|HCPCS A9270|00574-0145-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROSPIUM 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 38977|ERX|HCPCS A9270|69097-0912-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROSPIUM 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 38978|ERX|HCPCS A9270|60258-0162-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 3898|ERX|HCPCS A9270|50268-0431-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 3898|ERX|HCPCS A9270|50268-0431-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 3898|ERX|HCPCS A9270|68462-0302-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|INDOMETHACIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 38981|ERX|HCPCS A9270|00054-0347-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TINIDAZOLE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.61|PHR: 408101; CHG: 26||Not reimbursed separately|2.61|PHR: 408101; CHG: 26||External grouping not supported 3901|ERX|HCPCS RX001|69344-0102-33|0250 - PHARMACY - GENERAL CLASSIFICATION|INDOMETHACIN 50 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]||HUMANA [11839]|516.50|PHR: 408101; CHG: 26||Not reimbursed separately|516.50|PHR: 408101; CHG: 26||External grouping not supported 39063|ERX|HCPCS A9270|65649-0301-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIFAXIMIN 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.78|PHR: 408101; CHG: 26||Not reimbursed separately|61.78|PHR: 408101; CHG: 26||External grouping not supported 391|ERX|HCPCS A9270|00574-0292-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMILORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 391|ERX|HCPCS A9270|49884-0117-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMILORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 392|ERX|HCPCS A9270|00378-0577-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMILORIDE 5 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 39220|ERX|HCPCS A9270|43598-0583-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.50|PHR: 408101; CHG: 26||Not reimbursed separately|11.50|PHR: 408101; CHG: 26||External grouping not supported 39220|ERX|HCPCS A9270|45963-0565-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.50|PHR: 408101; CHG: 26||Not reimbursed separately|11.50|PHR: 408101; CHG: 26||External grouping not supported 39220|ERX|HCPCS A9270|62559-0700-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.50|PHR: 408101; CHG: 26||Not reimbursed separately|11.50|PHR: 408101; CHG: 26||External grouping not supported 39221|ERX|HCPCS A9270|43598-0584-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.50|PHR: 408101; CHG: 26||Not reimbursed separately|11.50|PHR: 408101; CHG: 26||External grouping not supported 39221|ERX|HCPCS A9270|62559-0701-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.50|PHR: 408101; CHG: 26||Not reimbursed separately|11.50|PHR: 408101; CHG: 26||External grouping not supported 39221|ERX|HCPCS A9270|67877-0508-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.50|PHR: 408101; CHG: 26||Not reimbursed separately|11.50|PHR: 408101; CHG: 26||External grouping not supported 39222|ERX|HCPCS A9270|43598-0585-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|PHR: 408101; CHG: 26||Not reimbursed separately|3.86|PHR: 408101; CHG: 26||External grouping not supported 39222|ERX|HCPCS A9270|43598-0585-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|PHR: 408101; CHG: 26||Not reimbursed separately|3.86|PHR: 408101; CHG: 26||External grouping not supported 39222|ERX|HCPCS A9270|43598-0743-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|PHR: 408101; CHG: 26||Not reimbursed separately|3.86|PHR: 408101; CHG: 26||External grouping not supported 39222|ERX|HCPCS A9270|66582-0313-54|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|PHR: 408101; CHG: 26||Not reimbursed separately|3.86|PHR: 408101; CHG: 26||External grouping not supported 39222|ERX|HCPCS A9270|67877-0509-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.86|PHR: 408101; CHG: 26||Not reimbursed separately|3.86|PHR: 408101; CHG: 26||External grouping not supported 39223|ERX|HCPCS A9270|43598-0586-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.61|PHR: 408101; CHG: 26||Not reimbursed separately|4.61|PHR: 408101; CHG: 26||External grouping not supported 39223|ERX|HCPCS A9270|62559-0703-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.61|PHR: 408101; CHG: 26||Not reimbursed separately|4.61|PHR: 408101; CHG: 26||External grouping not supported 39223|ERX|HCPCS A9270|66582-0315-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EZETIMIBE 10 MG-SIMVASTATIN 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.61|PHR: 408101; CHG: 26||Not reimbursed separately|4.61|PHR: 408101; CHG: 26||External grouping not supported 39254|ERX|HCPCS A9270|67546-0111-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITAZOXANIDE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|400.63|PHR: 408101; CHG: 26||Not reimbursed separately|400.63|PHR: 408101; CHG: 26||External grouping not supported 39255|ERX|HCPCS A9270|61958-0701-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.17|PHR: 408101; CHG: 26||Not reimbursed separately|179.17|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|00703-4246-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.17|PHR: 408101; CHG: 26||Not reimbursed separately|24.17|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|00703-4248-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|45 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.85|PHR: 408101; CHG: 26||Not reimbursed separately|73.85|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|00703-4248-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|45 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.85|PHR: 408101; CHG: 26||Not reimbursed separately|73.85|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|61703-0339-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|34.44|PHR: 408101; CHG: 26||Not reimbursed separately|34.44|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|00703-4239-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.44|PHR: 408101; CHG: 26||Not reimbursed separately|145.44|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|00703-4239-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.44|PHR: 408101; CHG: 26||Not reimbursed separately|145.44|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|61703-0339-56|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.44|PHR: 408101; CHG: 26||Not reimbursed separately|145.44|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|63323-0172-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.44|PHR: 408101; CHG: 26||Not reimbursed separately|145.44|PHR: 408101; CHG: 26||External grouping not supported 39265|ERX|HCPCS J9045|71288-0100-51|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.44|PHR: 408101; CHG: 26||Not reimbursed separately|145.44|PHR: 408101; CHG: 26||External grouping not supported 39275|ERX|HCPCS A9270|47335-0381-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|PHR: 408101; CHG: 26||Not reimbursed separately|0.26|PHR: 408101; CHG: 26||External grouping not supported 39275|ERX|HCPCS A9270|60505-2995-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|PHR: 408101; CHG: 26||Not reimbursed separately|0.26|PHR: 408101; CHG: 26||External grouping not supported 39275|ERX|HCPCS A9270|67877-0263-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|PHR: 408101; CHG: 26||Not reimbursed separately|0.26|PHR: 408101; CHG: 26||External grouping not supported 39275|ERX|HCPCS A9270|68084-0675-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.26|PHR: 408101; CHG: 26||Not reimbursed separately|0.26|PHR: 408101; CHG: 26||External grouping not supported 39276|ERX|HCPCS A9270|00904-6453-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 39276|ERX|HCPCS A9270|47335-0382-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 39276|ERX|HCPCS A9270|51991-0747-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 39276|ERX|HCPCS A9270|57237-0018-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 39276|ERX|HCPCS A9270|67877-0264-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 39276|ERX|HCPCS A9270|68084-0683-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 39277|ERX|HCPCS A9270|00904-6454-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 60 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 39277|ERX|HCPCS A9270|43547-0381-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 60 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 39277|ERX|HCPCS A9270|47335-0383-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 60 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 39277|ERX|HCPCS A9270|60505-2997-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 60 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 39277|ERX|HCPCS A9270|68084-0692-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 60 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 39277|ERX|HCPCS A9270|68084-0692-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DULOXETINE 60 MG CAPSULE,DELAYED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.02|PHR: 408101; CHG: 26||Not reimbursed separately|2.02|PHR: 408101; CHG: 26||External grouping not supported 39278|ERX|HCPCS J7612|00093-4147-19|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION|1 Each|HUMANA [1294]||HUMANA [11839]|8.60|PHR: 408101; CHG: 26||Not reimbursed separately|8.60|PHR: 408101; CHG: 26||External grouping not supported 39278|ERX|HCPCS J7612|00093-4147-56|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.60|PHR: 408101; CHG: 26||Not reimbursed separately|8.60|PHR: 408101; CHG: 26||External grouping not supported 39278|ERX|HCPCS J7612|17478-0171-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.60|PHR: 408101; CHG: 26||Not reimbursed separately|8.60|PHR: 408101; CHG: 26||External grouping not supported 39278|ERX|HCPCS J7612|17478-0171-30|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.60|PHR: 408101; CHG: 26||Not reimbursed separately|8.60|PHR: 408101; CHG: 26||External grouping not supported 39496|ERX|HCPCS A9270|47335-0186-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 10 MG-LEVODOPA 100 MG DISINTEGRATING TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.37|PHR: 408101; CHG: 26||Not reimbursed separately|1.37|PHR: 408101; CHG: 26||External grouping not supported 39522|ERX|HCPCS A9270|00781-6078-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFDINIR 250 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.45|PHR: 408101; CHG: 26||Not reimbursed separately|2.45|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|00093-5352-86|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|51079-0241-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|51079-0241-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|60687-0121-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|60687-0121-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|68382-0569-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39720|ERX|HCPCS A9270|68462-0435-18|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACAMPROSATE 333 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.72|PHR: 408101; CHG: 26||Not reimbursed separately|1.72|PHR: 408101; CHG: 26||External grouping not supported 39837|ERX|HCPCS J1438|58406-0021-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETANERCEPT 50 MG/ML (1 ML) SUBCUTANEOUS SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|3,972.04|PHR: 408101; CHG: 26||Not reimbursed separately|3,972.04|PHR: 408101; CHG: 26||External grouping not supported 39975|ERX|HCPCS A9270|54092-0252-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANTHANUM 500 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.37|PHR: 408101; CHG: 26||Not reimbursed separately|13.37|PHR: 408101; CHG: 26||External grouping not supported 39975|ERX|HCPCS A9270|66993-0422-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANTHANUM 500 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.37|PHR: 408101; CHG: 26||Not reimbursed separately|13.37|PHR: 408101; CHG: 26||External grouping not supported 39975|ERX|HCPCS A9270|66993-0422-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANTHANUM 500 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.37|PHR: 408101; CHG: 26||Not reimbursed separately|13.37|PHR: 408101; CHG: 26||External grouping not supported 39975|ERX|HCPCS A9270|68180-0819-42|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANTHANUM 500 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.37|PHR: 408101; CHG: 26||Not reimbursed separately|13.37|PHR: 408101; CHG: 26||External grouping not supported 39975|ERX|HCPCS A9270|68180-0819-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANTHANUM 500 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.37|PHR: 408101; CHG: 26||Not reimbursed separately|13.37|PHR: 408101; CHG: 26||External grouping not supported 40090|ERX|HCPCS A9270|50242-0063-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERLOTINIB 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.66|PHR: 408101; CHG: 26||Not reimbursed separately|726.66|PHR: 408101; CHG: 26||External grouping not supported 40091|ERX|HCPCS A9270|00378-7133-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERLOTINIB 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|821.90|PHR: 408101; CHG: 26||Not reimbursed separately|821.90|PHR: 408101; CHG: 26||External grouping not supported 40091|ERX|HCPCS A9270|50242-0064-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERLOTINIB 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|821.90|PHR: 408101; CHG: 26||Not reimbursed separately|821.90|PHR: 408101; CHG: 26||External grouping not supported 40120|ERX|HCPCS J2323|64406-0008-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|21,275.06|PHR: 408101; CHG: 26||Not reimbursed separately|21,275.06|PHR: 408101; CHG: 26||External grouping not supported 4026|ERX|HCPCS A9270|00555-0066-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISONIAZID 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 4027|ERX|HCPCS A9270|00555-0071-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISONIAZID 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 4027|ERX|HCPCS A9270|51079-0083-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISONIAZID 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 4027|ERX|HCPCS A9270|51079-0083-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISONIAZID 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 403|ERX|HCPCS RX001|00409-4346-73|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|16.98|PHR: 408101; CHG: 26||Not reimbursed separately|16.98|PHR: 408101; CHG: 26||External grouping not supported 403|ERX|HCPCS RX001|00409-4346-16|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|16.98|PHR: 408101; CHG: 26||Not reimbursed separately|16.98|PHR: 408101; CHG: 26||External grouping not supported 403|ERX|HCPCS RX001|00517-9120-01|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|16.98|PHR: 408101; CHG: 26||Not reimbursed separately|16.98|PHR: 408101; CHG: 26||External grouping not supported 40320|ERX|HCPCS A9270|63402-0190-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESZOPICLONE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.35|PHR: 408101; CHG: 26||Not reimbursed separately|43.35|PHR: 408101; CHG: 26||External grouping not supported 40321|ERX|HCPCS A9270|47335-0587-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESZOPICLONE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 40322|ERX|HCPCS A9270|68462-0384-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESZOPICLONE 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 40369|ERX|HCPCS A9270|00378-9230-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1,000 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 40369|ERX|HCPCS A9270|58914-0501-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1,000 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.88|PHR: 408101; CHG: 26||Not reimbursed separately|41.88|PHR: 408101; CHG: 26||External grouping not supported 40389|ERX|HCPCS A9270|41167-4320-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEXOFENADINE-PSEUDOEPHEDRINE ER 180 MG-240 MG TABLET,EXT.RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 40389|ERX|HCPCS A9270|41167-4320-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FEXOFENADINE-PSEUDOEPHEDRINE ER 180 MG-240 MG TABLET,EXT.RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 40392|ERX|HCPCS A9270|51248-0150-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOLIFENACIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 40392|ERX|HCPCS A9270|51248-0150-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOLIFENACIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 40392|ERX|HCPCS A9270|60505-4702-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOLIFENACIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 40392|ERX|HCPCS A9270|60505-4702-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOLIFENACIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 40392|ERX|HCPCS A9270|67877-0527-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SOLIFENACIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 40400|ERX|HCPCS J2425|66658-0112-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION|6.3 mg|HUMANA [1294]||HUMANA [11839]|8,158.39|PHR: 408101; CHG: 26||Not reimbursed separately|8,158.39|PHR: 408101; CHG: 26||External grouping not supported 40402|ERX|HCPCS A9270|69097-0431-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARIFENACIN ER 7.5 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.24|PHR: 408101; CHG: 26||Not reimbursed separately|7.24|PHR: 408101; CHG: 26||External grouping not supported 40403|ERX|HCPCS A9270|59746-0517-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARIFENACIN ER 15 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.09|PHR: 408101; CHG: 26||Not reimbursed separately|9.09|PHR: 408101; CHG: 26||External grouping not supported 40403|ERX|HCPCS A9270|69097-0432-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DARIFENACIN ER 15 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.09|PHR: 408101; CHG: 26||Not reimbursed separately|9.09|PHR: 408101; CHG: 26||External grouping not supported 40475|ERX|HCPCS J9264|68817-0134-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PACLITAXEL-PROTEIN BOUND 100 MG INTRAVENOUS SUSPENSION|20 mL|HUMANA [1294]||HUMANA [11839]|3,999.99|PHR: 408101; CHG: 26||Not reimbursed separately|3,999.99|PHR: 408101; CHG: 26||External grouping not supported 4064|ERX|HCPCS A9270|68001-0374-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4064|ERX|HCPCS A9270|68084-0082-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4064|ERX|HCPCS A9270|68084-0082-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4065|ERX|HCPCS A9270|63739-0367-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 4065|ERX|HCPCS A9270|68084-0083-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 4065|ERX|HCPCS A9270|68084-0083-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 4068|ERX|HCPCS A9270|00143-1769-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 4068|ERX|HCPCS A9270|50268-0447-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 4068|ERX|HCPCS A9270|68001-0373-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ISOSORBIDE DINITRATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 407|ERX|HCPCS J0280|00409-5921-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.46|PHR: 408101; CHG: 26||Not reimbursed separately|32.46|PHR: 408101; CHG: 26||External grouping not supported 40800011|ERX|HCPCS J9025|99999-4444-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 25 MG/ML SYRINGE|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|PHR: 408101; CHG: 26||Not reimbursed separately|331.74|PHR: 408101; CHG: 26||External grouping not supported 40800051|ERX|HCPCS J9041|63020-0049-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BORTEZOMIB IV SYRINGE|3.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,020.60|PHR: 408101; CHG: 26||Not reimbursed separately|5,020.60|PHR: 408101; CHG: 26||External grouping not supported 40800126|ERX|HCPCS J1170|99999-2222-55|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 0.2 MG/ML PCA SYRINGE|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.81|PHR: 408101; CHG: 26||Not reimbursed separately|27.81|PHR: 408101; CHG: 26||External grouping not supported 40800146|ERX|HCPCS 92211408|99999-1111-96|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL 3 MCG/ML AND BUPIVICAINE 0.125% EPIDURAL|130 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 40800150|ERX|HCPCS J0690|99999-5555-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 2 G IN NS 100ML IVPB|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.82|PHR: 408101; CHG: 26||Not reimbursed separately|2.82|PHR: 408101; CHG: 26||External grouping not supported 40800151|ERX|HCPCS J0690|99999-2222-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 1 G/10 ML IV SYRINGE|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 40800169|ERX|HCPCS A9270|99999-3333-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGIC SKIN CREAM (NICU)|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.69|PHR: 408101; CHG: 26||Not reimbursed separately|12.69|PHR: 408101; CHG: 26||External grouping not supported 40800173|ERX|HCPCS RX001|99999-2222-84|0250 - PHARMACY - GENERAL CLASSIFICATION|NEOMYCIN 1 G/5 ML FOR IRRIGATION|500 mL|HUMANA [1294]||HUMANA [11839]|64.50|PHR: 408101; CHG: 26||Not reimbursed separately|64.50|PHR: 408101; CHG: 26||External grouping not supported 40800177|ERX|HCPCS J2590||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 20 UNITS IN LR 1000 ML (PYXIS - INDUCTION)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.92|PHR: 408101; CHG: 26||Not reimbursed separately|7.92|PHR: 408101; CHG: 26||External grouping not supported 40800191|ERX|HCPCS C9257|99999-4444-29|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BEVACIZUMAB 25 MG/ML (5 MG/0.2 ML) EYE SYRINGE|0.05 mL|HUMANA [1294]||HUMANA [11839]|29.89|PHR: 408101; CHG: 26||Not reimbursed separately|29.89|PHR: 408101; CHG: 26||External grouping not supported 40800199|ERX|HCPCS RX001|99999-1111-05|0250 - PHARMACY - GENERAL CLASSIFICATION|MILES MIXTURE|120 mL|HUMANA [1294]||HUMANA [11839]|14.40|PHR: 408101; CHG: 26||Not reimbursed separately|14.40|PHR: 408101; CHG: 26||External grouping not supported 40800199|ERX|HCPCS RX001|99999-3333-07|0250 - PHARMACY - GENERAL CLASSIFICATION|MILES MIXTURE|15 mL|HUMANA [1294]||HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 40800200|ERX|HCPCS RX001|99999-9999-20|0250 - PHARMACY - GENERAL CLASSIFICATION|CATARACT EYE GEL|1 Syringe|HUMANA [1294]||HUMANA [11839]|28.05|PHR: 408101; CHG: 26||Not reimbursed separately|28.05|PHR: 408101; CHG: 26||External grouping not supported 40800202|ERX|HCPCS RX007|99999-3333-14|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|DERMABOND TOPICAL LIQUID|1 Each|HUMANA [1294]||HUMANA [11839]|110.52|PHR: 408101; CHG: 26||Not reimbursed separately|110.52|PHR: 408101; CHG: 26||External grouping not supported 40800205|ERX|HCPCS J2997||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 2.5 MG/50 ML INTRAPLEURAL SYR. (SIMPLE)|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|641.85|PHR: 408101; CHG: 26||Not reimbursed separately|641.85|PHR: 408101; CHG: 26||External grouping not supported 40800263|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|ACETIC ACID 10% (V/V) IN ABSOLUTE ALCOHOL|30 mL|HUMANA [1294]||HUMANA [11839]|12.16|PHR: 408101; CHG: 26||Not reimbursed separately|12.16|PHR: 408101; CHG: 26||External grouping not supported 40801|ERX|HCPCS J9217|62935-0453-45|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE|45 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,106.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,106.00|PHR: 408101; CHG: 26||External grouping not supported 40801|ERX|HCPCS J9217|62935-0454-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUPROLIDE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE|45 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,106.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,106.00|PHR: 408101; CHG: 26||External grouping not supported 40801999|ERX|HCPCS RX011|10733-0412-60|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALUMINUM CHLORIDE TOPICAL HEMOSTATIC SOLN|60 mL|HUMANA [1294]||HUMANA [11839]|81.54|PHR: 408101; CHG: 26||Not reimbursed separately|81.54|PHR: 408101; CHG: 26||External grouping not supported 408100001|ERX|HCPCS RX001|99999-1111-00|0250 - PHARMACY - GENERAL CLASSIFICATION|URSODIOL (ACTIGALL) 25 MG/ML ORAL SUSPENSION (NICU)|1 mL|HUMANA [1294]||HUMANA [11839]|1.02|PHR: 408101; CHG: 26||Not reimbursed separately|1.02|PHR: 408101; CHG: 26||External grouping not supported 408100003|ERX|HCPCS RX001|99999-1111-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DR. SALZMAN'S COMPOUND ENEMA|1 Syringe|HUMANA [1294]||HUMANA [11839]|20.73|PHR: 408101; CHG: 26||Not reimbursed separately|20.73|PHR: 408101; CHG: 26||External grouping not supported 408100009|ERX|HCPCS A9270|09999-1111-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ID - CLOPIDOGREL OR PLACEBO (POINT TRIAL)|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100057|ERX|HCPCS J1940|36000-0283-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FUROSEMIDE FOR RENAL SCAN|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 408100059|ERX|HCPCS RX001|99999-1111-11|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 100 MG/5 ML ORAL SUSPENSION|12.5 mL|HUMANA [1294]||HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 408100059|ERX|HCPCS RX001|99999-1111-06|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 100 MG/5 ML ORAL SUSPENSION|25 mL|HUMANA [1294]||HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 408100060|ERX|HCPCS A9270|99999-1111-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 0.4 MG/ML ORAL SOLUTION (NICU)|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 408100062|ERX|HCPCS RX004|99999-1111-12|0258 - PHARMACY - IV SOLUTIONS|MANNITOL 20 % IV CONTINUOUS INFUSION|250 mL|HUMANA [1294]||HUMANA [11839]|27.00|PHR: 408101; CHG: 26||Not reimbursed separately|27.00|PHR: 408101; CHG: 26||External grouping not supported 408100072|ERX|HCPCS A9270|99999-1111-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 2 MEQ/ML ORAL SOLUTION (NICU)|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 408100073|ERX|HCPCS A9270|00597-0047-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEVIRAPINE 10 MG/ML ORAL SUSPENSION (NICU)|0.8 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.81|PHR: 408101; CHG: 26||Not reimbursed separately|1.81|PHR: 408101; CHG: 26||External grouping not supported 408100076|ERX|HCPCS A9270|99999-1111-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 4 MEQ/ML ORAL SOLUTION (NICU)|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 408100077|ERX|HCPCS J2060|99999-1111-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 1 MG/ML INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 408100095|ERX|HCPCS RX004|99999-1111-21|0258 - PHARMACY - IV SOLUTIONS|INSULIN 1 UNIT/ML DILUTION FOR NICU COMPOUNDING|10 mL|HUMANA [1294]||HUMANA [11839]|41.40|PHR: 408101; CHG: 26||Not reimbursed separately|41.40|PHR: 408101; CHG: 26||External grouping not supported 408100096|ERX|HCPCS A9270|99999-1111-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LANSOPRAZOLE 3 MG/ML ORAL SUSP (NICU)|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.20|PHR: 408101; CHG: 26||Not reimbursed separately|16.20|PHR: 408101; CHG: 26||External grouping not supported 408100099|ERX|HCPCS A9270|99999-1111-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 15 MG/ML ORAL SUSP (NICU)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 408100102|ERX|HCPCS A9270|99999-1111-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 1 MG/ML ORAL SUSP (NICU)|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,660.40|PHR: 408101; CHG: 26||Not reimbursed separately|2,660.40|PHR: 408101; CHG: 26||External grouping not supported 408100103|ERX|HCPCS A9270|99999-1111-26|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL 2 MG/ML ORAL SUSP (NICU)|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.64|PHR: 408101; CHG: 26||Not reimbursed separately|26.64|PHR: 408101; CHG: 26||External grouping not supported 408100104|ERX|HCPCS A9270|99999-1111-27|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 5 MG/ML ORAL SUSP (NICU)|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.96|PHR: 408101; CHG: 26||Not reimbursed separately|21.96|PHR: 408101; CHG: 26||External grouping not supported 408100112|ERX|HCPCS A9270|99999-1111-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 0.75 MG/ML ORAL SUSP (NICU)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.00|PHR: 408101; CHG: 26||Not reimbursed separately|21.00|PHR: 408101; CHG: 26||External grouping not supported 408100113|ERX|HCPCS A9270|99999-1111-29|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL 1 MG/ML ORAL SUSP (NICU)|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.48|PHR: 408101; CHG: 26||Not reimbursed separately|15.48|PHR: 408101; CHG: 26||External grouping not supported 408100114|ERX|HCPCS A9270|99999-1111-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCORTISONE 2 MG/ML ORAL SUSP (NICU)|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.44|PHR: 408101; CHG: 26||Not reimbursed separately|55.44|PHR: 408101; CHG: 26||External grouping not supported 408100120|ERX|HCPCS A9270|99999-1111-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLVAPTAN 15 MG - SPLIT TAB|0.5 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.35|PHR: 408101; CHG: 26||Not reimbursed separately|406.35|PHR: 408101; CHG: 26||External grouping not supported 408100132|ERX|HCPCS J0885|59676-0320-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA 20,000 UNIT/ML INJECTION - NON-DIALYSIS, NON-ONCOLOGY|0.5 mL|HUMANA [1294]||HUMANA [11839]|421.04|PHR: 408101; CHG: 26||Not reimbursed separately|421.04|PHR: 408101; CHG: 26||External grouping not supported 408100133|ERX|HCPCS J0885|59676-0340-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA 40,000 UNIT/ML INJECTION - NON-DIALYSIS, NON-ONCOLOGY|1 mL|HUMANA [1294]||HUMANA [11839]|1,684.17|PHR: 408101; CHG: 26||Not reimbursed separately|1,684.17|PHR: 408101; CHG: 26||External grouping not supported 408100154|ERX|HCPCS RX001|63713-0461-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SURGIFLO WITH THROMBIN|2 mL|HUMANA [1294]||HUMANA [11839]|486.39|PHR: 408101; CHG: 26||Not reimbursed separately|486.39|PHR: 408101; CHG: 26||External grouping not supported 408100184|ERX|HCPCS RX001|99999-1111-53|0250 - PHARMACY - GENERAL CLASSIFICATION|NITROGLYCERIN 100 MCG/ML IN 10 ML N.S.|10 mL|HUMANA [1294]||HUMANA [11839]|27.00|PHR: 408101; CHG: 26||Not reimbursed separately|27.00|PHR: 408101; CHG: 26||External grouping not supported 408100206|ERX|HCPCS RX001|99999-1111-61|0250 - PHARMACY - GENERAL CLASSIFICATION|GELFOAM PLUS ORIGINAL (HEMOSTASIS KIT)|1 Kit|HUMANA [1294]||HUMANA [11839]|291.69|PHR: 408101; CHG: 26||Not reimbursed separately|291.69|PHR: 408101; CHG: 26||External grouping not supported 408100207|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|FLOSEAL (HEMOSTATIC MATRIX) 5ML KIT|1 Each|HUMANA [1294]||HUMANA [11839]|464.95|PHR: 408101; CHG: 26||Not reimbursed separately|464.95|PHR: 408101; CHG: 26||External grouping not supported 408100208|ERX|HCPCS RX001|99999-1111-63|0250 - PHARMACY - GENERAL CLASSIFICATION|FLOSEAL (HEMOSTATIC MATRIX) 10ML KIT|1 Each|HUMANA [1294]||HUMANA [11839]|850.65|PHR: 408101; CHG: 26||Not reimbursed separately|850.65|PHR: 408101; CHG: 26||External grouping not supported 408100210|ERX|HCPCS A9270|99999-1111-67|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC ORAL SUSPENSION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.60|PHR: 408101; CHG: 26||Not reimbursed separately|21.60|PHR: 408101; CHG: 26||External grouping not supported 408100219|ERX|HCPCS RX001|99999-1111-71|0250 - PHARMACY - GENERAL CLASSIFICATION|GELFOAM PLUS POWDER (HEMOSTASIS KIT)|1 Kit|HUMANA [1294]||HUMANA [11839]|402.33|PHR: 408101; CHG: 26||Not reimbursed separately|402.33|PHR: 408101; CHG: 26||External grouping not supported 408100224|ERX|HCPCS J9041|99999-4444-46|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BORTEZOMIB SUBCUTANEOUS SYRINGE|1.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,809.00|PHR: 408101; CHG: 26||External grouping not supported 408100228|ERX|HCPCS J0153|09999-1111-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 1MG/ML IVPB|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.91|PHR: 408101; CHG: 26||Not reimbursed separately|332.91|PHR: 408101; CHG: 26||External grouping not supported 408100230|ERX|HCPCS J2997|99999-1111-72|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 1 MG/2 ML SOLUTION FOR INJECTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.74|PHR: 408101; CHG: 26||Not reimbursed separately|256.74|PHR: 408101; CHG: 26||External grouping not supported 408100247|ERX|HCPCS RX001|99999-2222-77|0250 - PHARMACY - GENERAL CLASSIFICATION|MICROFIBRILLAR COLLAGEN HEMOSTAT 1 GM POWDER|1 g|HUMANA [1294]||HUMANA [11839]|503.40|PHR: 408101; CHG: 26||Not reimbursed separately|503.40|PHR: 408101; CHG: 26||External grouping not supported 408100249|ERX|HCPCS RX007|99999-1111-77|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|HIGH VISCOSITY TISSUE ADHESIVE|1 Each|HUMANA [1294]||HUMANA [11839]|42.18|PHR: 408101; CHG: 26||Not reimbursed separately|42.18|PHR: 408101; CHG: 26||External grouping not supported 408100252|ERX|HCPCS RX001|99999-1111-78|0250 - PHARMACY - GENERAL CLASSIFICATION|ID - ULARITIDE (URODILATIN) / PLACEBO (TRUE-AHF STUDY)|250 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100268|ERX|HCPCS J3010|99999-1111-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL 5 MCG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 408100269|ERX|HCPCS RX001|99999-1111-82|0250 - PHARMACY - GENERAL CLASSIFICATION|ROCURONIUM 1 MG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]||HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 408100271|ERX|HCPCS J2060|99999-1111-84|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 0.2 MG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 408100272|ERX|HCPCS J2250|99999-1111-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 0.1 MG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.59|PHR: 408101; CHG: 26||Not reimbursed separately|1.59|PHR: 408101; CHG: 26||External grouping not supported 408100273|ERX|HCPCS RX011|99999-1111-86|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 0.1 MG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]||HUMANA [11839]|1.89|PHR: 408101; CHG: 26||Not reimbursed separately|1.89|PHR: 408101; CHG: 26||External grouping not supported 408100274|ERX|HCPCS RX001|99999-1111-87|0250 - PHARMACY - GENERAL CLASSIFICATION|VECURONIUM 1 MG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]||HUMANA [11839]|11.94|PHR: 408101; CHG: 26||Not reimbursed separately|11.94|PHR: 408101; CHG: 26||External grouping not supported 408100275|ERX|HCPCS J3475|99999-1111-88|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 200 MG/ML INJECTION (PEDI CODE NARRATOR)|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.59|PHR: 408101; CHG: 26||Not reimbursed separately|1.59|PHR: 408101; CHG: 26||External grouping not supported 408100332|ERX|HCPCS J1580|63323-0010-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN 40 MG/ML IM SYRINGE (NICU)|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.77|PHR: 408101; CHG: 26||Not reimbursed separately|1.77|PHR: 408101; CHG: 26||External grouping not supported 408100332|ERX|HCPCS J1580|63323-0010-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GENTAMICIN 40 MG/ML IM SYRINGE (NICU)|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.80|PHR: 408101; CHG: 26||Not reimbursed separately|49.80|PHR: 408101; CHG: 26||External grouping not supported 408100341|ERX|HCPCS A9270|00121-0577-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LACTULOSE 10 GRAM/15 ML ENEMA|150 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.40|PHR: 408101; CHG: 26||Not reimbursed separately|5.40|PHR: 408101; CHG: 26||External grouping not supported 408100344|ERX|HCPCS J2370|99999-1111-92|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 100 MCG/ML IN NACL 0.9% 10ML SYRINGE|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 408100346|ERX|HCPCS J2590||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 20 UNITS IN LR 1000ML (PYXIS - AFTER PLACENTA DELIVERY)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.92|PHR: 408101; CHG: 26||Not reimbursed separately|7.92|PHR: 408101; CHG: 26||External grouping not supported 408100349|ERX|HCPCS RX001|99999-2222-47|0250 - PHARMACY - GENERAL CLASSIFICATION|ID - TREBANANIB/PLACEBO (TRINOVA-3 STUDY) IV|150 mg|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100354|ERX|HCPCS RX011|99999-2222-73|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN 1 UNIT/ML IN 0.45% NACL 30 ML SYR (UAC LINE) PYXIS|30 mL|HUMANA [1294]||HUMANA [11839]|2.85|PHR: 408101; CHG: 26||Not reimbursed separately|2.85|PHR: 408101; CHG: 26||External grouping not supported 408100356|ERX|HCPCS A9270|00121-0595-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLN (NICU)|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 408100368|ERX|HCPCS A9270|00603-1508-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 20 MG/5 ML ORAL ELIXIR (NICU)|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 408100368|ERX|HCPCS A9270|99999-3333-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 20 MG/5 ML ORAL ELIXIR (NICU)|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 408100370|ERX|HCPCS RX011|99999-3333-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - EPTIFIBITIDE (CLEAR-FDR STUDY) BOLUS|10 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100371|ERX|HCPCS RX011|99999-3333-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - EPTIFIBITIDE (CLEAR-FDR STUDY) INFUSION|20 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100380|ERX|HCPCS J0171|76329-3316-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPINEPHRINE 0.1 MG/ML (1:10,000) SYRINGE (CODE NARRATOR)|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.76|PHR: 408101; CHG: 26||Not reimbursed separately|20.76|PHR: 408101; CHG: 26||External grouping not supported 408100381|ERX|HCPCS RX001|99999-3333-04|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % IV BOLUS (NICU)|1 mL|HUMANA [1294]||HUMANA [11839]|0.03|PHR: 408101; CHG: 26||Not reimbursed separately|0.03|PHR: 408101; CHG: 26||External grouping not supported 408100395|ERX|HCPCS A9270|99999-3333-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RANITIDINE 15 MG/ML SYRUP (NICU)|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 408100399|ERX|HCPCS J3475|63323-0106-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 GRAM/100 ML BOLUS|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 408100401|ERX|HCPCS J2590|99999-9999-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 20 UNITS IN NS 1000 ML (PYXIS - INDUCTION)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.92|PHR: 408101; CHG: 26||Not reimbursed separately|7.92|PHR: 408101; CHG: 26||External grouping not supported 408100402|ERX|HCPCS J2590|99999-9999-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 20 UNITS IN NS 1000ML (PYXIS - AFTER PLACENTA DELIVERY)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.92|PHR: 408101; CHG: 26||Not reimbursed separately|7.92|PHR: 408101; CHG: 26||External grouping not supported 408100423|ERX|HCPCS J1230|67457-0217-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHADONE 10 MG/ML INFUSION (HOSPICE CADD ONLY)|20 mL|HUMANA [1294]||HUMANA [11839]|674.04|PHR: 408101; CHG: 26||Not reimbursed separately|674.04|PHR: 408101; CHG: 26||External grouping not supported 408100426|ERX|HCPCS J1170|00703-0018-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 10 MG/ML INFUSION (HOSPICE CADD ONLY)|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|164.25|PHR: 408101; CHG: 26||Not reimbursed separately|164.25|PHR: 408101; CHG: 26||External grouping not supported 408100427|ERX|HCPCS J2270|99999-3333-66|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 10 MG/ML PCA SYRINGE 25ML (HIGH CONCENTRATION)|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.75|PHR: 408101; CHG: 26||Not reimbursed separately|30.75|PHR: 408101; CHG: 26||External grouping not supported 408100428|ERX|HCPCS J7682|99999-3333-69|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOBRAMYCIN 300 MG/7.5 ML FOR NEBULIZATION|7.5 mL|HUMANA [1294]||HUMANA [11839]|10.13|PHR: 408101; CHG: 26||Not reimbursed separately|10.13|PHR: 408101; CHG: 26||External grouping not supported 408100441|ERX|HCPCS RX001|99999-3333-68|0250 - PHARMACY - GENERAL CLASSIFICATION|NICU PROBIOTIC IN WATER|1 mL|HUMANA [1294]||HUMANA [11839]|1.83|PHR: 408101; CHG: 26||Not reimbursed separately|1.83|PHR: 408101; CHG: 26||External grouping not supported 408100446|ERX|HCPCS J2270|00409-1134-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 50 MG/ML INFUSION (HOSPICE CADD ONLY)|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.34|PHR: 408101; CHG: 26||Not reimbursed separately|32.34|PHR: 408101; CHG: 26||External grouping not supported 408100446|ERX|HCPCS J2270|00409-1134-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 50 MG/ML INFUSION (HOSPICE CADD ONLY)|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.70|PHR: 408101; CHG: 26||Not reimbursed separately|68.70|PHR: 408101; CHG: 26||External grouping not supported 408100449|ERX|HCPCS J9395|99999-3333-72|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100455|ERX|HCPCS A9270|99999-3333-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ID - ASPIRIN/PLACEBO (PRISMS STUDY) 325 MG TAB|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100475|ERX|HCPCS A9270|99999-3333-79|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCRALFATE 2 GRAM ENEMA IN WATER|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 408100484|ERX|HCPCS RX001|99999-3333-82|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.75 % EYE DROPS (ANESTHESIA)|600 Drop|HUMANA [1294]||HUMANA [11839]|5.37|PHR: 408101; CHG: 26||Not reimbursed separately|5.37|PHR: 408101; CHG: 26||External grouping not supported 408100490|ERX|HCPCS A9270|99999-3333-84|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 2.5 MG/5 ML ORAL SUSPENSION (FOR DESENSITIZATION)|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.80|PHR: 408101; CHG: 26||Not reimbursed separately|1.80|PHR: 408101; CHG: 26||External grouping not supported 408100498|ERX|HCPCS RX001|00338-0049-03|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INTRAVEOUS INFUSION (FLUSH FROM BAG)|20 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100498|ERX|HCPCS RX001|00338-0049-04|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INTRAVEOUS INFUSION (FLUSH FROM BAG)|20 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100500|ERX|HCPCS RX001|99999-3333-92|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPRENORPHINE SUBLINGUAL SOLUTION 75 MCG/ML (NICU)|1 mL|HUMANA [1294]||HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 408100501|ERX|HCPCS RX001|99999-3333-93|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENOBARBITAL 20 MG/5 ML ORAL SUSPENSION (NICU)|5 mL|HUMANA [1294]||HUMANA [11839]|2.40|PHR: 408101; CHG: 26||Not reimbursed separately|2.40|PHR: 408101; CHG: 26||External grouping not supported 408100524|ERX|HCPCS J0278|99999-4444-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIKACIN NEBULIZER SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 408100524|ERX|HCPCS J0278|99999-4444-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIKACIN NEBULIZER SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|5.88|PHR: 408101; CHG: 26||Not reimbursed separately|5.88|PHR: 408101; CHG: 26||External grouping not supported 408100536|ERX|HCPCS RX001|99999-4444-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CLONIDINE 20 MCG/ML ORAL SUSPENSION|100 mL|HUMANA [1294]||HUMANA [11839]|7.50|PHR: 408101; CHG: 26||Not reimbursed separately|7.50|PHR: 408101; CHG: 26||External grouping not supported 408100540|ERX|HCPCS J2590|09999-4444-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 10 UNIT IN LR 1000 ML (PYXIS-POST PARTUM)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.86|PHR: 408101; CHG: 26||Not reimbursed separately|7.86|PHR: 408101; CHG: 26||External grouping not supported 408100552|ERX|HCPCS J7050|00338-0049-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % IV BOLUS (SEPSIS)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100552|ERX|HCPCS J7050|00338-0049-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % IV BOLUS (SEPSIS)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100553|ERX|HCPCS J7120|00338-0117-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS IV BOLUS (SEPSIS)|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100553|ERX|HCPCS J7120|00338-0117-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS IV BOLUS (SEPSIS)|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100558|ERX|HCPCS RX001|66220-0160-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CONIVAPTAN 10 MG/50 ML IN 5 % DEXTROSE IV BOLUS|50 mL|HUMANA [1294]||HUMANA [11839]|1,056.30|PHR: 408101; CHG: 26||Not reimbursed separately|1,056.30|PHR: 408101; CHG: 26||External grouping not supported 408100559|ERX|HCPCS RX001|66220-0160-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CONIVAPTAN 20 MG/100 ML IN 5 % DEXTROSE IV BOLUS|100 mL|HUMANA [1294]||HUMANA [11839]|2,112.60|PHR: 408101; CHG: 26||Not reimbursed separately|2,112.60|PHR: 408101; CHG: 26||External grouping not supported 408100560|ERX|HCPCS J7120|00338-0117-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS IV BOLUS (OBSTETRIC)|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100560|ERX|HCPCS J7120|00338-0117-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS IV BOLUS (OBSTETRIC)|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100561|ERX|HCPCS J7050|00338-0049-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (RATE-BASED ALARIS BLACKLIST)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100561|ERX|HCPCS J7050|00338-0049-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (RATE-BASED ALARIS BLACKLIST)|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100562|ERX|HCPCS J7060|00338-0017-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS INFUSION (VOLUMETRIC FLUSH)|3 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100562|ERX|HCPCS J7060|00338-0017-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS INFUSION (VOLUMETRIC FLUSH)|3 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100563|ERX|HCPCS P9045|68516-5214-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % IV SOLUTION (ALARIS BLACKLIST)|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|PHR: 408101; CHG: 26||Not reimbursed separately|210.00|PHR: 408101; CHG: 26||External grouping not supported 408100563|ERX|HCPCS P9045|68516-5214-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 5 % IV SOLUTION (ALARIS BLACKLIST)|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|PHR: 408101; CHG: 26||Not reimbursed separately|210.00|PHR: 408101; CHG: 26||External grouping not supported 408100564|ERX|HCPCS RX001|00338-0049-03|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INTRAVEOUS SOLUTION (FLUSH BLOOD PRODUCTS)|40 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100564|ERX|HCPCS RX001|00338-0049-04|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INTRAVEOUS SOLUTION (FLUSH BLOOD PRODUCTS)|40 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100573|ERX|HCPCS RX001|99999-4444-09|0250 - PHARMACY - GENERAL CLASSIFICATION|CELLULOSE, OXIDIZED 4" X 4" PADS|1 Each|HUMANA [1294]||HUMANA [11839]|485.10|PHR: 408101; CHG: 26||Not reimbursed separately|485.10|PHR: 408101; CHG: 26||External grouping not supported 408100607|ERX|HCPCS RX013|68516-5216-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25% - NICU|50 mL|HUMANA [1294]||HUMANA [11839]|108.00|PHR: 408101; CHG: 26||Not reimbursed separately|108.00|PHR: 408101; CHG: 26||External grouping not supported 408100608|ERX|HCPCS RX011|60793-0700-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE - NICU|1 mL|HUMANA [1294]||HUMANA [11839]|274.73|PHR: 408101; CHG: 26||Not reimbursed separately|274.73|PHR: 408101; CHG: 26||External grouping not supported 408100609|ERX|HCPCS RX011|60793-0130-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G PROCAINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE - NICU|1 mL|HUMANA [1294]||HUMANA [11839]|91.72|PHR: 408101; CHG: 26||Not reimbursed separately|91.72|PHR: 408101; CHG: 26||External grouping not supported 408100626|ERX|HCPCS RX001|99999-4444-16|0250 - PHARMACY - GENERAL CLASSIFICATION|SHUGARCAINE OPHTHALMIC INJECTION-FTT|2 mL|HUMANA [1294]||HUMANA [11839]|14.22|PHR: 408101; CHG: 26||Not reimbursed separately|14.22|PHR: 408101; CHG: 26||External grouping not supported 408100632|ERX|HCPCS J0690|99999-4444-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFAZOLIN 3 G IN D5W 100 ML IVPB|3 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.88|PHR: 408101; CHG: 26||Not reimbursed separately|11.88|PHR: 408101; CHG: 26||External grouping not supported 408100643|ERX|HCPCS RX001|99999-4444-22|0250 - PHARMACY - GENERAL CLASSIFICATION|VANCOMYCIN 5 MG/0.5 ML OPHTHALMIC SYRINGE|0.5 mL|HUMANA [1294]||HUMANA [11839]|6.78|PHR: 408101; CHG: 26||Not reimbursed separately|6.78|PHR: 408101; CHG: 26||External grouping not supported 408100652|ERX|HCPCS RX001|00409-1761-18|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE SPINAL 0.75% IN DEXTROSE 8.25% (BD SPINAL TRAY)|2 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408100658|ERX|HCPCS A9270|59316-0115-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MENTHOL (BIOFREEZE) 5 % TOPICAL GEL|1 Packet|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 408100661|ERX|HCPCS RX011|99999-4444-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBUPROFEN 800 MG IN D5W 250 ML IVPB (PYXIS)|258 mL|HUMANA [1294]||HUMANA [11839]|48.00|PHR: 408101; CHG: 26||Not reimbursed separately|48.00|PHR: 408101; CHG: 26||External grouping not supported 408100664|ERX|HCPCS RX001|99999-4444-30|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 1MG/10 ML INJECTION-CATHLAB|10 mL|HUMANA [1294]||HUMANA [11839]|23.64|PHR: 408101; CHG: 26||Not reimbursed separately|23.64|PHR: 408101; CHG: 26||External grouping not supported 408100665|ERX|HCPCS RX001|99999-4444-31|0250 - PHARMACY - GENERAL CLASSIFICATION|NITROPRUSSIDE 100 MCG/ML-10 ML INJECTION-CATHLAB|10 mL|HUMANA [1294]||HUMANA [11839]|108.18|PHR: 408101; CHG: 26||Not reimbursed separately|108.18|PHR: 408101; CHG: 26||External grouping not supported 408100666|ERX|HCPCS J0153|99999-4444-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 6 MG/500 ML INJECTION SOLUTION-CATHLAB|583.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.27|PHR: 408101; CHG: 26||Not reimbursed separately|4.27|PHR: 408101; CHG: 26||External grouping not supported 408100667|ERX|HCPCS J0153|99999-4444-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 180 MG IVPB-CATHLAB|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.92|PHR: 408101; CHG: 26||Not reimbursed separately|121.92|PHR: 408101; CHG: 26||External grouping not supported 408100669|ERX|HCPCS J0131|43825-0102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ACETAMINOPHEN 10 MG/ML IV (REMOTE E/D PEDIATRIC)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.00|PHR: 408101; CHG: 26||Not reimbursed separately|129.00|PHR: 408101; CHG: 26||External grouping not supported 408100676|ERX|HCPCS A9270|99999-4444-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALGANCICLOVIR 30 MG/ML ORAL SUSPENSION (NICU)|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.80|PHR: 408101; CHG: 26||Not reimbursed separately|145.80|PHR: 408101; CHG: 26||External grouping not supported 408100677|ERX|HCPCS J9999|50242-0917-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - ATEZOLIZUMAB/PLACEBO (GOG 3015)|20 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100679|ERX|HCPCS J2997|99999-4444-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 0.25 MG/0.5 ML NICU CATHETER SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.19|PHR: 408101; CHG: 26||Not reimbursed separately|64.19|PHR: 408101; CHG: 26||External grouping not supported 408100680|ERX|HCPCS J9041|99999-4444-46|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BORTEZOMIB SUBQ SYRINGE|1.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|PHR: 408101; CHG: 26||Not reimbursed separately|4,809.00|PHR: 408101; CHG: 26||External grouping not supported 408100681|ERX|HCPCS J9025|99999-4444-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE SUBQ SYRINGE|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|PHR: 408101; CHG: 26||Not reimbursed separately|331.74|PHR: 408101; CHG: 26||External grouping not supported 408100682|ERX|HCPCS J0153|99999-4444-39|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 6 MG/250 ML INJECTION SOLUTION-CATHLAB|291.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.27|PHR: 408101; CHG: 26||Not reimbursed separately|4.27|PHR: 408101; CHG: 26||External grouping not supported 408100686|ERX|HCPCS RX001|99999-4444-40|0250 - PHARMACY - GENERAL CLASSIFICATION|EDETATE DISODIUM 3% EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|557.34|PHR: 408101; CHG: 26||Not reimbursed separately|557.34|PHR: 408101; CHG: 26||External grouping not supported 408100690|ERX|HCPCS J3010|99999-4444-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL 10 MCG/ML INFUSION (PYXIS)|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.26|PHR: 408101; CHG: 26||Not reimbursed separately|11.26|PHR: 408101; CHG: 26||External grouping not supported 408100691|ERX|HCPCS J3010|99999-4444-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL 20 MCG/ML INFUSION (PYXIS)|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22.52|PHR: 408101; CHG: 26||Not reimbursed separately|22.52|PHR: 408101; CHG: 26||External grouping not supported 408100692|ERX|HCPCS J2250|99999-4444-45|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 0.5 MG/ML INFUSION (PYXIS)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.38|PHR: 408101; CHG: 26||Not reimbursed separately|4.38|PHR: 408101; CHG: 26||External grouping not supported 408100692|ERX|HCPCS J2250|99999-4444-49|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 0.5 MG/ML INFUSION (PYXIS)|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.14|PHR: 408101; CHG: 26||Not reimbursed separately|13.14|PHR: 408101; CHG: 26||External grouping not supported 408100739|ERX|HCPCS J9299|09999-4444-53|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - NIVOLUMAB INJECTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100741|ERX|HCPCS J9264|09999-4444-54|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - PACLITAXEL-PROTEIN BOUND INJECTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408100896|ERX|HCPCS RX011|99999-5555-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV|1,000 mL|HUMANA [1294]||HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 408100903|ERX|HCPCS J2270|99999-5555-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML IV SYRINGE (CUSTOM)|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.17|PHR: 408101; CHG: 26||Not reimbursed separately|4.17|PHR: 408101; CHG: 26||External grouping not supported 408100924|ERX|HCPCS RX001|99999-5555-19|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 10 MG/ML 2ML SYRINGE (CUSTOM)|1 mL|HUMANA [1294]||HUMANA [11839]|0.71|PHR: 408101; CHG: 26||Not reimbursed separately|0.71|PHR: 408101; CHG: 26||External grouping not supported 408100925|ERX|HCPCS RX001|00338-0709-48|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE 0.1 MEQ/ML NICU INJECTION|100 mL|HUMANA [1294]||HUMANA [11839]|7.80|PHR: 408101; CHG: 26||Not reimbursed separately|7.80|PHR: 408101; CHG: 26||External grouping not supported 408100926|ERX|HCPCS J1459|44206-0437-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 % (PRIVIGEN) - (NICU)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.00|PHR: 408101; CHG: 26||Not reimbursed separately|2,637.00|PHR: 408101; CHG: 26||External grouping not supported 408100926|ERX|HCPCS J1459|44206-0438-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 % (PRIVIGEN) - (NICU)|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,274.00|PHR: 408101; CHG: 26||Not reimbursed separately|5,274.00|PHR: 408101; CHG: 26||External grouping not supported 408100926|ERX|HCPCS J1459|44206-0436-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMMUNE GLOB,GAMM(IGG) 10 % (PRIVIGEN) - (NICU)|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,318.50|PHR: 408101; CHG: 26||Not reimbursed separately|1,318.50|PHR: 408101; CHG: 26||External grouping not supported 408100931|ERX|HCPCS J3010|99999-5555-34|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FENTANYL 500 MCG/ML INJECTION STOCK BAG|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 408100934|ERX|HCPCS RX001|99999-5555-36|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE 1.5% W EPINEPHRINE 1:200,000 INJECTION|3 mL|HUMANA [1294]||HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 408100944|ERX|HCPCS J0697|99999-5555-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFUROXIME 1 MG/0.1 ML INTRACAMERAL SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.10|PHR: 408101; CHG: 26||Not reimbursed separately|8.10|PHR: 408101; CHG: 26||External grouping not supported 408100954|ERX|HCPCS J1100|99999-5555-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXAMETHASONE 400 MCG/0.1 ML INTRACAMERAL SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.65|PHR: 408101; CHG: 26||Not reimbursed separately|4.65|PHR: 408101; CHG: 26||External grouping not supported 408100967|ERX|HCPCS J1170|00409-1283-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 0.5 MG/0.5 ML (PF/NON-PF) INJECTION SYRINGE SO|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 408100967|ERX|HCPCS J1170|00409-1283-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 0.5 MG/0.5 ML (PF/NON-PF) INJECTION SYRINGE SO|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 408100967|ERX|HCPCS J1170|76045-0009-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 0.5 MG/0.5 ML (PF/NON-PF) INJECTION SYRINGE SO|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 408100967|ERX|HCPCS J1170|76045-0009-57|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 0.5 MG/0.5 ML (PF/NON-PF) INJECTION SYRINGE SO|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 408100976|ERX|HCPCS J1170|00409-1283-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 1 MG/1 ML (PF/NON-PF) INJECTION SYRINGE SO|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.78|PHR: 408101; CHG: 26||Not reimbursed separately|2.78|PHR: 408101; CHG: 26||External grouping not supported 408100976|ERX|HCPCS J1170|76045-0009-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 1 MG/1 ML (PF/NON-PF) INJECTION SYRINGE SO|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.78|PHR: 408101; CHG: 26||Not reimbursed separately|2.78|PHR: 408101; CHG: 26||External grouping not supported 408100976|ERX|HCPCS J1170|00409-1283-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 1 MG/1 ML (PF/NON-PF) INJECTION SYRINGE SO|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.24|PHR: 408101; CHG: 26||Not reimbursed separately|9.24|PHR: 408101; CHG: 26||External grouping not supported 408100977|ERX|HCPCS J1170|00409-1312-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/1 ML (PF/NON-PF) INJECTION SYRINGE SO|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.83|PHR: 408101; CHG: 26||Not reimbursed separately|4.83|PHR: 408101; CHG: 26||External grouping not supported 408100977|ERX|HCPCS J1170|76045-0010-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HYDROMORPHONE 2 MG/1 ML (PF/NON-PF) INJECTION SYRINGE SO|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.83|PHR: 408101; CHG: 26||Not reimbursed separately|4.83|PHR: 408101; CHG: 26||External grouping not supported 408100985|ERX|HCPCS A9270|99999-5555-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MOXIFLOXACIN 0.5 % INTRAOCULAR INJECTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.01|PHR: 408101; CHG: 26||Not reimbursed separately|3.01|PHR: 408101; CHG: 26||External grouping not supported 408101021|ERX|HCPCS RX001|69194-0550-01|0250 - PHARMACY - GENERAL CLASSIFICATION|C.I. ACID BLUE 90 (PF) 0.025% INTRAOCULAR SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|80.40|PHR: 408101; CHG: 26||Not reimbursed separately|80.40|PHR: 408101; CHG: 26||External grouping not supported 408101022|ERX|HCPCS J1644|00264-9872-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV - CATH|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.50|PHR: 408101; CHG: 26||Not reimbursed separately|10.50|PHR: 408101; CHG: 26||External grouping not supported 408101022|ERX|HCPCS J1644|00409-7620-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV - CATH|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.50|PHR: 408101; CHG: 26||Not reimbursed separately|10.50|PHR: 408101; CHG: 26||External grouping not supported 408101023|ERX|HCPCS A9270|99999-2222-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION UD|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.31|PHR: 408101; CHG: 26||Not reimbursed separately|0.31|PHR: 408101; CHG: 26||External grouping not supported 408101024|ERX|HCPCS A9270|99999-2222-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION UD|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 408101025|ERX|HCPCS A9270|99999-2222-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION UD|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.11|PHR: 408101; CHG: 26||Not reimbursed separately|1.11|PHR: 408101; CHG: 26||External grouping not supported 408101032|ERX|HCPCS RX001|99999-5555-62|0250 - PHARMACY - GENERAL CLASSIFICATION|TRANEXAMIC ACID 500 MG/5 ML FOR NEBULIZATION|5 mL|HUMANA [1294]||HUMANA [11839]|7.95|PHR: 408101; CHG: 26||Not reimbursed separately|7.95|PHR: 408101; CHG: 26||External grouping not supported 408101033|ERX|HCPCS A9270|99999-4444-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION UD|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 408101036|ERX|HCPCS A9270|99999-2222-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION UD|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.50|PHR: 408101; CHG: 26||Not reimbursed separately|4.50|PHR: 408101; CHG: 26||External grouping not supported 408101038|ERX|HCPCS A9270|99999-2222-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION UD|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 408101040|ERX|HCPCS A9270|99999-5555-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION UD|1.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 408101042|ERX|HCPCS A9270|99999-5555-64|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION UD|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 408101046|ERX|HCPCS RX011|99999-5555-65|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZITHROMYCIN 500 MG IN NS 250 ML IVPB|250 mL|HUMANA [1294]||HUMANA [11839]|9.10|PHR: 408101; CHG: 26||Not reimbursed separately|9.10|PHR: 408101; CHG: 26||External grouping not supported 408101047|ERX|HCPCS J7050|00338-0049-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (WEIGHT-BASED DOSE)|1,000 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408101047|ERX|HCPCS J7050|00338-0049-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (WEIGHT-BASED DOSE)|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408101047|ERX|HCPCS J7050|00338-9543-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (WEIGHT-BASED DOSE)|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408101047|ERX|HCPCS J7050|00338-0049-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION (WEIGHT-BASED DOSE)|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 408101055|ERX|HCPCS J1644|25021-0400-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION FOR HD MAINTENANCE|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.78|PHR: 408101; CHG: 26||Not reimbursed separately|9.78|PHR: 408101; CHG: 26||External grouping not supported 408101069|ERX|HCPCS J7060|00338-0017-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5% INTRAVENOUS SOLUTION (PURGE FLUID)|500 mL|HUMANA [1294]||HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 408101075|ERX|HCPCS RX001|99999-5555-71|0250 - PHARMACY - GENERAL CLASSIFICATION|NITROGLYCERIN 40 MCG/ML SYRINGE - IR|10 mL|HUMANA [1294]||HUMANA [11839]|26.55|PHR: 408101; CHG: 26||Not reimbursed separately|26.55|PHR: 408101; CHG: 26||External grouping not supported 408101076|ERX|HCPCS RX001|99999-5555-72|0250 - PHARMACY - GENERAL CLASSIFICATION|COMPOUND BENZOIN TINCTURE SWAB |1 Each|HUMANA [1294]||HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 408101078|ERX|HCPCS RX001|00942-0641-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CITRATE DEXTROSE SOLUTION - NON-CRRT|1,000 mL|HUMANA [1294]||HUMANA [11839]|43.56|PHR: 408101; CHG: 26||Not reimbursed separately|43.56|PHR: 408101; CHG: 26||External grouping not supported 408101095|ERX|HCPCS J7131|00338-0054-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 3 % INTRAVENOUS INFUSION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.50|PHR: 408101; CHG: 26||Not reimbursed separately|10.50|PHR: 408101; CHG: 26||External grouping not supported 408101102|ERX|HCPCS J0558|60793-0601-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE (PEDI)|2 mL|HUMANA [1294]||HUMANA [11839]|379.32|PHR: 408101; CHG: 26||Not reimbursed separately|379.32|PHR: 408101; CHG: 26||External grouping not supported 408101102|ERX|HCPCS J0558|60793-0601-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML IM SYRINGE (PEDI)|2 mL|HUMANA [1294]||HUMANA [11839]|379.32|PHR: 408101; CHG: 26||Not reimbursed separately|379.32|PHR: 408101; CHG: 26||External grouping not supported 408101105|ERX|HCPCS J3475|00409-6727-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 G/100 ML IN D5W RAPID RESPIRATORY INFUSION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 408101105|ERX|HCPCS J3475|44567-0410-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 G/100 ML IN D5W RAPID RESPIRATORY INFUSION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 408101105|ERX|HCPCS J3475|63323-0108-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 G/100 ML IN D5W RAPID RESPIRATORY INFUSION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 408101105|ERX|HCPCS J3475|63323-0108-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 1 G/100 ML IN D5W RAPID RESPIRATORY INFUSION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.30|PHR: 408101; CHG: 26||Not reimbursed separately|21.30|PHR: 408101; CHG: 26||External grouping not supported 408101107|ERX|HCPCS RX011|09999-5555-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - MK-3475 (PEMBROLIZUMAB/PLACEBO) 100 MG INJECTION|4 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408101113|ERX|HCPCS RX001|85446-0369-71|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE (HEALON PRO) 10 MG/ML INTRAOCULAR SYRINGE|0.55 mL|HUMANA [1294]||HUMANA [11839]|280.59|PHR: 408101; CHG: 26||Not reimbursed separately|280.59|PHR: 408101; CHG: 26||External grouping not supported 408101113|ERX|HCPCS RX001|85445-0084-21|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE (HEALON PRO) 10 MG/ML INTRAOCULAR SYRINGE|0.85 mL|HUMANA [1294]||HUMANA [11839]|396.00|PHR: 408101; CHG: 26||Not reimbursed separately|396.00|PHR: 408101; CHG: 26||External grouping not supported 408101113|ERX|HCPCS RX001|85446-0369-81|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE (HEALON PRO) 10 MG/ML INTRAOCULAR SYRINGE|0.85 mL|HUMANA [1294]||HUMANA [11839]|396.00|PHR: 408101; CHG: 26||Not reimbursed separately|396.00|PHR: 408101; CHG: 26||External grouping not supported 408101127|ERX|HCPCS 92211408|99999-5555-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NOREPINEPHRINE 16 MG/250 ML (64 MCG/ML) INFUSION (PYXIS)|250 mL|HUMANA [1294]||HUMANA [11839]|72.00|PHR: 408101; CHG: 26||Not reimbursed separately|72.00|PHR: 408101; CHG: 26||External grouping not supported 408101130|ERX|HCPCS J2250|99999-5555-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MIDAZOLAM 1 MG/ML INFUSION (PYXIS)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 408101156|ERX|HCPCS RX001|09999-5555-96|0250 - PHARMACY - GENERAL CLASSIFICATION|ID - PUL-042 / PLACEBO SOLUTION FOR NEBULIZATION|4 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408101157|ERX|HCPCS 92211408|61703-0418-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VITAMIN A PALMITATE 5,000 UNIT/0.1 ML IM SOLUTION (NICU)|1 mL|HUMANA [1294]||HUMANA [11839]|165.87|PHR: 408101; CHG: 26||Not reimbursed separately|165.87|PHR: 408101; CHG: 26||External grouping not supported 408101158|ERX|HCPCS J3590|09999-5555-89|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - REMDESIVIR 100 MG VIAL (GS-5734)|100 mg|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408101175|ERX|HCPCS 92211408|09999-6666-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - LENZILUMAB/PLACEBO 10 MG/ML INTRAVENOUS SOLUTION |1 Each|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 408101177|ERX|HCPCS RX001|09999-6666-08|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 2 MG/ML INFUSION SYRINGE|25 mL|HUMANA [1294]||HUMANA [11839]|175.50|PHR: 408101; CHG: 26||Not reimbursed separately|175.50|PHR: 408101; CHG: 26||External grouping not supported 408101181|ERX|HCPCS A9270|99999-6666-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRANEXAMIC ACID TOPICAL PASTE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.80|PHR: 408101; CHG: 26||Not reimbursed separately|19.80|PHR: 408101; CHG: 26||External grouping not supported 408101188|ERX|HCPCS RX011|09999-6666-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ID - MK-3475 (PEMBROLIZUMAB) 100 MG INJECTION|4 mL|HUMANA [1294]||HUMANA [11839]|0.01|PHR: 408101; CHG: 36||Not reimbursed separately|0.01|PHR: 408101; CHG: 36||External grouping not supported 40810181|ERX|HCPCS J1644|25021-0402-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION - DIALYSIS|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.70|PHR: 408101; CHG: 26||Not reimbursed separately|3.70|PHR: 408101; CHG: 26||External grouping not supported 4081062801|ERX|HCPCS A9270|99999-2222-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 50 MCG TAB - SPLIT TAB|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 4081062802|ERX|HCPCS A9270|99999-1111-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MISOPROSTOL 25 MCG TAB - SPLIT TAB|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.75|PHR: 408101; CHG: 26||Not reimbursed separately|0.75|PHR: 408101; CHG: 26||External grouping not supported 408114279|ERX|HCPCS RX001|63713-0019-52|0250 - PHARMACY - GENERAL CLASSIFICATION|CELLULOSE, OXIDIZED 4" X 8" PADS|1 Strip|HUMANA [1294]||HUMANA [11839]|237.99|PHR: 408101; CHG: 26||Not reimbursed separately|237.99|PHR: 408101; CHG: 26||External grouping not supported 408114280|ERX|HCPCS RX001|63713-0019-43|0250 - PHARMACY - GENERAL CLASSIFICATION|CELLULOSE, OXIDIZED 3" X 4" PADS|1 Each|HUMANA [1294]||HUMANA [11839]|198.55|PHR: 408101; CHG: 26||Not reimbursed separately|198.55|PHR: 408101; CHG: 26||External grouping not supported 408125961|ERX|HCPCS A9270|99999-3333-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM GLUCONATE 2.5 % TOPICAL GEL|25 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|PHR: 408101; CHG: 26||Not reimbursed separately|100.50|PHR: 408101; CHG: 26||External grouping not supported 408143381|ERX|HCPCS RX001|99999-9999-76|0250 - PHARMACY - GENERAL CLASSIFICATION|BLISTEX LIP OINTMENT|1 Each|HUMANA [1294]||HUMANA [11839]|5.73|PHR: 408101; CHG: 26||Not reimbursed separately|5.73|PHR: 408101; CHG: 26||External grouping not supported 40814643|ERX|HCPCS J0885|59676-0320-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA 20,000 UNIT/ML INJECTION - ONCOLOGY|0.5 mL|HUMANA [1294]||HUMANA [11839]|421.04|PHR: 408101; CHG: 26||Not reimbursed separately|421.04|PHR: 408101; CHG: 26||External grouping not supported 40816521701|ERX|HCPCS RX001|99999-2222-67|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVETIRACETAM 100 MG/ML ORAL SOLN (PEDS)|1 mL|HUMANA [1294]||HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 408165469|ERX|HCPCS RX001|66220-0160-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CONIVAPTAN 10 MG/50 ML IN 5 % DEXTROSE IV|50 mL|HUMANA [1294]||HUMANA [11839]|1,056.30|PHR: 408101; CHG: 26||Not reimbursed separately|1,056.30|PHR: 408101; CHG: 26||External grouping not supported 408172723|ERX|HCPCS RX001|99999-9999-78|0250 - PHARMACY - GENERAL CLASSIFICATION|NO RINSE SHAMPOO|8 don't use|HUMANA [1294]||HUMANA [11839]|6.45|PHR: 408101; CHG: 26||Not reimbursed separately|6.45|PHR: 408101; CHG: 26||External grouping not supported 4081783701|ERX|HCPCS RX001|99999-5555-13|0250 - PHARMACY - GENERAL CLASSIFICATION|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION (1 PUFF CHARGE)|1 Puff|HUMANA [1294]||HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 408200168|ERX|HCPCS A9270|99999-2222-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 1 MG/ML ORAL SYRINGE (NICU)|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 408236401|ERX|HCPCS J7060|00338-6346-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION (NON-PVC)|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 40824513|ERX|HCPCS J0885|59676-0340-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA 40,000 UNIT/ML INJECTION - ONCOLOGY|1 mL|HUMANA [1294]||HUMANA [11839]|1,684.17|PHR: 408101; CHG: 26||Not reimbursed separately|1,684.17|PHR: 408101; CHG: 26||External grouping not supported 4082783801|ERX|HCPCS J7050|00264-1800-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9% INTRAVENOUS SOLUTION (NON-PVC)|100 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 4082783801|ERX|HCPCS J7050|00338-9543-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9% INTRAVENOUS SOLUTION (NON-PVC)|250 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 4082783801|ERX|HCPCS J7050|00338-9543-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 0.9% INTRAVENOUS SOLUTION (NON-PVC)|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 40833109|ERX|HCPCS RX001|85445-0083-21|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 23 MG/ML INTRAOCULAR SYRINGE|0.6 mL|HUMANA [1294]||HUMANA [11839]|356.88|PHR: 408101; CHG: 26||Not reimbursed separately|356.88|PHR: 408101; CHG: 26||External grouping not supported 40833109|ERX|HCPCS RX001|85446-0369-91|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM HYALURONATE 23 MG/ML INTRAOCULAR SYRINGE|0.6 mL|HUMANA [1294]||HUMANA [11839]|356.88|PHR: 408101; CHG: 26||Not reimbursed separately|356.88|PHR: 408101; CHG: 26||External grouping not supported 40838386|ERX|HCPCS RX001|00268-6557-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TRICHOPHYTON ALLERGENIC EXTRACT 1:200 INTRADERMAL|0.1 mL|HUMANA [1294]||HUMANA [11839]|15.63|PHR: 408101; CHG: 26||Not reimbursed separately|15.63|PHR: 408101; CHG: 26||External grouping not supported 40838386|ERX|HCPCS RX001|99999-3333-19|0250 - PHARMACY - GENERAL CLASSIFICATION|TRICHOPHYTON ALLERGENIC EXTRACT 1:200 INTRADERMAL|0.1 mL|HUMANA [1294]||HUMANA [11839]|15.63|PHR: 408101; CHG: 26||Not reimbursed separately|15.63|PHR: 408101; CHG: 26||External grouping not supported 40840026|ERX|HCPCS RX001|63323-0269-65|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPOFOL INFUSION 10 MG/ML|100 mL|HUMANA [1294]||HUMANA [11839]|30.90|PHR: 408101; CHG: 26||Not reimbursed separately|30.90|PHR: 408101; CHG: 26||External grouping not supported 40840035|ERX|HCPCS A9270|00906-9904-41|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCROSE 24 % ORAL SOLUTION|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.59|PHR: 408101; CHG: 26||Not reimbursed separately|1.59|PHR: 408101; CHG: 26||External grouping not supported 408423801|ERX|HCPCS RX011|99999-9999-77|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KETAMINE 10MG/ML PCA SYRINGE 30ML|1 Syringe|HUMANA [1294]||HUMANA [11839]|18.00|PHR: 408101; CHG: 26||Not reimbursed separately|18.00|PHR: 408101; CHG: 26||External grouping not supported 408444404|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|AVEENO MOISTURIZING BAR|1 Bar|HUMANA [1294]||HUMANA [11839]|5.55|PHR: 408101; CHG: 26||Not reimbursed separately|5.55|PHR: 408101; CHG: 26||External grouping not supported 4086224|ERX|HCPCS J2560|00641-0476-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENOBARBITAL SODIUM 65 MG/ML LOADING DOSE (NICU)|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.23|PHR: 408101; CHG: 26||Not reimbursed separately|55.23|PHR: 408101; CHG: 26||External grouping not supported 4086256|ERX|HCPCS J1165|00641-0493-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYTOIN SODIUM 50 MG/ML SYRINGE (NICU)|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 4086256|ERX|HCPCS J1165|00641-2555-45|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYTOIN SODIUM 50 MG/ML SYRINGE (NICU)|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.52|PHR: 408101; CHG: 26||Not reimbursed separately|4.52|PHR: 408101; CHG: 26||External grouping not supported 4087306|ERX|HCPCS RX001|00409-5534-34|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRINGE (NICU)|10 mL|HUMANA [1294]||HUMANA [11839]|27.00|PHR: 408101; CHG: 26||Not reimbursed separately|27.00|PHR: 408101; CHG: 26||External grouping not supported 4087317|ERX|HCPCS RX001|08290-3065-53|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % SYRINGE (NICU) MEDICATION FLUSH|5 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 4087317|ERX|HCPCS RX001|08881-5701-25|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % SYRINGE (NICU) MEDICATION FLUSH|5 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 40873171|ERX|HCPCS RX001|08290-3065-53|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % SYRINGE (NICU) HEP LOCK FLUSH|5 mL|HUMANA [1294]||HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 40873171|ERX|HCPCS RX001|08881-5701-25|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % SYRINGE (NICU) HEP LOCK FLUSH|5 mL|HUMANA [1294]||HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 4088981|ERX|HCPCS P9047|68516-5216-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % IV SOLUTION (ALARIS BLACKLIST)|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|PHR: 408101; CHG: 26||Not reimbursed separately|216.00|PHR: 408101; CHG: 26||External grouping not supported 4088981|ERX|HCPCS P9047|68516-5216-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % IV SOLUTION (ALARIS BLACKLIST)|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.00|PHR: 408101; CHG: 26||Not reimbursed separately|108.00|PHR: 408101; CHG: 26||External grouping not supported 4089997|ERX|HCPCS RX011|99999-2222-71|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LORAZEPAM 2 MG/ML INFUSION SYRINGE|1 Syringe|HUMANA [1294]||HUMANA [11839]|37.50|PHR: 408101; CHG: 26||Not reimbursed separately|37.50|PHR: 408101; CHG: 26||External grouping not supported 41063|ERX|HCPCS A9270|60505-2795-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IBANDRONATE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.31|PHR: 408101; CHG: 26||Not reimbursed separately|9.31|PHR: 408101; CHG: 26||External grouping not supported 41138|ERX|HCPCS A9270|47335-0835-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 41138|ERX|HCPCS A9270|65862-0744-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 41142|ERX|HCPCS A9270|00597-0087-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|1 Puff|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.69|PHR: 408101; CHG: 26||Not reimbursed separately|5.69|PHR: 408101; CHG: 26||External grouping not supported 41144|ERX|HCPCS J2248|00469-3250-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|77.99|PHR: 408101; CHG: 26||Not reimbursed separately|77.99|PHR: 408101; CHG: 26||External grouping not supported 41144|ERX|HCPCS J2248|63323-0728-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.99|PHR: 408101; CHG: 26||Not reimbursed separately|77.99|PHR: 408101; CHG: 26||External grouping not supported 41144|ERX|HCPCS J2248|63323-0728-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.99|PHR: 408101; CHG: 26||Not reimbursed separately|77.99|PHR: 408101; CHG: 26||External grouping not supported 41146|ERX|HCPCS RX001|50383-0249-71|0250 - PHARMACY - GENERAL CLASSIFICATION|BROMFENAC 0.09 % EYE DROPS|1.7 mL|HUMANA [1294]||HUMANA [11839]|311.56|PHR: 408101; CHG: 26||Not reimbursed separately|311.56|PHR: 408101; CHG: 26||External grouping not supported 41146|ERX|HCPCS RX001|62332-0508-17|0250 - PHARMACY - GENERAL CLASSIFICATION|BROMFENAC 0.09 % EYE DROPS|1.7 mL|HUMANA [1294]||HUMANA [11839]|311.56|PHR: 408101; CHG: 26||Not reimbursed separately|311.56|PHR: 408101; CHG: 26||External grouping not supported 41147|ERX|HCPCS A9270|00093-5786-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTECAVIR 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 41147|ERX|HCPCS A9270|00093-5786-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTECAVIR 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 41147|ERX|HCPCS A9270|31722-0833-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTECAVIR 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 41147|ERX|HCPCS A9270|69097-0426-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTECAVIR 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 41149|ERX|HCPCS A9270|00003-1614-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENTECAVIR 0.05 MG/ML ORAL SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.48|PHR: 408101; CHG: 26||Not reimbursed separately|126.48|PHR: 408101; CHG: 26||External grouping not supported 41174|ERX|HCPCS RX001|00186-6040-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION|20 mg|HUMANA [1294]||HUMANA [11839]|12.39|PHR: 408101; CHG: 26||Not reimbursed separately|12.39|PHR: 408101; CHG: 26||External grouping not supported 41188|ERX|HCPCS A9270|00006-0710-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALENDRONATE 70 MG-CHOLECALCIFEROL (VITAMIN D3) 2,800 UNIT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.42|PHR: 408101; CHG: 26||Not reimbursed separately|126.42|PHR: 408101; CHG: 26||External grouping not supported 41283|ERX|HCPCS RX001|00310-6524-01|0250 - PHARMACY - GENERAL CLASSIFICATION|EXENATIDE 10 MCG/DOSE(250 MCG/ML)2.4 ML SUBCUTANEOUS PEN INJECTOR|2.4 mL|HUMANA [1294]||HUMANA [11839]|2,015.26|PHR: 408101; CHG: 26||Not reimbursed separately|2,015.26|PHR: 408101; CHG: 26||External grouping not supported 41294|ERX|HCPCS J9185|25021-0242-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.69|PHR: 408101; CHG: 26||Not reimbursed separately|150.69|PHR: 408101; CHG: 26||External grouping not supported 41294|ERX|HCPCS J9185|63323-0192-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|150.69|PHR: 408101; CHG: 26||Not reimbursed separately|150.69|PHR: 408101; CHG: 26||External grouping not supported 41382|ERX|HCPCS A9270|00406-9012-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.36|PHR: 408101; CHG: 26||Not reimbursed separately|9.36|PHR: 408101; CHG: 26||External grouping not supported 41382|ERX|HCPCS A9270|47781-0423-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.36|PHR: 408101; CHG: 26||Not reimbursed separately|9.36|PHR: 408101; CHG: 26||External grouping not supported 41382|ERX|HCPCS A9270|47781-0423-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.36|PHR: 408101; CHG: 26||Not reimbursed separately|9.36|PHR: 408101; CHG: 26||External grouping not supported 41382|ERX|HCPCS A9270|60505-7010-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.36|PHR: 408101; CHG: 26||Not reimbursed separately|9.36|PHR: 408101; CHG: 26||External grouping not supported 41382|ERX|HCPCS A9270|60505-7080-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.36|PHR: 408101; CHG: 26||Not reimbursed separately|9.36|PHR: 408101; CHG: 26||External grouping not supported 41598|ERX|HCPCS J9263|00703-3985-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.06|PHR: 408101; CHG: 26||Not reimbursed separately|114.06|PHR: 408101; CHG: 26||External grouping not supported 41598|ERX|HCPCS J9263|00955-1725-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.06|PHR: 408101; CHG: 26||Not reimbursed separately|114.06|PHR: 408101; CHG: 26||External grouping not supported 41598|ERX|HCPCS J9263|00955-1731-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.06|PHR: 408101; CHG: 26||Not reimbursed separately|114.06|PHR: 408101; CHG: 26||External grouping not supported 41598|ERX|HCPCS J9263|61703-0363-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|114.06|PHR: 408101; CHG: 26||Not reimbursed separately|114.06|PHR: 408101; CHG: 26||External grouping not supported 41598|ERX|HCPCS J9263|67457-0469-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.06|PHR: 408101; CHG: 26||Not reimbursed separately|114.06|PHR: 408101; CHG: 26||External grouping not supported 41598|ERX|HCPCS J9263|70860-0201-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.06|PHR: 408101; CHG: 26||Not reimbursed separately|114.06|PHR: 408101; CHG: 26||External grouping not supported 41652|ERX|HCPCS J3243|00008-4990-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TIGECYCLINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|144.87|PHR: 408101; CHG: 26||Not reimbursed separately|144.87|PHR: 408101; CHG: 26||External grouping not supported 41652|ERX|HCPCS J3243|70121-1647-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TIGECYCLINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|144.87|PHR: 408101; CHG: 26||Not reimbursed separately|144.87|PHR: 408101; CHG: 26||External grouping not supported 41676|ERX|HCPCS A9270|00597-0003-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TIPRANAVIR 250 MG CAPSULE|2 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.71|PHR: 408101; CHG: 26||Not reimbursed separately|81.71|PHR: 408101; CHG: 26||External grouping not supported 41793|ERX|HCPCS RX001|24201-0201-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|51.29|PHR: 408101; CHG: 26||Not reimbursed separately|51.29|PHR: 408101; CHG: 26||External grouping not supported 41793|ERX|HCPCS RX001|67457-0163-00|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|51.29|PHR: 408101; CHG: 26||Not reimbursed separately|51.29|PHR: 408101; CHG: 26||External grouping not supported 41793|ERX|HCPCS RX001|67457-0163-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|51.29|PHR: 408101; CHG: 26||Not reimbursed separately|51.29|PHR: 408101; CHG: 26||External grouping not supported 41822|ERX|HCPCS A9270|00093-5401-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 41822|ERX|HCPCS A9270|60505-3170-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 41822|ERX|HCPCS A9270|64380-0761-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 41822|ERX|HCPCS A9270|65162-0034-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|00093-5517-98|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|27241-0124-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|50268-0717-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|60687-0416-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|60687-0416-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|65162-0351-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41832|ERX|HCPCS A9270|65862-0688-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 41899|ERX|HCPCS A9270|00299-3820-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 1 % TOPICAL GEL|60 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,040.76|PHR: 408101; CHG: 26||Not reimbursed separately|1,040.76|PHR: 408101; CHG: 26||External grouping not supported 42064|ERX|HCPCS A9270|64764-0805-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RAMELTEON 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.49|PHR: 408101; CHG: 26||Not reimbursed separately|35.49|PHR: 408101; CHG: 26||External grouping not supported 42162|ERX|HCPCS A9270|00071-1012-68|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 42162|ERX|HCPCS A9270|59762-1342-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 42162|ERX|HCPCS A9270|60687-0473-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 42162|ERX|HCPCS A9270|60687-0473-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 42162|ERX|HCPCS A9270|69097-0954-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 42163|ERX|HCPCS A9270|00071-1013-41|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 42163|ERX|HCPCS A9270|43598-0292-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 42163|ERX|HCPCS A9270|59762-1344-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 42163|ERX|HCPCS A9270|60687-0484-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 42163|ERX|HCPCS A9270|60687-0484-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 42163|ERX|HCPCS A9270|69097-0955-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 42164|ERX|HCPCS A9270|00071-1014-41|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42164|ERX|HCPCS A9270|00071-1014-68|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42164|ERX|HCPCS A9270|43598-0293-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42164|ERX|HCPCS A9270|59762-1346-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42164|ERX|HCPCS A9270|60687-0495-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42164|ERX|HCPCS A9270|60687-0495-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42165|ERX|HCPCS A9270|00071-1015-41|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42165|ERX|HCPCS A9270|43598-0294-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42165|ERX|HCPCS A9270|59762-1348-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42165|ERX|HCPCS A9270|60687-0506-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42165|ERX|HCPCS A9270|60687-0506-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 42165|ERX|HCPCS A9270|69097-0957-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREGABALIN 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.88|PHR: 408101; CHG: 26||Not reimbursed separately|0.88|PHR: 408101; CHG: 26||External grouping not supported 4236|ERX|HCPCS RX001|42023-0113-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 4236|ERX|HCPCS RX001|67457-0181-00|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 4236|ERX|HCPCS RX001|67457-0181-20|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.40|PHR: 408101; CHG: 26||Not reimbursed separately|1.40|PHR: 408101; CHG: 26||External grouping not supported 4237|ERX|HCPCS RX001|00143-9509-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 100 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 4237|ERX|HCPCS RX001|42023-0115-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 100 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 4237|ERX|HCPCS RX001|67457-0108-00|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 100 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 4237|ERX|HCPCS RX001|00143-9509-01|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 100 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|5.33|PHR: 408101; CHG: 26||Not reimbursed separately|5.33|PHR: 408101; CHG: 26||External grouping not supported 4238|ERX|HCPCS RX001|00143-9508-01|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 50 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 4238|ERX|HCPCS RX001|42023-0114-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 50 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 4238|ERX|HCPCS RX001|67457-0001-00|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 50 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 4238|ERX|HCPCS RX001|67457-0001-10|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 50 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 4238|ERX|HCPCS RX001|99999-2222-62|0250 - PHARMACY - GENERAL CLASSIFICATION|KETAMINE 50 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 42486|ERX|HCPCS RX001|00065-0002-03|0250 - PHARMACY - GENERAL CLASSIFICATION|NEPAFENAC 0.1 % EYE DROPS,SUSPENSION|3 mL|HUMANA [1294]||HUMANA [11839]|750.94|PHR: 408101; CHG: 26||Not reimbursed separately|750.94|PHR: 408101; CHG: 26||External grouping not supported 4318|ERX|HCPCS J7120|00338-0117-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 4318|ERX|HCPCS J7120|00338-0117-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS INTRAVENOUS SOLUTION|250 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 4318|ERX|HCPCS J7120|00338-0117-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 432|ERX|HCPCS A9270|16729-0171-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 432|ERX|HCPCS A9270|51079-0131-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 432|ERX|HCPCS A9270|51079-0131-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 433|ERX|HCPCS A9270|16729-0175-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 433|ERX|HCPCS A9270|51079-0563-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 433|ERX|HCPCS A9270|51079-0563-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 43391|ERX|HCPCS A9270|00074-6799-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOPINAVIR-RITONAVIR 200 MG-50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.03|PHR: 408101; CHG: 26||Not reimbursed separately|25.03|PHR: 408101; CHG: 26||External grouping not supported 435|ERX|HCPCS A9270|00904-0201-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 435|ERX|HCPCS A9270|16729-0172-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 435|ERX|HCPCS A9270|51079-0107-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 435|ERX|HCPCS A9270|51079-0107-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 435|ERX|HCPCS A9270|60687-0433-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 435|ERX|HCPCS A9270|60687-0433-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 436|ERX|HCPCS A9270|00904-0202-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 436|ERX|HCPCS A9270|16729-0173-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 436|ERX|HCPCS A9270|51079-0133-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 436|ERX|HCPCS A9270|51079-0133-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 436|ERX|HCPCS A9270|60687-0444-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 436|ERX|HCPCS A9270|60687-0444-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 437|ERX|HCPCS A9270|00781-1489-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 437|ERX|HCPCS A9270|16729-0174-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 437|ERX|HCPCS A9270|51079-0147-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 437|ERX|HCPCS A9270|51079-0147-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMITRIPTYLINE 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.98|PHR: 408101; CHG: 26||Not reimbursed separately|0.98|PHR: 408101; CHG: 26||External grouping not supported 439|ERX|HCPCS RX001|39822-9900-01|0250 - PHARMACY - GENERAL CLASSIFICATION|AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION|1 Ampule|HUMANA [1294]||HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 439|ERX|HCPCS RX001|39822-9900-02|0250 - PHARMACY - GENERAL CLASSIFICATION|AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION|1 Ampule|HUMANA [1294]||HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 4392|ERX|HCPCS J0640|00703-5140-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]||HUMANA [11839]|55.29|PHR: 408101; CHG: 26||Not reimbursed separately|55.29|PHR: 408101; CHG: 26||External grouping not supported 4392|ERX|HCPCS J0640|25021-0814-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.29|PHR: 408101; CHG: 26||Not reimbursed separately|55.29|PHR: 408101; CHG: 26||External grouping not supported 4393|ERX|HCPCS J0640|00143-9552-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION|350 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.86|PHR: 408101; CHG: 26||Not reimbursed separately|67.86|PHR: 408101; CHG: 26||External grouping not supported 4393|ERX|HCPCS J0640|00703-5145-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION|350 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.86|PHR: 408101; CHG: 26||Not reimbursed separately|67.86|PHR: 408101; CHG: 26||External grouping not supported 4393|ERX|HCPCS J0640|25021-0816-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION|350 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.86|PHR: 408101; CHG: 26||Not reimbursed separately|67.86|PHR: 408101; CHG: 26||External grouping not supported 4393|ERX|HCPCS J0640|25021-0816-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION|350 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.86|PHR: 408101; CHG: 26||Not reimbursed separately|67.86|PHR: 408101; CHG: 26||External grouping not supported 4393|ERX|HCPCS J0640|67457-0530-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION|350 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.86|PHR: 408101; CHG: 26||Not reimbursed separately|67.86|PHR: 408101; CHG: 26||External grouping not supported 4394|ERX|HCPCS J0640|00143-9555-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION|1 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.96|PHR: 408101; CHG: 26||Not reimbursed separately|9.96|PHR: 408101; CHG: 26||External grouping not supported 4394|ERX|HCPCS J0640|25021-0813-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.96|PHR: 408101; CHG: 26||Not reimbursed separately|9.96|PHR: 408101; CHG: 26||External grouping not supported 4397|ERX|HCPCS A9270|51079-0582-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEUCOVORIN CALCIUM 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.13|PHR: 408101; CHG: 26||Not reimbursed separately|20.13|PHR: 408101; CHG: 26||External grouping not supported 4398|ERX|HCPCS A9270|00054-8496-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEUCOVORIN CALCIUM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.26|PHR: 408101; CHG: 26||Not reimbursed separately|3.26|PHR: 408101; CHG: 26||External grouping not supported 4398|ERX|HCPCS A9270|51079-0581-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEUCOVORIN CALCIUM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.26|PHR: 408101; CHG: 26||Not reimbursed separately|3.26|PHR: 408101; CHG: 26||External grouping not supported 4398|ERX|HCPCS A9270|51079-0581-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEUCOVORIN CALCIUM 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.26|PHR: 408101; CHG: 26||Not reimbursed separately|3.26|PHR: 408101; CHG: 26||External grouping not supported 4418|ERX|HCPCS RX001|42023-0202-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 200 MCG INTRAVENOUS POWDER FOR SOLUTION|200 mcg|HUMANA [1294]||HUMANA [11839]|451.05|PHR: 408101; CHG: 26||Not reimbursed separately|451.05|PHR: 408101; CHG: 26||External grouping not supported 4418|ERX|HCPCS RX001|63323-0647-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 200 MCG INTRAVENOUS POWDER FOR SOLUTION|200 mcg|HUMANA [1294]||HUMANA [11839]|451.05|PHR: 408101; CHG: 26||Not reimbursed separately|451.05|PHR: 408101; CHG: 26||External grouping not supported 4419|ERX|HCPCS RX001|42023-0203-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 500 MCG INTRAVENOUS POWDER FOR SOLUTION|25 mcg|HUMANA [1294]||HUMANA [11839]|54.60|PHR: 408101; CHG: 26||Not reimbursed separately|54.60|PHR: 408101; CHG: 26||External grouping not supported 4419|ERX|HCPCS RX001|63323-0648-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LEVOTHYROXINE 500 MCG INTRAVENOUS POWDER FOR SOLUTION|25 mcg|HUMANA [1294]||HUMANA [11839]|54.60|PHR: 408101; CHG: 26||Not reimbursed separately|54.60|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|00074-4341-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|00527-1341-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|00781-5180-92|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|51079-0444-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|51079-0444-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|60687-0453-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|60687-0453-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4420|ERX|HCPCS A9270|69238-1830-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 25 MCG TABLET|4 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.48|PHR: 408101; CHG: 26||Not reimbursed separately|3.48|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|00074-4552-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|00074-4552-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|00527-1342-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|51079-0440-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|51079-0440-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|60687-0464-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4421|ERX|HCPCS A9270|60687-0464-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 50 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.67|PHR: 408101; CHG: 26||Not reimbursed separately|1.67|PHR: 408101; CHG: 26||External grouping not supported 4422|ERX|HCPCS A9270|00074-5182-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 75 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 4422|ERX|HCPCS A9270|51079-0441-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 75 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 4422|ERX|HCPCS A9270|51079-0441-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 75 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 4422|ERX|HCPCS A9270|60687-0475-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 75 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 4422|ERX|HCPCS A9270|60687-0475-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 75 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 4422|ERX|HCPCS A9270|69238-1832-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 75 MCG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.16|PHR: 408101; CHG: 26||Not reimbursed separately|2.16|PHR: 408101; CHG: 26||External grouping not supported 4423|ERX|HCPCS A9270|00074-6624-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4423|ERX|HCPCS A9270|00527-1345-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4423|ERX|HCPCS A9270|51079-0442-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4423|ERX|HCPCS A9270|60687-0497-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4423|ERX|HCPCS A9270|60687-0497-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4423|ERX|HCPCS A9270|69238-1834-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 100 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.05|PHR: 408101; CHG: 26||Not reimbursed separately|1.05|PHR: 408101; CHG: 26||External grouping not supported 4424|ERX|HCPCS A9270|00074-7068-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 125 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 4424|ERX|HCPCS A9270|51079-0443-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 125 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 4424|ERX|HCPCS A9270|51079-0443-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 125 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 4424|ERX|HCPCS A9270|60687-0519-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 125 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 4424|ERX|HCPCS A9270|60687-0519-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 125 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 4424|ERX|HCPCS A9270|69238-1836-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 125 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|00074-7069-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|00074-7069-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|00527-1349-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|51079-0445-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|51079-0445-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|60687-0530-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|60687-0530-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4425|ERX|HCPCS A9270|69238-1838-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 150 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 4426|ERX|HCPCS A9270|00074-7148-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4426|ERX|HCPCS A9270|00074-7148-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4426|ERX|HCPCS A9270|00378-1819-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4426|ERX|HCPCS A9270|69238-1840-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOTHYROXINE 200 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4448|ERX|HCPCS RX001|17478-0711-30|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 2 % MUCOSAL JELLY|30 mL|HUMANA [1294]||HUMANA [11839]|108.09|PHR: 408101; CHG: 26||Not reimbursed separately|108.09|PHR: 408101; CHG: 26||External grouping not supported 4448|ERX|HCPCS RX001|17478-0711-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 2 % MUCOSAL JELLY|5 mL|HUMANA [1294]||HUMANA [11839]|18.02|PHR: 408101; CHG: 26||Not reimbursed separately|18.02|PHR: 408101; CHG: 26||External grouping not supported 4448|ERX|HCPCS RX001|17478-0711-31|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 2 % MUCOSAL JELLY|5 mL|HUMANA [1294]||HUMANA [11839]|18.02|PHR: 408101; CHG: 26||Not reimbursed separately|18.02|PHR: 408101; CHG: 26||External grouping not supported 4450|ERX|HCPCS RX001|00054-3505-47|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|52.95|PHR: 408101; CHG: 26||Not reimbursed separately|52.95|PHR: 408101; CHG: 26||External grouping not supported 4450|ERX|HCPCS RX001|00527-6004-80|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|52.95|PHR: 408101; CHG: 26||Not reimbursed separately|52.95|PHR: 408101; CHG: 26||External grouping not supported 4450|ERX|HCPCS RX001|52565-0009-50|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|52.95|PHR: 408101; CHG: 26||Not reimbursed separately|52.95|PHR: 408101; CHG: 26||External grouping not supported 4451|ERX|HCPCS RX001|00409-4275-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 5 MG/ML (0.5 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4451|ERX|HCPCS RX001|63323-0484-57|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 5 MG/ML (0.5 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4452|ERX|HCPCS RX001|00409-4276-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|2.01|PHR: 408101; CHG: 26||Not reimbursed separately|2.01|PHR: 408101; CHG: 26||External grouping not supported 4452|ERX|HCPCS RX001|55150-0251-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|2.01|PHR: 408101; CHG: 26||Not reimbursed separately|2.01|PHR: 408101; CHG: 26||External grouping not supported 4452|ERX|HCPCS RX001|63323-0201-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|2.01|PHR: 408101; CHG: 26||Not reimbursed separately|2.01|PHR: 408101; CHG: 26||External grouping not supported 4452|ERX|HCPCS RX001|63323-0201-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|3.24|PHR: 408101; CHG: 26||Not reimbursed separately|3.24|PHR: 408101; CHG: 26||External grouping not supported 4452|ERX|HCPCS RX001|63323-0485-57|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|3.24|PHR: 408101; CHG: 26||Not reimbursed separately|3.24|PHR: 408101; CHG: 26||External grouping not supported 4452|ERX|HCPCS RX001|00409-4276-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|3.72|PHR: 408101; CHG: 26||Not reimbursed separately|3.72|PHR: 408101; CHG: 26||External grouping not supported 4453|ERX|HCPCS RX001|00409-4776-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|19.14|PHR: 408101; CHG: 26||Not reimbursed separately|19.14|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|00143-9575-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|00143-9575-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|00409-4277-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|00409-4277-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|00409-4277-16|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|00409-4277-17|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|55150-0254-10|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|55150-0255-20|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0202-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0486-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0486-02|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0486-17|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0486-26|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0486-27|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4454|ERX|HCPCS RX001|63323-0486-57|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 4455|ERX|HCPCS RX001|00409-4283-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|9.45|PHR: 408101; CHG: 26||Not reimbursed separately|9.45|PHR: 408101; CHG: 26||External grouping not supported 4455|ERX|HCPCS RX001|00409-4283-11|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|9.45|PHR: 408101; CHG: 26||Not reimbursed separately|9.45|PHR: 408101; CHG: 26||External grouping not supported 4455|ERX|HCPCS RX001|00409-4283-25|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|9.45|PHR: 408101; CHG: 26||Not reimbursed separately|9.45|PHR: 408101; CHG: 26||External grouping not supported 4459|ERX|HCPCS RX001|00409-1323-05|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE|2.5 mL|HUMANA [1294]||HUMANA [11839]|7.32|PHR: 408101; CHG: 26||Not reimbursed separately|7.32|PHR: 408101; CHG: 26||External grouping not supported 4459|ERX|HCPCS RX001|76329-3390-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE|2.5 mL|HUMANA [1294]||HUMANA [11839]|7.32|PHR: 408101; CHG: 26||Not reimbursed separately|7.32|PHR: 408101; CHG: 26||External grouping not supported 4459|ERX|HCPCS RX001|00409-4903-34|0250 - PHARMACY - GENERAL CLASSIFICATION|LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE|5 mL|HUMANA [1294]||HUMANA [11839]|7.32|PHR: 408101; CHG: 26||Not reimbursed separately|7.32|PHR: 408101; CHG: 26||External grouping not supported 4498|ERX|HCPCS A9270|60432-0834-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LINDANE 1 % SHAMPOO|1 Bottle|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.76|PHR: 408101; CHG: 26||Not reimbursed separately|302.76|PHR: 408101; CHG: 26||External grouping not supported 450|ERX|HCPCS A9270|00093-3107-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 450|ERX|HCPCS A9270|00781-2020-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 4504|ERX|HCPCS A9270|42794-0019-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIOTHYRONINE 25 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.57|PHR: 408101; CHG: 26||Not reimbursed separately|1.57|PHR: 408101; CHG: 26||External grouping not supported 4504|ERX|HCPCS A9270|42794-0019-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LIOTHYRONINE 25 MCG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.57|PHR: 408101; CHG: 26||Not reimbursed separately|1.57|PHR: 408101; CHG: 26||External grouping not supported 451|ERX|HCPCS A9270|00781-2613-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 451|ERX|HCPCS A9270|65862-0017-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.22|PHR: 408101; CHG: 26||Not reimbursed separately|0.22|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|00591-0408-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|00904-6799-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|60687-0333-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|60687-0333-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|63739-0350-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|68001-0335-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|68180-0981-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4526|ERX|HCPCS A9270|68180-0981-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LISINOPRIL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 4528|ERX|HCPCS A9270|00054-8526-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE 150 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 4529|ERX|HCPCS A9270|00054-2527-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 4529|ERX|HCPCS A9270|00054-8527-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 4529|ERX|HCPCS A9270|31722-0545-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 453|ERX|HCPCS A9270|00143-9888-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 4530|ERX|HCPCS A9270|00054-8531-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE 600 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 4530|ERX|HCPCS A9270|68462-0222-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LITHIUM CARBONATE 600 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 454|ERX|HCPCS A9270|00781-6041-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 454|ERX|HCPCS A9270|00143-9889-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION|80 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 4560|ERX|HCPCS A9270|51079-0690-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOPERAMIDE 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 4560|ERX|HCPCS A9270|60687-0229-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOPERAMIDE 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 4560|ERX|HCPCS A9270|60687-0229-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOPERAMIDE 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|00591-0240-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|00591-0240-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|00591-0240-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|00904-6007-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|00904-6007-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|51079-0417-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4572|ERX|HCPCS A9270|69315-0904-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|00591-0241-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|00591-0241-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|00904-6008-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|00904-6008-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|51079-0386-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|60687-0355-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4573|ERX|HCPCS A9270|60687-0355-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 4574|ERX|HCPCS A9270|00904-6009-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 4574|ERX|HCPCS A9270|51079-0387-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 4574|ERX|HCPCS A9270|51079-0387-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 4574|ERX|HCPCS A9270|60687-0367-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORAZEPAM 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 4599|ERX|HCPCS A9270|00591-0370-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOXAPINE SUCCINATE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4600|ERX|HCPCS A9270|00527-1396-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LOXAPINE SUCCINATE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.54|PHR: 408101; CHG: 26||Not reimbursed separately|1.54|PHR: 408101; CHG: 26||External grouping not supported 464|ERX|HCPCS J0285|39822-1055-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION|50 mg|HUMANA [1294]||HUMANA [11839]|99.18|PHR: 408101; CHG: 26||Not reimbursed separately|99.18|PHR: 408101; CHG: 26||External grouping not supported 465|ERX|HCPCS A9270|00781-2144-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMPICILLIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 466|ERX|HCPCS A9270|00781-2145-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMPICILLIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.35|PHR: 408101; CHG: 26||Not reimbursed separately|1.35|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|00781-3404-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|00781-3404-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|00781-9261-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|25021-0136-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|55150-0113-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|70860-0114-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 469|ERX|HCPCS J0290|70860-0114-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 471|ERX|HCPCS RX011|00781-3400-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 125 MG SOLUTION FOR INJECTION|125 mg|HUMANA [1294]||HUMANA [11839]|10.48|PHR: 408101; CHG: 26||Not reimbursed separately|10.48|PHR: 408101; CHG: 26||External grouping not supported 4711|ERX|HCPCS A9270|00869-0693-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM CITRATE ORAL SOLUTION|148 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 4711|ERX|HCPCS A9270|00904-6787-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM CITRATE ORAL SOLUTION|148 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 4711|ERX|HCPCS A9270|24385-0675-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM CITRATE ORAL SOLUTION|148 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 4711|ERX|HCPCS A9270|87701-0402-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM CITRATE ORAL SOLUTION|148 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 4711|ERX|HCPCS A9270|00869-0686-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.67|PHR: 408101; CHG: 26||Not reimbursed separately|2.67|PHR: 408101; CHG: 26||External grouping not supported 4719|ERX|HCPCS J3475|00409-6729-23|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.20|PHR: 408101; CHG: 26||Not reimbursed separately|13.20|PHR: 408101; CHG: 26||External grouping not supported 4719|ERX|HCPCS J3475|63323-0106-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.20|PHR: 408101; CHG: 26||Not reimbursed separately|13.20|PHR: 408101; CHG: 26||External grouping not supported 472|ERX|HCPCS J0290|00781-3408-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 472|ERX|HCPCS J0290|00781-3408-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 472|ERX|HCPCS J0290|00781-9273-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 472|ERX|HCPCS J0290|55150-0114-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 472|ERX|HCPCS J0290|70860-0115-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 472|ERX|HCPCS J0290|70860-0115-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|51754-1000-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|51754-1000-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0064-43|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0642-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4720|ERX|HCPCS J3475|63323-0642-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.36|PHR: 408101; CHG: 26||Not reimbursed separately|4.36|PHR: 408101; CHG: 26||External grouping not supported 4722|ERX|HCPCS RX001|00869-0602-43|0250 - PHARMACY - GENERAL CLASSIFICATION|MAGNESIUM SULFATE (BULK) 100 % CRYSTALS|454 g|HUMANA [1294]||HUMANA [11839]|2.73|PHR: 408101; CHG: 26||Not reimbursed separately|2.73|PHR: 408101; CHG: 26||External grouping not supported 473|ERX|HCPCS J0290|00781-3402-78|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 473|ERX|HCPCS J0290|00781-3402-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]||HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 473|ERX|HCPCS J0290|25021-0134-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 474|ERX|HCPCS J0290|00781-3407-78|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.08|PHR: 408101; CHG: 26||Not reimbursed separately|2.08|PHR: 408101; CHG: 26||External grouping not supported 474|ERX|HCPCS J0290|00781-3407-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.08|PHR: 408101; CHG: 26||Not reimbursed separately|2.08|PHR: 408101; CHG: 26||External grouping not supported 474|ERX|HCPCS J0290|55150-0112-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMPICILLIN 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.08|PHR: 408101; CHG: 26||Not reimbursed separately|2.08|PHR: 408101; CHG: 26||External grouping not supported 4749|ERX|HCPCS RX004|00338-0357-03|0258 - PHARMACY - IV SOLUTIONS|MANNITOL 20 % INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|109.50|PHR: 408101; CHG: 26||Not reimbursed separately|109.50|PHR: 408101; CHG: 26||External grouping not supported 4750|ERX|HCPCS J2150|00409-4031-16|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MANNITOL 25 % INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 4750|ERX|HCPCS J2150|63323-0024-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MANNITOL 25 % INTRAVENOUS SOLUTION|25 mL|HUMANA [1294]||HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 4750|ERX|HCPCS J2150|00409-4031-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MANNITOL 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.90|PHR: 408101; CHG: 26||Not reimbursed separately|3.90|PHR: 408101; CHG: 26||External grouping not supported 479|ERX|HCPCS RX001|46414-2222-01|0250 - PHARMACY - GENERAL CLASSIFICATION|AMYL NITRITE 0.3 ML SOLUTION FOR INHALATION|1 Ampule|HUMANA [1294]||HUMANA [11839]|6.12|PHR: 408101; CHG: 26||Not reimbursed separately|6.12|PHR: 408101; CHG: 26||External grouping not supported 480100270|ERX|HCPCS RX011|99999-1111-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 0.3 MG/ML SYRINGE (NEONATE CODE NARRATOR)|10 mL|HUMANA [1294]||HUMANA [11839]|2.85|PHR: 408101; CHG: 26||Not reimbursed separately|2.85|PHR: 408101; CHG: 26||External grouping not supported 4854|ERX|HCPCS A9270|00555-0779-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEDROXYPROGESTERONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 4854|ERX|HCPCS A9270|59762-0056-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEDROXYPROGESTERONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 4854|ERX|HCPCS A9270|59762-3742-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEDROXYPROGESTERONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 4854|ERX|HCPCS A9270|60687-0105-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEDROXYPROGESTERONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.37|PHR: 408101; CHG: 26||Not reimbursed separately|0.37|PHR: 408101; CHG: 26||External grouping not supported 4855|ERX|HCPCS A9270|59762-0055-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEDROXYPROGESTERONE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 4871|ERX|HCPCS A9270|00904-3571-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEGESTROL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.53|PHR: 408101; CHG: 26||Not reimbursed separately|0.53|PHR: 408101; CHG: 26||External grouping not supported 4917|ERX|HCPCS A9270|55111-0641-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MEPROBAMATE 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.31|PHR: 408101; CHG: 26||Not reimbursed separately|6.31|PHR: 408101; CHG: 26||External grouping not supported 4952|ERX|HCPCS A9270|00054-3555-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 4952|ERX|HCPCS A9270|99999-2222-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 4953|ERX|HCPCS A9270|00054-8554-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 4953|ERX|HCPCS A9270|00406-5771-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 4953|ERX|HCPCS A9270|00904-6530-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 4953|ERX|HCPCS A9270|68084-0738-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 4953|ERX|HCPCS A9270|68084-0738-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 4954|ERX|HCPCS A9270|00054-8553-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 4954|ERX|HCPCS A9270|00406-5755-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 4954|ERX|HCPCS A9270|60687-0214-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 4954|ERX|HCPCS A9270|60687-0214-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHADONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|00517-1825-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|00517-1825-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|25021-0675-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|55150-0223-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|63323-0778-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|67457-0273-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|67457-0273-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|70069-0101-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|70069-0101-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|70860-0653-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4970|ERX|HCPCS J2800|71288-0716-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOCARBAMOL 100 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.64|PHR: 408101; CHG: 26||Not reimbursed separately|5.64|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|31722-0533-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|31722-0533-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|43547-0405-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|60687-0559-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|60687-0559-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|70010-0754-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|76385-0123-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4971|ERX|HCPCS A9270|76385-0123-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 4972|ERX|HCPCS A9270|31722-0534-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 4972|ERX|HCPCS A9270|60687-0568-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 4972|ERX|HCPCS A9270|60687-0568-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 4972|ERX|HCPCS A9270|70010-0770-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 4972|ERX|HCPCS A9270|76385-0124-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHOCARBAMOL 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 4973|ERX|HCPCS J8610|00054-8550-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM 2.5 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|3.69|PHR: 408101; CHG: 26||Not reimbursed separately|3.69|PHR: 408101; CHG: 26||External grouping not supported 4974|ERX|HCPCS J9260|00143-9519-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 4974|ERX|HCPCS J9260|16729-0277-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 4974|ERX|HCPCS J9260|16729-0277-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 4974|ERX|HCPCS J9260|00703-3671-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION|0.6 mL|HUMANA [1294]||HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 4974|ERX|HCPCS J9260|00703-3678-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION|0.6 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.03|PHR: 408101; CHG: 26||Not reimbursed separately|5.03|PHR: 408101; CHG: 26||External grouping not supported 4982|ERX|HCPCS A9270|16729-0030-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 4982|ERX|HCPCS A9270|16729-0030-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 4982|ERX|HCPCS A9270|51079-0200-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 4982|ERX|HCPCS A9270|51079-0200-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.50|PHR: 408101; CHG: 26||Not reimbursed separately|0.50|PHR: 408101; CHG: 26||External grouping not supported 4983|ERX|HCPCS A9270|16729-0031-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 4983|ERX|HCPCS A9270|51079-0201-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 4983|ERX|HCPCS A9270|51079-0201-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLDOPA 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 4984|ERX|HCPCS J0210|00517-8905-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLDOPATE 250 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|119.70|PHR: 408101; CHG: 26||Not reimbursed separately|119.70|PHR: 408101; CHG: 26||External grouping not supported 4985|ERX|HCPCS Q9968|17478-0504-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.47|PHR: 408101; CHG: 26||Not reimbursed separately|49.47|PHR: 408101; CHG: 26||External grouping not supported 4985|ERX|HCPCS Q9968|17478-0504-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|49.47|PHR: 408101; CHG: 26||Not reimbursed separately|49.47|PHR: 408101; CHG: 26||External grouping not supported 4986|ERX|HCPCS A9270|00406-1144-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 4986|ERX|HCPCS A9270|10702-0101-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 4986|ERX|HCPCS A9270|68084-0823-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 4986|ERX|HCPCS A9270|68084-0823-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 4987|ERX|HCPCS A9270|00406-1146-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.69|PHR: 408101; CHG: 26||Not reimbursed separately|3.69|PHR: 408101; CHG: 26||External grouping not supported 4987|ERX|HCPCS A9270|31722-0175-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.69|PHR: 408101; CHG: 26||Not reimbursed separately|3.69|PHR: 408101; CHG: 26||External grouping not supported 4988|ERX|HCPCS A9270|00406-1142-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4988|ERX|HCPCS A9270|10702-0100-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4988|ERX|HCPCS A9270|31722-0173-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4988|ERX|HCPCS A9270|57664-0228-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4988|ERX|HCPCS A9270|68084-0805-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4988|ERX|HCPCS A9270|68084-0805-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METHYLPHENIDATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 4992|ERX|HCPCS J7509|59746-0003-14|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE 16 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.49|PHR: 408101; CHG: 26||Not reimbursed separately|5.49|PHR: 408101; CHG: 26||External grouping not supported 4993|ERX|HCPCS J7509|00603-4593-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE 4 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 4993|ERX|HCPCS J7509|59746-0001-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 4995|ERX|HCPCS J1030|00009-3073-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]||HUMANA [11839]|17.45|PHR: 408101; CHG: 26||Not reimbursed separately|17.45|PHR: 408101; CHG: 26||External grouping not supported 4995|ERX|HCPCS J1030|00009-3073-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.45|PHR: 408101; CHG: 26||Not reimbursed separately|17.45|PHR: 408101; CHG: 26||External grouping not supported 4995|ERX|HCPCS J1030|00703-0031-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.45|PHR: 408101; CHG: 26||Not reimbursed separately|17.45|PHR: 408101; CHG: 26||External grouping not supported 4995|ERX|HCPCS J1030|00703-0031-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.45|PHR: 408101; CHG: 26||Not reimbursed separately|17.45|PHR: 408101; CHG: 26||External grouping not supported 4996|ERX|HCPCS J1040|00009-3475-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|10.72|PHR: 408101; CHG: 26||Not reimbursed separately|10.72|PHR: 408101; CHG: 26||External grouping not supported 4996|ERX|HCPCS J1040|00703-0051-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.72|PHR: 408101; CHG: 26||Not reimbursed separately|10.72|PHR: 408101; CHG: 26||External grouping not supported 4996|ERX|HCPCS J1040|00703-0051-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.72|PHR: 408101; CHG: 26||Not reimbursed separately|10.72|PHR: 408101; CHG: 26||External grouping not supported 4996|ERX|HCPCS J1040|00009-3475-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21.44|PHR: 408101; CHG: 26||Not reimbursed separately|21.44|PHR: 408101; CHG: 26||External grouping not supported 5002|ERX|HCPCS J2765|00409-3414-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 5002|ERX|HCPCS J2765|00703-4502-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 5002|ERX|HCPCS J2765|00703-4502-81|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 5002|ERX|HCPCS J2765|23155-0240-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 5002|ERX|HCPCS J2765|00703-4502-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 5002|ERX|HCPCS J2765|00703-4502-84|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.76|PHR: 408101; CHG: 26||Not reimbursed separately|8.76|PHR: 408101; CHG: 26||External grouping not supported 5004|ERX|HCPCS A9270|00121-1576-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 5005|ERX|HCPCS A9270|00093-2203-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 5005|ERX|HCPCS A9270|51079-0888-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 5005|ERX|HCPCS A9270|51079-0888-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 5005|ERX|HCPCS A9270|68084-0676-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 5005|ERX|HCPCS A9270|68084-0676-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 5006|ERX|HCPCS A9270|00093-2204-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 5006|ERX|HCPCS A9270|51079-0886-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 5006|ERX|HCPCS A9270|63739-0103-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOCLOPRAMIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|00143-9660-01|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|00143-9873-01|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|00143-9873-25|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|00409-1778-05|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|00409-1778-15|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|36000-0033-10|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|47781-0587-17|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|47781-0587-20|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|63323-0660-05|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|70860-0300-05|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|70860-0300-41|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|72611-0740-01|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5007|ERX|HCPCS RX001|72611-0740-10|0250 - PHARMACY - GENERAL CLASSIFICATION|METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION|2.5 mL|HUMANA [1294]||HUMANA [11839]|0.76|PHR: 408101; CHG: 26||Not reimbursed separately|0.76|PHR: 408101; CHG: 26||External grouping not supported 5008|ERX|HCPCS A9270|62584-0267-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 5009|ERX|HCPCS A9270|51079-0801-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 5009|ERX|HCPCS A9270|51079-0801-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 5009|ERX|HCPCS A9270|57664-0477-52|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 5009|ERX|HCPCS A9270|62584-0266-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METOPROLOL TARTRATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 5015|ERX|HCPCS A9270|00904-1453-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.78|PHR: 408101; CHG: 26||Not reimbursed separately|0.78|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|29300-0227-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|42292-0001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|42292-0001-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|50111-0334-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|60687-0550-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|60687-0550-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5016|ERX|HCPCS A9270|68001-0365-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|METRONIDAZOLE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|00264-5535-32|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|00338-1055-48|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|00338-9541-24|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|00409-7811-24|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|00409-7811-37|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|25021-0131-82|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5018|ERX|HCPCS RX001|36000-0001-24|0250 - PHARMACY - GENERAL CLASSIFICATION|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 5039|ERX|HCPCS A9270|11701-0045-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL CREAM|142 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.26|PHR: 408101; CHG: 26||Not reimbursed separately|32.26|PHR: 408101; CHG: 26||External grouping not supported 5039|ERX|HCPCS A9270|00472-0735-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.38|PHR: 408101; CHG: 26||Not reimbursed separately|5.38|PHR: 408101; CHG: 26||External grouping not supported 5039|ERX|HCPCS A9270|51672-2001-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % TOPICAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.76|PHR: 408101; CHG: 26||Not reimbursed separately|10.76|PHR: 408101; CHG: 26||External grouping not supported 5040|ERX|HCPCS A9270|00472-0730-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % VAGINAL CREAM|45 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.47|PHR: 408101; CHG: 26||Not reimbursed separately|16.47|PHR: 408101; CHG: 26||External grouping not supported 5040|ERX|HCPCS A9270|00904-7734-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MICONAZOLE NITRATE 2 % VAGINAL CREAM|45 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.47|PHR: 408101; CHG: 26||Not reimbursed separately|16.47|PHR: 408101; CHG: 26||External grouping not supported 5086|ERX|HCPCS A9270|99999-1111-94|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINERAL OIL ORAL|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.89|PHR: 408101; CHG: 26||Not reimbursed separately|1.89|PHR: 408101; CHG: 26||External grouping not supported 5086|ERX|HCPCS A9270|48433-0202-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINERAL OIL ORAL|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.89|PHR: 408101; CHG: 26||Not reimbursed separately|1.89|PHR: 408101; CHG: 26||External grouping not supported 5087|ERX|HCPCS RX001|00132-0301-40|0250 - PHARMACY - GENERAL CLASSIFICATION|MINERAL OIL ENEMA|1 Enema|HUMANA [1294]||HUMANA [11839]|4.79|PHR: 408101; CHG: 26||Not reimbursed separately|4.79|PHR: 408101; CHG: 26||External grouping not supported 5110|ERX|HCPCS A9270|00591-5695-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOCYCLINE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.23|PHR: 408101; CHG: 26||Not reimbursed separately|1.23|PHR: 408101; CHG: 26||External grouping not supported 5111|ERX|HCPCS A9270|00591-5694-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOCYCLINE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 5111|ERX|HCPCS A9270|13668-0482-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOCYCLINE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 5114|ERX|HCPCS A9270|00591-5643-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOXIDIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 5114|ERX|HCPCS A9270|49884-0257-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOXIDIL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 5115|ERX|HCPCS A9270|00591-5642-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOXIDIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 5115|ERX|HCPCS A9270|68084-0204-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOXIDIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 5115|ERX|HCPCS A9270|68084-0204-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MINOXIDIL 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.14|PHR: 408101; CHG: 26||Not reimbursed separately|1.14|PHR: 408101; CHG: 26||External grouping not supported 5168|ERX|HCPCS J2270|63323-0451-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 10 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.67|PHR: 408101; CHG: 26||Not reimbursed separately|3.67|PHR: 408101; CHG: 26||External grouping not supported 5172|ERX|HCPCS J2270|76045-0005-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 4 MG/ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.06|PHR: 408101; CHG: 26||Not reimbursed separately|2.06|PHR: 408101; CHG: 26||External grouping not supported 5175|ERX|HCPCS J2270|76045-0007-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 8 MG/ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.61|PHR: 408101; CHG: 26||Not reimbursed separately|2.61|PHR: 408101; CHG: 26||External grouping not supported 5176|ERX|HCPCS A9270|68094-0001-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 10 MG/5 ML ORAL SOLUTION|1.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 5176|ERX|HCPCS A9270|00054-0237-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 10 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 5176|ERX|HCPCS A9270|68094-0001-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 10 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.11|PHR: 408101; CHG: 26||Not reimbursed separately|3.11|PHR: 408101; CHG: 26||External grouping not supported 5177|ERX|HCPCS A9270|00054-0238-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|0.7 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 5178|ERX|HCPCS A9270|00054-0235-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 5178|ERX|HCPCS A9270|00054-0235-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 5179|ERX|HCPCS A9270|00054-0236-24|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 30 MG IMMEDIATE RELEASE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.79|PHR: 408101; CHG: 26||Not reimbursed separately|1.79|PHR: 408101; CHG: 26||External grouping not supported 5180|ERX|HCPCS A9270|00574-7112-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MORPHINE 10 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.12|PHR: 408101; CHG: 26||Not reimbursed separately|13.12|PHR: 408101; CHG: 26||External grouping not supported 5184|ERX|HCPCS RX001|00406-1521-53|0250 - PHARMACY - GENERAL CLASSIFICATION|MORPHINE (BULK) 100 % POWDER|5 g|HUMANA [1294]||HUMANA [11839]|78.63|PHR: 408101; CHG: 26||Not reimbursed separately|78.63|PHR: 408101; CHG: 26||External grouping not supported 5330|ERX|HCPCS A9270|60687-0302-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NADOLOL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.97|PHR: 408101; CHG: 26||Not reimbursed separately|5.97|PHR: 408101; CHG: 26||External grouping not supported 5330|ERX|HCPCS A9270|60687-0302-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NADOLOL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.97|PHR: 408101; CHG: 26||Not reimbursed separately|5.97|PHR: 408101; CHG: 26||External grouping not supported 5331|ERX|HCPCS A9270|51079-0813-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NADOLOL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.17|PHR: 408101; CHG: 26||Not reimbursed separately|7.17|PHR: 408101; CHG: 26||External grouping not supported 5331|ERX|HCPCS A9270|60687-0313-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NADOLOL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.17|PHR: 408101; CHG: 26||Not reimbursed separately|7.17|PHR: 408101; CHG: 26||External grouping not supported 5331|ERX|HCPCS A9270|60687-0313-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NADOLOL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.17|PHR: 408101; CHG: 26||Not reimbursed separately|7.17|PHR: 408101; CHG: 26||External grouping not supported 5333|ERX|HCPCS RX001|25021-0139-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 5333|ERX|HCPCS RX001|55150-0122-15|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 5333|ERX|HCPCS RX001|63323-0327-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 5333|ERX|HCPCS RX001|70860-0116-26|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 5333|ERX|HCPCS RX001|70860-0116-41|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA [1294]||HUMANA [11839]|11.70|PHR: 408101; CHG: 26||Not reimbursed separately|11.70|PHR: 408101; CHG: 26||External grouping not supported 5334|ERX|HCPCS RX001|44567-0223-01|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA [1294]||HUMANA [11839]|113.37|PHR: 408101; CHG: 26||Not reimbursed separately|113.37|PHR: 408101; CHG: 26||External grouping not supported 5334|ERX|HCPCS RX001|63323-0330-60|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA [1294]||HUMANA [11839]|113.37|PHR: 408101; CHG: 26||Not reimbursed separately|113.37|PHR: 408101; CHG: 26||External grouping not supported 5334|ERX|HCPCS RX001|70860-0119-99|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA [1294]||HUMANA [11839]|113.37|PHR: 408101; CHG: 26||Not reimbursed separately|113.37|PHR: 408101; CHG: 26||External grouping not supported 5335|ERX|HCPCS RX001|55150-0123-15|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA [1294]||HUMANA [11839]|20.46|PHR: 408101; CHG: 26||Not reimbursed separately|20.46|PHR: 408101; CHG: 26||External grouping not supported 5335|ERX|HCPCS RX001|63323-0328-20|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA [1294]||HUMANA [11839]|20.46|PHR: 408101; CHG: 26||Not reimbursed separately|20.46|PHR: 408101; CHG: 26||External grouping not supported 5335|ERX|HCPCS RX001|63323-0328-21|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA [1294]||HUMANA [11839]|20.46|PHR: 408101; CHG: 26||Not reimbursed separately|20.46|PHR: 408101; CHG: 26||External grouping not supported 5335|ERX|HCPCS RX001|63323-0328-22|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA [1294]||HUMANA [11839]|20.46|PHR: 408101; CHG: 26||Not reimbursed separately|20.46|PHR: 408101; CHG: 26||External grouping not supported 5335|ERX|HCPCS RX001|70860-0117-26|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA [1294]||HUMANA [11839]|20.46|PHR: 408101; CHG: 26||Not reimbursed separately|20.46|PHR: 408101; CHG: 26||External grouping not supported 5335|ERX|HCPCS RX001|70860-0117-41|0250 - PHARMACY - GENERAL CLASSIFICATION|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA [1294]||HUMANA [11839]|20.46|PHR: 408101; CHG: 26||Not reimbursed separately|20.46|PHR: 408101; CHG: 26||External grouping not supported 5339|ERX|HCPCS J2300|00409-1463-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALBUPHINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|9.41|PHR: 408101; CHG: 26||Not reimbursed separately|9.41|PHR: 408101; CHG: 26||External grouping not supported 5340|ERX|HCPCS J2300|00409-1465-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALBUPHINE 20 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|14.77|PHR: 408101; CHG: 26||Not reimbursed separately|14.77|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|00409-1215-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|00409-1219-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|00641-6132-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|00641-6132-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|67457-0292-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|67457-0292-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|67457-0599-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|67457-0599-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|70069-0071-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5373|ERX|HCPCS J2310|70069-0071-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 0.4 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.76|PHR: 408101; CHG: 26||Not reimbursed separately|2.76|PHR: 408101; CHG: 26||External grouping not supported 5374|ERX|HCPCS J2310|76329-3469-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 1 MG/ML INJECTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.90|PHR: 408101; CHG: 26||Not reimbursed separately|32.90|PHR: 408101; CHG: 26||External grouping not supported 5374|ERX|HCPCS J2310|76329-3369-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|NALOXONE 1 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.90|PHR: 408101; CHG: 26||Not reimbursed separately|32.90|PHR: 408101; CHG: 26||External grouping not supported 5384|ERX|HCPCS A9270|00065-0085-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.50|PHR: 408101; CHG: 26||Not reimbursed separately|13.50|PHR: 408101; CHG: 26||External grouping not supported 5391|ERX|HCPCS A9270|50268-0594-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 5391|ERX|HCPCS A9270|50268-0594-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 5391|ERX|HCPCS A9270|68462-0188-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.49|PHR: 408101; CHG: 26||Not reimbursed separately|0.49|PHR: 408101; CHG: 26||External grouping not supported 5392|ERX|HCPCS A9270|50268-0595-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 375 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 5392|ERX|HCPCS A9270|68462-0189-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 375 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 5393|ERX|HCPCS A9270|60687-0268-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 5393|ERX|HCPCS A9270|60687-0491-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 5393|ERX|HCPCS A9270|60687-0491-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 5393|ERX|HCPCS A9270|68462-0190-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.48|PHR: 408101; CHG: 26||Not reimbursed separately|0.48|PHR: 408101; CHG: 26||External grouping not supported 5394|ERX|HCPCS A9270|53746-0193-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN SODIUM 275 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.61|PHR: 408101; CHG: 26||Not reimbursed separately|3.61|PHR: 408101; CHG: 26||External grouping not supported 5395|ERX|HCPCS A9270|53746-0194-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NAPROXEN SODIUM 550 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.62|PHR: 408101; CHG: 26||Not reimbursed separately|5.62|PHR: 408101; CHG: 26||External grouping not supported 5472|ERX|HCPCS A9270|00093-1177-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 5472|ERX|HCPCS A9270|39822-0310-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 5472|ERX|HCPCS A9270|39822-0310-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 5475|ERX|HCPCS RX015|24208-0631-10|0250 - PHARMACY - GENERAL CLASSIFICATION|NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|207.36|PHR: 408101; CHG: 26||Not reimbursed separately|207.36|PHR: 408101; CHG: 26||External grouping not supported 5536|ERX|HCPCS A9270|10006-0700-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIACIN ER 250 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 5540|ERX|HCPCS A9270|54629-0710-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIACIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 5540|ERX|HCPCS A9270|79854-0201-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIACIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 5542|ERX|HCPCS A9270|00904-2272-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIACIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 5545|ERX|HCPCS A9270|47335-0539-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 5558|ERX|HCPCS A9270|59762-1004-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 5558|ERX|HCPCS A9270|60687-0425-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 5558|ERX|HCPCS A9270|68084-0022-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 5558|ERX|HCPCS A9270|68084-0022-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 5558|ERX|HCPCS A9270|69315-0211-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NIFEDIPINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.35|PHR: 408101; CHG: 26||Not reimbursed separately|2.35|PHR: 408101; CHG: 26||External grouping not supported 5595|ERX|HCPCS A9270|00115-1643-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 5595|ERX|HCPCS A9270|00904-7026-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 5595|ERX|HCPCS A9270|47781-0307-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 5595|ERX|HCPCS A9270|60687-0472-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 5595|ERX|HCPCS A9270|60687-0472-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 5601|ERX|HCPCS A9270|49483-0222-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN ER 6.5 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 5601|ERX|HCPCS A9270|49483-0222-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN ER 6.5 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.06|PHR: 408101; CHG: 26||Not reimbursed separately|1.06|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|00071-0418-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|43598-0436-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|43598-0436-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|59762-3304-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|68462-0639-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|68462-0639-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5604|ERX|HCPCS A9270|68462-0639-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 5606|ERX|HCPCS A9270|00281-0326-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.10|PHR: 408101; CHG: 26||Not reimbursed separately|6.10|PHR: 408101; CHG: 26||External grouping not supported 5606|ERX|HCPCS A9270|00281-0326-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.79|PHR: 408101; CHG: 26||Not reimbursed separately|182.79|PHR: 408101; CHG: 26||External grouping not supported 5674|ERX|HCPCS A9270|51672-4001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 5674|ERX|HCPCS A9270|51672-4001-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 5675|ERX|HCPCS A9270|51672-4002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 5675|ERX|HCPCS A9270|60687-0293-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 5675|ERX|HCPCS A9270|60687-0293-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 5676|ERX|HCPCS A9270|51672-4003-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 5677|ERX|HCPCS A9270|51672-4004-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 5677|ERX|HCPCS A9270|51672-4004-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NORTRIPTYLINE 75 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 5749|ERX|HCPCS A9270|00316-0221-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.67|PHR: 408101; CHG: 26||Not reimbursed separately|10.67|PHR: 408101; CHG: 26||External grouping not supported 5749|ERX|HCPCS A9270|00713-0678-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.67|PHR: 408101; CHG: 26||Not reimbursed separately|10.67|PHR: 408101; CHG: 26||External grouping not supported 5749|ERX|HCPCS A9270|45802-0059-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.67|PHR: 408101; CHG: 26||Not reimbursed separately|10.67|PHR: 408101; CHG: 26||External grouping not supported 5750|ERX|HCPCS A9270|00168-0007-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.02|PHR: 408101; CHG: 26||Not reimbursed separately|7.02|PHR: 408101; CHG: 26||External grouping not supported 5750|ERX|HCPCS A9270|00472-0166-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.02|PHR: 408101; CHG: 26||Not reimbursed separately|7.02|PHR: 408101; CHG: 26||External grouping not supported 5750|ERX|HCPCS A9270|00713-0686-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.02|PHR: 408101; CHG: 26||Not reimbursed separately|7.02|PHR: 408101; CHG: 26||External grouping not supported 5750|ERX|HCPCS A9270|45802-0048-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.02|PHR: 408101; CHG: 26||Not reimbursed separately|7.02|PHR: 408101; CHG: 26||External grouping not supported 5751|ERX|HCPCS A9270|00121-4785-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 5751|ERX|HCPCS A9270|60432-0537-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 5751|ERX|HCPCS A9270|66689-0008-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 5751|ERX|HCPCS A9270|66689-0037-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 5751|ERX|HCPCS A9270|66689-0037-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 5751|ERX|HCPCS A9270|68094-0599-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.64|PHR: 408101; CHG: 26||Not reimbursed separately|1.64|PHR: 408101; CHG: 26||External grouping not supported 5754|ERX|HCPCS A9270|00168-0081-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.86|PHR: 408101; CHG: 26||Not reimbursed separately|9.86|PHR: 408101; CHG: 26||External grouping not supported 5754|ERX|HCPCS A9270|00472-0150-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.86|PHR: 408101; CHG: 26||Not reimbursed separately|9.86|PHR: 408101; CHG: 26||External grouping not supported 5754|ERX|HCPCS A9270|45802-0880-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.86|PHR: 408101; CHG: 26||Not reimbursed separately|9.86|PHR: 408101; CHG: 26||External grouping not supported 5754|ERX|HCPCS A9270|51672-1263-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.86|PHR: 408101; CHG: 26||Not reimbursed separately|9.86|PHR: 408101; CHG: 26||External grouping not supported 5755|ERX|HCPCS A9270|45802-0244-94|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 5755|ERX|HCPCS A9270|51672-1272-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.21|PHR: 408101; CHG: 26||Not reimbursed separately|15.21|PHR: 408101; CHG: 26||External grouping not supported 5886|ERX|HCPCS J2360|17478-0538-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|9.13|PHR: 408101; CHG: 26||Not reimbursed separately|9.13|PHR: 408101; CHG: 26||External grouping not supported 5930|ERX|HCPCS A9270|62584-0812-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXAZEPAM 10 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.15|PHR: 408101; CHG: 26||Not reimbursed separately|4.15|PHR: 408101; CHG: 26||External grouping not supported 5931|ERX|HCPCS A9270|62584-0813-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.64|PHR: 408101; CHG: 26||Not reimbursed separately|4.64|PHR: 408101; CHG: 26||External grouping not supported 5932|ERX|HCPCS A9270|00228-2073-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.72|PHR: 408101; CHG: 26||Not reimbursed separately|2.72|PHR: 408101; CHG: 26||External grouping not supported 5938|ERX|HCPCS A9270|00904-2821-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.01|PHR: 408101; CHG: 26||Not reimbursed separately|1.01|PHR: 408101; CHG: 26||External grouping not supported 5938|ERX|HCPCS A9270|68084-0400-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.01|PHR: 408101; CHG: 26||Not reimbursed separately|1.01|PHR: 408101; CHG: 26||External grouping not supported 5938|ERX|HCPCS A9270|68084-0400-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.01|PHR: 408101; CHG: 26||Not reimbursed separately|1.01|PHR: 408101; CHG: 26||External grouping not supported 5940|ERX|HCPCS A9270|00406-0512-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 5940|ERX|HCPCS A9270|00904-6437-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 5940|ERX|HCPCS A9270|68084-0355-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 5940|ERX|HCPCS A9270|68084-0355-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 5943|ERX|HCPCS A9270|00904-6761-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.97|PHR: 408101; CHG: 26||Not reimbursed separately|2.97|PHR: 408101; CHG: 26||External grouping not supported 5943|ERX|HCPCS A9270|24385-0352-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.97|PHR: 408101; CHG: 26||Not reimbursed separately|2.97|PHR: 408101; CHG: 26||External grouping not supported 5943|ERX|HCPCS A9270|45802-0410-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.97|PHR: 408101; CHG: 26||Not reimbursed separately|2.97|PHR: 408101; CHG: 26||External grouping not supported 5943|ERX|HCPCS A9270|87701-0435-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.97|PHR: 408101; CHG: 26||Not reimbursed separately|2.97|PHR: 408101; CHG: 26||External grouping not supported 5944|ERX|HCPCS J2590|42023-0116-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 10 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 5944|ERX|HCPCS J2590|42023-0116-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 10 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 5944|ERX|HCPCS J2590|63323-0012-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 10 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 5944|ERX|HCPCS J2590|63323-0012-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 10 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 5944|ERX|HCPCS J2590|63323-0012-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OXYTOCIN 10 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|8.30|PHR: 408101; CHG: 26||Not reimbursed separately|8.30|PHR: 408101; CHG: 26||External grouping not supported 6013|ERX|HCPCS RX001|00409-4646-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|2.71|PHR: 408101; CHG: 26||Not reimbursed separately|2.71|PHR: 408101; CHG: 26||External grouping not supported 6030|ERX|HCPCS J2440|00517-4002-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PAPAVERINE 30 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|84.77|PHR: 408101; CHG: 26||Not reimbursed separately|84.77|PHR: 408101; CHG: 26||External grouping not supported 6086|ERX|HCPCS J2540|00049-0420-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|2.5 Million Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.32|PHR: 408101; CHG: 26||Not reimbursed separately|16.32|PHR: 408101; CHG: 26||External grouping not supported 6086|ERX|HCPCS J2540|00049-0520-84|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|2.5 Million Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.32|PHR: 408101; CHG: 26||Not reimbursed separately|16.32|PHR: 408101; CHG: 26||External grouping not supported 6086|ERX|HCPCS J2540|00049-0520-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HUMANA [1294]||HUMANA [11839]|16.32|PHR: 408101; CHG: 26||Not reimbursed separately|16.32|PHR: 408101; CHG: 26||External grouping not supported 6087|ERX|HCPCS RX001|00781-6153-94|0250 - PHARMACY - GENERAL CLASSIFICATION|PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION|0.6 Million Units|HUMANA [1294]||HUMANA [11839]|76.75|PHR: 408101; CHG: 26||Not reimbursed separately|76.75|PHR: 408101; CHG: 26||External grouping not supported 6087|ERX|HCPCS RX001|00781-6153-95|0250 - PHARMACY - GENERAL CLASSIFICATION|PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HUMANA [1294]||HUMANA [11839]|76.75|PHR: 408101; CHG: 26||Not reimbursed separately|76.75|PHR: 408101; CHG: 26||External grouping not supported 6091|ERX|HCPCS A9270|00093-4127-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.95|PHR: 408101; CHG: 26||Not reimbursed separately|0.95|PHR: 408101; CHG: 26||External grouping not supported 6092|ERX|HCPCS A9270|00093-1172-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.53|PHR: 408101; CHG: 26||Not reimbursed separately|1.53|PHR: 408101; CHG: 26||External grouping not supported 6092|ERX|HCPCS A9270|00781-1205-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.53|PHR: 408101; CHG: 26||Not reimbursed separately|1.53|PHR: 408101; CHG: 26||External grouping not supported 6093|ERX|HCPCS A9270|00781-1655-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 6093|ERX|HCPCS A9270|57237-0041-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 6093|ERX|HCPCS A9270|65862-0176-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENICILLIN V POTASSIUM 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 6157|ERX|HCPCS Q0175|00378-5350-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 6157|ERX|HCPCS Q0175|00591-4101-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 6157|ERX|HCPCS Q0175|00781-1046-13|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 2 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 6157|ERX|HCPCS Q0175|00904-6599-61|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.46|PHR: 408101; CHG: 26||Not reimbursed separately|2.46|PHR: 408101; CHG: 26||External grouping not supported 6158|ERX|HCPCS Q0175|00378-5351-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 6158|ERX|HCPCS Q0175|68084-0602-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 6158|ERX|HCPCS Q0175|68084-0602-11|0250 - PHARMACY - GENERAL CLASSIFICATION|PERPHENAZINE 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.29|PHR: 408101; CHG: 26||Not reimbursed separately|2.29|PHR: 408101; CHG: 26||External grouping not supported 6159|ERX|HCPCS A9270|00378-5352-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERPHENAZINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.98|PHR: 408101; CHG: 26||Not reimbursed separately|2.98|PHR: 408101; CHG: 26||External grouping not supported 6159|ERX|HCPCS A9270|00781-1048-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERPHENAZINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.98|PHR: 408101; CHG: 26||Not reimbursed separately|2.98|PHR: 408101; CHG: 26||External grouping not supported 6159|ERX|HCPCS A9270|00904-6601-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERPHENAZINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.98|PHR: 408101; CHG: 26||Not reimbursed separately|2.98|PHR: 408101; CHG: 26||External grouping not supported 6159|ERX|HCPCS A9270|68084-0607-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERPHENAZINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.98|PHR: 408101; CHG: 26||Not reimbursed separately|2.98|PHR: 408101; CHG: 26||External grouping not supported 6159|ERX|HCPCS A9270|68084-0607-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PERPHENAZINE 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.98|PHR: 408101; CHG: 26||Not reimbursed separately|2.98|PHR: 408101; CHG: 26||External grouping not supported 6193|ERX|HCPCS A9270|10135-0620-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENAZOPYRIDINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.21|PHR: 408101; CHG: 26||Not reimbursed separately|1.21|PHR: 408101; CHG: 26||External grouping not supported 6193|ERX|HCPCS A9270|42937-0701-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENAZOPYRIDINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.21|PHR: 408101; CHG: 26||Not reimbursed separately|1.21|PHR: 408101; CHG: 26||External grouping not supported 6193|ERX|HCPCS A9270|51293-0810-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENAZOPYRIDINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.21|PHR: 408101; CHG: 26||Not reimbursed separately|1.21|PHR: 408101; CHG: 26||External grouping not supported 6193|ERX|HCPCS A9270|69367-0162-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENAZOPYRIDINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.21|PHR: 408101; CHG: 26||Not reimbursed separately|1.21|PHR: 408101; CHG: 26||External grouping not supported 6194|ERX|HCPCS A9270|51293-0811-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENAZOPYRIDINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.59|PHR: 408101; CHG: 26||Not reimbursed separately|1.59|PHR: 408101; CHG: 26||External grouping not supported 6212|ERX|HCPCS A9270|00603-1508-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.09|PHR: 408101; CHG: 26||Not reimbursed separately|3.09|PHR: 408101; CHG: 26||External grouping not supported 6215|ERX|HCPCS A9270|00603-5165-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 16.2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 6217|ERX|HCPCS A9270|00904-6575-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 32.4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.56|PHR: 408101; CHG: 26||Not reimbursed separately|1.56|PHR: 408101; CHG: 26||External grouping not supported 6219|ERX|HCPCS A9270|13517-0112-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 64.8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.45|PHR: 408101; CHG: 26||Not reimbursed separately|1.45|PHR: 408101; CHG: 26||External grouping not supported 6219|ERX|HCPCS A9270|51293-0627-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENOBARBITAL 64.8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.45|PHR: 408101; CHG: 26||Not reimbursed separately|1.45|PHR: 408101; CHG: 26||External grouping not supported 622|ERX|HCPCS A9270|00904-4215-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARGININE (L-ARGININE) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 6221|ERX|HCPCS J2560|00641-0477-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.67|PHR: 408101; CHG: 26||Not reimbursed separately|71.67|PHR: 408101; CHG: 26||External grouping not supported 6221|ERX|HCPCS J2560|00641-0477-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71.67|PHR: 408101; CHG: 26||Not reimbursed separately|71.67|PHR: 408101; CHG: 26||External grouping not supported 6224|ERX|HCPCS J2560|00641-0476-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.23|PHR: 408101; CHG: 26||Not reimbursed separately|55.23|PHR: 408101; CHG: 26||External grouping not supported 6224|ERX|HCPCS J2560|00641-0476-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|55.23|PHR: 408101; CHG: 26||Not reimbursed separately|55.23|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|00641-6142-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|00641-6142-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|00641-6229-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|42023-0213-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|42023-0213-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|42023-0214-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|42023-0214-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|63323-0751-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|63323-0751-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|70121-1577-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|70121-1578-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|71288-0807-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|76014-0004-32|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.39|PHR: 408101; CHG: 26||Not reimbursed separately|8.39|PHR: 408101; CHG: 26||External grouping not supported 6242|ERX|HCPCS J2370|76014-0004-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.09|PHR: 408101; CHG: 26||Not reimbursed separately|27.09|PHR: 408101; CHG: 26||External grouping not supported 6243|ERX|HCPCS A9270|00225-0800-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.25 % NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.78|PHR: 408101; CHG: 26||Not reimbursed separately|8.78|PHR: 408101; CHG: 26||External grouping not supported 6243|ERX|HCPCS A9270|50323-0006-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.25 % NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.78|PHR: 408101; CHG: 26||Not reimbursed separately|8.78|PHR: 408101; CHG: 26||External grouping not supported 6243|ERX|HCPCS A9270|69536-0025-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.25 % NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.78|PHR: 408101; CHG: 26||Not reimbursed separately|8.78|PHR: 408101; CHG: 26||External grouping not supported 6244|ERX|HCPCS A9270|00225-0805-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.5 % NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.91|PHR: 408101; CHG: 26||Not reimbursed separately|8.91|PHR: 408101; CHG: 26||External grouping not supported 6244|ERX|HCPCS A9270|50323-0006-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.5 % NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.91|PHR: 408101; CHG: 26||Not reimbursed separately|8.91|PHR: 408101; CHG: 26||External grouping not supported 6244|ERX|HCPCS A9270|69536-0050-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.5 % NASAL SPRAY|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.91|PHR: 408101; CHG: 26||Not reimbursed separately|8.91|PHR: 408101; CHG: 26||External grouping not supported 6244|ERX|HCPCS A9270|69536-0050-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYLEPHRINE 0.5 % NASAL SPRAY|21 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.82|PHR: 408101; CHG: 26||Not reimbursed separately|17.82|PHR: 408101; CHG: 26||External grouping not supported 6246|ERX|HCPCS RX001|99999-5555-49|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 2.5 % EYE DROPS|0.05 mL|HUMANA [1294]||HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 6246|ERX|HCPCS RX001|17478-0201-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 2.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|249.30|PHR: 408101; CHG: 26||Not reimbursed separately|249.30|PHR: 408101; CHG: 26||External grouping not supported 6246|ERX|HCPCS RX001|42702-0102-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 2.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|249.30|PHR: 408101; CHG: 26||Not reimbursed separately|249.30|PHR: 408101; CHG: 26||External grouping not supported 6246|ERX|HCPCS RX001|17478-0201-02|0250 - PHARMACY - GENERAL CLASSIFICATION|PHENYLEPHRINE 2.5 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|33.24|PHR: 408101; CHG: 26||Not reimbursed separately|33.24|PHR: 408101; CHG: 26||External grouping not supported 6255|ERX|HCPCS A9270|51672-4069-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 125 MG/5 ML ORAL SUSPENSION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 6255|ERX|HCPCS A9270|66689-0775-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN 125 MG/5 ML ORAL SUSPENSION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 6256|ERX|HCPCS J1165|00641-0493-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 6256|ERX|HCPCS J1165|00641-0493-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 6256|ERX|HCPCS J1165|00641-2555-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 6256|ERX|HCPCS J1165|00641-2555-45|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 6257|ERX|HCPCS A9270|00378-1560-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 6257|ERX|HCPCS A9270|51079-0905-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 6257|ERX|HCPCS A9270|51672-4111-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 6257|ERX|HCPCS A9270|68084-0376-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 6257|ERX|HCPCS A9270|68084-0376-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 6270|ERX|HCPCS RX001|17478-0510-02|0250 - PHARMACY - GENERAL CLASSIFICATION|PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|108.22|PHR: 408101; CHG: 26||Not reimbursed separately|108.22|PHR: 408101; CHG: 26||External grouping not supported 6271|ERX|HCPCS J3430|76329-1240-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.40|PHR: 408101; CHG: 26||Not reimbursed separately|57.40|PHR: 408101; CHG: 26||External grouping not supported 6279|ERX|HCPCS RX001|17478-0223-12|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 1 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|129.33|PHR: 408101; CHG: 26||Not reimbursed separately|129.33|PHR: 408101; CHG: 26||External grouping not supported 6279|ERX|HCPCS RX001|61314-0203-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 1 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|129.33|PHR: 408101; CHG: 26||Not reimbursed separately|129.33|PHR: 408101; CHG: 26||External grouping not supported 6279|ERX|HCPCS RX001|70069-0181-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 1 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|129.33|PHR: 408101; CHG: 26||Not reimbursed separately|129.33|PHR: 408101; CHG: 26||External grouping not supported 6280|ERX|HCPCS RX001|99999-1111-76|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 2 % EYE DROPS|0.5 mL|HUMANA [1294]||HUMANA [11839]|4.44|PHR: 408101; CHG: 26||Not reimbursed separately|4.44|PHR: 408101; CHG: 26||External grouping not supported 6280|ERX|HCPCS RX001|00998-0204-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 2 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|133.20|PHR: 408101; CHG: 26||Not reimbursed separately|133.20|PHR: 408101; CHG: 26||External grouping not supported 6280|ERX|HCPCS RX001|17478-0224-12|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 2 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|133.20|PHR: 408101; CHG: 26||Not reimbursed separately|133.20|PHR: 408101; CHG: 26||External grouping not supported 6280|ERX|HCPCS RX001|61314-0204-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 2 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|133.20|PHR: 408101; CHG: 26||Not reimbursed separately|133.20|PHR: 408101; CHG: 26||External grouping not supported 6280|ERX|HCPCS RX001|70069-0191-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 2 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|133.20|PHR: 408101; CHG: 26||Not reimbursed separately|133.20|PHR: 408101; CHG: 26||External grouping not supported 6282|ERX|HCPCS RX001|61314-0206-15|0250 - PHARMACY - GENERAL CLASSIFICATION|PILOCARPINE 4 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|219.74|PHR: 408101; CHG: 26||Not reimbursed separately|219.74|PHR: 408101; CHG: 26||External grouping not supported 6297|ERX|HCPCS A9270|29033-0028-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PINDOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 6297|ERX|HCPCS A9270|57664-0655-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PINDOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 6297|ERX|HCPCS A9270|76385-0131-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PINDOLOL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.90|PHR: 408101; CHG: 26||Not reimbursed separately|1.90|PHR: 408101; CHG: 26||External grouping not supported 6311|ERX|HCPCS A9270|42543-0115-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIROXICAM 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 6311|ERX|HCPCS A9270|42571-0177-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIROXICAM 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 6311|ERX|HCPCS A9270|59762-0145-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PIROXICAM 20 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 6393|ERX|HCPCS RX001|63323-0367-01|0250 - PHARMACY - GENERAL CLASSIFICATION|POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION|500,000 Units|HUMANA [1294]||HUMANA [11839]|11.48|PHR: 408101; CHG: 26||Not reimbursed separately|11.48|PHR: 408101; CHG: 26||External grouping not supported 6393|ERX|HCPCS RX001|63323-0367-11|0250 - PHARMACY - GENERAL CLASSIFICATION|POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION|500,000 Units|HUMANA [1294]||HUMANA [11839]|11.48|PHR: 408101; CHG: 26||Not reimbursed separately|11.48|PHR: 408101; CHG: 26||External grouping not supported 6420|ERX|HCPCS RX001|51754-2001-04|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|7.44|PHR: 408101; CHG: 26||Not reimbursed separately|7.44|PHR: 408101; CHG: 26||External grouping not supported 6420|ERX|HCPCS RX001|00409-3294-51|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|27.45|PHR: 408101; CHG: 26||Not reimbursed separately|27.45|PHR: 408101; CHG: 26||External grouping not supported 6423|ERX|HCPCS A9270|50201-2400-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM BICARBONATE-CITRIC ACID 25 MEQ EFFERVESCENT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 6423|ERX|HCPCS A9270|51801-0001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM BICARBONATE-CITRIC ACID 25 MEQ EFFERVESCENT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 6423|ERX|HCPCS A9270|51801-0001-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM BICARBONATE-CITRIC ACID 25 MEQ EFFERVESCENT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 6423|ERX|HCPCS A9270|51801-0007-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM BICARBONATE-CITRIC ACID 25 MEQ EFFERVESCENT TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|00409-6651-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|00409-6651-19|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|63323-0965-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|63323-0965-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.31|PHR: 408101; CHG: 26||Not reimbursed separately|2.31|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|00409-6653-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|00409-6653-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|63323-0965-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 6429|ERX|HCPCS J3480|63323-0965-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.66|PHR: 408101; CHG: 26||Not reimbursed separately|3.66|PHR: 408101; CHG: 26||External grouping not supported 6431|ERX|HCPCS A9270|62037-0559-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE ER 8 MEQ CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.64|PHR: 408101; CHG: 26||Not reimbursed separately|0.64|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|00121-1680-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|00121-1680-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|00603-1542-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|60687-0341-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|66689-0047-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|99999-4444-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.35|PHR: 408101; CHG: 26||Not reimbursed separately|10.35|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|60505-6184-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.20|PHR: 408101; CHG: 26||Not reimbursed separately|119.20|PHR: 408101; CHG: 26||External grouping not supported 6432|ERX|HCPCS A9270|69238-1459-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.20|PHR: 408101; CHG: 26||Not reimbursed separately|119.20|PHR: 408101; CHG: 26||External grouping not supported 6434|ERX|HCPCS RX015|69238-1617-01|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE 20 MEQ ORAL PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|4.37|PHR: 408101; CHG: 26||Not reimbursed separately|4.37|PHR: 408101; CHG: 26||External grouping not supported 6434|ERX|HCPCS RX015|69238-1617-03|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM CHLORIDE 20 MEQ ORAL PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|4.37|PHR: 408101; CHG: 26||Not reimbursed separately|4.37|PHR: 408101; CHG: 26||External grouping not supported 6445|ERX|HCPCS A9270|71740-0112-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|984.15|PHR: 408101; CHG: 26||Not reimbursed separately|984.15|PHR: 408101; CHG: 26||External grouping not supported 6451|ERX|HCPCS RX001|00409-7295-01|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|38.03|PHR: 408101; CHG: 26||Not reimbursed separately|38.03|PHR: 408101; CHG: 26||External grouping not supported 6451|ERX|HCPCS RX001|00409-7295-11|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|38.03|PHR: 408101; CHG: 26||Not reimbursed separately|38.03|PHR: 408101; CHG: 26||External grouping not supported 6451|ERX|HCPCS RX001|63323-0086-15|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|38.03|PHR: 408101; CHG: 26||Not reimbursed separately|38.03|PHR: 408101; CHG: 26||External grouping not supported 6451|ERX|HCPCS RX001|63323-0086-05|0250 - PHARMACY - GENERAL CLASSIFICATION|POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|23.88|PHR: 408101; CHG: 26||Not reimbursed separately|23.88|PHR: 408101; CHG: 26||External grouping not supported 6455|ERX|HCPCS A9270|00904-1102-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 10 % TOPICAL OINTMENT|28.35 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 6458|ERX|HCPCS A9270|67618-0150-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 10 % TOPICAL SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.24|PHR: 408101; CHG: 26||Not reimbursed separately|3.24|PHR: 408101; CHG: 26||External grouping not supported 6458|ERX|HCPCS A9270|67618-0150-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 10 % TOPICAL SOLUTION|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.36|PHR: 408101; CHG: 26||Not reimbursed separately|11.36|PHR: 408101; CHG: 26||External grouping not supported 6458|ERX|HCPCS A9270|52380-1905-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POVIDONE-IODINE 10 % TOPICAL SOLUTION|59 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.25|PHR: 408101; CHG: 26||Not reimbursed separately|4.25|PHR: 408101; CHG: 26||External grouping not supported 6462|ERX|HCPCS J2730|60977-0141-27|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION|0.25 g|HUMANA [1294]||HUMANA [11839]|239.69|PHR: 408101; CHG: 26||Not reimbursed separately|239.69|PHR: 408101; CHG: 26||External grouping not supported 6462|ERX|HCPCS J2730|60977-0141-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]||HUMANA [11839]|239.69|PHR: 408101; CHG: 26||Not reimbursed separately|239.69|PHR: 408101; CHG: 26||External grouping not supported 6468|ERX|HCPCS A9270|51079-0630-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.87|PHR: 408101; CHG: 26||Not reimbursed separately|2.87|PHR: 408101; CHG: 26||External grouping not supported 6468|ERX|HCPCS A9270|51079-0630-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.87|PHR: 408101; CHG: 26||Not reimbursed separately|2.87|PHR: 408101; CHG: 26||External grouping not supported 6468|ERX|HCPCS A9270|68084-0996-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.87|PHR: 408101; CHG: 26||Not reimbursed separately|2.87|PHR: 408101; CHG: 26||External grouping not supported 6469|ERX|HCPCS A9270|51079-0631-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.81|PHR: 408101; CHG: 26||Not reimbursed separately|3.81|PHR: 408101; CHG: 26||External grouping not supported 6469|ERX|HCPCS A9270|51079-0631-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.81|PHR: 408101; CHG: 26||Not reimbursed separately|3.81|PHR: 408101; CHG: 26||External grouping not supported 6469|ERX|HCPCS A9270|68084-0997-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.81|PHR: 408101; CHG: 26||Not reimbursed separately|3.81|PHR: 408101; CHG: 26||External grouping not supported 6469|ERX|HCPCS A9270|68084-0997-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 2 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.81|PHR: 408101; CHG: 26||Not reimbursed separately|3.81|PHR: 408101; CHG: 26||External grouping not supported 6470|ERX|HCPCS A9270|51079-0632-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.90|PHR: 408101; CHG: 26||Not reimbursed separately|7.90|PHR: 408101; CHG: 26||External grouping not supported 6470|ERX|HCPCS A9270|51079-0632-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRAZOSIN 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.90|PHR: 408101; CHG: 26||Not reimbursed separately|7.90|PHR: 408101; CHG: 26||External grouping not supported 6487|ERX|HCPCS RX001|60758-0119-10|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|0.05 mL|HUMANA [1294]||HUMANA [11839]|390.63|PHR: 408101; CHG: 26||Not reimbursed separately|390.63|PHR: 408101; CHG: 26||External grouping not supported 6487|ERX|HCPCS RX001|11980-0180-10|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|10 mL|HUMANA [1294]||HUMANA [11839]|781.26|PHR: 408101; CHG: 26||Not reimbursed separately|781.26|PHR: 408101; CHG: 26||External grouping not supported 6487|ERX|HCPCS RX001|61314-0637-10|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|10 mL|HUMANA [1294]||HUMANA [11839]|781.26|PHR: 408101; CHG: 26||Not reimbursed separately|781.26|PHR: 408101; CHG: 26||External grouping not supported 6487|ERX|HCPCS RX001|11980-0180-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|390.63|PHR: 408101; CHG: 26||Not reimbursed separately|390.63|PHR: 408101; CHG: 26||External grouping not supported 6487|ERX|HCPCS RX001|60758-0119-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|390.63|PHR: 408101; CHG: 26||Not reimbursed separately|390.63|PHR: 408101; CHG: 26||External grouping not supported 6487|ERX|HCPCS RX001|61314-0637-05|0250 - PHARMACY - GENERAL CLASSIFICATION|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HUMANA [1294]||HUMANA [11839]|390.63|PHR: 408101; CHG: 26||Not reimbursed separately|390.63|PHR: 408101; CHG: 26||External grouping not supported 6492|ERX|HCPCS J7512|00054-3722-63|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|7.50|PHR: 408101; CHG: 26||Not reimbursed separately|7.50|PHR: 408101; CHG: 26||External grouping not supported 6492|ERX|HCPCS J7512|99999-3333-77|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.50|PHR: 408101; CHG: 26||Not reimbursed separately|7.50|PHR: 408101; CHG: 26||External grouping not supported 6493|ERX|HCPCS J7512|00054-8739-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 6493|ERX|HCPCS J7512|59746-0171-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.44|PHR: 408101; CHG: 26||Not reimbursed separately|0.44|PHR: 408101; CHG: 26||External grouping not supported 6494|ERX|HCPCS J7512|00054-0017-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 6494|ERX|HCPCS J7512|59746-0173-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 6494|ERX|HCPCS J7512|60687-0134-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 6494|ERX|HCPCS J7512|60687-0134-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 6494|ERX|HCPCS J7512|63739-0519-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 6496|ERX|HCPCS J7512|00054-0018-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 6496|ERX|HCPCS J7512|59746-0175-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 6496|ERX|HCPCS J7512|59746-0175-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 6496|ERX|HCPCS J7512|60687-0145-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 6496|ERX|HCPCS J7512|60687-0145-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 6496|ERX|HCPCS J7512|63739-0588-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 6497|ERX|HCPCS J7512|00054-8724-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 6497|ERX|HCPCS J7512|00378-0640-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 6497|ERX|HCPCS J7512|60687-0122-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 6497|ERX|HCPCS J7512|60687-0122-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 6497|ERX|HCPCS J7512|63739-0518-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PREDNISONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.32|PHR: 408101; CHG: 26||Not reimbursed separately|0.32|PHR: 408101; CHG: 26||External grouping not supported 6498|ERX|HCPCS J7512|00054-0019-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREDNISONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 6498|ERX|HCPCS J7512|00054-0019-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PREDNISONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.69|PHR: 408101; CHG: 26||Not reimbursed separately|0.69|PHR: 408101; CHG: 26||External grouping not supported 654|ERX|HCPCS RX001|67457-0118-50|0250 - PHARMACY - GENERAL CLASSIFICATION|ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|4.97|PHR: 408101; CHG: 26||Not reimbursed separately|4.97|PHR: 408101; CHG: 26||External grouping not supported 6541|ERX|HCPCS A9270|00024-1596-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMAQUINE 26.3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.39|PHR: 408101; CHG: 26||Not reimbursed separately|3.39|PHR: 408101; CHG: 26||External grouping not supported 6541|ERX|HCPCS A9270|76385-0102-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMAQUINE 26.3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.39|PHR: 408101; CHG: 26||Not reimbursed separately|3.39|PHR: 408101; CHG: 26||External grouping not supported 6544|ERX|HCPCS A9270|00527-1231-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.54|PHR: 408101; CHG: 26||Not reimbursed separately|1.54|PHR: 408101; CHG: 26||External grouping not supported 6544|ERX|HCPCS A9270|53746-0545-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.54|PHR: 408101; CHG: 26||Not reimbursed separately|1.54|PHR: 408101; CHG: 26||External grouping not supported 6544|ERX|HCPCS A9270|68084-0203-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.54|PHR: 408101; CHG: 26||Not reimbursed separately|1.54|PHR: 408101; CHG: 26||External grouping not supported 6544|ERX|HCPCS A9270|68084-0203-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PRIMIDONE 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.54|PHR: 408101; CHG: 26||Not reimbursed separately|1.54|PHR: 408101; CHG: 26||External grouping not supported 6561|ERX|HCPCS A9270|00527-1367-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROBENECID 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.81|PHR: 408101; CHG: 26||Not reimbursed separately|1.81|PHR: 408101; CHG: 26||External grouping not supported 6562|ERX|HCPCS J2690|00409-1902-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|207.81|PHR: 408101; CHG: 26||Not reimbursed separately|207.81|PHR: 408101; CHG: 26||External grouping not supported 6563|ERX|HCPCS J2690|00409-1903-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCAINAMIDE 500 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|153.27|PHR: 408101; CHG: 26||Not reimbursed separately|153.27|PHR: 408101; CHG: 26||External grouping not supported 6563|ERX|HCPCS J2690|00409-1903-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCAINAMIDE 500 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|153.27|PHR: 408101; CHG: 26||Not reimbursed separately|153.27|PHR: 408101; CHG: 26||External grouping not supported 6563|ERX|HCPCS J2690|14789-0900-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCAINAMIDE 500 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|153.27|PHR: 408101; CHG: 26||Not reimbursed separately|153.27|PHR: 408101; CHG: 26||External grouping not supported 6563|ERX|HCPCS J2690|14789-0900-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCAINAMIDE 500 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|153.27|PHR: 408101; CHG: 26||Not reimbursed separately|153.27|PHR: 408101; CHG: 26||External grouping not supported 6582|ERX|HCPCS Q0164|51079-0542-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE MALEATE 10 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 6582|ERX|HCPCS Q0164|51079-0542-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE MALEATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 6582|ERX|HCPCS Q0164|59746-0115-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROCHLORPERAZINE MALEATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.25|PHR: 408101; CHG: 26||Not reimbursed separately|1.25|PHR: 408101; CHG: 26||External grouping not supported 6583|ERX|HCPCS Q0164|59746-0113-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PROCHLORPERAZINE MALEATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.84|PHR: 408101; CHG: 26||Not reimbursed separately|0.84|PHR: 408101; CHG: 26||External grouping not supported 6597|ERX|HCPCS J2675|00143-9725-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6597|ERX|HCPCS J2675|63323-0261-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL|0.1 mL|HUMANA [1294]||HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-0928-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-1495-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-1495-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-6082-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-6084-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-6208-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-6208-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6618|ERX|HCPCS J2550|00641-0928-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 25 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|2.50|PHR: 408101; CHG: 26||Not reimbursed separately|2.50|PHR: 408101; CHG: 26||External grouping not supported 6619|ERX|HCPCS J2550|00641-1496-31|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 50 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.46|PHR: 408101; CHG: 26||Not reimbursed separately|1.46|PHR: 408101; CHG: 26||External grouping not supported 6619|ERX|HCPCS J2550|00641-1496-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROMETHAZINE 50 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.46|PHR: 408101; CHG: 26||Not reimbursed separately|1.46|PHR: 408101; CHG: 26||External grouping not supported 6620|ERX|HCPCS A9270|60432-0608-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.60|PHR: 408101; CHG: 26||Not reimbursed separately|0.60|PHR: 408101; CHG: 26||External grouping not supported 6622|ERX|HCPCS A9270|00904-6461-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 6624|ERX|HCPCS A9270|00713-0132-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 50 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.35|PHR: 408101; CHG: 26||Not reimbursed separately|68.35|PHR: 408101; CHG: 26||External grouping not supported 6624|ERX|HCPCS A9270|40085-0220-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 50 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.35|PHR: 408101; CHG: 26||Not reimbursed separately|68.35|PHR: 408101; CHG: 26||External grouping not supported 6627|ERX|HCPCS A9270|50383-0804-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 6627|ERX|HCPCS A9270|60432-0606-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 6627|ERX|HCPCS A9270|99999-1111-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROMETHAZINE 6.25 MG-CODEINE 10 MG/5 ML SYRUP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.30|PHR: 408101; CHG: 26||Not reimbursed separately|0.30|PHR: 408101; CHG: 26||External grouping not supported 664|ERX|HCPCS A9270|00904-0523-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 664|ERX|HCPCS A9270|87701-0407-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 664|ERX|HCPCS A9270|87701-0407-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 664|ERX|HCPCS A9270|99999-5555-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 6644|ERX|HCPCS RX001|17478-0263-12|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPARACAINE 0.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|86.94|PHR: 408101; CHG: 26||Not reimbursed separately|86.94|PHR: 408101; CHG: 26||External grouping not supported 6644|ERX|HCPCS RX001|24208-0730-06|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPARACAINE 0.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|86.94|PHR: 408101; CHG: 26||Not reimbursed separately|86.94|PHR: 408101; CHG: 26||External grouping not supported 6644|ERX|HCPCS RX001|61314-0016-01|0250 - PHARMACY - GENERAL CLASSIFICATION|PROPARACAINE 0.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|86.94|PHR: 408101; CHG: 26||Not reimbursed separately|86.94|PHR: 408101; CHG: 26||External grouping not supported 6654|ERX|HCPCS A9270|00054-3727-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.19|PHR: 408101; CHG: 26||Not reimbursed separately|1.19|PHR: 408101; CHG: 26||External grouping not supported 6656|ERX|HCPCS A9270|00115-1659-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 6656|ERX|HCPCS A9270|00591-5554-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 6656|ERX|HCPCS A9270|00591-5554-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 6656|ERX|HCPCS A9270|00904-6550-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 6657|ERX|HCPCS A9270|00115-1660-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 6657|ERX|HCPCS A9270|00591-5555-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 6657|ERX|HCPCS A9270|00603-5483-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 6657|ERX|HCPCS A9270|60687-0306-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 6658|ERX|HCPCS A9270|00115-1661-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 6658|ERX|HCPCS A9270|00591-5556-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 6658|ERX|HCPCS A9270|00603-5484-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPRANOLOL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 6662|ERX|HCPCS A9270|00228-2348-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPYLTHIOURACIL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 6662|ERX|HCPCS A9270|67253-0651-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROPYLTHIOURACIL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 6677|ERX|HCPCS J2720|63323-0229-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 6677|ERX|HCPCS J2720|63323-0229-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 6677|ERX|HCPCS J2720|63323-0229-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 6677|ERX|HCPCS J2720|63323-0229-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 6677|ERX|HCPCS J2720|63323-0229-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.25|PHR: 408101; CHG: 26||Not reimbursed separately|5.25|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|00536-3607-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|00904-5053-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|24385-0432-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|24385-0432-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|45802-0432-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|46122-0428-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|87701-0429-67|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|87701-0601-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6714|ERX|HCPCS A9270|87701-0910-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PSEUDOEPHEDRINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 6738|ERX|HCPCS A9270|61748-0012-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRAZINAMIDE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.52|PHR: 408101; CHG: 26||Not reimbursed separately|5.52|PHR: 408101; CHG: 26||External grouping not supported 6738|ERX|HCPCS A9270|61748-0012-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRAZINAMIDE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.52|PHR: 408101; CHG: 26||Not reimbursed separately|5.52|PHR: 408101; CHG: 26||External grouping not supported 6744|ERX|HCPCS J3415|63323-0180-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|8.17|PHR: 408101; CHG: 26||Not reimbursed separately|8.17|PHR: 408101; CHG: 26||External grouping not supported 6745|ERX|HCPCS A9270|37864-0910-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6745|ERX|HCPCS A9270|50268-0859-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6745|ERX|HCPCS A9270|50268-0859-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6745|ERX|HCPCS A9270|51645-0910-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6745|ERX|HCPCS A9270|80681-0025-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 6748|ERX|HCPCS A9270|37864-0909-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 6748|ERX|HCPCS A9270|51645-0909-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 6748|ERX|HCPCS A9270|77333-0940-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 6748|ERX|HCPCS A9270|77333-0940-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.38|PHR: 408101; CHG: 26||Not reimbursed separately|0.38|PHR: 408101; CHG: 26||External grouping not supported 6782|ERX|HCPCS A9270|68084-0947-32|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUININE 324 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.28|PHR: 408101; CHG: 26||Not reimbursed separately|10.28|PHR: 408101; CHG: 26||External grouping not supported 6782|ERX|HCPCS A9270|68084-0947-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUININE 324 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10.28|PHR: 408101; CHG: 26||Not reimbursed separately|10.28|PHR: 408101; CHG: 26||External grouping not supported 679|ERX|HCPCS A9270|00904-6794-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 679|ERX|HCPCS A9270|24385-0278-68|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 679|ERX|HCPCS A9270|63739-0434-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 679|ERX|HCPCS A9270|66553-0002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.07|PHR: 408101; CHG: 26||Not reimbursed separately|0.07|PHR: 408101; CHG: 26||External grouping not supported 681|ERX|HCPCS A9270|57896-0901-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 681|ERX|HCPCS A9270|66553-0001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 681|ERX|HCPCS A9270|87701-0426-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 325 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.16|PHR: 408101; CHG: 26||Not reimbursed separately|0.16|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|00904-6751-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|43292-0564-29|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|46122-0180-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|46122-0180-87|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|46122-0598-48|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|63739-0522-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|63739-0522-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|69618-0046-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|87701-0408-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 688|ERX|HCPCS A9270|87701-0539-29|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 81 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.02|PHR: 408101; CHG: 26||Not reimbursed separately|0.02|PHR: 408101; CHG: 26||External grouping not supported 693|ERX|HCPCS A9270|00574-7034-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 300 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 696|ERX|HCPCS A9270|00574-7036-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN 600 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 70261|ERX|HCPCS J1815|00169-3687-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN DETEMIR (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.59|PHR: 408101; CHG: 26||Not reimbursed separately|289.59|PHR: 408101; CHG: 26||External grouping not supported 7028|ERX|HCPCS RX001|00409-1966-05|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.58|PHR: 408101; CHG: 26||Not reimbursed separately|2.58|PHR: 408101; CHG: 26||External grouping not supported 7028|ERX|HCPCS RX001|00409-1966-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 7028|ERX|HCPCS RX001|00409-1966-07|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 70287|ERX|HCPCS J0129|00003-2187-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION|250 mg|HUMANA [1294]||HUMANA [11839]|4,223.40|PHR: 408101; CHG: 26||Not reimbursed separately|4,223.40|PHR: 408101; CHG: 26||External grouping not supported 70306|ERX|HCPCS A9270|43598-0554-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 70306|ERX|HCPCS A9270|62332-0097-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 70306|ERX|HCPCS A9270|62332-0097-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 70306|ERX|HCPCS A9270|65862-0661-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 70306|ERX|HCPCS A9270|67877-0430-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ARIPIPRAZOLE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 7035|ERX|HCPCS A9270|51293-0804-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SALSALATE 750 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.91|PHR: 408101; CHG: 26||Not reimbursed separately|0.91|PHR: 408101; CHG: 26||External grouping not supported 70392|ERX|HCPCS A9270|24208-0317-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFACETAMIDE-PREDNISOLONE 10 %-0.23 % (0.25 %) EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.41|PHR: 408101; CHG: 26||Not reimbursed separately|31.41|PHR: 408101; CHG: 26||External grouping not supported 70397|ERX|HCPCS A9270|00054-0229-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 70397|ERX|HCPCS A9270|00904-6639-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 70397|ERX|HCPCS A9270|60505-3132-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 70397|ERX|HCPCS A9270|60687-0338-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 70397|ERX|HCPCS A9270|60687-0338-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 70424|ERX|HCPCS A9270|00069-0550-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUNITINIB 12.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.90|PHR: 408101; CHG: 26||Not reimbursed separately|354.90|PHR: 408101; CHG: 26||External grouping not supported 70434|ERX|HCPCS A9270|27241-0125-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 70434|ERX|HCPCS A9270|45963-0418-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 70434|ERX|HCPCS A9270|61958-1003-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.26|PHR: 408101; CHG: 26||Not reimbursed separately|1.26|PHR: 408101; CHG: 26||External grouping not supported 70472|ERX|HCPCS A9270|64764-0240-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LUBIPROSTONE 24 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.93|PHR: 408101; CHG: 26||Not reimbursed separately|16.93|PHR: 408101; CHG: 26||External grouping not supported 70498|ERX|HCPCS RX001|08065-1837-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CHONDROITIN SULF-SODIUM HYALURONATE 40 MG-17 MG/ML INTRAOCULAR SYRINGE|1 mL|HUMANA [1294]||HUMANA [11839]|269.25|PHR: 408101; CHG: 26||Not reimbursed separately|269.25|PHR: 408101; CHG: 26||External grouping not supported 70536|ERX|HCPCS A9270|00054-3270-99|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.69|PHR: 408101; CHG: 26||Not reimbursed separately|8.69|PHR: 408101; CHG: 26||External grouping not supported 70536|ERX|HCPCS A9270|50383-0700-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.69|PHR: 408101; CHG: 26||Not reimbursed separately|8.69|PHR: 408101; CHG: 26||External grouping not supported 70536|ERX|HCPCS A9270|60505-0829-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.69|PHR: 408101; CHG: 26||Not reimbursed separately|8.69|PHR: 408101; CHG: 26||External grouping not supported 70544|ERX|HCPCS J1740|25021-0822-73|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE|1 Each|HUMANA [1294]||HUMANA [11839]|243.84|PHR: 408101; CHG: 26||Not reimbursed separately|243.84|PHR: 408101; CHG: 26||External grouping not supported 70544|ERX|HCPCS J1740|25021-0827-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.84|PHR: 408101; CHG: 26||Not reimbursed separately|243.84|PHR: 408101; CHG: 26||External grouping not supported 70544|ERX|HCPCS J1740|55150-0191-83|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.84|PHR: 408101; CHG: 26||Not reimbursed separately|243.84|PHR: 408101; CHG: 26||External grouping not supported 70544|ERX|HCPCS J1740|60505-6097-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.84|PHR: 408101; CHG: 26||Not reimbursed separately|243.84|PHR: 408101; CHG: 26||External grouping not supported 70544|ERX|HCPCS J1740|67457-0524-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.84|PHR: 408101; CHG: 26||Not reimbursed separately|243.84|PHR: 408101; CHG: 26||External grouping not supported 70579|ERX|HCPCS A9270|55111-0364-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OMEPRAZOLE 40 MG-SODIUM BICARBONATE 1.1 GRAM CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.51|PHR: 408101; CHG: 26||Not reimbursed separately|7.51|PHR: 408101; CHG: 26||External grouping not supported 70678|ERX|HCPCS RX001|39822-1201-02|0250 - PHARMACY - GENERAL CLASSIFICATION|NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|18.25|PHR: 408101; CHG: 26||Not reimbursed separately|18.25|PHR: 408101; CHG: 26||External grouping not supported 70838|ERX|HCPCS A9270|45802-0626-26|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 1 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 70838|ERX|HCPCS A9270|51991-0837-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 1 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 70838|ERX|HCPCS A9270|54838-0552-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 1 MG/ML ORAL SOLUTION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7137|ERX|HCPCS RX001|00517-6510-25|0250 - PHARMACY - GENERAL CLASSIFICATION|SELENIUM 40 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|3.95|PHR: 408101; CHG: 26||Not reimbursed separately|3.95|PHR: 408101; CHG: 26||External grouping not supported 716|ERX|HCPCS A9270|00093-0753-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 716|ERX|HCPCS A9270|00378-0757-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 716|ERX|HCPCS A9270|51079-0685-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 716|ERX|HCPCS A9270|51079-0685-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 716|ERX|HCPCS A9270|68382-0024-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 717|ERX|HCPCS A9270|00093-0787-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 717|ERX|HCPCS A9270|00378-0218-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 717|ERX|HCPCS A9270|51079-0759-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 717|ERX|HCPCS A9270|51079-0759-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 717|ERX|HCPCS A9270|68382-0022-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 717|ERX|HCPCS A9270|68382-0022-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 718|ERX|HCPCS A9270|00093-0752-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 718|ERX|HCPCS A9270|51079-0684-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 718|ERX|HCPCS A9270|51079-0684-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 718|ERX|HCPCS A9270|68382-0023-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATENOLOL 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 7224|ERX|HCPCS A9270|61570-0131-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILVER SULFADIAZINE 1 % TOPICAL CREAM|400 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|PHR: 408101; CHG: 26||Not reimbursed separately|240.00|PHR: 408101; CHG: 26||External grouping not supported 7224|ERX|HCPCS A9270|67877-0124-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILVER SULFADIAZINE 1 % TOPICAL CREAM|400 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|PHR: 408101; CHG: 26||Not reimbursed separately|240.00|PHR: 408101; CHG: 26||External grouping not supported 7224|ERX|HCPCS A9270|43598-0210-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILVER SULFADIAZINE 1 % TOPICAL CREAM|50 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.00|PHR: 408101; CHG: 26||Not reimbursed separately|30.00|PHR: 408101; CHG: 26||External grouping not supported 7224|ERX|HCPCS A9270|61570-0131-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILVER SULFADIAZINE 1 % TOPICAL CREAM|50 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.00|PHR: 408101; CHG: 26||Not reimbursed separately|30.00|PHR: 408101; CHG: 26||External grouping not supported 7224|ERX|HCPCS A9270|67877-0124-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SILVER SULFADIAZINE 1 % TOPICAL CREAM|50 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.00|PHR: 408101; CHG: 26||Not reimbursed separately|30.00|PHR: 408101; CHG: 26||External grouping not supported 7227|ERX|HCPCS A9270|00904-5068-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7227|ERX|HCPCS A9270|24385-0118-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7227|ERX|HCPCS A9270|37864-0860-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7227|ERX|HCPCS A9270|57896-0791-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7227|ERX|HCPCS A9270|63739-0225-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7227|ERX|HCPCS A9270|87701-0703-44|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 7228|ERX|HCPCS A9270|00536-2220-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 7228|ERX|HCPCS A9270|00904-5894-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 7228|ERX|HCPCS A9270|46122-0547-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 7228|ERX|HCPCS A9270|56184-0120-41|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 7228|ERX|HCPCS A9270|99999-4444-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 7242|ERX|HCPCS A9270|00395-2661-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SIMPLE SYRUP|473 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29.80|PHR: 408101; CHG: 26||Not reimbursed separately|29.80|PHR: 408101; CHG: 26||External grouping not supported 730|ERX|HCPCS J0461|00409-1630-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.1 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.74|PHR: 408101; CHG: 26||Not reimbursed separately|4.74|PHR: 408101; CHG: 26||External grouping not supported 730|ERX|HCPCS J0461|00409-4910-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.1 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.74|PHR: 408101; CHG: 26||Not reimbursed separately|4.74|PHR: 408101; CHG: 26||External grouping not supported 730|ERX|HCPCS J0461|00409-4911-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.1 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.74|PHR: 408101; CHG: 26||Not reimbursed separately|4.74|PHR: 408101; CHG: 26||External grouping not supported 730|ERX|HCPCS J0461|00409-4911-34|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.1 MG/ML INJECTION SYRINGE|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.74|PHR: 408101; CHG: 26||Not reimbursed separately|4.74|PHR: 408101; CHG: 26||External grouping not supported 730|ERX|HCPCS J0461|76329-3339-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.1 MG/ML INJECTION SYRINGE|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23.79|PHR: 408101; CHG: 26||Not reimbursed separately|23.79|PHR: 408101; CHG: 26||External grouping not supported 7301|ERX|HCPCS RX001|00409-7299-73|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|8.22|PHR: 408101; CHG: 26||Not reimbursed separately|8.22|PHR: 408101; CHG: 26||External grouping not supported 7301|ERX|HCPCS RX001|00409-7299-83|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|8.22|PHR: 408101; CHG: 26||Not reimbursed separately|8.22|PHR: 408101; CHG: 26||External grouping not supported 7306|ERX|HCPCS RX001|00409-5534-34|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE|100 mL|HUMANA [1294]||HUMANA [11839]|270.00|PHR: 408101; CHG: 26||Not reimbursed separately|270.00|PHR: 408101; CHG: 26||External grouping not supported 7309|ERX|HCPCS RX001|00409-6637-34|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE|50 mL|HUMANA [1294]||HUMANA [11839]|22.80|PHR: 408101; CHG: 26||Not reimbursed separately|22.80|PHR: 408101; CHG: 26||External grouping not supported 7309|ERX|HCPCS RX001|76329-3352-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE|50 mL|HUMANA [1294]||HUMANA [11839]|22.80|PHR: 408101; CHG: 26||Not reimbursed separately|22.80|PHR: 408101; CHG: 26||External grouping not supported 731|ERX|HCPCS J0461|00641-6006-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.4 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.60|PHR: 408101; CHG: 26||Not reimbursed separately|12.60|PHR: 408101; CHG: 26||External grouping not supported 731|ERX|HCPCS J0461|00517-0401-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.4 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.60|PHR: 408101; CHG: 26||Not reimbursed separately|12.60|PHR: 408101; CHG: 26||External grouping not supported 731|ERX|HCPCS J0461|00641-6006-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 0.4 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.60|PHR: 408101; CHG: 26||Not reimbursed separately|12.60|PHR: 408101; CHG: 26||External grouping not supported 7312|ERX|HCPCS A9270|00223-1721-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM BICARBONATE 650 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 7312|ERX|HCPCS A9270|66553-0008-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM BICARBONATE 650 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.19|PHR: 408101; CHG: 26||Not reimbursed separately|0.19|PHR: 408101; CHG: 26||External grouping not supported 7317|ERX|HCPCS RX001|08290-3065-00|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|08290-3065-46|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|08290-3065-47|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|63807-0100-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|63807-0100-91|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|64253-0111-30|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|10 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|08290-3065-45|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|5 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7317|ERX|HCPCS RX001|08881-5701-25|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE|5 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7318|ERX|HCPCS RX004|00338-0043-04|0258 - PHARMACY - IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7318|ERX|HCPCS RX004|00338-0043-03|0258 - PHARMACY - IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-02|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-10|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-12|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|63323-0186-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|63323-0186-10|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|1.08|PHR: 408101; CHG: 26||Not reimbursed separately|1.08|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-03|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-20|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|63323-0186-03|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|63323-0186-20|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|20 mL|HUMANA [1294]||HUMANA [11839]|2.70|PHR: 408101; CHG: 26||Not reimbursed separately|2.70|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-06|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 7319|ERX|HCPCS RX001|00409-4888-50|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % INJECTION SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 7320|ERX|HCPCS J7131|00409-6657-73|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.42|PHR: 408101; CHG: 26||Not reimbursed separately|3.42|PHR: 408101; CHG: 26||External grouping not supported 7320|ERX|HCPCS J7131|00409-6660-75|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 2.5 MEQ/ML INTRAVENOUS SOLUTION|40 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.12|PHR: 408101; CHG: 26||Not reimbursed separately|3.12|PHR: 408101; CHG: 26||External grouping not supported 7321|ERX|HCPCS J7131|00264-7805-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 7321|ERX|HCPCS J7131|00338-0054-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION SOLUTION|500 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.00|PHR: 408101; CHG: 26||Not reimbursed separately|15.00|PHR: 408101; CHG: 26||External grouping not supported 7322|ERX|HCPCS RX001|63323-0088-61|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|17.70|PHR: 408101; CHG: 26||Not reimbursed separately|17.70|PHR: 408101; CHG: 26||External grouping not supported 7322|ERX|HCPCS RX001|63323-0187-30|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|6.93|PHR: 408101; CHG: 26||Not reimbursed separately|6.93|PHR: 408101; CHG: 26||External grouping not supported 7325|ERX|HCPCS RX001|00378-6986-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HUMANA [1294]||HUMANA [11839]|0.46|PHR: 408101; CHG: 26||Not reimbursed separately|0.46|PHR: 408101; CHG: 26||External grouping not supported 7325|ERX|HCPCS RX001|00378-6987-89|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|5 mL|HUMANA [1294]||HUMANA [11839]|0.77|PHR: 408101; CHG: 26||Not reimbursed separately|0.77|PHR: 408101; CHG: 26||External grouping not supported 7325|ERX|HCPCS RX001|00487-9302-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|5 mL|HUMANA [1294]||HUMANA [11839]|0.77|PHR: 408101; CHG: 26||Not reimbursed separately|0.77|PHR: 408101; CHG: 26||External grouping not supported 7325|ERX|HCPCS RX001|76204-0300-50|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|5 mL|HUMANA [1294]||HUMANA [11839]|0.77|PHR: 408101; CHG: 26||Not reimbursed separately|0.77|PHR: 408101; CHG: 26||External grouping not supported 7327|ERX|HCPCS A9270|00378-6997-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 3 % FOR NEBULIZATION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.85|PHR: 408101; CHG: 26||Not reimbursed separately|1.85|PHR: 408101; CHG: 26||External grouping not supported 7328|ERX|HCPCS A9270|00223-1760-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 1 GRAM TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 7331|ERX|HCPCS A9270|17478-0622-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 5 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.08|PHR: 408101; CHG: 26||Not reimbursed separately|26.08|PHR: 408101; CHG: 26||External grouping not supported 7331|ERX|HCPCS A9270|24208-0385-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 5 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.08|PHR: 408101; CHG: 26||Not reimbursed separately|26.08|PHR: 408101; CHG: 26||External grouping not supported 7331|ERX|HCPCS A9270|24208-0385-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 5 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.08|PHR: 408101; CHG: 26||Not reimbursed separately|26.08|PHR: 408101; CHG: 26||External grouping not supported 7332|ERX|HCPCS A9270|17478-0623-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 5 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.16|PHR: 408101; CHG: 26||Not reimbursed separately|16.16|PHR: 408101; CHG: 26||External grouping not supported 7332|ERX|HCPCS A9270|24208-0277-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM CHLORIDE 5 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.16|PHR: 408101; CHG: 26||Not reimbursed separately|16.16|PHR: 408101; CHG: 26||External grouping not supported 734|ERX|HCPCS J0461|00517-1010-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ATROPINE 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.74|PHR: 408101; CHG: 26||Not reimbursed separately|20.74|PHR: 408101; CHG: 26||External grouping not supported 735|ERX|HCPCS A9270|24208-0825-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATROPINE 1 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.89|PHR: 408101; CHG: 26||Not reimbursed separately|43.89|PHR: 408101; CHG: 26||External grouping not supported 7351|ERX|HCPCS RX001|00409-7391-72|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|58.73|PHR: 408101; CHG: 26||Not reimbursed separately|58.73|PHR: 408101; CHG: 26||External grouping not supported 7351|ERX|HCPCS RX001|00409-7391-82|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|58.73|PHR: 408101; CHG: 26||Not reimbursed separately|58.73|PHR: 408101; CHG: 26||External grouping not supported 7351|ERX|HCPCS RX001|63323-0170-15|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION|15 mL|HUMANA [1294]||HUMANA [11839]|58.73|PHR: 408101; CHG: 26||Not reimbursed separately|58.73|PHR: 408101; CHG: 26||External grouping not supported 7351|ERX|HCPCS RX001|63323-0170-05|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|23.88|PHR: 408101; CHG: 26||Not reimbursed separately|23.88|PHR: 408101; CHG: 26||External grouping not supported 7356|ERX|HCPCS A9270|10702-0036-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SODIUM POLYSTYRENE SULFONATE ORAL POWDER|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.65|PHR: 408101; CHG: 26||Not reimbursed separately|7.65|PHR: 408101; CHG: 26||External grouping not supported 7359|ERX|HCPCS A9270|24208-0670-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFACETAMIDE SODIUM 10 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.54|PHR: 408101; CHG: 26||Not reimbursed separately|95.54|PHR: 408101; CHG: 26||External grouping not supported 7359|ERX|HCPCS A9270|61314-0701-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFACETAMIDE SODIUM 10 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.54|PHR: 408101; CHG: 26||Not reimbursed separately|95.54|PHR: 408101; CHG: 26||External grouping not supported 736|ERX|HCPCS RX001|17478-0215-02|0250 - PHARMACY - GENERAL CLASSIFICATION|ATROPINE 1 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|141.90|PHR: 408101; CHG: 26||Not reimbursed separately|141.90|PHR: 408101; CHG: 26||External grouping not supported 736|ERX|HCPCS RX001|00065-0303-55|0250 - PHARMACY - GENERAL CLASSIFICATION|ATROPINE 1 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|141.90|PHR: 408101; CHG: 26||Not reimbursed separately|141.90|PHR: 408101; CHG: 26||External grouping not supported 736|ERX|HCPCS RX001|17478-0215-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ATROPINE 1 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|141.90|PHR: 408101; CHG: 26||Not reimbursed separately|141.90|PHR: 408101; CHG: 26||External grouping not supported 7364|ERX|HCPCS RX001|60267-0705-50|0250 - PHARMACY - GENERAL CLASSIFICATION|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|534.00|PHR: 408101; CHG: 26||Not reimbursed separately|534.00|PHR: 408101; CHG: 26||External grouping not supported 7413|ERX|HCPCS A9270|46287-0500-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SORBITOL 70 % SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 7413|ERX|HCPCS A9270|46287-0500-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SORBITOL 70 % SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 7413|ERX|HCPCS A9270|54162-0700-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SORBITOL 70 % SOLUTION|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.07|PHR: 408101; CHG: 26||Not reimbursed separately|2.07|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|51079-0103-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|51079-0103-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|53489-0143-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|53746-0511-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|53746-0511-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|59746-0216-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|59746-0216-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|60687-0465-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|60687-0465-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7437|ERX|HCPCS A9270|63739-0544-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.29|PHR: 408101; CHG: 26||Not reimbursed separately|0.29|PHR: 408101; CHG: 26||External grouping not supported 7439|ERX|HCPCS A9270|53489-0144-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.17|PHR: 408101; CHG: 26||Not reimbursed separately|2.17|PHR: 408101; CHG: 26||External grouping not supported 7439|ERX|HCPCS A9270|59762-5014-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.17|PHR: 408101; CHG: 26||Not reimbursed separately|2.17|PHR: 408101; CHG: 26||External grouping not supported 7485|ERX|HCPCS RX007|00338-0004-03|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7485|ERX|HCPCS RX007|00338-0004-04|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 7508|ERX|HCPCS J3000|39822-0706-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION|1 g|HUMANA [1294]||HUMANA [11839]|207.34|PHR: 408101; CHG: 26||Not reimbursed separately|207.34|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|00409-6629-12|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|00781-3411-70|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|00781-3411-95|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|69918-0700-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|70069-0301-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|70121-1581-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|0.3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7536|ERX|HCPCS J0330|00409-6629-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|53.01|PHR: 408101; CHG: 26||Not reimbursed separately|53.01|PHR: 408101; CHG: 26||External grouping not supported 7554|ERX|HCPCS RX015|00185-0757-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SULFADIAZINE 500 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|7.71|PHR: 408101; CHG: 26||Not reimbursed separately|7.71|PHR: 408101; CHG: 26||External grouping not supported 7555|ERX|HCPCS A9270|00904-2725-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 7556|ERX|HCPCS RX001|00703-9514-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 7556|ERX|HCPCS RX001|00703-9514-03|0250 - PHARMACY - GENERAL CLASSIFICATION|SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 7556|ERX|HCPCS RX001|70069-0362-01|0250 - PHARMACY - GENERAL CLASSIFICATION|SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 7556|ERX|HCPCS RX001|70069-0362-10|0250 - PHARMACY - GENERAL CLASSIFICATION|SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|18.87|PHR: 408101; CHG: 26||Not reimbursed separately|18.87|PHR: 408101; CHG: 26||External grouping not supported 7557|ERX|HCPCS A9270|50268-0728-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 7557|ERX|HCPCS A9270|50268-0728-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.57|PHR: 408101; CHG: 26||Not reimbursed separately|0.57|PHR: 408101; CHG: 26||External grouping not supported 7562|ERX|HCPCS A9270|00591-0796-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFASALAZINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 7562|ERX|HCPCS A9270|50268-0730-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFASALAZINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 7562|ERX|HCPCS A9270|50268-0730-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFASALAZINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 7562|ERX|HCPCS A9270|59762-5000-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFASALAZINE 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.74|PHR: 408101; CHG: 26||Not reimbursed separately|0.74|PHR: 408101; CHG: 26||External grouping not supported 7563|ERX|HCPCS A9270|59762-0104-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULFASALAZINE 500 MG TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.59|PHR: 408101; CHG: 26||Not reimbursed separately|0.59|PHR: 408101; CHG: 26||External grouping not supported 7579|ERX|HCPCS A9270|00591-5660-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULINDAC 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 7579|ERX|HCPCS A9270|53489-0479-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SULINDAC 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.42|PHR: 408101; CHG: 26||Not reimbursed separately|0.42|PHR: 408101; CHG: 26||External grouping not supported 76334|ERX|HCPCS J0881|55513-0032-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE|0.3 mL|HUMANA [1294]||HUMANA [11839]|3,251.74|PHR: 408101; CHG: 26||Not reimbursed separately|3,251.74|PHR: 408101; CHG: 26||External grouping not supported 76344|ERX|HCPCS J0348|00049-0114-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANIDULAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|109.68|PHR: 408101; CHG: 26||Not reimbursed separately|109.68|PHR: 408101; CHG: 26||External grouping not supported 76364|ERX|HCPCS J0894|16729-0224-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DECITABINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|503.16|PHR: 408101; CHG: 26||Not reimbursed separately|503.16|PHR: 408101; CHG: 26||External grouping not supported 76364|ERX|HCPCS J0894|43598-0427-37|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DECITABINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|503.16|PHR: 408101; CHG: 26||Not reimbursed separately|503.16|PHR: 408101; CHG: 26||External grouping not supported 76364|ERX|HCPCS J0894|47335-0361-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DECITABINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|503.16|PHR: 408101; CHG: 26||Not reimbursed separately|503.16|PHR: 408101; CHG: 26||External grouping not supported 76364|ERX|HCPCS J0894|47335-0361-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DECITABINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|503.16|PHR: 408101; CHG: 26||Not reimbursed separately|503.16|PHR: 408101; CHG: 26||External grouping not supported 76364|ERX|HCPCS J0894|55111-0556-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DECITABINE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|503.16|PHR: 408101; CHG: 26||Not reimbursed separately|503.16|PHR: 408101; CHG: 26||External grouping not supported 76472|ERX|HCPCS A9270|51672-2073-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 76472|ERX|HCPCS A9270|54838-0558-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LORATADINE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.56|PHR: 408101; CHG: 26||Not reimbursed separately|0.56|PHR: 408101; CHG: 26||External grouping not supported 76518|ERX|HCPCS 90736|00006-4963-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOSTER VACCINE LIVE (PF) 19,400 UNIT/0.65 ML SUBCUTANEOUS SUSPENSION|19,400 Units|HUMANA [1294]||HUMANA [11839]|654.15|PHR: 408101; CHG: 26||Not reimbursed separately|654.15|PHR: 408101; CHG: 26||External grouping not supported 76518|ERX|HCPCS 90736|00006-4963-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZOSTER VACCINE LIVE (PF) 19,400 UNIT/0.65 ML SUBCUTANEOUS SUSPENSION|19,400 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.15|PHR: 408101; CHG: 26||Not reimbursed separately|654.15|PHR: 408101; CHG: 26||External grouping not supported 767|ERX|HCPCS J7501|00143-9566-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZATHIOPRINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]||HUMANA [11839]|611.64|PHR: 408101; CHG: 26||Not reimbursed separately|611.64|PHR: 408101; CHG: 26||External grouping not supported 76718|ERX|HCPCS RX001|00003-0528-11|0250 - PHARMACY - GENERAL CLASSIFICATION|DASATINIB 50 MG TABLET|2 Tab|HUMANA [1294]||HUMANA [11839]|1,483.54|PHR: 408101; CHG: 26||Not reimbursed separately|1,483.54|PHR: 408101; CHG: 26||External grouping not supported 76835|ERX|HCPCS A9270|15584-0101-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|EFAVIRENZ 600 MG-EMTRICITABINE 200 MG-TENOFOVIR DISOPROX 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.24|PHR: 408101; CHG: 26||Not reimbursed separately|291.24|PHR: 408101; CHG: 26||External grouping not supported 76843|ERX|HCPCS J8501|00006-0464-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|PHR: 408101; CHG: 26||Not reimbursed separately|132.75|PHR: 408101; CHG: 26||External grouping not supported 76843|ERX|HCPCS J8501|00006-0464-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 40 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|132.75|PHR: 408101; CHG: 26||Not reimbursed separately|132.75|PHR: 408101; CHG: 26||External grouping not supported 76843|ERX|HCPCS J8501|00781-2321-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|PHR: 408101; CHG: 26||Not reimbursed separately|132.75|PHR: 408101; CHG: 26||External grouping not supported 76843|ERX|HCPCS J8501|68462-0583-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|APREPITANT 40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|PHR: 408101; CHG: 26||Not reimbursed separately|132.75|PHR: 408101; CHG: 26||External grouping not supported 76964|ERX|HCPCS J0881|55513-0057-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE|0.42 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.96|PHR: 408101; CHG: 26||Not reimbursed separately|541.96|PHR: 408101; CHG: 26||External grouping not supported 76965|ERX|HCPCS J0881|55513-0021-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.13|PHR: 408101; CHG: 26||Not reimbursed separately|867.13|PHR: 408101; CHG: 26||External grouping not supported 76965|ERX|HCPCS J0881|55513-0021-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE|0.4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.13|PHR: 408101; CHG: 26||Not reimbursed separately|867.13|PHR: 408101; CHG: 26||External grouping not supported 77009|ERX|HCPCS J2274|00641-6039-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE (PF) 10 MG/ML INJECTION SOLUTION|20 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.04|PHR: 408101; CHG: 26||Not reimbursed separately|575.04|PHR: 408101; CHG: 26||External grouping not supported 7711|ERX|HCPCS A9270|00378-0144-91|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMOXIFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.01|PHR: 408101; CHG: 26||Not reimbursed separately|1.01|PHR: 408101; CHG: 26||External grouping not supported 7711|ERX|HCPCS A9270|00591-2472-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMOXIFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.01|PHR: 408101; CHG: 26||Not reimbursed separately|1.01|PHR: 408101; CHG: 26||External grouping not supported 7711|ERX|HCPCS A9270|63739-0269-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TAMOXIFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.01|PHR: 408101; CHG: 26||Not reimbursed separately|1.01|PHR: 408101; CHG: 26||External grouping not supported 77173|ERX|HCPCS A9270|00173-0715-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER|90 Puff|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.71|PHR: 408101; CHG: 26||Not reimbursed separately|867.71|PHR: 408101; CHG: 26||External grouping not supported 77195|ERX|HCPCS J1953|00409-1886-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 77195|ERX|HCPCS J1953|00409-1886-15|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 77195|ERX|HCPCS J1953|00409-1886-22|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 77195|ERX|HCPCS J1953|63323-0400-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 77195|ERX|HCPCS J1953|67457-0790-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.32|PHR: 408101; CHG: 26||Not reimbursed separately|4.32|PHR: 408101; CHG: 26||External grouping not supported 77371|ERX|HCPCS A9270|00085-1328-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.00|PHR: 408101; CHG: 26||Not reimbursed separately|100.00|PHR: 408101; CHG: 26||External grouping not supported 77411|ERX|HCPCS A9270|25021-0602-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.74|PHR: 408101; CHG: 26||Not reimbursed separately|20.74|PHR: 408101; CHG: 26||External grouping not supported 77411|ERX|HCPCS A9270|51754-0501-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.74|PHR: 408101; CHG: 26||Not reimbursed separately|20.74|PHR: 408101; CHG: 26||External grouping not supported 77411|ERX|HCPCS A9270|63323-0406-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.74|PHR: 408101; CHG: 26||Not reimbursed separately|20.74|PHR: 408101; CHG: 26||External grouping not supported 77412|ERX|HCPCS J0706|42571-0244-69|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|13.93|PHR: 408101; CHG: 26||Not reimbursed separately|13.93|PHR: 408101; CHG: 26||External grouping not supported 77412|ERX|HCPCS J0706|51754-0500-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|13.93|PHR: 408101; CHG: 26||Not reimbursed separately|13.93|PHR: 408101; CHG: 26||External grouping not supported 77412|ERX|HCPCS J0706|63323-0407-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|13.93|PHR: 408101; CHG: 26||Not reimbursed separately|13.93|PHR: 408101; CHG: 26||External grouping not supported 77412|ERX|HCPCS J0706|72485-0104-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|13.93|PHR: 408101; CHG: 26||Not reimbursed separately|13.93|PHR: 408101; CHG: 26||External grouping not supported 77484|ERX|HCPCS J9303|55513-0954-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|3,742.77|PHR: 408101; CHG: 26||Not reimbursed separately|3,742.77|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|00228-2076-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|00378-4010-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|51079-0418-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|51079-0418-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|63739-0877-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|65162-0556-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|67877-0146-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7753|ERX|HCPCS A9270|67877-0146-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 15 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 7754|ERX|HCPCS A9270|00228-2077-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 7754|ERX|HCPCS A9270|00378-5050-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 7754|ERX|HCPCS A9270|51079-0419-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 7754|ERX|HCPCS A9270|51079-0419-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 7754|ERX|HCPCS A9270|65162-0557-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 7754|ERX|HCPCS A9270|67877-0147-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TEMAZEPAM 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.35|PHR: 408101; CHG: 26||Not reimbursed separately|0.35|PHR: 408101; CHG: 26||External grouping not supported 77615|ERX|HCPCS A9270|00006-0221-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SITAGLIPTIN 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.04|PHR: 408101; CHG: 26||Not reimbursed separately|46.04|PHR: 408101; CHG: 26||External grouping not supported 77616|ERX|HCPCS A9270|00006-0112-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SITAGLIPTIN 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.04|PHR: 408101; CHG: 26||Not reimbursed separately|46.04|PHR: 408101; CHG: 26||External grouping not supported 77617|ERX|HCPCS A9270|00006-0277-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SITAGLIPTIN 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.04|PHR: 408101; CHG: 26||Not reimbursed separately|46.04|PHR: 408101; CHG: 26||External grouping not supported 77648|ERX|HCPCS A9270|00003-3622-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ATAZANAVIR 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|133.57|PHR: 408101; CHG: 26||Not reimbursed separately|133.57|PHR: 408101; CHG: 26||External grouping not supported 7783|ERX|HCPCS J1071|00009-0347-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HUMANA [1294]||HUMANA [11839]|5.16|PHR: 408101; CHG: 26||Not reimbursed separately|5.16|PHR: 408101; CHG: 26||External grouping not supported 7784|ERX|HCPCS J1071|00009-0417-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.43|PHR: 408101; CHG: 26||Not reimbursed separately|6.43|PHR: 408101; CHG: 26||External grouping not supported 7784|ERX|HCPCS J1071|00409-6562-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.43|PHR: 408101; CHG: 26||Not reimbursed separately|6.43|PHR: 408101; CHG: 26||External grouping not supported 7784|ERX|HCPCS J1071|00009-0417-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.71|PHR: 408101; CHG: 26||Not reimbursed separately|25.71|PHR: 408101; CHG: 26||External grouping not supported 7797|ERX|HCPCS A9270|51991-0907-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TETRACYCLINE 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.13|PHR: 408101; CHG: 26||Not reimbursed separately|0.13|PHR: 408101; CHG: 26||External grouping not supported 7800|ERX|HCPCS A9270|00536-1217-94|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TETRAHYDROZOLINE 0.05 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 7800|ERX|HCPCS A9270|24385-0075-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TETRAHYDROZOLINE 0.05 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 7800|ERX|HCPCS A9270|87701-0149-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TETRAHYDROZOLINE 0.05 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 78064|ERX|HCPCS A9270|00378-3979-93|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.10|PHR: 408101; CHG: 26||Not reimbursed separately|24.10|PHR: 408101; CHG: 26||External grouping not supported 78064|ERX|HCPCS A9270|00591-3693-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.10|PHR: 408101; CHG: 26||Not reimbursed separately|24.10|PHR: 408101; CHG: 26||External grouping not supported 78064|ERX|HCPCS A9270|10147-0952-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.10|PHR: 408101; CHG: 26||Not reimbursed separately|24.10|PHR: 408101; CHG: 26||External grouping not supported 78064|ERX|HCPCS A9270|47335-0765-83|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.10|PHR: 408101; CHG: 26||Not reimbursed separately|24.10|PHR: 408101; CHG: 26||External grouping not supported 78310|ERX|HCPCS A9270|00378-7401-78|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 78310|ERX|HCPCS A9270|54092-0100-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 78310|ERX|HCPCS A9270|54092-0476-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 78310|ERX|HCPCS A9270|63304-0175-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 78310|ERX|HCPCS A9270|68382-0711-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.15|PHR: 408101; CHG: 26||Not reimbursed separately|6.15|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|16729-0306-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|43598-0305-62|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|43598-0465-62|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|43598-0678-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|59572-0102-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]||HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|64679-0096-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78420|ERX|HCPCS J9025|72485-0201-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZACITIDINE 100 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.72|PHR: 408101; CHG: 26||Not reimbursed separately|1,755.72|PHR: 408101; CHG: 26||External grouping not supported 78653|ERX|HCPCS A9270|66993-0141-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALISKIREN 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.69|PHR: 408101; CHG: 26||Not reimbursed separately|20.69|PHR: 408101; CHG: 26||External grouping not supported 78653|ERX|HCPCS A9270|70839-0150-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALISKIREN 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.69|PHR: 408101; CHG: 26||Not reimbursed separately|20.69|PHR: 408101; CHG: 26||External grouping not supported 78654|ERX|HCPCS A9270|70839-0300-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALISKIREN 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.10|PHR: 408101; CHG: 26||Not reimbursed separately|26.10|PHR: 408101; CHG: 26||External grouping not supported 7876|ERX|HCPCS J3411|63323-0013-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.74|PHR: 408101; CHG: 26||Not reimbursed separately|7.74|PHR: 408101; CHG: 26||External grouping not supported 7876|ERX|HCPCS J3411|63323-0013-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.74|PHR: 408101; CHG: 26||Not reimbursed separately|7.74|PHR: 408101; CHG: 26||External grouping not supported 7876|ERX|HCPCS J3411|67457-0196-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.74|PHR: 408101; CHG: 26||Not reimbursed separately|7.74|PHR: 408101; CHG: 26||External grouping not supported 7876|ERX|HCPCS J3411|67457-0196-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.74|PHR: 408101; CHG: 26||Not reimbursed separately|7.74|PHR: 408101; CHG: 26||External grouping not supported 7876|ERX|HCPCS J3411|63323-0013-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|7.74|PHR: 408101; CHG: 26||Not reimbursed separately|7.74|PHR: 408101; CHG: 26||External grouping not supported 7877|ERX|HCPCS A9270|37864-0905-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE HCL (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 7877|ERX|HCPCS A9270|40985-0211-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE HCL (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 7877|ERX|HCPCS A9270|58526-0005-04|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE HCL (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 7877|ERX|HCPCS A9270|58526-0005-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE HCL (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 7877|ERX|HCPCS A9270|87701-0407-29|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIAMINE HCL (VITAMIN B1) 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 7894|ERX|HCPCS A9270|51079-0565-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIORIDAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 7894|ERX|HCPCS A9270|51079-0565-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIORIDAZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 7899|ERX|HCPCS A9270|51079-0566-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIORIDAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 7899|ERX|HCPCS A9270|51079-0566-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIORIDAZINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.31|PHR: 408101; CHG: 26||Not reimbursed separately|1.31|PHR: 408101; CHG: 26||External grouping not supported 7900|ERX|HCPCS A9270|00378-0616-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIORIDAZINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.03|PHR: 408101; CHG: 26||Not reimbursed separately|2.03|PHR: 408101; CHG: 26||External grouping not supported 7901|ERX|HCPCS J9340|00143-9565-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|THIOTEPA 15 MG SOLUTION FOR INJECTION|15 mg|HUMANA [1294]||HUMANA [11839]|1,828.74|PHR: 408101; CHG: 26||Not reimbursed separately|1,828.74|PHR: 408101; CHG: 26||External grouping not supported 7902|ERX|HCPCS A9270|00378-1001-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIOTHIXENE 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.63|PHR: 408101; CHG: 26||Not reimbursed separately|2.63|PHR: 408101; CHG: 26||External grouping not supported 7902|ERX|HCPCS A9270|70954-0014-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIOTHIXENE 1 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.63|PHR: 408101; CHG: 26||Not reimbursed separately|2.63|PHR: 408101; CHG: 26||External grouping not supported 7906|ERX|HCPCS A9270|51079-0588-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIOTHIXENE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.65|PHR: 408101; CHG: 26||Not reimbursed separately|6.65|PHR: 408101; CHG: 26||External grouping not supported 7906|ERX|HCPCS A9270|51079-0588-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIOTHIXENE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.65|PHR: 408101; CHG: 26||Not reimbursed separately|6.65|PHR: 408101; CHG: 26||External grouping not supported 7906|ERX|HCPCS A9270|70954-0016-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|THIOTHIXENE 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.65|PHR: 408101; CHG: 26||Not reimbursed separately|6.65|PHR: 408101; CHG: 26||External grouping not supported 7994|ERX|HCPCS J3260|63323-0306-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOBRAMYCIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 7994|ERX|HCPCS J3260|63323-0306-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOBRAMYCIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 7994|ERX|HCPCS J3260|67457-0428-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOBRAMYCIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 7994|ERX|HCPCS J3260|67457-0473-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TOBRAMYCIN 40 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.87|PHR: 408101; CHG: 26||Not reimbursed separately|3.87|PHR: 408101; CHG: 26||External grouping not supported 7995|ERX|HCPCS RX001|00065-0643-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|28.35|PHR: 408101; CHG: 26||Not reimbursed separately|28.35|PHR: 408101; CHG: 26||External grouping not supported 7995|ERX|HCPCS RX001|17478-0290-10|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|28.35|PHR: 408101; CHG: 26||Not reimbursed separately|28.35|PHR: 408101; CHG: 26||External grouping not supported 7995|ERX|HCPCS RX001|24208-0290-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|28.35|PHR: 408101; CHG: 26||Not reimbursed separately|28.35|PHR: 408101; CHG: 26||External grouping not supported 7995|ERX|HCPCS RX001|61314-0643-05|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|28.35|PHR: 408101; CHG: 26||Not reimbursed separately|28.35|PHR: 408101; CHG: 26||External grouping not supported 7995|ERX|HCPCS RX001|70069-0131-01|0250 - PHARMACY - GENERAL CLASSIFICATION|TOBRAMYCIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|28.35|PHR: 408101; CHG: 26||Not reimbursed separately|28.35|PHR: 408101; CHG: 26||External grouping not supported 8020|ERX|HCPCS A9270|51672-2020-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLNAFTATE 1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.36|PHR: 408101; CHG: 26||Not reimbursed separately|5.36|PHR: 408101; CHG: 26||External grouping not supported 8083|ERX|HCPCS A9270|50111-0434-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 8083|ERX|HCPCS A9270|53489-0511-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 8083|ERX|HCPCS A9270|60687-0454-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 8083|ERX|HCPCS A9270|60687-0454-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 8084|ERX|HCPCS A9270|53489-0517-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 8084|ERX|HCPCS A9270|60687-0432-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 8084|ERX|HCPCS A9270|60687-0432-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 8084|ERX|HCPCS A9270|68084-0608-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.17|PHR: 408101; CHG: 26||Not reimbursed separately|1.17|PHR: 408101; CHG: 26||External grouping not supported 8085|ERX|HCPCS A9270|00904-6868-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 8085|ERX|HCPCS A9270|53489-0510-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 8085|ERX|HCPCS A9270|60687-0443-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 8085|ERX|HCPCS A9270|60687-0443-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 8085|ERX|HCPCS A9270|68382-0805-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRAZODONE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.25|PHR: 408101; CHG: 26||Not reimbursed separately|0.25|PHR: 408101; CHG: 26||External grouping not supported 8112|ERX|HCPCS A9270|00168-0003-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.90|PHR: 408101; CHG: 26||Not reimbursed separately|5.90|PHR: 408101; CHG: 26||External grouping not supported 8112|ERX|HCPCS A9270|45802-0063-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.90|PHR: 408101; CHG: 26||Not reimbursed separately|5.90|PHR: 408101; CHG: 26||External grouping not supported 8113|ERX|HCPCS A9270|00168-0004-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.69|PHR: 408101; CHG: 26||Not reimbursed separately|32.69|PHR: 408101; CHG: 26||External grouping not supported 8113|ERX|HCPCS A9270|45802-0064-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.69|PHR: 408101; CHG: 26||Not reimbursed separately|32.69|PHR: 408101; CHG: 26||External grouping not supported 8113|ERX|HCPCS A9270|00168-0004-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|453.6 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.69|PHR: 408101; CHG: 26||Not reimbursed separately|32.69|PHR: 408101; CHG: 26||External grouping not supported 8113|ERX|HCPCS A9270|45802-0064-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|454 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.69|PHR: 408101; CHG: 26||Not reimbursed separately|32.69|PHR: 408101; CHG: 26||External grouping not supported 8113|ERX|HCPCS A9270|52565-0056-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|80 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.69|PHR: 408101; CHG: 26||Not reimbursed separately|32.69|PHR: 408101; CHG: 26||External grouping not supported 8116|ERX|HCPCS A9270|00713-0676-53|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % LOTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.08|PHR: 408101; CHG: 26||Not reimbursed separately|37.08|PHR: 408101; CHG: 26||External grouping not supported 8116|ERX|HCPCS A9270|52565-0011-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % LOTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.08|PHR: 408101; CHG: 26||Not reimbursed separately|37.08|PHR: 408101; CHG: 26||External grouping not supported 8116|ERX|HCPCS A9270|60432-0561-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % LOTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.08|PHR: 408101; CHG: 26||Not reimbursed separately|37.08|PHR: 408101; CHG: 26||External grouping not supported 8116|ERX|HCPCS A9270|60432-0561-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % LOTION|60 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.08|PHR: 408101; CHG: 26||Not reimbursed separately|37.08|PHR: 408101; CHG: 26||External grouping not supported 8117|ERX|HCPCS A9270|45802-0054-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.32|PHR: 408101; CHG: 26||Not reimbursed separately|9.32|PHR: 408101; CHG: 26||External grouping not supported 8118|ERX|HCPCS A9270|00168-0006-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.54|PHR: 408101; CHG: 26||Not reimbursed separately|5.54|PHR: 408101; CHG: 26||External grouping not supported 8118|ERX|HCPCS A9270|45802-0055-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.54|PHR: 408101; CHG: 26||Not reimbursed separately|5.54|PHR: 408101; CHG: 26||External grouping not supported 8118|ERX|HCPCS A9270|00168-0006-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT|80 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.21|PHR: 408101; CHG: 26||Not reimbursed separately|33.21|PHR: 408101; CHG: 26||External grouping not supported 8118|ERX|HCPCS A9270|45802-0055-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT|80 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.21|PHR: 408101; CHG: 26||Not reimbursed separately|33.21|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|00003-0293-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]||HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|00003-0293-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|00003-0293-28|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|00703-0241-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|70121-1049-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|70121-1049-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|70121-1168-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8120|ERX|HCPCS J3301|70121-1169-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25.89|PHR: 408101; CHG: 26||Not reimbursed separately|25.89|PHR: 408101; CHG: 26||External grouping not supported 8121|ERX|HCPCS A9270|00713-0655-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE|5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.66|PHR: 408101; CHG: 26||Not reimbursed separately|72.66|PHR: 408101; CHG: 26||External grouping not supported 8121|ERX|HCPCS A9270|64980-0320-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE|5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.66|PHR: 408101; CHG: 26||Not reimbursed separately|72.66|PHR: 408101; CHG: 26||External grouping not supported 8132|ERX|HCPCS A9270|60505-2656-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 8134|ERX|HCPCS A9270|51079-0433-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 8134|ERX|HCPCS A9270|51079-0433-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.48|PHR: 408101; CHG: 26||Not reimbursed separately|1.48|PHR: 408101; CHG: 26||External grouping not supported 81428|ERX|HCPCS A9270|00574-0120-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION|120 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24.48|PHR: 408101; CHG: 26||Not reimbursed separately|24.48|PHR: 408101; CHG: 26||External grouping not supported 81428|ERX|HCPCS A9270|00574-0120-76|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION|240 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.96|PHR: 408101; CHG: 26||Not reimbursed separately|48.96|PHR: 408101; CHG: 26||External grouping not supported 81462|ERX|HCPCS J8700|47335-0930-80|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|TEMOZOLOMIDE 180 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|299.28|PHR: 408101; CHG: 26||Not reimbursed separately|299.28|PHR: 408101; CHG: 26||External grouping not supported 81479|ERX|HCPCS A9270|58914-0601-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISMUTH SUBCIT K 140 MG-METRONIDAZOLE 125 MG-TETRACYCLINE 125 MG CAP|3 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.70|PHR: 408101; CHG: 26||Not reimbursed separately|63.70|PHR: 408101; CHG: 26||External grouping not supported 8161|ERX|HCPCS A9270|00378-2401-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLUOPERAZINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.47|PHR: 408101; CHG: 26||Not reimbursed separately|2.47|PHR: 408101; CHG: 26||External grouping not supported 8161|ERX|HCPCS A9270|51079-0572-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLUOPERAZINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.47|PHR: 408101; CHG: 26||Not reimbursed separately|2.47|PHR: 408101; CHG: 26||External grouping not supported 8161|ERX|HCPCS A9270|51079-0572-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLUOPERAZINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.47|PHR: 408101; CHG: 26||Not reimbursed separately|2.47|PHR: 408101; CHG: 26||External grouping not supported 8164|ERX|HCPCS A9270|00378-2405-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLUOPERAZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.68|PHR: 408101; CHG: 26||Not reimbursed separately|4.68|PHR: 408101; CHG: 26||External grouping not supported 8164|ERX|HCPCS A9270|51079-0574-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLUOPERAZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.68|PHR: 408101; CHG: 26||Not reimbursed separately|4.68|PHR: 408101; CHG: 26||External grouping not supported 8164|ERX|HCPCS A9270|51079-0574-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIFLUOPERAZINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.68|PHR: 408101; CHG: 26||Not reimbursed separately|4.68|PHR: 408101; CHG: 26||External grouping not supported 8166|ERX|HCPCS A9270|00591-5335-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIHEXYPHENIDYL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 8167|ERX|HCPCS A9270|00591-5337-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIHEXYPHENIDYL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 8182|ERX|HCPCS A9270|43386-0330-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TRIMETHOPRIM 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.45|PHR: 408101; CHG: 26||Not reimbursed separately|0.45|PHR: 408101; CHG: 26||External grouping not supported 81880|ERX|HCPCS RX001|17478-0307-03|0250 - PHARMACY - GENERAL CLASSIFICATION|AZITHROMYCIN 1 % EYE DROPS|2.5 mL|HUMANA [1294]||HUMANA [11839]|570.09|PHR: 408101; CHG: 26||Not reimbursed separately|570.09|PHR: 408101; CHG: 26||External grouping not supported 820000|ERX|HCPCS RX001||0250 - PHARMACY - GENERAL CLASSIFICATION|GI COCKTAIL SUSPENSION|30 mL|HUMANA [1294]||HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 820000|ERX|HCPCS RX001|99999-0000-01|0250 - PHARMACY - GENERAL CLASSIFICATION|GI COCKTAIL SUSPENSION|30 mL|HUMANA [1294]||HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 82089|ERX|HCPCS A9270|16729-0095-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 82089|ERX|HCPCS A9270|50742-0637-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|PHR: 408101; CHG: 26||Not reimbursed separately|0.67|PHR: 408101; CHG: 26||External grouping not supported 82090|ERX|HCPCS A9270|16729-0096-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.04|PHR: 408101; CHG: 26||Not reimbursed separately|1.04|PHR: 408101; CHG: 26||External grouping not supported 82200|ERX|HCPCS J9190|63323-0117-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|6.39|PHR: 408101; CHG: 26||Not reimbursed separately|6.39|PHR: 408101; CHG: 26||External grouping not supported 8249|ERX|HCPCS A9270|61314-0354-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TROPICAMIDE 0.5 % EYE DROPS|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.82|PHR: 408101; CHG: 26||Not reimbursed separately|8.82|PHR: 408101; CHG: 26||External grouping not supported 8250|ERX|HCPCS RX001|00998-0355-15|0250 - PHARMACY - GENERAL CLASSIFICATION|TROPICAMIDE 1 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|14.04|PHR: 408101; CHG: 26||Not reimbursed separately|14.04|PHR: 408101; CHG: 26||External grouping not supported 8250|ERX|HCPCS RX001|17478-0102-12|0250 - PHARMACY - GENERAL CLASSIFICATION|TROPICAMIDE 1 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|14.04|PHR: 408101; CHG: 26||Not reimbursed separately|14.04|PHR: 408101; CHG: 26||External grouping not supported 8250|ERX|HCPCS RX001|61314-0355-02|0250 - PHARMACY - GENERAL CLASSIFICATION|TROPICAMIDE 1 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|14.04|PHR: 408101; CHG: 26||Not reimbursed separately|14.04|PHR: 408101; CHG: 26||External grouping not supported 8250|ERX|HCPCS RX001|61314-0355-01|0250 - PHARMACY - GENERAL CLASSIFICATION|TROPICAMIDE 1 % EYE DROPS|3 mL|HUMANA [1294]||HUMANA [11839]|14.04|PHR: 408101; CHG: 26||Not reimbursed separately|14.04|PHR: 408101; CHG: 26||External grouping not supported 82504|ERX|HCPCS A9270|00781-7304-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.30|PHR: 408101; CHG: 26||Not reimbursed separately|13.30|PHR: 408101; CHG: 26||External grouping not supported 82504|ERX|HCPCS A9270|00781-7304-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.30|PHR: 408101; CHG: 26||Not reimbursed separately|13.30|PHR: 408101; CHG: 26||External grouping not supported 82504|ERX|HCPCS A9270|47781-0304-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.30|PHR: 408101; CHG: 26||Not reimbursed separately|13.30|PHR: 408101; CHG: 26||External grouping not supported 82504|ERX|HCPCS A9270|47781-0304-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.30|PHR: 408101; CHG: 26||Not reimbursed separately|13.30|PHR: 408101; CHG: 26||External grouping not supported 82505|ERX|HCPCS A9270|00781-7309-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.58|PHR: 408101; CHG: 26||Not reimbursed separately|8.58|PHR: 408101; CHG: 26||External grouping not supported 82505|ERX|HCPCS A9270|00781-7309-58|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.58|PHR: 408101; CHG: 26||Not reimbursed separately|8.58|PHR: 408101; CHG: 26||External grouping not supported 82505|ERX|HCPCS A9270|47781-0305-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH|1 Patch|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.58|PHR: 408101; CHG: 26||Not reimbursed separately|8.58|PHR: 408101; CHG: 26||External grouping not supported 8259|ERX|HCPCS RX001|42023-0104-01|0250 - PHARMACY - GENERAL CLASSIFICATION|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|21.88|PHR: 408101; CHG: 26||Not reimbursed separately|21.88|PHR: 408101; CHG: 26||External grouping not supported 8259|ERX|HCPCS RX001|49281-0752-21|0250 - PHARMACY - GENERAL CLASSIFICATION|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|21.88|PHR: 408101; CHG: 26||Not reimbursed separately|21.88|PHR: 408101; CHG: 26||External grouping not supported 8259|ERX|HCPCS RX001|49281-0752-22|0250 - PHARMACY - GENERAL CLASSIFICATION|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|21.88|PHR: 408101; CHG: 26||Not reimbursed separately|21.88|PHR: 408101; CHG: 26||External grouping not supported 8259|ERX|HCPCS RX001|49281-0752-78|0250 - PHARMACY - GENERAL CLASSIFICATION|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|21.88|PHR: 408101; CHG: 26||Not reimbursed separately|21.88|PHR: 408101; CHG: 26||External grouping not supported 8259|ERX|HCPCS RX001|49281-0752-98|0250 - PHARMACY - GENERAL CLASSIFICATION|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|21.88|PHR: 408101; CHG: 26||Not reimbursed separately|21.88|PHR: 408101; CHG: 26||External grouping not supported 8259|ERX|HCPCS RX001|99999-2222-42|0250 - PHARMACY - GENERAL CLASSIFICATION|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|21.88|PHR: 408101; CHG: 26||Not reimbursed separately|21.88|PHR: 408101; CHG: 26||External grouping not supported 8429|ERX|HCPCS A9270|00591-4012-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALPROIC ACID 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 8429|ERX|HCPCS A9270|00832-0310-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALPROIC ACID 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 8429|ERX|HCPCS A9270|69452-0150-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VALPROIC ACID 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.58|PHR: 408101; CHG: 26||Not reimbursed separately|0.58|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|47781-0597-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|63323-0284-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|63323-0284-26|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|63323-0284-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|67457-0340-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|67457-0340-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|70860-0105-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8442|ERX|HCPCS J3370|70860-0105-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.75|PHR: 408101; CHG: 26||Not reimbursed separately|7.75|PHR: 408101; CHG: 26||External grouping not supported 8443|ERX|HCPCS J3370|47781-0598-07|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 8443|ERX|HCPCS J3370|63323-0221-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 8443|ERX|HCPCS J3370|63323-0221-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 8443|ERX|HCPCS J3370|63323-0221-38|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.75|PHR: 408101; CHG: 26||Not reimbursed separately|6.75|PHR: 408101; CHG: 26||External grouping not supported 8444|ERX|HCPCS J3370|00143-9358-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.54|PHR: 408101; CHG: 26||Not reimbursed separately|66.54|PHR: 408101; CHG: 26||External grouping not supported 8444|ERX|HCPCS J3370|25021-0157-99|0250 - PHARMACY - GENERAL CLASSIFICATION|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.54|PHR: 408101; CHG: 26||Not reimbursed separately|66.54|PHR: 408101; CHG: 26||External grouping not supported 8444|ERX|HCPCS J3370|63323-0295-61|0250 - PHARMACY - GENERAL CLASSIFICATION|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.54|PHR: 408101; CHG: 26||Not reimbursed separately|66.54|PHR: 408101; CHG: 26||External grouping not supported 8444|ERX|HCPCS J3370|63323-0295-66|0250 - PHARMACY - GENERAL CLASSIFICATION|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.54|PHR: 408101; CHG: 26||Not reimbursed separately|66.54|PHR: 408101; CHG: 26||External grouping not supported 8444|ERX|HCPCS J3370|67457-0341-05|0250 - PHARMACY - GENERAL CLASSIFICATION|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5,000 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.54|PHR: 408101; CHG: 26||Not reimbursed separately|66.54|PHR: 408101; CHG: 26||External grouping not supported 849|ERX|HCPCS A9270|00574-4144-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.15|PHR: 408101; CHG: 26||Not reimbursed separately|42.15|PHR: 408101; CHG: 26||External grouping not supported 849|ERX|HCPCS A9270|24208-0785-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.15|PHR: 408101; CHG: 26||Not reimbursed separately|42.15|PHR: 408101; CHG: 26||External grouping not supported 850|ERX|HCPCS A9270|45802-0060-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT|14 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.57|PHR: 408101; CHG: 26||Not reimbursed separately|2.57|PHR: 408101; CHG: 26||External grouping not supported 850|ERX|HCPCS A9270|45802-0060-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.13|PHR: 408101; CHG: 26||Not reimbursed separately|5.13|PHR: 408101; CHG: 26||External grouping not supported 850|ERX|HCPCS A9270|00713-0280-31|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT|29 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.69|PHR: 408101; CHG: 26||Not reimbursed separately|7.69|PHR: 408101; CHG: 26||External grouping not supported 851|ERX|HCPCS RX001|00009-0233-03|0250 - PHARMACY - GENERAL CLASSIFICATION|BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION|5,000 Units|HUMANA [1294]||HUMANA [11839]|13.41|PHR: 408101; CHG: 26||Not reimbursed separately|13.41|PHR: 408101; CHG: 26||External grouping not supported 851|ERX|HCPCS RX001|63323-0329-31|0250 - PHARMACY - GENERAL CLASSIFICATION|BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION|5,000 Units|HUMANA [1294]||HUMANA [11839]|13.41|PHR: 408101; CHG: 26||Not reimbursed separately|13.41|PHR: 408101; CHG: 26||External grouping not supported 851|ERX|HCPCS RX001|00009-0233-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION|50,000 Units|HUMANA [1294]||HUMANA [11839]|13.41|PHR: 408101; CHG: 26||Not reimbursed separately|13.41|PHR: 408101; CHG: 26||External grouping not supported 852|ERX|HCPCS RX001|00574-4022-35|0250 - PHARMACY - GENERAL CLASSIFICATION|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|4 g|HUMANA [1294]||HUMANA [11839]|515.16|PHR: 408101; CHG: 26||Not reimbursed separately|515.16|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|42571-0313-75|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|42571-0313-87|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|42571-0313-97|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|51754-0203-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|51754-0203-02|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|70069-0271-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|70069-0271-25|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|72485-0108-01|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8527|ERX|HCPCS J3490|72485-0108-25|0250 - PHARMACY - GENERAL CLASSIFICATION|VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.06|PHR: 408101; CHG: 26||Not reimbursed separately|12.06|PHR: 408101; CHG: 26||External grouping not supported 8528|ERX|HCPCS A9270|00904-2924-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL 120 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 8529|ERX|HCPCS A9270|00591-0404-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL 40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8530|ERX|HCPCS A9270|00904-2920-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VERAPAMIL 80 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.21|PHR: 408101; CHG: 26||Not reimbursed separately|0.21|PHR: 408101; CHG: 26||External grouping not supported 856|ERX|HCPCS A9270|00574-4021-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.54|PHR: 408101; CHG: 26||Not reimbursed separately|13.54|PHR: 408101; CHG: 26||External grouping not supported 856|ERX|HCPCS A9270|24208-0555-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT|3.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13.54|PHR: 408101; CHG: 26||Not reimbursed separately|13.54|PHR: 408101; CHG: 26||External grouping not supported 8594|ERX|HCPCS J9360|63323-0278-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|98.10|PHR: 408101; CHG: 26||Not reimbursed separately|98.10|PHR: 408101; CHG: 26||External grouping not supported 8597|ERX|HCPCS J9370|00703-4402-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|77.64|PHR: 408101; CHG: 26||Not reimbursed separately|77.64|PHR: 408101; CHG: 26||External grouping not supported 8597|ERX|HCPCS J9370|61703-0309-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.64|PHR: 408101; CHG: 26||Not reimbursed separately|77.64|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|00172-4096-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|00832-1054-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|00904-6475-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|63739-0479-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|68084-0855-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|68084-0855-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 860|ERX|HCPCS A9270|70710-1285-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BACLOFEN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 8639|ERX|HCPCS A9270|00904-2085-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|VITAMIN A 10,000 UNIT CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.05|PHR: 408101; CHG: 26||Not reimbursed separately|0.05|PHR: 408101; CHG: 26||External grouping not supported 864|ERX|HCPCS RX001|00409-3977-01|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 864|ERX|HCPCS RX001|00409-3977-03|0250 - PHARMACY - GENERAL CLASSIFICATION|WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION|30 mL|HUMANA [1294]||HUMANA [11839]|3.33|PHR: 408101; CHG: 26||Not reimbursed separately|3.33|PHR: 408101; CHG: 26||External grouping not supported 8748|ERX|HCPCS A9270|00832-1219-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 8748|ERX|HCPCS A9270|00832-1219-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 8748|ERX|HCPCS A9270|65162-0769-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 8749|ERX|HCPCS A9270|00832-1212-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8749|ERX|HCPCS A9270|00832-1212-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8749|ERX|HCPCS A9270|62584-0984-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8750|ERX|HCPCS A9270|00832-1213-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8750|ERX|HCPCS A9270|00832-1213-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8750|ERX|HCPCS A9270|68084-0027-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8751|ERX|HCPCS A9270|00832-1216-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8751|ERX|HCPCS A9270|00832-1216-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 8752|ERX|HCPCS A9270|00832-1218-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 8752|ERX|HCPCS A9270|00832-1218-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|WARFARIN 7.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.55|PHR: 408101; CHG: 26||Not reimbursed separately|0.55|PHR: 408101; CHG: 26||External grouping not supported 88042|ERX|HCPCS J9250|61703-0350-38|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|13.83|PHR: 408101; CHG: 26||Not reimbursed separately|13.83|PHR: 408101; CHG: 26||External grouping not supported 88223|ERX|HCPCS A9270|00093-6817-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.59|PHR: 408101; CHG: 26||Not reimbursed separately|33.59|PHR: 408101; CHG: 26||External grouping not supported 88223|ERX|HCPCS A9270|00093-6817-45|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.59|PHR: 408101; CHG: 26||Not reimbursed separately|33.59|PHR: 408101; CHG: 26||External grouping not supported 88223|ERX|HCPCS A9270|00093-6817-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.59|PHR: 408101; CHG: 26||Not reimbursed separately|33.59|PHR: 408101; CHG: 26||External grouping not supported 8865|ERX|HCPCS J3490|00409-4090-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.59|PHR: 408101; CHG: 26||Not reimbursed separately|37.59|PHR: 408101; CHG: 26||External grouping not supported 8865|ERX|HCPCS J3490|00409-4090-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37.59|PHR: 408101; CHG: 26||Not reimbursed separately|37.59|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|00004-0802-85|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|33342-0256-66|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|47781-0468-13|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|64380-0797-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|68180-0675-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|69238-1264-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 88704|ERX|HCPCS A9270|70710-1008-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OSELTAMIVIR 30 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.96|PHR: 408101; CHG: 26||Not reimbursed separately|4.96|PHR: 408101; CHG: 26||External grouping not supported 8872|ERX|HCPCS A9270|80681-0002-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC GLUCONATE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 8874|ERX|HCPCS A9270|75834-0170-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC OXIDE 20 % TOPICAL OINTMENT|28.4 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.96|PHR: 408101; CHG: 26||Not reimbursed separately|3.96|PHR: 408101; CHG: 26||External grouping not supported 8874|ERX|HCPCS A9270|00536-5700-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC OXIDE 20 % TOPICAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.96|PHR: 408101; CHG: 26||Not reimbursed separately|3.96|PHR: 408101; CHG: 26||External grouping not supported 8880|ERX|HCPCS A9270|00731-0401-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC SULFATE 220 MG (50 MG) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 8880|ERX|HCPCS A9270|37864-0991-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC SULFATE 220 MG (50 MG) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 8880|ERX|HCPCS A9270|51645-0991-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC SULFATE 220 MG (50 MG) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 8880|ERX|HCPCS A9270|68585-0008-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC SULFATE 220 MG (50 MG) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 8880|ERX|HCPCS A9270|77333-0983-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ZINC SULFATE 220 MG (50 MG) CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.04|PHR: 408101; CHG: 26||Not reimbursed separately|0.04|PHR: 408101; CHG: 26||External grouping not supported 8922|ERX|HCPCS A9270|00527-1552-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.83|PHR: 408101; CHG: 26||Not reimbursed separately|1.83|PHR: 408101; CHG: 26||External grouping not supported 8922|ERX|HCPCS A9270|00591-3219-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.83|PHR: 408101; CHG: 26||Not reimbursed separately|1.83|PHR: 408101; CHG: 26||External grouping not supported 89346|ERX|HCPCS RX001|00904-6467-07|0250 - PHARMACY - GENERAL CLASSIFICATION|CLOPIDOGREL 300 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|20.66|PHR: 408101; CHG: 26||Not reimbursed separately|20.66|PHR: 408101; CHG: 26||External grouping not supported 89346|ERX|HCPCS RX001|68084-0752-25|0250 - PHARMACY - GENERAL CLASSIFICATION|CLOPIDOGREL 300 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|20.66|PHR: 408101; CHG: 26||Not reimbursed separately|20.66|PHR: 408101; CHG: 26||External grouping not supported 89346|ERX|HCPCS RX001|68084-0752-95|0250 - PHARMACY - GENERAL CLASSIFICATION|CLOPIDOGREL 300 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|20.66|PHR: 408101; CHG: 26||Not reimbursed separately|20.66|PHR: 408101; CHG: 26||External grouping not supported 89387|ERX|HCPCS A9270|59011-0415-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|OXYCODONE ER 15 MG TABLET,EXTENDED RELEASE,12 HR|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.11|PHR: 408101; CHG: 26||Not reimbursed separately|14.11|PHR: 408101; CHG: 26||External grouping not supported 8939|ERX|HCPCS A9270|00378-1200-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACEBUTOLOL 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.85|PHR: 408101; CHG: 26||Not reimbursed separately|0.85|PHR: 408101; CHG: 26||External grouping not supported 8939|ERX|HCPCS A9270|50268-0050-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACEBUTOLOL 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.85|PHR: 408101; CHG: 26||Not reimbursed separately|0.85|PHR: 408101; CHG: 26||External grouping not supported 8939|ERX|HCPCS A9270|50268-0050-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACEBUTOLOL 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.85|PHR: 408101; CHG: 26||Not reimbursed separately|0.85|PHR: 408101; CHG: 26||External grouping not supported 8939|ERX|HCPCS A9270|53746-0669-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACEBUTOLOL 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.85|PHR: 408101; CHG: 26||Not reimbursed separately|0.85|PHR: 408101; CHG: 26||External grouping not supported 8949|ERX|HCPCS A9270|00406-0484-23|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 8949|ERX|HCPCS A9270|00406-0484-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.34|PHR: 408101; CHG: 26||Not reimbursed separately|0.34|PHR: 408101; CHG: 26||External grouping not supported 8958|ERX|HCPCS A9270|00527-1695-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.84|PHR: 408101; CHG: 26||Not reimbursed separately|2.84|PHR: 408101; CHG: 26||External grouping not supported 8958|ERX|HCPCS A9270|00591-3369-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.84|PHR: 408101; CHG: 26||Not reimbursed separately|2.84|PHR: 408101; CHG: 26||External grouping not supported 8958|ERX|HCPCS A9270|68084-0396-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.84|PHR: 408101; CHG: 26||Not reimbursed separately|2.84|PHR: 408101; CHG: 26||External grouping not supported 8958|ERX|HCPCS A9270|68084-0396-65|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.84|PHR: 408101; CHG: 26||Not reimbursed separately|2.84|PHR: 408101; CHG: 26||External grouping not supported 8962|ERX|HCPCS A9270|50742-0233-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.00|PHR: 408101; CHG: 26||Not reimbursed separately|5.00|PHR: 408101; CHG: 26||External grouping not supported 8969|ERX|HCPCS A9270|00093-8940-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 8969|ERX|HCPCS A9270|00904-5789-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 8969|ERX|HCPCS A9270|60505-0042-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 8969|ERX|HCPCS A9270|68084-0107-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.28|PHR: 408101; CHG: 26||Not reimbursed separately|0.28|PHR: 408101; CHG: 26||External grouping not supported 8970|ERX|HCPCS A9270|00378-8712-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.02|PHR: 408101; CHG: 26||Not reimbursed separately|3.02|PHR: 408101; CHG: 26||External grouping not supported 8970|ERX|HCPCS A9270|00472-0082-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.02|PHR: 408101; CHG: 26||Not reimbursed separately|3.02|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|00093-8947-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|31722-0778-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|60505-5307-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|61442-0113-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|68084-0109-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|68084-0109-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8972|ERX|HCPCS A9270|68382-0792-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACYCLOVIR 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 8975|ERX|HCPCS J0153|17478-0542-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 8975|ERX|HCPCS J0153|17478-0542-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 8975|ERX|HCPCS J0153|63323-0651-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 8975|ERX|HCPCS J0153|67457-0855-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 8975|ERX|HCPCS J0153|67457-0855-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.84|PHR: 408101; CHG: 26||Not reimbursed separately|1.84|PHR: 408101; CHG: 26||External grouping not supported 8979|ERX|HCPCS A9270|42799-0110-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALBENDAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.13|PHR: 408101; CHG: 26||Not reimbursed separately|673.13|PHR: 408101; CHG: 26||External grouping not supported 8979|ERX|HCPCS A9270|52054-0550-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALBENDAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.13|PHR: 408101; CHG: 26||Not reimbursed separately|673.13|PHR: 408101; CHG: 26||External grouping not supported 8979|ERX|HCPCS A9270|54505-0055-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALBENDAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.13|PHR: 408101; CHG: 26||Not reimbursed separately|673.13|PHR: 408101; CHG: 26||External grouping not supported 8979|ERX|HCPCS A9270|70710-1021-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALBENDAZOLE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.13|PHR: 408101; CHG: 26||Not reimbursed separately|673.13|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|00053-7680-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]||HUMANA [11839]|249.30|PHR: 408101; CHG: 26||Not reimbursed separately|249.30|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|68516-5216-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.30|PHR: 408101; CHG: 26||Not reimbursed separately|249.30|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|68982-0643-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.30|PHR: 408101; CHG: 26||Not reimbursed separately|249.30|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|00053-7680-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|00053-7680-92|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|44206-0251-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|44206-0251-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|44206-0251-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|44206-0251-91|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|68516-4216-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|68516-5216-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|68516-5216-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8981|ERX|HCPCS P9047|68982-0643-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|PHR: 408101; CHG: 26||Not reimbursed separately|112.50|PHR: 408101; CHG: 26||External grouping not supported 8985|ERX|HCPCS A9270|00168-0263-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALCLOMETASONE 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.47|PHR: 408101; CHG: 26||Not reimbursed separately|39.47|PHR: 408101; CHG: 26||External grouping not supported 9001|ERX|HCPCS J0270|00009-3169-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALPROSTADIL 500 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|346.39|PHR: 408101; CHG: 26||Not reimbursed separately|346.39|PHR: 408101; CHG: 26||External grouping not supported 9003|ERX|HCPCS J2997|50242-0044-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,837.54|PHR: 408101; CHG: 26||Not reimbursed separately|12,837.54|PHR: 408101; CHG: 26||External grouping not supported 9003|ERX|HCPCS J2997|50242-0044-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALTEPLASE 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,837.54|PHR: 408101; CHG: 26||Not reimbursed separately|12,837.54|PHR: 408101; CHG: 26||External grouping not supported 9009|ERX|HCPCS A9270|00121-1761-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.86|PHR: 408101; CHG: 26||Not reimbursed separately|1.86|PHR: 408101; CHG: 26||External grouping not supported 9009|ERX|HCPCS A9270|46122-0433-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.86|PHR: 408101; CHG: 26||Not reimbursed separately|1.86|PHR: 408101; CHG: 26||External grouping not supported 9009|ERX|HCPCS A9270|87701-0429-74|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.86|PHR: 408101; CHG: 26||Not reimbursed separately|1.86|PHR: 408101; CHG: 26||External grouping not supported 9016|ERX|HCPCS A9270|00904-5365-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ALUMINUM HYDROX-MAGNESIUM CARB 160 MG-105 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 9050|ERX|HCPCS RX001|00409-7171-17|0250 - PHARMACY - GENERAL CLASSIFICATION|PARENTERAL AMINO ACID 15 % COMBINATION NO.2 INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|138.00|PHR: 408101; CHG: 26||Not reimbursed separately|138.00|PHR: 408101; CHG: 26||External grouping not supported 9062|ERX|HCPCS A9270|49411-0052-08|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION|4 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|130.66|PHR: 408101; CHG: 26||Not reimbursed separately|130.66|PHR: 408101; CHG: 26||External grouping not supported 9063|ERX|HCPCS A9270|49411-0050-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMINOCAPROIC ACID 500 MG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.80|PHR: 408101; CHG: 26||Not reimbursed separately|82.80|PHR: 408101; CHG: 26||External grouping not supported 9063|ERX|HCPCS A9270|69680-0115-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMINOCAPROIC ACID 500 MG TABLET|2 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|82.80|PHR: 408101; CHG: 26||Not reimbursed separately|82.80|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|55150-0181-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|63323-0616-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|63323-0616-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|67457-0153-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|67457-0153-09|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|67457-0153-18|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9065|ERX|HCPCS J0282|67457-0153-99|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION|3 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.94|PHR: 408101; CHG: 26||Not reimbursed separately|2.94|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|00245-0147-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|60687-0437-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|60687-0437-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|65862-0732-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|65862-0732-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|65862-0732-62|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|68084-0371-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|68084-0371-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9066|ERX|HCPCS A9270|68382-0227-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMIODARONE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.63|PHR: 408101; CHG: 26||Not reimbursed separately|0.63|PHR: 408101; CHG: 26||External grouping not supported 9069|ERX|HCPCS A9270|00904-6371-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 9069|ERX|HCPCS A9270|50268-0085-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 9069|ERX|HCPCS A9270|63739-0631-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 9070|ERX|HCPCS A9270|00904-6369-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 9070|ERX|HCPCS A9270|67877-0197-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 9070|ERX|HCPCS A9270|67877-0197-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|00904-6370-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|42806-0056-09|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|50268-0084-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|51079-0451-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|51079-0451-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|67877-0198-90|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|68382-0122-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9071|ERX|HCPCS A9270|68382-0122-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMLODIPINE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9079|ERX|HCPCS A9270|43598-0012-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 125 MG-POTASSIUM CLAVULANATE 31.25 MG/5 ML ORAL SUSP|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.29|PHR: 408101; CHG: 26||Not reimbursed separately|76.29|PHR: 408101; CHG: 26||External grouping not supported 9080|ERX|HCPCS A9270|60432-0065-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.15|PHR: 408101; CHG: 26||Not reimbursed separately|3.15|PHR: 408101; CHG: 26||External grouping not supported 9080|ERX|HCPCS A9270|43598-0204-51|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.30|PHR: 408101; CHG: 26||Not reimbursed separately|6.30|PHR: 408101; CHG: 26||External grouping not supported 9081|ERX|HCPCS A9270|00185-0842-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.72|PHR: 408101; CHG: 26||Not reimbursed separately|0.72|PHR: 408101; CHG: 26||External grouping not supported 9082|ERX|HCPCS A9270|00185-0853-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9082|ERX|HCPCS A9270|00406-8893-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9082|ERX|HCPCS A9270|00555-0973-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROAMPHETAMINE-AMPHETAMINE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9104|ERX|HCPCS J7192|99999-1111-35|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ANTIHEMOPHILIC FACTOR (RECOMB) 1,000 (+/-) UNIT INTRAVENOUS SOLUTION|1,000 Units|HUMANA [1294]||HUMANA [11839]|3.69|PHR: 408101; CHG: 26||Not reimbursed separately|3.69|PHR: 408101; CHG: 26||External grouping not supported 91047|ERX|HCPCS 90371|59730-4203-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|821.07|PHR: 408101; CHG: 26||Not reimbursed separately|821.07|PHR: 408101; CHG: 26||External grouping not supported 9119|ERX|HCPCS RX001|17478-0716-10|0250 - PHARMACY - GENERAL CLASSIFICATION|APRACLONIDINE 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|80.82|PHR: 408101; CHG: 26||Not reimbursed separately|80.82|PHR: 408101; CHG: 26||External grouping not supported 9119|ERX|HCPCS RX001|61314-0665-05|0250 - PHARMACY - GENERAL CLASSIFICATION|APRACLONIDINE 0.5 % EYE DROPS|5 mL|HUMANA [1294]||HUMANA [11839]|80.82|PHR: 408101; CHG: 26||Not reimbursed separately|80.82|PHR: 408101; CHG: 26||External grouping not supported 9120|ERX|HCPCS RX001|00065-0660-10|0250 - PHARMACY - GENERAL CLASSIFICATION|APRACLONIDINE 1 % EYE DROPS IN A DROPPERETTE|1 Each|HUMANA [1294]||HUMANA [11839]|76.50|PHR: 408101; CHG: 26||Not reimbursed separately|76.50|PHR: 408101; CHG: 26||External grouping not supported 9123|ERX|HCPCS RX001|00009-0436-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ARGININE HCL (L-ARGININE) 10 % INTRAVENOUS SOLUTION|30,000 mg|HUMANA [1294]||HUMANA [11839]|106.20|PHR: 408101; CHG: 26||Not reimbursed separately|106.20|PHR: 408101; CHG: 26||External grouping not supported 91278|ERX|HCPCS J2354|00641-6174-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.45|PHR: 408101; CHG: 26||Not reimbursed separately|12.45|PHR: 408101; CHG: 26||External grouping not supported 91278|ERX|HCPCS J2354|00641-6174-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.45|PHR: 408101; CHG: 26||Not reimbursed separately|12.45|PHR: 408101; CHG: 26||External grouping not supported 91278|ERX|HCPCS J2354|00703-3301-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.45|PHR: 408101; CHG: 26||Not reimbursed separately|12.45|PHR: 408101; CHG: 26||External grouping not supported 91278|ERX|HCPCS J2354|25021-0451-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.45|PHR: 408101; CHG: 26||Not reimbursed separately|12.45|PHR: 408101; CHG: 26||External grouping not supported 91278|ERX|HCPCS J2354|63323-0365-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|12.45|PHR: 408101; CHG: 26||Not reimbursed separately|12.45|PHR: 408101; CHG: 26||External grouping not supported 91279|ERX|HCPCS J2354|00641-6175-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.72|PHR: 408101; CHG: 26||Not reimbursed separately|7.72|PHR: 408101; CHG: 26||External grouping not supported 91279|ERX|HCPCS J2354|00703-3311-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.72|PHR: 408101; CHG: 26||Not reimbursed separately|7.72|PHR: 408101; CHG: 26||External grouping not supported 91279|ERX|HCPCS J2354|25021-0452-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.72|PHR: 408101; CHG: 26||Not reimbursed separately|7.72|PHR: 408101; CHG: 26||External grouping not supported 91279|ERX|HCPCS J2354|63323-0376-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.72|PHR: 408101; CHG: 26||Not reimbursed separately|7.72|PHR: 408101; CHG: 26||External grouping not supported 91279|ERX|HCPCS J2354|63323-0376-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.72|PHR: 408101; CHG: 26||Not reimbursed separately|7.72|PHR: 408101; CHG: 26||External grouping not supported 91281|ERX|HCPCS J2354|00641-6176-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.08|PHR: 408101; CHG: 26||Not reimbursed separately|36.08|PHR: 408101; CHG: 26||External grouping not supported 91281|ERX|HCPCS J2354|00703-3321-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.08|PHR: 408101; CHG: 26||Not reimbursed separately|36.08|PHR: 408101; CHG: 26||External grouping not supported 91281|ERX|HCPCS J2354|25021-0453-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.08|PHR: 408101; CHG: 26||Not reimbursed separately|36.08|PHR: 408101; CHG: 26||External grouping not supported 91281|ERX|HCPCS J2354|62756-0351-44|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.08|PHR: 408101; CHG: 26||Not reimbursed separately|36.08|PHR: 408101; CHG: 26||External grouping not supported 91281|ERX|HCPCS J2354|63323-0377-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|0.2 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.08|PHR: 408101; CHG: 26||Not reimbursed separately|36.08|PHR: 408101; CHG: 26||External grouping not supported 91281|ERX|HCPCS J2354|63323-0377-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.08|PHR: 408101; CHG: 26||Not reimbursed separately|36.08|PHR: 408101; CHG: 26||External grouping not supported 9158|ERX|HCPCS A9270|00904-5135-59|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.06|PHR: 408101; CHG: 26||Not reimbursed separately|0.06|PHR: 408101; CHG: 26||External grouping not supported 9175|ERX|HCPCS A9270|51672-1310-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.12|PHR: 408101; CHG: 26||Not reimbursed separately|11.12|PHR: 408101; CHG: 26||External grouping not supported 9183|ERX|HCPCS J7500|51079-0620-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZATHIOPRINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 9183|ERX|HCPCS J7500|51079-0620-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZATHIOPRINE 50 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 9183|ERX|HCPCS J7500|68382-0003-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|AZATHIOPRINE 50 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|1.15|PHR: 408101; CHG: 26||Not reimbursed separately|1.15|PHR: 408101; CHG: 26||External grouping not supported 9185|ERX|HCPCS S0073|00003-2560-16|0250 - PHARMACY - GENERAL CLASSIFICATION|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]||HUMANA [11839]|74.76|PHR: 408101; CHG: 26||Not reimbursed separately|74.76|PHR: 408101; CHG: 26||External grouping not supported 9185|ERX|HCPCS S0073|63323-0401-24|0250 - PHARMACY - GENERAL CLASSIFICATION|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]||HUMANA [11839]|74.76|PHR: 408101; CHG: 26||Not reimbursed separately|74.76|PHR: 408101; CHG: 26||External grouping not supported 9185|ERX|HCPCS S0073|63323-0401-20|0250 - PHARMACY - GENERAL CLASSIFICATION|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]||HUMANA [11839]|74.76|PHR: 408101; CHG: 26||Not reimbursed separately|74.76|PHR: 408101; CHG: 26||External grouping not supported 9186|ERX|HCPCS S0073|00003-2570-16|0250 - PHARMACY - GENERAL CLASSIFICATION|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]||HUMANA [11839]|149.51|PHR: 408101; CHG: 26||Not reimbursed separately|149.51|PHR: 408101; CHG: 26||External grouping not supported 9186|ERX|HCPCS S0073|63323-0402-24|0250 - PHARMACY - GENERAL CLASSIFICATION|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]||HUMANA [11839]|149.51|PHR: 408101; CHG: 26||Not reimbursed separately|149.51|PHR: 408101; CHG: 26||External grouping not supported 9186|ERX|HCPCS S0073|63323-0402-20|0250 - PHARMACY - GENERAL CLASSIFICATION|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]||HUMANA [11839]|149.51|PHR: 408101; CHG: 26||Not reimbursed separately|149.51|PHR: 408101; CHG: 26||External grouping not supported 9203|ERX|HCPCS A9270|61570-0031-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|NEOMYCIN-POLYMYXIN B-BACITRACIN-HYDROCORTISONE 1 % TOP OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.43|PHR: 408101; CHG: 26||Not reimbursed separately|439.43|PHR: 408101; CHG: 26||External grouping not supported 9219|ERX|HCPCS A9270|00574-7045-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.01|PHR: 408101; CHG: 26||Not reimbursed separately|54.01|PHR: 408101; CHG: 26||External grouping not supported 9219|ERX|HCPCS A9270|00574-7045-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 Suppository|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.01|PHR: 408101; CHG: 26||Not reimbursed separately|54.01|PHR: 408101; CHG: 26||External grouping not supported 9223|ERX|HCPCS A9270|65162-0751-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENAZEPRIL 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.15|PHR: 408101; CHG: 26||Not reimbursed separately|0.15|PHR: 408101; CHG: 26||External grouping not supported 9240|ERX|HCPCS A9270|11509-0003-67|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 5 %-RESORCINOL 2 % TOPICAL CREAM|28 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.31|PHR: 408101; CHG: 26||Not reimbursed separately|7.31|PHR: 408101; CHG: 26||External grouping not supported 9244|ERX|HCPCS A9270|40565-0111-82|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOIN TOPICAL TINCTURE|118 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.54|PHR: 408101; CHG: 26||Not reimbursed separately|3.54|PHR: 408101; CHG: 26||External grouping not supported 9259|ERX|HCPCS J0515|00143-9729-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BENZTROPINE 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.58|PHR: 408101; CHG: 26||Not reimbursed separately|15.58|PHR: 408101; CHG: 26||External grouping not supported 9259|ERX|HCPCS J0515|63323-0970-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BENZTROPINE 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|15.58|PHR: 408101; CHG: 26||Not reimbursed separately|15.58|PHR: 408101; CHG: 26||External grouping not supported 9260|ERX|HCPCS RX001|49471-0001-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BENZYLPENICILLOYL POLYLYSINE 0.25 ML INTRADERMAL INJECTION SOLUTION|0.01 mL|HUMANA [1294]||HUMANA [11839]|400.86|PHR: 408101; CHG: 26||Not reimbursed separately|400.86|PHR: 408101; CHG: 26||External grouping not supported 9260|ERX|HCPCS RX001|49471-0001-05|0250 - PHARMACY - GENERAL CLASSIFICATION|BENZYLPENICILLOYL POLYLYSINE 0.25 ML INTRADERMAL INJECTION SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|400.86|PHR: 408101; CHG: 26||Not reimbursed separately|400.86|PHR: 408101; CHG: 26||External grouping not supported 9266|ERX|HCPCS J0702|00517-0799-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.09|PHR: 408101; CHG: 26||Not reimbursed separately|6.09|PHR: 408101; CHG: 26||External grouping not supported 9266|ERX|HCPCS J0702|51754-5060-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.09|PHR: 408101; CHG: 26||Not reimbursed separately|6.09|PHR: 408101; CHG: 26||External grouping not supported 9266|ERX|HCPCS J0702|00085-4320-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12.17|PHR: 408101; CHG: 26||Not reimbursed separately|12.17|PHR: 408101; CHG: 26||External grouping not supported 9266|ERX|HCPCS J0702|00517-0720-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA [1294]||HUMANA [11839]|12.17|PHR: 408101; CHG: 26||Not reimbursed separately|12.17|PHR: 408101; CHG: 26||External grouping not supported 9268|ERX|HCPCS A9270|17478-0705-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETAXOLOL 0.5 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 9268|ERX|HCPCS A9270|61314-0245-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETAXOLOL 0.5 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.96|PHR: 408101; CHG: 26||Not reimbursed separately|93.96|PHR: 408101; CHG: 26||External grouping not supported 9285|ERX|HCPCS A9270|24385-0024-65|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 9285|ERX|HCPCS A9270|87701-0722-89|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.12|PHR: 408101; CHG: 26||Not reimbursed separately|0.12|PHR: 408101; CHG: 26||External grouping not supported 92853|ERX|HCPCS J7189|00169-7201-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION|1 mg|HUMANA [1294]||HUMANA [11839]|6,120.00|PHR: 408101; CHG: 26||Not reimbursed separately|6,120.00|PHR: 408101; CHG: 26||External grouping not supported 9289|ERX|HCPCS J9040|00703-3154-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION|15 Units|HUMANA [1294]||HUMANA [11839]|59.85|PHR: 408101; CHG: 26||Not reimbursed separately|59.85|PHR: 408101; CHG: 26||External grouping not supported 9289|ERX|HCPCS J9040|71288-0106-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION|2 Units|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.98|PHR: 408101; CHG: 26||Not reimbursed separately|7.98|PHR: 408101; CHG: 26||External grouping not supported 92895|ERX|HCPCS J3370|00338-3552-48|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]||HUMANA [11839]|28.11|PHR: 408101; CHG: 26||Not reimbursed separately|28.11|PHR: 408101; CHG: 26||External grouping not supported 9297|ERX|HCPCS A9270|00574-0106-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BROMOCRIPTINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.34|PHR: 408101; CHG: 26||Not reimbursed separately|4.34|PHR: 408101; CHG: 26||External grouping not supported 9297|ERX|HCPCS A9270|63304-0962-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BROMOCRIPTINE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.34|PHR: 408101; CHG: 26||Not reimbursed separately|4.34|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00409-1412-04|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00409-1412-34|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00409-1412-40|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00641-6007-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00641-6007-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00641-6008-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9308|ERX|HCPCS RX001|00641-6008-10|0250 - PHARMACY - GENERAL CLASSIFICATION|BUMETANIDE 0.25 MG/ML INJECTION SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|3.36|PHR: 408101; CHG: 26||Not reimbursed separately|3.36|PHR: 408101; CHG: 26||External grouping not supported 9310|ERX|HCPCS A9270|00185-0129-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUMETANIDE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 9310|ERX|HCPCS A9270|60687-0384-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUMETANIDE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 9310|ERX|HCPCS A9270|60687-0384-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUMETANIDE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.60|PHR: 408101; CHG: 26||Not reimbursed separately|3.60|PHR: 408101; CHG: 26||External grouping not supported 9311|ERX|HCPCS A9270|00185-0130-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUMETANIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.69|PHR: 408101; CHG: 26||Not reimbursed separately|1.69|PHR: 408101; CHG: 26||External grouping not supported 9311|ERX|HCPCS A9270|42799-0121-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUMETANIDE 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.69|PHR: 408101; CHG: 26||Not reimbursed separately|1.69|PHR: 408101; CHG: 26||External grouping not supported 9316|ERX|HCPCS RX001|00409-3613-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION|2 mL|HUMANA [1294]||HUMANA [11839]|5.92|PHR: 408101; CHG: 26||Not reimbursed separately|5.92|PHR: 408101; CHG: 26||External grouping not supported 9321|ERX|HCPCS A9270|60505-0157-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 9321|ERX|HCPCS A9270|60687-0351-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 9321|ERX|HCPCS A9270|60687-0351-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.89|PHR: 408101; CHG: 26||Not reimbursed separately|2.89|PHR: 408101; CHG: 26||External grouping not supported 9322|ERX|HCPCS A9270|51079-0943-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.14|PHR: 408101; CHG: 26||Not reimbursed separately|2.14|PHR: 408101; CHG: 26||External grouping not supported 9322|ERX|HCPCS A9270|51079-0943-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.14|PHR: 408101; CHG: 26||Not reimbursed separately|2.14|PHR: 408101; CHG: 26||External grouping not supported 9322|ERX|HCPCS A9270|60687-0340-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.14|PHR: 408101; CHG: 26||Not reimbursed separately|2.14|PHR: 408101; CHG: 26||External grouping not supported 9322|ERX|HCPCS A9270|60687-0340-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUPROPION HCL 75 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.14|PHR: 408101; CHG: 26||Not reimbursed separately|2.14|PHR: 408101; CHG: 26||External grouping not supported 9323|ERX|HCPCS A9270|00093-0054-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9323|ERX|HCPCS A9270|16729-0202-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9323|ERX|HCPCS A9270|51079-0986-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9323|ERX|HCPCS A9270|64380-0742-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9323|ERX|HCPCS A9270|64380-0742-07|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9323|ERX|HCPCS A9270|68382-0181-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|00093-0053-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|16729-0200-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|16729-0200-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|51079-0985-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|51079-0985-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|64380-0741-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9324|ERX|HCPCS A9270|68382-0180-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSPIRONE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.27|PHR: 408101; CHG: 26||Not reimbursed separately|0.27|PHR: 408101; CHG: 26||External grouping not supported 9325|ERX|HCPCS J8510|76388-0713-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUSULFAN 2 MG TABLET|1 Tab|HUMANA [1294]||HUMANA [11839]|64.11|PHR: 408101; CHG: 26||Not reimbursed separately|64.11|PHR: 408101; CHG: 26||External grouping not supported 9328|ERX|HCPCS RX001|10223-0201-03|0250 - PHARMACY - GENERAL CLASSIFICATION|BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY|20 g|HUMANA [1294]||HUMANA [11839]|152.10|PHR: 408101; CHG: 26||Not reimbursed separately|152.10|PHR: 408101; CHG: 26||External grouping not supported 9333|ERX|HCPCS J0595|00409-1623-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUTORPHANOL 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.51|PHR: 408101; CHG: 26||Not reimbursed separately|11.51|PHR: 408101; CHG: 26||External grouping not supported 9333|ERX|HCPCS J0595|00409-1623-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUTORPHANOL 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|11.51|PHR: 408101; CHG: 26||Not reimbursed separately|11.51|PHR: 408101; CHG: 26||External grouping not supported 9334|ERX|HCPCS J0595|00409-1626-21|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUTORPHANOL 2 MG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.08|PHR: 408101; CHG: 26||Not reimbursed separately|14.08|PHR: 408101; CHG: 26||External grouping not supported 9334|ERX|HCPCS J0595|00409-1626-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|BUTORPHANOL 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.08|PHR: 408101; CHG: 26||Not reimbursed separately|14.08|PHR: 408101; CHG: 26||External grouping not supported 9335|ERX|HCPCS A9270|60505-0813-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BUTORPHANOL 10 MG/ML NASAL SPRAY|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.16|PHR: 408101; CHG: 26||Not reimbursed separately|62.16|PHR: 408101; CHG: 26||External grouping not supported 9347|ERX|HCPCS J0630|67457-0675-02|0250 - PHARMACY - GENERAL CLASSIFICATION|CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|3,939.39|PHR: 408101; CHG: 26||Not reimbursed separately|3,939.39|PHR: 408101; CHG: 26||External grouping not supported 9348|ERX|HCPCS J0636|17478-0931-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|19.36|PHR: 408101; CHG: 26||Not reimbursed separately|19.36|PHR: 408101; CHG: 26||External grouping not supported 9350|ERX|HCPCS A9270|23155-0662-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCITRIOL 0.25 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9350|ERX|HCPCS A9270|60687-0345-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCITRIOL 0.25 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9350|ERX|HCPCS A9270|60687-0345-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCITRIOL 0.25 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9350|ERX|HCPCS A9270|64380-0723-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCITRIOL 0.25 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9350|ERX|HCPCS A9270|69452-0207-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCITRIOL 0.25 MCG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9385|ERX|HCPCS A9270|24385-0478-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9385|ERX|HCPCS A9270|24385-0485-47|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9385|ERX|HCPCS A9270|37864-0001-50|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9385|ERX|HCPCS A9270|66553-0004-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9385|ERX|HCPCS A9270|87701-0900-80|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 9385|ERX|HCPCS A9270|87701-0900-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.18|PHR: 408101; CHG: 26||Not reimbursed separately|0.18|PHR: 408101; CHG: 26||External grouping not supported 93931|ERX|HCPCS RX001|00378-9671-31|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN|1 Vial|HUMANA [1294]||HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 93931|ERX|HCPCS RX001|00487-0201-01|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN|1 Vial|HUMANA [1294]||HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 93931|ERX|HCPCS RX001|76204-0600-01|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN|1 Vial|HUMANA [1294]||HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 93931|ERX|HCPCS RX001|76204-0600-30|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN|1 Vial|HUMANA [1294]||HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 93931|ERX|HCPCS RX001|76204-0600-60|0250 - PHARMACY - GENERAL CLASSIFICATION|IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN|1 Vial|HUMANA [1294]||HUMANA [11839]|0.52|PHR: 408101; CHG: 26||Not reimbursed separately|0.52|PHR: 408101; CHG: 26||External grouping not supported 9401|ERX|HCPCS A9270|00781-8052-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 9401|ERX|HCPCS A9270|00904-5045-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 9401|ERX|HCPCS A9270|51079-0863-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 9401|ERX|HCPCS A9270|51079-0863-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 9401|ERX|HCPCS A9270|69292-0522-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 12.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.06|PHR: 408101; CHG: 26||Not reimbursed separately|3.06|PHR: 408101; CHG: 26||External grouping not supported 9402|ERX|HCPCS A9270|51079-0864-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.42|PHR: 408101; CHG: 26||Not reimbursed separately|3.42|PHR: 408101; CHG: 26||External grouping not supported 9402|ERX|HCPCS A9270|51079-0864-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.42|PHR: 408101; CHG: 26||Not reimbursed separately|3.42|PHR: 408101; CHG: 26||External grouping not supported 9402|ERX|HCPCS A9270|60687-0315-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.42|PHR: 408101; CHG: 26||Not reimbursed separately|3.42|PHR: 408101; CHG: 26||External grouping not supported 9402|ERX|HCPCS A9270|69292-0524-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAPTOPRIL 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.42|PHR: 408101; CHG: 26||Not reimbursed separately|3.42|PHR: 408101; CHG: 26||External grouping not supported 9406|ERX|HCPCS A9270|00378-0078-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 9406|ERX|HCPCS A9270|62756-0517-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 9406|ERX|HCPCS A9270|63739-0107-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.87|PHR: 408101; CHG: 26||Not reimbursed separately|0.87|PHR: 408101; CHG: 26||External grouping not supported 9407|ERX|HCPCS A9270|00904-6237-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 9407|ERX|HCPCS A9270|62756-0518-88|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 9407|ERX|HCPCS A9270|68084-0093-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 9407|ERX|HCPCS A9270|68084-0093-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.43|PHR: 408101; CHG: 26||Not reimbursed separately|0.43|PHR: 408101; CHG: 26||External grouping not supported 9408|ERX|HCPCS A9270|00904-6238-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 9408|ERX|HCPCS A9270|68084-0094-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.54|PHR: 408101; CHG: 26||Not reimbursed separately|0.54|PHR: 408101; CHG: 26||External grouping not supported 9413|ERX|HCPCS RX001|00009-0856-05|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|682.34|PHR: 408101; CHG: 26||Not reimbursed separately|682.34|PHR: 408101; CHG: 26||External grouping not supported 9413|ERX|HCPCS RX001|00009-0856-08|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|682.34|PHR: 408101; CHG: 26||Not reimbursed separately|682.34|PHR: 408101; CHG: 26||External grouping not supported 9413|ERX|HCPCS RX001|43598-0698-11|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|682.34|PHR: 408101; CHG: 26||Not reimbursed separately|682.34|PHR: 408101; CHG: 26||External grouping not supported 9413|ERX|HCPCS RX001|43598-0698-58|0250 - PHARMACY - GENERAL CLASSIFICATION|CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|682.34|PHR: 408101; CHG: 26||Not reimbursed separately|682.34|PHR: 408101; CHG: 26||External grouping not supported 9430|ERX|HCPCS A9270|00143-9985-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFACLOR 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.59|PHR: 408101; CHG: 26||Not reimbursed separately|4.59|PHR: 408101; CHG: 26||External grouping not supported 9458|ERX|HCPCS RX001|63323-0385-10|0250 - PHARMACY - GENERAL CLASSIFICATION|CEFOTETAN 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]||HUMANA [11839]|12.24|PHR: 408101; CHG: 26||Not reimbursed separately|12.24|PHR: 408101; CHG: 26||External grouping not supported 9460|ERX|HCPCS RX001|63323-0386-20|0250 - PHARMACY - GENERAL CLASSIFICATION|CEFOTETAN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]||HUMANA [11839]|48.94|PHR: 408101; CHG: 26||Not reimbursed separately|48.94|PHR: 408101; CHG: 26||External grouping not supported 9461|ERX|HCPCS J0694|00143-9878-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 9461|ERX|HCPCS J0694|25021-0109-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]||HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 9461|ERX|HCPCS J0694|44567-0245-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 9461|ERX|HCPCS J0694|63323-0341-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 9461|ERX|HCPCS J0694|63323-0341-29|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7.66|PHR: 408101; CHG: 26||Not reimbursed separately|7.66|PHR: 408101; CHG: 26||External grouping not supported 9463|ERX|HCPCS J0694|00143-9877-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.07|PHR: 408101; CHG: 26||Not reimbursed separately|16.07|PHR: 408101; CHG: 26||External grouping not supported 9463|ERX|HCPCS J0694|25021-0110-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.07|PHR: 408101; CHG: 26||Not reimbursed separately|16.07|PHR: 408101; CHG: 26||External grouping not supported 9463|ERX|HCPCS J0694|44567-0246-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.07|PHR: 408101; CHG: 26||Not reimbursed separately|16.07|PHR: 408101; CHG: 26||External grouping not supported 9463|ERX|HCPCS J0694|63323-0342-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.07|PHR: 408101; CHG: 26||Not reimbursed separately|16.07|PHR: 408101; CHG: 26||External grouping not supported 9463|ERX|HCPCS J0694|63323-0342-29|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.07|PHR: 408101; CHG: 26||Not reimbursed separately|16.07|PHR: 408101; CHG: 26||External grouping not supported 9468|ERX|HCPCS A9270|00781-5438-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFPODOXIME 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.72|PHR: 408101; CHG: 26||Not reimbursed separately|6.72|PHR: 408101; CHG: 26||External grouping not supported 9474|ERX|HCPCS J0713|00409-5082-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]||HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 9474|ERX|HCPCS J0713|25021-0127-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]||HUMANA [11839]|9.00|PHR: 408101; CHG: 26||Not reimbursed separately|9.00|PHR: 408101; CHG: 26||External grouping not supported 9476|ERX|HCPCS J0713|00409-5084-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]||HUMANA [11839]|16.57|PHR: 408101; CHG: 26||Not reimbursed separately|16.57|PHR: 408101; CHG: 26||External grouping not supported 9476|ERX|HCPCS J0713|25021-0128-50|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]||HUMANA [11839]|16.57|PHR: 408101; CHG: 26||Not reimbursed separately|16.57|PHR: 408101; CHG: 26||External grouping not supported 9476|ERX|HCPCS J0713|25021-0128-67|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]||HUMANA [11839]|16.57|PHR: 408101; CHG: 26||Not reimbursed separately|16.57|PHR: 408101; CHG: 26||External grouping not supported 9476|ERX|HCPCS J0713|44567-0236-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]||HUMANA [11839]|16.57|PHR: 408101; CHG: 26||Not reimbursed separately|16.57|PHR: 408101; CHG: 26||External grouping not supported 9487|ERX|HCPCS J0696|60505-6148-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 9487|ERX|HCPCS J0696|60505-6148-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.61|PHR: 408101; CHG: 26||Not reimbursed separately|1.61|PHR: 408101; CHG: 26||External grouping not supported 9487|ERX|HCPCS J0696|00409-7332-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.21|PHR: 408101; CHG: 26||Not reimbursed separately|3.21|PHR: 408101; CHG: 26||External grouping not supported 9487|ERX|HCPCS J0696|00409-7332-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.21|PHR: 408101; CHG: 26||Not reimbursed separately|3.21|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|00409-7335-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|00409-7335-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|00781-3209-90|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|25021-0107-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|25021-0107-68|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|60505-6149-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9488|ERX|HCPCS J0696|60505-6149-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.37|PHR: 408101; CHG: 26||Not reimbursed separately|6.37|PHR: 408101; CHG: 26||External grouping not supported 9489|ERX|HCPCS J0696|00409-7337-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 9489|ERX|HCPCS J0696|00409-7337-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 9489|ERX|HCPCS J0696|00781-3206-85|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 9489|ERX|HCPCS J0696|60505-6151-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 9489|ERX|HCPCS J0696|60505-6151-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 250 MG SOLUTION FOR INJECTION|250 mg|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.98|PHR: 408101; CHG: 26||Not reimbursed separately|1.98|PHR: 408101; CHG: 26||External grouping not supported 9490|ERX|HCPCS J0696|00409-7338-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 500 MG SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 9490|ERX|HCPCS J0696|00409-7338-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 500 MG SOLUTION FOR INJECTION|0.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.52|PHR: 408101; CHG: 26||Not reimbursed separately|2.52|PHR: 408101; CHG: 26||External grouping not supported 9491|ERX|HCPCS RX011|00409-7334-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION|10 g|HUMANA [1294]||HUMANA [11839]|45.75|PHR: 408101; CHG: 26||Not reimbursed separately|45.75|PHR: 408101; CHG: 26||External grouping not supported 9492|ERX|HCPCS J0696|00338-5002-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|28.50|PHR: 408101; CHG: 26||Not reimbursed separately|28.50|PHR: 408101; CHG: 26||External grouping not supported 9493|ERX|HCPCS J0696|00338-5003-41|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|PHR: 408101; CHG: 26||Not reimbursed separately|55.50|PHR: 408101; CHG: 26||External grouping not supported 9495|ERX|HCPCS A9270|57237-0058-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFUROXIME AXETIL 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 9495|ERX|HCPCS A9270|67877-0215-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFUROXIME AXETIL 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 9495|ERX|HCPCS A9270|67877-0215-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFUROXIME AXETIL 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 9495|ERX|HCPCS A9270|68180-0302-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFUROXIME AXETIL 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.24|PHR: 408101; CHG: 26||Not reimbursed separately|1.24|PHR: 408101; CHG: 26||External grouping not supported 9496|ERX|HCPCS A9270|57237-0059-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFUROXIME AXETIL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 9496|ERX|HCPCS A9270|67877-0216-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEFUROXIME AXETIL 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.60|PHR: 408101; CHG: 26||Not reimbursed separately|1.60|PHR: 408101; CHG: 26||External grouping not supported 9499|ERX|HCPCS A9270|50268-0151-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9499|ERX|HCPCS A9270|60687-0152-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9499|ERX|HCPCS A9270|60687-0152-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9499|ERX|HCPCS A9270|68180-0121-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 250 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|00093-3147-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|50268-0152-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|60687-0163-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|60687-0163-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|65862-0019-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|68180-0122-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9500|ERX|HCPCS A9270|69543-0102-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 500 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.61|PHR: 408101; CHG: 26||Not reimbursed separately|0.61|PHR: 408101; CHG: 26||External grouping not supported 9501|ERX|HCPCS A9270|00093-4175-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.83|PHR: 408101; CHG: 26||Not reimbursed separately|0.83|PHR: 408101; CHG: 26||External grouping not supported 9502|ERX|HCPCS A9270|00093-4177-73|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|00904-6717-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|24385-0998-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|43598-0811-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|51079-0597-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|51079-0597-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|60505-2633-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9506|ERX|HCPCS A9270|87701-0406-53|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CETIRIZINE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.36|PHR: 408101; CHG: 26||Not reimbursed separately|0.36|PHR: 408101; CHG: 26||External grouping not supported 9513|ERX|HCPCS A9270|76388-0635-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLORAMBUCIL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.59|PHR: 408101; CHG: 26||Not reimbursed separately|66.59|PHR: 408101; CHG: 26||External grouping not supported 9516|ERX|HCPCS RX001|00116-2001-04|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HUMANA [1294]||HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9516|ERX|HCPCS RX001|00116-2001-16|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HUMANA [1294]||HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9516|ERX|HCPCS RX001|69339-0138-15|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HUMANA [1294]||HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9516|ERX|HCPCS RX001|99999-4444-93|0250 - PHARMACY - GENERAL CLASSIFICATION|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HUMANA [1294]||HUMANA [11839]|1.71|PHR: 408101; CHG: 26||Not reimbursed separately|1.71|PHR: 408101; CHG: 26||External grouping not supported 9525|ERX|HCPCS A9270|65649-0311-12|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4.04|PHR: 408101; CHG: 26||Not reimbursed separately|4.04|PHR: 408101; CHG: 26||External grouping not supported 9526|ERX|HCPCS J1205|00517-1820-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|117.51|PHR: 408101; CHG: 26||Not reimbursed separately|117.51|PHR: 408101; CHG: 26||External grouping not supported 9526|ERX|HCPCS J1205|25021-0305-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|117.51|PHR: 408101; CHG: 26||Not reimbursed separately|117.51|PHR: 408101; CHG: 26||External grouping not supported 9526|ERX|HCPCS J1205|47335-0330-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|117.51|PHR: 408101; CHG: 26||Not reimbursed separately|117.51|PHR: 408101; CHG: 26||External grouping not supported 9526|ERX|HCPCS J1205|63323-0658-20|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|117.51|PHR: 408101; CHG: 26||Not reimbursed separately|117.51|PHR: 408101; CHG: 26||External grouping not supported 9526|ERX|HCPCS J1205|63323-0658-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|117.51|PHR: 408101; CHG: 26||Not reimbursed separately|117.51|PHR: 408101; CHG: 26||External grouping not supported 9526|ERX|HCPCS J1205|67457-0263-30|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|117.51|PHR: 408101; CHG: 26||Not reimbursed separately|117.51|PHR: 408101; CHG: 26||External grouping not supported 9582|ERX|HCPCS A9270|62542-0301-17|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-CHLORPHENIRAMINE 8 MG/5 ML ORAL SUSP EXTEND.REL 12HR|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 9582|ERX|HCPCS A9270|99999-2222-28|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|HYDROCODONE 10 MG-CHLORPHENIRAMINE 8 MG/5 ML ORAL SUSP EXTEND.REL 12HR|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.10|PHR: 408101; CHG: 26||Not reimbursed separately|5.10|PHR: 408101; CHG: 26||External grouping not supported 9602|ERX|HCPCS J0743|63323-0349-94|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION|250 mg|HUMANA [1294]||HUMANA [11839]|16.44|PHR: 408101; CHG: 26||Not reimbursed separately|16.44|PHR: 408101; CHG: 26||External grouping not supported 9603|ERX|HCPCS J0743|00006-3516-59|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA [1294]||HUMANA [11839]|26.20|PHR: 408101; CHG: 26||Not reimbursed separately|26.20|PHR: 408101; CHG: 26||External grouping not supported 9604|ERX|HCPCS A9270|00378-0053-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIMETIDINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.99|PHR: 408101; CHG: 26||Not reimbursed separately|0.99|PHR: 408101; CHG: 26||External grouping not supported 9604|ERX|HCPCS A9270|42037-0103-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIMETIDINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.99|PHR: 408101; CHG: 26||Not reimbursed separately|0.99|PHR: 408101; CHG: 26||External grouping not supported 9605|ERX|HCPCS A9270|00093-8192-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIMETIDINE 300 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 9606|ERX|HCPCS A9270|00093-8204-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIMETIDINE 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.41|PHR: 408101; CHG: 26||Not reimbursed separately|1.41|PHR: 408101; CHG: 26||External grouping not supported 9607|ERX|HCPCS A9270|00378-0541-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIMETIDINE 800 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.19|PHR: 408101; CHG: 26||Not reimbursed separately|3.19|PHR: 408101; CHG: 26||External grouping not supported 9610|ERX|HCPCS A9270|17478-0714-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.85|PHR: 408101; CHG: 26||Not reimbursed separately|17.85|PHR: 408101; CHG: 26||External grouping not supported 9610|ERX|HCPCS A9270|61314-0656-25|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.85|PHR: 408101; CHG: 26||Not reimbursed separately|17.85|PHR: 408101; CHG: 26||External grouping not supported 9610|ERX|HCPCS A9270|69315-0308-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17.85|PHR: 408101; CHG: 26||Not reimbursed separately|17.85|PHR: 408101; CHG: 26||External grouping not supported 9610|ERX|HCPCS A9270|00065-0656-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.70|PHR: 408101; CHG: 26||Not reimbursed separately|35.70|PHR: 408101; CHG: 26||External grouping not supported 9610|ERX|HCPCS A9270|61314-0656-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.70|PHR: 408101; CHG: 26||Not reimbursed separately|35.70|PHR: 408101; CHG: 26||External grouping not supported 9610|ERX|HCPCS A9270|69315-0308-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35.70|PHR: 408101; CHG: 26||Not reimbursed separately|35.70|PHR: 408101; CHG: 26||External grouping not supported 9611|ERX|HCPCS J0744|00409-4777-02|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]||HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 9611|ERX|HCPCS J0744|25021-0114-87|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 9611|ERX|HCPCS J0744|36000-0009-24|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|PHR: 408101; CHG: 26||Not reimbursed separately|6.00|PHR: 408101; CHG: 26||External grouping not supported 9612|ERX|HCPCS J9060|00703-5748-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.30|PHR: 408101; CHG: 26||Not reimbursed separately|111.30|PHR: 408101; CHG: 26||External grouping not supported 9612|ERX|HCPCS J9060|16729-0288-38|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION|100 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.30|PHR: 408101; CHG: 26||Not reimbursed separately|111.30|PHR: 408101; CHG: 26||External grouping not supported 9612|ERX|HCPCS J9060|00703-5747-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]||HUMANA [11839]|55.65|PHR: 408101; CHG: 26||Not reimbursed separately|55.65|PHR: 408101; CHG: 26||External grouping not supported 9612|ERX|HCPCS J9060|16729-0288-11|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION|50 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.65|PHR: 408101; CHG: 26||Not reimbursed separately|55.65|PHR: 408101; CHG: 26||External grouping not supported 9615|ERX|HCPCS J9065|63323-0140-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|380.79|PHR: 408101; CHG: 26||Not reimbursed separately|380.79|PHR: 408101; CHG: 26||External grouping not supported 9616|ERX|HCPCS A9270|00781-1961-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLARITHROMYCIN 250 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.90|PHR: 408101; CHG: 26||Not reimbursed separately|0.90|PHR: 408101; CHG: 26||External grouping not supported 9617|ERX|HCPCS A9270|00781-1962-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLARITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 9617|ERX|HCPCS A9270|65862-0226-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLARITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 9617|ERX|HCPCS A9270|68084-0651-95|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLARITHROMYCIN 500 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.29|PHR: 408101; CHG: 26||Not reimbursed separately|1.29|PHR: 408101; CHG: 26||External grouping not supported 9624|ERX|HCPCS A9270|00168-0277-40|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLINDAMYCIN 2 % VAGINAL CREAM|40 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.32|PHR: 408101; CHG: 26||Not reimbursed separately|181.32|PHR: 408101; CHG: 26||External grouping not supported 9626|ERX|HCPCS RX001|00338-3612-50|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|31.05|PHR: 408101; CHG: 26||Not reimbursed separately|31.05|PHR: 408101; CHG: 26||External grouping not supported 9626|ERX|HCPCS RX001|00338-3616-50|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|31.05|PHR: 408101; CHG: 26||Not reimbursed separately|31.05|PHR: 408101; CHG: 26||External grouping not supported 9626|ERX|HCPCS RX001|00781-3289-09|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|31.05|PHR: 408101; CHG: 26||Not reimbursed separately|31.05|PHR: 408101; CHG: 26||External grouping not supported 9626|ERX|HCPCS RX001|00781-3289-91|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|31.05|PHR: 408101; CHG: 26||Not reimbursed separately|31.05|PHR: 408101; CHG: 26||External grouping not supported 9627|ERX|HCPCS RX001|00338-3814-50|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|37.80|PHR: 408101; CHG: 26||Not reimbursed separately|37.80|PHR: 408101; CHG: 26||External grouping not supported 9627|ERX|HCPCS RX001|00338-4114-50|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|37.80|PHR: 408101; CHG: 26||Not reimbursed separately|37.80|PHR: 408101; CHG: 26||External grouping not supported 9627|ERX|HCPCS RX001|00781-3290-09|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|37.80|PHR: 408101; CHG: 26||Not reimbursed separately|37.80|PHR: 408101; CHG: 26||External grouping not supported 9627|ERX|HCPCS RX001|00781-3290-91|0250 - PHARMACY - GENERAL CLASSIFICATION|CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|50 mL|HUMANA [1294]||HUMANA [11839]|37.80|PHR: 408101; CHG: 26||Not reimbursed separately|37.80|PHR: 408101; CHG: 26||External grouping not supported 9630|ERX|HCPCS A9270|51672-1258-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBETASOL 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.17|PHR: 408101; CHG: 26||Not reimbursed separately|33.17|PHR: 408101; CHG: 26||External grouping not supported 9630|ERX|HCPCS A9270|70710-1456-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBETASOL 0.05 % TOPICAL CREAM|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.17|PHR: 408101; CHG: 26||Not reimbursed separately|33.17|PHR: 408101; CHG: 26||External grouping not supported 9631|ERX|HCPCS A9270|51672-1259-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBETASOL 0.05 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.31|PHR: 408101; CHG: 26||Not reimbursed separately|14.31|PHR: 408101; CHG: 26||External grouping not supported 9631|ERX|HCPCS A9270|52565-0039-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBETASOL 0.05 % TOPICAL OINTMENT|15 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.31|PHR: 408101; CHG: 26||Not reimbursed separately|14.31|PHR: 408101; CHG: 26||External grouping not supported 9631|ERX|HCPCS A9270|51672-1259-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOBETASOL 0.05 % TOPICAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28.62|PHR: 408101; CHG: 26||Not reimbursed separately|28.62|PHR: 408101; CHG: 26||External grouping not supported 9635|ERX|HCPCS A9270|00832-0630-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOMIPRAMINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.88|PHR: 408101; CHG: 26||Not reimbursed separately|3.88|PHR: 408101; CHG: 26||External grouping not supported 9635|ERX|HCPCS A9270|51672-4011-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOMIPRAMINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.88|PHR: 408101; CHG: 26||Not reimbursed separately|3.88|PHR: 408101; CHG: 26||External grouping not supported 9635|ERX|HCPCS A9270|70710-1065-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOMIPRAMINE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.88|PHR: 408101; CHG: 26||Not reimbursed separately|3.88|PHR: 408101; CHG: 26||External grouping not supported 9637|ERX|HCPCS A9270|00093-0832-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 9637|ERX|HCPCS A9270|16729-0136-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 9637|ERX|HCPCS A9270|16729-0136-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 9637|ERX|HCPCS A9270|60687-0544-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 9637|ERX|HCPCS A9270|63739-0263-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.14|PHR: 408101; CHG: 26||Not reimbursed separately|0.14|PHR: 408101; CHG: 26||External grouping not supported 9638|ERX|HCPCS A9270|16729-0137-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 9638|ERX|HCPCS A9270|51079-0882-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 9638|ERX|HCPCS A9270|51079-0882-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 9638|ERX|HCPCS A9270|60687-0555-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLONAZEPAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.08|PHR: 408101; CHG: 26||Not reimbursed separately|0.08|PHR: 408101; CHG: 26||External grouping not supported 9644|ERX|HCPCS A9270|00054-4146-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 10 MG TROCHE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 9644|ERX|HCPCS A9270|00054-8146-22|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 10 MG TROCHE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 9644|ERX|HCPCS A9270|00574-0107-70|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 10 MG TROCHE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 9644|ERX|HCPCS A9270|00574-0107-77|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOTRIMAZOLE 10 MG TROCHE|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.16|PHR: 408101; CHG: 26||Not reimbursed separately|3.16|PHR: 408101; CHG: 26||External grouping not supported 9647|ERX|HCPCS A9270|00093-7772-19|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 9647|ERX|HCPCS A9270|51079-0922-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 9647|ERX|HCPCS A9270|51079-0922-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 9647|ERX|HCPCS A9270|60687-0415-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 9647|ERX|HCPCS A9270|60687-0415-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.74|PHR: 408101; CHG: 26||Not reimbursed separately|1.74|PHR: 408101; CHG: 26||External grouping not supported 9648|ERX|HCPCS A9270|51079-0921-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.79|PHR: 408101; CHG: 26||Not reimbursed separately|0.79|PHR: 408101; CHG: 26||External grouping not supported 9648|ERX|HCPCS A9270|51079-0921-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CLOZAPINE 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.79|PHR: 408101; CHG: 26||Not reimbursed separately|0.79|PHR: 408101; CHG: 26||External grouping not supported 9675|ERX|HCPCS A9270|00591-5325-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROBENECID 500 MG-COLCHICINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.23|PHR: 408101; CHG: 26||Not reimbursed separately|2.23|PHR: 408101; CHG: 26||External grouping not supported 9675|ERX|HCPCS A9270|50742-0263-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROBENECID 500 MG-COLCHICINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.23|PHR: 408101; CHG: 26||Not reimbursed separately|2.23|PHR: 408101; CHG: 26||External grouping not supported 9675|ERX|HCPCS A9270|64980-0149-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PROBENECID 500 MG-COLCHICINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.23|PHR: 408101; CHG: 26||Not reimbursed separately|2.23|PHR: 408101; CHG: 26||External grouping not supported 9681|ERX|HCPCS J0770|63323-0393-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION|150 mg|HUMANA [1294]||HUMANA [11839]|29.46|PHR: 408101; CHG: 26||Not reimbursed separately|29.46|PHR: 408101; CHG: 26||External grouping not supported 9682|ERX|HCPCS A9270|50484-0010-30|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|674.37|PHR: 408101; CHG: 26||Not reimbursed separately|674.37|PHR: 408101; CHG: 26||External grouping not supported 9690|ERX|HCPCS J7631|00172-6406-49|0250 - PHARMACY - GENERAL CLASSIFICATION|CROMOLYN 20 MG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HUMANA [1294]||HUMANA [11839]|10.95|PHR: 408101; CHG: 26||Not reimbursed separately|10.95|PHR: 408101; CHG: 26||External grouping not supported 96937|ERX|HCPCS A9270|00093-7163-56|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5.01|PHR: 408101; CHG: 26||Not reimbursed separately|5.01|PHR: 408101; CHG: 26||External grouping not supported 9699|ERX|HCPCS RX001|00065-0395-15|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 0.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|170.10|PHR: 408101; CHG: 26||Not reimbursed separately|170.10|PHR: 408101; CHG: 26||External grouping not supported 9699|ERX|HCPCS RX001|17478-0096-15|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 0.5 % EYE DROPS|15 mL|HUMANA [1294]||HUMANA [11839]|170.10|PHR: 408101; CHG: 26||Not reimbursed separately|170.10|PHR: 408101; CHG: 26||External grouping not supported 9700|ERX|HCPCS RX001|00065-0397-02|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 2 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|20.91|PHR: 408101; CHG: 26||Not reimbursed separately|20.91|PHR: 408101; CHG: 26||External grouping not supported 9700|ERX|HCPCS RX001|17478-0097-02|0250 - PHARMACY - GENERAL CLASSIFICATION|CYCLOPENTOLATE 2 % EYE DROPS|2 mL|HUMANA [1294]||HUMANA [11839]|20.91|PHR: 408101; CHG: 26||Not reimbursed separately|20.91|PHR: 408101; CHG: 26||External grouping not supported 9706|ERX|HCPCS J7502|60505-0134-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE 100 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|21.24|PHR: 408101; CHG: 26||Not reimbursed separately|21.24|PHR: 408101; CHG: 26||External grouping not supported 9707|ERX|HCPCS J7515|00078-0240-61|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 9707|ERX|HCPCS J7515|60505-0133-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CYCLOSPORINE 25 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|5.32|PHR: 408101; CHG: 26||Not reimbursed separately|5.32|PHR: 408101; CHG: 26||External grouping not supported 97142|ERX|HCPCS RX001|99999-2222-76|0250 - PHARMACY - GENERAL CLASSIFICATION|METHOHEXITAL 500 MG SOLUTION FOR INJECTION|100 mg|HUMANA [1294]||HUMANA [11839]|40.92|PHR: 408101; CHG: 26||Not reimbursed separately|40.92|PHR: 408101; CHG: 26||External grouping not supported 97142|ERX|HCPCS RX001|42023-0105-01|0250 - PHARMACY - GENERAL CLASSIFICATION|METHOHEXITAL 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]||HUMANA [11839]|204.60|PHR: 408101; CHG: 26||Not reimbursed separately|204.60|PHR: 408101; CHG: 26||External grouping not supported 9715|ERX|HCPCS A9270|00555-0633-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DANAZOL 50 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.79|PHR: 408101; CHG: 26||Not reimbursed separately|2.79|PHR: 408101; CHG: 26||External grouping not supported 9716|ERX|HCPCS RX001|00143-9297-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DANTROLENE 20 MG INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]||HUMANA [11839]|144.09|PHR: 408101; CHG: 26||Not reimbursed separately|144.09|PHR: 408101; CHG: 26||External grouping not supported 9716|ERX|HCPCS RX001|27505-0003-67|0250 - PHARMACY - GENERAL CLASSIFICATION|DANTROLENE 20 MG INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]||HUMANA [11839]|144.09|PHR: 408101; CHG: 26||Not reimbursed separately|144.09|PHR: 408101; CHG: 26||External grouping not supported 9716|ERX|HCPCS RX001|42023-0123-06|0250 - PHARMACY - GENERAL CLASSIFICATION|DANTROLENE 20 MG INTRAVENOUS SOLUTION|60 mL|HUMANA [1294]||HUMANA [11839]|144.09|PHR: 408101; CHG: 26||Not reimbursed separately|144.09|PHR: 408101; CHG: 26||External grouping not supported 9718|ERX|HCPCS A9270|00115-4411-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DANTROLENE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.61|PHR: 408101; CHG: 26||Not reimbursed separately|3.61|PHR: 408101; CHG: 26||External grouping not supported 9718|ERX|HCPCS A9270|68084-0300-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DANTROLENE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.61|PHR: 408101; CHG: 26||Not reimbursed separately|3.61|PHR: 408101; CHG: 26||External grouping not supported 9718|ERX|HCPCS A9270|68084-0300-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DANTROLENE 25 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.61|PHR: 408101; CHG: 26||Not reimbursed separately|3.61|PHR: 408101; CHG: 26||External grouping not supported 97210|ERX|HCPCS A9270|46017-0018-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CAFFEINE 200 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.40|PHR: 408101; CHG: 26||Not reimbursed separately|0.40|PHR: 408101; CHG: 26||External grouping not supported 9723|ERX|HCPCS J0895|00409-2336-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEFEROXAMINE 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]||HUMANA [11839]|24.35|PHR: 408101; CHG: 26||Not reimbursed separately|24.35|PHR: 408101; CHG: 26||External grouping not supported 9723|ERX|HCPCS J0895|63323-0597-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEFEROXAMINE 500 MG SOLUTION FOR INJECTION|500 mg|HUMANA [1294]||HUMANA [11839]|24.35|PHR: 408101; CHG: 26||Not reimbursed separately|24.35|PHR: 408101; CHG: 26||External grouping not supported 97253|ERX|HCPCS RX001|00338-1148-03|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACIDS 5 % WITH LYTES AND CALCIUM IN D20W INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|93.00|PHR: 408101; CHG: 26||Not reimbursed separately|93.00|PHR: 408101; CHG: 26||External grouping not supported 97253|ERX|HCPCS RX001|00338-1125-04|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACIDS 5 % WITH LYTES AND CALCIUM IN D20W INTRAVENOUS SOLUTION|2,000 mL|HUMANA [1294]||HUMANA [11839]|174.00|PHR: 408101; CHG: 26||Not reimbursed separately|174.00|PHR: 408101; CHG: 26||External grouping not supported 9726|ERX|HCPCS A9270|42806-0143-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEMECLOCYCLINE 150 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.06|PHR: 408101; CHG: 26||Not reimbursed separately|33.06|PHR: 408101; CHG: 26||External grouping not supported 97347|ERX|HCPCS A9270|50458-0098-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27.42|PHR: 408101; CHG: 26||Not reimbursed separately|27.42|PHR: 408101; CHG: 26||External grouping not supported 97399|ERX|HCPCS RX001|14789-0015-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.44|PHR: 408101; CHG: 26||Not reimbursed separately|5.44|PHR: 408101; CHG: 26||External grouping not supported 97399|ERX|HCPCS RX001|14789-0015-07|0250 - PHARMACY - GENERAL CLASSIFICATION|ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION|0.1 mL|HUMANA [1294]||HUMANA [11839]|5.44|PHR: 408101; CHG: 26||Not reimbursed separately|5.44|PHR: 408101; CHG: 26||External grouping not supported 97399|ERX|HCPCS RX001|00187-4330-05|0250 - PHARMACY - GENERAL CLASSIFICATION|ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION|5 mL|HUMANA [1294]||HUMANA [11839]|271.74|PHR: 408101; CHG: 26||Not reimbursed separately|271.74|PHR: 408101; CHG: 26||External grouping not supported 97431|ERX|HCPCS A9270|00135-0200-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCOSANOL 10 % TOPICAL CREAM|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.86|PHR: 408101; CHG: 26||Not reimbursed separately|34.86|PHR: 408101; CHG: 26||External grouping not supported 97431|ERX|HCPCS A9270|00135-0200-03|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCOSANOL 10 % TOPICAL CREAM|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.86|PHR: 408101; CHG: 26||Not reimbursed separately|34.86|PHR: 408101; CHG: 26||External grouping not supported 97431|ERX|HCPCS A9270|00591-2981-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCOSANOL 10 % TOPICAL CREAM|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.86|PHR: 408101; CHG: 26||Not reimbursed separately|34.86|PHR: 408101; CHG: 26||External grouping not supported 97431|ERX|HCPCS A9270|00766-0801-55|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOCOSANOL 10 % TOPICAL CREAM|2 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.86|PHR: 408101; CHG: 26||Not reimbursed separately|34.86|PHR: 408101; CHG: 26||External grouping not supported 9747|ERX|HCPCS RX001|00781-6172-22|0250 - PHARMACY - GENERAL CLASSIFICATION|DESFLURANE 100 % INHALATION LIQUID|240 mL|HUMANA [1294]||HUMANA [11839]|388.80|PHR: 408101; CHG: 26||Not reimbursed separately|388.80|PHR: 408101; CHG: 26||External grouping not supported 9747|ERX|HCPCS RX001|10019-0641-34|0250 - PHARMACY - GENERAL CLASSIFICATION|DESFLURANE 100 % INHALATION LIQUID|240 mL|HUMANA [1294]||HUMANA [11839]|388.80|PHR: 408101; CHG: 26||Not reimbursed separately|388.80|PHR: 408101; CHG: 26||External grouping not supported 9747|ERX|HCPCS RX001|10019-0641-64|0250 - PHARMACY - GENERAL CLASSIFICATION|DESFLURANE 100 % INHALATION LIQUID|240 mL|HUMANA [1294]||HUMANA [11839]|388.80|PHR: 408101; CHG: 26||Not reimbursed separately|388.80|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|00703-5051-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|00703-5051-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]||HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|00703-5054-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|55566-2300-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|62756-0529-40|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|69918-0899-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|69918-0899-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 9748|ERX|HCPCS J2597|69918-0901-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26.69|PHR: 408101; CHG: 26||Not reimbursed separately|26.69|PHR: 408101; CHG: 26||External grouping not supported 97502|ERX|HCPCS A9270|42799-0806-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|IVERMECTIN 3 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9.82|PHR: 408101; CHG: 26||Not reimbursed separately|9.82|PHR: 408101; CHG: 26||External grouping not supported 97556|ERX|HCPCS J2270|63323-0452-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.45|PHR: 408101; CHG: 26||Not reimbursed separately|3.45|PHR: 408101; CHG: 26||External grouping not supported 97556|ERX|HCPCS J2270|63323-0452-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 2 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.45|PHR: 408101; CHG: 26||Not reimbursed separately|3.45|PHR: 408101; CHG: 26||External grouping not supported 97587|ERX|HCPCS J2270|63323-0458-00|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MORPHINE 8 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.00|PHR: 408101; CHG: 26||Not reimbursed separately|3.00|PHR: 408101; CHG: 26||External grouping not supported 97706|ERX|HCPCS A9270|54482-0148-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|LEVOCARNITINE 100 MG/ML ORAL SOLUTION|118 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.97|PHR: 408101; CHG: 26||Not reimbursed separately|107.97|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|99999-2222-39|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.32|PHR: 408101; CHG: 26||Not reimbursed separately|1.32|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|46122-0141-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|63824-0171-63|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|87701-0412-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|87701-0412-36|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|87701-0413-33|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|2.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 97734|ERX|HCPCS A9270|99999-2222-38|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DEXTROMETHORPHAN POLISTIREX ER 30 MG/5 ML ORAL SUSP EXT.RELEASE 12HR|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.66|PHR: 408101; CHG: 26||Not reimbursed separately|0.66|PHR: 408101; CHG: 26||External grouping not supported 97807|ERX|HCPCS A9270|00065-0246-10|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BETAXOLOL 0.25 % EYE DROPS,SUSPENSION|10 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.48|PHR: 408101; CHG: 26||Not reimbursed separately|858.48|PHR: 408101; CHG: 26||External grouping not supported 97848|ERX|HCPCS RX001|00409-4092-01|0250 - PHARMACY - GENERAL CLASSIFICATION|CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|51.00|PHR: 408101; CHG: 26||Not reimbursed separately|51.00|PHR: 408101; CHG: 26||External grouping not supported 97848|ERX|HCPCS RX001|00409-4092-11|0250 - PHARMACY - GENERAL CLASSIFICATION|CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|51.00|PHR: 408101; CHG: 26||Not reimbursed separately|51.00|PHR: 408101; CHG: 26||External grouping not supported 9788|ERX|HCPCS J7121|00338-0125-04|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 9788|ERX|HCPCS J7121|00338-0125-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|0.00|PHR: 408101; CHG: 23||Not reimbursed separately|0.00|PHR: 408101; CHG: 23||External grouping not supported 97893|ERX|HCPCS A9270|00378-8200-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|KETOPROFEN ER 200 MG 24 HR CAPSULE,EXTENDED RELEASE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.78|PHR: 408101; CHG: 26||Not reimbursed separately|19.78|PHR: 408101; CHG: 26||External grouping not supported 97961|ERX|HCPCS RX001|48433-0230-15|0250 - PHARMACY - GENERAL CLASSIFICATION|IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION|14 mL|HUMANA [1294]||HUMANA [11839]|86.27|PHR: 408101; CHG: 26||Not reimbursed separately|86.27|PHR: 408101; CHG: 26||External grouping not supported 98012|ERX|HCPCS J2543|63323-0304-74|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14.52|PHR: 408101; CHG: 26||Not reimbursed separately|14.52|PHR: 408101; CHG: 26||External grouping not supported 98016|ERX|HCPCS RX001|00264-9341-55|0250 - PHARMACY - GENERAL CLASSIFICATION|AMINO ACID 10 % INTRAVENOUS SOLUTION|500 mL|HUMANA [1294]||HUMANA [11839]|117.00|PHR: 408101; CHG: 26||Not reimbursed separately|117.00|PHR: 408101; CHG: 26||External grouping not supported 98106|ERX|HCPCS RX001|62991-2014-01|0250 - PHARMACY - GENERAL CLASSIFICATION|BUPIVACAINE (BULK) 100 % POWDER|5 g|HUMANA [1294]||HUMANA [11839]|61.20|PHR: 408101; CHG: 26||Not reimbursed separately|61.20|PHR: 408101; CHG: 26||External grouping not supported 98172|ERX|HCPCS J1815|00088-2220-33|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.48|PHR: 408101; CHG: 26||Not reimbursed separately|2.48|PHR: 408101; CHG: 26||External grouping not supported 98172|ERX|HCPCS J1815|99999-2222-58|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|0.1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.48|PHR: 408101; CHG: 26||Not reimbursed separately|2.48|PHR: 408101; CHG: 26||External grouping not supported 9828|ERX|HCPCS Q9963|00019-4816-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|120 mL|HUMANA [1294]||HUMANA [11839]|226.80|PHR: 408101; CHG: 26||Not reimbursed separately|226.80|PHR: 408101; CHG: 26||External grouping not supported 98407|ERX|HCPCS RX001|00406-1130-52|0250 - PHARMACY - GENERAL CLASSIFICATION|FENTANYL CITRATE (BULK) 100 % POWDER|1 g|HUMANA [1294]||HUMANA [11839]|2,051.70|PHR: 408101; CHG: 26||Not reimbursed separately|2,051.70|PHR: 408101; CHG: 26||External grouping not supported 98452|ERX|HCPCS A9270|55292-0201-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|SUCCIMER 100 MG CAPSULE|1 Each|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.26|PHR: 408101; CHG: 26||Not reimbursed separately|57.26|PHR: 408101; CHG: 26||External grouping not supported 98552|ERX|HCPCS A9270|42037-0104-75|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CARBAMIDE PEROXIDE 10 % ORAL RINSE|15 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.93|PHR: 408101; CHG: 26||Not reimbursed separately|11.93|PHR: 408101; CHG: 26||External grouping not supported 9859|ERX|HCPCS J1110|00143-9273-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.10|PHR: 408101; CHG: 26||Not reimbursed separately|195.10|PHR: 408101; CHG: 26||External grouping not supported 9859|ERX|HCPCS J1110|00143-9273-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.10|PHR: 408101; CHG: 26||Not reimbursed separately|195.10|PHR: 408101; CHG: 26||External grouping not supported 9859|ERX|HCPCS J1110|00574-0850-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION|0.5 mL|HUMANA [1294]||HUMANA [11839]|195.10|PHR: 408101; CHG: 26||Not reimbursed separately|195.10|PHR: 408101; CHG: 26||External grouping not supported 9859|ERX|HCPCS J1110|00574-0850-10|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION|1 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.20|PHR: 408101; CHG: 26||Not reimbursed separately|390.20|PHR: 408101; CHG: 26||External grouping not supported 98681|ERX|HCPCS Q9967|00270-1315-25|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|30 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.43|PHR: 408101; CHG: 26||Not reimbursed separately|11.43|PHR: 408101; CHG: 26||External grouping not supported 98681|ERX|HCPCS Q9967|00270-1315-47|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19.58|PHR: 408101; CHG: 26||Not reimbursed separately|19.58|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|00641-6013-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|00641-6013-10|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|00641-6014-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|00641-6015-01|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|17478-0937-05|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|17478-0937-10|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|17478-0937-25|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|17478-0937-26|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|70860-0301-05|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|70860-0301-41|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 9869|ERX|HCPCS RX001|70860-0301-43|0250 - PHARMACY - GENERAL CLASSIFICATION|DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|1.52|PHR: 408101; CHG: 26||Not reimbursed separately|1.52|PHR: 408101; CHG: 26||External grouping not supported 98697|ERX|HCPCS RX001|00409-9157-50|0250 - PHARMACY - GENERAL CLASSIFICATION|PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION|1 Ampule|HUMANA [1294]||HUMANA [11839]|11.04|PHR: 408101; CHG: 26||Not reimbursed separately|11.04|PHR: 408101; CHG: 26||External grouping not supported 9872|ERX|HCPCS RX011|17478-0526-03|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DIMERCAPROL 100 MG/ML INTRAMUSCULAR SOLUTION|3 mL|HUMANA [1294]||HUMANA [11839]|413.53|PHR: 408101; CHG: 26||Not reimbursed separately|413.53|PHR: 408101; CHG: 26||External grouping not supported 9875|ERX|HCPCS RX001|00009-0827-03|0250 - PHARMACY - GENERAL CLASSIFICATION|DINOPROSTONE 20 MG VAGINAL SUPPOSITORY|1 Suppository|HUMANA [1294]||HUMANA [11839]|6,624.36|PHR: 408101; CHG: 26||Not reimbursed separately|6,624.36|PHR: 408101; CHG: 26||External grouping not supported 988|ERX|HCPCS A9270|00904-6564-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZONATATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 988|ERX|HCPCS A9270|60687-0346-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZONATATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 988|ERX|HCPCS A9270|60687-0346-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZONATATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 988|ERX|HCPCS A9270|64380-0712-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZONATATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 988|ERX|HCPCS A9270|68382-0247-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZONATATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 988|ERX|HCPCS A9270|69452-0143-20|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZONATATE 100 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.93|PHR: 408101; CHG: 26||Not reimbursed separately|0.93|PHR: 408101; CHG: 26||External grouping not supported 98924|ERX|HCPCS RX001|00456-4300-01|0250 - PHARMACY - GENERAL CLASSIFICATION|FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|252.33|PHR: 408101; CHG: 26||Not reimbursed separately|252.33|PHR: 408101; CHG: 26||External grouping not supported 98924|ERX|HCPCS RX001|00456-4300-08|0250 - PHARMACY - GENERAL CLASSIFICATION|FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|252.33|PHR: 408101; CHG: 26||Not reimbursed separately|252.33|PHR: 408101; CHG: 26||External grouping not supported 98924|ERX|HCPCS RX001|70700-0268-99|0250 - PHARMACY - GENERAL CLASSIFICATION|FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET|1 Packet|HUMANA [1294]||HUMANA [11839]|252.33|PHR: 408101; CHG: 26||Not reimbursed separately|252.33|PHR: 408101; CHG: 26||External grouping not supported 98927|ERX|HCPCS A9270|16864-0680-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL|56 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11.26|PHR: 408101; CHG: 26||Not reimbursed separately|11.26|PHR: 408101; CHG: 26||External grouping not supported 9894|ERX|HCPCS A9270|00904-5522-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.46|PHR: 408101; CHG: 26||Not reimbursed separately|1.46|PHR: 408101; CHG: 26||External grouping not supported 9894|ERX|HCPCS A9270|16729-0211-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.46|PHR: 408101; CHG: 26||Not reimbursed separately|1.46|PHR: 408101; CHG: 26||External grouping not supported 9894|ERX|HCPCS A9270|60505-0093-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.46|PHR: 408101; CHG: 26||Not reimbursed separately|1.46|PHR: 408101; CHG: 26||External grouping not supported 9895|ERX|HCPCS A9270|00904-5523-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 9895|ERX|HCPCS A9270|60505-0094-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.44|PHR: 408101; CHG: 26||Not reimbursed separately|1.44|PHR: 408101; CHG: 26||External grouping not supported 9896|ERX|HCPCS A9270|00904-5524-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 9896|ERX|HCPCS A9270|59762-2340-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 4 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.49|PHR: 408101; CHG: 26||Not reimbursed separately|1.49|PHR: 408101; CHG: 26||External grouping not supported 9897|ERX|HCPCS A9270|60505-0096-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DOXAZOSIN 8 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.10|PHR: 408101; CHG: 26||Not reimbursed separately|0.10|PHR: 408101; CHG: 26||External grouping not supported 99|ERX|HCPCS A9270|00904-5791-46|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ACETAMINOPHEN 80 MG CHEWABLE TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.11|PHR: 408101; CHG: 26||Not reimbursed separately|0.11|PHR: 408101; CHG: 26||External grouping not supported 9904|ERX|HCPCS A9270|00904-6745-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 2.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.28|PHR: 408101; CHG: 26||Not reimbursed separately|8.28|PHR: 408101; CHG: 26||External grouping not supported 9904|ERX|HCPCS A9270|60687-0375-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 2.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.28|PHR: 408101; CHG: 26||Not reimbursed separately|8.28|PHR: 408101; CHG: 26||External grouping not supported 9904|ERX|HCPCS A9270|60687-0375-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 2.5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8.28|PHR: 408101; CHG: 26||Not reimbursed separately|8.28|PHR: 408101; CHG: 26||External grouping not supported 9905|ERX|HCPCS A9270|42858-0868-06|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.77|PHR: 408101; CHG: 26||Not reimbursed separately|20.77|PHR: 408101; CHG: 26||External grouping not supported 9905|ERX|HCPCS A9270|60687-0386-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.77|PHR: 408101; CHG: 26||Not reimbursed separately|20.77|PHR: 408101; CHG: 26||External grouping not supported 9905|ERX|HCPCS A9270|68084-0175-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.77|PHR: 408101; CHG: 26||Not reimbursed separately|20.77|PHR: 408101; CHG: 26||External grouping not supported 9905|ERX|HCPCS A9270|68084-0175-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|DRONABINOL 5 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20.77|PHR: 408101; CHG: 26||Not reimbursed separately|20.77|PHR: 408101; CHG: 26||External grouping not supported 99146|ERX|HCPCS A9270|00013-0132-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRAMUSTINE 140 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44.33|PHR: 408101; CHG: 26||Not reimbursed separately|44.33|PHR: 408101; CHG: 26||External grouping not supported 99196|ERX|HCPCS RX001|39822-0151-01|0250 - PHARMACY - GENERAL CLASSIFICATION|LIOTHYRONINE 10 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|898.47|PHR: 408101; CHG: 26||Not reimbursed separately|898.47|PHR: 408101; CHG: 26||External grouping not supported 9924|ERX|HCPCS A9270|00904-5610-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 9924|ERX|HCPCS A9270|68682-0712-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 10 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.96|PHR: 408101; CHG: 26||Not reimbursed separately|0.96|PHR: 408101; CHG: 26||External grouping not supported 9925|ERX|HCPCS A9270|51672-4037-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 9925|ERX|HCPCS A9270|64679-0923-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 9925|ERX|HCPCS A9270|68682-0710-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 2.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.20|PHR: 408101; CHG: 26||Not reimbursed separately|0.20|PHR: 408101; CHG: 26||External grouping not supported 9926|ERX|HCPCS A9270|64679-0926-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9926|ERX|HCPCS A9270|68084-0392-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9926|ERX|HCPCS A9270|68084-0392-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9926|ERX|HCPCS A9270|68682-0713-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 20 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.70|PHR: 408101; CHG: 26||Not reimbursed separately|0.70|PHR: 408101; CHG: 26||External grouping not supported 9927|ERX|HCPCS A9270|00904-5502-61|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.97|PHR: 408101; CHG: 26||Not reimbursed separately|0.97|PHR: 408101; CHG: 26||External grouping not supported 9927|ERX|HCPCS A9270|51672-4038-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.97|PHR: 408101; CHG: 26||Not reimbursed separately|0.97|PHR: 408101; CHG: 26||External grouping not supported 9927|ERX|HCPCS A9270|68682-0711-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ENALAPRIL MALEATE 5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.97|PHR: 408101; CHG: 26||Not reimbursed separately|0.97|PHR: 408101; CHG: 26||External grouping not supported 9929|ERX|HCPCS RX001|00143-9786-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|10.72|PHR: 408101; CHG: 26||Not reimbursed separately|10.72|PHR: 408101; CHG: 26||External grouping not supported 9929|ERX|HCPCS RX001|00143-9787-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|10.72|PHR: 408101; CHG: 26||Not reimbursed separately|10.72|PHR: 408101; CHG: 26||External grouping not supported 9929|ERX|HCPCS RX001|00143-9787-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|10.72|PHR: 408101; CHG: 26||Not reimbursed separately|10.72|PHR: 408101; CHG: 26||External grouping not supported 9929|ERX|HCPCS RX001|00143-9786-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION|2 mL|HUMANA [1294]||HUMANA [11839]|19.15|PHR: 408101; CHG: 26||Not reimbursed separately|19.15|PHR: 408101; CHG: 26||External grouping not supported 993|ERX|HCPCS A9270|67405-0825-05|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZOYL PEROXIDE 5 % TOPICAL CLEANSER|148 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15.99|PHR: 408101; CHG: 26||Not reimbursed separately|15.99|PHR: 408101; CHG: 26||External grouping not supported 99312|ERX|HCPCS A9270|00121-0677-16|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN|5 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.51|PHR: 408101; CHG: 26||Not reimbursed separately|0.51|PHR: 408101; CHG: 26||External grouping not supported 9938|ERX|HCPCS J0855|59676-0310-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|421.05|PHR: 408101; CHG: 26||Not reimbursed separately|421.05|PHR: 408101; CHG: 26||External grouping not supported 9941|ERX|HCPCS J0885|59676-0304-01|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA [1294]||HUMANA [11839]|308.77|PHR: 408101; CHG: 26||Not reimbursed separately|308.77|PHR: 408101; CHG: 26||External grouping not supported 9943|ERX|HCPCS A9270|39328-0357-60|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS|0.25 mL|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.33|PHR: 408101; CHG: 26||Not reimbursed separately|0.33|PHR: 408101; CHG: 26||External grouping not supported 99488|ERX|HCPCS J9150|00703-5233-13|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA [1294]||HUMANA [11839]|242.32|PHR: 408101; CHG: 26||Not reimbursed separately|242.32|PHR: 408101; CHG: 26||External grouping not supported 99491|ERX|HCPCS A9270|44523-0617-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|UREA 40 % TOPICAL CREAM|28.35 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.52|PHR: 408101; CHG: 26||Not reimbursed separately|157.52|PHR: 408101; CHG: 26||External grouping not supported 99491|ERX|HCPCS A9270|54295-0308-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|UREA 40 % TOPICAL CREAM|28.35 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.52|PHR: 408101; CHG: 26||Not reimbursed separately|157.52|PHR: 408101; CHG: 26||External grouping not supported 9957|ERX|HCPCS RX001|10019-0120-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|6.42|PHR: 408101; CHG: 26||Not reimbursed separately|6.42|PHR: 408101; CHG: 26||External grouping not supported 9957|ERX|HCPCS RX001|10019-0120-39|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|6.42|PHR: 408101; CHG: 26||Not reimbursed separately|6.42|PHR: 408101; CHG: 26||External grouping not supported 9957|ERX|HCPCS RX001|55150-0194-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|6.42|PHR: 408101; CHG: 26||Not reimbursed separately|6.42|PHR: 408101; CHG: 26||External grouping not supported 9957|ERX|HCPCS RX001|63323-0652-10|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|6.42|PHR: 408101; CHG: 26||Not reimbursed separately|6.42|PHR: 408101; CHG: 26||External grouping not supported 9957|ERX|HCPCS RX001|67457-0182-00|0250 - PHARMACY - GENERAL CLASSIFICATION|ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA [1294]||HUMANA [11839]|6.42|PHR: 408101; CHG: 26||Not reimbursed separately|6.42|PHR: 408101; CHG: 26||External grouping not supported 9959|ERX|HCPCS A9270|58657-0406-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.68|PHR: 408101; CHG: 26||Not reimbursed separately|6.68|PHR: 408101; CHG: 26||External grouping not supported 9961|ERX|HCPCS A9270|00591-0744-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTAZOLAM 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.50|PHR: 408101; CHG: 26||Not reimbursed separately|1.50|PHR: 408101; CHG: 26||External grouping not supported 9967|ERX|HCPCS A9270|42806-0088-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 9967|ERX|HCPCS A9270|51862-0333-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.24|PHR: 408101; CHG: 26||Not reimbursed separately|0.24|PHR: 408101; CHG: 26||External grouping not supported 9968|ERX|HCPCS A9270|42806-0089-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 9968|ERX|HCPCS A9270|51862-0334-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 2 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.39|PHR: 408101; CHG: 26||Not reimbursed separately|0.39|PHR: 408101; CHG: 26||External grouping not supported 9969|ERX|HCPCS A9270|00378-8770-35|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.26|PHR: 408101; CHG: 26||Not reimbursed separately|185.26|PHR: 408101; CHG: 26||External grouping not supported 9969|ERX|HCPCS A9270|00430-3754-14|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.26|PHR: 408101; CHG: 26||Not reimbursed separately|185.26|PHR: 408101; CHG: 26||External grouping not supported 9972|ERX|HCPCS J1410|00046-0749-05|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION|25 mg|HUMANA [1294]||HUMANA [11839]|861.54|PHR: 408101; CHG: 26||Not reimbursed separately|861.54|PHR: 408101; CHG: 26||External grouping not supported 9974|ERX|HCPCS A9270|00046-1102-81|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CONJUGATED ESTROGENS 0.625 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.33|PHR: 408101; CHG: 26||Not reimbursed separately|16.33|PHR: 408101; CHG: 26||External grouping not supported 9977|ERX|HCPCS A9270|00046-0872-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,084.32|PHR: 408101; CHG: 26||Not reimbursed separately|1,084.32|PHR: 408101; CHG: 26||External grouping not supported 9979|ERX|HCPCS RX001|42023-0157-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|2,349.84|PHR: 408101; CHG: 26||Not reimbursed separately|2,349.84|PHR: 408101; CHG: 26||External grouping not supported 9979|ERX|HCPCS RX001|67457-0297-50|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|2,349.84|PHR: 408101; CHG: 26||Not reimbursed separately|2,349.84|PHR: 408101; CHG: 26||External grouping not supported 9979|ERX|HCPCS RX001|68682-0012-27|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA [1294]||HUMANA [11839]|2,349.84|PHR: 408101; CHG: 26||Not reimbursed separately|2,349.84|PHR: 408101; CHG: 26||External grouping not supported 998|ERX|HCPCS A9270|60687-0356-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.82|PHR: 408101; CHG: 26||Not reimbursed separately|0.82|PHR: 408101; CHG: 26||External grouping not supported 998|ERX|HCPCS A9270|60687-0356-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 0.5 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.82|PHR: 408101; CHG: 26||Not reimbursed separately|0.82|PHR: 408101; CHG: 26||External grouping not supported 9980|ERX|HCPCS A9270|25010-0215-15|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHACRYNIC ACID 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.92|PHR: 408101; CHG: 26||Not reimbursed separately|16.92|PHR: 408101; CHG: 26||External grouping not supported 9980|ERX|HCPCS A9270|42799-0405-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHACRYNIC ACID 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.92|PHR: 408101; CHG: 26||Not reimbursed separately|16.92|PHR: 408101; CHG: 26||External grouping not supported 9980|ERX|HCPCS A9270|49884-0276-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHACRYNIC ACID 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.92|PHR: 408101; CHG: 26||Not reimbursed separately|16.92|PHR: 408101; CHG: 26||External grouping not supported 9980|ERX|HCPCS A9270|60429-0887-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHACRYNIC ACID 25 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16.92|PHR: 408101; CHG: 26||Not reimbursed separately|16.92|PHR: 408101; CHG: 26||External grouping not supported 9982|ERX|HCPCS A9270|54879-0001-00|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9982|ERX|HCPCS A9270|68180-0280-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 100 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.34|PHR: 408101; CHG: 26||Not reimbursed separately|1.34|PHR: 408101; CHG: 26||External grouping not supported 9983|ERX|HCPCS A9270|54879-0002-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 9983|ERX|HCPCS A9270|68084-0280-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 9983|ERX|HCPCS A9270|68084-0280-11|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 9983|ERX|HCPCS A9270|68850-0012-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 9983|ERX|HCPCS A9270|68850-0012-02|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETHAMBUTOL 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.36|PHR: 408101; CHG: 26||Not reimbursed separately|1.36|PHR: 408101; CHG: 26||External grouping not supported 9984|ERX|HCPCS J1430|67871-4790-06|0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION|1.5 mL|HUMANA [1294]||HUMANA [11839]|886.40|PHR: 408101; CHG: 26||Not reimbursed separately|886.40|PHR: 408101; CHG: 26||External grouping not supported 9989|ERX|HCPCS RX015|00071-0237-24|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHOSUXIMIDE 250 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|2.88|PHR: 408101; CHG: 26||Not reimbursed separately|2.88|PHR: 408101; CHG: 26||External grouping not supported 9989|ERX|HCPCS RX015|23155-0532-01|0250 - PHARMACY - GENERAL CLASSIFICATION|ETHOSUXIMIDE 250 MG CAPSULE|1 Cap|HUMANA [1294]||HUMANA [11839]|2.88|PHR: 408101; CHG: 26||Not reimbursed separately|2.88|PHR: 408101; CHG: 26||External grouping not supported 999|ERX|HCPCS A9270|00603-2438-21|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 999|ERX|HCPCS A9270|76385-0104-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|BENZTROPINE 1 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.23|PHR: 408101; CHG: 26||Not reimbursed separately|0.23|PHR: 408101; CHG: 26||External grouping not supported 9997|ERX|HCPCS A9270|60505-0039-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETODOLAC 200 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.07|PHR: 408101; CHG: 26||Not reimbursed separately|1.07|PHR: 408101; CHG: 26||External grouping not supported 9998|ERX|HCPCS A9270|51672-4017-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETODOLAC 300 MG CAPSULE|1 Cap|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2.25|PHR: 408101; CHG: 26||Not reimbursed separately|2.25|PHR: 408101; CHG: 26||External grouping not supported 9999|ERX|HCPCS A9270|51672-4018-01|0637 - PHARMACY - EXTENSION OF 025X - SELF-ADMINISTRABLE DRUGS (B)|ETODOLAC 400 MG TABLET|1 Tab|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.43|PHR: 408101; CHG: 26||Not reimbursed separately|1.43|PHR: 408101; CHG: 26||External grouping not supported P50-053-2515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2517|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.0MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-002-R005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLIQUE 5HOLE COMPRESSION RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HD HUM OFFSET THICK 50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442778|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 55MMX2.2MM LOPRFL SS 2.7MM SCR 5HL T-SHP VA EVOS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,318.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 13MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT281218|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 28.5MM 14.5MM 12MM GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXA107902A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIABAHN .035 IN 79MM 135CM OD10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF1245|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH INTRO 45CM 12FR 4.7MM 4MM GORE DRYSEAL FLX HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300019|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC EDWARDS CARPENTIER 19MM PERIMOUNT MAGNA PERICAR|1|HUMANA [1294]||HUMANA [11839]|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6287241|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X12MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]||HUMANA [11839]|4,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA22-70/I16-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 70MM 22MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300021|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC EDWARDS CARPENTIER 21MM PERIMOUNT MAGNA PERICAR|1|HUMANA [1294]||HUMANA [11839]|17,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZXR00I0120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +12.0 DIOP MOD C BCNVX 13MM 6MM PC 1 PC FLD ANT ASP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1237S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 12MM X 375MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300023|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC EDWARDS CARPENTIER 23MM PERIMOUNT MAGNA PERICAR|1|HUMANA [1294]||HUMANA [11839]|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 300025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC EDWARDS CARPENTIER 25MM PERIMOUNT MAGNA PERICAR|1|HUMANA [1294]||HUMANA [11839]|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported L1712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 1.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZS-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 4MM EASYSTEP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZXP15-15-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE SUPERELASTIC EXPRESS EASYCLIP 15X15X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 990215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKIN W10MM T7.2MM L9.6CM ALLOGRAFT HEMI BTB NO HL PS|1|HUMANA [1294]||HUMANA [11839]|8,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300027|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC EDWARDS CARPENTIER 27MM PERIMOUNT MAGNA PERICAR|1|HUMANA [1294]||HUMANA [11839]|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3603514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM SPNL MA IMPT OCCIPITOCRVICAL UP THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 360770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CUT 3.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300029|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC EDWARDS CARPENTIER 29MM PERIMOUNT MAGNA PERICAR|1|HUMANA [1294]||HUMANA [11839]|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,397.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3600315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPINAL W/TRANSVERSE CONNECTOR NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZ10621-525MP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST MD PR 13.8CM 5.0CM 525CC STRL|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-540MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.9X5.1M 540CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-525MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.8X5.0M 525CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-700HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 14.9X6.0CM 700CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZ10621-650HP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST HG PR 14.7CM 5.9CM 650ML STRL|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZ10621-700HP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST HG PR 14.9CM 6.0CM 700ML STRL|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXA230300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 3.3CM 23MM GRTX XCLDR C3 AORTA NTNL FEP DLV SYS|1|HUMANA [1294]||HUMANA [11839]|7,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZ10621-650MP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST MD PR 14.8CM 5.4CM 650CC STRL|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-695MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 15.1X5.5M 695CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-650MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 14.8X5.4M 650CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-650HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 14.7X5.9CM 650CC HSC+ SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXA260300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 3.3CM 26MM 18FR 22-23MM XCLDR LOPRFL AORTA GRTX|1|HUMANA [1294]||HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 13MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 40MM T8 2MM CORT ST EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 60MM LOPRFL SCR TI ANKL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACHV45|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP LIGATION 45MM FLEX-V F/LEFT ATRIAL APPENDAGE OCCLUSION|1|HUMANA [1294]||HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.0MM 48MM EVOS MN SS T8 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXA280300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 3.3CM 28.5MM XCLDR C3 AORTA GRTX NTNL FEP STNT|1|HUMANA [1294]||HUMANA [11839]|7,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72466307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7/3.5MM EVOS OLECRANON W/TINES 7H LT 114MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.3MM 36MM T8 2MM ST LCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629310S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 175MM TI 10 HL LCK VARIAX BN LFT POST MDL ELB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 60MML X 5.0MM DIA COMPRESSION CANNULATED ASNIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,920.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,920.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZXP25-22-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE SUPERELASTIC EXPRESS EASYCLIP 25X22X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-21.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1819-1220S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 200CM RT ANKL T2 IM ARTHDS LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1891-5040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 40MM TI PART THRD FLX3 LCK IN T2 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|571.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|571.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1818-0005S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END STD 5+ MM FEM T2 IM NL TI STRL 12MM|1|HUMANA [1294]||HUMANA [11839]|594.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|594.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0 34.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +34 DIOP +2.5 CYL BCNVX 13MM 6MM PC 1 PC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1037S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 10MM X 375MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.195S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FEMORAL NECK 95MML PERFORATED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,317.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,317.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.12/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 12MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16187545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 45MM RELINE MAS 2C SPNE MDLR SHNK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201993|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.3MM 2 OSTEORAPTOR ULBRD COBRAID BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,031.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,031.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910400010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM PEEK ZIP SZ2 ABSB FRC FRB SUTURE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|689.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|689.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.670S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 3.0MM 80MM TI T25 FT FEM LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|726.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 5 HL LCK BN LNG BN 95MM NON STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0296|SUP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PACING IMP ETAK RELNC 64CM DL COIL HELIX DF4 GR STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850046545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 5.5 X 45MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850046550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 50MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850045550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 5.5 X 50MM - 5.5/6.0 SV ATS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910200030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUT 5.5MM ZIP PEEK #2 SUT FORCE FIB NDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,769.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,769.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.681S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 145MM SS 2.4MM SCR 10HLE/HD 2HL VA LCP LFT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,411.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,411.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-4006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS HUM 6MM 40MM REUNION STD X3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT150165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +16.5 DIOP +1.5 CYL HPT C BCNVX 13MM 6MM PC 1 PC FL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXR00U0220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +22 DIOP MOD C BCNVX 13MM 6MM PC 1 PC FLD ANT ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1360C-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS INTFR BCMPS 4.75MM 6MM W/SWL LCK X2 LP RMER 7MM CANN 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V010-5-7MMX74CM|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN SAPHENOUS 7MM X 74CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5568-0015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 133MM 15MM REUNION STRL RVRS FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM UCL INTERNAL BRACE IMPLANT REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 34MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HHL80|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL HEAD LEFT FRESH|1|HUMANA [1294]||HUMANA [11839]|20,716.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,716.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-1-36-116-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 36MM X 116MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0234020290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACK SURGICAL PROCEDURE CUSTOM SETUP ACL W/DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,013.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4020C-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR 7MM 20MM BIOCOMPOSITCP FST THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2968050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 50MMX10MM CLYDESDALE 6D PEEK-VRTBRL TNTLUM MRK STRL|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 38MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277541|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X5MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47449|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 202MM 32MM ZNTH TX2 DISSECTION STR COMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,786.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,786.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47493|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 180MM 36MM ZNTH TX2 DISSECTION STR COMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 4.5MM 44MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277641|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X6MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281418|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 28.5MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT231416|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 23MM 14.5MM XCLDR LOPRFL TRNKIPSL LG GRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC141200|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 14.5MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-2509|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS VALVED 9FR 25CM SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72455305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 58MM SS 3.5MM SCR 5H LOPRFL VA EVOS LFT DP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 25MM TI INTGR LCK MDLN ALGN NTCH LOPRFL VNTR BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,777.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790323|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VENTURE 4.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 10MM X 345MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPK0121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSPACE KNEE MEDIUM 7064|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZS-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 10MM EASYSTEP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 34MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 36MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 40MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAVICULAR SS 2.4/2.7MM SCR VR AN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234800204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 92MM SS 3.5MM SCR 4 HL NONLOCK BN HUM LT PROX LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZDEG-P-28-142-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDO 142MM 28MM ZENITH TX2 DISCT STRGHT CMPNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,786.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,786.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.492|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR 2.4 X 61MM 5 HOLE HEAD 5 HOLE SHAFT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,130.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,130.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-04-0068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 4 LEVEL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 22MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.3MM 42MM T8 2MM ST LCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.876|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 16MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S1-1490U|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RITLENG BICANALICULUS LACRIMAL TUBE L300MM D0.64MM|1|HUMANA [1294]||HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08553|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPRSTH 20MM 16FR 50MM COOK-Z TRCHBRNCH SLF-EXPD DBL|1|HUMANA [1294]||HUMANA [11839]|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8973L-30-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA 3.0MM X 180MM LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 56MM LOPRFL SCR SS T15 FT HEXALOBE ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUTANEOUS 5.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850046540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 40MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.878|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 18MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850045540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 5.5 X 40MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850046535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 35MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6626746|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17X6MM DIVERGENCE 14MM LRDTC NCL PULPOSUS PEEK|1|HUMANA [1294]||HUMANA [11839]|12,705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6623517|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 17MM DIVERGENCE TI SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1126S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 260MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-140-042F|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI-MONSTER FULL THREAD CANNULATED 4.0X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|711.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 20MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72205020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MICRORAPTOR KNOTLESS RG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 251MM TI 14 HL AXSOS 3 BN TIB LT PROX LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9600CT26A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TISSUE 26MM SAPIEN 2 TRANSCATHETER BOVINE|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4020C-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR 8MM 20MM BIOCOMPOSITCP FST THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 12MM 5MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08552|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPRSTH 15MM 14FR 50MM COOK-Z TRCHBRNCH SLF-EXPD DBL|1|HUMANA [1294]||HUMANA [11839]|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 12MM 5.9MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT-00003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT LARGE HAMMERTOE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 22MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN MINI 3MM 24MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0A-19P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INT TOE 19MMX1.2MM SMRT TOE II 10D ANG NTNL 1 PC STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 13MM 5MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 16MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5500.12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM X 12MM TI CORT HEXA 6 TAPERED CORE FULL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5500.14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM X 14MM TI CORT HEXA 6 TAPERED CORE FULL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5500.15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM X 15MM TI CORT HEXA 6 TAPERED CORE FULL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5500.18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM X 18MM TI CORT HEXA 6 TAPERED CORE FULL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5500.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM X 16MM TI CORT HEXA 6 TAPERED CORE FULL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.11/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 11MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4650.67|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LK 2.0MM/2.3MM 6X2HL TI BLUE TRPZID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,843.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,843.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5500.20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM X 20MM TI CORT HEXA 6 TAPERED CORE FULL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 13MM 6.5MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534-A-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 9MM KN ALL PE CNDRL STAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,887.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-12-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SMALL SHELL 12MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 26MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 16MM 5.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC2408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN COMP LCKNG 2.4MM X 8MM XS PLT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 12MM VARIAX T6 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663809|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 9MM VARIAX T6 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NR642M|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR T4/T4+ 14MM KN REVISION HI CNSTRN GLDNG W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSS702|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO CATH 10CM 7FR PN STRGHT CROSS-CUT VL HYDROP 0.038IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 20MM 6.65MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSS502|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO CATH 10CM 5FR PN STRGHT CROSS-CUT VL HYDROP 0.038IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 27MM 1.3MM 4 HL TI STRGHT 2MM/2.3MM APT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,872.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,872.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 20MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 22MM 7.34MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 22MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 24MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS HUM 4MM 32MM SHLDR X3 CNSTRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 650CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-485|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 485CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 450CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSM-445|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA MOD SMH SHL SRFC SFTCH 445CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSM-405|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA MOD SMH SHL SRFC SFTCH 405CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 26MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 48MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,181.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,181.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 4.5MM 48MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651003040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 5.5MM 40MM CAPPED VOYAGER|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651003045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 5.5MM 45MM CAPPED VOYAGER|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION 20MM X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-510-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 10MM X3 CS RTN TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 28MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 16MM 48MM SHLDR LOS SFT TIS BAL AQLS ASCND FLX COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.6MM 46MM MN TI T10 RVRS CUT FLUT CNN HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-14-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE 14MMX48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658185|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 85MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 15.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00840004410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SIZE 4 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00840001407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ULNAR SIZE 4 75MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 32MM 10.66MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963AL-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL SS LT 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-10114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN VARIAX TI MEDIUM FT CALCANEUS MESH POLYAXI 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FA21-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 21-30CM 6.6MM ANGIOGRAFT FEM ART LF STRL|1|HUMANA [1294]||HUMANA [11839]|16,243.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,243.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 13MM 24MM 12CM ANGIOGRAFT AORTAILIAC ART LF ST|1|HUMANA [1294]||HUMANA [11839]|69,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-110-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 10MM KN X3 CS TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 32MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-310-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 10MM KN X3 CS BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8881023|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X10X10MM ELEV X-LOR EXP INTERBDY STRL|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442484|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y-SHP 2.4MM EVOS 5 HOLE HD 7 HOLE SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 42MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 50MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 65MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 34MM 11.32MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 44MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442488|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y-TINE 2.4MM EVOS 7 HOLE SHAFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,359.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,359.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 46MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 14MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2657DR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNT DIST CLVCL SS 8HL RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2658T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR DISTAL CLAVICLE REPAIR ASSEMBLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752550|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 30CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 34MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 6MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-SMB09R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 9HL SCAPULA MEDIAL BORDER RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 71MM 5 HL LCK CMPR AXSOS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1151015|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRCN 5.9X3.9IN XENMATRIX AQUAPURE RECT ACLR CLGN MTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,220.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,220.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719MXDS-1515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 15X15MM SUPERMX NTNL CMPR LOPRFL TROC TIP ALGN PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 36MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 38MM 12.6MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-135-034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI MONSTER HEADED SHORT THREAD 3.5 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-106-L101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3 HOLE COMPRESSION STANDARD LAPIDUS LEFT NO ARM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1152025|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRCN 7.9X9.8IN XENMATRIX AQUAPURE RECT ACLR CLGN MTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 38MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.066S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 180CM LT HINDFOOT NLEX IM CNN TI STRL GRN ARTHDS|1|HUMANA [1294]||HUMANA [11839]|5,010.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,010.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 40MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFNS2020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 20X20MM FUSEFORCE HND 2MM RMR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13015545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 45MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13016550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM RELINE-O 2S SPNE PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13016545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM RELINE-O 2S SPNE PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM RELINE-O 2S SPNE PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15355300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 300MM TI STRT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 42MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16017570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 70MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16018580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8.5MM 80MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080254P2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TLIF-O MODULUS 8X10X25MM 4 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777404432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 44MM DARCO SHRT ORTH FT HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.08/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 8MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 44MM 14.6MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.09/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 9MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 20MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 22MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CUT 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-00-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS SCKT RSP DJO SRG STD HUM HXE+ STRL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 44MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 18.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 46MM 15.3MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PH-M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONVENTUS PH MEDIUM|1|HUMANA [1294]||HUMANA [11839]|14,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PH-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONVENTUS PH SMALL|1|HUMANA [1294]||HUMANA [11839]|14,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PH-L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONVENTUS PH LARGE|1|HUMANA [1294]||HUMANA [11839]|14,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6038-1|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURE WASHER 3.5MM 5 HOLE|1|HUMANA [1294]||HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 46MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6486-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LARGE PH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7097-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING PH 86MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7098-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING PH 112MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 48MM 16MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 48MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3558|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3562|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3564|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CH3568|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADED 3.5MM X 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 52MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 54MM 18MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 54MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOINDUCTIVE WITH ARTHRO DEL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR BONE 3 W/ARTHRO DEL SYS ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,722.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,722.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 16.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235700814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 216MM SS 3.5MM SCR 14H LCK LOPRFL 2 CMPR SLOT BN TIB L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 11MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 56MM 18.6MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 60MM CANN PARTIALLY THEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 13MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 56MM FT FT/ANKL CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 17.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SL3522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1593|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SECONDARY FIXATION ACL/PCL REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 58MM 19.3MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC3556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 58MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 60MM 19.9MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 60MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM TI T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.258|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 44MM 2.4/2.7MM 2H SM VA 0DEG LCP FIRST RIGHT MTP FN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,929.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,929.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EL-1515S2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPL 15X15X15MM SECOD2.5 BME ELT 2 LG BRDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 30MM FEM LOPRFL INTNL HEX TRGN IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 62MM 20.6MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 62MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 64MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 66MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-P 6H RT 91MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,032.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,032.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 46MM 3.5MM SCR 4HL LCK EVOS BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|640.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|640.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS LONG THREAD 7.0MM L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125-1200S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 200MM HIP TROCH GAMMA3 IM 125D KT TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,051.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,051.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 66MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1941PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT SF TISSUE PEEK 3.9MM 10.2MM CSCR FWR KNTLS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 50MM LOPRFL ANKL LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1698-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INTERNALBRACE LISFRANC IMPLANT REPAIR SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXR00U0225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +22.5 DIOP MOD C BCNVX 13MM 6MM PC 1 PC FLD ANT ASP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 68MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 68MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0022-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 22MM ACUTWIST ACTRK TI FT TPR FT HND CMPR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXAL087902A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIABAHN .035 IN 79MM 135CM OD8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXAL085902A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIABAHN .035 IN 59MM 135CM OD8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXAL083902A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIABAHN .035 IN 39MM 135CM OD8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-24H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM CMPR FT TI STD FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 70MM 23.3MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC201400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 13.5CM 20MM 16MM XCLDR CNTRLT LG GRTX NTNL FEP|1|HUMANA [1294]||HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 17.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 15.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902126P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 11MMX11MMX26MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|18,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6040923|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 9MMX9MMX23MM COROENT 4D LARGE PEEK-OPTIMA PSTR L|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902726P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 07MMX11MMX26MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|18,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16017540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 40MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 70MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 72MM 24MM BIODUR 108 1/3 THRD HEX RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71678095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 11MM 95MM INTERTAN TI SUBTROCHANTER LAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,522.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,522.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3MM 28MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1142S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 420MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5065S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 65MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-410-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 10MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3003055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 55MM TI 3 LVL ZEVO BN SPNE CRV ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7713515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 15M ZEVO TI SPNE CRV ANT VAR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 72MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS HUM 12MM 36MM SHLDR X3 CNSTRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT281414|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 28.5MM 14.5MM GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXA115901A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIABAHN .035 IN L59 MM L80 CM OD1|1|HUMANA [1294]||HUMANA [11839]|9,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 46MML X 5.0MM DIA COMPRESSION CANNULATED ASNIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5047S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 47MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 60MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 20MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 4.0X28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902826P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 08MMX11MMX26MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-610-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 10MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 34MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 38MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 40MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850016550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 50MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 25MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850017550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 7.5 X 50MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651003055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 5.5MM 55MM CAPPED VOYAGER|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651003060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 5.5MM 60MM CAPPED VOYAGER|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500472|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.75MM 2 ICONIX FRC FBR 2 NDL INTELLIBRAID 2 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG FEM TRTHLN 6 CONE KN LFT TRITANIUM REV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 30MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CUT 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 35MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588TB-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 14MM TGHTRP RND CNV ATCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM TI T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 35MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 2.4/2.7MM SM VA 10DEG LCP FIRST LEFT MTP FN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3001021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 21MM TI 1 LVL ZEVO BN SPNE CRV ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8W15-3523-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CAPITATE 15MM 35MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 022-LDR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPINAL 12MM QUICK START DISTRACTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 30MM 5.5MM RELINE LRDTC TI MAS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7MM SPC T 42X7.5X1.4MM SS 2.7MM SCR MN FRG 3HL/HD5 STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,062.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 2.7MM EVOS MINI FLEX 56MM 8HL SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 40MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 44MM T8 CORT ST EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM TI LCK NS AXSOS 3 PERIPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-DS01BTV|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING TRNVG BLU 1.1CM X 45CM DESARA FM ST URINARY INC SURG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,839.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,839.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345744|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE 7X14X14MM CORT/CANL BLK ASSMB LRD CRNST ASR FZ|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500471|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 4.75MM OMEGA KNOTLESS SYSTEM SINGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.20/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 20MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4650.11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LK 29MM HOLE7 1MM THK TI T-SHP GRAY 2.0/2.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,461.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115205000|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE WHIPPLE 1152-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114704566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 22MM LOPRFL SCR TI ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 20.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-DS01B|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING EXCL BLUE 1.1CM X 45CM DESARA FEMALE STRESS URINARY INCONTINENCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,535.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,535.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3.5MM 65MM EVOS CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72453204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 3.5MM 70MM 4H LTRL PROXIMAL TIBIA PRTAL ARTCL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00436201500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE 15MM GLEN FIX TRAB MTL SHLD REV STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00436003600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOSPHERE TRABLR MTL REVERSE 3 DIA 36MM+0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-612-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 12MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-210-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 10MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-3638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 1.8MM FIBERTAK SOFT KNOTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CANNULA MENISCAL CINCH II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 50MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 44CM RT INTERTROCHANTER INTERTAN IM 130D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676583|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 42CM LT INTERTROCHANTER INTERTAN IM 130D 1.5MM 11.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0024-LDR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPINAL DISTRACTION QUICK START 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-VLY2654|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VERTESSA LITE Y SHP POLY 26CM X 5CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 50MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-710-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 10MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-0001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TIBIA COMPRESSION 5.5MM T2 ALPHA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,233.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,233.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 50MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-152-0001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE GORILLA 4 HOLE T-PLATE W/COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-412-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 12MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 42MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5025B-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR POLY L LAC ACD 16MM 3-3.7MM TPR SM BN CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 18.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902031P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 10MMX11MMX31MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16017550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 50MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BIOF6QA005CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EP 115CM 6FR 5MM YLW W/AUTO ID QUD FX A CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD134901|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EP 15MM 7FR LASSO NAVISTAR REPROCESSED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD134302|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EP 25-15MM 4FR 115CM LASSO VARIABLE REPROCESSED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BIOBD710FJ282CT|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ABLATION EZ STEER 282MM 7FR SPACE FJ CURVE REPROCES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BIOBD710DF282CT|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ABLATION EZ STEER 282MM 7FR CORONARY SINUS SPACING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R10439236|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ULTRASOUND 8FR SOUNDSTAR GE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BIO10439072|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ULTRASOUND 10FR INTRACARDIAC STEERING HAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACU10135936|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ULTRASOUND 8FR 90CM ACUNAV 4 WAY STEERING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 60MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 19.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUSSION 5.5CM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 60MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00436202000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE 26MM X 15MM X TRAB MTL SHLD REV STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 18.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA 9 HOLE LEFT 2.7/3.5 X 125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,417.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,417.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 60MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANDARD QUADRA-P SIZE 4 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22.100036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP PRIMARY UNCEMENTED HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 65MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 259MM 14 HL LCK CMPR AXSOS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719MXDS-1815|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 18X15MM SUPERMX NTNL CMPR LOPRFL TROC TIP ALGN PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0275|SUP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PACING IMP ETAK RELNC 59CM DL COIL HELIX DF4 NGR STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANDARD QUADRA-P SIZE 3 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 65MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08554|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPRSTH 25MM 16FR 50MM COOK-Z TRCHBRNCH SLF-EXPD DBL|1|HUMANA [1294]||HUMANA [11839]|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANDARD QUADRA-P SIZE 5 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZDEG-P-32-142-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDO 142MM 32MM ZENITH TX2 DISCT STRGHT CMPNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,786.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,786.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 14.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 22.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1788J-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INTERNAL BRACE STANDARD BIOCOMOSITE 4.75MM X 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 65MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22.100037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP PRIMARY CEMENTED HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4048HC10A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER FACE CHANGE 10 DEGREE ANGLE PE HC 40/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 70MM 16MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 70MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FC07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP FUSION 14MM 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,667.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587221RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION 10 DEGREE MEDIUM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N30038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 38MM DART-FIRE TI SM P/T FT SLF DRL ST CNN CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|786.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.074S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 70MM 15MM COMP HL4 SS HK SH PRE CNT 3.5 SCR LCP RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,549.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,549.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8530408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPNL 8MM CENTERPIECE OD PT CERVICAL OVAL LTRL HL TI CL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658390|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS SHORT THREAD 7.0MM L90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 75MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 20.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 75MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000101201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNIPOLAR HIP-LD FX POR ST ENDO HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9CRS-D200-A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST 10MM TAPER LONG 18.5MM BOSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 80MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627418S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 279MM TI 18 HL AXSOS 3 BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,587.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,587.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM AXSOS 3 TI LCK ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|909.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB3775|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DISC CERVICAL MOBI-C 17MM X 17MM H5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-SMB13L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 13HL SCAPULA MEDIAL BORDER LFT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 80MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-SLB10L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 10HL SCAPULA TI LATERAL BORDER LFT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION 19MM X 104MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-750|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 750CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 85MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 90MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XBR001001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD IMPLANT COCR ANKLE JOINT F/ARTHROERESIS SUBFIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|963.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|963.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 95MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71678090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 11MM 90MM INTERTAN TI SUBTROCHANTER LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,522.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,522.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 95MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-345|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 345CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-365|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 365CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-385|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 385CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSM-310|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA MOD SMH SHL SRFC SFTCH 310CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSM-330|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA MOD SMH SHL SRFC SFTCH 330CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSM-345|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA MOD SMH SHL SRFC SFTCH 345CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT50U245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 24.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 100MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 23.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 100MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840004545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 45MM SOLERA CD HZN COCR SPNE MA NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 75MM EVOS CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-P 10H LT 134MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 52MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 2.4/2.7MM SM VA 10DEG LCP FIRST RIGHT MTP FN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 105MM 16MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 105MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4300.12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN FIXATION TI 4/6H 0.6MM THK T-SH 1.2/1.5MM GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|786.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.13/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 13MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.14/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 14MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-135-030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI MONSTER HEADED SHORT THREAD 3.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 44MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-R152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 50D MED GORILLA BN MTP RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,211.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,211.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 105MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7140212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 12 XLIF 2 HL DECADE BN SPNE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,431.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,431.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPNL 55MM 5.5MM DECADE LG PLT XLIF NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 110MM 16MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7045M-90|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT 3-D I FUSE SI-BONE 7.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2144|SUP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROLAYER XENOGRAFT 4CMX4CM ACELLULAR DERMAL MATRIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTN-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR TI 120MM GEMINUS BN RDS LT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626966|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE STRAIGHT SLIM 6 HOLE T8 NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CUT 3.5MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 110MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.844.206S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE OSTEOTOMY COTTON PEEK 6.6MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 110MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 21.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1160606|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 6CM X 6CM XENMATRIX SQUARE ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1160610|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 6CM X 10CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1160616|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 6CM X 16CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1160808|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 8CM X 8CM XENMATRIX SQUR ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 115MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 10CMX10CM XENMATRIX SQUR ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 10CM X 20CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161028|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 10CM X 28CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 15CM X 20CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161525|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 15CM X 25CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161928|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 19CM X 28CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,871.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,871.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161935|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 19CM X 35CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,671.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,671.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1162020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 20CMX20CM XENMATRIX SQUR ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1162025|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 20CM X 25CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1162040|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 20CM X 40CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,948.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,948.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 115MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1163030|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 30CM X 30CM XENMATRIX SQUR ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61,816.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|61,816.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1162540|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 25CM X 40CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68,656.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|68,656.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1163045|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL 30CM X 45CM XENMATRIX RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92,710.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|92,710.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 11MM SPC STD 162X11.4X3.4MM SS 2.7/3.5MM SCR 12 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,816.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,816.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4300.11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN FIXATION TI 3/5H 0.6MM THK T-SH 1.2/1.5MM GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|786.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 115MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.04/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 4MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.05/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 5MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.09/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 9MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.09/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 2MM DIA 7MML TITANIUM CORTICAL HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.16/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 16MM TI CORT HEXA 6 TPD CR FL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902931P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 09MMX11MMX31MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCB5014BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 12MM COR RX GW 2 BLN SYR LF FLASHMINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OTW7012BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 7MM 135CML FLASH OSTIAL 12MM OTW PTA 0.035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 120MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OTW6012BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 6MM 135CML FLASH OSTIAL 12MM OTW PTA 0.035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1152530|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SUR 9.8IN X 11.8IN XENMATRIX RECT ACLR CLGN MTR RGNR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1151520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SUR 5.9IN X 7.9IN XENMATRIX RECT ACLR CLGN MTR RGNR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,572.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,572.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629776|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2MM 4MM SCREW 5 HOLE LOCK 41MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-140-032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI MONSTER HEADED SHORT THREAD 3.5 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 120MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-L102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 10 DEGREE MEDIUM MTP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0022-LDR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPINAL 12MM QUICK START DISTRACTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3002035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 35MM TI 2 LVL ZEVO BN SPNE CRV ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400541|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE 5X14X11MM CORTICAL FREEZE DRIED|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400641|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE 6X14X11MM BLK CORT SPNL LRDT STRLE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 120MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 125MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629782|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.7MM 4MM SCREW 5 HOLE LOCK 47MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANDARD QUADRA-P SIZE 2 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3652HC4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OFFSET 4MM PE HC A 36G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LATERAL QUADRA-P SIZE 6 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 125MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.7MM 18MM LOPRFL SCR SS FT/ANKL CORT SLD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 125MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFAT40U175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 17.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 130MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 40MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-312-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 12MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-003-R006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BABY GORILLA 1.1MM L2 6 HOLE RIGHT LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 18.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 14.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 130MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840006555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM SOLERA CD HZN COCR SPNE MA NS 5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 130MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 26.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 14MM EVOS T7 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 135MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 20MM EVOS T7 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 18MM EVOS T7 LOCK S-T STLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72468203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR EVOS 48MM 3HOLE RIGHT STANDARD DISTAL RADIUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2MM 2MM SCREW 5 HOLE LOCK 34MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 135MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD 2MM 4 HOLE LOCK 28MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 42MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013319J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VERSATURN 0.014IN 190CM J-TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 140MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANDARD QUADRA-P SIZE 6 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 140MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4363-036-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE ECC 36MM +3MM LATERAL OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-08-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER ALTIVATE REVERSE SMALL 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LATERAL QUADRA-P SIZE 4 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 600-10-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE COBALT MV W/GENTAMICIN 40GM|1|HUMANA [1294]||HUMANA [11839]|729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 145MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 148X10.7X3.5MM TMX 3.5MM SCR 17 HL ANTM LCK ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM COCR TIB T15 DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM COCR TIB T15 DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM COCR TIB T15 DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR TMX 10.9MMX88MM 9 HL RT ANTM ALPS BN ELB OLCRN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR TMX 10.7MMX74MM 9 HL RT ANTM ALPS BN ELB OLCRN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 145MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1825-0001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 8MM 1MM FEM T2 IM FLTX3 TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1128S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 280MM FEM IM T2 R1500|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-1-015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPLNG XTRNFX HFMN 3 ROD TO ROD DLT 11MM ROD 15MM APX|1|HUMANA [1294]||HUMANA [11839]|5,418.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,418.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 150MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-415|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 415CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-485MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.6X4.8M 485CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-455MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.3X4.6M 455CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-505HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.4X5.3CM 505CC HSC HG PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-505MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.7X4.9CM 505CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 150MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCX-545|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA CHSV 545CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM SPNL MA IMPT OCCIPITOCRVICAL UP THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2169-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOINDUCTIVE WITH ARTHRO DEL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.5MM 60MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB ZUK 6 KN LT MDL RL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 6 10MM KN TIB UNCMP VIVACIT-E ZM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 22MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD 2.7MM 8 HOLE LOCK 38MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 11MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 11MM VARIAX T8 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.5MM 60MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LATERAL QUADRA-P SIZE 3 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YP1301RB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.3MM 2 Y-KNT 1 LD 1 STRN PROFLEX HI-FI W/BL SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 22MM 5MM ASNIS CANNULATED MACRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 17.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 21.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2MM SCREW 8 HOLE LOCK L 48MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.5MM 60MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 13.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.07/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 7MM APTUS TRLK TI PHLNG HND HEXADRIVE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.66|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN APTUS LOCK HOLE10 TI TRAPEZOID HAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,736.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,736.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 65MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 4.5MM 50MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX5060|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSER DEVICE MYNX 5 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX6760|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSER DEVICE MYNX 6FR 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 65MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 65MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 40MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-0933S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 9MM X 330MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8MM 70MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS14A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN CANN CMP C-FIX 3.5MMX14MM TI FULL THRD SF-DRILL MGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0XS-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE SMRT TOE II X FUSE 10D 13 PROX INTPHAL IM FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1818-1115S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 150MM LT ANKL T2 IM ARTHDS LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1818-1120S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 200MM LT ANKL T2 IM ARTHDS LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5027S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 27MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 24MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 70MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.21/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 21MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.23/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 23MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 15MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD 2.7MM 10 HOLE LOCK 90MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5204800|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL DOUBLE-J 7.0 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|373.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1147-070-77|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 70MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 48MM ASNS CNN NS JNS FXN SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM ASNS CNN NS JNS FXN SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720163-01|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING ADVANCE XP MALE STRESS URINARY INCONTINENCE SUR MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 23.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APL-PUP-9HR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL ULNA 151MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON-LOCKING 2.7MM X 18MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-075-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 75MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|507.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1151530|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SUR 5.9IN X 11.8IN XENMATRIX RECT ACLR CLGN MTR RGNR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,845.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,845.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 35MM 2X4HL TI STRGHT 2MM/2.3MM APTUS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,168.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,168.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850015545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 5.5 X 45MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L2314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 2.3MM X 14M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-075-77|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 75MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00590103548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEX HEADED 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42560007514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PSN REV TAPERED SMOOTH EXT 14X75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42504605412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA REVISION CEMENTED RIGHT PLUS 3+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 112MM TI 5 HL AXSOS 3 BN HUM LFT PROX LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,768.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,768.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 35MM 5.5MM CRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-080-77|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 80MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T44150|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE BN 10CC GRAFT SM DBM MATRIX GRAFTON LF|1|HUMANA [1294]||HUMANA [11839]|5,157.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,157.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-D 20H RT 243MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,676.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,676.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676605|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 42CM LT INTERTROCHANTER INTERTAN IM 125D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-085-77|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 85MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 22.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFAT40U215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 21.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-100/I20-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-100/I20-40|1|HUMANA [1294]||HUMANA [11839]|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-090-77|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 90MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 95MM 32MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|507.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-095-77|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 95MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA53DRIGHT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 6FR LNCHR SCR4 CRV COR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629787|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2MM 5MM SCREW 10 HOLE LOCK 87MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442786|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 2.7MM HOLE6 SS TRIANGLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,318.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402723|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 23MM T8 2MM CORT ST EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ20-16-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL DVC FIXATION EASYCLIP 20X16X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,503.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,503.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-100-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 100MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71800106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 155MM SS 4.5MM SCR 6 HL LCK PRLC BN FEM LT DIST LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,773.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,773.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 25MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 80MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 38MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 100MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MOPS96|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE OSTEOCHONDRAL DISTAL FEMORAL MEDIAL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.5MM 7.9MM 40MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.5MM 7.9MM 42MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 20.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 100MM 16MM BIODUR 108 FT HEX RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201991|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.3MM 1 OSTEORAPTOR ULBRD COBRAID WHITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,060.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,060.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G2-M-IS|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT GLCM CRDVO ISTENT LT STRL LF DISP TRBCLR MIC BYPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 105MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2105|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE MATRIX ORTHO BONE VIABLE BIO4 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626938|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.6MM 38MM T8 CP LAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.820.103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RETAINER 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108843309|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL ACIS PRO 360 LORDOTIC LARGE 9MM HEIGHT|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 105MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-33.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 33.0 DIOPTER ACRYSOF 6.0MM ANTERIOR ASYMMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656310S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM VARIAX T8 FT LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656314S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM VARIAX T8 FT LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656312S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM VARIAX T8 FT LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656316S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM VARIAX T8 FT LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656410S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIAX T8 FULL THREAD L10 MM OD2.7 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.47|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OSTEOTOMY ADULT 110 DEGREE 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,796.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,796.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 105MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902226P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 12MMX11MMX26MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 7.9MM 38MM PERI-LOC STAINLESS STEEL T25 FLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 45MM 5.5MM CRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD 2.7MM 4 HOLE LOCK 39MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 110MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2125|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROLAYER XENOGRAFT 2CMX5CM ACELLULAR DERMAL MATRIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IM NL 300MM 13MM 125D R1.5 LNG LT TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM VARIAX T8 FT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656422S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM VARIAX T8 FT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 110MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902026P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 10MMX11MMX26MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB INFNT 5 STD CMPNT TL ANKL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6952020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL IMPLANT 10X38X28MM TI 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955171|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BOLT TI BASE 5.0X17.5MM FIXED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 110MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 34MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 32MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3601510|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR LATERAL CLOSED 10MM|1|HUMANA [1294]||HUMANA [11839]|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZSLE-16-39-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 16MM 5.4MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 115MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 115MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 44MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71820008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4.5MM 193MM PERI-LCK L-D FEM 8HL CNT SCL NON LCK SS LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,078.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,078.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 16MM PRLC SS T25 FLTX3 ST LCK LNG FGM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 18.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 17.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 115MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.340|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +34.0 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 120MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D412|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PERCIVA VR DF4 SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D413|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PERCIVA DR DF4 DUAL CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 120MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13015550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 50MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 120MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15455300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 300MM COCR STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108843008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL ACIS PRO 360 LORDOTIC LARGE 8MM HEIGHT|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108843007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CG SPNL ACIS PRO 360 TI L 7MM|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-512-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 12MM X3 CS RTN TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 125MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SYSTEM TENDON 10MM HOLEX1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20159|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SYSTEM TENDON 26MM HOLEX2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U320|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 32.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-31.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 31.0 DIOPTER ACRYSOF 6.0MM ANTERIOR ASYMMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-4419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 19MM 44MM SHLDR REUNION STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN CANN 3.2MM 4.5MM 46MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 30MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 125MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-420|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 420CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-470|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 470CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-445|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 445CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 125MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110018416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 12MM HEADLESS COMPRESSION NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|814.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676582|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 40CM RT INTERTROCHANTER INTERTAN IM 130D 1.5MM 11.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-38-117-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 38MM X 161MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,458.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,458.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 130MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BOM23EDGELGLIS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 23MM LOTUS EDGE SYS LG LOTUS INTR SET|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BOM25EDGELGLIS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 25MM LOTUS EDGE SYS LG LOTUS INTR SET|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BOM27EDGELGLIS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 27MM LOTUS EDGE SYS LG LOTUS INTR SET|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 36CM RT TROCH INTERTAN IM 130DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-R004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 0D SHRT GORILLA BN MTP RT 2HL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AFAPRO28|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARTIC FRONT ADVANCE PRO CRYOABLIATION 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 130MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AFAPRO23|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARTIC FRONT ADVANCE PRO CRYOABLIATION 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 18MM AXSOS 3 TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL M-D 18H RT 228MM 2.7/3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,162.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,162.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL 21.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 288226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 36MM LATARJET TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 130MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 288224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 32MM LATARJET TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 135MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VRG-001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PRESUTURED TENDON VERSAGRAFT 150-250MM 4-5MM STRL|1|HUMANA [1294]||HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14354|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ORBITAL SILICONE 18MM NONSTERILE|1|HUMANA [1294]||HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 135MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 30MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 32MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 135MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603750|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CUT 3.5MM X 50MM|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-332612-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR INTERBODY DEVICE 33MM X 26MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 140MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM SPNL MA IMPT OCCIPITOCRVICAL UP THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM SPNL MA IMPT OCCIPITOCRVICAL UP THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 28MM SPNL MA IMPT OCCIPITOCRVICAL UP THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7753890|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 3.5MM X 90MM|1|HUMANA [1294]||HUMANA [11839]|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7753880|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 3.5MM X 80MM|1|HUMANA [1294]||HUMANA [11839]|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CU18060S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EIT 6MM 8 DEGREE STERLIE|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 140MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZDEG-P-34-204-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDO 204MM 34MM ZENITH TX2 DISCT STRGHT CMPNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZDES-36-80-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 80MM 36MM ZNTH TX2 DISSECTION STR COMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712400|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715400|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 140MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 5.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 5.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4570|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIBERSTITCH CURVED W/2 POLYSTER IMPLANTS 2-0 FIBERW|1|HUMANA [1294]||HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-3638H|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS HIP FIBERTAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 145MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T45010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE BN GRAFT DEMINERALIZED BONE MATRIX 10ML GRAFTON PLUS|1|HUMANA [1294]||HUMANA [11839]|5,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24523006-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL IDYS ALIF 1006MM X 30MM X 40MM STERILE|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24430010-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPINAL IDYS ALIF 10MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24010520-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IDYS ALIF VETEBRAL 20MM 5MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 145MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-D 10H RT 134MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1670PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN 7MM 10MM VENTED BIO-TENODESIS LF STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-42H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM CMPR FT TI MN FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 145MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7969212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 42X30X12MM CRSNT SVRGN 12D LG PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|28,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.921S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 196MM 2.5MM TI 3.5MM SCR FRAG 8 HL SHFT LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,903.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,903.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08682|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRODUCER 70CM 14FR SHEATH FOR 15MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 150MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08683|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRODUCER 70CM 16FR SHEATH FOR 20-35MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SS8FMB74|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH STEERABLE 140DEG BIDIRECTIONAL STERILE SINGLE USE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720400|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.00MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 5.00MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 150MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708400|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 5.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 4.50MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 150MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CUI8070S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EIT 7MM 8 DEGREE S STERLIE|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM TI T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4363-036-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CENTRIC 36MM +3MM LATERAL OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANTs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 14.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 14.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 15.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 15.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 20.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 20.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 21.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 22.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 21.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 22.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 23.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 23.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 24.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 24.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BABY GORILLA 2.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5522|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SYSTEM ANTEROLATERAL RECONSTRUCTION STERILE|1|HUMANA [1294]||HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970AL-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM FUSION BONE ANKLE LEFT ANTERIOR 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33654309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3+ 9MM KNEE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-40H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 40MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-32-109-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 109MM 32MM 26-27MM ZNTH ALPHA FLXR CAPTOR 6MM CYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,458.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,458.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVPROPLUS-34US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR COREVALVE EVOLUT PRO+ 24MM PRCN PRICRD 1 LYR SLF|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4158DS-14S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT DYNAITE PIP 14MM STRAIGHT W/INSTRUMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1547BC-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SYSTEM FDL 4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-46H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM CMPR FT TI MN FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUTANEOUS 5.5MM X 50MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM SCRFT X TI T15 CORT LCK LOPRFL ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.17|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 54MM 10 HL TI STRGHT 2MM/2.3MM APTUS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,473.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,473.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.14/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 14MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.13/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 13MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 4 10MM KN TIB UNCMP VIVACIT-E ZM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629783|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.7MM 4MM SCREW 10 HOLE LOCK 87MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 15MM VARIAX T8 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 60MM VARIAX T8 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING POLY MEDIAL COLUMN FUSION RIGHT SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8W15-2223-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CAPITATE 15MM 22MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.5MM 36MM TI CMPR SH THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-CCP-RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN CENTRAL COLUMN RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-CCP-LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN CENTRAL COLUMN LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-RCP-RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN RADIAL COLUMN RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-RCP-LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN RADIAL COLUMN LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLA320400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 4.5CM 32MM XCLDR NTNL EP ABDML STNT AAA 12 FR|1|HUMANA [1294]||HUMANA [11839]|9,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TLEAD1058-50B|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT NRSTM BLU TRIAL 50CM NEVRO 5MM SPC LD STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 27.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 15.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 14.00 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 17.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 18.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 18.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72453608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -I EVOS 3.5MM TIBIA PARTIAL 8 HOLE RIGHT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,242.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,242.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629392S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 187MM TI 12 HL LCK VARIAX BN MDL ELB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 21.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 20.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 22.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT40U215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 21.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 14MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 20MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 22MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01708.003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL MAGENTA 4.5MM X 25MM VIRAGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.01710.009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVED TI VIRAGE 80MM X 3.5MM BLUE|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01710.007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVED TI VIRAGE 70MM X 3.5MM BLUE|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 14.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 14.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 15.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 15.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 17.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 18.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 24.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 23.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 24.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 24.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 20.5 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4566.10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LK 1.3MM 2/4HL 2.0MM/2.3MM TI BLUE TRPZID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,276.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,276.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629686|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2.4MM SCREW 6 HOLE LOCK L 48MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 28MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-525-015S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 15MM SHORT THREAD HEADLESS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-525-017S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 17MM SHORT THREAD HEADLESS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 709-04-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 46MM HIP 9 SCR HL CLSTR TRITANIUM TRDNT II D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3311510|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 160MM 5.5MM PATHFINDER NXT BLUE NONSTERILE|1|HUMANA [1294]||HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.02030.002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR TRANSVERSE ADJUSTABLE 36-41MM WIDE X 5.5MM|1|HUMANA [1294]||HUMANA [11839]|4,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROFILE 2MM 4 HOLE LOCK 22MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2MM SCREW 4 HOLE LOCK L 23MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M51|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T6 2.0MM L6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUTANEOUS 5.5MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955172|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BOLT TI BASE 5.0X17.5MM VARIABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7600709|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE GRAFT PUTTY MASTERGRAFT BIOLOGICS 9CC LX FR STRL|1|HUMANA [1294]||HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 8MM T10 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-153-2510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING BABY GORILLA 2.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-153-2526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING BABY GORILLA 2.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-008-RC05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5TH MET HOOK JMF COMPRESSION 5 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3228|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PENTA NEUROSTIMULATOR SJM 3MM 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1152020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRCN 7.9INX7.9IN XENMATRIX AQUAPURE RECT ACLR CLGN M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,596.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,596.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2MM SCREW 10 HOLE LOCK L 57MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1211823|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG PHASIX 8IN ST MESH WITH ECHO 2 PSTL SYSTEM PLATFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CUI8080S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EIT 8MM 8 DEGREE STERLIE|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT NRV 10MM 2MM AXOGUARD PRCN XCLR MTRX COAPTATION AID|1|HUMANA [1294]||HUMANA [11839]|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX510|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT NRV 10MM 5MM AXOGUARD PRCN XCLR MTRX COAPTATION AID|1|HUMANA [1294]||HUMANA [11839]|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG1020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRTC NRV 20MM 10MM AXOGUARD XCLR MTRX MULTILAMINAR STRL|1|HUMANA [1294]||HUMANA [11839]|5,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF-20.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 233225012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MMX12MM VARIABLE PITCH COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,006.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,006.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675384|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 18CM INTERTROCHANTER TRGN INTERTAN IM 130D ANTGRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 32.5MM FEM LOPRFL INTNL HEX TRGN IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977C190|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD NS 90CM SPC SURESCAN 2 CLMN 16 ELTRD MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 10.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFAT00U210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 21.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13016535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM RELINE-O 2S SPNE PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13015530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 30MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13015535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 35MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11500A25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 25MM|1|HUMANA [1294]||HUMANA [11839]|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS130105L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMMERUS PROXIMAL LEFT 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 325034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8MM 34MM 11.5MM ASNS III SS HIP SLF DRL ST CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM 12MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM 13MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM 16MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714P-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.4MM TRIANGLE 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MICRAAVTCPSYSTEM|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|SYSTEM PACING MICRA AV TRANSCATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714V-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM X 12MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM X 15MM LOW PROFILE TI CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714V-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM X 16MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1211520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL PHASIX 6X8IN ECHO 2 POSITIONAL SYSTEM PLATFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4933-8-010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FIXATION 1.8MM DIA 450MML DIAMOND POINT F/HOFFMANN II|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HL2LA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERLOCK 2 15MMX7MM 10 DEGREE LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 12MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 16MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01708.004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL MAGENTA 4.5MM X 30MM VIRAGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01715.002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL VIRAGE 3.5MM 400MM STRT OCCIPITAL CERVICO-THOR CO|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T44145|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE GRAFT ORTHOBLEND 5CC|1|HUMANA [1294]||HUMANA [11839]|3,579.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,579.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CUI8080L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EIT 7MM 8 DEGREE L STERLIE|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CUI8070L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EMERGING IMPLANT TECHONOLGIES 7MM 8 DEGREE L STRL|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CUI8050S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EMERGING IMPLANT TECHONOLGIES 5MM 8 DEGREE S STERLI|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING/SELF-TAPPING RESCUE 4.5MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71106575S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 75MM 22MM CANNULATED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 34CM RIGHT TROCHANTER INTERTAN INTRAMEDULLARY 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656414S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 14MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656416S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 16MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656318S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 18MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 20MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656322S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 22MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CIU8060S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CIF EMERGING IMPLANT TECHNOLOGIES 6MM 8 DEGREE S STERLI|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 16MM TI CMPR SHORT THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FM TM TIB VE SURF TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 13.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FA<21|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 18CM 8-8MM FEM ARTY CRYO ALGF LF STRL|1|HUMANA [1294]||HUMANA [11839]|13,202.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,202.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT150U205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +20.5 DIOP +1.5 ADD HPT C BCNVX 13MM 6MM PC 1 PC FL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT150U215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +21.5 DIOP +1.5 ADD HPT C BCNVX 13MM 6MM PC 1 PC FL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33654311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3+ 11MM KNEE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-181508TRC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT COMPRESSION SPEEDTRIAD 18X15X8MM CENTERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,130.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,130.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-201508TRC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT COMPRESSION SPEEDTRIAD 18X15X8MM CENTERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,130.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,130.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33653208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2+ 8MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122877|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 40MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT150U210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +21.0 DIOP +1.5 ADD HPT C BCNVX 13MM 6MM PC 1 PC FLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800310|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE GRAFT STRIP MASTERGRAFT 12CC 2CMX10CMX0.6CM|1|HUMANA [1294]||HUMANA [11839]|3,704.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,704.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1239S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 12MM X 390MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 15.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 16.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 17.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 17.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L30 MM OD3 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM ANCHORAGE TI T8 FT/ANKL TX HD LCK NS GLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR400000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TENDON IMPLANT STANDARD 4MMW X 24.5CML HUNTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L2312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 2.3MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-02-036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKY 2 LEVEL 36MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HD HUM 50MM 20MM SHLDR ANTMIC NTRL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 19.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 22.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 23.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 22.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 24.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 25.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 27.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 26.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 27.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 28.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 28.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 25.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U255|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 25.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 26.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 26.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 27.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 27.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 28.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT60U285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 28.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 25.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U255|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 25.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 26.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-08-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SMALL SHELL 8MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629684|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2.4MM SCREW 4 HOLE LOCK L 28MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 14MM 39MM SHLDR AQLS ASCND FLX COCR 1.5MM LO OFST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,409.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,409.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 20.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LEAD1058-70B|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT NRSTM BLU 70CM NEVRO 5MM SPC LD STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300641|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE LSR 6 X 14-11 HUMAN-TISSUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FLT10040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFT FLUENCY PLUS 10MM X 40MM X 117CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3392314|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14MM PRIMTR 8D MED PEEK-OPTM ADON ALIF|1|HUMANA [1294]||HUMANA [11839]|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 28MM T10 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 38MM T10 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 27.5MM TI INTGR LCK MDLN ALGN NTCH LOPRFL VNTR BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,777.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VENTURE 4.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5733730|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DIALYSIS HEMOSPLIT 23CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1151928|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PORCINE 19X28IN XENMATRIX AB STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,887.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,887.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5733690|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DIALYSIS HEMOSPLIT 19CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00590103527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEXAGONAL HEADED 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42545000508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE CENTRAL TIBIAL SIZE FIXED PERSONA REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42542007101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA FIXED NON POROUS LEFT SIZE E PERSONA REVISIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42555805115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL AUGMENT HALF BLOCK LEFT LATERAL SZ EF 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42555805315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL AUGMENT HALF BLOCK LEFT MEDIAL SZ EF 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42504606211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL SIZE 7 UNCOATED KNEE PROSTHESIS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512800716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 16MM POLYMER LEFT ARTICULAR FIXED BEARING CCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629537S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR STRG 91MM 7HL CMPR VARIAX BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,484.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 007837|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FELT,SOFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|786.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1555-03-040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAYLOR AUGMENT POST AGILITY|1|HUMANA [1294]||HUMANA [11839]|8,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 4.0MM X 20MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01710.011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVED TITANIUM VIRAGE 90MM X 3.5MM BLUE|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6207BTKL1|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS SOLO-TRAK 7FR SINGLE CHAMBER EX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 2.7MM 22MM CORTEX SELF TAP NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-016-91|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ F LEFT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,536.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,536.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-18714P-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CAGE 1.4MM 2X5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-036-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ F 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-18716-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 24MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716P-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CAGE 1.6MM 2X5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716V-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM X 18MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601791|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM G KN LT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,998.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,998.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716V-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM X 20MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716V-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM X 22MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716V-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM X 24MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220462|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 62MM CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42504606602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA REVISION CEMENTED RIGHT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-22.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42542007902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA FIXED NONPOROUS RIGHT SIZE G PERSONA REVN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42555807210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL AUGMENT HALF BLOCK LEFT LATERAL SZ GH 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 36CM LT TROCH INTERTAN IM 130DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW KOMPRESSOR 26MM MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE APTUS LOCK HOLE8 0.8MM TI TRAPEZOID HAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,786.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,786.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 187MM 5.0MM 10HOLE LOCK COMPRESSION AXSOS BONE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,078.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,078.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42555807410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL AUGMENT HALF BLOCK RIGHT MEDIAL SZ GH 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850014540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 4.5 X 40MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850015540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 5.5 X 40MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1554006500|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUTANEOUS 5.5MM X 500MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TF-21.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00102418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HIP POROUS ST/OSS CPE1 LN/CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287341|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 13X14MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30123604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 SZ D 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30123605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 SZ E 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00436503600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE 36MM +5MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX10MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RH20-1614407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL TOM-CAT STL ZERO PRF 4DEG 16X14X7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RH20-1614408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL TOM-CAT STL ZERO PRF 4DEG 16X14X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RH20-1614409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL TOM-CAT STL ZERO PRF 4DEG 16X14X9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RT10-T4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL TOMCAT 4MM FIXED SELFTAP 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RT10-T4016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL TOMCAT 4MM FIXED SELFTAP 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1220S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 200MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CV61-70|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN CRYO SAPHENOUS - CHECK SIZE|1|HUMANA [1294]||HUMANA [11839]|22,339.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,339.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4300.04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN FIXATION TI 16H 0.6MM THK STRAIGHT 1.2/1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|932.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|932.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4300.55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN FIXATION TI 3X2H 0.6MM THK RECTANGULAR 1.2/1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8213100033|SUP|HCPCS Q4102||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND OASIS 3CM X 3.5CM FENESTRATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE APTUS TRILOCK HOLE4 0.8MM TI STRAIGHT HAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,872.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,872.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE APTUS TRILOCK HOLE 8 0.8MM TI STRAIGHT HAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,168.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,168.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.05/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 5MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.16/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 16MM APTUS TRLK TI PHLNG HND HEXADRIVE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL1519P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE ALLODERM SLCT DUO CONT LG PERFORATED LG 2.4MMX0.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281218|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 28.5MM 12MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC121200|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 12MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD 2.7MM 6 HOLE LOCK 56MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21010005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE GRAFT SUBSITITUTE CORTOSS 5ML CARTRIDGE|1|HUMANA [1294]||HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21010010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE AUGMENTATION MATERIAL CORTOSS 10ML|1|HUMANA [1294]||HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413585|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 85MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC201000|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 9.5CM 20MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-P 8H RT 113MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.7MM 4MM SCREW 8 HOLE LOCK 64MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.04/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 4MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277341|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X13MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3603522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 14MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277241|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X12MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71653034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 34CM FEM TRGN MT-NL IM RTRGD TI AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 2.0MM HOLEX8 FLEX VARIABLE ANGLE SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM 40MM EVOS T6 CORT ST MN PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM 38MM EVOS T6 CORT ST MN PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 40MM EVOS T6 LOCKING SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277006|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X6MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM STRUT CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 38MM EVOS T6 LOCKING SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1039S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 10MM X 390MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 16MM EVOS T7 LOCKING SELF-TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75446545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM 14MM TI CANN COMP HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM 18MM TI CANN COMP HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 10MM VARIAX T8 FULL THREAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 325038S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM ASNS III SS HIP SLF DRL ST CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.41|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE APTUS TRILOCK HOLE9 0.8MM TI STRAIGHT HAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,505.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,505.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75447545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.12/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 12MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.16/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 16MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.17/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 17MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.13/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 13MM APTUS TRLK TI PHLNG HND HEXADRIVE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|409.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7540000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|485.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|485.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626987|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE SLIM Y-PLATE 7 HOLE T8 NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35360-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 36MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1020S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 200MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.0MM 8MM T6 LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115558|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 58-81MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]||HUMANA [11839]|5,568.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,568.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL IMPLANT 10X34X24MM TI 15DEGREE|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16026540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324KBC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR TIGHTROPE 4.75MM BIO-COMP KNOTLESS SWIVELOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXAIL NON LOCKING 3.5MM X 24MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4300.13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN FIXATION TI 2/4H 0.6MM THK T-SH 1.2/1.5MM GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GWC-12325LG-FT|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 325CM .012IN .014IN VIPERWIRE ADV CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42545000512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE CENTRAL TIBIAL SIZE MEDIUM PERSONA REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 20MM CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635TU70020|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR DOUBLE CURVE 4.8MM OD X 4.2MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635TU70040|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ANTERIOR CURVE 4.8MM OD X 4.2MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635TU70010|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR SINGLE CURVE 4.8MM OD X 4.2MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18724-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 15MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18724-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 22MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CLR7|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18724-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 26MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18724P-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.4MM TRIANGLE 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1824V-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM X 14MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18724V-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM X 22MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18724V-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM X 18MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 10X34MM 24MM BRIGADE 10D BASE TI|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6956172|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPINAL BASE 6.0X17.5MM VARIABLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 65MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDC-24703-X1A|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH 7FR 3 LUMEN 30CM 0.032 MULTI-LUMEN CENTRAL VENOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71820110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4.5MM 230MM PERI-LCK LD FEM 10HL CNT SCL NON LCK SS RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,145.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71827032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 32MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|380.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|380.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71826080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 80MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|107.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA25-80/I16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 80MM 25MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|4,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000075|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUTANEOUS 5.5MM X 75MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000070|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUTANEOUS 5.5MM X 70MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355070|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 70MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 2.7MM EVOS MINI FLEX 10HL SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42545001012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE CENTRAL FEMORAL SIZE MEDIUM PERSONA REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 50MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 44MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 50MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71827080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 80MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 48MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT261212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 26MM 12MM 18FR GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLL161207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENDER ENDOPROSTHESIS LILAC 16MM X 12MM X 7CM|1|HUMANA [1294]||HUMANA [11839]|9,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 188X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 10 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,991.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,991.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 73826060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 60MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 18MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.858|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 58MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012595|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR .018IN 300CM HI-TORQUE CONNECT 250T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012592|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR .018IN 300CM HI-TORQUE CONNECT FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012466|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR .014IN 190CM HI-TORQUE WINN 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012469|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR .014IN 300CM HI-TRQ WINN 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012475|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR .014IN 300CM HI-TRQ WINN 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-31.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 31.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5972-011-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN KNEE SIZE A RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTA4U0-25.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA LATERAL PROXIMAL 13HOLE LEFT 167MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,222.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,222.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PE24131YB|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.4FR .027IN 130CM 0.8MM COAXIAL GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5972-012-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN KNEE SIZE B LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MC*PC2013Y|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2FR .027IN 130CM 0.67MM STRAIGHT GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PC2015Y|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2FR .027IN 150CM 0.67MM STRAIGHT GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RG*GW1618SP|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR PERIPHERAL 0.016DIA 180CML 60DEG DBL ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PE24151YBN|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.4FR .027IN 150CM 0.8MM COAXIAL GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840004045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 45MM SOLERA CD HZN COCR SPNE MA NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5972-012-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN KNEE SIZE B RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71701830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE PARTIAL ZUK JOURNEY UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74026028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 HIP JOURNEY II OXNM LEFT MED/RIGHT LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74026719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ZUK 3 KNEE JOURNEY II SIZE 9 LEFT MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74026189|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT JOURNEY II UNI TIBIA MEDIAL SIZE 9-10 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-020-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG PURPLE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 03.333.336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM CANN STAINLESS STEEL COMPRESSION HEADLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 32MM CANN STAINLESS STEEL COMPRESSION HEADLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM CANN STAINLESS STEEL COMPRESSION HEADLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753880|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 80MM 3.5MM COBALT CHROMIUM MOLYBDENUM PLUS PRECUT|1|HUMANA [1294]||HUMANA [11839]|2,142.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,142.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500392|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS PEEK OMEGA 3.9MM DOUBLE-DOUBLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM 9MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-020-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG PURPLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-18714-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM X 14MM LOW PROFILE TI CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714V-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.4MM X 9MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714V-11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.4MM X 11MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCD10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE CANNULATED REVISION DOWEL 10MM X 26MM|1|HUMANA [1294]||HUMANA [11839]|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ONMC-25-33|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 25-33MM CONFORM ONX|1|HUMANA [1294]||HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-020-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG PURPLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,121.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 108843308|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL ACIS PRO 360 LORDOTIC LARGE 8MM HEIGHT|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108843307|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL ACIS PRO 360 LORDOTIC LARGE 7MM HEIGHT|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 55MM LOW PROFILE ANKLE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5972-020-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG PURPLE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8555-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 75MM LOPRFL SCR TI ANKL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-90H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 90MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770KT|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW THRD ORTH .094IN ARTHX TROC TIP 7MM SCR DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42822|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE DELTA REGULAR 1 #42822|1|HUMANA [1294]||HUMANA [11839]|4,677.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,677.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 595202020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG PURPLE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,390.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,390.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-031-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG STRIPED YELLOW 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,121.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-031-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG STRIPED YELLOW 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-031-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG STRIPED YELLOW 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-031-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG STRIPED YELLOW 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 628525S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 16MM 5 HOLE HOOK BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,867.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-031-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR XLPE CR NEXGEN PROLONG STRIPED YELLOW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-014-91|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ D LEFT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 118001|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA PARASTOMAL 12.5CM X 15.5CM STOMA 28MM-35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,282.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,282.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 38MM FULL THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LAG3.2-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.2MM 16MM FULL THREAD CORTICAL LAG SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6953615|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 30X42X6MM BRIGADE 12D TITANIUM NONSTERILE LX FR|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.333.003|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 1.6MM 220MM TROCAR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.333.004|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 2.8MM 220MM FLUTED TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.334.538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.5MM 38MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.334.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.5MM 40MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW KOMPRESSOR 22MM MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719MXDS-2020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 20X20MM SUPERMX NTNL CMPR LOPRFL TROC TIP ALGN PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1324S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 240MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM 10MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400741|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE 7X14X11MM BLK CORT SPNL LRDT STRLE|1|HUMANA [1294]||HUMANA [11839]|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400841|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE 8X14X11MM BLK CORT SPNL LRDT STRLE|1|HUMANA [1294]||HUMANA [11839]|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3002041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 41MM TITANIUM 2 LEVEL ZEVO BONE SPINE CERVICAL ANTERIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7714015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM ZEVO TI SPNE CRV ANT VAR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC181000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 9.5CM 18MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]||HUMANA [11839]|11,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6120828|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 28X8X9MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0276|SUP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PACING IMP ETAK RELNC 64CM DL COIL HELIX DF4 GR STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714P-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.4MM STRAIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.433|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 55MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U300|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 30.0 DIOP PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0673|SUP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PACING ENDOTAK RELIANCE 64CM 4 FRONT SINGLE COIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 40MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 45MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1091308P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL MODULUS TLIF-A 9MMX11MMX30MM 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.437|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 75MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM-P AMI COLLARD SIZE 5 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.683|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCK COMPRESSION 67MML HOLEX7 TI 2.7MM SCRW LCP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 14MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1826-1036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 360MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,143.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,143.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6216AMP47|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE MULTIPURPOSE ATTAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005206|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE SPARTACORE 14 Peripheral Guide Wire .014 10 cm x 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012590|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Connect Flex Guide Wire .018" 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013730|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Command 18 ST Guide Wire .018" 10 cm / 4 g, 210 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008193-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.0 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008194-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.0 mm x 20 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008199-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.5 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6218A-AM|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE ATTAIN AMPLATZ 7FR INNER DIAMETER 48.5CM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008200-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.5 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008202-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 7.0 mm x 20 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008202-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 7.0 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011339-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 7.0 mm x 20 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011339-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 7.0 mm x 30 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011342-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 10 mm x 20 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011504-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 7.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1002703|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE SUPRA CORE .035 Peripheral Guide Wire .035 x 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007710|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE STEELCORE 18 LT Peripheral Guide Wire 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012593|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Connect 250T Guide Wire .018" 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6228CTH80|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEERABLE PREVAIL ATTAIN 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008190-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.0 mm x 20 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008190-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.0 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008192-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.5 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008192-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.5 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008194-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.0 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008201-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 7.0 mm x 30 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008201-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 7.0 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011337-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 5.0 mm x 30 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011340-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 8.0 mm x 20 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011489-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.5 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6208S5S|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 8FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007709|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE STEELCORE 18 LT Peripheral Guide Wire 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012468|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HT WINN 80 Guide Wire .014" x 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012588|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Connect Guide Wire .018" 195 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2078172|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Command Guide Wire .014" 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008189-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.0 mm x 30 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008192-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.5 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008196-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.5 mm x 20 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008200-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.5 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011338-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 6.0 mm x 30 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011338-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 6.0 mm x 40 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112865030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 48MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,103.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,103.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1011339-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 7.0 mm x 40 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011486-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011487-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.0 mm x 15 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011505-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 7.0 mm x 18 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Floppy Guide Wire System 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-05|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Modified J Guide Wire System 175 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012531-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 20 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012531-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 40 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012531-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 80 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012532-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 20 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3393416|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16MM PRIMTR 12D LG PEEK-OPTM ADON ALIF|1|HUMANA [1294]||HUMANA [11839]|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012632-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 9.0 mm x 19 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012633-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 10.0 mm x 19 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 20 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011493-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.0 mm x 12 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011498-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.0 mm x 12 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011499-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.0 mm x 12 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011501-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.5 mm x 12 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 40MM 5.5MM CD HZN LGC PREBNT TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011650-75|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RX ACCUNET Embolic Protection System 7.5/300 Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012531-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012538-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 100 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012538-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 40 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012622-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 6.0 mm x 12 mm x 80 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012623-16|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 7.0 mm x 16 mm x 80 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012629-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 6.0 mm x 12 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012629-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 6.0 mm x 59 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011502-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.5 mm x 12 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.338S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 13MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011650-65|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RX ACCUNET Embolic Protection System 6.5/300 Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012067-05|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE FLEX-T Guide Wire System with MICROGLIDE Coating .018 200 cm DOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-07|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Modified J Guide Wire System 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012529-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 7.0 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012537-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 80 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012538-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012631-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 8.0 mm x 19 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.874|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 14MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005205|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE SPARTACORE 14 Peripheral Guide Wire .014 10 cm x 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012474|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HT WINN 200T Guide Wire .014" x 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007710-J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE STEELCORE 18 LT Peripheral Guide Wire J Tip 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008189-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.0 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008196-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.5 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008196-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.5 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011486-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.0 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011487-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.0 mm x 18 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.886|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 26MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011490-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.5 mm x 18 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011492-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.0 mm x 12 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011495-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.5 mm x 12 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011496-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.5 mm x 12 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012067-04|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE FLEX-T Guide Wire System with MICROGLIDE Coating .018 295 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005201|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE SPARTACORE 14 Peripheral Guide Wire .014 5.0 cm x 130 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012591|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Connect Flex Guide Wire .018" 195 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008191-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.5 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008195-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.5 mm x 30 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008202-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 7.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 12MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011337-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 5.0 mm x 40 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011338-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 6.0 mm x 20 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011490-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.5 mm x 12 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011492-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.0 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011498-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011501-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.5 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011501-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.5 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012538-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 30 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 74MM SS 2.4MM SCR 6 HL LCK LAT CLMN PRECONTOUR BN RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 100 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 150 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 200 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 14MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP038-005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Amplatzer Vascular Plug 4 5mm PKG STER|1|HUMANA [1294]||HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 200 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 40 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 150 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 16MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 100 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 20 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 120 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82095-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XACT Carotid Stent System 7.0 mm x 20 mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012538-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 80 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012623-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 7.0 mm x 12 mm x 80 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012629-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 6.0 mm x 19 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 20MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 120 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 200 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 200 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-08|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Standard Guide Wire System 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD Tapered Guide Wire System with Microglide Coating .035 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012529-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 7.0 mm x 20 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 22MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012530-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 8.0 mm x 20 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012537-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012630-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 7.0 mm x 12 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012630-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 7.0 mm x 59 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012631-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 8.0 mm x 59 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 24MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP038-006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Amplatzer Vascular Plug 4 6mm PKG STER|1|HUMANA [1294]||HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1025-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1030-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 3.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1040-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1040-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 4 mm x 60 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 4 mm x 120 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 6 mm x 150 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 7 mm x 80 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 4 mm x 250 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 12MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 5 mm x 150 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2100-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 10 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2100-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 10 mm x 80 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 150 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 20 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 40 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 80 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 5 mm x 150 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 5 mm x 200 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 6 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 22MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 7 mm x 120 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2090-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 9 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-030-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Supera Peripheral Stent System 6.5 mm x 30 mm x 120 cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005204|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE SPARTACORE 14 Peripheral Guide Wire .014 10 cm x 130 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012467|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HT WINN 40 Guide Wire .014" x 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012587|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Connect Guide Wire .018" 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013752|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Command 18 LT Guide Wire .018" 25 cm / 4 g, 210 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008190-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008190-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.0 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008192-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 4.5 mm x 20 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 14MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008195-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.5 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008200-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.5 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008202-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 7.0 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011340-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 8.0 mm x 40 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011487-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.0 mm x 12 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011490-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.5 mm x 15 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 180 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 16MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 60 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 100 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 60 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 100 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 150 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011495-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.5 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011495-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.5 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011504-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 7.0 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012067-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE FLEX-T Guide Wire System with MICROGLIDE Coating .018 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-06|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Floppy Guide Wire System 260 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-09|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Modified J Guide Wire System 260 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012530-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 8.0 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012531-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 30 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012532-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012538-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 20 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012622-16|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 6.0 mm x 16 mm x 80 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 45MM TI INTGR LCK MDLN ALGN NTCH LOPRFL VNTR BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012629-16|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 6.0 mm x 16 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012630-16|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 7.0 mm x 16 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012632-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 9.0 mm x 59 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 40 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1CVX002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH CV THK.5MM 9X1CM LO THROMBOGENICITY CNFRM HI STRTH|1|HUMANA [1294]||HUMANA [11839]|642.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 200 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 60 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 80 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82089-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XACT Carotid Stent System 9.0 mm x 20 mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012594|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Connect 250T Guide Wire .018" 195 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2078173|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Command Guide Wire .014" 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008194-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008194-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.0 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008197-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.0 mm x 30 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 40MM TI INTGR LCK MDLN ALGN NTCH LOPRFL VNTR BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008198-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.0 mm x 20 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008198-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.0 mm x 30 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008199-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.5 mm x 30 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011337-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 5.0 mm x 20 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011341-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK Carotid Stent System 9.0 mm x 40 mm x 132cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011486-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.0 mm x 12 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011489-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.5 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011650-45|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RX ACCUNET Embolic Protection System 4.5/300 Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012067-02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE FLEX-T Guide Wire System with MICROGLIDE Coating .018 145 cm DOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Modified J Guide Wire System 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5100-0002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHORLOK 1.9-2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-03|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Standard Guide Wire System 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012068-04|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Versacore Floppy Guide Wire System 175 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-03|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD Tapered Guide Wire System with Microglide Coating .035 300 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-06|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD II Tapered Guide Wire System with Microglide Coating .035 200 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012528-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 6.0 mm x 20 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012531-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 60 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012532-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 10.0 mm x 30 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012537-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 20 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012537-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 30 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013453-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.449S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 345MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013454-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14679-05|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STARCLOSE SE VCS WHITE SHEATH US|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82094-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XACT Carotid Stent System 7.0 mm x 30 mm Straight|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82097-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XACT Carotid Stent System 10.0 mm x 30 mm Tapered|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1015-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 1.5 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1025-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1025-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1030-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 3.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1040-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2040-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 80 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 0MM WITH T40 STARDRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|671.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 4 mm x 250 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1100-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 10 mm x 80 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 6 mm x 250 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 7 mm x 150 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1015-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 1.5 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1025-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1030-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 3.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2020-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 200 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 4 mm x 80 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 5 mm x 120 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.528S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 38MM WITH T25 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 5 mm x 250 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1100-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 10 mm x 60 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 6 mm x 100 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2120-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 12 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F2020-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 XT PTA Catheter 2.0 mm x 20 mm x 145 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2120-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 12 mm x 80 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2140-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 14 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-020-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Supera Peripheral Stent System 5 mm x 20 mm x 120 cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-020-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Supera Peripheral Stent System 6 mm x 20 mm x 120 cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 150 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.524S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 34MM WITH T25 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP038-004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Amplatzer Vascular Plug 4 4mm PKG STER|1|HUMANA [1294]||HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1015-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 1.5 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1025-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1025-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1030-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 3.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1040-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2025-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.5 mm x 20 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 4 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 6 mm x 200 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 6 mm x 250 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1140-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 14 mm x 20 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1140-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 14 mm x 60 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 5 mm x 250 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2120-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 12 mm x 20 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-030-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Supera Peripheral Stent System 6 mm x 30 mm x 120 cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86002X04|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT 2CM X 4CM|1|HUMANA [1294]||HUMANA [11839]|2,781.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 100 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 80 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 100 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 20 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1020-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1020-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1040-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2040-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 40 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 4 mm x 150 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 6 mm x 120 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 7 mm x 200 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1090-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 9 mm x 80 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2080-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 8 mm x 60 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2090-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 9 mm x 80 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C405087|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GDWR-TW ANGLED, FLOPPY 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F2015-012|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 XT PTA Catheter 1.5 mm x 12 mm x 145 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F2020-012|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 XT PTA Catheter 2.0 mm x 12 mm x 145 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-020-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Supera Peripheral Stent System 6.5 mm x 20 mm x 120 cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1020-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179772035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 35MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1030-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 3.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1040-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2040-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 20 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 5 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 7 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1120-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 12 mm x 80 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2140-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 14 mm x 20 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F2012-012|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 XT PTA Catheter 1.2 mm x 12 mm x 145 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-030-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Supera Peripheral Stent System 5 mm x 30 mm x 120 cm 6 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2078174|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hi-Torque Command ES Guide Wire .014" 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LDC315|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LACRI CATH 3MM LACRIMAL DUCT CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 187927409|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 27X9X9MM CNCRD LRDTC CFRP RADOPQ PLIF TLIF NS LF|1|HUMANA [1294]||HUMANA [11839]|9,706.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,706.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007709-J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE STEELCORE 18 LT Peripheral Guide Wire J Tip 190 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008196-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 5.5 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008197-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.0 mm x 40 mm x 135 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008198-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIATRAC 14 Plus Peripheral Dilatation Catheter 6.0 mm x 40 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011341-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX ACCULINK CarotidStent System 9.0 mm x 20 mm x 132 cm Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011489-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 4.5 mm x 12 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011492-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 5.0 mm x 15 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011498-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RX Herculink Elite Renal and Biliary Stent System 6.0 mm x 18 mm x 80 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011650-55|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RX ACCUNET Embolic Protection System 5.5/300 Rapid-Exchange|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012067-03|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HI-TORQUE FLEX-T Guide Wire System with MICROGLIDE Coating .018 200 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G19957|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .035 DIAMETER X 8CM LENGTH 5MM PRO|1|HUMANA [1294]||HUMANA [11839]|206.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|206.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD Tapered Guide Wire System with Microglide Coating .035 200 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-04|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD Tapered Guide Wire System with Microglide Coating .035 300 cm LOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-05|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD II Tapered Guide Wire System with Microglide Coating .035 145 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012069-07|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAD II Tapered Guide Wire System with Microglide Coating .035 260 cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012528-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 6.0 mm x 100 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012537-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 100 mm x 135 cm/ Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012537-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Absolute Pro Vascular Self-Expanding Stent System 9.0 mm x 40 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012630-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Omnilink Elite Vascular Balloon-Expandable Stent System 7.0 mm x 19 mm x 135 cm Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 40 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCE-38-14-8-NESTER|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION NESTOR .038 DIAMETER X 8CM LENGTH 10MM PRO|1|HUMANA [1294]||HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013455-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 3.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013456-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 4.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013458-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.0 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013459-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 150 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013460-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013463-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.0 mm x 60 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 2.5 mm x 80 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 5.5 mm x 180 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4372032161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STANDARD METASUL 32/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013470-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 18 PTA Catheter 6.0 mm x 40 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1015-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 1.5 mm x 120 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1020-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 20 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1020-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 60 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1020-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 2.0 mm x 80 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A1030-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 3.0 mm x 200 mm x 90 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2040-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 PTA Catheter 4.0 mm x 60 mm x 150 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 4 mm x 200 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 7 mm x 150 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1090-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 9 mm x 60 mm x 80 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 5D 38 M/0 12/14 32MM HIP METASUL PROTASUL-21WF STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,755.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,755.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 PTA Catheter 7 mm x 80 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 35 LL PTA Catheter 7 mm x 200 mm x 135 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C405084|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GDWR-TW ANGLED, FLOPPY 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C405088|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GDWR-TW STRAIGHT, FLOPPY 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F2012-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 XT PTA Catheter 1.2 mm x 20 mm x 145 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F2015-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Armada 14 XT PTA Catheter 1.5 mm x 20 mm x 145 cm / Over-The-Wire|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-0937S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 9MM X 375MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,443.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,443.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 52MM SS 2.4MM SCR 4 HL LCK LAT CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6040823|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 8MMX9MMX23MM COROENT 4D LARGE PEEK-OPTIMA PSTR L|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 16MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1134S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 11MM X 345MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,524.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,524.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30104006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 SIZE F 40MM VIVACIT-E NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 20MM SS CNCL PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.07/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 7MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.04/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 4MM APTUS TRLK TI PHLNG HND HEXADRIVE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|409.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANDARD QUADRA-P SIZE 1 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX755|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 755CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179712740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 7 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676629|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 44CM LT INTERTROCHANTER INTERTAN IM 130D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-08020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADL 8MMX2MM 31MM ALIGN TI SD LD HBRD HD DSGN UNQ ALGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA LATERAL DISTAL 4HOLE RIGHT 70MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,974.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,974.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6MM X 40MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71823026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM SS CORT ST PRLC VLP SM FRAG SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72824028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 32.6MMX58.8MM 3.5MM SS SCR PRM PRLC VLP BN LT MTP F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM SS CORT ST PRLC VLP SM FRAG SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM SS CORT ST PRLC VLP SM FRAG SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM SS CORT ST PRLC VLP SM FRAG SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM SS CORT ST PRLC VLP SM FRAG SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM SS CORT ST PRLC VLP SM FRAG SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM LOCKING SEFT TAPPING PERI-LOC VLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71821226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM LOCKING SEFT TAPPING PERI-LOC VLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179772040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 40MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD HUMERAL FLEX 45X17X1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWE403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID CORTILOC PEGGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,121.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,121.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-711-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 11MM KN X3 CS TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 12MM 20MM 63CM NITNIOL POLY BL AERO|1|HUMANA [1294]||HUMANA [11839]|6,348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.907|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL LOCKING 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,118.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-204|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 16MM 40MM 63CM NITNIOL POLY BL AERO|1|HUMANA [1294]||HUMANA [11839]|6,348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 10MM 20MM 63CM NITNIOL POLY BL AERO|1|HUMANA [1294]||HUMANA [11839]|6,348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479888|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD ATTAIN STABILITY QUAD MRI 88CM QUADPOLE LV SURESCAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479878|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD ATTAIN STABILITY QUAD MRI 78CM QUADPOLE LV SURESCAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 65MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6080828|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 8X9X28MM CRNT 8A LG PK-OPT PTR LMBR|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.00MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4016|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL MS 3.5MM X 6.0CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.50MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 2.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708300|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6207-S5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO 7FR SPLT STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715300|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720300|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.00MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712300|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-3633|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIBERTAK RC, TRIPOAD TAPE BL/W, BLK/W W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL JOURNEY UNI KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM STRAIGHT 12MM X 100MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-013-92|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ C RIGHT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,536.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,536.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 08.815.201S|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINE SYNFIX EVOLUTION MEDIUM 10.5MM/6DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.835.125.02S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNFIX EVOLUTION FINE TIP 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.815.224S|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINE SYNFIX EVOLUTION MEDIUM 15MM/14DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.815.213S|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINE SYNFIX EVOLUTION MEDIUM 13.5MM/10DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 15MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SC-2218-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD KIT LINEAR ST 70CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-40H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPR FT SCRW,3.5 MINI, 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-44H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPR FT SCRW, 3.5 MINI, 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCCULAR 21.5 DIOPTER PANOPTIX TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16018590|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RELINE MAS POLY ILIAC 2C 8.5X90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 3 HLF 10MM KN TIB PRECT TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 13017545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RELINE-O POLYAXIAL 2S 7.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5020305|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL PROPEL DBM 5CC|1|HUMANA [1294]||HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 28MM LOPRFL SCR TI T8 FT CORT SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 32MM LOPRFL SCR TI T8 FT CORT SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-5988-003-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED PTRCOAT NEXGEN SIZE 3 A/P WEDGED|1|HUMANA [1294]||HUMANA [11839]|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-605|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA FULL PRFL SIL SMTH SH SRFC HI 605|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 11MM EVOS T7 LOCKING SELF-TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON LOCKING 2.7MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4158DS-12S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT DYNANITE PIP 12MM STRAIGHT W/INSTRUMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA EVOS 2.7/3.5MM PL-D 5HL L 93MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,077.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,077.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 4.3MM 26MM T8 2MM SELF TAP LOCKING EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5988-003-29|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF TIBIAL AUGMENT 3/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,597.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2-LD DRG TRIAL SYS|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AXIUM STIMULATOR DORSAL ROOT GANGLION 2 LEAD TRAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,148.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,148.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN10350-50A|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD NEUROSTIMULATOR TRIAL 1MM DIA 50CML SLIMTIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,445.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,445.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE TFNA FENESTRATED HELICAL BLADE 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,438.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840005555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 55MM SOLERA CD HZN COCR SPNE MA NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1144S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 440MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,143.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,143.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4645.03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LK 2.0MM 6HL 2MM/2.3MM SRGHT GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|974.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|974.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 38MM 6 HL TI STRGHT 2MM/2.3MM APTUS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,276.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,276.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.18/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 18MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-032-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM YELLOW STRIPE EF 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 33655409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 4+ 9MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010005055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 55MM 5.5MM PRECONTOUR TITANIUM CAPPED|1|HUMANA [1294]||HUMANA [11839]|4,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010005045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 45MM 5.5MM PRECONTOUR TITANIUM CAPPED PREBENT|1|HUMANA [1294]||HUMANA [11839]|4,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS YLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|652.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|652.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported U228|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER CARDIAC RESYNCHRONIZATION THRPY VISIONIST CRT-P X4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-015-91|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ E LEFT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-3680|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPLANT FIBERTAK BUTTON SYSTEM|1|HUMANA [1294]||HUMANA [11839]|2,367.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71926226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 41MM RSRFC GNSS II UHMWPE KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,989.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,989.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 50MM 8 HL TI STRGHT 2MM/2.3MM APTUS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,406.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.18/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 18MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|409.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.8/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 2MM DIA 9MML TITANIUM CORTICAL HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 9MM LOW PROFILE SCREWS TITANIUM CORTICAL S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 10MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 12MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 13MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 15MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720P-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM STRAIGHT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18714P-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-Z 1.4MM 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC121000|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 10CM 12MM XCLDR LOPRFL CNTRLT LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ITV10F45/80|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM DELIVERY AMPLATZER TORQVUE 10 FR X 45 DEGREE X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11500A19|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 19MM|1|HUMANA [1294]||HUMANA [11839]|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11500A21|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 21MM|1|HUMANA [1294]||HUMANA [11839]|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11500A23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 23MM|1|HUMANA [1294]||HUMANA [11839]|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11500A27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 27MM|1|HUMANA [1294]||HUMANA [11839]|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11500A29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 29MM|1|HUMANA [1294]||HUMANA [11839]|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 52MM SS 2.4MM SCR 4 HL LCK LAT CLMN BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2654CR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE THIRD CENTRAL DISTAL CLAVICAL SS 8 HOLD RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 12MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-0928S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 280MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,224.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,224.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.815.123S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINE SYNFIX EVOLUTION SMALL 13.5MM 14DEGREE STRL|1|HUMANA [1294]||HUMANA [11839]|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.835.120.02S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNFIX EVOLUTION FINE TIP 20MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 050108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ANKLE JOINT 8MML TITANIUM SUBTALAR MBA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|629.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|629.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA22-60/I16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 60MM 22MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|44,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 24MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186788045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL VIPER 2 5.5MM 45MM LORDOTIC TI NON-STRL THRCLUMBR|1|HUMANA [1294]||HUMANA [11839]|2,126.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,126.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186760445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPINAL CFX VIPER POLY 45MML X 6.0MM TI CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,850.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,850.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186770445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPINAL CFX VIPER POLY 45MML X 7.0MM TI CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,850.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,850.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-15SE|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 15X11.5CM BRST 500-600CC SMOOTH INTGR PORT ALLOX2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-16SE|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 16X12CM BRST 580-690CC SMOOTH INTGR PORT ALLOX2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-01-436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET RSP DJO SURGICAL STANDARD HUMERAL HXE+ 36MM ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGMR313120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT THORACIC TAG CONFORM SG AC/ 31MM X 31MM X 20CM 20FR|1|HUMANA [1294]||HUMANA [11839]|58,962.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,962.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGMR313115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT THORACIC TAG CONFORM SG AC/ 31MM X 31MM X 15CM 20FR|1|HUMANA [1294]||HUMANA [11839]|58,962.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,962.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 38MM CANN STAINLESS STEEL COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500652|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS PEEK OMEGA 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F00022|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OPTHALMIC GLAUCOMA STERILE NON-BIOABSORBABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 709-04-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 50MM HIP 9 SCR HL CLSTR TRITANIUM TRDNT II D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13017540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RELINE-O POLYAXIAL 2S 7.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355035|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 35MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419690|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 22MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4650.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LK 2.0MM/2.3MM 2X4HL LEFT TI BLUE TRPZID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.815.163S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINE SYNFIX EVOLUTION MEDIUM 13.5MM/18DEGREE|1|HUMANA [1294]||HUMANA [11839]|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RT10-D3514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL TOMCAT 3.5MM FIXED SELFTAP 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -5MM 36MM HIP AL V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 14MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 40MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 52MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 46MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71933290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 4.5MM PERI-LOC FEMORAL MID SHAFT 18 HOLD LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,916.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,916.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.5MM 7.9MM 44MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2MM SCREW 6 HOLE LOCK L 34MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,689.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,689.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.0MM 10MM T6 LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M006210440|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 15CM 30FR NPHRMX AMPTZ 17CM SIL PTFE LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74026026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL JOURNEY II UNI SIZE 6 LEFT MED/LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74026715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL KNEE JOURNEY II SIZE 5 LEFT MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74026168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT JOURNEY II UNI TIBIA MEDIAL SIZE 5-6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629760S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD 2.7MM 20 HOLE LOCK 176MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,930.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,930.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656412S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 12MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC161400|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 13.5CM 16MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355075|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 75MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355080|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 80MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPINAL BASE 5.0X2.5MM FIXED TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6952815|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X8MM BRIGADE 15D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6952215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X12MM BRIGADE 15D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA-P CEMENTED STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6980845|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 45X18X8MM CRNT 10D XL PEEK LMBR INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7140208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 8 XLIF 2 HOLE DECADE BONE SPINE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.884|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 24MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102096|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 8CM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3.100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP 13MM 6MM PC 1 PC FLD APODIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G07465|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCTER FLEXOR W/SMALL CHECK FLO VALVE KCFW-9.0-38-30-RB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 24MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.7MM 36MM LOPRFL SCR SS FT/ANKL CORT SLD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMXP110RH|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST TIS EXPNDR 300CC SMTH HIGH PROFILE 11.0CM 11.0CM 6.0|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1518320P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE 16X20CM ALLODERM PERFORATED MEDIUM 1.6X0.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-10-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE SMALL SHELL 10MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020951070|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 15CM 7MM THOR KNTD HMSH G2 VLR MCVL PLSTR CLGN STRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,301.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,301.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-0926S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 260MM FEMORAL INTRAMEDULLARY T2 R1500|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,507.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,507.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M24|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 24MM 22.9MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M26|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 26MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020951080|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 15CM 8MM THOR KNTD HMSH G2 VLR MCVL PLSTR CLGN STRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 30MM 34.9MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M34|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 34MM 39.1MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M36|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 36MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M38|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 38MM 39.1MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 40MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112848120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 48MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 110031178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MODEL BONE VRS CONPREHENSIVE GLENOID REAMER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5 HEXAGON COMPREHENSIVE TI 4.75MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM X 50MM COMP REVERSE CONTROL RST STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18700-33|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE TRACAR 1.35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716P-29|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRIDGE STRAIGHT 1.6MM 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L DISTAL RADIUS 2.4MM LCP -90 DEGREE 2 HOLD HEAD 3 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00435000820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 200MM 8MM NONPOROUS REVERSE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787CT60LTBDVI0|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT LP TI VORTEX 6FR W/ATTACHABLE BIOFLO CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787CT80LTBDVI0|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT LP TI VORTEX 8FR W/ATTACHABLE BIOFLO CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787CT80STBDVI0|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT SID TI VORTEX 8FR W/ATTACHABLE BIOFLO CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1675BC-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INSTRUMENT ORTHOPAEDIC FOOT PEEK MINI F/LIGAMENT REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4158DS-16S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT DYNANITE PIP 16MM STRAIGHT W/INSTRUMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -90D L 49X6.3X1.6MM SS 2.4MM SCR 2 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04020013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 200CM 130MM 2 LUM 6-FOLD RADOPQ PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04025013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 250CM 130MM 2 LUM 6-FOLD RADOPQ PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05020013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 200CM 130MM 2 LUM 6-FOLD RADOPQ PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05025013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 250CM 130MM 2 LUM 6-FOLD RADOPQ PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06020013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 200CM 130MM 2 LUM 6-FOLD RADOPQ PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06025013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 250CM 130MM 2 LUM 6-FOLD RADOPQ PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629784|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.7MM 3MM SCREW 5 HOLE LOCK 47MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970AR-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM FUSION BONE ANKLE RIGHT ANTERIOR 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 46MM LOPRFL SCR TI ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626973|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BROAD STRAIGHT 3 HOLE T10 NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 6MM VARIAX T6 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 8MM VARIAX T6 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM 6MM VARIAX T6 FULL THREAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM 8MM VARIAX T6 FULL THREAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663906|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERG T6 2.5MM 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1174108D|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH CNTRL VENOUS 4FR SNG LUMAN MAX BR TRAY PWR SHERLOCK 3CG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1910-1273S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.5MM #2 C-7 SONICANCHOR KT FRC FIBRE 10MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991322|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX13MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 662508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.7MM 8MM T5 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 662507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.7MM 7MM T5 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 662510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.7MM 10MM T5 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 709-04-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 52MM HIP 9 SCR HL CLSTR TRITANIUM TRDNT II D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74820502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4.5MM 99MM PERI-LCK PRX FMR 2HL RIGHT NON LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,191.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74820095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MMX95MM CONICAL CANN FULL THREAD SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|666.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|666.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74820265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM X 65MM CANNULATED LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.619|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GW ORTH 100MM .8MM COCR SPD PNT 2.4MM CNN SCR NS|1|HUMANA [1294]||HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74820290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM X 90MM CANNULATED LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001PCB702090|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 90CM 20MM OTW INFL PORT TPR TIP PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCX-525|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA CHSV 525CC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4012|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL LS 4.5MM X 6.0CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150660003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE TIBIAL ROATING PLATFORM REVISION ATTUNE SIZE 3 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,160.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,160.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151710414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PLATFORM ROTATING CRS REVISION ATTUNE SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,839.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,839.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105581US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT HEARTMATE 3 LVAD OUTFLOW W/BEND RELIEF|1|HUMANA [1294]||HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106524US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEARTMATE 3 LVAD|1|HUMANA [1294]||HUMANA [11839]|296,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-214-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NS TIB 2 14MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629664|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROFILE 2.4MM 4 HOLE LOCK 26MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,141.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,141.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4015|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL LX 4.5MM X 9.0CM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629666|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROFILE 2.4MM 6HOLE LOCK 40MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,141.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,141.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.7MM 4MM SCREW 4 HOLE LOCK 32MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,685.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,685.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.7MM 4MM SCREW 6 HOLE LOCK 47MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,685.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,685.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3002043|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 43MM TITANIUM 2 LEVEL ZEVO BONE SPINE CERVICAL ANTERIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902926P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 09MMX11MMX26MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1440|SUP|HCPCS Q0495||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|CHARGER VENTRICULAR ASSIST UNIVERSAL LITHIUM HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2465|SUP|HCPCS Q0506||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BATTERY VENTRICULAR ASSIST 14V LITHIUM HEARTMATE II BX/8|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2865|SUP|HCPCS Q0497||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|CLIP VENTRICULAR ASSIST BATTERY 14V LITHIUM HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103426|SUP|HCPCS Q0477||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|POWER MODULE PATIENT CABLES|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104229|SUP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|HOLSTER VEST SMALL HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104230|SUP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|HOLSTER VEST MEDIUM HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104231|SUP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|HOLSTER VEST LARGE HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104232|SUP|HCPCS Q0501||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BAG SHOWER HEARTMATE II 2/PK|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104234|SUP|HCPCS Q0498||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BATTERY VENTRICULAR ASSIST HOLSTER HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106449|SUP|HCPCS Q0499||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BAG CONSOLIDATED LEFT VENTRICLE HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4020SS|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL SS 3.0MM X 2.6CM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-314-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 140MM KN X3 CS BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 2.7MM EVOS MINI FLEX 6HL SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104233|SUP|HCPCS Q0499||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BAG CONSOLIDATED RIGHT VENTRICLE HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106525US|SUP|HCPCS Q0477||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|CABLE LVAD MODULAR HEARTMATE 3|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106128|SUP|HCPCS Q0506||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BATTERY 11 VOLT LITHIUM-ION BACK UP|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109200|SUP|HCPCS Q0496||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|BATTERY POWER MODULE BACKUP HEARTMATE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 107760|SUP|HCPCS Q0485||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|LOCKING AC POWER CORD FOR MOBILE POWER UNIT HEARTMATE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 107754|SUP|HCPCS Q0479||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|MOBILE POWER UNIT AND LOCKING POWER CORD HEARTMATE II|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TF-25.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM 8MM ASNS III TI CNN SLFDRL ST P/T NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|785.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|785.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PLATFORM ROTATING CRS REVISION ATTUNE SZ 4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,839.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,839.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6.2MM 60MM NCB TI6AL4V 3.5MM ST HEX DRV NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6.2MM 55MM NCB TI6AL4V 3.5MM ST HEX DRV NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010008-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 8.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FPRPR3618|SUP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE PROCEDURE ICEFORCE 2.1 CXL 23CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 11MM VARIAX T8 FULL THREAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 20MM AUTOFIX SS T7 FT/ANKL ST SLF DRL CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,274.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0WT010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIL BN VOID 10X10X10MM CUBE DEMINERALIZE MTRX CNFRM FLX Q-PK|1|HUMANA [1294]||HUMANA [11839]|1,752.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RH20-1412408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL TOMCAT STL ZERO PRF 4DEG 14X12X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RT10-D3512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL TOMCAT 3.5MM FIXED SELFTAP 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.7MM 20MM LOPRFL SCR SS FT/ANKL CORT SLD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8973R-38-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA 3.8MM X 180MM RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55357|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH FLEX 22MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,714.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,714.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139105|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER URETERAL 5FR 70CM TIGER TAIL FLEXIBLE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-26-94-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BD MAIN FENESTRATED PROX 26X94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,891.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,891.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 709-04-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 60MM HIP 9 SCR HL CLSTR TRITANIUM TRDNT II D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L24 MM OD3.5 MM ODSEC6.8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902831P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 08MMX11MMX31MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCP-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER JOINT SZ 30 METACARPOPHALANGEAL SILICONE|1|HUMANA [1294]||HUMANA [11839]|4,225.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,225.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA-P-CEMENTED STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-21.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L36MM OD3.5MM ODSEC6.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73842038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 38MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.14/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 14MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N30030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 30MM DART-FIRE TI ALY FT SLF DRL ST CNN HD AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.636S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 36MM XPRT SPRL HUM TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-4027S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.0MM X 27.5MM T2 LOCKING STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-4032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.0MM X 32.5MM T2 LOCKING STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-4047S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.0MM X 47.5MM T2 LOCKING STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.820.103.02S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RETAINER SCREW 14MM 3.5MM PRODISC-C SPINE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,557.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 662506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.7MM 6MM T5 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.642S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 42MMX3.9MM 13MM XPRT SPRL FLUT CUT HUM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RH20-1614808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL TOMCAT STANDALONE ZERO PROFILE 8DEG 16X14X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3003063|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 63MM TI 3 LEVEL ZEVO BONE SPINE CERVICAL ANTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3030003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN ZEVO PLATE HOLDING PIN|1|HUMANA [1294]||HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.969S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL 7.5MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,317.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,317.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-02-132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 32MM RSP NONLOCKING GLENOID BASEPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6952615|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X6MM BRIGADE 15D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.660S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 0MM NAIL HUMERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35054535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 35MM PTHFND NXT SPNE CNN PA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284741|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPACER SPINAL 14X11MM 7MM CORNERSTONE CRV PEEK|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.822S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X 22MM FOR IM NAILS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM 20MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.826S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X 26MM FOR IM NAILS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8958-02S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TWO HOLE TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.26|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE KIRSCHNER 2.5MM DIA X 285MM LENGTH|1|HUMANA [1294]||HUMANA [11839]|340.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|340.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1593-BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.75MM SCND FIXTION BCMPS SWIVELOCK 19.1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.36.050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL SMS SOLID STANDARD #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3648HC4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OFFSET 4MM PE HC A 36F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA-P CEMENTED STANDARD #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA-P-CEMENTED LAT #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA-P-CEMENTED STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131530|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST ISOVUE 300 50ML BOTTLE NDC# 0270-1315-30|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74912060100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 12MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74912090100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 12MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74912120100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 12MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74914060100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 14MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74914090100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VENITI VICI 14MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74914120100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 14MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431001S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT HAMMERTOE IMPLANT (INCLUDES IMPLANT & SIZERS)|1|HUMANA [1294]||HUMANA [11839]|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74916060100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 16MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74916090100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 16MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74916120100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VENOUS VICI 16MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FCB80|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE MEDIAL FEMORAL HEMI-CONDYLE LEFT|1|HUMANA [1294]||HUMANA [11839]|33,877.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,877.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2331-1036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 360MM FEM GT LT T2 IM TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,471.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,471.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180253038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 38MM TMX SM RDC HD HIP CANC SLF DRL ST CNN LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180253044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 44MM TMX SM HIP CANC ST SLF DRL CNN LG RDC HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-3641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.6MM FIBERTAK SOFT KNOTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2010-02|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIL BN VOID 2.5CC DBM ALLOSYNC GEL|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7509115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM 1CM X 5CM|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15392|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.3MM PROFYLE HAND LOCKING 4X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102050|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 4CM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 10MM VARIAX T6 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663709|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 9MM VARIAX T6 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|314.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|314.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3604016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 16MM SPNL MA IMPT OCCIPITOCRVICAL UPR THOR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991622|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL 16MMX22MM CAPSTONE INTERBODY FUSION SYSTEM|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902731P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 7MMX11MMX31MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802400|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 20CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 03.820.102.02S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RETAINER SCREW SPINE 12MM 3.5MM TI PRODISC-C STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,557.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-34-113-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 34MMX113MM 18F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,458.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,458.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP 13MM 6MM PC 1 PC FLD APODIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5902731P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL TLX20 07MMX11MMX31MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB3796|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DISC CERVICAL MOBI-C 17MM X 19MM H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MUP-097|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FREEFIX MIDSHAFT ULNA 97MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,377.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,377.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMXP130RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST TIS EXPNDR 475CC SMTH HIGH PROFILE 13.0CM 13.0CM 6.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMXP135RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST TIS EXPNDR 500CC SMTH HIGH PROFILE 13.5CM 13.5CM 6.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMXP140RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST TIS EXPNDR 600CC SMTH HIGH PROFILE 14.0CM 14.0CM 7.1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7299|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE RESYNCHRONIZATION CARDIAC WITH ICD INSYNC SENTRY 40CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|65,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P71-025-2020-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE STRAIGHT ASSEMBLY 25MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP-3010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE WEDGE LAPIDUS 10DEGREE X 10MM|1|HUMANA [1294]||HUMANA [11839]|5,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-106-L203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LAPIDUS GORILLA 3 MM STEP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL 5.5MM DIA 120MML TITANIUM LORDOSED RELINE-O|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2344-001-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER PERIARTICULAR FLAT|1|HUMANA [1294]||HUMANA [11839]|50.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240964|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16X14MM VRTSTCK CRSTN PSR 9MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-06-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,690.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,690.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 73826080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 25MM PERI-LOC CORTICAL SELF-TAPPING T25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12780-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI SOFT .014" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 76MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 28MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 48MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 50MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72453505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -I EVOS 3.5MM TIBIA PARTIAL 5 HOLE LEFT 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LATERAL QUADRA-P SIZE 8 CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6626747|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17X7MM DIVERGENCE 14MM LRDTC NCL PULPOSUS PEEK|1|HUMANA [1294]||HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000121552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST/TM CUP/VITE LINER/CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP10-1214610|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 12X14X10 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720081-01|SUP|HCPCS C2622||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PENILE 11MM DIA X 16CML- 25CML DUAL LAYER SILICON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPK0322|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR CMNT INTSPC XLG 2 STG REV ARTHPL GNTA PMMA 90MM 74MM KN|1|HUMANA [1294]||HUMANA [11839]|13,446.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,446.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPK0222|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR CMNT INTSPC LG 2 STG REV ARTHPL GNTA PMMA 80MM 74MM KN|1|HUMANA [1294]||HUMANA [11839]|13,446.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,446.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951810|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X8MM BASE 10DEG TI VRB NS LF|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.273|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 65X11X2.5MM SS 3.5MM SCR SM FRAG SET 3 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,336.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,336.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 24MM AUTOFIX SS T7 FT/ANKL ST SLF DRL CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,274.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,274.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZDEG-P-30-142-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDO 142MM 30MM ZENITH TX2 DISCT STRGHT CMPNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 978B128|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT MRI LEAD INTERSTIM SURESCAN 28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 14MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 978B133|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT MRI LEAD INTERSTIM SURESCAN 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 978B141|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT MRI LEAD INTERSTIM SURESCAN 41CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656424S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 24MM VARIAX T8 FULL THREAD STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBT1802D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 50CM 18MM 9MM STD WL THNWL 2 BRCH PERI GRTX STRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBT1202D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 50CM 12MM 6MM STD WL THNWL 2 BRCH PERI GRTX STRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2652CL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE THIRD CENTRAL DISTAL CLAVICAL SS 8 HOLD LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 22MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCSD-25026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHRODESIS TITANIUM 2.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.05/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 5MM APTUS TRLK TI PHLNG HND HEXADRIVE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|409.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284841|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPACER SPINAL 14X11MM 8MM CORNERSTONE CRV PEEK|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFAT00U220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 22.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628539S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 16MM 9 HOLE HOOK BONE RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,831.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,831.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 46MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2323KBCC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 5.5MM SWIVELOCK BC KNOTLESS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-15013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN VARIAX 43MM HOLE5 TI NSTRL RECONST POLYAX LT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,202.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,202.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9795325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VENTURE 4.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CARTIMAX VIABLE CARTILAGE ALLOGRAFT|1|HUMANA [1294]||HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277941|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X9MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888121132|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ARGYLE PRESTERNAL PERITONEAL DIALYSIS CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,468.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,468.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403517|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 17MM 3.5MM EVOS CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72434040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 40MM T8 EVOS OSTEOPENIA T8 PARTIALLY THEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|226.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 10MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 85MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402719|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 19MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6651123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MYSTIQUE 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,721.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,721.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVSM06040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 6MM LENGTH 40MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVSM06060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 6MM LENGTH 60MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVSM06080|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 6MM LENGTH 80MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM07040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 7MM LENGTH 40MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM07060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 7MM LENGTH 60MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM08040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 8MM LENGTH 40MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM07080|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 7MM LENGTH 80MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6653115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MYSTIQUE 3.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,181.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM08060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 8MM LENGTH 60MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM08080|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 8MM LENGTH 80MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM09060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 9MM LENGTH 60MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM09040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 9MM LENGTH 40MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM09080|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 9MM LENGTH 80MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM10040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 10MM LENGTH 40MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM10060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 10MM LENGTH 60MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AVFM10080|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENTS VASCULAR COVERED DIA 10MM LENGTH 80MM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72453304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -T EVOS 3.5MM P/A PM-P TIBIA 4 HOLE LEFT 71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6650155|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN PREFIXATION MYSTIQUE|1|HUMANA [1294]||HUMANA [11839]|320.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|320.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC141000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 10CM 16MM GORE XCLDR CNTRLT LG AAA 12FR SHTH|1|HUMANA [1294]||HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00436003602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOSPHERE TRABLR MTL REVERSE 3 DIA 36MM+2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020951100|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 15CM 10MM THRX 2 VLR KNTD TXTL SL STRG TUBE HMSH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION 8MM X 92MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HM MED 69MM 2.7MM/3.5MM DSTL VA-LCP SH LFT 1H NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,698.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,698.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.5MM 26MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.5MM 20MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.5MM 22MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.5MM 18MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C01A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE KYPHX HV-R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6710932|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 32X9X10MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-C-2106L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 6MM CMNT REUNION LNG SHLDR TL ARTHPL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RFP10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FRESH GRAFT OSTEOCHONDRAL 10MM|1|HUMANA [1294]||HUMANA [11839]|7,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 662509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.7MM 9MM T5 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G2-W|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT GLCM CRDVO ISTENT LT STRL LF DISP TRBCLR MIC BYPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F04B|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FILLER BONE SZ3 KYPHX|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MUP-081|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FREEFIX MIDSHAFT ULNA 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ONXACE-19|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE HEART ON-X AORTIC 19MM|1|HUMANA [1294]||HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ONXACE-21|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE HEART ON-X AORTIC 21MM|1|HUMANA [1294]||HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ONXACE-23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE HEART ON-X AORTIC 23MM|1|HUMANA [1294]||HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ONXACE-25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE HEART ON-X AORTIC 25MM|1|HUMANA [1294]||HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ONXACE-27/29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE HEART ON-X AORTIC 27/29MM|1|HUMANA [1294]||HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-16-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL ALTIVATE DJO SURGICAL SMALL SHELL 16X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBA070502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMXP150RH|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST TIS EXPNDR 750CC SMTH HIGH PROFILE 15.0CM 15.0CM 7.7C|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010060-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 4.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.08/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 8MM TI CORT HEXA 6 TPD CR FL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.20/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 20MM TI CORT HEXA 6 TPD CR FL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97810|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM MICRO SURESCAN MRI RECHARGEABLE NEUROSTIMULATOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LEAD3005-50B|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT STIMULATOR 50CM SURPASS LEAD STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13827|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION PROGRAMMABLE PROMETRA 20ML STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11823|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER INTERVENTIONAL NON-BRAIDED LOW-PROFILE STERILE LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP STANDARD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44420|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHUNT STRATA LUMBOPERITONEAL KIT 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464502|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT BN CMNT 5CC PREFILLED ACCU 11GA KN SD DELV CANN STRLE|1|HUMANA [1294]||HUMANA [11839]|7,927.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,927.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCSD-35032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHRODESIS TITANIUM 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 978A128|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURESCAN MRI LEAD KIT 2.16MM SPACING - 28CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MUP-127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FREEFIX MIDSHAFT ULNA 127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,467.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,467.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 3.2MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS130113L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMMERUS PROXIMAL LEFT 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-1500S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRMDLLRY 1.5MM 300MM TI PRECURVED SHAFT T2 KIDS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|620.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MRP-097|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FREEFIX MIDSHAFT RADIUS 97MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,377.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,377.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 3.2MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-10116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN VARIAX TI FOOT CALCANEUS MESH POLYAX 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,949.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,949.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1819-1120S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 200CM RT ANKL T2 IM ARTHDS LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-0928S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 9MM X 285MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,524.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,524.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDVRA300Q|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ENTRANT VR ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,557.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,557.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDDRA300Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ENTRANT DR ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDVRA500Q|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER GALLANT VR ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDHFA300Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ENTRANT HF CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,836.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,836.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDDRA500Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER GALLANT DR ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|40,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDHFA500Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER GALLANT HF CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 28MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13019540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 40MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13018590|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 8.5MM 90MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11102255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CONN RELINE-O 5-6/5-6MM O-H MED|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18155002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 535MM TI LATERAL OFF MEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,849.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,849.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M28|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 28MM 32.9MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4450M32|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING PHYSIO ANNULOPLASTY CARPENTIER-EDWARDS 32MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME FLATCUT TALAR INFINITY SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,082.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,082.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33682208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ2 8MM ANKLE EVERLAST CROSS-LINKED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 3 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME FLATCUT TALAR INFINITY SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,082.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,082.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 270|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV SCLR 1.65MM .76MM SIL BCKL CMPNT STRL|1|HUMANA [1294]||HUMANA [11839]|34.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 3.2MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33683208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2+ 8MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME FLATCUT TALAR INFINITY SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,082.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,082.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33684307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3+ 7MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22.100026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE SPHERE EFFICIENCY J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00553660|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ELECTROCAUTERY ENHANCED AXIOS SYSTEM 20 X 10 10.8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,329.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,329.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7871055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 10MMX18MMX55MM CRNT 10D EXTR LATERAL XLG NS LF|1|HUMANA [1294]||HUMANA [11839]|15,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5485525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COROENT 5.5MM X 25MM XLF VARIABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 26MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS1518P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISS CONTOUR ALLODERM SM PERFORATED MED 1.6 +/- 0.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,082.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,082.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47332|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 3CM 3MM NST 3.2 LOOP SFT ENH RADOPC MCIOL .018IN|1|HUMANA [1294]||HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G23801|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INTERVENTIONAL NT2 CURVE MICRO 2.5FR .021IN 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2380-0810S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL DIA8 X 100 MM T2 ICF W/COMPRESSION SCREW STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2381-0820S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CAP NAIL 8MM X 20MM T2 ICF STERILE|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2381-0810S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CAP NAIL 8MM X 10MM T2 ICF STERILE|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39MM SS 2.4MM SCR 3 HL LCK LAT CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75807090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7.5MM X 90MM PROXIMAL CONQUEST FN P-L 20MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75808200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 8.5MMX100MM PROXIMAL CONQUEST FN P-L 25MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75807095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7.5MMX95MM PROXIMAL CONQUEST FN P-L 20MM THREADE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75808001L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60MM 1 HOLE CONQUEST FN LOCKING LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 24MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RT10-D3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL TOMCAT 3.5MM FIXED SELFTAP 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1519PBP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 19.3X9.6CM ALDRM SLCT THK 3.4-0.6MM THIN CNTR ALG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,511.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,511.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629243|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 80MM 3HOLE BONE HUMERUS LEFT DISTAL LATERAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,576.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,576.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 46MM T10 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|878.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|878.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 38MM CANN TI COMPRESSION HEADLES ST-36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG750|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARTEGRAFT BOVINE COLLAGEN CAROTID ARTERY 7MMX50CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 42CM RIGHT TROCHANTER INTERTAN INTRAMEDULLARY 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 42CM LEFT TROCHANTER INTERTAN INTRAMEDULLARY 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IAV12004008P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL BALLOON ANGIOPLASTY 12X40X80 ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16014540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT50U185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 18.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752540|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 28CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|323.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|323.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 26MM SS PERIART RADL DIST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 97MM 7 HL LCK CMPR AXSOS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,574.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,574.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 110MM 8 HL LCK CMPR AXSOS 4.0MM BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,780.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,780.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 18MM SS CNCL PERIART RADL DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 3.0MM 26MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92-29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STRIP RETINAL 5MM DIA SILICONE ROUND ASYMMETRICAL LABTICIAN|1|HUMANA [1294]||HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92-27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCLERAL BUCKLING STYLE 112 MERIDIONAL|1|HUMANA [1294]||HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANNULATED7.3MM THREAD 16MM X120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|872.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3664CONTRLSYS|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR PLUSE 3664 CONTROL SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,136.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63,136.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN10450-50A|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD NEUROSTIMULATOR 1MM DIA 50CML SLIMTIP AXIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,595.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,595.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208-925|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANNULATED 7.3MM THREAD 16MM X125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|872.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1230S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 300MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,143.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,143.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECON EVOS 3.5MM 88MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECON EVOS 3.5MM 132MM 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,443.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EVOS 3.5MM WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|100.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYUSOF IQ VIVITY EXTENDED VISION UV ABSORBING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 2.0MM HOLEX6 FLEX VARIABLE ANGLE SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM ASNS III TI P/T RVRS CUT FLUT TARSUS MTRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|785.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|785.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-02-134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 34MM RSP NONLOCKING GLENOID BASEPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-02-138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 38MM RSP NONLOCKING GLENOID BASEPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-00-436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS SCKT RSP DJO SRG 36MM +4 STD HUM HXE+ STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFP8X14|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH PERICARDIAL PHOTOFIX 8CM X 14CM BOVINE|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-30-124-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BD MN FENESTRATED PROXIMAL30X124M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,891.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,891.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-24-109-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BD MN FENESTRATED PROXIMAL24X109M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,891.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,891.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T44125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE GRAFT LARGE ORTHOBLEND 5CC|1|HUMANA [1294]||HUMANA [11839]|3,579.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,579.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-28-106-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDO CUSTOM DISTAL BIFURCATED MAIN BODY 12X28X106MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CV46-60|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN CRYO SAPHENOUS - CHECK SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,593.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,593.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080308P2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TLIF-O MODULUS 8X10X30MM 8 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080304P2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TLIF-O MODULUS 8X10X30MM 4 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2120308P2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TLIF-O MODULUS 12X10X30MM 8 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.0MM 26MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 18MM LOPRFL SCR TI CORTICAL SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720P-33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM STRAIGHT 8 HOLE REINFORCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720V-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TITANIUM 2.0MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720V-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TITANIUM 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720V-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TITANIUM 2.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720V-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TITANIUM 2.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18720V-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TITANIUM 2.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3641HC4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OFFSET 4MM PE HC A 36G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM-P AMI COLLARD SIZE 4 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1081305P2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TLIF-O MODULUS 8X11X30MM 15 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4363-040-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CENTRIC 40MM +3MM LATERAL OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 44MM ASNIS SOLID NONSTERILE JFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,755.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 48MM ASNIS SOLID NONSTERILE JFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,755.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RT10-D3510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL TOMCAT 3.5MM FIXED SELFTAP 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM 22MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1555BC-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT SYSTEM FDL 5.5MM INTERFERENCE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716P-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 1.6MM 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716V-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM X 9MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-18716V-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 1.6MM X 10MM VA LOCKING NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3.240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP 13MM 6MM PC 1 PC FLD APODIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3UCM223A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE SAPIEN 3 23MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3UCM226A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE SAPIEN 3 26MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL 11 HOLE LEFT 153MM 2.7/3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,816.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,816.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324KBCCT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 4.75MM SWIVELOCK KNOTLESS BLUE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324KBCCTT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 4.75MM SWIVELOCK KNOTLESS WHITE/BLACK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NL 11.5MM 18CM INTERTROCHANTER INTERTAN INTRAMEDULLARY 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 5.5MML SELF PUNCHING BIOCOMPOSITE POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 4.5MM HEALIX BR DYNACORD 3 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 4.5MM SIZE 2 36IN HEALIX BR DYNACORD 3 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5016001|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE BONE GRAFT SMALL CELLULAR MATRIX 1ML OSTEOCEL PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5016005|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE BONE GRAFT MED CELLULAR MATRIX 5ML OSTEOCEL PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5016010|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE BONE GRAFT LG CELLULAR MATRIX 10ML OSTEOCEL PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 22.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT415.245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 24.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626678|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 95MM 8 HOLE BONE NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,484.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 16MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS-15282-SPM|SUP|HCPCS C1752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|(SUB) HEMODIALYSIS CATHETER KIT 15FRX28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFP6X8|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH PERICARDIAL PHOTOFIX 6CM X 8CM BOVINE|1|HUMANA [1294]||HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629688|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 2.4MM SCREW 8 HOLE LOCK 56MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 40MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DUALN7|SUP|HCPCS L8614||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT PROCESSOR DUAL N7|1|HUMANA [1294]||HUMANA [11839]|41,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30154006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 SIZE F +5MM 40MM VIVACIT-E NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P783831|SUP|HCPCS L8614||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EAR COCHLEAR MODEL C1632 W/SLIM MODIOLAR ELECTRODE|1|HUMANA [1294]||HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCSD-20026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHRODESIS TITANIUM 2.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3.275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP 13MM 6MM PC 1 PC FLD APODIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46915|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DUET WITH THE EDM VENTRICULAR CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3362-5-105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 13MM 105MM 22MM OMEGA3 SS STD HIP FEM LG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,032.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597122S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD BRL 2HL KYLS OMG 3 BN HIP STRL 135DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3.280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP 13MM 6MM PC 1 PC FLD APODIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102106|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE XTRNFX 300MM 1.5MM ILZ TIB SS BYNT PNT STPR NS|1|HUMANA [1294]||HUMANA [11839]|706.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|706.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 19MM 44MM SHLDR REUNION 4MM OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCSD-20028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHRODESIS TITANIUM 2.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403585|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 85MM EVOS CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403590|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 90MM EVOS CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM AXSOS 3 TI FT CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|199.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|199.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H1-S|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ATHERECTOMY H1-S HAWKRONE S SMALL VESSEL 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 779145555|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR SPINAL 5.5/5.5MM DIA TITANIUM LATERAL CLOSED SIDE|1|HUMANA [1294]||HUMANA [11839]|4,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 779170005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW SPINAL 1/4-32 STANDARD TITANIUM CD HORIZON 6.35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YT50-AP20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR LUMBAR 4 SCREW L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YT30-5025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 5.0MM X 25MM HARRIE SA/RAVEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60D3-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported JP30-34251212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL HARRIER ALIF 34X25X12MM 12 DEG|1|HUMANA [1294]||HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H1-M|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ATHERECTOMY H1-S HAWKRONE M MULTI VESSEL 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-525-050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 50MM SHORT THREAD HEADLESS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P26-572-125M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW JOUST BEAM 7.2MM 125MM CANN HEADLESS MED THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,573.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,573.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 28MM LOCK PLATE GORILLA PLATING SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 38MM LOCK PLATE GORILLA PLATING SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-109-L001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 1.5MM MEDIAL COLUMN ARCH LEFT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,391.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,391.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-154-0003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE UNIVERSAL CADDY TEDDY BEAR LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,760.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,760.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1101305P2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL MODULUS TLIF-A 10MMX11MMX30MM 15 DEGREE|1|HUMANA [1294]||HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 50MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 55MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5733270|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DIALYSIS HEMOSPLIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 400MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14355055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELINE-O TI ROD 5.5X55MM LORDOTIC|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR GRYPHON PEEK WITH PROKNOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE CANNULATED 3.5MM 90 DEG 5 HOLE 30MM BLADE LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,773.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,773.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627244S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 288MM TI 14 HL AXSOS 3 BN HUM RT PROX LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,186.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,186.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-300HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST HI PR 11.4CM 4.6CM 300ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-15|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 15FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 36MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-18|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 18FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 50MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-21|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 21FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-24|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 24FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-27|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 27FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-30|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 30FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-33|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 33FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-36|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 36FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-39|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 39FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-42|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 42FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-45|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 45FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-51|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 51FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-48|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 48FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-57|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 57FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-54|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 54FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1214-60|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR ENDOSCOPIC 60FR SAFEGUIDE ESOPHAGEAL OTW LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010007-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.310|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +31 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10610-160LP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST LOW PR 10.5CM 2.5CM 160ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.060|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 28MM LOPRFL SCR TI ANKL VA ST SLD LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952TS-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT TITANIUM 4MM SCREW 5 HOLE LOW PROFILE BONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33683206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2+ 6MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110032420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE IMPLANT MEDIUM AUGMENTED W/TAPER ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT315.245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 24.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-7.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TI-115316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID VERSA-DIAL TI +6 MM OD36 MM SHOULDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180557|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.75MM X 15MM TI CTD CORT HEX FIXED NLCKNG REH SHLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 34MM LOPRFL SCR TI ANKL VA ST SLD LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-9.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 21.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-560|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA FULL PRFL SIL SMTH SH SRFC HI 560|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S1385108D5|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH POWERPICC 5FR 3-LMN MAX BARRIER 55CM GUIDE W/SHRK 3CG S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.493|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR 2.4 X 43MM 5 HOLE HEAD 3 HOLE SHAFT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 15.0 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRNT50U11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 11.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241401|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14X13.4CM SLX LM P6.2CM CNTR HI PRFL FULL PRJ ELIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588RTT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACL TIGHTROPE WITH FIBERTAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AO60P2400|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR +24.0 AKREOS ADVANCED OPTICS ASPHERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241351|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.5X13CM SLX LM P6CM CNTR HI PRFL FULL PRJ ELIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCP207|SUP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PROBE 7MM 17GA OSTEOCOOL RADIOFREQUENCY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T50309|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTON INJECTABLE DBF 9CC|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T50303|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTON INJECTABLE DBF 3CC|1|HUMANA [1294]||HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T50306|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTON INJECTABLE DBF 6CC|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241301|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13X12.5CM SLX LM P5.9CM CNTR HI PRFL FULL PRJ ELIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 20.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5030641|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 14MMX11MMX6MM TI CTD CERV 12DEG ANT PTC STRL|1|HUMANA [1294]||HUMANA [11839]|7,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5030541|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 5MMX14MMX11MM TI CTD PEEK CERV ANT PTC STRL|1|HUMANA [1294]||HUMANA [11839]|7,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S4 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TIB BASE L S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LI61AO-23.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER SOFPORT ADVANCED OPTICS ASPHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LI61AO-19.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER SOFPORT ADVANCED OPTICS ASPHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LI61AO-16.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER SOFPORT ADVANCED OPTICS ASPHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 32MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-36H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM CMPR FT TI MN FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNW6025|SUP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NRV 2.5CM NEUROMEND 6MM PERI BVN CLGN RSRB SEMIPERM FL|1|HUMANA [1294]||HUMANA [11839]|6,051.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,051.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-4025S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.0MM X 25MM T2 LOCKING STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.080|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.0 DIOP MOD L PLANAR 13MM 6MM PC ASPH UV BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.351|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 57X9X1MM TI 2.7/3.5MM CORT 3.5MM LCK SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|531.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|531.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL MEDIAL DISTAL 12HOLE RIGHT 162MM 2.7/3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,816.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,816.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.085|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.5 DIOP MOD L PLANAR 13MM 6MM PC ASPH UV BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.090|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9.0 DIOP MOD L PLANAR 13MM 6MM PC ASPH UV BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.095|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9.5 DIOP MOD L PLANAR 13MM 6MM PC ASPH UV BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 11MM SPC 125X10X2MM SS 2.7/3.5MM SCR 9 HL LOPRFL VA LC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,417.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,417.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.421|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 141X9X1MM TI 2.7/3.5MM CORT 3.5MM LCK SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 70X10.1X3.5MM TI 3.5MM SCR SM FRAG SET 5 HL RECON LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,384.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,384.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140X10.1X3.5MM TI 3.5MM SCR SM FRAG SYS 10 HL RECON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,819.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,819.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 4.3MM 30MM T8 2MM SELF TAP LOCKING EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 4.3MM 32MM T8 2MM SELF TAP LOCKING EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-4030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.0MM X 30MM T2 LOCKING STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108843607|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL ACIS PRO 360 LORDOTIC LARGE 7MM HEIGHT|1|HUMANA [1294]||HUMANA [11839]|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,797.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 168X10.1X3.5MM TI 3.5MM SCR SM FRAG SYS 12 HL RECON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT00U265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 26.5 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported JP30-34250610|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL HARRIER ALIF 34X25X10MM 6 DEG|1|HUMANA [1294]||HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7600703|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE GRAFT PUTTY MASTERGRAFT BIOLOGICS 3CC LX FR STRL|1|HUMANA [1294]||HUMANA [11839]|1,073.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,073.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 3.5MM X 18MM VIRAGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01702.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL 4MM X 12MM VIRAGE GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 72X11X3.4MM TI 3.5MM SCR SM FRAG 5 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|923.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|923.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977A160|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD NEUROSTIMULATOR 60CM 3MM VECTRIS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14355060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE-O 5.5MM 60MM LORDOSED TI|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6952010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL IMPLANT 10X38X28MM TI 10DEGREE|1|HUMANA [1294]||HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 189X11X3.4MM TI 3.5MM SCR SM FRAG 14 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,906.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,906.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 55MM VARIAX T8 FULL THREAD LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 55MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-350MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.0X4.8CM 350CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-365MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.7X4.0CM 365CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-380MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.8X4.2CM 365CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-395MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.9X4.2CM 395CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 67X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,166.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,166.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-410MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.0X4.2CM 410CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-425MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.2X4.2CM 425CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-440MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.4X4.2CM 440CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-470MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.7X4.3CM 470CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.161|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 78X11X1.5MM TI 3.5MM SCR SM FRAG SET 4 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,361.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4030C-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE 7MM 30MM BIOCOMPOSITE FAST THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4030C-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE 8MM 30MM BIOCOMPOSITE FAST THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4030C-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE 9MM 30MM BIOCOMPOSITE FAST THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13015540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 40MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42542007501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA FIXED NONPOROUS LEFT SIZE F PERSONA REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42545000511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE CENTRAL TIBIAL SIZE SMALL PERSONA REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.171|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 87X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,704.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,704.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840007530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 30MM SOLERA CD HZN COCR SPNE MA NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 16.0 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14274|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER URETERAL 5FR OPEN ENDED TIP POLYVINYLCHLORIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R T 63X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,205.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,205.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R T 96X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 20.0 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 22.0 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DAT015.175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IN 17.5 DIOPTER ACRYUSOF IQ VIVITY EXT VISION UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16026550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16027545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 45MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.941|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L T 63X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,271.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,271.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16027550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 50MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-03-0060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L60 MM SPINE 3 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-50H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 50MM CMPR FT TI 1.5MM MIC FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939354080|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 6FR ULTRASOUND CORONARY IMAGING STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL 8MM 32MM SHOULDER X3 CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.971|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L T 96X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,436.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,436.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-46H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 46MM CMPR FT TI 1.5MM MIC FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL 6MM 32MM SHOULDER X3 CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 90X12X2.5MM TI 3.5MM SCR SM FRAG SET 3 HL SHFT LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,963.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,963.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1819-1030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 300CM RT ANKL T2 IM ARTHDS LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,219.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,219.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR TT RIGHT CP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE COMPRESSION HEADLESS 7MM L105MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,604.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,604.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 666130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.0MM X 30MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 666132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.0MM X 32MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 666460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANNULATED 16MMX6.5MMX60MM NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 666505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANNULATED 16MMX6.5MMX150MM NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 114X12X2.5MM TI 3.5MM SCR SM FRAG SET 6 HLE/HD 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,119.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,119.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 8MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200193|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE PSN ASF PS FEM/CEM TIN VE SURF/STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702462|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 300MM 3.2MM ASNS III FEM HIP THRD CNN SCR SYS UNSTRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L-D FIBULA 59MM STAINLESS STEEL 2.7/3.5MM SCREW 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,070.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIAX T8 FULL THREAD L8 MM OD2.7 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629263|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS DISTAL POSTERIOR LATERAL RIGHT 3 HOLE/L80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,576.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,576.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 20MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING T8 FULL THREAD 2.7MM/L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42570606602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM SIZE 9 PS PSN CEMENTED STANDARD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01708.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPINAL POLYAXIAL4.5MM X 20MM VIRAGE MAGENTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01710.009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVED TI 3.5MMX80MM VIRAGE BLUE|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9933-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP 3.0MM X16MM CORTICAL MTP TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9933-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP 3.0X22MM CORTICAL MTP TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9944S-0R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXFORCE MTP STD 0-0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA-P-CEMENTED STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 55MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42504606611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA REVISION CEMENTED LEFT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42556606605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT REVISION PERSONA DISTAL FEMORAL 5MM SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512800910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE PERSONA REV VIVACIT-E POLYETHYLENE ARTICULAR 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42542007901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA FIXED NONPOROUS LEFT SIZE G PERSONA REVN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM-P AMI COLLARD SIZE 3 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629791|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW T 2.4MM SCREW 10 HOLE LOCK 81MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 42MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,567.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP30141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMALL LS ANCHORAGE LISFRANC LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,947.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,947.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM ANCHORAGE TI T8 FT/ANKL TX HD LCK NS BL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|942.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 10MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM ANCHORAGE TI T8 FT/ANKL TX HD LCK NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|652.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|652.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 44MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 38MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4052HC4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR OFFSET A 4MM 40MM HIGHCROSS HIP FLAT HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-355MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.1X4.4CM 350CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 12MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.817.504|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE MESH 12MMX23MM 10MM HEIGHT|1|HUMANA [1294]||HUMANA [11839]|11,430.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,430.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.817.512|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END RING 12MM X 23MM ANTERIOR 5 DEGREE|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 14MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFNT30U120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN INTRAOCCULAR 12.0 DIOPTER PANOPTIX TORIC NAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DFT415.180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF IQ VIVITY TORIC EXTEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0A-20P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE 20MM SMRT TOE II 10D FLT FT/ANKL IM NTNL 1 PC HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCSD-25034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHRODESIS TITANIUM 2.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 16MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9933-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP 3.0MM X20MM CORTICAL MTP TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9944P-0R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXFORCE MTP PETITE 0-0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 18MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 40MM ASNS SLD NS JNS FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,755.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NIPG2500|SUP|HCPCS C1822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT NRSTM SENZA IPG STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DFT015.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF IQ VIVITY TORIC EXTEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DFT015.170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF IQ VIVITY TORIC EXTEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13018545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 8.5MM 45MM RELINE-O 2S SPINE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10317550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7.5MM 50MM RELINE-O 2S SPINE POLYAXIAL LILIAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 20MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10318560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 8.5MM 60MM RELINE-O 2S SPINE POLYAXIAL ILIAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13018510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 8.5MM 100MM RELINE-O 2S SPINE POLYAXIAL ILIAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP20341|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCK 0MM TI STEP PRE-CONTOURED YELLOW LAPIDUS LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,947.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,947.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45647016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT HUMAN TISSUE OSTEOCHONDRAL 12MML|1|HUMANA [1294]||HUMANA [11839]|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGM343415|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT THORACIC TAG CONFORM SG AC/ 34MM X 34MM X 15CM 22FR|1|HUMANA [1294]||HUMANA [11839]|58,962.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,962.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 22MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF2233|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER 33CM 26FR 9.5MM 8.7MM GORE DRYSEAL FLEX HY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.333.114|SUP|HCPCS C1713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SCREW 2.5MM 14MM TITANIUM CANNULATED COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,357.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FGS-1000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SYNDESMOSIS FIBULINK STAINLESS STEEL REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FGS-1100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SYNDESMOSIS FIBULINK TITANIUM REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46.239.001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE COMPRESSION SMALL 9.34MM 4.15MM W/1.25 KW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46.239.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE COMPRESSION LG 9.34MM 4.15MM W/1.6 KWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 24MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11060A23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE RESILIA INSPIRIS AORTIC 23MM|1|HUMANA [1294]||HUMANA [11839]|43,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33683308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SIZE 3 8MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33680002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33681108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ1/1+ 8MM ANKLE EVERLAST CROSS-LINKED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM LCP TI T15 FT TIB MDL LAT PROX ST STRDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 6.5MM HEALIX BR DYANCORD 3 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DFT015.235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF IQ VIVITY TORIC EXTEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628546S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MM 6 HOLE HOOK BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,831.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,831.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 28MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3644HC4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OFFSET 4MM PE HIGHCROSS 1 36/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM-P AMI COLLARD SIZE 6 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 30MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM LCP TI T15 FT TIB MDL LAT PROX ST STRDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 34MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 36MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 38MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 134X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 7 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,429.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,429.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.591|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 170X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 9 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,583.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,583.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.611|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 206X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 11 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,851.57|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,851.57|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 260X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 14 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,231.97|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,231.97|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 226.591|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 170X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 9 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,851.57|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,851.57|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 226.611|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 206X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 11 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,119.68|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,119.68|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 422.300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL TIBIAL LISS 140MM RIGHT 5 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL TIBIAL LISS 220MM RIGHT 9 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL TIBIAL LISS 300MM RIGHT 13 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.309|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 300MM TI 5MM LCK SCR 13 HL LISS BN TIB LT PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,595.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.918|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 142X12X3.7MM SS 3.5MM SCR SM FRAG SET 5 HL SHFT LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,997.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,997.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.919|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 160X12X3.7MM SS 3.5MM SCR SM FRAG SET 6 HL SHFT LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.921|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 196X12X3.7MM SS 3.5MM SCR SM FRAG SET 8 HL SHFT LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,396.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,396.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234800835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.7MM 8MM SS RADL CORT PERIART DIST ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 10MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234803235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 32MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234803435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 34MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234803635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 36MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234803835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 38MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234804035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 40MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 30MM SS 2.4MM SCR 2 HL LCK LAT CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 74MM SS 2.4MM SCR 6 HL LCK LAT CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 30MM SS 2.4MM SCR 2 HL LCK LAT CLMN BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 32MM SS 2.4MM SCR 2 HL LCK MDL CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 40MM SS 2.4MM SCR 3 HL LCK MDL CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 54MM SS 2.4MM SCR 4 HL LCK MDL CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 78MM SS 2.4MM SCR 6 HL LCK MDL CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 32MM SS 2.4MM SCR 2 HL LCK MDL CLMN BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,056.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 40MM SS 2.4MM SCR 3 HL LCK MDL CLMN BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 54MM SS 2.4MM SCR 4 HL LCK MDL CLMN BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 78MM SS 2.4MM SCR 6 HL LCK MDL CLMN PRECONTOUR BN RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,373.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 36MM SS 2.4MM SCR 2 HL LCK BN RADL RT PERIART DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 44MM SS 2.4MM SCR 3 HL LCK BN RADL RT PERIART DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 56MM SS 2.4MM SCR 4 HL LCK BN RADL RT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 77MM SS 2.4MM SCR 6 HL LCK BN RADL RT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 44MM SS 2.4MM SCR 3 HL LCK BN RADL LT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 56MM SS 2.4MM SCR 4 HL LCK BN RADL LT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 77MM SS 2.4MM SCR 6 HL LCK BN RADL LT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 40MM SS 2.4MM SCR 1 HL LCK BN RADL RT PERIART DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 52MM SS 2.4MM SCR 2 HL LCK BN RADL RT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 74MM SS 2.4MM SCR 4 HL LCK BN RADL RT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-28145|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE SHEEHY COLLAR BUTTON VENT|1|HUMANA [1294]||HUMANA [11839]|46.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 95MM SS 2.4MM SCR 6 HL LCK BN RADL RT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 52MM SS 2.4MM SCR 2 HL LCK BN RADL LT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 74MM SS 2.4MM SCR 4 HL LCK BN RADL LT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 95MM SS 2.4MM SCR 6 HL LCK BN RADL LT DIST DRSL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235900824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 8MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 28MM SS RADL PERIART DIST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 30MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 32MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 34MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 36MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 38MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 40MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235900825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 8MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 28MM SS CNCL RADL PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 30MM SS CNCL RADL PERIART DIST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 32MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 34MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 36MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 38MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 40MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-016-92|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ F RIGHT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-036-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ F 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-032-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LCCK YELLOW STRIPE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 95MM SS 2.7/3.5MM SCR 8 HL NONLOCK BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112865040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 23MM 48MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,765.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 85451|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 5MM X 22MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,318.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,318.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.64|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW LC DCP 4.5MM 14 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-4065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRAME TI LC4 8CM|1|HUMANA [1294]||HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-4077|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRAME TI STRAIGHT 6CM|1|HUMANA [1294]||HUMANA [11839]|4,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-4079|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRAME TI STRAIGHT 8CM|1|HUMANA [1294]||HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814113003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XL 77.3X42.4X1MM TMX PRIMTR PERI BN CALC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814123006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION FIBULA 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM AIM TMX FT HUM CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815541018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 36MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.858|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 58MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.862|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 62MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 4.5 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 218.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 40MM SS 3.5MM FT CANC LG HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 50MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 80MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 85MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 90MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 95MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 100MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 110MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 30MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 35MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 40MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 45MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 65MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 70MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 75MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 80MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 85MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 90MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|109.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 95MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 105MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 110MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 22MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 24MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 85MM SS 4MM FT FEM CNDRL DIST CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 90MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 95MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 80MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 60MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 90MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 65MM SS P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.485|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 85MM SS P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.662|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 278X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 12 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,227.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,227.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.667|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 350X17.5X5.2MM SS 4.5MM SCR 16 HL LOPRFL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,621.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,621.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.669|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 386X17.5X5.2MM SS 4.5MM SCR 18 HL LOPRFL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.668|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 386X17.5X5.2MM SS 4.5MM SCR 18 HL LOPRFL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6208S5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 8FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6209S5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 10.5FR SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 32MM FULL THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 10MM SHORT THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 12MM SS ST RVRS CUT FLUT CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 14MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 18MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 20MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 22MM SS ST RVRS CUT FLUT CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|614.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|614.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.171|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 87X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,637.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,637.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R T 96X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L T 52X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,115.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,115.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 50MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|76.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 55MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 60MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|65.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 12MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 18MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|100.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 22MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 26MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 28MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 154MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,585.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,585.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.043|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 190MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,633.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,633.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 226MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,688.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,688.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 262MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,738.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 226MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,688.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,688.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 262MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,738.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 900.726|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 450MM 2.8MM TROC PNT THRD CLBRT 300MM 6.5/7.3 CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 30MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 35MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 40MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 50MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 60MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 65MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 70MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 75MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 85MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 90MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 95MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 100MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 105MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.417|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 110MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 115MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.419|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 120MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 125MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.421|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 130MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 135MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.423|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 140MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 145MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 150MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 45MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 50MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 60MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 80MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.439|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 85MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 90MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 95MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 100MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.443|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 105MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 110MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 115MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 120MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.447|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 125MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 130MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.449|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 135MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 140MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.451|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 145MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.452|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 150MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 84MM SS 4.5MM SCR BSC FRAG 4 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|563.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|563.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486507501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 75MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 25MM 12.5MM SS MLR LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 14MM 5MM SS P/T SM HEX HD NS SM FRAG UNV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 50MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-095-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 95MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 77X11X3.3MM SS 3.5MM SCR SM FRAG SET 6 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.57|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90X11X3.3MM SS 3.5MM SCR SM FRAG SET 7 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 103X11X3.3MM SS 3.5MM SCR SM FRAG SET 8 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.59|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116X11X3.3MM SS 3.5MM SCR SM FRAG SET 9 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|527.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|527.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 129X11X3.3MM SS 3.5MM SCR SM FRAG SET 10 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.83|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 88X15X2MM SS 3.5MM CORT 4MM CANC SCR SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|606.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 121MM 10 HOLE WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 37MM 3 HOLE WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 49MM 4 HOLE WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 50X10X1.2MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|248.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|248.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.23|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLQ T 53X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|431.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|431.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLQ T 63X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|670.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|670.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLQ T 75X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 24MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 26MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 28MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3.5 X 16S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES SIZE 16S 3.5 COLLARS (WITH SUTURE HOLES|1|HUMANA [1294]||HUMANA [11839]|126.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|126.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3.5 X 18S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES SIZE 18S 3.5 COLLARS (WITH SUTURE HOLES|1|HUMANA [1294]||HUMANA [11839]|111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3.5 X 20S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES SIZE 20S 3.5 COLLARS (WITH SUTURE HOLES|1|HUMANA [1294]||HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3.5 X 21S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES SIZE 21S 3.5 COLLARS (WITH SUTURE HOLES|1|HUMANA [1294]||HUMANA [11839]|111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3.5 X 22|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES SIZE 22 3.5 COLLARS (WITHOUT SUTURE HOL|1|HUMANA [1294]||HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 54MM SS 2.7/3.5MM SCR 4 HL NONLOCK BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4600-001-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATOR FRACTURE RADIUS DISTAL WRISTORE|1|HUMANA [1294]||HUMANA [11839]|3,315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRS-003-RMS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER BONE VOID NORIAN ROTARY MIX 3CC STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,510.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,510.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010007-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6MM X 50MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-02-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|746.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|746.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-72-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT261216|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 26MM 12MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.477S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 360MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PXT261418|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 26MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC201400|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 13.5CM 20MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB070502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB080202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 2.5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB060202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 2.5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB070202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 2.5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBA050202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 2.5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB080502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB071002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 10CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB060502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBB061002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 10CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4372032155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD METASUL 32 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 5D 38 L/+4 12/14 32MM HIP METASUL PROTASUL-21WF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,749.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,749.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 205MM SS 16 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 229MM SS 18 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 253MM SS 20 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700916|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 205MM SS 16 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700918|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 229MM SS 18 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 253MM SS 20 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 240MM SS 16 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 264MM SS 18 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 288MM SS 20 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 264MM SS 18 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L7308|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULA,ARTERIAL,PERFUSION,18F|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234700720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 288MM SS 20 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123-048-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD PC C.A.P. GLOBAL 48 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1762-02-010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH ST 10 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1768-04-312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6MM X 45MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-72-065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187923111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X9X11MM CNCRD PRLL CFRP RADOPQ PLIF TLIF NS LF|1|HUMANA [1294]||HUMANA [11839]|9,706.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,706.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-72-045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 45MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.866|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 16MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 26MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APC020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULA,ARTERIAL,PERFUSION,20F|1|HUMANA [1294]||HUMANA [11839]|60.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|60.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234702336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 36MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.888|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 28MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPC0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSPACE HIP XL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CRCRP510|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 10X5CM CLGN PTCH REPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 14MM SS PERIART RADL DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RRT05070080L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX 70CM RINGED TW 7 X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC121400|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 12MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 36MM SS 2.4MM SCR 2 HL LCK BN RADL LT PERIART DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MA.010|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +1 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 10MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 18MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235802601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DLT 40MM SS 2.4MM SCR 1 HL LCK BN RADL LT PERIART DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 10MM SS RADL PERIART DIST LCK M THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235901025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 10MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CLLJ|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LEFT J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-24.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM OFST TPR 36MM HIP AL CERM V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 16MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRS-010-RMS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER BONE VOID NORIAN ROTARY MIX 10CC STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,108.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,108.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 206.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 32MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2348-010-25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|76.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE RT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008191-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 4.5MM X 20MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010062-80|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 80MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4014|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL LSF 4.5MM X 6.0CM X 107CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3990BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 9MM 6/6.5/7FR 35MM 80CM 40MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39MM SS 2.4MM SCR 3 HL LCK LAT CLMN BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-87-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END PEG GLOBAL ADVANTAGE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9795225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RESCUE VENTURE 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1128-52-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 52MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G00509|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 X 145CM 15J CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 242.494|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR 2.4 X 61MM 5 HOLE HEAD 5 HOLE SHAFT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 40MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7540020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET LEGACY 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 30MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 45MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2424KITB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT FINGER SWANSON FINGER IMPLANT #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6653113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MYSTIQUE 3.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,181.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 26MM SS CNCL RADL PERIART DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-193|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR SINGLE CHAMBER ATLAS VR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1580|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA DUAL COIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8043|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 40MM 8MM TIB BABSR BSCR XTLK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961426|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X14MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8141-17-003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META SMALL 3MM HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM AIM TMX FT HUM CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM AIM TMX FT HUM CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S0E-4528|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE OVAL 20CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1501DR|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE ENRHYTHM DUAL CHAMBER WITH ATRIAL THER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT261214|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 26MM 12MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6238TEL|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE ATTAIN SELECT MB2 SOFT TIP TELESCOPING 7FR OU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T125|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR VITALITY OS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG413|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GLIDECATH 4FR 100CM LONG STRAIGHT TAPER (ST) TIP SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00146316B1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ZIPWIRE STIFF SHAFT .035 DIAMETER X 260CM LENGTH X 3CM FLEXI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47520|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 4.1CM 5-3MM TRND SFT .035IN STD SM PLTN|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D154ATG|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|CARDIOVERTER DEFIBRILLATOR IMPLANTABLE ENTRUST DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE060080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 130CM 80MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM TMX FT CORT ST SLD NS AIM SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM TMX FT CORT ST SLD NS AIM SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM TMX FT CORT ST SLD NS AIM SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|99.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|99.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814118009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL PILON 9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2487KITA|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TOE GREAT LPT (INCLUDES ONE IMPLANT)|1|HUMANA [1294]||HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 487-S001|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE GREAT LPT SIZE 1 REGULAR|1|HUMANA [1294]||HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP-1033|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX GRAFT DURAL PLUS DURAGEN 3 INCH X 3 INCH|1|HUMANA [1294]||HUMANA [11839]|2,722.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,722.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175432P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMASHIELD WOVEN DBL VELOUR 32CM X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1488TC-46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL SDX BIPOLAR 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1488TC-52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL SDX BIPOLAR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5172|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IDENTITY SR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5370|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IDENTITY DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1581-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1056T|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD QUICK SITE BI POLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-243|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5592-53|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSURE SP NOVUS 53CM ARTIAL BIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.534S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 44MM WITH T25 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.518S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 28MM WITH T25 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175430P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMASHIELD WOVEN DBL VELOUR 30CM. X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3830-59|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE SELECT SECURE 59CM ENDOCARDIAL BIPOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C304S59|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE ATTAIN STEERABLE SELECT SITE 59CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119708010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 8CM IM TRB MTL NS|1|HUMANA [1294]||HUMANA [11839]|10,204.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,204.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2246-023-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDEPIN 3.2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6931-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT FIDELIS 58CM TRIPOLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6947-58|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO SECURE 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6949-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT FIDELIS 65CM VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ICF09-52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CRYSTALLINE ACTIVE FIXATION 52CM ATR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1488TC-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL SDX BIPOLAR 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.315S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 10MM X 130DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-1265|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN CURVED SLIGHTLY 1.5MM X 14MM|1|HUMANA [1294]||HUMANA [11839]|839.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|839.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1254|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN CURVED 1.5MM X 6MM|1|HUMANA [1294]||HUMANA [11839]|839.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|839.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXB35-06-17-75|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PRIMUS GPS 6MM DIAMETER X 17MM LENGTH X 75MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXB35-07017075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PRIMUS GPS 7MM DIAMETER X 17MM LENGTH X 75MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1381|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN 45 DEGREE ANGLE 1.5MM X 9MM|1|HUMANA [1294]||HUMANA [11839]|864.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMK49B-52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE EXCELLENCE PS+ 52CM VENTRICULAR BIPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMK49B-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE EXCELLENCE PS+ 58CM VENTRICULAR BIPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KDR901|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 900 DR DUAL CHAMBER RATE RESPONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KDR903|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 900 DR DUAL CHAMBER RATE RESPONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KDR906|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 900 DR DUAL CHAMBER RATE RESPONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KDR921|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 900 DR DUAL CHAMBER RATE RESPONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KSR401|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 400 SR SINGLE CHAMBER RATE RESPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KSR403|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 400 SR SINGLE CHAMBER RATE RESPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSR303B|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE SIGMA 300 SR SINGLE CHAMBER RATE RESPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSR306U|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE SIGMA 300 SR SINGLE CHAMBER RATE RESPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6950305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET VERTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|458.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|458.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OCCIPITAL 3.2MM X 100MM PRE CURVED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,511.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,511.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.0MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,246.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,246.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7002526|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK MEDIUM ADJUSTABLE|1|HUMANA [1294]||HUMANA [11839]|3,927.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G29986|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR CHECK-FLO 7FR .018/.038" GUIDE DIAMETER 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBA061002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 10CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBT1201D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORETEX BIF 12MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VBB070501|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 5CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.591|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 124X11X3.4MM TI 3.5MM SCR SM FRAG 9 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,118.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 163X11X3.4MM TI 3.5MM SCR SM FRAG 12 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,271.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,271.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6947-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO SECURE 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE050060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 130CM 60MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE040060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 130CM 60MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175434P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMASHIELD WOVEN DBL VELOUR 34CM. X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6937-35|SUP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE TRANSVENE DF-1 35CM ENDOCAR|1|HUMANA [1294]||HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-58|SUP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT DF-1 58CM TRIPOLAR E|1|HUMANA [1294]||HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-65|SUP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT DF-1 65CM TRIPOLAR E|1|HUMANA [1294]||HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6944-58|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO 58CM VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6944-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO 65CM VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6944-75|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO 75CM VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6944-100|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO 100CM VENTRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE RT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.319S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 135DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3830-69|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE SELECT SECURE 69CM ENDOCARDIAL BIPOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C304-L69|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE ATTAIN STEERABLE SELECT SITE 69CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F06A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FILLER BONE EXPRESS SIZE 2 KYPHX|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G29983|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR CHECK-FLO 6FR .018/.038" GUIDE DIAMETER 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01774|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CURVED 0.35 DIAMETER X 80CM LENGTH 1.5MM TIP RADIU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7304|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE RESYNCHRONIZATION CARDIAC WITH ICD INSYNC SENTRY 40CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H175|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CONTAK RENEWAL 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.474S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 340MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.581|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 152X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 8 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.42|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,512.42|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60D3.240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 14MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241251|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.5X12CM SLX LM P5.7CM CNTR HI PRFL FULL PRJ ELIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241201|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12X11.5CM SLX LM P5.5CM CNTR HI PRFL FULL PRJ ELIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PA010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 70MM 1MM FRS FSN RECON SYS DISP|1|HUMANA [1294]||HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.456S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 360MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.075|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.080|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-8.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17AHPJ-505|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC HP 17MM|1|HUMANA [1294]||HUMANA [11839]|16,194.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,194.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 53-23620E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 20MM VARIAX TI T7 FT LCK NS DIST RDS LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 3.2MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 117X9X1MM TI 2.7/3.5MM CORT 3.5MM LCK SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-96-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END FIN GLOBAL ADVANTAGE 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14012-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 14IN 3.2MM ACE ST VERSANAIL TTC SYS NS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 809230038|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 38IN 3MM VERSANAIL BALL NOSE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8092-32-238|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 38IN 3.2MM VERSANAIL NL DRV STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8007-12-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL VERSA 12MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1515-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 5.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25AJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC ST. JUDE 25MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 45MM CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149811306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL ALL POLY UNI PRESERVATION 7MM SIZE 3 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149812206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL ALL POLY UNI PRESERVATION 7MM SIZE 2 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241307|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13X12.2CM SLX LM P5CM CNTR MDRT PRFL MDRT PRJ ELIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241257|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.5X11.8CM SLX LM P4.8CM CNTR MDRT PRFL MDRT PRJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27AJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC ST. JUDE 27MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60D3.135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 229X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 12 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.221.510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 10MM SS T25 ST LCK STRDR THRD HD NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.221.512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 12MM SS T25 ST LCK STRDR NS LG FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29AJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC ST. JUDE 29MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 32MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2487KITB|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TOE GREAT LPT (INCLUDES ONE IMPLANT SIZE 2)|1|HUMANA [1294]||HUMANA [11839]|4,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 16MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.662|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 300X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 16 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,043.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,043.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.255|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-CAVGJ-514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC CONDUIT 25MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60D3.275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.290|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.295|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3.300|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60D3-30.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815540035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-6.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-CAVGJ-514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC CONDUIT 27MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.541|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 80X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 4 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,090.77|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,090.77|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 98X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 5 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,166.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,166.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.561|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 116MM SS 4.5MM SCR LG FRAG SET 6 HL LCP CMBN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,235.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,235.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 224X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 12 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,991.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,991.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.661|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 296X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 16 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,610.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 226.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 224X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 12 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,250.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 226.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 260X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 14 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,504.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,504.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 27MJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ST. JUDE 27MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 226.661|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 296X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 16 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,043.17|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,043.17|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 240.181|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 147MM SS 4.5/5MM SCR SM FRAG SET 8 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,529.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,529.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 240.141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 83MM SS 4.5/5MM SCR SM FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,911.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 25MM 12MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 30MM 15MM SS 3.5MM P/T MLR HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 35MM 18MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 40MM 20MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 45MM 22MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 50MM 24MM SS 3.5MM P/T MLR HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 55MM 26MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 60MM 28MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 65MM 30MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 215.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 70MM 32MM SS 3.5MM P/T MLLE HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.73|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|98.73|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 28MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 30MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 32MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 34MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 36MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 38MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|40.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 40MM WITH 3.5MM HEXAGONAL SOCKET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2625 29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC 29MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 42MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|58.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 44MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|58.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 46MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|58.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 48MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|58.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 50MM 12MM SS STD P/T CORT SHFT LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|47.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 216.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 55MM 16MM THREADED WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 105MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 218.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM SS 3.5MM FT CANC LG HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 218.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM FULL THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 218.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM SS 3.5MM FT CANC LG HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2625 31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC 31MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 218.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM FULL THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.204.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 14MM SS T25 FT ST LCK STRDR NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.204.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 18MM SS T25 FT ST LCK STRDR NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.204.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 38MM SS T25 FT ST LCK STRDR NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.204.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 42MM SS T25 FT ST LCK STRDR NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 270019MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MAGNA AORTIC PERICARDIAL #19|1|HUMANA [1294]||HUMANA [11839]|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 20MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 22MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 40MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.221|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 60MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 65MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 70MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 75MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 270023MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MAGNA AORTIC PERICARIDAL #23|1|HUMANA [1294]||HUMANA [11839]|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 80MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 85MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.227|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 90MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 14MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 16MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 18MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 4.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 22MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 24MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 26MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25MJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ST. JUDE 25MM|1|HUMANA [1294]||HUMANA [11839]|15,543.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,543.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 414.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 28MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 4.5 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 32MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 34MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 38MM TI CORT ST LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 4.5 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 42MM TI CORT ST LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.844|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 44MM TI CORT ST LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 46MM TI CORT ST LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.848|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 48MM TI CORT ST LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 31MJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ST. JUDE 31MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 414.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 4.5 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.852|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 52MM TI CORT ST LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.864|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 64MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.866|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 66MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.868|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 68MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 4.5 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.458|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 5 HOLE HEAD 3 HOLE SHAFT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.459|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 5 HOLE HEAD 5 HOLE SHAFT RIGHT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.461|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 5 HOLE HEAD 3 HOLE SHAFT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.462|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 5 HOLE HEAD 5 HOLE SHAFT LEFT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33MJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ST. JUDE 33MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 242.464|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 4 HOLE HEAD 3 HOLE SHAFT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 4 HOLE HEAD 5 HOLE SHAFT RIGHT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,731.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.467|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 4 HOLE HEAD 3 HOLE SHAFT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,580.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.477|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T DISTAL RADIUS 2.4MM LCP 3 HOLE HEAD 3 HOLE SHAFT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,473.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,473.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.478|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T DISTAL RADIUS 2.4MM LCP 3 HOLE HEAD 4 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,535.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,535.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.490|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING DISTAL RADIUS 2.4MM STRAIGHT 6 HOLE 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,473.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,473.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D L 40X6.3X1.6MM SS 2.4MM SCR 2 HLE/HD 3 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D L 49X6.3X1.6MM SS 2.4MM SCR 2 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D L 40X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 3 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D L 49X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2625 21|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC 21MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 242.506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -90D L 40X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 3 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -90D L 49X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +20D L 52X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -20D L 43X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 3 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -20D L 52X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,494.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 6MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 8MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 30MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 6MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.758|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 8MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|209.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|209.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2625 23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC 23MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 201.760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 10MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|209.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|209.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.762|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 12MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 22MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.774|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 24MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.776|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 26MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.778|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 28MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 10MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.872|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 12MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.882|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 22MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 30MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625-LP 25MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 25MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.004.234S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL CANNULATED 8MM EX 270MM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.237S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 285MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.240S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 300MM TIB XPRT IM RND BRL CNN TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.243S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 315MM TIB XPRT IM RND BRL CNN TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.246S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 330MM TIB XPRT IM RND BRL CNN TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.249S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 345MM TIB XPRT IM RND BRL CNN TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.252S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 360MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.255S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 375MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.258S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 390MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.334S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 270MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19AHPJ-505|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC HP 19MM|1|HUMANA [1294]||HUMANA [11839]|16,194.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,194.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.004.337S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 285MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 300MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.343S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL CANNULATED 9MM EX 315MM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.346S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 330MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.349S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 345MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.352S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 360MM TIB XPRT IM RND CNN UNV TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.355S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 375MM TIB XPRT IM RND BRL CNN TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.358S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 390MM TIB XPRT IM RND BRL CNN TI STRL DRK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.434S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 270MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.437S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 285MM TIB XPRT IM RND BRL CNN TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21AHPJ-505|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC HP 21MM|1|HUMANA [1294]||HUMANA [11839]|15,876.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,876.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.004.440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 300MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.443S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 315MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.446S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 330MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.452S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 360MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.455S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 375MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.458S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 390MM TIB XPRT IM RND CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.534S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 270MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.537S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 285MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.540S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 300MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.543S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 315MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23AJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC ST. JUDE 23MM|1|HUMANA [1294]||HUMANA [11839]|15,543.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,543.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.004.546S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 330MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.549S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 345MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.552S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 360MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.555S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 375MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.558S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 390MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.634S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 270MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.637S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 285MM TIB XPRT IM FLUT BRL CNN TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.640S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 300MM TIB XPRT IM FLUT BRL CNN TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.643S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 315MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.646S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 330MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.649S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 345MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.652S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 360MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.655S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 375MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.658S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 390MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.520S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 30MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.525S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 35MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.530S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 40MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 45MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|627.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.540S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 50MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.545S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 55MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.550S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 60MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.555S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 65MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.560S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 70MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.565S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 75MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.570S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 80MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.015.575S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 85MM TI T25 FT TIB 2 COR ST LCK STRDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 5MM T40 TIB CNN STRDR XPRT IM NL SYS TI STRL AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|818.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|818.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.002S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 10MM TIB XTN T40 STRDR RCS IM NL TI STRL XPRT AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|818.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|818.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.003S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 15MM TIB XTN T40 STRDR RCS IM NL TI STRL XPRT AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|818.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|818.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.408S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 18MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.410S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 20MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.412S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 22MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.414S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 24MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.416S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 26MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.418S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 28MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 30MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.422S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 32MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.424S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 34MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.426S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 36MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.428S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 38MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.430S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 40MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.432S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 42MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.434S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 44MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.436S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 46MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.438S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 48MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 50MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.442S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 52MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.444S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 54MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.446S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 56MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.448S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 58MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-306B|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 X 150 #46-306-STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.005.450S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 60MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.452S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 62MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.454S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 64MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.456S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 66MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.458S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 68MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.460S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 70MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.462S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 72MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.464S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 74MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.466S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 76MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.468S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 78MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.470S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.3MM 80MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.516S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 26MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.520S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 30MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.522S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 32MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.526S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 36MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.530S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 40MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.532S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 42MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.536S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 46MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.538S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 48MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.540S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 50MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.542S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 52MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.544S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 54MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.546S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 56MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.548S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 58MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.550S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 60MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.554S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 64MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.556S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 66MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.558S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 68MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.560S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 70MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.562S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 72MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.564S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 74MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.566S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 76MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.568S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 78MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.570S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 80MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.575S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 85MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.580S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 90MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.585S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 95MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.590S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.3MM 100MM TI T25 FT TIB LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.309S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 120MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.314S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 10MM X 125DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.317S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.321S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.323S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 135DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.511S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 235MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.395S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 340MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.399S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 380MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.401S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 400MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.394S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 340MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.396S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 360MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.398S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 380MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.413S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 320MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.423S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 420MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.412S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 320MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.414S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 340MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.422S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 420MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.475S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 340MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.479S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 380MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.481S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 400MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.476S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 360MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.480S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 400MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 102061|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 10X5CM ALDRM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-736|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 10MM 75CM 40MM PERI OTW NC HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM TMX FT CORT ST SLD NS AIM SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-196|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1590-60|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DUAL COIL ENDOCARDIAL DEFIBRILLATOR PACING 60CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-239|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-233|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1590-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DUAL COIL ENDOCARDIAL DEFIBRILLATOR PACING 65CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6948-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT FIDELIS 65CM STEROID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1591-65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DUAL COIL ENDOCARDIAL DEFIBRILLATOR PACING HIGH VOLTAGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 7 HLF 10MM KN TIB PRECT TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported IML49JB-53|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE EXCELLENCE SS+ 53CM ATRIAL BIPOLAR T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6218A-EH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE ATTAIN EXTENDED HOOK 7FR INNER DIAMETER 48.5C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.826S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,888.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,888.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.854|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 54MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401855M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 8FR 35MM 55CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235801312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140MM SS 2.4MM SCR 12 HL LCK LAT CLMN BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,709.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,709.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3392312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 12MM PRIMTR 8D MED PEEK-OPTM ADON ALIF|1|HUMANA [1294]||HUMANA [11839]|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC48506|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIALIS ANTERIOR|1|HUMANA [1294]||HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814123009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA 9-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM ALPS TMX FT FIB CANC DIST SLD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCE-38-10-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION .038 DIAMETER X 10CM LENGTH 10MM PROXIMAL|1|HUMANA [1294]||HUMANA [11839]|131.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|131.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5966-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED CR SIZE 4 YELLOW 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TCMTNA-35-145-3-AMC-|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE TEFLON COATED MOVEABLE CORE WIRE .035 DIAMETER 145|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPK0221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSPACE KNEE LARGE 8074|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H215|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CONTAK RENEWAL 3 RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394930|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PTFE/HEPARIN COATED 035¬ť X 150CM FIXED CORE, 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.856|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 56MM TI CORT ST LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.255|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.290|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.295|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29.5 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60D3.300|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +30 DIOP +4 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.060|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.065|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.070|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.075|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.105|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.140|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF IQ 13.0MM LENGTH 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.260|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.265|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60WF.280|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 3.2MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4518|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 90CM 5.4FR 6FR COR VNS BP LV-1 CNCT EZTRK 2 STRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4470|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD FINELINE 2 BIPOLAR IS1 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM AIM TMX FT HUM CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814118005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 123MM TMX 5 HL PILON PERI BN TIB DIST MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|849.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|849.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0065079614|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PAK COMPLETE AQUALASE 9MML|1|HUMANA [1294]||HUMANA [11839]|698.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|698.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345641|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE L-ASR FEE 6 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GG625|SUP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT SKIN GAMMAGRAFT 5CM X 12.5CM APPROXIMATE SIZE|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.361|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 69X9X1MM TI 2.7/3.5MM CORT 3.5MM LCK SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|531.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|531.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRS-005-RMS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER BONE VOID NORIAN ROTARY MIX 5CC STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,247.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1230-40-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 40MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7843-014-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION BEADED BODY STANDARD SIZE 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,119.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,119.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14376-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM CANC LG CNN NONLOCK SM FRAG PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 40MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 45MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 50MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 55MM TI T15 FT ST LCK STRDR CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM LCP TI T15 FT TIB MDL LAT PROX ST STRDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961422|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX14MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR LCP WITH COLLAR 93MM 8 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|572.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.561|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85X11X3.4MM TI 3.5MM SCR SM FRAG 6 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|983.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|983.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.581|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 111X11X3.4MM TI 3.5MM SCR SM FRAG SET 8 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,074.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137X11X3.4MM TI 3.5MM SCR SM FRAG 10 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,152.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,152.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 5MM X 45MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,846.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,846.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.478S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 380MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 445.071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 98X10.1X3.5MM TI 3.5MM SCR SM FRAG SYS 7 HL RECON LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,684.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,684.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.081|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 112X10.1X3.5MM TI 3.5MM SCR SM FRAG SET 8 HL RECON LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,757.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,757.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1740-22-080|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSSOVER SZ 8|1|HUMANA [1294]||HUMANA [11839]|3,093.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,093.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 50X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,028.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,028.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 56X11X1.5MM TI 3.5MM SCR SM FRAG SET 4 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,060.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,060.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R T 52X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,150.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,150.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T PLATE LCP 3.5MM X 74MM 3 HOLE HEAD 5 HOLE SHAFT RIGH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|913.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L T 52X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,212.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,212.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.951|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L T 74X10X1.5MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,324.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,324.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.221.508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 8MM SS T25 ST LCK STRDR NS LG FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 247X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 13 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.652|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 282X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 15 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.672|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 318X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 17 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.682|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 336X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 18 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814123010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5376|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IDENTITY XLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.371|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 81X9X1MM TI 2.7/3.5MM CORT 3.5MM LCK SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P1-0612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.6 H SHAPE 6MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P1-0413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.6 T SHAPE 10MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S3-1604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 4MM QKTP NEUROPRO TI CRNL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S3-1605|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 5MM QKTP NEUROPRO TI CRNL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P2-0118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE COVER 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 357.932|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 17.0MM/3.2MM 161MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 357.381|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE 222MM 3.2MM 11MM WRE SRG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM FT TIB CANC DIST NONLOCK NS ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8155-40-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM ACTB CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485013|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING URETEX TRANSOBTURATOR NEEDLE HOOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,444.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,444.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-033-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ C 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-033-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ C 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-033-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ C 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-034-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ D 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234801406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 74MM SS 2.7/3.5MM SCR 6 HL NONLOCK BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S1-1605|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 5MM NEUROPRO TI CRNL CANC ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S1-1635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 3.5MM NEUROPRO TI CRNL CANC ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S1-2005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 5MM NEUROPRO TI CRNL CANC ST ER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-033-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ C 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-034-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ D 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599003502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN E 10MM KN POST ROT HNG PRECT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-035-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ E 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-035-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR ONLY SZ E 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-036-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ F 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-036-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR ONLY SZ F 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-037-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ G 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 157002110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM CMNTLS SMT DUOFIX 5 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5988-010-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM STRAIGHT 11MM X 145MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598801017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 17MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598801022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 22MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598802012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 12MM KN FEM TIV NXGN OFST STRLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598802014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 14MM KN FEM TIV NXGN OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598802017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 17MM KN FEM TIV NXGN OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 123052015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 52MM SHLDR GB CAP DUOFIX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,983.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,983.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598800427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 4 HLF 10MM KN TIB PRECT TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598800627|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 6 HLF 10MM KN TIB PRECT TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598800827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 8 HLF 10MM KN TIB TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599402233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 1-2 C-D MIC 58X40X33MM KN REV MACH MLD TIV UHMWPES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-030-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM YELLOW CD 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-030-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM YELLOW CD 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-030-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM YELLOW CD 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599403210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 66X42X10MM KN REV MACH MLD TIV UHMWPE LCCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-032-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM YELLOW STRIPE EF 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-032-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM YELLOW STRIPE EF 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-032-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM YELLOW STRIPE EF 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-032-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 23MM YELLOW STRIPE EF 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-040-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM GREEN EF 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599404012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 74X46X12MM KN REV MACH MLD TIV UHMWPE NG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-040-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM GREEN EF 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-040-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 23MM GREEN EF 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-041-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM GREEN STRIPE CD 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-041-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM GREEN STRIPE CD 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-041-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM GREEN STRIPE CD 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-041-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM GREEN STRIPE CD 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-041-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 23MM GREEN STRIPE CD 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-050-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM BLUE G 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-037-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZG 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-050-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM BLUE G 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-050-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM BLUE G 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-050-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM BLUE G 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3587A|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESUME II LEAD #3587A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,788.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,788.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-050-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM BLUE G 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-050-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 23MM BLUE G 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5990-037-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR ONLY SZ G 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-051-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM BLUE STRIPE EF 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-051-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM BLUE STRIPE EF 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-051-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM BLUE STRIPE EF 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-051-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM BLUE STRIPE EF 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-051-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM BLUE STRIPE EF 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5994-051-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 23MM BLUE STRIPE EF 7-10 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 88MM SS 3.5MM SCR SM FRAG 3 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|702.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 104MM SS 3.5MM SCR SM FRAG 4 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|751.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|751.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.320|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +32 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.001.410S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 150MM HUM PROX XPRT IM RND CNN TRNSV SLOT LCK HL TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,809.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,809.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.010.025|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE FX 240MM 2MM KRSH TI TROC PNT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 32MM SS 2.7/3.5MM SCR 2 HL NONLOCK BN ULN RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 74MM SS 2.7/3.5MM SCR 6 HL NONLOCK BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 116MM SS 2.7/3.5MM SCR 10 HL NONLOCK BN RADL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 137MM SS 2.7/3.5MM SCR 12 HL NONLOCK BN RADL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 826-213|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE SINGLE W/INTERGRAL-CRIMP|1|HUMANA [1294]||HUMANA [11839]|1,675.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,675.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234801402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 32MM SS 2.7/3.5MM SCR 2 HL NONLOCK BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 116MM SS 2.7/3.5MM SCR 10 HL NONLOCK BN RADL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 137MM SS 2.7/3.5MM SCR 12 HL NONLOCK BN RADL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 33MM SS 2.7/3.5MM SCR 2 HL BN RDS ULNA RT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 44MM SS 2.7/3.5MM SCR 3 HL BN RDS ULNA RT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801705|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 64MM SS 2.7/3.5MM SCR 5 HL BN RDS ULNA RT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801707|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 85MM SS 2.7/3.5MM SCR 7 HL BN RDS ULNA RT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 33MM SS 2.7/3.5MM SCR 2 HL BN RDS ULNA LT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 85MM SS 2.7/3.5MM SCR 7 HL BN RDS ULNA LT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 44MM SS 2.7/3.5MM SCR 1 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 55MM SS 2.7/3.5MM SCR 2 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 75MM SS 2.7/3.5MM SCR 4 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,866.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,866.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 96MM SS 2.7/3.5MM SCR 6 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 117MM SS 2.7/3.5MM SCR 8 HL BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 138MM SS 2.7/3.5MM SCR 10 HL BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 44MM SS 2.7/3.5MM SCR 1 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 55MM SS 2.7/3.5MM SCR 2 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 75MM SS 2.7/3.5MM SCR 4 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,866.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,866.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 96MM SS 2.7/3.5MM SCR 6 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 117MM SS 2.7/3.5MM SCR 8 HL BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM DLT 138MM SS 2.7/3.5MM SCR 10 HL BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 34MM SS 2.7/3.5MM SCR 2 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 76MM SS 2.7/3.5MM SCR 6 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 97MM SS 2.7/3.5MM SCR 8 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 118MM SS 2.7/3.5MM SCR 10 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 138MM SS 2.7/3.5MM SCR 12 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 34MM SS 2.7/3.5MM SCR 2 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 97MM SS 2.7/3.5MM SCR 8 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 118MM SS 2.7/3.5MM SCR 10 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,017.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 138MM SS 2.7/3.5MM SCR 12 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-053-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234807035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 70MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234807535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 75MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234808035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 80MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234808535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 85MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234809035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 90MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241357|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.5X12.8CM SLX LM P5.2CM CNTR MDRT PRFL MDRT PRJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241407|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14X13.2CM SLX LM P5.3CM CNTR MDRT PRFL MDRT PRJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234809535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 95MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234810035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 100MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234811035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 110MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234810535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 105MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482704201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 42MM SS SM HEX CORT ST NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482704401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 44MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482704601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 46MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482704801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 48MM SS SM HEX CORT ST NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482705201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 52MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482705401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 54MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482705601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 56MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482705801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 58MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482706001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 60MM SS ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482706501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 65MM SS ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482707001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 70MM SS ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234804235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 42MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234804435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 44MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234804635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 46MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234804835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 48MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234805035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 50MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234805235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 52MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234805435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 54MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234805635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 56MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234806035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 60MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7575535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 5.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7575540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 5.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7575545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 5.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484003200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 32MM SS FT CANC SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493503305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T OBLQ 52MMX1.5MM SS 3.5MM SCR SM FRAG 3 HLE/HD 3 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|514.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7570955|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET SEXTANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|861.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8670001|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH SXTNT SPNE TI BLNT INST ROD INS SYS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493503505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T OBLQ 74MMX1.5MM SS 3.5MM SCR SM FRAG 3 HLE/HD 5 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493503304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50MMX1.2MM SS 3.5MM SCR SM FRAG 3 HLE/HD 3 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493504404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 56MMX1.2MM SS 3.5MM SCR SM FRAG 4 HLE/HD 4 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493501200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 145MM 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T68|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 6.75MM X 8.22MM (FRESH FROZEN)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,481.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T810|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 8.75MM X 10.22MM (FRESH FROZEN)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR01|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDE PINNACLE STRAIGHT 45CM LENGTH 6FR 1/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3393312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 12MM PRIMTR 8D LG PEEK-OPTM ADON ALIF|1|HUMANA [1294]||HUMANA [11839]|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3393316|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16MM PRIMTR 8D LG PEEK-OPTM ADON ALIF|1|HUMANA [1294]||HUMANA [11839]|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,003.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12477|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 55MM 12MM 14FR ZNTH FLX H&L-B 1-SHOT BFUR ABD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,253.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,253.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1865-12-032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE EAGLE 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1865-50-014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING EAGLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1865-51-014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW OVERSIZED EAGLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7576535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 6.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GG225|SUP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT SKIN GAMMAGRAFT 2.5CM X 3.0CM APPROXIMATE SIZE|1|HUMANA [1294]||HUMANA [11839]|360.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7576545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GG400|SUP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT SKIN GAMMAGRAFT 4CM X 5CM APPROXIMATE SIZE|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1240111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP 11MM CRANIOFIX 2 TITANIUM|1|HUMANA [1294]||HUMANA [11839]|37.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1240116|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP TUBE 16MM CRNFX 2 CRNL FLP TI RSRB STRL|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1240120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP TUBE 20MM CRNFX 2 CRNL FLP TI RSRB STRL|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55191|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CONVERTER AAA 24MM PROX DIA X 12MM DISTAL DIA FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55192|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CONVERTER AAA 28MM PROX DIA X 12MM DISTAL DIA FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55193|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CONVERTER AAA 32MM PROX DIA X 12MM DISTAL DIA FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32179|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 22MM 18FR ZNTH FLX H&L-B 1-SHOT 2 BRCH SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G32180|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 24MM 6.9MM 18FR ZNTH FLX H&L-B 1-SHOT 2 BRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32181|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 26MM 6.9MM 18FR ZNTH FLX H&L-B 1-SHOT BFUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G32182|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 28MM 7.7MM 20FR ZNTH FLX H&L-B 1-SHOT 2 BRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G32183|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 30MM 7.7MM 20FR ZNTH FLX H&L-B 1-SHOT 2 BRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G32184|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 32MM 7.7MM 20FR ZNTH FLX H&L-B 1-SHOT BFUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G18506|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER GRAFT AAA 16MM X 20MM ZENITH FLEX|1|HUMANA [1294]||HUMANA [11839]|5,658.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,658.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12433|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCLR CV 20MM 24MM ZNTH FLX AAA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,626.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,626.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P1-0211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.6 STRAIGHT 2 HOLE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4024|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL ES 2.0MM X 2.2CM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3202|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STIMULATOR OSTEOGENISIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2960826|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX8MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBFS 045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM BONE SMALL FIXATION 1.1MM|1|HUMANA [1294]||HUMANA [11839]|920.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|920.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBFN045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL .045 FIXATION BONE SMALL|1|HUMANA [1294]||HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14817048|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT HEAD FEMORAL FROZEN FRESH|1|HUMANA [1294]||HUMANA [11839]|4,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GJX|SUP|HCPCS Q4113||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT EXPRESS 2CC|1|HUMANA [1294]||HUMANA [11839]|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMX49JB-53|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE 53CM TRANSVENOUS STEROID-ELUTING END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6651125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MYSTIQUE 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,721.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,721.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112865050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 52MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,103.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,103.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 814123008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 109.2MM TMX LWR XTRMT SYS 8 HL 1/3 TBLR COMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-37-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01253|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CURVED 0.35 DIAMETER X 260CM LENGTH 1.5MM TIP RADI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277141|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X10MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG-2520F|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AMNIO A 2.5 X 2.0CM A AG-2520F|1|HUMANA [1294]||HUMANA [11839]|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-9.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-053-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT231216|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 23MM 12MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7576540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 6.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BMW2021|SUP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRESSING WOUND INTEGRA MATRIX BILAYER 2" X 2"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,601.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,601.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3889-28|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD TINED INTERSTIM 28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3023|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SYSTEM INTERSTIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3095-10|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION INTERSTIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620206622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.190|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-066-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6201-070-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TMZF ACCOLADE 30MM #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.274|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90X11X2.5MM SS 3.5MM SCR SM FRAG SET 5 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,638.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,638.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.284|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 83X11X2.5MM SS 3.5MM SCR SM FRAG SET 5 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 20MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 36MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 16MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 30MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 40MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 48MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-01-003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE ROSTRAL MEDIUM ANTERIOR EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-01-004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE CAUDAL MEDIUM ANTERIOR EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-02-540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANTERIOR 5MM X 40MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,608.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,608.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-02-640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANTERIOR 6MM X 40MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,608.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,608.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-02-645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANTERIOR 6MM X 45MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-01-015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-03-065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 65MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-03-085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 85MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|869.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|869.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-04-015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS ANTERIOR 15MM EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-04-005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET CONNECTOR CROSS EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1734-01-209|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STACKABLE TOP 9MM|1|HUMANA [1294]||HUMANA [11839]|2,825.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,825.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1734-02-209|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STACKABLE BOTTOM 9MM|1|HUMANA [1294]||HUMANA [11839]|2,825.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,825.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1734-00-212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STACKABLE 12MM|1|HUMANA [1294]||HUMANA [11839]|3,708.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,708.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT231214|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 23MM 12MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE RT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-1405|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE|1|HUMANA [1294]||HUMANA [11839]|2,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5810|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER DUAL CHAMBER RATE RESPONSIVE VICTORY DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5610|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER SINGLE CHAMBER RATE RESPONSIVE VICTORY SR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LOCKING LEFT 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68271|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 270CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118002|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA PARASTOMAL 12CM X 15CM STOMA 35MM-45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,282.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,282.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 50MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.807.237|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 28X25X37-55MM SYNEX 20D LRDTC THORLMBR TI XPD LG|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-6006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPLANT PLUS MINI OPUS WHITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-6007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPLANT PLUS MINI OPUS CO-BRAID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9330003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE VANTAGE ATL ROSTAL TITANIUM|1|HUMANA [1294]||HUMANA [11839]|4,998.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,998.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9330004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE VANTAGE ATL CAUDAL TITANIUM|1|HUMANA [1294]||HUMANA [11839]|4,998.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,998.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9336545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VANTAGE ATL 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9330080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VANTAGE ATL 8.0CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,077.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,077.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9330000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT LOCK VANTAGE|1|HUMANA [1294]||HUMANA [11839]|693.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|693.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1217-07-062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PROFILE DEEP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101836508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8MM 14/16 OFST TPR 36MM HIP M SPC MTL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VB130202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 13MM X 2.5CMM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1230-56-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 56MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TIBIAL STEMMED WEDGE A/P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 4 HLF 5MM KN TIB PRECT TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported THSF-25-260-AES|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STIFF AMPLATZ COATED TFE .025 DIAMETER X 260CM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-00-312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVES ADAPTER 12/14 +2|1|HUMANA [1294]||HUMANA [11839]|884.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|884.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-00-748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM ASR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,378.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,378.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-90-243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FEMORAL UNI SIZE 43 ASR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,983.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-16.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1128-44-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL GLOBAL ADVANTAGE 44 X 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6637-0-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 19MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08699|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC 5FR X .035 DIAMETER X 100CM LENGTH HNB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL6SR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING SMALL RIGHT 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T5-16.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 82MM SS 3.5MM SCR 6 HL NONLOCK BN TIB LT PROX MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,234.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,234.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL10LL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING LARGE LEFT 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14-1P3-8615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PANEL PLATE 1.6 HEAVY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1136-42-026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR GLOBAL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,659.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,659.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.100.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SS 2.4/2.7 MM SCR LCK LCP BN NAVICULAR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.100.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SS 2.4/2.7 MM SCR LCK BN RT CUBOID NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,394.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,394.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.790|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 40MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.786|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 36MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 38MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 390.031|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX MED CMBN MR SF 3MM THRD ROD NS|1|HUMANA [1294]||HUMANA [11839]|1,819.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,819.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 18MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.327S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 235MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.397S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 360MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68240HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE SMOOTH ROUND HIGH-PRO 240CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68280HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE SMOOTH ROUND HIGH-PRO 280CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8711|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH IT 104.1CM 4.2FR .53MM NDR THNWL SIL 2 PC STRN RLF SLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961432|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32MMX14MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41112008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE 1.6 X 150MM|1|HUMANA [1294]||HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION LEFT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9791325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM VNTR TI SPNE CRV ANT SLF DRL VA INTGR LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.235|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 65MM TI INTGR LCK MDLN ALGN NTCH LOPRFL VNTR BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786401400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 149MM 14MM PRM PRFT TRB MTL TIV 12/14 41.5MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-011-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P1-0812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.6 BOX SHAPE 8 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S1-1604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 4MM NEUROPRO TI CRNL CANC ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1S1-1606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 6MM NEUROPRO TI CRNL CANC ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P1-0810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.6 X-SHAPE 8 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P1-1266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.6 STRAIGHT 12 HOLE 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P2-0114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE COVER 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P2-0122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE COVER 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P2-0218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE COVER PORTED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P2-0318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE COVER SLOTTED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P3-0650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P3-0886|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PANEL GAP 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|714.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|714.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P3-8613|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PANEL PLATE 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-1P3-9013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PANEL HEX 1.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR6550|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ICD DUAL CHAMBER OVATIO DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.460S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 400MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BJF25D|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD STELID II ATRIAL J BIPOLAR VITREOUS CARBON TIP TINED FI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ELAPASSPJ752|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ELAPASS PREFORMED J ATRIAL J BIPOLAR TINED POLARIS TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR2550|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER SYMPHONY DR DUAL CHAMBER DUAL SENSOR RATE RESPONSI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BJF26D|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD STELID II ATRIAL J BIPOLAR VITREOUS CARBON TIP TINED FI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-009-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-015-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-016-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-017-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 17MM STANDARD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-018-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 18MM STANDARD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-011-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL EXT TM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-012-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL EXT TM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-013-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL EXT TM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BMW4051|SUP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRSG BIO 5X4IN INTGR BVN CLGN GAG POLYSILOXANE BL MX STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,824.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,824.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-014-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL EXT TM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-015-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL EXT TM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-016-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL EXT TM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-24.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C154DWK|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CONCERTO DUAL CHAMBER WITH CARDIAC RESYNCHRONI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|65,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D154AWG|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR VIRTUOSO DR WITH ATRIAL AND VENTRICULAR THERAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SESR01|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD 2.8V .97AH 7.5MM 42.9MMX40.2MM SENSIA SR ATR VNTRC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADDR01|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ADAPTA DR DUAL CHAMBER WITH AT/AF INTERVENTIONS CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1230-48-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 48MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 241.287|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 110X11X2.5MM SS 3.5MM SCR SM FRAG SET 7 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-ELOX|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLNG TI BN ELB OLCRN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-H200L-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADL 20MM ACUMED ARH ANG ELB LT ANTM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0802-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 8.0MM X 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL-6SR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE RIGHT SHORT 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-00-315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVES ADAPTOR 12/14 +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|884.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|884.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ELAPASSP758|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ELAPASS PREFORMED J ATRIAL J BIPOLAR TINED POLARIS TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112840000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 40MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112840010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 40MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,833.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,833.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112840020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 40MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112848020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 48MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,610.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,610.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112852000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 52MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112852120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 52MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,718.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,718.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-56-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL GLOBAL ADVANTAGE 56 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-56-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL GLOBAL ADVANTAGE 56 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,086.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,086.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112856020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 56MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,710.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112856110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 56MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,295.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112856120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 56MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,295.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-65-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL CTA GLOBAL ADVANTAGE 44 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,757.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,757.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112865060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 23MM 52MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,830.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,830.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112865080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 23MM 56MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,765.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-06-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL ADVANTAGE 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,355.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,355.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-08-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE LONG 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-08-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL ADVANTAGE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,644.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,644.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-10-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE LONG 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-12-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE LONG 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-12-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL ADVANTAGE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-14-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,560.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,560.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-14-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE LONG 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,430.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-16-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,560.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,560.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-16-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL ADVANTAGE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,355.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,355.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported OM9006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPLANT PLUS MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-84-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END PEG GLOBAL ADVANTAGE 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-88-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END PEG GLOBAL ADVANTAGE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-89-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END PEG GLOBAL ADVANTAGE XL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-93-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK XS 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-94-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,790.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-95-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,790.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-96-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,263.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,263.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-97-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,263.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,263.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-98-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-99-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK XL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-06-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX LONG 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-06-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL FX 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-08-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX LONG 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-08-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL FX 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-10-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX LONG 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,045.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,045.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-10-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL FX 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,519.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,519.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-12-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-12-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX LONG 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-12-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL FX 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,944.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,944.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1136-40-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR GLOBAL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1136-41-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR GLOBAL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1136-43-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR GLOBAL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1136-44-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR GLOBAL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,490.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,490.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1136-45-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR GLOBAL XL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,980.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,980.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SBT1801D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX STRETCH BIF 18MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2236-80-091|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST ANTI-ROTATION PEG ANCHOR GLOBAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.937|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LEFTT 6-HOLE 107MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE LT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25396|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE UNV STD SHRT LCK VARIAX BN DIST VOLR RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T4.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482027|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX COLLEGEN ACELLULAR 2CM X 7CM PELVICOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,570.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,570.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482212|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX COLLEGEN ACELLULAR 2CM X 12CM PELVICOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,029.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,029.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482220|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX COLLEGEN ACELLULAR 2CM X 20CM PELVICOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,444.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,444.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 3.2MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433175|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CEMENT KNEE TIBIAL 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4204VL-21.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER STAAR ELASTIC 11.2MM LENGTH 6.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25394|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT UNV NAR TI LCK VARIAX BN HND RDS DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,146.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,146.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25395|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR LNG UNV 73MMX2MM TI LOPRFL VARIAX BN RDS LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25397|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE UNV STD LNG TI LCK VARIAX SMARTLOCK BN RDS DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25398|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE UNV W SHRT LCK VARIAX BN RADL DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25399|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG UNV W LCK VARIAX BN RDS DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD TI LCK VARIAX BN RDS RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,782.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,782.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25291|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD TI LCK VARIAX SMARTLOCK BN RDS LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25292|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE W 60MMX1.5MM TI VARIAX SMARTLOCK BN RDS RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,462.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,462.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25293|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE W LCK VARIAX SMARTLOCK BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT 44MMX1MM TI CLMN FRAG SPC VARIAX BN DIST RDSs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,912.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,912.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG TI CLMN SMARTLOCK BN RDS DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,458.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,458.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT LCK CLMN FRAG SPC VARIAX SMARTLOCK BN ULN RDS RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,838.16|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,838.16|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT 40MMX1MM TI FRAG SPC LCK CLMN VARIAX BN ULNA LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,458.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,458.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG LCK CLMN FRAG SPC VARIAX SMARTLOCK BN ULN RADL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,544.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,544.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG TI CLMN SMARTLOCK BN LT RADL DIST ULN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,544.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,544.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 653001|SUP|HCPCS L8606||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT URETHRAL TEGRESS|1|HUMANA [1294]||HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25374|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 56MMX2MM TI LCK VARIAX BN RDS LT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR LNG TI ANTM LCK VARIAX BN RADL RT DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,667.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG NAR 76MMX2MM TI LCK VARIAX BN RDS LT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25387|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD LNG 76MMX2MM TI LCK VARIAX BN RDS RT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,284.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,284.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25377|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD LNG 76MMX2MM TI LCK VARIAX BN RDS LT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,697.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25391|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR XLNG UNV TI LCK VARIAX BN LT DIST VOLR RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,697.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25392|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLNG STD UNV TI LCK VARIAX BN LT DIST VOLR RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,667.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25393|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLNG UNV TI LCK W VARIAX BN LT DIST VOLR RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,697.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25294|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD XLNG LCK VARIAX BN RT DIST DRSL RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25295|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD XLNG LCK VARIAX BN LT DIST DRSL RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25296|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLNG LCK W VARIAX BN RT DIST DRSL RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25297|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLNG LCK W VARIAX BN LT DIST DRSL RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,154.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 140808|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH CORKSCREW ADHERENT BOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-20616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING RADIUS 2.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|241.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-20618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING RADIUS 2.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-20620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING RADIUS 2.0 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-20622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING RADIUS 2.0 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-20624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING RADIUS 2.0 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-20626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING RADIUS 2.0 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5816|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER DUAL CHAMBER RATE RESPONSIVE VICTORY XL DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140806|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 80CM 4FR 6MM FGRTY ADH CLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23614E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|285.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23616E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|285.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|285.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|283.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|283.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.3 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PARTIALLY THREADED RADIUS 2.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PARTIALLY THREADED RADIUS 2.7 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PARTIALLY THREADED RADIUS 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PARTIALLY THREADED RADIUS 2.7 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PARTIALLY THREADED RADIUS 2.7 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PARTIALLY THREADED RADIUS 2.7 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23012E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|241.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|241.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|241.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23020E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|241.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|241.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-23038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.3 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|198.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-5035TB-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DELTA TAPERED BIO-INT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1351B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRANSFIX BIO LONG 5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|867.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 3.0 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003281|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PERIPHERAL HI-TORQUE STEELCORE 18 STRAIGHT TIP .01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003282|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .018IN STRG 5CM HTORQ STLCR SS MCGLD PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CQ7576|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 75CM 6CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CQ7586|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 75CM 6CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CQ7588|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 75CM 8CM PERI RPD INFL SHTHLS ENTRY RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CQ7594|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 9MM 75CM 4CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GJ48|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT REPAIR ULCER 4X8|1|HUMANA [1294]||HUMANA [11839]|9,084.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,084.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 86X11X3.3MM SS 3.5MM SCR SM FRAG SET 6 HL RND TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,809.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,809.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.925S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 2.5MM 440MM IM ELC TI PED STRL PNK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,079.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,079.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20789-540|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE POLE INFERIOR 540CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.304.322S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 220MM MRI SAFE LO-PRFL WRST FXTR|1|HUMANA [1294]||HUMANA [11839]|4,463.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,463.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 22MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00236003316|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 1.6MM STD PERIART SS DRL TIP NS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235700806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TIBIAL MEDIAL DISTAL 6-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,014.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6651127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MYSTIQUE 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,721.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,721.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47354|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 14CM 6MM NST 7.4 LOOP CATH END HL PLTN SNTH FBR|1|HUMANA [1294]||HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47521|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION EXTENDED 0.035 5.8CM X 6-3MM|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09059|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TIP BEACON PIG MARKER 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G04047|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 0.025 X 260CM AMPLATZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85414|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 7MM X 38MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-156B|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ZIP 0.035 X 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV025040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON PTA PLUS SUBMARINE 4-5F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV035060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON PTA PLUS SUBMARINE 4-5F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE070080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SAILOR PLUS 7MM DIAMETE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1230-56-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 56MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,401.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,401.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATOR MINI HINGED|1|HUMANA [1294]||HUMANA [11839]|5,088.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961232|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32MMX12MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75446550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6655113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MYSTIQUE 3.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,181.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149801004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL UNI CEMENTED PRESERVATION SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.165|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1230-40-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 40MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,656.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,656.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BG-101-350|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAERVELDT GLAUCOMA IMPLANT BG 101-350|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,406.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1230-04-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 44MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1230-44-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 44MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,001.98|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,001.98|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1230-48-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 48MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,742.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,742.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1230-52-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 52MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,870.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,870.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1230-56-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX HA PC GLOBAL C.A.P. 56MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,401.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,401.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136308000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR FEM CCRT ART/EZE -3MM 12/14 TPR HIP MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|814.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136310000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR FEM CCRT ART/EZE +0MM 12/14 TPR HIP MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|814.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136312000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR FEM CCRT ART/EZE +5MM 12/14 TPR HIP MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|814.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136314000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR FEM CCRT ART/EZE +10MM 12/14 TPR HIP MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|814.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|814.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136341000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 41MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MERIDIONAL 12MM X 12MM CURVED|1|HUMANA [1294]||HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136343000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 43MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VERTEX 3.2MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|943.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|943.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136344000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 44MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136345000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 45MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136346000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 46MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136347000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 47MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136348000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 48MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136349000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 49MM CCRT BALL HIP FEM MDLR ORTHOCENTRIC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136350000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 50MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136351000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 51MM CCRT BALL HIP FEM MDLR ORTHOCENTRIC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136352000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 52MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136353000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 53MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136354000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 54MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136356000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 56MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136358000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 58MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136360000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 60MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136342000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 42MM CCRT BALL HIP FEM MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,892.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86004X07|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKN 7X4CM GTJKT THK1.4MM ACLR DRML MTRX RGNRT NONMESH|1|HUMANA [1294]||HUMANA [11839]|8,508.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,508.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBA050502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 5MM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.070|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +7 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 68250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUTOPLAST PERICARDIUM 1.5CM #68250|1|HUMANA [1294]||HUMANA [11839]|855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 28MM 6MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-6728-005-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER II HPG SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,916.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,916.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-02-650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANTERIOR 6MM X 50MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-01-005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE ROSTRAL LARGE ANTERIOR EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-01-006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE CAUDAL LARGE ANTERIOR EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-03-080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 80MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|869.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|869.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-04-016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS ANTERIOR 16MM EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|3,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 495.319|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X28X31-46MM SYNEX 0D TI XPD LG EPLT CMPR LMBR|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-032-35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL HEAD 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PL-CL8LR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LG RIGHT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PROXIMAL RIGHT 6-HOLE 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,369.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,369.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 70MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 75MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345541|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE L-ASR FEE 5 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9790062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 62.5MM TI INTGR LCK MDLN ALGN NTCH LOPRFL VNTR BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14858-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 7MM DIAMETER 20MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71822908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON LOCKING LEFT 8-HOLE 107MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,319.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,319.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,SHAFT,3.5MM20MMLENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.68|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|55.68|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71825018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM SS CORT ST LCK PRLC SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71825020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71825026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71822360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CORTEX S-T 2.7MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71824016A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX S-T PERI-LOC 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71824020A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX S-T PERI-LOC 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71824022A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX S-T PERI-LOC 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 40MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 853KITA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ORTHOSPHERE (INCLUDES ONE IMPLANT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,252.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,252.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8530012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ORTHOSPHERE SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,118.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,118.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-114644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM SHLDR RSRFC CPLND HA 4 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 16MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP SMALL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-057-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 50MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PL-CL10RL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LARGE RIGHT 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-29.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86005X10|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT 5CM X 10CM|1|HUMANA [1294]||HUMANA [11839]|7,638.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,638.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8575|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR PUMP 40 DEGREE|1|HUMANA [1294]||HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.282|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 58X11X2.5MM SS 3.5MM SCR SM FRAG SET 3 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 12MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 46MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115401800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,HERBERT,SCAPHOID,18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|810.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 25MM 5MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-054-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530P419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 19MM KN CR TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 4 UNV KN COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5500-S-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED KNEE TOTAL TRIATHILON 12MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,912.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S5 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 5.5MM WITH MAXBRAID NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 783401256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LM EXT FULLCOAT BEADED 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,222.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,222.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12478|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 55MM 14MM 14FR ZNTH FLX H&L-B 1-SHOT BFUR ABD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,040.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,040.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115402000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,HERBERT,SCAPHOID,20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|810.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T5-17.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 278X17.5X5.2MM SS 4.5/5MM SCR 12 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,282.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,282.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129433130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB LCS CMPT MBT SGM 3 KN CMNT ROT PLAT KEEL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL RT PORUS C/R SZ-3 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME PTLR PFC S SM OVL35MM KN UHMWPE CMNT 3 PG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 CRV 10MM KN GVF UHMWPE FX BRNG ROT PLAT PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277041|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X10MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115402200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,HERBERT,SCAPHOID,22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|810.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9790060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-00-756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM ASR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,378.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,378.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BG3510-5-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADH SRG BIOGL SFT TIS BSA GLUT PREFL SYR 3 SPRDR 4 STD TIP|1|HUMANA [1294]||HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-058-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 672800300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 28MM STANDARD SIZE-C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,361.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115402400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,HERBERT,SCAPHOID,24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|810.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00119707510|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 7.5CM IM TRB MTL NS|1|HUMANA [1294]||HUMANA [11839]|10,204.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,204.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PISTON STAPES SMART FLOUROPLASTIC NITINOL 0.6MM X 4.|1|HUMANA [1294]||HUMANA [11839]|794.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|794.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5927|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PISTON STAPES SMART FLOUROPLASTIC NITINOL 0.6MM X 4.|1|HUMANA [1294]||HUMANA [11839]|794.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|794.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603020|SUP|HCPCS Q4112||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM CYMETRA 2CC SYRINGE|1|HUMANA [1294]||HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.544S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 320MM FEM XPRT IM FLUT CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.003.001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 5MM T40 FEM CNN XTN SLF RTN STRDR XPRT IM NL SYS TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|671.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2960822|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX8MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 5.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115403000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,HERBERT,SCAPHOID,30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|810.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9240200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPIRE 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,337.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,337.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 22MM 8MM SS T8 L/T FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36100|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE SOFT SURGISIS ABLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133FV-12|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 12X12.5CM BRST 400ML STY 133FV TXTR INJ ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133FV11|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE HEIGHT FULL PROJECTION VARIABLE 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CEMENT KNEE TIBIAL 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-120-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-120-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 120MM 120CM SLF XPD DLV CATH SYS SPRL CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LOCKING RIGHT 8-HOLE 168MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 24MM 5MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 982320|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 16CM X 20CM THICKNESS UL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S4 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.457S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 360MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.160|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 982128|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 8CM X 16CM THICKNESS ULT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 982144|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 12X12CM ALDRM XTHICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,491.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,491.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129433160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB LCS CMPT MBT SGM 6 KN CMNT ROT PLAT KEEL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL LF PORUS C/R SZ-5 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME PTLR PFC S LG OVL41MM KN UHMWPE CMNT 3 PG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 CRV 17.5MM KN GVF UHMWPE FX BRNG ROT PLAT PFC S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G13793|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC 5FR 65CM VANSCHITE #5 CURVE (HNBR5.0-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G13783|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC 5FR 65CM VANSCHITE #4 CURVE (HNBR5.0-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G13792|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO .035IN VANSCHIE3 CRV 5FR 65CM BFUR STRL BCNTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101812000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3MM 14/16 BALL TPR 28MM HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121940156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10-DEGREE ANGLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 36MM 14MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.324S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 10MM X 125DEG X 235MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,399.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0708-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 7.0MM X 8.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-H220L-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADL 22MM ACUMED ARH ELB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-24.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-056-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.001.222S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 7MM 210MM HUM XPRT IM RND CNN TRNSV SLOT LCK HL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.001.000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 0MM T25 HUM SPRL BLDE STRDR XPRT IM NL SYS TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|632.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|632.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.640S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 400MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.175|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFRT01|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR FLOOR PELVIC TOTAL PROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 26MM 10MM SS 1.1MM L/T SM BN T8 STRDR RCS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 28MM 10MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 26MM 5MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,MICRO,ST,4-HOLE,0.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200-56-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL NO-HOLES TRILOGY 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-016-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE F MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402.608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 8MM SHORT THREA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.609|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 9MM SHORT THREA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 10MM SHORT THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.611|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 11MM SHORT THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 12MM SHORT THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.613|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 13MM SHORT THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3545501|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.4CM SLTX P4.4CM MDRT + PRFL RND SIL GEL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3546001|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.7CM SLTX P4.5CM MDRT + PRFL RND SIL GEL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9791323|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 13MM VNTR TI SPNE CRV ANT SLF DRL VA INTGR LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT066070A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 70CM 6MM GORE THNWL HEP PROPATEN PTFE REM RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,536.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,536.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT087080A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 8MM GORE THNWL HEP PROPATEN PTFE REM RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,484.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,484.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.463S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 420MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS TORP BLACK OVAL #140858|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,234.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,234.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129433150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL KEEL CEMENTED MBT SIZE-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 CRV 10MM KN GVF UHMWPE FX BRNG ROT PLAT PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 194X13.5X3.7MM SS 3.5MM SCR 10 HL WO TAB RND EDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,227.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,227.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.325S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 10MM X 130DEG X 235MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,399.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 18MM 4MM SS T8 ST CMPR CNN ST HDLS NS ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.175|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 486010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVAULTA ANTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,051.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,051.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0956|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS APPLEBAUM SMALL #140956|1|HUMANA [1294]||HUMANA [11839]|1,046.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,046.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6278244|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X12MM VRTSTCK CRSTN PSR 14MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEO11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 11 HL LCK PRECONTOUR BN ELB OLCRN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5000-00-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CONDYLAR FEMUR LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,824.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,824.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5000-00-052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED 16/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,617.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,617.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5020-00-002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL HINGED SIZE-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,875.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,875.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6815-19-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED 10.5 X 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,821.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,821.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5020-02-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HINGED 2.9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,373.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,373.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140957|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS APPLEBAUM LARGE #140957|1|HUMANA [1294]||HUMANA [11839]|1,046.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,046.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5020-01-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT HINGE 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3550-31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY CABLE CONNECTOR SNAP-LID|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,636.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,636.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-013-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE C MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 102196|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X 16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-014-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE D MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-015-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE E MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0115321|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D RIGHT LARGE 0115321|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|550.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-016-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE F MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-017-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE G MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,636.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,636.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-013-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE C MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,636.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,636.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-014-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE D MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-015-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE E MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-017-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE G MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9790080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,741.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,741.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6292044|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR STRUT 14 X 11 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0115311|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D LEFT LARGE 0115311|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|539.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|539.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0115310|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D LEFT MEDIUM 0115310|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|499.95|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|499.95|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3544501|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.7CM SLTX P4.2CM MDRT + PRFL RND SIL GEL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3545001|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.1CM SLTX P4.2CM MDRT + PRFL RND SIL GEL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3506001BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15CM MEMORYGEL CHSV I P4.6CM MDRT + PRFL RND MDRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507001BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPL 15.8CM MEMORYGEL P4.9CM MDRT PRFL RND BRST GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-7600|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PROFILE MODERATE 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-7550BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15.9CM CHSV I MEMORYGEL P3.6CM MDRT PRFL RND SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0115320|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D RIGHT MEDIUM 0115320|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|499.95|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|499.95|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234800602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 49MM SS 2 HL NONLOCK BN HUM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,116.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,116.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-90-249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FEMORAL UNI SIZE 49 ASR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,983.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 5 HOLE LEFT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,798.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,798.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.311S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 0MM CNN TROCH FX NL TI STRL GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|655.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|655.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-114643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM SHLDR RSRFC CPLND HA 3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.155|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-25.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129433140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB LCS CMPT MBT SGM 4 KN CMNT ROT PLAT KEEL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMCP07|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS 20CM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,367.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 96-0023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL LF PORUS C/R SZ-3 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 125X11X3.3MM SS 3.5MM SCR SM FRAG SET 9 HL RND TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,953.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,953.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL RT NON-PORUS C/R SZ-6 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92-2042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SIGNA CV PFC SIZE-4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,880.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,880.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10715000|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOWEL BONE BICORTICAL 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 20MM 7MM SS T8 L/T FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMCP06|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS 18CM X 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,861.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,861.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-055-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7576550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 6.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505501 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.6CM MEMORYGEL CHSV I P4.5CM MDRT + PRFL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB LEGION 5 KN RT CMNT M TPR TI NPOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1MYM01|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 5CM X 10CM X 1MM #MYMO1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 96-0055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL RT NON-PORUS SZ-5 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 15MM KN GVF ROT PLAT STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 230MM SS 3.5MM SCR 10 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,947.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,947.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.640S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 300MM FEM XPRT IM FLUT CNN ANTGRD RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.003.000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 0MM T40 FEM CNN XTN SLF RTN STRDR XPRT IM NL SYS TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|671.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6271044|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X44MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM STRUT CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276411|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X4MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1MYM07|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 10CM X 15CM -OVAL #1MYMO7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T4.240|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 5 HLF 5MM KN TIB PRECT TIV PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10512-360|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE MODERATE 360CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10512-390|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE MODERATE 390CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-285|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE HIGH TEXTURED 285CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-305|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE HIGH TEXTURED 305CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-325|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE HIGH TEXTURED 325CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-355|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE HIGH TEXTURED 355CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-385HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE HIGH TEXTURED 385CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-435|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST PROFILE HIGH TEXTURED 435CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9662|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MANDIBULAR,ANGLE,60,RT.,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.100.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 104X10.1X3.7MM SS 3.5MM SCR 8 HL LCK LOPRFL RECON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,037.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,037.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10512-420|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE MODERATE 420CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00214.154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ACETABULAR DUROM METASUL UNCEMENTED 54/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100181480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM N LG DIA 48MM HIP METASUL LDH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00185.146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD LDH METASUL TAPER 12/14 18/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|466.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|466.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6950315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET VERTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|482.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|482.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 45MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9795223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED 4.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G880IMD|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE INTERNAL MAMMARY 8 FRENCH X 55CM LENGTH VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,T-SHAPE,REG,90DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T4.215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP EXTENDED RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4204VL-14.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER STAAR ELASTIC 11.2MM LENGTH 6.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 495.318|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 22X21X28-40MM SYNEX -5D TI XPD SM EPLT CMPR LMBR|1|HUMANA [1294]||HUMANA [11839]|21,159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEO9|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 9 HL LCK PRECONTOUR BN ELB OLCRN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276711|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X7MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276611|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 11 X 11 X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-20.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102082|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 4CM X 16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,676.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,676.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LI61AOV|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 34.0 DIOPTER SOFPORT ADVANCED OPTICS ASPHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83565401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TC 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276111|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X11MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9668|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MANDIBULAR,ANGLE,60,RT.,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276006|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X6MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM STRUT CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505001 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.1CM MEMORYGEL CHSV I P4.3CM MDRT + PRFL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504501BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.6CM CHSV I P4.2CM MDRT + PRFL SIL GEL RND SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.641S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 400MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37711|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROSTIMULATOR IMPLANTABLE INS RESTORE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37742|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROGRAMMER PATIENT EXTERNAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37082-40|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION STRETCH-COIL BIFURCATED 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5976-14-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CRA RIGHT SIZE D NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,619.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,619.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MANDIBULAR,ANGLE,60,LT.,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 960004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 71X65MM KN LT CMNT CR PFC S NPOR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 CRV 10MM KN GVF UHMWPE FX BRNG ROT PLAT PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME PTLR PFC S XS OVL32MM KN UHMWPE CMNT 3 PG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.190|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-18.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL MINI LOCKING RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,936.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,936.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75445040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 40MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,DOUBLE-Y,REG,01-9260|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8090030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,267.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,267.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9262|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,Y-STAPLE,LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TR-H240R-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL RIGHT 24.0MM DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.619|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL MINI LOCKING LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,936.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,936.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0602-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 6.0MM X 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M16-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M20-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL8LL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING LARGE LEFT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|612.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|612.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0112980|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BARD PLUG- EX LARGE|1|HUMANA [1294]||HUMANA [11839]|522.68|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|522.68|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.564|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.568|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MA.050|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +5 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.752|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.764|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.768|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS FULLY-THREADED 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 10MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 11MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 12MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 13MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 14MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 15MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 17MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.019|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 19MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 20MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 21MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 23MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 27MM 6MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.029|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 29MM 6MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 30MM 7MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 32MM 7MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 34MM 8MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 36MM 9MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 38MM 9MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 40MM 10MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 16MM 5MM SS T8 L/T FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 18MM 6MM SS T8 L/T FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 19MM 7MM SS T8 L/T FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 24MM 8MM SS T8 L/T FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 30MM 12MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 32MM 12MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 38MM 16MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 2MM 40MM 16MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-135|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE HIGH TEXTURED 135CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-155|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE HIGH TEXTURED 155CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20621-175|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE HIGH TEXTURED 175CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-19.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-23.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.145|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.472|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 320MM LOCKING F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,607.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.240|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MA.010|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +1 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MA.000|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +0 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.230|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 495.323|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X28X37-55MM SYNEX 10D TI XPD LG EPLT CMPR LMBR|1|HUMANA [1294]||HUMANA [11839]|23,274.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,274.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-6.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-6.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-7.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1230-44-005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD DUOFIX H.A. PC GLOBAL C.A.P. 44MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,983.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,983.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-03-110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 110MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-03-095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 95MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 56010228|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE K JONES 228MM|1|HUMANA [1294]||HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL6SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING SHORT LEFT 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75446540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY 6.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-7200BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH MODERATE 200CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503501 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PLUS MODERATE 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504001 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PLUS MODERATE 400CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277441|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 14 X 11 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TAPPING SELF 4.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TAPPING SELF 4.0 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9795313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TAPPING SELF 4.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,306.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,306.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE RT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-21.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-22.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 40MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,983.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,983.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136507000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8.5MM 12/14 OFST TPR 40MM HIP M SPC COCR ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TR-H260R-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADL 26MM ACUMED ARH ANG ELB RT ANTM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0804-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 8.0MM X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-13.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-27.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502251 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.9CM MEMORYGEL CHSV I P3.3CM RND MDRT + PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502001 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.5CM MEMORYGEL CHSV I P3.2CM MODEARTE PRFL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL8JL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING J LEFT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 8MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.637S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 360MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.340|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +34 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,145.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,145.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-00-750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM ASR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,378.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,378.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9998-90-245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FEMORAL UNI SIZE 45 ASR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,983.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-H200R-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL RIGHT 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0604-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 6.0MM X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-397|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-421|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-240|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.7CM NATRELLE P3.2CM MDRT PRFL RND SIL STY 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.0DIA.X 5.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10-270|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121836656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL ESC +4MM NTRL 56MM 36MM GVF TI PE HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101836503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3MM 14/16 OFST TPR 36MM HIP M SPC MTL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121836756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL ESC 10D +4MM 56MM 36MM GVF TI PE HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10512-450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE MODERATE 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10512-500|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE MODERATE 500CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10512-550|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL-FILLED PROFILE MODERATE 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.0DIAX7.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|108.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6184-1-005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET INJECTABLE HA BONE SUBSTITUTE CEMENT|1|HUMANA [1294]||HUMANA [11839]|3,487.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,487.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-33.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 33.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLRFLXB-3.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PLUS 3.0 DIOPTER CLARIFLEX WITH 10 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-24.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,795.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,795.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3508004 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15.5CM MEMORYGEL P6CM HI PRFL RND NAR BS SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3506004 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 600CC CHSV GEL SMTH MEMORYGEL SIL P5.6CM HI PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3506504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.4CM MEMORYGEL P5.7CM HI PRFL RND NAR BS SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.3DIAX9.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3060-0100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 100MM GAMMA3 TI HIP TROCH LG STRL NL 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3230-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LONG RIGHT 11 X 400 X 360 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,266.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,266.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 15-492|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-533|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-457|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0684-00-0478-01|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON INTRA-AORTIC 7.5 FR X 25CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102320|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 16CM X 20CM THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.0DIA.X11.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|52.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 102144|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 12X12CM ALDRM THK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,491.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,491.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102128|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 8CM X 16CM THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-15.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-15.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9122-1020-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL TOE 12MM HEMICAP 1MM 2MM OFST MTP COCRMO TI REINF MRSs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,842.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,842.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9080-0016-W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST TAPER 8.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6007-1200|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GD PIN ORTH 2MM HEMICAP SHLDR 25/30MM HEMISHOULDER ARTHPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.0DIA.X13.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|55.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71822340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 2.7MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71822350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 2.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71823904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON LOCKING RIGHT 4-HOLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,799.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,799.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71824012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LP 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71825016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71825024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71825034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF-TAPPING LOCKING 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.0DIA.X15.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-053-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS SZ-3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO20|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER ROUND 8"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,771.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,771.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 154X11X4.2MM SS 4.5/3.5MM SCR LG FRAG SET 10 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,004.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,004.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.195|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.225|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9457|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,2.3DIAX7.0MM,WL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|132.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T3.140|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.150|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.075|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +7.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 70MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G45208|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE STIFF EXTRA CURVE DOUBLE EXCHANGE LUNDERQUIST .03|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136531000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM 11/13 TPR 36MM HIP M SPC MTL SR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,4 HOLES,REG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 550516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING 13.5MM 7MM SR ZT 16F LG HIP POR MDLR SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV11|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 250CC STYLE-133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-475|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 475CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.230|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-23.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-055-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS SZ-5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.195|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,6 HOLES,REG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71522237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222984|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUPER WITH ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,791.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,791.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-10-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT 10 DEGREE X 3 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 945019|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE FX .045IN KRSH SS P/T ORTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 948071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED RATTLER 3MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|663.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-500|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 500CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-550|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-22.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO1510OS|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER SKIRTED 6" X 4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71642240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CAP HEX INT 5.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71642250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CAP HEX INT 5.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71642270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CAP HEX INT 5.0MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM E KN LT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-02-655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANT 6MM X 55MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-03-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 50MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1877-02-755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 7MM X 55MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-19.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173400312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 12MM STK I/F MED PEEK STKBL INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TG4015|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS TAG 40MM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1GK0010-40|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS VASCULAR POLYESTER KNITTED COATED COLLAGEN 10MM X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,482.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 CRV 10MM KN XLK FX BRNG PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OFX1000|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOIMPLANT FX ORTHOADAPT 4CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-339|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-371|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-12.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40R-19.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER THREE-PIECE 13.0MM LENGTH 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MA.020|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +2 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.080|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ANTERIOR CHAMBER 13MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +4 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LOCKING RIGHT 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,337.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,337.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEO-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRENON LOCKING 13-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM TI CANC HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-12.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D154VWC|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR VIRTUOSO VR SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,245.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,245.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-052-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AD3-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-27.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-28.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-30.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102070|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X 12CM THIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,344.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,344.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-7.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-8.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-8.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-9.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-9.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-10.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-10.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-11.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-11.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-13.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-14.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-14.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-17.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-21.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-25.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-26.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-26.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-27.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-28.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-28.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-29.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-29.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-30.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T5-30.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.105|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.110|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.115|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.120|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.125|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.130|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.135|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.255|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.105|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.110|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.115|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.120|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.130|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.140|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.260|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.150|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.265|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.160|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.270|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.260|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.270|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.275|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.290|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.285|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.290|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.300|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.295|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.125|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3.300|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.155|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.135|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T3-30.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.275|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.145|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4-30.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN OB L L CRNFCL TI 3X4 HL 1.5MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T4.165|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.285|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.225|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.265|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.235|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.255|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.295|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60T4.205|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL8SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICAL LOCKING SHORT LEFT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 100X4.8X.9MM 5MM SPC CRNFCL TI 20 HL ADP 2MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 65MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5049-5-520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 200MM 5MM HFMN CMPCT CNCT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75447540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,566.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,566.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-234|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.81|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 18X18X.9MM 13MM SPC X CRNFCL TI 4 HL 4.8MM 2MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 15-265|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON LEFT LCP 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-286|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-304|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-158|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-176|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-194|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133FV-13|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE HEIGHT FULL PROJECTION VARIABLE 500CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133FV-14|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE HEIGHT FULL PROJECTION VARIABLE 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-400|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 400CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-425|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 425CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBC081002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 10CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102071|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X12CM THICKNESS MEDI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,381.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,381.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDSM45|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX DURA 4CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 2MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-2012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-2014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 316-0107|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 X 4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D97130F5|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PACING BIPOLAR J TIP 5FRENCH X 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3701|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CHARGING ANS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3851ANS|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT ANS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3716|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BATTERY RECHARGEABLE IPG ANS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3214ANS|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELECTRODE TRIPOLE LAMITRODE ANS 16C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3383ANS|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION ANS 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404223|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING MALE ADVANCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 86MM SS 3.5MM SCR 2 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 112MM SS 3.5MM SCR 4 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,882.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,882.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238030T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 8 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231038T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 10 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239038T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 9 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231138T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 11 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231033T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 10 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239030T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 9 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231133T5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MATRIX 11 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 16 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001970|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7FR 22-28CM KNDY BLDR CURL RADOPQ OPN TIP DRN HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|241.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFRP01|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR FLOOR PELVIC POSTERIOR PROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001960|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 6FR 22-28CM KNDY BLDR CURL RADOPQ OPN TIP DRN HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|241.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|241.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ X3 INSERT 36mm ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60T4-9.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 112MM SS 3.5MM SCR 4 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,882.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,882.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TG3110|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORASIC 31MM X 10CM TAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TS2230|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER GORE 22FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52021|SUP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRSG WND 2X2IN BVN CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.705|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 168X13.5X3.7MM SS 3.5MM SCR 8 HL WO TAB RND EDG LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,439.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,439.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-8120-50|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SURGICAL 2 X 8.50CM PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,783.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,783.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-1110|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT GENERATOR PULSE IMPLANTABLE PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-4305|SUP|HCPCS C2631||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVES SUTURE PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|162.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-5500-4|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PROGRAMMER PATIENT PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37092|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ANTENNA EXTERNAL PATIENT PROGRAMMER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG0106N|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH CAROTID BOVINE VG-0106|1|HUMANA [1294]||HUMANA [11839]|518.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|518.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8578|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IT PMP 8709/8709SC SUTLS CNCT REV CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8596SC|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH IT SPNE PROX KT PMP REV SEG|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9152-2030-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ARTICULAR 2.0 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00214.150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ACETABULAR DUROM METASUL UNCEMENTED 50/44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100181440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD LDH METASUL COCR TAPER 18/20 5 DEG 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH081002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 10CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28953|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DENTAL WALLED STRAIGHT SELECT REPLACE 4.0 X 13MM|1|HUMANA [1294]||HUMANA [11839]|998.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|998.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28951|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DENTAL WALLED STRAIGHT SELECT REPLACE 4.0 X 10MM|1|HUMANA [1294]||HUMANA [11839]|998.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|998.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28956|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DENTAL WALLED STRAIGHT SELECT REPLACE 5.0 X 10MM|1|HUMANA [1294]||HUMANA [11839]|1,028.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,028.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28958|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DENTAL WALLED STRAIGHT SELECT REPLACE 5.0 X 13MM|1|HUMANA [1294]||HUMANA [11839]|1,028.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,028.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33452|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAR HEALING 4.0|1|HUMANA [1294]||HUMANA [11839]|170.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|170.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29447|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAR HEALING 5.0|1|HUMANA [1294]||HUMANA [11839]|170.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|170.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-752|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL STANDARD SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-046-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 22MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7570855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|861.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 24 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1128125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,PISTON,SCHUKNECHT,TEF-|1|HUMANA [1294]||HUMANA [11839]|363.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|363.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 99-7374|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-600|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-96-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID FIN CROSSLINK 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,263.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,263.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXL161407|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 7CM 14.5MM 12FR 12-13.5MM XCLDR LOPRFL ILIUM GRTX|1|HUMANA [1294]||HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL STANDARD SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY SZ-3 3.17MM YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1128130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,PISTON,SCHUKNECHT,TEF-|1|HUMANA [1294]||HUMANA [11839]|363.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|363.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-10-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT 3 X 10-DEGREE 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6570-0-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM OFST TPR 36MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 113884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD SURFACE ARTICULAR HUMERAL EXTENDED BIO-MOD 44MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,506.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,506.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-1-32-125|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 125MM 32MM ZNTH RENU AAA CNVTR 1-SHOT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,613.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,613.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.351|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 68.5MM SS 2.4MM SCR 9 HLE/HD 5 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED STRG 1.5MM 2.3MM SCR 4 HL LCK BAR VARIAX BN HND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED STRG 1.5MM 2.3MM SCR 4 HL LCK PRECONTOUR VARIAX BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23008E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 8MM VARIAX HND ST XPN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-28120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,PISTON,TEF-WIRE,.6X4.7|1|HUMANA [1294]||HUMANA [11839]|309.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|309.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 53-23006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6MM X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137646000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 8.5MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET PIN TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE TIBIAL TORNIER SZ-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY TORNIER SZ 0-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS LEFT TORNIER SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0124|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS SCHUKNECHT SLIM 4.0|1|HUMANA [1294]||HUMANA [11839]|280.98|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|280.98|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 37082-60|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION STRETCH-COIL BIFURCATED 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HYP-07|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TARSI SINUS HYPROCORE SIZE-7|1|HUMANA [1294]||HUMANA [11839]|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 59-12008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PROFYLE 1.2 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 59.5MM SS 2.4MM SCR 9 HLE/HD 4 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P085-0017-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STUD FIXATION 8.5MM RESURFACING HEMICAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,633.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,633.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P202-2020-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TROCHLEA FEMORAL 20MM +2.0 X -2.0 OFFSET RESURFACING HEMICAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS SCHUKNECHT SLIM 4.5|1|HUMANA [1294]||HUMANA [11839]|274.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|274.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P205-1045-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ANATOMIC 20MM 1.0MM X 4.5MM OFFSET RESURFACING HEMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,962.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,962.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 733030|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 30CM 30MM ABD THRX SUT RTNT UNQ HYDROLYZABLE GLWV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST TPR 36MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G47345|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 14CM 10MM NST 4.5 LOOP CATH END HL PLTN SNTH FBR|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LOCKING LEFT 3-HOLE X 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY TORNIER SZ-0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS RIGHT TORNIER SIZE-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY SZ 3 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,047.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47355|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 14CM 8MM NST 5.6 LOOP CATH END HL PLTN SNTH FBR|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7843-013-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION BEADED 6" 13MM OFFSET EXTENDED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 733028|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 30CM 28MM ABD THRX SUT RTNT UNQ HYDROLYZABLE GLWV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-616|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-659|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-575|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201251|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP,ANEURSYM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-87-456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 40MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,983.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,983.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL LPS ALL-POLY SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,047.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 4 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404232|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP MS 700CX AMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,147.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,147.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO2350|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER 10" X 8"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,510.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404155|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVIOR IZ AMS|1|HUMANA [1294]||HUMANA [11839]|6,923.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,923.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201252|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP,ANEURSYM|1|HUMANA [1294]||HUMANA [11839]|711.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|711.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC.235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136505000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL METAL ARTICULEZE 40MM +1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PCO2520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER 10" X 8"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,143.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,143.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 158MM SS 3.5MM SCR 6 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,404.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,404.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 730030ADP|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALSALVA TECHNIQUE SPARING VALVE GELWEAVE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 733026|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 30CM 26MM THRX ABD WVN VASCUTEK GLWV STRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 733032|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 30CM 32MM ABD THRX SUT RTNT UNQ HYDROLYZABLE GLWV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 733034|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 30CM 34MM ABD THRX SUT RTNT UNQ HYDROLYZABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7576555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 6.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 731508|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 15CM 8MM THRX ABD WVN VASCUTEK GLWV STRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|937.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|937.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 731510|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 15CM 10MM ABD THRX UNQ HYDROLYSABLE IMPREGNATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|937.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|937.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-375|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 375CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73281088/8|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PLEXIS BRANCHED 28MM X 40CM X 8MM *CONSIGNMENT*|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,983.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73301088/8|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 40CM 30MM 10/8/8/8MM 15CM AOR ARCH PLXS ANTGRD FLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,983.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 734028/8|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ANTEFLO GELWEAVE 1-BRANCH 28MM X 40CM X 8MM *CONSIGNME|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 734028/10|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ANTEFLO GELWEAVE 1-BRANCH 28MM X 40CM X 10MM *CONSIGNM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 734030/8|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ANTEFLO GELWEAVE 1-BRANCH 30MM X 40CM X 8MM *CONSIGNME|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 821501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT SHNT ACFL STRG 11MM CSF MTL STRL|1|HUMANA [1294]||HUMANA [11839]|353.43|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|353.43|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 734030/10|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ANTEFLO GELWEAVE 1-BRANCH 30MM X 40CM X 10MM *CONSIGNM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFRA01|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR FLOOR PELVIC ANTERIOR PROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLRFLXB-2.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PLUS 2.0 DIOPTER CLARIFLEX WITH 10 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLRFLXB-2.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PLUS 2.5 DIOPTER CLARIFLEX WITH 10 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71823409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 97MM SS 3.5MM SCR 8 HL LCK PRLC BN CLVCL RT MDL SUP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,824.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,824.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71824016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|114.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 28mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71824020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71825014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF TAPPING LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-018|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.451|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 68.5MM SS 2.4MM SCR 8 HLE/HD 5 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 50.5MM SS 2.4MM SCR 9 HLE/HD 3 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.341|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 59.5MM SS 2.4MM SCR 9 HLE/HD 4 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 50.5MM SS 2.4MM SCR 8 HLE/HD 3 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 59.5MM SS 2.4MM SCR 8 HLE/HD 4 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 68.5MM SS 2.4MM SCR 8 HLE/HD 5 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 28mm/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.110.350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 68.5MM SS 2.4MM SCR 9 HLE/HD 5 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 155MM 13MM CLRLS CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATOR MINI 70/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6570-0-436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -2.5MM OFST TPR 36MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H470045A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 45CM 4-7MM GORE STD WL TPR HEP PROPATEN PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H060040A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 6MM GORE STD WL HEP PROPATEN PTFE STRCH COAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 67.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37083-20|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION STRETCH-COIL SINGLE 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131217000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2D CNTR 45.3X11.7MM HAFNIUM SM FRAG SYS LCK LOPRFL F3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14376-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANCELLOUS CANNULATED 4.0 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 28mm/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TG3720|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORASIC 37MM X 20CM TAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6334-064-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONSTRAINED LONGEVITY TRILOGY TM 36MM/64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,897.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,897.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-34.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 34.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-33.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 33.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TG2815|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORASIC 28MM X 15CM TAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE STANDARD 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MA.030|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +3 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MA.040|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +4 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496H222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADL 22MM EVOL +2MM ELB PRLN MDLR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G07647|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTBT 70CM 11FR CK RTRGD 4MM ET TUBE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961032|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32MMX10MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL LT NON-PORUS SZ-2.5 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2.5 12.5MM KN GVF ROT PLAT STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM 12MM CLRLS CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7568|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CURVED 8 HOLE ORBITAL 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|753.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2056317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L RIGHT 3 X 2 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LEFT 3 X 2 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L RIGHT 5 X 3 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2057413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LEFT 5 X 3 HOLE 1.0MMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.7540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 3 X 2 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DOUBLE T 11 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.2MM X 5MM EMERGENCY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC54991|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT HAMSTRING TIBIALUS POSTERIOR|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55194|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CONVERTOR AAA 36MM PROX DIA X 12MM DISTAL DIA FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55217|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION BODY MAIN AAA 36MM X 73MM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED NAR T 1.5MM 2.3MM SCR 7 HL LCK PRECONTOUR VARIAX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23010E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 10MM VARIAX TI HND WRST ST LCK LOPRFL XPN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 14MM X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|229.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|229.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 59-53014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 59-23010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 10MM PRFL TI HND WRST ST XFT MDLR SM FRAG SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 59-23011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00185.147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD LDH METASUL TAPER 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|466.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|466.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL KEEL POROUS MBT SZ-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROUS C/R LF SIGMA PFC SZ-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA DOME 3-PED OV SIGMA PFC 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CV SIGMA PFC SIZE-3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-02-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALAR REVISION AGILITY SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,543.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,543.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LOCKING RIGHT 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,268.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,268.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0516RS|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS SOLO RELIEVA 5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0716RS|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS SOLO RELIEVA 7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH081502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 15CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R14030030|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORTEX RINGED 30CM 14MM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,817.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,817.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 495.316|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SYNEX 0 DEGREE 23-31MM|1|HUMANA [1294]||HUMANA [11839]|19,809.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,809.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9330060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VANTAGE ATL 6.0CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,077.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,077.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-21.25|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.25 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47225500800|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 70CM 2.4MM BALL TIP NTR NL SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-114647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RESURFACING HA COPELAND SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-05-17-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 5MM DIAMETER X 17MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7383|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.2MM X 3MM EMERGENCY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7377|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7373|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0MM X 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7372|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0MM X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.954S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 93MM SS 3.5MM SCR 4 HL LMT CNTCT LCP CMBN BN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,612.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,612.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.956S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 119MM SS 3.5MM SCR 6 HL LMT CNTCT LCP CMBN BN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.129|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 85MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 90MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 95MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.697|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 2.7MM X 40MM 4-HOLE 2-HOLE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,268.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,268.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 10MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROUS C/R SIGMA PFC RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,061.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CV SIGMA PFC SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.461S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 400MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL STANDARD SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-22.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.75 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS 10MM X 240MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE SPIRAL ARTHRODESIS 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.018.000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END ARTHRODESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|526.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|526.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PANALOCK RC DUAL SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M24-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M26-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M22-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.658S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.662S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END NAIL TIBIAL 0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|517.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|517.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-213|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MID-RANGE STYLE-15 212CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5954-047-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL METAL MODULAR TRABECULAR NEXGEN SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C8022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR POLY L LAC ACD 25MM 10MM FEM BABSR LTRM ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AX1-2-32-113|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTOR AAA RENU ZENITH 32MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR NON-POROUS C/S SIGMA PFC RIGHT SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SIGMA RP STB PFC SZ 2.5 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-016-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SZ F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VB131002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 13MM X 10CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281212|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 28.5MM X 12MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,337.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,337.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC181400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER EXTENDER 18 X 13.5CM|1|HUMANA [1294]||HUMANA [11839]|10,773.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,773.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.473S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 320MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-114645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RESURFACING HA COPELAND SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-005-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER HA COATED 5MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-006-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER HA COATED 6MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-007-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER HA COATED 7.5MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-009-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER HA COATED 9MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER HA COATED 10MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-011-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 11MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 12MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 13.5MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-015-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 15MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-017-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 17.5MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-020-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 20MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7711-022-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM H/D M/L TAPER HA COATED 22.5MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,514.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187823213|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BULLET CONCORD 11 X 13 X 23|1|HUMANA [1294]||HUMANA [11839]|16,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877502801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX COMPOSITE 12/14 28 X- 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877502802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 28 X +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8775-028-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 28 X +3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 32 X -3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 32 X +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 32 X +3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,719.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,719.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8775-032-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 32 X +7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 36 X -3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 36 X +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 36 X +3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877503604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 36 X +7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,158.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,158.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1103-010-05|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE COPU OS 3-STRIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-7000B|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE PLEURX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-7500B|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT DRN VAC BTL PLEURX 500ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37713|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROSTIMULATOR IMPLANTABLE INS RESTORE ADVANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37743|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROGRAMMER PATIENT EXTERNAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-17.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.75 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR NON-POROUS C/S SIGMA PFC RIGHT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 10MM KN GVF ROT PLAT STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL8ML|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING MEDIUM LEFT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 10MM CLRLS CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-H224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL EVOLVE +2 SZ.24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE STANDARD 7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75446535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG-2015F|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AMINO 2.0 X 1.5CM B AG-2015F|1|HUMANA [1294]||HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-17.25|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.25 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 900.721|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE 1.25MMX 150MM NON-THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 900.722|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE 1.25MM X 150MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-7150|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PROFILE MODERATE 150CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DC2832-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 0MM TI BAR DARCO BW BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DC 2825-114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM DARCO TI FOREFOOT MFS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DC2825-118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCK DARCO 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DC2825-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCK DARCO 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00111214001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT-PALACOS R|1|HUMANA [1294]||HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86UM-4X07|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT EXTREME MAXFORCE NON-MESHED 4CM X 7CM|1|HUMANA [1294]||HUMANA [11839]|9,623.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,623.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-21.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.75 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-21.50|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.50 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM TI CORT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60AT-33.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 33.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5954-037-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL METAL MODULAR TRABECULAR NEXGEN SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 239.936|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL RIGHT 6-HOLE 107MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496H020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADL 20MM EVOL ELB PRLN MDLR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE SIZE+4 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE QUARTER 63MM 8 HOLE WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L OBLIQUE LEFT 2.0MM 2 HOLE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 8MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 12MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 16MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 55X7X1MM SS 2.7MM SCR MN FRAG SET 7 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|323.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|323.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 47X7X1MM SS 2.7MM SCR MN FRAG SET 6 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|302.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|302.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 39X7X1MM SS 2.7MM SCR MN FRAG SET 5 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 31X7X1MM SS 2.7MM SCR MN FRAG SET 4 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|263.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|263.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L L 34X7X1MM SS 2.7MM SCR MN FRAG SET 3 HL DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R L 34X7X1MM SS 2.7MM SCR MN FRAG SET 3 HL DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 29X5X1MM SS 2MM SCR MN FRAG SET 5 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|205.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 23X5X1MM SS 2MM SCR MN FRAG SET 4 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 17X5X1MM SS 2MM SCR MN FRAG SET 3 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R L 19X5X1MM SS 2MM SCR MN FRAG SET 2 HL DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 6MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 10MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 14MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 18MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 20MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 7MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 8MM SS CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.809|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 9MM SS CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 10MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 12MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 200.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 12MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 14MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 16MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.935|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LEFTT 4-HOLE 81MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-18.25|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.25 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-31.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 31.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD3-32.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 32.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 13MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 286330SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286320SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,090.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,090.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 330225SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION UNI DEAL NEW 25MM 2-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111438SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 38MM QWIX TI HEX FOREFOOT CORT SLF DRL ST CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NXG1-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-06-17-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 6MM DIAMETER X 17MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-07-17-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 17MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 14MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported X3820K|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OXIMETRY VENOUS CENTRAL PRE-SEP NON-HEPARIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80-1480|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GRAFT DURAL DURAFORM 4CM X 5CM|1|HUMANA [1294]||HUMANA [11839]|3,423.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,423.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100181420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM H LG DIA 42MM HIP METASUL LDH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00214.148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ACETABULAR DUROM METASUL UNCEMENTED 48/42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VB111002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 11MM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED V NAR 1.5MM 2.3MM SCR 5 HL MC5 LCK VARIAX BN HND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-45340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LOCKING NARROW 2.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23008E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23006E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 6MM VARIAX PRFL TI HND WRST ST LOPRFL RND XPN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 15MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 58-23011E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46620006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE BONE 6MM CANCELLO-PURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23012E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 12MM VARIAX TI HND WRST ST LCK LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23009E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 9MM X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO X-TRA LOCK 8 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 330220SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MM 2 HL CMPR IMPL LWR XTRMT UNI-CP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5954-047-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL METAL MODULAR TRABECULAR NEXGEN SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00595402702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB 2 KN TRB MTL MDLR FX BRNG STM MIS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00785901600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 16MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5954-037-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL METAL MODULAR TRABECULAR NEXGEN SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5954-057-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL METAL MODULAR TRABECULAR NEXGEN SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5954-057-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL METAL MODULAR TRABECULAR NEXGEN SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,117.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00595409000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TRAY TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71508143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CONFORM PROFIX RT SZ 4-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3778-60|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 355029|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37712|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR RESTORE ULTRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER VERSYS DISTAL 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 58-30422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION TWIN FIX 3.2MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7843-012-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL BEADED FULL 12/14 NECK LM BODY SZ-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-19.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.75 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149813208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL FIXED BEARING RIGHT MEDIAL / LEFT LATERAL 9.5M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,688.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,688.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149823002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL FIXED BEARING RIGHT/ MEDIAL LEFT LATERAL CEMENTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,594.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,594.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 511212|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD EPICARDIAL PACE ENPATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER VERSYS DISTAL 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 57-10321|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LOCKING LEFT 6-HOLE 1.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17010E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17012E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17012E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS PIN SELF TAPPING 1.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17010E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS PIN SELF TAPPING 1.7 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|317.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD V40 CERAMIC DELTA BIOLOX 36MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,633.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,633.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-H026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL MODULAR EVOLVE STANDARD 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE SIZE+2 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-200|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 200CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 19MM VRSY HIP DIST CMNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-230|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 230CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-260|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 260CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1BSGC3334|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE LINE REINFORCEMENT MATERIAL BIOABSORABLE|1|HUMANA [1294]||HUMANA [11839]|906.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 37702|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NRSTM IMPL 49X65MM PRIMEADVANCED THK15MM SPNE FLXB PRGM 39ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RVP-0.4|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FISTULA RECTO-VAGINAL SURGISIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,478.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,478.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-20.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.75 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.472S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 320MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785900900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 9MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported NXG1-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER REZOOM MULTIFOCAL ARCYLIC POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-210|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 471512|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ACELLULAR DERMAL FLEX HD 5CM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,419.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,419.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 471612|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ACELLULAR DERMAL FLEX HD 6CM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,508.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,508.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136506000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 12/14 OFST TPR 40MM HIP M SPC COCR ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121730058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MULTIHOLE PINNACLE W/GRIPTION 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L93712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM 12MM COLR CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C-FPS-0.2|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FISTULA RECTO-VAGINAL SURGISIS 0.2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00785901000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 10MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C-RVP-0.7|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FISTULA RECTO-VAGINAL SURGISIS 0.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,478.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,478.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C-FPS-0.4|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FISTULA RECTO-VAGINAL SURGISIS 0.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 57-15321|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L MED 1.5MM 2.3MM SCR 6 HL LCK VARIAX BN 2.3MM LT HND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23012E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23018E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 18MM TI HND WRST ST LCK LOPRFL XPN HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23013E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 13MM VARIAX TI HND WRST ST LCK LOPRFL XPN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.648S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 340MM FEM XPRT IM FLUT CNN ANTGRD RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100181500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM P LG DIA 50MM HIP METASUL LDH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,261.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00214.156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ACETABULAR DUROM METASUL UNCEMENTED 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,098.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.483S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 420MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785901100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 11MM VRSY HIP DIST PMMA CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596202210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PROLONG FLEX LPS CD 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596202212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PROLONG FLEX LPS CD 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596202214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PROLONG FLEX LPS CD 1-2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596202217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PROLONG FLEX LPS CD 1-2 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121730052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACTB 52MM PNCL 10 DOME SCR MLHL II HIP STRL GRIPTION LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 155MM 13MM CLRLS CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -5MM OFST TPR 36MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported KPGS05|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT PESSARY GEHRUNG FOLDING SIZE-5 1-3/4" X 2-3/8" X 2"|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39565-30KIT|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SPECIFY (INCLUDES 39565-30 LEAD AND TWO 37081-40 EX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55216|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION BODY MAIN AAA 32MM X 58MM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71522270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8602M0K5|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL VOICE TERM SHORT PROLARYN 1.0CC|1|HUMANA [1294]||HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8090040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 97MM TRLK BPS GRIPTION 1 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136532330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 32MM +9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101204030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 101MM TRLK BPS GRIPTION 3 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7210440|SUP|HCPCS C1754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SPINAL INTERDISCAL 8-PIN|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9795315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TAPPING SELF 4.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +2.5MM OFST TPR 36MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.001.236S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 7MM 280MM HUM XPRT IM RND CNN TRNSV SLOT LCK HL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.646S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM FX AU 46MMX3.9MM 13MM HUM TI SPRL CUT FLUT SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.001.234S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 7MM 270MM HUM XPRT IM RND CNN TRNSV SLOT LCK HL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,809.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,809.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121732050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 50MM HIP SECT GRIPTION PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L93713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL 2 VARA SIZE-13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101204020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 99MM TRLK BPS GRIPTION 2 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3778-45|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD COMPACT 1X8 45CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL KEEL POROUS MBT SZ-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROCOAT C/R SIGMA RIGHT SZ-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720046-01|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING ARC MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-05-120-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 5MM .079IN 120MM 120CM OTW DLV SYS SLF XPD RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37081-40|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION 1X8 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET STANDARD SZ-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 37081-20|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION 1X8 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.286|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 110X11X2.5MM SS 3.5MM SCR SM FRAG SET 7 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.264|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90X11X2.5MM SS 3.5MM SCR SM FRAG SET 5 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149813408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL FIXED BEARING RIGHT MEDIAL / LEFT LATERAL 9.5M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,102.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,102.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149823004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL FIXED BEARING RIGHT/ MEDIAL LEFT LATERAL CEMENTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MAN03.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D -3 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60MAN04.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D -4 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG-1510F|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AMNIO 1.5 X 1.0CM|1|HUMANA [1294]||HUMANA [11839]|1,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 55MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 60MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705541|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 55MM 1/2 FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 60MM 1/2 FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5MM X 55MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5MM X 55MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5MM X 60MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-10310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T SM NAR 1MM 1.7MM SCR 10 HL LCK PRFL VARIAX BN HND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17008E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.7MM 8MM PRFL TI HND WRST ST LOPRFL XPN HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17015E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.7MM 15MM VARIAX HND WRST ST CROSSPIN BLNT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|170.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|170.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17014E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|170.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|170.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17007E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.7MM 7MM TI HND WRST ST LCK LOPRFL XPN HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107322015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO OM CRV 5FR 65CM VSCR RADOPQ FLSH HTORQ SHFT SFVU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 387445|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD SCS TRIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37083-40|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION STRETCH-COIL SINGLE 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-INTRAFIX 8MM - 10MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3776-60|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SUBCOMPACT 1X8 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 94MM SS 6 HL NONLOCK BN FIB LT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 95MM TRLK BPS GRIPTION 0 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6077-0335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE HFX SIZE #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-45-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 26mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8690045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-613|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-613|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE VISION 4 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 107MM TRLK BPS GRIPTION 6 HI OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136536310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1.5MM 12/14 TPR 36MM HIP BLX D ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,142.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,142.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1896-5030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 30MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3060-0080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 80MM GAMMA3 TI HIP TROCH LG STRL LNG NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3225-0300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 11MM X 300MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,266.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,266.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C8031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 25MM 7MM FEM BABSR LTRM ABS TRILOBE DRVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3060-0085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 85MM GAMMA3 TI HIP TROCH LG STRL NL 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3325-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 11 X 380MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6958712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM VRTX MX TI SPNE MA NS GRN RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 74MM SS 4 HL NONLOCK BN FIB RT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.748S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 340MM FEM XPRT IM FLUT CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95MM SS 6 HL NONLOCK BN FIB RT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116MM SS 8 HL NONLOCK BN FIB RT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 136MM SS 10 HL NONLOCK BN FIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.639S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 380MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.635S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 340MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 157MM SS 12 HL NONLOCK BN FIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 178MM SS 14 HL NONLOCK BN FIB RT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 74MM SS 4 HL NONLOCK BN FIB LT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95MM SS 6 HL NONLOCK BN FIB LT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116MM SS 8 HL NONLOCK BN FIB LT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 136MM SS 10 HL NONLOCK BN FIB LT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 157MM SS 12 HL NONLOCK BN FIB LT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 178MM SS 14 HL NONLOCK BN FIB LT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 73MM SS 4 HL NONLOCK BN FIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 94MM SS 6 HL NONLOCK BN FIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-18.50|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.50 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-18.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.75 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 115MM SS 8 HL NONLOCK BN FIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135MM SS 10 HL NONLOCK BN FIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 156MM SS 12 HL NONLOCK BN FIB RT PERIART LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 177MM SS 14 HL NONLOCK BN FIB RT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 73MM SS 4 HL NONLOCK BN FIB LT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 115MM SS 8 HL NONLOCK BN FIB LT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,463.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135MM SS 10 HL NONLOCK BN FIB LT DP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,611.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 156MM SS 12 HL NONLOCK BN FIB LT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,760.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 177MM SS 14 HL NONLOCK BN FIB LT PERIART DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,878.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020851800|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 40CM 18/10MM BFUR KNTD SFT SL FLXB HMSH GMCVL PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,188.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23009E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 9MM RND LOPRFL WR HND 1 STP PCKUP BLNT TIP ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496H022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADL 22MM EVOL ELB MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL STANDARD SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-1-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE +10 21MM HIP MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-44-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 44MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-8698|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE,FIXATION,12-8698,SM,13M|1|HUMANA [1294]||HUMANA [11839]|361.68|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|361.68|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-7-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 16MM X 155MM CONICAL DISTAL PLASMA MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121732054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR WITH GRIPTION 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NUETRAL +4 36 X 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136536320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 36MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,142.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,142.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-1-321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +30 21MM MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6260-5-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL COCR V40 26MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-7-117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 17MM X 450MM DISTAL CONICAL MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-52-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 52MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-8699|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE,FIXATION,12-8698,MED,16|1|HUMANA [1294]||HUMANA [11839]|297.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|297.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-10-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT X 3 10 DEG 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6570-0-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD V40 CERAMIC DELTA BIOLOX 32MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6704-0-520|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLEEVE CABLE BEADED VIT 2.0MM|1|HUMANA [1294]||HUMANA [11839]|1,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-1-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +0MM 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-50-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL COCR V40 26MM/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTP-002-SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP STANDARD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG0108N|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH VASCULAR PERIPHERAL VASCUGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-10316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT PROFYLE HAND 16 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17009E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17008E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS PIN SELF TAPPING 1.7 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|317.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17009E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS PIN SELF TAPPING 1.7 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|229.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|229.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23010E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI LOCK BPS WITH GRIPTION OFFSET STANDARD SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6481-2-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL KNEE HINGED REVISION HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING FEMORAL KNEE HINGED REVISION HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,026.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AXLE KNEE HINGED REVISION HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,515.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,515.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BUMPER KNEE HINGED REVISION HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,110.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,110.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL HINGED ROTATING MODULAR SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64813213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL KNEE HINGED REVISION HOWMEDICA 13MM X XS/S S1/S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786695|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED REGULAR 13 X 155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2481794|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE,FIXATION,W/SPIKE,MED.|1|HUMANA [1294]||HUMANA [11839]|1,029.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,029.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 64786625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED REGULAR 15 X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64811101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL XS RIGHT KNEE HINGED ROTATING HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64811200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL DISTAL HINGED ROTATING MEDULAR 10MM XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ROTATING TIBIAL KNEE HINGED ROTATING HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER OFFSET HRHK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FULL DURACON S-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122132448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL +4MM NTRL 48MM 32MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT 3 X 0 DEGREE 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50SE-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL +4 32 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MFT-002-PM|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD PEANUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-32.5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET HI SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TR1-2901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM STABILIZATION 306 AXIALIF 2 LEVEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-B-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY CEMENTED TRIATHLON SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550L360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC TRIATHLON S36 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,869.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,869.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-409-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL STABILIZED POSTERIOR 9MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 32 X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L92504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G36149|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 22MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36132|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUFF AORTIC RENU ZENITH 24MM X 62CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55212|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION BODY MAIN AAA 24MM X 58CM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,003.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5510-F-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550L319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC TRIATHLON S31 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531G411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 4-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-B-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY CEMENTED TRIATHLON SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5515-F-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5575-X-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION MODULAR DISTAL FEMORAL COCR TRIATHLON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,591.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,591.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 PS TRIATHLON SZ3 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503001 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PLUS PROFILE MODERATE 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503251 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PLUS PROFILE MODERATE 325CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136532310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 32MM +1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 231820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 9MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET PIN AND REAMER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE TIBIAL TORNIER SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS RIGHT TORNIER SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY TORNIER SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N118|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK9.9MM 61.7X79.5MM COGNIS HE VNTRC IMPL RSYN THRP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|71,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85415|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 7MM X 59MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85418|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 9MM X 38MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 2.4 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 2.4 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17011E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17013E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VB091502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 9MM X 15CM X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17013E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS-PIN SELF TAPPING 1.7 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT261218|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 26MM X 12MM X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,337.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,337.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXL161007|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXLUDER ENTENDER ILIAC 16MM X 10MM X 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D224DRG|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR SECURA-DR DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6077-0435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 127 DEGREE ACCOLADE HFX SIZE 4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D224VRC|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR SECURA-VR SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-51-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 52MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D224TRK|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR CONSULTA CARDIAC RESYNCHRONIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.753|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METAPHYSEAL LCP 4.5 X 3.5 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 32 X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60D3-7.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NEUTRAL PINNACLE MARATHON 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1806-0080S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BALL-TIPPED 3.0 X 800MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 15MM X 155MM STRAIGHT CONICAL DISTAL MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-54-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 54MM X 26CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE +10 23MM HIP MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-49-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MM X 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL LONG 26MM V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 509-02-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR REVISION 54MM HEMISPHERICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE GAP 6.5 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE GAP 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1016020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE GOODE-T 1.27MM GROMMET #1016020|1|HUMANA [1294]||HUMANA [11839]|130.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|130.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ATM-120-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION ACUTRAK 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TMT-002-12MR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD RIGHT TMT 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-23SR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMALL RIGHT TMT 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 19MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 15MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 6 5MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT POSTERIOR FEMORAL TRIATHLON SZ 6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 6 5MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 6 5MM LON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-S-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER OFFSET TRIATHLON 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-S-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER OFFSET TRIATHLON 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL UNIVERSAL KNEE TOTAL TRIATHLON SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 13MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550L298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC TRIATHLON S29 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-050-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-030-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL 6 DEGREE TAPER +14.0 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 32MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-300|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 375CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-325|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 325CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 471510|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ACELLULAR DERMAL FLEX HD 5CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,551.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,551.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286324SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SURFIX STAINLESS 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186 300 SND|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SURFIX STAINLESS 3.5MM|1|HUMANA [1294]||HUMANA [11839]|486.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|486.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254685|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FEMORAL INTRAFIX 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121732052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR WITH GRIPTION 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R010|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CRYO-ARTERY AORTO-ILIAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR HEMISPHERICAL HA CLUSTER 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-060-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TM MULTIHOLE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00592601402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN PTLFEM RT CMNT PRECT GNDR SOL NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598304033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596801651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,368.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,368.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254683|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FEMORAL INTRAFIX 8.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SUBTALAR 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9152-2030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ARTICULAR 15MM 2MM X 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NEUTRAL PINNACLE MARATHON 36MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M002020851480|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR GOLD HEMASHIELD 14MM X 8MM X 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,188.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT POSTERIOR FEMORAL TRIATHLON SZ 5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT POSTERIOR FEMORAL TRIATHLON SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON 13MM X 150MM TS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-S-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER OFFSET TRIATHLON 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL UNIVERSAL KNEE TOTAL TRIATHLON SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 5 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET STANDARD SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136536330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 36MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,142.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,142.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 976-140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 17MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 14MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL X 3 TRIATHLON SZ 5 22MM TS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.482S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 420MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET HIGH SZ-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60MAN05.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D -5 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET STANDARD SZ-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-47-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MM X 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112496|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER X-STOP 8MM|1|HUMANA [1294]||HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MT-SPF|SUP|HCPCS C1878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT THYROPLASTY FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.636S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 360MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6077-0130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 127-DEGREE ACCOLADE HFX SZ-1 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50SE-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-6-065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER MODULAR UNITRAX +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1498-14-308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT FB PRESERVATION LM/RL SIZE 3 9.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1498-24-003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL FIXED BEARING PRESERVATION LEFT MEDIAL RIGHT LATERAL 9.5MM SIZE-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9070-0013-W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST TAPER 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,548.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,548.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9122-1525-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ARTICULAR 12MM X 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9152-1525-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ARTICULAR OFFSET 1.5MM X 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276311|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 11 X 11 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL +4 36 X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PIP-200-30P-WW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP PROXIMAL 30P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PIP-200-20D-WW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP PROXIMAL 30D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121732060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR WITH GRIPTION 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 36 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8931-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICKFIX TI 3MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8930-11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 11MM QFIX TI FT 3 PR SLF DRL ST SNPOF MAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8930-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 13MM QFIX TI FT 3 PR SLF DRL ST SNPOF GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48455|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 14MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48460|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 16MM X 39CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12758-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 294.76|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 200MM 4.5MM SCHNZ PLVC SS BLNT TROC PNT MR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|311.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|311.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 175MM 4.5MM SCHNZ ST PLVC SS BLNT TROC PNT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|311.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|311.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.74|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 150MM 4.5MM SCHNZ ST PLVC SS BLNT TROC PNT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394.83|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 200MM 11MM CFBR MR CONDITIONAL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394.87|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 400MM 11MM CFBR MR CONDITIONAL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|902.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|902.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550L339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC TRIATHLON S33 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 TRIATHLON SZ3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VERTEX 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL STABILIZED POSTERIOR 11MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254681|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FEMORAL INTRAFIX 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-26.25|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.25 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8670002|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-113706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL BIO-MODULAR 10 MM X115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD OFFSET SHOULDER BIO-MODULAR 44MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,909.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,909.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 15MM X 195MM DISTAL CONICAL MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8930-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 12MM QFIX TI FT 3 PR SLF DRL ST SNPOF BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-114646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM SHLDR RSRFC CPLND HA 6 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133SX-12|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE SHORT-HEIGHT EXTRA PROJECTION 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133SX-13|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE SHORT-HEIGHT EXTRA PROJECTION 400CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133SX-14|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE SHORT-HEIGHT EXTRA PROJECTION 500CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-137|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE VISION 4 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276511|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 11 X 11 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276811|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 11 X 11 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS RESCUE FIXED 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 920-210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE POROUS OSSEOFIT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 920-208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE POROUS OSSEOFIT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-311-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 3-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET HI SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5510-F-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 3-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7541123|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK NARROW MEDIUM LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7541143|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK THORACIC MEDIUM LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7541122|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK NARROW SMALL LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7541112|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK WIDE SMALL LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,113.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 869-021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,558.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,558.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-B-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY CEMENTED TRIATHLON SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.272|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3-HOLE HUMERUS DISTAL POSTEROLATERAL 3.5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,336.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,336.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SZ 5-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 24MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 26MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 28MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 50MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 55MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL UNIVERSAL KNEE TOTAL TRIATHLON SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-S-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER OFFSET TRIATHLON 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,315.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 3 5MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 3 5MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 3-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7650-2038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HEADLESS STERILE 1/8"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 3 5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5010020|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRANULES GRAFT FOMA 20CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,863.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,863.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7521008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLP 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7555050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT XLP 5.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,157.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,157.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7555055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT XLP 5.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,157.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,157.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7510001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT LOCK XLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6981055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COROENT LARGE EXTRA 10-DEGREE LORDOTIC 10 X 18 X 55MM|1|HUMANA [1294]||HUMANA [11839]|14,886.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,886.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6981050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COROENT LARGE EXTRA 10-DEGREE LORDOTIC 10 X 18 X 50MM|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6980850|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COROENT LARGE EXTRA 10-DEGREE LORDOTIC 8 X 18 X 55MM|1|HUMANA [1294]||HUMANA [11839]|14,886.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,886.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7555045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT XLP 5.5MM X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,157.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,157.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7521006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLP 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT52SE-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT52SE-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121732058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR W/GRIPTION 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G31236|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OCCULSION 10 FR X .035 DIAMETER X 120 CM-40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-38.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 38.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTP-002-SR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP STANDARD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,348.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,348.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-416-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL STABILIZED POSTERIOR 16MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 80MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 5 HOLE RIGHT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,798.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,798.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-511-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 5-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT 3 X 10-DEGREE 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6570-0-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD V40 CERAMIC DELTA BIOLOX 30MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531G313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 3-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.290|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.295|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1.300|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +3 ADD BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12760-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 8MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12766-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 80MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-002-PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHAPED PEANUT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-002-Y|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y MFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,200.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,200.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTP-002-RL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP LEFT REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTP-002-RR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP RIGHT REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-0A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA SLOTLESS LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,516.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,516.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-0B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BETA SLOTLESS LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,516.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,516.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-10A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA 10-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-1A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA 1-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,652.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,652.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-1B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BETA 1-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,652.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,652.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-2A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA 2-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,743.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,743.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-2B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BETA 2-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,743.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,743.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-3A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA 3-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-3B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BETA 3-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-4A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA 4-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-4B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BETA 4-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-7A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA 7-SLOT LPS MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-12ML|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD LEFT TMT 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-12SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMALL LEFT TMT 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-12SR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMALL RIGHT TMT 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-23ML|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD LEFT TMT 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-23MR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD RIGHT TMT 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TMT-002-23SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMALL LEFT TMT 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR1-2301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANTS STABILIZATION AXIA LIF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L93714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL VARA SIZE 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MFT-011-27-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|519.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-27-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|519.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIO-SCREW INTERFERENCE FEM BIOABSORABLE 7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-409-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TBIAL CS TRIATHLON X3 SZ 4-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +0MM 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MFT-011-35-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CONFORM PROFIX LT SZ 4-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|519.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-021-35-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|441.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 4-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-41-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 41MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8010015|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELECTRODE SURFACE DUAL II MODULE NV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7376550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED POLY 6.5MM X 50MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12765-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 4MM X 60MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7376545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED POLY 6.5MM X 45MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7376540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED POLY 6.5MM X 40MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7370100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK II DBR NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7236175|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 17.5MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,231.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,231.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7236225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 22.5MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,231.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,231.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METAPHYSEAL 3.5 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,004.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,004.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FULL DURACON S-1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64811110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL XS LEFT KNEE HINGED ROTATING HOWMEDICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI LOCK BPS WITH GRIPTION OFFSET HIGH SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR AHRX NEUTRAL 32 X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 611.105.01S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE COCR 1.7MM W/TI CRIMP 750MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,546.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,546.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 32 X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,953.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 64813110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB 1 SM KN MDLR ROT HNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CR70BU-24.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER SINGLE-PIECE PMMA 13.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LOCKING LEFT 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,396.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,396.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.707|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LOCKING LEFT 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,939.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,939.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 7 HOLE RIGHT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,695.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.443|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 7 HOLE LEFT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 9 HOLE RIGHT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,743.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,743.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 9 HOLE LEFT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,743.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,743.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 11 HOLE RIGHT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,787.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,787.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.447|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL ANTEROLATERAL 11 HOLE LEFT 3.5 LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,955.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,955.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.934|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL RIGHT 4-HOLE 81MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.938|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL RIGHT 8-HOLE 133MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.940|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL RIGHT 10-HOLE 159MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.939|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LEFT 8-HOLE 133MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.941|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LEFT 10-HOLE 159MM 3.5MM LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 70MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.427|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 75MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 80MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.429|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 85MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 90MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 65MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 70MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.327|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 75MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 80MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.329|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 85MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONICAL SELF TAPPING 3.5MM X 90MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTRAFIX 7MM HARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,224.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,224.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-1110-02|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT GENERATOR PULSE IMPLANTABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,081.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,081.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-3138-25|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION CONTACT 8 X 25CM PRECISON BIONICS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,272.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,272.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-52D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HOLE CLUSTER HEMISPHERICAL TRITANIUM D 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.361.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 11MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.362.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 12MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 6 HOLE RIGHT 108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129433120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL KEEL CEMENTED MBT SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMUR STABILIZED POSTERIOR SIGMA SIZE 2.5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 7MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.809|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 9MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.811|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 11MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 13MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.757|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 7MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.759|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 9MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.761|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 11MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.876|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 6MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.877|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 7MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.878|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 8MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.879|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 9MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 10MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-397|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 397CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-421|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 421CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-457|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 457CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.881|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 11MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.882|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 12MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.883|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 13MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.884|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 14MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|427.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.886|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 16MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.888|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 18MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 20MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.892|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 22MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6077-0230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 127 DEGREE V40 ACCOLADE HFX SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-42-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 42MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.894|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 24MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.896|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 26MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.898|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 28MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0MM X 30MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.356.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 6MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.357.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 7MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.358.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 8MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.359.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 9MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.360.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 10MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.363.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 13MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.364.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 14MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.366.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 16MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.368.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 18MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.370.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 20MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.372.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 22MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.374.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 24MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.375.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 26MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.376.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 28MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.377.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 30MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.378.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 32MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.379.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 34MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.380.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 36MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.381.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 38MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.382.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.0MM X 40MM SELF TAPPING WITH T6 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 31MM 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|772.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.345|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 38MM 5-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|772.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 45MM 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|911.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,H/G-II,6.5X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 247.347|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 52MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|772.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.348|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 59MM 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|772.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 73MM 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-280|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 280CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-350|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.362|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP ADAPTION 2.0MM X 81MM 12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,306.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,306.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.0MM X 53MM 7-HOLE 3-HOLE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,365.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.349|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CONDYLAR 2.0MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,429.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,429.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 32MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121732048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR WITH GRIPTION 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00625006550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM TRLG TIV ACTB CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.27|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|276.27|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 202.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 34MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672808500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIM ELEVATED 28MM SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 42MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 44MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 60MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.892|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 32MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.894|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 34MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.896|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 36MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.898|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 38MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 40MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRILOGY 6.5 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.27|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|276.27|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 202.962|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 42MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.963|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 44MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.965|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 46MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.966|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 48MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.967|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 50MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.968|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 55MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.969|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 60MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|121.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|121.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.782|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 32MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.784|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 34MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.788|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 38MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 249.674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.4MM X 36MM 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,235.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,235.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.4MM X 44MM 5-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.676|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.4MM X 52MM 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.377|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.4MM X 60MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.678|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.4MM X 68MM 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,235.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,235.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.364|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.4MM X 84MM 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,227.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.366|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP ADAPTION 2.4MM X 88MM 12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,428.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,428.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 2.4MM X 58MM 7-HOLE 3-HOLE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,268.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,268.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.679|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CONDYLAR 2.4MM X 59MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,841.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,841.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 249.681|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.7MM X 49MM 5-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50SE-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 11.5MM LENGTH 5.0MM OPTIC DIAMETER SQUARE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.682|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.7MM X 58MM 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1-2210|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER X-STOP 10MM|1|HUMANA [1294]||HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121732056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR WITH GRIPTION 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 249.683|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.7MM X 67MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.372|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.7MM X 76MM 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.374|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 2.7MM X 94MM 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP ADAPTION 2.7MM X 97MM 12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,439.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,439.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.684|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CONDYLAR 2.7MM X 66MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,021.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,021.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 249.685|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 2.7MM X 32MM 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,268.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,268.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.687|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LCP OBLIQUE LEFT 2.7MM X 35MM 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.686|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LCP OBLIQUE RIGHT 2.7MM X 35MM 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.689|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LPC LEFT 2.7MM X 32MM 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.688|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LCP RIGHT 2.7MM X 32MM 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,237.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.763|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 13MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LPC CLAVICAL SUPERIOR ANTERIOR 6 HOLE RIGHT 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.107S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR DIA-META LCP 7-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,178.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,178.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMUR HINGE ROTATING LEFT F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,763.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,763.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS TIBIA HINGE ROTATING SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,445.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,445.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588006017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,444.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,444.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37083-60|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION STRETCH-COIL SINGLE 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TG2810|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORASIC 28MM X 10CM TAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION RIGHT STD SLIM CHARLOTTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41123216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEX MTP 3.2MM X 16MM CHARLOTTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41123218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEX MTP 3.2MM X 18MM CHARLOTTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ANTERIOR CORAIL W/O COLLAR HIGH-OFFSET SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PL-CL0-8SR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING SHORT RIGHT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported K15B|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAMP BONE INFLATABLE EXPRESS KYPHX 15/2|1|HUMANA [1294]||HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-15316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT HANDPROFYLE 2.3MM 16-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23011E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 11MM X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23016E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 16MM X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48458|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 14MM X 107CM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.638S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 380MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75445535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFF-SET HIGH SZ-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-7-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 14MM X 155MM DISTAL CONICAL MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6077-0537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 127 DEGREE ACCOLADE HFX SZ 5 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-55-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-10.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-10.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-11.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC-12.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-12.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-13.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-13.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-14.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-14.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-15.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-16.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC.175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-18.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-19.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-19.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-20.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC-20.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-21.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-21.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC-22.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-23.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-25.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-25.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-26.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-26.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AC-27.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF RESTOR 6.0MM ANTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-27.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC-28.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-28.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-29.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-29.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-30.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +30 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 136X11X4.2MM SS 4.5/3.5MM SCR LG FRAG SET 9 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,953.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,953.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6334-056-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONSTRAINED LONGEVITY TRILOGY TM 32MM/56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,897.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,897.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 99X11X3.3MM SS 3.5MM SCR SM FRAG SET 7 HL RND TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,864.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,864.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 112X11X3.3MM SS 3.5MM SCR SM FRAG SET 8 HL RND TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 151X11X3.3MM SS 3.5MM SCR SM FRAG SET 11 HL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,052.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,052.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 223.412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 164X11X3.3MM SS 3.5MM SCR SM FRAG SET 12 HL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,941.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,941.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP METAPHYSEAL 3.5MM 14-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 216X11X3.3MM SS 3.5MM SCR SM FRAG SET 16 HL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,154.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,154.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 242X11X3.3MM SS 3.5MM SCR SM FRAG SET 18 HL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,067.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,067.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TBIAL CS TRIATHLON X 3 SZ 4-16M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 172X11X4.2MM SS 4.5/3.5MM SCR LG FRAG 11 HL LCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,052.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,052.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.757|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 190X11X4.2MM SS 3.5MM SCR SM FRAG SET 12 HL TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,941.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,941.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.758|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 208X11X4.2MM SS 3.5MM SCR SM FRAG SET 13 HL TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,980.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,980.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.759|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 226X11X4.2MM SS 3.5MM SCR SM FRAG SET 14 HL TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,067.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,067.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.761|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 262X11X4.2MM SS 3.5MM SCR SM FRAG SET 16 HL TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,271.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,271.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 224.763|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 298X11X4.2MM SS 3.5MM SCR SM FRAG SET 18 HL TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,351.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,351.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.765|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 334X11X4.2MM SS 3.5MM SCR SM FRAG SET 20 HL TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,548.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,548.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.266S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS 12MM X 180MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.636S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RETROGRADE FEMORAL 12MM X 280MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MAN01.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR MINUS 1.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PIP-200-40P-WW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP PROXIMAL 40P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PIP-200-30D-WW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP PROXIMAL 30P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL LIPPED CS SMALL 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,H/G-II,6.5X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PXC201200|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LEG CONTRA 20MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1217-30-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MULTIHOLE PINNACLE WITH GRIPTION 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,864.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,864.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 HD DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 HD DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21. HD DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-53-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MM X 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550L391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC TRIATHLON S39 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-509-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARNING TIBIAL CS TRIATHLON X 3 SZ 5-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,H/G-II,6.5X25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 4 HOLE LEFT 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,770.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,770.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HOLE CLUSTER HEMISPHERICAL TRITANIUM F 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 17MM X 155MM CONICAL DISTAL PLASMA MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT3.100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH 6.0MM ASPHERIC OPTIC 0 DEGREE MODIFIED-L HAPTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.105|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.110|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.115|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.120|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.125|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.130|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 15MM TRLG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT3.135|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.140|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.145|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.150|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.155|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.160|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.165|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.175|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +7MM 12/14 TPR 28MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT3.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.190|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.195|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.205|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.225|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.230|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10.5MM 12/14 TPR 28MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,661.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT3.235|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.240|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.255|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.105|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.110|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.115|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.120|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT4.125|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.130|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.135|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4-14.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.145|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.150|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.155|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.160|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.165|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/CLUSTER-HOLE 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT4.175|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.190|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.195|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.205|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 17MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT4.225|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.230|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.235|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.240|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.255|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.105|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.110|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 18MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT5.115|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.120|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.125|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.130|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.135|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.140|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.145|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.150|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.155|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.160|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 14MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT5.165|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.175|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.190|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.195|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.205|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARD 16MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT5.215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.225|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.230|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.235|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.240|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.255|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 17MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 18MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 12MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 13MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 15MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5520-B-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY CEMENTED TRIATHLON SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510F601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-609-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SZ 6-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARD LM 16MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 502-03-56E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HOLE CLUSTER HEMISPHERICAL TRITANIUM SZ 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP RIGHT 4 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC59008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEMBRANE TYMPANIC LEFT DRUM EAR CADAVER|1|HUMANA [1294]||HUMANA [11839]|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 10MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12420059|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CARTILAGE COSTAL < 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 11MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6000470|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIMESH 4 INCH X 6INCH 65GRAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000424|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIMESH 12 INCH X 12 INCH 65 GRAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARD 12MM X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 13MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101214010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFFSET HI SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9152-2535-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ARTICULAR OFFSET 15MM 2.5 X 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 28 X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,899.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L93710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL 2 VARA COXA SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5515-F-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 16MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-2500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MAGNUM MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLZB32|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND ADJUSTABLE REALIZE CURVED|1|HUMANA [1294]||HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACTB 48MM PNCL 8 DOME SCR MLHL II HIP STRL GRIPTION LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254684|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTRAFIX 9MM HARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,4 HOLES,LONG,01-920|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.110.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP LEFT 4 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAX VERTEX 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD LFIT COCR C-TAPER 36MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-0000E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TI HEAD ALUMIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT VERTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,417.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,417.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955273|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMALL VERTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,001.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,001.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,246.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,246.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 3-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS-0515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS G-FORCE 5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASSER SUTURE G- FORCE|1|HUMANA [1294]||HUMANA [11839]|777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 595601702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-013-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-C MINUS RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-014-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-D MINUS RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,430.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,430.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-015-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-E MINUS RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-016-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-F MINUS RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP RIGHT 5 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP RIGHT 5 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP LEFT 5 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP LEFT 5 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP RIGHT 4 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP LEFT 4 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM VA STARDRIVE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.644S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|694.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|694.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-8010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR PASSER PERFECT SMARTSTITCH|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-1502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MAGNUM 2 OPUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-017-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-G MINUS RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,430.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,430.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM921T-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILLING CROSS HEAD 1.5MM X 4MM CRANIOPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|46.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5956-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM922T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILLING CROSS HEAD 1.5MM X 5MM CRANIOPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5956-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM961T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT CRAINOPLATE 2 HOLE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.85|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|77.85|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00511007555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FM963T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT CRAINOPLATE 4 HOLE 2OMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|90.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FM971T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE DRILL 16MM CRAINOPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.78|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|204.78|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FM972T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE DRILL 20MM CRAINOPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.78|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|204.78|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5956-013-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-C MINUS LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-014-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-D MINUS LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-015-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-E MINUS LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-016-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-F MINUS LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5956-017-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OPTION FLEX CR NEXGEN SIZE-G MINUS LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,310.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 HD DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-43-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MM X 43CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5565-S-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 18MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-509-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORALTRI-LOCK BPS WITH GRIPTION OFFSET HIGH SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7541124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK BLADE NARROW LARGE LEGACY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,748.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,748.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CROSSLINK 22MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,801.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,801.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROUS CR VANGUARD RIGHT 72.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA THIN 37 3-PEG SERIES A VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL I-BEAM 87MM CC BIOMET VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CR 10 X 87/91 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 8.5MM 32MM NXGN UHMWPE KN STRL BLU GRN PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,762.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT4.300|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 HD DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FWD301|SUP|HCPCS Q4114||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND FLOWABLE INTEGRA 3CC|1|HUMANA [1294]||HUMANA [11839]|12,741.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,741.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BMW4101|SUP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRESSING WOUND INTEGRA MATRIX BILAYER 4" X 10"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,117.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,117.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.060|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.065|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.070|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9226|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL RTNL 10.5MM SIL MERIODIONAL STRL|1|HUMANA [1294]||HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.075|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.080|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.085|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.090|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.095|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.060|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.065|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4-7.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.075|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.080|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.085|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.090|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.095|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.060|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.065|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.070|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.075|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.080|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.085|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.090|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.095|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.260|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.265|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.270|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.275|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.285|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.290|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.295|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.300|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.260|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.265|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.270|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.275|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.285|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.290|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4.295|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.260|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.265|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.270|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.275|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.285|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.290|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.295|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT5.300|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +3 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 28 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,899.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136528320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 28MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597201502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 5 HOLE RIGHT 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,816.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,816.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111324SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5100-0006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SOFT-TISSUE ANCHORLOK EDGE LEADING 2.5MM 2-0 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-643|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991026|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CAPSTONE 10MM X 26MM VERTESTAK|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-115-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TRABECULAR METAL SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-111-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TRABECULAR METAL SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 57-15316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT 16 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL TRIATHLON X 3 SZ 4 13MM TS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS FIT TRIATHLON TS 12MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 3 5MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 3 10MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 133SX-11|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE SHORT HEIGHT EXTRA PROJECTION 250CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-H424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL EVOLVE +4 SZ. 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-5475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE +4 7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERNECE FEMORAL GUARDSMAN 7MM X 20MM X 3.5 HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597001502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5510-F-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17016E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD V40 CERAMIC DELTA BIOLOX 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5550-G-360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC X 3 TRIATHLON S36 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CAPSTONE 10MM X 22MM VERTESTAK|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM920T-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILLING CROSS HEAD 1.5MM X 3MM CRAINOPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|46.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FM960T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT CRANIOPLATE 2 HOLE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.85|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|77.85|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FM962T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT CRANIOPLATE 4 HOLE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|90.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-800|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM967T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y-Y 6 HOLE CRAINOPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|155.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.013.744S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RETROGRADE FEMORAL 13MM X 320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.046S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE SPIRAL RETROGRADE 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END OMM NAIL RETROGRADE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|671.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|671.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST1109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SUBTALOR BIOARCH 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SW1106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BIOARCH ALIGNMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L93711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM 11MM COLR CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8115539|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CROSSLINK 39MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,568.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,568.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75444045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 4.0 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1655PS-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS PEEK 5.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5923|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PISTON STAPES SMART FLOUROPLASTIC NITINOL 0.5MM X 4.50MM|1|HUMANA [1294]||HUMANA [11839]|794.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|794.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5922|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PISTON STAPES SMART FLOUROPLASTIC NITINOL 0.5MM X 4.25MM|1|HUMANA [1294]||HUMANA [11839]|794.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|794.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-1012.5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH TEAR AWAY 12.5 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DL-35-90|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUMEN DUAL 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-16-120BL|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED INFRARENAL INTUI TRACK 25 X 16 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VPC MINI 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|702.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04865|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT X 3 0-DEGREE 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 117112ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF 3.O X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|974.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|974.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117116ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF 3.O X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|980.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|980.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117118ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF 3.O X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|974.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|974.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117012ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF 2.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|887.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|887.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117014ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF 2.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|893.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|893.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111424SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF 4.3 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,039.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,039.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117340ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HALL-UC RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-05290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.0 PROFYLES 2X2 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|745.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|745.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TG221|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHEET PROTECTOR TENDON|1|HUMANA [1294]||HUMANA [11839]|7,857.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,857.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 023805|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH,URETHERAL FILIFORM,5FR,ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 6 HOLE LEFT 108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN LEFT 6 HOLE HEAD 4 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROCOAT C/R SIGMA RIGHT SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CV SIGMA PFC SZ 4/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS-0510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS G-FORCE 5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9795317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING VENTURE 4.5 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 2.4 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 835.207|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CERVICAL MAINTAIN LORDOTIC 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL GLOBUS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,448.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,448.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANGLE FIXED GLOBUS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150.614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANGLE VARIABLE GLOBUS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 36 X 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 522033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL S-ROM 32MM 11/13 TAPER +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122072132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER L-SERIES ACETABULAR S-ROM MARATHON 32MM 10 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,144.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,144.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL HEAD CRUCIATE S-ROM 5.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2990826|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CAPSTONE 8MM X 26MM VERTESTAK|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UOCP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION ULNAR OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HEX3.2-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL HEX HEAD 3.2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|84.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HEX3.2-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL HEX HEAD 3.2MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LAG3.2-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LAG HEAD 3.2MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WIRE-1.6/100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KWIRE 1.6MM X 100MM|1|HUMANA [1294]||HUMANA [11839]|30.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 12MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 3-16MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27214E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27618E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27620E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BF-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SCREW BIOCORK WITH FIBERWIRE 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 2.5MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 2.5MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL UNIVERSAL KNEE TOTAL TRIATHLON SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,751.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,751.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37912-51915|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM STENT SD RENAL BILIARY EXPRESS 5.0 X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39031-30201|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON MR STERILING MONORAIL 3MM X 2MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 2.4 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PIP-200-20P-WW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP PROXIMAL 20P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 18MM X 155MM CONICAL DISTAL PLASMA MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6334-050-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONSTRAINED LONGEVITY TM 28MM/50-52-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6935-58|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DFBR 58CM 8.6FR TENSI-LCK SQ SCR HLX SIL ISOGLIDE ETFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 45MM SS 2.4MM SCR 6 HLE/HD 2 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 54MM SS 2.4MM SCR 6 HLE/HD 3 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 66MM SS 2.4MM SCR 6 HLE/HD 4 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 25MM 9MM FEM BIO ABS BSCR GRDSMN STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TBE-38-77-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR PROXIMAL EXTENSION TAA ZENITH TX2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL I-BEAM 75MM CC BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM RIGHT CR VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR THN 34MM 3 PG KN SER A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL CR 12MM X 71/75 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 47MM SS 2.4MM SCR 7 HLE/HD 2 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 55MM SS 2.4MM SCR 7 HLE/HD 3 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 68MM SS 2.4MM SCR 7 HLE/HD 4 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 25MM 8MM FEM BABSR LTRM ABS TRILOBE DRVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.111.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN LEFT 6 HOLE HEAD 2 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN LEFT 6 HOLE HEAD 3 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 20MM 9MM FEM BABSR LTRM ABS TRILOBE DRVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.721|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 47MM SS 2.4MM SCR 7 HLE/HD 2 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 26MM 10MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.731|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 55MM SS 2.4MM SCR 7 HLE/HD 3 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.741|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 68MM SS 2.4MM SCR 7 HLE/HD 4 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-B-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 2 KN CMNT PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 16MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8672030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136504000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -2MM 12/14 OFST TPR 40MM HIP M SPC COCR ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-4151DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT DISPOSABLE PIN DRILL TRIM-IT 1.5MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.392S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 320MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137647000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 9.25MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 10D +4MM 56MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 10D +4MM 56MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8598A|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT REVISION SPINAL SEGMENT INTRATHECAL CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8731SC|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH IT 38CM 1.4FR NDR INTRASPINE SIL SUTLS PMP CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-48-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.029|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LPC CLAVICLE SUPERIOR ANTERIOR 7 HOLE LEFT 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.958S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 145MM SS 3.5MM SCR 8 HL LMT CNTCT CNTR HD LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,727.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,727.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74002|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER POCKET 2 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6077-0637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 127 DEGREE ACCOLADE HFX SZ 6 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 3 HOLE RIGHT 69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,726.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,726.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 3 HOLE LEFT 69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,726.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,726.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 4 HOLE RIGHT 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,770.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,770.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 5 HOLE LEFT 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,816.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,816.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-8120-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SURGICAL 2 X 8 70CM PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,256.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,256.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 7 HOLE RIGHT 123MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.019|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 7 HOLE LEFT 123MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 8 HOLE RIGHT 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP CLAVICLE SUPERIOR ANTERIOR LATERAL EXTENSION 8 HOLE LEFT 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LPC CLAVICLE SUPERIOR ANTERIOR 6 HOLE LEFT 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 110MM SS 3.5MM SCR 7 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LPC CLAVICLE SUPERIOR ANTERIOR 8 HOLE RIGHT 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LPC CLAVICLE SUPERIOR ANTERIOR 8 HOLE LEFT 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMUR CEMENTED POSTERIOR SIGMA SZ 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZING PFC SIGMA SZ 6 -15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 8MM SELF TAPPING WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFRT02|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR FLOOR PELVIC TOTAL PROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFRA02|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR FLOOR PELVIC ANTERIOR PROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,949.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFRP02|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR FLOOR PELVIC POSTERIOR PROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,949.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 21MM X 166MM CONICAL DISTAL PLASMA MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE DISTAL LEFT 9-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149813308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL FIXED BEARING RIGHT MEDIAL / LEFT LATERAL 9.5MM SIZE-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149823003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL FIXED BEARING RIGHT/ MEDIAL LEFT LATERAL CEMENTED SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40E-15.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER SENSAR IOL WITH OPTIC EDGE ACR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LI61AOV-34.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 34.0 DIOPTER SOFPORT ADVANCED OPTICS ASPHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P359UV-34.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 34.0 DIOPTER SOFPORT ADVANCED OPTICS PMMA A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 12MM MMI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR DISTAL LATERAL LCP 2.7MM 3.5MM 7 HOLE LEFT 125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,044.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,044.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING STAR HEAD 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING STAR HEAD 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING STAR HEAD 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING STAR HEAD 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|337.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING STAR HEAD 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP10000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-17-102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING FRAG SMALL HS STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VARIABLE 4.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48412|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 82MM 26MM 18FR ZNTH FLX Z-TRK 2 BRCH SS PLSTR SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48418|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 96MM 28MM 7.7MM 20FR ZNTH FLX Z-TRK 2 BRCH SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48423|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 96MM 30MM 7.7MM 20FR ZNTH FLX Z-TRK BFUR PLSTR SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48427|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 82MM 32MM 7.7MM 20FR ZNTH FLX Z-TRK 2 BRCH SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,919.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|26,919.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48428|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 96MM 32MM 7.7MM 20FR ZNTH FLX 2 BRCH Z-TRK INTRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 005005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBM PROGENIX 5CC|1|HUMANA [1294]||HUMANA [11839]|1,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12480|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION LEG ILIAC 18MM X 55CM ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,661.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 005001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBM PROGENIX 1CC|1|HUMANA [1294]||HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.656S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 380MM FEM XPRT IM FLUT CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 42MM 16MM SHLDR TURON NTRL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-00-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM NK TURON NTRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON SZ 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-00-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON 10MM X 115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-00-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON 8MM X 115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-42-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 42MM 16MM SHLDR TURON NTRL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 46MM 16MM SHLDR TURON OFST STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 10D +4MM 54MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5HD DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD MODULAR COCR 28MM +3MM NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ARCOMON XL RINGLOCK 10-DEGREE 28MM SZ-21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,715.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,715.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGK09070M|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE FX 70MM .9MM KRSH FIXOS FT/ANKL SMTH TROC TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111332SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|905.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 14MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-409-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 73MM SS 2.7/3.5MM SCR 3 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.137|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 73MM SS 2.7/3.5MM SCR 3 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 86MM SS 2.7/3.5MM SCR 4 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.139|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 86MM SS 2.7/3.5MM SCR 4 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 99MM SS 2.7/3.5MM SCR 5 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 99MM SS 2.7/3.5MM SCR 5 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 112MM SS 2.7/3.5MM SCR 6 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.143|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 112MM SS 2.7/3.5MM SCR 6 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 125MM SS 2.7/3.5MM SCR 7 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,044.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,044.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-511-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL PS TRIATHLON SZ 5-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PERIARTICULAR TIBIAL MEDIAL PROXIMAL 4-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 151MM SS 2.7/3.5MM SCR 9 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.149|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 151MM SS 2.7/3.5MM SCR 9 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 177MM SS 2.7/3.5MM SCR 11 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,176.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,176.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.153|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 177MM SS 2.7/3.5MM SCR 11 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,176.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,176.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WRIST FUSION LOCKING SHORT BEND 3.5/2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,284.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,284.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-2-36-127-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 36MM X 127CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7577530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SEXTANT 7.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL CRUCIATE CC BIOMET 71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM CR POROUS VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL CR 10MM X 71/75 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM CR POROUS VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-2-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AXLE FEM GMRS SM KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,523.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,523.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64853113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 127MM 13MM CMNT BD SECT GMRS STRG HIP PROXS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-2-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSHNG FEM GMRS SM KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,058.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,058.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIB 80MM 11MM GMRS FLUT KN PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 194MM SS 3.5MM SCR 8 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.276|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116X11X2.5MM SS 3.5MM SCR SM FRAG SET 7 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,943.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,943.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.262|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 65X11X2.5MM SS 3.5MM SCR SM FRAG SET 3 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116X11X2.5MM SS 3.5MM SCR SM FRAG SET 7 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 194MM SS 3.5MM SCR 8 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.288|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 136X11X2.5MM SS 3.5MM SCR SM FRAG SET 9 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,831.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,831.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 19MM +0MM (STD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9152-2040-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ARTICULAR 15MM 2MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 22MM 8MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT231412|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 23MM X 14.5MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LCP 5 HOLE 156MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HOOK-L4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK L4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAB3.8-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 3.8MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.283|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 58X11X2.5MM SS 3.5MM SCR SM FRAG SET 3 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.285|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 83X11X2.5MM SS 3.5MM SCR SM FRAG SET 5 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.289|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 136X11X2.5MM SS 3.5MM SCR SM FRAG SET 9 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,831.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,831.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 158MM SS 3.5MM SCR 6 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,404.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,404.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.263|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 65X11X2.5MM SS 3.5MM SCR SM FRAG SET 3 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,907.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90X11X2.5MM SS 3.5MM SCR SM FRAG SET 5 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.267|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116X11X2.5MM SS 3.5MM SCR SM FRAG SET 7 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,549.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90X11X2.5MM SS 3.5MM SCR SM FRAG SET 5 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,638.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,638.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.277|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116X11X2.5MM SS 3.5MM SCR SM FRAG SET 7 HL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,943.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,943.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 138MM SS 3.5MM SCR 6 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,974.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,974.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 164MM SS 3.5MM SCR 8 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,066.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,066.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 138MM SS 3.5MM SCR 6 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,974.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,974.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 236.508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 164MM SS 3.5MM SCR 8 HL ELONGATE HL PROX TAB LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,066.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,066.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA STANDARD SERIES-A BIOMET 34MM X 8.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROUS CR VANGUARD RIGHT 67.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL CR 14MM X 71/75 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NW340|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEURAWRAP 3MM X 4CM|1|HUMANA [1294]||HUMANA [11839]|4,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL QXIN PS LEGION SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR TIBIAL CONSTRAINED GENESIS SIZE 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT LEGION STRAIGHT 14MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL REVISION LEGION SZ 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUPLER OFFSET LEGION 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,283.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,283.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75204|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 20MM 75CM 4CM RADOPQ RPD INFL COAX SHFT ATLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75224|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 22MM 75CM 4CM RADOPQ RPD INFL COAX SHFT ATLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75244|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 24MM 75CM 4CM RADOPQ RPD INFL COAX SHFT ATLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-0340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA RIGHT LONG 11MM X 340MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1896-5045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71508144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 955-519|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 30CM .062IN MTRX MED DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-150|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 150CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-180|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 180CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL X 3 TRIATHLON SZ 6 25MM TS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111211ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPIN 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111214ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPIN 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY TORNIER SZ-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS LEFT TORNIER SZ-2|1|HUMANA [1294]||HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3487A-33|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PISCES QUAD 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,963.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,963.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-00-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK HUMERAL TURON 7.5 DEGREE ANGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL TURON 46MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5791-044-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 33MM KNEE UNI M/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH PRECOAT SZ-E RT MEDIAL LEFT LATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PRECOAT RT MEDIAL LEFT LATERAL UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584202509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR FEMORAL SZ-5 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 113MM TRLK BPS GRIPTION 9 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-87-460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 40MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,983.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,983.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBC060501|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 5CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 68334|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUTOPLAST 1 X 3CM SCLERA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM RIGHT CR POROUS VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL I-BEAM 83MM CC BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL CR 10MM X 79/83 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA STANDARD SERIES A BIOMET 40MM 3-PEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM LEFT CR POROUS VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL STABILIZING ANTERIOR 14MM X 79 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,292.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,292.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL I-BEAM 79MM CC BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5 LEFT CR POROUS VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39565-65|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-113560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FRACTURE HUMERAL MACRO 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,163.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,163.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39586-65|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113769|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL BIO-MOD 48MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3788|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BATTERY RECHARGABLE 16-CHANNEL 1PG EON MINI ANS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,586.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,586.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3219ANS|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD TRIPOLE LAMITRODE 16 60CM ANS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3286|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD LAMITRODE S-8 LEAD ANS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3721|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYTEM CHARGING MINI EON ANS|1|HUMANA [1294]||HUMANA [11839]|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114025ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOLUSTAPLE 10MM 26 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114004ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOLUSTAPLE 10MM 90 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN352032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 20MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN271432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 2.7 X 14MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF3214C155XH|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA TALENT WITH XCELERANT HDS BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IW1420C90XH|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA TALENT WITH XCELERANT CONTRALATERAL LIMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48425|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 30MM X 125MM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 7MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,206.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN403432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 34MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION LEFT STANDARD SLIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,063.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.113.103S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 62MM SS 3.5MM SCR 3 HL SHRP HK LOPRFL PRECONTOUR LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,865.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,865.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HEX3.2-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.2MM 16MM CORT HEX ANKL FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAB3.8-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 3.8MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL STABILIZED POSTERIOR 13MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SS 7 HL SHFT LCP BN RDS RT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LJU216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY TORNIER SZ-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991032|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32MMX10MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB LEGION 3 KN LT CMNT M TPR TI NPOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71926225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA RESURFACING II GEN 38MM NICKLE FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,989.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,989.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MAN03.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR MINUS 3.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062201080|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNOCC 100CM 5FR 26FR OCLR 1 INFL PORT RADOPQ FLXB SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-750|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-800|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L93715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL VARA SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6958716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA THIN 31MM 3-PEG SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL I-BEAM CC 67MM BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL CR 10MM X 63/67 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-00-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7759970|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE KEEL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED LPS ALL-POLY SIZE 6 14MM GREEN E/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED LPS ALL-POLY SIZE 3 14MM YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,047.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,047.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8000-0036|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE ASCP RM 36MM PTLR DISP|1|HUMANA [1294]||HUMANA [11839]|1,228.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,228.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550-G-298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC X 3 TRIATHLON S29 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-309-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6981045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORDENT LARGE EXTRA 10-DEGREE LOROTIC 10 X 18 X 45|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7521010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XLP 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 115MM SS 3.5MM SCR 8 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN271032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 2.7 X 10MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NK011215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 1.2MM KRSH SMTH TIP HD|1|HUMANA [1294]||HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18717000|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT SEMI TENDENOSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85MM SS 3.5MM SCR 6 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.081|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85MM SS 3.5MM SCR 6 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100MM SS 3.5MM SCR 7 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.083|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100MM SS 3.5MM SCR 7 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.084|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 115MM SS 3.5MM SCR 8 HL PRECONTOUR LMT CNTCT TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IS-5|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING VAGINAL ISTOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE SUPERIOR LCP 3.5MM WITH LATERAL EXTENSION 6-HOLE RIGHT 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LAG3.2-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LAG HEAD 3.2MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.091|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE SUPERIOR LCP 3.5MM WITH LATERAL EXTENSION 6-HOLE LEFT 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,848.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.092|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE SUPERIOR LCP 3.5MM WITH LATERAL EXTENSION 7-HOLE RIGHT 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5023-5-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF MOD 4 X 150 CONT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5195-0-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY II DJD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,362.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,362.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5038-2-110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF APEX 3 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5045-5-200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN SMOOTH APEX 3 X 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.093|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE SUPERIOR LCP 3.5MM WITH LATERAL EXTENSION 7-HOLE LEFT 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,924.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.094|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE SUPERIOR LCP 3.5MM WITH LATERAL EXTENSION 8-HOLE RIGHT 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE SUPERIOR LCP 3.5MM WITH LATERAL EXTENSION 8-HOLE LEFT 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,999.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48431|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 32MM X 140CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RX1-32-62|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ANCILLARY AAA RENU ZENITH 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEM9L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL LOCKING 9 HOLE LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FA-CO3560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TAP 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2990822|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CAPSTONE 8MM X 22MM VERTESTAK|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48422|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 30MM X 82CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE SIZE +2 7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GG800|SUP|HCPCS Q4111||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT SKIN GAMMAGRAFT 9CM X 10CM APPROXIMATE SIZE|1|HUMANA [1294]||HUMANA [11839]|1,687.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,687.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL KNEE TOTAL TRIATHLON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 4 5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESSFIT TRIATHLON TS 16MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-6-060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER MODULAR UNITRAX 4MM|1|HUMANA [1294]||HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OG2030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEMBRANE RESORBABLE OSSEOGUARD 20 X 30MM|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955924|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 4.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 4.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7340300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,564.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,564.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 006005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBM PLUS PROGENIX 5CC|1|HUMANA [1294]||HUMANA [11839]|2,622.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,622.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-209-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SZ 5-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT311415|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 15CM 31MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1217-30-054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MULTIHOLE PINNACLE W/GRIPTION 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,864.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,864.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL STANDARD STANDARD SIZE 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SC-4395-70|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STYLET ENCHANCED 70CM|1|HUMANA [1294]||HUMANA [11839]|393.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550-G-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC X 3 TRIATHLON S31 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 13MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18916002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT QUAD AND PATELLAR WITH PROXIMAL TIBIA|1|HUMANA [1294]||HUMANA [11839]|14,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6334-062-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONSTRAINED LONGEVITY TRILOGY TM 62MM/36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,897.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,897.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM103025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PMI PERFORMA NORRIS RIGHT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103533|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48345084|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPACER VERTEBRAL 8 X 25 X 4|1|HUMANA [1294]||HUMANA [11839]|9,871.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,871.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482315545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PA XIA3 5.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,217.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,217.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48230000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCKER XIA 3|1|HUMANA [1294]||HUMANA [11839]|702.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|702.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48238090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RAD TI XIA3 6MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,411.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,411.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5110-053-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING MGII 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,972.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,972.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C20-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MICRO 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550-G-339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC X 3 TRIATHLON S33 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VARIABLE 4 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6201-052-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING REPLACEMENT CUP ACETABULAR 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991422|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX14MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON #3 10MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT POSTERIOR FEMORAL TRIATHLON SZ 3 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL TRIATHLON X 3 SZ 4 1MM TS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6981250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LORDOTIC 12 X 18 X 50|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 16MM X 195MM DISTAL CONICAL MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-46-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNW4025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROMEND 4.0MM DIAMETER 2.5MM LENGTH|1|HUMANA [1294]||HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL CEMENTED MEDIUM LATITUDE RIGHT TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,495.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,495.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPOOL HUMERAL CEMENTED MEDIUM RIGHT CENTERED LATITUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,636.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,636.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL MEDIUM LATITUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,680.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,680.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL 6.5MM LATITUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,603.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,603.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ULNAR STANDARD MEDIUM RIGHT LATITIUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,723.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,723.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 28MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 36MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ C LEFT MEDIAL KNEE UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL RIGHT MEDIAL SZ 3 UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HD-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 HD DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 30MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 32MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 60MM PARTIAL THREADED WITH 3.5MM HE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112852110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 52MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,678.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,678.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 14MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584202309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR HI FLEX 9MM UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VENTURE ANTERIOR CERVICAL 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,238.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 5-15MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 5-10MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NI-DERM-COM|SUP|HCPCS Q4106||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMAGRAFT 5CM X 7.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482024|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX COLLEGEN ACELLULAR 2CM X 4CM PELVICOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,214.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,214.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7712300|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH 3FR GRSHNG PICC 1 LUM REPL CNCT CAP FRST GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported EBO101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTRICTOR CEMENT 24MM LATITUDE TORNIER|1|HUMANA [1294]||HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EB0102|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTRICTOR CEMENT 13MM LATITUDE TORNIER|1|HUMANA [1294]||HUMANA [11839]|496.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|496.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 11MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134460|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 10.8CM X 15.9CM ELLIPTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,375.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,375.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR40E00230|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-054-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,667.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,667.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HH0710|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BIOABSORBABLE REINFORCEMENT TISSUE GORE 7CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-10-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,812.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,812.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6209BTK|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO LD 9FR SL-TRK 1 CHMBR BRD PERC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 357.399|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 3.2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CG505|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 65CM 5FR .047IN GLDCATH GLD TCH STRG CRV SS HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBFN062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 1.6MM FIXATION BONE SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|622.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|622.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991426|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX14MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200PA-110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OSTEOTOMY SLOPED AP 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B-2260|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM LAP-BAND GAST ADJ ACC PRT II STANDARD|1|HUMANA [1294]||HUMANA [11839]|9,465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B-2265|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM LAP-BAND GAST ADJ ACC PRT II LARGE|1|HUMANA [1294]||HUMANA [11839]|9,465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MULTIHOLE PINNACLE WITH GRIPTION 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 50MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 60MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 70MM SS 4MM FT CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310.243|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE TIP DRILL 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.656|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 170X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 20MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.23|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50X4X1MM TI 1.5MM SCR MN FRAG SET 3 HLE/HD 9 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|657.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|657.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC2218700|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 70CM LINEAR ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2158-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 70CM LINEAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5010125|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK FORMAGRAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14270|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRODUCER GUIDEWIRE SAFETY 12FR 5FR X 50CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-13005B-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SUBSTITUTE GRAFT HATNC 8MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC2218500|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 50CM LINEAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5928|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PISTON STAPES SMART FLOUROPLASTIC NITINOL 0.6MM X 4.50MM|1|HUMANA [1294]||HUMANA [11839]|794.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|794.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM915P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MESH MODULE 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,001.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,001.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-048-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6202-056-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6202-064-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6202-066-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SBFS062|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 1.6MM FIXATION BONE SMALL|1|HUMANA [1294]||HUMANA [11839]|920.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|920.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B012-56|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON LUMEN-MULTI CONTURA 5-6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B012-45|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON LUMEN-MULTI CONTURA 4-5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00620207020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,371.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 446.63|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36X3.5X.9MM TI 1.5MM SCR MDLR HND SYS 7 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|907.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|907.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.64|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36X3.5X.9MM TI 1.5MM SCR MDLR HND SYS 7 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|907.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|907.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 8MM LCP TI FT HEX SPHR RDS CORT DIST ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 14MM 2.5MM TI FT CORT ST SPHRCL HD SM HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 16MM 2.5MM TI FT CORT ST SPHRCL HD SM HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 6MM TI HND CORT ST CRFRM RCS NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 6MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 10MM TI CORT HND ST NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 8MM TI HND CORT ST CRFRM RCS NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAP 2.0MM10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 24MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 8MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 14MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 16MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 18MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 22MM TI HND CORT ST CRFRM RCS NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 22MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 16MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.416S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 360MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1DLMCP02|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS 80CM X 12.CM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48413|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 26MM X 96CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8400-0311|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOSET RBK 25CC|1|HUMANA [1294]||HUMANA [11839]|3,045.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,045.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 50MM 32MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2012-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT PRUITT-INAHARA CAROTID|1|HUMANA [1294]||HUMANA [11839]|1,797.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,797.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 038050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBX 5CC(DEMINERALIZED BONE MATRIX)|1|HUMANA [1294]||HUMANA [11839]|2,708.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,708.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.44S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 150 DEG 4 HOLE 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.35S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 145 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.240S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D STD BRL 78X19X5.8MM SS 4.5MM CORT SCR 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.34S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 145 DEG 4 HOLE 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,595.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,595.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.46S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 150 DEG 6 HOLE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.45S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 150 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.15S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 135 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.16S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 135 DEG 6 HOLE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130615|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BN CMNT XL 18-21MM IM CNL STRL|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D47300|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR ACCESS DIASTAT D47 X 30 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D06001|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR ACCESS DIASTAT D6 X 30 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7023-36S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE 3MM X 1000MM BALL-TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3550-16|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY EZ ANCHOR|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 467212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE DRIVING NAIL 3.2 X 48|1|HUMANA [1294]||HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 469055|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 55CM 3.2MM REACH SS BALL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS CROSS BIO-ABSORABLE C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|597.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|597.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 22.5 MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.96|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,452.96|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9060K-LOC|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVOIR TITAN 60CC|1|HUMANA [1294]||HUMANA [11839]|3,720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1935B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAK TISSUE 5MM C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D47150|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR ACCESS DIASTAT D47 X 15 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,607.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,607.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363311|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TEXTURED ANATOMICAL 310-325CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363511|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE TEXTURED-SHELL BIO-DIMENSIONAL LOW-ANA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1743-90-000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH TITANIUM SURGICAL (HARM`SCAGE) 10 X 15 X 23 X 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-74-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-153451|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-153 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542757|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.4CM SLTX P3.4CM MDRT PRFL RND SIL GEL TXTR 275|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102007|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 4X1CM ALDRM THK ACLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0333|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PISTON MCGEE PLATINUM STAINLESS 0.6MM 4.50|1|HUMANA [1294]||HUMANA [11839]|393.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV13|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 400CC STYLE-133 C1789|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV14|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 500CC STYLE133MV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542007|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.2CM SLTX P2.8CM RND MDRT PRFL SIL GEL TXTR 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.990S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 36MM DHS DCS SS HIP CNDRL CMPR SCKT STRL 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|293.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|293.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68211|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 210CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV16|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST HEIGHT MOD 700CC STYLE-133 C3400/C178|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3543257|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.9CM SLTX P3.6CM MDRT PRFL RND SIL GEL TXTR 325|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-72-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 30CM MIAMI MOSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|970.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|970.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905.139|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 9MM 13MM PRMSH RND TI LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|5,968.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,968.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501615|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 9.6-10CM MEMORYGEL P3.1-3.7CM MDRT PRFL RND SAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AM-0035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3520-9-945|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HUM LOCK NAIL SPREAD 5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6479-5-210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL DURATION KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,677.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,677.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64768260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 80MM CMNT KNMX COCR KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-01-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAYLOR ANKLE AGILITY SZ-1|1|HUMANA [1294]||HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-31-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ANKLE AGILITY SZ-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,938.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,938.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1134-53-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL MEDIUM 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6632-0-840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL STABILIZER LEFT-LARGE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,446.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,446.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3272-51|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECEIVER MATTRIX|1|HUMANA [1294]||HUMANA [11839]|14,730.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,730.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7495-10|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION IN-LINE C1883|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8627-10|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION SYNCHROMED W/FIL C1772|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.260|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.265|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.280|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.285|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.290|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.295|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +30 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-24.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-25.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-26.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-27.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-28.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-29.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-30.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.180|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +18 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.220|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +22 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-23.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.245|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +24.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-26.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00110901300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BN CMNT 13MM PLPLG MDLRY|1|HUMANA [1294]||HUMANA [11839]|196.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|196.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00110901900|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BN CMNT 19MM PLPLG HIP MDLRY|1|HUMANA [1294]||HUMANA [11839]|188.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|188.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 100700|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT XTRNFX ILZ FEM SLOT WRE BSC SET|1|HUMANA [1294]||HUMANA [11839]|64.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400160|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUFF S.T. 4.0CM (AMS 800) C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 870.292|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE HOLE 15MM X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8700286|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 13MM X 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8700272|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AXIS 2-HOLE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,182.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,182.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.155|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +15.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3023-2835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEDICLE 6.25 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|942.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 231X4.8X16.6MM SS 4.5MM SCR LG FRAG 14 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|682.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 20 DEG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139240|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTOR BI-MOORE II TAPER STANDARD|1|HUMANA [1294]||HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-13-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS TIBIAL ANKLE SZ-3 ANG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-03-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALOR AGILITY SIZE-3|1|HUMANA [1294]||HUMANA [11839]|8,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-33-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL AGILITY SIZE-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 237.084|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90D 40X11.7MM SS 4.5MM SCR 8 HL LMT CNTCT CNN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AP-0055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANNULATED HEADLESS ACUTRACK-PLUS 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRIR1485|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-LIMB 8.5CM 12MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-85-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END PEG GLOBAL ADVANTAGE 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207-2412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4 X 12MM SPIDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 100 DEGREE RIGHT EXTRA LONG 3MM X 3MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7096|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 1.5MM 7 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|417.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D06002|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR ACCESS DIASTAT D6 X 20 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,448.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,448.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-0160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FIXATION 2.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-0180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-0240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FIXATION 2.7 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AP-0040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANN HEADLESS ACUTRAK-PLUS 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AP-0050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANN HEADLESS ACUTRAK-PLUS 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-MPJL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 4 HL FSN BN 1ST MTP LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-1724R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPINAL KANEDA MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,730.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1743-17-000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,037.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,037.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-2027C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPINAL KANEDA LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,730.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5203-133|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK CLOSED NARROW BLADE 11.0MM|1|HUMANA [1294]||HUMANA [11839]|1,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-57-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK BODY EXTENDED MIAMI MOSS|1|HUMANA [1294]||HUMANA [11839]|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-64-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR TRANSVERSE MIAMI MOSS|1|HUMANA [1294]||HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.140|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13303-2.4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 2.4MM FEM BRKWY OSTM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200-7.5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WEDGE OPENING 7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BI-POLAR 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 35MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710182|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 82.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710187|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 87.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710190|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 90MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710195|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 95MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 100MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 105MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 110MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,694.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Z 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,224.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,224.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Z 9CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,831.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,831.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,092.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,092.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPNL 45MM 7MM ZPLT2 ANT THORLMBR SPNE TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT W/NUT ALT 7.0MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,029.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE ANT 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW-PROF ALT 6.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 821-004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE THORACIC 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,604.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,604.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 870-216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4109AAM1T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BREAK-OFF SET T25 TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 827-735|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 7.5 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4109AAMIT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 84118H|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOKS STANDARD RAMP|1|HUMANA [1294]||HUMANA [11839]|1,491.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,491.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1134-49-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1741-60-000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH TITANIUM SURGICAL (HARM`SCAGE) 15MM X 17 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1749-08-014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEAK POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1247-54-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR DURALOC 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-04-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALOR AGILITY SIZE-4|1|HUMANA [1294]||HUMANA [11839]|8,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-34-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL AGILITY SIZE-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-14-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS TIBIAL ANKLE AGILITY RT SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,753.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,753.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-23-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL TIBIAL LT SIZE-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814123007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 95.5MM TMX LWR XTRMT SYS 7 HL COMP ANTM LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3520-9-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUM LOCK 9 X 180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,406.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP #4 /12MM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6632-0-845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL STABILIZER LG RT 55MM A/P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,412.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,412.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07-0005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION LIMITED SPIDER LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3888|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD QUAD PISCES-PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8617L18|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION SYNCROMED W/FILTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133LV13|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 300CC STYLE133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542670|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.2CM SLTX P4.1CM MDRT PRFL RND SAL TXTR 425-475|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-9936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD COCR +4 28OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,266.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,266.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74-0056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL REFLECTION ACETABULAR 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,137.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,137.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74-0062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL REFLECTION ACETABULAR POROUS 62MM-O.D. LINER-SIZE H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-3032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-3036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-9006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL REVISION 12MM X 21CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 20MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 90MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 237.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90D 40X11.7MM SS 4.5MM SCR 5 HL LMT CNTCT CNN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 237.053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE 5-HOLE 30MM STAINLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-001-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL FORTE SMALL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-065-70|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANCELLOUS TI STERILE 6.5X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-065-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANCELLOUS TI STERILE 6.5X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-052-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL LARGE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115001000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 10MM HRBRT TIV MN SM BN NCLNLT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,077.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-004-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL FORTE SMALL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM FORTE SS FT PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579005512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB 27X44MM MG 2 KN LT MDL RL TIV ULTRAPEK UNCMP MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-024-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL PRECOAT KNEE UNI M/G MED-LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5788-050-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIBAL UNI M/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-SLH-4S-7X20|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE SOFT SURGISIS 7 X 20CM C1763|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,556.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,556.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1746-33-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SUMMIT 3.0MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68151|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 120CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68181|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 180CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168270|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ROUND TEXTURED STYLE-168 270-300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363136LF|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST LF SALINE TEXTURED SYTLE-363 410CC-430CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363140LF|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST LF SALINE TEXTURED STYLE-363 450CC-475CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-468496|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST BIO-DIMENSIONAL STYLE-468 495-520CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS ANKLE 10MM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5200-235|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK 11.0|1|HUMANA [1294]||HUMANA [11839]|1,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5203-123|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK CLOSED NARROW BLADE 9.5MM|1|HUMANA [1294]||HUMANA [11839]|1,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000-2011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 11MM X 11MM|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV15|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ANATOMICAL TEX SALINE MOD.VOL. 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 855-011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8700284|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE HOLE 13MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,344.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,344.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710177|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 77.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|981.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|981.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9051050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 50MM 10MM PRMSH RND TI MESH LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|17,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9051350|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG PRMSH 50MMX13MM CG TI RND LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|19,698.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,698.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-17.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14554-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN SHRT CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7276|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|CARDIOVERTER DEFIBRILLATOR IMPLANTABLE GEM III AT UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|61,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68481|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 480-510CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5972-021-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR NEXGEN 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,515.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,515.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5988-004-22|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE THIRD TIBIAL AUG SIZE4|1|HUMANA [1294]||HUMANA [11839]|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5988-008-22|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE 1/3 TIBIAL PRECOAT SZ8|1|HUMANA [1294]||HUMANA [11839]|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-008-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 8MM X 200MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-012-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 12MM X 200MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-014-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 14MM X 200MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.85S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 85MM 2.5MM FEM TI IM NL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.90S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 90MM 4.9MM 3.5MM FEM TI HEX DRV IM NL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.95S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 95MM 4.9MM FEM TI IM NL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 4.9MM FEM TIB TROCH DIST TI HEX DRV 100MM IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.72S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 72MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.80S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 80MM 4.9MM 8MM 3.5MM FT DIST TROCH FEM TIB TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225200200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 13MM MDN ORTH SS STRL|1|HUMANA [1294]||HUMANA [11839]|247.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 20MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225308037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 80MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2901488|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 3.2MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 3.2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 673208800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 32MM SIZE-H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902807000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HARRIS FEMORAL 300MMMEDIUM PRECOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902609500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER HARRIS PRECOAT PLUS HIP 12MM DIA.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-011-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 11M X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 12M X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 13M X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-014-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 14M X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-013-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS LM 13MM X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-014-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS LM 14MM X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-015-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS LM 15MM X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-016-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS LM 16MM X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-062-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 62 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 64 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-066-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 66 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-068-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 68 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-070-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 70 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-048-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 48 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-050-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 50 52 54 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 56 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-058-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 58 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-060-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 60 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-070-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 70 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8005-646-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS CUP ACETABULAR ALL-POLY ZCA 10-DEG 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,540.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,540.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM ST 12MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,329.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 486-0015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RADIAL HEAD TITANIUM 1.5 SWANSON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-015-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 15MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-016-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 16MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-017-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 17MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-018-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 18MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-012-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS LM 12MM X 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2457-001-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ECT EPIPHYSIS FRACTURE FIXATION LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-20.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-20.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-15.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-16.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-16.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-22.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-18.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-18.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-19.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-15.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-23.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-23.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-24.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-24.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-25.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-25.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-26.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-26.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-27.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-27.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-14.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597003501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 3 KN PRECT PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597004501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 5 KN PRECT PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597004502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 6 KN PRECT PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-049-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS ENDO UNIPOLAR FEMORAL HEAD 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMTB 39MM SS 4.5MM SCR LG FRAG 2 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|154.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|154.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 68MM SS 4.5MM SCR BSC FRAG 3 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 215MM SS 4.5MM SCR LG FRAG 13 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 231MM SS 4.5MM SCR LG FRAG 14 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 295X4.8X16.6MM SS 4.5MM SCR LG FRAG 18 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 247MM SS 4.5MM SCR LG FRAG 15 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 263MM SS 4.5MM SCR LG FRAG 16 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 119X4.8X16.6MM SS 4.5MM SCR LG FRAG 7 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-10.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.115|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +11.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-12.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-10.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-28.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.305S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 105MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 903002800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC 28MM +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,958.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,958.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1134-20-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL 12 X 10|1|HUMANA [1294]||HUMANA [11839]|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7854-014-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT STANDARD 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMBC-480|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEPRAMESH 4X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9990-017-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY-A 46MM-OFFSET PROXIMAL BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,918.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,918.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5970-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,535.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,535.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00430008200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 52MM KEEL BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1755-65-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR TRANSVERSE|1|HUMANA [1294]||HUMANA [11839]|1,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE 13MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7308|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER BUR HOLE LARGE 18.5 X 0.5 MM TITANIUM|1|HUMANA [1294]||HUMANA [11839]|573.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402255|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CYLINDER 15CM W/PUMP PRECONNECTED AMS 700 C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402258|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP PRECONNECT 18CM 700CX C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133LV11|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 150CC STYLE133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-5304M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 12X7CM BRST 150ML SMTH ELIP P7.2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-1515|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-2020|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST BECKER-50 400CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-2525|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILTEX/BECKER-50 GEL 500CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-3030|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILTEX/BECKER 50 GEL 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32902603035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 3.5MM LNG 28MM HIP ZML STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,106.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,106.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-10-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,399.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,399.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112852010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 52MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,610.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,610.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 25-68601|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ROUND SMOOTH MOD PROFILE 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68511|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 510-540CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-153361|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-153 360CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541757|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.7CM SLTX P2.8CM MDRT PRFL RND SIL GEL TXTR 175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464075|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRAME TI STRAIGHT 4CM|1|HUMANA [1294]||HUMANA [11839]|5,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4377-32-059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HOD SZ32/59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-12.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-15.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-20.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.105|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-16.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-18.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-20.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-22.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5967-033-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN SPRING NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|239.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|239.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ADAPTION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 135 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|921.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|921.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-005-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL RADIAL FORTE MEDIUM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-002-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL RADIAL FORTE MEDIUM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM 22MM TMX 4 CUT FLUT CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 18MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-028-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 28MM FORTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|193.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 32MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-012-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 12MM X 170MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-011-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 11MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598002701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 1 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,353.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,353.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7014-0334|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PISTON MCGEE PLATINUM STAINLESS 0.6MM 4.75|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5069-043-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INJECTOR BONE CEMENT RESTRICTOR|1|HUMANA [1294]||HUMANA [11839]|34.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1263|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT 1.5MM X 15MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1268|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN RIGHT-ANGLE 1.5MM X 10MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1262|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN SLIGHTLY-CURVED 1.5MM X 10MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600600|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HICKMAN CATH DUAL-LUMEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|971.85|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|971.85|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-1259|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN 180-DEGREE ROTATING 1.5MM X 7MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1267|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN CURVED 1.5MM X 12MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1352|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT FENESTRATED(4MM) 1.5MM X 12M|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1397|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN 90-DEGREE FENESTRATED 1.5MM X 12MM|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0330|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PISTON MCGEE PLATINUM STAINLESS 0.6MM 3.75|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902802000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL HARRIS PRECOAT MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,803.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 49MM 4 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 30MM 16MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 35MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 40MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41101|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VENTRICULAR CSF #41101|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 408.845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 45MM 16MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 50MM 16MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 55MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 60MM 16MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 65MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 130MM 16MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 45MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 55MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 60MM 32MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 65MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 70MM 32MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 75MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 80MM 32MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 85MM 32MM TI P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 90MM 32MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 95MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 100MM 32MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 105MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 110MM 32MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 115MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 120MM 32MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.925|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 125MM 32MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 409.930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 130MM 32MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-5303M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 10X6CM BRST 75ML SMTH ELIP P6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRS-005-US|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE NORIAN 5CC C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRS-010-US|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE NORIAN 10CC C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0331|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PISTON MCGEE PLATINUM STAINLESS 0.6MM 4.0|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1865-001-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PELVIC TRACTION 1865-01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400098|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP CONTROL C1815|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0332|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PISTON MCGEE PLATINUM STAINLESS 0.6MM 4.25|1|HUMANA [1294]||HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7925-011S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE SONGER DOUBLE|1|HUMANA [1294]||HUMANA [11839]|870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LACTOSORB 2.3 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|126.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.26S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 140 DEG 6 HOLE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.36S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 145 DEG 6 HOLE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112865010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 44MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,301.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,301.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5788-050-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL UNI M/G 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-025-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL PRECOAT KNEE UNI M/G MED RT.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-055-11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PRECOAT MG UNI MRT LLT 44MM AP S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5788-060-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL UNI M/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-6.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.075|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-8.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-8.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-9.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-9.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-31.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 31.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.320|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +32 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-34.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 34.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-24-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL TIBIAL LT SIZE-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-031-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL PRECOAT KNEE UNI SZ LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542655|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.3CM SLTX P3.9CM MDRT PRFL RND SAL TXTR 350-400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336452|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 52MM|1|HUMANA [1294]||HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-029-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL MG UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5788-070-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS INSERT TIBIAL MG UNI 4-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-075-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PRECOAT MG UNI MLT LRT 52MM AP S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-028-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT KNEE UNI MEDIUM LEFT LATERAL RIGHT 52 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175828P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 50CM 28MM 10MM THRX 2 VLR 1 BRCH SFT WVN HMSH PL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000-2009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGES BRANTIGAN 9 X 9MM|1|HUMANA [1294]||HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210133|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT PIN CROSS 3.3MM FEMORAL RIGID-FIX|1|HUMANA [1294]||HUMANA [11839]|597.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|597.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 65MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 75MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 70MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1110-20ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.322S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 130DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5790-026-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT KNEE UNI MEDIUM LEFT LATERAL RIGHT 50 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,376.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P302350|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .235 INTERVENTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5790-065-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PRECOAT MG UNI MLT LRT 48MM AP S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5788-070-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS INSERT TIBIAL MG UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G426-0101|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE FLEX SIZE-IS|1|HUMANA [1294]||HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.135|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +13.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1455-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 554913N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP OBLONG 57HS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,450.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,450.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 87-3544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY-DAIL N/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 TAPER FEM HD 28MM +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-1-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW GAMMA SET NAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905.163|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PYRAMESH ROUND 16MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905.194|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PYRAMESH 19MM X 40MM ROUND|1|HUMANA [1294]||HUMANA [11839]|8,556.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,556.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 27.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Z 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1391|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN ANGLE 4MM-OPENING 1.5MM X 5MM|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1392|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN 90-DEGREE FENESTRATED(4MM) 1.5MM X 12|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1362|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT 5MM-OPENING 1.5MM X 12|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-4066|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEV FX 4CM TI-FRM CSPN TI CRV LC2|1|HUMANA [1294]||HUMANA [11839]|5,115.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,115.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V10100L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX STRAIGHT 10MM X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,466.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,466.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-56236|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EAR PISTON FISCH TEF- PLATINUM 0.6MM X 6.00MM|1|HUMANA [1294]||HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.251S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 50MM DHS/DCS SS HIP CNDYL LG STRL 1 STP SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.655S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 55MM DHS/DCS SS HIP LG CNN STRL 1STP SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.660S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 60MM DHS/DCS SS HIP LG CNN STRL 1STP SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.81|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 300MM 2.8MM SS CLBRT FLUT DRL PNT TIP NONTHREAD 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.779|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 175MM 4MM SCHNZ HIP CNDYL SS SLF DRL MR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|529.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 419.89|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR THRD ORTH TI 3 MM CNN SCR NS|1|HUMANA [1294]||HUMANA [11839]|453.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 419.972|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 6.5MM CNN ORTH TI 3MM SCR NS|1|HUMANA [1294]||HUMANA [11839]|96.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437.053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE TITANIUM 90-DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE CANNULATED 3.5MM 90 DEG 5 HOLE 40MM BLADE LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437.063|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE 6-HOLE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,578.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,578.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437.064|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE TITANIUM 80-DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,578.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,578.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.473|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI BN RDS RT DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,562.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,562.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.482|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI BN RDS LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,343.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,343.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.483|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI BN RDS LT DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,720.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,720.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI DCP 2.0MM 5-HOLE 27MM C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 444.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DCP 2.7MM X 44MM 5 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|783.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|783.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 200MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.843|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 240MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,418.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.844|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 280MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,888.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,888.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.848|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.849|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,418.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.960|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END HUMERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.965S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END HUMERAL 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 420MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL 15 X 360|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.510E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 10MM SELF TAPPING 4MM HEAD WITH CRUCIFO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 475.082S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENSION 4.0 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.093S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.920S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 2MM 440MM IM ELC TI PED STRL GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,015.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,015.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.930S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 3MM 440MM IM ELC TI PED STRL AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 492.20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 2MM KRSH TI TROC PNT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 14MM 4MM TI ST CNN SLF DRL ST CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 15MM 4MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 16MM 4MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 18MM 5MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.619|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 19MM 5MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.514.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 14MM SELF TAPPING 4MM HEAD WITH CRUCIFORM RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 20MM SHORT THREADED WITH CRUCIFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 21MM 5MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 24MM 6MM TI ST CNN SLF DRL ST CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 25MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 28MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.629|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 29MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 30MM SHORT THREADED WITH CRUCIFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 32MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 34MM 7MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 36MM 7MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.863|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 55MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402.638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 38MM 8MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 40MM SHORT THREADED WITH CRUCIFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 14MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 15MM TI L/T CNN LCK STRDR RCS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 16MM 7MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.717|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 17MM 8MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 18MM 8MM TI L/T CNN SLF DRL ST CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.719|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 19MM 9MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 20MM LONG THREADED WITH CRUCIFORM R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 22MM 10MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 65MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|544.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402.723|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 23MM 10MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 24MM 10MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.725|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 25MM 10MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 26MM 12MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.727|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 27MM 12MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 28MM 12MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 30MM LONG THREADED WITH CRUCIFORM R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 32MM 14MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 34MM 16MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 36MM 16MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.866|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 70MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|459.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402.738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 38MM 18MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 40MM LONG THREADED WITH CRUCIFORM R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 62MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|77.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.617|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 17MM 4MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 22MM 5MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.623|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 23MM 5MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 26MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.627|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 27MM 6MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.721|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 21MM 9MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.729|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 1.2MM 29MM 12MM TI SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 30MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.205.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 30MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 80MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 40MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 45MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 55MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 60MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 65MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 70MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 32MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.205.285|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 85MM SS 4MM P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 7.3MM X 50MM WITH 4.0MM HEXAGONAL S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 75MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.583|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 22MM SS ST LG HEX THRD CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|307.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 34MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 222.587|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 38MM SS ST LG HEX THRD CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.588|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.4MM 42MM SS ST LG HEX THRD CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|307.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 70MM SS P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 75MM SS P/T CNN ST SLF DRL CNCL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451543V0|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 65CM 5FR .042IN CRDS TMP CBR SM ADLT 2 CRV VSCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 36MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0062181110|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URET 3FR 12FR 150CM 4CM GW LOPRFL BLNDIL PSPRT HDR+ SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-19.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-17.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 90MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 38MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00248001241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 18MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598002702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 2 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 487.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EXPANSIONHEAD SELF-TAPPING 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 20MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 22MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 24MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 26MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 28MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 40MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|234.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00482702801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 28MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482703001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 30MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114606532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 65MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5790-045-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PRECOAT MG UNI MRT LLT 40MM AP S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 210MM SS 10 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114604032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 40MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00248003440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM FORTE FT CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 12MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM 5MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM 5MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM FORTE CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 6D +7MM MED 32MM HIP ZML COCR LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 74X46X14MM KN REV MACH MLD TIV UHMWPE NGS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599708400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HEADLESS 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 44MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-08-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,690.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,690.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00225303555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 35MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KTCC-NP31|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BASE TIBIAL CC SZ3+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86DR-0300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY BONE DR ALLOMATRIX 3CC C1713|1|HUMANA [1294]||HUMANA [11839]|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5970-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VIK7S1|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 7FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8281246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET 3D DBL-HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|394.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|394.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234700206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 146MM SS 6 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5788-050-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL UNI M/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO POLY PAT-ONSET 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234702218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 18MM SS FT PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 242MM SS 12 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 18MM 7MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 242MM SS 12 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-343|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIOVERTER ATLAS HF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-299|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END ROUND 19MM PYRAMESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,528.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,528.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK BLU 50MM 3.9MM 8MM PROX HUM TI ST TROC TIP HEX RCS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 27-363154LF|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE TEXTURED LOW-HEIGHT FULL PROJECTION 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6860013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 13MM PRMR TI SPNE CRV CANC ANT VA ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,114.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,114.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93-7202|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING TUTOPLAST SUSPEND 2 X 18CM|1|HUMANA [1294]||HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1743-22-000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH TITANIUM SURGICAL (HARM`SCAGE) 12MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799137|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 37.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6003-001-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIXED MANDIBULAR TWO TRANSOSTEAL PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,989.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,989.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 53X5X1.2MM TI 2MM SCR MDLR HND SYS 2 HLE/HD 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8370060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE CUT 6.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8370040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE CUT 4.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8370050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE CUT 5.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8141-13-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL EX-SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5970-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402970|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVIOR 65ML INHIBIZONE 700CX C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1741-59-000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH TITANIUM SURGICAL (HARM`SCAGE) 10MMX17X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-60165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 150/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VERTEX 3.2MM X 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.19|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|533.19|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6900300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET VERTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8370080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE CUT 8.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133LV12|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 200CC STYLE133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPNL 40MM 7MM ZPLT2 ANT THORLMBR SPNE TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 27.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.96|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,452.96|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8370070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 7.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS ANKLE 10MM X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,274.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,274.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5970-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S0603|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 30CM 6MM STD WL PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK BLU 56MM 3.9MM 8MM 3.5MM PROX HUM TI ST TROC TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|701.22|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|701.22|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72400452|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PENILE MALLEABLE 600M C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 801302095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 13MM 9MM 95MM TK2 TMX STD HIP ST LG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|546.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|546.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 811305003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN TK2 TMX SHRT CMPR CPTR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6860053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 13MM PRMR TI SPNE CRV CANC ANT VA ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,158.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,158.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6860055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 15MM PRMR TI SPNE CRV CANC ANT VA ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,158.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,158.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5970-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,535.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,535.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.670E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4 X 10M RECON PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1128-08-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,820.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,820.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 801302090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 90MM STD LG KYLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.472|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI BN RDS RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,343.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,343.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-034-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ D 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1770-10-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BENT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1770-10-085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BENT 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1770-91-060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TYPHOON|1|HUMANA [1294]||HUMANA [11839]|765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6860165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PREMIER 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,797.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,797.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 25.0MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,544.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,544.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-030-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN YELLOW 10MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 459.26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 26MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 45.0MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8792117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS ZEPHIR 3.5MM X 17MM(BLUE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,037.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,037.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792717|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS ZEPHIR 4.0MM X 17MM (GRAY)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,226.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,226.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-166|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PYRAMESH 16MM X 60MM ROUND|1|HUMANA [1294]||HUMANA [11839]|22,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 178MM SS 8 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 210MM SS 10 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,254.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 273MM SS 14 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 305MM SS 16 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 337MM SS 18 HL NONLOCK BN FEM LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 28MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234700114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 273MM SS 14 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 337MM SS 18 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 59MM 3.5MM SCR 4 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 83MM 3.5MM SCR 6 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 131MM 3.5MM SCR 10 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 154MM SS 3.5MM SCR 12 HL NONLOCK BN TIB LT PROX LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 182MM SS 3.5MM SCR 14 HL NONLOCK BN TIB LT PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 202MM SS 3.5MM SCR 16 HL BN TIB LT PROX LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 59MM 3.5MM SCR 4 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 83MM 3.5MM SCR 6 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 4.9MM 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234700310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 131MM 3.5MM SCR 10 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 154MM SS 3.5MM SCR 12 HL NONLOCK BN TIB RT PERIART LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 182MM SS 3.5MM SCR 14 HL NONLOCK BN TIB RT PERIART LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 202MM SS 3.5MM SCR 16 HL NONLOCK BN TIB RT PERIART LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200113|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE ORTH SS 1.3MM 56CM STRL CBL RD|1|HUMANA [1294]||HUMANA [11839]|708.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|708.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2832093|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FRACTURE 16 HOLE 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,002.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,002.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -3MM 12/14 TPR 32MM HIP COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.418S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 380MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 459.32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 32MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 354-1500|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL 150CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175830P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 50CM 30MM 10MM THRX WVN HMSTS SFT FLXB KNIT HMSH PL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504254 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 425CC CHSV GEL SMTH MEMORYGEL SIL P5CM HI PRFL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-5305M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 14X8CM BRST 250ML SMTH ELIP P9CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112844000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 44MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 853841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM 10/12 TPR 32MM HIP COCR PFC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,236.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.075|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +7.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.080|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +8 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.085|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +8.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.095|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +9.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 34MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MA60AC.125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.318S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 170MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CZ70BD.100|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +10 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.105|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +10.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.110|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +11 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.115|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +11.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.120|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +12 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 36MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CZ70BD.125|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +12.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.130|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +13 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.145|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +14.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.155|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +15.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.275|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +27.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.280|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +28 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.285|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +28.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.290|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +29 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.295|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +29.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.300|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +30 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 38MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTA4U0-5.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 5.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.065|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +6.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Z 7.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,146.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,146.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-51-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTRACTOR MIAMI MOSS REDNESA|1|HUMANA [1294]||HUMANA [11839]|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-52-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE ANGLED MIAMI MOSS|1|HUMANA [1294]||HUMANA [11839]|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-54-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK WIDE MIAMI MOSS|1|HUMANA [1294]||HUMANA [11839]|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-53-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK NARROW MIAMI MOSS|1|HUMANA [1294]||HUMANA [11839]|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-70-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 48CM MIAMI MOSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,191.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,191.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5970-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 459.40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 40MM 4.9MM 8MM TI ST TROC TIP HEX DRV IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 30.0MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,147.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,147.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 32.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 35.0MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 40.0MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,829.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,829.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 42.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,829.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,829.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,583.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 50.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,246.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,246.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 52.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 55.0MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799157|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 57.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 459.42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 42MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,065.22|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 62.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799167|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 67.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8799170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL ZEPHIR 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,606.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114610000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 100MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114612500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 125MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225238010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 38CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225240010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 40CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225240014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 40CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 44MM 4.9MM 8MM TI ST TROC TIP HEX DRV IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00225242011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 42CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225246011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 46CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 75MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225309555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 95MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VERTEX 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 178MM SS 8 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114610532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 105MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 305MM SS 16 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00600300200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIXED-MANDIBULAR FOUR TRANSOSTEAL PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200641|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CORNERSTONE 6MM TISSUE HUMAN|1|HUMANA [1294]||HUMANA [11839]|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 46MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00202175928P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 50CM 28MM 10/10/8/8MM THOR 2 VLR 4 BRCH SFT FLXB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175930P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 50CM 30MM 10/10/8/8MM THOR 2 VLR 4 BRCH SFT FLXB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,444.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,444.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1770-10-045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 40MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.573|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 7.3MM X 80MM WITH 4.0MM HEXAGONAL S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8370030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE CUT 3.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-133|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 30MM 13MM PRMSH RND TI MESH LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|12,348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE 10MM FRS|1|HUMANA [1294]||HUMANA [11839]|534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555-11-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS TIBIAL ANKLE AGILITY SZ-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 48MM 4.9MM 8MM TI ST TROC TIP HEX DRV IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 354-6212|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER CONTOUR PROFILE MEDIUM 6200 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PREBENT CDH 5.5 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 199X4.8X16.6MM SS 4.5MM SCR LG FRAG 12 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|682.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 263X4.8X16.6MM SS 4.5MM SCR LG FRAG 16 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4945-011-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SELF COMPRESSION NARROW 11 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|384.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OG-1818SF|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ORBITAL WRAP BOVINE-PERICARDIAL|1|HUMANA [1294]||HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OG-2020SF|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ORBITAL OCUGUARD WRAP 20 MM|1|HUMANA [1294]||HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-10.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 50MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1755-26-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INNER MIAMI MOSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07-0006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION LTD SPIDER MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07-2408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07-2410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112848000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 48MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,833.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,833.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 113145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL 22MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,893.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,893.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 54MM 4.9MM 8MM HEX TROC FEM TI ST IM NL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-86-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END PEG GLOBAL ADVANTAGE 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1210-6450S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE 3.2 X 450MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1255-64-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP SOL DEEP-PROFILE 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,655.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,655.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 55MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2230-1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT 3/8"|1|HUMANA [1294]||HUMANA [11839]|174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LC-DCP STAINLESS NARROW 10-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225502500|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 70CM 2.4MM MDN HUM SMTH TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 18MM 7MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 56MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00248002040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM 8MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 270603|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GOLD SURGISIS 13 X 22CM HERNIA REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-153631|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE-GEL STYLE-153 640CC C1789|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|384.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS ANKLE 11MM X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,757.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,757.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS ANKLE 12MM X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503330|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11-11.3CM P4.8-6.2CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 58MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3503380|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.4-11.7CM P5.2-6.4CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503420|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.7-12CM P5.4-6.7CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503460|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.1-12.4CM P5.5-6.9CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-2000|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL 200CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 36MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 60MM 4.9MM TROCH TI IM NL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 457.010S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 15MM 0MM EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.54S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 54MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.674E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4 X 14MM RECON PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.676E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4 X 16MM RECON PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 44MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 44/45/46MM 28MM VRSY LD/FX HIP POLY PRFT CMNT ASMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 46MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 459.64|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 64MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 47MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 47/48/49MM 28MM VRSY LD/FX HIP POLY PRFT CMNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500105328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 53/54/55MM 28MM VRSY LD/FX HIP POLY PRFT CMNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-054-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 54MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5250-008-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LEFT OFFSET 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,038.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,038.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5400646|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DYNAMIC 1.7MM 90 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5788-040-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM TIBIAL UNI M/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,109.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-099-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG TAPER|1|HUMANA [1294]||HUMANA [11839]|2,847.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,847.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 60002012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X13X11MM BRGN I/F CFRP PLIF|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.68|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 68MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6000-2013|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 13MM X 13MM|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-0-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP PHS #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X62-64 20DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401685|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY (AMS 800) C1815|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.72|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 72MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7500-00-004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HUM SZ.8.5MM SELECT SHOULDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,959.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115519|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 19MM TI 5.5MM ROD LOPRFL FX LG X10 XLNK CD HZN BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 827-635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHOR 5.0 #2 DBS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902801000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL HARRIS PRECOAT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,803.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902803000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL HARRIS PRECOAT LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.76|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK TN 76MM 4.9MM 3.5MM PROX DIST TROCH FEM TIB TI ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BXS6120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT FIX BONE NAIL SMART 20MM X 1.5 C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|509.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|509.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C6140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5MM 2 SRV 2 BRAID PRELD PRTHD DRVR SMPL PLSTR DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|509.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|509.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-20.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 4.9MM 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LPS5013|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ACCESS VASCULAR PORT-TIATTACH 10F W/KIT|1|HUMANA [1294]||HUMANA [11839]|127.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.060|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +6 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.065|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +6.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.861|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 45MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MA60MA.050|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D -5 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-11000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE VENTILATION SHEPARD- GROMMET W/INTGRAL TAIL 1.1MM|1|HUMANA [1294]||HUMANA [11839]|118.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225200300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END HUM LCK IM NL SYS SS STRL MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2228-024-00|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BULLET-TIP 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KIMP-310R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KFTC-NP2L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL SZ2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KTCC-NP50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BASE N/P SZ-5 NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KFTC-PC2L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COATED SZ-2 LEFT NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KFTC-PC3R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO FEMORAL ADV RIGHT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.87|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 90MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported KFTC-PC5R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS COATED SZ-5 NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KPRC-25HI|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA 35MM HI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32810502504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT HUM 4IN CNRD MRY SM ELB TIV ZML UHMWPE 2 PC LCK PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,462.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,462.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-040-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 40MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WP2040|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH WHITTMAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402984|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CYLINDER PENILE PRE-COM PENOSCROTAL INHIB 12CM 700CX C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.872|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 100MM FOR USE WITH DISTAL FEMORAL NAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-48-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP 48MM 28MM UHR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY REV PATELLA SM PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,012.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,012.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK ACETABULAR 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK ACETABULAR 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS SHELL OSTEOLOCK NP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287-5-052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL PCA ACE/DEEP-SOCKET 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-17.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-25.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07-2414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4 X 14MM"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1CK003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MALAR MED-RIGHT|1|HUMANA [1294]||HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1CK004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MALAR MED-LEFT|1|HUMANA [1294]||HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3986|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD RESUME LT C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6283-7-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR SIZE-C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER VARIABLE|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SLOT|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 827-630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 30 MULTI-AXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.023.311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL LOCKING LT 5-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RRT10070070L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 70CM 10MM THNWL GRTX REM RING LN 70CM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.421S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 400MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 32-8105-053-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ULNAR SMALL 3" RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR TI 40MM 7MM 2MM ACL PCL CNN BLNT THRD RCI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG APICAL OSTEOLOCK|1|HUMANA [1294]||HUMANA [11839]|318.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 18MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 16MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 20MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OUTER 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.951|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 3.5MM X 74MM OBLIQUE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,221.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,221.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 10MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 12MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 22MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 24MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 26MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 34MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 38MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 40MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 45MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 50MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 52.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1134-41-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL MED 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM BI-MOORE II STRAIGHT SOLID 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 50MM 5.5MM CD HZN LGC PREBNT TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,311.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5511-033-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING TIBIAL A/P LIPPED 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,972.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,972.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1110-22ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1110-16ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-D6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE GREY SCREW 5.0MM DRILL 6MM HEX-SIZE 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STA-P3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 3.8MM PROXIMAL GREY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STA-D4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 4.3MM X 6MM MID GREY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STA-D3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 3.8MM X 6MM MID GREY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6120-066-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER TRILOGY 20 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,717.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 70MM 25.4MM VFX SS LG THRD HIP LNK LG CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 75MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 80MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 85MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 95MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7854-016-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT EXTENDED OFFSET 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL LOPRFL 86MM SS FEM FX SYS 4 HL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD BRL 70MM SS 3 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBE VERSA FX 135 DIAMETER 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBE VERSA FX 135 DIAMETER 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD BRL 118MM SS 6 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119314004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D STD BRL 86MM SS 4 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-065-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANCELLOUS TI STERILE 6.5X75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6860162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PREMIER 62.5RD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,797.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,797.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8220038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Z 9CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,124.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,124.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8941420P|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 20X17MM 14MM LTCG TI LMBR TPR FSN DEV|1|HUMANA [1294]||HUMANA [11839]|15,449.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,449.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234806535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 65MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248004040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1731-21-139|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 9MM X 13MM X 21MM|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-014-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1888-78-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN TIBIAL|1|HUMANA [1294]||HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1188-30-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP TIBIAL|1|HUMANA [1294]||HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501620|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10-10.6CM P3.3-3.9CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-058-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419685|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM 22MM TK2 TMX LG 4 CUT FLUT CANC CNN ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.135|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +13.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3586|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD RESUME|1|HUMANA [1294]||HUMANA [11839]|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19-CAVGJ-514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 12CM 19MM MSTR HMSHLD CLGN MECH LO POR GFT MR|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14333-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE SM."Y"4HOLE(NARROW)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA1402|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 20CM 14MM STD WL STRG LG DIA PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA1602|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 20CM 16MM STD WL STRG LG DIA PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,239.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,239.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 32mm/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3542625|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11CM SLTX P3.4CM MDRT PRFL RND SAL TXTR 200-225ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-10.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-10.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-17.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.255|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6213|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER CONTOUR PROFILE MEDIUM 6200 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6214|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER CONTOUR PROFILE MEDIUM 6200 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6215|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER CONTOUR PROFILE MEDIUM 6200 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL PROXIMAL LCP 3.5MM X 90MM 6 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AP-03000-M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP CONST FLOW MED 0.86-1.45|1|HUMANA [1294]||HUMANA [11839]|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 483-3104|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GREAT-TOE SILASTIC SIZE4|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-12.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 43MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 42MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-041-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 41MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 40MM MLPLR HIP MTL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 45MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-052-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 52MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-051-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 51MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 49MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-048-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 48MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-060-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 60MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-057-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 57MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500105500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 55MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,502.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,502.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500105300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 53MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.25S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 140 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 42/43MM 22MM VRSY LD/FX HIP POLY PRFT CMNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500106028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 60/62MM 28MM VRSY LD/FX HIP POLY PRFT CMNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|955.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500104022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 40/41MM 22MM VRSY LD/FX HIP POLY PRFT CMNT ASMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00500105028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 50/51/52MM 28MM VRSY LD/FX HIP POLY PRFT CMNT ASMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|955.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7255-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-054-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-048-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-058-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-062-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-060-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114610032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 100MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BP 57/58MM 28MM VRSY LD/FX HIP POLY PRFT CMNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|955.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|955.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8013-02-080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 348050|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE WEIL-CARVER|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.840S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCK 4.0 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-3290|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.5-10.8CM P4.7-5.9CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148883025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR CK CTR DOME 9.5MM 38MM CMNT A CRD U ALPLY KN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8141-00-004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPIDER OFF-SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 174022010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT ROD 1 XVR LOPRFL TI THORLMBR SPNE|1|HUMANA [1294]||HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 174022020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT ROD XVR 2 THORLMBR SPNE TI LOPRFL CX|1|HUMANA [1294]||HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1740-22-040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSSOVER SZ-4|1|HUMANA [1294]||HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1740-22-050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS SZ-5|1|HUMANA [1294]||HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3544350|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.7CM SLTX P4.9CM HI PRFL RND SIL GEL TXTR 350ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3544375|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12CM SLTX P5CM HI PRFL RND SIL GEL TXTR 375ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 55MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 5MM 65MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 118MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,532.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,532.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING LCP PROXIMAL TIBIA 4.5 RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,585.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,585.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 82MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483501201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 12MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 240.039|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 118MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,532.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,532.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.657|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 170X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.658|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 206X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 8 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,938.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,938.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.659|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 206X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 8 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,938.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,938.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.661|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 242X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 10 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,123.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,123.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.663|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 278X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 12 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,227.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,227.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.664|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 314X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 14 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,511.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,511.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 314X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 14 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,511.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,511.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 350X17.5X5.2MM SS 4.5/5MM SCR 16 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,495.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,495.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1571-34-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM SOLUTION 13.5 10" RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.511.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 11MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.814.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 14MM TI HND CORT ST CRFRM NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-045-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CORTICAL TI STERILE 4.5X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-045-58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CORTICAL TI STERILE4.5X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-045-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CORTICAL TI STERILE4.5X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6283-7-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PCA ACETABULAR LOW-PRO 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,460.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,460.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6283-7-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HOOD 32 X 58 61MM 10DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025-01.5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VSP A 1.5 SLOT STAINLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM 32MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-003-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL RADIAL FORTE LARGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2480-006-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL RADIAL FORTE LARGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,454.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM 5MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM 9MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM 10MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM 12MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248002840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM 14MM FORTE SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248001041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248003841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00248004041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM FORTE SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 100MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 105MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ABSORB CANNULATED 4.5 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-6-325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA 125-DEG 11 X 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173125110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X11X9MM JAG IFCG WDG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1731-21-111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 11MM X 11MM X 21MM|1|HUMANA [1294]||HUMANA [11839]|8,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 32mm/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6260-5-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 32mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5260-4-952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS SHELL OSTEOLOCK 52MM NP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK NP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK ACETABULAR OUTER 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,442.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,442.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484003000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 30MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484003400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 34MM SS FT SM HEX CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484003800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 38MM SS FT SM HEX CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483501604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 16MM NON SELF-TAPPING 6MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483501804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 18MM NON SELF-TAPPING 6MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 20MM NON SELF-TAPPING 6MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 22MM NON SELF-TAPPING 6MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 24MM NON SELF-TAPPING 10MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 66MM SS CORT ST LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 68MM SS LG HEX CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 22MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 24MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 26MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 28MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 30MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 32MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 34MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 36MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 40MM 12MM SS CORT LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 26MM NON SELF-TAPPING 10MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 28MM NON SELF-TAPPING 10MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 30MM NON SELF-TAPPING 10MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 32MM NON SELF-TAPPING 12MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 34MM NON SELF-TAPPING 12MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 36MM NON SELF-TAPPING 12MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 38MM NON SELF-TAPPING 12MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483504004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 40MM NON SELF-TAPPING 12MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483504504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 45MM NON SELF-TAPPING 15MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483505004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SHAFT ZPS 3.5MM X 50MM NON SELF-TAPPING 15MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 20MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00490004550|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT ORTH 2.7MM 11MM CORT SS 4.5MM SCR NS|1|HUMANA [1294]||HUMANA [11839]|166.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 22MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486504502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM 32MM SS FT CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486505002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486505502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486506002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 60MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486506502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM 32MM SS LG HEX CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486507002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM 32MM SS LG HEX CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486507502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 75MM 32MM SS LG HEX CANC THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486508002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 80MM 32MM SS LG HEX CANC THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486508502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486509502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 95MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486510002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM 32MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486510502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 105MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486511002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 110MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486507001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM 16MM SS LG HEX CANC THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486506500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM SS FT CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486510500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 105MM SS FT CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486511000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 110MM SS FT CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484006000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 60MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 61MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 73X10X3.3MM SS 3.5MM SCR SM FRAG 6 HL CMPR BN CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|365.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 109X10X3.3MM SS 3.5MM SCR SM FRAG 9 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493503504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 3.5MM 3-HOLE HEAD 5-HOLE SHAFT 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 38MM 12MM SS LG HEX CORT SHFT THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486509002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM 32MM SS CANC LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 30MM 15.5MM SS LG HEX MLR THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234803035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR 3.5MM X 30MM WITH 2.7MM HEAD SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482700701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 7MM SS SM HEX CORT ST NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482700901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 9MM SS CORT ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482702601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 26MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482703201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 32MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482703401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 34MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482703601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 36MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482703801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 38MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482704001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 40MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482705001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 50MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27615030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CANCELLOUS 30CC CHIPS|1|HUMANA [1294]||HUMANA [11839]|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1731-21-109|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 9MM X 9MM X 21MM|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173121110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 21X11X9MM JAG IFCG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1731-25-111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 11MM X 11MM X 25MM|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173125112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X13X11MM JAG IFCG WDG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM 4MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM 5MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM 5MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM 6MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM 8MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM 9MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM 10MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM 12MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM 14MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPM-35|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH POLYPROPYLENE CLEAR 3" X 5"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|126.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579104100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW GD 48MM PERSONA M/GSS KN HD UNCMP HI FLX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL PROXIMAL LCP 3.5MM X 114MM 6 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,843.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,843.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-040-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 40MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-046-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 46MM X 27MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402960|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVIOR 100ML INHIBI-ZONE 700 ULTREX|1|HUMANA [1294]||HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-D5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 5.0MM X 6MM MID GREY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4300-046-15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 46MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493501000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 121X10X3.3MM SS 3.5MM SCR SM FRAG 10 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-P1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 2.8MM PROXIMAL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|708.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STA-D1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 3.8MM X 6MM MID BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|708.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1770-73-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK NARROW 9.5MM|1|HUMANA [1294]||HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4193-88|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD LEFT VENTRICULAR IMPLANTABLE ATTAIN OTW 88CM UNIPOLAR 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 004807|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER BONE PLIF 7MM|1|HUMANA [1294]||HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-050-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN BLUE 10MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1731-25-109|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 9MM X 9MM X 25MM|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595204010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-H STD 74X46X10MM KN PRLNG NG CRFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-030-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN YELLOW 12MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5112-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.512.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 12MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 87-3545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NON-CONSTRAIN POLY-DIAL 32MM/10-DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.842S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.834S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCK 4.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.838S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|408.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.934S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 34MM TI 3.5MM FT FEM DIST ST LCK 2 LD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 414.550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.7MM 50MM 17MM TI ST RVRS CUT FLUT LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-P2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 3.3MM PROXIMAL GREY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5782-052-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR MG KNEE TIBIAL 8.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588604410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB YLW 67X47X10MM NXGN 4 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 65-6200-052-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL CLUSTER TRILOGY W/HOLE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,915.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,915.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.830S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.938S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 38MM TI 3.5MM FT FEM DIST ST LCK 2 LD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7210-050-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-058-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-042-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICUL TIBIAL 16MM MG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KPON-35ST|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SINGLE POST 35MM NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.932S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 32MM TI 3.5MM FT FEM DIST ST LCK 2 LD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.940S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 40MM TI 3.5MM FT FEM DIST ST LCK 2 LD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7862-015-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.946S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 8MM 46MM TI 3.5MM FT FEM DIST ST LCK 2 LD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 245.081|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECONSTRUCTION LCP 3.5MM X 112MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,720.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,720.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.581|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 111X11X3.4MM SS 3.5MM SCR SM FRAG SET 8 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,074.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM VRTX TI SPNE THOR CANC MA VA STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,261.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 8MM VRTX TI SPNE THOR CANC MA VA STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,261.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 8MM VRTX TI SPNE THOR CANC MA VA STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,261.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,261.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CQ7564|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 75CM 4CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CQ7574|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 75CM 4CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 240.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 82MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y6901000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR SCREW VERTEX|1|HUMANA [1294]||HUMANA [11839]|1,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MATRIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 5/40 36MM HIP TPR AL V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y6902525|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP CROSSLINK|1|HUMANA [1294]||HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-22.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60-1120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRIMARY 12MM X 4.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PYRAMESH 25MM X 15MM X 10MM|1|HUMANA [1294]||HUMANA [11839]|14,112.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,112.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-D2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 4.3MM X 6MM MID BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|708.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-SAH-8P|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR HERNIA GOLD SURGIGIS 7CM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 55MM SS 2.7/3.5MM SCR 4 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 55MM SS 2.7/3.5MM SCR 4 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90-9916SC|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PENILE TITAN SCROTAL 16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579104300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW GD 27MM PERSONA KN SS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|143.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|143.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 43MM SS 2.7/3.5MM SCR 3 HL NONLOCK BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234800712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 79MM SS 2.7/3.5MM SCR 12 HL NONLOCK BN HUM PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,364.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-042-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL M/G 18.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35361278|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 9IN .093IN STNM SS SMTH TROC PNT 1 END STRL|1|HUMANA [1294]||HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563024N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LG STR S-ROM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,894.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,894.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 163X11X3.4MM SS 3.5MM SCR SM FRAG SET 12 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,271.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,271.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.504S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D SHRT BRL 78MM SS 4 HL DHS/DCP BN HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GDS010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CHAMBER GRAFT LIFENET 10CC|1|HUMANA [1294]||HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GDS015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CHAMBER GRAFT LIFENET 15CC|1|HUMANA [1294]||HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-16.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-17.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-19.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-20.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-21.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-22.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-23.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-14.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9430|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SNTH TISS INFR ORBT RIM RT|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68651|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ROUND SMOOTH MOD PROFILE 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECONSTRUCTION LCP 3.5MM X 70MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,361.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001-058-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 58MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 470-5205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER GROMMET SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-6728-088-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER CROSSLINKED LONGEVITY ACETABULAR HGPII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,916.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,916.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207677|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR HA 30MM 7/7MM 1.5MM ACL PCL BABSR CNN BIORCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|809.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR HA 35MM 8MM 1.5MM ACL PCL BABSR CNN BIORCI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|809.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-012-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1770-73-065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOKS OPEN 6.5MM|1|HUMANA [1294]||HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-017-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-018-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-014-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM SS FT PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225338010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 38CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.67|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLOVERLEAF 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6110-066-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER TRILOGY 10 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,717.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 871-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 871-077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.5MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TARP-25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY TAILOR SJM 25MM|1|HUMANA [1294]||HUMANA [11839]|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TARP-27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY TAILOR SJM 27MM|1|HUMANA [1294]||HUMANA [11839]|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TARP-29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY TAILOR SJM 29MM|1|HUMANA [1294]||HUMANA [11839]|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TARP-31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY TAILOR SJM 31MM|1|HUMANA [1294]||HUMANA [11839]|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TARP-33|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY TAILOR SJM 33MM|1|HUMANA [1294]||HUMANA [11839]|7,002.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,002.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TARP-35|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY TAILOR SJM 35MM|1|HUMANA [1294]||HUMANA [11839]|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,353.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MA50BM-17.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2335|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LACTOSORB SUSPENSION 2.0 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-28.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503310|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.7-11CM P4.8-6CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.6CM MEMORYGEL CHSV I P5.5CM HI PRFL RND SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505004 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.2CM MEMORYGEL P5.3CM HI PRFL RND NAR BS SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.8CM MEMORYGEL P5.1CM HI PRFL RND NAR BS SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503754BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12CM CHSV I MEMORYGEL P4.8CM HI PRFL RND SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 350CC CHSV GEL SMTH MEMORYGEL SIL P4.8CM HI PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-14.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 9.0MM X 20MM INTERFERENCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 44X3.5MM LC DCP TI 3MM STD CORT HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2026-3235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP BONE 7.0MM X 35MMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112844110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 44MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 611819|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 24MM 100CM 4CM RPD INFL FLXB DIST TIP COAX SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1220-28-254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MARATHON 20-DEG. 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.14003.011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FIBULAR 10 X 6 X 0|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.14003.012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FIBULAR 10 X 7 X 0|1|HUMANA [1294]||HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1220-28-166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR DURALOC 28MM 660D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001-062-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 62MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5001-064-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MULTIPOLAR 64MM OD (BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,444.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,444.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5782-056-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 23MM MILLER-GALANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,892.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,892.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588604310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB YLW 67X43X10MM NXGN 3 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-3 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB YLW 67X47X12MM NXGN 4 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB YLW 67X47X17MM NXGN 4 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB GRN 75X47.5X10MM NXGN 5 C-H KN TIB TRB MTL PE CR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB GRN 75X47.5X12MM NXGN 5 C-H KN TRB MTL PE CR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB GRN 75X51X12MM NXGN 6 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB GRN 75X51X14MM NXGN 6 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-046-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-6 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB BLU 83X52X12MM NXGN 7 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-047-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-047-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-7 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-048-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-048-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-048-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-048-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-8 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-021-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN PURPLE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00595202112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN PURPLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-021-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN PURPLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-021-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN PURPLE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-021-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN PURPLE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-030-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN YELLOW 14MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00595203017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-H STD 66X42X17MM KN PRLNG UHMWPE CR-FLX NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-030-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN YELLOW 20MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-040-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN GREEN 12MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-040-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN GREEN 14MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-050-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN BLUE 12MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-050-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN BLUE 14MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-050-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN BLUE 17MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5952-050-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR NEXGEN BLUE 20MM MLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5966-004-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL-CR #4X14MM YELLOW NEX-GEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5976-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS COMPONENT FEMORAL CRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,619.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,619.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-017-91|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-017-92|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-017-91|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS LPS NEXGEN SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,958.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,958.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5992-017-92|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS LPS NEXGEN SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6341-044-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 44 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6341-046-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 7MM-OFFSET 46 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,645.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672200900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD ACETABULAR CUP J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|980.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|980.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672209200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ELEVATED RIM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-048-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,817.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,817.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-050-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-052-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-054-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-060-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-062-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7205-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 0-DEG 28MM 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,170.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-052-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-054-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-060-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6210-S5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LEAD INTRODUCER KIT PERC. 6210-S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-062-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7840-020-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS BEADED SZ-20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,213.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,213.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7854-011-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CT VERSYS 11X120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785401200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CT 12MM X 125MM CEMENTED VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785401300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT STANDARD 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785401320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT EXTENDED OFFSET 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7854-014-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT EXTENDED OFFSET 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785401500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CT 12MM X 140MM CEMENTED VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785401520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT EXTENDED OFFSET 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7854-016-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT STANDARD 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785401700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED CT STANDARD 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-011-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-011-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER LM BODY SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-011-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-012-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-013-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-015-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-017-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK LM 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-018-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.161|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 3.5MM X 78MM RIGHT ANGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,315.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,315.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.361|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR LCP 6 HOLE 69MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|531.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|531.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.102S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD BRL 46X19X5.8MM SS 4.5MM CORT SCR 2 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8790-050-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TIBIAL ALL-POLY UNIT M/G MED LAT RT.SZ2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.415S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 340MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 400MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MA50BM-11.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-14.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 483-3102|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE GREAT SWANSON 2 TITANIUM|1|HUMANA [1294]||HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2026-3250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP BONE 7.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224.601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 188X13.5X4.2MM SS 4.5MM SCR LG FRAG SET 10 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,620.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,620.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 25-68550HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE SMOOTH ROUND HIGH-PRO 550CC C1789|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.419S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 380MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PCA230300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS BIFURCATED EXCLUDER 23 X 3.3|1|HUMANA [1294]||HUMANA [11839]|6,777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCA260300|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXTENDER AORTIC 3.3CM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4333|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER VENT LEFT VENTRICULAR #4333|1|HUMANA [1294]||HUMANA [11839]|108.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|108.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 110-942|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 6 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|363.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|363.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL ZEPHIR 47.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8372645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 3D 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,515.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8372650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 3D 6.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,515.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8370035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CUT 3.0CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,162.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115-159|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET BREAK-OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4202022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTRICTOR CEMENT PEEK 10 X 22 NO|1|HUMANA [1294]||HUMANA [11839]|6,378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1107259|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD INTERFERNCE 9MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1107239|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION RCI 8MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5117904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DYNAMIC 1.7MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5119003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DYNAMIC 1.9MM X 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5117905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DYNAMIC 1.7MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-042-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR MG KNEE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-032-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL MG SM 8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-052-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING MG TIBIALLG GREY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-042-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL REG 8.5 M/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM 32MM HIP TPR VIT COCR V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,306.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,306.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-565|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT OSTEOLOCK P5 32MM 10DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,421.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,421.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902803500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL HARRIS PRECOAT EXTRA LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6632-0-750|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEGS FIXATION FEMORAL DISTAL|1|HUMANA [1294]||HUMANA [11839]|1,030.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,030.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-037-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL STEM PRECOAT MGII YELLOW SZ-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,648.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,648.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-047-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL STEM MG-II SIZE-F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,648.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,648.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,191.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-057-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL STEMMED SIZE-J MILLER-GALANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,648.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,648.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,191.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT M/G II SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,254.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL COMPRESSION PRECOAT SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,191.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,191.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 87-4221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM LONG CALCAR LEFT 3 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-870-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE CONDYLAR 70MM X 120MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-870-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE CONDYLAR 70MM X 200MM 12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,132.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,132.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-130-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS ECT 6.5MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-120-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-115-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.307S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM FX AU 110MM 11MM HLX TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.313S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 10MM TROCH XTD CNN IM NL TI STRL GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.305S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 100MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.308S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 115MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.306S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM FX AU 105MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1MYM15|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 18 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 32MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 42MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.836S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCK 4.0 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.854S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.430S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 150D STD BRL 62MM SS 3 HL DHS/DCP BN 38MM HIP CNDYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.830S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 150D SHRT BRL 62MM SS 3 HL DHS/DCP BN 25MM HIP CNDYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.330S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 145D STD BRL 62MM SS 3 HL DHS/DCP BN 38MM HIP CNDYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.230S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D STD BRL 62X19X5.8MM SS 4.5MM CORT SCR 3 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS3506|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 X 150 #46-305-ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 281.730S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 145D SHRT BRL 62MM SS 3 HL DHS/DCP BN HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.630S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D SHRT BRL 62MM SS 3 HL DHS/DCP BN HIP CNDYL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.131S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD BRL 62MM SS 3 HL CMPR DHS/DCP BN 38MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.530S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D SHRT BRL 62MM SS 3 HL DHS/DCP BN HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.505S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D SHRT BRL 94MM SS 5 HL DHS/DCP BN 25MM HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.031S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 62X19X5.8MM SS 4.5MM CORT SCR 3 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.503S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D SHRT BRL 62MM SS 3 HL DHS/DCP BN HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.021S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 46X19X5.8MM SS 4.5MM CORT SCR 2 HL DHS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6003-014-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT HEALING|1|HUMANA [1294]||HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 470-0003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER-JOINT SZ.3 C1776|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8015-30-003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BARREL 3-HOLE 130-DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8015-35-008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BARREL 105-DEG 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8015-40-004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4-HOLE 140-DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM CANC LG CNN NS ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 81008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONNECTING EXT FIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587806541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 10MM 41MM PRM NXGN TRB MTL PE POR KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-10-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL ADVANTAGE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 208.404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 45MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 55MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 7.9MM 2.9MM 80MM 16MM POR-PK SS P/T RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 65MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787100110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CLCR 10MM VRSY 13/15 HIP BUIL UP BLCK CMNT REV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 208.436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 70MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000-2014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 13MM X 15MM CFRP|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000-2015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 15 X 15|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787100130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK VERSYS CRC 13/15 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-13200-15|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL OPENING 15MM|1|HUMANA [1294]||HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68600HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE SMOOTH ROUND HIGH-PRO 600CC C1789|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611803|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 28MM 85CM 2CM FLXB DIST TIP COAX DEHP-FR RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCT261216|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 26MM 12MM XCLDR 2 BRCH TRNKIPSL LG STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCC141200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS BIFURCATED EXCLUDER LIMB 16 X 14.5 X 12|1|HUMANA [1294]||HUMANA [11839]|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787100210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK VERSYS CRC 17/19 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01-7035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 100 DEGREE RIGHT LONG 3MM X 3MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 100 DEGREE LEFT LONG 3MM X 3MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-131|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 10 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCT281416|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 28.5 12MM XCLDR 2 BRCH TRNKIPSL LG STNT|1|HUMANA [1294]||HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 111MM SS 3.5MM SCR SM FRAG SET 8 HL SHFT BN TIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|123.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787100220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK VERSYS CRC 17/19 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6293-1-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL RIGHT SIZE-2 POROUS COATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6293-1-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL RIGHT #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6293-0-180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP LEFT #8 PCA-E SERIES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,181.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,181.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9536|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SNTH TISS 40X9X1.1MM PE MDPR NSL SHT POR CRNMXF NOSE|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 35MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 40MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 50MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 483-0000|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GREAT-TOE SILASTIC SIZE0|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787100230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK VERSYS CRC 17/19 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MA50BM-30.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 7MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 22MM TI HND CORT ST CRFRM RCS NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 24MM TI HND CORT ST CRFRM RCS NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAP 2.0MM12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|108.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 26MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 30MM TI HND CORT ST CRFRM RCS NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 32MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 85MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787101361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 13 X 210MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AA4203TL-18.5-2.0CYL|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2362-004-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW ECT 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|131.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|131.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787101761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 17 X 230MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 33-345418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173121207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 21X9X9MM JAG IFCG WDG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|7,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787101960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 17 X 200MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00787101362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 13 X 250MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,744.41|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,744.41|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VIK10S1|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 10.5FR SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VIK9S1|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER PEEL-AWAY PERCUTANEOUS LEAD SINGLE CHAMBER 9 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-6.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-35.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 35.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.400|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +40 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787101363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 13 X 300MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00787101560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 15 X 180MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,146.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,146.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00787101561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 15 X 220MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00787101562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 15 X 250MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00787101563|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 15 X 300MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00787101760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 190MM 17MM REV CMNT VRSY ZML 47MM HIP CLCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00558370|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 8CM 6FR 15-18MM ESPH FX WRE BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00589100|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ESPH 6FR 10MM 180CM 6CM BLNDIL MXFC TTS LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5836|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 8CM 6FR 12-13.5-15MM ESPH FX WRE BLN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558380|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 8CM 6FR 18-20MM ESPH FX WRE BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SB2201|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BIFURCATED STRETCH 22 X 11 SB2201|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00556581|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 450CM KINK RST RX STRG TRM TIP JGWR DRM TIP 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WN-2020|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 20IN 2MM PLRS STD NTNL TROC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 7.5MM 26MM INSET NXGN UHMWPE KN STRL BLU GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 610-130|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE VASCULAR CLOSURE ANGIOSEAL VIP 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-552|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 26CM LG REG PGTL CRV DRMTR DRN HL CATH FLXB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR EBU 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465911|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE MAGIC TORQUE .035 DIAMETER X 180CM LENGTH WITH GLI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020952080|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 60CM 8MM 2 VLR STRG TUBE KNTD SFT FLXB HMSH GMCVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,614.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,614.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020952060|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 60CM 6MM 2 VLR KNTD STRG TUBE SFT FLXB HMSH GMCVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,614.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,614.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8811313015|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH DIALYSIS PERITONEAL 2-CUFF 57CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|219.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G22542|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP QTM TTC 5.5CM 240CM 12MM CLN BLN CATH NS DISP 2.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22543|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP QTM TTC 5.5CM 240CM 14MM 7FR GI 3W STPCK BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22544|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP QTM TTC 5.5CM 240CM 16MM 7FR GI 3W STPCK BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G22545|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP QTM TTC 5.5CM 240CM 18MM CLN BLN CATH NS DISP 2.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22997|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP QTM TTC 5.5CM 240CM 20MM 7FR GI 3W STPCK BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 12 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136506|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URET BARD 6FR 70CM LG OLV TIP ADPR KINK RST GRAD PU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136505|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URET BARD 5FR 70CM LG OLV TIP ADPR KINK RST GRAD PU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 13 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00785801400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 14 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 065024|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 24FR 3CM 2 EYE DRN RTNT HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00785801500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 15 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 065030|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 30FR 3CM 2 EYE DRN RTNT HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 16 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00785801700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 17 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.3MM ADAPTION 95MM 24 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,827.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,827.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 871-656|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN PLATE HOLDING|1|HUMANA [1294]||HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 20X11X.5MM 100D 9MM SPC L OB L CRNFCL TI 3 HL BS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 20X11X.5MM 100D 5MM SPC L OB L CRNFCL TI 3 HL BS 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 20X11X.5MM 100D 5MM SPC L OB R CRNFCL TI 3 HL BS 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.061|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 20X10X.5MM Y CRNFCL TI 5 HL 1.3MM CORT SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|384.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.3MM T 20MM X 11MM 3 X 4 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00556561|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .025IN 450CM KINK RST RX STRG TRM TIP JGWR DRM TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 100X100X.6MM RECT CRNFCL TI CNTR MESH RGD 1.3MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,521.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,521.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.081|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL X TI 1.3MM 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|666.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|666.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00589180|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ESPH 2.8MM 6FR 18MM 180CM 6CM HPRFR BLNDIL MXFC TTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22143|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPHNTM 200CM 6-5FR BLRTH2 BILE PNCR 2 LUM GW CNN BRD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 13X8MM BX CRNFCL TI 4 HL 1.3MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.099|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 100X100X.2MM CRNMXF TI CNTR MESH SCRN 1.3MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,121.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,121.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 43050|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH BIL 60MM 10MM 7.5FR MTL UNSTP + WLSTNT RP 194CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-552|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 16MM 75CM 40MM PERI LV SCRCH RST HI STRTH SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.53|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN OB R L CRNFCL TI 3X4 HL RGD 1.5MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 446.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 36X3.5X.9MM CNDYL LT TI 7 HL 1.5MM SCR MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SK400|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT GOOSE NECK MICROSNARE AMPLATZ 4MM LOOP DIAMETER X 175CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK700|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT GOOSE NECK MICROSNARE AMPLATZ 7MM LOOP DIAMETER X 175CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GN1500|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT SNARE GOOSE NECK AMPLATZ 15MM LOOP DIAMETER X 120CM SNAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR1805|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 150CM .018IN ANG 3CM GLDWR HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.81|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.5MM X 15MM X 15MM 4 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460032MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 32MM 39.6MM 31.9MM MTRL/TRCSPD FLXB BAND TMPLT|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460034MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 34MM 41.6MM 34MM MTRL/TRCSPD FLXB BAND TMPLT|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460036MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 36MM 43.6MM 35.9MM MTRL/TRCSPD FLXB TMPLT HNDL|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460038MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 38MM 45.6MM 37.9MM MTRL/TRCSPD FLXB TMPLT HNDL|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460026MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 26MM 33.6MM 25.9MM MTRL/TRCSPD FLXB BAND TMPLT|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460028MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 28MM 35.6MM 28MM MTRL/TRCSPD FLXB BAND TMPLT|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 447.53|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 31X15X.9MM 5MM SPC OB R L CRNMXF TI 3 HL BS 4 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 460030MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 30MM 37.6MM 30MM MTRL/TRCSPD FLXB BAND TMPLT|1|HUMANA [1294]||HUMANA [11839]|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6303|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEEROCATH-T TEMPERATURE ABLATION 8 FR X 4MM X 2.5M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 41X20X.9MM 5MM SPC OB L L CRNMXF TI 4 HL BS 6 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 447.55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 41X20X.9MM 5MM SPC OB R L CRNMXF TI 4 HL BS 6 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 447.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 32X19X.9MM Y CRNFCL TI 2 HLE/HD 4 HL SHFT 2 ARM 4.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|441.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 446.22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 49MM ORBT RIM 12 HL 1.5MM SCR BN TI NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CXS13300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 13MM 3MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.5MM OBLIQUE L 2 X 3 HOLE LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5235-6-032|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 1000MM 3.2MM ALTA SS PLN TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 22X5X.9MM ZYG 4 HL 2MM CORT SCR BN DCP TI NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|411.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5235-6-030|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 1000MM 3MM ALTA BALL IM HIP SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 27X5X.9MM DCP ZYG TI 5 HL 2MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 443.46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 32X5X.9MM DCP ZYG TI 6 HL 2MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 447.22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM ORBITAL RIM 153MM 12 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 447.50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM OBLIQUE L 2 X 3 HOLE LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 903330A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS VLV SHNT 46CM VENTRICULAR CL TP W/91CM PRAL CATH 14GA LF|1|HUMANA [1294]||HUMANA [11839]|3,921.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,921.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.51|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM OBLIQUE L 2 X 3 HOLE RIGHT TITANIU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 803-043|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 31X15X.9MM 5MM SPC OB L L CRNMXF TI 3 HL BS 4 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00026200704|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN,STEINMANN,THREADED,5/64IN|1|HUMANA [1294]||HUMANA [11839]|51.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|51.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1249|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GD PIN ORTH 1.1MM NTNL BIOINTF SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14914-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GRAPHIX 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406844|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SRO 8FR SWARTZ 63CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1001782J-HC|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE BALANCE MIDDLEWEIGHT .014" DIAMETER 300C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005302-10|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 4.0MM X 10MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8811313010|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH DIALYSIS PERITONEAL 2-CUFF 62CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|219.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1005298-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 2.5MM X 20MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005300-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 3.0MM X 20MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005302-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 3.5MM X 20MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005302-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 3.5MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ST. JUDE 29MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G10383|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CONTRALATERAL 6FR X 0.38 DIAMETER X 40CM LENGTH W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G10384|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CONTRALATERAL 7FR X 0.38 DIAMETER X 40CM LENGTH W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001164010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 75CM 20MM PERI OTW 2 LUM TPR TIP HI-PRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545560|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 7CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545570|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 10CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z26JL50SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR JUDKINS LEFT SH 5.0MM(CUSTOM MADE 4 WK LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY 10-DEG. 48 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H80222782001A0|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROTABLATOR CORONARY ROTALINK ADAPTER W/ TUBLAR DRIVE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22824-002|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ROTOWIRE 325CM X 2.8CM LENGTH FLOPPY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22768-002|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROTALINK PLUS SYSTEM BURR SIZE 1.25MM X 135CM LENGTH X 0.58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22768-003|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR CATH 135CM 1.5MM RTBL RTL DMD EXCHGL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22768-004|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROTALINK PLUS SYSTEM BURR SIZE 1.75MM X 135CM LENGTH X 0.58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22768-015|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR CATH 135CM 2.15MM RTBL RTL DMD EXCHGL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41050-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 100CM USABLE LENGTH X 10CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY 10-DEG 56 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10-346|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 3MM 135CM 20MM PERI OTW STD SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533770|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 7CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401790M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 7FR 35MM 90CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-850|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STEERABLE WIRE CONTROL .018 DIAMETER X 150CM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 48 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VT540135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL INTRACOIL 5MM DIAMETER X 40MM LENGTH X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-138|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLEXIMA 12 FR X 25 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-139|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER APD LOOP 14 FR 25 CM APD LOOP/14/25 REG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-550|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL USG/8/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 50 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 558845P|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8FR .088 RDC I 55CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630505632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 56 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00630505832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG STD NTRL 7.4MM 58MM 32MM LNGVT HIP STRL PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9012P3001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PH ONE-CHANNEL|1|HUMANA [1294]||HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 60 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001103210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 3MM 90CM 40MM PERI OTW LOPRFL STD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 62 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 064034|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 34FR 2 EYE DRN PROPORTIONATE HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 64 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P308A|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PALMAZ 30 MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 48 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00632005028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 20D 7.3MM 50/52/54MM 28MM LNGVT HIP STRL PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 859-130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 EXTENDED-BODY|1|HUMANA [1294]||HUMANA [11839]|3,792.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,792.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY 10-DEG 58 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 22768-005|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROTALINK PLUS SYSTEM BURR SIZE 2.0MM X 135CM LENGTH X 0.58 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22768-006|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR CATH 135CM 2.25MM RTBL RTL DMD EXCHGL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H802227680160|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR CATH 135CM 2.38MM RTBL RTL DMD EXCHGL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22768-007|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROTALINK PLUS SYSTEM BURR SIZE 2.5MM X 135CM LENGTH X 0.58 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY 10-DEG 60 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00631006232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY 10-DEG 62 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00556461|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .025IN 260CM HPRFR JGWR STD STRG RND BIL STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER POLY 10-DEG 64 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H965403320|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH TRCHBR 60MM 16MM 9FR MTL WLSTNT USTP+ 75CM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965402110|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 12 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-549|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL 8 FR X 20 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-551|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL USG/8/24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|341.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|341.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 58 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00632006028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 60 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00632006228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 62 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00632006428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 64 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 588841P|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD BLU YLW 55CM 8FR .088IN CRDS VSBR HS CRV PERI SS NYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005592-07|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL GUIDING VERIPATH 7FR X 50CM RDC1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,ELEVATED,RIM,POLY N,28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1005298-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 2.5MM X 30MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005300-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 3.0MM X 30MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005302-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 3.5MM X 30MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,ELEVATED,RIM,POLY P,28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00630504828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 48 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71-134|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 10X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 50 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 065028|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 28FR 3CM 2 EYE DRN RTNT HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4690|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON RETRIEVAL 9-12CM RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545630|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 12CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545640|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 15CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533810|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 5CM DDNL BND PUSH GD CATH INTRO KT TEMP AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 56 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00533830|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 10CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556841|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 260CM XTD KINK RST STRG DRM RND TIP JGWR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003312HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CROSS IT 3CM X 190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 58 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00631004828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,POLYETHYLENE,ELEVATED,RI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 27-129|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLEXIMA REGULAR 8FR NON-LOCKING APD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,POLYETHYLENE,ELEVATED,RI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14-515|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 14MM 120CM 40MM PERI LV SCRCH RST HI STRTH SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-583|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 8X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-503|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 10X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,POLYETHYLENE,ELEVATED,RI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00589120|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ESPH 6FR 12MM 180CM 6CM BLNDIL MXFC TTS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545580|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 12CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545590|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 15CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545610|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 7CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,POLYETHYLENE,ELEVATED,RI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00545620|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 10CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 10-DEGREE 64 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 77800400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 4.0 JUDKINS LEFT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77800300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 3.5 JUDKINS LEFT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77803400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH AMPLATZ LEFT .75 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77803600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH AMPLATZ LEFT 1 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77803700|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH AMPLATZ LEFT 1 SIDEHO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77804000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH AMPLATZ LEFT 2 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77808200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 4.0 JUDKINS RIGHT COR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77808300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FR X 100CM LENGTH 4.0 JUDKINS RIGHT COR W/SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77808000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR JR35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 60 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 77808100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 3.5 JUDKINS RIGHTCORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77808400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH AMPLATZ LEFT AL 2ST V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77827800|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR HOCKEYSTICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77819000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE INTERNAL MAMMARY 7 FRENCH X 10CM LENGTH VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77818200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR RCB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77811000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD BLU ORNG YLW 100CM 7FR .078IN VSBR TRUELUMEN AR1 CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77811100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD BLU YLW 100CM 7FR .078IN VSBR TRUELUMEN ARC 1 CRV SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 598931|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9 FRENCH X 100CM LENGTH 4.0 JUDKINS RIGHT COR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77800800|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 5.0 JUDKINS LEFT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77800900|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 5.0 JUDKINS LEFT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 0D STD NTRL 11.4MM 62MM 28MM LNGVT HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 77827000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH MULTIPURPOSE MPA1 VIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533840|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 12CM .035IN PUSH CATH INTRO KT PRCFLX AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 0D STD NTRL 12.4MM 64MM 28MM LNGVT HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1005296-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION CROSSSAIL 2.0MM X 30MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG506|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 65CM 5FR .047IN GLDCATH GLD TCH STRG CRV SS HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40331|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 16 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,191.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,191.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588834|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH SIDE HOLES JUDKINS L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588830|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH JUDKINS RIGHT CORONAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588816|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS RIGHT 8 FRENCH X 100CM LENGTH VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588815|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS LEFT 8 FRENCH X 100CM LENGTH VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67008300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS RIGHT 4.0 WIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588851|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH 3.5 JUDKINS LEFT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588823|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH JUDKINS LEFT CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3.5MM 12/14 TPR 32MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 588831|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH JUDKINS RIGHT W/ SIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 065036|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 36FR 3CM 2 EYE DRN RTNT HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606564|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER HICKMAN 10FR TRIPLE LUMEN CV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|934.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|934.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10.5MM 12/14 TPR 32MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 065038|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 38FR 3CM 2 EYE DRN RTNT HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCF-9-38-30-J-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRODUCER 9FR 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75307|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VASOSEAL #7 ORANGE 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001711200|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH TRCHBR 60MM 7MM 6FR MTL WLSTNT RP USTP+ 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,522.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,522.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115507005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14902-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE INTERMEDIATE PT GRAPHIX J TIP .014IN DIAMETER X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22235MJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE EXTRA SUPPORT .014 300 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502144|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE EXTENSION CINCH QR .014 DIAMETER X 145CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-500|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE 8 FR APDG/8/25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115504505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H787107204055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOS OMNI 5 FR (2).03880 CM .038 (5/BOX)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47523|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 8CM 7-3MM TRND PLTN ARTERIOVENOUS ACPT .035IN CATH|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115505505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115506005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75304|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VASOSEAL #4 GREEN 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|693.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75305|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VASOSEAL #5 PURPLE 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|693.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75306|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VASOSEAL #6 GRAY 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115507507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00533780|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 10CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533790|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 12CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533800|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 12CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115504005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115503005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00533820|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 7CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533850|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 15CM .035IN INTRO KT PRCFLX AMSDM PLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-312|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 14 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1333-77|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 350MG/ML 50 ML PREFILLED SYRINGE POWE|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625LP27MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 27MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6625LP35MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 35MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 065032|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH PEZ 32FR 3CM 2 EYE DRN RTNT HD STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G24566|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 3FR 4CM TPR DDNL PGTL CRV SPRL SH RADOPQ ZMN PE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPS0S-3-6N|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC 3.0FR X 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6907|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL 10MM X 30MM 16FR 95CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6908|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL 12MM X 30MM 16FR 95CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RC-09850|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET RAPID INFUSION CATH (BOTH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00455500700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR HEADS EXT ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|196.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10632201|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLUSH OMNI SOFT-VU 5FR. X 65CM .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14215016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE BANK DOWEL|1|HUMANA [1294]||HUMANA [11839]|2,190.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,190.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 314.23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHAFT SCRDRVR 270X4MM 2.9MM HEX CNN|1|HUMANA [1294]||HUMANA [11839]|1,052.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,052.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P5010|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY TRANSHEPATIC PALMAZ XL 49MM X 10MM|1|HUMANA [1294]||HUMANA [11839]|3,270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001125380|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 120CM 20MM PERI OTW HI-PRS BLU MAX 20 ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1001780J-HC|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE BALANCE MIDDLEWEIGHT .014" DIAMETER 190C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556902|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 200CM XTD HPRFR JGWR BIL STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00567420|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN ESCP MXFRC 3CM 2.8MM 8MM 5FR BIL DILATION DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00589150|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ESPH 2.8MM 6FR 15MM 180CM 6CM HPRFR BLNDIL MXFC TTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003381-13|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MULTI-LINK RX ULTRA 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003382-13|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MULTI-LINK RX ULTRA 5.0MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003382-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MULTI-LINK RX ULTRA 5.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-801|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE TRANSCEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41058-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 135CM USABLE LENGTH X 30CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41049-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 100CM USABLE LENGTH X 5CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41051-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 100CM USABLE LENGTH X 20CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0407-0690-10|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNISCAN 287MG/ML 10ML SINGLE DOSE VIAL NDC#|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-154|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY FLEXIMA 8 FR FIRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SDD-100|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR SALIVARY DUCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 610104|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH PEEL-AWAY 8 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMC16031|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE TRI-CORTICAL|1|HUMANA [1294]||HUMANA [11839]|2,895.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00567370|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL 5FR 6MM 180CM 2CM BLNDIL MXFRC LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5012|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 12FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03628-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PIVOT ACE 3.0 W/1 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77818300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS RIGHT 7 FRENCH X 100CM LENGTH SIDEH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008018-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.5MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008020-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.0MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008024-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 7.0MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008180-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 28MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008180-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 58MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008182-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 28MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008182-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 38MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-7584|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 8MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201101|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEERABLE DECAPOLAR DYNAMIC XT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 507-914Y|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STABILIZER BALANCED PERFORMANCE 300CM X .014 DIAMETER S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 507114Y|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STABILIZER PLUS STEERABLE 300CM X .014 DIAMETER SUPERSO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1001311J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE IRON MAN 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401915|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 6FR DECAPOLAR/ LIVEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG409|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDECATH 4 FRENCH X .038 GUIDEWIRE X 65CM LONG COBRA 2 TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902604501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported WWFS35260|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE WHOLEY 260CM FLOPPY STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401227|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 6FR JSN QUAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32216|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CONTRALATERAL 8FR X 0.38 DIAMETER X 40CM LENGTH W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5086TK2|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II 8 FR X 5 MM STD. SHAFT - LARGE CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GN3500|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT SNR 120CM 35MM 6FR AGN NTNL CATH INTRO TRQ DEV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSF-35-260-BH|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STRAIGHT 260CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43-1050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT CRANIOPLASTIC 2 SETS|1|HUMANA [1294]||HUMANA [11839]|1,740.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCE-38-8-8|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION .038 DIAMETER X 8CM LENGTH 8MM PROXIMAL|1|HUMANA [1294]||HUMANA [11839]|250.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|250.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01279|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION .038 DIAMETER X 8CM LENGTH 10MM PROXIMAL|1|HUMANA [1294]||HUMANA [11839]|174.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71-136|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 10X68X75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41059-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 135CM USABLE LENGTH X 40CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406898|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 8FR RAMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 610101|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH PEEL AWAY 5FR 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41048-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 65CM USABLE LENGTH X 20CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41047-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 65CM USABLE LENGTH X 10CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 503658|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .018IN STRBL RADOPQ STRG DIST TPR 8CM CRDS SV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-854|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STEERABLE WIRE CONTROL .018 DIAMETER X 300CM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001175560|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 4MM 75CM 20MM PERI OTW 2 LUM LOPRFL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSF-18-260|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STRAIGHT 0.18 DIAMETER X 260CM LENGTH TFE COATED S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465231|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 145CM .035IN FLX TP STRG 7CM AMP SPST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-500|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ SUPER STIFF .035 DIAMETER X 145CM LENGTH J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KSAW6.0-38-90-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH SHUTTLE 6FR X .038 DIAMETER X 90CM LENGTH FLEXOR TUOH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010565-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 40MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010565-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010566-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 8.0MM X 40MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588843|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH AMPLATZ LEFT CORONAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13165|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STRAIGHT 2.0 X 400MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010566-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 8.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010560-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 10.0MM X 40MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010568-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 10.0MM X 60MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010558-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 8.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010566-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 8.0MM X 20MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010568-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 10.0MM X 20MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010557-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 100MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VT-460-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL INTRACOIL 4MM DIAMETER X 60MM LENGTH X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0952-15|SUP|Custom 25500000||0255 - PHARMACY - DRUGS INCIDENT TO RADIOLOGY|CONRAY 30 50 ML. 50-50 ML. VIALS/BOX|1|HUMANA [1294]||HUMANA [11839]|9.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 14MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010564-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 6.0MM X 80MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010565-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 80MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011334-65|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM EMBOLIC PROTECTION RX ACCUNET 6.5MMX190CM|1|HUMANA [1294]||HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G13264|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 90CM 6FR 2.2MM FLXR SH ACPT .038IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3.5MM 12/14 TPR 28MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 22339MJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE EXCHANGE FLOPPY HI-TORQUE30 CM TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23239-001|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ROTOWIRE EXTRA SUPPORT 325CM X 2.8CM LENGTH STIFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0045031TK20|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II 7 FR X 4 MM STD. SHAFT - LARGE CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005527-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 4.00MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003381-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MULTI-LINK RX ULTRA 4.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03628-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1CM 1.5MM 20MM FX WRE ACE PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003381-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MULTI-LINK RX ULTRA 4.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003382-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MULTI-LINK RX ULTRA 5.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS18350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 18MM 3.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS23350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 23MM 3.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67006000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR XBLAD 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234003700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,CANCELLOUS,3.5X36MM,ECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|39.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CBM32515|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 3.25MM X 15MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM32510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.5MM 142CM 10MM PERI PLQ MODIFICATION NYL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM37515|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 3.75MM X 15MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM40010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 4.0MM X 10MM LENGTH FLEXTOME DILATION DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77811200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 2.0 AMPLATZ RIGHT VIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104504-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER XMI RAPID EXCH 4FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67018100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS LEFT 6 FRENCH X 100CM LENGTH SIDEHO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67008400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 5.0 JUDKINS RIGHT V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67000000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 3.0 JUDKINS LEFT VI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 138012|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URET BARD 6FR 70CM CONE TIP ADPR KINK RST DILATION PU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67027900|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH HOCKEYSTICK SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008195-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 5.5MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008023-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.5MM X 12MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8709AA|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDTRONIC INDURA CATHETER #8709|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,611.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SK200|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT GOOSE NECK MICROSNARE AMPLATZ 2MM LOOP DIAMETER X 175CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010557-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008025-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 7.OMM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77818000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS LEFT 7 FRENCH X 100CM LENGTH VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005525-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 3.50MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008023-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.5MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67011000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR AR1.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008021-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.0MM X 12MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008021-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.0MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008017-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.0MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008193-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 5.0MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008193-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 5.0MM X 20MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008197-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 6.0MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008023-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.5MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-7594|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 9MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008019-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.5MM X 12MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-0825|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-0830|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 3MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-0835|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 3.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-1225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS 2.5MM X 12MM PACLITAXEL-ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-1230|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-1235|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS 3.5MM X 12MM PACLITAXEL-ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-1625|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS 2.5MM X 16MM PACLITAXEL-ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-1630|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 3MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-1635|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 3.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2025|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 2.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2030|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS 3.0MM X 20MM PACLITAXEL-ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2035|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 3.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2425|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 2.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2430|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2435|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2830|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-2835|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00787101360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CRC 13 X 170MM VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,784.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 38970-3230|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 3MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38970-3235|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 3.5MM TAXUS XPR2 MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007850-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 4.00MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007850-23|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 4.00MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007850-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 4.00MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007850-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 4.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007850-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 4.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007850-08|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 4.00MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007849-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007849-23|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.50MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CR-07745|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO 45CM 7FR S ARWFLX PERC SHTH RADOPQ SDARM XTN TISS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007849-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007849-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005594-07|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL GUIDING VERIPATH 7FR X 50CM RDC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007849-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007849-08|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.50MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007848-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.00MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007848-23|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.00MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007848-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.00MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007848-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007848-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406853|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER GUIDING SRO CURVE 8.5FR 63 LENGTH SWARTZ SR SERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007848-08|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VISION RX 3.00MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008021-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.0MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661810|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 17G X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67012600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH EXTRA BACKUP XBRCA VI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67019100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE INTERNAL MAMMARY 6 FRENCH X 100CM LENGTH SIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010480-HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE PILOT 50 J TIP .014" DIAMETER 190CM LENG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4968-35|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSURE EPI 35CM ATRIAL/VENTRICULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010481-HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE PILOT 150 J TIP .014" DIAMETER 190CM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1009439-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER OTW 2.00MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1009441-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER OTW 2.50MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67018300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS RIGHT 6 FRENCH X 100CM LENGTH RCB S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67027100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH MULTIPURPOSE MP1 SIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67013000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH 3DCR VISTA BRITE TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-160|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 10FR 35CM FLXB STF CNN SFT DRMTR LG HL LCK BIL FLXM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67005600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH 4 EXTRA BACKUP VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008019-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.5MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/CI/W|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA WHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008019-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.5MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011394-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.50MM X 08MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011394-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.50MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011396-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.00MM X 08MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011396-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.00MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011394-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.50MM X 20MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011396-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.00MM X 20MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011398-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.50MM X 08MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011398-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.50MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011392-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.00MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011392-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.0OMM X 20MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011400-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 4.00MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011400-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 4.00MM X 20MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67019090|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR 90CM VISTA BRITE TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20100-190|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FILTERWIRE EZ 190CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008201-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 7.0MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41056-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 135CM USABLE LENGTH X 10CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005521-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 2.50MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005523-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 3.00MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005525-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 3.50MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005529-13|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 5.00MM X 13MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005521-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 2.50MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005523-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 3.00MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005527-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 4.00MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008178-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 6.0MM X 28MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008184-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 28MM CATHETER LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008184-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 38MM CATHETER LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008017-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.0MM X 12MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1056111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE TUBE SOILEAUTYTAN|1|HUMANA [1294]||HUMANA [11839]|50.79|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|50.79|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008017-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.0MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008025-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 7.0MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12160-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE EXCHANGE CHOICE PT 182 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008013-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 4.0MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008189-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 15MM PERI RX LOPRFL FLXB KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008189-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 4.0MM X 20MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010068-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 12MM X 40MM BAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010010-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 10.0MM X 20MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010012-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 12.0MM X 20MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMC06|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL 1MM 18CM X 24CM 1DLMCO6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,456.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,456.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G03095|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 145CM .035IN FLX TP XSTIF SHFT ATRM FLPY TIP 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-813|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STEERABLE TRANSEND .018 SHAFT X 165CM LENGTH X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMC07|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL 1MM 20CM X 30CM 1DLMO7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,794.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,794.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 638121|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FLEXIBLE-TIP 1CM X 0.38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00567330|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL 5FR 4MM 180CM 2CM RX BLNDIL MXFRC LF DISP ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001169410|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 20MM PERI OTW 2 LUM TPR TIP HI-PRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-124|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER APDL PIGTAIL 10FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-177|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHROSTOMY 8 FR X 25 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-185|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH NPHSTM 25CM 14FR PGTL CRV FLXM PU LCK SFT DRMTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WWES35001|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 X 115CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-128|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 6FR 20CM APD REG DRMTR FLXB STF CNN LG LUM FLXM MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-156|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON-DILATOR 12-4 X 7 X 75 C1725|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661815|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE 17 X 15 COAXIAL BIOPSY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12120-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE MAILMAN .014 X 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 595EJ014|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 195CM .014IN STRBL FLPY TIP SLV RADOPQ J 3CM CRDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12154-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE EXCHANGE CHOICE PT 300CM 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112012ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION SNAP-OFF 2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,120.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,120.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-132|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLEXIMA 8 FR FIRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 503558X|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .018IN STRBL RADOPQ STRG DIST TPR 5CM CRDS SV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS SCHUKNECHT SLIM 4.25|1|HUMANA [1294]||HUMANA [11839]|246.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|246.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8403J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .014 FLOPPY 175CM XT J TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77818100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS LEFT 7 FRENCH X 100CM LENGTH VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12673-0101|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSURE SUTURE MEDIATED PERCLOSE THE CLINCHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0127|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS SCHUKNECHT SLIM 4.75|1|HUMANA [1294]||HUMANA [11839]|246.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|246.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported KSR901|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE KAPPA 900 SR SINGLE CHAMBER RATE RESPO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005604-07|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL GUIDING VERIPATH 7FR X 50CM HS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00726005028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,605.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,605.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 32-8553-311-61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL NEFF 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8553-311-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL NEFF 13 X 340|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8553-311-17|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL NEFF 17MM X 340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401123M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 11FR 45MM 23CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41046-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 65CM USABLE LENGTH X 5CM INFUSION LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTM-08|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY MALE SIZE 8|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTM-09|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY MALE SIZE 9|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4010|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UNMOUNTED BILIARY TRANSHEPATIC PALMAZ XL 40MM X 10 MM|1|HUMANA [1294]||HUMANA [11839]|3,270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400141|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MALLABLE 600,16CMX11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VT740135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL INTRACOIL 7MM DIAMETER X 40MM LENGTH X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XC717F|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRIDGE X3|1|HUMANA [1294]||HUMANA [11839]|3,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3110|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 30MM XL DLV SYS UNMOUNT CLS CELL BLN XPD CRDS|1|HUMANA [1294]||HUMANA [11839]|4,681.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,681.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406506|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT UMBILICAL VEIN 69CMX6MM|1|HUMANA [1294]||HUMANA [11839]|4,665.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,665.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5031T|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II 7 FR X 4 MM STD. SHAFT - STD. CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00726005428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2752|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MICROVASIVE ANASTOMOTIC DEVICE 2.0 2752|1|HUMANA [1294]||HUMANA [11839]|407.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|407.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTF-07|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY FEMALE SIZE-7|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTF-08|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY FEMALE SIZE-8|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTF-09|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY FEMALE SIZE-9|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTF-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY FEMALE SIZE-10|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTM-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY MALE SIZE 10|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTM-11|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY MALE SIZE 11|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTM-12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY MALE SIZE 12|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-7564|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 6MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2753|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MICROVASIVE ANASTOMOTIC DEVICE 2.5 #2753|1|HUMANA [1294]||HUMANA [11839]|437.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|437.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 104307-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOJET EXPEDIOR 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8059|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 9MM ENDOPEARL SHLDR KN PLLA BABSR|1|HUMANA [1294]||HUMANA [11839]|176.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|176.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C8057|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 7MM ENDOPEARL SHLDR KN PLLA BABSR|1|HUMANA [1294]||HUMANA [11839]|176.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|176.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1427|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL POLYFLEX 16MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8058|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 8MM ENDOPEARL SHLDR KN PLLA BABSR|1|HUMANA [1294]||HUMANA [11839]|176.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|176.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008201-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 135CM 20MM PERI RX LOPRFL FLXB KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-502|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ.035 X 260CM J-TP 46502|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008197-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 6.0MM X 20MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008195-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 5.5MM X 20MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008199-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 6.5MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008199-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 6.5MM X 20MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67011100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ RIGHT SIDEHOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8400-0411|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT INJECTABLE INVASIVE MINI|1|HUMANA [1294]||HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 312022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL FIBERED PLATINUM COMPLEX/HELICAL 2MM COIL DIAMETER X 20|1|HUMANA [1294]||HUMANA [11839]|256.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|256.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCE-38-8-15|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION .038 DIAMETER X 8CM LENGTH 15MM PROXIMAL|1|HUMANA [1294]||HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 507114J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STABILIZER PLUS STEERABLE 180CM X .014 DIAMETER SUPERSO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21AJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC ST. JUDE 21MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103813-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOJET XVG140 5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77806000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH EXTRA BACKUP 3.5 XBLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5888100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH X 3.5 EXTRA BACKUP XB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6HSII|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR HS11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR05|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE SHEATH RENAL PINNACLE 7FR INNER DIAMETER HOCKEY STICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493505024250|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 2.5MM XPR2 MNRL SS PRMNT BLN XPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR16|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE SHEATH RENAL PINNACLE 7FR INNER DIAMETER LIMA W/CROSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35050-1225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.5MM XPR2 MNRL SS PRMNT BLN XPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493505016250|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 2.5MM XPR2 MNRL SS PRMNT BLN XPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011400-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 4.00MM X 30MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DCR508-BI|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LACRI CATH 5MM LACRIMAL DUCT CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493505020250|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 2.5MM XPR2 MNRL SS PRMNT BLN XPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6HS11SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR HOCKEY STICK WITH 2 SIDE HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6HSIISH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR HOCKEY STICK WITH 3 SIDE HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404560|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 3MJ SUPERSTIFF .032|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77827900|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH HOCKEYSTICK SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77811300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR AR2.0W/SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011391-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 1.50MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 810041A|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE TVT W/ABD-GUIDES CHOICE C1771|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,510.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported XT-7542|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 4MM BALLOON DIAMETER X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 527914J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STABILIZER STEERABLE 180CM X .014 DIAMETER SUPERSOFT TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7EBU40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 7FR X 0.081 DIAMETER CURVE STYLE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67019000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE INTERNAL MAMMARY 6 FRENCH X 100CM LENGTH VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234407200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STATAK SOFT TISSUE DEVICE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|541.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 46865|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT ASSEMBLY VALVE STRATA 120CM REGULAR|1|HUMANA [1294]||HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892820200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 142CM 20MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CQ75124|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 12MM 75CM 4CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 67005400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH 3.5 EXTRA BACKUP VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67006200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 4.0 EXTRA BACK UP V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67003400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ LEFT .75 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67000300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 3.5 SH V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67000200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 3.5 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67027800|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 90CM LENGTH HOCKEYSTICK VISTA BRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67003700|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ LEFT 1 WITH S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67000600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 4.5 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67003600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ LEFT 1 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6700820E|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6 FR JR 4.0 VISTA BR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67004200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ LEFT 3 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1324BF|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR BIO FASTAK W/FIBERWIRE 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 67011200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 2 AMPLATZ RIGHT COR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67018000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS LEFT 6 FRENCH X 100CM LENGTH LCB VI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67000500|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 4.0 WITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67001000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 6.0 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67008100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 3.5 JUDKINS RIGHT S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67000800|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 5.0 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67027000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH MULTIPURPOSE MP1 VIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67018200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY BYPASS RIGHT 6 FRENCH X 100CM LENGTH RCB V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67008000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 3.5 JUDKINS RIGHT V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1009497|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CENTERING G3 3.5X52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7EBU35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 7FR X 0.081 DIAMETER CURVE STYLE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892820250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 142CM 20MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07080ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 80MM 120CM DLV HNDL SLF XPD MICROMESH SEG ILC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502014CY|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE RADIOPAQUE REFLEX .014IN DIAMETER X 300CM LENGTH J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4202822|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTRICTOR CEMENT PEEK 8 X 22|1|HUMANA [1294]||HUMANA [11839]|6,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 073914|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET SHEATH PEEL-AWAY 14FR.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008198-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 15MM PERI RX LOPRFL FLXB KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008200-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6.5MM 80CM 20MM PERI RX LOPRFL FLXB KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5209100|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL DOUBLE-J 8.5 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|507.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SCBR5.038100PNSJB2|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SELECTIVE SLIP SCBR5.0-38-100-P-NS-JB2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZM9EBU40SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9FR EBU40SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67004000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ LEFT 2 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R08020080L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX RINGED 8MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,373.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,373.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-155|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 10FR 35CM FLXB STF CNN FIRM DRMTR LG HL LCK BIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZSS-10-9-RB|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PIGTAIL DOUBLE RADIOPAQUE 10FR X 9CM WITH INTRODUCER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZSS-10-5-RB|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PIGTAIL DOUBLE RADIOPAQUE 10FR X 5CM WITH INTRODUCER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E5617-16|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE SPHERE SILICONE 16|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3998|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPECIFY MEDTRONIC LEAD #3998|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,638.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,638.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10601701|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STRAIGHT 5FR X 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6700040E|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR JL 4 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38942|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ULTRASND ATLANTIS SR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7427|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYNERGY STIMULATOR 7427|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,040.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|35,040.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6ECR40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR ECR40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU30|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR EBU30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR EBU 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU375|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR EBU 3.75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU45|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR EBU4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU50|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR EBU 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7EBU30|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 7FR X 0.081 DIAMETER CURVE STYLE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7EBU45|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR EBU45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6MAC30|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR MAC30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6MAC35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR MAC35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7435|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYNERGY PATIENT PROGRAMMER #7435|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6MAC40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR 40 MAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6ECR35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR ECR3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-286|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE MICROCATHETER HI-FLO 115 CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1246-03-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELIMINATOR HOLE POSITIVE STOP APEX|1|HUMANA [1294]||HUMANA [11839]|356.19|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|356.19|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 38045-91040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EXPRESS LD 37MM X 10MM|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS18300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 18MM 3MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS23300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 23MM 3MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS18250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 18MM 2.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS13250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 13MM 2.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS33300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 33MM 3MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS08350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 8MM 3.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS08250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 8MM 2.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS08300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 8MM 3MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS13350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 13MM 3.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS23250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 23MM 2.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS28250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 28MM 2.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS28300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 28MM 3MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS28350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 28MM 3.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS33350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 33MM 3.5MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 007724|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT URETEROTOMY 7FR. X 24CM|1|HUMANA [1294]||HUMANA [11839]|275.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|275.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.371|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR LCP 7 HOLE 81MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PR-05052|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH 16GA 14GA 50CM BLU FLXTP 4IN .018IN PICC 2 LUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM20010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 142CM 10MM PERI PLQ MODIFICATION NYL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6520-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 20MM TX TI ACTB CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CBM22510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 2.25MM X 10MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM27510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.75MM 142CM 10MM PERI PLQ MODIFICATION NYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM27515|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 2.75MM X 15MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM30010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 3.0MM X 10MM LENGTH FLEXTOME DILATION DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM30015|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 3.0MM X 15MM LENGTH FLEXTOME DILATION DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM35010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 3.5MM X 10MM LENGTH FLEXTOME DILATION DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM35015|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.5MM 142CM 15MM PERI PLQ MODIFICATION NYL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE VERSYS 11 PROXIMAL CENTRALIZATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2236-031-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP NAIL ZMS BOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|286.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00615205832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG OBLQ 11.8MM 58MM 32MM UHMWPE HIP STRL REV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,021.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,021.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VB090501|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS 9MM X 5CM 75CM-LENGTH C1874|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0928-038-00|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE (CALIB DRILL POINT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCX1810|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 17GA X 4.6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GCO20-10|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER NEEDLE 19G X 4.6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615206032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG OBLQ 13MM 60MM 32MM UHMWPE HIP STRL REV MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,021.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,021.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00631005032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 6.3MM 50MM 32MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008020-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 6.0MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008024-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 7.0MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008016-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 5.0MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12746-16|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 4.0 MM DIAMETER 16 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500TH|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II STD CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0044500THK20|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II LG CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12745-16|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 3.5 MM DIAMETER 16 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6EBU40SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR EBU40SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00222901400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, BARBED FRACTURE 7/8IN|1|HUMANA [1294]||HUMANA [11839]|134.49|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|134.49|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6207S5S|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 7FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6EBU35SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR EBU35SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1488TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL SDX BIPOLAR VENTRICULAR SCREW-IN STEROID ELUTIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533760|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 5CM INTRO KT PUSH CATH TEMP DLV SYS AMSDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1213501J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CHOICE EXTRA SUPPORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-012-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL IM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,003.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,003.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MCX1410|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 14 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00231700100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT.CORTICAL,11MM,HEX,8MM|1|HUMANA [1294]||HUMANA [11839]|39.57|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|39.57|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 446.51|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN OB R L CRNFCL TI 2X3 HL RGD 1.5MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 20X11X.5MM 100D 9MM SPC L OB R CRNFCL TI 3 HL BS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 35X3.3X.5MM CRNFCL ORBT RIM TI 9 HL 1.3MM CORT SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GCO18-16|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER NEEDLE 17 X 10.6 10/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8158|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE PRODIGY SR SINGLE CHAMBER RATE RESPONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6EBU45SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR EBU45 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MWCE38-10-12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION .038 DIAMETER X 10CM LENGTH 12MM PROXIMAL|1|HUMANA [1294]||HUMANA [11839]|131.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|131.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47518|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .035 DIAMETER X 10CM LENGTH 5MM PR|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008176-16|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 5.0MM X 16MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008178-16|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 6.0MM X 16MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00511007540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00511007545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00511007550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,SELF-TAPPING,M/G-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115505005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZM6HSIII|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR HOCKEYSTICK 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115506505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA8EBU50|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115510007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SRD5908|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFINITY 4F .038 100 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115507007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115508007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115508507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115509007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SGW-019-30|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115509507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,CANNULATED,HERBERT,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47115402600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,HERBERT,SCAPHOID,26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|810.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 24270004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUNTER TENDON IMPLANT 4MM|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RCFW-18.0P-38-35-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER CHECKFLOW 18FR X 35CM C1894|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24270005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUNTER TENDON IMPLANT 5MM|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,11X123ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,12X130ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,692.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,692.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CIN1818S|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 18GA X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 660001321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,13X135ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,14X144ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,15X145ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,17X156ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6600-011-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,11X123ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MFT-06|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT THYROPLASTY FEMALE SIZE-6|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6JL50SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR JL50SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 660001222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,12X130ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,17X156ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,14X144ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MODG18848|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH .067 AMPLATZ RIGHT VI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6600-016-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,16X148ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6JL30SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR JL30 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007821-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007821-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.00MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007821-23|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.00MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7278|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR MAXIMO DR7278|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,065.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|43,065.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00556001|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 260CM RADOPQ DIST STRG RND TIP SD LD TRQ DEV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545890|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL 12 ATM 4MM 180CM 2CM RX LOPRFL RADOPQ BLNDIL HRCN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545910|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILITATION HURRICANE RX 6MM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545930|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL 11 ATM 8MM 180CM 2CM RX LOPRFL RADOPQ BLNDIL HRCN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6892|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL ULTRAFLEX 8-2 X 16 X 95 PROXIMAL|1|HUMANA [1294]||HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010009-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 9.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38928-1525|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 142CM 15MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892815300|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 142CM 15MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892809250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 142CM 9MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38928-1230|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 142CM 12MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011334-55|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM EMBOLIC PROTECTION RX ACCUNET 5.5MM X 190CM|1|HUMANA [1294]||HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011343-30|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6-8MM 30MM 132CM TPR SLF EXPANDABLE RX LOPRFL OPN|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007823-08|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.50MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007823-12|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007823-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007823-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007823-23|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.50MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1007823-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY MINI VISION RX 2.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892809200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 142CM 9MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38928-1225|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 142CM 12MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892815150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 142CM 15MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556011|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 260CM HPRFR RX RADOPQ DIST H JGWR PTFE HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892812350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.5MM 142CM 12MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FLT06040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT FLUENCY 6 X 40|1|HUMANA [1294]||HUMANA [11839]|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM07040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 40MM 7MM 8FR FLN + C EPTFE 2 LYR KINK RST INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FLT08040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFT FLUENCY PLUS 8MM X 40MM X 117CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEL08060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFT FLUENCY PLUS 8MM X 60MM X 117CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FLT06060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT FLUENCY 6 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EC1000|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67013100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDEWIRE 6 FRENCH X 100CM LENGTH SHAPE 3DRC SIDEHO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GCO 18 10|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 17G X 4.6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77800500|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 4.0 JUDKINS LEFT VIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011343-40|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6-8MM 40MM 132CM TPR SLF EXPANDABLE RX LOPRFL OPN|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-7562|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 6MM BALLOON DIAMETER X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892815350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.5MM 142CM 15MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22-7000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE POLYTEF|1|HUMANA [1294]||HUMANA [11839]|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011392-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.00MM X 08MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011392-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.00MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011394-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.50MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011396-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.00MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011398-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.50MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011397-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.25MM X 20MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011392-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.00MM X 30MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011393-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.25MM X 30MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011394-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 2.50MM X 30MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011396-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.00MM X 30MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011398-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.50MM X 30MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21881|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 12CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569800|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 8FR 100MM 194CM RX UPDS H JGWR GW WLSTNT MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7492062015150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 142CM 15MM OTW PUSH COIL BSLD MAVERICK2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7492062015200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 142CM 15MM OTW PUSH COIL BSLD MAVERICK2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7492062015250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 142CM 15MM OTW PUSH COIL BSLD MAVERICK2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12161-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CHOICE PT EX SUPPORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB803|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH PINNACLE 25CM RADIOPAQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT12054|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 5MM 120CM 4CM PERI 2 LUM OPTPLST ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB14060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 14MM DIAMETER X 60MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-602|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PLATINUM PLUS LT .018 DIAMETER X 260CM LENGTH X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-601|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PLATINUM PLUS LT .018 DIAMETER X 180CM LENGTH X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT12044|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 4MM 120CM 4CM PERI 2 LUM OPTPLST ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7003D|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DECAPOLAR 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB703|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PINNACLE 7F RADIOPAQUE MARKER INTRODUCER 7F INNER D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10732202|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SOFT VU OMNI FLUSH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10712004|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SOS OMNI 5FR X 80CM BRAIDED SOFT CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011340-30|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 30MM 132CM STRG SLF EXPANDABLE RX LOPRFL OPN|1|HUMANA [1294]||HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12673-03|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSURE SUTURE MEDIATED PERCLOSE PROGLIDE 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74912160012|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CHOICE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1002703-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PERIPHERAL HI-TORQUE SUPRA CORE 35 190CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10282|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ULTRA FIX RC 2.9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|535.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|535.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 34356-648|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER KR3H MACH 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011342-30|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 30MM 132CM STRG SLF EXPANDABLE RX LOPRFL OPN|1|HUMANA [1294]||HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011649-75|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS EMBL PRTC 190CM LOPRFL CRTD GW DLV SHTH FLTR BSKT RADOPQ|1|HUMANA [1294]||HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0678945|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER MICRO UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008180-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 38MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008182-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 58MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008183-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 28MM CATHETER LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008183-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 38MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008183-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 58MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008184-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 58MM CATHETER LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE LT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1156-359|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EAR MORTEZ PEG TOP PARTIAL OSSICULAR REPLACEMENT|1|HUMANA [1294]||HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12776-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI PROWATER .014" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KSAW-8.0-38-90-RB-SH|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH SHUTTLE 8FR X .038 DIAMETER X 90CM LENGTH FLEXOR TUOH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010066-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 10.0MM X 20MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010066-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 10.0MM X 40MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008165-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 18MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008165-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 28MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008165-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 58MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010063-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010062-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010061-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 5.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010064-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 8.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0859|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS,PORP,BLACK,OVAL 140859|1|HUMANA [1294]||HUMANA [11839]|1,148.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,148.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010065-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 9.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010065-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 9.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008169-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 18MM CATHETER LENGTH 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008169-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 28MM CATHETER LENGTH 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008169-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 38MM CATHETER LENGTH 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008169-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 58MM CATHETER LENGTH 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008168-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 18MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008168-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 28MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008168-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 38MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008168-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 9.0MM X 58MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008167-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK ,035 8.0MM X 18MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008167-58|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 58MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB5020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 20MM OTW TPR TIP INFL PORT PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB6020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 20MM OTW TPR TIP INFL PORT PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB7020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 135CM 20MM OTW TPR TIP INFL PORT PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB8020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 135CM 20MM OTW INFL PORT TPR TIP PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008167-28|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 28MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008165-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 38MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010004-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 4.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT12064|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 6MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008191-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION VIATRAC 14 4.5MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010061-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 5.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010060-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 4.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010060-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 4.0MM X 60MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VT-6-60-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL INTRACOIL 6MM DIAMETER X 60MM LENGTH X 135CM|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VT-7-60-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BRONCHIAL INTRACOIL 7MM DIAMETER X 60MM LENGTH X 135CM|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10712001|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SOS OMNI 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS3504|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STIFF SHAFT .035 DIAMETER X 260CM LENGTH X 3CM FLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WWFS35175|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE WHOLEY 175CM STRAIGHT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011344-40|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7-10MM 40MM 132CM TPR SLF EXPANDABLE RX LOPRFL|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005202|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PERIPHERAL SPARTACORE 14 190CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1002703-02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PERIPHERAL SUPRA CORE 35 300 CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12835|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHUTTLE FLEXOR 7FR KSAW-7.0-38-90-RB-SHTL-HC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR5.0-38-100-P-NS-JB1|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SELECTIVE SLIP 5FR X 100CM CEREBRAL SC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008184-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 10.0MM X 18MM CATHETER LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG141302|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI GRAND SLAM .014" DIAMETER 300 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12745-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 3.5MM DIAMETER 26MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 34356-651|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER KR3H MACH 1 W/SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-12074|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 7MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85453|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 6MM X 22MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85455|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 7MM X 22MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77800200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 3.5 JUDKINS LEFT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588845|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH AMPLATZ RIGHT VISTA B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011398-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 3.50MM X 20MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011400-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 4.00MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011400-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER RX 4.00MM X 08MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008015-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 4.5MM X 15MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008015-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY RX HERCULINK PLUS 4.5MM X 18MM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00222901300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 19X16MM 2.4MM SS BRB NS|1|HUMANA [1294]||HUMANA [11839]|134.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|134.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066401081|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 67011300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 2 AMPLATZ RIGHT SID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-10407|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 10MM X 37MM STENT LENGTH X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010009-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 9.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465251|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ SUPER STIFF .035 DIAMETER X 180CM LENGTH S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67002800|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 4.0 JCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31135|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 125CM 6FR SCTH BTP JB1 CRV SS NYL HDRPH RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-82013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EXPRESS BILIARY 8 X 17 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,574.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,574.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5003|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH THRMB 140CM 6FR .36MM PRNT V3 TPR PERC HDRPH ASP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEL07060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 60MM 7MM 8FR FLN + EVAS EPTFE C 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEL06060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFT FLUENCY PLUS 6MM X 60MM X 117CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEL08040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 40MM 8MM 9FR FLN + EVAS EPTFE C 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9031|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CHILLI II COOLED ABLATION STANDARD CURVE STYLE TYPE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9031K2|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CHILLI II COOLED ABLATION LARGE CURVE STYLE TYPE TH|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32372|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 10FR 40CM BLK U-O CNTRLT DSGN RADOPQ BAND WO GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G10385|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 40CM 8FR 2.9MM FLXR CHFL BLKN CRV ACPT .038IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-224J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE MARKER .014 DIAMETER X 180CM LENGTH SUPERSOFT J TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6603J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 185CM .014IN JTP XT STF SMWR2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408304|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER AGILIS 8.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 598917|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9FR IM X 98CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7EBU37SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010070-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 14MM X 40MM BAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010563-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 5.0MM X 80MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41053-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 100CM USABLE LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE060080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 80MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-287|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE MICROCATHETER HI-FLO 115 CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10712002|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SOS OMNI 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7491215501J1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PT CHOICE EXTRA SUPPORT 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07060ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 60MM 120CM DLV HNDL SLF XPD MICROMESH SEG ILC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07100ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 100MM 120CM DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB602|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PINNACLE RADIOPAQUE 6FR 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT12072|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 7MM 120CM 2CM PERI 2 LUM OPTPLST ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR5.0-38-125-P-NS-|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SELECTIVE SLIP 5FR X 125CM ANGLED SCBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB650680120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 6 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR5.0--38-125-P-NS|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SELECTIVE SLIP 5FR X 125CM CEREBRAL SC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5202200|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 6FR 28CM 100CM .028IN 1 STP INS PUSH CATH TRAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|373.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 16MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PG2960BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 6 X 29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3960BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 6MM 6/6.5/7FR 38MM 80CM 40MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,403.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,403.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2970BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 6MM 6/6.5/7FR 26MM 80CM 30MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,403.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,403.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3970BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 6/6.5/7FR 36MM 80CM 40MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG5970BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 6/6.5/7FR 57MM 80CM 60MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2980BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 8MM DIAMETER 29 MM LENGTH 80CM PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3980BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 6/6.5/7FR 36MM 80CM 40MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG5980BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 6/6.5/7FR 59MM 80CM 60MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2990BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 9MM 6/6.5/7FR 25MM 80CM 30MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG5990BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 9 X 59|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1910BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 6/6.5/7FR 16MM 80CM 20MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,174.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,174.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2910BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 6/6.5/7FR 24MM 80CM 30MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,429.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,429.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3910BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 6/6.5/7FR 32MM 80CM 40MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77808900|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR JR3.5ST SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010564-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 6.0MM X 100MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010564-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 6.0MM X 30MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010564-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 6.0MM X 40MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010564-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 6.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010565-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 100MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010565-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 7.0MM X 30MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1009438-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER OTW 1.50MM X 15MM BALLO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010061-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 5.0MM X 60MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010061-80|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 5.0MM X 80MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010062-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010062-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 60MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010063-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010063-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 60MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR5.0-38-100-P-NS-|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SELECTIVE SLIP 5FR X 100CM ANGLED SCBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1291|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER INSIGNIA ULTRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,013.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,013.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 610131|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE VASCULAR CLOSURE ANGIOSEAL STS 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1MYM10|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 15X19CM (OVAL SHAPED)#1MYM010|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0607650|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER X-PORT DUAL LUMEN 9.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010004-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 4.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-0050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE ARMSTRONG VENT BEVELED GROMMET|1|HUMANA [1294]||HUMANA [11839]|41.79|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|41.79|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CBM22515|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 2.25MM X 15MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM20015|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 2.00MM X 15MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6931-65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT FIDELIS 65CM TRIPOLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ICF09-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CRYSTALLINE ACTIVE FIXATION 58CM ATR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB12060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 12MM DIAMETER X 60CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB12040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 12MM DIAMETER X 40CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011649-65|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS EMBL PRTC 190CM LOPRFL CRTD GW DLV SHTH FLTR BSKT RADOPQ|1|HUMANA [1294]||HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010563-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 5.0MM X 100MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010563-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 5.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB12080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 12MM DIAMETER X 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-80-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 7 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported J068|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNISCAN 287MG/ML 5ML SINGLE DOSE VIAL NDC# 0|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1333-11|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 350MG/ML 100ML BOTTLE NDC# 0019-1333-|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011344-30|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7-10MM 30MM 132CM TPR SLF EXPANDABLE RX LOPRFL|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-314|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SYMMETRY BALLOON DIAMETER 2MM X BALLOON LENGTH 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001103400|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 2MM 135CM 20MM PERI OTW STD SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-344|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 2.5MM 135CM 40MM PERI OTW LOPRFL STD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001103520|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 4MM 135CM 20MM PERI OTW STD SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001103570|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 5MM 135CM 20MM PERI OTW LOPRFL STD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114030020|SUP|HCPCS C1888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT PROCEDURE VENA CURE 65CM|1|HUMANA [1294]||HUMANA [11839]|1,344.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,344.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 312077|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL FIBERED PLATINUM COMPLEX/HELICAL 7MM COIL DIAMETER X 70|1|HUMANA [1294]||HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT120104|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 10MM 120CM 4CM PERI 2 LUM OPTPLST ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-12084|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 10MM BALLOON DIAMETER X 4C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-731|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PLATINUM PLUS .018 DIAMETER X 180CM LENGTH X 8CM F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G29984|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 45CM 6FR .087IN CKFL FLXR .018/.038IN ANL3 CRV HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 312066|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL FIBERED PLATINUM COMPLEX/HELICAL 6MM COIL DIAMETER X 60|1|HUMANA [1294]||HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G13338|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH SHUTTLE 7FR X .038 DIAMETER X 80CM LENGTH FLEXOR TUOH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005203|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PERIPHERAL SPARTACORE 14 300CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT12052|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 5MM 120CM 2CM PERI 2 LUM OPTPLST ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8400-0101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOSET PELLET 20CC|1|HUMANA [1294]||HUMANA [11839]|2,763.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported XT12042|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 4MM 120CM 2CM PERI 2 LUM OPTPLST ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401011M|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 10FR 45MM 11CM KINK RST CNN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TDW-25-100-5|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE DEFLECTING REUTER TIP .025 DIAMETER X 100CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011649-55|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS EMBL PRTC 190CM LOPRFL CRTD GW DLV SHTH FLTR BSKT RADOPQ|1|HUMANA [1294]||HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011342-40|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 40MM 132CM STRG SLF EXPANDABLE RX LOPRFL OPN|1|HUMANA [1294]||HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50100-150|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FILTERWIRE EZ BENT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV040080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 130CM 80MM PERI OTW TPR TIP LOPRFL SBMRN+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV030040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 130CM 40MM PERI OTW TPR TIP LOPRFL SBMRN+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV020060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 130CM 60MM PERI OTW TPR TIP LOPRFL SBMRN+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV020040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 130CM 40MM PERI OTW TPR TIP LOPRFL SBMRN+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE070080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 80MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE060060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 60MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE040080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 130CM 80MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5202100|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL DOUBLE J 6 X 26 5202100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|373.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GR3509|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE STANDARD .035 DIAMETER X 260CM LENGTH X 3CM FLEXIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported XT-7554|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 5MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT7544|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 4MM 75CM 4CM PERI OPTPLST XT PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT7552|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 5MM 75CM 2CM PERI OPTPLST PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSCH-35-145-BH|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 DIAMETER X 145CM LENGTH TSCH-35-145-BH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26904|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 4CM ATB ADV ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-12062|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 6MM BALLOON DIAMETER X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB14040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 14MM DIAMETER X 40CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB10030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 10MM DIAMETER X 30CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB12030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 12MM DIAMETER X 30CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT-12064|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OPTIPLAST PTA 6MM BALLOON DIAMETER X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40153-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSION PERIPHERAL 5FR DIAMETER X 100CM USABLE LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1323-10|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 320MG/ML 100ML PREFILLED SYRINGE POWE|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1333-10|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 350MG/ML 100ML PREFILLED SYRINGE POWE|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU45|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZM9EBU40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9FR EBU4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZM9EBU45|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9FR EBU4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZM9JL40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9FR JL4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZM9JL50|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9FR JL50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SGW-250-SD|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SAVARY GILLIARD 250CM LENGTH FLEXIBLE PROGRESSIVEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC48174|SUP|HCPCS A9500||0343 - NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS|CARDIOLITE 25MCI SINGLE DOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 392006015|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM ENSNARE 9-15MM 120 CM LENGTH CATHETER 6FR X 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 391003008|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM MINI EN-SNARE 4-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82358-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI PROWATER FLEX .014" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PB2813Y|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.8-3FR .027IN 130CM 17CM MRKR BAND HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RG-GW1818SP|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .018IN 2 END 90D 60D 25CM GLDWR GT HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EB2S507U|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MICROSPHERE COMPRESSIBLE BEAD BLOCK 500-700 MICRONS|1|HUMANA [1294]||HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC48267|SUP|Custom 95131007||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|UP CHARGE REPLACED SINGLE CHAMBER RECALLED W/DUAL CHAMBER DE|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.944E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAP 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5202800|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT DIVERSION DOUBLE-J 6.0 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|373.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12TLW804F|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FOGARTY EMBOLECTOMY CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010006-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 60MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010006-80|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 80MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010007-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 60MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010007-80|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 7.0MM X 80MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12778-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI MIRACLEBROS 3 .014" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR6.5-35-125-P-NS-|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SHUTTLE SLIP 6.5FR JB2 125CM SCBR6.5-35-125-P-NS-JB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3376105|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 6FR 60CM PQCTH 3 LUM PICC PU 45CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG510|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDECATH 5 FRENCH X .038 GUIDEWIRE X 100CM LONG TIP SHAPE S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4018|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL MSF 3.5MM X 6.0CM X 107CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FLT09040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFT FLUENCY PLUS 9MM X 40MM X 117CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCFW-10-38-45-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPECIAL ITEM - MUST ORDER QTY OF 5 EA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KCFW-5.0-18/38-45-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR CHECK-FLO ANSEL 2 5FR .018/.038" GUIDE DIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08867|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 6FR 2.2MM 30CM SM VLV FLXR CHFL ACPT .038IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 070037A|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER 23 CM 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 060037A|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER 23CM 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 312055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL FIBERED PLATINUM COMPLEX/HELICAL 5MM COIL DIAMETER X 50|1|HUMANA [1294]||HUMANA [11839]|270.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB08030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 8MM DIAMETER X 30CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB08040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 8MM DIAMETER X 40CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09497|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 8.5FR 40CM MCLC 32 SDPRT RADOPQ BIL ULTHNE HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09498|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 10.2FR 40CM MCLC 32 SDPRT RADOPQ BAND BIL ULTHNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09501|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 8.5FR 25CM MCLC 6 SDPRT TROC MP RADOPQ ULTHNE AQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09502|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 10.2FR 25CM MCLC 6 SDPRT LCK LOOP RADOPQ BAND MP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 610152|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER TEAR AWAY W/LOCKING CLIP 10FR X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XT7572|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL XTHN 7MM 75CM 2CM PERI 2 LUM OPTPLST ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011649-45|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 190CM LOPRFL CRTD GW DLV SHTH FLTR BSKT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBN37510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 3.75MM X 10MM LENGTH FLEXTOME DILATION DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67004100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH AMPLATZ LEFT 2 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6JR50SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR JUDKINS RIGHT SIDE HOLES 5.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161103|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FAST TRACKER 140CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12784-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI CONFIANZA 9 .014/.9" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG143390|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI CONFIANZA 9 .014/.9" DIAMETER 300CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG14M350|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI MIRACLEBROS 3 .014" DIAMETER 300CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5230600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URINARY SINGLE J 7.0 X 90|1|HUMANA [1294]||HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600634|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH LEONARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010568-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 10.0MM X 40MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PTA107275|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIATORR 10MM X 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010483-HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE PILOT 50 STRAIGHT TIP .014" DIAMETER 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010484-HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE PILOT 150 J TIP .014" DIAMETER 300CM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752520|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 24CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG|1|HUMANA [1294]||HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G26896|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 4CM ATB ADV ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26900|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 4CM ATB ADV ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26906|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 9MM 80CM 4CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSCF-18-260-3-BH|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CURVE TEFLON COATED .035 DIAMETER X 260CM LENGTH T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV040040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON OTW PTA BALLOON DIAMETER 4.0MM X 40MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3275155|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 5FR DUAL LUMEN POWER PICC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-557|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 18MM 75CM 40MM PERI LV SCRCH RST HI STRTH SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4171640S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 14MM 80CM 40MM OTW 1 PC HUB BRD INR BD COAX DRLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4171840S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 7FR 18MM 80CM 40MM AORTA ESOPHOGEAL PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588836|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH .088 AMPLATZ RIGHT SIDE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31453|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE EXCHANGE STRAIGHT TFE COATED SS .035 DIAMETER 260|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR4.0-38-100-P-NS-|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC SLIP W AQ HYDROPHILIC COATING BEACON T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0407-0690-20|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNISCAN 287MG/ML 20ML SINGLE DOSE VIAL NDC#|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-12013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 10MM BALLOON X 30MM STENT LENGTH X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,574.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,574.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-72013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 7MM BALLOON X 20MM STENT LENGTH X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-74013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 7MM BALLOON X 40MM STENT LENGTH X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,850.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,850.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046740750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 7MM BALLOON X 37MM X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-83013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 8MM BALLOON X 30MM STENT LENGTH X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046830750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 8MM BALLOON X 27MM LENGTH X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-92013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 9MM BALLOON X 30MM STENT LENGTH X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-94013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 9MM BALLOON X 40MM STENT LENGTH X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,850.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,850.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G11638|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR CHECK FLO 6FR .038 55CM LENGTH KCFW-6.0-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G11633|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR CHECK FLO 7FR .038 55CM LENGTH KCFW-7.0-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G52917|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILTER GUNTHER TULIP FEMORAL VENA CAVA 30MM 65CM 8.5FR|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105835-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOJET SPIROFLEX 4FR 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-56222|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,PISTON,TEF-PLATINUM|1|HUMANA [1294]||HUMANA [11839]|465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-56304|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORETZ PEG TOTAL OSSICULAR 6304|1|HUMANA [1294]||HUMANA [11839]|768.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|768.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PG2470BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 6FR 23MM 135CM 25MM MED DLV SYS CLS CELL BLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3970BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 6/6.5/7FR 36MM 135CM 40MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-507|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE 8 FR APDG/8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26872|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 4CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600732|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HOHN 7FR DUAL LUMEN W/VITA CUFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600712|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HOHN 5FR SINGLE LUMEN W/VITA CUFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14677-01|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CLOSURE VESSEL SUTURE MEDIATED STARCLOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|648.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|648.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT24135|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH SRG 135CM 2.1FR ASAHI TORNUS BRD TPR TIP RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85402|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 6MM X 38MM X 80CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137504|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH,URETERAL,SPIRAL TIP,4FR,D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 45-310|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT MINI VAXCEL 8FR CATHETER LENGTH 63CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1001309J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE IRONMAN 190CM #1001309|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1323-77|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 320ML/MG 50ML PREFILLED SYRINGE POWER|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26868|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 10MM 120CM 4CM PERI 2 LUM XPD RADOPQ STRL ATB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC49360|SUP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEED LOOSE I-125 ACTIVITY .673 MCI|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KO24017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BALLOON ASSEMBLY PATIENT BREATHING BLUE|1|HUMANA [1294]||HUMANA [11839]|54.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KO24018|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BALLOON ASSEMBLY PATIENT BREATHING YELLOW|1|HUMANA [1294]||HUMANA [11839]|54.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26869|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 2CM ATB ADV ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 4CM ATB ADV ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL-07624|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH 6FR SUPER ARROW FLEX 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL-07824|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH 8FR SUPER ARROW FLEX 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532010|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 5CM 2 PGTL CRV GASTROINTESTINE CFLX PLS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|217.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|217.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066703081|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE DUAL-FLEX SENSOR .035X150 STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5386|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IDENTITY XL DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,589.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,589.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1688T/65|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL SDX BIPOLAR VENTRICULAR SCREW-IN STEROID ELUTIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1688TC/58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 58CM 7FR HLX TRNVNS ATR VNTRC IS-1 CNCT BP ACTFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE060060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 130CM 60MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG414|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 120CM 4FR .041IN GLDCATH GLD TCH STRG CRV SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10800703|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER SCHON XL ACUTE 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1688T/48|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL SDX BIPOLAR VENTRICULAR SCREW-IN STEROID ELUTIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-0185|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRAWFORD LACRIMAL SET WITHOUT SUTURE|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G26874|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 4CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1333-25|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 350MG/ML 125ML PREFILLED SYRINGE POWE|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06040ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY NITINOL 6MM DIAMETER X 40MM STENT LENGTH X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136405|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH,URETERAL,WHISTLE TIP 5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7014-0084|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOD,5.0MM,DRUM TO STAPES|1|HUMANA [1294]||HUMANA [11839]|432.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C08040ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 40MM 120CM DLV HNDL SLF XPD MICROMESH SEG ILC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C10040ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 40MM 120CM DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C08060ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 60MM 120CM DLV HNDL SLF XPD MICROMESH SEG ILC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C10060MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY NITINOL 10MM DIAMETER X 60MM STENT LENGTH X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C08081ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY NITINOL 8MM DIAMETER X 80MM STENT LENGTH X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C10080MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 80MM 120CM DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C08100ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY NITINOL 8MM DIAMETER X 100MM STENT LENGTH X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-06-80-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 6 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-07-40-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 7 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-07-60-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 7 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-08-40-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 8 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-08-60-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 8 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-08-80-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 8 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ECP135|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EMBOCATH CATHETER LENGTH 135CM 3.0-2.8 DIAMETER STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010558-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 8.0MM X 30MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MAN05.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR MINUS 5.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM25006|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING 2.5MM X 6MM LENGTH FLEXTOME DILATION DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CBM30006|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 142CM 6MM PERI PLQ MODIFICATION NYL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802230|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL CONTOUR 6 X 26 #180-223|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported E2DR06|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE ENPULSE DR DUAL CHAMBER RATE RESPONSIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL07040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 7 MM STENT D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802220|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CONTOUR 6 X 24 #180-222-01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00558350|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 8CM 6FR 10-12MM ESPH FX WRE BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1860BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SDS GENESIS AVIATOR 6MM DIAMETER 18 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2460BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SDS GENESIS AVIATOR 6MM DIAMETER 24 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1860BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 6MM DIAMETER 18 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2460BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 6MM DIAMETER 24 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137505|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH,URETHERAL,SPIRAL TIP,5FR,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H749389694970|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 100CM 6FR RWY ART3 CRV FEM PTFE LG LUM SH RADOPQ 4X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749343574970|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 100CM 7FR MACH1 ART3 CRV FEM PERI PTFE LG LUM SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749389694990|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 100CM 6FR RWY ART3.5 CRV FEM PTFE LG LUM SH RADOPQ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749389695010|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 100CM 6FR RWY ART4 CRV FEM PTFE LG LUM SH RADOPQ 4X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26873|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 2CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL06120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 6 MM STENT D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL07120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 7 MM STENT D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL06040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 6 MM STENT D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL06060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 6 MM STENT D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL06080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 6 MM STENT D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL07060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 7MM STENT DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL07080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 7MM STENT DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL08040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 8MM STENT DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL08060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 8MM STENT DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXL08080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY CONFORMEXX SELF EXPANDING NITINOL 8MM STENT DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLRFLXB-4.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PLUS 4.5 DIOPTER CLARIFLEX WITH 10 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB10040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 10MM DIAMETER X 40CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBT1401D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX BIF STRETCH 14MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LUB08060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 8MM DIAMETER X 60CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB08080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 8MM DIAMETER X 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB09060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 9MM DIAMETER X 60CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB09040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 9MM DIAMETER X 40CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LUB10060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LUMINEX 10MM DIAMETER X 60CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBT1601D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX STRETCH BIF 16MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6893|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL ULTRAFLEX 8-4 X 16 X 95 PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-07-30-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 7 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBT2001D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX STRETCH BIF 20MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G14521|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|POLLACK CATHETER 5FR OPEN-END FLEX TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G13287|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET RTRVL 80CM 6.3FR 11FR GNTH TLP VC 3W STPCK CATH COONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37911-51515|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY EXPRESS MONORAIL PREMOUNTED 5MM STENT DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 3FR TWIN PASS OVER THE WIRE LUMEN AND RAPID EXCHANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535DLM014|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STEER IT 180 CM 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26871|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 2CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532020|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 10CM 2 PGTL CRV GASTROINTESTINE CFLX PLS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-52112|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS DRG DLV 12CM ENDOWAVE CATH COR WRE KT PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-52118|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS DRG DLV 18CM ENDOWAVE CATH COR WRE KT PERI 5.2FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-52124|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS DRG DLV 24CM ENDOWAVE PERI INFS AREA US COR WRE 5.2FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-52130|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS DRG DLV 30CM ENDOWAVE PERI INFS AREA US COR WRE 5.2FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-52140|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INFS 5FR ENDOWAVE 40CM PERI INFS AREA US COR WRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-52150|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INFS 5.2FR ENDOWAVE 50CM PERI INFS AREA US COR WRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG3990BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 9MM DIAMETER 39 MM LENGTH 135CM P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-306|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VANSONNENBERG LOCKING VSCTT LOOP 12 FR X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-307|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VANSONNENBERG LOCKING VSCTT LOOP 14FR X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CCL2-1050HB|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY DRAINAGE CHOLE-CATH 10FR X 40 CM NCLUDES: C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM10040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 40MM 9FR 10MM FLN + EVAS EPTFE 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010555-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 5.0MM X 80MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-8646|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND,CPC,FLORIO,7/16,SHORT|1|HUMANA [1294]||HUMANA [11839]|129.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|129.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported NCL2-1035H|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHROSTOMY DRAINAGE 10FR X 27CM INCLUDES: CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPL2-0830H|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GENERAL PURPPOSE DRAINAGE 8FR X 20CM INCLUDES: CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1990BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 9MM DIAMETER 19MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-8648|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND,CPC,FLORIO,5/16,SHORT|1|HUMANA [1294]||HUMANA [11839]|129.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|129.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P4355K|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT TITAN WITH ATTACHED 7 FR CATHETER KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|687.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|687.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345988|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DUAL COIL RETRACTABLE SCREW IN 65/16 STEROID ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 347351|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DUAL COIL TINED 65/16CM STEROID ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1570|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA DUAL COIL 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26881|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 120CM 4CM ATB ADV ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26878|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 120CM 4CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26880|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 120CM 2CM PERI 2 LUM XPD RADOPQ STRL ATB ADV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545900|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILITATION HURRICANE RX 4MM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-140-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7040/65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA ST DUAL COIL 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0123|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS SCHUKNECHT SLIM 3.75|1|HUMANA [1294]||HUMANA [11839]|274.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|274.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 67008255|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 4.0 JUDKINS RIGHT V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1788TC/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL ST BIPOLAR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7000/65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD RIATA ST 65CM ICD 17CM SPACING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1788TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL ST BIPOLAR 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1016040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE GOODE T MODIFIED #1016040|1|HUMANA [1294]||HUMANA [11839]|97.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|97.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VC10118|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA COAXIAL 10G X 118MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-1006|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS VALVED 6FR 13CM SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005528-13|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 4.5MM X 13MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003094-40D|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CUTTER FLEXICUT 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008124|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FLEXIWIRE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-265|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-255|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-158|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR SINGLE CHAMBER RATE RESPONSIVE AUTOMATIC IMPLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7041/65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA ST DUAL COIL 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7001/60|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD RIATA ST DUAL COIL 60CM ICD 21CM SPACING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7001/65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD RIATA ST DUAL COIL 65CM ICD 21CM SPACING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1788TC/58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL ST BIPOLAR 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86005X05|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT PERIOSTEUM 5 X 5CM|1|HUMANA [1294]||HUMANA [11839]|5,739.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,739.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10800701|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER SCHON XL ACUTE 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|338.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10800702|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER SCHON XL ACUTE 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|338.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00514210|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 23MM X 28MM X 12CM DISTAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC18017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE BONE FIBULAR 6MM X 11MM|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P758|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD POLARIS TIP VENTRICULAR BIPOLAR TINED 58CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SR2250|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER SYMPHONY SR SINGLE CHAMBER DUAL SENSOR RATE RESPON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HBI-1|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO ESCP 10-6FR 200CM GW TPR TIP HWL .035IN BIL STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC18019|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE BONE FIBULAR 7MM X 11MM|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 85409|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 9MM X 59MM X 80CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14843-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 6MM DIAMETER 60MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC18020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE BONE FIBULAR 8MM X 11MM|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14829-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 5MM DIAMETER 60MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14821-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 5MM DIAMETER 40MM LENGTH 80CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14835-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 6MM DIAMETER 40MM LENGTH 80CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLC-8-038|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 8.5FR 25CM RSLV 8 HL LCK FLXB NONMARKER BAND PU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-365|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR TIERED THERAPY ATLAS 11 HF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407582|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER GUIDE CATHETER APEEL CS PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 507-914J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE STABILIZER BALANCED PERFORMANCE DIAMETER SUPERSOFT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 598930|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 9 FRENCH 4.0 JUDKINS RIGHT CORONARY VISTA BRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5733693|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER HEMO SPLIT WITH BIO BLOC COATING 19CM X 14.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5733733|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER HEMO SPLIT WITH BIO BLOC COATING 23CM X 14.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5733273|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER HEMO SPLIT WITH BIO BLOC COATING 27CM X 14.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24039-2|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT CSF LEVEL 2|1|HUMANA [1294]||HUMANA [11839]|1,830.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,830.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 24039-1|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT CSF LEVEL 1|1|HUMANA [1294]||HUMANA [11839]|2,430.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,430.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 41057-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH IV 5FR 135CM 1 LUM RADOPQ LG ID GW CRGG-MCNAM CRGG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008180-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 7.0MM X 18MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008178-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 6.0MM X 18MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008182-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 18MM CATHETER LENGTH 80C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14844-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 6MM DIAMETER 80MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14846-05|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 6MM DIAMETER 120MM LENGTH 120CM SHAF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14860-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 7MM DIAMETER 40MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14861-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 7MM DIAMETER 60MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14862-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 7MM DIAMETER 80MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14877-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 8MM DIAMETER 40MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14878-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 8MM DIAMETER 60MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14879-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 8MM DIAMETER 80MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4206040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7.5MM 6MM 80CM 40MM PERI 2 LUM OTW FLXB TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4207040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7.5MM 7MM 80CM 40MM PERI OTW 2 LUM FLXB TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 420-7040X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON POWERFLEX P3 7X40 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4209020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7.5MM 9MM 80CM 20MM PERI OTW 2 LUM FLXB TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 420-9020X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON POWERFLEX P3 9X20 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4202020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7.5MM 12MM 80CM 20MM PERI 2 LUM OTW FLXB TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43100|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL WITH PERMALUME 8FR X10MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1044588J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE ADVANCE J TIP .014" DIAMETER 190CM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1044586J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE ADVANCE LITE J TIP .014" DIAMETER 190CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2980BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 8MM DIAMETER 26MM LENGTH 135CM PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2103-36|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH OCCLUSION 3F-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PG3980BPX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 8MM DIAMETER 36MM LENGTH 135CM PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6954|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL DISTAL RELEASE COVERED 18MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6894|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 10MM X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4555|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 5CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4560|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 5CM DDNL BND RX DLV SYS DISP ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31537|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN XTRT 200CM 7-5FR 8.5MM FSN .035IN NTR RBR INJ ABV BIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VR6250|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ICD SINGLE CHAMBER OVATIO VR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XD618YF|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SHAFT RACER 6 MM DIAMETER 18 MM LENGTH SHAFT LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BTF26D|SUP|HCPCS C1898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD STELID II ATRIAL J BIPOLAR VITREOUS CARBON TIP TINED FI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5888103|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 100CM LENGTH XBLAD 3.5 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU40SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6904|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL DISTAL RELEASE COVERED 14MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6898|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL DISTAL RELEASE NON COVERED 14MM X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM09040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 40MM 9MM 9FR FLN + EVAS EPTFE C 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-168|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER RATE RESPONSIVE AUTOMATIC IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7000/60|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD RIATA ST 65CM ICD 21CM SPACING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77805400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH XB 3.5 VISTA BRITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77805500|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH XB 3.5 SIDE HOLES VI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77805600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH XB 4.0 VISTA BRITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77806200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH XBLAD 4.0 VISTA BRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77806300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH XBLAD 4.0 SIDE HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77806100|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH XBLAD 3.5 SIDE HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-020-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-030-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-040-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-060-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-080-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-100-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-150-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 150MM 120CM SLF XPD DLV CATH SYS SPRL CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1025001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE PAPARELLA TYPE I|1|HUMANA [1294]||HUMANA [11839]|99.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|99.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PRB35-07-040-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-060-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-080-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-100-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-150-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-040-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-060-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-080-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-100-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-120-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-150-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XD718XF|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SHAFT RACER 7 MM DIAMETER 18 MM LENGTH SHAFT LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FB830-F|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 8MM STENT DIAMETER 30MM STENT LENGTH 80CM SHAF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FB840-F|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 8MM STENT DIAMETER 40MM STENT LENGTH 80CM SHAF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07040ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 7X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802430|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 26CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]||HUMANA [11839]|342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CMM-CT4S105|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER 4 FR X 50CM SINGLE LUMEN CT PICC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|234.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB702|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PINNACLE 7F RADIOPAQUE MARKER II 10CM WITHOUT WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VC14116|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA COAXIAL 14G X 116MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VC14138|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA COAXIAL 14G X 138MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802420|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 24CM 3CM .038IN PGTL CRV STRG TPR TIP BLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LV/IS-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR OSCOR|1|HUMANA [1294]||HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G10554|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTBT 70CM 14FR .038IN RPFT SFTJ 3MM SS PTFE RTRGD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12591|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO TUBE 35CM 8FR 1.6MM FROVA RPFT INTBT ANG TIP STIFFEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G23646|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER INTUBATING FROVA 14 FR X 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569810|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL BILIARY 10MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE030040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 80CM 40MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE030080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 80CM 80MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE030040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 130CM 40MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUV035040090|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON OTW PTA BALLOON DIAMETER 3.5MM X 40MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUB035060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON OTW PTA BALLOON DIAMETER 3.5MM X 60MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588-846P|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8FR .088 RDC 55CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1333-81|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 350MG/ML 125ML PREFILLED SYRINGE POWE|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XD712YF|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SHAFT RACER 7 MM DIAMETER 12 MM LENGTH SHAFT LENGTH 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPR4015MX|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SPRINTER MX2 4.0X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPR2512MX|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 142CM 12MM FULCRUM DURA-TRC SPNTR MX2 PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DRV35015MX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT DRIVER MX2 3.5X15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-513|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE CHEST 12F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-514|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE CHEST 14F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPR2012MX|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SPRINTER MX2 2.0X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493808008450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 135CM 8MM TPR TIP LOPRFL Q MBSLD ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493808008500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 8MM TPR TIP LOPRFL Q MBSLD ACPT .014IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-14.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,MICRO,ST,8-HOLE,0.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SECX-6-20-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 6MM STENT DIAMETER X 20MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-6-30-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 6MM STENT DIAMETER X 30MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-6-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 6MM STENT DIAMETER X 40MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-7-30-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 7MM STENT DIAMETER X 30MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-7-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 7MM STENT DIAMETER X 40MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-7-60-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 7MM STENT DIAMETER X 60MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-8-30-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 8MM STENT DIAMETER X 30MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.069|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.3MM DOUBLE Y 18MM X 9MM 9 HOLE TITANIU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SECX-8-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 8MM STENT DIAMETER X 40MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-10-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 10MM STENT DIAMETER X 40MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-8-6-30-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE TAPERED 8/6MM STENT DIAMETER X 30MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-8-6-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE TAPERED 8/6MM STENT DIAMETER X 40MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-10-7-30-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE TAPERED 10/7MM STENT DIAMETER X 30M|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-10-7-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE TAPERED 10/7MM STENT DIAMETER X 40M|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-050-190|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE PROTECTION EMBOLIC FILTER 5.0 FX SPIDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-070-190|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 7MM .014IN LOOP CRTD LWR XTRMT CPTR WRE BRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-040-190|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE PROTECTION EMBOLIC FILTER 4.0 FX SPIDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-060-190|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 190CM .014IN CPTR WRE BRD RADOPQ LOOP 3.2-4.2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR STRG 29X4.8X1MM MNDB 4 HL LOPRFL 2MM SCR MDLR FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SECX-7-20-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 7MM STENT DIAMETER X 20MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-8-20-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 8MM STENT DIAMETER X 20MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-8-60-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 6MM STENT DIAMETER X 30MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SECX-9-40-135|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX PROTEGE STRAIGHT 9MM STENT DIAMETER X 40MM|1|HUMANA [1294]||HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12242|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 55CM 8FR 2.9MM FLXR CHFL RAABE MODIFICATION ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G880JR4D|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 8 FRENCH X 55CM LENGTH 4.0 JUDKINS RIGHT CORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM ADAPTION 119MM 20 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported IN4069|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLUG INSERT 16 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-266|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY FLEXIMA RO 10FR X 35 SOFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-267|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY FLEXIMA RO 12FR X 35 SOFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STRG 29X4.8X1.25MM MNDB 4 HL LOPRFL 2MM SCR MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported METII-35-260|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE WIRE TRACER METRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported METII-25-480|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE WIRE TRACER METRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31911|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPHNTM 25MM 7FR FSN OM-TOME BIL PNCR MFL DOME TIP PRELD FSN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00550330|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 3CM 75CM 8-9-10MM PULM BLN RADOPQ RECTILINEAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00550340|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 3CM 75CM 10-11-12MM PULM BLN RADOPQ RECTILINEAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 41X4.8X1.25MM MNDB 6 HL LOPRFL 2MM SCR MDLR FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|774.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ATEC TD 13-MR|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IDENTIFIER BIOPSY SITE FOR USE IN MRI GUIDED BREAST BIOPSY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1888TC/58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL ST BIPOLAR 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1888TC/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL ST BIPOLAR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STRG 55X4.8X1.25MM MNDB 8 HL LOPRFL 2MM SCR MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1888TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TENDRIL ST BIPOLAR 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670-004-00|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FRENCH X 100CM LENGTH JUDKINS LEFT 4 VISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67008200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 6FR JR 4.0 VISTA BR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1870BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 7MM DIAMETER 18 MM LENGTH 135CM PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1865BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 6.5MM DIAMETER 18 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1855BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 5.5MM DIAMETER 18 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM DCP 43MM 4 X 4 HOLE ANGLED TITANIU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|867.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PG1845BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 4.5MM DIAMETER 18 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1570BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 7.0MM DIAMETER 15 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1565BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 6.5MM DIAMETER 15 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1555BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 5.5MM DIAMETER 15 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1545BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SDS GENESIS 4.5MM DIAMETER 15 MM LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PB1550BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 5MM DIAMETER X 15MM LENGTH PALMAZ GENESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PB1850BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 5MM DIAMETER X 18MM LENGTH PALMAZ GENESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PB1560BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY 6MM DIAMETER X 15MM LENGTH PALMAZ GENESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PB1860BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PALMAZ BLU TRANSHEPATIC BILARY 6 MM X 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67006100|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER GUIDE 6 FRENCH X 100CM LENGTH X 3.5SH EXTRA BACK U|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 32X5X1.25MM MNDB 5 HL LOPRFL 2MM SCR MDLR FX SYS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67008300|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD BLU YLW 100CM 6FR .07IN VSBR TRUELUMEN STD JR 4 CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LANGSTON 145 PIGTAIL 125 CM LENGTH 7 FR DIAMETER 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 42X5X1.25MM MNDB 6 HL LOPRFL 2MM SCR MDLR FX SYS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|639.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FSW-35|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE WIRE SHORT ULTRA FUSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31522|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEV LCK GW FSN BILE PNCR STRL DISP FUJINON OLMPS SCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2006-S|SUP|HCPCS L8509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS VOICE 20 FR 6MM ADVANTAGE|1|HUMANA [1294]||HUMANA [11839]|837.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|837.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM DCP 48MM 7 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM DCP 54MM 8 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM NARROW 55MM 8 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|591.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 38080-2045|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 135CM 20MM TPR TIP LOPRFL Q MBSLD ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38080-2050|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 20MM TPR TIP LOPRFL Q MBSLD ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRIMARK TD 3609|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IDENTIFIER BIOPSY SITE FOR USE IN 9G STEREOTACTIC GUIDED BRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATEC TRIMARK TD13-12|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IDENTIFIER BIOPSY SITE FOR USE IN 12G STEREOTACTIC GUIDED BR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|218.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|218.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CELEROMARK|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IDENTIFIER BIOPSY SITE FOR USE WITH CELERO-12 BIOPSY DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CELERO INTRO-12|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 12G FOR USE WITH THE SUROS CELERO-12 BIOPSY DEVIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9900|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ULTRA ICE 9F 9MHZ 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5662ST|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CONVOY DELIVERY 8.5F 60.CM SOFT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0981-012|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROXIS EMBOLIC PROTECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE050060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 60MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE050080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 80MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE060120080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 120MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE070060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 60MM PERI OTW 2 LUM SLR+ ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48180|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT NPHURSTM 26CM 8.5FR COPE MCLC PGTL CRV ULTHNE LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83326|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COOL PATH MED CURVE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83327|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COOL PATH LARGE CURVE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83328|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COOL PATH EXTRA LARGE CURVE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83329|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COOL PATH FLUTTER CURVE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7020/65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA ST OPTIM 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7020/60|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA ST OPTIM 60 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7021/65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA ST OPTIM 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7021/60|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR RIATA ST OPTIM 60 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8637-40|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION SYNCHROMED 8637|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,920.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|31,920.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G10261|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET DRN 25CM 12FR HDRPH ULTHNE 6 SDPRT MC LC LCK MECH NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09499|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 12FR 40CM MCLC 32 SDPRT RADOPQ BAND BIL ULTHNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-563|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE AMPLATZ SUPER STIFF .035 DIAMETER X 75CM LENGTH ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10301202|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DURA-FLOW HEMODIALYSIS BASIC CARBO-THANE 23 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC18128|SUP|HCPCS C1818||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE PROSTHESIS KERATO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10301201|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DURA-FLOW HEMODIALYSIS BASIC CARBO-THANE 19 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106127-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FETCH ASPIRATION 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAE050120130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 130CM 120MM PERI OTW 2 LUM SLR+ ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601N0J0L1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE REGATTA FLOPPY MIDDLEWEIGHT J TIP 195 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602N0J0L1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE REGATTA MIDDLEWEIGHT J TIP 195 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603N0J0L1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE REGATTA MIDDLEWEIGHT PLUS J TIP 195 CM 90007440|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00513730|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 18MM X 23MM X 10CM DISTAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00513740|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 18MM X 23MM X 12CM DISTAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00514200|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 23MM X 28MM X 10CM DISTAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569650|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 60MM 194CM .035IN RX DLV SYS CVR GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AS2010-S|SUP|HCPCS L8509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS VOICE 20 FR 10MM ADVANTAGE|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-1011|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS VALVED 11FR 13CM SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106553-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET THROMBECTOMY ANGIOJET SPIROFLEX 4FR 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S2J752|SUP|HCPCS C1898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD BIPOLAR PERMANENT PACING 52 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050120130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 130CM 120MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558490|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 240CM 5.5CM 7.5FR 15-18MM EPC GW BLN CATH PEBAX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01716|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE MOVABLE CORE TAPERED TEFCOR .035 DIAMETER X 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE030020080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 80CM 20MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 40MM 13.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-4455-01|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PORT-A-CATH POWER PAC 28 BASE 7.8 FR 76 CM 8.5 INT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-4471-01|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PORT-A-CATH POWER PAC 25 BASE 7.8 FR 76 CM 8.5 INT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-4483-01|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PORT-A-CATH POWER PAC 25 BASE 5.8 FR 76 CM 6 INTROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVALUATION|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON MAVERICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVALUATION|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIBERTE|1|HUMANA [1294]||HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493808012300|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 12MM TPR TIP LOPRFL Q MBSLD ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893412300|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY VERIFLEX 3.0 X 12|1|HUMANA [1294]||HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48166|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT NPHURSTM 26CM 10.2FR COPE MCLC PGTL CRV ULTHNE LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888119369|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PALINDROME SAPPHIRE HEPARIN COATING 19/36 SPORTPACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS-QEB-XL-A|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLN XTRT 200CM 12-20MM FSN QUATTRO .035IN BIL NTR RBR STON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893424300|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3MM VERIFLEX MNRL BARE MTL PRMNT RADOPQ|1|HUMANA [1294]||HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893424350|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3.5MM VERIFLEX MNRL BARE MTL PRMNT RADOPQ|1|HUMANA [1294]||HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GCO 16-16|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER NEEDLE 15 GA X 11 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GCO 14-16|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER NEEDLE 13 GA X 11 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE060080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 130CM 80MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-910|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STEERABLE FATHOM 25 CM TIP LENGTH 180 CM LENGTH 01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 5CM 2 PGTL CRV GASTROINTESTINE CFLX PLS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|217.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|217.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105041-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOJET ULTRA XMI THROMBECTOMY SET 135 CM 4FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GCO 18/16|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569700|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 40MM RX WLSTNT UNSTP + RMLM COVERING DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011341-30|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 9MM 30MM 132CM STRG SLF EXPANDABLE RX LOPRFL OPN|1|HUMANA [1294]||HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82359-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI FIELDER .014" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADSR03|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ADAPTA SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410113|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CPS DIRECT SLITTABLE 47 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410141|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULATOR CPS AIM 90 CURVE 71 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LMGRF-7.0C-80-MPA|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER WHITE LUMAX 7.0 FR X 80 CM LMGRF-7.0C-80-MPA-PULM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058T|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING PASSIVE FIX LEFT VENTRICULAR S-CURVED 5 FR SX 86|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 351337|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PASSIVE FIXATUON QUADRUPOLAR ICD LINOX TD 65/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3386155|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH CV 6FR 70CM 3 LUM BSC GW RVRS TPR PICC P PICC SS PU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 351338|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PASSIVE FIXATUON QUADRUPOLAR ICD LINOX TD 65/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1255BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PALMAZ GENESIS TRANSHEPATIC 0.14 DELIVERY SYST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569710|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 60MM 194CM .035IN RX EPRSTH UNSTP DLV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569720|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 80MM 194CM TPR UPDS ELONGAT FX COR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569640|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 40MM 194CM WLSTNT STRL DISP ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ATV0845/80|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM DELIVERY AMPLATZER TORQVUE 8 FR X 45 DEGREE X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ATV09F45/80|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM DELIVERY AMPLATZER TORQVUE 9 FR X 45 DEGREE X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ATV1045/80|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM DELIVERY AMPLATZER TORQVUE 10 FR X 45 DEGREE X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ATV1245/80|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM DELIVERY AMPLATZER TORQVUE 12 FR X 45 DEGREE X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-EITV12F45/80|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM EXCHANGE AMPLATZER TORQVUE 12 FR X 45 DEGREE X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-SB-024|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON II AMPLATZER 24 CM 7FR X 0.035CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-SB-034|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON II AMPLATZER 34 CM 8FR X 0.035CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-GW-002|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 X 260CM AMPLATZER J-TIP SUPER STIFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545920|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL 11 ATM 6MM 180CM 4CM RX LOPRFL RADOPQ BLNDIL HRCN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00545940|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILITATION HURRICANE RX 8MM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1699TC/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD OPTISENSE ST BIPOLAR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G06451|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLTR EMBL 75CM VC FEM STRL DISP 40MM 11FR SS BNST ACPT .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU30|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE LAUNCHER 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10301203|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DURA-FLOW HEMODIALYSIS BASIC CARBO-THANE 32 CM STRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12022|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 120CM 2CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8042|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8044|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8052|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12024|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 120CM 4CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8054|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12032|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 120CM 2CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8058|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 8CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12036|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 120CM 6CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8062|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV-12038|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION ULTRAVERSE 0.18 PTA 3MM BALLOON DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV120310|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 120CM 10CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8064|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO POLY PAT-ONSET 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UV12042|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 2CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12044|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 4CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12046|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 6CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8066|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 6CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV120410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 10CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8068|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 8CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12052|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 2CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12054|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 4CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12056|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 6CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8072|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV120510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 10CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12062|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 2CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12064|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 4CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12072|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 120CM 2CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR120410|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 10CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UV12074|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 120CM 4CM OTW 2 LUM STRL LF ULTRAVERSE PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR12052|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 2CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR12054|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 4CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8074|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13556|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 6CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8076|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 6CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13558|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 8CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR120510|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 120CM 10CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75122|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 12MM 75CM 2CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR12062|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 2CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR12064|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 4CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8078|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 8CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT120124|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 12MM 120CM 4CM RADOPQ RPD INFL COAX SHFT ATLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8082|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75142|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 14MM 75CM 2CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8084|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT120144|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 14MM 120CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8086|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 6CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75162|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 16MM 75CM 2CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8088|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 8CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT120164|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 16MM 120CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8092|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 9MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75182|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 18MM 75CM 2CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT120184|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 18MM 120CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8094|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 9MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR8098|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 9MM 80CM 8CM PERI 3 LUM DORADO CK ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR80102|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 10MM 80CM 2CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13566|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 6CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR80104|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 10MM 80CM 4CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13532|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 2CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13534|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 4CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13568|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 8CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13542|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 2CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13544|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 4CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR120610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 120CM 10CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13572|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 135CM 2CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR13574|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 135CM 4CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR-13576|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DORADO PTA 135 CM SHAFT 7 X60 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR-13578|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DORADO PTA 135 CM SHAFT 7 X80 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DR120710|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 120CM 10CM PERI 3 LUM DORADO CK ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00554500|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP RGFLX II 90CM 10CM 30MM RADOPQ STRL LF ACPT .038IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIB6-80-14.0-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 BILIARY 14 MM DIAMETER 40 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIB6-80-14.0-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 BILIARY 14 MM DIAMETER 60 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIB6-80-12.0-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 BILIARY 12 MM DIAMETER 80 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIB6-80-12.0-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 BILIARY 12 MM DIAMETER 60 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIB6-80-12.0-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 BILIARY 12 MM DIAMETER 40 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4052|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL LS-M 4.5MM X 6.0CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KNS-1706-10|SUP|HCPCS C2614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NDL SPNL 6IN 17GA DSCGR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BVT8-080-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ISOLATED THROMBOLYSIS TRELLIS-8 15 CM TREATMENT ZON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BVT8-120-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ISOLATED THROMBOLYSIS TRELLIS-8 30 CM TREATMENT ZON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12747-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER OTW 4.5 MM DIAMETER 26 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85900|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EAGLE EYE GOLD CORONARY IMAGING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-181|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHROSTOMY FLEXIMA 12FR X 25 SOFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001271820|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH NPHSTM 25CM 14FR PGTL CRV FLXM PU LCK REG DRMTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-268|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER ICD ATLAS II + DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14938-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI MIRACLEBROS 6 .014" DIAMETER 300CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12744-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER OTW 3.0 MM DIAMETER 19 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12748-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER OTW 5.0 MM DIAMETER 19 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 84308|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COOL PATH 7 FR MEDIUM CURVE 1304-CP-7-25-M-AB|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 84309|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COOL PATH 7 FR LARGE CURVE 1304-CP-7-25-L-AB|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PIG1280K|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFETY-T-CENTESIS CATHETER DRAINAGE KIT 8FR X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-016|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7541|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 4 X 3 HOLE 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 99-7376|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401611M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER BRITE TIP 6 FR 35" 11 CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401711M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER BRITE TIP 7 FR 35" 11 CM LENGTH SHEATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14842-03|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 6MM DIAMETER 40MM LENGTH 120CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00583040|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPHNTM 20MM 260CM 4.4FR HDRTM RX 44 BIL PNCR CNN PRELD GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1003309HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE WIRE HI-TORQUE CROSS-IT 100XT J TIP 190 LENGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22299M-W2|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE WIRE .014 WIGGLE 190/2 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE030080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 130CM 80MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V-366|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR TIERED THERAPY ATLASII + HF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|68,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603N0S0L1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE REGATTA MIDDLEWEIGHT+ NLS 195 CM STR 90007874|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602N0S0L1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE REGATTA MIDDLEWEIGHT NLS 195 CM STR 90007404|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-242|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE SMALL VESSEL GOLD M001462420|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE030040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 130CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE040040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 130CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050020130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 130CM 20MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5348|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER SINGLE CHAMBER TEMPORARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008161-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 5.0MM X 18MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 11MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008163-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 6.0MM X 18MM CATHETER LENGTH 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 80MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-07-27-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 27MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-08-37-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 37MM 80CM 40MM BLN XPD FLXB MNT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625-0T-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT ALUMINA 0-DEGREE 28MM SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00513840|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 18MM X 23MM X 10CM PROXIMAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00513850|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 18MM X 23MM X 12CM PROXIMAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-07-27-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 27MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-08-27-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 8MM DIAMETER X 27MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67005200|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6F .070 XB 3 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE040080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 80CM 80MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE040060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ADMIRAL XTREME 4.0 MM DIAMETER X 60MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1250BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY AVIATOR GENESIS TRANSHEPATIC 0.14 DELIVERY SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6923|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 16MM X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6926|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL ULTRAFLEX 18 X 40 PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1250BAS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY AVIATOR GENESIS TRANSHEPATIC 0.14 DELIVERY SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1GTCFS-65-JUG-CELECT|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FILTER GUNTHER CELECT PERM JUGULAR VENA CAVA 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE060120080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 80CM 120MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 80CM 60MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749CBM200060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 142CM 6MM PERI PLQ MODIFICATION NYL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UW28D|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD SITUS OTW LEFT VENTRICULAR 7F INTRODUCER 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6750|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR OVATIO CRT BI VENTRICULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|71,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1156T/86|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRODUCER LEAD QUICKFLEX LV 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1323-91|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 320MG/ML 20 X 75ML UJ PWR INJ NDC# 00|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558470|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EPC 7.5FR 10-12MM 240CM 5.5CM GW BLNDIL CRE PEBAX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558480|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 240CM 5.5CM 7.5FR 12-15MM EPC GW BLN CATH PEBAX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005522-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION POWERSAIL 2.75MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005524-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.25MM 143CM 8MM RX SFTP RADOPQ PLTU HDRCT PWRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115100ND|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 100MM 1MM KRSH SS|1|HUMANA [1294]||HUMANA [11839]|114.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|114.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 89000|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH US 45MHZ 3.2FR 135CM 26MM ROT REINF REV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001182570|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE MICROCATHETER 2-TIP MAKER 3.0F 150 CM/20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 130CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ADMIRAL XTREME 5.0 MM DIAMETER X 60MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE050080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 130CM 80MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2010|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLEUTH IMPLANTABLE ECG MONITORING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1699TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD OPTISENSE ST BIPOLAR 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350053|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PASSIVE FIXATUON QUADRUPOLAR SD LINOX TD 65/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0928950|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT MICROINTRODUCER 5FR WITH FLEXURA 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0228960|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT MICROINTRODUCER 6FR WITH FLEXURA 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9174108|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|POWER PICC 4FR SL WITH TLS - FULL NURSING TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08427|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 60CM .018IN SFTP ANG TPR COPE NTNL PL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4137|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 60CM 6.7FR 10MM SPC ATR ECRDM VNTRC RT IS-1 CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1486|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 53CM 6.7FR 10MM SPC HLX ATR VNTRC RT BP XTD-RETRAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9528|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MONITOR ECG SUBCUTANEOUS IMPLANTABLE REVEAL DX LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-08-27-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 8MM DIAMETER X 27MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-08-57-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 8MM DIAMETER X 57MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4056|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL MS-M 3.5MM X 5.0CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE070040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 130CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE060040130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 130CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48188|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 90CM 4FR .059IN CKFL FLXR .018/.035IN ANL0 CRV HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48189|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 90CM 5FR .074IN CKFL ANL0 CRV STRG HDRPH CKFL VLV GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406871|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SHEATH SAFL 8F 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402811|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE 7F BI-DIRECTIONAL ABLATION LG CURL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402808|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE 7F BI-DIRECTIONAL ABLATION LG SWEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402810|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE 7F BI-DIRECTIONAL ABLATION MED CURL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402807|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE 7F BI-DIRECTIONAL ABLATION MED SWEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 81126|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IBI STEERABLE DECA H LARGE CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 81125|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IBI STEERABLE DECA H CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402804|SUP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER REFLEXION BI-DIRECTIONAL DUO SPIRAL|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408310|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER AGILIS BI-DIRECTIONAL STEERABLE 71CM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408309|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER AGILIS BI-DIRECTIONAL STEERABLE 71CM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406980|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE ACROSS TRANSEPTAL ACCESS 81CM SL-1 BRK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406979|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE ACROSS TRANSEPTAL ACCESS 81CM LAMP BRK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406981|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE ACROSS TRANSEPTAL ACCESS 63CM LAMP BRK-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406978|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE ACROSS TRANSEPTAL ACCESS 63CM SL-1 BRK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-25123-F|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARROW MULTI LUMEN CATH 12FR 20CM A25123F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|275.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|275.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 406977|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE ACROSS TRANSEPTAL ACCESS 63CM LAMP BRK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRIEF RADIATION IMPLANT FITS SIZE MED|1|HUMANA [1294]||HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C405086|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIGERWIRE ANGLED FLOPPY TIP .035 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1808060|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWERPORT 8FR ATTACHABLE CHRONOFLEX CATHETER RADIO TRANSLUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,663.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,663.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14679-01|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CLOSURE VESSEL SUTURE MEDIATED STARCLOSE SE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|681.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5620|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD THK6MM 44X41MM ZPHR SR 1 CHMBR RR IS-1 CNCT 8CC 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,016.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,016.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE030040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 80CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE060020130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 130CM 20MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 36-456|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ULTRASOUND PERIPHERAL ATLANTIS PV 8F .035 95 CM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00513710|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING NONCOVERED 18MM X 23MM X 10CM DISTAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE070080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ADMIRAL XTREME 5FR 7.0 MM DIAMETER X 80MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48004|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO 10CM 4FR 21GA MPNCH PSH+ .018IN NTNL CATH GW ECHTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMCP08|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS 26CM X 34CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12767-03|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 30MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749390711900|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FILTERWIRE EZ 2.25 MM -3.5MM 190CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMCP03|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS 10CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,446.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DEL-USD|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER OCCLUDER DELIVERY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS-28-VSD|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARDIO SEAL OCCLUDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1009539-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE V 2.5 X 8 DRUG ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMCP04|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS 15CM X 19CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,682.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,682.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1009541-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE V 3.0 X 15 DRUG ELUTING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-07-37-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 37MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG406|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIO HYDROPHILIC COATED .038" WIRE 4 FR JB2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE080060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 60MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00513860|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ULTRAFLEX SELF EXPANDING 18MM X 23MM X 15CM PROXIMAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE070060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 80CM 60MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE040080130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 130CM 80MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE060060130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 130CM 60MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5MM X 60MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-05-17-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 5MM DIAMETER X 17MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-06-17-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 6MM DIAMETER X 17MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-08-17-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 8MM DIAMETER X 17MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-FBSS-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT FANELLI 7FR X 50CM|1|HUMANA [1294]||HUMANA [11839]|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S603|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ALTRUA 60 DR 44 X 42 X 8 IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,613.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,613.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407854|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 5FR ACT ULTIMUM 23CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407856|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 6FR ACT ULTIMUM 23CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407858|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ACT 7FR ULTIMUM 23CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407860|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 8FR 50CM 23CM 2 DIST GW HMSTS VLV SDPRT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 9.8MM 60MM 36MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 81102|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DECA POLAR 6 FR STEERABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5826|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD THK6MM 52X44MM ZPHR XL DR 2 CHMBR IS-1 CNCT 11CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,622.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,622.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG2470BAX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GENESIS AVIATOR BILIARY SDS 7.0 DIAMETER 18 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-036|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS .035" GUIDEWIRE 90CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-038|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS .035" GUIDEWIRE 150 CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 12MM COLR VRSY FM MDCT 44MM XTD OFST STD BD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 49-297|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE THRUWAY 300CM SHORT TAPER STRAIGHT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 49-283|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE THRUWAY 300CM SHORT TAPER STRAIGHT .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-79-70|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 4.7 FR SINGLE CHANNEL VNIS VERSAFLEX DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3.5MM 12/14 TPR 36MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1207-36|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR DUAL CHAMBER CURRENT VR RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7121/65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4135|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING DEXTRUS 45CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787117327035|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO KMP CRV 5FR 100CM RADOPQ SLCT HTORQ SHFT DRTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6228CTH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACEMAKER CATHETER GUIDE 6228CTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402839|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE QUADRIPOLAR MEDIUM CURVE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402840|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE TX QUADRIPOLAR LARGE CURVE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11734302|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MARINER SOFT RADIOPAQUE TIP 4 FR 100CM .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402578|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CABLE SAFIRE TX 250CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85424|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 10MM X 38MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85417|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 8MM X 59MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,075.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,075.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85416|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 8MM X 38MM X 120CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ICV1011|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER REPLY DR DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATEC TD2S-3609|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IDENTIFIER BIOPSY SITE FOR USE IN 9G STEREOTACTIC GUIDED BRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-06-27-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 6MM DIAMETER X 27MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-06-37-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 6MM DIAMETER X 37MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCBR4.5-35-135-P-NS-|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SHUTTLE SLIP 4.5FR ANG 135CM SCBR4.5-35-135-P-NS-AN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787165004140|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 75CM 4CM LOPRFL COAX HI-PRS RADOPQ PLMR NYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787165004150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 75CM 4CM LOPRFL COAX HI-PRS RADOPQ PLMR NYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107343015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO ANG KMP CRV 4FR 40CM RADOPQ SLCT HTORQ SHFT SFVU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0116003|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CRURASOFT LARGE 8CM X 11 CM 0116003|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,668.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,668.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 612N060L0|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE REGATTA SB MIDDLE WT NLS 195CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C405085|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIGERWIRE ANGLED FLOPPY TIP .035 260CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12744-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER OTW 3.0 MM DIAMETER 26 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12745-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER OTW 3.5 MM DIAMETER 19 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-030-190|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE PROTECTION EMBOLIC FILTER 3.0 FX SPIDER 190 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85420|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COVERED CAST 10MM X 38MM X 80CM CATHETER LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749201003000|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FILTERWIRE EZ 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12006|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE PRESSUREWIRE CERTUS .014" 175CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012534-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 6.0MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011934-040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 7.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011937-060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 10.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 49-279|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE THRUWAY 190CM 3 STRAIGHT .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787165004460|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 10MM 75CM 4CM LOPRFL COAX HI-PRS RADOPQ PLMR NYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C610134|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE VASCULAR CLOSURE ANGIOSEAL EVOLUTION6 FR 10/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C610135|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE VASCULAR CLOSURE EVOLUTION ANGIOSEAL EVOLUTION 8FR 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749CBM3200060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLEXTOME MONORAIL 2.00 MM X 6MM CUTTING CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749CBM3325100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLEXTOME MONORAIL 3.25 MM X 10MM CUTTING CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83372-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 2.5MM 150CM 20MM PERI OTW LOPRFL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83169-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 20MM 150CM FXSV PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749CBM3200150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLEXTOME MONORAIL 2.00 MM X 15MM CUTTING CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 116001|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CRURASOFT SMALL 7CM X 6CM 0116001|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G47416|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .018 DIAMETER X 2CM LENGTH 3MM MIC|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47417|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .018 DIAMETER X 4CM LENGTH 4MM MIC|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47326|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .018 DIAMETER X 14CM LENGTH 3MM MI|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12766-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12766-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12767-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12768-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12768-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406967|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER TRANSEPTOR GUIDING SRO 10FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12757-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12764-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 3MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W03020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 3MM 135CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 135CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP25008UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP25012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP25014UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 14MM 2.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP25018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 2.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP30012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP30030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 30MM 3MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP25024UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 2.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP25030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 30MM 2.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP30009UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 9MM 3MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.936|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 6MM TI MNDB CORT ST CRS PTCH CRFRM NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|566.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|566.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ENSP30015UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 3MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP30018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP35024UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP35018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP30024UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PV10300|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER JET STREAM 2.1/3.0 AND CONTROL POD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBDC-8.5|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY DILATION SOEHENDRA 8.5 FR X 200 CM X .035 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBDC-10|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY DILATION SOEHENDRA 10 FR X 200 CM X .035 GU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPSOF-7-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC ZIMMON 7.0FR X 10CM|1|HUMANA [1294]||HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12761-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 9MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011933-040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 6.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 80CM 60MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-80-6-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 6 MM DIAMETER 60 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-80-7-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 7 MM DIAMETER 80 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-80-8-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 8 MM DIAMETER 40 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12758-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G50216|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 2CM ILC INFRAPOPLITEAL POPLT RNL ART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G50226|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 2CM ILC INFRAPOPLITEAL POPLT RNL ART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 135CM 120MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM060120130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ADMIRAL XTREME 5 FR 6.0MM DIAMETER X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y101|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNIPAQUE 180 MG/ML 10 ML VIAL NDC# 00407-141|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 389361-1225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS LIBERTE 2.5 X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 389361-1230|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS LIBERTE 3.0 X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 389361-1235|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS LIBERTE 3.5 X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 389361-1625|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY TAXUS LIBERTE 2.5 X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893616350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 3.5MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893616400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 4MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893620300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 3MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893620400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 4MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893624300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893628250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 2.5MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893632400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 4MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893632250|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 2.5MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]||HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787165004160|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 75CM 4CM LOPRFL COAX HI-PRS RADOPQ PLMR NYL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W0508135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 5MM DIAMETER X 80MM LENGTH USABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-9000B|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PLEURX PERITONEAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12770-03|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 80MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G11637|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 70CM 8FR 2.9MM FLXR CHFL RAABE MODIFICATION ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D402865|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER REFLEXION 7 FR BI-DIRECTIONAL DUO SPIRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83376-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 2.5MM 150CM 40MM PERI OTW LOPRFL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493897008220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.25MM TAXUS XPR2 ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493897012220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.25MM TAXUS XPR2 ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493897016220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 2.25MM TAXUS XPR2 ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493897020220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 2.25MM TAXUS XPR2 ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493897024220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 2.25MM TAXUS XPR2 ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2207-36|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CURRENT DR RF DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12759-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12757-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12758-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 60MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12759-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12760-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 8MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12761-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 9MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12762-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 10MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12759-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 60MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12763-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 12MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12763-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 12MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12765-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 4MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12766-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 60MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12767-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 60MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12768-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 60MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12769-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 8MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12770-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 9MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12771-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 10MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12772-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 12MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82153-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 3.0MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-037|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS .035" GUIDEWIRE 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83153-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 3MM 150CM 40MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL-07645|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO 17.75IN 6FR 8FR S ARWFLX PERC 3W STPCK TISS DIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y313|SUP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDIA CONTRAST OMNIPAQUE 300 CT 100ML BOTTLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y531|SUP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDIA CONTRAST OMNIPAQUE 300 CT 75ML BOTTLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y352|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNIPAQUE 300 CT 50ML BOTTLES|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y413|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNIPAQUE 350 CT 100ML BOTTLES|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011752-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 2.50MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011753-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 2.750MM X 8MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011754-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 3.0MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011756-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 3.50MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011758-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 4.00MM X 8MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011752-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 2.50MM X 15MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011754-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 3.0MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011758-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 4.0MM X 15MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011759-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 4.50MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011760-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 5.0MM X 12MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7900|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 185CM .014IN SFT GLD STRG TIP HI FDLT PRSS SNSR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86700|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH US 20MHZ 3.4FR 135CM INTVASC SCNR TRNDCR ARY EXC IMG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 88900|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH US .038IN 8.2FR 90CM INTVASC PULBCK SLED REV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011756-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 3.50MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12757-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 60MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-162|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY FLEXIMA 14FR X 35 SOFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14694|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COPE NEPHROSTOMY 8.2 FR 19.5 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14283|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COPE NEPHROSTOMY 10 FR 19.5 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005597-08|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL GUIDING VERIPATH 8FR X 50CM LIMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3207-36|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR PROMOTE RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|68,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 516412|SUP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CONTRAST MRI MULTIHANCE 5X5 ML VIALS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 270516413B|SUP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CONTRAST MRI MULTIHANCE 5X10 ML VIALS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 516414|SUP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CONTRAST MRI MULTIHANCE 5X15 ML VIALS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 516415|SUP|HCPCS A9577||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|CONTRAST MRI MULTIHANCE 5X20 ML VIALS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011755-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORONARY DILATATION VOYAGER NC 3.25MM X 12MM BALLOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR15|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE SHEATH PINNACLE DESTINATION 7FR 45CM LENGTH CURVE RD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PR-05052-HPX|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH 5FR 19 5/8IN .018IN PICC 2 LUM CV BLU FLXTP PU LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|250.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14000804|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE TOTAL ABSCESSION 10F X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787140008065|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DRN 14FR 30CM TL ABS BLU SLK 6 SH THRM MLD TIP LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADSR01|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD 2.8V 42.9X7.5X40.2MM ADAPTA SR ATR VNTRC 1 CHMBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-014|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6370|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON LOW PROFILE 20FR X 3 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14864-05|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 7MM DIAMETER 120MM LENGTH 120CM SHAF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12760-06|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 80MM X 60MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AS-1608NS|SUP|HCPCS C1878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS VOICE 16 FR 8MM ADVANTAGE NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|837.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14000803|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE TOTAL ABSCESSION 8F X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70XLTUD|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE 100MM 12.3MM 7MM CUFLS DIST XTN XTD LGTH SFT SWVL FLNG|1|HUMANA [1294]||HUMANA [11839]|178.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|178.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008167-38|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY OMNILINK .035 8.0MM X 38MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47519|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 2.6CM 4-3MM TRND PLTN STRL ACPT .035IN GW AVM|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G07516|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .035IN STF SHFT ANG TPR RDRR PC HDRPH NTNL PL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G42406|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION MREYE .035 DIAMETER X 2CM LENGTH 3MM|1|HUMANA [1294]||HUMANA [11839]|206.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|206.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-80-7-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 7 MM DIAMETER 60 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV635-80-8-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 8 MM DIAMETER 60 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM040120130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ADMIRAL XTREME 5 FR 4.0MM DIAMETER X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PJ752|SUP|HCPCS C1898||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PACING ATRIAL J BIPOLAR TIP TINED FIXATION 7 FR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12756-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 4MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 11MM PRM COLR ALGN GD VRSY TIV FM MDCT POR 41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00545960|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL 8 ATM 10MM 180CM 4CM RX LOPRFL RADOPQ BLNDIL HRCN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BCPM003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CEMENT AVA-TEX RADIOPAQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|740.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|740.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12757-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 80MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05800110|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE NIT-VU MICRO .018 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05800112|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE NIT-VU MICRO .018 X 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RM*BF5F10PA|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDESHEATH 5 FR 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7120|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA SN 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ASK-05052-HMC|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PRESSURE INJECTABLE PICC SET (ANOTHER SUB FOR PMM 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09-2005|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VIEWFLEX ULTRASOUND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00514300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL POLYFLEX 18MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF33VSD|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAR FLEX SEPTAL OCCLUDER 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF-28-VSD|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAR FLEX SEPTAL OCCLUDER 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC|SUP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEED LOOSE I-125 ACTIVITY .676 MCI|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT-105-29|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SET 8 FR PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410173|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CPS DIRECT PL 135 DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10302803|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DURAMAX DIALYSIS 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7121/60|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA 60 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7071/65|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD RIATA ST OPTIM 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1944/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ISOFLEX OPTIM BIPOLAR 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2211-36|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CURRENT + DR TIERED-THERAPY DUAL CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 405153|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER KIT PEEL AWAY 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-10-37-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 10MM DIAMETER X 37MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL LABRAL BANKART TACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|798.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PXB35-10-57-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 10MM DIAMETER X 57MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACT1530|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE ABLATION COOL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3295335|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DUAL LUMEN POWER PICC SOLO 5 FR 135CM WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FPRPR3224|SUP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE GALIL ICEROD 17G MULTIPACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3211-36|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR PROMOTE PLUS BIV ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1944/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ISOFLEX OPTIM BIPOLAR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1948/58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ISOFLEX OPTIM BIPOLAR 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1158T/86|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD QUICKFLEX XL LV 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48176|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COPE NEPHROURETEROSTOMY 8.5 FR X 24 .038 DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE040120130|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 130CM 120MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SBE080040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 80CM 40MM OTW 2 LUM LOPRFL RADOPQ FLEXITEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1948/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ISOFLEX OPTIM BIPOLAR 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5820|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ZEPHYR DD DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,622.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,622.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-018|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-020|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,060.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,060.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-022|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 22 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-MF-030|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL MULTI-FENESTRATED CRIBRIFORM 7 FR 30 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,060.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,060.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-030|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 30 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-103|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OCCLUSION BALLOON STANDARD 7 FR 100 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-301|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OCCLUSION BALLOON BERENSTEIN LARGE LUMEN 6 FR 80 LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22419|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .018IN 480CM X SPRT RADOPQ RDRR STRG 3CM DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22416|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .018IN 480CM X SPRT RADOPQ RDRR ANG 3CM DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPSO-3-5|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC 3FR 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G27190|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 3FR .018IN 3CM PSTN SLV PUSH CATH DDNL FLP PNCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPSO-3-7|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC 3FR 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G27192|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 3FR 8CM DRN OBSTRUCTED PSTN SLV PSH CATH DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22107|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 3CM .035IN PSTN SLV PUSH CATH GW DDNL FLP GNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22110|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 4CM CNTR PUSH CATH SPRL SH OFST FLP TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G27162|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 6CM DRN OBSTRUCTED PSTN SLV PSH CATH DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22113|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 7CM PSTN SLV PUSH CATH DDNL FLP GNN PE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G27163|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 8CM DRN OBSTRUCTED PSTN SLV PSH CATH DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7070/65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD RIATA ST OPTIM ICD 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893612220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893616220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893620220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893624220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893628220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FLOWJ-9-20|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE FEEDING JEJUNAL FLOW 20 9FR 60 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749389368220|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893632220|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 2.25MM TAXUS LBRT ATOM MNRL TRANSLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G46729|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .035IN FLPY TIP XSTIF SHFT 15CM STRG TPR 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195-88|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ATTAIN STARFIX OTW 88 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 419688|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ATTAIN ABILITY 88CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6250-EH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ATTAIN COMMAND EXTENDED HOOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C405089|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIGERWIRE ANGLED FLOPPY TIP .035 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM2210|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ACCENT RF DR DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410182|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CPS DIRECT PL 54 CM 115 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05800122|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE NIT-VU SHIFT ANGLED .014 X 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05800123|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE NIT-VU STANDARD ANGLED .014 X 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00554510|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP RGFLX II 90CM 10CM 35MM RADOPQ STRL LF ACPT .038IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749390713000|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FILTERWIRE EZ 2.25 MM -3.5MM 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6250-AM02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ATTAIN COMMAND AMPLATZ CORONARY SINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011934-060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 7.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011934-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 7.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011935-060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 8.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011935-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 8.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011935-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 8.0MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410176|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CPS DIRECT PL 7F DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2028BL|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEEROCATH DX OCTAPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406948|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH SLO TRANSEPTAL 63CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82156-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 3.0MM X 60MM X 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82379-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 2.5MM X 60MM X 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD1211-36Q|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CURRENT + VR TIERED-THERAPY SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 412|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STRAIGHT12 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G54535|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.8FR .025IN 135CM SUPERSELECTIVE KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMARK-CELERO|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IDENTIFIER BIOPSY SITE FOR USE WITH CELERO-12 BIOPSY DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|238.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|238.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU35SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CORONARY 8FR X 0.09 DIAMETER CURVE STYLE EB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401950|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUADRIPOLAR 6 FR W/CONNECTOR LEADS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402004|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUADRIPOLAR 6 FR CRD-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401442|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUADRIPOLAR 6 F CRD SUPREME|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12756-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 4MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GWR419488|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ATTAIN COMMAND HYBRID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ASK-05063-SEM|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PRESSURE INJECTABLE PICC SET TL WITH BLUE FLEXTIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GWR419588|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ATTAIN HYBRID 88 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83197-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 2MM 150CM 60MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83165-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 4MM 150CM 60MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83967-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 2.5MM 150CM 80MM PERI OTW LOPRFL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3211-36Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR PROMOTE PLUS BIV ICD SJ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2211-36Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CURRENT + DR TIERED-THERAPY DUAL CHAMBER ICD S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7120Q/65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA SJ4 ICD ACTIVE FIXATION 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7121Q/65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 65CM 7FR 21CM SPC ECRDM 2 COIL TRUE BP CARDVRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570660|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8.5FR 100MM .035IN UNCVR RX GW WALLFLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09312|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BEACON TIP TORCON ADVANTAGE 5FR .038 DIAMETER 80 LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10000-3331|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS EP ENST NVX LG PTCH INST|1|HUMANA [1294]||HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410183|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE CPS DIRECT PL 54 CM 135 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787103028045|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DURAMAX DIALYSIS 28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83976-02|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL LG CRSNT 5MM 150CM 80MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83979-02|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL LG CRSNT 6MM 150CM 20MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83980-02|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL LG CRSNT 6MM 150CM 40MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83981-02|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL LG CRSNT 6MM 150CM 60MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83983-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 6MM 150CM 100MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EXPORTAP|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EXPORT THROMBECTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9275108D|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 5FR 18GA P PICC 2 LUM MAXIMAL BRR RVRS TPR STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9386108D|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 6FR P PICC SHRLK 3 LUM TRY MAXIMAL BRR MCTRDCR STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9385108D|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|POWER PICC CATHETER 5FR TL FULL NURSING TRAY W/MAXIMAL BARRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM1210|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD THK6MM 52X52MM ACT SR RF VNTRC 1 CHMBR UNPLR BP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G29935|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER 11FR HAUSDORF HLA 091100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-024|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-026|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 26 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 20D ELEV 6.3MM 50/52/54MM 32MM LNGVT HIPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493893632350|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 3.5MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893632300|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 3MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38936-3835|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CORONARY LIEBERTE TAXUS 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493893638300|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 3MM TAXUS LBRT MNRL TRANSLUTE PCLTXL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH060501|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 6MMX5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,517.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,517.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH061002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 6MMX10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH070501|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 7MMX5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,517.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,517.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH071002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 7MMX10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570610|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 8FR 60MM RX DLV SYS WALLFLEX ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-056-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 56 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00570640|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 60MM 194CM WALLFLEX STRL DISP ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,555.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,555.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00569680|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 8FR 60MM .035IN RX DLV SYS WLSTNT UNSTP + RMLM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-028|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G13081|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR RTPS 10 FR .035 DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011834H|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE WHISPER 3CM STRAIGHT TIP .014" DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-058-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 58 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,127.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,127.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1008193-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 30MM PERI RX LOPRFL FLXB KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PR-05052-HPX|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH 5FR 19 5/8IN .018IN PICC 2 LUM CV BLU FLXTP PU LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|274.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|274.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-060-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 60 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RSS602|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO CATH 10CM 6FR PN STRGHT CROSS-CUT VL HYDROP 0.038IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS13225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 13MM 2.25MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PMII|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PROLENE PM-S 3" X 5"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|699.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CXS18225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 18MM 2.25MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXS23225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 23MM 2.25MM SRLM SS CYPHER RPTRL 137CM RX DLV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VT68080L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 6-8MM THNWL TPR GRTX LN STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82166-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 4MM X 60MM X 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2101-0005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CARTRIDGE BONE AUGMENTATION CORTOSS 5CC|1|HUMANA [1294]||HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G03831|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OCCLUSION 9FR X .035 DIAMETER X 120CM LENGTH CODA-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LOCK HAND PROFYLE 2.3MM LL 6-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48419|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 111MM 28MM 7.7MM 20FR ZNTH FLX Z-TRK 2 BRCH SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965451030|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT POWER XCELA STANDARD TITANIUM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1620002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 20X16CM STRATTICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,398.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|25,398.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00631007036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 14.8MM 70MM 36MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2110-0501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELIVERY SYSTEM ALIQUOT PLUNGER 15 CM|1|HUMANA [1294]||HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2090-0501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELIVERY SYSTEM ALIQUOT SYRINGE|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2110-0031|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELIVERY SYSTEM ALIQUOT MIXTIPS|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2110-0008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELIVERY SYSTEM ALIQUOT GUN|1|HUMANA [1294]||HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-84501|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DESTINATION 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20SL2860|SUP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER DX20 DUODECAPOLAR ABLATION 7F EXLARGE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404878|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE GUIDE RIGHT SUPER STIFF 3MMJ 260CM .032|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7120Q/58|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ICD 58CM 7FR DURATA OPTIM DF4 CNCT 2 COIL BP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7170Q/58CM|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PASSIVE SJ4 ICD ACTIVE FIXATION 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7171Q/58CM|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA SJ4 ICD ACTIVE FIXATION 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KCFN-6.0-18-13-RA|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLEXOR CHECK FLO 6FR .018 13CM LENGTH KCFW-6.0-18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6416-200|SUP|HCPCS C1779||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD TEMPORARY TRANSVENOUS PACING SYSTEM 200CM|1|HUMANA [1294]||HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6416-140|SUP|HCPCS C1779||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 3.5FR 6FR 4.3SQ MM TEMP BP CATH ACTFX PEBAX SS PE|1|HUMANA [1294]||HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9629|SUP|HCPCS C1764||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|MONITOR ECG SUBCUTANEOUS IMPLANTABLE REVEAL DX LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DM2100|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MONITOR CONFIRM ICM 6.5 CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PV31300|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER JET STREAM 2.1/3.0 AND CONTROL POD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER MTL STD BODY EXT NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010404-01|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH HERNIA PLUG & PATCH X-LARGE PROLITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|386.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN271632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 2.7 X 16MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN351432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 14MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SCN351632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 16MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-00-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET 54MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 189X11X3.4MM SS 3.5MM SCR SM FRAG SET 14 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,906.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,906.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.561|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85X11X3.4MM SS 3.5MM SCR SM FRAG SET 6 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|983.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|983.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137X11X3.4MM SS 3.5MM SCR SM FRAG SET 10 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,152.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,152.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 240MM SS 16 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 96MM SS 4 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114701631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 16MM 8MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-UL06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ULNAR SHORTENING 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,202.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,202.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC3512SP|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS PRO SOLO RELIEVA 3.5 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.010S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END EXT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|818.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|818.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR P GRYPHON BR DOUBLE STRAND WITH ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991232|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CAPSTONE 12MM X 32MM VERTESTAK|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ULNAR SHORT SMALL RIGHT LATITUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,723.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,723.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP ULNAR SMALL ELBOW LATITUDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,675.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,675.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL CEMENTED SMALL RIGHT LATITUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,495.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,495.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPOOL HUMERAL CENTERED SMALL RIGHT LATITUDE TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,636.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,636.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING STAR HEAD 2.3MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50604-06|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE POROUS OSSEOFIT 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48432|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 36MM X 95CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMUR CEMENTED STABILIZED POSTERIOR SZ 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZING PFC SIGMA SZ 3-10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFFSET HIGH SZ10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H060010A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROPATEN 6MM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|954.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|954.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0602902|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LONG TERM EPIDURAL CATHETER DU-PEN VITACUFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-120|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND HIGH PROFILE MODERATE STYLE-10 120C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-140|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPLANT BREAST GEL ROUND HIGH PROFILE MODERATE STYLE-10 140CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64853111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED STRAIGHT MRS REVISION 11MM-127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64953016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PROXIMAL SMALL INSERT GMRS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64953601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ROTATING TIBIAL GMRS SIZE SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,143.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,143.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64953101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA PROXIMAL GMRS SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,670.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,670.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64811111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE MRH SIZE SMALL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL THICK 50MM X 18MM TURON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ULNAR DISTAL VOLAR STANDARD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-T2314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREADED 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-T2316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 16MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.9MM 95MM SS T15 P/T ST STRDR SMTH CNCL HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS-0826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS G-FORCE 8MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS-0616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS G-FORCE 6MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN404032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 40MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S602|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ALTRUA 60 DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,613.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,613.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SIZE 3 - 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 3 - 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED TRIATHLON TS 10MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL TRIATHLON X 3 SIZE 3 - 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GC070RF|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE SINUS FLEX RELIEVA 70 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GC030RF|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE SINUS FLEX RELIEVA 30 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MD28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.8 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NL26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 90 DEGREE 3.8 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NL34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 90 DEGREE 3.8 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SNUS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL SNP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|275.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|275.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSPR3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHOULDER S3 3 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 35.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 45.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 50.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.8 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported NL28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 90 DEGREE 3.8 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NL30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 90 DEGREE 3.8 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSPL4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHOULDER S3 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED 4.0 X 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMUR CEMENTED STABILIZED POSTERIOR SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5926-012-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT JOINT PATELLA FEMORAL GENDER SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SIZE 5 -5MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SIZE 5 -5MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83822|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MALECOT SILICONE 22 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G14822|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL BANDER 7 FR PINK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|225.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G14823|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL BANDER 7 FR BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|227.43|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5380|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IDENTITY ADX DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1688TC/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 52CM 7FR HLX TRNVNS ATR VNTRC IS-1 CNCT BP ACTFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 62MM SS CORT ST LG HEX HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A33-08035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EBI CORTICAL PENNIG 80/35 3-3.3MM DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 414.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 30MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702690|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.510.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 10MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 28MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM SS FT PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 13MM ZPHR SPNE VA SLFDRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792815|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 15MM ZPHR TI SPNE CRV ANT VA SLF DRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,029.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792913|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 13MM ZPHR TI SM SPNE CRV CANC ANT VA SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM ZPHR TI SPNE CRV ANT VA SLF DRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM3210|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ANTHEM RF BI VENTRICULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,161.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,161.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48429|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 32MMX 111CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111326SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0902-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 9.0MM X 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL 54MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 TRITHLON PS 13MM #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN352232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 22MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN402432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 24MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN403232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 32MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3122040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE MV SMARTSET 40 GR|1|HUMANA [1294]||HUMANA [11839]|209.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|209.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3092040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE HV SMARTSET 40 GR|1|HUMANA [1294]||HUMANA [11839]|209.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|209.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-1010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ARTHROPLASTY TOE HEMI K2 SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130D|SUP|HCPCS C1887||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DELIVERY SYSTEM ATTAIN SELECT II 6248 DEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-4061|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRAME TI CODMAN 46-4061|1|HUMANA [1294]||HUMANA [11839]|5,115.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,115.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410101|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE CELLULAR EVOLUTION TRINITY 1CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3322020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE 2 CMW 20 GR (DEPUY)|1|HUMANA [1294]||HUMANA [11839]|378.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 545035500|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE GHV SMARTSET GENTAMICIN 40 GR|1|HUMANA [1294]||HUMANA [11839]|734.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|734.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.455S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 340MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09489|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NDL 7CM 19GA 5FR 4 SDPRT HLW STY STRG CATH PRC PERC DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09490|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NDL 10CM 19GA 5FR 4 SDPRT STRG CATH PRC PERC SS Y CNTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12892|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NDL 7CM 16GA 8FR 4 SDPRT HLW STY CATH STRG CAVITIES PRC DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112844010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 44MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,949.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 520-42-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL THICK TURON 42MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 330420SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION UNI DEAL NEW 20MM 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,744.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,744.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286318SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|877.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286322SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|877.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|877.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286328SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6201-050-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING REPLACEMENT CUP ACETABULAR 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL 32MM 6 DEGREE +10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M28-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C14-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MICRO 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 314X17.5X5.2MM SS 4.5/5MM SCR 14 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,391.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,391.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 386X17.5X5.2MM SS 4.5/5MM SCR 18 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 386X17.5X5.2MM SS 4.5/5MM SCR 18 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 314X17.5X5.2MM SS 4.5/5MM SCR 14 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,391.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,391.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.001.306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 350X17.5X5.2MM SS 4.5/5MM SCR 16 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,495.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,495.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22225MJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE XTRA-SUPPORT HI-TORQUE .014 175 CM (MUST PUR 10EACH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421204|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL OXIN PS LEGION SZ 4 RIGHT|1|HUMANA [1294]||HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PATELLA GNS II SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS BASE TIBIAL II GNS SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN PREFIXATION ATLANTIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VARIABLE 4.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92498|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL COLLAR AMT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 105MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 110MM 16MM BIODUR 108 RVRS CUT FLUT CNN ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114716570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 165MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114717070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 170MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114717570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 175MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114718070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 180MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 115MM 16MM BIODUR 108 RVRS CUT FLUT CNN ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 120MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 125MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 130MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 135MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 140MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ULTRA FIX MINI MITE 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|437.28|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|437.28|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114714570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 145MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 150MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 155MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-7.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114716070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 160MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 30MM 16MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 35MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 40MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 45MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 50MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT231212|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 23MM X 12MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 471816|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ACELLULAR DERMAL FLEX HD 8CM X 16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,236.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,236.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 55MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 60MM 16MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 65MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 75MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 80MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 85MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 90MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 95MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.2MM 105MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 110MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 115MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 120MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 125MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 130MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 135MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.221|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1101-02|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE COPOLYMER OSTEOBOND 40GM|1|HUMANA [1294]||HUMANA [11839]|201.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|201.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119314504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 145D STD BRL 86MM SS 4 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119315004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 150D STD BRL 86MM SS 4 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235800104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90MM SS 3.5MM SCR 4 HL 2 CMPR SLOT LCK LOPRFL BN HUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,014.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 140MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 145MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 22MM 7.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 150MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 155MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114716071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 160MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114716571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 165MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5626|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ZEPHYR XL SR SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,016.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,016.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48405|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 22MM X 125CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8000-0042|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUTTER PATELLA 42MM|1|HUMANA [1294]||HUMANA [11839]|1,228.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,228.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6519-1-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL TAPER UNIVERSAL ANATOMIC DELTA BIOLOX 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,318.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,318.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6519-T-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE ADAPTER TAPER V40 UNIVERSAL OFFSET +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48424|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 30MMX 111CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48468|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 20MM X 39MM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SB1E|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILTER REINFUSION SB LIPIGUARD PALL|1|HUMANA [1294]||HUMANA [11839]|59.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114717071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 170MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114717571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 175MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114718071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 180MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 50MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENDER STEM FLUTED 12MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 24MM 8MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED STRAIGHT MRS REVISION 11MM X 127MM BODY POROUS 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +20 21MM HIP MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 64813210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL KNEE MRH 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1498-01-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL UNI CEMENTED PRESERVATION SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 55MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 60MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8.1MM 65MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 70MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 75MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 85MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.925S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL HUMERUS LCP 3.5MM X 268MM LONG 12 HOLE SHAFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,944.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,944.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC8216500|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SURGICAL ARTISAN 2 X 8 50CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HERO1001|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT OUTFLOW VENOUS ACCESS VASCULAR HERO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HERO1002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GRAFT ARTERIAL ACCESS VASCULAR HERO|1|HUMANA [1294]||HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6190027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRANSLATIONAL ATLANTIS 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRANSLATIONAL ATLANTIS FIXED 4 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-30428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION TWIN FIX 3.2MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,102.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,102.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 130MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 90MM 32MM BIODUR 108 HEX RVRS CUT FLUT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 95MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EX061701CS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTENT SFA SELF EXPANDING 6MM X 170 MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 105MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 110MM BIODUR 108 FT HEX RVRS CUT FLUT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114711572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 115MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 120MM BIODUR 108 FT HEX RVRS CUT FLUT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 135MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 140MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 145MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 150MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 155MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114716072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 160MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114712572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 125MM BIODUR 108 FT HEX RVRS CUT FLUT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ES 5000 S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OIL SILICONE ES 5000S 10CC GLASS SYRINGE|1|HUMANA [1294]||HUMANA [11839]|1,256.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,256.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114716572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 165MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114717072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 170MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114717572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 175MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114718072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 180MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 20MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 25MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 60MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 65MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 70MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 75MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 22MM 7.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 80MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 85MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 90MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 95MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47116202400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION 4.7MM X 44.4MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|197.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-0-210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM GRIP CABLE MEDIUM 2.0 DALL MILES|1|HUMANA [1294]||HUMANA [11839]|3,469.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,469.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598304048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT JOINT PATELLA FEMORAL SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED STRAIGHT MRS REVISION 9MM X 102MM BODY POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 26MM 8.6MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BUMPER KNEE HINGED REVISION HOWMEDICA 3 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,110.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,110.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC8216700|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SURGICAL ARTISAN 2 X 8 70CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G17797|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER URETERAL LASER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114703072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 30MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 35MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 40MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 45MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 50MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.0MM X 55MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 26MM 8.6MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANNULATED 3.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANNULATED 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANNULATED 3.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESS FIT COCR 11MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 28MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EX071503CS|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTENT SFA SELF EXPANDING 7MM X 150 MM X 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201000304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MET STRAIGHT 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201024014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 542-11-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 60MM 61.8MM HIP 5 SCR HL CLSTR RIM HA TR PSL G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-10-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 201024012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL 4 HOLE RIGHT 109MM 3.5 LCP LOW BEND MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,363.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,363.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 4 HOLE LEFT 109MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,363.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,363.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTA MEDIAL 6 HOLE RIGHT 135MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,413.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,413.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 6 HOLE LEFT 135MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,413.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,413.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 8 HOLE RIGHT 161MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,454.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,454.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.519|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 8 HOLE LEFT 161MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,454.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,454.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 10 HOLE RIGHT 187MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,502.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,502.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.523|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 10 HOLE LEFT 187MM 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,502.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,502.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-07-57-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 57MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VIK8S1|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 8FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 100 DEGREE LEFT EXTRA LONG 3MM X 3MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-1325M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STIMULATOR BONE OSTEOGEN IMPLANTABLE|1|HUMANA [1294]||HUMANA [11839]|14,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503254 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.4CM MEMORYGEL P4.6CM HI PRFL RND NAR BS SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7255-052-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MONOBLOCK 0 DEGREE 28MM 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,149.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-046-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 46MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503500|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.8CM P5.6CM HI PRFL RND SAL SMTH 500ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482704501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 45MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 136MM SS 3.5MM SCR SM FRAG 6 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,018.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,018.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00491500119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 37MM SS 1.5MM SCR MN FRAG 7 HL BN CNDYL LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|711.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00491500219|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 37MM 1.5MM SCR 7 HL BN CNDRL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|711.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00491502002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 100MM SS 1.5MM SCR MN FRAG 20 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00491503904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 49MM SS 1.5MM SCR MN FRAG 3 HLE/HD 9 HL SHFT BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00491504904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 49MM SS 1.5MM SCR MN FRAG 4 HLE/HD 9 HL SHFT BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39MM SS 2MM SCR MN FRAG BN CNDRL LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|682.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 46MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00492000400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 22MMX1MM SS 2MM SCR MN FRAG 4 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 27MMX1MM SS 2MM SCR MN FRAG 5 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 32MMX1MM SS 2MM SCR MN FRAG 6 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 37MMX1.5MM SS 2MM SCR MN FRAG 7 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|474.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 42MMX1.5MM SS 2MM SCR MN FRAG 8 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|484.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|484.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492001000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 52MMX1.5MM SS 2MM SCR MN FRAG 10 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492001200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 62MMX1.5MM SS 2MM SCR MN FRAG 12 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492002002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 100MMX2MM SS MN FRAG 20 HL BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 26MMX2MM SS 2.7MM SCR MN FRAG 2 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|365.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57MM SS 2.7MM SCR MN FRAG BN FT LT ANKL CNDYL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MMX2MM SS 2.7MM SCR MN FRAG 2 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700219|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57MM SS 2.7MM SCR MN FRAG BN FT RT ANKL CNDYL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36MMX2MM SS 2.7MM SCR MN FRAG 4 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 44MMX2MM SS 2.7MM SCR MN FRAG 5 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|385.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 52MMX2MM SS 2.7MM SCR MN FRAG 6 HL CMPR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60MMX2.5MM SS 2.7MM SCR MN FRAG 7 HL CMPR BN FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 68MMX2.5MM SS 2.7MM SCR MN FRAG 8 HL CMPR BN FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 76MMX2.5MM SS 2.7MM SCR MN FRAG 9 HL CMPR BN FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492701000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 84MMX2.5MM SS 2.7MM SCR MN FRAG 10 HL CMPR BN FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492701200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100MMX2.5MM SS 2.7MM SCR MN FRAG 12 HL CMPR BN FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492003904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50MM SS 2MM SCR MN FRAG 3 HLE/HD 9 HL SHFT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492004904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50MM SS 2MM SCR MN FRAG 4 HLE/HD 9 HL SHFT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493503405|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T OBLQ 63MMX1.5MM SS 3.5MM SCR SM FRAG 3 HLE/HD 4 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493504704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 3.5MM 4-HOLE HEAD 7-HOLE SHAFT 89MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493504804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 100MMX1.2MM SS 3.5MM SCR SM FRAG 4 HLE/HD 8 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|563.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|563.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000219|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39MM SS 2MM SCR MN FRAG SHFT BN RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|682.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|682.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 25MM 2 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 37MM 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|316.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|316.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR CNTR 109MM SS SM FRAG 9 HL 2 CMPR COLR BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493501203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 145MM SS SM FRAG 12 HL COLR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140129|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 9IN 3.2MM THRD LF|1|HUMANA [1294]||HUMANA [11839]|96.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|96.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493504604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 3.5MM 4-HOLE HEAD 6-HOLE SHAFT 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 120MM SS 3.5MM SCR SM FRAG 5 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588604610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB GRN 75X51X10MM NXGN 6 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P1016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 2.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90-9480SC|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TITAN ASSEMBLY|1|HUMANA [1294]||HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PA011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 70MM 1.6MM FRS THRD RECON SYS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|123.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8915414|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14MM VRTSTCK SM LRDTC PEEK ADON LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|15,282.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,282.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PA016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 70MM 2MM FRS THRD RECON SYS DISP|1|HUMANA [1294]||HUMANA [11839]|123.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|123.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHOR 5.5 L-15 #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HAX02A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 70CM 8MM 8MM STD WL AXLBFM GRTX STRCH REM RING 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SARP-26|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY SEGUIN SJM 26MM|1|HUMANA [1294]||HUMANA [11839]|6,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SARP-28|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY SEGUIN SJM 28MM|1|HUMANA [1294]||HUMANA [11839]|7,725.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SARP-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY SEGUIN SJM 30MM|1|HUMANA [1294]||HUMANA [11839]|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SARP-32|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY SEGUIN SJM 32MM|1|HUMANA [1294]||HUMANA [11839]|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SARP-34|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY SEGUIN SJM 34MM|1|HUMANA [1294]||HUMANA [11839]|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,798.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AP-0060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANN HEADLESS ACUTRAK-PLUS 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5079-5-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 50MM 3MM HFMN2 MIC SS CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287-5-058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL PCA ACE/DEEP-SOCKET 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6289-5-049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL PCA ACETABULAR LOWPRO 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6251-1-052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS CUP PREMISE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,313.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,313.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-016-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM-TAPER EXTENDED NECK LM 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-016-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7303|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR INSYNC MAXIMO 7303|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7014-0724|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE EAR 4.75 LOOP TANTALUM|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0721|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE EAR 4.0 LOOP TANTALUM|1|HUMANA [1294]||HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2026-2840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP BONE 6.25MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN COMPRESSION SOC 30MM|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MENISCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HARPOON W/O-STOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL ZEPHIR 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5250-2-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP SCREW W/LOCK TUE ALTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6216A-MB2|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACEMAKER CATH GUIDE 6216A MB2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112848110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 48MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,678.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,678.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 442.15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR QUARTER 2.7MM 5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-015-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 15MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60-6260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3-DEG LEVEL 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,312.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,312.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1728-02-024|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE TI BOW 24MM|1|HUMANA [1294]||HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1728-03-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI BOW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1746-42-200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INNER SUMMIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.936E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +4MM 28MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6216A-MP|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACEMAKER CATH GUIDE 6216A-MP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported YRECX1455|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-EXTENDER CUFF 5.5CM 12MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 554916N|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETAB DEEP-PROFILE +E15 NEUTRAL OBLONG|1|HUMANA [1294]||HUMANA [11839]|10,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9825-005-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CENTRALIGN PRECOAT SIZE 5 150 MM ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,936.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,936.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9825-006-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CENTRALIGN PRECOAT SIZE 6 165 MM ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,036.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,036.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401811|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP SPINCTER-CONTROL (AMS 800) C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-075-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-070-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-065-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-060-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6228GWR|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACEMAKER GUIDEWIRE 6228GDWR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4300-040-15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 15MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-010-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 10MM X 200MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,383.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-052-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 30MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MI-L2|SUP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PLATE MOLTENO LEFT-EYE DOUBLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.5MM 2-0 MCMT STITCHPACK ULFX PRELD NDL BRD PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRECX24375|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA AORTIC-EXTENDER CUFF 3.75CM 24MM TAPERED|1|HUMANA [1294]||HUMANA [11839]|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRECX20375|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA AORTIC-EXTENDER CUFF 3.75CM 20MM TAPERED|1|HUMANA [1294]||HUMANA [11839]|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRIRX14115|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-LIMB 11.5CM 14MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 610462|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 22MM 85CM 4CM FLXB DIST TIP COAX DEHP-FR RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-30.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ULTRASORB 3.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-27.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5784-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL RIGHT LARGE MGII PRECOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,512.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,512.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5982-051-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-BLUE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7845-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS MIDCOAT FIBER METAL COLLARLESS 10MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437.043|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE LC-ANGLED CANNULATED TI- 90-DEG 4-HOLE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE LC-ANGLED CANNULATED TI 90-DEG 4-HOLE 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-052-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 52MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3982|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SYMMIX|1|HUMANA [1294]||HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173125113|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X13X13MM JAG IFCG WDG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173121112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 21X13X11MM JAG IFCG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1770-72-110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOKS OPEN 11MM|1|HUMANA [1294]||HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173125139|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X13X9MM JAG IFCG WDG PEEK PLIF|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1731-25-115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 15MM X 15MM X 25MM|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1731-25-114|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN 13MM X 15MM X 25MM|1|HUMANA [1294]||HUMANA [11839]|8,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1770-83-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK CLOSED 6.5|1|HUMANA [1294]||HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2749-03-014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN COMPRESSION 14MM|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3026-2835H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP BONE 6.25MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12TLW805F35|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 80CM 5.5FR 11MM FGRTY THRLMN ART SS SIL NTR RBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5876-010-19|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA AUGMENTED 19.5 MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-6728-004-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER RIM STD D/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,916.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,916.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.070|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +7 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5079-5-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 30MM 3MM HFMN2 MIC SS CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5079-5-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 40MM 3MM HFMN2 MIC SS CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3363-7-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3363-5-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG OMEGA 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3363-1-004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIDEPLATE OMEGA 130-DEG 4-HOLE|1|HUMANA [1294]||HUMANA [11839]|834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7833-018-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS LD/FX CEMENTED 18MM X 155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6320-066-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 66 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM DCP MINI 2.0MM 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404501000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR POLY 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|857.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404501100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR POLY 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|857.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404501200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR POLY 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|857.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404501300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR POLY 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|857.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404501400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR POLY 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|857.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|857.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404501500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR POLY 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3546114|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 15X10.9CM BRST 550ML STY 6100 TXTR NDL ORT TAB SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6115|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE PROFILE LOW 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502754 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.8CM MEMORYGEL P4.4CM HI PRFL RND SIL GEL SHL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503004BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.1CM MEMORYGEL P4.5CM RND HI PRFL SIL CHSV GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7862-013-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FM TAPER EXTENDED NECK 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-20.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.913|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 194X11X3.7MM SS 3.5MM SCR 10 HL LMT CNTCT MLLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,881.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,881.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234800504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 70MM SS 4 HL NONLOCK BN HUM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E2SR01|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER SINGLE CHAMBER ES2RO1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00234801408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 74MM SS 2.7/3.5MM SCR 8 HL NONLOCK BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,918.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 45MM SS 2.7/3.5MM SCR 3 HL BN RADL RT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 76MM SS 2.7/3.5MM SCR 6 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,849.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801805|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 64MM SS 2.7/3.5MM SCR 5 HL BN RDS ULNA LT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 44MM SS 2.7/3.5MM SCR 3 HL BN RDS ULNA LT DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-010-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 10MM X 170MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SARP-36|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY SEGUIN SJM 36MM|1|HUMANA [1294]||HUMANA [11839]|6,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00224001038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 38CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-17.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 36CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 18CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 34CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 42CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 174617714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUMMIT 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 40MM 4.5MM SSCR FT POLY L LAC ACD CNN ACL ASCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-10-045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 142X11X3.7MM SS 3.5MM SCR 6 HL LMT CNTCT MLLE TAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207249|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR TI 40MM 8MM 2MM ACL PCL CNN BLNT THRD RCI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-13.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCB60-12040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GDS005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CHAMBER GRAFT LIFENET 5CC|1|HUMANA [1294]||HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-23.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-13.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7496-66|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION FLAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.672E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4 X 12MM RECON PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-16.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-14.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23-3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23-3518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5 X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 116X11X3.7MM SS 3.5MM SCR 4 HL LMT CNTCT MLLE TAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,732.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,732.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23-3514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-10-065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BENT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-10-640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK MIAMI-MOSS SI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403824|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CYLINDER PENILE 18CM ULTREX 700 PENOSCROTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403386|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CYLINDER PENILE 18CM APPROACH PENOSCROTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 470-0005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER JOINT SIZE 5 SILASTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 16CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 18CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 32CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114610500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 105MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598003701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 3 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588604314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB YLW 67X43X14MM NXGN 3 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200-064-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,230.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G27023|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO CATH 35CM 16FR 5.3MM CKFL PRFRMR RADOPQ SET LG VLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-093-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ULNA X-LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12831|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 22FR 41CM 25CM DIL CKFL XL ACPT .035IN GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-9.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-9.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MA50BM-10.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT W/NUT ALT 7.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,029.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105.00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 81008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RT RIM ORBITAL LATERAL SUPERIOR|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TF-16.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MI-01|SUP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PLATE MOLTENO LEFT-EYE SINGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CALCITEK THREADED 3.75 X 10|1|HUMANA [1294]||HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-2814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.8 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-2812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.8 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 610461|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 20MM 85CM 4CM FLXB DIST TIP COAX DEHP-FR RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6207S1S|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 7FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60AC.090|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +9 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-0200-NS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8615S|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION SYNCHRO-MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-28.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-12.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-13.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y LACTOSORB 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-13.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 89104EHT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET BREAKOFF T25 TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|508.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|508.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AA4203TF-24.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98-169-R|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA PKP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AP-07008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INTRASPINAL FLEX-TIP PLUS|1|HUMANA [1294]||HUMANA [11839]|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-2406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLID 2.4 X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8015-35-004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BARREL 4-HOLE 135DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM H KN RT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187110214|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 14MM CGR 10D MED CFRP ALIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-29.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 203-6530-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS BONE 6.5 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SJOEVOL|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET RADIAL EVOLVE (INCLUDES 1 HEAD COMPONENT AND1 STEM COMPO|1|HUMANA [1294]||HUMANA [11839]|11,115.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-0120NS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-29.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23-3530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-4024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23-3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED-LAG 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 348052|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE SMALL|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 36MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-76-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK OPEN BLADE NARROW ANGLED RT|1|HUMANA [1294]||HUMANA [11839]|2,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT W/NUT ALT 7.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,029.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 703980|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE SMALL|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LPS5213US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ACCESS VASCULAR PORT-TIATTACH DUAL 12F W/KIT|1|HUMANA [1294]||HUMANA [11839]|2,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7250-050-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERIPHERAL 5.0MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7250-050-25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERIPHERAL 5.0MMX25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 38MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01-9846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 3.2MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|145.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-6.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HA60-15040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EBI CORTICAL 150/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-IHM-8X13|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX HERNIA ING.8CM X 13CM SURGISIS|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-7.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC45-12040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 120/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-7.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.219|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 50MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 23-3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED-LAG 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-8.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93172RHT|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK RIGHT OFFSET 1/4"|1|HUMANA [1294]||HUMANA [11839]|1,704.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,704.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-8.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93172LHT|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK LEFT OFFSET 1/4"|1|HUMANA [1294]||HUMANA [11839]|1,704.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,704.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4066-026-38|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RCD FENLIN 26MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 49MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2074|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUSPENSION LACTOSORB 2.0 X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721L|SUP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE DF-1 50CM UNIPOLAR EPICARDI|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721M|SUP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE DF-1 50CM UNIPOLAR EPICARDI|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.516E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 16MM SELF TAPPING 4MM HEAD WITH CRUCIFO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1743-82-000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 13 X 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2483-0002|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GREAT TOE SIZE 2 SILASTIC|1|HUMANA [1294]||HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2483-0003|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GREAT TOE SIZE 3 SILASTIC|1|HUMANA [1294]||HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T20A1BBA|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE T20 SR SINCLE CHAMBER RATE RESPONSIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8167L18|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION SYNCRHOMED W/FILTER W/SUTURE-LOOPS C1772|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 429-1|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAPEZIAL SIZE 1 SILASTIC|1|HUMANA [1294]||HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.011S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE LOCKING 110MM DEG STERIE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-28.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDEPIN THREADED 1.1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2712NS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7 X 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMPO4|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PLUS ANTIMICROBIAL 15 X 19CM 1MM-THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482-3R|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARPAL SCAPHOID SIZE 3 RIGHT SILASTIC|1|HUMANA [1294]||HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE X REG LACTOSORB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-0220NS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FIXATION 2.7 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210700|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FIBULAR 7MM|1|HUMANA [1294]||HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16559604828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP BI-ARTICULAR 16-5596-48-2828MM X 48 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,605.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41-4002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT DENVER P-V LOW|1|HUMANA [1294]||HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2018|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CALCITEK THEADED 3.75X15|1|HUMANA [1294]||HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2708NS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672802800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 28MM STANDARD SIZE-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|912.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|912.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2225|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN COMPRESSION SOC 25MM|1|HUMANA [1294]||HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55-1504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 5.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 7 X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-880-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE CONDYLAR 80MM X 120MM 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-8647|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND,CPC,FLORIO,7/16,WIDE,LONG|1|HUMANA [1294]||HUMANA [11839]|144.45|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.45|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1170-75-010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE|1|HUMANA [1294]||HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-880-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BLADE CONDYLAR 80MM X 200MM 12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|649.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|649.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KLMP-210L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SIZE-2 10MM-THICK NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM H KN LT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 915-2437|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LACTOSORB CURVED 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3555-60|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KLMP-510R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SZ-5 10MM THICK NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210-048-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK W/SCREW-HOLES 10-DEG 28MM 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,284.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888-4124|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STACKABLE 24MM|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888-4112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STACKABLE 12MM|1|HUMANA [1294]||HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888-4101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TOP STACKABLE|1|HUMANA [1294]||HUMANA [11839]|9,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8015-35-003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BARREL SIDE 135-DEG 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902803335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL HG 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888-8060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-77-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK OPEN BLADE NARROW ANGLED LT|1|HUMANA [1294]||HUMANA [11839]|2,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.11S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCK 39 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T60A1BAA|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE T60 DR DUAL CHAMBER RATE RESPONSIVE DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4332612|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX12MM TLMN-PPEEK-OPTM 3D END PC VERT BD REPL|1|HUMANA [1294]||HUMANA [11839]|11,413.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MA.020|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 2.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND SERIE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MA.000|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 0.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND SERIE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OG-1616SF|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ORBITAL WRAP BOVINE-PERICARDIAL|1|HUMANA [1294]||HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187105110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 10MM CGR 5D SM CFRP ALIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3025-2840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.25MM X 40MM PEDICLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139HF75P|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER THERMODILUTION 7.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3025-3235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 7.0MMX35MM PEDICLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1871-05-112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COUGAR 12MM X 5MM|1|HUMANA [1294]||HUMANA [11839]|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,230.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597003000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT M/RT LT LG UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,469.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,469.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-301|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK LOW-PROFILE|1|HUMANA [1294]||HUMANA [11839]|2,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TF-24.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-11.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-12.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8799037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL ZEPHIR 37.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.010S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE LOCKING 100MM DEG STERIE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 481-5|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARPAL LUNATE SIZE 5 SILASTIC|1|HUMANA [1294]||HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7250-050-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERIPHERAL 5.0MMX30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-4032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED-LAG 4.0 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7250-050-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERIPHERAL 5.0MMX35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT-1175-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION ACUTRACK 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7250-050-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERIPHERAL 5.0MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S40S06CRS|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STANDARD-WALL STRAIGHT CENTRAL SUPPORT SEALPTFE 6MM X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,10HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 10 X 340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,197.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,197.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TF-25.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-2828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED-LAG 2.8 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.70S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 6.0MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23-3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 841-051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER SLOT 4.35MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12-2412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL-LAG SOLID 2.4 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED-LAG 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-2816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED-LAG 2.8 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 470-0006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER-JOINT SZ.6 C1776|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T-SHAPE MINI-BONE 80 ANGLED-LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER MULTIPOLAR 64MM OD X 28MM ID(BIPOLAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|890.61|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|890.61|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1947-10-035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CATERA 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,14HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 16-5596-046-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP BI-ARTICULAR 28MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2324-026-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MALLEOLAR 25MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620006800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,230.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HNBR5.0-35-65-PNSJB1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CEREBRAL 5FR X .038 DIAMETER X 100CM LENGTH JB1 TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6633-7-520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|190.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|190.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 271764|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR GOLD SURGISIS 7 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00118113003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M15-10015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE 100/15 THREADED MINI DYNAFIX|1|HUMANA [1294]||HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64-5100/03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE "Y" HUMERAL DISTAL 9-HOLE LINK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 311120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER INTERFERENCE SPIKE 20MM|1|HUMANA [1294]||HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8865-014-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 14MM TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47346|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION NESTOR .035 DIAMETER X 14CM LENGTH 12MM PR|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P5031THK2|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER PRIME HTD ABLATION 7F 4MM LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4500THK2|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER PRIME HTD ABLATION 8F 8MM LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 70MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 12 HOLE LEFT 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1MYM09|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 6CM X 12CM X 1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1MYM16|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 20CM X 30CM X 1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMC03|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL 10CM X 15CM X 1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 471812|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ACELLULAR DERMAL FLEX HD 8CM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,139.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,139.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 471416|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ACELLULAR DERMAL FLEX HD 4CM X 16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,631.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,631.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596201351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-130-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 596201652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596201752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS FLEX SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,214.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-013-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-014-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-015-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-016-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-017-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-013-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-014-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-015-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-130-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,8 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-016-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5762-017-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS GENDER SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,814.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported J-120|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNISCAN 287MG/ML 15ML SINGLE DOSE VIAL NDC#|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0110151|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DULEX 10CM X 15CM X 1MM OVAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,481.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0115191|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DULEX 15CM X 19CM X 1MM OVAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,514.95|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,514.95|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0118241|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DULEX 18CM X 24CM X 1MM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,727.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,727.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-135-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,10HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0120301|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DULEX 20CM X 30CM X 1MM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,146.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,146.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0175101|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DULEX 7.5CM X 10CM X 1MM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117011|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SOFT 15CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|620.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5959360|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SEPRAMESH 7.6CM X 15.2CM IP COMPOSITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5959480|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SEPRAMESH 10.2CM X 20.3CM IP COMPOSITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,243.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,243.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5959680|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SEPRAMESH 15.2CM X 20.3CM IP COMPOSITE RECTANGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,040.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,040.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5959812|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SEPRAMESH 20.3CM X 30.5CM IP COMPOSITE RECTANGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,028.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,028.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134114|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 26.1CM X 36.1CM RECTANGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,306.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134450|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 11.4CM CIRCLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,163.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,163.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134680|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 15.9CM X 21.0CM ELLIPTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-135-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0134610|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 15.9CM X 26.1CM OVAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134810|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 21.0CM X 26.1CM ELLIPTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,788.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,788.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134113|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 26.1CM X 33.7CM ELLIPTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,054.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,054.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1180060|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOMAX 7CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1180090|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOMAX 13CM X 15CM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1180080|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOMAX 10CM X 15CM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0010102|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA LARGE OVAL 14CM X 17.78CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0134790|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX L/P 18.4CM X 23.5CM ELLIPTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-135-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,14HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1180010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOMAX 2CM X 4CM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1180616|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOMAX 6CM X 16CM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0123113|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH EX COMPOSIX 25CM X 33CM ELLIPTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0113480|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX 10CM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,482.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0010209|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CK 16.0CM X 31.2CM OVAL WITH EPTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,652.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,652.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000423|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIMESH 20CM X 15CM 65GRAMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 46-192|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE INFUSION KATZEN 145 CM KATZEN/.035/6/145|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71-118|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 7X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,522.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,522.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-596|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL STD 5MM 75CM 40MM PERI OTW NC HDRPH U-T SDS ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00118113503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,3 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 17-586|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL STD 5MM 75CM 20MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-658|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALLOON 7X4X120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|512.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|512.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001176460|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL STD 7MM 75CM 20MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-656|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL STD 7MM 75CM 40MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-616|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL STD 6MM 75CM 20MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-62075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY EXPRESS 6 X 17 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-505|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT WALL 10MMX50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-982|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY 10FR 35CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001103430|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL 4T CRV 2.5MM 135CM 20MM PERI OTW STD SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,021.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,021.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-523|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALL 12X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-133|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLEXIMA 6 FR APD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787137097015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SIZING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046840750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EXPRESS BILIARY 8 X 37 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-94075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EXPRESS 9X37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,850.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,850.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107089055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFVUE 5FR 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001145100|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON XXL 7FR 12 X 40 75CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965451090|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT IMPLINFN XCELA TI SIL PU 6.6FR 1.3MM 1 LUM LOPRFL PWR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWD-232|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT FIXATION EXTERNAL PIP DIGIT WIDGET|1|HUMANA [1294]||HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-135-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H787CT80STPD0|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT IMPLINFN SMRT PORT FLUOROMAX VTX TI PU 8FR 8FR 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSI-5F-23-035|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 5FR 80CM 23CM GRY HUB GW HMSTS VLV PRELUDE .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V554|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST VISIPAQUE 270MG/ML 150CC BOTTLE NDC# 0407-222|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y520|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNIPAQUE 240MG 50ML BOTTLES NDC 0407-1412-30|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-135-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,8 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 318315|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST CONRAY 43% SDV 50ML BOTTLE NDC# 0019-3183-15|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 095315|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST CONRAY 60% SDV 50ML BOTTLE NDC# 0019-0953-15|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5505-51|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST HEXABRIX 39.3-19.6% SDV NDC# 0019-5505-51|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2088TC/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 52CM 6FR HLX ECRDM IS-1 CNCT ACTFX BP SFT RTRCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM2110|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD THK6MM 52X46MM ACT DR VNTRC 2 CHMBR INDUCTIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48408|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 24MM X 96CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00118114003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,3 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MD24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.8 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.8 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.8 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.8 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSPR6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHOULDER S3 6 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,819.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,819.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED 4.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1180050|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOMAX 4CM X 16CM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT261212|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 26MM X 12MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V025|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST VISIPAQUE 270MG/ML 100CC BOTTLE NDC# 0407-222|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-140-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-140-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,8 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-145-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0616002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 16X6CM STRATTICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,620.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,620.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0610008|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 6CM X 10CM STOMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5515-F-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL X 3 POLY SZ 6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-145-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-145-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5566-S-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 16MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-319-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL X3 TRIATHLON SZ3 19MM TS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,10HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 38047-62013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR EXPR LD 6X17X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74938046730750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 27MM 75CM 30MM OTW PRMNT BLN XPD XPR LD TNDM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-52075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 5X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74937911614150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 6MM 14MM 150CM PRMNT BLN XPD CATH RADOPQ RNL XPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-900|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STEER 0.025IN 140CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-63013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6X27MM 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38948-6401|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI SENTINOL 6X40X135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38948-6601|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI SENTINOL 6X59X135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,758.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38948-7401|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI SENTINOL 7X39X135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 49-148|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE MOVE BENT 0.035INX260CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401745M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 7FR 35MM 45CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,14HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401911M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 9FR 35MM 11CM KINK RST CNN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37911-41515|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR 4X15MM 150CMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38948-6201|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI SENTINOL 6X20X135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38948-7801|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI SENTINOL 7X78X135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,758.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38948-8401|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI SENTINOL 8X42X135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74937912419150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR 4X19MM 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37912-61815|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR 6X18MM 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37912-71915|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR 7X19MM 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NL24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 90 DEGREE 3.8 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SSPL3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHOULDER S3 3 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1001782J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE J BMW 0.014" X 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005359H|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE WHISPER MS 0.014" X 190CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-72075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL EXPR LD 7X20MMX75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12119-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE XSUPRT CHOICE 0.014X300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDELINER 5 IN 6 .056" I.D.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401511M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 5FR 25MM 11CM KINK RST CNN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401645M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 6FR 35MM 45CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85443|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST 6MM X 22MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N351803|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FLEXABLE SHAFT NITREX 0.035" 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00691|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BENTSON .035" X 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,104.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G32032|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY ZILVER 6FR 5MM X 40MM 125CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32033|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY ZILVER 5FR 60MM X 125MM 125CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G43866|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 6FR 10MM X 40MM 80CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36022|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 5MM 6FR 80MM 125CM SLF XPD FLXB SLOT TUBE ZL 635|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G43828|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY ZILVER 6FR 7MM X 80MM 125CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00655|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 260CM .035IN FX COR FLX TP STD STRG TPR SS HEP PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00902|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .035IN FXCR TPR STD 3CM SFTJ PTFE SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-94|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 196040400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMUR CEMENTED STABILIZED POSTERIOR SZ 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-130-95|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIA STABILIZER PFC SIGMA SZ 4-10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 PS TRIATHLON SZ 2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01428|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .035IN FX COR HVDTY EXCH FLX TP J CRV 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-135-94|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,289.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PRB35-05-100-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 5MM .079IN 100MM 120CM OTW DLV SYS SLF XPD RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1808001|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWERPORT MRI 8FR WITH ATTACHABLE CHRONOFLEX CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM06040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 40MM 6MM 8FR FLN + EVAS EPTFE C 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM08060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL FLUENCY PLUS 8MM X 60MM X 117CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZMA00UO-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER TECNIS MULTIFOCAL POSTERIOR CH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G50122|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 6MM 6FR 140MM 80CM SLF XPD FLXB INTRO MLT MRKR ZL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-135-95|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00533660|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 5CM DDNL BND TEMP AMSDM PRCFLX PLS DISP ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533670|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 7CM DDNL BND TEMP AMSDM PRCFLX PLS DISP ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-140-94|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00556031|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE JAGWIRE HYDRA STIFF SHAFT 0.035 X 260CM 10CM TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5193|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE FLEXIBLE WITH STRAIGHT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556041|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE JAGWIRE HYDRA 0.035 X 450CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00802526412844|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 47CM 8FR RP ADV CS-EH CRV CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F6QF005CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HIS QUAD FIX 6F 4P F SD 5MM 12PN EEPROM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F6QA005CT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RVA/HRA QUAD FIX 6F 4P A SD 5MM 12PN EEPROM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BD710DF282CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BI DIR 7FR DEF CS D-F 12 PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BD710FJ282CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BI DIR 7FR DEF CS F-J 12 PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BN7TCFJ4L|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 4MM NAVIGATIONAL BI-DIRECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BN7TCDF4L|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 4MM NAVIGATIONAL BI-DIRECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-140-95|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BN7TCFJ8L|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8MM NAVIGATIONAL BI-DIRECT. JF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BN7TCDF8L|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8MM NAVIGATIONAL BI-DIRECT. DF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-260|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY FLEXIMA RO 8FR X 35 REG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320016|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RAPID DUO-DECCA 7 FR MD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D610DR002RT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 10 POLE HIS 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V1430120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 140CM 12CM PERI SHRT RX 2 LNGTDNL WRE HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V187060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 140CM 6CM PERI SHRT RX 2 LNGTDNL WRE HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001196330|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 90CM 6FR MACH1 MP2 CRV PERI PTFE LG LUM RADOPQ 2X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001196620|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 55CM 6FR MACH1 LIMA CRV PERI PTFE LG LUM RADOPQ 2X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-145-94|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001197620|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 55CM 7FR MACH1 LIMA CRV PERI PTFE LG LUM RADOPQ 2X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001197660|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 55CM 7FR MACH1 RDC CRV PERI PTFE LG LUM RADOPQ 2X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P46012001|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLN POLARCATH 4X60MM 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939031452010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 135CM 20MM PERI TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939031502010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 20MM PERI TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939031604010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 40MM PERI TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939031702010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 135CM 20MM PERI TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41060-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CRAGG-MCNAMARA 50CM 5FR 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032506010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 60MM OTW INFL PORT LOPRFL TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032508010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 80MM PERI OTW TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-145-95|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001193080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL TPR 4MM 135CM 100MM OTW HYDROPASS SNG PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-526|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHRO VTC PGTL 8FR 25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-180|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHRO PGTL REG 10FR 25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-588|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLN SDS 5MMX2CM 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001175980|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 5MM 135CM 40MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-628|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER UT SDS 6MMX4CM 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001176310|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 6MM 75CM 60MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001176880|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 8MM 135CM 40MM PERI OTW NC HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 820-243|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE REPLIFORM 4 X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,002.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,002.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-94|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,4 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001105510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4T CRV 1.5MM 150CM 20MM PERI OTW LOPRFL STF SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001145320|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 14MM 75CM 60MM PERI LV SCRCH RST HI STRTH SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19-361|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLN SYNERGY 6MMX4CM 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001193960|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 7MM 75CM 4CM PERI OTW TPR TIP HYDROPASS SNG PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001194310|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 75CM 4CM PERI OTW TPR TIP HYDROPASS SNG PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001175580|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 4MM 135CM 20MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001175680|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 4MM 135CM 40MM PERI OTW 2 LUM LOPRFL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001177110|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 9MM 75CM 40MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001175730|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 4MM 135CM 60MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-681|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER UT SDS 8MMX3CM 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-95|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,5 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,138.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 19-378|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLLN SYNERGY 6MMX10CM 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107085015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO PGTL CRV 5FR 65CM RADOPQ FLSH HTORQ SHFT SFVU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-527|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHSTMY VTC 10FRX25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107120055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO SOS O 1 CRV 5FR 80CM VSCR RADOPQ SLCT ULT TRQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10708504|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU PIGTAIL 5FR 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493892820150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 142CM 20MM TPR DIST SHFT LOPRFL COREWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10801701|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER SCHON XLG 14FR 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10801703|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER SCHON XLG 14FR 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|217.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|217.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13709801|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SIZING ACCU-VU PIGTAIL 0.035" 70CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10801702|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER SCHON XLG 14FR 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-090-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,9 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,849.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H787107085035|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO PGTL CRV 5FR 110CM RADOPQ FLSH HTORQ SHFT SFVU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10709003|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU SIM1 BRAIDED 5FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107140385|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO ANG MPA 4FR 65CM RADOPQ SLCT HTORQ SHFT SFVU ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10714047|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU HS1 NON-BRAIDED 4FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10719501|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU HH1 NON-BRAIDED 5FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10720402|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU OMNI1 BRAIDED 5FR 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10722703|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU BERN BRAIDED 5FR 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493808108350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.5MM 138CM 8MM OTW TPR TIP LOPRFL Q MBSLD ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13709803|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SIZING ACCU-VU PIGTAIL 5FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-090-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.79|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,967.79|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 18-303|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE 3/2.8FR 20/135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001182890|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE HI-FLO 135 LENGTH 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107318055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO CBR 2 CRV 5FR 65CM VSCR 2 SH RADOPQ SLCT HTORQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107341035|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO JB 1 CRV 5FR 100CM 3CM CRBRL RADOPQ SLCT ULT TRQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001181310|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MCTH INFS 130CM 3-2.4FR RNGD STC 18 STRG PERI HDR PASS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08422|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO ANG SIM2 CRV 5FR 100CM CRBRL MP SS NYL TRNB AD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08583|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO JB1 CRV 5FR 100CM CRBRL MP SS NYL TRNB AD BCNTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08809|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TORCON NB JB2 BEACON-TIP 5FR 100CM 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09406|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BEACON TIP PIGTAIL 4FR 70CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-090-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,821.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,821.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G11278|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HIGH FLOW PIGTAIL 4FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31129|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SHUTTLE H1 SLIP-CATH 5.0FR 125CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001177260|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 10MM 75CM 20MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-638|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER UT SDS 6MMX8CM 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001176610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 7MM 75CM 60MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-095-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,9 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,849.71|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,849.71|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001176930|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 8MM 135CM 60MM PERI OTW 2 LUM LOPRFL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5591200|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER VAS-CATH NIAGRA STRAIGHT ACUTE 13.5FR 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00174|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC PIGTAIL GROLLMAN 6.7FR 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31138|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 90CM 6FR .087IN FLXR SH-SL HDRPH T-B SDARM RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G10405|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CHECK-FLO 7FR 40CM (CUSTOM ITEM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W020120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.0MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W030120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 3.0MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W040120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 4.0MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-095-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.79|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,967.79|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W04120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 135CM 120MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W03080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 3MM 135CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 135CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 135CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 135CM 200MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 135CM 60MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 135CM 200MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 7MM 135CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-095-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,6 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,821.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,821.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P4030|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK SS 7FR 2.6 X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532030|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PIGTAIL BILIARY DRAINAGE 7FR 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532050|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PIGTAIL BILIARY DRAINAGE 10 FR 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|217.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|217.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533680|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 10CM DDNL BND TEMP AMSDM PRCFLX PLS DISP ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533690|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PERCUFLEX BILIARY DRAINAGE 10FR 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533700|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PERCUFLEX BILIARY DRAINAGE 10FR 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47116202100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,HEX HEAD,COMPRESSION,1IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|197.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-702|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SYS ACUSTK II J TIP 21GA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G11672|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CHECK-FLO 18FR 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14306|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRODUCER GUIDE WIRE SAFETY 12FR 22CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0805815|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 8FR .06IN 5CM 1 LUM MCTRDCR PWR INJ CV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-00376|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH 7FR 18GA 16CM BLU FLXTP 2.5IN .032IN 3 LUM GW NDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 135CM 120MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W08040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 8MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W020040150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.0MM X 40MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W035120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 3.5MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47116202200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,HEX HEAD,COMPRESSION,1-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|197.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W03040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 3MM 135CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00573100|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|JAGTONE RX 39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47116202300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,HEX HEAD,COMPRESSION,1-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|197.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00539210|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM STENT BILIARY FLEXIMA 7FR 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00539220|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM STENT BILIARY FLEXIMA 7FR 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558340|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CRE ESOPHAGEAL 8-9-10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22097|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC GEENEN 5FR 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G24543|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 3FR 4CM DRN OBSTRUCTED PSTN SLV PSH CATH DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00129206100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE LUQUE(CERCLAGE)1.22M ZIMM|1|HUMANA [1294]||HUMANA [11839]|111.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47116202500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,HEX HEAD,COMPRESSION,2IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|197.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9192508|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CRESCENT 8 X 25MM|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5 LEFT CR POROUS VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL CR 14MM X 63/67|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH101502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN HEPARNIZED 10MM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,286.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,286.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17817000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON PATELLA HEMI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.001.228S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL EX CANNULATED TITANIUM 7MM X 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,809.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,809.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,100MM,12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 916207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 7MM LORENZ TI MDFC SLF DRL HTORQ XDR BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-6205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE SELF DRILLING 2.0MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,105MM,12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 57-13440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCK HAND PROFYLE COMPRESSION NARROW 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|888.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|888.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 15MM X 2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9193015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CRESCENT 30 X 15MM|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,110MM,FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 24.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 018805|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST MAGNEVIST 5ML SDV NDC 50419-188-05|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,115MM,FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 018801|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST MAGNEVIST 10ML SDV NDC 50419-188-01|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 018815|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST MAGNEVIST 15ML SDV NDC 50419-188-15|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 018802|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST MAGNEVIST 20ML SDV NDC 50419-188-02|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 018838|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST MAGNEVIST 10ML IV SYRN NDC 50419-188-38|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-2307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.3MM X 7 EMERGENCY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.3 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|126.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP35012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP35015UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDEAVORSPRINT 3.5 X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,120MM,FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ENSP35030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 30MM 3.5MM ENDVR SPRNT ZOTAROLIMUS PHSCH COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136550100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL METAL ON METAL ASPHERE M-SPEC 36MM -2 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48403|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 22MM X 96CM ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M006180223010|SUP|HCPCS C1733||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 6FR 26CM .038IN STRG TPR TIP BLDR MRK LOPRFL STF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180-222-01|SUP|HCPCS C1733||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL CONTOUR WITH GUIDEWIRE 6FR X 24CM W/0.38 GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76310200M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE WITH SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,125MM,FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3037|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT INTERSTIM ICON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3058|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROSTIMULATOR INTERSTIM II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3889-33|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD TINED INTERSTIM 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3889-41|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD TINED INTERSTIM 41CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,130MM,FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00235800106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING HUMERAL LATERAL PROXIMAL 6-HOLE RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,113.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,113.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235906036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERI CANNULATED 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235905036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERI CANNULATED 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANNULATED 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1322DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINI BIO-SUTURETAK DISPOSABLE INST|1|HUMANA [1294]||HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8825B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINI BIO PUSHLOCK 2.5 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,60MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 45-671|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PICC XCELA 5FR DUAL MST 60-KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-459|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PICC PASV 4FR SINGLE MST 60-KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,65MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0066201250|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BENTSON FIX CORE .035 X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00129206000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE,LOOP,LUQUE(CERCLAGE)1.2MM|1|HUMANA [1294]||HUMANA [11839]|111.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00119301027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,70MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HD-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 HD DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4592|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ACUITY SPIRAL LVA SINGLE ELECTRODE 1S-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787065970485|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT MICROINTRODUCER 4 FR STIFF|1|HUMANA [1294]||HUMANA [11839]|127.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,75MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PL-ELCOL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CORONOID LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,80MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 36-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COIL OCCL INTLOK 3MMX6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 36-154|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COIL OCCL INTLOK 5MMX8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47345|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 14CM 10MM NST 4.5 LOOP CATH END HL PLTN SNTH FBR|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26999|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 14CM 6MM NST .038IN 7.4 LOOP PLTN STRL|1|HUMANA [1294]||HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,85MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00119301037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,90MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5076-65|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 65CM 6FR ATR VNTRC RT IS-1 BP ACTFX SCR IN CP NV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SNPG20|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN GUIDE SHOULDER 2.0MM|1|HUMANA [1294]||HUMANA [11839]|84.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|84.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001PCB5020900|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 90CM 20MM OTW TPR TIP INFL PORT PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,95MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001PCB6020900|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 90CM 20MM OTW INFL PORT TPR TIP PLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5833690|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATHETER DIALYSIS LONG-TERM HEMOSTAR 14.5FR 19CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5833730|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATHETER DIALYSIS LONG-TERM HEMOSTAR 14.5FR 23CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATEC1212-20|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HANDPIECE ULTRASOUND 12G (2.7MM) X 12CM 20MM ATEC|1|HUMANA [1294]||HUMANA [11839]|727.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|727.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180-823|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CONTOUR URETERAL 6 X 26 180-823|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|469.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|469.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 06597028|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT MICROINTRODUCER 4 FR 45CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70338007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET TUBE OTOLOGY DIEGO|1|HUMANA [1294]||HUMANA [11839]|59.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y DOUBLE 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7562|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y DOUBLE 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2019T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-1064|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FRACTURE 6 HOLE ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,602.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,602.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7383|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 1.2 X 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 1.2 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7372|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0 X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|147.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7373|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0 X 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|147.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7374|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SUHLS-1007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRODUCER LEAD PERCUTANEOUS 7FR 13CM SAFESHEATH|1|HUMANA [1294]||HUMANA [11839]|174.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|174.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SUHLS-1009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRODUCER LEAD PERCUTANEOUS VALVED 9FR 13CM SAFE SHEATH|1|HUMANA [1294]||HUMANA [11839]|174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95-2013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7376|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0 X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|156.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7377|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.0 X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|163.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SQUARE 1.5MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L RIGHT REGULAR 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LEFT REGULAR 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8961S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,INTERFERENCE,CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 24-1058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FRACTURE 8 HOLE SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,533.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,533.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID KEELED TURON SZ 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276025|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE STRUT 25MM X 11MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,892.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,892.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276911|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 9MM X 11MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276011|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 10MM X 11MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131709|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST ISOVUE 250 150ML BOTTLE NDC# 0270-1317-09|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6197-9-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT SIMPLEX P WITH TOBRAMYCIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|797.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|797.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5512-F-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 SZ 5-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-06-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ASPHERE M SPEC 12/14 40MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,717.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-52-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL METAL ASPHERE 12/14 +5 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5448-002-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGUMENT BLOCK HALF TAPERED TIBIAL METAL TRABECULAR SIZE 2 15MM RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,874.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,874.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-002-38|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGUMENT BLOCK HALF TAPERED TIBIAL METAL TRABECULAR SIZE 2 LL/RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,874.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,874.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-5500-3|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PROGRAMMING PATIENT PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 916104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE SELF DRILLING 1.5 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-6105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE SELF DRILLING 1.65 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-6106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE SELF DRILLING 1.5 X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-6107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE SELF DRILLING 1.5 X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10135936|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ACUNAV ULTRASOUND 8FR 90 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06597011|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT MICROINTRODUCER 4 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 1.5 16 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7074|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 1.5 2/2 LEFT MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 1.5 2/2 RIGHT MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2248435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT REGULAR 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8096|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LONG RIGHT 3 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8097|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LONG LEFT 3 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 29X4.8X1.25MM MNDB 4 HL LOPRFL 2MM SCR MDLR FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01-9222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ORBITAL 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1315-41|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST ISOVUE 300 300ML MULTI PACK|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PORCOAT C/R SIGMA LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-2009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STRG 42X4.8X1.25MM MNDB 6 HL LOPRFL 2MM SCR MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|684.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 91-2011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-2013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-2015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-2017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-2019|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS DRIVE 2.0 X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-5305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMF 2.0 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-5307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMF 2.0 X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-5309|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMF 2.0 X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-5311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMF 2.0 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27622E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27624E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27616E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL 2 STANDARD WITH OUT COLLAR CEMENTLESS SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MULTIHOLE PINNACLE WITH GRIPTION 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-89-146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 28MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,757.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,757.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENSP350009UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDEAVORSPRINT 3.5 X9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 20CM X 20CM FIRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,749.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|31,749.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC.065|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +6.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2839-13-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINAL CEMENT CONFIDENCE SYSTEM|1|HUMANA [1294]||HUMANA [11839]|1,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22437-19|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 190CM .014IN SM CRTD GW RADOPQ 2.5-4.8MM 5-6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX6700|SUP|HCPCS C1760||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSER DEVICE MYNX 6 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-51-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ASPHERE M SPEC 12/14 36 +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 30MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H965451190|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT IMPLINFN XCELA TI SIL PU 8FR 1.6MM 1 LUM PWR INJ ATCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EX090803CS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFE BILIARY 9MM X 8CM X 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR2504|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STANDARD .025 DIAMETER X 150CM LENGTH ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR2501|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STANDARD .025 DIAMETER X 150CM LENGTH STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07060080|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL .035IN 7MM 80CM 60MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACUFEX CANNULATED SCREW 7 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BN175TCFJH|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EZ STEER BIDIRECTIONAL THERMOCOOL NAV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C408509|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ENGAGE 8FR 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM973T|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 1.5 65 X 90MM|1|HUMANA [1294]||HUMANA [11839]|1,318.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,318.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401690M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH SI BRITE 6FR 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-034|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 34 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00554520|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP RGFLX II 90CM 10CM 40MM RADOPQ STRL LF ACPT .038IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48433|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 36MM X 113MM ZENITH FLEX Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH ROUND PROFILE HIGH 250CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN402832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 28MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55213|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION BODY MAIN AAA 26MM X 58MM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55211|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION BODY MAIN AAA 22MM X 58MM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-05-040-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 5FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-05-080-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 5FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9545|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SNTH TISS 27MMX16MMX.45MM PE MDPR SPCR POR CRNMXF ORBT|1|HUMANA [1294]||HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48407|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 24MM X 82MM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFLE-8-88-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILLIAC AAA 8MM X 88CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFLE-10-122-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 10MM X 122MM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115070ND|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE KIRSCHNER 70MM|1|HUMANA [1294]||HUMANA [11839]|91.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|91.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9513|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MALAR CONTOURED EXTENDED SMALL LEFT|1|HUMANA [1294]||HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MALAR CONTOURED EXTENDED SMALL RIGHT|1|HUMANA [1294]||HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5436024|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 6 X 24|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.008.216S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS 12MM X 180MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.666S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G02848|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .025IN 3MM FX COR STD TPR SFTJ SS HEP PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR2505|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE ANGLED .025 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-65709-HFWC|SUP|HCPCS C1757||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT THRMBL 65CM 7FR 7FR A-TR PTD 9MM PERC PU SHTH CATH HMSTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,267.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,267.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,LAG,COMPRESSION,55MM,FRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|880.05|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|880.05|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C408507|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ENGAGE 6FR ACT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C408500|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ENGAGE ACT 4FR .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-7-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 7 MM DIAMETER 40 MM 125 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL THICK 18MM X 50MM TURON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UROLUME ENDOPROSTHESIS 2.5|1|HUMANA [1294]||HUMANA [11839]|5,775.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G53461|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR PROXIMAL EXTENSION ZENITH 42MM X 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401605M|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 6FR 35MM 5.5CM KINK RST CNN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4196-78CM|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PCNG 78CM 4FR 2 CRV LT HRT TRNVNS BP IS-1 ATN ABL STRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 014957|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST CYSTOGRAFIN 300ML (30%) NDC 0270-1409-57|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36129|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CUF AORTIC RENU ZENITH 22MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38-1650|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE-U TYMPANOSTOMY 1.35MM|1|HUMANA [1294]||HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 20CM X 25CM FIRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,684.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|39,684.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3023A|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACK NEUROSTIMULATOR INTERSTIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5833270|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATHETER DIALYSIS LONG-TERM HEMOSTAR 14.5FR 27CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CONFORM PROFIX LEFT SIZE 4-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596801551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 TRIATHLON SIZE 2-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550L278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SYMMETRIC TRIATHLON S27 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620404F|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OCCLUSION FOGARTY 4FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0295|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG 121X11MM TI 10 HL MIDSHAFT LOPRFL BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864017|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKER TISSUE ULTRACLIP COIL SECOND SITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700515|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 5FR 1245ML/HR 1 LUM MCTRDCR PWR INJ CUF PWRLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE ANTERIOR MEDIAL 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9009-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHEATH TUNNELER LARGE BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|136.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062251020|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ULTRA UROMAX 6CM X 4CM X 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48409|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 24MM X 111CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48472|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 22MM X 39CM FLEXZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48434|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 36MM X 131CM FLEXZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 18MM 2Y CRNFCL TI 6 HL 1.5MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3023B|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACK NEUROSTIMULATOR INTERSTIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3031A|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT INTERSTIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600615|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER POWEHOHN 6FR DUAL LUMEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,144.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,144.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22440-31|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BAREWIRE WORKHORSE .014 35CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0606008|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 6CM X 6CM RENFORCEMENT STOMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,197.88|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,197.88|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401227|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 6FR JSN QUAD (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402004|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUADRIPOLAR 6 FR CRD-2 (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3544800|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15.4CM P6.3CM RND HI PRFL SLTX SIL GEL TXTR 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12996|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NDL 10CM 19GA 6FR 4 SDPRT HLW STY CATH STRG CAVITIES PRC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0123680|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX-"EX" 6" X 8"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,256.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,256.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5448-002-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK HALF TAPERED TIBIAL METAL TRABECULAR SIZE 2 RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,472.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,472.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-002-37|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK HALF TAPERED TIBIAL METAL TRABECULAR SIZE 2 LL/RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,472.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,472.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN RIGHT 6 HOLE HEAD 5 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.651|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN LEFT 6 HOLE HEAD 5 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN RIGHT 7 HOLE HEAD 5 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.751|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2 COLUMN LEFT 7 HOLE HEAD 5 HOLE SHAFT 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0123114|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX-"EX" 10" X 14"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400-256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS MEDIUM RIGHT SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BASE TIBIAL LARGE SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-143F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING MOBILE 9MM SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-65709-W|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT THRMBL 65CM 7FR A-TR PTD 9MM PERC 1 WY STPCK CATH OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-65509-HFC|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT THRMBL 65CM 5FR 6FR A-TR PTD 9MM PERC PU FRAGMENTATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-03009-RW|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|UNIT DRV 7FR A-TR PTD 3K RPM PERC OTW ROTR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V1850120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 140CM 12CM PERI SHRT RX 2 LNGTDNL WRE HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06150MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 6MM 150MM 120CM LNG DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0516SP|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS PRO SOLO RELIEVA 5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-416-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IRTH084040A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 8MM PROPATEN THNWL GRTX HEP INTGR RING 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,506.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,506.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT-106-14|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER MICRO ACCESS TEARAWAY 5 FR X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-LSGWO3801|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 0.18" X 80CM ANGLED NITINOL 5DM RADIOPAQUE TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EX061501CS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTENT SFA SELF EXPANDING 6MM X 150 MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V1420120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 140CM 12CM PERI SHRT RX 2 LNGTDNL WRE HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 11X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.100.033S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116MM SS 3.5MM SCR ARTHDS 7 HL LCP CMBN BN ANKL ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,350.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,350.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.100.032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100MM SS 4.5MM CORT SHFT CANC SCR ARTHDS 6 HL LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,263.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,263.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9193012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30X10X12MM VRTSTCK CRSNT 6D LRDTC STRG BLT NOSE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GC110S|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE SINUS RELIEVA 110 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT JOINT M-P TOE GREAT COATED POROUS MEDIUM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107334015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO ROSCH INFR MESENTRIC CRV 5FR 65CM VSCR RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10708603|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU STRAIGHT FLUSH NON- BRAIDED 5FR 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787055003022|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 150CM .035IN FX COR J 3CM PTFE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GN500|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT SNARE GOOSE NECK AMPLATZ 5MM LOOP DIAMETER X 120CM SNARE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 863017D|SUP|HCPCS A4648||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKER TISSUE ULTACLIP RIBBON DUAL TRIGGER 17 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|236.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345241|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE L-ASR FEE 12 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551L320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ASYMMETRIC TRIATHLON 32MM -10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL X 3 POLY SIZE 6-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 415-00-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG CEMENT CLEARCUT ENCORE|1|HUMANA [1294]||HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-32-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT GLND 30MM 6.5MM RSP SHLDR HA STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-32-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD GLND 32MM RSP NTRL SHLDR RTN SCR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-00-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL SOCKET HUMERAL RSP DJO NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,277.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,277.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-00-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET HUMERAL RSP DJO SZ 32 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-00-007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL RSP DJO SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NLSS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET LOCKING 90 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|193.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSPR4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHOULDER S3 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED 4.0 X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STP30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM LEFT CR ILOK VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM KNEE SPLINED BIOMET 16 X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL DCM (TM) VANGUARD PS 16 X 63/67|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14440052|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDEWIRE SCREW LAG|1|HUMANA [1294]||HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR ORTH SS 3.5-4 MM CNN SCR NS LF|1|HUMANA [1294]||HUMANA [11839]|110.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14410002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDEWIRE TIP BEAD 2.6MM X 80MM|1|HUMANA [1294]||HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-440121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ANKLE LOCKING 10 X 210MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14405080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LEAD TI DOUBLE 5.0 X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-405085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LEAD TI DOUBLE 5.0 X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-405075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LEAD TI DOUBLE 5.0 X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-405026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LEAD TI DOUBLE 5.0 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-405024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LEAD TI DOUBLE 5.0 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF3216C155XH|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA TALENT WITH XCELERANT HDS BIFURCATED 32 X 16 X 155|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IW1416C105XH|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA TALENT WITH XCELERANT CONTRALATERAL LIMB 14 X 16 X 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 7.3MM X 85MM WITH 4.0MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 40MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516710|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX COVERED 18MM X 12CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07120MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 120MM 120CM LNG DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VT45070L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX TAPERED TW 4.5M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 183322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SSK (TM) VANGUARD ILOK 60MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-76075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 7MM BALLOON X 60MM STENT LENGTH X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001176760|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 8MM 75CM 20MM PERI OTW LOPRFL HDRPH U-T SDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001181330|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MCTH INFS 130CM 3-2.4FR RNGD STC 18 90D PERI HDR PASS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-09-37-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 9MM DIAMETER X 37MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W025120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.5MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT106-16|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER MICRO ACCESS TEARAWAY 6 FR X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1020002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 10CM X 20CM FIRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,876.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,876.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00430204024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL BIGLIANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NEUTRAL PINNACLE MARATHON 38MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,848.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1926PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PUSHLOCK PECK 3.5MM X 19.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BNF-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOCORK WITH NEEDLES 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH071502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS VIABAHN 7MM X 15CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CRU014P|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CROSSER 14 P OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE SIZE +2 8.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,382.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,382.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MINI QUIK PLUS (#2/ SUTURE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,068.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-05-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL METAL ARTICULEZE 40MM +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.44|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,717.44|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4300-046-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL BIGLIANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5572|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDELINER 7 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VST10|SUP|HCPCS C9250||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KIT TISS CLSR VISTASEAL FBRN SLNT 10ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.44|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,441.44|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PXT231218|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 23MM X 12MM X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-005-37|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK HALF TIBIAL METAL TRABECULAR SIZE 5 10MM LL/RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,471.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-005-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK HALF TIBIAL METAL TRABECULAR SIZE 5 10MM RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,471.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-19.50|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.456S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RETROGRADE FEMORAL EX 10MM X 380MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-04-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ASPHERE M SPEC 12/14 40MM -2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.44|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,717.44|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2490-1530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRIPPER RHP SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 35.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS3509|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE RADIOFOCUS 0.035" X 260CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9193008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CRESCENT 30MM X 8MM|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401811M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 8FR 35MM 11CM KINK RST CNN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-2036|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PORP MICRON II ALL TITIANIUM CENTERED 150MM TITANIUM TILT TOP HEAD|1|HUMANA [1294]||HUMANA [11839]|943.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|943.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0123460|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX-"EX" 4" X 6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,071.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 83565559|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THRS 3D 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83565459|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THRS 3D 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83565509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THRS 3D 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8351520|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR SMALL THRS 3D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8351500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET THRS 3D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|514.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT XLK CURVED #3 12.5MM SIGMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158130000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL MOD CEMENTED COCR SIGMA #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT XLK CURVED #25 12.5MM SIGMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL MOD CEMENTED COCR SIGMA #2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14958|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT NPC M/L|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EX060803CS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 6FR 80MM 130CM .035IN SLF XPD CATH HLCL GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 10X10CM STRATTICE PRCN DERM RECON STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,944.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,944.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G36138|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 62MM 28MM 20FR RENU ZNTH ANCLRY MAIN BD XTN AAA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71-901|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID WALL 5FR 8 X 21 135CM|1|HUMANA [1294]||HUMANA [11839]|7,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH050502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 5MMX5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286316SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1CVX003|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH GRAFT GORE-TEX ACUSEAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|642.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 330217SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION UNI DEAL NEW 17MM 2-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,564.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,564.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0601110|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT INTRODUCER PTFE PERCUTANEOUS 10FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0112770|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG PERFIX LARGE BARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PANALOCK RC PLUS #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,182.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,182.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UWR1035|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE RADIOFOCUS 0.035"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 222.254|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LCP 9 HOLE 236MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,979.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,979.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT066080A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 6MM GORE THNWL HEP PROPATEN PTFE REM RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,238.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,238.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201101|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEERABLE DECAPOLAR DYNAMIC XT (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2028BL|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEEROCATH DX OCTAPOLAR (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10708801|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU 5FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10709602|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU HOOK 5FR 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08581|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO ANG DAVIS CRV LOPRFL TPR 5FR 100CM VISCUS MP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31453|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIREGUIDE TMSG35-260-7-LES2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0064|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACULOC NARROW EX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-T2322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C408508|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ENGAGE ACT 7FR .038 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-S2320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-T2308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 8MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-T2312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 12MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-T2310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C18-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MICRO 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG STANDARD 4.0 X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PORCOAT C/R SIGMA LEFT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL KEEL POROUS MBT SZ-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 976-147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFFSET HIGH SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50AO-18.50|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT XLK CURVED #5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158150000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL MOD CEMENTED COCR #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR POROCOAT C/R SIGMA RIGHT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ML2345|SUP|HCPCS C1728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MAMMOSITE MULTI 4-5CM LUMEN|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12115010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CORTICAL STRUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE UNV STRG 96X8X2.5MM MNDB 12 HL LCK RECON 2.4/3MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,593.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CV SIGMA PFC SIZE 5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CV SIGMA PFC SIZE 5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RZT-6.16|SUP|HCPCS Q4143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX DERMAL ACELLULAR TISSUE HUMAN REPRIZA 6.0 X 16.0CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,780.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,780.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3060-0095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 10.5 X 95 GAMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 160X8X2.5MM MNDB 20 HL LCK RECON 2.4/3MM SCR BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,205.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,205.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5448-006-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK HALF TIBIAL METAL TRABECULAR SIZE 6 10MM RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,471.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1547PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS PEEK 4.75MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001PCBO3015140F0|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL SM 3MM 137CM 1.5CM OTW TPR TIP PR CTBLN ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL LEFT MEDIAL RIGHT LATERAL PRECOAT UNI KNEE SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584202208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UNI KNEE SIZE 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 26MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939031402010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 20MM PERI TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 28MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 458.58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.013.440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RETROGRADE FEMORAL 10MM X 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.552S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 62MM F/IM NAILS WITH T25 STARDRIVE TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107327025|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO ANG KMP CRV 5FR 40CM RADOPQ SLCT HTORQ SHFT SFVU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported NK011615|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE KIRSCHNER 1.6MM|1|HUMANA [1294]||HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN353432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 34MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06120MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 6MM 120MM 120CM LNG DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 83964-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 2MM X 80MM X 150CM .035 BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C2836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 36MM TI 3.5MM HEX LOPRFL KN CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C2838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 38MM TI 3.5MM HEX LOPRFL KN CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C2840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM TI 3.5MM HEX LOPRFL KN CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.64|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L92508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 180MM 18MM COLR CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1025002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 25X10CM STRATTICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1016002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 16X10CM STRATTICE PRCN DERM RECON STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,702.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,702.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0808008|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 8CM X 8CM RENFORCEMENT STOMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,688.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,688.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.013.548S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 340MM FEM XPRT IM FLUT CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001176020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL STD 5MM 90CM 60MM PERI OTW 2 LUM LOPRFL HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-8-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY ZILVER 6FR 6MM X 40MM 125CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6464|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 8MM X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.66|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6466|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 10MM X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6477|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 12MM X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0294|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG 121X11MM TI 10 HL LCK MIDSHAFT LOPRFL BN CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM VRTX MX TI SPNE MA NS BLU RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT2-M30-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958843PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VERTEX PART-THREAD 4 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.68|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.110.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN RIGHT 7 HOLE HEAD 4 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE STANDARD 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16515005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SEGMENT FIBULAR FREEZE DRIED APPROXIMATELY 5CM|1|HUMANA [1294]||HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPS0021K|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SHOULDER INTERSPACE (INCLUDES CEMENT #1400/AG)|1|HUMANA [1294]||HUMANA [11839]|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7755240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VERTEX 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,713.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,713.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-6-070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX V40 TAPER SLEEVE +4mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.70|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131218000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER CORTICAL PRO LOW 3.5MM|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL DISTAL LATERAL LEFT 9 HOLE 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141796|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 6IN 2MM KRSH NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.72|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 816135026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM COCR 2.2MM TIB DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM COCR 2.2MM TIB DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7968212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 37X27X12MM CRSNT SVRGN 12D MED PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7965525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOVEREIGN 5.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7965530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOVEREIGN 5.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CSS-040-14|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE DOUBLE TROCAR 1.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-4252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING LONG-THREAD TORQUE MAX 4.0MM X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.74|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5565-S-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 11MM X 100MMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 28MM SS FT T15 FIB HUM RDS TIB SLF DRL CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 30MM SS T15 FT FIB HUM RDS TIB SLF DRL CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 49-294|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE THRUWAY .014 X 190CM LONG TAPER STRAIGHT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-032|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS .014" GUIDEWIRE 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48404|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 111MM 22MM 18FR ZNTH FLX Z-TRK BFUR ABD AORTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.76|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6958724|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM VRTX MX TI SPNE MA NS GRN RECON SYS|1|HUMANA [1294]||HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629284|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL EXTENDED 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 MM X L30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.78|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING TI 3.9MM 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 MM X L30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 MM X L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.957S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 119MM SS 3.5MM SCR 6 HL LMT CNTCT LCP CMBN BN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 70MM SS T15 FT SLF DRL CNN LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 75MM SS T15 FT SLF DRL CNN LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 85MM SS T15 FT SLF DRL CNN LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6958830|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM VRTX MX TI SPNE MA NS AU RECON SYS|1|HUMANA [1294]||HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.4MM X 14MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,282.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 290645SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HALLOLOCK LEFT 5 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,929.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,929.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285214SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SURFIX 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185200SND|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SURFIX LOCKING|1|HUMANA [1294]||HUMANA [11839]|361.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|361.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 295212SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SURFIX ALPHA 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285216SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SURFIX 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.676|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.4MM X 16MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,282.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8935-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LAPIDUS 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE MEDPORE SST-EZ 20MM|1|HUMANA [1294]||HUMANA [11839]|2,112.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,112.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE MEDPORE SST-EZ 22MM|1|HUMANA [1294]||HUMANA [11839]|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3231-40|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR UNIFY BI-VENTRICULAR ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2231-40|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR FORTIFY DUAL CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.678|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.4MM X 18MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|256.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CD1231-40|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK14MM 40J 40X73MM FORTIFY VR VNTRC TI 1 CHMBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD1231-40Q|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR FORTIFY SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM1110|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD THK6MM 52X42MM ACT SR VNTRC 1 CHMBR UNPLR BP IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 100MM 16MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFB-32-74|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 32MM X 74MM ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS2020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REINFORCEMENT TISSUE GORE BIO-A FLAT SHEET 20 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,986.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,986.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1258T/86|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD QUICKFLEX MICRO LEFT VENTRICULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,977.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,977.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787055001012|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 150CM .035IN MOV COR J 3CM AMPTZ PTFE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-SLH-8H-20X20|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT HERNIA SURGISIS BIODESIGN 20 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|21,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RZT-4.12|SUP|HCPCS Q4143||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX DERMAL ACCELLULAR TISSUE HUMAN REPRIZA 4.0-12.0CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +12.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +13.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +14.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +15.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +16.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +17.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +18.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +19.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +20.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV635-80-10-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 10 MM DIAMETER 60 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +11.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +21.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +22.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +23.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +24.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.255|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +25.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +26.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +27.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +28.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.290|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.295|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +29.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.300|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +30 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0607687000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT DELIVERY BONE CEMENT AUTOPLEX W/VERAPLEX HV-TRIM|1|HUMANA [1294]||HUMANA [11839]|2,017.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,017.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BD710FJ282CT|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BI DIR 7FR DEF CS F-J 12 PIN (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F6QA005CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RVA/HRA QUAD FIX 6F 4P A SD 5MM 12PN EEPROM (REPROC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F6QF005CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HIS QUAD FIX 6F 4P F SD 5MM 12PN EEPROM (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 27MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.129|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 3.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9193010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30X10X10MM VRTSTCK CRSNT 6D LRDTC STRG BLT NOSE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT JOINT M-P TOE GREAT NON POROUS MEDIUM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 934071|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEALANT SURGICAL COSEAL 4ML|1|HUMANA [1294]||HUMANA [11839]|1,855.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,855.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 934072|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEALANT SURGICAL COSEAL 8ML|1|HUMANA [1294]||HUMANA [11839]|2,166.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,166.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 600-005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE STIMULAN INJECTABLE 5CC|1|HUMANA [1294]||HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 75MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|798.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 80MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 85MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR BANTAM WITH GRIPTION PINNACLE 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NEUTRAL PINNACLE MARATHON 28MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,848.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958734PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VERTEX PART THREAD 3.5 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756074|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK LAMINAR|1|HUMANA [1294]||HUMANA [11839]|4,263.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,263.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5 X 240MM|1|HUMANA [1294]||HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7751110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CABLE|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600021|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SPRAY COSEAL EASYSPRAY|1|HUMANA [1294]||HUMANA [11839]|153.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507004BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL MEMORY SMOOTH ROUND PROFILE HIGH 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL MEMORY SMOOTH ROUND PROFILE HIGH 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W03080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 3MM 80CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C13166|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY TRCH SHLY CGL BLU RHINO PERC STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12565|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY TRCH 8FR SHLY CGL BLU RHINO PERC EZ PASS JTP NDL GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-3138-35|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION CONTACT 8 X 35CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,272.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,272.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FB22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP20000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131211115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG MULTIDIRECTION THREADED 2.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER THREADED 2.5MM|1|HUMANA [1294]||HUMANA [11839]|63.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING Y-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164206045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE TROCAR DOUBLE .045 X 6INCH|1|HUMANA [1294]||HUMANA [11839]|30.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTIONAL 3.8 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NL20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 90 DEGREE 3.8 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSPR11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHOULDER S3 11 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,701.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,701.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED 4.0 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STPT50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED 4.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101204080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TRI-LOCK BPS WITH GRIPTION OFFSET STANDARD SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-36D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT X 3 0 DEGREE 36MM "D"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FM966T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DOUBLE Y 6 HOLE 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|139.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|139.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062201090|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNOCC 65CM 7FR 34FR OCLR 1 INFL PORT RADOPQ FLXB SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +10.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.123.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 2 HOLE RIGHT 91MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,798.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,798.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.123.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 3 HOLE RIGHT 109MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,867.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,867.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 4 HOLE RIGHT 127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,942.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,942.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 5 HOLE RIGHT 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,066.61|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,066.61|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 6 HOLE RIGHT 163MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,208.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 8 HOLE RIGHT 199MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,408.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,408.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 10 HOLE RIGHT 235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,612.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,612.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 12 HOLE RIGHT 271MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,790.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 2 HOLE LEFT 91MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,798.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,798.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 3 HOLE LEFT 109MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,867.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,867.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 4 HOLE LEFT 127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,942.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,942.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.043|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 5 HOLE LEFT 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,066.61|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,066.61|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 6 HOLE LEFT 163MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,208.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 8 HOLE LEFT 199MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,408.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,408.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.029|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 10 HOLE LEFT 235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,612.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,612.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.123.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 12 HOLE LEFT 271MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,790.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TR-S0702-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 7.0MM X 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-2822S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL PROXIMAL LONG LEFT 8 X 220MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,368.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,368.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5035S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PV-3019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT,PERITONEO-VENOUS SHU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0045031TL0|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ABLT 110CM 7FR 4MM 2.5MM SPC STD CRV BLZR2 QDPL XTD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR JUGGERKNOT SINGLE SIZE 1|1|HUMANA [1294]||HUMANA [11839]|726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1525002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 15CM X 25CM FIRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,763.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|29,763.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4500THMK2|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II XP ALBATION 8FR 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-05-27-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 5MM DIAMETER X 27MM LENGTH X 080MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IRTH064040A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 6MM PROPATEN THNWL GRTX HEP INTGR RING 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,506.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,506.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061856070|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 24CM .035IN TPR TIP ATCH SUT INJ PSTNR GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR FLEXION HIGH XLPE CR LEGION SIZE 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OXIN C/R LEGION SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS BASE TIBIAL II GENESIS NP SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 48MM LONG THREAD STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.207.265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 7.3MM X 65MM WITH 4.0MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-0093S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SMOOTH 2.2 X 800MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR FLEXION HIGH LXPE CR LEGION SIZE 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.204.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X 30MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL OXIN LEGION CR RIGHT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14863-05|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 7MM DIAMETER 100MM LENGTH 120CM SHAF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-32-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD GLND 32MM RSP -4MM OFST SHLDR RTN SCR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-00-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL RSP DJO SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-02-130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE NON-LOCKING 3.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551L350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ASYMMETRIC TRIATHLON 35MM - 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LCP 9 HOLE 236MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,979.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,979.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MR-1420|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING 14C|1|HUMANA [1294]||HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 15MM 26MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 15MM 28MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1011935-040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 8.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14880-05|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XCEED BILIARY 6FR 8MM DIAMETER 100MM LENGTH 120CM SHAF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 120015N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN COMPRESSION 1.7MM X 15MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0684-00-0254-16|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .018 SENSATION 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8163-35-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTION 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0 MM X 48MM CAN LAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|418.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|418.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL MEDIAL 88MM LEFT 9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41054-01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CRAGG-MCNAMARA 50CM 5FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-37-018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 83565359|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THRS 3D 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8351521|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR MEDIUM THRS 3D|1|HUMANA [1294]||HUMANA [11839]|4,036.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,036.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS LOCKING 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS LOCKING 4.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8162-04-007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR COMPOTE LOCKING 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL FEMUR 9 HOLE 236MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,916.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,916.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.392|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 26MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|664.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.393|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 40MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|664.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.394|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 55MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.395|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 65MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.396|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 75MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.397|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 85MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET 54MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.699|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE KIRSCHNER 2.0MM X 280MM|1|HUMANA [1294]||HUMANA [11839]|129.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|129.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XY4008|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRUG YTTRIUM90 ZEVAIN KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|94,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|94,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LCP 5 HOLE 156MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD MODULAR ENDO UNITRAX 43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 35MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G53424|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 32 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-42-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD TURON 42MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 6MM 10MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 8MM 12MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 8MM 14MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 8MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 8MM 18MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 15MM 20MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 15MM 24MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|577.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|577.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 15MM 30MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|586.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|586.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121731052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR PINNACLE GRIPTION PINNACLE 100 WITH OUT HOLES 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 15MM 22MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8065-6011-85|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OIL SILICON 1000/1000 8.5ML|1|HUMANA [1294]||HUMANA [11839]|1,477.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,477.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED LOCKING 3.7MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3655-38|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY TUNNELING ROD|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 34MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 36MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 38MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 40MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 42MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 50MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 52MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.256|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 56MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.258|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 58MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 60MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 65MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 70MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 75MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.285|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 85MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 90MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.295|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 95MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1365-53-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL METAL ASPHERE 12/14 36MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,408.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CD2231-40Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR FORTIFY DUAL CHAMBER ICD SJ4 CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.254|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 54MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 80MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.240.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 44MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 46MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.240.248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 3.7MM X 25MM 48MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|549.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400-254|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS SMALL RIGHT SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-262|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BASE TIBIAL MEDIUM SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82919-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 4MM X 120MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010560-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 10.0MM X 80MM CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4968-60|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 60CM 8FR EPICARDIUM MYOCARDIUM BP SUT FX IS-1 CPSR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,482.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-10-17-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 10MM DIAMETER X 17MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-10-27-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 27MM 135CM 30MM BLN EXPANDABLE RADOPQ OPN LTC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-10-40-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 10 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-10-60-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 10 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-10-80-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 10 MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-12-40-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 12MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-12-60-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 12MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-12-80-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 12MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-08-17-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 8MM DIAMETER X 17MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W09020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 9MM 135CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W10020135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 10MM 135CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB3510040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 10X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 80CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3K20N18141|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH CNTRN STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 62.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET TURON 46MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7223-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS VOICE STARTER KIT PROVOX (KIT INCLUDES PROSTHESIS|1|HUMANA [1294]||HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6334-060-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTRAINED LONGEVITY TRILOGY TM 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,373.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,373.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.642S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 420MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.516.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 16MM SELF TAPPING 4MM HEAD WITH CRUCIFORM RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50AO-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-9.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40E-25.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER SENSAR IOL WITH OPTIC EDGE ACR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107091015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO CBR 1 CRV 5FR 65CM VSCR RADOPQ SLCT ULT TRQ SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE DISTAL LEFT 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5388|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER TEMPORARY DUAL CHAMBER EXTERNAL PULSE GENERATOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 70MM 32MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 85MM 32MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT CUP 10 DEGREE OMNIFIT SERIES II 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111334SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-3304-25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SPLITTER 2 X 4 D4 25 CM|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-3354-25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SPLITTER 2 X 4 W4 25CM|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MICRO,ORBITA,CVD.6-HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 502-03-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HOLE CLUSTER HEMISPHERICAL TRITANIUM E 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 141205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT TIBTRY BMT AS MX KN INTLK PRM LCK BAR|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2202310F|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH IRR FGRTY 10FR 23CM CLT MGMT ART LF|1|HUMANA [1294]||HUMANA [11839]|67.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2088TC/58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 58CM 6FR HLX ECRDM IS-1 CNCT ACTFX BP SFT RTRCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235800206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING HUMERAL LATERAL PROXIMAL 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,113.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,113.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FRACTURE,4-HOLE,35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00235902835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS1030|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REINFORCEMENT TISSUE GORE BIO-A FLAT SHEET 10 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B-V-243QA|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON TRIPLE LUMEN 15MM DISTAL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH061502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 6MMX15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,286.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,286.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2827710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FRACTURE 4-HOLE 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|519.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 876-715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS 4.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P4055|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SILVERHAWK PERIPHERAL LX-M 4.5MM X 9.0CM X 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1829500|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWERPORT 9.5FR ATTACHABLE CHRONOFLEX CATHETER RADIO TRANSLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,808.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,808.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2232-001-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON HEX STAINLESS 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2352-50E|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT 3-4 LEAD LINEAR 8 CONTACT 50 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO36D001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE KNEE SIGNATURE MODEL 04-05|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1322BNF|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINI BIO SUTURETAK WITH NEEDLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 68004|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURA TUTOPLAST 4 X 10CM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,716.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,716.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 112011ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION SNAP-OFF 2MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTVN-8.0-16-7.0 YEAH|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE CATHETER YUEH CENTESIS 8FR 16G NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3778-75|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD COMPACT 1X8 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5591150|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER VAS-CATH NIAGRA STRAIGHT ACUTE 13.5FR 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48415|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 125MM 26MM 7.1MM 18FR ZNTH FLX 2 BRCH MAIN BD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 101X14MM TI 3.5MM SCR 12 HL LCK TPR END LOPRFL BN 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.258|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 316MM SS 13 HL LCP BN FEM RT DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 44MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,603.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,603.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-87-464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 44MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,603.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,603.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00-5606-000-10|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE NATURAL DENOVO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,986.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,986.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136508000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 12/14 OFST TPR 40MM HIP M SPC COCR ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,157.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136560000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -2MM 12/14 TPR 44MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136561000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1.5MM 12/14 TPR 44MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 64922|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST 5MM X 16MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,013.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,013.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136562000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 12/14 OFST TPR 44MM HIP CMNTLS M SPC COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136563000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8.5MM 12/14 TPR 44MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136564000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 12/14 OFST TPR 44MM HIP CMNTLS M SPC COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136565000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +15.5MM 12/14 TPR 44MM HIP M SPC MTL ART/EZE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,392.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 62MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 64MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 66MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,117.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1217-20-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE BATAM 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,501.98|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,501.98|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121720046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 46MM HIP PRCT PNCL BNTM STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,494.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136528310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 28MM +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136528330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 28MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L92521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 190MM 20MM COLR CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L93709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 9MM COLR CMNTLS LOPRFL NK VRT GRV CRL ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L93716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL 2 VARA COXA SIZE 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L93718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 180MM 18MM COLR CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551-G-350-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYMMETRIC X3 PATELLA 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3L93720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CORAIL 2 VARA COXA SIZE 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,610.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,610.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101204100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 115MM TRLK BPS GRIPTION 10 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101204110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 117MM TRLK BPS GRIPTION 11 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101204120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 119MM TRLK BPS GRIPTION 12 STD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101214110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 117MM TRLK BPS GRIPTION 11 HI OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101214120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 119MM TRLK BPS GRIPTION 12 HI OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121732062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 62MM HIP SECT GRIPTION PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1217-32-064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PINNACLE SECTOR WITH GRIPTION 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,299.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,299.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121732066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 66MM HIP SECT GRIPTION PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,584.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-87-466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 44MM X 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,603.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,603.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48420|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 125MM 28MM 7.7MM 20FR ZNTH FLX Z-TRK BFUR PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 52.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7752537|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK LARGE|1|HUMANA [1294]||HUMANA [11839]|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 360MM FEM LT GAMMA3 IM 125D LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN RIGHT 6 HOLE HEAD 4 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.869S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 85MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|544.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 402025|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 7X4CM ALDRM THN ACLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802240|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 6FR 28CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50AO-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 75MM 32MM SS P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PHSM|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG PRLN 3 15/16INX1.75IN .5IN 2 15/16IN .75IN ONLAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,426.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,426.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 209.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 100MM 32MM SS P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5028-8-065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 65MM 8MM HFMN2 C CNCT MRI SAFE NCDTV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|987.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 100MM 8MM HFMN2 MRI C CNCT XTRNFX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|987.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 150MM 8MM HFMN2 C CNCT MRI SAFE NCDTV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|987.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 200MM 8MM HFMN2 C CNCT MRI SAFE NCDTV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,013.04|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,013.04|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 250MM 8MM HFMN2 C CNCT MRI SAFE NCDTV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|992.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|992.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 350MM 8MM HFMN2 STRG LNG BN C CNCT MRI DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,041.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,041.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 450MM 8MM HFMN2 C CNCT MRI SAFE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,071.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 500MM 8MM HFMN2 C CNCT MRI SAFE NCDTV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,127.52|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,127.52|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-1-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN INVERTED (TO ROD COUPLING 4-5/8MM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,856.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,856.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPLNG XTRNFX 8MM HFMN2 ROD TO ROD MRI CLR CD TLT SP REPRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,856.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,856.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-2-140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST XTRNFX 8MM HFMN2 30D CLR CD MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|328.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2030-6516-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 16MM TX TI ACTB CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-2-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST XTRNFX 8MM HFMN 3 STRG CLR CD MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|436.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|436.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-2-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX HFMN2 5 HL MRI CLR CD 4/5/6 MM PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,971.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-2-060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX HFMN2 10 HL MRI CLR CD 4/5/6 MM PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,628.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,628.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5018-5-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 150MM 5MM APX SS THRD SLFDRL ST 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5018-6-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 180MM 5MM APX HFMN2 CANC SS ST SLF DRL THRD 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9529|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RCDR CRD 62X19X8MM RVL XT 8MM 3.6V 256HZ SM TI SIL PU INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3231-40Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR UNIFY BI-VENTRICULAR ICD W/SJ4 CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 380MM FEM LT GAMMA3 IM 125D LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.731|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN LEFT 6 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.741|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN LEFT 6 HOLE HEAD 4 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.864|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 60MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|459.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.110.751|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN LEFT 6 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN RIGHT 7 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN RIGHT 7 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.831|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN LEFT 7 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN LEFT 7 HOLE HEAD 4 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-60F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D2N25014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 14MM DART-FIRE TI SM P/T FT SLF DRL ST CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N25016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 16MM DART-FIRE SM HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.868|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 80MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|544.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 300MM 8MM HFMN2 C CNCT MRI SAFE NCDTV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,041.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,041.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5028-8-400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 400MM 8MM HFMN2 CFBR CNCT MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,048.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,048.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.110.730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN RIGHT 6 HOLE HEAD 3 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.851|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN LEFT 7 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504004 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 400CC CHSV GEL SMTH MEMORYGEL SIL P5CM HI PRFL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504754BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13CM MEMORYGEL P5.3CM HI PRFL RND SIL GEL SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HEALIX 5.5MM WITH ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4921-2-160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST XTRNFX 8MM HFMN2 90D H MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.110.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP RADIUS DISTAL VOLAR COLUMN RIGHT 6 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570070|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ARWY 30MM 9MM 12MM PLFX PLSTR SIL SLF XPD RADOPQ DLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570110|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ARWY 30MM 9MM 14MM PLFX PLSTR SIL SLF XPD RADOPQ DLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570160|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ARWY 40MM 10MM 16MM PLFX PLSTR SIL SLF XPD RADOPQ DLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83970-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 3MM 150CM 80MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2260|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT REPAIR BICEPS DISTAL|1|HUMANA [1294]||HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6211|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 10.7X9.3CM 275ML STY 6200 TXTR SRFC CENTERSCOPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-T2314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 14MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-T2318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 18MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-T2320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 20MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-T2324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 24MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-T2326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 26MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 68X14MM TI 3.5MM SCR 9 HL BN 11MM CLVCL RT DIST SUP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE ANTERIOR LATERAL 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE ANTERIOR MEDIAL 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6468|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 12MM X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6471|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL PROXIMAL RELEASE NON COVERED 14MM X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 75X11MM TI 6 HL BN CLVCL LAT ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0684-00-0431-01|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON INTRA-AORTIC 8FR X 40CC FIDELITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 101X11MM TI 2.3MM SCR 16 HL LCK LOPRFL BN CLVCL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 101X11MM TI 2.3MM SCR 16 HL LCK LOPRFL BN CLVCL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,138.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,138.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 101X11MM TI 2.3MM SCR 16 HL LCK LOPRFL BN CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 68X11MM TI 2.3MM SCR 13 HL LCK LOPRFL BN CLVCL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 68X11MM TI 2.3MM SCR 13 HL LCK LOPRFL BN CLVCL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0286|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 88X11MM TI 8 HL LCK MIDSHAFT LOPRFL BN CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,886.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,886.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0287|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 88X11MM TI 8 HL MIDSHAFT LOPRFL BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0288|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG 98X11MM TI 8 HL LCK MIDSHAFT LOPRFL BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,262.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0289|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG 98X11MM TI 8 HL MIDSHAFT LOPRFL BN CLVCL RT SUP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED 94X11MM TI 8 HL LCK MIDSHAFT LOPRFL BN CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0292|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 87X11MM TI 8 HL LCK MIDSHAFT LOPRFL BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0292|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOW PROFILE SMALL LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0293|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 87X11MM TI 8 HL LCK MIDSHAFT LOPRFL BN CLVCL RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0296|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 74X10MM TI 6 HL LCK MIDSHAFT NAR PRFL BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0297|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 74X10MM TI 6 HL LCK MIDSHAFT NAR PRFL BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0298|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 87X10MM TI 8 HL LCK MIDSHAFT NAR PRFL BN CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0299|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 87X10MM TI 8 HL LCK MIDSHAFT NAR PRFL BN CLVCL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,262.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG 96X10MM TI 8 HL LCK MIDSHAFT NAR PRFL BN CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG 96X10MM TI 8 HL LCK MIDSHAFT NAR PRFL BN CLVCL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM TI CANC HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM TI CANC HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM TI CANC HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 35.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 40.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 50.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 28.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1896-5037S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 37MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1896-5042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3425-0340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 10 X 340MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3060-0090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 90MM GAMMA3 TI HIP TROCH LG STRL NL 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400-257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS MEDIUM LEFT SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BEARING TIBIAL 7MM STAR SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 48MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-G-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 13MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 132MM TI 6 HL VARIAX BN HUM LT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 156MM TI 8 HL VARIAX BN HUM LT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 109MM TI 4 HL VARIAX BN HUM RT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629288|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 143MM TI 8 HL XTD VARIAX BN HUM DIST MDL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,236.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,236.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 105MM TI 4 HL VARIAX BN HUM LT P/L NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 128MM TI 6 HL VARIAX BN HUM LT P/L NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL POSTERIOR 8 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 104MM TI 4 SHFT HL VARIAX BN RT POST MDL ELB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 128MM TI 6 SHFT HL VARIAX BN RT POST MDL ELB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 151MM TI 8 SHFT HL VARIAX BN RT POST MDL ELB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 89MM TI 4 HL VARIAX BN OLCRN LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 113MM TI 6 HL VARIAX BN OLCRN LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629348|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137MM TI 8 HL VARIAX BN OLCRN LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629364|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 89MM TI 4 HL VARIAX BN OLCRN RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629366|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 113MM TI 6 HL VARIAX BN OLCRN RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629368|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137MM TI 8 HL VARIAX BN OLCRN RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 8MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 20MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 24MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 32MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|768.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|768.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 34MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 36MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 38MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 40MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 42MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 44MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 46MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 48MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 55MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 60MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 65MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|636.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 70MM T10 LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 8MM VARIAX TI ELB ST LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM VARIAX TI ELB LCK ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 14MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 16MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 18MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 20MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 24MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 28MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|506.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|506.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 36MM VARIAX TI ELB LCK ST CLR CD NS PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM VARIAX TI ELB LCK ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 50MM TI T10 ELB ST LCK NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM VARIAX SS ELB ST LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM VARIAX TI ELB LCK ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 22MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM VARIAX TI ELB ST LCK NS PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 8MM VARIAX TI ELB ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|261.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM VARIAX TI ELB ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM VARIAX TI ELB ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|441.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 16MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 18MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|441.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 20MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|441.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|441.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 24MM VARIAX TI ELB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 26MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM VARIAX TI ELB ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 30MM VARIAX TI ELB ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 32MM VARIAX TI ELB ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 34MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 36MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 38MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 40MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 42MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 44MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 46MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|261.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 48MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 50MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 55MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 60MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|261.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614765|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 65MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|261.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 70MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 8MM VARIAX TI ELB LCK ST PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 10MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 12MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 14MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 16MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 36MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA-4600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 60.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 132MM TI 6 HL VARIAX BN HUM RT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 156MM TI 8 HL VARIAX BN HUM RT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,236.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,236.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629384|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 92MM TI 4 HL VARIAX BN HUM DIST MDL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629386|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116MM TI 6 HL VARIAX BN HUM DIST MDL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629388|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 139MM TI 8 HL VARIAX BN HUM DIST MDL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629286|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 120MM TI 6 HL XTD VARIAX BN HUM DIST MDL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 18MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM VARIAX TI ELB ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM VARIAX TI ELB ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 28MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 32MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 34MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 38MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM VARIAX TI ELB ST LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614844|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 46MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614848|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 48MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV NAR 29X4.8X1MM MNDB 4 HL LOPRFL 2MM SCR MDLR FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|591.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 50MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 55MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 60MM TI T10 ELB ST NS VARIAX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|281.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|281.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 614870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM VARIAX TI ELB ST LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G18508|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT OCCLUDER AAA 24MM X 30MM FLEX|1|HUMANA [1294]||HUMANA [11839]|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48453|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 124MM 12MM 6MM 16FR ZNTH FLX Z-TRK 2 BRCH PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-1-30-125|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 30MM X 125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 15X9X.5MM 6MM SPC 2Y CRNFCL TI 2 HL SHFT 1 HL ARM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G53444|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL TAPERED WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 34 X 157|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9351604|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CAP SPNL 16MM T2 4D|1|HUMANA [1294]||HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9351623|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 15-19MM 16MM T2 XVBR CENTERPIECE TI COCR NTNL XPD|1|HUMANA [1294]||HUMANA [11839]|23,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX MODULAR ENDO HEAD 47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2MM MED 150MM VIT 2 CBL GRP DLMLS BN HIP TROCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,701.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,701.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 157210150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 10IN 15MM RDC NK SOL POR 12/14 LG STAT BW TPR 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M18-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT2-S20-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4-4.1MM 20MM ACTRK2 TI STD FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AD1-8.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0319|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE J 64X11MM TI 8 HL LCK TPR END LOPRFL BN 15MM CLVCL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10383-010|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SET 16FR WITH GUIDE WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDC-45802-XP1A|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH 8FR 18GA 20CM .032IN 2 LUM INDWELL CATH GW NDL PRSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE J 64X11MM TI 8 HL LCK TPR END LOPRFL BN 15MM CLVCL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 533520A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL LABRAL CONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50AO-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 32.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 34MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 36.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G53446|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL TAPERED WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 36 X 157|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 38MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 40MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2745|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 45.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 50MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 55MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 506-00-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL RSP DJO SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 415-00-120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG CEMENT CLEARCUT ENCORE #12|1|HUMANA [1294]||HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551L299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 9MM 29MM ASYM TRTHLN PE KN SUP INFR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5551L381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 11MM 38MM ASYM TRTHLN PE KN SUP INFR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-G-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 11MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 60MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-2765|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 65.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 34.OMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6286211|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X12MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6286011|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X10MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,026.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7080902|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSTNR IMPL SPNE PIN PLT HLD|1|HUMANA [1294]||HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM ATLNTS TI SPNE CRV ANT ST VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3120214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM ATLNTS TI SPNE CRV ANT ST FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6190042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 42.5MM TI LCK ATLNTS TRANSLATIONAL BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported E5617-22|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE SPHERE SILICONE 22|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 45MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-3650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 8MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 12MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 12MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 14MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4350|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERCEED ADHESIVE BARRIER 3 X 4|1|HUMANA [1294]||HUMANA [11839]|978.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|978.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 16MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 18MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 20MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 22MM TI CORT NONTOGGLE HEX NS SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-TOGGLING 2.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-N2326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-TOGGLING 2.3MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CO-T2310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 10MM TI FT CORT LCK HEX NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT50AO-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-2380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-2650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 104MM TI 4 SHFT HL VARIAX BN LT POST MDL ELB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,468.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,468.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-3650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7967216|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32X23X16MM CRSNT SVRGN 12D SM PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-2360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported COL-2600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 60MM TI CORT LCK HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COL-3060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|282.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 128MM TI 6 SHFT HL VARIAX BN LT POST MDL ELB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,209.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,209.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 151MM TI 8 SHFT HL VARIAX BN LT POST MDL ELB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,236.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,236.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AD1-8.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-9.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E5617-17|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE SPHERE SILICONE 18|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 10 X 360MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1825-1140S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 11MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,741.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,741.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5070S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 70MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5052S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 52.5MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 80MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5065S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 65MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1238S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 380MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 49MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 46MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 50MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 55MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 51MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX MODULAR ENDO HEAD 53mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 41MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-6-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING U PCA +10MM HIP FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-6-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING U PCA +0MM HIP FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|386.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-6-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING U PCA +5MM HIP FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-6-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING U PCA -4MM HIP FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PCS-430-10WW|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PYROSPHERE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 16MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G01290|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .035IN FX COR ATRM TIP X FLPY STD 6CM BNTSN SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5023-5-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 120MM 4MM APX SLF DRL 35MM HFMN 3 XTRNFX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5018-6-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 150MM 5MM HFMN 3 APX UPR RT SLF DRL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5050-5-300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 300MM 6MM 5MM APX HFMN2 TRNFX CNTR THRD 50MM XTRNFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|483.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1927BCF-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 2 FT CSCR FWR 2 BCMPS 14MM STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTP-002-SRN|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP NARROW RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL RIGHT HELIX 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7803113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE HELIX 4MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7804213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED HELIX 4MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7807110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION HELIX|1|HUMANA [1294]||HUMANA [11839]|684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22438-19|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 190CM .014IN LG CRTD GW RADOPQ 4-7MM 5-6FR SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1008191-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 135CM 30MM PERI RX LOPRFL FLXB KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2323BCC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL BIOCOMPOSITE 5.5 MM X 19.1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 826-211|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE DOUBLE|1|HUMANA [1294]||HUMANA [11839]|2,137.38|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,137.38|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5750008|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TRIAD CR 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN352002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 20MM FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|417.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-002-PMX|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ORTHO LINK 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR DIA-META LCP 5-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,906.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,906.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 10MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E110|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ICD DUAL CHAMBER TELIGEN IS-1/DF-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-2510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 2.5MM 139CM 10MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-2515|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 2.5MM 139CM 15MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.085|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +8.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 19MM +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6519-T-204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL V40 +4mm ADAPTER SLEEVE (Ti)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 19mm +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 19mmX155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39122-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE KINETIX 185CM J TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +20 19MM MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-40F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG INSERT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.458S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 380MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 086036|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH NPHSTM 36FR MLCT NTR RBR 4 WNG DRN STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 542-11-50E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 542-11-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 542-11-54F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 542-11-58G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0062251070|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URN TRACT 5.8FR 15FR 75CM 6CM HI-PRS KINK RST SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5436026|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 6 X 26|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5332800|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 7 X 28|1|HUMANA [1294]||HUMANA [11839]|540.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5069-051-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INJECTOR/ BONE CEMENT/ RESTRICTOR SET|1|HUMANA [1294]||HUMANA [11839]|53.44|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|53.44|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2625 25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC 25MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,585.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 50327-07|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH OXIMETRIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 48MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 54MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 44MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 46-4063|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRAME TI LC4 6CM|1|HUMANA [1294]||HUMANA [11839]|4,155.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,155.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 50-400|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GREENFIELD VENA CAVA FILTER-JUGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,196.95|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,196.95|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400.754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 4MM TI MXLFCL CORT SLF DRL STRDR MDLR FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 086040|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH NPHSTM 40FR MLCT NTR RBR 4 WNG DRN STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 212865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITEK MICRO ANCHOR 13MM #212865|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BFR1035KD-A|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TESIO CATHETER KIT BFR103KD-A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|915.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 014859|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CANUFLEX .062 X 12 #014859|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 6MM TI MXLFCL CORT SLF DRL STRDR MDLR FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5110-043-09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE MG-II LIPPED 9MM 5110-43-09|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,336.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,336.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.637|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL LOCKING RECONSTRUCTION WITH DOUBLE ANGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,071.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,071.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6300-07-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS POLY PAT SZ-2/7MM NATURAL-KNEEII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,762.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-686|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORDIS ULTRA THIN ALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00-5110-033-09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING TIBAL A/P LIPPED MGII YELLOW 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,156.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,156.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320808F|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|THROMBECTOMY CATH 8FR X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01350|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANKLE ARTICULATING EBI|1|HUMANA [1294]||HUMANA [11839]|3,960.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 05-0108|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT SUBTALAR 8MM MBA BRL ANKL TI|1|HUMANA [1294]||HUMANA [11839]|6,822.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,822.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-0110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MBA SUBTAYLOR|1|HUMANA [1294]||HUMANA [11839]|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-0112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MBA SUBTALAR 12MM|1|HUMANA [1294]||HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-0109|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MBA SUBTALAR 9MM|1|HUMANA [1294]||HUMANA [11839]|4,498.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,498.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-156|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DUAL LUMEN URETERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0684-00-0430-01|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON INTRA-AORTIC 8FR. 34CC FIDELITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-2050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DENVER SHUNT KIT #42-2050|1|HUMANA [1294]||HUMANA [11839]|5,190.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,190.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM STRUT CURVED MANDIBLE 39.2MM 8 HOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|867.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 450.862|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 50MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 450.867|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 75MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|544.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|544.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 450.871|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 6.0MM X 95MM FOR USE WITH DISTAL FEMORAL NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 24-0052|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE TUBE ARMSTRONG|1|HUMANA [1294]||HUMANA [11839]|45.27|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|45.27|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6949|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD CARDIOVERTER-DEFIBRILLATOR ENDO-CARDIAL SINGLE COIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465011|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ SUPER STIFF 46-501|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 68252|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUTOGEN TUTOPLAST 5CM X 5CM 68257|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602900S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 100MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602905S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 105MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6332|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDPORE IMPLANT BLOCK 13 X 38 X 3|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 285112SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM SURFIX TI STD MTP LCK CLR CD HALLU-LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285114SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM SURFIX TI STD MTP LCK CLR CD HALLU-LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285116SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM SURFIX TI STD MTP LCK CLR CD HALLU-LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285118SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM SURFIX TI STD MTP LCK CLR CD HALLU-LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 6L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74012905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIT DRL 125MM 1/8MM JOURNEY BCS QCK CNCT PIN BI CRUCIATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|343.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|343.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74012904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN TROCAR QUICK CONNECT 1/8" X 3"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CMT TIB SIZE 5 {} LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZMA00UO-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER TECNIS MULTIFOCAL POSTERIOR CH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IRTH068080A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 6MM PROPATEN THNWL GRTX HEP INTGR RING 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570620|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFELX BILIARY UNCOVERED 8MM X 80MM 8.0FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FRACTURE,4-HOLE,35MM,45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCS-010-25-12L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD LONG 2.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-25-14L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD LONG 2.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-38-16S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD SHORT 3.8 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|708.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-48C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG X3 INSERT 32mm ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6190040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 40MM TI LCK ATLNTS TRANSLATIONAL BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,215.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9672|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FRACTURE,4-HOLE,40MM,45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 285122SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM SURFIX TI STD MTP LCK CLR CD HALLU-LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|815.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|815.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 290155SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 10D 2 S 50MM LCK HALLU BN MTP RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,929.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,929.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 660001621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,16X148ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121731058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 58MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 660001721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,17X153ST,LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1927PSF-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOCORKSCREW PEEK 4.5MM WITH #2 FW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1934BCF-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURETAK BIO-COMPOSITE 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|915.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5520B100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 1 KN CMNT PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515F102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 1 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6600-015-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,15X145ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P101010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOLOGIC COLLAGEN DERMAL PORCINE PERMACOL 10CM X 10C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,915.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,915.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P151015|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOLOGIC COLLAGEN DERMAL PORCINE PERMACOL 10CM X 15C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,733.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,733.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P151020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOLOGIC COLLAGEN DERMAL PORCINE PERMACOL 10CM X 20C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P151520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOLOGIC COLLAGEN DERMAL PORCINE PERMACOL 15CM X 20C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P151828|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOLOGIC COLLAGEN DERMAL PORCINE PERMACOL 18CM X 28C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,054.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|37,054.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 660001722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM,FEM,POROUS,17X153ST,RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 85900P|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EAGLE EYE PLATINUM IVUS 5FR 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8185J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 185CM .014IN JTP PRIMEWIRE PSTG SLYDX PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-H240L-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL LEFT 24.0MM DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.633|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANG 214X44X2.4MM MNDB RT 6 HLE/HD 23 HL SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,327.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,327.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TR-S0700-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 7.0MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LE013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON LOCKING 13 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501254 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 8.3CM MEMORYGEL P3.5CM RND HI PRFL SIL GEL SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 10MM X 360MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5047S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 47.5MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.632S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 14MM X 130DEG X 320MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE GTR LONG W/CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,862.29|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,862.29|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71423257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 7R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB LEGION 6 KN RT CMNT M TPR TI NPOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 94X10.7X3.5MM TMX 3.5MM SCR 11 HL ANTM LCK ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL MEDIAL 88MM RIGHT 9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE GTR SHORT W/CABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8161-35-018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1562BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR BCMPS 15MM 6.25MM ACL TENODESIS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7575550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW II SEXTANT 5.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,612.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8692035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SEXTANT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,216.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR TI LOPRFL LCK SHFT FX ANG SCR HL KWR HL ACLC BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.75MM X 30MM PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941-6|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 6IN .062IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941-7|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 7IN .062IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7967212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32X23X12MM CRSNT SVRGN 12D SM PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BG102-350|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAERVELDT GLAUCOMA IMPLANT BG 102-350|1|HUMANA [1294]||HUMANA [11839]|2,541.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,541.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2076-4020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 137CM 20MM FMPLT ART OTW RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2076-5020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OTW ANGIOSCULPT PTA 5.0 X 20MM X 137CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2076-6020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OTW ANGIOSCULPT PTA 6.0 X 20MM X 137CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-2010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 2MM 139CM 10MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-2015|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOSCULPT EX US PTCA 2.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-3010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 3MM 139CM 10MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-3015|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 3MM 139CM 15MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-3510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 3.5MM 139CM 10MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2034-3515|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LNG 3.5MM 139CM 15MM RADOPQ NTNL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5873C|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CHANGE LEAD & BATTERY 5873C|1|HUMANA [1294]||HUMANA [11839]|132.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|132.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 518-034|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS .018" GUIDEWIRE 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.740S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 300MM FEM XPRT IM FLUT CNN ANTGRD RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N119|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR COGNIS HE IS-1/DF-1/IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|71,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|71,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36126|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRAHEPATIC HASKAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.540S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 300MM FEM XPRT IM FLUT CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 60MM 12.5MM XPRT SPRL FEM TI CNN RTRGD FRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 130MM 12MM TRB MTL TIV SHLDR STRL RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434901500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT GLND 15MM SHLDR TRB MTL RVRS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434903611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHR GLND 36MM SHLDR TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434903606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR 36MM 7D +6MM OFST STD HUM TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75444545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 45MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 8MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104223048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 48MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|337.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 340MM FEM LT GAMMA3 IM 125D LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SCN352432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 24MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN405032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 50MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 20MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.092|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 22MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.094|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 24MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.096|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 26MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.098|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 28MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-058-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 58 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.210.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 30MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD BND 118MM SS FSN LCP BN WRST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,284.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,284.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12116-01J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE EXCHANGE CHOICE FLOPPY .014 X 300 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 112MM SS FSN LCP BN WRST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,284.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,284.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 10MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 12MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.084|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 14MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.086|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 16MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.088|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 18MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 14MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-060-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 60 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.200.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 16MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 18MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 20MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 22MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 24MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 26MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-112-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 12MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 12MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-062-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 62 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9192507|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X10X7MM VRTSTCK CRSNT 6D LRDTC STRG BLT NOSE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.200.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 28MM SS T15 FT CORT ST LOPRFL STRDR NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|80.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|80.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 9MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 56 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 11MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 12MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 13MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 15MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD SHORT 2.4 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 17MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 18MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.219|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 19MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 22MM 4MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-050-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 50 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 24MM 5MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 25MM 5MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 26MM 5MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.227|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 27MM 6MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 28MM 6MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.229|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 29MM 6MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 34MM 8MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 36MM 9MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 38MM 9MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 40MM 10MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902604101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 17MM 6MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.319|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 19MM 7MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 20MM 7MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.323|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 23MM 8MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 25MM 8MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.327|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 27MM 10MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.329|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 29MM 10MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 32MM 12MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 34MM 14MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 36MM 14MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-043-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.226.338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 38MM 16MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 40MM 16MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 32MM 7MM SS T8 ST FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.321|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 2MM 21MM 8MM SS T8 L/T FLUT CMPR CNN ST HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,121.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-047-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6519-T-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE ADAPTER TAPER V40 UNIVERSAL OFFSET -2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6519-1-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM UNV TPR 32MM HIP BLX D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3065USC|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TEST STIMULATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83965-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX SV CATHETER 2MM X 100MM X 150CM .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83974-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 4MM 150CM 100MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-051-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30571SC|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD TEST STIMULATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCP-N2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN COMPRESSION 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCP-SGW045|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE .045|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 130MM 14MM TRB MTL TIV SHLDR STRL RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PFX-426|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIP FIX SYSTEM MNL INSTRUCTIONAL FCS SRG|1|HUMANA [1294]||HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-053-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129433125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB LCS CMPT MBT SGM 2.5 KN CMNT ROT PLAT KEEL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401545M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 5FR 25MM 45CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGT3420|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS GRAFT ANEURYSM THORACIC 34MM X 20CM|1|HUMANA [1294]||HUMANA [11839]|37,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SDV2228|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRY SHEATH GORE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.0 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-055-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54840006040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5440020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET SOLERA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475001050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 100015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CANCELLOUS CHIPS 15CC|1|HUMANA [1294]||HUMANA [11839]|1,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-6-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX V40 TAPER SLEEVE +8mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 90MM 32MM SS P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-085|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS EXTREME .014" GUIDEWIRE 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-057-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 518-081|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER QUICKCROSS EXTREME .035" GUIDEWIRE 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4365022L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4FR 5MM 120CM 220MM PERI OTW LOPRFL COAX RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4364022L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 120CM 220MM FMPLT INFRAPOPLITEAL OTW LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 10MM WITH PLUS D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|202.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|202.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.294|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.0MM SELF TAPPING 8MM WITH PLUS DRIVE RECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|385.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9122-2030-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ARTICULAR HEMI 12MM 2.0MM X 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRRT08070080L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX RINGED TW 8MM X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,083.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,083.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5512-F-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 35MM BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 130MM 10MM TRB MTL TIV SHLDR STRL RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.013.840S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 300MM FEM NLEX IM CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.852S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 360MM FEM NLEX IM CNN RTRGD ANTGRD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.048S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 80MM 12.5MM NLEX SPRL FEM TI CNN FRN CUT END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.052S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 100MM 12.5MM XPRT SPRL FEM TI CNN FRN CUT END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.628S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 4.8MM 38MM TI T25 FT FEM LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.680S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 8MM 90MM NLEX TI FT FEM TIB T25 STRDR RCS LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.636S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 8MM 46MM NLEX TI FT FEM TIB T25 STRDR RCS LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501754 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 9.3CM MEMORYGEL CHSV I P3.9CM RND HI PRFL NAR BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PPLUS120|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PIONEER PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 11MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 157208180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 8IN 18MM RDC NK SOL POR 12/14 LG STAT BW TPR 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 28MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 38MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-025-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HUMERAL SMALL 6INCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,172.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,172.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 370120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 20MM AXSOS SS T20 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|542.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 38MM OMEGA3 SS FT HEX CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3130-1180S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 180MM TROCH GAMMA3 IM 130D KT TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,123.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,123.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-116-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 16MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-052-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 23MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5740106|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CC TRIAD 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5740107|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CC TRIAD 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5332400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 7.0 X 24|1|HUMANA [1294]||HUMANA [11839]|540.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7800236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27220E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27218E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27212E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM VARIAX TI T7 FT NS DIST RDS LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 427140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 191MM SS 5MM SCR BSC FRAG 10 HL LCK CMPR AXSOS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|673.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 86MM SS 3.5/4MM SCR 3X7X 1 HL LCK AXSOS BN HUM LT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM SS T15 ST LCK SCRDRVR NS AXSOS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00118115003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,3 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 371536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 54MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-501|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GREENFIELD VENA CAVA FILTER-FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,196.95|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,196.95|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00222900200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, BARBED, 3/4IN|1|HUMANA [1294]||HUMANA [11839]|134.49|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|134.49|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00222900300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, BARBED, 7/8IN|1|HUMANA [1294]||HUMANA [11839]|134.49|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|134.49|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00222900400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, BARBED, 1IN|1|HUMANA [1294]||HUMANA [11839]|134.49|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|134.49|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6327|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDPORE IMPLANT ROUND 18MM|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7207876|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FAST FIX STRAIGHT NEEDLE ASSEMBLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|816.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72201491|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FAST FIX CVD NEEDLE ASSEMBLY 7207877|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6625-LP 33MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 33MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 15MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6320-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 56 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00631005028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,POLYETHYLENE,ELEVATED,RI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00631006028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER,POLYETHYLENE,ELEVATED,RI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6326|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDPORE IMPLANT ROUND 16MM-DO NOT STOCK|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL LOCKING RECONSTRUCTION ANGLED 45MM X 189|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,327.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,327.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 254602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTRAFIX 6MM - 8MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|702.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00625006535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,H/G-II,6.5X35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 254609|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTRAFIX 7MM - 9MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|669.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 294.778|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SCHANZ 4.0MM X 150MM 40MM THREADED SELF DRILLING STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|529.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 430102|SUP|HCPCS C1765||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEPRAFILM MEMBRANE 5 X 6|1|HUMANA [1294]||HUMANA [11839]|957.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|957.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 254601|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRAFIX TIBIAL SHEATH|1|HUMANA [1294]||HUMANA [11839]|726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0066201020|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE,STIFF-BODIED,.038X15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-1253|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP,ANEURSYM|1|HUMANA [1294]||HUMANA [11839]|663.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|663.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6625-LP 29MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 29MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6625-LP 31MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL 31MM CARPENTIER-EDWARDS|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2700 21MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MAGNA AORTIC PERICARDIAL #21|1|HUMANA [1294]||HUMANA [11839]|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported E5617-20|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE SPHERE SILICONE 20|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1110-14ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,209.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,209.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL SHORT LOCKING RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,170.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 115070ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 70MM KRSH SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR3506|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 ANGLED 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 826100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CODMAN SHUNT ACCUFLO 14MM 82-6100|1|HUMANA [1294]||HUMANA [11839]|1,868.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,868.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.690|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 3.0MM X 8MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.692|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 3.0MM X 12MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-145-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,8 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,402.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 826101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM,SHUNT,ACCUFLO,24MM|1|HUMANA [1294]||HUMANA [11839]|1,942.38|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,942.38|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 823834|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CODMAN VALVE PROGRAMABLE SHUNT82-3834|1|HUMANA [1294]||HUMANA [11839]|15,429.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,429.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0123810|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX-"EX" 8" X 10"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7014-1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,SCHURRING,OSSICLE,CUP,6.0|1|HUMANA [1294]||HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-56221|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,PISTON,TEF-PLATINUM|1|HUMANA [1294]||HUMANA [11839]|513.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 241.623|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL SHORT LOCKING LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,170.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.3MM UNIVERSAL ORBITAL FLOOR 50MM X 50M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 1.3MM TI ORBITAL MESH 0.3MM THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,899.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,899.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.691|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 3.0MM X 10MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.693|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 3.0MM X 14MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.694|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 3.0MM X 16MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.695|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 3.0MM X 18MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0066401051|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ J TIP .035 640-105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0061802310|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7FR 22CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0061802340|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7FR 28CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0062251060|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URN TRACT 5.8FR 12FR 75CM 6CM HI-PRS KINK RST SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 22225MJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE EXTRA SPORT 190CM #22225MJS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00801802801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -3.5MM 12/14 TPR 28MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,733.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0061802320|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CONTOUR 7 X 24 #180-232-01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484001800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00483503001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 30MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 28MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484003501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 35MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484002000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 20MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47223703700|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SMOOTH ZIMMER #47-2237-37|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00801803201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -3.5MM 12/14 TPR 32MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,733.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00801802802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 0MM 12/14 TPR 28MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00625006520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,H/G-II,6.5X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484004001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 40MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484004501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 45MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00801803202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 0MM 12/14 TPR 32MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6984M|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACEMAKER ATRIAL LEAD EXTENDER 6984|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 320806F|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|THROMBECTOMY CATH ,6FR.X80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR STRG 42X4.8X1MM MNDB 6 HL LOPRFL 2MM SCR MDLR FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0123790|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH COMPOSIX-"EX" 7" X 9"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400.755E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-DRLG 1.5MM W/STARDRIVE (TM) RECESS 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.938E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.934|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 4MM TI MNDB CORT ST CRS PTCH CRFRM NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|142.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 900.723|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 230MM 2.5MM LCP DHHS SPD THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 449.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 30X5X1.25MM MNDB 4 HL LOPRFL 2MM SCR MDLR FX SYS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42866|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE STRATA II MEDTRONIC 42866|1|HUMANA [1294]||HUMANA [11839]|16,257.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,257.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 254514|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRAFIX GUIDEWIRE 1.1 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1110-18ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTRAFIX 8MM - 10MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|669.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.672|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.4MM X 12MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,282.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2465358|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND,CPC,FLORIO,5/16,LONG|1|HUMANA [1294]||HUMANA [11839]|122.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|122.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10060|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIO PRO NON POROUS TOE IMPLANT|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200344|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH SPACING QUADPOLAR 6FR 125CM #200344|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00225500800|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HUMERAL MDN BULLET #2255-26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 23MEC-102|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ST. JUDE 23MM|1|HUMANA [1294]||HUMANA [11839]|12,510.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,510.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.310E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.314E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 21MM 2Y CRNFCL TI 6 HL 1.5MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4555-010-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,FE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4555-020-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,FE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4555-030-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,FE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.668|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.4MM X 8MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|256.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-044-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-046-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-048-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-050-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MC35|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035" X 70CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VBD240T|SUP|HCPCS C1727||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR BALLOON GSA 240CC C1727|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8600-0500|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY ALLOMATRIX 5CC.-REPLACED|1|HUMANA [1294]||HUMANA [11839]|2,625.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-042-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-052-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0061802330|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7FR 26CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-4555-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-4555-020-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-4555-030-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-140-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-145-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,10HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 074112|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SAFTEY GUIDEWIRE #074112|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 497.670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI 2.4MM X 10MM F/(LOCKING RECONSTRUCTION PLATE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|256.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|256.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6021-0335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00118114503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,3 HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1110-12ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 786101004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS SIZE 10 X 115MM ENHANCED TAPER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4965-50|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER LEAD EPICARDIAL LV\RV 4965-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,482.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 254202|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING SHOT CROSS PIN 6.5 X 50|1|HUMANA [1294]||HUMANA [11839]|780.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 905556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE LACTOSCREW 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00490004051|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER ZIMMER SMALL 2344-07|1|HUMANA [1294]||HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 68019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FASCIA LATA 6 X 12CM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-060-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 459.52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 52MM 4.9MM 8MM HEX TROCH FEM TIB DIST PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|570.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 625-0T-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT ALUMINA 0-DEGREE 36MM SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400.623E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAP 1.3MMX3MM W/FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|183.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.306E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.626E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAP 1.3MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|250.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 625-0T-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT ALUMINA 0-DEGREE 32MM SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-056-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BXS4218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE IMPACT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 140058|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS TORP SHEA PLASTI-140058|1|HUMANA [1294]||HUMANA [11839]|625.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|625.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01-9650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FRACTURE,8-HOLE,60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|687.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|687.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-062-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BXS4216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR DUET SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|630.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.303S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 90MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-140-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,10HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,641.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-140-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,14HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-145-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,14HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,009.97|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported E5381-722|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,SCLERAL BUCKLING,276 S|1|HUMANA [1294]||HUMANA [11839]|48.96|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|48.96|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-060-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-054-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-040-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9026-038-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,ENDO,UNIPOLAR,FEMORAL HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,033.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4555-040-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,MOORE,MODULAR,HIP,STEM,FE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,230.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-052-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-048-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,605.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,605.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-058-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7260-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACET MONOBLOCK 10-DEG 28MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6020-0335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1181-015-37|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 15.8MM THREAD 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|744.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-040-09D|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K WIRE TROCAR DOUBLE .035|1|HUMANA [1294]||HUMANA [11839]|42.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR-1G|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING MR-1G|1|HUMANA [1294]||HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR-6D|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING MR-6D|1|HUMANA [1294]||HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9192509|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X10X9MM VRTSTCK CRSNT 6D LRDTC STRG BLT NOSE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 8MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7510400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN 2X1IN 20GA INFS MED RHBMP-2 BVN CLGN VL ABS SYR NDL|1|HUMANA [1294]||HUMANA [11839]|15,435.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,435.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1896-4025S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 25MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4024S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE REVOLUTION HELIX 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5740108|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CC TRIAD 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-PTACK|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TACK FX PIN PLT|1|HUMANA [1294]||HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN PTLFEM LT CMNT PRECT GNDR SOL NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 24MM 8MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 039224|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL SOF-FLEX 12FR X 24CM 4-6 WKS CUSTOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|417.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2839-05-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINAL CEMENT CONFIDENCE SYSTEM 5CC KIT|1|HUMANA [1294]||HUMANA [11839]|7,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 34MM 11.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ASK-45703-PSE|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH CENTRAL VENOUS TRIPLE LUMEN 7FR X 8" PRESSURE INJECTABLE CUSTOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S16-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK STANDARD 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111328SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 36MM 11.9MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111330SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-6545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 50MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111460SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 60MM QWIX LWR XTRMT FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111785SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QWIX 7.5MM X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,376.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,376.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1802.49.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG HEAD SMALL CANN CANCELLOUS 4MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101214005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 95MM TRLK BPS GRIPTION 0 HI OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,589.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,589.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 529061ND|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 250MM 2.5MM KRSH SS S/B END|1|HUMANA [1294]||HUMANA [11839]|177.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115516ND|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 200MM 1.6MM KRSH SS S/B END|1|HUMANA [1294]||HUMANA [11839]|100.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|100.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET TI SPNE CLSR TOP HLCL FLNG HEX HD SQ 5.5 MM ROD|1|HUMANA [1294]||HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.301.010S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATOR EXTERNAL LARGE ANKLE FRAME KIT STERILE|1|HUMANA [1294]||HUMANA [11839]|11,449.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,449.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.301.011S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATOR EXTERNAL LARGE TRAUMA KIT STERILE|1|HUMANA [1294]||HUMANA [11839]|11,880.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,880.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39286-65|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.454S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 340MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S28-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK STANDARD 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-M30-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATK2 MINI 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S34-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK STANDARD 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEL6L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FA-CO3536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TAP LOCK 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GKP-3302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 3.3MM 0 POPLOK HI-FI SCR FX VRSTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,032.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.393S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 320MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 76MM SS 3.5MM SCR 4 HL LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH080502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS VIABAHN 8MM X 5CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164206062|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE TROCAR DOUBLE .062 X 6INCH|1|HUMANA [1294]||HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 7L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB LEGION 6 KN LT CMNT M TPR TI NPOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL +4MM NTRL 58MM 40MM ALTRX LD HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 E-F 74X46X10MM KN UHMWPE CMNT LPS NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9193009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30X10X9MM VRTSTCK CRSNT 6D LRDTC STRG BLT NOSE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958724PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM VRTX MX TI P/T SPNE MA NS GRN RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM COCR 2.2MM TIB DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8240-74-001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION MEDFOOT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 824074003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG CNTR 37X27X2MM TMX 3.5MM SCR FSN LOPRFL ALPS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 824076101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TMX 3.5 MM SCR CLMN FSN ALPS BN RT MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180249042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM TMX P/T CANC CNN SM HD LG SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS SKN STPLR STPL REM STRL DERMACLOSE DISP|1|HUMANA [1294]||HUMANA [11839]|2,667.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,667.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551-G-320-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYMMETRIC X3 PATELLA 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-00-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET HUMERAL RSP DJO SZ 36MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-36-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD GLND 36MM RSP -4MM OFST RTN SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 380MM FEM LT GAMMA3 IM 125D LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8456540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8456545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8457535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 7.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8457540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 40MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8458535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 8.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8458540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 8.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8450245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS 45-60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8461100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 100MM ARMADA TI SPNE LCK OPN TULIP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GM1812|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE GOLD SMALL VESSEL 45 ANGLE 180CM .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.655E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI EMERGENCY 1.7MM 5MM W/FLUTED-TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|157.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 506-02-124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE NON-LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6459|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL ULTRAFLEX UNCOVERED DISTAL RELEASE 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,437.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,437.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6467|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL ULTRAFLEX UNCOVERED PROXIMAL RELEASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,437.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,437.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0200-18|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE FEEDING JEJUNAL MIC 18FR 28CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MS-LTT35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TAP BONE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|201.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|201.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FA-CO3560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM TI LCK TAP NS ELB PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FA-CO3550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM TI LCK TAP NS ELB PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEM8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 88MM TI 8 HL LCK BN ELB MDL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEL10L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100MM TI 10 HL LCK BN ELB L/L NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,760.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,760.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-44-015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP CTA DUOFIX GLOBAL 44MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-1040|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDESHEATH 4 FR 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSC02|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 90CM 7FR PN DSTN T-B STRG SS PTFE NYL HDRPH RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10732302|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLUSH 4 FR 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10732801|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LEVIN 4 FR 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107341015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO JB 1 CRV 5FR 65CM 3CM CRBRL RADOPQ SLCT ULT TRQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95MM SS 3.5/4MM SCR 2X5X 1 HL AXSOS BN TIB LT PROX LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 75MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 36MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 65MM AXSOS SS FEM HUM TIB ST LCK T15 STRDR RCS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 55MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 22MM SS L/T RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 26MM SS L/T RVRS CUT FLUT CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EUSCFS-070026-14-13|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOURETEROTOMY 7FR #007726|1|HUMANA [1294]||HUMANA [11839]|378.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|378.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434903603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+3MM 36MM 7D STD HUM TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 16MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 16MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 17MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4018|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 18MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4019|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 19MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 20MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4021|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 21MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 17MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3018|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 18MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3019|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 19MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 20MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3021|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 21MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 22MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3023|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 23MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3024|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 24MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11000-3025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 25MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3026|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCK JONES 3.0MM X 26MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4023|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DCT STD JNS 23MM 4MM FRST SUT HL|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4024|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 24MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 25MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4026|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 26MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5357M/S|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER DUAL VERITY ADX XLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,622.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,622.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-4022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TEAR DUCT JONES 4.0MM X 22MM FROSTED (WITH SUTURE HOLE)|1|HUMANA [1294]||HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-109-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 9MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4302-046-19|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 19MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SAX01D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AXBIFEM STRETCH FULLY RINGED 8MM X 70CM X 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM SS CORT 2 LD THRD ST SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166201P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 40CM 20MM 10MM THOR WVN SMTH NDL PSG SUT RTNT CNTRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,600.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,600.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 28MM SS L/T RVRS CUT FLUT CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 36MM SS L/T RVRS CUT FLUT CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 77MM SS 2.7/3.5MM SCR 3 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,993.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,993.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486503000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 30MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 77MM SS 2.7/3.5MM SCR 3 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,993.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,993.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 90MM SS 2.7/3.5MM SCR 4 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,025.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 90MM SS 2.7/3.5MM SCR 4 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,025.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 103MM SS 2.7/3.5MM SCR 5 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,053.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,053.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 103MM SS 2.7/3.5MM SCR 5 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,053.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,053.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 116MM SS 2.7/3.5MM SCR 6 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,085.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 129MM SS 2.7/3.5MM SCR 7 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 129MM SS 2.7/3.5MM SCR 7 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.81|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.81|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 155MM SS 2.7/3.5MM SCR 9 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.88|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,144.88|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 181MM SS 2.7/3.5MM SCR 11 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,176.98|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,176.98|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486503500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 35MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 181MM SS 2.7/3.5MM SCR 11 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,176.98|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,176.98|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 155MM SS 2.7/3.5MM SCR 9 HL LCP CMBN BN FIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.88|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,144.88|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.112.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 116MM SS 2.7/3.5MM SCR 6 HL LCP CMBN BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,085.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486504000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 40MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3505-6540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486504500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 45MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1297L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 50CM 2.4MM ACL SUT EYE PCL REPR STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 329.922|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BNDRG 2.4 MM LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B-2365|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM BANDING GASTRIC ADJUSTABLE LAP BAND PORT RAPID LARGE|1|HUMANA [1294]||HUMANA [11839]|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B-2360|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM BANDING GASTRIC ADJUSTABLE LAP BAND PORT RAPID STANDA|1|HUMANA [1294]||HUMANA [11839]|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 238.708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 220X13.5X3.7MM SS 3.5MM SCR 12 HL WO TAB RND EDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,939.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,939.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.709|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 220X13.5X3.7MM SS 3.5MM SCR 12 HL WO TAB RND EDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 238.710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL RIGHT 14-HOLE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,329.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,329.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 283.711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL DISTAL MEDIAL LEFT 14-HOLE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,939.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,939.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486505000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3313045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 45MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32MM +10MM FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0936S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 9MM X 360MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-0360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 11 X 360MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486505500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 55MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 506-02-122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE NON-LOCKING 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.652S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 360MM FEM XPRT IM FLUT CNN ANTGRD RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR LOCK SZ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING LOCK ACETABULAR LINER CONTRAINED SZ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6307-00-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS NP STM TIB B/P LT SZ4 NATURAL-KNEEII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5424-013-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PROLONG POLY CROSSLINKED FLEX NATURAL KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 1 KN PTLFEM LT CMNT PRECT GNDR SOL NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DORC 92-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STRIP RTNL 4MM SIL STY 42 STRL|1|HUMANA [1294]||HUMANA [11839]|42.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported J-SLH-4S|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE 4-LAYER SURGISIS BIODESIGN 4CM X 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,361.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,361.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486506000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-114642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM SHLDR RSRFC CPLND HA 2 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408314|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT INTRODUCER 8.5 AGILIS NXT 91CM BRK TRANSEPTAL NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VN1006200|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS BILIARY VIABIL GOR 10MM C 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9351639|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 31-44MM 16MM T2 XVBR CENTERPIECE TI COCR NTNL XPD|1|HUMANA [1294]||HUMANA [11839]|23,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9351600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CAP SPNL 16MM 0D|1|HUMANA [1294]||HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76446555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,803.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7640020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIB 115MM 15MM GMRS FLUT KN PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIB 115MM 17MM GMRS FLUT KN PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64813220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB THK20MM S1 S2 PROX MDLR ROT HNG GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 28MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 76446550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY 6.5 X 55MM FOR 6.35 INCH ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,803.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,803.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-113-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 13MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 630|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS OSSICULAR ADJUSTABLE LENGTH HA LITE TITANIUM 3.00|1|HUMANA [1294]||HUMANA [11839]|1,041.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,041.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 30MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 750-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS MYRINGOTOMY PARTIAL FRISBEE 3.00MM X 1.17MM X 1.0|1|HUMANA [1294]||HUMANA [11839]|849.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|849.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.3MM 12MM TI CRNMXF CORT ST CRS PTCH +DR AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|202.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|202.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-6550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 415-00-140|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RSTRC CMNT CL CT 14MM FEM HIP|1|HUMANA [1294]||HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-36-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD GLND 36MM RSP NTRL SHLDR RTN SCR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-00-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL RSP DJO SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT JOINT M-P TOE GREAT TITANIUM NON-PORPOUS SZ MEDIUM-L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,203.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850810|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X10X8MM CRNT 5D LG OBLQ PEEK-OPTM|1|HUMANA [1294]||HUMANA [11839]|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 32MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 509-02-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-56E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-3138-55|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION CONTACT 8 X 55CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,272.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,272.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186801028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,247.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186852014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186862014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONSTRAINED 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|917.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|917.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286850100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIX TEMPORARY|1|HUMANA [1294]||HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850811|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 30X10X8MM CRNT 5D LG OBLQ PEEK-OPTM|1|HUMANA [1294]||HUMANA [11839]|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 34MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR40E215|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +21.5 DIOP MOD C BCNVX 13MM 6MM PC FLD MFL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 36MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-13120T-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 14MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 18MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 10MM COCR CORT LCK ST SQ MLDIR ALPS HND FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164206035|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE TROCAR DOUBLE .035 X 6INCH|1|HUMANA [1294]||HUMANA [11839]|183.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484503801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 38MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484504001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 40MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CAB3.8-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 3.8MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MMSLED-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL MALLEOLAR SLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22-6050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR DOUBLE PLAY 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 20MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 42MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-13200M-05R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META OPEN RIGHT LOW PROFILE 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MMSLED-W|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SLED MEDIAL MALLEOLAR|1|HUMANA [1294]||HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6190025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRANSLATIONAL ATLANTIS 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,777.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,777.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM ATLNTS TI SPNE CRV ANT SLF DRL FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 44MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 560210|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PROCEDURE HTA HYDROTHERMAL ABLATION SINGLE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22-4036|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEEDLE FIRST PASS|1|HUMANA [1294]||HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 196MM SS 7 HL LCP BN FEM RT DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.257|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 276MM SS 11 HL LCP BN FEM LT DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.256|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 276MM SS 11 HL LCP BN FEM RT DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 196MM SS 7 HL LCP BN FEM LT DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02-205-275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 5.0MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|486.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|486.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 46MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 482151|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING PELVILACE TOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,629.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,629.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222.259|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LCP 13 HOLE 316MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 50MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.111.521|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 42MM SS 2.4MM SCR 6 HLE/HD 2 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 51MM SS 2.4MM SCR 6 HLE/HD 3 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.541|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 63MM SS 2.4MM SCR 6 HLE/HD 4 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 72MM SS 2.4MM SCR 6 HLE/HD 5 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 42MM SS 2.4MM SCR 6 HLE/HD 2 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 51MM SS 2.4MM SCR 6 HLE/HD 3 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 63MM SS 2.4MM SCR 6 HLE/HD 4 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 72MM SS 2.4MM SCR 6 HLE/HD 5 HL SHFT 2 CLMN VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 19MM 5MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 52MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.230.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 20MM 6MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|328.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|328.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|328.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|338.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 54MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.214.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC.090|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +9 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 23MM SS 1.5MM SCR MDLR MN FRAG SET 4 HL ST DRL GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|824.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|824.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 9MM 4MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 10MM 4MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 11MM 4MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 56MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.230.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 1.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|736.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|736.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 14MM 4MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 15MM 4MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 16MM 5MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 17MM 5MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 18MM 5MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36MM SS 1.5MM SCR MDLR MN FRAG SET 6 HL ST DRL GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|824.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|824.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 29MM SS 1.5MM SCR MDLR MN FRAG SET 6 HL ADP ST DRL GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,404.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,404.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 58MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.114.505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 59MM SS 1.5MM SCR MDLR MN FRAG SET 12 HL ADP ST DRL GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,404.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,404.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H SS 1.5MM SCR MDLR MN FRAG SET XTD ST DRL GD LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H SS 1.5MM SCR MDLR MN FRAG SET XTD ST DRL GD LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T SS 1.5MM SCR MDLR MN FRAG SET 3 HLE/HD 8 HL SHFT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,487.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,487.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T SS 1.5MM SCR MDLR MN FRAG SET 4 HLE/HD 8 HL SHFT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,487.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,487.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y SS 1.5MM SCR MDLR MN FRAG SET 3 HLE/HD 8 HL SHFT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 6MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 7MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 60MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.214.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 8MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 9MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 10MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 11MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 12MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 13MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 14MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 15MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 16MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 64MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.214.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 18MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 20MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 22MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 24MM SS T4 CORT ST STRDR NS HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM ALPS TI T15 TIB CORT PROX DIST LOPRFL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8163-27-024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484507001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 70MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8163-27-032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816327034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 34MM TMX T15 CORT LCK LOPRFL ST TIP TPR THRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8163-27-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 233532PTC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 32MM 3.5MM SSCR II P/T SS POLY L-LAC ACD SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.230.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 2.2MM 12MM 4MM SS T4 CMPR ST SLF DRL STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|852.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|852.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.214.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM SELF TAPPING WITH T4 STARDRIVE RECESS 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47418|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .018 DIAMETER X 5CM LENGTH 2MM MIC|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47419|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION TORNADO .018 DIAMETER X 6CM LENGTH 2MM MIC|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 48MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G47420|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 9CM 7-3MM TRND MLFRM SFT XSECT IDEALLY SUITED|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.205.275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED CONICAL 5.0MM X 75MM WITH 4.0MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-002-PL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LARGE PEANUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,932.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-002-PMLKG|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD PEANUT 2-SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTP-002-SLN|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP NARROW LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 11MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3525-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 400MM FEM LT GAMMA3 IM 125D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 65MM TI LCK ATL VS BN SPNE CRV ANT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ X3 INSERT 32mm ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9M52-1545-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ARTICULAR 15MM 4.5MM OFFSET RESURFACING HEMICAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4840-010-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 10MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|51.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 403110|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN EVANS CORT CNC WDG ALGRF FRZDR 22X22X10MM 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 403112|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN EVANS CORT CNC WDG ALGRF FRZDR 22X22X12MM 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125-1180S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 180MM HIP TROCH GAMMA3 IM 125D KT TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,479.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,479.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6851011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 30X10X10MM CRNT 5D LRDTC LG OBLQ PEEK-OPTM|1|HUMANA [1294]||HUMANA [11839]|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM TI T15 TIB CANC DIST LCK ST TPR THRD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7440240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PLUS GRADIENT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7460612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7460614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7461501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE ROUND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068903000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COAPTITE INJECTABLE BULKING AGENT 1ML|1|HUMANA [1294]||HUMANA [11839]|1,096.98|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,096.98|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 208.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 90MM 16MM SS P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7461500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 16MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 371324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING AXSOS 5.0MM L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 44MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 46MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 55MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 85MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371390|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 90MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3430-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 380MM FEM LT GAMMA3 IM 130D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3060-0105S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 105MM GAMMA3 TI HIP TROCH LG STRL NL 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT GAMMA 3S RIGHT 10 X 420MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 238MM SS 4.5/5/6.5MM SCR 10X5X 5 HL AXSOS BN FEM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING AXSOS 5.0MM L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 20MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6000138|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIMESH 10CM X 15CM 35 GRAMS|1|HUMANA [1294]||HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180249040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM TMX P/T SM HIP CANC RDC HD ST CNN LG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401890M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH BRITE TIP 8FR 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 24MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RSC01|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 90CM 6FR PN DSTN T-B STRG SS NYL HDRPH PTFE RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR02|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 45CM 6FR PN DSTN HS CRV SS NYL HDRPH PTFE XCUT VLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00249001230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 30.5CM 3MM TIB THRD NTR NL SYS|1|HUMANA [1294]||HUMANA [11839]|257.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|257.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 26MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00249004630|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 3MM NTR NL TIB THRD NS|1|HUMANA [1294]||HUMANA [11839]|276.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2490-046-20|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN GUIDE 2.0MM|1|HUMANA [1294]||HUMANA [11839]|300.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965100021|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EXODUS DRAINAGE 8F MPD STANDARD LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965100101|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EXODUS DRAINAGE 10F MPD STANDARD LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 28MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 207.734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 34MM SS L/T RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 40MM LONG THREAD STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484003001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 30MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1360C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR BCMPS 23MM 6MM ACL PCL CNN RDC HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 400MM FEM LT GAMMA3 IM 125D LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991432|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32MMX14MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 10D +4MM 52MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL DELTA CERAMIC TS 12/14 36MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,973.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,973.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-H226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL EVOLVE +2 SZ.26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484005001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 50MM PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4910L004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RH LONG SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8594520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 4.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X10MM BRIGADE 8D TI NS LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8456535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,203.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24920020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL RHP 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1109-001-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERTER POLY PLUG DISPOSABLE|1|HUMANA [1294]||HUMANA [11839]|735.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486503001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 30MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LN222515CT|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 20 POLE LASSO 2515 NAV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486503501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 35MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BN175TCDFH|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER EZ STEER THERMOCOOL D/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SNDSTR10|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOUNDSTAR ULTRASOUND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248510510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 105MM TI-6AL-4V CEPHALOMEDULLARY LG NTR NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 45-80100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 200MM 1.6MM KRSH FT VARIAX FT LCK PLT SYS NS|1|HUMANA [1294]||HUMANA [11839]|134.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|134.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-80200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 100MM 1.4MM KRSH SMTH VARIAX FT LCK PLT SYS NS|1|HUMANA [1294]||HUMANA [11839]|54.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486504001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 40MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-35024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486504501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 45MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-35648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 77X10X2MM TI 3 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 89X10X2MM TI 4 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486505001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-35016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486505501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 55MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-35620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|708.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM TI T10 FT/ANKL ST LCK VARIAX LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486506001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-35640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM VARIAX TI T10 FT FT/ANKL LCK ST NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 101X10X2MM TI 5 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20906|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 113X10X2MM TI 6 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,845.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20907|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 125X10X2MM TI 7 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137X10X2MM TI 8 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20909|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 149X10X2MM TI 9 HL LCK LOPRFL VARIAX BN 16X1.3MM FIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,005.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,005.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-80300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 100MM 2.5MM STNM SS NS|1|HUMANA [1294]||HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486506501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 65MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-35050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|191.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM VARIAX TI T10 FT FT/ANKL ST NS YLW LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486508001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 80MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3313040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 40MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P100510|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIOLOGIC COLLAGEN DERMAL PORCINE PERMACOL 5CM X 10CM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9M52-1535-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT ARTCSURF 15MM HEMICAP DF 3.5MM 1.5MM OFST FT MTP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48414|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 111MM 26MM 7.1MM 18FR ZNTH FLX Z-TRK BFUR PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 345MM TIB T2 IM STD LCK GUN DRL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON SZ 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1928SF-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE CORKSCREW FT II 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|690.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|690.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486508501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 85MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-4068-45L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURE LASSO 45 DEGREE CURVED LEFT|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7803115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE HELIX 4MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON STEM EXTENDER 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,981.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,981.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486509001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 90MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5544-A-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DHS DCS LAG ONE-STEP 12.7MM X 125MM ONE STEP STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,077.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 140 DEG 8 HOLE 142MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,241.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,241.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486509501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 95MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493912406450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 143CM 6MM RADOPQ NC QTM APX MNRL ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493912408450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 143CM 8MM RADOPQ NC QTM APX MNRL ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493912415450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 143CM 15MM RADOPQ NC QTM APX MNRL ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941434|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X14MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8594525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 4.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8457530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 7.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493912420450|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4.5MM 143CM 20MM RADOPQ NC QTM APX MNRL ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493912408500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 143CM 8MM RADOPQ NC QTM APX MNRL ACPT .014IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493912412500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 143CM 12MM RADOPQ NC QTM APX MNRL ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493912415500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 143CM 15MM RADOPQ NC QTM APX MNRL ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486510001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493912420500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 143CM 20MM RADOPQ NC QTM APX MNRL ACPT .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-114-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 14MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10722101|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BERENSTEIN 5FR 100CM NON BRAIDED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2990832|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32MMX8MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840005545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 45MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5440030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET SOLERA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486510501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 105MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54840006550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.5 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.105S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SS 5 HL SHFT LCP BN RDS LT DIST VOLR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,059.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,059.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486511001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 110MM 16MM THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6275-01-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS ULTRA TIB INS LT SZ1/2 16MM NATURAL-KNEEII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,308.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,308.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486507000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 70MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486508000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 80MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486508500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 85MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00486510000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484503508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,35MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 520-01-254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0416006|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 16X4CM STRATTICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-7211|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE CONTOUR SILTEX STYLE 7200 PROFILE HEIGHT MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102010|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 4X2CM ALDRM THN ACLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9790213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED VENTURE 4.0MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,40MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BD710DF282CT|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BI DIR 7FR DEF CS D-F 12 PIN (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-452|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE MICROCATHETER HI-FLO140CM WIRE 115 CM LENG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-7212|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE CONTOUR SILTEX STYLE 7200 PROFILE HEIGHT MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102TSL|SUP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERA SKIN 2 X 3 IN (39 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,519.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7801113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILL 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7802213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED SELF-DRILL 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484504508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,45MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7801111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILL 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6805115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 14X11X5MM CRNT SM PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6806115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 14X11X6MM CRNT SM PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-454|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RENEGADE MICROCATHETER HI-FLO180CM WIRE 150CM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPL2-1230H|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE GENERAL PURPOSE 12FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPL2-1430H|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE GENERAL PURPOSE 14FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,50MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5833310|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATHETER DIALYSIS LONG-TERM HEMOSTAR 14.5FR 31CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,450.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,450.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101TSS|SUP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERA SKIN 1 X 2 IN (13 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061453690|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7FR 20CM PGTL CRV TPR TIP RADOPQ ATCH SUT PSTNR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HR060545A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 45CM 6MM GORE STD WL HEP PROPATEN PTFE FX RING 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,702.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102016|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 8CM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484505508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,55MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 503356X|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .035IN STRBL SFTP RADOPQ STRG 13CM CRDS STORQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8914DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT MINI TIGHTROPE 1.1MM DISPOSABLE|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1320-0125S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP TUBE CLOSED GAMMA 3|1|HUMANA [1294]||HUMANA [11839]|459.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|459.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,60MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-0360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 11MM X 360MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 202MM SS 4.5/5/6.5MM SCR 8X5X 4 HL AXSOS BN FEM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 75MM SS T20 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 26MM AXSOS SS LCK ST T20 DRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 70MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611110S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 619904|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR LG ASNS III ORTH TI 6.5/8MM CNN SCR NS DISP|1|HUMANA [1294]||HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484506508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,65MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611120S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434900817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 170MM 8MM RVRS TRB MTL TIV SHLDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.124.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 76MM SS 3.5MM SCR 4 HL LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,473.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 70MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1370E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED INTERFERENCE 7 X 20MM SHEATHED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1391T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED INTERFERENCE 9 X 25MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1898S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM DELIVERY IMPLANT TRANSTIBIAL ACL|1|HUMANA [1294]||HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484507008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,MALLEOLAR,70MM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING AXSOS 5.0MM L80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9M52-2535-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT ARTCSURF 15MM HEMICAP DF 3.5MM 2.5MM OFST FT MTP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 8MM KN XLK FX BRNG STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158140000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB PFC S 4 KN COCR CMNT MDLR FX BRNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN RT CMNT POST STAB SGM COCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RVDR01|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER REVO MRI DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,867.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,867.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5086MRI45|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 45CM 6.9FR ATR RV TRNVNS BP SCR IN CHMBR HLCL CP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5086MRI52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 52CM 6.9FR HLX ATR VNTRC RT BP SCR IN CHMBR CP NV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5086MRI58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 58CM 6.9FR HLX ATR VNTRC RT BP SCR IN CHMBR CP NV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON M-2 10MM FULL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 10MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6642-5-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-4316|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT NS CLIK ANCH SPNL CORD SYS STRL|1|HUMANA [1294]||HUMANA [11839]|843.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4210664|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16X6MM 14MM PRVL PEEK-OPTM STNDALN CRV INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551-G-299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYMMETRIC X3 PATELLA 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484001200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 68337|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUTOPLAST 0.6 X 1CM SCLERA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8914P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BUTTRESS MINI TIGHTROPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 14MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VN1008200|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS BILIARY VIABIL GOR 10MM C 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12744-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER OTW 3.0 MM DIAMETER 12 MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-MF-018|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL MULTI-FENESTRATED CRIBRIFORM 7 FR 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,060.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,060.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-MF-025|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL MULTI-FENESTRATED CRIBRIFORM 7 FR 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0010101|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BARD KUGEL PATCH SMALL OVAL 0010101|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,247.99|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,247.99|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00484002200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 22MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 960005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 73X69MM KN LT CMNT CR PFC S NPOR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGT3720|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS GRAFT ANEURYSM THORACIC 37MM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SDV2428|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRY SEAL GORE 24 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED PARTIALLY THREADED 3.75MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941-12|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 12IN .062IN LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS75160-44|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBING SIZE-4 FRENCH SILASTIC 39 INCH|1|HUMANA [1294]||HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102108|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X 18CM THICKNESS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,092.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,092.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 24MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 982108|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X 18CM THICKNESS ULT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,092.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,092.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012278-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.0MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012278-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012278-25|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 25MM COR RX ULT LOPRFL RADOPQ FLXB DIST SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012278-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012279-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012279-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012280-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 5.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484002600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 26MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012269-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 1.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012269-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 1.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012270-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.00MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012270-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012270-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012270-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.00MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012270-25|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION MINI TREK RX 2.00MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012270-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.00MM X 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012272-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.50MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012272-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012272-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012272-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012272-25|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 25MM COR RX ULT LOPRFL RADOPQ FLXB DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012272-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 2.50MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012274-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.00MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012274-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012274-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012274-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.00MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012274-25|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 25MM COR RX ULT LOPRFL RADOPQ FLXB DIST SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012274-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.00MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012276-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.50MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012276-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012276-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012276-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012276-25|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3.5MM 25MM COR RX ULT LOPRFL RADOPQ FLXB DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012276-30|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 3.50MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012278-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.0MM X 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012278-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012280-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION RX TREK 5.0MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484004000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 40MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012405-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OTW TREK 2.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 60MM 32MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 95MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|932.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|932.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 266MM SS 3.5MM SCR 12 HL PRECONTOUR LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,806.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,806.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A45-12040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EBI CORTICAL 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION DIGITAL 1.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2.5 KN LT CMNT POST STAB SGM COCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484004500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 45MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2.5 10MM KN GVF ROT PLAT STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-060-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 5.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 70MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 65MM 5.5MM PREBNT CRV THORLMBR TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP12000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP16000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP32000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516910|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX PARTIALLY COVERED 18MM X 12CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,825.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,825.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484005000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 50MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 824071101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION MTP 1ST RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10306203|SUP|HCPCS C1881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER CENTROS CHRONIC DIALYSIS 24CM STRAIGHT BASIC KIT|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10302805|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER DURAMAX DIALYSIS 32CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20390|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATOR ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484005500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 55MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MOBILITY DUAL ANATOMIC ADM RESTORATION 56MM R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +4MM OFST TPR 28MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP28000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 824071001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION MTP 1ST LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00490006551|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 13MM 6.5MM LG ORTH SS 1.5MM 4.5/6.5MM SCR NS|1|HUMANA [1294]||HUMANA [11839]|94.95|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|94.95|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H787065076035|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH 16 FR VALVED PEEL A WAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.5 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 56MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 122MM SS 3.5MM SCR 4 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,849.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,849.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 10MM KN XLK FX BRNG STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB081234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERPLATE L-TI LUMBAR IFD 34MM X 12MM X 8 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DG0404SN|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURA GUARD REPAIR PATCH 4 X 4 CM DGO404S|1|HUMANA [1294]||HUMANA [11839]|1,010.43|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,010.43|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 2 HOLE 25MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RSB0112|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 12MM INTERPLATE CRV PEEK CVR ASMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB5020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE STANDARD INTERPLATE L-TI LUMBAR IFD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB081430S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER OPTIMA PEEK LUMBAR L-PS INTERPLATE 30MM X 14MM X 8 DE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4210764|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16X7MM 14MM PRVL PEEK-OPTM STNDALN CRV INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 420879|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TRUMATCH SPII 3T/4F/L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248402050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 20MM TI6AL4V FT FEM CORT DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248402250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 22.5MM TI6AL4V FT FEM CORT DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 3 HOLE 37MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|174.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248402550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 25MM TI6AL4V FT FEM CORT DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248402750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 27.5MM TI FT CORT ST FX ANG HEX RD 9.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248403050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 30MM TI FT CORT ST FX ANG HEX RD 9.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47-2484-032-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL FA ZNN 5.0MM X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248403550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 35MM TI FT CORT ST FX ANG HEX RD 9.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248403750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 37.5MM TI6AL4V FT CORT PROX DIST ST FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248404050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 40MM TI6AL4V FT CORT PROX DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248404250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 42.5MM TI6AL4V FT CORT PROX DIST ST FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248404550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 45MM TI-6AL-4V FT CORT FX ANG HEX HD NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248404750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 47.5MM TI6AL4V FT CORT PROX DIST ST FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 4 HOLE 49MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|185.91|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248405050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 50MM TI6AL4V FT CORT PROX DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248405250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 52.5MM TI FT CORT ST FX ANG HEX RD 9.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248405550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 55MM TI6AL4V FT CORT PROX DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248405750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 57.5MM TI-6AL-4V FT CORT FX ANG HEX HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248406050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 60MM TI-6AL-4V FT CORT FX ANG HEX HD NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248406550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 65MM TI6AL4V FT CORT PROX DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248407050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 70MM TI6AL4V FT CORT PROX DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248407550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 75MM TI-6AL-4V FT CORT FX ANG HEX HD NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248408050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 80MM TI6AL4V FT FEM CORT DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248408550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 85MM TI6AL4V FT FEM CORT ST FX ANG HEX HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 5 HOLE 61MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|185.91|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS0915|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BIO-ABSORBABLE REINFORCEMENT TISSUE GORE 9CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6851211|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 30X10X12MM CRNT 5D LRDTC LG OBLQ PEEK-OPTM|1|HUMANA [1294]||HUMANA [11839]|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,538.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248409050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 90MM TI6AL4V FT FEM CORT DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248409550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 95MM TI6AL4V FT FEM CORT DIST ST FX ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248508510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 85MM TI6AL4V CEPHALOMEDULLARY LG ST STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248509010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 90MM TI6AL4V CEPHALOMEDULLARY LG ST STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248509510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 95MM TI6AL4V CEPHALOMEDULLARY LG STRL NTR NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 6 HOLE 73MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|193.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248510010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 100MM TI6AL4V CEPHALOMEDULLARY LG STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248511010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 110MM TI6AL4V CEPHALOMEDULLARY LG STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248511510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 115MM TI6AL4V CEPHALOMEDULLARY LG ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248512010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 120MM TI6AL4V CEPHALOMEDULLARY LG ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248512510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 125MM TI6AL4V CEPHALOMEDULLARY LG ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248513010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 130MM TI6AL4V CEPHALOMEDULLARY LG ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248410050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 100MM TI6AL4V FT FEM CORT ST FX ANG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248507010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 70MM TI6AL4V CEPHALOMEDULLARY LG ST STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248507510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 75MM TI6AL4V CEPHALOMEDULLARY LG ST STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4935-007-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 7 HOLE 85MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|193.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|193.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248508010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 80MM TI6AL4V CEPHALOMEDULLARY LG ST STRL NTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,542.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248700200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 0MM CEPHALOMEDULLARY TI-6AL-4V NTR NL|1|HUMANA [1294]||HUMANA [11839]|573.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248700205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 5MM CEPHALOMEDULLARY TI-6AL-4V NTR NL|1|HUMANA [1294]||HUMANA [11839]|573.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248700210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 10MM CEPHALOMEDULLARY PERIPROSTHETIC TI6AL4V NTR NL|1|HUMANA [1294]||HUMANA [11839]|573.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248700215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 15MM CEPHALOMEDULLARY TI-6AL-4V NTR NL|1|HUMANA [1294]||HUMANA [11839]|573.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 46-605|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PLATINUM PLUS .018 X 260|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC-1000|SUP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS NUCEL HMN AMNIO PLCNT MEMBR MTRX WND HEAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493500803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 8 HOLE 97MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|207.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8452040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249321011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00494500303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|158.22|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|158.22|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RMT231414|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 23MM 14.5MM XCLDR C3 TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281412|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 28.5MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]||HUMANA [11839]|25,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249321111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 984151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 CRV 17.5MM KN GVF CMNT FX BRNG MDLR + CR PFC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6808815|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 15X13X8MM CRNT SM LRDTC + PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|3,588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7806213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED HELIX 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE HELIX 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2493-212-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 14.5MM X 21.5CM 130 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,903.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,903.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249321311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00494500503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|174.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47-2493-241-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 14.5MM X 21.5CM 135 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,903.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,903.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DG0608SN|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURA TUTOPLAST 6 X 8CM.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,870.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,870.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00494500603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|185.91|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 130D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249321410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249321411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249321413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,251.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249321510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 21.5CM CEPHALOMEDULLARY NTR NL IM 135D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,903.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,903.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249330213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00494500703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|189.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532G519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 19MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G31354|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY ZILVER 6FR 5MM X 60MM 125CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249330313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VBH131002A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 13MM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SDV1828|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRY SEAL GORE 18 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249330410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249330513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 30CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00492000204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,EPIPHYSIS,LT,RT,4-H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00492000302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,STRAIGHT,21MM,3HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|162.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|162.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-7-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 19mmX195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3505-6555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 55MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249334410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249332410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00492000402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,STRAIGHT,29MM,4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.99|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|177.99|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249332513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 32CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00492000502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,STRAIGHT,35MM,5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.91|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|185.91|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249334213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 85MM 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|375.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249334513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 34CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493500800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 3.5MM X 97MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|385.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CON2006|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG STRATTICE STRL MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,235.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,235.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249336311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CON3006|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE RECONSTRUCTIVE S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,971.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,971.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249336313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249336510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 481068|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOMESH COLLAGEN ACELLULAR PELVISOFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,125.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,125.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493501003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 121MM SS SM FRAG 10 HL COLR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301206|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 6MM BENGAL 7D LG CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,463.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,463.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 5MM BENGAL 7D LG CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7803111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE HELIX 4MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5080-2-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 45MM 2MM HFMN2 APX MIC SS ST SLFDRL 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|223.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4960-3-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ASMB FX HFMN2 MIC LNTHNR|1|HUMANA [1294]||HUMANA [11839]|11,220.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,220.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 420MM FEM LT GAMMA3 IM 125D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3060-0110S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 110MM GAMMA3 TI HIP TROCH LG STRL NL 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249336511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00492000602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,STRAIGHT,45MM,6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|207.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SP18000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249336513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 36CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249338011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 125D CCD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 13MM X 38CM 130 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249338313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47-2493-384-11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 11.5MM X 38CM 135 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47-2493-384-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 13MM X 38CM 135 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249338511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FPRPR3204|SUP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE GALIL ICEROD 90INCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482700601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 6MM SS ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 700-103909|SUP|HCPCS C1819||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROBE STARBURST SEMI FLEX W/CABLE|1|HUMANA [1294]||HUMANA [11839]|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08957|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CHECK FLO PERFORMER 14FR X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08024|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CHECK FLO PERFORMER 14FR X 13CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 100MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 105MM 16MM SS P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410190|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT CPS|1|HUMANA [1294]||HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NS7TCFL174HS|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ABLATION NAVISTAR F CURVE 4MM THERMOCOUPLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249338513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 38CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00482700801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 8MM SS ST SM HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249340011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48402|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 82MM 22MM 18FR Z-TRK ZNTH FLX 2 BRCH SS WVN PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-7-647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32X64-67MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570650|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8FR 80MM 3.2MM RX UNCVR SLF XPD DLV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,555.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,555.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G43858|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 6FR 80MM 80CM .035IN SLF XPD FLXB SLT TUBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249340210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00482701001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 10MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249340211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4827-012-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 12MM SELF TAPPING SMALL HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02-124-205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LCP 3.5MM BEND LOW 6-HOLE 102MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 128MM SS 3.5MM SCR 8 HL LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 154MM SS 3.5MM SCR 10 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 180MM SS 3.5MM SCR 12 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.221|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 206MM SS 3.5MM SCR 14 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,901.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,901.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 232MM SS 3.5MM SCR 16 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 102MM SS 3.5MM SCR 6 HL LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 128MM SS 3.5MM SCR 8 HL LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,580.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 154MM SS 3.5MM SCR 10 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,628.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 180MM SS 3.5MM SCR 12 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,848.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482701401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 14MM SELF TAPPING SMALL HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.124.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 206MM SS 3.5MM SCR 14 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,901.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,901.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 232MM SS 3.5MM SCR 16 HL LMT CNTCT LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 75MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249340511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249340513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 40CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 42CM CEPHALOMEDULLARY RT NTR NL IM 125D LNG SPRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482701601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 16MM SELF TAPPING SMALL HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported OCM01208|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX OSTEOCONDUCTIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LPP14|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST TEXTURED MID-HEIGHT POLE LOW DERMASPA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00482701801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 18MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9M52-1545-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL TOE 4.5X1.5MM 15MM HEMICAP DF MTP ARTC CMPNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR LO BND 102MM SS 3.5MM SCR 6 HL LMT CNTCT LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,528.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 42CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00482702001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 20MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 508-00-004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL SOCKET HUMERAL RSP DJO +4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,277.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,277.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G12479|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 55MM 16MM 14FR ZNTH FLX H&L-B 1-SHOT BFUR ABD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ081002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 10CM HEPRIN BIOACTIVE SURFACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1236-2-848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28mm FOR CUP OD 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-42E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 42MM E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6519-1-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM UNV TPR 28MM HIP BLX D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMC08|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DUAL PATCH 26CM X 34CM 1DLMO8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,321.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,321.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00482702201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 22MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249342513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249342310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 42CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0097|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD CRVTR 31MM 3 HL LCK BN RADL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249300000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET CEPHALOMEDULLARY TI6AL4V NTR NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249344011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249344111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7752536|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT ROD XLNK MED SPNEs|1|HUMANA [1294]||HUMANA [11839]|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482702401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2.5MM 24MM SS CORT ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CF7-7-100|SUP|HCPCS C1888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER CLOSURE FAST 7FR X 100CM VNUS|1|HUMANA [1294]||HUMANA [11839]|2,535.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,535.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1221-32-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ALTRX PINNACLE 32MM X 48MM NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122132050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 50MM 32MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 52MM 36MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ALTRX PINNACLE 36MM X 54MM NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 664639-100|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE WHISPER VIEW EDS CS-J .014 X 190CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249344113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2027BL|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEEROCATH DX OCTAPOLAR 7FR SPACING 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249344311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6485-3-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 15X127 FEM STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-2-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL DISTAL LEFT SMALL GMRS REPLACEMENT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,719.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,719.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIB 80MM 16MM GMRS FLUT KN PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249344413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249344513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 44CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-10-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2493-460-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 13MM X 46CM 125 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47-2493-461-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ZNN-CM 13MM X 46CM 125 DEGREE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,905.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249346313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249346410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 125D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 125D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249348113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 125D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 130D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 130D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 130D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 542-11-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 135D CCD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249348513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 15.5MM 48CM CEPHALOMEDULLARY NTR NL IM 135D CCD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121717054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACTB 54MM 48MM PNCL DPRFL 8 PERI 5 DOME SCR HL HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.403S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 125DEG X 420MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2490-046-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN ZNN 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CF5560|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATHETER DIALYSIS PERITONEAL EXXTENDED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4835-014-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 14MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47249346411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 15.5MM 46CM CEPHALOMEDULLARY NTR NL IM 135D CCD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,387.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LPP15|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST DERMASPAN LOW POLE TEXTURED MID HEIGH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL PCA TAPER SKIRTED 2 DEGREE 52 36MM/+15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602710S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 110MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105895|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ACCOMON RINGLOCK 10 DEGREE 36MM SIZE 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.047S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE SPIRAL RETROGRADE 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,879.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-4-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3MM 22.2MM HIP COCR V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,097.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,097.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260038D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB D 38MM HIP MDLR 2 MBL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4835-016-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 16MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6260-4-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM 22.2MM HIP COCR V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,097.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,097.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM X3 INSERT FOR MDM LINER 22.2mm / 38D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501504 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 8.8CM MEMORYGEL CHSV I P3.7CM RND HI PRFL NAR BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502004 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 9.7CM MEMORYGEL P4CM HI PRFL RND NAR BS SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502254 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.1CM MEMORYGEL CHSV I P4.2CM HI PRFL RND GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9M52-2545-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT ARTCSURF 15MM HEMICAP DF 4.5MM 2.5MM OFST FT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,018.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5888101|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE VISTA BRITE .88 XBLAD4 8FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 22MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3546111|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 11.4X8.1CM BRST 250ML STY 6100 TXTR SRFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6112|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE PROFILE LOW 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6113|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE PROFILE LOW 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX MODULAR ENDO HEAD 40mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 354-6116|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE PROFILE LOW 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0933S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 9MM X 330MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCP3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3 HL PIN CLMN RADL CLMN PIN PLT BN RADL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 24MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TRX2.3-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRX2.3-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRX2.3-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRX2.3-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.3MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 26MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4835-018-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 18MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3228ANS-60CM|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PENTA 60CM SJM DP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT CORONOID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,896.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,896.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588882|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR XB 3.5 VISTA BRITE 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588894|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR XB4 VISTA BRITE 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484001600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 16MM FULL THREADED HEXHEAD SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D314TRG|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR PROTECTA XT CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D314DRG|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR PROTECTA XT DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42,207.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42,207.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D314VRG|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR PROTECTA XT VR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C4TR01|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCMKR CRD THK6MM 57X59MM CONSULTA CRT-P ATR VNTRC 2 CHMBR RR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 36MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3425-0300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT GAMMA 3S RIGHT 10 X 300MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,782.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GKP-3301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 3.3MM 2 POPLOK HI-FI KNTLS TCH INDIV TNSN DL FX RB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,000.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,000.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 10MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944CL-P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT CNTR TI FSN MOD LOPRFL MTP PLT BN MTP LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.082S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 12MM 85MM SS 3.5MM SCR SM FRAG SET 5 HL HK PRECONTOUR RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.086S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 18MM 85MM SS 3.5MM SCR SM FRAG SET 5 HL HK PRECONTOUR RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7510200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INFUSE KIT-SMALL (BMP)|1|HUMANA [1294]||HUMANA [11839]|11,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8888102003HP|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY CATH 20CM 12FR 11 PU MHRKR VASC 3 LUM 1 NDL SF HLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792917|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILLING 17MM X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,241.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,241.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8792817|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILLING 17MM X 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,029.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,029.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23047|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PERITONEAL W/SLITS 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SEMC68110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEMBRANE TYMPANIC RIGHT DRUM EAR CADAVER|1|HUMANA [1294]||HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RMT231216|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 23MM 12MM XCLDR C3 TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 95MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 135CM 200MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF-1230|SUP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE AMNIOTIC AMBIO 5 SIZE 2 X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 869-022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 50CM 5.5MM LGC CD HZN LNG HEX TI LN CP 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-5420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 15 X 420MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604646S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 46MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VARIABLE 4.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1895-5090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 90MM T2 TI P/T CNDYL FEM LCK STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|587.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|587.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1895-5001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT ORTH 5MM T2 CNDYL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1895-5060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM T2 TI P/T CNDYL CNDYL STRL IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|587.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|587.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0152-0218S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 310MM 1.8MM KRSH CNDYL SCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-0932S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 9MM X 320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556101|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 260CM HPRFR RX KINK RST STRG TIP DREAMWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434811013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 130MM 10MM TRB MTL TIV 48D SHLDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1688TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 46CM 7FR HLX TRNVNS ATR VNTRC IS-1 CNCT BP ACTFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301105|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 5MM BENGAL 7D STD CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301104|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 4MM BENGAL 7D STD CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7737110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HLDR IMPL HLX ACP SPNE TEMP TACK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702459|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 150MM 1.4MM ASNS III HIP FEM THRD 4MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 15MM 85MM SS 3.5MM SCR SM FRAG SET 5 HL HK PRECONTOUR LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RM-1016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX COLLAGEN SYNOVIS 10CM X 16CM|1|HUMANA [1294]||HUMANA [11839]|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E100-25M-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MTRL 16MM 25MM 23MM EP FLEXFIT PRCN PRICRD BPRTH STNT|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E100-27M-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MTRL 16MM 27MM 23MM EP FLEXFIT PRCN PRICRD BPRTH STNT|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E100-29M-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL TISSUE PORCINE EPIC 29MM|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E100-31M-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL TISSUE PORCINE EPIC 31MM|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E100-33M-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL TISSUE PORCINE EPIC 33MM|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RMT231412|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 23MM 14.5MM XCLDR C3 TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC161000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 9.5CM 16MM 18FR 13.5-14.5MM XCLDR LOPRFL CNTRLT|1|HUMANA [1294]||HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC161200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 11.5CM 16MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]||HUMANA [11839]|11,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3800|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRA-AORTIC BALLOON 940|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SDV1628|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRY SEAL 16FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850204|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CONTOUR MEDIUM 4MM|1|HUMANA [1294]||HUMANA [11839]|3,588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800352|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602680S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 80MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST TPR 22MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602685S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 85MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2027BL|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEEROCATH DX OCTAPOLAR 7FR SPACING 2.5MM (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CONTOUR MEDIUM 5MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON SZ42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-01-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SZ8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM X3 INSERT FOR MDM LINER 22.2mm / 36C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-36C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 36mm C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6708926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 26X9X8MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 40 X 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA STANDARD SERIES A BIOMET 37MM X 10.0MM 3-PEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 31MM 3 PG KN SER A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,254.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,254.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT JOINT PATELLA FEMORAL TROCHLEA LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 50 X 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7772602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TULIP 6.25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7772001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 46MM 15.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 42MM 14MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6050-0530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP HEAD/NECK OMNIFIT C-TAPER 130MM SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 26MM HIP CTPR OFST COCR LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48416|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 140MM 26MM 18FR ZNTH FLX Z-TRK BFUR ABD AORTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750007|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TRIAD CR 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6278006|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X6MM VRTSTCK CRSTN PSR 14MM PEEK-OPTM STRUT CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-145-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,TUBE,COMPRESSION,12HOLE,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,728.84|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6278944|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X9MM VRTSTCK CRSTN PSR 14MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6278044|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X10MM VRTSTCK CRSTN PSR 14MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 255823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 26MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT22508UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.25MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT22512UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.25MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT22514UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 14MM 2.25MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT22518UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 2.25MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT22526UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 26MM 2.25MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT25008UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT25012UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT25014UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 14MM 2.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT25018UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 2.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT25022UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 22MM 2.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT25026UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 26MM 2.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT27508UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.75MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT27512UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.75MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT27514UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 14MM 2.75MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT27518UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 2.75MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT27522UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 22MM 2.75MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT27526UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 26MM 2.75MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10413|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT PC MD|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT30009UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 9MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT30012UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT30015UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT30018UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07150MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7MM 150MM 120CM LNG DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C08120MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 120MM 120CM LNG DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C08150MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 8MM 150MM 120CM LNG DLV HNDL SLF XPD MICROMESH SEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83163-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 4MM 150CM 40MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35012UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35015UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35018UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35022UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 22MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35026UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 26MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT30022UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 22MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT30026UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 26MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported INT30030UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 30MM 3MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35009UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 9MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT35030UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 30MM 3.5MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40012UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40009UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 9MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40015UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40018UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40022UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 22MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40026UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 26MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT40030UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 30MM 4MM INTGR MICROTRAC FULCRUM COCR RX 1 STRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 50MM SS L/T RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0898|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORP SHEA 3.0MM HEAD 5.5MM LENGTH|1|HUMANA [1294]||HUMANA [11839]|1,038.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,038.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516900|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX PARTIALLY COVERED 18MM X 10CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0113116|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM FIXATION ABSORBABLE SORBA-FIX LAPAROSCOPIC 36CM 30 FA|1|HUMANA [1294]||HUMANA [11839]|2,482.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,482.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0113115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM FIXATION ABSORBABLE SORBA FIX LAPAROSCOPIC 36CM 15 FA|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6050-0745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP HEAD/NECK OMNIFIT C-TAPER 150MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10MM OFST CTPR 28MM HIP COCR LFIT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-697|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER UT SDS 8MMX8CM 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVLT/PVAK|SUP|HCPCS C1888||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT PERFORATOR VEIN ABLATION VENA CURE EVLT|1|HUMANA [1294]||HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INT22522UX|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 22MM 2.25MM INTGR MICROTRAC FULCRUM COCR RX 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 15MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850206|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOURED COROENT 6MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-32PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 32MM CANNULATED PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-36PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 36MM CANNULATED PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0010301|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALEX SMALL CIRCLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,340.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,340.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported OM-3500|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT LABRA LOCK P|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5450-048-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CONE FULL METAL TRABECULAR EX-SMALL SIZE 48MM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 17X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON STEM EXTENDER 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,981.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,981.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SNTH TISS ULTHN 50X38X.85MM PE POR MDPR SHT SMTH TRNS|1|HUMANA [1294]||HUMANA [11839]|1,197.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,197.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L7310|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULA,ARTERIAL,PERFUSION,22F|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6941438|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X14MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8594522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 4.5MM X 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-3000-24|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT-A-CATH SYSTEM ARTERIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|837.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8456550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7133334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER XLPE ACETABULAR 50-52 20 DEGREE 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,633.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,633.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 60MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 65MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-28PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 28MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-32PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 32MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-36PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 36MM QFIX TI T10 P/T CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NL850-7210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT LUMBAR PERITONEAL #850-7210|1|HUMANA [1294]||HUMANA [11839]|1,727.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,727.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 506-00-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL RSP DJO SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM VRTX MX TI SPNE MA NS BLU RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1236S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 360MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,646.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,646.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102081|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 4CM X 16CM THICKNESS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,676.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,676.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM ATLNTS TI SPNE CRV ANT ST VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ060502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH SPRFC FEM ART ILIUM 5CM 6MM 6FR HEP VBHN 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ061002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 10CM X 120CM HEPRIN BIOACTIVE S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ051002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 10CM X 120CM HEPRIN BIOACTIVE S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1882TC/52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 52CM 7FR 10MM SPC J HLX ATR IS-1 CNCT BP ACTFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2751|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MICROVASIVE ANASTOMOTIC DEVICE 1.5 2751|1|HUMANA [1294]||HUMANA [11839]|282.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|282.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60AC-6.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +6 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-30PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 30MM CANNULATED PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 10MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944-P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT STRG TI FSN MOD LOPRFL MTP PLT BN MTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 28MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8945-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8955-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 40MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-80FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 80MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 80MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,350.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5740109|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CC TRIAD 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 34MM SS ST SM HEX HD NS SM FRAG UNV LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A402871|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE BLU ABLATION MED CURL|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A402872|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE BLU ABLATION LARGE CURL|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483504501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 45MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.205.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 4.4MM 25MM SS 4MM FT CNN ST SLF DRL LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-20FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 20MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-22FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 22MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-24FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 24MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483503201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 32MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8945-26FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 26MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-28FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 28MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-30FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 30MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-32FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 32MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-34FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 34MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-36FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 36MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-38FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 38MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-45FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 45MM TI FT CNN LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-50FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 50MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483504001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 40MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8945-60FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 60MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-65FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 65MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-70FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 70MM LOPRFL SCR TI FT HEX MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-75FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 75MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-20PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 20MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-22PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 22MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-24PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 24MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-26PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 26MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-28PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 28MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-30PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 30MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-32PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 32MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-35PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 35MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-36PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 36MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-38PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 38MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-45PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 45MM TI P/T CNN LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 50MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-60PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 60MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-65PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 65MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-70PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 70MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-75PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 75MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-80PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 80MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1258T/75CM|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD QUICKFLEX MICRO LEFT VENTRICULAR 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,397.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,397.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-55FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.5MM X 55MM CANNULATED FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-34PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 34MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TH-LS-M|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBOHAWK LS-M LARGE VESSEL STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945-55PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 55MM LOPRFL SCR TI P/T MLR CORT SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.084S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 15MM 85MM SS 3.5MM SCR SM FRAG SET 5 HL HK PRECONTOUR RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 15MM 99MM SS 3.5MM SCR SM FRAG SET 6 HL HK PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,660.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,660.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483505001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 50MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6850207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOURED COROENT 7MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-106-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 6MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-108-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 8MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00592601502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN PTLFEM RT CMNT PRECT GNDR SOL NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 507-10-175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM REVISION RSP ENCORE SZ10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,214.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,214.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 24MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8933-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 147MM SS 3.5/4MM SCR 6X5X 3 HL AXSOS BN TIB RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 70MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1011932-040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 5.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011932-060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 5.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011932-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 5.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011932-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 5.0MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4348-117-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 17MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-118-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 18MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-108-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 8MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-110-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 10MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-112-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 12MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4348-114-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 48 DEGREE 14MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00202175438P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMASHIELD WOVEN DBL VELOUR 38CM. X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-106-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 6MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-108-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 8MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-109-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 9MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-110-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 10MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-111-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 11MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-112-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 12MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-113-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 13MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-115-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 15MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-116-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 16MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10062|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT NPC LG|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4342-117-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 17MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-118-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 18MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-108-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 8MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-110-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 10MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-112-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 12MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4342-114-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 14MM X 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,947.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434900813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 130MM 8MM TRB MTL TIV SHLDR STRL RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434901017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 170MM 10MM TRB MTL TIV SHLDR STRL RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434901217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 170MM 12MM TRB MTL TIV SHLDR STRL RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 18MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|337.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported NL79026S02|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT T-TUBE 4 X 6 MM NL79026502|1|HUMANA [1294]||HUMANA [11839]|690.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|690.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 24MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|337.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|337.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 27MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 30MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 33MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 36MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0104223042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 42MM NCB AN SHLD PROTASUL-64WF CANC INVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PNG-130|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 1.5MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|3,794.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,794.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG-320|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 3.0MM X 2CM|1|HUMANA [1294]||HUMANA [11839]|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4342-114-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TM 42 DEGREE 14MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,845.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6021-0130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PNG-230|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 2.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG-330|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 3.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|3,804.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,804.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434903600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR 36MM 7D +0MM OFST STD HUM TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434904000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+0MM 40MM 7D STD HUM TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434904003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+3MM 40MM 7D STD HUM TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434904006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+6MM 40MM 7D STD HUM TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434906500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER HUM 36MM 65D +0MM SHLDR TRB MTL PE RTN RVRS SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434906503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+3MM 36MM 12D 65D HUM TRB MTL PE RVRS RTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434906506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+6MM 36MM 12D 65D HUM TRB MTL PE RVRS RTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434906600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+0MM 40MM 12D 65D HUM TRB MTL PE RVRS RTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434906603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR H+3MM 40MM 12D 65D HUM TRB MTL PE RVRS RTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1275108D|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH CV 5FR 2 LUM MAXIMAL BRR TRY TPS STY P PICC SHRLK 3CG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1386108D|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH CV 6FR 3 LUM MAXIMAL BRR TRY TPS STY P PICC SHRLK 3CG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434906606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHLDR 6+ MM 40MM 12D 65D HUM TRB MTL PE RVRS RTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0010302|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALEX MED CIRCLE 0010302|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,553.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,553.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-5955-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 50MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5955-55PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 55MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756064|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR LATERAL|1|HUMANA [1294]||HUMANA [11839]|1,813.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,813.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 23MM +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5520B700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 7 KN CMNT PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.302S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 85MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]||HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5510-F-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 83975-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 4MM 150CM 120MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434904011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHR GLND 40MM SHLDR TRB MTL PE RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,847.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,847.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434903909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR HUM 12D +9MM SHLDR TRB MTL RVRS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,070.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434903912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR HUM 12D +12MM SHLDR TRB MTL RVRS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,070.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00434903700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS HUM 2 TPR SHLDR TRB MTL TIV RVRS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4296-88CM|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ATTAIN ABILITY PLUS 88CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG-220|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 2.0MM X 2CM|1|HUMANA [1294]||HUMANA [11839]|3,159.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,159.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012447-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.5 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012447-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.5 MM X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012448-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.75 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012449-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.0 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012449-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.0 MM X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012450-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.25 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012451-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.5 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012451-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.5 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012451-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.5 MM X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012453-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 4.0 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10061|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT NPC MD|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012453-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 4.0 MM X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012454-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 4.5 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012455-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 5.0 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 13MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602870S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 70MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-46F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 46mm F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604644S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 44MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011933-060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 6.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012534-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 6.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011934-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 7.0MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C0510277|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CUSTOM 12 X 42|1|HUMANA [1294]||HUMANA [11839]|26,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G43823|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY ZILVER 6FR 6MM X 80MM 135CM DELIVERY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0805915|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 9.5FR .036IN 5CM CV POWERHICKMAN SRCF 2 LUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7871-001-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK VERSYS CRC 13/15 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT7.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +4.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534340|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 9CM DDNL BND PRELD RADOPQ RX DLV SYS ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8955-45PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 45MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8955-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 50MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8955-55PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 55MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8955-60PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 60MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8955-65PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 5.5MM X 65MM PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186801012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 12X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,247.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186850012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SD 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 176202014|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH ST 14 X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,948.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,948.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-28PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 28MM CANNULATED PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-38PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 38MM CANNULATED PARTIALLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-20PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 20MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-056-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 56 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3505-5545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 5.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-4545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 4.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-013-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE C MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-014-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE D MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-016-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE F MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-017-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE G MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BVT808030|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INFUSTION SYSTEM TRELLIS-8 PERIPHERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516730|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX COVERED 23MM X 10CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516750|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX COVERED 23MM X 15CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-015-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX LEFT SIZE E MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-013-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE C MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-014-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE D MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-015-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE E MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-016-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE F MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950-017-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT CR FLEX RIGHT SIZE G MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-300|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.6CM NATRELLE P3.5CM MDRT PRFL RND SIL STY 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-330|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-390|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENBF3216C145E|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 145MM 32-16MM 20FR ENDURANT BFUR EVAS ABD AORTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ENLW1610C124E|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 174MM 16-10MM 14FR ENDURANT EVAS ABD AORTA ILIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT LPS-FLEX NEXGEN PROLONG LEFT SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM D KN LT CMNT PRECT LPSFLX NXGN ZML PRLNG PMMA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534200|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 5CM DDNL BND PRELD RADOPQ RX DLV SYS ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM E KN LT CMNT PRECT NG LPSFLX ZML PRLNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM F KN LT CMNT PRECT NG LPSFLX ZML PRLNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM G KN LT CMNT PRECT NG LPSFLX ZML PRLNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT LPS-FLEX NEXGEN PROLONG RIGHT SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT LPS-FLEX NEXGEN PROLONG RIGHT SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-015-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT LPS-FLEX NEXGEN PROLONG RIGHT SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM F KN RT CMNT PRECT NG LPSFLX ZML PRLNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM G KN RT CMNT PRECT NG LPSFLX ZML PRLNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-21.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST TPR 28MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 91-56301|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS,INCUS,NECROSIS,6301|1|HUMANA [1294]||HUMANA [11839]|519.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|519.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 56MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 37911-71515|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY EXPRESS MONORAIL PREMOUNTED 7MM STENT DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001508140|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FATHOM 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787121026175|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRIPLE LUMEN PICC 80CM WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12102618|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRIPLE LUMEN PICC 130CM WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM LOPRFL SCR SS T10 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM LOPRFL SCR SS T10 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM LOPRFL SCR SS T10 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM LOPRFL SCR SS T10 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM LOPRFL SCR SS T10 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM LOPRFL SCR SS T10 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 22MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 24MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 26MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 10MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM LOPRFL SCR SS T10 FT ANKL CANC MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 14MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 16MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM LOPRFL SCR SS T10 FT ANKL CANC MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM LOPRFL SCR SS T10 FT ANKL CANC MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM LOPRFL SCR SS T10 FT ANKL CANC MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 26MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 28MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 24MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8830-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.0MM X 30MM CANCELLOUS FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM LOPRFL SCR SS T15 FT HEXALOBE ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BCF|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW BIOCOMPOSITE FT 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8835L-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 46MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 320MM FEM LT GAMMA3 IM 125D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM LOPRFL SCR SS T15 FT HEXALOBE ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM LOPRFL SCR SS T15 HEXALOBE FT ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM LOPRFL SCR SS T15 HEXALOBE FT ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83149-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 3MM 150CM 20MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM LOPRFL SCR SS T15 HEXALOBE FT ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM LOPRFL SCR SS T15 FT HEXALOBE ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM LOPRFL SCR SS T15 HEXALOBE FT ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 45MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835L-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 50MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02-2010-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DYNAGRAFT 10CC (NEURO CART)|1|HUMANA [1294]||HUMANA [11839]|3,675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8835-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 32MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 35MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 38MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM LOPRFL SCR SS T15 FT ANKL CORT MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 44MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 45MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 46MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 48MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 50MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 55MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 3.5MM X 60MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM LOPRFL SCR SS LNG .5 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 32MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM LOPRFL SCR SS L/T CNN ANKL FX MGMT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 35MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 36MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM LOPRFL SCR SS LNG .5 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM LOPRFL SCR SS LNG .5 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 44MM LOPRFL SCR SS T15 L/T .5 LGTH ANKL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 45MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 46MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 48MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM LOPRFL SCR SS T15 L/T .5 LGTH ANKL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 55MM LOPRFL SCR SS LNG .5 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PANALOCK 3.5 ANCHOR W/#2 ETHIBOND 210025|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,122.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,122.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 60MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 30MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 32MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 34MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 35MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 36MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM LOPRFL SCR SS ST CNN ANKL FX MGMT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 40MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM LOPRFL SCR SS SHRT 1/3 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 44MM LOPRFL SCR SS T15 ST 1/3 LGTH ANKL CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 45MM CANNULATED SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 46MM LOPRFL SCR SS SHRT 1/3 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 48MM LOPRFL SCR SS ST CNN ANKL FX MGMT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM LOPRFL SCR SS SHRT 1/3 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 55MM LOPRFL SCR SS SHRT 1/3 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840C-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM LOPRFL SCR SS SHRT 1/3 LGTH T15 HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM LOPRFL SCR SS T15 FT ANKL CANC MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL METAL TRABECULAR SIZE 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,532.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,532.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE HELIX 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-28105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-28110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-28115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-28120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 12MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 14MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 16MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 18MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 20MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588604710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB BLU 83X52X10MM NXGN 7 C-H KN TRB MTL PE CR MNBLCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8840-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 22MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 24MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 26MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 28MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 30MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 32MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 34MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM SS L/T LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 40MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 42MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 44MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 46MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 48MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 50MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 55MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 60MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 30MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 32MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM LOPRFL SCR SS ST ANKL FX MGMT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 36MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7510800|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN 26MM 18MM INFS LG SPNE RHBMP-2 BVN CLGN ABS SPNG|1|HUMANA [1294]||HUMANA [11839]|17,205.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,205.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8840P-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 42MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 44MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 46MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 50MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 55MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 60MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 30MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 50MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8931-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICKFIX TI 3MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 32MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 34MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 36MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 38MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 40MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 42MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E5381-611|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,SCLERAL BUCKLING,31 ST|1|HUMANA [1294]||HUMANA [11839]|34.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|34.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8840-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 44MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 45MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 46MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 48MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 50MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 55MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM LOPRFL SCR SS T15 FT ANKL CANC MDLR SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840PL-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0 MM X 38MM LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840P-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM LOPRFL SCR SS ST ANKL FX MGMT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BL-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOPRFL SS 4 HL LCK MDLR BN FIB LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-066-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 66 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8943BL-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 91MM SS 5 HL LCK MDLR LOPRFL BN FIB LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BL-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 104MM SS 6 HL LCK MDLR LOPRFL BN FIB LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BL-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130MM SS 8 HL LCK MDLR LOPRFL BN FIB LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BR-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 79MM SS 4 HL LCK MDLR LOPRFL BN FIB RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-32PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-36PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-068-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 68 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-44PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 44MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324BCCT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL BIOCOMPOSITE 4.75 MM X 19.1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,410.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6709926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 26X9X9MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7757545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHARK 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7757535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHARK 7.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7772002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TULIP 6.25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,772.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,772.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7782001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK HEAD TULIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BR-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 91MM SS 5 HL LCK MDLR LOPRFL BN FIB RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BR-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 104MM SS 6 HL LCK MDLR LOPRFL BN FIB RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943BR-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING DISTAL FIBULA SS RIGHT 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943TH-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK LOCKING LATERAL SS 3HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-070-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 70 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8943TH-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK LOCKING LATERAL SS 5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943TH-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK LOCKING LATERAL SS 7HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943H-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 61MM SS 3 HL HK LCK BN FT/ANKL MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943H-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK LOCKING MEDIAL SS 5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943H-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK LOCKING MEDIAL SS 7HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943C-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 131MM SS 10 HL LCK BN ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943C-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT SS 12HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943C-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT SS 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943C-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 80MM SS 6 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D ELEV 11.4MM 66MM 32MM LNGVT HIP STRL PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8943C-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 93MM SS 7 HL LCK BN ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943C-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 106MM SS 8 HL LCK BN ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STRAP25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION STRAP ABSORBABLE 25 STRAPS SECURE STRAP 5MM|1|HUMANA [1294]||HUMANA [11839]|1,466.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,466.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8943T-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBE 98MM SS 8 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8921CDS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT REPAIR SYNDESMOSIS TIGHTROPE CANNULATED|1|HUMANA [1294]||HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-16PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 16MM CANNULATED PARTIALLY THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-18PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 18MM CANNULATED PARTIALLY THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-20PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM LOPRFL SCR TI 2.5MM P/T HEX FOREFOOT CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-22PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM LOPRFL SCR TI 2.5MM P/T HEX FOREFOOT CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-24PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM LOPRFL SCR TI 2.5MM P/T HEX FOREFOOT CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-26PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM LOPRFL SCR TI 2.5MM P/T FOREFOOT CANC SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-34PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 34MM CANNULATED PARTIALLY THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 40MM LOPRFL SCR TI 2.5MM P/T FOREFOOT CANC SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG STRG TI FSN MOD LOPRFL MTP PLT BN MTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD STRG TI LOPRFL MTP PLT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 24MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D ELEV 12.4MM 68MM 32MM LNGVT HIP STRL PRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8933-10PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 10MM CANNULATED PARTIALLY THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-12PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM LOPRFL SCR TI 2.5MM P/T FOREFOOT CANC SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-14PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0 MM X 14MM CANNULATED PARTIALLY THRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 12MM PRM ALGN GD VRSY ZML PLSLFN BEADED FC +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,988.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,988.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SDV1228|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRY SEAL 12FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE ANT 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 909-0117|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER BUTTRESS 17MM|1|HUMANA [1294]||HUMANA [11839]|861.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|861.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE HELIX 4.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 330030SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION T-SHAPED SUREFIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,280.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,280.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 10-DEG 70 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 286314SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SUREFIX DEAL NEW 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|796.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|796.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-853|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VARIABLE 4.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,443.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5740105|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CC TRIAD 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7804211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED HELIX 4MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,094.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,094.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 55MM 28MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-066-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 66 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8967-2880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-2895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-28100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 50MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 85MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-18100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 100MM CANNULATED THREADED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-18105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 105MM CANNULATED THREADED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-18115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 115MM CANNULATED THREADED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-068-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 66 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8967-18120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 120MM CANNULATED THREADED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 40MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 45MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 55MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 70MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 75MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 90MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-1895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.7MM 95MM 18MM LOPRFL SCR TI 3.5MM CANC SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-003|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-004|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-070-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 66 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9-AVP2-006|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-008|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-010|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG CV 7MM 10MM AMPLZR NTNL TY II DLV SYS OPTM EMBL SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-14.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.140|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8928BC-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEEDBRIDGE ACHILLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,220.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939031602010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 20MM PERI TPR TIP LOPRFL INFL PORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001PCBM4015140F0|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL SM 4MM 142CM 1.5CM TPR TIP PR CTBLN MNRL ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944CL-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP LOW PROFILE CONTOURED TI LONG LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-048-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 48 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8944CR-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG CNTR TI FSN MOD LOPRFL MTP PLT BN MTP RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944CR-P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT CNTR TI FSN MOD LOPRFL MTP PLT BN MTP RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944CL-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD CNTR TI FSN MOD LOPRFL MTP PLT BN MTP LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944CR-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD CNTR TI FSN MOD LOPRFL MTP PLT BN MTP RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 397005|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SUBSTITUTE CEMENT BONE HA INJECTABLE HYDROSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,489.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,489.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95MM SS 3.5/4MM SCR 2X5X 1 HL AXSOS BN TIB RT PROX LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 45MM AXSOS SS 2.5MM FT HEX FEM HUM CANC PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-22D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR CONSTRAINED TRIDENT SZ D 22MM O DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-062-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 62 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G48417|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 28MM X 82CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6990625|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT XLT 6 X 16 X 25|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6991025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT XLT 10 X 16 X 25|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8454525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 4.5 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8454530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 4.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8454535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 4.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-012|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-014|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-016|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-064-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 64 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9-AVP2-020|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,496.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP2-022|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG II VASCULAR AMPLATZER 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PLUG-004|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PLUG-006|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP038-008|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PLUG-010|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PLUG-012|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PLUG-014|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PLUG-016|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG VASCULAR AMPLATZER 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-066-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 66 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8240-77-022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION CLOSED LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203263012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 285MM TI6AL4V PERIPROSTHETIC 12 HL NCB BN FEM RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,915.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29020280|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE 2.0MM|1|HUMANA [1294]||HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END LCK TI6AL4V NCB 8MM 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 30MM NCB TI6AL4V 3.5MM FEM CORT 2 LD THRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 32MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 34MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 38MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-068-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 68 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5750006|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TRIAD CR 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203151012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 12MM NCB TI6AL4V 2 LD THRD SHLW PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 28MM NCB TI-6AL-4V HUM ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47223206000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN CBL AU 2.5MM ZM CBL RD FEM TI6AL4V HEX DRV NCB PA LCK|1|HUMANA [1294]||HUMANA [11839]|474.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|474.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00547000|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN 200CM 6-7FR 9-12MM 3 LUM ABV INJ SQ SHLDR RTRVL BIL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00547010|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN 200CM 6-7FR 12-15MM 3 LUM ABV INJ SQ SHLDR RTRVL BIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00547020|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN 200CM 6-7FR 15-18MM 3 LUM ABV INJ SQ SHLDR RTRVL BIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534210|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 7CM DDNL BND PRELD TEMP RX DLV SYS ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534220|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 9CM DDNL BND RX PRELD ADVANIX NAVIFLEX PLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534230|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 12CM DDNL BND RX PRELD TPR TIP ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-070-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 20-DEG 70 X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00534320|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 5CM DDNL BND PRELD RADOPQ RX DLV SYS ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534330|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 7CM DDNL BND PRELD RADOPQ RX DLV SYS ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534350|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 12CM DDNL BND RX PRELD TPR TIP ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534360|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 15CM DDNL BND RX PRELD TPR TIP ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-18110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 6.7MM X 110MM CANNULATED THREADED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 503356|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .035IN STRBL SFTP RADOPQ STRG 13CM CRDS STORQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943T-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBE 123MM SS 10 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943T-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TUBULAR 1/3 SS 12HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943T-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBE 47MM SS 4 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943T-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBE 59MM SS 5 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-050-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-50 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8943T-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBE 72MM SS 6 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8943T-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBE 85MM SS 7 HL LCK BN ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000220|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00534240|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 15CM DDNL BND RX PRELD TPR TIP ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|596.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|596.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-19.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588846|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING VISTA BRITE AR2 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588842|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING VISTA BRITE 8FR MPA-1 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NLV-300800Y|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK MODULAR REJUVENATE ANGLE NECK 127 DEGREE/132 DEGREE 30M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-056-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-56 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SPT-070000S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MODULAR SPT REJUVENATE #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NLV-420800Y|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK MODULAR REJUVENATE ANGLE NECK 127 DEGREE/132 DEGREE 42M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36141|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 62MM 30MM 20FR ZN RN AAA ANCLRY MAIN BD XTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10722102|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BERENSTEIN 5FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G08448|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER C3 BEACON TIP TORCON NB ADVANTAGE 5FR 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR03|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DESTINATION 6FR X 45CM PERIPHERAL GUIDING SHEATH MULTIPURPOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401845M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 8FR 35MM 45CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-058-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-58 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-42PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-0340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 11 X 340MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5893|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR PORP OFF-CENTERED 5.9MM LONG|1|HUMANA [1294]||HUMANA [11839]|1,147.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,147.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000215|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 300318A|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY FOLEY IC ADVANCE 18FR 5CC WITH STATLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-060-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-60 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TEM1509G|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX SELF-FIXATING PRO-GRIP 15 X 9CM LEFT OR RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,008.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951642|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE ALIF 16MM X 42MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8555322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 4.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-062-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-62 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6921688|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X16MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921488|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X14MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,077.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8450250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS 50-60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-064-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-64 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT9.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7906160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7906000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8860DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT PARS SUTURE|1|HUMANA [1294]||HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03150.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-066-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-66 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.03150.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 65MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 70MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 75MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203264012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 278MM TI6AL4V PERIPROSTHETIC 12 HL SCLP MIS INTFC NCB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,915.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-7545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602690S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 90MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-068-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-68 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 602695S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 95MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-3440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 13 X 440MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1850-1034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 340MM FEM GT LT T2 IM TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28mm FOR CUP OD 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -2.7MM OFST TPR 28MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36135|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 62MM 26MM 18FR RENU H&L-B 1-SHOT ZNTH 2 BRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1031S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 315MM TIB T2 IM STD LCK GUN DRL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5025S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 25MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-070-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 36MM-70 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10-700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-750|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-800|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CRUS6|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CROSSER 154CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STW130AT|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STEWARD ANGLED TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported U8130315|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 130CM 15CM OTW REINF INR LUM RADOPQ ULT-CX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0120-24-3.0|SUP|HCPCS B4088||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN 3CM 24FR RADOPQ LOPRFL TPR DIST TIP PROX ANRFLX V GSTRM|1|HUMANA [1294]||HUMANA [11839]|295.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0125RL24|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URTH LBRCTH 24FR STD 3W 2 STGR DRN EYE FL MED RND TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 102049|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 4CM X 12CM THICKNESS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W0506135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 5 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9192512|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X10X12MM VRTSTCK CRSNT 6D LRDTC STRG BLT NOSE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840005550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 50MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840005050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 36MM 58 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1474000500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.75 X 500MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5442147|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 47-60MM TI 4.75MM SCR SOLERA X10 XLNK CD HZN MLSPN BN|1|HUMANA [1294]||HUMANA [11839]|5,061.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX11MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 20MM TX ACTB CANC TRITANIUM MLHL SHL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD V40 CERAMIC DELTA BIOLOX 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY LPS PS LEGACY NEXGEN SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C12-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 12MM ACTRK2 TI MIC FT SLF CUT CNN VAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0202264009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95D 238MM TI6AL4V PERIPROSTHETIC 9 HL NCB BN FEM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.02264.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL DISTAL PP NCB LL 238MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 46MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 50MM NCB TI6AL4V 3.5MM FEM CORT 2 LD THRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 80MM NCB PROTASUL-64 FEM ST HEX HD NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203152055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 55MM 32MM NCB TI6AL4V 3.5MM P/T FEM CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203152065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 65MM 32MM NCB TI6AL4V P/T HEX FEM CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03152.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS NCB 5.0MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-08PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 8MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-10PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 10MM QFIX TI T8 P/T HEXALOBE LOPRFL SM BN CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 10.8MM 62MM 36MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8720-12PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 12MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-14PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 14MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131211122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FX 2.5MM 22MM KN THRD MLDIR COCR DVR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OFX P340|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOIMPLANT ORTHOADAPT PERFORATED 3CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 11.8MM 64MM 36MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,192.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8935-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.120.601S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4.5MM SS 3.5MM SCR 4 HL LCK ATCH LCP BN FEM DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,734.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,734.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 12.8MM 66MM 36MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.120.606S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN SS 2 PRT CNCT STRDR STRL 4.5 MM LCK ATCH PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|664.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|664.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-16PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 16MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-18PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 18MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-20PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 20MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-22PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 22MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-24PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 24MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-28PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 28MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-30PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 30MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-08PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 8MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 13.8MM 68MM 36MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8724-10PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 10MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-12PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 12MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-14PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 14MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-16PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 16MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-18PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 18MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-22PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 22MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8720-26PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.0MM X 26MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602895S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 95MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM TI T15 FT HEXALOBE MIDFOOT CORT SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-26PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 26MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-24PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 24MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-28PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 28MM QFIX TI T8 P/T HEXALOBE LOPRFL SM BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-30PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 30MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-32PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 32MM QFIX TI T8 P/T HEXALOBE LOPRFL SM BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-34PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 34MM QFIX TI T8 P/T HEXALOBE LOPRFL SM BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-36PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 36MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM LOPRFL SCR TI T15 FT MIDFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM LOPRFL SCR TI T15 FT MIDFOOT CANC ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM LOPRFL SCR TI T15 FT HEXALOBE MIDFOOT CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8940-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942L-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H WDG 32X16X6MM TI LOPRFL BN MIDFOOT LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 992196|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X 16CM THICKNESS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HOLE CLUSTER HEMISPHERICAL TRITANIUM E 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942L-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H LOW PROFILE TI 38MM X 16MM 10MM WEDGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942L-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG H FLT 36X16MM TI LOPRFL BN MIDFOOT LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942L-M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED H FLT 32X16MM TI LOPRFL BN MIDFOOT LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942L-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM H FLT 28X16MM TI LOPRFL BN MIDFOOT LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942R-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H LOW PROFILE TI 34MM X 16MM 6MM WEDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942R-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H LOW PROFILE TI 36MM X 16MM 8MM WEDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942R-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H LOW PROFILE TI 38MM X 16MM 10MM WEDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942R-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG H FLT 36X16MM TI LOPRFL BN MIDFOOT RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942R-M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED H FLT 32X16MM TI LOPRFL BN MIDFOOT RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8942L-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H LOW PROFILE TI 36MM X 16MM 8MM WEDGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -3.5MM 12/14 TPR 36MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,593.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8942R-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM H FLT 28X16MM TI LOPRFL BN MIDFOOT RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM CMNTLS SMT PRCT 5 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588TDB-9|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE ACL DB 9MM|1|HUMANA [1294]||HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 614830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM X L30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W030020150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 3.0MM X 20MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82138-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XPERT BILIARY 4.0MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 0MM 12/14 TPR 36MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8730-10PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 10MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-12PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 12MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-14PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 14MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-16PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 16MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-18PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 18MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-24PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 24MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-26PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 26MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +7MM 12/14 TPR 36MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8730-30PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 30MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-34PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 34MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-38PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 38MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 40MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-42PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 42MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64951001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM STD NTRL HIP GMRS COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-20PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 20MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-22PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 22MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10.5MM 12/14 TPR 36MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8730-44PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 44MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-46PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 46MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-48PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 48MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-14PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 14MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-16PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 16MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-34FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED THREADED FULLY 3.75 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-36FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED THREADED FULLY 3.75 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TBE-40-81-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR PROXIMAL EXTENSION ZENITH 40MM X 81CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801804001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -3.5MM 12/14 TPR 40MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7376535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED POLY 6.5MM X 35MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD DBR2 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD DBR2 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-18PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 18MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-20PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 20MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-22PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 22MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-24PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-26PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-30PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801804002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 0MM 12/14 TPR 40MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-34PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported JCDS-2426-EDS-HC|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET DILATOR ENDOVASCULAR 24/26 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-38PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-58PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 58MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-60PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 60MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-40PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-46PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 46MM QFIX TI T15 ST CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-48PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 48MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801804003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3.5MM 12/14 TPR 40MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-50PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 50MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-52PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 52MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-54PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 54MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-56PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 4.0MM X 56MM CANNULATED PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DORAL ACULOC STANDARD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8945W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER 10MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEM1208GR|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX SELF-FIXATING PRO-GRIP 12 X 8CM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801804004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +7MM 12/14 40MM HIP ZML VRSY LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 412270401|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PULMONARY ARTERY S-TIP 7FR 4LUMEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02-110-300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE KIRSCHNER WITH TROCAR POINT 1.8MM|1|HUMANA [1294]||HUMANA [11839]|252.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8930-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 10MM QFIX TI FT FT HND ANKL WRST 3 PR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8930-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICKFIX TI 2MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8931-17|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 17MM QFIX TI FT 3 PR SLF DRL ST SNPOF AQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8931-19|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICKFIX TI 3MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8870W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER 7.0MM STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRANSLATIONAL ATLANTIS FIXED 4 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801804005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10.5MM 12/14 40MM HIP DIST PRM ZML LGC VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,892.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186862012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED ST 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186854012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE OVERSIZE ST 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82925-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 7MM X 120MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82923-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 6MM X 120MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83968-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 2.5MM 150CM 100MM PERI OTW LOPRFL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED ANGLED 4.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 13MM ATLNTS TI SPNE CRV ANT SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8737-23|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK CANNULATED 2.0/2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL STD BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8737-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRSNK DRL 3MM CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240641|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X6MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]||HUMANA [11839]|3,643.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240741|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X7MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]||HUMANA [11839]|3,643.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 277303014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN DISTRACTION BENGAL 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24920018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 49110418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 49110420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.0 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL STD BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 49105002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RH SHORT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DCELL254|SUP|HCPCS Q4122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE DERMIS DECELLULARIZED ADVANCED DERMACEL SOFT 6 X 16CM|1|HUMANA [1294]||HUMANA [11839]|8,850.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DCELL204|SUP|HCPCS Q4122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE DERMIS DECELLULARIZED ADVANCED DERMACEL SOFT 6 X 16CM|1|HUMANA [1294]||HUMANA [11839]|8,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2990926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX9MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.444S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 320MM FEM XPRT IM RND CNN RTRGD ANTGRD TI STRL GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LPP13|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST TEXTURED MID-HEIGHT POLE LOW DERMASPA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-28PTS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM QFIX TI SHRT P/T T15 HEXALOBE LOPRFL SM BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921244|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X12MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL STD BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10227-010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LUMBAR INTERBODY TLIF 12MM X 27MM X 10MM|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1762-02-012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE MESH ST 12 X 14MM|1|HUMANA [1294]||HUMANA [11839]|12,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 797-72-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 95MM EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL STD BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1797-72-030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 30MM EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220153|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 49.6X13.8X1.1MM TMX 1.5MM SCR LCK LOPRFL PRECONTOUR|1|HUMANA [1294]||HUMANA [11839]|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183612032|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE EAGLE 32MM|1|HUMANA [1294]||HUMANA [11839]|3,966.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,966.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183656012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWS ST 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941234|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X12MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 15MM ALPS TMX HND CORT NONLOCK SQ DRV ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551L401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 11MM 40MM ASYM TRTHLN X3 KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,870.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1915FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 3.5MM 2.5MM 0 2.3MM .5 CRC 2 DMD PT FT CSCR FWR FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 403205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN CTTN CORT CNC WDG ALGRF FRZDR 22X16X5MM FLATFOOT|1|HUMANA [1294]||HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 403207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN CTTN CORT CNC WDG ALGRF FRZDR 22X16X7MM FLATFOOT|1|HUMANA [1294]||HUMANA [11839]|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12BSGEC45|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE LINE REINFORCEMENT MATERIAL BIOABSORBABLE E|1|HUMANA [1294]||HUMANA [11839]|505.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|505.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6710926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 26X9X10MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER MTL STD BODY EXTNCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7237325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-043-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ULNAR SMALL EXTRA 3" LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ071502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 15MM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,361.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,361.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ081502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 15MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,361.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,361.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00420S0|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CABLE BLAZER DX DUOCAPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER METAL LM BODY EXT NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,756.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,756.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71204524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 11MM X 380MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,203.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,203.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-3380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 13 X 380MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 75MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1438S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 380MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 90MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-0003S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 4MM ANKL INS ARTHDS NL STRL T2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850106|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOURED SMALL 6MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850107|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOURED SMALL 7MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR DURATIN P4 32MM 15 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,772.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,772.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL PCA 32MM +5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83972-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 3MM 150CM 120MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406840|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8FR SWARTZ SL1 63CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7MAC30|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR MAC30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7MAC40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR MAC40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER METAL LM BODY EXT NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL L.M. BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784101550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL L.M. BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-4-207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N07 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM TI HEXALOBE NS SM FRAG BS SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9542|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE WEDGE ENOPHTHALMOS RIGHT REGULAR|1|HUMANA [1294]||HUMANA [11839]|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-0262|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0305|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 90MM 5 HL LOPRFL BN OLCRN RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0327|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEXALOBE NON-LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0247|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 90MM 5 HL LOPRFL BN OLCRN LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0263|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM ELB HEXALOBE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.14003.013|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE WEDGE FIBULAR 10 X 8|1|HUMANA [1294]||HUMANA [11839]|885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-0329|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM LCK HEXALOBE HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0237|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM TI LCK HEXALOBE HD NS SM FRAG BS SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0249|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM TI LCK HEXALOBE NS SM FRAG BS SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VISION SELF-TAPPING 4.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK SHORT V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NW1040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEURAWRAP 10MM X 4CM|1|HUMANA [1294]||HUMANA [11839]|4,794.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,794.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP24000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CORONOID RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,896.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,896.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921288|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X12MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N06 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HBD-18-19-202|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATION ESOPHAGEAL HERCULES 3 STAGE 18/19/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.190|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL LM BODY EXT-NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 920-212|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE POROUS OSSEOFIT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 920-204|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE POROUS OSSEOFIT 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N04 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL L.M. BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2990922|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX9MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-92075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 9 X 25 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INF20505|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH REINFORCEMENT INFORCE 5CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,771.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,771.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported INF20659|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH REINFORCEMENT INFORCE 6.5CM X 9CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,771.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,771.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HBD-15-16.5-18|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR BALLOON ESOPHAGEAL STAGE 3 HERCULES 15/16 5/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B112-45|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON LUMEN MULTI FLEX CONTURA 4-5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48173|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT NPHURSTM 22CM 8.5FR COPE MCLC PGTL CRV ULTHNE LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL L.M. BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939135152010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 143CM 20MM RX ULT LOPRFL NYBAX BSLD CYTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939135202010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 143CM 20MM RX ULT LOPRFL NYBAX BSLD CYTE ES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001PCBO3515140F0|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH BLNDIL SM 3.5MM 137CM 1.5CM OTW TPR TIP PR CTBLN ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,598.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,598.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71-906|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAROTID WALLSTENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71-905|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAROTID WALLSTENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,710.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,710.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS FIXED 4.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N05 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-11.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-11.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR11.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 904753|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH TOG TOGGLELOC ADJ|1|HUMANA [1294]||HUMANA [11839]|1,389.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,389.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N05 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK LONG V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8921438|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 12MM X 38MM X 28MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8555327|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8555328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8931634|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 12MM X 42MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-045-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,076.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532G709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 437514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 310MM SS 4.5/5/6.5MM SCR 10X5X 7 HL AXSOS BN FEM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 370114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 14MM AXSOS SS T20 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|542.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 370118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 18MM AXSOS SS T20 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|542.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 343075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 75MM AXSOS SS 3.5MM FT HEX FEM CANC DIST LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1848-1336S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON T2 13 X 350 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1897-6085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM TI FEM LG CNN STRL BRNZ T2 RECON NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1897-6080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 80MM TI FEM LG CNN STRL BRNZ T2 RECON NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1897-5090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG RECON T2 6.5 X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|963.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|963.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-D8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 6.5 MIDBLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-045-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK CR SZ-5 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STA-D7|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 5.5 MIDBLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STA-P4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAYFUSE SCREW 6.5MM PROXIMAL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-60F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75446555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LEGACY AXIAL MULTI 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD TI ACLC BN RT DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-11.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-11.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.155|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +15.5 DIOP CNVXPLN 13.5MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-040-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493902408350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ION MONORAIL 3.50 MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902412350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XS X 24MM SS 2.4/2.7MM SCR VA LCK LOPRFL CMPR WRE HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,976.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,976.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 39MM SS 2.4/2.7MM SCR VA FSN LOPRFL PRECONTOUR LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 24MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 32MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-040-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,251.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.231.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 34MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 65MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 70MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 75MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 50MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 80MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONDYLAR CURVED LCP VARIABLE ANGLE 4.5 X 10-HOLE 230MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,609.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,609.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONDYLAR CURVED LCP VARIABLE ANGLE 4.5 X 10-HOLE 230MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,609.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,609.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N04 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGT4020|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS GRAFT ANEURYSM THORACIC 40MM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGT3715|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS GRAFT ANEURYSM THORACIC 37MM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7908240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD COBALT 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.5 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.5 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G54534|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN .038IN 900 PSI MIC 2.8FR .025IN 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7908036|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS 36MM|1|HUMANA [1294]||HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7908032|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS 34MM|1|HUMANA [1294]||HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967W|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 13MM ORTH TI|1|HUMANA [1294]||HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67006400|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING XB LAD 4.5 6FR 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011493-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 5.0 X 15 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011493-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 5.0 X 18 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011496-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 5.5 X 15 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011496-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 5.5 X 18 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860C0500|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY ALLOMATRIX CANCELLOUS|1|HUMANA [1294]||HUMANA [11839]|3,510.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,510.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1011499-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 6.0 X 15 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011499-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 6.0 X 18 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011502-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 6.5 X 15 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011502-18|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 6.5 X 18 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011505-15|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RX HERCULINK ELITE 7.0 X 15 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24910024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NW540|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEURAWRAP 5MM X 4CM|1|HUMANA [1294]||HUMANA [11839]|4,713.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,713.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG630|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 6.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK TAPER SHORT 440 MODULAR ABG II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 058100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE MATRIX DBX 10CC|1|HUMANA [1294]||HUMANA [11839]|5,952.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,952.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT7-13.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-13.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6712126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 26X11X12MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 370112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 12MM AXSOS SS T20 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|542.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|542.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 343070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM AXSOS SS 3.5MM FT HEX FEM CANC DIST LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1BSGEC60A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE LINE REINFORCEMENT MATERIAL BIOABSORBABLE E|1|HUMANA [1294]||HUMANA [11839]|603.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0068502000|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ADVANTAGE SLING TRANSVAGINAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,262.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8253|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON REPLACEMENT 20FR X 2CM ENDOVIVE LOW PROF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8254|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON REPLACEMENT 20FR X 2.5CM ENDOVIVE LOW PROF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130200|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER URETERAL LUMEN DUAL C1758|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8251|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON REPLACEMENT 20FR X 1CM ENDOVIVE LOW PROF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8252|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON REPLACEMENT 20FR X 1.5CM ENDOVIVE LOW PROF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602875S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 75MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N03 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P60010|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BONE XPANSE SMALL R 20MM X 5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4941-1-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPLNG XTRNFX HFMN2 C PIN TO ROD 5 MM ROD POST 3-4 MM PIN MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,116.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,116.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602885S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 85MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602890S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 90MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4941-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPLNG XTRNFX HFMN2 C ROD TO ROD 5 MM ROD POST MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,116.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,116.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5048-5-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 150MM 5MM VECTRAN C CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5038-5-080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 80MM 3MM APX SS SLF DRL ST THRD 20MM XTRNFX SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-1605|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE BIOACTIVE FOAM PACK VITOSS BA 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,100.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,100.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1322BCNF|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.4MM 2-0 MIC STRG FWD TPR BSUT TK FBRWR SM BN 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-46B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 437308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 173MM SS 3.5/4MM SCR 8X5X 4 HL AXSOS BN TIB LT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 70MM AXSOS SS 2.5MM FT HEX FEM HUM CANC PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 32MM AXSOS SS FT HUM CORT PROX HEX DRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-064-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ECCENTRIC 64 X 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 437526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 166MM SS 4.5/5/6.5MM SCR 6X5X 3 HL AXSOS BN FEM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 36MM AXSOS SS HEX FEM CORT LAT DIST ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM SS CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 3.5MM 44MM AXSOS SS FEM CORT DIST LAT HEX DRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.617.128F|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FUSION INTERBODY CERVICAL ANTERIOR PROFILE ZERO 8MM|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.617.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM ZERO-PTI SPNE CRV LCK ST SLF CNTR NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK TAPER SHORT V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG X3 INSERT 32mm ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-066-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ECCENTRIC 66 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-4-418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK LONG V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 121MM SS 3.5/4MM SCR 4X5X 2 HL AXSOS BN TIB RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 75MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-1610|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUB BNGF VITOSS BTCP CLGN VOID FIL FM PK BIOACTIVE 10ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,570.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,570.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551-G-381-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYMMETRIC X3 PATELLA 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-4-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N06 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-068-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ECCENTRIC 68 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-4-107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N07 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2008-NS|SUP|HCPCS L8509||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS VOICE 20 FR 8MM ADVANTAGE|1|HUMANA [1294]||HUMANA [11839]|941.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|941.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-3380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 13MM X 380MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREAD FULL 2.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430205219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 19MM 52MM SHLDR MDLR BGLNI/FLTW ZML OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921444|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X14MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-070-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ECCENTRIC 70 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8931242|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 12MM X 42MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 673200500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 32MM SIZE-E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +5.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-28.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6152-062-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER OBLIQUE 62 X 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT9.290|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-18.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0608001|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE PLIABLE 6 X 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 30X20CM STRATTICE PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,361.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,361.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2040002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 40X20CM STRATTICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,486.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63,486.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2540002|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 40X25CM STRATTICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79,359.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79,359.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8455545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 5.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8455540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203264015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL DISTAL 15 HOLE RIGHT PERIPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-044-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 44 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0203150036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 36MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 38MM NCB TI-6AL-4V HUM ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03151.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL NCB 5.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.280|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM ATLNTS TI SPNE CRV ANT FX ANG ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 17MM ATLNTS TI SPNE CRV ANT ST FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 17MM ATLNTS TI SPNE CRV ANT VA ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154106000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP PROSTALAC SIZE 1 HI OFFSET 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1238S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 38CM FEM T2 IM LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-046-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY STANDARD 46 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1828-1136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 12MM X 360MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,492.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,492.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 85MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5055S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 55MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 80MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44174516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 45MM 16MM CHRLT SS ST MU CMPR CNN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8660012|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE BONE ALLOGRAFT EVANS ALLOPURE 12 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8662006|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE BONE ALLOGRAFT COTTON ALLOPURE 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402045|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 12X4CM ALDRM THN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER TRILOGY 10/20 ALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 44182523|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 230MM 2.5MM KRSH CHRLT THRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.8MM 22MM KOMPRESSOR TI MN ORTH CMPR IMPL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,364.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 20MM KOMPRESSOR MN CMPR IMPL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,364.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,364.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 6.3MM 46MM 28MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PL-DR60R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG ACLC BN RDS RT DIST VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 22MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-21.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-21.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.210|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902408250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.215|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902408300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902408400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 4MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902412250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-044-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 44 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493902412300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902412400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 4MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902416250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 2.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902416300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902416350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902416400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 16MM 4MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C16-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 16MM ACTRK2 TI MIC FT SLF CUT CNN VAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 42.5MM TI 2 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK SHORT V40 MODULAR III ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6320-046-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LONGEVITY 20-DEGREE 46 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 210024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT PNLK OTHCRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,698.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,698.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W06040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 7MM 135CM 60MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902432300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902432350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902438300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902438350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39024-2050|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ION MONORAIL 2.50 MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902420300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902420350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 11MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493902420400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 20MM 4MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902424250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 2.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902424300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902424350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902424400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 24MM 4MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902428250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 2.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902428300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902428350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902428400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 4MM ION CLIPIT MNRL TRANSLUTE PCLTXL PLTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493902432250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 32MM 2.5MM ION CLIPIT MNRL TRANSLUTE PCLTXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 786101104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS SIZE 11 X 120MM ENHANCED TAPER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SC-9004-55|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR PRECISION 55CM|1|HUMANA [1294]||HUMANA [11839]|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1846-1134S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON T2 11 X 340 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,887.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,887.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7291035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6570-0-736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +7.5MM OFST TPR 36MM HIP BLX D V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5020362G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 62MM PRM HMSPHR CH TRITANIUM G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ X3 INSERT 36mm ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672800400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR STANDARD 28MM SIZE-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 786101304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS SIZE 13 X 130MM ENHANCED TAPER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PXB35-06-27-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 6MM DIAMETER X 27MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 31-8106-43|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER UNIVERSAL C/M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32810503800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG WITH NOZZLE C/M 16MM & 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55246|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 74MM 24MM 16FR ZNTH SPRLZ Z-TRK BFUR ABD AORTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55231|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 56MM 13MM 5.4MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 32-8105-043-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ULNAR SMALL 3" RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 431190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD STEM HIP 9 X 125MM W/REINFORCEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,024.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,024.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CMNT STG1 0 HIP SIL SPCR NK ADPR STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD FEM HD 52MM STG1 SLCT HIP SIL 2 40G CMNT MX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,587.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,587.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74-3-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STABILIZED POSTERIOR SCORPIO 12MM SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,690.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,690.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CEMENTED STEM 12MMX50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 21MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55232|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 74MM 13MM 5.4MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55238|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 74MM 16MM 5.4MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55237|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 56MM 16MM 5.4MM 14FR ZNTH SPRLZ BFUR AAA PLSTR SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55241|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 56MM 20MM 6MM 16FR ZNTH SPRLZ 2 BRCH NTNL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55242|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 74MM 20MM 6MM 16FR ZNTH SPRLZ 2 BRCH NTNL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 84000611|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOSET RESORBABLE BEADS 5CC #84000611|1|HUMANA [1294]||HUMANA [11839]|2,106.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,106.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 520-01-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRIMARY TURON SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77542535|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK SMALL|1|HUMANA [1294]||HUMANA [11839]|4,163.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,163.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.0725|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK CLAVICLE 3.5MM LCP 4-HOLE 12 DEPTH 44MM/RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,241.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,241.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9393012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30MMX12MM CRSNT PEEK-OPTM VERT BD REPL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80-0724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRILL SRG FRAG-LOC 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|531.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|531.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0371|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION FRAG-LOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMRM3122|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENVELOPE PACEMAKER ANTIBACTERIAL AIGIS RX|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM 3.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0357|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 51X25MM 2.3MM SCR VA ACLC 2 BN RDS RT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186801014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 14X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,247.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,247.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ051502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH SPRFC FEM ART ILIUM 15CM 5MM 6FR HEP VBHN 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR080502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 5MM X 120MM HEPRIN BIOACTIVE SU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,311.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,311.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-09903-CDC|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PSI WITH INTEGRAL HEMOSTASIS VALVE SIDE PORT FOR USE WIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14000802|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE TOTAL ABSCESSION 6.5F X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14000825|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DRAINAGE TOTAL ABSCESSION 12F X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR TMX 7 HL ANTM LCK LOPRFL ALPS BN HUM RL DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-37-026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604642S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 42MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9122-1015-W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL TOE 12MM HEMICAP 1MM 1.5MM OFST MTP COCRMO TI REINF MRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4152DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT DISPOSABLE PIN DRILL TRIM-IT 2MM X 100MM|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 5 5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1318FT-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.2MM 4-0 3/8 CRC MIC FT TPR CSCR FWR FT/ANKL 2 NDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57.5MM TI 3 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM ATLNTS TI SPNE CRV ANT FX ANG ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FA 4MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55245|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 56MM 24MM 6MM 5.3MM ZNTH SPRLZ AAA AQ ILC LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8931638|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 14MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8555326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8456555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111434SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 34MM QWIX TI HEX FOREFOOT CORT SLF DRL ST CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604650S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 50MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 18mmX195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 25mm +0mm (STD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TF-25A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TISSUE TRIFECTA 25MM|1|HUMANA [1294]||HUMANA [11839]|17,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629264|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 105MM TI 4 HL VARIAX BN HUM RT P/L NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 128MM TI 6 HL VARIAX BN HUM RT P/L NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629268|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL POSTERIOR 8 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1847-1138S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON T2 11 X 380 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,887.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,887.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1846-1138S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON T2 11 X 380 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,887.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,887.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6248DEL|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DELIVERY SYSTEM ATTAIN SELECT II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-21.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-21.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-24.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-19.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9393010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30MMX10MM CRSNT PEEK-OPTM VERT BD REPL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85441|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST 5MM X 22MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W08020080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 8MM 80CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 40MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 60MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 70MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|733.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|733.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 50MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6711132|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 32X11X11MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|10,986.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,986.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6807115|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 14X11X7MM CRNT SM PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 159MM SS 4.5MM SCR 6 HL 4 CLMN THRD VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,256.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,256.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE ANGLE SELF TAP 5.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|556.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|556.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 84MMX2MM TI 6 HL LCK LOPRFL VARIAX BN FIB NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558390|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 5.5CM 7.5FR 6-8MM ESPH PYL CLN PEBAX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8255|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON REPLACEMENT 20FR X 3CM ENDOVIVE LOW PROF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-3400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 13 X 400MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,611.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5048-5-200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX YLW 200MM 5MM VECTRAN C CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 11MM X 400MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6709126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 26X11X9MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5023-3-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 120MM 4MM APX SS SLFDRL ST THRD 30MM XTRNFX SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-14-80-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 14MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-14-60-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 14MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 624890D02|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN 4 FR TO LFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9026-036-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL TAPER 6 DEGREES 26MM +14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HAT TOP LATARJET 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HAT TOP LATARJET 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6710132|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 32X11X10MM CRNT 4D LG IMPCT PEEK-OPTM NS LF|1|HUMANA [1294]||HUMANA [11839]|10,986.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,986.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 86MM SS 3.5/4MM SCR 3X7X 1 HL LCK AXSOS BN HUM RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6191-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE FULL PACK- HOWMEDICA SIMPLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|196.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4921-1-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPLNG XTRNFX HFMN2 PIN TO ROD MRI CLR CD 4-5 MM PIN 8 MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,766.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,766.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5028-7-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 174MM 8MM HFMN2 MRI C SEM CIRC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATF-180-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.2-2.5MM 18MM ACTRK TI FT SLF CUT CNN FSN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMRM3122-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENVELOPE PACEMAKER ANTIBACTERIAL AIGIS RX|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMRM3133-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENVELOPE PACEMAKER ANTIBACTERIAL AIGIS RX|1|HUMANA [1294]||HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2366-50|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 50CM 3-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 9MM KN X3 CRCTE SUB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.462S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 420MM LOCKING FIXATION RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130MM SS 4.5/5/6.5MM SCR 4X5X 2 HL AXSOS BN FEM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING AXSOS 5.0MM L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 343080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 80MM AXSOS SS 3.5MM FT HEX FEM CANC DIST LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061451490|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7-14FR 26CM THNWL PGTL CRV PSTNR SMTH SRFC TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|590.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 604746S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 46MM FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.114.514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SS 1.5 MM SCR MDLR MN FRAG SET 6 HL SHFT ST DRL GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,730.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,730.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK SHORT V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 56MM 11MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH NTNL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M57260600070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ITOTAL CONFORMIS 38MM X 8.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55226|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 74MM 11MM 5.4MM 4.7MM ZNTH SPRLZ AAA NTNL ILC LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TCR1111111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT KNEE RIGHT CR CONFORMIS ITOTAL (CONTAINS FEMORAL IMPLANT, TIBIA TRAY, LATERAL INSERT, MEDIAL INSERT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M57260600060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ITOTAL CONFORMIS 35MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TCR1111111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT KNEE LEFT CR CONFORMIS ITOTAL (CONTAINS FEMORAL IMPLANT, TIBIAL TRAY, LATERIAL INSERT, MEDIAL INSERT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061451500|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7-14FR 28CM THNWL PGTL CRV PSTNR SMTH SRFC TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|590.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3548314|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE BREAST STYLE 6300 HEIGHT TALL 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1117S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 170MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,154.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,154.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55233|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 13MM 5.4MM 14FR ZNTH SPRLZ BFUR AAA PLSTR SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55239|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 16MM 5.4MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55243|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 20MM 16FR SPRLZ ZNTH Z-TRK 2 BRCH AAA PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55247|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 24MM 6MM 16FR ZNTH SPRLZ AAA PLSTR SS NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT7-17.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,251.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82098-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 30MM STRG SLF XPD CLS CELL FLR END FRSTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82090-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8-6MM 40MM 136CM TPR SLF EXPANDABLE ERG HNDL FLXB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8921642|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 12MM X 38MM X 28MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P306-0090-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME PATELLA HEMICAP 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,064.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,064.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PX02-1005-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL TROCHLEA 10.0MM X 5.0MM XL OFFSET RESURFA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PX11-0218-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST TPR 11X21.5MM HEMICAP TI RSRFC PTLFEM ARTHPL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,851.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,851.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM ATLNTS TI SPNE CRV ANT SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4910S001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HEAD RADIAL EVOLVES SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24920012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CORTICAL 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24920022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CORTICAL 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-070-320|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE PROTECTION EMBOLIC FILTER 7.0 FX SPIDER 320CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PX00-0200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN KIT ARTHROSURFACE PF XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC70574|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCLERA TISSUE 1/2(PROCESSING FEE) (SEE COMMENTS FOR DETAILS)|1|HUMANA [1294]||HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BCFT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW BIOCOMPOSITE FT 5.5MM W/TIGERTAIL #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AXF-XL-15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT X-FUSE ARTHRODESIS IPJ HALLUX EXTRA LARGE 15 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AXF-L15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL IM X FUSE 15D LG FT/ANKL SUPERELASTIC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,307.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W07040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 7MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212843|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MICRO QA 3-0 ORTHOCORD W/BIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1670BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR BCMPS 10MM 7MM ACL TENODESIS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3060-0075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 10.5MM 75MM GAMMA3 TI HIP TROCH LG STRL NL 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL 50MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 415-00-160|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG CEMENT CLEARCUT ENCORE #16|1|HUMANA [1294]||HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 30MM 7MM FEM BABSR BSCR GRDSMN STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00235903537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 35MM SS CNCL PERIART CNN NS ACPT 1.6MM GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-056-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 21MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8931238|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 16MM X 38MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8991438|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 14MM X 38MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8457555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 55MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8457550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 50MM ARMADA TI SPNE PA NS ARM15T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8042075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012447-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.5 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8039|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 30MM 8MM FEM BABSR LTRM ABS BSCR GRDSMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012449-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.0 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 10-HOLE 79MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR POLY-L-LAC ACD 30MM 9MM FEM BABSR BSCR GRDSMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 816135036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111440SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 40MM QWIX TI HEX FOREFOOT CORT SLF DRL ST CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0358|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 51X22MM 2.3MM SCR VA ACLC 2 BN RDS LT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL PS 18MM X 71/75 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55227|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 11MM 14FR ZNTH SPRLZ Z-TRK 2 BRCH SS NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301106|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 6MM BENGAL 7D STD CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-52-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE STRAIGHT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068507000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS URTH SPRT 9CM SOLYX ADV MIDURETHRAL PP INCS SLNG DLV DEV|1|HUMANA [1294]||HUMANA [11839]|3,935.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,935.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAJ-233|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN ESCP CUF LTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAJ-249|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN ESCP CUF US LTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558400|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 5.5CM 7.5FR 8-10MM ESPH PYL GW BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558410|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL ESCP CRE 180CM 5.5CM 7.5FR 10-12MM ESPH PYL BLN CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 14MM SS T25 CNDRL VA ST LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|806.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|806.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011733-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 33MM 3MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011733-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 3MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011731-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 33MM 2.5MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011731-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 2.5MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011734-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 33MM 3.5MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011734-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 3.5MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011735-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 33MM 4MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011735-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 4MM XIENCE PRM EVEROLIMUS COCR RX RADOPQ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 20MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-860-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BLADE,CONDYLAR,60MMX9 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,037.31|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,037.31|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.231.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 26MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 28MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 30MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 36MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 38MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 42MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 44MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 46MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 48MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 55MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-860-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BLADE,CONDYLAR,60MMX12 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,132.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,132.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.231.280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 80MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.285|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 85MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 90MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 10MM SS T25 CNDRL VA ST LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|806.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|806.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 12MM SS T25 CNDRL VA ST LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|806.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|806.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602660S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 60MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602670S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 70MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 16MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200M-055R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WEDGE OPENING LOW PROFILE 5.5MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1319FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW MINI FT 2-0 FIBERWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2411-870-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BLADE,CONDYLAR,70MMX9 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,037.31|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,037.31|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.124.406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 159MM SS 4.5MM SCR 6 HL 4 CLMN THRD VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,256.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,256.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 195MM SS 4.5MM SCR 8 HL 4 CLMN THRD VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,359.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,359.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 195MM SS 4.5MM SCR 8 HL 4 CLMN THRD VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,359.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,359.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 266MM SS 4.5MM SCR 12 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,726.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,726.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 266MM SS 4.5MM SCR 12 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,726.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,726.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 301MM SS 4.5MM SCR 14 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,111.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,111.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 301MM SS 4.5MM SCR 14 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,111.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,111.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 336MM SS 4.5MM SCR 16 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.304S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 95MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.124.417|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 336MM SS 4.5MM SCR 16 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 370MM SS 4.5MM SCR 18 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,636.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,636.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.419|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CRV 370MM SS 4.5MM SCR 18 HL 4 CLMN THRD VA LCP CMBN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,636.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,636.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 20MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 25MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 30MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 35MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 40MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 45MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 55MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.301S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE IM NL AU 80MM 11MM HLCL TROCH TI CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,034.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.231.665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 65MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 70MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 75MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.685|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 85MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.690|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 90MM SS CNDRL VA SLF DRL LCK CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-5340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 15MM X 340MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-2210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUB BNGF BBTRAUMA VITOSS FM PK BIOACTIVE OSTCNDC SCFLD 10ML|1|HUMANA [1294]||HUMANA [11839]|9,954.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,954.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 49X24MM 2.3MM SCR VA ACLC 2 BN RDS LT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NEURO LOW PROFILE TI STRAIGHT 4-HOLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NEURO LOW PROFILE TI ORBITAL RIM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NEURO LOW PROFILE TI DOUBLE Y 6-HOLE 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING MANDIBLE LARGE TI 20-HOLE 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.295|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.3MM 10MM TI MNDB ST LCK +DR NS BLU 5 PK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|385.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.296|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.3MM 12MM TI MNDB ST LCK +DR NS BLU 5 PK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|385.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.297|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.3MM 14MM TI MNDB ST LCK +DR NS BLU 5 PK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|385.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|385.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 16MM SS T25 CNDRL VA ST LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|806.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|806.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 18MM SS T25 CNDRL VA ST LCK STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|806.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|806.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.6MM 2.9MM 4MM TI CRNL SLF DRL SLF RTN LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 22MM SS T25 CNDRL VA ST LCK STRDR NS PERIART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|575.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 9MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604670S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 70MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604655S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 55MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604640S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 40MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 619905|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER ASNIS III 4.0MM|1|HUMANA [1294]||HUMANA [11839]|94.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|94.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S22-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4-4.1MM 22MM ACTRK2 TI STD FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE ANGLE SELF TAP 5.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|556.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|556.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604648S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 48MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941034|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X10MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RMT311413|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 13CM 31MM 14.5MM XCLDR C3 TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SDV2028|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRY SEAL 20FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXA320400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 4.5CM 32MM XCLDR C3 AORTA GRTX NTNL FEP STNT XTD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75444530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 30MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75444535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 35MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75445035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 35MM CD HZN LGC TI FLUT SPNE MA ST RVRS ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,709.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-1056|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE BIOACTIVE FOAM PACK VITOSS BA 23CC|1|HUMANA [1294]||HUMANA [11839]|11,093.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,093.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST 28MM HIP VIT PCA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5200 M24|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 24MM MTRL C-E PH II|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M26|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 26MM MTRL C-E PH II|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M28|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II 28MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 30MM MTRL C-E PH II|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M32|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 32MM MTRL C-E PH II|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M34|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 34MM MTRL C-E PH II|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M36|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 36MM MTRL HLDR C-E PH II COCR SIL PLSTR STRL|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5200M38|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 38MM MTRL C-E PH II|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 41617000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TENDON TIBIAL POSTERIOR|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3300TFX21MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS AORTIC PERICARDIAL PERIMOUNT CARPENTIER-21MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3300TFX23MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS AORTIC PERICARDIAL PERIMOUNT CARPENTIER-23MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3300TFX25MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS AORTIC PERICARDIAL PERIMOUNT CARPENTIER-25MM|1|HUMANA [1294]||HUMANA [11839]|20,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|20,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3300TFX27MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS AORTIC PERICARDIAL PERIMOUNT CARPENTIER-27MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W09040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 9MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 135CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-48C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK LONG V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3300TFX19MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS AORTIC PERICARDIAL PERIMOUNT CARPENTIER-19MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-4-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N08 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44112000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE ORTH 150MM 1MM CHRLT MTP SS 1 END TROC PNT|1|HUMANA [1294]||HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL 54MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 45MM TI 2 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM ATLNTS TI SPNE CRV ANT SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3003-0822S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TITANIUM SET I X 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|507.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G53422|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 30 X 140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0201-0012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL SEMI CONSTRAINED CEQUENCE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0206-4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL SELF TAP 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0206-4012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL SELF TAP 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-C-1517-7|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 17X7MM C-+ 7D LRDTC 14.5MM PEEK-OPTM THRD CNCT|1|HUMANA [1294]||HUMANA [11839]|7,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-C-1517-6|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 17X6MM C-+ 7D LRDTC 14.5MM PEEK-OPTM THRD CNCT|1|HUMANA [1294]||HUMANA [11839]|7,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPS0121K|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR HUM 99MMX16MM 41MM 7MM INTSPC SM SHLDR PMMA GNTA .4GM|1|HUMANA [1294]||HUMANA [11839]|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 114005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP,VENA CAVA,PARTIAL OCCLUSI|1|HUMANA [1294]||HUMANA [11839]|738.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|738.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7967812|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32X23X12MM CRSNT SVRGN 8D SM PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11014L|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER FLOWGUARD WITH 14GA STANDARD TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FEL07040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 40MM 7MM 8FR FLN + EVAS EPTFE C 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.751S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57MM SS 2.4MM SCR 6 HLE/HD 5 HL SHFT VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 11 MM|1|HUMANA [1294]||HUMANA [11839]|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X8MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240941|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X9MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6241041|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STRUT SPNL 14X5MM VRTSTCK HDRSRB 11MM CRV PEEK-OPTM|1|HUMANA [1294]||HUMANA [11839]|9,702.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,702.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 13MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186802030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 30X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,444.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,444.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240664|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X16MM VRTSTCK CRSTN PSR 6MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]||HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240764|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X16MM VRTSTCK CRSTN PSR 7MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM ATLNTS TI SPNE CRV ANT ST FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18017000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LIGAMENT PATELLAR PRE SHAPED CENTRAL THIRD 10MM DOWEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00551.203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP UNCEMENTED TAPER 12/14 5 DEGREE SIZE B/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06020080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 80CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0185|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ICD 64CM 3MM 2.7MM ETAK RLNC GGORE STRD SIL 1.3MM ECRDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-2105|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUB BNGF VITOSS 2X BVN CLGN CA PHOS FM BIOACTIVE VOID FIL PK|1|HUMANA [1294]||HUMANA [11839]|4,731.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8554520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 4.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1651-48|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 80CM 4FR 10MM LMTR .025IN 1 LUM BLN OTW GW .75ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1651-88|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBOLECTOMY OVER-THE-WIRE 5FR X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR1-2905|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM STABILIZATION AXIALIF WITH AXIAL UNIVERSAL PLUG/ 3D|1|HUMANA [1294]||HUMANA [11839]|26,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BF14-7D19-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE BONE GRANULES BI-OSTETIC 10CC 14 DOWELS|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSCF-21-145-3|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SAFE-T-J CURVED .021 145 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W08080080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 8MM 80CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.928|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMF 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|284.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|284.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CX01B|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMNT BN KYPHON XPEDE SPNL MXR|1|HUMANA [1294]||HUMANA [11839]|630.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HF13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ALL SUTURE Y-KNOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|726.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|726.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629350S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 161MM TI 10 HL VARIAX BN OLCRN LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-20.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC02A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMNT BN KYPHON CDS 8ML CRTDG|1|HUMANA [1294]||HUMANA [11839]|300.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3420-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA RIGHT 3S 10 X 380MM X 120 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,006.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,006.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30650070S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET TI 70MM 10.5MM HIP U BLDE LG GAMMA3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,447.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,447.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496H024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL MODULAR EVOLVE STANDARD 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 65MM AXSOS SS 2.5MM FT HEX FEM HUM CANC PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL DELTA CERAMIC TS 12/14 32MM +1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,563.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,563.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N03 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0184|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LD PCNG 59CM 9FR 18CM SPC HLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3249-40Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR UNIFY QUADRA CRT-D BI-VENTRICULAR ICD DF4COMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE SIZE +4 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 30MM TI 1 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 12MM ATLNTS TI SPNE CRV ANT SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00618|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STRAIGHT .025 145 CMTSF-25-145-BH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1458Q/86|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD QUAD L V W/S CURVE FIX 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6711-00623|SUP|HCPCS C2639||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEED LOOSE I-125 W/XRAY MARKER .623 MCI|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD800F|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MERIDIAN IVC FILTER FEMORAL DEPLOYMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD800J|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MERIDIAN IVC FILTER JUGULAR DEPLOYMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,335.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,335.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W12040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 12MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27614E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 14MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 16MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 12MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM AXSOS SS 2.5MM FT HEX FEM HUM CORT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 427006S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 84MM SS 4MM SCR SM FRAG 6 HL LCK CMPR AXSOS BN WST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ-B RIGHT MEDIAL LEFT LATERAL P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL RIGHT MEDIAL LEFT LATERAL PRECOAT UNI KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510F102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 1 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-109-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 22MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200M-06R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META OPEN RIGHT LOW PROFILE 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-3822S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 220MM HUM RT PROX T2 IM LCK RTRGD ANTGRD GUN DRL TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-0073S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE ORTH TFLN T2 HUM NL SYS|1|HUMANA [1294]||HUMANA [11839]|774.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|774.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-0083S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GW ORTH 800MM 2.5MM HUM TI BALL TIP T2 NL SYS STRL|1|HUMANA [1294]||HUMANA [11839]|562.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|562.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55-2616|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X24X16MM ZUMA 8D PEEK-OPTM ALIF NS LF|1|HUMANA [1294]||HUMANA [11839]|17,334.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,334.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55-5525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ZUMA 5.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,827.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,827.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55-5530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ZUMA 5.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,827.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,827.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55-6016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CVR 16MM ZUMA SPNE LCK ALIF NS LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-16.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45710110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE PRO-TOE VO 10D SM HMRTOE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45710200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE PRO-TOE VO 0D LG HMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.802.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 25MM 20MM SYNFIX-LR TI SPNE PDCL LCK ST FN TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|926.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|926.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.802.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNFIX 4 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|926.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|926.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.802.016S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32X12-9MM SYNFIX-LR 8D LRDTC 26MM CNVX PEEK TI|1|HUMANA [1294]||HUMANA [11839]|19,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 70MM 16MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W10040080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 10MM 80CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.750S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57MM SS 2.4MM SCR 6 HLE/HD 5 HL SHFT VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT SZ 4 - BEADED W/PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 19X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS BN CMNT OPTVC T/H CRTDG NRM CPC CHRCL FLTR 2 BRKWY NOZ|1|HUMANA [1294]||HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CEMENT OPTIVAC 80 GRAM|1|HUMANA [1294]||HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 32mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2080-0015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GAP PLATE SCREWS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|370.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|370.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL PS 14MM X 71/75 VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY SZ 3 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802440|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 28CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9393011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30MMX11MM CRSNT PEEK-OPTM VERT BD REPL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5440430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET TI SPNE BRKOF SOLERA SXTNT CD HZN NS 4.75 MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|903.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|903.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 40MM 4.75MM SXTNT CRV COCR MLBDN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8453112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK LAMINA 6MM|1|HUMANA [1294]||HUMANA [11839]|2,493.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,493.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM VRTX MX TI SPNE MA NS GRN RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911412300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.00 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911412350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.50 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911412400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 4.00 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911416250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.50 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911416300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.00 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911416350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.50 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911416400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 4.00 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911420250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.50 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911420300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.00 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911420350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.50 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911420400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 4.00 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911424250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.50 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911424300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.00 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911424350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.50 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911424400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 4.00 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911428250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 2.5MM PROMUS ELMT + CLIPIT MNRL EVEROLIMUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911428300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.00 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911428350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.50 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911428400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 4.00 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911408220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911412220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840016555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911408250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.50 X 8MMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911408270|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.75 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911408300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.00 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911408350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 3.50 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911408400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 4.00 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911412250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.50 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911412270|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.75 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911416220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911420220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911424220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911428220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911432220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT MR STENT 2.25 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.120.704S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 105MM SS 3.5MM SCR 4 HL LOPRFL LMT CNTCT LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,157.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,157.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7509007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM SM 25X7.5MM INTVRTB|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840015540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840007545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 45MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 30MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 37.5MM TI 2 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM926T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.8 X 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|532.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM927T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.8 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|532.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM964T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE- Y 1.5MM X 17MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|131.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|131.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM9665T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM X 63MM 16 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|147.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|147.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM968T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BOXCAR 1.5MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|196.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM969T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BOXCAR 1.5MM 6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FM970T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BOXCAR 1.5MM 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G02819|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC 5FR X 100CM 5.0-53-100-P-NS-45-DEG-AN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W025100150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 2.5MM 150CM 100MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01793|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SAFE-T-J CURVED .021 180 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7509145|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM 5X1.75CM|1|HUMANA [1294]||HUMANA [11839]|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 46MM LONG THREAD STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186801016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 16X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 7MM BENGAL 7D LG CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186854014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE OVERSIZE ST 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 600-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE SULPHATE CALCIUM STIMULAN 10CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7577055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AFFEX II 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE MAGNITUDE 10MM|1|HUMANA [1294]||HUMANA [11839]|15,894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 12MM MGNT|1|HUMANA [1294]||HUMANA [11839]|15,894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840016550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840015550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 50MM SOLERA CD HZN TI COCR SPNE MA CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9393009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30MMX9MM CRSNT PEEK-OPTM VERT BD REPL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840016535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2990726|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX7MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1009544-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COR 8MM 2.25MM EVEROLIMUS ELUT COCR XIENCE V 143CM DLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SS9.5|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRODUCER LEAD PERCUTANEOUS VALVED 9.5 FR 13CM SINGLE CHAMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|107.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|107.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-1010|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS VALVED 10 FR 13CM SINGLE CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 296|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DEFIBRILLATOR ENDOTAK RELIANCE 64 CM IS4 DCG DUAL COIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-20.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.675S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 4.8MM 85MM TI T25 FT FEM LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.650S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 4.8MM 60MM TI T25 FT FEM LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7965520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOVEREIGN 5.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7967814|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FUSION LUMBAR SOVEREIGN 8 DEGREE 32 X 23 X 14MM|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5480016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5480015540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6007-3-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS ORTHOLOCK NAVIGATION 100CM|1|HUMANA [1294]||HUMANA [11839]|52.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6007-3-150|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS ORTHOLOCK NAVIGATION 150CM|1|HUMANA [1294]||HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8926SS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT REPAIR SYNDESMOSIS TIGHT ROPE KNOTLESS|1|HUMANA [1294]||HUMANA [11839]|2,640.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 27-183|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEPHROSTOMY CATHETER 10FR X 25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT6-23.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH091002|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 9MM X 10CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH111002A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 11MM X 10CM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W060060150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 6MM 150CM 60MM PERI OTW ULT LO CX PRFL GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W035080150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .014IN 3.5MM 150CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 13MM ATLNTS TI SPNE CRV ANT SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HNR4.0-35-90-P-10S-0|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC BEACON 5.0 FR X 90CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D314DRM|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR PROTECTA XT DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42,207.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42,207.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D314TRM|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR PROTECTA XT CRT-D BI VENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0295|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 59CM ECRDL 2 COIL STD DF4 TRM CNCT ACTFX CARDVRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6947M62|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ICD 62CM 8.6FR TENSI-LCK SQ HLX STD RV SVC ISOGLIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102R|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR DUO PULSE DUAL PIN 16CC VOLUME|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109676-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS THRMB ANGJT ULT SOLENT PROXI PERI CATH WST BG PMP SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6082-62|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCESSORY PACING BALL-TIPPED STYLET FOR 62CM LEAD 0.014 GRAY|1|HUMANA [1294]||HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6093-65|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCESSORY PACING BALL-TIPPED STYLET FOR 62CM LEAD 0.016 PURP|1|HUMANA [1294]||HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6056-M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCESSORY PACING PINCH-ON TOOL FOR SCREW-IN LEADS|1|HUMANA [1294]||HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 320MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301107|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 7MM BENGAL 7D STD CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|5,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47342|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 7CM 8MM NST 2.8 LOOP SFT ENH RADOPC MCIOL .018IN|1|HUMANA [1294]||HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47330|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 14CM 8MM NST 5.6 LOOP SFT RADOPC .018IN PLTN PERI|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G04194|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .018IN X FLPY TIP FX COR STD STRG BNTSN CRV SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G54531|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.5FR .021IN 135CM SUPERSELECTIVE KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT 6.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8800000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 45MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6910845|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 45X18X10MM CRNT XL PEEK RADOPQ TLIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8455550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 5.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8276545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REDUCTION ARMADA 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82775500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REDUCTION ARMADA 7.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8276555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REDUCTION ARMADA 6.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8276550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REDUCTION ARMADA 6.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7509141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM 10X1.75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840007550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 50MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 6MM 135CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-05-060-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 5FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10731501|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU STRAIGHT ART 5F X 90 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 26217000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON GRACILIS DOUBLE STRAND|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 40MM NCB PROTASUL-64 3.5MM UNICORTICAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03264.0181|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL DISTAL 18 HOLE RIGHT PERIPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,511.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,511.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3520-0300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 3 S 10 X 300MM X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,006.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,006.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37714|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROSTIMULATOR IMPLANTABLE RESTORE SENSOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP14000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 14MM TI 1.3MM PG ST TIP SQ NS DVR ALPS HND FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 9MM ALPS TMX HND CORT NONLOCK SQ DRV ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 12MM ALPS TMX HND CORT NONLOCK SQ DRV ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 40MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDC-42703-P1A|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH 7FR 18GA 16CM ARWG+ARD BLU + BLU FLXTP 2.5IN .032IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VH1006200|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS 10MM X 6CM 200CM-LENGTH W/HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-064-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7968812|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 37X27X12MM CRSNT SVRGN 8D MED PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7975525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 25MM SVRGN SPNE FA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7975520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 20MM SVRGN SPNE FA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-3400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 13MM X 400MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-64G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55228|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 107MM 11MM 5.4MM 14FR SPRLZ ZNTH AAA ILC LG FLXB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-64G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN RT CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN RT CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT 6.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 60MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 70MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588852|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR JL 4.5 VISTA BRITE TIP 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-2-30-113|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 30MM X 113MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M57260600050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ITOTAL CONFORMIS 32MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 27.5MM TI 1 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM ATLNTS TI SPNE CRV ANT ST VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13MMX127MM FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIB 80MM 18MM GMRS FLUT KN PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.955S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 93MM SS 3.5MM SCR SM FRAG SET 4 HL LMT CNTCT CNTR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,612.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,612.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2316-50|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 16 50CM INFINION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-3400-30|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SPLITTER 2 X 8 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFBC-5503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 2 FT CROSSFT BC HI-FI CNN CRT HL FX GS 96L/4D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,064.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BURR HOLE 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-3420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 13MM X 420MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 12MM ALPS COCR HND CORT NONLOCK STND ALONE ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-1708|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ZUMA-C LORDOTIC 7 X 13 X 8CM|1|HUMANA [1294]||HUMANA [11839]|10,743.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,743.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIABLE DOUBLE LEAD 4.0 X 14M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-9008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER LOCKING ZUMA-C 8MM|1|HUMANA [1294]||HUMANA [11839]|575.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|575.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-4516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIABLE DOUBLE LEAD 4.0 X 16M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8.170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP +5.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8.175|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +5.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y-530|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNIPAQUE 300 CT 50ML PLUSPAK BOTTLES|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77800600|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7 FRENCH X 100CM LENGTH 4.5 JUDKINS LEFT VIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC-16702|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH CV 7FR 20CM 3 LUM RADOPQ XTN LN CLP A-W BLU FLXTP PU LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7003|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SILICONE SELF EXPANDING AIRWAY 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00515171|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE JAGWIRE .035 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 2 HEALIX OTHCRD BRD PEEK 36IN BLU VIOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 18MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 427008S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 110MM SS 4MM SCR SM FRAG 8 HL LCK CMPR AXSOS BN WST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|572.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN RT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840015545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 45MM SOLERA CD HZN TI COCR SPNE MA CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUNATE DORSAL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0354|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE W 57X27MM 2.3MM SCR VA ACLC 2 BN RDS LT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-311|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT AERO DV FULLY COVERED BRONCHIAL 12MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-208|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT AERO FULLY COVERED BRONCHIAL 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-211|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT AERO FULLY COVERED BRONCHIAL 12MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PBD-421-1006|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LAYER DOUBLE 10FR - 6MM PROXIMAL BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D200F7|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH PA 110CM 7FR SG ATR VNTRC 4 LUM TD PCNG LTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7967214|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32X23X14MM CRSNT SVRGN 12D SM PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7976025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANGLED FIXED 6.0 X 25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W050200150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 5MM 150CM 200MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00514330|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESPH 14MM 21-25MM 9CM THNWL SLF XPD RADOPQ ESCP MRKR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.854|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 54MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 90129-212|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT AERO FULLY COVERED BRONCHIAL 12MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-213|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ALIMAXX FULLY COVERED ESOPHAGEAL 16MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-201|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESPH 16FR 18MM 67CM 70MM FULL CVR PROX SUT KNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-3360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 13 X 360MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510F201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-264|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BASE TIBIAL X-LARGE SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04020080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 80CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1332-06|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OPTIRAY 300MG/ML 50 ML BOTTLE NDC# 0019-1332-|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-02-028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6790226|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17X14X6MM CRNT SM INTLK 7D LRDTC CRV NS LF|1|HUMANA [1294]||HUMANA [11839]|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6791712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERLOCK 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37744|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR1-2217|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RASPS PREPARATION ENDPLATE AXIALIF|1|HUMANA [1294]||HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0356|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 51MM 2.3MM SCR VA ACLC 2 BN RDS LT VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117310|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MAX LIGHT MEDIUM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|636.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117320|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MAX LIGHT MEDIUM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|636.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9531|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDPORE BARRIER MINI CHANNEL PLATE #9531|1|HUMANA [1294]||HUMANA [11839]|1,170.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,170.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6941642|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 42X30X16MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-56E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1304-CPS-7-25MCBD|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE BLU ABLATION BIDIRECTIONAL 4MM TIP|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1304-CPS-7-25-LC-BD|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE BLU DUO ABLATION BIDIRECTIONAL 4MM TIP|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP CEMENTLESS MODULAR II ABG N08 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 109681-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS THRMB ANGJT ULT SOLENT OM PERI CATH WST BG PMP SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8213-0000-09|SUP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND OASIS ULTRA TRI-LAYER 7CM X 10CM MESHED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587806532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 10MM 32MM PRM NXGN TRB MTL PE POR KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5521-B-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 1 UNV KN COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.239|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D MED 52MM SS 2.4/2.7MM SCR VA FSN LOPRFL CMPR WRE HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK SHORT V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00587806535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 10MM 35MM PRM NXGN TRB MTL PE POR KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1026010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE VNT AVNT GD T-TB|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-18.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-18.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C0301AL-90|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA HALF MOON SPLIT THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602700S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 100MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 14MM FIXOS TI FT/ANKL CNN CMPR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XF0073200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REAMER CANNULATED FIXOS|1|HUMANA [1294]||HUMANA [11839]|539.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|539.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587806538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 10MM 38MM PRM NXGN TRB MTL PE POR KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7217030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941238|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X12MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-16702-CDC|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH 7FR 18GA 8IN .032IN 2 LUM RADOPQ SPRG GW INTRO NDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA ST VENTRIO CIRCLE SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,530.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 254201|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING SHOT CROSS PIN 6.5 X 40|1|HUMANA [1294]||HUMANA [11839]|627.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG SPRG OPN BIORESBL SLF XPD VENTRIO ST SEPRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,121.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,121.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950030|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 4.7X3.1IN SPRG OPN BIORESBL SLF XPD VENTRIO ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,848.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950040|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 5.5X4.3IN SPRG OPN BIORESBL SLF XPD VENTRIO ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,727.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,727.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950050|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 7X5.4IN SPRG OPN BIORESBL SLF XPD VENTRIO ST SEPRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,560.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,560.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950080|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA ST VENTRIO CIRCLE OVAL EXTRA LARGE 8." X 10.7"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,544.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950090|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 13.7X10.8IN SPRG OPN BIORESBL SLF XPD VENTRIO ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,938.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,938.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131211118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FX 2.5MM 18MM HND THRD MLDIR ALPS DVR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M57260600080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ITOTAL CONFORMIS 41MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 15MM ATLNTS TI SPNE CRV ANT SLF DRL FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 15MM ATLNTS TI SPNE CRV ANT SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8757-052-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM METAL TRABECULAR WITH CLUSTER HOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9996-016-35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE FEMORAL REVISION POROUS STANDARD 12/14 NECK TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,040.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,040.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9982-015-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TAPER REVISION 15MM DIAMETER 185MM TI ZMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,687.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,687.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23622 E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 22MM VARIAX TI T7 FT RDS DIST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6591012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 21-25MM 18MM X-COR XPD VERT BD REPL NS LF|1|HUMANA [1294]||HUMANA [11839]|26,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6533441|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CAP SPNL 40MM 18MM X-COR -4D VERT BD REPL NS|1|HUMANA [1294]||HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6539001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP LOCK SMALL|1|HUMANA [1294]||HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7251626|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE SUPERIOR SMALL|1|HUMANA [1294]||HUMANA [11839]|3,891.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,891.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7251526|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE INFERIOR SMALL|1|HUMANA [1294]||HUMANA [11839]|3,891.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,891.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7247535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 7.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7247540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7247545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7256015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR FIXED 15MM|1|HUMANA [1294]||HUMANA [11839]|3,606.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,606.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7248065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7248075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7241100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-10.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-10.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-11.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-11.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-12.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-29.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-29.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-30.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-12.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-13.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-14.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-14.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-15.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-15.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-16.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-17.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-18.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 8.5 X 26|1|HUMANA [1294]||HUMANA [11839]|540.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT6.220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.225|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-23.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.245|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.250|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-25.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.260|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.265|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6.270|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-27.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-28.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-28.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-10.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-12.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-12.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8751-010-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 52 II X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-13.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-14.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G02972|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO 7CM 4FR .018IN 2.9FR MPNCH CHKFL ECHTP APRCH 21GA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G52939|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN SMTH NVG STRG TPR APRCH PLTN SS HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G52542|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH SPRT 135CM 4FR CXI SS HDRPH LOPRFL GW D MRKR STRG TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G50001|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH SPRT 150CM 2.6FR CXI SS HDRPH LOPRFL STRG TIP BRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G50790|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN 6GM TIP LD TPR APRCH SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G50786|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .014IN TPR APRCH SS 6GM TIP LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840016545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-15.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-15.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-16.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported U302740|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 274CM. (ATHERECTOMY)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT7-16.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-17.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-19.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-22.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6947M55|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO SECURE 55CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-22.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-23.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-23.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-24.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-24.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-25.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-25.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-26.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-26.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-27.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-27.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-28.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-29.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-29.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-30.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941634|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X16MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-10.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 20mmX155mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60MAN02.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D -2 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-10.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-10.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-13.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-14.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-14.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-15.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-15.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-27.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-27.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-28.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-29.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-29.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-30.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-12.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-12.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-13.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-16.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-16.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-18.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-19.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-19.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-22.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-22.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-23.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-23.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-24.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-24.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-25.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-25.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-26.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-26.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1436S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 360MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,154.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,154.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.105|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10.5 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-13.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.110|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.115|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.120|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP +6 CYL BCNVX 13MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-12.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-13.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-14.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-15.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-15.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-16.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-16.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-17.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-17.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-18.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-19.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-19.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCS-430-20WW|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PYROSPHERE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,296.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,296.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107071025|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO PGTL CRV 4FR 90CM RADOPQ FLSH HTORQ SHFT SFVU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-20.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-22.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-22.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-23.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-0017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN GUIDE 2MM/.078 DIAMETER|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-23.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-24.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-25.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-26.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-26.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-27.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-27.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-28.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-29.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-30.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3476A|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD, QUAD, PISCES MEDTRONIC #3487A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,020.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,020.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MN60MAN01.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D -1 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4006|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH XTRT 138CM 6FR PRNT V4 COR PERI VSL HDRPH 2 LUM RX FLTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-4-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK LONG V40 MODULAR II ABG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-2020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM RECON HEAD CPTI SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,882.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,882.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410-0007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RECON CAPITELLUM RADIO SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451-1062|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE STAINLESS STEEL .062|1|HUMANA [1294]||HUMANA [11839]|66.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602705S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 105MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611105S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TALUS X-SMALL RIGHT SBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SNDSTR10|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOUNDSTAR ULTRASOUND (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195-78|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 78CM 5FR HRT LT IS-1 UNPLR DEPLOYABLE LOBE FX ATN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410-0001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CAPITELLUM RADIO SMALL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-120|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 120MM OTW LOPRFL TIP ARMADA ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287041|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X10MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287141|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X11MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,426.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012536-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASCULAR SELF-EXPANDING 8.0MM X 40MM X 135CM ABSOLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012536-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASCULAR SELF-EXPANDING 8.0MM X 60MM X 135CM ABSOLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012536-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 80MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 73.8X27.6X1.65MM TMX 2.5MM SCR LCK LOPRFL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404000|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH Y INTEPRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,730.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012535-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 60MM 135CM OTW SLF XPD ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5436022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 6 X 22|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 41055-01|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CRAGG-MCNAMARA 5CM 5FR 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9666|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MANDIBULAR,ANGLE,60,LT.,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6PK1W|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LAUNCHER GUIDE 6 FR RENAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6SCR40K|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LAUNCHER GUIDE 6 FR SHEPHERD CROOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W060100150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 6MM 150CM 100MM LF POWERCROSS ACPT 5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN RT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G25263|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .025IN 480CM RADOPQ KINK RST COR TRCR MHDRPH AQ COAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47611|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .025IN 480CM RADOPQ TIP ERCP TRCR MAQ COAT ANG 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-200-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX SELF EXPANDING SYSTEM 6 MM 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8213100037|SUP|HCPCS Q4102||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND OASIS 3CM X 7CM FENESTRATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|708.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|708.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71421234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2366-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 70CM 3-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FB-200-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE CLOSURE SUTURE FIXATE|1|HUMANA [1294]||HUMANA [11839]|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM AXSOS SS 2.5MM FT HEX FEM HUM CANC PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 50MM SS FT CANC HEX NS AXSOS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 18MM FIXOS TI FT/ANKL CNN CMPR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7577045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AFFIX 2 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7757540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7291850|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 6.25 X 50MM|1|HUMANA [1294]||HUMANA [11839]|1,032.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,032.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7291855|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 6.25 X 55MM|1|HUMANA [1294]||HUMANA [11839]|1,032.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,032.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3325-0420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LEFT LONG 11 X 420MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941638|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X16MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y503|SUP|HCPCS Q9967||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MEDIA CONTRAST OMNIPAQUE 300 30ML BOTTLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6981040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 40X18X10MM CRNT 10D XL PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported THS-LX-C|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBOHAWK LX-C VESSEL STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001PCBO2515140F0|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL SM 2.5MM 137CM 1.5CM OTW TPR TIP PR CTBLN ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8754-010-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY POLY 36MM, 7MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 5 KN PTLFEM LT CMNT PRECT GNDR SOL NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 199MM SS 3.5/4MM SCR 10X5X 5 HL AXSOS BN TIB LT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5213600|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT,URETERAL,TRACTFINDER,2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 345455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 55MM SS FT CANC HEX NS AXSOS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00111814001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMNT BN PLC LV+GGNTA 40GM GRN|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1920SNF|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE CORKSCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB 69.6X45.8X4.8MM MBT 3MM KN CMNT REV ROT PLAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1294-53-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE FULL FEMORAL POROUS UNIVERSAL 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,901.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,901.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129454100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV TIB 37X27X40MM MBT KN MTPHSL POR REV STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 115MM 14MM PRFT UNV FLUT KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 115MM 16MM PRFT UNV FLUT KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 71X65MM KN LT CMNT CR PFC S TC3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960781|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR FEM PFC S 5D KN BOLT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,751.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,751.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR FEM PFC S +2/-2 OFST KN BOLT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,102.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,102.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG FEM 4MM PFC S TC3 4 KN POST TI CMB CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960891|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG FEM 16MM PFC S TC3 4 KN LT TI CMB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 17.5MM KN GVF UHMWPE ROT PLAT SGM TC3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-50-016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0272|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PCNG LEAD 59CM 1 COIL ACT REL 4-FT TRM CNCT XTD-RETRAC HLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588TDB-7|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEV FX TGHTRP 7MM ACL DLV SYS DISP|1|HUMANA [1294]||HUMANA [11839]|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111580SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 80MM QWIX LWR XTRMT FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121575SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 75MM QWIX PSTNR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965458710|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATHETER PICC DUAL LUMEN CT 5FR 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850108|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOURED SMALL 8MM X 15 X 12|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.851S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57MM SS 2.4MM SCR 7 HLE/HD 5 HL SHFT VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 25mm +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9544|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE WEDGE ENOPHTHALMOS RIGHT LARGE|1|HUMANA [1294]||HUMANA [11839]|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BNI35FJH|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER THERMOCOOL SF CARTOXP F,JH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475005035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA SEXTANT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 30MM VRTX MX TI SPNE MA NS MAG RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-2101|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE BIOACTIVE FOAM PACK VITOSS BA 1.2CC 2X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,472.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,472.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-1601|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE BIOACTIVE FOAM PACK VITOSS 1.2CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,051.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,051.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7509215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM 5X1CM SPNE CRV POST|1|HUMANA [1294]||HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-253|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TALAR X-SMALL LEFT SINGLE COATED TOTAL ANKLE|1|HUMANA [1294]||HUMANA [11839]|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186721850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW GRTFX 8 X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C10-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 10MM ACTRK2 TI MIC FT SLF CUT CNN VAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958928|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 28MM VRTX MX TI SPNE MA NS MAG RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSZ20450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPL 12.4CM NATRELLE BCL P5.2CM HI PRFL RND BRST SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3249-40|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD 2V 40/45J 500OHM 60 PPM 83X41X14IN UNIFY QD TI IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-76-555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR ROD 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,882.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,882.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752500|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 20CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012536-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 30MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012536-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 100MM 135CM OTW SLF XPD ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011932-030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 5.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1011932-020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE PRO .035 5.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5211800|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT,URETERAL,TRACTFINDER,2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012534-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 20MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012534-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 30MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012534-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 40MM 135CM SLF EXPANDABLE ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012534-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 60MM 135CM SLF EXPANDABLE ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012535-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 20MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012535-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASCULAR SELF-EXPANDING 7.0MM X 30MM X 135CM ABSOLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012535-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 40MM 135CM OTW SLF XPD ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012535-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 80MM 135CM OTW SLF XPD ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012535-100|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 100MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012536-20|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 20MM 135CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-2-28-113|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 28MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM ALPS TMX FT ELB CORT NONLOCK HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816235012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 163.6X10.3X3.7MM TMX 3.5MM SCR SM FRAG 12 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|668.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|668.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM COCR 2.2MM TIB DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM TMX FT ELB CORT NONLOCK HEX DRV NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|72.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|72.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64786635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIB 80MM 17MM GMRS FLUT KN PROX TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-6-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 11MM TIBIAL STM W/OUT BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,479.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,479.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G53025|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNOCC 120CM 10FR 40MM CODA AORTA PU 2 LUM LOPRFL BLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7804215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED HELIX 4MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7806215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED HELIX 4.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5962172|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17-24MM 12MM X-COR MN XPD VERT BD REPL NS LF|1|HUMANA [1294]||HUMANA [11839]|20,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET END CAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5962527|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDCAP 7 DEGREE TOP 15 X 12MM|1|HUMANA [1294]||HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5962526|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDCAP 7 DEGREE BOTTOM 15 X 12MM|1|HUMANA [1294]||HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-2824S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 240MM HUM LT PROX T2 IM LCK RTRGD ANTGRD GUN DRL TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,332.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,332.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 704011S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GW ORTH 230MM 2.8MM HIP COCR THRD TIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3362-5-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 13MM 75MM 22MM OMEGA3 SS STD HIP FEM LG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597164S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD BRL 4 HL KYLS OMG 3 BN HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMX2030|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL PSMX GENTRIX 20CM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787117327025|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MARINER KUMPE 5 FR 40CM .035 NON BRAIDED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2333|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LACTOSORB SUSPENSION 2.0 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9543|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE WEDGE ENOPHTHALMOS LEFT LARGE|1|HUMANA [1294]||HUMANA [11839]|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.004.009S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 5MM GRAY NAIL TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 108MMX2MM TI 8 HL LCK LOPRFL VARIAX BN FIB NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-10320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 1MM 1.7MM SCR 6 HL L LCK VARIAX BN 1.7MM RT HND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|686.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|686.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-17007E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CROSS PIN SELF TAPPING 1.7 X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4156DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INST 2MM BN TAMP GD SLV RADIOLUCENCY SUP SHR STRTH TRMIT|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-64-014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REVISION 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7800252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL HELIX-R 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 370004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG CBL 4MM AXSOS SS SM FRAG|1|HUMANA [1294]||HUMANA [11839]|151.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7968814|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 37X27X14MM CRSNT SVRGN 8D MED PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7906120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.613.516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM VCTR TI SPNE CRV ANT SLF DRL SLF RTN VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.613.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BNT GRV PREBNT 23X16.5X2.5MM TI 4/4.5MM SCR 1 LVL 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,236.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 324.101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN TEMP VECTRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|307.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|307.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 889.931|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 15X5MM CERVIOS 12.5MM CNVX PEEK-OPTM AX CNL RADOPQ|1|HUMANA [1294]||HUMANA [11839]|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.617.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM ZERO-PTI SPNE CRV LCK ST SLF CNTR NS PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.617.1265|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK ZERO-P 6MM|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407861|SUP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRODUCER 9FR ULTIMUM ACT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-52D|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 135CM 40MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012528-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 40MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012528-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 60MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012528-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 80MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012529-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 40MM 80CM SLF EXPANDABLE ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012529-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 60MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012529-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 80MM 80CM OTW SLF XPD ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012530-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 30MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012530-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 40MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012530-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 60MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012530-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 80MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012532-40|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 40MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012532-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 60MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR7100-L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE CUTTING SHAPE MATCH LEFT|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CR TRIATHLON #6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2601-090925|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X9X9MM TRAXIS VUE PEEK-OPTM TLIF|1|HUMANA [1294]||HUMANA [11839]|14,283.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,283.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6MM X 35MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9393013|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30MMX13MM CRSNT PEEK-OPTM VERT BD REPL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPLNG XTRNFX HFMN 3 ROD TO ROD DLT 5/8/11 MM ROD 5 MM APX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W030120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 3MM 150CM 120MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W040120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 4MM 150CM 120MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W040200150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 4MM 150CM 200MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W050120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 5MM 150CM 120MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W050150150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 5MM 150CM 150MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-8-350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 350MM 11MM HFMN 3 VECTRAN C MDLR CNCT MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,068.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-8-450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 450MM 11MM HFMN 3 VECTRAN C MDLR CNCT MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,224.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,224.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 025228-OE|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STNT 75CM 8.2FR BNDR SFLX URETER OP-EN DVRSN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST TPR 32MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB18W060120150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .018IN 6MM 150CM 120MM PERI OTW ULT LO CX PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 4 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM 12MM CLRLS CMNTLS LOPRFL NK VRT GRV CRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05020080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 80CM 20MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PV41340|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NAVITUS 120CM 7FR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117321|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3DMAX RT LG LIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117311|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3DMAX LT LG LIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117312|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG 3DMAX 6.7X4.8IN ABD LT LTWT PORE KNIT MFL SL EDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117322|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MAX LIGHT X-LARGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RMT311417|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM DELIVERY ENDOPROSTHESIS LEF TRUNK EXCLUDER C3 GORE 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 44MM SS L/T RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO15X|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX OPTIMIZED POLYESTER ROUND 6INCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,291.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,291.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO12X|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX OPTIMIZED POLYESTER ROUND 4.8INCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,750.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 889.933|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 15X7MM CERVIOS 12.5MM CNVX PEEK-OPTM AX CNL RADOPQ|1|HUMANA [1294]||HUMANA [11839]|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F5CQA005RT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER A JOSEPHSON 5FR 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-84013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY LD EXPRESS 8MM BALLOON X 37MM STENT LENGTH X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 20MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 24MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938047730130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7X27MM 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602675S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 75MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.120.702S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL POSTERIOR MEDIAL LCP 3.5MM X 2 HOLE RIG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,947.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 62.5MM TI 3 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012532-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 80MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45710110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE PRO-TOE VO 10D SM HMRTOE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3711|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CHARGING MOBILE|1|HUMANA [1294]||HUMANA [11839]|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 4MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7931434|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 14MM X 34MM X 24MM|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3066-0100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCR 100MM 10.5MM TI U BLDE LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3066-0105S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCR 105MM 10.5MM TI U BLDE LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 61-3516|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION LOK ARROW 3.5MM X 16MM STRAIGHT|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35-3000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REAMER FIXATION LOK ARROW|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921644|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X16MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7893088|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR HALO 88MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,313.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,313.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7875524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HALO 5.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7875526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HALO 5.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7876526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HALO 6.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.011S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SS 11 HL SHFT LCP BN RDS RT DIST VOLR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,614.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,614.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8926T|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TIGHT ROPE KNOTLESS TITANIUM SYNDESMOSIS REPAIR|1|HUMANA [1294]||HUMANA [11839]|2,640.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 301805M|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDING LONG MULT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200061020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC NITINOL SE 6 X 100 X 120 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZILBS-8-4|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER METAL BILIARY 8MM 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WEB 46X12.8X1.1MM TMX 1.5MM SCR LCK LOPRFL PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 9MM ALPS COCR SQ HND CORT LCK ST TIP MLDIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 11MM ALPS COCR SQ HND CORT LCK ST TIP MLDIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 10MM TMX CORT ST SQ ALPS HND FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131217001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2D CNTR 45.3MM LOPRFL HI STRTH F3 BN 11.7MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131217002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2D CNTR STRG 50MM LOPRFL HI STRTH F3 BN 5.6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 16MM FIXOS TI FT/ANKL CNN CMPR SLF DRLs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 20MM FIXOS TI FT/ANKL CNN CMPR SLF DRLs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XFO051201|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIT DRL 12MM 1.7MM FIXOS FT/ANKL CNN AO DRV STP DISP|1|HUMANA [1294]||HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 370110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 10MM AXSOS SS T20 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 42MM SS T20 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSR8901020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RMR SRG SRFC MTRSL 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -4MM OFST TPR 32MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W04060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 4MM 135CM 60MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AFLEX400|SUP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMIS DECELLULARIZED ARTHROFLEX 4.0CM X 4.0CM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,557.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,557.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286850200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIX TEMP THREADED|1|HUMANA [1294]||HUMANA [11839]|384.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|384.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14266|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNFRMR OPTH LG PMMA HL HRD LTWT INERT STRL|1|HUMANA [1294]||HUMANA [11839]|162.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|162.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.923|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 232X12X3.7MM SS 3.5MM SCR SM FRAG SET 10 HL SHFT LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,598.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,598.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850105|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOURED COROENT 5MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PC02015X|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX OPTIMIZED POLYESTER 8INCH X 6INCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,906.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 45710210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE PRO-TOE VO 10D LG HMRTOE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6313|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE BREAST STYLE 6300 HEIGHT TALL 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82921-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 5MM X 120MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186860012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONSTRAINED 12MM SKYLINE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186850014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000035|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16MMX5MM 12MM PRVL PEEK STNDALN CRV INTRBD FS STRL|1|HUMANA [1294]||HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-2508|SUP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRODUCER LEAD PERCUTANEOUS VALVED 8FR 25CM SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|146.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|146.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G402047|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM KIT SHEATH AGILIS EPI 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P42210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE DEMINERALIZED GRAFTON PLF 2.5CM X 5.0CM|1|HUMANA [1294]||HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7967816|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 32X23X16MM CRSNT SVRGN 8D SM PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.106S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 18MM 112MM SS 3.5MM SCR SM FRAG SET 7 HL HK PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840015535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7509010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM MED 25X10MM INTVRTB|1|HUMANA [1294]||HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8456530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 194.226|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X10X10-15MM CLBR 4D LRDTC NS LF|1|HUMANA [1294]||HUMANA [11839]|17,397.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,397.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7756530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 60MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-110926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X9X11MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 45MM SPS TI P/T CANC SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-090926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X9X9MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM AXSOS SS 2.5MM FT HEX FEM HUM CORT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371585|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 85MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 400MM FEM LT GMA IM 125D LNG KT TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-100926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X9X10MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DIN25014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE 2.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DIN30014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE 3.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFP-4503N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 2 FT CROSSFT HI-FI NDL CNN PEEK 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,076.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,076.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186860016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONSTRAINED 16MM SKYLINE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186854016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 16MM SKYLINE TI OVSZ SPNE CRV ANT VAR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,124.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-004-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK TM SIZE 4 RIGHT/LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-004-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK TM SIZE 4 LEFT/LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 5 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFP-5503N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 2 FT CROSSFT HI-FI NDL CNN PEEK 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,076.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,076.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CFP-6503N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 6.5MM 2 FT CROSSFT HI-FI NDL CNN PEEK 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,076.34|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,076.34|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 211.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 3.5MM 12MM 5MM SS T8 L/T RVRS CUT FLUT CNN ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 211.815|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 3.5MM 15MM 7MM SS T8 L/T RVRS CUT FLUT CNN ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 6MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 17MM ATLNTS TI SPNE CRV ANT ST VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186860014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONSTRAINED 14MM SKYLINE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 17MM ATLNTS TI SPNE CRV ANT ST FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8453123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK OFF-SET ARMADA R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,162.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,162.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC221850E0|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD NRSTM 50CM PRCS .014IN TRL LNR STRG TIP PRELD STY SPNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136406|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH,URETERAL,WHISTLE TIP,6FR,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5516F602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 KN RT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6192-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMNT BN SMPX P SPEEDSET RADOPQ STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|196.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2825114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE LAG 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2825120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE LAG 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2832105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TPR 5MM TI OPN WDG LOPRFL NAR DIST SCR HL BN FOREFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,917.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,917.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0824S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 240MM HUM T2 IM LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4022S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958932|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 32MM VRTX MX TI SPNE MA NS MAG RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958934|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 34MM VRTX MX TI SPNE MA NS MAG RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CGS2008S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULA WITH GRAFT AXILLARY|1|HUMANA [1294]||HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186803054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 54X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,651.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,651.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 3.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F5CQA005RT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER A JOSEPHSON 5FR 110CM (REPROCESSED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11100-3521|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE JONES FROSTED WITH HOLE 3.5MM X 21|1|HUMANA [1294]||HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2234921|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MICRO ORBITA CURVED 0.6MM .8 HOLE REGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30650090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET TI 90MM 10.5MM HIP U BLDE LG GAMMA3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-56112|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS DRG DLV EKOSONIC MACH 4 MICROSONIC TX ZN INTLGNT CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-56130|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEV DRG DLV EKOSONIC MACH 4 INFS CATH US COR TX ZN EVAS ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55221|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 9MM 5.4MM 14FR ZNTH SPRLZ Z-TRK BFUR ABD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-09-27-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 9MM DIAMETER X 27MM LENGTH X 80MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 585192|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SUSPENSION FRONTALIS|1|HUMANA [1294]||HUMANA [11839]|123.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|123.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-027-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HUMERAL XSMALL 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-15061|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3D TI PA LCK LOPRFL VARIAX BN FT LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25450S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2XL 74MMX3MM 2.7MM SCR 5 HL ANTM NAR VARIAX BN VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-091126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X11X9MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-6535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1540BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR BCMPS 10MM 4MM ACL TENODESIS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334164|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III STRG CRNMXF TI 16 HL LOPRFL 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|949.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|949.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-34212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III STRG CRNMXF TI 2 HL LOPRFL BAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 16MMX.4MM UNV NEURO III DOG CRNMXF TI 2 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III SM BX CRNMXF TI 2X2 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III LG BX CRNMXF TI 2X2 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|909.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|909.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 6MMX.4MM UNV NEURO III STRG CRNMXF TI 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|409.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|409.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III 2Y CRNMXF TI 6 HL LOPRFL BAR 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|817.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III SM GAP CRNMXF TI 6 HL LOPRFL 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,023.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III LG GAP CRNMXF TI 6 HL LOPRFL 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,024.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,024.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III X CRNMXF TI 4 HL LOPRFL 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|854.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|854.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III STRG CRNMXF TI 8 HL LOPRFL 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|535.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|535.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5617304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.7 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|229.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|229.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5400262|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CRNL BLU 60X60X.1MM UNV NEURO 2 MIC ULTHN CRNMXF TI NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,483.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,483.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5400272|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CRNL 60X60X.2MM UNV NEURO III MIC CRNMXF TI 1.2MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,483.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,483.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5400346|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CRNL BLU 90X90X.3MM LEIBINGER UNV 2 GSP MDFC TI DYNMC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,749.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,749.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5400646|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH CRNL AU 90X90X.6MM GSP STD MDFC TI DYNMC 1.7MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,749.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,749.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .4MM UNV NEURO III RECT CRNMXF TI 2X2 HL LOPRFL 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|881.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|881.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5300342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 54X52X.3MM UNV NEURO III SM CRNMXF TI CLS OUTR FRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,345.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,345.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5300342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 54X52X.3MM UNV NEURO III SM CRNMXF TI CLS OUTR FRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,345.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,345.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-00362|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN .3MM 42MM UNV NEURO III SM RND CRNMXF TI CLS OUTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,472.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,472.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5300382|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 62X30X.3MM UNV NEURO III SM SUBOCCIPITAL TI CLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,485.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,485.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER BUR HL 14MMX.4MM UNV NEURO III CRNMXF TI LOPRFL SHNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER BUR HL THK20MM STD LOPRFL TAB SHNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|905.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9215994|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CROSS PIN 1.5 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9215905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD CROSS PIN SELF DRILLING 1.5 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|212.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|212.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 380MM FEM RT GMA IM 125D LNG KT TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 397010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SUBSTITUTE CEMENT BONE HA INJECTABLE HYDROSET 10CC|1|HUMANA [1294]||HUMANA [11839]|8,630.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,630.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5057S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 57.5MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3420-0420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 420MM RT GAMMA3 IM 120D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,006.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,006.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 427108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 151MM SS 5MM SCR BSC FRAG 8 HL LCK CMPR AXSOS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|505.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|505.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3386ANS|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION LEAD ANS 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXS4216H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 6MM 2 DUET HI-FI CLR CD NDL BN PNCH 16.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 6 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZILBS-10-8|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER METAL BILIARY 10MM 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZILBS-10-6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER METAL BILIARY 10MM 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,123.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,123.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZILBS-8-6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER METAL BILIARY 8MM 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS-BDB-4X4|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL .035IN 4MM 190CM 4CM LOPRFL GW ML PRT RADOPQ BLNDIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS-BDB-6X4|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL .035IN 6MM 190CM 4CM LOPRFL GW ML PRT RADOPQ BLNDIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012528-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 30MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FS-BDB-8X4|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BIL .035IN 8MM 190CM 4CM LOPRFL GW ML PRT RADOPQ BLNDIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 7 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3320-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R2.0 TITANIUM LEFT GAMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,009.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12770-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 9MM X 20MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286326ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM SURFIX INTGR SS WRST LCK NS TL FSN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,BONE,MICRO,L-SHAPE,0.6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6265-5215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT52AO-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2020-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 150CM 40MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2020-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 150CM 80MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2025-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 150CM 60MM FLXB MRKR STREAMLINE TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2025-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL ARMADA 14 PTA 2.5 MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2025-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 150CM 200MM FLXB MRKR STREAMLINE TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222286|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HEALIX KNOTLESS BR 4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-48G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 48mm G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1236-2-854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28mm FOR CUP OD 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MPQ-2.5|SUP|HCPCS L8603||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AGENT BULK POLYDIMETHYLSILOXANE PVP PP 2.5ML MACROPLASTIQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-053-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ULNAR SMALL 3" LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48811114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AVIATOR 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,867.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48844014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FIXED AVIATOR 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48844016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FIXED AVIATOR 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48834516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RESCUE FIXED AVIATOR 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48322064|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVG 4 DEGREE 6 X 12 X 14MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 8 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 22MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-1-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 25MM +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 602720S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 120MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602910S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 110MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203152060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 60MM 32MM NCB TI6AL4V P/T HEX FEM CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203152070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 70MM 32MM NCB TI6AL4V P/T HEX FEM CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 44MM NCB TI6AL4V ST HEX HD NS LG FRAG SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629272S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 196MM TI 12 HL VARIAX BN HUM RT P/L STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437114S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 228MM SS 14 HL 1 THRD LCK RND TPR AXSOS BN HUM LT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 122MM 8 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 82.5MM TI 4 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6272044|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X44MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM STRUT CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG430|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 4.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH2512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 12MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AW1105|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX KRSH CPTR EXTREMITIES SMTH FT DISP TH|1|HUMANA [1294]||HUMANA [11839]|89.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55219|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 56MM 9MM 5.4MM 4.7MM ZNTH SPRLZ AAA NTNL ILC LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN RT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G31921|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLN XTRT 200CM 12-20MM FSN QUATTRO .035IN BIL NTR RBR STON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14264|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONFORMER SMALL STERILE WITHOUT HOLES|1|HUMANA [1294]||HUMANA [11839]|162.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|162.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14268|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONFORMER MEDIUM STERILE WITH HOLES|1|HUMANA [1294]||HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16515010|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SEGMENT FIBULAR FREEZE DRIED APPROXIMATELY 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,683.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,683.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1530BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR BCMPS 8MM 3MM SFT TIS HNDL INSRTR TENODESIS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 75MM AXSOS SS 2.5MM FT HEX FEM HUM CANC PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 121MM SS 3.5/4MM SCR 4X5X 2 HL AXSOS BN TIB LT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRANSLATIONAL ATLANTIS FIXED 4 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276211|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 11X12MM VRTSTCK CRSTN PSR 12MM PEEK-OPTM CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.016S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 180MM RT HINDFOOT XPRT IM 12D CNN BLTP RM ROD DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB 74.9X49.3X4.8MM MBT 4MM KN CMNT REV ROT PLAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 65X61MM KN LT CMNT CRCTE STAB PFC S TC3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG FEM 4MM PFC S TC3 3 KN LT TI CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG FEM 4MM PFC S TC3 3 KN POST TI CMB CMNT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 15MM KN GVF UHMWPE ROT PLAT SGM TC3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6151-064-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ECCENTRIC 64 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,619.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AC2006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6312|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 11.3X11.8CM BRST 350CC STY 6300 INJ DOME SLFSL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 35MM 10MM TIB CORT TPR PROX END SEAT FLSH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-7500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SPEEDLOCK PEEK 3.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE STANDARD 8.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,EPIPHYSIS,LT,4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AD2038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD2050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DIGITAL 2.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE MICRO L SHAPED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AQ2008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 8MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 10MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 11MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 12MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 14MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICK SNAP 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|732.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112013ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION SNAP-OFF 2MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICK SNAP 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|752.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|752.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICK SNAP 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|752.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|752.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM CPTR METATARSUS SM BN QUICKSNAP SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QUICK SNAP 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|752.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|752.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|774.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 10MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 12MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|774.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|774.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 18MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481500601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 1.5MM X 6MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-0-206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM 12MM CMNTLS ABG II V40 HA 6 34MM LT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 120MM 11MM CMNTLS ABG II V40 HA 5 34MM RT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-6.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 20MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 24MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 26MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23013E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 13MM VARIAX HND NLCKG ST CROSSPIN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23014E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 14MM HND NLCKG ST CROSSPIN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY LPS PS LEGACY NEXGEN SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481500701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 1.5MM X 7MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AC2528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 28MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC2530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 30MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|494.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|494.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH2510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 10MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH2514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 14MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH2516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 16MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 20MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM 12MM CMNTLS ABG II V40 HA 6 34MM RT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH2522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 22MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60MM TI 3 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481500901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 1.5MM X 9MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AH2518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 18MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 28MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 3.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|653.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|653.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 3.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|653.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|653.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 34MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 10MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482000601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 1.5MM 6MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 28MM CPTR TRANSFORMING EXTREMITIES TI FOREFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 30MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 32MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 34MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482000801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 1.5MM 8MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 36MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC3040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 40MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602920S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 120MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 22MM FIXOS TI FT/ANKL CNN CMPR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 380MM FEM LT GMA IM 125D LNG KT TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 11 X 360MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 673200700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 32MM SIZE-G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00491500420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H 9MM SS 1.5MM SCR MN FRAG 4 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AH3026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM CPTR FOREFOOT MIDFOOT 2 THRD CNN SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|846.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|846.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 18MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H 12MM SS 2MM SCR MN FRAG 4 HL BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HF13A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE Y-KNOT BLUE #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,168.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W08080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 8MM 135CM 80MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32747002|SUP|HCPCS C9399||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TIBIA DISTAL FRESH LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6AR10|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LAUNCHER GUIDE 6 FR AMPLATZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-1360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IM NL 360MM 11MM GMA 125D LNG R1.5 FEM LT TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 22MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483502001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 20MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AC4028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 46MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC4050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM CPTR TI LOPRFL FOREFOOT MIDFOOT CNN HBRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|602.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|602.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481501201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 1.5MM X 12MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CDSLM33|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH DURA 3X3IN CLGN MTRX DRMTRX IMPL FLXB STRNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CEMENTED STEM-15MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6912850|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 50X18X12MM CRNT XL PEEK RADOPQ LMBR INTRBD FS NS|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 115MM 10MM CMNTLS ABG II V40 HA 4 32MM RT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482001201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.0MM X 12MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186803051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186862016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONSTRAINED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186803048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,837.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,837.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 44MM AXSOS SS HUM FEM TIB T15 DRV ST LCK SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 48MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DCELL200|SUP|HCPCS Q4122||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE DERMIS DECELLULARIZED ADVANCED DERMACEL SOFT 4 X 12CM|1|HUMANA [1294]||HUMANA [11839]|4,406.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,406.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482001401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.0MM X 14MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5444-0-400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CRANIAL CUSTOM X-LARGE WITH BACKUP IMPLANT AND HOST|1|HUMANA [1294]||HUMANA [11839]|48,818.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,818.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404087|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING BIOARC-TO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 24MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482001601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.0MM X 16MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.211.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.107.202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90MM SS 2.7/3.5MM SCR 2 HL VA TPR TIP RND PRFL LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ABG II CEMENTLESS V40 LEFT NO 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-40E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG INSERT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-15|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER FOR 3.75 SCREW|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED PARTIALLY THREADED 3.75MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 115MM 10MM CMNTLS ABG II V40 HA 4 32MM LT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8690090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 90MM 5.5MM CD HZN LGC PREBNT TI CNTR POSTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|902.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|902.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101337-40|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CAROTID RX ACCULINK 5.0MM X 40MM|1|HUMANA [1294]||HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482001801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.0MM X 18MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZTEG-2P-38-202-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 38 X 202|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTEG-2D-38-186-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT DISTAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27612E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN LT CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23610E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482002001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 1.5MM 20MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23612E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 12MM TI T7 FT RDS DIST LCK NS VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23614 E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 14MM VARIAX TI DIST RDS LCK T7 DRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23616 E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 16MM VARIAX TI DIST RDS LCK T7 DRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23210E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 10MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23212E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23618E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 18MM TI T7 FT RDS DIST LCK NS VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-2362E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3 MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23628E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23630E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23632E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482002201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.0MM X 22MM SELF TAPPING MINI HEXHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 53-23634E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23636E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23638E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.3MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23214E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 14MM TI T7 FT RDS DIST STRL VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23216E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 16MM TI T7 FT RDS DIST STRL VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23220E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23222E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 22MM TI T7 FT RDS DIST STRL VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23224E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 24MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23226E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 26MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23228E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 28MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482002401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 1.5MM 24MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED 4.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853-410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 10MM GFT CENTERPIECE BN SPNE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,949.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,949.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853-465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTERPIECE 2.6MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853-467|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTERPIECE 2.6MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSM0505|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL THIN GENTRIX 5CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MM0100|SUP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS MATRISTEM MICROMATRIX PRCN URN BLDR XCLR MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23230E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 30MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23232E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 32MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23234E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 34MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23236E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 36MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27610E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM VARIAX TI DIST RDS LCK T7 DRV STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27626E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27210E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM VARIAX TI T7 FT NS DIST RDS LCK PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27216E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27222S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27224E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|292.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|292.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27226E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T7 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27118E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM VARIAX TI T7 P/T RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112014ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION SNAP-OFF 2MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27120E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM VARIAX TI T7 P/T RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27122E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM VARIAX TI T7 P/T RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27124E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 24MM VARIAX TI T7 P/T RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27126E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM VARIAX TI T7 P/T RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23624E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 24MM TI T7 FT RDS DIST LCK NS VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23218E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 18MM TI T7 FT RDS DIST STRL VARIAX LCK PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23238E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 38MM VARIAX TI T7 FT RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27116E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM VARIAX TI T7 P/T RDS DIST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRS SCREW 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CEAC-M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CHIN ANATOMICAL EXTENDED CONFORM SIZE MEDIUM|1|HUMANA [1294]||HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FMG-VM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLOVE MANDIBULAR SIZE MEDIUM|1|HUMANA [1294]||HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5025B-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR POLY L LAC ACD 18MM 3-3.7MM TPR SM BN CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5025B-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR POLY L LAC ACD 20MM 2.7-3.7MM TPR SM BN CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5025B-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO COMPRESSION 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,EPIPHYSIS,OBLIQUE R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-5025B-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO COMPRESSION 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5025B-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO COMPRESSION 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2325PSLC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202468|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM DELIVERY NEEDLE CURVED 360 DEGREE FAST FIX|1|HUMANA [1294]||HUMANA [11839]|1,423.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,423.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200084020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 40MM 155CM 120CM OTW RADOPQ SLF XPD ILC ART|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200061220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 120MM 120CM SLF XPD ILC ART EP NTNL STRL ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W0704135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 7MM DIAMETER X 40MM LENGTH USABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S18-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4-4.1MM 18MM ACTRK2 TI STD FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S24-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4-4.1MM 24MM ACTRK2 TI STD FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S30-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4-4.1MM 30MM ACTRK2 TI STD FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S32-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4-4.1MM 32MM ACTRK2 TI STD FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C08-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 8MM ACTRK2 TI MIC FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C09-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 9MM ACTRK2 TI MIC FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C11-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 11MM ACTRK2 TI MIC FT SLF CUT CNN VAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-C13-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5-2.8MM 13MM ACTRK2 TI MIC FT SLF CUT CNN VAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3666-31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCESSORY KIT|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200066020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6 X 60 X 120 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZYG-1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM FUSION JOINT SACROILIAC SIMMETRY (CONTAINS - STABILIZ|1|HUMANA [1294]||HUMANA [11839]|47,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR POLY L LAC ACD 35MM 9MM TIB BABSR FX DEV BSCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT2-S26-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK STANDARD 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,218.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRS SCREW 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SRRT08030040L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 8MM THNWL PERI GRTX STRCH REM RING LN 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 205.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 1.35MM 46MM 15MM SS P/T RVRS CUT FLUT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|620.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 205.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 1.35MM 40MM 13MM SS P/T RVRS CUT FLUT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|620.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-MTP-PB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP 1ST MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,578.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,578.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40241320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM UNV T 20MM SS 2.7/3.5MM SCR 3 HL PA LCK THRD CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,899.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM ORTHOLOC SS 15D FT CORT PA LCK ST GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM ORTHOLOC SS 15D FT CORT PA LCK ST GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40250010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TACK ORTH CLW II ANKL/FT PLT DISP|1|HUMANA [1294]||HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR DECREASED 6 HOLE BRIDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 541110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARROW MENICUS 1.1MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|372.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131218400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS PROXIMAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,896.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,896.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222295|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 2 HEALIX ADV BR OTHCRD STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 222296|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 3 HEALIX ADV BR OTHCRD STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222297|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 2 HEALIX ADV OTHCRD ABS BRD BCRL RAPIDE TCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222298|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 3 HEALIX ADV BR OTHCRD STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222299|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 2 HEALIX ADV BR OTHCRD STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 6.5MM 2 HEALIX ADV BR OTHCRD STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ADVANCE HEALIX 6.5 BR 3 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ADVANCE HEALIX 6.5 BR WITH NEEDLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.097S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 18MM 99MM SS 3.5MM SCR SM FRAG SET 6 HL HK PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,660.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,660.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483501001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 10MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1868-64-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REVISION 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,039.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,039.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186802032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 32X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-1420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IM NL 420MM 11MM GMA 125D LNG R1.5 FEM LT TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP14342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI 3MM LCK 3.5MM NONLOCK SCR LOPRFL PIN FX THRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM ANCHORAGE TI T8 FT/ANKL TX HD LCK NS YLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS YLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS YLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44217002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON SEMI-TENODESIS AND GRACILIS DOUBLE BUNDLE|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE XS UNV 15MM SS 2.7/3.5MM SCR 2 HL PA LCK THRD CMPR CLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM UNV 20MM SS 2.7/3.5MM SCR 2 HL PA LCK THRD CMPR CLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED UNV 25MM SS 2.7/3.5MM SCR 2 HL PA LCK THRD CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG UNV 30MM SS 2.7/3.5MM SCR 2 HL PA CMPR ORTHOLOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,158.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MM SS 2.7/3.5MM SCR 4 HL PA CMPR CLW II BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 25MM SS 2.7/3.5MM SCR 4 HL PA CMPR CLW II BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40240430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 30MM SS 2.7/3.5MM SCR 4 HL PA CMPR CLW II BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40241330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG UNV T 30MM SS 2.7/3.5MM SCR 3 HL PA LCK THRD CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40241420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 20MM SS 2.7/3.5MM SCR 4 HL PA CMPR CLW II BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40241425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 25MM SS 2.7/3.5MM SCR 4 HL PA CMPR CLW II BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40241430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION POLYAXIAL CLAW II T 30MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,073.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7489-66|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION KIT #7495-66 (STIMULATOR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,980.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40242020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MM SS 2.7/3.5MM SCR PA CMPR LCK THRD CLW II BN 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40242025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MM SS 2.7/3.5MM SCR PA CMPR LCK THRD CLW II BN 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40242525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 25MM SS 2.7/3.5MM SCR PA CMPR LCK THRD CLW II BN 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40243010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM UNV U 18MM SS 2.7/3.5MM SCR PA LCK THRD CMPR CLW II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40243020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED UNV U 22MM SS 2.7/3.5MM SCR PA LCK THRD CMPR CLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4024303L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION POLYAXIAL CLAW II U LARGE LEFT STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4024303R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION POLYAXIAL CLAW II U LARGE RIGHT STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,769.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM ORTHOLOC SS 15D FT CORT PA LCK ST GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40E205|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 30MM ORTHOLOC SS 15D FT CORT PA LCK ST GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 34MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM ORTHOLOC SS 15D FT CORT PA LCK ST PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40233540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0904-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 9.0MM X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 35MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012529-30|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 30MM 80CM SLF XPD OTW PERI ABST PRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40232726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40232734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING POLYAXIAL ORTHOLOC CLAW II 2.7MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 26MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W05120080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 5MM 80CM 120MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-7550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 7.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55229|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 122MM 11MM 14FR SPRLZ ZNTH Z-TRK 2 BRCH AAA PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516-F-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED w/PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602645S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 45MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1925BF|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOCORKSCREW ANCHORS 6.5MM AR-1925BF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8452065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 5.5 X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 8MM SS CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.647.128S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 8MM ZERO-PPEEK-OPTM ELGILOY TI STD LRDTC|1|HUMANA [1294]||HUMANA [11839]|7,370.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,370.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.647.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING 3.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|901.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|901.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8135-0032W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST TAPER RESURFACING HEMICAP 13.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,637.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 110MM 9MM CMNTLS ABG II V40 HA 3 32MM RT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KSAW5.0-38-90-RB-SHT|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDE SHUTTLE FLEXOR 5FR KSAW5.0-38-90-RB-SHT-FLEX-HC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-0723|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE,LOOP,TANTALUM|1|HUMANA [1294]||HUMANA [11839]|200.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|200.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 300008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACCULIF TL8 12MM X 11MM|1|HUMANA [1294]||HUMANA [11839]|17,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CURVED 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CURVED 40MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 3 FULL 10MM KN TIB TIV PMMA PRECT STRLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203152050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 50MM 32MM NCB TI6AL4V P/T HEX FEM CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6.2MM 40MM NCB TI6AL4V 3.5MM ST HEX DRV NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 9 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM 13MM CMNTLS ABG II V40 HA 7 36MM RT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-40G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG INSERT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-09803-CDC|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PERCUTANEOUS SHEATH 8.5FR 10CM WITH CATHETER CONTAMINATI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02-2010-010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DYNAGRAFT 1CC (NEURO CART)|1|HUMANA [1294]||HUMANA [11839]|411.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|411.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT52AO-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939147201510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 150CM 150MM PERI OTW TPR TIP LOPRFL INFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939208181650|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEV ATHRCM 165CM .018IN TRUEPATH .017IN PERI DMD ROT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-360|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.4CM NATRELLE P3.7CM MDRT PRFL RND SIL STY 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.4CM NATRELLE P3.9CM MDRT PRFL RND SIL STY 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-550|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE MODERATE STYLE-10 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1175|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X11X7MM STX XD W CNVX PEEK XPD RADOPQ CRTDG STRL|1|HUMANA [1294]||HUMANA [11839]|18,897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 40MM 10MM BSCR XTLK ORTH PLLA INTFR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 3.0MM X 15/4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-30015S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 100MM 1.2MM KRSH 3MM ASNS MIC SCR STRL|1|HUMANA [1294]||HUMANA [11839]|73.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM 4MM ASNS TI MIC RVRS CUT FLUT FT HND SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 14MM TMX CORT ST SQ ALPS HND FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PEG 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02-2010-050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DYNAGRAFT 5CC (NEURO CART)|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-30114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM 4MM ASNS TI MIC RVRS CUT FLUT FT HND SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200M-05L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META OPEN LEFT LOW PROFILE 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1525|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X9X7MM STX XD CNVX PEEK XPD RADOPQ CRTDG STRL LF|1|HUMANA [1294]||HUMANA [11839]|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1550|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22X9X7MM STX XD 8D LRDTC PEEK XPD RADOPQ CRTDG|1|HUMANA [1294]||HUMANA [11839]|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MGT89030PPH|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROXIMAL PHALANX HEMI MOVEMENT MGT SIZE30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,838.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,838.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 541116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.1MM CNTR MNSC ARW MNSCS SLF REINF LOPRFL CNTR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|372.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported V010-4-5MMX66CMB+|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN SAPHENOUS 66CM 4-5MM B+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E0.8P8|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH VASC 8X.8CM XENOSURE BVN PRICRD TISS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|597.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|597.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1P6|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH VASCULAR BIOLOGIC XENOSURE 1CM X 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7121Q/58|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA SJ4 ICD ACTIVE FIXATION 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2311-36Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ELLIPSE DR ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48324060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVS 6 X 14 X 16MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48324050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVS 5 X 14 X 16MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48811230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AVIATOR 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,384.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,384.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 15MM 1-2MM AVANCE NRV ALGRF|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48824014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING AVIATOR 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 325046S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III SS 4.0 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200071020|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 100MM 120CM SLF XPD ILC ART EP NTNL STRL ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200081020|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 100MM 161CM 120CM SLF XPD ILC ART EP NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3225-3340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI GAMMA LONG RIGHT 13MM X 340MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,393.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222287|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HEALIX KNOTLESS PEEK 4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 18MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PIG1260TSP|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFETY-T-CENTESIS CATHETER DRAINAGE KIT 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12764-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 3MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G-FPS-0.4|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FISTULA SURGISIS BIODESIGN 0.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CKF5040L|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET CATH URCTH 3W STPCK DRN CLS SYS RADOPQ STRP RND TIP SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012446-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.25 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012452-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.75 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012453-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 4.0 MM X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012445-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.0 MM X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151648|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 12X4CM ALDRM THN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1516616|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 16X6CM ALDRM THN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152048|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 12X4CM ALDRM THK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1520616|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 16X6CM ALDRM THK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,997.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,997.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9-ASD-012|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME PTLR 41MM PFC S RND KN UHMWPE CMNT 3 POST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 20MM KN GVF ROT PLAT STAB PFC S STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM 13MM CMNTLS ABG II V40 HA 7 36MM LT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 62MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 122MM 8 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012623-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 7.0MM X 39MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012623-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 7.0MM X 59MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012624-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 8.0MM X 29MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012624-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 8.0MM X 59MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012630-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 7.0MM X 29MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012631-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 8.0MM X 29MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012631-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 8.0MM X 39MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012624-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 8.0MM X 39MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012625-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 9.0MM X 59MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012632-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 9.0MM X 39MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT52AO-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47331|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 3CM 2MM NST 4.8 LOOP SFT ENH RADOPC MCIOL .018IN|1|HUMANA [1294]||HUMANA [11839]|203.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|203.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47333|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 5CM 2MM NST 8 LOOP SFT ENH RADOPC MCIOL .018IN|1|HUMANA [1294]||HUMANA [11839]|296.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10719609|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT VU 4FR SIDEWINDER 1 BOX /5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 30MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.107.304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 116MM SS 2.7/3.5MM SCR 4 HL VA TPR TIP RND PRFL LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #4 35MM NECK 105MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GTS100L|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BYPASS MICRO TRABECULAR ISTENT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6209S5S47|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS SOLO-TRAK 9FR SINGLE CHAMBER ON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GTS100R|SUP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BYPASS MICRO TRABECULAR ISTENT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCS-430-30WW|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PYROSPHERE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,296.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,296.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-9.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 50MM TI 3 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00222900100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, BARBED, 5/8IN|1|HUMANA [1294]||HUMANA [11839]|134.49|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|134.49|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4922-8-300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 300MM 11MM HFMN 3 VECTRAN C MDLR CNCT MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,068.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001181370|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MCTH INFS 150CM 3-2.4FR RNGD STC 18 STRG PERI HDR PASS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001181380|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MCTH INFS 150CM 3-2.4FR RNGD STC 18 STRG PERI HDR PASS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001508100|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 200CM .014IN STRBL STRG 10CM FATHOM PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -4MM OFST TPR 40MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.210.078|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.8MM X 8MM VA BUTTRESS PIN WITH T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|428.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|428.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200071220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 7 X 120 X 120 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM HEALIX OTHCRD SHLDR TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-046-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 17MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7237375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 37.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM ATLNTS TI SPNE CRV ANT SLF DRL FX ANG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602880S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 80MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37746|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1882TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD VENTRICULAR LEFT TENDRIL 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82917-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 4MM X 80MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6935M55|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 55CM RV DF-4 TRPLR SCR DFBR SQ SCR S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D314VRM|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR PROTECTA VRM SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 23MM +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0372|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD LNG 65X24MM 2.3MM SCR VA ACLC 2 BN RDS LT VOLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0364|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NTRL ACLC 2 BN RDS DIST VOLR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,893.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,893.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 70MM AXSOS SS 3.5MM FT HEX FEM HUM CORT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340685|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 85MM AXSOS SS CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 343065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM AXSOS SS 3.5MM FT HEX FEM CANC DIST LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 34MM AXSOS SS HUM FEM TIB T20 DRV ST LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 36MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371365|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 65MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 238MM SS 4.5/5/6.5MM SCR 10X5X 5 HL AXSOS BN FEM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 55MM OMEGA3 SS CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83973-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 4.0MM X 80MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83969-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 2.5MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0093|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LINK EXTENSION VDR ACULOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29CAVGJ-514 00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC CONDUIT 29MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20789-470ACX|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ACX-LOW HEIGHT DOUBLE CHAMBER TEXTURED 470CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20789-390ACX|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ACX-LOW HEIGHT DOUBLE CHAMBER TEXTURED 390CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX-2-24-113|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH 24MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8690DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS FX CPR MN SCRPN DX|1|HUMANA [1294]||HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6041123|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X9X11MM CRNT 4D LG MAS PLIF NS LF|1|HUMANA [1294]||HUMANA [11839]|12,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7075530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PLIF 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,919.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,919.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7782004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEAD TULIP PLIF 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,772.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,772.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7292040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,983.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,983.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 230001SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM FUSION PIP IMPLANT IPP-ON SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 12/14 TPR 28MM HIP OXNM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,630.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN RT CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MICROSTABLE 20 DEGREE XLPE REFLECTION SIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,937.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,937.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122Q/58|SUP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PCNG 58CM 6.8FR 11MM SPC ECRDM 1 COIL TRUE BP ACTFX XTD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787103012115|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH ADLT 55CM 15.5FR DURATHANE DRFLW EMBOSAFE BSC 2 LUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 230002SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE IPP-ON 2 PIP SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,962.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,962.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 52.5MM TI 3 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-38-50S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION ZP THREAD SHORT 3.8 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-040-14-D|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE TROCAR DOUBLE 1.4MM|1|HUMANA [1294]||HUMANA [11839]|42.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-25-10L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD LONG 2.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9185J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 185CM .014IN JTP PRSS FRONTLINE PRIMEWIRE PSTG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67019055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR .070 IM 55 CM VISTA BRITE RENAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67027855|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR .070 STK 55 CM VISTA BRITE RENAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67021255|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR .070 RDC LARGE 55 CM VISTA BRITE RENAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67021055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR .070 RDCI SMALL 55 CM VISTA BRITE RENAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 48MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 32MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ICONIX 1.4MM WITH 1 STRAND #2 FORCED FIBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7885540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 40MM SPNE PA NS MAS PLIF 3Z|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7885535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 35MM SPNE PA NS MAS PLIF 3Z|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7886540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRI-SHANK 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7292070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7292060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-131134|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 34X11X13MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20645-250MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE OVAL TEXTUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20789-690ACX|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ACX-LOWHEIGHT DOUBLE CHAMBER TEXTURED 690CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN RT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5526-B-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY TRIATHLON #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-PTBSY-2600-PERC6|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY BALLOON WITH SHILEY PERCUTANEOUS CUFFED TRACHEOSTOMY TU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-PTBSY-2800-PERC8|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY BALLOON WITH SHILEY PERCUTANEOUS CUFFED TRACHEOSTOMY TU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM 5MM ASNS TI MIC RVRS CUT FLUT FT HND SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-9-001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TENDON TISSUE BOVINE FETAL TISSUEMEND 5CM X 6CM|1|HUMANA [1294]||HUMANA [11839]|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556161|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ESCP .035IN 450CM HPRFR RX KINK RST DREAMWIRE EGLD NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HBD-12-13.5-15|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATION ESOPHAGEAL HERCULES 3 STAGE 12-13.5-15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3265-40|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR QUADRA ASSURA CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A088109|SUP|HCPCS C2630||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SAFIRE BLU DUO ABLATION LARGE CURL|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3257-40|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK14MM 40J 79X40X14MM UNIFY ASR CRT-D ATR VNTRC TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|60,912.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 876-125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,380.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,380.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T60S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR APPIA FX BIOTENODESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,032.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-460|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.4CM NATRELLE P5.9CM X HI PRFL RND SIL STY 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-500|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.9CM NATRELLE P5.7CM X HI PRFL RND SIL STY 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.648S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 8MM 58MM NLEX TI FT FEM TIB T25 STRDR RCS LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.278S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 24CM LT HINDFOOT NLEX IM CNN TI STRL ARTHDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.694S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 120MM NLEX TI FT HINDFOOT FEM ST CNN LCK STRDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-25-16L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD LONG 2.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-38-40L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD LONG 3.8 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS21055|SUP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR PRIME GRAFIX 5 X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482001001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 1.5MM 10MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PE28111YB|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.8-3FR .027IN 110CM 50CM COAX RADOPQ MRKR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PE28131YB|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTVN MIC 2.8FR .027IN 130CM RADOPQ HDRPH PROGREAT ACPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111455SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 55MM QWIX LWR XTRMT FX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286322ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM SURFIX WRST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286324ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM SURFIX WRST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 20MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20676-275E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC TEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20676-310E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC TEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2257-40|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ASSURA FORTIFY ICD DR40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,562.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,562.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286330ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM UNI-CP SS FT LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484501401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 14MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8936BC-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT REPAIR ANKLE LATERAL ARTHROBROSTROM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7880034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRIGADE LORDOTIC 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8951SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LISFRANC SMALL TI LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SIR-Y001|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRTCL EMBL 5ML SIR-SPHERES STRL LF DISP YTTRIUM-90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484501801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 18MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AGH147000J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI PROWATER FLEX "J" DIAMETER 180CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484501601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 16MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00494500903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|227.43|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RRT10070080L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 10MM THNWL GRTX REM RING LN 70CM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6935M62|SUP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PCNG 62CM RV TRPLR SCR IN XTD-RETRAC HLX ELTRD SIL INSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202469|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEV FX FSTFX 360D RVRS CRV 2 ANCH PRETIE 2-0 5MM SUT MNSCL|1|HUMANA [1294]||HUMANA [11839]|1,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7880038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRIGADE LORDOTIC 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7806525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 6.5 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484502201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 4.5 X 22MM SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7806527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 6.5 X 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IRTH088080A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 8MM PROPATEN THNWL GRTX HEP INTGR RING 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.874|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 14MM 2.5MM TI PED T8 CORT ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.872|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 12MM 2.5MM TI PED T8 CORT ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|137.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|137.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 12MM TI T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.088|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|247.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.210.094|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.233|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D SM 42MM SS 2.4/2.7MM SCR VA FSN LOPRFL CMPR WRE HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6941442|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 42X30X14MM BRIGADE 8D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM07060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 60MM 7MM 8FR FLN + EVAS C EPTFE 2 LYR KINK RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|207.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RMT231416|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL EXCLUDER 23 X 14.5 16 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC231400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LEG CONTRA 23 X 14CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-2-140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST XTRNFX 11MM HFMN 3 30D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-8-250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 250MM 11MM HFMN 3 VECTRAN C MDLR CNCT MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,044.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,044.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-8-400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 400MM 11MM HFMN 3 VECTRAN C MDLR CNCT MRI SAFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,165.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,165.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5018-6-200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 200MM 5MM APX HFMN2 ORTH SS THRD 60MM XTRNFX SYS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED w/PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55240|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 39MM 20MM 6MM 16FR ZNTH SPRLZ 2 BRCH NTNL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371590|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 90MM AXSOS SS T15 FEM HUM TIB ST LCK NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|393.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|393.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|227.43|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7200021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 21MM TI 1 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1230S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 30CM TIB T2 IM STD LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,682.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,682.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ARTY|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH Y-SHAPED ARTISYN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7300TFX25MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS PERICARDIAL W/TERMAFIX PROCESS MITRAL PERIMOUNT 25MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7300TFX27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS PERICARDIAL W/TERMAFIX PROCESS MITRAL PERIMOUNT 27MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7300TFX29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS PERICARDIAL W/TERMAFIX PROCESS MITRAL PERIMOUNT 29MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7300TFX31MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS PERICARDIAL W/TERMAFIX PROCESS MITRAL PERIMOUNT 31MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7300TFX33MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS PERICARDIAL W/TERMAFIX PROCESS MITRAL PERIMOUNT 33MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 338624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,SEMI-TUBULAR,11 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|237.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|237.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 345438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM AXSOS SS 2.5MM FT HEX FEM HUM CANC PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 24MM SS T15 ST LCK NS AXSOS SM FRAG SET XTRMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437110S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 176MM SS 3.5MM 4MM SCR 10 HL 7 LCK 5 SHFT THRD BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7292035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,611.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,611.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RMT311415|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GRAFT EVAS 15CM 31MM 14.5MM XCLDR C3 TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSM0710|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL THIN GENTRIX 7CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,616.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,616.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA4820HKI|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH CENTRAL VENOUS QUAD- LUMEN 8.5FR X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MM0200|SUP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PRCN MATRISTEM MICROMATRIX URN BLDR XCLR MTRX MIRCO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,574.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,574.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP7|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE GLAUCOMA AHMED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #5 35MM NECK 108MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-25-20S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED THREAD SHORT 2.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|601.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|601.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951438|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X14MM BRIGADE 12D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8801069|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE K PRECEPT|1|HUMANA [1294]||HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6390209|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 12MM 9MM AFF CYL LRDTC TPR TI CLS CHMFR EDG MLT|1|HUMANA [1294]||HUMANA [11839]|12,450.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,450.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3688|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR PULSE IMPLANTABLE RECHARGABLE MINI EON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,946.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,946.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1194|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CINCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|202.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|202.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 300MM FEM LT GAMMA3 IM 125D LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45712800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 9MM 2.85MM 1.6MM PRO-TOE VO 0D PHALANX SS BLDE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 30MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 35MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6390208|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 12MM 8MM AFF CYL LRDTC TPR TI CLS CHMFR EDG MLT|1|HUMANA [1294]||HUMANA [11839]|12,450.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,450.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54840017535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 7.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840017540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437132S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 202MM 12 HL LCK WST AXSOS BN HUM RT PROX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1PVG506|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VESSEL GUARD PRECLUDE PTFE 5CM X 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1PVG610|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VESSEL GUARD PRECLUDE PTFE 6CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012623-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 7.0MM X 29MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012625-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 9.0MM X 29MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012625-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 9.0MM X 39MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012622-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 6.0MM X 29MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012622-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 6.0MM X 39MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012622-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 6.0MM X 59MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012630-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 7.0MM X 39MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7236325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL DUAL 32.5MM NUVASIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5307|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MICRO SUPER CROSS 150CM 120 DISTAL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 10X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 5MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,206.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6519-1-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM UNV TPR 36MM HIP BLX D STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,318.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,318.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL THICK 50MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30650085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET TI 85MM 10.5MM HIP U BLDE LG GAMMA3 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,447.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,447.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #6 35MM NECK 111MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 6.2MM 42MM NCB TI6AL4V 3.5MM FEM CORT 2 LD THRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 058050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE MATRIX DEMINERILIZED 5CC MIX DBX|1|HUMANA [1294]||HUMANA [11839]|3,801.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,801.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S17-45|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER AFX 17 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA22-80/I13-40|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 80MM 22-13MM 17FR AFX ACTIVESEAL STRATA BFUR EVAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EN2007030|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SNARE VASC 120CM 18-30MM 7FR ENSNR STD PLTN NTNL 3 INTERLACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HVA-100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR CATH 8IN 8FR PU HMSTS VLV STPCK SD ARM TUBE BLU|1|HUMANA [1294]||HUMANA [11839]|60.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1662BC-7|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 7MM SWIVELOCK BCMPS 19.5MM TENODESISs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-6171|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTRT SRG 3.5MM CNCL M|1|HUMANA [1294]||HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-6172|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTRT SRG 4MM CNCL M|1|HUMANA [1294]||HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-6173|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTRT SRG 5MM CNCL M|1|HUMANA [1294]||HUMANA [11839]|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6791713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5962152|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 15-20MM 12MM X-COR MN XPD VERT BD REPL NS LF|1|HUMANA [1294]||HUMANA [11839]|20,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 3.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7906138|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR 38MM|1|HUMANA [1294]||HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 24MM FIXOS TI FT/ANKL CNN CMPR SLF DRLs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OR-1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ORBITAL|1|HUMANA [1294]||HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR DECREASED 7 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A020|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 6-11+ CM 8-15MM CRYOARTERY DSND THOR AORTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6790227|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17X14X7MM CRNT SM INTLK 7D LRDTC CRV NS LF|1|HUMANA [1294]||HUMANA [11839]|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T68P|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 6.75MM X 8.22MM (FREEZE DRIED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.685S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 8MM 95MM NLEX TI FT FEM TIB T25 STRDR RCS LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM CHIN DOUBLE BEND 4MM 4 HOLE TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3525-1380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IM NL 380MM 11MM GMA 125D LNG R1.5 FEM LT TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RS0616M|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM SINUPLASTY BALLOON MAXILLARY SPIN RELIEVA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB LEGION 4 KN RT CMNT M TPR TI NPOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3 HL VARIAX BN CLVCL RL SUP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM TX ACTB CANC TRITANIUM MLHL SHL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12771-04|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX PLUS PTA BALLOON 10MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506005078068|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE STRIP LARGE SHAPE ACTIFUSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,910.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,910.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 447.142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM CHIN DOUBLE BEND 6MM 4 HOLE TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 506005078066|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE CYLINDER LARGE SHAPE ACTIFUSE|1|HUMANA [1294]||HUMANA [11839]|4,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 506005078064|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE CYLINDER MEDIUM SHAPE ACTIFUSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7292055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7292050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT DISPOSABLE JUGGERKNOT 1.4MM|1|HUMANA [1294]||HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 23MM 46MM SHLDR MDLR BGLNI/FLTW ZML OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.143|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM CHIN DOUBLE BEND 8MM 4 HOLE TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 222263|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ANCHOR HEALIX TRANSTEND BR/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,826.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,826.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222278|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ANCHOR HEALIX TRANSTEND PEEK/1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,701.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,701.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0-203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 110MM 9MM CMNTLS ABG II V40 HA 3 32MM LT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7968216|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 37X27X16MM CRSNT SVRGN 12D MED PEEK CVR PLT LMBR|1|HUMANA [1294]||HUMANA [11839]|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7975535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANGLE FIXED 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7975530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANGLE FIXED 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MAXILLOFACIAL 2.0MM CHIN DOUBLE BEND 10MM 4 HOLE TITAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RSF70|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD RLV SPIN F-70 FRNTL SIN SCT SFT DIST TIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-1340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 340MM FEM LT GMA IM 125D LNG KT TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 36MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.107.302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90MM SS 2.7/3.5MM SCR 2 HL VA TPR TIP RND PRFL LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR JUGGERKNOT 1.5 SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912041C|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CURVED STERILE JUGGERKNOT 1.5|1|HUMANA [1294]||HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7880036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRIGADE LORDOTIC 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7881034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONTOURED 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7806530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-5540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TBE-32-80-PF-US|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR PROXIMAL EXTENSION ZENITH 32MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-7-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER 635 7 MM DIAMETER 60 MM 125 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2325BCC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL BIOCOMPOSITE 3.5 MM X 14.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.115.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -90D RT 49MM SS 2.4MM SCR 2 HLE/HD 4 HL SHFT INTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0900-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 9.0MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10327-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 6MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702701|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV DRL KWR 3 SYS|1|HUMANA [1294]||HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702703|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV DRL KWR|1|HUMANA [1294]||HUMANA [11839]|828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 0D SM 42MM SS 2.4/2.7MM SCR VA FSN LOPRFL CMPR WRE HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.211.425|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 1.6MM LCP CMPR THRD 25MM NS|1|HUMANA [1294]||HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136528710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1.5MM 12/14 TPR 28MM HIP SLV TL STAB BLX D TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 75MM 22MM TMX LG RVRS RADL FLUT CANC CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121731064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 64MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64811120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM MED 70X61MM KN LT MDLR ROT HNG GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64953010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB SM 10MM PROX GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC28110ST|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MAESTRO 2.8/2.8F 110CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28ML2811045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MAESTRO 2.8/2.8F 110CM ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC28110SN|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 110CM 2.8FR MERIT MAESTRO MCTH NO TPR SWNCK HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC2813045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MAESTRO 2.8/2.8F 130CM ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MC29110ST|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 110CM 2.9FR .027IN MERIT MAESTRO .021IN .042IN MIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MC2911045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 110CM 2.9FR .027IN MERIT MAESTRO MIC 45D .021IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MC29110SN|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MAESTRO 2.9/2.9F 110CM SWAN NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MC29130ST|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MAESTRO 2.9/2.9F 130CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MC2913045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MAESTRO 2.9/2.9F 130CM ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V010|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN SAPHENOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,205.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,205.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-081126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X11X8MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10MM 26MM HIP CTPR COCR LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877702804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +7MM 12/14 XL 28MM HIP BLX D OPTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 13MM ATLNTS TI SPNE CRV ANT FX ANG ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10330-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 9MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10328-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 7MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10327-60|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 6MM X 60MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10326-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 6MM X 60MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10331-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 10MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10336-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 6MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10329-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 8MM X 20MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10335-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOXCROSS BALLOON 5MM X 120MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.652|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 52MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.654|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 54MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.656|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 56MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.658|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 58MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 60MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.664|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 64MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.668|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 68MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.672|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 72MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWM4051|SUP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRSG BIO 5X4IN INTGR BVN CLGN GAG POLYSILOXANE BL MX MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8780|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATH IT 114CM 4FR .5MM ASCENDA SIL PLMR 2 PC CNCT PIN FLXB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,901.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,901.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64852208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB MED 8MM ALPLY GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6910855|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 55X18X10MM CRNT XL PEEK RADOPQ TLIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6981245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 45X18X12MM CRNT 10D XL PEEK LMBR INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8801269|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE|1|HUMANA [1294]||HUMANA [11839]|282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7075534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PLIF 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1522|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22X9X7MM STX XD CNVX PEEK XPD RADOPQ CRTDG STRL LF|1|HUMANA [1294]||HUMANA [11839]|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-14-40-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 14MM STENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012632-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 9.0MM X 29MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7075540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PLIF 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7885530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 30MM SPNE PA NS MAS PLIF 3Z|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-7555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 7.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20676-450E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC TEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 176204010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X12X10-14MM OBLNG STRG TRPZD TI MESH LMBR INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,536.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,536.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179762120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 120MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 176202008|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH ST 8 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6908855|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 55X18X8MM CRNT XL PEEK LMBR INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 47.5MM TI 2 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1133S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 330MM TIB T2 IM STD LCK GUN DRL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 32MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437134S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 228MM SS 14 HL 1 THRD LCK RND TPR AXSOS BN HUM RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,287.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,287.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5800-MD00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT METACARPOPHANGEAL MCP SR SIZE MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,098.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6910850|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 50X18X10MM CRNT XL PEEK RADOPQ TLIF NS LF|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752850|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 30CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1851-1040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 400MM FEM GT RT T2 IM TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-6530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-701-03091|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 30X9X9MM TM ARDIS TRB MTL SLF DSTRCT NOSE|1|HUMANA [1294]||HUMANA [11839]|19,446.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,446.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNCT ROD 5.5MM 90D OPN CLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD OFFSET 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8051100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK CLOSED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|606.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E163|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ICD INCEPTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG TI LAPIDUS LOPRFL BN FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3 HL VARIAX BN CLVCL L/L SUP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.256E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 2.0MM EMERGENCY W/STARDRIVE(TM) RECESS 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|108.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7782002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2357-40Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK14MM 40J 40X71MM FORTIFY ASR 2 CHMBR DF4 IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,284.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,284.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.312E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSINT35022UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT RESOLUTE DRUG ELUTING 3.5 X 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 74MM 9MM 5.4MM 4.7MM ZNTH SPRLZ AAA NTNL ILC LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 65MM TI 3 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8650-0104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 5MM QUICKDRAW MINI DELAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7905416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 4.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-015-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-035S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING SHORT-THREAD TORQUE MAX 4.0MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING SHORT-THREAD TORQUE MAX 4.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629274S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL POSTERIOR 14 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFP8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FLEXIBLE PDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-10-60-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 6FR 10MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-060-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 8FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-10-40-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE 6 FR .035 10 MM X 40 MM 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-12-60-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 6FR 12MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.318E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SERB65-14-60-80|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY PROTEGE GPS SELF EXPANDING NITINOL 6FR 14MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08040-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 8FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA25-100/I16-40|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED 25 X 100 16X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EN2007045|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SNARE VASC 120CM 27-45MM 7FR ENSNR STD PLTN NTNL 3 INTERLACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515F801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.254E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 2.0MM EMERGENCY W/STARDRIVE(TM) RECESS 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|114.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|114.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7200087|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 87.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-5550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 5.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074225-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074225-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 2.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074225-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 2.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.360E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 23MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE XPEDITION DRUG ELUTING 2.5 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074250-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 2.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE XPEDITION DRUG ELUTING 3.0 X 08|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 3MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 4MM TI CRNFCL CORT ST FLUT TIP CRFRM NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|250.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103539000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP RUST 39MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1074300-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 23MM 3MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE XPEDITION DRUG ELUTING 3.0 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074300-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE XPEDITION DRUG ELUTING 3.0 X 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 3.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE XPEDITION DRUG ELUTING 3.5 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE XPEDITION DRUG ELUTING 3.5 X 33|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.386E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1074350-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 3.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 23MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074225-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 8MM 2.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074350-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 23MM 3.5MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103540000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP RUST 40MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1074400-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 33MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074400-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 4MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 KN RT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.453S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 320MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT52AO-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103541000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP RUST 41MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7509211|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN MAGNIFUSE DBM 10X1CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMRS0204|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL RS 2CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG130|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 1.5MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUT ACLC 2 BN RDS LUNATE VOLR DIST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DIVERGENT RADIAL STYLOID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58610005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5MM SPCR 28X15X1MM 2.7MM SCR OPN WDG OSTM LOPRFL OBLQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 14MM ORTHOLOC FT MIDFOOT CORT LCK ON AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 18MM ORTHOLOC FT MIDFOOT CORT LCK ON AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103542000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP RUST 42MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 58802720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 20MM ORTHOLOC FT MIDFOOT CORT LCK ON AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58862515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 2.5MM KRSH DISP|1|HUMANA [1294]||HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8953-035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING POW 3.5 TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 99MM 8 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 31-CAVGJ-514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC CONDUIT 31MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 45-700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.5CM NATRELLE P6.4CM X HI PRFL RND SIL STY 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 11 X 380MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3357-40Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD 40J UNIFY ASR RF TELEM DF4-LLHH IS-1 CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074325-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 12MM 3.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074325-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 18MM 3.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074325-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 15MM 3.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074325-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 23MM 3.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1074325-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 28MM 3.25MM XIENCE XPEDITION EVEROLIMUS COCR RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.2CM NATRELLE P6.2CM XHIGH PRFL RND SIL STY 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-1010-BC|SUP|HCPCS C9362||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CARTILAGE MICRONIZED BIOCARTILAGE 1 CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55214|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 58MM 28MM ZNTH FLX Z-TRK MAIN BD XTN AAA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G55215|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 58MM 30MM ZNTH FLX SS MAIN BD XTN Z-TRK INTRO SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8452070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 5.5 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6908845|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 45X18X8MM CRNT XL PEEK LMBR INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN402632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 26MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN403032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 30MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103543000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP GRY 43MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported NK001215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE 1.2MM|1|HUMANA [1294]||HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NK001615|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX KRSH|1|HUMANA [1294]||HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950009|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG SPRG OPN BIORESBL STRAP TNSN FR VNTRLX ST SEPRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,848.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C8024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 25MM 11MM FEM BIO ABS BSCR STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32747001|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TIBIA DISTAL FRESH RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2088TC/46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 46CM 6FR HLX ECRDM IS-1 CNCT BP ACTFX XTD-RETRAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 3 KN LT CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8052075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA28-100/I16-40|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE UNIBODY BIFURCATED 28MM 100/L 16-40 ILIAC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A28-28/C75|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION CUFF AORTIC PROXIMAL 28MM X 28MM COVERED 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 5MM TI CRNFCL CORT ST FLUT TIP CRFRM NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|183.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114703441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 34MM 1/2 FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8349-025-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE REVERSE TM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1236S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 12MM X 360MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,492.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,492.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 30MM AXSOS SS T20 FEM HUM TIB ST LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 310MM SS 4.5/6.5MM STD LCK SCR 14X5X 7 HL TL STAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,933.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 10MM EBTN CL ULT PRELD BRD SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 19MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 10MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported THS-LS-C|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBOHAWK LS-C VESSEL LARGE 8FR 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950007|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA ST VENTRALEX SMALL CIRCLE WITH STRAP 4.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,227.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,227.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950008|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA ST VENTRALEX MEDIUM CIRCLE WITH STRAP 6.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,469.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,469.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3313-080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PREBENT NXT 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 320MM FEM LT GAMMA3 IM 125D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103544000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR SELF CENTERING GRAY 44MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20646-270RB|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION HIGH BASE ROUND TEXTURED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20646-320RB|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION HIGH BASE ROUND TEXTURED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20646-235RB|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION HIGH BASE ROUND TEXTURED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20646-255RB|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION HIGH BASE ROUND TEXTURED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MM0060|SUP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS MATRISTEM MICROMATRIX PRCN URN BLDR XCLR MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|459.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-074-EDL|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK MINI BUNION|1|HUMANA [1294]||HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-074-MTP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK POCKETLOCK MTP MINI MAXLOCK EXTREME|1|HUMANA [1294]||HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-040-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301208|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 8MM BENGAL 7D LG CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,291.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00834903002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT GLND 30MM SHLDR TRB MTL RVRS POST STAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103545000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP GRY 45MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103546000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BRN 46MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103547000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR SELF CENTERING BROWN 47MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103548000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BRN 48MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103549000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR SELF CENTERING BROWN 49MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103550000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BRN 50MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103551000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BRN 51MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.362E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.364E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-210060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL EXPLOR 5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,473.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-210033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL EXPLOR 14 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-210061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL EXPLOR 6 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,473.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,473.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103552000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR SELF CENTERING BLUE 52MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5818001R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION MIDFOOT T RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58812716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.7MM 2MM 16MM ORTHOLOC FT MIDFOOT CORT LOPRFL HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58812718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 18MM ORTHOLOC FT MIDFOOT CORT LOPRFL HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5881-2728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5881-2730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103553000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BLU 53MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 58813532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 32MM ORTHOLOC FT MIDFOOT CORT LOPRFL HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58862515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 2.5MM KRSH DISP|1|HUMANA [1294]||HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516F801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 KN LT POST STAB BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103554000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BLU 54MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SC-1132|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT GENERATOR PULSE IMPLANTABLE SPECTRA PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-5532-1|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CONTROL REMOTE SPECTRA PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZS-25-8-70-AR|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL DUAL ANTI REFLUX VALVE 25MM X 8 CM|1|HUMANA [1294]||HUMANA [11839]|3,765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZS-25-10-70-AR|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL DUAL ANTI REFLUX VALVE 25MM X 10 CM|1|HUMANA [1294]||HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.228S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS 12MM X 240MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,812.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,812.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC OPTION BIOLOX 32MM +0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103555000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BLU 55MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1828-1434S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 14MM X 340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,492.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,492.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787103028185|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER KIT DURAMAX VASCPAK DIALYSIS 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787103028195|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH ADLT 28CM 15.5FR DURATHANE DURAMAX VASCPAK SFSHTHs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H787103028205|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH ADLT 32CM 15.5FR DURATHANE DURAMAX VASCPAK SFSHTHs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3713-5-090|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 230MM 1.15MM KRSH SS 2 END DMD PT NS|1|HUMANA [1294]||HUMANA [11839]|60.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 36MM NCB TI-6AL-4V HUM ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER 6.5MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 7MM ORTH TI 4MM QFIX SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430200|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 19.5+ CMX10-20MM AT ALGRF FRZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,315.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,315.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430340|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 22-38CMX6-12MM 6-12MM POST TIB TNDN ALGRF FRZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,000.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,000.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 7 UNV KN COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1506080|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSEEL 10ML|1|HUMANA [1294]||HUMANA [11839]|1,669.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,669.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1506078|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSEEL 2ML|1|HUMANA [1294]||HUMANA [11839]|418.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|418.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1506079|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSEEL 4ML|1|HUMANA [1294]||HUMANA [11839]|700.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|700.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1035-56-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR SELF CENTERING BLUE 56MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.18|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,605.18|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 241.083S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 12MM 85MM SS 3.5MM SCR SM FRAG SET 5 HL HK PRECONTOUR LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BGAT-27-SY|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIP APPLICATOR BIOGLUE 27CM|1|HUMANA [1294]||HUMANA [11839]|190.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|190.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BG3515-5-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADH SRG BIOGL SFT TIS BSA GLUT PREFL SYR 3 SPRDR 4 STD TIP 5|1|HUMANA [1294]||HUMANA [11839]|2,355.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,355.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20676-350E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC TEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N164|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILATOR INCEPTA CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103557000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP BLU 57MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.115.130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D L 37MM SS 2.4MM SCR 2 HLE/HD 3 HL SHFT VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RMT261412|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 26MM 14.5MM XCLDR C3 TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL1828|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH INTRO 28CM 18FR 6.8MM 6MM GORE DRYSEAL HDRPH DIL VLV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #3 30MM NECK 102MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5200M40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 40MM MTRL HLDR SW C-E PH II COCR SIL PLSTR STRL|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103559000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP GRN 59MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8004-15|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE COMPRESSION STAINLESS 15I X 15L|1|HUMANA [1294]||HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8005-20|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE COMPRESSION STAINLESS 20I X 20L|1|HUMANA [1294]||HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -90D RT 41MM SS 2.4MM SCR 2 HLE/HD 3 HL SHFT INTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4571-4010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE VO PRO-TOE SIZE 4.0MM X 16MM ANGLE 1O DEGR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45713210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 16MM 3.2MM 1.6MM PRO-TOE VO 10D PHALANX SS BLDE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8785|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACCESSORY ANCHOR|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103561000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP GRN 61MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ONE2500|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM ENDOVASCULAR SNARE 25MM X 120 CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DS8501750|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DIREX STEERABLE 8F 71CM SMALL 50 DEGREE CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161928|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL XENMATRIX 19CM X 28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,871.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,871.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 46MM SS 2.4MM SCR 5 HL VA RADL CLMN LCP CMBN BN RDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,691.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,691.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0931S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 9MM X 315MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0010S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END STD 10+ MM FEM T2 IM NL TI STRL 11.5MM|1|HUMANA [1294]||HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 44MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 254MM SS 16 HL 1 THRD LCK RND TPR AXSOS BN HUM RT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103563000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BP GRN 63MM 28MM SLFCNTR HIP FEM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1235-2-562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MOBILITY DUAL ANATOMIC ADM RESTORATION 56MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M006630206B1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW URO 150CM .035IN ZPWR URET NTNL PU HDRPH RADOPQ STRBL ANG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121701048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 48MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M006630205B1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HYDROPHILIC ZIPWIRE .035 STRAIGHT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6921088|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X10MM CRNT 8D XL PEEK-OPTM RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-MCN-S40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL IMPLATE METACARPAL 4.0 TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-DRN-LNG|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 6.5MM 7.6MM 70MM WRST RADL DIST IMPLATE IM TI NS ARTHDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WC-0222|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR IMPLATE 2MM X 22 DEGREE|1|HUMANA [1294]||HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STSC-30020-CS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM COCR WRST SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UCNL-28060-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL 2.8MM X 6.0MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UCNL-28080-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL 2.8MM X 8.0MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UCNL-28100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL 2.8MM X 10.0MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UCNL-28120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL 2.8MM X 12.0MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 50MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported IMP-DUC-0341|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRILL IMPLATE UNICORTICAL 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WAN-MR2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REAMER IMPLATE METACARPAL 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WAN-MR3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REAMER IMPLATE METACARPAL 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9873135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PYRAMID 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98716250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 25MM PRMD TI SPNE ANT VA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82088-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 9MM 30MM STRG SLF EXPANDABLE ERG HNDL FLXB CRTD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 56MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3306-8545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SEQUOIA 8.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3306-8540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SEQUOIA 8.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HBD-W-10-11-12|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILITATION ESOPHAGEAL HERCULES 3-STAGE 10-11-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 62MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HBD-W-8-9-10|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILITATION ESOPHAGEAL HERCULES 3-STAGE 8-9-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3722ANS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CHARGING LE MINI EON ANS|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82092-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 30MM STRG SLF EXPANDABLE ERG HNDL FLXB CRTD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82099-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 20MM STRG SLF XPD CLS CELL FLR END FRSTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82091-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6-8MM 30MM TPR SLF XPD CLS CELL FLR END FRSTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82087-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7-9MM 30MM TPR SLF XPD CLS CELL FLR END FRSTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 64MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STM361308|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STALIF MIDLINE 36MMX 13MM X 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|25,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STM60253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STAFLIF MIDLINE ABO 6MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97792|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ACC .133IN INJEX SIL BASO4 BIWING FLXB REM TL PRELD|1|HUMANA [1294]||HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00574770|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY TH COVERED 10MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,006.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00574780|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 8.5FR 60MM 75CM .035IN CATH FULL CVR SLF XPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,006.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 66MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00574790|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY TH COVERED 10MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,006.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,006.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00574670|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY TH UNCOVERED 10MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00574670|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY TH UNCOVERED 10MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00574680|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY TH UNCOVERED 10MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00574690|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY TH UNCOVERED 10MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41522000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TENDON TIBIALIS ANTERIOR ASEPTIC NON-IRRADIATED|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121715500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 15MM PNCL ACTB CANC STRL REV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6958730PT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM VRTX MX TI P/T SPNE MA NS GRN RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82093-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 20MM STRG SLF XPD DNS SCFLD CLS CELL LO CX|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1161015|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PRCN 5.9X3.9IN XENMATRIX AQUAPURE RECT ACLR CLGN MTRX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,205.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496H220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL EVOLVE +2 SZ.20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 20MM PNCL ACTB CANC STRL REV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 904755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION TOGGLELOC WITH #7 PE ZIPLOOP EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0600-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 6.0MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFBC-5503N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 2 FT CROSSFT HI-FI NDL CNN GS 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,118.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-525|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROTHESIS WALLGRAFT 12MMX50MMX90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-545|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROTHESIS WALLGRAFT 14MMX50MMX90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-547|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROTHESIS WALLGRAFT 14MMX70MMX90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 48MM HIP SECT PRCT PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3362-5-090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 13MM 90MM 22MM OMEGA3 SS STD HIP FEM LG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 596001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 32.2MM OMEGA2 SS HIP CMPR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597404S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D 150MM SS 4 HL STAB OMG 3 BN TROCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-040-320|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 320CM CRTD LWR XTRMT CPTR WRE BRD RADOPQ LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840007540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 40MM SOLERA CD HZN OSTEOGRIP TI COCR SPNE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP SECTOR II PINNACLE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 222320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HEALIX BR. 4.5 3 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0117060|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BARD MESH PERFIX TM LIGHT MEDIUM 1.3" X 1.6" (3.3CM X 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|519.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0117070|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BARD MESH PERFIX TM LIGHT LARGE 1.6" X 1.9" (4.1CM X 4.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0117080|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BARD MESH PERFIX TM LIGHT EXTRA LARGE 1.5" X 2.0" (3.8C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0117010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BARD SOFT 4" X 6" (10CM X 15CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|191.19|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|191.19|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0117016|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG BARD 12X12IN MFL SFT LTWT LOPRFL PP SQ HRN REPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|515.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|515.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5954460|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH BARD VENTRALIGHT ST PS TM 4" X 6" (10.2CM X 15.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,181.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,181.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121722056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP SECTOR II PINNACLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5955680|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG VENTRALIGHT ST SEPRA ECHO PSSPRFLM PP DDRGL 8X6IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,186.79|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,186.79|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5955790|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG VENTRALIGHT ST ECHO PSSPRFLM PP DDRGL 9X7IN MFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,772.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,772.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5955810|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH BARD VENTRALIGHT ST W/ECHO PS TM 8" X 10" (20.3CM X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,529.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0126341|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH DULEX 26CM X 34CM X 1MM RECTANGULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5954450|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH BARD VENTRALIGHT ST PS TM 4.5" (11.4CM) CIRCLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,515.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,515.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72202403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS BIORAPTOR SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,266.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,266.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP SECTOR II PINNACLE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 437214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 224MM SS 3.5/4MM SCR 14X4X 7 HL LCK AXSOS BN TIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200T26|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS TRICUSPID PHYSIO 26MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200T28|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS TRICUSPID PHYSIO 28MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200T30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS TRICUSPID PHYSIO 30MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200T32|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANLPLS 32MM TRCSD PRCS C-E PH 3D WVFRM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200T34|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS TRICUSPID PHYSIO 34MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121722062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 62MM HIP SECT PRCT PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200T36|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS TRICUSPID PHYSIO 36MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6200T24|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY CARPENTIER-EDWARDS TRICUSPID PHYSIO 24MM|1|HUMANA [1294]||HUMANA [11839]|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4307-063-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN GLENOID TM 2.5MM X 150MM|1|HUMANA [1294]||HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3265-40Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR QUADRA ASSURA DDQP+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 64MM HIP SECT PRCT PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2102-2205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUB BNGF BBTRAUMA VITOSS FM 5ML|1|HUMANA [1294]||HUMANA [11839]|5,333.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,333.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 28MM FIXOS TI FT/ANKL CNN CMPR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,476.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,476.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18722000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT SEMI TENOSIS ASEPTIC NON-IRRADIATED|1|HUMANA [1294]||HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6.2MM 42MM NCB TI6AL4V 3.5MM ST HEX DRV NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482802635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 6.5MM 35MM 15MM ES2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482804640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY SHORT ES2 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482807070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT ES2 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48289999|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW BLOCKER ES2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|712.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|712.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48230230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE SHARP ES2|1|HUMANA [1294]||HUMANA [11839]|132.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35-0002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN STEINMAN 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 66MM HIP SECT PRCT PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL COMBO MEDIUM LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 11 X 400MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OFFSET COUPLER 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,283.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,283.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 60MM HIP GRIPTION PNCL STRL LF 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121735500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM PNCL ACTB CANC STRL REV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4326-040-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4326-046-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4326-052-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2040-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 200MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB LG 20MM KN PE ROT PLAT LCS CMPT STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIB 80.6X53.1X4.8MM MBT 5MM KN CMNT REV ROT PLAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1217-40-500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM PNCL DOME 4 PNT CUT FLUT HIP ACTB CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported XPCK1300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FXTR XTRNFX CORETRAK SDKCK 40MM STD STERIPACK LOPRFL|1|HUMANA [1294]||HUMANA [11839]|7,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507640MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 16.5CM MEMORYGEL P3.9CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507680MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 17CM MEMORYGEL P3.9CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507750MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 17.5CM MEMORYGEL P4CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507800MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 18CM MEMORYGEL P4.1CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301204|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 4MM BENGAL 7D LG CFRP CRV INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|4,463.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,463.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121745500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM PNCL ACTB CANC STRL REV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121750500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM PNCL ACTB CANC STRL REV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121755500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM PNCL GRIPTION TF DOME 4 PNT CUT FLUT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-87-362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186803045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-87-366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-89-148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,320.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1218-89-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 28MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,320.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 48MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 50MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 52MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 54MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 56MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 58MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 60MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 620405F|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNOCC 5FR 40CM VASC ATRM FGRTY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 62MM 28MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,160.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1219-28-064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NEUTRAL PINNACLE MARATHON 28MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,139.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,139.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1219-28-066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER NEUTRAL PINNACLE MARATHON 28MM X 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,139.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,139.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 48MM 28MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 50MM 28MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 52MM 28MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 54MM 28MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 56MM 28MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121928258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 58MM 28MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1219-28-260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED PINNACLE MARATHON 28MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1219-28-262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED PINNACLE MARATHON 28MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1219-28-264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED PINNACLE MARATHON 28MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1219-28-266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED PINNACLE MARATHON 28MM X 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,170.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 52MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 54MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 56MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 58MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 60MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 05-0106|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MBA SUBTAYLOR 6MM|1|HUMANA [1294]||HUMANA [11839]|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 62MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 111010ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 541113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.1MM CNTR MNSC ARW MNSCS SLF REINF LOPRFL CNTR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|372.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0229-005-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE,FRACTURE,5/8X7/64|1|HUMANA [1294]||HUMANA [11839]|65.28|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|65.28|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0229-006-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE,FRACTURE,7/8X7/64|1|HUMANA [1294]||HUMANA [11839]|65.28|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|65.28|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 64MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL NTRL 66MM 32MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,212.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 52MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 54MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 56MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 58MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 60MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 62MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 64MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121932266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 15D 66MM 32MM MRTHN HIP STRL LIP LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136511000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1.5MM 12/14 STD TPR 28MM HIP MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136512000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 12/14 STD TPR 28MM HIP MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136513000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8.5MM 12/14 STD TPR 28MM HIP MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported N161|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK.39IN SM 2.43X3.13IN INCEPTA 2.54OZ CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136514000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 12/14 STD TPR 28MM HIP SKRT MTL ART/EZE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 241.65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 87MMX2MM SS 3.5MM CORT 4MM CANC 3.5MM CNN SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,670.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,670.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136515000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +15.5MM 12/14 STD TPR 28MM HIP SKRT MTL ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,522.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2AF234|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARCTIC FRONT ADVANCE 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2AF284|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARCTIC FRONT ADVANCE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136521000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1MM 12/14 STD TPR 32MM HIP MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4FC12|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH INTRO 65CM 15FR 12FR FLEXCATH ADV 135D PEBAX BASO4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 990063-015|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ACHIEVE MAPPING 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 990063-020|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ACHIEVE MAPPING 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0044790THK20|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II ABLATION 10MM LARGE CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-7540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-701-03081|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 30X9X8MM TM ARDIS TRB MTL SLF DSTRCT NOSE|1|HUMANA [1294]||HUMANA [11839]|16,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G42419|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 5CM 3MM MREYE 5.3 LOOP CATH END HL MNTN RADL FRC|1|HUMANA [1294]||HUMANA [11839]|206.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|206.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5954680|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG VENTRALIGHT ST SEPRA 8X6IN MFL ABS LOPRFL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,711.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,711.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5954610|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG VENTRALIGHT ST SEPRA ECHO PSSPRFLM PP DDRGL 10X6IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TALAR ANKLE TOTAL METAL TRABECULAR ZIMMER SIZE 3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-043-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BASE TIBIAL ANKLE TOTAL METAL TRABECULAR ZIMMER SI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-053-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT INSERT TIBIAL POLY CROSSLINKED PROLONG TM ZIMMER S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136522000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 12/14 STD TPR 32MM HIP MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4501-040-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN CALCANEUS ANKLE TOTAL TM ZIMMER|1|HUMANA [1294]||HUMANA [11839]|1,041.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,041.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235701806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 106MM SS 2.7-3.5MM SCR 6 HL LCK BN FIB LT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482801402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM SS ELB PERIART LCK NS SM FRAG UNV LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482801602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM SS ELB PERIART LCK NS SM FRAG UNV LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136523000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +9MM 12/14 STD TPR 32MM HIP MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MD102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DECOMPRESSION METATARSAL CO CR SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL BLU 90MM 5.5MM SQ PREBNT THORLMBR TI CNTR POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,762.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP15000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136524000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +13MM 12/14 STD TPR 32MM HIP SKRT MTL ART/EZE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,595.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 338665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM SS 2.5MM CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8826530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 6.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8826540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 6.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8826535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 6.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 65MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136525000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +17MM TPR BALL 32MM HIP CMNTLS M SPC COCR ART/EZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,406.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,406.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8801068|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE K|1|HUMANA [1294]||HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CR70BU-12.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER SINGLE-PIECE PMMA 13.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-701-04081|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 26X11X8MM TM ARDIS TRB MTL SLF DSTRCT NOSE|1|HUMANA [1294]||HUMANA [11839]|16,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-7530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 7.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.107.102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 73MM SS 2.7/3.5MM SCR 2 HL VA TPR TIP RND PRFL LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 42MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 13MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 18MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 7MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136511500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1.5MM 12/14 TPR 28MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,328.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 201.809|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 9MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.811|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 11MM SS CORT ST CRFRM NS MN FRAG SET MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 13MM SS CORT ST NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 6MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|155.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.637|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 7MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|155.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 8MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.639|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 9MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|155.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 11MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|155.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.643|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 13MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|155.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|155.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 16MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136512500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 12/14 TPR 28MM HIP M SPC ULMT ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,328.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 201.648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 18MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.500.10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE RDC 150MM 1.25MM SS THRD TIP SM STP PLT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.501.10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE REDUCTION 1.25MM WIRE THREADED TIP WITH LARGE STOP/150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532160|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 3CM 2 PGTL CRV RX TEMP ADVANIX PLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532190|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 7CM 2 PGTL CRV THNWL RX TEMP TPR TIP ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532240|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 3CM 2 PGTL CRV RX TEMP ADVANIX PLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532270|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 7CM 2 PGTL CRV THNWL RX TEMP TPR TIP ADVANIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2990722|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX7MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD FS|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 10D +4MM 58MM 40MM ALTRX LD HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5950070|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 9.7X7.7IN SPRG OPN BIORESBL SLF XPD VENTRIO ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,506.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,506.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136513500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8.5MM 12/14 TPR 28MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,328.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5950060|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 10.1X6.1IN SPRG OPN BIORESBL SLF XPD VENTRIO ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9393015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 30MMX15MM CRSNT PEEK-OPTM VERT BD REPL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-215|SUP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL COVERED FULLY AERO 14MM-40MM/16FR X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-205|SUP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 16MM 22FR 60MM 59CM GMTR OTW FLLY CVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-202|SUP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL COVERED FULLY AERO 18MM-60MM/22FR X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503751 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.8CM MEMORYGEL CHSV I P4CM RND MDRT + PRFL MDRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 8MM TMX CORT ST SQ ALPS HND FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504251 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.4CM MEMORYGEL P4.1CM MDRT + PRFL RND SIL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136550000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -2MM 12/14 TPR 36MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131220511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 11MM ALPS TMX HND CORT NONLOCK SQ DRV ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-014-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.114.513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y LCP 1.5MM 3 HOLE HEAD 8 HOLE SHAFT WITH GUIDES TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,423.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 7MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 9MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 110MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 7MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 8MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136555000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +15.5MM 12/14 TPR 36MM HIP M SPC MTL ART/EZE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.214.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 9MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 10MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OVAL RESURFACING PAT 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90129-217|SUP|HCPCS C1894||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL COVERED FULLY AERO 20MM-60MM/22FR X 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-0907|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SPEED 9 X 7 X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137620000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 11MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CD2311-36|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK12MM 36J 51X69MM ELLIPSE DR VNTRC TI 1 CHMBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 990066|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CABLE ACHIEVE MAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187823109|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X9X9MM CNCRD PRLL BLT NOSE CFRP RADOPQ PLIF TLIF|1|HUMANA [1294]||HUMANA [11839]|14,796.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,796.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00533560|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM STENT RX DELIVERY NAVIFLEX 7 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YP1301B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.3MM 2 Y-KNT 1 LD 1 STRN PROFLEX HI-FI BL SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|897.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2080-0045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM TX ACTB CANC TRITANIUM MLHL SHL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137621000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 12MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5972-066-35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY NEXGEN 35MM PROLONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,123.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,123.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55234|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 107MM 13MM 5.4MM 14FR SPRLZ ZNTH 2 BRCH AAA PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1179|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 29X11X7MM STX XD W CNVX PEEK XPD RADOPQ CRTDG STRL|1|HUMANA [1294]||HUMANA [11839]|18,897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8883120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 20MM 1 LVL ARCHON BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8884113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARCHON 4 X 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8844650|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOCK COVER|1|HUMANA [1294]||HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6807714|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 14X11X7MM CRNT 5D LRDTC SM PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|3,588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187823108|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X9X8MM CNCRD PRLL BLT NOSE CFRP RADOPQ PLIF TLIF|1|HUMANA [1294]||HUMANA [11839]|13,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8888102004HP|SUP|HCPCS C1752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY CATH 24CM 12FR 18GA STRG PU MHRKR 3 LUM XTN HI-PRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6209BTKD1|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LEAD INTRODUCER PERCUTANEOUS SOLO-TRAK 9FR SINGLE CHAMBER TW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00224001426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 26CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 30CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6428-028-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS FEMORAL 0 X 28MM CERAMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137622000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 13MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 650-1065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING G7 -3MM OFST TPR HIP TI TY 1 BLX D BIOLOX OPTN|1|HUMANA [1294]||HUMANA [11839]|1,062.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,062.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 36MM HIP BLX D OPTN G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,536.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,536.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21656|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 7CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137626000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 16MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7753770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 70MM 3.5MM CCM + PCUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1134S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 345MM TIB T2 IM STD LCK GUN DRL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRK20|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT SNARE FILTER REMOVAL 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43503734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 3.7MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540000032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY CEMENTED PERSONA 32MM 8.5MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540000035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY CEMENTED PERSONA 35MM 9.0MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137636000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 14MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1678-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPL INTERNALBRACE SWIVELOCK FIBERTAPE 3.5MM 2 2 NDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 11MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,206.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5972-066-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY NEXGEN 32MM PROLONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,762.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,762.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137637000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 15MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 482804635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY LONG ES2 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482804640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY LONG ES2 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482807090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT ES2 5.5 X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482807100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT ES2 5.5 X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4326-040-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 40MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4326-046-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 46MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4326-046-53|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 46MM X 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4326-052-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 52MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137648000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 10MM CMNTRLZR HIP FEM PMMA CMNT SMT SYS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4326-052-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID TRABECULAR METAL 52MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-72-085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1894-01-406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSS SFX 5.5 TI MEDIUM SIZE A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,732.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,732.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228143|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUN MENISCAL DEPLOYMENT|1|HUMANA [1294]||HUMANA [11839]|459.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|459.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ASCP FX OMNISPAN 27D MNSCL REPR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8757-048-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM METAL TRABECULAR WITH CLUSTER HOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM CMNTLS SMT DUOFIX 1 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8751-008-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 48 GG X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,412.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,412.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00102.616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TAPER REVISION WAGNER SL 265MM (PROTASUL 100)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,847.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,847.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8917DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ESCP INST TGHTRP 3.5MM DRL GW HNDL INSRTR REPR STRL FT|1|HUMANA [1294]||HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8884650|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER LOCK|1|HUMANA [1294]||HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0033-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FUSION 30MM ACUTRAK 6MM NOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7880040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRIGADE LORDOTIC 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM CMNTLS SMT DUOFIX 2 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 611757|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON Z MED II 20MM X 4 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611753|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON Z MED II 18 MM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-060-320|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE EMBOLIC PROTECTION SPIDERFX 6.0 X 320CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM CMNTLS SMT DUOFIX 8 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W12060080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL .035IN 12MM 80CM 60MM PERI OTW LOPRFL GW RBST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5030-5-250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 250MM 5MM 4MM APX CANC SS TRNFX ST SLF DRL CNTR THRD|1|HUMANA [1294]||HUMANA [11839]|427.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|427.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG7910BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10MM 6/6.5/7FR 73MM 80CM 80MM LG DLV SYS CLS CELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,304.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,304.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG5910BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LONG GEN/PRO 59 X 10 BIL 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,304.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,304.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 23MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 11 X 320MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 165MM CMNTLS SMT DUOFIX 9 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 338.002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GW ORTH 300MM 2.5MM COCR DRL TIP THRD 12MM NS|1|HUMANA [1294]||HUMANA [11839]|222.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6791714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERLOCK 4 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6791716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERLOCK 4 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8890000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 45MM PRCPT SPNE MDLR SHNK NS LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8896545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM PRCPT SPNE MDLR SHNK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8826545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.510S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 12MM X 125DEG X 235MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 170MM CMNTLS SMT DUOFIX 10 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.221.003S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 3.5MM 3.5MM SS T25 STRDR/HEX RCS CRLGE 1/1.7MM CBL|1|HUMANA [1294]||HUMANA [11839]|577.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|577.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8807530A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 7.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IM NL 400MM 13MM 125D R1.5 LNG RT TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.237|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 0D MED 52MM SS 2.4/2.7MM SCR VA FSN LOPRFL CMPR WRE HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMWCE-35-5-8|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION MREYE .035 DIAMETER X 5CM LENGTH 8MM|1|HUMANA [1294]||HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 54MM 18MM SHLDR TURON NTRL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20645-400MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE OVAL TEXTUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20645-450MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE OVAL TEXTUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20645-500MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE OVAL TEXTUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 97MM CMNT SMT 2 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HLXMA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERLOCK MEDIUM ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ADVANCE MILAGRO 7MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,488.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,488.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787CT80STPDVI1|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT IMPLINFN SMRT PORT FLUOROMAX VTX SFSHTH ULT LT TI PU 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5527-B-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE FIXATION SCREW TRIATHLON SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 108MM CMNT SMT 3 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CFBC-4503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 3 CROSSFT BC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,064.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGK0214150|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 1.4MM KRSH SMTH TROC TIP|1|HUMANA [1294]||HUMANA [11839]|98.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MV30A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXOS MV 4.0 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,476.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,476.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 114MM CMNT SMT 4 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-13120T-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 26MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200M-07R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META OPEN RIGHT LOW PROFILE WEDGE 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0704-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 7.0MM X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH091502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH ILC ART 15CM 9MM 9FR HEP VBHN 120CM ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8782|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER INTERTHECAL SEGMENT SPINAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC2411045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 110CM 2.8FR 2.4FR .020IN MERIT MAESTRO .038IN .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC2811045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 110CM 2.8FR 2.4FR .024IN MERIT MAESTRO .038IN .021|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-4116|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE NRSTM 213CM PRCS SPCTR 1X16 SPLTR XTN|1|HUMANA [1294]||HUMANA [11839]|15.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1551|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 25X9X7MM STX XD 8D LRDTC PEEK XPD RADOPQ CRTDG|1|HUMANA [1294]||HUMANA [11839]|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FB-201-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND TISSUE FIXATE (DUAL PACK)|1|HUMANA [1294]||HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7076530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK PLIF MAS 6.5 X 30MM 3Z BLAST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5023-3-090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 90MM 4MM APX SS ST SLF DRL THRD 30MM XTRNFX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T79P|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 7.75MM X 9.22MM (FREEZE DRIED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 176204008|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 23X12X8-12MM OBLNG STRG TRPZD TI MESH LMBR INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 120MM CMNT SMT 5 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 338648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 48MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 129MM SS 10 HL COLR SPS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 127MM CMNT SMT 6 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CFBC-4503N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.5MM 2 FT CROSSFT BC HI-FI NDL SDL TIP RLB FX CRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,118.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L-11-06|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 32.5MMX11MM LOOP 6D PEEK TLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|21,897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XPRES310|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY 300 XPRESS 10CC|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 20MM SS FT CANC HEX NS AXSOS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5527-B-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE FIXATION SCREW TRIATHLON SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.647.127S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 7MM ZERO-PPEEK-OPTM ELGILOY TI STD LRDTC|1|HUMANA [1294]||HUMANA [11839]|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 133MM CMNT SMT 7 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.647.125S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 5MM ZERO-PPEEK-OPTM ELGILOY TI STD LRDTC|1|HUMANA [1294]||HUMANA [11839]|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.647.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 52MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 24MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 711086|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SNARE OVAL ISNARE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711088|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SNARE HEX 25GA 3MM ISNARE NDL OLMPS STY ACT CORD SPRG LD LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCS-002NR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTC STANDARD EXTREME MAXLOCK NEUTRAL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTF-011-35-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTF-021-35-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157003150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 139MM CMNT SMT 8 12/14 STD OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTF-021-35-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 75MM 6 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16517010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SEGMENT FIBULAR APPROXIMATELY 10CM FROZEN CRYO|1|HUMANA [1294]||HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254682|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FEMORAL INTRAFIX 8MM HARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83978-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 5MM 150CM 120MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-080-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6947M-72CM|SUP|HCPCS C1895||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TACHYARRHYTHMIA IMPLANTABLE SPRINT QUATTRO SECURE 72CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,167.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 112MM SS 2.7/3.5MM SCR 6 HL VA LOPRFL LCP CMBN BN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,000.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,000.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM PRFT BSC SMT 2 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.118.526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 26MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 30MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 40MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 42MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 44MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 52MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM NONLOCK HEXALOBE HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM PRFT BSC SMT 3 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-0326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5527-B-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE FIXATION SCREW TRIATHLON SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-1400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 400MM FEM LT GMA IM 125D LNG KT TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2030-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 14 PTA 3.0MM X 200MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0259|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM NONLOCK HEXALOBE HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 28MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 30MM LOPRFL SCR TI T10 FT FOREFOOT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952XL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG X TI 3MM SCR BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM PRFT BSC SMT 4 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1365-54-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL METAL ASPHERE 12/14 36MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,544.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,544.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 100MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 95MM PRECEPT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM PRFT BSC SMT 5 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DTBX1QQ|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR VIVA QUAD C CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 112MM SS 2.7/3.5MM SCR 4 HL VA LOPRFL LCP CMBN BN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 26MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM PRFT BSC SMT 6 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.206.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 30MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 36MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 40MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 38MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 40MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 99MM 8 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604660S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 60MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6910260|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 60X22X10MM CRNT XL W PEEK NS LF|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 155MM PRFT BSC SMT 7 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6912260|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XTRA LARGE COROENT 12 X 22 X 60|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7459315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7510100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INFUSE EXTRA SMALL (BMP)|1|HUMANA [1294]||HUMANA [11839]|5,715.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,715.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFB-30-74|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 30MM X 74MM ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6790225|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17X14X5MM CRNT SM INTLK 7D LRDTC CRV NS LF|1|HUMANA [1294]||HUMANA [11839]|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6790712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COROENT 12 X 3.5MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21374|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 7FR 5CM .035IN PSTN SLV PUSH CATH GW DDNL FLP GNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPSO-7-7|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC 7FR 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157005150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM PRFT BSC SMT 8 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,292.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G21379|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 7FR 9CM .035IN PSTN SLV PUSH CATH GW DDNL FLP GNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21507|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 7FR 12CM DRN OBSTRUCTED PSTN SLV PSH CATH DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21509|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 7FR 15CM TPR CNTR SPRL SH OFST FLP GNN PE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22111|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 5CM PSTN SLV PUSH CATH DDNL FLP GNN PE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22114|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 9CM PSTN SLV PUSH CATH DDNL FLP GNN PE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22099|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 5FR 12CM DRN OBSTRUCTED PSTN SLV PSH CATH DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|184.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|184.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21371|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PNCR 7FR 3CM .035IN PSTN SLV PUSH CATH GW DDNL FLP GNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5527-B-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE FIXATION SCREW TRIATHLON SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7900021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET CADDY VUEPOINT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|711.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7901310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL TULIP 3.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505590 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.5CM MEMORYGEL CHSV I P6.3CM RND ULT HI PRFL GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97791|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR INJEX BUMPY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G56236|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ANSEL FLEXOR 6FR .035 DIAMETER 55CM MULTIPURPOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G49043|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ANSEL FLEXOR 7FR .035 DIAMETER 55CM MULTIPURPOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G56221|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ANSEL FLEXOR RTPS 6FR .035 DIAMETER 70CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8946-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEUS STEP 7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 97MM CMNT BSC SMT 2 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012580-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT RX 2.8 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012583-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT RX 4.5 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 108MM CMNT BSC SMT 3 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported XPRES3C10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PUTTY WITH CANCELLOUS CHIPS 300 EXPRESS 10CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN402232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 20MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45712810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 9MM 2.85MM 1.6MM PRO-TOE VO 10D PHALANX SS BLDE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 14MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 6MM SS CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 7MM SS CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.586|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39MMX1.2MM SS 2MM SCR MDLR HND SYS 6 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|779.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|779.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 10MM SELF TAPPING STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 114MM CMNT BSC SMT 4 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 200.532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 12MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 14MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.686|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 6MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.687|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 7MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.688|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 8MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.690|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 10MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.694|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 14MM SS CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 46MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21720|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 5CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21721|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 7CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 121MM CMNT BSC SMT 5 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G21722|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 9CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22213|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 12CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G22217|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 7FR 15CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21652|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 5CM .035IN PSTN SLV ESCP CHNL DDNL FLP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21658|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 9CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21883|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BIL 10FR 15CM DRN OBSTRUCTED PSTN SLV ESCP CHNL DDNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 246.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 29X3.8X.8MM SS 1.5MM SCR MDLR HND SYS 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-0255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING WEB 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,402.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 127MM CMNT BSC SMT 6 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FEM10060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 60MM 10MM 9FR FLN + C EPTFE 2 LYR KINK RST INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM08040|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRACHEOBRONCHIAL FLUENCY PLUS 8MM X 40MM X 117CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 133MM CMNT BSC SMT 7 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 345440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 40MM SS FT CANC HEX NS AXSOS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 250MM BN TIB RT DIST MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,648.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,648.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS32A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM FIXOS CMPR CNN ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XFO041701|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIT DRL 17MM 2MM FIXOS CNN CNTRSNK AO DISP|1|HUMANA [1294]||HUMANA [11839]|583.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157006150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM CMNT BSC SMT 8 12/14 TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,735.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11114665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM SHLDR RSRFC CPLND EAS MACROBOND HA 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00102.214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TAPER REVISION UNCEMENTED WAGNER SL 5 DEGREE P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,847.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,847.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EDL-001-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE EDGELOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,081.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,081.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8- 6.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-6.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1436S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 14MM X 360MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PF IMPLANT MED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II RESURF PAT 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.755S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 375MM TIB XPRT IM FLUT CNN UNV TI STRL LGHT GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,583.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATF-240-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2-2.5MM 24MM ACTRK TI FT SLF CUT CNN FSN HDLS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1234S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 12MM X 340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STM331508|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 33X15MM STALIF MDLN 8D LRDTC SM STAT 2.4ML|1|HUMANA [1294]||HUMANA [11839]|25,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WEB 2.5MM LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,402.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875701036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALLOFIT TRILOGY CONTINUUM LONGEVITY NEUTRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZILBS-10-4|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER METAL BILIARY 10MM 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G28999|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 20FR 25CM SET CKFL .035IN XL STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062502250|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH ACC 12-14FR 2 DRMTR DIL RADOPQ INNOVATIVE HUB NVGTR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0062502260|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ACCESS URETERAL HD NAVIGATOR 12/14FR X 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RS0616F|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM SINUPLASTY BALLOON FRONTAL SPIN RELIEVA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MGT89030MT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT METATARSAL MOVEMENT SIZE 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,814.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,814.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MGT89030PPT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE MOV 30 PHALANX PROX TI UHMWPE HEMIRESURFACE SUT HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,095.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,095.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSR8903040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RMR SRG SRFC 30/40|1|HUMANA [1294]||HUMANA [11839]|623.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSR8903040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RMR SRG SRFC PHALANX PROX 30/4|1|HUMANA [1294]||HUMANA [11839]|623.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSM110|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD SCT SFT DIST TIP RLV SPIN M-110 MXL SIN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSS0|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD SCT SFT DIST TIP RLV SPIN 0D S-0 SPND SIN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM CMNTLS SMT DUOFIX HA 1 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ETBF2816C124E|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 124MM 28-16MM 18FR ENDURANT II 2 BRCH EVAS NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222333|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ADVANCE HEALIX KNOTLESS 4.75MM PEEK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ETLW1610C93E|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM GRAFT STENT ENDURANT II LIMB CONTRALATERAL 16/10 X 93|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ETLW1610C156E|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM GRAFT STENT ENDURANT II LIMB CONTRALATERAL 16/10 X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18022000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT PATELLAR LIGAMENT 10MM DOWEL ASEPTIC NON IRRADIATE|1|HUMANA [1294]||HUMANA [11839]|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ X3 INSERT 32mm ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM CMNTLS SMT DUOFIX HA 2 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DVBB1D4|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR EVERA XTVR SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DDBB1D1|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK13MM 57SQ CM 51X66MM EVERA XT SMARTSHOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DDBB1D4|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK13MM 51X68MM EVERA XT DR SMARTSHOCK 2 CHMBR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTBA1D1|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR VIVA XT CRT-D BI-VENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DVBB1D1|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK13MM 51X66MM PHYSIOCURVE EVERA XT VR SMARTSHOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,974.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|40,974.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2DR01|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ADVISA DUAL CHAMBER MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTBA1D4|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD VIVA XT CRT-D BIPHASIC WVFRM DF-4 CNCT ICD 35ML 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM CMNTLS SMT DUOFIX HA 3 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 223114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ORTHOCORD MO-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OVAL RESURFACING PAT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CON ART INS 9MM SZ 3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB DRLC 10D +4MM NTRL 56MM 36MM MRTHN HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124956000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACTB 56MM DRLC DYNMC HIP LCK STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB PNCL 10D +4MM 50MM 32MM ALTRX HIP STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +9MM 12/14 TPR 32MM HIP SLV BLX D TI ART/EZE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,563.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,563.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM CMNTLS SMT DUOFIX HA 5 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 228140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ASCP FX OMNISPAN 0D MNSCL REPR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ASCP FX OMNISPAN 12D MNSCL REPR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM HEALIX ADV KNTLS BR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 38MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 48MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012626-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 10.0MM X 39MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 10MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012626-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 10.0MM X 59MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM CMNTLS SMT DUOFIX HA 8 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012633-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 10.0MM X 29MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012633-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 10.0MM X 39MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012633-59|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 10.0MM X 59MM CATHETER LENGTH 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.75MM HEALIX ADV KNTLS BR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G53423|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 30 X 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 13H 104MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 165MM CMNTLS SMT DUOFIX HA 9 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 816135060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012626-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT OMNILINK ELITE 10.0MM X 29MM CATHETER LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22-18-135-0|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MICRO VALET 1.8F 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM ALPS TMX T15 ELB CORT LCK ST TIP TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 170MM CMNTLS SMT DUOFIX HA 10 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 510-00-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MONOBLOCK RSP SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 18MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157013090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 108MM CMNT SMT 3 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71424004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 10MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 598945|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 9F VISTA BRITE AR 1 .098 98 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-30-124-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM ZENITH FENESTRATED PROXIMAL MAIN B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-16-62-76-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM DISTAL BIFURCATED MAIN BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 28MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 157013100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 114MM CMNT SMT 4 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1100-08-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM UNITE GLOBAL STANDARD SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1100-20-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAR UNITE GLOBAL SIZE 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,701.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,701.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1100-30-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY UNITE GLOBAL SIZE 10-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110044510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 44MM SHLDR MDLR GLBL UNITE STD PLAT ARTHPL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231817|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ADVANCE MILAGRO 8MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ADVANCE MILAGRO 9MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.366E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587115LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D SM RECON SYS FSN LOPRFL ORTHOLOC 3DI BN MTP LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 10MM ORTHOLOC FT MIDFOOT CORT LCK ON AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 12MM ORTHOLOC FT MIDFOOT CORT LCK ON AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58812712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 2MM 12MM ORTHOLOC FT CORT 3DI NONLOCK LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068318201|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG UPSYLON Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,770.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0068318210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEV PRRY COLPASSIST VAG 2 END PSTN FLT SUT SRFC|1|HUMANA [1294]||HUMANA [11839]|1,083.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,083.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D131502|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TCOOL SF CARTO 3UNI D CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D131503|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TCOOL SF CARTO TC, F CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D131504|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TCOOL SF CARTO TC, J CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D134901|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LASSONAV 15MM 10 POLE 7 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D134903|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LASSONAV 20MM 7 FR SH 12P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WORLVI-75-5-62-07-RE|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER WORLEY ADV TELESCOPIC LVI 7FR 62 CM RENAL SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157013110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 121MM CMNT SMT 5 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported WOR-CSG-B1-09|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER KIT WORLEY ADV STD W/BRAIDED CORE 9FR 50CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WOR-CSG-B2-09|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER KIT WORLEY JUMBO W/BRAIDED CORE 9FR 59CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4486535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DBR III 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4486545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DBR III 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407451|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SWARTZ BRAIDED TRANSSEPTAL 8.5FR 63CM SL0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407453|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SWARTZ BRAIDED TRANSSEPTAL 8.5FR 63CM SL1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00488|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SAFE-T-J CURVED .032 145 LENGTH 3MM TIP CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157013120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 127MM CMNT SMT 6 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 504610T|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER AVANTI 10FR 23CM BOX/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504611T|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER AVANTI 11FR 23CM BOX/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09.820.055S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRODISC LARGE 5MM|1|HUMANA [1294]||HUMANA [11839]|17,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235701706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 106MM SS 2.7-3.5MM SCR 6 HL LCK BN FIB RT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482801802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 18MM SS ELB PERIART LCK NS SM FRAG UNV LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-024-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TALAR ANKLE TOTAL METAL TRABECULAR ZIMMER SIZE 4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-044-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BASE TIBIAL ANKLE TOTAL METAL TRABECULAR ZIMMER SI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-054-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT INSERT TIBIAL POLY CROSSLINKED PROLONG TM ZIMMER S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03.820.102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RTNR SCR 12MM 3.5MM PRODISC-C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157013135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 133MM CMNT SMT 7 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4828-012-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29MC29130SN|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 130CM 2.9FR MERIT MAESTRO .027IN MIC NO TPR SWNCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC24130SN|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 130CM 2.8-2.4FR .02IN .04IN MERIT MAESTRO .018IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIL BN VOID 10CC 20CC CA SLF STIMULAN RPD CURE KT PST BEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,557.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,557.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LVI/75-5-62-07-HS|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH WORLEY TELESCOPIC BRAIDED HOCKEY STICK 9FR 62CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported U8150330|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 30CM OTW REINF INR LUM RADOPQ ULT-CX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001508100|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 200CM .014IN STRBL STRG 10CM FATHOM PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157013150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 139MM CMNT SMT 8 12/14 HI OFST TPR HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,619.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3507150MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.3CM MEMORYGEL P2.5CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507190MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11CM MEMORYGEL P2.7CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507235MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.8CM MEMORYGEL P2.9CM MDRT PRFL STD PRJ RND SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507275MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.5CM MEMORYGEL P3CM MDRT CLS PRFL STD PRJ RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20676-210E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC TEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20676-240E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC TEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 12MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-017-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 17MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8952MS-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG TI 2.4MM SCR 6 HL LOPRFL BN FT MTRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 10MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5536-B-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 5 KN TRITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5536-B-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 3 KN TRITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620-005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIL BN VOID 5CC 12.5CC CA SLF STIMULAN RPD CURE KT PST BEAD|1|HUMANA [1294]||HUMANA [11839]|3,582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00560402007|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT OSTEOCHONDRAL CHONDROFIX 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-5604-020-09|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT OSTEOCHONDRAL CHONDROFIX 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,920.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,920.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-5604-020-11|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT OSTEOCHONDRAL CHONDROFIX 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,049.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,049.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-5604-020-15|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT OSTEOCHONDRAL CHONDROFIX 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,231.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,231.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 30MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3313-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT NXT 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,452.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13280-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 45MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13280-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 50MM CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13370-4|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE OSTEO OSFERION 15MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13380-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 4.5 X 32MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13380-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 4.5 X 36MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13380-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 4.5 X 48MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13720-15.0|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WEDGE SLOPED HTO CONTOURLOCK 15MM LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7864-018-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL TM 18MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,695.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1828-1530S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 15MM X 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5023-6-150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 150MM 4MM APX SS SLFDRL ST THRD 50MM XTRNFX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|371.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|371.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5048-5-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CONNECTING MRI COMPACT 5MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-009-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 9MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 343085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM AXSOS SS 3.5MM FT HEX FEM CANC DIST LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|112.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-7114|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST CPX3 CONTOUR HEIGHT LOW TEXTURED 550C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-1529|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 29X9X7MM STX XD CNVX PEEK XPD RADOPQ CRTDG STRL LF|1|HUMANA [1294]||HUMANA [11839]|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4486540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DBR III 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200502|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE SPHERX LONG|1|HUMANA [1294]||HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 10MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5536-B-700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 7 KN TRITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L-08-06|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE LOOP T-LIF 8 X 32MM X 6 DEGREES|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE SULPHATE CALCIUM STIMULAN RAPID CURE 20CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP13000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-2202|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE BIOACTIVE FOAM PACK VITOSS BB 2.5CC|1|HUMANA [1294]||HUMANA [11839]|2,844.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,844.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 120MM 10 HL INCR CRVTR MIDSHAFT VARIAX BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.032.075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 11MM 75MM TI FEM TROCH PROX FX STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-011-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 11MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 03.820.133S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERTER TIP FOR LARGE DEEP IMPLANTS|1|HUMANA [1294]||HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5536-B-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON TRITANIUM BASEPLATE SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 130MM 16MM RVRS TRB MTL TIV SHLDR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131211116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FX 2.5MM 16MM KN THRD MLDIR DVR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1100-10-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM UNITE GLOBAL STANDARD SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 12MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1100-20-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAR UNITE GLOBAL SIZE 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,701.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,701.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3218|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY DRAINAGE DOUBLE PIGTAIL 7 FR X 5 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3221|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY DRAINAGE DOUBLE PIGTAIL 7FR X 10 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3229|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY DOUBLE PIGTAIL 10FR X 10 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5521-B-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 8 UNV KN COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,244.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110048500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 48MM SHLDR MDLR GLBL UNITE STD PLAT ARTHPL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 13MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported E160|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|SYSTEM MANAGEMENT INCISION PRESSURE NEGATIVE PREVENA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01947|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 50CM .035IN CRV FXCR 3MM SFTJ SS STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM OFST TPR 40MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7095535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK MAS PLIF 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70956535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK MAS PLIF 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7095540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK MAS PLIF 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7095530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK MAS PLIF 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7070000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TULIP PLIF MAS MODULAR|1|HUMANA [1294]||HUMANA [11839]|3,693.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7070003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK FIXATION PLIF MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-015-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 15MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7242070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CONVENTIONAL SPHERX II 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3504751BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.9CM MEMORYGEL P4.2CM MDRT + PRFL SIL GEL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8757-052-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM TM MULTI HOLES 52 MM SIZE II PORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,741.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,741.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.06010.006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MULLER AVENIR STANDARD UNCEMENTED HA TAPER 12/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-85FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958926|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 26MM VRTX MX TI SPNE MA NS MAG RECON SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921260|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 60X22X12MM CRNT XL W LRDTC PEEK LMBR INTRBD FS NS|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 266MM SS 3.5MM SCR 12 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,479.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,479.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-017-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 17MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,922.09|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,922.09|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.104.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 302MM SS 3.5MM SCR 14 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,835.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,835.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL DISTAL 3.5 LCP EXTRA ARTICULAR LEFT 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,769.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,769.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 266MM SS 3.5MM SCR 12 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,302.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,302.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.104.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 302MM SS 3.5MM SCR 14 HL PRECONTOUR LMT CNTCT TPR HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,866.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,866.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8751-010-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 52 II X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,412.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,412.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00551.211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP UNCEMENTED TAPER 12/14 5 DEGREE SIZE 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771102000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 139MM 20MM PRM ML TIV POR TPR STRG STD OFST HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7200172|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 72.5MM TI 4 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5536-B-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 6 KN TRITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 48MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 20MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 693565|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 65CM 8.6FR HLX VNTRC 1 COIL ACTFX DFBR TRPLR SQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,152.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,152.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5076110|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 110CM ATR VNTRC SCR IN FX BP CP NV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 32MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00771101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 121MM 11MM PRM ML TPR TIV POR 12/14 49MM XTD OFST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6057-110|SUP|Custom 95131007||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|ACCESSORY PACING BALL-TIPPED STYLET FOR 110CM LEAD|1|HUMANA [1294]||HUMANA [11839]|96.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6082-110|SUP|Custom 95131007||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|ACCESSORY PACING BALL-TIPPED STYLET FOR 110CM LEAD|1|HUMANA [1294]||HUMANA [11839]|96.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459888|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 88CM 5.3FR 5.1FR LV TRNVNS QDPL ELTRD STERIOD ELUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4190020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA/.035 PTA PRO 10 X 20 X 80MM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 122MM 10 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-101126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26X11X10MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 28MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT02062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS CINCHLOCK 2.4MM W/ INSERTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-012-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 12MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5536-B-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB TRTHLN 4 KN TRITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L-10-06|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE LOOP T-LIF 10 X 32.5MM X 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35022S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM DART-FIRE SM HD CNN P/T ST CMPR AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35024S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADED 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-013-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 13MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2102-2201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUB BNGF BBTRAUMA BN BRDG TECHNOLOGIES VITOSS FM PK 1.2ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,659.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,659.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YP1802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.8MM 2 Y-KNT 2 LD 2 STRN FLXB SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 2.5MM 42MM SS CORT ST HEX NS AXSOS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT311415|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 15CM 31MM 14.5MM XCLDR C3 TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC161200|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 11.5CM 16MM 13.5-14.5MM XCLDR CNTRLT LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL1228|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL COATING HYDROPHILIC GORE 12FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-015-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 15MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RMT261416|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 26MM 14.5MM GORE XCLDR C3 TRNKIPSL LG AAA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 439888|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ATTAIN PERFORMA 88CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +4MM OFST TPR 40MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-017-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 17MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D134302|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 7FR 115CM LASSO 2515 NAV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 142MM SS 2.7/3.5MM SCR 6 HL VA LOPRFL LCP CMBN BN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 24MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 34MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 34MM SS T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 79MM SS 2.7MM SCR 3 HL VA LOPRFL CNTR SHFT LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,539.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,539.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 14MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 211215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 15MM 2-3MM AVANCE NRV ALGRF|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 30MM 1-2MM AVANCE NRV NTR CNCT|1|HUMANA [1294]||HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771102020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 139MM 20MM PRM TIV POR TPR STRG XTD OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 211230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 30MM 2-3MM AVANCE NRV ALGRF MLT CLN|1|HUMANA [1294]||HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 411230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 30MM 4-5MM AVANCE NRV ALGRF|1|HUMANA [1294]||HUMANA [11839]|6,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-080922|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22X9X8MM ARDIS PEEK-OPTM PLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0044790TH0|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BLAZER II ABLATION 8FR 10MM STANDARD CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1005357H|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI TORQUE WHISPER MS WIRE .14" X 190 CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 14MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM C STD KN LT CMNT POST STAB NG LPS OPTN ZML STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85445|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST 7MM X 22MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604748S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 48MM FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTEG-2P-32-140-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 32 X 140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|37,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMWCE-38-5-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION MREYE .038 DIAMETER X 5CM LENGTH 10MM|1|HUMANA [1294]||HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G42410|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION MREYE .035 DIAMETER X 3CM LENGTH 5MM|1|HUMANA [1294]||HUMANA [11839]|206.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|206.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 311215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT NRV 15MM 3-4MM AVANCE ALGRF STRL|1|HUMANA [1294]||HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 411215|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 15MM 4-5MM AVANCE NRV|1|HUMANA [1294]||HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D LT 41MM SS 2.4MM SCR 2 HLE/HD 3 HL SHFT INTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111030ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM C STD KN RT CMNT POST STAB LPS OPTN NXGN ZML STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 13MM 18MM RVRS TRB MTL SHLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 17MM 14MM RVRS TRB MTL SHLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434901617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 17MM 16MM RVRS TRB MTL SHLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-AVP038-007|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG 4 VASCULAR AMPLATZER 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111028ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 904922P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ALLTHREAD 5.5MM PEEK III TPD NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|942.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 7 KN LT CRCTE RTN BEAD TRTHLN PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459878|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 78CM 5.3FR 5.1FR .014-.018IN OFST S LV QDPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 510-00-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MONOBLOCK RSP SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM D STD KN LT CMNT POST STAB NG LPS OPTN ZML STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 100.12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET ESCP 165CM 10.5-12MM OTSC 6MM NTNL T CLIP PNT TTH STRL|1|HUMANA [1294]||HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-040-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX SELF EXPANDING BILIARY STENT 6FR DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2030-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 40MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 20MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 40MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 80MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM D STD KN RT CMNT POST STAB NG LPS OPTN ZML STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2030-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 135CM 20MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 100MM OTW LOPRFL TIP ARMADA ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 135CM 120MM OTW LOPRFL TIP ARMADA ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-020|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 60MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 80MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 25MM 3.5MM VRTX SLCT PCUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 34MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599601552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM E KN RT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0258|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM TI HEXALOBE NS SM FRAG BS SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0261|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM NONLOCK HEXALOBE HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0271|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 40MM NON LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM ELB LCK HEXALOBE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 16MM TI LCK HEXALOBE NS SM FRAG BS SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM LCK HEXALOBE HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 4.8MM 80MM TI T25 FT FEM LCK ST BLNT TIP 2 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM F KN LT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-10/12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL TI PRESS-FIT SIZE 10/125MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,496.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,496.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 42MM 16MM SS T15 L/T CMPR ST SLF DRL HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 48MM 18MM SS T15 L/T CMPR ST SLF DRL HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 100MM OTW LOPRFL TIP ARMADA ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 120MM OTW LOPRFL TIP ARMADA ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 6 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 6 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 60MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 80MM OTW LOPRFL TIP ARMADA ACPT .035IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-309-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 3 - 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.647.120S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT VA ZERO-P LORDOTIC HEIGHT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5536-B-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON TRITANIUM BASEPLATE SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,376.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G56279|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH GD 45CM 12FR 4.1MM FLXR CHFL STRG HI FLX DIL ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLS-1008|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PRELUDE SNAP SPLITTABLE HEMOSTATIC INTRO 8FR, 13CM 18GA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-1008.5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 8.5F 13 CM .112 LT BLUE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLS-1009|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 9F 13 CM .118 BLACK 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CLS-1009.5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 9.5F 13 CM .125 WHITE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-1010|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 10F 13 CM .131 WHITE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM F KN RT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-1010.5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO WHT 13CM 10.5FR 18GA .138IN CLS SHTH STD SPLT HMST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-1011|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 11F 13 CM .144 WHITE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-1012|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 12F 13 CM .158 WHITE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-1012.5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 12.5F 13 CM .164 WHITE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 6MM 135CM 120MM OTW LOPRFL TIP ARMADA ACPT .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLS-1006|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PRELUDE SNAP SPLITTABLE HEMOSTATIC INTRO 6FR 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLS-1007|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 7F 13 CM .092 ORANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-2508|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 8F 25 CM .0105 BLUE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLS-2509|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 9F 25 CM .118 BLACK 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS-2507|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH CLASSIC 7F 25 CM .092 ORANGE 5/BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP11000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 16 HL SHFT BN TIB DIST MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,648.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,648.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM G KN LT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.114.503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ST 29MM TI 1.5MM SCR 6 HL ADP LCP BN SPNE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,404.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,404.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 11MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130MM TI 4 HL AXSOS 3 BN FEM LT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 28MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661185|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 85MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661190|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.5MM 50MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM G KN RT NG LPS OPTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 55MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 60MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 238MM TI 10 HL AXSOS 3 BN FEM RT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 18MM AXSOS 3 TI LCK ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 65MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 70MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-32-18S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION ZP THREAD SHORT 3.2 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-010-32-20S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION ZP THREAD SHORT 3.2 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|627.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-014-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,652.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,652.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BALL SINGLE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-040-11D|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE TROCAR DOUBLE 1.1 (GREEN/BLUE)|1|HUMANA [1294]||HUMANA [11839]|42.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFS-1010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT KIT FUSEFORCE 10 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFS-1212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT KIT FUSEFORCE 12 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 468-195|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE SALINE STYLE 468 TEXTURED MODERATE P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 468-230|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.5X11CM NATRELLE BCL P4.2CM FULL HT SAL STY 468|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 70MM 16MM AXSOS 3 TI P/T CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-014-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,652.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,652.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 310MM TI 14 HL AXSOS 3 BN FEM LT DIST LAT NSs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 14MM AXSOS 3 TI LCK ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 16MM AXSOS 3 TI LCK ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 30MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661175|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 75MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +90D L 51MM SS 2.4MM SCR 2 HLE/HD 5 HL SHFT VA LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 51MM SS 2.4MM SCR 3 HLE/HD 5 HL SHFT VA LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.451|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -20D OBLQ L 55MM SS 2.4MM SCR 3 HLE/HD 5 HL SHFT VA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70143266|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOIDBONE PHOSPATE CALCIUM OTOMIMIX 2 GM|1|HUMANA [1294]||HUMANA [11839]|1,134.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,134.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5964-013-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MGT89040MT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT METATARSAL MOVEMENT MGT SIZE 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,899.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,899.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV-14-T|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 500CC STYLE133MV W/SUTURE TAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 36MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|77.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5964-013-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3225|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 2.5 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3235|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 3.5 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3240|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 4.0 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493911438250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS COR STNT 38MM 2.5MM PROMUS ELMT + CLIPIT MNRL EVEROLIMUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3830|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 3.0 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3835|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 3.5 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3840|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 4.0 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83175-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG CRSNT 5MM 150CM 60MM PERI OTW LOPRFL TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39114-3230|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS ELEMENT DE STENT 3.0 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3543407MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.2CM MEMORYGEL P3.4CM MDRT PRFL SLTX GEL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-015-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE ACHILLES PRESHAPED 10MM|1|HUMANA [1294]||HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453019|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE PATELLAR PRESHAPED 10MM|1|HUMANA [1294]||HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3543207MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.9CM MEMORYGEL P3.3CM MDRT PRFL SLTX GEL RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 30MM 3.5MM VRTX PCUT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 121MM TI 4 HL AXSOS 3 BN TIB RT PROX LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,127.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,127.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM AXSOS 3 TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM TI CORT LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3530-0380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 380MM FEM LT GAMMA3 IM 130D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 51MM SS 2 HL COLR SPS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|200.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|200.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-015-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1033S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 330MM TIB T2 IM STD LCK GUN DRL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231819|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ADVANCE MILAGRO 10MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110005096|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR JUGGERKNOT 2.9 WITH TAPERED NEEDLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SE-0910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPL 10X9MM SPD NTNL 1.5X1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 55MM 5.5MM XPDM PREBNT TI LN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.368E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP COARSE PITCH 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122-65|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD DURATA 65 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE SEMITENDINOSUS 200-219MM|1|HUMANA [1294]||HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8884215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARCHON 4 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-016-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 65MM AXSOS 3 TI LCK ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKNG 4.0MM X L90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N3-0026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADLESS 3.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604750S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 50MM FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-016-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8934BCNF-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 0 .5 CRC 4 DMD SUT TK FBRWR S JNT NDL BCMPS 22.2MM|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207681|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR HA 25MM 9MM 1.5MM ACL PCL BABSR CNN BIORCI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|809.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.104S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 15MM 112MM SS 3.5MM SCR SM FRAG SET 7 HL HK PRECONTOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN402622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 26MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 17MM SPK RND ORTH NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-017-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6914250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 50X22X14MM CRNT XL W PEEK RADOPQ LMBR INTRBD FS NS|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516940|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX PARTIALLY COVERED 23MM X 12CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-017-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION SIZE-G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,358.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 50MM HIP 12 SCLP CH SNPFT GRV INTGR LCK MECH TRB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8751-009-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 50 HH X 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00101.916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TAPER REVISION UNCEMENTED WAGNER SL 12/14 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,847.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,847.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 501-112|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH DIL 12FR VISISHEATH 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 501-114|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH DIL 14FR VISISHEATH 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 501-116|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DIL SHTH 33CM 16FR VISISHEATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-15031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1 RECT TI LOPRFL CMPR VARIAX SMARTLOCK BN FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT9-33.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 33.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965451110|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT XCELA LOW PROFILE TITANIUM 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C-BIG-8X10|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR HERNIA GOLD SURGISIS 8-PLY W/O PERFERATIONS 8 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4486550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DBR III 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482804645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY LONG ES2 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482806045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RAD ES2 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48230231|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE BLUNT ES2|1|HUMANA [1294]||HUMANA [11839]|132.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE INTERBODY FUSION ACCULIF PL 6-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L-09-06|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE LOOP T-LIF 9 X 32MM X 6 DEGREES|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6912855|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 55X18X12MM CRNT XL PEEK RADOPQ LMBR INTRBD FS NS|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6914255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 55X22X14MM CRNT XL W PEEK RADOPQ LMBR INTRBD FS NS|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 38MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.77|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|79.77|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596203012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 12MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 482804540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY LONG ES2 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482806050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RAD ES2 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE -20D OBLQ L 41MM SS 2.4MM SCR 3 HLE/HD 3 HL SHFT VA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 35MM TI 2 LVL ATL VS ELT BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82096-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8-10MM 40MM TPR SLF XPD CLS CELL FLR END FRSTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802210|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 6FR 22CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 207.738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 38MM SS L/T RVRS CUT FLUT CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000060|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-33.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 33.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 14MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1828-1338S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 13MM X 380MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2040-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 120MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 150MM 5MM SCHNZ SLF DRL CALC FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PR-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER LARGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PR-M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER MEDIUM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-L-SP06S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE END SUPERIOR LARGE 6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,458.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,458.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-L-IP00S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPLT INTVRTB DISC 39X30MM PRODISC-L LG LS INFR COCRMO UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,458.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,458.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-L-PT10S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INLAY INTVRTB DISC PRODISC-L 10MM LG LS TI TNTLM PE MRKR|1|HUMANA [1294]||HUMANA [11839]|2,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 17MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5968-014-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 15CM LT HINDFOOT NLEX IM CNN TI STRL GRN ARTHDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,864.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.654S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 4.8MM 64MM TI T25 FT FEM LCK CNN ST BLNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55222|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 107MM 9MM 5.4MM 14FR SPRLZ ZNTH NTNL AU CNTRLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55223|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 122MM 9MM 5.4MM 4.7MM ZNTH SPRLZ AAA NTNL ILC LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 88MM 7 HL DCRS CRVTR MIDSHAFT VARIAX BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 173MM TI 8 HL AXSOS 3 BN TIB LT PROX LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,258.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,258.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 55MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 30MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 20MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 34MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661785|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 85MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 2 HOLE L95MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 75MM TI ST LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 26MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 46MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 23MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7217075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE BENT DBR III 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 120MM 10 HL INCR CRVTR MIDSHAFT VARIAX BN CLVCL RT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 97MM 8 HL INCR CRVTR MIDSHAFT VARIAX BN CLVCL LT SUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-20001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRIVER CANNULATED 2.0MM AO COUPLING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|688.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|688.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 11MM 5MM ASNS TI MIC RVRS CUT FLUT FT HND SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45712410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 16MM 2.4MM 1.6MM PRO-TOE VO 10D PHALANX SS BLDE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45712010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 13MM 2MM 1.1MM PRO-TOE VO 10D PHALANX SS BLDE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N30012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM DART-FIRE TI P/T FT SLF DRL ST CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D2N3-0020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADLESS 3.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991122|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX11MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2561032|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 32.5MMX10MM LOOP 6D PEEK TLIF STRL LF|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840017545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA CANNULATED 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1476006100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AFLEX101|SUP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMIS DECELLULARIZED ARTHROFLEX 4.0CM X 7.0CM X 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,725.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,725.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 13MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505251 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.3CM MEMORYGEL CHSV I P4.4CM RND MDRT + PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482807030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RAD ES2 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012581-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT RX 3.5 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012582-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT RX 4.0 X 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 10MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 12MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200M-06L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META OPEN LEFT LOW PROFILE WEDGE 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 12MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6250V-MP|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ATTAIN COMMAND MULTIPURPOSE W/SUREVALVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PML|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PROLENE PM-L 12" X 12"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,717.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,717.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TWINFIX ULTRA 4.5 WITH 2 SUTURES BLUE AND BLACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported K173DR|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|SYSTEM PACING INGENIO IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE ACHILLES PRESHAPED 11MM|1|HUMANA [1294]||HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1-2214|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER X-STOP 14MM|1|HUMANA [1294]||HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E162|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2 CHMBR DF-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 14MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported N160|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK.39IN SM 2.43X3IN INCEPTA 2.54OZ CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M004PM4500|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INTELLA TIP XP 7F 8MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M004PM4790|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INTELLA TIP XP 7F 10MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7577025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI AFFEX II 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186802034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 14MM PREBNT 34X16X2.5MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,444.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,444.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 188318310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MTN 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,606.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,606.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 188342200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET INNER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 188316120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,103.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,103.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM H KN LT CMNT PRECT NG LPSFLX ZML PRLNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 40MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596203217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 17MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5970-000-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDES PIN PRI LPS-FLEX NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M004PM4500K20|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ABLT 110CM 8FR 2-5MM SPC LG CRV STRG INTELLATIP MIFI XP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M004PM4790K20|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INTELLA TIP XP 7F 10MM LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505751 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.8CM MEMORYGEL CHSV I P4.5CM RND MDRT + PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55235|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 122MM 13MM 5.4MM 14FR ZNTH SPRLZ BFUR AAA PLSTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 20MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM TI CORT LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM AXSOS 3 TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7840-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS BEADED 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,692.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,692.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062502280|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ACCESS URETERAL HD NAVIGATOR 13/15FR X 36CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ADVANCE MILAGRO 11MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F 23MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 53-23006E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 6MM TI HND WRST ST LCK LOPRFL XPN HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23010E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 10MM VARIAX TI HND WRST ST LCK LOPRFL XPN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED NAR T 1.5MM 2.3MM SCR 6 HL LCK PRECONTOUR VARIAX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8950-06|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 3MM .045IN 2 TROC TIP GRAD DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.924|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 31X6.5X1.6MM SS 2.4MM SCR MDLR HND SYS 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|921.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|921.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6250V-EHXL|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN COMMAND EH-XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 10MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 201.642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 12MM SS CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7EBU40SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 7FR EBU 4.0 WITH SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 510-00-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MONOBLOCK RSP SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1317.15.020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RESURFACING SHOULDER SMR SPALLA TIBIA14V DIA 13 L 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1327.10.540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RESURFACING SHOULDER CODR SMR DIA 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 12MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 50419-421-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE INTRAUTERINE MIRENA|1|HUMANA [1294]||HUMANA [11839]|2,091.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,091.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6981255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LARGE EXTRA 10-DEGREE LORDOTIC 12 X 18 X 55MM|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT H2 EXTENSURE II 10MM|1|HUMANA [1294]||HUMANA [11839]|6,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 6 STD KN LT CR PERSONA COCR POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR POLY PERSONA FIXED BEARING CR LEFT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1-2212|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER X-STOP 12MM|1|HUMANA [1294]||HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532007101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE LFT SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CMNT STG1 -6 HIP SIL SPCR NK ADPR STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00022900300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, FRACTURE, 5/8 X 3/32|1|HUMANA [1294]||HUMANA [11839]|146.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|146.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 418300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CARTRIDGE CAPACITY MAXIMUM TRIPLE MIX OPTIVAC 120 GRAM|1|HUMANA [1294]||HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL COCR 12/14 36MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,836.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,836.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX STRAIGHT 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 10HOLE 199MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82139-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XPERT BILIARY 4.0MM X 30MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 14MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0224512|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRUE DILATATION BALLON 22MM X 4.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0244512|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRUE DILATATION BALLONN 24MMX 4.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0204511|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRUE DILATATION BALLOON 20MM X 4.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 10 HOLE L199MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 17MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6914855|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL COROENT 14 X 18 X 55MM|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6914850|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL COROENT 14 X 18 X 50MM|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-013-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-013-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-017-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5968-017-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR LPS FLEX TINIDIUM NEXGEN SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,981.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532007901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA CEMENTED PERSONA 5 DEGREE STEMMED LEFT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 20MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42502807001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONAFIXED BEARING UC LEFT 13MM HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540000038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY CEMENTED PERSONA 38MM 9.5MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532007502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA CEMENTED PERSONA 5 DEGREE STEMMED RIGHT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,399.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 10MM HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 11MM(FEM3-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.114.506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 1.5MM 3 HOLE HEAD 8 HOLE SHAFT WITH GUIDES TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,487.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,487.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 112MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 13MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 14MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 12MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 14MM SELF TAPPING WITH T4 STARDRIVE RECESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-006-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 6MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-008-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 8MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 42MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.77|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|79.77|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596204023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F 23MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4350-009-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 9MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00435001013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 10MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-011-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 11MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-012-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 12MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00435001313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 13MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-014-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 14MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-015-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 15MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-016-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 16MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4350-018-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE NON-POROUS 18MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596204112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D 12MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.357S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 10MM X 130DEG X 360MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D 14MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596204117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D 17MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1830-0726S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL T2 7MM X 260MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3430-0340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT GAMMA 3S RIGHT 10 X0340MM X 130 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-MTP-PA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP EXTREME MAXLOCK MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,962.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,962.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-35900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW WASHER 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|197.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7555035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT XLP 5.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D 20MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6981450|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LARGE EXTRA 10-DEGREE|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7555035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BOLT LATERAL XLP 5.5X35M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6912845|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XTRA LARGE COROENT 12 X 18 X 45|1|HUMANA [1294]||HUMANA [11839]|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186802028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKY 2 LEVEL 28MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,622.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3060-0115S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 10.5X115MM GAMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-0440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 10 X 440 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CHARGING SENSOR RESTORE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D 23MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 59960514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY LPS NEXGEN SIZE 5 GREEN/E,|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,073.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179702000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INNER SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|746.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|746.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 35MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3430-0360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT GAMMA 10 X 360MM X 130 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0256|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 10MM NON LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0257|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 12MM NON LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0233|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 10MM HEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 G-H 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DORSOLATERAL12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0073|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ULNA MIDSHAFT 12-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2030-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 14 PTA 3.0MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-5970-000-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDES PIN PRI LPS-FLEX INSTRUMENT SPECIFIC PATIENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 11 X 340MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8595525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7571135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AFFIX II S BLADED 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7577035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AFFIX 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7125530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL 3Z PLIF MAS 5.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,586.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,586.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7125535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL 3Z PLIF MAS 5.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,586.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,586.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7242035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT FIXATION PLIF MAS 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,191.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,191.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7242040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT FIXATION PLIF MAS 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,191.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,191.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CONSTRUCT OXINUM LEGION SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL REVSION LEGION SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT STRAIGHT 14MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-1010C|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CHARGER AND IPG PRECSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 G-H 12MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71424048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT STRAIGHT 15MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,371.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,371.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-70FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-H200L-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL LEFT 20.0MM DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-56-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR HEAD UNIVERSAL UHR 26MMX56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186803042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PL-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER SMALL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.844|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 44MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596204214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 G-H 14MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM /L80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 11MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97740|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT ADVANCED PRIME|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39232-30018|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VICTORY STR 18G .018 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 G-H 17MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 39233-19530|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VICTORY STR 30G .018 195CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39232-19518|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VICTORY STR 18G .018 195CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39233-30030|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VICTORY STR 30G .018 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP22000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG 2.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012402-15A|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MINI TREK OTW 1.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207682|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIOCRCI 9X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIOCRCI 7X25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|771.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 G-H 20MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5962253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI X-CORE 25-40MM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK MINI TI X-CORE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8883362|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACP ARCHON 62MM 3LEVEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-6373|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HEARTRAIL II 6FR 100CM IL4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-6370|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HEARTRAIL II 6FR 100CM IL3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596204223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 G-H 23MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 406965|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER RAMP 8.5FR .038 60CM SHEATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD2357-40C|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR FORTIFY ASSURA DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,562.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,562.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.5 X 35 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SPIKED 14MM|1|HUMANA [1294]||HUMANA [11839]|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G03831|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OCCLUSION 9FR X .035 DIAMETER X 120CM LENGTH CODA-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT084050A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR COATED HEPARIN PROPATEN RING REMOVABLE WALL T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,358.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,358.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ECH060040A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROPATEN ACCUSEAL HD 6 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532008302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA CEMENTED PERSONA 5 DEGREE STEMMED RIGHT SIZE H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 10MM(FEM 3-11TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT064050A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR COATED HEPARIN PROPATEN 6MM X 50CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,358.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,358.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532007102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE RGT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H 12MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7967218|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FUSION LUMBAR SOVEREIGN 12 DEGREE 18 X 23 X 32MM|1|HUMANA [1294]||HUMANA [11839]|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 307F3|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FREEZOR MED BLUE 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H 14MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PNG730|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 7.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|5,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN404432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 44MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS-FIT TRIATHLON TS 18MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,704.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,704.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532007902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA CEMENTED PERSONA 5 DEGREE STEMMED RIGHT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-02-118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE NON-LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H 17MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 627312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 12 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-066-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR CEMENTED PS NARROW PERSONA LEFT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532006701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE LFT SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5216-005-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR POLY PERSONA FIXED BEARING CPS LEFT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-004-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR POLY PERSONA FIXED BEARING CR LEFT 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7755545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHANK 5.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4485540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DBR III 5.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55244|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 24MM X 39CM FLEX ZENITH SPIRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PROLONG FLEX LPS GH 7-10 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3201-101130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 10MM X 11MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012584-19|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 4.8MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT UNIVERSAL 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP-MFT-001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y R20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VAR-031-35-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VAR-031-35-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT THREAD 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-70-70L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LONG THREAD 7.0 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H 23MM KN FX BRNG PRLNG LPSFLX NXGN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZTEZ-2P-30-120-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR 30 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3065-0100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TITANIUM U-BLADE LAG SET 10.5 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3362-5-110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG PLUS OMEGA 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|808.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|808.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597023S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HIP BARREL STANDARD KEYED 135 DEGREE 3-HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,252.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,252.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597214S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HIP BARREL SHORT KEYED 135 DEGREE 4-HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,252.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,252.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 46MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596205110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F 10MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-30118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 3.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0930S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 9MM X 300MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-5027S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL 5.0MM X 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7969814|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER INTERBODY 42MM X 30MM X 8 DEGREES|1|HUMANA [1294]||HUMANA [11839]|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SOLERA 4.75MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F 12MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 220438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3530-0360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 10MM X 360MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661485|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM/L85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5038-1-110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN APEX 3 x 110 THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL LONG 32MM V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL FRICTION LOW 40MM +0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86SR0404|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE SUBSTITUTE PRO-STIM INJECTABLE|1|HUMANA [1294]||HUMANA [11839]|5,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532007501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA CEMENTED PERSONA 5 DEGREE STEMMED LEFT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F 14MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,270.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42532006702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE RGT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 10 MM HEIG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-009|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430335|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT FROZEN FRESH TIBIALIS ANTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,657.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,657.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952828250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952824250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952808220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F 17MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,121.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493952816220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952816250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952812220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952820250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952812250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952808250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952820300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952816300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952838250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952828300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F 20MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493952838300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952824300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952812300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952808300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952832300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.00X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952832250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.50X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952832350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012581-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596205123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F 23MM KN FX BRNG PRLNG NG LPSFLX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,924.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493952824350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012584-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 4.8MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952812350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952828350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952838350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952808350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952816350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952820350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 3.50X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012582-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT JOSTENT GRAFTMASTER 4.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-048-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1312-27-212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP NON LOCKING 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1318-110-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DVR LOCK NARROW RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG SMOOTH LOCKING 2.2MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG SMOOTH LOCKING 2.2MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-27-320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-050-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7033|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT AIRWAY PULMONARY 22 MM X 80 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2650-29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC PORCINE SAV EDWARDS 29MM|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6RBU40SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR RBU 4.0 SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6RBU35SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR RBU 3.5 SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6RBU40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR RBU 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6RBU35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR RBU 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-052-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71204749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULATING GENISUS PS MEDIUM RIGHT 15 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 11MM X 360MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 54MM HIP PRM SLD TIV POR TRLG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 427109S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION LOCKING NARROW 9-HOLE/L169MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|621.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2.4MM RIM SHAFT 4 HOLE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL SUPERIOR 7-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952808400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952832400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952820400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952816400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952824400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-550|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.848|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 48MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00620005621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 56MM HIP PRM SLD TIV POR TRLG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493952828400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952838400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952812400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 4.00X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HPW-18-150|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE UNIGLIDE 0.18 DIAMETER X 150CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450-383|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE SHAFT TIBIA DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,022.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,022.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0044PM4790|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER INTELLA TIP MI 7FR 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2.4MM RIM SHAFT HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-058-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 03.820.104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09.820.076S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRODISC XL DEEP 6MM|1|HUMANA [1294]||HUMANA [11839]|17,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-111130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 11MM X 11MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25446S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW RIGHT 2.7MM 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179712745|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 7MM X 45 MM EXPEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187827110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE INTERBODY CONCORDE 9MM X 10 MM X 27 MM|1|HUMANA [1294]||HUMANA [11839]|14,227.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,227.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-71-085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI EXPEDIUM 5.5 MM X 85 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-060-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 286705200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE EXPEDIUM|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532008301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA CEMENTED PERSONA 5 DEGREE STEMMED LEFT SIZE H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATION CR PERSONA FIXED BEARING LEFT 14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 12 MM(FEM 7-12TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD POROUS RIGHT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7600706|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY MASTERGRAFT 6CC|1|HUMANA [1294]||HUMANA [11839]|2,013.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,013.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814100003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPIDER 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-062-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5022-062-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING POLY PERSONA FIXED BEARING CR LEFT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 338620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 3.5X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBEULAR ONE THIRD 7HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|200.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|200.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5516-F-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STABILIZED POSTERIOR TRIATHLON #1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6200-064-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRILOGY NON-HOLED 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,601.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5516-F-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STABILIZED POSTERIOR TRIATHLON #1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,142.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5536-B-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL TRITANIUM TRIATHLON SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-M-PT10S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INLAY POLYETHYLENE W.TANTALUM MARKER MEDIUM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-M-SP06S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE END SUPERIOR MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-M-IP00S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE END INFERIOR MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MS-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE STRAIGHT 2.4MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-16402|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATH CENTRAL VENOUS DOUBLE LUMEN FLEX TIP 4FR X 12" 5/CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 992007|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 1CM X 4CM THIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44317002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT GRACILIS SINGLE STRAND|1|HUMANA [1294]||HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-200-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX .35 8MM 200MM 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07200-120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX .035 6MM 200MM 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6250-MPR|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN COMMAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287641|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END CORNERSTONE PSR 6 X 14 X 11MM|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1822-1030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 10MM X 300MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287741|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END CORNERSTONE PSR 7 X 14 X 11|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86800105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE KNOTLESS QUICKDRAW 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3530-0400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 10 MM X 400 MM X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG-530|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 5.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|6,063.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,063.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0 SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR LATERAL DISTAL 10HOLE/L238MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MMXL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661195|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM/L95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|776.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|776.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.656E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI EMERGENCY 1.7MM 6MM W/FLUTED-TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|157.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MSZ15700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST FOR STYLE 15 NATURALLE 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSZ20600|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST FOR STYLE 20 NATRELLE 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207686|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIORCI 7 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 220235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SCREW CANNULATED 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SCREW CANNULATED 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SCREW CORTICAL 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207678|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIORCI 8 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIABIAL LM/RL TRIATHLON SIZE 2-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM WEB LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131220410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M-2000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CROSSBOSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7AR10|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 7 FR AR1 LAUNCHER GUIDING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8213-0000-13|SUP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND OASIS ULTRA TRI-LAYER 5CM X 7CM MESHED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G28434|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 12 FR HAUSDORF SHEATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504611X|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER 11 FR SHEATH 5/ BOX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 50MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5992-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M-3004|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STINGRAY HPC 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported K172|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER INGENIO SR IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M-3012|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STINGRAY HPC 185 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5955610|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH BARD VENTRALIGHT ST W/ECHO PS TM 6" X 10" OVAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1680BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS BIOCOMPOSITE 8MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1590BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS BIO 9 X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 100.27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET OTSC SYSTEM 12/6GC (165CM)|1|HUMANA [1294]||HUMANA [11839]|1,734.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,734.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR OTSC (165CM)|1|HUMANA [1294]||HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,614.32|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 456.355S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 10MM X 130DEG X 340MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,967.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0264|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 26 MM NON-LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNW12025|SUP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX NEUROMEND 12MMIDX2.5CM|1|HUMANA [1294]||HUMANA [11839]|5,493.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,493.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0243|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XPRES3C25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY BONE WITH CANCELLOUS CHIPS 300 EXPRESS 2.5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG530|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 5.0MM X 3CM|1|HUMANA [1294]||HUMANA [11839]|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-032|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 7 FR 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCER-35-7-14|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL RETRACTA DETACH EMBOLIZATION 7FR 14|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,689.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MWCER-35-7-12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL RETRACTA DETACH EMBOLIZATION 7FR 12|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCER-35-7-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL RETRACTA DETACH EMBOLIZATION 7FR 10|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-4-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL V40 STRYKER 22.2MM/LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.078S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED ARTHRODESIS HINDFOOT TI EX 10 MMX240MM/LT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,813.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,813.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.008.000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END NAIL ARTHRODESIS HINDFOOT SPIRAL BLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XLR WIDE 10X22X55MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B7117|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ACCESS URETERAL FORTE 14F-16F 35CM 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,925.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,925.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CD3357-40C|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR UNIFY ASSURA BI V ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60,912.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L-12-06|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE LOOP T-LIF 6 X 32.5MM X 6 DEGREES|1|HUMANA [1294]||HUMANA [11839]|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,002.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-100930|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 10 MM X 9 MM X 30 MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16517015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SEGMENT FIBULAR GREATER THAN 10 CM FROZEN CRYO|1|HUMANA [1294]||HUMANA [11839]|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #9 37MM NECK 120MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED BEARING ULTRACONGRUEMT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1332S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 13MM X 320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A34-34/C100-O20V|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION CUFF AORTIC PROXIMAL 34MM X 34MM COVERED 100 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS LPS SIZE-G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,925.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,925.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4104-260/.014|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ENDOLOGIX 260 CM X .014"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977A260|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD PERCUTANEOUS MRI SURESCAN VECTRIS 1X8 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952824220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952820220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952832220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493952828220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROMUS PREMIER PLATINUM 2.25X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 429678|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ATTAIN ABILITY PLUS 78CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1934BCF-24-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURETAK BIO-COMPOSITE 2.4MM DOUBLE LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-053-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-3 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 48665025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AVS ANCHOR-L 5.0X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48663142|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AVS ANCHOR -L 12DEGREE 14X25X35|1|HUMANA [1294]||HUMANA [11839]|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482802645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY SHORT ES2 6.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,159.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48667000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING AVS ANCHOR-L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482806030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RAD ES2 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 4 HOLE L121MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482806035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RAD ES2 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5X28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|126.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-054-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661480|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.00102.217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TAPER 12/14 REVISION UNCEMENTED WAGNER SL PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,934.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,934.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATION CR PERSONA FIXED BEARING LEFT 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT GRACILIS TENDON|1|HUMANA [1294]||HUMANA [11839]|3,619.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,619.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA 2.7/3.5MM VA-LCP 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,468.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,468.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 22MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-054-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.211.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X3 SZ 7 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6AR10SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE AMPLATZ RIGHT WITH SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA .35 80CM 40 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6JR45|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 6FR JR 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122776-02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIREPROWATER J 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1030-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 80CM 20 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-054-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-4 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10005357HJ|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE WHISPER MS J 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1080-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA .35 80CM 60 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7AR10SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 7FR AR1 W/SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 5MM 20 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 5MM 20MM 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 5MM 40MM 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RIGIDLOOP CORTICAL FIXATION IMPLANT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00146152B1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE-GLIDEWIRE .035 X 180CM #46-152|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-055-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 97712|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BATTERY RESTORE ULTRA MRI COMPATIABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186803036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,837.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,837.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 004023|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE SEMITENDINOSUS|1|HUMANA [1294]||HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT H2 EXTENSURE II 14MM|1|HUMANA [1294]||HUMANA [11839]|6,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201996|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.9 OSTEORAPTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,001.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,001.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1555BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOCOMPOSITE 5.5MM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TWINFIX ULTRA 4.5 WITH 2 SUTURES BLUE & BLACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-055-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-5 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1547BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOCOMPOSITE 4.75MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2090-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 9 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1080-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 8 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2090-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 9 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1080-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 8 X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1090-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 9 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2080-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 8 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1100-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 10 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1120-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 12 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1120-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 12 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-056-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B1120-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 12 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2120-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA WORKHORSE 12 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2100-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 10 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PL-XS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER X-SMALL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9045-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 4.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-056-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6495-9-004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TENDON TISSUE BOVINE FETAL TISSUEMEND 6CM X 10CM|1|HUMANA [1294]||HUMANA [11839]|10,013.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,013.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL LATERAL PROXIMAL 8-HOLE/173MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,577.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,577.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRC02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 360D 2 Y-KNT HI-FI 2 LD 2 STRN SLF PNCH FRMFT FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZNGRLS180J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE ZINGER LIGHT LS 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-056-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-6 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7209016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIORCI 10 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700812003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00340.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 1LEVEL 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700656002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION|1|HUMANA [1294]||HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01268.021|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE ALLOGRAFT PUROS-S2 7X11X14MM 7DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1090-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 9 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1100-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 10 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #2 30MM NECK 99MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502805602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-057-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42502805802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502807002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502807402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502805402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-056-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-058-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-062-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502206002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502206402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-057-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5022-066-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502207002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502206802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502205002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502205202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-054-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502605602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502605802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-057-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-7 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42502606002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502607002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502605402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502607402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED RIGHT SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-058-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42502006402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502007002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-058-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42522000412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED BEARING PERSONA RIGHT 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-027-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HUMERAL XSMALL 4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RX1-32-43|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CUFF AORTIC RENU ZENITH 32MM X 43CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-058-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5534008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT H2 EXTENSURE II 8MM|1|HUMANA [1294]||HUMANA [11839]|6,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL VERSA -DIAL 46X18X53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL WIDE COROENT 12X22X50MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRIMARY 14MM MICRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE GLENOID HYBRID LARGE 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID HYBRID POST -POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STD TI TAPER VERSA-DIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-058-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-8 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CNW12050|SUP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROMEND 12MMID X 5.0CM LENGTH|1|HUMANA [1294]||HUMANA [11839]|6,144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6914245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL COROENT 14X22X45MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3365-40Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR QUADRA ASSURA CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3365-40C|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR QUADRA ASSURA CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6248V-90L|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN II SELECT SUREVALVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTEROLATERAL DISTAL TIBIA 2.7/3.5MM VA-LCP 10 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 38MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-063-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.206.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 32MM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|145.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|145.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186801024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,084.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,084.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186801026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,084.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,084.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186864018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REVISION 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,081.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,081.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186854018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE OVERSIZE ST 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,081.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,081.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186852018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE STRAIGHT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|917.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|917.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR MIDSHAFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-063-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1662BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL BIOCOMPRESSION 6.25 X 19.1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 13 X 340 X 125 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1851-1032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL RIGHT 10 X 320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1131S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 11MM X 315MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6719|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR PORT PIN PLUG|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-RTS-4HL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS, STANDARD 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-063-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PANL-35140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 12.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8956-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIFTH METARSAL UNIVERSAL HOOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-063-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-3 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.118.556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XPRES3C05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PUTTY WITH CANCELLOUS CHIPS 300 EXPRESS 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PDL-L-SP11S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE END SUPERIOR LG. 11 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,458.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,458.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86500105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE KNOTLESS QUICKDRAW 5MM #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOOP CORTICAL FIXATION 20MM|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-9-116|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TENDON TISSUE BOVINE FETAL TISSUE PERFORATED 6CM X 6CM|1|HUMANA [1294]||HUMANA [11839]|5,710.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,710.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-064-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 627644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR LATERAL DISTAL 14HOLE L310MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,769.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,769.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MMXL38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8595527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5X27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE ACL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL TS 5 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR004C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE REPAIR MENISCAL SEQUENT CURVED NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,652.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,652.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-064-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SNDSTR10G|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOUNDSTAR ULTRASOUND (G)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-303|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LASER GLIDELIGHT 80HRTZ 16 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D1N20016S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE 2.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N2-0018S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE 2.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3506501 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH ROUND PROFILE PLUS MODERATE 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS-5140|SUP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPIFIX 14MM DISK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|898.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|898.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS-5230|SUP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPIFIX 2CM X 3 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-064-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported GS-5440|SUP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPIFIX 4CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44421|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SHUNT LUMBAR-PERITONEAL NSC PRESSURE ADJUSTABLE|1|HUMANA [1294]||HUMANA [11839]|14,914.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,914.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS1520|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGERATIVE ALLODERM CONTOUR SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 44MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954MR-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROCESS STD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6502|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX DUODENAL 27/22MM DIAMETER 9CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1240S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 12MM X 405MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-064-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-4 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1570BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS BIOCOMPOSITE 7 X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-065-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5955450|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH BARD VENTRALIGHT ST W/ECHO PS 4.5"(11.4CM) CIRCLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,121.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,121.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZHP68650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST FOR STYLE 668HP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YPRC03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 360D 2 Y-KNT HI-FI 3 LD 2 STRN SLF PNCH FRMFT FX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,296.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 68-510|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE SALINE STYLE 68 MODERATE PROFILE 510|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,776.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,776.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-066-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965458710|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHER PICC BIOFLO DUAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965458760|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHER PICC BIOFLO SINGLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-RTS-3HL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS STANDARD 3 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012403-15A|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OTW MINI TREK II 2.0MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588606512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB GRN STRP 12MM LPSFLX NXGN 5 G-H KN TRB MTL PE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 912000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT JUGGERKNOT 1.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,554.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,554.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCLP-27200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTS-3HL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS STANDARD 3 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23190-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-065-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 603014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 1/3RD 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1030-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 3 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2050-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 5MM 40MM 135CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE4 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 6MM 40 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-065-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-5 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B2050-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 5 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 4 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 6 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1080-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 8 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 4 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2060-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 6 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2080-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-066-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B1060-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 6MM 60 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1070-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9045-45PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 4.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 13 X 440MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AD1-7.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-066-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SV30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW S-FIX 2.5LG 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATION CR PERSONA FIXED BEARING LEFT 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7502104|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE HYPERLORDOTIC 10 X 38 X 28MM 20 DEGREE|1|HUMANA [1294]||HUMANA [11839]|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8825545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 5.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 7 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C0301AL-85|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA HALF MOON SPLIT THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LL4006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID LOAD GOLD THIN PROFILE 0.6 GRAM|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-066-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LL4008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID LOAD GOLD THIN PROFILE 0.8 GRAM|1|HUMANA [1294]||HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LL4010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID LOAD GOLD THIN PROFILE 1.0 GRAM|1|HUMANA [1294]||HUMANA [11839]|765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LL4012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID LOAD GOLD THIN PROFILE 1.2 GRAM|1|HUMANA [1294]||HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE MEDPORE SST-EZ 18MM|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DL900J|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT JUGULAR DENALI VENA IVC FILTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5618000|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT A CATH CLEARVUE SLIM LOW PROFILE 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DL900F|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT FEMORAL DENALI VENA IVC FILTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5616000|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT A CATH CLEARVUE SLIM LOW PROFILE 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5608062|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT A CATH CLEARVUE INTERMEDIATE 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B1060-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 6MM 20 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 5 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1040-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 4 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1050-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 5 X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4 HOLE TI ONE THIRD TUBULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-066-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS GH SZ-6 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 690030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K WIRE TI 1.6X150MM|1|HUMANA [1294]||HUMANA [11839]|46.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-8105-035-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HUMERAL SMALL 6" LONG FLANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 16MM(FEM 3-11TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 18MM(FEM 3-11TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 11MM(FEM 3-11TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 13MM(FEM 3-11TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 14MM(FEM 7-12TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 16MM(FEM 3-11TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA RIGHT 18MM(FEM 3-11TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2672116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 16 HOLES REG 01-921|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5886-067-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42532006401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE LFT SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532005801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE LFT SZ A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532006101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE LFT SZ B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532008801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE LFT SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532006402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE RGT SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532005802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE RGT SZ A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532006102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE RGT SZ B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42532008802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIA CEMENTED STEMMED PERSONA 5 DEGREE RGT SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540000041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY CEMENTED PERSONA 41MM 10.0MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540000029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY CEMENTED PERSONA 29MM 8.0MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-067-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42540000026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA ALL POLY CEMENTED PERSONA 26MM 7.5MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1100-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 10 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1580BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS BIOCOMPOSITE 8 X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-067-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5222-004-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-004-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE RT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-067-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-7 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42522200514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-005-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE RT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-006-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-006-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-006-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-006-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5222-006-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-068-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5222-006-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE RT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE RT (FEM1-2 TIB AB)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE RT (FEM1-2 TIB AB)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE RT (FEM1-2 TIB AB)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D132705|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CARTO SMART TOUCH DF 8FR BI-DIRECTIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502805601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D133602|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CARTO SMART TOUCH F 8FR UNI-DIRECTIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D133603|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CARTO SMART TOUCH J 8FR UNI-DIRECTIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D133601|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CARTO SMART TOUCH D 8FR UNI-DIRECTIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502805801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-068-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D132704|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CARTO SMART TOUCH FJ 8FR BI-DIRECTIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502806401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502807401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502805401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA STANDARD POROUS LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-058-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-056-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502206001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED CR LFT 10 MM (FEM3-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-064-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502205001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-068-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5022-070-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502206801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502205201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5022-054-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM CR PERSONA NARROW POROUS LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL WIDE COROENT 12X22X45MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7140410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DECADE XLIF 4HOLE SZ10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 5.5X35MM LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 5.5X40MM LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 5.0X40MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 5.0X35MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-068-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS EF SZ-8 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCLP-27210-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200068020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPIC STENT VASCULAR 6MM X 80MM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERLATERAL DISTAL TIBIA 2.7/3.5MM VA-LCP 10 HOLE LEF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1520|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM READY TO USE CONTOUR MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,363.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,363.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200064020|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6MM X 41MM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74201157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL OXINIUM JOURNEY II CR SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,689.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,689.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NON POROUS JOURNEY SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025671|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR CR XLPE JOURNEY II SIZE 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-075-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8954YL-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROC/POST TUBER LONG LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1695|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX PARTIALLY COVERED 23MM X 15CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-004-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 11MM (FEM 3-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 12MM (FEM 3-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-004-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 13MM (FEM 3-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-004-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 14MM (FEM 3-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-004-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 18MM (FEM 3-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-075-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42512000512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 12MM (FEM 3-11TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 13MM (FEM 3-11TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-005-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 16MM (FEM 3-11TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 14MM (FEM 3-11TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-005-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 18MM (FEM 3-11TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-006-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 11MM(FEM7-12TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-006-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 13MM(FEM7-12TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-006-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 18MM(FEM7-12TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR FIXED PERSONA LEFT 16MM(FEM7-12TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-075-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42512200410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE LFT (FEM3-7 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-075-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-5 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42512200510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE LFT (FEM4-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE LFT (FEM7-12 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502605601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502605801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-076-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42502606601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502607001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502606801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502605401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502607401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR TM PERSONA CR STANDARD CEMENTED LEFT SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-076-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42502006401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502006801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502007001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42502005401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CR NARROW CEMENTED LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP 3.5X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-076-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 605016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 2.7X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 605018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 2.7X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR TI 1/3 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0X34MM SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 349630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF TAPPING S/S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207679|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIORCI 8 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|809.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5886-076-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA MONOBLOCK LPS CD SZ-6 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,503.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72202901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 4.5 FOOTPRINT ULTRA PACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86800104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE KNOTLESS QUICKDRAW WHITE 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA25-90/120-30|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED 25 X 90/120-30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1662BC-8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL BIOCOMPOSITE 8 X 19.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,148.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,148.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 13MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 11MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9045-55PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 4.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-015-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TALAR ANKLE TOTAL METAL TRABECULAR ZIMMER SIZE 5 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-045-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BASE TIBIAL ANKLE TOTAL TM SIZE 5 GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-055-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT INSERT TIBIAL POLY CROSSLINKED PROLONG TM SIZE5 GR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00482802002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5527-B-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE FIXATION SCREW TRIATHLON SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANCELLOUS VITALLIUM TRIATHLON 30 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 55 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F5QA005CT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 5FR QUADRIPOLE A CURVE WITH AUTO ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-RTN-3HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS NARROW 3 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTN-3HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS NARROW 3 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-RTN-4HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS NARROW 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTN-4HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS NARROW 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTS-4HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS STANDARD 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-RTS-7HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS STANDARD 7 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,792.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,792.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTS-7HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS STANDARD 7 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,792.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,792.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-RTW-4HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS WIDE 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-LTW-4HL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS WIDE 4 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,537.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 1.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T-SHAPE LOCK 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-4315M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE CRESCENT 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +0MM 27MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R1.5 TITANIUM RIGHT 11 X 420MM X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20190-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20210-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20230-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20320-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27190-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27230-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCLP-27320-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING HIGH COMPRESSION 2.7MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23210-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO X-TRA LOCK 9 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23230-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23320-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPNL-27320-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED NON-LOCKING 2.7MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25100-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|379.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|379.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25120-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|446.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25140-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|379.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|379.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25160-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|446.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25180-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|446.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25220-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|446.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25200-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|446.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25240-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|446.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|446.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25280-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|379.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|379.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25300-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|379.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|379.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PALS-25260-CC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL LOCKING CANNUALTED COCR 2.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|379.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|379.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35080-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35090-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35130-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35110-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35150-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported COLS-35180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35080-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35090-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35110-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35150-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35130-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WBTN-2750-T|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER INSIDE 2.7MM OUTSIDE 5.0MM|1|HUMANA [1294]||HUMANA [11839]|127.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU313115|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 31MM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL2228|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL COATING HYDROPHILIC GORE 22FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407452|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER GUIDE SWARTZ SLO 81cm 8.5 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMRM6122US-S|SUP|Custom 95131007||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|ENVELOPE PACEMAKER ANTIBACTERIAL AIGIS R MED|1|HUMANA [1294]||HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.7MM X 40MM FULL THREAD LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000225|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-HP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE GEMINUS HOOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-HP-SCRW|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW GEMINUS HOOK PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|224.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 8.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 14.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 16.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 18.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 22.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 24.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 26.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 28.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 32.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 36.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 34.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 40.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724V-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI VA LOW PROFILE 2.4MM X 38.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9045-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 4.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588843T|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8F .088 AL 1 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8826550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 6.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XLR WIDE 10X22X60MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIORCI-HA 7 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|809.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977D260|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD PERCUTANEOUS TRIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588844T|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8F .088 AL 2 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9045-60PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 4.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9055-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 5.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9045-65PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 4.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9055-45PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 5.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9055-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 5.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9055-65PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 5.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9055-55PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 5.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9055-60PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 5.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9060-40PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 6.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9060-45PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 6.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9060-50PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 6.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9060-55PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 6.0MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60010|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER BROVIAC RT. ATRIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|207.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-9060-65PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 6.0MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9060-60PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE PARTIAL THREAD TI 6.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-08H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LL6012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID LOAD PLATINUM 1.2 GM|1|HUMANA [1294]||HUMANA [11839]|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453206|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCCLEANSE ACHILLES PRESHAPED WITH CALCANEUS|1|HUMANA [1294]||HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE GRACILIS|1|HUMANA [1294]||HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6961438|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 14 X 38 X 32MM 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.358.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-DRLG 2.0MM W/STARDRIVE (TM) RECESS 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20676-400E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE PROJECTION MODERATE BASE CLASSIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133MV-13-T|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 400CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-09H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-11H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-10H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-12H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-14H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-13H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-18H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-16H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-22H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-20H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-24H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-62-91-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY MAIN CUSTOM BIFURCATED DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-28-124-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-26H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-30H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8725-28H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MICRO HEADLESS COMP FT CANNULATED TI 2.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-14H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-12H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-16H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-20H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-18H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-24H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-22H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-26H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-28H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-30H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-32H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8730-34H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI HEADLESS COMP FT CANNULATED TI 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 064010|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PEZZER 10FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8967-40FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-45FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-50FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-55FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-60FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-65FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-75FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-80FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-90FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-95FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-100FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-105FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-120FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-110FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8967-115FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI CANNULATED FULL THREADED 6.7MM X 115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-SB-018|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON II AMPLATZER 18 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-015|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PL-M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER MEDIUM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PR-XS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER X-SMALL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954YL-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROC/POST TUBER STD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954YR-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROC/POST TUBER STD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954YR-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROC/POST TUBER LONG RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954ML-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROCESS STD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954MR-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROCESS LONG RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PL-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER LARGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522200720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE RT (FEM9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 10MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 11MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 13MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 12MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954PR-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE PERIMETER SMALL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8954ML-L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL FRACTURE ANTERIOR PROCESS LONG LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 14MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 16MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522000718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 18MM VE RT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 10MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 12MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 11MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 13MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 14MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5120-007-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 16MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512000718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CR PERSONA 18MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 10MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 12MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 11MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 16MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 14MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 20MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512200718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 18MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SMART 2.4MM X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|408.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-301|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LASER GLIDELIGHT 80HRTZ 12 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 500-302|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LASER GLIDELIGHT 80HRTZ 14 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42512200713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UC PERSONA 13MM VE LEFT (FEM 9-12 TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LNQ11|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REVEAL LINQ SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951238|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 12X38X28MM 12 DEGREE|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00342.001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 3 LEVEL 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00394.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION TRINICA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131822050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DVR LOCK STANDARD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG SMOOTH LOCKING 2.2MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 6.5 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET VOYAGER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000823|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201992|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.3 OSTEORAPTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6 HOLE TI ONE THIRD TUBULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1132S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 11MM X 320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-032-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-012-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV HA STEM-52MM 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4487550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DBP III SCREW 7.5X50MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4487540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DBP III SCREW 7.5X40MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749236310150|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BURR ROTALINK PLUS 2.15 MM PRECONNECTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0098|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIAL HEAD 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179712640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 65MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 45MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 50MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 38MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 40MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 55MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.212.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 3.5MM X 56MM SELF TAP W/STARDRIVE REC SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.212.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 3.5MM X 54MM SELF TAP W/STARDRIVE REC SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.212.058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 3.5MM X 58MM SELF TAP W/STARDRIVE REC SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 42MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 48MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 46MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.848|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 48MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 34MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 32MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 36MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W020100150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERCROSS 2MM X 100MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588853|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8F .088 JLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430355|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT FRESH FROZEN SEMI TENDINOSUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,373.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,373.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201594|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN PASSING FLEXIBLE 13.5X2.4MM|1|HUMANA [1294]||HUMANA [11839]|357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-9-118|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TENDON TISSUE BOVINE FETAL TISSUE PERFORATED 8CM X 8CM|1|HUMANA [1294]||HUMANA [11839]|8,100.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G19920|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION MREYE .038 DIAMETER X 10CM LENGTH 10MM|1|HUMANA [1294]||HUMANA [11839]|206.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|206.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-45-020-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 20MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-45-030-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 30MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-45-040-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 40MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-45-060-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 60MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 823838|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE PROGRAMABLE INLINE RT ANG. 82-3838|1|HUMANA [1294]||HUMANA [11839]|15,429.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,429.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-45-080-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 80MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-45-100-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 100MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-45-120-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 4.5MM X 120MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTEROLATERAL DISTAL TIBIA 2.7/3.5MM VA-LCP 8 HOLE RIG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 7 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 8-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W020150150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERCROSS 2.0 X 150 X 150 .018 PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-020-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 20MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-030-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 30MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-040-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 40MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-060-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 60MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-080-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 80MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-100-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 100MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-120-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 120MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-55-150-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.5MM X 150MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-040-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.5MM X 40MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1589RT|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE BUTTON EXTENDER|1|HUMANA [1294]||HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-009-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV M/L TAPER SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-022-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR DINECTIV 12/14 TAPER SIZE B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 349622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 349624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAP CORTICAL STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437112S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PROXIMAL LATERAL 12 HOLE/202MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,062.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,062.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 349628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAP CORTICAL STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL WIDE COROENT 10X22X50MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL WIDE COROENT 12X22X55MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7140408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DECADE XLIF 4 HOLE SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7146540|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 6.5X40MM LARGE|1|HUMANA [1294]||HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 5.5X45MM LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT PLATE DECADE XLIF 5.0X45MM STANDARD|1|HUMANA [1294]||HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86SR-0410|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE SUBSTITUTE PRO -STIM INJECTABLE|1|HUMANA [1294]||HUMANA [11839]|10,782.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,782.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MMXL36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MMXL60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLXS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HAMMERLOCK SMALL IMPLANT|1|HUMANA [1294]||HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W10060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 10MM X 60MM X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD1357-40Q|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR FORTIFY ASSURA VR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 5.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-022-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ANKLE TOTAL TALUS RIGHT SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-042-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BASE TIBIAL ANKLE TOTAL METAL TRABECULAR SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-052-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT INSERT TIBIAL POLY CROSSLINKED PROLONG TM ZIMMER S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47235701706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING FIBULA LATERAL DISTAL 6-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,898.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,898.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9541|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE WEDGE ENOPHTHALMOS LEFT REGULAR|1|HUMANA [1294]||HUMANA [11839]|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.118.560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MMX60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RIGIDLOOP IMPLANT CORTICAL FIXATION XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL DELTA CERAMIC TS 12/14 36MM +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,973.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,973.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-042-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR KINECTIV 12/14 TAPER R2 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV M/L TAPER SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R7D282CT|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DECA NAV D CURVE 7FR 2-8-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL-07845|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SUPER ARROW-FLEX SHEATH 8FR 45cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU282815|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 28MM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL2028|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL COATING HYDROPHILIC GORE 20FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.844|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 44MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.652|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 22MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1016005|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE LAP 10CMX16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,702.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,702.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133MV-15-T|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541308|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL 355CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541358|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL MEMORY SHAPE 395CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541408|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL MEMORY SHAPE 440CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.202|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SUBCHONDROPLASTY KNEE WITH SIDE-TARGETED ACCUPORT|1|HUMANA [1294]||HUMANA [11839]|9,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEALICOIL REGENESORB SUTURE ANCHOR 4.75MM W/2 ULTRABRAID SUTURES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULA THREADED FLEX 8.0X90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 5-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.390E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN403832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 4.0 X 38MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-033-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV NECK MOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-007-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV M/L TAPER SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.647.220S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT VA ZERO-P LORDOTIC HEIGHT 10MM|1|HUMANA [1294]||HUMANA [11839]|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.392E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-023-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KNECTIV MODULAR NECK 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RR47010045L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR 4-7MM TAPER 10CM WITH REMOVABLE RINGS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,031.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,031.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AD-5230|SUP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE AMNIOTIC AMBIO DRY 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-S045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT STEM HEAD RADIAL MODULAR EVOLVE STANDARD 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,541.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED STRAIGHT MRS REVISION POROUS 15MM X 127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64951002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PROXIMAL GMRS NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588823T|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8 FR JL 4.0 90 CM GUIDING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.394E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012581-16|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT 3.5 MM X 16 MM GRAFTMASTER RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012582-16|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT 4.0 MM X 16 MM GRAFTMASTER RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64956050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIECE EXTENSION GMRS 50 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LATERAL 8 HOLE /L202MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,031.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,031.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 6MM L80MM/FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8FR GUIDELINER V3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8AL75D*|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR AL .75 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU35D*|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR EBU 3.5 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8EBU40D|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR EBU 4.0 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED 4.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97714|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BATTERY RESTORE SURE SCAN MRI COMPATIABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977A290|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD PERCUTANEOUS MRI SURESCAN VECTRIS 1X8 90CM|1|HUMANA [1294]||HUMANA [11839]|6,420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 87SR0404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO-DENSE INJECTABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,476.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,476.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.396E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL FRICTION LOW 32MM +4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.105S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE HOOK LCP 3.5MM 7 HOLE 15MM LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M005ATS25010|SUP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER THERMOPLASTY BRONCHIAL ALAIR ATS2-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.398E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140001|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI FIELDER FC 180CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140002|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI FIELDER XT 190CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82903-02|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI MIRACLEBROS 12 300CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82902-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI CONFIANZA PRO12 180CM STRAIGHT 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R001S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI SION 180CM 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010482-H|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HITORQUE PILOT 200 180CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012405-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MINI TREK OTW 2.50MM X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.114.514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONDYLAR 1.5MM TI LCP 6 HOLE SHAFT WITH GUIDES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,627.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,627.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SLF-TPNG WITH T4 STARDRIVE RECESS 1.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TANG WITH T4 STARDRIVE RECESS 1.5MM X 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SLF-TPNG WITH T4 STARDRIVE RECESS 1.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TPNG WITH T4 STARDRIVE 1.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TPNG WITH T4 STARDRIVE RECESS 1.5MM X 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X-021687|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PFR TITANIUM PERFORMA GRISSOM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-62-76-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32534|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-121126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 12MM X 11MM X 26MM|1|HUMANA [1294]||HUMANA [11839]|14,880.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,880.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75700450|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BLUNT VOYAGER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000673|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000825|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 50MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PV3116F|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER JETSTREAM SC 1.6MM 7F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,EPIPHYSIS,RIGHT,4HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 607360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X L60MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 6 HOLE L147MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X 48M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS DISTAL LATERAL VA-LCP 2.7MM/3.5MM 1HOLE 69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MED.DISTAL VA-LCP 2.7MM/3.5MM 1HOLE 72MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,703.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,703.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2333-110-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,CANCELLOUS,110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|40.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.211.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3X95MM 32MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM3242|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ALLURE QUADRA BIVENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,161.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,161.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 605014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 2.7X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL SUPERIOR 5-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661775|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL VA-LCP 3.5MMX147MM/8HOLE/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,547.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,547.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.175|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.704.010S|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INJECTION DRILLABLE NORIAN 10CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,579.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,579.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482807045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT ES2 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,527.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CSW135-26N|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORSAIR 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MIDSHAFT ULNA 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR RADIUS 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45714000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE VO PRO-TOE 4.0MM X 16MM ANGLE 0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 711 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CSW150-26N|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CORSAIR 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012403-20A|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OTW TREK 2.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012402-20A|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION OTW TREK 1.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588890|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8 Fr. AL .75 GUIDING EA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6MP2|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 6 FR. MULTIPURPOSE 2 GUIDING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8JR35D|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR JR 3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM2160|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ENDURITY DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 746HF8|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INTELLICATH 746H 8 FR.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131227113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.518E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 18MM SELF TAPPING 4MM HEAD WITH CRUCIFO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131227115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 42MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-1417S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE FIXATION SPI 3.0X285MM WCH COATED|1|HUMANA [1294]||HUMANA [11839]|690.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|690.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 605020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 2.7X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT35135|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TORNUS 88 FLEX 2.6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012583-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFTMASTER RX 4.5 X 26 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOW PROFILE 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOW PROFILE 6.5MM X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOW PROFILE 6.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207676|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIOCRCI 7X30 8MMHEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|771.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRONON LEFT 3-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0319|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEXALOBE NON-LOCKING 3.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0295|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 3.0 MM X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0294|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEXALOBE NON-LOCKING 3.5 MM X 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0296|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEXALOBE LOCKING 3.0 MM X 50 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01268.023|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE ALLOGRAFT PUROS-S29X11X14MM 7DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01268.022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE ALLOGRAFTPUROS-S28X11X14MM 7DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00812.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4210864|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PREVAIL 8 X 16 X 14MM|1|HUMANA [1294]||HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235700710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TIBIAL MEDIAL DISTAL 10-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,993.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,993.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-080-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.5MM X 80MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-100-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.5MM X 100MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-150-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.5MM X 150MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-060-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.5MM X 60MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012403-12A|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATION OTW TREK 2.0 MM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012402-12A|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATION OTW TREK 1.5MM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700342003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 3LEVEL 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT DISHED ARTICULAR XLPE LEGION 13MM SIZE 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA-85|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CASSETTE ENDOANCHOR (10) W/APPLIER SYS ENDOANCHOR HELI-FX|1|HUMANA [1294]||HUMANA [11839]|13,239.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,239.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0260S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT GAMMA 3S RIGHT 10X260X125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607365|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X L65MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 2 HOLE L95MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X L70MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VPR-GW-14|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE VIPER 335 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588847|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING AL 1.0 SH 8FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA8AL75SSH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8FR AL 75 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-7.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000255|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.5X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL RM/LL TRIATHLON SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7390|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE R350 350CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5490-036-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT FEMORAL DISTAL ANTERIOR OR POSTERIOR SZ F 5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM LONG FLUTED SHARP 17 MM X 130 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,490.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,490.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TENDON PATELLAR PRESHAPED BIOCLEANSE 10/10MM|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN353632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 36MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587110LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP SMALL 0 DEGREE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58812714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74934358490|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8 FR. MAC1 FR5 3.5 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749343585010|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 8 FR. MAC1 ART4 3.5 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47375|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION NESTER .035 DIAMETER X 7CM LENGTH 8MM|1|HUMANA [1294]||HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFBC-6503N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CROSSFT BC 6.5MM 3 HI FI # 2 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749343584990|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING 8 FR. ART 3.5 SH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM/L65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX3.5MM/L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784804400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR KINECTIV 12/14 TAPER D +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-034-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR KINECTIV 12/14 TAPER J +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-011-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV M/L TAPER SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784802300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR DINECTIV 12/14 TAPER SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-8757-056-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM TM MULTI HOLES 56 MM SIZE II PORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-8851-012-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM VIVACIT-E NEUTRAL KK 40 X 56 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877504003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA MATRIX 12/14 40 X +3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-121130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 12MM X 11MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45713200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE VO PRO-TOE SIZE 3.2MM X 16MM ANGLE 0 DEGRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334800|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 8.5 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.0 X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR LATERAL DISTAL 12 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,872.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,872.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-9.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-8.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938969190|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR AL1 125 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493896939B0|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR MP2 125CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749389696620|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6FR JL4 125CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000821|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT01858|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE NANOTACK WITH FLEX INSERTER 1.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MED.DISTAL VA-LCP 2.7MM/3.5MM 1HOLE/RIGHT/72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,703.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,703.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL DISTALVA-LCP 2.7MMX3.5MM 2HOLE/RIGHT/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010485-H|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE PILOT 200 300CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AFLEX401|SUP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMIS DECELLULARIZED ARTHROFLEX 4.0CM X 7.0CM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,322.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,322.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G24888|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 6FR 40 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-7-40-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 7FR 40 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-6-60-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 6FR 60 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-7-60-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 7FR 60 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-6-80-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 6FR 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-7-80-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 7FR 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-6-100-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 6FR 100 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-10304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING STRAIGHT PROFYLE HAND 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-7-100-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 7FR 100 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA25-110/120-30|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED 25 X 110/120-30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A34-34/C80-O20 V|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION CUFF AORTIC PROXIMAL 34MM X 34MM COVERED 80 CM -O2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9978-001-99|SUP|HCPCS Q4101||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APLIGRAF SKIN GRAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,885.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515F101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 1 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS-15322-VSP|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNON DIALYSIS CATH 15FR 27CM CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 628310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR MIDSHAFT 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000639|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED KNEE TOTAL TRIATHILON 15MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZILBS-635-6-8|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER METAL BILIARY 6 FR 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.354S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.OMM LCP ROTATION CORRECTION 2H HEAD/4H SHAFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,623.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,623.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT02462|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CINCHLOCK KNOTLESS SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,487.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,487.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25684|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE INTERMEDIATE 2 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPANNING WRIST 9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061856080|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL CONTOUR 4.8X26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ZUK KNEE RIGHT MEDIAL LEFT LATERAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584202410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR UNI KNEE SIZE 4 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203151010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL NCB 5.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC44010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG PORT IPG SPECTRA PRECISION|1|HUMANA [1294]||HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 3.0MM X 17/4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HPWA-18-150|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ROADRUNNER UNIGLIDE 0.18X 150CM BX/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PRECOAT SZ 4 RT MEDIAL/LEFT LATERAL UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8595520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR KINECTIV 12/14 TAPER SIZE P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-WF40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUB CAP WRIST FUSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,655.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-WF60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER SCREW HUB CAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-F2708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-F2710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-F2706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-F2712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507405MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 405CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-4445MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 445CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507425MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 425CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507470MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 470CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507490MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 490CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507555MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 555CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507510MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 510CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111024ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BOLD 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|905.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTOR LINER CONSTRAINED REFLECTION 50-52 MM O.D.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER CONSTRAINED CO-CR 26MM 50-52 MM O.D.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,289.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,289.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8029|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 35MM 11MM TIB CORT TPR PROX END SEAT FLSH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIECE EXTENSION GMRS 30 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187823107|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONCORD 9X7X23|1|HUMANA [1294]||HUMANA [11839]|14,227.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,227.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-600|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND SMOOTH PROFILE HIGH 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 4-22 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03821635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY XIA 6.5X35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,733.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,733.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03756230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XIA SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32551|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY MAIN CUSTOM BIFURCATED DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-28-94-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48238035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3 XIA 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,359.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48238040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3 XIA 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,359.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO X-TRA LOCK 11 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSM-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SILICONE FACIAL SUBMALAR BINDER SMALL|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910-200-082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR INTRALINE BIOSTEON 5.5 MM 2 SUTURE W/ NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25673|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE INTERMEDIATE DR VOLAR 10 HOLE LEFT EXTRA SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6611-003-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRILL FLEXIBLE HGP 3.2 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM U-E NEUTRAL 36MM X 52 II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-0106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SUBTALAR MBA 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,272.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,272.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85404|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST COVERED 7MM X 38MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85405|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST COVERED 7MM X 59MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85406|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST COVERED 8MM X 38MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85407|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST COVERED 8MM X 59MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-06-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTOR STEM HUMERAL RSP 6 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,979.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,979.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6195-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT W/GENTAMICIN SIMPLEX HV FULL DOSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|685.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|685.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4500-053-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT INSERT TIBIAL POLY CROSSLINKED PROLONG TM ZIMMER S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4500-023-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ANKLE TOTAL TALUS RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA MEDIAL DISTAL 14HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,648.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,648.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7217070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PREBENT DBR III 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW LEFT 2.7MM 11HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM U-E NEUTRAL 36MM X 54 JJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 54MM HIP 12 SCLP CH SNPFT GRV INTGR LCK MECH TRB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2155-3040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ANGIO SCULPT 3MM X 40MM 155 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2200-3015|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ANGIO SCULPT 3MM X 15MM 137 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LDA210Q/58|SUP|HCPCS C1777||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD OPTISURE DEFIBRILLATION 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,427.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,427.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23631-006|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROTALINK PLUS SYSTEM BURR SIZE 2.25MM X 135CM LENGTH X 0.58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.388E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.4MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4302-056-19|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/FLATOW 19MMX56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 3-15MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806550A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 6.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6612125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LC 12 X 11 X 25 8 DEGREES|1|HUMANA [1294]||HUMANA [11839]|10,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1138S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 11MM X 380MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL STABILIZER TOTAL X 3 POLY SZ 6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 100 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,454.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,454.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8827535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 7.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT52AO-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 AO DIOPTER CRYSTALENS POSTERIOR CHAMBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-006-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK HALF TIBIAL TM RT LATERAL/LT MEDICAL SZ 6-5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604638S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 38MM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EN2006020|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM ENSNARE 12-20MM CATHETER 6FR X 100CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EN2006015|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM ENSNARE 9-15MM CATHETER 6FR X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MV34A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXOS MV 4.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MV36A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXOS MV 4.0 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00565050|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COLONIC WALLFLEX 30/25MM DIAMETER 9CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 42MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6511|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COLONIC WALLFLEX 27/22MM DIAMETER 9CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402438|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE COBALT MV 40GM|1|HUMANA [1294]||HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8784|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25677|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE INTERMEDIATE DR VOLAR 14 HOLE LEFT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5038-5-060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF APEX 3 X 60 10 CONT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 56-01210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION BLOCK AMING DR VARIAX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|913.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KCFW-6.0-35-55-RB-HFANL0-HC|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDING ANSEL FLEXOR STRAIGHT W/ CHECK FLO VALVE/HIGH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KCFW-6.0-35-55-RB-HFANL1-HC|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDING ANSEL FLEXOR MULTI-PURPOSE W/ CHECK FLO VALVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported THSF-35-260-AES-ST|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STIFF AMPLATZ COATED TFE .035 DIAMETER X 260CM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CXI-4.0-35-90-P-NS-0|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER CXI SUPPORT 4 FR 90 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5334400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 8.5 X 24|1|HUMANA [1294]||HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496H420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT HEAD RADIAL EVOLVE SIZE 20MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.0 X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6081128|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT MP LARGE 11X9X28 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|15,996.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,996.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8455555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 5.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL METAL TRABECULAR SIZE 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,109.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,109.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-25008E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERG CROSSPIN 2.5X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-25010E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERG CROSSPIN 2.5X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR INTERMEDIATE LEFT 11 HOLE SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00516740|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL WALLFLEX COVERED 23MM X 12CM 18.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,210.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,210.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #1 27MM NECK 96MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000120|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000265|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000260|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000075|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KCFW-7.0-35-55-RB-HFANL0-HC|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDING ANSEL FLEXOR 7 FR. X 55 CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6610125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LORDOTIC 10 X 11 X 25 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|10,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8457545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARMADA POLY 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7459023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK DRIVER TI ARMADA 6.25 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|771.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8452856|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR ASF26T ROD-ROD 6.5H-5.5O|1|HUMANA [1294]||HUMANA [11839]|4,923.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,923.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7377550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED POLY 7.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7377545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED POLY 7.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,612.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7502102|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE HYPERLORDOTIC 8 X 38 X 28MM 20 DEGREE|1|HUMANA [1294]||HUMANA [11839]|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENDER STEM FLUTED REVISION 15MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629332S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL POSTERIOR 12HOLE/RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5332600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT UROPASS 7 X 26|1|HUMANA [1294]||HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787103028225|SUP|HCPCS C1881||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER KIT DURAMAX VASCPAK DIALYSIS 40CM|1|HUMANA [1294]||HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000280|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700342006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 3LEVEL 66 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700811007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED TRIMCOR 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00119.003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RECOVERY VARIABLE TRIMCOR 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00120.003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RECOVERY FIXED TRIMCOR 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48322054|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVG 4 DEGREE 5 X 12 X 14MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48322050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVG 0 DEGREE 5 X 12 X 14MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PHSE|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG PRLN 4 15/16INX2 5/32INX.5IN 3 15/16IN .75IN SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,499.78|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,499.78|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 48811226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AVIATOR 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,384.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,384.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMRM6133|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENVELOPE PACEMAKER ANTIBACTERIAL AIGIS RX LARGE|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D135403|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DUO LOOP LASSO D/F CURVE 25MM, 3-8-3 SPACING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97702|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BATTERY ADVANCED PRIME NON-RECHARABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74001|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER POCKET 1 X 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 4.5X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 4.5X54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.226.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS THREAD LONG 4.5X56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,136.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541458|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL MEMORY SHAPE 480CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26517|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETRIEVAL SET NEEDLE'S EYE SNARE 94CM 16FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD MODULAR COCR 28MM +9MM NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-056-23|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/FLATOW 23MMX56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-056-19|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/FLATOW 19MMX56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MV40A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXOS MV 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MV44A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXOS MV 4.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5490-035-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT FEMORAL DISTAL ANTERIOR OR POSTERIOR SZ E 5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RX1-30-43|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CUFF AORTIC RENU ZENITH 30MM X 43CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 2 5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27615015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CANCELLOUS CHIPS 15CC|1|HUMANA [1294]||HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-111134|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 11MM X 11MM X 34MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-090930|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 9MM X 9MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON LOCKING 3 HOLE RIGHT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-021-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KNECTIV MODULAR NECK 12/14 SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1850-1040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL GTN T2 10X400MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS TIBIA HINGE ROTATING SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL SIZE 4 10 MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,107.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,107.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588005017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING SIZE E 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL HINGE ROTATING RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000589|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE REVERSE 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TI-115310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSHERE 36MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-115393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL STANDARD 44-36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL REVERSE 44MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,679.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,679.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER REVERSE 6.5X30MMST/RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5HEXAGONAL 4.75X15 ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5HEXAGONAL 4.75X25ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110003484|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEINMANN THREADED 3.2MM 9"|1|HUMANA [1294]||HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47374|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL NESTER EMBOLIZATION 7-6|1|HUMANA [1294]||HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WC-0715|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR IMPLATE 7MMX15 DEGREE|1|HUMANA [1294]||HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-DRN-SHT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL IMPLANT DISTAL RADIUS SHORT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,268.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,268.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UCNL-28050-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL 2.8MMX5.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.221|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL VA-LCP 3.5MM X 117MM SMALL BEND 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629562|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD,CVD 12HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,822.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001125310|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STENT BLUE MAX 6 X 4 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200076020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC NITINOL 7 X 60 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-63075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EXPRESS LD 6 X 27 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200086070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC NITINOL SE 8 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939171060470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLN MUSTANG 6 X 4 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.512E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 12MM SELF TAPPING 4MM HEAD WITH CRUCIFO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 38046-64075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EXPRESS LD 6 X 37 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR JUGGERKNOT 1.0MM MINI 3-0 NDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLN CHARGER 5 X 4 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLN CHARGER 6 X 2 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032200610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 2 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032406010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060810|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206061210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 8 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032250690|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 2.5 X 60 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 8 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206061210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206100470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 10 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050810|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 7 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148251510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 2.5 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032502210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 5 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148401510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 4 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39031-25601|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 2.5 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206042010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 4 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206052010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S1DLCP|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER LEADLESS NANOSTIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACCOLADE II 127 DEGREE SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0099|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3HOLE SMALL CURVATURE RADIAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6360753|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER PERIMETER 7X15X13MM|1|HUMANA [1294]||HUMANA [11839]|4,007.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,007.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203159040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180300304|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH CARDIOVASCULAR 0.4 X 3MM X 3 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1803006004|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH CARDIOVASCULAR 0.4 X 3 MM X 6 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48324054|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVS 5 X 14 X 16MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-035-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ E 20MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-070-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED BEARING PERSONA NEXGEN RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A28-28/C95-O20V|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENTENSION CUFF AORTIC PROXIMAL 28MM X 28MM COVERED 95MM OPEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-25012E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERG.CROSSPIN 2.5X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-25006E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERG. CROSSPIN 2.5X6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500805602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500805802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 9 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GM2754|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MICROVASIVE ANASTOMOTIC DEVICE 3.0 #2754|1|HUMANA [1294]||HUMANA [11839]|437.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|437.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42500806802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 10 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500807002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 11 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500807402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 12 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-056-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500805402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL PS POROUS STANDARD SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500605802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-060-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-062-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-064-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-066-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-068-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-054-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-074-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD RT SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-056-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/FLATOW 27MMX56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-056-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/FLATOW 24MMX56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6250MPR02|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN COMMAND MP-R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500805601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500805801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5008-064-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,418.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,418.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 10 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500806601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 9 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500807001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 11 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500805401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-056-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED STANDARD SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 3.5MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1037S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 10MM X 375MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SCREW CORTICAL 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133MV-12|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MF-410335|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MODERATE HEIGHT FULL PROJECTION 335CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548312|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE CPX 4 STYLE 8300 350CC TALL HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1060-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 6MM X 80 X 80CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 349626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAP CORTICAL STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8780617|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARCHON SELF TAP VARIABLE4.5X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8780615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARCHON SELF-TAP VARIABLE 4.5X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8780315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARCHON SELF TAP FIXED4.0X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8780517|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ARCHON SELFTAP FIXED4.5X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8787470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ARCHON 4LEVEL 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLDIP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERLOCK DIP 12MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-062-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-058-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-060-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-064-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500606801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-066-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-074-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-054-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-056-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA POROUS PS NARROW RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-058-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-060-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-064-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-062-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-068-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-066-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-054-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-070-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW RT SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6360653|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER PERIMETER 6MMX15MMX13MM|1|HUMANA [1294]||HUMANA [11839]|4,007.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,007.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AK-22123-F|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARROW MULTI LUMEN CATH 12FR 16CM AK22123|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|275.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|275.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5000-058-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-056-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-060-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-062-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-064-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-068-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-054-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-056-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-058-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-060-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-062-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-066-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-064-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-068-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-070-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5002-054-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS NARROW LEFT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-056-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-058-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-060-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-064-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-062-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-068-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-070-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-054-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW LEFT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5006-070-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA CEMENTED PS STANDARD LT SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-008-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,8 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|185.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|185.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-066-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM 3-5TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6209S1S|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS PEELABLE 9FR SINGLE CHAMBER ONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5124-006-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM 3-5TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-MCN-M40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL IMPLATE METACARPAL MINI 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WC-0215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR IMPLATE 2MMX15. 0DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UCNL-28070-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL 2.8MM X 7.0MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-009-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FOREARM 9 HOLE TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5000-070-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS CEMENTED NARROW RIGHT SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM 6-9TIBCD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM 6-9TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM 6-9TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM 6-9TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM 6-9TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM 6-9TIBGH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM 6-9TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 28MM (FEM 6-9TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM 6-9TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM 6-9TIBEF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512400820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM10-11TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM10-12TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 10MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 11MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 12MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 13MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 14MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 16MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 20MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512401118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA LEFT 18MM (FEM10-12TIB J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11MM (FEM3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM 3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16MM (FEM 3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18MM (FEM 3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20MM (FEM 3-5 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18MM (FEM 3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20MM (FEM 6-9 TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ-B LT MEDIAL RT LATERAL PRECOA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION VARIAX NARROW STRAIGHT 8HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,060.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,060.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1843-1036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON LEFT RI.5 10X360MMX125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6360553|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER 5MMX15MMX13MM|1|HUMANA [1294]||HUMANA [11839]|4,007.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,007.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784803301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MOD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 4 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784802401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MOD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM10-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20MM (FEM 6-9 TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11MM (FEM10-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM10-11 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16MM (FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM 6-9 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18MM (FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10MM (FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522400820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20MM (FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12MM (FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13MM (FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14MM (FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16M (FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18 (FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 20 FEM10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 10 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 11 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 12 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 14 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 13 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 16 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522401118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS FIXED PERSONA RT 18 FEM10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 10MM (FEM3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 14MM (FEM3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 12MM (FEM3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-8115|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST CPX4 LOW HEIGHT STYLE 81 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 16MM (FEM3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 18MM (FEM3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 20MM (FEM3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-7.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +7.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTBA1QQ|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|GENERATOR VIVA QUAD XT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTBA1Q1|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR VIVA QUAD XT-D CRT-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 429888|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD ATTAIN PERFORMA 88CM 4298|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403656|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING SELF-FIXATING SPARC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068503000|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING MID-URETHRAL SUPRAPUBIC LYNX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,093.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,093.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507501 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH PLUS PROFILE MODERATE 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 87SR0420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO-DENSE INJECTABLE 20CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8754-011-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM LONGEVITY 36 MM 7MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-013-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV M/L TAPER SZ 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PNG720|SUP|HCPCS C9352||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEURAGEN 7.0MM X 2CM|1|HUMANA [1294]||HUMANA [11839]|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0359|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VDR ACULOC 2 PIT NARROW RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0361|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VDR ACULOC 2 PIT WIDE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON MTF PATELLAR PRESHAPED 10MM DOWELS|1|HUMANA [1294]||HUMANA [11839]|8,289.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,289.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 10MM (FEM3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 12MM (FEM3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-006-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 14MM (FEM3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-006-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 18MM (FEM3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-006-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 16MM (FEM3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-006-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 20MM (FEM3-5 TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1370C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-COM INT TAPER TIP 7X23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 10MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 16MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 12MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 14MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 18MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-007-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 10MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-005-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 20MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-007-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 12MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-007-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 14MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 18MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-007-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 16MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-007-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FIXED PERSONA LFT 20MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-008-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 10MM FEM 10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-008-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 12MM FEM 10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-008-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 14MM FEM 10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 18MM FEM 10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-008-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 16MM FEM 10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 20MM FEM 10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-009-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 10MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-009-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 14MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 12MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.402.007S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL STRAIGHT TI 7MM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD STRAIGHT 8HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09.402.022S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL STANDARD COCR 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MM X L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MM X L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MM X L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MM X L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5554-L-350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL ASYMMETRIC TRIATHLON A35MM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3508001 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL MODERATE PLY PROFILE 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8595522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 5.5 X 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548116|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST CP X 4 LOW HEIGHT STYLE 8100 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7140210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DECADE 2HOLE SZ10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,431.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,431.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL WIDE COROENT 10X22X45MM|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION VARIAX STRAIGHT 7HOLES/L90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534-A-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL ALL-POLY CS SZ 4-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,887.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STM6030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STAFLIF MIDLINE ABO 6MM X 30 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STM331312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE STALIF MIDLINE 33MM X 13MM X 12 DEGREE|1|HUMANA [1294]||HUMANA [11839]|25,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6610925|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LORDOTIC 10 X 9 X 25 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|10,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4380-32-059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR CONSTRAINED DURASUL EPSILON SZ 32MM/59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,491.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,491.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6714|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON VENOGRAM 90 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 545-509|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING TIGHTRAIL 9FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 545-511|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING TIGHTRAIL 11FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 545-513|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING TIGHTRAIL 13FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 540-009|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING MINI TIGHTRAIL 9FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 540-011|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING MIN TIGHTRAIL 11FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5871-220LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP MEDIUM 0 DEGREE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58812710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN352632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 26MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F6CQA005RT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COMPLI SOFT TIP 6FR 4P 5MM FIXED 115CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1922BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PUSHLOCK BIOCOMPOSITE 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6478-6-440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESS FIT COCR 15MM X 155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64811210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL DISTAL HINGED ROTATING MEDULAR 10MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628168|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR INCREASED 8 HOLE BRIDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5300-075-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 510-08-175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MONOBLOCK RSP SIZE 8 175 LONG REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-8214|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST STYLE 8200 HEIGHT MEDIUM CPX 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548213|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST STYLE 8200 HEIGHT MEDIUM CPX 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48324064|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVS 6 X 14 X 16MM|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48811112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AVIATOR 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,867.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,867.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48844012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FIXED AVIATOR 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,679.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48834514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RESCUE FIXED AVIATOR 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602715S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 115MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G17844|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER URETHRAL DILATION BALLOON 7.0FR 29CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1520128|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM READY TO USE 6CM X 18CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,092.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,092.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602640S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 40MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602650S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 50MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602665S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 65MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602655S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 55MM TL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-009-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 14MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-009-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 18MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602855S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 55MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602860S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 60MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602865S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 65MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602915S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 6.5 X 115MM TL40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611055S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611065S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611070S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611115S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 8.0 X 115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-009-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 20MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-010-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 10MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120417|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRANSLATIONAL ATLANTIS FIXED 4 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-010-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 12MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-010-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 14MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-010-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 16MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512601018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 18MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512601020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 20MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-011-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 12MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-011-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 10MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-011-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 16MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5126-011-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 14MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512601118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 18MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512601120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA LFT 20MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM 3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM 3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM 3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM 3-5 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 3-5 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 3-5 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM 3-5 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM 3-5 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM 3-5 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM 3-5 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9120AS323A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 3 ASCENDRA (THV) SAPIEN EDWARDS 23MM|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9120AS326A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 3 ASCENDRA (THV) SAPIEN EDWARDS 26MM|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9355ASP29A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ASCENDRA + (THV) SAPIEN XT EDWARDS 2900|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200074070|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 7 X 40 X75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175832P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GOLD HEMASHIELD ARCHED 1-BRANCH 32MM X 50CM/10MM BRANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,646.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,646.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175834P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GOLD HEMASHIELD ARCHED 1-BRANCH 34MM X 50CM/10MM BRANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,646.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,646.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5554-L-381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL ASYMMETRIC TRIATHLON A38MM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM 6-9 TIB CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14M FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16 FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18FEM 6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM6-9 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM10-11 TIB EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM 6-9 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM 10-12 TIB GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 10MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 12MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 14MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 16MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 18MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR CPS FXD PERSONA RT 20MM FEM 10-12 TIB J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5300-064-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5300-067-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530007901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5300-071-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530008301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530008801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING LF SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530006402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530006702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530007102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530007502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530007902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530008802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42530008302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIA NATURAL PERSONA TM 2-PEG POROUS FIXED BEARING RT SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0934S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 9MM X 345MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPSL|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PROLENE PS GYNEMESH GYNECARE 10CM X 15CM|1|HUMANA [1294]||HUMANA [11839]|1,693.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,693.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR JUGGERKNOT 1.0MM MINI 2-0 NDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232805303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT STANDARD 3 HOLE VOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,274.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232901625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 2.4MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232902025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 2.4MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232901224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232901824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232902024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232901024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232901424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB18W020200150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERCROSS 2MM X 200MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83159-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOX SV 4MM X 20 MMM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0352|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATES VDR PROXIMAL NARROW LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 72.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG-3535F|SUP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AMNIO 3.5 X 3.5CM C AG-3535F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-65-120-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.5MM X 120MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232901624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-35|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 35.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLXSA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMELOCK SMALL ANGLED 16MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548212|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST STYLE 8200 HEIGHT MEDIUM CPX 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR051002A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 10CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR051502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 15CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJ061002|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 10CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR061502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 15CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR062502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 25CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492000209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,MINI,EPIPHYSIS,OBLIQUE L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR070502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 5.0CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,311.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,311.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR071002A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 10CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48654014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED HYBRID REFLEX 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,424.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,424.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48651112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HYBRID REFLEX LEVEL 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,825.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,825.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A34-34/C100 V|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT RENAL INFRA VELA 34-34/C100V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7752535|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK SMALL|1|HUMANA [1294]||HUMANA [11839]|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BCF-3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW BIOCOMPOSITE ITE 5.5 X 14.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-MCN-S46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL IMPLATEMETACARPAL STANDARD 4.6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-9-114|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TENDON TISSUE BOVINE FETAL TISSUE PERFORATED 4CM X 4CM|1|HUMANA [1294]||HUMANA [11839]|2,787.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,787.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806545A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806540A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 6.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8896540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PRECEPT 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7050-90|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT I FUSE SI-BONE 7.0MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7045-90|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT I FUSE SI-BONE 7.0MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7040-90|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT I FUSE SI-BONE 7.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSZ20800|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST FOR STYLE 20 NATRELLE 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSZ20700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST FOR STYLE 20 NATRELLE 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|123.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|123.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629383S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3 HOLE LEFT/RIGHT HUMERUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1434S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 14MMX340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003008X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER DILATATION 3.0 X 80 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002506X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 2.5 X 60 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48004015X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 4 X 150 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002515X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 2.5 X 150 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF05120MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART LONG 5 X 120 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777352832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DARCO HEADLESS SCREW 3.5X28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587110RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTP FUSION PLATE SMALL 0DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7209017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIORCI 10 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|809.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|809.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00486502500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 25MM FULL THREADED HEXHEAD LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6717205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT SMALL 5X17X12MM 10DEGREE|1|HUMANA [1294]||HUMANA [11839]|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6717204|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT SMALL 4X17X12MM 10DEGREE|1|HUMANA [1294]||HUMANA [11839]|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5076-65|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSUREFIX NOVUS 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF08060SB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART LONG 8 X 60 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF06150MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART LONG 8 X 150 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48004004X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 4.0 X 40 X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF06080MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART LONG 6 X 80 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003015X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 3.0 X 150 X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48004006X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 4 X 60 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF05100MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART LONG 5 X 100 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002510X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 2.5 X 100 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400604X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 6 X 40 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF06040MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART LONG 6 X 40 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400504X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 5 X 40 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RIGIDLOOP CORTICAL FIXATION IMPLANT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WC-1215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR IMPLATE 12MM X 15.0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|892.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|892.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002015X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 2 X 150 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCN-S360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RADIAL RECON 6MM COLLAR SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,408.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,408.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCN-H3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD RADIAL RECON SIZE3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,404.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,404.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5554-L-320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL ASYMMETRIC TRIATHLON A32MM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400406X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 4 X 60 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.402.008S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TI STRAIGHT 8MM RADIAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09.402.020S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL STANDARD COCR 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1851-1138S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL RIGHT 11 X 380|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR DECREASED 6 HOLE BRIDGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2656DR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL CLAVICLE SHORT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400704S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 7 X 40 X 80 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS FULL THREAD 6MM 6.0MM/L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR LATERAL DISTAL 12HOLE /L274MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5MMXL32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48005030X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 5 X 300 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48004030X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 4 X 300 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4401004S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 10 X 40 X 80 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400512X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 5 X 120 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548112|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST CPX4 LOW HEIGHT STYLE 8100 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951638|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE ALIF16X38X28 12 DEGREE|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6961638|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BRIGADE 16 X 38 X 32MM 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400508X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 5 X 8 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400602X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 6 X 20 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM3222|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ALLURE RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,161.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,161.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25573|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR NARROW LEFT 8-HOLE EX SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196789480|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CO CR 5.5 X 480 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,317.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,317.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196789600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CO CR 5.5 X 600 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,317.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,317.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186731850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 8.0 X 50 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187301209|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SPACER BENGAL LARGE 9MM|1|HUMANA [1294]||HUMANA [11839]|4,463.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,463.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09.402.226S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RADIAL HEAD COCR 2MM HT EXTENSION/15.5MM STER 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.402.009S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RADIAL STEM 30MM STRAIGHT TI 9MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-1440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 11 X 440 X 125 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7055-90|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT I FUSE SI-BONE 7.0MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-10407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 6 HOLE M PROFYLE HAND COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4262508X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SLEEK OTW 2.5 X 80 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PG1860BPS|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PALMAZ GENESIS BX 6MM X 18 MM LENGTH 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,403.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,403.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186731845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 8.0 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003004X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER PTA .018 3.0 X 80 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48006030X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 6 X 300 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48004008X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 4 X 80 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X L50MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-002-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,2 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS0615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS G-FORCE 6MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,347.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003030X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 3.0 X 300 X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC231650E0|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 50CM INFINION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6717206|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKERS TA COROENT SMALL 6X17X12MM 10 DEGREE|1|HUMANA [1294]||HUMANA [11839]|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1562PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEEK VENTED TENODESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8919DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE MINI REPAIR|1|HUMANA [1294]||HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-003-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,3 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 30MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952TS-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE TI STRAIGHT 3.0MM 2 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000827|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 60MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000828|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 65MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25783|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR STANDARD RIGHT 10HOLE EXTRASHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-L-320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL TRITANIUM ASYMMETRIC A 32 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-L-350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL TRITANIUM ASYMMETRIC A 35 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-004-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,4 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX TI 2.4MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012580-26|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT GRAFTMASTER RX 2.8 X 26 MM RX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported THSCF-35-260-3-AES|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE AMPLATZ EXTRA STIFF J CURVE 260CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT DBM PLUS PUTTY 5CC|1|HUMANA [1294]||HUMANA [11839]|3,561.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W025020150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.5MM X 20MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-005-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,5 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|169.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|169.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195040X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OPTA PRO .35 PTA 5 X 40 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002006X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER PTA .018 2.0 X 60 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400404X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 4 X 40 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF06100MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART FLEX REG 6 X 100 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48005015X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 5 X 150 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400415X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 4 X 15 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4197040X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OPTA PRO .35 PTA 7 X 40 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4262515X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SLEEK OTW 2.5 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4262004X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SLEEK OTW 2.0 X 40 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS0410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS G-FORCE 4MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE CANNULATED PHALINX SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE CANNULATED PHALINX EXTRA SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE CANNULATED PHALINX MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL HUMERUS POSTLATERAL RT 9H 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200019|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,306.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 27.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 52.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 67.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCFW-6.0-38-48-RB-MTS|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDING MULLINS 6FR 48CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42557000114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM PERSONA TAPERED CEMENTED 14MM +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313-075|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PREBENT NXT 75MM|1|HUMANA [1294]||HUMANA [11839]|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS2030|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REINFORCEMENT TISSUE GORE BIO-A FLAT SHEET 20 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,012.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,012.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-L-381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL TRITANIUM ASYMMETRIC A 38 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FA 4MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED 4.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200167|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 67.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-006-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,6 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 77.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,821.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200185|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200182|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 82.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7200105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS ELITE 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,169.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRANSLATIONAL ATLANTIS FIXED 4 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-007-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,7 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125417|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXED 4.5MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 4 X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,343.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120517|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 4 X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125517|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4.5MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3120311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 4MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,493.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400515X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 5 X 100 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF06120MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART FLEX REG 6 X 120 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SB050120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SALVATION 5.0X120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,926.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,926.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SB070130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEAM SALVATION 7.0X130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,992.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,992.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SB005085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SALVATION 5.0X85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,926.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,926.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3066-0085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW LAG-U-BLADE 10.5 X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 13 X 360 X 125 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DNE-4000-380-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS HALF 3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DNE-4000-3100-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS HALF 3MM 100MM/20MM THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-8114|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST CPX4 LOW HEIGHT STYLE 8100 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400606X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 6 X 60 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400608X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 6 X 80 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400612X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 6 X 120 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4196040X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER OPTA PRO .35 PTA 6 X 40 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400804X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035 PTA 8 X 40 X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 04.0MM/L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON 5 MM SZ 8 MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400408X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035PTA 4 X 80 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4400522X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERFLEX PRO .035PTA 5 X 22 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002504X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 2.5 X 40 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-7713-009-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV ML TAPER STEM SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607-001-330|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCAFFOLD DERMAL REPAIR PRIMATRIX MESHED 3CM X 3CM|1|HUMANA [1294]||HUMANA [11839]|1,545.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,545.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607-005-440|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCAFFOLD DERMAL REPAIR PRIMATRIX MESHED 4CM X 4CM|1|HUMANA [1294]||HUMANA [11839]|1,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607-004-440|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCAFFOLD DERMAL REPAIR PRIMATRIX FENESTRATED 4CM X 4CM|1|HUMANA [1294]||HUMANA [11839]|1,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607-005-550|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCAFFOLD DERMAL REPAIR PRIMATRIX MESHED 5CM X 5CM|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607-104-440|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCAFFOLD DERMAL REP ANTIMICROBIAL PRIMATRIX AG FEN 4X4 CM|1|HUMANA [1294]||HUMANA [11839]|1,728.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,728.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607-105-440|SUP|HCPCS Q4110||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCAFFOLD DERMAL REP ANTIMICROBIAL PRIMATRIX AG MESH 4X4 CM|1|HUMANA [1294]||HUMANA [11839]|1,728.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,728.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T8 2.4 MM X L20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T8 2.4 MM X L18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FULL THREAD 2.7 MM X L14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7713-006-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR M/L DINECTIV PF PLASMA SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 605024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TISELF TAP CORTICAL 2.7X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548215|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST STYLE 8200 HEIGHT MEDIUM CPX4 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341302|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE 495CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341252|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE 440CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341352|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE 555CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP10461|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE MTP LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP40460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE UTILITYS STRAIGHT 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,007.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,007.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE LOCKING 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE STANDARD 3.5MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE STANDARD 3.5MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0229-002-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE,FRACTURE,7/8X1/16|1|HUMANA [1294]||HUMANA [11839]|65.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|65.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.114.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 1.5MM TI LCP 3H HEAD 8 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 11MM SELF TAPPING WITH T4 STARDRIVE R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02-6000-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE DEMINERALIZED EVO3 ACCELL INTEGRA 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZIV6-35-125-6-80-PTX-SET|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 6FR 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 619909|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER TI FOR 2.7/3.5/4.0 SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-L-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL TRITANIUM ASYMMETRIC A 40 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232447|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RIGIDLOOP ADJUSTABLE BUTTON STANDARD|1|HUMANA [1294]||HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507445MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 445CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 076584|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ABLATION 5F RF MARINR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PHSL|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG PRLN 3 15/16INX1.75IN .5IN 3 15/16IN .75IN ONLAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,354.51|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,354.51|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SP08000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SCREW 2.5 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-200SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STEALTH SOLID CROWN 30 2.00MM 145CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-125MICRO145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 MICRO OAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2317-50|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 16 CX INFINION 50CCM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977A275|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD PERCUTANEOUS MRI SURESCAN VECTRIS 1X8 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0383|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VDR PROXIMAL RIGHT LONG NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-S2328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING 2.3 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629390S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL HUMERUS 10HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548113|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST CPX4 LOW HEIGHT STYLE 8100 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-L-299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA BACKED METAL TRITANIUM ASYMMETRIC A 29 X 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 18MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8916VSL-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS TI STD LEFT 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.5MM X 12MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.5MM X 12MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.104.028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS EXTRA-ARTICULAR LCP 3.5MM 194MM /8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,828.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,828.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 16MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-2316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE ANGLE 2.3X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-2314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE ANGLE 2.3X14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700342002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 3LEVEL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00118.003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RESCUE VARIABLE 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0640103071|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK VISTA-S 7X14X14|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784802201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR 12/14 TAPER SIZE BB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTEG-2P-28-120-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 ZENITH 28 X 120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1154-028-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HERBERT 28MM SCAPHOID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FS0808|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BIO-ABSORBABLE REINFORCEMENT TISSUE GORE 8CM X 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7969818|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER INTERBODY SOVEREIGN LARGE 8DEGREE 42MMX30MMX18MM|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9874045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4HOLE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98716300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2359-042-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235700714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TIBIAL MEDIAL DISTAL 14-HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,108.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,108.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9P15-PB01-A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC TOE MTN THK3.6MM 01 2.5MM OFST MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9P15-S180-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT TOE 13.6MM TOE MTN DF-P STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8827530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT REDUCTION 7.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6850208|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONTOUR COROENT 8MM|1|HUMANA [1294]||HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186803057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SKYLINE 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,031.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5213800|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT,URETERAL,TRACTFINDER,2.3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-8336-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD COVER EDGE 32 CONTACT PADDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231831|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1231S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 12MM X 315MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111445SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW QWIX FIXATION 4.3MM X 45MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,105.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286318ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SURFIX LOCKING SS 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286320ND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SURFIX LOCKING SS 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02-2100-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE ORTHOBLAST 1CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|681.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|681.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT WIDE DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LDS5530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AND WASHER LOCKDOWN 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LD110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE LOCKDOWN AC 11CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 30.MM 32/6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 3.0MM 36/7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 50MM 16.6MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXSLIMSTR|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PXSLIM DELIVERY 025 STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXSLIM045|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PXSLIM DELIVERY 025 - 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXSLIM090|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PXSLIM DELIVERY 025 - 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXSLIM130|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PXSLIM DELIVERY 025 - 130(J)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCFW-6.0-38-63-RB-MTS|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH MULLINS CHECK-FLO 6FR 63CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T8 2.4 MM X L22 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL MEDIAL TIBIA 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.308E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27615005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CANCELLOUS CHIPS 5CC|1|HUMANA [1294]||HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM2240|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ASSURITY DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W025080150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.5MM X 80MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W030100150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 3.0MM X 100MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A14BX030060170|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RAPIDCROSS 3.0MM X 60MM X 170CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.356|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-DRLG 2.0MM W/STARDRIVE (TM) RECESS 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|141.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|141.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71323126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER CONSTRAINED 0 DEGREE 28MM 58-60 MM O.D. G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTOR LINER CONSTRAINED REFLECTION 58-60 MM O.D. G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTOR LINER CONSTRAINED REFLECTION 54-56 MM O.D. F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-005-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV M/L TAPER SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8851-009-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM U-E NEUTRAL 32MM X 50 HH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604744S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629566S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD CURVED 16 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,289.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,289.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D97120F5|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER PACING 5FR STRAIGHT 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502501 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MODERATE PLUS SMOOTH SILICONE 250CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #7 37MM NECK 114MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-114666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RESURFACING HA COPELAND SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48324084|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE AS AVS 8X14X16|1|HUMANA [1294]||HUMANA [11839]|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,798.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629343S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 3HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEALICOIL REGENESORB SUTURE ANCHOR 5.5MM W/2 ULTRABRAID SUTURES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 471505|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOPATCH HD THICK 5 X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000829|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED PTRCOAT A/P WEDGED SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1662BCC-7|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIO COMPOSITE SWIVELOCK TENODESIS 7X19.1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2600SBS-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEEDBRIDGE IMPLANT SYSTEM WITH BIO COMP SWIVEL LOCK 4.75X1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,220.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED 3.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED 3.0 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700342004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 3LEVEL 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700120002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RECOVERY FIXED TRIMCOR 14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548216|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST STYLE 8200 HEIGHT MEDIUM CPX4 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ESLE-16-55-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION LEG ILIAC 16MM X 55CM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351306100|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX 035 PTA 6MM X 100MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7140214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DECADE 2HOLE SZ14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,431.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,431.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6921450|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE XL WIDE 14X22X50MM LORDOTIC|1|HUMANA [1294]||HUMANA [11839]|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-002-YB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y BETA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203707|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEALICOIL REGENESORB SUTURE ANCHOR 5.5MM W/3 ULTRABRAID SUTURES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,165.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,165.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS11023|SUP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR PRIME GRAFIX 2 X 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8827545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REDUCTION PRECEPT 7.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRECEPT 50MM|1|HUMANA [1294]||HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200106070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 10 X 60 X75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,370.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,370.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965404110|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT 18 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,211.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,211.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|753.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL MEDIAL TIBIA LEFT 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS11055|SUP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR PRIME GRAFIX 5 X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9010000824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-B-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PRIMARY CEMENTED TRIATHLON SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 PS TRIATHLON SZ 1-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 PS TRIATHLON SZ 1-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 TRIATHLON PS 16MM #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 TRIATHLON PS 19MM #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 19MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 16MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532G219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL X 3 TRIATHLON SZ-2 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 19MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL STABILIZED POSTERIOR 19MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CR TRIATHLON #1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CR TRIATHLON #8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8864-010-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE,FOREARM,10 HOLE,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|205.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517-F-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CR TRIATHLON #1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CR TRIATHLON #8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5517F202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CR TRIATHLON #2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,976.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SIZE 2-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SIZE 2-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 3-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TBIAL CS TRIATHLON X 3 SZ 4-19M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SIZE 2-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON SZ 5-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 6-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 6-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 6-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 7-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CS TRIATHLON X 3 SZ 7-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 8MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 14MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 7 5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 7 5MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT POSTERIOR FEMORAL TRIATHLON SZ 7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5565-S-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FLUTED PRESS FIT TRIATHLON TS 25MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,594.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK HALF AUGMENT TIBIAL TRIATHLON SZ 7 5MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1137S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 11MM X 375MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25583|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR NARROW RIGHT 8 HOLE EXTRA SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-52318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-52316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-52320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH 2.3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V550|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST VISIPAQUE 270ML 50CC PLUS PK 10/BX|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ETBF3616C166E|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM GRAFT STENT ENDURANT II BIFURCATED 36MM X 16MM X 166C|1|HUMANA [1294]||HUMANA [11839]|29,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ETLW1616C93E|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM GRAFT STENT ENDURANT II LIMB CONTRALATERAL 16/20 X 15|1|HUMANA [1294]||HUMANA [11839]|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR STANDARD 28MM SIZE-E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777353832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6250V-MPR|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN COMMAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 04.0MM / L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,854.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,854.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.255E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 2.0MM EMERGENCY W/STARDRIVE(TM) RECESS 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|108.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU343420|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE34 MM X 20 CM|1|HUMANA [1294]||HUMANA [11839]|48,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT311413|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 31MM X 14.5MM X 13CM|1|HUMANA [1294]||HUMANA [11839]|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC161400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRALATERAL 16MM X 13.5CM|1|HUMANA [1294]||HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8949-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEUS STEP 7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5114-004-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR FIXED BEARING PS LEFT 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N2-0012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE 2.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|459.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|459.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-07-17-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 17MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ETLW1620C156E|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM GRAFT STENT ENDURANT II LIMB CONTRALATERAL 16/20X156|1|HUMANA [1294]||HUMANA [11839]|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TEMPLATE MPFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6 HOLE BRIDGE LEFT SUPERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATOR MINI 70/30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL LIPPED CS MEDIUM 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175734P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BRANCH 4 ARCH AORTIC WOVEN PLATINUM 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,445.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,445.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8865-016-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,BONE,16MM,TIV.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|34.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175732P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BRANCH 4 ARCH AORTIC WOVEN PLATINUM HEMOSHIELD 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,445.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,445.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-32-94-ZT|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-28-76-ZT|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM DISTAL BIFURCATED MAIN BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.354|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-DRLG 2.0MM W/STARDRIVE (TM) RECESS 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|125.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|125.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7145150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BOLT DECADE XLIF 5.5X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25683|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR INTERMEDIATE DR RIGHT 10 HOLE EXTRA SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1625559|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COROENT XL-W 10 DEGREE BULLETED 12X22X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-52-016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONSTRAINED 4X16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 6.0XL85MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,496.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965402130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WALLSTENT UNISTEP PLUS HALO 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,633.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,633.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT5|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ASPIRATION 132CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.316E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|120.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported TGU343415|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE34 MM X 15 CM|1|HUMANA [1294]||HUMANA [11839]|48,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU373720|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 37MM X 20CM|1|HUMANA [1294]||HUMANA [11839]|47,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLA360400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 36 MM X 4.5 CM|1|HUMANA [1294]||HUMANA [11839]|9,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL2428|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL COATING HYDROPHILIC GORE 24 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4154P-3010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DART PEEK 10DEGREE 2.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WD-11.24.12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PLIF WAVE 11MM X 24 MM|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5071-53|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSURE EPI 53CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,482.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,482.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HL2L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERLOCK PROXIMAL 15MM-DISTAL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HL2S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERLOCK PROXIMAL12MMXDISTAL5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 09.402.024S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RADIAL HEAD COCR 24MM HT STANDARD/13.0MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL LONG KIT RIGHT 13X360MMX125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7805535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE PLATE 5.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7806535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRIGADE 6.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10207|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH KUGEL COMPOSIX OVAL 10X13 0010207|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,921.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,921.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MXM-002-3P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ORTHOLINK MINI EXTREME 3HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-24-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.4MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VAR-031-24-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI VARIABLE 2.4MMMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-24-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI EXTREME 2.4MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VAR-031-24-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI VARIABLE 2.4MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628537S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PLATE 7 HOLE 16MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA7AR20SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 7FR AR2 W/SIDEHOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS-15282-VSP|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNON DIALYSIS CATH 15FR 23CM CC3200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA7AR20|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 7FR AR 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123400000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP NEUFLEX MCP SIZE 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123430000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER NEUFLEX MCP SIZE 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTEG-2P-36-202-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DFX-002-SL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA DISTAL SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,822.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCS-002-MCL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL COLUMN FUSION LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611310S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS TI 8.0X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS LONG THREAD 7.0MM/L100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588005012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING SIZE E 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502751BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MODERATE PLUS PROFILE 275CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4MM 4.0/L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-71-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2357-07-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TIBIAL MEDIAL DISTAL 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,993.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,993.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0015S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 15MM T2|1|HUMANA [1294]||HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2359-032-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FGL|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT PRESUTURED|1|HUMANA [1294]||HUMANA [11839]|6,519.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,519.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588BTB|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE ACL BTB|1|HUMANA [1294]||HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MM/L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MM/L75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MM/L80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RC-09700|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET CATH 7FR .025IN 2IN RC AFLX 13 1/8IN SHTH SPRG GW TISS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3341355|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE PLUS MED HEIGHT 475CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341405|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE PLUS MED HEIGHT 525CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541608|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE MED HEIGHT 640CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541708|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE MED HEIGHT 775CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 645641|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PINNACLE-L FEE 6 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,297.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,297.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB14W025210150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.5MM X 210MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W025060150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.5MM X 60MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8825535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW REDUCTION PRECEPT 5.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629203S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL HUMERUS 3HOLE/L84MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW S-FIX 2.5LG 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45-20015S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ASNIS MICRO K-WIRE 2.0MM 0.8X100MM STERILE|1|HUMANA [1294]||HUMANA [11839]|98.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ASNIS CANNULATED 5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ASNIS CANNULATED SCREW 5X36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702460|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE WIRE ASNIS 2.0X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 237025M5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE BIOABSORABLE MATRYX GENESYS 7.0MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558700|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR BALLOON CAE WIRE GUIDED 15-18MM 240 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558690|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 12-13.5-15MM 240 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LA6AR20|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDE 6 FR AR2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777353432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 3.5X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58510001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LAPIDUS 1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58803514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58813514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58813518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58813516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MD103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT METATARSAL HEAD SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431191|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD STEM HIP 11 X 135 MM W/REINFORCEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL VERSA-DIAL 42 X 18 X 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM COMP PRIMARY 10MM MICRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406669|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN STENIMAN THREADED TIP .125 X 2.5 IN 2PK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-070-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK GOLD 4.0|1|HUMANA [1294]||HUMANA [11839]|583.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-325S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT THREAD 4.0X32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-141F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORE SLIDING 7 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400-255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TALOR SMALL SZ LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,407.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6719404|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT SMALL 4X19X14MM 20DEGREE|1|HUMANA [1294]||HUMANA [11839]|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6719303|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT SMALL 3X19X14MM 15DEGREE|1|HUMANA [1294]||HUMANA [11839]|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6717207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT SMALL 7X17X12MM 10DEGREE|1|HUMANA [1294]||HUMANA [11839]|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1868-50-018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE 4X18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802250|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL CONTOUR 6 X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SRK30|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT DENALI IVC FILTER RETRIEVAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W12040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 12X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W12060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON EVERCROSS 12X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AX1-2-28-113-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITH FLEX 28MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2100-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 10MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601770S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III 5X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8009-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SQUARE 20 MM COMP DOBLE 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601660S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIN III 5X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 619906|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER III ASNIS 5.0MM|1|HUMANA [1294]||HUMANA [11839]|101.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|101.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCS-002-8RP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIALMAX POCKETLOCK 8DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VAR-031-35-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE 3.5X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCS-074|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK MEDIALMAX POCKETLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-020S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT THREAD 4.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D128208|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PENTARAY NAV ECO 7FR, F, 2-6-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D128207|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PENTARAY NAV ECO 7FR, F, 4-4-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D128209|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PENTARAY NAV ECO 7FR, F,1-8-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D128210|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PENTARAY NAV ECO 7FR, D,4-4-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D128211|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PENTARAY NAV ECO 7FR, D,2-6-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130640|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX 035 PTA 6MM X 40MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55388|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTOR AAA RENU ZENITH FLEX 32MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4210964|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PREVAIL 9 X 16 X 14MM|1|HUMANA [1294]||HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MS-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE STRAIGHT 2.4MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-24-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.4MMX30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-24-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.4MMX35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-4A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE UNIVERSAL MINI MAXLOCK EXTREME 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777403232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT THREAD 4.0X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58140000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COTTON FLAT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58813520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCK 3.5X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58803516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.7MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1140-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 14 X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL SUPERIOR 4-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 88901|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VISIONS IVUS PV 0.35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.402.010S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RADIAL STEM 32MM STRAIGHT TI 10MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,467.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1105|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL DBM ALLOGRAFT 5CC|1|HUMANA [1294]||HUMANA [11839]|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OC4522|SUP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX OCULO 2X2 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M006630208B1|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HYDROPHILIC ZIPWIRE .038 ANGLED TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 437105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL LATERAL HUMERUS TS 5 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,387.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL VERSA -DIAL 50X24X52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM COMP PRIMARY 15MM MICRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS-5180|SUP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPIFIX 18MM DISK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,056.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,056.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS-5220|SUP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPIFIX 2CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS-5240|SUP|HCPCS Q4186||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPIFIX 2CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,856.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,856.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-1040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACCOLADE II 127 DEGREE SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7848-012-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR KINECTIV 12/14 TAPER SIZE E1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597000036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDES INSTRUMENT SPECIFIC PATIENT FEM/TIB NEXGEN PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180553|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 HEXAGONAL 4.75X30ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10439236|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOUNDSTAR ECO GE 8F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13123-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.3MM X 14MMSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLAPLE 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777403632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.0 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201000206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201024014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 2.4 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,101.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,101.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201024018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 2.4 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201124014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCK 2.4 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201124022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCK 2.4 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-44H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD HEADLESS COMP FT 4.0 X 44M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-4231-36|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLANK LEAD EDGE COVER|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1370TC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-COM INT FT 7 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324BCC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL BIOCOMPOSITE WITH OUT TAPE 4.75 X 19.1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201994|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.9 OSTEORAPTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|984.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|984.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL MEDIAL RT.4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX STRAIGHT 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3300TFX29MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE BIOPROSTHESIS AORTIC PERICARDIAL PERIMOUNT CARPENTIER-29MM|1|HUMANA [1294]||HUMANA [11839]|18,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130660|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX 035 PTA 6MM X 100MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TV-AB3480|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOGRAFT BODY AORTIC OVATION 34 MM|1|HUMANA [1294]||HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TV-IL1410140|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOGRAFT OVATION LIMB INIAC 10 MM X 140 MM|1|HUMANA [1294]||HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 15MM SZ3-4 LT/MDL-RT/LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT LEGION STRAIGHT 13MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR TIBIAL CONSTRAINED GENESIS SIZE 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FEMORAL SCREW-ON DISTAL LEGION SIZE 3 -5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT STRAIGHT 13MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL CONSTRUCT OXINUM LEGION SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RX1-32-43-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CUFF AORTIC RENU FLEX ZENITH 32MM X 43CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL POST LATERAL LEFT 9 HOLE 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECT 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL SUPERIOR 5-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 4.5 X 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X030MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW 4.5 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 5.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8950JD-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRACTION DISTRACTOR JOINT MINI 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970TT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION ANKLE LATERAL TT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970-09T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAK BB THREADED LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-090922|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 9MM X 9MM X 22MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX STRAIGHT 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541158|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE GEL 245CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541208|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE/GEL 280CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00565040|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COLONIC WALLFLEX 30/25MM DIAMETER 6CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6512|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COLONIC WALLFLEX 27/22MM DIAMETER 12CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00565060|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COLONIC WALLFLEX 30/25MM DIAMETER 12CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,609.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,609.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6510|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT COLONIC WALLFLEX 27/22MM DIAMETER 6CM LENGTH 230CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00556161|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DREAMWIRE F/G .035/STIFF450CM/STR BX/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58510000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LAPIDUS 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777402632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT DARCO 4.0X26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777402832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT DARCO 4.0X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45712000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TOE VO HAMMERTOE IMPLANT 2.0X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45712400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TOE VO HAMMERTOE IMPLANT 2.4X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203159042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.5X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTEROLATERAL DIATAL TIBIA VA-LCP 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,000.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,000.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL2.7MM X 54MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.154|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX LOW PROFILE SELF TAPPING STARDRIVE 3.5 MM X 60M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8929BC-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEEDBRIDGE ACHILLES MID-SUBATANCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ER8075|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVIOR TITAN 75CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90-9916SNC|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET /W PUMP CYLINDER TITAN 16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604636S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|324.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|324.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-05140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROFYLES XS T 90DG NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-12005E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW CROSSPINSELFT 1.2X5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-12006E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW CROSSPINSELFT 1.2X6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-12008E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW CROSSPINSELFT 1.2X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT JOINT PATELLA FEMORAL TROCHLEA RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W025100150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.5MM X 100MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350 975|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD SETROX S 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 371 994|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ENTOVIS SR-TPRO MRI SC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR072502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 25CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL CALOTTE 43MMX16MM LOW COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 7 5MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF601A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PTC STANDARD 127 5 DEGREE X66MM SIZE 1A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.7MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING MINI MAXLOCK EXTREME 2.7MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI MAXLOCK EXTREME 2.7MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MIMI MAXLOCK EXTREME 2.7MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 397003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SUBSTITUTE CEMENT BONE HA INJECTABLE HYDROSET 3CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,799.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,799.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI FULL THREAD 4MMXL44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA MEDIAL DISTAL 4HOLE L97MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8807545A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 7.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8807540A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 7.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOCKING SCREW T10 FULL THREAD 3.5MM/L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION PLATE BROAD CRVD. 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,913.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOCKING SCREW T10 FULL THREAD 3.5MM/ L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T10 FULL THREAD 3.5MM / L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965459630|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PICC TRIPLE LUMEN 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 WORKHORSE 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT PC MEDIUM/SMALL 18.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505650 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CANCELLOUS 4.0X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR TI 1/3 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|168.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|168.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1843-1040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON LEFT RI.5 10X400MMX125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1897-6095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG RECON T2 6.5 X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1897-6100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG RECON T2 6.5 X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL DBM ALLOGRAFT 1CC|1|HUMANA [1294]||HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8692DS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMLANT VIPER|1|HUMANA [1294]||HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MMXL26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44177516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 7.0X75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 87SR0410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRODENSE INJECTABLE 10CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 03-5015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 80/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX STRAIGHT 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,774.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,774.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206030270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 3 X 20 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206030470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 3 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206031210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 3 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206032010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 3 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040810|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-1140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACCOLADE II 127 DEGREE SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206041210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 4 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 6X40X75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X20X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206051210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X120X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 6 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 7 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070810|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 7 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 7 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 7 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206071210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 7 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206062010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 6 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI FT 4.0MM X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE THIRD TI 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL MEDIAL TIBIA 149MM RIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587225RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTP FUSION PLATE MEDIUM 5 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUTOFIX COMPRESSION MOD T7 DR 2.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUTOFIX COMPRESSION MOD T7 DR 2.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR DECREASED 6 HOLE/ LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,037.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206072010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 7 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080810|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 8 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206090410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 9 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206120870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 7FR 12 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080870|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 8 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26566|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET SHEATH LEAD EXTRACTION CURVE 16FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206120410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 7FR 12 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206120210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 7FR 12 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 8 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206100410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 10 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206120470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 7FR 12 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080670|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 8 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206090270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 9 X 20 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206100210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 10 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206080410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 8 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G26505|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LEAD EXTRACTION CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206090470|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 9 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206090210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 6FR 9 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3541508|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE MED HEIGHT 530CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR LATERAL DISTAL 8HOLE/L202MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,407.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,407.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319416A|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY FOLEY URINE METER IC 16FR W/STATLOCK/TEMP SENSOR LATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM1160|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|ENDURITY SR SINGLE CHAMBER PACEMAKER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046760750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 7MM X 60MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046740750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 7MM X 40MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046-82075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 8MM X 20MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046860750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 8MM X 60MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046830750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 8MM X 30MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046102070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 9MM X 60MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804694075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 9MM X 40MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-53075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 5 MM X 30MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938046840750|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 8MM X 40MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804610207|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 10MM X 30MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804610607|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 10MM X 60MM X 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804762013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 6MM X 20MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804763013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 6MM X 30MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804772013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 7MM X 20MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938047820130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 8MM X 20MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938047830130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 8MM X 30MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM RADIAL LATERAL SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD RADIAL SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,511.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,511.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493804792013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 9MM X 30MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-12013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 7FR 10MM X 30MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200064070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR FR 6mm x 40mm x 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200066070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR FR 6mm x 60mm x 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200068070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR FR 6mm x 80mm x 75cm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200076070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 7 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200078070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 7 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200084070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 8 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938047730130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILI EXPR LD 6FR 7MM X 30MM X 135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200088070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 8 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200094070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 9 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200096070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 9 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200098070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 9 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200104070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200106070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200124070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 12 X 40 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200108070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200126070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 12 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 18MM LOW PROFI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 12MM LOW PROFI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SELF TAPPING 4.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|83.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|83.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0112720|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MARLEX 6" X 6" #0112720|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|167.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|167.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1016010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE GOODE T 1 1MM I.D 2MM #1016010|1|HUMANA [1294]||HUMANA [11839]|130.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|130.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939200074020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 7MM x 40MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200078020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 7MM x 80MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200081220|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 8MM x 120MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200104020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10MM x 40MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200106020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10MM X 60MM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200101020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10MM x 100MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200108020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 10MM x 80MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200124020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 12MM x 40MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939200126020|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPIC VASCULAR 6FR 12MM x 60MM x 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 10MM LOW PROFI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1385108QD|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT PICC 5FR TRIPLE LUMEN HF 3CG MAX BARRIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD RADIAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587110RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP SMALL 0 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777404632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO SHORT THREAD 4.0X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8781|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER ASCENDA INTRATHECAL IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,901.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,901.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72006601|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMS 800 (TM) ACCESSORY KIT|1|HUMANA [1294]||HUMANA [11839]|3,410.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,410.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404127|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP CONTROL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,484.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,484.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0826S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL T2 8MM X 260MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404131|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUFF 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,117.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,117.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-00-432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL SOCKET SZ32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX 40MM X 56MM 10 DEGREE +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BP414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE ANGLE 4.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-1018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416607|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 7 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T8 FULL THREAD 2.7MM/L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T8 FULL THREAD 2.7MM/L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL HINGE ROTATING LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T8 FULL THREAD 2.7MM/L20MM NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5490-035-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT FEMORAL DISTAL ANTERIOR OR POSTERIOR SZ E 5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2232-060-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON CABLE NCB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|474.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON PECTORALIS REPAIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203265012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHAFT FEMUR CURVED NCB 12 HOLE 249MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,789.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,789.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03151.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL NCB 5.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 90MM 3.5MM CCM + PCUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF06060MB|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SMART FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133MV-16-T|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE SMOOTH ROUND MODERATE 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL RIGHT 4-HOLE/L99MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE V40 ACCOLADE II SZ #8 37MM NECK 117MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720185-01|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESEVIOR CONCEAL AMS 100ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,923.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,923.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404252|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP LGX MS 700CX AMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,660.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,660.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202814|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN PASSING 3MM SPADE TIP STERILE|1|HUMANA [1294]||HUMANA [11839]|777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43504532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 4.5X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43504538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 4.5X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T46P|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 4.75MM X 6.22MM (FREEZE DRIED)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-1016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS FULL THREAD 4.0MMXL42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MMXL55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCR-05F|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEAD RESORBABLE OSTEOCURE 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXB35-06-37-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 6MM DIAMETER X 37MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629363S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON RIGHT ULNA 3 HOLE L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR DECREASED 10 HOLE/RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI SELF TAP CORTICAL 3.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CANCELLOUS 4.0X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CANCELLOUS 4.0X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA22-90/116-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENTBODY MAIN AFX 22-90/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-55-035S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THREAD SHORT 5.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|745.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|745.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-55-040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THREAD SHORT 5.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|745.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|745.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-70-075L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LONG THREAD 7.0X75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|903.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|903.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXL-002-6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT MAXLOCK EXTREME 6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA 4MM CANCELLOUS RT 6 HOLE/L147MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,902.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,902.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS FULL THREAD 6MM 6.0MM/L75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1688-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRACE INTERNAL LIGAMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341407|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MENTOR LOW HEIGHT MOD PLUS 465C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341457|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MENTOR LOW HEIGHT MOD PLUS 515C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10439236|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOUNDSTAR 8FR ECO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6278744|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 6 X 14 X 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6278644|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 7 X 14 X 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0924S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL T2 9MM X 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10439072|SUP|HCPCS C1759||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOUNDSTAR ECO 10F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3789ANS|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR IP PROTEGE 3.0.1, PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3852ANS|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT PROTEGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD RADIAL LATERAL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,181.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,181.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR LATERAL 4HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SLH-4-PR1|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR PEYRONIE'S SURGISIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,478.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,478.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133MV-12-T|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSZ20350|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST NATRELLE 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5800-LG00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT METACARPOPHANGEAL MCP SR SIZE LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL RIGHT 10-HOLE/L176MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,931.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,931.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA28-120/L16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE UNIBODY BIFURCATED 28MM 120/L 16-40 ILIAC|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9385108QD|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|POWER PICC CATHETER 6FR TL FULL NURSING TRAY W/MAXIMAL BARRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3386355|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERPICC 6FR TL 70CM GUIDE 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58812722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADED 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548315|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE CPX 4 STYLE 8300 650CC TALL HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 831HF75P|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH PA 110CM 7.5FR SG VIP .032IN STD AMC THRMBSH 5 LUM TD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5571-S-3206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 32MMX6MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-3204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP HUMERAL 32MMX4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,374.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,374.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHEAL 4.5MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR081002A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 10CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL 4.5MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL 4.5MMX36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL 4.5MMX24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-C-3206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CONCENTRIC 32MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-6536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER 6.5MMX36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-6540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL STARFIRE 6.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-6555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL STARFIRE 6.5X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-P070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-P060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-5525SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELFDRILLING 5.5X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-332611-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR 33X26X12DEGREE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET10-0001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW STARFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-3204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 32MMX4MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL 4.5MMX28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL 4.5MMX32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-6528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER 6.5MMX28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-C-3202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CONCENTRIC 32MM X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 3.5X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0369|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RIGHT STANDARD LONG VDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL1UT 16.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TRULIGN TORRIC SPHERE 16.0 CYLINDER 1.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BP416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWS SELFDRILLING VARIABLE ANGLE 4.0MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-2034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 2LEVEL 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-382811-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR 38X28X12DEGREE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 4.5 X 26 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 4.5 X 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 4.5 X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-845L-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970TTC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL TTC FUSION ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 4 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33654406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ 4-6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,883.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,883.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33630024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME TALAR INFINITY SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PROXIMAL LEFT 10 HOLE/L176MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,931.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,931.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.118.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL SELF TAPPING STAR RECESS 2.7X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE RECESS 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE RECESS 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STAR DRIVE RECESS 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STAR DRIVE RECESS 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.117.303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS 2.7MM/3.5MM -SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.117.704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7MM/3.5MM MEDIAL -LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,703.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,703.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436.503S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MMTI LCP OLECRANON 2 HOLE LEFT 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,011.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,011.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.876|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.094S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK CLAVICLE 3.5MMLCP6HOLE 15MM/73MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,660.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,660.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507130MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL CLASSIC MODERATE SMOOTH 130CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0WT016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE CONFORM FLEX 16MM X 16MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,362.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,362.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.118.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL SELF TAPPING STAR RECESS 2.7X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629527S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION 7 HOLE/ L90MM WITH 4 LOCKING HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9000240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RIALTO 12X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BNI35DFCT|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|THERMOCOOL SF D-F CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-6532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER 6.5MMX32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 510-00-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MONOBLOCK RSP SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP26000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG 2.5X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG FULL THREAD 2.5X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-P050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-382813-08PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBER IRIX-A 38X28X8DEGREE 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6428-032-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA CERAMIC 12/14 32 X -3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,368.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3341459|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE LOW HEIGHT MOD PLUS 615CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341509|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 680CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505750 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86MX-5X05|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT 5X5CM MAXFORCE|1|HUMANA [1294]||HUMANA [11839]|7,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00532260|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ADVANIX PIGTAIL DOUBLE 10FR 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30150|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6428-032-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA CERAMIC 12/14 32 X 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,519.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AC21D30155|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30170|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30165|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30180|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30175|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30185|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30190|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30195|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30210|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6428-032-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL ALUMINA CERAMIC 12/14 32 X +3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,660.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,660.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AC21D30200|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30205|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30215|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30220|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30225|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30230|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30235|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30240|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30245|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30250|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000105|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB00110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 13.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000140|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 14.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416606|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 6 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-2036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 2LEVEL 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-34-137-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-28-106-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM DISTAL BIFURCATED MAIN BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000255|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000260|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000265|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 26.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB00280|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 28.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000290|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000285|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000295|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCB0000300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 1 PRELOAD DIOPTER 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030105|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 13.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030140|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 14.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030255|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030260|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030265|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 26.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030290|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030280|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 28.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030285|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030295|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC21D30160|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS ANTERIOR CHAMBER DURALENS II IOL DIOPTER 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-3604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP HUMERAL 36MMX4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-3604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 36MMX4MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-C-3602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CONCENTRIC 36MM X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416605|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 5 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA25-70/120-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED 25-70/120-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032402010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 4 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032408010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032502010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032702010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032608010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032701010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 7 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032802010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032701210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 7 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032902010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 9 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032401010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 4 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032404010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS MONOFOCAL TECNIS 3-PIECE DIOPTER 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BP418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE ANGLE SELF DRILLING 4.0MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5X44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI FULL THREAD 4MMXL46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL MEDIAL TIBIA LEFT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2268|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT REPAIR PECTORALIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186201010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 2 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939134254010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 2.5 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939134304010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 3 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186251010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 2.5 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186308010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 3 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186301010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 3 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186301210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COYOTE .014 3 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032601010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON STERLING 6 X 100 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806535A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 6.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8896535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PRECEPT 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,919.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,919.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6708920|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK IMPACTED LARGE 8 X 9 X 20 4 DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720074-03|SUP|HCPCS C2622||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PENILE SPECTRA TM AMS 12MM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,306.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,306.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL RIGHT 8-HOLE/L151MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,931.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,931.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113633|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRIMARY 13MM MICRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,596.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,596.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL VERSA -DIAL 46X24X47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,508.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HTM0400408M|SUP|HCPCS Q4126||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MEMODERM 4X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,011.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,011.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9P15-PB02-A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC TOE MTN THK3.6MM 2 2.5MM OFST MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952TT-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|T-PLATE LOW PROFILE 3.0MM 3 HOLE TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-3054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 54MM 3LEVEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 5FR 5 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40E-5.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER SENSAR IOL WITH OPTIC EDGE ACR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6711126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE IMPACTED LARGE 11 X 11 X 26MM 4 DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WD-10.24.12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PLIF WAVE 10MM X 24 MM 4 DEG|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE MILAGRO 5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,422.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,422.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8007-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMP DBL 3 HOLE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6440530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET VOYAGER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850016545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.5MMX45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 427107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7 HOLE LOCKING COMPRESSION NARROW L133MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|621.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCUFIL 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H965402120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT 12 X 60 X 75 ENDOPROSTHESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965403130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT 14 X 90 X 75 ENDOPROSTHESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,633.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,633.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012589|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI TORQUE .018 300CM 5/PK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0202263302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL TROC LEFT WIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,887.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,887.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4210564|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PREVAIL 5 X 16 X 14MM|1|HUMANA [1294]||HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03263.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL PROXIMAL 12-HOLE LEFT LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,915.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00236901235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING IT 3.5 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00236901435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING IT 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625-0T-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT ALUMINA 0-DEGREE 36MM SIZE H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493501801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203151018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL NCB 5.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR071502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 7MM X 15CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 04.0MM / L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 180403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLOFEMORAL MCK RESTORIS SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180320-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLA MCK RESTORIS SZ 35 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 6-8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ONLAY MCK RESTORIS SZ 6 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NX-4532K-SC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT HAMMERTOE 4.5MM MIDDLE PHALANX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5018-5-250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN APEX 5X250 50 THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR GRYPHON BR WITH PROKNOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL 3 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201024012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK 2.4 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201000306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT MET LESS 6- HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201124012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCK 2.4 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR081502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 15CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 002685|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CONDYLE HEMI FEMORAL MEDIAL RIGHT 70 X 26|1|HUMANA [1294]||HUMANA [11839]|32,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERERENCE MILAGRO 6X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,329.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,329.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.160|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201120012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCK 2.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.175|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.180|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.185|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.190|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.205|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.210|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.215|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.220|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.245|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.250|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8916VNR-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS TI NARROW RIGHT 3HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.5MM X 10MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8916VSR-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR DISTAL RADIUS TI STD. RIGHT 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM9026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAGNUM 2 PLUSWHITE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL LEFT 4-HOLE/L99MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,127.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,127.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 20MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FPSST|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PRESUTURED ANKLE TENDON|1|HUMANA [1294]||HUMANA [11839]|3,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MT-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE T 2.4MM 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 784702400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR KINECTIV 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG R 1.5 TITANIUM RT. 13X420MMX125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8918CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT DELTOID LIGAMENT RECONSTRUCTION IMPLANT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71-137|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT 10 X 68 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345741|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE L-ASR FEE 7 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 628527S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 7 HOLE/16MM/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 14HOLE L 227MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1002612|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS ANGULAR 0.2 X 3.25 X 0.5MM TI|1|HUMANA [1294]||HUMANA [11839]|1,344.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,344.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1002 610|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS ANGULAR 0.2 X 2.25 X 0.5MM TI|1|HUMANA [1294]||HUMANA [11839]|1,311.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,311.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1004 930|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR OMEGA 1.5 X 0.8 X 0.5MM (FL=0.5MM)|1|HUMANA [1294]||HUMANA [11839]|645.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 443002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE PATELLAR PRESHAPED 10/10MM|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14000901|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BILIARY ABCESSION DRAINAGE 8F X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5101-90039|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET EVEREST MI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5111-06545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MI EVEREST 6.5 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3303-21028M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT INTERBODY ALEUTIAN LORDOTIC II TLIF LUMBAR TRANSFORA|1|HUMANA [1294]||HUMANA [11839]|12,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3303-21128M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT INTERBODY ALEUTIAN LORDOTIC II TLIF LUMBAR TRANSFORA|1|HUMANA [1294]||HUMANA [11839]|12,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101-65555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CONTOUR 5.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,455.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,455.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7755279|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OC ADJUSTABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,170.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,170.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 5.0 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 5.0 X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7755275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CURVED VERTEX 3.5 X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,142.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,142.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NS0-2011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP OFF 2.0X11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NS0-2013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP OFF 2.0X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED 3.0X28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED 3.0X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCS-002-NBP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE POCKET NEUTRAL BETA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-40P-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 4.0 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|514.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0010105|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SRG 5.5X4.3IN GROIN 2 LYR MFL MEM RECL RING SLF XPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|861.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BA25-110/116-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED 25 X 110/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505650 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2040-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 231822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ADVANCE MILAGRO 9MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-332613-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR INTEGRATED FUSION SYTEM 33X26X12DEGREE 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MT-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METATARSAL LOW PROFILE T 2.4MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75FHXL60|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TRACHESTOMY SILICONE 6.0MM BIVONA|1|HUMANA [1294]||HUMANA [11839]|301.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|301.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02-2100-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE ORTHOBLAST 3CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,498.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,498.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1923BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURE ANCHOR BIOCOMP-SITE PUSHLOCK 2.9X15.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0719S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL T2 7MM X 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505800 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588TB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE BUTTON ABS 8 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75FHXL70|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TRACHESTOMY SILICONE 7.0MM BIVONA|1|HUMANA [1294]||HUMANA [11839]|330.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|330.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZIV6-35-125-8-80-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING .035 8FR 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R7F282CT|SUP|HCPCS C1732||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DECA NAV F CURVE 2-8-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107100015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FLUSH 6F/65CM .035" 10/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 605026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TISELF TAP CORTICAL 2.7X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14016B|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 1.6MM WITH BALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-4T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T MINI MAXLOCK EXTREME FLAT 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING MINI MAXLOCK EXTREME 2.7X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75FHXL80|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE TRACHESTOMY SILICONE 8.0MM BIVONA|1|HUMANA [1294]||HUMANA [11839]|301.53|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|301.53|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MXM-011-27-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING MINI MAXLOCK EXTREME 2.7X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.7MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VAR-031-24-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI VARIABLE 2.4MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-6530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEDICLE STARFIRE POLYAXIAL 6.5X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-6535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEDICALE STARFIRE POLYAXIAL 6.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-6025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RESCUE 6.0X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-P040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8896550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PRECEPT 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6709920|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE IMPACTED LARGE 9 X 9 X 20MMX 4DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6710126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE IMPACTED LARGE 10 X 11 X 26MM 4DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 28MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933L-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.0MM X 38MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10412|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT PC SM|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1552-50-526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER REPLACEMENT TRI-LOCK AML PROFILE STANDARD 32X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,231.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,231.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2228611|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRES 100 X 1.1MM|1|HUMANA [1294]||HUMANA [11839]|91.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|91.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2807003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TARSALIS 3 HOLE STRAIGHT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,121.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TARSALIS 4 HOLE SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,121.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,121.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2822012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE 2.2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|736.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|736.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2822110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE LAG 2.2MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2822114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE LAG 2.2MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2822112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLATE LAG 2.2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58803518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58803522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130440|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 4MM X 40MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130460|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 4MM X 60MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130480|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 4MM X 80MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351304100|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 4MM X 100MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130560|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 5MM X 60MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130540|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 5MM X 40MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX35130580|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 5MM X 80MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305100|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 5MM X 100MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSCLX35130680|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 6MM X 80MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL DBM ALLOGRAFT 10CC|1|HUMANA [1294]||HUMANA [11839]|4,893.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,893.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TISELF TAP CORTICAL 3.5X36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-P080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-8535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEDICLE STAR FIRE POLYAXIAL 8.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING HEXALOBE 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0268|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5 X 34MM NON LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0349|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING HEXALOBE 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3012-15018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG HEXALOBE 1.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON STANDARD 7-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SCREW CORTICLE 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3012-15020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG HEXALOBE 1.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-24-94-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY FENESTRATED PROXIMAL CUSTOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0362|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NEUTRAL TOTAL WRIST FUSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935L-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.5MM X 46MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3004-23012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI HEXALOBE 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3004-23016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI HEXALOBE 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787055017022|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE ROSEN 1.5FC 180-035 PG 10/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8825P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURE ANCHOR PEEK MINI PUSHLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP TI 3.5X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 605028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP TI 2.7X28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI FULL THREAD 4.0MM/ L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A3SR01|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ADVISA SR MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,119.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,119.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505430 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 430CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505455 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 455CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFS-1816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT KIT FUSEFORCE 18MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 50MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5820|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHER VENTURE RAPID EXCHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 840-259|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH POLYFORM 15 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,465.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,465.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-2YB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Y-PLATE BETA MINI MAXLOCK EXTREME 2HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-24-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING MINI MAXLOCK EXTREME 2.4MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-24-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI MAXEXTREME 2.4MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-24-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING MINI MAX EXTREME 2.4MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0823S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL T2 8MM X 230MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM X 16MM TI LOCKING SLF-TPNG WITH T8 STARDRIVE REC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.878|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.372|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7MM TI LCP(TM) 8 HOLES/76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM X 18MM TI LOCKING SLF-TPNG WITH T8 STARDRIVE REC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.374|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7MM TI LCP (TM) 10 HOLES/94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA22-70/116-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENTBODY MAIN AFX 22-70/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-018S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT THREAD 4.0X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MCS-002-4AP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ALPHA MEDIALMAX 4 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,189.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 730034ADP|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALSALVA TECHNIQUE SPARING VALVE GEL WEAVE 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-7545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL STARFIRE 7.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-7540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL STARFIRE 7.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EOTS-SM1806|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOTOMY TRUSS 18X18MM 14DEGREE 6.5HEIGHT|1|HUMANA [1294]||HUMANA [11839]|7,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MED.DISTAL VA-LCP 2.7MM/3.5MM 1HOLE/RIGHT/69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA LOCK 2.7MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|449.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|449.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 3.5MMX32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING HEXALOBE 2.7MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04004013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 4 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05012013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 5 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04006013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 4 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04012013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 4 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05004013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 5 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05006013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 5 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05008013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 5 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06004013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 6 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04008013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 4 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06006013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 6 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06008013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 6 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM07004013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 7 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06012013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 6 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM07008013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 7 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM07006013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 7 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LDA210Q-65|SUP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD OPTISURE DEFIBRILLATION 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,081.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5603150|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWER TL 15CM ST ACUTE DIAL KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5603200|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWER TL 20CM ST ACUTE DIAL KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5603240|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWER TL 24CM ST ACUTE DIAL KIT 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5603300|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWER TL 30CM ST ACUTE DIAL KIT 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBM PLUS ALLOGRAFT 10CC|1|HUMANA [1294]||HUMANA [11839]|6,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MM X L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 705234|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE UNTHREADED GUIDE 2.0 X 150MM ASNIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 1.3 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-20-316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 1.3 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3086|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD OCTRODE TRIAL KIT 60CM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 219466|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PIN TRACKER SYSTEM 2MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 219465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PIN TRACKER SYSTEM 2MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24-0059|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE RICHARDS T SILICONE SOFT 24-0059|1|HUMANA [1294]||HUMANA [11839]|58.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|58.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PXB35-07-37-135|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VISI-PRO 7MM DIAMETER X 37MM LENGTH X 135MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IQ35F80J1O5RS|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ROSEN INQUIRE .35 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLY-COM 5X5|SUP|HCPCS Q4195||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY 5X5 (25 SQ CM)|1|HUMANA [1294]||HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLY-COM 2X4|SUP|HCPCS Q4195||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY 2X4 (8 SQ CM)|1|HUMANA [1294]||HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLY-COM 6X9|SUP|HCPCS Q4195||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY 6X9 (54 SQ CM)|1|HUMANA [1294]||HUMANA [11839]|16,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLYAM-COM 5X5|SUP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY AM 5X5 (25 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLYAM-COM 6X9|SUP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY AM 6X9 (54 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLYAM-COM 2X4|SUP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY AM 2X4 (8 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLYAM-COM 2X2|SUP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY AM 2X2 (4 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3201-081130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK OPTIMA ARDIS 8MM X 11MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2317-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 16 CX INFINION 70CCM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416608|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 8 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-2019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RECON RHEAD PLASMA COATED SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,221.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,221.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410-0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAPITELLUM LARGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,410.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,410.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ONLAY MCK RESTORIS SZ 2 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 2-8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRRT06040050L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORETEX RING SRRTO6040050L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,823.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,823.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54850016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.5MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 4.75 X 35 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062251240|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON URO MAX (FOR ENDOPYELOTOMY)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRRT08040050L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORETEX SRRT08040050L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,823.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,823.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 410-0008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RECON CAPITELLUM SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIBIAL INFINITY SZ 3 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,803.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,803.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33630022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME TALAR INFINITY SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33653206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ 2+-6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-3058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON THREE-LEVEL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.157S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 360MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR DECREASED 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.290S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 90 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8007-25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMP DBL 3 HOLE 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VWML|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH WOVEN VICRYL 30 X 30 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,955.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,955.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FWPL|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LIGAMENT PATELLAR WHOLE 20MM|1|HUMANA [1294]||HUMANA [11839]|11,609.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,609.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203263115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL PROXIMAL 15-HOLE LEFT LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03150.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203151016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW UNICORTICAL NCB 5.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE CERCLAGE W/CRIMP 1.8 36IN CABLE-READY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,206.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,206.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43504544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 4.5 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 10MM 5MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT BEARING TIBIAL CONSTRAINED DCM MAX 22 X79/83|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZMB00U0235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ASPHERIC MULTIFOCAL 23.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-ASD-010|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER SEPTAL AMPLATZER 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL HINGE ROTATING RIGHT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588040017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING SIZE D 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS TIBIA HINGE ROTATING SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL SIZE 3 10 MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,107.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,107.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FATB|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON ACHILLES FLEXIGRAFT WITH BONE|1|HUMANA [1294]||HUMANA [11839]|5,410.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627214S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL 14 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 10MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3771ANS|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR IP MRI PR PROTEGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3853ANS|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT PROTEGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43503738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 3.7 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT150220|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 TECNIS TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 12MM 5MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PROXIAL LATERAL 3 HOLE L86MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,532.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,532.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55203|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION LEG ILIAC 24MM X 55CM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.107.102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VA-LCP PROXIMAL OLECRANON 2.7/3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE RECESS 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.107.304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI VA-LCP OLECRANON 2.7/3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,267.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 12MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|408.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201000204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T MET LESS 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201020014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK TI 2.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201120014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCK TI 2.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0112680|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MARLEX 3" X 6" #0112680|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|115.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|115.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114701240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 12MM 5MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3303-20932W|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT INTERBODY ALEUTIAN LORD II TLIF LUM TRANS 12X32X9|1|HUMANA [1294]||HUMANA [11839]|12,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2901-10001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET SCREW PEDICLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101-65540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CONTOUR 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5111-06540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MI EVEREST 6.5 X 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 14MM 5MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101-6550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-CONTOUR 5.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|633.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|633.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NCS-3024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANNULATED NEXFIX 3.0X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ONLAY MCK RESTORIS SZ 6 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF603B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ASCEND FLEX STANDARD 3B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL FLEX 51X17X4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,848.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,848.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1321-20-513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 1.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 14MM 7MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83173-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 5MM X 40MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.044S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 130 DEG 235MM RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 5-15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.295S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7713-006-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR CEMENTLESS KINECTIV/ML TAPER SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 14MM 5.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40M-5.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR MINUS 5.0 DIOPTER SENSAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-T440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFB-26-74|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 26MM X 74MM ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R5350-4021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REUNION HUMERAL HEAD 40MMX21 THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,837.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,837.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported R5351-4509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REUNION HA FRACTURE STEM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI SELF TAP CORTICAL 3.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 14MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54840006560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.5 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CK000540|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERPICC 4FR SL 70CM GUIDE 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CK000541|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERPICC 5FR DL 70CM GUIDE 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 14MM 5.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CK000542|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER POWERPICC 5FR TL HF 70CM GUIDE 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL HUMERUS RIGHT 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64956060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIECE EXTENSION GMRS 60 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.704.005S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INJECTION DRILLABLE NORIAN 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 15MM 5MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-66625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST 6 X 6 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 15MM 7.4MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-40030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 4.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-30224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 3.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-46618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST 4.6MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000105|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 16MM 5.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000140|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 16MM 5.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCB4508BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ANGIOPLASTY DUAL 4.5 X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCB3008BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLASH ANGIOPLASTY 3.0MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCB4008BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLASH ANGIOPLASTY 4.0MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OCB3508BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLASH ANGIOPLASTY 3.5MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 16MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000290|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000295|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000285|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MAKO RESTORIS 5-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 16MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE PLATE TIBIAL ONLAY MCK RESTORIS SZ 5 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 22MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 26MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 17MM 5.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5605150|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY POWER TRIALYSIS STRAIGHT 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB00275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER TECNIS SINGLE FOCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5605240|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY POWER TRIALYSIS STRAIGHT 13 FR 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DS2C023|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACEMAKER CPS DIRECT UNIVERSAL FINAL PACK 47CM RS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5605200|SUP|HCPCS C1752||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY POWER TRIALYSIS STRAIGHT 13 FR 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-2000S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL PRECURVED 2.0X300MM FLEXIBLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-24-62-91-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY MAIN CUSTOM BIFURCATED DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701731|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 17MM 8.5MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-5535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POYAXIAL STARFIRE 5.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL SCREW 4.5MMX48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3309-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR TRANS MEDIUM|1|HUMANA [1294]||HUMANA [11839]|4,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-5540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POYAXIAL STARFIRE 5.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL DISTAL 2HOLE/L72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 18MM 6MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3512160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD NXT PATHFINDER 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,284.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,284.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CMNT 48MM STG1 HIP SIL SPCR STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,818.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,818.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.144S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 235MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OAB6012BA|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FLASH OSTIAL 6.0 MM X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701831|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 18MM 8.9MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.285S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCN-H2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD RADIAL BIPOLAR #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,714.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,714.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3355|SUP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CERVICAL MOBI-C STANDARD 13X15X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 4.0 MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 18MM 5.9MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MM VA-LCP PROX-TIBIAL SMALL BEND 4H/87MM/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,823.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,823.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 463002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE PATELLAR PRE-SHAPED 10/10MM|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-3048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 3-LEVEL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BL412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL 4.5MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION VARIAX NARROW, STRAIGHT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 18MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0937S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 9MM X 375MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 44MM LOW PROFI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 4.0 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 132-34015-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE I 3,4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-32-109-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY FENESTRATED PROXIMAL CUSTOM 32X109MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 18MM 5.9MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD1357-40C|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR FORTIFY ASSURA VR ICD U PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00483506001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL ZPS 3.5MM X 60MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFFB-32-125-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 32MM X 125CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629548S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD,,STRAIGHT 8 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 18MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406854|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SR1 8.5 FR SWARTZ 63CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR 104 MODEL DUO DEMIPULSE 10CC, DUAL PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|65,316.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|65,316.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784804301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK MOD KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4197040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 7 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4199040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 9 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 19MM 6.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4198040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO 8MM X4CM X80 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4190020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 10 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4190040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 10 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4194060L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 4 X 60 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195040L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 5 X 40 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195080L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 5 X 80 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195000L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 5 X 100 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4196080L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .0356 X 80 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4196000L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 6 X 100 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003508X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 3.5 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114701931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 19MM 9.4MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003020X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 3.0 X 200 X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48005030S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 5.0 X 30 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48005030X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 5.0 X 30 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4193080X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 3 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48006008X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER 6.0 X 80X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 5 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4195040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 5 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4196040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 6 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4196020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 6 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4197020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 7 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 20MM 6.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-40H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION STANDARD 4.0MM X 40MM HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4198020S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 8 X 20 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1307-60-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAGLENE CEMENTLESS XTEND DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4192040S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 12 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4197000L|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OPTA PRO .035 7 X 100 X 110|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1307-20-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPIPHYSIS CENTERED MODULAR CEMENTLESS XTEND DELTA SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,434.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,434.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003006X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER PTA .018 3.0 X 60 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48003010X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER PTA .018 3.0 X 100 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1307-38-203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP HUMERAL STANDARD XTEND DELTA 38MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,344.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,344.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 20MM 10MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130770018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING METAGLENE 4.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48006010X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER PTA .018 6.0 X 100 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1307-60-138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE STANDARD XTEND DELTA 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,098.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130790036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING XTEND DELTA 4.5 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|911.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1307-90-024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING XTEND DELTA 4.5 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|911.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON DOG BONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RS0616MFS2|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM SINUPLASTY BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 20MM 6.6MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85910P|SUP|HCPCS C1753||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL IVUS: Visions® PV .014P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT225240|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 TECNIS TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4-31.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +31 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP110RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA HP 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 1.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 20MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FULL THREAD 2.7 MM X L22 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601670S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI ASNIS III CANNULATED 5X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-36-720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL DELTA CERAMIC TS 12/14 36MM +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,984.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,984.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48421|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 28MM X 140CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 20MM 6.6MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADED 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMOPONENT PATELLOFEMORAL MCK RESTORIS SZ3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED HERITAGE VERSYS 15MM X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 20MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3189|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD OCTRODE 90CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,682.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,682.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3186ANS|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD OCTRODE 60CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-5430|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE 430CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3545455|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE 455CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3545480|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE 480CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3545535|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE 535CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0167SI22|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER FOLEY IRRIGATION IC 22FR 30CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3341152|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEDIUM HEIGHT HIGH PROFILE 345CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341202|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEDIUM HEIGHT HIGH PROFILE 390CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 21MM 7MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 3.5MM X 90MM 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,022.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,022.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA28-110/120-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE UNIBODY BIFURCATED 28MM 110/L 20-30 ILIAC|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ET30-7535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL STARFIRE 7.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB121230S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR L-P SPACER 30MM X 12MM X 12DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT225200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 TECNIS TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.105|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.100|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.110|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-11.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 21MM 10.4MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-12.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.120|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.130|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.140|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-13.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-14.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LINQSYS|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REVEAL LINQ PRODUCT SYSTEM DEVICE AND MONITOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287841|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END CORNERSTONE PSR 8 X 14 X 11|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6710120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE IMPACTED LARGE 10 X 11 X 20MM 4DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187823111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CONCORD 9X11X23|1|HUMANA [1294]||HUMANA [11839]|14,796.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,796.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 22MM 7.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-2318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE ANGLE 2.3MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-2320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE ANGLE 2.3MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7209012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HA BIORCI 8 X 20 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|771.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|771.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.150|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.160|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.165|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.175|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.170|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.180|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.190|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 22MM 10.9MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.185|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.195|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.200|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.205|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.210|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.215|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.225|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.220|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.230|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.240|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 22MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.235|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.250|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.245|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.255|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.260|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.270|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-26.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5U0.280|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-27.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-28.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 22MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-29.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-29.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA5UO-30.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ANTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/MN/W|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA WHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/MN/S|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA PRE-CUT ENDOTHELIAL KERATOPLASTY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 23MM 7.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9740-48H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD HEADLESS COMP FT 4.0 X 48M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-1040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP ANGLE NECK 132 DEGREE ACCOLADE II SZ #10 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1390C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-COM INT TAPER TIP 9 X 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103-0303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RIM STANDARD R HEAD LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702331|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 23MM 11.5MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 171-2714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL (MOD T7 DRIVE)2.7MMX4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 171-2716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL (MOD T7 DRIVE)2.7MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 171-2720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL (MOD T7 DRIVE)2.7MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|258.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|258.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173-2718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SS 2.7X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587338RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION REVISION RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,131.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,131.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2658|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE DISTAL BUTTON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626762S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LONG TN (TALO-NAVICULAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,553.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,553.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 24MM 8MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB121430S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER INTERPLATE PEEK 30MMX14MMX12DEGREE|1|HUMANA [1294]||HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T8 FULL THREAD 2.7MM/L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2656DL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE DISTAL SHORT LEFT SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 24MM 11.9MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4-31.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +31.5 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BRISTOW-LATARJET TOP HAT 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE CELLULAR EVOLUTION TRINITY LARGE|1|HUMANA [1294]||HUMANA [11839]|17,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.7MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-011-27-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCKING MINI MAXLOCK EXTREME 2.7MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 24MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-4YB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Y-PLATE BETA MINI MAXLOCK EXTREME 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR XLPE CR JOURNEY II SIZE5-6 9MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL OXINIUM JOURNEY II CR SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NON POROUS JOURNEY SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626677S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 7 HOLE L83MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505480 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 480CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20645-370MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SILICONE TEXTURED OVAL BASE MODERATE 370CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 24MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 25MM 8.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION VAL INTERCARPAL 2.4MM 6 HOLE/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,903.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,903.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222343|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HEALIX BR 3.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203986|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT FIX FAST TFCC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,736.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,736.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 25MM 12.4MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777404222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED LONG 4.0MM X 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777455022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED LONG 4.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777456022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED LONG 4.5MM X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627618S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LATERAL LEFT 18HOLE/L379MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIPROSTHETIC 5.0MM/L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIPROSTHETIC 5.0MML16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIPROSTHETIC 5.0MM/L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT4-32.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +32 DIOP +2.25 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 26MM 8.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AM20-4X04|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEMBRANE CARRIER AMNIOTIC 4CMX4CM|1|HUMANA [1294]||HUMANA [11839]|7,656.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,656.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 26MM 13MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 56MM HIP SPCR MLD SS SIL STG1 SLCT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,818.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,818.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341159|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEDIUM HEIGHT HIGH PROFILE 305CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DDMB1D4|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE EVERA MRI XT DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DDMC3D4|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE EVERA MRI S DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|40,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DVMB1D4|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE EVERA MRI XT VR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 26MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2504-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE TENDON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 26MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8847025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI PRECEPT PREBENT LORDOTIC 25MM|1|HUMANA [1294]||HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUTOFIX COMPRESSION MOD T7 DR 2.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB081235S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACERS PEEK INTERPLATE 35MMX12MMX8DEGREE|1|HUMANA [1294]||HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSB081435S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER PEEK INTERPLATE 35MMX14MMX8DEGREE|1|HUMANA [1294]||HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2T46-P090|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 6.0X90MM|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 27MM 9MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG-5050F|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AMNIO 5.0 X 5.0CM|1|HUMANA [1294]||HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4565|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAGEN SCAFFOLD RECONSTITUTED ARTHROSCOPIC MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.630S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI F/IM NAIL 6.0MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AMAF-0010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE PLACENTAL 1.0CC VIAFLOW|1|HUMANA [1294]||HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.948S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL CANN RETRO 15MMX340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1026145|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE VENTILATION SHEEHY 1.2MM|1|HUMANA [1294]||HUMANA [11839]|46.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 15.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 15.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702731|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 27MM 13.4MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 16.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 16.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 16.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 16.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 17.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 17.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-17.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-18.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 18.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-19.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 19.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-19.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-20.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 20.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 28MM 9.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-21.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-22.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 22.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 23.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 23.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-23.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 23.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-24.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 24.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 24.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 24.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 25.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-25.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 25.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 26.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 26.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702831|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 28MM 13.9MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 26.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 26.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 27.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 27.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 27.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 27.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 28.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 28.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 29.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-29.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 29.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-30.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80-1060|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDESHEATH SLENDER 6FR 3/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 28MM 9.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626680S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 10 HOLE/L119MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIN III 5X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-1035S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROXIMAL HUMERUS NAIL CANNULATED LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,182.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,182.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA30AC.300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 ACRYSOF 12.5MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-27.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 21.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 28MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-28.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 28.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404251|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PENILE PUMP MS PRECONNECT PENOSCROTAL 700 AMS 15C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,660.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,660.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHEAL 4.5MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629546S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD STRAIGHT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-C-3606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CONCENTRIC 36MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-6524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER 6.5MMX24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-004-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR BEARING FIXED UC PERSONA LEFT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 28MM 9.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626679S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 9 HOLE 1/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0343|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 2.7MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70006-1170N-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACU-LOC WRIST SPANNING PLATE,SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,045.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,045.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 2.7MMX10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING HEXALOBE 2.7MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604634S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 29MM 9.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.305S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.158S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 380MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.261S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 12MM/130 DEG 400MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.105S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TFNA 105 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.258S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 12MM/130 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629547S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION VARIAX 7HOLE/L91MM W/2LOCKING HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 29MM 14.5MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42500807401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMUR PERSONA PS POROUS STANDARD SIZE 12 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED HERITAGE VERSYS 14MM X 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X060-3614P|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE AXLE FUSION SYSTEM PEEK INSERT 36MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB3555|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CERVICAL DISC PROSTHESIS MOBI-C 15X15 H5|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341309|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE TALL MODERATE PLUS 445CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.156S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 360MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T50106|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTON DBF 6CC|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 30MM 10MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX 2.4MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724L-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 2.4MM X 28MM CORTEX LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MS-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE STRAIGHT 2.4MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628517S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 7 HOLE/ 12MM /RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9600CM23A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT VALVE HEART TF SAPIEN 3 EDWARDS 23MM|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 30MM 15MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9600CM29A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT VALVE HEART TF SAPIEN 3 EDWARDS 29MM|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9600CM26A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT VALVE HEART TF SAPIEN 3 EDWARDS 26MM|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8213-0000-16|SUP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND OASIS ULTRA TRI-LAYER 3CM X 3.5CM MESHED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|481.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|481.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 5MM LOCKING 5.0MM/L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 30MM 10MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCN-S3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM BIPOLAR #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MT-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|T-PLATE LOW PROFILE 2.4MM 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL DISTAL RIGHT 2HOLE/L72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 30MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-12-630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EXPEDIUM 6X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 30MM 10MM BIODUR 108 FLUT RVRS CUT SPNE CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 5X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 5X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 5X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4349-025-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE REVERSE 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,580.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,580.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5397150|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER GLIDE PATH DIALYSIS 15CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 30MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43503748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 3.7 X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43504542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 4.5 X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43504550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LISFRANC 4.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.142S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-7857-015-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED HERITAGE VERSYS 15X140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5397190|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER GLIDE PATH DIALYSIS 19CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 32MM 10.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5397230|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER GLIDE PATH DIALYSIS 23CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5397270|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER GLIDE PATH DIALYSIS 27CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6711926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LI 11X9X26 MM 4 DEGREE|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43500045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER LISFRANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13120T-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE 2.3MM X 24MM CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 32MM 16MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5572-4544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL 4.5MMX44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-32-204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT GLND 30MM RSP SHLDR P2 STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-40-101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW RETAINING GLENOID HEAD 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-01-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL SOCKET 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 510-08-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER W/RETAINING SCREW 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TP1000|SUP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SURGICAL PLACEMENT PROSTHESIS VOICE BLOM-SINGER 16FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|690.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|690.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIN III 5X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0925S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL T2 9MM X 250MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMOPONENT PATELLOFEMORAL MCK RESTORIS SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 32MM 10.6MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU404015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 40 MM X 15 CM|1|HUMANA [1294]||HUMANA [11839]|47,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU454515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 45 MM X 15 CM|1|HUMANA [1294]||HUMANA [11839]|49,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 014206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CNFLX 1.0 6 X 20 STER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX 2.4 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX 2.4 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE CORTEX 2.4 X 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 32MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE PLATE TIBIAL ONLAY MCK RESTORIS SZ 4 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 4-8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G28438|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCTER SET PERFORMER 14FR 4.6 X 30 .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G28433|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCTER SET PERFORMER 12 FR 4.6 X 30 .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 32MM 10.6MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT500000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HUNTER PASSIVE TENDON|1|HUMANA [1294]||HUMANA [11839]|5,364.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,364.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LT10-4012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL 4.0X12PEDICLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LT10-4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL 4.0X14 PEDICLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LT10-4016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCRW POLYAXIAL 4.0X16 PEDICLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LT40-S080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT TI 3.5X80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LT40-S120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT TI 3.5X120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LT10-0001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP10-1214608|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER STEALTH 12X14X8 6DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-1022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICALFALCON22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 THREAD PARTIAL 2.7MM/26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 32MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BL416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-TAPPING VARIABLE ANGLE4.5X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ONLAY MCK RESTORIS SZ 5 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 736527|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS CORTICAL ASSEMBLED 7X15X9 4MM 6DEG|1|HUMANA [1294]||HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7731508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MINI DIVERGENCE 18.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,306.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406188|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER HEMOSTATIC 14 FR X 30 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7733513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA 3.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.256S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 12MM/130 DEG 360MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 34MM 11.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TFNA 95 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TFNA 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-C-2009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL CEMENTED REUNION 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-6544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER 6.5MMX44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0A-19|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMART TOE 19MM ANGLED|1|HUMANA [1294]||HUMANA [11839]|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0A-15P|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMART TOE II 15MM ANGLED|1|HUMANA [1294]||HUMANA [11839]|2,507.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,507.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 34MM 16.9MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-3208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 32MMX8MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0A-16P|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMART TOE II 16MM ANGLED|1|HUMANA [1294]||HUMANA [11839]|2,507.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,507.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP130RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA HP 475CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.062S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 130 DEG 420MM RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.154S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 340MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3556|SUP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC CERVICAL MOBI-C 15X15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0093|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FORTEX 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 34MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N600001068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINOUS 5.5MM 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-6540SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0042|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP FORTEX|1|HUMANA [1294]||HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TFNA 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 125 DEG 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9600CM20A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT VALVE HEART TF SAPIEN 3 EDWARDS 20MM|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5030-3-200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN THREAD 35MM LENGHT200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|427.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0320|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0220|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 2MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 34MM 11.3MM BIODUR 108 1/3 THRD HEX RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068318261|SUP|HCPCS C2631||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE CAPTURING SUTURE SLIM CAPIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,246.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,246.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TVTOML|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CONTINENCE EXACT TVT GYNECARE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TVTRL|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CONTINENCE GYNECARE EXACT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,508.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,508.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-6545SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-7535SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 7.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 36MM 12MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001093|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINUOUS 5.5MMX45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-7540SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700341003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SELECT TRINICA 2L LEVEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FORTEX 8.25 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-5530SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELFDRILLING 5.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL FIXED BEARING UC RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W020080150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NANOCROSS 2.0 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AMP020150152|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON AMPHIRION PTA 2.0 L150 S=150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 36MM 18MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRM-375|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH MODERATE 375 CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION TI 10HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201120010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCK TI 2.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621463|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|T-PLATE TI OBLIQUE 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48-0700404|SUP|HCPCS Q4126||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMASPAN .5MM - 9MM 4X4 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 36MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-4318|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR X CLIK|1|HUMANA [1294]||HUMANA [11839]|843.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL1UT 22.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|TRULIGN TORIC LENS BL1UT 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 36MM 11.9MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1380C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-COM INT TAPER TIP 8X23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628536S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 6HOLE 16MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001069|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINUOUS 5.5MMX60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777271232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 2.7 X 12 SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 36MM BIODUR 108 .5 THRD HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777271432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 2.7 X 14 SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777271602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 2.7 X 16 FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777351602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 16 FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP10341|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP V1 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 38MM 12.7MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING T8 3.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|386.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING T8 3.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|384.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8, 3.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48-1805|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE MATRIX 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703831|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 38MM 18.9MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR060502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 6MM X 5.0CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,311.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,311.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8, 3.0X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1349M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1365-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST BI-CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5018-7-250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN DIA 5MM X 250MM SD/ST 70 THR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5099-025-25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEX 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 38MM 12.6MM BIODUR 108 P/T HEX RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 100 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.159S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 380MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP140RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA TE 600CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PBD-1031-1009|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY EVA SINGLE USE 10 FR X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|152.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|152.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4MM/L30/FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4MM/L32/FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4MM/L55/FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA MEDICAL DISTAL LEFT 12-HOLE/L201MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,535.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,535.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 38MM BIODUR 108 FT HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521-01-254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED SZ54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA 13X420MMX125DEGREE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X060-3612P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE INTERSPINOUS 36MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX515|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE CONNECTOR AXOGUARD 5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8852-017-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER RIM ELEVATED CONTINUUM TRILOGY CROSSLINK POLY 36MM SIZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8757-066-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM TM W/HOLES 66MM SZ PP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 38MM 12.6MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP120RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA HP 375CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GANDRAS VISCI-G 5FR 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,854.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,854.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-27-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING EXTREME MAXLOCK MINI 2.7MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|304.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|304.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-MTP-R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP EXTREME MAXLOCK MINI RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,796.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,796.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTEG-2P-40-162-PF-US|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G53441|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PROXIMAL WITH PROFORM GRAFT ENDOVASCULAR TAA TX2 Z|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,282.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7209014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIORCI-HA 11 X 30 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 38MM BIODUR 108 .5 THRD HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220454|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8851-008-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM GG NEUTRAL 32X48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85408|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ICAST COVERED 9MM X 38MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,338.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 40MM 13.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T102.7MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MMXL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629506S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION VARIAX NARROW STRAIGHT 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629507S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR STRG 90MM 7 HL CMPR VARIAX BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,190.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850015545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 5.5 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO 24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER CRYSTALENS POSTERIOR CHAMBER 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 501420|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH RESTORELLE Y 24CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 501440|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH RESTORELLE L 24CM X 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 4MM 40MM 19.9MM BIODUR 108 .5 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED MICRO ASNIS 3.0 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZM10-10-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATION DEVICE MONOCORTICAL EASYCLIP 10 X 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92-1612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CANCELLOUS CRUSH 5CC FD ASP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627705|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL MEDIAL LT 5 HOLE/84MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL HUMERUS 3HOLE/L84MM NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 40MM 13.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3577|SUP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC CERVICAL PROSTHESIS STANDARD 15X17 H7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3575|SUP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC CERVICAL PROSTHESIS STANDARD 15X17 H5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-1014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-005-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 12MM (FEM 3-11, TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341402|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MEDIUM HIGH PROFILE 620CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341359|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE PLUS MED HEIGHT 495CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341409|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE MODERATE PLUS MED HEIGHT 555CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1328.10.540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RESURFACING SHOULDER CTA 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601640S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ASNIS CANNULATED SCREW 5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 40MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601642S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ASNIS CANNULATED SCREW 5X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9P15-S180-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT TOE HEMICAPDF-P TOE MTN PHLNG PROX COCRMO TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR PULSE MODEL 102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8895545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PRECEPT MODUALR 5.5 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,919.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,919.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8805540A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 5.5 X 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6712920|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CORENT LI 12 X 9 X 20MM 4 DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8895540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PRECEPT MODUALR 5.5 X 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195SSL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METATARSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 42MM 13.9MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195-2408L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195-2412L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195-2414L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195-2408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.4MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL PCA 32MM +0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195-2412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 62997525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR HOODED 10 DEGREE 32MM X52MM 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 42MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CDC-21242-X1A|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT MAC ACCESS TWO-LUMEN CENTRAL VENOUS 2-L 9FR DIS X11.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ML-00703|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COMPONENT CVC 3-LUMEN 7FR (USE ONLY W/ARROW MAC DEV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ML-00701|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COMPONENT CVC 7FR (USE W/ARROW MAC DEVICE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ML-00702|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER COMPONENT CVC 2-LUMEN 7FR (USE ONLY W/ARROW MAC DEV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3066-0090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW LAG-U-BLADE 10.5 X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,066.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 42MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8724W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER TI 6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLOFEMORAL MCK RESTORIS SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP10-1214605|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERVICAL SPACER STEALTH 12X14X5.6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 44MM 14.6MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 6-9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961216500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALISER VOID C-STEM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|417.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED OFFSET HIGH C-STEM AMT SZ7 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 44MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA25-90/116-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT BIFURCATED 25 X 90/116-30|1|HUMANA [1294]||HUMANA [11839]|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,740.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-2028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-2040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 44MM 14.6MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587115RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION MTP SMALL 5DG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8928P-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEEDBRIDGE ACHILLES PEEK SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0030-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION ACUTRAK ACUTWIST 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7801130|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CRAINIAL CUSTOM PEEK LARGE|1|HUMANA [1294]||HUMANA [11839]|48,552.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,552.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 44MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BL414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCRW SELF-TAPPING V.A. 4.5MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE PLATE TIBIAL ONLAY MCK RESTORIS SZ 7 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 10MM (FEM 3-9, TIB CD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 7-8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFBC-4503B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENESYS CROSS FT SUTURE ANCHOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,064.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,064.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3510-045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PREBENT PERCUTANEOUS 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 46MM 15.3MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 10.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.105|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 10.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 11.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 11.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 12.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 13.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 12.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 13.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 46MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.140|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 14.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 14.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 15.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 16.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 15.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 16.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 17.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 18.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 17.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 18.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 46MM 15.3MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 19.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 19.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 20.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 20.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 21.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 21.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 22.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 23.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 22.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 46MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 24.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 23.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 24.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 25.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965404120|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT ENDOPROSTHESIS 18 X 60 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,211.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,211.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965404130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT ENDOPROSTHESIS 18 X 90 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,903.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,903.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965404310|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT ENDOPROSTHESIS 20 X 55 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,211.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,211.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.161S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 400MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURE BUTTON 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 48MM 16MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1039S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 10MM X 390MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 6MM X 195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-00-436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET HUMERAL RSP STD SZ 36MM +4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001092|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINUOUS 5.5MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 510-06-175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MONOBLOCK RSP SZ 6 175MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ICONIX 2 WITH INTELLIBRAID TECHNOLOGY 2.3MM WITH 2 ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 48MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-3606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 36MMX6MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-040-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.0MM X 40MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-060-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.0MM X 60MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-100-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.0MM X 100MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-120-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.0MM X 120MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-040-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.0MM X 40MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-060-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.0MM X 60MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-120-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.0MM X 120MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-150-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.0MM X 150MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0016-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTWIST ACUTRAK COMPRESSION 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 48MM 16MM BIODUR 108 1/3 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0018-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTWIST ACUTRAK COMPRESSION 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 4 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33654307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3+ 7MM KNEE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33630023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME TALAR INFINITY SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8006-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION DOUBLE 2-HOLE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-HYB-10X15|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR HERNIA HYBRID ZENAPRO 10X15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-100-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.0MM X 100MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1MYM08|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO 5X10CM (ING HERNIA) #1MYMO8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114704841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 48MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186715650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VIPER 6.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,910.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,910.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186788080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VIPER 80 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,126.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,126.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186715000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|841.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|841.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186715645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VIPER 6.0 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,910.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,910.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.803.110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE OPAL 10X28X10 MM|1|HUMANA [1294]||HUMANA [11839]|15,510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6 HOLE MIDSHAFT ULNA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LATERAL RT 6 HOLE /L166MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 50MM 16.6MM BIODUR 108 P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-004-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED CR LEFT 13MM TIB C-D FEM 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 5MM 50MM BIODUR 108 FT RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|518.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|518.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-9-006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH TISSUEMEND 3CM X 3CM|1|HUMANA [1294]||HUMANA [11839]|3,935.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,935.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629343|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON ULNA 3HOLE/L65MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.06/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.5 TRILOCK 06MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.09/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.5 TRILOCK 09MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.10/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.5 TRILOCK 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.310S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 110 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,164.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,164.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 50MM BIODUR 108 .5 THRD RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.80|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.2/1.5 TRILOCK SCAPHOID 3X2H, T0.8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,058.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,058.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 4-9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0087|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FORTEX 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU454520|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS THORACIC TAG GORE 45MM X 20CM|1|HUMANA [1294]||HUMANA [11839]|49,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 32MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,563.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,563.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7510050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INFUSE XX SMALL|1|HUMANA [1294]||HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-30-94-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BODY MAIN FENESTRATED PROXIMAL30X94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2483-065-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.0 X 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|613.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|613.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2484-075-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.0 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248308560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.0 X 85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|613.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|613.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2494-200-11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RETROGRADE FEMORAL 11.5MM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,031.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,031.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2557H22|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HEMATURIA 3 WAY 22 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 087018|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NEPHROSTOMY EDELMAN 18FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X L 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587220LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION ZERO DEGREE MEDIUM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5881-2720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961210500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CENTRALISER VOID C-STEM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|417.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201781|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOSURE HA 9MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM C AMT STD OFFSET SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141799|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 9IN 2MM STNM SS HLF BYNT PNT NS|1|HUMANA [1294]||HUMANA [11839]|54.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|54.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72201786|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-091210A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPL 9MM SPD ARC 12/10 WRE BRDG INS TL LG 1.5X1.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.056S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 130 DEG 360MM RIGHT STERILES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,810.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,810.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-004-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FB UC RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL DISTAL FIBULA 2.7MM VA-LCP 4-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-5530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM OFST TPR 36MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3505-5535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2359-050-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PERIARTICULAR 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 10MM X 340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MMX22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP NON LOCK 2.7MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP NON LOCK 2.7MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626676S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 6HOLE/L71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-52-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP CTA DUOFIX GLOBAL 52X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,924.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,924.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131822040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DVR LOCK MINI L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,606.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,606.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404132|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUFF 5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,881.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,881.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123552015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP CTA DUOFIX GLOBAL 52X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,924.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,924.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.058S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 130 DEG 380MM RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSPL0710|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX PLUS SURGICAL GENTRIX 7CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMT2030|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL THICK GENTRIX 20CM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,060.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,060.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MM1000|SUP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWDER MATRIX MICRO MATRISTEM 1000MG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,642.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,642.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35046S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADED 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55266|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR GOLD SURGISIS 8-PLY W/O PERFERATIONS 8 X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADED 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-BIG-8X20|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT REPAIR HERNIA GOLD SURGISIS 8-PLY W/O PERFS 8 X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0520|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0720|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0340|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 2.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|680.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AG0540|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0310|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0740|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 7MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0510|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG0710|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX715|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE CONNECTOR AXOGUARD 7MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX315|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE CONNECTOR AXOGUARD 3MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850015540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 5.5 X 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,083.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX215|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE CONNECTOR AXOGUARD 2MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G-240-3527S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VISIGLIDE .035" 270CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FCPD7|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS DOWEL PLUG SIZE 7|1|HUMANA [1294]||HUMANA [11839]|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FCPD8|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS DOWEL PLUG SIZE 8|1|HUMANA [1294]||HUMANA [11839]|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FCPD10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS DOWEL PLUG SIZE 10|1|HUMANA [1294]||HUMANA [11839]|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FCPD11|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS DOWEL PLUG SIZE 11|1|HUMANA [1294]||HUMANA [11839]|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FCPD9|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS DOWEL PLUG SIZE 9|1|HUMANA [1294]||HUMANA [11839]|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/LMEB/W|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA WHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-005-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 10MM (FEM 3-11, TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192412C110|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER AORITC 19 MM V8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232812C110|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER AORITC 23 MM V8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FPRPR3560|SUP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE GALIL ICE SPHERE 90 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201785|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 10MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9P15-PB01-W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3.6MM HEMICAPDF-P TOEMOTION THK3.6MM 01 1.5MM OFST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSM0710|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND MULTILAYER MATRISTEM 7CM X10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSM1015|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND MULTILAYER MATRISTEM 10CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,535.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,535.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 786101204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS SIZE 12 X 125MM ENHANCED TAPER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VBJR050502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 5MM X 5CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 2-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579104200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ D L/M RL KNEE UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2495-360-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 9.3MM X 36CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2483-042-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 5.0 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2487-005-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP NAIL TIBIAL ZNN 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|593.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2483-032-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 5.0 X 32.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-382813-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE IRIX-A LUMBAR INTEGRATED FUSION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-7545SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-6550SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MMXL26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MMXL28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI SELF TAP CORTICAL 3.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C6TR01|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER BI VENTRICULAR VIVA CRT-P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,584.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,584.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4005B-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DART CHONDRAL ARTHREX 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|363.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|363.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131217003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING HS Y SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.702S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BROAD CURVED 4.5MM 20 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,104.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,104.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0051|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EAR PROSTHESIS PORP,PLASTI-PORE #140051|1|HUMANA [1294]||HUMANA [11839]|624.57|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|624.57|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42511000512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED CR LEFT 12MM TIB E-F FEM 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|400.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|400.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-005-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL FIXED BEARING UC RT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI SELF TAP CORTICAL 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T57P|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 5.75MM X 7.22MM (FREEZE DRIED)|1|HUMANA [1294]||HUMANA [11839]|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T810P|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 8.75MM X 10.22MM (FREEZE DRIED)|1|HUMANA [1294]||HUMANA [11839]|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627233|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL LATERAL HUMERUS 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,532.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,532.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T10 FULL THREAD 3.5MM/L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604624S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-040-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX BILIARY STENT 6FR X 40 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-06-060-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX BILIARY STENT 6FR X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-060-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX BILIARY STENT 7FR X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-07-080-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX BILIARY STENT 7FR X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRB35-08-080-080|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PROTEGE EVERFLEX BILIARY STENT 8FR X 80 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MM VA-LCP PROX-TIBIAL SMALL BEND 4H/87MM/RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,823.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,823.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSPL1015|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX PLUS SURGICAL GENTRIX 10CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,070.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,070.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MM0500|SUP|HCPCS Q4118||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POWDER MATRIX MICRO MATRISTEM 500MG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,628.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,628.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMX1015|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL PSMX GENTRIX 10CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,070.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,070.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 18MM X 167MM STRAIGHT DISTAL PLASMA MODULAR RESTORA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406184|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER HEMOSET 12FR X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0203150022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-15033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECTANGULAR COMPRESSION SIZE 2 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2102-2102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUBSTITUTE GRAFT BONE BIOACTIVE FOAM PACK VITOSS BA 2 X 2.5C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-005-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL FIXED BEARING UC RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-2000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FLEXIBLE PRE-CURVED 2.0 X 300 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|693.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-2500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FLEXIBLE PRE-CURVED 2.5 X 450 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|764.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|764.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCFW-18.0P-38-30-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SHEATH 18FR X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D1N2-0010S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED DARTFIRE 2.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N25018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS DARTFIRE 2.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N2-5020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS DARTFIRE 2.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA 2.7/3.5MM VA-LCP 8 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,607.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,607.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1620002P|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX STRATTICE PERFORATED 16 X 20 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345841|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE L-ASR FEE 8 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PSM1015|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL THIN GENTRIX 10CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,749.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,749.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493927424450|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT REBEL BARE METAL 4.5 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT RVSR SHLDR GLNSP 3 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT RVRS SHDR GLEN BSPLT HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT RVS CNTRL 6.5X25MM ST/RST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LK 3.5 HEX 4.75 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|774.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LK 35. HEX 4.75 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|774.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 345941|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE L-ASR FEE 9 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 405800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN REV SHLDR 9 IN STEINMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661490|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM/L90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661495|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM/L95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T10 FULL THREAD 3.5MM/L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 645541|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PINNACLE-L FEE 5 X 14 X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,297.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,297.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8952TS-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE TI STRAIGHT 3.0MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201778|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 8MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 7MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT NUCLEUS SIMPLICITI SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,315.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,315.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-004-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL FIXED BEARING UC RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122876|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 23MM 52MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-0440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 400CM FEM RT GAMMA3 IM 125D LNG LCK TI STRL R1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBJR082502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 8MM X 25CM X 120CM W/RADIOPAQUE MARK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 4.5 HEALIXADV BR ANC PCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223129|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 4.5 HEALIXADV BR3SUTANCP CORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1220-70-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULER MARATHON S-ROM 28MM+3 10 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,153.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL S-ROM COCR 28MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D A 4.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM REVISION CORAIL STD 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.229S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 12MM 125 DEG 380MM/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1327.10.520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RESURFACING SMR COCR 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X067-0105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP CERTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X067-0380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5 X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X067-1501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL POSTERIOR CERTEX 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.257S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANN. 12MM/130 360MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.275S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.131S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 125 DEG 400MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCS1014J|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT CAROTID LOOP LUMEN SINGLE|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6250V-EH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN COMMAND VEH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLOFEMORAL MCK RESTORIS SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 5.5 HEALIXADV BR3SUTANCP CORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 5.5 HEALIXADV BR ANC PCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223133|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 6.5 HEALIXADV BR3SUTANCP CORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.4MM TI VA LOCKING STARDRIVE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.731|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.766|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 16MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1934BCF-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURETAK BIO-COMPOSITE 3.0MM W/2 #2 FIBERWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944C-10S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP 10 DEGREE VALGUS 8 DEGREE DORSIFL.STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0368|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACCULOC 2 STANDARD LONG LEFT VDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMT2020|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL THICK GENTRIX 20CM X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT CONE SYM TRIATHLON SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 6MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.758|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 8MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 10MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.762|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 12MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.764|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 14MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.768|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 18MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 20MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 22MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.774|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 24MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.776|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 26MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.778|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 28MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 30MM SELF TAPPING W/T8 STARDRIVE RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.872|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.874|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|113.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|113.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.882|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.884|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.888|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.886|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX STARDRIVE RECESS 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.086|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.084|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.096|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.092|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.098|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.210.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS LOCKING VA TITANIUM 1.8MM T8 STARDRIVE RECESS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|421.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|421.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4MM X75MM LEFT FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMX0710|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL PSMX GENTRIX 7CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2001-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBM STIMUBLAST 2.5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-006-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 11MM (FEM 7-12, TIB GH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.521|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.651|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 6H HD/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.721|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,027.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.741|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.751|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM VLR 2 COL VA-LCP TITANIUM 7H HD/5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSPL0507|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX PLUS SURGICAL GENTRIX 5CM X 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,583.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,583.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8944-10S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP VALGUS STANDARD 10 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47225500801|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE BULB-TIPPED 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ABS-2013-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL DBM STIMUBLAST 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.111.541|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM NRW 2 COL VA-LCP TITANIUM 6H HD/4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,265.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TS LARGE DURATION DURACON 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1016002P|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE PERFORATED STRATTICE 10X16CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE SEMITENDINOSUS 220MM+|1|HUMANA [1294]||HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-8.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +8 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-7.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +7 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-8.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +8.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN60AC-9.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +9.5 DIOP MOD C BCNVX 13MM 6MM PC MLPC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T26|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 26MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T28|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 28MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 30MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T32|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 32MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T36|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 36MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T34|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 34MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465091|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE AMPLATZ SUPER STIFF .035 X 260CM X 1CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXSLIMAN135T45|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LANTERN DELIVERY MICRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 5H HD/3H SHAFT/RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 531525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FX 25MM 1.5MM SNL 2MM FLT RND LOPRFL PLLC ACD SLF REINF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.99|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.110.202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 5H HD/5H SHAFT/RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 5H HD/3H SHAFT/LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 5H HD/5H SHAFT/LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521-01-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED SZ50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86660006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOPURE PLUS COTTON 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,044.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,044.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO 3.0MMX26MM CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP29372|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LAPIDUS CP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 531520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FX 20MM 1.5MM SNL 2MM FLT RND ACL PCL PLLC ACD SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.99|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLSS3522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING T8, 35.X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|386.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|386.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8, 3.0X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|562.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8, 3.0X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|562.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8, 3.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|562.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 588002010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL SIZE 2 10 MM THICKNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,107.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,107.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588003020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL HINGE ROTATING RIGHT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.254S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANN. 12MMX130DEG 340MM/RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB 62X41MM NXGN 2 KN ZML PMMA UHMWPE PRECT ROT HNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-3826S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL PROXIMAL T2LONG RIGHT 260MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE STANDARD 11 X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MR-1400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING 14|1|HUMANA [1294]||HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 4H HD/3H SHAFT/RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 4H HD/3H SHAFT/LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,146.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 4H HD/5H SHAFT/RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.110.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VLR VA-LCP TITANIUM 4H HD/5H SHAFT/LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,386.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2003-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY CB STIMUBLAST 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200D-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL TIB OSTEO OPENWEDGE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE STANDARD 12 X 125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5549-A-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT CONE SYM TRIATHLON SIZE B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13370-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE OSTEO OSFERION 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT CONE FEMORAL TRIATHLON SZ 5/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3375|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS CERVICAL DISC 13X17XH5|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.280|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.285|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP +90 DEG 3H HD/5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP -90 DEG 3H HD/5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP T-PLATE 3H HD/3H SHA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP T-PLATE 3H HD/5H SHA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 13MM 9.5MM PRM CMNT STN FNSH VRSY ADVCT ZML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.115.450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP +20 DEG 3H HD/5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP +20 DEG 3H HD/3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.431|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP -20 DEG 3H HD/3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.451|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP -20 DEG 3H HD/5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED LPS ALL-POLY SZ 4 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T 10 FULL THREAD 3.5MM/L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430345|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT FROZEN PERONEUS LONGUS TENDON|1|HUMANA [1294]||HUMANA [11839]|4,210.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VKMM|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH KNITTED VICRYL 15 X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,129.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,129.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL RAD COL VA-LCP 5H SHAFT TITA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE STANDARD 14 X 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.115.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL RAD COL VA-LCP 6H SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP +90 DEG 2H HD/3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.641|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP -90 DEG 2H HD/4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.631|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP -90 DEG 2H HD/3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,858.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.115.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 2.4MM DRSL VA-LCP +90 DEG 2H HD/4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,927.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0928S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBAIL 9MM X 285MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 736526|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CANCELLOUS CORTICAL ASSEMBLED 6X15X9.4 MM 6DEG|1|HUMANA [1294]||HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7733515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SD 3.5 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7731506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DIVERGENCE 16.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,306.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,306.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE STANDARD 15 X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported EVOLUTR-26-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TRANSCATHETER EVOLUT R 26 MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE TIBIALIS POSTERIOR|1|HUMANA [1294]||HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-6-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE ADJUSTMENT NECK UNITRAX V40 OFFSET +12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5030-4-300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN APEX TRANSFIX 4 X 300 PIN 5 X 40 THR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|427.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|427.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114610001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET THROMBECTOMY ANGIOJET ZELANTEDVT PWR PULSE VENOUS UL CAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE STANDARD 16 X 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT10-3050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINOUS 5.5MM 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMB1QQ|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFRIBRILLATOR AMPLIA QUAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4900T38|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ANNULOPLASTY MC3 TRICUSPID 38MM|1|HUMANA [1294]||HUMANA [11839]|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS11015|SUP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR PRIME GRAFIX 1.5CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS11034|SUP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR PRIME GRAFIX 3CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE STANDARD 17 X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 658038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS12015|SUP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR CORE GRAFIX 1.5CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS12023|SUP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR CORE GRAFIX 2CM X 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS12034|SUP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR CORE GRAFIX 3CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS12055|SUP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR CORE GRAFIX 5CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 52MM SELF TAPPING WITH STARDRIVE RECES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM 12MM 9MM PRM CMNT STN FNSH VRSY ADVCT ZML 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00584209408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 4-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ D R/M LL KNEE UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-8757-056-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM TM MULTI HOLES 56 MM SIZE KK PORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-8752-012-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER RIM ELEV POLY LONGEVITY TRILOGY CONTINUUM 36MM SZ KK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4894-050-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR REVISION TM 50MM -10MM THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,722.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,722.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL PCA 36MM +10MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-005-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL PERSONA FIXED BEARING UC RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0351|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACU-LOC 2VDR PROX STANDARD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-013-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE EXTENDED 13 X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 180614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ONLAY MCK RESTORIS SZ 4 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201782|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 9MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP155RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA TE 850CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED OFFSET HIGH C-STEM AMT SZ2 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926008220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY EVEROLIMUS-ELUTING 2.25X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-014-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE EXTENDED 14 X 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493926012220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.25MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926020220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.25MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926016220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.25MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926008250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926016250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926012250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926020250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926024250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926028250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926038250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 38 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7850-015-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED ADVOCATE EXTENDED 15 X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493926032250|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 2.50MM X 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926012300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926008300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926016300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926020300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926028300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926024300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926038300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926032300|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926008350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM 16MM PRM CMNT STN FNSH VRSY ADVCT ZML 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,155.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493926012350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926016350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926020350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926024350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926028350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926032350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926038350|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 3.50MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926008400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926012400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597201101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN KNEE SIZE A LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,432.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,432.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H7493926016400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.270|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.275|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-1750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FLEXIBLE PRE-CURVED 1.75 X 300 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926020400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926024400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-2250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FLEXIBLE PRE-CURVED 2.25 X 300 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926028400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926032400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926038400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY(MR) EVEROLIMUS-ELUTING 4.00MM X 38 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202902|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 5.5 FOOTPRINT ULTRA PACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.265|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 26.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.255|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 25.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.260|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 26.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 27.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 27.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.280|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 28.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.285|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 28.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.295|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 29.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.290|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 29.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AU00T0.300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR PRELOADED 30.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77801000|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE CATH VISTA BRITE CORONARY JL 7FR 6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152072|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM THICK RTU 6 X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,381.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,381.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSSSL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MS-2416L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MS-2412L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MS-2418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.4MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MS-2414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.4MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBEC-125|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH DIAMONDBACK 135CM CORONARY CLS 1.25MM ORBT CRWN PD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GWC-12325LG-FLP|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VIPERWIRE ADVANCE325CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FORTEX 8.25 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-90/116-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-90/116-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T10 FULL THREAD 3.5MM L50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U85|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U90|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.850S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR VA LCP 2.4MM RIM SHAFT HOLES 5 HEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM PATIENT SYSTEM|SUP|HCPCS C2624||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM CARDIOMEMS PA SENSOR AND DELIVERY W/CM2000 CM1000|1|HUMANA [1294]||HUMANA [11839]|63,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475001070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 4.75X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475001035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 4.75X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T10 FULL THREAD 3.5MM L55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2078175|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE HI-TORQUE COMMAND ES 300 .014|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-60-080-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 6.0MM X 80MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L301|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ACCOLADE DR IS-1 DUAL CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8978P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SWIVELOCK DX SL 3.5 X 8.5MM WITH FORK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MAKO RESTORIS 5-9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-H220R-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL RIGHT 22.0MM DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,677.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RAD STEM COLLAR LATERAL SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102009|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 2CM X 4CM GRAFTABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|992.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|992.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-6-40-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 6FR 40 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-6-60-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 6FR 60 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-6-80-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 6FR 80 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-6-100-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 6FR 100 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-6-120-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 6FR X120 X125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-7-60-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 7FR X 60 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-7-80-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 7FR X 80 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-7-40-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 7FR X 40 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-7-100-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 7FR X 100 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.04227.005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME CENTRIC DOMELOCK ANTAOMICAL SHOULDER TI6A17NB/TI6A14V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.04212.485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL DOMELOCK 48-17 RT 26.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-8-40-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 8FR X 40 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.04201.123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL UNCEMENTED 12 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-7-120-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 7FR X 120 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-8-60-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 8FR X 60 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-8-80-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 8FR X 80 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.04214.400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID COMPONENT CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3492312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PERIMETER 12MM MEDIUM 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|10,604.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,604.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-8-100-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 8FR X 100 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZISV6-35-125-8-120-PTX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ZILVER PTX DRUG ELUTING 35 8FR X 120 X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-30226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-30434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG SHORT THREADED CANNULATED 3.0MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101-00006|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 1.6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-02076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK SMALL X POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-70620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST X SMALL 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 118-50030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 5.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,836.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.242S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 12MM/170 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFIB 10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SEGMENT FIBULAR L=100MM|1|HUMANA [1294]||HUMANA [11839]|1,887.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,887.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 3.5MM X L38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMOPONENT PATELLOFEMORAL MCK RESTORIS SZ5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE TENDON BONE HEMI WITH QUAD|1|HUMANA [1294]||HUMANA [11839]|7,435.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,435.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SCP KNEE COMPLETE W/ACCUPORT SIDE DELIVERY CANNULA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,927.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,927.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60000309|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT 5.5MMX300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60000307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT 5.5MM 180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FORTEX 8.25 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430337|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT ANTERIOR TIBIALIS|1|HUMANA [1294]||HUMANA [11839]|4,373.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,373.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MA-MINUS 2.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR MINUS 2.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2623|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE X 8-HOLE STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,436.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,436.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BOX 4-HOLE STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,803.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,803.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2643|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 4-HOLE 100 DEGREE STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,803.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,803.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE JL 8-HOLE STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154118000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PROSTALAC RT SIZE 3 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154142320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR PROSTALAC 42 X 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,654.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,654.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WS12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP OFF LG 2MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.253S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 12MM/130 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 75 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,062.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,062.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.280S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 80 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.244S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 12MM/130 RIGHT 235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45301002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45301001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED EXTRA SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 4 HOLE/L47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4-HOLE STRAIGHT STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,803.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,803.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627454|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL ANTEROLATERAL DISTAL LEFT 4-HOLE/102MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626673|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 3 HOLE/L35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-1952|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 8-HOLE STRAIGHT STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 30MM 10MM FEM BABSR TRILOBE DRVR BSCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FT 2.7MM/L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FT 2.7MM/L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FT 2.7MM/L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FT 2.7MM/L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LADDER 12 HOLE STERNALOCK BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,553.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,553.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LADDER WIDE 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,553.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,553.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-21.25|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.25 DIOPTER CRYSTALENS POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMOPONENT PATELLOFEMORAL MCK RESTORIS SZ5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521-01-242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED SZ 542|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-110/I20-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-110/I20-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.852|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 52MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported A-5250.11/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.5 TRILOCK 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.08/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.5 TRILOCK 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5250.12/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 1.5 TRILOCK 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628507S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 7 HOLE 12MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 10MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 8MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 14MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 12MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 18MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 16MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS SELF DRILLING 2.4MM X 20MM (GOLD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 8MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 10MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 12MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 16MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 14MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 18MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANCELLOUS 2.7MM X 20MM (MAGENTA)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58803520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MAKO RESTORIS 5-10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-7-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR HOODED 10 DEGREE 32MM X46MM 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AFLEX301|SUP|HCPCS Q4125||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMIS DECELLULARIZED ARTHROFLEX 4.0CM X 7.0CM X 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,083.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,083.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S0800-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 8.0MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0013635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON FIXATION 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,302.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,302.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVOLUTR-29-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TRANSCATHETER EVOLUT R 29 MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-5250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-TUBE BEVELED GROMET POPE|1|HUMANA [1294]||HUMANA [11839]|39.41|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|39.41|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported EVOLUTR-23-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TRANSCATHETER EVOLUT R 23 MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1CVX004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH CARDIOVASCULAR ACUSEAL 1CVX|1|HUMANA [1294]||HUMANA [11839]|798.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|798.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MCS-P3-31-AOA-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TRANSCATHETER COREVALVE 31MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G7731509|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MINI DIVERGENCE 19.5MM|1|HUMANA [1294]||HUMANA [11839]|6,306.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,306.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8805545A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 5.5 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93-4400|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SURGICAL TRANS-OBTURATOR ARIS COLOPLAST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.259S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED 12MM/130 360MM/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM C AMT STD OFFSET SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2002.01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL DBM STIMUBLAST 1CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-1101-20|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CARTIFORM 20MM DISC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-1101-10|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CARTIFORM 10MM DISC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.465S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 14MM 130 DEG 424MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.315S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 115 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLOFEMORAL MCK RESTORIS SZ6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201020012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCK 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,068.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201000304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT MET LESS 4- HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7001-0206L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE POLARIUS POSTERIOR PLATE 6 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3025-35028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3MMX36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3X34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3MMX42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3011-43032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 4.3MMX32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3025-35026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE HEXALOBE 3.5X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201120016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCK TI 2.0X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3369-40Q|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR QUADRA ASSURA MP CRT-D DF4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,574.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64,574.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.130S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 125 DEG 400MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2358-012-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL ULNAR 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,116.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,116.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2358-108-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL LOCKING 3 HOLE SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2359-012-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2359-016-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2359-020-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4828-022-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4828-024-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4828-030-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5050-4-300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN APEX TRANSFIXING 5/6MM 40MM X 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-2359-024-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4828-028-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.7MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,101.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.112.531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL 14 HOLE LEFT 3.5 LCP LOW BEND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,610.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,610.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 10 HOLE/ L119MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL1UT 24.50|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TRULIGN TORRIC SPHERE 24.50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 11.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 11.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT50AO-19.75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.75 AO DIOPTER CRYSTALENS POSTERIOR CHAMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSR1015|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX 3-LAYER WOUND CYTAL 10X15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FT10-BP412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING VARIABLE ANGLE4.0X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521-01-246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED TURON SZ426|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-2E-3602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE ECCENTRIC 36MM X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MM X L22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-6535SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEDICALE FORTEX6.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINUOUS 5.5MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-332613-08PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR INTEGRATED FUSION33X26X8DEGREE 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-332611-08PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR INTEGRATED FUSION IRIX-A 33X26X8DEGREE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 038100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBX 10CC #038100 (SYNTHES)|1|HUMANA [1294]||HUMANA [11839]|4,260.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,260.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5112-005-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 10 MM TIBIA E-F/CR FEMU4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628516S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 6 HOLE /12MM/RIGHT|1|HUMANA [1294]||HUMANA [11839]|6,357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP135RH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA HP 500CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00553640|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC AXIOS SYSTEM 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00553650|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT PANCREATIC AXIOS SYSTEM 15 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-002-2YA|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y ALPHA EXTREME MINI MAXLOCK 2-HOLE|1|HUMANA [1294]||HUMANA [11839]|3,640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-24-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING EXTREME MINI MAXLOCK 2.4MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-021-24-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X10MM MINI MAXLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1192ANS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIFT NON-CE|1|HUMANA [1294]||HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627486|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL ANTEROLATERAL DISTAL RT 6-HOLE/127MM|1|HUMANA [1294]||HUMANA [11839]|8,097.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,097.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FT 2.7MM/L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FT 2.7MM/L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BODY CONE PROXIMAL +10 29MM MODULAR RESTORATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 12.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179710100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHERS TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201788|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 11MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 397015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SUBSTITUTE CEMENT BONE HA INJECTABLE HYDROSET 15CC|1|HUMANA [1294]||HUMANA [11839]|12,384.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,384.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM3262|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ALLURE MP RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,303.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,303.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-6540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER 6.5MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|580.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|580.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3376|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS CERVICAL DISC 13 X 17 X H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 11MM KN FEM TIV NXGN OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74025665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT CR 48MM XLPE JOURNEY II SIZE 5-6 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL OXINIUM JOURNEY II NP SIZE 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NON POROUS JOURNEY SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSX0710|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND 6-LAYER CYTAL 7CMX10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,453.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,453.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 230325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE INTERFERENCE 7 X 25 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|921.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|921.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSX0505|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND 6-LAYER CYTAL 5CMX5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8806555A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 6.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7270741|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER PSR 7X14X11MM|1|HUMANA [1294]||HUMANA [11839]|4,836.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,836.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 130 DEG 235MM LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626678S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 8HOLE/L95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3060-0120S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 10.5 X 120MM GAMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,420.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.155S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 130 DEG 340MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-5220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 52 20MM REUNION TS4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-5220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 52 20 MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107224055|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HOCKEY STICK 2 5FR 65CM .038 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107224025|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HOCKEY STICK 2 5FR 100CM .035 5/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-P-0052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72204366|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAT-TRICK PIP FUSION 2.7MMPROX 0DEG. 4MM MID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,702.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3595|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC CERVICAL PROSTHESIS STANDARD 15X19 H5|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-005-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ART TIBIAL PERSONA FIXED BEARING UC RT 14MM E-F 4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020002P|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 20CM X 20CM PERFORATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025002P|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE 20CM X 25CM PERFORATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,082.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,082.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SC-1140|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT GENERATOR PULSE IMPLANTABLE NOVI PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 10 MM TIBIA C-D/CR FEM 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201776|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 8MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSX1015|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND 6-LAYER CYTAL 10CMX15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910600062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR REELX STT 4.5MM KNOTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,372.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,372.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910-500-322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ICONIX 2 TT WITH INTELLIBRAID TECHNOLOGY 2.3MM ANCHOR WITH 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00188.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRINICA 4 LEVEL 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.114S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM 125 DEG 235MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787117327015|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER MARINER KUMPE 5 FR 65CM .035 NON BRAIDED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201020010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING 2.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,068.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,068.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201020018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCK 2.0X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,101.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,101.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.112.142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR DISTAL LAT TI LCP 2.7MM 3.5MM 6 HOLE RIGHT 112|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM X 14MM TI LOCKING SLF-TPNG WITH T8 STARDRIVE REC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM X 12MM TI LOCKING SLF-TPNG WITH T8 STARDRIVE REC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17011E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWS LOCKING CROSS-PIN 1.7X11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|317.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-10360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-T PROFYLE HAND LOCK REG,7HOLE 1.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17005E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS PIN SELF TAP 1.7 X 5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|317.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2001-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY CB STIMUBLAST 1CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL1UT 29.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TRULIGN TORRIC SPHERE 29.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102031|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 4CM X7CM THICKNESS THIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|863.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|863.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558610|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 8-9-10MM 180 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558620|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 10-11-12MM 180 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558630|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 12-13.5-15MM 180 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558640|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 15-16.5-18MM 180 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558680|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 10-11-12MM 240 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558650|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 18-19-20MM 180 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558710|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 18-19-20MM 240 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00537350|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT STENT PANCREATIC ADVANIX 4FR 3CM PIGTAIL/NO LEADING BARB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|626.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|626.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE ANGLE SELF TAP 5.0 X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|593.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.231.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING VARIABLE ANGLE SELF TAP 5.0 X 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|593.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T10 FULL THREAD 3.5MM/L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLP450|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE BURR 15MM|1|HUMANA [1294]||HUMANA [11839]|403.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLP451|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE BURR W/SHUNT 15MM|1|HUMANA [1294]||HUMANA [11839]|319.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|319.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLP452|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COVER HOLE BURR 22MM|1|HUMANA [1294]||HUMANA [11839]|631.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|631.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP1022|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REGENERATION DURAL PLUS DURAGEN 2X2 IN|1|HUMANA [1294]||HUMANA [11839]|1,349.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,349.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP1013|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REGENERATION DURAL PLUS DURAGEN 1X3 IN|1|HUMANA [1294]||HUMANA [11839]|1,312.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,312.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS164|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING SELF1.6 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|179.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING SELF1.6 X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|179.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLS194|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 1.9 X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|179.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLP411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT LONG 2 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|200.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|200.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLP442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE GAP 6 HOLE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.115.430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL DORSAL LEFT 2.4MM 20 DEGREE 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,723.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX STRAIGHT 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUICKANCHOR PLUS GII MITEK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,413.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,413.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1390P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEEK INTER 9 X 23MM WITH DISP SHTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSR0710|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX 3-LAYER WOUND CYTAL 7X10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED CR LEFT 10MM TIB C-D FEM 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED CR LEFT 10MM TIB-G-H FEM 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCFW-12.0-38-30-RB|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SET PERFORMER 12FR 30MM .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-2312|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX 23X120|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-406|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MAXXWIRE STIFF SUPER .035X260CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED PTRCOAT A/P WEDGED SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,195.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBM STRYKER 2.5CC|1|HUMANA [1294]||HUMANA [11839]|1,498.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,498.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6937A-58|SUP|HCPCS C1896||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD TRANSVENE-CS/SVC|1|HUMANA [1294]||HUMANA [11839]|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W020100150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NANOCROSS ELITE 2.0 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 48MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626684|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE THIRD 14 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 16MM 43MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT NUCLEUS SIMPLICITI SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,315.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,315.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW T 10 FULL THREAD 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS3503|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE STIFF SHAFT .035 DIAMETER X 180CM LENGTH X 3CM FLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT75166|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PTA ATLAS 16 X 6 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75126|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PTA ATLAS 12 X 6 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206120670|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON CHARGER 7FR 12 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965404320|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLSTENT ENDOPROSTHESIS 20 X 55 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,903.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,903.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 125 DEG 235MM RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.015S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 125 DEG 235MM LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001091|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINUOUS 5.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GS3508|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE STIFF SHAFT .035 DIAMETER X 180CM LENGTH X 3CM FLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported X022-7530SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILLING FORTEX 7.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3595|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTVRTB 19X5MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505535 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 535CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 2.0MM X 16/7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503250|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SMOOTH ROUND HIGH PROFILE 250CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MICRATCPSYSTEM|SUP|HCPCS C1786||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRANSCATHETER MIRCA PACING SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505240 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH ULTRA HIGH PROFILE 240CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505295 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH ULTRA HIGH PROFILE 295CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505270 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH ULTRA HIGH PROFILE 270CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505350 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH ULTRA HIGH PROFILE 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505320 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH ULTRA HIGH PROFILE 320CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106608-001|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOJET SPIROFLEX VG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35372|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 44MM X 233 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35402|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT DISTAL ENDOVASCULAR THORACIC ALPHA ZENITH 44MM X 211 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-1024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL HINGE ROTATING LEFT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5450-020-35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE METAPHYSEAL FEMORAL TM 35 SM/ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,903.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,903.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588003012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657442|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.926|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DC-LCP 2.4MM 6-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,040.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,040.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL-STD BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8805550A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PRECEPT POLYAXIAL 5.5 X 50 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8895550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK PRECEPT MODUALR 5.5 X 50 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6710920|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COROENT LI 10X9X20MM 4DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626674S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 4HOLE/L47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLA230300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXTENDER AORTIC AAA EXCLUDER 23MM X 3.3CM|1|HUMANA [1294]||HUMANA [11839]|9,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Q50 - 65P|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOONSTENT-GRAFT PLUS Q50 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784102020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL-STD BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131545|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST ISOVUE 300 200ML IBP 10/BX|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RHI-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL ALIGN 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RHI-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL ALIGHN 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-0900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN 9MM X 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-0800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN 8MM X 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TFNA 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM C AMT STD OFFSET SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961212500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CENTRALIZER VOID C-STEM 12DM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|417.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|417.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 19MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 590-001|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OCCULSION BRIDGE 90 X 20 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03155.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03155.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 4.0MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03150.85|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI LCP 2.0MM / 45MM 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|772.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.359.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 2.0MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING TI SELF-TAPPING 2.0MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784102000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 20MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.360.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SLF-TPNGWITH STARDRIVE RECESS TI 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP40220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE UTILITY STRAIGHT 3HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE LOCKING 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MMXL36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MMXL30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSCF-25-260-3|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 3M J CURVED .025 X 260|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 2.MM 14/6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 2.MM 13/6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL LM BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-30124S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 3.0MMASNIS MICRO CANNULATED 24/6MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341259|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE 395CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPLS-20170-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG SMOOTH LOCKING RADIUS 2.0MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPLS-23170-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED LOCKING 2.3MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012269-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION MINI TREK RX 1.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784102050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM FEMORAL VERSYS MIDCOAT FIBER-MTL L.M. BODY EXT-NCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported X080-382811-08PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR IRIX-A 38X28X8DEGREE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.226S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 12MM 125 DEG 360MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784101930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 19MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCS-25030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 30MM, TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 26MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 28MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82086-01|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM XACT CAROTID 9MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784102030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 20MM PRM COLR ALGN GD VRSY TIV FM PLSLFN MDCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,854.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCS-25022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 24MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 16MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 18MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 10MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-25012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 12MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 12MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 10MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 14MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801803214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +7MM 12/14 TPR 32MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,661.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCS-35016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 16MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 18MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 24MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 26MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 28MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-35030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 3.5MM X 30MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFH|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT FEMORAL HEAD|1|HUMANA [1294]||HUMANA [11839]|3,321.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,321.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 7FR 20CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]||HUMANA [11839]|342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HCS-25014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 2.5MM X 14MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,192.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626682S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 12 HOLE/L 143MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,049.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 36MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.112.143|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR DISTAL LAT TI LCP 2.7/3.5MM 6 HOLE LT/112|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC1VR01US|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER MICRA SINGLE CHAMBER SURESCAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-4R|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPLINT,NAIL INRO SURGICAL MED.|1|HUMANA [1294]||HUMANA [11839]|90.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.127.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROX VA-LCP 3.5X 147MM SM BEND 8 HOLE /RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,547.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,547.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2408-56|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 56CM MRI AVISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-1200|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KITGENERATOR PULSE IMPLANTABLE MRI MONTAGE PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-4319|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MRI X CLIK|1|HUMANA [1294]||HUMANA [11839]|843.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC555210|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CONTROL REMOTE FREELINK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FULL THREAD 2.7 MM X L24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCS-070-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINK 3.8 HCS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|604.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|604.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977C165|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD STIMULATOR SURE SCAN SPECIFY MRI 65CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3549213|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE CPX 4 STYLE 9200 450CC MEDIUM HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12781-01|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ASAHI GRAND SLAM 0.014" DIAMETER 180 LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0068505110|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING URETHERAL MID HALO OBTRYX II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,583.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,583.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70-0313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON EXTENDED 5 HOLE RT.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 2-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203705|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEALICOIL REGENESORB SUTURE ANCHOR 4.75MM W/1 UT & 1 UB BK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3512-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT PERC NXT PATHFINDER 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505-5555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PATHFINDER N X T 5.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0274|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING HEXALOBE 3.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEM12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING MEDIAL 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,760.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,760.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0267|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING HEXALOB 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 531516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FX 16MM 1.5MM SNL 2MM FLT RND LOPRFL PLLC ACD SLF REINF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|408.99|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|408.99|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1934BCFT-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURETAK BIO-COMPOSITE 3.0MM W/2 #2 TIGERTAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-35-054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICLE LOCKING 3.5MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1038S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 10MM X 380MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T10 FULL THREAD 3.5MM L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068505000|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING TRANSOBTURATOR HALO OBTRYX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629383|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 002682|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT CONDYLE HEMI FEMORAL LATERAL LEFT|1|HUMANA [1294]||HUMANA [11839]|38,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM X 20MM TI LOCKING SLF-TPNG WITH T8 STARDRIVE REC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.112.140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR DISTAL LAT TI LCP 2.7/3.5MM 5 HOLE RT/99MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,986.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP14341|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT ANCHORAGE MTP CP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD ANCHORAGE 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE STANDARD 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 7-9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE PLATE TIBIAL ONLAY MCK RESTORIS SZ 3 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY MCK RESTORIS 3-8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749393120SR0|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STINGRAY LP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW BREAK OFF|1|HUMANA [1294]||HUMANA [11839]|639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3493312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER 8 DEGREE 12 X 30MM|1|HUMANA [1294]||HUMANA [11839]|10,604.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,604.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3493314|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER 8 DEGREE 14 X 30MM|1|HUMANA [1294]||HUMANA [11839]|10,604.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,604.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FMP250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FMT LOWER DELIVERY (COLONOSCOPY, SIGMOIDOSCOPY OR ENEMA)|1|HUMANA [1294]||HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110030300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL PROXIMAL LEFT 3HOLE 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-40-028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP20342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATING LAPIDUS ANCHORAGE 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD ANCHORAGE 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING ANCHORAGE 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ15-15-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATION DEVICE EASYCLIP 15X15X15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZM12-10-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATION DEVICE MONOCORTICAL EASYCLIP 12 X 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING ANCHORAGE 3.5MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT WEDGE EVANS 8X22X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3597|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CERVIAL DISC PROTHESIS MOBI-C 15X19 H7|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ18-14-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION EASYCLIP 18X14X14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001145540|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER XXL DILATION 16X 60 X 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEALICOIL RSB SA 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626676|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ONE THIRD TUBULAR 6 HOLE/L 71MM|1|HUMANA [1294]||HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5010024|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILTER LP VENA CAVA SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629254S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL POSTERIOR DISTAL 14 HL/LT|1|HUMANA [1294]||HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-1002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN, 10MM X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T10 FULL THREAD 3.5MMXL24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 3-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1651-64|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBOLECTOMY 6FR OVER-THE-WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1312-18-604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 17-HOLE 154MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341305|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE TALL MODERATE PLUS 420CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO TM SS 2.7 X 42MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO TM SS 2.7 X 40MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 30MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 36MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963MR-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA SS 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404130|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUFF 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,117.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,117.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-3440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA 13X440MMX125DEGREE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197616140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TAPERED DISTAL RECLAIM 16X140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197520095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY PROXIMAL CONICAL RECLAIM 20X95MM 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604636S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE LOCKING 3.5MM X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-5619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 56X19 MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-P-0056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO TM SS 2.7 X 44MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO TM SS 2.7 X 48MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO TM SS 2.7 X 46MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LO-PRO TM SS 2.7 X 50MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963AR-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTEROLAT DISTAL TIBIA SS 6 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001-0224R-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL ARH SLIDE-LOC RIGHT 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,959.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,959.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001-0410R-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL LONG ARH SLIDE-LOC RIGHT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5001-0301N-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK RADIAL ARH SLIDE-LOC +1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,299.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,299.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM12060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT FLUENCY GRAFT 12MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0194-2500S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FLEXIBLE PRE CURVED 2.5X450MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8979P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DX SWIVELOCK 3.5X13.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965403330|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WALLSTENT W/ UNISTEP PLUS 16 X 19 100 75 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,903.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,903.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122871|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 17MM 46MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3549115|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST PROFILE CONTOUR HEIGHT LOW 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-005-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 11MM (FEM 3-11, TIB EF)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0825S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 8MM X 255MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL RT 6HOLE L 123MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM 130 DEG 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607348|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS TI 4.0 X L48MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-005-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK TM SIZE 5 RT/LAT-LT/MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5448-005-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK TM SIZE 5 LT/LAT-RT/MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,645.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MM PROX TIBIA VA-LCP SMALL BEND 6 HOLE 117MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,876.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.228S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED 12MM/380MM/RIGHT 125 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 831F75P|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VENOUS INFUSION THERMODILUTION 7.5FR NO HEPARIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWCER-35-14-14|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL RETRACTA EMBOLIZATION 35-14-14|1|HUMANA [1294]||HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47361|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL RETRACTA EMBOLIZATION 35-20-20|1|HUMANA [1294]||HUMANA [11839]|354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47354|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL NESTER EMBOLIZATION 35-14-16|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7770823|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ELEVATE 8X23MMX10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136540720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC TS DELTA 12/14 40MM +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.260S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 12MM/130 DEG 400MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T-SHAPE LOCK 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,211.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM X L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT COTTON WEDGE 6 X 24 X 14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING ANCHORAGE 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MENISCAL REPAIR TRUESPAN 12 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MENISCAL REPAIR TRUESPAN 0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MENISCAL REPAIR TRUESPAN 24 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 2 15MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-7-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR HOODED 10 DEGREE 32MM X58MM 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-004-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC TIBIAL PERSONA FIX BEAR UC RT 14MM-C-D/3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB ZUK 4 KN LT MDL RL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012445-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.0 MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012447-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.5 MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012449-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.0 MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012451-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.5 MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012453-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 4.0 MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G36226|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG FISTULA ANAL SURGISIS|1|HUMANA [1294]||HUMANA [11839]|2,344.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,344.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 657044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 2.7MMXL48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D02812|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOWEL BONE UNICORTICAL FULLY CANNULATED 12MM|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D02814|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOWEL BONE UNICORTICAL FULLY CANNULATED 14MM|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D02816|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOWEL BONE UNICORTICAL FULLY CANNULATED 16MM|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341452|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL MED HEIGHT HIGH PROFILE 685CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139F75|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SWAN-GANZ CCO 7.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6525-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 CANCELLOUS BONE SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 604038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CANCELLOUS 4.0X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|81.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|81.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8044M0K5|SUP|HCPCS C1878||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT INJECTABLE PLUS PROLARYN 1.0CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PM1240|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER ASSURITY SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,041.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI SELF TAP CORTICAL 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 3HOLE 5MM X 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.940|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 10MM TI MNDB CORT ST CRS PTCH CRFRM NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|142.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM TI L 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7770828|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ELEVATE 8 X 28MM X 10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 45MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7770928|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ELEVATE 9X28X10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 10 MM TIBIA G-H/CR FEM 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197520085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY PROXIMAL CONICAL RECLAIM 20 X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197620190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TAPERED DISTAL RECLAIM 20 X 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.942|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 12MM TI MNDB CORT ST CRS PTCH CRFRM NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|142.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 19VAVGJ-515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALVED VALSALVA HP MASTERS 19MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21VAVGJ-515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALVED VALSALVA HP MASTERS 21MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 23VAVGJ-515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALVED VALSALVA HP MASTERS 23MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27VAVGJ-515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALVED VALSALVA HP MASTERS 27MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25VAVGJ-515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALVED VALSALVA HP MASTERS 25MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29VAVGJ-515|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VALVED VALSALVA HP MASTERS 29MM|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0382|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACU-LOC 2VDR PROX NARROW LONG LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MXM-003-MTP-PA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POCKETLOCK WITH A SLOT MTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.946|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 16MM TI MNDB CORT ST CRS PTCH CRFRM NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|126.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.130.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES1.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.268|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL METACARPAL NECKPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.948|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 18MM TI MNDB CORT ST CRS PTCH CRFRM NS AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|126.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9240535|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPIRE 36MM|1|HUMANA [1294]||HUMANA [11839]|25,824.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,824.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VBH130502A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CATHETER VIABAHN ENDOPROSTHESIS 13MM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720157-01|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUFF /W IZ 800 AMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,117.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,117.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM04015013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 4 X 150 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM05015013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 5 X 150 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ADM06015013P|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON IN.PACT ADMIRAL PACLITAXEL 6 X 150 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8751-012-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 56 KK X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64813224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL HRHK 24MM XS/S S1/S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877704004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC OPTION BIOLOX 40MM +7 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,630.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,630.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-2315|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX 23X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.054S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 10MM/130 RIGHT 340MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AQ2010V-24.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER 3 PIECE SILICONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14788|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL SOF-FLEX 10FR X 26CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|365.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AQ2010V-25.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER 3 PIECE SILICONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMOSTAT FLOWABLE D-STAT|1|HUMANA [1294]||HUMANA [11839]|381.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|381.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported N60001060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD STRAIGHT 5.5MM 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.124S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MM/125 DEG 340MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENDER STEM FLUTED REVISION 13MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64813216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL KNEE HINGED REVISION HOWMEDICA 16MM X XS/S S1/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-004-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC BEAR FIX UC PERSONA LEFT 13MM-TIB C-D/FEM 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628506S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT HOOK 6 HOLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628526S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT HOOK 6 HOLE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33630021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DOME TALAR INFINITY SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,758.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,758.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33651106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ 1/ 1+ 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-22-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM PURPLE STRIPE C,D LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS IT 6.0MM/L70MM/TL32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709500|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR ORTH SS 3 MM CNN SCR NS LF|1|HUMANA [1294]||HUMANA [11839]|110.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5015005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY ATTRAX 5CC SYNTHETIC|1|HUMANA [1294]||HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TPNGWITH T4 STARDRIVE RECESS 1.3MM X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TPNGWITH T4 STARDRIVE RECESS 1.3MM X 7M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TPNGWITH T4 STARDRIVE RECESS 1.3MM X 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.157|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI LOCKING PHALANGE HEADPLATE 1.3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,475.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,475.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LOCKING SLF-TPNGWITH T4 STARDRIVE RECESS 1.3MM X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3125-0170S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA TROCH FOR 3 S NAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,496.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,496.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700341009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SELECT TRINICA 2L LEVEL 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700340001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRIMCOR SELECT 1LEVEL 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.115S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFN 11MM/125 DEG. LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G42466|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL MRI EMBOLIZATION .038 DIAMETER X 5CM LENGTH 12MM|1|HUMANA [1294]||HUMANA [11839]|247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7280V|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCERS MICRO 4F .018 X 40CM TUNGSTEN TIP 7CM 10/BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WS11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP OFF LG 2MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-P-0048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 48 21 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL REUNION RSA X3 36MMX4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PRESS FIT REUNION 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.145S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 11MMX130 235MM LEFT sterile|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6972660|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC CERVICAL LP PTRESTIGE 6 MM X 16 MM|1|HUMANA [1294]||HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKNG 4.0MM X L95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-8-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD HOFFMANN 3 CONNECTING 11X100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,014.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,014.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5018-5-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN APEX S/D HALF PIN 35 THREAD 5 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991222|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 22MMX12MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|12,098.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,098.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 786100904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS SIZE 9 X 110MM ENHANCED TAPER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.214.104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 4MM SELF TAPPING WITH T4 STARDRIVE RECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS FULL THREAD 6MM 6.0MM/L40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661765|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 4.5MM X L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5015001|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY ATTRAX 1CC SYNTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,014.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,014.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 786101404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM VERSYS SIZE 14 X 145MM ENHANCED TAPER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,811.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLP11341|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE MTP V2 LEFT S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP NON LOCK 2.7MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-382815-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR FUSION IRIX-A 38X18X12DEGREE 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110030400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL PROXIMAL HI RIGHT 3HOLE X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 48 18 THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-5217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 52 17 MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-K-0044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DOUBLE Y|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|798.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.112.148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR DISTAL LAT TI LCP 2.7/3.5MM 9 HOLE RT/151MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 293.940|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN STEINMAN 5.0MM WITH CENTRAL THREAD 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -5MM OFST TPR 36MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.362.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SLF-TPNGWITH STARDRIVE RECESS TI 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN WITH T6 STARDRIVE RECESS TI 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN WITH T6 STARDRIVE RECESS TI 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416611|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 11 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN WITH T6 STARDRIVE RECESS TI 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.130.355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONDYLAR VAL 2 HOLES HEAD-6 HOLES SHAFT TI 2.OMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,775.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,775.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FULL THREAD T10 2.7MMXL30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.057S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 10MM/130 LEFT 360MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5015010|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY ATTRAX 10CC SYNTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 44 16MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6530-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 CANCELLOUS BONE SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3341455|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE 585CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341357|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE 415CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CS16A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CS16 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,662.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZM08-08-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATION DEVICE MONOCORTICAL EASYCLIP 8 X 8 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 7 0 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.457S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 14MM 130 DEG 360MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4922-2-340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP HOFFMAN3 5 HOLE PIN 30 DEG DIA. 4/5/6 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,178.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,178.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 55MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 60MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.013.564S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RETROGRADE FEMORAL 11MM X 420MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,231.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TFNA 100 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED TI 4.0X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G23773|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON OCCULSION 10 FR X .035 DIAMETER X 140 CM-46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANC LOCK 45.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816140048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CANC 4.0 X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MMXL38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MMXL30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-K-0040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SZ 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK 2- 4.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,359.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK 2- 4.7MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,359.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELFTAPPING STARDRIVE VIARIABLE ANGLE 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE VARIABLE ANGLE 3.5MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180733-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 3-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-004-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629509S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR STRG 114MM 9 HL CMPR VARIAX BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,060.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,060.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629561S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD CURVED 11 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18261340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 13MM X 400MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1458QL/86|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD QUADRIPOLAR L HEART ENDOCARIDAL/S CURVE 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840007540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 7.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840009540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 9.5 X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840006540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 52MM HIP SECT PRCT PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 55840008540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 8.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM RADIAL LATERAL SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED MICRO ASNIS 3.0MM 22X5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,968.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 658022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MMX22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-1020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6360053|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER PERIMETER 10 X 15 X 13MM|1|HUMANA [1294]||HUMANA [11839]|5,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136552000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 12/14 TPR 36MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3910100015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE WEDGE 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|577.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|577.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234010161|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSTEON 7MMX23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5570-4004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP HUMERAL 40MMX4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-C-4006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CONCENTRIC 40MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-4004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 40MMX4MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM CMNTLS SMT DUOFIX 6 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-5100-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTBOLT TIBIAL 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626682|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE THIRD 12 HOLE/L143MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LL 6016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID LOAD PLATINUM 1.6 GM|1|HUMANA [1294]||HUMANA [11839]|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401062000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.00 X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401102000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.00 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401062500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.50 X 6 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401102500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.50 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401152500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.50 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401063000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.00 X 6 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401103000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.00 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401153000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.00 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401103500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.50 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401153500|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.50 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401103750|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.75 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401153750|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.75 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401104000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 4.00 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401154000|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 4.00 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T45001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE DBM GRAFTON 1 CC|1|HUMANA [1294]||HUMANA [11839]|687.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|687.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED OFFSET HIGH C-STEM AMT SZ4 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|346.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|346.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1132S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 12MM X 320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 64853313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED CURVED LG MRS REVISION 13MM 203MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-K-0048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8840CL-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 4.0MM X 40MM CANNULATED LONG THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 246.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 1.5MM 3 HOLE HEAD/8 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VST04|SUP|HCPCS C9250||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KIT TISS CLSR VISTASEAL FBRN SLNT 2ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|626.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|626.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported STRAP12|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION STRAP ABSORBABLE 12 STRAPS SECURE STRAP 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,122.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,122.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00584200302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL RIGHT MEDIAL LEFT LATERAL SZ 3 UNI KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ-C RT MEDIAL LT LATERAL UNI KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR VIVACIT-E SZ 3 - 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 40MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963MR-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA SS 8 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NB262|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURE GENESYS PRESS FT 2.6 WITH 2 #1 SUTURES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M365SC8336500|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD COVER EDGE 32 50CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5100-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTBOLT TIBIAL 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 977C265|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD SPECIFY MRI SURESCAN 2X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.154|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI PHLANGE BASEPL-2 HOLES HEAD-5 HOLES SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,475.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,475.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 34MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7MM X 42MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5100-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTBOLT TIBIAL 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-10-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE 10MMX108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-0005S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 5MM T2|1|HUMANA [1294]||HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H1-LS|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATHERECTOMY HAWKONE LS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H1-LX|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATHERECTOMY HAWKONE LX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported THS-SX-C|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATHERECTOMY TURBOHAWK SX-C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6535-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM TX TI ACTB CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PS60013|SUP|HCPCS Q4133||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR PRIME GRAFIX 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,336.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,336.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS60014|SUP|HCPCS Q4132||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REPAIR CELLULAR CORE GRAFIX 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,336.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,336.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TR-S1000-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HEAD RADIAL 10.0MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-022-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM PURPLE STRIPE C,D LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5450-020-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE METAPHYSEAL FEMORAL TM 35 SM/ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,903.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,903.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3662|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR PULSE IMPLANTABLE/W CONTROLLER 7 ELITE PROCLAIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 30MM 11MM BSCR ORTH PLLA INTFR ASCP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM TI CORTEX 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 11.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 11.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL2628|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL COATING HYDROPHILIC GORE 26FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.363|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM TI VAL 1ST METCARPALPLATE-DORSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,280.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN WITH T6 STARDRIVE RECESS TI 2.0MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.366.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SLF-TPNGWITH STARDRIVE RECESS TI 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 14.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 14.5S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W015020150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NANOCROSS ELITE 1.5 X 20 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT02643|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS FLEX CINCH LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,336.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,336.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3001023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL ANTERIOR ZEVO 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7713513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ZEVO VA 3.5X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,371.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7714013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ZEVO VA 4.0 X 13 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124226527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER CONSTRAINED DURALOC 66X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5621|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GOLD TURNPIKE 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5640|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SPIRAL TURNPIKE 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5638|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LP TURNPIKE 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5639|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LP TURNPIKE 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5642|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER STANDARD TURNPIKE 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 514.302|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SCP FOOT AND ANKLE|1|HUMANA [1294]||HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8757-062-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM TM MULTI HOLES 36X62MM SIZE NN PO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8751-015-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-005-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA FIXED CR LEFT 10MM TIB E-F FEM 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR3504|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 260CM .035IN JKT COR TO TIP ATRM STD STRG 3CM GLDWR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.118.546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.7MM METAPHYSEAL SLF TPNW/T9 STRDRIVE/46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA 2.7/3.5MM VA-LCP 6 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.361.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM TI CORTEX SLF-TPNG WITH STARDRIVE RECESS 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.365.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM TI CORTEX SLF TPNG WITH T6 STARDRIVE RECES 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48006015X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 6 X 15 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 48002530X|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON SABER .018 PTA 2.5 X 30 X 150 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI VAL STRAIGHT 2.0MM 6 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,546.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,546.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX 40MM X 62MM 10 DEGREE +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136540740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC TS DELTA 12/14 40MM +12.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RHI-260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL ALIGHN 26mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-1000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN 10MM X 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 100TSXS|SUP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERA SKIN 1 X 1 IN (6 SQ SM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG417|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDECATH 4 FR 120CM NTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 48 15MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6248V-130|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ATTAIN SELECT II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.263|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL METACARPAL DORSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING STRAIGHT 6 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,180.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,180.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING STRAIGHT 12 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING "T" PLATE 3 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.153|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING "Y" PLATE 3 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.156|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING PHLANGE HEAD PLATE-RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,475.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,475.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.158|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING STRUT PLATE 8 HOLES OBLIQUE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.159|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING STRUT PLATE 8 HOLES OBLIQUE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,294.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.161|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.3MM TI LOCKING WEB PLATE 14 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,363.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,363.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL STRAIGHT 6 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,326.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,326.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL STRAIGHT 12 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107342085|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SOFT-VU JB1 5FR 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341307|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE LOW HEIGHT MODERATE PLUS 370CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3549215|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE CPX 4 STYLE 9200 650CC MEDIUM HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9240545|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPIRE 41 MM|1|HUMANA [1294]||HUMANA [11839]|25,824.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,824.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 9MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201771|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4377-32-053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HOD SZ32/53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7110-54-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER SHELL REVISION POLY TM LONGEVITY 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,167.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,167.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL"T" PLATE 3 HOLE HEAD 7 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL "Y" PLATE 3 HOLE HEAD 7 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.254|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL PHLANGE BASEPL-2 HOLES HEAD-6 HOLES SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL CONDYLA BASEPL-2 HOLES HEAD-6 HOLES SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,512.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.256|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL PHLANGE HEAD PLATE-RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.257|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL PHALANGE HEADPLATE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.258|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL STRUT PLATE 8 HOLES OBLIQUE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.259|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL STRUT PLATE 8 HOLES OBLIQUE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRUT 1.5MM TI VAL 12 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.261|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WEB 1.5MM TI VAL 14 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.264|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METACARPAL 1.5MM TI VAL 1ST LATERAL-RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METACARPAL 1.5MM TI VAL 1ST LATERAL-LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-06803|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6MM X 80MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-06153|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6MM X 150 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELFTAPPING STARDRIVE VIARIABLE ANGLE 3.5X 28M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07403|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 40 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07103|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 100 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-06103|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 MM X 100 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 39293-06203|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 MM X 200 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07603|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 60 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07123|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 120 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-06123|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 MM X 120 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07023|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 20 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07803|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 80 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07203|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 200 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-07153|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 MM X 150 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-06-020-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 20 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|648.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|648.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported EVD35-06-040-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-06-060-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-06-080-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-06-100-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-06-120-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-06-150-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 6 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-07-020-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 7 X 020 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-07-040-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 7 X 040 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-07-060-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 7 X 060 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-07-080-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 7 X 080 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4076-45|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSUREFIX NOVUS 45CM ATRIAL/VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported EVD35-07-100-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 7 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-040-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 40 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-080-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 80 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-120-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 120 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MENISCAL REPAIR TRUESPAN 24 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1.5MM TI VAL ROTATION CORR 6 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.351|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI VAL STRAIGHT 2.0MM 12 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,661.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.352|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM TI VAL "T"-PLATE 3 HOLE HEAD 7 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,661.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.353|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM TI VAL "Y"-PLATE 3 HOLE HEAD 7 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,661.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,661.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4076-52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSUREFIX NOVUS 52CM ATRIAL/VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.130.354|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM TI VAL PHALANGEAL BASE 2 HOLE HEAD 6 HOLD SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,821.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,821.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM TI VAL STRUT 12 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,821.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,821.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.366|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.0MM TI VAL ROTATION CORR 6 HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,280.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,280.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 7MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-020-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 20 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-060-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 60 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-100-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-08-150-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 8 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4076-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSUREFIX NOVUS 58CM ATRIAL/VENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,437.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PCP050-060-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PACIFIC PLUS 5 X 80 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCP050-120-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PACIFIC PLUS 5 X 120 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCP060-080-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PACIFIC PLUS 6 X 80 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCP060-120-180|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PACIFIC PLUS 6 X 120 X 180|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVD35-07-150-150|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EVERFLEX ENTRUST 7 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72204367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAT-TRICK PIP FUSION 3.2MM MMPROX 0DEG. 4MM MID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,702.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197520075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY PROXIMAL CONICAL RECLAIM 20 X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197617190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TAPERED DISTAL RECLAIM 17X190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123548015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP CTA DUOFIX GLOBAL 48X18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,924.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,924.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5076-45|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 45CM 6.2FR 2MM 10MM SPC SM STRG ATR VNTRC BP SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 626891|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT LOCKING POLYAXIAL MTP CROSS-PLATE (T8)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-004-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 12 MM TIBIA C-D/CR FEM 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 11MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 12MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.533|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 13MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 14MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5076-52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 52CM 6.2FR 2MM 10MM SPC SM STRG ATR VNTRC BP SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LX351304150|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 4MM X 150MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305150|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 5MM X 150MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSCLX351306150|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER LUTONIX DCB 6MM X 150MM X 130 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5076-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PCNG 58CM 6.2FR 2MM 10MM SPC SM STRG ATR VNTRC BP SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.037.023S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM/125 DEG 325MM LT/STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 28 X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877702803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC OPTION BIOLOX 28MM +3.5/5 DEG12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MENISCAL REPAIR TRUESPAN 0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197619190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TAPERED DISTAL RECLAIM 19X190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI CORTEX SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-06403|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 MM X 40 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-06603|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 MM X 60 MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 420-006|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBO ELITE 2.0 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423-001|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBO ELITE 2.3 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410-152|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBO ELITE 0.9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414-151|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBO ELITE 1.4 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417-152|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TURBO ELITE 1.7 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8880828|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE EXPANDABLE INTERBODY LORDOTIC EXTRA 8X28X10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 65MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ANTERIOR CORAIL-2 NON-COLLAR HIGH-OFFSET SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122881|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HD HUM 18MM 44MM SHLDR SFT TIS BAL SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-111210A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMPLANT ARC SPEED 11X12X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588004023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING 23MM/SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58804026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS SURFACE ARTICULATING HINGE ROTATING SIZE D 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102282S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0MM QFX 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-2520TI|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMPLANT TITAN SPEED 25X20X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-1512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW IMPANT SPEED 15X12X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5010|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PRONTO LP EXTRACTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-2020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RECON RHEAD PLASMA COATED SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL HINGE ROTATING LEFT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.063S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 10MM 130 DEG 420MM/LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 10MM 130 DEG 400MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.113|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI LCKNG SLF-TPNWITH T4 STARDRIVE RECESS 1.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|350.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|350.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 5MM SELF TAPPING WITH T4 STARDRIVE RECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 6MM SELF TAPPING WITH T4 STARDRIVE RECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.108|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.5MM X 8MM SELF TAPPING WITH T4 STARDRIVE RECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-004-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 12MM TIB C-D FEM 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75144|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 14MM 75CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX 36MM X 58MM 10-DEGREE +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628557S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 7 HOLE/20MM /RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 15MM SELF TAPPING WITH T4 STARDRIVE R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 20MM SELF TAPPING WITH T4 STARDRIVE R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.214.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 22MM SELF TAPPING WITH T4 STARDRIVE RE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75124|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 12MM 75CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.214.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 1.5MM X 24MM SELF TAPPING WITH T4 STARDRIVE RE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|142.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|142.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI VA-LOCKING SLF-WITH T4 STARDRIVE RECES 1.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.356.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 2.0MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.357.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAPPING 2.0MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PR20|SUP|HCPCS C1886||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROBE PRECISION 20 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-005-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ART TIBIAL PERSONA FIXED BEARING UC RT 11MM E-F 4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1139S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL T2 STD. TIBIAL 11MMX390MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5028C-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-COMP INTERFERENCE 8MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS LATERAL PROXIMAL RIGHT 12-HOLE/L202MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,281.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,281.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-2310|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX 23X100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-237|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX 23X70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6428-028-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS FEMORAL -3.5 X 28MM CERAMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,660.12|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,660.12|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7750088|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5880005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS TIBIA HINGE ROTATING SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-005-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 14 MM TIBIA E-F/CR FEMU4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C0914|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH PERICARDIAL 9X14CM|1|HUMANA [1294]||HUMANA [11839]|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-006-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC TIBIAL FIX BEARING UC RT 10MM TIBIA G-H/CR FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-DSP-210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DORSAL SPANNING TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6248-028-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS +0 X 28MM CERAMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,519.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTLS-30080-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING TI 3.0MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-30100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING TI 3.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-30120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING TI 3.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-30140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING TI 3.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-30120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION TI 3.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BLV/BIS-10|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD ADAPTER KIT BIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180736-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 6-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6428-028-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS FEMORAL +3.5 X 28MM CERAMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,519.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,519.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 340622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-TAP CORTICAL 4.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 340624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING 4.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 432010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION SS 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154128000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PROSTALAC RT SIZE 3 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7770723|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ELEVATE 7 X 23MM|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7770728|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ELEVATE 7 X 28MM|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-50-080-120-P6|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SUPERA 5.0MM X 80MM X 120CM 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ARMADA 18 OTW 5 X 200 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON ARMADA 18 OTW 4 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W020150150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER NANOCROSS ELITE 2.0 X 150 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GPL2-1630HB|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAIN GENERAL PURPOSE 16 FR 21 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD CERAMIC OPTION DELTA BIOLOX 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6501066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TAPER CERAMIC 0MM OPT TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,236.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC E1 32MM SZ22/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING REPLACEMENT RINGLOC SZ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING LOCK ACETABULAR SZ22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SE-1310|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE SPEED 13 X 10 X 10 MM|1|HUMANA [1294]||HUMANA [11839]|2,979.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,979.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-1110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE SPEED 11 X 10 X 10MM|1|HUMANA [1294]||HUMANA [11839]|2,979.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,979.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN WITH T6 STARDRIVE RECESS TI 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.364.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SLF-TPNGWITH STARDRIVE RECESS TI 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 472505|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOPATCH HD ULTRA THICK 5CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,857.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,857.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GMN-DSP-160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DORSAL SPANNING SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-1000-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT BIOCARTILAGE SMALL JOINT|1|HUMANA [1294]||HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235250-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 2.50MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235250-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 2.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235250-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 2.50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235250-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 2.50MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235250-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 2.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235300-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235300-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235300-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.00MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N25012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 2.5MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-005-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 11MM TIB E-F FEM 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35356|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 36MM X 209 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235350-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235300-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.00MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235300-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.00MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235350-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235350-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.50MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235350-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ABSORB GT1 VASCULAR SCAFFOLD BIORESORB 3.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VAL CONDYLAR 2 HOLE HD-6 HOLES SHAFT 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,512.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LOCKING SLF-TPNGWITH T4 STARDRIVE RECESS 1.5MM X 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 5.0 X L55MM SOLID COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-FSP-LR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN FRAGMENT DOUBLE HOCKEY STICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.231S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 12MM/125/LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LOCKING SELF-TAPPING T4 1.5MM X 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LOCKING SELF-TAPPING 1.5MM X 14M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.257|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PHALANGEAL VAL LEFT 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,581.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1233S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 12MM X 330MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G50977|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FUSION LOOPTIP .035 X 480CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-15012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CURVED 5 HOLES RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-27618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|424.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|424.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-27616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|424.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|424.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-27614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|424.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|424.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35364|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 40MM X 217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-40-167-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 40MM X 167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626924|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CP 3.6MM,1.24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING POLYAXIAL UNIVERSAL CROSS PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,652.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,652.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2269|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LARGE PEC BUTTON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL ONLAY MCK RESTORIS SZ 3 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180733-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 3-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM X L24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012450-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.25 MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012450-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.25 MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012450-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.25 MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012452-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.75 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012452-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.75 MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012448-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.75 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002021759120|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 30CM 12MM 8MM THRX WVN HMSTS SFT FLXB KNIT HMSH PL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,967.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,967.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1012452-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 3.75 MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012448-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.75 MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012448-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.75 MM X 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING HEXALOBE 3.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0285|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING HEXALOBE 3.0 MM X 22 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00659.002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINS FIXATION TRINICA|1|HUMANA [1294]||HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01268.020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE ALLOGRAFT PUROS-S2 6X11X14MM 7DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0701617001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE INVIZIA 3L 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 30MM FRS TI FOREFOOT ST CNN 2 THRD HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-48H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION 4.0 X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180734-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 4-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 3.0MM 24/6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM ASNIS MICRO 26/6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629564S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD CURVED 14 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,822.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,822.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2408-74|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD CONTACT 8 MRI AVISTA 74CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 34MM FRS TI FOREFOOT ST CNN 2 THRD HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLP50230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATING WEDGE OPEN ANCHORAGE RIGHT 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM FRS TI FOREFOOT ST CNN 2 THRD HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00-8757-058-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM TM MULTI HOLES 56 MM SIZE II PORO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8851-013-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM VIVACIT-E NEUTRAL LL 40 X 58 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGX310|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE CONNECTOR AXOGUARD 3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1938BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUTURETAK BIO-COMPOSITE 3.0MM KNOTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2811|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TWIST OFF 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54850016550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 6.5MMX50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850015535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER 5.5 X 35 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8880823|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE EXPANDABLE INTERBODY LORDOTIC EXTRA 8X23X10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 19MM 50MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TWIST OFF 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5542-K-0052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,016.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWD063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN ALIGNMENT 02.5MM L 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|365.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWE513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID AEQUALIS PERFORM KEELED M40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,938.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,938.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.363.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX SLF-TPNGWITH STARDRIVE RECESS TI 2.0MM X 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN WITH T6 STARDRIVE RECESS TI 2.0MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSP0616MFS|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM SINUPLASTY BALLOON SPIN PLUS 6X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0028-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION ACUTRAK ACUTWIST 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4155P-3010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DART PEEK 10 DEGREE 3X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 58MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported VST02|SUP|HCPCS C9250||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|KIT TISS CLSR VISTASEAL FBRN SLNT 1ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|338.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|338.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ALN-RHI-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL ALIGHN 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SR PIP-3|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER PIP PROXIMAL SIZE 3|1|HUMANA [1294]||HUMANA [11839]|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2653CR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE FRAC CENTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8757-058-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR CONTINUUM METAL TRABECULAR WITH CLUSTER HOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136551000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +1.5MM 12/14 TPR 36MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8751-013-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL POLY CROSSLINKED HIGHLY LONGEVITY 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP11342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE MTP V2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD ANCHORAGE 3.5MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TWINFIX ULTRA 2.8 WITH NEEDLE 2-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,033.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102220S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 155MM CMNTLS SMT DUOFIX HA 7 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71102218S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL DELTA CERAMIC TS 12/14 36MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,973.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,973.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55407|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CUFF AORTIC RENU FLEX ZENITH 28MM X 62CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,596.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,596.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-03-138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING 5.0 X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-00-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET HUMERAL RSP SZ 36MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-00-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET HUMERAL RSP SZ32MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCN-S260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RECON RHEAD NON-COATED SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,064.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,064.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 155MM CMNTLS SMT DUOFIX 7 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1927BCFT-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW BIOCOMPOSITE FT 4.5MM W/TIGERTAIL #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH SZ-C RIGHT MEDIAL LEFT LATERAL P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 1-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PRECOAT RT MEDIAL LEFT LATERAL SZ-1 UNI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION AUTOFIX T7 DR 2.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141-2013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION AUTOFIX MOD T7 DR 2.0X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,416.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55714|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT DRAINAGE - FUHRMAN 6.0 FR PIGTAIL CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55724|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY - DRAINAGE FUHRMAN 8.5 FR PIGTAIL CATHETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM X L32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WS16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP OFF LG 2MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF.200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL1UT-20.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TRULIGN TORRIC BL1UT 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.160S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 11MM/130 RIGHT 400\MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.129S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA380MM LEFT 11MM/125 DEG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8754-013-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM LONGEVITY 36 X58MM 7MM OFFSET LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL COCR 6 DEG 36MM +7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06030ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06080ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06150ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07060ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 7X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06040ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06100ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07030ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 7X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07080ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 7X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06060ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C06120ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 6X120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C07100ML|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMARTSTENT 7X100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 4.0MMXL20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CAR-10-US|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARTIVA 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 4.75 X 60 MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71103214S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71103216S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-005-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 18MM TIB E-F FEM 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840005540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 5.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840006535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY 6.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5X60MM|1|HUMANA [1294]||HUMANA [11839]|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 12.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 12.0S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL LIPPED AP DURATION DURACON 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86LL0006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOPURE BICORTICAL 6MM CT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,044.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,044.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFNS0808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE NITINOL 8 X 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.255|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.260|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.265|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.290|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.295|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.300|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U60|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U65|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U70|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U75|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U80|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0U95|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.100|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.105|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.115|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.120|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.125|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.135|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41113013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION MTP 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.140|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMT3030|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL THICK GENTRIX 30CM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|66,420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66,420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416610|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 10 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-0107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FORTEX 8.25 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001098|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RADIUS CONTINOUS 5.5MM X 90MM|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14960|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT PC M/L|1|HUMANA [1294]||HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110030401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL PROXIMAL RIGHT 4HOLE X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LP T15 3.5X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588TN|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE ABS IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.110|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACRYSOF RESTOR 2.5 APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-1514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LID CHAIN 1.4 GRAM PLATINUM|1|HUMANA [1294]||HUMANA [11839]|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10414|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TOE JOINT PC LG|1|HUMANA [1294]||HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TI-113032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL VRSDL 42X18X46 TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,899.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,899.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRIMARY 10MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1100-30-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY ANT UNITE GLOBAL 135 SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110048510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNITE GLOBAL 48MM X 18 STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113048995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEG ANCHOR STEPTECH GLOBAL SZ48 +5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,509.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,509.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627648S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR LATERAL DISTAL 18 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.060|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.065|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.070|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.075|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.080|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.085|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.090|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9.095|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-7.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 32MM FRS TI FOREFOOT ST CNN 2 THRD HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN6AT8-7.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-8.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-8.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-9.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT8-9.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-6.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-6.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7.070|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-7.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-8.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT7-9.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACRYSOF TORIC IQ 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-6.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +6 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-7.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +7 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-8.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-8.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT6-9.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +9.5 DIOP +3.75 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27617015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CANCELLOUS CHIPS 15CC FROZEN|1|HUMANA [1294]||HUMANA [11839]|62.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013464-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ARMADA 18 .018 2.5MM X 120MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ARMADA 18 .018 5MM X 100MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P3032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1013465-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ARMADA 18 .018 3MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON ARMADA 18 .018 3MM X 40MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180253060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM TMX SM RDC HD HIP CANC SLF DRL ST CNN LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|477.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 663446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION SOLID 4.0/46L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION SOLID 5.0/46L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF.210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 21.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF-21.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 21.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF-22.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180253055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 55MM TMX SM CANC SLF DRL CNN LG RDC HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|477.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 180416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMOPONENT PATELLOFEMORAL MCK RESTORIS SZ6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL TRIATHLON TS PLUS X 3 POLY SZ 8-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL1UT-18.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TRULIGN TORRIC BL1UT 18.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1802-53-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM TMX SM HIP CANC SLF DRL CNN LG RDC HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|477.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 340658|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAP CORTICAL 4.5MMX58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0928S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL 9MMX280MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING THREAD FULL T2 4MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT150200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TECNIS SYMFONY TORIC 20.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800429|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 4 20MM RL/LM KN TIB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,597.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 700-010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY I-FACTOR 1.0CC SYRINGE|1|HUMANA [1294]||HUMANA [11839]|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 700-025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY I-FACTOR 2.5CC SYRINGE|1|HUMANA [1294]||HUMANA [11839]|3,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 3.5MM/L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657348|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM ST 15MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481500801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 8MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-26H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION FULL THREAD 4.0X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8956R-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE METATARSSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629283|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MEDIAL DISTAL EXTENDED LEFT/RIGHT 3HOLE/L69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481501001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 10MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1826-1232S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 12X320MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT VAL 12 HOLES 1.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,441.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LOCKING SELF-TAPPING T4 1.5MM X 7mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.130.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LOCKING SELF-TAPPING T4 1.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-55-425S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THREAD SHORT 5.5X42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|895.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|895.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86ST4X07|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTJACKET RTM STD THICKNESS 4X7|1|HUMANA [1294]||HUMANA [11839]|7,194.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,194.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180735-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 5-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ICONIX 2.3MM INTELLIBRAID 2.0MM XBRAID TT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SELF TAPPING T6 STARDRIVE RECESS TI 2.0MM X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481501101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 11MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 55840005545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 5.5/6.0 505X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1554200500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 500MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9391628|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE T2 28-36 X 16MM|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS DUOFIX CEMENTLESS STD COLLAR SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS DUOFIX CEMENTLESS HIGH COLLAR SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS DUOFIX CEMENTLESS ST COLLAR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS CEMENTLESS STANDARD COLLAR SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLYAM-COM 8X16|SUP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PURAPLY AM 8X16 (128 SQ CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481501401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 14MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported YRC02N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR Y-KNOT RC WITH NEEDLES 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROFILE LOW CURVED RECONPLATE 8-HOLE 88MM RAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,484.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,484.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6360853|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER PERIMETER 8MMX15MMX13MM|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 137638000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM CEMENTRALIZER DISTAL 10.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|413.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|413.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154101000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP PROSTALAC SIZE 1 STD OFFSET 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481501601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 16MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4804|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ENDOLOGIX .035|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-3824S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL PROXIMAL LONG T2 RIGHT 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72824015S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VLP 2.7MM MTP PRIM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VLP LOCK OST 4.OMM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VLP LOCK OST 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VLP LOCK OST 4.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102211S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102214S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT150165|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 TECNIS TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481501801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 18MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71103336S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED HEADLESS 3.0MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938047520130|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPRESS LD 5MM X 17MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293081230|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 8MM X 120MM X 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM14060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT FLUENCY 13.5 X 60 X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-90/120-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-90/120-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55714|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - PIGTAIL 6.0 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD3369-40C|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ASSURA MP ICD V PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3525-1320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 11 X 320 X 125 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481502001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 20MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42511000411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 11MM TIB C-D FEM 3-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-004-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 14MM TIB C-D/ FEM 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-PPDY-850-IMH|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - PIGTAIL 8.5 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T10 FULL THREAD 3.5MM/L8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481502201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 22MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 700-050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY I FACTOR 5CC SYRINGE|1|HUMANA [1294]||HUMANA [11839]|5,355.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,355.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PELVIC CORTEX SELF-TAPPING 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTERX TI 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|87.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|87.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED OFFSET HIGH C-STEM AMT SZ3 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ASNIS MICRO CANNULATED 3.0 30/6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT-00001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SMALL HAMMERTOE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00481502401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 24MM SS CORT ST HEX HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 197528085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY PROXIMAL CONICAL RECLAIM 28 X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297500645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAR TENSILE ASSEMBLY RECLAIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,167.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,167.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRC02STA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR Y-KNOT WITH TAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZKB00225|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER TECNIS MULTI FOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990-035-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL ONLY SZ E 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 20-8000-000-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEAD HEX 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|175.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT225-21.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TECNIS SYMFONY TORIC 21.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF-22.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 22.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF-25.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF PH/IOL CLEAR 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A219|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|GENERATOR - EMBLEM S-ICD MRI PULSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 85413|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPANDABLE ATRIUM ICAST BALLOON 6MM X 59MM X 120CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,908.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-200|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - ARMADA 18 5.5 MM X 200 MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9391322|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ALTITUDE T2 13 X 22 MM|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70011|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SINUS REGULAR BIOABSORBABLE PROPEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60011|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SINUS MINI BIOABSORABLE PROPEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1910-1272S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SONICANCHOR KIT 2.5MM X 10MM/FORCE FIBRE #2-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,734.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,734.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.161|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 115MM SS 4.5/5MM SCR SM FRAG SET 6 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,190.72|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,190.72|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-2923BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR BIOCOMP PUSHLOCK 2.9 X 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71932912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR RESURFACING JOURNEY 32MM 7.5 THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NONPOROUS JOURNEY SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR DISH DEEPJOURNEY A/P42MM/ML60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8758-012-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER CONSTRAINED POLY LONGEVITY CONTINUUM 32MM SZKK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8758-012-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER CONSTRAINED POLY LONGEVITY CONTINUUM 28MM SZKK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC OPTION BIOLOX 32MM +7/5 DEG12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010-12-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110005093|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR JUGGERKNOT 2.9 WITH CUTTING NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0234010162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSTEON 7MMX23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 55MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1419775|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED LARGE 6.5MM 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DBP-125MICRO145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 1.25MM MICRO 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 3.5MM X 30 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7753870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-150SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 1.50MM SOLID 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-125MICRO60|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 1.25MM MICRO 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-200CLASS145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 2.00MM CLASSIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-125SOLID60|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 1.25MM SOLID 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-200SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 2.00MM SOLID 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-125SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 1.25MM SOLID 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-150CLASS145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DIAMONDBACK 360 1.50MM CLASSIC 145CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206070670|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHARGER - 7.0 X 60 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186300610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE - 3MM X 60MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032300610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FG STERLING OTW 3.0 X 60 X 150 (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186250610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE - 2.5MM X 60MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC141400|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 14.5MM XCLDR LOPRFL CNTRLT LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939186301010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE 3MM X 100MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148201590|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STERLING SL OTW 2 X 150 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHARGER 6.0 X 20 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186251010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE - 2.5MM X 100MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939134152010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ES OTW 1.5MM X 20MM X 142CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148201010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STERLING SL OTW 2.0 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060670|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHARGER - 6.0 X 60 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186200610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE - 2MM X 60MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148251010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STERLING SL OTW 2.5 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700309|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L OBLQ 35MM SS 2.7MM SCR MN FRAG BN FT LT ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939186201010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE - 2MM X 100MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032250610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FG STERLING OTW 2.5 X 60 X 150 (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT HUMERAL CONDYLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,329.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,329.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ULNA SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,052.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,052.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414992|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE SMALL 6MM|1|HUMANA [1294]||HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L OBLQ 35MM SS 2.7MM SCR MN FRAG BN FT RT ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 9P15-PA01-W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC HEMICAPDF-P THK3.6MM 02 1.5MM OFST MDLR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W03080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 3 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 4 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 5 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 6 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W03120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 3 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 4 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05150135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 5 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06150135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 6X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1865-12-028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE EAGLE 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,565.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,565.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AB35W03150135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 3 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04150135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 4 X 150 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 5 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 6 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W03200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 3 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04200135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 4 X 200 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 6 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 7 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 4 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05040135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 5 X 40 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1865-50-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING EAGLE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 6 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 7 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W04060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 4 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W05060135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 5 X 60 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W06080135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 6 X 80 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB35W07120135|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVERCROSS 7 X 120 X 135|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5110-005-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 13MM TIB E-F FEM 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EVANS WEDGE 12X22X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2865-30-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION EAGLE|1|HUMANA [1294]||HUMANA [11839]|390.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136528730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 12/14 28MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PELVIC CORTEX SELF-TAPPING 3.5x65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PELVIC CORTEX SELF-TAPPING 3.5X75mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PELVIC CORTEX SELF-TAPPING 3.5x55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECON CURVED PROFILE LOW 3.5/88MM RAD/12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,730.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,730.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404231|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTH PENILE PUMP MS PRECONNECT PENOSCROTAL 700 CX 15CMX12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,477.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,477.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MOLD HIP W/REINF 17X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR NK STG1 SLCT +6MM HIP SPCR MLD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628547S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 7 HOLE/ 20MM /LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T46|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 4.75MM X 6.22MM (FRESH FROZEN)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,481.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627490|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL ANTEROLATERAL DISTAL RIGHT 10-HOLE/178MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,712.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,712.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-5223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 52 23 MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED STRAIGHT MRS REVISION 17MM X 127MM BODY POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T57|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 5.75MM X 7.22MM (FRESH FROZEN)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,481.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,481.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 5-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PRECOAT LT MEDIAL RT LATERAL SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH PRECOAT SZ-F LT MEDIAL RT LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS DUOFIX CEMENTLESS STD COLLAR SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DVFB1D1|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|VISIA AF MRI VR SURESCAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DVFB1D4|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|VISIA AF MRI VR SURESCAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PFO-035|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER - AMPLATZER PFO 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9-PFO-025|SUP|HCPCS C1817||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER - AMPLATZER PFO 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL 3 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACYURE PLT CORTICAL 3.5X26MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14130NL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MMX 30MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLT CANCELLOUS 4.0X32MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLT CANCELLOUS 4.0X36MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLT CANCELLOUS 4.0X40MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLT CANNELLOUS TI 4.0X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SIMPLICITI NUCLES SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,315.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,315.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 2.7MM 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 431185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CMNT 64MM STG1 HIP SIL SPCR HD STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD STEM HIP 17 X 200MM W/REINFORCEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 3-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD LEFT 2.7MM 15HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25424S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD LEFT 2.7MM 11HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE QUARTER 23MM 3 HOLE WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|189.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25428S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD LEFT 2.7MM 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25432S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD LEFT 2.7MM 5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25436S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW LEFT 2.7MM 15HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25444S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW LEFT 2.7MM 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25448S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW LEFT 2.7MM 5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMB1D1|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|AMPLIA MRI CRT-DIS-1/DF-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMB1D4|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|AMPLIA MRI CRT-DIS-1/DF4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DDMB1D1|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|EVERA MRI XT DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMB1Q1|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|AMPLIA MRI CRT-D IS4/DF1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 31MMX1MM SS MN FRAG 4 HL COLR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|197.76|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|197.76|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25422S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD RIGHT 2.7MM 15-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25426S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD RIGHT 2.7MM 11-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25430S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD RIGHT 2.7MM 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25434S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL STD RIGHT 2.7MM 5-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25438S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW RIGHT 2.7MM 15-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25442S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL VOLAR XXL NARROW RIGHT 2.7MM 11-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 39MMX1MM SS 2.7MM SCR MN FRAG 5 HL COLR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.43|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|227.43|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 52-27716E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PARTIALLY THREADED 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27718E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PARTIALLY THREADED 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27720E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PARTIALLY THREADED 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27722E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PARTIALLY THREADED 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27724E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PARTIALLY THREADED 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27726E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PARTIALLY THREADED 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27716E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 PARTIALLY THREADED 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27718E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 PARTIALLY THREADED 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27720E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 PARTIALLY THREADED 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27722E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 PARTIALLY THREADED 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 47MMX1MM SS MN FRAG 6 HL COLR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|247.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 53-27724E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 PARTIALLY THREADED 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-27726E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T7 PARTIALLY THREADED 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-20616E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING T7 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-20618E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING T7 2.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-20620E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING T7 2.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-20622E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING T7 2.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-20624E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING T7 2.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-20626E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG LOCKING T7 2.0MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|339.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|339.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-P-0040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 55MMX1MM SS 2.7MM SCR MN FRAG 7 HL COLR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|257.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|257.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RM*RS5F16PA|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT - TERUMO 4/5FR SLENDER RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-5023|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - TERUMO JACKY 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MC*PV2815Y|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TERUMO 2.8 CM PROGREAT W/O WIRE 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-5024|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - TERUMO SARAH 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ADM RESTORATION INSERT X 3 28MM/28/50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-005-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 18 MM TIBIA E-F/CR FEMU4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE .25 TBLR 63MMX1MM SS MN FRAG 8 HL COLR BN FT/ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|267.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200347901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TALAR INBONE 10MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220220904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME TALAR INBONE SZ 4 SULCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,133.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,133.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33655407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INIFINTY SZ4+ 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL INFINITY SZ 5 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 45MM SS 2.7MM SCR MULTIFRAGMENT 7 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|189.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-2657DL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICAL DISTAL 8 HOLE LEFT SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP10-1214606|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER STEALTH CERVICAL 12X14X6 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4208-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROSTOP SUBTALAR ARTHROERESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TEXP120RUH|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST ARTOURA HIGH ULTRA PROFILE 535CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 32MM SS 2.7MM SCR MN FRAG BN FT LT ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00493501601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP 3.5 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493502401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP 3.5 X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00236902035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING IT 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0202263301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TROC LEFT NARROW NCB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,689.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,689.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS CEMENTLESS STANDARD COLLAR SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0115312|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D LEFT X-LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|608.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|608.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00492700308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 32MM SS 2.7MM SCR MN FRAG BN FT RT ANKL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|166.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0115322|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D RIGHT X-LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,975.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,975.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341157|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE LOW HEIGHT MOD PLUS 255CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341257|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE LOW HEIGHT MOD PLUS 330CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341207|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY SHAPE LOW HEIGHT MOD PLUS 290CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-2032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON TWO-LEVEL 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL LONG LOCKING RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,314.47|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,314.47|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00584209408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 4-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORALCR II JOURNEY OX NP LT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR DD XLPE JOURNEY LT SZ 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG 76MMX2MM SS 2.7/3.5MM CORT SCR LCK LCP BN CALC LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,314.47|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,314.47|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74022221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIA JOURNEY NP LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39311-0825|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - EXPEL 8FR LOOP TYPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-2021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RECON RHEAD PLASMA COATED SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,018.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,018.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RCN-H4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HEAD RADIAL BIPOLAR #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5850-043-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT XT FEMORAL DISTAL SZ C RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,517.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,517.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5850-013-96|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT XT POLY SEGMENTAL SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5850-030-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR POST HINGE SEG SZ C 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60MMX1.2MM SS 3.5MM CORT 4MM CANC 3.5MM CNN SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.17|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,636.17|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5852-050-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM FLUTED PRECOAT STR 11MM 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,757.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,757.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5852-040-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAR STEM TM 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT HALF TIBIAL PRECOAT SIZE 3 15MM LL/RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETAB OSSEOTI G7 MULTI HOLE CEMENTLESS 56MM/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR WALL HIGH E1 40MM/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180736-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 6-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 70MMX1.2MM SS 3.5MM CORT 4MM CANC 3.5MM CNN SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,670.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,670.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZMB00U0145|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ASPHERIC MULTIFOCAL 14.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZMB00U0150|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ASPHERIC MULTIFOCAL 15.0 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZMB00U0155|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ASPHERIC MULTIFOCAL 15.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241507|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15X14.1CM SLX LM P5.8CM CNTR MDRT PRFL MDRT PRJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DS2C020|SUP|HCPCS C1893||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - CPS DIRECT UNIVERSAL 47CM -135 LEFT SIDED OUTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062502220|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ACCESS URETERAL HD NAVIGATOR 11/13F X 36CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0062502230|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ACCESS URETERAL HD NAVIGATOR 11/13F X 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 521-07-254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED ALL-POLY E-PLUS 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL 54MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3241457|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.5X13.7CM SLX LM P5.6CM CNTR MDRT PRFL MDRT PRJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1553201080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416609|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14X16X9 6DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-006-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 12MM TIBIA G-H/CR FEM 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136540730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC TS DELTA 12/14 40MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 11MM X 360MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15390|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.3M PROFYLE LOCK 3-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA25-110/I16-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX2 25-110/I16-30|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 2.3MM ICONIX INTELL 2 STRANDS #2FORCE FIBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,667.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,667.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 36MM X 56MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZKB00230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER TECNIS MULTI FOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT150205|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 TECNIS TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1226-7101-003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID LARGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2070-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - ARMADA 35 7MM X 120MM X 135CM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2080-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - ARMADA 35 8MM X 120MM X 135CM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - ARMADA 18 5.5MM X 120MM X 150CM PTA OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1845-1036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL RECON RIGHT R1.5 10 X 360 MM X 125|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANN 4.0MM/L 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-00-432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET HUMERAL RSP SZ32MM STD +4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-08-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE 8MMX108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IJS-ELB-BPA|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE IJS-E BASE ASSEMBLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35260-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW, POLYAXIAL NON LOCKING 3.5MM X 26MM, TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35300-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW, PLOYAXIAL NON LOCKING 3.5MM X 30MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IJS-EAP-25450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN IJS-E 2.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TV-IL1414100-J|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOGRAFT OVATION LIMB ILIAC 14 MM X 100 MM|1|HUMANA [1294]||HUMANA [11839]|14,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7270541|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL CORNERSTONE 5X14X11MM|1|HUMANA [1294]||HUMANA [11839]|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5988-06-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL SZ 6 10MM PRECOAT NEX GEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING LO-PROFILE 2.7 X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963AR-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTEROLAT DIS TIB SS 4 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7035-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT I FUSE SI-BONE 7.0MM X 35MM|1|HUMANA [1294]||HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P2813|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TWIST OFF 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P2814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TWIST OFF 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D7T20282CT|SUP|HCPCS C1731||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - TRICUSPID/HALO XP 7F 2-8-2MM 110CM|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-006-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC TIBIAL FIX BEARING UC RT 14MM TIBIA G-H/CR FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5966-006-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL CR SIZE 6 GRN 14MM NEXGEN (FEM C-H)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 2.5MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP40280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE UTILITY STRAIGHT 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD ANCHORAGE 3MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW STANDARD ANCHORAGE 3MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK101010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 10X10X10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 41110002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP STANDARD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,063.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,063.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72203697|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEALICOIL RSB SA 4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 7 HOLE RT.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE-BENT 60MM|1|HUMANA [1294]||HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL FRICTION LOW 26MM+0MM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-4004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL REUNION RSA X3 40MMX4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1226-7101-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID LEFT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201024016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK TI 2.4X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,101.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,101.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201120020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NONLOCK TI 2.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 4.0MM/XL34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.468|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR EXTRA ARTICULAR 4 HOLE HEAD 5 HOLE SHAFT LEFT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,216.52|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,216.52|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported L98013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM REVISION CORAIL STD SZ 13 135DEG 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032300690|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - STERLING .018 3 X 60 X 90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148301010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - STERLING .018 3 X 100 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032406080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - STERLING .018 4 X 60 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220220901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME TALAR INBONE SZ 1 SULCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,133.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,133.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAY TIABIAL INFINITY SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220220903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME TALAR INBONE SZ 3 SULCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,133.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,133.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK121010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 12X10X10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 4.0MM 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G408319|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER - AGILIS NXT STEERABLE 61CM 8.5F - MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G408318|SUP|HCPCS C1766||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER - AGILIS NXT STEERABLE 61 CM 8.5F SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 710.050.97S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE CHRONOS BETA-TCP 10 DEGREE RECTANGULAR|1|HUMANA [1294]||HUMANA [11839]|1,905.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,905.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-5051-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LO-PRO 4 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LO-PRO 4 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951234|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 12X34X24MM 12 DEGREE|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8594530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XLR-R CORENT 4.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1027S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL STANDARD T2 10MMX270MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 710.052.97S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE CHRONOS BETA-TCP 18 DEGREE RECTANGULAR|1|HUMANA [1294]||HUMANA [11839]|2,145.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5791-041-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093977|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 4 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094157|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 4.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094156|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 3.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10009069|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T 5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH PRECOAT SZ-E LTMEDIAL RT LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 2-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094158|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 5.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM CMNTLS SMT DUOFIX 4 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 89866|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 6 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094159|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 6.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10009070|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T 7 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094160|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 7.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093979|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 8 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094161|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 8.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093980|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 9 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094162|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 9.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10009071|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T 10 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094163|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 10.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 54MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10093981|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 11 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094164|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 11.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093982|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 12 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094165|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 12.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093983|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 13 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094166|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 13.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093984|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 14 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094167|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 14.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10009072|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T 15 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094168|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 15.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,968.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10093985|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 16 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094169|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 16.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093986|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 17 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094170|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 17.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093987|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 18 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094171|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 18.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10093988|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 19 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10094172|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T CUSTOM 19.5 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10009073|SUP|HCPCS C2616||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERASPHERE - Y-90T 20 US COMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35MJ-501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE MITRAL ROTATABLE 35MM|1|HUMANA [1294]||HUMANA [11839]|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported R020|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTERY FEM-POP CRYOLIFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8880923|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE INTERBODY EXPANDABLE LORDIC EXTRA 23 X 9 X 10|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 3-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N3-0024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADLESS 3.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-73075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPRESS-B-I LD PMTD 7.0X30X75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-84075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPRESS-B-I LD PMTD 8.0X40X75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38046-86075|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPRESS-B-I LD PMTD 8.0X60X75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-64013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPRESS-B-I LD PMTED 6.0X40X135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 38047-74013|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - EXPRESS-B-I LD PMTD 7.0X40X135 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293054030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 5 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293056030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 5 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39293-05803|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - INNOVA 5 X 80 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR-1L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING CIONNI MR-1L RIGHT SIDE|1|HUMANA [1294]||HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293051030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 5 X 100 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293051230|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 5 X 120 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293060230|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 X 20 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293064030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 6 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293076030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 7 X 60 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293084030|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 8 X 40 X 130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939293086070|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT INNOVA 8 X 60 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LPA1200M-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD - TENDRIL MRI - 58CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.061|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 84X10.1X3.5MM TI 3.5MM SCR SM FRAG SET 6 HL RECON LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,601.79|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,601.79|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LPA1200M-52|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD - TENDRIL MRI 52CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LPA1200M-46|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD - TENDRIL MRI 46CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM1272|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER - ASSURITY MRI SR-RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,388.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,388.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM2272|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER - ASSURITY MRI DR-RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,158.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,158.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531G811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL CS TRIATHLON X3 SZ8-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206050670|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 5.0 X60 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206100270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 10.0 X20 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206120270|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 12.0 X20 75CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206040610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 4.0 X60 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 52MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939206060210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 6.0 X20 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206030410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 3.0 X40 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206060410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 6.0 X40 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39206-07061|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 7.0 X60 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206071010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 7.0 X100 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510F101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 1 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-12-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE 12MMX108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1519320|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX RTU TISSUE SELECT ALLODERM 16X20CM THICK SELECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1520P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX RTU TISSUE SELECT ALLODERM CONTOUR MED PERF THICH 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM CMNTLS SMT DUOFIX HA 4 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1217-00-158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTRESS REVISION ACETABULAR GRIP PINNACLE 56MM NEU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,983.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,983.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANCELLOUS FLAT HEAD 6.5X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.232H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD CERAMIC MEDACTA 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.240A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER SLEEVE TAPER12/14 SZ SM -3MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATF-200-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FUSION ACUTRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 30MM PNCL GRIPTION TF DOME 4 PNT CUT FLUT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121725800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TF GRIPTION 5.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT150065|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TECNIS SYMFONY TORIC 6.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACU-LOC VDU LEFT LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-22E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR CONSTRAINED TRIDENT SZ E 22MM O DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628556S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 6 HOLE 20MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP SECTOR II PINNACLE 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939134152010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE ES OTW 1.5MM X 20MM X 142CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939134202010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE ES OTW 2MM X 20MM X 142CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939134204010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE ES OTW 2MM X 40MM X 144CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186200610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE 2.0MM X 60MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186200810|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE 2.0MM X 80MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186201010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE 2.0MM X 100MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939134252010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE ES OTW 2.5MM X 20MM X 143CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186250610|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - COYOTE 2.5MM X 60MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186251010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE 2.5MM X 100MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186251210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE 2.5MM X 120MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM 16MM 11MM LATERALIZE NK CMNTLS SR CERM +4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939134302010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE ES OTW 3MM X 20MM X 143CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186301210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE 3.0MM X 120MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939186401210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COYOTE 4.0MM X 120MM X 150CM OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148251210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FG STERLING SL OTW 2.5MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032300410|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING OTW 3.0X40X150 (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148301210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING SL OTW 3.0MM X 120MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032402010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING OTW 4.0MMX20MMX135CM (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032404010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING OTW 4.0MMX40MMX135CM (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939148408010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING SL OTW 4.0MM X 80MM X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032502010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING OTW 5.0MMX20MMX135CM (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3MM 11/13 TPR 36MM HIP M SPC MTL SR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,004.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939032501010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING OTW 5.0MMX100MMX135CM (4F)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939032501210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - FG STERLING OTW 5.0X120X150-HYBRID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1456Q/86|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD - QUARTET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE STANDARD 3MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-15092|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,232.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,232.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FT 2.4MM/L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FT 2.4MM/L26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FT 2.4MM/L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FT 2.4MM/L16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626893|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CROSS LEFT LAPIDUS LOCKING AXIAL POLY T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING 13.5MM 5MM SR ZT 16D LG HIP POR MDLR SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 626826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CP 04.1MM,L26MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FT 2.4MM/L14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFS-101513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STAPLE 10X15X13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122869|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 41MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLATE CORTICAL 3.5X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14128NL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TITANIUM 3.5MMX28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLATE CANCELLOUS 4.0X38MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-14242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLATE CANCELLOUS 4.0X42MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-36-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|99.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|99.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-14244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRACTURE PLATE CANCELLOUS 4.0X44MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2290|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SYSTEM PROXIMAL TENODESIS 10029328|1|HUMANA [1294]||HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVOLUTR-34-US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AORTIC TRANSCATHETER EVOLUT US 34 MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPK0122|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSPACE KNEE HIGH MEDIUM REL|1|HUMANA [1294]||HUMANA [11839]|11,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3660CONTRLSYS|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR IP W/PAT CONTROLLER 5 ELITE PROCLAIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5511-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REPAIR IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8153-41-018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 521-07-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED ALL-POLY E-PLUS 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET THICK 50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122875|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIMPLICITI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI 120MMX5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,617.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840005535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 5.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35351|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 34MM X 161MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G38190|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TAPERED PROX ENDOVASCULAR THORACIC ALPHA ZENITH38-34-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2271|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT REPAIR AC ACUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23014E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23016E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CRUO14SA|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - CROSSER PERIPHERAL CTO 14S 146CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SD110ATG|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - SUPPORT SIDEKICK ANGLE TAPER 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SD110TG|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - SUPPORT SIDEKICK STRT TAPER 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF-0250|SUP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TISSUE PLACENTAL HUMAN AMNIOFILL 250MG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMUR DISTAL LATERAL LT 6 HOLE /L166MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23024E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58-23026E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING SELF TAPPING 2.3MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206071510|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - CHARGER 7.0 X150 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 4-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 814118007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 153MM TMX 7 HL PILON PERI BN TIB DIST MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6287541|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END CAP 5X14X11MM|1|HUMANA [1294]||HUMANA [11839]|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,329.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIA JOURNEY NP LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT DISH DEEP JOURNEY II XLPE LT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC OPTION BIOLOX 36MM 0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0030303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 90X7.7MM LTD EV TI SM STD SQ ELB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DKY212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPOOL HUMERAL ELBOW LATITUDE SZ PETITTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,358.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,358.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401023M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH - CORDIS 10FR BRITE TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-5022|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - SARAH RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1895-5080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CONDYLE T2 5MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 144170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACK PIN BONE 4MM X 170MM 2-PK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD STEM HIP 13 X 145MM W/REINFORCEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 13.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 13.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-0147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CLAVICLE DUAL-TRAK 3.8MMX120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,889.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1655PS-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS PEEK 5.5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6626528|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE INTERBODY STAND-ALONE 6DEG 8 X 15 X 12MM|1|HUMANA [1294]||HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35220-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW, PLOYAXIAL NON LOCKING 3.5MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35280-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW, PLOYAXIAL NON LOCKING 3.5MM X 28MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6623513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWS PACK (2 EA) VA 3.5 X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,508.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,508.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP10-1214607|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 12X14X7 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-4072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON FOUR-LEVEL 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635WU21060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE - CLOSURE WATCHMAN LLA 21MM|1|HUMANA [1294]||HUMANA [11839]|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635WU24060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE - CLOSURE WATCHMAN LLA 24MM|1|HUMANA [1294]||HUMANA [11839]|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635WU27060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE - CLOSURE WATCHMAN LLA 27MM|1|HUMANA [1294]||HUMANA [11839]|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635WU30060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE - CLOSURE WATCHMAN LLA 30MM|1|HUMANA [1294]||HUMANA [11839]|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M635WU33060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE - CLOSURE WATCHMAN LLA 33MM|1|HUMANA [1294]||HUMANA [11839]|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AB14W020060150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON NANOCROSS ELITE 2.0 MM X 60 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - ARMADA 18 5.0MM x 20MM x 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625-0T-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT ALUMINA 0-DEGREE 28MM SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6260-7-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL TAPER ALUMINA 28MM +0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,454.85|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,454.85|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D7L1012RT|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LASSO - 12MM FIXED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported N60001072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CONTINUOUS RADIUS 5.5MMX100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16185540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK MOD MAS RELINE 5.5 X 40MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16186535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK MOD MAS RELINE 6.5 X 35MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16015545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 5.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 40MM LORDOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16171111|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TULIP RELINE MOD|1|HUMANA [1294]||HUMANA [11839]|4,077.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,077.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13550000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK RELINE TULIP OPEN 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.460S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 14MM 130 DEG 400MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-17-103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y HF LOCKING SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,626.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported U128|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER CARDIAC RESYNCHRONIZATION THERAPY VALITUDE X4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 FT 2.4MM/L12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T10 FULL THREAD 3.5MM L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM DISTAL STS REVISION MOD ARCOS 16MM/150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11301302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONE PROX BODY SIZ B STAND OFFSET 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD CERAMIC OPTION BIOLOX DELTA 40MM TYPE16/18 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-2360|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM LAP BAND WITH RAPIDPORT EZ AP STANDARD|1|HUMANA [1294]||HUMANA [11839]|10,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-2365|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM LAP BAND WITH RAPIDPORT EZ AP LARGE|1|HUMANA [1294]||HUMANA [11839]|10,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587806529|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA POROUS 29MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP1045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX REGENERATION DURAL PLUS DURAGEN 4X5 IN|1|HUMANA [1294]||HUMANA [11839]|4,578.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,578.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST TPR 36MM HIP COCR V40 LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 16185535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK MOD MAS RELINE 5.5 X 35MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16015540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 5.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 35MM LORDOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4MM X28MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4MMX36MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197524075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY PROXIMAL CONICAL RECLAIM 24 X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197621190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TAPERED DISTAL RECLAIM 21 X 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 3.0MM X 40MM LONG THREADED W/CRUCIFORM RECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|738.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP 23MM X 155MM CONICAL DISTAL PLASMA MODULAR RESTORAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL HUMERUS POSTLATERAL RT 11H 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218707|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL MEDIAL 127MM LEFT 13 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-37-055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121725500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 25MM PNCL ACTB CANC STRL REV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00584209510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ5-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNI HI FLEX SZ G LM-RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE FULL FEMORAL POROUS UNIVERSAL 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,755.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,755.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129454120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE METAPHYSEAL POROUS MBT REVISION SIZE 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1987-06-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE ADAPTER LPS +5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,047.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,047.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1987-14-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL DISTAL X-SM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,505.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,505.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1987-27-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HINGE INSERT TIBIAL UNIVERSAL X-SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,819.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,819.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM UNIVERSAL FLUTED REVISION 75 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1100-12-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM STD UNITE GLOBAL SZ12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121701060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 60MM HIP PRCT PNCL 100 SER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1100-40-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY ANT UNITE GLOBAL 135 SZ12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110052510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD STD UNITE GLOBAL 52X18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113052993|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID AUGMENTED STEPTECH LEFT 52+3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,509.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,509.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET 46MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-07-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK HUMERAL NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-10-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SHORT 10MMX65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-005-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 2-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP40340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANCHORAGE UTILITY STRAIGHT 5HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLSL3528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ANCHORAGE STANDARD 3.5MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-28-109-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY FENESTRATED PROXIMAL CUSTOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-6012|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - 6FR RADIAL TIG 4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-6021|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - 6 FR JACKY 4.0 RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-6011|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - 6 FR RADIAL TIG 4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157012120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM CMNTLS SMT DUOFIX HA 6 12/14 HI OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported IH2530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 2.5MM LENGTH 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZKB00170|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER TECNIS MULTI FOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL OXINIUM JOURNEY II NP SIZE 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71932913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR RESURFACING JOURNEY 35MM 7.5 THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIA JOURNEY NP LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR DD XLPE JOURNEY II SIZE 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 5MM LOCKING 5.0MM/L46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010-13-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS CEMENTLESS STANDARD COLLAR SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MSD-010-40-026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHORT THREAD 4.0X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136553000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8.5MM 12/14 TPR 36MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LATSYS03|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT NASAL ABSORBABLE LATERA W/DELIVERY DEVICE|1|HUMANA [1294]||HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 1 -10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-043|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE CANNULATED PHALINX LARGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC DELTA 11/13 32MM +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,835.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9532|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BARRIER MICROPLATE CHANNEL IMPLANT 40 X 52 X 2.3MM|1|HUMANA [1294]||HUMANA [11839]|2,930.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,930.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAS0541|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SCHANZ 4.0MM|1|HUMANA [1294]||HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T50101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTON DBF 1CC|1|HUMANA [1294]||HUMANA [11839]|1,197.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,197.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM RADIAL LATERAL SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RADIAL HEAD LATERAL SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,511.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,511.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK141212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 14X12X12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK988|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 9X8X8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8162-35-008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MM LOCKING COM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|549.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-37-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG1040|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NERVE PROTECTOR AXOGUARD 10MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT525-15.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 TECHNIC TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZLB00165|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER TECHNIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR VIT E PERSONA MC LEFT 13MM/G-H FEMUR/CR SZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840007545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 7.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFB-24-74|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 24MM X 74MM ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840007535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 7.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS MICRO 2.0MMX15/6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMA1QQ|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|QUAD - CLARIA MRI - DTMA1QQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMA1Q1|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|QUAD - CLARIA MRI - DTMA1Q1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMA1D4|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|QUAD - CLARIA MRI - DTMA1D4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DTMA1D1|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|QUAD - CLARIA MRI - DTMA1D1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121828748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONSTRAIN POLY GVF PINN +4 10 DEG 28X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.112S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 11MM/125 DEG 170\MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-004-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 11MM/C-D FEMUR/CR SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G38180|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TAPER PROX ENDO THORACIC ALPHA ZENITH38-34-167|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G38208|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TAPER PROX ENDO THORACIC ALPHA ZENITH44-40-179|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1342S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL SUPRACONDYLAR T2 13MM X 420MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NMRM6133|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENVELOPE NEURO ABSORABLE ANTIBACTERIAL-LARGE|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT-00002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157002090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM CMNTLS SMT DUOFIX 3 12/14 STD OFST TPR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,820.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 39206-10087|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 10 X 80 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206081070|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 8 X 100 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A-10.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1-9.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACRYSOF RESTOR 6.0MM APODIZED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BMM0710|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BURN MESHED MATRISTEM 7 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 14MM 39MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1227-7001-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IM(PLANT GLENOID RIGHT SIZE SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00484003600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 36MM SS FT CANC ST SM HEX HD NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X022-6530SD|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILLING FORTEX PEDICLE 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 10MM/E-F FEM/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 11MM/E-F FEM/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 926000|SUP|HCPCS C1728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE EVALUATION CAVITY MAMMOSITE|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1010-11-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS CEMENTLESS STANDARD COLLAR SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS CEMENTLESS STANDARD COLLAR SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-005-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA FB/UC LEFT 13MM/E-F FEM/CR SZ 4-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8953-065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE POW LOCKING TI 6.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1218-87-356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PINNACLE NEUTRAL METAL 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,777.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.037.163S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 11MM 130 DEG 420MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WC-0200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR IMPLATE 2MM X 0 DEGREE|1|HUMANA [1294]||HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IMP-WC-0207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR IMPLATE 2MM X 7.5 DEGREE|1|HUMANA [1294]||HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-058-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 58MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FEL10060|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - FLUENCY PLUS 10 X 60 X 117CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FEM12080|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - FLUENCY PLUS 12 X 80 X 118 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587220RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTP FUSION PLATE MEDIUM 0 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521-07-246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED ALL-POLY E-PLUS 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-060-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 60MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SND1T3-27.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-28.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VA-LCP MEDIAL DISTAL 12 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40E+3.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR +3.0 DIOPTER SENSAR IOL WITH OPTIC EDGE ACR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-062-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 62MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CD2411-36Q|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|ICD - ELLIPSE HV GENERATOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,284.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,284.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840004535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1603200500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 500MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X060-3610P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE INSERT PEEK FUSION 36MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT10-2030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-064-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 64MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 246.191|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 1.5MM 12 HOLE STAINLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1519320P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE SELECT ALLODERM DUO THICK 16X20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840005530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 5.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD 3.5MM/42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10185JP|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE - VERRATA PLUS PRESSURE - 185CM J TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-066-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 66MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.118.013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA 2.7/3.5MM VA-LCP 16 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,239.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,239.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16015550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 5.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 70MM LORDOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1200710|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX 7CMX10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1190200|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX 4X6" (10.2CM X 15.2CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 11 HOLE / L149MM X 4.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 420-050|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - TURBO POWER LASER 2.0 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423-050|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - TURBO POWER LASER 2.3 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-068-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 68MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 45301003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CANNULATED MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.061S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA 400MM LEFT 10MM/130 DEG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR40E+4.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR +4.0 DIOPTER SENSAR IOL WITH OPTIC EDGE ACR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553200500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 500MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,376.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122891|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 56MM SHLDR SFT TIS BAL SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1226-7102-003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID RIGHT SIZE LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 219467|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PIN TRACKER 2MMX 77MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6305-070-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER STANDARD I.D. 40MM 70MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,959.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SND1T3-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RM*RS5F10PA|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDESHEATH - SLENDER 5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28MC24150SN|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - MAESTRO MICRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8951ML|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LISFRANC LEFT MEDIUM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220220902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME TALAR INBONE SZ 2 SULCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,123.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,123.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33652208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ 2-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,696.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-042-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM GREEN STRIPE FEM G 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-3602-2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIBERTAK LOADED DOUBLE W/ 1.3 SUTURETAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010-11-090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS DUOFIX CEMENTLESS STD COLLAR SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9943T-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TUBULAR THIRD TI 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9943T-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TUBULAR THIRD TI 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840004540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.5X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER RESTOR MULTIFOCAL TORRI5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180735-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 5-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.255S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA 12MM/130 X340MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-12-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SHORT 12MM X 67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1113-140-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PALACOS R & G BONE CEMENT WITH GENTAMYCIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T3-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/CI/P|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA PATCH GLAUCOMA|1|HUMANA [1294]||HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1201015|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX ST RECTANGULAR 10 X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1201520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX ST RECTANGULAR 15 X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,190.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,190.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1202025|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX ST RECTANGULAR 20 X 25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|38,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|38,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1202530|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX ST RECTANGULAR 25 X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1203035|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX ST RECTANGULAR 30 X 35CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1190300|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX 6X8" (15.2CM X 20.3CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1190400|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX 8X10" (20.3CM X 25.4CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1190500|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX 10X12" (25.4CM X 30.5CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1193030|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX SQUARE 12X12" (30CM X 30CM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 90MM SELF TAPPING WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1519320PBP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE PERF REGEN SELECT ALLODERM BIL PAIR THICK 16X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61,032.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|61,032.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V010-7-7MMX64CM|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN SAPHENOUS 64CM X 7-7MM A+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926712350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926715350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926720350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.50MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926730350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.50MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926706350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.50MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926708350|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - NC EMERGE DILITATION - 3.50MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 251800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ALL SUTURE 1.8MM Q FIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N2-5010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 2.5MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HTM0400404M|SUP|HCPCS Q4126||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT MESHED MEMODERM ACD 4CMX4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,777.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,777.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702473|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COUNTERSINKE CANNULATED 4.0W/ AO FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|947.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|947.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVPROPLUS-29US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE CORE PRO+ EVOLUT AORTIC TRANSCATH 29MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR-1410|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING 14A|1|HUMANA [1294]||HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800726|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - LIFESTREAM EXPANDABLE COVERED 7MM X 26MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0284514|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - TRUE DILATATION VALVULOPLASTY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0264513|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - TRUE DILATATION VALVULOPLASTY 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611815|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - ZMED VALVULOPLASTY BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSL1633|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH - DRYSEAL 16FR 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CANBLOCK|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT (FD) BLOCK CANCELLOUS 20X20X30MM|1|HUMANA [1294]||HUMANA [11839]|1,248.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,248.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT I FUSE SI-BONE 7.0MM X 30MM|1|HUMANA [1294]||HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.461S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 14MM 130 DEG 400MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TF0243514|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - TRUE FLOW VALVUPLASTY PERFUSION 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PKS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BANDAGE CORNEAL PROKERA SLIM|1|HUMANA [1294]||HUMANA [11839]|2,847.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,847.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF1633|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER - DRYSEAL 16 FR x 33 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX22508UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.25 X 08MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX22512UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.25 X 12MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX22515UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.25 X 15 MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX22518UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.25 X 18MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX22522UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.25 X 22MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25008UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 08MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 12MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25015UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 15MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 18MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25022UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 22MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 30MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25034UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 34MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX25038UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 38MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30008UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 08MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 12MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30015UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 15MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 18MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30022UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 22MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30026UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 26MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 30MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30034UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 34MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX30038UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.0 X 38MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35008UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 08MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 12MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35015UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 15MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 18MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-048-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RONYX35022UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 22MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35026UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 26MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 30MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35034UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 34MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX35038UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 3.5 X 38MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40008UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 08MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40012UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 12MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40015UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 15MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40018UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 18MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40022UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 22MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-050-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RONYX40026UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 26MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40030UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 30MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40034UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 34MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RONYX40038UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 4.0 X 38MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122873|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 16MM 50MM SHLDR SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-052-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported RONYX25026UX|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYSTEM - 2.50 X 26MM RESOLUTE ONYX RX CORONARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-DS01BS|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM SLING DESARA BLUE SHORT SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5570|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER 5.5 FR GUIDELINER V3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5994-42-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM GREEN STRIPE FEM G LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179771095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT3000200|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER TECHNIC TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939407L0|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE - SAFARI2 .035 X 275CM - LARGE CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939407S0|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE - SAFARI2 .035 X 275CM - SMALL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-054-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CQF7566|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CONQUEST 6 X 6 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939031202210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - STERLING 2.0 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620205622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939031252210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - STERLING 2.5 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939031302210|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - STERLING 3.0 X 220 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF-0500|SUP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TISSUE PLACENTAL HUMAN AMNIOFILL 500MG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC-5350|SUP|HCPCS Q4100||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT TISSUE PLACENTAL HUMAN AMNIOFILL 3X5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T10 3.5MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|987.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|987.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONESCREW T10 FULL THREAD 3.5MM/L70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-058-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UQI00008|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SPINAL COFLEX SZ 8MM|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATF-320-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK FUSION 32.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,221.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,221.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 10MM/E-F FEMUR/CR SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ADVANCE HEALIX KNOTLESS 6.5MM BIOCRYL RAPIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 10MM/C-D FEM/CR SZ 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 2-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50011|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SINUS CONTOUR BIOABSORBABLE PROPEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350837|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT - LIFESTREAM BALLOON EXPAND COVERED 8MM X 37MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620206022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,509.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,509.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 64853311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED CURVED LG MRS REVISION 11MM 203MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249532009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 9.3MM X 32CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1200011|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX ST 11CM ROUND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,655.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,655.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00-7857-010-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL VERSYS HERITAGE 10X115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-064-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1006255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES CLIP SOFT 4.0MM X 0.6MM|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1006 543|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES TYPE BUCKET 4.0MM X 0.9MM|1|HUMANA [1294]||HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1006 545|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES TYPE BUCKET 4.5MM X 0.9MM|1|HUMANA [1294]||HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1006563|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES TYPE BUCKET 4.0MM X 1.0MM|1|HUMANA [1294]||HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1006565|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES TYPE BUCKET 4.5MM X 1.0MM|1|HUMANA [1294]||HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1006651|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES PISTON ANGULAR|1|HUMANA [1294]||HUMANA [11839]|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1006256|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES CLIP SOFT 4.25MM X 0.6MM|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 897005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SUBSTITUTE CEMENT BONE HA INJECTABLE XT HYDROSET|1|HUMANA [1294]||HUMANA [11839]|7,818.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,818.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-P-2008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION TSA PRESS-FIT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,752.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-062-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM CLUSTER HOLE 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,197.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939407XS0|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE - SAFARI 2 275 CM X 5ML CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL KIT LONG RIGHT 13 X 320 X 125 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-006-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC TIBIAL FIX BEAR UC RT 12MM TIBIA G-H/CR FEM 7-|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604665S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4 X 65MM UNSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LXMC13|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MANAGEMENT REFLUX LINX SZ 13|1|HUMANA [1294]||HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LXMC14|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MANAGEMENT REFLUX LINX SZ 14|1|HUMANA [1294]||HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LXMC15|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MANAGEMENT REFLUX LINX SZ 15|1|HUMANA [1294]||HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-050-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LXMC16|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MANAGEMENT REFLUX LINX SZ 16|1|HUMANA [1294]||HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LXMC17|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM MANAGEMENT REFLUX LINX SZ 17|1|HUMANA [1294]||HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 8-11 E-F 10MM KN RT VIVACIT-E PERSONA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR GRYPHON P BR WITH PERMACORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR MULTIHOLE PINNACLE WITH GRIPTION 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETAB POLY ALTRX PINN NEU 40MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136540710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC TS DELTA 12/14 40MM +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 36MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-048-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-5051-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 40MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 48MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558660|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 6-7-8MM 240CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00558670|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON DILATATION CRE WIREGUIDED 8-9-10MM 240CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55382|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERTER AAA RENU ZENITHFLEX 30MM X 113CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,127.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,127.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72204399|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE REGENESORB 8MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-052-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72204404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE REGENESORB 9MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING T8 FULL THREAD 2.7MM/L10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-054-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported H74939206031010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHARGER - 3.0 X 100 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206041010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHARGER - 4.0 X 100 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 56MM SHLDR SFT TIS BAL SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP10342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACHORAGE MTP V1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-056-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLSL3010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING ANCHORAGE 3MMX10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0234010160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSTEON STRYKER 6MMX23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|807.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|807.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8162-11-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING DIST TIB MED LT 12-H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,548.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,548.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP NON LOCKING 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234-110-017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX 17MM X 1.0MM|1|HUMANA [1294]||HUMANA [11839]|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-058-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7122883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 48MM SHLDR SFT TIS BAL SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 12MM/C-D FEM/CR SZ 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8161-40-080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS LOCKING 4.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816135080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8162-35-809|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL LOCKING PROX RT 9-HOLE STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-060-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CRUOS106|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - CROSSER CTO 14S OTW 106CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CRUS6106|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - CROSSER S6 CTO 106CM SFA/BTK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CRUS6A|SUP|HCPCS C1714||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - CROSSER S6 CTO 154CM BTK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SD70TG|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - SIDEKICK STRT TAPER 70CM SUPPORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SD110ATG|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - SIDEKICK ANGLE TAPER 110CM SUPPORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported USH83ATG|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - USHER ANGLE TAPER 83CM SUPPORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported USH130ATG|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - USHER ANGLE TAPER 130CM SUPPORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8150-37-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-062-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00235700706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TIBIAL MEDIAL DISTAL RT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,014.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628166|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR INCREASED 6-HOLE BRIDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 12MM/C-D FEMUR/CR SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMP TIBIAL STEM POLY LPS PS LEGACY NEXGEN SIZE3 YELL/C,D 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED OFFSET HIGH C-STEM AMT SZ5 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT10MM/C-D FEMUR/CR SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0024-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK ACUTWIST COMPRESSION 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-064-21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM WITHOUT HOLES 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.037.212S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA 12MM/125 DEG 170MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,398.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626936|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CP LAG 03.6MM,L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626894|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING POLYAXIAL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626842|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CP LAG 04.1MM,L42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16186545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK MOD MAS RELINE 6.5 X 45MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16016545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 45MM LORDOTIC|1|HUMANA [1294]||HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANN 4.0MM/L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE ICONIX FIBER FORCE #2 WITH INTELLIBRAID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,667.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,667.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E8P14|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH PERICARDIAL BIOLOGIC XENOSURE 8CM X 14CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FF491T|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP 16MM TITANIUM 2 CRAINOFIX|1|HUMANA [1294]||HUMANA [11839]|439.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|439.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5221-009-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 11MM/G-H FEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 10MM/G-HFEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570360|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY RX FC RMV US 10MM X 40MM 8.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,726.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,726.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570370|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY RX FC RMV US 10MM X 60MM 8.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,726.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,726.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00570380|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT WALLFLEX BILIARY RX FC RMV US 10MM X 80MM 8.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,726.73|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,726.73|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FF492T|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP 20MM TITANIUM 2 CRANIOFIX|1|HUMANA [1294]||HUMANA [11839]|527.16|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|527.16|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 59960710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY LPS PS LEGACY NEXGEN SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8751-013-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETAB NEU POLY CROSSLINKED HIGH LONGEVITY 40MM SZ LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7857-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED HERITAGE VERSYS 17MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877504001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL CERAMIC BIOLOX 40/3.5 5DEG12/14 40MM X +3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-5217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 52 17 MM THKNS ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802200|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL CONTOUR 6 X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 6||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 6||External grouping not supported 72204395|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE REGENESORB 7MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|792.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|792.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FF490T|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP 11MM TITANIUM 2 CRANIOFIX|1|HUMANA [1294]||HUMANA [11839]|354.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|354.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1588TN-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE ABS IM(LANT OPEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|582.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|582.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11300917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM DISTAL TAPER SPL REVISION MOD ARCOS 17MM/190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,703.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,703.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ECH470045A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TAPERED ACCUSEAL 4-7MM DIAMETER X 45MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12115122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD CERAMIC MODULAR +3 36MM TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11301342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY PROX CONE STANDARE POR PLASMA SZ B 80MM TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 10.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR AFFINITY COLLAMER SINGLE PIECE DIOPTER 10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629510S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION NARROW STRAIGHT 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ALL POLY CROSSFIRE TRIDENT 44MMX28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-46D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5542-P-0044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SELF-PRESSURIZING SIZE 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71173807|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN PF 2.0MM X 14MM|1|HUMANA [1294]||HUMANA [11839]|702.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|702.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCK S-T VLP 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCK S-T VLP 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823114|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCK S-T VLP 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71823020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX S-T 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72823220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS F-T VLP 4.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71934818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP LEFT NARROW VLP 2.7MM 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71103328S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS CANNULATED 3.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,557.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT BLOCK FULL TIBIAL SZ8 10MM PRECOAT NEX GEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-2530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 626771|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL LOCKING POLYAXIAL SHORT LEFT T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840008545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 8.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERS MC RT12MM/E-F FEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-3535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 101012090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS COLLARED HI SZ9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM UNIVERSAL FLUTED REVISION 75 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL SIGMA TC3 CEMENTED SZ5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL RP TC3 SIZE 4-17.5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1318-120-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DVR LOCK STANDARD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK SQUARE 2.7MMX24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-FSP-DU|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL ULNA PROTEAN FRAGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-4535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.111.570S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.4/2.7 VA-LCP 2-C DRP NRW6H HD/7H SHAFT/105MM/RT-STER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,860.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,860.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-0026-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACUTRAK ACUTWIST COMPRESSION 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LEAD3005-70B|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SURGICAL 70CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NIPG1500|SUP|HCPCS C1822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IPG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61,959.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|61,959.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CHGR2500|SUP|HCPCS C1822||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CHARGER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT225185|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TECNIS SYMFONY TORIC 18.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FX-410450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE TEXTURED FULL HEIGHT 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-5537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M00558330|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CRE 6-8MM X 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55824|SUP|HCPCS C2627||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET CATHETER MALECOT DRAINAGE 14 X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 310-0005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM RADIAL LATERAL COLLAR SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5568-0009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM HUMERAL REUNION RFX 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,034.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,034.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1226-7102-002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID RIGHT SIZE MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840006545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-2530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1521-21-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL ENDURANCE TAPER 12/14 SZ 2 180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,874.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,874.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA25-80/I13-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX2 25-80/L13-40|1|HUMANA [1294]||HUMANA [11839]|41,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT10MM/C-D FEMUR/CR SZ 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERUS WHOLE RIGHT|1|HUMANA [1294]||HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410520|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE TEXTURED MOD HGT EXTRA FULL 520CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249536012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 12MM X 36CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-3535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1553201030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-005-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 12MM TIBIA E-F/CR FEM 4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03260.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL NCB DISTAL 9-HOLE LT 246MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,955.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,955.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249532010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 10MM X 32CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L311|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER - ACCOLADE MRI DR IS-1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-4535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #4.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5568-0010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL FRACTURE STEM 10MM REUNION RFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 298.838S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN CERCLAGE POSITIONING THREADED 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|577.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|577.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03152.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS NCB 5.0MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234-110-015|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX 15MM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported W1TR01|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE - PERCEPTA MRI CRT-P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported W4TR01|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE - PERCEPTA MRI QUAD CRT-P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-5537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported IBI-81938|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - INQUIRY LUMA CATH - 7FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B001-0110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT PLUG SIZED #1 DIA 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136554000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 12/14 TPR 36MM HIP M SPC MTL ART/EZE STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,912.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3772 CONTRLS YS|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRODIGY MRI IPG W/PROGRAMMER AND CHARGER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-80/I20-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-80/120-40|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-008-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERS MC RT14MM/E-F FEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL SIGMA TC3 CEMENTED SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL RP TC3 SIZE 4-17.5MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BA-28-110/L16-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE UNIBODY BIFURCATED 28MM 110/L 16-30 ILIAC|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 54MM HIP SECT PRCT PNCL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3548316|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE BREAST STYLE HEIGHT TALL 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.125S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TFNA TI 11MM 125 DEG 340MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-005-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 11 MM TIBIA E-F/CR FEMU4-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 12MM/E-F FEM/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410410|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE TEXTURED MOD HGT EXTRA FULL 410CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410445|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE TEXTURED MOD HGT EXTRA FULL 445CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410470|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE TEXTURED MOD HGT EXTRA FULL 470CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410420|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE TEXTURED MOD HGT EXTRA FULL 420CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4674|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELECTRODE - ACUITY X4 SLVA IS4 PASSIVE 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR VIT E PERSONA MC LT 13MM/C-D/4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR VIT E PERSONA MC LT 13MM/C-D/CR 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD MODULAR ENDO UNITRAX 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LT 16MM/E-F FEM/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6711920|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE COROENT LI 11X9X20 MM 4 DEGREE|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16186540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK MOD MAS RELINE 6.5 X 40MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE COLLAR BUTTON VENT 1.27MM|1|HUMANA [1294]||HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1987-07-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL LPS 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,752.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,752.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HINGE INSERT TIBIAL UNIVERSAL X-SM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,819.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,819.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MODULAR CEMENTED SIGMA PFC 13MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9943BL-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI FIBULA DISTAL LOCKING LEFT 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FIB30180R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA LONG 3.0 X 180 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FIB6000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END NAIL FIBULOCK SONOMA|1|HUMANA [1294]||HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC2720-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SONOMA 2.7 X 20 MM (STERILE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC2716-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SONOMA 2.7 X 16 MM (STERILE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO3555-DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNDESMOTIC 3.5 X 55 MM (STERILE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA4045-CS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAL MEDIAL 4.0 X 45MM (STERILE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA4050-CS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAL MEDIAL 4.0 X 50MM (STERILE)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BCF-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW BIO-COMPOSITE FT 6.5 X 14.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ASNIS MICRO 3.0MM,11/4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EL-2020S2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT ELITE COMPRESSION 20 X 20 X 20 MM 2 LEGS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,015.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,015.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6288744|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PSR CORNERSTONE 7X14X14MM|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6288644|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PSR CORNERSTONE 6X14X14MM|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548316|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EXPANDER TISSUE CPX 4 STYLE 8300 750CC TALL HEIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7045-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT 3-D I FUSE SI-BONE 7.0MM X 45MM|1|HUMANA [1294]||HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7040M-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT 3-D I FUSE SI-BONE 7.0MM X 40MM|1|HUMANA [1294]||HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ICONIX TT WITH INTELLIBRAID TECHNOLOGY 1.4MM ANCHOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,820.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,820.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 40 14MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.005.524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM STARDRIVE 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|554.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|554.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CLYDESDALE 22MM 12MM X 55MM X 6DEG|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850017540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 7.5MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850017545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 7.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT600-16.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 TECHNIC TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALL-0100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOGEN AMNION LARGE 1.00ML|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-008-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERS MC RT11MM/E-F FEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 2.5MM 14MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 2.5MM 16MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 3.0MM 18MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 598801101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM STRAIGHT NEXGEN 13MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.132S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFN 11MM/125 DEG RIGHT 420MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-093|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER - QUICK CROSS SELECT .018 X 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8141-16-007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE META LARGE 7-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-2850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR CONSTRAINED ALL POLY TRIDENT 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351304405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 4.0 X 40 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351304605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 4.0 X 60 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX351304805F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 4.0 X 80 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513041005F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 4.0 X 100 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX3513041205F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 4.0 X 120 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX3513041505F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 4.0 X 150 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 5.0 X 40 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 5.0 X 60 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX351305805F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 5.0 X 80 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513051005F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 5.0 X 100 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX3513051205F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 5.0 X 120 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX3513051505F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 5.0 X 150 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX351306405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 6.0 X 40 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351306605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 6.0 X 60 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX351306805F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 6.0 X 80 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513061005F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 6.0 X 100 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX3513061205F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 6.0 X 120 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX3513061505F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 6.0 X 150 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX351307405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 7.0 X 40 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BSLX351307605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - LUTONIX DCB 5FR 7.0 X 60 130CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240073|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE VENT BUTTERFLY ENT GYRUS|1|HUMANA [1294]||HUMANA [11839]|66.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|66.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656418S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE SCREW T8 FULL THREAD 2.7MM/L18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 991058S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT DR INTERM EXTRA SHORT RT 49MM VARIAX 2 EXPRESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPC0123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSPACE HIP SHORT 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-14-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REVERSE 14MMX108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-80/I16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-80/I16-40|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7 X 38MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963ML-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL SS LT 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS DUOFIX CEMENTLESS STD COLLAR SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL LATERAL 102MM RIGHT 11 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECT 3.5MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1540CDS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L10 MM OD4 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012454-08|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON TREK NC 4.5MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012454-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON TREK NC 4.5MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012454-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON TREK NC 4.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT CONE SYM TRIATHLON SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7750010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM 3.5 X 120 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35352|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 34MM X 209MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-2E-4006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE ECCENTRIC 40MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4677|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD ACUITY X4 SPIRAL L LVA QUAD ELECTRODE IS4 PASSIVE 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-C-2108L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL CEMENTED REUNION LONG 8X200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,017.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,017.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4671|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD ACUITY X4 SPIRAL L LVA QUAD ELECTRODE IS4 PASSIVE 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.368.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP W/STARDRIVE RECESS 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.370.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP W/STARDRIVE RECESS 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.372.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP W/STARDRIVE RECESS 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.374.97|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI 2.0MM SELF TAP W/STARDRIVE RECESS 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2.0MM X 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2.0MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6021-0840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE PLUS TMZF HIP STEM #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.130.320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601634S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 5X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601638S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIN III 5X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 10MM/E-F FEM/CR SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.130.309|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VA-LCKING SLF-TPN W T6 STARDRIVE RECESS TI 2.0MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1519320BP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE PERF REGEN SELECT DUO ALLODERM 16X20 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59,256.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59,256.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP 10 HOLE / L136MM X 4.0MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965451810|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT POWER XCELA LUMEN DUAL PLASTIC 9.6FR W/O SUTURE HOLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3401|SUP|HCPCS C1896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELECTRODE EMBLEM S-ICD SUBCUTANEOUS|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-C-2006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL CEMENTED REUNION 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N40030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARTFIRE HEADED 4.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 3-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6020-0840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE TMZF HIP STEM #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0202263201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TROC RIGHT NARROW NBC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,689.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,689.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0202263009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FEMORAL PROX PP NCB RL 245MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493502001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493502201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP 3.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00493502601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAP 3.5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 5D +16MM 28MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,161.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,161.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 626675S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE THIRD 5 HOLE L59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 12 HOLE L225MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL MEDIAL RT.14-HOLD/201MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010-13-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ACTIS CEMENTLESS STANDARD COLLAR SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-004-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERS MC RT 14MM/CD FEMUR/CR SZ6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFM1015|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACELL PELVIC FLOOR MATRIX 10X15 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,623.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,623.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFM0912|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRISTEM PELVIC FLOOR MATRIX 9CM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,313.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,313.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM TPR 28MM HIP COCR V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 663044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CANN 4.0MM/L44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-27-322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MD 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL FRICTION LOW 36MM +10 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 131812040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DVR LOCK MINI RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03150.85|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB 5.0MM X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|522.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|522.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1555CDS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOCOMPOSITE 5.5MM X 15MM /W DISP DRIVER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.7MM X 10MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|208.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1226-7101-002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID MEDIUM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3992611|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CAPSTONE PTC 26X11MM|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-4006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL REUNION RSA X3 40MMX6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL PROFILE LOW 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|132.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|132.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 603010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL TI SELF TAP 3.5 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION TI 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.562|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4MM 12MM TI MNDB ER NS BLU MDLR FX SYS 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|208.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42512100912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LF 12MM/G-HFEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG840|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARTERY CAROTID BOVINE 7MM X 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR ASPIRE SR SINGLE-PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85,896.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85,896.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T45005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PASTE DBM GRAFTON 5CC|1|HUMANA [1294]||HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 29992|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAGEN SCAFFOLD RECONSTITUTED ARTHROSCOPIC MINI MED-OPEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.564|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4MM 14MM TI MNDB ER NS BLU MDLR FX SYS 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|208.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00599600517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED ALL-POLY LPS NEXGEN SZ5 GR 17MM-FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T50103|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFTON DBF 3CC|1|HUMANA [1294]||HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-0700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN 7MM X 0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-607|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 17 HOLE LEFT 154MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,643.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-382817-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR FUSION IRIX-A 38X28X12DEGREE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1190100|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PHASIX CIRCLE 3 IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.7MM X 16MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|208.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3525-3320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LEFT 13 X 320 X 125 LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-2826S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL PROXIMAL T2 LONG LEFT 260MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7050M-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT 3-D I FUSE SI-BONE 7.0MM X 50MM|1|HUMANA [1294]||HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7035M-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT 3-D I FUSE SI-BONE 7.0MM X 35MM|1|HUMANA [1294]||HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-005-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC TIBIAL PERSONA 13MM FB UC RT 4-11 EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.568|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EMERGENCY 2.7MM X 18MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|208.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42512100813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR VIT E PERSONA MC LEFT 13MM/8-11/E-F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152123000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP FEMORAL ENDURANCE SZ 2 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6560-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 CANCELLOUS BONE SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported X067-1502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CERVICAL POSTERIOR CERTEX 4.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X067-0376|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1237S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 12MM X 375MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FIB30130L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA 3.0X130MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA4055-CS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAL MEDIAL 4.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO3350-DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNDESMOTIC 3.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-SURE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR / GYN|1|HUMANA [1294]||HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD1411-36C|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR ELLIPSE VR SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41,674.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6555-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 CANCELLOUS BONE SCREW 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.124.208S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LCP 3.5MM BEND LOW 8HOLE 128MM/RIGHT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,734.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,734.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELFTAPPING STARDRIVE VIARIABLE ANGLE 3.5X 44M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.156|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELFTAPPING STARDRIVE VIARIABLE ANGLE 3.5X 56M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3596|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT MOBI-C M STANDARD 15 X 19 H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ESLE-18-55-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENSION LEG ILIAC 18MM X 55CM ZENITH FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6550-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 CANCELLOUS BONE SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5552-S-4416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 44 X 16MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30112|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED MICRO ASNIS 3.0MMX12/4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF2633|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DRYSEAL COATING HYDROPHILIC GORE 26FR X 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 4.5 X 3 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6545-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM TX TI ACTB CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8545-36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 4.5 X 36 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-70|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 5.5 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PROFILE LOW TI 4.5 X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970AL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION ANKLE ANTERIOR TT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8925SS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE K-LESS W/DRIVER REPAIR SYNDYSMOSIS SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030-6540-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM TX TI ACTB CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2503-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE ROTATION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 14MM/C-D FEM/CR SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16017545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 7.5 X 45 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16187550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK RELINE MAS POLAXIAL 7.5 X 45 MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16187555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK RELINE MAS POLAXIAL 7.5 X 55 MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16186550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK RELINE MAS POLYAXIAL 6.5 X 50MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 65MM LORDOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 60MM LORDOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 2.5MM X 18MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZS-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE STEP 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZS-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE STEP 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCK LO-PRO TI 5.5 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1234S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 12MM X 345MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1236S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL 12MM X 360MM T2 STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 30MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 38MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013731|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE COMMAND 18 ST .018" 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013753|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE COMMAND 18 LT .018" 25CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-62H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AT10-3044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL FALCON THREE-LEVEL 44 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.50 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9943T-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING TUBULAR THIRD TI 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE TI 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-1910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EVANS WEDGE 10X22X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626751|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOCKING POLYAXIAL NAVICULAR-CUNEIFORM LEFT SHORT (T10)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3U200|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-66I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5568-0013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STEM HUMERAL REUNION RFX 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,713.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MEDIAL DISTAL TIBIA 2.7/3.5MM VA-LCP 12 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 2.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 2.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/SLS/W|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA WHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/SLS/S|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA PRE CUT ENDOTHELIEL KERATOPLASTY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5552-S-4014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 40 X 14MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16014550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 4.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 160MM LORDOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONSTRAINED PINNACLE 36MM/54MM +4 10-DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,185.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,185.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PANL-35200-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NON-LOCKING 3.5MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35240-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXIAL NON-LOCKING TI 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IJS-EAP-25450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN IJS-E 2.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RHI-180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD RADIAL ALIGHN 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626686S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR ONE-THIRD 16 HOLE/L 191MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,033.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 26MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL DISTAL LATERAL LEFT 7 HOLE 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1312-18-700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERAL DISTAL LATERAL RIGHT 9 HOLE 88MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EC-5230|SUP|HCPCS Q4187||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT EPICORD 2CM X 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5991520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG VENTRALIGHT ST ECHO 2 20X15CM ELLIPSE 6X8IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1588TB-1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIGHTROPE BUTTON ABS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIECE EXTENSION GMRS 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35320-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW, PLOYAXIAL NON LOCKING 3.5MM X 32MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35360-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLOYAXIAL NON LOCKING 3.5MM X 35MM IT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 20MM IT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR INCREASED 8 HOLE BRIDGE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,712.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800616|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 6MM X 16MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LSMU0800626|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 6MM X 26MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800637|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 6MM X 37MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800658|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 6MM X 58MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800716|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 7MM X 16MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800758|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 7MM X 58MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800816|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 8MM X 16MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800826|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 8MM X 26MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800837|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 8MM X 37MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800858|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 8MM X 58MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0801058|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 10MM X 58MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LSMU1350616|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 6MM X 16MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350626|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 6MM X 26MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350716|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 7MM X 16MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350726|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 7MM X 26MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350737|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 7MM X 37MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350816|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 8MM X 16MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350826|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 8MM X 26MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0800737|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 7MM X 37MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU0801038|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT LIFESTREAM BALLOON EXPAND COVERED 10MM X 38MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 201.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 20MM SELF TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7097|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ACC STANDARD 11FR NON-HEMOSTASIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7131|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER ACC LONG 11FR NON-HEMOSTASIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-003-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT10MM/CD FEMUR/CR SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VAL TI 3.0 X 24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MED.DISTAL VA-LCP 2.7MM/3.5MM 1HOLE 69MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MED.DISTAL VA-LCP 2.7MM/3.5MM 2HOLE 82MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SV25T3-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 19.50 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 17.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL STEMMED LPS ALL-POLY SIZE 6 17MM GREEN E/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 70-0312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON EXTENDED 5 HOLE LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-535-022S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS CANNULATED SHORT THREAD 3.5 X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.5 X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P50-053-2522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-014-R003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROMO RIGHT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,202.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,202.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35180-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PLOYAXIAL NON LOCKING 3.5MM X 18MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47-2495-340-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 10MM X 34CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47-2487-005-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP NAIL TIBIAL ZNN 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|593.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CP 4.1MM x L40MM T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL MEDIAL RIGHT 10 HOLD / 149MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CLYDESDALE 22MM 12MM X 45MM X 6DEG|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELF TAPPING STARDRIVE REC IT 2.7MM X 10MM T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.112.139|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR DISTAL LAT TI LCP 2.7/3.5MM 4 HOLE LT/86MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,959.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,959.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131227220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LP NON LOCK 2.7MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401451|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PENILE AMBICORE AMS 16CM X 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36,682.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36,682.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.037.027S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM/125 DEG 360MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FPRPR3601|SUP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE CRYOSURGICAL ICEPEARL 90 D OD2.1 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FPRPR3602|SUP|HCPCS C2618||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE PROCEDURE ICEFORCE 2.1 CX 90 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET ALTIVATE ANATOMIC 54MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-16-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SHORT ALTIVATE ANATOMIC 16MMX78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACH 240|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP EXCLUSION LAA GILLINOV-COSGROVE ATRICLIP 40MM|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL VOYAGER L70MM OD4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported X080-332615-08PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR IRIX-A 33X26X8DEGREE 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVE L120 MM OD5.5 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5112-006-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC FB UC PERSONA LEFT 18MM TIBIA G-H/CR FEM 7-12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR VIT E PERSONA MC LT 1MM/C-D/CR 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5212-004-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC TIBIAL FB UC RT 11MM TIBIA C-D/CR FEM 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P20-520-012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.5X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-520-014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 2.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-520-012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 2.0X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 2.7MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625-0T-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TRIDENT ALUMINA 0-DEGREE 36MM SIZE I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P50-453-2714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-R002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 0 DEGREE MEDIUM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7755271|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD OC 3.5MM X 200 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7750606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 5.0MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA0306|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVIVE SOFT TISSUE MEMBRANE 3CM X 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 28MM/-2.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7210760|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MTO SOFTSILK 10MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOFTSILK 1.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676581|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130 DEG 1.5 11.5MM X 40CM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,625.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,625.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7167-7095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 95MM / 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910100135|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR STUTURE II WEDGE 5.0MM WQITH NEEDLES|1|HUMANA [1294]||HUMANA [11839]|653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +4MM 5/40 28MM HIP TPR AL V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,454.85|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,454.85|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 991052S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL 49MM EX-SRT NARROW RT KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 903335A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE LUMBAR HORIZONTAL-VERTICAL|1|HUMANA [1294]||HUMANA [11839]|3,921.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,921.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97715|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROSTIMULATOR RECHAR ADAPT-STIM SURE SCAN INTELLIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 97745|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CONTROLLER MANAGER THER PATIENT PROGRAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061856090|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT CONTOUR URETERAL 4.8 X 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-36.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 36.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ALUMINA 32MM -4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SV25T3-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8956L-02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK LONG 5TH METATARSAL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 560-013|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING TIGHTRAIL SUB-C 13FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG1030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARTERY CAROTID BOVINE 8MM X 30CM|1|HUMANA [1294]||HUMANA [11839]|6,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ALUMINA 32MM 0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 25-2800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.8MM Q-FIX ALL SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ALUMINA 32MM +4 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P20-530-018S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.3X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-016S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 560-009|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING TIGHTRAIL 9FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 560-011|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH DILATOR ROTATING TIGHTRAIL SUB-C 11FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFFB-24-125-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN AAA 24MM X 125CM FLEX ZENITH Z-TRAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAR-08-US|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARTIVA 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ALUMINA 36MM 0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,128.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,128.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 55840005550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 5.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840007550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA 7.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-200SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STEALTH SOLID CROWN 30 GRIT 2.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-150SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STEALTH SOLID CROWN 30 GRIT 1.50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBP-125SOLID145|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STEALTH SOLID CROWN 30 MICRON 1.25MM 145CM SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 20.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 18.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HD HUM 18MM 48MM SHLDR SFT TIS BAL SIMPLICITI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ALUMINA 36MM +5 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,128.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,128.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FF410425|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-410 425CC 13CM X 13.5CM X 5.2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPC0023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSPACE WEDGE TAPER HIP SHORT 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-02-38|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOSPHERE EXPANDED RS EQUINOXE 38MM+4MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-15-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EQUINOXE SHOULDER GLENOSPHERE LOCK REVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-38-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER HUMERAL EQUINOXE 38 MM +0 MM SHOULDER REVERSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,853.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-20-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EQUINOXE 4.5X26MM SHDR KIT COMP LOCK CAP REV ORGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-20-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EQUINOXE 4.5X38MM SHDR KIT COMP LOCK CAP REV GREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-20-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EQUINOXE 4.5X46MM SHDR KIT COMP LOCK CAP REV PURP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 320-20-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EQUINOXE 4.5X34MM SHDR KIT COMP LOCK CAP REV RED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-2312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CA0102|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVIVE SOFT TISSUE MEMBRANE 1CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX535-535CC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 535CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-100/I16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AFX 28-100/I6-40|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXR00I0230|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER TECHNIS SYM MULTIFOCAL EXT RAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-4514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54-25773|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VOLAR STANDARD LEFT 10HOLE EXTRASHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX560-560CC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 560CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-008-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 13MM/E-F FEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4486555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED DBR III 6.5 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-4515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8161-35-056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL LOCKING 3.5MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|310.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|310.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-RHP-RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIAL HEAD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 680001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMERAL HEAD|1|HUMANA [1294]||HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201775|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 8MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-5625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 56 X 25MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-4516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6958828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AXIAL MULTI VERTEX 4.0MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,254.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584201702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FLEX HIGH PRECOAT SZ-G RT MEDIAL LEFT LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 5-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL RT MEDIAL LT LATERAL SZ1 UNI KNEE PRECOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TS-121040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER ALLOGRAFT TARSYS 1CM X 4CM EYELID 12 LAYER OCULOP|1|HUMANA [1294]||HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-4517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42-5112-004-16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC BEAR FIX UC PERSONA LEFT 16MM-TIB C-D/FEM 3-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.01268.024|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE ALLOGRAFT PUROS S2 10X11X14MM 7DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2030002P|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE PERFORATED 20CM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,361.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,361.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1221-28-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL 28 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVPROPLUS-26US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE CORE PRO+ EVOLUT AORTIC TRANSCATH 26MM|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-14-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SHORT 14MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-6718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 520-54-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL 54MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL LATERAL 12 HOLE L225MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WSR0505|SUP|HCPCS Q4166||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX 3-LAYER WOUND CYTAL 5X5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HUS-V9|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AIRWAY SPIRATION CARTRIDGE 9MM|1|HUMANA [1294]||HUMANA [11839]|10,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HUS-V6|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AIRWAY SPIRATION CARTRIDGE 6MM HUD|1|HUMANA [1294]||HUMANA [11839]|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HUS-V7|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AIRWAY SPIRATION CARTRIDGE 7MM HUD|1|HUMANA [1294]||HUMANA [11839]|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-2313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72204368|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAT-TRICK PIP FUSION 3.7MM MM PROX DEG 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,702.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,702.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM CANNULATED 5 X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM CANNULATED 5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 5.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 1.5 11.5MM X 40CM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71677090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 90MM / 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2968850|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL CLYDESDALE 8 X 50 MM 6 DEG|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6240864|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PEEK 8MM X 16MM X 14MM|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-2314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8827L-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING LO-PROFILE 2.7 X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963ML-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA DISTAL MEDIAL SS LT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5121-009-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LT 11MM/G-HFEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STX-CMA-IS3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STABLYX CMC SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STX-CMA-IS4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STABLYX CMC SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STX-CMA-IS2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STABLYX CMC SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6959970|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE KEEL MIDLINE SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-2315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72204398|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE REGENESORB 8MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA TI CANNULATED 10MM/125 DEG 360MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACH 235|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP EXCLUSION LAA GILLINOV-COSGROVE ATRICLIP 35MM|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACH 245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP EXCLUSION LAA GILLINOV-COSGROVE ATRICLIP 45MM|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACH 250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP EXCLUSION LAA GILLINOV-COSGROVE ATRICLIP 50MM|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-56-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET THICK 56MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-6715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FFNS1010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE NITINOL 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,314.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,314.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1850-1338S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 TITANIUM 13X380MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT231412|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 23MM X 14.5MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC271400|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRALATERAL 27MM X 14CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-6716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLC271000|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRALATERAL 27MM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CEB231210A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER BRANCH LILAC 23X12MM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HGB161207A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESE EXCLUDER BRANCH ILIAC 16MM X 12MM X 7CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF1233|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER DRYSEAL 12FR X 33CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965251050|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CATHETER XCELA MST NITINOL REVERSE TAPER 5F DL MST 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS14010503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS100301L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAPS LOCKING 2.7T|1|HUMANA [1294]||HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-6717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MDS1002M16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-1160|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT GENERATOR PULSE IMPLANTABLE WRITER WAVE SPECTRA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,272.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6057-0230D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED ACCOLADE 30MM #2 127-DEGREE NECK V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P20-520-010S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED THREAD SHORT HEADLESS 2.0 X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6501068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TAPER CERAMIC +6 OPT TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8754-009-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM LONGEVITY 36 X50MM 7MM OFFSET LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-30-109-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 30MM X 109MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2ACH15|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ELECTROPHYSIOLOGY ACHIEVE ADVANCE OD15 MM MAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2ACHC|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CABLE CATHETER ACHIEVE ADVANCE L1.96 MR 10 PIN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6057-0335D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE C CS 127 NK SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 627742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA PROXIMAL MEDIAL RT 12 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249538011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 11MM X 38CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926055|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CLYDESDALE 22MM 10MM X 55MM X 6DEG|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0608005|SUP|HCPCS Q4130||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE STRATTICE LAPARASCOPIC 6CM X 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6057-0435D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE C CS 127 NK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LX-410625|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE SILICONE 625CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX-410570|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE SILICONE 570CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NMRM6122|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENVELOPE ABSORBABLE TYRX POLYARYLATE MEDIUM 2.7IN X 2.5IN|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.123.026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS PERIARTICULAR PROX LCP 3.5MM 8 HOLE RT 199M ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,561.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,561.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.127S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFN CANN 11MM /123 DEG LEFT 360MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL DORSAL VA-LCP 2.4MM 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,780.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 12MM/E-F FEM/CR SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6057-0537D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE C CS 127 NK SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE QUICKFIX STAINLESS STEEL SMALL L10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT DISHED ARTICULAR XLPE LEGION 11MM SIZE 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLA260300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXTENDER AORTIC 26MM X 3.3CM|1|HUMANA [1294]||HUMANA [11839]|9,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 04.1MM X 30MM LAG CROSS PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE SS 2.7 X 32MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341505|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ULTRA HIGH PROFILE SMOOTH 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787065072105|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR STAINLESS 80CM .018 IN MANDREL TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351304405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 4X40MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 5X40MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351306405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 7X40MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6057-0637D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE C CS 127 NK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LX351304605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 4X60MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 5X60MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351306605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 6X60MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351307605F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 7X60MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351304805F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 4X80MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351305805F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 5X80MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351306805F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 6X80MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513041005F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 4X100MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513051005F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 5X100MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513061005F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 6X100MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6057-0740D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE C CS 127 NK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LX3513041205F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 4X120MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513051205F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 5X120MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513061205F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 6X120MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513041505F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 4X150MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513051505F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 5X150MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX3513061505F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 6X150MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LX351307405F|SUP|HCPCS C2623||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON DILATATION LUTONIX 035 IN 130CM 7X40MM PTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UL400-4|SUP|HCPCS L8699||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT UROLOGICAL UROLIFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED ACCOLADE 40MM #7 132-DEGREE NECK V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,478.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,478.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 16016550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 6.5 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6726910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIAL LI CORENT 10X9X26MM 4DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|777.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|777.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324PSLC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LOCK SWIVEL PEEK 4.75 X 19.1 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1360P|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE PEEK-OPTIMA W/DISP SHTH 6X23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787055009022|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR PTFE J 035IN X 70CM X3MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-5622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RADIUS SINGLE SIZE 56 X 22MM THKNS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0637D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 158MM CMNT NK ACLD 132D 6 45MM OFST 37MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported WS13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP OFF LG 2MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CP 4.1MM X L36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3701-1511N-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 15MM X 11MM COMPRESSION RATCHET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735471510|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE AND CARTILAGE PROC 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8958TDS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2 HOLE SYSTEM FIXATION TIGHTROPE BB-TAK 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0537D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM CMNT NK ACLD 132D 5 44MM OFST 37MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4240764|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL PEEK TANTALUM 16MM X 14MM X 7MM ANATOMIC ST|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4240964|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL PEEK TANTALUM 16MM X 14MM X 9MM ANATOMIC ST|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601644S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM 5X44MM SELF TAPP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT150170|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 TECNIS TORRIC ONE PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 5.0 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71677080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 80MM / 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0435D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 137MM CMNT NK ACLD 132D 4 42MM OFST 35MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71675383|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 10S 10MM X 18CM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,964.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,964.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5221-005-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 12MM/C-D FEMUR/CR SZ 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676553|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 1.5 11.5MM X 34CM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71677085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 85MM / 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS POST LAT VA-LCP 2.7MM/3.5MM 3HOLE 75MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS MED.DISTALVA-LCP 2.7MM/3.5MM 2HOLE 82MM MED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0335D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 131MM CMNT NK ACLD 132D 3 39MM OFST 35MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.118.522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW METAPHYSEAL 2.7MMX22MM SLF TPNW/T8 STARDRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D150|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN ENDURALIFE DF4 VR 1 CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115397|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE COMP 35MMCX6.5MM SHOULDER CENTRAL HEX DRIVER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 13MM X 400MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM CEMENTED ACCOLADE 30MM #2 132-DEGREE NECK V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,478.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,478.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8750-44H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION COMP 5.0X44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-48H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION COMP 5.0X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-60H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION COMP 5.0X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2968250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL CLYDESDALE PEEK-OPTIMA 12MMX50MM 6DEG LUMBAR|1|HUMANA [1294]||HUMANA [11839]|18,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7055M-90|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM IMPLANT 3-D I FUSE SI-BONE 7.0MM X 55MM|1|HUMANA [1294]||HUMANA [11839]|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL DORSAL VA-LCP 90 DEG RT 2.4MM 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,034.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C6170H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR REVO MINI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|638.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|638.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.115.131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DISTAL DORSAL -90 DEG VA-LCP 2.4MM 2 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,034.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,034.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952MS-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOW PROFILE STRAIGHT 2.4MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 5X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO3545-DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNDESMOTIC 3.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FIB30180L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIXATION SONOMA FIBULOCK LONG 3.0MM X180MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC2714-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SONOMA 2.7MM X 14MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6712932|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CORENT LI 12 X 9 X 32MM 4 DEG|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-5210-005-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PERSONA CR FIXED RIGHT 13MM/3-11EF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LEFT 14MM/E-F FEM/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626898|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LONG MIDFOOT ANKLE LOCK POLYAXIAL CROSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 4.1 MM X L20 MM LAG CROSS PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL PLATFORM ROTATIONG STAB AOX SZ3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584209314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULATING VIVACIT-E SZ 3-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130 DEG 1.5 13MM X 40CM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7167-7105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 105MM /100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676557|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 1.5 11.5MM X 38CM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71678085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG INTERTAN TITANIUM 85MM X 11MM SUBTROCH LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,700.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,700.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TI 5.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET TURON 46MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521-07-242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID PEGGED ALL-POLY E-PLUS 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 7-10MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5573-C-4002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOSPHERE CONCENTRIC 40MM X 2MM THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,793.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CP 4.1MM X L34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4240864|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL PEEK TANTALUM 16MM X 14MM X 8MM ANATOMIC ST|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFK-555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CROSSFIT KNOTLESS 5.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VA-LCP 2.4/2.7MM MTP FUSION MED 5 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234-110-020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX 20MM X 1.0MM|1|HUMANA [1294]||HUMANA [11839]|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRC02STB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR Y-KNOT RC WITH WHITE/BLACK TAPE HIFI SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-525-014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 14MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 40MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE 3.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 3.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-L002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 0 DEGREE MEDIUM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-024S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 24MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 3.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-R001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE MTP 0 DEGREE SHORT RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 10S 10MM X38CM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TRIGEN 5.0 X 42.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180735-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 5-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 3.5 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KIT-039-03|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT MICROINTRODUCER STIEN FLUENT SILICONE 4 FT 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD VOYAGER 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-36-161-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 36MM X 161MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSCMG-35-300-E-LESDC|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE EXCHANGED CURVE DOUBLE X-STIFF LUNDERQUIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249528010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 10MM X 28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,228.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,228.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249530008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL YELLOW ZNN 8.3MM X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248403040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL FA ZNN 4.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|599.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|599.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7167-7100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 100MM / 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130DEG 1.5 13MM X 38CM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TRIGEN 5.0 X 47.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.671S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VA-LCP 2.4/2.7MM STANDARD SHAFT 6 HOLD 109MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,860.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,860.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8928BCJ-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM FIXATION SPEEDBRIDGE JUMPSTART BIOCOMPOSITE ACHILLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248403240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL FA ZNN 4.0MM X 32.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|553.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|553.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VB100202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 10MM X 2.5CM X 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4240664|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL PEEK TANTALUM 16MM X14MMXH6MM ANATOMIC CERVIC|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676578|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130DEG 1.5 13MM X 36CM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-5619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 19MM 56MM SHLDR REUNION STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815037046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 46M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|119.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|119.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VB100502|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS VIABAHN 10MM X 5CM X 110C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FUSION MTP FIRST VA-LCP LARGE 5 DEGREE RIGHT 2.4/2.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-55H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION COMP 5.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-75H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION 7.0MM X 75MM FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3550-63|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT NEUROSTIMULATOR 63CM 6.5FR PERCUTANEOUS LEAD INTRODUCER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1938DHS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INSERTION SUTURETAK HIP KNOTLESS XL 3.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1938PHS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE SUTURETAK PEEK HIP KNOTLESS EXTEND LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2140-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 14.0MM X 40MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1140-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 14.0MM X 40MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B1140-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 14.0MM X 80MM X 80CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B2140-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ARMADA 35 PTA 14.0MM X 80MM X 135CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-26-105-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 26MM X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D03120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE BLOCK LLIUM TRICORTICAL 20MM X15MM|1|HUMANA [1294]||HUMANA [11839]|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,920.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D03125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE BLOCK LLIUM TRICORTICAL 25MM X30MM X14MM|1|HUMANA [1294]||HUMANA [11839]|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2999-3|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COLLAGEN SCAFFOLD RECONSTITUTED ARTHROSCOPIC MINI-OPEN LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported F0304|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKER FIDUCIAL BIOZORB 3CM X 4CM SOFT TISSUE IMPLANTABLE|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F0203|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKER FIDUCIAL BIOZORB 2CM X 3CM SOFT TISSUE IMPLANTABLE|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F0231|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKER FIDUCIAL BIOZORB LP 2CMX3CMX1CM SOFT TISSUE IMP|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported F0303|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MARKER FIDUCIAL BIOZORB 3CM X 3CM SOFT TISSUE IMPLANTABLE|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626965|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SLIM STRAIGHT 5 HOLE T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T8 2.4 MM X L12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T8 2.4 MM X L 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING FULL THREAD T8 2.4 MM X L14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626964|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SLIM STRAIGHT 4 HOLE T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626963|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SLIM STRAIGHT 3 HOLE T8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.158|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING SELFTAPPING STARDRIVE VIARIABLE ANGLE 3.5X56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840008535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY SOLERA 8.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 16MM/E-F FEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STX-CMA-IS1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STABLYX CMC SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00584200101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL LT MEDIAL RT LATERAL SZ1 UNI KNEE PRECOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,954.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SELF DRILL HEADLESS 3.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629559S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VARIAX COMPRESSION BROAD CURVED 9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8990|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE FIBERTAK WITH NUMBER 1 FIBERWIRE AND NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-382815-08PC-STR|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE INTERBODY 38MM X 15MM X 8 DEGREE|1|HUMANA [1294]||HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 23.0 RESTOR TORIC MULITFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 20.5 RESTOR TORIC MULITFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3856ANS|SUP|HCPCS C1787||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRAMMER PATIENT PRODIGY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANN LP 4 X 28MM BLUNT TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25384|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 56MMX2MM TI LCK VARIAX BN RDS RT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3772ANS|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR PRODIGY MRI IPG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|95,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-30080-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION TI 3.0MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-30100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION TI 3.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-30140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION TI 3.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122140058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETAB POLY ALTRX PINN NEU 40MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180734-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ONLAY UNI MAKO X3 SZ 4-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-020F|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI-MONSTER FULL THREAD CANNULATED 3.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-018F|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FULL THREAD HEAD 3.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P53-014-L004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROMO LEFT SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,202.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,202.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFM0710|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACELL PELVIC FLOOR MATRIX 7CM X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,424.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,424.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27014E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING RADIUS 2.7 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|326.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P20-525-022S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 22MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501|SUP|HCPCS C1896||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELECTRODE DEFIBRILLATOR EMBLEM S-ICD SUBCUTANEOUS|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 501520|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL RESTORELLE SMARTMESH Y CONTOUR 24CM X 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951434|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRIGADE 14X34X24MM 12 DEGREE|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 1.5 13MM X 40CM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G32545|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY FENESTRATED PROXIMAL CUSTOM 34X107MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248406060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TI-6AL-4V FULL THREAD CANCELLOUS FIXANGLE6.0X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249438013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI6AL4V FEMORAL RETROGRADE 13MM X 38CM BEVEL TIP PURPLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,031.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,031.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25386|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 56MMX2MM TI LCK VARIAX BN RDS RT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 47248405560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TI-6AL-4V FULL THREAD CANCELLOUS FIXANGLE6.0X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248407060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TI-6AL-4V FULL THREAD CANCELLOUS FIXANGLE6.0X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT261412|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 26MM X 14.5MM X 12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC181400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRALATERAL 16MM X 13.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.925|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP PROXIMAL HUMERUS LONG 268X12X3.7MM 12 HOLE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,790.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,790.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-022S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 22MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 26MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-2716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM X 16MM NON-LOCKING PLATE R3CON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-2717|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 2.7MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-25376|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD 56MMX2MM TI LCK VARIAX BN RDS LT VOLR DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P50-453-2718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-2720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 3.5 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DBM005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE INTERGRO DEMINERALIZED BONE MATRIX 5 CC PASTE|1|HUMANA [1294]||HUMANA [11839]|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201768|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIOSURE HA 6MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CP 4.1MM X L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52-27620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING RADIUS 2.7 X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71645060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TRIGEN 5.0MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676607|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 1.5 13MM X 44CM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2991326|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE CAPSTONE 13MM X 26MM VERTESTAK|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 24.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PROFILE LOW TRIGEN 5.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71677115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG COMPRESSION INTERTAN TRIGEN 115MM / 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,115.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676609|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 DEG 1.5 13MM X 46CM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130DEG 1.5 13MM X 36CM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-6.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-6.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-7.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-7.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-8.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-9.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-9.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FBRC|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS REM 75CM 10FR RCVR CN .035IN VASC NTNL WRE BSKT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SV25T3-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-27.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-28.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-6.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 6.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-6.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 6.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-7.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 7.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-7.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 7.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-8.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 8.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP PREMIUM CEMENTED STEM WTH UNIPOLAR / BIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP STANDAR FRACTURE STEM WTH UNIPOLAR / BIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP PREMIUM PRIMARY CEMENTLESS STEM CUP HEAD INSER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP STANDAR PRIMARY CEMENTLESS STEM CUP HEAD INSER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP UNICONDYLAR KNEE STANDARD PRIMARY CEMENTED UNI-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE PREMIUM PRIM CEMENTRD FEMUR CEMENTLESS TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DB1009PT|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT 9 FRENCH LOOP DUAL BALLOON|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 92167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE STANDARD PRIM CEMENTRD FEMUR TIBIA INSERT P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TS BASEPLATE - UP CHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92169|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP COATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNCOATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP COATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UNCOATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE UNICONDYLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE COATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE PREMIUM PRIM CEMENTLESS FEMUR TIBIA INSERT PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE HYBRID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE UNCOATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.123S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TFNA CANNULATED TI 11MM /125 DEG 320MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203155050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL NCB TI6AL4V 4.0MMX50MM SELF TAP HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-8.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 8.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-9.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 9.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-9.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 9.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 10.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 10.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 11.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 11.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 12.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 13.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 14.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 14.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 15.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 15.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 16.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 16.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 17.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210709|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR LUPINE DUAL SUTURE PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 18.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 18.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 19.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 20.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 21.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 21.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 22.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 22.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 23.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235902435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 24.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 25.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 26.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 26.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 27.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-27.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 27.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-28.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 28.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 28.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 29.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 29.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235903435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 30.0 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-6.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-6.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-7.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-7.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-8.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-8.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-9.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-9.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235904435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-8.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T3-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-18.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-27.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-28.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-6.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-6.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-7.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-7.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-8.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-8.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 8.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-9.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC RT 13MM/C-D FEMUR/CR SZ 8-9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-9.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 9.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-10.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-10.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-11.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-11.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-12.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-12.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-13.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-14.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-14.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735472010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX CRYO 20X10|1|HUMANA [1294]||HUMANA [11839]|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-15.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-16.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-17.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-17.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-19.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-20.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-20.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-21.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-21.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE FULL FEMORAL POROUS UNIVERSAL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,755.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,755.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL UNIVERSAL FLUTE 75MM X 18MM KNEE PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SIGMA TC3 GVF UHMWPE 4 - 22.5 MM ROTATE PLTFOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MM VA-LCP PROX-TIBIAL SMALL BEND 10H/177MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,612.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,612.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.127.122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T15 22MMX3.5MM METAPHYSEAL VARIABLE ANGLE STARDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-22.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-23.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-23.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-24.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T4-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR DIOPTER 13.5 RESTOR TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-24.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-25.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-25.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T5-13.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACTIVE FOCUS TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-26.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-27.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-27.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 27.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-28.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-28.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-29.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-29.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 29.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-30.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 30.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-15.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-26.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G138|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC MOMENTUM X4 CRT-D IS-1 / DF-1 / IS4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249440013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TI6AL4V FEMORAL RETROGRADE 13MM X 40CM BEVEL TIP PURPLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,031.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,031.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104TSXLR|SUP|HCPCS Q4121||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|THERA SKIN XLG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75164|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 16MM 75CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71676580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130DEG 1.5 11.5MM X 38CM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECT 3.5MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC PERSONA FIX CR LEFT 14MM TIB E-F FEM 3-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT75184|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL LG DIA 18MM 75CM 4CM RPD INFL COAX SHFT RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 627538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP NARROW 8 HOLD / L151MM X 5.0MM LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ALTRX NEUTRAL +4 40MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27617030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE CANCELLOUS 4-9.5 MM 30 ML FROZEN CHIPS|1|HUMANA [1294]||HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601646S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ASNIS III CANNULATED TITANIUM 46MM X 5MM X15.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-46C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRIDENT II TRITANIUM C 46MM SCREWHOLE CLUST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 393014|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC ITREVIA 7 HF-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630-205B|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE ZIPWIRE NITINOL PLY HYDROPHILIC .035 IN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM REGULAR .6 MM 2.0MM RIGHT MIDFACE 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM REGULAR .6 MM 2.0MM LEFT MIDFACE 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM REGULAR .6 MM 2.0MM 6 HOLE STRAIGHT WHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.390S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL TFNA 90MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VA-LCP MEDIAL DISTA TIBIA 2.7/3.5MM 10 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SELF TAPPING STARDRIVE 3.5MM X 16MM LOW PROFI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|133.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|133.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MAN040|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR MINUS 4.0 DIOPTER ACRYSOF MULTIPIECE-EXPAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-D-28-160-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT DISTL ENDOVASCULAR THORACIC ALPHA ZENITH 28MM X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-PT-32-28-201-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 7.1MMX201MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 2.7MM/L28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103-0302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE STANDARD RADIAL HEAD RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,004.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,004.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 171-2718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL MOD T7 DRIVE 2.7MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7841|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING INGEVITY L52 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7842|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING INGEVITY L59 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L331|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER CARDIAC ACCOLADE MRI LATITUDE .75CMX4.45CMX5.88CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L310|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER CARDIAC ACCOLADE SR-MRI SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,141.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,141.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D151|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN EL VR SINGLE CHAMBER RT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D120|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC MOMENTUM EL VR SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D232|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC VIGILANT EL VR DF4 SINGLE CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|44,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|44,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D153|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN EL DR DUAL CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D152|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN EL DR IS-1 DF4 DUAL CHAMBER I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G150|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN ACUSHOCK DF4 BIVENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G151|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN ACUSHOCK DF1 BIVENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G156|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN X4 BIVENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G124|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC MOMENTON IS1 DF4 BIVENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G158|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC DYNAGEN X4 DF4 BIVENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7840|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING INGEVITY STRAIGHT 45CM MRI POSITIVE W/O GUIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0273|SUP|HCPCS C1777||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCNG LEAD 64CM 1 COIL ACT RT 4-FT TRM STD ECRDM CNCT CARDV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D121|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC MOMENTUM EL DR DUAL CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D233|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC VIGILANT EL VR DF4 DUAL CHAMBER ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR TRIDENT II TRITANIUM D 50MM SCREWHOLE CLUST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,638.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRIDENT II HEX LOW PROFILE 6.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT DISTAL FEMORAL TRIATHLON SZ 2 10MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT POSTERIOR FEMORAL TRIATHLON SZ 2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G247|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR CARDIAC VIGILANT X4 IS4 DF4 BIVENT ICD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|64,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR3508|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE STANDARD .035 DIAMETER X 180CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71676601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 D 1.5 MM 12MMX38CM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ATTUNE AOX 4 7MM KNEE CRUCIATE RETAINING FIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL SIGMA TC3 GVF UHMWPE SIZA 4 30.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCS COMP LG RT CEM ROTATE PLATFORM FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL LCS COMPLETE LG 10MM ROTATE PLATFORM STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-03-0051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR 51MM SPINE 3 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING 4.0X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF DRILLING/TAPPING 4.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-120-008S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI-MONSTER SHORT THREAD 2.0 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported W1SR01|SUP|HCPCS C1786||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER AZUREXT SR MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,719.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,719.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported W1DR01|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER AZURE XT DUAL CHAMBER MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS COMPRESSION 5.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION HEADLESS 07.0MM/L75MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D02810|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOWEL BONE UNICORTICAL FULLY CANNULATED 10MM|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D02811|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOWEL BONE UNICORTICAL FULLY CANNULATED 11MM|1|HUMANA [1294]||HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OM-2300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MULTIFIX S PEEK 535MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72290001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE MULTIFIX S ULTRA PEEK 5.5 MM KNOTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.107.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VA-LCP OLERANON 2.7MM/3.5MM 2 HOLE RIGHT 73MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,905.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-022S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-40-117-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 40MM X 117MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO3550-DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L50 MM OD3.5 MM SYNDESMOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FIB30130R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA 3.0X130MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRX-700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST IMPLANT BREAST GEL ROUND EX FULL 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRX-750|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST IMPLANT BREAST GEL ROUND EX FULL 750CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRX-800|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL ROUND EX FULL 800CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LEAD1058-50B|SUP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT NEUROSTIMULATOR NEVRO 5MM SPACING 50CM LEAD BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ACCK5300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT ANCHOR LEAD N300|1|HUMANA [1294]||HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL NEXGEN TRABECULAR METAL D H5MM KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL NEXGEN TRABECULAR METAL D H10MM KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCP TI 5X12 HOLE VA 2.4MM/27MM LOCKING MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF TAPPING LOCKING STARDRIVE RECESS 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|503.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|503.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADLESS 2.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-115363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HUMERAL COMPREHENSIVE ARCOMXL STANDARD 44-36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT REVERSE 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO3560-DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SYNDESMOTIC 3.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FIB38130R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIXATION L130MM OD3.8MM FIBULA RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,655.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,655.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC2718-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFFB-30-140-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BODY MAIN BIFURCATED AAA 30MM X 140CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,136.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628227|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL SUPERIOR 7 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-01-0016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L16 MM SPINE 1 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT REVERSE GLENOSPHERE SHOULDER STD 36MM HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8213000018|SUP|HCPCS Q4124||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX WOUND OASIS ULTRA 3CM X 7CM MESHED 5/CA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500921|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ICONIX 2.3MM WITH ONE STRAND 1.2MM X BRAID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ICONIX 2.3MM WITH TWO STRAND 1.2MM X BRAID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT375235|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR TECHNIS SYMPONY TORIC 23.5 DIOPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,952.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 602640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ASNIS III TITANIUM PARTIALTHREAD 6.5X40MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401102250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.25 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401102750|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.75 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401152750|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 2.75 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939401153250|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CUTTING WOLVERINE (MR) 3.25 X 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-03-0054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L54 MM SPINE 3 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE EXTENDER|1|HUMANA [1294]||HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI-MONSTER SHORT THREAD L50 MM OD3 MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12355300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TI MAS RELINE 5.5 X 300MM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16185545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHANK MOD MAS RELINE 5.5 X 45MM 2C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-70H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION COMP 5.0X70MM TITANIUM T15 LARGE FULL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6712926|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL COROENT 4 D LARGE IMPACT L26 MM X W12 MM X H9 MM|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTIC VIT E PERSONA MC LF 10MM/G-HFEMUR/CR SZ 8-11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16185550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE RELINE MAS 2C 50MM X 5.5MM SPINE MODULAR SHANK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD RELINE TITANIUM MAS LORDOTIC 75MM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16014545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 4.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-01-0018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L18 MM SPINE 1 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL OXINIUM OD40 MM MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,507.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,507.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR R3 XLPE 20 D OD58 MM ID40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71344247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE ORTHOPEDIC SMF TITANIUM +0 12/14 TAPER MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|620.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVE L70 MM OD5.5 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO4204A 14.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +14.0 DIOP BCNVX TORIC 14MM 6MM PC 1 PC FLD ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341209|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST COHESIVE III CPG 332 MEMORYGEL 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TNDL1656|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE GORE TIPS 16 G 10FR GUIDING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSTH1040|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER SHEATH GORE TIPS 10 FR 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TSET1016|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET GORE TIPS 10FR 16 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PTB8106275|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS VIATORR GORE SZ 8-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PTB8108275|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIATORR L8 CM L2 CM OD8-10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN L37.5 MM OD5 MM FEMUR LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-C-2012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION L128 MM OD12 MM SHOULDER PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 H10 MM OD36 MM SHOULDER CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B003-0140|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT UHMWPE 3 L17.5 MM HIP|1|HUMANA [1294]||HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-03-0057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L57 MM SPINE 3 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL-1600-003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE CELLULAR FORMABLE VIVIGEN LARGE|1|HUMANA [1294]||HUMANA [11839]|12,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8913DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIXATION TIGHTROPE MINI INSERTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HNR5.0-35-70-P-10S-0|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC BEACON 5.0 FR X 70CM STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3910500931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ICONIX 2.3MM WITH THREE STRAND 1.2MM X BRAID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN TI PMMA 5 FULL 10MM KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72202992|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SUTURE 17MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-6315|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 12.3X12.9CM BREAST 650ML STY 6300 TALL CNSP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX595|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 595CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 650CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 700CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-72I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-74J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-76J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-78J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-80J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-4615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 46MM OD X 15MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-4620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 46MM OD X 20MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-4625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 46MM OD X 25MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 50MM OD X 15MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 50MM OD X 20MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 50MM OD X 25MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 54MM OD X 15MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 54MM OD X 20MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 54MM OD X 25MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 58MM OD X 15MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 58MM OD X 20MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-5825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 58MM OD X 25MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-6215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 62MM OD X 15MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-6220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 62MM OD X 20MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-6225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 62MM OD X 25MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-6615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 66MM OD X 15MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-6620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 66MM OD X 20MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5096-6625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ACETABULAR 66MM OD X 25MM WEDGE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,202.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-0711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 7X11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-0713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 7X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-0812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 8X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-0814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 8X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-0913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 9X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 9X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-1014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 10X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-1016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 10X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 11X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-1117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 11X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-1216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 12X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6012-1218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 155MM STRT STM 12X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,180.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-0812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 8X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-0814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 8X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-0913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 9X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 9X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 10X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 10X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 11X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6013-1117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 11X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 12X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 12X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 13X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 13X19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 14X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6013-1420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA 205MM STRT STM 14X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-0814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 8X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 9X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-1016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 10X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-1117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 11X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-1218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 12X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-1319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 13X19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6018-1420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA CALCAR 205 STEM-15MM RESECTION 14X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0525-200L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0525-200R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0525-250L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0525-250R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0525-300L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0525-300R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0730-200L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0730-200R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0730-250L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0730-250R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0730-300L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0730-300R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0935-200L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0935-200R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0935-250L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0935-250R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0935-300L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-0935-300R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-1140-200L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-1140-200R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-1140-250L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-1140-250R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-1140-300L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6088-1140-300R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT CEMENTED LONG STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,021.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 VITALLIUM HEAD 28+6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,205.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,205.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 1X11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 1X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 2X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 2X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 3X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 3X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 4X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 4X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 5X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 5X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 6X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 6X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 7X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 7X19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 8X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 8X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-6-921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 165MM TI NEU STM 9X21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 1X11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 1X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 2X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 2X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 3X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 3X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 4X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 4X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 5X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 5X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 6X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 6X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 7X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 7X19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 8X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 8X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-8-921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST PS 203MM TI NEU STM 9X21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 29MM +0MM (STD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 31MM +0MM (STD)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 27MM +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 31MM +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 27MM +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 29MM +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 31MM +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 25MM +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 27MM +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 29MM +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-1-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX CONE BODY 31MM +30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 19MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 21MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 23MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 25MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 27MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 29MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 31MM SHALLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 19MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 21MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 23MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 25MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 27MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 29MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 31MM DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 27MM X-DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-2-229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 29MM X-DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-2470-24|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRODUCER 8.5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-2-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD MILLED BODY 31MM X-DEEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-3-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PROX BROACHED BODY SIZE #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,768.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 19MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 21MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 23MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 25MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 27MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 29MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 31MM +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 19MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 21MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 23MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 25MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 27MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 29MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 31MM +20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 19MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 21MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 23MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 25MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 27MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 29MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-4-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CALCAR BODY 31MM +30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,443.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 11MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 12MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 13MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 14MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 15MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 17MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 18MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 19MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 20MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 21MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 22MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 23MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 24MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 25MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 26MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 11MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 12MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 13MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 14MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 15MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 16MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX RIGHT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-5-117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 17MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 19MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 20MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 21MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 22MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 23MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 24MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 25MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL STEM 26MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,413.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 11MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-5-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 12MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 13MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 14MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 15MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 16MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 17MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 18MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 19MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 20MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 21MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-5-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 22MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 23MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 24MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 25MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 26MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 11MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 12MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 13MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 14MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 15MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5952-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-FLEX LEFT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-5-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 16MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 17MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 18MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 19MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 20MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 21MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 22MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 23MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 24MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 25MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 26MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 11MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 12MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 13MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 14MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 15MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 16MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 17MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 18MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 19MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 20MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 21MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 22MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 23MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 24MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 25MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 26MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 11MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 12MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 13MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 14MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 15MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 16MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 17MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 18MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 19MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 20MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 21MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 22MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 23MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 24MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 25MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-5-626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA DISTAL BOWED STEM 26MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 11MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 12MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 13MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 14MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 15MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 16MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 17MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNC2025|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NRV 2X2.5MM NEUROMATRIX PERI CLGN MTRX RSRB SEMIPERM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,170.25|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,170.25|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-6-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 18MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 19MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 20MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 21MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 22MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 23MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 24MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 25MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 26MMX127MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 11MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 12MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 13MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 14MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 15MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 16MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 17MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 18MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 19MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 20MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 21MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1083301|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE SHEEHY 1.27MM|1|HUMANA [1294]||HUMANA [11839]|87.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|87.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-6-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 22MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 23MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 24MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 25MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL STEM 26MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 11MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 12MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 13MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 14MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 15MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 16MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 17MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 18MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 19MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 20MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 21MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 22MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 23MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 24MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 25MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 26MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 11MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 12MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 13MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 14MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 15MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 16MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 17MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 18MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 19MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1103-010-01|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER VOID BONE COPU OS 1-STRIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|816.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-6-420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 20MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 21MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 22MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 23MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 24MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 25MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 26MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,087.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 11MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 12MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 13MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 14MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 15MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 16MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 17MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 18MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 19MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 20MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 21MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 22MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 23MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 24MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 25MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 26MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 11MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 12MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 13MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 14MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 15MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 16MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 17MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 18MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 19MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 20MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 21MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 22MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 23MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 24MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 25MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-6-626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD FLUTED DISTAL BOWED STEM 26MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,728.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 24MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 25MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 26MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 27MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 28MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 14MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 20mmX195mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 21MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 22MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 23MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 24MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 25MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 26MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 27MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL STEM 28MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,963.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 14MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 16MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 17MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 18MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 19MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 20MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 21MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 22MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 23MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 24MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 25MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 26MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 27MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 28MMX195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,627.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 14MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 15MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1808000|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRI POWERPORT (USE FOR FLORENCE/FT THOMAS ONLY)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 16MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 17MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 18MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 19MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 20MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 21MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 22MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 23MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 24MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 25MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 26MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 27MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-7-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD CONICAL DISTAL BOWED STEM 28MMX235MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,290.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 13MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 14MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 15MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 16MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 17MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 18MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 19MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 20MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 21MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 22MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 23MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 24MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 25MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 26MMX167MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,820.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 13MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 14MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 15MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 16MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 17MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 18MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 19MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 20MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 21MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 22MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 23MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 24MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 25MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 26MMX217MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,456.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 13MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 14MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 15MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 16MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 17MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 18MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 19MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 20MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 21MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8026|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BIOSCREW\ENDOPEARL GUIDEWIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6276-8-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 22MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 23MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 24MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 25MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 26MMX267MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,107.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 13MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 14MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 15MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 16MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 17MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 18MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 19MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 20MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 21MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 22MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 23MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 24MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 25MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6276-8-626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST MOD PLASMA TRI-SLOT BOWED STEM 26MMX317MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,743.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA 36MM FEMORAL HEAD -3MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA 26MM STD FEM HEAD COMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA 36MM FEMORAL HEAD 0MM STD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26MM +5MM FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM +5MM FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA 36MM FEMORAL HEAD +5MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26MM +10 FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM +10MM FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22.2MM + 2MM 252 HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22.2MM + 5MM 252 HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-0-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22.2MM + 10MM 252 HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6280-3-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32MM-3MM FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,832.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6293-0-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA FEMORAL HEAD DIA .32MM STANDARD NECK WITH SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,905.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,905.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6293-0-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA FEMORAL HEAD DIA .32MM +5 WITH SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,905.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,905.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-2-403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X40-43MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-2-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X46-49MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-2-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X52-55MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-2-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X58-61MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-3-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28X46-49MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-3-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28X52-55MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-3-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28X58-61MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-3-647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28X64-67MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-4-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32X46-49MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-4-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32X52-55MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-4-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32X58-61MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-4-647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32X64-67MM NEUTRAL INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-5-403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X40-43MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-5-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X46-49MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-5-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X52-55MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-5-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26X58-61MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-8-403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22X40-43MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-8-469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22X46-49MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-8-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22X52-55MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6299-8-581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22X58-61MM 10 DEG INS DURAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,546.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P2 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P3 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P4 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P5 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P6 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P7 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P8 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P9 28MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P3 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P4 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P5 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P6 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P7 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P8 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-6-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P9 32MM 10¦ +4MM INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,874.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID22 OD40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID22 OD42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID22 OD44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-2-860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID28 OD60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID32 OD60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID36 OD52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID36 OD54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID36 OD56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID36 OD58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-3-660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID36 OD60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-4-056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID40 OD56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-4-058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID40 OD58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6309-4-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER X3 RIMFIT CUP ID40 OD60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010741|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ORTHO SORB PIN,ABSORBABLE|1|HUMANA [1294]||HUMANA [11839]|493.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|493.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6900P-27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PERICARDIAL PLUS PERIMOUNT EDWARDS 27MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6352-5-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,993.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 643-00-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ELEVATED RIM 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,402.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,050.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-00-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 0¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900P-25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PERICARDIAL PLUS PERIMOUNT EDWARDS 25MM|1|HUMANA [1294]||HUMANA [11839]|19,185.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,185.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 663-10-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,003.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10 DEG 36MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663-10-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT X3 ECCENTRIC 10¦ 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,413.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-0-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M SM GRIP AND 2 1.6mm CABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,469.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,469.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-0-310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M LG GRIP AND 2 2.0mm CABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,469.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,469.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-0-410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6mm VIT CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,186.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,186.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900P-29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PERICARDIAL PLUS PERIMOUNT EDWARDS 29MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6704-0-420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6mm VIT BEADED CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-0-510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 2.0mm VIT CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,186.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,186.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES SMALL VITALLIUM GRIP WITH 2 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES MEDIUM VITALLIUM GRIP WITH 2 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES VITALLIUM GRIP GRIP PLATE 100MM WITH 2, 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES MEDIUM VITALLIUM GRIP PLATE 200MM WITH 2, 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,058.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,058.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE VITALLIUM GRIP WITH 2 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE VITALLIUM GRIP PLATE 110MM WITH 2, 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,376.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE VITALLIUM GRIP PLATE 160MM WITH 2, 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,701.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,701.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-3-093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE VITALLIUM GRIP PLATE 200MM WITH 2, 2.0MM CABLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,058.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,058.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900P-31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PERICARDIAL PLUS PERIMOUNT EDWARDS 31MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6704-4-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M VIT CABLE SLEEVE 2.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|728.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|728.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-6-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M VIT GROOVED BUTTON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,113.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,113.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-8-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M VIT MINI CLEAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-8-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6MM VIT CABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,043.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,043.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG CONSTRAINED INSERT 28F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG CONSTRAINED INSERT 28G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG CONSTRAINED INSERT 32H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG CONSTRAINED INSERT 32I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0 DEG CONSTRAINED INSERT 32J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-10-22E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTRAINED INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900P-33|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PERICARDIAL PLUS PERIMOUNT EDWARDS 33MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 690-10-22F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTRAINED INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-10-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTRAINED INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-10-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTRAINED INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-10-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTRAINED INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-10-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTRAINED INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 690-10-28K|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CONSTR. ACET. INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,029.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-2244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-2246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-2248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625ESR-LP27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PORCINE LP DURAFLEX EDWARDS 27MM|1|HUMANA [1294]||HUMANA [11839]|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 69-2854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-3256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-3258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 69-3260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL POLY CONSTRAINED INSERT 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,373.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625ESR-LP29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PORCINE LP DURAFLEX EDWARDS 29MM|1|HUMANA [1294]||HUMANA [11839]|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-2301C-2858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-2874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2301C-3274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625ESR-LP31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PORCINE LP DURAFLEX EDWARDS 31MM|1|HUMANA [1294]||HUMANA [11839]|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-2302C-2858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-2874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625ESR-LP33|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PORCINE LP DURAFLEX EDWARDS 33MM|1|HUMANA [1294]||HUMANA [11839]|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-2302C-3262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2302C-3274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE ECCENTRIC INSERT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-0711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STR STM 7X11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-0713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 7X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-0812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 8X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-0814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 8X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-0913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 9X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 9X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6625ESR-LP35|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PORCINE LP DURAFLEX EDWARDS 35MM|1|HUMANA [1294]||HUMANA [11839]|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|16,185.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-2651-1014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 10X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-1016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 10X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 11X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-1117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 11X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-1216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 12X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2651-1218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 155MM STRT STM 12X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,977.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-0812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 8X112MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-0814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 8X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-0913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 9X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 9X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 10X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 10X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 11X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 11X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 12X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 12X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 13X17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 13X19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 14X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2652-1420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 14X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2500P21|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC STENTLESS PLUS PRIMA EDWARDS 21MM|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-2652-1422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REST HA -5 RED NK 205MM STRT STM 14X22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,159.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0920-2-920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER STEM CENTRALISER PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0939-0-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER PMMA BONE PLUGS 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2500P23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC STENTLESS PLUS PRIMA EDWARDS 23MM|1|HUMANA [1294]||HUMANA [11839]|15,300.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1034-0000J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOORSE/C-TAPER ADAPTER SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,478.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,478.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1058-0011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT BARIUM PROX. SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-2310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-2311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-4512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-4513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-6713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1059-6714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT UNIVERSAL DISTAL PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234407500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STATAK SOFT TISSUE DEVICE 5.2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|541.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 70142144|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS STAPES CLASSIC SHAFT 4MM X 0.6MM|1|HUMANA [1294]||HUMANA [11839]|613.44|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|613.44|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1067-0013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2500P25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC STENTLESS PLUS PRIMA EDWARDS 25MM|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1067-0023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1067-0025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS UNIV. DISTAL SPACER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-15MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-20MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-25|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-25MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-30MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-35MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-40MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-45|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-45MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2500P27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC STENTLESS PLUS PRIMA EDWARDS 27MM|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186005-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-50MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-55|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-55MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186005-60|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE BONE SCREW-6.5 DIA-60MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OCCLUDER-DOME HOLE IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19-0000T|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL C-TAPER +0MM ADAPTER SLEEVE (TI)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19-0005T|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL C-TAPER +5mm ADAPTER SLEEVE (Ti)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19-0025T|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL C-TAPER +2.5MM ADAPTER SLEEVE (TI)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 19-0325T|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL C-TAPER -2.5MM ADAPTER SLEEVE (TI)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6520-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6525-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2500P29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC STENTLESS PLUS PRIMA EDWARDS 29MM|1|HUMANA [1294]||HUMANA [11839]|13,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2020-6530-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6535-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6540-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6545-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6550-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6555-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2020-6560-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5 BONE SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5515-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5520-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5525-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2650-23|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC PORCINE SAV EDWARDS 23MM|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2029-5530-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5535-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5540-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5545-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5550-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5555-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2029-5560-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5 CANCELLOUS BONE SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2650-25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC PORCINE SAV EDWARDS 25MM|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY CNCLS SCRW-6.5MMX65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.15.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.20.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2650-27|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE AORTIC PORCINE SAV EDWARDS 27MM|1|HUMANA [1294]||HUMANA [11839]|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,085.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3600.25.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.30.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.35.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.40.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.45.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.50.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.55.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3600.60.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z CANCELLOUS SCREW-6.5MM X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|802.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|802.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-4560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-7-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX C-TAPER SLEEVE -3mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-7-065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX C-TAPER SLEEVE +0mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-7-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX C-TAPER SLEEVE +5mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-7-085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX C-TAPER SLEEVE +10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7030-6560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6.5MM LOW PROFILE HEX SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B000-0185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SM. UNIVERSAL CEMENT RESTRICTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B000-0240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MD. UNIVERSAL CEMENT RESTRICTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B000-0300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RV. UNIVERSAL CEMENT RESTRICTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B000-1185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SM. UNIVERSAL CEMENT RESTRICTOR W/DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B000-1240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MD. UNIVERSAL CEMENT RESTRICTOR W/DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B000-1300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RV. UNIVERSAL CEMENT RESTRICTOR W/DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B002-0125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS SIZED CEMENT-PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B004-0155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS SIZED CEMENT-PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234405000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STATAK SOFT TISSUE DEVICE 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|541.87|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|541.87|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PCO1510|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER 6" X 4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,750.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported B005-0170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS SIZED CEMENT-PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B006-0185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS SIZED CEMENT-PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B007-0200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS SIZED CEMENT-PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B008-0215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEONICS SIZED CEMENT-PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-44|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-44MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-46MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-48MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-50MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-52MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-54MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO15|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER ROUND 6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,371.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,371.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186002-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-56MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-58MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-60|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-60MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-62MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-64|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-64MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-66MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186002-68|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE SHELL-CLUST HOLE POR-68MM IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-44A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-46B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO2520OS|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER SKIRTED 10" X 8"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,725.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,725.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 500-03-60F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-64G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-03-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI SOLIDBACK CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-44A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-03-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY TRITANIUM HEMI CLUSTER HOLE CUP 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-42A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 42A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-44B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 44B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 48D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 52E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 54E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 56F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 58F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 60G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 62G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 64H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 702-04-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT II TRITANIUM CLUSTERHOLE 66H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,043.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.01.346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 46MM CUP TPR SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN 48MM CUP-TAP SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 50MM CUP-TPR SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 52MM CUP-TPR SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 54MM CUP-TPR SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 56MM CUP-TPR SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 58MM CUP-TPR SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 60MM CUP-TPR SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 62MM CUP-TPR SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY 64MM CUP-TPR SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.48.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.50.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.52.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.54.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.56.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.58.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.60.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.62.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3400.64.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR SHELL SIZE 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-42A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-44B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-46C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-70I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-01-74J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL SOLID BK 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-42A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-44B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-46C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-70I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-11-74J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA SOLID BK 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-42A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-44B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-46C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-70I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-01-74J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL CLUSTER 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-42A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-44B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-46C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-70I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502-11-74J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL HA CLUSTER 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-42A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-44B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-46C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-50D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-52E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720003-01|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR PROLAPSE ANTERIOR TRANOBTURATOR WITH INTEPRO PERIGEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-54E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-58F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-62G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-70I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-11-74J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT HEMISPHERICAL MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,255.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-40A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-42B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-44C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-46D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-48D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-50E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-54F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-56F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-58G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-60G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-62H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-64H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-66I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-68I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-70J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 540-11-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA SOLID BACK 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,350.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-40A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-42B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-44C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-70J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 542-11-72J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT PSL HA CLUSTER 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,104.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720002-01|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM REPAIR PROLAPSE VAULT VAGINAL APOGEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-2866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65C-3266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT ALL POLY CUP-CROSSFIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,147.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER SHORT STEM 44 NO 0 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,216.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,216.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 200MM LG 44MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 220MM LG 44MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 240MM LG 44MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 260MM LG 44MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 35.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 37.5MM NO 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 37.5MM NO 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 37.5MM NO 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 37.5MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 37.5MM NO 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 44MM NO 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 50MM NO 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 50MM NO 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 50MM NO 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 50MM NO 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-1-505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER V40 STEM 50MM NO 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,892.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0580-3-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER 205MM TAP 44MM NO 2 V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0230D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 124MM CMNT NK ACLD 132D 2 35MM OFST 30MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6058-0740D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 158MM CMNT ACLD 132D 7 48MM OFST 40MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-0425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-0530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-0630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-0735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-0835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-0940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-1040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6097-1140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-0425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-0530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-0630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-0735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-0835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-0940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-1040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6098-1140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT EON 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,533.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 1 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600654|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT CATH 12.5FR 51CM HKMN PEEL-APART 3 LUM LOPRFL ADPR SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,044.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,044.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186003-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 2 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 3 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 4 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 6 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-07|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 7 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 8 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 9 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 10 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 11 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186003-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL STEM-STD NECK-SIZE 12 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 1 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 2 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 3 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 4 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 6 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-07|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 7 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 8 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 9 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO2015OS|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER SKIRTED 8" X 6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,327.93|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,327.93|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 10 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 11IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186004-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM STEM-HI OFFSET NK-SIZE 12 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.01.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.02.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.03.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.04.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.05.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.06.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.07.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.08.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3101.09.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL STEM SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABGII NO 1 CEMENTLESS RIGHT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABGII NO 2 CEMENTLESS RIGHT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABGII NO 8 CEMENTLESS RIGHT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1BSGC25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE LINE REINFORCEMENT MATERIAL BIOABSORBABLE CIRCULAR|1|HUMANA [1294]||HUMANA [11839]|906.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4845-0201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABGII NO 1 CEMENTLESS LEFT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABGII NO 2 CEMENTLESS LEFT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-0208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABGII NO 8 CEMENTLESS LEFT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-STANDARD SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-STANDARD SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.0010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX STANDARD FEM STEM-SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-LATERALIS SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-LATERAL SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.1010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX LATERAL FEM STEM-SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125DEGREE SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579.2010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX FEM STEM-125 DEGR SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-0425S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-0525S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-0625S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-0730S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-0830S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-0935S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-1035S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-1140S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-1240S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-1340S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6051-1440S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 132 HIP STEM #14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-0625S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-0730S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-0830S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-0935S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-1035S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-1140S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-1240S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6052-1340S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT MAX 127 HIP STEM #13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,014.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0509S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #5/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0511S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #5/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0610S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0612S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0711S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #7/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0713S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #7/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0812S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0814S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0913S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #9/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-0915S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #9/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1014S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1016S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #10/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1115S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #11/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1117S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #11/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1216S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #12/16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1218S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #12/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1317S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #13/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1319S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #13/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1418S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX#14/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6054-1420S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY SECUR-FIT PLUS MAX #14/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00111914001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT VISCOSITY LOW PLUS G PALACOS 40GR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #0 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #9 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #0 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA STEM #9 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,859.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #0 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #9 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-5219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CITATION TMZF HA SHORT STEM #9 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,140.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT ARC/HA COLLAR STEM#4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT ARC/HA COLLAR STEM#5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT ARC/HA COLLAR STEM#6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF07|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT ARC/HA COLLAR STEM#7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT ARC/HA COLLAR STEM#8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECUR-FIT ARC/HA COLLAR STEM#9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECURFIT ARC/HA COLLAR STEM#10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECURFIT ARC/HA COLLAR STEM#11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECURFIT ARC/HA COLLAR STEM#12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECURFIT ARC/HA COLLAR STEM#13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-2337-HF14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SECURFIT ARC/HA COLLAR STEM#14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,869.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-0525A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #05 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-0625A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #06 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-0730A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #07 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-0830A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #08 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-0935A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #09 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-1035A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #10 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6070-1140A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #11 132|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6076-0525A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #05 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6076-0625A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #06 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6076-0730A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #07 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6076-0830A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #08 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6076-0935A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #09 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6076-1035A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT HFX HIP STEM SIZE #10 127|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6077-0740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE HFX SIZE #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6077-0840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACCOLADE HFX SIZE #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,756.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,756.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #0/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #1/11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #2/12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #3/13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #4/14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #5/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #6/16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-2-007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE PF HIP #7/17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-04132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 4 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-05132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 5 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-06127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 6 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-06132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 6 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-07127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 7 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-07132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 7 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-08127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 8 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-08132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 8 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-09127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 9 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-09132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 9 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-10127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 10 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-10132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 10 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-11127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 11 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-11132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 11 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-12127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|127 SIZE 12 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1601-12132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|132 SIZE 12 SECUR-FIT ADVANCED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 1 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 2 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 3 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 4 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MICROFIX WITH 3.0 ETHIBOND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 5 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 6 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 7 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 8 RIGHT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 1 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 2 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 3 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 4 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 5 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 6 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 7 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 8 RIGHT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 1 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 2 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 3 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 4 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 5 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 6 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 7 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 8 LEFT ANTEVERTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 1 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 2 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 3 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 4 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 5 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 6 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 7 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4845-7-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANATO STEM SIZE 8 LEFT NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-0027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 0 ACCOLADE II 132 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6720-1140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 11 ACCOLADE II 132 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6721-0027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 0 ACCOLADE II 127 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,814.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-36-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-38-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-40-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-41-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-42-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-42-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X42mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-43-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-44-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-44-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X44mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-45-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-45-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X45mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-46-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-46-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-47-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-47-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X47mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-48-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-48-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-49-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-49-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X49mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-49-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-50-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-50-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-50-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-51-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-51-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X51mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-51-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-52-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-52-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-52-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-052-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-53-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-53-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-53-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-54-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-54-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-54-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-55-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-55-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-55-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-56-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-054-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-56-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-56-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-58-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-58-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-58-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-58-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-61-22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 22X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-61-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-61-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-61-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-056-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,605.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,605.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported UH1-64-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-64-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-64-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-68-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-68-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-68-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-72-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 26X72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-72-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 28X72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UH1-72-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UHR BIPOLAR 32X72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-28MM X -3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-058-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 104.2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-28MM X -3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.2805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-28MM X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.2810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-28MM X +3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.3200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-32MM X -4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.3205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-32MM X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.3210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-32MM X +4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.3600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-36MM X -4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.3605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-36MM X 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104.3610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRINITY DELTA HEAD-36MM X +4.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,641.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-2800E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 28MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-060-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 17-2805E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 28MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-28-3E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 28MM/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-3200E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 32MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-3205E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 32MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-32-3E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 32MM/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-3600E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 36MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,529.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-3605E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 36MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,529.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 17-36-5E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER ALUMINA HEAD 36MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,529.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,529.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 28MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-2805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 28MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-062-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 18-2825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 28MM/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-28-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 28MM/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 32MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 32MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 32MM/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-32-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 32MM/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,844.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 36MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 36MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 36MM/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-36-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 36MM/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7260-064-32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP TRABECULAR MONOBLOCK METAL 10-DEG 32MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,266.10|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 18-36-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 36MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18-3675|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER BIOLOX+ DELTA HEAD 36MM/+7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186628-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 28MM SM-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186628-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 28MM MED-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186628-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 28MM LG-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186632-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 32MM SM-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186632-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 32MM MED-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186632-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 32MM LG-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186632-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 32MM XL-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186636-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 36MM SM-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186636-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 36MM MED-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186636-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 36MM LG-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186636-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 36MM XL-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,527.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186640-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 40MM SM-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186640-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 40MM MED-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186640-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 40MM LG-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186640-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-CERAMIC 40MM XL-RESTORIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,330.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6519-1-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA UNIVERSAL TAPER ANATOMIC HEAD SIZE 44+0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,318.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,318.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 28MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 28MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212851|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MINILOCK WITH 2.0 ETHIBOND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 22MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 22MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 22MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 28MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 28MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-2898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 28MM/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 32MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 32MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 32MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 36MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 36MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 36MM/+2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3675|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 36MM/+7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3697|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 36MM/-2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 36MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186028-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 28MM/-3.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186028-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 28MM/0 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186028-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 28MM/+3.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186028-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 28MM/+7 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186028-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 28MM/+10.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-004-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 4MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186032-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 32MM/-3.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186032-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 32MM/0 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186032-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 32MM/+3.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186032-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 32MM/+7 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186032-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 32MM/+10.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186036-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 36MM/-3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186036-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 36MM/0 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186036-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 36MM/+3.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186036-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 36MM/+7 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186036-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 36MM/+10.5 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,150.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9095-0018-W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST TAPER 9.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,548.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,548.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.32.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-32MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.32.035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-32MM X -3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.32.350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-32MM X 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.32.700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-32MM X7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.36.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-36MM X 0.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.36.035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-36MM X -3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.36.350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-36MM X 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3200.36.700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z FEMORAL HEAD-36MM X 7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 22MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 22MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-015-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6001-2600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 26MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 26MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 26MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 28MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 28MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-2810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 28MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-3200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 32MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-3205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 32MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-3210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 32MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6001-3299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR HEAD 32MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-5-426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR HEAD 26mm/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 26MM/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 28MM/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 28mm/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 22.2mm/+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 26MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 28MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 22.2MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 26MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-005-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 5MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6260-9-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 28MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 32MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 26MM/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 28MM/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 32MM/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM +6 LFIT V40 FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 26MM/-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 28MM/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 32MM/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 FEM HEAD ORTHINOX 36-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,059.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,059.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-006-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 6MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6364-2-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 22MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 26MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 28MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 32MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 FEM HEAD ORTHINOX 36-0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,059.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,059.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 26MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 28MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 32MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 FEM HEAD ORTHINOX 36+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,059.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,059.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 22MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-007-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 7MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6364-2-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 26MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 28MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6364-2-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ORTHINOX HEAD 32MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,039.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 28MM HD -3.5 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 32MM HD -4.0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 36MM HD -4.0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 28MM HD 0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 32MM HD 0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 36MM HD 0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 28MM HD +3.5 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771101600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 16MM STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported E321.232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 32MM HD +4.0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS METAFIX 36MM HD +4.0 OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH22|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER INTER.NK HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH31|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER INTER.NK HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH32|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER INTER.NK HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH34|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER INTER.NK HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER LFIT INTER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH64|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER LFIT INTER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH82|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER LFIT INTER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S-1400-HH84|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER LFIT INTER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-013-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6942-5-038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX MODULAR ENDO HEAD 38mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNITRAX MODULAR ENDO HEAD 61mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/+2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/+7.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/-2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 40MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-004-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 4MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 06-4405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/+10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/+2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/+7.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4497|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/-2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-4499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-TAPER COCR LFIT HEAD 44MM/-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186040-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 40MM/-3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186040-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 40MM/0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186040-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 40MM/+3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186040-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 40MM/+7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-005-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 5MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186040-04|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HEAD-COCR 40MM/+10.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 44MM/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 44MM/+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 44MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 40MM/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 44MM/+8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-9-444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 COCR LFIT HEAD 44MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,103.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN FEM HEAD-40M X-4.0MM OFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,967.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN FEM HEAD-40M X 0MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,967.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E321.240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN FEM HEAD-40M X+4.0MM OFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,967.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,967.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-006-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 6MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.01.628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP NTRL LNR-28MM- SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.01.728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 1 28MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.01.828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 1 28MM OBLIQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.01.928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP EPW LNR-28MM- SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL-28MM TPR SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP NTRL LNR-32MM- SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-28MM TPRSZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST 32MM TPRSZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ 28MM TPRSZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 2 32MM OBLIQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-014-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,012.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.02.928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD 28MM TPR SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.02.932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP EPW LNR-32MM- SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR HXLPE NTRAL 28MM TPR SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL 32MM TPR SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP NTRL LNR-36MM- SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-28MM TPRSZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-32MM TPRSZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RES TRINITY CUP LNR-HXLPE +4 36 SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-28MM TPRSZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-32MM TPRSZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-007-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 7MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.03.836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 3 36MM OBLIQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-28MM-TPR SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-32MM-TPR SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.03.936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP EPW LNR-36MM- SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL-28MM-TPR SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL-32MM-TPR SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP NTRL LNR-36MM- SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL-40MM-TPR SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-28MM TPRSZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-32MM TPRSZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-009-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 9MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.04.736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 4 36MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-40MM TPRSZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-28MM TPRSZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-32MM TPRSZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 4 36MM OBLIQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-40MM TPRSZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-28MM-TPR SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-32MM-TPR SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP EPW LNR-36MM ID-SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.04.940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-40MM-TPR SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-010-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 10MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.05.632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL-32MM-TPR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP NTRL LNR-36MM- SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE NTRAL-40MM-TPR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-28MM TPRSZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-32MM TPRSZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 5 36MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OFST-40MM TPRSZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-28MM TPRSZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-32MM TPRSZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HXLPE LINER SZ 5 36MM OBLIQUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7711-016-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP M/L TAPER 16MM EXTENDED OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,578.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 321.05.840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE4MM OBLQ-40MM TPRSZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-28MM-TPR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-32MM-TPR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS TRIN XLP EPW LNR-36MM ID-SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 321.05.940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RST TRIN CUP LNR-HXLPE ELVTD-40MM-TPR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.48.032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 32mm-SZ 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.50.032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 32mm-SZ 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.52.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 33mm-SZ 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.54.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 36mm-SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.56.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 36mm-SZ 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.58.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 36mm-SZ 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.60.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 36mm-SZ 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.62.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 36MM-SZ 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501.64.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS Z ACETABULAR INSERT 36MM-SZ 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,466.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ POLY INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-22J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00576401651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM F KN LT NG LPSFLX GNDR SOL OPTN COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-00-26H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-26J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-017-51|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-00-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 36 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-00-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-10-22G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-22J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621-10-26I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-26J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 26MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28 MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621-10-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 10¦ CROSSFIRE INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 641-00-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 575001701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 641-00-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641-00-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ELEVATED RIM INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,399.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 28J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-013-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 0¦ 32J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE ECCENTRIC INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE ECCENTRIC INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE ECCENTRIC INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE ECCENTRIC INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE ECCENTRIC INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-00-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT 0¦ CROSSFIRE ECCENTRIC INSERT 36MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661-10-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 28J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-32D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-32E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661-10-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 32J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-36E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 36E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-36F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 36F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-36G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 36G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 36H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 36I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661-10-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIDENT CROSSFIRE ECCENTRIC 10¦ 36J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,415.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186128-44|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-28/44 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186128-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-28/46 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186128-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-28/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186128-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-28/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186132-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-32/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186132-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-32/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186132-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-32/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186132-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-32/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186136-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-36/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186136-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-36/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186136-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-36/56 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186136-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-36/58-60 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186136-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-36/62-64 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186136-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY NEUT-36/66-70 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS XLVE ACETABULAR LINER NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186140-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-NEUT-40/56 RESTORIS XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186140-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-NEUT-40X58/60 RESTORIS XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186140-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-NEUT-40X62/64 RESTORIS XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186140-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-NEUT-40X66/68 RESTORIS XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186228-44|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-28/44 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186228-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-28/46 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186228-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-28/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-014-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,770.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186228-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-28/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186232-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-32/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186232-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-32/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186232-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-32/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186232-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-32/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186236-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-36/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186236-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-36/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186236-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-36/56 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186236-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-36/58-60 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186236-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-36/62-64 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186236-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY HIGH-36/66-70 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORIS XLVE ACETABULAR LINER HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186240-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-HIGH-WALL 40/56 RESTORIS XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186240-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-HIGH-WALL 40X58/60 RESTOR XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186240-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-HIGH-WALL 40X62/64 RESTOR XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186240-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-HIGH-WALL 40X66/68 RESTOR XLVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186328-44|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-28/44 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186328-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-28/46 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186328-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-28/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186328-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-28/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186332-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-32/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186332-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-32/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186332-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-32/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186332-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-32/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186336-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-36/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186336-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-36/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186336-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-36/56 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186336-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-36/58-60 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186336-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-36/62-64 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186336-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4OFF-36/66-70 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-013-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE C MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186428-44|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-28/44 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186428-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-28/46 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186428-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-28/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186428-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-28/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186432-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-32/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186432-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-32/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186432-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-32/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186432-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-32/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186436-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-36/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186436-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-36/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-014-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE D MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186436-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-36/56 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186436-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-36/58-60 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186436-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-36/62-64 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186436-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 EL-36/66-70 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186528-44|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-28/44 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186528-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-28/46 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186528-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-28/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186528-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-28/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186532-48|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-32/48 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186532-50|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-32/50 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-015-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE E MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 186532-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-32/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186532-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-32/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186536-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-36/52 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186536-54|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-36/54 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186536-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-36/56 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186536-58|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-36/58-60 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186536-62|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-36/62-64 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186536-66|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACE LINR-E-POLY +4 HI-36/66-70 IMPLANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,991.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRDNT 0D A 7.8MM 22MM X3 HIP HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRDNT 0D B 8.8MM 22MM X3 HIP HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-015-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-22C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRDNT 0D C 9.8MM 22MM X3 HIP HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D D 10.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D E 12.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D F 14.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D G 16.3MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 18.1MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 19.6MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-22J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 21.6MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D C 7.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D D 8.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-016-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE F MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-26E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D E 10.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D F 12.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D G 14.4MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 16.2MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 17.7MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-26J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 19.7MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D B 5.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D C 6.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D D 7.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D E 9.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-017-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF LEFT SIZE G MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D F 11.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D G 13.4MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 15.2MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 16.7MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 18.7MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D F 9.9MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D G 11.4MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 13.2MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 14.7MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 16.7MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-016-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,400.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 11.2MM 36MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 12.7MM 36MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 14.7MM 36MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-40H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 9.1MM 40MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-40I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 10.6MM 40MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-40J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 12.6MM 40MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-44F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D B F 3.8MM 44MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-44G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D G 5.4MM 44MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-44H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D H 7.1MM 44MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-00-44I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D I 8.6MM 44MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5764-017-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL GSF LSP FLEX PS LEGACY NEXGEN SZ G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,332.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,332.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-00-44J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 0D J 10.6MM 44MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D A 7.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D B 8.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D C 9.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D D 10.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D E 12.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D F 14.8MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D G 16.3MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D H 18.1MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-22I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D I 19.6MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-013-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE C MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-10-22J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D J 21.6MM 22MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D C 7.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D D 8.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D E 10.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D F 12.9MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D G 14.4MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D H 16.2MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D I 17.7MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-26J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D J 19.7MM 26MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D C 6.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-014-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE D MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-10-28D|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D D 7.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D E 9.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D F 11.9MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D G 13.4MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D H 15.2MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D I 16.7MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-28J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D J 18.7MM 28MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-32F|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D F 9.9MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-32G|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D G 11.4MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-32H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D H 13.2MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-015-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE E MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 623-10-32I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D I 14.7MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-32J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D J 16.7MM 32MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,474.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-36H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D H 11.2MM 36MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-36I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D I 12.7MM 36MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623-10-36J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB 10D J 14.7MM 36MM X3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,980.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-52H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 52mm H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-54I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 54mm I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626-00-58J|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MDM COCR LINER 58mm J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,085.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-016-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE F MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1235-2-850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1235-2-864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM INSERT 28/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5750-017-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL PRECOAT NEXGEN CR-FLEX GSF RIGHT SIZE G MINUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,098.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1236-2-860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1236-2-864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,581.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-2810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-3200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-3205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-3210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-3299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LFIT MORSE TAPER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 22MM +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 26MM +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 28MM +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 32MM +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 26MM -3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 28MM -3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-0-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 32MM -3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-5-026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 26MM +5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-5-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 28MM +5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0586-5-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXETER ORTHINOX HEAD 32MM +5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-2-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PLUG EXETER X-CHANGE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-2-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PLUG EXETER X-CHANGE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-2-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PLUG EXETER X-CHANGE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-2-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PLUG EXETER X-CHANGE 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-2-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PLUG EXETER X-CHANGE 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-2-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE PLUG EXETER X-CHANGE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE SCREW 3.5X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE SCREW 3.5X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE SCREW 3.5X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE SCREW 3.5X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE SCREW 3.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE SCREW 3.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|367.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|367.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE FEMORAL MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE WALL MESH LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE WALL MESH SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE FLAT MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE RIM MESH SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE RIM MESH MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE RIM MESH LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0942-8-070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CHANGE FEMORAL ANATOMICAL MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,152.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-2244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 22MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-2856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-2861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1OBSGPROX75|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE LINE REINFORCEMENT MATERIAL BIOABSORABLE 75MM|1|HUMANA [1294]||HUMANA [11839]|627.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|627.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2006-3252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-3256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2006-3261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OMNIFIT SERIES I ACET. INSERT 20¦ 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,353.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-2244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II INS 10 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-2846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 28MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II INS 10 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2041C-3274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSFIRE SERIES II 10¦ INSERT 32MM ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,552.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2050-2040CS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IRELAND PRE-HA SECUR-FIT PSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,654.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,654.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2050-2042CS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IRELAND PRE-HA SECUR-FIT PSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,654.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,654.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2050-2044CS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IRELAND PRE-HA SECUR-FIT PSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,654.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,654.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GAP PLATE SCREWS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GAP PLATE SCREWS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GAP PLATE SCREWS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6007-1200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 2MM HEMICAP SHLDR 25/30MM HEMISHOULDER ARTHPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2080-0060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GAP PLATE SCREWS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|478.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|478.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0048L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0048R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0052L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0052R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0056L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0056R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0060L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0060R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0064L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9152-1535-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL TOE 15MM HEMICAP 1.5MM 3.5MM OFST MTP COCRMO TI RSRFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0064R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0068L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0068R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0072L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2082-0072R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP II ACET SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,799.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2083-0072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION GAP RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,498.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2099-2874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONSTRAINED ACETABULAR INSERTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,959.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-0-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6MM SS BEADED CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-0-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 2.0MM SS BEADED CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-0-410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6MM SS CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-0-510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 2.0MM SS CABLE/SLEEVE SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-1-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6MM SS CABLE SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-1-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 2.0MM SS CABLE SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES SMALL STAINLESS STEEL GRIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,899.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,899.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES MEDIUM STAINLESS STEEL GRIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,899.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,899.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES MEDUIM STAINLESS STEEL GRIP PLATE 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,804.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,804.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES MEDUIM STAINLESS STEEL GRIP PLATE 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,302.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,302.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES MEDUIM STAINLESS STEEL GRIP PLATE 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,807.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,807.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE STAINLESS STEEL GRIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,899.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,899.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE STAINLESS STEEL GRIP PLATE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,804.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,804.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE STAINLESS STEEL GRIP PLATE 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,302.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,302.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-2-093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DALL MILES LARGE STAINLESS STEEL GRIP PLATE 210MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,807.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,807.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-3-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 6.5" SS BROAD COMP PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-3-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 8.0" SS BROAD COMP PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-3-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 10" SS BROAD COMP PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-3-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 12" SS BROAD COMP PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-8-236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 1.6MM SS CABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3704-8-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M 2.0MM SS CABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,270.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4653-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HEAD 28MM DIAMETER +0MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4653-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HEAD 28MM DIAMETER -5MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4653-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HEAD 28MM DIAMETER +5MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4655-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HEAD 32MM DIAMETER +0MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4655-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HEAD 32MM DIAMETER -5MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4655-03|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HEAD 32MM DIAMETER +5MM OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4847-2-858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ABG I REVISON HOODED ACETABULAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,802.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,802.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-54C-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 54 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-54C-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 54 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-56D-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 56 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-56D-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 56 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-58D-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 58 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-58D-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 58 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-60D-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 60 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-60D-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 60 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-62E-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 62 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-62E-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 62 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-64E-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 64 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-64E-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 64 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-66F-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 66 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-66F-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 66 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-68F-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 68 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-68F-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 68 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-70G-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 70 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-70G-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 70 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-72G-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 72 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-72G-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 72 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-74H-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 74 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-74H-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 74 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-76H-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 76 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-76H-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 76 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-78H-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 78 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-78H-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 78 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-80H-L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 80 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 504-02-80H-R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESTORATION ANATOMIC SHELL SIZE 80 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,196.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-66H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-68H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-70I|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM REVISION ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,442.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT S2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT S2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT S2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT M1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT M1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT M1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT M1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT M2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT M2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT M2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT M2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT L1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT L1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT L1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT L1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT L2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT L2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT L2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT L2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT XL1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT XL1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT XL1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT XL1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT XL2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT XL2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT XL2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT XL2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON L-2 10MM FULL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,216.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6634-0-330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURA UNI FEM LT MED/RT LAT SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,953.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,953.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 9MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 11MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 13MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 16MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 22MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 25MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 28MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 31MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 9MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 11MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 16MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 19MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 25MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 28MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 31MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 9MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 11MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 13MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0064001161|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URET AXXCESS 6FR 70CM TPR TIP 1 LUM RADOPQ OP-EN PRCFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6637-0-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 16MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 19MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 22MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 25MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 28MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 31MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 9MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 11MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 13MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 16MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 19MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 22MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 25MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 28MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS L 31MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 9MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 11MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 13MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 16MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 19MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 22MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 25MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 28MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 31MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 9MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 11MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 13MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 16MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 19MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 22MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 25MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 28MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 31MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 9MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 11MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 13MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 16MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 19MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 22MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 25MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1OBSPROX55|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLELINE REINFORCEMENT MATERIAL BIOABSORBABLE 55MM|1|HUMANA [1294]||HUMANA [11839]|609.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|609.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6637-0-828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 28MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 31MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 9MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 11MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 13MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 16MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 19MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 22MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 25MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-0-928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 28MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1OBSGPROX100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE-LINE REINFORCEMENT MATERIAL BIOABSORBABLE 100MM|1|HUMANA [1294]||HUMANA [11839]|678.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|678.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6637-0-931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK/DURA REV INS R 31MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 9MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 11MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 13MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 16MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 19MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 25MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 9MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 11MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 22MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 25MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 28MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 31MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 9MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 11MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 13MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 16MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 19MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 22MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 25MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 28MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 31MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 9MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 11MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 13MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 16MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 19MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 22MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 25MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 28MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6637-4-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA NEUT/DURA REV INS 31MM XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,141.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E5617-14|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE 14 EYE SILICONE|1|HUMANA [1294]||HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPEDTIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-1-925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION A/P LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,177.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION ASYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION ASYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION ASYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION ASYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION ASYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION SYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION SYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION SYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION INSET PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-627|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION INSET PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-629|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION INSET PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION SYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION INSET PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-633|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION INSET PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION SYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-2-645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION SYMMETRIC PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,404.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.441|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 59.5MM SS 2.4MM SCR 8 HLE/HD 4 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,720.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,720.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6642-5-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS SM 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS MED 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.110.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 50.5MM SS 2.4MM SCR 9 HLE/HD 3 HL SHFT CLMN RND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,637.57|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,637.57|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6642-5-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS LG 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XL 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XL 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XL 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G17976|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH AMPLATZ 30FR X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6642-5-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XL 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XL 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XL 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XLG 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-5-431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION TS TIB INS XLG 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS LG 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS LG 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS LG 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS LG 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS LG 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6642-9-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON CNSTR TIB INS LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,414.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-1-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410236F|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FOGERTY BILIARY PROBE 6FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6728-2-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-2-940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY REV PATELLA MED PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,012.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,012.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS LT LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA MTK REV TIB INS RT LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,962.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6728-4-940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY REV PATELLA LG PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,012.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,012.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT LUPINE BR OTHCRD DS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-1-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION PS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,693.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-209X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT MEDIUM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-211X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT MEDIUM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-213X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT MEDIUM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-309X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT MEDIUM 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-311X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT LARGE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-313X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT LARGE 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-409X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT XLARGE 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-411X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT XLARGE 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-413X|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON X3 CS TIBIAL INSERT XLARGE 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,322.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0616RS|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS SOLO RELIEVA 6MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6742-4-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6742-4-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON DURATION CS LIPPED TIBIAL INS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-1924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-5710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-5712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-5714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-5716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-5718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-5721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VP210STD|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAC PLACEMENT CATHETER DIALYSIS PERITONEAL Y-TEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-4-5724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-7524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-4-9124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,785.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-1105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-1305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-1310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-1-1315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS DISTAL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S POSTERIOR FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S POSTERIOR FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S POSTERIOR FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S POSTERIOR FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-1105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-1305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-2-1310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS POSTERIOR FEM BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,798.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 732012/8X2|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARCH AORTIC TRIFURCATE GELWEAVE 12MM X 8CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75-3-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-1105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-3-1305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 732012/10X2|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARCH AORTIC TRIFURCATE GELWEAVE 12MM X 10CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75-3-1310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS HALF BLOCKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,097.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS 10MM FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-0410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S FULL BLOCK -10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS 10MM FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-0610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S FULL BLOCK -10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS 10MM FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS 10MM FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS 10MM FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-4-1310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS 10MM FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-0305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-0405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-0505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-0605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-0705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-0905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-1105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75-5-1305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FULL TIBIAL WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4103L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4103R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4105L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4105R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4107L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4107R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4109L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4109R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4111L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4111R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4113L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76-4113R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS FEM. W/LFIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,090.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS MOD. TIB. TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S MODULAR TIB TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS MOD. TIB. TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO T/S MODULAR TIB TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS MOD. TIB. TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS MOD. TIB. TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS MOD. TIB. TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 77-4013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO TS MOD. TIB. TRAY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIT'CANC' SCREW 6.5 DIA X 16MMTRIATHLON TOTAL KNEE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5585-C-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON VITALLIUM CANCELLOUS BONE SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEV FX 40MM EBTN ACL PRELD PLSTR BRAID SUT STFR CNT LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5513-F-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,001.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 25MM EBTN CL ULT PRELD BRD SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5514-F-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS FEM COMPONENT - BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,135.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 KN LT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5510-F-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 8 KN RT CR CMNT TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,508.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN LT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5515-F-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM 2 KN RT CMNT POST STAB TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,615.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-L-SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-L-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-L-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-R-SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-R-SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-R-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLOFEMORAL-R-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,884.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-LM-RL-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK FEMORAL-RM-LL-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,790.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B-2240|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND LAP STANDARD 0-10CC PORT STANDARD|1|HUMANA [1294]||HUMANA [11839]|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5530-P-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B-2245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BAND LAP STANDARD 0-14CC PORT STANDARD|1|HUMANA [1294]||HUMANA [11839]|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,465.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5530-P-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-P-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CR INSERT SZ1 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ1 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER LEFT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531-P-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ1 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ1 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ1 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER RIGHT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531-P-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ3 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ3 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ3 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS LIPPED INS. SZ3-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ3 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ3 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ 3 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-013-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531-P-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ4 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ 4 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ5 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ5 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ 5 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ5 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-013-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-RIGHT SIZE C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531-P-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ5 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ 5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ6 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS TRIAL SZ6 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER LEFT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531-P-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ7 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER RIGHT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5531-P-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-P-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CS INSERT SZ8 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-014-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-LEFT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,260.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-P-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-014-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-RIGHT SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-P-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-P-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-P-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-015-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-LEFT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5532-P-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-P-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PS TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,352.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-015-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-RIGHT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-12-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-LEFT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-12-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-RIGHT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-12-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-016-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-LEFT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-12-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-12-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,034.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-016-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-RIGHT SIZE F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-13-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER LEFT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-13-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER RIGHT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-13-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-13-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,179.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-017-05|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-LEFT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-15-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5752-017-06|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL POROUS CR-GENDER MINUS-RIGHT SIZE G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,570.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-15-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0113092|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERMASORB FIXATION DEVICE LAPAROSCOPIC ABSORBABLE|1|HUMANA [1294]||HUMANA [11839]|710.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|710.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-15-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212733|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PANALOCK RC PLUS WITH DUAL ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,041.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,041.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-15-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,716.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212137|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PANALOK RC PLUS WITH ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-16-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,697.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #3 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44102|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVIOR CATHETER VENTRICULAR SIDE-INLET 18MM .3ML|1|HUMANA [1294]||HUMANA [11839]|1,180.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,180.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 82-2-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #7 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44103|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESERVIOR CATHETER VENTRICULAR SIDE-INLET 28MM 1.1ML|1|HUMANA [1294]||HUMANA [11839]|1,180.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,180.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 82-2-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #9 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-2-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG CR TIBIAL BEARING INSERT #11 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,033.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #7 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752530|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 26CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG|1|HUMANA [1294]||HUMANA [11839]|331.74|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 82-3-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #9 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-3-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG PS INSERT #11 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,054.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5530-G-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE1 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-211-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-213-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE2 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-309-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE3 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE3 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE3 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-411-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE5 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE6 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-709-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE7 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE7 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE7 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE8 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE8 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5531-G-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X3 TRIATHLON CS INS SIZE8 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,711.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 25MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 25MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-709-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 9MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 7 25MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 22MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5532-G-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 8 25MM KN X3 POST STAB BRNG TRTHLN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-25-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX PS X3 TIB INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,696.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5086-02|SUP|HCPCS C1765||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACK PROCEDURE SEPRAFILM 3" X 5" 6-SHEETS|1|HUMANA [1294]||HUMANA [11839]|2,134.88|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,134.88|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72-26-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062101170|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEPHROMAX BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72200147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 20MM EBTN CL ULT PRELD BRD SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72-26-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO-FLEX CR X3 TIBIAL INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,680.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #7 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200149|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 30MM EBTN CL ULT PRELD BRD SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #9 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 15MM EBTN CL ULT PRELD BRD SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-6-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 CR TIBIAL INSERT #11 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 35MM EBTN CL ULT PRELD BRAID SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 45MM EBTN CL ULT PRELD BRAID SUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NRG PS TIBIAL INSERT X3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #7 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #9 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 82-7-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO NRG X3 PS TIBIAL INSERT #11 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,919.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180701-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 1-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 410235F|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FOGARTY BILIARY PROBE 5FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 180702-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180702-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 2-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180703-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 3-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180704-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 4-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 5-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 5-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 5-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 5-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 5-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180705-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 5-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180706-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 6-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180707-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 7-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200153|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON ULTRA CL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-7|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180708-9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL ONLAY INSERT-SZ 8-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180731-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 1 - 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200154|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON ULTRA CL 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180731-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 1 - 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180731-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 1 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180731-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 1 - 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180732-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 2 - 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180732-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 2 - 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180732-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 2 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180732-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 2 - 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180733-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 3 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180733-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 3 - 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180734-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 4 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON ULTRA CL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|989.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|989.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180734-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 4- 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180735-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 5- 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180736-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 6 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180736-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 6 - 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180737-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 7 - 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180737-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 7 - 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180737-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 7 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180737-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 7 - 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180738-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 8 - 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180738-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 8 - 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON DIRECT FIXATION DEVICE 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|913.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180738-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 8 - 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180738-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 8 - 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5556-L-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM SYMMETRIC METAL BACKED PATELLA S31X9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5556-L-339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM SYMMETRIC METAL BACKED PATELLA S33X9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5556-L-360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM SYMMETRIC METAL BACKED PATELLA S36X10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5556-L-391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRITANIUM SYMMETRIC METAL BACKED PATELLA S39X11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,870.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3044-0026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO RECESSED PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3044-0028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO RECESSED PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3044-0030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO RECESSED PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3044-0032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO RECESSED PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON DIRECT FIXATION DEVICE 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|913.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON DIRECT FIXATION DEVICE 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|913.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-0110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-2910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-3110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-3308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-3508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON DIRECT FIXATION DEVICE 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|941.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|941.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-3708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-3710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-3910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,144.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550-G-278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON SYMMETRIC X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5550-G-391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON SYMMETRIC X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5551-G-401-E|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYMMETRIC X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,624.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-0110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO M-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOBUTTON DIRECT FIXATION DEVICE 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|913.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|913.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-2110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-2510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-2710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-2910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO C-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-3110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-3308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-3508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-3708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-3710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-3910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCORPIO U-DOME X3 PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72200134|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION XTENDOBUTTON|1|HUMANA [1294]||HUMANA [11839]|513.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|513.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-4026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECESSED PATELLAR COMP X3 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-4028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECESSED PATELLAR COMP X3 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-4030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECESSED PATELLAR COMP X3 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73-20-4032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECESSED PATELLAR COMP X3 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180320-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLA RESURFACING ROUND DOME-26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180320-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLA RESURFACING ROUND DOME-29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180320-3|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLA RESURFACING ROUND DOME-32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180320-5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLA RESURFACING ROUND DOME-38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180320-6|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK PATELLA RESURFACING ROUND DOME-41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,561.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR-2C|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING MR-2C|1|HUMANA [1294]||HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5520-M-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON MIS BASEPLATE #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,016.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL BASEPLATE-LM/RL-SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL BASEPLATE-LM/RL-SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL BASEPLATE-LM/RL-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL BASEPLATE-RM/LL-SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL BASEPLATE-RM/LL-SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MCK TIBIAL BASEPLATE-RM/LL-SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,197.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6366-9-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS AXIS PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6465-6-007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS WEDGE - 7 X 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,041.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,041.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6465-6-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS BEARING - 18 X 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|997.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|997.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MR-2L|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MORCHER CAPSULAR TENSION RING MR-2L|1|HUMANA [1294]||HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6466-9-230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS/G I-II CIRCLIPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,159.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,159.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6475-3-933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIB BEARING COMP ROT/HIN KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,767.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,767.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6475-3-940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH STANDARD AXLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOW ROT HNG KNEE FEM XS LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOW ROT HNG KNEE FEM MED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOW ROT HNG KNEE FEM LG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOW ROT HNG KNEE FEM LG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOW ROT HNG KNEE FEM XL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOW ROT HNG KNEE FEM XL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH DIS FEM AUGMENT 10mm MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH DIS FEM AUGMENT 10mm LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-1-240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH DIS FEM AUGMENT 10mm XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,412.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB ROT COMP LG/XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH CROSSOVER TIB BEAR LONG XS/XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH CROSSOVER TIB BEAR SHORT XS/XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH CROSSOVER TIB BEAR PEDIATRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH CROSSOVER TIB BEAR COMP TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,153.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-2-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH/GMRS DISTAL FEMUR POLY PACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,546.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,546.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH TIBIAL BASEPLATE S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH TIBIAL BASEPLATE M2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRH TIBIAL BASEPLATE L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,346.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 20mm XS/S S1/S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 24mm XS/S S1/S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 10mm M/l M2/L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 13mm M/l M2/L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 16mm M/L M2/L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 20mm M/L M2/L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6481-3-324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HRHK TIB INS 24mm M/l M2/L2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6483-1-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS ROT HINGE FEMORAL BUSHING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,659.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,659.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6483-1-350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS ROT HINGE AXLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6483-2-153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUMPER INSERT 3 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6483-2-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS ROT HINGE TIBIAL ROTATING COMPONENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,126.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,126.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6483-3-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS ROT HINGE TIBIAL INSERT 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,194.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,194.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6483-3-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HMRS ROT HINGE TIBIAL INSERT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,194.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,194.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5204100|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URETERAL DOUBLE-J 7.0 X 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|373.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6485-1-915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINEMATIC DURATION PATELLA SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,828.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,828.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XS KRH ALL POLY TIBIA 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XS KRH ALL POLY TIBIA 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XS KRH ALL POLY TIBIA 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XS KRH ALL POLY TIBIA 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SM KRH ALL POLY TIBIA 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SM KRH ALL POLY TIBIA 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SM KRH ALL POLY TIBIA 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SM KRH ALL POLY TIBIA 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MED KRH ALL POLY TIBIA 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MED KRH ALL POLY TIBIA 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MED KRH ALL POLY TIBIA 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MED KRH ALL POLY TIBIA 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LG KRH ALL POLY TIBIA 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LG KRH ALL POLY TIBIA 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LG KRH ALL POLY TIBIA 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LG KRH ALL POLY TIBIA 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XL KRH ALL POLY TIBIA 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XL KRH ALL POLY TIBIA 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XL KRH ALL POLY TIBIA 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XL KRH ALL POLY TIBIA 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH DURATION BUSHING STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH DURATION BUSHING SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM PT1 ALLPOLY TIB KRH XXXS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM PT1 ALLPOLY TIB KRH XXXS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM PT2 ALLPOLY TIB KRH XXS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-2-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM PT2 ALLPOLY TIB KRH XXS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,205.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM FEM STM 10X102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM FEM STM 8X102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM FEM STM 9X102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111320SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM FEM STM 10X102 W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM FEM STM 8X102 W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 17X127 FEM STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 11X127 FEM STM W/FEM TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13X127 FEM STM W/FEM TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 15X127 FEM STM W/FEM TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 17X127 FEM STM W/FEM TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,738.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM CURVED FEM STM 10X102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM CURVED FEM STM 8X102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM CURVED FEM STM 9X102|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM CRV FEM STM 10X102 W/O|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 15MMX203MM FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 17MMX203MM FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,276.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM CRV PT FEM STM 8X102 W|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SM CRV FEM STM 9X102 W/O|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 11MMX203MM FEM/STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0524RS|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS SOLO RELIEVA 5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6485-3-613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13mmX203mm FEM/STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 15mmX203mm FEM/STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 17MMX203MM FEM/STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 11X127 CURVED FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13X127 CURVED FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 15X127 CURVED FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 17X127 CURVED FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,215.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 11X127 CUR FEM STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13X127 CUR FEM STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 15X127 CUR FEM STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 17X127 CUR FEM STEM W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,573.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-3-915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINEMATIC DURATION PATELLA MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,828.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,828.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH DURATION STANDARD BUMPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH DURATION 12.5MM BUMPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH DURATION 14.5MM BUMPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH DURATION 16.0MM BUMPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,127.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-4-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MET ENCAP INSERT DURATION MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,170.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-6-409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 9MM TIBIAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,093.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,093.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-6-411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 11MM TIBIAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,093.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,093.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-6-413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13MM TIBIAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,093.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,093.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-6-509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 9MM TIBIAL STEM W/OUT BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,479.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,479.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-6-513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 13MM TIBIAL STM W/OUT BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,479.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,479.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-8-435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHORT TIBIA BEARING COMPONENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,947.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,947.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-8-450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH TIBIAL BEARING COMP 3XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,143.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,143.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6485-8-460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KRH SM AXLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,616.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,616.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-1-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 40MM HUMERAL BDY M/F TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-1-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 60MM HUMERAL BDY M/F TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-1-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 80MM HUMERAL BDY M/F TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-1-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 100MM HUMERAL BDY M/F TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-1-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 120MM HUMERAL BDY M/F TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-1-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 140MM HUMERAL BDY M/F TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,410.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-2-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 7MMX75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-2-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 7MMX115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-3-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 9MMX75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-3-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 9MMX115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-4-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 11MMX75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-4-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 11MMX115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,392.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS SCREW HUMERAL INTERCALARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,545.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,545.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 40MM PROXIMAL HUMERAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,121.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,121.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 44MM PROXIMAL HUMERAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,121.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,121.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 7X75 W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 25MM BODY X 75MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 25MM BODY X 100MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-5-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUM STEM W/O BOD 7MMX115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-6-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUMERAL STEM 9X75 W/O BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-6-076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 50MM BODY X 75MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-6-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 50MM BODY X 100MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-6-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUM STEM W/O BOD 9MMX115MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-7-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUM STEM W/O BOD 11MMX75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-7-076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 75MM BODY X 75MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-7-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 75MM BODY X 100MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-7-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS HUM STEM W/O BOD 11MMX115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-8-051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 100MM BODY X 50MM HUM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,975.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6487-9-051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MRS 50MM PROXIMAL HUM CAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,365.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-1-001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS STANDARD PROXIMAL FEMUR NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-1-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS STD PROX FEMUR 15¦ ANTEVERTED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-1-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS TROCHANTERIC PROX FEMUR 15¦ ANTEVERTED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-1-201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS STD PROX FEMUR 15¦ ANTEVERTED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-1-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS TROCHANTERIC PROX FEMUR 15¦ ANTEVERTED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,152.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-2-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 65MM DISTAL RIGHT GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,719.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,719.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-2-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STD LT DIST FEM 65mm GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,494.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,494.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-2-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STD RT DIST FEM 65mm GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,494.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,494.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-3-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS SM TIB INS 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-3-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS SM TIB INS 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-3-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS SM TIB INS 24mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,922.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-3-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STANDARD PROXIMAL TIBIAL GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,670.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,670.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19mm PRESS FIT FLUTED STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,653.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15MM PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19mm PRESS FIT BOWED STEM 200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-5-219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19mm PRESS FIT BOWED STEM 150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,501.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS 80mm LT CONNECTION PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,914.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,914.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS 90mm LT CONNECTION PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,914.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,914.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS 80mm RT CONNECTION PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,052.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,052.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMRS 90mm RT CONNECTION PIECE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,052.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,052.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|70mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|80mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|100mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|120mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|140mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0724RS|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS SOLO RELIEVA 7MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6495-6-160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|160mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|180mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|200mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6495-6-220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|220mm EXTENSION PIECE - GMRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,367.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS LEFT 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS LEFT 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS LEFT 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS LEFT 180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS LEFT 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS LEFT 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS RIGHT 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS RIGHT 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS RIGHT 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS RIGHT 180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-590|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS RIGHT 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-1-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISTAL FEMORAL GROWING PROSTHESIS RIGHT 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102,139.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-2-301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL BEARING COMPONENT FOR DISTAL FEMORAL GROWING TO PEDIATRIC ALL-POLY TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-2-302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL BEARING COMPONENT FOR DISTAL FEMORAL GROWING TO MRH KEEL TIBIAL BASEPLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6497-2-303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL BEARING COMPONENT FOR DISTAL FEMORAL GROWING TO GMRS SMALL PROXIMAL TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-1-018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ICA FEM COMP 18MM DIAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,732.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,732.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-2-012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WICHITA NAIL TIB COMP 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,295.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,295.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WICHITA NAIL COMPRESSION SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,840.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,840.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X25MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X30MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X35MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X40MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X45MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X50MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X55MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6647-3-160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WFN 6.0X60MM FULL-THD SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|816.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|816.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 810081L|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM OBTURATOR TVT WITH MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,933.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,933.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2627-2-905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VAK TIB INS 5MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,709.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,709.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2627-2-915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VAK STD TIB INSERT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,709.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,709.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-1-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS SML 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-3-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS MED 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-5-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS LRG 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS XLRG 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS XLRG 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS XLRG 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS XLRG 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS XLRG 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS XLRG 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,565.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,425.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,425.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,425.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,425.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2642-6-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PCA P/R TIB INS 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,425.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,425.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-0924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3052-1124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SERIES II TIBIAL BEAR INSERT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,414.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5512-F-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI TS FEMUR SZ8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,998.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5537-G-831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5540-A-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 5MM - SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,126.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5541-A-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 10MM - SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5542-A-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL DISTAL AUGMENT 15MM - SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,546.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5543-A-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1BSGC2829|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEAMGUARD STAPLE LINE REINFORCEMENT MATERIAL BIOABSORBABLE|1|HUMANA [1294]||HUMANA [11839]|906.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5543-A-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5544-A-800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI POST AUGMENT SZ8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,334.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5545-A-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI LM/RL TIB AUG SZ8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5546-A-802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI RM/LL TIB AUG SZ8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,864.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON SYM CONE AUGMENT SIZE A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON SYM CONE AUGMENT SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,313.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE B LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE B RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE C LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE C RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE D LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE D RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE E LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON ASYM CONE AUGMENT SIZE E RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,377.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 1 & 2 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 1 & 2 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 3 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 4 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 5 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 6 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 6 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 7 & 8 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5549-A-372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON FEMORAL CONE AUGMENT SIZE 7 & 8 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,440.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CEMENTED STEM-9MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CEMENTED STEM 9MMX100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI CEMENTED STEM 12MMX100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CEMENTED STEM-9MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CEMENTED STEM-12MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5560-S-315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON CEMENTED STEM-15MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 15X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PRESS-FIT STEM 20MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 21X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PRESS-FIT STEM 22MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 23X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIATHLON PRESS-FIT STEM 24MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5566-S-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRI PRESS-FIT STEM 25X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON PATELLA SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,597.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON PATELLA MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,597.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON PATELLA LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,597.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON XS FEMORAL COMPONENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON SM FEMORAL COMPONENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON MED FEMORAL COMPONENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6430-0-300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVON LG FEMORAL COMPONENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,039.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6476-1-400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-MAX PLUS BSEPLT ASSY SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,150.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,150.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6476-8-250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR CEMENTED STEM 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6476-8-270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR CEMENTED STEM 155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 10MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-397|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 12MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-398|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 13MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 14MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 16MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 17MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 18MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 19MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 21MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 23MMX80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 10MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 11MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 12MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 13MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 14MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 16MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 17MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 18MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 19MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 21MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR PRESSFIT STEM 23MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,173.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-495|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OFFSET ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OFFSET ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-585|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OFFSET ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 10X80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 12X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 14X80mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 19X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-655|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 21X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 23X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 10X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-685|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 11X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-690|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 12X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-695|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 13X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 14X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 15X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 16X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 17X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 18X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 19X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 21X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6478-6-750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REGULAR FLUTED STEM 23X155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,880.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT S1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT S1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT S1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254629|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHEATH TIBIAL BIO-INTRAFIX SMALL|1|HUMANA [1294]||HUMANA [11839]|1,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE LT FLT S1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6630-6-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURACON TIB WEDGE RT FLT S2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,124.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6MM 55MM 32MM AXSOS 3 TI P/T CANCELLOUS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608495|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6MM 95MM 32MM AXSOS 3 TI P/T CANCELLOUS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1000|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR SENTIVA SINGLE PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX755|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 755CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF-1150|SUP|HCPCS Q4159||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE L1.5 CM X W1.5 CM AFFINITY|1|HUMANA [1294]||HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840009535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SOLERA COCR 35 MM 9.5 MM SPINE MULTIAXIAL 5.5 MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-INTRAFIX 6MM - 8MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350858|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC LIFESTREM 8MM 58MM 135CM BLN EXPNDBLE LOPRFL CVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM DART-FIRE TI ALY FT SLF DRL ST CNN HD AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N40034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM DART-FIRE TI ALY FT SF DRL ST CNN HD DK B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|693.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|693.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6626749|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 17X9MM DIVERGENCE 14MM LRDTC NAR PRFL CRV ANT PEEK|1|HUMANA [1294]||HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6623515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM L15 MM OD3.5 MM SPINAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-INTRAFIX 6MM - 7MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626928|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ANCHORAGE T8 L28 MM OD3.6 MM LAG CROSS PLATE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWK404LA25S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID CORTILOC 25 D MEDIUM SHOULDER LEFT AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF604B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL AEQUALIS ASCEND FLEX 132.5 4B STANDARD 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL AEQUALIS ASCEND FLEX COCR 4 MM H23 MM OD52 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534-A-609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL ALL-POLY CS SZ 6-9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626932|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ANCHORAGE T8 L32 MM OD3.6 MM LAG CROSS PLATE ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CD HORIZON COCRMO CURVE L40 MM OD5.5 MM NONSTERIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113649|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 122MM X 9MM CMPRH POR SHLDR RVRS SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID COMPREHENSIVE HYBRID SMALL 4MM SHLD BS M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TI-113042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL COMPREHENSIVE VERSA-DIAL 46X18X53 TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA0304|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE AVIVE SOFT MEMBRANE 3CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L24 MM OD4.5 MM ANKLE LOCK LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOW PROFILE L45 MM OD5.5 MM ANKLE CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8970AR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE ANKLE RIGHT ANTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212859|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MICROFIX ABSORBABLE WITH 3.0 ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,743.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,743.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Standard #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO-INTRAFIX 7MM - 9MM X 30MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,104.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem H Collared Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254628|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHEATH TIBIAL BIO-INTRAFIX LARGE|1|HUMANA [1294]||HUMANA [11839]|1,173.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,173.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC STANDARD #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.39.412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MASTERLOC LATERALIZED PLUS #12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H STANDARD #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H LATERALIZED #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.98SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.20SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.21SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.22SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.23SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.24SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.25SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.26SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.27SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.28SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.29SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.30SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN STANDARD #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.31SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.32SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.33SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.34SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.35SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.36SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.37SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA H SN LATERALIZED #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.100R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.101R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #1 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.102R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #2 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.103R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #3 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.104R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.105R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #5 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.106R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #6 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.107R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #7 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.108R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #8 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.100L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.101L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #1 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.102L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #2 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.103L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.104L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #4 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.105L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #5 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.106L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #6 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.107L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #7 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.13.108L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINIMAX HA CEMENTLESS #8 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Standard #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.18.108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMIStem C Lateralized #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA C STANDARD #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA C STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Quadra C Standard #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Quadra C Standard #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA C STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA C STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA C STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA C STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.99SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.00SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.01SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.02SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.03SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.04SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.05SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.06SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.07SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.08SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.09SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.10SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN STANDARD #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S STANDARD #10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.11SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.12SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CL8MR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LOCKING MEDIUM RIGHT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.13SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.14SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.15SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.16SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.17SN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S SN LATERALIZED #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA S LATERALIZED #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22MM COCR HEAD S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|22MM COCR HEAD S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm CoCr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm CoCr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm CoCr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM COCR HEAD XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm CoCr Head XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm CoCr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm CoCr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm CoCr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm CoCr Head XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm CoCr Head XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm CoCr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm CoCr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm CoCr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm CoCr Head XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm CoCr Head XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm CoCr Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm CoCr Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm CoCr Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40MM COCR HEAD XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.25.089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm CoCr Head XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm BIOLOX Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm BIOLOX Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm BIOLOX Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm BIOLOX Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm BIOLOX Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm BIOLOX Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm BIOLOX Delta Head XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm BIOLOX Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm BIOLOX Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm BIOLOX Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36mm BIOLOX Delta Head XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm BIOLOX Delta Head S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm BIOLOX Delta Head M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm BIOLOX Delta Head L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm BIOLOX Delta Head XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 40mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 41mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 42mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 43mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 44mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 45mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 46mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 47mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 48mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 49mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 50mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 51mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 52mm/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 44mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 45mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 46mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 47mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 48mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 49mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 50mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 51mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 52mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 53mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 54mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 55mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 56mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 57mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 58mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 59mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25060.2860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Bipolar Head 60mm/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.46MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720127-01|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELEVATE SYNTHETIC PROLAPSE REPAIR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01.26.48MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.50MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.52MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.54MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.56MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.58MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.60MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.62MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.64MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2246MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Versafitcup DM Liner HC 46/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNC6025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX NEURO 6.0MM X 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2248MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 48/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2848MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2850MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 50/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2852MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2854MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 54/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2856MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Versafitcup DM Liner HC 56/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2858MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 58/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2860MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 60/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2862MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 62/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2864MHC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP DM LINER HC 64/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.1164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO CUP NH 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.45.0070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOLE PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2233HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 22/AZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2837HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 28/B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2839HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 28/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2844HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 28/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2848HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 28/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2852HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 28/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3239HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 32/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3244HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 32/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3248HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 32/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3252HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 32/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3644HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 36/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3648HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 36/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3652HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO FLAT LINER HC 36/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2233HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 22/AZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2837HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 28/B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PMH|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PROLENE PM-M 6" X 6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|774.37|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|774.37|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01.26.2839HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 28/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2844HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 28/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2848HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 28/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.2852HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 28/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3244HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 32/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3248HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 32/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.3252HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO HOODED LINER HC 32/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.65.20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.65.25|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.65.30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.65.35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.65.40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.26.65.45|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSAFITCUP CC TRIO SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.146MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact DM Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.148MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact DM Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.150MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.152MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.154MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.156MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.158MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.160MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.162MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.164MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.166MB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DM CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.146DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.148DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.150DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.152DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 52mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.154DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 54mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.156DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 56mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.158DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.160DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.162DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT TWO HOLE CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.164DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Two Hole Cup 64mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.166DH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT TWO HOLE CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.146SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact No Hole Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.148SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact No Hole Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.150SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.152SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.154SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-4545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.156SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.158SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.160SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.162SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.164SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.166SH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT NO HOLE CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2237HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2239HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2241HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2244HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2248HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2252HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2837HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2839HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2841HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2844HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2848HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2852HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3239HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Flat Liner HC 32/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3241HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 32/D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3244HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 32/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3248HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 32/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3252HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 32/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3644HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Flat Liner HC 36/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3648HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 36/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3652HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 36/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4048HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Flat Liner HC 40/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4052HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Flat Liner HC 40/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2256HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2856HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BC0524SP|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON SINUS PRO SOLO RELIEVA 5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01.32.3256HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 32/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3656HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 36/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4056HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 40/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2260HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 22/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2860HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 28/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3260HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 32/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3660HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 36/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4060HCT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT FLAT LINER HC 40/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2237HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2239HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2241HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2244HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2248HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2252HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2837HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2839HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2841HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2844HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2848HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2852HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3239HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3241HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3244HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3248HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3252HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3644HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 36/E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3648HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 36/F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3652HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 36/G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2256HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2856HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3256HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3656HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 36/J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2260HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 22/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.2860HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 28/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3260HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 32/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.3660HCAT|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT HOODED LINER HC 36/K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.31.55TP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR DOME HOLE PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 20mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DOME SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DOME SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 35mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DOME SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT DOME SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 50mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 55mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 60mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 65mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.6570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Dome Screw 70mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.12.069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUADRA R STANDARD #9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,925.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.230H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28mm BIOLOX Option Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.231H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32mm BIOLOX Option Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.233H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40mm BIOLOX Option Head|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,868.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.241A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX Option Sleeve M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.242A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX Option Sleeve L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.29.243A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX Option Sleeve XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.146MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Multi Hole Cup 46mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.148MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Multi Hole Cup 48mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.150MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.152MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.154MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.156MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.158MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Multi Hole Cup 58mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.160MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.162MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.164MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.166MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Mpact Multi Hole Cup 66mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.168MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.170MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.172MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.174MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.176MH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT MULTI HOLE CUP 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.156RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.158RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.160RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.162RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.164RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.166RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.168RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.170RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.172RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.174RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.176RH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM HOLE CUP 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.32.4055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPACT RIM SCREW 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION PROXIMAL BODY 40MM X 20MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION PROXIMAL BODY 50MM X 20MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION PROXIMAL BODY 60MM X 20MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION PROXIMAL BODY 40MM X 20MM LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION PROXIMAL BODY 50MM X 20MM LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION PROXIMAL BODY 60MM X 20MM LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,976.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166126P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 12 X 6MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,600.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,600.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01.22.107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION DISTAL STEM 140MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01.22.201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M-VIZION LOCKING SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|481.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|481.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2001L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2001R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2002L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2002R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2003L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2003R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2004L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2004R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2005L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2005R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2006L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2006R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2007L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2007R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2201L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2201R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2202L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2202R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2203L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2203R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2204L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2204R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2205L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2205R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2206L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2206R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2207L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2207R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2012L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S2 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2012R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S2 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2013L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S3 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2013R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S3 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2014L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S4 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2014R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S4 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2015L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S5 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2015R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S5 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2016L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED LEFT S6 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2016R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR STD CEMENTED RIGHT S6 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2212L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S2 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2212R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S2 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2213L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S3 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2213R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S3 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2214L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S4 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2214R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S4 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2215L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S5 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2215R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S5 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2216L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S6 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2216R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S6 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2217L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED LEFT S7 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2217R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR P.S. CEMENTED RIGHT S7 NARROW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1201L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1201R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1202L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1202R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1203L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166147P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 14 X 7MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,599.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,599.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.1203R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1204L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1204R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1205L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Left S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1205R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1206L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.1206R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK Tibial Tray Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0110SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0112SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0114SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0117SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0120SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 20MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0210SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0212SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0214SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0217SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0220SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 20MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0310SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0312SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0314SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0317SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0320SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0410SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0412SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0414SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0417SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0420SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0510SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0512SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0514SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166148P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 14 X 8MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,302.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,302.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0517SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0520SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 20MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0610SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0612SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0614SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0617SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0620SF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STD. 20MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0110FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0112FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0114FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166168P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 16 X 8MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,437.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,437.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0117FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0120FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 20MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0210FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0212FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0214FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0217FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0220FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 20MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0310FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0312FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0314FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166169P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 16 X 9MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0317FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0320FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0410FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0412FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0414FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0417FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0420FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0510FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0512FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0514FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0517FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0520FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 20MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0610FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0612FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0614FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0617FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0620FUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT U.C. 20MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0110PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0112PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0114PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166180P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 18 X 10MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0117PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0120PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 20MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0210PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0212PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0214PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0217PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0220PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 20MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0310PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0312PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0314PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166189P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 18 X 9MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,302.26|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,302.26|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0317PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0320PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0410PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0412PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0414PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0417PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0420PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0510PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0512PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0514PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0517PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0520PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 20MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0610PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0612PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0614PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0617PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0620PSF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT P.S. 20MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0110APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0112APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0114APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166201P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 20 X 10MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,600.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,600.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0117APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0210APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0212APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0214APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0217APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0310APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0312APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0314APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0317APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0410APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166211P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 20 X 11MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0412APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0414APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0417APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0510APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0512APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0514APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0517APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0610APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0612APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0614APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0617APUC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE UC TIBIAL COMPONENT 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0110APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0112APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0114APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0117APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0210APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0212APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0214APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0217APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0310APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166221P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 22 X 11MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,599.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,599.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0312APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0314APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0317APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0410APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0412APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0414APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0417APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0510APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0512APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0514APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202166241P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 24 X 12MM 40CM WOVEN DOUBLE VELOUR BIFURCATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,188.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.07.0517APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0610APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0612APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0614APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0617APPS|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FULL-PE PS TIBIAL COMPONENT 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0033RP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Patella Resurfacing S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0034RP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Patella Resurfacing S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0035RP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Patella Resurfacing S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0036RP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Patella Resurfacing S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0041IP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA INSET Ą 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0042IP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA INSET Ą 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0043IP|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA INSET Ą 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F11030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Primary Extension Stem Ř11mm L30mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F11066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRIMARY EXTENSION STEM Ř11MM L65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0001L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0001R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0002L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0002R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0003L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0003R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175208P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 8MM 30CM WOVEN DOUBLE VELOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,600.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,600.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.12.0004L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0004R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0005L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE FEMUR CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0005R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0006L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0006R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0007L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0007R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0021L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S1 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0021R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S1 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0022L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S2 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0022R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S2 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0023L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S3 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0023R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S3 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0024L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S4 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0024R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S4 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0025L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S5 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0025R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S5 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0026L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Left S6 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0026R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Femur Cemented Right S6 +|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175210P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 10MM 30CM WOVEN DOUBLE VELOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,781.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,781.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.12.0110FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0110FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 10mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0111FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 11mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0111FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 11mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0112FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0112FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 12mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0113FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 13mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0113FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 13mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0114FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0114FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 14mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175412P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HEMASHIELD PLATINUM 12MM 30CM WOVEN DOUBLE VELOUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,032.65|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,032.65|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.12.0117FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0117FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 17mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0120FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0120FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 20mm S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0210FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0210FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0211FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 11MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0211FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 11MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0212FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0212FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0213FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 13MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0213FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 13MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0214FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0214FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0217FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0217FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0220FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 20MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0220FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 20mm S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0310FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0310FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 10mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0311FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 11mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0311FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 11MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0312FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0312FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0313FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 13mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0313FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 13mm S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0314FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0314FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0317FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0317FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0320FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0320FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0410FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0410FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 10mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0411FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 11mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0411FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 11mm S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0412FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0412FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0413FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 13MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0413FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 13MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 56014540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0414FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0414FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0417FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0417FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0420FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX LEFT 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0420FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPHERE INSERT FLEX RIGHT 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0510FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0510FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 10mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0511FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 11mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0511FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 11mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 56014550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0512FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0512FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 12mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0513FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 13mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0513FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 13mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0514FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0514FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 14mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0517FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0517FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 17mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0520FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0520FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 20mm S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-4555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0610FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0610FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 10mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0611FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 11mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0611FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 11mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0612FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0612FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 12mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0613FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 13mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0613FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 13mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0614FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0614FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 14mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-4565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0617FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0617FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 17mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0620FL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Left 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0620FR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Sphere Insert Flex Right 20mm S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.T3I4L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tibial tray fixed cemented # T3-I4 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.T3I4R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tibial tray fixed cemented # T3-I4 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.T4I3L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tibial tray fixed cemented # T4-I3 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.T4I3R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tibial tray fixed cemented # T4-I3 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2501L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2501R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-4570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 4.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2502L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2502R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2503L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2503R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2504L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2504R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2505L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2505R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2506L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2506R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR STD CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-5540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2401L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2401R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2402L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2402R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2403L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2403R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2404L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2404R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2405L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2405R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 56015545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2406L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.2406R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. FEMUR P.S. CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,981.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F11065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą11MM / L 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F11105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą11MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F11150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą11MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F13065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą13MM / L 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F13105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą13MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F13150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą13MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F16065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą16MM / L 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F16105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą16MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-5550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F16150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą16MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F19065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą19MM / L 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F19105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą19MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F19150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą19MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F22065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą22MM / L 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F22105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą22MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.F22150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM Ą22MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FSC11065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLUTED EXTENSION STEM CEMENTED Ř 11 L 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FSC11105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLUTED EXTENSION STEM CEMENTED Ř 11 L 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FSC13065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLUTED EXTENSION STEM CEMENTED Ř 13 L 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-5555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FSC13105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLUTED EXTENSION STEM CEMENTED Ř 13 L 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FSC16065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLUTED EXTENSION STEM CEMENTED Ř 16 L 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FSC16105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLUTED EXTENSION STEM CEMENTED Ř 16 L 105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL10065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą10MM / L 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL10105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą10MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL10150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą10MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL11065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą11MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL11105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą11MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL11150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą11MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL12065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą12MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-5560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL12105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą12MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL12150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą12MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL13065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą13MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL13105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą13MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL13150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą13MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL14065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą14MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL14105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą14MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL14150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą14MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL15065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą15MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL15105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą15MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-5565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL15150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą15MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL16065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą16MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL16105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą16MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL16150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą16MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL18065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą18MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL18105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą18MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL18150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą18MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL20065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą20MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL20105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą20MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL20150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą20MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-5570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 5.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL22065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą22MM / L 065MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL22105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą22MM / L 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.FCL22150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTLESS EXTENSION STEM Ą22MM / L 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OFFSET CONNECTOR 3 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,441.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,441.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OFFSET CONNECTOR 5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,441.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,441.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.00TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.01TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.02TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.03TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.04TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 56016540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.05TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.06TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 5MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.10TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.11TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.12TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.13TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.14TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.15TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.16TW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.01PW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 5MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-6545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.02PW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 5MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.03PW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 5MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.04PW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 5MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.05PW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 5MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.06PW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 5MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.110FPW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.210FPW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.310FPW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.410FPW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.510FPW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-6550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.610FPW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. POST FEM WEDGE 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.104FDW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 4MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.204FDW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 4MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.304FDW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 4MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.404FDW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 4MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.504FDW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 4MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.604FDW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 4MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.01DW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 8MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.02DW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 8MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.03DW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 8MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-6555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.04DW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 8MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.05DW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 8MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.05.06DW|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. DIST FEM WEDGE 8MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.112FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #1/ 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.212FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #2/ 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.312FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #3/ 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.412FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #4/ 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.512FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #5/ 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.612FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #6/ 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.116FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #1/ 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-6560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.216FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #2/ 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.316FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #3/ 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.416FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #4/ 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.516FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #5/ 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.616FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #6/ 16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.120FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENATION #1/ 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.220FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #2/ 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.320FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #3/ 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.420FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #4/ 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.520FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #5/ 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-6565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,551.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.620FDA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL DISTAL AUGMENTATION #6/ 20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0681L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0681R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0682L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0682R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0683L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0683R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0684L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0684R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0685L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5601-6570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATION CAROLINA JONES 6.5MM X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0685R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0686L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0686R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV. TIBIAL TRAY RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 5MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BIO 8MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL WEDGE HINGE 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2601L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2601R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2602L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2602R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2603L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2603R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2604L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2604R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2605L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2605R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2606L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.2606R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK FEMUR HINGE CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4001L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4001R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4002L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4002R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4003L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4003R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4004L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4004R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4005L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4005R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4006L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.4006R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK TIBIAL TRAY HINGE RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0112H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0114H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0117H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0120H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 20MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0123H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 23MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0126H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 26MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0212H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0214H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0217H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0220H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 20MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0223H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 23MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0226H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 26MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0312H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0314H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0317H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0320H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0323H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 23MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0326H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 26MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0412H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0414H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0417H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0420H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0423H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 23MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0426H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 26MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0512H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0514H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0517H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0520H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 20MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0523H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 23MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0526H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 26MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0612H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0614H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0617H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0620H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 20MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0623H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 23MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.0626H|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GMK-HINGE INSERT 26MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0110SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0112SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0114SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0117SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 17MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0120SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 20MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0123SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 23MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0126SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 26MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0210SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0212SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0214SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0217SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 17MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0220SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 20MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0223SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 23MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0226SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 26MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0310SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0312SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0314SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0317SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 17MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0320SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 20MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0323SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 23MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0326SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 26MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0410SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0412SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0414SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0417SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 17MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0420SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 20MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0423SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 23MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0426SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 26MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0510SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0512SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0514SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0517SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 17MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0520SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 20MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0523SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 23MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0526SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 26MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0610SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0612SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0614SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0617SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 17MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0620SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 20MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0623SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 23MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.07.0626SCF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SEMICONSTRAINED 26MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA115RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #1 15MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,285.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA115LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #1 15MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA215RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #2 15MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA215LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #2 15MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA315RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #3 15MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA315LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #3 15MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA415RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #4 15MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA415LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #4 15MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA515RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #5 15MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA515LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #5 15MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA615RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #6 15MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48450|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 12MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.09.TA615LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #6 15MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA120RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #1 20MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA120LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #1 20MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA220RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #2 20MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA220LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #2 20MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA320RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #3 20MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA320LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #3 20MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA420RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #4 20MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA420LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #4 20MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA520RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #5 20MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48462|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 16MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA520LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #5 20MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA620RMLL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #6 20MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.09.TA620LMRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWED TIBIAL AUGMENTATION #6 20MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.001RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.002RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.003RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.004RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.005RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.006RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.007RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48456|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 14MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.008RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.009RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.010RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED RIGHT S10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.001LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.002LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.003LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.004LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.005LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.006LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.007LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48466|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 18MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.008LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.009LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.010LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL FEMORAL CEMENTED LEFT S10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF1.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF2.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF3.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF4.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF5.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF6.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF7.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48470|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 20MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.TF8.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED RIGHT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF1.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF2.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF3.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF4.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF5.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF6.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF7.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.TF8.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO MEDIAL TIBIA TRAY CEMENTED LEFT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48474|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 22MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF1.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48478|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 24MM X 73MM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF2.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9152-2545-W|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD ARTICULAR OFFSET 25MM X 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TFLE-8-88|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILLIAC AAA 8MM X 88CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF7.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.08.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 8MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.09.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 9MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.10.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 10MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.11.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 11MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.12.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 12MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.14.RM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT RIGHT 14MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48438|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 8MM X 71CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF1.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF1.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF2.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48440|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 8MM X 105CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF3.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF3.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48449|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 12MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF4.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF5.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48443|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 10MM X 54CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF6.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF6.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF7.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.08.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 8MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48444|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 10MM X 71CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.18.IF8.09.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 9MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.10.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 10MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.11.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 11MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.12.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 12MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.18.IF8.14.LM|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOTO TIBIA INSERT LEFT 14MM S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71770928|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TRIGEN TITANIUM 28CM X9/7.5MM HUMERUS BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,416.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,416.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48445|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 10MM X 88CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71754022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN TITANIUM 22MMX4MM HUMERUS CORTICAL SELFTAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|532.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71755048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN TITANIUM 49MMX5MM HUMERUS CORTICAL SELFTAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|647.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71755046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN TITANIUM 46MMX5MM HUMERUS CORTICAL SELFTAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|647.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71755042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN TITANIUM L42 MM OD5 MM CANCELLOUS SELFTAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|647.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71754024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN TITANIUM 24MMX4MM HUMERUS CORTICAL SELFTAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|532.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHREX TITANIUM L44 MM OD4.5 MM LOCK LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARTHREX TITANIUM L46 MM OD4.5 MM LOCK LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOW PROFILE L55 MM OD5.5 MM ANKLE CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48451|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 90MM 12MM 6MM 16FR ZNTH FLX Z-TRK 2 BRCH PLSTR SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BB10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BB17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48452|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 12MM X 107CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BC10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BC17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48454|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 14MM X 39CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BD10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BD17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48457|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 14MM X 90CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BE10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BE17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48461|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 16MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BF10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BF17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48463|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 16MM X 90CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BG10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BG17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48464|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 18MM X 39CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BH10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BH17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48465|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 18MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BJ10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BJ17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48467|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 18MM X 90CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BK10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BK17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48469|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 20MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-BL10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-BL17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-1L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-2L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48471|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 20MM X 90CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-517-3L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-4L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-5L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 5, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-6L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 6, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-7L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 7, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-8L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 8, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-9L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 9, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-10L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 10, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-1R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-2R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48473|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 22MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-517-3R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-4R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-5R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 5, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-6R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 6, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-7R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 7, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-8R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 8, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-9R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 9, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-517-10R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 10, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-1L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-2L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48475|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 22MM X 90CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-516-3L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-4L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-5L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 5, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-6L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 6, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-7L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 7, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-8L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 8, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-9L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 9, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-10L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 10, LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-1R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-2R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48476|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 24MM X 39CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-516-3R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-4R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-5R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 5, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-6R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 6, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-7R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 7, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-8R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 8, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-9R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 9, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-516-10R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 10, RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48477|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 24MM X 56CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|9,255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-RB10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RB18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G48479|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 24MM X 90CM FLEX ZENITH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,988.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-513-RC11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RC18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RD18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RE18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RF18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RG18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RH18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RJ18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111316SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RK18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111314SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL09|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL16|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111312SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTD|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTE|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTG|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTH|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-503-TTTJ|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA TIBIAL TRAY SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PMA0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF PATELLA MEDIALIZED SIZE 31, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PMB0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF PATELLA MEDIALIZED SIZE 33, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PMC0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF PATELLA MEDIALIZED SIZE 36, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PMD0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF PATELLA MEDIALIZED SIZE 38, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSA0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF DOME PATELLA SIZE 27, 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSB0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF DOME PATELLA SIZE 30, 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSC0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PF DOME PATELLA SIZE 34, 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSD0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE PATELLA IMPLANT DOME, 37 X 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBA0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 1, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBA1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 1, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBA2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 1, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBA4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 1, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBA8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 1, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBA9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 1, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBB0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 2, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBB1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 2, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBB2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 2, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBB4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 2, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBB8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 2, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBB9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 2, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBC0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 3, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBC1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 3, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBC2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 3, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBC4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 3, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBC8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 3, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBC9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 3, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBD0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 4, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBD1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 4, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBD2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 4, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBD4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 4, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBD8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 4, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBD9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 4, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBE0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 5, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBE1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 5, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBE2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 5, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBE4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 5, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBE8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 5, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBE9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 5, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBF0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 6, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBF1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 6, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBF2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 6, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBF4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 6, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBF8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 6, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TBF9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL BEARING, SIZE 6, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTLA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 1, LEFT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTLB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 2, LEFT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTLC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 3, LEFT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTLD|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 4, LEFT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTLE|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 5, LEFT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTLF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 6, LEFT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTRA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 1, RIGHT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTRB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 2, RIGHT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTRC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 3, RIGHT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTRD|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 4, RIGHT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTRE|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 5, RIGHT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-TTRF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA TIBIAL TRAY SIZE 6, RIGHT-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFLA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 1, L-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFLB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 2, L-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFLC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 3, L-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFLD|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 4, L-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905453|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOMET ANCHOR MICROMAX 2.9 LONG SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-501-UFLE|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 5, L-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFLF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UNI FEMORAL CEMENTED SIZ 6, L-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFRA|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 1, R-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFRB|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 2, R-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFRC|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 3, R-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFRD|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 4, R-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFRE|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 5, R-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-501-UFRF|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE UKA FEMORAL CEMENTED SIZ 6, R-MEDIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-1L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-2L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905943|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOMET ANCHOR ALLTHREAD 5.5MM BLUNT NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-502-3L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-4L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-1R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-2R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-3R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-502-4R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSA8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA IMPLANT, DOME 27 X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSB8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA IMPLANT, DOME 30 X 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSC9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA IMPLANT, DOME 34 X 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-504-PSD10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA IMPLANT, DOME 37X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-602-26|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 1 OSTEOTOMES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-602-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 2 OSTEOTOMES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-602-28|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 3 OSTEOTOMES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-602-29|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZE 4 OSTEOTOMES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-1050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, STEM EXTENSION, 10MM DIA X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-10100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, STEM EXTENSION, 10MM DIA X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-1250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, STEM EXTENSION, 12MM DIA X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-12100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, STEM EXTENSION, 12MM DIA X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-1450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, STEM EXTENSION, 14MM DIA X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-14100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, STEM EXTENSION, 14MM DIA X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,710.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 1, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL25|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 2, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 3, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL45|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 4, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL55|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 5, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL65|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 6, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL75|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 7, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL85|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 8, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL95|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 9, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 10, 5MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 1, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM25|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 2, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM35|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 3, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM45|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 4, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM55|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 5, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM65|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 6, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM75|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 7, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM85|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 8, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM95|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 9, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 10, 5MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 1, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 2, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 3, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 4, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 5, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 6, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 7, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 8, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 9, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RL1010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 10, 10MM, RL/LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 1, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 2, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 3, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 4, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 5, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 6, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 7, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 8, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 9, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-RM1010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IBALANCE TKA, TIBIAL AUGMENT, SIZE 10, 10MM, RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-TL5|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOCKING SCREW, TIBIAL AUGMENT, 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-TL10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOCKING SCREW, TIBIAL AUGMENT, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-020S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840008550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE COCR L50 MM OD8.5 MM SPINE MULTIAXIAL 5.5 MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493933515060|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING GUIDEZILLA II Z-GLIDE L150 CM OD6 FR ID.057|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AF-1250|SUP|HCPCS Q4159||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE L2.5 CM X W2.5 CM AFFINITY|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1160C|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE 1.6 SQ CM NUSHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1230|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE NUSHIELD L3 CM X W2 CM ORTHO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,385.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1240|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE NUSHIELD L4 CM X W2 CM ORTHO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1340|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE NUSHIELD L4 CM X W3 CM ORTHO L4 CM X W3 CM ORTHO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1440|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE NUSHIELD L4 CM X W4 CM ALLOGRAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,580.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,580.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1460|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SYNTHETIC TISSUE L6 CM X W4 CM ORTHO NUSHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NO-1660|SUP|HCPCS Q4160||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE NUSHIELD L6 CM X W6 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE TITANIUM LORDOTIC L50 MM OD5.5 MM NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE TITANIUM LORDOTIC L55 MM OD5.5 MM NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO3565-DS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 65MM SYNDESMOTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-1910|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX SILICONE L100 MM L90 CM OD19 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5991015|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 ELLIPSE L15 CM X W10 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,770.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-02-0040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR TWO-LEVEL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING 4.0X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71754020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TRIGEN TITANIUM 20MM 4MM HUMERUS CORTICAL SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|532.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|532.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71755044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN TRIGEN TITANIUM 44MM 5MM HUMERUS CANCELLOUS SF TP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|647.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71770824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TRIGEN TITANIUM 24CM 8/7MM HUMERUS BENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,416.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,416.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71755038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN TRIGEN TITANIUM 38MM 5MM HUMERUS CANCELLOUS SF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|647.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS C STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS G STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 14MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 16MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 25MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 26MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 20MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 21MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 22MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 24MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 20MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 220MM 11MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 220MM 15MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLAR MODULAR REACH HA 3 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 50MM ARCOS A HIGH OFFSET HIP FEMORAL TITANIUM MODULAR REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 13MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 18MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 21MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 22MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 23MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 26MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 23MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 26MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 250MM 11MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLAR MODULAR REACH HA 1 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108397|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLAR MODULAR REACH HA 4 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP156269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 4 BIPLANAR MORSE TAPER HIP TITANIUM COLLARLESS SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34D TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS G HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 17MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 19MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 23MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 24MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 26MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 21MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 20MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 24MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G03301|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET DRN 29CM 9FR 18GA STD THOR SS VNYL PTFE 1 WY STPCK CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-302017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 22MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 24MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 250MM 19MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS G HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 20MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 14MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 25MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 12MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 25MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 16MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 21MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 25MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 220MM 17MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLARLESS MODULAR REACH HA 4 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 50MM ARCOS A STANDARD OFFSET HIP FEMORAL TITANIUM MODULAR REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS G STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS G STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 20MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 14MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 20MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 24MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 26MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLARLESS MODULAR REACH HA 3 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLARLESS MODULAR REACH HA 5 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP156270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 20MM ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34B TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 6 BIPLANAR MORSE TAPER HIP TITANIUM COLLARLESS SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108397|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 4 BIPLANAR MORSE TAPER HIP TITANIUM COLLAR SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 6 BIPLANAR MORSE TAPER HIP TITANIUM COLLAR SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45C TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55A TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 22MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 58 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 56MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 60MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 23 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 24 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 24 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 25 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLAR MODULAR REACH HA 5 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP156254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 14MM ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP156255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45A TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55C TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108159|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55E TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 3 BIPLANAR MORSE TAPER HIP TITANIUM COLLAR SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45B TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55B TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 69MM 28MM BIOMET TRIPOLAR HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-222844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 44MM 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-222846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 46MM 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 64MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 24 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 24 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP SHORT FLANGE TITANIUM PAR 5 NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45D TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45E TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 50 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 27MM 27MM BIOMET TRIPOLAR HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-212844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 44MM 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 48MM 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 22 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 25 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP RIGHT MEDIUM FLANGE TITANIUM PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LINER POROUS E UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 64MM HEALEY RINGLOC 26 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 70MM HEALEY RINGLOC 28 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS B STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS A HIGH OFFSET HIP FEMORAL TITANIUM MODULAR REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 21MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 19MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 23MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 25MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 22MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 22MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 20MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS C STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS A HIGH OFFSET HIP FEMORAL TITANIUM MODULAR REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM ARCOS G HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 12MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 15MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 24MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 12MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 22MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 23MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 16MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 220MM 13MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLAR MODULAR REACH HA 2 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 60MM ARCOS A HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS C STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 70MM ARCOS C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 22MM BULLET TIP PRESS FIT ARCOS TITANIUM STRAIGHT DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 13MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 18MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 26MM BULLET TIP PRESS FIT ARCOS TITANIUM BOW DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 21MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 21MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 23MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 18MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 19MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 250MM 17MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34A TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45D TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45E TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 65A TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 22MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 56 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 25MM BIOMET TRIPOLAR HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 58MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 64MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 52MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 56MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 58MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 26 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP RIGHT SHORT FLANGE TITANIUM PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP MEDIUM FLANGE TITANIUM PAR 5 NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 28MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP COMPONENT RECONSTRUCTION QUADRANT SPARING 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-109256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP HA PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-126474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM 64MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LIMIT 4 HOLE OSSEOTI G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP MULTIHOLE OSSEOTI G7 C HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP MULTIHOLE OSSEOTI G7 J HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP MULTIHOLE OSSEOTI G7 J HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 25 +5MM STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 48 +5MM STANDARD FACE 36MM ARCOM HIP LOW PROFILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 10D 25 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 10D 27 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 27 STANDARD FACE 5.8MM 44MM 28MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 25 5.8MM 38MM 22MM POLY HIP TRIPOLAR HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D 4 28MM ARCOM HIP SUPERIOR LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM C NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017169|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM E NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM D NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP MULTIHOLE RIM SCREWS POROUS RINGLOC UNIVERSAL D 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 50MM HEALEY RINGLOC 23 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 52MM HEALEY RINGLOC 23 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 54MM HEALEY RINGLOC 24 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-124656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM 46MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP LIMIT 3 HOLE OSSEOTI G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LIMIT 3 HOLE OSSEOTI G7 B HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LIMIT 3 HOLE OSSEOTI G7 D HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP MULTIHOLE OSSEOTI G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC II 10D 23 50/52MM 32MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC II 10D 24 54/56MM 32MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 10D 28 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 26 STANDARD FACE 5.3MM 41MM 28MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103573|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 3 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 4 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103583|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D 3 28MM ARCOM HIP SUPERIOR LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM B NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM E NEUTRAL 36MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017189|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 36MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-124858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM 48MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-126676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM 66MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP LIMIT 3 HOLE OSSEOTI G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LIMIT 3 HOLE OSSEOTI G7 E HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LIMIT 4 HOLE OSSEOTI G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP MULTIHOLE OSSEOTI G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP MULTIHOLE OSSEOTI G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP MULTIHOLE OSSEOTI G7 J HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 46 +5MM STANDARD FACE 36MM ARCOM HIP LOW PROFILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 10D 26 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET +5MM 26 10.3MM 41MM 28MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103585|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D 5 28MM ARCOM HIP SUPERIOR LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM D NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017193|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 40MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM 28MM HIP TRIPOLAR POLY BIOMET RINGLOC 27 5.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000981|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM C 32MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D I 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM G 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM C NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM E NEUTRAL 32MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 25MM INTERLOCK PRESS FIT ARCOS PPS TITANIUM DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,244.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 220MM 19MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 250MM 13MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45C TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55A TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 1 BIPLANAR MORSE TAPER HIP TITANIUM COLLARLESS SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 3 BIPLANAR MORSE TAPER HIP TITANIUM COLLARLESS SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34A TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM BIOMET TRIPOLAR HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 26MM BIOMET TRIPOLAR HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-212642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 42MM 26MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,766.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,766.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-212846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 46MM 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 62MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 50MM 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 54MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 60MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 22 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 23 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP LEFT MEDIUM FLANGE TITANIUM PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP LEFT LONG FLANGE TITANIUM PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP156253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 12MM ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45B TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55B TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55D TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 45A TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55C TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 32MM RANAWAT/BURNSTEIN HIGH WALL PEG HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 28MM RANAWAT/BURSTEIN PEG HIGH WALL REAMER HIP POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 28MM BIOMET TRIPOLAR HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,647.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 66MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-222642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 42MM 26MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,766.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,766.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 62MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 23 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 23 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP RIGHT LONG FLANGE TITANIUM PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP RIGHT LONG FLANGE TITANIUM PAR 5 NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LINER POROUS C UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 48MM HEALEY RINGLOC 22 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL 250MM 15MM MALLORY-HEAD HIP CALCAR 80% POROUS HA MODULAR ROLLER HARDEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLARLESS MODULAR REACH HA 1 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34D TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 2 BIPLANAR MORSE TAPER HIP TITANIUM COLLARLESS SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 2 BIPLANAR MORSE TAPER HIP TITANIUM COLLAR SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 31-108730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIAL HIP MALLORY-HEAD 75A FEMORAL CALCAR METAPHYSEAL MODULAR STEM PROVISIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34B TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108159|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55E TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 32MM RANAWAT/BURNSTEIN HIGH WALL PEG HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 52 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 62 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 48MM 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 52MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-223666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 66MM 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 26 FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 26MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 27MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 68MM HEALEY RINGLOC 27 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL COLLARLESS MODULAR REACH HA 2 HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34C TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34E TAPER HIP CALCAR POROUS MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,812.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 5 BIPLANAR MORSE TAPER HIP TITANIUM COLLARLESS SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 1 BIPLANAR MORSE TAPER HIP TITANIUM COLLAR SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 108399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL REACH 5 BIPLANAR MORSE TAPER HIP TITANIUM COLLAR SEGMENTAL LOCK SCREW MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,485.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34C TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 34E TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-108157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT METAPHYSEAL MALLORY-HEAD 55D TAPER HIP CALCAR HA MODULAR TYPE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 28MM RANAWAT/BURNSTEIN HIGH WALL PEG HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 32MM RANAWAT/BURNSTEIN HIGH WALL PEG HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 54 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 60 STANDARD FACE 36MM ALL POLY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 50MM 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-213654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 54MM 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,183.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP LINER TITANIUM POROUS MCLAUGHLIN RINGLOC +5MM 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM RANAWAT/BURSTEIN RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR HIP LEFT SHORT FLANGE TITANIUM PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 26MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 27MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 66MM HEALEY RINGLOC 27 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-109260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP HA PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-109268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP HA PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-124252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM 42MM REGENEREX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-125666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM 56MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LIMIT 4 HOLE OSSEOTI G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LIMIT 4 HOLE OSSEOTI G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP MULTIHOLE OSSEOTI G7 D HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP MULTIHOLE OSSEOTI G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC II 10D 28 70/80MM 32MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 28 +5MM STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 24 STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 26 STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 26 5.3MM 41MM 28MM POLY HIP TRIPOLAR HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 28 5.8MM 48MM 28MM POLY HIP TRIPOLAR HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM E NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 36MM 22MM HIP TRIPOLAR POLY BIOMET RINGLOC 24 4.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM H 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM J 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM I 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM A NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 24MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ACETABULAR 46MM QUADRANT SPARING RINGLOC 22 HIP RECONSTRUCTION SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 60MM HEALEY RINGLOC 25 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-125262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM 52MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-125464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM 54MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-126272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM 62MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP MULTIHOLE OSSEOTI G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP MULTIHOLE OSSEOTI G7 B HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP MULTIHOLE OSSEOTI G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 26 +5MM STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 43 +5MM STANDARD FACE 36MM ARCOM HIP LOW PROFILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 10D 24 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 28 STANDARD FACE 5.8MM 48MM 28MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 24 4.8MM 36MM 22MM POLY HIP TRIPOLAR HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-105024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 32MM CONSTRAIN ARCOM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,287.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,287.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103577|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 7 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM D NEUTRAL 36MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017179|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 40MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 44MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM I 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D C 32MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM D 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM F 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125.9MM 16MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 31.1MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.4MM 18MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 32.5MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.8MM 20MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 33.9MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC TITANIUM NONPOROUS 6 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC PROTASUL-100 POROUS 8 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992116533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 16.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992121033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 21MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992125532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25.5MM BOWED ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998013521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 13.5MM STRAIGHT SPLINED ZMR HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUICKANCHOR MINI PLUS 2-0 SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,746.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,746.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998015021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 15MM SPLINED ZMR TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998015032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 15MM SPLINED ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998018033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 18MM SPLINED BOWED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998113521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 13.5MM STRAIGHT ZMR TIVANIUM POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998115021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 15MM STRAIGHT ZMR TIVANIUM POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998116522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM REVISION COMPRESSION NUT ZMR TIVANIUM NITRITED POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998116533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 16.5MM BOWED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998118032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM BOWED ZMR TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998119521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 19.5MM REVISION ZMR TIVANIUM POROUS STRAIGHT HIP NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998124022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 24MM REVISION STRAIGHT COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998125522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25.5MM REVISION STRAIGHT COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 16MM ZMR TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 17MM TAPERED REVISION ZMR TIVANIUM POROUS 3.5D TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 18MM 3 POINT FIXATION ZMR TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998202023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 20MM TAPERED ZMR TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998202223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 22MM TAPERED ZMR TIVANIUM ALLOY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998319532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 19.5MM SLOTTED BOWED ZMR POROUS TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994201635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 75MMX35MM 36MM ZMR 16.6MM AA HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999002346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 23.7MM 46MM F HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MMX45MM 46MM ZMR 130D A EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905940|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ALLTHREAD 5.5MM CUTTING NEEDLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM 35MM ZMR 22.5MM HIP FEMUR TIVANIUM REVISION MODULAR 46MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 100MM 55MM ZMR E HIP FEMUR TIVANIUM EXTENDED OFFSET 46MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999401755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MMX55MM 46MM ZMR A HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999401945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM 46MM ZMR C HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999402145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM 46MM ZMR E HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 36MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 40MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 40MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D B 32MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM B 32MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111318SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|905.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|905.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM E 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM B NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM E NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 NEU +5MM E1 LINER 28MM J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM D NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125.9MM 16MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 33.4MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127.4MM 23MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 39.2MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127.6MM 24MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 40MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.6MM 19MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 33.2MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC 5 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111436SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIX QUICK DEAL NEW 4.3MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,039.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,039.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992118032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM BOWED ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992119533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992121034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 21MM BOWED ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992124033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 24MM BOWED ZMR XL TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992125522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25.5MM BOWED ZMR XL TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 18MM ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 41MM 28MM HIP TRIPOLAR POLY BIOMET RINGLOC 26 5.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000980|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM B 32MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D D 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D G 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TECT1510AL|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX ANATOMICAL LEFT 6" X 4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 NEU +5MM E1 LINER 28MM I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125.7MM 15MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 32.5MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.4MM 18MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 35MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.8MM 20MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 36.7MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125.7MM 15MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 30.4MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC PROTASUL-100 POROUS 10 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992116532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992118033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 18MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992119532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 19.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905473|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOMET ANCHOR MICROMAX 3.9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|756.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00992125533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 25.5MM BOWED ZMR XL TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 17MM ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 21MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 23MM TAPERED ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998016521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 16.5MM STRAIGHT SPLINED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998016522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM SPLINED ZMR TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998112032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 12MM REVISION ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998115022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 15MM REVISION STRAIGHT COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998116521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 16.5MM STRAIGHT ZMR TIVANIUM POROUS HIP NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998122522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 22.5MM REVISION STRAIGHT COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998125532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25.5MM BOWED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 16MM ZMR TIVANIUM ALLOY TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998315034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 15MM SLOTTED REVISION BOWED COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992307840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 78MM 23MM ZMR XL STANDARD OFFSET TAPER HIP TIVANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992307845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 78MM ZMR XL 23MM HIP TIVANIUM EXTENDED OFFSET TAPERED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992310340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 55MM TAPERED BODY STANDARD OFFSET ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992310345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 103MM ZMR XL 55 HIP TIVANIUM EXTENDED OFFSET TAPERED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 20MM C HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999101855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR 18.9MM B HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999102145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM ZMR E HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999102355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR 23.7MM F HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MMX35MM 35MM ZMR 46MM OFFSET D HIP TIVANIUM POROUS REVISION MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MM 35MM ZMR HIP FEMUR TIVANIUM REVISION MODULAR 46MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 35MM 40MM ZMR C HIP FEMUR TIVANIUM STANDARD OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MM 40MM ZMR 20MM C HIP FEMUR TIVANIUM REVISION MODULAR 45MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999701755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM 40MM ZMR 17.7MM A HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125.5MM 14MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 29.7MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.2MM 17MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 31.8MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC 4 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC PROTASUL-100 POROUS 7 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992116534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 16.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992118034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 18MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992121022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 21MM BOWED ZMR XL TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 18MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 22MM TAPERED ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 22MM TAPERED REVISION MODULAR ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998015033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM SPLINED BOWED ZMR TIVANIUM 220MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998113532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 12MM BOWED ZMR TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998113533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13.5MM ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998115032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 15MM BOWED ZMR TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998118033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 18MM ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998121033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 21MM REVISION ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998124032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 24MM BOWED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998124033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 24MM BOWED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 15MM ZMR TIVANIUM 3.5D TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 18MM TAPERED ZMR TIVANIUM ALLOY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 19MM ZMR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998316532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM SLOTTED BOWED ZMR POROUS TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998318034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 18MM SLOTTED REVISION BOWED COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992308340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 83MM ZMR XL 35 STANDARD OFFSET TAPER HIP TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994001640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL 40MM 35MM ZMR XL AA HIP TIVANIUM POROUS SPOUT BODY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994101635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MMX35MM ZMR AA STANDARD HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994801635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 40X35MM ZMR AA HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 18.9MM 46MM B HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999101955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR 20MM C HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 45MM 46MM ZMR B HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999401745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM ZMR 130D A EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999402055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MX55MM ZMR HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 55MM 40MM ZMR B STANDARD OFFSET HIP FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999701745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM ZMR 40MM 17.7MM A HIP TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 80MMX35MM 17.7MM ZMR 40MM OFFSET A HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MMX55MM 40MM ZMR B 18.9MM OFFSET HIP FEMUR TIVANIUM POROUS EXTEND REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 975049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 50MM MULLER HIP PROTASUL-TI CEMENTED REVISION REINFORCEMENT ROOF STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 55MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700005420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700006820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615405032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD 6.3MM 50/52/54MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806595232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 32MM ZCA SNAP IN SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP TITANIUM PAR-5 RINGLOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,242.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,242.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 24MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 25MM RINGLOC UNIVERSAL MULTIHOLE RIM SCREW HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 58MM HEALEY RINGLOC 25 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 62MM HEALEY RINGLOC 26 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,517.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,517.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-125060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM 50MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LIMIT 4 HOLE OSSEOTI G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP LIMIT 4 HOLE OSSEOTI G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP MULTIHOLE OSSEOTI G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP MULTIHOLE OSSEOTI G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 24 +5MM STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 45 +5MM STANDARD FACE 36MM ARCOM HIP LOW PROFILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 47 +5MM STANDARD FACE 36MM ARCOM HIP LOW PROFILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET +5MM 25 10.8MM 38MM 22MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET +5MM 27 10.8MM 44MM 28MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 56MM HEALEY RINGLOC 24 HIP POROUS REVISION FLANGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT ACETABULAR 56MM REGENEREX RINGLOC+ 24 HIP MULTIHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-126070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM 60MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LIMIT 3 HOLE OSSEOTI G7 C HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP MULTIHOLE OSSEOTI G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP MULTIHOLE OSSEOTI G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP MULTIHOLE OSSEOTI G7 J HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC II 10D 26 62/64MM 32MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 27 STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 24 STANDARD FACE 4.8MM 36MM 22MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 25 STANDARD FACE 5.8MM 38MM 22MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 2 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 5 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D 2 28MM ARCOM HIP SUPERIOR LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM A NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 36MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 36MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM 28MM HIP TRIPOLAR POLY BIOMET RINGLOC 28 5.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D E 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D F 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM C 32MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 NEU +5MM E1 LINER 28MM H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125.5MM 14MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 31.7MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127MM 21MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 37.5MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127.2MM 22MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 38.3MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 817503150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 15MM REVISION PRECEDENT 3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,031.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,031.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992116522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM BOWED ZMR XL TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992119522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 19.5MM BOWED ZMR XL TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992119534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 19.5MM BOWED ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992125534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 25.5MM BOWED ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 17MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 22MM TAPERED ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998016532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM BOWED SPLINED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998016533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 16.5MM SPLINED BOWED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998112022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 12MM REVISION COMPRESSION NUT ZMR TIVANIUM NITRITED POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998115033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM REVISION ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998122532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 22.5MM BOWED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998125533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 25.5MM BOWED ZMR TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 16MM ZMR TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 17MM TAPERED ZMR TIVANIUM ALLOY HIP FEMUR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-109264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP HA PAR 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-106080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP MULTIHOLE MODULAR TITANIUM POROUS REGENEREX RINGLOC+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,663.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-124454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM 44MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-125868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM 58MM HIP TITANIUM POROUS REGENEREX REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,871.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LIMIT 4 HOLE OSSEOTI G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LIMIT 4 HOLE OSSEOTI G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,627.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP MULTIHOLE OSSEOTI G7 E HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP MULTIHOLE OSSEOTI G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC II 10D 27 66/68MM 32MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,717.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 23 +5MM STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 27 +5MM STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,518.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 44 +5MM STANDARD FACE 36MM ARCOM HIP LOW PROFILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 25 STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR FREEDOM 28 STANDARD FACE 36MM ARCOM HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET 27 5.8MM 44MM 28MM POLY HIP TRIPOLAR HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET +5MM 24 9.8MM 36MM 22MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM B NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 13MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 27.5MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127MM 21MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 34.7MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127.4MM 23MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 36.1MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992122532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 22.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992122534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 22.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 19MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998012032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 12MM SPLINED ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998013533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13.5MM SPLINED ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998112021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 12MM STRAIGHT ZMR TIVANIUM POROUS HIP NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998116532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 16.5MM ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998121032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 21MM BOWED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM 3 POINT FIXATION ZMR TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,030.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 18MM TAPERED REVISION ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998202018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 20MM REVISION ZMR TIVANIUM POROUS TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998202218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 22MM 3 POINT FIXATION ZMR TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992308345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 83MM 23MM ZMR XL 35 HIP TIVANIUM EXTENDED OFFSET TAPERED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR B OFFSET HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999101745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM 46MM ZMR 23.7MM F HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MMX35MM 46MM ZMR 17.7MM A HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999401855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 55MM 46MM ZMR B HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999402155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MMX55MM 46MM ZMR 130D E EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999402345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM 46MM ZMR F HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MMX55MM 40MM ZMR C 20MM HIP FEMUR TIVANIUM STANDARD OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 974249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 42MM MULLER HIP PROTASUL-TI CEMENTED REVISION REINFORCEMENT ROOF STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 53MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536300053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 53MM CONVERGE HIP POROUS REVISION SEALED SCREW HOLE PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700005020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700006420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700007470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700007870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700008070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615405632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D RING 6.4MM 56MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806595632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 59MM 32MM ZCA SNAP IN SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433828053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 53MM 28MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 51MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 55MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 61MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 65MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633407036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 13.4MM 70MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633407836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 17.4MM 78MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710504828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 48MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 58MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 19MM TAPERED ZMR XL TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 23MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998015022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 116MM 15MM STRAIGHT SPLINED ZMR HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998019533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 218MM 19.5MM SPLINED BOWED ZMR TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998118021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 18MM REVISION ZMR TIVANIUM POROUS STRAIGHT HIP NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,744.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998119522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 19.5MM REVISION STRAIGHT COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998122533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 22.5MM REVISION ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 17MM 3 POINT FIXATION ZMR TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998315032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 15MM SLOTTED BOWED ZMR POROUS TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998319534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 19.5MM SLOTTED REVISION BOWED COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994301635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 35MM 40MM AA STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 20MM 46MM C HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999002340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR F HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999101945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM ZMR 20MM C HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999102055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR 21.2MM D FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 100MMX55MM ZMR A STANDARD OFFSET HIP FEMUR TIVANIUM PLASMA REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 46MM 35MM ZMR 20MM HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 100MMX55MM 46MM ZMR D HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MMX45MM 46MM ZMR 130D F EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999401955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MMX55MM 46MM ZMR C HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 45MM 40MM ZMR A HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615405832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 7.3MM 58MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615406432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 10.3MM 64MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615407432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 15.4MM 74MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615408032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 18.3MM 80MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 61MM 32MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 61MM 32MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 67MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436632059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EPSILON LEGACY 59MM 32MM POLYETHYLENE HIP STERILE PRIMARY PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633407636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 16.3MM 76MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 52MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 66/68/70MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 66/68/70MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 56MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 58MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 62/64MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711505432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 54MM 32MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711506036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 60MM 36MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM D NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 40MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 12/14 32MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 35MM 40MM ZMR 35MM B FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999602135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 45X35MM ZMR E STANDARD OFFSET FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999701945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM ZMR 40MM 20MM C HIP TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999701955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR 20MM C HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 47MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 49MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 59MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700006220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP REVISION TRABECULAR METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700007670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP REVISION TRABECULAR METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615407232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 14.4MM 72MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00701004828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EXPLANT 10D 48MM 28MM UHMWPE HIP STERILE REVISION SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00702005828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EXPLANT 20D 58MM 28MM UHMWPE HIP STERILE REVISION SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806595432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 32MM ZCA SNAP IN SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 55MM 32MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433732055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 55MM 32MM POLYETHYLENE HIP PRIMARY HOOD ENHANCED PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 53MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 59MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633406636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 11.4MM 66MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 50MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 54MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 62/64MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 72/74MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 76/78/80MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711004828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 48MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 54MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 58MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 60MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 66/68/70MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 76/78/80MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 32MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 40MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 44MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 50MM 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110004138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 FDM MOD HD T12/14 32MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 32MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-107021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM OFFSET 12/14 36MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 24MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 28MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 23 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 58MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 43-45MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 58MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806595832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 61MM 32MM ZCA SNAP IN SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 51MM 32MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433828055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 55MM 28MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 57MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433832063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 63MM 32MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633407236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 14.3MM 72MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 56MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 62/64MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 56MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 66/68/70MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 76/78/80MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711506236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 62/64MM 36MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024459|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 A 32MM COCR HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110004140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 FDM MOD HD T12/14 32MM +3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 36MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-107016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 12/14 36MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-107019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 12/14 36MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 21MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RINGLOC+ REPLACEMENT RING SZ21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 25 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 52MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR BIOMET +5MM 28 10.8MM 48MM 28MM POLY HIP TRIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,148.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103571|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 6 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 8 28MM ARCOM HIP SUPERIOR LOCK HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 28MM ARCOMXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM C NEUTRAL 32MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017191|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 40MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017197|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 44MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000982|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM D 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000984|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM F 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D H 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM 10D J 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM D NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM B NEUTRAL 32MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 24MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.2MM 17MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 34.2MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 13MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 26.2MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL REVISION ALLOCLASSIC 3 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992118022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM BOWED ZMR XL TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992121032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 21MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992124032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 24MM BOWED ZMR XL TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992124034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 24MM BOWED ZMR XL TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,886.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998321032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 21MM SLOTTED BOWED ZMR POROUS TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998325533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 25.5MM BOWED SLOTTED ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992309345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 93MM ZMR XL 45 EXTENDED OFFSET TAPER HIP TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994601635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 75MMX35MM ZMR HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999101845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM ZMR 18.9MM B HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999102155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR E HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999102345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90X45MM ZMR F HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 46X55MM ZMR C EXTENDED OFFSET FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MMX45MM 46MM ZMR D HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MM 45MM ZMR HIP FEMUR TIVANIUM REVISION MODULAR 46MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999302155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 100MMX55MM 46MM ZMR 130D E EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999402045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM ZMR 130D D EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 55MM 40MM ZMR C HIP FEMUR TIVANIUM STANDARD OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999602035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 80MMX35MM 40MM ZMR 130D D STANDARD OFFSET HIP FEMUR TIVANIUM PLASMA POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999701845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 90MMX45MM ZMR 40MM 18.9MM B HIP TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999701855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR B 40MM HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 975849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 58MM MULLER HIP PROTASUL-TI CEMENTED REVISION REINFORCEMENT ROOF STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 51MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 57MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615406032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD RING 8.4MM 60MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615406232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD RING 9.3MM 62MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615407632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 16.3MM 76MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615407832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 17.3MM 78MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806595032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 53MM 32MM ZCA SNAP IN SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,240.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 59MM 32MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433728049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 49MM 28MM POLYETHYLENE HIP PRIMARY HOOD ENHANCED PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433732053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 53MM 32MM POLYETHYLENE HIP PRIMARY HOOD ENHANCED PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436628049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EPSILON LEGACY 49MM 28MM POLYETHYLENE HIP STERILE PRIMARY PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436632055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EPSILON LEGACY 55MM 32MM POLYETHYLENE HIP STERILE PRIMARY PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633407436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 15.4MM 74MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 54MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 56MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 66/68/70MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 66/68/70MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 50MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 52MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711005828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 58MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 60MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 62/64MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 62/64MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711505632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM 1.8MM OFFSET 56MM 32MM LONGEVITY HIP CEMENTED CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711505836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 58MM 36MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017198|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 44MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 38MM 22MM HIP TRIPOLAR POLY BIOMET RINGLOC 25 5.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,477.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000983|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM E 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000985|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM G 36MM E1 HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM H 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110010296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 FREEDOM +5MM J 36MM E1 HIP CONSTRAIN COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,875.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM C NEUTRAL 32MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 25MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126.6MM 19MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 125D 35.9MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127.2MM 22MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 35.4MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100561324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 127.6MM 24MM PRIMARY WAGNER CONE PROSTHESIS PROTASUL-100 POROUS 135D 36.8MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,149.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992122522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 22.5MM BOWED ZMR XL TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992122533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 22.5MM BOWED ZMR XL TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,739.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992124022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 24MM BOWED ZMR XL TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,523.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 20MM TAPERED ZMR XL TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 20MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 24MM TAPERED ZMR XL TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998012022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 12MM STRAIGHT SPLINED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998013522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 168MM 13.5MM STRAIGHT SPLINED ZMR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998025532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25.5MM BOWED SPLINED ZMR TIVANIUM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998118022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM REVISION COMPRESSION NUT ZMR TIVANIUM NITRITED POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998119532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 19.5MM REVISION ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998121022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 21MM REVISION STRAIGHT COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,042.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 14MM TAPERED ZMR TIVANIUM ALLOY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 19MM TAPERED REVISION ZMR TIVANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,766.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998316534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 16.5MM SLOTTED REVISION BOWED COMPRESSION NUT SYSTEM ZMR TIVANIUM NITRITED POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992309340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 93MM ZMR XL TIVANIUM POROUS STANDARD OFFSET TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 16.6MM AA HIP FEMUR TIVANIUM PLASMA REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 40 17.7MM A HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999002046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 21.2MM 40MM D HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999002146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 22.5MM 46MM E HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999101755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 100MMX55MM ZMR 17.7MM A HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999401845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM ZMR B EXTEND OFFSET HIP FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 35MM 40MM ZMR FEMUR HIP TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 100MMX55MM 40MM ZMR A 40MM OFFSET HIP TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 55MM 40MM ZMR A HIP FEMUR TIVANIUM STANDARD OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 40MMX35MM 40MM ZMR C STANDARD OFFSET FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 61MM CONVERGE HIP POROUS REVISION MULTIHOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536300057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 57MM CONVERGE HIP POROUS REVISION SEALED SCREW HOLE PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536300069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 69MM CONVERGE HIP POROUS REVISION SEALED SCREW HOLE PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700005820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP REVISION TRABECULAR METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700006020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP REVISION TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999402355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 100MMX55MM 46MM ZMR F HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 80MMX35MM ZMR B FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM 40MM ZMR C 20MM HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 974049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 40MM MULLER HIP PROTASUL-TI CEMENTED REVISION REINFORCEMENT ROOF STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536200063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 63MM HIP REVISION MULTIHOLE SEAL SCREW HOLE POROUS CONVERGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536300055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 55MM CONVERGE HIP POROUS REVISION SEALED SCREW HOLE PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536300061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 61MM CONVERGE HIP POROUS REVISION SEALED SCREW HOLE PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536300065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 65MM CONVERGE HIP POROUS REVISION SEALED SCREW HOLE PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700004820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700007020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615406632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 11.4MM 66MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433628049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 49MM 28MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433628055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 55MM 28MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433732059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 59MM 32MM POLYETHYLENE HIP PRIMARY HOOD ENHANCED PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433822045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 45MM 22MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433828049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 49MM 28MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633405832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 9.4MM 58MM 32MM LONGEVITY HIP CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633408036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 18.3MM 80MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 58MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 60MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 60MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710505836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 58MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 76/78/80MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 76/78/80MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 60MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 66/68/70MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 6/68/70MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 72/74MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 76/78/80MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 40MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 40MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 44MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B 36MM COCR HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 60MM COCR HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110004137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 FDM MOD HD T12/14 32MM -3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110004139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 FDM MOD HD T12/14 32MM +6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 32MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 36MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 36MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 28MM HIP BIOLOX DELTA BIOLOX OPTION G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,311.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,311.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 40MM HIP BIOLOX DELTA BIOLOX OPTION G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,106.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,106.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 24 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 12/14 32MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 36MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-107017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 12/14 36MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-107020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 12/14 36MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 26MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 67MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 42MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 48 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 55MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 58MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 58MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 40-50MM MALLORY-HEAD HIP CALCAR LATERAL COCR 1 PIECE CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 26MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302129|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 29MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 30MM ARCOS TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 51MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302154|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 54MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 35MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150498|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 7CM KNEE LEFT OSS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,841.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,841.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS OSSEOTI MODULAR TROCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 44 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 70MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 67MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 68MM MALLORY-HEAD HIP LEFT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 56MM REGENEREX LARGE HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 45-55MM MALLORY-HEAD HIP CALCAR LATERAL COCR 1 PIECE CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 25MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 34MM ARCOS TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 50MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104913|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60-70MM 2 PIECE MALLORY-HEAD BONE HIP TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 55MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150497|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 7CM KNEE RIGHT OSS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,841.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,841.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 8.5CM COMPRESS FINN OSS KNEE RIGHT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 8.5CM COMPRESS FINN OSS KNEE LEFT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 7CM COMPRESS OSS LETSON KNEE LEFT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 8.5CM COMPRESS OSS LETSON KNEE RIGHT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 31CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 6IN 1/3 4IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 6IN 1/3 7IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711507236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 72/74MM 36MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D LL 58MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D RR 70MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 52MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 61MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 51-52MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 46 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 40 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 52MM MALLORY-HEAD RINGLOC HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 61MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 64MM MALLORY-HEAD HIP RIGHT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 56MM REGENEREX MEDIUM HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR SHORT FLANGE PAR-5 WIDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104914|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 45-55MM TITANIUM MODULAR SYSTEM 1 PIECE MALLORY-HEAD BONE HIP CALCAR TROCHANTERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 55-65MM MALLORY-HEAD HIP CALCAR LATERAL COCR 1 PIECE CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 27MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 32MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302143|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 43MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302153|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 53MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104911|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 40-50MM 2 PIECE MALLORY-HEAD BONE HIP TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 45MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150459|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM RIGHT PROXIMAL MODULAR OSS LETSON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 7CM COMPRESS FINN OSS KNEE RIGHT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 10CM COMPRESS FINN OSS KNEE LEFT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 235MM 17MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 18MM ZMR XL TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992201918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 19MM ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 20MM TAPERED ZMR XL TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 21MM TAPERED ZMR XL TIVANIUM TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00992202418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 24MM ZMR XL TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998012021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 12MM SPLINED ZMR TIVANIUM POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,428.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998018032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM BOWED SPLINED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,008.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111322SND|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION QUIX 3.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,135.14|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,135.14|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00998119533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19.5MM ZMR TIVANIUM POROUS BOW HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998201918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 19MM TAPERED ZMR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998318033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 18MM BOWED SLOTTED ZMR TIVANIUM POROUS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00994701635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 75MMX35MM ZMR 16.6MM AA HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999001640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL 40MM 35MM ZMR AA HIP FEMUR TIVANIUM POROUS SPOUT BODY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999002040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 80MMX35MM ZMR 21.2MM 46MM D HIP FEMUR TIVANIUM POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999002140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 46X45MM ZMR E STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999102045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY SPOUT 46X45MM ZMR D EXTENDED OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 46X35MM ZMR B EXTENDED OFFSET FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 100MMX45MM 55MM ZMR 18.9MM 46MM B HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999301945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MMX45MM 45MM ZMR 130D E EXTEND OFFSET HIP FEMUR TIVANIUM PLASMA POROUS REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MM 40MM ZMR 17.7MM A HIP FEMUR TIVANIUM REVISION MODULAR 45MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999601845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 90MMX45MM 40MM ZMR B 18.9MM HIP FEMUR TIVANIUM REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999602335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CONE 35MM 40MM ZMR F HIP FEMUR TIVANIUM STANDARD OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G7 NEU +5MM E1 LINER 32MM I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 32MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 44MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 12/14 32MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 12/14 32MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 36MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-107018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 12/14 36MM HIP MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 23MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 27MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 20 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 61MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 64MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 41MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 53-55MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 45 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 61MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 6MM MAX-TI WEDGE HIP PPS TITANIUM ILIAC FLANGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,914.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,914.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-110158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 58MM SMALL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104913|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60-70MM TITANIUM MODULAR SYSTEM 1 PIECE MALLORY-HEAD BONE HIP CALCAR TROCHANTERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 55-65MM TITANIUM MODULAR SYSTEM 1 PIECE MALLORY-HEAD BONE HIP CALCAR TROCHANTERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 50-60MM MALLORY-HEAD HIP CALCAR LATERAL COCR 1 PIECE CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700007270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615406832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 12.4MM 68MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433628047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 47MM 28MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433628051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 51MM 28MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433732061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 61MM 32MM POLYETHYLENE HIP PRIMARY HOOD ENHANCED PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433732063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 63MM 32MM POLYETHYLENE HIP PRIMARY HOOD ENHANCED PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433828047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 47MM 28MM POLYETHYLENE HIP PRIMARY HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436632061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EPSILON LEGACY 61MM 32MM POLYETHYLENE HIP STERILE PRIMARY PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 60MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 62/64MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 72/74MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 72/74MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711505028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 50MM 28MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM E NEUTRAL 36MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 36MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM J NEUTRAL 36MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 40MM COCR HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 44MM HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 32MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 44MM HIP SKIRT BIOLOX DELTA BIOLOX OPTION G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,106.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,106.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 28 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 70MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 72/74MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710507628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 76/78/80MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711006228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 62/64MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 72/74MM 28MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 72/74MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 72/74MM 40MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711505228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 52MM 28MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM G NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM H NEUTRAL 40MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C 38MM COCR 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E1 S 42MM 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 54MM COCR HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 32MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 32MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 32MM HIP BIOLOX DELTA BIOLOX OPTION G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,311.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,311.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 27 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC II HIP TITANIUM CONSTRAIN EXTRA RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 64MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109573|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 73MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 42 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 64MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 52MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 52MM MALLORY-HEAD HIP LEFT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 60MM MALLORY-HEAD HIP LEFT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 52MM MALLORY-HEAD HIP RIGHT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 60MM MALLORY-HEAD HIP RIGHT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 52MM REGENEREX SMALL HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 56MM REGENEREX SMALL HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 54MM REGENEREX LARGE HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PAR 5 HIP ACETABULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104911|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 40-50MM TITANIUM MODULAR SYSTEM 1 PIECE MALLORY-HEAD BONE HIP CALCAR TROCHANTERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ARCOS TITANIUM 3.5MM FEMORAL LOCK HEXAGON DRIVE STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,134.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,134.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302137|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 37MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302139|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 39MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302146|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 46MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 48MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 55-65MM 2 PIECE MALLORY-HEAD BONE HIP TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 60MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM LEFT PROXIMAL MODULAR OSS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 35CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 39CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 49CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC+ 26 HIP REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|358.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|358.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 55MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 48-50MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 41 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 47 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 67MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 73MM MALLORY-HEAD HIP RIGHT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 64MM MALLORY-HEAD HIP LEFT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 56MM MALLORY-HEAD HIP RIGHT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 52MM REGENEREX MEDIUM HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 50-60MM TITANIUM MODULAR SYSTEM 1 PIECE MALLORY-HEAD BONE HIP CALCAR TROCHANTERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SPIRALOCK CALCAR DISTAL SEGMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 40MM ARCOS TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 45MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302149|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 49MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC MALLORY-HEAD OBLONG HIP TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MMX40MM TI KAESSMANN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 50MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 7CM COMPRESS FINN OSS KNEE LEFT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LETSON MOD PROX FMRL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 10CM COMPRESS FINN OSS KNEE RIGHT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 10CM COMPRESS OSS LETSON KNEE LEFT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL FINN LEFT PROXIMAL POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,137.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,137.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 6IN 1/3 5IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10IN 1/3 6IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11IN 1/3 6IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D NN 62MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D NN 62MM 36MM LONGEVITY HIP STERILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP 66MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP 66MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D VV 78/80MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672800701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II G STANDARD 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673209301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II N ELEVATED 32MM LONGEVITY HIP STERILE PRIMARY RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 51MM 28MM HIP CONSTRAINED DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 57MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438038063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 63MM 38MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438038065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 65MM 38MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 12/14 SMALL 36MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877704001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 12/14 SMALL 40MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877704002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 MEDIUM 40MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800500300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 58MM 54MM ZCA HIP LEFT TITANIUM RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800505400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 58MM 54MM ZCA 53MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489400154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 54MM STRAIGHT HIP TRABECULAR METAL BUTTRESS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 15MM 50MM TRABECULAR METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 10MM 58MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 10MM 62MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 15MM 62MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712307668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 76/78/80MM 68MM SHORT HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712405648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 56/58/60MM 48MM SHORT HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712506658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 66/68/70MM 58MM LONG HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712507264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 72/74MM 64MM LONG HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32833305500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM VERSYS HERITAGE STANDARD HIP PROXIMAL PMMA SLEEVE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32833305600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 17MM VERSYS HIP PMMA CEMENTED CENTRALIZER REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 21MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 76MM 8MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102MM 19MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 106MM 20MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM 9MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 14MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 10 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107.5MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 11 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 113MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 14 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D TT 74MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673200601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II F STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673208901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II J ELEVATED 32MM LONGEVITY HIP STERILE PRIMARY RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 65MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 69MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438032055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 55MM 32MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 LARGE 32MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800500200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 52MM 48MM ZCA HIP RIGHT TITANIUM REVISION CEMENTED RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800500600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 64MM 60MM ZCA HIP RIGHT TITANIUM REVISION CEMENT RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800506000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 64MM 60MM ZCA 59MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489400105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 5D HIP TRABECULAR METAL SHIM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 10MM 54MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 54MM THK15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 10MM 66MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712305648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 56/58/60MM 48MM HIP RIGHT TRABECULAR METAL REVISION CUP SHORT FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712407668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 76/78/80MM 68MM SHORT HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712606254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 62/64MM 54MM HIP LEFT TRABECULAR METAL REVISION CUP LONG FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712607264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 72/74MM 64MM LONG HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 94MM 17MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 77MM 9MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 86MM 15MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM 13.5MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 10MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 13MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 10MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 13MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107.5MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 11 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 113MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 14 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 24 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 TAPERLOC MICROPLASTY XR SERIES PPS 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 7MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM PRIMARY MEDIALIZE INSERTION HOLE NNONCOLLAR X SERIES BI-METRIC PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 21MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1002 020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PORP PARTIAL VARIAC TTP KURZ|1|HUMANA [1294]||HUMANA [11839]|1,365.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,365.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 16-116058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LIMIT HOLE COLOR CODED POROUS G7 D HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LIMIT HOLE COLOR CODED POROUS G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LETSON MOD PROX FMRL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL FEMUR DIAPHYSIS 43CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12IN 1/3 6IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D JJ 54MM 28MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D QU 68MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1004 020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS TORP TOTAL VARIAC TTP KURZ|1|HUMANA [1294]||HUMANA [11839]|1,365.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,365.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 32672800301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II C STANDARD 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673200801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II H STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673200901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II J STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673209101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II L ELEVATED 32MM LONGEVITY HIP STERILE PRIMARY RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 55MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 61MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 75MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 LARGE 36MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800504800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 52MM 48MM ZCA 47MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489400115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 15D HIP TRABECULAR METAL SHIM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 20MM 66MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712306658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 66/68/70MM 58MM SHORT HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712406658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 66/68/70MM 58MM SHORT HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 82MM 13MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 35MM 40MM ZMR AA HIP FEMUR TIVANIUM EXTENDED OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00999801845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 90MMX45MM 40MM ZMR B 18.9MM OFFSET HIP FEMUR TIVANIUM POROUS EXTEND REVISION MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700005220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700005620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00700006620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP REVISION TRABECULAR METAL TANTALUM TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,703.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00615407032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY RING 13.3MM 70MM 32MM TIVANIUM UHMWPE HIP STERILE REVISION MODULAR CUP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00701005228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR EXPLANT 10D 52MM 28MM UHMWPE HIP STERILE REVISION SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433628059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 59MM 28MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 51MM 28MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 433632057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR APR LEGACY 57MM 32MM UHMWPE HIP STERILE PRIMARY ENHANCED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,452.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00633406836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 12.4MM 68MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00710506236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 0D NEUTRAL 62/64MM 36MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,034.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711007632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OBLIQUE 76/78/80MM 32MM LONGEVITY HIP REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,303.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 32MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM F NEUTRAL 36MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 +5MM I NEUTRAL 36MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MFT-011-35-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110024465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 46MM HIP 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-107021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM OFFSET 36MM HIP TYPE 1 MODULAR COCR G7 FREEDOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 20MM RINGLOC HIP LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 73MM RECOVERY HIP RIGHT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 55MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 28MM ARCOS HIP TROCHANTER COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 52MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 50-60MM 2 PIECE MALLORY-HEAD BONE HIP TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 25MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP250311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 30MM ARCOS TITANIUM HIP FEMORAL TRANSVERSE FIXATION STERILE MODULAR REVISION SYSTEM KAESSMANN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|616.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|616.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905942|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ALLTHREAD LACTOSORB 5.5MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OSS RIGHT PROXIMAL LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,784.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,784.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OSS LEFT PROXIMAL LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,784.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,784.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 8.5CM COMPRESS OSS LETSON KNEE LEFT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,862.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 10CM COMPRESS OSS LETSON KNEE RIGHT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,476.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 29CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 45CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 6IN 1/3 3IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 8IN 1/3 6IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9IN 1/3 6IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D MM 60MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D MM 60MM 36MM LONGEVITY HIP STERILE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D OO 64MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D OO 64MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D QU 68MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672600201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II B STANDARD 26MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672801201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II M STANDARD 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673200501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II E NEUTRAL 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 70MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 119003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR RINGLOC 43 HIP LOW PROFILE XRAY WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 55MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 73MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 56MM MALLORY-HEAD HIP LEFT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 72MM MALLORY-HEAD HIP LEFT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 72MM MALLORY-HEAD HIP RIGHT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 54MM REGENEREX SMALL HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 52MM REGENEREX LARGE HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC MALLORY-HEAD TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,530.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,530.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL MALLORY-HEAD MEDIUM HIP TROCHANTERIC LATERAL COCR CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 100MM ARCOS LARGE HIP TROCHANTERIC COCRMO MODULAR REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,560.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,560.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 25MM ARCOS TROCHANTER BUTTON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,428.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,428.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 36MM ARCOS TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 38MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 41MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 47MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104914|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 45-55MM 2 PIECE MALLORY-HEAD BONE HIP TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM RIGHT PROXIMAL MODULAR OSS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FINN MOD PROX FMRL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,137.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,137.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL FEMUR DIAPHYSIS 53CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D TT 74MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D UU 76MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672808701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II G ELEVATED 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672809201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II M ELEVATED 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673201101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II L STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673208701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II G 32MM LONGEVITY HIP STERILE PRIMARY ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438038071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 71MM 38MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877702802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 MEDIUM 28MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800505000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 54MM 50MM ZCA 49MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 20MM 58MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 30MM 66MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7600110|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMIC RESORBABLE MASTER GRAFT 10CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,587.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00489430000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR HIP RIGHT ANTERIOR LEFT POSTERIOR TRABECULAR METAL BUTTRESS COLUMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 86MM 15MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 79MM 11MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 94MM 17MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM 11MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 22.5MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 18MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 7.5MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL FEMUR DIAPHYSIS 37CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0684-00-0469-01|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON INTRA-AORTIC 7.0 FR X 34CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 180039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 51CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D UU 76MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672800601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II F STANDARD 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672808601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II F 28MM LONGEVITY HIP STERILE PRIMARY ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673200701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II G STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673201001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II K STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673209001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II K ELEVATED 32MM LONGEVITY HIP STERILE PRIMARY RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 59MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 73MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5211600|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT,URETERAL,TRACTFINDER,2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0684-00-0470-01|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON INTRA-AORTIC 7.0 FR X 40CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 438028077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 77MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438038069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 69MM 38MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877702801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 12/14 SMALL 28MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 12/14 SMALL 32MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,839.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489440000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR HIP RIGHT POSTERIOR LEFT ANTERIOR TRABECULAR METAL BUTTRESS COLUMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712306254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM SHT FLANGE CAGE RT 62/64 SHELL/54 LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712407264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 72/74MM 64MM SHORT HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712505648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 56/58/60MM 48MM LONG HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712606658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 66/68/70MM 58MM LONG HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-108060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 97.5MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 6 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-108070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 97MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 7 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 15 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 18 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 14MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LIMIT HOLE COLOR CODED POROUS G7 C HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LIMIT HOLE COLOR CODED POROUS G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000669|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LIMIT HOLE COLOR CODED POROUS G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000671|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP LIMIT HOLE COLOR CODED POROUS G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP LIMIT 3 HOLE FIN POROUS G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 23MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 25MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 26MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 24MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 27MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-104060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM 41MM HIP 2 HOLE METAL M2A-TAPER MALLORY-HEAD RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD118860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM 38MM HIP METAL M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 38MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM 40MM HIP SOLID REGENEREX RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM 40MM HIP SOLID REGENEREX RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LIMIT 3 HOLE FIN POROUS G7 E HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LIMIT 4 HOLE FIN POROUS G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LIMIT 4 HOLE FIN POROUS G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 21 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105875|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 32MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105877|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 32MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 6 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 20 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102MM 19MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 75MM 7MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 12MM ECHO BI-METRIC MICROPLASTY HIGH OFFSET FULL PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 16MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM 11MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM 13.5MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 13 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 10 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 117MM TYPE 1 COMPLETE MICROPLASTY TAPERLOC PPS TITANIUM 133D 16 TAPER HIGH OFFSET 39.6MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 18 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-108040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 93MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 4 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-108050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 5 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-109070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 99MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 7 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107.5MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 11 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-149040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 93MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 4 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 17MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 58MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-109567|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 67MM RECOVERY HIP LEFT TITANIUM LARGE ILIUM FLANGE ANTERIOR CUTOUT INFERIOR WINDOW GRIT BLAST FINISH PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,577.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING BIPOLAR 46-47MM RINGLOC HIP ACETABULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 64MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 70MM MALLORY-HEAD HIP LEFT PROTRUSIO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,765.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 4MM 68MM MALLORY-HEAD HIP RIGHT PPS TITANIUM MODULAR ANTERO INFERIOR SCREW HOLE AUGMENTABLE ILIAC ISCHIAL FLANGE PROTRUSIO STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 6MM MAX-TI FLAT HIP PPS TITANIUM ILIAC FLANGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,914.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,914.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 54MM REGENEREX MEDIUM HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 58MM REGENEREX MEDIUM HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-210358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 58MM REGENEREX LARGE HIP TITANIUM POROUS MULTIPLE HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,006.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 109220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PAR-5 OBTURATOR HOOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 60-70MM MALLORY-HEAD HIP CALCAR LATERAL COCR 1 PIECE CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,339.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL MALLORY-HEAD LARGE HIP TROCHANTERIC LATERAL COCR CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAW FEMORAL 100MM ARCOS SMALL HIP TROCHANTERIC COCRMO MODULAR REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,560.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,560.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 24MM ARCOS TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302133|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 33MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 35MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 42MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-302144|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC 44MM ARCOS HIP TROCHANTERIC COCRMO MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,599.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673208801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II H NEUTRAL 32MM LONGEVITY HIP STERILE PRIMARY ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673209201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II M 32MM LONGEVITY HIP STERILE PRIMARY ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 53MM 28MM HIP CONSTRAINED DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 63MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438032057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 57MM 32MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438038061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 61MM 38MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438038067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 67MM 38MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877703604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +7MM 12/14 XL 36MM HIP BIOLOX DELTA CPT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800500100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 52MM 48MM ZCA HIP LEFT TITANIUM REVISION CEMENT RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800500400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 58MM 54MM ZCA HIP RIGHT TITANIUM REVISION CEMENT RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G00631|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 628413 (CYSTO)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00800505600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 60MM 56MM ZCA 55MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800505800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 62MM 58MM ZCA 57MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 20MM 50MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 30MM 54MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 30MM 58MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 20MM 62MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712307264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 72/74MM 64MM SHORT HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712406254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 62/64MM 54MM HIP LEFT TRABECULAR METAL REVISION CUP SHORT FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712506254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 62/64MM 54MM LONG HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712507668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 76/78/80MM 68MM LONG HIP RIGHT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712605648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 56/58/60MM 48MM LONG HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998209902|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT ORTHOPEDIC ZMR LARGE HIP TIVANIUM COMPRESSION MODULAR JUNCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 79MM 11MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 106MM 20MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 98MM 18MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 21MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 7.5MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102.5MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 9 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 12 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 12 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 13 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-108080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 101MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 8 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 117MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 16 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 17 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13MM PRIMARY MEDIALIZE INSERTION HOLE NNONCOLLAR X SERIES BI-METRIC PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 14MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 17MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 33CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 47CM KNEE DIAPHYSIS FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,063.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875800928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D HH 50MM 28MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D SS 72MM 36MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D VV 78/80MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32672808901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II J ELEVATED 28MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32673201301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGP II N STANDARD 32MM LONGEVITY HIP STERILE PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800505200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 56MM 52MM ZCA 51MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489400158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 58MM STRAIGHT HIP TRABECULAR METAL BUTTRESS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,273.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 15MM 58MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489407010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 10MM 70MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489407015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 15MM 70MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 78MM 10MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 19MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM 9MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17.5MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 117MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 16 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 18 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 22.5MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 17 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 20 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 20 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-109060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 97.5MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 6 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 10 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-149060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 97.5MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 6 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-149080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 101MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 8 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 20MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 28MM BIO-CLAD HIGH WALL PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP LIMIT HOLE COLOR CODED POROUS G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00712607668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 76/78/80MM 68MM LONG HIP LEFT TRABECULAR METAL REVISION CUP FLANGE SHELL LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 16MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 98MM 18MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 84MM 14MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 16MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 10MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 12.5MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 15 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 24 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102.5MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 9 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 TAPERLOC MICROPLASTY XR SERIES PPS 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 TAPERLOC MICROPLASTY XR SERIES PPS 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 19MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 8MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 24MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD118864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 38MM M2A HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 56MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 58MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 44MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 56MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM 40MM HIP SOLID REGENEREX RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066201010|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .038 MICROVASIVE #620-101|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PT-116064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105865|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 3 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 5 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 8 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 2 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 43MM 22MM HIP STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 22 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 46 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 43 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 43 32MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 48 32MM UHMWPE HIP LOW PROFILE HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105976|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 46 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 31 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 36 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 37 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D A 28MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D D 28MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D E 32MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105881|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 21 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 22 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 43 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 28 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-112028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC IMPACT 8 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242848117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ARCOM 10D OFFSET 48MM 28MM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242852107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 52MM 28MM ARCOM HIP KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242856117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 56MM 28MM ARCOM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242860107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 60MM 28MM ARCOM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 39MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM PRIMARY CEMENT SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 47MM EXTENDED OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 45MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 20 22MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 43 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 48 28MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 44 32MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 47 32MM UHMWPE HIP LOW PROFILE COMPONENT HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105982|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 22 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105993|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 33 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR B 28MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR E 32MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D C 32MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105894|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 24 32MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 25 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 26 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 46 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 40 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242656117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 56MM 26MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242852117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 52MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242856107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 56MM 28MM ARCOM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242862117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 62MM 28MM ARCOM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 47MM EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 19MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LIMIT HOLE COLOR CODED POROUS G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 23MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 25MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 28MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-104048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM 37MM HIP 2 HOLE METAL M2A-TAPER MALLORY-HEAD RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-104064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM 41MM HIP 2 HOLE METAL M2A-TAPER MALLORY-HEAD RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-106070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM 28MM HIP MULTI HOLE LOCKING RING POROUS M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 48MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 42MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83971-02|SUP|HCPCS C1725||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALLOON FOX SV CATHETER 3MM X 100MM X 150CM .018 BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PT-104050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM 40MM HIP SOLID REGENEREX RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LIMIT 3 HOLE FIN POROUS G7 C HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 42 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105867|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 2 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 6 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 7 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 4 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 83155-02|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON FOX SV CATHETER 3MM X 60MM X 150CM .018 BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-105825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 42MM 22MM HIP STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105865|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 41 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 45 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 46 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105978|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 48 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 38 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR C 32MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 23 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105896|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 26 32MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM LEFT PROXIMAL MODULAR CLAW OSS LETSON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,307.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 7CM COMPRESS OSS LETSON KNEE RIGHT REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,363.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 6IN 1/3 6IN HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,099.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711506636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 66/68/70MM 36MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00711507636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 1MM .072IN OFFSET 76/78/80MM 36MM LONGEVITY HIP CEMENT CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D II 52MM 28MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D LL 58MM 28MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875801932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D RR 70MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875802032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D SS 72MM 32MM LONGEVITY HIP CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,865.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 67MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 438028071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 71MM 28MM HIP CONSTRAIN DURASUL EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877704003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 LARGE 40MM HIP BIOLOX DELTA OPTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800500500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE ACETABULAR 64MM 60MM ZCA HIP LEFT TITANIUM REVISION CEMENTED RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,247.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800504600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACETABULAR 50MM 46MM ZCA 45MM HIP TITANIUM REVISION CEMENT ROOF RECONSTRUCTION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,708.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489400110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 10D HIP TRABECULAR METAL SHIM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 30MM 50MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489405420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 20MM 54MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 30MM 62MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00489406615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT ACETABULAR 15MM 66MM HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 12MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 84MM 14MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 82MM 13MM FULL PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17.5MM TAPERLOC TITANIUM HA POROUS STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-104117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM PRIMARY MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 10MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-123206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12.5MM PRIMARY LATERALIZE TAPERLOC HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-124314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 14MM PRIMARY LATERALIZE MALLORY-HEAD HA POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 15 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-106220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 129MM TYPE 1 TAPERLOC MICROPLASTY PPS 133D 22 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102.5MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 9 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM TYPE 1 TAPERLOC MICROPLASTY TITANIUM PPS 133D 17 HIGH OFFSET TAPER HIP STERILE COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-109080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 101MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 8 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 12 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 113MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 14 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 8MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 18MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 18MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LIMIT HOLE COLOR CODED POROUS G7 B HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000667|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LIMIT HOLE COLOR CODED POROUS G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LIMIT HOLE COLOR CODED POROUS G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 26MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD118866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 38MM M2A HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD118868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 38MM M2A HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 60MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 56MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM 40MM HIP SOLID REGENEREX RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM 40MM HIP SOLID REGENEREX RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP LIMIT 3 HOLE FIN POROUS G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105873|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 32MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 32MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 4 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 3 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 21 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105873|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 44 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 45 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 42 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 48 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 46 32MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 43 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105981|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 21 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 34 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 35 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D B 28MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D C 28MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D D 32MM ARCOM HIP HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 22 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 27 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 47 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 48 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 27 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-107220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 129MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 22 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-109050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY PPS 133D 5 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-145130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 13 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-149050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 5 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-149070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 99MM TYPE 1 PRESS FIT TAPERLOC MICROPLASTY XR SERIES PPS 123D 7 TAPER 32.3MM HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-180321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 21MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D STANDARD OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000659|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP LIMIT HOLE COLOR CODED POROUS G7 A HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-105064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM 38MM HIP 1 PIECE FLARED METAL M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-105070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM 38MM HIP 1 PIECE FLARED METAL M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-106058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 38MM M2A-38 NONFLARED HIP METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-106066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM M2A-38 LOCKING RING MULTIHOLE HIP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 38MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 44MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 46MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 50MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 54MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM 40MM HIP SOLID REGENEREX RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LIMIT 4 HOLE FIN POROUS G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 47 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 43 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 45 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 47 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105876|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 40 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105975|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 45 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-105068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM 38MM HIP 1 PIECE FLARED METAL M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD118870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 38MM M2A HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 40MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 50MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 54MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 48MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 52MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM 40MM HIP SOLID REGENEREX RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP SOLID TITANIUM REGENEREX RINGLOC+ 28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LIMIT 4 HOLE FIN POROUS G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LIMIT 4 HOLE FIN POROUS G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 44 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 46 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 48 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 44 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 8 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC 10D 41 22MM ARCOM HIP LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 21 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105875|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105877|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 21 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 41 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105984|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105991|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 21 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR D 28MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 28 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 22 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 20 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 28 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 42 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 21 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 23 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 25 36MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 28 36MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-112023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC IMPACT 3 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-165178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 28 64/68MM 28MM ARCOM HIP HIGH WALL TTAP/ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242846117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 46MM 28MM ARCOM HIP KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242850107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 50MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242858117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 58MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 264450117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 44-50MM 26MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM PRIMARY CEMENT SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 36MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 39MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 5MM 40MM STANDARD OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130X10MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 5MM 50MM EXTRA EXTENDED OFFSET 20MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENT AVENIR 1 HIP LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR LATERAL STEM CEM 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENT AVENIR 4 LATERAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735735002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR STEM SHT NECK SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735935005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR OFFSET STEM SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM ANTEVERTED APS NATURAL-HIP 6 42MM STANDARD OFFSET 41MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM ANTEVERTED APS NATURAL-HIP 8 45MM STANDARD OFFSET 45MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 27MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-104058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM 41MM HIP 2 HOLE MALLORY-HEAD RADIAL M2A-TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-104062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM 41MM HIP 2 HOLE METAL M2A-TAPER MALLORY-HEAD RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-106068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM M2A-38 NONFLARED HIP METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M2A-MAGNUM RECAP CUP 58ODX52ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 52MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM 40MM HIP SOLID REGENEREX RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-104066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM 40MM HIP SOLID REGENEREX RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PT-116058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LIMIT HOLE TITANIUM POROUS REGENEREX RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LIMIT 3 HOLE FIN POROUS G7 B HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LIMIT 3 HOLE FIN POROUS G7 D HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LIMIT 4 HOLE FIN POROUS G7 G HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LIMIT 4 HOLE FIN POROUS G7 H HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110017111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP LIMIT 4 HOLE FIN POROUS G7 I HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 43 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 45 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 39MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 39MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 47MM EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105X7.5MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 0MM 37MM EXTENDED OFFSET 9MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130X9MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 2MM 46MM EXTRA EXTENDED OFFSET 13MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720093-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELEVATE ANTERIOR REPAIR SYSTEM|1|HUMANA [1294]||HUMANA [11839]|6,930.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,930.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0106010201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR STANDARD STEM CEM 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED AVENIR 4 STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED AVENIR 5 STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT NATURAL-HIP COCR NONPOROUS 2 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT NATURAL-HIP COCR NONPOROUS 3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT NATURAL-HIP COCR NONPOROUS 5 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741401120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741402135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.5MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM ANTEVERTED APS NATURAL-HIP 2 33MM STANDARD OFFSET 27MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM ANTEVERTED APS NATURAL-HIP 4 39MM STANDARD OFFSET 36MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM ANTEVERTED APS NATURAL-HIP 5 39MM STANDARD OFFSET 36MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671001101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL NATURAL-HIP 11 STANDARD HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671001202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12 STANDARD RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRIMARY CEMENT SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 45MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 45MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 1MM 34MM STANDARD OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 2MM 41MM EXTEND OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130X9MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 3MM 47MM EXTRA EXTENDED OFFSET 15.5MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811405000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130X7.5MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 30MM SMALL OFFSET 9MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905944|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR ALLTHREAD 6.8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR STANDARD STEM CEM 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR LATERAL STEM CEM 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTED PRIMARY NATURAL-HIP COCR 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735935003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR OFFSET STEM SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741402120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM ANTEVERTED APS NATURAL-HIP 2 33MM STANDARD OFFSET 27MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671001001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM ANTEVERTED APS NATURAL-HIP 10 48MM STANDARD OFFSET 50MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM 5MM REDUCE NECK LENGTH TIVANIUM POROUS 36MM TAPER STANDARD OFFSET HIP MEDIAL LATERAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771101210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 124MM 12.5MM PRIMARY M/L TIVANIUM POROUS 42MM STANDARD OFFSET TAPER 38MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905945|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOMET ANCHOR ALLTHREAD 6.8MM WITH TAPER NEEDLES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00771101240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 124MM 12.5MM PRIMARY TIVANIUM 47MM TAPER EXTENDED OFFSET REDUCED NECK HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 23 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 21 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 24 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 23 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 44 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 44 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 25 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 26 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905456|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MICROMAX FLEX 2.9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,167.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,167.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 42 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-112025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC IMPACT 5 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242846107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 46MM 28MM ARCOM HIP KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242850117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 50MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243256117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 56MM 32MM ARCOM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY CEMENT SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 44MM EXTENDED OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 45MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 0MM 32MM STANDARD OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENT AVENIR PROTASUL-S30 2 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR STANDARD STEM CEM 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENT AVENIR 7 LATERAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR STEM SZ 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X21-182320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 20MM PRIMARY MEDIALIZE INSERTION HOLE NONCOLLAR BI-METRIC X SERIES PPS TITANIUM HA 3D LATERALIZE OFFSET BIPLANAR TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP LIMIT HOLE RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LIMIT HOLE COLOR CODED POROUS G7 E HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LIMIT HOLE COLOR CODED POROUS G7 F HEMISPHERE OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM MALLORY-HEAD RADIAL 3 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM MALLORY-HEAD RINGLOC 3 HOLE HIP NRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-104056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM 41MM HIP 2 HOLE METAL M2A-TAPER MALLORY-HEAD RADIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-106064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 38MM M2A-38 NONFLARED HIP METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 42MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US157852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 46MM M2A-MAGNUM PRESS FIT HIP STERILE COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 40MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E3625|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILTER ULPA OPTIMUMM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US257866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 60MM M2A-MAGNUM TRI-SPIKE HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-129076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 +5MM 46 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105878|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 32MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 21 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNC3025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX NEURO 3.0MM DIAMETER 2.5CM LENGTH|1|HUMANA [1294]||HUMANA [11839]|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 45 32MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105974|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 44 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR IMPACT 32 28MM ARCOM HIP HIGH WALL LIPPED LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR A 28MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR C 28MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 26 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105893|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 23 32MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105895|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 25 32MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105897|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 27 32MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNC4025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX NEURO 4.0MM DIAMETER 2.5CM LENGTH|1|HUMANA [1294]||HUMANA [11839]|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 22 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 23 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 25 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 27 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 24 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 45 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 41 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-165166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 28 44MM 28MM ARCOM HIP HIGH WALL TTAP/ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-165170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TAPERLOC C 28MM HIP STERILE TAP LATEX FREE DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNC5025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX NEURO 5.0MM DIAMETER 2.5CM LENGTH|1|HUMANA [1294]||HUMANA [11839]|3,175.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,175.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-165174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR E 28MM EXTEND RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242858107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 58MM 28MM ARCOM KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242860117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 60MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 42MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 50MM EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 36MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 44MM EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 2MM 36MM STANDARD OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 3MM 37MM STANDARD OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR STANDARD STEM CEM 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNC2525|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX NEURO 2.5MM DIAMETER 2.5CM LENGTH|1|HUMANA [1294]||HUMANA [11839]|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,170.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT NATURAL-HIP COCR NONPOROUS 0 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT NATURAL-HIP COCR NONPOROUS 1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735235006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR STEM SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM ANTEVERTED APS NATURAL-HIP 1 33MM STANDARD OFFSET 27MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM ANTEVERTED APS NATURAL-HIP 1 33MM STANDARD OFFSET 27MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM ANTEVERTED APS NATURAL-HIP 5 39MM STANDARD OFFSET 36MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105983|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105992|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 22 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 26MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 25 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 27 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 28 32MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 21 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM: 27 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 26 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 28 26MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 21 22MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 41 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 46 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 48 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105994|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 24 36MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 26 36MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 27 36MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-112022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC IMPACT 2 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-112024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC IMPACT 4 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242848107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 48MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 264450107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 44-50MM 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 265254107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 52-54MM 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY CEMENTED SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 42MM EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 117MM 9MM PRIMARY M/L TITANIUM 38MM TAPER STANDARD OFFSET REDUCE NECK LENGTH HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 11X130MM STD BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 14X140MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 42MM STANDARD OFFSET LARGE METAPHYSEAL BODY STRAIGHT 38MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 17X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 17X160MM LM BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 48MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 36MM STRAIGHT STANDARD OFFSET 32MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 44MM STRAIGHT EXTEND OFFSET 36MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784502000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 48MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786200900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 9MM PRIMARY VERSYS TIVANIUM FIBER METAL POROUS 33MM STANDARD OFFSET STRAIGHT TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY STANDARD BODY VERSYS TIVANIUM FIBER METAL POROUS 53MM TAPER STRAIGHT EXTEND OFFSET 49MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786202050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 20MM PRIMARY LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL POROUS 53MM TAPER STRAIGHT EXTEND OFFSET 49MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 01 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 2 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY NATURAL-HIP POROUS 2 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 28MM HIP NONARCOM HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 5 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 7 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 26MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105867|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105878|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 21 28MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 32MM ARCOM HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 40 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 42 22MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 47 28MM ARCOM HIP HIGH WALL RIM LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 44 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 47 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105977|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 2 10D 47 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105985|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 22MM ARCOM HIP HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-105994|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 26MM UHMWPE HIP COMPONENT HIGH WALL RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR E 28MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-104309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR D 32MM ARCOM HIP HIGH WALL HEXAGONAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC 24 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 43 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 10X130MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 39MM STANDARD OFFSET LARGE METAPHYSEAL BODY STRAIGHT 34MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 34MM STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 13X140MM LM BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 16X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 53MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE BEADED MIDCOAT POROUS 48MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 138MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 1 41MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 143MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 2 42MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 161MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 6 47MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 166MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 7 48MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 1 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 4 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 8 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 9 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 0 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 6 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 7 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 13X140MM LM BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 42MM STANDARD OFFSET LARGE METAPHYSEAL BODY STRAIGHT 38MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 50MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 16X160MM LM BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784500900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 9MM PRIMARY ALIGNMENT GUIDE COLLARLESS STANDARD BODY VERSYS TIVANIUM FIBER METAL POLYSULFONE BEADED MIDCOAT 33MM STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE BEADED MIDCOAT POROUS 41MM STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 47MM STRAIGHT EXTEND OFFSET 41MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 50MM STRAIGHT EXTEND OFFSET 45MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE STANDARD BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 48MM STRAIGHT OFFSET 46MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY VERSYS TIVANIUM FIBER METAL BEADED POROUS 48MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 5 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 12 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 1 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 2 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741401165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16.5MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM ANTEVERTED APS NATURAL-HIP 3 36MM STANDARD OFFSET 32MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM ANTEVERTED APS NATURAL-HIP 4 39MM STANDARD OFFSET 36MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM ANTEVERTED APS NATURAL-HIP 7 42MM STANDARD OFFSET 41MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM ANTEVERTED APS NATURAL-HIP 9 45MM STANDARD OFFSET 45MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM 6MM PRIMARY REDUCE NECK M/L TITANIUM POROUS 36MM STANDARD OFFSET TAPER 32MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771101040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM 10MM PRIMARY REDUCE NECK M/L TIVANIUM 46MM EXTEND OFFSET TAPER 39MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771102220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM 22.5MM PRIMARY TIVANIUM POROUS 50MM TAPER STRAIGHT EXTENDED OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 40MM STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 11X130MM LM BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 15X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 15X160MM LM BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 44MM STRAIGHT EXTENDED OFFSET 36MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 45MM STRAIGHT STANDARD OFFSET 42MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 48MM STRAIGHT STANDARD OFFSET 46MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 47 32MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 43 22MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242844117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 44MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242854107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 54MM 28MM ARCOM HIP KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242854117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 54MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242862107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 62MM 28MM ARCOM HIP KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243252107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ARCOM KM3 KM4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY CEMENT SATIN FINISH VERSYS ADVOCATE V-LIGN ZIMALOY 42MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785701620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY CEMENTED PROXIMAL CENTRALIZER VERSYS HERITAGE ZIMALOY PMMA SLEEVE 50MM EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 1MM 39MM EXTEND OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 3MM 42MM EXTEND OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 4MM 43MM EXTEND OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENT AVENIR PROTASUL-S30 6 LATERAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR LATERAL STEM CEM 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735935001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR OFFSET STEM SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741401150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741402105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10.5MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM ANTEVERTED APS NATURAL-HIP 7 42MM STANDARD OFFSET 41MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM ANTEVERTED APS NATURAL-HIP 9 45MM STANDARD OFFSET 45MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671001002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM ANTEVERTED APS NATURAL-HIP 10 48MM STANDARD OFFSET 50MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671001102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL NATURAL-HIP 11 STANDARD HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671001201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12 STANDARD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771101110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM 11MM PRIMARY REDUCE NECK M/L TIVANIUM POROUS 42MM STANDARD OFFSET TAPER 38MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771101140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM 11MM PRIMARY TIVANIUM 47MM TAPER EXTENDED OFFSET REDUCED NECK HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 12X140MM LM BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 13X140MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 13X140MM STD BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 50MM STRAIGHT EXTENDED OFFSET 45MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 01 39MM 12/14 STRAIGHT OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 3 43MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 172MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 8 50MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 3 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 7 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 10 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 5 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 00 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 2 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130X10MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 4MM 38MM STANDARD OFFSET 17.5MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 4MM 48MM EXTRA EXTEND OFFSET 31MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR LATERAL STEM CEM 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD06005045L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX 6 X 45 RINGED DIALYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,872.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,872.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0106010305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENT AVENIR PROTASUL-S30 5 LATERAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735935000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR OFFSET STEM SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735935002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR OFFSET STEM SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741401105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10.5MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741401135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.5MM PRIMARY CEMENT APR COCR NONPOROUS 12/14 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM ANTEVERTED APS NATURAL-HIP 6 42MM STANDARD OFFSET 41MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM ANTEVERTED APS NATURAL-HIP 8 45MM STANDARD OFFSET 45MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 114MM 7.5MM PRIMARY M/L TITANIUM 37MM TAPER STANDARD OFFSET REDUCED NECK HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 117MM 9MM PRIMARY REDUCE NECK M/L TIVANIUM 43MM EXTEND OFFSET TAPER 35MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 47MM EXTEND OFFSET STANDARD BODY STRAIGHT 41MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 17X160MM STD BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 18X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784100900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 9MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 33MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 41MM STRAIGHT EXTENDED OFFSET STANDARD HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735502201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SHT NK SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 2, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 4, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 1, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 2, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 4, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741701165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR STD BODY DISTALLY TEXTURED - SIZE 16.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741802120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY DISTALLY TEXTURE APR LARGE BODY HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741802150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR LG BODY DISTALLY TEXTURED - SIZE 15.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 743001135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR COLLARLESS STD BODY DISTAL TEXT SZ 13.5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 36MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 42MM STANDARD BODY OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 53MM STANDARD BODY EXTENDED OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RX90 2 45 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 22 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-105954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +5MM 24 28MM ARCOM HIP FLAT FACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-112026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RIMLOC IMPACT 6 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242654117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D OFFSET 54MM 26MM ARCOM HIP KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242844107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 44MM 28MM ARCOM HIP KM3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785700900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 9MM PRIMARY CEMENTED POLISH VERSYS HERITAGE CDH ZIMALOY 125D 28MM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRIMARY CEMENTED POLISH CPT ZIMALOY 12/14 5MM 45MM EXTEND OFFSET 26MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811404000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 85X7MM PRIMARY CEMENT POLISHED CPT ZIMALOY 12/14 28MM XS OFFSET 8MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR STANDARD STEM CEM 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVENIR STANDARD STEM CEM 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735265004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP PREMIER SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735935004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP NP COCR OFFSET STEM SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00671000301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM ANTEVERTED APS NATURAL-HIP 3 36MM STANDARD OFFSET 32MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 11X130MM LM BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 44MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 1 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 3 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 4 OFFSET HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 0, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 1, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741701180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR STD BODY DISTALLY TEXTURED - SIZE 18.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741702180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR STD BODY DISTALLY TEXTURED - SIZE 18.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741801150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR LG BODY DISTALLY TEXTURED - SIZE 15.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741802180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR LG BODY DISTALLY TEXTURED - SIZE 18.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741901135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 13.5 X 15.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 44MM EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 39MM STANDARD BODY OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 47MM EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 45MM STANDARD BODY OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 48MM STANDARD BODY OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735501203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SHT NK SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 1 OFFSET HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 4, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741701135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.5MM PRIMARY DISTAL TEXTURE APR STANDARD BODY HIP LEFT NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741702165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16.5MM PRIMARY DISTALLY TEXTURE APR STANDARD BODY HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741801135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.5MM PRIMARY DISTALLY TEXTURE APR LARGE BODY HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741902120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 12.0 X 13.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 44MM STANDARD BODY EXTEND OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 42MM LARGE METAPHYSEAL BODY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM VERSYS EPOCH FULLCOAT 125D 40MM REDUCED BODY/NECK HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS EPOCH, 17MM STD BODY EXT OFS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 45MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS EPOCH, 18MM LM BODY EXT OFS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 48MM STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS 6 INCH BEADED FC STEM 11X160MM LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 13MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 6IN LARGE METAPHYSEAL BODY STANDARD OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 53MM STRAIGHT EXTEND OFFSET 49MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786202030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 20MM PRIMARY VERSYS TIVANIUM FIBER METAL BEADED POROUS 48MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 151MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 4 45MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 156MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 5 46MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 4 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 00 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 4 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735501201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SHT NK SZ 1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 3, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 2, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741801165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16.5MM PRIMARY DISTALLY TEXTURE APR LARGE BODY HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741901165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 16.5 X 18.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM VERSYS EPOCH COCR BEADED FULLCOAT 125D 43MM STANDARD BODY LOW HEAD CENTER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM 5MM PRIMARY REDUCE NECK M/L TIVANIUM 41MM EXTEND OFFSET TAPER 35MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM 6MM PRIMARY REDUCE NECK M/L TIVANIUM 41MM EXTEND OFFSET TAPER 35MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771100740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 114MM 7.5MM PRIMARY REDUCE NECK M/L TITANIUM 42MM EXTEND OFFSET TAPER 35MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771101010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM 10MM PRIMARY REDUCE NECK M/L TITANIUM POROUS 41MM STANDARD OFFSET TAPER 35MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771102200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM 22.5MM PRIMARY M/L TIVANIUM POROUS 45MM TAPER STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 36MM STANDARD BODY OFFSET STRAIGHT 32MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S1-1500U|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT MONOKA MINI|1|HUMANA [1294]||HUMANA [11839]|189.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 53MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 44MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 44MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE BEADED MIDCOAT POROUS 53MM STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 53MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784502030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 53MM STRAIGHT STANDARD OFFSET 46MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786202020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 20MM PRIMARY STANDARD BODY VERSYS TIVANIUM FIBER METAL POROUS 53MM TAPER STRAIGHT EXTEND OFFSET 49MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 178MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 9 52MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 6 12/14 HIP STERILE MCRTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 11 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 0 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 5, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 6, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741702120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY DISTALLY TEXTURE APR STANDARD BODY HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741702150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM PRIMARY DISTALLY TEXTURE APR STANDARD BODY HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741801105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR LG BODY DISTALLY TEXTURED - SIZE 10.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741901105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 10.5 X 12.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741901120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 12.0 X 13.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM VERSYS EPOCH FULLCOAT 125D 40MM REDUCED BODY/NECK HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 57MM EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 17MM VERSYS EPOCH FULLCOAT 125D 43MM REDUCED BODY/NECK HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 13MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 6IN LARGE METAPHYSEAL BODY EXTEND OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 14MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN EXTEND OFFSET LARGE METAPHYSEAL BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784502020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE STANDARD BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 53MM STRAIGHT EXTEND OFFSET 49MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784502050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE COLLARLESS LARGE METAPHYSEAL BODY VERSYS TIVANIUM FIBER METAL POLYSULFONE BEADED MIDCOAT POROUS 53MM STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784701500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 42MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 0 40MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100121100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 184MM PRIMARY ALLOCLASSIC SL PROTASUL-100 POROUS 10 53MM 12/14 STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL CEMENTLESS PRIMARY STRAIGHT TAPERED ALLOCLASSIC SL PROTASUL-100 POROUS 0 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY NATURAL-HIP POROUS 5 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735502202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SHT NK SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 1, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY NATURAL-HIP POROUS 5 OFFSET HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 3 OFFSET HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported OP001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EYELID DYNAROD|1|HUMANA [1294]||HUMANA [11839]|177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SZ 6, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741802105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR LG BODY DISTALLY TEXTURED - SIZE 10.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741802135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.5MM PRIMARY DISTALLY TEXTURE APR LARGE BODY HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741902135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 13.5 X 15.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408802026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 53MM STANDARD BODY EXTEND OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408802226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 22MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 53MM STANDARD BODY EXTENDED OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 13MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 6IN STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS 6 INCH BEADED FC 16X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM BEAD FULL COAT STANDARD BODY NECK VERSYS 6IN STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 22MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 22MM PRIMARY VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 5 33MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 2 37.5MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 3 38MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 14 45.25MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 2 44.5MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 4 52.5MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 6 53.62MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 8 54.88MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 14X140MM LM BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY COLLAR ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED MIDCOAT POROUS 47MM EXTEND OFFSET STANDARD BODY STRAIGHT 41MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784001650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS BEADED MC CLR 16X160MM LM BODY EXT NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM PRIMARY ALIGNMENT GUIDE STANDARD BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 47MM STRAIGHT EXTEND OFFSET 41MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE BEADED MIDCOAT POROUS 47MM STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE STANDARD BODY VERSYS TIVANIUM FIBER METAL BEADED MIDCOAT POROUS 50MM STRAIGHT EXTEND OFFSET 45MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE VERSYS TIVANIUM FIBER METAL POLYSULFONE MIDCOAT POROUS 50MM STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY VERSYS TIVANIUM FIBER METAL POROUS 48MM TAPER STANDARD BODY OFFSET 46MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY VERSYS TIVANIUM FIBER METAL BEADED POROUS 53MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735401203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 3 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY NATURAL-HIP POROUS 4 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 0 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735501202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARED SHT NK SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735502102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SHT NK SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 3, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 14MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STANDARD OFFSET LARGE METAPHYSEAL BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 21MM PRIMARY ALIGNMENT GUIDE STANDARD BODY VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 21MM PRIMARY VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 137D 7 40.25MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 10 42.5MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 129D 6 46.62MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 11 57MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 14 59.25MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM AVENIR MULLER PROTASUL-64WF HA 7 48.55MM OFFSET LATERAL 68.66MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126MM 13.5MM PRIMARY M/L TIVANIUM TCP HA 50MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 129MM 15MM PRIMARY M/L TIVANIUM TCP HA 51MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 39MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE MIDCOAT POROUS 39MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 45MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TCP MIDCOAT FIBER METAL POLYSULFONE 53MM STANDARD OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STANDARD OFFSET LARGE METAPHYSEAL BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS 6 INCH BEADED FC 18X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY COLLAR ALIGNMENT GUIDE STANDARD BODY VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 21MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 3 32MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 10 36.25MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 14 39.25MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 137D 5 39MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 12 43.75MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 7 47.25MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 2 51.5MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 9 55.5MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 10 56.25MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 129MM AVENIR MLLER PROTASUL-64WF HA 1 38.74MM OFFSET STANDARD 54.79MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 141MM LATERALIZED AVENIR-MULLER PROTASUL-64WF HA 3 45.67MM OFFSET 64.59MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM LATERALIZED AVENIR-MULLER PROTASUL-64WF HA 9 50.54MM OFFSET 71.48MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM 10MM PRIMARY M/L TIVANIUM TCP HA 49MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771102020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 139MM 20MM PRIMARY M/L TIVANIUM TCP HA 54MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE MIDCOAT POROUS 39MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE MIDCOAT POROUS 45MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784500900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 9MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 33MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 42MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 45MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 44MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 44MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 47MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 45MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 18MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 53MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735601100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 0 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 32MM BIO-CLAD HIGH WALL PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163492|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 32MM 10D BIO-CLAD PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM FULL HEMISPHERE RINGLOC SOLID HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 47MM STANDARD BODY EXTEND OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 50MM STANDARD BODY EXTENDED OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 50MM EXTEND OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408802006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 48MM STANDARD BODY/OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 12MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 6IN STANDARD BODY EXTEND OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD BODY LOW HEAD CENTER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 21MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 22MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 8 34.88MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 12 37.75MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 9 41.5MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 129D 9 48.5MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 14 52.25MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 141MM AVENIR MULLER PROTASUL-64WF HA 3 39.68MM OFFSET STANDARD 56.11MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM AVENIR MULLER PROTASUL-64WF HA 7 42.55MM OFFSET STANDARD 60.18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735402205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 5 HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 6, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 2 OFFSET HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741701105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10.5MM PRIMARY DISTALLY TEXTURE APR STANDARD BODY HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741801120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRIMARY DISTALLY TEXTURE APR LARGE BODY HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 39MM STANDARD BODY OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 44MM EXTENDED OFFSET STANDARD BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 39MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM VERSYS EPOCH FULLCOAT 135D 36MM REDUCED BODY/NECK HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 47MM STANDARD BODY EXTEND OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 47MM EXTEND OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 45MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 45MM STANDARD BODY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 19MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 53MM STANDARD BODY EXTENDED OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 7 34.25MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 9 35.5MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 13 44.5MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST FITMORE PROTASUL-64 PLASMA SPRAY 129D 10 49.25MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 21MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 137D 8 40.88MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 129D 4 45.5MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 5 46MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 8 47.88MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 12 57.75MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 13 58.5MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM 16.25MM PRIMARY M/L TIVANIUM TCP HA 47MM TAPER STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 36MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 39MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 48MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS FM MC CLRLSS HATCP 10X130 STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS FM MC CLRLSS HATCP 14X140 STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 36MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 41MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM PRIMARY LARGE METAPHYSEAL BODY VERSYS FIBER METAL TCP BEAD HA 42MM TAPER STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 50MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 36MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 39MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 44MM EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM VERSYS EPOCH FULLCOAT 125D 40MM REDUCED BODY/NECK HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408802106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 21MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 48MM STANDARD BODY/OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS 6 INCH BEADED FC 11X160MM STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 13MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 6IN STANDARD BODY OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN EXTEND OFFSET LARGE METAPHYSEAL BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16MM LOW HEAD CENTER PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 22MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 6 33.62MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 137D 1 37MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 1 44MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 3 45MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 11 50MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 13 51.5MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 127D 5 53MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 7 54.25MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 153MM AVENIR-MULLER PROTASUL-64WF HA 5 40.22MM OFFSET STANDARD 57.88MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM LATERALIZED AVENIR-MULLER PROTASUL-64WF HA 2 45.17MM OFFSET 63.88MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771100620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM 6MM PRIMARY M/L TIVANIUM TCP HA 45MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771100920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 117MM 9MM PRIMARY M/L TIVANIUM TCP HA 48MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 33MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE MIDCOAT POROUS 42MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS FM MC CLRLSS HATCP 13X140 STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 48MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 39MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 42MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY VERSYS FIBER METAL TCP BEAD HA 42MM TAPER STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 48MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786202020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 20MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 53MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM FULL HEMISPHERE RINGLOC SOLID HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM FULL HEMISPHERE RINGLOC SOLID HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 171MM AVENIR-MULLER PROTASUL-64WF HA 8 43.66MM OFFSET STANDARD 61.75MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 129MM LATERALIZED AVENIR-MULLER PROTASUL-64WF HA 1 44.75MM OFFSET 63.28MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771100520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM 5MM PRIMARY M/L TIVANIUM TCP HA 45MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771100720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 114MM 7.5MM PRIMARY M/L TIVANIUM TCP HA 48MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM 16.25MM PRIMARY M/L TIVANIUM TCP HA 52MM TAPER STRAIGHT EXTENDED OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM COLLAR EXTEND NECK VERSYS FIBER METAL HA TCP MIDCOAT LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA BEADED MIDCOAT POROUS 39MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA BEADED MIDCOAT POROUS 45MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 44MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 44MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 47MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 47MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 45MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 53MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786202000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 20MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 48MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFP-6503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CROSSFT 6.5 WITH #2 HI-FI SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|848.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|848.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM SOLID LINER POROUS RINGLOC 26 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CKP-4500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR POPLOK 4.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,032.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,032.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 12-103566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM SOLID LINER POROUS RINGLOC 27 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 27MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CFP-5503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CROSSFT 5.5 WITH #2 HI-FI SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|848.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|848.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 FULL HEMISPHERE 68MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 FULL HEMISPHERE 80MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP LIMIT HOLE FIN RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735601202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP HA POROUS 2 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735601205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 5, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744001120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 12.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744002150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 15.0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744101165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 16.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771300600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 111MM 6MM ZIMMER M/L KINECTIV 133D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 119MM 10MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 5MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 7MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 8MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771302200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M/L TAPER KINECTIV HA STEM SIZE 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784803001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784803401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK J1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800565032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 53MM 32MM 10D STANDARD ZCA PRIMARY CEMENT INCLINED FACE HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806554428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 47MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 3, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS COLLARLESS SZ 5, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP POROUS 5 OFFSET HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741701120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR STD BODY DISTALLY TEXTURED - SIZE 12.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741701150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR STD BODY DISTALLY TEXTURED - SIZE 15.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741802165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR LG BODY DISTALLY TEXTURED - SIZE 16.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741901150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 15.0 X 16.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741902105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 10.5 X 12.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 741902150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR OVERSIZE DISTAL TEXT SZ 15.0 X 16.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM VERSYS EPOCH COCR BEADED FULLCOAT 135D 41MM EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM VERSYS EPOCH FULLCOAT 135D 36MM REDUCED BODY/NECK HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 42MM STANDARD BODY OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 42MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00408801836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 18MM VERSYS EPOCH COMPOSITE FULLCOAT 135D 48MM STANDARD OFFSET LARGE METAPHYSEAL BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA 39MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 10MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 33MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 39MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735601101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1802009004|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EYE PATCH CARDIOVASC. .4MM #1802009004|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|702.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 735601201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY COLLAR NATURAL-HIP HA POROUS 1 HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 32MM BIO-CLAD HIGH WALL PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP APEX HOLE TRI-SPIKE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM SOLID LINER POROUS RINGLOC 21 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP LIMIT HOLE FIN RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 2, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 4, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 5, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744002105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 10.5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744002180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 18.0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744101135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 13.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744202105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 10.5 X 12.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 20MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771301600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M/L TAPER KINECTIV HA STEM SIZE 16.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784801100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM SOLID LINER POROUS RINGLOC 24 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP LIMIT HOLE FIN RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP LIMIT HOLE FIN RINGLOC+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP LIMIT HOLE FIN RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 1, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 1, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 4, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744001150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 15.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744102105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 10.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744201105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 10.5 X 12.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744201165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 16.5 X 18.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744202135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 13.5 X 15.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 126MM 13.5MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.75MM BREVIUS CLS KINECTIV PROTASUL-64 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771301700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M/L TAPER KINECTIV HA STEM SIZE 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784800201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK K1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784800301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 153MM AVENIR-MLLER PROTASUL 64 5 46.9MM OFFSET 66.33MM LATERAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771100440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107MM 4MM PRIMARY M/L TCP HA 40MM TAPER STRAIGHT EXTENDED OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 124MM 12.5MM M/L TCP HA 12/14 TAPER EXTEND OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 42MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE LARGE METAPHYSEAL BODY VERSYS TCP MIDCOAT FIBER METAL POLYSULFONE 45MM STANDARD OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 11MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP HA POROUS 36MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS FM MC CLRLSS HATCP 15X160 LM BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 41MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 42MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 50MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 18MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 53MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786202030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 20MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 48MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 28MM BIO-CLAD HIGH WALL PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM FULL HEMISPHERE RINGLOC SOLID HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM FULL HEMISPHERE RINGLOC SOLID HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM SOLID LINER POROUS RINGLOC 23 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM SOLID LINER POROUS RINGLOC 26 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 28MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM 25MM HIP SOLID APEX HOLE UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 007839|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FELT CV 6X6IN BARD THK1.85MM PTFE LO POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,179.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,179.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14-103670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 27MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 FULL HEMISPHERE 76MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP LIMIT HOLE FIN RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 0 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 3, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 1, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 129D 12 50.75MM 12/14 B HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCN353032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DARCO HEADED 3.5 X 30MM SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM AVENIR-MLLER PROTASUL 64 5 39.17MM OFFSET 55.4MM LATERAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM AVENIR MLLER PROTASUL-64WF HA 4 40.22MM OFFSET STANDARD 57.88MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 171MM AVENIR MULLER PROTASUL-64WF HA 8 49.66MM OFFSET 70.23MM LATERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771100410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107MM 4MM M/L TCP HA 35MM TAPER STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784100900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 9MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 33MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 45MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP HA MIDCOAT 39MM STRAIGHT STANDARD HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA BEADED MIDCOAT POROUS 42MM STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 12MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 39MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 14MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 47MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 45MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65802601300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 98MM PRIMARY REVISION CONSERVATIVE MAYO TCP HA POROUS 12/14 43MM LARGE STRAIGHT 33MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163491|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 32MM 10D BIO-CLAD PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM 28MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735601200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 0 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 32MM BIO-CLAD HIGH WALL PEG REAMER HIP ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP 3 DOME SPIKE APICAL HOLE TRI-SPIKE RINGLOC HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 28MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM SOLID LINER POROUS RINGLOC 22 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP LIMIT HOLE FIN RINGLOC+ 26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 27MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM SOLID LINER POROUS RINGLOC 27 UNIVERSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 42MM 20MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 40MM 20MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066201300|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE .035 MOVABLE CORE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 14-103650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP 2 HOLE WITHOUT RIM SCREWS RINGLOC 24 UNIVERSAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 FULL HEMISPHERE 66MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 FULL HEMISPHERE 70MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 FULL HEMISPHERE 72MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP LIMIT HOLE FIN RINGLOC+ 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP LIMIT HOLE FIN RINGLOC+ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735601204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-001|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LASER EXCIMER 12FR 50CM 8.3/.109/2.77|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00806555828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 61MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-159015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 15MM LATERALIZE SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 145MM 13MM INTEGRAL HIP COCR LATERALIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 165MM 17MM INTEGRAL HIP COCR LATERALIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 135MM 11MM INTEGRAL HIP COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-164254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANMORE COCR 4 STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 10MM SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM CEMENTED SIRIUS 125D 38MM 20MM D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM CEMENTED SIRIUS 125D 44MM 24MM D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-012|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LASER EXCIMER 14FR 50CM 10.2/.134/3.4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 103200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 7.5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 157MM 18.5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 19MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 8MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 124MM 9MM NONCOLLAR BI-METRIC CDH POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500-013|SUP|HCPCS C2629||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH LASER EXCIMER 16FR 50CM 12.5/.164/4.17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 166322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 18MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-062|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEV LD LCK 65CM .015-.023IN LLD PLTN IR LOPRFL RADOPQ 19LB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 192513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 148MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 14 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 16 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 146MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 13 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 15 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 12 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM TYPE 1 COMPLETE PRESS FIT REDUCE TAPERLOC PPS 133D 12 HIGH OFFSET TAPER DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 16 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 156MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 18 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-039|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT LD LCK .012IN .015-.026IN VASC 1 PC STYLETE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00784301426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 14MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN EXTEND OFFSET STANDARD BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN EXTEND OFFSET STANDARD BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN EXTEND OFFSET LARGE METAPHYSEAL BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 17MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY VERSYS ZIMALOY BEADED FULLCOAT POROUS 6IN STRAIGHT EXTRA EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 22MM PRIMARY ALIGNMENT GUIDE VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 6IN STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 140D 2 31.5MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 4 32.5MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B7217|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|URETERAL ACCESS SHEATH FORTE 10FR X 12F-16F X 35CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 0100551111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 11 37MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 140D 13 38.5MM 12/14 A HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 137D 4 38.5MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLAST UNCEMENTED FITMORE PROTASUL-64 TITANIUM VACUUM PLASMA SPRAY 137D 6 39.62MM 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 1 51MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100551403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL ROUGH BLASTING FITMORE PROTASUL-64 PLASMA SPRAY 127D 3 52MM 12/14 C HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM AVENIR-MULLER PROTASUL-64WF HA 9 44.54MM OFFSET STANDARD 62.99MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM LATERALIZED AVENIR-MULLER PROTASUL-64WF HA 4 46.22MM OFFSET 65.37MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784801301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK P1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 53MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-018|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT LD LCK 140CM .012IN .013-.016IN VASC STYLETE 65CM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00806555628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 59MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 105611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM PRIMARY MALLORY-HEAD INTERLOK COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-164243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANMORE COCR 3 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM LATERALIZE ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM 9MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 12.5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 10MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 12.5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM 13.5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-019|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT LD LCK .015IN .017-.026IN VASC STYLETE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-104109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 14MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17.5MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17.5MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 518-020|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT LD LCK .015IN .027-.032IN VASC STYLETE STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 166330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 170097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 19MM BALANCE POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 170098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM BALANCE POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 14MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM TYPE 1 FULL PROFILE TAPERLOC PPS 133D 7 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 10 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 154MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 17 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784801400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784801401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK X1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800554632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 49MM 32MM STANDARD ZCA PRIMARY CEMENT HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800555432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 32MM STANDARD ZCA PRIMARY CEMENT HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806554828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 53MM 32MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806564628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 49MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-164242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANMORE COCR 2 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 11MM SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM CEMENTED SIRIUS 125D 34MM 18MM C HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM CEMENTED SIRIUS 125D 50MM 27MM F HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM 11MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17.5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 13MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 16MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 7MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 6 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 156MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 18 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B7297|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH ACCESS URETERAL FORTE 10FR X 12F-16F X 45CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 51-101060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 6 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 11 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-102050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 5 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM PRESS FIT REDUCE TAPERLOC PPS 133D 9 STANDARD OFFSET TAPER 34.3MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 15 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 164MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 22 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744102165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 16.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744201135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 13.5 X 15.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744202120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 12.0 X 13.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM 16.25MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771302000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 139MM 20MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16.25MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784801200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL KINECTIV E STRAIGHT HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784802400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784804401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK DD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 135MM 11MM INTEGRAL HIP COCR LATERALIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 165MM 17MM INTEGRAL HIP COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 15MM SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM CEMENTED SIRIUS 125D 32MM 16MM B HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM 6MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM 11MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 16MM ORTHOSIS TAPERLOC POROUS LARGE RIGHT ANKLE FOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM 9MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 22.5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 8MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM 13.5MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 12.5MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 22.5MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 8MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 13MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B7017|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORTE URETERAL ACCESS SHEATH HD 12FR 14F-18F X 35CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 51-100040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 128MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 4 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 146MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 13 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 TAPERLOC PPS 133D 24 STANDARD OFFSET FULL PROFILE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 FULL PROFILE TAPERLOC PPS 133D 20 HIGH OFFSET HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 FULL PROFILE TAPERLOC PPS 133D 22 HIGH OFFSET HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-102070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 7 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 11 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 154MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 17 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 9 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 167MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 24 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B7097|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORTE URETERAL ACCESS SHEATH HD 12FR 14F-18-F X 45CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 51-105170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 154MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 17 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 78MM 28MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 24MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 66MM 27MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 70MM 27MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM 28MM UNIVERSAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 21MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 48MM 22MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 74MM 28MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 FULL HEMISPHERE 74MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 FULL HEMISPHERE 78MM HIP SOLID APEX HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 2, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 0, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744001180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 18.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S6-2422U|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYMBLEPHARON RING MEDIUM 22MM (CONFORMER)|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744101105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 10.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 12.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 17.5MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771301500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M/L TAPER KINECTIV HA STEM SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784800300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784801101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK AA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 32MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-159011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 11MM LATERALIZE SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-164251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANMORE COCR 1 STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM LATERALIZE ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175426P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMASHIELD WOVEN DBL VELOUR 26CM. X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,694.28|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,694.28|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S6-2425U|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYMBLEPHARON RING LARGE 25MM (CONFORMER)|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM CEMENTED SIRIUS 125D 38MM 20MM C HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 10MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735901400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 0, OFFSET LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744001165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 16.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744102135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 13.5 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771302000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 139MM 20MM M/L KINECTIV TCP HA 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806564428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 47MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 125MM 9MM INTEGRAL HIP COCR LATERALIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S6-2420U|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYMBLEPHARON RING SMALL 20MM (CONFORMER)|1|HUMANA [1294]||HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 155MM 15MM INTEGRAL HIP COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-164241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANMORE COCR 1 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 13MM SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17MM SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM LATERALIZE ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL SIRIUS 30A HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM CEMENTED SIRIUS 125D 34MM 18MM B HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM 13.5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17.5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 5MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735602102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARLESS SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744001105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 10.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744001135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 13.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744002120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA STD BODY DISTALLY TEXTURED SIZE 12.0 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744101150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 15.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744102120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 12.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771300700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 114MM 7.5MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM 11MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 6MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784803101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK P2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800564428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 47MM 28MM 10D STANDARD ZCA PRIMARY CEMENT INCLINED FACE HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800565232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 32MM 10D STANDARD ZCA PRIMARY CEMENT INCLINED FACE HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 59MM 32MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-159017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 17MM LATERALIZE SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 125MM 9MM INTEGRAL HIP COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 145MM 13MM INTEGRAL HIP COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 148MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 14 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 16 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 156MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 18 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM NONCOLLAR PRIMARY PRESS FIT BI-METRIC TITANIUM PLASMA SPRAY POROUS 130D LATERALIZE OFFSET HIP SERIES X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY BI-METRIC TITANIUM PLASMA SPRAY POROUS STANDARD OFFSET HIP SERIES X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 7MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 8MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 11MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 12MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436532055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON SULENE HOD LINER SZ 32X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 7.1MM 44MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0106010106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 159MM LATERALIZED AVENIR-MULLER PROTASUL-64WF HA 6 47.65MM OFFSET 67.39MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 121MM 11MM PRIMARY M/L TIVANIUM TCP HA 49MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771101720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM 17.5MM PRIMARY M/L TIVANIUM TCP HA 53MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65771102220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM 22.5MM PRIMARY M/L TIVANIUM TCP HA 55MM TAPER STRAIGHT EXTEND OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM COLLAR EXTEND NECK VERSYS FIBER METAL HA TCP MIDCOAT STANDARD BODY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 14MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 42MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY ALIGNMENT GUIDE VERSYS FIBER METAL TCP POLYSULFONE HA MIDCOAT POROUS 45MM STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784501700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VERSYS FM MC CLRLSS HATCP 17X160 STD BODY STD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 36MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM PRIMARY VERSYS FIBER METAL TCP BEAD HA 39MM TAPER STRAIGHT STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 45MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 16MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 50MM TAPER STRAIGHT EXTENDED OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 50MM TAPER STRAIGHT EXTENDED OFFSET STANDARD BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 18MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 48MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 18MM PRIMARY VERSYS FIBER METAL TCP BEADED HA POROUS 48MM TAPER STRAIGHT STANDARD OFFSET LARGE METAPHYSEAL BODY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65786201900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 19MM PRIMARY VERSYS FIBER METAL TCP HA POROUS 48MM TAPER STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 50MM RINGLOC 23 HIP SOLID FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM FULL HEMISPHERE RINGLOC SOLID HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 16 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 20 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM PRIMARY BI-METRIC TITANIUM PLASMA SPRAY POROUS STANDARD OFFSET HIP SERIES X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MALLORY HEAD FEM HAP 8X145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 20MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 22.5MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 20 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 10 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 12 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00202175428P0|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMASHIELD WOVEN DBL VELOUR 28CM. X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,112.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported X11-180318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM NONCOLLAR PRIMARY PRESS FIT BI-METRIC TITANIUM PLASMA SPRAY POROUS 130D LATERALIZE OFFSET HIP SERIES X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 97.5MM 6MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 18.5MM TAPERLOC MICROPLASTY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 7.5MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 18.5MM TAPERLOC MICROPLASTY LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 14MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNCF2025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROFLEX 2.0 DIAMETER 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|4,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MALLORY-HEAD FEM HAP 6X135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MALLORY-HEAD FEM HAP 16X180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 112.5MM 13.5MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM 10MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 25MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 13MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00672600500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HGP II NEUTRAL STD POLY LINER 26 ID, SIZE E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 7.3MM 48MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 10.4MM 58MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 12.3MM 62MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 16.4MM 70MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 10MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 13MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 22.5MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 147MM 13.5MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 170096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 19MM BALANCE POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 170099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM BALANCE POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHO POR FMRL RED LAT NC 7X115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 9 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 136MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 7 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 9 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 16 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 156MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 18 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNCF2525|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROFLEX 2.5MM DIAMETER 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|4,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM PRIMARY BI-METRIC TITANIUM PLASMA SPRAY POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNCF3025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROFLEX 3.0MM DIAMETER 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|4,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM PRIMARY COLLARLESS BI-METRIC POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 20MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 7MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 10MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 12.5MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNCF4025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROFLEX 4.0MM DIAMETER 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|4,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 16MM PRIMARY REDUCE TAPERLOC POROUS STANDARD OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 7MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 8MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 10MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNCF5025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROFLEX 5.0MM DIAMETER 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|3,721.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,721.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNCF6025|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEUROFLEX 6.0MM DIAMETER 2.5MM LONG|1|HUMANA [1294]||HUMANA [11839]|3,721.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,721.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM TYPE 1 COMPLETE FULL PROFILE TAPERLOC PPS 133D 5 STANDARD OFFSET TAPER 34.3MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 7 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 10 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 12 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 FULL PROFILE TAPERLOC PPS 133D 22 STANDARD OFFSET HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 5 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-102040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 128MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 4 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-102060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 6 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-102080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 136MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 8 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM PRESS FIT REDUCE TAPERLOC PPS 133D 10 STANDARD OFFSET TAPER 34.3MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 148MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 14 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-164252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL STANMORE COCR 2 STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 9MM SMOOTH RX90 COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM ANSWER COCR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LARGE CHRISTENSEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM CEMENTED SIRIUS 125D 38MM 20MM E HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 22.5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 157MM 18.5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 132MM 6MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 16MM PRIMARY TAPERLOC TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 6MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 18MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM MALLORY-HEAD POROUS 131.5D LATERALIZE OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM 11MM NONCOLLAR BI-METRIC CDH POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 8.2MM 46MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 10.1MM 50/52/54MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 11.3MM 56MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 16.2MM 66MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 17.2MM 68MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 16.3MM 72MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 20.4MM 78MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 6.1MM 42MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 7.1MM 44MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 13.4MM 64MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 14.4MM 66MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 17.4MM 74MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 15.4MM 74MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631008032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 18.3MM 80MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 6.1MM 42MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 11.4MM 60MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 15.4MM 68MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632008026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 21.3MM 80MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632008032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 18.3MM 80MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 106260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL/LINER ACETABULAR 60MM RINGLOC 25 HIP SOLID FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 24MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 26MM MALLORY-HEAD RINGLOC SOLID APEX HOLE 4 FIN WITHOUT RIM SCREW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 23MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-106060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 25MM RANAWAT/BURSTEIN RINGLOC LIMIT HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP SOLID RINGLOC UNIVERSAL 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-103558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP SOLID RINGLOC UNIVERSAL 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM 22MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 23MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-104072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM MALLORY-HEAD RADIAL SOLID APEX HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 64MM 26MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 68MM 27MM VISION RINGLOC HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 25MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 72MM 28MM UNIVERSAL 2 HOLE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-104048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP SOLID APEX HOLE RINGLOC FULL HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP LIMIT HOLE FIN RINGLOC+ 24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-104170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP LIMIT HOLE FIN RINGLOC+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735902403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-HIP POROUS HA COLLARED SZ 3, OFFSET RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 12.5MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 17.5MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725505432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 54MM 32MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725506032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM 32MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436532061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON SULENE HOD LINER SZ 32X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 6.1MM 40MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 13.2MM 60MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 20.2MM 74MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0600560|SUP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HICKMAN 9.6FR SINGLE-LUMEN WITH INTRODUCER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00630507628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 18.3MM 76MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 11.3MM 56MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 10.3MM 58MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 19.2MM 72MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 17.3MM 72MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 16.3MM 76MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 19.4MM 78MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632003822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 5.3MM 38MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D ELEVATED 7.3MM 48MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 10.1MM 50/52/54MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 16.2MM 66MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 14.4MM 66MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 21.2MM 76MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 19.3MM 76MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 16.3MM 76MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 7.3MM 48MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 5.3MM 48MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 9.3MM 62MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 12.4MM 68MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875100728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR GG NEUTRAL 46MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR JJ NEUTRAL 54MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RR NEUTRAL 70MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D CC ELEVATED 40MM 22MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D DD ELEVATED 42MM 22MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D NN ELEVATED 62MM 32MM LONGEVITY HIP ELEVATED HIGHLY CROSSLINKED CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D UU ELEVATED 76MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D VV ELEVATED 78/80MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM GG OFFSET 48MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET KK 56MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET LL 58MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET LL 58MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET PP 66MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744101180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 18.0 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744102150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 15.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744102180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA LG BODY DISTALLY TEXTURED SIZE 18.0 - RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744201120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 12.0 X 13.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 744201150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APR HA OVERSIZE DIST TEXT SIZE 15.0 X 16.5 - LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771300500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 109MM 5MM ZIMMER M/L KINECTIV 134D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 124MM 12.5MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 129MM 15MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771301700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 134MM 17.5MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00771302200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM 22.5MM ZIMMER M/L KINECTIV 132D TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11.25MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100296125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12.5MM CLS BREVIUS KINECTIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784800200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784802001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK K2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784804101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KINECTIV MODULAR NECK X2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800554428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 47MM 28MM STANDARD ZCA PRIMARY CEMENT HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 15MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725506232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 62MM 32MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 6.1MM 42MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 6.4MM 56MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 11.4MM 60MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 18.2MM 70MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 18.4MM 74MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 21.2MM 76MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 19.3MM 76MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 17.4MM 78MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631003622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 4.2MM 36MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 8.2MM 46MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 8.2MM 50/52/54MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 13.2MM 60MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 12.4MM 62MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 18.2MM 70MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 20.3MM 74MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 19.3MM 76MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 18.3MM 76MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 17.4MM 78MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631008026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 21.3MM 80MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632003622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 4.2MM 36MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D ELEVATED 12.2MM 58MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 15.2MM 64MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 16.4MM 70MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 18.4MM 74MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 20.4MM 78MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 8.2MM 46MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 6.4MM 56MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 13.2MM 60MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR CUP 7MM OFFSET LINER LONGEVITY 60X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 11.4MM 66MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR LL NEUTRAL 58MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D FF ELEVATED 46MM 22MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D GG ELEVATED 48MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D LL ELEVATED 58MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D MM ELEVATED 60MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D OO ELEVATED 64MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 7.3MM 48MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 16.3MM 72MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 6.1MM 40MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 6.3MM 44MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 8.2MM 46MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 8.3MM 50/52/54MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 11.3MM 56MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 13.4MM 64MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 14.3MM 72MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 17.4MM 78MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 7.1MM 44MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 10.3MM 58MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 10.3MM 64MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634107032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 13.3MM 70MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875100828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR GG NEUTRAL 48MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR JJ NEUTRAL 54MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR KK NEUTRAL 56MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR QU NEUTRAL 68MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TT NEUTRAL 74MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D HH ELEVATED 50MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D KK ELEVATED 56MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP ELEVATED 66MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D SS ELEVATED 72MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET FF 46MM 28MM LONGEVITY HIP LIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET KK 56MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM TT OFFSET 74MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D LL OBLIQUE 58MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D OO OBLIQUE 64MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D VV OBLIQUE 78/80MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 58MM 32MM LL STANDARD HIP PRIMARY ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437622041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 22X41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 17.8MM 76MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR OO NEUTRAL 64MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR SS NEUTRAL 72MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MALLORY HEAD FEM HAP 7X140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 17.5MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 25MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102.5MM 9MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 112.5MM 13.5MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 15MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 22.5MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 14MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 15MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725505632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 56MM 32MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725505832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 58MM 32MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630503622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 4.2MM 36MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630503822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 5.3MM 38MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 15.4MM 68MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 14.3MM 72MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 17.3MM 74MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 16.3MM 76MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 6.3MM 44MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 167MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 24 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 10 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 148MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 14 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 164MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 22 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 137MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 9 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM 5MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 7.5MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 105MM 10MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM 12.5MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 15MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 10MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 9.1MM 48MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 14.2MM 62MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 10MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 11MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 18MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 9MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 16MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 136MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 8 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 11 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 154MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 17 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 FULL PROFILE TAPERLOC PPS 133D 20 STANDARD OFFSET HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 148MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 14 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-103130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 146MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 13 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 11 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 146MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 13 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 15 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 5.3MM 42MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 8.2MM 50/52/54MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 11.2MM 56MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634107026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 16.3MM 70MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR OO NEUTRAL 64MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR PP NEUTRAL 66MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D II ELEVATED 52MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D JJ ELEVATED 54MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET GG 48MM 28MM LONGEVITY HIP LIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET MM 60MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875500728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D FF OBLIQUE 46MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D RR OBLIQUE 70MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 32MM 54 JJ STANDARD HIP PRIMARY ALPHA DURASUL STERILE ALLOFIT ALLOFIT-S ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 56MM 32MM KK HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 60MM 32MM MM HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET RR 70MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D II OBLIQUE 52MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D II OBLIQUE 52MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 66MM 32MM PP STANDARD HIP PRIMARY ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 59MM 32MM STANDARD HIP PRIMARY DURASUL EPSILON NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 53MM 28MM HIP PRIMARY HOOD DURASUL EPSILON NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 18.9MM 78MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 16.9MM 78MM 40MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TT NEUTRAL 74MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR UU NEUTRAL 76MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VV NEUTRAL 78/80MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR II ELEVATED 52MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM VV OFFSET 78/80MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR OO OBLIQUE 64MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D TT OBLIQUE 74MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800555232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 32MM STANDARD ZCA PRIMARY CEMENT HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00800555832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 61MM 32MM STANDARD ZCA PRIMARY CEMENT HIP STERILE ALL POLY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806554628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 49MM 28MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806554832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 32MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 32MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806555832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 61MM 32MM NEUTRAL ZCA SPACER HIP LONGEVITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 155MM 15MM INTEGRAL HIP COCR LATERALIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 110MM CEMENTED SIRIUS 125D 44MM 24MM E HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM CEMENTED SIRIUS 125D 44MM 22MM F HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM CEMENTED SIRIUS 125D 50MM 27MM G HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 7.5MM PRIMARY TAPERLOC TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 14MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM CEMENTED MALLORY-HEAD POROUS 136.5D STANDARD OFFSET HIP STERILE PRIMARY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM LATERALIZE INTEGRAL POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-103212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 25MM REDUCE TAPERLOC TITANIUM POROUS LATERALIZE OFFSET DISTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 114MM 7MM NONCOLLAR BI-METRIC CDH POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM COLLARLESS BI-METRIC POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY DUCKBILL COLLAR SHARP DISTAL FLUTE CORONAL SLOT PROGRESSIVE TITANIUM POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM 3 POINT FIXATION PRESS FIT BALANCE POROUS BIPLANAR TAPER HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET EE 44MM 28MM LONGEVITY HIP LIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET II 52MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET II 52MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET NN 62MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM VV OFFSET 78/80MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875500832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D GG OBLIQUE 48MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 62MM 32MM NN STANDARD HIP PRIMARY ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 47MM 28MM HIP PRIMARY HOOD DURASUL EPSILON NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM NONCOLLAR FULL PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 7MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 135D STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM NONCOLLAR REDUCE PROXIMAL PROFILE PRESS FIT ECHO BI-METRIC TITANIUM POROUS 130D LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-100150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 15 STANDARD OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 144MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 12 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 156MM TYPE 1 PRESS FIT FULL PROFILE TAPERLOC PPS 133D 18 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-101240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL TYPE 1 FULL PROFILE TAPERLOC PPS 133D 24 HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 142MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 11 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY NONCOLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 130D LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM NONCOLLAR PRIMARY PRESS FIT BI-METRIC TITANIUM PLASMA SPRAY POROUS 130D LATERALIZE OFFSET HIP SERIES X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR JJ ELEVATED 54MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D RR ELEVATED 70MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET QU 68MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E JJ 54MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E QU NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E UU NEUTRAL 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E LL ELEVATED 58MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E PP ELEVATED 66MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E JJ 54MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E PP 66MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E QU 68MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E VV 78/80MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E JJ ELEVATED 54MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E RR ELEVATED 70MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E SS ELEVATED 72MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 32MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D +7MM MEDIUM+ 22MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D 14MM LONG 26MM HIP ZIMALOY COCR LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6 DEGREE COCR FEM HEAD 36MM +10.5 (M+)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 9.4MM 56MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 12.2MM 58MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 22.2MM 78MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 20.4MM 78MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 10.4MM 58MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 17.2MM 68MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 15.4MM 74MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 18.3MM 76MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 22.2MM 78MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 9.1MM 48MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 10.1MM 50/52/54MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 11.4MM 60MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 14.2MM 62MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 12.3MM 62MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 15.4MM 68MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR II NEUTRAL 52MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR LL NEUTRAL 58MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR SS NEUTRAL 72MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VV NEUTRAL 78/80MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D EE ELEVATED 44MM 22MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 15.2MM 64MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 19.2MM 72MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 15.4MM 74MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630508026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 21.3MM 80MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 15.4MM 68MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 16.4MM 70MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631008022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 23.2MM 80MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 7.1MM 44MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 6.3MM 46MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 12.4MM 62MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 17.3MM 72MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 20.3MM 74MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 17.4MM 74MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 13.3MM 64MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 16.2MM 66MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 17.2MM 68MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875100628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NEUTRAL EE 44MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875100928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HH NEUTRAL 50MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM NEUTRAL 60MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NN NEUTRAL 62MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-104170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 154MM TYPE 1 PRESS FIT REDUCE TAPERLOC PPS 133D 17 HIGH OFFSET TAPER HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 146MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 13 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-105150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM PRESS FIT FULL PROFILE TAPERLOC XR SERIES POROUS 123D 15 HIP COMPLETE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP152770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 5MM OFFSET TAPERLOC POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-170319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 19MM PRIMARY PROFILE INTEGRAL X SERIES PPS LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X11-180321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM PRIMARY COLLARLESS LATERALIZED X SERIES BI-METRIC POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X12-171320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 20MM PRIMARY REDUCE PROXIMAL PROFILE INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X170317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM PRIMARY INTEGRAL X SERIES PPS STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM PRIMARY NONCOLLAR BI-METRIC X SERIES INTERLOK TITANIUM POROUS 135D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 102.5MM 9MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107.5MM 11MM TAPERLOC MICROPLASTY TITANIUM POROUS STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 97.5MM 6MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 8MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 9MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 10MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 11MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 6.3MM 46MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 10.1MM 50/52/54MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 16.9MM 74MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 18.9MM 78MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR JJ NEUTRAL 54MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR PP NEUTRAL 66MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR QU NEUTRAL 68MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D OO ELEVATED 64MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D VV ELEVATED 78/80MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET MM 60MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET PP 66MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR LL OBLIQUE 58MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D VV OBLIQUE 78/80MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885100828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E GG NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E II NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E OO 64MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E II ELEVATED 52MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E JJ ELEVATED 54MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 KK ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E TT ELEVATED 74MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E VV ELEVATED 78/80MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E KK NEUTRAL 56MM 36MM POLYETHYLENE VITAMIN E HIP HIGH CROSSLINK CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR OO NEUTRAL 64MM 36MM VIVACIT-E HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E SS 72MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM ELEVATED 60MM 36MM VIVACIT-E HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E OO ELEVATED 64MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E VV ELEVATED 78/80MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10.5MM 12/14 32MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3.5MM 12/14 36MM METASUL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 36MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012387|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D +4MM 12/14 LARGE 38MM HIP PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720505028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +5MM 28MM COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720510028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10MM 28MM COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721022350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12/14 COCR FEMORAL HEAD 22MM +3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721026000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 MEDIUM 26MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 734028000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 0MM 12/14 MEDIUM 28MM HIP PROTASUL-21WF METASUL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 734028400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +4MM 12/14 LARGE 28MM HIP PROTASUL-21WF METASUL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 35MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 50MM TRILOGY TIVANIUM HIP SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 40MM HGP II TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 60MM HGP II ACETABULAR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 25MM TITANIUM FULL THREAD CANCELLOUS CUP COUNTERSUNK HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCL BONE SCW TI 6.5MMX70MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 58MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785002550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 15MM VERSYS ADVOCATE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 14.4MM 66MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 17.3MM 72MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630508022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 23.2MM 80MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630508028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 20.3MM 80MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630508032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 18.3MM 80MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 5.3MM 42MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 16.2MM 66MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 17.2MM 68MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 21.2MM 76MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 5.3MM 42MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632004822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 9.1MM 48MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 13.2MM 60MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 14.2MM 62MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D ELEVATED 16.3MM 72MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632008028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 20.3MM 80MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 6.1MM 40MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 6.1MM 42MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 6.3MM 50/52/54MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 9.3MM 56MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E MM 60MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E RR 70MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E SS NEUTRAL 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E VV NEUTRAL 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885200728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E FF ELEVATED 46MM 28MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885200828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 GG ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 OO ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E OO ELEVATED 64MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E PP 66MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E QU 68MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E RR 70MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E UU 76MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 0MM 12/14 TAPER 26MM HIP ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877002803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5D 12/14 28MM HIP METASUL TRILOGY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D 3.5MM SMALL+ 26MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D 7MM MEDIUM 26MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D -4MM 12/14 SMALL 38MM HIP PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721028400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +4MM 12/14 LARGE 28MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877004005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10.5MM 12/14 40MM METASUL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 14.9MM 74MM 40MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D STANDARD 72MM 36MM LONGEVITY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR PP NEUTRAL 66MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RR NEUTRAL 70MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM ELEVATED 60MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D TT ELEVATE 74MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY II OBLIQUE 52MM 36MM LONGEVITY HIP ALLOFIT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP OBLIQUE 66MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D SS OBLIQUE 72MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437644065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 44X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885100628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E EE 44MM 28MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E KK 56MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E MM NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885200932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E HH ELEVATED 50MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E MM ELEVATED 60MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NN NEUTRAL 62MM 36MM VIVACIT-E HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E TT 74MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E VV 78/80MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 TAPER 26MM HIP ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X180318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 18MM PRIMARY BI-METRIC TITANIUM PLASMA SPRAY POROUS HIP SERIES X|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 8MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 10MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 12MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X181321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 185MM 21MM PRIMARY COLLAR PRESS FIT BI-METRIC X SERIES INTERLOK TITANIUM POROUS 140D STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM TAPERLOC MICROPLASTY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 95MM 5MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 107.5MM 11MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 125MM 20MM TAPERLOC MICROPLASTY TITANIUM POROUS LATERALIZE OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-103215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM TAPERLOC MICROPLASTY LATERALIZE OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 7MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 12MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 13MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00612005032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D ELEVATED 6.3MM 50/52/54MM 32MM UHMWPE HIP STERILE PRIMARY MODULAR CUP RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00672608400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HGP II ELEVATED RIM STD POLY LINER 26 ID, SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 5.3MM 42MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630504426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 6.3MM 44MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 9.3MM 56MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D 38 XL/+8 12/14 32MM HIP METASUL PROTASUL-21WF STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721028000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 MEDIUM 28MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721028004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -4MM 12/14 SMALL 28MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721032000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12/14 COCR FEMORAL HEAD 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D -8MM 12/14 XS 44MM HIP PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 25MM TRABECULAR METAL HGP II HIP ACETABULAR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 40MM PROTASUL-64WF FULL THREAD CANCELLOUS CUP COUNTERSUNK HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORT BONE SCW 4.5MMX22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 42MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 56MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM VERSYS HERITAGE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV DISTAL CENTRALIZER 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 18MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440422042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 42MM 22MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR ASSY COCR 26MM ID 43MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500107200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 72MM LEGACY VERSYS MULTIPOLAR HIP METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 53/54/55MM 22MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 57/58MM 32MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 60/62MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 68/70MM 28MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 46MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS +10MM 44MM OFFSET STRAIGHT HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 13.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10+ MM OFFSET BOW HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301881|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 22.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100101919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 19MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 18MM DISTAL FILL UNCEMENTED WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 16MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 18MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 20MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 61MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP PRIMARY TIVANIUM POROUS TRILOGY STANDARD SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630505822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 12.2MM 58MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 13.4MM 64MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 22.2MM 78MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 19.3MM 78MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631003822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 5.1MM 38MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 6.1MM 40MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 6.3MM 46MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631004822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 9.1MM 48MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631005022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 10.1MM 50/52/54MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 11.4MM 60MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 14.2MM 62MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATE RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 15.2MM 64MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATE 14.4MM 72MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D 18.4MM 74MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631008028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATED 20.3MM 80MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632005626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 9.4MM 56MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 18.2MM 70MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 19.2MM 72MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632007828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 19.4MM 78MM 28MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632008022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 20D 23.2MM 80MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP ELEVATED RIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 6.3MM 44MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634104626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 6.3MM 46MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 12.2MM 58MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634105832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 7.3MM 58MM 32MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 14.4MM 66MM 26MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR KK NEUTRAL 56MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NN NEUTRAL 62MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR GG ELEVATED 48MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D ELEVATED JJ 54MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR KK ELEVATE 56MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET NN 62MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET OO 64MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM SS OFFSET 72MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D KK OBLIQUE 56MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D MM OBLIQUE 60MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 60MM 32MM MM STANDARD HIP PRIMARY ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 64MM 32MM OO STANDARD HIP PRIMARY ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 54MM 32MM JJ HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 58MM 32MM LL HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 68MM 32MM QU HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D EE ELEVATED 46MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D LL ELEVATED 58MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D MM ELEVATED 60MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D NN ELEVATED 62MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D TT ELEVATED 74MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM CC OFFSET 40MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET HH 50MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM HH OFFSET 50MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET JJ 54MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET MM 60MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET QU 68MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET QU 68MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM UU OFFSET 76MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875500932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D HH OBLIQUE 50MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D JJ OBLIQUE 54MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 68MM 32MM QU STANDARD HIP PRIMARY ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 52MM 32MM II HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437622049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SZ 22/49MM STD INS DAS EPSILON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR QU NEUTRAL 68MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR UU NEUTRAL 76MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D EE ELEVATED 44MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875200932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D ELEVATED HH 50MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D OO ELEVATED 64MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP ELEVATED 66MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D QU ELEVATED 68MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D RR ELEVATED 70MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM DD OFFSET 42MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM EE OFFSET 44MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET JJ 54MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET OO 64MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875500828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D GG OBLIQUE 48MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875500928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D HH OBLIQUE 50MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D NN OBLIQUE 62MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP OBLIQUE 66MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D TT OBLIQUE 74MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D UU OBLIQUE 76MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 28MM QU HIP PRIMARY ALPHA RIM HOOD DURASUL STERILE ALLOFIT ALLOFIT-S ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 64MM 32MM OO HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 59MM 28MM STANDARD HIP PRIMARY DURASUL EPSILON NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 19MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735275003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 3 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735275005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 5 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440422039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 39MM 22MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 46MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 48MM 26MM CENTERPULSE LEGACY HIP ZIMALOY LINER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500107000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 70MM LEGACY MULTIPOLAR HIP METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 47/48/49MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 50/51/52MM 22MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 42MM LEGACY CENTERPULSE 12/14 HIP FEMORAL ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 44MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785703314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 13MM REVISION CEMENT VERSYS HERITAGE ZIMALOY 45MM LONG HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130X9.5MM REVISION CEMENT CPT ZIMALOY 12/14 2MM 36MM LONG 13MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200X11MM REVISION CEMENT CPT ZIMALOY 12/14 4MM 43MM LONG 16MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS +10IN 44MM OFFSET BOW HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301591|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 47MM BOW OFFSET HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301691|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 45MM BOW OFFSET HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 18MM REVISION DISTAL FILL VERSYS CARBON COBALT CHROME BEADED FULLCOAT PLUS POROUS 7.5IN STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 22.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 48MM BOW OFFSET HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100101914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 14MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100101917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 17MM DISTAL FILL UNCEMENTED WAGNER SL REVISION TI6AL7NB PROTASUL-100 135D 12/14 TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 21MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 25MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 19MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 22MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 75MM 7MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 77MM 9MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP PRIMARY TIVANIUM POROUS TRILOGY SMALL SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP PRIMARY TIVANIUM POROUS TRILOGY STANDARD SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP PRIMARY TIVANIUM POROUS TRILOGY STANDARD SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 57MM CONVERGE HIP POROUS PRIMARY CLUSTER HOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634106422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 15.2MM 64MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00634107022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 7MM OFFSET 18.2MM 70MM 22MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM NEUTRAL 60MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR OO NEUTRAL 64MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR PP NEUTRAL 66MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR II ELEVATED 52MM 32MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP ELEVATED 68MM 28MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875400732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM FF OFFSET 46MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET PP 66MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875500628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D EE OBLIQUE 44MM 28MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D QU OBLIQUE 68MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D SS OBLIQUE 72MM 32MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 32MM II 52 STANDARD HIP PRIMARY ALPHA DURASUL STERILE ALLOFIT ALLOFIT-S ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 32MM 56 KK STANDARD HIP PRIMARY ALPHA DURASUL STERILE ALLOFIT ALLOFIT-S ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 62MM 32MM NN HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100013516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 66MM 32MM PP HIP PRIMARY HOOD ALPHA DURASUL ALLOFIT ALLOFIT-S STERILE ALLOCLASSIC CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D +8MM 12/14 XL 44MM HIP NECK COCR LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662404535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 35MM HGP II HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCL BONE SCW TI 6.5MMX55MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 32MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 34MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 44MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 46MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 13MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 11MM VERSYS HERITAGE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 14MM VERSYS HERITAGE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785802357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 13MM VERSYS HERITAGE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785802657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM VERSYS HERITAGE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436000100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE CONVERGE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 53MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 56MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 59MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 44/45/46MM 22MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 60MM 22MM LEGACY HIP UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 64/66MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500107228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 72MM 28MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 45MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451010004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD ADAPTER -4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811401318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180X9.5MM REVISION CEMENT CPT ZIMALOY 12/14 2MM 36MM LONG VALGUS NECK 16MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 8IN STANDARD BODY OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 167MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20MM 57MM OFFSET STRAIGHT HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301982|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 20MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN STRAIGHT STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM 21MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 48MM STRAIGHT OFFSET HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 21MM REVISION DISTAL FILL VERSYS CARBON COBALT CHROME BEADED FULLCOAT PLUS POROUS 7.5IN STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100101920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 20MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 20MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 22MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 24MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 23MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 19MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 20MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806564828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 59MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877002801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3.5D 12/14 28MM HIP METASUL TRILOGY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877002804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D +7MM 12/14 28MM METASUL COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D +.5MM SMALL 22MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D +8MM 12/14 XL 38MM HIP PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720555028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -5MM 28MM HIP ZIMALOY COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721026350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 LARGE 26MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721032400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +4MM 12/14 LARGE 32MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877004004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +7MM 12/14 40MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877504002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 MEDIUM 40MM HIP ACETABULUM BIOLOX DELTA TRILOGY IT CONTINUUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 20MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 70MM CONTINUUM TRILOGY TRABECULAR METAL TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 35MM TRABECULAR METAL HGP II CANCELLOUS SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCL BONE SCW TI 6.5MMX50MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORT BONE SCW 4.5MMX26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 38MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 52MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 11MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 17MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785002350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 13MM VERSYS ADVOCATE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 12MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735275001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735275002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 2 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440422044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 44MM 22MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR ASSY COCR 26MM ID 50MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 55MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 60MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500103922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 39MM 22MM VERSYS LD/FX HIP POLY PRESS FIT CEMENTED ASSEMBLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 47/48/49MM 22MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 53/54/55MM 32MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 64/66MM 32MM LEGACY HIP UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 12/14 49MM HIP UNIPOLAR ENDOPROSTHETIC ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 48MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 49MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 56MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785703522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM REVISION CEMENT VERSYS HERITAGE ZIMALOY 45MM LONG HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230X11MM REVISION CEMENT CPT ZIMALOY 12/14 4MM 43MM LONG 16MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 10IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM REVISION DISTAL FILL STANDARD BODY VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 15MM REVISION DISTAL FILL VERSYS BEADED FULLCOAT PLUS COCR POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301571|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20MM 45MM BOW OFFSET HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620203822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 38MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620206821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP PRIMARY MODULAR SOLID TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875304801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP CLUSTER HOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT GG HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP CLUSTER HOLE SNAP FIT LOCK GROOVE TIVANIUM TRILOGY IT HH HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP UNIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM CC HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP CLUSTER HOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM FF HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631008036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 10D 80MM 36MM LONGEVITY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RR NEUTRAL 70MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR SS NEUTRAL 72MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR LL ELEVATED 58MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NN ELEVATED 62MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR SS ELEVATE 72MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET NN 62MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 61MM 38MM STANDARD HIP PRIMARY DURASUL EPSILON NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437644069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 44X69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885100728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E FF 46MM 28MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885200928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 HH ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 II ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E UU ELEVATED 76MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E II NEUTRAL 52MM 36MM POLYETHYLENE VITAMIN E HIP HIGH CROSSLINK CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 17.9MM 76MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 15.9MM 76MM 40MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630508036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 19.9MM 80MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR CONTINUUM TRILOGY IT OO NEUTRAL 64MM 40MM LONGEVITY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TT NEUTRAL 74MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR UU NEUTRAL 76MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875102336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VV NEUTRAL 78/80MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D QU ELEVATED 68MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875202236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D UU ELEVATED 76MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM UU OFFSET 76MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NN OBLIQUE 62MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D QU OBLIQUE 68MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875502236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D UU OBLIQUE 76MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437628065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 28X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437722049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SZ 22/49MM HOD INS DAS EPSILON/DURASUL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437732065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 32X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 15.9MM 72MM 36MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630508040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 0D STANDARD NEUTRAL 17.9MM 80MM 40MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631007436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 10D ELEVATE 16.9MM 74MM 36MM LONGEVITY HIP MODULAR CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM NEUTRAL 60MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR NN NEUTRAL 62MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET OO 64MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET RR 70MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM TT OFFSET 74MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR JJ OBLIQUE 54MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR KK OBLIQUE 56MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D RR OBLIQUE 70MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP PRIMARY MODULAR SOLID TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620206022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 60MM MODULAR CLUSTER HOLE HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP CLUSTER HOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT OO HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM FF HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP 12 SCALLOP CLUSTER HOLE SNAP FIT GROOVE INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM MM HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP 12 SCALLOP CLUSTER HOLE SNAP FIT GROOVE INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM OO HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875708001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP CLUSTER HOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT JJ HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT LL HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT PP HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437632061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 32X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437728065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL HOODED LINER SZ 28X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY STANDARD NEUTRAL 13.9MM 72MM 40MM LONGEVITY HIP STERILE PRIMARY MODULAR CUP LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR KK NEUTRAL 56MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM NEUTRAL 60MM 40MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875101836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR QU NEUTRAL 68MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875201736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D PP ELEVATED 66MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875401236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM OFFSET KK 56MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875402036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 45D 7MM SS OFFSET 72MM 36MM LONGEVITY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875501436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MM OBLIQUE 60MM 36MM LONGEVITY HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437638055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 38X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885100928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E HH NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E II 52MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E OO NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E PP NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 JJ ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E KK ELEVATED 56MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E QU ELEVATED 68MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E SS ELEVATED 72MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E LL 58MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E MM 60MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR LL ELEVATED 58MM 36MM VIVACIT-E HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E NN ELEVATED 62MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E UU ELEVATED 76MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +7MM 12/14 32MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 36MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +7MM 12/14 36MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D +0MM 12/14 MEDIUM 38MM HIP NEUTRAL NECK PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720500032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 32MM HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720505032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR HD +5MM NECK 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721022800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +8MM 12/14 XL 22MM HIP COCR PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721032800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +8MM 12/14 XL 32MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877004002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 40MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 15MM TRILOGY TIVANIUM HIP SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 30MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 40MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 50MM HGP II ACETABULAR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725005045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 45MM TRABECULAR METAL HIP ACETABULAR STERILE MONOBLOCK CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 15MM PROTASUL-64WF FULL THREAD CANCELLOUS CUP COUNTERSUNK HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 55MM CONVERGE HIP POROUS PRIMARY CLUSTER HOLE SEALED SCREW HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620003620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 36MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620003820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 38MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620008020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP CLUSTER HOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT II HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP CLUSTER HOLE SNAP FIT INTEGRATE LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT JJ HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP CLUSTER HOLE SNAP FIT INTEGRATE LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT QU HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM GG HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP UNIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM LL HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP CLUSTER HOLE SNAP FIT GROOVE INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM PP HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP CLUSTER HOLE SNAP FIT LOCK GROOVE TRABECULAR METAL TIVANIUM CONTINUUM SS HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 48MM STRAIGHT OFFSET HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301871|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20MM 48MM BOW OFFSET HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN STANDARD BODY OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 21MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 15MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 19MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 15MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 76MM 8MM REDUCE PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 78MM 10MM ECHO BI-METRIC MICROPLASTY STANDARD OFFSET FULL PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 53MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP UNIHOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875304802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT GG HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT NN HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM DD HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP MULTIHOLE SNAP FIT LOCK GROOVE TRABECULAR METAL TIVANIUM CONTINUUM QU HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725504422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM 22MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285254107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 52-54MM 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285254117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 52-54MM 28MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D B 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 44 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 24 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 23 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 10D 42 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM +3MM 21 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 22 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 47 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-156237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-185235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-185236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 44MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-107827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR +3MM 24 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-109928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-166236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-195238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 48MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 60MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000878|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D E 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E NN 62MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E OO 64MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E SS 72MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E TT 74MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D 0MM SMALL 36MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D 3.5MM SMALL+ 36MM HIP ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720510032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10MM 32MM HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721022000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 12/14 MEDIUM 22MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721026800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +8MM 12/14 XL 26MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721028800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +8MM 12/14 XL 28MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 734028004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -4MM 12/14 SMALL 28MM HIP PROTASUL-21WF METASUL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 60MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625006580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 80MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 60MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 12MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785002450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 14MM VERSYS ADVOCATE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785002650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM VERSYS ADVOCATE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 15MM VERSYS HERITAGE STANDARD HIP PROXIMAL SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 9MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 11MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 14MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735275004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437644061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 44X61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 437644063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPSILON DURASUL NEUTRAL LINER SZ 44X63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E LL 58MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E NN NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E QU 68MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E TT NEUTRAL 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885200628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E EE ELEVATED 44MM 28MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885200832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E GG ELEVATED 48MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 NN ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E NN ELEVATED 62MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 PP ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E RR 70MM 40MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3.5MM 12/14 TAPER 26MM HIP ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10.5MM 12/14 TAPER 26MM HIP ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877002802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D 0 38 12/14 TAPER 28MM COCR MOLYBDENUM METASUL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D +0MM SMALL 26MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D 10.5MM MEDIUM+ 26MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D -4MM 12/14 XS 38MM HIP PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721026035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12/14 COCR FEMORAL HEAD 26MM -3.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 721032004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -4MM 12/14 SMALL 32MM HIP PROTASUL-20 LEGACY NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E JJ NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E KK NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E LL NEUTRAL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E NN 62MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E PP 66MM 32MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 LL ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 MM ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E 2 QU ELEVATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E RR ELEVATED 70MM 32MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885101436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E MM 60MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885102236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E UU 76MM 36MM HIP NEUTRAL CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E II ELEVATED 52MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E KK ELEVATED 56MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885201836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E QU ELEVATED 68MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00885202136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VIVACIT-E TT ELEVATED 74MM 36MM HIP CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +7MM 12/14 26MM HIP ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3.5MM 12/14 32MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 32MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877003605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10.5MM 12/14 36MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 6D +3.5 MEDIUM 22MM HIP ZIMALOY LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D 38 S/-4 12/14 32MM HIP METASUL PROTASUL-21WF STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720500028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 28MM HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP MULTIHOLE SNAP FIT LOCK GROOVE TRABECULAR METAL TIVANIUM CONTINUUM UU HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875708002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP MULTIHOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725505028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 50MM 28MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286064117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 60-64MM 28MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 A NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D E 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000769|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D C 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000776|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 32MM ARCOMXL HIP COLOR CODED FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000779|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D E 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 28MM ARCOMXL HIP HIGH WALL COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 46 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105894|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105994|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 24 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCL BONE SCW TI 6.5MMX30MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORT BONE SCW 4.5MMX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 17MM VERSYS HERITAGE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 13MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0962|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT APOLLO 2 3202|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 10MM PRESSFIT VERSYS LD/FX ZIMALOY 36MM OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440422040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 40MM 22MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 45MM 26MM CENTERPULSE LEGACY HIP ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 47MM 26MM CENTERPULSE LEGACY HIP FEMUR ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 66MM LEGACY MULTIPOLAR HIP METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 68MM LEGACY MULTIPOLAR HIP METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 47/48/49MM 32MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 50/51/52MM 26MM LEGACY HIP UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 57/58MM 22MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785703718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM REVISION CEMENT VERSYS HERITAGE ZIMALOY 45MM LONG HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180X9.5MM REVISION CEMENT CPT ZIMALOY 12/14 3MM 42MM LONG 16MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP UNIHOLE TRABECULAR METAL TIVANIUM CONTINUUM UU HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875304402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT EE HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM GG HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP MULTIHOLE SNAP FIT TRABECULAR METAL TIVANIUM CONTINUUM MM HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 265254117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 52-54MM 26MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285658117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 56-58MM 28MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286670117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 66-70MM 28MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D B 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000771|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D E 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000796|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 A 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 42 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 48 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 10D 41 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRILOGY ACET SHELL 68MM OD MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65620004823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 48MM HIP PRIMARY TCP HA POROUS TRILOGY SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875304401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP CLUSTER HOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT EE HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM EE HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP CLUSTER HOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM EE HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP UNIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM HH HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM KK HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP UNIHOLE SNAP FIT LOCK GROOVE TRABECULAR METAL TIVANIUM CONTINUUM QU HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP CLUSTER HOLE TRABECULAR METAL TIVANIUM CONTINUUM SS HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT II HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM FF HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP MULTIHOLE TRABECULAR METAL TIVANIUM CONTINUUM TT HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000759|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D C 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000797|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105897|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 23 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 21 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 10D 44 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 47 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM +3MM 23 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 42 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 48 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-156235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-185238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000787|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 40MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000793|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 44MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-107926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 26 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR +3MM 26 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-166238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 38MM 28MM HIP STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-195234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000993|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 36MM 22.2MM ACTIVE ARTICULATION B ARCOMXL G7 2 MOBILITY SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 50MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000876|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D C 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000879|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000899|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000929|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 23 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105896|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 22 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J NEUTRAL 40MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000939|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 22 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 24 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EPOLY 36MM +5 RGLC LNR HW SZ23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM +5MM 21 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 21 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-156233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM +5MM 23 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 40MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 40MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 40MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 44MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 44 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-156238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-175232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 22 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 40MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 44MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 44MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-107927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 25 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-176235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-176238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-196237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 58MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000891|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 26 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 24 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +3MM 25 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 28 44MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-166238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 28 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-195236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-196235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000991|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 36MM 22.2MM ACTIVE ARTICULATION B E1 2 MOBILITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 58MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 28MM HIP STANDARD NECK MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM 32MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 38MM HIP MODULAR NO SKIRT COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 4MM OFFSET TAPER 28MM HIP MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 4MM OFFSET TAPER 32MM HIP STANDARD NECK MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163673|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM OFFSET 32MM HIP TYPE 1 SKIRT COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD TAPER 28MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD TAPER 32MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR C2A-TAPER LONG 32MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532800000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 28MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM OFFSET 40MM HIP ACETABULAR TYPE 1 SKIRT COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 40MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 24 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000871|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 44MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J NEUTRAL 44MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 40MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 44MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 27 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 27 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 28 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 26 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-166235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 25 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-176236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 26 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-176238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 28 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-131003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR M2A-RINGLOC 23 STANDARD 28MM HIGH CARBON HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-131022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28MM 22MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 15-105022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR M2A-TAPER 41MM 28MM HIGH CARBON HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 38MM HIP MODULAR COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 4MM OFFSET TAPER 28MM HIP STANDARD NECK MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -5MM 22.2MM HIP MODULAR TYPE 1 COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 12/14 40MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 28MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 36MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 38MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000998|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 25MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 9MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162659|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 15MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162781|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 9MM GENERATION 4 HIP PROXIMAL PMMA MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM STANMORE 1 HIP DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 -6MM OFFSET TAPER HIP TITANIUM TYPE 1 BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130617|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRAMEDULLARY PLUG XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9MM ECHO FX COCR LATERAL OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 17MM LATERALIZE ECHO FX COCR OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM FENESTRATE BIO-MOORE II INTERLOK TITANIUM STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 165011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM GENERATION 4 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 10MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 17MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 43MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 52MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD BIO-MOORE ENDO II STANDARD TAPER HIP FEMORAL STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162387|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 11MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 49MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 51MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 12/14 54MM HIP UNIPOLAR ENDOPROSTHETIC ZIMALOY VERSYS LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 39MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 54MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451010800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD LEGACY +8MM HIP FEMUR UNIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785703516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 160MM 15MM REVISION CEMENT VERSYS HERITAGE ZIMALOY 45MM LONG HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,841.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 8IN STANDARD BODY OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 10IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20 10IN BOW OFFSET HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10 10IN BOW OFFSET HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20 10IN BOW OFFSET HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,087.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,087.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 22.5MM REVISION DISTAL FILL VERSYS CARBON COBALT CHROME BEADED FULLCOAT PLUS POROUS 7.5IN STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 22.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 48MM BOW OFFSET HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100101915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 15MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM OFFSET 28MM HIP TYPE 1 SKIRT COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM TAPER 28MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM TAPER 32MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532610000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10MM 26MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533201000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -5MM 32MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533205000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +5MM 32MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 40MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 12/14 40MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S001140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 40MM HIP SOLID MODULAR COCR SELEX M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 38MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 38MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 38MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000997|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 20MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 12MM 1.5MM RX90 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 17MM 1.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 18MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 11MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 13MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 14MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 16MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 42-50MM +9MM HIP TAPERED METAL M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 +4MM OFFSET 12/14 HIP TITANIUM BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 135300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE 4D TAPER HIP ACETABULAR APICAL OPTIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16-116082|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE RINGLOC+ ACETABULUM SCREW LIMIT HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11MM ECHO FX COCR STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 17MM ECHO FX COCR STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13MM LATERALIZE ECHO FX COCR OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 14MM FENESTRATE BIO-MOORE II INTERLOK TITANIUM STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 165013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM GENERATION 4 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 52MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 55MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 61MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 59MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 61MM HIP ACETABULUM MODULAR COCRMO ENDO II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 9MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM REVISION STRAIGHT MALLORY-HEAD POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM REVISION MALLORY HEAD POROUS HIP STERILE LATEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM REVISION PRESS FIT RESECTION MALLORY-HEAD 45MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 17MM REVISION PRESS FIT RESECTION MALLORY 45MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877004001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3.5MM 12/14 40MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0101012445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 5D -4MM 12/14 SMALL 44MM HIP PROTASUL-20 LEGACY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877504004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +7MM 12/14 XL 40MM HIP ACETABULUM BIOLOX DELTA TRILOGY IT CONTINUUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 15MM HGP II TIVANIUM HIP ACETABULAR SELF TAP STERILE ACETABULAR CUP SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCL BONE SCW TI 6.5MMX60MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORT BONE SCW 4.5MMX30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 36MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 48MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 14MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785001550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 15MM VERSYS ADVOCATE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 12MM VERSYS HERITAGE HIP PROXIMAL SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785801357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 13MM VERSYS HERITAGE STANDARD HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785802457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 14MM VERSYS HERITAGE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785802557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 15MM VERSYS HERITAGE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 436200100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE CONVERGE HIP SCREW HOLE SEAL REVISION SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 52MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 57MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 58MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 42/43MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 60/62MM 32MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 720555032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -5MM 32MM HIP COCR ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00877004003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3.5MM 12/14 40MM HIP ACETABULUM METASUL TRILOGY IT CONTINUUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00625004525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 25MM TRILOGY TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662404520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 20MM HGP II TIVANIUM HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 20MM TRABECULAR METAL HGP II HIP ACETABULAR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00662406530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 30MM TRABECULAR METAL HGP II HIP ACETABULAR SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 20MM PROTASUL-64WF FULL THREAD CANCELLOUS CUP COUNTERSUNK HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCL BONE SCW TI 6.5MMX35MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430107045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 45MM PROTASUL-64WF FULL THREAD CANCELLOUS CUP COUNTERSUNK HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORT BONE SCW 4.5MMX24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORT BONE SCW 4.5MMX28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 40MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 50MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650007054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 54MM CANCELLOUS CORTICAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785002250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 12MM VERSYS ADVOCATE EXTENDED HIP PROXIMAL PMMA CEMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735130016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM UNIVERSAL HIP FEMUR DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 735275000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL PRIMARY CEMENT LOW DEMAND NATURAL-HIP COCR 0 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440422041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 41MM 22MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440422043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 43MM 22MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 42MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM STRAIGHT MALLORY-HEAD POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 15MM 1 PIECE HOLE MALLORY-HEAD TITANIUM POROUS STRAIGHT 34MM HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104929|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 13MM RIVISION PRESSFIT RESECTION LEVEL MALLORY-HEAD 45MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 15MM PRESS FIT RESECTION REVISION MALLORY-HEAD 55MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 9MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104977|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 19MM HOLE MALLORY-HEAD 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 14MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 19MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 24MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 19MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 9.5MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 22MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 15MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 16MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 23 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 44 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 46 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 46 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-156233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 23 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J NEUTRAL 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J NEUTRAL 44MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR +3MM 28 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-109927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-196235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 42MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 54MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000881|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 28MM E1 HIP COLOR CODED FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D B 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000897|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 8IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 8IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10 10IN BOW OFFSET HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN STANDARD BODY/OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 16.5MM REVISION DISTAL FILL VERSYS CARBON COBALT CHROME BEADED FULLCOAT PLUS POROUS 7.5IN STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20 10IN BOW OFFSET HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 167MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20MM 64MM STRAIGHT OFFSET HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,087.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,087.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301891|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 48MM BOW OFFSET HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100101918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 18MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 15MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 20MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 22MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 14MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 18MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 20MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 21MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 76MM 8MM REDUCE PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 40MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 44MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000949|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 44MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 28 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 27 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108627|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +3MM 27 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-166236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 26 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-195234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 40MM ACTIVE ARTICULATION E1 D UHMWPE ALPHA-TOCOPHEROL 2 MOBILITY 28MM MODULAR HEAD STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 54MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 28MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163687|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 32MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 38MM HIP SOLID MODULAR COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 38MM HIP SOLID MODULAR COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 32MM HIP MODULAR TITANIUM IRONGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 31-163220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRIAL HIP 28MM BIOMET -3 OFFSET FEMORAL HEAD NECK PROVISIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 4MM OFFSET TAPER 32MM HIP MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 26MM HIP MODULAR STANDARD NECK NO SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 28MM HIP MODULAR NO SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163667|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 32MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 32MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM TAPER 28MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL LARGE TAPER 22MM HIP MODULAR STANDARD NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532805000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +5MM 28MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 12/14 38MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 40MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S031140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 40MM HIP SOLID MODULAR COCR SELEX M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 32MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 36MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000996|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 15MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 50MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 60MM TITANIUM DOME HIP ACETABULAR CANCELLOUS LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 13MM 1.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 13MM 2.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 15MM 2.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM STANMORE 3 HIP DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 10- MM SIRIUS FEMORAL WINGLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 +3MM OFFSET TAPER HIP TITANIUM TYPE 1 BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123741|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE 3/8-24IN HIP APICAL CUP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 7MM ECHO FX COCR STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13MM ECHO FX COCR STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 14MM SOLID BIO-MOORE II INTERLOK TITANIUM STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 145MM 13MM POLISH INTRIGUE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 21MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 16MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 17MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 17MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP PRIMARY TIVANIUM POROUS TRILOGY STANDARD SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP PRIMARY TIVANIUM POROUS TRILOGY STANDARD SPIKE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 46MM MODULAR CLUSTER HOLE HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875304601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP CLUSTER HOLE SNAP FIT LOCK GROOVE TIVANIUM TRILOGY IT FF HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 58MM HIP CLUSTER HOLE SNAP FIT LOCK GROOVE TIVANIUM TRILOGY IT LL HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 76MM MODULAR MULTIHOLE REVISION HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620208020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP MULTIHOLE TRABECULAR METAL TIVANIUM CONTINUUM OO HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP MULTIHOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 265658117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 10D 56-58MM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104974|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104975|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104978|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 16MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 17MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 13MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 18MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 13MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 18MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 20MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 22MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 11MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 9.5MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 13MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 14MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 210X17MM 1 PIECE REVISION ARCOS TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM REACH POROUS STRAIGHT HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM REACH POROUS STRAIGHT HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 15MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162491|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 15MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162579|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 15MM BI-METRIC HIP LEFT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162591|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 13MM BI-METRIC HIP LEFT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 9MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 11MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 11MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 12MM REVISION COLLARLESS STRAIGHT BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 14MM COLLARLESS REVISE BI-METRIC POROUS HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 14MM COLLORLESS REVISION STRAIGHT BI-METRIC POROUS RIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 14MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 12MM COLLARLESS REVISE BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 14MM COLLARLESS RESVISED BI-METRIC RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 14MM COLLARLESS REVISION BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 10MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 13MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 68/70MM 26MM LEGACY HIP UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500106832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 68/70MM 32MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500107226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 72MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500107232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 72MM 32MM LEGACY HIP UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451010400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD LEGACY +4MM HIP FEMUR UNIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811401218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180X9.5MM REVISION CEMENT CPT ZIMALOY 12/14 2MM 36MM LONG VALGUS NECK 13MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 12MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 8IN STANDARD BODY OFFSET STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,087.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,087.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301981|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 21MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT PLUS POROUS 8IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784302211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 22.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 18MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 44MM 26MM CENTERPULSE LEGACY HIP ZIMALOY COMPLETE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440426054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD BIPOLAR 54MM 26MM LEGACY CENTERPULSE HIP ZIMALOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500103800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 38MM LEGACY MULTIPOLAR HIP METAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500103900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 39MM METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,284.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500103822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER BIPOLAR 38MM 22MM LEGACY HIP POLY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 40/41MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500104426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 44/45/46MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 50/51/52MM 32MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 53/54/55MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR VERSYS 57/58MM 26MM HIP CEMENTED PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 47MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451000055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 55MM LEGACY CENTERPULSE 12/14 HIP FEMUR ZIMALOY MODULAR ENDOPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451010000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIPOLAR FEMORAL HEAD ADAPTER +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00811400423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230X11MM REVISION CEMENT CPT ZIMALOY 12/14 4MM 43MM LONG 16MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,392.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 13.5MM PRIMARY REVISION ALIGNMENT GUIDE DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT PLUS POROUS 7.5IN LARGE METAPHYSEAL BODY STRAIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,509.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 45MM OFFSET STRAIGHT HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS 10IN BOW HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,601.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 177MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10MM 45MM STRAIGHT OFFSET HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 167MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20MM 58MM STRAIGHT OFFSET HIP CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301671|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 230MM 16.5MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +20MM 45MM BOW OFFSET HIP LEFT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 9.5MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 18MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175X20MM 1 PIECE REVISION ARCOS TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 15MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 22MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 210X17MM 1 PIECE REVISION ARCOS TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM REACH POROUS STRAIGHT HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 9MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 15MM BI-METRIC HIP LEFT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 11MM BI-METRIC HIP RIGHT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162590|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 13MM BI-METRIC HIP RIGHT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162593|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 9MM BI-METRIC HIP LEFT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 13MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 14MM COLLARLESS REVISION BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 9MM COLLARLESS REVIES BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 13MM COLLARLESS REVISION BI-METRIC POROUS RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162979|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 18MM COLLARLESS REVISION BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 12MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 14MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 12MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 19MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 60% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 16MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 14MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-154775|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 13MM SLOT MODULAR MALLORY-HEAD POROUS DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 22MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 14MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 23MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 22MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 25MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 28MM E1 HIP COLOR CODED HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 23 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 23 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-155232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM +5MM 22 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM 25 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 27 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +3MM 28 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 26 44MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-196236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 48MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163679|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 28MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 28MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM 28MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163689|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 32MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163691|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 32MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 36MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 36MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM OFFSET 36MM HIP TYPE 1 SKIRT COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 32MM HIP MODULAR TITANIUM IRONGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 4MM OFFSET TAPER 32MM HIP MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 26MM HIP MODULAR NO SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 26MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM 26MM HIP MODULAR SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 28MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 32MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163695|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD TAPER 26MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM TAPER 28MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM TAPER 32MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532205000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +5MM 22MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533215000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +15MM 32MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 12/14 STANDARD 38MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S331140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 40MM HIP SOLID MODULAR COCR SELEX M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 193008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 76MM 8MM FULL PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 57MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP PRIMARY SOLID TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 44MM MODULAR CLUSTER HOLE HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP CLUSTER HOLE SNAP FIT INTEGRATE LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT NN HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP CLUSTER HOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT PP HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM NN HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM OO HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 155MM 15MM POLISH INTRIGUE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 7MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 8MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR GREEN 45MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 51MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 56MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR RUST 58MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 45MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 50MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDO II TAPER INSERT +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 13MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM REVISION MALLORY-HEAD POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 9MM 1 PIECE HOLE MALLORY-HEAD TITANIUM POROUS STRAIGHT 34MM HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 9MM PRESS FIT REVISION RESECTION MALLORY-HEAD 45MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 11MM PRESS FIT REVISION RESECTION MALLORY-HEAD 55MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 285658107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 56-58MM 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000765|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 28MM ARCOMXL HIP COLOR CODED FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000773|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000775|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 43 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 45 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105896|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 22 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 45 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 45 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 47 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 22 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-156234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-156236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 44MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 44MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 44MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106985|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-107826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-107828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 28 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR +3MM 25 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-195236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 52MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000875|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D B 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000877|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D D 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 28MM E1 HIP COLOR CODED FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 21 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 21 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-115951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR +5MM 21 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 40MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 40MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-109925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 50MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 52MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 56MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 32MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 14MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 17MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 11MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 40% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 11MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 19MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 24MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 12MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 21MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 23MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 24MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 26MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 14MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 20MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 30MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 19MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 20MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 14MM DISTAL FILL UNCEMENTED WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 23MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 16MM BALANCE MICROPLASTY TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 18MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 19MM BALANCE MICROPLASTY TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806564632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 49MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806564832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 51MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620007820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP PRIMARY MULTIHOLE TIVANIUM POROUS TRILOGY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620203821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 38MM HIP PRIMARY MODULAR SOLID TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY POLYSULFONE BEADED FULLCOAT POROUS 8IN STANDARD BODY OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 18MM REVISION DISTAL FILL VERSYS ZIMALOY BEADED FULLCOAT POROUS +10 10IN BOW OFFSET HIP RIGHT CALCAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,439.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 16MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 17MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100102619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 265MM 19MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0100103017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 305MM 17MM DISTAL FILL WAGNER SL REVISION PROTASUL-100 POROUS 135D 12/14 HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,763.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 75MM 7MM REDUCE PROFILE ECHO BI-METRIC MICROPLASTY STANDARD OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 192907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 75MM 7MM REDUCE PROFILE ECHO BI-METRIC MICROPLASTY HIGH OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 53MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 55MM 28MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 59MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00806565832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 61MM 32MM 10D ELEVATED ZCA PRIMARY CEMENT INCLINED FACE SPACER HIP STERILE LONGEVITY PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536000069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE CLUSTER-HOLE W/ SEALED SCREW HOLES 69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 536100065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE W/ SEALED SCREW HOLES 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 12MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 24MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 21MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 28MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS A HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM B STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 12MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 11MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 EF 11MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 12MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 10MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 12MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 12MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S991140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 40MM HIP MODULAR TYPE 1 COCR SELEX M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000999|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 30MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 15MM TITANIUM DOME HIP ACETABULAR CANCELLOUS LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 25MM TITANIUM DOME HIP ACETABULAR CANCELLOUS LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 9MM 1.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 15MM 1.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 15MM GENERATION 4 HIP PROXIMAL PMMA MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 8MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 10MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 51-199300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM SIRIUS FEMORAL WING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000994|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE G7 ACETABULAR APICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 9MM LATERALIZE GENERATION 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 130MM 13MM LATERALIZE GENERATION 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR BLUE 41MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR BLUE 43MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 48MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 46MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 54MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 9MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 11MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 9MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 9MM PRESS FIT REVISION RESECTION MALLORY-HEAD 55MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 13MM REVISION PRESS FIT RESECTION MALLORY-HEAD POROUS 45MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 13MM PRESS FIT RESECTION REVISION MALLORY-HEAD 55MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 17MM PRESS FIT REVISION RESECTION MALLORY 55MM LEFT CALCAR HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 9MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104969|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 11MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 15MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 17MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 12MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 14MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 14MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 22MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 11MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP UNIHOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875708000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 80MM HIP UNIHOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM MODULAR CUP 72MM MULTI-HOLE REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT KK HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT MM HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 64MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT OO HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT QU HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP MULTIHOLE TRABECULAR METAL TIVANIUM CONTINUUM UU HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 28MM ARCOMXL HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D D 32MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000778|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D D 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 28MM ARCOMXL HIP HIGH WALL COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 15MM PRESS FIT REVISION RESECTION MALLORY-HEAD 45MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 9MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104959|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 9MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104984|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 21MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 12MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175X20MM 1 PIECE REVISION ARCOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 16MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 17MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 18MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 210X11MM 1 PIECE REVISION ARCOS TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 16MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162577|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 15MM BI-METRIC HIP LEFT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 13MM BI-METRIC HIP RIGHT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162595|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 11MM BI-METRIC HIP LEFT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 38MM HIP MODULAR NO SKIRT COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM 38MM HIP MODULAR SKIRT COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM OFFSET 36MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 32MM HIP MODULAR TITANIUM IRONGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 32MM HIP MODULAR TITANIUM IRONGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 32MM HIP MODULAR TITANIUM IRONGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 4MM OFFSET TAPER 32MM HIP MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163627|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 26MM HIP MODULAR NO SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM TAPER 26MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163696|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM TAPER 26MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL SHORT 28MM HIP MODULAR ALUMINA C2A-TAPER BIOLOX FORTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532801000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 28MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532810000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10MM 28MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 12/14 38MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 12/14 38MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 12/14 38MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S061140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 40MM HIP SOLID MODULAR COCR SELEX M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 60MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 40MM TITANIUM DOME HIP ACETABULAR CANCELLOUS LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103539|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 70MM C2A-TAPER TITANIUM DOME LOW PROFILE HIP ACETABULAR CANCELLOUS SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 13MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 11MM GENERATION 4 HIP PROXIMAL PMMA MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-7 C-D 20MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 16MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 11MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 11MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 10MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 18MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-11 E-F 16MM KNEE RIGHT CRUCIATE RETAIN POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-7 C-D 20MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 CD 16MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP PRIMARY MODULAR SOLID TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620208022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 80MM MODULAR CLUSTER HOLE HIP TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 56MM HIP CLUSTER HOLE SNAP FIT LOCK GROOVE TIVANIUM TRILOGY IT KK HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP UNIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM JJ HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP UNIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM MM HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 66MM HIP UNIHOLE SNAP FIT LOCK GROOVE TRABECULAR METAL TIVANIUM CONTINUUM PP HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 72MM HIP UNIHOLE TRABECULAR METAL TIVANIUM CONTINUUM TT HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP CLUSTER HOLE TRABECULAR METAL TIVANIUM CONTINUUM UU HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM HH HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 54MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM JJ HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP MULTIHOLE SNAP FIT LOCK GROOVE TRABECULAR METAL TIVANIUM CONTINUUM RR HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00725505232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR 52MM 32MM 0D NEUTRAL PRIMARY MONOBLOCK NATURAL HIP STERILE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286064107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 60-64MM 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 286670107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR INTEGRITY 66-70MM 28MM ARCOM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 B NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D A 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D D 28MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 41 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-104947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 47 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 45 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 44 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-185233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 23 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-185234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000789|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 40MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 40MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-107928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 24 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 27 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-176236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-176237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-196238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 40MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636000065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE HEMI W/ SEALED SCREW HOLES 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 636100057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONVERGE RIMFLARE 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP PRIMARY MODULAR SOLID TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP PRIMARY MODULAR SOLID TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620206822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620207422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 74MM HIP PRIMARY MODULAR CLUSTER HOLE TRABECULAR METAL TANTALUM TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875306001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 60MM HIP CLUSTER HOLE SNAP FIT INTEGRATE LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT MM HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP UNIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM DD HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875705200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 52MM HIP UNIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM II HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 62MM HIP 12 SCALLOP CLUSTER HOLE SNAP FIT GROOVE INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM NN HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875706801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 68MM HIP CLUSTER HOLE SNAP FIT GROOVE INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM QU HEMISPHERICAL TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 70MM HIP UNIHOLE TRABECULAR METAL TIVANIUM CONTINUUM SS HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 76MM HIP CLUSTER HOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875707801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 78MM HIP CLUSTER HOLE TRABECULAR METAL TIVANIUM CONTINUUM VV HEMISPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620203820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 38MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620204220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 42MM HIP PRIMARY MODULAR MULTIHOLE TRABECULAR METAL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875304602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 46MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT FF HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 14MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 16MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 14MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-7 C-D 16MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-11 E-F 20MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 16MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 11MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 10MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 12MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 12MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B 10MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D 17MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F 20MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G 20MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 16MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 13MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 9MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 19MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 11MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 9MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 13MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 9MM BI-METRIC HIP RIGHT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162588|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 11MM BI-METRIC HIP RIGHT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162596|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 13MM BI-METRIC HIP RIGHT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 9MM RIGHT HIP COLLARLESS REVISION STRAIGHT NECK POROUS BI-METRIC 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 9MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM COLLARLESS REVISE BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM COLLARLESS REVISION BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 10MM COLLARLESS STRAIGHT REVISE BI-METRIC POROUS LEFT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM COLLARLESS REVISION BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 9MM COLLARLESS REVIES STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 11MM COLLARLESS STRAIGHT REVISE BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162974|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM 16MM COLLARLESS REVISE BI-METRIC POROUS HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 19MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 11MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 22 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 23 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 28 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 41 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 43 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 42 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR +3MM 27 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-109926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-196236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 26 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 44MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 10MM COLLARLESS REVISE BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM COLLARLESS REVISE STRAIGHT BI-METRIC POROUS LEFT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 12MM COLLARLESS BI-METRIC POROUS HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM 16MM COLLARLESS REVISION BI-METRIC POROUS RIGHT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 12MM COLLARLESS REVISE BI-METRIC POROUS HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162977|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM COLLARLESS REVISE BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 17MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 16MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 14MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 17MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 60% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 40% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108459|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 40% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 18MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135169|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 20MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 19MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 25MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 14MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 15MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 18MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 22MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 30MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 16MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 10MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 9MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 11MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR 42-50MM +6MM HIP TAPERED METAL M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000995|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG DOME HOLE G7 ACETABULAR SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM LATERALIZE ECHO FX COCR OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM SOLID BIO-MOORE II INTERLOK TITANIUM STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 16MM SOLID BIO-MOORE II INTERLOK TITANIUM STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR BLUE 42MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR GREEN 47MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 49MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 57MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 49MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 51MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 13MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 13MM 1 PIECE HOLE MALLORY-HEAD TITANIUM POROUS STRAIGHT 34MM HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 11MM REVISION PRESS FIT RESECTION MALLORY-HEAD 45MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 15MM PRESS FIT REVISION RESECTION MALLORY-HEAD 55MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 9MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 10MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 EF 10MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 11MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B 14MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C 10MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 14MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F 17MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G 12MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 13MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 16MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 11MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 19MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 11MM KNEE LEFT CRUCIATE RETAIN ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 13MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 13MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 17MM KNEE FIXED BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 A NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 D NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E NEUTRAL 28MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E1 J NEUTRAL 32MM POLYETHYLENE HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D A 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000895|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D D 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E 36MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 22 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 23 32MM E-POLY HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 44MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E1 I HIGH WALL 40MM COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 J 40MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 26 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 24 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 25 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-166234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 24 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875305002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 50MM HIP MULTIHOLE SNAP FIT INTEGRATED LOCK MECHANISM TIVANIUM FIBER METAL TRILOGY IT HH HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 40MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM CC HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00875704402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR 44MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM TRABECULAR METAL TIVANIUM CONTINUUM EE HEMISPHERE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E NEUTRAL 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 36MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 28MM ARCOMXL HIP COLOR CODED FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000781|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000783|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D I 36MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000798|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 23 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 23 STANDARD 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 22 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 26 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 32MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 24 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 G 10MM KNEE FIX BEARING PROLONG NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE RIGHT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 1/2, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 3/4/5, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595204020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X20MM KNEE PROLONG NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591704010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 D XL 10MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591705020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E XL 20MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591707010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7-8 G XL 10MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 14MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 13MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 13MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 EF 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 11MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 12MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 13MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSN MC VE ASF R 13MM 8-11 GH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 7MM NEXGEN LEGACY 3D 7 FULL FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 7 HALF FLUTE 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ3 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ5 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ6 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ4 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2MM 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3MM 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4MM 10MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM LCCK NEXGEN SMALL CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 50MM LCCK NEXGEN SMALL CONE TAPER RIGHT TRABECULAR METAL COMPETE KNEE SOLUTION LEGACY LCCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM LARGE CONE DIAPHYSIS RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545006720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 30-15MM NEXGEN 67MM CONE LARGE STEP KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN C 5MM DISTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 13MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 15MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 19MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R/H M/H 13X300 60%(210) DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 14MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 12MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 17MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 20MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 20MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 22MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 18MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 28MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 25MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 56MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 28MM E1 HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 C NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D C 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D E 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000896|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D E 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 A 28MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H 28MM E1 HIP COLOR CODED HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 22 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105894|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 24 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 27 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 27 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 22 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000865|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 40MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 40MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106985|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 25 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 26 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 26 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 25 44MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 27 44MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 11MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 10MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 EF 10MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 12MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 GH 10MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 12MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 16MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 13MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 12MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 EF 12MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 10MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 11MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 10MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C 14MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104949|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104989|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 19MM HOLE MALLORY-HEAD 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 20MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 23MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 11MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 18MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 11MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 17MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 20MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 18MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 22MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 9.5MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 12MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 15MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 9MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 15MM BI-METRIC HIP RIGHT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 15MM BI-METRIC HIP RIGHT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 9MM BI-METRIC HIP LEFT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162583|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 11MM BI-METRIC HIP LEFT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 9MM BI-METRIC HIP RIGHT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 9MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 9MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 12MM COLLARLESS HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM COLLARLESS REVISION BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 16MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM COLLARLESS REVISION BI-METRIC POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 12MM COLLARLESS BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM COLLARLESS REVISE BI-METRIC POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM COLLARLESS REVISE BI-METRIC POROUS LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 16MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 18MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 13MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 16MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 17MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 20MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN LPS-FLEX FIXED PROLONG ART SUR E 1-2, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 10MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 23MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE RIGHT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 1/2, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .75/5 13MM KNEE LEFT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591702010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B XL 10MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591706014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F XL 14MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 14MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 G-H 14MM KNEE LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 12MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 14MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-166237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 27 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-176235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 25 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-176237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +5MM 27 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 42MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 44MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 60MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-131023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28MM 23MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13-131026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28MM 26MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 4MM OFFSET TAPER 28MM HIP MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 22.2MM HIP MODULAR TYPE 1 COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 28MM HIP MODULAR NECK COCR M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 32MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532600000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26MM +0 MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 532605000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|26MM +5 MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533200000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +0MM 32MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM OFFSET 40MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 40MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 12/14 40MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 12/14 40MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 32MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 36MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-105936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 26 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 10D 43 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 46 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-106968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 48 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM +3MM 22 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-108321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 21 28MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC RX90 +5MM 48 28MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-129073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RX90 +5MM 43 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-155233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 23 32MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-185237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 36MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 40MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 40MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 44MM ARCOMXL HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G 40MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-166234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 24 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-166235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-166237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 38MM ARCOMXL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-195235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-195237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 38MM ARCOMXL HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000992|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 32MM 22.2MM ACTIVE ARTICULATION A ARCOMXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 38MM ACTIVE ARTICULATION ARCOMXL 2 MOBILITY 28MM MODULAR HEAD STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported XL-200152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 46MM ACTIVE ARTICULATION ARCOMXL 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,451.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E1 H NEUTRAL 28MM POLYETHYLENE HIP COLOR CODED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN C KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN F KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 54X8.5MM I/B II 7D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 59X22MM I/B II 20D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 64X10MM I/B II 16D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598809100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE NEXGEN TIBIA WEDGE ATTACHMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 00 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 00 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 28MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 30MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 26MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS B STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS D STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM B STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM A HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-11 E-F 20MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-195238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-196237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-196238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 28 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ACTIVE ARTICULATION G 46MM 28MM E1 HIP STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 28MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 32MM HIP STANDARD NECK MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163690|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 32MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM OFFSET 36MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM OFFSET 36MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 4MM OFFSET TAPER 32MM HIP MODULAR COCR BIOMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 26MM HIP MODULAR NO SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM 26MM HIP MODULAR SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 22.2MM HIP MODULAR TYPE 1 COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163693|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM TAPER 26MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM TAPER 28MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM LARGE TAPER 22MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533210000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +10MM 32MM HIP MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 12/14 38MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S661140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 40MM HIP SOLID MODULAR COCR SELEX M2A-MAGNUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 28MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 35MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 45MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 70MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 20MM TITANIUM DOME HIP ACETABULAR CANCELLOUS LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 14MM 1.5MM CENTRALIZER RX90 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 14MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 13MM GENERATION 4 HIP PROXIMAL PMMA MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 7MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM STANMORE 5 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 +6MM OFFSET TAPER HIP TITANIUM TYPE 1 BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT BIO-PLUG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM LATERALIZE GENERATION 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM LATERALIZE GENERATION 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR GREEN 44MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 47MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 53MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 55MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD BIO-MOORE ENDO II +6MM TAPER HIP FEMORAL STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 9MM REVISION PRESS FIT RESECTION MALLORY-HEAD 55MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 13MM REVISION PRESS FIT RESECTION MALLORY-HEAD 4 SMALL 55MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 15MM REVISION PRESS FIT MALLORY-HEAD 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 10MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 17MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F 14MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G 14MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 11MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 19MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 9MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 16MM KNEE RIGHT CONGRUENT CRUCIATE RETAIN PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 9MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 9MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 19MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 11MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 10MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 E 12MM KNEE FIX BEARING PROLONG NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 12MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 20MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .5 13MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 00/0, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 19MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 13MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-154778|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 19MM SLOT MALLORY-HEAD POROUS DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 18MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 21MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 23MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 21MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 13MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 21MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 12MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 14MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 27MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 50MM ARCOS A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM A HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM C STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 14MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 13MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 14MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 GH 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 12MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 G-H 13MM KNEE RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 11MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512601011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 GH 11MM KNEE LEFT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512601111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 11MM KNEE LEFT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 31MM LCCK NEXGEN 7D 4 CONE TRABECULAR METAL COUPLE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 36MM 31MM LCCK NEXGEN 7D 4 CONE TRABECULAR METAL COUPLE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ5 5MM 41X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ4 5MM 41X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ5 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 0D 7 5MM 46X34X5MM KNEE CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3MM 15MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 38MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 11MM 1.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 9MM 2.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 11MM 2.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 10MM GENERATION 4 ECHO ANSWER HIP DISTAL PMMA POSITIONER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 20MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 17MM GENERATION 4 ECHO ANSWER HIP DISTAL PMMA POSITIONER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 19MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 15MM HIP FEMORAL PMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 -3MM OFFSET 12/14 HIP TITANIUM BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 STANDARD OFFSET 12/14 HIP TITANIUM BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT BIO-PLUG 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT BIO-PLUG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11MM LATERALIZE ECHO FX COCR OFFSET HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 16MM FENESTRATE BIO-MOORE II INTERLOK TITANIUM STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 135MM 11MM POLISH INTRIGUE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 165015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 140MM 15MM GENERATION 4 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 165017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM GENERATION 4 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR GREEN 46MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 53MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR WHITE 54MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 59MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 H NEUTRAL 32MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 G NEUTRAL 36MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D G 28MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D D 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000889|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D F 32MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 36MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 E 32MM E1 HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 28 32MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 25 28MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105895|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 25 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105897|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 28 28MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 36MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 24 32MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-105994|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC MAX-ROM 24 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 23 36MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 F NEUTRAL 40MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000867|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 I NEUTRAL 40MM E1 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D H 44MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR G7 10D J 44MM E1 HIP FACE CHANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-106997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC 10D 27 38MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-107925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR 25 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 0 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 1 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 2 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 0 KNEE MEDIAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 3 KNEE MEDIAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 1 KNEE LATERAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 3 KNEE MEDIAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 5 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 00 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 4 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 0 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F 76X66MM KNEE RIGHT ROTATE HINGE NEXGEN ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,632.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,632.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502001012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1 12MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585002012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR B 12MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585002017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR B 17MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 14MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585005017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E 17MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-6 B 58X40X12MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM +3MM 28 40MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 25 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +3MM 28 40MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-108626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR MAX-ROM RINGLOC +3MM 26 44MM E-POLY HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-195235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 25 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-195237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR RINGLOC +5MM 27 38MM E-POLY HIP HIGH WALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010000990|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR ACTIVE ARTICULATION A 32MM 22.2MM E1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-200144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING HIP 38MM ACTIVE ARTICULATION E1 28MM MODULAR HEAD 2 MOBILITY SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,351.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163673|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +12MM 32MM HIP SKIRTED MODULAR METAL M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-163677|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 28MM HIP MODULAR HIGH CARBON M2A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-173660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 38MM HIP SOLID MODULAR COCR M2A-38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-363664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 36MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +3MM 26MM HIP MODULAR NO SKIRT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM OFFSET 28MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163669|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD OFFSET 32MM HIP TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM OFFSET 32MM HIP TYPE 1 SKIRT COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163697|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM TAPER 26MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM TAPER 32MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM TAPER 32MM HIP TYPE II MODULAR COCR RANAWAT/BURNSTEIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 32MM MODULAR C2A-TAPER BIOLOX FORTE ALUMINA SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM OFFSET 40MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +9MM OFFSET 44MM HIP ACETABULAR TYPE 1 COCR G7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 11MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 13MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 16MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 EF 10MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 12MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C 20MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D 12MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 11MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 16MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 11MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 16MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 19MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 12MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 14MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 16MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 11MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 12MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 14MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 15MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 15MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 13MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 20MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 13MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 11MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 13MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162585|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 13MM BI-METRIC HIP LEFT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595202117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR FLEX PROLONG ART SURF C-H/1,2 SPUR 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595202120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H MICRO 58X40X20MM KNEE PROLONG CR-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591702017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B XL 17MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591702020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B XL 20MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591703010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C XL 10MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591703020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C XL 20MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591706012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F XL 12MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591707014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G XL 14MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 10MM PERSONA VIVACIT-E STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 12MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 14MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 GH 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 GH 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 12MM KNEE RIGHT VIVACIT-E PERSONA MEDIAL CONGRUENT STERILE MC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 13MM KNEE CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 EF 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 10MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-5 AB 11MM LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 CD 11MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 EF 11MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ2 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ4 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ6 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ3 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ4 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ5 5MM 41X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 20MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 10MM RIGHT LATERAL LEFT MEDIAL TIBIA KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4MM 15MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800529|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5MM 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6MM 15MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 10MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 20MM KNEE LEFT ULTRA CONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 10MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 12MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 13MM KNEE RIGHT CRUCIATE RETAIN POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 18MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 18MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-7 C-D 18MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-11 E-F 16MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 11MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 18MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 GH 10MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C 12MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800629|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM 10MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM 15MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 40MM LCCK NEXGEN SMALL CONE TAPER RIGHT TRABECULAR METAL COMPETE KNEE SOLUTION LEGACY LCCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM LCCK NEXGEN MEDIUM CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545002136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 35MM MEDIUM CONE METAPHYSIS RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545002235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 35MM LARGE CONE METAPHYSIS LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN C 5MM POSTERIOR TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 10MM NEXGEN C KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN D 5MM FEMORAL POSTERIOR TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 54X20.5MM I/B II 20D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 9.5MM I/B II 7D 59 KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 69X17.5MM I/B II 13D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 69X10.5MM I/B II 16D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 00 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BIPOLAR 60MM 28MM RINGLOC BIO-MOORE II HIP ACETABULUM COCR 2 ARTICULATE SURFACE LOCK MECHANISM ECCENTRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 48MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 58MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 60MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 13MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM CEMENTED RX90 COCR HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 9MM STRAIGHT REVISION MALLORY-HEAD POROUS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM REVISE MALLORY-HEAD POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 170MM 11MM 1 PIECE HOLE MALLORY-HEAD TITANIUM POROUS STRAIGHT 34MM HIP CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 13MM PRESS FIT RESECTION REVISION MALLORY-HEAD 45MM HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104939|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 17MM PRESS FIT REVISION RESECTION MALLORY 55MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104976|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 15MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 18MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-158322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 270MM 22MM 1 PIECE SPLINE PLR TITANIUM OFFSET TAPER HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,932.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 14MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588003014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-6 C 64X40X14MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588005026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 74X44X26MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585000210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 KNEE PROXIMAL SEGMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,074.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,074.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 10MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 14MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 19MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 18MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 10MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMORAL STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 19MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 FULL 10MM KNEE TIBIA ROTATING HINGE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 HALF 5MM KNEE TIBIAL PRECOAT TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 TAPER HALF 20MM KNEE TIBIA ROTATING HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 HALF TAPER 15MM KNEE TIBIAL LEFT MEDIAL RIGHT LATERAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 TAPER HALF 15MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800639|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 20MM LEFT LATERAL RIGHT MEDIAL KNEE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN C KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585000011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INSTRUMENT TIBIA PROXIMAL SEGMENTAL WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585001296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY HUMERAL ZIMMER SEGMENTAL SYSTEM STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,042.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,042.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEG TM HIP FLAT 7MM WASHE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585204209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 30MM KNEE TIVANIUM SMOOTH COLLAR 9-16MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -6MM 12/14 40MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BH400340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 12/14 STANDARD 40MM HIP MODULAR COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 28MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL -3MM 32MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL +6MM 32MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-115121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL STANDARD 36MM HIP MODULAR BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-0790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA XLW-18 INS 28/37G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 010001001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 40MM 6.5MM G7 DOME HIP ACETABULAR LOW PROFILE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 17MM 2.5MM RX90 HIP SMOOTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM 12MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM STANMORE 2 HIP DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 164239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER STEM STANMORE 4 HIP DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 +7MM OFFSET 12/14 HIP TITANIUM BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 650-1066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING G7 STANDARD OFFSET TAPER HIP TITANIUM TYPE 1 BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130613|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT LARGE 22MM INTRAMEDULLARY CANAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT BIO-PLUG 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE CEMENT BIO-PLUG 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-165017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM LATERALIZE GENERATION 4 HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9MM ECHO FX COCR STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-151315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 15MM ECHO FX COCR STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 165009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 115MM 9MM GENERATION 4 STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 9MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 11MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 14MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-150316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 16MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 42MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 44MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNIPOLAR 56MM ENDO II HIP ACETABULUM COCRMO MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD BIO-MOORE ENDO II -3MM TAPER HIP FEMORAL STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 139248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD BIO-MOORE ENDO II 3+ MM TAPER HIP FEMORAL STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 150MM 11MM BI-METRIC HIP COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM CEMENTED RX90 COCR HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,521.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 104815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM REVISED MALLORY-HEAD POROUS HIP LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 11MM PRESS FIT RESECTION REVISION MALLORY-HEAD 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 260MM 11MM PRESS FIT RESECTION REVISION MALLORY-HEAD 55MM HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,617.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 17MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 34MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 9MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP RIGHT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104985|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 45MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-104987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 19MM 1 PIECE PRESS FIT HOLE MALLORY-HEAD TITANIUM POROUS 55MM HIP LEFT CALCAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,031.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NK FLX PRLNG UL CONG ART SURF, SZ 3/4/5-RT, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 16MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 22MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 23MM KNEE FIX BEARING PROLONG NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 G 12MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 G 17MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 1/2, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 1/2, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE LEFT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 3/4/5, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591703014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C XL 14MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591704017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D XL 17MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162587|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 9MM BI-METRIC HIP LEFT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162597|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 13MM BI-METRIC HIP LEFT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 10MM COLLARLESS STRAIGHT REVISE BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM COLLARLESS REVISION BI-METRIC POROUS HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162939|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 18MM COLLARLESS REVISE BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162959|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM COLLORLESS REVISE BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 9MM COLLARLESS REVISION BI-METRIC POROUS STANDARD LEFT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 10MM HIP LEFT COLLARLESS REVISION STRAIGHT NECK POROUS BI-METRIC 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM COLLARLESS REVISE STRAIGHT BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162975|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 16MM COLLARLESS REVISE BI-METRIC POROUS LEFT HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 12MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 18MM PRIMARY INTEGRAL HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R/H M/H 11X300 60%(210) DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 11MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 38MM 68MM LARGE CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM NEXGEN MEDIUM CONE KNEE RIGHT DIAPHYSIS TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545005901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 59-15MM FULL MEDIUM CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545005920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 30-15MM NEXGEN 59MM CONE MEDIUM STEP KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN C 10MM DISTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN D 10MM KNEE DISTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 10MM NEXGEN F KNEE DISTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN F KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 64X10MM I/B II 7D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 74X17MM I/B II 26D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 00 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C 17MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D 10MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D 14MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 9MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR .5 9MM KNEE LEFT CRUCIATE RETAIN ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 13MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 13MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR .5 13MM KNEE RIGHT CRUCIATE RETAIN ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 13MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 E 10MM KNEE FIX BEARING PROLONG NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 00/0, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 1/2, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595203020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X20MM KNEE PROLONG NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591703017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C XL 17MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591707012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G XL 12MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591707017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G XL 17MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 0 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 3 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 3 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 3 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 4 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 3 KNEE LATERAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 4 KNEE MEDIAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 2 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 5 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B 58X50MM KNEE RIGHT ROTATE HINGE NEXGEN ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,632.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,632.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 13MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 14MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 17MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 22MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 9.5MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 175MM 12MM 1 PIECE REVISION ARCOS TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 11MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 210X12MM 1 PIECE REVISION ARCOS TAPER HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 16MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 20MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM REACH POROUS STRAIGHT HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162489|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 15MM BI-METRIC HIP COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 15MM BI-METRIC HIP RIGHT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 9MM BI-METRIC HIP RIGHT COCR 34MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162589|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 11MM BI-METRIC HIP LEFT COCR 45MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162594|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 250MM 11MM BI-METRIC HIP RIGHT COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 9MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 AB 11MM RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 EF 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630010106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 10MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540200026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 7.5MM 26MM VIVACIT-E ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620001102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 10MM NATURAL-KNEE II METAL POLYETHYLENE POROUS CSTI KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579006511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 30X48MM M/G 3 KNEE RIGHT MEDIAL LEFT LATERAL TIVANIUM ULTRAPEK UNICOMPARTMENTAL MODULAR SERIES 3 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA C KNEE LEFT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA J KNEE LEFT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F 77X65.5MM KNEE RIGHT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE LEFT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599402220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D MICRO 58X40X20MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G 74X46X20MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511003317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C-D 66X42X17MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK7.3MM 59X10MM KNEE POSTERIOR STABILIZE MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK15.3MM 64X18MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK12.3MM 69X15MM KNEE POSTERIOR STABILIZE MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP RIGHT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-162119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-166015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 15MM REDUCE PROXIMAL PROFILE DUCKBILL COLLAR DISTAL CORONAL SLOT INTEGRAL 70% PPS TITANIUM 140D HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 210MM 9.5MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-303413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 13MM ARCOS STANDARD OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 175MM 13MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-304418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 210MM 18MM ARCOS HIGH OFFSET TAPER HIP 1 PIECE REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM REACH POROUS STRAIGHT HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-162487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD/NECK FEMORAL 200MM 11MM BI-METRIC HIP COCR 55MM REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM DUCKBILL COLLAR EXTEND NECK LENGTH REACH TITANIUM POROUS CYLINDRICAL BOW BIPLANAR TAPER HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,783.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 9MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 11MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 9MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 10MM REVISION COLLORLESS STRAIGHT BI-METRIC RIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 11MM COLLARLESS STRAIGHT REVISE BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162976|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM COLLARLESS BI-METRIC POROUS HIP RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162978|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 18MM NONCOLLARED BI-METRIC POROUS RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591705012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E XL 12MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591707020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7-8 G XL 20MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 C-D 11MM KNEE LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 10MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 E-F 11MM KNEE LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 13MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 14MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 EF 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 11MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ7 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ6 5MM 41X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 10MM RIGHT LATERAL LEFT MEDIAL TIBIA KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 5MM TIBIA RIGHT MEDIAL LEFT LATERAL TRABECULAR METAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 20MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 15MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 16MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 25MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 23MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 27MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 29MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 26MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 27MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300929|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 29MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 23MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 25MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS A STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS C STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS C HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 1 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 4 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 1 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 1 KNEE MEDIAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 0 KNEE LATERAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 1 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 00 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 2 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL OFFSET 38MM PROXIMAL SEGMENTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,361.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,361.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588009013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL C KNEE TIBIA ROTATE HINGE NEXGEN POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502002006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2 6MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502002021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2 21MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502004009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4 9MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502010016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 16MM KNEE PROXIMAL HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585002023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR B 23MM KNEE ROTATE HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C 23MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 20MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585006023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F 23MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-6 B 58X40X23MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588005020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 74X44X20MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 56X41MM NEXGEN 1 KNEE ZIMALOY PMMA UHMWPE PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 62X41MM NEXGEN 2 KNEE ZIMALOY PMMA UHMWPE ROTATE HINGE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 16MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 14MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 15MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 12MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 19MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 12MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 17MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 16MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588009012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SILASTIC HINGE KIT FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 HALF TAPER 15MM KNEE TIBIAL LEFT MEDIAL RIGHT LATERAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 TAPER HALF 15MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 8 15MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN D 20MM FEMORAL DISTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEG INTERCALARY SEGMENT, 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 11MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 10MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 13MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 18 G-H 18MM KNEE RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 AB 11MM LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ2 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ5 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ4 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ6 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN TRAB METAL TIB AGMT BLK, 15MM RLAT/LMED SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM 5MM RIGHT LATERAL LEFT MEDIAL TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 50MM LCCK NEXGEN SMALL CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502001006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1 6MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502001021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1 21MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502003006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3 6MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585005012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E 12MM SEGMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-6 B 58X40X20MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588006014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 F 77X44X14MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585000110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL PROXIMAL TIBIA, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,074.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,074.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL NEXGEN 5 KNEE ZIMALOY PMMA UHMWPE ROTATE HINGE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 12MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 10MM SEGMENTAL STRAIGHT FLUTE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 13MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 16MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 15MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 17MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 FULL 10MM KNEE TIBIA ROTATING HINGE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 FULL 10MM KNEE TIBIA ROTATING HINGE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 TAPER HALF KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800629|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 20MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN G KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 9MM PRESS FIT BI-METRIC TITANIUM POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 13MM PRESS FIT BI-METRIC TITANIUM POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM COLLARLESS REVISION STRAIGHT BI-METRIC POROUS HIP RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162929|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 13MM COLLORLESS BI-METRIC LEFT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,148.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-8-240|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE GRIP "CABLE' BOTH|1|HUMANA [1294]||HUMANA [11839]|1,043.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,043.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 162949|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM COLLORLESS REVISION STRAIGHT BI-METRIC POROUS LEFT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM STRAIGHT COLLARLESS REVISE BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,063.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162969|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 13MM COLLARLESS STRAIGHT REVISION BI-METRIC POROUS HIP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM COLLARLESS REVISE STRAIGHT BI-METRIC POROUS RIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 180MM 11MM PRIMARY INTEGRAL HIP REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,179.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 18MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 19MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 60% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 13MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 40% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 240MM 20MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 18MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 25MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 26MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 19MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 20MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.3MM 69X25MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 59/54MMX10MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 59/54MMX12MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 69/64MMX12MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522403207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.5MM 59X25MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE I/B II CCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672013103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672013201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672019101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672022101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 22MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672025203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 25MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672509201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672516201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672519100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672525100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 25MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672525101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 25MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522001200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR DOME 8MM 34MM 1 PEG I/B II UHMWPE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587601123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT PATELLAR 23MM NEXGEN LARGE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621400620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II .5 +14MM KNEE LEFT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621400640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II .75 +14MM KNEE LEFT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 +4MM KNEE RIGHT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3-4 +14MM KNEE RIGHT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD ORTHOPEDIC 75MM 12MM I/B II FLUTE KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN STRAIGHT STEM EXT 12.7MM DIA X 75MM,(30MM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 10MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 19MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621500060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 60MM NATURAL-KNEE II TIBIA TITANIUM REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621520125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 200MM 12.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621525125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 12.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II CURVE BOW STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681515205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 20.5MM REVISION KNEE TITANIUM NATURAL-KNEE II FLUTE OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 HALF 5MM KNEE TIBIAL PRECOAT TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 15MM NEXGEN 26D 4 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 17MM NEXGEN 26D 6 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10MM NEXGEN 7D 7 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN D KNEE ANTERIOR TIVANIUM PMMA ROTATE HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL NEXGEN LEGACY 16D 3D 4 HALF FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 7MM NEXGEN LEGACY 3D 5 FULL FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B MICRO 58X49.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE LPS NEXGEN ZIMALOY PMMA STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL A MICRO 54X45.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE NEXGEN LPS OPTION ZIMALOY STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 3 KNEE LEFT CEMENTED CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 166025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 15MM PRIMARY INTEGRAL HIP LEFT REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,515.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 11MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 15MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 80% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,905.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 220MM 15MM SEGMENTAL LOCK SCREW ROLLER HARDENED MALLORY-HEAD 40% POROUS HIP CALCAR DIAPHYSEAL MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,555.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-108740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 14MM ROLLER HARDENED MALLORY-HEAD STS HIP CALCAR MODULAR SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 15MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-135170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 165MM 21MM ROLLER HARDENED MALLORY-HEAD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,988.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 13MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 15MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 17MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 16MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 24MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 26MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 24MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 26MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 13MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 16MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 21MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 23MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 FULL 10MM KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN TRAB METAL TIB AGMT BLK, 5MM LLAT/RMED SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 15MM LEFT LATERAL RIGHT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 20MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 31MM 36MM MEDIUM CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 34MM 46MM MEDIUM CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 36MM 55MM LARGE CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 50MM LCCK NEXGEN LARGE CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM SMALL CONE KNEE RIGHT DIAPHYSIS TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545006701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 67-15MM FULL CONE LARGE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN D KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 10MM NEXGEN E KNEE DISTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 59X9MM I/B II 16D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 15MM I/B II 26D 64 KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 74X11.5MM I/B II 7D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598809200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUGMENT NEXGEN KNEE FEMUR REPLACEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN B KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-6-020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE GRIP "GRIP" ALL|1|HUMANA [1294]||HUMANA [11839]|2,049.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,049.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 11-301210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 50MM ARCOS +0MM A HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARCOS CAL SZ C STD +10 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-11 E-F 16MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 11MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 EF 13MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 14MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 11MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEG INTERCALARY SEGMENT, 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004655|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT MALE-FEMALE 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-MALE, 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR C SEGMENTAL SVC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR F ARTICULAR SURFACE SEGMENTAL HINGE SHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 GH 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541800801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 8MM NATURAL-KNEE FLEX ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591101128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR NATURAL-KNEE POLYETHYLENE STERILE LATEX FREE DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630010104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 10MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542001002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 10MM NATURAL-KNEE FLEX PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540200041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 10MM 41MM VIVACIT-E ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 9MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 31MM 31MM MEDIUM CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 34MM 52MM LARGE CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM SMALL CONE DIAPHYSIS LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545005905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 59-30MM FULL MEDIUM CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545005921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 15-30MM NEXGEN 59MM MEDIUM STEP CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545006705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 67-30MM FULL CONE LARGE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN D KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN F KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 54X14MM I/B II 13D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 59X15MM I/B II 13D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 64X16.5MM I/B II 13D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 74X11.5MM I/B II 16D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522009000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUGMENT I/B II KNEE TIBIA TIVANIUM ATTACHMENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|523.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|523.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN B KNEE POSTERIOR TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 00 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 00 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 00 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 1 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 0 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 2 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 0 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 0 KNEE LATERAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 1 KNEE LATERAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 1 KNEE MEDIAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 2 KNEE MEDIAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 00 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-MALE, 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585204130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 30MM KNEE TRABECULAR METAL COLLAR 17-19MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585204135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 35MM KNEE TRABECULAR METAL COLLAR 17-19MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 GH 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541800802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 8MM NATURAL-KNEE FLEX ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541801002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 10MM NATURAL-KNEE FLEX ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630007101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 7MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630010107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 10MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 38MM NEXGEN PROLONG KNEE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620001100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 10MM NATURAL-KNEE II METAL POLYETHYLENE POROUS CSTI KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620001103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 10MM NATURAL-KNEE II CSTI METAL POLYETHYLENE POROUS KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA C KNEE RIGHT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA G KNEE RIGHT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F KNEE RIGHT SET SCREW LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 200MM 22MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 12MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 13MM SLOT PRESS FIT ARCOS TITANIUM BOW TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 19MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 17MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-300920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 190MM 20MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 17MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 18MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 19MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARCOS CAL SZ C STD +0 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM B HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +10MM E HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +20MM E STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 11MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 13MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 18MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 12MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 C-D 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-KNEE GSF NP FLEX FEM, SIZE 3-RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT LARGE KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 72.5MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 60MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 67.5MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VANGUARD 360 OFFSET TAPER FEMORAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59-67MM VANGUARD XP G2 KNEE LOCK BAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE RIGHT RESURFACE SEGMENTAL FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,579.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,579.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE RIGHT MODULAR SEGMENTAL REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 7CM COMPRESS KNEE RIGHT POROUS SEGMENTAL REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,909.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,909.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153982|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64X12MM UHMWPE KNEE MODULAR TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153984|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 14MM KNEE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 20MM OSS POLY KNEE REDUCE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 14MM OSS UHMWPE KNEE TIBIAL AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 16MM OSS KNEE REDUCE LATERAL STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 22MM OSS KNEE REDUCE LATERAL STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS LONG KNEE NONMODULAR 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 83MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 67MM OSS POLY HYBRID STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 3CM OSS PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,915.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,915.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 51MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 71MM OSS SHORT KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS-NP NON-MOD TIB SHORT 67|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,276.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,276.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 79MM OSS KNEE MODULAR TAPE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 12MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 17MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 17.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 150MM 21.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 300MM 16.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 14.5MM OSS PROXIMAL POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 14MM SPLINE OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 15.5MM FINN POROUS STRAIGHT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 17.5MM FINN POROUS STRAIGHT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS 20MM TIBIA LEFT MEDIAL RIGHT LATERAL 79/83MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 3CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 17CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 22MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 24MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 250MM 29MM PRESS FIT SPLINE ARCOS STS TITANIUM TAPER DISTAL STERILE MODULAR REVISION SYSTEM EXTENDED TROCHANTERIC OSTEOTOMY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,653.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY BROACHED 60MM ARCOS F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM B STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM F STANDARD OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM A HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM D HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-301216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY CALCAR 60MM ARCOS +0MM F HIGH OFFSET HIP TITANIUM MODULAR FEMORAL REVISION SYSTEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-7 C-D 18MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 13MM KNEE LEFT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 12MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511200720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 11MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 18MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 10MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 EF 12MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 11MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 4 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 2 KNEE MEDIAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 2 KNEE LATERAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 13MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 20MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 14MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 10MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 12MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 11MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 11MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 16MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F 10MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 19MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 9MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 9MM KNEE RIGHT CONGRUENT CRUCIATE RETAIN PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 13MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 19MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 11MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 16MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G KNEE LEFT SET SCREW CONSTRAIN LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL D 68X57.5MM KNEE LEFT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G 81X70.5MM KNEE RIGHT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599402228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D MICRO 58X40X28MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN LCCK ART SURF, G 5-6/STRIPE GREEN, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511003323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C-D 66X42X23MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511005320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR G-H-J-K 82X50X20MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK7.3MM 54X10MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK15.3MM 59X18MM KNEE POSTERIOR STABILIZE MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK18.5MM 74X21MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672009201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672019203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672025103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 25MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 1 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL OFFSET 46MM PROXIMAL SEGMENTAL TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,361.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,361.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588009014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN ROTATING HINGE FEM HINGE SVC PARTS, SIZE D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502001016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1 16MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502003021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3 21MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502004012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4 12MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502010021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 21MM KNEE PROXIMAL HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585002014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR B 14MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585002020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR B 20MM KNEE ROTATE HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C 17MM KNEE ROTATE HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C 26MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 12MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 17MM KNEE ROTATE HINGE SEGMENTAL MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585005014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E 14MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585005020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E 20MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585005023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E 23MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585006012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F 12MM KNEE ROTATE HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 13MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 13MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 16MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 18MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E 72X61.5MM KNEE LEFT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599402214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D MICRO 58X40X14MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599402223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D MICRO 58X40X23MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE NEXGEN LCCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN LCCK ART SURF, G 5-6/STRIPE GREEN, 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511003311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C-D 66X42X11MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511003315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C-D 66X42X15MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511005309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR G-H-J-K 82X50X9MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.3MM 54X25MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK18.5MM 59X21MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.3MM 59X25MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK18.5MM 69X21MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK7.3MM 74X10MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 59/54MMX15MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 64/59MMX10MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522403407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.5MM 69X25MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE I/B II CCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 GH 14MM KNEE LEFT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 16MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-11 E-F 18MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 20MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 E-F 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 11MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 12MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B 17MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B 20MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D 20MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 12MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G 10MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-8 G 17MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 11MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL OSS STRAIGHT KNEE OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS 30CM TOTAL FEM DIAPH CPLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 19CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 21CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 26CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 29CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151863|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 22CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151864|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 23CM 14MM ORTHOPEDIC SALVAGE SYSTEM STERILE LATEX FREE DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151868|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 27CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151869|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 28CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING TIBIAL KNEE ROTATING HINGE FINNED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|891.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|891.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|YOKE FEMORAL FINN LONG KNEE COCR POLYETHYLENE RESURFACING HINGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 14CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 24CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 22CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 12CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 22CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS AVL TIBIAL LOCK RING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,276.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,276.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM SPDL WITH PINS 600LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM SPDL WITH PINS 800LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511400920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 20MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 11MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511401113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 13MM KNEE LEFT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 13MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521000616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 16MM KNEE RIGHT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 18MM KNEE RIGHT ULTRACONGRUENT POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521200720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM PERSONA 9-12 J RIGHT KNEE POLYETHYLENE ULTRACONGRUENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 11MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 C-D 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 CD 11MM KNEE RIGHT POSTERIOR STABILIZE POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 11MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 E-F 13MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 14MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 E-F 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521400912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 G-H 12MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42521401018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 G-H 18MM KNEE RIGHT POSTERIOR STABILIZED POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B 12MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 20MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F 12MM KNEE MOBILE MACHINE MOLD POLYETHYLENE NEXGEN LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 11MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 19MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MOD CMTD TIBIA BP SPACER SZ 3, MED 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 3 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 5 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE ROTATE HINGE BASIC MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ZIMMER DISPOSABLE SEGMENTAL SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,215.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,215.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588009015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E KNEE TIBIA ROTATE HINGE NEXGEN POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502003016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3 16MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502004006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4 6MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502004016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4 16MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502010006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6MM KNEE PROXIMAL HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C 12MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C 14MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585005026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E 26MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585006014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F 14MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588003026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-6 C 64X40X26MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588004014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-6 D 70X40X14MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BG103-250|SUP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT GLAUCOMA BAERVELDT AREA SURFACE 250MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,406.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00588004020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-6 D 70X40X20MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588005014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 74X44X14MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR SMALL ELLIPSE MOST OPTIONS ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 18MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 12MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR .5 9MM RIGHT KNEE CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 19MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 11MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 19MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 20MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 G 14MM KNEE FIXED BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 G XL 20MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00/0 9MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620110913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 00/0, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE LEFT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .5 9MM KNEE RIGHT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .5 13MM KNEE RIGHT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 3/4/5, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 3/4/5, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595205020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR FLEX PROLONG ART SURF C-H/7,10 BLUE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591703012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-4 C XL 12MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672511100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672511200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672513201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672516203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672519200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672522200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 22MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672522201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 22MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587601022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT PATELLAR 22.5MM NEXGEN MEDIUM KNEE TRABECULAR METAL POLYETHYLENE REVISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522002300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 70X52X64MM I/B II KNEE TIVANIUM UHMWPE CEMENT MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620400440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 +4MM KNEE LEFT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 +4MM KNEE LEFT CEMENTED MODULAR CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1-2 +14MM KNEE RIGHT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 14MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 17MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578208600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 67MM 90MM 12.7MM KNEE TIVANIUM MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,598.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,598.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 16MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 17MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21954|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET BILIARY STENT-LEUNG CLBS 7FR|1|HUMANA [1294]||HUMANA [11839]|387.36|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|387.36|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598801614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 14MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 200MM 17MM KNEE FEMUR TIVANIUM NEXGEN OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621512145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 125MM 14.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 16MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 18MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 13MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 FULL 10MM KNEE TIBIA ROTATING HINGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 FULL 10MM KNEE TIBIA ROTATING HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 FULL 10MM KNEE TIBIA ROTATE HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588009601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPLANT NEXGEN C KNEE TIBIAL AUGMENT FULL BLOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 TAPER HALF 10MM KNEE TIBIA ROTATING HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN TIBIAL AUGMENT BLK LT LAT/RT MED 20MM SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 HALF TAPER 15MM KNEE TIBIAL RIGHT MEDIAL LEFT LATERAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 TAPER HALF 20MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 TAPER HALF 20MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN D KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN E KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN G KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INSTRUMENT FLAT HIP 4MM SEGMENTAL WASHER TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-1007|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|7FR 13CM FEMORAL INTRODUCER SAFESHEATH (PEEL AWAY)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00585004618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 180MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672009103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672019103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 19MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672509103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672509203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672511201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672513203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672522100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 22MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672525103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 25MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672525200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 25MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522001300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 8.5MM 36MM 1 PEG I/B II UHMWPE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522001400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 9.5MM 38MM 1 PEG I/B II UHMWPE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522002200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 64X48X59MM I/B II KNEE TIVANIUM UHMWPE CEMENT MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621401600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 00/0 +14MM KNEE RIGHT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621401620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II .5 +14MM KNEE RIGHT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 +4MM KNEE LEFT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2-3 +14MM KNEE RIGHT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 10MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD ORTHOPEDIC 75MM 13MM I/B II FLUTE KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 18MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GR3501|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE STANDARD .035 DIAMETER X 150CM LENGTH X 3CM FLEXIBLE TIP STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598801117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 200MM 17MM NEXGEN STRAIGHT TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 13MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542401019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 19MM KNEE LEFT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 13MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 16MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 11MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 16MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4-5 16MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 14MM KNEE FIXED BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 23MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 E 17MM KNEE FIXED BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 E 20MM KNEE FIXED BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .5 16MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .5 9MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 00/0, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 00/0, 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 1/2, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 3/4/5, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591702012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B XL 12MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 038010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY DBX 1CC (DEMINERALIZE) BONE MATRIX|1|HUMANA [1294]||HUMANA [11839]|660.03|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|660.03|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 178360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC COMPRESS C600LB STANDARD ELLIPTICAL KNEE ANTIROTATION PIN SALVAGE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM SHT SPDL W PINS 800LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END COMPRESSION COMPRESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|277.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|277.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 18MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM M-H F SPINDLE 12MM PCHA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 19MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 28MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 32MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 48MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 24MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 25MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 64MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|220.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT XS 400LB SPNDL W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT ELLIPT 400LB SPNDL W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT ELLIPT 800LB SPNDL W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 30MM MINI COMPRESS C400LB STANDARD HUMERAL ANTIROTATION REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178787|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 30MM MINI COMPRESS C400LB SHORT HUMERAL ANTIROTATION REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE OSS SMALL THREAD DIAPHYSEAL LOCK XL BIG HEAD MODULAR ARTHRODESIS SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|473.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542402113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 13MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8637-20|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFUSION SYNCHROMED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,920.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|31,920.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00542402119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 19MM KNEE RIGHT CONGRUENT CRUCIATE RETAINING PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 9MM KNEE LEFT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542801113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 13MM KNEE LEFT CRUCIATE RETAIN ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 00-0 9MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542802116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 16MM KNEE RIGHT CRUCIATE RETAINING ULTRACONGRUENT PROLONG GENDER SOLUTIONS NATURAL-KNEE FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596202012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 12MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B XL 14MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596203117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 17MM KNEE FIX BEARING PROLONG LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620108913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE RIGHT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .75/5 9MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620109816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE LEFT DURASUL CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 00/0, 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627600616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS LT, SZ 00/0, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627601716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 1/2, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .75/5 16MM KNEE LEFT DURASUL CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627602719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII DURASUL ULTRA CONG TIB INS RT, SZ 3/4/5, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 17MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 17MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 10MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMORAL BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 12MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 14MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500005005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL MOST OPTIONS KNEE POLY REPLACEMENT SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 FULL 10MM KNEE TIBIA ROTATE HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 TAPER HALF 15MM KNEE TIBIA ROTATING HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 TAPER HALF 20MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 15MM LEFT LATERAL RIGHT MEDIAL KNEE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 8 TAPER HALF 15MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN B KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN F KNEE DISTAL TIVANIUM PMMA ROTATE HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC51031|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA HALF (PROCESSING FEE) (SEE COMMENTS FOR DETAILS)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENT MALE-FEMALE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR ZIMMER C FEMORAL HINGE SERVICE SEGMENTAL SYSTEM XT STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-5 AB 11MM RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542000801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 8MM NATURAL-KNEE FLEX PROLONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542001001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 10MM NATURAL-KNEE FLEX PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 7.5MM 26MM NEXGEN ALL POLY PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591704014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D XL 14MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591705010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5-6 E XL 10MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591705014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E XL 14MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/CI/S|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA PRE CUT ENDOTHELIAL KERATOPLASTY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 E-F 10MM KNEE LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 12MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 14MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 C-D 11MM KNEE RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 11MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 10MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 12MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 14MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ6 5MM 46X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ6 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 5MM TIBIA LEFT MEDIAL RIGHT LATERAL TRABECULAR METAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3MM 15MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3MM 10MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 10MM LEFT LATERAL RIGHT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800639|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM 15MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 34MM 41MM MEDIUM CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 34MM 51MM LARGE CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 36MM 56MM LARGE CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 36MM 60MM LARGE CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 50MM LCCK NEXGEN MEDIUM CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 50MM CONE LARGE LEFT TRABECULAR METAL NEXGEN LCCK AND RH KNEE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 10MM NEXGEN E POSTERIOR KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN TRAB METAL AUG BLK DISTAL ONLY SIZE E, 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 59X14MM I/B II 26D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 69X11MM I/B II 7D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 69X16.5MM I/B II 26D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 74X19MM I/B II 13D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 10MM NEXGEN B KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621520105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 200MM 10.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681515125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 12.5MM REVISION KNEE TITANIUM NATURAL-KNEE II FLUTE OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681517145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 175MM 14.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681519165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 16.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 26D 2 HALF WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 HALF 5MM KNEE TIBIAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 9MM NEXGEN 7D 5 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 18.5MM NEXGEN 26D 7 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 18.5MM NEXGEN 26D 8-9 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 8-9 HALF 5MM KNEE TIBIAL PRECOAT TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 11MM NEXGEN 7D 9 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 3 HALF FLUTE 5MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222983|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.4MM 2 CP-2 G2QKAN + OTHCRD NDL NTNL 8.8MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,605.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,605.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596601301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL C STANDARD 63X53.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL D STANDARD 68X57.5MM KNEE LEFT CRUCIATE RETAIN CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E STANDARD 72X61.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B MICRO 58X49.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE NEXGEN LPS OPTION ZIMALOY STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL LT, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 4 KNEE RIGHT CEMENTED CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL RT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 220MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR E ARTICULAR SURFACE SEGMENTAL HINGE SHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542001003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 10MM NATURAL-KNEE FLEX PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540200029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 29MM VIVACIT-E ALL POLY KNEE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540200032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 32MM VIVACIT-E ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 9MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 9MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR VERSALOK WITH ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00579004511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 25X40MM M/G KNEE RIGHT MEDIAL LEFT LATERAL TIVANIUM ULTRAPEK SERIES 1 UNICOMPARTMENTAL MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN KNEE LCCK FEMORAL,SIZE C-LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511003320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR C-D 66X42X20MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511004311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E-F 74X46X11MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAIN MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511004323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E-F 74X46X23MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511005323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR G-H-J-K 82X50X23MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 20MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 16MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 200MM 155MM 15MM KNEE FEMUR TIVANIUM NEXGEN OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-4-016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE GRIP "SLEEVE" BOTH|1|HUMANA [1294]||HUMANA [11839]|728.70|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|728.70|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8709SC|SUP|HCPCS C1755||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTRATHECAL INDURA CATHETER 1 PIECE SILICONE 89CM W\SUTURELESS PUMP CONNECTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,001.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,001.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 621519095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 9.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621519115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 11.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621575145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII REV STRAIGHT SMOOTH STEM 14.5MM X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681515145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 14.5MM REVISION KNEE TITANIUM NATURAL-KNEE II FLUTE OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681519115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 11.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 9.5MM NEXGEN 22D 3 THIRD KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 8MM NEXGEN 7D 3 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 8MM NEXGEN 7D 4 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10.5MM NEXGEN 16D 5 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 11.5MM NEXGEN 16D 8-9 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN E KNEE ANTERIOR TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 2 HALF FLUTE 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL C STANDARD 63X53.5MM KNEE RIGHT CRUCIATE RETAIN CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL RT, SIZE 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 0 KNEE LEFT CEMENT CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE RIGHT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591702014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-3 A-B XL 14MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591704020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D XL 20MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591706017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F XL 17MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591706020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-7 F XL 20MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 13MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 18MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 EF 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 11MM KNEE CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 C-D 12MM KNEE RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 14MM KNEE RIGHT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 14MM KNEE CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 16MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 GH 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 14MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 CD 11MM LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 EF 11MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 EF 11MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512600911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-9 GH 11MM KNEE LEFT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 74X50X12MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 82X51X17MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 4 C-D 66X46X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 G-H 82X54X12MM KNEE ALL POLY CEMENTED LPS NEXGEN STERILE GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 E-F 82X50X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 E-F 82X54X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X10MM KNEE UHMWPE CEMENT LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621801816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 16MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621810919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 19MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 16MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621830913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 13MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 4MM NEXGEN KNEE TIVANIUM PMMA UHMWPE PRECOAT CEMENT MODULAR FIXED BEARING STEM MIS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597005504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 89X57MM NEXGEN 10 MACRO KNEE TIVANIUM PMMA CEMENTED MODULAR PEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598605702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X54MM OPTION NEXGEN 8 KNEE TIVANIUM CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL YELLOW YELLOW STRIPE 66X46X4MM OPTION NEXGEN 7D STANDARD FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599805802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 89X54X8MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II .25 KNEE LEFT SET STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE LT, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE RT, SIZE 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595203017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X17MM KNEE PROLONG NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595204017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X17MM KNEE PROLONG NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90595205017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 C-H STANDARD 82X51X17MM KNEE PROLONG NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591704012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 D XL 12MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591705017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E XL 17MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591706010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6-7 F XL 10MM KNEE MOBILE LPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 20MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 C-D 12MM KNEE LEFT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSN MC VE ASF L 11MM 8-9/CD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 CD 14MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 18MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512100916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 GH 16MM KNEE LEFT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42512101010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 10MM KNEE LEFT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 CD 18MM KNEE RIGHT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 CD 13MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-9 C-D 11MM KNEE RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 10MM KNEE CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 12MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-5 EF 18MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540200035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 35MM VIVACIT-E ALL POLY KNEE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HEALIX 5.5MM WITH ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42528200612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 9MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA D KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA G KNEE LEFT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN KNEE LCCK FEMORAL,SIZE C-RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL D KNEE RIGHT SET SCREW LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E KNEE RIGHT SET SCREW LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212853|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR MINILOK ABSORBABLE WITH 2.0 ORTHOCORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,584.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,584.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 631512041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 74X46X33MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511004313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E-F 74X46X13MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511004315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E-F 74X46X15MM KNEE TIBIA ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511004320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E-F 74X46X20MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511005313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR G-H-J-K 82X50X13MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TECT1510AR|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX ANATOMICAL RIGHT 6" X 4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.15|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|510.15|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 620508110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCO9|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PARIETEX POLYESTER ROUND 3.6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,173.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,173.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 620708302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 3 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 2 KNEE LATERAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 4 KNEE MEDIAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 1 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0010303|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH HERNIA CIRCLE VENTRALEX MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,740.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00541001602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CRUCIATE RETAIN CEMENTED NATURAL-KNEE FLEX GENDER SOLUTIONS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B KNEE LEFT CEMENTED NEXGEN LPS-FLEX ZIMALOY PROLONG PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599201201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B MICRO 58X49.5MM KNEE LEFT POSTERIOR STABILIZE LPS NEXGEN ZIMALOY POROUS STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CSTI POROUS FEMORAL RT, SIZE 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CSTI POROUS FEMORAL LT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT XL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT 2XL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT XL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT MEDIUM KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 67.5MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 72.5MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 5MM KNEE FEMUR POSTERIOR PEG INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL VANGUARD 360 5MM OFFSET KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,092.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,092.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK5.3MM 54X8MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK12.3MM 54X15MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK9.3MM 59X12MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK15.3MM 69X18MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.3MM 74X25MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672009200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672009203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672011100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672011103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672013101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672016201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672019100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 222323|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM 2 HEALIX ADV MPK RAPIDE BCRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 672025200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 25MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672519103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 19MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672522203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 22MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522008000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 24MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 18MM NEXGEN STRAIGHT KNEE TIBIA ROTATE HINGE 200MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 11MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 13MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 130MM 15MM NEXGEN KNEE FEMUR TIVANIUM SHARP FLUTED REPLACEMENT SCREW 175MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CRUCIATE RETAIN CEMENTED NATURAL-KNEE FLEX GENDER SOLUTIONS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596401801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN LPS-FLEX OPTION FEMORAL, H-LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596401802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN LPS-FLEX OPTION FEMORAL, H-RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596201652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F KNEE RIGHT NEXGEN LPS-FLEX POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT XS KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT LARGE KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT 2XL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 80MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 55MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 62.5MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 10MM KNEE FEMUR POSTERIOR PEG INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL VANGUARD 360 2.5MM OFFSET KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,092.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,092.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERTER SURGICAL LOCK BAR VANGUARD XP G1 TIBIA 69-75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 69-75MM VANGUARD XP G2 KNEE LOCK BAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT RESURFACE REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE LEFT RESURFACE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,579.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,579.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT RESURFACE REDUCE ROTATE HINGE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 10CM COMPRESS KNEE LEFT POROUS SEGMENTAL REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,188.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,188.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ3 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CKP-4502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR POPLOK 4.5 WITH #2 HI-FI SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,099.08|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,099.08|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00544605441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ4 5MM 41X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ3 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ6 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 FULL 10MM TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 5MM TIBIA LEFT MEDIAL RIGHT LATERAL TRABECULAR METAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800429|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 15MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5MM 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM 5MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM 20MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM LCCK NEXGEN SMALL CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 40MM LCCK NEXGEN SMALL CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM LCCK NEXGEN MEDIUM CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 40MM LCCK NEXGEN MEDIUM CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545002135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 35MM MEDIUM CONE METAPHYSIS LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545002236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 35MM NEXGEN LARGE CONE KNEE RIGHT METAPHYSIS TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545006721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 15-30MM NEXGEN 67MM CONE LARGE STEP KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 8.5CM KNEE LEFT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 14MM OSS POLY KNEE TIBIAL STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 20MM OSS POLY KNEE TIBIAL STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 22MM OSS POLY KNEE REDUCE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 16MM OSS UHMWPE KNEE TIBIAL AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 12MM OSS KNEE REDUCE LATERAL STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 18MM OSS KNEE REDUCE LATERAL STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS SHORT KNEE NONMODULAR 67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS SHORT KNEE NONMODULAR 71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 11MM OSS 7CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 59MM OSS POLY HYBRID STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 71MM OSS POLY HYBRID STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 5CM OSS PROXIMAL OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,406.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,406.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 5CM OSS PROXIMAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 71MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 71MM OSS LONG KNEE NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 75MM OSS LONG KNEE NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 15MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 17MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 14.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 15.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 150MM 22.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 225MM 12.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 225MM 18.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 11MM COLLAR OSS BOW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 11MM COLLAR OSS BOW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 13.5MM FINN POROUS STRAIGHT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS UNIVERSAL 10MM TIBIA 71/75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 5CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 11CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150478|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION OSS KNEE POLYETHYLENE LOCK COMPRESSION MOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 24CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151861|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 20CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 29CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151871|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 30CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153861|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION LOCKING ROTATING HINGE KNEE FINN POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|687.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|687.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 8.5CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 18CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 10CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 12CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING FEMORAL OSS KNEE POLY SET AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS XS SPDL WITH PINS 800LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM SPDL WITH PINS 400LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG SHT SPDL W PINS 600LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE LT, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE RT, SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 6 FLUTE KNEE PRECOAT MOBILE STEMMABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 00 KNEE LEFT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 KNEE RIGHT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MGII KNEE SLF-TAP BONE STR SCRW, 6.5MM DIAX55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579002100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 21X42MM KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AP03000H|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP INFS CDMN 3K INTRASPINAL HFLO CNST FLWPAIN MGMT 30ML|1|HUMANA [1294]||HUMANA [11839]|15,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579003200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE++ 28X60MM KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578806008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 30X48X8MM KNEE TIBIAL UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE SERIES 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578808010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 35X56X10MM KNEE SERIES 5 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611001013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611003013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5-6 13MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG412|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDECATH 4 FRENCH X .038 GUIDEWIRE X 65CM LONG STRAIGHT TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 6-7 EF 11MM KNEE RIGHT VIVACIT-E PERSONA MEDIAL CONGRUENT STERILE MC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 12MM KNEE CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 G-H 14MM KNEE RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522100920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 8-11 GH 20MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 GH 11MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522101113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12 J 13MM KNEE RIGHT CRUCIATE RETAIN VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 7 HALF FLUTE 5MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL NEXGEN LEGACY 16D 3D 8 HALF FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ5 5MM 31X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544605641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 7D SZ6 5MM 41X34 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 0D 5 31X31X5MM KNEE LCCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544705536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCCK 0D SZ5 5MM 36X31 CPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,884.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 5MM TIBIA RIGHT MEDIAL LEFT LATERAL TRABECULAR METAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 FULL 10MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3 20MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 3MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 15MM LEFT LATERAL RIGHT MEDIAL KNEE TIBIA TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,470.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5MM 30MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,436.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G470-0007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER-JOINT W/GROMMET SIZE-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00544800710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7MM FULL 10MM KNEE TIBIA TRABECULAR METAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,888.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK15.3MM 54X18MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.3MM 64X25MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK7.3MM 69X10MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK9.3MM 74X12MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 69/64MMX10MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672011101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672011200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672011203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672016200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-013-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION C LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672016203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672022103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 22MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672022201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 22MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672025100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 25MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672509100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672516101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672519203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 19MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522001100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR DOME 7MM 32MM 1 PEG I/B II UHMWPE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620400420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 +4 KNEE LEFT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620401420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 +4MM KNEE RIGHT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-014-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION D LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620401440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 +4M KNEE RIGHT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 4 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 38MM OFFSET KNEE PROXIMAL BASIC SEGMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,981.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,981.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT KNEE ZIMMER SEGMENTAL SYSTEM STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,215.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,215.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588001201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B 58X50MM KNEE LEFT ROTATE HINGE NEXGEN ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,632.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,632.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588009016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F KNEE FEMUR TIBIA ROTATING HINGE NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,150.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502003012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3 12MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502004021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4 21MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502010009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 9MM KNEE PROXIMAL HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-015-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION E LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585002026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR B 26MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585006017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F 17MM KNEE ROTATE HINGE SEGMENTAL MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588003023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-6 C 64X40X23MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588004012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-6 D 70X40X12MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588004017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-6 D 70X40X17MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588004026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-6 D 70X40X26MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588006026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 F 77X44X26MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR MEDIUM ELLIPSE MOST OPTIONS ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 17MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 11MM SEGMENTAL STRAIGHT FLUTE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-016-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION F LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 9MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMORAL BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 11MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMORAL BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOST TOTAL FEMUR SEGMENT 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,137.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,137.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 27MM 14MM CEMENTED MOST OPTIONS CSTI BOW HEXAGON KNEE INTRAMEDULLARY NAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,982.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,982.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 TAPER HALF 20MM KNEE TIBIA ROTATING HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 TAPER HALF 15MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 8 20MM RIGHT LATERAL LEFT MEDIAL KNEE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 8 20MM LEFT LATERAL RIGHT MEDIAL KNEE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-017-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION G LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR B FEMUR SEGMENTAL HINGE SERVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR ZIMMER B FEMORAL HINGE SERVICE SEGMENTAL SYSTEM XT STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630007103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 7MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542000800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 8MM KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542000802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 8MM NATURAL-KNEE FLEX PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542001000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 10MM NATURAL-KNEE FLEX PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206629|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 29MM NEXGEN PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 14MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 9MM KNEE VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-014-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION D RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579008511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 35X56MM M/G KNEE RIGHT MEDIAL LEFT LATERAL TIVANIUM ULTRAPEK SERIES 5 UNICOMPARTMENTAL MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79-81MM VANGUARD XP G2 KNEE LOCK BAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 7CM KNEE LEFT SEGMENTAL OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT RESURFACE REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT RESURFACE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT RESURFACE REDUCE ROTATE HINGE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 7CM KNEE RIGHT SEGMENTAL REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-015-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS E-R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,704.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,704.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 7CM KNEE RIGHT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8.5CM KNEE LEFT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 8.5CM KNEE RIGHT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 12MM OSS UHMWPE KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 16MM OSS POLY KNEE REDUCE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 11MM OSS 5CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 13MM OSS 5CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 7CM OSS PROXIMAL OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,202.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,202.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-017-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION G RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 7CM OSS PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,822.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,822.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PLATE 59MM NONMODULAR OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 55MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9CM OSS UHMWPE KNEE REDUCE MODULAR BODY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 63MM OSS SHORT KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 71MM OSS KNEE MODULAR AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 10MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 13MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 13MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 13.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 16MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 150390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 19.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150398|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 19.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 300MM 12.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 9MM COLLAR OSS STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 12MM SPLINE OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION OSS LARGE TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 13CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD122065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 55/59MMX20MM OSS KNEE LEFT MEDIAL RIGHT LATERAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 3CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 15CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 24MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 150477|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING FEMORAL OSS KNEE POLYETHYLENE AUXILIARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|638.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|638.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AXLE TIBIAL OSS KNEE LOW FRICTION INTERFACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,384.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,384.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION OSS KNEE POLYETHYLENE LOCK BUMPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,276.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,276.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151866|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 25CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 10CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 10CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 20CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 18CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 24CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING FEMORAL OSS HIP POLYETHYLENE REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,276.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,276.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 20CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 100MM 145MM 13MM CEMENTED KNEE TIVANIUM NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 200MM 18MM KNEE FEMUR TIVANIUM NEXGEN OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621500090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 90MM NATURAL-KNEE II KNEE TIBIA TITANIUM REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621500155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 155MM NATURAL-KNEE II TIBIA TITANIUM REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621512125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 125MM 12.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681515185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 18.5MM REVISION KNEE TITANIUM NATURAL-KNEE II FLUTE OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681517125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 175MM 12.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681519125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 12.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681519145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 14.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 7.6MM NEXGEN 7D 2 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 24CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 HALF 10MM KNEE TIBIAL PRECOAT TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 9.5MM NEXGEN 16D 4 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10.5MM NEXGEN 16D 6 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 11.5MM NEXGEN 16D 7 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10.5MM NEXGEN 22D 7 THIRD KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 3 HALF FLUTE 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 5 HALF FLUTE 5MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL NEXGEN LEGACY 16D 3D 6 HALF FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL NEXGEN LEGACY 16D 3D 7 HALF FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 28CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E STANDARD 72X61.5MM KNEE RIGHT CRUCIATE RETAINING CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 54X8.5MM I/B II 16D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 54X13MM I/B II 26D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 69X26MM I/B II 20D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598809000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET FEMUR STEM LEGACY NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620504143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 4 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 00 KNEE LEFT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 32CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 1 KNEE RIGHT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE LEFT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 0 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 1 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 40CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 14MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178496|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG M-H F SPINDLE 12MM PCHA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 19MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 22MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 10MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178568|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 26MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TAPER FEMUR LOCK SCREW COMPRESSION COMPRESS OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,729.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,729.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 25MM MINI COMPRESS C600LB STANDARD HUMERAL REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 42CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 30MM MINI COMPRESS C600LB STANDARD HUMERAL ANTIROTATION REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 25MM MINI COMPRESS C400LB SHORT HUMERAL REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD ARTHRO NL 3CM DIASL CNCTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 82X51X10MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 82X51X12MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 82X54X10MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 82X54X12MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 C-D 66X42X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X17MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 18CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 C-D 74X50X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 E-F 82X54X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621810909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 9MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621830909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 9MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621830911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 11MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595002701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 1MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595004701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 5MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597002501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PURPLE PURPLE STRIPE 58X40X1MM NEXGEN 1 MICRO KNEE TIVANIUM PMMA CEMENTED MODULAR PEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598003712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 4MM 4+ STANDARD METAL PRECOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598603701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL YELLOW STRIPE 66X42MM NEXGEN OPTION 3 KNEE TIVANIUM CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 24CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598604702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL GREEN GREEN STRIPE 74X50MM OPTION NEXGEN 6 KNEE TIVANIUM CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE LT, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE LT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE RT, SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE RT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE RT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591606000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION 6 FLUTE KNEE MOBILE STEMMABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 7 FLUTE KNEE ZIMALOY PRECOAT MOBILE STEMMABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 KNEE LEFT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE LEFT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 28CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 KNEE RIGHT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 32CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146398|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146596|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 34CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 36MM 60MM LARGE CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 38MM 67MM LARGE CONE KNEE LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 50MM LCCK NEXGEN MEDIUM CONE KNEE RIGHT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,335.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM MEDIUM CONE KNEE DIAPHYSIS LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545001930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 30MM LARGE CONE DIAPHYSIS LEFT TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00545005201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 52-15MM SMALL FULL CONE KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 15MM NEXGEN C KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN E KNEE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00549003602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 10MM NEXGEN F KNEE POSTERIOR TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,155.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 36CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 64X24MM I/B II 20D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 74X28MM I/B II 20D KNEE FEMUR TIVANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620508141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE LEFT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 2 KNEE RIGHT MEDIAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 3 KNEE RIGHT LATERAL REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 3 KNEE RIGHT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 0 KNEE TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 38CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620704302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 4MM NATURAL-KNEE II 2 KNEE TITANIUM NONPOROUS CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 3 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 2 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621400610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0/1 +14MM KNEE LEFT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 +4MM KNEE RIGHT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 +4MM KNEE RIGHT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0-1 +14MM KNEE LEFT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 14MM NEXGEN STRAIGHT ROTATE HINGE 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 10MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 12MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 40CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 60MM 105MM 13MM CEMENTED KNEE TIVANIUM NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 100MM 11MM NEXGEN OFFSET KNEE TIBIA TIVANIUM REPLACEMENT SCREW STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,323.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,323.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621500120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 120MM NATURAL-KNEE II TIBIA TITANIUM REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621500180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 180MM NATURAL-KNEE II TIBIA TITANIUM REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621512105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 125MM 10.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681517185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 175MM 18.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681517225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 175MM 22.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681519135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 13.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL NEXGEN 16D 2 HALF WEDGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 8.7MM NEXGEN 22D 2 THIRD KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 42CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 9.5MM NEXGEN 16D 3 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 FULL 10MM KNEE TIBIA ROTATE HINGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 9MM NEXGEN 7D 6 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 FULL 10MM KNEE TIBIAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA D KNEE LEFT PARTIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA E KNEE LEFT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA F KNEE RIGHT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA H KNEE LEFT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL D KNEE LEFT SET SCREW LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 16CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE LEFT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599403028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 66X42X28MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 74X46X28MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 74X46X28MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511004317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR E-F 74X46X17MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511005315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR G-H-J-K 82X50X15MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAINING MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK9.3MM 54X12MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK18.3MM 54X21MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 18CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK9.3MM 64X12MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK18.5MM 64X21MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK5.3MM 69X8MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK12.3MM 74X15MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 64/59MMX15MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|YOKE TIBIAL 12MM OSS KNEE COCR BUSHING AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,968.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,968.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG SPDL WITH PINS 600LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM SHT SPDL W PINS 400LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 12MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 24MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 24CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 17MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 20MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 15MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL OSS TAPER FEMALE TO FEMALE CPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178558|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 16MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 18MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178573|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 72MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|220.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT 800# LARGE SPINDLE HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR JOINT 1CM OSS ELLIPTICAL MODULAR ARTHRODESIS SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR JOINT 3CM OSS ELLIPTICAL MODULAR ARTHRODESIS SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 28CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 66X42X12MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 74X46X17MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 E-F 74X50X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 G-H 82X50X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 C-D 74X50X17MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621801809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 9MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621801909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 9MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 11MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595002702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 2MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 32CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595003712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 4+ MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595005702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 8MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595005703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 9MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PURPLE PURPLE STRIPE 48X10X1MM OPTION NEXGEN 7D MICRO FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PURPLE PURPLE STRIPE 62X41X2MM OPTION NEXGEN 7D MICRO FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599802801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PURPLE PURPLE STRIPE 58X40X1MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE LT, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE RT, SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE RIGHT CEMENT MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591601001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 1 FLUTE KNEE PRECOAT MOBILE STEMMABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 34CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 5 FLUTE KNEE ZIMALOY PRECOAT CEMENTED MOBILE STEMMABLE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 KNEE LEFT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 5 KNEE LEFT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MGII KNEE SLF-TAP BONE STR SCRW, 6.5MM DIAX20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUGMENTATION 35MM 6.5MM MG II KNEE TIVANIUM SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F STANDARD 77X65.5MM KNEE RIGHT CRUCIATE RETAINING CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL A MICRO 54X45.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE NEXGEN LPS OPTION ZIMALOY STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 0 KNEE RIGHT CEMENTED CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL LT, SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 36CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CRUCIATE RETAIN CEMENTED NATURAL-KNEE FLEX GENDER SOLUTIONS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CRUCIATE RETAIN CEMENTED NATURAL-KNEE FLEX GENDER SOLUTIONS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 38CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT SMALL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT 2XL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT SMALL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT LARGE KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 65MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 4 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 4 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 2 KNEE LEFT LATERAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 00 KNEE MEDIAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621504401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 4 KNEE LATERAL CSTI POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 40CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 0 KNEE MEDIAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 0 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 3 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 3 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 4 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 5 KNEE LEFT LATERAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502001009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1 9MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502002012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2 12MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502003009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3 9MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502010012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 12MM KNEE PROXIMAL HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 42CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 23MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR D 26MM KNEE ROTATE HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-6 B 58X40X14MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-6 B 58X40X17MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588006020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 F 77X44X20MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588000302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 67X46MM NEXGEN 3 KNEE ZIMALOY PMMA UHMWPE PRECOAT ROTATE HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,212.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE RIGHT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 KNEE RIGHT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 KNEE RIGHT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595006775|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM NEXGEN KNEE TIBIA DROP DOWN PLATE MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 16CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MGII KNEE SLF-TAP BONE STR SCRW, 6.5MM DIAX40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578804014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 25X40X14MM KNEE UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE SERIES 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578806014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 30X48X14MM KNEE SERIES 3 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578807014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 32X52X14MM KNEE SERIES 4 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578808012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 35X56X12MM KNEE SERIES 5 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 20CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146198|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 24CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183588|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 28CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620708214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 8MM NATURAL-KNEE II 4 KNEE RIGHT LATERAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620712201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL 12MM NATURAL-KNEE II 1 KNEE RIGHT MEDIAL CONSTRAINED REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,406.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001332|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 32CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620800102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 2 KNEE LEFT MEDIAL TITANIUM NONPOROUS CONSTRAINED REVISION ADAPTER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,790.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621508301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 3 KNEE LATERAL CSTI POROUS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641504000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 4MM NATURAL-KNEE II 00 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641508010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER TIBIAL 8MM NATURAL-KNEE II 0 KNEE LEFT MEDIAL TITANIUM UHMWPE POROUS CEMENT MODULAR BASEPLATE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B KNEE LEFT ZIMMER STERILE SEGMENTAL SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,215.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,215.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 502002016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2 16MM KNEE ROTATING HINGE MOST OPTIONS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585006020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F 20MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585006026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR F 26MM KNEE ROTATING HINGE SEGMENT MACHINE MOLD MOST II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-6 B 58X40X26MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588003017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 2-6 C 64X40X17MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 34CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588005023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 4-6 E 74X44X23MM KNEE ROTATING HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588006012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 F 77X44X12MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588006023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 F 77X44X23MM KNEE ROTATE HINGE MACHINE MOLD ZIMALOY UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585000310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL PROXIMAL TIBIA, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,074.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,074.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 19MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 9MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMORAL STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 11MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMORAL STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN F KNEE ANTERIOR TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 7MM NEXGEN LEGACY 3D 2 FULL FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 4 HALF FLUTE 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001336|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 36CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 5 HALF FLUTE 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 6 HALF FLUTE 5MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F STANDARD 77X65.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G STANDARD 81X70.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597001802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL H MACRO 85X76MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 2 KNEE RIGHT CEMENTED CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE RIGHT CRUCIATE RETAIN CEMENTED NATURAL-KNEE FLEX GENDER SOLUTIONS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595601702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G 76.5X70.4MM KNEE RIGHT CEMENT CR-FLEX OPTION NEXGEN ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 38CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT XS KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672011201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672013100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672016100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 40CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672016103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672022200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 22MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672022203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 22MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672025101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 25MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672509101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672513101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672516103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672519201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672525203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 25MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X51MM NEXGEN 7 WEDGE KNEE TIVANIUM PMMA PRECOAT CEMENT MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 42CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522002100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 59X44X54MM I/B II KNEE TIVANIUM UHMWPE CEMENT MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522002700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 70MMX52MMX59+ MM I/B II KNEE TIVANIUM UHMWPE CEMENT MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620400410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 +4MM KNEE LEFT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620401430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 +4MM KNEE RIGHT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621400600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 00/0 +14MM KNEE LEFT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 +4MM KNEE RIGHT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 +4MM KNEE RIGHT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595006700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM NEXGEN KNEE TIBIA DROP DOWN PLUG MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579002300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ 21X44MM KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 16CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578806012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 30X48X12MM KNEE TIBIAL UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE SERIES 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578808014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 35X56X14MM KNEE SERIES 5 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611003009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5-6 9MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 20CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR PLASMA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 70MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 65MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 24CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150495|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 8.5CM KNEE RIGHT SEGMENTAL OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT RESURFACE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT RESURFACE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT RESURFACE REDUCE ROTATE HINGE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 7CM KNEE LEFT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE LEFT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153992|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64X22MM UHMWPE KNEE MODULAR TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 14MM OSS POLY KNEE REDUCE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 18MM OSS POLY KNEE REDUCE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 28CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 20MM OSS KNEE REDUCE LATERAL STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 79MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 55MM OSS POLY HYBRID STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 5CM OSS PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,373.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,373.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 47MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OSS KNEE TAPE MODULAR AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 75MM OSS KNEE MODULAR AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 83MM OSS KNEE MODULAR TAPE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 67MM OSS LONG KNEE NONMODULAR AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,239.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,239.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 63MM AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 34CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 12.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150389|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 18.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 9MM CEMENT SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 15MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN STRAIGHT FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL STR FLUTED STEM, 9X190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 14MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585205415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 15MM CEMENTED SEGMENTAL KNEE FEMUR TRABECULAR METAL NEXGEN BOW FLUTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,155.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 13MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 14MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 18MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 36CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 FULL 10MM KNEE TIBIA ROTATE HINGE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00588002610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 FULL 10MM KNEE TIBIA ROTATING HINGE TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,066.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 TAPER HALF 20MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 TAPER HALF KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN F KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEG INTERCALARY SEGMENT, 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 30MM NEXGEN KNEE TIBIAL FIBULA TIVANIUM MALE TO FEMALE TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585204025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 25MM KNEE TRABECULAR METAL COLLAR 9-16MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585204035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 35MM KNEE TRABECULAR METAL COLLAR 9-16MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 38CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 CD 11MM RIGHT VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-11 EF 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522601111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 10-12 J 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541800803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 8MM NATURAL-KNEE FLEX ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541801000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 10MM NATURAL-KNEE FLEX ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630007100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 7MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 41MM NEXGEN PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42540200038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 38MM PERSONA VIVACIT-E ALL POLY KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620001101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 10MM NATURAL-KNEE II METAL POLYETHYLENE POROUS CSTI KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 10MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 40CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 9MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 12MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E KNEE LEFT SET SCREW LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,121.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F KNEE LEFT SET SCREW LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL E 72X61.5MM KNEE RIGHT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CRK NONPOROUS FEMORAL RT, SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225246010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 46CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599402217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D MICRO 58X40X17MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE NEXGEN LCCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225419510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 19.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225422510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 22.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX20MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX24MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225424010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 24CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225425510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 25.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225427010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 27CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD E-POLY ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 28MM ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 31MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225419511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 19.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 28MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR XS 28MM 4 SPIKE ARCOM POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM KNEE COCR I BEAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 19MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,605.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585207415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 15MM SEGMENTAL VARIABLE STIFFNESS KNEE FEMUR TRABECULAR METAL PRECOAT NEXGEN BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,472.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOST FEMORAL SEGMENT 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,892.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,892.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 500000040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 25MM 12MM CEMENTED MOST OPTIONS CSTI BOW HEXAGON KNEE INTRAMEDULLARY NAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,982.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,982.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225421011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 21CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 TAPER HALF 15MM KNEE TIBIA ROTATING HINGE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 4 HALF TAPER 20MM KNEE TIBIAL RIGHT MEDIAL LEFT LATERAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800529|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 5 TAPER HALF 20MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 TAPER HALF 15MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 20MM NEXGEN C KNEE DISTAL TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,506.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585003219|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INSTRUMENT CURVE HIP 4MM SEGMENTAL WASHER TRABECULAR METAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,179.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-FEMALE, 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,359.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585004820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SEGMENTAL FEM/TIB MALE-MALE, 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,954.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR C ARTICULAR SURFACE SEGMENTAL HINGE SHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,946.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR B ARTICULAR SURFACE SEGMENTAL HINGE SHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225422511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 22.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585007514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TKR D ARTICULAR SURFACE SEGMENTAL HINGE SHIELD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00585204217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 30MM KNEE TIVANIUM SMOOTH COLLAR 17-19MM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,632.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 CD 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42522600611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-5 EF 11MM KNEE RIGHT MID LEVEL CONSTRAINT VIVACIT-E PERSONA STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541800800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 0 8MM NATURAL-KNEE FLEX ALL POLY KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT MEDIUM KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT XS KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT MEDIUM KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT XS KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT XS KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225424011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 24CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179078|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|331.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179158|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL ASCENT KNEE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|331.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 62.5MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 80MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT RESURFACE OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT RESURFACE OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150496|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 8.5CM KNEE LEFT SEGMENTAL OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT RESURFACE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT RESURFACE REDUCE ROTATE HINGE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,250.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 8.5CM KNEE LEFT SEGMENTAL REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225425511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 25.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 8.5CM COMPRESS KNEE LEFT POROUS SEGMENTAL REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,050.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,050.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE RIGHT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 8.5CM KNEE RIGHT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 7CM KNEE RIGHT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE RIGHT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 12CM OSS UHMWPE KNEE REDUCED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,878.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 13MM OSS 7CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 90MM OSS KNEE TIBIA PROXIMAL MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,655.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,655.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1-2 +14MM KNEE LEFT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3-4 +14MM KNEE LEFT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225427011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 27CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 22MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 13MM NEXGEN STRAIGHT KNEE TIBIA ROTATE HINGE 200MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 12MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 22MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 24MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 11MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 22MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 30MM 75MM 13MM CEMENTED KNEE TIVANIUM NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN OFFSET STEM EXT 13MM DIA X 200MM,(155MM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621500215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION 215MM NATURAL-KNEE II TIBIA TITANIUM REVISION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225419512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 19.5CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621575125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 12.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681517165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 175MM 16.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681517205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 175MM 20.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681519185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 18.5MM REVISION KNEE TITANIUM NATURAL-KNEE II STRAIGHT FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 2 FULL 10MM KNEE TIBIAL TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10MM NEXGEN 22D 6 THIRD KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 6 HALF 5MM KNEE TIBIAL PRECOAT TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN G KNEE ANTERIOR TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 51MM OSS POLY HYBRID STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 9CM OSS ELLIPTICAL PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,278.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,278.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225421012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 21CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 51MM OSS SHORT KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 3CM OSS PROXIMAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 63MM OSS LONG KNEE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,239.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,239.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113459|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 9CM OSS KNEE MODULAR AVL ANTILUXATION REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 9CM OSS KNEE COCR MODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 18MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 17MM CEMENTED OSS INTRAMEDULLARY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,136.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,136.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 11.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225422512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 22.5CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 13.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 15.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 11MM OSS PROXIMAL CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150447|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 15MM OSS PROXIMAL CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150449|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 12.5MM OSS PROXIMAL POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150492|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 15MM COLLAR OSS STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 10MM SPLINE OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150429|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS 20MM TIBIA RIGHT MEDIAL LEFT LATERAL 63/67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS 20MM TIBIA RIGHT MEDIAL LEFT LATERAL 71/75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225424012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 24CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION OSS FEMUR RIGHT RESURFACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL OSS SMALL KNEE AUGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225425512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 25.5CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM TRADITION AGC KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225430013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 30CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150397|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 18.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 20.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 10.5MM OSS PROXIMAL POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 152MM 11.5MM FINN POROUS STRAIGHT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,369.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS UNIVERSAL 10MM TIBIA 63/67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS 20MM TIBIA LEFT MEDIAL RIGHT LATERAL 71/75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225421007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 7MM 21CM HUM BILAT MDN IM SLD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION 3CM OSS ANTERIOR RESURFACE FLANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,716.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,716.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL OSS LARGE TAPER KNEE OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL OSS KNEE OSSEOTI DIAPHRAM PLATFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD122061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 55/59MMX10MM OSS UNIVERSAL KNEE REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD122063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 47/51MMX20MM OSS KNEE LEFT MEDIAL RIGHT LATERAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110008542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION OSS LOCK MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 13CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 17CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150481|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW OSS FEMUR DIAPHYSEAL LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD OSS HIP FEMUR SEGMENTAL STACK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|451.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|451.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225419508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 19.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 27CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 28CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS 2MM SPIKE WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151862|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 21CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151867|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 26CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING FEMORAL FINN KNEE POLYETHYLENE MODULAR ROTATE HINGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|647.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|647.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 152X13X8.5MM FINN KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G 74X46X28MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G 74X46X33MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511005311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR G-H-J-K 82X50X11MM KNEE ANTERIOR POSTERIOR LIP CRUCIATE RETAIN MACHINE MOLD UHMWPE MG II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225421008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 21CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK5.3MM 59X8MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK5.3MM 64X8MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK9.3MM 69X12MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK5.3MM 74X8MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 64/59MMX12MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672009100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672009101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672013200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672019200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672509200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225422508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 22.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672511103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672511203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672516100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672522101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 22MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672525201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 25MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522001500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 10MM 40MM 1 PEG I/B II UHMWPE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 +4MM KNEE LEFT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183590|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225424008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 24CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225425508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 25.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX20MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225427008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 27CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225419509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 19.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225421009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 21CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX12MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX12MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX16MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX10MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX20MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225422509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 22.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225424009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 24CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591101137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 NATURAL-KNEE POLYETHYLENE KNEE STERILE DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630010105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 10MM CRUCIATE RETAINING NATURAL-KNEE II SULENE-PE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00542000803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 8MM NATURAL-KNEE FLEX PROLONG KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 11MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579007511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 32X52MM M/G KNEE RIGHT MEDIAL LEFT LATERAL TIVANIUM ULTRAPEK SERIES 4 UNICOMPARTMENTAL MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579008512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 35X56MM M/G KNEE LEFT MEDIAL RIGHT LATERAL TIVANIUM ULTRAPEK SERIES 5 UNICOMPARTMENTAL MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA E KNEE RIGHT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA F KNEE LEFT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225425509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 25.5CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA H KNEE RIGHT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42538000902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL PERSONA J KNEE RIGHT MEDIAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G KNEE RIGHT SET SCREW CONSTRAIN LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL C 63X53.5MM KNEE RIGHT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL F 77X65.5MM KNEE LEFT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597601701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G 81X70.5MM KNEE LEFT CRUCIATE RETAIN REVISION CEMENTED AUGMENTABLE PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,078.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620512031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II CSTI STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 00 KNEE LEFT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631512021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225427009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 27CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632000200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE RIGHT CEMENTED REVISION CONSTRAIN NATURAL-KNEE II COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,459.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 2 HALF FLUTE 5MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 4 HALF FLUTE 5MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL NEXGEN LEGACY 16D 3D 5 HALF FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800627|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN LEGACY 3D 6 HALF FLUTE 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G STANDARD 81X70.5MM KNEE RIGHT CRUCIATE RETAIN CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL LT, SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 5 KNEE LEFT CEMENTED CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224005000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT ORTH 6.5MM MDN FEM CORT SS 2 LD IM NL STRL LF|1|HUMANA [1294]||HUMANA [11839]|533.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT GENDER SOLUTIONS NATURAL-KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE LEFT CRUCIATE RETAIN CEMENTED NATURAL-KNEE FLEX GENDER SOLUTIONS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 LEFT KNEE GENDER SOLUTIONS NATURAL-KNEE FLEX NONPOROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00575001701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G KNEE LEFT CEMENTED PRECOAT NEXGEN CR-FLEX GENDER SOLUTIONS ZIMALOY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL A KNEE LEFT CEMENTED PRECOAT NEXGEN LPS-FLEX ZIMALOY PROLONG PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CRUCIATE RETAIN NATURAL-KNEE II CSTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541201801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1181-150-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBE COMPRESSION 8 HOLE 150 DEGREE FREE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,402.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,402.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT 2XL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 23CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL OSS MEDIUM TAPER KNEE OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,143.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,143.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD122060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 47/51MMX10MM OSS UNIVERSAL KNEE REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD122062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 47/51MMX20MM OSS KNEE RIGHT MEDIAL LEFT LATERAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 23CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4CM KNEE DIAPHYSEAL OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150493|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|YOKE TIBIAL OSS KNEE REINFORCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151827|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS 4MM SPIKE WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151829|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS 8MM SPIKE WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 8.5CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 16CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 14CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 18CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS XS SPDL WITH PINS 400LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC COMPRESS C400LB STANDARD ELLIPTICAL KNEE ANTIROTATION PIN SALVAGE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC COMPRESS C800LB STANDARD ELLIPTICAL KNEE ANTIROTATION PIN SALVAGE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS XS SHT SPDL W PINS 600LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 34MM TMX T15 FT TIB CANC DIST ST TIP TPR HD SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 13MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 15MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 44MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 14MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183563|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD POROUS KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114613000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 130MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX20MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX22MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SOLID 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX20MM VANGUARD ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SOLID 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 8.5CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 10CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 20CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 22.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 24CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG SPDL WITH PINS 400LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM SHT SPDL W PINS 600LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG SHT SPDL W PINS 400LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 22MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM M F SPINDLE 12MM PC HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 16MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 23MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL OSS TAPER FEMALE TO MALE CPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL OSS TAPER MALE TO MALE CPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 25MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 68MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|220.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178579|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT 600# LARGE SPINDLE HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT XS 600LB SPNDL W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT XS 800LB SPNDL W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178759|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 30MM MINI COMPRESS C800LB STANDARD HUMERAL ANTIROTATION REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522006800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 40MM 15MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 16MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 19MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 16MM NEXGEN STRAIGHT KNEE TIBIA ROTATE HINGE 200MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,280.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 14MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 27.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 15MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 18MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN OFFSET STEM EXT 16MM DIA X 200MM,(155MM)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621512185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 125MM 18.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621519135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 13.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621519155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 190MM 15.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621575165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 16.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621575185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 18.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 681515165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 16.5MM REVISION KNEE TITANIUM NATURAL-KNEE II FLUTE OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,880.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 15MM NEXGEN 26D 3 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 32.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 17MM NEXGEN 26D 5 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10MM NEXGEN 22D 5 THIRD KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 7 HALF 5MM KNEE TIBIAL PRECOAT TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 10MM NEXGEN 7D 8 FULL KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL NEXGEN LEGACY 16D 3D 3 HALF KNEE TIVANIUM PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD E-POLY ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 37.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 34MM 1 PEG WIRE ASCENT ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR SMALL 31MM 3 POST ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR LARGE 37MM 3 POST ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 25MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR ASYMMETRIC 8MM 25MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184791|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR ASYMMETRIC 8MM 28MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 23MM 1 PEG ARCOM KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 42.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 23MM 1 PEG ARCOM KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX8MM TRADITION AGC KNEE HIGH POST POSTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX8MM TRADITION AGC KNEE HIGH POST POSTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX16MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX20MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 52.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 85X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM 15MM PRIMARY FIN EXTENSION BIOMET ASCENT MAXIM TITANIUM KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM AGC FLUTE KNEE BASE PRIMARY MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL TRAY TAPER CAP REGENEREX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS PARTIAL KNEE PHASE 3 TWIN PEG UNICOMPARTMENTAL OXFORD COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 57.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL PARTIAL KNEE PHASE 3 TWIN PEG UNICOMPARTMENTAL OXFORD COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159567|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159585|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159795|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL B8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 62.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VANGUARD M UNI BRNG D7 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL A8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD C RIGHT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL A3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL F3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 67.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL F4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ D RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OXFORD B LEFT MEDIAL PPS HA PARTIAL KNEE REPLACEMENT CEMENTLESS SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OXFORD C KNEE RIGHT MEDIAL CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 72.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599403010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 66X42X10MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE NEXGEN LCCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599403233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 66X42X33MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 74X46X33MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE LCCK NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G 74X46X14MM KNEE NEXGEN LCCK GREEN STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK12.3MM 59X15MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK7.3MM 64X10MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK12.3MM 64X15MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522003505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK15.3MM 74X18MM KNEE POSTERIOR STABILIZED MACHINE MOLD UHMWPE I/B II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,661.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522005404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 69/64MMX15MM KNEE TIBIA CONDYLE POSTERIOR STABILIZED I/B II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225206055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 60MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522403307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR THK22.5MM 64X25MM KNEE REVISION MACHINE MOLD TIVANIUM UHMWPE I/B II CCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672013203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672016101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672019201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672022100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 22MM KNEE LEFT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672025201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 25MM KNEE RIGHT UHMWPE CONSTRAINED REVISION NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672511101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672513100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672513103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672513200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225206555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 65MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672516200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE RIGHT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT SMALL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT SMALL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT LARGE KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 24MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT 2XL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 57.5MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT RESURFACE OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE RIGHT SEGMENTAL OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225207055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 70MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 7CM KNEE RIGHT SEGMENTAL OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,043.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT RESURFACE REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT RESURFACE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 8.5CM KNEE RIGHT SEGMENTAL REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8.5CM KNEE RIGHT SEGMENTAL OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8.5CM KNEE LEFT SEGMENTAL OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS RS 8.5CM SEG FMRL LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 8.5CM COMPRESS KNEE RIGHT POROUS SEGMENTAL REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,050.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,050.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 8.5CM KNEE LEFT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPTICAL 7CM KNEE LEFT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225207555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 75MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE LEFT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 18MM FINN KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 15MM OSS 7CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 17MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT 400# SM SPINDLE HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178577|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT 800# SM SPINDLE HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT 400# LARGE SPINDLE HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 26MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178799|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD 4CM MINI COMPRESS MOSAIC STANDARD TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,815.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,815.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178950|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD 4CM COMPRESS 30D STANDARD TAPER HIP SELF RETAINING SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225209055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 90MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE OSS FEMUR SIDE LOCK STEM MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|986.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD ARTHRO NL 7 DEG LCK COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD ARTHRO NL 1CM DIASL CNCTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 66X42X17MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 4 66X46X17MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 74X46X12MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 G-H 82X50X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 G-H 82X54X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 E-F 82X50X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 E-F 82X54X17MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-030-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX CD/34-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X17MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 11MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD E-POLY ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-032-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX EF/34-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 31MM 1 PEG WIRE ASCENT ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR MEDIUM 34MM 3 POST ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 37MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 28MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR ASYMMETRIC 10MM 37MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR MEDIUM 34MM 4 SPIKE ARCOM POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR MEDIUM 34MM 1 PEG INSET AGC TIVANIUM UHMWPE POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 37MM 3 PEG REGENEREX SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM KNEE COCR I BEAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D STD 66X42X12MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX16MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178951|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD 4CM MINI COMPRESS 30D TAPER HIP SELF RETAINING SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,536.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,536.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260609|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE OSS SMALL THREAD DIAPHYSEAL LOCK LONG BIG HEAD MODULAR ARTHRODESIS SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|473.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 66X42X10MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 66X42X14MM KNEE ALL POLY CEMENTED CRUCIATE RETAINING NEXGEN STERILE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 74X46X14MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E5381 700|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT,SCLERAL BUCKLING,240 S|1|HUMANA [1294]||HUMANA [11839]|83.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|83.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5960-032-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX EF/34-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 74X50X10MM KNEE ALL POLY CEMENTED CRUCIATE RETAINING NEXGEN STERILE GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 4 C-D 66X46X12MM KNEE UHMWPE CEMENTED NEXGEN LPS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 E-F 74X46X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 G-H 82X50X17MM KNEE UHMWPE CEMENT LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621801811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 11MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598605701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X51MM OPTION NEXGEN 7 KNEE TIVANIUM CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598614712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN OPTION STEMMED TIBIAL PLATE, SIZE 6+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 3MM NEXGEN FLUTE KNEE CORUNDUM CEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL GREEN GREEN STRIPE 74X50X6MM OPTION NEXGEN 7D 6 STANDARD KNEE TIVANIUM UHMWPE CEMENT MODULAR FLUTE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-030-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX CD/34-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 89X57X10MM OPTION NEXGEN 7D MACRO FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599802802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PURPLE PURPLE STRIPE 62X41X2MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE LEFT SET STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 KNEE LEFT CEMENT MODULAR STEM NONPOROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE LT, SIZE 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE LT, SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE LT, SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE RT, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE RT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE RT, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F STD 66X42X14MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE RT, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 2 FLUTE KNEE ZIMALOY PRECOAT MOBILE STEMMABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 KNEE LEFT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 3-4 KNEE MODULAR KEEL STEMMABLE MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00592601102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT PATELLOFEMORAL CEMENTED GENDER SOLUTIONS NEXGEN PRECOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611001009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611003011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5-6 11MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D STD 66X42X17MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 7MM NEXGEN LEGACY 3D 3 FULL FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B MICRO 58X49.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE NEXGEN LPS OPTION ZIMALOY STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL LT, SIZE 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP FEMORAL RT, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 671700010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CEMENTED POSTERIOR STABILIZE NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F STD 66X42X17MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-KNEE GSF NP FLEX FEM, SIZE 4-LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL H KNEE RIGHT CEMENTED PRECOAT NEXGEN LPS-FLEX ZIMALOY PROLONG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL G STANDARD 81X70.5MM KNEE LEFT CRUCIATE RETAINING NEXGEN ZIMALOY POROUS STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599201202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B MICRO 58X49.5MM KNEE RIGHT POSTERIOR STABILIZE LPS NEXGEN ZIMALOY POROUS STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596201252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B KNEE RIGHT LPS-FLEX NEXGEN POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT SMALL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT XL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT MEDIUM KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT XL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-030-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX CD/34-20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM HOUSING CRUCIATE RETAINING KNEE LEFT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 57.5MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596003220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 E-F STD 66X42X20MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 80MM XL POROUS PERFORATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM VANGUARD COMPLETE KNEE SYSTEM STERILE LATEX DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596004110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F STD 74X46X10MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 85X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM ASCENT MAXIM KNEE PRIMARY FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT CUSTOM SCREW VANGUARD TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE LEFT PRIMARY ASCENT POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-040-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX EF/56-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-042-10|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX GH/56-10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX24MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672519101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672522103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 22MM KNEE LEFT UHMWPE CONSTRAINED REVISION POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,463.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522002000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 11MM 41MM 3 PEG I/B II UHMWPE KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,331.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00587601120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT PATELLAR 20MM 35MM NEXGEN LARGE KNEE TRABECULAR METAL POLYETHYLENE REVISION 11MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X54MM NEXGEN 8 WEDGE KNEE TIVANIUM PMMA PRECOAT CEMENT MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522002400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 75X56X69MM I/B II KNEE TIVANIUM UHMWPE CEMENT MODULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,647.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-041-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX CD/56-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620400401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 +4MM KNEE LEFT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620400430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 +4MM KNEE LEFT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620401410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 +4MM KNEE RIGHT REVISION MODULAR TITANIUM POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,960.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621400630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2/3 +14MM KNEE LEFT REVISION POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 +4MM KNEE LEFT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632400104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 +4MM KNEE LEFT CEMENT MODULAR CONSTRAINED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2-3 +14MM KNEE RIGHT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632414200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0-1 +14MM KNEE RIGHT CEMENT MODULAR CONSTRAINED TITANIUM NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,174.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD ORTHOPEDIC 75MM 15MM I/B II FLUTE KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00522007800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 20MM KNEE TIVANIUM I/B II FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,466.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-040-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX EF/56-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 18MM NEXGEN FLUTE KNEE TIBIA TIVANIUM SHARP REPLACEMENT SCREW 120MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 19MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 20MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 130MM 175MM 24MM SHARP REPLACEMENT SCREW KNEE FEMUR TIVANIUM NEXGEN FLUTE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,139.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS 240MM KNEE 1 PIECE 3CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,050.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,050.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 47MM OSS SHORT KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 55MM OSS SHORT KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 59MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 63MM OSS SHORT KNEE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 71MM OSS SHORT KNEE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-042-12|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX GH/56-12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 9CM OSS KNEE MODULAR AVL ANTILUXATION REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 9CM OSS KNEE COCR MODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 17MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 11MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150379|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 15MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,136.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,136.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 10.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 9MM OSS PROXIMAL CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 13MM OSS PROXIMAL CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596004114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F STD 74X46X14MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 9MM SPLINE OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 11MM SPLINE OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS 20MM TIBIA LEFT MEDIAL RIGHT LATERAL 63/67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION OSS FEMUR LEFT RESURFACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 21CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL OSS SMALL TAPER KNEE OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL OSS SMALL DISTAL OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL OSS SMALL KNEE SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 635002111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CONG ALL-POLY TIBIA RT, SZ 1, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597005503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 89X53MM NEXGEN 9 MACRO KNEE TIVANIUM PMMA CEMENTED MODULAR PEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596004014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D STD 74X46X14MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL GREEN GREEN STRIPE 74X46X5MM OPTION NEXGEN 7D STANDARD FLUTE KNEE TIVANIUM UHMWPE CEMENT MODULAR STEM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 5MM NEXGEN FLUTE KNEE CORUNDUM CEMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599803801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL YELLOW YELLOW STRIPE 66X42X3MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE RIGHT CEMENTED MODULAR STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE LT, SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE LT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 3 FLUTE KNEE ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 KNEE LEFT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 KNEE LEFT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUGMENTATION 60MM 6.5MM MG II KNEE TIVANIUM SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-042-14|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX GH/56-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596009010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BASEPLATE NEXGEN KNEE MODULAR LOCK FLEX MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579003000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ 28X56MM KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT MEDIAL PARTIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578804008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 25X40X8MM KNEE UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE SERIES 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611001011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611002009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4 9MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RD122064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 55/59MMX20MM OSS KNEE RIGHT MEDIAL LEFT LATERAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,995.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 21CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE OSS SMALL THREAD FEMUR LOCK LARGE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|734.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|734.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596004117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F STD 74X46X17MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150494|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD 1CM OSS HIP FEMUR DIAPHYSEAL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 23CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER KNEE SPIKE OSS ORTHOPEDIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS 6MM SPIKE WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 152X12X11MM FINN KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 18CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 22CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 16CM 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|YOKE TIBIAL 16MM OSS KNEE COCR BUSHING AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,968.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,968.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161079|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE ELLIPSE 3CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596004017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D STD 74X46X17MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS XS SHT SPDL W PINS 400LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS XS SHT SPDL W PINS 800LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG SHT SPDL W PINS 800LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC COMPRESS C600LB SHORT ELLIPTICAL KNEE ANTIROTATION PIN SALVAGE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SM HF SPINDLE 12MM PC HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 14MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 16MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX18MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX14MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-042-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX GH/56-17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596004120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 E-F STD 74X46X20MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 68MM SMALL POROUS PERFORATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0112960|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BARD PLUG- MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|439.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00596004020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 5-6 C-D STD 74X46X20MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146598|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5960-042-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR LPS FLEX GH/56-20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183583|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H STD 82X51X10MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 70MM HOUSING CRUCIATE RETAINING KNEE RIGHT FEMUR COCRMO VANGUARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,158.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VANGUARD SSK KNEE FEMUR POSTERIOR STABILIZE CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 15MM KNEE FEMUR POSTERIOR PEG INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184299|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL VANGUARD KNEE POSTERIOR INTERLOK TITANIUM BOLT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|597.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|597.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERTER SURGICAL LOCK BAR VANGUARD XP G1 TIBIA 79-91MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE LEFT RESURFACE REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT RESURFACE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT RESURFACE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE LEFT RESURFACE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,004.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 10CM COMPRESS KNEE RIGHT POROUS SEGMENTAL REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,188.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,188.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H STD 82X51X12MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8.5CM KNEE RIGHT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8.5CM KNEE LEFT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 16MM OSS POLY KNEE TIBIAL STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 18MM OSS POLY KNEE TIBIAL STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 12MM OSS UHMWPE KNEE TIBIAL AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 14MM OSS KNEE REDUCE LATERAL STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS SHORT KNEE NONMODULAR 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS KNEE MODULAR 71MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,778.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 9MM OSS 7CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,289.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL 63MM OSS POLY HYBRID STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 G-H STD 82X51X14MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 3CM OSS PROXIMAL OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 9CM OSS PROXIMAL OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,002.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,002.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 7CM OSS PROXIMAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,412.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,412.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 63MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7700015B|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 10MM TITANIUM SHORT TIBIA LOCK PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE UNICOMPARTMENTAL VANGUARD M STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM PARTIAL KNEE PHASE 3 TWIN PEG UNICOMPARTMENTAL OXFORD COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE PARTIAL KNEE PHASE 3 TWIN PEG UNICOMPARTMENTAL OXFORD COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 GH STD 82X51X17MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159569|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159595|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160796|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL B8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F STD 82X51X20MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD A KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD A KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL E3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 GH STD 82X51X20MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ E LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ E RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ F RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX16MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 827-640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,796.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX20MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX22MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX20MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX20MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0112970|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BARD PLUG- LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.41|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.41|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 827-645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX20MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX16MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX12MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155696|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 843-005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT LOCK|1|HUMANA [1294]||HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX12MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF LIPPED C/R TIB BRNG 15X64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX10MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 72MMX15MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG SML 22X68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117240000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM CANC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 200MM 12MM KNEE FEMUR TIVANIUM NEXGEN OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 155MM 200MM 14MM KNEE FEMUR TIVANIUM NEXGEN OFFSET STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,278.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117245000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM CANC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621512165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 125MM 16.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621520145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 200MM 14.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621525105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 250MM 10.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II CURVE BOW STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621575105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 75MM 10.5MM REVISION SMOOTH KNEE TITANIUM NATURAL-KNEE II STRAIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,673.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION NEXGEN 1 FULL 10MM KNEE TIBIA TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,789.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 5MM NEXGEN C KNEE ANTERIOR TIVANIUM PMMA PRECOAT ROTATING HINGE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,922.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599800423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE TIBIAL 7MM NEXGEN LEGACY 3D 4 FULL FLUTE KNEE TIVANIUM PMMA PRECOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596601402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL D STANDARD 68X57.5MM KNEE RIGHT CRUCIATE RETAIN CEMENTED OPTION NEXGEN ZIMALOY STERILE BLUE GREEN YELLOW PURPLE STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597001801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL H MACRO 85X76MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRECOAT NEXGEN ZIMALOY STERILE BLUE GREEN PURPLE STRIPE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B MICRO 58X49.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE LPS NEXGEN ZIMALOY PMMA STERILE PURPLE YELLOW STRIPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1245-80-058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACETABULAR DURALOC 28MM 660D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER FEMORAL NATURAL-KNEE II 3 KNEE RIGHT CEMENTED CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541001701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT NATURAL-KNEE FLEX GENDER SOLUTIONS MALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541401402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NATURAL-KNEE GSF NP FLEX FEM, SIZE 1-RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL A KNEE RIGHT CEMENTED PRECOAT NEXGEN LPS-FLEX ZIMALOY PROLONG PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596001252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B KNEE RIGHT CEMENTED NEXGEN LPS-FLEX ZIMALOY PROLONG PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CSTI POROUS FEMORAL LT, SIZE 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2230-525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CROSS INT SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|903.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|903.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60002110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 21X9X9MM BRGN I/F CFRP PLIF|1|HUMANA [1294]||HUMANA [11839]|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178529|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 40MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178533|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 56MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 13MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6000-2109|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE BRANTIGAN CFRP|1|HUMANA [1294]||HUMANA [11839]|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 18MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT 600# SM SPINDLE HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 27MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 25MM MINI COMPRESS C400LB STANDARD HUMERAL REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178785|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 25MM MINI COMPRESS C600LB SHORT HUMERAL REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178789|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 30MM MINI COMPRESS C800LB SHORT HUMERAL ANTIROTATION REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER HEAD 4CM COMPRESS MOSAIC MINI TAPER HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,815.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,815.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE BUMPER OSS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|986.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD ARTHRO NL 5 DEG LCK COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS SMALL COLLAR LOCK MODULAR ARTHRODESIS SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8141-13-001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CALCANEAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|945.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|945.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 4 66X46X12MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 74X46X10MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 G-H 82X50X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 G-H 82X54X17MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 E-F 82X50X17MM KNEE ALL POLY CEMENTED LPS NEXGEN STERILE GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 A-B 66X42X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621810911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 11MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 9MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 13MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 635002109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CONG ALL-POLY TIBIA RT, SZ 1, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 26MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597002502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL PURPLE PURPLE STRIPE 62X41MM NEXGEN 2 MICRO KNEE TIVANIUM PMMA CEMENTED MODULAR PEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X50X7MM OPTION NEXGEN 7D 7 STANDARD FLUTE KNEE TIVANIUM UHMWPE CEMENT MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE STRIPE 89X53X9MM OPTION NEXGEN 7D MACRO FLUTE KNEE TIVANIUM UHMWPE CEMENT MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599803802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL YELLOW YELLOW STRIPE 74X46X4MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599804802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL GREEN GREEN STRIPE 82X50X6MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE RT, SIZE 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II .25 KNEE RIGHT SET STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE LT, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 00 KNEE RIGHT CEMENT MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591603001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 3 FLUTE KNEE ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1390TB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS BIO 9 X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 4 FLUTE KNEE ZIMALOY PRECOAT CEMENTED MOBILE STEMMABLE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591608000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 8 FLUTE KNEE ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 KNEE LEFT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595009000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BASEPLATE NEXGEN KNEE FLEX MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596009200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BASEPLATE LCCK NEXGEN KNEE MODULAR LOCK MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579002700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL REGULAR+ 25X50MM KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM ASCENT MAXIM KNEE PRIMARY I BEAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 40MM BIOMET KNEE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153595|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXFORD II BEARING SIZE 3 LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159573|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159594|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160793|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 30MM TI FT CANC HEX SCKT NS LC DCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL C8 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD C LEFT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD D RIGHT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL B3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 146MM SS 6 HL NONLOCK BN FEM RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,135.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183594|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137MM 4.5MM SCR 8 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX20MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX24MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX11MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX22MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 169MM SS 4.5MM SCR 10 HL NONLOCK BN TIB RT PERIART LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX20MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 75MM OSS SHORT KNEE NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9CM OSS COCR KNEE BODY TIBIAL ELLIPSE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,181.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,181.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 13MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 11MM CEMENTED BOWED OSS INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150387|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 16.5MM OSS POROUS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 225MM 14.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 225MM 16.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 11MM COLLAR OSS BOW HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 11MM COLLAR OSS STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 105MM 4.5MM SCR 6 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 120MM 13MM SPLINE OSS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,048.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS UNIVERSAL 10MM TIBIA 79/83MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 7CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 9CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 15CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 11CM KNEE DIAPHYSEAL SEGMENT OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 25CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 30CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 232MM SS 4.5MM SCR 14 HL NONLOCK BN TIB LT PROX LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS 10MM SPIKE WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 24CM 14MM ORTHOPEDIC SALVAGE SYSTEM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153841|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FINN LARGE KNEE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AXLE TIBIAL FINN KNEE TITANIUM ROTATING HINGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,294.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,294.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 16CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71-75MMX24MM VANGUARD 360 VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD CONSTRAIN TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 40MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 44MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX22MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM ASCENT KNEE PRIMARY TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX20MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 1/75MMX11MM KNEE ASCENT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 28MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 2.5MM OFFSET KNEE ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,052.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,052.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 10MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 10MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 12MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 24MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.225|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +22.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 14MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 22MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 18MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141634|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 12MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-23.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 18MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 24MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 17MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 20MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 18MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 13IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00541601302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE RIGHT NATURAL-KNEE FLEX GENDER SOLUTIONS POROUS FEMALE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596201251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL B KNEE LEFT LPS-FLEX NEXGEN POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-18.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT MEDIUM KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT 2XL KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT XS KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT MEDIUM KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 12MM ASCENT XL KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,659.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL VANGUARD 360 7.5MM OFFSET KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,092.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,092.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185229|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 5MM VANGUARD 360 KNEE BOLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3CM KNEE RIGHT RESURFACE OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE LEFT SEGMENTAL OSS POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL ELLIPSE 7CM KNEE LEFT SEGMENTAL REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-19.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7CM KNEE LEFT MODULAR SEGMENTAL REDUCE OSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS RS 8.5CM SEG FMRL RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BODY FEMORAL 7CM COMPRESS KNEE LEFT POROUS SEGMENTAL REDUCE RESECTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,909.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,909.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8.5CM KNEE RIGHT REDUCE OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,208.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5CM KNEE RIGHT OSS POROUS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 22MM OSS POLY KNEE TIBIAL STANDARD STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 16MM KNEE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153990|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 20MM KNEE FINN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,477.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL OSS LONG KNEE NONMODULAR 67MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 9MM OSS 5CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-20.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM TRADITION AGC KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM TRADITION AGC KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-21.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-21.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578804012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 25X40X12MM KNEE SERIES 1 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611002011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4 11MM KNEE UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 77.5MM KNEE RIGHT CRUCIATE RETAINING VANGUARD POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-22.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.3-13CM P3.8-4.5CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-23.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ C RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXFORD CEMENTLESS TIBIA E LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE VANGUARD SSK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-23.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT CUSTOM SCREW VANGUARD SSK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-24.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-17.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183563|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183583|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-16.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 273024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SOFT-TISSUE 3MM #2-TICRON BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 34MM ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 34MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 40MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 25MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 25MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR SMALL 31MM 4 SPIKE ARCOM POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-13.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR LARGE 37MM 4 SPIKE ARCOM POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR SMALL 31MM 1 PEG INSET AGC TIVANIUM UHMWPE POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 28MM 3 PEG REGENEREX SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 14CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 16CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AXLE FEMORAL OSS KNEE REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,384.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,384.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING TIBIAL OSS POLY SET AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,092.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS XS SPDL WITH PINS 600LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N140|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +14 DIOP BCNVX 13MM 6MM PC MLPC FLD MULTIFOCAL ARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG SPDL WITH PINS 800LBF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 10MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 16MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 20MM STANDARD HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,824.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG H F SPINDLE 12MM PC HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT ORTHOPEDIC COMPRESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,006.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,006.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 20MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 21MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 12MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 14MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-14.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178564|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 22MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 24MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178574|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 76MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|220.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|220.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTER FEMORAL 5MM COMPRESS OSS TAPER KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,815.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,815.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS SHRT ELLIPT 600LB SPNDL W/|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 25MM MINI COMPRESS C800LB STANDARD HUMERAL REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX20MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-15.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX12MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX12MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX10MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX16MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-15.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX14MM AGC MODULAR TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155690|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 22IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 16IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-24.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 21IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA40N-26.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER ARRAY MULTIFOCAL 6.0MM OPTIC P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 75MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 83MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 67MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 71MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 83MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 72.5MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 60MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 15MM OSS 5CM PROXIMAL NONMODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,667.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE TIBIAL 9CM OSS ELLIPTICAL PROXIMAL REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,012.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,012.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT-1250-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.3-4.6MM 25MM ACTRK TI STD SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 67MM OSS SHORT KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,186.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 67MM OSS LONG KNEE NONMODULAR REDUCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,578.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 67MM OSS SHORT KNEE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 9MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 90MM 11MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,052.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,499.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 15MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 300MM 13MM CEMENTED OSS HIP INTRAMEDULLARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,136.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,136.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 300MM 14.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT-1300-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.3-4.6MM 30MM ACTRK TI STD SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 300MM 18.5MM CEMENTED KNEE FEMUR INTRAMEDULLARY POROUS OSS BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,492.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 150MM 16.5MM OSS PROXIMAL POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,859.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 11MM COLLAR OSS STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150491|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 225MM 13MM COLLAR OSS STRAIGHT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,832.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION OSS 20MM TIBIA RIGHT MEDIAL LEFT LATERAL 79/83MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,409.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 3.5MM OSS ANTERIOR FLANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 4CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,577.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT SEGMENTAL 19CM OSS TAPER KNEE DIAPHYSIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,522.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL OSS LARGE DISTAL OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSS 10CM TOTAL FEM DIAPH CPLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,732.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATM-140-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.8-3.6MM 14MM ACTRK TI MN FT SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUSHING TIBIAL OSS KNEE POLYETHYLENE LOW FRICTION INTERFACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|912.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|912.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150499|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 20CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD INTRAMEDULLARY 22CM OSS FEMORAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,401.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT ORTHOPEDIC OSS 0MM SPIKE WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|520.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|520.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 14CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 20CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 24CM 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 12CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 22CM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 152MM KNEE SEGMENT FINN TITANIUM 20CM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,683.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9529|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SNTH TISS 40X52X2.3MM PE POR MDPR MINIPLATE CHNL SHT|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AXLE FEMORAL OSS KNEE AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,377.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,377.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|YOKE TIBIAL 14MM OSS KNEE COCR BUSHING AVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,968.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,968.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC COMPRESS C400LB SHORT ELLIPTICAL KNEE ANTIROTATION PIN SALVAGE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC COMPRESS C800LB SHORT ELLIPTICAL KNEE ANTIROTATION PIN SALVAGE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 18MM KNEE HIGH SPINDLE COMPRESS HA POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPS LG M F SPINDLE 12MM PC HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,013.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 24MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 36MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 52MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FIXATION 60MM COMPRESS FEMORAL TRANSVERSE REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 8MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178562|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG ANCHOR COMPRESS 20MM SHORT HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING 28MM COMPRESS HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 25MM MINI COMPRESS C800LB SHORT HUMERAL REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINDLE ORTHOPEDIC 30MM MINI COMPRESS C600LB SHORT HUMERAL ANTIROTATION REPLACEMENT SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,492.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 7MM TI CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 84-1060|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 40MM 1.3MM OTHSRB SS RSRB ASCP STRL|1|HUMANA [1294]||HUMANA [11839]|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 308-3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146590|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146594|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM TRADITION AGC KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550295|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 5MM SR HIP LINR LCK STRL|1|HUMANA [1294]||HUMANA [11839]|585.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX20MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX24MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX22MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX20MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE FIBULAR CORNERSTONE 6MM|1|HUMANA [1294]||HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX24MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX24MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146776|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146796|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX14MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX14MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX14MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN CURVED 1.5MM X 6MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX18MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1257|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN SIDE-ANGLE 1.5MM X 9MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1258|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN SIDEWARD-ANGLE 1.5MM X 9MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 74X50X17MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 82X51X14MM KNEE UHMWPE CEMENT CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 82X54X14MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596600817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 82X54X17MM KNEE UHMWPE CEMENTED CRUCIATE RETAINING NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 C-D 74X46X14MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 C-D 74X50X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 E-F 82X54X12MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621801911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 11MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621810811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 11MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1261|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN CURVED SLIGHTLY 1.5MM X 8MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621830811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 11MM KNEE LEFT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 635003009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII CONG ALL-POLY TIBIA LT, SZ 2, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595004702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 6MM NEXGEN KNEE PRECOAT CEMENTED MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595005701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 7MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598603702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL YELLOW YELLOW STRIPE 66X46MM NEXGEN OPTION 4 KNEE TIVANIUM CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598604701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL GREEN GREEN STRIPE 74X46MM NEXGEN OPTION 5 KNEE TIVANIUM CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL YELLOW YELLOW STRIPE 66X42X3MM OPTION NEXGEN 7D 3 STANDARD FLUTE KNEE TIVANIUM UHMWPE CEMENT MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE LT, SIZE 00|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630700250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP STEM TIBIAL BASEPLATE LT, SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1266|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN CURVED 1.5MM X 7MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX8MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF CURVED C/S TIB BRNG 15X60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX15MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX18MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG MED 18X72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG LRG 18X76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1308|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN FORWARD-CURVED 1.5MM X 8MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 80MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 65MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1354|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT 4MM-OPENING|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 70MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 65MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 LARGE HALF A TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 XS FULL TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 63MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 91MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 83MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 67MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141765|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 79MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141781|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 63MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1360|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT FENESTRATED(5MM) 1.5MM X 6MM|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 91MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141793|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 71MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141797|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 87MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX6MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX6MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX6MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX6MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX10MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX10MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT SMALL KNEE RIGHT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1361|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT FENESTRATED(5MM) 1.5MM X 9MM|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL KNEE BUMPER PLUS OSS MAK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|986.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|986.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP260600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD ARTHRO NL 0 DEG LCK COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,816.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599600810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 8 G-H 82X54X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 6 C-D 74X50X14MM KNEE ALL POLY CEMENTED LPS NEXGEN STERILE GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599601710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 7 E-F 82X50X10MM KNEE UHMWPE CEMENTED LPS NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599602317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 A-B 66X42X17MM KNEE ALL POLY CEMENTED LPS NEXGEN STERILE YELLOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621810913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 13MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 9MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621820913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2 13MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621830916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 16MM KNEE RIGHT ALL POLY ULTRACONGRUENT CEMENTED NATURAL-KNEE II STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1396|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN 90-DEGREE FENESTRATED(5MM) 1.5MM X 9M|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595003701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL PLATE 3MM CEMENT MODULAR STEM NEXGEN PRECOAT KNEE MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595003702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 4MM NEXGEN KNEE PRECOAT CEMENTED MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595005704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL 10MM NEXGEN KNEE PRECOAT CEMENT MODULAR STEM MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X54X8MM OPTION NEXGEN 7D STANDARD FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599804801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL GREEN GREEN STRIPE 74X46X5MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599805801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL BLUE BLUE STRIPE 82X50X7MM OPTION NEXGEN 3D FLUTE KNEE TIVANIUM UHMWPE CEMENTED MODULAR STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 KNEE RIGHT CEMENT MODULAR STEM NONPOROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE RT, SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE LEFT CEMENT MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1269|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN BAYONET 1.5MM X 7MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 31MM ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 37MM ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 25MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 34MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 8.5MM 37MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR LARGE 37MM 1 PEG INSET AGC TIVANIUM UHMWPE POROUS KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 31MM 3 PEG REGENEREX SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1350|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT FENESTRATED(4MM) 1.5MM X 6MM|1|HUMANA [1294]||HUMANA [11839]|681.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|681.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM KNEE COCR I BEAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX12MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX14MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX20MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1351|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT FENESTRATED(4MM) 1.5MM X 9MM|1|HUMANA [1294]||HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LPS7013|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM ACCESS VASCULAR PORT- DELRIN ATTACH10F W/KIT|1|HUMANA [1294]||HUMANA [11839]|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,245.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX20MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX20MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX20MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155634|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1301|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT 1.5MM X 25MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX20MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL STERILE LATEX FREE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 59X8MM POLYETHYLENE PROSTHESIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX8MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT 1.5MM X 5MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX15MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 76MMX10MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX15MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG MED 22X72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177885|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG LRG 15X76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN STRAIGHT 1.5MM X 20MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM ASCENT KNEE PRIMARY TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 107MM 3.5MM SCR 8 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 107MM 3.5MM SCR 8 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 85X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM MODULAR SPLINE HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL TRAY KNEE STEM TAPER PLUG BIOMET MAXIM POLYETHYLENE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE UNICOMPARTMENTAL VANGUARD M STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS KNEE UNICOMPARTMENTAL OXFORD COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153593|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXFORD II BEARING SIZE 1 LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 153600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXFORD II BEARING SIZE 8 LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 837-125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PRE CUT 25CM X 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,508.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,508.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159559|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159565|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE RT, SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 630701330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII NP PGLS STEM TIBIAL BASEPLATE RT, SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 00 KNEE LEFT CEMENT MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642001240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE RT, SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591602000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 2 FLUTE KNEE TIBIA ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8379120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR 3D SMALL|1|HUMANA [1294]||HUMANA [11839]|3,257.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,257.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591607000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 7 FLUTE KNEE ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 KNEE LEFT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 3 KNEE LEFT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 4 KNEE RIGHT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 1 KNEE RIGHT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 KNEE RIGHT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 5 KNEE RIGHT MODULAR STEM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00595006745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 45MM NEXGEN KNEE TIBIA DROP DOWN PLATE MIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MGII KNEE SLF-TAP BONE STR SCRW, 6.5MM DIAX25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578805014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 27X44X14MM KNEE UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE SERIES 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578807012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 32X52X12MM KNEE SERIES 4 UNICOMPARTMENTAL MACHINE MOLD UHMWPE M/G STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM ASCENT KNEE PRIMARY TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-1264|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANEURYSM MCFADDEN SLIGHTLY-CURVED 1.5MM X 12MM|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL VANGUARD 360 KNEE MODULAR REVISON PRIMARY 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141493|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL OFFSET KNEE STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402457|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SOFT-TISSUE UROLOGIC MAINSTAY C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141496|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5MM OFFSET KNEE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 16MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 22MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT LARGE KNEE LEFT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE RIGHT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE LEFT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5210-2835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CLOSED 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 80MM KNEE HIGH POSTERIOR STABILIZE INTERLOK FINISH AGC TRADITION COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE RIGHT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE RIGHT POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X73MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X58MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X73MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 65MM KNEE CEMENTED CRUCIATE RETAINING AGC TRADITION INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 65MM KNEE CEMENTED POSTERIOR STABILIZE AGC TRADITION LEGACY INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 40MMLG FULL-THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 642000220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII MODULAR CEMENT TIBIAL BASEPLATE LT, SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591604000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 4 FLUTE KNEE ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591605000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 5 FLUTE KNEE ZIMALOY CEMENT MOBILE STEM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 45MMLG FULL-THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00591608001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL OPTION NEXGEN 8 FLUTE KNEE ZIMALOY PRECOAT MOBILE STEMMABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621200100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE LEFT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 0 KNEE RIGHT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621201120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL NATURAL-KNEE II 2 KNEE RIGHT RESURFACING MODULAR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW AUGMENTATION 30MM 6.5MM MG II KNEE TIVANIUM SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579002000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 21X42MM KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579002200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ 21X44MM KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00579003300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE++ 28X60MM KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL PRECOAT M/G ZIMALOY PMMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42558000402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT MEDIAL PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 50MMLG FULL-THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 55MMLG FULL-THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 60MMLG FULL-THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 85X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 12.5MM ASCENT MAXIM KNEE PRIMARY FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 40MM PRESSFIT MODULAR KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE UNICOMPARTMENTAL VANGUARD M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE UNICOMPARTMENTAL PEG OXFORD STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 28MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR THIN 31MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 34MM 3 PEG REGENEREX SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM ASCENT MAXIM KNEE INTERLOK TITANIUM CRUCIATE RETAINING PRIMARY CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141563|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX10MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX16MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM ASCENT POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 31MM BUTTON SUTURE HOLE CONSTRUCT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141492|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OFFSET KNEE ADAPTER PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,087.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,087.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 14MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 16MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 16MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 12MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 18MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 20MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1749-02-041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL PEAK POLY 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,760.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,760.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 16MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159579|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159591|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159593|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159793|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SB2401D|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 24MM 12MM STD WL 2 BRCH PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,517.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,517.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160795|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL 7 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL A7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL A8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD AA RIGHT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401923M|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 9FR 35MM 23CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL B3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL F5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ C LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578808008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|M/G UNI KNEE TIBIAL ARTICULAR SURF SERIES 5, 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 611002013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4 13MM KNEE UHMWPE UNICOMPARTMENTAL CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL D 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL E 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE LEFT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM MAXIM ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1755-27-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT OUTER MIAMI MOSS|1|HUMANA [1294]||HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 14MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 24MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 12MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 40MM 12MM SPLINE KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,655.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,655.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 10MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 22MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 24MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 15MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 22MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-013-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 13MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 13MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 16IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 13IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP110560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAXIM STEM 14X40MM EXTENSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,146.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,146.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-014-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 14MM X 170MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX10MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 91MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 63MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 71MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 83MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 59MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-014-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 14MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 63MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 75MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 91MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 67.5MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 70MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 13MM 100MM CAPTURED SCREW ASSEMBLY TIMAX 140D HIP SUPRACONDYLAR TROCHANTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-016-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 16MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X59MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X78MM KNEE RIGHT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 14MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 20MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G-H 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 E-F 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-052-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 52MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 9MM KNEE LEFT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 19MM KNEE RIGHT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE RIGHT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620010819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE LEFT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 11MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 11MM KNEE LEFT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-052-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 52MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM MAXIM KNEE PRIMARY CRUCIATE RETAINING LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 71-75MMX16MM ANTERIOR POSTERIOR POSTERIOR STABILIZE ARCOM MAXIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM MAXIM ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-052-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 52MM X 27MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430008500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 40MM PG BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,971.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,971.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 159558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 7MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159571|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159588|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159590|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160791|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430008600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 46MM PG BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported US154706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154775|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD F LEFT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430008700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 52MM PG BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 155330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430008000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 40MM KEEL BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 189502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430008100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 46MM KEEL BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 141638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141876|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 16MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 11MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 12MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 15IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 20IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 19IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 40MM SHLDR MDLR BGLNI/FLTW ZML OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 71MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 79MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 40MM SHLDR MDLR BGLNI/FLTW ZML OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 67MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 75MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 60MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 57.5MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 60MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 80MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 65MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 57.5MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 70MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 57.5MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 40MM SHLDR MDLR BGLNI/FLTW ZML OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 57.5MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 60MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 62.5MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 72.5MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 62.5MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 80MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 25MM REGENEREX MEDIUM CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 SMALL HALF A TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 MEDIUM FULL TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 71MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0112660|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MARLEX 10" X 14" #0112660|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|293.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|293.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4302-052-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 18MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ D LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OXFORD D KNEE LEFT MEDIAL CEMENTLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166579|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXFORD CEMENTLESS TIBIA E RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-052-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 21MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 8MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID 40MM 22.2MM BIPOLAR BIO-MODULAR SHOULDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-052-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 24MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM AGC TRADITION KNEE PRIMARY TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430205227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 27MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183634|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185387|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 72.5MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 55MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 80MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 55MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 67.5MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 SMALL HALF B TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 MEDIUM HALF B TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 59MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 75MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 75MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141795|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 79MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX6MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX6MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX6MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX6MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX6MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX10MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT XS KNEE LEFT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT 2XL KNEE LEFT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE RIGHT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5977-056-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HOLDING SHORTHEAD NEXGEN|1|HUMANA [1294]||HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE RIGHT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 19MM KNEE LEFT PROLONG ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 22MM RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 1/2, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 1/2, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 3/4/5, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 22MM KNEE RIGHT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 00/0, 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-006-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 6MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,704.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,704.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 00/0, 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597002117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H MICRO 58X40X17MM KNEE NET MOLD UHMWPE CR-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597003010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X10MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597003020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X20MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597004017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X17MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 18MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING INLAY DIRECT COMPRESSION MOLD TIBIAL 3D STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-007-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 7MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD KNEE LIPPED TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD ARCOM KNEE CRUCIATE RETAINING LIPPED TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD POROUS KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD ARCOM KNEE POSTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183690|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM VANGUARD KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-008-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 8MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD AA LEFT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL C3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DG1016SN|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH DURAL -REPAIR 10CM X 16CM|1|HUMANA [1294]||HUMANA [11839]|2,296.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,296.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4300-008-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 8MM X 170MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL F6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL A3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ B RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 55MM KNEE RIGHT POSTERIOR STABILIZE CONSTRAIN OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 55MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-009-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 9MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 14MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD SSK KNEE RIGHT POSTERIOR STABILIZE CONSTRAIN TIBIAL 60 SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT CUSTOM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT BIPOLAR 22.2MM 44MM SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2XL KNEE RIGHT PRIMARY ASCENT POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE LEFT PRIMARY ASCENT POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-046-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 46MM X 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 85X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 10MM ASCENT MAXIM KNEE PRIMARY FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM AGC FLUTE KNEE BASE PRIMARY MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 80MM MODULAR PRESS FIT REGENEREX HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE UNICOMPARTMENTAL OXFORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE PEG OXFORD STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159563|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-040-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL STANDARD BIGLIANI/FLATOW 18MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,078.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159577|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159583|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159587|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159589|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159791|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL B6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-113707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM BIO-MODULAR 11MM HUMERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,984.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,984.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 91MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141783|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 71MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141791|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 63MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX6MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX10MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT XS KNEE RIGHT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MMX67NN KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-052-30|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 30MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE RIGHT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 70MM KNEE CEMENTED POSTERIOR STABILIZE AGC TRADITION LEGACY INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE RIGHT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE RIGHT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE RIGHT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE RIGHT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE LEFT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-046-15|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 15MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 46MM SHLDR MDLR BGLNI/FLTW ZML OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX22MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX20MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX24MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX20MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX24MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX22MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-046-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 21MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-046-24|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 24MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-046-27|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET BIGLIANI/ FLATOW 27MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,974.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE LEFT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE LEFT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE RIGHT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE LEFT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE LEFT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102021|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 7X3CM ALDRM THK ACLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,406.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X58MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 55MM KNEE CEMENTED CRUCIATE RETAINING AGC TRADITION INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X78MM KNEE LEFT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 70MM KNEE CEMENTED CRUCIATE RETAINING AGC TRADITION INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 80MM KNEE CEMENTED POSTERIOR STABILIZE AGC TRADITION LEGACY INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS KNEE LEFT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE LEFT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1036-45-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HIP SELF-CENTERING 45MM+ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE RIGHT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 14MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1365-43-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL ZIRCONIA 1.5 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 14MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 20MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 20MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G-H 14MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 G-H 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 11MM KNEE RIGHT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 13MM KNEE RIGHT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE RIGHT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 19MM LEFT PROLONG ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 22MM LEFT ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE LEFT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE LEFT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 19MM KNEE LEFT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 22MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1855-20-500|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TISSUE SOFT ORTHO RESTORE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX13MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD E-POLY ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD E-POLY ANTERIOR STABILIZED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95MM SS 3.5MM SCR 6 HL BN TIB RT DIST MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,714.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,714.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 37MM 1 PEG WIRE ASCENT ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR XS 28MM 3 POST ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 5/16 34MM PEG WIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85MM SS 3.5MM SCR SM FRAG SET 6 HL SHFT BN TIB LT PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM VANGUARD POROUS KNEE POSTERIOR STABILIZE PLUS DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX22MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX13MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM VANGUARD ARCOM KNEE ANTERIOR STABILIZE INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX11MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68241|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 240CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX13MM VANGUARD KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX11MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX13MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183588|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD E1 KNEE CRUCIATE RETAINING LIPPED INLAY TIBIAL 0D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68301|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 300CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0010103|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH BARD KUGEL PATCH SM CIRCLE 0010103|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,546.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,546.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 25-68331|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 330CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX10MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68361|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-68 ROUND SMOOTH 360CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL E8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD E KNEE RIGHT MEDIAL UNICOMPARTMENTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154776|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD F RIGHT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL B7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL C6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL E6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68421|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH SALINE 420CC STYLE-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL F7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL C5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154379|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL F7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL 60MM KNEE RIGHT POSTERIOR STABILIZE CONSTRAIN OPEN BOX VANGUARD SSK INTERLOK POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 9MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68451|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SMOOTH SALINE 450CC-480CC FILL STYLE-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42528200309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL C 9MM KNEE RIGHT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD SSK KNEE LEFT POSTERIOR STABILIZE CONSTRAIN TIBIAL 60 SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT CUSTOM SCREW VANGUARD TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 178055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE LEFT POSTERIOR STABILIZE CLOSED BOX ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,593.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,593.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS KNEE LEFT PRIMARY ASCENT POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2XL KNEE LEFT PRIMARY ASCENT POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-163531|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST TEXTURED RECON SALINE 530CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183894|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-163781|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE TEXTURED STYLE163 780CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE RIGHT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE LEFT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-468196|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-468 195- 205CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X73MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596002012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B STANDARD 58X40X12MM KNEE MACHINE MOLD FIXED POLYETHYLENE LPS-FLEX NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 12MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 20MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 12MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 20MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 14MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G-H 17MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 EF 14MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG ONE-STEP 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,077.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,077.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597203017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X17MM KNEE TIBIA REGULAR CONSTRAINT CRUCIATE RETAINING AUGMENT MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597602120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H 58X40X20MM KNEE ANTERIOR CONSTRAIN CRUCIATE RETAINING MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 9MM KNEE RIGHT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146778|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146798|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX18MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX14MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX18MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF LIPPED C/R TIB BRNG 12X72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 19MM KNEE LEFT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 3/4/5, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 00/0, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 00/0, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 00/0, 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 00/0, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1DLMC04|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH MYCRO DUAL 15 X 19 X 1 OVAL #IDLMO4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,286.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,286.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 308-3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 00/0, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597002120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H MICRO 58X40X20MM KNEE NET MOLD UHMWPE CR-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597003012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X12MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597004010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X10MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 16MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 12MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 16MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 10MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 28MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR ASYMMETRIC 8MM 31MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 308-3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184795|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR ASYMMETRIC 10MM 40MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR STANDARD 8MM 23MM 1 PEG WIRE KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141567|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX10MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX18MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX20MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 316-0004|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE 0.45 X 6"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX11MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM VANGUARD E1 KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-183742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM VANGUARD E1 KNEE POSTERIOR STABILIZE PLUS TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX13MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX11MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EP-189128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX18MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 28MM 1 PEG WIRE ASCENT ARCOM KNEE ANTERIOR POSTERIOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184793|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR ASYMMETRIC 8.5MM 34MM 3 PEG KNEE SERIES A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM KNEE COCR I BEAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM ASCENT MAXIM KNEE INTERLOK COCR 1 PIECE CRUCIATE FIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLISHED FINNED TIB TRAY 79MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141565|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79X20MM KNEE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX10MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151079|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX18MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM KNEE POROUS PRIMARY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,069.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF POR TIB TRAY LARGE/76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM VANGUARD COMPLETE KNEE SYSTEM STERILE LATEX DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 85X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 30MM ASCENT MAXIM KNEE PRIMARY I BEAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155607|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE AGC KNEE TIBIA LOCK MODULAR II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE UNICOMPARTMENTAL VANGUARD M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 161468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL PARTIAL KNEE PHASE 3 TWIN PEG UNICOMPARTMENTAL OXFORD COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 3MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL C7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX16MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX22MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX24MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 319-3024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANNULATED 3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX20MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX16MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX20MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MAXIM VI PS ARCOM BRNG 12X91MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501430|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.8-10-9CM SPCTRM P3.5-4.3CM RND SAL STY 1400 ADJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX22MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX16MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX12MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE RIGHT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE LEFT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 16MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542450M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.6-12.9CM SPCTRM P3.7-4.5CM RND SLTX PS ADJ POST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE LEFT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 1/2, 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 1/2, 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 3/4/5, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 00/0, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597003014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X14MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542514|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.7-14X11.9CM SLX SPC P6.4-7.9CM CNTR PRFL TRDRP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 11MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 16MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 60MMX18MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX18MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX12MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 72MMX18MM PERFORMANCE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 76MMX12MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG XLRG 12X80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542620|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.6CM SLTX P3.3CM MDRT PRFL RND SAL TXTR 175-200|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13CM SLTX P3.8CM MDRT PRFL RND SAL TXTR 325-375ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX12MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX20MM AGC TRADITION ARCOM KNEE HIGH POST POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 65X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 70X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 75X8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 80X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY INTERLOK COCR UMHWPE 85X16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542660|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.6CM SLTX P4CM MDRT PRFL RND SAL TXTR 375-425ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING LIPPED TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM VANGUARD MONO-LOCK KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 189724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM VANGUARD MONO-LOCK KNEE CRUCIATE RETAINING TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF POR TIB TRAY XSM/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542713|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.2X11CM SLTX P6.1CM CNTR PRFL HI PRFL STY 2700|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 72MM MEDIUM POROUS PERFORATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM REGENEREX KNEE PRIMARY CRUCIATE RETAINING POSTERIOR STABILIZE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,269.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 65X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 70X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 75X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE TIBIAL AGC KNEE POSTERIOR STABILIZE MOLD PRIMARY POROUS 80X18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL MODULAR I-BEAM SHORT LARGE HIP METAPHYSEAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM AGC FLUTE KNEE BASE PRIMARY MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM AGC FLUTE KNEE BASE PRIMARY MODULAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542715|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15X12.7CM SLTX P6.6CM CNTR PRFL HI PRJ SAL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE UNICOMPARTMENTAL OXFORD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,328.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 4MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 6MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 8MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159796|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 9MM OXFORD ARCOM KNEE LEFT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 160792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 5MM OXFORD ARCOM KNEE RIGHT MENISCUS PHASE 3 UNICOMPARTMENTAL TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL C8 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 359.083S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROD RM 850MM 2.5MM TI CLBRT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL E8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL A4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD D LEFT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD E KNEE LEFT MEDIAL UNICOMPARTMENTAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE RIGHT MEDIAL LEFT LATERAL UNICOMPARTMENTAL TIBIAL 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US154742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD M KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL TIBIAL A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD B LEFT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL OXFORD B RIGHT MEDIAL UNICOMPARTMENTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL A5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL A6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL B5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL C3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL E3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL E4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL E5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF PH3 CEMENTLESS TIB SZ F LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 25MM 3MM CFBR CNCT RDLCNT MN FXTR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OXFORD LEFT MEDIAL KNEE PPS HA PARTIAL KNEE REPLACEMENT CEMENTLESS SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL F 11MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL G 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 10MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 60MM 3MM CFBR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX22MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 75MM 3MM CFBR CNCT RDLCNT MN XTRNFXTR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX10MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 6MM TI CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP103266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX11MM ASCENT POSTERIOR STABILIZE TIBIAL STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 28MM BUTTON SUTURE HOLE CONSTRUCT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 34MM BUTTON SUTURE HOLE CONSTRUCT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-010-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 10MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 24MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 12MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 24MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 14MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX24MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-012-13|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL 12MM X 130MM BIGLIANI FLATOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,047.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX10MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX14MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX10MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 76MMX15MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,991.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,991.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177590|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX10MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX10MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG MED 12X72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX10MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG XLRG 15X80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX22MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 26X5X1.25MM MNDB 4 HL CMPR TNSNBND 2.4MM SCR BN TI NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX16MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5895|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR WEHRS-INCUS DOUBLE NOTCH|1|HUMANA [1294]||HUMANA [11839]|1,159.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,159.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX20MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX12MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX18MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX10MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX20MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX12MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-150863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 37MM BUTTON SUTURE HOLE CONSTRUCT KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,590.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5896|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR WEHRS-INCUS STAPES DOUBLE NOTCH|1|HUMANA [1294]||HUMANA [11839]|1,159.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,159.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 71MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 12MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 18MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 22MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 20MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM 160MM 16MM SMOOTH REVISION KNEE FEMUR VANGUARD 360 BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 16MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 20MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400023|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALLOON FGS 51-60CM (AMS 800)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX18MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX12MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX12MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177578|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 76MMX18MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX12MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX15MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG XLRG 18X80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400024|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALL PRESSURE REGULATOR (AMS 800) C1815|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,829.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,829.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX22MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 72/75MMX22MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400025|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALL PRESS REGULAR (AMS 800) C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX20MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX20MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX10MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7433|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROGRAMMER PATIENT HAND-HELD C1787|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 59MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 75MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 87MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 16MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 20MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 18MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 22MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 14MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 18MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 22MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 14MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141896|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 14MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 23MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 16MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 22MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 24MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 17IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 15IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 17IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL E7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE LEFT LATERAL FIX TIBIAL F4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL B4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL C4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL F3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154377|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL F5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING OXFORD KNEE RIGHT LATERAL FIX TIBIAL F6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported US166573|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL OXFORD B RIGHT MEDIAL PPS HA PARTIAL KNEE REPLACEMENT CEMENTLESS SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL H 12MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42518200908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL J 8MM KNEE LEFT MEDIAL VIVACIT-E PERSONA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE LEFT VANGUARD 360 POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING VANGUARD SSK KNEE LEFT POSTERIOR STABILIZE CONSTRAIN TIBIAL 55 SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT CUSTOM SCREW VANGUARD SSK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP113128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT CUSTOM SCREW VANGUARD TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,298.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE LEFT PRIMARY ASCENT POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,399.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD SSK POROUS KNEE POSTERIOR STABILIZE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL SMALL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 22MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 18MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 16MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 22MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 10MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 14MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 24MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 14MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 16MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 20MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 22MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141696|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 16MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 10MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 12MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 18MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 19MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 20MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX24MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM MAXIM ARCOM CONSTRAINED VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX22MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX24MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX14MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX16MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX22MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-14.5|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX24MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX10MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 65MMX16MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX10MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 70MMX18MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX12MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX14MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX12MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 12MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 16MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 150MM 12MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 20MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 20MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141698|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141894|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 13MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 24MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 15MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 19MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 21MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 23MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 18IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX22MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX18MM VANGUARD SSK KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,818.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE NONCONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM VANGUARD 360 POLYETHYLENE KNEE POSTERIOR STABILIZE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,707.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX22MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX14MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-143178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 91MMX18MM MAXIM ARCOM POSTERIOR STABILIZE VI REVISION TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,114.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75X10MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BMT 360 TIB SM CRUCIATE WING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 59MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 91MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 59MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 55MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 72.5MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 80MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 57.5MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 67.5MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 72.5MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200741|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CORNERSTONE 7MM|1|HUMANA [1294]||HUMANA [11839]|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 65MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 55MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 72.5MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 65MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 25MM REGENEREX SMALL CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 40MM REGENEREX XS CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 40MM REGENEREX MEDIUM CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 75MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 83MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 63MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.19|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 100X5X1MM TI 2MM SCR 20 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 75MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141767|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 87MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 83MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX6MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX6MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX6MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX6MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX10MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX10MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX10MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L SMALL 2.7MM OBLIQUE ANGLED LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|156.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX10MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX10MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX10MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT XL KNEE RIGHT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50X4X1MM TI 1.5MM SCR 4 HLE/HD 9 HL SHFT BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 55MM KNEE CEMENTED POSTERIOR STABILIZE AGC TRADITION LEGACY INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 75MM KNEE CEMENTED POSTERIOR STABILIZE AGC TRADITION LEGACY INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE LEFT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2XL KNEE RIGHT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS KNEE LEFT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE LEFT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183004TNBN|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TINBN VG INT CR ANAT FM R 60M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57X7X1.5MM TI 2.7MM SCR 7 HL BN CNDRL LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 19IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 21IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 19IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.41|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 32X7X1.2MM TI 2.7MM SCR 3 HL BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.19|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 100X3.8X.8MM TI 1.5MM SCR 20 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|758.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|758.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX10MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX12MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX18MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX24MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57X7X1.5MM TI 2.7MM SCR 7 HL BN CNDRL RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 59MMX18MM KNEE AGC STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX14MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,413.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,413.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX18MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 72MMX10MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 72MMX12MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 64MMX12MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL XS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG X/SML 22X64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177865|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 72MMX15MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERF P/S TIB BRG LRG 22X76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50X5X1.2MM TI 2MM SCR 4 HLE/HD 9 HL SHFT BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX12MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX18MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX22MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX18MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX24MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX16MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX10MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX18MM ASCENT KNEE PRIMARY TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.23|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 50X5X1.2MM TI 2MM SCR 3 HLE/HD 9 HL SHFT BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX10MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX12MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX14MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179865|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX20MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141494|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL NEUTRAL OFFSET KNEE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141495|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 2.5MM OFFSET KNEE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 14MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 67MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 18MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 20MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 16MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 16MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|40.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX10MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 75MMX10MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TIBIAL TRAY 360D LARGE KNEE CRUCIATE WING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 63MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185239|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 10MM VANGUARD 360 KNEE BOLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 18MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 63MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 57.5MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 65MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 70MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 70MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 75MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 60MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 72.5MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 80MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 80MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 20MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 72.5MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL VANGUARD 360 SMALL KNEE CRUCIATE WING REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 25MM REGENEREX XS CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 40MM REGENEREX LARGE CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 79MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 87MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141785|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 79MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141787|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 87MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX6MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX6MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 22MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX10MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX10MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX10MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX10MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX10MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX10MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX10MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX14MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX12MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX16MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 24MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX20MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-144104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 75MMX24MM MAXIM ARCOM KNEE CONSTRAIN TIBIAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,834.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX10MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX24MM MAXIM ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,929.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX10MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL I|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-153390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 85MMX20MM AGC KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX12MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155698|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX18MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 26MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|40.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|40.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-155710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 83MMX10MM KNEE MODULAR DIRECT COMPRESSION MOLD TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,892.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX14MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM AGC TRADITION KNEE POSTERIOR STABILIZE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX10MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87MMX14MM AGC POLY KNEE MODULAR TIBIAL II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,224.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177595|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 80MMX15MM PERFORMANCE KNEE CONDYLAR STABILIZE TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,902.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX12MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 68MMX18MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 76MMX10MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,947.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 76MMX12MM PERFORMANCE KNEE POSTERIOR STABILIZE TIBIAL LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 28MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX12MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX14MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX20MM ASCENT ARCOM KNEE POSTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,190.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX16MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX20MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX22MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX12MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX10MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 32MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX16MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71/75MMX20MM ASCENT ARCOM KNEE CONSTRAIN DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 87/91MMX14MM ASCENT ARCOM KNEE PRIMARY LIPPED DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX10MM ASCENT KNEE PRIMARY TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 59MMX14MM ASCENT KNEE PRIMARY TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63/67MMX16MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79/83MMX14MM ASCENT ARCOM KNEE PRIMARY DIRECT COMPRESSION MOLD TIBIAL CURVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX14MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 34MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X58MM KNEE LEFT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE LEFT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X78MM KNEE LEFT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X58MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X73MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 CD 17MM KNEE NET MOLD FIX UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 17MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 14MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 38MM LC DCP TI CORT NS LG FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 G-H 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 G-H 17MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597203014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X14MM KNEE TIBIA REGULAR CONSTRAINT CRUCIATE RETAIN MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 11MM KNEE LEFT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 16MM KNEE LEFT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE RIGHT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620010811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE LEFT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 11MM LEFT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 40MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 22MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 67MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 75MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 79MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 79MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 62.5MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 67.5MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 42MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 62.5MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 62.5MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 67.5MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 75MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 60MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 70MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 75MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 70MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 75MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL VANGUARD 360 LARGE KNEE CRUCIATE WING REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,917.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 46MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 SMALL FULL TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 LARGE FULL TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 10MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 12MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 10MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 22MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 22MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 12MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 48MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 14MM VANGUARD 360 BOW KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 12MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 18MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 23MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 16MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 21MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 14MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 54MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|84.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 15IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 17IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 21IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX5MM FEMORAL DISTAL LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX5MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX5MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 67.5MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 60MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|84.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 70MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX10MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 80MMX10MM FEMORAL POSTERIOR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX15MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 87MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 59MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 71MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 87MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 91MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.064|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 64MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|84.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 67MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 87MMX15MM VANGUARD 360 KNEE RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 62.5MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX10MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT 2XL KNEE RIGHT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 66MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 80MM KNEE CEMENTED CRUCIATE RETAINING AGC TRADITION INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2XL KNEE LEFT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE LEFT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2XL KNEE LEFT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 68MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X68MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE RIGHT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE LEFT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT CRUCIATE RETAINING VANGUARD POROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 14MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 70MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|84.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|84.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 20MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 G-H 14MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 G-H 20MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 E-F 20MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 E-F 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 13MM KNEE LEFT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 19MM KNEE LEFT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE LEFT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 28MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE RIGHT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE RIGHT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT UHMWPE CRUCIATE RETAINING CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620010809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 16MM KNEE LEFT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 63MMX18MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 67MMX16MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX14MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 71MMX18MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX16MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 30MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING 79MMX20MM ASCENT KNEE ANTERIOR STABILIZE DIRECT COMPRESSION MOLD TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,076.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM VANGUARD 360 KNEE POROUS REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 79MM OFFSET KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,186.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141489|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL NEUTRAL OFFSET KNEE ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,052.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,052.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141491|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 5MM OFFSET KNEE ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,052.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,052.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 63MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 83MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL 91MM KNEE INTERLOK STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,807.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 14MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 20MM VANGUARD 360 KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 32MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 16MM VANGUARD 360 BOW KNEE SMOOTH REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 18MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 40MM 20MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 16MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,670.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 20MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 12MM VANGUARD 360 KNEE GRIT BLAST REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 100MM 20MM SCREW ASCENT KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 14MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 10MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 34MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 16MM VANGUARD 360 KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 14MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141878|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 18MM VANGUARD 360 BOW KNEE SPLINE EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,569.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 10MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 11MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 80MM 17MM VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 12IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 120MM 14IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 160MM 22IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM TIBIAL 200MM 13IN VANGUARD 360 KNEE SPLINE VERSION 2 EXTENSION REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,308.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 36MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX5MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 55X10MM KNEE FEMUR RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX10MM FEMORAL DISTAL RIGHT MEDIAL LEFT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 60MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 65MMX10MM FEMORAL POSTERIOR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 57.5MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 62.5MMX15MM KNEE FEMUR LEFT MEDIAL RIGHT LATERAL INTERLOK TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 83MMX5MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 13MM KNEE LEFT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 19MM RIGHT ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 38MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 11MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 19MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 1/2, 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 1/2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE RIGHT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597005009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CR ART SURF CH7-10/BLUE 09MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597005012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR-FLEX ART SURF C-H/7-10 BLUE, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 40MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597005020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR-FLEX ART SURF C-H/7-10 BLUE, 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 9-12 J 12MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 65MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 75MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 80MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 60MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 55MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 57.5MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 57.5MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 42MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 60MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 65MMX15MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 XS HALF B TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 LARGE HALF B TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 87MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 63MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 75MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX6MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX6MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 44MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX6MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT SMALL KNEE LEFT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X68MM KNEE RIGHT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X68MM KNEE LEFT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE RIGHT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE LEFT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 60MM KNEE CEMENTED CRUCIATE RETAINING AGC TRADITION INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 46MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 75MM KNEE CEMENTED CRUCIATE RETAINING AGC TRADITION INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS KNEE RIGHT PRIMARY INTERLOK FINISH ASCENT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE RIGHT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2XL KNEE RIGHT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE LEFT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 48MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 75MM ANATOMIC PRIMARY MAXIM POROUS KNEE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X58MM KNEE RIGHT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X58MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 10MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 10MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 4.5MM X 50MM 13MM THREADED WITH 3.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 17MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 10MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 17MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6MM G-H 12MM KNEE NET MOLD FIX UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G-H 20MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597602112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H 58X40X12MM KNEE ANTERIOR CONSTRAIN CRUCIATE RETAINING MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620007916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 0 16MM KNEE RIGHT PROLONG SURFACE CONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 16MM KNEE RIGHT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 9MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 293.93|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 300MM 4.5MM 5MM STNM CNTR THRD LG XTRNFXTR|1|HUMANA [1294]||HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 19MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 22MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 13MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE LEFT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 67MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 59MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 67MMX16MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141798|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 91MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX6MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX6MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 60MMX10MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX10MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145386|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 6MM MAXIM BOLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|361.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|361.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 8MM ASCENT XL KNEE LEFT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00110901700|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BN CMNT 17MM MDLRY POLY|1|HUMANA [1294]||HUMANA [11839]|188.94|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|188.94|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 145110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE RIGHT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75X72MM KNEE LEFT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE LEFT PRIMARY ASCENT INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XS KNEE RIGHT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE RIGHT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 9MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 16MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00110901100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BN CMNT 11MM PLPLG MEDULLA|1|HUMANA [1294]||HUMANA [11839]|196.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|196.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 627500722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 22MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 16MM KNEE RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .75/5 22MM RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597002109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H MICRO 58X40X9MM KNEE NET MOLD UHMWPE CR-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597005010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 C-H STANDARD 82X51X10MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597005014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR-FLEX ART SURF C-H/7-10 BLUE, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-9 C-D 14MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 11MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL XL KNEE LEFT POSTERIOR STABILIZE OPEN BOX CONSTRAIN ASCENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1109-015-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BONE 15-16MM|1|HUMANA [1294]||HUMANA [11839]|196.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|196.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 160618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG RP HI FLEX INTLK FML LT 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60X59MM KNEE RIGHT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 140073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X68MM KNEE LEFT CRUCIATE RETAINING PRIMARY MAXIM TITANIUM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00110900900|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG BN CMNT 9MM PLPLG MEDULLA POLY|1|HUMANA [1294]||HUMANA [11839]|196.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|196.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 155044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE RIGHT CRUCIATE RETAINING PRIMARY VANGUARD TITANIUM COCR POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-D 20MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 A-B 17MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-D 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 G-H 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 E-F 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596405117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-10 E-F 17MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597602110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H 58X40X10MM KNEE ANTERIOR CONSTRAIN CRUCIATE RETAINING MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597602114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H 58X40X14MM KNEE ANTERIOR CONSTRAIN CRUCIATE RETAINING MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597602123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H 58X40X23MM KNEE ANTERIOR CONSTRAIN CRUCIATE RETAINING MACHINE MOLD UHMWPE NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620008813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 13MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625001713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL A 13MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 13MM KNEE RIGHT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 9MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL .5 22MM LEFT UHMWPE ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 1/2, 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 1/2, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 3/4/5, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 00/0, 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597002110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 C-H MICRO 58X40X10MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597003017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X17MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597004009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X9MM KNEE NET MOLD UHMWPE CR-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 87MMX10MM VANGUARD 360 UNIVERSAL KNEE REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 79MMX15MM VANGUARD 360 KNEE LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 75MMX5MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136404|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH,URETHERAL TIP,4FR,DISP.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72401467|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PENOSCROTAL ULTREX-700 PLUS 18CM C1813 (Use 92049)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 55MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 75MMX5MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 55MMX5MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 55MMX10MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 62.5MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 67.5MMX10MM KNEE FEMORAL RIGHT MEDIAL LEFT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 62.5MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 UNIVERSAL 67.5MMX10MM KNEE FEMORAL POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION VANGUARD 360 67.5MMX15MM KNEE FEMORAL LEFT MEDIAL RIGHT LATERAL REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,926.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 25MM REGENEREX LARGE CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6003-009-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT SLEEVED 3.0MM (MANDIBULAR)|1|HUMANA [1294]||HUMANA [11839]|756.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|756.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 184606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT TIBIAL 40MM REGENEREX SMALL CONE KNEE TITANIUM POROUS SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 XS HALF A TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 185532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE AUGMENTATION VANGUARD 360 MEDIUM HALF A TIBIA OSSEOTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE AUGMENTATION 59MM MAXIM 10D HEMI KNEE TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 59MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 67MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 71MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 79MMX6MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 71MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 83MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6003-004-00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SELF-TAPPING 9.0MM (MANDIBULAR)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 91MMX10MM KNEE TIBIA TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,668.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 59MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 141792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION ASCENT MAXIM 67MMX16MM KNEE TIBIA RIGHT MEDIAL LEFT LATERAL TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,904.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX6MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 75MMX6MM FEMUR DISTAL LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX6MM FEMUR POSTERIOR LEFT MEDIAL RIGHT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 65MMX10MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 70MMX10MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 80MMX10MM FEMUR DISTAL RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENTATION MAXIM 55MMX10MM FEMUR POSTERIOR RIGHT MEDIAL LEFT LATERAL CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,737.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-4307M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS BRST 550ML SMTH INJ DOME REINF BS P5.8CM CNTR PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUGMENT FEMORAL 4MM ASCENT LARGE KNEE RIGHT POSTERIOR REVISION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE LEFT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE LEFT POSTERIOR STABILIZE MAXIM INTERLOK RF VII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 60MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT POSTERIOR STABILIZE OPEN BOX MAXIM INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE RIGHT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X78MM KNEE RIGHT CRUCIATE RETAINING AGC INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 3/4/5, 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 4-HOLE REG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE RIGHT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE RIGHT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE RIGHT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE RIGHT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597003009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-H STANDARD 66X42X9MM KNEE NET MOLD UHMWPE CR-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597004012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X12MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 13MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 14MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 7-12 G-H 18MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597005017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR-FLEX ART SURF C-H/7-10 BLUE, 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7047|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT LONG 1.5 MM 4 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 18MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80X77MM KNEE LEFT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 55X54MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE LEFT POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152977|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT POSTERIOR STABILIZE AGC INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL UNIVERSAL 60MM KNEE CEMENTED POSTERIOR STABILIZE AGC TRADITION LEGACY INTERLOK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE RIGHT PRIMARY INTERLOK FINISH ASCENT COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 62.5MM KNEE RIGHT CRUCIATE RETAINING CEMENTED PRIMARY VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 75MM KNEE LEFT CEMENTED POSTERIOR STABILIZE OPEN BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 80MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 57.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 67.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 183233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 72.5MM KNEE LEFT CEMENTED POSTERIOR STABILIZE CLOSED BOX VANGUARD INTERLOK COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,562.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65X63MM KNEE RIGHT CRUCIATE RETAINING AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 70X67MM KNEE RIGHT CEMENTED POSTERIOR STABILIZE AGC POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 17MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.044S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FLEX 7.5MM X 210MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596402023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 1-2 A-B 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 C-D 14MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596403223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-4 E-F 23MM KNEE NET MOLD FIX UHMWPE LPS-FLEX NEXGEN STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 12MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 E-F 17MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596404210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 G-H 10MM KNEE FIX NET MOLD UHMWPE NEXGEN LPS-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620009813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 13MM KNEE LEFT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620010816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 16MM KNEE LEFT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B60-17080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS EBI 110MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 620010909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 9MM KNEE RIGHT UHMWPE CONGRUENT CRUCIATE RETAINING NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620010911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 11MM KNEE RIGHT CONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 9MM KNEE LEFT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 625002616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL B 16MM KNEE LEFT PROLONG CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627500619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 00-0 19MM KNEE LEFT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627501719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1-2 19MM KNEE RIGHT ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE LEFT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627502711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 11MM KNEE RIGHT UHMWPE CRUCIATE RETAINING ULTRACONGRUENT NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 1/2, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10164|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 1/2, 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670501919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT RT, SIZE 1/2, 19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3-4-5 9MM KNEE LEFT UHMWPE POSTERIOR STABILIZED NATURAL-KNEE II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670502813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 3/4/5, 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 670503811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NKII PS TIBIAL INSERT LT, SIZE 00/0, 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597002112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR-FLEX ART SURF C-H/ 1-2 STR PURPLE, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597002114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEXGEN CR-FLEX ART SURF C-H/ 1-2 STR PURPLE, 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597004014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X14MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 90597004020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 5-6 C-H STANDARD 74X46X20MM KNEE NET MOLD UHMWPE NEXGEN CR-FLEX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42511000516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ARTICULAR 3-11 E-F 16MM KNEE LEFT CRUCIATE RETAINING POLYETHYLENE PERSONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A60-11040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL EBI 110MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 42511000713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 13MM PERSONA 9-12 J LEFT KNEE POLYETHYLENE CRUCIATE RETAINING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6278844|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER VERTE-STACK CORNERSTONE PSR PEEK-OPTIMA 14X14X8MM|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-018S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI MONSTE HEADED SHORT THREAD 3.0 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-014-L003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROMO LEFT SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,202.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,202.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOCKING BG 2.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-525-012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MM X 12MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP20-1416612|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 14 X 16 X 12 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A60-11050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EBI CORTICAL 110/50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|249.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AD-5012|SUP|HCPCS V2790||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE AMBIODRY2 AMBIODISK MEMBRANE OD12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE CONSTRUCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 992|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE UNICONDYLAR KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92659|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22.100015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP BIPOLAR HIP CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP BIPOLAR HIP PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22.100001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE SPHERE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.100005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE UNICONDYLAR KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400152|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RSRV PROS 65ML AMS 700CX ULTRX INFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL TITANIUM CURVE L110 MM OD5.5 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2968255|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL CLYDESDALE 6D PEEK 55MM X12MM LUMBAR INTER FN|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35247|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SURGICAL BIODESIGN COLLAGEN SN LATEX FREE RECTOPEXY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,825.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 150MM EBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG730|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARTEGRAFT BOVINE CAROTID ARTERY 6MMX30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,417.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,417.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG740|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ARTEGRAFT BOVINE CAROTID ARTERY 6MMX40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,657.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,657.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI TITANIUM T9 18MM 4.1MM 3MM SEC2.1MM HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 42CM RT INTERTROCHANTER INTERTAN IM 125D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676598|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 34CM RT INTERTROCHANTER INTERTAN IM 125D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN L35 MM OD5 MM FEMUR LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW R3CON LOCKING PLATE 3.5X34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-206-0002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDIAL MALLEOLUS PLATE 2 HOLE ANATOMICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L32 MM OD3.5 MM NONLOCK GORILLA PLATING SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SUPPLEMENTAL 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE AXSOS 3 TITANIUM L14MM OD4.5MM CORTICAL NONSTERLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248405060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6MM 35MM 50MM FT CANCELLOUS ST FA HEX HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1457Q/86|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD QUARTET DOUBLE BEAD 86CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,385.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DM3500|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECORDER CARDIAC CONFIRM RX SM SLIM 1 TOUCH DATA MONITOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L1714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 1.7MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A60-15050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL EBI 150MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported HERO1000|SUP|HCPCS C1750||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT HEMODIALYSIS SUPER HERO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1555501080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL CURVE L80 MM OD5.5 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM 2.5 MM L28 MM OD4.5 MM CORTICAL HEX DRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0700340006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TRINICA SELECT TITANIUM 32MM ANTERIOR LEVEL 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4240564|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 16X14X5MM PEEK TNTLM ANTM CRV INTRBD FS STRL|1|HUMANA [1294]||HUMANA [11839]|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L30 MM OD4 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L36 MM OD4 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 14X16X50MM ECCENTRIC ASCEND FLEX HIGH OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF606B|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 86MM PRFT AQLS ASCND FLX PTC 132.5D 6B STD SHLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CD1411-36Q|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DFBR CRD THK12MM 36J ANG 51X66MM ELLIPSE VR DYNAMICTX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,590.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,590.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE ANCHORAGE 2MM STEP LEFT LOCK CROSS LAPIDUS T10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45301004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 13MM 4-2.8MM PHALINX O D THK1.9MM LG CN HAMMERTOE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC2712-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L12 MM OD2.7 MM CORTICAL DISTAL SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFNS1515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE FUSEFORCE L15 MM X W15 MM HAND STERILE 2 MM REAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,045.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,045.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFNS1212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE FUSEFORCE L12 MM X W12 MM HAND STERILE 2 MM REAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 18MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72204394|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE BIOSURE REGENESORB L20 MM OD7 MM OPEN ARC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TGU282810|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT EPRSTH THOR AORTA 10CM 28MM NTNL FEP EPTFE GORE TAG|1|HUMANA [1294]||HUMANA [11839]|51,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF2033|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH INTRO 33CM 20FR 9.5MM 8.7MM GORE DRYSEAL FLX HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.902|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMERUS 2.7MM/3.5MM DISTAL MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H7493926038220|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT SYNERGY SYSTEM 2.25MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 620-110|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FLEXIBLE STRAIGHT .035IN X 150CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC121200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRALATERAL 12MM X 12CM|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT351414|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 35MM X 14.5MM X 14CM|1|HUMANA [1294]||HUMANA [11839]|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLX161207|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR EXCLUDER ILIAC 16MM X 12MM X 7CM|1|HUMANA [1294]||HUMANA [11839]|10,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 530-06-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL ALTIVATE DJO SURGICAL 6 STANDARD 108MM SHOULDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF1833|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER GORE DRYSEAL FLEX HYDROPHILIC 33CM 18FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-28.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 28.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC271200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRALATERAL 27MM X 12CM|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF1533|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER GORE DRYSEAL FLEX HYDROPHILIC 33CM 15FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG511|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER HYDROPHILIC COATED GLIDECATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131220254|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE ALPS TIMAX T Y 55.5MM X 19.5MM X 1.65MM HAND LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,262.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131211120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION DVR L20 MM OD2.5 MM KNEE THREAD MULTIDIRECTIONA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131211126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION 26MM OD2.5MM HAND MULTIDIRECTIONAL THREAD ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION FULL THREAD L28 MM OD2.5 MM HAND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110007757|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TIMAX L90 MM L16 MM OD6.5 MM LONG BONE CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 390018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER ORTHOPEDIC ASNIS III STAINLESS STEEL 4 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8555-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOW PROFILE L65 MM OD5.5 MM ANKLE CANCELLOUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1101-00-0830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR FASTENER TIBIAL 8MM X 30MM EXOSHAPE SOFT TISSUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1317FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR NANO CORKSCREW FT TI W 3-0 FW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-12.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H05110U|SUP|HCPCS C1730||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LEAD PACING TEMP BIPOLAR 5FR 8MM BALLON UNSCHROUDED LX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APL-PUP-6HL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL ULNA 108MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION TI 3.5MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION TI 3.5MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-13.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850016555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM CD HZN SOLERA SPNE MA CNN XTD TAB NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6709120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 20X11X9MM COROENT 4D LARGE IMPACT NONSTERILE LAT|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-038S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MMX38MM SH THREAD HEADLESS MINI MONSTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 36MM SHORT THREAD HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-044S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MMX44MM SH THREAD HEADLESS MINI MONSTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 3.5MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING PLATE R3CON 3.5MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-110-L002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION SLANTED-T 5 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-15.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 15.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING PLATE R3CON 3.5X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-07037|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BERMAN 110CM 7FR 1.5ML 2 LUMEN FLOW DIRECT END HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 08.501.001.01S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE ORTHOPEDIC ZIP-FIX PEEK-OPTIMA W/NEEDLE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|489.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AI-07127|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SINGLE LUMEN 7FR BALLOON WEDGE PRESSURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-265|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA GEL 265CC SMOOTH COHESIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-295|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA GEL 295CC SMOOTH COHESIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-16.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-325|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA GEL 325CC SMOOTH COHESIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-365|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA GEL 365CC SMOOTH COHESIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203150026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 3.5MM 26MM NCB TI6AL4V ST HEX HD NS LG FRAG SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|464.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|464.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1829-2062S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL ARTHRODESIS RIGHT 10MM X 620MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,693.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,693.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI TITANIUM T9 40MM 3MM ODSEC4.3MM HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,866.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,866.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102216S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MMX16MM SELF DRILLING LOW PROFILE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102283S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE QUICKFIX L14 MM OD2 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS14010602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL STANDARD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71102213S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 2.5MMX13MM SELF DRILLING LOW PROFILE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|640.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|640.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-17.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002M20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS100SM18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTIUSE 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-345|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA GEL 345CC SMOOTH COHESIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-335|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA GEL 335CC SMOOTH COHESIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHORT THREAD MINI-MONSTER 4.0MMX30MM HEADLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT.185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-R003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE GORILLA LONG METATARSOPHALANGEAL RIGHT NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE GORILLA L16MM OD3.5MM NONSTERILE R3CON NON LOCK P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL-1600-004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE CELLULAR FORMABLE VIVIGEN 15CC X-LARGE|1|HUMANA [1294]||HUMANA [11839]|15,228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP LINER POROUS FEM W/COCR HEAD & XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP LINER POROUS FEM W/OXINIUM HD & XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP TANDEM BIPOLAR CMTD FEM WITH COCR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP TANDEM BIPOLAR POROUS FEM W/COCR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-19.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71703318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP POROUS FEM W/OXINIUM HEAD & R3 XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71703600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP LINER BIOLOX DELTA HEAD W/R3 XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE JOURNEY 11 CR OXI VERILAST W/NP TIBIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE JOURNEY II UNI OXI/ZUK UNI HYBRID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71704565|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE LEGION GII CR VERILAST NP TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L3.545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 3.5 X 45MM CANNULATED SELF DRILL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71704575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE LEGION GII PS VERILAST NP TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71709020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE JOURNEY II BCS COCR FEM & NP TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71709000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE JOURNEY 11 OXI W/VERI & NP TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-23.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 23.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ZUK CEM UNI W/METAL BACK TIBIA & STD POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000245000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ZUK CEM UNI W/METAL BACK TIBIA VITE POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 604632S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED ASNIS III TI 4X32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE JOURNEY II CR COCR W/CR INSERT & NON POR TIBI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-540-032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED SHORT THREAD MINI-MONSTER 4.0MMX32MM HEADLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-24.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 24.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL LEGION L120 MM OD16 MM KNEE PRESS FIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL LEGION XLPE 3-4 H15 MM KNEE POSTERIOR STABILIZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.004.008S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 0MM T40 TIBIAL STARDRIVE CANNULATED STERILE GRAY|1|HUMANA [1294]||HUMANA [11839]|671.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|671.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FP24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION F3 FULL THREAD L24 MM OD2.5 MM FOOT LOCK SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|244.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|244.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131211128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION ALPS DVR L28 MM OD2.5 MM HAND THREAD MULTIDIREC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|433.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|433.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1.1712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILL CC I THREADED 1.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-25.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN L45 MM OD5 MM FEMUR LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1518P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE ALLODERM THK.4-1.6MM MED CONTOUR 19.3CMX9.6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534-A-709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ALL POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1351058|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 58MM 135CM BLN EXPANDABLE LOPRFL CVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CC4204A 13.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +13 DIOPTER BI CONVERX TORIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6A01.085|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR ACRYSOF IQ RESTOR MONOFLEX 10 D +8.5 DIOPTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-26.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1351238|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASCULAR LIFESTREAM L38 MM L135 CM OD12 MM BALLOON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP MOP MARATHON POROUS LESS <= 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,526.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,526.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported #|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP MOP MARATHON CEMENTED LESS <= 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UPCHARGE ALTRX LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 92947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UPCHARGE CERAMIC HEAD BIOLOX DELTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UPCHARGE GRIPTION CUP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 9.0MM X 25MM INTERFERENCE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110007755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TIMAX L85 MM L16 MM OD6.5 MM LONG BONE CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.896S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TI-END (FOR DISTAL FEMORALNAIL)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|535.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|535.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT281416|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 26MMX14MMX16CM|1|HUMANA [1294]||HUMANA [11839]|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC121000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR GORE EXCLUDER 10CM 12MM CONTRALATERAL LEG|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC141400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR GORE EXCLR 14CM 14MM CONTRALATERAL LEG|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990011|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 CIRCLE 11CM 4.5" CIRCLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5991823|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 ELLIPSE 23CMX18CM 7X9IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL 6MM X 36MM SHOULDER X3 CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5992025|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 ELLIPSE 25CMX20CM 8X10IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.10S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 135 DEG 10 HOLE 174MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,247.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,247.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234-210-020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX 20MM|1|HUMANA [1294]||HUMANA [11839]|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN LOW PROFILE L52.5 MM OD5 MM FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported STX-CMA-IS5|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIXATION STABLYX 5 CMC NONCEMENT STERILE ARTHROPLAST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-CRD-RT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN CONRONOID ASSEMBLED RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON LOCKING 2.7MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON LOCKING 2.7MM X 12MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED FLUTED LOCKING 2.3MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5100-0012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SOFT-TISSUE ANCHORLOK 3.5MM #0-SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-520|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA 520CC SMOOTH SHELL SURFACE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-560|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SF TOUCH FULL PROFILE 560CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APL-PUP-3HL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL ULNA 73MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 16MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35450-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 45MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35500-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 50MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5100-0014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SOFT-TISSUE ANCHOLOK 3.5MM #2-SUTURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXAIL NON LOCKING 3.5MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 247.360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LCP STAINLESS STEEL 73MM 10 HOLE LOW PROFILE 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|911.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|911.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXAIL NON LOCKING 3.5MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000671501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ZUK CEM KNEE STD VITE POLY W-INSTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74938931042|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VASCULAR PT2 0.14X300CM MODERATE SUPPORT STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF2200|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT 11 X 20CM MEDIUM PERF SHAPED PLIABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,454.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,454.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.013S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE LOCKING 130-DEGREE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3548313|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 450CC 8300 SERIES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 86PS0415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREWS INTERFERENCE PEEK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3313085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL BLUE SEQUOIA TITANIUM PREBENT 85MM 5.5MM THORACOL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-02-0038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR TWO-LEVEL 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AC-5230|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE AMNIOCORD PURION 3CM X 2CM|1|HUMANA [1294]||HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.40S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 40MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT450-9.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 9.5 DIOPTER +4.5 CYLINDER MODIFIED C BICONVEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16016555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 6.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16015555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MAS RELINE POLYAXIAL 2C 5.5MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249536010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY NATURAL NAIL TIBIAL 10MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,647.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.30S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 30MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.245S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 235MM FEMORAL LEFT PROXIMAL TFN-ADV LATERAL RELIEF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,057.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8666-1000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WEDGE ALLOPURE EVANS ALLOTRUE BICORTICAL 20MMX22MMX10MMX5.5M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 1.5MM 38CM 13MM RIGHT INTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58802722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM ORTHOLOC LNG CORT ANKL/FT 3DI TCH LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H3-53204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL OMNIHIP BIOLOX DELTA +4 MM OD32 MM HIP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 230400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NECK FEMORAL MODULAR NEUTRAL SIZE MED 37.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFM0412|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE 4X12CM MATRISTEM PELVIC FLOOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,719.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,719.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.32S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 32MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-3608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL 8MM 36MM SHOULDER X3 CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-03-0048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L48 MM SPINE 3 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L40 MM OD4 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.5MM 14MM MN TI T8 CNN TPR DIST TIP HEXALOBE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WS14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 1.2MM 14MM FIXOS TWSTOF TI FT/ANKL CANC ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33650003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRAY TIBIAL INFINITY 1 STANDARD ANKLE COMPONENT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.34S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 34MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7968214|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL SOVEREIGN 12 D L37 MM X W27 MM X H14 MM|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7968810|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL SOVEREIGN 8 D MEDIUM L37 MM X W27 MM X H10 MM|1|HUMANA [1294]||HUMANA [11839]|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-02-0036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVIAL AMBASSADOR TWO-LEVEL 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT400-7.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 7.0 DIOPTER 4.00 CYLINDER MODIFIED C BICONVEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-RHP-LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIAL HEAD LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.36S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 36MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK242020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT STAPIX NITINOL 20MM X 24MM SUPERELASTIC STAPLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626926|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ANCHORAGE T8 L26 MM OD3.6 MM FOOT ANKLE LAG CROSS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.50S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 50 MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.120S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|352.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|352.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 12MM 0MM EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 600-15-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE COBALT GENTAMICIN 40 GM HIGH VISCOSITY STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE TENDON TIBIALIS POSTERIOR BIOCLEANSE 290MM|1|HUMANA [1294]||HUMANA [11839]|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D08708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE BICORTICAL BLOCK 8MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,626.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,626.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5569-C-2008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL REUNION OD8 MM SHOULDER CEMENT TOTAL ARTHROPLAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,982.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-4012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 H12 MM OD40 MM SHOULDER CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.30S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 30MM 4.9MM 8MM 3.5MM FT DIST TROCH FEM TIB TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHORS BONE 3W ARTHRO DEL SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8W95-0016-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POST TAPER HEMICAPITATETM L16 MM OD7.5 MM CAPITATE STERILE L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8W12-2217-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT 12MM CAPITATE 22MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MTP FUSION VA-LCP FIRST 2.4 / 2.7MM RIGHT 0 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,932.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,932.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-5390 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ULTRA HIGH 590CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-65H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPR 5.0FT 65MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-45H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPR 7.0 FT 45MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941PLS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PLANTAR LAPIUS SHORT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.32S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 32MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MA.040|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +4 DIOPTER MODIFIED C MENISCUS 13MM 6MM POSTERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|497.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|497.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2324BCCTT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE SWIVELOCK C BIOCOMPOSITE PEEK 19.1 MM 4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported X080-332615-12PC-STR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LUMBAR INTERBODY DEVICE 33MM X 15MMX 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.34S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 34MM 4.9MM 8MM 3.5MM FT DIST TROCH FEM TIB TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9943BR-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE TITANIUM FIBULA DISTAL 4 HOLE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8935-52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM L52 MM OD3.5 MM CORTICAL LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 8 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 28/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71353252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COMP 32/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71353255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 32/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV SM SZ 18-19 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV SM 22-23 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MODULAR SLEEVE 22-23 {} XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MODULAR SLEEVE 24-25 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.36S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 36MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 68 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 9 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71353258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COMP 32/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV SM SZ 20-21 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 16-17 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 24-25 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.38S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 38MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLEEVE 18-19 {} XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MODULAR SLEEVE 26/27 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 70-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 66-68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 74 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 50 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 62 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 8 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71353249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 32/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.40S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 40MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLVE SM SZ 12-13 STIKTITEW/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLVMED SZ 20-21 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MED SZ 24-25 STIKTITEW/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 12-13 STIKTITEW/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 56 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 74 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.42S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 42MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354449|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 68 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 62 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 62 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 16 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 28MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 19 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.44S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 44MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 26 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 15 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 20 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 18 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 9 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 28/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 28/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV SM SZ 24-25 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLVE SM SZ 26/27 STKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 26/27 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.46S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 46MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV 11 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT {} MOD SLEEVE 16-17 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 28MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 28/46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV SM SZ 16-17 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MED SZ 12-13 STIKTITEW/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.48S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 48MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MEDSZ 16-17 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MEDSZ 26/27 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,795.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 14-15 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 18-19 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 66-68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 76-80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.50S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 50MM 4.9MM 3.5MM FT UNV DIST FEM TIB TI SLFCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLVE SM SZ 11 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV SM SZ 14-15 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MEDSZ 18-19 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MEDSZ 22-23 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 11 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.52S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 52MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 62 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 68 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 28/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71353261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 32/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 22-23 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLEEVE 14-15 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MODULAR SLEEVE 20-21 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.56S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 56MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 62 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 68 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 74 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 28/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MED SZ 11 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV MEDSZ 14-15 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV LG SZ 20-21 STIKTITE W/HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.58S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 58MM 4.9MM 3.5MM FT UNV DIST FEM TIB TI SLFCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT MOD SLV 12-13 XS GRIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT FULLY POROUS SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,312.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT HOLE COVER KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 50 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.60S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 60MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 68 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 18 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 14 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 18 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 20 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 23 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.64S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 64MM 4.9MM 8MM 3.5MM TI ST TROC TIP HEX IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 25 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 24 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 15 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 20 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354771|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 27 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 16 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 19 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 26 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 27 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 26 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.68S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 68MM 4.9MM 8MM 3.5MM FT DIST TROCH FEM TIB TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 18 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 25 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 18 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354865|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 22 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 74 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 15 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 17 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 21 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228321|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEEDLE 12-DEG RADIDLOC|1|HUMANA [1294]||HUMANA [11839]|414.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|414.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354509|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 76-80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 15 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 17 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 21 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 224545C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR PLLA 45MM 4.5MM FT CNN SSCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 56 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 50 MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 68 MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 56 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 62 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 14 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354479|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 13 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 19 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13200-10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOTOMY.10MM TIBIAL OPENING WEDGE|1|HUMANA [1294]||HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 70-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 56 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 68 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 56 MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 50 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 19 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 21 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 17 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.140S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD BRL 78X19X5.8MM SS 4.5MM CORT SCR 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 66-68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354559|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 44MM X 70-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 44MM X 76-80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 74 MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 50 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354447|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 56 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 13 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 18 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.18S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 135 DEG 8 HOLE 142MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,247.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,247.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 76-80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 44MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 12 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 13 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 74 MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 12 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 16 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.540S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHORT BARREL DHS 135 DEG 4 HOLE 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354478|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 12 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 20 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 70-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 14 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 16 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 22 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR TI 25MM 7MM 2MM ACL PCL CNN BLNT THRD RCI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT ANTE CMT XLPE LNR 40MM X 76-80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLICE AUGMENT 50 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 62 MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 74 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT STAPLE AUGMENT 56 MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,729.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 20 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 190MM SZ 15 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT LOCKING SCREW 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 44MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR TI 25MM 9MM 2MM ACL PCL CNN BLNT THRD RCI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 25 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 14 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354759|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 17 {} HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 21 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354767|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 24 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354769|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 26 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 20 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 822-245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOW PROFILE ANT 6.5 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 20 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 13 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 17 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 17 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 43OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 49OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 64OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,626.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,626.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 52OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 870-214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 3.5 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 32ID 52OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 40OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 55OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 32ID 49OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE ALL PLY CUP 36 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71369894|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 SCREW HOLE COVER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|116.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 58-60 0 DG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 46-48 0 DG SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 66-68OD ANT +4 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.935S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 3.5MM 440MM IM ELC TI PED STRL BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,189.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,189.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 40 OD 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X70-76 20DG SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X44 20 DEG SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71743250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 50-52 20DG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 23 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 27 H0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 13 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 20 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 13 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TITANIUM DCP MINI 2.0 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|628.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|628.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 16 {} HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 18 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 23 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 23 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 22 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 24 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 16 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 22 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 14 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 25 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.76S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LCK GRN 76MM 4.9MM 8MM 3.5MM FT DIST TROCH FEM TIB TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|724.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|724.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354871|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 27 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 46OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 61OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 70MM 16MM TI LG BN CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 36MM X 66-68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 40MM X 70-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT 0 DEG CMT XLPE LNR 44MM X 66-68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 27 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 14 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 17 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 26 H0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 21 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 12 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.875|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 75MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 12 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 15 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 12 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 15 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 13 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 19 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 21 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 15 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 17 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 25 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 80MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 17 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 19 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 20 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 26 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 16 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 21 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 23 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 16 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 18 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 22 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 85MM 16MM THREADED WITH 4.0MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|932.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|932.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 27 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 13 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 17 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 18 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 13 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 14 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 27 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 23 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 20 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.895|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 95MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 55OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 58OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 100MM 16MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|798.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|798.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 24 H0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 12 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ14 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 19 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 19 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 22 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 24 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 105MM 16MM TI P/T LG BN CNN ST SLF DRL SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 16 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 23 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 25 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 15 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 21 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 13 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354869|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 26 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 110MM 16MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 64OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 32ID 58OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE ALL PLY CUP 36 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 115MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,569.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 32ID 55OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0782|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE PISTON PLATINUM FLUROPLAST|1|HUMANA [1294]||HUMANA [11839]|381.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|381.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 408.920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.3MM X 120MM 16MM THREADED WITH 4.0MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 32ID 61OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE ALL POLY CUP SZ 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,986.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,986.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 50-52 0 DG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 54-56 0 DG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 62-64OD ANT +4 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X42 20 DEG SZ B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X46-48 20 DEG SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26 X 46-48 20 DG SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.925|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 125MM 16MM TI LG HEX HMSPHR LG BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X 70-76 20DG SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71746062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE LNR 28/62-64 0DG SZH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESURFACING FEMORAL HEAD 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74123156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL HEAD 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74124051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR IDE STUDY MOD SLEEVE +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71747062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE LNR 28/62-64 20DG SZH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,211.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,211.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETLR CUP HAP 66MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR HEAD 42 MM -4 (SHORT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR CUP HAP SIZE 56/62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74124050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR IDE STUDY MOD SLEEVE -4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.622|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE GUIDE 1.1MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 36 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500084|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 84 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 72/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 12 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 24 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.10S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 22 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 240MM SZ 25 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,957.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 16 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 23 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 26 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354765|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 22 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVLS MONO STEM 300MM SZ 25 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 14 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 21 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 18 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 240MM SZ 21 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,862.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 14 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 24 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 12 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 19 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96101HT|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK WIDE BLADE 6.35|1|HUMANA [1294]||HUMANA [11839]|1,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 52OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 61OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 66-68 0 DG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 70-76 0 DG SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 70-76 0 DG SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 46-48OD ANT +4 SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-468561|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT STANDARD ANATOMICAL SALINE TEXTURED 560CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 70-76OD ANT +4 SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X 62-64 20 DG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 62-64 20DG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 66-68 20DG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPLASIA CUP HAP 48/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74124053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR IDE STUDY MOD SLEEVE +8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-468301|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STANDARD ANATOMICAL SALINE 300-315CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X44 20 DEG SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X50-52 20 DEG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X 50-52 20 DG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542680|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.8CM SLTX P4.2CM MDRT PRFL RND SAL STY 2600 TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12TLW806F|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 80CM 6FR FGRTY ART SS SIL NTR RBR THRLMN OTW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X54-56 OD 20 DEG SZF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE ALL PLY CUP 36 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE ALL PLY CUP 36 61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363158LF|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE 690-720CC STYLE-363LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 62-64 0 DG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X58-60 20 DEG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133LV16|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER BREAST 500CC STYLE133LV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X 66-68 20DG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71743254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 54-56 20 DG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71743262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 62-64 20 DG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71747066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE LNR 28/66-68 20DG SZJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR HEAD 46 MM -8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR HEAD 54MM {} -4 (SHORT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR CUP HAP SIZE 56/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPLASIA CUP HAP 52/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,674.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,674.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000179|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-468351|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ANATOMICAL SALINE 350-370CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL TRIO 48/39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 48/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 7 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 9 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 4 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 6 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 11 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 1 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22X62-64 20DG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X 54-56 20DG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71743266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 66-68 20DG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETLR CUP HAP 60MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETLR CUP HAP 64MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPL CUP HAP 66MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR HEAD 38MM -4 (SHORT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR HEAD 46 MM -4 (SHORT)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,975.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,975.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S4 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR CUP HAP SIZE 48/54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPLASIA CUP HAP 56/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,674.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,674.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74123148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL HEAD 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 24 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 60 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 80 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500088|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 88 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG502|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 65CM 5FR .047IN GLDCATH GLD TCH CBR 2 CRV SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000189|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000191|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 48/39|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 60/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 54-56 0 DG SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26ID 0 DEG SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 62-64 0 DG SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 66-68 0 DG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 50-52OD ANT +4 SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 54-56OD ANT +4 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020952120|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 60CM 12MM 2 VLR KNTD WVN TXTL HMSH GPLSTR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,614.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,614.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 44/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 1 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 6 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001939|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 1 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 3 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 8 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 10 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 12 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 8 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3887-33|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD COMPACT PICES QUAD C1778|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,170.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,170.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 10 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 0 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 7 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002795|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 1 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 40 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 44 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542511|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.1-11.5X9.4-9.5CM SLX SPC P5.1-6.3CM CNTR PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS UNI STD STEM 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 58/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 66/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 44/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 48/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 12 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 19 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 27 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542513|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.7-13.2X11CM SLX SPC P6.1-7.5CM RND CNTR PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 15 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71354867|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REDAPT SLVD MONO STEM 300MM SZ 24 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,055.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POROUS SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71356112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POROUS SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY SO POR PL HA SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71357111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANTHOLOGY HO POR PL HA SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,061.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71743270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 70-76 20 DG SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETLR CUP HAP 62MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESURFACING FEMORAL HEAD 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESURFACING FEMORAL HEAD 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR CUP HAP SIZE 48/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRIDGING CUP HAP SIZE 44/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,127.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,127.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74123152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL HEAD 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,771.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 145112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 65MM RT PS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,846.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,846.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT W. TI/HA 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 1 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 8 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 5 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 7 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,424.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,424.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 8 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 10 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 11 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-146550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL P.S. 10 X 71/75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 1AS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,774.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,774.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 11CL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 12CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 48/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 60/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 28 XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 32XL CONE 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 38S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 42S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 56S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 46M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 50M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 56M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 59|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 57/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,199.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,199.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 59/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008561|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP IMPACTED ANCHORING PEG (2PC)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000193|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT W. TI/HA 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000197|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT W. TI/HA 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL STANDARD 52/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 54/44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 39/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 3 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001930|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 5 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 3 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 7 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 8 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002696|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 2 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002698|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 3 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 9 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 10 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 01 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 2 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 8 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 9 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 10 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.472|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL RIGHT STAINLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,242.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 5 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 7 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 10 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 1AL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 2AL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 4 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 6 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001949|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 11 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 1 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 4 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 240.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 109MM SS 4.5MM SCR 6 HL SHFT LCP BN TIB LT PROX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,824.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,824.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 6 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 7 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 11 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 0 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 4 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 6 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 7 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 1 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002796|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 2 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 2AS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 293.54|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 300MM 5MM STNM ORTH SS LG XTRNFXTR NS|1|HUMANA [1294]||HUMANA [11839]|268.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|268.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 7BL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002839|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 9CL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 5BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002845|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 7BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 58/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 62/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 64/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 28 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 22L CONE 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 41/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025-1A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VSP BONE 1-SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 44/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X 58-60 OD 20DG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 20 DEG SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 58-60 20DG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 70-76 20DG SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71746046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|3REF XLPE LNR 28/46-48 0DG SZD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETLR CUP HAP 58MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPL CUP HAP 58MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR CUP HAP SIZE 52/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025-15|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER PLATE TAPERED|1|HUMANA [1294]||HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPLASIA CUP SCREW - 52 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500064|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 64 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 68 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 41/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 01 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 2 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 9 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002695|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 1 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 3 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.140|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +14 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 3 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 5 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 9 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,609.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 10CL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW CL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 42/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS UNI STD STEM 01|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL TRIO 62/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710185|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 85MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,571.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 56/44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 2 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001929|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 4 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 12 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 2 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001959|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 9 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002697|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 2 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 8 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 49 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,841.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,841.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 51 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 55 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017198|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 51 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 53 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 57 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 63 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Lat. Ti/HA 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 51/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 47 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 53 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 57 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 61 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 65 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 57 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 43 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 45 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 01 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 22233240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 40MM ISL VSP TI +5 SPNE PDCL NO CUT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|972.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|972.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 0 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 3 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 5 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 10 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 2 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 22ID 58OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 46OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 28ID 49OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ALL POLY 32ID 64OD XLPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71358067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE ALL PLY CUP 36 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 50-52 0 DG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71740858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X 58-60 0 DG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71741058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28ID 58-60OD ANT +4 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 22ID 0 DEG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,504.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 8 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 870-314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 8BL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 12CL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 6BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW BL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW CX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 50/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 60/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BICON-PLUS PE INSERT STD 3/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,211.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,211.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 40S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 50S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 870-316|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 4.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 48M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 39/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 45/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 46/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 56/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 57|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2120F|SUP|HCPCS C1880||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FLTR VASC FEM VN VC SIM NTL DLV KT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 33-345434|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TI 5.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY PE.INSRT 46.54/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,194.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,194.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 46/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013969|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 50/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 57 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 59 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 26X 66-68 20 DG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71742850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 28X50-52 20 DEG SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71743258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LNR 32X 58-60 20DG SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71746066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE LNR 28ID 66-68OD 0 DEG SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74120156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETLR CUP HAP 56MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A60-11030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL EBI 110MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74120262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DYSPL CUP HAP 62MM W/ IMPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,229.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74121242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR HEAD 42 MM -8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,952.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74122158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACETABULAR CUP HAP SIZE 52/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,579.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74124052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR IDE STUDY MOD SLEEVE +4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 28 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 56 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74500076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR DYSPLASIA SCREW 76 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|297.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|297.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM WITH TI/HA 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 3AS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 4AS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423892|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOTOME 6MM LONG-CURVED|1|HUMANA [1294]||HUMANA [11839]|609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 9CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 11CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW AS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 58/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 50/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 54/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BICON-PLUS PE INSERT ANTIL 5/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,346.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,346.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 28XL CONE 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 32 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 54M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363391|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE TEXTURED-SHELL BIO-DIMENSIONAL LOW-ANA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 49/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 54/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 57/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 63/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011498|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017189|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 59 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017191|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 63 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 45 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017197|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 49 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 351.041S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE SMOOTH 3.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 67/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP CORTICAL SCREW 4.5X40 NON CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017237|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP CORTICAL SCREW 4.5X60 NON CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS INTEGR MIA STEM LAT. W. TI/HA 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,668.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS UNI STD STEM 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 50/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 52/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-1724C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPINAL KANEDA MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,730.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,730.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 41/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 52/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 39/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 44/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 10NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 0 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001945|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 7 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 47/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 51/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 57/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 45/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 49/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 67/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 48/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 56/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 44/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 28L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 32XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 46S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 52S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 38M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 44M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 58M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 40/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 60/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 20MM PARTIAL THREADED WITH 3.5MM HE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS POLARCUP SHELL TI COATED W.PEGSPLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,666.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,666.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI STANDARD STEM 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,009.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL TRIO 50/41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF SHELL REVISION 62/48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,339.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS IPM CENTRALIZER 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|467.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|467.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT STANDARD 44/32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPF PE INSERT HOODED 52/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 22MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 8 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM LATERAL 11NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,916.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM 5 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 5 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS MIA STEM LATERAL 10 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,622.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 5 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 5 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 7 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 12 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 1 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 24MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 4 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002769|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 11 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002797|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 2 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 4 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 6 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 6 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 9 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 3AL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 6BL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW AX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 28MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 54/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 48/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 28 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 32 S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004149|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 32XXL CONE 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 44S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 54S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 60S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 52M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 43/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 30MM PARTIAL THREADED WITH 3.5MM HE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007759|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 53|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 47/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 51/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 59 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 67 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 40/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 42/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 52/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013975|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 62/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 34MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 47 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 43/22 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,887.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,887.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 49/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 36MM TI P/T RVRS CUT FLUT CNN ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 2 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 32 MM 12/14 S / +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 36 MM 12/14 L / +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 44MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342599|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 46MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH {} 62MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36/56MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0015C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MP1620Z|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX POR SLV 16 STR 20.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 38MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TI-FIT STEM #1 COLLARLESS 115MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TI-FIT 22MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,059.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,059.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126559|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI 14/16 TPR SLV + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126655|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 743070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF I POR ACET SHELL 70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 40MM PARTIAL THREADED WITH 3.5MM HE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 MD CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 9 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 01 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 2 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002759|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 6 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002765|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 9 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002767|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 10 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,784.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,784.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 4 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 11 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,902.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,902.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 4AL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 42MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.LONG 5BL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 8BS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE DIST.SHORT 10CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,586.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW AL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Lat. Ti/HA 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 53/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018959|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 55/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 59/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 63 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 45 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 44MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 61 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 7 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100477|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 4 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 7 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 4 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STANDARD STEM 6 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 3 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 46MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 5 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,071.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002798|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 3 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,338.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLR-PLUS REVISION STEM 3 NON-CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,110.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW CS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,682.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOD PLUS REV STEM MODULE PROX.W.SCREW BX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,963.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,963.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 46/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 52/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 62/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 64/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 28XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 48MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 32XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 48S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 58S COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 40M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 42M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FRACTURE HEAD 60M COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 59/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75007764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL CEMENTED 63|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 43/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,199.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,199.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 55/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 52MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 53 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 57 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,428.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 38/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 44/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 58/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013976|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 64/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 49 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 43 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 54MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 45/22 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,887.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,887.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 47/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LAT. TI/HA 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 43/22 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 61 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 57/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 63/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017233|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP CORTICAL SCREW 4.5X44 NON CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 56MM PARTIAL THREADED WITH 3.5MM HEXAGONAL SOCKET TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP CORTICAL SCREW 4.5X55 NON CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 45/22 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 45 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 59 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 53 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 55 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 67 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 43 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.564|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 64MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 51/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 55/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 61/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,402.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP CORTICAL SCREW 4.5X48 NON CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 63/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 53 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 57 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 9 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 9 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 72MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 11 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 1 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 53/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 55/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,141.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 49 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,996.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,996.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI COATED 51 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,841.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,841.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY PE.INSRT 56+58/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,973.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 54/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75013974|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS PE CUP 60/22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.72|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 20MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 53 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017193|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 67 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 55 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 53/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP CORTICAL SCREW 4.5X52 NON CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290931|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 LG CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 11 SH REV POL + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291675|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV MED CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV SM CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 22MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291689|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV LG CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV LG CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM PRIMARY HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15 SLV SM CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 17 XL CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV11 SMCONE1 SP {} TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV11 SMCONE2 SP {} TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291825|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 LG CONE1 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291827|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 LG CONE3 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM PRIMARY HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 24MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 19 XL CONE 1 SPOU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 19 SH REV POL +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19 STEM LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 21XL CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,008.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,008.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,008.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,008.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 22 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 28 -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 28 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 26MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 32 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STD. TI/HA 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Lat. Ti/HA 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Lat. Ti/HA 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 49/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 65/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 55 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 67 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 4 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 28MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 1 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 10 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101969|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LAT. TI/HA 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Lat. Ti/HA 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 47/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,732.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 67/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 43 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 49 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 32MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 49 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 51 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 63 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 51 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100459|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 59 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 4 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 36MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 7 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 32 MM 12/14 M / +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 42MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 50MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343999|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 66-70MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134351599|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32MM M/+4 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36MM {} L/+8 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32/50MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0008C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.74|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM LC DCP TI FT ORTH CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 51 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,203.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 47 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100447|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 65 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 49 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 61 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 2 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 11 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,586.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,586.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 44MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,998.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 5 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 6 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 9 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 32 MM 12/14 L / +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342999|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 54MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134351399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32MM XS/-3 12/14 {} FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 46MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134351499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32MM S/+0 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36MM {} S/+0 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0011C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0012C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX SM TRUN TI TPR SLV+16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0839C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA PROXIMAL CENTRALIZER 8L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 3 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 4 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 6 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 54MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 48MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343899|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 64MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40MM L/+8 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353599|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36/54MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40/54MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0017C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH2212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FEM HEAD 22MMOD +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 39MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 50MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126659|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 32MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 828260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TW FEM COMP SZ 6 X 270|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,507.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 MD CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 MD CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMPERION STEM 11 SH REV GRIT +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,421.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,421.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 11 LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.752|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 52MM FULL THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|646.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|646.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11 LNG REV POL +20 R IMPLT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 13 LNG REV POL +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 47 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 63 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 1 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 8 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL W/ANTEVERTED HOLE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75101972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS SDP W/ANTEVERTED HOLE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,972.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 54MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 0 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 36 MM 12/14 XL / +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH38MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 48MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 56/28 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,379.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 52/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75003524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PE-PLUS CUP 56/32 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 28 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,184.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS METAL METAL BALL HD 28 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 56MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL BALL HD 32 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAL METAL BALL HEAD 22M CONE 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,395.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 48/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 50/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 53/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 55/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIPOLAR PROSTHESIS 58/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75008551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP LINER 65/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,309.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 3 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 9 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.76|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 60MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 1 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342899|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 52MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343599|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 58MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134351899|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32MM XL/+12 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36MM {} XL/+12 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352599|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40MM S/+0 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32/48MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36/52MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353999|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40/58MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134354299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40/62MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.764|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 64MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMD016-1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR 14/16 TAPER SLEEVE +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 36MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR SO STEM SZ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.768|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 68MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM COMPONENT SZ 14,175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM FEM SZ 12 225MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 28MM +5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRI SO 12/14 SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRIM HO 12/14 SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 195MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 225MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 165MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 195MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 419.91|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 10MM ORTH TI 4.5MM CNN SCR NS|1|HUMANA [1294]||HUMANA [11839]|93.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 225MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM SO 12/14 SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM SO 12/14 SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71315114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM BOW SZ 14R 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0009C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0811A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX HFMS SZ 8L 14/16 TAPER 11DD 130L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,306.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,306.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0838C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA PROXIMAL CENTRALIZER 8S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 10MM SHORT THREADED WITH 2.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH1038C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA PROXIMAL CENTRALIZER 10S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|365.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MP1014Z|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX POR SLV 10 STR 14.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 28MM 57-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI 14/16 TPR SLV + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126649|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 12MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 28MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129984|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOFIT ST #5 {} 200 W/COL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 427439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX COLLARED STEM SIZE-5.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,692.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,692.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 746615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF ACET FIX PEG 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|364.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|364.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV SM CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV MED CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV MED CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV LG CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 14MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291679|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV LG CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15 SLV SM CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 XL CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17 SLV SM CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17SLV MED CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19SLV SM CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|23SLV SM CONE1 SPOU TALL SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|23SLV SM CONE2 SPOU TALL SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 23 SMCONE 3 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 MD CONE 1 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 16MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291837|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13 SLV SMCONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291975|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 19 LNG REV POL +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 23XL CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71300619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT DIS SLV 16 STR 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,785.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,785.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71300621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT DIS SLV 16 STR 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,785.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,785.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 32 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 2 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 8 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 18MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 36 MM 12/14 M / +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134342799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 50MM MODULAR FEMORAL HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 60MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134351799|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32MM L/+8 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40MM XS/-4 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36/50MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0014C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX SM TRUN TI TPR SLV +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH1039C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA PROXIMAL CENTRALIZER 10L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|365.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|365.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TI-FIT 22MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,059.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,059.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 20MM SHORT THREADED WITH 2.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI 14/16 TPR SLV + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 28MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 527458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|H/A TIFIT ACETABULAR CUP SHELL SIZE 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 11 STEM PRIMARY SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 24MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 11M CON 2 SPT TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 11 SH REV POL + 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM SH REV POL +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291575|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 15 LNG REV POL +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV SM CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV SM CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV MED CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV SM CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV LG CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 26MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291693|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV SM CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291698|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV LG CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 17 LNG REV POL +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19SLV MED CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV11 MDCONE1 SP TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM PRIMARY SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291659|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV LG CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291671|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV SM CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV MED CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV MED CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 28MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV MED CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM PRIMARY SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13 SLV SM CONE2 SPT TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM SH REV POL +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|21SLV MED CONE2 SPOU TALL SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 SM CONE2 SPOU SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 MD CONE3 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 MD CONE3 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 56MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134351999|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36MM {} XS/-3 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 30MM SHORT THREADED WITH 2.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 36MM {} M/+4 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40MM M/+4 12/14 FEM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,606.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CMD016-2|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BHR 14/16 TAPER SLEEVE +4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX TI TPR SLEEVE +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|508.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|508.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0018C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|227.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|227.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH1288C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX CEMENTRA REV FEM 12S 12DD 200LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,642.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,642.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MP1619Z|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX POR SLV 16 STR 19.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR 42MM SHELL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 32MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH1013A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX HFMS SZ10L 14/16 TAPER 13DD 140L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,306.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,306.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH1238C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA PROXIMAL CENTRALIZER 12S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MP1418Z|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX POR SLV 14 STR 18.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,910.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 34MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 28MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 32MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129990|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOFIT ST #6 {} 340 W/COL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,448.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,448.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER 38MM FEM HD 14/16 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,850.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,850.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 828150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TW FEM COMP SZ 5 X 210|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,438.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,438.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 LG CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 11 STEM PRIMARY HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291574|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 15 LNG REV POL +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV SM CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 36MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV MED CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291667|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV LG CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV LG CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291673|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV SM CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV SM CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13 SLV MD CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 17 XL CONE 3 SPOU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX TI TPR SLEEVE +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|508.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|508.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX SM TRUN TI TPR SLV +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX SM TRUN TI TPR SLV+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 38MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH1299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX RMHS POR CLRD FEM 12L 12DD 150LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH2204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FEM HEAD 22MMOD +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TI-FIT 22MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,059.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,059.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 26MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 26MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOFIT ST #1 {} 290 W/COL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,448.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,448.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 527460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|H/A TIFIT ACETABULAR CUP SHELL SIZE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 40MM SHORT THREADED WITH 2.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 9 {} RO 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 SM CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 11 LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 11 LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM PRIMARY HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM SH REV POL +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 42MM LCP TI 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV MED CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV SM CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291696|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV MED CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291771|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291773|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19 SLV MED CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|21SLV SM CONE2 SPOU TALL SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 21 MDCONE1 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 LG CONE1 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 LG CONE3 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 44MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 21XL CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 23XL CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 LNG REV POL +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71301619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT PRI DIS SLV 16/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71301621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT PRI DIS SLV 16/21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 28 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SL-PLUS STEM LATERAL 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,853.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS MPF MPF.PRIMARY SHELL 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,742.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 45 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 61 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 46MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA 65 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,517.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 47 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,388.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 59/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP PE INSERT 65/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,521.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75017231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP ANCHORING PEG (2 EACH)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Std. Ti/HA 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM Collar Lat. Ti/HA 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 57/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75018962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP XLPE INSERT 61/28 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,791.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 48MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 43 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL TI-PLASMA/HA 59 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,514.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARCUP SHELL 55 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,982.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 6 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM STD TI/HA 8 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 3 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100478|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 5 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75100479|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM STEM LAT.TI/HA 6 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,213.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102079|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM VALGUS TI/HA 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LAT. TI/HA 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,592.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,592.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 50MM SHORT THREADED WITH 2.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR LATERAL TI/HA 8 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 5 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 180MM STR SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 16MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 180MM STR SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 180MM STR SZ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA {} SO STEM SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 18MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 26 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 22 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 28 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 53MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 55MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 47OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 49OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 54OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 LG CONE2 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 20MM LONG THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 SH REV POL +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 23XL CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 SH REV POL +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71301618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT PRI DIS SLV 16/18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 28 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 28 + 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 36MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 22MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 38OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 TAPER FEM HD32MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 32ID 47-51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 44OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 50OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 51OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM SHL/XLPE LNR 39OD26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 41OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 45OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 24MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 52OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 54OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 54MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 56MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 LNG REV POL +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 26MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 22 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 26 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 26 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 32 + 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,379.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,379.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306979|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN FRAC MGMT FEM SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,679.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,679.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 28MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 15MM CAL SZ 12 175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRIM HO 12/14 SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 195MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 225MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 195MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 30MM LONG THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 60MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71326600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNI 12/14 TPR SLV + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71326612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNI 12/14 TPR SLV + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACET SHELL 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF I POR HA ACET SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE CER 32 HD 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,514.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,514.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X70-76 0 DEG LAT +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0DEG XLPE ACET LNR 36 X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 58MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 O DEG XLPE LNR ACET 40MM ID 76X80 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 32MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 O DEG XLPE ACET LNR 44MM ID 62 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE LNR 44MM ID X 76-80 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,425.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,425.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 34MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE US HEAD 36MM S/+0 12/14TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X54-56 20 DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X66-68 20DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER 28MM HD 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,692.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,692.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNI 14/16 TPR SLV + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 57MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 36MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129933|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 26MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 FEM HEAD 32MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 527462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|H/A TIFIT ACETABULAR CUP SHELL SIZE 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,524.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,524.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 9 SO 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 SM CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290932|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 LG CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 11 LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM PRIMARY SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 36MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 38MM TI L/T RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 170MM STR SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 175MM STR SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 40MM TI L/T RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291775|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 17 LNG REV POL +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17SLV SM CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|17SLV MED CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|23SLV MED CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 MD CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 SM CONE1 SPOU SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 19 XL CONE 3 SPOU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291974|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 19 LNG REV POL +20 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 42MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 21XL CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,520.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 LNG REV POL +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 32 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,379.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,379.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75102257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POLARSTEM COLLAR STANDARD TI/HA 7 (US)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,219.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 76539165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 36 MM 12/14 S / +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,088.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134343299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 52MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134352999|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 32/46MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134353899|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40/56MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 44MM TI .5 THRD SM BN CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7134354199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ODH 40/60MM ACETABULAR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,540.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH0016C|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX CEMENTRA DISTAL CENTRALIZER 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH2200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FEM HEAD 22MMOD +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MH2208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FEM HEAD 22MMOD +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,702.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 47MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM FEM SZ 12 175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM 15MM CALCAR SZ 14,175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 46MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM 15MM CALCAR SZ 16,225MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 30MM CAL SZ 16 175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 30MM CAL SZ 14 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 28MM -5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRI SO 12/14 SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRI SO 12/14 SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COBRA PRIM SO 12/14 SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COBRA PRIM SO 12/14 SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,372.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 135MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 135MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 48MM TI .5 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASIS 12/14 TPR PRI CLLD SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRI SO 12/14 SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM HO 12/14 SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM HO 12/14 SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71314112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM BOW SZ 12L 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71314114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM BOW SZ 14L 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 50MM LONG THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 28 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 49MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 DEG 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 DEG 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 42 SZ B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 50-52 SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333387|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333398|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 40 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 175MM STR SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3543757|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.4CM SLTX P3.8CM MDRT PRFL RND SIL GEL TXTR 375|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM COMPONENT SZ 14,225MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM 15MM CALCAR SZ 14,225MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 22MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 26MM -5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRIM HO 12/14 SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF SO CLS 12/14 SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,282.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,282.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COBRA PRIM SO 12/14 SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 165MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3544007|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.5CM SLTX P3.9CM MDRT PRFL RND SLTX GEL TXTR 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333449|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-68551|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ROUND SMOOTH MOD PROFILE 550CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333489|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333585|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 28 20 DEG 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 225MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASIS 12/14 TPR PRI CLLD SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM SO 12/14 SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM HO 12/14 SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60002010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 25X11X9MM BRGN I/F CFRP PLIF|1|HUMANA [1294]||HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 40MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 42MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 43MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 38OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 40OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322847|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 28ID 47-51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CON LNR 0DEG 22ID 46-48OD SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,289.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,289.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR ADPTR 62-64OD H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 45MM 3MM CFBR MN FXTR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 38OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 40OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 47OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 49OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 53OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 55OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 42OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 52MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 US DELTA HEAD 32 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 13 STEM LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291571|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291573|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291655|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV MED CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV MED CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV MED CONE3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291677|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV LG CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV SM CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291691|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV SM CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15 SLV MD CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|15SLV MED CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,143.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,143.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|19SLV SM CONE1 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 225MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM SO 12/14 SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,477.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 273028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SEW 3MM #2 TICRON BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|690.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|690.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71315509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN SEL II CEM HO 10/12 SZ9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,285.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,285.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 26 + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 48MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 54MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 48OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 55OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9526|SUP|HCPCS C1764||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MONITOR ECG SUBCUTANEOUS IMPLANTABLE REVEAL PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 57OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 28 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 32 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 32ID 52-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 42OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 45OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 40OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 44OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y306|SUP|Custom 80164353||0998 - STATISTICAL CHARGES|MEDIA CONTRAST OMNIPAQUE 300 MG/ML 10 ML VIAL NDC# 00407-141|1|HUMANA [1294]||HUMANA [11839]|0.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 15MM CAL SZ 12 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 22MM -3 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,418.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 26MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRIM HO 12/14 SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 165MM M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2026-1203|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER PLATE SPACER 3MM|1|HUMANA [1294]||HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 45MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 47MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 42OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 59OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 28ID 57-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 28 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 41OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 66 68MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.777|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 125MM 4MM SCHNZ HIP CNDYL SS SLF DRL MR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|529.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 5 46MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 5 54MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF I POR HA ACET SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE CER 28 HD 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,514.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,514.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 175MM STR SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025-01.2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VSP BONE DOUBLE HALF SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO STEM SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO STEM SZ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 30MM CAL SZ 12 175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 30MM CAL SZ 14 175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 30MM CAL SZ 16 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 26MM +5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRI SO 12/14 SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COBRA PRIM SO 12/14 SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2025-01.3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VSP BONE TRIPLE HALF SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COBRA PRIM SO 12/14 SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 165MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 135MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 165MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASIS 12/14 TPR PRI CLLD SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASIS 12/14 TPR PRI CLLD SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM HO 12/14 SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM HO 12/14 SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2223-3235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP 7.0 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,023.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG LAT +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 54 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 58 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 54MM F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5200-1518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TITANIUM ISOLA 1/4"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 52MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 51OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 52OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 TAPER FEM HD 28MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 28 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR ADPTR 66-68OD {} J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2230-635|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK-J 1/4"|1|HUMANA [1294]||HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 47OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 48OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 590D 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US DELTA LINER 48MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 US DELTA HEAD 36 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACET SHELL 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV BI-POLAR SHELL 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 51MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,386.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 126661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNIPOLAR 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,676.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECONSTRUCTION 3.5MM 8 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71290913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 9 SM CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMPERION STEM 11 SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMPERION STEM 11 SH REV GRIT +20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,712.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,712.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11 LNG REV POL +20 L IMPLT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 13 LNG REV POL +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 15 STEM PRIMARY HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV LG CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP11 SLV LG CONE 2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8700294|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 15MM 4-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,614.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,614.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 66/68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFLECTION SPIKED SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 59/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 65/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 48X5X1.2MM TI 2MM SCR MDLR MN FRAG SYS 3 HLE/HD 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338667|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 40MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338685|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 40MM X 72-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.568|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 68MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338690|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 40MM ID X 62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338692|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 40MM X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338697|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM X 60 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM X 72-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 40MM X 58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 US DELTA HEAD 36 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71326603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNI 12/14 TPR SLV -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE CER 32 HD 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,514.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,514.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET TH SZ 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X62-64 0DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.19|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECONSTRUCTION 3.5MM 9 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|786.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO 5 POR HA ACET 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE LNR 44MM ID X 72-74 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE LNR 36MM ID X 76-80 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X46-48 20 DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,049.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,049.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X MM56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER 32MM HD 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,824.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,824.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 42 B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 51OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 53OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 62MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71326608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNI 12/14 TPR SLV + 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 44 X 60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 44 X 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE CER 28HD 12/14 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X46-48 0DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,696.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,696.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 56MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5092-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSURE SP NOVUS 58CM VENTRICULAR BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 O DEG XLPE ACET LNR 44MM ID 64 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 44MM ID X 64 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 44MM ID X 66 70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE LNR 36MM ID X 76-80OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|21SLV SM CONE1 SPOU TALL SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|23SLV MED CONE2 SPOU TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 SM CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM PRIMARY SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,345.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV 19 XL CONE 2 SPOU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71300620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT DIS SLV 16 STR 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,785.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,785.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6210-0-300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOTOME FLEXIBLE HRIS 6 X 120MM|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 22 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 28 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 32 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,091.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 44 X 72-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF I POR HA ACET SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET NH SZ 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,164.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,164.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5249-0-834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD TIBIAL ALTA 8.25 X 345MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,903.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,903.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET NH SZ 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 64MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 68MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 72MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 40MM ID X 76-80 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 36MM ID X 76-80OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE LNR 40MM ID X 76-80OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE LNR 44ID X {} 64 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-7-525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA RT 11 X 440/125-DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV SM CONE 1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291669|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP13 SLV LG CONE 3 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP15 SLV SM CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291685|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV MED CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291687|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP17 SLV LG CONE1 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291695|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV MED CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291697|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP19 SLV LG CONE1 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,920.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|13 SLV MED CONE1 SPT TALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,385.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM SH REV POL +10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 17 STEM LNG REV POL +0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,365.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-7-130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LARGE RIGHT 11 X 360/130-DEG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|21SLV MED CONE1 SPOU TALL SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,761.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 SMCONE3 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV21 MDCONE2 SPOUT SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP SLV23 LG CONE2 SPOUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM SH REV POL +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,381.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71291972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP 19 STEM LNG REV POL +10 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 21 LNG REV POL +20 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 LNG REV POL +0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,602.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71292373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EMP STEM 23 LNG REV POL +10 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,800.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 451543V2|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 65CM 5FR .042IN CRDS TMP CBR SM ADLT 2 CRV VSCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71301620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTX FLT PRI DIS SLV 16/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,636.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 22 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 26 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71302612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 26 + 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,666.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71303600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COCR 12/14 FEM HEAD 36MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,682.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR HO FEM COM SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE CER 32 HD 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET TH SZ 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X50-52 0DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 44MM ID X 72-74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-6-025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LONG LT 11 X 340/125-DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE LNR 44ID X {} 72-74 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-6-125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA LONG LT 11 X 360/125DG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71315112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM BOW SZ 12R 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 26 + 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,290.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 51MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 44OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-6-225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL GAMMA 11 X 380MM 125-DEG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 50OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 53OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 32 58-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 28 20 +4 54-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 28 50-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 0.6MM 90 DEGREE REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 20L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15CAL SZ 12L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 17L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340619|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 19L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 22L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR FEM COMP SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 175MM STR SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 80MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR SO STEM SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM COMPONENT SZ 16,175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM 15MM CALCAR SZ 16,175MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRI SO 12/14 SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 46-48 SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 58-60 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333397|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333459|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 50MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333495|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X50-54 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 16R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 15L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340817|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 17L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP HO SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 11 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X63-70 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X46-48 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 52MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|77.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|77.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 17 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 19 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 32 MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 36 MM L/+8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 225MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRIM SO 12/14 SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,893.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,893.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 56MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM FEM COMP SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN CEM HO FEM COMP SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71320428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ZIRC 12/14 FEM HD 28 + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 58MM WITH 3.5MM HEXAGONAL SOCKET TITANI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE US HD36MM M +4 12/14 TPR +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X70-76 20 DEG LAT +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF LOCKING HEAD PEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71346004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 40MM 12/14 SHORT+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71346150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACC 150MM TITANIUM PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,217.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71346250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACC 250MM TITANIUM PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,326.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,326.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 3 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 4 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR QUARTER 5 HOLE 39MM WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333497|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 47X7X1MM TI 2.7MM SCR MN FRAG 6 HL .25 TBLR COLR BN .3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|267.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|267.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 56 {} F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 60MM G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 66MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 72MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 26ID 38-42 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 28 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR 0 DEG 32 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,236.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L SMALL 2.7MM OBLIQUE ANGLED RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|124.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|124.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR ADPTR46-48OD D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323149|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CNSTR LNR ADPTR 70-76OD K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,695.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 46OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 46OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 49OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 50OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US DELTA LINER 50MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,078.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 44 X 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 44 X 66-70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF I POR HA ACET SHELL 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,128.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 811-401|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK 1/4" L.P. L=.625 TI|1|HUMANA [1294]||HUMANA [11839]|4,407.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,407.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET NH SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X58-60 0DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 62MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 70MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 44MM ID X 60 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 44MM ID X 62 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4XLPE LNR 40MM ID X 76-80OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,728.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE LNR 44ID X {} 60 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 811-402|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK PROFILE LOW|1|HUMANA [1294]||HUMANA [11839]|4,407.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,407.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 811-422|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK MULTISPAN PROFILE LOW|1|HUMANA [1294]||HUMANA [11839]|5,080.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,080.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333319|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 DEG 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 58-60 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 828-090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333587|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 26 20 DEG 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A60-13040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EBI CORTICAL 130/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71306415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA HO PF FEM SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA PF FEM COMP SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,028.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71306818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN TI PF FEM COMP SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,754.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV POR 175MM STR SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,956.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71307220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN HA ON POR HO FEM COMP SZ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,312.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA SO STEM SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HO STEM SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8042|SUP|HCPCS C2621||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEVICE RESYNCHRONIZATION CARDIAC INSYNC III SEQUENTIAL PACIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71309116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYN POR PLUS HA HO STEM SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,609.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON CEM FEM COMPONENT SZ 16,225MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,968.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 50MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 43OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 46OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 28ID 52-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV COCR 14/16 TAPER FEM HD32MM +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 43OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 52OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 59OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-013-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 55OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 57OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 58MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 US DELTA HEAD 32 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 US DELTA HEAD 36 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332561|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 66/68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 DEG 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 44 SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5964-016-02|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL LPS NEXGEN FLEX OPTION F RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,023.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 50-52 SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 70-76 SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 44 SZ C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 58-60 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE LNR 44ID X {} 66-70 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 13MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71331846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,491.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 50-52 SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X50-52 20DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 14MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71332535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER 32MM HD 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,824.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,824.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 DEG 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 DEG 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 DEG 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 18MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71333357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333377|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 62-64 SZ H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 70-76 SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,679.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332079|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE US 36MM HD L+8 12/14 TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 20MM NXGN STRG KN TIB ROT HNG 145MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71332500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFLECTION SCREW HOLE COVER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER 28MM HD 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,765.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,765.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER 32MM HD 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,824.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,824.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 16CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 DEG 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 DEG 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 46-48 SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,689.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,689.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 46-48 SZ D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 50-52 SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333447|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 20CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS FM CV MD W/TPR SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,758.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM MED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM XLGE LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 20CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM MAG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE MED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 916160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT RGT 21MM XLG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,442.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,442.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS RESURF PAT PROS LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204529|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD RT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204673|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224001318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 18CM FEM MDN IM CLS RTRGD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,311.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204675|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG RT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II NON-POR TIB SZ 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225421010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 21CM HUM BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 22MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US CRMC FORTE ACET LNR 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334942|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 22MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X MM50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA PER HOLE SZ 56 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA PERI HOLE SZ60MM E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225427012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 27CM HUM BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 62MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 68MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 80MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71310712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH CEM 30MM CAL SZ 12 225|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,764.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71311915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEM HD ZIRC 10/12 28MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,540.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF PRIM HO 12/14 SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,180.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 165MM L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 LS 195MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC EF 12/14 NR 195MM S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,675.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASIS 12/14 TPR PRI CLLD SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,237.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM AIM TMX FT HUM CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71312370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CPCS COCR PRI HO 12/14 SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,295.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71316515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONQ FX FEM COMP SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,458.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 22MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 22MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 47.5MM ITST MDN SS MED FEM CORT INTLK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFLECTION SPIKED SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF INTERFIT THRD HOLE COVER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|312.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|312.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225208055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 80MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 5 48MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX FORTE CER 28 HD 12/14 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X54-56 0DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 60MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF FSO 9 66MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,771.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 O DEG XLPE LNR ACET 44MM ID 60 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 44MM ID X 76-80OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE LNR 44ID X {} 62 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM HIP MERIDIAN #4-12MM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF RC3 SZ 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MERIDIAN #7 15MM POR STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,259.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,259.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE SZ 42MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFLECTION SPIKED SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,392.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,392.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV CAN ACET SCREW 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|406.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|406.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECON RING 56/52 LFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECN RING 74OD 70ID RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +8MM 28MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX XLPE ANVTD 26 +4 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER LNR 28ID 46-48 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER LNR 28ID 56-66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338673|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338675|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US CRMC LINER 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232401700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 2.7 X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 66-70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 32 20 +4 58-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 32X56-62 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.786|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 200MM 5MM SCHNZ HIP CNDYL SS SLF DRL MR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 15 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +6 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333478|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333479|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333581|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 32 20 DEG 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 28 20 DEG 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUMINA 12/14 HEAD 36MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUMINA 12/14 HEAD 36MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 28MM ID US CRMC FORTE ACET LNR 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US CRMC FORTE ACET LNR 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CR PLY TIB SZ1 9MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ4 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ4 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ5 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420398|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +6 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 22 20 DEG 44-45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.529|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 9MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 22MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 22MM X MM40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 52 {} E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 56MM F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335478|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 78MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL MM48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 10MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF RC3 SZ 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFLECTION SPIKED SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFLECTION SPIKED SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,593.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,593.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,425.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,425.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 58-60 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 11MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X58-60 20DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,818.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL LOCKING HEAD PEG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|572.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL LOCKING HEAD PEG 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|572.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPHER HEAD SCREW 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 1.0MM X 12MM SELF TAPPING WITH CRUCIFORM RECESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|231.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|231.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420498|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CON ART INS 9MM SZ 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II BICONVEX PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PAT W/FLEX LOK 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 10MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LONG STEM 10X150MM W/SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.533|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 13MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|224.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 POST FEM WDG 5-6 5 LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,385.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,385.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ1-2 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ5-6 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333477|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +6 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 22 20 DEG 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 32 20 DEG 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333583|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 28 20 DEG 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.691|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 11MM TI HND CORT ST CRFRM LOPRFL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 22MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420778|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420798|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.698|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 18MM TI HND CORT ST CRFRM LOPRFL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420876|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420976|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 20MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420990|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII TIB FIN FIX PEG1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420994|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII FIN FIX PEG SIZE 5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LEFT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.518.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TI SELF-TAP 2.4MM18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LEFT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 3-4 5MM LTLA-RTMED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 6N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 4N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 5N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 3N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.530.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 30MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM NSLT14X100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 10X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 22X200M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 24X200M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 41MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 44MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71321046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM UNIPOLAR HEAD 46MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 39OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 41OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM BIPOLAR COCR 45OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,996.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 22MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71322843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 28ID 43-46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|353.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|353.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71323257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV B-P LINER 32ID 57-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 39OD 22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 48OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 54OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71324057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM INTL BIPOLAR 57OD 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNDM BP SHL/XLPE LNR 43OD 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US DELTA LINER 64MM OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71325171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 US DELTA HEAD 32 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71326604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TANDEM UNI 12/14 TPR SLV + 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 26MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 44 X 76-80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET TH SZ 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTFT HA ACET TH SZ 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71330466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF LNR 28X66-68 0DEG L+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331099|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 O DEG XLPE ACET LNR 44MM ID 66-70 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,834.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 44IDX76-80OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,415.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 20 ANT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.809.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 9MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 28MM ID US CRMC FORTE ACET LNR 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 62 {} H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 64 {} H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 58MM G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 64MM H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 66MM J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.811.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 11MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 74MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.816.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 16MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 44/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 47/43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECN RING 74OD 70ID LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 66 {} J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 68 {} J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 68MM J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 76MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 68/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX XLPE ANVTD 28 +4 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338671|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE LNR 36MM ID X 72-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338691|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 40MM ID X 64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338698|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM X 62 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 {} XLPE ACET LNR 40MM X 64M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20DEG +4 XLPE ACET LNR 40MM X 66/70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20DEG +4 XLPE ACET LNR 36MM X 72-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 32 20 +4 66-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 32 54-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER 28MM HD 12/14 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,692.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,692.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 23MM TI 1.3MM SCR 6 HL LOPRFL PRECONTOUR RECON BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 DEG 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,966.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 DEG 40 SZ A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 50-52 SZ E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333379|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 DEG 70-76 SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333389|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 70-76 SZ K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 42 B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 29X3.8X.8MM TI 1.5MM SCR MDLR HND SYS 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 62/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 22MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECON RING 62/58 LFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECN RING 68OD 64ID LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX XLPE ANVTD 32 +4 56-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 44X4X1MM TI 1.5MM SCR MDLR HND SYS 4 HLE/HD 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER LNR 32ID 50-54 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER LNR 32ID 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338677|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 40MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338689|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 40MM ID X 60 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.233|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 53X5X1.2MM TI 2MM SCR MDLR HND SYS 3 HLE/HD 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 32 20 +4 54-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE ACET SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,398.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71331960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE HA CTD ACET SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF FSO CER ACET COMP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,425.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,425.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,537.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.913|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 54X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 2 HLE/HD 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|836.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|836.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 HOLE HA CTD ACET SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332541|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERIPHERAL SCREW {} 5.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|403.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|403.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG+4 XLPE ACET LNR 36MM X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71332754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 DEG 40 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 DEG 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 DEG 46-48 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 DEG 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.916|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 8 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 58-60 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 DEG 66-68 SZ J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 DEG 54-56 SZ F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 DEG 58-60 SZ G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,237.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 20 ANT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 62-64 H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333429|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 20 ANT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 44 C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.917|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 57X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 8 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333494|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +6 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333496|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET NH SZ 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NH HA SHELL SZ 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.936|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36X5.5X1.25MM TI 2MM SCR MDLR HND SYS 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,008.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 22MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 17 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 19L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 15 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 16 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 22R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ18R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340819|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 19L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.896|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TI-END (FOR DISTAL FEMORALNAIL)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|268.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|268.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 21L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 14R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 15R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 21R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP HO SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECON RING 50/46 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECN RING 68OD 64ID RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER LNR 28ID 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUM CER LNR 32ID 56-66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338679|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEGREE XLPE ACET LNR 40MM ID X 56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 40MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338694|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 72/74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 457.011S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 15MM 10MM EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|265.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|265.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421386|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK 13MM BOLT - SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421388|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK 18MM BOLT - SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S1-2 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S3-4 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S5-6 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S5-6 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S7-8 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421661|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421667|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421721|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S3 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TI-END(FOR TI-CANNUALTED TIBIAL NAIL)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421723|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S3 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S4 5D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421765|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S7 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421771|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S8 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF RC3 SZ 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,890.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464.38S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL SOLID 9MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 50/46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 53/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 22MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECON RING 56/52 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX XLPE ANVTD 32 +4 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX XLPE ANVTD 36 +4 63-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.330S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 10MM X 330MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER LNR 32ID 56-66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,444.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEGREE XLPE ACET LNR 40MM ID X 60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338693|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 40MM X 72/74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338696|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM X 58 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM X 66/70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 {} XLPE ACET LNR 40MM X 60M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.280S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 285MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 36 62-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 13 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.34S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 345MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 13 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 20R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 21R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 36 70-76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,081.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,081.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 28 20 +4 50-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.138S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 30MM CAL SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 21L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 12 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 18 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 18L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 20L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X46-48 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X63-70 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 13R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 18L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.230S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340919|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 19R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP HO SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM HO 12/14 SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341915|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 28MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 32MM +5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 12 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 16 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X44-45 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X50-54 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 20 ANT +4 70-76 K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.238S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,831.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,831.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 20 ANT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 40 A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 42 B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 22 0 LAT +4 58-60 G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 26 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 28 0 LAT +4 54-56 F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 50-52 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 32 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333498|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF XLPE 36 0 LAT +4 66-68 J|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTI-FIX XLPE 26 20 DEG 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,686.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71333600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALUMINA 12/14 HEAD 36MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,197.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF NO HOLE SHELL SZ 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US CRMC FORTE ACET LNR 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71334948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 50MM E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 52MM E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA PERI HOLE 58MM E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 393.753|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD ATTACHMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|872.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|872.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 64MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,550.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL MM46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,504.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421938|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK AXLE SZ 7 FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,106.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,106.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 1LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.783|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 125MM 5MM SCHNZ SS SLF DRL MR CONDITIONAL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 7 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 2 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE RM/LL SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 1-2 10MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 5-6 10MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 3-4 15MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G11208|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER VISCERAL 5FR X 65CM LENGTH X .038 WIRE GUIDE DIAMET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ1 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRIR15115|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-LIMB 11.5CM 15MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 8L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 21MM SZ 2-3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 15MM SZ 4-5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 18MM SZ 4-5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 5-6 LL/RM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423429|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 1-2 LM/RL 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 1-2 LM/RL 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406136|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER HEMOSET 14FR .X 12CM FAST CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET MH SZ 74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF ACET MH SZ 50 E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,563.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA MH SHELL 62MM H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL HA PER HOLE SZ 54 D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL PERIPHERAL HOLE 70MM HA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 3 HOLE ACET SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,405.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 36MM X 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 22MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71335946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRBR2816135|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA BIFURCATED 13.5CM 28MM X 16MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SP3 THREE HOLE SHELL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRIR1585|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-LIMB 8.5CM 15MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 32MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 22MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX XLPE ANVTD 28 +4 50-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465921|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE MAGIC TORQUE .035 DIAMETER X 260CM LENGTH WITH GLI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACT LNR 36MM X 66/68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338669|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338687|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE LNR 40MM ID X 56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20DEG +4 XLPE ACET LNR 40MM X 72-74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MMX76-80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 32 20 +4 62-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 32 20 +4 70-76|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338699|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM X 64 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401723M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRAVENTIONAL 7 FRENCH X 23CM LENGTH X .035CM GUIDEW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 {} XLPE ACET LNR 40MM X 62M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 36 58-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,081.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,081.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACC SS CABLE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401623M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHTH INTRO GRN 23CM 6FR BRTP CNN INTVN ACPT .035IN GW LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 14 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 19R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15CAL SZ 14L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 15L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 19R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 12L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 13L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 28X50-54 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 12R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM 12/14 SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01261|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 145CM .035IN FXCR HVDTY MNDL J RSN CRV 1.5CM PTFE SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM SO 12/14 SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 26MM +5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 22 MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 28 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 28 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 26MM -5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341939|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 32MM -5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 14 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 20 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 32 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL SHORT PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 32 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 36 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 26 MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 26 MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXNM FEM HD 28MM +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 28X56-62 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 32 MM +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 32X63-70 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 22R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 28X56-62 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 6D 10.5MM MED+ 28MM HIP ZML LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 28X63-70 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340917|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 17R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 22MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 28MM -5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 18 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 22 MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|44MM COCR MODULAR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,874.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,874.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X50-54 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998113522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 13.5X170MM LG.JUNCTION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,213.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,213.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 28MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 22 MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X56-62 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 12 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 14 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 16 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 32MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 32MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71344245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TITANIUM MODULAR HEAD SLV 12/14 TPR -4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|620.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|620.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71344249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TITANIUM MODULAR HEAD SLV 12/14 TPR +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|584.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|584.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00998013532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM BOWED SPLINE 170MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,444.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,444.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 2 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 3 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206529|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 8MM 29MM NXGN UHMWPE KN STRL BLU GRN PUR STRP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 75007718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FAI/PAO PR.GANZ SCHANZS SCREW 5X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 15MM KN FEM TIV NXGN OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 124188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS FM CV MD W/TPR LG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,758.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524859|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 18MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM MAG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE LGE LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS BICONVEX PAT PROS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS RESURF PAT PROS SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LARGE LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM OFFSET 18MM X 145MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71204534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM LT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG LT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204687|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL RT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204689|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL RT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS P/S ART IS SM LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 13MM KN FEM TIV NXGN OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,758.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71420068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CMT TIB SIZE 7 {} LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CMT TIB SIZE 1 {} RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TIB SZ 1 11MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ4 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X46-48 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X63-70 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION STEM STRAIGHT 15MM X 75MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,646.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71342800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 28MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 28MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 11 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 20 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 36MM +16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71346005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 40MM 12/14 MEDIUM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF STEM WITH STIKTITE HO SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 2 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 5 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 6 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401791|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM G 76.5X70.5MM KN LT STSCR CMNT REV LCCK OPTN NXGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71335954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 28MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT ACET TH SZ 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF RC3 SZ 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF RC3 SZ 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,187.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,187.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE SZ 44MM C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF HA THREE HOLE 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,768.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF SPIKED SHELL SZ 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,544.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREE HOLE SHELL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,379.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF THREADED HOLE COVER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|299.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|299.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401592|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ E RIGHT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71336956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71336966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 66/68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT REINF RING 56/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECON RING 50/46 LFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT TIBIAL 10MM SZ-5 NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 724422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM MAG PL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 728210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS UNI MD/LG ART ISRT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,180.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,180.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 913658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS TIB I/M PEG 18X41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,353.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,353.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SMALL RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599403020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 20MM YELLOW CD 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71424022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 9MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 20MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 24MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 11MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 13MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 14MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424089|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 16MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 12MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM10MMX120MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM10MMX160MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599403023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 23MM YELLOW CD 3-4 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71424208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM16MMX160MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM20MMX160MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEGREE XLPE LNR 32MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 36 66-68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,081.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,081.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 28 20 +4 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 14MM GREEN STRIPE CD 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71340115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 12 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 22L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 17 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 21L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 12R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 5 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599404017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR 17MM GREEN EF 5-6 LCCK NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,864.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71420342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420388|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599403033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 3-4 C-D 66X42X33MM KN REV MACH MLD TIV UHMWPE LCCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,888.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,888.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ 7-8 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785800200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER VERSYS PROXIMAL V-LIGN 14/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II BICONVEX PAT 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 24MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 16MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 10MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,808.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,808.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ5-6 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420836|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785800300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER VERSYS PROXIMAL V-LIGN 16/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420974|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 15MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420978|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 25MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LT {} SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LEFT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OVAL RESURFACING PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 28 46-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 16 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 21R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 15R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 17R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5351-4108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT HUM 130MM 12MM SLR 2 WDG SHLDR TI FINS ROT STAB PRFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 14L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 20L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 16R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 28MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 28X63-70 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71346006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOLOX DELTA HEAD 40MM 12/14 LONG +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 1 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 1 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5350-4518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 45MM SHLDR SLR COCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 6 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,774.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,774.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP HO SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 26MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.611|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 1.5MM 1 X 3-HOLE LOW-PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 19 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X44-45 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 28 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 36 +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40MM COCR MODULAR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 28X50-54 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 18 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 36 MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 36 MM XL/+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71346200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACC 200MM TITANIUM PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ADAPTATION 2.0MM X 193MM 30 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF STEM WITH STIKTITE SZ -1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 5 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 7 SO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS INSERT ACETABULAR P7 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM 10/12 TPR FEM HD 36MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 36 MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/61|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF STEM WITH STIKTITE HO SZ -1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OUTER ACETABULAR 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,442.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,442.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONT RECON RING 62/58 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,382.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK P3 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 28MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG XLPE ACET LNR 32MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 28MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71337948|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 32MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RF INTERFIT TPRD ID 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTL ALUM CER LNR 28ID 50-54 OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,273.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 36MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK P4 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 MULTI HOLE ACETABULAR SHELL 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,986.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SM LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204669|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD RT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XS-SM 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK P4 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT MD-LG 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT MD-LG 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XL-MG 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XL-MG 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICONII/GENESIS INSERT LEFT 12MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524878|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 15MM SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK P5 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM LGE RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM LGE LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS TIB BS SM PL PL R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART INSRT SMALL LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SM RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204539|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,435.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,435.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL OSTEOLOCK P5 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5645-1-042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5MM S/T 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICONII/GENESIS INSERT LEFT 15MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 12MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM MAG PL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE SM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS TIB BS SM PL PL L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 916155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LF 18MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SM RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SM LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783301100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 120MM 10MM CMNT VRSY LD/FX 11 36MM OFST 32MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71204657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM RT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204667|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD RT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD LT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS UNI ART ISRT MED LG 8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT MD-LG 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XL-MG 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XL-MG 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00632006828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 20D 14.4MM 68MM 28MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00631006628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 10D 13.4MM 66MM 28MM LNGVT HIP STRL PRM MDLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,968.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 4 {} RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 1 15MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ1 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ1 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ5 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 0D STD NTRL 13.4MM 66MM 28MM LNGVT HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420492|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420494|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ART INS SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,689.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,689.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ3-4 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630506828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 0D STD NTRL 14.4MM 68MM 28MM LNGVT HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420584|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PAT W/ FLEX LOK PEG 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00630507028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACTB TRLG 0D STD NTRL 15.4MM 70MM 28MM LNGVT HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,756.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,756.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,233.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,233.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,233.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,233.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225244010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 44CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM NSLT16X100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 18X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 22X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 20X200M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421387|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK 15MM BOLT - SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S3-4 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225246012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 46CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S5-6 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 40MM X 66/70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338695|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 40MM ID X 56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG +4 XLPE ACET LNR 36MM X 72-74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 20 DEG +4 XLPE ACET LNR 40MM X 56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,214.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 32MM ID US CRMC LINER 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71338960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 36MM ID US CRMC LINER 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,286.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 CONST 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,157.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REFL XLPE 35 32 62-64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71339556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|R3 0 DEG XLPE ACET LNR 32MM X 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,270.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225234014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 34CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 190MM STR SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 120766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TYPE II FEM PAT CO R LG C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,847.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,847.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICONII/GENESIS INSERT LEFT 10MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICONII/GENESIS INSERT LEFT 18MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225234015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 34CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR LT 18MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 15MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GENESIS INSERT LEFT 8MM SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524879|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 18MM SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS FEMORAL X-SM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM MED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE MAG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS TIB BASE SM PL LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SM LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225236015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 36CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204655|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM RT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204665|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD RT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD LT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG LT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71243522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN TIB PLY OLAY XL RM/LL 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,715.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,715.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XS-SM 8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225238015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 38CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 {} 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,643.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225240015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 40CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 3-4 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PFJ IMPLANT X-SM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PF IMPLANT MED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PF IMPLANT LG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225242015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 42CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO METAPHYSEAL STM SM 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 20X100 SOLID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,102.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,102.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225244015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 44CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225246015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 15MM 46CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ1 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ1 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225328011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 28CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ5 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNSII CON INS SZ3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225328012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 28CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ3-4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420586|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PAT W/ FLEX LOK PEG 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204671|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG RT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XS-SM 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225328013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 28CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS P/S FEM SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 14R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225330013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 30CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 20R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 22R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP HO SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM HO 12/14 SZ 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 22MM -3 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 28MM +5 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 13 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 15 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X46-48 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 22 MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225332013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 32CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X50-54 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 22X63-70 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,862.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STR 15MM CAL SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,750.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 32X63-70 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 18 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR STD 260MM BOW SZ 14 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 13L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 15 CAL SZ 16L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,849.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X56-62 0 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225334013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 34CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 15 CAL SZ 20R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 16L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260 BW 30 CAL SZ 22L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 13R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71340918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH POR 260BW 30 CAL SZ 18R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,928.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK LINK ASSY SZ 6-7 FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421637|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WEG SCREW 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421666|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421668|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION 15MM DISTAL WEDGE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225336013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 36CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421699|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION 10MM DISTAL WEDGE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S2 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421751|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S6 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421764|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S7 10D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421766|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S7 15D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421827|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION 5MM POS WEDGE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421937|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK AXLE SZ 6 FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 4RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 6RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 2LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225338013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 38CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDGE SZ 4 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDGE SZ 6 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,286.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,286.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,286.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,286.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 30MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 3 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 5 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 1 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 20MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ1-2 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ7-8 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 45MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 7-8 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420960|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SIZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 55MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CM TIB SIZE 2 {} RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420198|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ4 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 4 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ5 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM 14MM PRM VRSY TIV FM POR 42MM STD OFST LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,740.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,740.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER LM BODY SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420478|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ3-4 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II BICONVEX PAT 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 12MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 14MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 14MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM VRSY FM POR 16MM STD OFST 42MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CMT TIB SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 5 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 8 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 5 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER LM BODY SIZE 17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ6 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ7-8 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,983.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,983.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER LM BODY SIZE 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420878|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420986|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 45MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER SIZE 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 10MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 14MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 10MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 16MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 20MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 12MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 150MM 17MM PRM VRSY TIV FM POR 45MM TPR STD BD OFST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 20MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 14MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 18MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ3-4 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ5-6 {} 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 1-2 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 60MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420970|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420988|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 50MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OVAL RESURFACING PAT 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP SO SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PRI FEM COMP HO SZ 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,642.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 65MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 22MM +3 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71341940|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM HD 10/12 32MM +0 EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECHELON PP HA SZ 17 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 32 +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXI FM HEAD 14/16 TPR 36 +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,316.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 26 MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 26X56-62 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXNM FEM HD 28MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACET LNR 32X56-62 20 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM 10/12 TPR FEM HD 36MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 70MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ4 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 75MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420588|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PAT W/ FLEX LOK 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420634|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 16MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 16MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225308042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 80MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420982|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 35MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 1-2 5MM LTLA-RTMED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 3N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 5N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|44MM OXINIUM MODULAR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,507.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,507.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225308542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 85MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71342600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 26 MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 13 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ECH PP HA SZ 15 190MM +15 CAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,720.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 32MM +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM 10/12 TPR FEM HD 36MM -5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71344248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TITANIUM MODULAR HEAD SLV 12/14 TPR +4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|584.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|584.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/43|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/49|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REF CEMENT ACET COM 22/55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,026.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225309042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 90MM SS MED FEM CORT INTLK STRL BLU ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 3 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE RM/LL SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 1-2 15MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423047|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 5-6 15MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ2 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225208555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 85MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 21MM SZ 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 21MM SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 13MM SZ 2-3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225200100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP IM NL MDN FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|622.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|622.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS FM CV MD W/TPR XLG L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,758.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,758.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524858|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 15MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225200105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP IM NL 5MM MDN FEM XTD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR LT 15MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS FEM SM PLUS RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 3N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 6N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 5N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,814.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,814.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM NSLT12X100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225200110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 10MM FEM XTD IM NL SYS SS STRL MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|652.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|652.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 16X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 7-8 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 7-8 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420996|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII FIN FIX PEG SIZE 7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LEFT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225200115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 15MM FEM XTD IM NL SYS SS STRL MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|711.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|711.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OVAL RESURFACING PAT 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,719.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 5-6 5MM LTMD-RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 7-8 5MM LTMD-RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 4N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421389|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK 21MM BOLT - SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER LM BODY SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 7-8 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S3-4 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S3-4 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421656|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421672|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S3 5D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421731|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S4 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421733|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S4 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S5 10D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 13MM PRM VRSY TIV FM POR 39MM STD OFST LM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421756|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S6 15D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 5MM SZ1-2 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 10MM SZ7-8 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 5 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,088.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,088.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 2RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 15MM SZ 4-5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 3-4 LL/RM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 5-6 LL/RM 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 7-8 LL/RM 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM 16MM PRM VRSY TIV FM POR 45MM TPR STD BD OFST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423428|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 7-8 LL/RM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423439|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 7-8 LM/RL 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 9MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 11MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM20MMX120MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM12MMX160MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM18MMX160MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OFFSET COUPLER ANGLED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 15MM PRM VRSY TIV FM POR 42MM STD BD OFST TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS GNS FEM SM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE XLG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204429|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS BICONVEX PAT PROS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS RESURF PAT PROS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT XLG LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM RT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204659|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM RT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER SIZE 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204677|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG RT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204679|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG RT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204688|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL LT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204690|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL LT 25M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71245014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI THICK FEMORAL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,042.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,042.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 7-8 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S1-2 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S5-6 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK LINK ASSY SZ 2-5 FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,095.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,095.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER SIZE 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421664|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421676|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421698|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION 5MM DISTAL WEDGE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421725|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S3 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S3 15D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S4 15D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421741|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S5 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421761|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S7 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421774|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S8 10D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421775|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S8 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421804|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 10MM SZ3-4 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK AXLE SZ 4 FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,778.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,778.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422159|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00786201000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS METAL FIBER TAPER SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,309.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 6 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 2 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 3 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL VERSYS BEADED SZ-15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422377|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 7 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ3LM/RL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE RM/LL SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 5-6 10MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 801803204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS FEMORAL +7 X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 3L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 RT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 RT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 LT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONST ISRT S2 LT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 LT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,719.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,719.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 LT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 LT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00117901200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 7.5MM 3.5MM SPHRCL ORTH SS 4.2MM NS LF|1|HUMANA [1294]||HUMANA [11839]|122.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|122.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509457|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 LT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 LT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71343604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXINIUM FEM HD 12/14 36 MM M/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF STEM WITH STIKTITE SZ 0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,866.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 4 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMF FXD NECK SIZE 7 HO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,803.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8590855|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEDICLE M8 BREAK-OFF SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR P-2 28MM 15-DEGREE-HOOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,876.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,876.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST SZ1-2 5MM LTMD RTLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 3-4 5MM LTMD-RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 7-8 5MM LTLA-RTMED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 4N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 5N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 6N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR P-3 28MM 15D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM NSLT10 X 100|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 12X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 14X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 7-8 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT {} SZ 7-8 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S1-2 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR P-4 28MM 15DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S5-6 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421663|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S3 10D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S4 10D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421735|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S4 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S5 5D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421762|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S7 5D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421773|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S8 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL VITALOCK CLUSTER 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,910.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,910.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 2R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,335.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,335.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 6R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,777.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,777.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 2L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-152|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 NARROW-BLADE RAMPED|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 14X200M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,910.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,910.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 18X200M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421377|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 3-4 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115203000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 30MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421519|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S7-8 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421639|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SCREW 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421654|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421659|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421671|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421673|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421743|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S5 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 4L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115202600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 11MM SZ 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 13MM SZ 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 11MM SZ 2-3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 11MM SZ 4-5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 13MM SZ 4-5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 11MM SZ 6-7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 13MM SZ 6-7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 3-4 LM/RL 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 5-6 LM/RL 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115202000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GDPN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 20MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 10MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 18MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 22MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 13MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 22MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 24MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 14MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SHORT STEM EXT 10 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115201800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 18MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SHORT STEM EXT 14 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71430869|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 4 SAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|308.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|308.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115201600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71450000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON-P INSET PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47115503505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 35MM HRBRT TIV SM BN CNN STRL ACPT 1.6MM GDPN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,216.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 7-8 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PFJ IMPLANT X-SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 14X100 SOLID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 6LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115201400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,484.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402010|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UROLUME ENDOPROSTHESIS 2.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,160.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|14,160.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00115201200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GDPN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 10MM SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 524869|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRICON II/GEN INSR RT 18MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115202200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS FEMORAL X-SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,873.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS TIB BASE LGE RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR GNS TIB BASE SM PL RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,613.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 916156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LF 21MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,620.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,620.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS BICONVEX PAT PROS XSM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,933.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT SM RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT MED RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115202800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 28MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 4 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CMT TIB SIZE 2 {} LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,527.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CMT TIB SIZE 8 {} LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420191|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CEM TIB SIZE 8 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,702.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TIB SZ1 13MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.65|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 230MM 2MM SS THRD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ4 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S5 15D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421753|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S6 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421755|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S6 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 5MM SZ5-6 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 5MM SZ7-8 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK GDE INSERT LOCK SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|351.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|351.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 8RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 5LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 7LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX TITANIUM 2.4MM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 1 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 7 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 2 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 4 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 5 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 6 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 14MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ4LM/RL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ6LM/RL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ5RM/LL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE RM/LL SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 7-8 10MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 5-6 15MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ6 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.618|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 18MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 3R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 5R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 11MM SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 15MM SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 13MM SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 21MM SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 15MM SZ 2-3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 15MM SZ 6-7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421776|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S8 15D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 10MM SZ1-2 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 28MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|129.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 5MM SZ3-4 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421934|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK AXLE SZ 3 FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII TIB OFFSET COUP W/SLV 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 8LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII {} HA POR TIBIAL {} SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 24MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S5 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S5 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S5 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 26MM 2.5MM TI FT CORT ST SPHRCL HD SM HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} SZ6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 18X100 SOLID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 16X200 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 487.214|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STATURE SMALL 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,860.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 30MM SELF TAPPING 3.5MM HEAD WITH CRUCI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 5 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 4 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ1RM/LL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ2RM/LL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ3RM/LL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 10MM TI FT CORT ST SPHRCL HD SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ4RM/LL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE RM/LL SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE RM/LL SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 7-8 10MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423079|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS ART ISRT LG RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS SM LT 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 18MM TI FT CORT ST SPHRCL HD SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS MD LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS LG LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,184.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL RT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71204685|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS CSYS ART IS XL RT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,953.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XS-SM 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,547.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT MD-LG 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71248342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN UNI ART INSRT XL-MG 12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,316.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II C/R FEM SIZE 2 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 1 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,269.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR FEM SIZE 6 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 20MM SELF TAPPING WITH 2.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NON-MOD CEM C/R FEM SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420098|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 3-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00578207600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM EXTENSION MGII 43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,892.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,892.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 5-6 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,827.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,827.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 5 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.240|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +24 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 3 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 13MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 13MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A33-07020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EBI CORTICAL PENNIG 70/20 3-3.3MM DIAMETER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71420426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ2 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 18MM SZ 6-7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 21MM SZ 6-7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 1-2 LL/RM 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 1-2 LL/RM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423437|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 5-6 LM/RL 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 15MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4204VL-20.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER STAAR ELASTIC 11.2MM LENGTH 6.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424049|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 16MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 10MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 16MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION LOCKING SET SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|373.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|373.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4LM/RL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 7 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,282.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,282.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 1 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 5 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ1LM/RL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ2LM/RL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ6RM/LL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 1-2 10MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 3-4 10MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,976.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47223703300|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 100CM 2.4MM SS SMTH TIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK FULL TIB WDGE SZ7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,408.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,808.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ6 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ7-8 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II BICONVEX PAT 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 39MM SS 4.5MM SCR LG FRAG 2 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 22MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420649|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LONG STEM 12MX150MM W/SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 20MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,808.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,808.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 87MM SS 4.5MM SCR LG FRAG 5 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS FEM OXIN CEM PS LT S 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021169|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 103MM SS 4.5MM SCR LG FRAG 6 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS P/S FEM SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII NONPOROUS PS FEM SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 3 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SZ 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 2 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 1 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,454.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 119MM SS 4.5MM SCR LG FRAG 7 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POR TIB SIZE 6 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,121.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 5 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ8 15MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR PLY TB SZ2 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ 4 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR ALL POLY TB SZ7 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 9MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 135MM SS 4.5MM SCR LG FRAG 8 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 16MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 16MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 18MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 30MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 151MM SS 4.5MM SCR LG FRAG 9 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|395.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|395.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 18MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 18MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 10MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 20MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 RT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 RT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 LT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 167MM SS 4.5MM SCR LG FRAG 10 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|514.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 2R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ8 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 116MM SS 4.5MM SCR BSC FRAG 6 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,408.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 4R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 13MM SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 18MM SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 11MM SZ 2-3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 18MM SZ 2-3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 21MM SZ 2-3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 18MM SZ 4-5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 21MM SZ 4-5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 15MM SZ 6-7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO METAPH TIB STEM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,656.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,656.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|METAPHYSEAL TIB STEM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 16X150 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71502110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX POR FEMORAL RT SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,041.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,041.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71504170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX POR TIB BASE RT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 113410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL 10 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S6 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 1-2 LM/RL 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 5-6 LM/RL 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 22MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 14MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 24MM 220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 12MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 15MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 18MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 20MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM16MMX120MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245700205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ECT EPIPHYSIS FRACTURE FIXATION RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245600007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ECT SMALL FRAGMENT 15MM X 44.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|73.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|73.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,154.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,154.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MI-R2|SUP|HCPCS L8612||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PLATE MOLTENO RIGHT-EYE DOUBLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 2L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 5L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 8R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 15MM SZ 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 13MM SZ 4-5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 11MM SZ 6-7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 13MM SZ 6-7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 3-4 LM/RL 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3546216|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 15.6X13.3CM 800ML STY 6200 SLF SL TCH CENTERSCOPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 22MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 CONST INSRT SZ1-2 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420984|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 40MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII FEM OFFSET COUP W/SLV {} 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,659.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,659.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401463|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PENOSCROTAL ULTREX-PLUG 15CM C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 3L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 4L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TIB BASE L S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,781.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,781.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400095|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PACKAGE DEACTIVATION C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S1 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S5 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S3 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S3 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ3 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TB SZ5 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS ALL POLY TIB SZ8 11MM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ1 11MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 133FV-15|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST EXPANDER TEXTURED 750CC(ANATOMICAL-STYLE 133)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII P/S ALL POLY TIB SZ7 15MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,309.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420496|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,768.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R ART INS SZ7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,316.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CON ART INS 9MM SZ 7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II CON INS SZ7-8 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II RESURF PAT 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 12MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII LNG STEM 14MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,999.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII STEP HEMI WDG SZ3-4 {} 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,989.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,573.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420776|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 3-4 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420794|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420796|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII DISHED INS SZ 7-8 {} 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,336.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS INSERT SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401466|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PENOSCROTAL ULTREX 18CM C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,995.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,995.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II POROUS P/S FEM SZ8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,305.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420959|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CON ART INS 9MM SZ 1-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,174.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420980|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|G2 6.5MM SCREW 30MM LNGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420992|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII FIN FIX PEG SIZE 3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|568.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|568.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401477|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RESV PLUS 100ML 700-ULTREX C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 12MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 30MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 16MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 30MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 12MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 14MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 20MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 16MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 10MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400142|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS MALLEABLE-600 20CMX13OR 11MM C1813|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 24MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 15MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424069|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 16MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 11MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 20MMX220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 10MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102107|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE XTRNFX 400MM 1.8MM ILZ TIB SS BYNT PNT STPR NS|1|HUMANA [1294]||HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 15MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 22MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 24MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM14MMX120MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 1-2 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PF IMPLANT SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB KEEL STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,656.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,656.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 10X150 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71504270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO POR TIB BASE LT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B60-11050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS EBI 110MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71453242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS XLPE INSERT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 3-4 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO METHAPHYSEAL STM SM 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 10X100 SOLID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 20X150 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 12X200 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ8 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 WIDE-BLADE|1|HUMANA [1294]||HUMANA [11839]|1,881.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,881.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 20X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,745.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 24X150M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 1-2 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S3-4 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WEG SCREW 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SCREW 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 810-304|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK LOW-PROFILE|1|HUMANA [1294]||HUMANA [11839]|3,857.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,857.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421669|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S2 5D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421745|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S5 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S7 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} S5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 34-36MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,630.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36-39MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,630.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB ISRT PS STD 5-6 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115539|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39-45MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,568.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,568.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 R 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 R 13 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXIN P/S FEM RIGHT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HM ST 5-6 5MM LTLA-RTMED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,785.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OX CONSTRAINED FEM 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS OXIN FEM SZ6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,893.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR OXIN FEM SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW CR OXIN SZ 4N RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 45-58MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,816.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,816.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 3N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION NARROW PS OXIN SZ 6N LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,318.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 7 LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,088.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,088.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV PRESSFIT STEM SLOT 16X200M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,910.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,910.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK FEM ASSEMBLY SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,060.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK 11MM BOLT - SLEEVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,884.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 5-6 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PS HI FLEX ISRT SZ 7-8 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,098.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 845-011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,408.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,408.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023874|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023961|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023963|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023979|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023996|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 1-2 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023998|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ1-2 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B60-13040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS EBI 130MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74024002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 1-2 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ1-2 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ3-4 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 18MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 RT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 RT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 LT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 LT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5680-6-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER CANCELLOUS LARGE|1|HUMANA [1294]||HUMANA [11839]|36.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 LT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71514220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB PREP PLATE LT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B60-13060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS EBI 130MM X 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71453103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported B60-16090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS EBI 160MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71453185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 5-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S4 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S5 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 10MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 12MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 14MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 20MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 14MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 16MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 14MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 12MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 RT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 LT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509436|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 LT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509447|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 LT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 LT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421752|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S6 5D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421763|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S7 10D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION 10MM POS WEDGE SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|369.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|369.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK AXLE SZ 5 FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,174.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 3RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 5RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 3LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDGE SZ 5 20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,286.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,286.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SOLID 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S4 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SOLID 3.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S1-2 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S1-2 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S7-8 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S7-8 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR DEEP FLEX ISRT S7-8 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,210.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421662|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421674|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SCRW DIS FEM WDG SZ8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,243.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL SOLID 3.5MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S2 15D X 5P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421754|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S6 10D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION SCW LWDG S8 5D X 10P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,217.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POS FEM WDG 10MM SZ5-6 LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,913.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK TIBIAL BASE SZ 3 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,526.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII TIB OFFSET COUP W/SLV 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 7RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII C/R HA POROUS FEM SZ 4LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,404.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII HA POR TIBIAL {} SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,708.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM AIM TMX FT CORT ST SLD NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDGE SZ 3-20M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ3 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK DIS FEM WDG SZ5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S1-2LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S3-4LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY UNI TIBINRT S5-6LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,653.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS1RM/LL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 871-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS4LM/RL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIB S4RM/LL9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 32.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 4R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 5R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710137|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 37.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 5L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 7L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,335.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,335.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE LT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S3 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 40MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 42.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO METAPH TIB STEM 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 12X150 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 14X150 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 20X200 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71504141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO POR TIB BASE W/OH R4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,553.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,553.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S1 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 20MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 45MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 12MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 16MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 30MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 12MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 10MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 14MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 18MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 RT 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 RT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710147|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 47.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 RT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 LT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509467|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 LT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71514240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB PREP PLATE LT SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71514260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB PREP PLATE LT SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 50MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 3R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 6L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE RT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,781.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,781.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ5-6 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 7-8 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|970.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|970.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 23 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024929|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025677|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER SLOT 4.35MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025686|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS2RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS3LM/RL11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5RM/LL10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS6LM/RL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 4 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 6 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 1 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42824|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE DELTA REGULAR 2 #48284|1|HUMANA [1294]||HUMANA [11839]|4,933.35|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,933.35|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8710121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 21.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 4 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 1-2 15MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 7-8 15MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR FULL STEP 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBS5RM/LL8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 2 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI OX FB FEM SZ 3 RM LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUNI COCR FB FEM SZ 6 LM RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 25MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,736.34|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNYUNI APTIBSZ5LM/RL7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,656.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71422424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY UNI TIBIAL BASE LM/RL SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,042.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 3-4 10MM LTLA RTMD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SC HM ST 7-8 15MM LTMD RTLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423097|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL WEDGE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|398.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|398.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEN II MIS TIB BASE CEM SZ3 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,075.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION PS NP FEM SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,358.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 6R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 18MM SZ 2-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 18MM SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 30MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,165.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 13MM SZ 2-3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 RT 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710157|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 57.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023783|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 LT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71514230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB PREP PLATE LT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 60MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 5R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM LT SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,573.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,573.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 62.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,306.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,306.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} S4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} S4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS FEM OXIN CEM PS RT S 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 65MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021139|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS FEM OXIN CEM PS RT S 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021159|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S5 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710167|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 67.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S5 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 18MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 10MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 70MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 20MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025785|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025787|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710172|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 72.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ7-8 LT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX POLY PATELLAR 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710175|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 75MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,049.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,049.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S7 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S1 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S1 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 55MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,165.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT XTB PF S2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021119|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS FEM OXIN CEM PS LT S 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710053|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER SLOT 4.35MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 8 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION CR NP FEM SZ 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,068.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POROUS CR FEM SZ 2R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 11MM SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK RP ISRT 15MM SZ 6-7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,346.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710073|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,237.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,237.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 15MM SZ 2-3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 18MM SZ 2-3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 21MM SZ 4-5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 21MM SZ 6-7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 3-4 LL/RM 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 3-4 LL/RM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423427|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 7-8 LL/RM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 7-8 LM/RL 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 7-8 LM/RL 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 10MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 487.052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW EXPANSIONHEAD SELF-TAPPING 4.35 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 12MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 15MM X 160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,296.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 13MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN SHORT STEM EXT 12 X 80|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,042.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM18MMX120MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN OFFSET COUPLER 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,283.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,283.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 2 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 7 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815341024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 11MM SZ 4-5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,580.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEGION HK GD MOTION ISRT 18MM SZ 6-7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,263.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 1-2 LL/RM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 5-6 LL/RM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71423432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN RK/HK HEMI SZ 3-4 LM/RL 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,441.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM TMX FT CORT ST SLD NS AIM SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN REV TIBIA BASE SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,022.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 11MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 12MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRESSFIT STEM 18MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,177.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 12MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 20MMX220MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,831.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 18MM X220MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PRSFT STEM 11MMX280MM BWD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,989.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM AIM TMX FT CORT ST SLD NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM12MMX120MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,356.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71424206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CEMENT STEM14MMX160MM STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,560.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71425217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN POR CR HA FEM SZ 7 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,411.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71426005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN COCR CONSTRAINED FEM 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,783.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815036016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM TMX FT CORT ST SLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|69.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|69.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ATLANTIS 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,909.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,909.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 30MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023976|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023983|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023985|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ1-2 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ1-2 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ5-6 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 5-6 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 35MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024529|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 29 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 32 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024921|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025627|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025633|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 5-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 7-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 45MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025776|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 50MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 55MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS LT 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP VKS LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS RT 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000298|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000329|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 2/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CANCELLOUS 4.0MM X 60MMLG 20MMTHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001398|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP RT 2 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP RT 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIBIAL COMP TC SYM 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 4L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 25MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 6L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TIB BASE R S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S3 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 30MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S7 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S1 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S5 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 16MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 18MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 12MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 18MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 16MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 RT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 35MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 LT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 LT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,719.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,719.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71514210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB PREP PLATE LT SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRI FIXED TIBL COMP PLUS VKS LT 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,751.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,751.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS RT 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP VKS RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000303|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 40MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 45MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,154.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,154.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453159|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 L 13 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 R 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM 16MM SS PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,484.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,154.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,154.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453149|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE CR INSERT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,260.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN CR HIGH FLEX XLPE SZ 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,926.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 3-4 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,738.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,372.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 3-4 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} SZ6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 55MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021129|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS FEM OXIN CEM PS LT S 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,780.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,780.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702455|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIBIAL COMP TC SYM 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL COMPONENT 8 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,415.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,415.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006059|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 2/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC10/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 6/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM TIBIAL INSERT TC CS ULTRAC 12/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009856|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIBL COMP REV LT LT / PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702660|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 60MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TC REV FEM COMP. REV LT VKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010989|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TC REV FEM COMP. REV LT VKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP RT 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011866|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PS SOLU TIBL INSRT PS 4.17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 60MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000377|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP RT 5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002897|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002899|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 35/10MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005489|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 8/11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 60MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL COMPONENT 4 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,415.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,415.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL COMPONENT 6 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,415.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,415.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453295|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PF IMPLANT LG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO METAPH TIB STEM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,366.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 18X150 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702665|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S1 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S2 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 4R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 7R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 7R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 2L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,335.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,335.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 5L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,975.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ7 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,049.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,049.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S3 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN PS HIGH FLEX XLPE SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,590.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE PS INSERT SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,636.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM SS FT PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,946.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71453294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN XLPE DISHED ISRT SZ 7-8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,230.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71461012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY PFJ IMPLANT SM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,599.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB I-BEAM STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 12X100 SOLID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 16X100 SOLID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 10X200 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023953|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023964|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023974|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023992|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ1-2 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ3-4 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 5-6 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023844|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702675|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 75MM SS FT PERIART CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023951|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023957|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023968|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023972|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 3-4 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 75MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 26 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 32 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 26 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024835|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 35 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024838|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 38 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024928|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 75MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025655|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025657|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 LT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 80MM FULL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 R 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 L 11 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702480|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 80MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579104100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|48MM HEADED SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|196.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579104300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|27MM HEADED SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|196.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 2 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE B RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE F RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 3 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 12MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 80MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 12MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 12MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005997|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM TIBIAL INSERT TC CR STAND 6/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 4/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010988|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TC REV FEM COMP. REV LT VKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TCREV FEM COMP. REV RT VKS2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TCREV FEM COMP. REV RT VKS3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702685|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM SS FT CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75015075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS RT SOLU TIBL INSRT W.CLAMP 8.17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S5 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S7 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702485|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN FEM OXIN CEM PS RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN FEM OXIN CEM PS RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,972.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702585|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 85MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,402.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 18MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 12MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702490|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM 16MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 18MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 10MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S4 12MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 10MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S5 20MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 RT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ5-6 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ7-8 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ7-8 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 7-8 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702590|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM 32MM SS CANC PERIART NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 23 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 29 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024923|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025645|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025646|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025767|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027247|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL SZ E 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74027252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 14X200 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71501318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NEUT STM 18X200 SLOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL ONLY SZ G 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71507134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S3 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT RT S5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S1 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,801.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S1 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S3 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S4 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S3 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S4 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG FEM 10MM NXGN G KN TIV PMMA ROT HNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71508162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025781|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025782|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL ONLY SZ C 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74027222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023774|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023781|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL ONLY SZ D 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74023850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023884|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023959|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023969|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023978|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023993|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ1-2 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT DISTAL ONLY SZ F 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74024011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ3-4 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ3-4 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ5-6 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ7-8 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ7-8 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024926|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024927|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401792|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ G RIGHT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,536.89|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,536.89|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74025636|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 5-6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025685|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 10MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 14MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ C LEFT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 584209608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74014531|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR TIB SPEED PIN 6M X 27M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE A LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599401492|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LCCK SZ D RIGHT NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|19,734.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 584201301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE C LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE D LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE F LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE G LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 1 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00406602626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RCD FENLIN 26MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,759.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,759.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00406602632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL RCD FENLIN 26MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 LT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509343|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 RT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT ACETABULAR DURATN P-3 32MM 15-DEG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,523.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 LT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S4 LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S5 LT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71514250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO TIB PREP PLATE LT SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|533.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|533.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,573.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,573.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6251-2-052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS CUP PREMISE 28MMX52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,313.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,313.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR R 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,724.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 6R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S1 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S3 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S6 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD MOD COCR 28MM-3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S2 14MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 14MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 20MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 10MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,920.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S6 14MMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 16MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO P/S ART ISRT S3 20MML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CONSTRD ART ISRT 3-4 RT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029259|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 RT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 163660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD MOD. COCR 28MM-6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS RT 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS LT 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 10/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 133MM SS 10 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029229|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 157MM SS 12 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029237|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029278|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS RT 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP VKS RT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP VKS LT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 181MM SS 14 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 61MM SS 4 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 0/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP LT 4 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ1 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE LT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR LT S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,250.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85MM SS 6 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S7 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234701008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 109MM SS 8 HL NONLOCK BN TIB LT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA STTB IN TR/S4/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 133MM SS 10 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS TIB ISRT PS STD SZ 5-6 LT, 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,577.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,577.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 LT 9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 L 10 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023780|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 157MM SS 12 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 LT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023952|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700914|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 181MM SS 14 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025773|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 61MM SS 4 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S2 RT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 RT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 RT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 LT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S3 LT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71509466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONSTR ISRT S6 LT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700906|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 85MM SS 6 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OXID NP SZ 1 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 109MM SS 8 HL NONLOCK BN TIB RT DIST LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029249|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 RT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS LT 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP VKS RT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS LT 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00672808600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR HGPII SIZE-F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS RT 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000304|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000339|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 672808700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ELEVATED-RIM 28MM SIZE-G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,681.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 4/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 8/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 2/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 14MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 10MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 14MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 12MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 168MM SS 10 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIB COMPRESSION SCREW 22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|512.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|512.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 192MM SS 12 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 8/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002893|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 2/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002896|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004787|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 26/10MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 4/14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 6/8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 216MM SS 14 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PRIM FEM. COMP LEFT 12 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,484.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,484.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB COMP TC SYM 2 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM TIBIAL INSERT TC CS ULTRAC 12/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 2/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,778.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,778.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 8/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC10/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009853|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIBL COMP REV LT LT / PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009854|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIBL COMP REV LT LT / PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIB COMP REV RT RT / PLUS V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 96MM SS 4 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S7 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBK ISRT STB PF S1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 120MM SS 6 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} S4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN FEM OXIN CEM PS LT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,780.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,780.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 144MM SS 8 HL NONLOCK BN TIB LT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002913|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 12/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004739|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PRIM FEMORAL COMP. LEFT 10 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIBIAL COMP TC SYM 10 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIBIAL COMP TC SYM 12 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004785|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 29/8MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004789|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 32/10MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB COMP TC SYM 8 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 168MM SS 10 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB COMP TC SYM 12 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 6/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 4/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 6/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC10/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM TIBIAL INSERT TC CS ULTRAC 12/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM TIBIAL INSERT TC CS ULTRAC 12/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X60MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 192MM SS 12 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S3 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 216MM SS 14 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 3 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S6 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S6 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 120MM SS 6 HL NONLOCK BN TIB RT PERIART MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023965|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023977|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023991|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023994|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 144MM 8 HL BN TIB RT DIST MDL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,155.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 3-4 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ3-4 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 5-6 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 7-8 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 7-8 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ7-8 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN PAT RESRF RD 32 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,834.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,834.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024924|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401720|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS MALLEABLE 650 20CM V13MM FGS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX NON-POR FEM RT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,312.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 3R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/O TPR 3L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,084.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR FEM W/TPR L 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,177.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NP P/S FEM W/TPR 7L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,757.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,757.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX POLY PATELLAR 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71540101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE POR RT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA RT S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71544203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE HA LT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71549101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB BASE NONPOR RT S1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,861.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,861.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S1 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S1 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71621813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 RT S8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP LT 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 6/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CROSSLINK LOW PROFILE L-.100" 5.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004788|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 29/10MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 8/14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 4/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 8/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 8/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC10/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X35MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIB COMP REV RT RT / PLUS V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 811-305|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOPRFL 1.125IN TI 5.5MM ROD XLNK BN SPNE|1|HUMANA [1294]||HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 869121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC 3IN STEINMN PIN W/HD PKG10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,093.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,093.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 28-30MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,287.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,287.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 865118|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 5-DEG IM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,874.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,874.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA*SIN PEG OV/DOM PAT TR 41|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 5 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 5 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE A RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE G RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 30-34MM TI 5.5MM ROD LOPRFL LGC MLSPN X10 XLNK CD HZN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,630.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,630.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021255|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CROSSLINK LOW PROFILE L-.750" 5.5MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,801.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,801.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN LT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 3 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY TIBIA BASE NP RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,487.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 RT 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 25MM TI 5.5MM ROD LOPRFL FX LG X10 XLNK CD HZN BN SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X45MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIB COMP REV RT RT / PLUS V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIB COMP REV RT RT / PLUS V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ D 10MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 966338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUDSON MODTIBDRL POR 13M 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 STD NCEM TB PUN SZ 2.5-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 MOD TIB NCEM PUN SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 MOD TB CEM PUN SZ 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ E 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 966382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2MOD TIB DRL POR 13MMSZ1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 F WED CUT BLK 10DEG/LL/RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 F WED CUT BLK 10DEG/LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ F 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74025644|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 3-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025771|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599003701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUGMENT POSTERIOR SZ G 5MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,092.55|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 74027241|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S3 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71622709|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT G2 LT S7 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-124|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 ANGLED-BLADE|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} S5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO MB ISRT STABILZ {} SZ5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71641714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MB ISRT STB PF S7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,118.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,262.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURNEY FEM OX NP BCS RT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,615.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021149|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RENASYS FEM OXIN CEM PS LT S 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM OX NP RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOUR FEM COCR NP LT SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,817.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 NARROW-BLADE|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TCREV FEM COMP. REV RT VKS1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TCREV FEM COMP. REV RT VKS4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75015068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS RT SOLU TIBL INSRT W.CLAMP 6.17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-122|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 NARROW-BLADE SMALL-GROOVE|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 1 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 3 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE C RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR SZ2/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 WIDE-BLADE SMALL-GROOVE|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 EXTENDED-BODY SMALL|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 3 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 4 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE D RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 5 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 12MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 NARROW-BLADE SMALL|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 10MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 14MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 10MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 12MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 3 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-052|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 NARROW-BLADE RAMPED SMALL|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420999|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII PRI FEMORAL LUGS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|251.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|251.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74013401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NONRIM SPEED PIN 110 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 RT15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 1-2 LT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK PEDICLE M8 WIDE-BLADE SMALL|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 LT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 LT21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 3-4 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 7-8 L 15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023773|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER BODY MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224410065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224410565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS LT 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS LT 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP RT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021261|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224411065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74021265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR FEM COCR NP LT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEMORAL OXIN RT SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,163.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74022296|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR BASEPLATE SZ 6 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,547.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 1-2 RT 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS SM 3-4 LT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,530.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023234|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023236|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 3-4 RT18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 5-6 RT25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,299.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224408065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOURN ART INS BCS STD 7-8 RT13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,854.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 5-6 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023873|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023962|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023967|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ3-4 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2244-085-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023981|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023989|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023995|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 1-2 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 1-2 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 3-4 RT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 3-4 LT 9MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ5-6 RT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ5-6 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ7-8 LT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024219|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR RT SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224409065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024629|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 29 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 32 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 41 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 1-2 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025647|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025667|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 5-6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00224409565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|359.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|359.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025687|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE E RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 3 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 14MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 12MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00115202400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM HRBRT/WPL TIV SCPHD CNN STRL ACPT 1MM GD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,285.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 12MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 10MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 10MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 6 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR SZ2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 4 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 4 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8696530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 6 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 IM ROD 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 12MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8696535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 10MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 14MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 14MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 2 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8696540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598304033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MIS Headed Screw 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|205.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8696545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 6.5 X 35 MULTIAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202472300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TEMPLATE SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202472600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TEMPLATE SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8696550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTIAZIAL 6.5 X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|35MM OVAL PATELLA TR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 865119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 7-DEG IM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,408.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,408.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR SZ2/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TRSZ2/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 2/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM SS PERIART CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000369|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000375|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 8/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000379|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 10/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000487|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM SS PERIART CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002894|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002895|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004786|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 32/8MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 4/11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 1-2 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REN TIB INS PS STD 5-6 RT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,649.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 1-2 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 3-4 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 RT 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 5-6 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023771|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE MED 7-8 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023811|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023813|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 1-2 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 3-4 RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023871|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 RT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023881|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR INS XLPE LAT 7-8 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023958|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ1-2 LT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023975|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 RT 10MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023982|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ5-6 LT 11MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74023984|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE MED SZ7-8 RT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ3-4 RT 12MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XR ART ISRT XLPE LAT SZ 5-6 LT 8MM -2DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,329.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT BICONVEX 26 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024729|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 29 MM SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY BCS PAT RESRF RD 26 MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,811.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74024922|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS FEM COCR LT SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,441.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 1-2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025634|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 3-4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 3-4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025765|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 5-6 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025775|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 20MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027233|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4-RT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 RT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 3-4 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2EXTRAMED BASE TIB ALIGN DEV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,928.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,928.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 STD CEM TIB PUN SZ1.5/2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 MOD TIB NCEM PUN SZ 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 MOD TIB DRL NP15MM SZ4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966383|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2MOD TIB DRILL POR 15MMSZ4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC2*TB CE ST PUN1.5-3SZ13X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 TB CE STM PUN/SZ4-6/15X60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 FL WED CUT BLK 15DE/LL/RM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598304048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MIS Headed Screw 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|205.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71421932|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LGN HK AXLE PLUG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|445.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74014535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II XR TIB SPEED PIN 6.5MX40M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|194.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|194.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 869116|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC 2INHDLES STEINMN PINPKG10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|654.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|654.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74013472|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RIM SPEED PIN 65MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CORTICAL 3.5 SELF-TAP 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR SZ2/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIARTICULAR CORTICAL 3.5 SELF-TAP 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR SZ2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005486|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 6/11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005649|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB COMP TC SYM 4 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,243.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,243.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 2/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 8/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X55MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|319.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|319.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UC-PLUS SOLU FEMORAL COMPONENT 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,669.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75015061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS RT SOLU TIBL INSRT W.CLAMP 4.17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,593.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 5-6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 5-6 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE LT SZ 5-6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025673|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025675|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II CR ISRT XLPE RT SZ 7-8 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 1-2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 3-4 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 3-4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025777|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD RT SZ 7-8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74025783|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II ISRT XLPE DD LT SZ 7-8 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,197.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 1-2 LT 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 RT 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 5-6 LT 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029227|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029238|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 RT 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029244|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 5-6 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 5-6 LT 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 46MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 9M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 7-8 LT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS RT 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,794.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,794.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS RT 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP VKS RT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000294|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 12/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM SS PERIART CORT ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR SZ2/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER DEPTH STOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|41MM OVAL PATELLA TR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA*SIN PEG OV/DOM PAT TR 32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA*SIN PEG OV/DOM PAT TR 38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 MOD TB NCEM PUN GD/1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPEC2*TB CE ST PUN1.5-3SZ13X60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 75MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2FEMNTCHGD BSH13MM7DG+2L/-2R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 F NOT GD BH,13M/7D 0 OFFS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2FEMNTCHGD BSH15MM7DG+2L/-2R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 6 LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE B LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 80MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|89.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|89.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 2 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 5 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 12MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 10MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584207114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 5 14MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 26MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217861090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM IM PLATE LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,070.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,070.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 28MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 2/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 30MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000385|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000479|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 4/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000490|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 12/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 2/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002891|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 2/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002898|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 6/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 10/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 4/8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 34MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005488|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RT-PLUS TIBIAL INSERT 8/8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB COMP TC SYM 10 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 4/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 2/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 4/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 6/13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 10/9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X50MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|332.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|332.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIB COMP REV RT RT / PLUS V|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 38MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010986|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TC REV FEM COMP. REV LT VKS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 RT 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74027283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS XLPE ART ISRT SZ 7-8 LT 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,745.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 RT 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 1-2 LT 12M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029242|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 10M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702340|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 15M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT 3-4 LT 21M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 13M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74029277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JRNY II BCS CNSTRD ART ISRT RT 7-8 18M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,609.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL COMP PLUS VKS LT 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM VKS LT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PRI FIXED TIBL CEM PLUS VKS RT 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,174.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000297|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000299|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR LT 6/17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702342|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 42MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 4/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 4/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 6/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS LT 8/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 4/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 6/12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CS RT 12/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75000489|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 10/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,587.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP LT 5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75001399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS FEM COMP RT 3 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,461.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702346|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 46MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002904|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 8/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,461.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75002906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB INSERT VKS CR RT 10/10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,706.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIBIAL COMP TC SYM 2 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,534.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIBIAL COMP TC SYM 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,983.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,983.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702348|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 48MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 50MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1405010010|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GORTEX SOFT TISSUE PATCH 5 X 10CM X 1MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|837.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 55MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 3 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 4 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 3 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 60MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 SIGMA FEM INSERT/EXTRACT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,683.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,683.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702365|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 65MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 70MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR SZ2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 2 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 2.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 6 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 IM ROD 400MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702375|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 75MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 85MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420063|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII FEMORAL FLEX LOK PEGS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|595.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|595.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234702390|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 90MM SS CORT PERIART ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74013470|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RIM SPEED PIN 30MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74013471|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RIM SPEED PIN 45MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75004784|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS PATELLAR COMPONENT 26/8MM CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,999.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75005650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM FIXED TIB COMP TC SYM 6 NON-CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,682.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 8/15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,207.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 660001822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL POROUS 17 X 156 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,475.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,475.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 2/19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM/TC REV TIB INS TC CS ULTRAC 6/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75006091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC PRIM TIBIAL INSERT TC CS ULTRAC 12/11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,923.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009855|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIBL COMP REV LT LT / PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75009857|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TIBL COMP REV LT LT / PLUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,877.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75010990|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TCREV FEM COMP. REV LT VKS5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUS VKS REV TC REV FEM COMP. REV RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,688.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784301406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL VERSYS BEADED SZ-14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75023376|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC-PLUS TIBIA INSERT 6 LT VALGUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,794.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,794.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 4 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 6 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 1 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598802016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENTION STEM OFFSET 16MM X 145MM NEXGEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,350.54|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 584202214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 4 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 6 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202471300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI FEM FIN BLK SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202474100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 1R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202474300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 3R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRBR2615135|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA BIFURCATED 13.5CM 26MM X 16MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRBRHXC2816165|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA BIFURCATED 16.5CM 28MM X 16MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM THRD SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,439.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,439.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB 2 DEG BROACH 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV CEMENTED TIBIAL PUNCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,014.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRIRHXC16115|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-LIMB 11.5CM 16MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV FEM SLEEVE/STEM IMPACT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2*EXT ALIGNMT DEV BASE PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966359|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 STD CEM TIB PUN SZ2.5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966361|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 MOD TB CE PUN GD SZ 4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700610|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 169MM SS 4.5MM SCR 10 HL NONLOCK BN TIB LT PROX LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 201MM 4.5MM SCR 12 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUDSON MODTIBDRL CEM 13M 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 MOD TIB CEM PUNCH SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 MOD TIB DRL NP13MM SZ1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,054.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 TB CE STM PUN/SZ4-6/15X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,116.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700602|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 42MM 4.5MM SCR 2 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 73MM 4.5MM SCR 4 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217855030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION FEM POSTNR SM/SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,054.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,054.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTED STEM BUSHING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 137MM 4.5MM SCR 8 HL BN TIB LT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,294.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL BROACH 29 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB 2 DEG BROACH 53MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REV SLEEVE IMPACTOR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,467.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,467.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|38MM OVAL PATELLA TR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 201MM 4.5MM SCR 12 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR SZ2/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR S2/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR SZ2/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 232MM SS 4.5MM SCR 14 HL NONLOCK BN TIB RT PERIART LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,353.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011864|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PS SOLU TIBL INSRT PS 2.17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 75011868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUSTC PS SOLU TIBL INSRT PS 6.17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,798.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579104200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|48MM HEADLESS SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|196.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 42MM 4.5MM SCR 2 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 579104400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|33MM HEADED SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|205.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|205.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 1 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584200202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Tib Base Sz 2 RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 10MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 10MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584205212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 3 12MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 14MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 1 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 3 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Vivacit-E Art Surf Sz 4 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 73MM 4.5MM SCR 4 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 5 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7162241399|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PMB ISRT G2 LT S4 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,079.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 724559|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIB COMPRESSION SCREW 16M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|512.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|512.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234700506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 105MM 4.5MM SCR 6 HL BN TIB RT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,214.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-514|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 14MM 75CM 40MM PERI LV SCRCH RST HI STRTH SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501271|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF ANT ROT GDE 7DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501273|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP CLASSIC ROT GDE 0DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501287|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-3199|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|128.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|128.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-3192|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|786.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER SLEEVE MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201103051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP REV STEM BOLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7112-3150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CHS 4-SLOT 135-DEG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,098.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,098.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976749|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER BODY SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.720S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL 7.5MM X 205MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.722S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL 7.5 X 220|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584201501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL SIZE E LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584202310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICULAR SURFACE SIZE 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.723S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL 7.5 X 230|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 10MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584203214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 1 14MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584204214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 2 14MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 10MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584206114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 4 14MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584208112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALL-POLY TIB SZ 6 12MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,844.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 5 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.841S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED DISTAL FEMORAL 13MM X 160MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 584209612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VIVACIT-E ART SURF SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,956.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74013490|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NONRIM SPEED PIN 80 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|60.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|60.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.842S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL TI-DISTAL 13MM 200MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA*SIN PEG OV/DOM PAT TR 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/2.5/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S4/12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.844S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED DISTAL FEMORAL 13MM X 280MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S5/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR SZ2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 2 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.847S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.848S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL TI-DISTAL 13MM 360MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,312.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,312.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.850S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 13MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201103052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP REV SLEEVE BOLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,181.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,181.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202471500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI FEM FIN BLK SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.27S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 270MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202472100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TEMPLATE SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202472400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TEMPLATE SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202473200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 2L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202473400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 4L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.28S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 285MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.31S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 315MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUDSON MODTIBDRL CEM 15M 4-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 MOD TB CEM PUN SZ 4-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.40S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2FEMNTCHGD BSH13MM7DG+2R/-2L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.27S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 270MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.30S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA 5DE/F ST TR ADA ASSY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,146.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,146.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3TB IN TR/1.5/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 961537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 TB IN TR/S3/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|501.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|501.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TBIN TR 6 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 462.923S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HUMERAL 9 X 230MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,684.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,684.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 2.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 4 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR 6 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR SZ 3 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 IM ROD 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.033S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 330MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 INTRAMED TIB ALIGNMENT DE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,597.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,597.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PF*2 MOD TB CE PUN GD SZ 1.5-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 345MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.038S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,255.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,255.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4D HIGH PERFORMANCE LCS BONE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D HIGH PERFORMANCE LCS BONE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503019|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7D HIGH PERFORMANCE LCS BONE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 8D HIGH PERFORMANCE LCS BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.441S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL 14 X 400|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.912S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV LCK LGHT BLU 120D FEM TI SLD 13-15MM CNN NL SPRL BLDE|1|HUMANA [1294]||HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102407500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL CEMENT UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501286|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 355.042S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GD ROD ORTH 950MM 2.5MM TI SMTH TIP TIB NL SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S4 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB IN TR S6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 963317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIB INSERT TR S1.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,244.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966123|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 IM ROD 8MM TO 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.058|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DCP 2.0MM X 42MM 8 HOLE 1.5MM THICKNESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 STD TB PUNCH GDE SZ 1.5-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 F NOT GD BH,15M/7D 0 OFFS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2FEMNTCHGD BSH15MM7DG+2R/-2L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,009.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DCP TIT. 2.0MM 7-HOLE C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|474.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|474.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DCP 2.0MM X 22MM 4 HOLE 1.0MM THICKNESS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,022.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,022.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLET REV FEM BSHNG 5DEG 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202471200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI FEM FIN BLK SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202474200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 2R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202474400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 4R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 457.012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 15MM 20MM EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 973101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STBIN TR S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,759.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 12MM 20MM EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF POST ROT GDE 7DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,668.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 902929|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HARPOON SUTURE SIZE-2|1|HUMANA [1294]||HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF ANT ROT GDE 0DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501279|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501282|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501289|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202471100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI FEM FIN BLK SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,364.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,364.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202471400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI FEM FIN BLK SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202473500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 5L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 298.801.01S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE ORTH SS 1.7MM 750MM LNG BN CRMP CRLGE STRL LCP|1|HUMANA [1294]||HUMANA [11839]|1,544.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,544.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102408300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 8MM KNEE UNICONDYLAR RIGHT MEDIAL LEFT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102408500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 8MM KNEE UNICONDYLAR RIGHT MEDIAL LEFT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102403200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 31.6MM CEMENTED SIGMA COCRMO PATELLOFEMORAL LEFT TROCHLEA GCK PARTIAL KNEE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501660|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.8-13.6CM P4-4.8CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102403400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 4 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL LEFT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 63X59MM KNEE LEFT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 66X61MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 73X69MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196001400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE RIGHT CEMENTED CRUCIATE RETAINING SIGMA COCR NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196063500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196068500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501625|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.4-11CM P3.4-3.9CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196077500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ KNEE RIGHT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE LEFT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 NARROW KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501645|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.1-12.6CM MENTR P3.7-4.3CM MDRT PRFL RND SAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 NARROW KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 10 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 7MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL XLK FIX BEARING UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542615|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10CM SLTX 3.1CM MDRT PRFL RND SAL TXTR 150-175ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 9MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 9MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ1 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542630|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.5CM SLTX P3.5CM MDRT PRFL RND SAL TXTR 225-250|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168240|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT ROUND TEXTURED STYLE-168 240-270CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3D HIGH PERFORMANCE LCS BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4D HIGH PERFORMANCE LCS BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 MOD TIB NONCEM PUN SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 966473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP*2 F WED CUT BLK 15DEG/LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,299.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.24S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 24MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|246.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|246.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER BODY LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,226.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,226.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER SLEEVE SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SP2 PAT PLANER SLEEVE LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,856.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,856.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.28S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT LOCKING 3.9MM X 28MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|222.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 6MM LCP TI FT RDS CORT DIST ST SPHRCL HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217855025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS HP DIST LONG IM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,339.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,339.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.125|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX 1.25MM HLD MN XTRNFXTR NS|1|HUMANA [1294]||HUMANA [11839]|2,422.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM TAPERED RMR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLET REV FEM BSHNG 5DEG 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX 1.6MM HLD 1.6MM KWR MN XTRNFXTR NS|1|HUMANA [1294]||HUMANA [11839]|2,422.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,422.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202471600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI FEM FIN BLK SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,338.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202473300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 3L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202474500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 5R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PW FEM 3IN1 SZ 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,637.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,637.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 7MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 7MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.133|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX 3MM CNCT MN XTRNFXTR NS|1|HUMANA [1294]||HUMANA [11839]|2,252.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,252.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217855035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION FEM POSTNR MED/LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.134|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLAMP XTRNFX 3X4MM CNCT MN XTRNFXTR SEF NS|1|HUMANA [1294]||HUMANA [11839]|2,252.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,252.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM IMPCT SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV PRESSFIT TIBIAL PUNCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,014.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,014.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162912|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE CENTERING FEM 12MM|1|HUMANA [1294]||HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 162902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FRACTURE FEMORAL 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254900270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE REV SLD RP INSRT SZ3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254900280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE REV SLD RP INSRT SZ5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102407100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL CEMENT UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102403500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 5 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL LEFT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196000400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE LEFT CEMENTED CRUCIATE RETAINING SIGMA COCR NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11165224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP WHT 50MM 28MM RNGLC BIOMR II HIP ACTB COCR 2 ARTC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE RIGHT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE RIGHT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD+ KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501610|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 9.1-9.5CM P3-3.4CM MDRT PRFL RND SAL STY 1600 SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3232-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK CARVING OVAL TESTICULAR SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228771000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MODULAR PATELLA FACE PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,454.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,454.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228772000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS PATELLA HEAD SM MD/LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228774000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS PATELLA HEAD STD LG/LAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,896.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB 2 DEG BROACH 37MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217863113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB 2 DEG BROACH 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101468000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 14/16 BALL TPR 32MM HIP COCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KTCO-NP21|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BASE TIBIAL N/P SZ-2+ NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported KPON-32ST|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATELLA SINGLE-POST SX-32MM NO C-CODE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,022.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,022.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H787107204035|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO SOS O2 CRV 5FR 80CM VSCR RADOPQ SLCT HTORQ SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD+ INS 1.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158101120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158103115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158104112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.665S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 65MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202472200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TEMPLATE SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202472500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TEMPLATE SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202473100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP TROCH ANT BLK SZ 1L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WCEP-8.4|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS ESOPHAGEAL SET 8.4|1|HUMANA [1294]||HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 10 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 NARROW KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 NARROW KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 NARROW KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 10 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ1 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX POLY PATELLA 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 1.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE RT S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT RT S4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542430M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.1-11.3CM SLX SPC P3.3-4.2CM RND SAL TXTR ADJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501265|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF POST ROT GDE 3DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,668.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF ANT ROT GDE 5DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP CLASSIC ROT GDE 3DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP CLASSIC ROT GDE 7DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501284|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1002949-28|SUP|HCPCS C1877||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY MEGALINK 28MM|1|HUMANA [1294]||HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.473|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,244.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,244.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217865140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIBIAL VIEW PLT SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UROLUME ENDOPROSTHESIS 3.0|1|HUMANA [1294]||HUMANA [11839]|15,009.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|15,009.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 22261205|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR SPNL 5MM VSP TI SPCR NS|1|HUMANA [1294]||HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 4 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ5 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2026-2435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP BONE 5.5MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-11.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM COLLAR 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,953.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217860063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMP REV CEM STEM BUSHING 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217861092|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPLETION REV FEM IM PLATE RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,070.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,070.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONVERGENT ORION 80MM TITANIUM ALLOY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,653.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD+ INS 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD+ INS 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970453|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970471|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970481|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158100117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158102112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158102115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158103112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158103117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158104115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2225-1.5A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VSP A 1.5A SLOT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,898.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,898.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33-345436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 2.5MM 36MM SS FT CANC HEX NS AXSOS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|318.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|318.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 26MM TI 1/3 THRD CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.73|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 30MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 34MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 38MM TI FT CNN ST SLF DRL LG HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6D HIGH PERFORMANCE LCS BONE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 414.772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 1.75MM 72MM TI FT CNN ST LG HEX SCKT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 0D HIGH PERFORMANCE LCS BONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,511.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,511.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 22MM TI 1/3 THRD CNN ST SLF DRL SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 228773000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS PATELLA HEAD STD/LG MDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,606.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,606.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254900230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE REV SLD FB INSRT SZ3-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102404400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 4 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL RIGHT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE RIGHT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394.80|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 100MM 11MM CFBR SLF DRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE RIGHT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF POST ROT GDE 0DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501283|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394.82|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 150MM 11MM CFBR MR CONDITIONAL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501285|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF POST ROT GDE 5DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,668.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,668.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501269|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP FIXED REF ANT ROT GDE 3DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,616.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501280|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501281|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FEM FINISH BLK SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,317.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394.84|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 250MM 11MM CFBR MR CONDITIONAL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|822.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|822.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066401071|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ J TIP .038 640-107|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 394.85|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 300MM 11MM CFBR MR CONDITIONAL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|822.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|822.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501275|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP CLASSIC ROT GDE 5DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,036.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 394.86|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 350MM 11MM CFBR MR CONDITIONAL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|822.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|822.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440.14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 84MM TI 4.5MM SCR LG FRAG 4 HL SHFT LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 116MM TI 4.5MM SCR LG FRAG 6 HL SHFT LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440.18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 148MM TI 4.5MM SCR LG FRAG 8 HL SHFT LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|744.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 4 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 6 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440.44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANG LT L BTRS 86X14X3.8MM TI 4.5MM SCR 4 HL SHFT LC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|679.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|679.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.00|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECONSTRUCTION 3.5MM 10 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|804.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|804.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102407300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102408100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 8MM KNEE UNICONDYLAR RIGHT MEDIAL LEFT LATERAL CEMENT UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130MM TI 3.5MM SCR 11 HL RECON BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|819.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|819.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ1.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ4 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 58MM TI 3.5MM SCR SM FRAG SET 5 HL RECON LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|729.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|729.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196076500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD KNEE RIGHT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ KNEE RIGHT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ KNEE RIGHT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CRUCIATE RETAINING PFC SIGMA POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-1-046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 46MM HIP CH VIT VTLK P2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 NARROW KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 NARROW KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 NARROW KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 NARROW KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-1-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 50MM HIP CLSTR VIT VTLK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-1-054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 54MM HIP CH VIT VTLK P4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 11MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL XLK FIX BEARING UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 9MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-1-056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 56MM HIP CLSTR VIT VTLK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 1.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-1-058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 58MM CLSTR VIT VTLK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6352-5-075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM 12 CROSSFIRE 10¦ 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,424.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102407200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102404300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 33.8MM CEMENTED SIGMA COCRMO PATELLOFEMORAL RIGHT TROCHLEA GCK PARTIAL KNEE SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 66X61MM KNEE LEFT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 63X59MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ACTB 32MM 10D P4 HIP DRTN S12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE LEFT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196073500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE RIGHT CEMENTED LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE+ KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE RIGHT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ACTB 32MM 10D P5 HIP DRTN S12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 NARROW KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 NARROW KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 NARROW KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ACTB 32MM 10D P6 HIP DRTN S12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,876.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,876.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 10MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL XLK FIX BEARING UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 7MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 7MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6302-5-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ACTB 32MM 10D P3 HIP DRTN S12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,227.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6632-3-615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB DRCN 1 MED UNV KN 72X48MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3D HIGH PERFORMANCE LCS BONE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6632-3-620|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB DRCN 2 MED UNV KN CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,136.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,136.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6632-3-630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT TIB DRCN 2 LG UNV KN CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,467.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,467.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TIB IN 6 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85-2708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 8MM MNDB ER HTORQ XDR MAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ3 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970443|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVDPLUS INS2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|124.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|124.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970484|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158100110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158100112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158101115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158102117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158103110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158105117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158105120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158106112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRT CRNMXF 4 HL TMPLT 2MM SCR BN LCTSRB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 60X56MM KNEE LEFT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 78X74MM KNEE LEFT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 57X53MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196009400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE RIGHT CEMENTED ROTATE PLATFORM PFC SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2315|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 4MM LCTSRB CRNMXF ER CLR CD RSRB HEX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196066500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196072500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196074500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196079500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ KNEE RIGHT CEMENTED LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD+ KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD+ KNEE RIGHT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CRUCIATE RETAINING PFC SIGMA POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 1.5MM LCTSRB SE CRNMXF RSRB HEX HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE RIGHT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD+ KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501263|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP FIXED REF FEM SIZER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,168.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,168.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP CLASSIC ANT DOWN FEM SIZER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45,513.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45,513.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501277|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HP CLASSIC POST UP FEM SIZER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51,381.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51,381.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501288|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA RPF HP FEM FIN BLK SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 FIX REF BLK SZ 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950501413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG HP 150 CLASSIC BLK SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 10 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 NARROW KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 10 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|100.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 NARROW KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 NARROW KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL XLK FIX BEARING UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 1 9MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL XLK FIX BEARING UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ1 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 7MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 3.2MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|136.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|136.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970441|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 5MM LCTSRB CRNMXF ER CLR CD RSRB HEX PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|120.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|120.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254900250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE REV SLD FB INSRT SZ7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCTSRB STRG CRNMXF 4 HL 1.5MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ1 7MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 7MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 9MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 9MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 915-2414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCTSRB CRNMXF 4 HL STRG XTD RSRB 1.5 MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPM-149|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH POLYPROPYLENE CLEAR 14" X 9"|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD+ INS 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158100120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 1.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158101108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158103120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158104117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 8 HOLE REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|183.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|183.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6 HOLE LONG TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|198.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|198.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93-7200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 4X2CM SPND TTPL URTH FSCA LATA SLNG PRC IRR|1|HUMANA [1294]||HUMANA [11839]|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,080.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ1.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ1.5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37040410|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CBL SLV ORTH 1.6MM DLMLS HIP SS SET|1|HUMANA [1294]||HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 1.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSERT SZ 2 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 444.004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 36X8X2MM TI 2.7MM SCR MN FRAG 4 HL DCP BN FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|694.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|694.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ2 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ7 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 444.006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 52X8X2MM TI 2.7MM SCR MN FRAG 6 HL DCP BN 2.7MM FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|919.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|919.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.51|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD BND TI 2.7/3.5MM CORT SCR 8 HL FSN BN WRST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,656.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,656.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT BND TI 2.7/3.5MM CORT SCR 8 HL FSN BN WRST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,897.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,897.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 442.53|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG TI 2.7/3.5MM CORT SCR 9 HL FSN BN WRST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,481.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,481.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158101110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158102110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158105108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158105112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158106117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 71MM SS 4.5MM SCR LG FRAG 4 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 1.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 1.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254900290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE REV SLD RP INSRT SZ7-8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102407400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102408200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 8MM KNEE UNICONDYLAR RIGHT MEDIAL LEFT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102404100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL RIGHT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE LEFT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196050400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196069500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD+ KNEE RIGHT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD+ KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CRUCIATE RETAINING PFC SIGMA POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3515-1-238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 38CM LT FEM GRS-K IM RECON TI GRS-K|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,254.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,254.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 NARROW KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 9 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 NARROW KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 9MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 7MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 9MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254900240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE REV SLD FB INSRT SZ5-6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATM-240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.8-3.6MM 24MM ACTRK TI MN FT RADL MTRSL MIDFOOT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSERT SZ 1 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72400161|SUP|HCPCS C1815||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL URO A800 OCL CUF URN CNTRL SYS 4.5CM SPHNCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +4MM 32MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,417.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,417.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD+ INS 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVDPLUS INS2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970482|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158100115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158101112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -4MM 32MM HIP VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,593.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,593.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158102120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158104120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158106120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 8MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72401476|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PENL 701 ULRX+ RSRV PREFL 65ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 9MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102451500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ5 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102451600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ6 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB10MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB15MM,SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB12.5,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB 8MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB12.5,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962633|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 15MMSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6215-5-021|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LARGE HOWMEDICA BONE PLUG 1PK|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 32MM XX-LG 5-DEG 40-TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,282.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,282.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1128135|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS OSS 4.75MM .6MM SCHKNT EAR SS FLRPLAS PSTN WRE|1|HUMANA [1294]||HUMANA [11839]|309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201260|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANRSM 9X1.5MM MCFADDEN 30D 6MM OPN MP35N ALY ANG FWD|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201270|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANRSM 9X1.5MM MCFADDEN 30D 7MM OPN BYNT STRG MP35N MRI|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D HIGH PERFORMANCE LCS BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6D HIGH PERFORMANCE LCS BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7D HIGH PERFORMANCE LCS BONE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950503021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 8D HIGH PERFORMANCE LCS BONE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,895.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201256|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP ANRSM 5X1.5MM MCFADDEN 30D 6MM OPN MP35N ALY ANG RT MRI|1|HUMANA [1294]||HUMANA [11839]|636.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|636.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-5-055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.28MM 55MM GMA SS HIP FEM IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102404200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 2 31.6MM CEMENTED SIGMA COCRMO PATELLOFEMORAL RIGHT TROCHLEA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102404500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 5 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL RIGHT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2758115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CEMENTED CRUCIATE SUBSTITUTE OPEN BOX PFC SIGMA UHMWPE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,589.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196008400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE LEFT CEMENTED ROTATE PLATFORM PFC SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196040450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE LEFT CEMENTED POSTERIOR STABILIZE SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,661.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196062500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-5-080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.28MM 80MM GMA SS HIP FEM LCK IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196075500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE RIGHT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129412060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE LEFT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE RIGHT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-7-230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 38CM HIP RT FEM GMA IM 130D LNG LCK SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,829.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,829.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSERT SZ3 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-7-030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 34CM HIP RT GMA IM 130D LNG LCK TI|1|HUMANA [1294]||HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-7-330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 40CM HIP RT FEM GMA IM 130D LNG LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866026|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA MOD TIB TRAY CEM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG MOD TIB TRAY CEM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 5 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-6-130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 36CM HIP LT GMA IM 130D LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,309.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 7 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 2 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR KEEL TIB TRAY SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR KEEL TIB TRAY SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 6 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 8 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA INSET PAT 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-3-111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE CM CEMENTED HIP #1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LO PRO POLPAT SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-3-112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE CM CEMENTED HIP #2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-3-113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE CM CEMENTED HIP #3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ3 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ3 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-3-114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE CM CEMENTED HIP #4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 9MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-3-115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE CM CEMENTED HIP #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,176.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 9MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 14mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129416210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 NARROW KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 NARROW KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 NARROW KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 15mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 150410126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 NARROW KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410224|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 NARROW KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 7MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 8MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 9MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 16mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 102454210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 7MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 1.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158116008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 17mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 158123008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970445|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158100108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 1.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158103108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 18mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6265-4-414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CNTRLZR STM 14MM DFN HIP FEM TY A MOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|226.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S6 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 4 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 10mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 11mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151620708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 12mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151640712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S2.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S2.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 3 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6259-8-130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELIANCE DISTAL CENT 13mm|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|445.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|445.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LO PRO POL PAT LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151820029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL DOME PAT 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151820035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL DOME PAT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151810035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL ANAT PAT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151810041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL ANAT PAT 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-3-104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM CMNT COLR DFN PM VIT 132D 4 35MM HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL RT SZ 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154703002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154704001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 4 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154707004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154708002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154907003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150640005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE CRS FB TIB BASE SZ 5 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151214050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CEMENTED STEM 14X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151214130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CEMENTED STEM 14X130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151316110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM16X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151318060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM18X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-4-966|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 66MM HIP NPOR OSTLK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,862.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151318160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM18X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +16MM 2XL 28MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,674.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192151|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192161|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5260-5-020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OSTEOLOCK BONE SCREW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102407600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 8MM KNEE UNICONDYLAR LEFT MEDIAL RIGHT LATERAL CEMENT UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102408400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 8MM KNEE UNICONDYLAR RIGHT MEDIAL LEFT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102408600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 8MM KNEE UNICONDYLAR RIGHT MEDIAL LEFT LATERAL CEMENTED UNICOMPARTMENTAL HIGH PERFORMANCE SIGMA POLYETHYLENE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,305.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102403100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 1 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL LEFT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280023MM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 23MM CRP-ED PRIMNT RSR XENOLOGIX COCR BVN PRICRD|1|HUMANA [1294]||HUMANA [11839]|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102403300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT PATELLAR 3 CEMENTED HIGH PERFORMANCE SIGMA COCRMO PATELLOFEMORAL LEFT TROCHLEA GCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,169.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED ROTATE PLATFORM HIGH FLEXION PFC SIGMA STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,816.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158105115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158106108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158106110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158110117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 444.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60X8X2.5MM TI 2.7MM SCR MN FRAG 7 HL DCP BN FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 1.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158121117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 3 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 8MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102451400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ4 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 3.5MM 16MM TI SM HND RDS CORT DIST ST CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|166.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|166.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102452300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ3 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102452500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ5 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB12.5,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB8MM, SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB12.5,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB10MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB15MM,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB10MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 15MMSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 3.5MM 24MM TI SM HND RDS CORT DIST ST CRFRM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|207.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|207.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 10 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 10 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 1 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 3 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR KEEL TIB TRAY SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 1 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 5 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LO PRO POL PAT SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 492.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|K-WIRE 1.6MM DIA 150MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151820032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL DOME PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151820041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL DOME PAT 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL LT SZ 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440204|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL RT SZ 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.811.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 11MM TI CORT ST NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S6 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.522.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 22MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM LEFT S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960088|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM RT SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ2,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960832|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ2RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960861|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ3,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+INS 22.5MMSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+INS 12.5MMSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+INS 17.5MMSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.520.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 20MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 12.5MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962733|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 17.5MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962742|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962753|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 17.5MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 30MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 15MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS17.5MM,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 17.5MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 25MM, SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.526.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 26MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962333|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962345|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962353|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S4,15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962357|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S4,25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 980132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY LM/RL S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 981164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY RM/LL S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-2710NS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ3 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192141|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-13303-3.0|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 3MM FEM BRKWY OSTM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7495-25|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION IN-LINE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114604500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 45MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ5 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630708|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114604000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 40MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 57X53MM KNEE LEFT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2 60X56MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 71X65MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 78X74MM KNEE RIGHT CEMENTED CRUCIATE RETAINING PFC SIGMA NONPOROUS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,831.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196020500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196030400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE RIGHT CEMENTED SIGMA COCR STERILE CR150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,662.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196064500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114603000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 30MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196065500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196067500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE LEFT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196078500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 2.5 KNEE RIGHT CEMENTED POSTERIOR STABILIZE LUG SIGMA COCR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,259.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129401010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE RIGHT CEMENTED LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129402060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL LARGE KNEE LEFT CEMENT LCS COMPLETE COCR STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,158.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE RIGHT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129411040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL STANDARD KNEE RIGHT CEMENTED STABILIZE ROTATE PLATFORM FLEXION LCS COMPLETE STERILE LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1.5 KNEE LEFT CRUCIATE RETAINING PFC SIGMA POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 940019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 4N KNEE LEFT CRUCIATE RETAINING PFC SIGMA POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,510.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129403020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL+ KNEE RIGHT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114603500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 35MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL SMALL KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129404030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL MEDIUM KNEE LEFT LCS COMPLETE POROCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,291.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114605000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 50MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL RT SZ 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154708001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 8 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154708004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154907002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E2100-12|SUP|HCPCS C2628||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH OCCLUSION AORTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114605500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 55MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150640008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE CRS FB TIB BASE SZ 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152303102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG LM/RL SZ 3/4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152307202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG RM/LL SZ 7/8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114606500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 65MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 4 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114607000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 70MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 NARROW KNEE LEFT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 1 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 3 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150400205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE RIGHT CEMENTED CRUCIATE RETAINING ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 5 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 7 KNEE LEFT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114607500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 75MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150410210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 10 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ATTUNE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,280.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE LEFT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 8 KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150401226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT FEMORAL 6 NARROW KNEE RIGHT CRUCIATE RETAIN CEMENTLESS ATTUNE POROCOAT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ2 9MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ3 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ4 7MM LM/RL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102453610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ1 9MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 9MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114606032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 60MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ5 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102454608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI INS SZ6 8MM RM/LL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,391.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158112020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 2.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158113017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD GVF INS 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 1.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 2.5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158123015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114609000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 90MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB GVF INS 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,016.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2.5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114609500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 95MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ3 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114611000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 110MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114611500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 115MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630305|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ4 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 981167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY RM/LL S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB TRAY SIZE 4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* TIB STM EXT 4/5/6 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAPER CEM STEM 13X90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867433|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 115X20MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 115X24MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129454000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT TRAY SLEEVE POR M/L 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114612000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 120MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129454130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT TRAY SLEEVE POR M/L 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIV FEM SLEEVE CEM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL FEM SLV DIS POR 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-10MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD STP 1OMMSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRRT06060070L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX RINGED TW 6MM X 7O|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,645.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114604532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 45MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114605032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 50MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ6 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ3 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114605532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 55MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 6 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114607532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 75MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 9 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S2 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114608032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 80MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114608532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 85MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ9 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151304000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUN REV OFFST STM ADPTR 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151214030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CEMENTED STEM 14X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151216130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CEMENTED STEM 16X130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151316060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM16X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151320060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM20X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151320160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM20X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM RT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114611532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 115MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960823|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ2,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960828|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA FEM POST AUG SZ2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960829|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ2LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960851|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,2.5,LFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 25MM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962732|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962754|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970461|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970473|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLK CVD PLUS INS 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 970475|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA XLKCVD PLUS INS 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114612032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 120MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158101117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158102108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158104108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158104110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158105110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158106115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA PLI XLK INS 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158111117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158114115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114609032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 90MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA CRVD XLK INS 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158122120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 2.5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158124125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158125125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158126125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA STAB XLK INS 6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,505.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114609532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 95MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650307|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114611032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 110MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ9 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650918|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1952-71-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FIXATION 7MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875707|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875709|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REVFEM CEM L STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM STD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM STD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195270000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 20MM CNN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSERT SZ 1 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1952-75-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 9 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S6 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1952-76-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 9 X 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 4 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CVTBIN S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 972101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1952-77-000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED FIXATION 9MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|434.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|434.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630914|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4833|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE 3 MTP GRT TOE SIL|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ10 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 8MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS17.5MM,SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 22.5MM, SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS17.5MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS22.5MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 30MM, SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4831|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE 1 MTP GRT TOE SIL|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 12.5MM, SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 20MM,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INSERT10MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 15MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G4260010|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE FLXB HNG|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 9MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 8MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 8MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 9MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102451100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ1 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB 8MM,SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426-0030|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE SWNSN 3 LAT MTP SIL FLXB HNG REG STM WO GRMT|1|HUMANA [1294]||HUMANA [11839]|2,463.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,463.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB10MM,SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB12.5MM,SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB10MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151620916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 9 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151621010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR FB INSRT SZ 10 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 7 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151640818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 9MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 8MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 9MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102452400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ4 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB15MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB12.5,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB12.5,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P,P/S TB 8MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781809900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR HD VRSY LGC +7MM 12/14 HIP FEM TIV UNPLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.75|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|399.75|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P,P/S TB 15MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623421R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH FEM W/PIN XSMRT 66X58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, X-SML, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, X-SML, 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY XS 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621635|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*DOME PAT UHMWPE 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ1, 8.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ2, 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781809901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR HD VRSY LGC +10.5MM 12/14 HIP FEM TIV UNPLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|291.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 984682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS, SZ4, 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMODC/S STAB INS SZ3N 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ3 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781809902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADPR HD VRSY LGC +14MM 12/14 HIP FEM TIV UNPLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|291.60|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|291.60|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151650205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ2 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650907|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650916|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650920|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783301200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM 12MM CMNT VRSY LD/FX ZML 38MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129416125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783301400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM 14MM CMNT VRSY LD/FX ZML 40MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 196192023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ4 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ5 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783301600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 145MM 16MM CMNT VRSY LD/FX ZML 42MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129417112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 8MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102451200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ2 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 130MM 13MM PRFT VRSY LD/FX ZML 38MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 102452200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ2 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102452600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ6 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960631|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB10MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960633|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB15MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB 8MM,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 8MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 10MM,SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIGMA STAB ALPOLYTIB 15MMS5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA MOD TIB TRAY CEM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 967505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 135MM 14MM PRFT VRSY LD/FX ZML 40MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 967508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962346|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962355|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S4,20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 981168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY RM/LL S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REVISION CEM TIB TRAY SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB TRAY SIZE 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866404|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* TIB STM EXT 4/5/6 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866469|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAPER CEM STEM 15X90|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 115X10MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 115X18MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 140MM 15MM PRFT VRSY LD/FX ZML 40MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 867444|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X16MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867447|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X20MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453235|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL FEM SLV DIS POR 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453246|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL FEM SLV FUL POR 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,755.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,755.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860381|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD STP 15MMSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 15MM,SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864182|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158120000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG MOD TIB TRAY CEM COCR 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158160000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG MOD TIB TRAY CEM COCR 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 150600004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 7 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 1 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 2 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA INSET PAT 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151641006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 47MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151641008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS FB INSRT SZ 10 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 1.5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 951042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG RPF INS SZ 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,934.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S3 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP CV TB/IN S4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,384.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 2 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 3 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMARP STB TB IN 6 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,940.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT SM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT MED 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT STD+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129405720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP INSERT LG+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,628.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS SM 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS MED 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS STD+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129416720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS INS LG+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,247.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 49MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 196191011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 1.5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196191062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RPF AOX INS SZ 6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,908.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ1.5 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986097|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ6 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127836025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM+/STD 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 50MM HIP UNPLR EPRSTH ZML VRSY LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 127862025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127883025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+/LG 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127887025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+/LG 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129028025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 20.0MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129040025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149235025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149238025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149240025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149256025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149273025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 51MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 149275025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149278025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168854025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168855025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168862025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168875025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195668025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195671025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS CRUC M/B PAT REPLC GVF LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148492025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK ALL POLY 3-PEG PAT 7.5X30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 52MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 198715000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS XX-SM HINGE PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,610.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,610.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 12X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 14X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962661|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 10MM,SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA MOD TIB TRAY CEM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 967510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 9 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 53MM HIP UNPLR EPRSTH ZML VRSY LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129431140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129433170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM KEEL TIB TRAY SZ7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432130|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR KEEL TIB TRAY SZ7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 4 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA/RD/DOME PAT 3PEG,32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA INSET PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986039|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIG 1PST RD/DOME PAT 41MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ10 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151651018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 8MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 8MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 10MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB 8MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 8MM,SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 15MM,SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962641|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P,P/S TB 10MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 55MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962642|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P,P/S TB 12.5,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 8MM,SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 8MM,SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS MED 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 46MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151630112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630807|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 2 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 9 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781803900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 39MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 150610010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 10 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR KEEL TIB TRAY SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 2 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA/RD/DOME PAT 3PEG,38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986037|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIG 1PST RD/DOME PAT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LO PRO POLPAT MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 40MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151810029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL ANAT PAT 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIG STAB ALPOLYTIB 12.5MMS5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA TIB TRAY CEM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 967504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 967506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 967507|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 967509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA PRIMARY POR TIB S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,547.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 1 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 3 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 41MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129433115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM KEEL TIB TRAY SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM R MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM R LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM L SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM STD LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129426051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM STD+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIG 1PST RD/DOME PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 43MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129409720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL LT SZ 7 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154704003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154706002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154706003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154904001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 4 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154905002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781804400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD VERSYS ENDO FEMORAL 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 151700524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ2 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ4 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX CRV INS SZ4 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ1.5 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ2.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ3 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781805700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 57MM HIP UNPLR EPRSTH ZML VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 196192136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ3 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 196192167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG RP AOX STB INS SZ6 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,795.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS SM+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS MED 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 17.5X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781806000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 60MM HIP UNPLR EPRSTH ZML VRSY LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122132260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 36IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 36IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781806300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 63MM HIP UNPLR EPRSTH ZML VRSY LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136516500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM 28MM +0 M HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,328.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136566500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 44MM M SPEC+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136528230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 28MM +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117270000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197617140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 17X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197618190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 18X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197718290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 18X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197719290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 19X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197723190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 23X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9483|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 13MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|397.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197731290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 31X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197524105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 24X105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197528095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 28X95|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526424N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 24X19X230N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526424R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 24X19X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ4 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650606|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ6 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650607|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650805|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 8 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ1 9MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5645-1-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 8MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 8MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 11MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411609|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 9MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412209|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 9MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ2 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ4 10MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412509|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ5 9MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ6 11MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102451300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ3 LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114608500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 85MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB8MM, SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB12.5,SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960643|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB15MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL LT SZ 5 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL RT SZ 3 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154705001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 5 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154706001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 6 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154706004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5645-1-036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154903001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 3 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154904002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5645-1-038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 4.5MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700812|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700822|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152303001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG UNIV SZ 3/4 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152305001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG UNIV SZ 5/6 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152307103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG LM/RL SZ 7/8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151306000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUN REV OFFST STM ADPTR 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151216080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CEMENTED STEM 16X80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-56310|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT EAR MALLEUS TO FOOTPLATE STRUT POLYEEL M/FP|1|HUMANA [1294]||HUMANA [11839]|798.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|798.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151320110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM20X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL LT SZ 3 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL RT SZ 5 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154705003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154707002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 7 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154708003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154903002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154906001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 6 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154907001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 7 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154908003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 8 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 28MM 3.5MM SSCR FT KN ACL POLY L LACTD ASCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 10 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA/RD/DOME PAT 3PEG,35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LO PRO POLPAT STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE POLY PATELLA LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409610|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 24MM 3.5MM SSCR ORTH PLLA ASCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154705002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154908002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 32MM 3.5MM SSCR FT POLY L LAC ACD CNN ACL ASCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700808|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700824|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150640003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE CRS FB TIB BASE SZ 3 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152305102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG LM/RL SZ 5/6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151324110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM24X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA TC3 FEM LEFT SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM/1.5,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960841|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG4MM,S2.5,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG8MM,S2.5,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BABSR 40MM 3.5MM SSCR FT POLY L LAC ACD CNN ACL ASCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960863|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ3,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960869|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ3LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960883|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ4,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, X-SML, 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, SMALL, 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*DOME PAT UHMWPE 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621638|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*DOME PAT UHMWPE 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984199|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ6, 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984391|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3N, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 312145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3N, 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3N, 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984681|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3, 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986057|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117820025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127826025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD+/LG 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127876025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD/LG 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127884025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+/LG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129003025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129006025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1705015006|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH CV THK.6MM 15X5CM GRTX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,746.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,746.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129026025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 15.0MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129039025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149232025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149234025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149236025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149241025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149243025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149257025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149269025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149271025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020952100|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 360CM 10MM 2 VLR STRG TUBE KNTD SFT FLXB HMSH GMCVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,698.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,698.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149277025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152303202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG RM/LL SZ 3/4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152303203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG RM/LL SZ 3/4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152305202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG RM/LL SZ 5/6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152307102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG LM/RL SZ 7/8 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151310160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM10X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151312160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM12X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151322110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM22X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM/1.5,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114607032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 70MM 32MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960803|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM/1.5,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 12MM/1.5 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ2,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960848|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG FEM POST AUG SZ2.5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,2.5,RGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563118N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 18X13X215N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563214L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 30+4L 14X09X205L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152172000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ3 250MM BOW LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157167000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 1.5X16.5 CALCAR 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157171000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 1.5X19.5 CALCAR 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114606000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 60MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/18.0 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/16.5 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/21.0 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157208136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/13.5 R BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157210195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/19.5 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157309000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X22.5 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157314000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X15.0 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L92524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KAR HA FEMORAL STEM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L92528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KAR HA FEMORAL STEM 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151322160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM22X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114608000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 80MM 16MM MGNFX SS SM BN CNN HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM LEFT S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA POST AUG 4MM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG4MM,S2.5,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960852|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,2.5,RGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ3RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ5,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ5,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960911|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ5LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 45MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+INS 22.5MMSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962746|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 25MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962755|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 22.5MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 17.5MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 20MM, SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 30MM, SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 20MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 42MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960531|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 12.5MM, SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 15MM, SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 30MM, SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962337|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962351|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S4,10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS STD+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6942-5-052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 52MM UNTRX HIP MDLR EPRSTH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,748.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129417720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RPS AOX INS LG+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,261.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS SM+ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS STD+ 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129418720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP RP AOX INS LG+ 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,103.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6215-5-011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MED HOWMEDICA BONE PLUG 1PK|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 6 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ7 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630814|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 8 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151630908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 9 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151631016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CR RP INSRT SZ 10 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL NECK 32 SHORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 1 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ2 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ5 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB10MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 8MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB 10MM,SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB12.5MM,SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902603400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|00889024156159|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 158115000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG MOD TIB TRAY CEM COCR 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,479.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 5 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150600006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 3 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129433110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM KEEL TIB TRAY SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,458.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 9 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 3 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIG 1PST RD/DOME PAT 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452805400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168842025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168861025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168863025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195672025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195695025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195697025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409860|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148495025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK ALL POLY 3-PEG PAT 9.5X38|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148496025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK ALL POLY 3-PEG PAT 10.0X40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452805200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XXSM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727226|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MULTIHOLE W/GRIPTION 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MULTIHOLE W/GRIPTION 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00452805600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121836758|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 36IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 40IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121844672|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 44IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121844676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 44IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122028050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LINER 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960889|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ4LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960910|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ5RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452805000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ5RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 12.5MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 25MM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962735|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 22.5MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INSERT10MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 15 MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 22.5MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960532|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 15MM, SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452804800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962336|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962338|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962348|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD PLUS TIBIAL TRAY SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD PLUS TIBIAL TRAY SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD PLUS TIB TRAY SZ 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 980137|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY LM/RL S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 981162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY RM/LL S2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860178|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-10D SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452804000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-10MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-15MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860373|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD STP 1OMMSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960871|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ3LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960881|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ4,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960892|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ4RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960901|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ5,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452804200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-42|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960909|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ5LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962714|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 22.5MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 12.5MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962744|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962745|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 22.5MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 12.5MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962757|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452804400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962765|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 22.5MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150640007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE CRS FB TIB BASE SZ 7 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152305103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG LM/RL SZ 5/6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152307203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG RM/LL SZ 7/8 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151302000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUN REV OFFST STM ADPTR 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151310060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM10X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151310110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM10X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 452804600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP ACETABULAR TI-BAC-46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,487.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151314060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM14X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151314160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM14X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151322060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM22X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM RT SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM/1.5,RIGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960826|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA FEM POST AUG SZ2 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ2RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG8MM,S2.5,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA FEM POST AUG SZ3 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960890|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,SZ4RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962716|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB + INS 25MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 12.5MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 15MM, SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 25MM,SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 17.5MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960540|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INSERT10MM,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 22.5MM, SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE D LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962363|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860124|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD PLUS TIBIAL TRAY SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 980138|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY LM/RL S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REVISION CEM TIB TRAY S2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB TRAY SIZE 2 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866498|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAPER CEM STEM 13X120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867426|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 115X12MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867446|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X18MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453245|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL FEM SLV DIS POR 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860181|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-15MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE E LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM R STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REVFEM CEM R STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM R LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM L MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN YELLOW 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM L LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM SM+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM STD+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 15MM LG+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM LG+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCSIG 1PST RD/DOME PAT 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN YELLOW 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT CEM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL LT SZ 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL LT SZ 8 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154707001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 7 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154905001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 5 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154906002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154908001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE POST FEM AUG SZ 8 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN YELLOW 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 5 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650707|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 7 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650806|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ8 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151650912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 9 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151651016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE PS RP INSRT SZ 10 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,644.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102411309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 9MM LMRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN YELLOW 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102412308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI A/P SZ3 8MM RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,848.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102452100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA HP UNI TIB TRAY SZ1 RMLL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,649.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960651|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB10MM,SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960663|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P CVD TB15MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,646.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962632|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA A/P P/S TB12.5,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,115.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 9X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 11X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198714111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS DISTAL FEM COMP XXSM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,036.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,036.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN YELLOW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 36IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN YELLOW 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 10D LNR 36X58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122070128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MARATHON LINER M 28 10DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,144.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,144.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124146526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR BANTAM 10D 22.225X46 LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 28MM HEAD +0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101814000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 28MM +8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136528740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DLT TS CER HD 12/14 28MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121715270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 15X70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 20X66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-YELLOW 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101175000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 60OD X 57ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101177000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 64ODX61ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X30MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121735800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X35MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875705|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM L LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-YELLOW 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM SM+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM MED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM LG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 15MM LG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426071|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM LG+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426073|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM LG+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 15MM LG+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 25MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS12.5MM,SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-YELLOW 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 25MM, SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS12.5MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INSERT10MM,SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 20MM, SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 22.5MM, SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,30.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 980134|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY LM/RL S4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-YELLOW 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REVISION CEM TIB TRAY S1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB TRAY SIZE 3 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 12.5MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962324|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962347|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962365|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860122|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD PLUS TIBIAL TRAY SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 980135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY LM/RL S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 75X10MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867421|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 75X24MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-YELLOW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867442|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X14MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X22MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860171|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-10D SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-20D SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-10D SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860371|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD HEMI-10DSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860372|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD HEMI-20DSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM R SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599603223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-YELLOW 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM L SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM SM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM SM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM MED RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 15MM STD+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 15MM STD+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM LG+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN GREEN 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, SMALL, 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, MEDIUM, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, LARGE, 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621604|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY XS 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY MED12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN GREEN 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY MED26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984142|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ2, 8.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984149|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3, 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3, 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984198|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ6, 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984392|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3N, 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3N 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ3 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ6 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STRIP RTNL FLT 125X4X1.25MM SIL SLV SPNG STRL|1|HUMANA [1294]||HUMANA [11839]|36.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN GREEN 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117821025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD/12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117827025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD+/17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117831025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG/17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127803025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM/STD 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127820025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD/LG 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127827025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD+/LG 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127832025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM/STD 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127853025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS R BRDG BRG STD+/LG 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN GREEN 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152303103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG LM/RL SZ 3/4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152305203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG RM/LL SZ 5/6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152307001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN TIB AUG UNIV SZ 7/8 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151312060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM12X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151312110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM12X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151314110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM14X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151324060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE PRESSFIT STR STEM24X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960809|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 12MM/1.5LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960821|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ2,RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960846|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIG FEM POST AUG SZ2.5 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN GREEN 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960849|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG12MMCO,2.5,LFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960872|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ3RGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 864180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC KEEL TIB TRAY CEM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,969.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD TIB TRAY NP, SZ 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150670006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE FB TIB BASE SZ 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,426.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129431115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT CEM TIBIAL TRAY SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,067.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 5 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150610007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 7 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,718.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129432150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR TIBIAL TRAY SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,008.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN GREEN 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129434120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT POR KEEL TIB TRAY SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,199.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 7 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150611009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE RP TIB BASE SZ 9 POR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,915.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LOPRO POLPAT STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE LO PRO POLPAT LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,107.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101402500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BANTAM FEM HEAD 22.225MM+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101480790|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BANTAM FEM HEAD 28MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-GREEN 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136518500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM 28MM +6 M HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,328.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 522032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*HEAD FEMORAL COCR 32+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136534000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM M HEAD 36MM +9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136544720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DLT TS CER HD 12/14 44MM +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121765500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN CAN BONE SCREW 6.5MMX65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197614190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 14X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197619140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 19X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197719240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 19X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197721240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 21X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-GREEN 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121745800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X45MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563040N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L20X15X270N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563042L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L22X17X275L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563058L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 18X13X315L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563140L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,20X15X270L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563142L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,22X17X275L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563144L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,24X19X275L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 538075T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROMTROCHANTER WASHER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 538077T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*WASHER,TROCHANTER,54X70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 538152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,TROCHANTER,52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|606.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-GREEN 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,5.0MM DIA,55 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125750000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125765000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 65|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 75X12MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-20D SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860185|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-10D SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860193|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-20D SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD HEMI-10DSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-GREEN 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM SM+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM STD+ LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 15MM LG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM LG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-GREEN 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, LARGE, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY XS 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621605|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY XS 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984143|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ2, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984145|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ2, 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599604123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-GREEN 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ4, 8.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ6, 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127861025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127869025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127874025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127877025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD/LG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129004025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129005025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129024025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 10.0MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129037025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN BLUE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149233025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149237025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149242025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149249025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149265025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149270025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN BLUE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623411R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRHFEM W/PIN SM RT 66X62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU,X-SML,10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, SMALL, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622177|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, MEDIUM, 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622183|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, LARGE, 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN BLUE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621611|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY SM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621630|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*DOME PAT UHMWPE 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,702.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ2, 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS, SZ4, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984390|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3N, 8.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3N, 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3N 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3N 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986043|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ1 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ2 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN BLUE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ2 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ3 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ5 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986087|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ5 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 4MM,SZ4,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ5,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960906|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA FEM POST AUG SZ5 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960908|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA FEM POST AUG SZ5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962713|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 17.5MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN BLUE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962743|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 17.5MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962756|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 25MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962761|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 12.5MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962763|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 17.5MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962767|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 30MM SZ6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 10MM,SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INSERT10MM,SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ6 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN BLUE 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117822025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117829025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG/12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117832025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG+/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127801025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM/STD 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127807025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM+/STD 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127825025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD+/LG 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127830025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM/STD 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127834025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM+/STD 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127851025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS R BRDG BRG STD+/LG 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127859025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-BLUE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127867025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127879025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD/LG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127885025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+/LG 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129007025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM+ 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129008025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129038025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129042025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129055025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD R BRDG BRG STD/LG 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149231025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149244025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00596005112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS ARTC 7-10 E-F STD 82X51X12MM KN MACH MLD FX PE LPSFLX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,348.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149255025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149263025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149272025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149276025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168834025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 1 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168871025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168874025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE M/B PAT POR STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,974.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151820038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL DOME PAT 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-BLUE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151810032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL ANAT PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151810038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE MEDIAL ANAT PAT 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,176.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150440207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FEMORAL RT SZ 7 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,095.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154703001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 3 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154703003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154704002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154707003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE DIST FEM AUG SZ 7 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,620.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-BLUE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700706|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 62L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 56R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 13X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 15X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 13X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 17X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-BLUE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197721290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 21X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197722240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 22X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197723240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 23X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526614N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STL,36+21CRNK,14X09X205N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563016N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR4L 16X11X205N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599605123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR PS NEXGEN STRIPE-BLUE 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,937.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563022R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 22X17X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563118L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 18X13X215L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563118R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 18X13X215R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563216R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 30+4L 16X11X205R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152125000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 3 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152173000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ3 300MM BOW RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/12.0 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157210225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/22.5 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/15.0 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,711.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,711.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424510|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623411L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRHFEM W/PIN SM LFT 66X62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622167|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, SMALL, 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, MEDIUM, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622186|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, LARGE, 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621614|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY SM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT PS NEXGEN SIZE D RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621615|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY SM 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY MED16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621625|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY MED31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168833025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168841025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168851025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168853025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168864025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195637025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195643025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE E RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,770.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195651025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195653025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195663025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195665025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195696025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195699025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS CRUC M/B PAT REPLAC GVF LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 30MM,SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 25MM, SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 25MM, SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S1.5 20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962322|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962325|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962367|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REVISION CEM TIB TRAY SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB TRAY SIZE 3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866499|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TAPER CEM STEM 13X150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867419|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 75X20MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 75X22MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X12MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 11MM X 120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860173|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP 1OMM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860188|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-15MM SZ4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-10MM SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD STP-15MMSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129428010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM R SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM SM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM SM+ RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM STD+ LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301201|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 12MM X 125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM LG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM LG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 10MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195635025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195641025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195648025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195659025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195661025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 13MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195673025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195698025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409850|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148494025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK ALL POLY 3-PEG PAT 9X36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148819025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK POLY PATELLA 7.5 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XXSM 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727131|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ1 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 14MM X 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ2 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ2 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986067|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ5 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986086|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ5 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986093|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ6 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ6 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117828025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117830025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 15MM X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117835025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG+/17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127802025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM/STD 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127805025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM+/STD 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127808025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM+/STD 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127831025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM/STD 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127833025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM+/STD 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127852025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS R BRDG BRG STD+/LG 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127860025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127864025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127866025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 16MM X 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129023025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 20.0MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129025025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 12.5MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129036025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149247025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149248025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149250025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149262025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS CEMENTED PLUS 17MM X 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301321|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS EXTENDED OFFSET 13MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 7 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700816|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151700820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CRS FB INSRT SZ 8 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150640004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE CRS FB TIB BASE SZ 4 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150640006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUNE CRS FB TIB BASE SZ 6 CEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,390.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151214080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATTUNE CEMENTED STEM 14x80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,979.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151316160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM16X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151318110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM18X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7853-014-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS EXTENDED OFFSET 14MM X 135MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151324160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ATUN PRESSFIT STR STEM24X160MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,289.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM RT SZ5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960092|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 FEM RT SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,258.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960831|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DI AUG16MMCO,SZ2LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960862|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ3,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157313000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X13.5 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785301521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS EXTENDED OFFSET 15MM X 140MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716078|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832752|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,185.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,185.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121836660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN LNR CONS NEUT +4 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121836760|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840762|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 40IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840766|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 40IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122028048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LINER 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122028448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LINER 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,547.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,547.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XXSM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 785301621|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS EXTENDED OFFSET 16MM X 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,817.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 10X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 11.5X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198713105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS DISTAL FEM COMP XSM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,036.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,036.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 36IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ1, 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ4, 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ5, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984159|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ5, 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ6, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984197|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ6, 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3N 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMODC/S STAB INS SZ3N 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ1 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ2 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986077|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ4 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ5 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986084|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ5 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM+ 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620006620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS MED 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424512|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS STD+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623401L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRHFEM W/PIN MEDLFT 71X66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623401R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRHFEM W/PIN MED RT 71X66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 623421L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRHFEM W/PIN XSMLFT 66X58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,385.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, SMALL, 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622175|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, MEDIUM, 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, MEDIUM, 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620004820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621613|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY SM 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 12X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 17X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 14.5X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198713111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS DISTAL FEM COMP XXSM LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,036.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,036.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 36IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 36IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 522029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*HEAD FEMORAL COCR 28+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101480789|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BANTAM FEM HEAD 28MM+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136545500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 40MM M SPEC+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136547500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 40MM M SPEC+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 36MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117215000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117230000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117255000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121770500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN CAN BONE SCREW 6.5MMX70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W HOLE 6200-56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960882|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA DIS AUG 8MM,SZ4,LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960888|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA FEM POST AUG SZ4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,609.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+INS 12.5MMSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+INS 17.5MMSZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962704|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 15MM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620005820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL W/HOLE 6200-58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,247.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 20MM SZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 10MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962736|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC SIGMA STAB+ INS 25MM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,488.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 20MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 25MM,SZ1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 20MM, SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 22.5MM,SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149264025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168835025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168852025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00785800100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CENTRALIZER VERSYS PROXIMAL V-LIGN 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195632025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195634025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195636025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195642025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195649025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195652025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195654025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195662025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195666025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195675025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 0MM 12/14 TPR 22MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 129409340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS CRUC M/B PAT REPLC GVF STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -2MM 12/14 TPR 22MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,733.40|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122032460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 10D LNR 36X54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124212527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 52X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124214527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 54X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00801802230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +3MM 12/14 TPR 22MM HIP COCR VRSY STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 159923058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR OPT LPW POLY INS 28/58,60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 522022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*HEAD FEMORAL COCR 22+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,864.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,864.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101472000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 32MM +18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101813000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 28MM +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101836511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14/16 LG TAPER M HEAD 36MM+11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 20X62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101176000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 60OD X 57ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101178000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 64ODX61ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101182000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 68ODX65ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986091|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ6 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65784101430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM METAL FIBER LM HACOATED 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,261.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,261.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117825025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD+/12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117826025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD+/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117833025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG+/12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127822025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD/LG 15.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127823025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD/LG 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127854025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS R BRDG BRG STD+/LG 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127856025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127868025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127871025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127872025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 6D +3.5 MED 22MM HIP ZML LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|948.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|948.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127875025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129002025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129021025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 15.0MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY MED21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ1, 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ4,12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984155|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS, SZ4,15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ5, 8.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ5, 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ5, 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL LONG NECK 22MM 9026-23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,740.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ6, 8.00MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMODC/S STAB INS SZ3N 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3N 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ2 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986063|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 36IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602900|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS HEAD FEMORAL 28 DIAMETER MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 44IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 44IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121887658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101401500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BANTAM FEM HEAD 22.225MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,721.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136529000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL/EZE BALL 22.225+4 NK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,566.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,566.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM M HEAD 36MM+12 NON SKIRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 120MM 11MM PRFT VRSY LD/FX ZML 36MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136541500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 40MM M SPEC-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197620140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 20X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197716240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 16X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197719190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 19X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197725290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 25X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197524095|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 24X95|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD36+21CR 16X11X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526420L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 20X15X225L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526422L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 22X17X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 125MM 12MM PRFT VRSY LD/FX ZML 38MM OFST HIP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,727.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,727.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 526516N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,16X11X205N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526522R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,22X17X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563018L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 18X13X215L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563024L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 24X19X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563024R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 24X19X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*SIGMA TC3 INS 30MM, SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,585.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962327|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2,25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962334|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962335|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S2.5,20.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00783401600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM VERSYS LD/FX PRESS FIT 16MM X 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 962341|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S3,17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TC3 RP TIBIAL INSERT S5,12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,010.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860127|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC* MOD + TIB TRAY SZ 2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,627.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 980133|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY LM/RL S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 981163|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY RM/LL S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 981165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC OFFSET TIB TRAY RM/LL S5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,413.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REVISION CEM TIB TRAY SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,936.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129435415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT REV TIB TRAY SIZE 4 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,981.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 866402|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIG TIB CEM STM 13X60 2/2.5/3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,582.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00614105628|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER ACETABULAR TRILOGY 28MM ID 7MM-OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,042.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,042.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867434|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 115X22MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867438|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X10MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 867449|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL STEM 150X24MM FLUTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,644.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129454110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT TRAY SLEEVE POR M/L 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129454140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MBT TRAY SLEEVE CEM M/L 29MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129453215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSAL FEM SLV DIS POR 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG STP-15MM SZ2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860179|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WDG HEMI-20D SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860379|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*MOD PL TB WD HEMI-20DSZ2.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,812.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7227|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.5MM/EMER 1.8MM/7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|100.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|100.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIGMA POR TRAY SCREW 6.5/55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|716.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|716.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129429040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMPLETE REV FEM CEM L STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,002.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426033|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 5MM MED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM MED LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129426041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM DSTL AUG 10MM STD RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 8 HOLE REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129427060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM POST AUG 5MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,927.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS SM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424612|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424617|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129424712|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COMP VVC INS LG+ 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,874.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24270003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUNTER TENDON IMPLANT 3MM|1|HUMANA [1294]||HUMANA [11839]|360.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|360.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 01-7045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED STRG 17MMX.6MM MDFC 4 HL 1.5MM SCR BN TI SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ORBITAL 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,248.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,248.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS CRUC M/BPAT REPLC GVF STD+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 16X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726109|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 10.5X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 13.5X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198721105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX TIB REPLC COMP XSM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,024.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,024.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ORBITAL 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X16MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X20MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124962000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR DYNAMIC LOCK RING 62 OR 74|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124966000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LOCK RING 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563038N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L18X13X255N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563042N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L22X17X275N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563056L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+4L 16X11X300L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ORBITAL 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563138R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,18X13X255R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563140R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,20X15X270R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563162L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STXXL,36+8LNK,22X17X325L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 538142|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,TROCHANTER,42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|606.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 538162|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,TROCHANTER,62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|606.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|606.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125760000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129056025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD R BRDG BRG STD/LG 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149230025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149252025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149259025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149260025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149268025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168831025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168832025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 1 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168843000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168844025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168845025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168873025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 5 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195639025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195644025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ4 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ4 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986081|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ5 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117823025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD/17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117824025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING STD+/10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117834025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING LG+/15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127821025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD/LG 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127824025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG STD+/LG 10.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127828025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM/STD 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.623|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 150MM 1.1MM SS NONTHREAD CNN SCR SET NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127829025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM/STD 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127857025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127858025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127870025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127873025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136544710|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DLT TS CER HD 12/14 44MM +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136544730|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DLT TS CER HD 12/14 44MM +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 528323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*HEAD FEMRL ALUMINA 32+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,239.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,239.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197614140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 14X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197615140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 15X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SELF-TAPPING MGII 7.0X45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197717240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 17X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197721190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 21X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197722190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 22X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197724240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 24X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197729240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 29X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197520105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 20X105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526682|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD36+21CR 22X17X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526418N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 18X13X215N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526422R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 22X17X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563124L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 24X19X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00511007050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SELF-TAPPING MGII 7.0X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563216N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 30+4L 16X11X205N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/22.5 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/18.0 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/13.5 R BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157318000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X21.0 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 857723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.*LINR 48-52/10 DEG-28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 873556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*LINR LSER,0 DEG,28MM C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121828650|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598005703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 9 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121832670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832676|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,319.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,319.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840768|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 40IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622157|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, X-SML, 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 622187|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NPS TIB PLATEAU, LARGE, 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,778.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 621602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM NRH TIB PLAT ASSY XS 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,108.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ1, 10.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS,SZ3, 8.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 984683|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*CVD TB INS SZ5, 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,182.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 24270006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUNTER TENDON IMPLANT 6MM|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598005704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 10 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 986061|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ3 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC MOD C/S STAB INS SZ4 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ4 12.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986094|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ6 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 986096|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFCMOD C/S STAB INS SZ6 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,461.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127804025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM/STD 17.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127806025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS M BRDG BRG SM+/STD 12.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,039.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597205503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL POROUS PEGGED NEXGEN SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597205504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL POROUS PEGGED NEXGEN SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 36IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 44IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 44IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597205501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 7 KN POR CRCTE RTN PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136509000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|12/14 ARTICUL 40MM M SPEC+15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136542500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 40MM M SPEC+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136544500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 40MM M SPEC+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136561500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 44MM M SPEC-3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136564500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 44MM M SPEC+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136528210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 28MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 36MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117220000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121760500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN CAN BONE SCREW 6.5MMX60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597205502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL POROUS PEGGED NEXGEN SIZE 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 528330|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*HEAD FEMRL ALUMINA 32+6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,239.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,239.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197615190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 15X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197717190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 17X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197718190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 18X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197725240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 25X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197729190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 29X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197729290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 29X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197731190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 31X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197524085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 24X85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597203501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL POROUS PEGGED NEXGEN SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 62N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 56L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 14X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 15X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 11.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597203502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB YLW STRP 66X46X4MM NXGN KN TIV UHMWPE POR PRECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195645025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195656025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195664025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195676025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195679025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409820|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409870|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP LG+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XXSM 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597204501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL POROUS PEGGED NEXGEN SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XXSM 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727114|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727323|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727331|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 31MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127878025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD/LG 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129001025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS MENIS BEARING SM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129019025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 10.0MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129020025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 12.5MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597204502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL POROUS PEGGED NEXGEN SIZE 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,410.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129027025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 17.5MM SM+|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129057025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD R BRDG BRG STD+/LG 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129058025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD R BRDG BRG STD+/LG 25.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149245025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149253025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149254025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149258025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149261025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149266025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149267025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ4 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 597201701|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE G LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 526514R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM LG,36 NK,14X09X205R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526518N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,18X13X215N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563016L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR4L 16X11X205L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563016R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR4L 16X11X205R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563022L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 22X17X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563122L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 22X17X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563124R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 24X19X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152126000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 4 250MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152127000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 3 300MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157161000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 1.5X12.0 CALCAR 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE H LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,080.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,080.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/12.0 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/13.5 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/21.0 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157208195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/19.5 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122028150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LINER 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124114527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 54X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597605023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN BLUE 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 124126527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 66X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155248526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X48SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155254526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X54SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159923054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR OPT LPW POLY INS 28/54,56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101836505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14/16 LG TAPER M HEAD 36MM+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121710158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 10X58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121715258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 15X58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101181000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 68ODX65ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597605020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN BLUE 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597605017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN BLUE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 127835025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM+/STD 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127837025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRDG BRG SM+/STD 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127863025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127865025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+ 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127881025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD/LG 20.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127886025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD+/LG 17.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129022025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD BRG 17.5MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129035025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG STD 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129041025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS DD ROT BRG LG+ 22.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,167.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597605014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN BLUE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 149239025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ1 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149246025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ2 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149251025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ3 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149274025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195631025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526678|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD36+21CR 18X13X160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526418L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 18X13X215L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526418R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 18X13X215R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526514N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM LG,36 NK,14X09X205N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526516L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,16X11X205L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597605012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN BLUE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 526518R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,18X13X215R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563020R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 20X15X225R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563022N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 22X17X230N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563122R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 22X17X230R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563124N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 24X19X230N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563214R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 30+4L 14X09X205R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152174000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ3 300MM BOW LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157163000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 1.5X13.5 CALCAR 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/13.5 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597603017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN YELLOW 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597603014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN YELLOW 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597603012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN YELLOW 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 198726112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 13.5X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 15.5X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597603010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN YELLOW 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122132154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597005501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 7 KN PRECT PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149279025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRT ULTRA TIB INS SZ5 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,433.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168843025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168844000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 2 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168865025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 4 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 168872025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONS TIB INS SIZE 5 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,337.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195638025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195646025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195647025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 2 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195657025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597005502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 8 KN PRECT PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195658025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195677025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195678025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409830|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148491025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK ALL POLY 3-PEG PAT 7.5X26|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157208225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/22.5 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157210210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/21.0 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/16.5 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157304000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X15.0 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L92522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KAR HA FEMORAL STEM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597003502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 4 KN PRECT PG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,471.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98115|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98116|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716074|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 857725|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.*LINER 60-64/10DEG-28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111529025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACS POLY 20D 28 GR4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,787.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,787.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121718800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X18MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121770800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X70MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124940503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LKG RING 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124954000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LOCK RING 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124960000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR DYNAMIC LOCK RING 60 OR 72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563042R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L22X17X275R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563060R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 20X15X325R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW.5.0MM DIA,50 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521553|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,5.0MM DIA,35 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125735000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125755000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 55|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700168|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 68N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198712205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM TROC BDY 15DEG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221800044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|44MM PINN ESC CONS RING INSRTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887352|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40MM PINN AB IN TR 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40MM PINN AB IN TR 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|44MM PINN AB IN TR 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 11X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716213|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 14.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-19.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 17.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598003702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 4 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 195633025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 1 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195655025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 3 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195667025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195669025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 4 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 195674025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK CONGR PS INS SIZE 5 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 129409810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LCS COM 3 PEG M/B PAT REP SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,906.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148493025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK ALL POLY 3-PEG PAT 8.5X34|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148829025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK POLY PATELLA 10.0 X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 148881025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AMK POLY PATELLA 8.5 X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,189.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598004701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 5 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 198727216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727221|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS SM 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 13X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198725415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEMENTED STEM 15X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,129.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/15.0 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/10.5 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/22.5 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/15.0 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/19.5 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598004702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 6 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 157208165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/16.5 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157208210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/21.0 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157305000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X16.5 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157307000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X19.5 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157317000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X19.5 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157319000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X22.5 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598005701|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 7 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598005702|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIB NXGN 8 KN PRECT STM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,399.20|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122140176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 44IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 44IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875955|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM HEAD FEMORAL COCR 32+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136533000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM M HEAD 36MM +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136563500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 44MM M SPEC+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,080.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,080.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 136532220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 32MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,835.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 36MM +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136544740|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DLT TS CER HD 12/14 44MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,507.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117235000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154113000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTALAC LT 150 STEM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154138000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTALAC RT 240 STEM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197621140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 21X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197716190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 16X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197720240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 20X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197723290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 23X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 197725190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 25X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197726190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 26X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197727240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 27X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526420N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 20X15X225N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526516R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,16X11X205R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526520N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,20X15X225N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526520R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,20X15X225R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563020L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 20X15X225L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563120L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 20X15X225L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563122N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 22X17X230N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201802|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE H RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,080.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,080.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152124000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 2 230MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XXSM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727118|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS XSM 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727314|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198727328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS UNIV TIB HIN INS MED 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,315.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198726111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 12.5X100MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201301|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE C LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 198726415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 16.5X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252123501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ3 REV NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,193.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,193.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252232003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 32MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253070000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRV 22.225+7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201401|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT FEM D STD 68X57.5MM KN LT CR NXGN ZML POR STRL BLU GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 253072000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 26+7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253083000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 28+8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253085000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 28+15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253152000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL TR BALL GRVD 36 +5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253154000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL TR BALL GRVD 36 +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597201601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL POROUS CR NEXGEN SIZE F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,800.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121836658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN LNR CONS NEUT +4 36IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840764|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 40IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122028450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LINER 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,547.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,547.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 10D LNR 36X60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 10D LNR 36X66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597605010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN BLUE 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.21|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,625.21|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 124140526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR BANTAM 10D 22.225X40 LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124216527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 56/68X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155244526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X44SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159923062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR OPT LPW POLY 28/62,64,66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853834|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 28MM HEAD +5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101811000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 28MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101871000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 28MM +11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962575000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962735000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 32MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121710170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 10X70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597604023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN GREEN 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121715266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 15X66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 30X62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101183000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 72OD X 69ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121722800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X22MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121760800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X60MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124964000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LOCK RING 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597604020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN GREEN 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597604017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN GREEN 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 198726417|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS POROUS STEM 18.5X125MM STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,101.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 36IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,027.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136170|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597604014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN GREEN 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122136264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 36IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 857724|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFC*LINER 28MM/ 54-58MM,10 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121828648|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121828750|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 10D 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,424.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597604012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN GREEN 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,542.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121832668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840666|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 40IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 10D LNR 36X64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124112527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 52X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124138526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR BANTAM 10D 22.225X38 LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124142526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR BANTAM 10D 22.225X42 LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597604010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN GREEN 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,539.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,539.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 122132464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,390.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136176|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 36IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122136474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 36IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,640.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 40IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140172|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 40IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,036.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122140460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 40IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,156.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 44IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597603023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN YELLOW 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 121887652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 36 X 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,637.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*HEAD FEMORAL COCR 28+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136530000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL/EZE BALL 22.225+7 NK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,566.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,566.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ0/1 STD NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ4/5 STD NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ10 STD NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597603020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC NEXGEN YELLOW 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,524.23|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 257605017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 17-12D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597206535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 9MM 35MM NXGN UHMWPE KN STRL BLU GRN PUR STRP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597206538|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 9.5MM 38MM NXGN UHMWPE KN STRL BLU GRN PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597206541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR STD 10MM 41MM NXGN UHMWPE KN STRL BLU GRN PUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00597001602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE F RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297617240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 17X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297621290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 21X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297622240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 22X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297623190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 23X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297626190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 26X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297626290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 26X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152161000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE CALCAR SZ3 145MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152162000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE CALCAR SZ3 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,412.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,412.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/10.5 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597001702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE G RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/21.0 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/16.5 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157210136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/13.5 L BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157210165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/16.5 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/18.0 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/19.5 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157303000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X13.5 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157316000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X18.0 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98113|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563056N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+4L 16X11X300N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563060L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 20X15X325L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563158R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STXXL,36+8LNK,18X13X315R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563160R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STXXL,36+8LNK,20X15X325R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,3.5MM DIA,45 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125725000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197500105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM LOCKING BOLT 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464111|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANTERIOR CERVICAL 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 56N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198710105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM STD BODY NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198711205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM TROC BDY 15DEG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707125|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 125MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715216|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 16X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122144162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 44IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,456.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4520004|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT TRAPEZIUM SILASTIC 4|1|HUMANA [1294]||HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889654|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121889658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CERAMAX CERAMIC INSERT 28 X 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,553.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136517500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM 28MM +3 M HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,328.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,328.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136565500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 44MM M SPEC+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136528220|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 28MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117265000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121708500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN CAN BONE SCREW 6.5MMX8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197616190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 16X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,490.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197618140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 18X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197718240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 18X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197720190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 20X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197727290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 27X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197731240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 31X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962734000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 28MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962747000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 28MM +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121710162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 10X62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121710166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 10X66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121715254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 15X54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121715262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 15X62/64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 20X54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 30X50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 30X58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101173000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 56OD X 53ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121755800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X55MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121765800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X65MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124942503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LKG RING 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124952000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LOCK RING 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875956|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM HEAD FEMORAL COCR 32+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136526000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM M HEAD 36MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,004.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136543500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 40MM M SPEC+3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,213.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.514E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 14MM SELF TAPPING 4MM HEAD WITH CRUCIFO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136562500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|11/13 S-ROM 44MM M SPEC+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136532210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,835.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,835.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DELTA CER HEAD 11/13 36MM +9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136536250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM DELTA CERAMIC 36MM +12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,211.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117225000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117250000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 117260000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANCELLOUS BONE SCREW 6.5X60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154123000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTALAC LT 200 STEM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 154133000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTALAC LT 240 STEM SZ3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,320.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197714190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 14X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223000300|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, COVENTRY, 3/16IN|1|HUMANA [1294]||HUMANA [11839]|61.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|61.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 450.822S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 200MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212912000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALL 32 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20414|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.823S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 240MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 298772010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS DIST FEM ASSEMBLY BASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,754.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 298772020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM ASSEMBLY BASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,520.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ6 STD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ8 STD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 13.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.824S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 280MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 76MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 873435|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*LINR MSER,0 DEG,28MM C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111527025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACS POLY 20D 28 GR2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,787.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,787.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111528025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACS POLY 20D 28 GR3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,787.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,787.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832656|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832662|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,319.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,319.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.825S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,258.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,258.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840668|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 40IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716211|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 12.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 16.5X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.827S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,051.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464.36S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL SOLID 9MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464.40S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL SOLID 9MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197528075|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 28X75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197528105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM PRX BDY CONE 28X105|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,543.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526684|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD36+21CR 24X19X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526424L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 24X19X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526514L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM LG,36 NK,14X09X205L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563020N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 20X15X225N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563214N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 30+4L 14X09X205N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563216L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 30+4L 16X11X205L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157165000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 1.5X15.0 CALCAR 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464.420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL SOLID 9MM X 420MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157169000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 1.5X18.0 CALCAR 12/14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|27,157.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/16.5 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/13.5 L BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/18.0 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157207225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/22.5 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563038R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L18X13X255R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563058R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 18X13X315R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563060N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 20X15X325N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563158L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STXXL,36+8LNK,18X13X315L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563160L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STXXL,36+8LNK,20X15X325L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,3.5MM DIA,40 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,5.0MM DIA,25 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556078|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,6.5MM DIA,55MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125730000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125740000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700368|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 68R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198712105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM STD BODY 15DEG RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 17X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197715190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 15X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223000600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, COVENTRY, 3/8IN|1|HUMANA [1294]||HUMANA [11839]|61.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|61.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 474.034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197720290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 20X290A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197724190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 24X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197726240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 26X240A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,645.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197727190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM DISTAL TAPERED 27X190A|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,832.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526420R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 20X15X225R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526422N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 42 NK 22X17X230N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526518L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,18X13X215L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526520L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,20X15X225L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526522L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,22X17X230L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526522N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG,36NK,22X17X230N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,753.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563018N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 18X13X215N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563018R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMLG36+21CR8L 18X13X215R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,293.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563120R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM LG 36+8L 20X15X225R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.041S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 46|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252124501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ4 REV NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,193.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,193.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252232002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253093000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 32+9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253095000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 32+17|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253153000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL TR BALL GRVD 36 +8.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253155000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL TR BALL GRVD 36+15.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,613.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,613.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 420MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 255443000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXCEL X/O SEGMENT 12/14 43MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 255452000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXCEL X/O SEGMENT 12/14 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ2/3 STD NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ8/9 HI NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.044S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 10MM 440MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 2/3 STD NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 4/5 STD NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 19|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605023|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 23|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.242S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 420MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 258000010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT BROACH SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 258000012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT BROACH SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 19.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6IN AML LRG STATURE 10.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 13.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ8 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.132S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 11MM 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD,36NK,22X17X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD,30NK,14X09X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523292|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,30 NK,16X11X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875973|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*18X12X160 STEM,36MM NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521405|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 20B-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.134S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 11MM 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 10D LNR 36X62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124108527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 48X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124116527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 56/68X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124120527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 60/72X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124220527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 60/72X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124222527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 62/74X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155246526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X46SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155256526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X56SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159923052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR OPT LPW POLY INS 28/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 11MM 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853842|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 32MM HEAD +5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,236.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853843|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 32MM HEAD +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,236.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,236.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.138S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 11MM 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2230-009-00|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE, COVENTRY, 9/16IN|1|HUMANA [1294]||HUMANA [11839]|61.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|61.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 474.141S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL CANNULATED TI 10MM 400MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157208150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/15.0 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.142S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 11MM 420MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157210180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/18.0 L LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157306000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X18.0 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157308000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X21.0 CALCAR 9.0 L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L92526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KAR HA FEMORAL STEM 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L92530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KAR HA FEMORAL STEM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,512.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MULTIHOLE W/GRIPTION 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MULTIHOLE W/GRIPTION 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MULTIHOLE W/GRIPTION 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.144S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 11MM 440MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,665.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832652|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,565.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121840664|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 40IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,703.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121844670|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 44IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121844674|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 44IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,401.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 474.232S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED FEMORAL 12MM 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,842.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122072332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MAR LNR L 32MM+3MM 10 DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,144.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,144.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124144526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR BANTAM 10D 22.225X44 LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 853833|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.* 28MM HEAD +10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 136528720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DLT TS CER HD 12/14 28MM +5.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,133.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 20X50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 20X58/60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720370|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 20X70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716215|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 16.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716317|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 18.5X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.828S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,258.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,258.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.829S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152122000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 3 190MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 152171000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ3 250MM BOW RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,559.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157201195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/19.5 SML ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/15.0 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157202195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 8/19.5 LRG ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,803.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/21.0 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157211225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL SYS 10/22.5 R LRG STAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,234.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157315000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SOL 2.25X16.5 CALCAR 9.0 R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,989.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM STD 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.830S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 12MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L98112|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL REVISION STEM HO 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30,334.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MULTIHOLE W/GRIPTION 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,583.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121716072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN REVISION W/GRIPTION 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,505.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121717056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN DP REVSN W/GRIPTION 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,206.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 857726|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|P.F.C.*LINER 66-70/10DEG-28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,214.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 873557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*LINR LSER,0 DEG,32MM C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875987|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*LINR XL46 10 DEG 32MM C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,017.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832658|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121832660|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN LNR CON +4 NEUT 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,718.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.802S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 200MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122028148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LINER 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,959.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR NEUT LNR 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR 10D LNR 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,022.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122032464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 LNR 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,669.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122036460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR MAR +4 NEUT LNR 36X60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,629.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124110527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 50X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124118527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 58/70X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124122527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 62/74X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535386|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE CONE TEXT SPA 18F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.803S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 240MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 14F-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550533|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 20D-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22F-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550751|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 24F-XXL22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550772|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*SLEVE ZTT UNSZ 24D XL26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.804S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 280MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,598.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,598.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297618290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 18X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.805S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297621140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 21X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297621240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 21X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297622290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 22X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297627290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 27X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297628240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 28X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101471000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 32MM +15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962572000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 28MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962573000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 28MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121710154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 10X54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.806S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121715250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 15X50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 30X66/68|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101185000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 48ODX45ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101186000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 48ODX45ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*PIN LOCK,3.5MM DIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124938503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LKG RING 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124946503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LKG RING 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124948000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LOCK RING 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563036L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR4L16X11X240L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563038L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L18X13X255L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.807S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.808S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.809S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 30X54/56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101172000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 52OD X 49ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101174000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 56OD X 53ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.810S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 11MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121724800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X24MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121740800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X40MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121750800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X50MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124958000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR DYNAMIC LOCK RING 58 OR 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563040L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L20X15X270L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563040R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR8L20X15X270R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563058N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 18X13X315N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563142R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,22X17X275R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563144R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,24X19X275R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563162R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STXXL,36+8LNK,22X17X325R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,445.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.789S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 538076T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*WASHER,TROCHANTER,60X45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,446.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,446.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN 100 W/GRIPTION 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932274|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR LIP LNR 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932474|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX74OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 36IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX46OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,289.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,289.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.786S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,418.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,418.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128266|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124124527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 64X28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124218527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 58/70X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124224527|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC CONST LINER 64X32|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,161.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155252526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X52SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155258526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML/TL ENDR REP LINER 32X58SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,827.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.787S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,763.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 159923048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DUR OPT LPW POLY INS 28/48,50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,294.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101467000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 32MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101470000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 32MM +11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,145.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101836500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|14/16 LG TAPER M HEAD 36MM+0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,464.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101875000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TOTAL HIP BALL 28MM +15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,238.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 962574000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE MODULAR HD 32MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,003.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121710150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 10X50/52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV AUGM 30X70/72|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,952.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.788S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,258.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,258.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.782S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 200MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20413|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.783S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 240MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 298772025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS ASSEMBLY BASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ7 STD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.784S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL TI DISTAL 10MM 280MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ8 HI OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6IN AML SM STATURE 12.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 NON COL HO SIZE 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563062R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 22X17X325R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.785S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563138L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*ST XL,36+8LNK,18X13X255L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,581.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,3.5MM DIA,35 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,6.5MM DIA,25MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556077|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,6.5MM DIA,50MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197500085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM LOCKING BOLT 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198711105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM STD BODY 15DEG LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707045|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707085|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450.790S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL DISTAL 10MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716214|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 15.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 12.5X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 14.5X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 345MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,5.0MM DIA,45 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,6.5MM DIA,15MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 125745000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.0MM DIA TPRD HD PER SCRW 45|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197500075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM LOCKING BOLT 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 68L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121700362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN GRIP TF REV BUTTRESS 62R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,147.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198710205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PROX FEM TROC BODY NEUTRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,791.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707065|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 12X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198715311|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS CEM FEM STEM 11X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,389.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.31S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 315MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.36S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,232.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101171000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 52OD X 49ID R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101184000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROTRUSIO CAGE 72ODX69ID L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,363.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121714800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|5.5X14MM GRIPTION TF STE SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124944503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LKG RING 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 124950000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DURALOC DYNAMIC LOCK RING 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,169.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563036N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR4L16X11X240N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563036R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXLG36+21CR4L16X11X240R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|26,894.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563056R|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+4L 16X11X300R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563062L|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 22X17X325L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563062N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STMXXL36+21+8L 22X17X325N|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,812.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,3.5MM DIA,25 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,3.5MM DIA,30 MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556073|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,6.5MM DIA,30MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.40S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.027S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 270MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523293|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,30 NK,18X13X160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523394|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,42 NK,20X15X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM ST,36+8L NK,18X13X160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563618|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM STM STD 36+12L 13X18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 14B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 14D-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550567|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 24F-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 285MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550748|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 24F-LRG22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550770|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*SLEVE ZTT UNSZ 24D S 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550771|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*SLEVE ZTT UNSZ 24D L 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550777|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*SLEVE ZTT UNSZ 24F S 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122350000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 50OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN BANTAM W/GRIPTION 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN 100 W/GRIPTION 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103565000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SELF CENT HIP 65X28 GRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,423.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.031S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 315MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.038S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 380MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 10MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.128S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 285MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.130S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 300MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.131S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 315MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.133S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 330MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SCREW,6.5MM DIA,45MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101140070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLF TAPPING ROOF PILE SCRW70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|684.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|684.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 197500095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM LOCKING BOLT 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|924.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|924.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198707040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS SEGMENTAL COMPONENT 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,588.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198708055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS TOTAL FEM SEG COMP 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,085.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,085.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716212|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 13.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716217|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 18.5X150MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,294.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.134S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 345MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,262.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,262.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 198716310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS PC FEM STEM 11.5X200MM BOW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,597.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.140S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.227S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 270MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.228S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 285MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.231S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 315MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212909000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALL ONLY 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,590.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.233S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 330MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,067.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221800040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40MM PINN ESC CONS RING INSRTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 52|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252222002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 22.225MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252232001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 32MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253092000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 32+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.234S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 345MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 255440000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXCEL X/O SEGMENT 12/14 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128256|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 459.013S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI 12MM 10MM EXT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.012S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE LOCKING 120MM DEG STERIE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|615.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|615.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212920000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BALL 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464.320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL SOLID 9MM X 320MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 464.340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL SOLID 9MM X 340MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.195|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +19.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-13.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.150|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +15 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.165|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +16.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ2/3 HI NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ8/9 STD NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.185|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +18.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 2/3 HI NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 4/5 HI NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 21|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605117|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 17-14B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.190|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +19 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.200|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +20 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297616140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 16X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297619140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 19X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297621190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 21X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-20.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221800032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|32MM PINN ESC CONS RING INSRTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|44MM PINN AB IN TR 62|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 48|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.210|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +21 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-21.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-163656|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE TEXTURED 655CC STYLE163|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221800028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN ESC CONS RING INSRTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221800036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN ESC CONS RING INSRTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232400900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 2.7 X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM MERIDIAN POROUS HIP #5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297624240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 24X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297625240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 25X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM MERIDIAN HIP #5/13MM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297627240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 27X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297630240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 30X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297630290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 30X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HIP #3 11MM POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,976.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,976.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6IN AML SM STATURE 10.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 16.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6265-0-009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS STEM MERIDIAN #4/14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,976.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,976.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 19.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ3 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ10 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ6 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252122501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 2 REV SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,193.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,193.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6264-5-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM STD 28MM HIP TPR VIT V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253073000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 26+10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253082000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 28+5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253094000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 32+13|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 255445000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXCEL X/O SEGMENT 12/14 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,809.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6215-5-001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMALL HOWMEDICA BONE PLUG 1PK|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1710015006|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT GORE-TEX CV PATCH 10.0CM X 15.0CM 0.6MM THICHNESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232401900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL BONE 2.7 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.69|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 300MM 3.2MM SS CLBRT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.653E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.7MM 3MM TI FLUT CRNFCL ER CRFRM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.50|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|157.50|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 294.784|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 150MM 5MM SCHNZ HIP CNDYL SS SLF DRL MR|1|HUMANA [1294]||HUMANA [11839]|598.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887358|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|44MM PINN AB IN TR 64|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.785|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 175MM 5MM SCHNZ HIP CNDYL SS SLF DRL MR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|598.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|598.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252111501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 1 HIGH NK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252228004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 28MM +6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253081000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 28+1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 351.76S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ROD RM 950MM 3MM STRG BALL TIP XPRT NL SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 356.544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSRTR SRG BOLT TI CNN TIB NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ0/1 HI NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 31|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 258000011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT BROACH SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 STD SIZE 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20310|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 NON COL HO SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1MM 1.6MM 14MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|218.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|218.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523393|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,42 NK,18X13X160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM ST,36+8L NK,20X15X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563620|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM STM STD 36+12L 15X20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563626|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM STM ST 36+12L 21X26X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521423|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535362|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX SPA, 16B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 14B-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 14D-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.686|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 6MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550513|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 16D-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550564|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 24D-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 18F-LRG16ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550747|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 24F-SML22ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550778|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*SLEVE ZTT UNSZ 24F L 26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122348000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 48OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122360000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 60OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.687|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 7MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|235.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|235.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121922038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 22.225IDX38OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121922044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 22.225IDX44OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX44OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,313.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,313.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.688|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 8MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887354|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN TEAL 100X100X.4MM CRNFCL TI CNTR MESH MLBL 1.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,221.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,221.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 400.689|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 9MM TI HND CORT ST CRFRM LOPRFL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 54|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.69|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 10MM TI CORT HND ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 60|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252222003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 22.225MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.692|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 12MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 0/1 HI NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 8/9 STD NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 8/9 HI NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.693|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 13MM TI CORT ST CRFRM LOPRFL HD NS MN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.694|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 14MM TI HND CORT ST CRFRM LOPRFL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.696|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.3MM 2.4MM 16MM TI HND CORT ST CRFRM LOPRFL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|242.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|242.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ6/7 STD NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.809.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 9MM TI CORT ST NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 6/7 STD NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.812.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 12MM TI CORT ST NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.813.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 13MM TI CORT ST NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|36MM PINN AB IN TR 66|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221887458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|40MM PINN AB IN TR 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 44|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.506.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 6MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253069000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRV 22.225+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253071000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 26+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605029|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 29|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.096|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 13X13MM BX CRNFCL TI 4 HL 1.3MM SCR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.507.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 7MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 258000013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT BROACH SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,709.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297615140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 15X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297618240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 18X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297620290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 20X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.508.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 8MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297628190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 28X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20410|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20418|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.509.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 9MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221760004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN REV LINERS 28/32/36 LID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,140.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 56|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 221889158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|28MM PINN AB IN TR 58|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252101501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE SZ 1 STD NK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.513.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 13MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252222001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 22.225MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252228001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 28MM -3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252228002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 28MM +0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 252228003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ELITE IMPL TR HD 28MM +3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.524.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 24MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ1 HI OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 16.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ5 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ2 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ9 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932470|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.528.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 28MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128254|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128258|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.532.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 4.5MM 32MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|254.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|254.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297616190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 16X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297617140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 17X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297618190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 18X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297624290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 24X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297625190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 25X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297630190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 30X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.807.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 7MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20416|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20431|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STD NECK SEGMENT CORAIL AMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,094.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,094.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253084000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 28+12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253091000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTIC/EZE TR BALL GRVD 32+1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253151000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL TR BALL GRVD 36 +1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 255430000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXCEL X/O SEGMENT 12/14 TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,942.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,942.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.810.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 10MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ4/5 HI NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ6/7 HI NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257003550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT SZ10 HI NECK SEGMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,957.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.812.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 12MM TI HND CORT ST CRFRM LOPRFL HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297614190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 14X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297615190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 15X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297619290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 19X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297620240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 20X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297624190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 24X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297625290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 25X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297628290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 28X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297629240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 29X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297631290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 31X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 400.654|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.7MM 2.4MM 4MM TI CRNMXF ER CRFRM RCS NS TEAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 401.813.96|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 13MM TI CORT ST CRFRM NS MDLR HND SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20409|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20412|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157014120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ6 HI OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 18.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ1 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ1 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ3 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SIZE 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523197|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD,36NK,26X21X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523207|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,30 NK,12X07X115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563624|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM STM ST 36+12L 19X24X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521425|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22B-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535364|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX SPA, 16D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535382|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX SPA, 18B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550523|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18D-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18F-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550526|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18F-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22D-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22F-XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550562|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 24B-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550572|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE PROX ZTT, 12D-SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550728|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 20F-LRG18ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550737|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 22F-SML20ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122354000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 54OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122358000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 58OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 22MM 2.5MM TI FT CORT ST SPHRCL HD SM HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN BANTAM W/GRIPTION 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121731044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN 100 W/GRIPTION 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,769.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121922040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 22.225IDX40OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121922042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 22.225IDX42OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 47MM TI 1.3MM SCR 12 HL LOPRFL PRECONTOUR RECON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE EXTENDED H 1.3MM 19MM 8 HOLE RIGHT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297616240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 16X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297617190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 17X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297618140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 18X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297622190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 22X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297623240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 23X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297626240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 26X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297627190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 27X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.321|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H 19MMX.5MM TI 1.3MM SCR 8 HL XTD LOPRFL PRECONTOUR BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 253150000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARTICUL TR BALL GRVD 36-2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,697.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257013350|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT 6/7 HI NK SEG W/COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.333|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 32MM TI 1.3MM SCR 3 HLE/HD 8 HL SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 257605027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM MILLER SHELL SZ 27|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 90X4X.6MM LOPRFL CRNFCL TI 20 HL ADP 1.5MM CORT SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 421.334|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 32MM TI 1.3MM SCR 4 HLE/HD 8 HL SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297614140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 14X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 421.335|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 37MM TI 1.3MM SCR 3 HLE/HD 8 HL SHFT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ4 STD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 21.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 18.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 21.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ4 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ7 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ9 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ10 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 STD SIZE 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39X5X1.2MM TI 2MM SCR 7 HL BN CNDRL LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|673.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|673.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 NON COL HO SIZE 18|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 NON COL HO SIZE 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SIZE 1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SIZE 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523196|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD,36NK,24X19X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 39X5X1.2MM TI 2MM SCR 7 HL BN CNDRL RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523395|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,42 NK,22X17X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523396|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,42 NK,24X19X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM ST,30+4L NK,18X13X160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563622|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM STM STD 36+12L 17X22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521463|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 16B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521465|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 16B-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535366|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE CONE TXTRD SPA16F|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928146|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX46OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,313.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,313.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 28IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 28IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 59X3.8X.8MM TI 1.5MM SCR MDLR HND SYS 12 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|775.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|775.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932270|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR LIP LNR 32IDX70OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932472|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 36IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936066|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 36IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936156|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,899.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,827.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.233|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 44X4X1MM TI 1.5MM SCR MDLR HND SYS 3 HLE/HD 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20432|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COR VAR NECK SEGMENT COR AMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,094.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,094.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 298772011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LPS XXSM DIST FEM ASSMBLY BASE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,805.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,805.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.482|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H 22MM TI 1.5MM SCR MDLR HND SYS 8 HL XTD LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157004110|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|C-STEM AMT SZ5 STD OFFSET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,959.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401180|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 18.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402121|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|6IN AML LRG STATURE 12.0 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ4 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157011135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ7 HI OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101012100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SIZE 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.483|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE H 22MM TI 1.5MM SCR MDLR HND SYS 8 HL XTD LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523194|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM STD,36NK,20X15X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,30 NK,12X06X115|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523208|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD 30 NK 14X8X130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523291|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,30NK 14X09X130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 875971|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*16X10X150 STEM,36MM NECK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521403|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 20B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX SPA, 18D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 14F-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523191|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,36NK,14X09X130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523192|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,36NK,16X11X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 446.612|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 46X4X1MM TI 1.5MM SCR MDLR HND SYS 3 HLE/HD 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|717.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|717.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563514|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM ST,30+4L NK,14X09X130|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563517|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM STM ST,36+6L NK,11X16X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18B-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE CONE TXTRD SPA14D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550536|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 20F-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550568|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 24F-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550717|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 18F-SML16ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550741|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 22F-XXL20ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550779|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*SLEVE ZTT UNSZ 24F XL26ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720038|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE BANTAM ACET CUP 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,494.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 35X5X1.2MM TI 2MM SCR MDLR HND SYS 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|680.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|680.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297619190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 19X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297619240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 19X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297620140|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 20X140|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297620190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 20X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297623290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 23X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297629190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 29X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297629290|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 29X290|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297631190|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 31X190|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 71X5X1.2MM TI 2MM SCR MDLR HND SYS 12 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|813.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|813.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 297631240|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RECLAIM TAPERED RMR 31X240|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,673.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20411|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BROACH CORAIL AMT 11|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,731.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 16F-XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550524|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18D-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22D-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 24B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550565|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 24D-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.906|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 36X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 6 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550727|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 20F-SML18ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550738|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 22F-LRG20ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122352000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 52OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122356000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 56OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720068|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 68MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550530|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18F-XXL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.912|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 72X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 12 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 20F-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 22F-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550571|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE PROX ZTT, 12B-LARG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550731|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 20F-XXL18ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928458|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 28IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932276|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR LIP LNR 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.914|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 54X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 3 HLE/HD 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|893.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|893.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932452|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932476|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX76OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103748000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SELF CENT HIP 48X22.225 BRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,362.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,362.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121922046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 22.225IDX46OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,452.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 56X6.3X1.25MM TI 2.4MM SCR MDLR HND SYS 3 HLE/HD 8|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|863.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|863.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932468|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128250|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128262|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.924|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 31X6.5X1.6MM TI 2.4MM SCR MDLR HND SYS 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,040.37|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,040.37|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128456|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX56OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128462|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121711062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 100 HA ACET CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712058|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 58MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121730042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN BANTAM W/GRIPTION 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,368.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 28IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932268|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR LIP LNR 32IDX68OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.926|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 47X6.5X1.6MM TI 2.4MM SCR MDLR HND SYS 6 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,168.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932272|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR LIP LNR 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,632.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936158|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX58OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936454|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128164|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128464|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.928|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 63X6.5X1.6MM TI 2.4MM SCR MDLR HND SYS 8 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,262.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,262.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155401210|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML SM STATURE 21.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155402225|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML LG STATURE 22.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.931|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 24X5.5X1.25MM TI 2MM SCR MDLR HND SYS 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403135|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 13.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 15.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403165|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 16.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155403195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AML HIGH OFFSET LG STAT 19.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,241.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ2 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ6 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 157001150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SUMMIT POR TAPER SZ8 STD OFF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,100.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 STD SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3L92516|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 STD SIZE 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20315|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 NON COL HO SIZE 15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 449.938|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 48X5.5X1.25MM TI 2MM SCR MDLR HND SYS 8 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|999.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|999.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L20316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORAIL2 NON COL HO SIZE 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,276.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101013100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED STD SZ 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101014070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ACTIS COLLARED HIGH SZ 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,017.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523193|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*STM STD,36NK,18X13X160|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,404.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523422|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM ST,36+8L NK,22X17X165|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 523424|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SROM*STM ST,36+8L NK,24X19X175|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,982.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521483|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 18B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 535342|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX SPA, 14B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 16F-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550570|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 12B-SML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550573|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLEEVE PRX ZTT, 12D-LRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|S-ROM*SLVE ZTTOVSZ 18F-XXL16ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122344000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 44OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122346000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDURANCE 20D 46OD X 28ID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,271.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121703056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE 300 ACET CUP 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,512.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE BANTAM ACET CUP 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,494.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720042|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE BANTAM ACET CUP 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,494.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,494.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121720062|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINNACLE MULTIHOLE II CUP 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,742.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR NEUT 36IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,208.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 36IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 28IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,899.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,899.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128248|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128252|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX52OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,029.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128260|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128264|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX LIP LNR 28IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,956.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132060|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132064|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX64OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712048|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END TI FOR-SOLID-TIBIAL-NAILS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|175.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|175.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121712050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN SECTOR HA ACET CUP 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,736.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 103744000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SELF CNTR HIP 44X22.225 GRY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,362.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,362.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121928154|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 28IDX54OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,575.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932148|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932162|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 32IDX62OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,657.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121932466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 NEUT 32IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,995.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936160|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX60OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121936166|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PINN MAR +4 10D 36IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,730.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP END 15MM-EXT.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128144|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX44OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,472.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128448|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX48OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122132072|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX NEUT 32IDX72OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,880.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 10D 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128450|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX50OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,394.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 122128466|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALTRX +4 NEUT 28IDX66OD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,315.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35347|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 32MMX155MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35348|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 32MMX201MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.300S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID TI 8MM 300MMSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PF2816|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT HD FLEX PLIABLE THICK L16CM X W8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,487.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,487.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-S-3608|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUMERAL X3 H8 MM OD36 MM SHOULDER CONSTRAIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE PATELLAR PRESHAPED 11/11MM|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645062|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIGEN L62.5 MM OD5 MM FEMUR LOW PROFILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71642937|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET META-TAN 5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|704.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|704.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71642605|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TRAUMA FIXATION META-TAN 105MM /100MM COMPRESSION SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,088.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,088.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71642600|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT TRAUMA FIXATION META-TAN 100MM /95MM COMPRESSION SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,088.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,088.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71640640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TRIGEN META-TAN 40CM 10MM FEMUR RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,821.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH12E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ALLOX2 FULL HEIGHT 12CM X 11CM 270-330CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH13E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ALLOX2 FULL HEIGHT 12CM X 11CM 360-430CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 478.360S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 8MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0200-20|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE FEEDING JEJUNAL MIC 20FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF2202|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKIN 20X11CM FLEXHD THICK/MED ALLOGRAFT PERF 2 UNITS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,454.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,454.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676604|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 40CM RIGHT INTERTROCHANTER INTERTAN IM 125D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645057|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MMX57.5MM FEMUR LOW PROFILE INTERNAL HEX TRIG IN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 479.33S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL SOLID 9MM X 330MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,752.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645067|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L67 MM OD5 MM FEMUR LOW PROFILE INTERNAL HEX TRIG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|669.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|669.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 249.680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCP ST STEEL L40 MM 4 HOLE LOW PROFILE CTL 2.7 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,303.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/KL/W|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA WHOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A25-25/C75-O20 V|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION AORTIC|1|HUMANA [1294]||HUMANA [11839]|15,897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TV-IL1412140-J|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION ILIAC OVATION IX 12MM X 140MM|1|HUMANA [1294]||HUMANA [11839]|14,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.127S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 11MM X 270MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2503-A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE STAPLES WITH INSTRUMENT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 408.900|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L100 MM L16 MM OD7.3 MM CANNULATED THREADED NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS24075|SUP|HCPCS Q4132||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MATRIX REPAIR CELLULAR PRIME GRAFIX 7.5CM X 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|32,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|32,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952PPR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE ARTHREX PETITE L3 MM PLANTAR RIGHT NONSTERILE FIR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L1708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL C L THD 1.7 08MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL CLYDESDALE PEEK TANTALUM 6 D 50MM X22MM X10MM|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926250|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL CLYDESDALE PEEK TANTALUM 6 D 50MM X22MM X12MM|1|HUMANA [1294]||HUMANA [11839]|20,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.236S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 360MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,779.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-46-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL NEUTRAL 46MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF2002|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKIN 20X11CM ALLOGRAFT FLEX HD THICK MEDIUM PERFORATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,817.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,817.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-10-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SMALL SHELL 10MM X 108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-7000-32FT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN TI FULL THREAD 32MM 3.75MM SHOULDER CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 485.240S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TIBIAL 12MM X 400MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,312.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675533|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125DEG 36CM 10MM RIGHT TROC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET RSP DJO SURGICAL NEUTRAL HUMERAL HXE+ SZ 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTERTAN 10S 10MM X 40CM 123 DEGREE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L12 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L14 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L16 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L50 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L55 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123105|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY GRAFTON DBM 5CC|1|HUMANA [1294]||HUMANA [11839]|1,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L60 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|95.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|95.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 1/3 TUBULAR L94 MM 8 HOLE LOCK STERILE 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFS-1515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE FUSEFORCE NITINOL 3 MM L15MM X W15MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N35036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE DART-FIRE SMALL L36 MM OD3.5 MM HEAD STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7207002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE TITANIUM L25MM 7MM 1.5MM ACL PCL CANNULA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350938|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASCULAR LIFESTREAM L38 MM L135 CM OD9 MM BALLOON EXPA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S0604|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 6MM STD WL PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,467.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,467.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1927BCT-475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TAPE 4.75MM CORKSCREW FT BC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.1MM 32MM T10 LG CX PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-520-020S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 2.0X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM FIXATION RIGIDLOOP LONG CORTICAL ADJUSTABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-024S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 2.0X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507215MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SMOOTH ROUND MODERATE PROFILE CLASSIC 215ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507170MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SMOOTH ROUND MODERATE PROFILE CLASSIC 170ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L10 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA L-D 3.5MM EVOS 7H R 103MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,534.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,534.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L40 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719DS-1818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE DYNANITE NITINOL L18MM X W18MM H1MM TROCAR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719DS-2020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE DYNANITE NITINOL L20MM X W20MM H1MM TROCAR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442080N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TINE EVOS 7H 5MM SPACE STRAIGHT L38MM XW5MMXH1.2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,193.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,193.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS STAINLESS STEEL T6 L8 MM OD2 MM SMALL BONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T6 L16 MM OD2 MM ODSEC3 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T6 L18 MM OD2 MM ODSEC3 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850014545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MAS L45 MM OD4.5 MM SPINE CANNULATED EXTENSION TA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850015550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.5MM 50MM SOLERA CD HORI MULTIAXAIL 4.75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8717DS-1110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE ARTHREX DYNANITE NITINOL TITANIUM L10MMXW11M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T6 L11 MM OD2 MM ODSEC3 MM CORTEX SELF TAP M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402732|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 2.7MM X 32MM CORTEX SELF TAP FLAT HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L12 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L15 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L14 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L46 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 12MM X 2.7MM SEC4.3 MM T8 DR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI L10 MM OD2.7 MM ODSEC4.3 MM T8 DRIVER L|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225240012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 40CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 14MM X 2.7MM SEC4.3 MM T8 DR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 2MM X16MM X2.7MM SEC4.3MM SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE EVOS 2.7MM/3.5MM LATERAL DISTAL FIBULA PLATE 5H L 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,609.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,609.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-5223|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL REUNION STANDARD 23MM 52MM SHOULDER 1 RADI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL AEQUALIS ASCEND FLEX COCR 48MM X 20MM X 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,943.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,943.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179712040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EXPEDIUM TI 40MM X7.5MM SPINE 1 INNIE POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,974.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWK404RA35S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID CORTILOC 35 D MEDIUM SHOULDER RIGHT AUGMEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8718DS-1310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE ARTHREX DYNANITE NITINOL TITANIUM L10MM X W13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8718DS-1512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE ARTHREX DYNANITE NITINOL TITANIUM L12MM X W15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225238012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 38CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-02-0034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L34 MM SPINE 2 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3576|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTERVERTEBRAL MOBI-C COCRMO D15MM W17MM X H6MM TI UHM|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LCP COMBI STAINLESS STEEL L121 MM 5 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA0204|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AVIVE SOFT TISSUE MEMBRANE 2CM X 4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225236012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 36CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-28-76-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM DISTAL BIFURCATED MAIN BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,124.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,124.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L34 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225244011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 44CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463921|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA EVOS 2.7/3.5 M-D 21 HOLE L 261MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,934.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,934.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L32 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM EVOS CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L26 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L24 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L20 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72424744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS FULL THREAD L44 MM OD4.7 MM STERILE OSTEOPEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|223.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225240011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 40CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225238011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 38CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225236011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 36CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225246014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 46CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225244014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 44CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225242014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 42CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225238014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 38CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225236014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 36CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225246013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 46CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225244013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 44CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225242013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 42CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225240013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 40CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225238013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 38CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225236013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 36CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225244012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 44CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225242012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 42CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225234011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 34CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225242010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 42CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225236010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 36CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225234010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 34CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225334008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 34CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225332008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 32CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225330008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 30CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225328008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 28CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225338009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 38CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225336009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 36CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225334009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 34CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168181|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MODERATE ROUND 180CC STYLE-168|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-4303M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 10.6X9.3CM BRST 400ML SMTH DCRN P6.6CM RECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168211|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MODERATE ROUND 210CC STYLE-168|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245210404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 4 HL ECT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L ANG LT 85MM SS 4.5MM SCR LG FRAG 4 HL BTRS BN LT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPN 100MM SS 4.5MM SCR LG FRAG 5 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|622.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|622.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T BUTTRESS 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|820.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|820.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 112MM SS 4.5MM SCR LG FRAG 6 HL BTRS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|899.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|899.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L ANG RT 85MM SS 4.5MM SCR LG FRAG 4 HL BTRS BN RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|721.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|721.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 80MM SS 4.5MM SCR LG FRAG 4 HL BTRS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|800.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|800.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500601|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 103X4.8X16.6MM SS 4.5MM SCR LG FRAG 6 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500501|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 87X4.8X16.6MM SS 4.5MM SCR LG FRAG 5 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 135X4.8X16.6MM SS 4.5MM SCR LG FRAG 8 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 199MM SS 4.5MM SCR LG FRAG 12 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|514.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|514.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500901|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 151X4.8X16.6MM SS 4.5MM SCR LG FRAG 9 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494501001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD STD 167X4.8X16.6MM SS 4.5MM SCR LG FRAG 10 HL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|642.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|642.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 14MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 12MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 55MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 26MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14370-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 42MM 16MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14370-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 44MM 16MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14370-46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 46MM 16MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 55MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14369-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANCELLOUS SM.22|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1436920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANCELLOUS SM.20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14332-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE SM."Y"4HOLE(SMALL)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM TI FT CORT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 40MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14375-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 44MM TMX FT BLNT HIP CORT 2 LD CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 28MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM 16MM CANC CNN LG NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 32MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 36MM 16MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14370-40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 40MM 16MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 65MM 16MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14369-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANCELLOUS SM.24|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE SM."Y"2HOLE(SMALL)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 46MM CANC LG CNN NONLOCK SM FRAG PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14376-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM CANC LG CNN NS ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100D 1/3 TBLR CNTR 61X9.2X1.3MM 3.5MM SCR SM FRAG SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100D TBLR 3.5MM SCR 6 HL BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143557|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100D TBLR SM FRAG SYS 7 HL BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|201.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|201.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143558|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100D TBLR 109X9.2X1.3MM 3.5MM SCR SM FRAG SYS 8 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3 HL STRG BN ORTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4 HL STRG BN ORTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|438.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 6 HL STRG BN ORTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14342-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14342-6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|552.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|552.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14342-8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|621.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|621.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143444|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE "L"LEFTMEDIUM 4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14344-8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE "L"LEFTMEDIUM 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143454|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANG RT T BRD NAR TMX 4.5MM SCR 4 HL HBRD CMPR MOD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|504.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|504.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14345-6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE "L"RIGHTMEDIUM 6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 45MM 32MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14372-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 55MM 32MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM 32MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|264.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|264.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14372-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 65MM 32MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14372-70|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANNULATED CANCELLOUS SM.3.5/4.0 70MM 32MM-THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143553|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100D TBLR 109X9.2X1.3MM 3.5MM SCR SM FRAG SYS 3 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|159.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|159.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 100D TBLR 49X9.2X1.3MM TMX 3.5MM SCR SM FRAG SYS 4 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 32MM TMX FT HIP CORT 2 LD SLD CPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500613|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPN 120MM SS 4.5MM SCR LG FRAG 6 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|672.39|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|672.39|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419790|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM 40MM TMX LG 4 CUT FLUT CANC CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STD NAR 55MM SS 4.5MM SCR LG FRAG 3 HL CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500504|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 100MM SS 4.5MM SCR BSC FRAG 5 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|593.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|593.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 25MM 22MM TMX LG 4 CUT FLUT CANC CNN ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 30MM 22MM TK2 TMX 4 CUT FLUT HIP CANC CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419635|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM 22MM TMX LG 4 CUT FLUT CANC CNN ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8MM 80MM 24MM TMX LG 4 CUT FLUT CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8MM 90MM 24MM TMX LG HIP CANC 4 CUT FLUT CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14192100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8MM 100MM 24MM TMX LG HIP CANC 4 CUT FLUT CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|462.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|462.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234001700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM ECT FT CANC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245208803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 3 HL ECT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|536.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|536.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245405303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM OBLQ T 53MM 3 HL ECT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|404.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|404.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245407505|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T OBLQ 75MM 5 HL ECT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|416.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|416.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2454-056-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T ECT SMALL 4HOLE 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|206.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|206.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00242901200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 154MM 3.5MM SCR 12 HL SC ECT BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245800205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLQ ECT BN EPIP RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245800105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLQ ECT BN EPIP LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00245901205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ECT BN EPIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2454-050-03|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T ECT SMALL 3HOLE 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|196.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|196.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00235003815|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 8MM ECT SS HEX CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420048|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1420070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL MEDIUM 4.5MM 70MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14340-3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4.5MM3HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14340-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4.5MM4HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|294.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|294.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14340-6|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4.5MM6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4.5MM8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1434010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4.5MM10HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|396.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|396.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14340-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE RECONSTRUCTIVE 4.5MM12HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14197-95|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 95MM 40MM TK2 TMX 4 CUT FLUT HIP CANC CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232002100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 20MM ECT CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232400700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 6MM ECT CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 143446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE "L"LEFTMEDIUM 6HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|579.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|579.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14345-8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ACE "L"RIGHTMEDIUM 8HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|651.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|651.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.771|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SCHANZ SELF-DRILLING 4.0MM/3.0MM 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|529.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 100MM 4MM SCHNZ PLVC SS SPD PNT 25MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.46|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 120MM 4MM SCHNZ PLVC SS SPD PNT MR CONDITIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232402100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 20MM ECT CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|36.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|36.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.68|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH 300MM 2.8MM SS THRD TROC PNT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.71|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WIRE KIRSCHNER 1.6MM DIA 150MM LENGTH W/THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.784|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CARBON FIBER 8.0MM X 220MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|517.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|517.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 26MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 36MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 40MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.772|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4/3MM 100MM 20MM SCHNZ SS ORTH SLFDRL NS LG XTRNFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|529.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14374-30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANCELLOUS SOLID 4.0 X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14374-35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG CANC SOLID 4.0MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1437630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM TMX TIB CANC DIST CNN NONLOCK LG NS ALPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 65MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 60MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 55MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 50MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 45MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 40MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225310055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 100MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225309055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 90MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225308555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 85MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225308055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 80MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 75MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 70MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 30MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 25MM SS LG FEM CORT INTLK STRL GRN ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225213055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 130MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225212555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 125MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225212055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 120MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225211555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 115MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225309037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 90MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225308537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 85MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 40MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 35MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225303037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 30MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 25MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225302037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 20MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225211055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 110MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225210555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 105MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225210055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 100MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225209555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.5MM 95MM SS LG FEM RECON STRL GRN STRP MDN IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|781.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|781.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225307037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 70MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 65MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225306037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 60MM MDN SS SM FEM INTLK STRL YLW IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 55MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225305037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 50MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225304537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.7MM 45MM SS SM FEM CORT INTLK STRL YLW ITST MDN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|524.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|524.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-5-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.28MM 30MM GMA SS HIP FEM LCK STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-5-035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.28MM 35MM GMA SS HIP FEM LCK STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|333.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|333.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-5-040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.28MM 40MM GMA SS HIP FEM LCK STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-5-045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.28MM 45MM GMA SS HIP FEM DIST IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-2-085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12MM 85MM GMA SS HIP FEM LG STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-2-090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12MM 90MM GMA SS HIP FEM LG STRL IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-2-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LAG 12 X 100 NAIL GAMMA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-1-060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12MM 60MM GMA SS HIP FEM LG IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6317|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MEDPORE IMPLANT ROUND 20MM|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3370-8-125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 18CM HIP TROCH GMA IM 125D LCK SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-8-130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL HIP TROCH GMA IM 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,911.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-2-110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12MM 110MM GMA HIP LG IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3370-2-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12MM 120MM GMA SS HIP LG IM NL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|780.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|780.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 395.786|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD CARBON FIBER 8.0MM X 240MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|517.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|517.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37040510|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CBL SLV ORTH 2MM DLMLS HIP SS SET|1|HUMANA [1294]||HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LDC508|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON CATHETER DCR LACRICATH LDC 508|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 281.55S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHORT BARREL DHS 135 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.255S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 55MM DHS/DCS SS HIP CNDYL LG STRL 1 STP SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.260S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 60MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.265S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 65MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.270S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 70MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.275S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 75MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.670S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 70MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.675S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 75MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.680S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 80MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.685S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 85MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7425|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPINAL GENERATOR ITREL III #7425|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,215.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|22,215.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 280.690S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 90MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.695S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 95MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.701S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 100MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.280S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 80MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.285S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 85MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.290S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 90MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.295S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 95MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.301S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DHS DCS LAG ONE-STEP 12.7MM X 100MM ONE STEP STAINLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.310S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 110MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.315S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 115MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7434|SUP|HCPCS C1787||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROGRAMER- PT HAND HELD #7434|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 280.320S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 8MM 2.7MM 120MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,230.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.705S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 105MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.710S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 110MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.715S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 115MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 280.720S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 14MM 8MM 2.7MM 120MM 22MM DHS DCS SS HIP CNDRL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,368.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 78X19X5.8MM SS 4.5MM CORT SCR 4 HL LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.05S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 130 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.06S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD DHS 130 DEG 6 HOLE 110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.64S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D SHRT BRL 78MM SS 1 STP SYS 4 HL CMPR DHS/DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.65S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHORT BARREL DHS 140 DEG 5 HOLE 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7489-51|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXTENSION KIT #7489-51|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,980.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 281.74S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHORT BARREL DHS 145 DEG 4 HOLE 78MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.75S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 145D SHRT BRL 94MM SS 1 STP SYS 5 HL CMPR DHS/DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.840S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 150D SHRT BRL 78X19X5.8MM SS 4.5MM CORT SCR 4 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,840.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 281.85S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 150D SHRT BRL 94MM SS 1 STP SYS 5 HL CMPR DHS/DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|936.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|936.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 12-139006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD UNPLR 41MM E-2 HIP ACTB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 56MM SS STD CORT LG HEX SCKT NS LG FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|50.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|50.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401823M|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 8FR 35MM 23CM KINK RST CNN INTVN HMST VLV RADOPQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported YREC1655|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-EXTENDER CUFF 5.5CM 16MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRIRHXC1685|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT AAA ILIAC-LIMB 8.5CM 16MM TAPERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M001465261|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDEWIRE AMPLATZ SUPER STIFF .035 DIAMETER X 260CM LENGTH S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GN2500|SUP|HCPCS C1773||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT SNARE GOOSE NECK AMPLATZ 25MM LOOP DIAMETER X 120CM SNAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CG415|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLIDECATH 4 FRENCH X .038 GUIDEWIRE X 65CM LONG ANGLED TAPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-CAVGJ-514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 12CM 21MM MSTR HMSHLD CLGN MECH LO POR GFT MR|1|HUMANA [1294]||HUMANA [11839]|17,034.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,034.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 23-CAVGJ-514|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR 12CM 23MM MSTR HMSHLD CLGN MECH LO POR GFT MR|1|HUMANA [1294]||HUMANA [11839]|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|17,376.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 7496-51|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION ITREL-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 749851|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT DUAL-4 EXTENSION BIFURCATED|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7424|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR ITREL-II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TRNMTR NRSTM MATTRIX 2 CHNL|1|HUMANA [1294]||HUMANA [11839]|14,070.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,070.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA2202|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 20CM 22MM STD WL STRG LG DIA PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 142603401A|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH SFT TIS 34X26CM SFT CNFRM TRM STRNG GRTX THK1MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,074.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,074.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA2402|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 20CM 24MM STD WL STRG LG DIA PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA1802|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 20CM 18MM STD WL STRG LG DIA PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA2002|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 20CM 20MM STD WL STRG LG DIA PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110064505|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR HYBRID PTFE DIA6MM LENGTH-45CM (DIALYSIS)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,560.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11-2057|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE FEMORAL THREADED 3.2MM X 305MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 111647|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ASCP 2.4MM 305MM THRD TIP CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|250.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HN1202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET HIP CENTERING SLV IMHS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|223.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|223.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71163038R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 38CM RT IMHS IM 130D LNG SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,663.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,663.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71122399|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NUT ORTH STBLK|1|HUMANA [1294]||HUMANA [11839]|321.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.195|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +19.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.190|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +19 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.185|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +18.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.180|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +18 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.175|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +17.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.170|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +17 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.165|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +16.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.160|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +16 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.245|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +24.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.250|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +25 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.255|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +25.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.260|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +26 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.265|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +26.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.270|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +27 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S2|SUP|HCPCS C1783||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE GLCM 184SQ MM THK1.9MM AHMED PP SIL 16X13MM .635MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.210|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +21 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.205|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +20.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.200|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +20 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.150|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +15 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.140|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +14 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.215|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +21.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.220|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +22 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.225|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +22.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.230|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +23 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.235|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +23.5 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ70BD.240|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +24 DIOP MOD C BCNVX 12.5MM 7MM PC 1 PC UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 24MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 24MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.865|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 65MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 80MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.885|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 85MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.890|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 90MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 16MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 16MM 6MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 18MM 6MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|55.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|55.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 22MM 6MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|59.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|59.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 24MM 10MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 26MM 10MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 28MM 10MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 30MM 10MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|30.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-0184|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CRAWFORD LACRIMAL SET WITH SUTURE|1|HUMANA [1294]||HUMANA [11839]|255.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 404.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 32MM 12MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|47.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|47.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 34MM 12MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 36MM 12MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 38MM 12MM TI P/T SM HEX SCKT SHFT SPHRCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 10MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 12MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 14MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 16MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 18MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 20MM SELF TAPPING WITH 2.5MM HEXAGONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.822|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 22MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 24MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 26MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 28MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 30MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 32MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 34MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.836|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 36MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 38MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 404.845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 6MM 45MM 2.5MM TI FT CORT ST SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 10MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 12MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 14MM TI P/T CANC SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 16MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM FULL THREADED WITH 2.5MM HEXAGON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 20MM FULL THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 22MM FULL THREADED WITH 2.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 24MM TI P/T CANC SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 26MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 28MM TI P/T CANC SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 30MM TI P/T CANC SM HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 35MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 45MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 50MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 55MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 60MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 10MM LC DCP TI TIB CANC PROX MDL P/T NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 12MM 5MM TI P/T CANC SM HEX SCKT NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 14MM 5MM TI P/T CANC SM HEX SCKT NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 16MM 6MM TI P/T CANC SM HEX SCKT NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 18MM 7MM TI P/T CANC SM HEX SCKT NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 20MM LC DCP TI TIB CANC PROX MDL P/T NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 22MM 9MM TI P/T CANC SM HEX SCKT NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 24MM 10MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 26MM 12MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 28MM 14MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 30MM 14MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 35MM 14MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 40MM LC DCP TI TIB CANC PROX MDL P/T NS SM FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 45MM 15MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 407.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 50MM 15MM TI P/T CANC SM HEX SCKT NS SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 419.98|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 7MM ORTH TI 3.5MM CORT 4MM CANC SCR NS|1|HUMANA [1294]||HUMANA [11839]|91.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|91.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LC DCP 3.5MM 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|438.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|438.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.57|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LC DCP 3.5MM 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|473.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|473.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LC DCP 3.5MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|476.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|476.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.59|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LC DCP 3.5MM 9 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|451.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|451.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 423.60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LC DCP 3.5MM 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 50X10X1.2MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|344.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|344.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 67X10X1.2MM TI 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.23|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T OBLQ ANG 53X10X1.5MM TI 3.5MM SCR SM FRAG SET 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|589.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|589.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T OBLQ ANG 63X10X1.5MM TI 3.5MM SCR SM FRAG SET 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|742.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|742.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.25|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T OBLQ 75X10X1.5MM TI 3.5MM SCR 3 HLE/HD 5 HL SHFT LC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|742.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|742.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 25MM 2 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|182.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|182.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 37MM 3 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|186.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|186.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 61MM 5 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 73MM 6 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|218.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|218.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.37|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 85MM 7 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 97MM 8 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|236.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.40|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 97MM 10 HOLE WITH COLLAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|236.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|236.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 60MMX1.2MM TI 3.5MM CORT 4MM CANC SCR 3.5MM CNN SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,666.38|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,666.38|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 70MMX1.2MM TI 3.5MM CORT 4MM CANC SCR 3.5MM CNN SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,706.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,706.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 87MMX2MM TI 3.5MM CORT 4MM CANC SCR 3.5MM CNN SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,706.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,706.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 441.83|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLVRLF 88X15X2MM TI 3.5/4MM SCR 3 HL THN BLDE LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 293.74|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 200MM 5MM 5.5MM STNM CNTR THRD SS LG XTRNFXTR NS|1|HUMANA [1294]||HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 80MM 4MM 3MM SCHNZ SS TROC PNT MR CONDITIONAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|272.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|272.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 150MM 5MM SCHNZ PLVC SS BLNT TROC PNT MR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 170MM 5MM SCHNZ XLNG PLVC SS BLNT TROC PNT 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|348.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 294.56|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW XTRNFX 200MM 5MM SCHNZ PLVC SS BLNT TROC PNT MR|1|HUMANA [1294]||HUMANA [11839]|348.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|348.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 70MM TI 3.5MM SCR SM FRAG SET 6 HL RECON LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|843.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|843.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 445.17|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 82MM TI 3.5MM SCR SM FRAG SET 7 HL RECON LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|723.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G470-0006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT FNGR SWNSN 6 GRMT MTP SIL HI RST STAB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30263245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 45MM VSP SS STD SPNE PDCL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|942.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|942.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52102840|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.25MM 40MM KANEDA ISOLA TI SPNE ANT CLS .25IN ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD COUPLER 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,235.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 100 DEGREE LEFT MEDIUM 3MM X 3MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7079|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L RIGHT LONG TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7225|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.8MM 5MM LORENZ TI CTR DR ER NS DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 100 DEGREE RIGHT MEDIUM 3MM X 3MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT 6-HOLE REG.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7078|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L LEFT LONG TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|303.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|303.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y DOUBLE REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|384.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.5MM/5.0MM(5/PK)|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|126.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|126.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7204|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 4MM LORENZ TI CRNMXF CTR DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|247.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|247.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.5MM/3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.5MM/6.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.5MM/7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-7209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CENTER DRIVE 1.5MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|92.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|92.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9474|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 4.0MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|397.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9481|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 11MM CNTR-DRV TI MNDB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|163.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9485|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 15MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|397.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9487|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 17MM T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|138.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|138.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9489|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 19MM T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|129.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|129.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 019499|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 2MM 9MM CTR DR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|397.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9497|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|157.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|157.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG .6MM RT MDFC 2X2 HL L 2MM SCR BN TI SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG .6MM LT MDFC 2X2 HL L 2MM SCR BN TI SLVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|699.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|699.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2254279|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y DOUBLE 0.6MM REGULAR TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|918.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|918.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 40MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 65MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 70MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 75MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 80MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM 32MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM 32MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 65MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 70MM 32MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 75MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 80MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 90MM 32MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 30MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 35MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 85MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 90MM 16MM THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 95MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM 16MM THREADED WITH 3.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 105MM 16MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 416.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 110MM 16MM THREADED WITH 3.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 95MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 100MM 32MM THREADED WITH 3.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 105MM 32MM TI P/T CANC LG HEX SCKT NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 417.110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 110MM 32MM THREADED WITH 3.5MM HEXA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 55MM TI FT CANC LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 60MM FULL THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 70X13.5X4.2MM TI 4.5MM SCR LG FRAG 4 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 88X13.5X4.2MM TI 4.5MM SCR LG FRAG 5 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 106X13.5X4.2MM TI 4.5MM SCR LG FRAG 6 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.57|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 124X13.5X4.2MM TI 4.5MM SCR LG FRAG 7 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|306.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|306.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 25MM TI FT CANC HEX SCKT NS LC DCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 35MM TI FT CANC HEX SCKT NS LC DCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 40MM FULL THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM TI FT CANC LG HEX SCKT NS LCP LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 418.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 6.5MM X 50MM FULL THREADED WITH 3.5MM HEXAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMTB 71X12X1MM TI 3.5MM SCR LG FRAG 4 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|179.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|179.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMTB 87X12X1MM TI 3.5MM SCR LG FRAG 5 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|99.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|99.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMTB 103X12X1MM TI 3.5MM SCR LG FRAG 6 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|108.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|108.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 422.07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SMTB 119X12X1MM TI 3.5MM SCR LG FRAG 7 HL LC DCP BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|117.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|117.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 142X13.5X4.2MM TI 4.5MM SCR LG FRAG 8 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.59|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 160X13.5X4.2MM TI 4.5MM SCR LG FRAG 9 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|243.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|243.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW LC DCP 4.5MM 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 196X13.5X4.2MM TI 4.5MM SCR LG FRAG 11 HL LC DCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 424.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NAR 214X13.5X4.2MM TI 4.5MM SCR LG FRAG 12 HL LC DCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.56|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 106X17.5X5.2MM TI 4.5MM SCR LG FRAG 6 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.57|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 124X17.5X5.2MM TI 4.5MM SCR LG FRAG 7 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|549.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|549.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.58|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 142X17.5X5.2MM TI 4.5MM SCR LG FRAG 8 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.59|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 160X17.5X5.2MM TI 4.5MM SCR LG FRAG 9 HL LC DCP BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 440.54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE ANG RT L BTRS 86X14X3.8MM TI 4.5MM SCR 4 HL SHFT LC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.64|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 250X17.5X5.2MM TI 4.5MM SCR LG FRAG 14 HL LC DCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW LC DCP 4.5MM X 178MM 10 HOLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.61|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 196X17.5X5.2MM TI 4.5MM SCR LG FRAG 11 HL LC DCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 426.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 214X17.5X5.2MM TI 4.5MM SCR LG FRAG 12 HL LC DCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 237.62|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95D 60MM SS 16 HL DCP BN 267MM CNDYL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,228.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 237.26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 95D 70MM SS 12 HL DCP BN 204MM HIP CNDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,037.18|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,037.18|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00902602800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 6D +0MM SM 28MM HIP ZML COCR LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,733.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,733.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 004809|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR ALGRF 22X8X9-6.6MM CNTR WDG SPNE CORT FRZN SLOT PRMDL|1|HUMANA [1294]||HUMANA [11839]|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3544507|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.9CM SLTX P4.1CM MDRT PRFL RND SLTX GEL TXTR 450|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542507|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.5CM SLTX P3.3CM MDRT PRFL RND SLTX GEL TXTR 250|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3543007|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.6CM SLTX P3.5CM MDRT PRFL RND SLTX GEL TXTR 300|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168390|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND SALINE TEXTURED STYLE-168 390CC C1789|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168360|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND TEXTURED STYLE-168 360CC-390CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168330|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND TEXTURED STYLE-168 330CC-360CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168300|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST ROUND TEXTURED STYLE-168 300CC-330CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542257|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.4CM SLTX P3CM MDRT PRFL RND SIL GEL TXTR 225ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3543507|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.4CM MEMORYGEL SLTX P3.7CM RND MDRT PRFL SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363651|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15.8X13.5CM BCL BIOCURVE P6.1CM LO HT FULL PRJ SAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-168121|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 9CM BCL P3CM SAL STY 168 TXTR RND 120-150ML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-468271|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11X11.5CM BCL BDIM P4.3CM FULL HT MDRT PRFL SAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-163441|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.8X13.6CM BCL P5.2CM FULL HT SAL STY 163 TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-163361|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12X12.8CM BCL P4.9CM FULL HT SAL STY 163 TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0786|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSTN OTO 4.75MM .6MM EAR STPS PLTN FLRPLAS RBN LOOP|1|HUMANA [1294]||HUMANA [11839]|454.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -3MM 32MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM STD 32MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,539.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 32MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,539.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,539.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-332|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 10MM 32MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,359.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-326|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +10MM 26MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 06-3205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM OFST CTPR 32MM HIP COCR LFIT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,683.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 12.7MM 9MM 90MM 21MM AMBI CHS IMHS P/T HIP STD LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28.5MM AMBI IMHS CLS SS HEX HIP SP CNDL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G4260005|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE SWNSN 5 MTP SIL REG STM FLXB HNG GRMT STRL|1|HUMANA [1294]||HUMANA [11839]|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 470-0010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT FNGR SWNSN 0 MCP FLEXSPAN DRSL HNG DSGN FLXB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,755.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 470-0001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FINGER JOINT SIZE 1 SILASTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 470-0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT FNGR SWNSN 2 MCP GRMT FLXB HNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G470-0003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT FNGR SWNSN 3 GRMT MTP SIL HI RST STAB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G470-0004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT FNGR SWNSN 4 GRMT MTP SIL HI RST STAB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G470-0005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT FNGR SWNSN 5 GRMT MTP SIL HI RST STAB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8590-41|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TNLR SRG ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 210330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR PANALOCK RC W/(PANACRYL) C1713|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|555.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|555.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CLXSMO|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SMTH BN 9.5MM CRUCIAL TL|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR PLLA 25MM 9MM TIB BABSR LTRM ABS TRILOBE DRVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|289.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|289.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2 CP-2 SQA+ EBND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|744.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCO-3300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL POLARUS 3.5 X 30|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HR-0820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD ORTH 200MM 8MM PLRS + HUM HUM IM IMPL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 187MM 6 HL 6 BAND CBL RD BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,868.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,868.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HCA5450-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 45MM PLRS TI SHLDR HUM CANC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200303|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 305MM 10 HL 10 BAND CBL RD BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,966.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,966.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200302|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 246MM 8 HL 8 BAND CBL RD BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,432.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,432.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00223200118|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYS CBL 559MM 1.8MM CBL RD SS CRLGE STRL LF|1|HUMANA [1294]||HUMANA [11839]|1,048.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,048.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 24MM ART TK2 TMX FT CORT SLD ST NS AIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.7MM 26MM 5MM CORT NS GRN DOT VERSANAIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|42.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|42.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 48MM TMX FT HIP CORT 2 LD SLD CPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 50MM TMX HIP CORT 2 LD SLD CPTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 52MM TK2 TMX FT FEM TROCH CORT PROX SLD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 60MM TK2 A/A VERSANAIL TMX FT CORT SLD ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|51.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|51.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 65MM A/A TK2 VERSANAIL TMX FT FEM TROCH CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9282|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 1MM THICK 4 HOLE MEDIUM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 42-4000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT PRTNVN DNVR ASCT 2 VLV|1|HUMANA [1294]||HUMANA [11839]|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 34MM VERSANAIL TK2 TMX FT 3 TRNSV 1 OBLQ ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 40MM TK2 A/A VERSANAIL TMX FT HIP FEM CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 44MM ART TK2 TMX FT CORT SLD ST NS AIM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 70MM A/A TK2 VERSANAIL TMX FT FEM TROCH CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 75MM A/A TK2 VERSANAIL TMX FT FEM TROCH CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1402280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 80MM A/A TK2 VERSANAIL TMX FT FEM TROCH CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|57.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|57.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-8050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN SLVR REG STRG CRNMXF TI 4 HL 2MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|249.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|249.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9284|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION 1MM THICK 4 HOLE LONG TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|171.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|171.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.530MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.532MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.534MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.536MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0607|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR GORE-TEX 6MM X 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1425038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.538MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.540MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14250-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.542MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.544MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.546MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14250-48|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.548MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14250-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.550MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.555MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.560MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 40MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0807|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR GORE-TEX 8MM X 70|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1422542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 42MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 44MM 20MM TMX CANC LG CNN STD HD SLFDRL ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 46MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 48MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|429.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|429.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 55MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14369-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CANCELLOUS SM.10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|78.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|78.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9475|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 5MM CNTR-DRV TI MNDB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|397.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|397.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9477|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 7.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|156.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|156.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 01-9479|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FACIAL ORAL MAXILLO CRANIO CENTER DRIVE 2.0MM X 9.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|160.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|160.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 21-2000-24|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT-A-CATH PERITONEAL 15FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|837.06|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|837.06|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1425065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.565MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|418.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|418.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1425070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ACE CORTICAL LAGMEDIUM 4.570MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|252.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|252.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 30MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 32MM 20MM TMX HIP CANC ST SLF DRL CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 34MM 20MM TMX CANC HIP LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 36MM 20MM TMX CANC LG CNN STD HD SLFDRL ST NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|288.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|288.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 38MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 65MM 20MM TMX CANC LG CNN STD HD SLFDRL NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1422570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 70MM CANC LG CNN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|273.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|273.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 127044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 8MM 44MM IMHS CORT ST THRD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-45|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 45MM 22MM TMX LG 4 CUT FLUT HIP CANC CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM 22MM TMX 4 CUT FLUT CANC CNN ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419655|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM 22MM TMX LG 4 CUT FLUT CANC CNN ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-60|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 60MM 22MM TMX LG CANC SLF DRL ST RVRS RADL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 65MM 22MM TMX LG HIP CANC 4 CUT FLUT CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-70|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 70MM 22MM TMX LG 4 CUT FLUT CANC CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 80MM 22MM TMX LG 4 CUT FLUT CANC CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419690|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM 22MM TMX LG 4 CUT FLUT CANC CNN ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1419695|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 95MM 22MM TMX LG 4 CUT FLUT CANC CNN ST TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 100MM 22MM TMX 4 CUT FLUT CANC CNN SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-105|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 105MM 22MM TMX 4 CUT FLUT CANC CNN SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|444.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|444.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 110MM 22MM TMX 4 CUT FLUT CANC CNN SLF DRL ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196-115|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 115MM 22MM TMX LG 4 CUT FLUT HIP CANC CNN SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14196120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 120MM 22MM TK2 TMX 4 CUT FLUT HIP CANC CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 406.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 6MM 40MM TI FT CANC SM HEX SCKT NS SM FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.234|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 34MM 12MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.32|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBULAR 1/3 25MM 2 HOLE WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|176.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|176.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 219.98|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 7MM ORTH SS NS|1|HUMANA [1294]||HUMANA [11839]|91.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|91.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 73X9X1MM SS 3.5MM SCR SM FRAG SET 6 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.37|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 85X9X1MM SS 3.5MM SCR SM FRAG SET 7 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|248.19|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|248.19|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 97X9X1MM SS 3.5MM SCR SM FRAG SET 8 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|224.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|224.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 111MM SS 3.5MM SCR SM FRAG SET 8 HL SHFT BN TIB LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G01264|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE CURVED 0.35 DIAMETER X 180CM LENGTH 1.5MM TIP RADI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 46MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.648|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 48MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 50MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.626|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 26MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 16MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.630|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 30MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 28MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.632|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 32MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|709.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|709.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.636|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 36MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 34MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|607.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|607.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.638|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 38MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 42MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|709.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|709.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.640|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 40MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 20MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 18MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.856|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 56MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.868|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 68MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 202.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 20MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 60MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 75MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 70MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 217.065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 65MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 218.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 35MM SS 3.5MM FT CANC LG HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 241.141|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 56X11X1.5MM SS 3.5MM SCR SM FRAG SET 4 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,026.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,026.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0784|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSTN OTO 4.25MM .6MM EAR STPS PLTN FLRPLAS RBN LOOP|1|HUMANA [1294]||HUMANA [11839]|454.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8213|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIO-STINGER 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIO-STINGER 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10175|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.9MM 2 ULFX RC ST ROTR CUF PRELD SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|507.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|507.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 487.044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 14MM CSLP TI SPNE CORT ST XPD HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 497.78|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.8MM 5MM TI SPNE LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|68.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|68.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 632010P|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 45CM 20X10MM KNTD BFUR GLSFT + PLSTR GELTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,721.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,721.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M002020852410|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT CV 40CM 24MM 12MM WVN FLXB SMTH NDL PSG SUT RTNT HMSH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,437.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,437.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA08D08BE0YN|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR RR 8-8MM X 110 90< Y RING 200FF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,595.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V46040L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 40CM 4-6MM STD WL TPR GRTX LN STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,056.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,056.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C8216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BIO-STINGER 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-328|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEMORAL 28MM +10MM-STEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +5MM 28MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-128|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM STD 28MM HIP PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284-0-126|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM STD 26MM HIP CMPNT COCR VIT PCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,323.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67044020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CBL 2MM DLMLS MED HIP VIT GRP CRMP|1|HUMANA [1294]||HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-7-020|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M VIT CABLE GRIP LG 2.0MM|1|HUMANA [1294]||HUMANA [11839]|2,049.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,049.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67048236|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE ORTH VIT 1.6MM 750MM HIP GRP DLMLS|1|HUMANA [1294]||HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G426-0103|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE SWNSN 3S LAT MTP SIL TI GRMT FLXB HNG SHRT STM|1|HUMANA [1294]||HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501640|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.7-12.3CM P3.7-4.2CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501635|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.9-11.2CM P3.6-4.1CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501685|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.5-15CM P4.2-5.1CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542712|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.3X10.5CM SLTX P5.3CM CNTR PRFL HI PRJ SAL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501630|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.9-11.5CM P3.5-4CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501655|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.6-13.3CM P3.9-4.7CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626984|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX SLIM Y 4 HOLE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501670|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 425-475CC STY 1600 SMTH SLFSL DPHRM VLV SAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3501680|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.2-14.8CM P4.2-4.9CM MDRT PRFL RND SAL STY 1600|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,650.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-4304M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS BRST 700ML RND SAL P6.7CM 14.6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 350-4308M|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS BRST 850ML SMTH RND RDVN SAL P7.2CM 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133FV14|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 14X14.5CM BRST 600ML STY 133 2 STG TXTR ANTM DSGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 37-133500|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 13X14CM BRST 500ML STY 133MV TXTR P5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-363231|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.5X9.5CM BCL BIOCURVE BDIM P4.4CM LO HT FULL PRJ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121150|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN GRFTN DBM 10ML ALGRF GEL|1|HUMANA [1294]||HUMANA [11839]|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5894|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS OSS 4.5MM 2.5MM 1MM WEHRS INCUS HAPEX HA 1 NTCH FULL|1|HUMANA [1294]||HUMANA [11839]|1,246.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,246.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7014-5897|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS EAR WEHRS INCUS STAPES SINGLE NOTCH|1|HUMANA [1294]||HUMANA [11839]|1,246.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,246.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0783|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSTN OTO 4MM .6MM EAR STPS PLTN FLRPLAS RBN LOOP|1|HUMANA [1294]||HUMANA [11839]|420.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|420.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 14-0785|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PSTN OTO 4.5MM .6MM EAR STPS PLTN FLRPLAS RBN LOOP|1|HUMANA [1294]||HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 013186|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BTN FX 12MM 4MM EBTN FEM SFT TIS TI ASCP STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S47045|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 45CM 4-7MM STD WL TPR PERI GRTX STRCH STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,707.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,707.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6704-5-016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|D/M VIT CABLE GRIP SM 1.6MM|1|HUMANA [1294]||HUMANA [11839]|2,049.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,049.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 484-0002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RADIAL HEAD 2 SILASTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 484-0001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT RADIAL HEAD 1 SILASTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 481-3001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARPAL LUNATE SIZE 1 SILASTIC C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,302.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,302.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 481-3003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT CARPAL LUNATE SIZE 3 SILASTIC|1|HUMANA [1294]||HUMANA [11839]|399.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|399.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4832|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE 2 MTP GRT TOE SIL|1|HUMANA [1294]||HUMANA [11839]|660.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|660.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 7 X 20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 292.72|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW ORTH YLW 150MM 1.6MM SS THRD SPD PNT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM SS PARTIALLY-THREADED 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|661.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|661.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 086032|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH NPHSTM 32FR MLCT NTR RBR 4 WNG DRN STRL LTX DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 219.91|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 10MM ORTH SS 4.5MM CNN SCR NS|1|HUMANA [1294]||HUMANA [11839]|87.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|87.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 67X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,120.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,120.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 40MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|61.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 45MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|49.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 50MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 35MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|61.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|61.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 30MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 26MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 22MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 55MM COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 24MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 30MM VARIAX T8 FULL THREAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 60MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 55MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 40MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 45MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 30MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 35MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 22MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 14MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 18MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 20MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 14MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 16MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 18MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 12MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|76.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 10MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 20MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 22MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 30MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 28MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.832|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 32MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 34MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 38MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|76.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|76.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 10MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 206.012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 12MM FULL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2026-3240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VSP BONE 7.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.870|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 70MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5079-5-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 120MM 3MM HFMN2 MIC SS CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|48.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|48.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5079-5-090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD XTRNFX 90MM 3MM HFMN2 MIC SS CNCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|41.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|41.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 219.99|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 13MM ORTH SS 6.5/7/7.3MM CNN SCR NS|1|HUMANA [1294]||HUMANA [11839]|88.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|88.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 27-153541|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.9X14.9CM MCGHN BCL P5.2CM SIL STY 153 TXTR ANTM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3542714|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14X11.9CM CNTR PRFL SLTX P6.4CM HI PRJ SAL TXTR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 526680|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 165MM 20MM 15MM LATERALIZE NK CLCR REPL CMNTLS SR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,147.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 40MM SR TI LG DOME HIP ST LOPRFL HEX HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556074|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 35MM SR TI LG HIP ACTB ST LOPRFL HEX HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D08600|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BICORTICAL BLOCK 10X20MM|1|HUMANA [1294]||HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PFM0505|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE MATRISTEM PELVIC FLOOR MATRIX 5CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,938.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,938.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1101-00-0930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION EXOSHAPE H30 MM OD9 MM TIBIAL FASTENER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-181815TI|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT SPEEDTITAN L18 MM X W18 MM L15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,353.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,353.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-2015TI|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT SPEEDTITAN L15 MM X W20 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,385.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,385.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 521503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PERIPHERAL HEAD CRUCIATE S-ROM 5.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72453106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-P P/A EVOS 3.5MM 6 HOLE 91MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,919.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,919.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403534|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L34 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L70 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L75 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L50 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413532|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L32 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-8416-70|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD NEUROSTIMULATOR ARTISAN L70 CM MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 563120N|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 225MM 20MM 15MM LATERALIZE NK CMNTLS SR CERM 135D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,337.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402712|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI STAINLESS STEEL T8 12MMX2.7MM CORTEX ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 50MM 2.7MM SEC4.5MM CORTEX T8 ST FLAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI T8 38MM X2.7MM SEC4.5MM CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 20MM 2.7MM SEC4.3MM T8 DR LOCK FLAT H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS LP 2.7 X 70MM 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,545.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,545.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442720N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7MM SPC T 42X7.5X1.4MM SS 2.7MM SCR MN FRG 3HLE/HD5 NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,492.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,492.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-1912|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX SILICONE L120 MM L90 CM OD19 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 556071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 20MM SR TI LG DOME HIP ACTB ST LOPRFL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|619.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|619.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-1915|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX SILICONE L150 MM L90 CM OD19 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MAXX-1970|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ENDOMAXX SILICONE L70 MM L90 CM OD19 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402748|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 48MM 2.7MM SEC4.5MM CORTEX T8 ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-FSP-YS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE PROTEAN Y STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING 13.5MM 5MM SR ZT 20D LG HIP POR MDLR SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550540|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING 17.5MM 7MM SR ZT 20F 2XL HIP POR MDLR SYS STRL|1|HUMANA [1294]||HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 550569|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLV CENTERING 17.5MM 7MM SR ZT 24F 2XL HIP POR MDLR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,335.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 522030|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 11/13 TPR 28MM HIP COCR SR STRL MDLR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 522034|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +12MM 11/13 TPR 32MM HIP COCR SR STRL MDLR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,767.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 522028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM 11/13 TPR 28MM HIP COCR SR STRL MDLR SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,692.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT-1125|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.3-4.6MM 12.5MM ACTRK TI STD FT FT HND ST CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT-1150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.3-4.6MM 15MM ACMD/TRK TI STD FT TPR ST CNN VAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AT-1225-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.3-4.6MM 22.5MM ACTRK TI STD SLF CUT CNN VAR PTCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATM-100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.8-3.6MM 10MM MN ACTRK TI FT ORTH ST CNN CMPR HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATM-160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.4MM 16MM ACTRK TI MN FT TPR RDS MTRSL MIDFOOT CNN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|705.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|705.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATM-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.8-3.6MM 18MM ACTRK TI MN FT RADL MTRSL MIDFOOT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ATM-260|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.8-3.6MM 26MM ACTRK TI MN FT RADL MTRSL MIDFOOT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|735.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|735.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8700282|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE HOLE 13MM X 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,107.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 859-150|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK SPNL HZNM8 STD PDCL TI BLDE RAMP 5.5MM ROD|1|HUMANA [1294]||HUMANA [11839]|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,148.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 871-001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|479.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|479.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 871-016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 16MM ORN TI CANC ANT CSPN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|477.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|477.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8710013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|970.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|970.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8590-1|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INFS DCRN MESH PCH SNCHR DRG DLV SYS|1|HUMANA [1294]||HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225234013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 34CM FEM MDN IM OPN RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225338008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 38CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225336008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 36CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225332009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 32CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225330009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 30CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G14442|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH PEEL-AWAY INTRODUCER 12FR #073912|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00225328009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 28CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225336010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 36CM TIB MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225334010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 34CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225332010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 32CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225332011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 32CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225338012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 38CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225336012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 36CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225334012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 34CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225332012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 32CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5568-0012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|REUNION RFX HUMERAL FRACTURE STEM 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,899.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,899.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00341.001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|38MM 2 LVL TRIN SELECT PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINI MONSTER CANNULATED SHORT THREAD SCREW HEADLESS 3.0X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT300-28.0|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +28 DIOPTER +3 CYLINDER MODIFY C BICONVEX 13MM 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225330012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 30CM TIB BILAT MDN IM OPN SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UWR1025|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE M GLIDEWIRE 630-092 025X150|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00225330010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 30CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628559S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HOOK 9 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,357.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,357.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225328010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 28CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225234012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 34CM FEM MDN IM CLS RECON SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,005.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225330011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 30CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT074050A|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE 50CMX 40CM 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,358.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,358.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-535-024S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MINI MONSTER CANNULATED SHORT THREAD SCREW HEADLESS 3.5X24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF HA L150 MM L35 MM OD6 MM EXTERNAL FIXATION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF HA L150 MM L30 MM OD6 MM EXTERNAL FIXATION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF HA L150 MM L40 MM OD6 MM EXTERNAL FIXATION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225338011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 38CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225336011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 36CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE EXTERNAL FIXATION ILIZAROV ST 370 MM OD1.8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|203.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|203.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00225334011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 34CM TIB BILAT MDN IM CLS SS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,085.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719DS-2015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE DYNANITE NITINOL 20MMX15MM 1MM COMPRESS LP TROC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI STAINLESS STEEL T8 15MM 2.7MM SEC4.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719DS-2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE ARTHREX DYNANITE NITINOL TITANIUM 20MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 OD2 MM L18 MM OD2.7 MM ODSEC4.3 MM SMALL BONE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L36 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72441004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS L52 MM 4 HOLE COMPRESSION STERILE 3.5 MM SCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|519.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|519.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355120|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE TITANIUM LORDOTIC L120 MM OD5.5 MM NONSTER|1|HUMANA [1294]||HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465205|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA L-D EVOS 2.7/3.5 5H RIGHT 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,609.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,609.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676579|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130 D 1.5 MM L38 CM L11.5 MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402726|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 26MM 2.7MM 4.5MM CORTEX T8 DR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 OD2 MM L28MM OD2.7MM ODSEC4.5MM CORTEX SELF TP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L18 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440507|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 1/3 TUBULAR 82MM LOCK 7 HOLE STERILE 3.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.160|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +16 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L44 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L10 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658126|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FIXOS TITANIUM L26 MM OD5 MM MIDFOOT REARFOOT COM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926455|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL CLYDESDALE PEEK 6 D L55 MM X W22 MM X H14 MM RAD|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L2328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF-DRILL LOW THREAD 2.3MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066201080|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ SUPER STIFF 620-108|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported MTA4U0.170|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +17 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LDA220Q-58|SUP|HCPCS C1895||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD DEFIBRILLATOR OPTISURE OPTIM L58 CM L17 CM OD8 FR ENDOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,427.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,427.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.175|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +17.5 DIOP CNVXPLN 13MM 5.5MM AC 1 PC UV ABS KLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM EVOS CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA L-D 2.7/3.5 EVOS 7H RIGHT 103MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,800.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,800.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658365|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 65MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-6.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 6.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN AXSOS 3 TI L227 MM TIBIA LEFT DISTAL MEDIAL 14HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,567.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,567.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8952PPL|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PLANTAR 1ST MET OST 3MM PETITE LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629270S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LATERAL TI DISTAL POSTERIOR 10 HOLD RIGHT LOCKING STER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234-210-017|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRO CHONDRIX ALLOGRAFT FRESH CRYO 17MM X 1.0MM|1|HUMANA [1294]||HUMANA [11839]|12,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-17.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-50H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM ARTHX TI T15 LG FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI T8 20MM X2.7MM SEC4.5MM CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 429878|SUP|HCPCS C1900||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD LV ATTAIN PERFORMA MRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,768.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,768.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719DS-1515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 15X15MM DYNANITE NTNL CMPR LOPRFL TROC TIP ALGN PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 601680|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 80MM ASNS III TI CANNULATED STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-21.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|372.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|372.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-21.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.5 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 475.915S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TITANIUM L300 MM OD1.5 MM DIAPHYSIS LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|962.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|962.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AXSOS NARROW L223 MM 12 HOLE LOCK COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,565.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,565.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CNW6050|SUP|HCPCS C9361||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE NERVE NEUROMEND BOVINE COLLAGEN 6 MM L5 CM|1|HUMANA [1294]||HUMANA [11839]|5,061.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,061.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.310|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +31 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.33|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +33 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.32|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +32 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA50BM-22.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER ACRYSOF MULTIPIECE-POSTERIOR C|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT3.34|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +34 DIOP +1.5 CYL BCNVX 13MM 6MM PC 1 PC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-7.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 7.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122889|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 56MM SHLDR SFT TIS BAL SIMPLICITI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.100|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +10 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.211.240|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 10D LG 57MM SS 2.4/2.7MM SCR VA FSN LOPRFL CMPR WRE HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,116.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-10.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 10.5 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN L20MM OD2.4MM ODSEC4.5MM CORTEX SELF TAP SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|151.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|151.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0066401061|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE AMPLATZ STRAIGHT .038|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SN60AT.110|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TDT546|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT MATRIX HD 5MM 4CM X 6CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,039.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,039.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 24MM 2.7MM 4.5MM CORTEX T8 DR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|118.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|118.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412750|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI 50MM 2.7MM 4.5MM CORTEX T8 DR SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442784N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7MM X 7HOLE SFT Y-TINE EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,205.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,205.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T8 OD2 MM L24 MM OD2.7 MM ODSEC4.3 MM SELF TAP LO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5534-A-309|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL ALL POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,887.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,887.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.115|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +11.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661002S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CABLE PLUG AXSOS3 TI 5.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|894.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|894.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5015-7-250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF APEX HOFFMANN II L250 MM L70 MM OD5MM CANCELLOUS TH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1547CDS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SWIVELOCK BIOCOMPOSITE L15 MM OD4.75 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1224S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL T2 TI LONG RETROGRADE 240MM 12MM SUPRACONDYLAR LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-10104|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX TI MED 69MM FOOT CALCANEUS MESH POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35340-IJS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM L34 MM OD3.5 MM POLYAXIAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IJS-EAP-25550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 55MM 2.5MM IJS AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.120|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 304-20|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LEAD NEUROSTIMULATOR VNS THERAPY PERENNIAFLEX OD2 MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|22,380.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,380.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC231200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR 12CM 23MM 21.5-25MM EXCLUDER CO|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DSF1433|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH INTRODUCER 33CM 14FR 6.7MM 6MM GORE DRYSEAL FLEX HYDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657138|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 2.7MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.125|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +12.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TV-AB2380-J|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOGRAFT BODY AORTIC OVATION 23 MM|1|HUMANA [1294]||HUMANA [11839]|35,997.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,997.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DST0655507D2|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STEERABEL GUIDING SHEATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-0702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN 7MM X 2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-02-036|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET RSP DJO SURGICAL NEUTRAL HUMERAL HXE+ SZ 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FHSS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HUMERAL SHAFT SZ L=120MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,202.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,202.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16017555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7.5MM 55MM RELINE 2C SPINE POLYAXIAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-0902|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADIAL ALIGN TI 17MM 33MM 2MM 9MM SIDE LOAD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.130|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APL-PUP-3HR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL ULNA 73MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,876.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,876.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 28MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 12MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 30MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BL-1600-001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE VIVIGEN FORMABLE CELLULAR BONE MATRIX 1 CC|1|HUMANA [1294]||HUMANA [11839]|1,745.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,745.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.135|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +13.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX630|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORYGEL P5.1CM PLUS PROFILE OD14.7CM 630 CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX645|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORYGEL P5.1CM PLUS PROFILE OD14.9CM 645CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX685|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORYGEL P5.2CM PLUS PROFILE OD15.3CM 685CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX755|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORYGEL P5.4CM PLUS PROFILE OD15.7CM 755CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT-14.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 14.0 DIOPTER ACRYSOF 13.0MM LENGTH 6.0 ANTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX790|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 790CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,610.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.145|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +14.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1330S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY T2 TITANIUM L300 MM OD13 MM SUPRACONDYLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L48 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC121400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR GORE EXCLUDER L14 CM OD12 MM CONTRALATERA|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L38 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676623|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130 D 1.5 MM L38 CM L13 MM LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463909|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA 9-H L130MM EVOS 2.7/3.5 M-D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,890.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,890.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.262S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 420MM 130 DEG FEMORAL PROXIMAL TFN-ADV LATERAL REF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402424|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI T7 L24 MM OD2.4 MM CORTEX SELF TAP STER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|112.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.150|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX S-T 2.0 X 22 EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|106.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|106.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402440|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T7 L40 MM OD2.4 MM CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|112.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402448|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS MINI T7 L48 MM OD2.4 MM CORTEX SELF TAP STER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|112.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|112.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L15 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72453404|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 11MM SPACE T 71MMXW10.9MMXH2MM W32 TIBIA RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,770.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,770.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72424785|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS FULL THREAD L85 MM OD4.7 MM STERILE OSTEOPEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L80 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.155|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +15.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L42 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93541|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UNIPOLAR FX/CEMENTED STEMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP BIPOLAR FX CEMENTED STEMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93542|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UNIPOLAR POROUS STEMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93544|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP BIPOLAR POROUS STEMS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP MOP CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93545|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP MOP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93549|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP GRIPTION CUP UPCHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93547|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP COP CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,726.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,726.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93552|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE HP UNI ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.160|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93555|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE SIGMA FB CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93554|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE HP UNI METAL BACKED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93558|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ATTUNE FB WITH DOME PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93556|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE SIGMA FB HYBRID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93557|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE SIGMA FB POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93561|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ANATOMIC PATELLA UPCHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93560|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ATTUNE RP UPCHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93553|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE ALL POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP BPS HA DUOFIX ACTIS UPCHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93550|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP SROM UPCHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.165|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +16.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93548|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP COP POROUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,926.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,926.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 93559|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE SIGMA RP UPCHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701455|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP TANDEM BIPOLAR POROUS FEM W/CO CR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.170|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 14MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35380-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 38MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 18MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VLBPL-3-7|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VOLAR BEARING PLATE TI LEFT WRIST 3H 7 PEG LOCKIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPEG-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION L14 MM WRIST VOLAR THREAD LOCK TORX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPEG-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION L18 MM WRIST VOLAR THREAD LOCK TORX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPEG-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG FIXATION L16 MM WRIST VOLAR THREAD LOCK TORX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.175|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +17.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH11E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ALLOX2 P5-5.7CM FULL HEIGHT 230-280CC 11X10.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.180|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35400-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 40MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110025877|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JUGGERKNOT 1.5MM W/1 #2 BLUE MB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|818.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|818.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.185|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +18.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6713126|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 26X11X13MM COROENT 4D LARGE IMPACT PEEK OPTIMA|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D2N30010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE DART-FIRE TI SM PARTIAL TH 10MMX3.0MM HEADLESS BR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-1815TI|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT COMPRESSION SPEEDTITAN 18X15X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,353.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,353.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AO60P1600|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR +16.0 AKREOS ADVANCED OPTICS ASPHERIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218703|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE ALPS TIMAX CONTOUR LT MEDIAL 10H PROXIMAL 97MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.190|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 131218208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE HUM DIST LAT LEFT 15H 142MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APL-PUP-6HR|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROXIMAL ULNA 108MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,410.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35200-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 22MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749389696860|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING RUNWAY JUDKINS RIGHT 4 CURVE OD6 FR FEMUR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0203263015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE NCB TI6AL4V L324 MM FEMUR RIGHT PROXIMAL 15 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,152.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.195|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +19.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249140012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL Z PF UNIV 12MM X 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,884.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,884.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SD242.003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LCP ST STEEL STRAIGHT L170MM WRIST NONSTE 2.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH14E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 14X12.9CM BRST 480-575CC TXTR INTGR PORT ALLOX2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC181200|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR L11.5 CM OD18 MM ID14.5-16.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC181000|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR L9.5 CM OD18 MM ID14.5-16.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.200|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI DIRECTIONAL 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.205|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +20.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675515|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 125 D L40 CM OD10 MM LEFT TROCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,628.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-002-LC05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OBLIQUE 5HOLE COMPRESSION LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.210|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.0MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-153-2010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING BG 2.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-DS01SL|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING TRANSVAGINAL DESARA SHORT LENGTH TAPER L12 CM MIDLINE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,838.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,838.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.215|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +21.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35400-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 40MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 26MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905217|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 30 9MM X 30MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|884.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|884.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905256|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 9MM X 25MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|958.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|958.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905257|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 9MM X 30MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|958.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|958.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IJS-EAP-25400|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN AXIS 2.5MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-2267|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON FIXATION PECTORALIS INSERTER LARGE EYELET LATEX FREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,305.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.225|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440506|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 1/3 TUBULAR L70 MM 6 HOLE LOCK STERILE 3.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|871.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|871.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS160102L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OLECRANON 2 HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X54|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 54MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.230|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1002X38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 2.7MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248410560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS ZNN 6.0MM X 105MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248409560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS ZNN 6.0MM X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905258|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 9MM X 35MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|958.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|958.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.235|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +23.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34442|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET GASTROSTOMY ENTUIT START SMALL OD12-14 FR ODSEC16 FR COO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34443|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET GASTROSTOMY ENTUIT START PEEL-AWAY MEDIUM OD16-18 FR ODS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.240|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L14 MM OD3 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L10 MM OD2.5 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI TITANIUM TAPER CUT FLUTE L16 MM OD3 MM ODSEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L12 MM OD3 MM HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE EVOS 1/3 TUBULAR L22 MM 2H LOCK STERILE 3.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|639.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|639.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72454603|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL P-D P/A 3.5MM EVOS 3H R 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,996.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,996.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413546|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L46 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413544|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L44 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.245|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +24.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403538|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L38 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72455406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE FIBULA AG PL-D EVOS 6H 69MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,658.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,658.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L28 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA L-D 3.5MM EVOS 5H L 81MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,406.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,406.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L20 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L16 MM OD3.5 MM SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|443.04|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|443.04|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403542|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L42 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|85.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|85.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442235|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER ORTHOPEDIC EVOS 2 STERILE 3.5 MM SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.250|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627706|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AXSOS 3 TITANIUM L97 MM TIBIAL LEFT PROXIMAL MEDI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,178.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,178.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71800016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE PERI-LOC STAINLESS STEEL L342 MM FEMUR LEFT DISTA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,868.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,868.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.255|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +25.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 74820270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERI-LOC STAINLESS STEEL FULL THREAD L70 MM OD6.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|897.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERI-LOC TRIPLE LEAD THREAD L70 MM OD4.5 MM ODSEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERI-LOC STAINLESS STEEL T25 FLUTE L60 MM OD4.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERI-LOC STAINLESS STEEL T25 FLUTE L12 MM OD4.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERI-LOC STAINLESS STEEL T25 FLUTE L30 MM OD4.5 M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE PERI-LOC TRIPLE LEAD THREAD L22 MM OD4.5 MM ODSEC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|430.92|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|430.92|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.260|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201124010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ORTHOLOC TITANIUM NITRIDE L10 MM OD2.4 MM FOREFOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX490|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL P5.8 CM HIGH PROFILE ROUND O|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34444|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET GASTROSTOMY ENTUIT START LARGE OD20-24 FR ODSEC22-26 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.265|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +26.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1120S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 200MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.311S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LCP COMBI STAINLESS STEEL L179 MM HUMERUS LEFT DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,744.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,744.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905259|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 10MM X 25MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,188.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,188.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47365|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION NESTER PLATINUM SYNTHETIC FIBER .035 IN L7|1|HUMANA [1294]||HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G47340|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBOLIZATION NESTER PLATINUM SYNTHETIC FIBER .018 IN L7|1|HUMANA [1294]||HUMANA [11839]|222.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|222.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.270|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905261|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 10MM X 30MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|984.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|984.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905262|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 10MM X 35MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905263|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 11MM X 30MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,188.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,188.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905264|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPOSITICP 60 11MM X 35MM IN SCREW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,067.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,067.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 912029|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE JUGGERKNOT MAXBRAID 2 OD2.9 MM 2 LOAD BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|835.44|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|835.44|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.275|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +27.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.400S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16016535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE RELINE 2C L35 MM OD6.5 MM SPINE POLYAXIAL NONSTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L25 MM OD10 MM STERILE LATEX FREE DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L30 MM OD10 MM STERILE LATEX FREE DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.280|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L30 MM OD11 MM STERILE LATEX FREE DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L30 MM OD12 MM STERILE LATEX FREE DI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L20MM OD7MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-1725|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L25MM OD7MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L20MM OD8MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L30MM OD8MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1825|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L25MM OD8MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L20MM OD9MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.285|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +28.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1925|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L25MM OD9MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1930|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE IFIX L30MM OD9MM STERILE LATEX FREE DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|865.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|865.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM3008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APERFIX TIBIAL IMPLANT 8MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-3009C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APERFIXII CANN TIBIAL 9MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM3010C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APERFIXII CANN TIBIAL 10MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM3011C|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|APERFIXII CANN TIBIAL 11MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,074.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.290|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM6127|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOWICK SURELOCK ANCHOR 2.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9129|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO LINK OD2.9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|848.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|848.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO LINK OD 4.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9155|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO LINK OD 5.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,092.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9145SP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO LINK OD 4.5 MM SP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,092.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,092.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM9255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO X FORCE FIBER PEEK 2 OD5.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|838.08|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|838.08|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM9265|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO X FORCE FIBER PEEK 2 OD 6.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|835.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|835.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM9255X3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO 3X FORCE FIBER PEEK 2 OD5.5 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,065.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM9329|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO FORCE FIBER PEEK OD2.9 MM GLENOID|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|732.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|732.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.295|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +29.5 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|468.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|468.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM9329GL2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE QUATTRO FORCE FIBER 2 OD2.9 MM COBRAID BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|788.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|788.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9614|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE SURELOCK UHMWPE 2 OD1.4 MM PRELOAD IMP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM9614F|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE SURELOCK UHMWPE 2 OD1.4 MM PRELOAD FLEXIBLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|939.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|939.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9622|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SURELOCK 2.2 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|946.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM-9622F|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SURELOCK 2.2 MM FLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|946.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|946.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN60AT.300|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +30 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35380-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 38MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35120-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 12MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71703316|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP CMTD FEM W/OXIN HD & R3 XLPE LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1818-0001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM L14.5 MM OD8 MM ANKLE CANNULATED COMPRES|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|529.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|529.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1818-1215S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY T2 TITANIUM L15 CM OD12 MM LEFT ANKLE AR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-26.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658170|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FIXOS TITANIUM L70 MM OD5 MM MIDFOOT REARFOOT COM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,941.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71653038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TRIGEN META-NAIL TITANIUM L38CM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L65 MM OD5 MM FEMUR LOW PROFILE INTERNAL HEX TRIG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-21.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 21.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOW PROFILE SCREWS TITANIUM L 50MM OD4.5MM ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-34|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOW PROFILE SCREWS TITANIUM L34 MM OD4.5 MM ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-55|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LOW PROFILE SCREWS TITANIUM L 55MM OD4.5MM ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5 MM 20MM LOW PROFILE ANKLE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5 MM 22MM LOW PROFILE ANKLE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-20.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 20.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827L-28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 28MM LOPRFL SCR SS FT T10 HEXALOBE ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963MR-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE CONTOUR L128 MM TIBIA RIGHT DISTAL MEDIAL 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,220.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502300|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST SALINE P5 CM MODERATE PLUS PROFILE OD11.2 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-11.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 11.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71655135|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TRIGEN META-NAIL TITANIUM L35CM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676628|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 42CM RT INTERTROCHANTER INTERTAN IM 130D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676584|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY INTERTAN 130 D1.5MM L42CM L11.5MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71677110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SCREW INTERTAN TITANIUM L110 MM L105 MM OD11 MM TROCHANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71106595S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 95MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-13.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 13.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71106590S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 90MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 18MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 28MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L20 MM OD3.5 MM ODSEC18 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L20 MM OD3.5 MM ODSEC6.8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71822906|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE PERI-LOC STAINLESS STEEL L81MM LEFT OLECRANON 6H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,543.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,543.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73822350|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L50 MM OD2.7 MM ODSEC 4.7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|321.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|321.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CZ60BD-18.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 DIOPTER SINGLE PIECE PMMA 12.5MM LENGT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|376.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|376.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 18MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-110/I16-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 110MM 28MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 30MM|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TF-26.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.5 DIOPTER 2.0 CYLINDER STAAR TORIC 10.8M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-19.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-D-12-28-91-C|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM DISTAL BIFURCATED MAIN BODY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,124.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,124.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L85 MM OD6.5 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L95 MM OD6.5 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.385S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL 85|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-19.0-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.0 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 897010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE HYDROSET XT HA 10CC INJECTABLE STERILE LATEX FR|1|HUMANA [1294]||HUMANA [11839]|14,883.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,883.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ANCHORAGE TITANIUM STANDARD T8 L28 MM OD3.5 MM FO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ15-12-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE EASY CLIP SUPERELASTIC 2 MM L12 MM X W15 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,943.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC141200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 14.5MM GORE XCLDR CNTRLT LG|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47248409060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM FULL THREAD L90 MM OD6 MM ODSEC3.5 MM CO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|573.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|573.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MA60MA.030|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +3 DIOP MOD C MNSCS 13MM 6MM PC MLPC FLD UV ABS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 47249134013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY 13MM 34CM FEMORAL PIRIFORMIS BEVEL TIP G|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,884.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,884.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX465|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 465CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX415|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 415CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX450|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MEMORY GEL XTRA SMOOTH RD HIGH PROFILE 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT351416|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 35MM 14.5MM 30-32MM 12-13.5MM GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Z9000-16.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER TECNIS POSTERIOR CHAMBER 12.0M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8941PRS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE SHORT PLANTAR RIGHT NONSTERILE LAPIDUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4941514N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIAD EVOLVE 1.1 MM FULL THREAD L14 MM OD1.5 MM E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4941516N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TRIAD EVOLVE FULL THREAD L16 MM OD1.5 MM ELBOW ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|483.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|483.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS L13 MM OD3.5 MM CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60AT-36.0|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 36.0 DIOPTER ACRYSOF SINGLE-PIECE 13.0MM LE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402718|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 L18 MM OD2.7 MM ODSEC4.5 MM CORTEX SELF T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465107|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA 7 HOLE LEFT 2.7/3.5 X 103MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,318.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,318.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING EVOS T8 S-T 2.7MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6711932|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL COROENT PEEK-OPTIMA 4 D LARGE IMPACT L32 MM X W9|1|HUMANA [1294]||HUMANA [11839]|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,424.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 11355080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPINAL RELINE TITANIUM LORDOTIC L80 MM OD5.5 MM NONSTERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,947.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported V010-5-6MMX62CM|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN SAPHENOUS 5MM X 62CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|29,640.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|29,640.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990015|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 CIRCLE OD6 IN 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5991525|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 OVAL L25 CM X W15 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5990020|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 CIRCLE OD20 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5993035|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SURGICAL VENTRALIGHT ST ECHO 2 ELLIPSE L35 CM X W30 CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SPD2-US-050-320|SUP|HCPCS C1884||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYS EMBL PRTC 320CM CRTD LWR XTRMT CPTR WRE BRD RADOPQ LOOP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840009545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE COCR L45 MM OD9.5 MM SPINE MULTIAXIAL 5.5 MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA25-11/I20-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT 110MM 20MM 16MM AFX2 2BR MAIN BODY ILIAC LIMB30M|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A25-25/C95-O20 V|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STENT 95MM 25MM VELA 20MM AAA|1|HUMANA [1294]||HUMANA [11839]|12,720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB3776|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DISC CERVICAL MOBI-C 17MM X 17MM H6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.395S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE TFNA FENESTRATEDHELICAL 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,438.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,438.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00597001302|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL PRECOAT CR NEXGEN SIZE C RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,608.31|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRD06005045L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 45CM 6MM STD WL PERI GRTX STRCH RING LN 5CM DLYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.124.204S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE LCP COMBI ST STEEL L102MM TIBIA RT PROX 3.3MM 6H|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,681.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,681.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402714|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX T8 S-T EVOS 2.7X14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464907|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR L-D 7H L 103MM 3.5 EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,095.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,095.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658370|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FIXOS TITANIUM SHORT THREAD L70 MM OD7 MM MIDFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,102.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,102.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 24MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00599001601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS FEMORAL CEMENTED LPS NEXGEN SIZE F LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 402.812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 5MM 12MM 2.5MM TI FT CORT ST SPHRCL HD SM HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 355.041S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD ROD ORTH 950MM 3MM SMTH TIP DFN SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|545.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|545.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS130103R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMMERUS PROXIMAL RIGHT 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3.5MM 14MM TI HND CORT ST CRFRM NS MN FRAG SET|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|109.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|109.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M36|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-377-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L 4-HOLE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M39|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 39MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS110301L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAPS LOCKING 3.5T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350958|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASCULAR LIFESTREAM L58 MM L135 CM OD9 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8115531|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK LOW-PROFILE TI 5.5 31MM FXD|1|HUMANA [1294]||HUMANA [11839]|4,801.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,801.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8963ML-06|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE L128 MM TIBIA LEFT DISTAL MEDIAL 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,220.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,220.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7274|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|CARDIOVERTER DEFIBRILLATOR IMPLANTABLE MARQUIS DR DUAL CHAMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 132-28013-S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIXATION HAMMERFIX PEEK L5.5 MM SMALL L13.5 MM L6.5|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00500105000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL BP 50MM MLPLR HIP MTL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,444.86|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,444.86|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SEMC16371|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON ACHILLES|1|HUMANA [1294]||HUMANA [11839]|7,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-30060-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MULTI THREAD COMPRESSION 3.0MMX6MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-30060-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MULTI THREAD LOCKING 3.0MM X 6MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEMC16385|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON PATELLA WHOLE|1|HUMANA [1294]||HUMANA [11839]|12,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6209BTKL1|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS SOLO-TRAK 9FR SINGLE CHAMBER EX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR W/NEEDLE 5.5.MM L15|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7133384|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER XLPE ACETABULAR 50-52 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 811-5528|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CROSSLINK X-10|1|HUMANA [1294]||HUMANA [11839]|4,287.66|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,287.66|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6061-0537|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM #5 ACCOLADE PLUS TMZF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0.330|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +33 13MM X 5MM ULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.340|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 34.0 DIOPTER RESTORE MONOFLEX 10D POSTERIOR CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI TI T8 REVERSE CUT FLUTE TAPER L20MM 2.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,071.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-1010.5|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS VALVED 10.5FR 13CM SINGLE CHAMB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 600-15-000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE DJO SURGICAL COBALT 40 GM HIGH VISCOSITY STERILE|1|HUMANA [1294]||HUMANA [11839]|195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-08-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SMALL SHELL 8MM X 108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0WT306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER BONE VOID CONFORM FLEX Q-PACK DEMINERALIZE BONE MATRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,549.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,549.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWB174|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM SHOULDER FRACTURE 6.5 TORNIER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.405S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWB243|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 16MM 43MM SHLDR CMNT RVRS AQLS TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT281418|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR 18CM 28.5MM 14.5MM|1|HUMANA [1294]||HUMANA [11839]|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CEB231410A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR GORE EXCLUDER 10CM 14MM ILIAC BR COMP AAA|1|HUMANA [1294]||HUMANA [11839]|33,882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BXA117902A|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ENDOPROSTHESIS GORE VIABAHN .035 IN L79 MM L135 CM OD1|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,977.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,977.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628307|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE ANTERIOR 7 HOLE MIDSHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10170A|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR RC ULTRAFIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062181100|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URET 3FR 12FR 150CM 2CM GW LOPRFL BLNDIL PSPRT HDR+ SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 3503560|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.1-13.4CM P5.7-7.3CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 208.910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANNULATED THREAD 16MM X110MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71508253|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF PL TB ISRT LT S5 14|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,636.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AXSOS 3 FEMUR LATERAL DISTAK 4 HOLE L130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,542.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,542.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522267|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ6 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525041|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO POLY PAT-ONSET 39MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-089-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FREE DRILL 2.0 X 5MM KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-089-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FREE DRILL 2.0 X 7MM KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-091-13|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0 X 13MM KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-091-15|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.0 X 15MM KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|96.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|96.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 25-081-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW 2.3 X 7MM EMERGENCY KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-379-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L-SHAPE LONG RT KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-381-04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L-SHAPE LONG LT KLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|345.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|345.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.35|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 61X9X1MM SS 3.5MM SCR SM FRAG SET 5 HL COLR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|208.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|208.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7843-017-08|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL BEADED FC 18X200 VERSYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,119.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,119.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 8MM 80MM 32MM BIODUR 108 RVRS CUT FLUT FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|662.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|662.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.860|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 60MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.862|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 62MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.864|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 64MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 214.866|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 66MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P50-353-3520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE GORILLA L20 MM OD3.5 MM NONSTERILE R3CON LOCK PLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-535-028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI-MONSTER SHORT THREAD 3.5MM X 28MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840004040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SOLERA CD HORIZON COCR L40 MM OD4 MM SPINE MULTIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1851-1034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY T2 TITANIUM L340 MM OD10 MM FEMUR GREATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,964.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING/SELF-TAPPING RESCUE 4.5MMX12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-01-0014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 1-LEVEL 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1408010|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH EMBL 80CM 6FR 10MM FGRTY ADH CLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 202.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 6MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-345|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT FULL 345CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-365|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT FULL 365CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCX-420|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT EXTRA FULL 420CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCF-385|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT FULL 385CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCX-495|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT EXTRA FULL 495CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCX-470|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT EXTRA FULL 470CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SCX-445|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMPLANT EXTRA FULL 445CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 8MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-54-320|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET ALTIVATE ANATOMIC 54MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 218.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 30MM SS 3.5MM FT CANC LG HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 8W12-3517-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CAPITATE 12MM 35MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TI-115313|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID VERSA-DIAL TI +3 MM OD36 MM SHOULDER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5 HEXAGON COMPREHENSIVE TI 4.75MM X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 218.025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 25MM SS 3.5MM FT CANC LG HEX SCKT NS LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEL6R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE TITANIUM L58 MM ELBOW RIGHT LATERAL 6H LOCK NONST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,182.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,182.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0273|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM ELB HEXALOBE NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0272|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM NONLOCK HEXALOBE HEAD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-LEM7|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 88MM TITANIUM 7 HOLE LOCK BONE ELBOW MEDIAL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,182.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,182.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L32 MM OD2.7 MM ELBOW HEXALOBE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0276|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM ELBOW HEXALOBE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 608090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6MM 90MM TITANIUM FULL THREAD CANCELLOUS NONSTERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|228.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|228.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 20MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|906.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|906.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE TITANIUM L20 MM OD5 MM LOCK NONSTERILE AXSOS 3 PE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 217.045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 45MM 32MM SS 3.5MM P/T CANC LG HEX SCKT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.11|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|103.11|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 30-0275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 60MM NONLOCK HEXALOBE HEAD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R T 52X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,113.69|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,113.69|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626983|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX SLIM Y 3 HOLE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-02-0032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L32 MM SPINE 2 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,260.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT FEM CEM TIBIA STD SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200101|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM PS FEM CEM TIB STD SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200105|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FEM CEM TIB FLX PRLNG SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FEM CEM TIB FLEX SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FEM CEM TIB PRLNG ART SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200111|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FEM PRCT TIB PRLNG SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200107|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT FEM CEM TIBIA STD SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200349|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FEM CEM MB TIB MB PRLG SF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000600003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FM CEM TIB PRLG SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLX FEM CEM TIB FLX SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200019|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLX FEM CEM TIB STD SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLX FEM CEM TIB PRLG SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLEX FEM CEM TIB FLEX SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLEX FEM ST TIB FLEX SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLEX FEM CEM TIB PRLNG SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLX FEM MOB LPS TIB MOB SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,762.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200340|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEM FLX FM CEM MB TIB MB PRLG SF STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200344|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CM FM CM MB TIB MPRLG SF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000230028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CM FLX KN MIS PC TB PRLG SF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000250001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CEM FEM CEM TIB FLX SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000250003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CEM FEM CEM TIB STD SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000250006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CEM FEM CEM TIB PRLG SURF STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000250028|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CEM FM CEM TIB PRLNG SUR XLPE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000250054|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF CR FLX CEM FM CEM TIB FLX SUR STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000251700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CEM FM MIS PC TIB FLX SUR STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000251715|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CM FM MIS PC TB PRLG SF XLPE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000251801|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX CEM FEM CEM TIB FLX SUR XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000240000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FEM CEM TIB STD SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000240100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FEM CEM TIB ST D SUR PRLNG PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000240700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FEM CEM TIB VE SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000240705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CM FM CEM TB CPS VE SUR XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000241020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FEM CEM TIB STD SURF VE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF HA L150 MM L25 MM OD6 MM EXTERNAL FIXATION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|569.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000241505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FM CEM TIB CPS VE SUR STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000241520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FEM CEM TIB VE SURF VE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000241521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FM CEM TIB CPS VE SUR VE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000641520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FM CEM TIB V E SURF VE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00494500804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 8-HOLE 4.5 X 148MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|889.92|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|889.92|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 240.042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 190MM SS 4.5MM SCR LG FRAG SET 4 HL LMT CNTCT TPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,633.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,633.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000640705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FM CEM TB CPSVE SUR XLPE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM FEM CEM TIB ARC PAT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72201784|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTERFERENCE HA 10MM X 20MM ACL BIOSURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200503|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM CR FEM CEM TIB ARC PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200504|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM PS FEM CEM TIB ARC PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM CR FEM CEM TIB E1 PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM FEM CEM TIB E1 PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200528|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB KNEE-PROLONG ART SURF XLPE PATELLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB FLX KN-CM FM MIS TM TIB FLX SF ST PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000240200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA HYB-CEM FM TM TIB STD SUR STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CONDYLAR LCP 4.5MM X 242MM 10 HOLE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,123.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,123.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA HYB-TM FM CEM TB STD SURF STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA HYB-TM FEM CM TI B VE SUR STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244720|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA HYB-TM FEM CM TI B VE SUR VE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,418.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,418.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200543|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM FEM RGX TIB ARC PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200566|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB KN-POR FEM CEM TIB PRL SURF XLPE PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000201506|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB FLX KN-POR FEM CEM TB PRLSF STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.924S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 24MM FOR IM NAILS TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|583.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|583.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000251551|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HY FL KN-GSF CR PO FM CM TB NSM SF ST PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB FLX GSF POR FM CM TB PRLG SF ST PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255027|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB FLX GSF POR FM CM TB PRLG SF XLPE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG POR FEM CEM TIB E1 PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,618.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200515|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG POR FEM CEM TIB ARC PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,718.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FEM MIS TM TIB STD SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FEM MIS TM TIB PRLG SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000200010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FLX FEM POR TIB PRLG ART SUR STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000220020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR LEX FEM TM MONO TIB TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FEM MIS TM TIB STD SURF TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133LV15|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST 400CC STYLE 133LV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FLX FEM MIS TM TIB STD SURF TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225021|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FLX FM MIS TM TIB FLX SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225022|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FLX FEM MIS TM TIB PRL ART SUR ST PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000225024|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FLX FEM MIS TM TIB PRLNG SURF TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM POR TIB PRLNG SUR STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM POR TIB PRLNG SUR TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM POR TIB PRLG SUR XLPE PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM POR TIB PRLNG SUR MET PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,387.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FEM TM MONO TIB TM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM MIS TM TIB PRLG SUR ST PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 243.41|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 18MM SS 2MM SCR MN FRAG SET 2 HLE/HD 2 HL SHFT DCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|174.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|174.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM MIS TM TIB PRLG SUR TM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FEM TM TB STD SURF STD PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FEM TM TIB ST D SURF TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FM TM TIB PRL NG SUR ST PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244810|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FM TM TIB PRLNG SURF TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000246002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FEM TM MOD TB PRLG SURF TM PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200518|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG POR FEM RGX TIB E1 PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG POR FEM RGX TIB ARC PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG POR FEM POR TIB E1 STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 10MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR FEM CEM MON TIB PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200521|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG CEM FEM CEM MON TIB PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,238.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,238.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200602|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF CEM FEM MON TIB UNI KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF CEM FEM CEM TIB STD AS UNI KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000210000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFJ FEMORAL COMPONENT STD PATELLA UNI KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000210100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFJ FEM ORAL COMPONENT XLP PATELLA UNI KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000210020|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PFJ FEMORAL COMPONENT VE PAT UNI KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,428.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,428.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000270000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA UNI FEM PERSONA UNI TIBIA VE SUFA UNI KN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST POR CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST TM CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 14MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST TM CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000121502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST TM CUP XLPE LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120501|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST TM CP LG XLPE LN LG ST HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP POR ST POR CUP XLPE LN STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CUP LG XLPE LN LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CUP XLPE LINER CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100080|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST TM CUP LG XLPE LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100076|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CUP LG XLPE LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS ST TM CUP XLPX LINER STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000105001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CUP XLPE LINER CERAMIC HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 16MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP POR ST TM CUP LG XLPE LN LG STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS ST TM CUP VIT E LINER STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST TM CUP LG VIT E L N LG STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000125003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST TM CUP XLPE LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000125053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST TM CUP VIT E LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100711|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CP XL LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100718|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST G7 CP XL LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100902|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CP E1 LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100721|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST G7 CP LG XL LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CP LG E1 CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 200.806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 3MM 6MM SS CORT ST CRFRM LOPRFL HD NS MN FRAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|102.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|102.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100912|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CP E1 LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000241500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA CEM FEM CEM TIB VE SURF STD PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200123|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OXF CEM FEM CEM ALL POLY TIB UNI KNEE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,528.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.380S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE HELICAL FENSETRATED TFNA 80MM STERILE TAN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CGC6100SBS40|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING SBS4 CURVE L100 CM OD6 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CGC6100SBS35|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER GUIDING CONCIERGE ST PTFE POLYMER SBS35|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 16MM 6MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00232201500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,CANCELLOUS,14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|39.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 204.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 18MM 6MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.220|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 20MM 6MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|56.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|56.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 777353032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE DARCO SHORT THREAD L30 MM OD3.5 MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|471.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|471.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100925|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST RGX CP E1 LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100935|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST MOM CP E1 AA LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,326.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,326.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100936|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST MOM CP E1 AA LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,426.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,426.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100943|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST G7 CP LG E1 LN CERHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100946|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST G7 CP E1 LN STD HC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100083|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HA POR ST TM CUP LG XLPE LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HA POR ST TM CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.222|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 22MM 6MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|58.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|58.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000125102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HA POR ST TM CUP XLPE LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000125153|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HA POR ST TM CUP VIT E LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FITMORE ST POR CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25TO.310|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL ACRYSOF IQ RESTOR STABLEFORCE ACRYLIC 0 D +31 DIOPTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.130|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL IQ RESTOR MONOFLEX 10 D +13 DIOPTER +3 CYLINDER BIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FIT ST POR CUP LG XLPE LN LG STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FTMORE ST TM CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FIT ST TM CUP LG XLPE LN LG STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.224|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 24MM 10MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FITMORE ST TM CUP XLPE LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1334S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY T2 TITANIUM L340 MM OD13 MM SUPRACONDYLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626982|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX SLIM Y 2 HOLE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIAX T8 FULL THREAD L10 MM OD2.7 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIAX T8 FULL THREAD L28 MM OD2.7 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.226|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 26MM 10MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-10102|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX TITANIUM SMALL FOOT CALCANEUS MESH POLYAXI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,347.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,347.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE VARIAX T8 FULL THREAD L32 MM OD2.7 MM NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|516.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|516.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150055|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FITMORE ST TM CUP VIT E LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FIT ST TM CUP LG XLPE LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100703|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST POR CP XL LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150056|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AVRN-FIT ST TM CUP LG VIT E LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100719|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP XL LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100723|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP XL LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100903|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST POR CP E1 LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.228|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 28MM 10MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100722|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP LG XL LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100944|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP LG E1 LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100947|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP E1 LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100941|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP E1 LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100950|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PREM ST G7 CP LG E1 LN LGHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000130001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK POR CUP XLPE LINER STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000132001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CUP XLPE LN STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000132003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CUP XLPE LINER CERAMIC HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000132002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CUP LG XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 30MM 10MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000132051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CUP VIT 3 LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000132052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CUP LG VIT E LN LG STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000135001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK POR CP XLPE LN CER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000132053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CUP VIT E LINER CER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000135002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CP LG XLPE LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000135052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST-NK TM CP LG VIT E LN LG CER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000135053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HA POR ST-NK TM CUP VIT E LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 45X22X10MM CLYDESDALE 6D PEEK RADIOPAQUE LUMBAR|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100582|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP LG VIT E LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.232|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 32MM 12MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|45.81|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|45.81|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100082|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM ST TM CUP LG XLPE LN LG CER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000140013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM ST POR CUP LG XLPE LN LG CER HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000140011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST POR CUT LG XLPE LN LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP LG XLPE LN LG HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP XLPE LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP LG XLPE LINER LG STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP VIT E LN STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142603|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP XLPE LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142052|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP LG VIT E LN LG STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000145001|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST POR CUP XLPE LINER CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 36MM 12MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNIPOLAR HIP-POROUS ST ENDO HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000142653|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TM POR ST TM CUP VIT E LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000101100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNIPOLAR HIP-CEMENT ST ENDO HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNIPOLAR HIO-CEM FRACT ST UNIPOLR FEM HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000101200|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNIPOLAR HIP-LD FX CEM ST ENDO HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000140400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP UNIPOLAR HIP-TM POROUS ST ENDO HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP POROUS PRIMARY UNIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP POROUS FX UNIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP CEMENTED FX UNIPOLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH15E|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE ALLOX2 P6.4-7.9 CM FULL HEIGHT W15 CM X H13.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.238|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SHAFT 3.5MM X 38MM 12MM THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100106|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPLR HIP-HA POR ST MLTPLR CP & LN ST HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPOLAR HIP-POR ST MLTPLR CP & LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100601|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP PRESSFIT(LD/FX) BIPLR HP BIPLR CP STD HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000130600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPOLAR HIP-POR ST-NK MLTPLR CUP & LN ST HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000101000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPOLAR HIP-LD FX CEM ST MLTPL CP & LN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000150600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPOLAR HIP AVRN-FIT ST MLTPL CP & LN ST HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000140600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPOLAR HIP-TM POR ST MLTPLR CP & LN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98783400300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP POR (LD/FX) ST MLTPLR CUP MLTPLR LINER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP CEM FX BIPOLAR STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP POR PRIMARY BIPOLAR STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234003300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW,CANCELLOUS,3.5X35MM,ECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39.33|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|39.33|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 207.010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 10MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110035368|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE BIOMET 40 GM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|180.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|180.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100104|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP POR FX BIPOLAR STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110034355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BN REFOBACIN ST LATEX FREE DISPOSABLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|594.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|594.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100949|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST G7 LG E1 LN LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-8213|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST EXPANDER STYLE 8200 450CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 14MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203784|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TWINFIX TITANIUM 2 OD3.5 MM 2 ULTRABRAID NEEDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|787.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|787.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 16MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442068|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRENGTH EVOS 2.0MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 12MM EVOS T6 CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE L72 MM OD5 MM FEMUR LOW PROFILE INTERNAL HEX TRIG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676562|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 42CM RT INTERTROCHANTER INTERTAN IM 125D 1.5MM 11.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100300|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP FRAC CEM ST MLTPLR CUP MLTPLR LNR STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 20MM PARTIAL THREADED WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP PARTIAL HIP BIPOLAR HIP-CEM ST MLTPLR CP & LN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2713CR|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX CR 13MM|1|HUMANA [1294]||HUMANA [11839]|14,790.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,790.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-65|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 65MM LOW PROFILE SCREWS TITANIUM ANKLE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 24MM LOW PROFILE SCREWS TITANIUM ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 176204006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 6X10 ST|1|HUMANA [1294]||HUMANA [11839]|9,286.62|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,286.62|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 72X11X3.4MM SS 3.5MM SCR SM FRAG SET 5 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|923.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|923.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-207|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L70 CM OD12 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341254|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYSHAPE SILTEX 485CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-209|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L120 CM OD12 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 223.591|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 124X11X3.4MM SS 3.5MM SCR SM FRAG SET 9 HL LMT CNTCT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,118.28|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,118.28|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-208|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L100 CM OD12 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-212|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L120 CM OD14 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-210|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L70 CM OD14 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-211|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L100 CM OD14 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-214|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L100 CM OD16 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-215|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L120 CM OD16 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-202|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L100 CM OD18 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-203|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L120 CM OD18 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-204|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L70 CM OD 22 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-205|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L100 CM OD 22 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.061|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECONSTRUCTION LCP 3.5MM X 84MM 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,572.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,572.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3341304|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYSHAPE SILTEX 545CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80129-206|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT ESOPHAGEAL ALIMAXX-ES L120 CM OD 22 MM FULLY COVERED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS60005|SUP|HCPCS Q4133||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRAFT SOFT TISSUE STRAVIX PLACENTAL TISSUE L4 CM X W2 CM ALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,130.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,130.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1101-00-0730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE FIXATION EXOSHAPE ANGLE L30 MM OD7 MM DEPLOYMENT CART|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L36 MM OD3 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.263S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TFN-ADVANCED TITANIUM COCR 130 D LONG L4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,164.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 473505|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKIN ALLOPATCH HD ACELLULAR DERMIS THK4-5 MM XULTRATHI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,509.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,509.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.071|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 98X10.1X3.5MM SS 3.5MM SCR SM FRAG SET 7 HL RECON LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,649.91|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,649.91|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-1004|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RADL 10MMX4MM 36MM ALIGN TI SD LD HBRD HD DSGN UNQ ALGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.101|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140X10.1X3.5MM SS 3.5MM SCR SM FRAG SET 10 HL RECON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,785.12|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,785.12|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 245.121|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 168X10.1X3.5MM SS 3.5MM SCR SM FRAG SET 12 HL RECON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,977.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440804|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 46MM 3.5MM SCR 4 HL LCK EVOS BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|250.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-06-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SMALL SHELL 6MM X 108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2968045|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 45MMX10MM CLYDESDALE 6D PEEK-OPTM RADOPQ HLW LMBR|1|HUMANA [1294]||HUMANA [11839]|18,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626844|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.1MM 44MM T10 LAG CROSS PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658425|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE COMPRESSION HEADLESS 7MM L125MM SHORT THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEADLESS 4.0MM X 44 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658395|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS SHORT THREAD 7.0MM L95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 70MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,767.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 120MM FIXOS TI L/T MIDFOOT REARFOOT CMPR HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.131|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RT ANG T 50X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|994.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|994.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 L18 MM OD2.7 MM CORTEX SELF TAP NONSTERIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122880|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 44MM SHLDR SIMPLICITI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB R T 63X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,164.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,164.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.051|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 3.5MM X 74MM OBLIQUE RIGHTs|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,216.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,216.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2009-05|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE ALLOGRAFT ARTHROCELL 5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 38CM LEFT TROCHANTER INTERTAN INTRAMEDULLARY 125D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72434046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 46MM T8 EVOS OSTEOPENIA T8 PARTIALLY THEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|226.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72434050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 50MM T8 EVOS OSTEOPENIA T8 PARTIALLY THEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|226.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.941|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T LCP 3.5MM X 63MM OBLIQUE LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,168.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,168.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412717|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 4.3MM 17MM T8 2MM SELF TAP LOCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 30MM MINI HEAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.971|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE OB L T 96X10X1.5MM SS 3.5MM SCR SM FRAG SET 3 HLE/HD 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,322.22|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,322.22|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658380|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS SHORT THREAD 7.0MM L80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 36MM COMPRESSION HEADLESS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,848.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,848.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ20-20-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE DEVICE FIXATION EASYCLIP 20X20X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,503.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,503.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ25-22-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE DEVICE FIXATION EASYCLIP 25X20X20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,503.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,503.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR LCP 5 HOLE 57MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|609.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|609.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-42H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 42MM COMPRESSION FT TITANIUM STANDARD FULL TH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 58813512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 2.5MM 12MM ORTHOLOC FULL THREAD MIDFOOT COR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING EVOS T8 S-T 2.7MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1516P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE 19.3X9.6CM ALLODERM SELECT THK.1.0-0.2MM THIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L32 MM OD3 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.381|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 93X9X1MM SS 2.7/3.5MM CORT 3.5MM LCK SCR SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|572.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|572.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.401|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR LCP 10 HOLE 117MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|676.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|676.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1518PBP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 19.3X9.6CM ALLODERM SELECT DUO THK.4-1.6MM MD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,511.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,511.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 11MM EVOS CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|70.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|70.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 3.5MM X 60MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|384.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|384.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 13MM EVOS SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 118MM 3.5MM SCR 10 HL LOCK EVOS BONE STE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|907.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|907.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR 118MM 3.5MM SCR 10 HL EVOS BONE STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|262.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|262.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72434044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.0MM 44MM T8 EVOS OSTEOPENIA T8 PARTIALLY THEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|226.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.7MM 4.3MM 13MM T8 2MM SELF TAP LOCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7843-016-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL BEADED FULL 12/14 NECK LM BODY SZ-16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,457.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULA EVOS 2.7/3.5MM LATERAL DISTAL 3 HOLE L 59MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,070.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,070.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420150|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII OXINIUM FEM SIZE 4 RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,800.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130-75130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEAM FIXATION 7.5MM X 130MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 130-75925|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|X-CLIP 7.5MM X 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,739.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,739.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.415S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE TFNA FENESTRATED HELICAL BLADE 115MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00550300|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PULMONARY DILATION CATHETER 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420312|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GII CR POLY TB SZ4 9MM RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,554.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00550320|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PULMONARY DILATION CATHETER 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M00550310|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON PULMONARY DILATION CATHETER 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC4038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 4.0MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,071.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,071.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX240|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 10.8CM 3.7CM XTRA 240CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX215|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 10.4CM 3.6CM XTRA 215CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71420576|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GNS II RESURF PAT 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,409.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661720|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 20MM TITANIUM CORTICAL NONSTERILE AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FEMORAL T2 R1500 14MM X 400MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FFNS1816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE 18X16MM FUSEFORCE 2MM REAMER STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,153.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,153.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-525|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 525CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-545|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 545CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 334-1454|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST CONTOUR MEMORYGEL TALL HGT HGH PROFL 755CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1796-01-027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOC SLIM 27MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RL1519PBP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE 2.4MM/0.4MM ALLODERM SELECT DUO THK.4-1.6MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|63,576.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|63,576.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1796-07-014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING SELF 14MM SLIM LOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.624|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 5MM 1.35MM 24MM SS ST RVRS CUT FLUT CNN ST SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500922|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.3MM ICONIX SPEED 2 STRAND 2 FORCE FIBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXR00-18.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +18.5 DIOP MOD C BCNVX 13MM 6MM PC 1 PC FLD ANT ASP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS60008|SUP|HCPCS Q4100||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRAFT TISSUE STRAVIX 3CM X 6CM FROZEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,019.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00340.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 34MM TITANIUM 1 LEVEL TRINICA SELECT BN CERVICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LNHC08|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL HYDRATED LORDOTIC 8MM|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-L003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 0D LONG GORILLA BONE METATARSOPHALANGEAL LEFT NONSTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35080-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 8MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 207.644|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.0MM X 44MM SHORT THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|644.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|644.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 10MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255006|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FM POR TIB PRLNG SUR TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000255018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GSF FLX POR FEM TM MONO TIB TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,187.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00200546|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VG POR FEM POR TIB E1 STD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,287.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000120511|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HYB HIP-CEM ST TM CP LG XLPE LN LG ST HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000139053|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HA POR ST-NK TM CUP VIT E LN CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CUP LG XLPE LN LG HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100202|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS PRIMARY UNIPOLAR PARTIAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100205|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POROUS FX UNIPOLAR PARTIAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 815540055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS LAG 4MM X 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENTED FX UNIPOLAR PARTIAL HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,084.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 26MM VARIAX T8 FULL THREAD NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00784501520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM 160MM 15MM PRM ALGN GD STD BD VRSY TIV FM BEADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,409.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 14MM LOW PROFILE SCREWS STAINLESS STEEL FOO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 430005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE HEMI SHAPED BTB ALLOGRAFT|1|HUMANA [1294]||HUMANA [11839]|7,435.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,435.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070835|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 150MM 6MM HA 45MM XTRNFX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|569.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0044|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS FEMORAL LT NON-PORUS SZ-4 SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,572.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 20CM INTERTROCHANTER INTERTAN INTRAMEDULLARY 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606100S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L100 MM OD6.5 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 960102|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DOME PTLR PFC S OVL38MM KN UHMWPE CMNT 3 PG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,751.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1562CDS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 6.25MM SWIVELOCK BIOCOMPOSTITE TENODSIS 15 VE5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-521-TBB9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL UKA VIT E 9MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-521-TBE8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BEARING TIBIAL UKA VIT E 8MM SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 96-0460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT STAB SZ-5 8MM SIGMA PFC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070810|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF 150MM 6MM HA 50MM EXTERNAL FIXATION SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|569.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1828-1234S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 34CM FEMUR T2 INTRAMEDULLARY LOCK TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,153.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L90 MM OD6.5 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627539|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 169MM X 5.0MM 9 HOLE LOCK COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,078.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,078.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122887|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HD HUM 18MM 52MM SHLDR SFT TIS BAL SIMPLICITI LF STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000100580|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST TM CUP LG VIT E LN LG CER HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98B00100702|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|POR ST POR CP XL LN STD HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598801010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XTN STM 100MM 145MM 10MM KN NXGN STRG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,329.67|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00598800228|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 2 TPR HLF 15MM KN TIB TIV PMMA PRECT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,597.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00598800239|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLOCK AUG NXGN 2 TPR HLF 20MM KN TIB TIV PMMA PRECT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,597.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,597.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32-6728-085-01|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER RIM ELEVATED E/28|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-82-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK WIDE 9.5MM MONARCH|1|HUMANA [1294]||HUMANA [11839]|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-560|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 560CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-83-080|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK NARROW 8.0MM MONARCH|1|HUMANA [1294]||HUMANA [11839]|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1710-22-030|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CONNECTOR CROSSOVER SZ-3|1|HUMANA [1294]||HUMANA [11839]|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-10-075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD BENT PRE 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FX-410560|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE STYLE 410 560CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-580|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 580CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0.265|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1796-01-025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LOC SLIM 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545L-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 18MM LOW PROFILE ANKLE LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628128|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SUPERIOR INCREASED 8 HOLE BRIDGE RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA3U0-26.5|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 26.5 DIOPTER ANTERIOR CHAMBER 12.5MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1796-07-012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING SELF 12MM SLIM-LOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2013-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FILLER BONE VOID 1CC DEMINERALIZED BONE MATRIX ALLOSYNC GEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6202-062-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR TM MULTIHOLE 62MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5552-S-4815|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL 15MM 48MM REUNION STANDARD RADIUS TOTAL SHOULDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620206820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL ACTB 68MM HIP PRM MDLR MLHL TRB MTL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|7,372.56|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 629222S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 72MM 2 HOLE BONE HUMERUS RIGHT DISTAL LATERAL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,262.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522147|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ4 RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8W15-3517-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CAPITATE 15MM 35MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71507231|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO CONF TB ISRT LT S3 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,590.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550225-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.25MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71522257|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROFIX ZIRCON OX NP FEM SZ5 LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,253.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING EVOS T8 S-T 2.7MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412008N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 8MM EVOS T6 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412012N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 12MM EVOS T6 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71524230|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO NON-POR TB BASE LT S3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,098.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412018N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 18MM EVOS T6 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 16MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442454N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 2.4MM EVOS 3 HOLE HD 5 HOLE SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,864.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,864.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 18MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412418N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 18MM EVOS T7 LOCKING SELF TAPPING NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412416N|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 16MM EVOS T7 LOCK S-T NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442054|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 2.0MM EVOS 3 HOLE HEAD 5 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464805|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7MM EVOS L-D FIBULA 5 HOLE RIGHT 61MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,628.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,628.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCT261416|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 26MM 14.5MM XCLDR 2 BRCH TRNKIPSL LG STNT|1|HUMANA [1294]||HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 30MM EVOS SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|336.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|336.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72454503|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 3.5MM EVOS P/A P-D TIBIA 3H LEFT 63MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,996.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,996.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413540|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 40MM EVOS SELF TAP LOCK STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCC141000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS CONTRA-LEG -16 X 14.5 X 10|1|HUMANA [1294]||HUMANA [11839]|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM -4MM 32MM HIP AL V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,143.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,143.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-1690|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PYRAMESH 16 X 90|1|HUMANA [1294]||HUMANA [11839]|18,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-44|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 44MM LOW PROFILE SCREWS TITANIUM ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550325-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.25MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976-190|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,623.42|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,623.42|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550350-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.50MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-08|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-12|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-23|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-15|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-33|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550400-38|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 4.00MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-615|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VISION 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,296.54|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-42-121-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 42MM X 121MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZSLE-20-39-ZT|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT LEG ILIAC AAA 20MM X 39CM FLEX ZENITH SPIRAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,534.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00118.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.6MM 14MM TRINICA VARIABLE STRAIGHT MAGENTA S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-L001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 0 DEGREE SHORT MTP LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 70MM SS 3 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-026S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840006530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 30MM SOLERA CD HORIZON COCR SPINE MULTIAXIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840008530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8.5MM 30MM SOLERA CD HZN COCR SPNE MA NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2716|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 16MM GORILLA R3CON LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8925T|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SYNDESMOSIS TIGHTROPE XP TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 102MM SS 5 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550300-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 3.00MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627537|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE NARROW 133MMX5MM 7HOLE LOCK COMPRESSION BONE NONSTE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,481.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,481.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661722|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM TI L 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661724|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM TI L 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000246000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA TM FEM TM MONOBLOCK TIB TM PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P60ST042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BUNIONETTE 4 HOLD 5MS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD TUBE 118MM SS 6 HL CMPR KY LOPRFL VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P64ST409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P65ST212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COLAG 2.5MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|867.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|867.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P64ST411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P64ST412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P62ST413|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON LOCKING 24MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-3340S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INTRAMEDULLARY NAIL 340MM 13MM 125D R1.5 LONG RIGHT TITA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 150MM SS 8 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502251BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH ROUND ULTRA HIGH PROFILE 225CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3502501BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH ROUND ULTRA HIGH PROFILE 250CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3507255MC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST GEL SMOOTH ROUND MODRT CLASSIC PROFILE 255CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550275-18|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.75MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1550250-28|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT XIENCE SIERRA EVRLMUS ELUTING CORONARY 2.50MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,850.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119313508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD 8 HL CMPR TUBE LOPRFL KY VFX2 BN FEM PROX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 20MM 5MM ASNIS CANNULATED MACRO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119314003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D STD BRL 70MM SS 3 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZXT375-19.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +19.0 DIOPTER +3.75 CYL HAPTIC C BICONVEX 13MM 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119314005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TUBE VERSA FIX LOW PROFILE 5 HOLE 140 DEGREE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L80 MM OD6.5 MM FULLY THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 132-40015-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT FIXATION HAMMERFIX PEEK L6.8MM LARGE L15 MM L7.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119314006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D STD BRL 118MM SS 6 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,334.88|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119314008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 140D STD BRL 150MM SS 8 HL CMPR TUBE LOPRFL KY VFX2 BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,750.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,750.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 55MM 25.4MM VFX SS LG THRD HIP LG CMPR LNK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 60MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301525|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 65MM 25.4MM VFX SS LG THRD HIP LG CMPR LNK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32247001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE FRESH RIGHTMEDIAL HEMI CONDYE|1|HUMANA [1294]||HUMANA [11839]|35,010.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,010.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA25-100/I16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 100MM 28MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA25-70/I16-30|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 70MM 25MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 30MM|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LNHC09|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL HYDRATED LORDOTIC 9MM|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301547|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 110MM 25.4MM VFX FRLC SS LG THRD HIP LNK LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1101-00-1030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR FASTENER TIBIAL 10MM X 30MM EXOSHAPE SOFT TISSUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-521-TBB8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRNG TIBIAL UKA VIT E 8MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-521-TBC8|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRNG TIBIAL UKA VIT E 8MM SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 115MM 25.4MM VFX SS LG THRD HIP LNK LG CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301552|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 120MM 25.4MM VFX SS LG THRD HIP LNK LG CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 125MM 25.4MM VFX SS LG THRD HIP LNK LG CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00119301557|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 15.8MM 130MM 25.4MM VFX SS LG THRD HIP LNK LG CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|959.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|959.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5976-021-17|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR AC 1-2/STRIPPURPLE 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,524.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,524.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4092-58|SUP|HCPCS C1898||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD PACING IMPLANTABLE CAPSURE SP NOVUS 58CM VENTRICULAR BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,575.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71525031|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PRO POLY PAT-ONSET 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,415.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6611|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG SOFT PUNCTUM SILICONE MINI 0.5MM|1|HUMANA [1294]||HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5018-3-120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HALF 120MM 3MM APEX STAINLESS STEEL THREADED SELF DRILLI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|461.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|461.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442478|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRENGTH TINE EVOS 2.4MM 5 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,013.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,013.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402428|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 28MM EVOS MINI T7 CORTEX SELF TAP STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 14MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 12MM EVOS T7 LOCKING SELF-TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 533-12-108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SMALL SHELL 12MM X 108MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,374.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6612|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG SOFT PUNCTUM SILICONE PETITE 0.6MM|1|HUMANA [1294]||HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2102|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE MATRIX ORTHO BONE VIABLE BIO4 2.5CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-17006E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING CROSS PIN SELF TAPPING 1.7 X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|317.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|317.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L20 MM OD3.5 MM ODSEC12 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L20 MM OD3.5 MM ODSEC14 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L20 MM OD3.5 MM ODSEC16 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6613|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG SOFT PUNCTUM SILICONE SMALL 0.7MM|1|HUMANA [1294]||HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 16MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 14MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 20MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71823406|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE MED INFERIOR 10 HOLE 117MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,944.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,944.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP TANDEM BIPOLAR NON POR FEM W/ OXIHD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6614|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG SOFT PUNCTUM SILICONE MEDIUM 0.8MM|1|HUMANA [1294]||HUMANA [11839]|165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/SLS/DMEK|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA TISSUE PRE CUT SPLIT FOR DMEK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155502040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT TLR AGL 2 ANKL POST AUG|1|HUMANA [1294]||HUMANA [11839]|8,502.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,502.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155532000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 ANKL PE AGL STRL TL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,592.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,592.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS13023|SUP|HCPCS Q4132||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|MATRIX REPAIR CELLULAR CORE GRAFIXPL 2CM X 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,970.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 155512000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL TIB AGL 2 ANKL RT TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1796-07-013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW DRILLING SELF 13MM SLIM-LOC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179607015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 15MM SKNLC TI SPNE CRV CANC ANT SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23180-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8717DS-0910|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE 10X9MM ARTHREX DYNANITE NITINOL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.564|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 64MM STAINLESS STEEL T8 ELBOW METAPHYSEAL S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|144.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|144.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CL1518PBP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE ALLODERM SLCT DUO CONT LG PERFORATED MED 1.6MM/0.4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,263.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,263.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07-2818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.8 X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|111.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|111.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6287941|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER SPINAL 14X9MM VERTE-STACK CORNERSTONE PSR 11MM PEEK-O|1|HUMANA [1294]||HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DUP3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PIN DORAL ULNA 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,518.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WHD-4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE DORSAL WRIST HOOK 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,773.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,773.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BP27|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN BUTTRESS DORSAL 27MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|702.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|702.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187110112|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 12MM CGR 10D SM CFRP ALIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRX2.3-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM 10MM ANKLE TORX CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRX2.3-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM 20MM ANKLE TORX CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-82-110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK WIDE 9.5 MONARCH|1|HUMANA [1294]||HUMANA [11839]|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported WFP3|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE WIRE FORM 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,047.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TRX2.3-22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.3MM 22MM ANKLE TORX CORTICAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-10-005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187105212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 12MM CGR 5D MED CFRP ALIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-10-035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD 5.5 X 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-10-645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY MIAMI MOSS 6MM X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133MV12|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE 300CC STYLE-133|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2218-50E|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT 50CM 8 CONTACT TRAIL LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2316-50E|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT NEUROSTIMULATOR 50CM INFINION 16 CONTACT LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6626527|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPINAL 15X8MM DIVERGENCE 12MM LORDOTIC NUCLEUS PULPOSUS|1|HUMANA [1294]||HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CEB231010A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR GORE EXCLUDER 10CM 10MM ILIAC BR COMP AAA|1|HUMANA [1294]||HUMANA [11839]|33,057.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,057.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC231000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR 10CM 23MM 21 5-25.5MM EXCL CONTRALATE|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-95-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END FIN GLOBAL ADVANTAGE 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HGB161007A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR 7CM 10MM GORE EXCLUDER ILIAC INTERNAL COM|1|HUMANA [1294]||HUMANA [11839]|9,456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 46MM ASNIS CANNULATED NONSTERILE JONES FRACTU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS13034|SUP|HCPCS Q4133||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRAFT SOFT TISSUE PRIME 3CM X 4CM GRAFIXPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8927BC|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR CORKSCREW BC FT SUTURE DX 4.5MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220220905|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT TALAR INBONE 5 DOME ANKLE SULCUS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,123.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,123.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112844120|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 44MM SHLDR GB ADV ECNTRC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,678.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,678.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BL-1600-002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX BONE CELLULAR FORMABLE VIVIGEN 5CC MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,045.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,045.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33655508|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 5 8MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33653308|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT TIBIAL 3 8MM ANKLE POLY INFINITY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/CI/DMEK|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA TISSUE PRE-CUT SPLIT FOR DMEK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112865070|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 56MM SHLDR GB ADV CTA STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,765.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|6,765.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLL161007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EXTENDER ENDOPROSTHESIS LILAC 16MM X 10MM X 7CM|1|HUMANA [1294]||HUMANA [11839]|10,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX605|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 14.5CM 5.1CM XTRA 605CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX560|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 14.3CM 4.8CM XTRA 560CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.115.151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 90D LT 90MM SS 2.4MM SCREW 2 HOLE HEAD 5 HOLE SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,812.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-14-050|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL PC GLOBAL ADVANTAGE 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,355.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|11,355.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported C315HIS|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDE CATHETER DELIVERY 43CM C315HIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C304L69|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER SYSTEM SELECT SITE DEFLECTABLE 40CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6310-056-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 36MM 56 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LNHC10|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL HYDRATED LORDOTIC 10MM|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00341.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 40MM TI 2 LVL TRNC SL BN SPNE CRV ANT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656436|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 36MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 36MM ASNS CNN NS JNS FXN SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 40MM ASNS CNN NS JNS FXN SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1822-1242S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 420MM TIB T2 IM STD LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,479.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1420S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 200MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 905-137|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PYRAMESH 13 X 70|1|HUMANA [1294]||HUMANA [11839]|22,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PURAPLYAM-COM 1.6 DISC|SUP|HCPCS Q4196||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRSG WND 1.6CM URAPLY DISC CM ANMC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PS13055|SUP|HCPCS Q4132||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|GRAFT SOFT TISSUE PRIME 5CM X 5CM GRAFIXPL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900PTFX25|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VALVE MITRAL PERICARDIAL PLUS PERIMOUNT THERMA|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900PTFX31|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VL MITRAL PERICARDIAL PLS PERIMOUNT THRM 31MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900PTFX29|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VL MITRAL PERICARDIAL PLS PERIMOUNT THRM 29MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 204.845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 3.5MM X 45MM SELF TAPPING WITH 2.5 HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.02|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.02|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 239.908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 168X11X3.7MM SS 3.5MM SCR 8 HL LMT CNTCT MLLE TAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,825.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,825.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6900PTFX33|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BIOPROSTHESIS VL MITRAL PERICARDIAL PLS PERIMOUNT THRM 33MM|1|HUMANA [1294]||HUMANA [11839]|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71934767|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7MM 110MM CANNULATED HEADLESS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,971.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71934768|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7MM 115MM CANNULATED HEADLESS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,971.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71934765|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 7MM 100MM CANNULATED HEADLESS STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,971.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,971.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P1022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FRS 3.0MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|561.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|561.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 447.344|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 31MM TITANIUM 2MM SCREW MODULAR MINI FRAGMENT SYSTEM 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|772.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|772.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.882|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 12MM LCP TITANIUM SMALL BONE CORTICAL SELF TA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.888|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 18MM LCP TITANIUM BONE CORTICAL SELF TA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 401.886|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 16MM LCP TITANIUM BONE CORTICAL SELF TAP STA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|362.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|362.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35450-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 45MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZMB00U0195|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +19.5 DIOPTER +4 ADD MODIFIED C BICONVEX 13MM 6MM P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8W15-2217-A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT CAPITATE 15MM 22MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 187105210|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 10MM CGR 5D MED CFRP ALIF NS LF|1|HUMANA [1294]||HUMANA [11839]|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,680.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-1.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 1.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5210-2845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CLOSED KANEDA 1/4 X 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-2075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD KANEDA 6.35 X 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-2090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD KANEDA 6.35 X 90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 85MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 6.5MM X 90MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-085-75|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 85MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported E2DR01|SUP|HCPCS C1785||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER IMPLANTABLE ENPULSE DR DUAL CHAMBER RATE RESPONSIV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +4MM 5/40 32MM HIP TPR AL V40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,143.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,143.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6310-050-36|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 36MM 50 X 36|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,921.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,921.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 80MM 16MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 90MM 16MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 30MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 26MM 8.66MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 30MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 30MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BN TIBIAL RIGHT PROXIMAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,670.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,670.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 4.5MM X 50MM 1/3 PARTIAL THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709700|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR ORTH SS 4.5 MM CNN SCR NS LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|110.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1147-080-76|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 80MM 32MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 85MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709076|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 8.2MM 90MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709300|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 9IN 3.2MM SMTH SHFT DRL PNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-01-0022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 1-LEVEL 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114623|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD SHOULDER RESURFACTING MB COPELAND SZ-5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,343.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,343.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 496-KITXL|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT RADIAL EVOLVE(KIT INCLUDESRADIAL HEAD AND STEM)|1|HUMANA [1294]||HUMANA [11839]|11,115.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,115.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061802410|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 8FR 22CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG INR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 948051|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMERTOE NO-THREAD WEIL-CARVER|1|HUMANA [1294]||HUMANA [11839]|681.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|681.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-232|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 32MM/+4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 112848010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 48MM SHLDR GB ADV STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,610.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,610.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6565-0-032|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|V40 ALUMINA HEAD 32MM/-4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6565-0-132|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM +0MM OFST TPR 32MM HIP AL CERM V40 STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,731.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 239.905|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CNTR 142X11X3.7MM SS 3.5MM SCR 6 HL LMT CNTCT MLLE TAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,780.17|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102072|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE REGENERATIVE ALLODERM 6CM X12CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,071.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,071.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 50MM T10 FULL THREAD LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 40MM T10 FULL THREAD LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.7MM 60MM T10 FULL THREAD LOCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 873-030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW THREADED FULL 4.0 X 30MM VCS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,460.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH2520|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM 20MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.832S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 8MM 32MM TI 3.5MM FT TIB CNN ST LCK SLF CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1137-12-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL ADVANTAGE 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,690.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|12,690.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1137-97-025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID SHOULDER END FIN GLOBAL ADVANTAGE 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCT231418|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 23MM 14.5MM XCLDR 2 BRCH TRNKIPSL LG STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SN6AT9-12.5|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 12.5 DIOPTER ACRYSOF TORIC IQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7232CX|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|CARDIOVERTER DEFIBRILLATOR IMPLANTABLE MAXIMO VR SINGLE CHAM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|39,480.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|39,480.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING 4.0X13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 458.846S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 8MM 46MM TI 3.5MM FT TIB CNN ST LCK SLF CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|425.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|425.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 95MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 10MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 2.4MM EVOS 2 HOLE HEAD 6 HOLE SHAFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,864.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,864.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402411|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 11MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 8MM EVOS T7 CORTEX SELF TAP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-15081|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN VARIAX 35MM HOLE4 1MM NSTRL RECONST POLYAX LT FOOT TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,232.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,232.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663560|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5MM 60MM ASNIS SOLID NONSTERILE JONES FRACTURE FI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SND1T4-16.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 16.0 DIOPTER RESTOR MULTIFOCAL TORRIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149801002|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL UNI CEMENTED PRESERVATION SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149812306|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL ALL POLY PRESERVATION 7MM SIZE 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8933V-26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 26MM LOW PROFILE SCREWS TITANIUM ANKLE VARIAB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 70MM 32MM BIODUR 108 HEX RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 80MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114708566|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 85MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1797-10-650|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLY MIAMI MOSS 6MM X 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.328S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 235MM LOCKING FIXATION TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,257.69|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00114709066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 90MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6260-7-136|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD V40 STANDARD 36MM CERAMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6269-1-818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM RESTORATION #8 PS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,235.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,235.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 179772055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 55MM 5.5MM MS M SI PREBNT TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCC201000|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS LIMB CONTRA 16 X 20 X 10CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.581|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 152MM SS 4.5MM SCR LG FRAG SET 8 HL LCP CMBN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,711.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,711.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1826-1134S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 340MM SUPRACONDYLAR T2 INTRAMEDULLARY LOCK RETROGR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 44MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.218|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 48MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403321|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CYLINDER PENILE CX 15CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4945-11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SELF COMPRESSION NARROW 11 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|363.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|363.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72204834|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT INVISIKNOT ANKLE SYNDESMOSIS FRACTURE KIT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,510.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,510.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 234-210-015|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PRO CHONDRIX ALLOGRAFT FRESH CRYO 15MM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALB-0100S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ALLOGEN LIQUID LARGE 1.00ML|1|HUMANA [1294]||HUMANA [11839]|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801304|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 54MM SS 2.7/3.5MM SCR 4 HL NONLOCK BN RADL RT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,769.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71800110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 342MM STAINLESS STEEL 4.5MM SCREWS 10 HOLE LOCKING PER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,056.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,056.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71828080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.7MM X 80MM CANNULATED LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71828085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 5.7MM X 85MM CANNULATED LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCT261418|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 26MM 14.5MM XCLDR 2 BRCH TRNKIPSL LG STNT|1|HUMANA [1294]||HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 36MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 7.9MM 32MM PERI-LOC STAINLESS STEEL T25 FLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 7.9MM 34MM PERI-LOC STAINLESS STEEL T25 FLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73828185|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM X 85MM PERI-LOC CANNCELLOUS PARTIAL THREAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|127.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|127.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PCC121400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS CONTRA-LEG 12 X 14|1|HUMANA [1294]||HUMANA [11839]|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,669.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 14MM 400MM SUPRACONDYLAR T2 INTRAMEDULLARY LOCK RETROGR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626761|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T10 SHORT POLYAXIAL LOCK BONE TALONAVICULAR STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,658.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,658.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10-1340M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STIMULATOR IMPLANTABLE 2 LEAD GROWTH BONE OSTEO-GEN|1|HUMANA [1294]||HUMANA [11839]|15,225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3544400|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.3CM MEMORYGEL P5.1CM HI PRFL RND SLTX GEL SHL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX370|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 12.6CM 4.1CM XTRA 370CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX350|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 12.3CM 4.1CM XTRA 350CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 860C-1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY GRAFT BONE ALLOMATRIXC 10CC|1|HUMANA [1294]||HUMANA [11839]|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114706446|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 64MM BIODUR 108 FT RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234802203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM T 45MM SS 2.7/3.5MM SCR 3 HL BN RADL LT DIST DRSL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00118113002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 130D STD BRL 59MM SS 2 HL SC TUBE FRLC BN 38.1MM 13.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00118113502|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 135D STD BRL 59MM SS 2 HL SC TUBE FRLC BN 38.1MM 13.7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,512.87|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,512.87|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 67-133FV16|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER TISSUE BREAST STYLE-133FV 850CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,125.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00342.001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 51MM TRINICA 3 LEVEL TITANIUM SELECT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB 3557|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTERVERTEBRAL 15X7MM MOBI-C 15MM SPINE CERVICAL COCRMO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277841|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X8MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM CRV INTRBD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX650|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 650CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277025|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X25MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM STRUT CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,893.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX700|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 700CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 26MM GORILLA R3CON NONLOCK PLATE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-3526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 26MM GORILLA R3CON LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-154-0002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN UNIVERSAL CADDY TEDDY BEAR MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,760.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,760.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 30MM GORILLA NONSTERILE R3CON NON LOCK PLAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6277741|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNERSTONE PSR 7MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-32-P4-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR BODY FENESTRATED PROXIMAL CUSTOM 32X94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|28,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|28,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8958-01S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TWO HOLE STAINLESS STEEL STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 976157|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE VISION ATLANTIS 57.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,448.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,448.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876.815|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS SELF-TAP 4.0 X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS SELF-TAP 4.0 X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-4017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL 17MM 40MM REUNION STANDARD RADIUS TOTAL SHOULDE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3505700 BC|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST 13.3CM MEMORYGEL COHESIVE I P6.5CM ULTRA HIGH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.6MM 20MM ANCHORAGE T8 FOOT ANKLE LAG CROSS PLAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149801003|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FEMORAL UNI CEMENTED PRESERVATION SIZE 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,497.27|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4MM 50MM ASNIS SOLID NONSTERILE JFX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 149812406|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIBIAL ALL POLY PRESERVATION 7MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,468.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-86-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK CLOSED ANGLED RT 9.5MM|1|HUMANA [1294]||HUMANA [11839]|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-87-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK CLOSED ANGLED LT 9.5MM|1|HUMANA [1294]||HUMANA [11839]|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,090.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZMXP10-10-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE 10X10X10MM SUPERELASTIC EASYCLIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,445.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,445.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 177410085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 85MM 5.5MM MNRCH PREBNT TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.561|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 116X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 6 HL LMT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,317.63|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,317.63|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 656010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.4MM 10MM VARIAX T8 FULL THREAD LOCK NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.204.046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 4.0MM X 46MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|453.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|453.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6958732PT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3.5MM 33MM VERTEX MAX TITANIUM PARTIAL THREAD SPI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,565.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y1802R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 1.8MM Y-KNOT FLEX WITH 2 RIBBONS 1.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRC03R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE RC Y-KNOT FLEX WITH 3 RIBBONS 1.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 24MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YRC02R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE RC Y-KNOT FLEX WITH 2 RIBBONS 1.3MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y1301RW|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 1.8MM Y-KNOT FLEX WITH 1 RIBBONS WHITE/BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported Y1301RB|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 1.8MM Y-KNOT FLEX WITH 1 RIBBONS BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT525U180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 TECHNIC TORRIC ONE PIECE 6MM CYL 5.25|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT450U180|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 18.0 TECHNIC TORRIC ONE PIECE 6MM CYL 4.50|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EL-1818S2|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT 18X18X18MM SECOD2.5 BME ELITE 10.4MM 2 LEG BRI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,664.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,664.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EL-2520S4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPL 25X20X20X20X20MM SECOD2.5 BME ELT 7.1MM 4 LG BRDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,313.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,313.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.215|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 42MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.571|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD 134MM SS 4.5MM SCR LG FRAG SET 7 HL LCP CMBN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,400.13|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,400.13|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71676559|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 40CM INTERTROCHANTER LT TRGN INTERTAN IM 125D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645070|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 70MM FEM LOPRFL INTNL HEX TRGN IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 13MM GORILLA R3CON LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC231400|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR 14CM 23MM 18.5-21.5MM EXCLUDER CONTRALATE|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT261414|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR 14CM 26MM 14.5MM 22-23MM 12-13.5MM GORE E|1|HUMANA [1294]||HUMANA [11839]|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|34,671.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71103312S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 12MM HEADLESS CANNULATED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71103313S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 13MM HEADLESS CANNULATED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|741.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|741.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 10MM TI LCK NS AXSOS 3 PERIPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626846|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.1MM 48MM T10 LAG CROSS PLATE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,053.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 28MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442074|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRENGTH EVOS 2.0MM 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,519.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 10MM EVOS T6 CORTEX SELF TAP MINI PLATE S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 26MM EVOS T6 CORTEX SELF TAP MINI PLATE S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PL-CLL8|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CLAVICLE LG LEFT 8-HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,901.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,901.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0062251040|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH URN TRACT 5.8FR 24FR 75CM 4CM HI-PRS KINK RST SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 16MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|163.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 12MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4760.11|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.5MM TRILOCK RSL FUSION PI LEFT DORSAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,192.65|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,192.65|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 16MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 14MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 18MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 22MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 20MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CO-3180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM TI CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|192.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|192.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5700.24|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2.5MM X 24MM CORTICAL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA-4200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANCELLOUS 4.0MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|163.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114710066|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 100MM 32MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709903|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 12IN 3.2MM SMTH SHFT DRL PNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709800|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR ORTH SS 5.5-7.5 MM CNN SCR NS LF|1|HUMANA [1294]||HUMANA [11839]|110.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|110.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.479|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 48X6.3X1.6MM SS 2.4MM SCR 5 HL LOPRFL RND EDG LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,397.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,397.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.824|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 24MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.828|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 28MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X22|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X26|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.768|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 18MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|167.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|167.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102M33|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI USE 3.5MM X 33MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 30MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.508|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE +20D L 43X6.3X1.6MM SS 2.4MM SCR 3 HLE/HD 3 HL SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.766|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 16MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|203.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|203.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.814|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 1.9MM 14MM SS T8 ST LCK STRDR CNCL HD NS LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.816|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 16MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 94954|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP TRIDENT II - UP CHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP MDM - UP CHARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33652206|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT POLY INFINITY SZ2 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,096.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-85H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 85MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.764|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 14MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|209.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|209.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6972860|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTVRTB 18MM 6MM PSTG LP CSPN TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1830-0723S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 7MM 23CM HUM T2 IM RTRGD ANTGRD LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,545.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,545.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HLS-2507|SUP|HCPCS C1892||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER LEAD PERCUTANEOUS VALVED 7FR 25CM SINGLE CHAMBER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657465|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM VARIAX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5112-047-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL STEMMED SZE GREEN MGII|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,357.09|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,357.09|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC4042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW HEADED 4.0MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2968245|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 45MMX12MM CLYDESDALE 6D PEEK-OPTM RADOPQ HLW LMBR|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701700|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE JOURNEY PFJ OXINIUM W/RESURF PAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PRT-CRD-LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE PROTEAN CONRONOID ASSEMBLED LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON LOCKING 2.7MM X 30MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON LOCKING 2.7MM X 26MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 64MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C-SLH-4S-4X7|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT TISSUE SOFT SURGISIS 4 X 7|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,256.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,256.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TPFL-23220-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PEG THREADED TI FLUTED LOCKING 2.3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|342.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|342.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676554|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 34CM RT INTERTROCHANTER INTERTAN IM 130D 1.5MM 11.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8545-38|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM 38MM LOW PROFILE SCREWS TITANIUM ANKLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWB251|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 19MM 50MM SHLDR CMNT RVRS AQLS TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,570.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.111.771|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STANDARD 110MM STAINLESS STEEL 2.4MM SCR 7 HOLE HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,066.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,066.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1516PBP|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX TISSUE 19.3X9.6CM DUO ALLODERM SLCT THIN 1.0-0.2MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,161.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,161.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 115394|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 20MM CMPRH TI 3.5MM CNTR HEX STRL RVRS SHLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|810.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|810.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-73-095|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK OPEN 9.5MM MONARCH|1|HUMANA [1294]||HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZMXP12-10-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE 12X10X10MM SUPERELASTIC EASYCLIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 12MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 35057535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 35MM PTHFND NXT SPNE CNN PA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,330.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-4008|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS HUM 8MM 70MM SHLDR X3 CNSTRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-72-110|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK WIDE 11MM MONARCH|1|HUMANA [1294]||HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-1516|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL EYLD BERGHAUS/SCHROM PLTN CHN FLXB 1.6GM STRL|1|HUMANA [1294]||HUMANA [11839]|2,688.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,688.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1530P-CP|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT INTERNALBRACE SYSTEM PEEK FOREFOOT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102011|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRX TISSUE 2X4CM REGEN CONTR 8SSQCM SM ALLODERM ACLR DERM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,359.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,359.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 587225LT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D MED 47MM 3DI FSN LOPRFL CMPR SLOT ORTHOLOC BN FT LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,134.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H965451010|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT IMPL INF PWR INJ 6.6FR 1.3MM ID STRD 75CML CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M311|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW FIXATOR MINI 60/20|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALN-RST-1100|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STM RADL 11MMX0MM 37MM ALIGN TI SD LD HBRD HD DSGN UNQ ALGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35550-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 55MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35240-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 24MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS130103L|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE HUMMERUS PROXIMAL LEFT 3 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X30|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MDS1102X28|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 28MM CORT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627567|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT NAR 137MMX5MM 7HL LCK CMPR BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,481.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,481.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS SHORT THREAD 7.0MM L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 40CM LT TROCH INTERTAN IM 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910100145|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 6.5MM FRC FBR GLND NDL WDG TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|613.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|613.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSL3522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM ANCHORAGE TI T8 FT/ANKL TX HD LCK NS YLW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX355|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11CM MENTR MEMORYGEL P5.5CM HI PRFL RND SMTH 355CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX380|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 11.3CM MENTR MEMORYGEL 5.5CM HI PRF RND SMTH 380CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SHPX335|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.3CM MENTR MEMORYGEL 5.4CM HI PRF RND SMTH 335CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-605|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 605CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-550|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST INSPIRA 550CC BI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410685|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 15.5X13.9CM NATRELLE P7.1CM MDRT HT X FULL PRJ SIL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M122|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIXATOR MINI ARTICULATING|1|HUMANA [1294]||HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629330S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 175MM TI 10 HL LCK VARIAX BN RT POST MDL ELB STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,162.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35280-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXAIL NON LOCKING 3.5MM X 28MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXAIL NON LOCKING 3.5MM X 30MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZTA-P-28-109-W|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT PROX ENDOVASCULAR THORACIC ALPHA ZENITH 28MM X 109MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|46,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114709200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE PIN TROCAR POINT 3.2 X 9INCH SMOOTH|1|HUMANA [1294]||HUMANA [11839]|67.24|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|67.24|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7122886|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 15MM 52MM SHLDR SFT TIS BAL SIMPLICITI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,268.55|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 123552025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 21MM 52MM SHLDR RSRFC APCL FLT GLBL CAP CTA DUOFIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,431.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,431.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707576|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CANNULATED 7.5MM X 75MM 32MM THREADED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|691.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|691.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7843-012-18|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEMORAL 12MM X 90MM POROUS FULLCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,767.43|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,767.43|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 32102027R|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LG TI KND SR BN SPNE ROSTRUM|1|HUMANA [1294]||HUMANA [11839]|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5210-2850|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CLOSED KANEDA 50MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,340.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZKB00240|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +24 DIOP C HPT BCNVX 13MM 6MM PC 1 PC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173401309|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 9MMX7MM STK I/F MED PEEK STKBL TOP NS LF|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173402309|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 9MMX7MM STK I/F MED STKBL BTM NS LF|1|HUMANA [1294]||HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 173400324|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 24MM STK I/F MED PEEK STKBL INTRBD FS NS LF|1|HUMANA [1294]||HUMANA [11839]|7,920.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,920.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 460522|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GFT SFT TISS DIST FEM MDL OSTCHND RT LF|1|HUMANA [1294]||HUMANA [11839]|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-56-222|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL OFFSET NEUTRAL 56MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1734-50-065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE LOCKING 60MM W/SCREW AND NUT|1|HUMANA [1294]||HUMANA [11839]|1,181.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,181.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 60MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-2218-50|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT 50CM 8 CONTACT LEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,097.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-VL1022|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH POLY LIGHTWEIGHT FLEX STR 10CMW X 22 CML|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71704502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE LEGION GII CR ALL POLY TIBIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-2085|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SR 85 X 6.35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201020008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 8MM ORTHOLOC TI NTRD FOREFOOT LCK AU MAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5201020016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2MM 16MM ORTHOLOC TI NTRD FOREFOOT LCK AU MAG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,137.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,137.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 52020206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT BN ORTHOLAC 6 HOLE T-PLATEORTHOLOC 3DI SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,781.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-04-0072|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 4 LEVEL 72MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3210-2095|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SR 95 X 6.35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55840006550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 50MM SOLERA CD HZN COCR SPNE MA NS 5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,046.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ST0XS-11|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JOINT TOE SMRT TOE II X FUSE 10D 11 PROX INTPHAL IM FT/ANKL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-82-080|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK BLADE WIDE MONARCH|1|HUMANA [1294]||HUMANA [11839]|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,145.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1774-73-080|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK NARROW MONARCH|1|HUMANA [1294]||HUMANA [11839]|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,935.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3503270|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 10.2-10.4CM P4.6-5.8CM HI PRFL RND SAL STY 3K SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,725.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CQ75104|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 10MM 75CM 4CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported CQ7584|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 8MM 75CM 4CM RADOPQ RPD INFL SHTHLS ENTRY CONQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported G47523|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COIL EMBL 8CM 8-4MM TRND PLTN STRL ACPT .035IN GW AVM|1|HUMANA [1294]||HUMANA [11839]|245.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|245.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010556-60|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT BILIARY SELF-EXPANDING ABSOLUTE .035 6.0MM X 60MM CATH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4516|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING/SELF-TAPPING RESCUE 4.5MMX16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5881035001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER FOR 3.5/4.0MM SCREW DART-FIRE SMALL SCREW SYSTEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-64501|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DESTINATION 6FR X 45CM PERIPHERAL GUIDING SHEATH STRAIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54-74501|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRO SHTH 7FR DIA 45CM JYDRO CTD PTEF INN LAYER ST SL CL PR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1130S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 300MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 20CM INTERTROCHANTER TRGN INTERTAN IM 125D ANTGRD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,440.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71645022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 22.5MM FEM LOPRFL INTNL HEX TRGN IM NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|603.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|603.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010005-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 5.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MB3356|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT DISC CERVICAL MOBI-C 13MM X 15MM H6|1|HUMANA [1294]||HUMANA [11839]|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 629505S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE 5 HOLE NARROW STRAIGHT COMPRESSION VARIAX STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,484.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,484.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151710616|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT PLATFORM ROTATING CRS REVISION ATTUNE SZ 6 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,256.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,256.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 150660007|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASE TIBIAL ROATING PLATFORM REVISION ATTUNE SIZE 7 CEMENTED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|18,858.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|18,858.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010005-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 5.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 151111203|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLEEVE KNEE TIBIAL REVISION POROCOAT ATTUNE 45MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,872.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,872.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC201000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 10CM 20MM 21.5-25MM GRTX XCLDR CNTRLT LG NTNL FEP|1|HUMANA [1294]||HUMANA [11839]|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,217.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-60H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 60MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1845-1238S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 38CM 125D FEM T2 IM LCK TI RECON RT 1.5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,266.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1897-6090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 90MM TI FEM LG CNN STRL BRNZ T2 RECON NL SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|718.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|718.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010006-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1336S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 360CM SP CNDL T2 IM LNG LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6248V-90|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 7FR POLY BLK 12 LF HRT 90D CRV TIP ATTN SLCT II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N30028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 28MM DART-FIRE TI ALY FT SLF DRL ST CNN HD AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N30024S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 24MM DART-FIRE TI ALY FT SLF DRL ST CNN HD AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010006-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 6.0MM X 40MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010008-20|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 8.0MM X 20MM BA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010010-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 10.0MM X 40MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010012-40|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER PERIPHERAL DILATATION AGILTRAC .035 12.0MM X 40MM B|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTA4U0-25.0|SUP|HCPCS V2630||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 25.0 DIOPTER ANTERIOR CHAMBER 13.0MM LENGTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2961026|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX10MM VRTSTCK CPSTN PEEK-OPTM END PC LMBR|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71705318|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP POROUS FEM W/OXI HD R3 XLPE R3 MULTI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,175.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK-M|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE MESH FROZEN 232CM SQ STERILE|1|HUMANA [1294]||HUMANA [11839]|1,777.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,777.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SK-HM|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SOFT TISSUE MESH FROZEN 500CM SQ STERILE|1|HUMANA [1294]||HUMANA [11839]|2,289.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,289.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2015-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 150CM 20MM FLXB MRK STREAMLNE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1010405-02|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH SRG PRLT 5X4IN HRN OVL PSHP NO HL STRL PP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|167.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|167.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2015-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 150CM 40MM FLXB MRK STREAMLNE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2015-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 1.5MM 150CM 80MM FLXB MRK STREAMLNE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2015-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL ARMADA 14 1.5MM 150CM 120MM FLXB MRK STREAMLNE T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2020-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 150CM 20MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2020-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 150CM 60MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2020-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2MM 150CM 120MM FLXB MRK STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2030-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 20MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2030-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 40MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2030-80|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 80MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1128-06-000|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL GLOBAL FX 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,820.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|8,820.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported A2030-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 60MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 20MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 60MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013465-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 80MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 40MM OTW 4FR LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-020|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 20MM OTW 4FR LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 60MM OTW 4FR LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 80MM OTW 4FR LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 150CM 40MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281214|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 28.5MM 12MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 150CM 80MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 150CM 60MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013468-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 150CM 120MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012622-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 19MM 80CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012623-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 7MM 19MM 80CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012624-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 8MM 19MM 80CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012625-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 9MM 19MM 80CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012626-19|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 10MM 19MM 80CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-55H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 55MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281416|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 16CM 28.5MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71932637|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR 7.5MM 35MM RSRFCNG GEN II|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,556.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,556.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZFEN-P-2-30-109-R|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT ENDOVASCULAR CUSTOM BD MN FENESTRATED PROXIMAL30X109M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G56572|SUP|Custom 27200000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HEMOSPRAY ENDOSCOPIC HEMOSTAT HEMO-7|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT261414|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 26MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL FEP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,360.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G21049|SUP|Custom 27200000||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HEMOSPRAY ENDOSCOPIC HEMOSTAT HEMO-10|1|HUMANA [1294]||HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 22MM 3.5MM SCR 4 HL LCK EVOS BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|250.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|250.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5800-MD00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT METACARPOPHANGEAL MCP SR SIZE MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431184|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD CMNT 60MM STG1 HIP SIL HD STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,530.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,530.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013466-120|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 4MM 150CM 120MM OTW 4FR LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC16100|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER LIMB CONTRA 16 X 10|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,310.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,310.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-50|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 50MM CNN BLNT TIP LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH4028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 28MM MN HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 3MM 28MM MINI HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,761.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 520-50-218|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 50MM 18MM SHLDR ANTMIC NTRL STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 607338|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM AXSOS 3 TI FT CANC NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|204.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|204.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1442S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NL 14MM 420MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,965.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,965.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FB-101-01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DEVICE SUTURING MECHANICAL FIXATE TISSUE BAND|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16868|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MPLANT MPJ LESSER TOE HEMI 12.5MM 2ND-5TH DIA COBALT CHROME|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 456.417S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL CANNULATED TROCHANTERIC 11MM X 130DEG X 360MM LOCKING FIXATION LEFT TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|5,602.83|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AGH146000|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN COR 3CM ASAHI PROWATER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH146300|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN COR 3CM ASAHI PROWATER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH146000J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN COR TO TIP J 3CM ASAHI PROWATER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH146300J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN COR TO TIP J 3CM ASAHI PROWATER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 876-717|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW ATLANTIS VISION 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,128.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH147300|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN HBRD RADOPQ STRG TIP 3CM ASAHI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH147300J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN COR TO TIP J 3CM ASAHI PROWATERFLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140001J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN RADOPQ STRG TIP J 3CM A FLDR FC HDRPH P|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R004S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .036IN SION BLUE STR TIP HDRPH 3CM PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R304S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .036IN SION BLUE STR TIP HDRPH 3CM PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R004J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .036IN SION BLUE J TIP HDRPH PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R304J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .036IN SION BLUE J TIP HDRPH PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850015550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 5.5 X 50MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850016545|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 45MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 55850016535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VOYAGER SOLERA 6.5 X 35MM - 5.5/6.0|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 242.491|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RADIUS DISTAL LCP VOLAR 2.4 X 43MM 5 HOLE HEAD 3 HOLE SHAFT LEFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,505.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,505.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6540530|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET SCREW 5.5/6.0 SOLERA VOYAGER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|993.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|993.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 651000065|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD PERCUSSION 5.5CM X 65MM|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1832-1045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 8MM 150MM HUM RT PROX T2 IM TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,015.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,015.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1896-4030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM TI FT LCK STRL T2 NL SYS UNV SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|550.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|550.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1553201050|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 50MM 5.5MM CRV TI CP4 NS|1|HUMANA [1294]||HUMANA [11839]|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0312CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 12MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0314CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 14MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0411CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 11MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0510CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 10MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 18MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|435.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|435.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0512CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 12MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0211CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 11MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0310CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 10MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0311CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 11MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0313CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 13MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.820|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 2.4MM X 20MM SELF TAPPING WITH STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|368.94|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|368.94|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72424050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4MM 50 MM MINI EVOS T8 FL THD CNTSNK LCKNG STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|226.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|226.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3660ANS|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR IP 5.3AH SCS MRI ELFU RED GBL PR NSW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|52,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|52,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZMXP08-08-08|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE BONE 8X8X8MM SUPERELASTIC EASYCLIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,265.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,265.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HGB161407A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRF EVAS 7CM 16MM GORE XCLDR ILC INTNL CMPNT AAA|1|HUMANA [1294]||HUMANA [11839]|9,456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX440|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.1CM MENTR MEMORYGEL P4.5CM MDRT + PRFL RND SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 201.770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.4MM X 20MM SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|177.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|177.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX405|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 12.7CM MENTR MEMORYGEL P4.4CM MDRT + PRFL RND SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX465|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.3CM MENTR MEMORYGEL P4.7CM MDRT + PRFL RND SMTH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0314CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 14MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0414CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 14MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0410CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 10MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0510CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 10MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0513CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 13MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VG2C-T79|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ALLOGRAFT BONE VERTIGRAFT CERVICAL VG2 7.75MM X 9.22MM (FRESH FROZEN)|1|HUMANA [1294]||HUMANA [11839]|3,361.83|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,361.83|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140300|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN FIELDER PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140000|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN FIELDER PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140000J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN FIELDER J TIP PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140300J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN FIELDER J TIP PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140301|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN FIELDER FC PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APW14R309S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN FIELDER XT-A STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APW14R009S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .014IN FIELDER XT-A STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 950093|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN STEINMAN STERILE 5/64 X 9|1|HUMANA [1294]||HUMANA [11839]|54.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APW14R305S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .014IN FIELDER XT-R STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported APW14R305S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN FIELDER XT-R STR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG14M060|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN RADOPQ STRG TIP 11CM ASAHI MRCLBRS 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG14M070|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN RADOPQ STRG TIP 11CM ASAHI MRCLBRS 12|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH143090|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN RADOPQ STRG TIP 20CM A CFNZ PRO 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGH143390|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN RADOPQ STRG TIP 20CM A CFNZ PRO 9|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AGP140302|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN COR TO TIP STRG 16CM A FLDR XT HDRPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R301S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN STRG 3CM SION ASAHI SS HDRPH DISP PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14S003S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN STRG ULTIMATEBROS 3 SS PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14S303S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN STRG ULTIMATEBROS 3 SS PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 948052|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMER-TOE CARVER-WEIL MEDIUM|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14S303J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN STRG ULTIMATEBROS 3 J TIP SS PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14S003J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN STRG ULTIMATEBROS 3 J TIP SS PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG141002J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 180CM .014IN STRG J TIP RADOPQ COR TO TIP A GRN SLM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG141302J|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN STRG J TIP RADOPQ COR TO TIP A GRN SLM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R307P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .036IN GAIA FIRST PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R007P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .036IN GAIA FIRST PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 948050|SUP|HCPCS L8642||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMER-TOE CARVER-WEIL SMALL|1|HUMANA [1294]||HUMANA [11839]|681.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|681.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R008P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .036IN GAIA SECOND PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R308P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .036IN GAIA SECOND PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R011P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .036IN GAIA THIRD PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R311P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .036IN GAIA THIRD PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39171-08157|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 8 X150 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 39171-08207|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON - CHARGER 8 X 200 X 75|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R013S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .014IN SUOH03 PTCA STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R013P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 190CM .014IN SUOH03 PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R313S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN SUOH03 PTCA STRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 40MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW14R313P|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 300CM .014IN SUOH03 PTCA PRE-SHAPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626985|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX SLIM Y 5 HOLE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,028.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,028.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AG149000|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 165CM .014IN EXTN WIRE PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AHW10S302S|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 330CM .010IN RG3 PTCA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5568-0011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 123MM 11MM REUNION STRL RVRS FX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,899.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,899.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676625|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 40CM RT INTERTROCHANTER INTERTAN IM 130D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114707565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 75MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0414CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 14MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0110CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 10MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114713565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 135MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0111CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 11MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0112CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 12MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0113CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 13MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0114CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 14MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0210CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 10MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0211CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 11MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0212CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 12MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0213CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 13MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 140MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0214CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 14MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0310CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 10MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0311CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 11MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0313CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 13MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0410CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB SZ4 10MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0412CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 12MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0413CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 13MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0511CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 11MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114714565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 145MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0513CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 13MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0514CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 14MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0610CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 10MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463918|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 11MM SPC STD 228X11.4X3.4MM SS 2.7/3.5MM SCR 18 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,162.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,162.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413526|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 26MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464909|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR L-D 9H L 125MM 3.5 EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,219.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,219.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114715065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 8MM 150MM 16MM BIODUR 108 RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|643.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|643.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0612CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 12MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0611CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 11MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0613CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 13MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0614CRL|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 14MM LT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0110CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 10MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0412CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 12MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00234801403|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SM 43MM SS 2.7/3.5MM SCR 3 HL NONLOCK BN RADL LT DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,710.63|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5035S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 35MM T2 LOCKING STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 45MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0111CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 11MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0112CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 12MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0113CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 13MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0114CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1 14MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0210CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 10MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N30032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 32MM DART-FIRE TI ALY FT SLF DRL ST CNN HD AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported D1N30034S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.0MM 34MM DART-FIRE TI ALY FT SLF DRL ST CNN HD AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|537.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|537.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0212CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 12MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0213CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 13MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0214CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 2 14MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0312CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 3 12MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0411CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 11MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0413CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 4 13MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0511CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 11MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0512CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 12MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0514CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 5 14MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0610CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 10MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0611CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 11MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0612CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 12MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0613CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 13MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.12.0614CRR|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 6 14MM RT SPHR CNGRNT GMK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,250.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 10MM 4MM ASNS TI MIC RVRS CUT FLUT FT HND SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626677|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 83MM 7 HL BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,527.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7210301|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE 2.8MM DIA TI W/#2 DURABRAID STRX2 NDL TWINFIX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|976.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|976.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657160|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 2.7MM/L60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,778.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03155.020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 20MM NCB TI-6AL-4V HUM ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|296.64|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|296.64|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440904|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE RECON EVOS 3.5MM 44MM 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,008.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,008.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 70MM 3.5MM SCR 6 HL LCK EVOS BN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|259.05|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|259.05|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-0931S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 9MM X 315MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSR04|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEATH GUIDING 7 FRENCH X 45CM LENGTH PINNACLE CURVE STYLE R|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5037S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 37.5MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1131S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 11MM X 315MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 40MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5060S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 60MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-530-028S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-103-R052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 5D MED GORILLA BN MTP RT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,257.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00781803800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD FEM 12/14 38MM HIP UNPLR EPRSTH ZML VRSY LGC STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,117.80|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LA6JR40SH|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH GD 100CM 6FR .071IN LNCHR JL 4 BRD NYL LG LUM FLXB DIST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 20-05|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHEETING SILICONE PHARMELAST 20 NON-REINFORCED 0.005 6"X8" *|1|HUMANA [1294]||HUMANA [11839]|291.33|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|291.33|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1036S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 10MM X 360MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 42MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5047S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 47.5MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5057S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 57.5MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 50MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402417|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 17MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-046-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID W/KEEL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,561.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,561.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72442480|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT BN 2.4MM 46MM EVOS 7 HL STGHT TINE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,013.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,013.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121659|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULATED HIP PIN 55MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|978.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|978.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 121661|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CANNULATED HIP PIN 65MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.45|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.45|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7145550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPNL 50MM 5.5MM DECADE LG PLT XLIF NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-046-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID W/KEEL 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported A2025-040|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 150CM 40MM FLXB MRKR STREAMLINE TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2926450|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 50X22X14MM CLYDESDALE 6D PEEK RADOPQ LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 641003075|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 75MM 4.75MM CD HZN COCRMO CAP|1|HUMANA [1294]||HUMANA [11839]|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-046-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID W/KEEL 52MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported A2025-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 2.5MM 150CM 80MM FLXB MRKR STREAMLINE TIP RPD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A2030-080|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 3MM 150CM 80MM FLXB MRKR STREAMLINE TIP RPD DFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SE-1515TI|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPL 15MM 15MM SPEEDTITAN COMPRESSION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,386.96|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,386.96|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4300-052-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GLENOID W/KEEL 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 4300-052-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID W/KEEL 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,589.46|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 606075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L75 MM OD6.5 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT261214|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 26MM 14.5MM 12MM GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TF0203511|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRUE FLOW VALVUPLASTY PERFUSION 20MM 3.5CM 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RK1816|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MATRIX 8CM X 16CM 0.8-1.7MM THK ACELLUAR DERM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204046|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 40MM 46MM PG ARTCSURF BGLNI/FLTW SHLDR STRL SS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FL-410320|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-410 320CC 13CM X 13.5CM X 3.8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MX-410520|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-410 520CC 14CM X 12.9CM X 6.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FX-410495|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST STYLE-410 410CC 13.5CM X 14CM X 6.2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1236S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 12MM X 360MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5045S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 45MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00430204640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 46MM 40MM PG BGLNI/FLTW SHLDR STRL SS UHMWPE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,971.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,971.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2361-5055S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 55MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 75MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402734|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 34MM 2.7MM 4.5MM CORTEX SELF TAP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412728|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.3MM 28MM T8 2MM ST LCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412744|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.3MM 44MM T8 2MM ST LCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413524|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3.5MM 24M EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413528|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3.5MM 28MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413548|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 48MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463915|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 11MM SPC STD 195X11.4X3.4MM SS 2.7/3.5MM SCR 15 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLP10462|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LNG 1.3MM TI 3MM LCK 3.5MM NONLOCK SCR 8HL LOPRFL PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,879.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-046-52|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID 52MM PEGGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PLSS3022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3MM 22MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3MM 24MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF605A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUM 82MM PRFT AQLS ASCND FLX PTC 127.5D 5A STD SHLDR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,290.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG152|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 20MM 51MM SHLDR SFT TIS BAL AQLS ASCND FLX COCR 4MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWK405LA15S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 15D LRG AUG CORTILOC SHLDR LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWK404RA15S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT GLND 15D MED AUG CORTILOC SHLDR LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,070.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-052-46|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID 46MM PEGGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,971.66|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|4,971.66|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 663550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 50MM ASNS SLD NS JNS FXN SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,934.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4302-052-56|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COMPONENT GLENOID 56MM PEGGED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported D2N30030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 30MM DART-FIRE TI SM P/T FT SLF DRL ST CNN CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|786.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 816335038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 38MM COCR 2.2MM TIB DIST MLDIR LCK SQ DRV ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|454.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|454.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631005840|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 58 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657365|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM T10 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631006040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 60 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1031S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 10MM X 315MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 209.880|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.3MM 8.2MM 2.9MM 80MM 32MM SS P/T RVRS CUT FLUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|847.41|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|847.41|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6310-062-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 62 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35260-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW POLYAXAIL NON LOCKING 3.5MM X 26MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402742|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 42MM T7 CORT SLFRET SCRDRVR ST FLT HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72455306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 11MM SPC 69X9.5X1.5MM SS 3.5MM SCR 6H R LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,658.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,658.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442776|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7MM SPC LOPRFL 52MMX2.2MM SS 2.7MM SCR MN FRAG 7HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,211.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,211.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631006440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 64 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402709|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 9MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402710|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 10MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442762|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 7MM SPC LOPRFL 140MMX2.2MM SS 2.7MM SCR MN FRAG 20HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 11MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWG051|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 17MM 51MM SHLDR LOS SFT TIS BAL AQLS ASCND FLX COCR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,468.58|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 631006640|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 66 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ABS-2014-05|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIL BN VOID 5ML CANC DBM STIMUBLAST PTTY RVRS PHS MED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,460.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH13SE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 13X11.9CM BRST 360-430CC SMTH SRFC INTGR PORT ALLO|1|HUMANA [1294]||HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6310-068-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 68 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6972870|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTVRTB 18MM 7MM PSTG LP CSPN TI|1|HUMANA [1294]||HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-521-TBE0|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRNG TIBIAL UKA VIT E 10MM SIZE 5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|966.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|966.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6310-070-40|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LINER LIPPED 10-DEG I.D. 40MM 70 X 40|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,111.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1240S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 12MM 400MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SRRT06070080L|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT VASC 80CM 6MM THNWL PERI GRTX STRCH REM RING LN 70CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,059.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CV71-80|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VEIN SAPHENOUS 3MM L = 71-80CM|1|HUMANA [1294]||HUMANA [11839]|22,475.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|22,475.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20805|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRG 72MMX2MM TI 5 HL LCK LOPRFL VARIAX BN FIB NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,213.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-1427-14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VALT 2.7MM X 14MM RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|270.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|270.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72455407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 80MM SS 3.5MM SCR 7 HL RT LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,806.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,806.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402715|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 15MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402746|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 46MM T7 CORT SLFRET SCRDRVR ST FLT HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAL-VLY2643A|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VERTESSA LITE Y SHAPE POLYROYLENE 26CM X 4CM X 3CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-1427-18|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VALT 2.7MM X 14MM RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 34MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 30MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 32MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-1427-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VALT 2.4MM X 20MM RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5052S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 52MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8973L-38-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA 3.8MM X 180MM LEFT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254801|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 8MMX23MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254800|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 7MM 23MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254802|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 9MMX23MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254806|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 7MMX30MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-1350-10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 10MM RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254803|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 10MMX23MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254807|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 8MMX30MM SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254808|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 9MMX30MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 254809|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SYSTEM TIB FTNR INTRAFIX ADV BR SHTH AND SCR 10MMX30MM LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,325.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-80H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 80MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,475.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,475.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-1350-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTICAL 3.5MM X 12MM RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|90.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-04-0080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 4 LEVEL 80MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported USH-718-R|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STNT URTH 7FR 18CM AQ HYDR SF THR W/PT UNVL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|391.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|391.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-0125-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT 4/4 HOLE RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00620106600|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING LOCK REPLACEMENT CUP MODULAR 66MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 5MM 65MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6284941|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 14X9MM VRTSTCK CRSTN PSR 11MM PEEK-OPTM LAT PORT|1|HUMANA [1294]||HUMANA [11839]|4,836.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,836.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IH3034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI L34 MM OD3 MM HEADLESS NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 226.642|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BRD CRV 265X17.5X5.2MM SS 4.5MM SCR LG FRAG SET 14 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,504.67|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,504.67|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 8MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442460|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT BN 2.4MM 37MM EVOS 6 HL VAR-ANGL FLEX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.211|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 34MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35340-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 34MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35300-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 30MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71829456|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4.5MM 124MM PERI-LCK NARROW CMPR 6 HL NON LCK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|426.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|426.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 4.5MM X 20MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 22MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 36MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported TF0183511|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER TRUE FLOW VALVUPLASTY PERFUSION 18MM 3.5CM 110CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 24MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 214.826|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 4.5MM X 26MM SELF TAPPING WITH 3.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|67.62|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|67.62|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 2991226|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 26MMX12MM CPSTN PEEK-OPTM SLF DSTRCT LMBR INTRBD|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G35617|SUP|HCPCS C1889||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE GASTROSTOMY 18 FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|214.86|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|214.86|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1033S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 10MM X 330MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5032S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 32MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-E-4017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 17MM 40MM SHLDR REUNION 4MM OFST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,076.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114705245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 52MM 17.3MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-513-T4|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUG TIB MDLR TRY IBALANCE SZ 4 SCR TKA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-523-A408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BRNG TIBIAL CR PLS VIT E 8MM SIZE 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-524-PSC9|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CMPNT PTLR POLY DOME 34MM 9MM VIT E|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95534|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE IBALANCE TKA VIT E POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 95535|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL KNEE IBALANCE PATELLA VIT E POLY|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5055S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 55MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 460520|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GFT SFT TISS DIST FEM MDL OSTCHND RT LFT LF|1|HUMANA [1294]||HUMANA [11839]|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 28MM TI CMPR LNG THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 30MM TI CMPR LNG THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33654408|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB SZ 4 8MM ANKL POLY INFNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-50H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 50MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB0000080|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL +8 DIOP MOD C BCNVX 13MM 6MM PC 1 PC ANT ASPH SQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 30MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110001|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 13MM X 11MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 43110002|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 13MM X 13MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported LNHC11|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL HYDRATED LORDOTIC 11MM|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLSS3010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3MM 10MM ANCHORAGE TI STD T8 FT/ANKL TX HD NS BLU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676621|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 36CM LT INTERTROCHANTER INTERTAN IM 130D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.03159.036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 3.5MM 36MM CANN NCB -64 ST HEX DRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|355.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|355.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110003|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 15MM X 11MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M0068302410|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GFT SFT TIS 2CMX7CM REPAIR MATRIX XENFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068302430|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GFT SFT TIS 4CMX7CM REPAIR MATRIX BN FZ DR XENFORM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,518.26|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,518.26|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068302450|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIS 6CMX10CM BIO MATRIX FT BV DRML FZ DR XENFORM STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,998.76|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,998.76|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0068302470|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TIS 8CMX12CM BIO MATRIX FT BV DRML FZ DR XENFORM STRLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,465.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,465.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT231212|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 23MM 14.5MM 12MM GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110004|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 15MM X 13MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 657132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 32MM T10 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110005|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 15MM X 15MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10721-300HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.4X4.6CM 300CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-330HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.7X4.7CM 330CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-350HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12X4.8CM 350CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 619920|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER T8 & T10 SCREWS 2.4MM / 2.7MM / 3.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6972650|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTVRTB 16MM 5MM PSTG LP CSPN TI|1|HUMANA [1294]||HUMANA [11839]|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110006|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 20MM X 15MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 07.00118.001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.6MM 12MM TRINICA VARIABLE ST MAGENTA S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00340.002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 24MM TI 1 LEVEL TRNS SLCT BN CRV|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110007|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 20MM X 20MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 43110008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 20MM X 25MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported M001207111|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE VSCLR .018IN 60CM ACC II J RN TIP CRV FL NTL PLT 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1140S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 11MM X 405MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CA0202|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT AVIVE SOFT TISSUE MEMBRANE 2CM X 2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110009|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 25MM X 20MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-1934BCT|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 3MM 2 SUT TK FBRWR BCMPS 14.5MM STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,020.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM X 50/18MM CORT THD SLF DRILLING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|276.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|276.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 43110012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE 13MM X 17MM COMPRESSION CHARLOTTE|1|HUMANA [1294]||HUMANA [11839]|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 661770|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 70MM TI CORT NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|213.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|213.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EL-3020S4|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPL 30X20X20X20X20MM SECOD2.5 BME ELT 7.1MM 4 LG BRDG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,313.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,313.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45110001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 11MM CHRLT TI FT HND SNPOF ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|753.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.226.034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3.0MM 34MM TI CMPR SH THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352356|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR REDAPT 56MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,371.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626974|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE STRAIGHT BROAD T10 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,968.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,968.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626995|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX SLIM Y 5 HOLE NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,367.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627716S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 227MM TI 16 HL AXSOS 3 BN TIB LT PROX MDL S|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,227.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,227.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657165|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 65MM T10 FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|564.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|564.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45110002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 12MM CHRLT TI FT HND SNPOF ST SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|738.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|738.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported DG0814SN|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PATCH DURA 14X8CM DRGRD BVN PRICRD STRL LF|1|HUMANA [1294]||HUMANA [11839]|2,149.53|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,149.53|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-101-2011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 1.1MM 15MM GORILLA 2H LCKNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G09492|SUP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NDL 15CM 19GA 5FR 4 SDPRT STRG CATH PRC PERC SS Y CNTS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 460523|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GFT SFT TISS DIST FEM MDL OSTCHND LTRL RGT RT LXF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|35,880.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45110003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF CHARLOTTE 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|696.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|696.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71676558|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 38CM INTERTROCHANTER RT TRGN INTERTAN IM 125D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45110004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF CHARLOTTE 2.7MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|714.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|714.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10721-385MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.5X4.5CM 385CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-415MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.9X4.6CM 415CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-385HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.3X4.9CM 385CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-415HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.5X5.0CM 415CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-435MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.2X4.6CM 435CC HSC MOD PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-440HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 12.8X5.1CM 435CC HSC HG PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-470HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.1X5.2CM 470CC HSC HG PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45110005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF CHARLOTTE 2.7MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|663.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|663.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported BEA22-80/I16-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 80MM 22MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|37,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1417S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NL 14MM 170MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5080S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 80MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 75MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 90MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5095S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 95MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15379|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MED NAR T 1.5MM 2.3MM SCR 13 HL LCK PRECONTOUR VARIAX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,461.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,461.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 45110006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SNAP-OFF CHARLOTTE 2.7MM X 17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|714.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|714.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 53-23015E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 15MM VARIAX TI HND WRST ST LCK LOPRFL XPN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 53-23014E|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.3MM 14MM VARIAX TI HND WRST ST LCK LOPRFL XPN HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|315.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|315.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110001|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 3.0MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8740-30H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 30MM CMPR FT TI STD FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 07.00812.007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.2MM 16MM TRNC SPNL SLF DRL VA NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LNHC12|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL HYDRATED LORDOTIC 12MM|1|HUMANA [1294]||HUMANA [11839]|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,150.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 3.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FCON|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 160MM FLEXIGRAFT AT PRST ZRC FRZN|1|HUMANA [1294]||HUMANA [11839]|3,666.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,666.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110003|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM CHRLT SS FT ST CNN CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P20-530-010S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MINI MONSTER HEADLESS CANNULATED SHORT THREAD 3.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|747.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|747.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P71-008-0808-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE STRAIGHT ASSEMBLY 8MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-006-3007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE Y 7 HOLE Y3 1.1MM THICK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0234210015|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHRONDRIX CRYO 15MM X 1.0MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,234.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 16MM CHRLT SS FOREFOOT MIDFOOT MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 44110005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 3.0MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 44110006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 20MM CHRLT SS MIDFOOT CNN CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported FGLTS|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BN GRAFTLINK FRZN TRPL STND 65MM 95MM|1|HUMANA [1294]||HUMANA [11839]|6,588.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,588.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.402|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 92MM SS 2.7MM SCR 4 HL VA LOPRFL CNTR SHFT LCP CMBN BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,733.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,733.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.118.512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 12MM SS T8 ELB MTPHSL ST STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|148.68|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|148.68|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.206.250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 50MM SS T15 CORT ST LOPRFL STRDR NS MDL CLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|116.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 22MM CHRLT SS 1ST MTRSL CNN MU CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|744.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 02.206.242|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 42MM SS T15 CORT ST LOPRFL STRDR NS MDL CLMN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|116.82|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|116.82|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110008|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 24MM CHRLT SS MTP MU CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|786.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|786.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 656308|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 8MM VARIAX T8 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|930.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|930.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCT22590|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +9.0 DIOP +2.25 ADD MOD C BCNVX 13MM 6MM PC 1 PC AN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-70H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 70MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 13018550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 8.5MM 50MM RELINE-O 2S SPNE PA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,026.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 26MM CHRLT SS FT ST SLFDRL CNN MU CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 05-100-01-0020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 1-LEVEL 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 28MM CHRLT SS FT ST CNN CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|762.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|762.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 658385|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS SHORT THREAD 7.0MM L85MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 3.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|723.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 00620105800|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RING ACTB 58MM TRLG HIP TRB MTL TIV MDLR CUP LCK REPL STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|181.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|181.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402717|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 17MM EVOS MN SS T8 CORT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF424A|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT HUM 6MM 42MM D17.5 POLY ANGD RTN RVSR EQUALIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,601.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,601.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DWF522|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ASCEND FLEX ECCENTRIC REVERSED 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,160.84|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,160.84|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 3.0MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|723.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|723.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 54850017550|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 50MM SOLERA CD HZN SPNE MA CNN XTD TAB NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 54850017555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 55MM SOLERA CD HZN SPNE MA CNN XTD TAB NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,025.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1475501090|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 90MM 4.75MM SOLERA COCR MLBDN CRV NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,890.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110027734|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT GLENOID VRS COMPREHENSIVE TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|43,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110031378|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ADAPTOR VERSA-DIAL TAPER COMPREHENSIVE VRS 25MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|870.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|870.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-1124S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11MM 240MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110013|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 34MM CHRLT SS MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|744.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|744.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71676627|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 42CM LT INTERTROCHANTER INTERTAN IM 130D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L1713|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 1.7MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10621-415MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MOD PR 12.9CM 4.6CM 415ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-415HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST HI PR 12.5CM 5.0CM 415ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-435MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MOD PR 13.2CM 4.6CM 435ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-440HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST HI PR 12.8CM 5.1CM 440ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported YP1301W|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.3MM 2 Y-KNT 1 LD 1 STRN PROFLEX HI-FI W/B SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|897.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|897.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676608|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 44CM RT INTERTROCHANTER INTERTAN IM 125D 1.5MM 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZA90030750|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 5 D +7.5 DIOP MOD C BCNVX 13MM 6MM PC 3 PC ANT ASPH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|447.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|447.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6194-1-010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BN SIMPLEX HV 20ML 40GM RADIOPAQUE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|452.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|452.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3510075|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 75MM 5.5MM PTHFND NXT PREBNT SPNE TI PERC APRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 657022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 22MM T10 FT LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658355|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 55MM FIXOS TI ST MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110017|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 16017535|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7.5MM 35MM RELINE 2C SPNE PA NS MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,629.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442462|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT BN 2.4MM 49MM EVOS 8 HL VAR-ANGL FLEX STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,914.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 10MM EVOS T7 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 22MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|861.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|861.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72402412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 12MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 15MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71106565S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 6.5MM 65MM 22MM CANNULATED STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|560.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|560.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352360|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR REDAPT 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,371.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,371.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-453-3510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 10MM GORILLA NS R3CON NONLOCK PLT GORILLA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|432.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|432.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110019|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 24MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported P53-101-2021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 1.5MM 15MM GORILLA 2H LCKNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.0MM X 14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-001-0004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BABY GORILLA 1.1MM STRAIGHT 4 HOLE LOCKING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HT-00005|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 10 DG MED DRILL HAMMERTOE SYS STRL DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2110|SUP|HCPCS C1762||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE MATRIX ORTHO BONE VIABLE BIO4 10CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,975.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,975.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EZ18-12-12|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 12X18X1.8-1.3MM 2MM EASYCLIP ANKL/FT SUPERELASTIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,738.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,738.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 26MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported ZCT225100|SUP|HCPCS V2787||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL +10 DIOP +2.25 ADD MOD C BCNVX 13MM 6MM PC 1 PC ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ZCB00 8.5|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LEN IOL +8.5 DIOP MOD C BCNVX 13MM 6MM PC 1 PC ANT ASPH SQ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|465.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|465.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP1057|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SFT TIS 5X7IN DRGN + CRNL DURA BVN CLGN MTRX PTCH RSRB|1|HUMANA [1294]||HUMANA [11839]|6,464.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,464.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 28MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported S-MAK401NPD|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER CATH 4FR 10CM MAK PLLDM TIP COAXIAL ECHO CR .018|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110022|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported Y13TN|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TRUSHOT 1.3MM Y-KNOT ALL STR 2 HI-FI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,448.52|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,448.52|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110023|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 32MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported Y18TN|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR SUTURE TRUSHOT 1.8MM Y-KNOT ALL STR WITH 2 HI-FI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,479.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,479.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1806-0090S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GW ORTH 800MM 3.0MM HUM TI SMTH TIP T2 NL SYS STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|562.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|562.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1818-1020S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 200CM LT ANKL T2 IM ARTHDS LCK TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,598.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71110056|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GD PIN ORTH 230MM 3.2MM THRD TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|163.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|163.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72821042S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCKNG ANKLE PRIM RT COMP 3.5MM 67MM 3H STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L28 MM OD3.5 MM ODSEC6.8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 30MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825055|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 55MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 30MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 34MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 73824024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 24MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L20 MM OD3.5 MM ODSEC 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 40MM 3.5MM 6.8MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 3.4MM 10MM FIXOS TI FT/ANKL CNN CMPR SLF DRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,016.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,016.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P71-108-0808-S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLE ANGLED ASSEMBLY 8MM X 8MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,951.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,951.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-0934S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 9MM X 345MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626977|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BROAD STRAIGHT 7 HOLE NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,466.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,466.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5065S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 65MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110025|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5567-P-3016|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION16MM X 101MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|25,623.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|25,623.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 8594527|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 27.5MM BRIGADE CRNT SPNE NS XLRF SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71633438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 38CM INTERTROCHANTER TRGN FEM TIBIAL GLD TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,950.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SF1502|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKN 10X17CM 1.5-2.2MM FLEXHD PLB PERFRTD THK SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SP1502|SUP|HCPCS Q4128||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT SKN 10X17CM 1.5-2.2MM FLEXHD PLB THK SM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,166.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0202263109|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT BN FMRL NCB 245MM 9H POLY LF PRX PERI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,717.90|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 38MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 71653438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 13MM 38CM FEM TRGN MT-NL IM RTRGD TI AU|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,830.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH14SE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 14X12.9CM BRST 480-575CC SMTH INTGR PORT ALLOX2|1|HUMANA [1294]||HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3102-2720CR|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT PROCHONDRIX CR 20MM|1|HUMANA [1294]||HUMANA [11839]|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110027|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 40-30119|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 19MM 5MM ASNS TI MIC RVRS CUT FLUT FT HND SLF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72204408|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR REGENESORB 25MM 10MM FULL LGTH SLD BIOSURE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|793.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|793.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4401010S|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLN 10MM 80CML 100MML PERI NCMP RPD INFL PTA POWERFLEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 232016|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LOOP CORTICAL FIXATION 30MM|1|HUMANA [1294]||HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110028|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 42MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72442080|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 5MM SPC STRG 38X5X1.2MM SS 2MM SCR MN FRAG 7HL TINE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402014|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM 14MM T6 CORTX SLFRET SCRDRVR ST FLT HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM 20MM T6 CORTX SLFRET SCRDRVR ST FLT HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110029|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 5567-P-3014|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION14MM X 98MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 46MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported YP1802R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 1.8MM 2 Y-KNT 2 LD 2 STRN PRO FLX HI-FI SFT W/RIBBO|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,185.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3015|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION15MM X 99MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 180558|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW NON-LOCKING 3.5 HEX 4.75 X 20MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|840.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|840.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110031|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 48MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|750.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|750.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 110032430|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BASEPLATE IMPLANT LARGE AUGMENTED W/TAPER ADAPTER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PM3562|SUP|HCPCS C1882||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|PACEMAKER CARDIAC QUADRA ALLURE MP RF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|23,100.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,100.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3013|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION13MM X 97MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110032|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 50MM CHRLT SS ST MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-8750-46H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 46MM ARTHX TI T15 LG FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8750-42H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 42MM ARTHX TI T15 LG FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,425.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-100H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 100MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8770-110H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 7MM 110MM ARTHX TI T25 XL FT CMPR CANNULATION HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110033|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 36MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported AR-4157-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 20MM RETROFUSION STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX490|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.6CM MENTR MEMORYGEL 4.7CM MDRT+ PRFL RND SM 490|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX525|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 13.9CM MENTR MEMORYGEL 4.7CM MDRT+ PRFL RND SM 525|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 38MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported SMPX545|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST 14.0CM MENTR MEMORYGEL 4.9CM MDRT+ PRFL RND SM 545|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8835-52|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 52MM LOPRFL SCR SS T15 FT HEXALOBE ANKL CORT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|105.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|105.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1137S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 11MM X 375MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5070S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 70MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 40MM CHRLT SS L/T MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 72412738|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.3MM 38MM T8 2MM ST LCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412740|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.3MM 40MM T8 2MM ST LCK EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIAL M-D 15H RT 195MM 2.7/3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,898.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,898.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA28-120/I6-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 120MM 28MM 16MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G02988|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET INTRO 7CM 5FR .018IN 2.9FR MPNCH CHKFL ECHTP APRCH 21GA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 42MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported YPRC03R|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH ALL SUT 1.3MM RC Y-KNT 3 STRN PRO FLX HI-FI SFT W/RBON|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186750445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 45MM VPR TI SPNE PA CNN NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,856.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,856.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 186760450|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6MM 50MM VPR TI SPNE PA CNN NS 5.5MM ROD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,850.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,850.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSZMPX525S|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT MEMORYGEL XTR 5.1CM MD PRF RND 13.7CM 525CC|1|HUMANA [1294]||HUMANA [11839]|645.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|645.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-150|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5.5MM 150CM 150MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951815|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X8MM BASE 15D TI VRB NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110037|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 44MM CHRLT SS L/T MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 6955201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPINAL BASE 5.0X20.0MM FIXED TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPINAL BASE 5.0X20.0MM VARIABLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.0MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.140|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 40MM TI L/T ORTH CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,155.57|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 46MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.211.236|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 2.4/2.7MM MED VA 0DEG LCP FIRST RIGHT MTP FN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,210.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.209|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 9MM TI CMPR LNG THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,421.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,421.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1519108|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 18X6CM ALDRM SLCT 2.0-2.8MM THK ALGRF RGNRT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,075.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,075.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110039|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 48MM CHRLT SS L/T MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 04.211.237|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 2.4/2.7MM MED VA LCP FIRST LEFT MTP FN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,299.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,299.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.024|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 24MM TI T8 ST LCK VA STRDR NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|439.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|439.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.3MM 50MM CHRLT SS L/T MU CMPR CNN HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 10721-565HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 14X5.5CM 565CC HSC HG PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-590HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 14.3X5.6CM 590CC HSC HG PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110041|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 55MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported 1520160|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 20X8CM ALDRM SLT 2.0-2.8MM THK ACLR DERM ALGRF RGN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|14,388.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|14,388.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-535HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 13.7X5.4CM 535CC HSC HG PLS RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27140-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON-LOCKING 2.7MM X 14MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44110042|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW COMPRESSION CHARLOTTE 4.3MM X 60MM LONG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|828.00|Inv Loc: 1071000; OR Loc: 1071000||Not reimbursed separately|828.00|Inv Loc: 1071000; OR Loc: 1071000||External grouping not supported PANL-27100-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON-LOCKING 2.7MM X 10MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-27160-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW PEG THREADED CORTICAL NON-LOCKING 2.7MM X 16MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35320-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 32MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported FC10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CUP FUSION 18MM 10 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,667.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,667.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC2410|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN COMP LCKNG 2.4MM X 10MM XS PLT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC2414|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN COMP LCKNG 2.4MM X 14MM XS PLT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC2412|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN COMP LCKNG 2.4MM X 12MM XS PLT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC2416|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN COMP LCKNG 2.4MM X 16MM XS PLT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported NC2418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN COMP LCKNG 2.4MM X 18MM XS PLT FT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|219.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|219.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 44112008|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 150MM 1.6MM KRSH CHRLT DARCO SS 1 TROC MTP FSN SYS|1|HUMANA [1294]||HUMANA [11839]|75.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|75.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SA60WF.220|SUP|HCPCS V2632||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +22 DIOP MOD L BCNVX 13MM 6MM PC 1 PC FLD ANT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|402.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|402.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 212.207|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING 5.0MM X 26MM SELF TAPPING WITH T25 STARDRIVE RECESS STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|460.59|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|460.59|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 431195|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MOLD FEM STM 200MM 9MM STG1 SLCT HIP SS SIL REINF SPCR STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,163.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,163.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1133S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 11MM X 330MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5040S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 40MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5035S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 35MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5037S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 37.5MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5050S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 50MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2361-5070S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN ADVND 5.0MM X 70MM T2 LOKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402009|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM 9MM EVOS T6 CORT ST MN PLT SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3293314|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE VERASTACK 14MM|1|HUMANA [1294]||HUMANA [11839]|8,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402021|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 3MM 21MM T6 CORTX SLFRET SCRDRVR ST FLT HD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|88.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|88.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4194-88|SUP|HCPCS C1900||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|LEAD LEFT VENTRICULAR IMPLANTABLE ATTAIN OTW 88CM BIPOLAR 6|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,151.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,151.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.226.634|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 4.5MM 34MM TI CMPR SH THRD HDLS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,170.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,170.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9090117|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WASHER SPINAL BON3E GRAFT 17MM TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|753.48|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|753.48|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-38H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 38MM CMPR FT TI STD FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported YSTN0|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH ALL SUT 1.7MM SHLW Y-KNT 1 STRN HI-FI W/NDL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,448.49|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,448.49|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T0 8.5|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 0 D +8.5 DIOP +2.5 CYL BCNVX 13MM 6MM PC 1 PC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MN6AD1.85|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS IOL 10 D +8.5 DIOP +3 CYL BCNVX 13MM 6MM PC MLPC FLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 606070S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE ASNIS III TITANIUM L70 MM OD6.5 MM CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|850.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|850.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6972450|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DISC INTVRTB 14MM 5MM PSTG LP CSPN TI|1|HUMANA [1294]||HUMANA [11839]|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,700.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 482068|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DERMIS PORCINE PELVICOL 6CM X 8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,932.89|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,932.89|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5782-052-21|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SURFACE ARTICULAR TIBIAL MG 21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,923.02|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 8MM GORILLA R3CON LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 983-1000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ASSEMBLY MINI-X-FIX 35MM|1|HUMANA [1294]||HUMANA [11839]|21,195.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,195.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450-3501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN SELF DRILLING CORTICAL 3.0MM 60MM 15MM|1|HUMANA [1294]||HUMANA [11839]|489.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450-3502|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN SELF DRILLING CORTICAL 3.0MM 60MM 20MM|1|HUMANA [1294]||HUMANA [11839]|489.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|489.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-01-0012|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE CERVICAL AMBASSADOR 1-LEVEL 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.038.410S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BLADE TFNA FENESTRATED HELICAL BLADE 110MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,367.93|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3017|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION17MM X 102MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701025|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UNIPOLAR CEMENTED LOW DMD FEM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626994|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX BROAD Y 4 HOLE T10 NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G52383|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER ANGIOGRAPHIC 5FRX.035IN DIA 80X14CM LP PTA ADV 35LP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 22MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402426|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 26MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402432|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 32MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402736|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE EVOS T8 36MM 2.7MM 4.5MM CORTEX SELF TAP NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412422|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 22MM EVOS T7 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626672S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR 2 HL 23MM BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,419.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,419.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTLS-35550-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 55MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35600-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD COMPRESSION 3.5MM X 60MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719-1818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 18X18MM NTNL CMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8717DS-111512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 11X15/12MM ARTHREX DYNANITE NTNL TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2510|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.5MM X 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-053-2513|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW LOCKING BG 2.5MM X 13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72469216|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7/3.5MM EVOS EA-D HUM 16H R 195MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,368.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,368.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412719|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 19MM EVOS MN SS T8 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|305.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|305.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH12SE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 12X11CM BRST 270-330CC SMTH SRFC INTGR PORT ALLO|1|HUMANA [1294]||HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH11SE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 11X10.2CM BRST 230-280CC SMTH SRFC INTGR PORT ALLO|1|HUMANA [1294]||HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3011|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION11MM X 95MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-001-0275-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMER TUB 2.7MM 0DEG CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-001-0350-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMER TUB 3.50MM 0DEG CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-002-0275-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMER TUB 2.75MM 10DEG CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-002-0350-S|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT HAMMER TUB 3.50MM 10DEG CANNULATED|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,411.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-001-0275-SK|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT HAMMERTUBE 2.75MM 0DEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-001-0350-SK|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT HAMMERTUBE 3.50MM 0DEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-002-0275-SK|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT HAMMERTUBE 2.75MM 10DEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P40-002-0350-SK|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IMPLANT HAMMERTUBE 3.50MM 10DEG STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,851.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 30-0255|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 8MM NONLOCK HEXALOBE HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|327.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|327.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-001-0C04|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BABY GORILLA 1.1MM COMPRESSION STRAIGHT 4 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,691.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PSMX0505|SUP|HCPCS C1763||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MATRIX SURGICAL PSMX GENTRIX 5CM X 5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,845.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3012|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION12M X 96M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72203783|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 4.50MM UL PK SM SLNG SLF LCKNG ACH TND RP FTP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,038.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,038.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72404252-10|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROS PENL AMS 700 LGX MS PMP 10CM INFL PRECNCT PENOSCROTAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|31,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627212|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 202MM TI 12 HL AXSOS 3 BN HUM LT PROX LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,772.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,772.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING/SELF-TAPPING RESCUE 4.5MMX14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71655132|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL INTRAMEDULLARY TRIGEN META-NAIL TITANIUM L32CM 10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,717.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT261218|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 18CM 26MM 12MM GORE XCLDR C3 TRK IPIS LG 18FR|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413522|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 22MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72466210|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7/3.5MM EVOS PL D HUM 16H R 129MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,108.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,108.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.817.503|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE MESH 12MMX23MM 8MM HEIGHT TI|1|HUMANA [1294]||HUMANA [11839]|11,430.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,430.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.817.511|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|END RING 12MM X 23MM ANTERIOR OR POSTERIOR/ 2.5 DEG TI|1|HUMANA [1294]||HUMANA [11839]|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,200.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.817.501|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE MESH 12MMX23MM 4MM HEIGHT TI|1|HUMANA [1294]||HUMANA [11839]|11,430.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,430.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 030400HD|SUP|HCPCS Q4152||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALLOGRAFT TISSUE 3CMX4CM DERMPURE DCELLZTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 040600HD|SUP|HCPCS Q4152||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALLOGRAFT TISSUE 4CMX6CM DERMPURE DCELLZTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 071000HD|SUP|HCPCS Q4152||0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)|ALLOGRAFT TISSUE 7CMX10CM DERMPURE DCELLZTN STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3425-1440S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT IM NL 440MM 11MM GMA 125D LNG R1.5 FEM RT TI STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,028.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012446-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.25 MM X15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6952015|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 38X28X10MM BRIGADE 15D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463206|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-D 6H RT 91MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,032.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,032.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403570|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 70MM EVOS CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413565|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 65MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SMPX325|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MENTOR MEMORYGEL 11.9CM 4.1CM XTRA 325CC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,775.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 101011090|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM FEM COLR ACTIS 9 DUOFIX CMT STD OFST HIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627316S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 277MM TI 16 HL AXSOS 3 BN TIB LT PROX LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|10,695.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,695.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 18260934S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 340CM SP CNDL T2 IM LNG LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71675514|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 38CM LT TROCH INTERTAN IM 130DEG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IJS-EAP-25500|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN FX 50MM 2.5MM IJS AXIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|960.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|960.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RSZ-2751|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT 11.3CM MEMORYGEL P3.4CM SMOOTH ROUND MODERATE|1|HUMANA [1294]||HUMANA [11839]|600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72821044S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN LCKNG ANKLE PRIM RT COMP 3.5MM 92MM 5H STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,217.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,217.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L26 MM OD3.5 MM ODSEC6.8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824026|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 26MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73825038|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE L38 MM OD3.5 MM ODSEC6.8 MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|326.70|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|326.70|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 34MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824046|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 46MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73824044|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE SS T20 CUT FLUTE 44MM 3.5MM 6.8 MM CORTEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-255HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 10.8X4.4CM 255CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-280HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.1X4.5CM 280CC HSC SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-255HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST HI PR 10.8CM 4.4CM 255ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-305MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.7X4.0CM 305CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-280HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST HI PR 11.1CM 4.5CM 280ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-325MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.8X4.4CM 325CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-305MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MOD PR 11.7CM 4.0CM 305ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10621-325MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST MOD PR 11.8CM 4.4CM 325ML RD SM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3MM 34MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC3036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 3MM 36MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440708|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION EVOS LOCKING 3.5MM 93MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,107.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,107.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676577|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 36CM INTERTROCHANTER LT TRGN INTERTAN IM 130D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626997|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BROAD Y-PLATE 7 HOLE VARIAX NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,904.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,904.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT281412|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 28MM 14.5MM 12CM GORE XCLDR C3|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 162MM 12 HL LCK CMPR AXSOS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,978.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,978.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661418|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM TI CORT LCK NS AXSOS 3|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|189.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|189.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2330-0001S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE COMPRESSION FEMUR 5.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,233.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,233.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2331-1038S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 380MM FEM GT LT T2 IM TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,834.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UQI00014|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SPINAL COFLEX SZ 14MM|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH15SE|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 15X13.8CM BRST 600-720CC SMTH INTGR PORT ALLOX2|1|HUMANA [1294]||HUMANA [11839]|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-07-4018|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING/SELF-TAPPING RESCUE 4.5MMX18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported DP10-1214609|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPACER CERVICAL STEALTH 12X14X9MM 6 DEGREE|1|HUMANA [1294]||HUMANA [11839]|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626993|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE BROAD Y-PLATE 3 HOLE VARIAX NON-STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,367.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72464911|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE FIBULAR L-D 11H L 147MM 3.5 EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,326.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,326.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701035|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP UNIPOLAR HIGH DMD W/UNIPOLAR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 98000244705|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PERSONA HYB-TM FEM CM TB-CPS VE SUR-STD-PT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|17,118.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|17,118.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71701451|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAP TOTAL HIP TANDEM BIPOLAR FEM W/CO CR HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LSMU1350537|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 5MM 37MM 135CM BLN EXPANDABLE LOPRFL CVR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,750.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/KL/DMEK|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA TISSUE PRE CUT DMEK PATEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CORN/KL/S|SUP|HCPCS V2785||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CORNEA TISSUE PRE CUT SPLIT FOR PATEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MWM2021|SUP|HCPCS Q4104||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|DRSG BIO 2X2IN INTGR BVN CLGN GAG POLYSILOXANE BL MX MESH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,998.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,998.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 50MML X 5.0MM DIA COMPRESSION CANNULATED ASNIS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5025S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 25MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported LATSYS01|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LATERA ABSORBABLE NASAL IMPLANTS SYSTEM DELIVERY DEVICE|1|HUMANA [1294]||HUMANA [11839]|4,517.97|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,517.97|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1826-0917S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 9MM 170MM SP CNDL T2 IM LCK RTRGD TI STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,052.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 897015|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE HYDROSET XT HA 15CC INJECTABLE STERILE LATEX FR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|21,354.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|21,354.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627646|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 343MM TI 16 HL AXSOS 3 BN FEM RT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported ALLOX2-FH16E|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 16X14.7CM BRST 750-900CC SMTH INTGR PORT ALLOX2|1|HUMANA [1294]||HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CM1519P|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 19.3X9.6CM ALDRM SLCT THK 2.0-0.4MM THIN CNTR ALG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,216.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627572|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 227MM 12 HL LCK CMPR AXSOS BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,078.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,078.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported RLT261216|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 12CM 26MM 16MM GORE XCLDR C3 TRK IPIS LG 16FR|1|HUMANA [1294]||HUMANA [11839]|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L2318|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 2.3MM X 18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|882.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|882.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555380|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 33-13MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 40-14MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555440|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 44-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555420|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 45-15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555460|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 46-16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555500|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 50-18MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555485|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 48-20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555480|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 48-17MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555520|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 52-19MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555505|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 50-21MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555525|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUMERAL SIDUS STEM FREE SHOULDER 52-23MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555120|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HUMERAL SIDUS STEM FREE SHOULDER MEDIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HUMERAL SIDUS STEM FREE SHOULDER SMALL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0104555130|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR HUMERAL SIDUS STEM FREE SHOULDER LARGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658575|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS LONG THREAD 7.0MM L75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-10106|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN VARIAX TI LARGE FT CALCANEUS MESH POLYAXI 75MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,295.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,295.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 661312|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5MM 12MM TI LCK NS AXSOS 3 PERIPROSTHETIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,110.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0202|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 2 CDS0601-XTR LARGE|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0102|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 2 CDS0601-NTR|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MTNL-35360-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW MULTI THREAD LOCKING 3.5MM X 36MM TI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402409|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 9MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402407|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 7MM EVOS T7 CORT ST|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.60|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.60|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72465005|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 81MM SS 3.5MM SCR 5 HL L-D EVOS BN FIB RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,988.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,988.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402730|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 4.5MM 30MM T8 2MM CORT ST EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|98.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|98.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442766|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT 7MM SPC LOPRFL 42MMX2.2MM SS 2.7MM SCR MN FRAG 6HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,103.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442782|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 7MM SPC Y LOPRFL 52X7.5-14.3X1.4MM SS 2.7MM SCR 5 HL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,648.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,648.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P53-151-1004|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN UNVRSL GORILLA 25MM DOG BN SL W/COMPR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,591.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-030S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI-MONSTER SHORT THREAD L30 MM OD3 MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P50-353-2711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.7MM 11MM GORILLA R3CON LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|558.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|558.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC161000|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 9.5CM 16MM 13.5-14.5MM XCLDR CNTRLT LG GRTX NTNL|1|HUMANA [1294]||HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442050|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 2.0MM EVOS 6 HOLE HD 2 HOLE SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412011|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 11MM EVOS T6 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-SURE-02|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SYS PEEK 2XANCH F/PLV FL RP TRNSV SCRP FIX ANCH|1|HUMANA [1294]||HUMANA [11839]|525.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|525.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627246S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 254MM TI 16 HL AXSOS 3 BN HUM RT PROX LAT STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,540.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,540.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656122|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 22MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 656124|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 24MM VARIAX T8 FT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|543.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|543.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658134|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 5MM 34MM FIXOS TI MIDFOOT REARFOOT CMPR HDLS NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,076.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION10MM X 94MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.087S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 18MM 95MM SS 3.5MM SCR SM FRAG SET 5 HL HK PRECONTOUR LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,664.78|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,664.78|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE 2MM 3MM 10MM EVOS T6 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|295.35|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|295.35|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 443043|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TENDON BIOCLEANSE PATELLAR PRESHAPED 290MM|1|HUMANA [1294]||HUMANA [11839]|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8827-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.7MM 16MM LOPRFL SCR SS FT/ANKL CORT SLD SHFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|135.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|135.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8973R-30-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL FIBULA 3.0MM X 180MM RIGHT STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,985.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported HL2M|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL FX 20MM HAMMERLOCK 2 0D MED 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,240.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 220245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 2.5MM 45MM TI CANC WSHR HEX NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|720.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|720.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749393001250|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR PRE CONT EXCHG 1.25MM ROTAPRO CATH ADV DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749393001750|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR PRE CONT EXCHG 1.75MM ROTAPRO CATH ADV DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749393002000|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR PRE CONT EXCHG 2.0MM ROTAPRO CATH ADV DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749393001500|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR PRE CONT EXCHG 1.50MM ROTAPRO CATH ADV DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H749393002150|SUP|HCPCS C1724||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BURR PRE CONT EXCHG 2.15MM ROTAPRO CATH ADV DEVICE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 657020|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE T10 FULL THREAD 2.7MM/L20MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,035.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7771128|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SPCR SPNL 28MMX11MMX10MM ELEV STD PEEK TI STRL|1|HUMANA [1294]||HUMANA [11839]|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,358.16|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 663060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 60MM ASNS CNN NS JNS FXN SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,841.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16186555|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 6.5MM 55MM RELINE 2C SPNE MDLR SHNK NS LF MAS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 506-02-136|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM RSP GLND BSPLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|378.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|378.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3018|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION18MM X 103MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-014S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE CANN MINI-MONSTER SHORT THREAD 3.0MM 14MM HEAD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSLP-265|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH 265CC 12.25CM 3.2CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSL-260|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH 260CC 12.25CM 2.5CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-495|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH 495CC 12.5CM 6.1CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSLP-250|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH 250CC 12.0CM 3.1CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSL-230|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH 230CC 12.0CM 2.4CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3510065|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 65MM 5.5MM PTHFND NXT PREBNT SPNE TI PERC APRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3510060|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 60MM 5.5MM PTHFND NXT PREBNT SPNE TI PERC APRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,835.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 33651108|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS TIB 1/1+ 8MM ANKL POLY INFNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,279.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,279.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6955202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BOLT SPINAL BASE 5.0X20.0MM VARIABLE TITANIUM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,733.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,733.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 6951615|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 34X24X6MM BRIGADE 15D TI NS LF|1|HUMANA [1294]||HUMANA [11839]|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|23,625.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626838|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.1MM 38MM T10 LG CX PLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,209.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,209.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.037.052S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 10MM 320MM FEM RT PROX TFN-ADV LAT RLF CUT IM 130D LNG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,349.47|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,349.47|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 78-10040|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BONE PEEK CUSTOMIZED CRANIAL KIT XL|1|HUMANA [1294]||HUMANA [11839]|49,672.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|49,672.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0203|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 3 CDS0601-XTR LARGE|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.075S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN 70MM 15MM COMP HL4 SS HK SH PRE CNT 3.5 SCR LCP LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,549.13|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,549.13|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0103|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 3 CDS0601-NTR|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0101|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 1 CDS0601-NTR|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0201|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 1 CDS0601-XTR LARGE|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0301|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 1 CDS0601-NTR & 1 CDS0601 XTR L|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0302|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 2 CDS0601-NTR & 1 CDS0601 XTR L|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported MBR0303|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MITRACLIP BUNDLE 1 SGC0301 & 3 CDS0601-NTR & 1 CDS0601 XTR L|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1518128|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 16X8CM ALDRM MED ACLR DERM ALGRF RGRT SLT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|11,505.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,505.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402420|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 20MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413536|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 36MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported UQI00016|SUP|HCPCS C1821||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT SPINAL COFLEX SZ 16MM|1|HUMANA [1294]||HUMANA [11839]|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-1525PS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW TENODESIS PEEK 2.5MM X 6MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,275.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 627616|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 343MM TI 16 HL AXSOS 3 BN FEM LT DIST LAT NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6626526|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE SPNL 15X6MM DIVERGENCE 12MM LRDTC NCL PULPOSUS PEEK|1|HUMANA [1294]||HUMANA [11839]|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,550.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G6623511|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 11MM DIVERGENCE TI SPNE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,016.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported P20-130-012S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE MINI MONSTER HEADED SHORT THREAD 3.0 X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|630.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|630.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1910-1271S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 2.5MM 2-0 C-2 SONICANCHOR KT FRC FIBRE 10MM STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,908.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8717D-0907|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 7X9MM ARTHREX DYNANITE NITINOL TITANIUM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G55400|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 24MM 43MM 18FR ZNTH RENU 7.1MM ABDM ARTA MAIN BD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,596.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,596.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 658590|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN COMPRESSION HEADLESS LONG THREAD 7.0MM L90MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,955.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34111|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT RESONANCE METALIC 6FR X 26CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402438|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 38MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72402430|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.4MM 30MM EVOS MN T7 CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|93.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|93.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676551|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 32CM LT INTERTROCHANTER INTERTAN IM 130D 1.5MM 11.5MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72413518|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 18MM EVOS ST LCK STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|366.30|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|366.30|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440707|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION EVOS LOCKING 3.5MM 81MM 7 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|990.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|990.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72440208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE COMPRESSION EVOS LOCKING 2.7MM 61MM 8 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,031.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,031.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 628306|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE MIDSHAFT ANTERIOR 6 HOLE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,375.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L1709|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 1.7MM X 9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported L1711|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SELF DRILL CANNULATED COMPRESSION LTHD 1.7MM X 11MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|933.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|933.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012445-12|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION NC TREK 2.0 MM X 12MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012445-15|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER BALLOON NC TREK 2.0 MM X 15MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-9212|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 11.7X10CM 350ML STY 9200 CENTERSCOPE SUT TP STRL CP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 354-9214|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|XPD TISS 13.5X11.7CM 550ML STY 9200 CENTERSCOPE SUT TP STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8990ST|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT DX 1 ARTHX FIBERTAK FBRWR NDL STRL LF DISP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,395.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5552-S-4818|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEAD HUM 18MM 48MM SHLDR REUNION STD STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,774.75|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1013469-100|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL ARMADA 18 5.5MM 100CM 150MM OTW 2 LUM RADOPQ COAX JETCOAT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.230|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 2.4/2.7MM SM VA 0DEG LCP FIRST RIGHT MTP FN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,210.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 04.211.231|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TI 2.4/2.7MM SM VA 0DEG LCP FIRST LEFT MTP FN BN NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,210.03|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,210.03|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SV25T6-22.0|SUP|HCPCS V2788||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 22.0 DIOPTER RESTOR TORIC MULTIFOCAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,685.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PLC201200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 11.5CM 20MM 16.5-18.5MM GRTX XCLDR CNTRLT LG NTNL|1|HUMANA [1294]||HUMANA [11839]|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,869.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 05-100-03-0063|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE AMBASSADOR L63 MM SPINE 3 LEVEL NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M0061752510|SUP|HCPCS C2617||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT URET 4.8FR 22CM PGTL CRV TPR TIP BLDR MRK LOPRFL LG|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|331.74|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|331.74|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VPR-GW-18|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 335CM .018IN VIPERWIRE ADV PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626892|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LCK PA MTP CX BN RT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,961.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72463208|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE TIBIA L-P 8H RT 113MM 3.5MM EVOS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,090.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,090.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72403580|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 80MM EVOS CORT ST STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|79.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|79.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72424780|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.7MM 80MM EVOS FT STRL OSTEOPENIA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|212.85|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|212.85|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported BEA22-40/I13-40|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT STNT 40MM 22MM 13MM AFX2 2 BRCH MAIN BD ILC LMB 40MM|1|HUMANA [1294]||HUMANA [11839]|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|43,497.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZ10621-620HP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST HG PR 14.5CM 5.9CM 620ML STRL|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-620HP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 14.5X5.8CM 620CC HSC+ SMT RND HG PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported VPR-GW-FLEX18|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GW VASC 335CM .018IN VIPERWIRE ADV FLEX TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 626992|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BONE VARIAX BROAD Y 2 HOLE T10 NONSTERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,367.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,367.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8719MXDS-1818|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STPL BN 18X18MM SUPERMX NTNL CMPR LOPRFL TROC TIP ALGN PIN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,485.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-9943T-07|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TBLR TI 7 HL LCK BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|765.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|765.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 450-1329|SUP|HCPCS C1813||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROSTHESIS PENILE TESTICULAR LRG 2.9CM 4.5CM SLNE FLD SCR LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,165.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,165.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71676556|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL 11.5MM 36CM INTERTROCHANTER RT TRGN INTERTAN IM 125D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|5,925.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71070812|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN HLF 150MM 6MM HA 55MM XTRNFX SYS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|569.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|569.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SZ10621-285MP|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SIZER IMPLANT BREAST MD PR 11.4CM 4.0CM 285ML STRL|1|HUMANA [1294]||HUMANA [11839]|225.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|225.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-255MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.0X3.9CM 255CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10721-285MP|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BREAST IMP 11.4X4.0CM 285CC SMT RND MOD PLS PRJTN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,285.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442452|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLT BN 2.4MM 53MM EVOS 8 HL T-SHAPED STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,864.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,864.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72412415|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCR BN 2.4MM 15MM EVOS T7 LOCK S-T|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|301.95|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|301.95|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00434902502|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BSPLT GLND 25MM SHLDR TRB MTL RVRS STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,580.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,580.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3512-180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD SPNL 180MM 5.5MM PTHFND NXT PREBNT SPNE TI PERC APRCH|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,286.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,286.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC4036|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEADED 4.0MM X 36MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 57-15360|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE L MED 1.5MM 2.3MM SCR 7 HL LCK VARIAX BN 2.3MM HND|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,462.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTF220A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 14F SAPIEN 3 20MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTF223A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 14F SAPIEN 3 23MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTF226A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 14F SAPIEN 3 26MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTF229A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 14F SAPIEN 3 29MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTA120A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 18F SAPIEN 3 20MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTA123A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 21F SAPIEN 3 23MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTA126A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 21F SAPIEN 3 26MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported S3USTA129A|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT AORTIC VALVE 21F SAPIEN 3 29MM ULTRA TRANSCATHETER|1|HUMANA [1294]||HUMANA [11839]|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|97,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT261416|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ENDOPROSTHESIS EXCLUDER TRUNK 26 X 14.5 X 16|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|24,495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-5051-42|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 42MM CNN BLNT TIP LOPRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|495.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|495.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC181200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 11.5CM 18MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]||HUMANA [11839]|11,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|11,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16175540|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK TRACTION 5.5MM 40MM MOD MAS MULTI AXIAL MODULAR RELINE|1|HUMANA [1294]||HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 16175545|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHANK TRACTION 5.5MM 45MM MOD MAS MULTI AXIAL MODULAR RELINE|1|HUMANA [1294]||HUMANA [11839]|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,087.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported H74939206051010|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH BLNDIL 5MM 135CM 100MM OTW NC 2 LUM SHFT LOPRFL TPR TIP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported EVPROPLUS-23US|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|VALVE AOR COREVALVE EVOLUT PRO+ 23MM PRCN PRICRD 1 LYR SLF|1|HUMANA [1294]||HUMANA [11839]|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|90,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4203TL-19.5-2.0CYL|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 19.5 DIOPTER 2.0 CYLINDER STAAR TORIC 11.2M|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|675.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|675.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AA4204VL-17.0|SUP|HCPCS C1780||0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS|LENS INTRAOCULAR 17.0 DIOPTER STAAR ELASTIC 11.2MM LENGTH 6.|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|450.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|450.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 110-004|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ATHRCM 135CM 0.9IN 6FR TIP FB CNY RX ELCA GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 114-009|SUP|HCPCS C1885||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ATHRCM 135CM 1.4IN 7FR TIP FB CNY RX ELCA GW|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85450|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 5MM 6FR 16MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85452|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 6MM 6FR 16MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85454|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 7MM 6FR 16MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85413|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 6MM 7FR 59MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85412|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 6MM 7FR 38MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85410|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 5MM 7FR 38MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85414|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 7MM 7FR 38MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 85419|SUP|HCPCS C1874||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT TRCHBR 9MM 7FR 59MM 120CM CVR CATH INTRO ICAST SS PTFE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|6,600.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported C2620|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WSHR 14MM SPK LOPRFL ORTH TI 1.3MM STRL DISP|1|HUMANA [1294]||HUMANA [11839]|427.29|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|427.29|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34108|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT RESONANCE METALIC 6FR X 20CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34109|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT RESONANCE METALIC 6FR X 22CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34112|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT RESONANCE METALIC 6FR X 28CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34176|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT RESONANCE METALIC 6FR X 30CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 27-1427-16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VALT 2.7MM X 16MM RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|255.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|255.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72454103|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 2.7MM/3.5M EVOS P/A A-D TIBIA 3H 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,118.50|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00840002407|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM ULNAR SIZE 4 75MM RIGHT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,300.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00840004415|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM HUMERAL SIZE 4 150MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,350.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,350.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00840009400|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT REVISION ARTICULATION SIZE 4 STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00840009000|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT SCREW BONE NEXEL HUMERAL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5571-C-4010|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS HUM 10MM 40MM SHLDR X3 CNSTRN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,635.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 28-0064-01|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE LEFT 6/4 HOLE RADIUS DISTAL VIPER|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC4016|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEADED 4.0MM X 16MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC4030|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEADED 4.0MM X 30MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC4040|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE HEADED 4.0MM X 40MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported G34110|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET STENT RESONANCE METALIC 6FR X 24CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,349.14|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 60-0011|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE FX 1.1MM KRSH KMI|1|HUMANA [1294]||HUMANA [11839]|30.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|30.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.06/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 6MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.10/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 10MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXT281414|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 14CM 28.5MM 14.5MM XCLDR TRNKIPSL LG GRTX NTNL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|20,940.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5200.08/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 8MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SR4689|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 125CM 5FR SP TORQUE LF NON-RADIOLUCENT JR4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SR5004|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH ANGIO 125CM 5FR SP TORQUE LF NON-RADIOLUCENT JR5|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.02|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 32MM 5 HL TI STRGHT 2MM/2.3MM APTUS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,168.10|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,168.10|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.10/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 10MM TI CORT HEXA 6 TPD CR FL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.12/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 12MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PXC141000|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT EVAS 10CM 14.5MM XCLDR C3 CNTRLT LG GRTX NTNL FEP STNT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|12,900.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.11/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 11MM TI CORT HEXA 6 TPR CORE FL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.15/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 15MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.08/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 8MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.10/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 10MM TI CORT HEXA 6 TPRD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7288|SUP|HCPCS C1721||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|CARDIOVERTER DEFIBRILLATOR IMPLANTABLE INTRINSIC DR DUAL CHA|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|54,000.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71820006|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 4.5MM 155MM PERI-LCK L-D FEM 6HL CNT SCL NON LCK SS LT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,455.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,455.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827074|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 74MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73826034|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM X 34MM PERI-LOC CORTICAL SELF-TAPPING|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|62.79|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|62.79|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 73827064|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 7.9MM 64MM PRLC SS T25 FLUT LNG BN SM BN 3 LD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|383.40|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|383.40|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 71352374|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL MODULAR REDAPT 74MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|8,764.56|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,764.56|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4650.10|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LK 1.0MM 2/4HL 2MM/2.3MM TI BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,391.61|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,391.61|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.12/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 12MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702445|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 24MM 8MM BIODUR 108 1/3 THRD RVRS CUT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.14/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 14MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.13/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 13MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.07/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 7MM TI CORT HEXA 6 TPD CR FL GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4350.14|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SCPHD 1.2MMX0.8MM TI 1.5MM SCR 8 HL APTUS TRLK BN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,381.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,381.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114702845|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 28MM 9.32MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 80-1070|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT INTRODUCER 10CM 7FR 21GA GLIDESHEATH SLENDER .021IN 35MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL3560|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 3.5MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL4560|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 4.5MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL5060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 5.0MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL5560|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 5.5MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL6060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 6.0MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL7060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 7.0MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL6560|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 6.5MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114703645|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 36MM 11.98MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910200035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCH SUT 5.5MM PEEK ZIP W/#2 SUTURE STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|676.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|676.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported M5IVL4060|SUP|HCPCS C1725||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER IV M5 SHOCKWAVE 4.0MM 60MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704045|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 40MM 13.3MM BIODUR 108 1/3 THRD HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 72442052|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE T 2.0MM EVOS 8 HOLE HD 2 HOLE SFT|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,470.15|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,470.15|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00114704245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4.5MM 6.5MM 42MM 13.9MM BIODUR 108 1/3 THRD RVRS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|547.20|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|547.20|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30114S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 14MM 4MM ASNS TI MIC RVRS CUT FLUT FT HND STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-30113S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3MM 13MM 4MM ASNS TI MIC RVRS CUT FLUT FT HND STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.16/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.5MM 16MM APTUS LCKNG TI DBLE FL THD HND HEXADRIVE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10200010|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK SPINAL RELINE-O 6MM LAMINA WIDE|1|HUMANA [1294]||HUMANA [11839]|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 202.830|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW CORTEX 2.7MM X 30MM SELF TAPPING WITH 2.5MM HEXAGONAL SOCKET STAINLESS STEEL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|103.71|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|103.71|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10200012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK SPINAL RELINE-O 8MM LAMINA WIDE|1|HUMANA [1294]||HUMANA [11839]|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 10200014|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HOOK SPINAL RELINE-O 10MM LAMINA WIDE|1|HUMANA [1294]||HUMANA [11839]|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,512.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 352-7100|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER SELF INFLATING TISSUE SPHERE 1 ML|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 102062|SUP|HCPCS Q4116||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MTRX TISS 10X5CM ALDRM THK|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,434.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 352-7200|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|EXPANDER SELF INFLATING TISSUE SPHERE 2 ML|1|HUMANA [1294]||HUMANA [11839]|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,085.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP-07811|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET SHEATH INTRODUCER WITH GUIDEWIRE 8FR 11CM BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP-07711|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET SHEATH INTRODUCER WITH GUIDEWIRE 7FR 11CM ORANGE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CP-07611|SUP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET SHEATH INTRODUCER WITH GUIDEWIRE 6FR 11CM GREEN|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 241.421|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE 1/3 TUBULAR LCP 12 HOLE 141MM WITH COLLAR|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|591.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|591.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported IC2512|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2.5MM 12MM MN HD NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,011.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported GJ44|SUP|HCPCS Q4107||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|JACKET GRAFT REPAIR ULCER 4X4|1|HUMANA [1294]||HUMANA [11839]|4,543.36|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,543.36|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 508-40-103|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INS SCKT 40MM DJO SRG RSP -4MM SHD RTN SCR STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,320.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 509-03-040|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INSERT SOCKET RSP DJO SURGICAL SM SEMI CNSTD HUMERAL HXE+ SZ|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,852.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2360-5085S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 5.0MM X 85MM T2 LCKNG STRL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,215.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-8740-36H|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 4MM 36MM CMPR FT TI STD FT CMPR ST CNN HEX|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,050.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7427V|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GENERATOR PULSE IMPLANTABLE C1767|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|33,585.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|33,585.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012629-29|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 29MM 135CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 1012629-39|SUP|HCPCS C1876||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT VASC 6MM 39MM 135CM LOPRFL THN BLN EXPANDABLE OTW PERI|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,400.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 453012|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT BONE TENDON PATTELAR POSTERIOR BIOCLEANSE 9MMX10MM|1|HUMANA [1294]||HUMANA [11839]|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|10,800.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 7489-40|SUP|HCPCS C1883||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT EXTENSION C1883|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,980.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,980.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3293316|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PERIMETER 16MM VERTESTACK|1|HUMANA [1294]||HUMANA [11839]|8,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00236902435|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 24MM TI LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 00236903035|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 30MM TI LCK NS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|286.77|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|286.77|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 0202266002|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE FOR PLATE CONNECTION NCB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|415.32|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|415.32|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported PANL-35320-TS|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 3.5MM 32MM GEMINUS TI CORT PA NS DIST RDS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|456.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|456.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SC-8216-50|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT LEAD SURGICAL 2 X 8 50CM PRECISION|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|13,500.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9240100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SPIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|15,337.98|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|15,337.98|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 50-100-07-4010|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW VARIABLE SELF-DRILLING 4.0X10MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|855.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|855.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.013S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT 205MM SS 2.7/3.5MM SCR 13 HL VA TPR TIP RND PRFL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,969.99|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,969.99|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.606|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT 137MM SS 2.7/3.5MM SCR 6 HL VA TPR TIP XTD LCP XL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,814.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5100.10/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 1.2MM 10MM APTUS LCKNG TI DBLE FL THD HND HD4 GOLD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 2341-1136S|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NAIL TIBIAL T2 ALPHA 11MM X 360MM STERILE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|9,801.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 9240150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW SET 50MM SPNE M4 BRKOF CD HZN SPIRE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|405.72|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|405.72|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEP6|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEPRTR THRMB .028IN 6 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEP3|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEPRTR THRMB .028IN 3 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEP8|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEPRTR THRMB .028IN 8 LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CATRXKIT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO RX 140CM+ LG LMN ASPIRATION TB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CATD|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO D+ LMN ASPIRATION TB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEPD|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEPARATOR D|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SEPC4|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEPARATOR 4|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3293312|SUP|Custom 27800000||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CAGE PERIMETER 12MM 8-DEG LARGE VERTESTACK|1|HUMANA [1294]||HUMANA [11839]|8,820.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|8,820.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT3KIT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO 3+ LMN ASPIRATION TB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT6KIT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO 6+ LMN ASPIRATION TB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT5KIT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO 5+ LMN ASPIRATION TB|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT8TORQ85KIT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO 8+ LMN ASPIRATION TB TORQ 85CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported CAT8XTORQ115KIT|SUP|HCPCS C1887||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH INDIGO 8+ LMN ASPIRATION TB XTORQ 115CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|0.01|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|0.01|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 02.117.704|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE SHRT 111MM SS 2.7/3.5MM SCR 4 HL VA TPR TIP XTD LCP|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|3,814.23|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|3,814.23|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-6200-44-20|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHELL CLUSTER TRILOGY W/HOLE CERAMIC 44MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|7,938.21|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|7,938.21|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 5567-P-3009|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM PRESSFIT HUMERAL REUNION 9MM X 93MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|19,217.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 3910500391|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR KNOTLESS PEEK OMEGA 3.9MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,815.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSX-400|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPLANT BREAST NATRELLE INSPIRA SMOOTH 400CC 11.5CM 5.8CM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported SSF-335|SUP|HCPCS C1789||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|IMPL BRST NATRELLE INSPIRA SMTH SHL SRFC SFTCH 335CC STRL LF|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|4,005.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 65-7862-009-00|SUP|HCPCS C1776||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STEM SIZE 9 METAL FIBER VERSYS CERAMIC|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|16,496.07|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|16,496.07|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 40-20110|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BN 2MM 10MM 4MM ASNS TI MIC RVRS CUT FLUT FT BL HND SL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|623.25|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|623.25|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-3670|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SET IMPLANT FIBER TAK BICEPS|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|1,875.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported T175|SUP|HCPCS C1722||0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PACEMAKER|DEFIBRILLATOR SINGLE CHAMBER VITALITY 2|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|53,277.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|53,277.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported AR-4020C-09|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW INTFR 9MM 20MM BIOCOMPOSITCP FST THD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|885.00|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|885.00|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported 4451-008-20|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ROD FIBER CARBON 8.0MM X 200MM|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|343.80|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|343.80|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-4655.16|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE BN COMP LCKING 56MM 10 HL TI STRGHT 2MM/2.3MM APTUS HD|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|2,292.06|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|2,292.06|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5400.17/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 17MM TI CORT HEXA 6 TAPERED CORE FULL|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|240.51|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|240.51|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.07/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 7MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported A-5450.09/1|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW BONE LCKNG 2MM X 9MM TI CORT HEXA 6 TPD CORE FL BLUE|1|HUMANA [1294]|HUMANA COMMERCIAL EDGEWOOD [136]|HUMANA [11839]|389.46|Inv Loc: 1071700; OR Loc: 1071000||Not reimbursed separately|389.46|Inv Loc: 1071700; OR Loc: 1071000||External grouping not supported